Multiple Choice Questions

Lower Limb Pathology

Test your knowledge , learn more and get ready for your orthopaedic exam

 

5. The magnetic resonance image in this distance runner reveals:

A) Iliopsoas tendinitis
B) Hip flexor injury
C) Pelvic stress fracture
D) Femoral neck stress fracture
E) Subtrochanteric stress fracture

 

4. A 40y old man has had hip pain with increased activity over the past year. 

Examination reveals restriction of motion and tenderness with combined hip flexion, adduction, and internal rotation. An AP radiograph is shown in the figure attached. 

What is the most likely diagnosis?

A) Developmental dysplasia of the hip
B) Osteonecrosis
C) Pseudogout
D) Femoral acetabular impingement                                                                                                                                                                                              E) Perthes disease                                                

 

3. Trenderburg’ s sign can be elicited in all of the following except :

Trendelenburg test or sign | Epomedicine
A) Congenital dislocation of the hip
B) Infantile paralysis of the gluteal muscles
C) Coxa vara
D) Tuberculous arthritis of the hip joint
E) Non-united fracture of the femoral neck

 

2. A 60-year-old patient presents to clinic complaining of left hip squeaking and stiffness following a ceramic-on-ceramic total hip replacement five years earlier. Initially, he was extremely pleased with the operation, but these symptoms of squeaking and stiffness have developed fairly abruptly over the past 6 months. 

On physical exam, he has a well-healed incision, a 1 centimeter leg length discrepancy (left shorter than right), decreased hip flexion, and decreased internal rotation. 

A radiograph is shown in Figure. 

C-reactive protein is 0.2 mg/dL (nl <0.9 mg/dL) and erythrocyte sedimentation rate is 5 mm/hr (nl 0-15 mm/hr). 

What would you recommend for this patient?

A ) Observation and physical therapy
B) Left hip corticosteroid injection
C) Left hip aspiration
D) Thorough debridement and two-stage revision
E) Thorough debridement and one-stage head and liner revision

 

1.  25 years old rugby player sustained posterior hip dislocation when several players landed on his back with the hip flexed to 90 degrees, resulting in posterior hip dislocation. 

Hip Dislocation – Core EM

What is the most common complication of hip dislocation?

A) Posttraumatic arthritis
B) Avascular necrosis
C) Sciatic nerve injury
D) Recurrent dislocation
E) Femoral artery occlusion

91.What is the % energy expenditure above baseline during ambulation following an average transtibial amputation?

A) 10%
B) 25%
C) 45%
D) 65%
E) 75%

90. All of the following signs correlate with a cruciate ligament injury EXCEPT

A) Positive Lachman’s test
B) Positive dial test in 90 degrees flexion
C) Positive dial test in 30 degrees flexion
D) Positive pivot shift test
E) Positive quadriceps active test

 89. Which of the following statements is TRUE regarding acute Septic Arthritis

A) A gram-negative bacteria is the usual infecting organism
B) Treatments involves joint irrigation
C) Small Joints are prefertionally affected to large joints
D) Antibiotics are usually withheld until the appropriate sensitivities are confirmed
E) Movement of the joints restricted due to the formation of adhesions

88. What lies in the lateral first layer of the knee?

A) Arcuate ligament, fabellar ligament, capsule, LCL
B) Iliotibial tract, biceps femoris, fascia
C) Patellar retinacular and PFL ligament
D) Sartorius and fascia hyperparathyroidism
E) Superficial MCL, posterior oblique ligament, semimembranosus

 87. Which of the following is NOT a recognised complication of posterior Hip dislocations:

A) Posterior acetabular rim fracture
B) Avascular necrosis of femoral head
C) Femoral nerve injury
D) Sciatic nerve injury
E) Chrondromalcia of the femoral head

 86. Which of the following statements regarding the peroneal division of the sciatic nerve is true?

A) It crosses anterior to the lateral head of the gastrocnemius muscle through the posterior intermuscular septum
B) An injury at the level of the thigh will denervate the branches to the short head of the biceps and the tibialis anterior
C) It is most commonly injured during an anterior knee dislocation
D) The deep division initially runs medial to the tibial artery and later crosses over to become lateral
E) It originates from the L3-S1 nerve roots

