OITE & ABOS Orthopedic Board Prep MCQs: Trauma, Shoulder & Deformity | Part 202

Figure 91 shows the radiograph of a 57-year-old man who fell 6 feet off a ladder. He is neurovascularly intact but reports shoulder pain. What is the most appropriate acute treatment for this patient?

When compared with reamed intramedullary nailing for an unstable diaphyseal tibia fracture, unreamed nailing is associated with which of the following?

An 18-year-old man was in a motor vehicle accident and sustained a closed head injury, right displaced scapular body and glenoid fractures, a right proximal humeral fracture, fractures of ribs one through three, facial fractures, and bilateral pubic rami fractures with minimal displacement. He has a systolic blood pressure of 80/40 mm Hg despite fluid resuscitation. A radiograph is shown in Figure 17. Spiral CT does not identify any thoracic or abdominal injuries. What is the next most appropriate step in management?

Dorsal intercalated segment instability (DISI) describes which carpal deformity?

A 33-year-old female with generalized ligamentous laxity is diagnosed with spontaneous atraumatic subluxation of the sternoclavicular joint. She notes mild, intermittent pain and a small amount of prominence to that area. What is the most appropriate treatment at this time?

A 22-month-old child has scrapes and bruises on his head and a severe deformity of the forearm after being thrown from a car as an unrestrained passenger in a motor vehicle accident. Examination reveals a Glasgow Coma Scale score of 12. Prior to treatment of the forearm, management should include

below show the radiographs obtained from an 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?

Which of the following pieces of equipment currently offers the greatest opportunity for lowering the number of equestrian injuries?

What is the most common complication following arthroscopic capsular release in a patient with adhesive capsulitis of the shoulder?

Of the following variables, which has the strongest influence on external fixator stiffness?

Figure 22 shows the radiographs of a 16-year-old boy who injured his elbow in a fall 1 year ago. Although he has no pain, he reports restricted forearm rotation and elbow flexion. What is the most likely diagnosis?

During placement of an external fixator for a distal radius fracture, the most commonly injured nerve is a branch of which of the following nerves?

Which of the following has been associated with a decreased rate of glenoid component radiolucent lines?

Based on the type of articulation shown in Figure 32, wear is not affected by which of the following factors?

Figure A shows intraoperative images of a right knee in an 8-year-old boy after he sustained an injury. Which of the following is the most common indication for performing this procedure? Review Topic

.Figures 59a and 59b are the axial T2 and T1 with contrast MRI scans of a 32-year-old woman who has a 10-year history of pain and a 1-year history of progressive swelling in her right leg. The histopathology is shown in Figure 59c. A radiograph of her leg showed no mineralizations or osseous erosions. The chromosomal abnormality that is associated with this disease is

An 11-year-old girl sustained an injury to her right foot when a 500-lb headstone fell on it. The headstone was removed after 3 minutes. Radiographs show multiple midfoot fractures. Examination reveals severe pain that is worse with passive toe motion. Clinical photographs are shown in Figure 28. Management should consist of

Figures  1  and  2  demonstrate  the  radiographs  obtained  from  a  35-year-old  woman  with  end-stage debilitating osteoarthritis of the right hip. She is contemplating total hip arthroplasty (THA). She has a history of right hip dysplasia and underwent hip osteotomy as an adolescent. Over the years, nonsurgical treatment,  including  weight  loss,  activity  modifications,  and  intra-articular  injections,  has  failed.  Her infection   work-up   reveals   laboratory   findings   within   defined   limits.   Which   bearing   surface   is contraindicated for this patient?

A 14-year-old male soccer player was seen initially in the emergency room 1 week ago after an acute right hip injury during a soccer tournament. The patient reports that the hip pain has improved, but still requires crutches for long distance ambulation. His radiograph is seen in Figure A. What would be the next most appropriate step in management? Review Topic

..Figure 93 is the radiograph of a 72-year-old woman. Treatment includes fixation of the ulna. What options are recommended for the radius?

A 52-year-old man has had right shoulder pain in the deltoid region that increases at night for the past 2 months. He denies any history of trauma. Examination reveals mild tenderness over the greater tuberosity, and the Neer and Hawkins impingement signs are positive. AP and outlet lateral radiographs are shown in Figures 24a and 24b. Initial management should consist of

What bilateral surgical intervention is considered inappropriate based on the findings shown in the radiograph in Figure 52?

