ABFAS REVIEW EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 ABFAS REVIEW EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ 18 y/o gymnast substance acute inversion ankle injury and ruptures her lateral collateral ligaments (a)NWB 6 weeks, ankle Brace (b)Ankle bracing followed by aggressive PT 12 weeks (c)Early functional rehab program (d)NWB x8 weeks followed by PT Correct Answer: (c) Early functional rehab program Patient is a 45 y/o male performing a triple arthrodesis he has 6 degrees of tibial varum what is the appropriate position for the calcaneus to the tibia to be in this position? (a)4 Degrees Everted (b)6 Degrees Everted (c)8 Degrees Everted (d)10 Degrees Everted Correct Answer: (c)8 Degrees Everted 2 Performing a triple arthrodesis if you translate the talus anteriorly on the calcaneus what would be the effect? (a)Anterior talus will plantarflex the forefoot increase the arch height (b)Anterior talus will dorsiflex the forefoot and increase arch height (c)Anterior talus will plantarflex the forefoot and decrease arch height (d)Anterior talus will dorsiflex the forefoot and decrease the arch height Correct Answer: (a)Anterior talus will plantarflex the forefoot increase the arch height You are performing a pantalar arthrodesis. The patient is a smoker and you are concerned about a nonunion. Which joint has the highest risk of nonunion? (A)CCJ (B)TNJ (C)Ankle (D)STJ Correct Answer: (C)Ankle You are performing a triple arthrodesis which joint would you prep last and fixate first? (A)TNJ (B)CCJ (C)STJ (D)Ankle Correct Answer: (C)STJ 3 You are performing a lateral subtalar arthrodesis, which structure do you incise in order to access the joint? (A) ATFL (B) CFL (C) PTFL (D) Bifurcate ligament Correct Answer: (B) CFL You are performing a STJ arthrodesis what is the hardest deformity to fix (A) Varus (B) Valgus (C) Sagittal Plane (D) Transverse plane Correct Answer: (A) Varus You are performing an ankle arthrodesis on a patient you make a mistake with positioning of the arthrodesis, which position would be best to have the foot in? (A)5 Degrees Plantarflexed (B)5 Degrees Dorsiflexed (C)5 mm Anteriorly Offset (D)6 degrees of valgus Correct Answer: (B)5 Degrees Dorsiflexed 4 You are with a certain attending who fuses the ankle in a plantarflexed position, what would be the complication with this positioning? (A) Shoulder drop on the affected side (B) Supination of the affected extremity (C) Pronation of the contralateral extremity (D) Vaulting gait Correct Answer: (D) Vaulting gait What would be a contraindication to Arthroscopic ankle arthrodesis? (A)Severe Inflammatory Arthritis (B)Endstage arthritis with extensive osteophytes (C)BMI 35 (D)15 degrees of ankle varus Correct Answer: (D)15 degrees of ankle varus Also 5 degrees of varus. 10 degrees varus/valgus for TAR contraindication You are performing a triple arthrodesis. You put the patient in varus by accident. What would be the most common complication ? (A) Ankle Arthritis (B) Lateral Column Pain (C) Lateral ankle instability (D) Plantar Fasciitis 5 Correct Answer: (B) Lateral Column Pain Patient has a calcaneal fracture with a massive lateral wall blowout. What is the most common complication for a poor reduction? (A)Nonunion (B)Lateral Column Instability (C)Peroneal Tendonitis (D)Sural Neuritis Correct Answer: (C)Peroneal Tendonitis Patient has a 4 cm rupture of the achilles tendon you repair the rupture what is the most common complication? (A)Re-rupture (B)Infection (C)Weakness (D)Dehiscence Correct Answer: (D)Dehiscence You are doing a medial subtalar joint dissection approach. Which structure do you not incise? (A)Superficial Deltoid (B)Deep Deltoid (C)Posterior Tibialis 6 (D)Interosseous Ligament Correct Answer: (B)Deep Deltoid You wish to block factor II which medication does this? (A)Pradaxa (B)Eliquis (C)Brilinta (D)Plavix Correct Answer: (A)Pradaxa In performing a posteromedial release for a congenital clubfoot deformity, what is the most important joint to release to prevent recurrence of the deformity? •A. ankle. •B. subtalar. •C. talonavicular. •D. calcaneocuboid. Correct Answer: C. talonavicular For a severe rigid and painful talipes equinovarus in an adult, what primary surgical approach is contraindicated? (note negative format) •A. soft-tissue release and tendon transfer. •B. talectomy and foot-to-leg arthrodesis. •C. tarsal osteotomies. 