 85. A 60-year-old patient presents to clinic complaining of left hip squeaking and stiffness following a ceramic-on-ceramic total hip replacement five years earlier. Initially, he was extremely pleased with the operation, but these symptoms of squeaking and stiffness have developed fairly abruptly over the past 6 months. On physical exam, he has a well-healed incision, a 1 centimeter leg length discrepancy (left shorter than right), decreased hip flexion, and decreased internal rotation. A radiograph is shown in Figure. C-reactive protein is 0.2 mg/dL (nl <0.9 mg/dL) and erythrocyte sedimentation rate is 5 mm/hr (nl 0-15 mm/hr). What would you recommend for this patient?

A ) Observation and physical therapy
B) Left hip corticosteroid injection
C) Left hip aspiration
D) Thorough debridement and two-stage revision
E) Thorough debridement and one-stage head and liner revision

 

84. A Pelvic Xray (part of Trauma series)is taken in a 30 yr old female after a history of Motor vehicle accident .


Diagnostic Possibilities include:

A) Hyperparathyroidism
B) Osteopoikilosis
C) Osteopetrosis
D) Multiple Myeloma                                                                                                                                                                                                                               E) Osteoporosis

 

83. In the treatment of Osteoarthritis of the Knee :

A) Physiotherapy has no value even in mild cases
B) High osteotomy is indicated when it affects mainly the medial compartment providing deformity is not severe
C) Knee arthrodesis is the treatment of choice in bilateral cases
D) Total Knee replacement is the treatment of choice in the under 40 year age group
E) High Tibial osteotomy will increase the range of movements in a stiff Knee joint

 

82. The lateral pivot shift test shares maximum similarity with which of the following tests ?

A) Slocum Anterior Rotary Drawer Test
B) Jerk test of Hughston and Losee
C) Reverse pivot shift sign of Jakob, Hassler and Stäubli
D) Flexion Rotation Drawer Test
E) External Rotation-Recurvatum Test

 

81. Using the three layer description of the medial structures of the knee, the medial patellofemoral ligament is described as being within the:

A) First layer
B) Second layer
C) Third layer
D) All three layers
E) The medial patellofemoral ligament does not exist

 

80. What are the main findings of medial tibial stress syndrome on a bone scan?

A) Delayed uptake of tracer and nonfocal uptake over the posteromedial tibial border
B) Lack of uptake of tracer in all phases
C) Focal uptake of tracer in early phase only
D) Focal uptake of tracer in delayed phases
E) Nonspecific uptake of tracer in all phases

 

79. Which of the following physical examination maneuvers is suggestive of piriformis syndrome?

A) Forced internal rotation of an extended thigh
B) Forced external rotation of a flexed thigh
C) Forced internal rotation of a flexed thigh
D) Forced external rotation of an extended thigh
E) Forced internal rotation of a flexed knee

 

78. After anteromedialization of the tibial tubercle, patients with which patellar lesions were found to have better outcomes:

A) Medial facet and distal lesions
B) Lateral facet and distal lesions
C) Medial facet and proximal lesions
D) Lateral facet and proximal lesions
E) Medial and lateral facet lesions

 

77. The most common technical errors when performing anterior cruciate ligament reconstruction are:

A) Excessively anterior tunnels
B) Intraoperative fracture
C) Iatrogenic posterior cruciate ligament injury
D) Excessively posterior tunnels
E) Excessively medial tunnels

 

76. The anterior cruciate ligament is composed of which of the following bundles:

A) Anterolateral, posteromedial
B) Anteromedial, posterolateral
C) Mediolateral, posteromedial
D) Anterior, posterior
E) Medial, lateral

 

75. Which of the following is a risk factor for anterior cruciate ligament (ACL) injury in noncontact athletes?

A) Smaller than average cross sectional size of the ACL
B) High shoe-surface coefficient of friction
C) Smaller than average diameter of the femoral notch
D) Failure to use a knee brace
E) Failure to modify activity of female athletes during certain phases of the menstrual cycle

 

