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1. A 3 8.year-old marathon runner has had Achilles tendon pain for the past 2
months. Examination reveals that the tendon is thickened and tender proximal to
the calcaneal insertion. The tendon sheath is not thickened or tender. The
pathophysiology of the tendon is best described as
1-Acute inflammation.
2- Chronic inflammation.
3- Partial tendon rupture.
4- Anaerobic degeneration.
5- Impaired collagen cross-linking.
2. A 14-year-old boy with a history of cerebral palsy has a clawed hallux, cavus foot
deformity, and associated pain. Examination reveals pain under the first
metatarsal head and a rigid first tarsometatarsal joint. Treatment should consist
of
1- extensor hallus longus lengthening.
2- midfoot osteotomy.
3- first metatarsal osteotomy.
4- transfer of the extensor hailucis longus to the neck of the first metatarsal,
5- transfer of the extensor hallucis longus to the neck of the first metatarsal with first
metatarsal osteotomy.
3. A 30-year-old man has chronic pain, joint stiffness, and symmetrical
polyarthropathy but no significant synovitis. Examination reveals enlargement of
the second and third metatarsal heads, Radiographs show chondrocalcinosis of
the ankles and bony enlargement of the midfoot; no marginal erosions are evident
at the metatarsophalangeal level. What is the most likely diagnosis?
I- Osteoarthritis
2- Rheumatoid arthritis
3 Hemochromatosis
4- Reiter’s syndrome
5- Pseudogout calciumpyrophosphate deposition disease)
4- A Trendelenburq qait is most lik:ely to be seen in association with
1— a central disk herniation at L3—L4.
2— an psilateral paracentral disk herniation at L:3—L4,
3— an psilateral paracentral disk herniation at L4—L.
4— an ipsilateral paracentral disk herniation at L5—S1
5— an ipsilateral far lateral disk herniation at L4—L5
1
5-
A 35-year-old man sustained a posterior dislocation of the hip with
a shearing fracture of the femoral head. The most critical factor in
minimizing the risk of osteonecrosis of the femoral head is the
1)
2)
3)
4)
5)
interval between injury and reduction of the dislocation
surgical approach chosen for internal fixation of the fracture
type of internal fixation used for the fracture
presence of other musculoskeletal injuries
type of femoral head fracture
6- In a retroperitoneal approach to the lumbar spine, what structure runs along the
medial aspect of the psoas and along the lateral border of the spine?
1— Ilioinquinal nerve
2— Genitofemoral nerve
3— Sympathetic trunk
4— Ureter
5— Aorta
7- If a laminectomy for spiral stenosis is performed, which of the following is an
indication for concomitant arthrodesis at that level?
1— Prior laminectomy at an adjacent level
2— Ten degrees cf degenerative scoliosis
3— Removal of 25% of each facet joint at surgery
4— Degenerative spondylolisthesis at the level of the laminectomy
5— Forreminal stenosis at the level of the laminectomy
8-
A 27—year—old man sustained a gunshot wound to the lumbar spine and
undergoes an exploratory laparatomy . An injury to the cecum is identified and
treated. Management should now include
1—no antibiotics.
2— oral broad—spectrum antibiotics for 7 days,
3— intravenous broad—spectrum antibiotics for 45 hours.
4— intravenous broad—spectrum antibiotics for 7 days.
5— intravenous antibiotics specific for Staphylococcus for 7 days
2
9- Five weeks after undergoing a successfull L4—L5 diskectomy, with complete relief of
his preoperative sciatica, a 36-year-old man has severe, relentless back and buttock
pain. Examination and laboratory studies are unremarkable with the exception of
an erythrocyte sedimentation rate (ESR) of 90 mm/h. What is the next most
appropriate step in management?
1- Broad-spectrum-intravenous antibiotics
2- AP, lateral, and flexion-extension lateral radiographs
3- MRI with gadolinium
4- Open biopsy of the surgical disk space
5- Anterior debridement and interabody fusion
10- A 45-year-old women sustained a closed, minimally displaced
midshaft fracture of the humerus. She had no associated
injuries. The best management for this fracture is
1)
2)
3)
4)
5)
a hanging arm cast
a Velpeau dressing
a shoulder spica cast
a functional brace
an intramedullary nail
11- What nerve is most likely to develop a traumatic neuroma following open
reducation and internal fixation of a talar neck fracture via a posterolateral
approach?
I - Dorsal intermediate cutaneous
2- Sural
3- Saphenous
4- Medial plantar
5- Lateral plantar (Baxter)
12- A 32-year-old construction worker reports a persistent burning, tingling sensation
on the dorsum of his right foot and significant sensitivity on the plantar surface
after a 500-lb steel beam dropped on it 8 weeks ago. Initial radiographs revealed no
fractures, and the skin remained intact at the time of injury. Physical therapy, antiinflammatory drugs. and a serotonin reuptake inhibitor have failed to provide
relief. What is the next most appropriate step in management?
