Orthopedic Surgery Board Review MCQs: Sports Medicine & Arthroplasty | Part 181

What are the proposed biomechanical advantages of the Grammont reverse total shoulder arthroplasty when compared to a standard shoulder arthroplasty?

A patient with an acromioclavicular dislocation has a very prominent distal clavicle. Examination reveals that the deformity increases rather than reduces with an isometric shoulder shrug. Which of the following structures is most likely intact?

A 17-year-old high school soccer player sustains an anterior cruciate ligament (ACL) tear at the beginning of the season. An MRI scan confirms a complete ACL tear with no meniscal injuries. The patient plans an early return to play and would like to avoid surgery. Therefore, the patient and family should be advised that nonsurgical management consisting of rehabilitative exercises and the use of a functional knee brace will most likely result in

An acetabular reinforcement cage is most often indicated for which of the following conditions?

What would be the advantage of surgery for the patient described in this scenario?

A 53-year-old woman reports a 4-month history of gradual onset diffuse shoulder pain and limited function. She has had no prior treatment, and her medical history is unremarkable. Examination reveals globally painful active range of motion to 120 degrees forward elevation, 25 degrees external rotation with the arm at the side, and internal rotation to the sacrum. Passive range of motion is also limited in comparison with the contralateral shoulder. Radiographs are shown in Figures 31a through 31c. What is the most appropriate management? Review Topic

A 15-year-old boy reports leg pain after being tackled during football practice. Radiographs and a CT scan are shown in Figures 46a through 46c. The patient has a pathologic fracture through what underlying lesion?

A 35-year-old man who is an avid weight lifter competing in local tournaments reports new onset pain and loss of motion in his dominant right shoulder. Examination reveals joint line tenderness, active elevation to 100 degrees, and external rotation to 10 degrees. His contralateral shoulder reveals 170 degrees forward elevation and 50 degrees external rotation. Radiographs are shown in Figures 46a and 46b. What is the next most appropriate step in management? Review Topic

A 40-year-old man with an acetabular chondrosarcoma has a small soft-tissue mass. Treatment should consist of

A 65-year-old woman has nausea, vomiting, and abdominal distention after undergoing total knee arthroplasty 48 hours ago. An abdominal radiograph is shown in Figure 14. Associated risk factors for this disorder include

What is the most consistent finding regarding glenohumeral kinematics in patients with symptomatic tears of the rotator cuff?

98 degrees (range, 0 degrees to 9 degrees). In knees with varus joint lines

A new composite material is being evaluated for potential use as a prosthetic ligament. In measuring the tensile strength of this material, why is it important to consider and accurately control the loading rate?

A 24-year-old man sustains the injury shown in Figures 19a through 19e in a paragliding accident. He is neurologically intact. He also sustained fractures of his left femur and right distal radius. Which of the following represents the best option for management of the spinal injury?

A “p value” of 4% (p=0.04) indicates that the

What is the mechanism of action of bisphosphonates?

A 25-year-old man is brought to the emergency department following a motor vehicle accident. Extrication time was 2 hours, and in the field he had a systolic blood pressure by palpation of 90 mm Hg. Intravenous therapy was started, and on arrival in the emergency department he has a systolic blood pressure of 90 mm Hg with a pulse rate of 130. Examination reveals a flail chest and a femoral diaphyseal fracture. Ultrasound of the abdomen is positive. The trauma surgeons take him to the operating room for an exploratory laparotomy. At the conclusion of the procedure, he has a systolic pressure of 100 mm Hg with a pulse rate of 110. Oxygen saturation is 90% on 100% oxygen, and he has a temperature of 95.0° F (35° C). What is the recommended treatment of the femoral fracture at this time?

Figure 8 shows the radiograph of a 72-year-old man who has had severe pain in the left hip for the past 3 weeks. History reveals alcohol abuse. The next most appropriate step should consist of

Figures 23a and 23b show the AP and lateral radiographs of a 67-year-old woman who has severe left knee pain when ambulating. History reveals that she underwent primary total knee arthroplasty 7 years ago. The patient reports increasing deformity over the past several years and uses a knee brace and a cane. Examination reveals that she walks with a varus thrust and has an uncorrectable varus deformity with valgus force. What is the primary reason for implant failure?

