Orthopedic Surgery Board Review MCQs: Hip, Arthroplasty, Foot, Trauma | Part 231

Figures 61a and 61b show the CT and MRI scans of a 40-year-old man who has hip pain. He undergoes total hip arthroplasty and curettage and cementation of the lesion as shown in Figure 61c. Histopathologic photomicrographs of the curettage specimen are shown in Figures 61d and 61e. What is the best course of treatment?

• The Injury Severity Score (ISS), using point scores from five different body systems, is a method that aids in predicting the chances of mortality in a patient with multiple injuries by

Which of the following acetabular cup designs has shown the greatest survivorship at 10 years in patients younger than age 60 years?

An adult with a distal humeral fracture underwent open reduction and internal fixation. What is the most common postoperative complication?

Figures 51a through 51c show the radiographs of a 7-year-old soccer player who reports a gradual onset of midfoot pain that began shortly after the start of soccer season. He states that the pain is worse with activity and is partially alleviated by rest. Examination reveals soft-tissue swelling, and tenderness and warmth in the region of the talonavicular and navicular cunieform joints. Management should consist of

A 12-year-old boy has severe left shoulder pain after being struck by an automobile. A chest radiograph, AP and lateral radiographs, and a CT scan with three-dimensional reconstruction of the scapula are shown in Figures 38a through 38d. Management should consist of

Figures 79a through 79d are the plain radiographs and axial CT scans of an 80-year-old woman with severe dementia and a newly noted thigh mass. Examination reveals a large, nonmobile anterior thigh mass that is minimally tender. What is the best next treatment step?

What is the most common cause for late revision (> 2 years post op) total knee arthroplasty?

A 62-year-old man has a severe pes planus and pain in the hindfoot. Radiographs show advanced degenerative changes at the talonavicular and subtalar joints with good preservation of the ankle joint. What is the most appropriate surgical procedure to alleviate his pain?

Total hip arthroplasty in a patient with a long-standing hip fusion on the contralateral side is most likely to result in

Which of the following structures may help maintain radial length after a radial head fracture?

In the anterior cruciate ligament-deficient knee, what structure provides an important secondary restraint to anterior tibial translation?

In a patient who has had low back pain for less than 2 weeks, which of the following findings is an indication for continued observation and symptomatic treatment rather than more aggressive evaluation and/or treatment?

Figures 1 through 4 are selected sagittal MR images of an otherwise healthy 20-year-old collegiate football running back who was tackled during a game and has immediate onset of right knee pain. Video analysis of the injury shows that his flexed knee impacted the field. He is not able to return to play. On examination in the training room the following morning, he has a moderate effusion, no patellar instability, minimal joint line tenderness, and is stable to varus and valgus stress at 30° of knee flexion. A dial test is also negative. He has increased laxity in the anterior to posterior direction. What is the most appropriate next step in treatment?

A 3-year-old girl has had wrist pain, a fever, and has refused to move her right wrist for the past 10 days. She has an oral temperature of 102 degrees F (38.7 degree C). Laboratory studies show an erythrocyte sedimentation rate of 50 mm/h, a WBC count of 11,000/mm 3 , and a left shift. AP and lateral radiographs are shown in Figures 57a and 57b. What is the most likely diagnosis?

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

A 56-year-old woman sustains a type IIIB open tibial shaft fracture. She undergoes irrigation and debridement and intramedullary nailing with flap coverage 24 hours later. Cultures are taken pre-debridement and post-debridement. She develops a surgical site infection at 6 weeks, which requires removing the hardware and placing show Commented [1]: an external fixator. Deep cultures are most likely to pathogens found in

Which examination finding points toward a brachial plexus injury rather than root avulsion?

During the approach to the lumbar spine for an L4-L5 anterior lumbar interbody fusion, which structure generally is found overlying the anterior surface of the L4 vertebra?

A 17-year-old high school football linebacker sustains an injury while making a tackle. His initial symptoms are right shoulder pain, bilateral biceps weakness, and right arm numbness. The symptoms only last a few minutes, and he continues to play in the game. He tells his parents after the game, and they bring him to your office for evaluation the next day. He no longer has any symptoms, and his examination findings and cervical spine radiographs are normal. What is the best next step?