1- Continued physical therapy
2- Alteration of medication to include an anti-epileptic
3- Tarsal tunnel release
4- Sympathetic blocks
5- Neurostimulation
3
13- Which of the following structures are found in the anterior tarsal tunnel?
1- Extensor hallucis longus, tibialis anterior, extensor digitorum longus, dorsalis pedis
artery, deep peroneal nerve
2- Extensor hallucis longus, tibialis anterior, extensor digitorurn longus, dorsalis pedis
artery, superficial peroneal nerve
3— Extensor hallucis longus, tibialis anterior, extensor digitorum longus, dorsalis pedis
artery, deep peroneal nerve, superficial peroneal nerve
4- Extensor hallucis brevis, extensor hallucis longus, extensor digitorun-i Iongus, dorsalis
pedis artery, deep peroneal nerve
5- Dorsalis pedis artery, deep peroneal nerve, superficial peroneal nerve
14. An 11-year-old boy stepped on a nail and sustained a puncture to the right
forefoot 6 days ago. He was wearing tennis shoes at the time of injury.
Treatment in the emergency department consisted of local debridement and
tetanus prophylaxis; a radiograph was negative for foreign body, chondral
defect, or fracture. He was discharged with a 3-day prescription of amoxicillin
and calvulanate. The patient now has increasing pain and tenderness at the
puncture site. What is the best course of action?
1- Change the antibiotic to ciprofloxacin
2- Initiate gentamicin
3- Resume the prescription for amoxicillin and clavulanate
4- Observation and follow-up in 48 hours
5- Surgical debridement
15-A patient who has recalcitrant medial plantar heel pain and pain directly over the
medial side of the heel undergoes open release of the plantar fascia. After
releasing a portion of the plantar fascia, the deep fascia of the abductor hallucis
muscle is released to relieve pressure on which of the following structures?
I- Lateral plantar artery
2- Tibial nerve
3- First branch of the lateral plantar nerve
4- Sural nerve
5- Flexor hallucis brevis muscle
16- The Lisfranc ligament connects the base of the
1- first metatarsal and the medial cuneiform.
2- first metatarsal and the base of the second metatarsal.
3- first metatarsal and the middle cuneiform.
4- second metatarsal and the medial cuneiform.
5- second metatarsal and the middle cuneiform.
4
17- A 20—year—old man sustained a closed tibial fracture and is treated with a reamed
intramedullary nail. What is the most common complication associated with this
treatment?
1—nonunioni
2— malunion
3— Infection
4— knee paint
5— Compartment syndrome
18- Tibial tubercle transfer is indicated in all the followings except:
1) Recurrent dislocation of the patella.
2) Recurrent subluxation will give way in the knee joint.
3) Internal rotation of the tibia.
4) Flat lateral femoral condy1.
5) Hypoplasia of the patella.
19- A 4--year—old girl sustains an isolated spiral femoral fracture after falling from
her tricycle,
Management should consist of
1— external fixation.
2— plate fixation.
3— skeletal traction for S weeks.
4— immediate spica cast immobilization,
5—flexible nailing with titanium nails.
20- An 18—month--old child sustains a crush amputation of the tip of the index finqer.
bone is exposed, but the nail is intact, Management should consist of
1— dressing changes and healing by secondary intention.
2— a split—thickness skin graft.
3- a full-thickness skin graft.
4— a thennar flap.
5— a V—Y flap.
21- An otherwise healthy 25—year—old man sustained a wound with a 1—cm by 1.5—
cm soft—tissue loss over the volar aspect of the middle phalanx of his middle finger
After appropriate debnidernent and irrigation, the flexor digitorum profundus
tendon and neurovascular bundles are visible. The wound should be treated with a
1- split-thickness skin graft.
2- thennar flap.
3- cross-finger flap.
4— lateral arm flap.
5— Moberg (vol.ar advancerrient flap.
