Orthopedic Board Review MCQs (2026 Edition) - Part 3

What structure is considered the single most important soft-tissue restraint to anterior-posterior stability of the sternoclavicular joint?

Conservative management of recurrent unidirectional posterior shoulder
2. instability emphasizes strengthening of the
3. 1- deltoid.
4. 2- trapezius.
5. 3- infraspinatus.
6. 4- pectoralis major.
7. 5- latissimus dorsi.

Slide 1
A 42-year-old man with diabetes presents for treatment of a swollen foot (Slide). He does not recall the onset of swelling, and he states that his foot is not painful. On examination, the foot is hot to touch and swollen. Upon radiographic examination, no deformities are evident. Which of the following treatment options should be used next:

What is the most serious outcome associated with this injury?

A
B
Figures 52a and 52b are the radiographs of a patient who was involved in a motor vehicle collision. He was wearing his seat belt and is now complaining of midthoracic back pain. Radiographs in the emergency department do not reveal a fracture. What is the most appropriate next step?

Arthroscopic resection/debridement posterior to the midline of the radio-capitellar joint can result in damage to ligament, resulting in instability.

Which clinical or radiographic finding is not commonly associated with moderate or severe hallux valgus deformity in adults:

Figures 96a and 96b are the MRI sections of the symptomatic left knee of a 28-year-old man with left anterior knee pain 18 months after undergoing an allogenic bone marrow transplant for acute myelogenous leukemia. His intraoperative fluoroscopy images are shown in Figures 96c and 96d. What is most critical when obtaining a diagnosis for this patient?

A 70-year-old man has a 1-year history of progressive right shoulder pain, motion loss, and weakness associated with rotator cuff arthropathy. He has failed nonsurgical treatment. During the informed consent process, the patient is counseled regarding his treatment options, and the surgeon recommends that he undergo a right reverse total shoulder arthroplasty (rTSA). The patient must be informed about the complications associated with this type of procedure, the most common of which is

A 32-year-old volleyball player has dull posterior shoulder pain. An examination reveals moderate external rotation weakness with his arm at his side but normal strength on supraspinatus isolation. Deltoid and supraspinatus bulk appear normal, although there appears to be mild infraspinatus atrophy. Sensation is normal throughout the shoulder and shoulder girdle. What is the most likely diagnosis?

What is the most appropriate systemic therapy for this patient in the short term?

Which treatment of the current fracture will provide the best long-term outcome?

Superficial peroneal nerve injury following ankle fracture:

A 30-year-old female involved in a severe motor-vehicle collision that requires prolonged extrication. She arrives at a referral trauma center almost 10 hours after her initial injury. She receives tetanus and intravenous antibiotics upon arrival. The patient has an open tibial fracture with significant periosteal stripping and a closed head injury that requires intracranial pressure monitoring. She is cleared for operative intervention by the neurosurgery and trauma surgery services the following morning. She undergoes a thorough debridement, placement of an antibiotic bead pouch, and external fixator placement approximately 18 hours after her injury. She is definitively treated 4 days after her injury with a repeat debridement, gracilis flap and intramedullary nail. Which of the following factors places the patient at increased risk of infection?

Orthopedic MCQS online Shoulder and Elbow 017
SHOULDER AND ELBOW SELF-
SCORED SELF-ASSESSMENT EXAMINATION
_AAOS 2017_
CLINICAL SITUATION FOR QUESTIONS 1 THROUGH 4
A 55-year-old man falls on his outstretched arm and sustains the injury shown in the 3-dimensional CT scans in Figures 1a and 1b.
Which ligamentous structure attaches to the fracture fragment?

A 19-year-old linebacker for a
collegiate football team
has had two episodes of
bilateral arm tingling and
weakness after tackling; the
symptoms resolved after
30 minutes of rest. Three
follow-up neurologic
examinations have been
normal. Cervical spine
CT and MRI scans
Figure 13a
are
Figure 13b
shown in
Figure 13c
Figures 13a through
13c. What is the next best step in management?

During open reduction and internal fixation of a both bone forearm fracture, restoration of the radial bow has been most associated with which of the following?

