2007 E

1) What region of the physis does collagen type X play a prominent role? 

1.   resting zone

2.   proliferative zone

3.   zone of hypertrophy

4.   metaphysis

5.   diaphysis

2) Which of the following modalities has been shown to have a positive effect when treating early stages of complex regional pain syndrome? 

1.   Casting of the involved extremity

2.   Plyometric exercises

3.   Ultrasound therapy

4.   Acupuncture

5.   Gentle physiotherapy

3) A 72-year-old male presents with increasing thigh pain. Radiographs and high power biopsy are shown in Figures A and B. Staging studies demonstrate no further sites of disease. What is the next step in treatment?

FIGURES:A  B

1.   Neoadjuvant chemotherapy

2.   Neoadjuvant radiation therapy

3.   Marginal excision

4.   Wide surgical excision and reconstruction

5.   Palliative care

4) (OBQ07.204) A 24-year-old male sustains the isolated, closed injury seen in Figure A as the result of a fall. What surgical treatment is recommended for this fracture?   Review TopicFIGURES: A            

QID: 865

1.   Intramedullary nailing

2.   Tension band with intramedullary screw

3.   Triceps advancement

4.   Plate and screw fixation

5.   Total elbow arthroplasty4) (OBQ07.204) A 24-year-old male sustains the isolated, closed injury seen in Figure A as the result of a fall. What surgical treatment is recommended for this fracture?   Review Topic

FIGURES: A

1.   Intramedullary nailing

2.   Tension band with intramedullary screw

3.   Triceps advancement

4.   Plate and screw fixation

5.   Total elbow arthroplasty

5) Highly cross-linked ultra high molecular weight polyethylene has which of the following characteristics as compared to conventional polyethylene? 

1.   Improved ductility

2.   Increased fracture toughness

3.   Increases the elongation to break

4.   Improved resistance to crack propagation

5.   Improved wear resistance

6) (OBQ07.206) Arachidonic acid is directly metabolized by which of the following substances? 

1.   Carbonic anhydrase

2.   HMG-CoA reductase

3.   1-lipoxygenase

4.   Cyclooxygenase

5.   Thromboxane synthetase

7) Partial patellectomy is the recommended treatment for which of the following injuries? 

1.   Vertical patella fractures

2.   Bipartite patella

3.   Severely comminuted inferior pole fracture

4.   Stellate patella fracture

5.   Chronic quadriceps tendon rupture

8) A 56-year-old female is referred for a second opinion after placement of an intramedullary nail through a presumed metastatic lesion in her proximal femur. Final biopsy results from the lesion show a high-grade chondrosarcoma and staging studies show this to be an isolated site of disease. What treatment should be recommended? 

1.   Intramedullary nail removal and radiotherapy to the limb

2.   Systemic chemotherapy and keep nail in place to prevent fracture

3.   Wide proximal femoral resection and hemiarthroplasty followed by radiotherapy

4.   Wide resection including hip disarticulation

5.   Palliative care

9) Which of the following describes the mechanical axis of the limb in template preparation for a total knee arthroplasty? 

1.   A vertical line drawn from the femoral head through the center of the knee down to the center of the ankle

2.   A valgus angle of 5-7 degrees created by two lines drawn down the shaft of the femur and tibia

3.   A varus angle of 3 degrees created by two lines drawn down the shaft of the femur and tibia

4.   A vertical line drawn from the femoral head passing 1.5 centimeters lateral to the center of the knee down to the center of the ankle

5.   A vertical line drawn from the femoral head passing 1.5 centimeters medial to the center of the knee down to the center of the ankle

10) All of the following substances inhibit osteoclastogenesis, EXCEPT? 

1.   Tumor necrosis factor-alpha (TNF-a)

2.   Osteoprotegerin

3.   Calcitonin

4.   Bisphosphonates

5.   Denosumab

11) In the treatment of intra-articular calcaneal fractures, surgical reduction and fixation has been shown to have improved outcomes over nonoperative treatment in all of the following patient groups EXCEPT: 

1.   Sedentary job

2.   Sanders IIb fractures

3.   Women

4.   Younger age (<29 years old)

5.   Previous calcaneus fracture

12) Protamine functions to reverse the pharmacologic effects of which of the following anti-coagulants? 

1.   Aspirin

2.   Clopidogrel (e.g. plavix)

3.   Low molecular weight heparin

4.   Warfarin

5.   Hirudin

13) In total hip arthroplasty, which of the following techniques will lead to improved stability by increasing the abductor tension? 

