OITE & ABOS Orthopedic Board Exam MCQs: Spine, Trauma, Knee - Part 142

Pedicle subtraction osteotomies (PSO) are commonly performed in the lumbar spine to treat sagittal imbalance. What is the most common complication following a PSO in the lumbar spine? Review Topic

Figure 38a shows the radiograph of a 12-year-old boy who underwent a reamed intramedullary nailing for a closed femoral shaft fracture. One year after rod removal, he reports groin pain. A current radiograph is shown in Figure 38b. The findings are most likely the result of

A 21-year-old woman has a nontraumatic rupture of the Achilles tendon. Which of the following commonly prescribed medications has been associated with this condition?

A 41-year-old woman has medial-sided knee pain and varus deformity. Her radiographic findings are consistent with isolated medial compartment osteoarthritis. Her pain persists despite nonsurgical therapy. A medial-sided, opening-wedge osteotomy with locking plate fixation is performed. What factor is most associated with delayed union or nonunion of the osteotomy?

Surgical restoration of sagittal balance of an adult spinal deformity will have which effect on outcome?

Figure 13 shows the clinical photograph of a 66-year-old man who has had an increasingly painful right foot deformity for the past 3 years. Examination reveals that the subtalar joint is fixed in 15° of valgus, and forefoot supination can be corrected to 10° from neutral. Nonsurgical management has failed to provide relief. Treatment should now consist of

What is the most accurate description of the relationship between gender and knee loading during landing while playing basketball?

A 30-year-old woman injures her knee while skiing. Based on the MRI scan shown in Figure 5, treatment should consist of

A 74-year-old woman with rheumatoid arthritis reports shoulder pain that has failed to respond to nonsurgical management. AP and axillary radiographs are shown in Figures 23a and 23b. Examination reveals active forward elevation to 120 degrees and external rotation to 30 degrees. What treatment option results in the most predictable pain relief and function?

A 35-year-old recreational basketball player reports shoulder pain following a sprawl for a rebound. While examination reveals that he can actively elevate the arm with pain, a subacromial injection fails to provide relief. An MRI scan reveals medial subluxation of the long head of the biceps. Which of the following structures most likely has also been injured?

A 24-year-old man sustained a bilateral C5-6 facet dislocation in a car accident and was intubated at the scene. He remains sedated in the intensive care unit

A 57-year-old man has had a 2-week history of neck pain. He has no history of radiating symptoms, and has no complaints of numbness or paresthesias. There was no trauma associated with the onset of the pain. Figure 26 shows the MRI scan initially obtained by his family physician. What should the patient be told regarding the prevalence of the MRI findings in his age group? Review Topic

Which of the following is considered a potential advantage in prophylaxis for the prevention of deep venous thrombosis associated with the use of low-molecular weight heparin (LMWH) as compared with fixed-dose unfractionated heparin?

Figures 1a and 1b show the clinical photograph and oblique radiograph of a 52-year-old man who has plantar first metatarsal pain. A felt pad in the shoe proximal to the area of pain has failed to provide relief. Management should now consist of

A 20-year-old man sustained a closed tibial fracture and is treated with a reamed intramedullary nail. What is the most common complication associated with this treatment?

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

Based on the injury shown on the axial MRI scan of the shoulder in Figure 1, what other pathology should be closely examined for during surgery?

An active 66-year-old man who underwent total shoulder arthroplasty 3 years ago now reports pain. Laboratory studies reveal an elevated erythrocyte sedimentation rate and C-reactive protein. Intraoperative frozen section reveals greater than 10 white blood cells per high power field on two slides and the Gram stain reveals gram-positive cocci in clusters. What is the most appropriate surgical treatment to eradicate the infection and maintain function? Review Topic

A 7-year-old male is struck by a motor vehicle while crossing the street and suffers an open tibia fracture with a crush injury of the ipsilateral foot. After multiple attempts at limb salvage, the family and treating surgeon elect to proceed with a knee disarticulation. What complication of pediatric amputations is avoided with a knee disarticulation as opposed to a transtibial amputation?

A 6-year-old sustains the injury shown in Figures A and B. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups?

