Orthopedics Hyperguide Review | Dr Hutaif General Ortho -...
Updated: Feb 2026
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Looking for accurate information on ORTHOPEDICS HYPERGUIDE MCQ 501-550? The Musculoskeletal Tumor Society (MSTS) is crucial for advancing research and treatment in bone and soft tissue tumors. While topics like rotator cuff repair and shoulder injection accuracy are vital in orthopedics, MSTS focuses on specialized care within orthopedic oncology. The society contributes significantly to education, patient management guidelines, and innovative approaches, ensuring comprehensive care for complex musculoskeletal conditions affecting patients’ long-term outcomes.
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ORTHOPEDICS HYPERGUIDE MCQ 501-550
QUESTION 1
What soft tissue augmentation is used in the reconstruction of the subscapularis when associated with anterior instability following shoulder arthroplasty:
1
Tendo Achilles allograft
2
Hamstring tendons
3
Middle-third patellar tendon autograft
4
Triceps autograft
5
Fascia lata
Moeckel and colleagues reported the use of tendo Achilles allograft for the treatment of anterior instability following shoulder arthroplasty in combination with attempted subscapularis repair.
QUESTION 2
Which of the following factors is associated with posterior instability following shoulder arthroplasty:
1
Retroverted humeral component
2
Posterior capsular laxity
3
Retroverted glenoid component
4
Disruption of the posterior capsule
5
All of the above
All of the above factors may contribute to posterior instability following shoulder arthroplasty. Correct Answer: All of the above
QUESTION 3
Which of the following strategies are used to treat posterior instability following shoulder arthroplasty:
1
Increasing the anteversion of the humeral component
2
Using posterior capsular plication
3
Creating a neutral orientation for the glenoid
4
Delaying postoperative rehabilitation program
5
All of the above
All of the above are potential treatment strategies for treating posterior instability following shoulder arthroplasty. Correct Answer: All of the above
QUESTION 4
What is the rate of recurrent instability following revision surgery for an unstable shoulder prosthesis:
1
Less than 5%
2
Between 5% and 10%
3
Between 10% and 20%
4
Between 20% and 30%
5
Greater than 30%
In the study by Sanchez and colleagues, more than 50% of the shoulders in the study remained unstable despite attempts at revision.
QUESTION 5
Labral and soft tissue pathology are best visualized using:
1
Standard pelvis magnetiCresonance image (MRI)
2
Plain film radiograph
3
3D computed tomography (CT) scan
4
Hip arthrogram
5
MR arthrogram
Although standard pelvis MRI has a role in visualizing soft tissues and bone, MR arthrogram best images the intra-articular structures of the hip. Hip arthrogram alone, CT, and plain film do not provide adequate soft tissue resolution.
QUESTION 6
Advantages of plain film radiograph in diagnosis and treatment of femoral acetabular impingement do NOT include:
1
Visualization of cam impingement lesion
2
Detection of labral injury
3
Observation of joint space narrowing
4
Detection of developmental dysplasia of the hip (DDH)
5
Assessment for pincer impingement
Plain film radiographs can successfully detect cam and pincer impingement and cartilage space narrowing, as well as allow quantified measurement of femoral head coverage. A magnetiCresonance arthrogram is necessary, however, to successfully visualize labral pathology.
QUESTION 7
Upon review of a plain film series for developmental dysplasia of the hip (DDH), contraindication to periacetabular osteotomy is suggested by:
1
Cup medialization
2
Excessive acetabular index
3
Center edge angle of 5°
4
Anterior coverage of less than 5° on false profile
5
No cartilage space maintained on abduction view
None of the options necessarily preclude periacetabular osteotomy as a treatment option for DDH provided that the patient wishes to proceed; however, little or no cartilage space, or poor concentriCreduction of hip joint would suggest poor outcome with this procedure.
QUESTION 8
The most valuable imaging study for assessment of radiographiCleg length in patients preparing to undergo total hip arthroplasty is:
1
Anteroposterior (AP) of the hip
2
3D computed tomography
3
MagnetiCresonance image of the pelvis
4
AP of the pelvis
5
Lauenstein lateral hip
Of all the study techniques listed, only the AP of the pelvis allows radiographiCcomparison of hips. This imaging may prove helpful in assessment of leg-length disparity due to lower extremity inequity or pelviCobliquity.
