APMLE Part 2 Boards II Pages 11-20 Questions With
Complete Solutions
12 y/o male who plays soccer and is suffering from heel pain.
Identify the condition? Most common in boys 10-11 with a
cavus foot type who presents with complaints of pain in the heel
especially after rigorous activity. Squeezing the medial/lateral
epiphyseal margins of the calcaneus exacerbates pain. Correct
Answers Calcaneual Apophysitis (Sever's disease)
68-year-old woman with fainting? Correct Answers a. Mitral
stenosis
7 lag screw fails and you want to put 3.5, what do you do?
Correct Answers a. Over drill 3.5 and thread 3.5
A dorsiflexed first ray leads to? Correct Answers Decreased
MPJ dorsiflexion
A met Primus Elevatus leads to? Correct Answers a. Decreases
dorsiflexion
b. Hallux limitus
A nerve trunk tenderness above and below the point of
compression, with paresthesias proximal and distal to the point
of percussion? Correct Answers Valleix Phenomena
A patient has an isolated ATFL chronic rupture, what procedure
do you do? Correct Answers Evans or Nilsonne
,A tingling in region of distribution of the involved nerve with
light percussion, results in the paresthesias distal to the site of
percussion? Correct Answers Hoffman Tinel's sign
Ages of Frequency of Tarsal Coalitions
a. Calcaneonavicular Coalition (C-N bar)? Correct Answers 8-
12 yo.
i. Most symptomatic
ii. MO view to evaluate "comma sign" -> protrusion of
calcaneus toward navicular
iii. Anteater nose sign
iv. Excision of coalition with interposition of EDB
1. Later curvilinear or Ollier type of incision is made over sinus
tarsi
2. EDB origin reflected off calcaneus, retracted distally and gain
access to underlying calcaneal navicular
bar
3. Must preserve the TN and CC joint ligaments
4. In calcaneaonavicular 1A (Tachdjian's classification)à
resection arthroplasty is procedure of choice
Ages of Frequency of Tarsal Coalitions
a. Talocalcaneal (STJ coalition)? Correct Answers 12-16 yo
MOST COMMON
i. Intra-articular coalitions traditionally considered indication for
fusion
Ages of Frequency of Tarsal Coalitions
a. Talonavicular Coalition (T-N)? Correct Answers 3-5 yo -->
3rd most common
i. Intra-articular coalition
,ii. Asymptomatic; if symptomatic, resection then fusion, as well
as fusion of TC and CC joints recommended
An entrapment or compression neuropathy within the tarsal
tunnel beneath the flexor retinaculum (laciniate ligament). Pins-
andneedles,
numbness, burning, or shooting pains over the entire plantar
foot. Symptoms exacerbated by prolonged weight bearing,
walking or running and forced eversion. Correct Answers
Tarsal tunnel syndrome
Angle between Hallux proximal and distal phalanx? Correct
Answers HIA - Hallux abductus interphalangeus angle
i. Normal angle = 10
ii. Procedure of choice: Distal Akin
Angle between the 1st metatarsal and the proximal phalanx?
Correct Answers a. Hallux Abductus angle (HA)
i. Normal = 0-15
Angle between the first metatarsal and 2nd metatarsal. Normally
measuring 8-12 degrees? Correct Answers a. Intermetatarsal
angle
i. IM > 16 =base wedge osteotomy
Angle formed b/w bisection of medial cuneiform and 2nd
metatarsal shaft; it is another measurement of metatarsus
adductus (MA)? Correct Answers a. Engles angle (normal
value: 24)
, Arthritic "beaking" secondary to middle facet coalition? What is
indicated? Correct Answers a. Calcaneocuboid coalition: intra-
articular
b. Double arthrodesis of TN and TC joint may be indicated
Bone looks Smokey lesion? Correct Answers a. IM infart
i. The most common time for MI post-op is on day 3
ii. Should wait 6 months before considering elective surgery
post MI
Bone scan is positive for ________ and negative for _______
non-union. Correct Answers Hypertrophic; atrophic (avascular)
Borders of the tarsal tunel? Correct Answers 1. Flexor
retinaculum (laciniate ligament) - medially and posteriorly
a. Extends from the medial malleolus to the medial process of
the calcaneal tuberosity and the
plantar aponeurosis
2. Calcaneus and posterior aspect of talus - laterally
3. Distal tibia and medial malleolus - anteriorly
Boutonniere deformities? Correct Answers a. extended DIPJ
and flexed PIPJ
b. Found in RA
Child with IM of 20 and hypermobile first ray? Correct Answers
a. Metatarsal-cuneiform metatarsal fusion (Lapidus)
Clostridium (anaerobic) Correct Answers a. Perfringes: gas
gangrene, liquefaction necrosis, and hemolysis from alpha
toxins
Complete Solutions
12 y/o male who plays soccer and is suffering from heel pain.
