OITE & ABOS Orthopedic Board Exam MCQs: Sports Medicine, Reconstruction, Trauma - Part 244

What structure is the primary restraint to inferior translation of the shoulder?

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?

-The patient experienced little improvement with activity modification and physical therapy. An intraarticular corticosteroid injection provides excellent but short-lived pain control. She requests surgical treatment for her hip and she is counseled regarding arthroscopy and consent is obtained. Intraoperatively,a capsulolabral separation is observed with an underlying pincer lesion. No articular cartilage injury is seen. What treatment is most appropriate considering these findings?

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A clinical trial is being conducted on a new orthopaedic device that is different from existing devices that are moderately successful, but have frequent complications when used to treat fractures in the elderly. To comply with international standards for clinical trials, the investigator must include in the study design

A 26-year-old female twists her knee while playing soccer and sustains the injury shown in Figure A. She undergoes a reconstructive surgery and is started on an accelerated rehabilitation program. Which of the following is true regarding this type of rehabilitation protocol? Review Topic

belowdepicttheAPandlateralradiographsobtainedfromayear-oldmanwithlong-standing
rightkneeosteoarthritisandpainthatisunresponsivetononsurgicaltreatment.Thepatientundergoes navigatedcruciate-retainingrighttotalkneearthroplasty.Aftersurgery,thispatientcontinuesto experiencepainandswellingofthekneewithrecurrenteffusions.Hereturnstotheofficereporting continuedpain2yearsaftersurgery.Hedescribesinstability,particularlywhendescendingstairs.On examination,rangeofmotionof0°to120°isobserved,withnoextensorlag.Slopeofthetibialcomponent is7°.Thekneeisstabletovarusandvalgusstressinextension,butflexioninstabilityispresentinboth theanterior-posteriordirectionandthevarus-valgusdirection.Bracingleadstoaslightdecreasein symptomsbutisnotwelltolerated.Isokinetictestingdemonstratesdecreasedkneeextensionvelocityat
midpush.Radiographsdemonstratewell-alignedandfixedkneeimplants.Aninfectionwork-upis negative.Whatisthemostappropriatesurgicalinterventionatthistime?

Which of the following is the only nonreversible effect of anabolic steroids?

What is the main function of collagen found within articular cartilage?

Giant cell tumors of bone can occur in many different areas throughout the body. All of the following are common locations for giant cell tumors of bone EXCEPT?

What is the preferred treatment of a symptomatic curly toe deformity in a 6-year-old child?

Which of the following is considered the most common long-term effect on the spine of a professional race horse jockey?

What is the best way to determine whether a radial head implant is too thick intraoperatively?

Figure 1 shows a patient with an open tibia fracture who presents to the emergency department after a propeller injury in brackish water (river water and sea water). What is the most appropriate antibiotic coverage for this patient?

A patient with rheumatoid arthritis has an unstable pseudarthrosis after undergoing C1-2 posterior fusion. No neurologic deficits are noted, and repair with posterior transarticular fixation screws and a posterior wiring technique at C1-2 is planned. Which of the following preoperative studies offers the best visualization?

A 10-year-old soccer player has bilateral heel pain and reports that the pain is worse during and immediately after sports. Examination reveals that the calcaneal tuberosities are painful to palpation bilaterally. What is the most likely diagnosis?

Which of the following is true regarding intimate partner violence (IPV)?

A 70-year-old former baseball catcher reports long-standing pain in the ring and little fingers. A gradient-echo MRI scan is shown in Figure 26. What is the most likely diagnosis?

When reconstructing the anterior cruciate ligament (ACL), what is the most common source of potential autograft failure? Review Topic

Figures 51a and 51b show the radiographs of a 12-year-old boy obtained after an attempted closed reduction of an elbow injury in the emergency department. His motor examination is intact but he reports decreased sensation along the palmar aspect of his ring and little finger. What is the best treatment plan? Review Topic

What is the most common clinically significant preventable complication secondary to the treatment of a displaced talar neck fracture?