74. The recommended treatment for an acute combined anterior cruciate ligament and complete posterolateral corner
disruption in a young athlete is:

A) Anterior cruciate ligament reconstruction alone
B) Nonoperative treatment emphasizing quadriceps strengthening
C) Anterior cruciate ligament reconstruction and posterolateral corner repair
D) Anterior cruciate ligament repair and posterolateral corner repair
E) Posterolateral corner repair alone

 

73. The results of anteromedial tibial tubercle transfer for patellar malalignment are best when patellar lesions are
located:

A) Distally on the lateral facet
B) Proximally on the lateral facet
C) Proximally on the medial facet
D) Distally on the medial facet
E) Proximally on either facet

 

72. Popliteal cysts in adults are most commonly associated with which of the following knee problems:

A) Anterior cruciate ligament tears
B) Lateral meniscus tears
C) Medial meniscus tears
D) Posterior cruciate ligament tears
E) Medial collateral ligament tears

 

71. The primary intervention for patients with medial tibial stress syndrome is:

A) Surgery with release of the posteromedial fascia
B) Cortisone injections at the insertion of the soleus on the posteromedial tibia
C) Viscosupplementation of the knee
D) Activity modification, icing after activities, and nonsteroidal anti-inflammatory medication
(E) Increasing activities until pain subsides

 

70. Which of the following is the most commonly injured knee ligament? 

A) Lateral collateral ligament
B) Medial collateral ligament
C) Anterior cruciate ligament
D) Posterior cruciate ligament
E) Falciform ligament

 

69. The reported 3 to 5 year success rate of a chondral lesion microfracture technique in the knee is:

A) 10% improvement
B) 25% improvement
C) 40% improvement
D) 75% improvement
E) 95% improvement

 

68. The magnetic resonance image (MRI) of a 16-year-old high school football player who sustained a knee injury
during a game is presented . 

He reports mild swelling at the time of injury but does not recall hearing a “pop.”
He has attempted to return to football but is unable to make side-to-side movements. 

On clinical examination, no difference in anterior or posterior laxity is appreciated when comparing the injured knee to the uninjured knee. 

What is the most appropriate initial management?

A) Open reduction internal fixation of the tibial plateau fracture
B) Percutaneous fixation of the tibial plateau fracture
C) Medial patellofemoral ligament reconstruction
D) Medial collateral ligament repair
E) Functional rehabilitation with progressive return to play

 

67. In the literature, the patella redislocation rate for conservatively treated patients ranges from:

A) 5% to 10%
B) 10% to 20%
C) 15% to 45%
D) 40% to 70%
E) 75% to 90%

 

66. With regard to the meniscofemoral ligaments, the ligament of Humphrey runs  ________ to the posterior cruciate ligament (PCL) and the ligament of Wrisberg runs  _____  to the PCL.

A) Posterior, anterior
B) Anterior, posterior
C) Anterior, anterior
D) Posterior, posterior
E) Medial, lateral

 

65. In the posterior cruciate ligament the anterolateral bundle is tight in  ______  and the posteromedial
bundle is tight in ___________

A) Flexion, extension
B) Extension, flexion
C) Extension, extension
D) Flexion, flexion
E) Neither bundle tightens throughout the knee’s range of motion.

 

64. Use of functional knee bracing after anterior cruciate ligament (ACL) reconstruction will most likely result in which of
the following scenarios:

A) Better range of motion at the 2-year follow-up
B) Better knee stability at the 2-year follow-up
C) Better knee function at the 2-year follow-up
D) More knee pain at the 3-month follow-up
E) More quadriceps atrophy at the 3-month follow-up

 

63. The resting pressure criteria for diagnosing chronic exertional compartment syndrome in athletes is equal to or greater than:

A) 10 mm Hg
B) 15 mm Hg
C) 20 mm Hg
D) 25 mm Hg
E) 30 mm Hg

 

62. Adductor longus tenotomy in athletes with chronic adductor pain resistant to nonoperative treatment results in:

A) Full objective strength
B) Return to sport at a lower level of play for most athletes
C) Return to full sports for most athletes despite decreased objective adductor strength
D) Inability to return to sports
E) Unacceptable complication rates

 

61. The posterior cruciate ligament sustains from 85% to 100% of the load of a posterior directed force at 90º of flexion. Which fibers of the ligament are responsible for this?

