Quiz of the Month – August 2023

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

/10
264
Created on
quiz of the month JBJS

Quiz of the Month - August 2023

1 / 10

Pediatrics

A 15-year-old female patient with a history of diabetes mellitus presents with right thigh pain and difficulty with ambulation. She had an insect bite on her right thigh several days ago that became red and swollen. Her temperature is 100° F (37.7° C) and she reports intermittent fevers over the past few days. The thigh has a tender and indurated area of erythema measuring 12 cm x 8 cm.  Select all the appropriate diagnostic and treatment recommendations.

Remediation:
A. An MRI is appropriate to evaluate for possible abscess in this immunocompromised patient.
B. Although blood cultures would be appropriate, gram positive organisms remain the most common cause of soft tissue infections in patients with diabetes. Therefore, initial coverage of gram negative organisms is not indicated without information from cultures.
C. The history and clinical examination suggests a soft tissue or combined soft tissue/bony infection. Rheumatologic labs are not indicated.
D. if there is an abscess, surgical debridement is recommended.

2 / 10

Hand & Wrist

A 65-year-old male patient who has type 2 diabetes mellitus is transferred from another facility after an injury from a table saw 9 hours prior to arrival. The affected digits are dysvascular. He is deemed medically stable and appropriate for revascularization.  A clinical photograph and radiograph are shown. Given the ischemia time, which of the following steps should be performed first?
hand and wrist

Remediation:
A. Skeletal stabilization should be performed first, followed by repair of tendons, arteries, nerves, and veins. Without skeletal stabilization, there is no stable platform for performing the neurorrhaphy. In addition, the artery would be repaired before the nerve because the nerve is more superficial.
B. Skeletal stabilization should be performed first, followed by repair of tendons, arteries, nerves, and veins. This allows a stable platform for the revascularization. In more proximal injuries (i.e., forearm), a shunt may be used to restore perfusion first.
C. Skeletal stabilization should be performed first, followed by repair of tendons, arteries, nerves, and veins. This allows a fixed-length, stable platform to perform the tendon repairs, allowing proper tensioning of the tenorrhaphy.
D. In the absence of 12 hours of warm ischemia time or 24 hours of cold ischemia time, there is no contraindication to the standard techniques of revascularization with the skeletal stabilization being performed first.
E. Skeletal stabilization should be performed first, followed by repair of tendons, arteries, nerves, and veins. Without skeletal stabilization, there is no stable platform for performing the venous anastomosis.

3 / 10

Foot and Ankle

A 60-year-old male patient presents with a painful bunionette that is associated with wearing dress shoes. There is no ulceration or threatened skin. Which of the following is the most appropriate initial treatment?

foot

Remediation:
A. Nonoperative interventions such as wide toe-box shoes or shoe stretching should be the first line of treatment for a bunionette.
B. Nonoperative treatments should be tried before operative treatments are offered.
C. Nonoperative treatments should be tried before operative treatments are offered.
D. A toe spacer would not decrease pain at the lateral aspect of the foot and may make it worse by increasing pressure at the fifth toe-shoe interface.
E. This could cause irritation of the skin over the bunionette.

4 / 10

Basic Science

A 35-year-old male patient presents to the emergency department following a motor vehicle collision. The patient has an Injury Severity Score (ISS) of 27 and undergoes orthopaedic surgery for his injuries. Which of the following interventions, if performed for this patient, increases his risk for developing acute respiratory distress syndrome (ARDS)?

Remediation:
A. Aspiration of gastric contents is associated with ARDS. Misplacement of the endotracheal tube is not likely with fiberoptic intubation, which theoretically decreases the risk of intubation-related complications such as aspiration.
B. Transfusion of blood products is an indirect lung-injury risk factor for ARDS.
C. Although some authors support delaying fracture fixation due to the risk of ARDS, there is also literature to support early long bone fixation.
D. Corticosteroid administration may help improve oxygenation early in the course of ARDS but is not a risk factor for ARDS development.

5 / 10

Spine

Which of the following outcomes has been demonstrated in patients using a hard cervical collar after a single-level anterior cervical discectomy and fusion (ACDF)?

Remediation:
A. Multiple studies have shown that there is no difference in fusion rates following single-level ACDF with or without postoperative collar immobilization. This is likely due to improved fixation techniques.
B. In the study by Campbell et al., patients who wore a cervical collar after 1-level ACDF had no difference in the number of revision surgeries when compared to those who did not wear a collar postoperatively.
C. There is no difference in return to work time for patients who wore a cervical collar after ACDF and those who did not.
D. Multiple studies have shown that there are no clinical or radiographic benefits to using a hard cervical collar postoperatively. This is likely due to improved fixation techniques.