A 35-year-old man reports the development of a painful 2-cm nodule on his dorsal wrist over the past 3 years. A surgeon excised the lesion with a presumptive diagnosis of a ganglion cyst. Histology sections from the excision are shown in Figures 11a and 11b. What is the most likely diagnosis?

Which of the following associated type acetabular fracture patterns is defined based on the fact that all articular segments are detached from the intact portion of the ilium, which remains attached to the sacrum through the sacroiliac joint?

A patient is scheduled to undergo total knee arthroplasty (TKA) following failure of nonsurgical management. History reveals that she underwent a patellectomy as a teenager as the result of a motor vehicle accident. Examination reveals normal ligamentous stability. For the most predictable outcome, which of the following implants should be used?

A 15-year-old boy has hindfoot pain and very limited subtalar motion. A CT scan reveals a talocalcaneal coalition involving 40% of the middle facet. He has no degeneration of the posterior subtalar facet. Following failure of nonsurgical management, treatment should consist of

A 9-year-old girl reports progressive right knee pain. Radiographs are shown in Figures 59a and 59b. Work-up reveals no other sites of disease. Low- and high-power photomicrographs are shown in Figures 59c and 59d. What is the most appropriate treatment?

A 12-year-old child with spina bifida paraplegia requires brace management for ankle stability. Which of the following principles applies to brace management in this individual?

A 51-year-old woman is seen for evaluation of chronic supraspinatus and infraspinatus tendon tears. Three years ago, in an attempted repair the surgeon was unable to repair the supraspinatus and infraspinatus tendon tears. Currently she has a marked amount of pain, reduced range of motion, and weakness. Examination reveals anterosuperior escape. Radiographs show no signs of arthritic changes. You are considering a latissimus dorsi tendon transfer. During the discussion, you mention that

A 14-year-old boy has an asymptomatic mass on the right arm. MRI scans and biopsy specimens are shown in Figures 51a through 51d. Immunostaining is positive for desmin. Additional staging studies should include

A 43-year-old woman has a 2-week history of right shoulder pain. She denies any injury to initiate her symptoms but states that she has shoulder pain with range of motion and lifting objects. Examination reveals mild pain with abduction, empty can testing, and with the Neer and Hawkins impingement tests. Her range of motion with the right shoulder reveals passive forward flexion to 90 degrees, abduction to 90 degrees, external rotation at the side to 15 degrees, and internal rotation to her buttock. The uninvolved left shoulder has forward flexion to 160 degrees, abduction to 150 degrees, external rotation at the side to 60 degrees, and internal rotation to T6. Radiographs of the shoulder are normal. What is the next most appropriate step in management? Review Topic

Figure 11 shows the radiograph of a 2-year-old child with marked genu varum and tibial bowing. Based on these findings, what is the best initial course of action?

The patient in Figure 55 is actively attempting to make a fist. This clinical scenario suggests which of the following anatomic lesions?

The most appropriate treatment for this fracture is

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 18a and 18b show the radiographs of a 13-year-old baseball player who sustained a patellar dislocation with an associated lateral femoral condyle fracture. What ligament is attached to this fragment?

Limited weight bearing usually is recommended following open reduction and internal fixation of intra-articular lower extremity fractures. A bone graft, or bone graft substitute is often placed in the metaphyseal void beneath the reduced articular fragments. Which of the following bone grafts or bone graft substitutes will most likely permit earlier weight bearing without subsidence of the articular reduction?

A 21-year-old man has had posterior neck discomfort for the past 6 months. A whole-body bone scan and a cervical single-photon emission CT reveal increased activity at the C7 spinous process. MRI reveals multifocal involvement of the spinous process lamina and facet of C7. A CT-directed needle biopsy reveals osteoblastoma. What is the best course of action?

The arrow in Figure 39 is pointing to which of the following ligaments?