The patient does well initially but returns for the 4-month postsurgical evaluation with ongoing stiffness and pain despite going to physical therapy twice weekly and working on motion at home. She is unable to bear weight comfortably. What is the best next step?

During cemented total hip arthroplasty, peak pulmonary embolization of marrow contents occurs when the

In the treatment of acetabular dysplasia, what type of pelvic osteotomy leaves the “teardrop” in its original position and redirects the acetabulum?

..Figures 107a through 107c are the radiograph, CT, and bone scan of a 68-year-old man. While walking, he collapsed and was unable to ambulate because of pain and deformity in his right leg. What is the most appropriate next step?

Following surgery for an ankle fracture, which of the following is considered the most important factor in achieving a satisfactory outcome? Review Topic

What inflammatory mediator has been most closely associated with the magnitude of the systemic inflammatory response to trauma and with the development of multiple organ dysfunction syndrome (MODS)?

An 18-year-old girl with quadriplegic cerebral palsy underwent posterior spinal fusion from T2 to the pelvis 3 weeks ago. She now has a low-grade fever and mild midline erythema in a 1-cm area from which there is slight clear yellowish drainage. What is the next most appropriate step in management?

A 41-year-old right-hand-dominant man has been treated nonsurgically for right elbow arthritis. His radiographs reveal end-stage ulnohumeral arthritis with complete loss of the joint space. He reports pain during the mid-arc of elbow flexion and extension. During the last 8 years, he has attempted activity modification, medication, physical therapy, and multiple cortisone injections. His symptoms have progressed, resulting in constant pain, loss of a functional range of motion, and an inability to perform many activities of daily living. Secondary to his age and activity demands, he undergoes a soft-tissue interposition arthroplasty of his elbow with an Achilles allograft. Which presurgical finding correlates with elevated risk for postsurgical complications?

Four weeks after undergoing elective THA, an 80-year-old man is in the emergency department with sudden-onset right hip pain and an inability to bear weight after bending over in his garden.

Botulinum toxin is used to treat vasospastic disorders of the hand such as the Raynaud phenomenon to improve digital perfusion and reduce pain. Botulinum toxin enables which transmitter to be unopposed, resulting in vasodilation?

A 7-year-old girl has pain and swelling of the right elbow after falling off her bicycle. Radiographs are shown in Figure 31. What is the most appropriate initial step in management?

During a revision total knee arthroplasty (TKA), there is difficulty gaining exposure and a tibial tubercle osteotomy (TTO) is performed. The final components are stable and include a stemmed tibial component that bypasses the osteotomy site. The tibial tubercle is reattached to the osteotomy site with multiple cerclage wires. Following closure of the arthrotomy, the knee is flexed to 90 degrees, and there is no observed displacement of the TTO. What is the best next step in postsurgical rehabilitation?

A surgeon prepares a medial gastrocnemius rotational flap to cover a medial proximal tibia defect at the time of revision knee replacement surgery. To optimize coverage, the surgeon must optimally mobilize which artery?

Corticosteroids inhibit the formation of effectors of the inflammatory pathway via inhibition of

All of the following are considered contraindications to the use of functional bracing of a humeral shaft fracture EXCEPT:

Figure 40 shows the plain radiograph of a 30-year-old woman who has had a long history of standing bilateral anterior knee pain and a sense of patellar instability without frank dislocation. Nonsurgical management consisting of anti-inflammatory drugs and physical therapy has failed to provide relief. Examination reveals full range of motion of both knees, with moderate patellofemoral crepitance. Patellar apprehension and patellar grind tests are positive. The Q-angle measures 20°. Management should now consist of

Which of the following is not considered to be a part of the constellation of the clinical entities known as the female athlete triad? Review Topic

What acetabular procedure for developmental dysplasia of the hip does not require a concentric reduction of the femoral head in the acetabulum?

Which 2 tendons are identified in the dissection shown in Video 92?

