Uh/ Tamc Oite 2006

Front 1

"In the child with acute onset diskitis, what is the earliest radiographic finding? 1- Narrowing of the intervertebral disk space
2- Scalloping of the superior vertebral body
3- Scalloping of the inferior vertebral body
4- Vertebra Magna
5- Loss of normal lumbar lordosis

Back 1

5 loss of lordosis

Front 2

"A 10 year-old girl has abdominal pain following a motor vehicle accident where she was restrained in the back seat by a lap belt. Bruising is noted across the lower abdomen. Radiographs reveal a flexion-distraction injury of T12-L1. What is the most likely associated nonskeletal injury? 1- Iliac vein tear
2- Uterine rupture
3- Colonic perforation
4- Cardiac contusion
5- Aortic dissection

Back 2

3 colonic perforation

Front 3

"Which of the following groups of women are at the highest risk for domestic violence and abuse?

1- Women older than age 35
2- Women older than age 65
3- Women with an income above $15,000
4- Women with high self-esteem
5- Pregnant women
"

Back 3

"5 pregnant women - It has been estimated that 8% to 12% of American women are abused by intimate partners each year.

Front 4

"An 8 year-old girl sustained a Salter-Harris type II fracture of the right distal femoral epiphysis 18 months ago that was treated with closed reduction and percutaneous screw fixation through the metaphyseal fragment. Over the past year, her mother has noted a progressive knock-knee deformity of the right leg. Following removal of the implant, radiographs and T1-weighted MRI scan are shown in Figures 10a through 10d. Treatment should know consist of

1- distal femoral osteotomy.
2- distal femoral osteotomy and epiphysiodesis.
3- contralateral distal femoral epiphysiodesis.
4- resection of the physeal bridge and interposition of fat.
5- observation.
"

Back 4

"4- resectin of the physeal bridge and interposition of fat Growth arrest secondary to physeal bridge formation is an uncommon but well-recognized complication of physeal fractures and other injuries. Regardless of the underlying etiology, physeal bridges may cause angular and/or longitudinal growth disturbances, with progression dependent on the remaining physeal growth potential. Physeal bridge resection and insertion of interposition material releases the tethering effect of the bridge. Physeal bridge resection has become an accepted treatment option for patients with existing or developing deformity and for those with at least 2 years or 2 cm of growth remaining.

Front 5

"What type of nonunion is most likely to unite by increasing biomechanical stability?

1- Atrophic
2- Oligotrophic
3- Hypertrophic
4- Infected
5- Synovial pseudarthrosis
"

Back 5

"3- hypertrophic:: Hypertrophic “elephant foot” callus is the sign of motion at a vascular nonunion where the interposed tissue is fibrocartilage. Unless there is gross malalignment, there is no need for resection of the nonunion tissue or ends, and bone graft is usually unnecessary. Union will occur rapidly when motion is stopped by stable internal fixation.

Front 6

"On an AP ankle radiograph, the measurement of the tibial clear space (the syndesmotic space) should be less than 5 mm if there is no syndesmotic widening. The tibial clear space is defined as the

1- distance between the medial border of the fibula and incisura fibularis.
2- distance from the incisura fibularis to the lateral tibial border.
3- distance from the medial malleolus to the talus.
4- overlap of the anterior portion of the lateral tibia on the fibula.
5- overlap of the posterior portion of the lateral tibia on the fibula.
"

Back 6

1- distance between the medial border of the fibula and incisura fibularis

Front 7

"A 32 year-old woman fell on her outstretched hand 4 weeks ago. Initial radiographs reveal no evidence of fracture; therefore, management consisted of a wrist splint. She now reports increased swelling of the entire hand, intense burning pain, increased sensitivity to touch, and mottled skin color appearance. Repeat radiographs are normal. What is the most likely diagnosis?

1- Compartment syndrome of the forearm
2- Carpal tunnel syndrome
3- Complex regional pain syndrome, type 1
4- Allergic reaction to the splint material
5- Rupture of the extensor pollicis longus tendon
"

Back 7

3-Complex regional pain syndrome, type 1:: Complex regional pain syndrome, type I and type II have been the new nomenclature set forth by the International Association for the Study of Pain (IASP) to replace the terms RSD and Causalgia, respectively.

Front 8

A reverse total shoulder arthroplasty is most appropriate in which of the following situations?

Back 8

3. Elderly individual with a painful, arthritic shoulder and an irreparable rotator cuff tear with active forward flexion of 30

Front 9

During normal knee flexion from 0 to 100 which of the following kinematic motions occurs?

Back 9

2. The lateral condyle moves more posteriorly than the medial condyle

Front 10

A greater trochanteric entry site for femoral intramedullary nailing, compared to a piriformis fossa starting point is associated with

Back 10

"1. more disruption of the gluteus medius tendon

Front 11

What region of the growth plate seen in figure 12 is commonly damaged in a salter-harris type 1 physeal injury?

