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Orthopedics Online MCQs
A 55-year-old woman reports a spontaneous onset of severe pain in her ribs. AP
2. and lateral chest radiographs show severe osteopenia, two rib fractures, and
3. three vertebral compression fractures. Laboratory studies show a hemoglobin
4. level of 9.0 g/dL and a monoclonal spike on serum protein electrophoresis.
5. Which of the following imaging studies would be most helpful in establishing
6. the diagnosis?
7. 1- Skeletal survey
8. 2- Technetium bone scan
9. 3- Bone density determination
10. 4- MRI scan of the thoracic spine
11. 5- CT scan of the chest and abdomen
2. and lateral chest radiographs show severe osteopenia, two rib fractures, and
3. three vertebral compression fractures. Laboratory studies show a hemoglobin
4. level of 9.0 g/dL and a monoclonal spike on serum protein electrophoresis.
5. Which of the following imaging studies would be most helpful in establishing
6. the diagnosis?
7. 1- Skeletal survey
8. 2- Technetium bone scan
9. 3- Bone density determination
10. 4- MRI scan of the thoracic spine
11. 5- CT scan of the chest and abdomen
Figure 1 shows a current AP radiograph of the elbow of a 12-year-old high
2. school pitcher who has pain and restricted motion, especially in extension.
3. Physical therapy has failed to relieve the symptoms. Treatment should now
4. include
5. 1- continued physiotherapy.
6. 2- manipulation under anesthesia.
7. 3- debridement with osteochondral allograft replacement of the defect.
8. 4- arthroscopy and possible open debridement.
9. 5- arthroscopy, bone graft, and arthroscopic fixation of the fragment.
2. school pitcher who has pain and restricted motion, especially in extension.
3. Physical therapy has failed to relieve the symptoms. Treatment should now
4. include
5. 1- continued physiotherapy.
6. 2- manipulation under anesthesia.
7. 3- debridement with osteochondral allograft replacement of the defect.
8. 4- arthroscopy and possible open debridement.
9. 5- arthroscopy, bone graft, and arthroscopic fixation of the fragment.
What is the most common metastatic carcinoma to the hand?
2. 1- Lung
3. 2- Renal
4. 3- Breast
5. 4- Thyroid
6. 5- Prostate
2. 1- Lung
3. 2- Renal
4. 3- Breast
5. 4- Thyroid
6. 5- Prostate
An otherwise healthy 45-year-old man has an intraosseous low-grade
2. chondrosarcoma of the distal femur with no dedifferentiation or metastatic
3. disease. Treatment should consist of
4. 1- surgical resection only.
5. 2- radiation therapy only.
6. 3- radiation therapy and surgical resection.
7. 4- chemotherapy only.
8. 5- chemotherapy and surgical resection.
2. chondrosarcoma of the distal femur with no dedifferentiation or metastatic
3. disease. Treatment should consist of
4. 1- surgical resection only.
5. 2- radiation therapy only.
6. 3- radiation therapy and surgical resection.
7. 4- chemotherapy only.
8. 5- chemotherapy and surgical resection.
The postulated mode of action of capsaicin (pepper) cream in producing
2. analgesia can be best described as
3. 1- demyelination of nociceptive afferents.
4. 2- neuropeptide depletion in unmyelinated C fibers.
5. 3- lowered threshold of larger diameter A-beta fibers.
6. 4- selective membrane stabilization of A-delta fibers.
7. 5- increased lateral inhibition in second order neurons.
2. analgesia can be best described as
3. 1- demyelination of nociceptive afferents.
4. 2- neuropeptide depletion in unmyelinated C fibers.
5. 3- lowered threshold of larger diameter A-beta fibers.
6. 4- selective membrane stabilization of A-delta fibers.
7. 5- increased lateral inhibition in second order neurons.
Polymerase chain reaction is a technique for
2. 1- sequencing DNA aminobuds.
3. 2- measuring RNA levels in cells.
4. 3- amplifying specific DNA sequences.
5. 4- identifying specific DNA sequences.
6. 5- determining the ploidy of a tumor.
2. 1- sequencing DNA aminobuds.
3. 2- measuring RNA levels in cells.
4. 3- amplifying specific DNA sequences.
5. 4- identifying specific DNA sequences.
6. 5- determining the ploidy of a tumor.
Figure 2 shows the lateral radiograph of the left hindfoot and ankle of a patient
2. who fell 10 feet and landed on his left foot. The most predictable advantage of
3. open reduction and internal fixation compared with closed management without
4. reduction is
5. 1- an earlier return to function.
6. 2- decreased subtalar arthrosis.
7. 3- increased ankle dorsiflexion.
8. 4- increased subtalar range of motion.
9. 5- restoration of height and width of the heel.
2. who fell 10 feet and landed on his left foot. The most predictable advantage of
3. open reduction and internal fixation compared with closed management without
4. reduction is
5. 1- an earlier return to function.
6. 2- decreased subtalar arthrosis.
7. 3- increased ankle dorsiflexion.
8. 4- increased subtalar range of motion.
9. 5- restoration of height and width of the heel.
In a fatigue test, the maximum stress under which the material will not fail,
2. regardless of how many loading cycles are applied, is defined as the
3. 1- yield stress.
4. 2- failure stress.
5. 3- critical stress.
6. 4- elastic limit.
7. 5- endurance limit.
2. regardless of how many loading cycles are applied, is defined as the
3. 1- yield stress.
4. 2- failure stress.
5. 3- critical stress.
6. 4- elastic limit.
7. 5- endurance limit.
A 65-year-old man has aseptic loosening of a cemented acetabular component
2. with a well-fixed femoral component. The medial wall and acetabular rim are
3. intact. Treatment for acetabular revision should include
4. 1- an oversized bipolar component.
5. 2- a cemented metal-backed acetabular component.
6. 3- a cemented all-polyethylene acetabular component.
7. 4- a cementless acetabular component with screw fixation.
8. 5- a protrusio ring with a cemented all-polyethylene component.
2. with a well-fixed femoral component. The medial wall and acetabular rim are
3. intact. Treatment for acetabular revision should include
4. 1- an oversized bipolar component.
5. 2- a cemented metal-backed acetabular component.
6. 3- a cemented all-polyethylene acetabular component.
7. 4- a cementless acetabular component with screw fixation.
8. 5- a protrusio ring with a cemented all-polyethylene component.
What is the most appropriate biomechanical fixation method/device for a
2. reverse oblique intertrochanteric fracture?
3. 1- Ender pins
4. 2- Sliding hip screw
5. 3- 95-degree fixed angle device
6. 4- Cerclage wire with interfragmentary fixation
7. 5- Medial displacement osteotomy with sliding hip screw
2. reverse oblique intertrochanteric fracture?
3. 1- Ender pins
4. 2- Sliding hip screw
5. 3- 95-degree fixed angle device
6. 4- Cerclage wire with interfragmentary fixation
7. 5- Medial displacement osteotomy with sliding hip screw
A patient has a fractured acetabulum associated with injury to the sciatic nerve
2. that results in loss of function in the peroneal nerve distribution. Three days
3. later, open reduction and internal fixation of the fracture is performed without
4. incident. Postoperatively, the patient's neurologic status is unchanged;
5. however, the treating physician notices that there is inadequate documentation
6. in the medical record regarding the patient's preoperative neurologic deficit.
7. Concerned that the traumatic nerve injury could be erroneously attributed to
8. the surgical procedure, the physician decides to immediately add further
9. documentation to the medical record. The proper procedure for making this
10. correction is to
11. 1- completely erase the original note and make the necessary corrections.
12. 2- make a note providing clarification in the margin next to the original
13. entry.
14. 3- remove the original entry sheet from the chart and replace it with the
15. corrected information.
16. 4- make no changes to the chart until notification of a professional liability
17. claim is received.
18. 5- place the correct information after the most recent chart entry, explain the
19. change, and date and initial it.
2. that results in loss of function in the peroneal nerve distribution. Three days
3. later, open reduction and internal fixation of the fracture is performed without
4. incident. Postoperatively, the patient's neurologic status is unchanged;
5. however, the treating physician notices that there is inadequate documentation
6. in the medical record regarding the patient's preoperative neurologic deficit.
7. Concerned that the traumatic nerve injury could be erroneously attributed to
8. the surgical procedure, the physician decides to immediately add further
9. documentation to the medical record. The proper procedure for making this
10. correction is to
11. 1- completely erase the original note and make the necessary corrections.
12. 2- make a note providing clarification in the margin next to the original
13. entry.
14. 3- remove the original entry sheet from the chart and replace it with the
15. corrected information.
16. 4- make no changes to the chart until notification of a professional liability
17. claim is received.
18. 5- place the correct information after the most recent chart entry, explain the
19. change, and date and initial it.
In a cemented total hip arthroplasty, use of a cobalt-chromium alloy for the
2. femoral stem is preferred over a titanium alloy because the cobalt-chromium
3. alloy
4. 1- is more flexible.
5. 2- requires less bone preparation.
6. 3- bonds to cement better than titanium.
7. 4- is easier to machine and manufacture.
8. 5- generates less particulate metal debris.
2. femoral stem is preferred over a titanium alloy because the cobalt-chromium
3. alloy
4. 1- is more flexible.
5. 2- requires less bone preparation.
6. 3- bonds to cement better than titanium.
7. 4- is easier to machine and manufacture.
8. 5- generates less particulate metal debris.
What type of prosthesis produces the most predictable results in patients who
2. have had a prior patellectomy?
3. 1- Fixed-hinged
4. 2- Rotating hinge
5. 3- Unicompartmental
6. 4- Cruciate retaining
7. 5- Posteriorly constrained
2. have had a prior patellectomy?
3. 1- Fixed-hinged
4. 2- Rotating hinge
5. 3- Unicompartmental
6. 4- Cruciate retaining
7. 5- Posteriorly constrained
Figure 3 shows the MRI scan of a patient with known metastatic breast
2. carcinoma who has low back pain and bilateral leg pain. The arrow is pointing
3. to
4. 1- epidural fat.
5. 2- an epidural tumor.
6. 3- a herniated disk.
7. 4- a ligamentum flavum.
8. 5- a lateral facet capsule.
2. carcinoma who has low back pain and bilateral leg pain. The arrow is pointing
3. to
4. 1- epidural fat.
5. 2- an epidural tumor.
6. 3- a herniated disk.
7. 4- a ligamentum flavum.
8. 5- a lateral facet capsule.
Posterolateral rotatory elbow instability is caused by a deficiency of which of
2. the following ligaments?
3. 1- Annular
4. 2- Ulnar part of the lateral collateral
5. 3- Anterior band of the medial collateral
6. 4- Posterior band of the medial collateral
7. 5- Transverse band of the medial collateral
2. the following ligaments?
3. 1- Annular
4. 2- Ulnar part of the lateral collateral
5. 3- Anterior band of the medial collateral
6. 4- Posterior band of the medial collateral
7. 5- Transverse band of the medial collateral
Figure 4a shows a pigmented lesion on
2. the right side of the neck of a 41-year-old
3. man. The patient's history reveals that he
4. had multiple bone lesions during
5. childhood and juvenile-onset diabetes
6. mellitus. Figures 4b and 4c show
7. radiographs of his knee and leg. What is
8. the most likely
9. diagnosis?
10. 1- 2-Ollier's disease
11. 2- Neurofibromatosis
12. 3- McCune-Albright
13. syndrome
14. 4- Multiple hereditary
15. exostoses
16. 5- Multiple nonossifying
17. fibromas
2. the right side of the neck of a 41-year-old
3. man. The patient's history reveals that he
4. had multiple bone lesions during
5. childhood and juvenile-onset diabetes
6. mellitus. Figures 4b and 4c show
7. radiographs of his knee and leg. What is
8. the most likely
9. diagnosis?
10. 1- 2-Ollier's disease
11. 2- Neurofibromatosis
12. 3- McCune-Albright
13. syndrome
14. 4- Multiple hereditary
15. exostoses
16. 5- Multiple nonossifying
17. fibromas
Figure 5a shows the radiograph
2. of a 22-year-old man 3 years
3. after undergoing reduction and
4. fixation for a fracture of the
5. radius and ulna with two plates
6. secured with 4.5 mm screws. A
7. postoperative radiograph after
8. plate removal is shown in
9. Figure 5b. Which of the
10. following factors increases the
11. risk of refracture?
12. 1- Young age
13. 2- Incomplete healing
14. 3- Use of a large plate
15. 4- Bony overgrowth around the plate
16. 5- Insufficient amount of time between
17. fracture and plate removal
2. of a 22-year-old man 3 years
3. after undergoing reduction and
4. fixation for a fracture of the
5. radius and ulna with two plates
6. secured with 4.5 mm screws. A
7. postoperative radiograph after
8. plate removal is shown in
9. Figure 5b. Which of the
10. following factors increases the
11. risk of refracture?
12. 1- Young age
13. 2- Incomplete healing
14. 3- Use of a large plate
15. 4- Bony overgrowth around the plate
16. 5- Insufficient amount of time between
17. fracture and plate removal
The most commonly used parameter to estimate trunk muscle contractive force
2. potential is the
3. 1- length of the muscle.
4. 2- moment arm of the muscle.
5. 3- total volume of the muscle.
6. 4- physiologic cross-sectional area.
7. 5- distribution of slow and fast twitching fibers.
2. potential is the
3. 1- length of the muscle.
4. 2- moment arm of the muscle.
5. 3- total volume of the muscle.
6. 4- physiologic cross-sectional area.
7. 5- distribution of slow and fast twitching fibers.
What is an effective way to control knee hyperextension in midstance in an
2. ambulatory patient with spastic diplegia?
3. 1- Perform daily quadriceps stretching.
4. 2- Lengthen the hamstrings at the pelvis origin.
5. 3- Use an ankle-foot orthosis to control the ground reaction force.
6. 4- Perform selective rhizotomy involving lumbar levels 2, 3, and 4.
7. 5- Transfer the vastus medialis obliquus to the hamstring laterally.
2. ambulatory patient with spastic diplegia?
3. 1- Perform daily quadriceps stretching.
4. 2- Lengthen the hamstrings at the pelvis origin.
5. 3- Use an ankle-foot orthosis to control the ground reaction force.
6. 4- Perform selective rhizotomy involving lumbar levels 2, 3, and 4.
7. 5- Transfer the vastus medialis obliquus to the hamstring laterally.
A 42-year-old health care professional has had knee pain for the past 2 months.
2. An MRI scan of the knee reveals a large effusion with loculations and synovial
3. thickening, and results of an open biopsy and culture are consistent with
4. tuberculosis. Sensitivity tests show no resistance to antibiotics. Following
5. debridement and synovectomy, appropriate antibiotic therapy should include
6. 1- rifampin and pyridoxine. rifampin and
7. 2- ethambutol hydrochloride.
8. 3- isoniazid.
9. 4- isoniazid and pyridoxine.
10. 5- isoniazid, rifampin, pyrazinamide, and pyridoxine.
2. An MRI scan of the knee reveals a large effusion with loculations and synovial
3. thickening, and results of an open biopsy and culture are consistent with
4. tuberculosis. Sensitivity tests show no resistance to antibiotics. Following
5. debridement and synovectomy, appropriate antibiotic therapy should include
6. 1- rifampin and pyridoxine. rifampin and
7. 2- ethambutol hydrochloride.
8. 3- isoniazid.
9. 4- isoniazid and pyridoxine.
10. 5- isoniazid, rifampin, pyrazinamide, and pyridoxine.
A college football player twists his knee when he attempts to tackle an
2. oncoming player. Examination reveals no medial lateral laxity or jointline
3. tenderness. The anterior and posterior drawer tests and pivot shift results are
4. negative; however, the Lachman test result is positive. What is the most likely
5. diagnosis?
6. 1- Minor knee sprain
7. 2- Medial collateral ligament injury
8. 3- Lateral collateral ligament injury
9. 4- Anterior cruciate ligament injury
10. 5- Posterior cruciate ligament injury
2. oncoming player. Examination reveals no medial lateral laxity or jointline
3. tenderness. The anterior and posterior drawer tests and pivot shift results are
4. negative; however, the Lachman test result is positive. What is the most likely
5. diagnosis?
6. 1- Minor knee sprain
7. 2- Medial collateral ligament injury
8. 3- Lateral collateral ligament injury
9. 4- Anterior cruciate ligament injury
10. 5- Posterior cruciate ligament injury
A college basketball player has had foot pain for the past 3 months that is
2. worse at the conclusion of a game or practice. Radiographs show an incomplete
3. fracture of the fifth metatarsal at the proximal metaphyseal-diaphyseal junction.
4. Treatment should consist of
5. 1- external bone stimulation and immobilization in a short leg cast.
6. 2- immobilization in a short leg cast with no weightbearing for 6 weeks.
7. 3- open reduction and internal fixation and an immediate bone graft.
8. 4- open reduction and internal fixation with an A-O compression plate.
9. 5- open reduction and internal fixation with an intramedullary cancellous
10. screw.
2. worse at the conclusion of a game or practice. Radiographs show an incomplete
3. fracture of the fifth metatarsal at the proximal metaphyseal-diaphyseal junction.
4. Treatment should consist of
5. 1- external bone stimulation and immobilization in a short leg cast.
6. 2- immobilization in a short leg cast with no weightbearing for 6 weeks.
7. 3- open reduction and internal fixation and an immediate bone graft.
8. 4- open reduction and internal fixation with an A-O compression plate.
9. 5- open reduction and internal fixation with an intramedullary cancellous
10. screw.
A 10-year-old boy has had intermittent pain in his right groin and proximal
2. thigh for the past 6 months. Figures 6a and 6b show plain radiographs of the hip.
3. Figure 6c shows an axial proton density MRI scan through the lesion, and
4. Figure 6d shows representative tissue biopsy specimens at low power. What is
5. the most likely diagnosis?
6. 1- Chondroblastoma
7. 2- Ewing's sarcoma
8. 3- Giant cell tumor
9. 4- Simple bone cyst
10. 5- Aneurysmal bone cyst
2. thigh for the past 6 months. Figures 6a and 6b show plain radiographs of the hip.
3. Figure 6c shows an axial proton density MRI scan through the lesion, and
4. Figure 6d shows representative tissue biopsy specimens at low power. What is
5. the most likely diagnosis?
6. 1- Chondroblastoma
7. 2- Ewing's sarcoma
8. 3- Giant cell tumor
9. 4- Simple bone cyst
10. 5- Aneurysmal bone cyst
After reduction and internal fixation of the fibula fracture, the posterior
2. fragment of a trimalleolar fracture should be reduced and fixed if it involves
3. more than 25% of the plafond and is
4. 1- comminuted.
5. 2- more than 3 cm in proximal to distal length.
6. 3- displaced in any plane.
7. 4- displaced more than 2 mm.
8. 5- associated with a tear of the deltoid ligament.
2. fragment of a trimalleolar fracture should be reduced and fixed if it involves
3. more than 25% of the plafond and is
4. 1- comminuted.
5. 2- more than 3 cm in proximal to distal length.
6. 3- displaced in any plane.
7. 4- displaced more than 2 mm.
8. 5- associated with a tear of the deltoid ligament.
A 28-year-old man has had symptoms of lateral epicondylitis for 3 weeks.
2. Initial management should include
3. 1- corticosteroid injection.
4. 2- isometric strengthening exercises.
5. 3- surgical release of the extensor carpi radialis brevis origin.
6. 4- nonsteroidal anti-inflammatory medication and a short arm cast.
7. 5- nonsteroidal anti-inflammatory medication, ice, and activity modification.
2. Initial management should include
3. 1- corticosteroid injection.
4. 2- isometric strengthening exercises.
5. 3- surgical release of the extensor carpi radialis brevis origin.
6. 4- nonsteroidal anti-inflammatory medication and a short arm cast.
7. 5- nonsteroidal anti-inflammatory medication, ice, and activity modification.
A 40-year-old woman sustains multiple fractures as a result of being pushed
2. down the stairs at home. Which of the patient's family members is most likely
3. to be responsible for the injury?
4. 1- Mother
5. 2- Father
6. 3- Spouse
7. 4- 15-year-old son
8. 5- 15-year-old daughter
2. down the stairs at home. Which of the patient's family members is most likely
3. to be responsible for the injury?
4. 1- Mother
5. 2- Father
6. 3- Spouse
7. 4- 15-year-old son
8. 5- 15-year-old daughter
Viscoelastic behavior of a musculoskeletal structure is a function of what aspect
2. of the material?
3. 1- Toughness
4. 2- Endurance limit
5. 3- Internal friction
6. 4- Tensile strength
7. 5- Modulus of elasticity
2. of the material?
3. 1- Toughness
4. 2- Endurance limit
5. 3- Internal friction
6. 4- Tensile strength
7. 5- Modulus of elasticity
Figures 7a and 7b show the wound and radiograph
2. of a 44-year-old man who underwent plating for a
3. closed fracture of his tibia 7 months ago. The
4. wound has been draining for 4 months, and cultures
5. are positive for Staphylococcus aureus. In addition
6. to antibiotics, metal removal, and debridement,
7. treatment should include
8. 1- electrical stimulation and casting.
9. 2- soft-tissue coverage and replating with a bone graft.
10. 3- bone grafting, soft-tissue coverage, and application
11. of a cast.
12. 4- external fixation, staged soft-tissue coverage, and
13. bone grafting.
14. 5- intramedullary rodding, staged soft-tissue coverage,
15. and bone grafting.
2. of a 44-year-old man who underwent plating for a
3. closed fracture of his tibia 7 months ago. The
4. wound has been draining for 4 months, and cultures
5. are positive for Staphylococcus aureus. In addition
6. to antibiotics, metal removal, and debridement,
7. treatment should include
8. 1- electrical stimulation and casting.
9. 2- soft-tissue coverage and replating with a bone graft.
10. 3- bone grafting, soft-tissue coverage, and application
11. of a cast.
12. 4- external fixation, staged soft-tissue coverage, and
13. bone grafting.
14. 5- intramedullary rodding, staged soft-tissue coverage,
15. and bone grafting.
An 11-year-old girl has had intermittent pain in her left hip after activity and an
2. occasional limp after falling off her bicycle 3 weeks ago. The radiograph shown
3. in Figure 8 was obtained 2 weeks after the injury. The patient reports pain in the
4. hip region that is worse with activity; however, she cannot identify where the
5. pain is localized. She has no fever or night pain. Examination shows normal
6. range of motion and no limp, although she has some pain in the left groin and
7. buttock with internal rotation of the left hip. There is no tenderness about the
8. hip, and the knee examination is normal. Which of the following diagnostic
9. studies should be
10. obtained next?
11. 1- CT scan of both hips
12. 2- MRI scan of both hips
13. 3- Bone scan of both hips
14. 4- Frog lateral view of both hips
15. 5- CBC and erythrocyte
16. sedimentation rate
2. occasional limp after falling off her bicycle 3 weeks ago. The radiograph shown
3. in Figure 8 was obtained 2 weeks after the injury. The patient reports pain in the
4. hip region that is worse with activity; however, she cannot identify where the
5. pain is localized. She has no fever or night pain. Examination shows normal
6. range of motion and no limp, although she has some pain in the left groin and
7. buttock with internal rotation of the left hip. There is no tenderness about the
8. hip, and the knee examination is normal. Which of the following diagnostic
9. studies should be
10. obtained next?
11. 1- CT scan of both hips
12. 2- MRI scan of both hips
13. 3- Bone scan of both hips
14. 4- Frog lateral view of both hips
15. 5- CBC and erythrocyte
16. sedimentation rate
What structure is shown at the tip of the arrow in Figure 9?
2. 1- L5, S1 disk
3. 2- L4 pedicle
4. 3- L4 nerve root
5. 4- L5 nerve root
6. 5- L5 segmental vertebral artery
2. 1- L5, S1 disk
3. 2- L4 pedicle
4. 3- L4 nerve root
5. 4- L5 nerve root
6. 5- L5 segmental vertebral artery
What is a unique physiologic characteristic of immature articular cartilage?
2. 1- Type II collagen production
3. 2- Glycosaminoglycan synthesis
4. 3- Link protein message expression
5. 4- Nutrition from the synovial cavity
6. 5- Existence of a stem cell population
2. 1- Type II collagen production
3. 2- Glycosaminoglycan synthesis
4. 3- Link protein message expression
5. 4- Nutrition from the synovial cavity
6. 5- Existence of a stem cell population
Figures l0a and 10b show radiographs of a
2. 27-year-old woman who sustained an
3. injury to her left, nondominant forearm as
4. a result of a motor vehicle accident. Under
5. anesthesia, it is noted that the distal
6. radioulnar joint is unstable but reducible in
7. supination. Treatment should include
8. 1- closed reduction, followed by splint
9. immobilization with the limb in supination.
