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 Table of Contents  
ARTICLES
Year : 2013  |  Volume : 48  |  Issue : 2  |  Page : 209-215

Questions


Date of Web Publication19-Jul-2014

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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EOJ.0000432303.86750.45

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How to cite this article:
. Questions. Egypt Orthop J 2013;48:209-15

How to cite this URL:
. Questions. Egypt Orthop J [serial online] 2013 [cited 2020 Jul 16];48:209-15. Available from: http://www.eoj.eg.net/text.asp?2013/48/2/209/137097

(1) A 37-year-old man fell from 24 ft and sustained a subarachnoid hemorrhage and closed femoral shaft fracture. What is most likely to lead to an adverse outcome?

Intraoperative hypotension.

Temporizing external fixation.

Elevated cerebral perfusion pressure.

Immediate reamed intramedullary nailing.

Skeletal traction with intramedullary nailing in 72 h.

(2) What is the most common anatomic location of the lateral femoral cutaneous nerve?

Deep to the psoas muscle.

Medial to the femoral vein.

Under the inguinal ligament.

Adjacent to the femoral nerve.

Deep to the iliopectineal fascia.

A 28-year-old woman with a history of systemic lupus erythematosus was involved in a motor vehicle crash. She sustained a closed left tibia fracture and underwent surgery. During surgery, the tourniquet was left inflated while the surgeon reamed the tibial canal to place the largest diameter nail that could be fit. At 6 weeks’ follow-up, there is evidence of massive bone necrosis. What event most likely led to the necrosis?

History of steroid use.

History of systemic lupus erythematosus.

Over-reaming of the tibial canal.

Reaming of the tibia with the tourniquet inflated.

Reaming of the tibia with the knee in hyperflexion.

When comparing the results of open reduction and internal fixation (ORIF) versus antegrade intramedullary nailing (IMN) fixation of the humeral diaphysis in prospective randomized trials, which of the following statements is most accurate?

Union rates are higher with IMN.

Reoperation rates are higher with IMN.

Shoulder outcomes are similar for ORIF and IMN.

Infection rates are higher with ORIF.

Radial nerve complications are higher with ORIF.

Which inflammatory marker is most closely tied to a systemic inflammatory response following orthopedic injury and treatment?

Interleukin 1 (IL-1).

Interleukin 6 (IL-6).

Interleukin 10 (IL-10).

Tumor necrosis factor-α.

D-dimer.

When attempting to treat a proximal tibial metadiaphyseal fracture with an intramedullary nail, what is the most common angular malalignment?

Varus alone.

Valgus alone.

Varus and procurvatum.

Valgus and procurvatum.

Valgus and recurvatum.

Of the following variables, which has the strongest influence on external fixator stiffness?

Pin diameter.

Pin spread.

Bone quality.

Stacking a second fixator bar.

Distance from bone to fixator bar.

A starting point entry portal that is too lateral on a trochanteric femoral nail will result in what deforming force?

Varus.

Valgus.

Flexion.

Extension.

Excessive hoop stress.

A 26-year-old man is involved in a high-speed motorcycle accident. He sustains a grade IIIB open tibia fracture. Examination shows a large soft-tissue defect and an insensate foot. What is the expected outcome in this scenario?

Equal functional outcome when limb salvage is compared with amputation.

Worse functional outcome with limb salvage than with primary amputation.

Better functional outcome when amputation is compared with limb salvage.

Amputation within 6 months of injury.

Permanent loss of plantar sensation.

Which of the following clinical scenarios represents the strongest indication for the locked plating technique in a 70-year-old woman?

Segmentally comminuted ulnar fracture.

Simple diaphyseal fracture of the humerus.

Transverse midshaft displaced clavicle fracture.

Periprosthetic femur fracture distal to a well-fixed total hip arthroplasty.

Schatzker 2 fracture of the tibia with severe joint depression and comminution.

A fracture of what portion of the coronoid is most often associated with a terrible triad injury?

Tip.

Rim.

Base.

Anterolateral facet.

Anteromedial facet.