5
22- A 20-year old women involved in a motor vehicle accident
sustained multiple injuries, including ipsilateral femoral neck
and shaft fractures. The most appropriate treatment for this
patient's orthopaedic injuries is
1) skeletal traction until the patient's is stable, then internal fixation
of the femoral neck fracture and locked intramedullary nailing of
the femoral shaft fracture
2) skeletal traction until the patient's is stable, then fixation of femoral
neck and shaft fracture with a femoral reconstruction nail
3) immediate fixation of femoral neck and shaft fracture with multiple
screws and Enders' nails
4) immediate fixation of the femoral neck and shaft fracture with
multiple screws and retrograde intramedullary nailing
5) immediate fixation of the femoral neck and shaft fracture with
multiple screws and antegrade intramedullary nailing
23- A 12—year--old boy sustains open comminuted midshaft tibial and fibular fractures
while playing indoor soccer, The wound is grossly clean and measures 7 cm with
some periosteal stripping .Antibiotics and tetanus toxoid are administered
immediately in the emergency department. Following irrigation and debridement
of the wound in the operating room, treatment should include
1- a long leg cast.
2- a reamed nail.
3— an unreamed nail,
4- an external fixator,
5— plates and screws
24- Which of the following is an advantage of unrearmed nailing of the tibia
compared to reamed nailing?
1— Less surgical time
2—Lower risk of nonunion
3— Lower rate of malunion
4— Faster time to union
5— Less secondary procedures to achieve union
25- An otherwise healthy 35—year—old woman reports dorsal wrist pain and has
trouble extending her thumb after sustaining a minimally displaced fracture of the
distal radius 3 months ago. what is the next most appropriate step in management?
1— Neuropliysiologic test to evaluate the posterior interosseous nerve
2— Transfer of extensor inidicis proprius to the extensor pollicis longus tendon
3— Interphalangeal joint arthrodesis cf the thumb
4— Extension splinting of the thumb
5— Fine cut CT of the distal radius to evaluate Lister’s tubercle
6
26- What is the major difference in outcome following open reduction and internal
fixation of the tibial plafond at 2 to 5 days versus 10 to 20 days?
1— Improved ankle range of motion
2— Increased risk of wound complications
5— Decreased ankle pain
4— Decreased risk of nerve injures
5— Decreased risk of development of traumatic arthritis
27- A 7-year—old boy has a swollen and deformed right arm after falling off his
bicycle Radiographs reveal a completely displaced posterolateral supracondylar
humeral fracture. Examination reveals ,a warm, pink hand and forearm but
absent pulses. What is the next most appropriate step in management ?
1— Angiography
2— Immediate closed reduction and casting in extension
3— Surgical exploration and repair of the artery, followed by skeletal stabilization
4— Closed reduction and pinning, followed by reassessment of the vascular status
5— Magnetic resonance angiography MRA
28- A55—year—old woman fell and sustained an elbow dislocation with . coronoid
fracture and a radial head fracture. The elbow is reduced and splinted. What is
the most common early complication?
1— Brachial artery intimal tear
2— Recurrent dislocation
3— Forearm compartment syndrome
4— Posterior interosseous nerve injury
5—ulnar nerve palsy
29- A 35-year-old patient sustained a bimalleolar ankle fracture. What is the most
rehable method of predicting a tear of the interosseous membrane?
1- Level of the fibular fracture
2- Lauge-Hansen fracture class
3- Intraoperative stress testing
4- Widening of the medial clear space
5- Talar dislocation
30- When performing a flexor tendon repair of a digit other than the thumb, what
structures of the flexor tendon sheath should be preserved?
1- Al. and A pulleys
2- Al. and A3 pulleys
3- A2 and A3 pulleys
4- A2 and A4 pulleys
5- C1. and C2 pulleys
7
31- A distal radius fracture in an elderly man is strongly predictive for what
subsequent injury?
I.- Another distal radius fracture
2- Insufficiency fracture of the spine
3- Insufficiency fracture of the pelvis
4- Hip fracture
5- Proximal humerus fracture
32- In the treatment of ankle fractures, the superficial peroneal nerve is most commonly
injured by
1- a posterior-lateral approach.
2- a lateral approach.
3- a medial approach.
4- an anterior-medial approach.
5- rigid cast immobilization.
33- A 54-year-old man sustained a small superficial abrasion over the left
acromioclavicular joint after falling from his bicycle. Examination reveals no other
physical findings. Radiographs show a displaced fracture of the lateral end of the
clavicle distal to a line drawn vertically to the coracoid process. Management
should consist of
1- open reduction and plate fixation.
2- a figure-of-8 bandage for 4 to 8 weeks.
3- a sling for comfort, followed by physical therapy when pain-free.
4- excision of the outer end of the clavicle.
5- a tension band and Kirschner wires.
34- An adult with a distal humeral fracture underwent open reduction and internal
fixation. What is the most common postoperative complication?
1- Loss of elbow range of motion
2- Nonunion
3- Malunlon
4- Infection
5- Ulnar nerve dysfunction
35- A 25—year—old woman undergoes surgical treatment of a displaced proximal
humeral fracture via a deltopectoral approach. At the first postoperative visit, she
reports a tingling numbness along the anterolateral aspect of the forearm. What
structure is most likely injured?