QUESTION 9
In the presence of osteolysis around the acetabular component, the most thorough means of visualizing bone loss is via:
1
PelviCJudet views
2
Cross-table lateral radiograph
3
Standard magnetiCresonance imaging (MRI) of the pelvis
4
Bone scan
5
Computed tomography (CT) of the hip
Computed tomography scan remains the most thorough means of assessing bone loss in the pelvis. MRI is relatively ineffective due to artifact scatter; cross-table lateral radiographs and bone scan are of little use; and pelviCJudet views, although helpful, are not as thorough as CT.
QUESTION 10
Advances in cement technique include all of the following EXCEPT:
1
Retrograde canal filling
2
Pressurization
3
Canal plugging
4
Canal lavage
5
Pressurized mixing
Retrograde canal filling, canal pressurization and plugging, and lavage are all developments in cement technique. The mixing process has been enhanced by mixing under vacuum conditions, however, rather than pressure.
QUESTION 11
In the Gruen classification of cement mantle, zone 4 is located:
1
Superior lateral
2
Superior medial
3
Mid lateral
4
Distal medial
5
Tip of the stem
In the classification described by Gruen, zone 4 is located at the tip of the stem; zone 1 is proximal lateral, and zone 7 proximal medial.
QUESTION 12
Cemented stem failure is most likely to result from:
1
Varus stem
2
Thin medial cement mantle
3
Stem contact with endosteal cortex
4
Excessive mantle laterally
5
Valgus stem placement
All of the above variables do not elevate the risk of stem failure with the exception of stem-cortical contact. This avoidable circumstance is thought to result in an excessively thin mantle and risk for cement fracture and subsequent loosening.
QUESTION 13
Initial enthusiasm of cemented femoral stems in total hip arthroplasty was tempered by:
1
Stem fracture
2
Poor survivorship in patients younger than 50 years of age
3
Recurrent dislocation
4
Infection
5
Fracture
Early outcomes were characterized by poor survivorship in the young population, a situation that corrected with subsequent polyethylene improvements and cement techniques.
QUESTION 14
Variables that affect the rate at which cement polymerizes include the following EXCEPT:
1
Room temperature
2
Humidity
3
Rate of mixing
4
Material makeup of the mixing bowl
5
Inclusive agents, such as antibiotics
Temperature, humidity, mixing rate, and added agents affect the rate of polymerization. The materials with which the polymer and powder contact are not known to affect this rate.
QUESTION 15
Which is the preferred imaging modality to determine the fracture pattern in a patient with a proximal humerus nonunion:
1
Plain radiographs
2
Fluoroscopically-positioned plain radiographs
3
MagnetiCresonance image
4
Tomograms
5
Computed tomography (CT) scan
A CT scan provides important information in regard to the fracture pattern, the amount of bone remaining in the humeral head, as well as information about the possibility of performing an ORIF with bone graft compared to proceeding with an arthroplasty procedure.
QUESTION 16
Which is the most common complication among patients who undergo shoulder arthroplasty for proximal humerus nonunion:
1
Infection
2
Instability
3
Humeral component loosening
4
Glenoid component loosening
5
Greater tuberosity nonunion
The most common reason for an unsatisfactory outcome after shoulder arthroplasty for a proximal humerus nonunion is a greater tuberosity nonunion.
QUESTION 17
Which organism is most frequently found in patients with an infected humeral nonunion:
1
Escherichia coli
2
Streptococcus
3
Propionibacterium acnes
4
Brucella
5
None of the above
One of the most common organisms found in an infected proximal humerus nonunion is Propionibacterium acnes. Staphylococcus aureus is another organism that is frequently found in patients with an infected humeral nonunion.
QUESTION 18
Who would be a good candidate for shoulder arthroplasty for a proximal humerus nonunion:
1
An elderly patient
2
A patient with a high fracture pattern
3
A patient with poor quality bone in the humeral head
4
A patient with glenohumeral arthritis
5
All of the above
The ideal candidate for shoulder arthroplasty for a proximal humerus nonunion is an elderly patient with a small humeral head fragment of poor bone quality with associated glenohumeral arthritis.
QUESTION 19
Who would be an ideal candidate for internal fixation and bone grafting in the setting of a proximal humerus nonunion:
1
A patient with a low fracture pattern
2
A patient with minimal to no glenohumeral arthritis
3
A young patient
4
A patient with an intact rotator cuff
5
All of the above
The ideal patient for an attempt at open reduction internal fixation is a young patient with a low fracture pattern, an intact rotator cuff, and minimal to no glenohumeral arthritis.