A 13-year-old girl injures her ankle playing soccer. Radiographs reveal a displaced Tillaux fracture. CT scans are shown in Figure 25. What is the most important consideration for appropriate management?

The third plantar intrinsic muscle layer of the foot consists of which of the following structures?

In girls with idiopathic scoliosis, peak height velocity (PHV) typically occurs at what point?

Which of the following is most associated with local recurrence of the lesion seen in the radiograph and MRI scan shown in Figures 27a and 27b?

High periosteal signal; normal marrow T1 signal; high marrow T2 signal

A 52-year-old woman has bicompartmental osteoarthritis following patellectomy. Treatment should consist of

Which component is most common to both simple and complex elbow dislocations?

Which of the following is considered the most appropriate shoe modification following transmetatarsal amputation?

Figures 45a and 45b show the radiographs of a 14-year-old boy who sustained a distal radius fracture while playing hockey. After 1 year the patient is asymptomatic. Follow-up and comparison radiographs and an MRI scan are shown in Figures 45c and 45d. What is the next most appropriate step in management?

What role does quorum sensing play in the development of a bacterial biofilm?

-Figures 190a and 190b are the sagittal and axial T2-weighted MRI scans of a 75-year-old man who is experiencing progressively worsening bilateral lower-extremity pain and difficulty walking distances. In another 4 years, nonsurgical treatment of his condition--compared to surgical treatment--is expected to result in

A 32-year-old recreational basketball player underwent a successful anterior cruciate ligament (ACL) reconstruction using hamstring autograft approximately 15 months ago. His chart notes that he has good functional knee outcome scores as tested by his physical therapist. However, he has not returned to play despite being cleared by his physician 3 months ago. After successful ACL reconstruction, which of the following factors has shown to contribute the greatest influence on a player's decision to return to sport? Review Topic

A 20-year-old collegiate football player who sustained blunt head trauma during the first half of a game is emotional and confused. During the halftime intermission, his affect, memory, and disorientation are totally resolved and have returned to preinjury baseline. The only residual finding is a very mild headache. He wants to play the second half. What is the most appropriate course of action?

Figures below show the radiographs obtained from an 86-year-old-woman who has had chronic left hip pain for several years. She now uses a walker and a wheelchair for ambulation. She is medically healthy. What is the most appropriate surgical intervention?

Late surgical treatment of posttraumatic cubitus varus (gunstock deformity) is usually necessitated by the patient reporting problems related to

A 40-year-old man has had hip pain with increased activity over the past year. Examination reveals restriction of motion and tenderness with combined hip flexion, adduction, and internal rotation. An AP radiograph is shown in Figure 34. What is the most likely diagnosis?

A 79-year-old woman with polyarticular rheumatoid arthritis has had progressively increasing right shoulder pain for the past year, and nonsurgical management has failed to provide relief. Her neurologic examination is entirely normal, but she is unable to elevate her arm against gravity. An AP radiograph is shown in Figure 13. Treatment should consist of

A 13-year-old boy sustains a valgus stress injury to the knee while playing football, and he is unable to bear weight after the injury. Examination reveals tenderness medially superior to the joint line. The knee is held in flexion, and he has a large effusion and localized medial swelling. Plain radiographs show no obvious fracture. What is the next diagnostic step?

When using the direct lateral (or Hardinge) approach for hip arthroplasty, three muscles are detached from the femur. In addition to the vastus lateralis, they include the

A 26-year-old weightlifter had increasing pain in his left shoulder for 4 months. Nonsurgical treatment consisting of anti-inflammatory medication,

During the application of halo skeletal fixation, the most appropriate position for the placement of the anterior halo pins is approximately 1 cm above the superior orbital rim and

When examining a patient with marked hyperreflexia, which of the following findings best suggests that the condition is not caused by a cerivcal spine pathology?

Figures 78a and 78b show the CT scans of a 22-year-old man with back pain after falling out of a tree. Examination reveals no palpable spinal step-offs, posterior spinal pain, and normal neurologic function in the lower extremities. Normal perineal sensation and normal rectal tone are present. What is the best management? Review Topic

According to Musculoskeletal Infection Society (MSIS) guidelines, which set of patient laboratory study results fits the definition of chronic prosthetic joint infection?