A) Anterolateral bundle
B) Anteromedial bundle
C) Posteromedial bundle
D) Posterolateral bundle
E) Anterolateral and posteromedial equally

 

60. Septic arthritis of the knee within 4 weeks following anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone autograft should initially be treated with:

A) Culture-specific intravenous antibiotics
B) Culture-specific intravenous antibiotics and surgical irrigation with graft retention
C) Culture-specific intravenous antibiotics and surgical irrigation with graft removal
D) Culture-specific intravenous antibiotics, surgical irrigation with graft removal, and immediate revision reconstruction
E) Culture-specific intravenous antibiotics, surgical irrigation with graft removal, and delayed revision reconstruction

 

59. Patellar tendinitis is associated with:

A) Pain at the insertion of the patellar tendon on the tibia
B) Pain at the insertion of the patellar tendon on the patella
C) Lateral knee pain during downhill running
D) Locking and popping of the knee during activity
E) “Giving way” of the knee during activity

 

58. Which of the following anatomic landmarks of the knee represents the contact area between the lateral femoral condyle and the anterior horn of the lateral meniscus when the knee is in full extension:

A) Outerbridge’s ridge
B) Blumensatt’s line
C) Notch of Grant
D) David’s point
E) Sulcus terminalis

 

57. In a congruent patellofemoral joint, the patella centers within the trochlear groove by what degree of flexion:

A) 5° to 10°
B) 10° to 15°
C) 15° to 20°
D) 20° to 25°
E) 25° to 30°

 

56. A magnetic resonance image (MRI) of the left hip of a 26-year-old female triathlete with progressive pain is shown . Recommended initial management includes:

A) Percutaneous fixation with cannulated screws
B) Resumption of activities as tolerated
C) Incisional biopsy
D) Fixation with a dynamic hip screw
E) A period of nonweight bearing with further workup including nutritional and menstrual history

 

55. The magnetic resonance image in this distance runner reveals:

A) Iliopsoas tendinitis
B) Hip flexor injury
C) Pelvic stress fracture
D) Femoral neck stress fracture
E) Subtrochanteric stress fracture

 

54. Which of the following represents the most common scenario of injury resulting in athletic pubalgia:

A) Repetitive hyperextension of the trunk in association with hyperabduction of the thigh pivoting on the anterior pelvis and pubic symphysis in a female athlete
B) Repetitive hyperextension of the trunk in association with hyperabduction of the thigh pivoting on the anterior pelvis and pubic symphysis in a male athlete
C) A single forced hyperextension of the trunk in association with hyperabduction of the thigh pivoting on the anterior pelvis and pubic symphysis in a female athlete
D) A single forced hyperextension of the trunk in association with hyperabduction of the thigh pivoting on the anterior pelvis and pubic symphysis in a male athlete
E) A single forced hyperflexion of the trunk in association with hyperabduction of the thigh pivoting on the anterior pelvis and pubic symphysis in a male athlete

 

53. What is the name of the sign elicited with the test for piriformis syndrome:

A) Wilson’s sign
B) McMurray’s sign
C) Pellegrini-Stieda sign
D) Hoffman’s sign
E) Pace’s sign

 

52. Where is the primary pathology site for athletic pubalgia?

A) Sartorius origin
B) Rectus abdominus origin
C) Rectus abdominus insertion
D) Inguinal canal
E) Ischial tuberosity

 

51. Which of the following is the main advantage of an all-inside meniscus repair compared to an inside-out repair:

A) Cheaper implants
B) Biomechanically superior repair
C) Ease of use, less operative time, and no incision
D) Fewer implant complications
E) Better long-term results

 

50. Which of the following structures is most commonly injured in conjunction with a posterior cruciate ligament rupture?

