Quiz of the Month

107
quiz

Quiz of the Month

Which of the following is the most likely long-term outcome of utilizing a cylindrical fully porous-coated femoral stem prosthesis for a patient with Dorr A femoral morphology?

Remediation:
A. Fully porous-coated femoral stems in Dorr A bone will usually lead to distal fixation and proximal bone remodeling from stress shielding.
B. Fully porous-coated femoral stems in Dorr A or good quality bone will usually lead to distal fixation and proximal bone remodeling as opposed to femoral loosening.
C. Fully porous-coated femoral stems in Dorr A or good quality bone will usually lead to distal fixation and proximal bone remodeling as opposed to subtrochanteric fracture, which could happen in poor quality bone.
D. Fully porous-coated femoral stems in Dorr A or good quality bone will usually lead to distal fixation and proximal bone remodeling due to stress shielding as opposed to proximal femoral osteolysis, which would be the result of debris from polyethylene wear.

A 55-year-old male patient presents with left knee pain. History, physical examination, and radiographs show moderate knee osteoarthritis. After completing land-based physical therapy, including aerobic exercises and traditional strengthening, his pain scores are most likely to show which of the following?

Remediation:
A. 
A recent meta-analysis showed a reduction in pain and improvement of quality of life for those who underwent a monitored physical therapy program.
B. Monitored physical therapy showed reduction in pain equal to that of patients who were taking NSAIDS
C. Physical therapy provides short-term pain relief; however, this is not sustained once the exercises are stopped.
D. Patients undergoing physical therapy showed an equal reduction in pain compared to those taking NSAIDS.

A 27-year-old female patient presents one year after hallux valgus correction with a distal soft-tissue procedure. She has increased varus deformity of her great toe. The deformity is flexible and there is no pain with passive and active hallux motion. She has tried shoe modification and toe taping without improvement. Which of the following is an appropriate operative option for her?

Remediation:
A.
The sesamoids act like pulleys to optimize the function of the flexor hallucis brevis muscle. A fibular sesamoidectomy might therefore result in additional varus deformity.
B.  he extensor hallucis longus can be split, routed laterally under the intermetatarsal ligament, and then transferred to the 1st metatarsal. This will counter the varus moment at the metatarsophalangeal (MTP) joint. Alternatively, the entire extensor hallucis brevis (EHB) can be transferred to accomplish the same goal.
C. A successful 1st MTP joint fusion will address the varus deformity but should be reserved for patients with arthritis or rigid deformities.
D. A 1st metatarsophalangeal joint cheilectomy is a treatment for hallux rigidus, not hallux varus.

A 27-year-old male patient presents following a motor vehicle collision. He is diagnosed with a posterior wall acetabular fracture. Which of the following findings would be an indication for operative treatment of this patient's fracture?

Remediation:
A. 
Operative management is indicated with an articular step-off of >2 mm
B. Posterior wall fracture fragments involving 20% to 40% of the posterior wall should undergo stress examination and, if unstable, operative repair.
C. Nonoperative treatment can be undertaken if the femoral head is congruent within the acetabulum.
D. Operative treatment is indicated if there are intra-articular loose bodies.

You are evaluating an 18-year-old female patient who is a basketball player. The patient reinjured her knee 1 year after anterior cruciate ligament (ACL) reconstruction with an allograft. She has a positive Lachman test and pivot on examination. Which of the following factors likely contributed most to her ACL reconstruction failure?

Remediation:
A.  The use of allograft in this young patient is likely the reason for failure. Other causes of graft failure include a technical error during the surgery (often involving the vertical tunnel placement), a high level of activity, and a younger patient age.
B.  The use of allograft in this young patient is likely the reason for failure. Other causes of graft failure include a technical error during the surgery (often involving the vertical tunnel placement), a high level of activity, and a younger patient age.
C.  Causes of graft failure after ACL reconstruction include a technical error during the surgery (often involving the vertical tunnel placement), a high level of activity, a younger patient age, and use of an allograft in a young patient
D. The use of allograft in this young patient is likely the reason for failure. Other causes of graft failure include a technical error during the surgery (often involving the vertical tunnel placement), a high level of activity, and a younger patient age.

A 29-year-old male patient who is a construction worker falls 30 feet. His injuries include a subdural hematoma, femoral shaft and acetabular fractures, traumatic amputation of his right arm, and C2 fractures. Computed tomography scanning demonstrates complete C2 fractures through the pars interarticularis bilaterally with complete dislocation of the C2-C3 facet joints. The patient is awake and following commands, but is unable to move his upper or lower extremities. Which of the following is the most appropriate definitive treatment for his C2 fractures?