1.   Use of a high offset femoral component

2.   Decreasing neck length

3.   Use of a low offset femoral component

4.   Increasing the head size

5.   Medializing the acetabular component

14) (OBQ07.214) An MR aortogram is shown in Figure A. What structure is identified by the red arrow in the coronal and axial views?   Review Topic

FIGURES: 

1.   hypogastric plexus

2.   superior mesenteric artery

3.   inferior mesenteric artery

4.   segmental lumbar artery

5.   sympathetic chain

15) A 6-month-old boy is brought to the emergency department by his mother because he has been irritable for the last week. Initially the mother reports no history of trauma, but later she says that he may have fallen from a changing table. Radiographs of the knee demonstrate metaphyseal corner lesions of the distal femur and proximal tibia. White blood cell count and erythrocyte sedimentation rate values are normal. What is the most appropriate next step in treatment? 

1.   vitamin D & calcium levels

2.   MRI of the knee

3.   aspiration of the hip

4.   admission and activation of child abuse work-up

5.   hip spica cast

16) A 17-year-old football player sustained an injury to his shoulder. The MRI images are seen in Figures A and B. What is the most likely finding seen at the time of arthroscopy?   Review TopicFIGURES: 

A B

1.   Rotator cuff tear

2.   SLAP tear

3.   Bankart lesion

4.   Glenoid fracture

5.   Humeral avulsion of glenohumeral ligaments (HAGL)

17) Concomitant flexion of the hip and extension of the knee is most likely to result in an injury to which structure? 

1.   Sartorius

2.   Rectus femoris

3.   Adductor magnus

4.   Biceps Femoris

5.   Tensor fascia lata

19) Which of the following conditions exhibit the inheritance pattern shown in Figure A, assuming no new mutations? 

FIGURES: A

1.   Duchenne muscular dystrophy

2.   Hunter's syndrome

3.   Hemophilia

4.   Spondyloepiphyseal dysplasia (SED) tarda

5.   Diastrophic dysplasia

20) Figure A demonstates different anatomic patterns in congenital scoliosis. Which pattern has the worst prognosis and is an indication for surgery.  FIGURES: A

1.   Illustration 1

2.   Illustration 2

3.   Illustration 3

4.   Illustration 4

5.   Illustration 5

21) (OBQ07.221) A newly adopted 7-year-old girl from Liberia has a history of poliomyelitis 2 years ago. She had flaccid paralysis of her legs that made her bedridden for 6 months. She has recovered all strength and has no complaints at this time. The parents would like to know if they should be concerned about any residual effects of the infection. How should they be counseled?   Review TopicQID: 882

1.   The child has no risk of further paralysis or weakness from polio

2.   The child may experience muscle weakness and fatigue as an adult

3.   If the child has no recurrent episodes of paralysis by the time she reaches skeletal maturity, then she will never have further weakness

4.   The child will certainly have weakness and possibly paralysis as an adult, and therefore she should abstain from sports to prevent further muscle injury

5.   The child will most likely be wheelchair bound by the age of 25 years.

22) A 65-year-old female has severe knee arthritis with a significant flexion contracture and valgus deformity. In the recovery room following her total knee replacement, she is unable to dorsiflex her ankle. Management should include? 

1.   Application of an AFO to prevent an equinus contracture

2.   Unwrap any compressive dressings and flex the knee

3.   Immediate EMG

4.   Open exploration of the peroneal nerve

5.   Reassurance

23) Appropriate treatment of the bimalleolar ankle fracture shown in Figure A includes which of the following?   Review TopicFIGURES: A            

1.   Bridge plating of the fibula with oblique medial malleolar screws

2.   Antiglide plating of the fibula with oblique medial malleolar screws

3.   Intramedullary fibular screw with medial malleolar tension banding

4.   Fibular plating with open correction of plafond impaction with medial malleolar antiglide plate

5.   Fibular plating with open correction of syndesmosis and oblique medial malleolar screws

24) A 20-year-old man presents with a type III odontoid fracture and undergoes halo application. What structure is in danger if the anterior pins are placed too medially? 