All of the following may be seen with preganglionic lesion EXC EPT:

Epidural analgesia in the postoperative period after total joint replacement is widely used and is associated with all of the following complications except:

A 53-year-old man reports acute, severe left shoulder pain after undergoing abdominal surgery 10 days ago. Initial management, consisting of anti-inflammatory drugs, physical therapy, and a subacromial injection of corticosteroid, fails to provide relief. Reexamination of the shoulder 2 months after the onset of symptoms reveals atrophy of the infraspinous and supraspinous fossa and profound weakness of active abduction and external rotation. His neck is supple with a full range of motion. Plain radiographs and an MRI scan of the shoulder are normal. What diagnostic study should be performed next in the evaluation of this patient?**

In the evaluation of somatosensory-evoked potential waveforms for intraoperative neuromonitoring for spinal surgery, the minimum criteria for determining potentially significant changes include

Arthrodesis of the ankle in a 34-year-old woman should be performed with the ankle positioned in:

The greatest amount of step-off that is well-tolerated in a Bennettâs fracture is:

Which of the following areas of the osteoclast is responsible for attachment to the bone surface prior to the bone resorption process:

Severe neurological manifestations have been attributed with accumulation of what metal ion in the brain:

-
Which of the following findings is the most specific for ankylosing spondylitis?

Subchondral drilling for cartilage defects is effective for:

An 18-year-old rugby player has had pain in his ring finger after missing a tackle 1 week ago. Examination reveals tenderness in the distal palm, and he is unable to actively flex the distal interphalangeal (DIP) joint. Radiographs are normal. What is the most appropriate management? ](http://www.orthobullets.com/anatomy/12300/2017-moc-hand-89-day-study-plan)

Which of the following is considered a reasonable goal for arthroplasty surgery in rotator cuff arthropathy?

A 42-year-old male sustains a left leg injury as the result of a high-speed motor vehicle collision. Physical exam reveals a grossly deformed left leg with a 1 centimeter open wound over the anterolateral aspect of his tibia; no gross neurovascular deficits are noted. Injury radiographs are shown in Figures A and B. He undergoes immediate tibial nailing with debridement and primary closure of his traumatic wound. Which of the following is the Gustilo-Anderson classification for his fracture?

-is the initial lateral radiograph of the foot of a 55-year-old woman who felt a pop in her left foot as she stepped off the curb. She subsequently had severe heel pain and could not bear weight.Examination in the emergency department revealed a bony prominence over the posterior aspect of the heel with blanching of the surrounding skin. What is the most appropriate orthopaedic management?

Which of the following can be seen in the heart of a well-conditioned athlete?

A 12-year-old boy is seen 1 week after injuring his knee while playing soccer. He notes pain and swelling. Examination reveals an effusion, laxity with Lachman testing, and he walks with a limp. Radiographs and an MRI scan are shown in Figures 95a through 95d. Treatment should consist of which of the following?

Which of the following conditions is not associated with an increased risk of congenital vertical talus?

A 47-year-old man undergoes a 3-column osteotomy as part of scoliosis surgery. During closure, somatosensory-evoked potentials decrease.

In treating which of the following elbow fractures is it most important to begin early range of motion:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
What is the least helpful test in further management of this patient:

Which of the following surgical maneuvers is most likely to enhance proper patellar tracking during total knee arthroplasty and minimize the need for a lateral retinacular release?

Which of the following is most important to achieve a good outcome following a Syme amputation?

A 10-year-old patient with Hurler syndrome has undergone a bone marrow transplant and is currently medically stable. He has developed a painful thoracolumbar kyphosis that measures 50° with 25% subluxation T12 on L1. Recommended treatment includes which of the following:

Which image seen during arthroscopic treatment is most likely associated with this patient’s condition?
A
b c
d

What is the most likely diagnosis?

Posttraumatic physeal arrest is most common at which of the following locations?

Figure 54 is the lateral radiograph of a 55-year-old man who is evaluated for a 2-year history of pain and stiffness of his right metatarsophalangeal (MTP) joint. Upon examination he has dorsal bossing, severe crepitation, and pain
with passive range of motion. There is pain with the "grind" test. Dorsiflexion is limited to 0 degrees. No sesamoid tenderness is present. What is the most appropriate surgical treatment?