10. 2- closed reduction and external fixation of the
11. radius, followed by splint immobilization with
12. the limb in supination.
13. 3- open reduction and external fixation of the
14. radius, with fixation of the radioulnar joint.
15. 4-open reduction and internal plate fixation of the
16. radius, with fixation of the distal radioulnar /
17. joint.
18. 5- open reduction and internal plate fixation of the
19. radius, with immobilization of the distal
20. radioulnar joint in supination.
2. 27-year-old woman who sustained an
3. injury to her left, nondominant forearm as
4. a result of a motor vehicle accident. Under
5. anesthesia, it is noted that the distal
6. radioulnar joint is unstable but reducible in
7. supination. Treatment should include
8. 1- closed reduction, followed by splint
9. immobilization with the limb in supination.
10. 2- closed reduction and external fixation of the
11. radius, followed by splint immobilization with
12. the limb in supination.
13. 3- open reduction and external fixation of the
14. radius, with fixation of the radioulnar joint.
15. 4-open reduction and internal plate fixation of the
16. radius, with fixation of the distal radioulnar /
17. joint.
18. 5- open reduction and internal plate fixation of the
19. radius, with immobilization of the distal
20. radioulnar joint in supination.
Torsional rigidity of a long bone fracture under internal or external fixation is
2. determined by
3. 1- bone rotation versus torque applied.
4. 2- bone deflection versus bending moment applied.
5. 3- axial displacement at the fracture gap.
6. 4- maximum shear stress on the bone surface.
7. 5- normal and shear stresses at the fracture gap.
2. determined by
3. 1- bone rotation versus torque applied.
4. 2- bone deflection versus bending moment applied.
5. 3- axial displacement at the fracture gap.
6. 4- maximum shear stress on the bone surface.
7. 5- normal and shear stresses at the fracture gap.
When visualizing an MRI cross-sectional scan of the wrist, the ulnar artery
2. bears what relationship to the ulnar nerve?
3. 1- Directly deep
4. 2- Directly superficial
5. 3- Deep and ulnar
6. 4- Superficial and radial
7. 5- At the same level and ulnar
2. bears what relationship to the ulnar nerve?
3. 1- Directly deep
4. 2- Directly superficial
5. 3- Deep and ulnar
6. 4- Superficial and radial
7. 5- At the same level and ulnar
A 60-year-old woman has pain along the medial aspect of the ankle.
2. Examination reveals pain along the posterior tibial tendon with normal single
3. toe raise. Despite undergoing conservative treatment consisting of nonsteroidal
4. anti-inflammatory medication, physical therapy, and cast immobilization for 8
5. weeks, she continues to have pain. What is the next appropriate step in
6. management?
7. 1- Steroid injection
8. 2- Subtalar joint arthrodesis
9. 3- Synovectomy of the posterior tibial tendon
10. 4- Reconstruction of the posterior tibial tendon
11. 5- Anterior tibial tendon transfer and calcaneal cuboid arthrodesis
2. Examination reveals pain along the posterior tibial tendon with normal single
3. toe raise. Despite undergoing conservative treatment consisting of nonsteroidal
4. anti-inflammatory medication, physical therapy, and cast immobilization for 8
5. weeks, she continues to have pain. What is the next appropriate step in
6. management?
7. 1- Steroid injection
8. 2- Subtalar joint arthrodesis
9. 3- Synovectomy of the posterior tibial tendon
10. 4- Reconstruction of the posterior tibial tendon
11. 5- Anterior tibial tendon transfer and calcaneal cuboid arthrodesis
A normal lower extremity has a valgus angulation at the knee when measured
2. 1- along the mechanical axis.
3. 2- between the mechanical axis of the femur and tibia.
4. 3- between the mechanical and anatomic axes of the tibia.
5. 4- between the anatomical axis of the femur and tibia.
6. 5- between the mechanical axis of the femur and the anatomical axis of the tibia.
2. 1- along the mechanical axis.
3. 2- between the mechanical axis of the femur and tibia.
4. 3- between the mechanical and anatomic axes of the tibia.
5. 4- between the anatomical axis of the femur and tibia.
6. 5- between the mechanical axis of the femur and the anatomical axis of the tibia.
The incidence of vascular injury after an anterior knee dislocation is
2. 1- less than 5%.
3. 2- 10% to 25%.
4. 3- 30% to 50%.
5. 4- 60% to 80%.
6. 5- greater than 95%.
2. 1- less than 5%.
3. 2- 10% to 25%.
4. 3- 30% to 50%.
5. 4- 60% to 80%.
6. 5- greater than 95%.
A 72-year-old woman has an irreparable massive rotator cuff tear and
2. symptomatic glenohumeral arthritis. What procedure will most likely yield the
3. best long-term clinical result?
4. 1- Arthrodesis
5. 2- Hemiarthroplasty
6. 3- Resection arthroplasty
7. 4- Total shoulder arthroplasty
8. 5- Acromioplasty and debridement
2. symptomatic glenohumeral arthritis. What procedure will most likely yield the
3. best long-term clinical result?
4. 1- Arthrodesis
5. 2- Hemiarthroplasty
6. 3- Resection arthroplasty
7. 4- Total shoulder arthroplasty
8. 5- Acromioplasty and debridement
A 45-year-old man sustains an injury to
2. his pelvic ring as a result of a motor
3. vehicle accident. Radiographs are shown
4. in Figures 11a through 11c, and a CT scan
5. is shown in Figure 11d. Examination
6. reveals that he is hemodynamically stable
7. and has no associated injuries.
8. Management should include
9. 1- anterior sacroiliac plate fixation.
10. 2- anterior fixation of the pubic symphysis.
11. 3- posterior fixation of the left sacroiliac joint.
12. 4- early mobilization and weightbearing without
13. internal fixation.
14. 5- combined anterior fixation to the pubic
15. symphysis and posterior fixation of the left
16. sacroiliac joint.
2. his pelvic ring as a result of a motor
3. vehicle accident. Radiographs are shown
4. in Figures 11a through 11c, and a CT scan
5. is shown in Figure 11d. Examination
6. reveals that he is hemodynamically stable
7. and has no associated injuries.
8. Management should include
9. 1- anterior sacroiliac plate fixation.
10. 2- anterior fixation of the pubic symphysis.
11. 3- posterior fixation of the left sacroiliac joint.
12. 4- early mobilization and weightbearing without
13. internal fixation.
14. 5- combined anterior fixation to the pubic
15. symphysis and posterior fixation of the left
16. sacroiliac joint.
Radiographs of a 24-year-old man who
2. sustained an open tibial fracture 11
3. months ago are shown in Figures 12a
4. and 12b. Examination shows an
5. anteromedial draining wound over the
6. mid-tibia. Which of the following
7. methods will most accurately identify
8. the pathologic microorganisms?
9. 1- Swab culture of the sinus tract
10. 2- Operative sampling of the sinus tract
11. 3- Operative sampling of the posterolateral
12. sequestrum
13. 4- Operative sampling of deep specimens from
14. multiple foci
15. 5- Needle aspiration of the distal tibial
16. metaphyseal abscess
2. sustained an open tibial fracture 11
3. months ago are shown in Figures 12a
4. and 12b. Examination shows an
5. anteromedial draining wound over the
6. mid-tibia. Which of the following
7. methods will most accurately identify
8. the pathologic microorganisms?
9. 1- Swab culture of the sinus tract
10. 2- Operative sampling of the sinus tract
11. 3- Operative sampling of the posterolateral
12. sequestrum
13. 4- Operative sampling of deep specimens from
14. multiple foci
15. 5- Needle aspiration of the distal tibial
16. metaphyseal abscess
Which of the following conditions has the highest rate of malignant change?
2. 1- Ollier's disease
3. 2- Enchondromatosis
4. 3- Maffucci’s syndrome
5. 4- Multiple exostoses
6. 5- Solitary osteochondroma
2. 1- Ollier's disease
3. 2- Enchondromatosis
4. 3- Maffucci’s syndrome
5. 4- Multiple exostoses
6. 5- Solitary osteochondroma
A 37-year-old man who sustained a type IIIB open fracture of the middle third of
2. the tibia after a severe crush injury has significant contusions and some necrosis
3. of the posterior muscles. Treatment consists of debridement and external
4. fixation. Which of the following muscle flaps should be used for soft-tissue
5. coverage of the exposed anteromedial tibia?
6. 1- Soleus
7. 2- Fasciocutaneous
8. 3- Medial gastrocnemius
9. 4- Lateral gastrocnemius
10. 5- Free vascularized muscle
2. the tibia after a severe crush injury has significant contusions and some necrosis
3. of the posterior muscles. Treatment consists of debridement and external
4. fixation. Which of the following muscle flaps should be used for soft-tissue
5. coverage of the exposed anteromedial tibia?
6. 1- Soleus
7. 2- Fasciocutaneous
8. 3- Medial gastrocnemius
9. 4- Lateral gastrocnemius
10. 5- Free vascularized muscle
A previously active 36-year-old woman who fractured her right ankle 10 years
2. ago and was treated with 6 weeks of cast immobilization now has had pain and
3. swelling for the past year and is no longer able to play tennis or jog.
4. Examination shows swelling and a 10-degree loss of dorsiflexion when
5. compared with the normal, contralateral ankle. Radiographs show shortening of
6. the fibula, widening of the ankle mortise, lateral tilt of the talus, and slight
7. narrowing of the tibiotalar joint space. Treatment should include
8. 1- ankle fusion.
9. 2- osteotomy of the fibula.
10. 3- deltoid ligament reconstruction.
11. 4- a custom-made plastic shoe insert.
12. 5- nonsteroidal anti-inflammatory drug therapy.
2. ago and was treated with 6 weeks of cast immobilization now has had pain and
3. swelling for the past year and is no longer able to play tennis or jog.
4. Examination shows swelling and a 10-degree loss of dorsiflexion when
5. compared with the normal, contralateral ankle. Radiographs show shortening of
6. the fibula, widening of the ankle mortise, lateral tilt of the talus, and slight
7. narrowing of the tibiotalar joint space. Treatment should include
8. 1- ankle fusion.
9. 2- osteotomy of the fibula.
10. 3- deltoid ligament reconstruction.
11. 4- a custom-made plastic shoe insert.
12. 5- nonsteroidal anti-inflammatory drug therapy.
Which of the following proteins is a cell-wall pump that functions to eliminate
2. natural toxins and some chemotherapeutic agents from the cytoplasm into the
3. extracellular environment, and allows both normal and neoplastic cells to
4. develop resistance to chemotherapeutic agents?
5. 1- Interleukin 2
6. 2- P-glycoprotein
7. 3- Parathyroid hormone
8. 4- Platelet-derived growth factor
9. 5- Transforming growth factor beta
2. natural toxins and some chemotherapeutic agents from the cytoplasm into the
3. extracellular environment, and allows both normal and neoplastic cells to
4. develop resistance to chemotherapeutic agents?
5. 1- Interleukin 2
6. 2- P-glycoprotein
7. 3- Parathyroid hormone
8. 4- Platelet-derived growth factor
9. 5- Transforming growth factor beta
A 9-year-old boy has an abnormal gait that has become progressively worse for
2. the past 2 years. Examination reveals high arches in both feet, an irregular and
3. unsteady gait, and difficulty walking in a straight line. Reflexes are absent in
4. both knees and ankles, but a positive Babinski's sign is present. He also has
5. scoliosis and slurred speech. This child should also be evaluated for
6. 1- hip dysplasia.
7. 2- cardiomyopathy.
8. 3- aortic dilation.
9. 4- pseudohypertrophy.
10. 5- cervical spine anomalies.
2. the past 2 years. Examination reveals high arches in both feet, an irregular and
3. unsteady gait, and difficulty walking in a straight line. Reflexes are absent in
4. both knees and ankles, but a positive Babinski's sign is present. He also has
5. scoliosis and slurred speech. This child should also be evaluated for
6. 1- hip dysplasia.
7. 2- cardiomyopathy.
8. 3- aortic dilation.
9. 4- pseudohypertrophy.
10. 5- cervical spine anomalies.
What two nerves, other than the femoral nerve, innervate the muscles that
2. contribute tendons to the pes anserinus?
3. 1- Sural and sciatic
4. 2- Tibial and peroneal
5. 3- Saphenous and tibial
6. 4- Saphenous and sciatic
7. 5- Sciatic and obturator
2. contribute tendons to the pes anserinus?
3. 1- Sural and sciatic
4. 2- Tibial and peroneal
5. 3- Saphenous and tibial
6. 4- Saphenous and sciatic
7. 5- Sciatic and obturator
A 3-year-old child refuses to walk, has restricted, painful hip motion, and a
2. temperature of 100.4°F (38°C) after being treated with antibiotics for the past 5
3. days for an upper respiratory infection and otitis media. Laboratory studies show
4. an erythrocyte sedimentation rate of 50 mm/hr and a peripheral WBC of
5. 9,000/mm3 with 70% polys and 2% bands. An ultrasound of the hip shows a
6. mild to moderate effusion, and aspiration of the hip yields 1 1/2 mL of cloudy
7. fluid with a WBC of 50,000/mm3. No organisms are seen on the Gram stain.
8. Management should consist of
9. 1- open arthrotomy and drainage.
10. 2- antibiotics and a repeat aspiration in 24 hours.
11. 3- observation and a repeat aspiration in 24 hours.
12. 4- bed rest with a spica cast.
13. 5- bed rest, observation, and anti-inflammatory medication.
2. temperature of 100.4°F (38°C) after being treated with antibiotics for the past 5
3. days for an upper respiratory infection and otitis media. Laboratory studies show
4. an erythrocyte sedimentation rate of 50 mm/hr and a peripheral WBC of
5. 9,000/mm3 with 70% polys and 2% bands. An ultrasound of the hip shows a
6. mild to moderate effusion, and aspiration of the hip yields 1 1/2 mL of cloudy
7. fluid with a WBC of 50,000/mm3. No organisms are seen on the Gram stain.
8. Management should consist of
9. 1- open arthrotomy and drainage.
10. 2- antibiotics and a repeat aspiration in 24 hours.
11. 3- observation and a repeat aspiration in 24 hours.
12. 4- bed rest with a spica cast.
13. 5- bed rest, observation, and anti-inflammatory medication.
A 21-year-old man has had increasing hip
2. pain primarily during weightlifting
3. exercises. AP and oblique radiographs of
4. his hip are shown in Figures 13a and 13b.
5. A CT scan of the hip is shown in Figure
6. 13c and a T2-weighted coronal MRI scan
7. is shown in Figure 13d. Low- and high-
8. power photomicrographs of the biopsy
9. material are shown in Figures 13e and
10. 13f. What is the most likely diagnosis?
11. 1- Chondroblastoma
12. 2- Giant cell tumor
13. 3- Unicameral bone cyst
14. 4- Aneurysmal bone cyst
15. 5- Hyperparathyroidism
2. pain primarily during weightlifting
3. exercises. AP and oblique radiographs of
4. his hip are shown in Figures 13a and 13b.
5. A CT scan of the hip is shown in Figure
6. 13c and a T2-weighted coronal MRI scan
7. is shown in Figure 13d. Low- and high-
8. power photomicrographs of the biopsy
9. material are shown in Figures 13e and
10. 13f. What is the most likely diagnosis?
11. 1- Chondroblastoma
12. 2- Giant cell tumor
13. 3- Unicameral bone cyst
14. 4- Aneurysmal bone cyst
15. 5- Hyperparathyroidism
A patient who underwent a successful posterior stabilized total knee
2. arthroplasty, 9 months ago reports an audible clunk with increasing pain and
3. disability as he extends the knee from 45 to 30 degrees of flexion. Surgical
4. treatment should now consist of
5. 1- patellectomy
6. 2- open patellectomy
7. 3- patellar component revision
8. 4- extensor mechanism realign
9. 5- excision of a soft-tissue lesion.
2. arthroplasty, 9 months ago reports an audible clunk with increasing pain and
3. disability as he extends the knee from 45 to 30 degrees of flexion. Surgical
4. treatment should now consist of
5. 1- patellectomy
6. 2- open patellectomy
7. 3- patellar component revision
8. 4- extensor mechanism realign
9. 5- excision of a soft-tissue lesion.
What is the most significant factor leading to nonunion when a halo vest is used
2. to treat a type II fracture at the base of the odontoid?
3. 1- Diabetes
4. 2- Osteoporosis
5. 3- Extension injury
6. 4- Age older than 65 years
7. 5- Displacement more than 5 mm
2. to treat a type II fracture at the base of the odontoid?
3. 1- Diabetes
4. 2- Osteoporosis
5. 3- Extension injury
6. 4- Age older than 65 years
7. 5- Displacement more than 5 mm
An 8-year-old boy with diplegic cerebral palsy has spastic ankle equinus that
2. interferes with gait. A posterior polypropylene "leaf-spring" ankle-foot orthosis
3. is prescribed. The purpose of the device is to
4. 1- strengthen the ankle muscles.
5. 2- prevent ankle dorsiflexion in midstance.
6. 3- reduce excessive equinus in swing phase.
7. 4- release stored energy during third rocker.
8. 5- permanently correct the shortened Achilles tendon.
2. interferes with gait. A posterior polypropylene "leaf-spring" ankle-foot orthosis
3. is prescribed. The purpose of the device is to
4. 1- strengthen the ankle muscles.
5. 2- prevent ankle dorsiflexion in midstance.
6. 3- reduce excessive equinus in swing phase.
7. 4- release stored energy during third rocker.
8. 5- permanently correct the shortened Achilles tendon.
Radiographs of a 45-year-old man who
2. has pain in his left shoulder 11 days after
3. being admitted to the neurology
4. department for an uncontrolled seizure
5. disorder are shown in Figures 14a and
6. 14b. Examination will most likely reveal
7. 1- limited internal rotation and fullness beneath
8. the coracoid.
9. 2- limited internal rotation and abduction with the
10. humeral head palpable posterior to the
11. acromion.
12. 3- restriction of all range of motion in the
13. shoulder with normal shoulder contours.
14. 4- the shoulder locked in internal rotation and a
15. prominent coracoid process.
16. 5- the shoulder held in abduction with marked
17. restriction of adduction and a palpable gap
18. beneath the acromion.
2. has pain in his left shoulder 11 days after
3. being admitted to the neurology
4. department for an uncontrolled seizure
5. disorder are shown in Figures 14a and
6. 14b. Examination will most likely reveal
7. 1- limited internal rotation and fullness beneath
8. the coracoid.
9. 2- limited internal rotation and abduction with the
10. humeral head palpable posterior to the
11. acromion.
12. 3- restriction of all range of motion in the
13. shoulder with normal shoulder contours.
14. 4- the shoulder locked in internal rotation and a
15. prominent coracoid process.
16. 5- the shoulder held in abduction with marked
17. restriction of adduction and a palpable gap
18. beneath the acromion.
Parathyroid hormone-related protein and its receptor are implicated in
2. 1- rickets.
3. 2- Stickler syndrome.
4. 3- hypochondroplasia.
5. 4- metaphyseal dysplasia.
6. 5- osteogenesis imperfecta.
2. 1- rickets.
3. 2- Stickler syndrome.
4. 3- hypochondroplasia.
5. 4- metaphyseal dysplasia.
6. 5- osteogenesis imperfecta.
An orthopaedic surgeon is most likely to be sued by a patient for which of the
2. following reasons?
3. 1- An unexpected result of treatment
4. 2- Excessive waiting time in the physician's office
5. 3- A delay in healing or prolonged recovery time
6. 4- A treatment fee in excess of the allowance by an insurer
7. 5- Poor communication with the patient's primary care physician
2. following reasons?
3. 1- An unexpected result of treatment
4. 2- Excessive waiting time in the physician's office
5. 3- A delay in healing or prolonged recovery time
6. 4- A treatment fee in excess of the allowance by an insurer
7. 5- Poor communication with the patient's primary care physician
What nerve must be retracted during a recession of the gastrocnemius
2. aponeurosis?
3. 1- Tibial
4. 2- Saphenous
5. 3- Deep peroneal
6. 4- superficial peroneal
7. 5- Medial sural cutaneous
2. aponeurosis?
3. 1- Tibial
4. 2- Saphenous
5. 3- Deep peroneal
6. 4- superficial peroneal
7. 5- Medial sural cutaneous
What deformity of the great toe is most likely to occur if both sesamoids are
2. removed?
3. 1- Floppy toe
4. 2- Cock-up toe
5. 3- Hallux varus
6. 4- Hallux valgus
7. 5- Hallux rigidus
2. removed?
3. 1- Floppy toe
4. 2- Cock-up toe
5. 3- Hallux varus
6. 4- Hallux valgus
7. 5- Hallux rigidus
Figure 15 shows the radiograph of a 6-year-
2. old girl who sustained a fracture after falling
3. from the top of the monkey bars. Treatment
4. should consist of
5. 1- open reduction and internal fixation
6. 2- open reduction, epiphysiodesis, and internal fixation
7. 3- application of a long leg cast with the foot in a
8. neutral position
9. 4- closed reduction and percutaneous pin fixation
10. 5- closed reduction and application of a short leg cast
11. with the foot in an equinus position
2. old girl who sustained a fracture after falling
3. from the top of the monkey bars. Treatment
4. should consist of
5. 1- open reduction and internal fixation
6. 2- open reduction, epiphysiodesis, and internal fixation
7. 3- application of a long leg cast with the foot in a
8. neutral position
9. 4- closed reduction and percutaneous pin fixation
10. 5- closed reduction and application of a short leg cast
11. with the foot in an equinus position
A 38-year-old woman who sustained multiple blunt injuries, including a
2. unilateral lateral compression injury to the pelvic ring as a result of a motor
3. vehicle accident, is awake, alert, and normotensive; however, she has a
4. decreased pulse pressure, a pulse of 110/min and a urine output of 20 mL/hr. She
5. responds to an initial fluid bolus; however, after the fluids are slowed, perfusion
6. begins to deteriorate. An increase in fluids and blood administration is instituted.
7. To evaluate the abdomen as a potential bleeding source, management should
8. include
9. 1- obtaining a CT scan of the abdomen.
10. 2- obtaining lateral decubitus radiographs of the abdomen.
11. 3- obtaining a cross-table lateral radiograph of the abdomen.
12. 4- performing an exploratory laparotomy.
13. 5-performing a supraumbilical diagnostic peritoneal lavage.
2. unilateral lateral compression injury to the pelvic ring as a result of a motor
3. vehicle accident, is awake, alert, and normotensive; however, she has a
4. decreased pulse pressure, a pulse of 110/min and a urine output of 20 mL/hr. She
5. responds to an initial fluid bolus; however, after the fluids are slowed, perfusion
6. begins to deteriorate. An increase in fluids and blood administration is instituted.
7. To evaluate the abdomen as a potential bleeding source, management should
8. include
9. 1- obtaining a CT scan of the abdomen.
10. 2- obtaining lateral decubitus radiographs of the abdomen.
11. 3- obtaining a cross-table lateral radiograph of the abdomen.
12. 4- performing an exploratory laparotomy.
13. 5-performing a supraumbilical diagnostic peritoneal lavage.
A bifid (high division) of the median nerve at the wrist is usually associated
2. with
3. 1- a persistent median artery.
4. 2- an all median-innervated hand.
5. 3- an absent palmar cutaneous branch.
6. 4- proximal take off of the motor branch.
7. 5- an incomplete superficial palmar arch.
2. with
3. 1- a persistent median artery.
4. 2- an all median-innervated hand.
5. 3- an absent palmar cutaneous branch.
6. 4- proximal take off of the motor branch.
7. 5- an incomplete superficial palmar arch.
A 35-year-old construction worker has left leg pain and difficulty walking on
2. the left foot. Examination is normal except for decreased sensation to the lateral
3. border of the left foot, the inability to walk on the toes of the left foot, and a
4. positive stretch test producing left heel and lateral foot pain. A standard MRI
5. scan shows a large herniated nucleus pulposus on the left side at L5-S 1. The
6. gait abnormality is most likely due to
7. 1- cauda equina syndrome.
8. 2- L5 radiculopathy and gastrocnemius soleus denervation.