A 68-year-old patient undergoes total knee arthroplasty for end-stage degenerative joint disease. Two years later, she trips and falls at home and sustains a fracture seen in Figures A and B. Before her fall, she was a community ambulator and had no knee pain. The component is determined to be stable and the surgeon decides to treat this fracture with closed reduction and retrograde intramedullary fixation with a supracondylar nail. Which of the following statements is true?

Figure 7 shows the radiograph of an 18-year-old hockey player who sustained a shoulder injury during a fall into the side boards. Examination reveals a significant prominence at the acromioclavicular joint. Management should consist of

Augmentation of a Broström repair with the mobilized lateral portion of the extensor retinaculum (Gould modification) is expected to produce

Figures 1 and 2 depict the postoperative radiographs obtained from a 22-year-old man who was involved in a motor vehicle accident. The most likely limitation in motion arising from this treatment is

A 15-year-old baseball pitcher who reports increasing pain in his right shoulder over the past 3 weeks states that the pain increases the more he pitches. Radiographs of both shoulders are shown in Figures 35a and 35b. What is the next most appropriate step in management?

A 15-year-old boy has a fracture of the proximal tibia extending from the apophysis of the tubercle up through the posterior part of the proximal tibial epiphysis and into the joint. What is the most likely mechanism of injury?

Injury to the popliteal artery during total knee arthroplasty (TKA) is most likely to occur when placing a sharp retractor

Design factors that enhance the long-term survival of proximally coated cementless hip implants include both initial stability and

Figures 65a and 65b show the MRI scans of a 33-year-old man with severe left leg pain. He has had symptoms for 3 months with progressive worsening pain and function. Examination reveals ankle plantar-flexor weakness and diminished light touch sensation on the plantar surface of the foot. What treatment provides the best outcome? Review Topic

The sartorius muscle is innervated by which of the following nerves?

Cortical bone demonstrates viscoelastic behavior as its mechanical properties are sensitive to strain rate and duration of applied load. Regarding longitudinal strain in cortical bone, which of the following statements regarding this characteristic is true?

A 57-year-old man has had right ankle pain for the past 10 months following an injury that went untreated. Radiographs are shown in Figures 30a through 30c. Management should consist of

Figure 35 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?

Figure 74 shows the radiograph of an 84-year-old woman who reports severe right knee pain. At the time of total knee arthroplasty, she is found to have gross insufficiency and attenuation of the medial collateral ligament (MCL) complex. Optimal management should consist of

Figures below show the AP and lateral radiographs obtained from a 54-year-old woman who has worsening groin pain 18 months after a primary left total hip arthroplasty. The pain is worst when climbing stairs, when rising from a seated position, and during resisted hip flexion. Her pain improved early after surgery but did not completely resolve. Her C-reactive protein and erythrocyte sedimentation rate results of less than 1 mg/dL and 10 mm/hr, respectively, were obtained in the office. What is the best next step?

Figure 20 shows the clinical photograph of a man who has had diabetes mellitus controlled with oral medication for the past 10 years. He wears soft-soled shoes and only uses leather-soled shoes for important business meetings. Examination reveals palpable dorsalis pedis and posterior tibial pulses, although they are somewhat diminished. He is insensate to pressure with the Semmes-Weinstein 5.07 monofilament. The ulcer heals after treatment with a full contact cast. What is the best course of action at this time?

..Figures 83a and 83b are the radiographs of a 53-year-old otherwise healthy homemaker who had a syncopal episode and sustained a ground-level fall and injury to her right elbow. She presently admits to right elbow pain, swelling, and an inability to bend her elbow. What is the best initial treatment for this injury?

A 70-year-old woman who underwent total knee replacement 18 months ago has had 3 weeks of moderate drainage from a previously healed wound. What is the most appropriate treatment?

What root is most commonly involved with a segmental root level palsy after laminoplasty?

Figure 30a is the anteroposterior radiograph of a 20-year-old woman with mild right groin pain and intermittent “catching” in the hip region. What is the most appropriate next step? tear

A B Figures 19a and 19b are the CT scans of an 18-year-old man who was a restrained driver in a rollover motor vehicle collision. What was the primary mechanism of injury?