A 72-year-old woman has had progressively increasing pain in the right knee for the past 6 months. She denies any trauma and has no pain in any other joints, but she notes occasional swelling in the knee and a catching sensation. Figures 31a and 31b show the plain radiographs and Figure 31c shows the MRI scan. Treatment should consist of

A B C D E Figures 45a through 45c are the MR images of a 22-year-old woman who has had 6 months of ankle pain related to activities of daily living. She recently completed a course of cast immobilization and protected weight bearing without symptom resolution. Figures 45d and 45e are the intraoperative arthroscopy images after minimal probing. What is the most appropriate treatment?

Which of the following best describes the course of the ulnar nerve in the midforearm?

A 25-year-old man has an isolated flexor digitorum profundus laceration just proximal to the distal interphalangeal (DIP) flexion crease of his ring finger. The tendon ends are trimmed, removing 10 mm from each end (secondary to fraying) and the tendon repaired. Four months later, he reports limited finger motion of the long, ring, and small fingers. He cannot fully extend his wrist and all joints of the 3 fingers simultaneously. He has full passive flexion but cannot actively completely close his fingers into a fist. What is the most likely cause?

What is the recommended optimal timing of presurgical antibiotic administration to prevent infection in patients undergoing total joint replacement surgery?

The spring ligament of the foot connects what two bones?

A 65-year-old man who underwent cemented right total hip arthroplasty 6 years ago now reports acute pain for the past week. He denies any trauma, recent illnesses, or symptoms other than pain. Plain radiographs show possible loosening of the femoral component. A normal result from which of the following studies will most specifically rule out infection?

During the early swing phase of the normal gait cycle, what lower extremity muscle is primarily contracting?

below show the radiographs obtained from a year old man with progressively worsening right side hip pain over the last 8 months. He is 6 feet tall, with a BMI of 51 kg/m 2 and reports that his index total hip arthroplasty was performed 8 years ago. The preoperative work-up includes negative infectious laboratory results. What is the most appropriate surgical plan for revision of the femoral component in this patient?

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 teenage female is referred to you for evaluation of curvature in her back that was discovered on routine school screening. She is diagnosed with adolescent idiopathic scoliosis. In which of the following scenarios is a bracing program the most appropriate treatment? Review Topic

Surgical arthroscopy performed 1 week after injury presents increased risk for

Figure 15a shows the radiograph of a patient who has a chondrosarcoma of the acetabulum. Bone scans are shown in Figures 15b and 15c. Numerous soft subcutaneous masses are present. A clinical photograph of the hand is shown in Figure 15d. What is the most likely diagnosis?

-Figure is the radiograph of a 55-year-old veteran who developed avascular necrosis after a traumatic hip dislocation. He was treated with hemiarthroplasty 10 years ago and also has posttraumatic stress disorder and chronic pain. He has had multiple spinal surgeries and takes 30 mg of methadone daily. He now has severe groin pain and is unable to ambulate. Laboratory studies showed a C-reactive protein level of 0.2 mg/L (reference range, 0-3 mg/L), erythrocyte sedimentation rate of 50 mm/h (reference range, 0-20 mm/h), hip aspiration of 500/mm3 white blood cell count, 50% polynucleated cells, 30%monocytes, and 20% lymphocytes What is the most likely cause of his hip pain?

A 19-year-old man has had pain and swelling in his left forearm for the past 8 months. Laboratory studies show a mildly elevated WBC count and erythrocyte sedimentation rate. Radiographs are shown in Figures 58a and 58b, a CT scan is shown in Figure 58c, and T 1 - and T 2 -weighted MRI scans are shown in Figures 58d and 58e, respectively. A biopsy specimen is shown in Figure 58f. Immunohistochemistry demonstrates that the lesion is negative for leukocyte common antigen (CD34). What is the most common cytogenetic translocation associated with this lesion?

What type of muscle contraction occurs while the muscle is lengthening?

When obtaining grafts from a trochlear donor site during an osteochondral autograft transplantation procedure, where on the trochlea are the lowest contact pressures found? Review Topic

What type of thoracolumbar spinal injury is associated with an increased risk of neurologic deterioration following admission to the hospital?

Figure 34 shows the standing AP radiograph of a 2-year-old girl who has a left bowleg deformity. Her mother states that she first noticed the problem when the child began walking at age 10 months, and the deformity has worsened over the past 6 months. Examination reveals a definite lateral thrust of the knee during the stance phase of gait. Management should consist of

You are interested in learning a new technique for minimally invasive total knee arthroplasty. The Keyhole Genuflex system seems appealing to you because the instrumentation comes with wireless controls. Which of the following represents an acceptable arrangement?

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?

A 4-month-old infant is unable to flex her elbow as a result of an obstetrical brachial plexus palsy. This most likely illustrates a predominate injury to what structure?

A 47-year-old male with a history of a Putti-Platt procedure 20 years ago presents with right shoulder pain with decreased range-of-motion. Radiograph is shown in Figure A. What is the most accurate diagnosis? Review Topic

A 17-year-old boy who fell on a pitchfork in a barn 1 day ago now has a painful, swollen forearm. Examination reveals erythema, exquisite tenderness, and crepitus to palpation of the forearm. He has a pulse rate of 110/min and a blood pressure of 80/60 mm Hg. Radiographs show subcutaneous air and no fractures. Gram stain of wound drainage reveals a gram-positive bacillus. The next most appropriate step in management should consist of

What is the most common neurologic complication following an anterior cervical diskectomy and fusion?

An otherwise healthy 45-year-old man has a 3-cm subcutaneous mass on his anterior thigh that is presumed to be a lipoma. Removal of the mass is performed in the office of his primary care physician. Pathologic evaluation shows a high-grade malignant fibrous histiocytoma. Staging reveals no evidence of metastatic disease. Management at this time should consist of

Use of long-term (at least 5 years) bisphosphonate medications for osteoporosis is associated with

With respect to femoral component design, stress relief osteopenia in the proximal femur following noncemented total hip arthroplasty appears to be most strongly influenced by the

Figure 1 is the radiograph of a 21-year-old college lacrosse player who has a 2-year history of progressive left groin pain that is exacerbated by activity. Pain is preventing him from participating with his team. Examination reveals a fit man without tenderness to palpation around the hip. No clicking or popping occurs with hip range of motion. Strength of all muscles about the hip is normal, but there is some mild pain with resisted hip flexion and hip adduction. While lying supine, progressive hip flexion with internal rotation and adduction reproduces his groin pain. The patient participates in physical therapy for 8 weeks with his team's trainer but notes little improvement. What is the most appropriate next diagnostic step to determine the cause of his pain?

A 68-year-old man presents with severe right shoulder pain. He had a prolonged course of physical therapy and received several cortisone injections for his pain without improvement. Examination reveals pseudoparalysis of the right shoulder with a 20-degree external rotation lag with the shoulder adducted. With the shoulder placed in 90 degrees of abduction, he can actively externally rotate his shoulder. The patient was treated with a medialized reverse prosthesis shown in Figure A. Which of the following statement is true regarding this treatment option? Review Topic

A 24-year-old woman has a spleen laceration and hypotension. Radiographs reveal a pulmonary contusion and a displaced mid-diaphyseal fracture of the femur. The trauma surgeon clears her for stabilization of the femoral fracture. What technique will offer the least potential for initial complications?

An eversion mechanism of injury is associated with which of the following ankle conditions?

Which gene correlates with severity of disease in spinal muscular atrophy (SMA)? Review Topic

The patient in Figure 99 has pain at the first MTP joint.

A 45-year-old coach sustains a complete distal biceps tendon rupture at the elbow. Surgical repair is most indicated to Review Topic

Which of the following factors is most commonly associated with mechanical failure of a cemented total hip arthroplasty?

An 76-year-old woman falls from standing and sustains the injury shown in Figure A. Her most recent T score was -1.9, 3 months prior to presentation. If labwork were performed, which values would be consistent with her bone density score?

Glenohumeral inferior stability in the adducted shoulder position is primarily a function of the

A lower chance of failure when using an extensor mechanism allograft to address a chronic disruption of an extensor tendon is associated with

The most important radiographic predictor of a good clinical outcome following adult spinal deformity surgery is correction of Review Topic

A study is conducted to measure the difference in bone mineral density between postmenopausal women taking a drug treatment versus those taking a placebo. What is the most important result to be reported from this study?

A 27-year-old woman reports the acute atraumatic onset of burning pain in her right shoulder followed a week later by significant weakness and the inability to abduct her shoulder. One week prior to this incident she had recovered from a flu-like syndrome. Examination reveals full passive motion of the shoulder and the inability to actively raise the arm. Sensation in the right upper extremity is normal. Cervical spine examination is normal. Radiographs of the shoulder and cervical spine are normal. What is the most likely diagnosis? Review Topic

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

The so-called high ankle sprain from an external rotation mechanism of injury typically involves injury to which of the following structures?

A 30-year-old man requires surgical stabilization of a hypermobile spondylolisthesis of L5 on S1. History reveals that he has smoked one pack of cigarettes a day for 15 years. During preoperative counseling, the patient should be advised to

Which of the following is an indication for surgical management of a Weber type B distal fibular fracture?

A 55-year-old woman with a long history of low back and left lower extremity pain has failed to respond to exhaustive nonsurgical management. MRI scans show bulging and degeneration at L3-4 and L4-5 as well as a normal disk at L2-3 and L5-S1. She undergoes provocative lumbar diskography at L3-4, L4-5, and L5-S1. Post-diskography axial CT images of L3-4 and L4-5 are shown in Figures 6a and 6b, respectively. The injections at L3-4 and L4-5 produce no pain. The injection at L5-S1 produces 10/10 concordant back pain with radiation to the lower extremity. What is the most appropriate recommendation at this time? Review Topic

below show the radiographs, and the MRIs obtained from a year-old man with worsening left knee pain. A foot hip-to-ankle radiograph shows a degree varus knee deformity. The patient sustained a major left knee injury 5 years ago and a confirmed complete anterior cruciate ligament (ACL) tear. He managed this injury nonsurgically with a functional brace but experienced worsening pain. He was seen by an orthopaedic surgeon 18 months ago, and a medial meniscus tear was diagnosed; the tear was treated with an arthroscopic partial medial meniscectomy. Since then, his knee has been giving way more often, and he no longer feels safe working on a pitched roof. The patient received 6 months of formal physical therapy and was fitted for a new functional ACL brace, but he still has pain and instability. He believes he has exhausted his nonsurgical options and would like to undergo surgery. What is the most appropriate treatment at this time?

Patellofemoral arthroplasty is contraindicated in the presence of

A 77-year-old man has had increasing right knee pain for the past 3 months. A radiograph and coronal T 1 -weighted MRI scan are shown in Figures 19a and 19b. A biopsy specimen is shown in Figure 19c. What is the most likely diagnosis?

A 25-year-old man sustained the closed injury shown in Figures 22a and 22b. Examination reveals that this is an isolated injury, and he is hemodynamically stable. Treatment should consist of

Collagen orientation is parallel to the joint surface in what articular cartilage zone?

• A 20-year-old college football player sustains a forceful hyperextension injury to his shoulder 4 months after undergoing an anterior capsular shift. Examination 2 weeks later reveals anterior tenderness. He is unable to lift the dorsum of his hand away from his back. What is the most likely diagnosis?

Figures 1 through 5 are the MR images of a 12-year-old boy with left lateral-sided knee pain following a football injury. He has a several-year history of recurrent knee pain that improves with rest. An examination reveals a moderate effusion. Range of motion is 0° to 90° and is limited by pain in deep flexion. He has tenderness to palpation along the lateral joint line, and no instability is noted. Treatment should include

A 50-year-old patient underwent multiple débridements for an open radial shaft fracture with bone loss. The bed currently shows no evidence of infection but has a 14-cm diaphyseal bone defect. The most appropriate treatment includes open reduction and internal fixation along with

A 45-year-old male auto mechanic presents to your office with left lateral elbow pain for 6 weeks. On physical exam he has tenderness to palpation over the lateral epicondyle and pain with resisted wrist extension. An MRI is shown in figures A and B. After failing non-surgical treatment modalities, he undergoes arthroscopic surgical management. At 3 months post-operatively, the patient reports persistent left elbow pain and an audible clicking since surgery which occurs when he lifts heavy objects and when he pushes himself up out of a chair. What is the best surgical treatment option? Review Topic

A 56-year-old woman presents with left hip pain and diminishing range of motion. Examination reveals pain with range of motion of the hip. Radiographs reveal multiple calcific lesions within the hip and well-preserved joint space. MRI scan shows thickened synovium nodular loose bodies with decreased signal on T1 and T2. What is the best next step?