Which set of patient characteristics has the highest risk of developing osteonecrosis after an intracapsular femoral neck fracture?

A 45-year-old woman with a displaced fracture.

A 55-year-old man with a nondisplaced fracture.

A 70-year-old woman with a nondisplaced fracture.

A 70-year-old man with a displaced fracture.

An 85-year-old woman with a displaced fracture.

In the evaluation of somatosensory-evoked potential waveforms for intraoperative neuromonitoring for spinal surgery, the minimum criteria for determining potentially significant changes include

10% decrease in amplitude, 50% decrease in latency.

10% decrease in amplitude, 50% increase in latency.

0% loss of amplitude, transient increase in latency.

50% decrease in amplitude, 10% increase in latency.

50% decrease in amplitude, 10% decrease in latency.

A 44-year-old man was involved in a low-speed rear-end motor vehicle accident 4 weeks ago. He predominantly reports pain in the back of the neck, with occasional radiation into the trapezius region bilaterally. He denies any extremity pain. The pain has not changed in intensity, but is worse with neck range of motion. Cervical spine radiographs were negative for acute osseous trauma or instability. What is the next most appropriate step in management?

Continued observation.

Cervical epidural injections.

NSAIDs, activity modification, and physical therapy.

Cervical facet blocks.

Cervical MRI.

A patient with a grade 2 L5–S1 isthmic spondylolisthesis reports low back pain and bilateral lower extremity pain. Nonsurgical management has failed to provide relief, and the patient is now a candidate for surgical intervention. The surgeon elects to proceed with L5–S1 laminectomy and posterior instrumented fusion after reduction of the spondylolisthesis. If a postoperative neurologic deficit develops, what structure has most likely been affected?

L4 nerve root.

L5 nerve root.

SI nerve root.

Genitofemoral nerve.

Cauda equine.

A 63-year-old man has a feeling of generalized clumsiness in his arms and hands, difficulty buttoning his shirt, and gradually worsening gait instability. During examination, his neck is gently passively flexed to end range while he is seated. The patient describes an electric shock-like sensation that radiates down the spine and into the extremities. This describes which of the following?

A positive Lhermitte sign.

A positive Spurling sign.

A positive Jackson sign.

A positive Lasegue sign.

A positive Hoffmann sign.

A 46-year-old man has a recurrent disk herniation on the left side at L4–L5 and has had persistent radicular symptoms for 3 months without neurologic deficit. His previous surgery was performed 13 months ago. What is the best method of surgical treatment?

Posterior lumbar interbody fusion.

Anterior lumbar interbody fusion.

Revision diskectomy.

Artificial disk replacement.

Interspinous process spacer.

Of the following, what is the most reliable method of assessing spinal fusion?

Radiographs.

MRI.

Flexion/extension radiographs.

CT.

CT myelography.

An 80-year-old man with a history of chronic obstructive pulmonary disease (COPD) and dementia is involved in a fall from standing height, striking his forehead. He is seen in the emergency department with predominantly mechanical neck pain but no obvious neurologic deficits. Radiographs indicate a nondisplaced type II odontoid fracture. What is the most appropriate treatment?

Immobilization in a rigid cervical orthosis for 6–8 weeks.

Posterior occipital–cervical fusion with an iliac crest bone graft.

Open reduction and internal fixation of the odontoid process with an anterior odontoid screw.

Resection of the odontoid process through a transoral approach.

Halo skeletal fixation.

A 42-year-old woman has a 3-week history of acute lower back pain with radiation into the left lower extremity. There is no history of trauma and no systemic symptoms are noted. Examination indicates a positive straight leg test at 25° on the left side. Motor testing shows mild weakness of the gluteus maximus and weakness of the gastrocnemius at 3/5. Sensory examination indicates decreased sensation along the lateral aspect of the foot. Knee reflex is intact; however, the ankle reflex is absent. MRI scans show a posterolateral disk herniation. The diagnosis at this time is consistent with a herniated nucleus pulposus at what level?

Ll–L2.

L2–L3.

L3–L4.

L4–L5.

L5–S1.



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