How much should training time and intensity be increased per week to avoid bone stress injury:

Figure 21 shows a coronal T1-weighted MRI scan of the knee. The arrow indicates what anatomic structure? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)

Video 2 shows the squeeze test for a biceps tendon rupture. This test

Slide 1 Slide 2 Slide 3
A 44-year-old obese man presents for treatment of acute ankle pain. He does not have a history of trauma or a systemic history of note. His opposite foot has had multiple episodes of acute pain in the past, lasting from 3 to 5 days. On examination, the
ankle is warm, swollen, and exquisitely tender to palpation and any range of motion (Slide1, Slide 2, and Slide 3). C oncerned about the source of pain, you aspirate the joint and send the sample for analysis. You expect to find:

A 21-year-old football player had severe pain and immediate swelling in the left anteromedial chest wall while bench pressing near maximal weights several days ago. Examination at the time of injury revealed a mass on the anteromedial chest wall. Follow-up examination now reveals decreased swelling, and axillary webbing is observed. The patient has weakness to adduction and forward flexion. The injured muscle originates from the

Figure 1 is the sagittal MR image of a 56-year-old woman who has a 3-year history of severe back pain. Her pain is worse with flexion at the lumbosacral junction and is relieved with extension. She denies any pain in her lower extremities and has no symptoms of neurogenic claudication. Which mediators play roles in the pathogenesis of this condition?

1247) When comparing the fibular plating techniques shown in Figures A and B, the plate position shown in Figure B is associated with which of the following?

Flexor tendon nutrition is derived from:

A tailorâs bunion is an abnormal prominence of the lateral aspect of the 5th metatarsal head. Similar to hallux valgus deformities, tailorâs bunions can be due to a widened intermetatarsal angle between the 4th and 5th metatarsal shafts. The normal 4-5 intermetatarsal angle is:

Figure 1 is the ultrasound of a 23-year-old patient who has had a volar radial 1.5-cm tender and painful wrist mass for 6 months. The additional workup prior to surgery should consist of
---

The diagnosis of gout can be made either by the presence of tophaceous deposits in the skin or bursae of the extremities or by the presence of which of the following?

Which of the following methods has the highest sensitivity in detecting skeletal lesions in patients with Langerhans cell histiocytosis:

A 36-year-old man has a 2-day history of acute lower back pain with severe radicular symptoms in the left lower extremity. The patient has a positive straight leg test at 40 degrees on the left side and mild decreased sensation on the dorsum of the left foot. What is the most appropriate management at this time?

Figure 7 shows the radiograph of an otherwise healthy 65-year-old man who injured his right dominant shoulder while skiing 18 months ago. He did not seek treatment at the time of the injury. He now reports intermittent soreness when playing golf but has no other limitations. Examination reveals full range of motion and no tenderness, but he has slight pain with a crossed arm adduction stress test. He is neurologically intact. Initial management should consist of

Figure 35 is the radiograph of a 37-year-old woman who began having right forefoot pain about 4 weeks ago after increasing her daily running mileage. She denies any specific injury. Upon examination she has tenderness over the medial forefoot with mild swelling. In addition to her activity level, what is the primary etiology of the radiograph finding?

Compared with iliac crest bone graft, rh2 bone morphogenetic protein (BMP) has a higher rate of

A 16-year-old girl sustained the injury shown in Figure 7a. CT scans are shown in Figures 7b through 7d. The results of treatment of this injury have been shown to most correlate with which of the following factors?

The net effect of calcitonin on the calcium and phosphorus concentrations in the extracellular fluid and serum is:

What is the average time to radiographic union of this fracture?

-
A 13-year-old quarterback feels a “pop” in his knee while being tackled. Radiographs of the knee and results of a Lachman’s test are normal. Examination reveals tenderness over the distal femoral physis. To help confirm the diagnosis, management should first include

Which of the following is true of a knee disarticulation as compared to a transtibial amputation?

