Orthopedic Surgery Mock Exam - Set 00C4AD

A 28-year-old male sustains a closed midshaft tibia fracture. He is treated with a reamed intramedullary nail.

Which of the following is the most significant advantage of reaming the canal prior to nail insertion compared to unreamed nailing for closed tibia fractures?

In modern total hip arthroplasty, the use of highly cross-linked polyethylene (HXLPE) compared to conventional ultra-high-molecular-weight polyethylene is associated with which of the following?

A 22-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. During the rehabilitation phase, she is at highest risk for which of the following complications compared to a hamstring autograft?

Which of the following transcription factors most strongly promotes the differentiation of mesenchymal stem cells into osteoblasts during fracture healing?

A 13-year-old obese boy presents with 3 weeks of left groin pain and a limp. Examination reveals obligatory external rotation of the left hip during passive flexion. A radiograph is provided.

What is the recommended definitive management for a stable slipped capital femoral epiphysis (SCFE)?

A 45-year-old woman presents with severe carpal tunnel syndrome. During open carpal tunnel release, the surgeon must be careful to avoid injuring the recurrent motor branch of the median nerve. This branch most commonly exhibits which of the following anatomic variations?

A 65-year-old man presents with progressive clumsiness in his hands, difficulty buttoning his shirt, and a broad-based gait. A T2-weighted MRI shows spinal cord compression with intrinsic cord signal change at C4-C5.

Which of the following MRI findings is associated with the poorest prognosis for neurological recovery after surgical decompression in cervical spondylotic myelopathy?

A 25-year-old male sustains a midfoot injury. Weight-bearing radiographs demonstrate widening of the interval between the medial and middle cuneiforms.

The Lisfranc ligament connects which of the following two structures?

A 15-year-old boy presents with a destructive, bone-forming lesion in the distal femoral metaphysis with a 'sunburst' periosteal reaction. Biopsy confirms high-grade osteosarcoma. Assuming the patient has localized disease, which of the following is the most important prognostic factor for long-term survival?

A 30-year-old man sustains a highly comminuted proximal tibia fracture.

Twelve hours post-admission, he develops severe pain with passive toe stretch. His diastolic blood pressure is 75 mmHg and anterior compartment pressure is 55 mmHg. What is the most appropriate next step in management?

A 22-year-old male falls onto an outstretched hand. Follow-up MRI at 2 weeks confirms a nondisplaced fracture of the scaphoid proximal pole.

The blood supply to the proximal pole of the scaphoid is tenuous because the major nutrient vessels enter the scaphoid at which location?

A 4-month-old female infant is treated for developmental dysplasia of the hip (DDH) with a Pavlik harness. During treatment, what is the most significant risk associated with excessive abduction of the hips in the harness?

In the process of endochondral ossification during fracture healing, which type of collagen is most predominantly synthesized by chondrocytes in the hypertrophic zone just prior to calcification?

A 14-year-old female gymnast presents with insidious onset of low back pain exacerbated by extension. Radiographs show a unilateral pars interarticularis defect at L5.

What is the classic radiographic appearance of this defect on an oblique lumbar radiograph?

A 25-year-old male undergoes arthroscopy for a bucket-handle tear of the medial meniscus. The surgeon decides to perform an inside-out meniscus repair. Which of the following neurovascular structures is at greatest risk of injury during the posteromedial repair?

A 65-year-old man presents with anterior knee pain and a feeling of instability during stair climbing 1 year after a primary total knee arthroplasty.

Examination reveals a lateral patellar tilt. CT scan is performed to evaluate component rotation. Which of the following errors in component positioning is most likely responsible for his symptoms?

Galvanic corrosion between orthopedic implants occurs when two dissimilar metals are in contact within an electrolytic environment. Which of the following combinations of metals is most likely to result in significant galvanic corrosion in vivo and is generally contraindicated?

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. During surgical repair, the surgeon must be careful to avoid injuring the sural nerve. At approximately what distance proximal to the calcaneal insertion does the sural nerve typically cross the lateral border of the Achilles tendon?