QUESTION 20
Which of the following bone tumors commonly occurs in patients with closed physes between 20 and 50 years of age:
1
Osteoid osteoma
2
Chondromyxoid fibroma
3
Solitary bone cyst
4
Giant cell tumor
5
Non-ossifying fibroma
Certain bone tumors have a predilection to occur in certain age groups. Non-ossifying fibroma, chondromyxoid fibroma, solitary bone cyst, and osteoid osteoma tend to occur in young patients with open physes. In contrast, giant cell tumor of bone rarely occurs in patients with open physes. When giant cell tumor occurs in children with open physes, it tends to involve only the metaphysis.
The common tumors in children with open physes are:
Benign
Osteoid osteoma Osteochondroma Chondroblastoma Solitary bone cyst
Malignant Osteosarcoma Ewingâs tumor Leukemia
In adults with closed physes, the common tumors are
Benign
Giant cell tumor
Pagetâs disease
QUESTION 21
Which of the following bone tumors arises exclusively in the epiphysis:
1
Osteoid osteoma
2
Chondromyxoid fibroma
3
Giant cell tumor
4
Chondroblastoma
5
Non-ossifying fibroma
Bone tumors tend to occur in certain locations within a bone. Knowing the specifiClocation in the bone where a tumor arises is a good clue in determining the nature of a lesion. Chondroblastomas uniquely arise in the epiphysis or the apophysis of long bones. Common locations that one should remember include:
Epiphysis
Chondroblastoma
Clear cell chondrosarcoma
Metaphysis
Osteoid osteoma Osteoblastoma Osteosarcoma Giant cell tumor
Non-ossifying fibroma Chondromyxoid fibroma Ewingâs tumor Chondrosarcoma
Diaphysis
Ewingâs tumor
Adamantinoma
Osteosarcoma (7% of cases occurring in long bones)
QUESTION 22
Which of the following bone tumors commonly arises from the surface of the posterior cortex of the distal femur:
1
Ewingâs tumor
2
Periosteal osteosarcoma
3
Parosteal osteosarcoma
4
Giant cell tumor
5
Periosteal chondroma
Parosteal osteosarcomas usually have a distinctive radiographiCappearance:
Heavily mineralized nodular lesion on the surface of the bone
Broad attachment to the cortex
Lucent areas at the periphery of the lesion
Large lesions encircling the bone
The most common location of parosteal osteosarcomas is the posterior cortex of the distal femur. When this lesion occurs in young patients, it is virtually diagnostiCof parosteal osteosarcoma.
QUESTION 23
Which of the following patterns of bone destruction suggests a benign process:
1
Permeative
2
Moth-eaten
3
GeographiCwith a sclerotiCrim
4
Cortical erosion with cortical thickening
5
Large lytiCfocus with ill-defined margin
Active lesions in the intramedullary cavity of a bone tend to destroy the trabecular bone and will eventually remove the cortex and extend into the soft tissues. In contrast, non-aggressive lesions will generally remain in the intramedullary cavity and the host
bone will contain the lesion by developing a rim of bone around the lesion. Lodwick described three patterns of bone destruction:
Geographic: The clinician can easily see where the lesion starts and ends due to a well-circumscribed area of bone destruction. There may be a rim of reactive bone that surrounds the lesion.
Moth-eaten: Multiple holes in the bone with some of the holes appearing to coalesce into a larger hole. This pattern of destruction is similar to how a group of moths destroy a piece of cloth.
Permeative: This pattern consists of multiple, small lytiClesions in the bone that are poorly marginated.
Moth-eaten and permeative patterns suggest a malignant lesion. Correct Answer: GeographiCwith a sclerotiCrim
QUESTION 24
The most common location of adamantinoma of bone is the:
1
Radius
2
Ulna
3
Femur
4
Tibia
5
Fibula
Adamantinomas almost exclusively occur in the tibia alone or in the tibia and fibula. Occasionally, this rare tumor occurs in the femur, radius, or ulna (very rare).
Radiographically, this lesion is based in the diaphysis; there is usually one dominant lesion with surrounding sclerosis and other smaller lesions, again with areas of sclerosis.
QUESTION 25
The most common location of osteofibrous dysplasia is the:
1
Femur
2
Tibia
3
Fibula
4
Radius
5
Ulna
Osteofibrous dysplasia occurs exclusively in the tibia. This non-neoplastiCcondition may be related to adamantinoma. The lesion is usually located in the anterior cortex and there is often bowing of the tibia.