9. 3- L5 radiculopathy and extensor hallucis longus weakness.
10. 4- S1 radiculopathy and gastrocnemius soleus denervation.
11. 5- S1 radiculopathy and extensor hallucis longus weakness.
2. the left foot. Examination is normal except for decreased sensation to the lateral
3. border of the left foot, the inability to walk on the toes of the left foot, and a
4. positive stretch test producing left heel and lateral foot pain. A standard MRI
5. scan shows a large herniated nucleus pulposus on the left side at L5-S 1. The
6. gait abnormality is most likely due to
7. 1- cauda equina syndrome.
8. 2- L5 radiculopathy and gastrocnemius soleus denervation.
9. 3- L5 radiculopathy and extensor hallucis longus weakness.
10. 4- S1 radiculopathy and gastrocnemius soleus denervation.
11. 5- S1 radiculopathy and extensor hallucis longus weakness.
An 18-year-old woman has a closed femoral shaft fracture and facial trauma.
2. Cervical spine radiographs are normal. Because of moderate facial edema,
3. internal fixation of the femur is delayed. Two days later, the patient is noted to
4. have mental confusion and dyspnea. The lungs are clear to auscultation with
5. normal breath sounds. Vital signs are pulse, 100/min; respiration, 35/min; blood
6. pressure, 140/95 mm Hg. Arterial blood gases are p02,70; PC02,45. The pH
7. was 7.35. The most likely diagnosis is
8. 1- occult head injury.
9. 2- pulmonary embolism.
10. 3- spontaneous pneumothorax.
11. 4- fat embolism.
12. 5- upper airway obstruction.
2. Cervical spine radiographs are normal. Because of moderate facial edema,
3. internal fixation of the femur is delayed. Two days later, the patient is noted to
4. have mental confusion and dyspnea. The lungs are clear to auscultation with
5. normal breath sounds. Vital signs are pulse, 100/min; respiration, 35/min; blood
6. pressure, 140/95 mm Hg. Arterial blood gases are p02,70; PC02,45. The pH
7. was 7.35. The most likely diagnosis is
8. 1- occult head injury.
9. 2- pulmonary embolism.
10. 3- spontaneous pneumothorax.
11. 4- fat embolism.
12. 5- upper airway obstruction.
Which of the following factors most heavily influences a patient's perception of
2. results after undergoing a total hip arthroplasty?
3. 1- Pain relief
4. 2- Walking ability
5. 3- Hip range of motion
6. 4- General improvement in health
7. 5- Patient-physician relationship
2. results after undergoing a total hip arthroplasty?
3. 1- Pain relief
4. 2- Walking ability
5. 3- Hip range of motion
6. 4- General improvement in health
7. 5- Patient-physician relationship
A new surgical procedure is described for treating symptomatic osteochondritis
2. dissecans. Results of clinical trials at 1 year are better than no treatment, but no
3. long-term studies are available. A patient with a large osteochondrotic defect
4. asks about this treatment, but you have not previously performed the procedure.
5. As his physician, you should
6. 1- decline to perform the procedure until 10-year follow-up data are available.
7. 2- do whatever the patient requests, even if you have reservations about efficacy.
8. 3- agree to perform the procedure only if the patient is entered into a clinical trial.
9. 4- agree to perform the procedure if it is technically within your competence, and you
10. and the patient each feel it is the best alternative.
11. 5- convince the patient to undergo the procedure if you feel it is worthwhile, but avoid
12. confusing the patient with information about the lack of long-term follow-up data.
2. dissecans. Results of clinical trials at 1 year are better than no treatment, but no
3. long-term studies are available. A patient with a large osteochondrotic defect
4. asks about this treatment, but you have not previously performed the procedure.
5. As his physician, you should
6. 1- decline to perform the procedure until 10-year follow-up data are available.
7. 2- do whatever the patient requests, even if you have reservations about efficacy.
8. 3- agree to perform the procedure only if the patient is entered into a clinical trial.
9. 4- agree to perform the procedure if it is technically within your competence, and you
10. and the patient each feel it is the best alternative.
11. 5- convince the patient to undergo the procedure if you feel it is worthwhile, but avoid
12. confusing the patient with information about the lack of long-term follow-up data.
A 12-year-old girl has had painful, unilateral toe walking for the
2. past 12 months. Examination shows that her foot is fixed in
3. equinus, and she has exquisite point tenderness over the proximal
4. and medial aspect of the medial gastrocnemius muscle. A lateral
5. radiograph of the knee is shown in Figure 16a, and a T2- weighted
6. axial MRI scan of the proximal leg is shown in Figure 16b. A
7. photomicrograph of biopsy material is shown in Figure 16c. What
8. is the most likely diagnosis?
9. 1- Rhabdomyosarcoma
10. 2- Nodular fasciitis
11. 3- Heterotopic ossification
12. 4- Soft-tissue hemangioma
13. 5- Soft-tissue Ewing's sarcoma
2. past 12 months. Examination shows that her foot is fixed in
3. equinus, and she has exquisite point tenderness over the proximal
4. and medial aspect of the medial gastrocnemius muscle. A lateral
5. radiograph of the knee is shown in Figure 16a, and a T2- weighted
6. axial MRI scan of the proximal leg is shown in Figure 16b. A
7. photomicrograph of biopsy material is shown in Figure 16c. What
8. is the most likely diagnosis?
9. 1- Rhabdomyosarcoma
10. 2- Nodular fasciitis
11. 3- Heterotopic ossification
12. 4- Soft-tissue hemangioma
13. 5- Soft-tissue Ewing's sarcoma
A 57-year-old woman who sustained a minimally displaced fracture of the
2. distal radius is unable to fully extend her thumb 3 months after the injury. What
3. is the best treatment?
4. 1- Intercalated tendon graft of the extensor pollicis longus
5. 2- Transfer of the brachioradialis to the extensor pollicis longus
6. 3- Transfer of the flexor carpi ulnaris to the extensor pollicis longus
7. 4- Transfer of the flexor digitorum sublimis of the ring finger to the extensor pollicis
8. longus
9. 5- Transfer of the extensor digitorum communis of the index finger to the extensor
10. pollicis longus
2. distal radius is unable to fully extend her thumb 3 months after the injury. What
3. is the best treatment?
4. 1- Intercalated tendon graft of the extensor pollicis longus
5. 2- Transfer of the brachioradialis to the extensor pollicis longus
6. 3- Transfer of the flexor carpi ulnaris to the extensor pollicis longus
7. 4- Transfer of the flexor digitorum sublimis of the ring finger to the extensor pollicis
8. longus
9. 5- Transfer of the extensor digitorum communis of the index finger to the extensor
10. pollicis longus
Figures 17a and 17b show the radiographs of a 13-year-old girl who has had a bump on
2. her left thigh for the past 6 months, but no constitutional symptoms and no pain except
3. with sport activities. The bump has not increased in size in 6 months, but she reports that
4. she did not feel it before 6 months ago. Examination reveals a palpable, fixed, hard, 4 x 4 cm mass on the left lateral thigh.
5. Range of motion in the knee and
6. hip is full. There is no erythema,
7. but palpation is uncomfortable.
8. What is the most likely
9. diagnosis?
10. 1- Osteoblastoma
11. 2- Osteochondroma
12. 3- Osteogenic sarcoma
13. 4- Chondrosarcoma
14. 5- Parosteal osteogenic sarcoma
2. her left thigh for the past 6 months, but no constitutional symptoms and no pain except
3. with sport activities. The bump has not increased in size in 6 months, but she reports that
4. she did not feel it before 6 months ago. Examination reveals a palpable, fixed, hard, 4 x 4 cm mass on the left lateral thigh.
5. Range of motion in the knee and
6. hip is full. There is no erythema,
7. but palpation is uncomfortable.
8. What is the most likely
9. diagnosis?
10. 1- Osteoblastoma
11. 2- Osteochondroma
12. 3- Osteogenic sarcoma
13. 4- Chondrosarcoma
14. 5- Parosteal osteogenic sarcoma
Figure 18 shows the MRI scan of a 72-year-old woman who has intractable
2. pain in the back and leg that has been unresponsive to conservative treatment.
3. What is the best surgical treatment at L4-5?
4. 1- Bilateral microdiskectomy
5. 2- Posterior decompression
6. 3- Posterior decompression and
7. posterolateral fusion
8. 4- Posterolateral intertransverse
9. fusion
10. 5- Anterior diskectomy and
11. fusion with allograft and
12. internal fixation
2. pain in the back and leg that has been unresponsive to conservative treatment.
3. What is the best surgical treatment at L4-5?
4. 1- Bilateral microdiskectomy
5. 2- Posterior decompression
6. 3- Posterior decompression and
7. posterolateral fusion
8. 4- Posterolateral intertransverse
9. fusion
10. 5- Anterior diskectomy and
11. fusion with allograft and
12. internal fixation
A 12-year-old girl has a Ewing's sarcoma of the proximal fibula with no
2. metastatic disease or neurovascular involvement. Treatment should include
3. 1- radiation therapy.
4. 2- chemotherapy.
5. 3- surgical resection.
6. 4- radiation therapy and surgical resection.
7. 5- chemotherapy and surgical resection.
2. metastatic disease or neurovascular involvement. Treatment should include
3. 1- radiation therapy.
4. 2- chemotherapy.
5. 3- surgical resection.
6. 4- radiation therapy and surgical resection.
7. 5- chemotherapy and surgical resection.
Which of the following methods is most effective in improving the fatigue
2. strength of polymethylmethacrylate?
3. 1- Porosity reduction
4. 2- Viscosity reduction
5. 3- Chilling the monomer
6. 4- Addition of antibiotics
7. 5- Addition of radiopacifiers
2. strength of polymethylmethacrylate?
3. 1- Porosity reduction
4. 2- Viscosity reduction
5. 3- Chilling the monomer
6. 4- Addition of antibiotics
7. 5- Addition of radiopacifiers
Figure 19 shows the radiograph of an active 70-year-old woman who had
2. surgery 25 years ago for a painful bunion. She has pain with weightbearing and
3. a prominent screwhead. Conservative management has failed. The best
4. surgical option is screw removal and
5. 1- fascial arthroplasty.
6. 2- silicone implant
7. arthroplasty.
8. 3- a shortening osteotomy.
9. 4- a basal chevron
10. realignment osteotomy.
11. 5- a metatarsophalangeal
12. joint arthrodesis.
2. surgery 25 years ago for a painful bunion. She has pain with weightbearing and
3. a prominent screwhead. Conservative management has failed. The best
4. surgical option is screw removal and
5. 1- fascial arthroplasty.
6. 2- silicone implant
7. arthroplasty.
8. 3- a shortening osteotomy.
9. 4- a basal chevron
10. realignment osteotomy.
11. 5- a metatarsophalangeal
12. joint arthrodesis.
A 25-year-old woman who has multiple injuries, including closed femoral and
2. tibial shaft fractures, is initially awake and alert, but during resuscitation she
3. becomes somnolent. A chest radiograph shows three rib fractures on the right
4. side, and an AP view of the pelvis shows a 3-cm pubic diastasis. She has a
5. systolic blood pressure of 220 mm Hg and a pulse rate of 38/min. Treatment
6. should include
7. 1- pelvic angiography.
8. 2- diagnostic peritoneal lavage.
9. 3- emergency CT scan of the head and a neurosurgical consultation.
10. 4- administration of 2 L of crystalloid and blood type and crossmatching.
11. 5- insertion of a chest tube in the midclavicular line of the second intercostal space.
2. tibial shaft fractures, is initially awake and alert, but during resuscitation she
3. becomes somnolent. A chest radiograph shows three rib fractures on the right
4. side, and an AP view of the pelvis shows a 3-cm pubic diastasis. She has a
5. systolic blood pressure of 220 mm Hg and a pulse rate of 38/min. Treatment
6. should include
7. 1- pelvic angiography.
8. 2- diagnostic peritoneal lavage.
9. 3- emergency CT scan of the head and a neurosurgical consultation.
10. 4- administration of 2 L of crystalloid and blood type and crossmatching.
11. 5- insertion of a chest tube in the midclavicular line of the second intercostal space.
A 4-year-old child who has a
2. history of several fractures of the
3. right femur and tibia now has
4. acute pain in the right tibia.
5. Current radiographs of the femur
6. and tibia are shown in Figures 20a
7. through 20d. There is a family
8. history of fracture difficulties, but
9. no physical characteristics of
10. neurofibromatosis. Management
11. should include
12. 1- a long leg brace with a free knee and
13. ankle.
14. 2- a long leg brace with a fixed knee and
15. free ankle.
16. 3- open reduction and plate fixation of
17. the tibia fracture.
18. 4- femoral and tibial osteotomies with
19. fine wire external fixation.
20. 5- multiple realignment osteotomies and
21. intramedullary fixation of the femur
22. and tibia.
2. history of several fractures of the
3. right femur and tibia now has
4. acute pain in the right tibia.
5. Current radiographs of the femur
6. and tibia are shown in Figures 20a
7. through 20d. There is a family
8. history of fracture difficulties, but
9. no physical characteristics of
10. neurofibromatosis. Management
11. should include
12. 1- a long leg brace with a free knee and
13. ankle.
14. 2- a long leg brace with a fixed knee and
15. free ankle.
16. 3- open reduction and plate fixation of
17. the tibia fracture.
18. 4- femoral and tibial osteotomies with
19. fine wire external fixation.
20. 5- multiple realignment osteotomies and
21. intramedullary fixation of the femur
22. and tibia.
A 10-year-old boy who is in the 20th percentile for height has a waddling gait.
2. Examination reveals a 15-degree scoliosis and frontal bossing, and radiographs
3. show bilateral coxa vara and a widened symphysis pubis. Results of the
4. neurologic examination are normal. What is the most likely diagnosis?
5. 1- Rickets
6. 2- Achondroplasia
7. 3- Cleidocranial dysplasia
8. 4- Developmental coxa vara
9. 5- Metaphyseal chondrodysplasia
2. Examination reveals a 15-degree scoliosis and frontal bossing, and radiographs
3. show bilateral coxa vara and a widened symphysis pubis. Results of the
4. neurologic examination are normal. What is the most likely diagnosis?
5. 1- Rickets
6. 2- Achondroplasia
7. 3- Cleidocranial dysplasia
8. 4- Developmental coxa vara
9. 5- Metaphyseal chondrodysplasia
As a third-year orthopaedic resident you are in surgery with an attending
2. surgeon treating a patient who has a grossly contaminated open tibia fracture.
3. As the case proceeds, it becomes apparent to you and other operating room staff
4. that the attending surgeon has recently consumed alcohol and his judgment is
5. impaired. You disagree with the wound management insisted on by the
6. attending surgeon. At this point, you should
7. 1- take over the treatment and call the Chief of Service.
8. 2- refuse to proceed as directed and leave the operating room.
9. 3- proceed as directed but also administer high doses of antibiotics.
10. 4- proceed as directed and report the physician to the Chief of Service.
11. 5- proceed as directed and write a note in the chart that you disagree with the
12. management of the patient.
2. surgeon treating a patient who has a grossly contaminated open tibia fracture.
3. As the case proceeds, it becomes apparent to you and other operating room staff
4. that the attending surgeon has recently consumed alcohol and his judgment is
5. impaired. You disagree with the wound management insisted on by the
6. attending surgeon. At this point, you should
7. 1- take over the treatment and call the Chief of Service.
8. 2- refuse to proceed as directed and leave the operating room.
9. 3- proceed as directed but also administer high doses of antibiotics.
10. 4- proceed as directed and report the physician to the Chief of Service.
11. 5- proceed as directed and write a note in the chart that you disagree with the
12. management of the patient.
Force is a vector because it
2. 1- produces potential energy.
3. 2- has direction and magnitude.
4. 3- causes rotation and translation.
5. 4- cannot be added or subtracted.
6. 5- can only be analyzed graphically.
2. 1- produces potential energy.
3. 2- has direction and magnitude.
4. 3- causes rotation and translation.
5. 4- cannot be added or subtracted.
6. 5- can only be analyzed graphically.
Figure 21 shows the radiograph of an 18-month-old infant. What is the most
2. appropriate surgical procedure for reconstruction of the thumb?
3. 1- Tendon rebalancing
4. 2- Proximal phalanx osteotomy and lengthening
5. 3- Opening wedge osteotomy of the delta phalanx
6. 4- Closing wedge osteotomy of the delta phalanx
7. 5- Total excision of the delta phalanx and
8. soft-tissue reconstruction
2. appropriate surgical procedure for reconstruction of the thumb?
3. 1- Tendon rebalancing
4. 2- Proximal phalanx osteotomy and lengthening
5. 3- Opening wedge osteotomy of the delta phalanx
6. 4- Closing wedge osteotomy of the delta phalanx
7. 5- Total excision of the delta phalanx and
8. soft-tissue reconstruction
Figures 22a and 22b show plain radiographs of a 33-year-old man who has had
2. progressive pain in his nondominant left shoulder for the past 5 months. A proton density
3. MRI scan is shown in Figure 22c, and histologic materials from the solid portion of the
4. lesion are shown in Figures 22d and 22e. What is the most likely diagnosis?
5. 1- Enchondroma
6. 2- Giant cell tumor
7. 3- Chondroblastoma
8. 4- Chondromyxoid fibroma
9. 5- Clear cell chondrosarcoma
2. progressive pain in his nondominant left shoulder for the past 5 months. A proton density
3. MRI scan is shown in Figure 22c, and histologic materials from the solid portion of the
4. lesion are shown in Figures 22d and 22e. What is the most likely diagnosis?
5. 1- Enchondroma
6. 2- Giant cell tumor
7. 3- Chondroblastoma
8. 4- Chondromyxoid fibroma
9. 5- Clear cell chondrosarcoma
A 200-lb, 52-year-old male construction worker is evaluated for surgical
2. correction of medial unicompartmental arthritis of the knee that has become
3. increasingly symptomatic for the past 3 years. Range of motion in his knee is 5
4. degrees to 120 degrees. Long leg radiographs show a mechanical axis that
5. measures 5 degrees varus. Surgical treatment should consist of
6. 1- high tibial osteotomy.
7. 2- total knee replacement.
8. 3- distal femoral osteotomy.
9. 4- unicompartmental arthroplasty.
10. 5- arthroscopic debridement of the medial. compartment.
2. correction of medial unicompartmental arthritis of the knee that has become
3. increasingly symptomatic for the past 3 years. Range of motion in his knee is 5
4. degrees to 120 degrees. Long leg radiographs show a mechanical axis that
5. measures 5 degrees varus. Surgical treatment should consist of
6. 1- high tibial osteotomy.
7. 2- total knee replacement.
8. 3- distal femoral osteotomy.
9. 4- unicompartmental arthroplasty.
10. 5- arthroscopic debridement of the medial. compartment.
What is the best method of skeletal stabilization for a 23-year-old man who
2. sustains a comminuted diaphyseal femoral fracture as a result of a low-velocity
3. gunshot?
4. 1- Plate fixation
5. 2- External fixation
6. 3- Flexible intramedullary nailing
7. 4- Intramedullary nailing with static interlocking
8. 5- Traction and delayed fixation dependent on the status of the wound
2. sustains a comminuted diaphyseal femoral fracture as a result of a low-velocity
3. gunshot?
4. 1- Plate fixation
5. 2- External fixation
6. 3- Flexible intramedullary nailing
7. 4- Intramedullary nailing with static interlocking
8. 5- Traction and delayed fixation dependent on the status of the wound
Figures 23a and 23b show
2. radiographs of a 52-year-old man
3. with diabetes who has had purulent
4. drainage from the medial side of his
5. right great toe for 3 weeks. He was
6. recently started on insulin.
7. Examination reveals a good dorsalis
8. pedis pulse but poor sensation from
9. the malleoli to the toes. Treatment
10. should consist of
11. 1- amputation of the great toe.
12. 2- bone culture and 6 weeks of IV
13. antibiotics.
14. 3- joint aspiration and 2 weeks of IV
15. antibiotics.
16. 4- excision interphalangeal arthroplasty.
17. 5- excision of infected bone and
18. interphalangeal joint arthrodesis.
2. radiographs of a 52-year-old man
3. with diabetes who has had purulent
4. drainage from the medial side of his
5. right great toe for 3 weeks. He was
6. recently started on insulin.
7. Examination reveals a good dorsalis
8. pedis pulse but poor sensation from
9. the malleoli to the toes. Treatment
10. should consist of
11. 1- amputation of the great toe.
12. 2- bone culture and 6 weeks of IV
13. antibiotics.
14. 3- joint aspiration and 2 weeks of IV
15. antibiotics.
16. 4- excision interphalangeal arthroplasty.
17. 5- excision of infected bone and
18. interphalangeal joint arthrodesis.
Which of the following factors has been shown to increase the risk of
2. neurovascular injury after insertion of an uncemented acetabular component?
3. 1- Vertical cup
4. 2- Posterior acetabular screws
5. 3- Anterior acetabular screws
6. 4- Cups greater than 70 mm in diameter
7. 5- Medialization of the cup to the floor of the true acetabulum
2. neurovascular injury after insertion of an uncemented acetabular component?
3. 1- Vertical cup
4. 2- Posterior acetabular screws
5. 3- Anterior acetabular screws
6. 4- Cups greater than 70 mm in diameter
7. 5- Medialization of the cup to the floor of the true acetabulum
The elastic modulus of polymethylmethacrylate is closest to that of
2. 1- titanium.
3. 2- carbon fiber.
4. 3- polyethylene.
5. 4- hydroxyapatite.
6. 5- cancellous bone.
2. 1- titanium.
3. 2- carbon fiber.
4. 3- polyethylene.
5. 4- hydroxyapatite.
6. 5- cancellous bone.
Treatment of a transverse femoral shaft fracture at the tip of a well-fixed total
2. hip stem should consist of
3. 1- retrograde intramedullary fixation.
4. 2- roller traction, followed by cast bracing.
5. 3- plate fixation with or without an allograft strut.
6. 4- a cemented revision femoral long stem prosthesis.
7. 5- an uncemented revision femoral long stem prosthesis.
2. hip stem should consist of
3. 1- retrograde intramedullary fixation.
4. 2- roller traction, followed by cast bracing.
5. 3- plate fixation with or without an allograft strut.
6. 4- a cemented revision femoral long stem prosthesis.
7. 5- an uncemented revision femoral long stem prosthesis.
A 38-year-old construction worker with no history of trauma has had a painful
2. swelling in the hypothenar eminence of his dominant hand for the past 4 weeks.
3. He also reports numbness in the two ulnar digits and cold intolerance. Which of
4. the following studies is most useful for diagnosis?
5. 1- CT scan
6. 2- Bone scan
7. 3- Arteriogram
8. 4- Doppler ultrasound
9. 5- Electrodiagnostic study
2. swelling in the hypothenar eminence of his dominant hand for the past 4 weeks.
3. He also reports numbness in the two ulnar digits and cold intolerance. Which of
4. the following studies is most useful for diagnosis?
5. 1- CT scan
6. 2- Bone scan
7. 3- Arteriogram
8. 4- Doppler ultrasound
9. 5- Electrodiagnostic study
Initial radiographs of a 56-year-old
2. man who sustained a closed fracture
3. of the distal tibia in a motor vehicle
4. accident are shown in Figures 24a
5. and 24b. Figure 24c shows a clinical
6. photograph of the injured foot and
7. ankle in the operating room 8 days
8. later. The chances of surgical wound
9. complications are most likely to be
10. minimized by
11. 1- avoiding plate fixation of the distal tibia.
12. 2- keeping the incisions spread by more than
13. 7 cm.
14. 3- using low-profile malleable plates.
15. 4- using a "pilon" fracture incision and a femoral
16. distractor.
17. 5- using a topical antibiotic cream and delaying
18. surgery for 3 to 5 more days.
2. man who sustained a closed fracture
3. of the distal tibia in a motor vehicle
4. accident are shown in Figures 24a
5. and 24b. Figure 24c shows a clinical
6. photograph of the injured foot and
7. ankle in the operating room 8 days
8. later. The chances of surgical wound
9. complications are most likely to be
10. minimized by
11. 1- avoiding plate fixation of the distal tibia.
12. 2- keeping the incisions spread by more than
13. 7 cm.
14. 3- using low-profile malleable plates.
15. 4- using a "pilon" fracture incision and a femoral
16. distractor.
17. 5- using a topical antibiotic cream and delaying
18. surgery for 3 to 5 more days.