Back 11

"region D

Front 12

A 17 year old girl has late-onset idiopathic scoliosis. The natural history of the condition, compared with unaffected control subjects, is associated with which if the following?

Back 12

"3 – increased chronic and acute back pain

Front 13

Figure 13 shows the clinical photograph of a patient with underwent a BKA. Why are the “dog ears” at the edge of the incision typically present?

Back 13

"1 – removal risks the posterior flap blood supply

Front 14

A 46 year old woman has plantar heel pain for the past 5 months. The pain is most severe when she arises out of bed in the morning and when she stands after being seated for a period of time. Initial treatment should consist of

Back 14

"4 – a stretching program and a cushioned insert

Front 15

Avulsion fractures of the anterior inferior iliac spine in adolescent athletes occur from forceful contraction of which of the following muscles?

Back 15

"4 – rectus femoris

Front 16

39. In patients with ipsilateral femoral neck and shaft fractures, what percentage of femoral neck fractures are significantly displaced?

Back 16

"3 – 40%

Front 17

40. Which of the following is considered a critical step in the pathologic process of metastasis for a malignant cell?

Back 17

"2 – Intravasation

Front 18

"81. A terrible triad elbow injury that includes a comminuted nonreconstructable radial head fx and T3 coronoid fx with elbow dislocation is best treated with acute rad head.

"

Back 18

"5-arthroplasty, coronoid orif and lcl repair

Front 19

82. 38 yo female with numbness to medial border of left hand and forearm after low impact mvc 4 wks ago. Exam shows fine motor difficulty and long finger flexor weakness to fingers and thumb. What is the diagnosis?

Back 19

"1-c8 radiculopathy

Front 20

83. Examination of a 24 yr old man with HMSN show cavovarus hindfoot correctable with block tests. Treatment:

Back 20

"1-plantar fascia release, 1st mt dorsal closing wedge osteotomy and PL to PB transfer.

Front 21

84. A 57 yo man with prostate ca diagnosed 3 years ago, neg margins and lymph nodes. Now with 3 wk history of R hip pain with WB. XR’s given, CT and body scans are neg for mets or other lesions. Next step?

Back 21

"3-Biopsy of the R femur

Front 22

85. A patient sustained a distal fibula fx with nonsurg tx. Talocrural angle is overall increased, which is associated with this malunion?

Back 22

"1-lateral talar tilt.

Front 23

86. What is the direct intracellular target for nitrogen-containing bisphosphonates?

Back 23

"1-Farnesyl diphosphate synthase

Front 24

87. The inhibitory effect of quinolone-class abx on early fracture healing is most linked to toxic effects on which structures?

Back 24

"4- chodrocytes

Front 25

88. A 17 yr old male hockey player twists his knee and is now unable to passively extend it past 20deg. MRI shows displaced bucket-handle tear with a 3mm rim. This is confirmed on arthroscopy, what is the next step?

Back 25

"2-reduction and inside-out repair with vertical mattress sutures.

Front 26

89. Compared with standard incision for THA, minimally invasive THA with single incision less that 4 inches shows:

Back 26

"3-cosmetic improvement only

Front 27

90. 27a/b show a 1yr old girls xrays. She has normal knee extension strength. The right foot is at the level of the left midtibia. Treatment:

Back 27

"1-tibfib synostosis, symes amp and prosthesis.

Front 28

91. Fig 28a/b show 23 yo male with gsw to L wrist from handgun. Muzzle velocity is 1500 ft/s. Dorsal and volar wounds measure 3mm in diameter are present but not bleeding. He is NVI fully at the hand, tendons all work. What is the treatment?

Back 28

"5- local wound care in ED with po abx for 3 days.

Front 29

"92. A 25 yo male pro boxer has pain/swelling to the over the long finger MCPJ. He has failed all conservative management for 3 mos, xrays are normal, what’s next?

"

Back 29

"5-Repair of the extensor hood.

Front 30

93. 65 yo male with L1 burst fx from fall one month out. Has back pain, increased difficulty with voiding, diffuse bilat foot numbness. He is weak to long toe flexors and decreased perianal sensation. MRI has medullaris compression due to retropulsed fx fragment. Next?

Back 30

"2-Anterior decompression with grafting, w/wout instrumentation.

Front 31

95. In mesenchymal neoplasia, an antioncogene refers to what function in a gene?

Back 31

"2- loss of gene function leads to a malignancy

Front 32

96. 12 yo male with knee injury from bike accident and improving knee pain since. Incidental finding of distal femoral lesion, management:

Back 32

"5- observation and followup

Front 33

97. 7 yo boy with crpp of supracondylar fx 8hrs ago and now with s/sx compartment syndrome. Next?

Back 33

"4- measurement of compartment pressures

Front 34

98. What is most frequent cause of long-term physical morbidity in abused kids?

Back 34

"2- Head injury

Front 35

99. 39 yo male laborer with medial knee pain. History of nonop mgmt of PCL tear 20 years ago. Films shown, what surgery will best help him?