A 32-year-old man sustains a closed spiral fracture of the distal third of his humerus (Holstein-Lewis fracture). He has a wrist drop on presentation.

Initial management with a functional fracture brace is selected. At what point is surgical exploration of the radial nerve indicated if there is no clinical or electromyographic improvement?

A 55-year-old man presents with dull, aching pain in his right pelvis for 6 months. Radiographs reveal a large, lytic lesion in the right ilium with 'popcorn' calcifications.

Biopsy demonstrates a moderately cellular cartilage tumor with plump, binucleated chondrocytes. What is the most appropriate definitive management for this patient?

A 24-year-old athlete sustains a hyperplantarflexion injury to the midfoot. Radiographs show widening between the 1st and 2nd metatarsal bases. The primary stabilizing ligament of this joint originates from and inserts into which of the following structures?

A 45-year-old man is involved in a motor vehicle collision.

Imaging demonstrates a traumatic spondylolisthesis of the axis (Hangman's fracture) with 15 degrees of angulation and 2 mm of translation (Levine and Edwards Type IIA). Which of the following treatments or maneuvers is strictly CONTRAINDICATED in the initial nonoperative management of this specific fracture pattern?

A 12-year-old obese boy presents with a left-sided slipped capital femoral epiphysis (SCFE).

Which of the following represents the strongest indication for prophylactic in situ pinning of the contralateral, asymptomatic hip?

The pivot shift test is widely considered the most specific clinical examination maneuver for an anterior cruciate ligament (ACL) tear. Which of the following best describes the biomechanics of a positive pivot shift test in an ACL-deficient knee?

Bone morphogenetic proteins (BMPs) play a crucial role in osteoinduction and are utilized in various spine and trauma applications.

Which of the following intracellular signaling molecules is directly phosphorylated following the binding of BMP-2 or BMP-7 to its serine/threonine kinase membrane receptor?

A 28-year-old rugby player presents with an inability to actively flex the distal interphalangeal (DIP) joint of his ring finger after catching it in an opponent's jersey. Radiographs reveal a small bony avulsion fragment located volar to the proximal interphalangeal (PIP) joint. According to the Leddy and Packer classification, what is the correct injury type and the anatomic structure that arrests the retracted tendon?

A 15-year-old boy is diagnosed with a high-grade intramedullary osteosarcoma of the distal femur.

He undergoes a standard protocol of neoadjuvant chemotherapy followed by wide surgical resection. Which of the following factors has been established as the single most important prognostic indicator for his long-term survival?

A 35-year-old skier sustains a Schatzker Type II (split-depression) tibial plateau fracture after a fall. Which of the following intra-articular structures is most frequently injured in conjunction with this specific fracture pattern?

A 68-year-old man presents with bilateral leg pain, heaviness, and cramping that worsens after walking two blocks. The orthopedic surgeon is attempting to distinguish between neurogenic claudication secondary to lumbar spinal stenosis and vascular claudication. Which of the following clinical findings most reliably points toward a diagnosis of neurogenic claudication?

A 45-year-old male recreational athlete sustains an acute mid-substance Achilles tendon rupture.

He is discussing management options with his surgeon. Based on current high-level evidence, which of the following statements comparing nonoperative management versus surgical repair is most accurate?

A 6-week-old infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). During a routine follow-up, the parents report that the child has stopped actively kicking the affected leg. On physical examination, there is an absent patellar reflex and decreased active knee extension. The harness is found to be in excessive hyperflexion. Which of the following nerves is most likely compressed?

A 50-year-old woman complains of acute posterior knee pain and a 'pop' while squatting deeply. MRI reveals a complete tear of the medial meniscus posterior root.

Biomechanically, if left untreated, a complete posterior root tear of the medial meniscus acts as the equivalent to which of the following?

Articular cartilage exhibits complex viscoelastic properties under loading. When a constant deformation (strain) is rapidly applied and maintained on articular cartilage, the internal peak stress gradually decreases over time until it reaches an equilibrium. Which of the following terms best describes this specific biomechanical phenomenon?

A 30-year-old male is brought to the trauma bay with hemodynamic instability following a high-speed motorcycle crash. Pelvic radiographs show a severely displaced 'open-book' pelvic fracture (APC-III).

