orthobullet 2007 D

7/23/2019 orthobullet 2007 D

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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

. A !-year-old lethargic boy with a "#$ count of 1%&&&'mm( after a wee of nafcillin and

vancomycin(. A !-year-old girl with three days of pain% fever% and a "#$ of 1%&&&'mm( who presents to the *+

,. An -year-old boy whose pain and fever have decreased after , hours of ampicillin

. An -year old lethargic girl with a "#$ of 1%&&&'mm( and a $+/ of 9 after , hours of gentamicin

) 0#2&!.1) A ,&-year-old recreational basetball player in3ured his nee while 3umping for a

rebound. 4e felt a pop and developed immediate swelling. 4is radiographs are shown in 5igures A

and #. "hat is the recommended management?

5I67+*8

1. btain an :+I

. Ice% rest% and observation

(. /hysical therapy to regain motion

,. ;nee arthroscopy and repair

. pen surgical repair


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() Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what

factor?

1.


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(. 6luteus muscles

,. Adductors

. Abdominals

) 0#2&!.1) A -year-old man presents with shoulder pain. +adiographs are shown in 5igure A

and #. "hat is the most liely cause? +eview @opic

5I67+*8 A #

1. Acute acromial fracture

. @ype I acromioclavicular separation

(. >eltoid avulsion

,. 5ailure of fusion between the meso-acromion and pre-acromion

. 5ailure of fusion between the meso-acromion and meta-acromion

!) "hat is the post-amplification product of reverse transcription polymerase chain reaction 0+@-

/$+)?

1. +


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. Immunoglobulins

) A (-year-old woman falls from standing and lands on her right hand. 8he complains of deformity

and wrist pain. +adiographs are provided in 5igure A. 5ollowing closed reduction% the patient

inBuires whether she has osteoporosis and if she is liely to have another fracture. In counselling the

patient% which of the following is the strongest predictor for a future fracture from low energy trauma?

5I67+*8A

1. #one mineral density @-score C -.

. =ow vitamin > levels

(. 5amily history of osteoporosis

,. 4istory of a prior fragility fracture

. @en year history of oral prednisone use

9) 4eterotopic ossification has been recogniDed as a rare complication from 8teinmann pins placed

in which location for traction purposes?

1. distal femur

. proximal tibia

(. calcaneus

,. radius shaft

. metacarpal shaft
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1&) 5igure A shows the radiograph of a -year-old girl after a fall on the playground. "hat is the most

appropriate course of action?

5I67+*8 A

1. bservation with treatment in a sling

. $losed reduction and long arm casting

(. $losed reduction percutaneous pinning with -wires

,. pen reduction internal fixation with -wires

. pen reduction with plate fixation

11) "hat effect does intermittent administration of parathyroid hormone have on bone?1. Anabolic

. $atabolic

(. ecreased Buantity

. >ecreased Buality

1) "hich of the following factors has been shown to increase mortality in poly-trauma patients with

severe head in3uries?

1. >elayed fixation of fractures

. >ecreased intracranial pressure


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(. Intra-abdominal in3ury

,. Intra-operative hypotension

. >ecreased platelet count

1() A 9-year-old man with nown metastatic lung cancer presents with a pathological fracture after

a fall from standing height 05igure A). "hich of the following options is the best choice for treating

this fracture?

5I67+*8A

1. @otal hip arthroplasty

. 4emiarthroplasty

(. 8liding hip screw

,. >ynamically loced cephalomedullary nail

. 8tatically loced cephalomedullary nail

1,) 0#2&!.1!() A (,-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. 8he wors as a waitress and recently had

bariatric surgery with a current #:I of (. 8he has a gastrocnemius contracture noted on

8ilversiold testing. A/ and obliBue radiographs are shown in 5igure A and lateral radiograph is

shown in 5igure #. "hat is the most liely diagnosis? +eview @opic
http://void%280%29/http://void%280%29/http://www.orthobullets.com/foot-and-ankle/7025/plantar-fasciitishttp://www.orthobullets.com/foot-and-ankle/7025/plantar-fasciitishttp://void%280%29/http://www.orthobullets.com/foot-and-ankle/7025/plantar-fasciitis


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A B1.


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5I67+*8A1. 4amstring myotendinous 3unction rupture

. /elvic ramus fracture

(. 4amstring muscle belly rupture

,. 4amstring tendinous insertion rupture

. 8ports hernia

1!) @he flexor hallucis longus tendon is at greatest ris of in3ury with a lateral-to-medial drill or screw

during fixation of what structure?1. =isfranc fracture-dislocation

.


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19) >


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1. $, to $! cervical laminectomy

. $, to $! cervical laminectomy with fusion

(. $, to $! laminoplasty with plate fixation

,. :ultilevel anterior cervical decompression with fusion and stabiliDation

. ImmobiliDation in a halo orthosis for wees followed by gradual +: exercises

) "hen 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 *H$*/@?1. 4igher dislocation rate

. 4igher periprosthetic fracture rate

(. Increased serum metal ion levels

,. 4igher rates of osteonecrosis

. =arger incision and surgical dissection

) A !-year-old boy complains of worsening left nee pain over the last wees. 4e has been

unable to bear weight through the left lower extremity for the past , hours. @he nee and lower leg

are warm and tender to palpation. $urrent temperature is 1&&.9 degrees 5ahrenheit% and $+/ is 11

mg'd= 0nml C1). A radiograph is provided in 5igure A. A 3oint aspiration yields m=Es of synovial fluid

demonstrating a cell count of %&& and no organisms on gram stain. "hich of the following is themost appropriate next step in management?