A 70-year-old healthy man had total knee arthroplasty 18 years ago, and it now is painful. Radiographs reveal aseptic loosening and the range of motion before surgery is 15 to 85 degrees. The strongest indication for performing a tibial tubercle osteotomy to aid in exposure in his knee would be

-Figures a through f are the radiograph, CT scan, MRI scan, and bone scan of a 28-year-old woman with a newly diagnosed breast carcinoma who underwent a bone scan for staging. She has no hip pain but a lesion is noted. What is the best next treatment step?

What is the most common complication associated with scalene regional anesthesia for shoulder procedures?

A 10-year-old boy has a painful, swollen knee after falling off his bicycle. Examination reveals that the knee is held in 45 degrees of flexion, and any attempt to actively or passively extend the knee produces pain and muscle spasms. A lateral radiograph is shown in Figure 4. What is the most likely diagnosis?

Patients with patellar clunk syndrome are best managed by which of the following methods?

An 18-year-old collegiate basketball player has had a 3-month history of activity-related back pain. She describes isolated low back pain without radiation that increases with training and playing basketball. Her pain resolves with rest. Physical therapy for 6 weeks has failed to provide relief. An axial CT scan is shown in Figure 17a, and Figures 17b and 17c show sagittal CT reconstructions through the right and left lumbar facets, respectively. Further management should consist of which of the following?

A 75-year-old woman reports foot pain and states that her foot has become progressively “flatter” in the past 3 years. Custom inserts and physical therapy have failed to provide relief. Examination reveals a flexible hindfoot and mild heel cord contracture. The patient is able to perform a single limb heel rise. Weight-bearing radiographs are shown in Figures 21a through 21d. What is the most appropriate surgical management?

A left-handed 23-year-old man who fell 5 feet from a ladder onto his left elbow sustained the closed injury shown in Figure 26. Management should consist of

A 26-year-old man sustained an isolated injury to his left hip joint in a motor vehicle accident. Closed reduction was performed, and the postreduction radiograph is shown in Figure 29. Management should now consist of

A 26-year-old rugby player injured his foot when tackled from behind. Radiographs are seen in Figures 35a through 35c. What is the most appropriate treatment?

Figure 38 shows the radiograph of a 5-year-old child who sustained a type III supracondylar fracture. Examination reveals the absence of a radial pulse, but an otherwise well-perfused hand. Following closed reduction and percutaneous pinning, the radial pulse remains absent; however, the hand is pink and well perfused. Management should now include

A 17-year-old male football player is seen 1 week after developing symptoms of infectious mononucleosis in the middle of the season. Examination reveals evidence of splenomegaly. He and his parents want to know if he can play in a game the following day. What is the most appropriate recommendation? Review Topic

Figures 57a and 57b are the MRI scans of a 61-year-old man who is unable to elevate his dominant arm following a golf injury 24 hours ago. He has moderate pain during attempted arm elevation. Examination reveals significant spinati atrophy and he is only able to elevate his arm fully overhead while supine. The neurologic examination is normal. What is the next most appropriate step in management? Review Topic

A 25-year-old woman returns for her first postoperative visit after arthroscopic thermal capsulorrhaphy for recurrent multidirectional instability. Examination reveals that the portals are healed, there is no swelling; and passive range of motion is within the normal range. However, she is unable to actively raise her arm. Shoulder radiographs are normal. What is the most likely cause of these findings? Review Topic

A year-old woman had a primary total hip arthroplasty 7 years ago that included a proximally coated titanium stem, a cobalt alloy femoral head, a titanium hemispherical acetabular component, and a polyethylene liner. She did well for 4 years but has now had two dislocations and reports pain and weakness around the left hip. She denies any fevers, chills, or constitutional symptoms. On examination, the patient walks well without any signs of an antalgic or Trendelenburg gait. Her abductor mechanism demonstrates good strength. Her erythrocyte sedimentation rate and C-reactive protein level are normal. On radiographs, all components appear well fixed and in good alignment. What is the most appropriate treatment at this time?