A 14-year-old boy has a 4-month history of aching pain in the distal thigh. Examination
2. reveals a mass in the distal thigh. Figure 25a shows a plain radiograph, Figures 25b and
3. 25c show MRI images, Figure 25d shows a bone scan, and Figure 25e shows a CT scan of
4. the chest. The most likely diagnosis and Musculoskeletal Tumor Society (Enneking) stage
5. is
6. 1- osteosarcoma, stage IIB.
7. 2- osteosarcoma, stage III.
8. 3- parosteal osteosarcoma, stage IIB.
9. 4- periosteal osteosarcoma, stage IIB.
10. 5- periosteal osteosarcoma, stage III.
2. reveals a mass in the distal thigh. Figure 25a shows a plain radiograph, Figures 25b and
3. 25c show MRI images, Figure 25d shows a bone scan, and Figure 25e shows a CT scan of
4. the chest. The most likely diagnosis and Musculoskeletal Tumor Society (Enneking) stage
5. is
6. 1- osteosarcoma, stage IIB.
7. 2- osteosarcoma, stage III.
8. 3- parosteal osteosarcoma, stage IIB.
9. 4- periosteal osteosarcoma, stage IIB.
10. 5- periosteal osteosarcoma, stage III.
Which of the following structures, in addition to the piriformis, pass through the
2. greater sciatic foramen?
3. 1- Sciatic nerve and obturator internus
4. 2- Sciatic nerve and superior gluteal artery
5. 3- Sciatic nerve and gemellus superior
6. 4- Obturator internus and gemellus superior
7. 5- Superior gluteal artery and gemellus superior
2. greater sciatic foramen?
3. 1- Sciatic nerve and obturator internus
4. 2- Sciatic nerve and superior gluteal artery
5. 3- Sciatic nerve and gemellus superior
6. 4- Obturator internus and gemellus superior
7. 5- Superior gluteal artery and gemellus superior
A 21-year-old basketball player sustains a knee injury while decelerating and
2. pivoting for the ball and hemarthrosis develops immediately after the injury.
3. Examination shows a large effusion and 2+ Lachman's test result. If an MRI
4. scan were to be performed immediately, the most common location(s) of an
5. osteochondral injury would be the
6. 1- tibial spine.
7. 2- medial tibial plateau.
8. 3- medial femoral condyle and the medial tibial plateau.
9. 4- lateral femoral condyle and the medial tibial plateau.
10. 5- lateral femoral condyle and the lateral tibial plateau.
2. pivoting for the ball and hemarthrosis develops immediately after the injury.
3. Examination shows a large effusion and 2+ Lachman's test result. If an MRI
4. scan were to be performed immediately, the most common location(s) of an
5. osteochondral injury would be the
6. 1- tibial spine.
7. 2- medial tibial plateau.
8. 3- medial femoral condyle and the medial tibial plateau.
9. 4- lateral femoral condyle and the medial tibial plateau.
10. 5- lateral femoral condyle and the lateral tibial plateau.
Which of the following muscles can be used to protect the sciatic nerve during a
2. posterior approach to the hip?
3. 1- Gluteus minimus
4. 2- Gluteus medius
5. 3- Gluteus maximus
6. 4- Adductor magnus
7. 5- Short external rotators
2. posterior approach to the hip?
3. 1- Gluteus minimus
4. 2- Gluteus medius
5. 3- Gluteus maximus
6. 4- Adductor magnus
7. 5- Short external rotators
A 78-year-old man has had a chronic symptomatic anterior dislocation of his
2. dominant right shoulder for the past 2 years. Treatment should include
3. 1- arthrodesis.
4. 2- resection arthroplasty.
5. 3- open reduction and stabilization.
6. 4- closed reduction and physical therapy.
7. 5- nonconstrained total shoulder arthroplasty.
2. dominant right shoulder for the past 2 years. Treatment should include
3. 1- arthrodesis.
4. 2- resection arthroplasty.
5. 3- open reduction and stabilization.
6. 4- closed reduction and physical therapy.
7. 5- nonconstrained total shoulder arthroplasty.
Figure 26 shows an oblique coronal proton density MRI scan of a 40-year-old
2. man with shoulder pain. What is the most significant finding?
3. 1- Full-thickness subscapularis tendon tear
4. 2- Full-thickness supraspinatus tendon tear
5. 3- Partial-thickness subscapularis tendon tear
6. 4- Partial-thickness supraspinatus tendon tear
7. 5- A ganglion cyst of the supraspinatus tendon
2. man with shoulder pain. What is the most significant finding?
3. 1- Full-thickness subscapularis tendon tear
4. 2- Full-thickness supraspinatus tendon tear
5. 3- Partial-thickness subscapularis tendon tear
6. 4- Partial-thickness supraspinatus tendon tear
7. 5- A ganglion cyst of the supraspinatus tendon
Figures 27a and 27b show the radiographs of an otherwise healthy 6-month-old infant
2. who has been treated with serial casting since birth for a foot deformity. There has been
3. no change in the foot position over the past month of casting. Management should now
4. consist of
5. 1- split transfer of the anterior tibial tendon.
6. 2- surgical release of the residual deformities.
7. 3- use of an ankle-foot orthosis to prevent further deformity.
8. 4- continued serial casting with
9. the knee in an extended
10. position.
11. 5- continued serial casting with
12. dorsiflexion under the first
13. metatarsal.
2. who has been treated with serial casting since birth for a foot deformity. There has been
3. no change in the foot position over the past month of casting. Management should now
4. consist of
5. 1- split transfer of the anterior tibial tendon.
6. 2- surgical release of the residual deformities.
7. 3- use of an ankle-foot orthosis to prevent further deformity.
8. 4- continued serial casting with
9. the knee in an extended
10. position.
11. 5- continued serial casting with
12. dorsiflexion under the first
13. metatarsal.
Examination of a 27-year-old man who injured his knee playing soccer shows
2. full range of motion, no jointline tenderness, negative Lachman and anterior
3. drawer test results, but a positive grade I posterior drawer test result.
4. Radiographs and signs of posterolateral instability are negative. Initial
5. management should consist of
6. 1- primary posterior cruciate ligament repair.
7. 2- rehabilitation, with emphasis on quadriceps strengthening.
8. 3- rehabilitation, with emphasis on hamstring strengthening.
9. 4- reconstruction of the posterior cruciate ligament using an autogenous patellar tendon. 5- reconstruction of the posterior cruciate ligament using an autogenous hamstring
10. tendon.
2. full range of motion, no jointline tenderness, negative Lachman and anterior
3. drawer test results, but a positive grade I posterior drawer test result.
4. Radiographs and signs of posterolateral instability are negative. Initial
5. management should consist of
6. 1- primary posterior cruciate ligament repair.
7. 2- rehabilitation, with emphasis on quadriceps strengthening.
8. 3- rehabilitation, with emphasis on hamstring strengthening.
9. 4- reconstruction of the posterior cruciate ligament using an autogenous patellar tendon. 5- reconstruction of the posterior cruciate ligament using an autogenous hamstring
10. tendon.
What type of displaced proximal humerus fracture would most likely require
2. immediate treatment with a hemiarthroplasty?
3. 1- Two-part
4. 2- Three-part
5. 3- Head-splitting
6. 4- Two-part fracture-dislocation
7. 5- Three-part fracture-dislocation
2. immediate treatment with a hemiarthroplasty?
3. 1- Two-part
4. 2- Three-part
5. 3- Head-splitting
6. 4- Two-part fracture-dislocation
7. 5- Three-part fracture-dislocation
Figure 28 shows an axial CT scan through the body and posterior elements of
2. L5 in a young man with low back pain. What is the radiographic diagnosis?
3. 1- Spondylolysis
4. 2- Osteoid sarcoma
5. 3- Acute facet fracture
6. 4- Dysplastic spondylolisthesis
7. 5- Congenital failure of posterior element formation
2. L5 in a young man with low back pain. What is the radiographic diagnosis?
3. 1- Spondylolysis
4. 2- Osteoid sarcoma
5. 3- Acute facet fracture
6. 4- Dysplastic spondylolisthesis
7. 5- Congenital failure of posterior element formation
What is the main disadvantage of using aluminum in the fabrication of
2. orthoses?
3. 1- Too rigid
4. 2- Limited availability
5. 3- Lower endurance limit
6. 4- High strength-to-weight ratio
7. 5- Too heavy for upper extremity applications
2. orthoses?
3. 1- Too rigid
4. 2- Limited availability
5. 3- Lower endurance limit
6. 4- High strength-to-weight ratio
7. 5- Too heavy for upper extremity applications
A 56-year-old man who has a 2-year history of a progressive peripheral
2. neuropathy has symmetric motor and sensory deficits in the lower extremities
3. that are worse distally. Plain radiographs of the spine and pelvis show multiple
4. small sclerotic lesions in the pubic rami, left and right ilia, and the lumbosacral
5. spine. Serum protein immunoelectrophoresis shows a monoclonal spike. What
6. is the most likely diagnosis?
7. 1- Metastatic lung cancer
8. 2- Metastatic prostate cancer
9. 3- Osteosclerotic myeloma
10. 4- Non-Hodgkin's lymphoma
11. 5- Primary hyperparathyroidism
2. neuropathy has symmetric motor and sensory deficits in the lower extremities
3. that are worse distally. Plain radiographs of the spine and pelvis show multiple
4. small sclerotic lesions in the pubic rami, left and right ilia, and the lumbosacral
5. spine. Serum protein immunoelectrophoresis shows a monoclonal spike. What
6. is the most likely diagnosis?
7. 1- Metastatic lung cancer
8. 2- Metastatic prostate cancer
9. 3- Osteosclerotic myeloma
10. 4- Non-Hodgkin's lymphoma
11. 5- Primary hyperparathyroidism
A 52 year old woman has thumb basilar arthritis and ipsilateral carpal tunnel
2. syndrome. Conservative treatment consists of a custom orthosis and
3. nonsteroidal anti-inflammatory medication. The orthotic prescription should
4. read
5. 1- hand-based thumb spica splint, IP free.
6. 2- hand-based thumb spica splint, to base of nail.
7. 3- forearm-based thumb spica splint, IP free.
8. 4- forearm-based thumb spica splint, to base of nail.
9. 5- radial gutter wrist support splint, neutral.
2. syndrome. Conservative treatment consists of a custom orthosis and
3. nonsteroidal anti-inflammatory medication. The orthotic prescription should
4. read
5. 1- hand-based thumb spica splint, IP free.
6. 2- hand-based thumb spica splint, to base of nail.
7. 3- forearm-based thumb spica splint, IP free.
8. 4- forearm-based thumb spica splint, to base of nail.
9. 5- radial gutter wrist support splint, neutral.
A 35-year-old drill press operator lacerated her index finger over the dorsum
2. of the proximal interphalangeal joint on a piece of sheet metal 6 months ago.
3. Initial treatment included irrigation, debridement, and application of a splint
4. for 6 weeks. She has returned to work; however, she is dissatisfied with finger
5. mobility. She has a 30-degree arc of active and passive motion at the proximal
6. interphalangeal joint and full metacarpophalangeal and distal interphalangeal
7. motion. Management should consist of
8. 1- serial casting.
9. 2- a passive joint mobilization program.
10. 3- dorsal proximal interphalangeal joint capsulotomy.
11. 4- extensor tenolysis.
12. 5- extensor tenolysis and dorsal proximal interphalangeal joint capsulotomy.
2. of the proximal interphalangeal joint on a piece of sheet metal 6 months ago.
3. Initial treatment included irrigation, debridement, and application of a splint
4. for 6 weeks. She has returned to work; however, she is dissatisfied with finger
5. mobility. She has a 30-degree arc of active and passive motion at the proximal
6. interphalangeal joint and full metacarpophalangeal and distal interphalangeal
7. motion. Management should consist of
8. 1- serial casting.
9. 2- a passive joint mobilization program.
10. 3- dorsal proximal interphalangeal joint capsulotomy.
11. 4- extensor tenolysis.
12. 5- extensor tenolysis and dorsal proximal interphalangeal joint capsulotomy.
While performing a wrist fusion using a dorsally applied plate, the surgeon
2. notes that supination is limited after application of the plate. Intraoperative
3. radiographs show evidence of significant ulnocarpal abutment between the
4. distal ulna and the triquetrum. What is the next step in the procedure?
5. 1- Ulnar shortening
6. 2- Resection of the triquetrum
7. 3- Radial lengthening and bone graft
8. 4- Darrach resection of the distal ulna
9. 5- Hemiresection arthroplasty of the distal radioulnar joint
2. notes that supination is limited after application of the plate. Intraoperative
3. radiographs show evidence of significant ulnocarpal abutment between the
4. distal ulna and the triquetrum. What is the next step in the procedure?
5. 1- Ulnar shortening
6. 2- Resection of the triquetrum
7. 3- Radial lengthening and bone graft
8. 4- Darrach resection of the distal ulna
9. 5- Hemiresection arthroplasty of the distal radioulnar joint
A 26-year-old cashier sustained a transverse extra-articular fracture of the proximal phalangeal base
2. of the small finger 10 months ago. Treatment consisted of closed reduction and 5 weeks of
3. immobilization in an ulnar gutter splint. Figure 29a shows active extension, and Figure 29b shows
4. active flexion of the small finger. Figure 29c shows passive flexion of the small finger. There is 20
5. degrees of active flexion in the distal interphalangeal joint with blocking. Radiographs show a well-
6. healed fracture in satisfactory alignment. Treatment should now include
7. 1- a free tendon graft.
8. 2- a dorsal interphalangeal joint capsulotomy.
9. 3- staged tendon reconstruction with a silicone rod.
10. 4- sublimis and profundus tenolysis.
11. 5- sublimis tenodesis and distal interphalangeal joint fusion.
2. of the small finger 10 months ago. Treatment consisted of closed reduction and 5 weeks of
3. immobilization in an ulnar gutter splint. Figure 29a shows active extension, and Figure 29b shows
4. active flexion of the small finger. Figure 29c shows passive flexion of the small finger. There is 20
5. degrees of active flexion in the distal interphalangeal joint with blocking. Radiographs show a well-
6. healed fracture in satisfactory alignment. Treatment should now include
7. 1- a free tendon graft.
8. 2- a dorsal interphalangeal joint capsulotomy.
9. 3- staged tendon reconstruction with a silicone rod.
10. 4- sublimis and profundus tenolysis.
11. 5- sublimis tenodesis and distal interphalangeal joint fusion.
For the fracture shown in Figures 30a and 30b, the greatest mechanical rigidity
2. is obtained using which of the following fixation techniques?
3. 1- A Y-plate extending onto the medial and lateral column
4. 2- A medial column 3.5-mm plate and lateral tension band wiring
5. 3- A lateral contoured buttress plate and medial
6. interfragmentary 4.5-mm screw
7. 4- Two 3.5-mm reconstruction plates, one placed
8. medially and one placed posterolaterally
9. 5- Two 1/3 tubular plates,
10. one placed
11. posteromedially
12. and one placed
13. posterolaterally
2. is obtained using which of the following fixation techniques?
3. 1- A Y-plate extending onto the medial and lateral column
4. 2- A medial column 3.5-mm plate and lateral tension band wiring
5. 3- A lateral contoured buttress plate and medial
6. interfragmentary 4.5-mm screw
7. 4- Two 3.5-mm reconstruction plates, one placed
8. medially and one placed posterolaterally
9. 5- Two 1/3 tubular plates,
10. one placed
11. posteromedially
12. and one placed
13. posterolaterally
Figure 31 shows the radiographs of a 3-year-old boy with bowlegs. A family
2. history notes bowlegs in his grandfather and his mother is of short stature. His
3. dietary history is normal. The bowing was first noted when he started to walk
4. and has gradually increased. Laboratory studies are most likely to show normal
5. parathyroid hormone and
6. 1- normal serum calcium, phosphorus, and
7. alkaline phosphatase levels.
8. 2- normal serum calcium, low serum phosphorus,
9. and increased alkaline phosphatase levels.
10. 3- elevated serum calcium, low serum phosphorus,
11. and normal alkaline phosphatase levels.
12. 4- elevated serum calcium, low serum phosphorus,
13. and increased alkaline phosphatase levels.
14. 5- elevated serum calcium, normal serum
15. phosphorus, and increased alkaline
16. phosphatase levels.
2. history notes bowlegs in his grandfather and his mother is of short stature. His
3. dietary history is normal. The bowing was first noted when he started to walk
4. and has gradually increased. Laboratory studies are most likely to show normal
5. parathyroid hormone and
6. 1- normal serum calcium, phosphorus, and
7. alkaline phosphatase levels.
8. 2- normal serum calcium, low serum phosphorus,
9. and increased alkaline phosphatase levels.
10. 3- elevated serum calcium, low serum phosphorus,
11. and normal alkaline phosphatase levels.
12. 4- elevated serum calcium, low serum phosphorus,
13. and increased alkaline phosphatase levels.
14. 5- elevated serum calcium, normal serum
15. phosphorus, and increased alkaline
16. phosphatase levels.
When performing an anterolateral (Watson-Jones) approach to the hip, the
2. appropriate muscular interval is between the
3. 1- gluteus medius and piriformis
4. 2- gluteus medius and gluteus minimus
5. 3- gluteus medius and gluteus maximus
6. 4- tensor fascia lata and rectus femoris tensor
7. 5- fascia lata and gluteus medius
2. appropriate muscular interval is between the
3. 1- gluteus medius and piriformis
4. 2- gluteus medius and gluteus minimus
5. 3- gluteus medius and gluteus maximus
6. 4- tensor fascia lata and rectus femoris tensor
7. 5- fascia lata and gluteus medius
What is the most common clinical sign of pulmonary embolism following
2. total hip arthroplasty?
3. 1- Fever
4. 2- Tachypnea
5. 3- Tachycardia
6. 4- Pleural rub
7. 5- Edema and tenderness of the leg
2. total hip arthroplasty?
3. 1- Fever
4. 2- Tachypnea
5. 3- Tachycardia
6. 4- Pleural rub
7. 5- Edema and tenderness of the leg
Malignant melanoma of the foot is most commonly located on the
2. 1- toe web space
3. 2- dorsal surface
4. 3- plantar surface
5. 4- subungual space of the great toe
6. 5- subungual space of the lesser toe
2. 1- toe web space
3. 2- dorsal surface
4. 3- plantar surface
5. 4- subungual space of the great toe
6. 5- subungual space of the lesser toe
Immediate postoperative management after repair of a large rotator cuff tear
2. should include
3. 1- limited, passive range of mot,
4. 2- full, active shoulder range of motion exercises
5. 3- active range of motion exercises and resistive exercises
6. 4- protection in a sling for 3 weeks, but no motion exercises. protection in an abduction 5- pillow for 3 week, but no motion exercises
2. should include
3. 1- limited, passive range of mot,
4. 2- full, active shoulder range of motion exercises
5. 3- active range of motion exercises and resistive exercises
6. 4- protection in a sling for 3 weeks, but no motion exercises. protection in an abduction 5- pillow for 3 week, but no motion exercises
Which of the following factors is responsible for the largest proportional
2. increase in the cost of total hip arthroplasty from 1980 to 1990?
3. 1- Surgeon fees
4. 2- Cost of the prosthesis
5. 3- Operating room charges
6. 4- Physician fees other than the surgeon
7. 5- Charges other than the operating room
2. increase in the cost of total hip arthroplasty from 1980 to 1990?
3. 1- Surgeon fees
4. 2- Cost of the prosthesis
5. 3- Operating room charges
6. 4- Physician fees other than the surgeon
7. 5- Charges other than the operating room
Which of the following terms best describes most chondrosarcomas at initial
2. presentation?
3. 1- Metastatic
4. 2- Low-grade, intracompartmental
5. 3- Low-grade, extracompartmental
6. 4- High-grade, intracompartmental
7. 5- High-grade, extracompartmental
2. presentation?
3. 1- Metastatic
4. 2- Low-grade, intracompartmental
5. 3- Low-grade, extracompartmental
6. 4- High-grade, intracompartmental
7. 5- High-grade, extracompartmental
In which of the following anatomic sites will a patient with an early central
2. cord syndrome resulting from a cervical fracture-dislocation have more
3. neurologic dysfunction?
4. 1- Central torso
5. 2- Bowel and bladder
6. 3- Upper extremities
7. 4- Lower extremities
8. 5- Sympathetic nervous system
2. cord syndrome resulting from a cervical fracture-dislocation have more
3. neurologic dysfunction?
4. 1- Central torso
5. 2- Bowel and bladder
6. 3- Upper extremities
7. 4- Lower extremities
8. 5- Sympathetic nervous system
Which of the following imaging studies is considered the most specific
2. technique for diagnosing a recurrent disk herniation?
3. 1- Myelogram
4. 2- MRI scan
5. 3- MRI scan with gadolinium
6. 4- CT scan with IV contrast
7. 5- CT scan with intrathecal contrast
2. technique for diagnosing a recurrent disk herniation?
3. 1- Myelogram
4. 2- MRI scan
5. 3- MRI scan with gadolinium
6. 4- CT scan with IV contrast
7. 5- CT scan with intrathecal contrast
Ruffled borders and resorption pits (Howship's Lacunae) are histologic
2. features associated with which of the following cell types?
3. 1- Osteocytes
4. 2- Osteoclasts
5. 3- Osteoblasts
6. 4- Fibroblasts
7. 5- Chondroblasts
2. features associated with which of the following cell types?
3. 1- Osteocytes
4. 2- Osteoclasts
5. 3- Osteoblasts
6. 4- Fibroblasts
7. 5- Chondroblasts
Joint motion is maintained at a constant velocity under changing resistance in
2. which of the following exercises?
3. 1- Isotonic
4. 2- Isometric
5. 3- Isokinetic
6. 4- Eccentric
7. 5- Co-contraction
2. which of the following exercises?
3. 1- Isotonic
4. 2- Isometric
5. 3- Isokinetic
6. 4- Eccentric
7. 5- Co-contraction
The quadratus femoris is detached from the femur during a posterolateral
2. approach to the hip, and profuse arterial bleeding is encountered. The bleeding
3. is most likely from a branch of what artery?
4. 1- Obturator
5. 2- Profunda femoris
6. 3- First perforating
7. 4- Medial femoral circumflex
8. 5- Lateral femoral circumflex
2. approach to the hip, and profuse arterial bleeding is encountered. The bleeding
3. is most likely from a branch of what artery?
4. 1- Obturator
5. 2- Profunda femoris
6. 3- First perforating
7. 4- Medial femoral circumflex
8. 5- Lateral femoral circumflex
When an anterior approach to the cervical spine is being performed, many
2. surgeons prefer the left-sided approach to the right-sided approach because on
3. the left side the recurrent laryngeal nerve is
4. 1- larger.
5. 2- more consistent in location.
6. 3- entirely within the carotid sheath.
7. 4- well protected by the strap muscles of the neck.
8. 5- located between the longus colli and the esophagus.
2. surgeons prefer the left-sided approach to the right-sided approach because on
3. the left side the recurrent laryngeal nerve is
4. 1- larger.
5. 2- more consistent in location.
6. 3- entirely within the carotid sheath.
7. 4- well protected by the strap muscles of the neck.
8. 5- located between the longus colli and the esophagus.
Figure 32 shows the radiograph of an 8-year-old boy
2. who has pain in his shoulder after throwing a ball.,
3. Management at this time should include
4. 1- a sling.
5. 2- a biopsy.
6. 3- bone grafting.
7. 4- en bloc resection.
8. 5- administration of an intralesional steroid.
2. who has pain in his shoulder after throwing a ball.,
3. Management at this time should include
4. 1- a sling.
5. 2- a biopsy.
6. 3- bone grafting.
7. 4- en bloc resection.
8. 5- administration of an intralesional steroid.
An 18-year-old active duty soldier sustains a 6-cm segmental loss to the tibial
2. diaphysis from an antipersonnel mine. Treatment consists of a fine wire circular
3. external fixator with bone transport, and the immediate postoperative course is
4. uneventful. The patient is given instructions in advancing the frame during a
5. convalescent leave. A radiograph taken 5 weeks postoperatively shows a gain
6. of 4.5 cm and a radiolucent linear area transversely through the middle of the
7. regenerate bone. This finding is most likely the result of
8. 1- a fracture.
9. 2- a pin tract infection.
10. 3- advancing the frame too fast.
11. 4- advancing the frame too slowly.
12. 5- infection within the regenerate.