Back 35

"2- Medial opening wedge proximal tibial osteotomy

Front 36

"100. 35 yo woman with foot pain after tripping down a flight of stairs 2 weeks ago. The midfoot is swollen and tender, she limps. Figures show NWB and WB films. Treatment?

"

Back 36

"3-ORIF

Front 37

"101. A 20-year-old man with a traumatic transtibial amputation reports buckling of his knee in the heel strike phase. What is the most likely cause of his symptoms?

1- Socket extension
2- Prosthetic foot too firm
3- Prosthetic foot placed too forward
4- Prosthetic foot plantar flexed
5- Excessive prosthetic length
"

Back 37

"2- Prosthetic foot too firm:: Transtibial amputation prosthetics commonly cause gait deviations at the knee joint. Resulting knee flexion at heel strike is typically cause by either a foot in too much dorsiflexion, an excessively stiff heel cushion, anterior translation of the socket in relation to the pylon, or a residual limb flexion contracture. In contrast, the opposite is usually true if the abnormality is the knee hyperextends at heel strike. Excessive plantarflexion of the foot, an excessively soft heel cushion, posterior displacement of the socket in relation to the pylon, or weak quads on the residual limb.

Front 38

"102. A 42-year-old woman who was treated with cast immobilization for a nondisplaced distal radius fracture now reports the sudden inability to extend her thumb. What is the most likely cause of this problem?

1- Entrapment of the flexor pollicis longus tendon
2- Entrapment of the extensor pollicis longus tendon
3- Rupture of the extensor pollicis longus tendon
4- Posterior interosseous nerve palsy
5- C-7 disk herniation
"

Back 38

"3- Rupture of the extensor pollicis longus tendon:: Delayed rupture of the EPL tendon after distal radius fractures is a well described phenomenon in the literature. Incidence is rather low and has been reported to be around 0.3%. Interestingly, it seems to occur more often in nondisplaced fractures than in displaced fractures. Causative factors are thought to be mechanical irritation, attrition, and vascular impairment. Many feel a mechanical irritation of the tendon caused by a sharp edge of the fractured bone and a direct microvascular compromise of the poorly vascularized tendon is the predominant cause. Also a narrowing of the third dorsal compartment at Lister’s tubercle is thought to cause irritation and vascular compromise whereas in displaced fractures this does not occur as badly as the retinaculum is torn from the bone. Microangiographic studies have shown an area of the tendon about 5mm in length around Lister’s tubercle to have a very poor blood supply and totally lacking in mesotenon. Rupture typically occurs late at 6 weeks to 3 months after the injury. Treatment for delayed rupture consists of mobilization and repair with a tendon transfer.

Front 39

"103. A 30-year-old recreational jogger reports gradually worsening plantar heel pain that is most pronounced with the first few steps after getting out of bed and when getting up after sitting all day at a desk. Examination reveals tenderness to palpation over the medial calcaneal tuberosity. What is the most likely diagnosis?

1- Calcaneal stress fracture
2- Entrapment of the first branch of the lateral plantar nerve
3- Plantar fasciitis
4- Posterior ankle impingement
5- Flexor hallucis longus tendinitis
"

Back 39

"Plantar fasciitis (3)is the most common cause of heel pain in runners. It accounts for 10% of running injuries. Repetitive, impact-oriented activity (jogging) can lead to inflammation and microtears of the fascia, most commonly seen around its origin at the medial calcaneal tuberosity. Complaints are typically plantar-medial heel pain with insidious onset. Pain is worse when rising from bed and with standing after prolonged periods of inactivity. Pain on palpation of medial calcaneal tuberosity is a classic physical finding.

Front 40

"103. A 30-year-old recreational jogger reports gradually worsening plantar heel pain that is most pronounced with the first few steps after getting out of bed and when getting up after sitting all day at a desk. Examination reveals tenderness to palpation over the medial calcaneal tuberosity. What is the most likely diagnosis?

1- Calcaneal stress fracture
2- Entrapment of the first branch of the lateral plantar nerve
3- Plantar fasciitis
4- Posterior ankle impingement
5- Flexor hallucis longus tendinitis
"

Back 40

"Shoulder arthroplasty::

Front 41

""106. A 24-year-old man with grade III (greater than 50% slip) isthmic spondylolisthesis of L5 on S1 is scheduled for surgery. The procedure should include

1- posterior lumbar fusion.
2- L5 corpectomy.
3- laminectomy alone.
4- stand-alone anterior lumbar interbody fusion.
5- complete reduction of the deformity.
"

Back 41

"1: posterior lumbar fusion:: This study evaluated 21 patients with grade III, IV, or V spondylolistheses and attempted to review the clinical and radiographic outcomes of surgical treatement. In their discussion they reviewed the literature regarding operative treatment. Indications for surgery are continued pain despite nonop measures and progression of the deformity. The mainstay surgical procedure is in-situ posterior lumbar instrumentation and fusion L4-S1 with or without L5 laminectomy. The problem in the past has been significantly higher pseudoarthosis rates and worsening deformity in patients without posterior fusion. Successful posterior fusion in-situ without instrumentation has been shown to have up to a 26% incidence of worsening deformity, now making instrumentation more favorable. Reduction of the deformity (5) is controversial at best and neurological complications associated with it are high (10-50%) including cauda equina syndrome.