A funnel plot is used in meta-analyses to perform which of the following functions:

Which of the following cohorts of patients is at highest risk of a future anterior cruciate ligament (ACL) tear? Review Topic

Figure 41 shows the MRI scan of a 39-year-old man who has severe left groin and anterior thigh pain. What is the most likely diagnosis?

A 75-year-old man sustains an anterior dislocation of his reverse total shoulder arthroplasty. What activity places the arm in the position most commonly associated with reverse total shoulder dislocation?

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What is the primary mechanism of wear of polyethylene acetabular components?

A 17-year-old girl develops chronic posterolateral rotatory instability (PLRI) of the elbow following closed treatment of an elbow dislocation. Advanced imaging reveals incompetence of the lateral collateral ligament complex, and ligament reconstruction is planned. Examination under anesthesia is performed with the forearm in maximal supination and valgus force applied to the elbow, demonstrated in Video 1. As the elbow is brought through a range of motion assessment, the radial head is

74 A

B
year-old with the injury seen in Figures 74a and 74b

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

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? Review Topic

A 72-year-old woman who is right hand-dominant has severe pain in the right shoulder that has failed to respond to nonsurgical management. She reports night pain and significant disability. Examination reveals 30 degrees of active forward elevation. An AP radiograph is shown in Figure 27. Which of the following treatment options will provide the best functional improvement? Review Topic

Following insertion of a cementless femoral component into the total hip arthroplasty construct, the amount of femoral stress shielding is most associated with

Figures below show the radiograph and the MRI scan obtained from a 37-year-old woman with a 2-month history of left hip pain. Which presurgical factor is most commonly associated with a poor outcome after a hip joint salvage procedure?

An acute posterolateral disk herniation at the L4-5 level will most likely affect what nerve root? Review Topic

A patient has right shoulder pain. Figure 1a shows a gadolinium-enhanced transverse MRI scan at the level of the coracoid. Figure 1b shows an arthroscopic view of the anterior structures from a posterior portal. These images reveal which of the following findings?

All of the following indicators of resuscitation may be within normal limits for a trauma patient that is in "compensated" shock EXCEPT:

-Where is the physis with the highest growth rate (in mm per year) located?

A 29-year-old man sustained an injury when he was playing basketball, landing on his left knee while jumping for a rebound. He had vague pain in the anterior aspect of the knee for several weeks. The initial radiographs were negative with the exception of a large traumatic effusion. Examination reveals no apparent ligament instability but a significant extension lag of 30 degrees. There was a palpable defect above the superior pole of the patella. What is the most appropriate management? Review Topic

A 60-year-old man reports increasing pain in his right foot with limited ankle dorsiflexion and anterior ankle pain after sustaining a fracture of the calcaneus in a fall several years ago. Bracing, nonsteroidal anti-inflammatory drugs, and cortisone injections have failed to provide significant relief. Radiographs are shown in Figures 19a and 19b. What is the next most appropriate step in management?

A 37-year-old patient with type I diabetes mellitus has a flexor tenosynovitis of the thumb flexor tendon sheath following a kitchen knife puncture wound to the volar aspect of the thumb. Left unattended, this infection will likely first spread proximally creating an abscess in which of the following spaces of the palm?

Which of the following medications inhibits release of neurotransmitters by binding to presynaptic calcium channels?

Figures 34a through 34c show an axial proton density (spin echo long TR, short TE) image, a sagittal inversion recovery (STIR) image, and a sagittal T1-weighted (short TR, short TE) image of the left thigh. What is the most likely diagnosis?

An 82-year-old woman reports right buttock pain after a car trip. Laboratory studies show an erythrocyte sedimentation rate of 30 mm/h and WBC of 4,600/mm 3 . Figure 34a shows a plain AP radiograph of the pelvis, and Figure 34b shows a delayed technetium Tc 99m bone scan. Management should consist of

Following operative repair of lower extremity long bone and periarticular fractures, what is the time frame for patients to return to normal automobile braking time?

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

Which lower extremity muscle is first weakened in Charcot-Marie-Tooth (CMT) disease?

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?