A) Anterior cruciate ligament
B) Posterolateral corner
C) Medial collateral ligament
D) Lateral meniscus
E) Patellar tendon

 

49. Which of the following structures is the major stabilizer of the knee to valgus stress at 30°:

A) Posterior oblique ligament
B) Deep medial collateral ligament
C) Superficial medial collateral ligament
D) Medial meniscus
E) Anterior cruciate ligament

 

48. Meniscus repair is most successful for tears in which of the following zones:

A) Red-blue zone
B) Red-red zone
C) Red-white zone
D) White-white zone
E) White-red zone

 

47. A magnetic resonance image of a 15-year-old female volleyball player who twisted her knee is shown . 

Despite 6 weeks of rehabilitation, she has been unable to return to volleyball without having her knee give out. 

What is the most appropriate treatment?

A) Anterior cruciate ligament reconstruction
B) Posterior cruciate ligament reconstruction
C) Continued physical therapy
D) Use of a knee brace
E) Medial patellofemoral ligament reconstruction

 

46. The recommended treatment for patients with chronic exertional compartment syndrome is:

A) Stretching and strengthening program
B) Activity modification
C) Fasciotomy
D) Ultrasound
E) Steroid injections to reduce muscle swelling

 

45. The differential diagnosis for chronic exertional compartment syndrome includes all of the following except:

A) Tibial stress fracture
B) Medial tibial periostalgia
C) Popliteal artery entrapment
D) Fascial herniations
E) Femoral neck stress fracture

 

44. The healing rate of meniscal repairs in association with acute anterior cruciate ligament (ACL) reconstruction
is_______ that reported for isolated meniscal repairs:

A) Higher than
B) Lower than
C) Equal to
D) Meniscal repairs are not recommended in this situation
E) Unknown

 

43. Which of the following positions of knee flexion produces the greatest strain in the anterior cruciate ligament with anterior loading of the tibia:

A) 30° (Lachman test)
B) 45°
C) 55°
D) 75°
E) 90° (anterior drawer test)

 

42. Which of the following is not consistent with a complete rupture of the Achilles tendon:

A) A palpable defect 3 cm to 4 cm proximal to the Achilles insertion
B) Ability to plantarflex the foot against gravity
C) Sensation of being kicked in the calf
D) Plantarflexion of the foot with the Thompson test
E) No previous symptoms of Achilles related pain

 

41. Patients with symptomatic chronic proximal hamstring ruptures typically complain of:

A) Anterior thigh cramping with running
B) Difficulty decelerating the leg during running
C) Difficulty ascending stairs
D) Difficulty descending stairs
E) Difficulty accelerating the leg during running

 

40. The following radiographs are of a 19-year-old female distance runner who complained of pain in her
right distal tibia. She reports having shin splints 2 years earlier that affected her right proximal tibia. She has been
unable to run secondary to symptoms for 3 weeks. She reports being amenorrheic for approximately the last 3
years. 

Bilateral distal tibial stress fractures in a military recruit | BMJ Case Reports

Which of the following should be included in her initial treatment regimen:

A) Treatment with nonsteroidal anti-inflammatory medications
B) Localized steroid injection
C) Intramedullary nailing with bone grafting
D) Continuation of current training regimen
E) Initiation of hormone replacement therapy

 

39. After high velocity knee dislocations, there is serious injury to the popliteal vessels in approximately what
percentage of patients:

A) 5%
B) 10%
C) 30%
D) 75%
E) More than 90%

 

38. Sectioning the posterolateral structures and posterior cruciate ligament results in:

A) Increased posterior tibial translation at 30°
B) Increased posterior tibial translation at 90
C) Increased posterior tibial translation at 30° and 90°
D) No increase in tibial translation
E) Increased anterior tibial translation at 30° and 90° 

 

37. The following structures are found in the superficial layer of the posterolateral corner:

A) The biceps tendon and fabellofibular ligament
B) The patellofemoral ligaments and quadriceps retinaculum
C) The iliotibial tract and biceps tendon
D) The joint capsule and fabellofibular ligament
E) The popliteofibular ligament and biceps tendon

 

36. The most common physical finding in patients with athletic pubalgia is:

A) Tenderness over the pubic tubercle
B) Inguinal hernia
C) Tenderness to palpation of the adductor longus
D) Pain with resisted hip adduction
E) Pain with resisted sit-ups

 