Front 42

"107. An obese 72-year-old woman with isolated medial knee osteoarthritis and 100° of passive motion is considering undergoing unicompartmental knee arthroplasty. Which of the following is considered the greatest advantage of unicompartmental knee arthroplasty compared with a total (tricompartmental) knee arthroplasty?

1- Improved range of motion postoperatively
2- Greater prosthetic longevity
3- Greater relief of postoperative knee pain
4- Faster early rehabilitation
5- Better correction of preoperative deformity

"

Back 42

"4- faster early rehabilitation:: Heck DA, Marmor L, Gibson A, et al: Unicompartmental knee arthroplasty: A multicenter investigation with long-term follow-up. Clin Orthop 1993;286:154-159.

Front 43

"
108. According to the arithmetic method of determining limb-length discrepancy, what is the rate of growth per year of the distal femoral physis?

1- 4mm
2- 6mm
3- 10mm
4- 14mm
5- 18mm
"

Back 43

10mm:: The arithmetic method, also known as the rule of thumb method, is based on four assumptions about growth: 1)boys stop growing at age 16; (2) girls stop growing at age 14; (3) the distal femoral physis grows 10mm yearly; and (4) the proximal tibia grows 6mm yearly. Typically this method of discrepancy prediction is only useful during late childhood and doesn’t work very well in young children. It doesn’t account well for the fact that some individuals may mature earlier or later. Other methods of predicting LLD are the Eastwood-Cole method, the Green-Anderson growth-remaining method, and the Moseley straight-line graph method (this is Dr. Gates’ preferred method). Pictures of the different graphs are show below in that order. For further discussion and instructions on using these graphs, please see this instructional article: Pritchett JW, Bortel DT: Single bone straight line graphs for the lower extremity. Clin Orthop Relat Res 1997;342:132-140.

Front 44

"110. Which of the following is considered the most common problem that limits active overhead shoulder motion after hemiarthroplasty performed for a four-part proximal humeral fracture?

1- Retroversion of the prosthesis
2- Varus alignment of the prosthesis
3- Acromioclavicular arthritis
4- Greater tuberosity nonunion
5- Use of a cemented stem
"

Back 44

"Greater tuberosity nonunion::

Front 45

111. A 28-year-old woman who previously underwent excision of the lateral (fibular) seasmoid for a painful intractable plantar keratosis now has a painful hypertrophic callus under the medial (tibial) seasmoid. Shoe modification and asymptomatic treatment have failed to provide relief. She is now requesting excision of the remaining seasmoid. What is the most common surgical complication from this procedure?

Back 45

"1- Claw toe deformity

Front 46

"
114. Which of the following tumors has the greatest potential to metastasize to the lungs?
"

Back 46

"4- Giant cell tumor

Front 47

115. Which of the following is considered the most common disadvantage of using posterior antiglide plating in the treatment of lateral malleolar fractures compared to lateral neutralization plating?

Back 47

"3- Peroneal irritation if the plate is placed too distally

Front 48

116. Figure 38 shows the radiograph of a 2-year-old boy with a unilateral bowing of the leg. What is the most likely diagnosis?

Back 48

"2- Focal Fibrocartilaginous dysplasia

Front 49

117.What type of prescription footwear is covered per year under the Medicare’s Therapeutic Shoe Bill for patients with diabetic neuropathy?

Back 49

"1- One pair of extra-depth shoes and three pairs of inserts

Front 50

118. While performing a quadriceps-sparing minimally invasive total knee arthroplasty, the patellar tendon starts to peel off the tibial tubercle. Retraction is stopped before the integrity of the tendon is compromised. What is the best course of action?

Back 50

"5- Convert the quadriceps-sparing technique into a standard medial parapatellar arthrotomy.

Front 51

121. A 2-week-old girl has hematogenous septic arthritis of her right knee. There are no open lesions and no other sites of infection. The most common infecting organism in this setting include S. aureus and

Back 51

"1- Group B Strep and Gm(-) Bacilli

Front 52

"122. After repair of a torn quadriceps tendon, which of the following rehabilitation protocols provides range of motion and minimal stress on repair?

1- Active open chain extension and active open chain flexion
2- Active open chain extension and active closed chain flexion
3- Active-assisted extension and active open chain flexion
4- Passive extension and active open chain flexion
5- Passive extension and active closed chain flexion
"

Back 52

"5- Passive extension and active closed chain flexion:: The areas that are most crucial during rehabilitation, strain, stability, joint force, range of motion (ROM), and strength. The safest Kinetic Chain Exercise will decrease stress, strain, and an increase in stability as well as range of motion

Front 53

"122. A 5-year-old girl has a history of frequent fractures, progressive hearing loss, and deteriorating eyesight. Radiographs are shown in figures 41a and 41b. It has been determined that she is not a candidate for bone marrow transplant. What is the pathophysiology of this disorder?