1— Medial cord of the brachial plexus
2— Radial nerve
3— Median nerve 4— Axillary nerve
5— Musculocutaneous nerve
8
36- A 5 0—years—old man sustained a non displaced extra—articular fracture of the
proximal aspect of the third metatarsal after dropping a heavy object on his left
foot. Management should consist of
1— open reduction and internal fixation.
2— external bone stimulation
3— percutaneous pin fixation,
4— weight bearing in a walking boot or walking cast.
5— open reduction and internal fixation and primary tarsormetatarsal joint fusion.
37- A 52—year—old woman sustained a closed, displaced talar neck fracture in a
motor vehicle accident. Which of the flowing is an avoidable complication of
surgical treatment?
1— Posttraumatic .arthrit of the subtalar joint
2— Posttraumatic arthritis of the ankle joint
3— Malunon of the talus
4— Osteorperosis of the talus
5— Complex regional pain syndrome
38- A 34-year-old man sustained a tibial fracture in a motorcycle accident. What
perioperative variable is associated with the greatest relative risk for reoperation
to achieve bone union?
1- Gender
2- Delay in initial surgical treatment
3- Use of nonsteroidal anti-inflammatory drugs
4- Smoking
5- cortical contact of less than or equal to 50%
39- A 30—year--old woman sustains a transverse amputation of the distal phalanx of
the index finger ,leaving exposed bone What is the most appropriate
management of the soft—tissue defect?
1— Dressing changes and healing by secondary intention
2— Split—thickness skin grafting
3— V—y advancement flap
4— Moberg volar advancement flap)
5— First dorsal metacarpal artery—island pedicled flap
9
40- A 35—year—old man sustains a closed Monteggia fracture Examination reveals that
sensation, vasnular status, and finger flexion are normal. When he extends his
wrist, it deviates radially , and he is unable to extend his fingers or thumb . After
reduction of the fracture, what is the next step in treatment for the extensor deficits
of the thumb and fingers?
1— Exploration of the radial nerve
2— Exploration of the median nerve
3— Nerve conduction velocity studies
4— Tendon transfers after the fracture is stabilized
5— Observation
41- An 3—year—old girl sustained a displaced fracture at the base of the femoral
neck in a motor vehicle accident, Management should consist of
1— closed reduction and spice cast immobilization.
2— closed reduction and fixation of the femoral fracture with smooth pins across the physis
3— open reduction and fixation with screws across the fracture and short of the growth plate, and a
spice cast,
4— skeletal traction in a90— 90 position.
5— temporary traction until fixation with a specially ordered pediatric hip screw is possible
42- Long bone fracture repair following intramedullary stabilization occurs primarily
through which of the following healing mechanisms?
1— Haversiani remodelinq
2— endosteal ossification only
3— Intramernbranous ossificatiorl only
4— Endochondral ossification only
5— intramernbranous and endochondral ossification
43- Nutritional rickets is associated with which of the following changes in chemical
blood level?
1- Low Vitamin D levels
2- High to normal calcium levels
3- High phosphate levels
4- Decreased PTH
5- Decreased alkaline phosphatase levels
10
44- A 30—year—old man reports pain and weakness in his right arm, Examination
reveals grade 4 strength in wrist flexion and elbow extension, decreased senisation
over the middle finger ,decreased triceps reflex, These symptoms are most
compatible with impingement on what nerve root?
1— CS
2— C6
3—C7
4— C8
5— T1
45- A 25—year--old man is brought to the emergency department following a motor
vehicle accident, Extrication time was 2 hours, and in the field he had .A systolic
blood pressure by palpation of 90 mm Hg. Intravenous therapy was started, and or
arrival in the emergency department he has a systolic: blood pressure of 90 mm Hq
with a pulse rate of 130. Examination reveals a flail chest and a femoral diaphyseal
fracture. Ultrasound of the abdomen is positive. The trauma surgeons take him to
the operating room for an exploratory laparotomy. At the conclusion of the
procedure, he has a systolic pressure of 100 mm Hg with a pulse rate of 110.
Oxygen saturation is 90% on 100% oxygen, and he has a temperature of 95.0
degrees F (35 degrees 0). What is the recommended treatment of the femoral
fracture at this time?
1— Reamed intramedullary nail
2—unreamed intramedullary nail
3— Percutaneous plate fixation
4— Skeletal traction
5— External fixation
46- Figures 9a and 9b show the radiographs of a 60-year-old man who was struck by
an automobile 24 hours ago. Examination reveals palpable dorsalis pedis and
posterior tibial pulses, active flexion and extension of the toes, normal sensation,
and no pain on passive flexion or extension of the toes. Figures 9c and 9d show
clinical photographs of the leg. Immediate treatment should include:
1- application of sterile dressings, followed by external fixation.