A 24-year-old man was thrown from a car and is seen in the emergency department with a Glasgow Coma Scale (GCS) score of 8. A CT scan of the head shows no significant bleeding. The patient is hemodynamically stable. The left femur has the closed injury shown on the radiographs in Figures 53a and 53b. What is the best treatment for this patient?

What is the most common turf toe mechanism of injury?

Which of the following clinical scenarios represents an appropriate indication for convex hemiepiphysiodesis/hemiarthrodesis in the treatment of a child with a congenital spinal deformity?

The anatomy of the sciatic nerve as it exits the pelvis is best described as exiting through the

A 78-year-old woman has had activity-limiting cervical pain and occipital headaches for the past 4 years. Management consisting of injections, analgesics, and part-time collar wear has provided temporary relief. Examination reveals that her neck pain seems to be primarily located immediately below the skull and is aggravated by long periods of sitting and rotation of her head. Plain radiographs are shown in Figures 36a through 36c. What is the best course of action?

-An otherwise healthy 15-year-old wrestler has a 6-cm cutaneous lesion on the posterior aspect of his right elbow that he reports as a spider bite. What is the most likely diagnosis?

An athletic 55-year-old man reports a painless mass in the anterior aspect of the thigh that appeared 3 weeks ago and has not changed in size. The patient denies any history of trauma. Examination reveals a firm, well-defined nontender mass in the anterior thigh and no inguinal adenopathy or cutaneous changes. Plain radiographs are unremarkable. T1- and T2-weighted MRI scans are shown in Figures 44a and 44b. What is the most likely diagnosis?

-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?

A 14-year-old boy with a history of cerebral palsy has a clawed hallux, cavus foot deformity, and associated pain. Examination reveals pain under the first metatarsal head and a rigid first tarsometatarsal joint. Treatment should consist of

A 32-year-old man has intense right hand and wrist pain, a deformed wrist, and numbness in his fingers after falling off his motorcycle. This is an isolated injury. Examination reveals a swollen wrist, normal capillary refill to all fingers, and limited flexion of all fingers. Radiographs are shown in Figures 21a and 21b. Neurologic examination of the hand will most likely reveal

• Which of the following nerves supply the muscles on each side of internervous plane identified when performing the anterior (Smith-Petersen) approach to the hip?

Figure 1 shows the radiograph obtained from a 67-year-old man recently diagnosed with osteoarthritis, 8 years after receiving a left metal-on-metal total hip arthroplasty (THA). The acetabular component has a modular cobalt alloy acetabular liner. The patient states that he did very well postoperatively, but for the last 6 months has noted worsening pain and swelling in his left hip. Serum metal ion testing reveals a chromium level of 12.4 ng/mL, compared with a normal level of less than 0.3 ng/mL, and a cobalt level of 11.8 ng/mL, compared with a normal level less than 0.7 ng/mL. An MRI with metal artefact reduction sequence (MARS) was performed and is shown in Figure 2. What is the most appropriate management at this time?

A 28-year-old man has a painful nodule on the plantar aspect of his foot in the midarch. Use of a soft orthosis has failed to provide relief. Examination reveals that the mass is approximately 2 1/2 cm in diameter, firm, and tender to palpation. An MRI scan confirms the presence of a plantar fibroma. Management should now consist of

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

To avoid damage to the ascending branch of the anterior humeral circumflex artery during open reduction and internal fixation of a proximal humeral fracture, the blade plate should be placed in what position?

A 25-year-old man reports wrist pain following a motorcycle accident. Examination reveals minimal swelling, slightly limited active range of motion, and point tenderness in the snuff box region. AP and oblique radiographs are shown in Figures 40a and 40b. Management should consist of

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?

Figures 29a and 29b show the radiograph and CT scan of a 48-year-old man who has diffuse spinal pain. What is the most likely diagnosis?

What postoperative complication occurs at a significantly higher rate in patients undergoing bilateral simultaneous total knee arthroplasty than in patients undergoing unilateral total knee arthroplasty?

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

03 An 18 month old child has bilateral “corner fractures” of the distal femoral metaphyses of unknown origin. Following a skeletal survey, the first step in management should consist of

A 60-year-old woman sustains the injury shown in Figure 75. Prior to her injury, she lived independently and was a community ambulator without need for any assistive devices. What treatment will give her the greatest long-term painless hip function with the lowest reoperation rate?

