Question 1

A child with blue scleras, mildly short stature, and no deformity with a history significant for 10 fractured bones most likely has:

Accepted Answer

A child with blue scleras, mildly short stature, and no deformity with a history significant for 10 fractured bones most likely has Type I osteogenesis imperfect, which is the mildest type. Type II is severe and usually lethal in the perinatal period. Type III is considered progressive and deforming. Type IV is deforming, but with normal scleras.

Question 2

Decreased metatarsal bone girth is seen in which of the following diseases?

Accepted Answer

Decreased metatarsal bone girth is seen in osteogenesis imperfecta. It is a genetic disease that results in weakness of the bones secondary to a malfunction of the body's production of collagen. Pedal features include reduced metatarsal girth.

Question 3

Which of the following muscle diseases is an autoimmune disorder?

Accepted Answer

The muscle disease that is an autoimmune disorder is myasthenia gravis. It is an autoimmune disorder in which specific antibodies to acetylcholine receptors (AchRs) reduce the number of AChRs available at neuromuscular junctions.

Question 4

Duchenne's muscular dystrophy is an example of what kind of disorder?

Accepted Answer

Duchenne's muscular dystrophy is an example of X-linked recessive inheritance. The patient's mother carries one copy of the recessive gene and, therefore, the disease is only found in males.

Question 5

All of the following features support the diagnosis of a ruptured Baker's (popliteal) cyst rather than a deep venous thrombosis (DVT) except:

Accepted Answer

All of the listed features supports the diagnosis of a ruptured Baker's (popliteal) cyst rather than a deep venous thrombosis (DVT) except sudden onset calf pain and swelling. Baker's cysts occur when fluid from a chronic inflammatory arthritis dissects into potential space in the popliteal region. When this collection of fluid ruptures, it can produce pain very similar to that of a DVT.

Question 6

What is the optimal management of a fracture-dislocation of the tarsal-metatarsal joint, also known as Lisfranc's joint?

Accepted Answer

The optimal management of a fracture-dislocation of the tarsal-metatarsal joint, also known as Lisfranc's joint, is urgent orthopedic consultation for possible open reduction and internal fixation. A fracture at the base of the second metatarsal is almost pathognomonic of a disrupted joint. Treatment is difficult and may require open reduction and internal fixation. It is important to obtain orthopedic consultation as early as possible.

Question 7

A fracture at which of the following sites is most likely to be associated with a disruption of the midfoot?

Accepted Answer

A fracture at the base of the second metatarsal is most likely to be associated with a disruption of the midfoot. The tarsal-metatarsal joint is referred to as Lisfranc joint. Injuries to this joint are uncommon and result from relatively severe trauma, such as motor vehicle crashes.

Question 8

Regarding Achilles tendon rupture, all of the following statements are true except:

Accepted Answer

Regarding Achilles tendon rupture, all of the listed statements are true except active plantar flexion excludes the diagnosis. Achilles tendon rupture most commonly occurs in middle-aged men, more often on the left side, and usually during forceful dorsiflexion of the ankle. Active plantar flexion may be maintained, although it is weaker than on the contralateral ankle.

Question 9

What compartment pressure indicates the need for fasciotomy in a patient with suspected compartment syndrome?

Accepted Answer

The compartment pressure that indicates the need for fasciotomy in a patient with suspected compartment syndrome is 30 mm Hg or higher. Compartment syndrome occurs when injured muscle within a fascial sheath swells and compresses blood vessels and nerves within the compartment.

Question 10

In a patient with a laceration that causes an 8-cm cut on the medial plantar aspect of the left foot, which peripheral nerve block is appropriate?

Accepted Answer

In a patient with a laceration that causes an 8-cm cut on the medial plantar aspect of the left foot, a posterior tibial nerve block is most appropriate. The posterior tibial nerve innervates the sole of the foot. To perform a peroneal nerve block, 1 percent lidocaine is injected into the subcutaneous tissue lateral to the posterior tibial artery at the upper border of the medial malleolus.

