Quiz of the Month – December 2022

This quiz does not earn users CME credits. The questions must be answered within Clinical Classroom to earn CME credits

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Quiz of the Month - December 2022

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Trauma

Which of the following is the most common type of Monteggia fracture pattern in adults?

Remediation:
a. Bado type 1  fractures are defined by an anterior angulation of the ulnar fracture with anterior dislocation of the radial head. This Monteggia lesion is the most common form in the pediatric population and is thought to result from a fall on an extended and hyperpronated arm. In adults, Bado type-2 injuries are most common.
b. Bado type 2 fractures are defined as posterior angulation of the ulnar fracture and posterior dislocation of the radial head. This Monteggia injury is the most common in adults.
c. Bado type 3 fractures are defined as proximal ulnar metaphysis fractures and lateral dislocations of the radial head. Bado type 2 fractures are the most common Monteggia injuries seen in adults.
d. Bado type 4 fractures are characterized by fractures of both the proximal aspect of the ulna and the radius. The radial head is also dislocated, typically anteriorly. Bado type-2 fractures are the most common Monteggia injuries seen in adults.

2 / 10

Sports Medicine

An 18-year-old male patient who is a high school senior presents after an ankle injury sustained while playing football. He reports that he was running, went to change direction, and was tackled. He was able to bear weight after the injury. He complains of pain and swelling over his lower leg and ankle. He denies any previous injury to this ankle. On examination, the anterolateral portion of the ankle is tender just proximal to the joint line. He has pain in the lateral aspect of his ankle when you squeeze his tibia/fibula together midway up his leg. Which of the following is the most likely diagnosis?

Remediation:
a. A fibular fracture would be indicated by point tenderness rather than pain on the squeeze test, which indicates a high ankle sprain/syndesmotic injury.
b. Pain on the squeeze test is indicative of a high ankle sprain/syndesmotic injury.
c. Pain on the squeeze test is indicative of a high ankle sprain/syndesmotic injury.
d. Pain on the squeeze test is indicative of a high ankle sprain/syndesmotic injury.

3 / 10

Spine

A 14-year-old female patient with adolescent idiopathic scoliosis is scheduled for a posterior instrumented fusion. A medical student, who will be observing the surgery, asks about the risks and efficacy between using high-dose versus low-dose tranexamic acid (TXA). Which of the following information should you provide?

Remediation:
a. The risks of high-dose and low-dose TXA are similar, but high-dose TXA is more efficacious
b. The risks of high-dose and low-dose TXA are similar, but high-dose TXA is more efficacious
c. The risks of high-dose and low-dose TXA are similar, but high-dose TXA is more efficacious
d. The risks of high-dose and low-dose TXA are similar, but high-dose TXA is more efficacious

4 / 10

Shoulder & Elbow

A 44-year-old male patient undergoes an arthroscopic rotator cuff repair. The tear size is 2 cm, and it is anterior-posterior, crescent in shape, and mobile. The repair is completed with excellent coverage of the footprint, and there are no complications during surgery. Postoperatively, you schedule the patient for physical therapy. When compared with an early range-of-motion protocol, a more prolonged immobilization protocol may lead to which of the following at 6 months postoperatively?

Remediation:
a. There is slightly improved range of motion and higher VAS scores in the patients undergoing early mobilization.
b. There is no difference in retear rates or patient satisfaction at 6 months postoperatively.
c. Patients undergoing early immobilization have worse stiffness and slightly higher visual analog scale (VAS) pain scores at 6 months postoperatively.
d. Patients utilizing an early immobilization have slightly higher VAS pain scores at 6 months postoperatively.

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Pediatrics

Which of the following patients with congenital scoliosis has the highest risk for progression of their curve patterns?

Remediation:
a. A bar with a contralateral hemivertebra has the highest risk for progression from asymmetric growth potential combined with a tether.
b. While this may involve a progressive curve, it is not as high risk as other patterns.
c. At an age closer to skeletal maturity, some progression is possible but less likely than at younger ages
d. At an age closer to skeletal maturity, some progression is possible but less likely than at younger ages.

6 / 10

Basic Science and Pathology

Which of the following musculoskeletal tissues has orthotropic structural properties rather than transversely isotropic structural properties?