A right-hand-dominant 45-year-old man sustained an injury to the anterior aspect of his right elbow during sudden elbow flexion while trying to lift a heavy load 3 days ago. He reports the sensation of a sudden, sharp pain at the time of injury, which has since subsided. He has ecchymosis in the anterior and medial elbow regions and has difficulty with resisted forearm supination with the elbow in a flexed position. A diagnosis of an acute distal biceps tendon rupture is made, and, after having a discussion with the patient, surgical treatment is chosen. During surgical reattachment, what is the relationship of the distal biceps tendon within the antecubital fossa to the median nerve and recurrent radial artery before the tendon attaches to the bicipital tuberosity?

Figure 1 is the MR image of a high school soccer player who sustained a right knee injury during a game while making a cut toward the ball. He felt a pop and his leg gave way. During physical examination, as the knee is moved from full extension into flexion with an internal rotation and valgus force, you notice a "clunk" within the knee. What is the most likely biomechanical basis for the "clunk"?

In approaching the lateral lumbar spine through the psoas, the lumbosacral plexus is in danger of being injured. The location of the plexus is best described as which of the following? ](http://www.orthobullets.com/anatomy/10053/psoas)

What is the most likely complication following treatment of the humeral shaft fracture shown in Figure 6?

Figures 1 through 3 are the radiographs of a 55-year-old woman who fell on her outstretched right arm, resulting in acute elbow pain and swelling. On examination, she has lateral elbow bruising and tenderness, with a mechanical block to forearm supination and pronation. She has no medial tenderness. During surgery through a direct lateral approach, the surgeon observes a completely bare lateral epicondyle and surgical repair is performed, resulting in a stable and congruent joint. Initial postoperative rehabilitation should include

-
An otherwise healthy 65-year-old man has had chronic pain in his prosthetic knee for the past 9 months. Repeated aspirations reveal a coagulase-negative staphylococcus infection. To eradicate the infection while maintaining the best possible joint function, management should consist of

Which of the following is the seating arrangement recommended for a 5-year-old in a family automobile:

The MRI scan of the shoulder shown in Figure 2 was performed with the arm in abduction and external rotation. The image reveals what condition?**

Initial repair of the large U-shaped rotator cuff tear shown in Figure 12 consists of closing the tear side-to-side to take advantage of margin convergence. The most significant biomechanical consequence of this repair step results in

A 12-year-old boy sustains open comminuted midshaft tibial and fibular fractures while playing indoor soccer. The wound is grossly clean and measures 7 cm with some periosteal stripping. Antibiotics and tetanus toxoid are administered immediately in the emergency department. Following irrigation and debridement of the wound in the operating room, treatment should include

Figures below show the radiographs, MRI, and MR arthrogram obtained from a 25-year-old collegiate
soccer player who has new-onset left groin pain. He played competitive soccer from a young age and has competed or practiced 5 to 6 times per week since the age of 10. He denies any specific hip injury that necessitated treatment, but his trainer contends that he had a groin pull. He reports groin pain with passive flexion and internal rotation of the left hip, and his hip has less internal rotation than his asymptomatic right hip. He is otherwise healthy.When counseling patients who have a cam deformity, the orthopaedic surgeon should note that

-Bacterial resistance to tetracycline is confirmed by ribosome protection, tetracycline modification, and

A 37-year-old electrician is diagnosed with a frozen shoulder after sustaining an electrical injury at work 2 weeks ago. Examination reveals that he cannot actively or passively externally rotate or abduct the arm. The glenohumeral joint and scapula move in a 1:1 ratio. Radiographs are shown in Figures 15a and 15b. The best course of action
should be**

Which of the following scoring techniques is the weakest when used to compare specifiCphysical dynamics of a prosthesis:

Figures 16a and 16b are the radiograph and MR image of a 15-year-old dance athlete with 2 weeks of pain at the left distal femur, a limp, and an inability to dance. Knee motion is 0 to 135 degrees with minimal pain and there is no effusion. Her temperature is 37.0°C, WBC is 12000 /µL (rr, 4500-11000 /µL), CRP is 0.8 mg/L (rr, 0.08-3.1 mg/L), and ESR is 21 mm/h (rr, 0-20 mm/h).