1- Parvovirus infection of bone
2- Failure of Osteoclastic resorption of bone
3- Oversensitivity of osteoblast to parathyroid hormone
4- Qualitative defect of type I collagen synthesis
5- Overproduction of calcitonin
"

Back 53

"2- Failure of Osteoclastic resorption of bone:: Parvovirus think immunocompromised person with osteomylitis

Front 54

"124. In comparison to nonsurgical management, surgical decompression for degenerative lumbar stenosis results in

1- better functional outcome at 5 years
2- worse functional outcomes at 2 years
3- equivalent functional outcomes at 2 years (????)
4- a higher rate of cauda equine syndrome
5- more delayed relief of symptoms

"

Back 54

"3- equivalent functional outcomes at 2 years (????):: Nonoperative methods are effective in the treatment of most patients with symptomatic degenerative spondylolisthesis and spinal stenosis. Initial treatment consists of short-term activity restriction and a nonsteroidal analgesic, if tolerated. Physical therapy along with massage, heat, ultrasound, and limited pelvic traction may be used as well. Ultimately, patients are to establish a regular exercise program consisting of aerobic, active flexion, and abdominal and back strengthening exercises. Surgery should be advised to pts in this study who fail to respond to a reasonable trial of nonoperative treatment for a minimum of 3 months.

Front 55

"125. Doxorubicin used in the treatment of sarcomas, is thought to affect cell death by inducing

1- necrosis .
2- apoptosis
3- Senescence
4- antiangiogenesis
5- downregulation of oncogenes
"

Back 55

"2- apoptosis:

Front 56

"126. A healthy, active 26-year-old woman sustained a displaced two-piece calcaneal fracture with subluxation of a posterolateral fragment into the subfibular recess. Recommended treatment should consist of

1- Open or percutaneous reduction and internal fixation
2- Excision of the posteriolateral fragment
3- non-weight-bearing and early mobilization
4- Casting for 3 months
5- posterior arthroscopic debridement
"

Back 56

"Open or percutaneous reduction and internal fixation:: Treatment of calcaneal fractures dramatically improved in last 20 years. ORIF, without joint transfixation, is established as standard therapy for displaced fractures with good to excellent results in 2/3-3/4 of cases in large clinical series. Anatomical reduction of subtalar joint congruity and restoration of the overall shape of the calcaneus are important prognostic factors. The quality of joint reduction should be reliably proved intra-operatively with imaging. The extended lateral approach respects the neurovascular supply to the heel and allows a good exposition of the fractured lateral wall, the subtalar and calcaneocuboid joints in complex fractures. In simple fracture patterns percutaneous screw fixation, supplemented by arthroscopic control if necessary, is a good alternative with minimal affection of the soft tissues.

Front 57

"128. A 21-year-old college football player reports a history of feeling his shoulder “pop in and out” during play. Examination reveals mild apprehension with a significant anterior shift and a positive sulcus examination. Physical therapy has failed to provide relief. A current coronal T1- weighted MRI scan shown in Figure 43. Based on these findings what is the most likely diagnosis?

1- Supraspinatus tendon tear of the anterior portion
2- Humeral avulsion of the inferior glenohumeral ligament (HAGL)
3- Superior labral tear (SLAP lesion)
4- Inferior labral tear
5- Osteochondral injury of the humeral head
"

Back 57

"Humeral avulsion of the inferior glenohumeral ligament (HAGL)::

Front 58

"129. When using hyperbaric oxygen treatment for a crush injury to the extremity, which of the following mechanisms of action is present?

1- Increased hydrostatic pressures
2- Increased tissue edema
3- Increased gradient for diffusion
4- Decreased leukocyte function
5- Decreased arteriolar vasoconstriction
"

Back 58

"Increased gradient for diffusion:: HBO therapy allows patients to breathe 100% oxygen in a chamber under conditions of increased barometric pressure. Most HBO therapy treatments are administered at barometric pressures ranging from 1 to 2 atmospheres greater than the pressure experienced at sea level except the Bends. All pressures are designated as absolute atmospheres (ATA), which takes into account the ambient pressure at one atmosphere before the chamber is pressurized. Most clinical hyperbaric medicine is at 2 to 3 ATA—that is, 1 or 2 atmospheres greater than ambient pressure. Each atmosphere is 760 mm Hg; so 100% oxygen at 3 ATA is exposed to a pO2 of 2,280 mm Hg. This partial pressure of oxygen supports gas diffusion for a greater distance than normal conditions, thus delivering oxygen to relatively ischemic and hypoxic tissues

Front 59

"130. A 67 year-old man with diabetes mellitus has undergone initial casting for a displaced midfoot neuroarthropathic collapse. Examination reveals an unstable midfoot with blanching of the skin with weight bearing. What is the most appropriate step in management?