7 •D. triple arthrodesis. Correct Answer: A. soft-tissue release and tendon transfer In a six-month-old child, aggressive casting for the equinus component of a clubfoot deformity may result in which of the following conditions? •A. dislocation of the ankle. •B. subluxation of the midtarsal joint. •C. compression of the subtalar joint. •D. rupture of posterior talotibialligament. Correct Answer: B. subluxation of the midtarsal joint For a one-year-old patient with calcaneal valgus, what is an acceptable treatment plan? •A. manipulation only. •B. manipulation with serial casting. •C. soft-tissue release. •D. arthroereisis. •E. triple arthrodesis at skeletal maturity. Correct Answer: B. manipulation with serial casting For Talipes equinovarus select a statement that is true: (a)TC angle < 15 , Talo1stmet angle <15 (b)TC angle > 15, Talo1stmet angle <15 (c)TC angle <15, Talo1stmet angle >15 8 (d)TC angle >15, Talo1stmet angle >15 Correct Answer: (c)TC angle <15, Talo 1st met angle >15 For ponsetti method what surgical procedure is done last? (a)Medial release (b)TN Release (c)Achilles Tenotomy (d)PT release Correct Answer: (c)Achilles Tenotomy What structure is NOT released on a soft tissue release procedure for clubfoot? (a)Knot of Henry (b)Spring Ligament (c)CFL (d)PTFL (e)Deep Deltoid Ligament (f)Posterior tibial tendon Correct Answer: (e)Deep Deltoid Ligament When is the best time to do clubfoot soft tissue release surgery? (a) 0-1 year (b) 1-2 year (c) 3-4 year 9 (d) 5-6 year Correct Answer: (b) 1-2 year Which benign soft-tissue lesion may be invasive into bone? •A. synovioma. •B. histiocytoma. •C. villonodular synovitis. •D. neurilemmoma. Correct Answer: C. villonodular synovitis On a peripheral blood smear stained with hematoxylin and eosin, the presence of "rosettes" (clusters of polynuclear leukocytes surrounding an extracellular hematoxylin body) most likely indicates which of the following systemic disorders? •A. rheumatoid arthritis. •B. lupus erythematosus. •C. hematogenous infection. •D. thrombocytopenic purpura. Correct Answer: B. lupus erythematosus A 31-year-old female presents with a complaint of pain of the dorsal distal aspect of the hallux. Radiographs reveal a radiolucent area at the distal phalanx with surrounding sclerosis. There is no sign of infection, no sinus tract, and no edema. What is the clinical diagnosis? 10 •A. subungual exostosis. •B. enchondroma. •C. osteoid osteoma. •D. osteochondroma. •E. aneurysmal bone cyst. Correct Answer: B. enchondroma What type of tumor is pictured here (well demarcated radiolucent lesion in the epiphysis of proximal tibia)? •A. subungual exostosis. •B. enchondroma. •C. osteoid osteoma. •D. osteochondroma. •E. aneurysmal bone cyst •F. Chondroblastoma •G. Non ossifying Fibroma •H. Fibrous Dysplasia Correct Answer: F. Chondroblastoma Based on the MRI image (large decreased signal density around ankle) the patient has had a growing soft tissue mass for 3 years the imaging is shown what is the diagnosis? (a)PVNS (b)Schwannoma 11 (c)Rhadbdomyosarcoma (d)Histiocytoma (e)Giant Cell tumor Correct Answer: (a)PVNS Based on the MRI image (bubbly on MRI, large radiolucency on xray) the patient has had a growing soft tissue mass for 2 years the imaging is shown what is the diagnosis? (a)PVNS (b)Schwannoma (c)Rhadbdomyosarcoma (d)Histiocytoma (e)Giant Cell tumor Correct Answer: (e)Giant Cell tumor 6-month patient pain for the proximal fibula (a)Osteochondroma (b)Fibrous Dysplasia (c)Non ossifying fibroma (d)Osteosarcoma (e)Ewing Sarcoma (f)Giant Cell tumor Correct Answer: (e)Ewing Sarcoma 12 Based on the image (middle phalanx well demarcated radiolucency with thin cortex) what is the diagnosis? (a)Chondroblastoma (b)Osteoid Osteoma (c)Non ossifying fibroma (d)Enchondroma (e)PVNS (f)Giant Cell tumor Correct Answer: (d)Enchondroma New patient palpable foot mass with nonhealing ulceration. What type of biopsy would you do for this? (a)Punch Biopsy (b)Excisional Biopsy (c)MOHS (d)Radical Resection Correct Answer: (a)Punch Biopsy You perform an opening base wedge osteotomy what would be a common the most common complication below? (a) Hallux varus (b) Sesamoiditis (c) Hallux Limitus 13 (d) Metatarsalgia transfer lesions (e) Nonunion Correct Answer: (c) Hallux Limitus You are performing a closing base wedge osteotomy. If the superior pole of axis manipulated laterally what effect is created for the dorsomedial