An orthopaedic surgeon in his first year of practice is negotiating with a private for-profit hospital to be their employed trauma specialist. The state of employment is known to have a high rate of malpractice claims because of a favorable plaintiff legal environment. During the course of negotiations, malpractice insurance is being discussed. The surgeon should ask the hospital to provide which type of malpractice insurance policy?

A 12-year-old boy with a history of Duchenne muscular dystrophy is being evaluated for progressive scoliosis. He now has 35° long thoracolumbar scoliosis, which was 20° only 6 months ago. He has a pelvic obliquity of 20°. He is a full-time wheelchair user. What is the most appropriate next step for this patient's spine deformity care?

If the culture results are positive, which treatment will most likely resolve the infection?

A woman injures the metacarpophalangeal (MCP) joint of her thumb while skiing. Examination reveals tenderness along the ulnar aspect of the MCP joint. Radially directed stress of the joint in full extension produces 5° of angulation. When the MCP joint is flexed 30°, a radially directed stress produces 45° of angulation. Radiographs are otherwise normal. Management should consist of

A 14-year-old boy is lifting weights and feels a sudden pain in his back, associated with sciatica bilaterally. The sciatica persists for several weeks. The radiograph shown in Figure 7a is negative, and the CT scan shown in Figure 7b is available for evaluation. An MRI scan is read as a disk bulge. Management should consist of

The most common risk factors for stress fractures is:

Talar body fractures are best classified by a fracture line:

Slide 1
A 23-year-old carpenter fell off a roof 4 weeks ago. He has pain in the ankle and a deformity. The lateral radiograph is presented (Slide). Which of the following treatments is most likely to return this patient to work with a functioning foot and ankle:

An 19-year-old male presents to the emergency room following an motor vehicle accident as an unrestrained driver. Examination reveals unilateral jugular vein engorgement. Chest and special view
radiographs are seen in Figures A and B respectively. Following CT scan of the chest, the next step in management is

A 24-year-old former high school wrestler had anterior cruciate ligament (ACL) reconstruction with hamstring autograft 6 years ago. He now experiences daily instability of his knee with routine activities including walking. Examination reveals a grade 3+ Lachman test with a soft endpoint, varus laxity at 30°, and a positive dial test at 30° that dissipates at 90° of knee flexion. He has mild medial joint line tenderness. When walking, there is a slight varus thrust. Radiographic alignment is neutral. What treatment is most likely to lead to a successful outcome?

Figure 30 shows the radiograph of a 38-year-old man who reports persistent pain laterally and plantarly about the fifth metatarsal head. Examination reveals calluses dorsolaterally and plantarly about the fifth metatarsal head. Nonsurgical management has failed to provide relief. Surgical treatment should include

A 9-month-old infant with torticollis has failed to gain weight and has recurrent lower respiratory tract infections. Neurologic examination is normal, and there is no palpable mass in the sternocleidomastoid muscle. Radiographs of the neck show no bony anomalies. Management should now include

-Decreased sun exposure leads to decreased bone health via what mechanism?

The strongest portion of the scapholunate interosseous ligament (SLIL) is the:

A 22-year-old patient underwent successful reduction of a posterolateral elbow dislocation. Management should now consist of

C omplete ischemia of a peripheral nerve results in irreversible damage after hours.

Which of the following resist articular cartilage compression and fluid flow:

The pathogenesis of this condition is associated with

Which of the following is an effective medication for osteopetrosis:

An otherwise healthy 31-year-old man has had right knee pain for the past 9 months. His former physician
administered a cortisone injection and ordered 6 months of physical therapy. The patient later had an arthroscopy with debridement of the right knee by another physician and completed another course of physical therapy. The patient received minimal relief from these treatments and still is not able to walk longer distances or go on hikes. On examination, he is a healthy appearing male with a body mass index of 24 kg/m2. He has a small effusion, minimal quadriceps atrophy, no tenderness about the knee, full range of motion, stable to varus and valgus stress at 30° of flexion, a grade 1 Lachman test, and a normal posterior drawer. Figures 1 through 4 are his arthroscopic views, radiograph and MRI scan from his prior surgical procedure. What is the next most appropriate step in treatment?