Figure 2 shows the radiograph of a 72-year-old woman who reports pain after a fall. History includes several years of increasing thigh pain and limb shortening. Management consisting of an extensive work-up for infection reveals normal laboratory studies, a positive bone scan, and a negative hip aspiration. What is the most likely etiology of this complication?

Examination of a 28-year-old woman reveals a moderate hallux valgus deformity and a prominence of the medial eminence. She reports that she can participate in all activities, wear 3-inch heels with minimal discomfort, and walk in a 1-inch heel with no pain. However, she is concerned that the deformity will get worse and requests recommendations regarding surgical correction. What is the best course of action?

A 20-year-old man is brought to the emergency department after a high-speed motor vehicle accident. His initial blood pressure is 70/40 mm Hg. He is currently receiving intravenous fluids as well as blood. His Focused Assessment with Sonography for Trauma examination did not show any free fluid in his abdomen and his chest radiograph is unremarkable. An AP pelvis radiograph is shown in Figure 15. What is the next most appropriate step in the management of his pelvic injury? Review Topic

Figure below shows the abdominal radiograph obtained from a 70-year-old woman who experiences nausea and abdominal tightness 48 hours following left total knee arthroplasty performed under general anesthesia. She received 24 hours of cefazolin antibiotic prophylaxis and a patient-controlled analgesia narcotic pump for pain management. She has been receiving warfarin for thromboembolic prophylaxis. Her severe abdominal distension and markedly decreased bowel sounds are most likely secondary to the administration of

For the athlete performing heavy exercise, the magnitude of core temperature and heart rate increase is most proportional to

• Radiographs of a 20-year-old college athlete who sustained an injury to the ankle reveal no fractures or widening of the ankle mortise. Examination shows swelling at the ankle region and pain with medial lateral compression of the distal tibiofibular joint. Which of the following studies would best help in confirming a diagnosis?

What portion of the pitching phase creates forces approaching the tensile limit of the medial ulnar collateral ligament of the elbow? 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?

Figure 19 shows an arthroscopic view from the anterior lateral portal of the knee looking into the suprapatella pouch. The use of an electrothermal device during this procedure most commonly causes significant postoperative complications by damaging which of the following structures?

Which of the following factors is associated with the worst prognosis in soft-tissue sarcomas?

An 18-year-old football player sustains a contact injury to his right lower leg, and radiographs show a closed transverse fracture of the middle third of the tibia. Based on the clinical examination, a compartment syndrome is suspected. When measuring compartment pressures, the highest tissue pressure is recorded how many centimeters proximal or distal to the fracture site?

Figure 10 shows the radiograph of an 18-year-old woman who sustained a spinal cord injury in a motor vehicle accident. Based on the radiographic findings, her injury is best described as

Figures 2a and 2b show the clinical photograph and radiograph of a 16-year-old cheerleader who fell on her left lower extremity while performing a pyramid. Following adequate sedation, closed reduction is performed, but an incomplete reduction is noted. What structure is most likely preventing a reduction?

Figures 25a through 25c are the axial T1 and postcontrast MRI scans and biopsy specimen of a 35-yearold man with a painless right thigh mass. He noticed the mass about 2 weeks ago and is unsure if it has changed in size. Which translocation most commonly is associated with this type of tumor?

A 23-year-old man has had heel pain and fullness for the past several months. He reports that initially the pain was present only with activity, but more recently the pain has become constant. Figures 53a through 53d show a radiograph, a bone scan, and T2-weighted and gadolinium MRI scans. What is the most likely diagnosis?

Which of the following nutraceuticals has been associated with perioperative bleeding?

A patient has pain 2 years after undergoing a metal-on-metal (MOM) left total hip arthroplasty (THA). Which test(s) best correlate with a prognosis if this patient is having a reaction to metal debris?

When performing a posterior cruciate ligament reconstruction with a tibial inlay-type approach, what is the approximate anatomic distance of the popliteal artery from the screws used for fixation of the bone block?

Disadvantages of anterior-inferior plate fixation for acute clavicular fractures relative to superior plating include

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is characterized by Review Topic

Moderate distance running has what effect on knee articular cartilage in asymptomatic distance runners?

As reflected by the SF-36 scores, patients with which of the following conditions demonstrate the most disability in physical function?