5I67+*8A
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1. +epeat aspiration of the left nee

. bservation with repeat radiographs in one wee

(. :agnetic resonance imaging 0:+I)

,. #egin intravenous broad-spectrum antibiotics and obtain an infectiouse disease consult

. *xploratory surgical arthrotomy

) "hich of the following items is located medial to the iliocostalis and lateral to the semispinalis

muscle?1. :ultifidus

. +otatores

(. =ongissimus

,. 2uadratus lumborum

. =atissimus

!) 6iant cell tumors of bone can be locally aggressive and result in significant bone destruction.

"hich of the following is responsible for this type of bone destruction?1. :ultinuclear giant cells

. steocytic stromal cells

(. @umor cell activation of osteoclasts

,. @umor cell inactivation of osteoblasts


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. steoprotegrin activation of osteoclasts

@A6

) "hich of the following treatment techniBues decreases the ris of osteonecrosis in patients with

unstable slipped femoral capital epiphysis 08$5*)?1. pen reduction and pinning with multiple cannulated screws in an inverted triangle configuration

. $losed reduction and pinning with multiple cannulated screws in an inverted triangle configuration

(. $losed reduction and pinning with a single cannulated screw

,. In situ percutaneous pinning with multiple cannulated screws in an inverted triangle configuration

. In situ percutaneous pinning with a single cannulated screw

9) @he resistance to pullout of a screw in osteoporotic bone is increased by all of the following

*H$*/@?1. /lacement parallel to the trabecular pattern

. /urchase in cortical bone

(. 7se of a fixed angle 0locing screw construct)

,. @apping prior to screw placement

. Augmentation with polymethylmethacrylate

(&) In patients with symptoms of cervical myelopathy% what variable is associated with improved

outcomes with nonoperative management?1. Increased $entral :otor $onduction @ime 0$:$@)

. @ransverse area of the spinal cord !&mm

(. Isolated low intramedullary signal on @1"I

,. A midsagittal diameter of the spinal canal of C1(mm

. Founger age


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(1) >uring total nee replacement with the trial components in place% the nee achieves full

extension but experiences tightness in flexion with a range to only 9& degrees. "hat is the most

appropriate action?1. +esect more proximal tibia

. >ownsiDe the femoral component

(. Addition of a distal femoral augment

,. >ownsiDe the tibial polyethylene insert

. +esect more distal femur

() 6igantism affects which region of the growth plate labeled in 5igure A?

5I67+*81. A

. #

(. $

,. >

. *

(() "hich of the following is


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. 6rade I chondromalacia

(,) 0#2&!.19() A -year-old diabetic female presents with a two-month history of mild anle pain

and sub3ective instability. 8he denies any specific in3ury and she does not have any foot ulcerations

or woundsJ her foot and anle are edematous with erythema that resolves upon elevation. 4er *8+%

$+/% and "#$ levels are within normal limits. 4er radiographs are shown in 5igures A and #. "hat

is the most appropriate initial treatment? +eview @opic

5I67+*81. :odification of shoe wear

. 7se of a total contact cast

(. Anle arthrodesis

,. 8panning external fixation of the anle and hindfoot

. #elow-nee amputation

() /ostoperative varus alignment of a subtrochanteric femur fracture treated with an intramedullary

nail has been shown to be related to which of the following factors?1. 7se of a piriformis entry nail through a greater trochanteric entry portal

. 7se of a greater trochanteric entry nail through a piriformis entry portal

(. 7se of a lateral entry nail through a piriformis entry portal

,. 7se of a femoral distractor device to obtain reduction

. 7se of a fracture table to obtain reduction

() 0#2&!.19) A -year-old man undergoes total nee arthroplasty. /reoperative radiographs

are shown in 5igure A. 5ollowing bone resections and placement of trial implants% the nee is stable
http://www.orthobullets.com/foot-and-ankle/7047/diabetic-foot-charcot-neuropathyhttp://www.orthobullets.com/foot-and-ankle/7047/diabetic-foot-charcot-neuropathy


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in flexion% but cannot achieve full extension. "hich of the following interventions will most liely

result in a nee that is balanced in flexion and extension? +eview @opic

5I67+*8A

1. +esect more distal femur

. +esect more distal femur and downsiDe the femoral component

(. +esect more proximal tibia

,. >ecrease polyethelene liner thicness

. /lace posterior femoral augments

(!) A 1,-year-old boy sustains the in3ury shown in figure A. 4e subseBuently develops compartment

syndrome and reBuires fasciotomy. In3ury to what artery is most liely responsible ?

5I67+*8A

1. /eroneal

. /osterior tibial

(. :iddle geniculate

,. 8aphenous

. Anterior tibial recurrent
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() A ,&-year-old female presents with dull pain in her nee that has been increasing in severity over

the past months. 5igures A through > show representative radiographs% :+I% and biopsy section.

"hat is the most appropriate treatment? +eview @opic

5I67+*8A # $ >

1. bservation

. #one marrow biopsy

(. Intra-lesional curettage with local ad3uvant therapy

,.


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(. anterior and proximal

,. anterior and distal

. directly superficial

orthobullet 2007 D

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