35. The initial management of athletic pubalgia consists of:

A) Modified Bassini hernia repair
B) Adductor release
C) Hip arthroscopy
D) Core trunk stabilization and rest
E) Laparoscopic hernia repair

 

34. The reason a patient with an acute rupture of the anterior cruciate ligament will usually have a hemarthrosis is due to disruption of what main blood supply to the ligament:

A) Lateral superior geniculate artery
B) Medial superior geniculate artery
C) Middle geniculate artery
D) Medial inferior geniculate artery
E) Lateral inferior geniculate artery

 

33. All of the following factors have a significant influence on the long-term anteroposterior (AP) laxity of the knee
following anterior cruciate ligament (ACL) reconstruction except:

A) Integrity of the medial meniscus
B) Graft tunnel placement
C) Graft tissue selection
D) Timing of surgery following injury
E) Graft elongation behavior at the time of reconstruction

 

32. During arthroscopic repair of a medial meniscal tear, the following structure is at greatest risk for damage:

A) Popliteal artery
B) Popliteal vein
C) Saphenous nerve
D) Sural nerve
E) Popliteus tendon

 

31. When performing elbow arthroscopy, the arthroscopic portal that must be established first is the:

A) Anteromedial portal
B) Anterolateral portal
C) Lateral portal
D) Posterolateral portal
E) Posterior portal

 

30. A 30-year-old male avid runner presents with a 2-week history of right lateral knee pain. He denies any history of trauma, swelling, or mechanical symptoms. The pain only occurs with running and is relieved by cessation of
activity. 

Physical examination does not demonstrate any effusion, and there is no pathologic laxity of the collateral
or cruciate ligaments. There is tenderness to palpation along the lateral aspect of the knee that is most severe over
the lateral epicondyle, particularly with the knee flexed to 30°. 

The next most appropriate course of action is:

A) Obtain an magnetic resonance image
B) Steroid injection to the right knee
C) Arthroscopic debridement of the right lateral meniscus
D) Arthroscopic repair of the right lateral meniscus
E) Stretching of the right iliotibial band, temporary decrease in mileage, and anti-inflammatory medication

 

29. Which of the following statements concerning allograft use in anterior cruciate ligament (ACL) reconstruction is
incorrect:

A) Allograft sterilization using gamma irradiation has not been shown to adversely affect its tensile properties.
B) Allograft use avoids donor site morbidity.
C) Allograft use diminishes postoperative pain.
D) Allograft use decreases surgical time.
E) Allograft incorporation is slower than autograft.

 

28. A 24-year-old cross-country runner complains of anterior knee pain after running. 

Palpation reveals point tenderness at the inferior pole of the patella. Range of motion is full and exam demonstrates no patellofemoral crepitus. 

Management should include:

A) Cortisone injection into the site of tenderness
B) Use of a knee immobilizer for 6 weeks
C) Nonsteroidal anti-inflammatory medication and quadriceps stretching exercises
D) Arthroscopic lateral release
E) Open patellar tendon debridement

 

27. All of the disorders listed below are examples of osteochondrosis except:

A) Legg-Calvé-Perthes disease
B) Scheuermann’s disease 
C) Osgood Schlatter disorder 
D) Gorham’s disease
E) Blount disease

 

26. What is the histological difference between avascular necrosis of the femoral head in children versus adults ?

A) Children have less creeping substitution than adults
B) Children do not demonstrate osseous collapse. 
C) Large areas of fibrovascular tissue do not form in children. 
D) There is no osteoclastic resorption in children. 
E) Children do not have any residual changes after 2 years. 

 

25. The result of treatment of developmental dysplasia of the hip with Salter osteotomy is is worse with which of the following:

A) A higher degree of the dislocation before treatment (Tonnis grade)
B) Bilaterality 
C) Higher preoperative acetabular index
D) Increased age at surgery 
E) Performing open reduction at a separate surgery than the osteotomy

 

24. Which of the following is an appropriate position for arthrodesis of the hip :

A) Flexion of 45°
B) Abduction of 15° if there is shortening
C) Adduction of 0°
D) External rotation of 25° 
E) Shortening of at least 3 cm

 

23. Osteochondral defects occur bilaterally in the distal femur in approximately:

A) 10% to 20% of patients. 
B) 20% to 30% of patients. 
C) 30% to 40% of patients.
D) 60% to 70% of patients. 