Figures 14a and 14b show the plain radiographs of an 85-year-old woman who has had severe pain in the right knee for the past 4 months. 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 toddler is brought in by his parents for evaluation of gait problems. Birth history and neurologic examination are unremarkable. After evaluating femoral torsion, tibial torsion, and foot contour, the diagnosis is excessive internal tibial torsion. The parents should be advised to expect which of the following outcomes? Review Topic

A 75-year-old woman who sustained a fall now reports neck pain and upper extremity weakness. Examination reveals 4 of 5 strength in the upper extremities and 5 of 5 strength in the lower extremities. Radiographs show multilevel degenerative disk disease. An MRI scan is shown in Figure 96. Her clinical presentation is most compatible with which of the following? Review Topic

Figure A shows immediate post-operative radiographs of a 75-year-old patient with primary osteoarthritis. She presents 3 years later with increasing pain and weakness in the shoulder despite home physical therapy. Examination reveals limited active range of motion, with forward elevation of 80 degrees and external rotation of 50 degrees. Her deltoid function is intact. Repeat radiographs are seen in Figure B.

Figure 1 is the clinical photograph of a 22-year-old college pitcher who complains of posterior shoulder pain and feelings of shoulder weakness. He denies shoulder trauma. Evaluation should include

A 56-year-old man has upper thoracic pain after undergoing stereotactic radiosurgery for a blastic metastatic lesion in the vertebral body of T5. He has normal alignment without collapse, but the tumor involves the entire vertebral body. Which factor increases this patient's risk for a pathologic fracture?

An otherwise healthy 54-year-old man who underwent a successful multilevel lumbar decompression and fusion 4 years ago now reports increasingly severe bilateral thigh claudication with paresthesia and severe back pain for the past 12 months. Physical therapy, bracing, and epidural steroids have failed to provide relief. A radiograph and MRI scans are shown in Figures 15a through 15c. He is afebrile, and laboratory studies show an erythrocyte sedimentation rate of 5 mm/h and a normal WBC count. What is the best course of action?

Pacinian corpuscles are lamellated nerve endings that are responsible for providing the perception of

A 2-week-old infant has had diminished movement of the right upper extremity since birth. Examination reveals weakness of shoulder abduction and external rotation, elbow flexion, and forearm supination. Both pupils are equally round and responsive to light. The remainder of the examination is normal. Radiographs of the upper limb show a healing middle-third clavicle fracture. Management should consist of

The attachments of the transverse carpal ligament include which of the following structures?

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

A healthy, active collegiate soccer player returns to your office approximately 10 months after returning to full play and 18 months after undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) autograft. The patient reports landing awkwardly after a jumping for a ball and felt his knee give way. He presents with pain, worse with weight bearing. On physical exam, there is a mild effusion and a grade 2B Lachman. Radiographs are shown in Figure A. What is the likely underlying cause of his current diagnosis? Review Topic

A 10-year-old girl has been referred for evaluation of a prominence at the lower cervical spine. The patient is asymptomatic, and the examination reveals no evidence of neurologic abnormality. A radiograph and CT scans are shown in Figures 12a through 12c. What is the most likely diagnosis?

A 16-year-old boy has had left knee pain and swelling after sustaining a minor twisting injury while playing basketball 2 weeks ago. Figures 5a through 5e show the radiograph, MRI scans, and biopsy specimens. What is the most likely diagnosis?

Figure 1 is the T2 coronal MRI scan of a 52-year-old woman with a 6- month history of shoulder pain. She does not recall a history of trauma. Physical therapy is recommended. What is the most significant predictor of failure of nonoperative treatment?

Figure 1 shows the radiograph of a 60-year-old woman who underwent a previous operation for great toe pain 20 years ago. She has had increasing pain over the past 5 years and now reports pain with any motion, swelling, and clicking. She also reports pain under the ball of foot. What is the most appropriate management to alleviate her metatarsalgia and great toe pain?

An 18-year-old female Marine Corps recruit enters basic training. Her enlistment history and physical examination showed that she was an elite high school cross country runner. What is her most significant risk factor for a femoral or pelvic stress fracture during basic training?