Question 11

Which of the following conditions is not considered a contributory factor in the development of Trench foot?

Accepted Answer

A condition that is not considered a contributory factor in the development of Trench foot is exposure to freezing conditions. Trench foot develops from exposure to wet and cold, but nonfreezing conditions over hours to days. Early on, tissue damage is reversible, but can become permanent if the foot is not removed from the cold environment.

Question 12

Which of the following fractures is a contraindication to the application of a femoral traction splint?

Accepted Answer

The fracture that is a contraindication to the application of a femoral traction splint is a pelvic fracture. The femoral traction splint is the preferred device for immobilization of femur fractures. Traction is applied by using a hitch on the ankle that encounters resistance when the splint impinges proximally on the pelvis.

Question 13

You have a patient with bilateral knee and ankle joint pain and subcutaneous nodules over the extensor surfaces. Which of the following additional criteria is needed to confirm the diagnosis of acute rheumatic fever (ARF)?

Accepted Answer

In a patient with bilateral knee and ankle joint pain and subcutaneous nodules over the extensor surfaces, the additional criteria that is needed to confirm the diagnosis of acute rheumatic fever (ARF) is evidence of preceding streptococcal infection. This patient has two major Jones' criteria for ARF. To make the diagnosis, evidence of streptococcal antibodies is needed. Major Jones' criteria include carditis, polyarthritis, erythema marginatum, chorea, and subcutaneous nodules.

Question 14

Which of the following is the most common ligament injured during ankle sprain?

Accepted Answer

The most common ligament injured during ankle sprain is anterior talofibular ligament. More than 90 percent of all ankle sprains involve the lateral ligaments. Of lateral ligament injuries, 90 percent involve the anterior talofibular ligament, with 65 percent of these sprains being isolated and 25 percent with concomitant injury to the calcaneofibular ligament.

Question 15

In a patient with posterior ankle pain, which occurred suddenly while playing volleyball, what is the most likely diagnosis if the Thompson's test is positive?

Accepted Answer

In a patient with posterior ankle pain, which occurred suddenly while playing volleyball, the most likely diagnosis if the Thompson's test is positive is Achilles tendon rupture. It is often missed by the podiatrist on initial examination and it may be misdiagnosed as an ankle sprain. Tendon rupture tends to occur with forceful dorsiflexion of the ankle.

Question 16

Which of the following knee injuries is most likely to be associated with vascular trauma?

Accepted Answer

The knee injury that is most likely to be associated with vascular trauma is posterior dislocation (tibia posterior to the femur), which has an approximately 50 percent likelihood of associated popliteal artery injury. In addition, the patient must be evaluated for peroneal nerve, ligamentous, and meniscal injuries.

Question 17

The anterior drawer sign, Lachman's test, and the pivot shift are used to measure stability of which knee structure?

Accepted Answer

The anterior drawer sign, Lachman's test, and the pivot shift are used to measure stability of anterior cruciate ligament. All three tests measure stability of the anterior cruciate ligament, which is most often injured in forceful twisting of the knee.

Question 18

What is the most common site for a compartment syndrome?

Accepted Answer

The most common site for a compartment syndrome is the anterior compartment of the leg. A tibial fracture is the usual etiology; however, other causes may also be involved.

Question 19

Aspirin therapy is used in all of the following conditions except:

Accepted Answer

Aspirin therapy is used in all of the following conditions except Kohler disease, which refers to the avascular necrosis of the tarsal navicular bone. This condition affects boys four times more frequently than girls and is not treated with aspirin due to the bleeding risk associated with aspirin.

Question 20

In the case of a knee joint dislocation, which of the following tests must be performed emergently?

Accepted Answer

In the case of a knee joint dislocation, the test that must be performed emergently is an arteriography. This test helps in early symptom resolution and prompt diagnosis can be limb saving.

Quiz 2: Orthopedic and Podiatric Conditions and Diseases