1.   Facial nerve

2.   Supraorbital nerve

3.   Supratrochlear nerve

4.   Superior laryngeal nerve

5.   Temporal artery

25) (OBQ07.225) A 21-year-old second-trimester pregnant female arrives in the trauma bay with a closed head injury as well as an open ankle injury. During evaluation, what positioning is recommended to limit positional hypotension?   Review TopicQID: 886

1.   Reverse Trendelenburg

2.   Trendelenburg

3.   Left lateral decubitus

4.   Right lateral decubitus

5.   Supine

26) A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. Which of the following factors has been associated with redisplacement of the fracture after closed manipulation?  FIGURES: A            

1.   Triangular fibrocartilage complex tear

2.   Open injury

3.   Ipsilateral radial head fracture

4.   Time to reduction

5.   Severity of initial displacement

27) (OBQ07.227) A 65-year-old male falls from a standing height and sustains the injury seen in Figure A and undergoes the treatment seen in Figure B. Compared to a total hip arthroplasty, this treatment is associated with which of the following:   Review TopicFIGURES: A     B          

1.   Increased blood loss

2.   Lower incidence of revision surgery

3.   Increased risk of peri-prosthetic fracture

4.   Lower dislocation risk

5.   Increased risk deep venous thrombosis

28) Which of the following statements regarding rhabdomyosarcoma is true? 

1.   Most common soft tissue sarcoma in the foot

2.   Most common soft tissue sarcoma in a child

3.   Commonly shows calcification on plain radiographs

4.   Soft tissue sarcoma associated with Maffucci's syndrome

5.   Dedifferentiates from benign myxomatous tumors

29) What nerve is the most frequently injured in the condition shown in the radiograph?  FIGURES: A            

1.   Axillary

2.   Median

3.   Musculocutaneous

4.   Radial

5.   Suprascapular

30) (OBQ07.253) 32-year-old male presents to the emergency department following a motor vehicle accident. A radiograph is shown in Figure A, and a sagittal and axial CT scan are shown in Figure B and C respectively. What is the most likely mode of failure of the posterior spinal column?   Review TopicFIGURES: A     B     C        

1.   Tension

2.   Torsion

3.   Fatigue

4.   Compression

5.   Shear

31) Which of the following structures is at risk during proximal dissection of a single lateral perifibular approach for compartment syndrome of the leg? 

1.   Common peroneal nerve

2.   Superficial peroneal nerve

3.   Deep peroneal nerve

4.   Anterior tibial artery

5.   Lateral inferior genicular artery

32)  Each of the following are indications for microvascular replantation EXCEPT? 

1.   Thumb amputation

2.   Index finger amputation in a child

3.   Through wrist amputation

4.   Long finger amputation through the proximal phalanx

5.   Mid-palm amputation of all four fingers

33) What factor has highest risk for recurrent instability following a traumatic anterior shoulder dislocation? 

1.   History of contralateral shoulder dislocation

2.   Young age (<25-years-old) at time of dislocation

3.   Dislocation of the dominant shoulder

4.   Family history of shoulder instability

5.   History of patella instability

34) (OBQ07.260) A 5-year-old boy has sustained multiple fractures since birth. A pelvis radiograph taken 4 years ago is shown in Figure A. A current spine radiograph is shown in Figure B. Which of the following describes the mode of inheritance of this disease?   Review TopicFIGURES: A     B          

1.   Autosomal dominant

2.   Autosomal recessive

3.   X-linked dominant

4.   X-linked recessive

5.   Trinucleotide repeat

35) Which of the following is NOT included in the best management of a elderly female newly diagnosed with a fragility fracture? 

1.   Hip and spine densitometry

2.   Laboratory analysis for secondary causes of osteoporosis

3.   Administration of calcium 1,500 mg/day

4.   Administration of Vitamin D 400 to 800 IU/day

5.   Low protein diet

36) If a team experiences an outbreak of community acquired methicillin-resistant staph aureus (MRSA), which of the following factors is most likely to be the etiology?

1.   Presence of turf burns

2.   Use of a cold whirlpool

3.   Use of a warm whirlpool

4.   Sharing locker room soap

5.   Sharing locker room towels

37) The ascending branch of the lateral femoral circumflex artery is at risk with which of the following surgical approaches? 

1.   Stoppa approach

2.   Kocher-Langenbach approach

3.   Ilioinguinal approach

4.   Watson-Jones approach

5.   Smith-Petersen approach

38) Which term used in rehabilitiation describes a strengthening exercise performed at a constant speed? 

1.   Open chain

2.   Closed chain

3.   Isotonic

4.   Isometric

5.   Isokinetic

39) Which of the following is an indication for surgical treatment of an acute humeral shaft fracture? 

1.   radial nerve palsy

2.   long oblique fracture type

3.   comminuted fracture

4.   Holstein-Lewis fracture type

5.   ipsilateral both bone forearm fracture

45) Which of the following patients who sustained a calcaneal fracture will most likely undergo an eventual subtalar fusion? 

1.   Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees

2.   Female worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees

3.   Male non-worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees

4.   Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees

5.   Female non-worker's compensation patient who participates in heavy labor work with an initial Böhler less than 0 degrees