 

22. A patient underwent bone-patellar-bone anterior cruciate ligament reconstruction. Postoperative radiographs show the femoral tunnel has been placed too far anteriorly. 

What is the most likely clinical result of anterior placement of the femoral tunnel?

A) Limited extension
B) Anterior instability
C) Anterior knee pain
D) Limited flexion
E) Posterior instability

 

21. In the setting of chronic anterior cruciate ligament (ACL) deficiency .

which of the following meniscal tear patterns is most common:

A) Peripheral posterior horn tears of the medial meniscus
B) Peripheral posterior horn tears of the lateral meniscus
C) Peripheral anterior horn tears of the medial meniscus
D) Peripheral anterior horn tears of the lateral meniscus
E) Central posterior horn tears of the medial meniscus

 

20. After landing awkwardly on his flexed knee, a 22-year-old basketball player has immediate onset of pain and difficulty bearing weight. 

With the knee flexed 30°, examination reveals increased varus, external rotation, and posterior translation which decreases when the knee is flexed to 90°. 

The patient most likely has injured what structures:

A) Posterolateral complex
B) Posterolateral complex and posterior cruciate ligament
C) Posterior cruciate ligament
D) Lateral collateral ligament
E) Posterior cruciate ligament and medial collateral ligament

 

19. Which tear pattern is most responsive to meniscus repair:

A) Radial
B) Complex
C) Parrot beak
D) Longitudinal
E) Horizontal Cleavage

 

18. Which of the following most accurately describes the location of the tibial attachment of the posterior cruciate ligament:

A) At the level of the tibial plateau
B) 0 mm to 5 mm inferior to the level of the tibial plateau
C) 5 mm to 10 mm inferior to the level of the tibial plateau
D) 10 mm to 15 mm inferior to the level of the tibial plateau
E) 15 mm to 20 mm inferior to the level of the tibial plateau

 

17. All of the following are either primary or secondary stabilizers of the knee to posterior translation except:

A) Posterior cruciate ligament 
B) Anterior cruciate ligament 
C) Medial collateral ligament 
D) Lateral collateral ligament 
E) Posterolateral corner 

 

16. Placing a highly tensioned soft tissue graft across the open femoral physis during anterior cruciate ligament reconstruction results in which of the following outcomes

A) Premature closure of the physis 
B) No growth disturbance 
C) Development of femoral varus 
D) Development of femoral valgus 
E) Femoral overgrowth 

 

15. Which of the following findings has not been reported following abrasion arthroplasty as treatment for the painful, arthritic knee:

A) An increase of the medial joint space on radiograph 
B) Intermediate or long-term symptomatic improvement in the majority of patients 
C) Formation of a fibrocartilage articular surface 
D) Formation of primarily type I collagen 
E) Worsening of symptoms in 10% to 20% of patients 

 

14. In which of the following anatomic locations have authors described a characteristic osteochondral lesion that occurs with an acute anterior cruciate ligament (ACL) injury:

A) Posterolateral aspect of the tibia and the anterolateral aspect of the lateral femoral condyle 
B) Posterolateral aspect of the tibia and the posterolateral aspect of the lateral femoral condyle 
C) Lateral patellar facet and lateral trochlear groove 
D) Anterolateral aspect of the tibia and the posterolateral aspect of the lateral femoral condyle 
E) Posteromedial aspect of the tibia and the anteromedial aspect of the lateral femoral condyle 

 

13. Which of the following processes may produce cystic bone erosions in the cortex on both sides of a joint:

A) Septic Arthritis
B) Synovial chondormatosis
C) Pigmented villonodular synovitis 
D) Ochronosis
E) Hemochromatosis

 

12. A 40y old man has had hip pain with increased activity over the past year. 

Examination reveals restriction of motion and tenderness with combined hip flexion, adduction, and internal rotation. An AP radiograph is shown in the figure attached. 

What is the most likely diagnosis?