2. diaphysis from an antipersonnel mine. Treatment consists of a fine wire circular
3. external fixator with bone transport, and the immediate postoperative course is
4. uneventful. The patient is given instructions in advancing the frame during a
5. convalescent leave. A radiograph taken 5 weeks postoperatively shows a gain
6. of 4.5 cm and a radiolucent linear area transversely through the middle of the
7. regenerate bone. This finding is most likely the result of
8. 1- a fracture.
9. 2- a pin tract infection.
10. 3- advancing the frame too fast.
11. 4- advancing the frame too slowly.
12. 5- infection within the regenerate.
A patient undergoes anatomic reduction and stable fixation of a spiral distal
2. fibula fracture that is 4.5 cm above the joint. With which of the following
3. concomitant injuries is the patient most likely to benefit from placement of a
4. syndesmosis screw?
5. 1- Deltoid ligament rupture
6. 2- Wagstaffe's avulsion fracture
7. 3- Rupture of the anterior inferior tibiofibular ligament
8. 4- Oblique medial malleolus fracture that has been reduced and stabilized
9. 5- Transverse medial malleolus fracture that has been reduced and stabilized
2. fibula fracture that is 4.5 cm above the joint. With which of the following
3. concomitant injuries is the patient most likely to benefit from placement of a
4. syndesmosis screw?
5. 1- Deltoid ligament rupture
6. 2- Wagstaffe's avulsion fracture
7. 3- Rupture of the anterior inferior tibiofibular ligament
8. 4- Oblique medial malleolus fracture that has been reduced and stabilized
9. 5- Transverse medial malleolus fracture that has been reduced and stabilized
A 36-year-old woman who has had intermittent pain in her knee for the past 8
2. months reports that over the last 2 months the pain has increased in frequency
3. and intensity. Laboratory studies show that the CBC and erythrocyte sedimentation rate are within normal
4. limits. AP and lateral radiographs
5. are shown in Figures 33a and 33b.
6. Low- and high-power
7. photomicrographs of the biopsy
8. specimen are shown in Figures 33c
9. and 33d. What is the most likely
10. diagnosis?
11. 1- Lymphoma
12. 2- Osteomyelitis
13. 3- Unicameral bone cyst
14. 4- Aneurysmal bone cyst
15. 5- Eosinophilic granuloma
2. months reports that over the last 2 months the pain has increased in frequency
3. and intensity. Laboratory studies show that the CBC and erythrocyte sedimentation rate are within normal
4. limits. AP and lateral radiographs
5. are shown in Figures 33a and 33b.
6. Low- and high-power
7. photomicrographs of the biopsy
8. specimen are shown in Figures 33c
9. and 33d. What is the most likely
10. diagnosis?
11. 1- Lymphoma
12. 2- Osteomyelitis
13. 3- Unicameral bone cyst
14. 4- Aneurysmal bone cyst
15. 5- Eosinophilic granuloma
What structure is most commonly injured when the anterior bolts are placed
2. through a halo fixation device?
3. 1- Frontal sinus
4. 2- Ethmoid sinus
5. 3- Temporal artery
6. 4- Supraorbital nerve
7. 5- Superior rectus muscle
2. through a halo fixation device?
3. 1- Frontal sinus
4. 2- Ethmoid sinus
5. 3- Temporal artery
6. 4- Supraorbital nerve
7. 5- Superior rectus muscle
When an orthopaedic surgeon who works for and is paid by an HMO discusses
2. proposed treatments with a patient, the surgeon should
3. 1- discuss all reasonable treatment options.
4. 2- discuss only the proposed treatment to be done.
5. 3- discuss only the options that are cost-effective and outcome-proven.
6. 4- have the patient and two witnesses sign a transcript of the discussion.
7. 5- refer the patient to the medical administrator for covered treatment options.
2. proposed treatments with a patient, the surgeon should
3. 1- discuss all reasonable treatment options.
4. 2- discuss only the proposed treatment to be done.
5. 3- discuss only the options that are cost-effective and outcome-proven.
6. 4- have the patient and two witnesses sign a transcript of the discussion.
7. 5- refer the patient to the medical administrator for covered treatment options.
What cell type is implicated as the origin for the mediators of bone resorption
2. and osteolysis about both uncemented and cemented total hip arthroplasty?
3. 1- Fibroblast
4. 2- Macrophage
5. 3- Plasma cell
6. 4- T-lymphocyte
7. 5- B-lymphocyte
2. and osteolysis about both uncemented and cemented total hip arthroplasty?
3. 1- Fibroblast
4. 2- Macrophage
5. 3- Plasma cell
6. 4- T-lymphocyte
7. 5- B-lymphocyte
A claim must be made within what time period to be covered by an occurrence
2. professional liability insurance policy in effect a the time the injury occurred?
3. 1- Prior to physician's retirement
4. 2- Up to 1 year after the incident occurred
5. 3- Up to 3 years after the incident occurred
6. 4- Up to 7 years after the incident occurred
7. 5- There are no time restrictions
2. professional liability insurance policy in effect a the time the injury occurred?
3. 1- Prior to physician's retirement
4. 2- Up to 1 year after the incident occurred
5. 3- Up to 3 years after the incident occurred
6. 4- Up to 7 years after the incident occurred
7. 5- There are no time restrictions
Figures 34a through 34c show a bone scan, MRI
2. scan, and CT scan of a 16-year old boy who has had
3. upper thoracic pain for the past 6 months. The pain
4. does not radiate into the extremities, although it does
5. awaken him at night. His neurologic examination is
6. normal, and plain radiographs show no abnormality.
7. What is the most likely diagnosis?
8. 1- Osteosarcoma
9. 2- Osteoblastoma
10. 3- Giant cell tumor
11. 4- Old trauma with sclerotic healing
12. 5- Encapsulated nonossifying fibroma
2. scan, and CT scan of a 16-year old boy who has had
3. upper thoracic pain for the past 6 months. The pain
4. does not radiate into the extremities, although it does
5. awaken him at night. His neurologic examination is
6. normal, and plain radiographs show no abnormality.
7. What is the most likely diagnosis?
8. 1- Osteosarcoma
9. 2- Osteoblastoma
10. 3- Giant cell tumor
11. 4- Old trauma with sclerotic healing
12. 5- Encapsulated nonossifying fibroma
A 17-year-old boy who runs cross country has a 6-week history of bilateral
2. deep anterior medial leg pain that persists for 2 to 3 hours after running.
3. Examination shows no pain with palpation, and radiographs are normal. Which
4. of the following tests will best confirm a diagnosis?
5. 1- CT scan
6. 2- MRI scan
7. 3- Gallium bone scan
8. 4- Stereoroentgenography
9. 5- Preexercise and postexercise compartment measurements
2. deep anterior medial leg pain that persists for 2 to 3 hours after running.
3. Examination shows no pain with palpation, and radiographs are normal. Which
4. of the following tests will best confirm a diagnosis?
5. 1- CT scan
6. 2- MRI scan
7. 3- Gallium bone scan
8. 4- Stereoroentgenography
9. 5- Preexercise and postexercise compartment measurements
Surgical treatment of the femoral window used to remove cement in a revision
2. hip arthroplasty should consist of
3. 1- plugging the defect with polymethylmethacrylate.
4. 2- bridging the window with a femoral strut allograft.
5. 3- plating and bone grafting the window prophylactically.
6. 4- inserting a retrograde intramedullary nail to span the defect.
7. 5- spanning the defect with a prosthesis by at least two cortical diameters.
2. hip arthroplasty should consist of
3. 1- plugging the defect with polymethylmethacrylate.
4. 2- bridging the window with a femoral strut allograft.
5. 3- plating and bone grafting the window prophylactically.
6. 4- inserting a retrograde intramedullary nail to span the defect.
7. 5- spanning the defect with a prosthesis by at least two cortical diameters.
A 35-year-old man has multi-system blunt injuries as a result of a 15-foot fall.
2. During the resuscitation phase of acute management, the patient is stabilized
3. and radiographs are ordered. Which of the following radiographic views
4. should be selected at this phase of the patient's care?
5. 1- Cervical spine
6. 2- Cervical spine and AP chest
7. 3- Cervical spine, AP chest, and supine abdomen
8. 4- Cervical spine, AP chest, and AP pelvis
9. 5- Cervical spine, AP chest, and cross-table lateral thoracolumbar spine
2. During the resuscitation phase of acute management, the patient is stabilized
3. and radiographs are ordered. Which of the following radiographic views
4. should be selected at this phase of the patient's care?
5. 1- Cervical spine
6. 2- Cervical spine and AP chest
7. 3- Cervical spine, AP chest, and supine abdomen
8. 4- Cervical spine, AP chest, and AP pelvis
9. 5- Cervical spine, AP chest, and cross-table lateral thoracolumbar spine
Examination of a 10-year-old girl who has a Salter type II fracture of the
2. proximal humeral metaphysis reveals that the fracture is angulated 40 degrees
3. (apex lateral) and displaced 30%. There are no other injuries. Treatment should
4. consist of
5. 1- open reduction and internal fixation.
6. 2- immobilization in a sling and swathe.
7. 3- closed reduction and percutaneous pin fixation.
8. 4- closed reduction followed by application of an abduction shoulder spica cast.
9. 5- olecranon pin traction for 2 weeks, followed by application of a shoulder spica cast.
2. proximal humeral metaphysis reveals that the fracture is angulated 40 degrees
3. (apex lateral) and displaced 30%. There are no other injuries. Treatment should
4. consist of
5. 1- open reduction and internal fixation.
6. 2- immobilization in a sling and swathe.
7. 3- closed reduction and percutaneous pin fixation.
8. 4- closed reduction followed by application of an abduction shoulder spica cast.
9. 5- olecranon pin traction for 2 weeks, followed by application of a shoulder spica cast.
What biomechanical considerations enter into the pathophysiology of the
2. condition shown in Figure 35?
3. 1- Early joint motion initiates joint deformation.
4. 2- Laxity of the cruciate ligaments allows tibial
5. subluxation.
6. 3- Static compressive loads adversely affect
7. physeal cartilage.
8. 4- Static compressive loads adversely affect
9. articular cartilage.
10. 5- Hypertrophic bone on the compressive side
11. further impinges on the growth plate.
2. condition shown in Figure 35?
3. 1- Early joint motion initiates joint deformation.
4. 2- Laxity of the cruciate ligaments allows tibial
5. subluxation.
6. 3- Static compressive loads adversely affect
7. physeal cartilage.
8. 4- Static compressive loads adversely affect
9. articular cartilage.
10. 5- Hypertrophic bone on the compressive side
11. further impinges on the growth plate.
A 14-year-old boy undergoes excisional biopsy of a 3-cm mass over the lateral
2. aspect of the proximal forearm. No imaging studies were obtained prior to the
3. biopsy. A photomicrograph of the biopsy specimen is shown in Figure 36.
4. What is the most likely diagnosis?
5. 1- Desmoid tumor
6. 2- Rhabdomyosarcoma
7. 3- Synovial sarcoma
8. 4- Nodular fasciitis
9. 5- Proliferative fasciitis
2. aspect of the proximal forearm. No imaging studies were obtained prior to the
3. biopsy. A photomicrograph of the biopsy specimen is shown in Figure 36.
4. What is the most likely diagnosis?
5. 1- Desmoid tumor
6. 2- Rhabdomyosarcoma
7. 3- Synovial sarcoma
8. 4- Nodular fasciitis
9. 5- Proliferative fasciitis
When should risk management begin in a hospital setting?
2. 1- At discharge from the hospital
3. 2- At the completion of a procedure
4. 3- At the physician's first encounter with a patient
5. 4- When a patient files a formal complaint
6. 5- When a patient initiates legal action against a physician
2. 1- At discharge from the hospital
3. 2- At the completion of a procedure
4. 3- At the physician's first encounter with a patient
5. 4- When a patient files a formal complaint
6. 5- When a patient initiates legal action against a physician
Which of the following conditions best characterizes hypermobile pes planus?
2. 1- Hindfoot varus
3. 2- Forefoot adduction
4. 3- Talonavicular instability
5. 4- Lack of supination at push-off
6. 5- Difficulty abducting the forefoot at push-off
2. 1- Hindfoot varus
3. 2- Forefoot adduction
4. 3- Talonavicular instability
5. 4- Lack of supination at push-off
6. 5- Difficulty abducting the forefoot at push-off
Figure 38 shows an axial cat of the L4-5 disk space. Physical findings
2. expected in this patient would be weakness of the
3. 1- left quadriceps and depressed left knee jerk.
4. 2- right quadriceps and depressed right knee jerk.
5. 3- right gastrocsoleus muscle and absent right ankle jerk.
6. 4- left extensor hallucis longus and numbness of the little toe.
7. 5- right extensor hallucis longus and numbness of the right big toe.
2. expected in this patient would be weakness of the
3. 1- left quadriceps and depressed left knee jerk.
4. 2- right quadriceps and depressed right knee jerk.
5. 3- right gastrocsoleus muscle and absent right ankle jerk.
6. 4- left extensor hallucis longus and numbness of the little toe.
7. 5- right extensor hallucis longus and numbness of the right big toe.
A 56- year old man has had a
2. slowly enlarging soft tissue
3. mass in his left thigh for the past
4. 6 months. Plain radiographs
5. show only a soft-tissue shadow
6. with no mineralization or
7. obvious bony involvement. The
8. proton density MRI scar shown
9. in Figures 39a and 39b show a
10. coronal view and axial view,
11. respectively, of the thigh. At this
12. time management should include
13. 1- excisional biopsy
14. 2- incisional biopsy
15. 3- resection with a wide margin
16. 4- a repeat MRI scan in 3 months
17. 5- a repeat clinical examination
18. in 3 months
2. slowly enlarging soft tissue
3. mass in his left thigh for the past
4. 6 months. Plain radiographs
5. show only a soft-tissue shadow
6. with no mineralization or
7. obvious bony involvement. The
8. proton density MRI scar shown
9. in Figures 39a and 39b show a
10. coronal view and axial view,
11. respectively, of the thigh. At this
12. time management should include
13. 1- excisional biopsy
14. 2- incisional biopsy
15. 3- resection with a wide margin
16. 4- a repeat MRI scan in 3 months
17. 5- a repeat clinical examination
18. in 3 months
A 10-year-old boy of Mediterranean ancestry whose height is in the 25th
2. percentile sustains a fracture of the distal femur following a mild fall.
3. Radiographs reveal an impacted fracture of the distal femur, as well in both
4. femora and the pelvis. Laboratory studies show a hemoglobin level of 7
5. mg/dL. A complete hematologic evaluation is likely to reveal
6. 1- hemoglobin S and C
7. 2- hemoglobin S chains only
8. 3- no hematologic abnormalities
9. 4- increased total iron-binding capacity
10. 5- absence of or severely deficient beta globulin
2. percentile sustains a fracture of the distal femur following a mild fall.
3. Radiographs reveal an impacted fracture of the distal femur, as well in both
4. femora and the pelvis. Laboratory studies show a hemoglobin level of 7
5. mg/dL. A complete hematologic evaluation is likely to reveal
6. 1- hemoglobin S and C
7. 2- hemoglobin S chains only
8. 3- no hematologic abnormalities
9. 4- increased total iron-binding capacity
10. 5- absence of or severely deficient beta globulin
A 42-year-old woman has had progressive difficulty walking for the past 4
2. months. An MRI scan reveals a large T10-T11 disk herniation with
3. significant compression of the spinal cord. Which of the following signs
4. would be most suggestive of spinal cord compression?
5. 1- Clonus
6. 2- Weakness
7. 3- Hyporeflexia
8. 4- Flaccid paralysis
9. 5- Positive Hoffman's sign
2. months. An MRI scan reveals a large T10-T11 disk herniation with
3. significant compression of the spinal cord. Which of the following signs
4. would be most suggestive of spinal cord compression?
5. 1- Clonus
6. 2- Weakness
7. 3- Hyporeflexia
8. 4- Flaccid paralysis
9. 5- Positive Hoffman's sign
A 72-year-old man has persistent drainage following a total knee arthro
2. performed 3 weeks ago. A knee aspirate shows moderate polymorphonuclear
3. leukocytes and Gram-positive cocci in clusters. Management should include
4. 1- one-stage exchange arthroplasty
5. 2- two-stage exchange arthroplasty
6. 3- local wound care and oral antibiotics
7. 4- oral antibiotics with reexamination in a few days
8. 5- irrigation, debridement, and retention of the components
2. performed 3 weeks ago. A knee aspirate shows moderate polymorphonuclear
3. leukocytes and Gram-positive cocci in clusters. Management should include
4. 1- one-stage exchange arthroplasty
5. 2- two-stage exchange arthroplasty
6. 3- local wound care and oral antibiotics
7. 4- oral antibiotics with reexamination in a few days
8. 5- irrigation, debridement, and retention of the components
Which of the following analyses must be performed to ensure that the sample
2. size of an experiment is sufficient to draw statistical conclusions?
3. 1- Student's t-test
4. 2- Repeatability test
5. 3- Power analysis
6. 4- Variance analysis
7. 5- Multivariate analysis
2. size of an experiment is sufficient to draw statistical conclusions?
3. 1- Student's t-test
4. 2- Repeatability test
5. 3- Power analysis
6. 4- Variance analysis
7. 5- Multivariate analysis
Which of the following is the treatment of choice for a neurologically intact
2. patient with the C2 fracture shown on the lateral radiograph in Figure 40?
3. 1- Application of a halo brace
4. 2- Application of a rigid orthosis
5. 3- Screw fixation across the fracture
6. 4- Posterior wiring and a halo brace
7. 5- Posterior wiring and a rigid orthosis
2. patient with the C2 fracture shown on the lateral radiograph in Figure 40?
3. 1- Application of a halo brace
4. 2- Application of a rigid orthosis
5. 3- Screw fixation across the fracture
6. 4- Posterior wiring and a halo brace
7. 5- Posterior wiring and a rigid orthosis
What is the mechanism of injury for the L1 injury shown in Figure 41?
2. 1- Translation
3. 2- Distraction
4. 3- Axial rotation
5. 4- Flexion
6. 5- Flexion-distraction
2. 1- Translation
3. 2- Distraction
4. 3- Axial rotation
5. 4- Flexion
6. 5- Flexion-distraction
What is the most likely cause of heel pain in an athletic 12-year-old boy?
2. 1- Tarsal coalition
3. 2- Reiter's syndrome
4. 3- Calcaneal apophysitis
5. 4- Calcaneal osteomyelitis
6. 5- Calcaneal stress fracture
2. 1- Tarsal coalition
3. 2- Reiter's syndrome
4. 3- Calcaneal apophysitis
5. 4- Calcaneal osteomyelitis
6. 5- Calcaneal stress fracture
A 25-year old man sustains multiple injuries, including a pelvic ring
2. disruption, in a motor vehicle accident. He is hemodynamically stable.
3. Attempts to pass a urinary catheter are unsuccessful. What diagnostic test
4. should be obtained next?
5. 1- CT scan
6. 2- Cystogram
7. 3- Urinalysis
8. 4- Excretory urogram
9. 5- Retrograde urethrogram
2. disruption, in a motor vehicle accident. He is hemodynamically stable.
3. Attempts to pass a urinary catheter are unsuccessful. What diagnostic test
4. should be obtained next?
5. 1- CT scan
6. 2- Cystogram
7. 3- Urinalysis
8. 4- Excretory urogram
9. 5- Retrograde urethrogram
A 45-year-old man who has pain in his wrist and elbow underwent resection of
2. the radial head for a comminuted fracture 8 years ago. Four years ago, a
3. modified Darrach distal ulna resection of the same arm was performed for wrist
4. pain, but with no relief of symptoms. Two years ago additional ulna was
5. resected. He has instability and pain with ballottement of the distal ulna, as well
6. as pain and snapping with forearm rotation. Treatment should now consist of
7. 1- ulnar shortening
8. 2- creation of a one bone forearm (radioulnar syntosis).
9. 3- distal radioulnar joint stabilization using the flexor carpi ulnaris
10. 4- distal radioulnar joint fusion with proximal ulnar pseudoarthrosis (Sauve-Kapandji).
11. 5- implantation of a radial head replacement and distal radioulnar joint stabilization
2. the radial head for a comminuted fracture 8 years ago. Four years ago, a
3. modified Darrach distal ulna resection of the same arm was performed for wrist
4. pain, but with no relief of symptoms. Two years ago additional ulna was
5. resected. He has instability and pain with ballottement of the distal ulna, as well
6. as pain and snapping with forearm rotation. Treatment should now consist of
7. 1- ulnar shortening
8. 2- creation of a one bone forearm (radioulnar syntosis).
9. 3- distal radioulnar joint stabilization using the flexor carpi ulnaris
10. 4- distal radioulnar joint fusion with proximal ulnar pseudoarthrosis (Sauve-Kapandji).
11. 5- implantation of a radial head replacement and distal radioulnar joint stabilization
A 22-year-old woman sustains multiple injuries, including a femoral shaft
2. fracture, when she is struck by an automobile. The fracture is 15 cm proximal
3. to the knee joint and has a 10-cm open wound directly over it. Management of
4. the fracture should include administration of antibiotics and surgical
5. debridement, in addition to
6. 1- external fixation.
7. 2- plate fixation and bone grafting.
8. 3- immediate closed intramedullary nailing.
9. 4- closed reduction and balanced skeletal traction.
10. 5- delayed primary closure and delayed intramedullary nailing.
2. fracture, when she is struck by an automobile. The fracture is 15 cm proximal
3. to the knee joint and has a 10-cm open wound directly over it. Management of
4. the fracture should include administration of antibiotics and surgical
5. debridement, in addition to
6. 1- external fixation.
7. 2- plate fixation and bone grafting.
8. 3- immediate closed intramedullary nailing.
9. 4- closed reduction and balanced skeletal traction.
10. 5- delayed primary closure and delayed intramedullary nailing.
A middle-aged man has pain at the base of the first and second metatarsals, a
2. dorsal prominence, and degenerative changes of the first and second
3. tarsometatarsal joints. Treatment should include surgical removal of the
4. exostosis and
5. 1- tendon transfer.
6. 2- nerve decompression.
7. 3- first metatarsal osteotomy.
8. 4- tarsometatarsal arthrodesis.
9. 5- realignment of the metatarsals.
2. dorsal prominence, and degenerative changes of the first and second
3. tarsometatarsal joints. Treatment should include surgical removal of the
4. exostosis and
5. 1- tendon transfer.
6. 2- nerve decompression.
7. 3- first metatarsal osteotomy.
8. 4- tarsometatarsal arthrodesis.
9. 5- realignment of the metatarsals.
When using the posterior surgical approach to the hip, extending the incision
2. too far proximally through the gluteus maximus muscle may result in
3. significant injury to which of the following structures?
4. 1- Sciatic nerve
5. 2- Inferior gluteal nerve
6. 3- Inferior gluteal artery
7. 4- Superior gluteal nerve
8. 5- Superior gluteal artery
2. too far proximally through the gluteus maximus muscle may result in
3. significant injury to which of the following structures?
4. 1- Sciatic nerve
5. 2- Inferior gluteal nerve
6. 3- Inferior gluteal artery
7. 4- Superior gluteal nerve
8. 5- Superior gluteal artery
A 35-year-old man sustains a closed Galeazzi fracture-dislocation and a fry: of
2. the ulnar styloid process as a result of a high-speed motor vehicle accident The
3. radius fracture is anatomically fixed with a plate; however, the ulnar head
4. remains dislocated. What structure is most likely responsible for preventing
5. reduction?
6. 1- Radioulnar capsule
7. 2- Pronator quadratus
8. 3- Flexor carpi ulnaris
9. 4- Extensor carpi ulnaris
10. 5- Triangular fibrocartilage complex
2. the ulnar styloid process as a result of a high-speed motor vehicle accident The
3. radius fracture is anatomically fixed with a plate; however, the ulnar head
4. remains dislocated. What structure is most likely responsible for preventing
5. reduction?
6. 1- Radioulnar capsule
7. 2- Pronator quadratus
8. 3- Flexor carpi ulnaris
9. 4- Extensor carpi ulnaris
10. 5- Triangular fibrocartilage complex
A patient has had residual pain along the lateral hindfoot following an
2. inversion sprain 4 months ago. Examination reveals tenderness over the origin
3. of the extensor digitorum brevis muscle. There is pain with subtalar inversion;
4. however, there is no pain with ankle movement and no ankle instability is
5. noted. Plain stress radiographs of the ankle are normal, and an MRI scan of
6. the ankle ligaments is normal. What is the most likely diagnosis?
