One Hundred Orthopedic Conditions Every Doctor Should ...



Multiple choice questions taken from material in

One Hundred Orthopedic Conditions Every Doctor Should Understand

Read the chapters related to upper extremity conditions (chapters 2, 4, 5, 6, 7, 11, 12, 13, 14, 19, 24, 26, 28, 29, 33, 35, 36, 38, 40, 41, 42, 43, 44, 46, 49, 56, and 58).

Take the quiz, submit your answer sheet along with $50 for 8 hours of continuing education credit. Passing scores are 54 correct (70%) and above.

Learning objectives

1. collect a good history & exam for common and/or severe upper extremity

orthopedic conditions

2. discuss current treatment options with the patient

3. participate more effectively in the care of the patient

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One Hundred Orthopedic Conditions Every Doctor Should Understand

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One Hundred Orthopedic Conditions Every Doctor Should Understand, 2nd edition

The following questions are taken from 27 of the 61 chapters (2, 4, 5, 6, 7, 11, 12, 13, 14, 19, 24, 26, 28, 29, 33, 35, 36, 38, 40, 41, 42, 43, 44, 46, 49, 56, and 58) and pertain to upper extremity conditions

1. Which of the following malunion deformities following a metacarpal fracture in a child will not remodel with continued growth?

A. Apex dorsal angulation

B. Apex volar angulation

C. Apex medial angulation

D. Apex lateral angulation

E. Lateral rotation causing scissoring

2. A cat bite is often more problematic than a dog bite because

A. Dogs are nicer than cats

B. Cats carry more and more virulent bacteria in their saliva than dogs

C. Dog bites tear the tissues more, which then bleed profusely

D. Cats bite and hold on, whereas dogs generally bite and release

E. Cats know instinctively to bite over vulnerable joints and tendon sheaths

3. A 30-degree apex dorsal malunion of a small finger metacarpal neck fracture is typically not a problem functionally because

A. The bony deformity is well-compensated for by the natural hypermobiiltiy of the MP joint in flexion

B. The bone deformity is well-compensated for by the natural hypermobility of the MP joint in extension

C. A pugilist doesn’t object to a few stiff joints because they help stabilize his fist for maximizing punching power

D. In adults, the angular deformity will remodel and correct itself over time

E. The small finger’s lost function following fracture malunion can be easily substituted by the index finger.

4. A small laceration over the dorsum of the middle finger MP joint

A. Can be ignored in a 23-year-old yahoo once he tells you he cut it on a tuna fish can

B. Should be considered the result of an impact against an upper incisor until proven otherwise

C. Is treated no differently than a similarly-sized laceration elsewhere on the hand

D. Will predictably heal once sutured securely

E. Has no implications for the joint, since the joint is well-protected by the intervening EDC tendon

5. When examining an x-ray that shows a fracture of the distal radius, diminished bone density

A. Can only be seen radiographically when there is at least a 30% loss

B. Is more evident in the ulna than the radius

C. Is apparent when comparing the injured side to the uninjured side

D. Should be measured in the dominant wrist regardless of the side the fracture is on

E. Will not be apparent in men

6. In osteoporosis

A. The bone quality and quantity are both sufficient

B. The bone quality and quantity are both deficient

C. The bone quality is good, the quantity is deficient

D. The bone quantity is good, the quality is deficient

E. Osteoblast activity outpaces osteoclast activity

7. In adults, the most common malignancy of bone is

A. Osteosarcoma

B. Chondrosarcoma

C. Multiple myeloma

D. Metastatic cancer

E. Rhabdosarcoma

8. Following internal fixation of a humeral shaft fracture, the patient is noted to have a radial nerve palsy. What documentation would be most helpful in explaining the probable cause to the patient?