A) Developmental dysplasia of the hip
B) Osteonecrosis
C) Pseudogout
D) Femoral acetabular impingement                                                                                                                                                                                              E) Perthes disease                                                

 

11. Bleeding is encountered while developing the internervous plane between the tensor fascia lata and the sartorius during the anterior approach to the hip. 

The most likely cause is injury to what artery?

A) Ascending branch of the lateral femoral circumf ex
B) Superior gluteal
C) Femoral
D) Profunda femoris
E) Medial femoral circumfl ex

 

10. Which of the following images is best for detecting anterior acetabular deficiency in the dysplastic hip?

A) Pelvic inlet
B) Judet
C) AP pelvis
D) False profile
E) Frog lateral

 

9. At the level of tibial bone resection in TKA, where does the common peroneal nerve lie?

A) Deep to the arcuate ligament
B) Closer to bone in larger legs
C) On the muscle belly of the popliteus
D) On the bony posterolateral corner of the tibia
E) Superficial to the lateral head of the gastrocnemius

 

8. What complication is more likely following excessive medial retraction of the anterior  structures during the anterolateral (Watson-Jones) approach to the hip?

A) Numbness over the anterolateral thigh
B) Ischemia to the leg
C) Quadriceps weakness
D) Abductor insufficiency
E) Foot drop

 

7. Trenderburg’ s sign can be elicited in all of the following except :

Trendelenburg test or sign | Epomedicine
A) Congenital dislocation of the hip.
B) Infantile paralysis of the gluteal muscles.
C) Coxa vara.
D) Tuberculous arthritis of the hip joint.
E) Non-united fracture of the femoral neck.

 

6.  A football player fell on his flexed knee with the foot in plantar flexion. 

On examination, he has a positive quadriceps active test.

Which knee ligament in most likely injured in this patient?

Quadriceps Active Test

 A) Anterior cruciate ligament (ACL)
B) Posterior cruciate ligament (PCL)
C) Lateral collateral ligament (LCL)
D) Medial collateral ligament (MCL)
E) Posterolateral corner complex (PLC)

 

5.  The posterior approach to the acetabulum and hip provides good exposure for fixing for hip fractures and hip arthroplasty. 

Where is the sciatic nerve likely to be found?

A) Under the piriformis muscle
B) Above the piriformis muscle
C) Under the quadratus femoris
D) Underneath the gluteus minimus
E) Exits through the obturator foramen

 

4.  A  69 years old man presented with ipsilateral hip and knee pain. 

On examination, he has painful and restricted movement of the hip, but knee movements were complete and painless.

Radiographes of the hip and knee show severe degenerative arthritis of the hip and mild arthritis of the knee. 

Which nerve is responsible for this patient’s referred pain from hip to knee?

 A) The femoral nerve
B) The sciatic nerve
C) The lateral femoral cutaneous nerve
D) The saphenous nerve
E) The obturator nerve 

 

3.  A 28 years old man was involved in a motorbike road traffic accident sustaining head injury resulting in a coma and hip fracture. 

Indomethacin is indicated here to prevent which complication?

A) Non union
B) Infection
C) Vascular compromise
D) Pressure ulcers
E) Heterotopic ossification 

 

2.  25 years old rugby player sustained posterior hip dislocation when several players landed on his back with the hip flexed to 90 degrees, resulting in posterior hip dislocation. 

Hip Dislocation – Core EM

What is the most common complication of hip dislocation?

A) Posttraumatic arthritis
B) Avascular necrosis
C) Sciatic nerve injury
D) Recurrent dislocation
E) Femoral artery occlusion


1.  A 14 years old boy attended the orthopaedic clinic with a swollen painful knee and inability to weight bear. 

What is the most common cause of recurrent haemoarthrosis ?

A) Minor trauma
B) Septic Arthritis
C) Haemophilic arthropathy
D) Osteoarthritis
E) Inflammatory arthritis

Test your knowledge , learn more and get ready for your orthopaedic exam

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1 thought on “Lower Limb Pathology”

  1. Very well written post. It will be valuable to anybody who employess it, as well as yours truly :). Keep up the good work – canr wait to read more posts.

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