2-application of sterile dressings and a long-leg walking cast.
3- debridement of the fracture blisters, skin grafting, and internal fixation with Ender nails.
4- debridement of the fracture blisters, skin grafting, and internal fixation with interlocking
nail.
5- open reduction and internal fixation with a plate and screws, and delayed primary closure
of the wound,
11
12
47- Figures 10a and 10b show the hand of a 50-year-old man with insulin-dependent
diabetes who has increasing pain, tenderness, and swelling of the palm.
Examination reveals tenderness over the palm and thenar eminence and pain on
attempts at active flexion of the thumb and index finger. The diagnosis most
likely is infection of the:
1-midpalmar space.
2- thenar compartment.
3- thenar space.
4- flexor tendon sheath of the thumb.
5- flexor tendon sheath of the index finger.
48- Peroneal nerve palsy secondary to total knee replacement is most common in
patients who have which of the following preoperative deformities?
1- Varus
2- Valgus
3- Flexion
4-Flexion and valgus
5- Flexion and varus
49- In pigmented villonodular synovitis:
1.
2.
3.
4.
5-
The condition typically presents in elderly females.
The condition is typically rapidly progressive.
Involvement of the knee occurs in about 80% of cases.
The condition is polyarticular in the majority of cases.
The erythrocyte sedimentation rate is typically elevated.
13
50- The following statements are correct concerning metastatic deposits in bone:
1. Carcinoid lung tumours tend to produce sclerotic secondaries.
2. The same primary tumour cannot simultaneously produce both lytic and sclerotic
secndaries.
3. Secondaries fràm thyroid carcinoma tend to expand bone.
4. Alkaline phosphate usually increase.
5. A secondary deposit in a digital phalanx is most likely to be due to a bronchial
carcinoma.
51- In Brodie’s abscess:
1.
2.
3.
4.
5.
A sclerotic margin is usually seen.
There is a characteristic appearance at angiography.
The appearances on plain radiography may mimic an osteoid osteoma.
The lesion is typically sited in the epiphysis.
The lower limb is more commonly involved.
52-The following are correct associations:
1.
2.
3.
4.
5.
Monteggia fracture—oblique ulnar shaft fracture with anterior dislocation of the radial head.
Smith’s fracture—distal radial fracture with dorsal angulations of the distal fragment.
Barton’s fracture—a marginal posterior radial fracture involving the articular surface.
Bennett’s fracture—a fracture of the proximal end of the first metacarpal which extends into
the first carpometacarpal joint.
Salter—Harris type II fracture—fracture through the growth plate and the metaphysic
53- Teratologic dislocation of the hip characterized by the following features except:
1.
2.
3.
4.
5.
Dislocations occur before birth.
Are not reducible on examination.
Has significant limited ROM.
Usually associated with other neuromuscular syndromes.
Usually treated by Pavlik Harness
54- The most common muscle to be involved in calcifying tendinitis is :
1.
2.
3.
4.
5.
supraspinatus
infraspinatus
teres minor
subscapularis
biceps
55- Giant cell tumour of bone:
1.
2.
3.
4.
5.
Accounts for approximately 5% of primary bone tumours.
Typically has a well-defined sclerotic margin.
Is best treated by curettage followed by radiotherapy.
Typically exhibits periosteal reaction.
Affecting the spine usually involves the posterior elements.
14
56- Recognized features of osteomalacia include all except
1.
2.
3.
4.
5.
Increased quantity of normally mineralized bone.
Poor callus formation.
Accentuation of the cortical outline of the vertebral bodies.
Looser’s zones.
Protrtisio acetabuli.
57- Osteochondromas
1. a Are a characteristic feature of Maffucci’s syndrome.
2. Originate in the metaphysis.
3. Are due to the presence of aberrant epiphyseal cartilage.
4. That show punctate calcification in the cartilage cap have stopped growing.
5. When solitary rarely undergo malignant degeneration.
58- In metastatic bone disease
1. A solitary bone metastasis is more common than a primary malignant neoplasm of bone in
patients over 50 years of age.
2. The axial skeleton is most often affected.
3. Vascular invasion is the main mode Of spread from the primary tumour.
4. A skeletal radionuclide scan is the investigation of choice in the assessment of the extent of bony
involvement.
5. Bony sclerosis is due to the production of tumorous bone in most cases.
59- Osteonecrosis of the femoral head is a recognized complication of
1. Haemophilia.
2. polycythaemia rubra vera.