7. 1- Residual ankle synovitis
8. 2- Peroneal tendon subluxation
9. 3- Functional ankle instability
10. 4- Osteochondral talar fracture
11. 5- Subtalar instability and sinus tarsi syndrome
2. inversion sprain 4 months ago. Examination reveals tenderness over the origin
3. of the extensor digitorum brevis muscle. There is pain with subtalar inversion;
4. however, there is no pain with ankle movement and no ankle instability is
5. noted. Plain stress radiographs of the ankle are normal, and an MRI scan of
6. the ankle ligaments is normal. What is the most likely diagnosis?
7. 1- Residual ankle synovitis
8. 2- Peroneal tendon subluxation
9. 3- Functional ankle instability
10. 4- Osteochondral talar fracture
11. 5- Subtalar instability and sinus tarsi syndrome
Management of medial scapular winging emphasizes strengthening of the
2. 1- trapezius
3. 2- rhomboids.
4. 3- subscapularis.
5. 4- latissimus dorsi.
6. 5- serratus anterior
2. 1- trapezius
3. 2- rhomboids.
4. 3- subscapularis.
5. 4- latissimus dorsi.
6. 5- serratus anterior
The principal weapon in defending any claim of medical negligence is the
2. 1- surgeon
3. 2- deposition
4. 3- expert witness
5. 4- medical record
6. 5- defense attorney
2. 1- surgeon
3. 2- deposition
4. 3- expert witness
5. 4- medical record
6. 5- defense attorney
Which of the following medications acts as an antagonist to warfarin?
2. 1- Rifampin
3. 2- Phenytoin
4. 3- Cimetidine
5. 4- Cefamandole
6. 5- Trimethoprim
2. 1- Rifampin
3. 2- Phenytoin
4. 3- Cimetidine
5. 4- Cefamandole
6. 5- Trimethoprim
A 2-year-old boy with Larsen's syndrome was seen at the age of 15 months for
2. untreated clubfoot, dislocations of the knees and radial heads, and a cervical
3. kyphosis of 45 degrees. He is able to move all extremities. History reveals that
4. he sat independently at 10 months; however, he is not yet pulling to stand, and
5. there has been no improvement in motor milestones. Initial treatment should
6. consist of
7. 1- anterior cervical fusion.
8. 2- posterior cervical fusion.
9. 3- open reduction of the dislocated knees.
10. 4- correction of the clubfoot by complete subtalar release.
11. 5- reduction of the radial head and annular ligament reconstruction.
2. untreated clubfoot, dislocations of the knees and radial heads, and a cervical
3. kyphosis of 45 degrees. He is able to move all extremities. History reveals that
4. he sat independently at 10 months; however, he is not yet pulling to stand, and
5. there has been no improvement in motor milestones. Initial treatment should
6. consist of
7. 1- anterior cervical fusion.
8. 2- posterior cervical fusion.
9. 3- open reduction of the dislocated knees.
10. 4- correction of the clubfoot by complete subtalar release.
11. 5- reduction of the radial head and annular ligament reconstruction.
Examination of a construction worker who received an accidental electrical
2. shock while on the job reveals that he is awake, alert, and holding his arm
3. tightly against the chest and holding his forearm tightly to the front of the
4. trunk. External rotation and abduction are severely limited and painful. Which
5. of the following injuries best accounts for these findings?
6. 1- Luxatio erecta
7. 2- Anterior dislocation of the glenohumeral joint
8. 3- Superior dislocation of the glenohumeral joint
9. 4- Posterior dislocation of the glenohumeral joint
10. 5- Greater tuberosity fracture of the proximal humerus
2. shock while on the job reveals that he is awake, alert, and holding his arm
3. tightly against the chest and holding his forearm tightly to the front of the
4. trunk. External rotation and abduction are severely limited and painful. Which
5. of the following injuries best accounts for these findings?
6. 1- Luxatio erecta
7. 2- Anterior dislocation of the glenohumeral joint
8. 3- Superior dislocation of the glenohumeral joint
9. 4- Posterior dislocation of the glenohumeral joint
10. 5- Greater tuberosity fracture of the proximal humerus
What is the most common clinical indicator of reflex sympathetic dystrophy of
2. the knee?
3. 1- Effusion
4. 2- Muscle atrophy
5. 3- Atrophic hair changes
6. 4- Disproportionate pain
7. 5- Decreased range of motion
2. the knee?
3. 1- Effusion
4. 2- Muscle atrophy
5. 3- Atrophic hair changes
6. 4- Disproportionate pain
7. 5- Decreased range of motion
Which of the following tests is most useful for detecting infection in the work-
2. up of a painful joint arthroplasty?
3. 1- Indium scan
4. 2- Hip aspiration
5. 3- Plain radiograph
6. 4- Three-phase bone imaging
7. 5- Erythrocyte sedimentation rate
2. up of a painful joint arthroplasty?
3. 1- Indium scan
4. 2- Hip aspiration
5. 3- Plain radiograph
6. 4- Three-phase bone imaging
7. 5- Erythrocyte sedimentation rate
A 14-year-old boy who has myelodysplasia with a neurologic level at L4-5
2. now has swelling and redness around the ankle joint after he decided to walk
3. without an orthosis or crutches. These findings are most likely due to
4. 1- calcaneal fracture.
5. 2- acute fracture.
6. 3- acute osteomyelitis.
7. 4- acute joint infection.
8. 5- acute ankle synovitis.
2. now has swelling and redness around the ankle joint after he decided to walk
3. without an orthosis or crutches. These findings are most likely due to
4. 1- calcaneal fracture.
5. 2- acute fracture.
6. 3- acute osteomyelitis.
7. 4- acute joint infection.
8. 5- acute ankle synovitis.
Figure 42 shows a photograph of a 30-year-old man who has had a slowly
2. growing mass at the level of the proximal interphalangeal joint of his middle
3. finger for the past 5 years. Radiographs show a soft-tissue mass without bony
4. or articular abnormalities. The biopsy specimen shows giant cell tumor of the
5. tendon sheath. Treatment should include
6. 1- ray amputation.
7. 2- wide excision.
8. 3- marginal excision.
9. 4- excision and low-dose external
10. beam radiation therapy.
11. 5- excision and high-dose external
12. beam radiation therapy.
2. growing mass at the level of the proximal interphalangeal joint of his middle
3. finger for the past 5 years. Radiographs show a soft-tissue mass without bony
4. or articular abnormalities. The biopsy specimen shows giant cell tumor of the
5. tendon sheath. Treatment should include
6. 1- ray amputation.
7. 2- wide excision.
8. 3- marginal excision.
9. 4- excision and low-dose external
10. beam radiation therapy.
11. 5- excision and high-dose external
12. beam radiation therapy.
Figures 44a and 44b show the plain radiographs of
2. a 12-year-old boy who has had left medial knee
3. pain for the past 4 months. Figure 44c shows
4. representative histologic material. What is the most
5. likely diagnosis?
6. 1- Enchondroma
7. 2- Osteoblastoma
8. 3- Giant cell tumor
9. 4- Chondroblastoma
10. 5- Osteochondritis dissecans
2. a 12-year-old boy who has had left medial knee
3. pain for the past 4 months. Figure 44c shows
4. representative histologic material. What is the most
5. likely diagnosis?
6. 1- Enchondroma
7. 2- Osteoblastoma
8. 3- Giant cell tumor
9. 4- Chondroblastoma
10. 5- Osteochondritis dissecans
The clinical photograph of the hand of a 72-year-old woman who sustained a
2. laceration of the flexor pollicis longus in her thumb is shown in Figure 45. She
3. cannot actively flex the interphalangeal joint. Which pulley, in addition to the
4. oblique pulley, has been lacerated?
5. 1- A-1
6. 2- A-2
7. 3- A-3
8. 4- A-4
9. 5- A-5
2. laceration of the flexor pollicis longus in her thumb is shown in Figure 45. She
3. cannot actively flex the interphalangeal joint. Which pulley, in addition to the
4. oblique pulley, has been lacerated?
5. 1- A-1
6. 2- A-2
7. 3- A-3
8. 4- A-4
9. 5- A-5
Which of the following nerves is most commonly at risk for injury during
2. resection of a calcaneonavicular tarsal coalition?
3. 1- Saphenous
4. 2- Lateral plantar
5. 3- Lateral branch of the deep peroneal
6. 4- Medial plantar .
7. 5- Medial branch of the deep peroneal
2. resection of a calcaneonavicular tarsal coalition?
3. 1- Saphenous
4. 2- Lateral plantar
5. 3- Lateral branch of the deep peroneal
6. 4- Medial plantar .
7. 5- Medial branch of the deep peroneal
Bending stiffness of an external fixation frame will be decreased by
2. 1- changing to a hybrid frame.
3. 2- axially dynamizing the frame.
4. 3- increasing patient weightbearing.
5. 4- increasing the frame-bone distance.
6. 5- adding another pin close to the fracture site.
2. 1- changing to a hybrid frame.
3. 2- axially dynamizing the frame.
4. 3- increasing patient weightbearing.
5. 4- increasing the frame-bone distance.
6. 5- adding another pin close to the fracture site.
A newborn with low lumbar level spina bifida has convex pes valgus. The first
2. ray cannot be made colinear with the talus, even with forced plantar flexion.
3. Management should include
4. 1- serial casting
5. 2- primary talectomy before walking age
6. 3- soft shoes, with no manipulation or surgery
7. 4- performing subtalar arthrodesis at age 6 years
8. 5- surgical realignment and appropriate tenotomies before walking age.
2. ray cannot be made colinear with the talus, even with forced plantar flexion.
3. Management should include
4. 1- serial casting
5. 2- primary talectomy before walking age
6. 3- soft shoes, with no manipulation or surgery
7. 4- performing subtalar arthrodesis at age 6 years
8. 5- surgical realignment and appropriate tenotomies before walking age.
The functional expectations of a patient with C6 quadriplegia include
2. 1- functional thumb pinch.
3. 2- functional wrist flexion.
4. 3- functional grip strength.
5. 4- manual wheelchair locomotion.
6. 5- independent transfers without aids.
2. 1- functional thumb pinch.
3. 2- functional wrist flexion.
4. 3- functional grip strength.
5. 4- manual wheelchair locomotion.
6. 5- independent transfers without aids.
Figure 46 shows an axial MRI view of the L3-4 disk space with pathology that
2. is best described as
3. 1- a left facet cyst.
4. 2- an aortic aneurysm.
5. 3- central spinal stenosis.
6. 4- central disk herniation.
7. 5- left foraminal disk herniation.
2. is best described as
3. 1- a left facet cyst.
4. 2- an aortic aneurysm.
5. 3- central spinal stenosis.
6. 4- central disk herniation.
7. 5- left foraminal disk herniation.
A 60-year-old woman has persistent well localized
2. pain over the proximal tibia following total knee
3. arthroplasty. Examination reveals that the
4. proximal tibia feels significantly warmer than the
5. opposite side. Range of motion in the knee is
6. similar to that in the opposite side, and there is no
7. effusion. An radiograph of the tibia is shown in
8. Figure 47a, a technetium bone scan of knees is
9. shown in Figure 47b, and a CT scan through the
10. area of the tibia with increased uptake is shown in
11. Figure 47c. What is the most likely diagnosis?
12. 1- Lymphoma
13. 2- Osteomyelitis
14. 3- Paget's disease
15. 4- Stress fracture
16. 5- Metastatic carcinoma
2. pain over the proximal tibia following total knee
3. arthroplasty. Examination reveals that the
4. proximal tibia feels significantly warmer than the
5. opposite side. Range of motion in the knee is
6. similar to that in the opposite side, and there is no
7. effusion. An radiograph of the tibia is shown in
8. Figure 47a, a technetium bone scan of knees is
9. shown in Figure 47b, and a CT scan through the
10. area of the tibia with increased uptake is shown in
11. Figure 47c. What is the most likely diagnosis?
12. 1- Lymphoma
13. 2- Osteomyelitis
14. 3- Paget's disease
15. 4- Stress fracture
16. 5- Metastatic carcinoma
A 9-year-old boy sustains a closed fracture of the distal radius as a result of a
2. fall. Examination reveals that the radius is completely displaced and shortened
3. 1 cm. The patient is placed under sedation and regional anesthesia in the
4. emergency department, and two attempts at reduction are made. The radius
5. cannot be anatomically reduced; there is bayonet apposition with complete
6. correction of angulation and rotation and 5 mm of shortening. Treatment
7. should now consist of
8. 1- cast application.
9. 2- percutaneous pin fixation.
10. 3- open reduction and casting.
11. 4- open reduction and plate fixation.
12. 5- open reduction and intramedullary fixation.
2. fall. Examination reveals that the radius is completely displaced and shortened
3. 1 cm. The patient is placed under sedation and regional anesthesia in the
4. emergency department, and two attempts at reduction are made. The radius
5. cannot be anatomically reduced; there is bayonet apposition with complete
6. correction of angulation and rotation and 5 mm of shortening. Treatment
7. should now consist of
8. 1- cast application.
9. 2- percutaneous pin fixation.
10. 3- open reduction and casting.
11. 4- open reduction and plate fixation.
12. 5- open reduction and intramedullary fixation.
Amputation of the lower extremity in adults is most commonly associated
2. with which of the following conditions?
3. 1- Tumor
4. 2- Trauma
5. 3- Infection
6. 4- Congenital malformation
7. 5- Peripheral vascular disease
2. with which of the following conditions?
3. 1- Tumor
4. 2- Trauma
5. 3- Infection
6. 4- Congenital malformation
7. 5- Peripheral vascular disease
A 28-year-old man with sickle cell anemia has debilitating bilateral hip pain.
2. A plain radiograph of the more symptomatic hip is shown in Figure 48. The
3. contralateral hip has a similar appearance. Treatment of the symptomatic hip
4. should include
5. 1- hip arthrodesis
6. 2- total hip replacement
7. 3- excision arthroplasty
8. 4- bipolar hemiarthroplasty
9. 5- intertrochanteric osteotomy
2. A plain radiograph of the more symptomatic hip is shown in Figure 48. The
3. contralateral hip has a similar appearance. Treatment of the symptomatic hip
4. should include
5. 1- hip arthrodesis
6. 2- total hip replacement
7. 3- excision arthroplasty
8. 4- bipolar hemiarthroplasty
9. 5- intertrochanteric osteotomy
A 45-year old woman who has had increasing foot pain for the past 9 months
2. has tenderness over the region of the cuboid. Oblique and lateral radiographs
3. are shown in Figures 49a and 49b. Low- and high-power photomicrographs are
4. shown in Figures 49c and 49d. What is the most likely diagnosis?
5. 1- Chondroblastoma
6. 2- Giant cell tumor
7. 3- Unicameral bone cyst
8. 4- Aneurysmal bone cyst
9. 5- Metastatic carcinoma
2. has tenderness over the region of the cuboid. Oblique and lateral radiographs
3. are shown in Figures 49a and 49b. Low- and high-power photomicrographs are
4. shown in Figures 49c and 49d. What is the most likely diagnosis?
5. 1- Chondroblastoma
6. 2- Giant cell tumor
7. 3- Unicameral bone cyst
8. 4- Aneurysmal bone cyst
9. 5- Metastatic carcinoma
The carotid tubercle is located at which of the following levels?
2. 1- C3
3. 2- C4
4. 3- C5
5. 4- C6
6. 5- C7
2. 1- C3
3. 2- C4
4. 3- C5
5. 4- C6
6. 5- C7
Which of the following radiographic findings is the most likely indication that
2. child abuse has occurred?
3. 1- Growth plate injury
4. 2- Healing spiral tibia fracture
5. 3- Isolated acute spiral femur fracture
6. 4- Fracture with abundant periosteal new bone formation
7. 5- Multiple fractures in various stages of healing
2. child abuse has occurred?
3. 1- Growth plate injury
4. 2- Healing spiral tibia fracture
5. 3- Isolated acute spiral femur fracture
6. 4- Fracture with abundant periosteal new bone formation
7. 5- Multiple fractures in various stages of healing
A 40-year-old man who is 6'8" and weighs 250 lb has progressive pain in the
2. knee that is localized to the lateral aspect of the joint with weightbearing and
3. stressful activities. Despite conservative treatment, the pain continues to be
4. disabling. A plain radiograph is shown in Figure 50a, and a 30-degree flexed
5. knee view is shown in Figure 50b. A full-length AP radiograph shows a valgus
6. deformity measuring 17 degrees. Surgical treatment should include
7. 1- knee arthrodesis.
8. 2- a total knee arthroplasty.
9. 3- a distal femoral varus
10. osteotomy.
11. 4- a proximal tibial varus
12. osteotomy.
13. 5- a lateral unicompartmental
14. arthroplasty.
2. knee that is localized to the lateral aspect of the joint with weightbearing and
3. stressful activities. Despite conservative treatment, the pain continues to be
4. disabling. A plain radiograph is shown in Figure 50a, and a 30-degree flexed
5. knee view is shown in Figure 50b. A full-length AP radiograph shows a valgus
6. deformity measuring 17 degrees. Surgical treatment should include
7. 1- knee arthrodesis.
8. 2- a total knee arthroplasty.
9. 3- a distal femoral varus
10. osteotomy.
11. 4- a proximal tibial varus
12. osteotomy.
13. 5- a lateral unicompartmental
14. arthroplasty.
Radiographs of a 35-year-old man who has a
2. closed midshaft fracture as a result of a blow to the
3. subcutaneous border of the ulna are shown in
4. Figures 51a and 51b. Examination reveals no
5. tenderness in the wrist or elbow, and radiographs
6. of the wrist and elbow are normal. Management
7. should consist of
8. 1- open reduction and plate fixation.
9. 2- closed reduction and percutaneous intramedullary
10. nailing.
11. 3- closed reduction and application of a long arm cast for
12. 6 weeks.
13. 4- a short arm functional brace after 10 days of casting.
14. 5- application of a long arm cast for 6 weeks.
2. closed midshaft fracture as a result of a blow to the
3. subcutaneous border of the ulna are shown in
4. Figures 51a and 51b. Examination reveals no
5. tenderness in the wrist or elbow, and radiographs
6. of the wrist and elbow are normal. Management
7. should consist of
8. 1- open reduction and plate fixation.
9. 2- closed reduction and percutaneous intramedullary
10. nailing.
11. 3- closed reduction and application of a long arm cast for
12. 6 weeks.
13. 4- a short arm functional brace after 10 days of casting.
14. 5- application of a long arm cast for 6 weeks.
A 12-year-old child with L5 level myelodysplasia has progressive scoliosis. At
2. age 8 years the curve measured 5 degrees, at age 10 years the curve measured
3. 8 degrees, and at age 12 years the curve measured 28 degrees as measured
4. from T5 to T12. The curve is convex to the right. The right hip is located, the
5. left hip is mildly subluxated, but abduction of the left hip is limited to 0
6. degrees. Initial management should include
7. 1- an MRI scan of the spine.
8. 2- observation for progression.
9. 3- adductor release of the left hip.
10. 4- valgus osteotomy of the left hip.
11. 5- posterior spinal fusion and instrumentation.
2. age 8 years the curve measured 5 degrees, at age 10 years the curve measured
3. 8 degrees, and at age 12 years the curve measured 28 degrees as measured
4. from T5 to T12. The curve is convex to the right. The right hip is located, the
5. left hip is mildly subluxated, but abduction of the left hip is limited to 0
6. degrees. Initial management should include
7. 1- an MRI scan of the spine.
8. 2- observation for progression.
9. 3- adductor release of the left hip.
10. 4- valgus osteotomy of the left hip.
11. 5- posterior spinal fusion and instrumentation.
Which of the following structures pass through the quadrangular space about
2. the shoulder?
3. 1- Radial nerve and the axillary nerve
4. 2- Radial nerve and the suprascapular nerve
5. 3- Posterior humeral circumflex artery and the radial nerve
6. 4- Posterior humeral circumflex artery and the axillary nerve
7. 5- Posterior humeral circumflex artery and the circumflex scapular artery
2. the shoulder?
3. 1- Radial nerve and the axillary nerve
4. 2- Radial nerve and the suprascapular nerve
5. 3- Posterior humeral circumflex artery and the radial nerve
6. 4- Posterior humeral circumflex artery and the axillary nerve
7. 5- Posterior humeral circumflex artery and the circumflex scapular artery
A 65-year-old man has a chronic draining sinus and a chronic patellar tendon
2. rupture with no active extension following a cemented total knee arthroplasty 3
3. years ago. A culture of the joint fluid grows resistant enterococcus. Treatment
4. should consist of
5. 1- arthrodesis.
6. 2- resection arthroplasty.
7. 3- one-stage primary exchange arthroplasty.
8. 4- two-stage exchange arthroplasty.
9. 5- operative debridement with patellar tendon reconstruction.
2. rupture with no active extension following a cemented total knee arthroplasty 3
3. years ago. A culture of the joint fluid grows resistant enterococcus. Treatment
4. should consist of
5. 1- arthrodesis.
6. 2- resection arthroplasty.
7. 3- one-stage primary exchange arthroplasty.
8. 4- two-stage exchange arthroplasty.
9. 5- operative debridement with patellar tendon reconstruction.
A 12-year-old boy sustains a closed Salter type II fracture of the proximal
2. tibial physis as a result of being hit by a car 1 hour ago. The metaphyseal
3. segment is displaced posteriorly by 100%. No distal pulses are found by
4. Doppler, and no other skeletal injuries are noted. Initial management should
5. consist of
6. 1- an angiogram.
7. 2- closed reduction of the fracture.
8. 3- application of an external fixator.
9. 4- fasciotomy of all four compartments.
10. 5- direct open exploration of the popliteal trunk at the fracture site.
2. tibial physis as a result of being hit by a car 1 hour ago. The metaphyseal
3. segment is displaced posteriorly by 100%. No distal pulses are found by
4. Doppler, and no other skeletal injuries are noted. Initial management should
5. consist of
6. 1- an angiogram.
7. 2- closed reduction of the fracture.
8. 3- application of an external fixator.
9. 4- fasciotomy of all four compartments.
10. 5- direct open exploration of the popliteal trunk at the fracture site.
A 55-year-old man with metastatic prostate cancer has a painful lesion of the
2. midshaft of the humerus in which approximately 75% of the cortex is
3. involved. Management should consist of
4. 1- an incisional biopsy.
5. 2- a humeral cuff and sling.
6. 3- closed interlocking nailing.
7. 4- radiation therapy to the humerus.
8. 5- plate fixation with bone grafting.
2. midshaft of the humerus in which approximately 75% of the cortex is
3. involved. Management should consist of
4. 1- an incisional biopsy.
5. 2- a humeral cuff and sling.
6. 3- closed interlocking nailing.
7. 4- radiation therapy to the humerus.
8. 5- plate fixation with bone grafting.
The change in strain of a material under a constant load that occurs with time
2. is defined as
3. 1- creep.
4. 2- relaxation.
5. 3- energy dissipation.
6. 4- plastic deformation.
7. 5- elastic deformation.
2. is defined as
3. 1- creep.
4. 2- relaxation.
5. 3- energy dissipation.
6. 4- plastic deformation.
7. 5- elastic deformation.
A 12-year-old girl has a left thoracic scoliosis of 46 degrees and a kyphosis of
2. 65 degrees. Vertebrae in the region of the curve show some scalloping of the
3. bodies and widening of the foramina. She has subcutaneous nodules in several
4. areas, as well as freckles in her axillae. Management for the spinal deformity
5. should include
6. 1- a Milwaukee brace.
7. 2- a syringopleural shunt.
8. 3- posterior spinal fusion and instrumentation.
9. 4- laminectomy and removal of the foraminal lesions.
10. 5- anterior and posterior spinal fusion and instrumentation.
2. 65 degrees. Vertebrae in the region of the curve show some scalloping of the
3. bodies and widening of the foramina. She has subcutaneous nodules in several
4. areas, as well as freckles in her axillae. Management for the spinal deformity
5. should include
6. 1- a Milwaukee brace.
7. 2- a syringopleural shunt.
8. 3- posterior spinal fusion and instrumentation.
9. 4- laminectomy and removal of the foraminal lesions.
10. 5- anterior and posterior spinal fusion and instrumentation.