Remediation:
a. Tendon has transversely isotropic structural properties (similar in the radial and transverse directions)
b. Muscle has transversely isotropic structural properties (similar in the radial and transverse directions).
c. Cortical bone in the femoral shaft has transversely isotropic structural properties (similar in the radial and transverse directions).
d. Cancellous bone in the femoral neck has orthotropic structural properties (different in the axial, radial, and transverse directions).

7 / 10

Hand & Wrist

A 30-year-old male patient was working in a recycling center and sustained a sharp laceration to the mid-forearm causing complete amputation. The patient presented to a local emergency department and was subsequently transferred to the level-I trauma center. The amputated part is available and was transported on ice. It is now 9 hours since the amputation occurred. After a thorough debridement, which of the following should be done first?

Remediation:
a. An arterial shunt should be placed first to establish blood flow, especially since it has been >6 hours since the amputation occurred. Bone is fixed next to establish axial stability.
b. An arterial shunt should be placed first to establish blood flow, especially since it has been >6 hours since the amputation occurred. Definitive repair of the artery should be done after the deeper structures are fixed.
c. An arterial shunt is necessary to re-establish blood flow to the forearm, especially since it has been >6 hours since the amputation occurred.
d. An arterial shunt should be placed first to establish blood flow, especially since it has been >6 hours since the amputation occurred. Deep structures are fixed after provisional flow is established.

8 / 10

Foot & Ankle

Which of the following is an appropriate initial nonoperative treatment for hallux rigidus?

Remediation:
a. A 3/4 length orthotic is too short to fully shield the 1st metatarsophalangeal joint.
b. There is no evidence to support these interventions in the treatment of hallux rigidus.
c. A heel cup insert will not influence the 1st metatarsophalangeal joint.
d. A full-length rigid insert with Morton's extension will shield the 1st metatarsophalangeal joint and is a mainstay of the nonoperative treatment of hallux rigidus.

9 / 10

Knee

A 47-year-old female patient presents for evaluation of her right knee. She has had medial knee pain for 2 years and is beginning to notice a bowed-leg deformity. After a discussion with the patient about her treatment options, she would like to exhaust nonoperative treatments prior to considering surgery. To obtain the best overall improvements in pain and knee function, the patient's knee should have a brace applied in which of the following alignments?

Remediation:
a. A varus alignment of 4° or a lateral unloader brace may be an option for the nonoperative treatment of lateral compartment osteoarthritis of the knee. This patient has a bow-leg deformity and overload of the medial compartment.
b. A valgus alignment or a medial unloader brace may be an option for the nonoperative treatment of medial compartment osteoarthritis of the knee. However, it will not provide better outcomes than a brace in neutral alignment.
c. A knee braced in neutral alignment will provide the best overall improvements in both pain and knee function scores
d. Data show that scores for pain and function were worst when the knee was unsupported.

10 / 10

Hip

When comparing historical and contemporary data about the causes of failure of revision total hip arthroplasty (THA), which of the following best describes the differences in the data?

Remediation:
a. According to a 2019 review of 2,500 revision THA procedures performed between 2005 and 2015, the most common reasons for failure/re-revision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening. Instability has remained the most common cause of reason for re-revision, while aseptic loosening and polyethylene wear are less frequent causes of re-revision compared with historical data.
b. According to a 2019 review of 2,500 revision THA procedures performed between 2005 and 2015, the most common reasons for failure/re-revision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening. Instability has remained the most common reason for re-revision, while aseptic loosening and polyethylene wear are less frequent causes of re-revision compared with historical data.
c. According to a 2019 review of 2,500 revision THA procedures performed between 2005 and 2015, the most common reasons for failure/re-revision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening. Instability has remained the most common cause of re-revision, while aseptic loosening and polyethylene wear are less frequent causes of re-revision compared with historical data.
d. According to a 2019 review of 2,500 revision THA procedures performed between 2005 and 2015, the most common reasons for failure/re-revision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening. Instability has remained the most common cause of re-revision, while aseptic loosening and polyethylene wear are less frequent causes of re-revision compared with historical data.

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