3. Gaucher’s disease.
4. Multiple myeloma.
5. Cushing syndrome
60- absolute criteria for primary amputation in Mangled Extremity injuries include
all of the following except one :
1.
2.
3.
4.
5.
warm ischemia time of > 6 hr in lower limb injuries
gas gangrene
complete limb avulsion
major soft tissue loss
bone loss of > 1 cm
61- Starting Allopurinol treatment is indicated in all of the following patients, except:
1.
2.
3.
4.
5.
Acute gouty attack
Tophi.
Chronic gouty arthritis.
Very high uric acid levels.
Associated uric acid stones.
15
62- Following an anterior approach to the hip for joint replacement , a
patient complains of numbness over the lateral thigh, The structure
in the figure most likely to have been injured during the operative
procedure is
1)
2)
3)
4)
5)
B
C
D
E
F
63- After undergoing intramedullary nailing for a fracture of the
femur , a patient complains of numbness in the scrotum. The
structure in the figure most likely to have been injured is
1)
2)
3)
4)
5)
G
H
I
J
K
64- In the anterior approach to the proximal third of the radius, the deep
muscle incised to gain access to the bone is innervated by which nerve
1)
2)
3)
4)
5)
Radial
Median
Posterior interosseous
Ulnar
Musculocutaneous
16
65- In the anterolateral approach to the ankle, dissection should
proceed in the interval between the
1)
2)
3)
4)
5)
Extensor digitorum longus and peroneus tertius
Extensor digitorum longus and tibialis anterior
Extensor digitorum longus and peroneus brevis
Peroneus tertius and peroneus bervis
Peroneus bervis and peroneus longus
66- The structure(s) LEAST likely to cause compression of the
posterior interosseous nerve is (are) the
1)
2)
3)
4)
5)
Fibrous bands anterior to the radial head
Recurrent radial vessels
Extensor carpi radialis longus
Arcade of Frohse
Distal border of the supinator
67- All the following statements regarding Sprengel's deformity are
true EXCEPT that
1) the affected scapula is abnormally high
2) an omohyoid bone may be attached to the vertebral border of the
affected scapula
3) the affected scapula is usually smaller than the unaffected scapula
4) the trapezius on the affected side is usually defective
5) operative treatment is usually unnecessary
68- The most common pattern of degenerative arthritis encountered
in the wrist is
1)
2)
3)
4)
5)
69-
triscaphe arthritis
scapholunate advanced collapse (SLAC)
scapholunate arthritis
triquetrolunate arthritis
capitolunate arthritis
The muscles most severely affected in Volkmann's ischemic
contracture in the wrist is
1)
2)
3)
4)
5)
flexor digitorum superficialis and flexor carpi radialis
flexor digitorum superficialis and flexor pollicis longus
flexor carpi ulnaris and pronator teres
flexor digitorum profundus and flexor pollicis longus
flexor digitorum profundus and flexor carpi radialis
17
70-
A 56-year-old man has had 1 month of persistent lower back
pain and radiculopathy. The most appropriate treatment is
1) activity as tolerated, with strengthening and flexibility exercises
2) laminectomy and disk excision
3) appropriate imaging studies and chemonucleolysis if the disk is not
sequestrated
4) appropriate imaging studies and percutaneous aspiration of the
disk if it is not sequestrated
5) appropriate imaging studies and microdiskectomy
18
71- The changes in the fibula in
the figure are most likely
caused by
A)
B)
C)
D)
E)
72-
The bone at the tip of the
arrow in the figure is most
likely
A)
B)
C)
D)
E)
73-
Tumor bone
Fracture callus
An involucrum
A sequestrum
Viable endochondral bone
Two months following avascular necrosis of the entire femoral
head in a 32- year-old man, histologic examination of the
center of the necrotic area would most often reveal
1)
2)
3)
4)
5)
74-
Parosteal osteosarcoma
Ewing's sarcoma
Osteogenesis imperfecta
Tuberculous osteomyelitis
Hematogenous
osteomyelitis
Viable fatty marrow
Osteoclastic activity along the necrotic trabeculae
Osteoblasts lining the necrotic trabeculae
No evidence of cellular activity
Fibrous tissue within the marrow spaces
On histologic examination , an aneurysmal bone cyst can most
easily be confused with
1)
2)
3)
4)
5)
An osteogenic sarcoma
A nonossifying fibroma
A chondroblastoma
A hemangioendothelioma
A giant cell tumor
19
75-
Following total knee arthroplasty, patient with venograms
positive for deep venous thrombosis should be anticoagulated
with therapeutic doses of
1)
2)
3)
4)
5)
76-
The most common site of terminal bony overgrowth in
children with acquired amputations is the
1)
2)
3)
4)
5)
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Humerus
Radius
Femur
Tibia
Fibula
A 16-year- old baseball player has had 2 weeks of aching low
back pain during athletic activities. Examination was normal
except for mild paraspinal muscle spasm . radiographs showed
bilateral spondylolysis at L5 , with no spondylolisthesis . the
most appropriate initial treatment is
1)
2)
3)
4)
5)
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heparin for 3 weeks
heparin for 3 months