A. A nerve conduction study performed immediately

B. A nerve conduction study performed 3 weeks post-operatively

C. An electromyogram performed immediately

D. A carefully performed and recorded pre-op exam

E. Comparison of the pre-op and immediate post-op x-rays

9. Osteochondromas and osteosarcomas are more likely to occur in a humerus than a metacarpal because

A. The tissues are warmer in the more proximal portions of the limb

B. The neuroregulation is closer to the source

C. The epiphyseal growth plates of the humerus have more growth potential

D. The mechanical stresses are directly proportional to the length of the bone

E. The odds are stacked against two humeruses compared to 10 metacarpals

10. The most common locations of ganglions in descending order are

A. Dorsal wrist, volar wrist, volar base of finger

B. Dorsal wrist, dorsal base of finger, volar wrist

C. Volar wrist, dorsal wrist, volar base of finger

D. Volar wrist, volar base of finger, dorsal wrist

E. Volar base of finger, volar wrist, dorsal wrist

11. Characteristics of a ganglion that can typically distinguish it from a neoplasm include its

A. Sudden appearance, inability to transmit light

B. Sudden appearance, ability to transmit light

C. Spherical shape and firm consistency

D. dumbbell shape and fluid-filled consistency

E. Classic location immediately dorsal to the triquetro-hamate joint

12. Localized nodular tenosynovitis, the most common neoplasm in the hand, is also known as

A. Giant cell tumor of bone

B. Giant cell tumor of tendon sheath

C. Stenosing tenosynovitis

D. Erythropoikilosis

E. Epithelial inclusion cyst

13. Localized nodular tenosynovitis is

A. Always benign and never recurs once excised

B. Always benign and disappears after aspiration

C. Always benign but can recur locally

D. Malignant and may metastasize

E. Malignant but does not recur after wide local excision

14. Abduction, external rotation shoulder injuries will likely produce

A. A shoulder dislocation in younger people and a proximal humeral fracture in older people

B. A shoulder dislocation in people of all ages

C. A proximal humeral fracture in people of all ages

D. A proximal humeral fracture in younger people and a shoulder dislocation in older people

E. An acromioclavicular separation in people of all ages

15. The likely complication of a shoulder dislocation is

A. Recurrent dislocation in younger people and permanent stiffness in older people

B. Permanent stiffness in younger people and recurrent dislocation in older people

C. Recurrent dislocation regardless of the person’s age

D. Permanent stiffness regardless of the person’s age

E. Permanent axillary nerve palsy regardless of the person’s age

16. Comminuted humeral head fractures are problematic because one or more of the fragments

A. Can become lodged against the brachial plexus

B. Can develop avascular necrosis

C. Can become wedged between the clavicle and the corocoid

D. Can disrupt the normal course of the tendon of the bicep’s long head

E. Can become infected secondary to lymphatic obstruction

17. The two well-known complications of supracondylar humeral fractures in children are

A. Malunion and elbow stiffness

B. Elbow stiffness and compartment syndrome

C. Compartment syndrome and malunion

D. Compartment syndrome and median nerve palsy

E. Lateral epicondylitis and radial nerve palsy

18. Of the five cardinal signs for compartment syndrome, the most important is

A. Pallor

B. Pulselessness

C. Paresthesias

D. Pain

E. Paralysis

19. The most important treatment for compartment syndrome is

A. Removal of tight bandages

B. Enforced, maximum elevation of the injured limb

C. Radial pulse checks every 15 minutes for 48 hours

D. Ice packs for the first 48 hours, then warm compresses

E. Emergency fasciotomy

20. In a patient with the sudden onset of a red, swollen, hot, painful wrist, gout can be differentiated from pseudogout by performing

A. A microscopic analysis of joint fluid aspirate

B. A chemical analysis of joint fluid aspirate

C. A blood test for uric acid levels

D. A detailed history of dietary intake over the past week

E. A careful physical examination looking for carpal instability

21. Which two of the following diagnoses at the thumb MP joint are most likely to

mimic each other?