hinge? (a)Dorsiflexion of the first ray (b)Plantarflexion of the first ray Correct Answer: (b)Plantarflexion of the first ray How should you align the axis guide for a closing base wedge osteotomy? (a)Perpendicular to the axis of the metatarsal (b)Perpendicular to the weight bearing surface (c)Perpendicular to the frontal plane (d)Perpendicular to the midfoot Correct Answer: (b)Perpendicular to the weight bearing surface Axis guide for a distal first metatarsal osteotomy if you deviate the lateral pole proximal and plantar how does it affect the capital fragment? (a)Lengthening plantarflexion (b)Shortening and dorsiflexion (c)Lengthening and dorsiflexion (d)Shortening and plantarflexion 14 Correct Answer: (d)Shortening and plantarflexion What type of patient is this fixation used for (fibular plate with 3 quadricortical syndesmotic screws and posterior fixation)? •A. Comminuted fracture •B. Syndesmotic Instability •C. Osteoporosis •D. Neuropathy Correct Answer: D. Neuropathy You are performing a syndesmotic repair which test has the least false positive/negatives? A.External rotation test B.Gravity Stress Test C.Cotton Hook Test D.Stress inversion/Eversion E.Medial/Lateral Malleolar Squeeze Test Correct Answer: C. Cotton Hook Test You see the fracture what would be the first step for reduction (Weber C)? A.Pronation External rotation B.Supination External Rotation C.Pronation Abduction 15 D.Supination Adduction Correct Answer: Which of the following is true about the pathology pictured here on the patient s/p high energy ankle fracture (fracture blisters). A.Increased interstitial pressure of fluids B.Decreased healing of bone C.Hemorrhagic type is indicative of less severity D.Indication for emergent surgery E.Requires debridement Correct Answer: A.Increased interstitial pressure of fluids Patient is s/p calcaneal fracture patient does not follow up for 2 weeks and they present to your office with this dehiscence of their surgical site -plate is exposed no purulence n/v status intact, what is the most appropriate next treatment step? a.Removal of plate antibiotic spacer application IV antibiotics b.PICC line IV abxwoundcare c.Admission debridement leave, plate in IV abx d.Below knee amputation e.Application of graft and Correct Answer: c.Admission debridement leave, plate in IV abx 16 The following fracture comes to the hospital (Pilon with weber c, comminuted) what would be the most appropriate first course of treatment? N/V status intact not open fracture, no fracture blisters or compartment syndrome. a.ORIF fibula application of delta frame b.Application of delta frame c.Emergent ORIF of the tibia and fibula d.Inpatient admission ORIF of tibia and fibula next day Correct Answer: a.ORIF fibula and application of delta frame What is the purpose of the medial plate for a pilon fractures (which is most appropriate)? a.Get the medial malleolus out to length b.To Assist reduction syndesmosis c.To buttress comminution d.To reduce varus from pilon fracture Correct Answer: d.To reduce varus from pilon fracture What is the most appropriate treatment for this fracture (maisonneuve fracture)? a.Tension Band Wiring b.Interfragmentary screw c.Syndesmotic Screws d.Staple 17 e.Casting Correct Answer: c.Syndesmotic Screws Fracture of ankle comes in from severe MVA. The limb shows diminished pulses and perfusion to the foot what would be the most appropriate next treatment? a.Vascular consultation b.Peripheral Angiogram c.Arterial Doppler d.CT angiogram e.Closed reduction f.OR evaluation for N/V compromise Correct Answer: e.Closed reduction Ankle fracture is shown there was attempted closed reduction (medial mal fracture), with maintained deformity what is the most likely cause? a.Lateral ankle impingement b.Tillaux-Chaputfracture c.Interposition of posterior tibial tendon d.Deltoid Impingement Correct Answer: d.Deltoid Impingement 18 You have a patient on warfarin you need to perform an emergent ankle fracture what would be the fastest way to reverse their anticoagulation? a.Vitamin K Oral b.Hold Warfarin c.Fresh Frozen Plasma d.Whole blood transfusion Correct Answer: c.Fresh Frozen Plasma Patient presents to your office with fracture shown below also has Lisfranc fracture and fractures of the 2,3 rdmetatarsal bases what would be the most appropriate treatment? a.ORIF with homerun screw b.Percutaneous repair ORIF c.Arthrodesis 1,2,3 TMT d.Closed reduction and