heparin for 6 months
warfarin ( coumadin )for 3 weeks
warfarin ( coumadin )for 3 months
Bed rest for 2 weeks
Cessation of athletic activities for 3 months
Immobilization in a cast or brace
Limitation of activity as determined by symptoms
Posterior spinal fusion
A 15-year-old wrestler noted the sudden, atraumatic onset of
shoulder pain and felt as though he had " lost control " of his
shoulder . examination showed weakness of his deltoid , biceps,
triceps, and wrist extensors . the most likely diagnosis is
1) Dislocation of the shoulder with injury to the axillary nerve
2) Dislocation of the shoulder with injury to the musculocutsneous
nerve
3) Acute brachial neuropathy
4) Thoracic outlet syndrome
5) Acute herniation of a cervical disk
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79-
A 3-year-old girl recovering from an upper respiratory tract
infection suddenly refused to walk. Examination revealed the
right hip to be held in flexion and external rotation, and any
attempt at motion caused severe pain. Her temperature was
39°C (102.2°F), WBC 17,000/mm³ , and erythrocyte
sedimentation rate (ESR) 75 mm/h. The next step in
management should be
1)
2)
3)
4)
5)
80-
A 15½-year-old boy had a nonprogressive inequality of leg
lengths of 2 cm. The most appropriate treatment is
1)
2)
3)
4)
5)
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use of a heel lift on the shorter leg
epiphysiodesis of the distal femur of the longer leg
epiphysiodesis of the distal tibia of the longer leg
closed femoral shortening of the longer leg
one-stage femoral lengthening of the shorter leg
Which of the following statements regarding developmental
coxa vara is correct?
1)
2)
3)
4)
5)
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a CT scan of the hip
an MRI scan of the hip
a bone scan
aspiration of the hip
surgical drainage of the hip
The incidence is greater in females
Hip pain is usually present
Bilateral involvements is usual
The deformity corrects spontaneously with growth
Epiphysiodesis of the greater trochanter is not recommended
treatment
In a 4-year-old with infantile tibia vara, radiographs
demonstrated a stage III Langenskiold lesion and a
tibiofemoral angle of 25° varus. The most appropriate
treatment is
1)
2)
3)
4)
5)
Observation
Application of an orthosis at night
Application of a full-time orthosis
Hemiepiphysiodesis
Tibial osteotomy
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83-
All the following may be
neurofibromatosis EXCEPT
1)
2)
3)
4)
5)
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with
Fibromolluscum
Elephantiasis
Focal gigantism
Subperiosteal bone proliferation
Scoliosis
elevating the limb and performing serial examinations
univalving the cast
bivalving the cast and dividing the cast padding
removing the cast
measuring intracompartmental pressure
Closed reduction and application of an above-elbow cast
A collar and cuff
Skeletal traction
Open reduction and internal fixation
Excision of the fracture fragment
Nine months following treatment of a Salter type II distal
femoral fracture in a 9-year-old boy, routine radiographs reveal
"tenting" of the physis. You suspect a central growth arrest. The
best imaging modality to confirm this impression is
1)
2)
3)
4)
5)
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association
The most appropriate treatment for a 6-year-old boy with a
displaced fracture of the lateral humeral condyle is
1)
2)
3)
4)
5)
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in
Three hours after closed reduction and above-knee casting for a
tibial shaft fracture, a 25-year-old patient complained of
increasing pain in the leg. Capillary refill was sluggish and
passive motion of the toes caused pain in the leg. The most
appropriate initial management of this patient is
1)
2)
3)
4)
5)
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seen
Oblique radiography of the knee
Polytomography
Hypocycloidal motion tomography
CT
MRI
Radiographs of a 4-year-old boy seen 7 days following an elbow
injury revealed posterior and medial displacement of the
proximal radius and ulna relative to the distal humerus. Optimal
treatment is
1)
2)
3)
4)
5)
Cast immobilization
Closed reduction
Closed reduction and percutaneous pinning
Open reduction and percutaneous pinning
A sling that allows motion of the elbow
22
88-
In the treatment of a mid-shaft fracture of the femur in a 7years-old child in skeletal traction, the traction pin should be
inserted in the
1)
2)
3)
4)
5)
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Proximal tibia with the knee fully extended
Proximal tibia with the knee flexed 90 °
Distal femur with the knee fully extended
Distal femur with the knee flexed 90 °
Distal femur and proximal tibia
A 12-year-old boy sustained a complete, midsubstance rupture
of the anterior cruciate ligament (ACL) and an avulsion of the
medial collateral ligament (MCL) from its tibial insertion. The
knee is grossly unstable to valgus and anteroposterior stresses.