An emergency pelvic binder is to be applied to reduce pelvic volume. To be biomechanically effective and stabilize the fracture, the binder should be centered directly over which of the following anatomical landmarks?

A 45-year-old woman undergoes an open carpal tunnel release. Postoperatively, she reports a new, severe weakness in thumb opposition, despite normal opposition preoperatively. The surgeon suspects an iatrogenic nerve injury. The affected nerve branch most likely originates from which aspect of the median nerve?

A 60-year-old man presents with progressive, deep pelvic pain.

A core needle biopsy of a large lytic lesion in the ilium confirms the diagnosis of conventional Grade II chondrosarcoma. Staging studies are negative for metastasis. Which of the following is the standard of care for definitive management?

A 55-year-old patient with long-standing, poorly controlled diabetes mellitus presents with a swollen, erythematous, and warm right foot. Radiographs reveal periarticular fragmentation, bony debris, and early subluxation of the midfoot joints. Laboratory markers for infection are negative. According to the Eichenholtz classification, what is the current stage of this patient's Charcot arthropathy and the most appropriate initial management?

A 2-week-old infant is being treated for idiopathic congenital talipes equinovarus using the Ponseti method of serial casting.

According to this method, the components of the deformity must be corrected sequentially. Which of the following represents the correct sequence of correction?

A 22-year-old collegiate football player presents with recurrent anterior shoulder instability. Advanced imaging reveals a 15% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. He undergoes an arthroscopic Bankart repair combined with a remplissage procedure. What structure is transferred or tenodesed into the Hill-Sachs defect during a remplissage?

A 28-year-old man sustains a high-energy closed comminuted fracture of the tibial diaphysis.

Six hours post-injury, he complains of disproportionate leg pain that is severely exacerbated by passive stretch of the toes. The clinical suspicion for acute compartment syndrome is high. Which of the following pressure measurements provides the most widely accepted absolute indication for an emergency four-compartment fasciotomy?

A 35-year-old male sustains an isolated closed proximal third tibia fracture and is scheduled for intramedullary nailing.

The surgeon elects to use a suprapatellar approach instead of a traditional infrapatellar approach. According to current biomechanical and clinical literature, what is the primary advantage of the suprapatellar approach for this specific fracture pattern?

A 13-year-old obese boy presents with right thigh pain and a noticeable limp.

Radiographs confirm a slipped capital femoral epiphysis (SCFE). Pathologically, the biomechanical failure and slippage in a SCFE occurs through which specific zone of the proximal femoral physis?

A 28-year-old carpenter sustains a laceration to the volar aspect of his index finger, resulting in an inability to flex the distal interphalangeal (DIP) joint.

During zone II flexor tendon repair, the surgeon must be mindful of the tendon's blood supply. The segmental vascular supply to the flexor tendons within the digital sheath is provided primarily by:

A 14-year-old gymnast presents with persistent lower back and radicular leg pain.

Imaging reveals an L5-S1 isthmic spondylolisthesis with 60% anterior translation of L5 on S1 (Meyerding Grade III). She has failed non-operative management, and surgical reduction with instrumented fusion is planned. Which nerve root is at the highest risk of iatrogenic traction injury during the reduction maneuver?

A 65-year-old male presents with deep bone pain, fatigue, and recent weight loss.

Radiographs demonstrate multiple 'punched-out' lytic lesions in his skull, pelvis, and proximal femurs. Based on the most likely diagnosis, which of the following laboratory findings is expected?

A 55-year-old male with poorly controlled diabetes mellitus presents with a swollen, erythematous, and painless left foot.

Radiographs show fragmentation and subluxation of the midfoot. To differentiate between acute Charcot arthropathy and superimposed osteomyelitis, an MRI is obtained. Which of the following MRI findings is highly specific for osteomyelitis in this setting?

A 60-year-old highly active male undergoes a total hip arthroplasty using a ceramic-on-ceramic (CoC) bearing surface.

Two years postoperatively, he complains of a highly audible 'squeaking' sound emanating from his hip during ambulation. What is the most widely recognized biomechanical cause for squeaking in CoC articulations?