A. Infection and gout

B. Non-displaced fracture and gout

C. Tendinitis and infection

D. Tendinitis and gout

E. Collateral ligament tear and sesamoiditis

22. Gout can at least be partially controlled by controlling

A. Blood pressure

B. Exposure to cold

C. Anaerobic exercise

D. Diet

E. Sleep pattern

23. A 4 year-old girl falling onto her outstretched hand is likely to sustain a

A. Greenstick (torus) fracture of distal radius

B. Distal radius epiphyseal fracture

C. Radial head subluxation

D. Scaphoid fracture

E. Comminuted, intra-articular distal radius fracture

24. The “silver fork deformity” refers to the appearance of the wrist seen after

A. An apex volarly angulated distal radius fracture

B. An apex dorsally angulated distal radius fracture

C. A scaphoid fracture with apex dorsal angulation

D. Dorsal intercalated segmental instability (DISI)

E. Volar intercalated segmental instability (VISI)

25. Different injury patterns seen in patients of varying ages following falls on outstretched wrist are accounted for by differences in

A. Body mass index

B. Height and body build

C. Top running speed

D. Risk adversity

E. Relative tissue strengths

26. Onset of numbness in tingling in the median nerve distribution noted immediately after a fall on outstretched hand with fracture of the distal radius is likely caused by

A. Median nerve contusion in the distal forearm

B. Latent carpal tunnel syndrome

C. Latent pronator syndrome

D. Brachial plexus neurapraxia

E. Subclinical chronic regional pain syndrome

27. Athetoid cerebral palsy is characterized by

A. Constant uncontrollable movements

B. Spasticity in the athetoid muscle groups

C. Flaccidity in the athetoid muscle groups

D. C6 and C7 muscle spasticity

E. Fixed joint contractures unilaterally

28. The earliest findings of cerebral palsy include

A. Spasticity noted in the newborn nursery

B. Constant uncontrollable movements in the newborn nursery

C. Muscle flaccidity, persistent infantile reflexes and delayed motor development in the first year

D. Upper limb greater than lower limb muscle spasticity noted in the first year

E. Right greater than left muscle spasticity noted in the first year

29. Tendinous mallet fingers require longer immobilization than bony mallet fingers because

A. Bony mallet fingers occur with lower energy injuries

B. The bone chip heals faster than the stretched tendon

C. The damaged cartilage releases critical healing stimulants

D. The damaged cartilage release critical healing inhibitors

E. Pressure from the splint stimulates osteoblasts for than it stimulates fibroblasts

30. Pulling out a hang nail with tweezers risks the development of a

A. Felon

B. Herpetic whitlow

C. Mucous cyst

D. Paronychia

E. Subungual fungal infection

31. An acute subungual hematoma involving the entire sterile matrix is best treated by

A. Decompression by creating a hole in the nail plate

B. Decompression by releasing the restraining pulp fascial septa

C. Elevation and ice

D. Anticoagulation and digital block

E. Splinting the DIP joint in moderate flexion

32. A mucous cyst causing nail plate deformity is best treated by

A. Aspiration

B. Cryotherapy

C. Cortisone injection

D. Osteophyte excision

E. Nail removal

33. Tardy ulnar palsy denotes that

A. Motor symptoms and findings are late findings

B. Sensory symptoms and findings are late findings

C. The patients are consistently late for appointments

D. Symptoms occur years after a provoking injury

E. Recovery following treatment is delayed and incomplete

34. Patients with ulnar nerve palsy at the elbow can be distinguished from those with ulnar nerve palsy at the wrist by asking them if