The most appropriate treatment is
1) Application of a knee immobilizer; early knee motion
2) Application of an above-knee cast for 6 weeks; vigorous
rehabilitation
3) Surgical repair of the MCL; rehabilitation for the ACL
4) Surgical repair of the MCL; intraarticular reconstruction of the
ACL
5) Surgical repair of the MCL; extraarticular reconstruction of the
ACL
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90-
Six months following closed reduction and casting of a tibial
shaft fracture, an 18-year-old man had pain when he
ambulated more than 30 min at a time. Radiographs of his
tibia are shown below. All the following forms of treatment
could be justified in this patient EXCEPT
1)
2)
3)
4)
5)
resection of 2 cm of fibula
posterolateral bone grafting
pulsed electromagnetic field stimulation
reamed intramedullary nailing
take-down of the nonunion site, with plating and bone grafting
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91-
The posterior approach to the shoulder is most safely and
easily accomplished by dissection
1)
2)
3)
4)
5)
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Along the inferior border of the teres major
Between the teres major and the teres minor
Between the teres minor and the infraspinatus
Between the infraspinatus and the supraspinatus
Between the long lateral heads of the triceps
All the following are important consideration for a successful
metacarpophalangeal (MCP) arthoplasty EXCEPT
1) The functional status of the proximal and distal interphalangeal
joints
2) The functional status of the wrist joints
3) Release of MCP capsular contracture
4) Release of intrinsic contracture
5) Amount of osteopenia in the hand
93-
Which of the following is most important in the early
management of cervical radiculopathy ?
1)
2)
3)
4)
5)
94-
The most common initial manifestation of rheumatoid disease
in the forefoot is
1)
2)
3)
4)
5)
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Immobilization
Traction
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Exercises to strengthen the paravertebral musculature
Trigger-point injection
dorsal tenosynovitis
lateral deviation of the toes
fusiform swelling of the toes
tender callosities over the PIP joints
metatarsalgia
Optimal management of severe disuse osteopenia with hypercalcemia is
1) mechanical compressive treatment; maintenance of water and
electrolyte balance
2) calcium and phosphate supplements
3) calcitonin or diphosphonates ; maintenance of water and
electrolyte balance
4) phosphate supplements; mechanical compressive treatment
5) immobilization
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96-
Five weeks after treatment of an extra articular fracture of
the distal radius in a below-elbow cast, a 70 year-old woman
was suddenly unable to extend her thumb. The most likely
diagnosis is :
1)
2)
3)
4)
5)
97-
Deep wound infection following primary total hip arthroplasty
occurs in approximately
1)
2)
3)
4)
5)
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1 percent of cases, of which 15 percent develop after 24 months
2 percent of cases, of which 25 percent develop after 24 months
3 percent of cases, of which 35 percent develop after 24 months
4 percent of cases, of which 45 percent develop after 24 months
5 percent of cases, of which over 50 percent develop after 24
months
Third-generation bisphosphanates exert most of their effect
by:
1)
2)
3)
4)
5)
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Compression of the posterior interosseous nerve.
Rupture of the extensor pollicis longus .
Displacement of the fracture .
Compartment syndrome in the forearm.
Osteoarthritis of the basilar joint of the thumb.
Increasing osteoblast production of primary spongiosa.
Increasing osteoclast resorptive fronts.
Decreasing osteoblast production of secondary spongiosa.
Decreasing osteoclastic resorption.
Inhibiting matrix vesicle dissolution.
Loosening of the tibial component following total knee
arthroplasty has been associated primarily with
1)
2)
3)
4)
5)
Poor surgical technique
Poor prosthetic design
Marked preoperative varus deformity
Marked preoperative valgus deformity
preoperative recurvatum deformity
100- An 18-year-old wrestler sustained a posterolateral dislocation of
the elbow. Examination after reduction of the elbow revealed
that the elbow could be easily redislocated. Radiographs
obtained after reduction showed a concentric reduction with
anatomic alignment. Further treatment should consist of
1)
2)
3)
4)
5)
immobilization at 90° for 1 week
immobilization at 90° for 3 week
immobilization at 90° for 6 week
operative repair of the medial collateral ligament
operative repair of the medial and lateral collateral ligament
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