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain and a 25-degree loss of internal rotation (GIRD) compared to the contralateral side.

An MRI reveals a type II SLAP tear. The 'peel-back' mechanism is widely considered the primary etiology of this lesion in overhead athletes. During which phase of the throwing motion does the 'peel-back' mechanism occur?

A 35-year-old male sustains an open fracture of the tibial diaphysis.

The orthopedic surgeon considers using recombinant human bone morphogenetic protein-2 (rhBMP-2) on a collagen sponge carrier to augment fracture healing. For which of the following indications is rhBMP-2 specifically FDA-approved in orthopedic trauma?

A hemodynamically unstable 40-year-old male arrives in the trauma bay with an anteroposterior compression (APC) type III pelvic ring injury.

The trauma team applies a pelvic circumferential compression device (binder). To achieve optimal biomechanical reduction of the pelvic volume and control hemorrhage, the binder must be centered over which specific anatomical landmarks?

A 45-year-old construction worker presents with chronic wrist pain and weakness.

Radiographs reveal a scaphoid nonunion advanced collapse (SNAC) pattern. The imaging demonstrates arthritic changes involving the entire radioscaphoid joint as well as the capitolunate joint, while the radiolunate joint is completely spared. This pattern corresponds to which stage of a SNAC wrist?

A 2-week-old infant presents to the clinic with idiopathic congenital talipes equinovarus (clubfoot).

The parents agree to proceed with the Ponseti method of serial casting. According to the foundational principles of the Ponseti technique, what is the correct sequence of deformity correction?

A 30-year-old female is involved in a motor vehicle collision and sustains a traumatic spondylolisthesis of the axis (Hangman's fracture).

Radiographs show severe angulation of C2 on C3, widening of the posterior C2-C3 disk space, but minimal anterior translation. This pattern is consistent with a Levine and Edwards Type IIA fracture. What is the mechanism of injury for a Type IIA fracture, and what early management step is strictly contraindicated?

A 45-year-old recreational tennis player sustains an acute, complete rupture of his Achilles tendon.

He considers non-operative management. Based on recent, high-level randomized controlled trials evaluating functional rehabilitation protocols, how does non-operative management compare to open surgical repair?

A 68-year-old female is undergoing a primary total knee arthroplasty for a severe fixed valgus deformity.

Intraoperatively, after the standard bone cuts, the trial components are placed, and the lateral side is found to be symmetrically tight in BOTH 90 degrees of flexion and full extension. Which lateral soft-tissue structure is the primary restraint to lateral opening in both flexion and extension, and should be released to balance the knee?

Articular cartilage relies on a highly specialized architectural organization to resist complex mechanical loads.

In the deep (radial) zone of articular cartilage, which statement accurately describes the orientation of Type II collagen fibers and the concentration of proteoglycans?

A 28-year-old male sustains an isolated, grade III posterior cruciate ligament (PCL) injury during a rugby match.

He opts for non-operative management. Long-term follow-up studies of isolated, non-operatively treated PCL tears indicate that altered knee kinematics most commonly lead to the premature development of osteoarthritis in which compartments?

A 32-year-old male is admitted with a highly comminuted, closed tibial shaft fracture.

Four hours after admission, he complains of unrelenting pain out of proportion to his injury and exquisite pain with passive stretch of his toes. Compartment pressures are measured. What pressure differential (Delta P) is considered the standard clinical threshold indicating the need for emergent four-compartment fasciotomy?

A 42-year-old female presents with an acute finger injury after her hand was struck by a basketball.

Radiographs reveal a dorsal avulsion fracture of the distal phalanx involving 45% of the articular surface, accompanied by volar subluxation of the distal phalanx (bony mallet finger). What is the most appropriate management for this specific injury pattern?

A 60-year-old male presents with a dull, aching pain in his proximal thigh. Radiographs reveal a large, destructive lytic lesion in the proximal femur with intralesional 'popcorn' calcifications.

Core needle biopsy confirms a conventional, intermediate-grade (Grade II) chondrosarcoma. What is the standard, definitive treatment for this primary bone tumor?