1- Charcot restraint orthotic walker (CROW)
2- Triple arthrodesis
3- reduction of the midfoot and application of an external fixator
4- midfoot arthroplasty
5- Rigid foot orthosis with posting of the lateral midfoot
"

Back 59

"Charcot restraint orthotic walker (CROW)::

Front 60

144. Compared to normal synovium, which of the following best characterizes synovium in patients with rheumatoid arthritis?

Back 60

"#4 Prominent intimal hyperplasia

Front 61

145. A Syme ( through the ankle) amputation is considered most appropriate for which of the following patients?

Back 61

"#2. A 35 yo man with a severe crushing and degloving injury to the forefoot with intact plantar skin.

Front 62

146. A 58 yo woman with rheumatoid arthritis reports progressive neck pain and difficulty with fine motor movements, including playing cards and handling coins. Examination revealed hyperreflexia without objective weakness. What is the most important radiographic factor that may predict neural recovery after decompressive surgery?

Back 62

"#3.. Posterior atlanto-dens interval of greater than 13mm

Front 63

149. Figure 54 shows a graphic representation depicting the current understanding of signaling pathways leading to the formation of multinucleated osteoclasts that can resorb bone. Which of the following is known to directly inhibit the RANKL- mediated osteoclast formation process?

Back 63

"#3. Osteoprotegerin

Front 64

"150. What is the order of resorbtion rates from fastest to slowest of the following bone graft substitutes?

"

Back 64

"#1. Calcium sulfate, tri calcium phosphate, hydroxyapatite

Front 65

"161. A 16 year old girl has had vague right hip pain for the past 2 months. An AP radiograph of the pelvis and a T¹-weighted fat suppression, gadolinium-enhanced MRI scan are shown in Figure 62a and 62b. A biopsy specimen is shown in Figure 62c. What characteristic genetic translocation is associated with this disease?

1- t(X;18)
2- t(2;13)
3- t(9;22)
4- t(11;22)
5- t(12;16)
"

Back 65

"Ewing’s Sarcoma is the second most common bone tumor of late childhood and early adulthood. Classified as one of the “small round cell tumors.” Translocation t(11;22) is present in at least 85% of cases, producing a fusion transcription factor – EWS/FLI-1.

Front 66

"162. If the posterior condylar axis is used for determining the rotation of the femoral component, which of the following errors is expected when 3˚ of external rotation are built into the jig that controls femoral rotation?

1- Internal rotation of the femoral component if the lateral femoral condyle is hypoplastic
2- Internal rotation of the femoral component in a varus knee
3- Internal rotation of the femoral component when there is wear of the posterior aspect of the medial femoral condyle
4- External rotation of the femoral component if the lateral femoral condyle is hypoplastic
5- Femoral component rotation parallel to the epicondyle axis in all knees
"

Back 66

"1- Internal rotation of the femoral component if the lateral femoral condyle is hypoplastic:: The premiss for the question is that cutting jigs in TKA are not designed to allow the surgeon to be on autopilot. The individual anatomy must be considered, especially in extreme varus or valgus knees.

Front 67

"164. According to workers’ compensation law, when can a patient with a fracture settle his or her claim?

1- Following 1 year post injury
2- Following release to light duty
3- Following release to full duty
4- Following maximal improvement
5- Upon fracture healing
"

Back 67

"4- Following maximal improvement:: AIM OF THE STUDY: To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery. PATIENTS AND METHODS: Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers (n=87), wage earners in the private sector (n=90) and civil servants (n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group. RESULTS: For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days. DISCUSSION: The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants.

Front 68

"165. During revision total knee arthroplasty for flexion instability, the tibial baseplate is retained. Compared to the original femoral component, the revision femoral component should be

1- smaller
2- larger
3- more distal
4- lateralized
5- at the same position and size, with a thicker tibial insert.
"

Back 68

larger

Front 69

"166. What anatomic region or landmark is best seen on the iliac oblique radiograph of the pelvis?

1- Posterior column
2- Sacroiliac joint
3- Iliopectineal line
4- Profile of the obturator foramen
5- Posterior wall of the acetabulum
"

Back 69

"posterior column::

Front 70

"168. What is the most likely complication following open or endoscopic anterior surgery of the thoracic spine?

1- Pseudarthrosis
2- Intercostal neuralgia
3- tension pneumothorax
4- Aortic laceration
5- Parenchymal lung injury
"

Back 70

"2- Intercostal neuralgia:: In the reference article of the 212 patient undergoing this procedure there were 12 access related complications including pleural effusion, pneumothorax, intercostal neuralgia, and L1 sensory deficit. 5 implant loosening, 3 conversion to open, 3 Superficial portal infections,1 vascular injury, 1 neurologic deterioration.