Figure 52 shows an MRI scan of a 9-year-old girl who
2. has a 20-degree right thoracic scoliosis, an angle of
3. trunk rotation of 9 degrees, and absent abdominal
4. reflexes. A chest radiograph obtained 6 months earlier
5. revealed no scoliosis. Management should include
6. 1- performing a biopsy of the lesion.
7. 2- evaluation by a neurosurgeon.
8. 3- observation for progression of the curve with repeat radiographs in 2 months.
9. 4- application of a nighttime thoracolumbosacral orthosis.
10. 5- application of a full-time thoracolumbosacral orthosis.
2. has a 20-degree right thoracic scoliosis, an angle of
3. trunk rotation of 9 degrees, and absent abdominal
4. reflexes. A chest radiograph obtained 6 months earlier
5. revealed no scoliosis. Management should include
6. 1- performing a biopsy of the lesion.
7. 2- evaluation by a neurosurgeon.
8. 3- observation for progression of the curve with repeat radiographs in 2 months.
9. 4- application of a nighttime thoracolumbosacral orthosis.
10. 5- application of a full-time thoracolumbosacral orthosis.
A 55-year old woman who has had severe pain in her arm for the past 4 months
2. reports that she felt a sudden snap in her arm after trying to open a tight jar lid.
3. An AP radiograph of the humerus is shown in Figure 53a. A high-power
4. photomicrograph of the biopsy specimen is shown in Figure 55b. What is the
5. most likely diagnosis?
6. 1- Lymphoma
7. 2- Multiple myeloma
8. 3- Hyperparathyroidism
9. 4- Metastatic bone disease
10. 5- Mesenchymal chondrosarcoma
2. reports that she felt a sudden snap in her arm after trying to open a tight jar lid.
3. An AP radiograph of the humerus is shown in Figure 53a. A high-power
4. photomicrograph of the biopsy specimen is shown in Figure 55b. What is the
5. most likely diagnosis?
6. 1- Lymphoma
7. 2- Multiple myeloma
8. 3- Hyperparathyroidism
9. 4- Metastatic bone disease
10. 5- Mesenchymal chondrosarcoma
A 22-year old football player sustains a hyperflexion injury to the knee, reports
2. feeling a "pop," and is then unable to bear weight. A hemarthrosis develops
3. within 1 hour. Which of the following ligaments has most likely been
4. damaged?
5. 1- Medial collateral
6. 2- Posterolateral complex
7. 3- Posterior cruciate
8. 4- Anterior cruciate
9. 5- Anterior and posterior cruciate
2. feeling a "pop," and is then unable to bear weight. A hemarthrosis develops
3. within 1 hour. Which of the following ligaments has most likely been
4. damaged?
5. 1- Medial collateral
6. 2- Posterolateral complex
7. 3- Posterior cruciate
8. 4- Anterior cruciate
9. 5- Anterior and posterior cruciate
A 21-year-old woman has had anterior knee pain for the past 4 weeks that
2. worsens when she descends stairs and squats. Examination shows patellar
3. apprehension and medial facet tenderness; however, there is minimal effusion,
4. full range of motion, no jointline tenderness, and stable ligaments. Treatment
5. should include
6. 1- lateral retinacular release.
7. 2- patellar tendon realignment
8. 3- arthroscopic debridement of chondromalacia
9. 4- short arc open chain quadriceps exercises.
10. 5- short arc closed chain quadriceps exercises.
2. worsens when she descends stairs and squats. Examination shows patellar
3. apprehension and medial facet tenderness; however, there is minimal effusion,
4. full range of motion, no jointline tenderness, and stable ligaments. Treatment
5. should include
6. 1- lateral retinacular release.
7. 2- patellar tendon realignment
8. 3- arthroscopic debridement of chondromalacia
9. 4- short arc open chain quadriceps exercises.
10. 5- short arc closed chain quadriceps exercises.
A 30-year-old soccer player has pain and swelling 4 hours after being kicked
2. in the anterior compartment of the leg. Which of the following physical
3. findings best indicates increased compartment pressure?
4. 1- Anterior compartment tenderness
5. 2- Pain with active ankle dorsiflexion
6. 3- Pain with passive flexion of the toes
7. 4- Pain with passive extension of the toes
8. 5- Decreased sensation on the dorsum of the foot
2. in the anterior compartment of the leg. Which of the following physical
3. findings best indicates increased compartment pressure?
4. 1- Anterior compartment tenderness
5. 2- Pain with active ankle dorsiflexion
6. 3- Pain with passive flexion of the toes
7. 4- Pain with passive extension of the toes
8. 5- Decreased sensation on the dorsum of the foot
Cadaver studies show that alteration in joint kinematics following posterior
2. cruciate ligament sectioning leads to
3. 1- increased contact pressures in all three compartments of the knee.
4. 2- increased contact pressures in the medial and patellofemoral compartments.
5. 3- increased contact pressures in the lateral and patellofemoral compartments.
6. 4- decreased contact pressure in the patellofemoral compartment, but increased contact
7. pressure in the medial compartment.
8. 5- decreased contact pressure in the patellofemoral compartment, but increased contact
9. pressure in the lateral compartment.
2. cruciate ligament sectioning leads to
3. 1- increased contact pressures in all three compartments of the knee.
4. 2- increased contact pressures in the medial and patellofemoral compartments.
5. 3- increased contact pressures in the lateral and patellofemoral compartments.
6. 4- decreased contact pressure in the patellofemoral compartment, but increased contact
7. pressure in the medial compartment.
8. 5- decreased contact pressure in the patellofemoral compartment, but increased contact
9. pressure in the lateral compartment.
A 10-month-old infant with achondroplasia recently began to sit
2. independently, but the parents note a bulge in the lower spine. Radiographs
3. show a kyphosis of 35 degrees from T12 to L2. Management should consist of
4. 1- observation.
5. 2- a hyperextension spica cast.
6. 3- a thoracolumbosacral orthosis.
7. 4- in situ posterior spinal fusion.
8. 5- anterior and posterior spinal fusion.
2. independently, but the parents note a bulge in the lower spine. Radiographs
3. show a kyphosis of 35 degrees from T12 to L2. Management should consist of
4. 1- observation.
5. 2- a hyperextension spica cast.
6. 3- a thoracolumbosacral orthosis.
7. 4- in situ posterior spinal fusion.
8. 5- anterior and posterior spinal fusion.
Figures 54a and 54b show the radiographs of an 8-year-old boy who has a swollen, very
2. painful knee after falling off his bicycle. Figure 54c shows the lateral radiograph obtained
3. with the knee in extension after aspiration of 45 mL of bloody fluid from the knee.
4. Management should now include
5. 1- excision of the fragment. 3- surgical reduction and internal fixation.
6. 2- a second attempt at closed reduction. 4- maintenance of the cast in extension for 6 weeks.
7. 5- application of a cylinder cast in 30 degrees of flexion.
2. painful knee after falling off his bicycle. Figure 54c shows the lateral radiograph obtained
3. with the knee in extension after aspiration of 45 mL of bloody fluid from the knee.
4. Management should now include
5. 1- excision of the fragment. 3- surgical reduction and internal fixation.
6. 2- a second attempt at closed reduction. 4- maintenance of the cast in extension for 6 weeks.
7. 5- application of a cylinder cast in 30 degrees of flexion.
Radiographs of a 30-year-old woman who has pain in her right wrist are shown
2. in Figure 55. What is the most likely diagnosis?
3. 1- Septic arthropathy
4. 2- Charcot arthropathy
5. 3- Traumatic arthropathy
6. 4- Crystalline arthropathy
7. 5- Juvenile rheumatoid arthritis
2. in Figure 55. What is the most likely diagnosis?
3. 1- Septic arthropathy
4. 2- Charcot arthropathy
5. 3- Traumatic arthropathy
6. 4- Crystalline arthropathy
7. 5- Juvenile rheumatoid arthritis
What anatomic structure is the primary restraint to shoulder dislocation when
2. the arm is held in shoulder abduction and external rotation?
3. 1- Glenoid labrum
4. 2- Subscapularis muscle
5. 3- Inferior glenohumeral ligament
6. 4- Middle glenohumeral ligament
7. 5- Superior glenohumeral ligament
2. the arm is held in shoulder abduction and external rotation?
3. 1- Glenoid labrum
4. 2- Subscapularis muscle
5. 3- Inferior glenohumeral ligament
6. 4- Middle glenohumeral ligament
7. 5- Superior glenohumeral ligament
A patient who sustains a closed crushing injury to the hand must undergo a
2. complete release of all hand compartments. Excluding the digits, how many
3. compartments must be released?
4. 1- 4
5. 2- 6
6. 3- 8
7. 4- 10
8. 5- 12
2. complete release of all hand compartments. Excluding the digits, how many
3. compartments must be released?
4. 1- 4
5. 2- 6
6. 3- 8
7. 4- 10
8. 5- 12
A young adult with a severe ankle sprain was treated with a short leg cast for 6
2. weeks. Figures 56a and 56b show radiographs obtained after cast removal that
3. reveal a previously undiagnosed calcaneus fracture. Examination shows a very
4. warm, painful, and stiff foot
5. and ankle with hyperesthesia.
6. Treatment should include
7. 1- phonophoresis
8. 2- continued casting.
9. 3- oral corticosteroids.
10. 4- talocalcaneal arthrodesis.
11. 5- aggressive range of motion
2. weeks. Figures 56a and 56b show radiographs obtained after cast removal that
3. reveal a previously undiagnosed calcaneus fracture. Examination shows a very
4. warm, painful, and stiff foot
5. and ankle with hyperesthesia.
6. Treatment should include
7. 1- phonophoresis
8. 2- continued casting.
9. 3- oral corticosteroids.
10. 4- talocalcaneal arthrodesis.
11. 5- aggressive range of motion
A 3 l -year-old woman has had instability of the right ankle for the past 10
2. years. Stress radiographs show asymmetrical anterior drawer translation,
3. excess lateral opening, and a unilateral os subfibulare on the affected side. In
4. this patient, the os subfibulare represents
5. 1- supernumerary bone.
6. 2- an unfused accessory ossification center.
7. 3- a nonunion of an avulsion fracture of the talus.
8. 4- a nonunion of an avulsion fracture of the fibula
2. years. Stress radiographs show asymmetrical anterior drawer translation,
3. excess lateral opening, and a unilateral os subfibulare on the affected side. In
4. this patient, the os subfibulare represents
5. 1- supernumerary bone.
6. 2- an unfused accessory ossification center.
7. 3- a nonunion of an avulsion fracture of the talus.
8. 4- a nonunion of an avulsion fracture of the fibula
What is the main disadvantage of using stainless steel in the fabrication of
2. orthoses?
3. 1- Weight
4. 2- Cost
5. 3- Rigidity
6. 4- Availability
7. 5- Manufacturing difficulty
2. orthoses?
3. 1- Weight
4. 2- Cost
5. 3- Rigidity
6. 4- Availability
7. 5- Manufacturing difficulty
A 57-year-old man under workers' compensation underwent a carpal tunnel
2. release 1 year ago and has not returned to work because of numbness and pain.
3. His job requires him to use a rivet gun. The previous carpal tunnel release was
4. performed through a standard incision. Electromyogram and nerve conduction
5. studies are normal; however, conservative treatment, including splinting,
6. stretching exercises, and a steroid injection has failed. Two-point discrimination
7. measures 5 mm in each digit. Management at this time should include
8. 1- observation and possible job retraining.
9. 2- internal neurolysis and coverage of the nerve with silicone sheeting.
10. 3- iontophoresis, fluids therapy, and transcutaneous nerve stimulation.
11. 4- surgical decompression through a standard approach.
12. 5- surgical decompression and coverage of the nerve with a hypothenar fat flap.
2. release 1 year ago and has not returned to work because of numbness and pain.
3. His job requires him to use a rivet gun. The previous carpal tunnel release was
4. performed through a standard incision. Electromyogram and nerve conduction
5. studies are normal; however, conservative treatment, including splinting,
6. stretching exercises, and a steroid injection has failed. Two-point discrimination
7. measures 5 mm in each digit. Management at this time should include
8. 1- observation and possible job retraining.
9. 2- internal neurolysis and coverage of the nerve with silicone sheeting.
10. 3- iontophoresis, fluids therapy, and transcutaneous nerve stimulation.
11. 4- surgical decompression through a standard approach.
12. 5- surgical decompression and coverage of the nerve with a hypothenar fat flap.
Management of lateral scapular winging emphasizes strengthening of the
2. 1- deltoid.
3. 2- trapezius.
4. 3- subscapularis.
5. 4- latissimus dorsi.
6. 5- serratus anterior.
2. 1- deltoid.
3. 2- trapezius.
4. 3- subscapularis.
5. 4- latissimus dorsi.
6. 5- serratus anterior.
Which of the following margins is achieved in a hip disarticulation performed
2. as surgical treatment of a Musculoskeletal Tumor Society (Enneking) type IIA
3. distal femoral osteogenic sarcoma?
4. 1- Wide
5. 2- Radical
6. 3- Marginal
7. 4- Intralesional
8. 5- Wide-contaminated
2. as surgical treatment of a Musculoskeletal Tumor Society (Enneking) type IIA
3. distal femoral osteogenic sarcoma?
4. 1- Wide
5. 2- Radical
6. 3- Marginal
7. 4- Intralesional
8. 5- Wide-contaminated
Which of the following studies is the most sensitive monitor of the course of
2. infection in children with acute hematogenous osteomyelitis?
3. 1- WBC
4. 2- C-reactive protein
5. 3- Serial bone scans
6. 4- Serial blood cultures
7. 5- Erythrocyte sedimentation rate
2. infection in children with acute hematogenous osteomyelitis?
3. 1- WBC
4. 2- C-reactive protein
5. 3- Serial bone scans
6. 4- Serial blood cultures
7. 5- Erythrocyte sedimentation rate
Palpable jointline cysts in the knee are most commonly associated with
2. 1- Baker's cyst.
3. 2- medial meniscus tears
4. 3- lateral meniscus tears.
5. 4- congenital discoid lateral meniscus
6. 5- anterior cruciate ligament and meniscal tears
2. 1- Baker's cyst.
3. 2- medial meniscus tears
4. 3- lateral meniscus tears.
5. 4- congenital discoid lateral meniscus
6. 5- anterior cruciate ligament and meniscal tears
When a short intramedullary hip fixation device is used instead of a
2. compression hip screw for internal fixation of intertrochanteric fractures of
3. the femur, there is an increased risk of which of the following complications?
4. 1- Hardware failure
5. 2- Fracture nonunion
6. 3- Femoral shaft fracture
7. 4- Intraoperative bleeding
8. 5- Varus fracture malposition
2. compression hip screw for internal fixation of intertrochanteric fractures of
3. the femur, there is an increased risk of which of the following complications?
4. 1- Hardware failure
5. 2- Fracture nonunion
6. 3- Femoral shaft fracture
7. 4- Intraoperative bleeding
8. 5- Varus fracture malposition
An asymptomatic 10-year-old child has a grade II isthmic spondylolisthesis
2. with a 35% slip and a slip angle of -10 degrees (10 degrees of lumbosacral
3. lordosis). The iliac crests are Risser 0. The neurologic examination is normal,
4. and straight leg raising is possible to 80 degrees. Management should consist
5. of
6. 1- observation.
7. 2- application of an antilordotic brace.
8. 3- in situ posterior L5 to S1 fusion.
9. 4- in situ posterior fusion with instrumentation.
10. 5- posterior fusion with reduction and instrumentation.
2. with a 35% slip and a slip angle of -10 degrees (10 degrees of lumbosacral
3. lordosis). The iliac crests are Risser 0. The neurologic examination is normal,
4. and straight leg raising is possible to 80 degrees. Management should consist
5. of
6. 1- observation.
7. 2- application of an antilordotic brace.
8. 3- in situ posterior L5 to S1 fusion.
9. 4- in situ posterior fusion with instrumentation.
10. 5- posterior fusion with reduction and instrumentation.
Which of the following findings on physical examination best indicates
2. isolated posterolateral instability of the knee?
3. 1- Reverse pivot shift
4. 2- Positive Lachman test result
5. 3- Positive quadriceps active test result
6. 4- Increased external rotation of the foot relative to the contralateral side at 30 degrees
7. of knee flexion only
8. 5- Increased external rotation of the foot relative to the contralateral side at both 30 and
9. 90 degrees of knee flexion
2. isolated posterolateral instability of the knee?
3. 1- Reverse pivot shift
4. 2- Positive Lachman test result
5. 3- Positive quadriceps active test result
6. 4- Increased external rotation of the foot relative to the contralateral side at 30 degrees
7. of knee flexion only
8. 5- Increased external rotation of the foot relative to the contralateral side at both 30 and
9. 90 degrees of knee flexion
What is the best treatment for a patient with a recent diagnosis of symptomatic
2. adhesive capsulitis?
3. 1- Shoulder hemiarthroplasty
4. 2- Arthroscopic debridement
5. 3- Open release of the shoulder
6. 4- Closed manipulation of the shoulder
7. 5- Physical therapy and nonsteroidal anti-inflammatory medications
2. adhesive capsulitis?
3. 1- Shoulder hemiarthroplasty
4. 2- Arthroscopic debridement
5. 3- Open release of the shoulder
6. 4- Closed manipulation of the shoulder
7. 5- Physical therapy and nonsteroidal anti-inflammatory medications
An asymptomatic 14-year-old girl with scoliosis has a right thoracic curve
2. measuring 38 degrees from T5 to T12, and trunk rotation measuring 7 degrees
3. by inclinometer. The neurologic examination is normal. The iliac crests are
4. Risser 4, she has a bone age of 16 years, and menarche began at age 11 years.
5. Management should consist of
6. 1- exercises.
7. 2- observation.
8. 3- application of a thoracolumbosacral orthosis or a Milwaukee brace.
9. 4- posterior spinal fusion and instrumentation.
10. 5- anterior and posterior spinal fusion and posterior instrumentation.
2. measuring 38 degrees from T5 to T12, and trunk rotation measuring 7 degrees
3. by inclinometer. The neurologic examination is normal. The iliac crests are
4. Risser 4, she has a bone age of 16 years, and menarche began at age 11 years.
5. Management should consist of
6. 1- exercises.
7. 2- observation.
8. 3- application of a thoracolumbosacral orthosis or a Milwaukee brace.
9. 4- posterior spinal fusion and instrumentation.
10. 5- anterior and posterior spinal fusion and posterior instrumentation.
Which of the following factors constitutes a contraindication to
2. unicompartmental knee arthroplasty?
3. 1- Weight of less than 180 lb
4. 2- Varus deformity of 5 degrees
5. 3- Valgus deformity of the knee
6. 4- Absent anterior cruciate ligament
7. 5- Osteonecrosis of the medial femoral condyle
2. unicompartmental knee arthroplasty?
3. 1- Weight of less than 180 lb
4. 2- Varus deformity of 5 degrees
5. 3- Valgus deformity of the knee
6. 4- Absent anterior cruciate ligament
7. 5- Osteonecrosis of the medial femoral condyle
In peer-reviewed scientific journals, all co-authors of a submitted paper must
2. sign an affidavit because it
3. 1- verifies the co-author's existence and affiliation.
4. 2- obtains permission from all the authors for publicity needs.
5. 3- makes a file of the investigators for future journal paper reviewers.
6. 4- ensures each co-author's identity and qualification.
7. 5- ensures that each author has read the paper and agrees with its content.
2. sign an affidavit because it
3. 1- verifies the co-author's existence and affiliation.
4. 2- obtains permission from all the authors for publicity needs.
5. 3- makes a file of the investigators for future journal paper reviewers.
6. 4- ensures each co-author's identity and qualification.
7. 5- ensures that each author has read the paper and agrees with its content.
Six hours after sustaining a painful traumatic subungual hematoma involving
2. the entire nail head, a 22-year-old woman undergoes decompression of the
3. hematoma. Management should now include
4. 1- reexamination in 24 to 48 hours.
5. 2- IV antibiotics and a dorsal splint.
6. 3- nail removal and nail bed repair.
7. 4- nail removal and marsupialization of the nail bed.
8. 5- oral antibiotics, a narcotic analgesic, and a dorsal splint.
2. the entire nail head, a 22-year-old woman undergoes decompression of the
3. hematoma. Management should now include
4. 1- reexamination in 24 to 48 hours.
5. 2- IV antibiotics and a dorsal splint.
6. 3- nail removal and nail bed repair.
7. 4- nail removal and marsupialization of the nail bed.
8. 5- oral antibiotics, a narcotic analgesic, and a dorsal splint.
Conservative management of recurrent unidirectional posterior shoulder
2. instability emphasizes strengthening of the
3. 1- deltoid.
4. 2- trapezius.
5. 3- infraspinatus.
6. 4- pectoralis major.
7. 5- latissimus dorsi.
2. instability emphasizes strengthening of the
3. 1- deltoid.
4. 2- trapezius.
5. 3- infraspinatus.
6. 4- pectoralis major.
7. 5- latissimus dorsi.
A 29-year-old man has severe pain in his back as a result of a fall. Examination shows ecchymosis
2. and a palpable step-off at the thoracolumbar junction with marked tenderness. He is neurologically
3. intact. AP and lateral radiographs of the lumbar spine and an axial CT scan of L1 are shown in
4. Figures 57a through 57c. Results of the examination, radiographs, and CT scan indicate which of the
5. following injuries?
6. 1- Bilateral pars fractures at L1
7. 2- Bilateral laminar fractures at L1
8. 3- Horizontal fracture through the spinous process, laminae, and pedicles
9. 4- Disruption of the interspinous and
10. supraspinous ligaments and the
11. ligamentum flavum
12. 5- Disruption of the anterior
13. longitudinal ligament and posterior
14. longitudinal ligament
2. and a palpable step-off at the thoracolumbar junction with marked tenderness. He is neurologically
3. intact. AP and lateral radiographs of the lumbar spine and an axial CT scan of L1 are shown in
4. Figures 57a through 57c. Results of the examination, radiographs, and CT scan indicate which of the
5. following injuries?
6. 1- Bilateral pars fractures at L1
7. 2- Bilateral laminar fractures at L1
8. 3- Horizontal fracture through the spinous process, laminae, and pedicles
9. 4- Disruption of the interspinous and
10. supraspinous ligaments and the
11. ligamentum flavum
12. 5- Disruption of the anterior
13. longitudinal ligament and posterior
14. longitudinal ligament
A 35-year-old man has had increasing pain in
2. the knee for the past 4 months. An AP
3. radiograph of the knee is shown in Figure 58a,
4. and low- and high-power photomicrographs of
5. the biopsy specimen are shown in Figures 58b
6. and 58c. What is the most likely diagnosis?
7. 1- Osteosarcoma
8. 2- Chondroblastoma
9. 3- Giant cell tumor
10. 4- Aneurysmal bone cyst
11. 5- Desmoplastic fibroma
2. the knee for the past 4 months. An AP
3. radiograph of the knee is shown in Figure 58a,
4. and low- and high-power photomicrographs of
5. the biopsy specimen are shown in Figures 58b
6. and 58c. What is the most likely diagnosis?
7. 1- Osteosarcoma
8. 2- Chondroblastoma
9. 3- Giant cell tumor
10. 4- Aneurysmal bone cyst
11. 5- Desmoplastic fibroma
A 15-year-old girl has had pain and swelling over the carpal canal and thenar
2. eminence of her nondominant hand and subjective numbness in the median
3. nerve distribution for the past 18 months. An MRI scan is shown in Figure 59a.
4. The carpal tunnel is exposed, and a nerve biopsy specimen is shown in Figure
5. 59b. Management should include
6. 1- no further treatment.
7. 2- wide resection and reconstruction.
8. 3- administration of dapsone.
9. 4- administration of amphotericin B.
10. 5- administration of ethambutol hydrochloride and rifampin.
2. eminence of her nondominant hand and subjective numbness in the median
3. nerve distribution for the past 18 months. An MRI scan is shown in Figure 59a.
4. The carpal tunnel is exposed, and a nerve biopsy specimen is shown in Figure
5. 59b. Management should include
6. 1- no further treatment.
7. 2- wide resection and reconstruction.
8. 3- administration of dapsone.
9. 4- administration of amphotericin B.
10. 5- administration of ethambutol hydrochloride and rifampin.
What is the most likely long-term result when a bulk structural allograft is
2. used in conjunction with an uncemented acetabular component for acetabular
3. deficiency?