A. They sleep with their elbow in complete flexion

B. They are numb over the dorsum of their small finger metacarpal

C. Have increased symptoms with overhead activities

D. They can snap their fingers

E. If the numbness extends to the radial side of their ring finger

35. Which will likely produce the most valuable information regarding the diagnosis of cubital tunnel syndrome?

A. A detailed, thorough history

B. A detailed, thorough physical exam

C. A detailed, thorough review of systems and family history

D. An electromyographic evaluation in the maximally stressed position

E. An MRI with contrast dye

36. The mechanism of injury for an acromioclavicular separation usually consists of

A. A downward blow on the tip of the shoulder with the arm abducted

B. A downward blow on the tip of the shoulder with the arm adducted

C. An external rotation, hyperextension twist to the shoulder

D. An internal rotation, hyperextension twist to the shoulder

E. A neutral rotation, hyperabduction twist to the shoulder

37. Left unrepaired, complete acromioclavicular separations usually result in

A. A permanent change in appearance but not function

B. A permanent change in function but not appearance

C. Only a temporary change in appearance and function

D. Complete recovery of normal appearance and function

E. Late acromioclavicular and glenohumeral arthritis

38. Clavicle fracture fragments tend to override one another because of the

A. Inferiorly directed forces of the rhomboid major and teres major

B. Medially directed forces of the pectoralis major and latissimus dorsi

C. Laterally directed forces of the supraspinatus and coracobrachialis

D. Rotational forces of the subclavius and sternocleidomastoid

E. Effects of gravity when the patient is supine.

39. The proximal end of a clavicle fracture tends to ride upwards because of

A. The weight of the limb when the patient is standing

B. The effect of the serratus anterior

C. The effect of the pectoral muscles

D. The effect of the sternocleidomastoid

E. The effect of the levator scapulae

40. Bursas allow for

A. Frictionless gliding of one layer of tissue over another

B. A reservoir of synovial fluid to quickly resupply adjacent joints

C. A defense against joint infection

D. A reservoir of cartilage precursors to quickly resupply adjacent joints

E. Lubrication of muscle-tendon junctions

41. Pressure on the median nerve at the wrist first causes

A. ischemia and neurapraxia

B. ischemia and axonotmesis

C. increased conduction velocity and demylenation

D. decreased conduction velocity and demylenation

E. neuropraxia and axonotmesis

42. Which of the following findings is likely to occur later than the others in progressively severe carpal tunnel syndrome?