Front 71

"169. A 15 month old boy requires treatment with a halo device. What is the preferred pin configuration?

1- Four pins, with a torque of 6 to 8 in-lb
2- Four pins, with a torque of 2 to 4 ft-lb
3- Four pins, with a torque of 6 to 8 ft-lb
4- Six to twelve pins, with a torque of 2 to 4 in-lb
5- Six to twelve pins, with a torque of 2 to 4 ft-lb
"

Back 71

"4- Six to twelve pins, with a torque of 2 to 4 in-lb:: Halo devices have fallen out of favor because of the frequent complications related to their use. Children are more likely than adults to experience these complications, probably because of the thinner scalps and calvariae in the former group of patients. In a series of 37 patients between 3 and 16 years of age treated with a halo, 68% of the children experienced a complication related to the device. The most frequent complication is pin site infection, with others including pin loosening, dural or calvarial penetration, and supraorbital nerve injury. Halo devices can also inhibit activity and physiotherapy. Because of the thinner calvaria, special consideration needs to be given before placing a child in a halo device. First, more pins need to be used, with children younger than 2 years of age requiring eight to 10 pins. As children get older, fewer pins are required, and by the age of 4 to 5 years, only four pins are necessary. Second, the amount of torque applied to pins for fixation decreases with the patient's age. Table 1 summarizes the torque recommendations for pediatric patients.

Front 72

"170. To decrease morbidity and mortality in a elderly ambulatory patient with a displaced femoral neck fracture, optimal management should include

1- surgical intervention within 4 days of injury
2- open reduction and internal fixation
3- a delay in surgery of 7 days
4- early surgery irrespective of medical comorbidities.
5- transfer to a level 1 trauma center
"

Back 72

"1- surgical intervention within 4 days of injury::

Front 73

203. After severe collision in a game a football player is laying face down and is unconscious. He is carefully log rolled to his back onto a backboard. He then begins to show signs of respiratory distress. What’s next?

Back 73

"3-Removal of the facemask only with helmet and pads in place.

Front 74

"
204. What complication occurs more frequently with current resurfacing arthroplasty compared with THA?
"

Back 74

"4-Periprosthetic fracture

Front 75

205. A 6 year-old girl has sustained numerous long bone fractures in the past. Her parents report that there is no family history of any similar problems. Exam shows normal-appearing sclera and brownish opalescent teeth. A radiograph of her lower extremities is shown in fig 80. What is causing the disorder?

Back 75

"
5-qualitative defect of type 1 collagen synthesis

The stem describes dentogenesis imperfecta-a clinical manifestation of OI. Type 1 collagen is present in bone, dentin, sclera and thus the deformities can present there. Teeth malformations may or may not be present in the intermediate or mild forms.

BONE, 2 alp 1 chains (17) and 1 alp 2 chain (7). heterotrimer Formed in a helix
OI: type one with blue sclera and deafness, reduced T1 collagen
Type 2 is perinatal lethal spontaneous new mutations with no normal T1 coll
Type 3 autosomal recessive, normal sclera and hearing (severely deforming)
Type 4 like t1 but normal sclera and hearing

MORQUIO SYNDROME is what choice 4 describes, a mucopolysaccharidosis that presents with SED/MED

"

Front 76

209. A posterolateral or posterior peritrochanteric portal for hip arthroscopy place the sciatic nerve at risk when the hip is in what position?

Back 76

"3-External rotation:: Posterior Paratrochanteric Portal: This is a valuable portal, but it is potentially hazardous if one does not bear in mind the important adjacent structures. The approach is made 2 to 3 cm posterior to the tip of the greater trochanter at a level that corresponds to the anterior para-trochanteric

Front 77

210. Which of the following features improves fluid film lubrication in a metal on metal THA?

Back 77

"
4-Larger diameter femoral head, a slight clearance between socket and head, minimal surface roughness

larger heads improve stability and also lubrication by having an increased relative sliding velocity and reducing impingement. Based on the literature, it may be concluded that a head-to-cup clearance between 50 and 100 lm, bearing sphericity of less than 5 micrometers, and bearing surface finish in the range 10 to 50 nm should provide satisfactory bearing performance. Wear is reduced at the lower end of each range provided tolerances can be maintained. There is disagreement on the preferred alloy for maximal wear resistance.


"

Front 78

"
231. A 35-year-old man has pain, limited motion, and swelling of his middle finger after sustaining a volar puncture wound 3 days ago. Examination reveals a flexed resting posture, pain with passive stretching, and tenderness along the flexor tendon sheath. Appropriate management should consist of

1- outpatient management with oral antibiotics.
2- IV antibiotics alone.
3- surgical drainage over the entire length of the finger.
4- surgical drainage via small incisions and intraoperative sheath irrigation
with a catheter.
5- needle aspiration of the flexor tendon sheath with continuous irrigation and oral
antibiotics.
"

Back 78

"4- surgical drainage via small incisions and intraoperative sheath irrigation with a catheter.::

Front 79

"During a two-incision minimally invasive total hip arthroplasty, the socket is inserted without any complications. While inserting the proximally coated nonmodular femoral stem, a fracture is noted at the junction between the proximal and middle thirds of the femur, roughly at the anticipated tip of the stem. What is the best course of action?