Remediation:
A. 
This is a severe, highly unstable injury that requires more stability than a rigid collar can provide.
B. The patient has a type-III traumatic spondylolisthesis (hangman's fracture) that is highly unstable and cannot be adequately controlled with external immobilization alone.
C. The patient has a type-III traumatic spondylolisthesis (hangman's fracture) that cannot be adequately treated with an anterior approach.
D.  This is a type-III traumatic spondylolisthesis (hangman's fracture).This injury is highly unstable and requires internal stabilization. The dislocated C2-C3 joints require open reduction followed by stabilization and arthrodesis, typically from C2-C3 or C1-C3.

A 17-year-old male patient who is a high school football player with several collegiate scholarship offers presents with posterior shoulder pain and "giving way" that occurs with heavy bench presses and blocking maneuvers. His physical examination is noteworthy for a grade-2 posterior load shift and positive jerk and Kim tests. Radiographs demonstrate normal humeral head and glenoid morphology. Magnetic resonance imaging results are pending. Which of the following is the most likely successful operative approach to this pathology?

Remediation:
A.
An arthroscopic Bankart repair would be a better choice for a patient with anterior instability.
B. The patient is presenting with posterior instability symptoms, and an arthroscopic posterior repair would be the best operative treatment choice.
C.  The radiographs show normal glenoid morphology; therefore, an osteotomy would be unnecessary.
D. With normal humeral head anatomy on the radiographs, this would be unnecessary. A modified McLaughlin procedure is performing an osteotomy of the lesser tuberosity to transfer into the reverse Hill-Sachs defect.

A 12-year-old boy with a known history of spina bifida has an L4 functional level. He has been doing well ambulating with ankle-foot orthotics. His spine radiographs showed a 10° scoliotic curve 1 year ago, and no bracing was deemed necessary.  Radiographs obtained within the past 1 week show the scolisois has progressed to  40°. Which of the following is the next most appropriate step for this patient?

Remediation:
A. Rapid curve progression can often suggest an intrathecal abnormality for a patient with spina bifida, such as a tethered cord.  Magnetic resonance imaging is indicated to rule out such a process.
B. Rapid curve progression can often suggest an intrathecal abnormality for a patient with spina bifida, such as a tethered cord.  Magnetic resonance imaging is indicated to rule out such a process. Surgical intervention may be necessary in the future, if the scoliosis progresses to the point where it interferes with patient comfort and seating.  However, scoliosis surgery in the setting of an unidentified tethered cord is likely to worsen the patient's neurologic picture.
C.  Rapid curve progression can often suggest an intrathecal abnormality for a patient with spina bifida, such as a tethered cord.  Magnetic resonance imaging is indicated to rule out such a process.  Bracing is generally not effective for a neuromuscular scoliosis.
D. Rapid curve progression can often suggest an intrathecal abnormality for a patient with spina bifida, such as a tethered cord.  Magnetic resonance imaging is indicated to rule out

Which of the following types of RNA does not play a natural regulatory role in normal human osteoblast homeostasis?

Remediation:
A.
mRNA molecules are essential for encoding key proteins needed for osteoblast differentiation and activity.
B. microRNA molecules regulate mRNA epxression and are important for maintaining homeostasis of osteoblastic genes.
C. lncRNA molecules have been shown to regulate the translation of mRNAs and are thus capable of regulating osteoblast homeostasis.
D.  siRNA molecules are used in the laboratory setting and currently are being studied as therapeutic agents. They do not play a role in the normal regulation of osteoblast homeostasis.

A 59-year-old female patient presents following an index trigger finger (A1 pulley) release 6 months ago by another surgeon. She states that she has continued to have ‘locking’ of the finger since the surgery. On examination, she has a proximal interphalangeal (PIP) flexion contracture of 20°. If revision surgery is performed, which of the following structures may need to be resected?

Remediation:
A. 
The first-line operative treatment for trigger finger is incision of the A1 pulley. Persistent triggering can be treated with excision of one slip of the flexor digitorum superficialis (FDS) tendon. Excision of the FDP tendon should be avoided to maintain active distal interphalangeal flexion.
B.  The superficial transverse metacarpal ligament, also known as the ligament of Skoog, is a thin transverse band of the distal palmar aponeurosis. It is superficial to the deep transverse metacarpal ligament and is not resected in A1 pulley revision surgery.
C.  The first-line operative treatment for trigger finger is incision of the A1 pulley. Persistent triggering can be treated with excision of one slip of the flexor digitorum superficialis tendon.
D. Resection of the volar metacarpophalangeal joint capsule is not a part of the algorithm for the operative treatment of recurrent trigger finger.

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