Which of the following zones of articular cartilage has the highest concentration of proteoglycans?

A 65-year-old man with ankylosing spondylitis sustains an extension injury to his cervical spine. Two days later, a progressive neurologic deficit develops at the C6 level. An MRI scan is shown in Figure 1. What is the most likely diagnosis?

A 12-year-old boy who pitches on two “select” baseball teams has had pain in his dominant right shoulder for the past 6 weeks. The pain is present only with throwing and is associated with decreased throwing velocity and control. He has no radiation of pain or paraesthesias of the upper extremity. An AP radiograph and MRI scan are shown in Figures 19a and 19b, respectively. Management should consist of Review Topic

A 21-year-old male is brought to the emergency department after being involved in gang-related violence. A radiograph of his pelvis is shown in Figure A. The patient is hemodynamically stable. Which of the following imaging modalities is the next best step in evaluating this patient for the most common associated injury? Review Topic

Figures 15a and 15b are intrasurgical photographs from the posterolateral viewing portal that were taken at the beginning and end of a right shoulder arthroscopic procedure performed on a 54-year-old man. This technique demonstrates superior results compared to traditional arthroscopic techniques when evaluating which outcome?

In providing culturally competent care to a Muslim woman with a cervical spine injury, which of the following most accurately describes the steps a male orthopaedist should take to respect her religious beliefs during his examination?

The most common complication associated with corticosteroid injection for the treatment of interdigital neuroma is

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?

During the first stage of osteoarthritis, which of the following processes predominates?

A sagittal T1-weighted MRI scan of the knee joint is shown in Figure 23. What structure is identified by the arrow?

When harvesting an iliac crest bone graft from the posterior approach, what anatomic structure is at greatest risk for injury if a Cobb elevator is directed too caudal?

03 Which of the following findings is the best indication for the use of temporary external fixation of a femoral shaft fracture?

An 18-year-old male soccer player sustains a knee injury during a game. Examination is notable for a positive pivot shift test. What other physical examination finding is most likely to be present? Review Topic

What is the most important muscle adaptation resulting from endurance training? Review Topic

• A skeletal survey is more accurate than a bone scan for detecting skeletal involvement in which of the following neoplastic diseases?

A 59-year-old woman with a history of osteoporosis is involved in a high-speed motor vehicle accident, resulting in left hip pain and deformity. The initial radiograph from the trauma bay is shown in Figure 1. Postreduction  CT  is  shown  in  Figures  2  through  4.  What  is  the  most  appropriate  definitive  surgical treatment?

Osteoporosis is best diagnosed by

A 35-year-old woman dislocated her right shoulder in a fall from a step stool several months ago. She now reports several painful recurrences. Examination reveals anterior and inferior apprehension that reproduces her symptoms. An MRI scan is shown in Figure 17. Management should consist of

Figure 1 is the MR image of a 55-year-old man who sustained an acute traumatic injury to his right shoulder with loss of active range of motion. He was initially evaluated by his primary care physician and treated with physical therapy without success. He was referred to an orthopaedist for surgical consultation 8 weeks after sustaining the injury. The orthopaedic surgeon performs a successful arthroscopic repair but notes poor tendon quality at the repair site. The treating surgeon keeps the patient in a sling full time for 6 weeks without formal therapy. One year after surgery, in comparison to early therapy, this rehabilitation program will likely result in

A 25-year-old woman has had pain and stiffness in her knee following a motor vehicle accident 9 months ago. The radiograph, CT scan, MRI scan, and biopsy specimen are shown in Figures 53a through 53d. What is the most likely diagnosis?

What is the most common type of malalignment after intramedullary nailing of distal 1/3 tibia fractures?

The comparative outcomes of needle aponeurotomy (NA) and collagenase Clostridium histolyticum (CCH) use in the treatment of Dupuytren contracture indicate that patients treated with CCH have

A healthy, active 72-year-old man trips and falls, landing on his left hip 10 weeks after an uncomplicated left primary uncemented total hip replacement. A radiograph taken 6 weeks after surgery and before the fall is shown in Figure 1. A radiograph taken after the fall is shown in Figure 2. He is unable to bear weight and is brought to the emergency department. Examination reveals a slightly shortened left lower extremity and some mild ecchymosis just distal to the left greater trochanteric region, but his skin is intact, without abrasions or lacerations. What is the most appropriate treatment?