1- Extend the incision with the patient in the supine position, insert the femoral
stem, and use a cable-plate for internal fixation of the femur.
2- Insert a longer stem through the minimally invasive approach, and reduce the
fracture under radiographic control as the stem is being advanced.
3- Close both incisions prior to inserting the stem, reposition the patient into
the lateral position, extend the femoral incision into an extensile
posterolateral approach to expose the hip joint and the fracture, and insert
a longer fully porous-coated stem to bypass the fracture.
4- Close both incisions prior to inserting the stem, reposition the patient into the
lateral position, extend the femoral incision into an extensile posterolateral
approach to expose the hip joint and the fracture, reduce the fracture, insert the
proximally coated stem into the proximal femur, and use cerclage cables to fix
the fracture.
5- Continue the surgery with the patient in the supine position, insert the femoral
stem into the femur under radiographic control, and use a minimally invasive
locking plate technique to fix the fracture.
"

Back 79

" 3- Close both incisions prior to inserting the stem, reposition the patient into

Front 80

"233. A 37-year-old man is undergoing an anterior cervical discectomy and fusion for a large central disk herniation. Following placement of an interbody strut into the disk space, motor-evoked potentials are lost in the right and left upper extremities. What is the next most appropriate step in management?

1- Close the wound and perform a laminectomy.
2- Close the wound and obtain an emergent MRI.
3- Perform a wake-up test.
4- Remove the interbody strut.
5- Insert an anterior cervical plate.
"

Back 80

"4- Remove the interbody strut.::

Front 81

"234. Medial displacement calcaneal osteotomy and flexor digitorum longus transfer to the navicular is considered the treatment of choice for which of the following patients?

1- A 24-year-old male runner with posterior tibial tenosynovitis and no hindfoot
deformity
2- A 27-year-old man with cerebral palsy and a spastic cavovarus foot
3- A 35-year-old man with painful cavovarus foot secondary to Charcot-Marie-
Tooth disease
4- A 60-year-old woman with a painful flexible adult-aquired flatfoot
deformity secondary to posterior tibial tendon dysfunction
5- A 75-year-old woman with a rigid adult-acquired flatfoot deformity secondary
to posterior tibial tendon dysfunction
"

Back 81

"4- A 60-year-old woman with a painful flexible adult-aquired flatfoot

Front 82

"235. A 35-year-old runner who has had intermittent calf pain for the past 4 months now reports cramping, coolness of the leg, and occasional paresthesias of the foot. Symptoms are worse with walking and relieved with running. Examination reveals that dorsiflexion and plantar flexion of the ankle accentuate the patient’s symptoms. What diagnostic study will best confirm the diagnosis?

1- Electromyography and nerve conduction velocity studies
2- Vascular studies
3- Compartment pressure measurement
4- Noncontrast MRI
5- Noncontrast CT
"

Back 82

"Vascular studies::

Front 83

"236. Bisphosphonates are clinically used for osteoporosis or osteolytic metastatic bone cancers. What is the common mechanism of pharmacologic action?

1- Increased mineralization of bone matrix
2- Increased apoptosis of osteoclasts
3- Increased production of alpha-v-beta-3 integrin by osteoclasts
4- Potentiation of PTM-related peptide effect on osteoblasts
5- Amplification of BMP-2 signal
"

Back 83

"2- Increased apoptosis of osteoclasts::

Front 84

"237. Submuscular plating techniques, when compared to conventional plating techniques, offer

1- less compromise to medullary and periosteal perfusion.
2- greater compromise to medullary and periosteal perfusion.
3- no difference with regard to periosteal perfusion only.
4- no difference with regard to medullary perfusion only.
5- no difference with regard to periosteal and medullary perfusion.
"

Back 84

"1- less compromise to medullary and periosteal perfusion.::

Front 85

"238. Hip pointers are contusion injuries to what area of the hip?

1- Iliac wing
2- Greater trochanter
3- Hip joint
4- Quadriceps muscle
5- Femoral shaft
"

Back 85

"Iliac wing::

Front 86

"239. A bone marrow biopsy is a routine part of the staging work-up for what type of sarcoma?

1- Osteosarcoma
2- Synovial sarcoma
3- Ewing’s sarcoma
4- Fibrosarcoma
5- Chondrosarcoma

"

Back 86

"Ewings:

Front 87

251. What is the most appropriate treatment method for a displaced vertical medial malleolus fracture?

Back 87

"5- Medial antiglide plate

Front 88

252. A stress fracture is most prone to development of a nonunion or delayed union in which of the following areas?

Back 88

"3- Anterior tibial cortex