A 32-year-old man underwent a total medial meniscectomy 2 years ago. He now reports pain and recurrent swelling for the past 3 months. Work-up includes full standing hip-knee-ankle radiographs, standing AP radiographs of both knees in full extension, an axial view of the patellofemoral joint, and a 45-degree flexion AP radiograph. Contraindication to meniscus allograft transplantation includes which of the following? Review Topic

03 What is the most common site of fracture because of osteolysis following cementless total hip arthroplasty with an extensively porus-coated femoral component?

Figure 11 shows the radiograph of a 26-year-old man with type I diabetes mellitus who was struck by a motor vehicle. What is the most common complication associated with this pelvic fracture?

Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture?

• Following closed reduction for the injury shown in Figures 69a and 69b, treatment should consist of

A 47-year-old man comes for evaluation of his dominant right elbow, which has been bothering him with activity for the past 3 months, especially with activities requiring wrist extension. He is an active squash player and has been unable to continue this sport. Examination shows tenderness at the common extensor origin. What is the next best step? Review Topic

Figure 2 shows the lateral radiograph of an 8-year-old boy who sustained an acute injury to the elbow after falling down the stairs. Management should consist of

Figure 76 is the MR image of a 16-year-old high school football player who sustained a traumatic dominant shoulder dislocation during a game. On-field reduction was unsuccessful. The shoulder is reduced in the emergency department, and the player and his family followup in clinic. Which factor is most associated with failure of surgical treatment in this scenario?

What measure of physiologic status best evaluates whether an injured patient is fully resuscitated and best predicts that perioperative complications will be minimized following definitive stabilization of long bone fractures?

A 6-year-old boy has had increasing pain and a mass in the suprapatellar region of the right femur for the past week. Examination of the mass reveals it may be firm, immobile, and tender to palpitation. The patient has no systemic symptoms. Laboratory studies show a WBC of 7000 per cubic millimeter, a hematocrit of 40%, and an erythrocyte sedimentation rate of 10 mm/hr. radiographs are normal. Figures 64a and 64b show saggital and axial T1-weighted MRI scans. Figure 64c shows frozen section pathology of the biopsy specimen. What is the most likely diagnosis?

A college football player performs bicep curls as part of his weight lifting routine. During the flexion phase of the curl, what term defines the type of muscle contraction?

Figures 13a and 13b show the MRI scans of a 70-year-old patient who has a posterior calf mass. Examination reveals that the mass extends to the midcalf level. A biopsy specimen reveals a high-grade soft-tissue sarcoma. Metastatic work-up shows no lesions. Management should consist of

A 48-year-old man reports localized plantar forefoot pain. Examination reveals a discrete callus (intractable plantar keratosis) with well-localized tenderness beneath the second metatarsal head. The callus most likely lies beneath what structure?

Which of the following studies is considered most sensitive in monitoring a therapeutic response in acute hematogenous osteomyelitis?

Figure 24 shows an axial MRI scan of the ankle. The arrowhead is pointing to what structure?

When balancing gaps in the coronal plane, what structure preferentially impacts the flexion space more than the extension space?

Figures 36a and 36b show the MRI scans of a 15-year-old girl who has had pain and recurrent hemarthrosis in the knee for the past year. Plain radiographs are normal. What is the most likely diagnosis?

Which of the following increases radiation exposure to patients and personnel during surgery?

Which of the following articulation couplings shows the lowest coefficient of friction as tested in the laboratory?

Figure 26 shows the radiograph of a 48-year-old woman who has right arm pain and hematuria. A bone scan reveals increased uptake in the left ribs and thoracic spine. A needle biopsy specimen shows that the lesion is highly keratin positive and composed primarily of clear cells. What is the best course of action?

During C1-C2 transarticular screw fixation, screw misplacement is most likely to result in injury to the

Risk for vascular injury during transtibial drilling for reconstruction of this injury is increased by

The clinical factors shown to most significantly predict the long-term outcome of Perthes disease of the hip include which of the following? Review Topic