New painful paresthesias near the site of the incision after an ulnar nerve transposition is the result of injury to what nerve?

What is the most appropriate orthotic management for the lesion shown in Figure 6?

What is the structure indicated by the letter “A” in Figure A? Review Topic

Figure 28 shows the postoperative radiograph of a 36-year-old patient. The cerclage cable was placed for a minimal medial calcar fracture seen during femoral preparation. In the immediate postoperative period, what is the highest level of activity that would be safely permitted?

repair of the rotator cuff

A 12-year-old girl with juvenile rheumatoid arthritis (JRA) has had chronic pain and synovitis about the knee that is now well-controlled medically. Examination reveals 20° of valgus at the knee. Knee range of motion shows 10° to 90° of flexion. Treatment should consist of

A patient with Pott's disease, tuberculosis of the spine, is more likely to have which of the following early findings? Review Topic

A 21-year-old female college athlete sustained a stress fracture of the fifth metatarsal 1 year ago which was treated successfully with surgical stabilization and she returned to normal activities. She now has a tension-sided femoral neck fracture. Along with surgical fixation of the fracture, what is the next step in management? Review Topic

A 17-year-old football player is tackled with an opposing player's helmet hitting him hard in the abdomen. He is knocked backwards and suffers a diaphyseal femur fracture. He denies any loss of consciousness. Vital signs reveal a heart rate of 118, mean arterial pressure (MAP) of 68, and a respiration rate of 32 per minute. A FAST ultrasound study shows trace free fluid in the perisplenic space. A CBC taken prior to bolus IV fluids reveals a hematocrit of 48%, and a blood gas shows a lactate level of 1.8 and a base excess of -2.0. Which of the follow statements regarding the patient's hemodynamic status is correct?

In Ewing’s sarcoma, neoplastic properties are thought to be related to a

Figures below depict the radiographs obtained from a 53-year-old man who has had swelling in his right knee for 2 years, with minimal pain. He did not note an injury to the knee but has been unable to ambulate without crutches during this period. His past history is unremarkable, and he denies a history of diabetes or back problems. The social history reveals that he emigrated from China, and he works at a desk job. Physical examination shows a healthy man in no acute distress. Range of motion of the right knee is 5° to 120° actively and 0° to 120° passively, without pain. Sensation is decreased on the bottom of both feet, but otherwise the neurologic examination is unremarkable. Laboratory testing reveals a positive rapid plasma reagin (RPR) test. What is the best next step?

Complications following a reverse shoulder prosthesis occur most frequently when performed for what diagnosis? Review Topic

An elderly woman with radiographic evidence of spinal stenosis reports difficulty walking and calf pain that is relieved by rest and a change of position. The most likely cause of pain is ischemia of the

-The Coleman block test is used to test for

During reconstruction of insertional gaps of a chronic Achilles tendon rupture, what tendon provides the most direct route of transfer?

Avascular necrosis

A 30-year-old accountant and recreational softball player, who is seen at the end of his baseball season, reports a several month history of pain along the medial side of his dominant elbow. He cannot identify a specific injury and notes it only hurts when he throws the ball in from the outfield. Besides the pain, he remarks that his speed and distance while throwing have diminished considerably. Examination reveals tenderness along the medial elbow but no weakness or gross instability is found. Radiographs are normal. Based on the history, what is the most likely diagnosis? Review Topic

-Figures 156a and 156b are the radiographs of a 38-year-old man with diabetes mellitus who fell 8 feet from a ladder and sustained an isolated closed injury of his leg. Examination revealed swollen but soft compartments. His neurovascular examination was unremarkable. A damage-control fixator was initially applied, and his soft-tissue envelope is now amenable to further intervention. What is the most appropriate treatment?

The dominant arterial blood supply to the patella enters at which anatomical location?