A. A positive wrist flexion test

B. Paresthesias with tapping over the nerve

C. Widened two-point discrimination

D. Paresthesias with direct digital pressure over the nerve

E. Night waking with paresthesias

43. The depicted findings support the diagnosis of

A. Carpal tunnel syndrome in the right hand because of increased grime on the fingers

B. Carpal tunnel syndrome in the left hand because of decreased grime on the fingers

C. Carpal tunnel syndrome in the left hand because of the plane of the thumb nail with respect to the plane of the palm

D. Carpal tunnel syndrome in the right hand because of the plane of the thumb nail with respect to the plane of the palm

E. Right hand dominance because of the pattern of grime and presence of a subungual hematoma on the left thumb

44. At 6 months of age, a child with a complete transverse upper limb deficiency would be ready for

A. A body-powered, active-opening hook prosthesis

B. A body-powered, active-closing hook prosthesis

C. A limb extender with a terminal mitt

D. A basic myoelectric prosthesis

E. A passively-positionable hook prosthesis

45. Trigger finger is so named because

A. Of its frequent occurrence in the right index finger

B. Dr. Lucas Trigger is credited for first describing it

C. Of the catching motion an affected finger makes

D. Of its tendency to trigger other tendon entrapments

E. Somebody mistranslated “trick finger” from the original French

46. Locked trigger digits in infants most often occur in the

A. Thumb

B. Index finger

C. Middle finger

D. Ring finger

E. Small finger

47. First dorsal compartment tendonitis is most frequently seen in

A. Washerwomen

B. Basketball referees

C. Tennis players

D. Bowlers

E. New mothers

48. A useful test for diagnosing tennis elbow is pain on

A. Resisted elbow flexion

B. Resisted elbow extension

C. Resisted wrist flexion

D. Resisted wrist extension

E. Resisted forearm supination

49. In the upper extremity, the most likely location for a giant cell tumor of bone is the

A. Distal radius

B. Proximal radius

C. Proximal ulna

D. Distal humerus

E. Proximal humerus

50. The mechanism of injury to produce a chip fracture at the volar base of the middle phalanx is sudden

A. Hyperflexion from forceful FDS contraction

B. Hyperextension during forceful FDS contraction

C. Hyperextension with volar plate avulsion

D. Impaction in 20 degrees of flexion

E. Distraction in full extension

51. The most likely long-term consequence of the chip fracture from the volar base of the middle phalanx is

A. Instability

B. Stiffness

C. Osteoarthritis

D. Triggering

E. Pain

52. Digital swelling following a chip fracture from the volar base of the middle phalanx typically

A. Takes 10-14 days to subside maximally

B. Takes 4-8 weeks to subside maximally

C. Takes 6-12 months to subside maximally

D. Takes 2-3 years to subside maximally

E. Subsides only to recur many years later

53. The most common bone neoplasm in the hand is

A. Enchondroma

B. Osteosarcoma

C. Ganglion

D. Osteoblastoma

E. Mucous cyst

54. The first awareness of a tumor such as the one depicted often comes from

A. Feeling a lump while washing one’s hands

B. Pain following a trivial injury

C. Numbness after prolonged keyboard activity

D. Limited digital extension with triggering

E. Inability to wear a previously-fitting ring

55. Nursemaid’s elbow is seen in

A. Newborns

B. Toddlers

C. Tweens

D. Teenagers

E. Nursemaids

56. Nursemaid’s elbow is caused by

A. Entrapment of the radial head in the annular ligament

B. Entrapment of the ulnar head in the annular ligament

C. Entrapment of the humeral head in the annular ligament

D. Momentary subluxation of the ulnohumeral joint

E. Momentary spastic contracture of the anconeus

57. In a 25 year-old patient complaining of chronic shoulder pain, the most likely diagnosis is

A. Rotator cuff tear

B. Impingement

C. Instability

D. Arthritis

E. Neoplasm

58. In shoulder impingement syndrome, the rotator cuff gets pinched between

A. The subclavius and the corocoid

B. The corocoid and the clavicle

C. The clavicle and the acromion

D. The humeral head and the subclavius

E. The acromion and the humeral head

59. Repair of a complete rotator cuff repair typically

A. Improves comfort more than motion

B. Improves motion more than comfort

C. Improves motion and comfort equally

D. Improves neither motion nor comfort but delays onset of arthritis

E. Includes suturing of the teres major tendon

60. A complete nerve laceration is technically known as

A. Axonotmetsis

B. Neurotmesis

C. Neurapraxia

D. Paresthesia

E. Parthenogenesis

61. Peripheral nerve regeneration following laceration and repair proceeds at

A. Approximately a millimeter a day and is faster in children than adults

B. Approximately a millimeter a month and is faster in children than adults

C. Rates dependent on the specific nerve and is faster in women than men

D. Rates dependent on the proximity of the injury to the spinal cord

E. Rates dependent on the patient’s activity level and frequency of nerve massage

62. Following median nerve laceration and repair at the wrist in a 70 year-old Australian, the outcome will likely be