QUESTION 26
The most common soft tissue sarcoma of the foot and ankle is:
1
Primitive neuroectodermal tumor
2
Malignant fibrous histiocytoma
3
Liposarcoma
4
Epithelioid sarcoma
5
Synovial sarcoma
Malignant melanoma is the most common soft tissue malignancy of the foot; however, synovial sarcoma is the most common soft tissue sarcoma. There may be a long duration of presence of the mass, with or without growth of the lesion. When one evaluates a patient with a small or large soft tissue mass on the foot, synovial sarcoma should be considered in the differential diagnosis.
QUESTION 27
The most common soft tissue sarcoma of the upper extremity is:
1
Primitive neuroectodermal tumor
2
Malignant fibrous histiocytoma
3
Liposarcoma
4
Epithelioid sarcoma
5
Synovial sarcoma
Epithelioid sarcoma is the most common soft tissue sarcoma of the upper extremity. This soft tissue sarcoma may have a deceptive presentation. The tumor occurs in young patients and often presents itself as a small, superficial mass or a deep tumor. When located in a superficial location, the lesion will also ulcerate. Even with biopsy, this lesion is confused with other processes such as rheumatoid nodules, granulomas, granuloma annulare, and others.
QUESTION 28
Which of the following describes the signal sequences on T1 and T2 weighted imaging of a soft tissue sarcoma:
1
Moderate(T1) / Low(T2)
2
Low(T1) / Low(T2)
3
High(T1) / High(T2)
4
Low(T1) / High(T2)
5
High(T1) / Moderate(T2)
Soft tissue sarcomas have a characteristiCMRI appearance: Low signal on T1 weighted images and high signal on T2 weighted images.
It is important to remember the characteristiCsignal sequences of both normal tissues and abnormal ones:
â Signal drop out (very low signal on gradient echo sequences) Correct Answer: Low(T1) / High(T2)
QUESTION 29
Which of the following describes the signal sequences on T1 and T2 weighted images of a ganglion cyst:
1
Moderate(T1) / Low(T2)
2
Low(T1) / Low(T2)
3
High(T1) / High(T2)
4
Low(T1) / High(T2)
5
High(T1) / Moderate(T2)
Ganglion cysts are composed of fluid under pressure, with a thin lining of cells. This fluid gives a uniformly low signal (very homogeneous) on T1 weighted images and a bright (hyperintense) signal on T2 weighted images. If the patient is given a contrast agent, such as gadolinium, the cyst fluid will not enhance, but the wall often will.
It is important to remember the appearances of common tissues on both T1 and T2 weighted images:
â Signal drop out (very low signal on gradient echo sequences) Correct Answer: Low(T1) / High(T2)
QUESTION 30
Pigmented villonodular synovitis occurs most commonly in which of the following joints:
1
Hip
2
Knee
3
Shoulder
4
Elbow
5
Ankle
Pigmented villonodular synovitis occurs mainly in the large joints of the lower extremity. The knee is the most common location, followed by the hip and shoulder. This lesion may also occur in the ankle and other smaller joints.
QUESTION 31
To which of the following organs do soft tissue sarcomas most commonly metastasize:
1
Brain
2
Lungs
3
Adrenals
4
Other bones
5
Kidneys
Soft tissue sarcomas most commonly metastasize to the lungs. Plain chest radiographs may not reveal small lesions. Computerized tomography of the chest is the most sensitive method to detect small nodules that are 3 mm to 15 mm in diameter. Other sites of metastases include other bones and visceral organs, such as the liver, spleen, and kidneys.
QUESTION 32
A 15-year-old boy has a destructive lesion in the distal femur with soft tissue extension. Needle biopsy shows a high-grade osteosarcoma. CT scan of the chest is normal and the technetium bone scan shows involvement of only the distal femur. What is the surgical stage according to the system of the Musculoskeletal Tumor Society:
1
Stage 1
2
Stage 2
3
Stage 3
4
Stage I
5
Stage II
From the data provided in the question, this lesion has the following feature:
The lesion is asymptomatic with no evidence of active growth
The Surgical Staging System of the Musculoskeletal Tumor Society is a useful system to both predict prognosis and plan treatment. The system for benign lesions is divided into three groups - inactive (latent), active, and aggressive:
539/. (29) Q2-65:
A 12-year-old boy has a solitary osteochondroma arising from the medial cortex of the distal femur. The lesion is not painful, nor is it causing any disability. What surgical stage would be assigned according to the system of the Musculoskeletal Tumor Society:
