Q 2007 D
1) In which of the following patients with osteomyelitis of the tibia is surgical debridement the next
best step in treatment?
1.
A 9-year old girl with new-onset pain and fever
2.
A 7-year-old lethargic boy with a WBC count of 21,000/mm3 after a week of nafcillin and
3.
vancomycin
A 7-year-old girl with three days of pain, fever, and a WBC of 21,000/mm3 who presents to the ER
4.
An 8-year-old boy whose pain and fever have decreased after 24 hours of ampicillin
5.
An 8-year old lethargic girl with a WBC of 21,000/mm3 and a CRP of 9 after 24 hours of gentamicin
2) (OBQ07.152) A 40-year-old recreational basketball player injured his knee while jumping for a
rebound. He felt a pop and developed immediate swelling. His radiographs are shown in Figures A
and B. What is the recommended management?
FIGURES:
1.
Obtain an MRI
2.
Ice, rest, and observation
3.
Physical therapy to regain motion
4.
Knee arthroscopy and repair
5.
Open surgical repair
3) Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what
factor?
1.
Non-anatomic reduction
2.
Mismatch of the radius of curvature of implant and bone
3.
Usage of too large an implant
4.
Lateral patient positioning
5.
Lateral proximal starting point
4) Which of the following is not characteristic of the pathologic process displayed in Figure A
1.
Dislocation of the talonavicular joint
2.
Associated with posteromedial tibia bowing
3.
Associated with neural tube defects
4.
Associated with arthrogryposis
5.
Rigid rocker bottom deformity
5) Increased ACL injury rates in women athletes compared to male athletes may be due to muscular
imbalance and relative weakness in which of the following muscle groups?
1.
Quadriceps
2.
Hamstrings
3.
Gluteus muscles
4.
Adductors
5.
Abdominals
6) (OBQ07.156) A 22-year-old man presents with shoulder pain. Radiographs are shown in Figure A
and B. What is the most likely cause?
Review Topic
FIGURES: A
1.
Acute acromial fracture
2.
Type IV acromioclavicular separation
3.
Deltoid avulsion
4.
Failure of fusion between the meso-acromion and pre-acromion
5.
Failure of fusion between the meso-acromion and meta-acromion
7) What is the post-amplification product of reverse transcription polymerase chain reaction (RTPCR)?
1.
RNA
2.
DNA
3.
Protein
4.
Mitochondria
5.
Immunoglobulins
8) A 63-year-old woman falls from standing and lands on her right hand. She complains of deformity
and wrist pain. Radiographs are provided in Figure A. Following closed reduction, the patient
inquires whether she has osteoporosis and if she is likely to have another fracture. In counselling the
patient, which of the following is the strongest predictor for a future fracture from low energy trauma?
FIGURES: A
1.
Bone mineral density T-score < -2.5
2.
Low vitamin D levels
3.
Family history of osteoporosis
4.
History of a prior fragility fracture
5.
Ten year history of oral prednisone use
9) Heterotopic ossification has been recognized as a rare complication from Steinmann pins placed
in which location for traction purposes?
1.
distal femur
2.
proximal tibia
3.
calcaneus
4.
radius shaft
5.
metacarpal shaft
10) Figure A shows the radiograph of a 6-year-old girl after a fall on the playground. What is the most
appropriate course of action?
FIGURES: A
1.
Observation with treatment in a sling
2.
Closed reduction and long arm casting
3.
Closed reduction percutaneous pinning with k-wires
4.
Open reduction internal fixation with k-wires
5.
Open reduction with plate fixation
1.
11) What effect does intermittent administration of parathyroid hormone have on bone?
Anabolic
2.
Catabolic
3.
No effect
4.
Decreased quantity
5.
Decreased quality
12) Which of the following factors has been shown to increase mortality in poly-trauma patients with
severe head injuries?
1.
Delayed fixation of fractures
2.
Decreased intracranial pressure
3.
Intra-abdominal injury
4.
Intra-operative hypotension
5.
Decreased platelet count
13) A 69-year-old man with known metastatic lung cancer presents with a pathological fracture after
a fall from standing height (Figure A). Which of the following options is the best choice for treating
this fracture?
FIGURES: A
1.
Total hip arthroplasty
2.
Hemiarthroplasty
3.
Sliding hip screw
4.
Dynamically locked cephalomedullary nail
5.
Statically locked cephalomedullary nail
14) (OBQ07.173) A 34-year-old female has an insidious onset of heel pain when first getting out of
bed and at the end of the day after prolonged standing. She works as a waitress and recently had
bariatric surgery with a current BMI of 35. She has a gastrocnemius contracture noted on
Silverskiold testing. AP and oblique radiographs are shown in Figure A and lateral radiograph is
shown in Figure B. What is the most likely diagnosis?
Review Topic
1.
A
Navicular stress fracture
2.
Freiberg's Infraction
3.
Plantar fasciitis
4.
First branch of the lateral plantar nerve (Baxter's) entrapment
5.
Anterior tarsal tunnel syndrome
1.
15) A 70-year-old woman trips on the grass while playing golf and sustains a displaced comminuted
femoral neck fracture. What is the optimal treatment for this patient?
Open reduction internal fixation
2.
Bipolar hemiarthroplasty
3.
Total hip arthroplasty
4.
Unipolar hemiarthroplasty
5.
Traction and non operative treatment
16) A 15-year-old boy sustains the injury seen in Figure A while running the hurdles. The same
mechanism in an adult athlete would most likely result in which of the following injuries?
1.
FIGURES:A
Hamstring myotendinous junction rupture
2.
Pelvic ramus fracture
3.
Hamstring muscle belly rupture
4.
Hamstring tendinous insertion rupture
5.
Sports hernia
1.
17) The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw
during fixation of what structure?
Lisfranc fracture-dislocation
2.
Navicular body fracture
3.
Intra-articular calcaneus fracture
4.
Nutcracker cuboid fracture
5.
Talar neck fracture
1.
18) You are caring for an 18-year-old boy with severe hip arthritis and pain from a missed slipped
capital femoral epiphysis. You decide that a hip arthrodesis is the best treatment option. What is the
optimum position for a hip arthrodesis to maximize function and prevent complications?
0 external rotation, 0 adduction, 0 hip flexion
2.
5 external rotation, 0 adduction, 20 hip flexion
3.
5 external rotation, 15 abduction, 5 hip flexion
4.
15 external rotation, 0 adduction, 20 hip flexion
5.
15 external rotation, 15 abduction, 5 hip flexion
1.
19) DNA replication occurs during which phase of the cell cycle?
M
2.
3.
4.
G1
5.
G2
20) A 7-year-old boy falls off the playground and sustains the injury shown in figure A. What motor
deficit is associated with the nerve most commonly injured in this fracture pattern?
Review Topic
FIGURES: A
1.
Weakness of the flexor digitorum profundus to the index finger
2.
Weakness of the extensor pollicis longus
3.
Wrist drop
4.
Weakness of the flexor pollicis longus
5.
Hand intrinsic weakness
21) (OBQ07.180) A 63-year-old female presents with a broad-based shuffling gait, loss of manual
dexterity, and exaggerated deep tendon reflexes in the lower extremities. A T2-weighted MRI scan is
shown in Figure A. What is the most appropriate treatment?
Review Topic
FIGURES:
1.
C4 to C7 cervical laminectomy
2.
C4 to C7 cervical laminectomy with fusion
3.
C4 to C7 laminoplasty with plate fixation
4.
Multilevel anterior cervical decompression with fusion and stabilization
5.
Immobilization in a halo orthosis for 6 weeks followed by gradual ROM exercises
1.
22) When discussing metal on metal hip resurfacing versus metal on polyethylene total hip
replacement, the surgeon should inform the patient that all of the following are disadvantages of hip
resurfacing EXCEPT?
Higher dislocation rate
2.
Higher periprosthetic fracture rate
3.
Increased serum metal ion levels
4.
Higher rates of osteonecrosis
5.
Larger incision and surgical dissection
25) A 7-year-old boy complains of worsening left knee pain over the last 2 weeks. He has been
unable to bear weight through the left lower extremity for the past 24 hours. The knee and lower leg
are warm and tender to palpation. Current temperature is 100.9 degrees Fahrenheit, and CRP is 11
mg/dL (nml <1). A radiograph is provided in Figure A. A joint aspiration yields 2 mL's of synovial fluid
demonstrating a cell count of 2,500 and no organisms on gram stain. Which of the following is the
most appropriate next step in management?
FIGURES: A
1.
Repeat aspiration of the left knee
2.
Observation with repeat radiographs in one week
3.
Magnetic resonance imaging (MRI)
4.
Begin intravenous broad-spectrum antibiotics and obtain an infectiouse disease consult
5.
Exploratory surgical arthrotomy
1.
26) Which of the following items is located medial to the iliocostalis and lateral to the semispinalis
muscle?
Multifidus
2.
Rotatores
3.
Longissimus
4.
Quadratus lumborum
5.
Latissimus
1.
27) Giant cell tumors of bone can be locally aggressive and result in significant bone destruction.
Which of the following is responsible for this type of bone destruction?
Multinuclear giant cells
2.
Osteocytic stromal cells
3.
Tumor cell activation of osteoclasts
4.
Tumor cell inactivation of osteoblasts
5.
Osteoprotegrin activation of osteoclasts
TAG
1.
28) Which of the following treatment techniques decreases the risk of osteonecrosis in patients with
unstable slipped femoral capital epiphysis (SCFE)?
Open reduction and pinning with multiple cannulated screws in an inverted triangle configuration
2.
Closed reduction and pinning with multiple cannulated screws in an inverted triangle configuration
3.
Closed reduction and pinning with a single cannulated screw
4.
In situ percutaneous pinning with multiple cannulated screws in an inverted triangle configuration
5.
In situ percutaneous pinning with a single cannulated screw
1.
29) The resistance to pullout of a screw in osteoporotic bone is increased by all of the following
EXCEPT?
Placement parallel to the trabecular pattern
2.
Purchase in cortical bone
3.
Use of a fixed angle (locking screw construct)
4.
Tapping prior to screw placement
5.
Augmentation with polymethylmethacrylate
1.
30) In patients with symptoms of cervical myelopathy, what variable is associated with improved
outcomes with nonoperative management?
Increased Central Motor Conduction Time (CMCT)
2.
Transverse area of the spinal cord >70mm2
3.
Isolated low intramedullary signal on T1WI
4.
A midsagittal diameter of the spinal canal of <13mm
5.
Younger age
1.
31) During total knee replacement with the trial components in place, the knee achieves full
extension but experiences tightness in flexion with a range to only 90 degrees. What is the most
appropriate action?
Resect more proximal tibia
2.
Downsize the femoral component
3.
Addition of a distal femoral augment
4.
Downsize the tibial polyethylene insert
5.
Resect more distal femur
32) Gigantism affects which region of the growth plate labeled in Figure A?
1.
FIGURES:
A
2.
3.
4.
5.
1.
33) Which of the following is NOT a contra-indication to isolated medial meniscal transplantation?
ACL deficiency
2.
Patient age over thirty
3.
Inflammatory arthritis
4.
Varus alignment
5.
Grade IV chondromalacia
34) (OBQ07.193) A 65-year-old diabetic female presents with a two-month history of mild ankle pain
and subjective instability. She denies any specific injury and she does not have any foot ulcerations
or wounds; her foot and ankle are edematous with erythema that resolves upon elevation. Her ESR,
CRP, and WBC levels are within normal limits. Her radiographs are shown in Figures A and B. What
is the most appropriate initial treatment?
Review Topic
1.
FIGURES:
Modification of shoe wear
2.
Use of a total contact cast
3.
Ankle arthrodesis
4.
Spanning external fixation of the ankle and hindfoot
5.
Below-knee amputation
1.
35) Postoperative varus alignment of a subtrochanteric femur fracture treated with an intramedullary
nail has been shown to be related to which of the following factors?
Use of a piriformis entry nail through a greater trochanteric entry portal
2.
Use of a greater trochanteric entry nail through a piriformis entry portal
3.
Use of a lateral entry nail through a piriformis entry portal
4.
Use of a femoral distractor device to obtain reduction
5.
Use of a fracture table to obtain reduction
36) (OBQ07.195) A 62-year-old man undergoes total knee arthroplasty. Preoperative radiographs
are shown in Figure A. Following bone resections and placement of trial implants, the knee is stable
in flexion, but cannot achieve full extension. Which of the following interventions will most likely
result in a knee that is balanced in flexion and extension?
Review Topic
FIGURES: A
1.
Resect more distal femur
2.
Resect more distal femur and downsize the femoral component
3.
Resect more proximal tibia
4.
Decrease polyethelene liner thickness
5.
Place posterior femoral augments
37) A 14-year-old boy sustains the injury shown in figure A. He subsequently develops compartment
syndrome and requires fasciotomy. Injury to what artery is most likely responsible ?
FIGURES: A
1.
Peroneal
2.
Posterior tibial
3.
Middle geniculate
4.
Saphenous
5.
Anterior tibial recurrent
38) A 40-year-old female presents with dull pain in her knee that has been increasing in severity over
the past 6 months. Figures A through D show representative radiographs, MRI, and biopsy section.
What is the most appropriate treatment?
Review Topic
FIGURES: A
B
C
D
1.
Observation
2.
Bone marrow biopsy
3.
Intra-lesional curettage with local adjuvant therapy
4.
Neoadjuvant chemotherapy, surgical excision, and adjuvant chemotherapy
5.
Neoadjuvant radiotherapy and surgical excision
1.
39) Residual end-organ hypoperfusion in a polytraumatized patient is shown by which of the
following?
Urine output of 0.8 mL/kg/hr
2.
SpO2 < 90%
3.
Platelet count < 80
4.
Base excess of 3.0 mEq/L
5.
Serum lactate of 4.5 mmol/L
1.
2.
40) In relation to the femoral insertion of the popliteus, the femoral attachment of the lateral collateral
ligament is
posterior and proximal
posterior and distal
3.
anterior and proximal
4.
anterior and distal
5.
directly superficial