A 7-year-old boy with spastic diplegia is a limited community ambulator. He has a moderately severe crouched gait. The parents request a treatment that will result in a permanent decrease in lower extremity muscle tone. This is best accomplished with

Figure 83 is the CT scan of a 36-year-old man who fell from a roof. Eight hours later at the emergency department he describes low-back pain with numbness and weakness in his bilateral lower extremity. A neurologic examination reveals 2/5 strength in his quadriceps and iliopsoas bilaterally, 2/5 strength in his right anterior tibialis and gastrocsoleus, and 1/5 strength in his left anterior tibialis and gastrocsoleus. Two hours later, strength in his lower extremities has diminished markedly. What is the best next step?

When planning pin placement for external fixation of the tibia, what is the maximum extent of the knee capsular reflection from the subchondral joint line?

Treatment of an atrophic nonunion of the radial diaphysis should include which of the following?

A 5-year-old boy has had right hip pain and a limp for the past 3 months. Examination of the right hip reveals irritability and restricted abduction and internal rotation. AP and lateral radiographs of the hips are shown in Figures 31a and 31b. Initial management should consist of

What is the most frequent complication of both lateral closing wedge high tibial osteotomy and medial opening wedge osteotomy?

A 24-year-old baseball pitcher reports pain over the posterior aspect of his shoulder that occurs only during throwing. He notes that the discomfort is greatest during the late cocking and early acceleration phases. Examination reveals localized tenderness with palpation over the external rotators and posterior glenoid. Radiographs are shown in Figures 38a through 38c. What is the most likely diagnosis?

A 24-year-old man who plays golf noted the immediate onset of pain on the ulnar side of his hand and has been unable to swing a club for the past 6 weeks after striking a tree root with his club during his golf swing. Examination reveals full motion of the wrist, diminished grip strength, and tenderness over the hypothenar region. A CT scan of the hand and wrist is shown in Figure 26. Management should consist of

Figures 39a and 39b are the radiographs of a 45-year-old man with diabetes who fell 12 feet from a ladder and sustained an isolated closed injury to his left leg. Examination revealed that he was neurovascularly intact and compartments were soft. A damage control knee spanning external fixator was applied and after 2 weeks in the frame, his blisters have resolved and his skin now wrinkles. What is the most appropriate treatment?

A 13-year-old boy who has a history of a pituitary adenoma has an unstable unilateral slipped capital femoral epiphysis. What is the indication for prophylactic pinning of the contralateral, unslipped side? Review Topic

What is the principal advantage of surgical repair for the lesion shown in Figure 19?

A 41-year-old male underwent intramedullary nailing for a low-energy left femoral shaft fracture. At his follow-up appointment, he complains that his feet are pointing in opposite directions when walking. Using the imaging study shown in Figure A, which of the following represents this patient's left femur malalignment?

1 to 1 micron

Figures 23a through 23h are the radiographs and MR images of a 32-year-old man with worsening left knee pain. A 3-foot hip-to-ankle radiograph shows a 13-degree varus knee deformity. The patient sustained a major left knee injury 5 years ago and a confirmed complete anterior cruciate ligament (ACL) tear. He managed this injury nonsurgically with a functional brace but experienced worsening pain. He was seen by an orthopaedic surgeon 18 months ago and a medial meniscus tear was diagnosed; the tear was treated with an arthroscopic partial medial meniscectomy. Since then, his knee has been giving way more often and he no longer feels safe working on a pitched roof. The patient received 6 months of formal physical therapy and was fitted for a new functional ACL brace, but he still has pain and instability symptoms. He believes he has exhausted his nonsurgical options and would like to undergo surgery. What is the most appropriate treatment at this time?

What is the most common mode of failure following unconstrained total elbow arthroplasty? Review Topic

Which of the following methods best aids in diagnosis of an interdigital neuroma?

A 44-year-old farmer involved in a rollover accident on his tractor sustained an L1 burst fracture with a 20% loss of anterior vertebral body height, 30% canal compromise, and 15 degrees of kyphosis. He remains neurologically intact. The preferred initial course of action should consist of

• Examination of a 32-year old woman who has pain in her shoulder as a result of a head-on motor vehicle accident reveals tenderness directly over the scapula and painful motion of the shoulder. Radiographs show a displaced extra-articular fracture of the scapula. Which of the following studies would best detect commonly associated injuries?

A 7-year-old boy sustains an acute injury to the distal radial metaphysis, along with a completely displaced Salter-Harris type I fracture of the ulnar physis, as shown by the arrows in Figure 12. After satisfactory reduction of both injuries, what is the major concern?

What is the most common complication of halo vest immobilization in adults?

Commotio cordis is best treated with