Identify the condition? Most common in boys 10-11 with a
cavus foot type who presents with complaints of pain in the heel
especially after rigorous activity. Squeezing the medial/lateral
epiphyseal margins of the calcaneus exacerbates pain. Correct
Answers Calcaneual Apophysitis (Sever's disease)
68-year-old woman with fainting? Correct Answers a. Mitral
stenosis
7 lag screw fails and you want to put 3.5, what do you do?
Correct Answers a. Over drill 3.5 and thread 3.5
A dorsiflexed first ray leads to? Correct Answers Decreased
MPJ dorsiflexion
A met Primus Elevatus leads to? Correct Answers a. Decreases
dorsiflexion
b. Hallux limitus
A nerve trunk tenderness above and below the point of
compression, with paresthesias proximal and distal to the point
of percussion? Correct Answers Valleix Phenomena
A patient has an isolated ATFL chronic rupture, what procedure
do you do? Correct Answers Evans or Nilsonne
,A tingling in region of distribution of the involved nerve with
light percussion, results in the paresthesias distal to the site of
percussion? Correct Answers Hoffman Tinel's sign
Ages of Frequency of Tarsal Coalitions
a. Calcaneonavicular Coalition (C-N bar)? Correct Answers 8-
12 yo.
i. Most symptomatic
ii. MO view to evaluate "comma sign" -> protrusion of
calcaneus toward navicular
iii. Anteater nose sign
iv. Excision of coalition with interposition of EDB
1. Later curvilinear or Ollier type of incision is made over sinus
tarsi
2. EDB origin reflected off calcaneus, retracted distally and gain
access to underlying calcaneal navicular
bar
3. Must preserve the TN and CC joint ligaments
4. In calcaneaonavicular 1A (Tachdjian's classification)à
resection arthroplasty is procedure of choice
Ages of Frequency of Tarsal Coalitions
a. Talocalcaneal (STJ coalition)? Correct Answers 12-16 yo
MOST COMMON
i. Intra-articular coalitions traditionally considered indication for
fusion
Ages of Frequency of Tarsal Coalitions
a. Talonavicular Coalition (T-N)? Correct Answers 3-5 yo -->
3rd most common
i. Intra-articular coalition
,ii. Asymptomatic; if symptomatic, resection then fusion, as well
as fusion of TC and CC joints recommended
An entrapment or compression neuropathy within the tarsal
tunnel beneath the flexor retinaculum (laciniate ligament). Pins-
andneedles,
numbness, burning, or shooting pains over the entire plantar
foot. Symptoms exacerbated by prolonged weight bearing,
walking or running and forced eversion. Correct Answers
Tarsal tunnel syndrome
Angle between Hallux proximal and distal phalanx? Correct
Answers HIA - Hallux abductus interphalangeus angle
i. Normal angle = 10
ii. Procedure of choice: Distal Akin
Angle between the 1st metatarsal and the proximal phalanx?
Correct Answers a. Hallux Abductus angle (HA)
i. Normal = 0-15
Angle between the first metatarsal and 2nd metatarsal. Normally
measuring 8-12 degrees? Correct Answers a. Intermetatarsal
angle
i. IM > 16 =base wedge osteotomy
Angle formed b/w bisection of medial cuneiform and 2nd
metatarsal shaft; it is another measurement of metatarsus
adductus (MA)? Correct Answers a. Engles angle (normal
value: 24)
, Arthritic "beaking" secondary to middle facet coalition? What is
indicated? Correct Answers a. Calcaneocuboid coalition: intra-
articular
b. Double arthrodesis of TN and TC joint may be indicated
Bone looks Smokey lesion? Correct Answers a. IM infart
i. The most common time for MI post-op is on day 3
ii. Should wait 6 months before considering elective surgery
post MI
Bone scan is positive for ________ and negative for _______
non-union. Correct Answers Hypertrophic; atrophic (avascular)
Borders of the tarsal tunel? Correct Answers 1. Flexor
retinaculum (laciniate ligament) - medially and posteriorly
a. Extends from the medial malleolus to the medial process of
the calcaneal tuberosity and the
plantar aponeurosis
2. Calcaneus and posterior aspect of talus - laterally
3. Distal tibia and medial malleolus - anteriorly
Boutonniere deformities? Correct Answers a. extended DIPJ
and flexed PIPJ
b. Found in RA
Child with IM of 20 and hypermobile first ray? Correct Answers
a. Metatarsal-cuneiform metatarsal fusion (Lapidus)
Clostridium (anaerobic) Correct Answers a. Perfringes: gas
gangrene, liquefaction necrosis, and hemolysis from alpha
toxins