A 20-year-old college baseball pitcher reports the insidious onset of medial elbow pain. Examination reveals medial elbow tenderness, a normal neurologic examination, and no obvious valgus laxity. Plain radiographs are normal. MRI scans are shown in Figures 39a and 39b. Management should consist of

A 45-year-old man has a draining sinus and recurrent infection of his right total knee arthroplasty. He has
had two prior revision surgeries after the primary procedure and three other surgeries before his initial replacement,  including  a  proximal  tibial  osteotomy  and  subsequent  hardware  removal.  On  clinical examination, he has a draining sinus in the mid portion of his surgical scar and a range of motion of 5° to
85°. AP and lateral radiographs of the right knee are shown in Figures below. During surgery, the femoral component  is  found  to  be  grossly  loose,  but  the  tibial  component  is  well  fixed.  What  is  the  most appropriate  extensile  approach  that  would  provide  adequate  exposure  and  aid  in  tibial  component extraction?

-The patient asks if something about her anatomy has resulted in this injury. ACL anatomy differs between men and women in what manner?

A 23-year-old baseball pitcher who has diffuse pain along the posterior deltoid reports pain during late acceleration and follow-through. Examination of his arc of motion from external rotation to internal rotation at 90 degrees of shoulder abduction reveals a significant deficit in internal rotation when compared to the nonthrowing shoulder. Initial management should consist of

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

Following a radial nerve neurapraxia at or above the elbow, return of muscle function can be expected to start at the brachioradialis and return along which of the following progressions?

What is the most common malignant tumor of the foot?

Figure 8 shows the CT scan of an 11-year-old boy who has had a 1-year history of worsening painful flatfeet. He reports pain associated with physical education at school, especially with running and jumping. Management consisting of activity restriction, anti-inflammatory drugs, and casting has failed to provide relief. Treatment should now consist of

An osteoconductive bone graft material has which of the following properties?

A 17-year-old football player is injured during a play and reports abdominal pain that is soon followed by nausea and vomiting. What organ has most likely been injured?

Which of the following substances makes up the majority by weight of the extracellular matrix for articular cartilage?

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

A 21-year-old man has mild but persistent aching pain in his left proximal thigh during impact loading activities. He denies pain at rest and has no other symptoms. Figures 34a through 34e show the radiographs and T1-weighted, T2-weighted, and gadolinium MRI scans of the left hip. What is the most likely diagnosis?

A coach of three football teams—the B team, junior varsity team, and varsity team—wants to study the
average times in the 40-yard dash for his players. Which test would help him determine if the mean 40-yard dash times for the athletes on one team are different from those on the other teams?

Which of the following radiographic parameters is most predictive of a poor result following multilevel fusion surgery for adult degenerative scoliosis? Review Topic

A complication associated with using the Morrey approach (triceps reflecting) to implant a semiconstrained total elbow arthroplasty is

Figures 21a and 21b show the radiographs of a 22-year-old man who was shot through the abdomen the previous evening. An exploratory laparotomy performed at the time of admission revealed a colon injury. Current examination reveals no neurologic deficits. Management for the spinal injury should include

The blood supply to the anterior cruciate ligament is primarily derived from what artery?

Figure 4 shows the AP radiograph of a 28-year-old woman who has had moderate pain in the left hip for the past year. Nonsurgical management has failed to provide relief. She denies any history of hip pain, pathology, or trauma. Management should consist of

When performing the exposure for an anterior approach to the cervical spine, excessive retraction of the trachea and esophagus should be avoided to prevent injury of the

Figures 21a and 21b show the radiographs of a 12-year-old patient with an L4-level myelomeningocele who has scoliosis that has been slowly progressing for the past several years. There has been no loss of motor function. An MRI scan shows no syringomyelia or increased hydrocephalus. Management should consist of

Figures 1 and 2 are the radiographs of a 20-year-old college multisport athlete who has had longstanding pain in his left hip. He denies any specific event that initiated his pain, but he notes that he had hip problems when he was an infant. He denies pain with activities of daily living, but he believes his pain is increasingly limiting his ability to exercise. He localizes the pain to his groin. He denies low-back or buttock pain or pain that radiates down his leg. Images from an MRI scan of this patient's left hip are shown in Figures 3 through 5. What is the most likely cause of his acute pain?