4. 1- Deep infection
5. 2- HIV transmission
6. 3- Full incorporation of the graft
7. 4- Component failure secondary to graft resorption
8. 5- Significant ingrowth of the component into the allograft
2. used in conjunction with an uncemented acetabular component for acetabular
3. deficiency?
4. 1- Deep infection
5. 2- HIV transmission
6. 3- Full incorporation of the graft
7. 4- Component failure secondary to graft resorption
8. 5- Significant ingrowth of the component into the allograft
Figures 60a and 60b show the radiographs of the ankle and distal leg of an 1-
2. year-old girl after she twisted her ankle while playing soccer. She has no
3. history of ankle or leg pain. Examination reveals localized swelling and
4. tenderness over the lateral ankle, and the tibia is not tender. The bone lesion
5. identified in the tibia most likely is
6. 1- osteoblastoma.
7. 2- osteoid osteoma.
8. 3- ossifying fibroma.
9. 4- fibrous dysplasia.
10. 5- nonossifying fibroma.
2. year-old girl after she twisted her ankle while playing soccer. She has no
3. history of ankle or leg pain. Examination reveals localized swelling and
4. tenderness over the lateral ankle, and the tibia is not tender. The bone lesion
5. identified in the tibia most likely is
6. 1- osteoblastoma.
7. 2- osteoid osteoma.
8. 3- ossifying fibroma.
9. 4- fibrous dysplasia.
10. 5- nonossifying fibroma.
A 25-year-old man sustains the ring avulsion injury shown in Figure 61. The
2. flexor tendons and central slip of the extensor mechanism are intact, and there
3. are no fractures. Treatment of the ring finger should include
4. 1- revascularization with appropriate vein and/or artery repair.
5. 2- amputation at the level of the metacarpophalangeal joint.
6. 3- amputation at the level of the proximal interphalangeal joint.
7. 4- ray amputation with deep transverse metacarpal ligament repair.
8. 5- ray amputation with small to ring metacarpal transposition.
2. flexor tendons and central slip of the extensor mechanism are intact, and there
3. are no fractures. Treatment of the ring finger should include
4. 1- revascularization with appropriate vein and/or artery repair.
5. 2- amputation at the level of the metacarpophalangeal joint.
6. 3- amputation at the level of the proximal interphalangeal joint.
7. 4- ray amputation with deep transverse metacarpal ligament repair.
8. 5- ray amputation with small to ring metacarpal transposition.
Figure 63 shows a pelvis radiograph of a 4-year-old boy of normal intelligence
2. who has spastic diplegia and severe scissoring when trying to walk. He has
3. excellent head control and is able to sit with his hands supporting his trunk.
4. Examination shows hyperreflexia and clonus in the lower extremities but near
5. normal function in the upper extremities. Management should include
6. 1- bilateral obturator neurectomies.
7. 2- bilateral innominate osteotomies.
8. 3- bilateral hip-knee-foot-ankle orthoses.
9. 4- bilateral proximal femoral varus rotation
10. osteotomies.
11. 5- an abductor cushion for sleeping and a pommel
12. for the wheelchair.
2. who has spastic diplegia and severe scissoring when trying to walk. He has
3. excellent head control and is able to sit with his hands supporting his trunk.
4. Examination shows hyperreflexia and clonus in the lower extremities but near
5. normal function in the upper extremities. Management should include
6. 1- bilateral obturator neurectomies.
7. 2- bilateral innominate osteotomies.
8. 3- bilateral hip-knee-foot-ankle orthoses.
9. 4- bilateral proximal femoral varus rotation
10. osteotomies.
11. 5- an abductor cushion for sleeping and a pommel
12. for the wheelchair.
Which of the following nerves or neural structures is at risk of laceration
2. during excision of the posterior prominence of the calcaneus through a lateral
3. approach?
4. 1- Saphenous
5. 2- Deep peroneal
6. 3- Superficial peroneal
7. 4- Lateral dorsal cutaneous
8. 5- Lateral calcaneal branch of the sural
2. during excision of the posterior prominence of the calcaneus through a lateral
3. approach?
4. 1- Saphenous
5. 2- Deep peroneal
6. 3- Superficial peroneal
7. 4- Lateral dorsal cutaneous
8. 5- Lateral calcaneal branch of the sural
Which of the following terms best describes most osteosarcomas at the time of
2. diagnosis?
3. 1- Metastatic
4. 2- Low-grade, intracompartmental
5. 3- Low-grade, extracompartmental
6. 4- High-grade, intracompartmental
7. 5- High-grade, extracompartmental
2. diagnosis?
3. 1- Metastatic
4. 2- Low-grade, intracompartmental
5. 3- Low-grade, extracompartmental
6. 4- High-grade, intracompartmental
7. 5- High-grade, extracompartmental
A 6-year-old child who has had increasing fever, pain in the knee, and
2. difficulty with weightbearing for the past 2 days currently has a temperature of
3. 103.1°F (39.5°C). Examination shows mild restriction of knee motion and
4. tenderness over the distal femur. A plain radiograph is negative; however, a
5. bone scan is positive for increased uptake over the distal medial femoral
6. metaphysis. Before administering antibiotics, management should include
7. 1- blood cultures and bone aspiration.
8. 2- an open biopsy of the distal femur.
9. 3- an open biopsy of the distal femur and bone debridement.
10. 4- an NMI scan, blood cultures, and aspiration of the knee joint.
11. 5- an ultrasound of the knee and distal femur, with ultrasound-guided aspiration of the
12. knee joint.
2. difficulty with weightbearing for the past 2 days currently has a temperature of
3. 103.1°F (39.5°C). Examination shows mild restriction of knee motion and
4. tenderness over the distal femur. A plain radiograph is negative; however, a
5. bone scan is positive for increased uptake over the distal medial femoral
6. metaphysis. Before administering antibiotics, management should include
7. 1- blood cultures and bone aspiration.
8. 2- an open biopsy of the distal femur.
9. 3- an open biopsy of the distal femur and bone debridement.
10. 4- an NMI scan, blood cultures, and aspiration of the knee joint.
11. 5- an ultrasound of the knee and distal femur, with ultrasound-guided aspiration of the
12. knee joint.
What is the most likely reason that blood for a homologous transfusion that
2. tested negative for the HIV-antibody can carry a low but definite risk of HIV
3. transmission to recipients?
4. 1- There are many mutations of the HIV virus.
5. 2- The test for HIV-antibody is not very accurate.
6. 3- The virus may hide in the wall of red blood cells.
7. 4- The virus may hide in the wall of white blood cells.
8. 5- There is a delay between infection with HIV and the development of a detectable
9. antibody.
2. tested negative for the HIV-antibody can carry a low but definite risk of HIV
3. transmission to recipients?
4. 1- There are many mutations of the HIV virus.
5. 2- The test for HIV-antibody is not very accurate.
6. 3- The virus may hide in the wall of red blood cells.
7. 4- The virus may hide in the wall of white blood cells.
8. 5- There is a delay between infection with HIV and the development of a detectable
9. antibody.
What is the most current recommendation for definitive treatment of a 15-
2. year-old boy who has a high-grade osteosarcoma of the distal femur?
3. 1- Surgical resection only
4. 2- Radiation therapy only
5. 3- Radiation therapy and surgical resection
6. 4- Chemotherapy only
7. 5- Chemotherapy and surgical resection
2. year-old boy who has a high-grade osteosarcoma of the distal femur?
3. 1- Surgical resection only
4. 2- Radiation therapy only
5. 3- Radiation therapy and surgical resection
6. 4- Chemotherapy only
7. 5- Chemotherapy and surgical resection
What is the most common cause of injury to the vertebral artery during
2. anterior cervical decompression surgery?
3. 1- Excessive retraction of the vertebral artery
4. 2- Overdistraction of the cervical spine
5. 3- Lateral bone removal with an air drill
6. 4- Kyphotic kinking of the vertebral artery
7. 5- Malalignment of the anterior strut graft
2. anterior cervical decompression surgery?
3. 1- Excessive retraction of the vertebral artery
4. 2- Overdistraction of the cervical spine
5. 3- Lateral bone removal with an air drill
6. 4- Kyphotic kinking of the vertebral artery
7. 5- Malalignment of the anterior strut graft
Congenital scoliosis is detected in the chest radiograph of a 2-year-old child
2. undergoing a work-up for a heart murmur. The T7 hemivertebra is
3. semisegmented, and the patient has a 35-degree curve from T6 to T8. An MRI
4. scan is negative for intraspinal pathology, and a lateral radiograph shows that
5. the sagittal alignment is within the normal range. Management should consist
6. of
7. 1- observation.
8. 2- hemivertebra excision.
9. 3- in situ posterior fusion.
10. 4- in situ anterior and posterior fusion.
11. 5- application of a thoracolumbosacral brace.
2. undergoing a work-up for a heart murmur. The T7 hemivertebra is
3. semisegmented, and the patient has a 35-degree curve from T6 to T8. An MRI
4. scan is negative for intraspinal pathology, and a lateral radiograph shows that
5. the sagittal alignment is within the normal range. Management should consist
6. of
7. 1- observation.
8. 2- hemivertebra excision.
9. 3- in situ posterior fusion.
10. 4- in situ anterior and posterior fusion.
11. 5- application of a thoracolumbosacral brace.
What molecular defect correlates with the short stature condition shown in the
2. radiograph in Figure 65?
3. 1- BMP
4. 2- FGF3 receptor
5. 3- Type I collagen
6. 4- Type II collagen
7. 5- Proteoglycan metabolism
2. radiograph in Figure 65?
3. 1- BMP
4. 2- FGF3 receptor
5. 3- Type I collagen
6. 4- Type II collagen
7. 5- Proteoglycan metabolism
Figures 66a and 66b show radiographs of a man who twisted his foot and ankle
2. while playing basketball. Examination shows no deformity of the fifth toe, nor
3. is there a prominence beneath the fifth metatarsal. Treatment for the metatarsal
4. fracture should include
5. 1- splinting with no weightbearing.
6. 2- open reduction with lag screws.
7. 3- open reduction with plate fixation.
8. 4- closed reduction and percutaneous fixation.
9. 5- a below-knee cast and partial weightbearing.
2. while playing basketball. Examination shows no deformity of the fifth toe, nor
3. is there a prominence beneath the fifth metatarsal. Treatment for the metatarsal
4. fracture should include
5. 1- splinting with no weightbearing.
6. 2- open reduction with lag screws.
7. 3- open reduction with plate fixation.
8. 4- closed reduction and percutaneous fixation.
9. 5- a below-knee cast and partial weightbearing.
A 7-year-old boy who is in the 25th percentile for height has vague pain in
2. both lower extremities following exertion. Examination shows mild genu
3. valgum and mild short stature. Radiographs reveal symmetrical ovoid-shaped
4. femoral heads with irregular ossification, and mild flattening of the distal
5. femora and tibiae. The spine is straight, and the vertebrae are not flattened.
6. What is the most likely diagnosis?
7. 1- Achondroplasia
8. 2- Kniest syndrome
9. 3- Pseudoachondroplasia
10. 4- Multiple epiphyseal dysplasia
11. 5- Spondyloepiphyseal dysplasia congenita
2. both lower extremities following exertion. Examination shows mild genu
3. valgum and mild short stature. Radiographs reveal symmetrical ovoid-shaped
4. femoral heads with irregular ossification, and mild flattening of the distal
5. femora and tibiae. The spine is straight, and the vertebrae are not flattened.
6. What is the most likely diagnosis?
7. 1- Achondroplasia
8. 2- Kniest syndrome
9. 3- Pseudoachondroplasia
10. 4- Multiple epiphyseal dysplasia
11. 5- Spondyloepiphyseal dysplasia congenita
The lateral radiograph of a 3-year-old child with congenital kyphosis shows a
2. failure of segmentation associated with 35 degrees of kyphosis at the
3. thoracolumbar junction. Management should consist of
4. 1- observation for progression.
5. 2- brace treatment of the kyphosis.
6. 3- in situ posterior fusion.
7. 4- in situ anterior and posterior fusion.
8. 5- anterior release and osteotomy with posterior fusion and instrumentation.
2. failure of segmentation associated with 35 degrees of kyphosis at the
3. thoracolumbar junction. Management should consist of
4. 1- observation for progression.
5. 2- brace treatment of the kyphosis.
6. 3- in situ posterior fusion.
7. 4- in situ anterior and posterior fusion.
8. 5- anterior release and osteotomy with posterior fusion and instrumentation.
A 20-year-old man who sustains closed femoral and tibial shaft fractures has
2. mild distention of the abdomen, a systolic blood pressure of 75 mm Hg, and a
3. pulse rate of 135/min. His neurovascular examination is normal. Lateral
4. cervical spine, chest, and AP pelvis radiographs are normal. After
5. administration of 2 L of crystalloid, he has a systolic blood pressure of 95 mm
6. Hg and a pulse rate of 120/min. Management should now include
7. 1- diagnostic peritoneal lavage.
8. 2- immediate femoral nailing and splinting of the tibia.
9. 3- immediate stabilization of both the femur and the tibia.
10. 4- splinting the tibia and placing the femur in skeletal traction.
11. 5- simultaneous retrograde femoral nailing and an exploratory laparotomy.
2. mild distention of the abdomen, a systolic blood pressure of 75 mm Hg, and a
3. pulse rate of 135/min. His neurovascular examination is normal. Lateral
4. cervical spine, chest, and AP pelvis radiographs are normal. After
5. administration of 2 L of crystalloid, he has a systolic blood pressure of 95 mm
6. Hg and a pulse rate of 120/min. Management should now include
7. 1- diagnostic peritoneal lavage.
8. 2- immediate femoral nailing and splinting of the tibia.
9. 3- immediate stabilization of both the femur and the tibia.
10. 4- splinting the tibia and placing the femur in skeletal traction.
11. 5- simultaneous retrograde femoral nailing and an exploratory laparotomy.
Charcot-Marie-Tooth hereditary polyneuropathy is caused by a defect in
2. 1- myelin wrapping.
3. 2- fast axoplasmic transport.
4. 3- neurofilament phosphorylation.
5. 4- secondary synaptic cleft formation.
6. 5- postsynaptic hydrolysis of acetylcholine.
2. 1- myelin wrapping.
3. 2- fast axoplasmic transport.
4. 3- neurofilament phosphorylation.
5. 4- secondary synaptic cleft formation.
6. 5- postsynaptic hydrolysis of acetylcholine.
A 35-year-old man has had pain in the posteromedial ankle for the past 3
2. months when running, walking, or climbing stairs. Examination reveals
3. tenderness and swelling behind the medial malleolus. Passive extension of the
4. great toe is greater when the foot is plantarflexed. The most likely diagnosis is
5. 1- tarsal tunnel syndrome.
6. 2- sustentaculum talus impingement.
7. 3- posterior tibial tendinitis.
8. 4- flexor hallucis longus tendinitis.
9. 5- flexor digitorum longus tendinitis.
2. months when running, walking, or climbing stairs. Examination reveals
3. tenderness and swelling behind the medial malleolus. Passive extension of the
4. great toe is greater when the foot is plantarflexed. The most likely diagnosis is
5. 1- tarsal tunnel syndrome.
6. 2- sustentaculum talus impingement.
7. 3- posterior tibial tendinitis.
8. 4- flexor hallucis longus tendinitis.
9. 5- flexor digitorum longus tendinitis.
The end of spinal cord shock is signaled by the return of
2. 1- normal bowel sounds.
3. 2- spontaneous respirations.
4. 3- the Hoffman reflex.
5. 4- the bulbocavernosus reflex.
6. 5- a bilateral Babinski reflex.
2. 1- normal bowel sounds.
3. 2- spontaneous respirations.
4. 3- the Hoffman reflex.
5. 4- the bulbocavernosus reflex.
6. 5- a bilateral Babinski reflex.
The radiograph shown in Figure 67 most likely represents which of the
2. following disease processes?
3. 1- Sickle cell anemia
4. 2- Rheumatoid arthritis
5. 3- Ankylosing spondylitis
6. 4- Degenerative disk disease
7. 5- Diffuse idiopathic skeletal
8. hyperostosis
2. following disease processes?
3. 1- Sickle cell anemia
4. 2- Rheumatoid arthritis
5. 3- Ankylosing spondylitis
6. 4- Degenerative disk disease
7. 5- Diffuse idiopathic skeletal
8. hyperostosis
Which of the following factors is the most important determinant of the
2. stability of an intertrochanteric fracture?
3. 1- Fracture displacement
4. 2- Status of the posteromedial cortex
5. 3- Angulation of the proximal fragment
6. 4- Displacement of the greater trochanter
7. 5- Bone density of the proximal femur
2. stability of an intertrochanteric fracture?
3. 1- Fracture displacement
4. 2- Status of the posteromedial cortex
5. 3- Angulation of the proximal fragment
6. 4- Displacement of the greater trochanter
7. 5- Bone density of the proximal femur
Figure 70 shows a CT scan of a 13-year-old girl who has had midcervical pain
2. of increasing intensity for the past 8 months. The pain does not radiate, and her
3. neurologic examination is normal. Results of CBC, erythrocyte sedimentation
4. rate, and chemistry profile are all within normal limits. Management should
5. include
6. 1- administration of a Philadelphia collar.
7. 2- administration of aspirin for a trial period.
8. 3- a lateral approach and excision of the lesion.
9. 4- an anterior approach and excision of the lesion.
10. 5- a posterior approach and excision of the lesion.
2. of increasing intensity for the past 8 months. The pain does not radiate, and her
3. neurologic examination is normal. Results of CBC, erythrocyte sedimentation
4. rate, and chemistry profile are all within normal limits. Management should
5. include
6. 1- administration of a Philadelphia collar.
7. 2- administration of aspirin for a trial period.
8. 3- a lateral approach and excision of the lesion.
9. 4- an anterior approach and excision of the lesion.
10. 5- a posterior approach and excision of the lesion.
Figures 71a and 71b show the radiographs of a 5-year-old boy who has had
2. occasional pain in the hip and a minimal limp for the past 4 months. The
3. symptoms do not limit his activities, and he has no history of injury.
4. Examination shows normal range of motion, but he has some discomfort when
5. the right hip is rotated internally. Management should include
6. 1- observation.
7. 2- application of Petrie casts.
8. 3- a Scottish Rite abduction brace.
9. 4- bilateral interconnected long leg braces.
10. 5- varus rotation osteotomy of the involved hip.
2. occasional pain in the hip and a minimal limp for the past 4 months. The
3. symptoms do not limit his activities, and he has no history of injury.
4. Examination shows normal range of motion, but he has some discomfort when
5. the right hip is rotated internally. Management should include
6. 1- observation.
7. 2- application of Petrie casts.
8. 3- a Scottish Rite abduction brace.
9. 4- bilateral interconnected long leg braces.
10. 5- varus rotation osteotomy of the involved hip.
What is the most appropriate indication for lateral retinacular release in the
2. knee?
3. 1- Diffuse knee pain following arthroscopy
4. 2- Anterior knee pain following physiotherapy
5. 3- Acute patellar dislocation associated with an increased Q angle
6. 4- Lateral patellar compression syndrome following physiotherapy and associated
7. lateral patellar subluxation
8. 5- Lateral patellar compression syndrome following physiotherapy and associated
9. lateral patellar tilt
2. knee?
3. 1- Diffuse knee pain following arthroscopy
4. 2- Anterior knee pain following physiotherapy
5. 3- Acute patellar dislocation associated with an increased Q angle
6. 4- Lateral patellar compression syndrome following physiotherapy and associated
7. lateral patellar subluxation
8. 5- Lateral patellar compression syndrome following physiotherapy and associated
9. lateral patellar tilt
The radiographic findings of a child's wrist shown in Figures 72a and 72b are
2. most likely the result of which of the following processes?
3. 1- Traumatic
4. 2- Infectious
5. 3- Congenital
6. 4- Neoplastic
7. 5- Normal development
2. most likely the result of which of the following processes?
3. 1- Traumatic
4. 2- Infectious
5. 3- Congenital
6. 4- Neoplastic
7. 5- Normal development
A 28-year-old laborer has an infection in his left shoulder following open
2. reduction and internal fixation of a proximal humerus fracture. The infection
3. is controlled after hardware removal, multiple debridements, and a long course
4. of IV antibiotics. The patient has loss of articular cartilage of the
5. glenohumeral joint and has severe pain with only 30 degrees of motion.
6. Surgical treatment should consist of
7. 1- shoulder arthrodesis.
8. 2- total shoulder arthroplasty.
9. 3- uncemented hemiarthroplasty.
10. 4- excision of the humeral head.
11. 5- debridement and release of contractures.
2. reduction and internal fixation of a proximal humerus fracture. The infection
3. is controlled after hardware removal, multiple debridements, and a long course
4. of IV antibiotics. The patient has loss of articular cartilage of the
5. glenohumeral joint and has severe pain with only 30 degrees of motion.
6. Surgical treatment should consist of
7. 1- shoulder arthrodesis.
8. 2- total shoulder arthroplasty.
9. 3- uncemented hemiarthroplasty.
10. 4- excision of the humeral head.
11. 5- debridement and release of contractures.
A surgeon performs a fibular osteotomy during a corrective tibial osteotomy.
2. When measurement is made from the most proximal portion of the fibular
3. head, at what location is the peroneal nerve most at risk?
4. 1- 10 mm to 39 mm
5. 2- 40 mm to 69 mm
6. 3- 70 mm to 99 mm
7. 4- 100 mm to 129 mm
8. 5- Greater than 130 mm
2. When measurement is made from the most proximal portion of the fibular
3. head, at what location is the peroneal nerve most at risk?
4. 1- 10 mm to 39 mm
5. 2- 40 mm to 69 mm
6. 3- 70 mm to 99 mm
7. 4- 100 mm to 129 mm
8. 5- Greater than 130 mm
A 35-year-old man sustained a comminuted type II open fracture of the
2. humeral shaft associated with a complete radial nerve palsy as a result of a
3. motor vehicle accident. Along with administration of antibiotics and
4. debridement, treatment should include
5. 1- skeletal traction, an electromyogram, and nerve conduction studies.
6. 2- immediate nerve exploration and application of a hanging arm cast.
7. 3- surgical fracture fixation and immediate nerve exploration.
8. 4- surgical fracture fixation and nerve exploration if no recovery is apparent after 4
9. months.
10. 5- functional humeral bracing and nerve exploration in four months if no recovery is
11. apparent after 4 months.
2. humeral shaft associated with a complete radial nerve palsy as a result of a
3. motor vehicle accident. Along with administration of antibiotics and
4. debridement, treatment should include
5. 1- skeletal traction, an electromyogram, and nerve conduction studies.
6. 2- immediate nerve exploration and application of a hanging arm cast.
7. 3- surgical fracture fixation and immediate nerve exploration.
8. 4- surgical fracture fixation and nerve exploration if no recovery is apparent after 4
9. months.
10. 5- functional humeral bracing and nerve exploration in four months if no recovery is
11. apparent after 4 months.
Which of the following factors is most responsible for the greater mechanical
2. demands on a plate, as compared to an intramedullary nail, when used in the
3. treatment of a subtrochanteric fracture?
4. 1- A greater bending moment on the plate
5. 2- Function of the plate as a tension band
6. 3- Less interfragmentary motion with the plate
7. 4- Less accurate restoration of the medial cortex
8. 5- Smaller screw diameters for the plate versus the intramedullary nail
2. demands on a plate, as compared to an intramedullary nail, when used in the
3. treatment of a subtrochanteric fracture?
4. 1- A greater bending moment on the plate
5. 2- Function of the plate as a tension band
6. 3- Less interfragmentary motion with the plate
7. 4- Less accurate restoration of the medial cortex
8. 5- Smaller screw diameters for the plate versus the intramedullary nail
A 22-year-old student has pain in the ulnar side of the wrist following a recent
2. twisting injury. Examination reveals a possible peripheral detachment of the
3. triangular fibrocartilage. This diagnosis is best confirmed by
4. 1- an MRI scan.
5. 2- a CT arthrogram.
6. 3- diagnostic arthroscopy.
7. 4- three compartment wrist arthrography.
8. 5- standard wrist radiographs and a 30-degree supinated lateral view.
2. twisting injury. Examination reveals a possible peripheral detachment of the
3. triangular fibrocartilage. This diagnosis is best confirmed by
4. 1- an MRI scan.
5. 2- a CT arthrogram.
6. 3- diagnostic arthroscopy.
7. 4- three compartment wrist arthrography.
8. 5- standard wrist radiographs and a 30-degree supinated lateral view.