A 39-year-old man has had persistent right shoulder pain for the past 6 months. A formal physical therapy program has failed to provide relief, and an injection several months ago provided only short-term relief. Examination reveals a positive Neer and Hawkins test. There is no instability and the neurovascular examination is normal. Arthroscopy reveals a partial rotator cuff tear on the bursal side measuring 60% of the tendon thickness. What is the next most appropriate step in management?

Which of the following lumbar disk components has the highest tensile modulus to resist torsional, axial, and tensile loads?

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?

Smoking has been associated with lower fusion rates in both cervical and lumbar fusion. Which of the following statements best describes an explanation for these findings?

A 25-year-old patent underwent anterior cruciate reconstruction (ACL) surgery 6 months ago. He returns to clinic with persistent instability. Physical examination reveals full range of motion of the knee. Additional tests show a 1A Lachman, 2+ pivot shift, negative external rotation dial, negative reverse pivot shift and negative McMurray. His radiographs are shown in Figure A. What is the likely cause of his persistent symptoms? Review Topic

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?

A 15-year-old male jumps off a 6 foot ramp and lands awkwardly. His knee swells up immediately and he is taken to the emergency room. Figures A is a sagittal CT scan image. In the next 3 hours, he complains of increasing leg pain. This is likely because of injury to which of the following structures? Review Topic

An 18-year-old football player is injured after making a tackle with his left shoulder. He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. Motor examination reveals weakness to shoulder abduction and external rotation as well as elbow flexion. He has decreased reflexes of the biceps tendon on the left side but full, nontender range of motion of the cervical spine. What anatomic site has been injured? Review Topic

After surgery, this patient continues to experience pain and swelling of the knee with recurrent effusions. He returns to the office with continued pain 2 years after surgery. He describes instability, particularly when descending stairs. Upon examination, there is range of motion from 0 to 120 degrees with no extensor lag. The knee is stable to varus and valgus stress in extension, but there is flexion instability in both the anterior-posterior direction and in the varus-valgus direction. Bracing leads to a slight decrease in symptoms but is not well tolerated. Isokinetic testing demonstrates decreased knee extension velocity at mid push. Radiographs demonstrate well-aligned and fixed knee implants. An infection workup is negative. What is the most appropriate surgical intervention at this time?

A 6-year-old child sustained a closed nondisplaced proximal tibial metaphyseal fracture 1 year ago. She was treated with a long leg cast with a varus mold, and the fracture healed uneventfully. She now has a 15-degree valgus deformity. What is the next step in management?

What is the most common presenting sign or symptom in an adult with lumbar pyogenic infection?

A 25-year-old woman sustains a fall on an outstretched hand. She complains of elbow pain. Examination reveals tenderness over the lateral elbow and pain on elbow motion. Injury radiographs and CT scans are shown in Figures A and B, respectively. What is the next best step?

A 23-year-old man reports a 6-year history of recurrent instability in the right dominant shoulder. He has not undergone surgery and has essentially stopped all of his sporting activities. On examination, he has instability and apprehension in the midrange of motion (abduction of 45 to 60 degrees with external rotation) and a palpable clunk representing a transient dislocation over the anterior glenoid rim. A three-dimensional CT scan is shown in Figure 31. What is the most appropriate surgical intervention to provide him with reliable stability postoperatively?

A 42-year-old patient has had painful inferior subluxation of the glenohumeral joint following a recent cerebrovascular accident (CVA). Figure 34 shows the AP radiograph of the shoulder. Management should consist of

During a posterior cruciate ligament (PCL)-retaining total knee arthroplasty, a critical principle to remember is to

A 16-year-old boy with spastic quadriplegic cerebral palsy has been referred for evaluation and management of scoliosis. His parents report increasing problems with sitting balance, positioning, and hygiene because of the deformity. The radiograph shown in Figure 46 reveals a lordoscoliosis of 105° with marked pelvic obliquity. Attempts at correcting the pelvic obliquity on supine bending radiographs show significant rigidity. Management should consist of

A 42-year-old woman has cervical stenosis and radicular deficits at the C5-6 and C6-7 levels. History reveals that she has smoked one pack of cigarettes a day for 25 years. Because nonsurgical management has failed to provide relief, she is now seeking surgical treatment. After preoperative counseling, it becomes clear that she is not likely to stop smoking. Which of the following surgical procedures should be used?