The major benefit of irrigation with a castile soap solution over irrigation with bacitracin solution for the treatment of the open fracture shown in Figure 42 can be seen in which of the following outcomes?

What is the effect on knee kinematics following placement of an anterior cruciate ligament (ACL) graft at the 12 o’clock position? Review Topic

Which of the following benign bone lesions can develop lung metastases?

A 16-year-old boy falls while playing soccer. He reports that his knee buckled when he planted his leg to kick a ball. He noticed an obvious deformity of his knee, which spontaneously resolved with a “clunk.” He could not finish the game but was able to bear weight with a limp. He has had two similar episodes but has never sought medical attention. An initial examination demonstrated an effusion, tenderness at the proximal medial collateral region and medial patellofemoral retinaculum, decreased range of motion, and patella apprehension. A lateral patellar glide performed at 30° of flexion was 3+. He was otherwise ligamentously stable, and there were no other noteworthy findings.Figures 3 and 4 are this patient's proton density fat-saturated MR images. His tibial tubercle-trochlear groove (TT-TG) distance is 12 mm, and he has normal limb-alignment film findings. Treatment at this stage should include

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 45-year-old man sustained the injury seen in Figure 130a 6 weeks ago. He denies any prior injury to his shoulder. After treatment of the injury in the emergency department, he was noted to have significant weakness with empty can testing and external rotation at the side. He has full passive range of motion with forward flexion, abduction, and internal and external rotation, but has difficulty initiating abduction with his arm at his side. He has negative apprehension and relocation signs. A detailed neurologic examination shows no deficits. A coronal image from a follow-up MRI scan is seen in Figure 130b. Follow-up radiographs reveal no fractures. What is the most appropriate next step in his treatment? Review Topic

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 experiences little improvement with activity modification and more physical therapy. An intra-articular corticosteroid injection provides excellent relief, but relief only lasts for 1 month. The player requests further treatment for his hip and is counseled regarding surgical intervention. Hip arthroscopy is performed. Intraoperatively, a capsulolabral separation is observed with an underlying pincer lesion. No articular cartilage injury is seen. Which treatment is most appropriate considering these findings?

The newborn foot deformity seen in Figures 64a and 64b should initially treated with

Which of the following patients is considered the most appropriate candidate for an isolated split posterior tendon transfer?

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Gamma ray irradiation for sterilization of ultra-high molecular weight polyethylene in an oxygen environment can have what effect on the material?

Serum parathyroid hormone level
The plain radiograph of the shoulder shows lytic lesions in the scapular spine, distal clavicle, and the proximal third of the clavicle. There is an elliptical erosion in the proximal clavicle. These three lesions suggest a diagnosis of metastatic bone disease or multiple myeloma. The biopsy specimen shows plasma cells. The plasma cells have these characteristic features:
Eccentrically placed nucleus
Peripheral clumping of the nuclear chromatin A perinuclear halo
The diagnosis is multiple myeloma. Staging is important and is performed with a skeletal survey, bone marrow biopsy, hemoglobin level, and chemistry studies including kidney function and serum calcium determination.
Serum protein electrophoresis is performed to assess the amount of abnormal gammaglobulin in the serum. There are three major criteria in the diagnosis of multiple myeloma:

An 8-year-old boy with moderate factor VIII hemophilia played kickball earlier in the day and now reports progressively severe groin pain and is unable to walk. Examination reveals marked paresthesias over the medial aspect of the distal tibia. What is the most likely diagnosis?

When considering a flexor digitorum longus tendon transfer as part of the surgical treatment in patients with symptomatic flatfoot deformity caused by posterior tibial tendon insufficiency, which of the following patients is the most appropriate candidate?

The patient is given a blood transfusion. After starting the transfusion, nurses note that her temperature is 38.8°C and she has shaking and chills. What is the most likely cause of this problem?