A. Full recovery of sensory and motor function

B. Full recovery of sensory function and no recovery of motor function

C. Modest recovery of sensory function and no recovery of motor function

D. Modest recovery of sensory function and full recovery of motor function

E. No recovery of sensory function and modest recovery of motor function

63. The depicted hand most likely belongs to

A. A 20-year old Hispanic rock climber

B. A 60-year old Hispanic rock climber

C. A 55-year old Australian business man

D. A 40-year old carpenter following tenolysis

E. A Japanese sailor with diabetes

64. Fibrous thickenings similar to those found in the palm in Dupuytren’s disease can also occur

A. In the shaft of the penis and on the arch of the foot

B. In the shaft of the penis and on the planter surfaces of the toes

C. On the plantar and dorsal surfaces of the toes

D. On the extensor surfaces of the elbow and knee

E. On the extensor surfaces of the wrist and DIP joints

65. Dupuytren’s disease is so named after

A. The Scandinavian village where the original cases were discovered

B. The surgeon credited erroneously with the first surgical treatment

C. The medically correct name for the offending myofibroblast causing the condition

D. A phonetic spelling of the Celtic expression for “cord in palmar fascia”

E. The author of the first book on orthopedic conditions

66. The progression of Dupuytren’s disease is

A. More rapid in women than men

B. More rapid in the thumb and index finger than the other digits

C. Erratic and unpredictable

D. Halted by careful splinting

E. Retarded by exercise and diet

67. Displaced midshaft fractures of the radius and ulna in children can be safely treated nonoperatively in casts with the expectation of recovery of forearm rotation because

A. The muscles responsible for pronation and supination adapt to the bony alignment

B. The healing and growing bones remodel to nearly normal alignment over time

C. Pain is less of an issue so early motion prevents stiffness

D. The vascular supply in children precludes the development of compartment syndromes

E. The interosseous membrane remains intact and substitutes for plate fixation

68. When a displaced proximal ulna fracture is associated with a radial head dislocation, anatomical plating of the ulna often results in

A. Stability of the reduced radiocapitellar joint without other fixation

B. Increased instability of the radiocapitellar joint requiring pin fixation

C. Heterotopic bone and cross union of the radius and ulna

D. Radial nerve palsy

E. Compartment syndrome

69. A minimally displaced radial head fracture is best treated with

A. Radial head excision and prosthetic replacement A

B. A long arm cast for 6 weeks

C. A short arm cast for 6 weeks

D. Open reduction and screw fixation

E. A sling for several days and early recovery of motion

70. A nightstick fracture refers to

A. A distal radius fracture with disruption of the distal radioulnar joint

B. Midshaft fractures of the radius and ulna

C. A proximal ulna fracture and radial head dislocation

D. An open olecranon fracture

E. An isolated midshaft ulna fracture

71. Which of the following injuries would have a better functional result without replantation rather than with replantation?

A. Index finger through the middle phalanx

B. Index finger through the proximal phalanx

C. Thumb through the metacarpophalangeal joint

D. Thumb through the mid metacarpal

E. Hand through the midpalm

72. Leech therapy following replantation is used to

A. Temporarily relieve venous congestion

B. Stimulate capillary budding

C. Reduce the blood’s viscosity

D. Stimulate nerve regrowth

E. Reduce arterial vasoconstriction

73. Limb replantation surgery is best considered

A. Complete restoration surgery

B. Salvage surgery

C. Restoration for sensory nerves, salvage for bone

D. Restoration for flexor tendons, salvage for bone

E. Restoration for function, salvage for appearance

74. The main obstacles to routine limb transplantation are issues of

A. Bone fixation

B. Circulation

C. Infection

D. Immunology

E. Early aging

75. The depicted anomaly is best described as

A. Complex complete syndactyly

B. Complex incomplete syndactyly

C. Compound incomplete syndactyly

D. Simple incomplete syndactyly

E. Simple variable syndactyly

76. The depicted anomaly is best

A. Left untreated

B. Removed in the newborn nursery

C. Treated only if bilateral

D. Carefully reconstructed

E. Replaced by an index pollicization

77. Characteristics of achondroplasia include short stature, bulging forehead, depressed bridge of nose, normal intelligence, and

A. disproportionately short forearms compared to upper arms with normal hands

B. Disproportionately short upper arms compared to forearms with normal hands

C. Disproportionately short upper arms compared to forearms with splayed fingers

D. Proportionately sized forearms compared to upper arms with syndactyly

E. Proportionately sized forearms compared to upper arms with polydactyly

-----------------------

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and every orthopedically-inclined OT and PT

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