Placing the starting point for an antegrade femoral nail too anterior to the axis of the medullary canal can lead to what intraoperative complication?

A newborn girl is referred for evaluation of suspected hip instability. What information from her history would place her in the highest risk category?

A previously healthy 29-year-old man reports a 2-day history of severe atraumatic lower back pain. He denies any bowel or bladder difficulties and no constitutional signs. Examination is consistent with mechanical back pain. No focal neurologic deficits or pathologic reflexes are noted. What is the most appropriate management?

..A lateral radiograph (Figure 131a), sagittal short tau inversion recovery MRI scan (Figure 131b), and an axial T1 contrast MRI scan (Figure 131c) were performed on a 15-year-old boy who has injured his right knee twice during the last 5 months. He has a reduced range of motion of the knee and posterior thigh tenderness. A biopsy showed bland spindle cells, giant cells, and blood-filled spaces without endothelial lining. What is the most appropriate treatment?

A 6-year-old girl sustains an ankle injury after falling on roller blades. An AP radiograph is shown in Figure 68. Treatment should consist of which of the following?

Figure 12a shows the clinical photograph of a 36-year-old man who has left shoulder pain and dysfunction after undergoing a lymph node biopsy 2 years ago. The appearance of the shoulder during abduction and a wall push-up maneuver is shown in Figures 12b and 12c, respectively. Which of the following procedures provides the best pain relief and function?

Figures 11a and 11b show the clinical photograph and radiograph of a newborn. Based on these findings, what is the best course of action?

A 12-year-old boy is emergently transported to the emergency department following a motor vehicle accident. He was restrained in the back seat with a lap belt. On a physical exam bruising is noted across his abdomen as shown in Figure A. Lateral radiographs are shown in Figure B. Which of the following injuries are most frequently associated with this injury pattern? Review Topic

What is an example of cognitive rest after concussion? Review Topic

What preoperative factor correlates best with the outcome of rotator cuff repair?

A right-handed 14-year-old pitcher has had a 3-month history of shoulder pain while pitching. Examination reveals full range of motion, a mildly positive impingement sign, pain with rotational movement, and no instability. Plain AP radiographs of both shoulders are shown in Figures 25a and 25b. Management should consist of

The additional risk of complications in organ transplant patients receiving a total joint arthroplasty is attributed to

Which of the following factors is associated with failure of arthroscopic excision of the distal clavicle?

Figures 1a through 1c are the radiographs of a 40-year-old woman who sustained a minor injury to her left ring finger. Prior to this injury, she was asymptomatic, but she now notes pain and swelling. What is the best course of treatment?

A 15-year-old high school soccer player collides with an opponent and is unconscious when the trainer arrives on the field. He is conscious within 15 seconds, breathing appropriately, and denies any headache, neck pain, or nausea. It is his first head injury. Provided that the athlete is free of symptoms, when should he be allowed to return to athletic activity?

Total hip arthroplasty is most appropriate for the injury shown in Figure A for which of the following patients?

A year-old man who underwent left partial knee arthroplasty 6 months earlier was doing well until he experienced left knee pain and swelling for 4 weeks following a dental procedure. The left knee aspirate was bloody, with a white blood cell count of 8,000 and 70% neutrophils. Culture grew group B Streptococcus ( Granulicatella adiacens ), and serologies were elevated, with an erythrocyte sedimentation rate of 55 mm/h (reference range: 0 to 20 mm/h) and a C-reactive protein level of 24 mg/L (reference range: 08 to 1 mg/L). What is the best next step?

A 24-year-old professional male soccer player has lower abdominal pain on exertion. He has pain with resisted hip adduction and with sit-ups. There is no palpable inguinal hernia with a Valsalva maneuver. Nonsurgical management has failed to provide relief. After ruling out malignancies, what is the next most appropriate step in management?

A 12-year-old girl has back pain after falling 20 feet and landing in the sitting position. She has no fractures or other injuries, and her neurologic examination is normal. A lateral radiograph, transverse CT scan, and reformatted sagittal CT scan are shown in Figures 25a through 25c. Which of the following methods is associated with the best long-term outcome?