6 / 10

Sports Medicine

A 36-year-old male patient who is active and athletic is undergoing right knee anterior cruciate ligament reconstruction. Magnetic resonance imaging is shown. Which of the following is the most appropriate procedure to treat the associated medial meniscal injury?

sports medicine

Remediation:
A. The first line treatment for a displaced bucket handle meniscus tear is meniscectomy or meniscal repair. Meniscus repair is favored in younger patients in tears where tissue quality is good and the tear is in the peripheral zone, less than 4 mm from the meniscal rim.
B. The first line treatment for a displaced bucket handle meniscus tear is meniscectomy or meniscal repair. Meniscus repair is favored in tears where tissue quality is good and the tear is in the peripheral zone, less than 4 mm from the meniscal rim. Especially in younger patients.
C. The first line treatment for a displaced bucket handle meniscus tear is meniscectomy or meniscal repair. Meniscus repair is favored in tears where tissue quality is good and the tear is in the peripheral zone, less than 4 mm from the meniscal rim.
D. The first line treatment for a displaced bucket handle meniscus tear is meniscectomy or meniscal repair. Meniscus repair is favored in tears where tissue quality is good and the tear is in the peripheral zone, less than 4 mm from the meniscal rim.

7 / 10

Shoulder and Elbow

Which of the following is a risk factor for recurrent posterior shoulder instability?

Remediation:
A. Most patients with posterior instability will have a posterior labral tear, but the size of the labral tear has not been determined to be related to the risk of recurrence. On the other hand, the size of a reverse Hill-Sachs lesion has been associated with increased risk of recurrent posterior instability.
B. As is the case with anterior instability, one of the greatest risks factors for recurrence of posterior instability is young age of the patient at the time of the initial dislocation.
C. A large reverse Hill-Sachs lesion is associated with recurrent posterior instability. A Hill-Sachs lesion, on the the other hand, is typically associated with anterior instability.
D. Electrocution is a risk factor for posterior dislocation but is not necessarily associated with recurrence.

8 / 10

Trauma

You are called to assess a 20-year-old male patient who jumped from a highway overpass. Primary and secondary surveys show a pelvic injury, left calcaneal fracture, and lumbar spine injuries. The patient is currently in a pelvic binder. His radiographs prior to binder application and left distal femoral traction are shown. According to the Young-Burgess classification, which of the following describes this patient's injury?

TRAUMA

Remediation:

A. The radiograph demonstrates a vertical shear pelvic ring injury that commonly occurs from an axial/superior force. These injuries result in vertical displacement of the hemipelvis and may be associated with substantial hemorrhage.
B. An APC type 1 injury is defined as an anterior applied force that results in either <2.5 cm of pubic symphysis diastasis or vertical pubic rami fractures.
C. An APC type 2 pelvic ring injury has >2.5 cm of anterior ring diastasis with an anterior sacroiliac joint opening.
D. An LC type 1 injury results from a lateral force delivered over the posterior aspect of the pelvis. This results in transverse pubic rami fracture(s) and ipsilateral sacral compression.
E. An LC type 3 injury commonly occurs from lateral compression that crosses the midline to produce an external rotation injury of the contralateral hemipelvis, resulting in a "windswept" pelvis.

9 / 10

Knee

Patients with Kellgren-Lawrence grade-4 osteoarthritis have which of the following findings, distinguishing them from patients with lower grades of osteoarthritis?

Remediation:

A. The Kellgren and Lawrence scale is a radiographic grading system of knee osteoarthritis, based on a scale of 0 to 4.
0: no radiographic findings of osteoarthritis.
1: joint spaces are maintained with possible osteophyte formation.
2: possible joint-space narrowing on weight-bearing anteroposterior radiographic views of the knee, with osteophyte formation.
3: joint-space narrowing, subchondral sclerosis, osteophtye formation, and possible bony deformity.
4: joint-space narrowing, subchondral sclerosis, osteophtye formation, and definite bony deformity.
B.  Grade-2 changes show definite osteophytes; possible osteophytic lipping is a grade-1 change.
C. This is seen in grade-3 and 4 changes.
D. This is seen in grade 4 changes.

10 / 10

Hip

A 63-year-old female patient who underwent acetabular component revision for right hip instability at another hospital presents to the emergency department 1 week postoperatively after feeling a pop in the operative hip while moving in bed. A radiograph is shown. Which of the following is the least likely cause of her symptoms?

hip

Remediation: 
A, B,C,D -
According to a 2019 review of 2,500 revision total hip arthroplasty procedures performed between 2005 and 2015, the most common reasons for failure/rerevision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening.

0%

Menu