casting e.Bridge plating ORIF Correct Answer: c.Arthrodesis 1,2,3 TMT For the same patient what is the mechanism of injury? a.Hyperdorsiflexion b.Pronation axial loading c.Supination d.Direct impact 19 e.External rotation Correct Answer: b.Pronation axial loading S/P 8 week talar dome starts to demonstrate lucency after previous talar neck fracture what is the significance? a.Sign of AVN of the talus b.Sign of OCD of the Talus c.Consistent with post operative course d.Requires hardware removal Correct Answer: c. Consistent with post operative course S/P talar fracture at 5 weeks there is no subchondral lucencies noted at the talar dome what is the significance? a.Sign of AVN of the talus b.Sign of OCD of the Talus c.Consistent with post operative course d.Requires hardware removal Correct Answer: c. Consistent with post operative course Hawkins seen 6-8 weeks What would be the mechanism of action for the injury shown below (Talar Neck Fxr)? a.Excessive inversion plantarflexion 20 b.Excession Dorsiflexion c.Pronation d.Supination Correct Answer: b.Excession Dorsiflexion Pictured below what would be the most common complication (talar neck fracture? a.AVN of the talus b.STJ Arthritis c.TNJ Arthritis d.Ankle Arthritis Correct Answer: b.STJ Arthritis Lateral Process talar fracture what is the mechanism of injury? a.Plantarflexion inversion b.Inversion and Dorsiflexion c.External Rotation d.Internal Rotation Correct Answer: b.Inversion and Dorsiflexion Patient has pain and "popping" sensation with circumduction of the foot. What would be the mechanism of injury to cause this? a.Internal Rotation b.Sudden inversion and dorsiflexion 21 c.Plantar flexion inversion d.External Rotation Correct Answer: b.Sudden inversion and dorsiflexion A patient with a history of true penicillin allergy is scheduled for a total joint implant. Antibiotic prophylaxis would best be served with which of the following medications? •A. Ancef •B. Ciprofloxacin •C. Erythromycin •D. Vancomycin Correct Answer: D. Vancomycin A 60-year-old male suddenly begins complaining of a "crushing" sensation in his chest. The episode lasts very briefly then subsides. It begins again and is more intense. What should you administer to this patient? •A. nitroglycerin (Nitrogard) 0.5 mg. •B. diazepam (Valium) 5 mg. •C. ephedrine (Racephedrine) 25 mg. •D. morphine sulfate 15 mg. Correct Answer: A. nitroglycerin (Nitrogard) 0.5 mg 22 A 65-year-old female diabetic on insulin therapy arrives at the surgeon's office. While waiting she begins to feel faint and loses consciousness. What would be the treatment of choice? •A. administer phenytoin (Dilantin) 200 mg. intramuscularly (IM). •B. administer epinephrine 0.5 cc. intramuscularly (IM). •C. protect patient from injury and observe. •D. administer 25 cc. of 50 percent dextrose in water intravenously (IV) Correct Answer: D. administer 25 cc. of 50 percent dextrose in water intravenously (IV) A patient has a history of hypertension which is controlled by furosemide (Lasix) 40 mg. (q.d.). What is the most frequent electrolyte disturbance observed in this type of patient? •A. hypokalemia. •B. hyponatremia. •C. hyperkalemia. •D. hypernatremia Correct Answer: A. hypokalemia Patient has painful metatarsophalangeal joint, exquisitely tender to palpation you perform joint aspiration 75,000 WBC, rhomboid crystals, friable mucin glucose is 50 mg lower than blood glucose. What is true about the cause? •A. Septic Joint •B. Gouty Arthropathy •C. Osteoarthritis 23 •D. Chondrocalcinosis Correct Answer: D. Chondrocalcinosis Patient is given penicillin for syphilis what drug would improve the efficacy of the penicillin given? •A. Penicillamine •B. Probenecid •C. Propanolol •D. ClavulonicAcid •E. Lasix Correct Answer: B. Probenecid Patient has liver cirrhosis which local anesthetic would be most prudent to give? •A. Prilocaine •B. Procaine •C. Marcaine •D. Lidocaine Correct Answer: B. Procaine Patient has surgery tomorrow which medication would you take the day of surgery? •A. Lisinopril •B. Inhaled Glucocorticoid •C. Cholestyramine 24 •D. Methotrexate Correct Answer: B. Inhaled Glucocorticoid Patient has surgery tomorrow which medication would you take the day of surgery? •A. Warfarin •C. B12 •D. Propanolol •E. Lasix Correct Answer: D. Propanolol Patient is taking warfarin you find that there INR is 1.2 what would be the next step? •A. Cancel the surgery move later •B. Give FFP •C. Give Vitamin K •D. Continue with Surgery Correct Answer: D. Continue with Surgery You are going to perform an ankle arthroplasty tomorrow patient has a fatty liver. You are called about a PTT what would be the next step? PT 16.1 , PTT 38 , INR 0.7 •A. Cancel Surgery •B. Give FFP •C. Hold all Medications •D. Proceed with surgery 25 Correct Answer: D. Proceed with surgery Below is an IM nail 2 months there is still ankle pain and not complete osseous union. What would be a procedure that could be done to improve arthrodesis •A. Complete hardware removal •B. Remove proximal screw •C. Revision with Anterior plate •D. Bone Stimulator Correct Answer: B. Remove proximal screw Nail dynamization what is true about it. •A. Promotes Stability •B. Increases Osteogenesis •C. Bone Stimulator •D. Improves compression Correct Answer: D. Improves compression What is the primary function of this frame (proximal tibia Taylor spacial ring frame)? •A. Correct angular deformity •B. Buttress the fracture 26 •C. Distract and reduce the fracture •D. Compress Fracture site Correct Answer: D. Compress Fracture site How would you achieve compression for this frame (static ring frame distal tibia)? •A. Tighten the struts •B. Tension the wire •C. Apply foot plate •D. Tighten and lock screws Correct Answer: B. Tension the wire What is the function of the plate here (plate over lapidus with single screw fixation)? •A. Tension band •B. Neutralization plate •C. Buttress Plate •D. Provide primary compression •E. All immediate weight bearing Correct Answer: B. Neutralization plate What is the function of the plate here (distal tibia with screws in proximal and distal aspects of plate, but none in the center)? 27 •A. Tension band •B. Neutralization plate •C. Buttress Plate •D. Provide primary compression •E. All immediate weight bearing Correct Answer: C. Buttress Plate Most common mechanism for peroneal dislocation? •A. Sudden pronation, external rotation •B. Sudden Supination External rotation •C. Sudden dorsiflexion with reflex peroneal contraction •D. Sudden Plantarflexion with reflex contraction of peroneal Correct Answer: C. Sudden dorsiflexion with reflex peroneal contraction 35 y/o male patient playing basketball foot was inverted and suddenly dorsiflexes, what is the most likely type of fracture? •A. Anterior process fracture •B. Posterior talarprocess fracture •C. Lateral Process Fracture •D. Medial TalarDome Fracture 28 Correct Answer: C. Lateral Process Fracture What is false for OCD lesions of the talus? •A. Most common for inversion injury •B. Lateral lesions more commonly resolve on their own •C. Medial lesions are deeper •D. Lateral lesions are less common Correct Answer: B. Lateral lesions more commonly resolve on their own What is true for OCD lesions of the talus? •A. Occurs most commonly by inversion injury •B. Medial lesions deeper than lateral •C. Most common lesions are medial •D. All of the above Correct Answer: D. All of the above A tuberosity fracture of the navicular would be described as what stage Watson Jones? •A. I •B. II •C. III 29 •D. IV Correct Answer: A. I Which of the following transfers is best suited for peroneal muscle atrophy? •A. Flexor hallux longus •B. Extensor Digitorum brevis •C. Achilles tendon •D. Posterior tibial tendon Correct Answer: D. Posterior tibial tendon A 21-year old female presents with pain and swelling to the right ankle the patient states that last week she jumped from a fence on to uneven ground twisted her foot and fell forward. Assuming the foot was inverted then forced into dorsiflexion this type of trauma would suggest what type of mixed fracture? (A)Lateral Process of the talus (B) Avulsion of the medial malleolus (C) Oblique Proximal fibula (D) Sustentaculum taliof the calcaneus Correct Answer: (A)Lateral Process of the talus 30 A 27-year old male presents with a deep wound infection three weeks following an ORIF pilon fracture. The patient is admitted the wound is derided and placed on IV ab. Following the debridement there is exposed hardware what should be done regarding the hardware? (A)Remove regardless of fracture healing (B) Remove and apply monoliteral ex-fix (C) Remove and replace with clean hardware (D) Left in place unless loosening occurred Correct Answer: (D) Left in place unless loosening occurred A 30-year old male presents with medial ankle and arch pain after resection of a CN bar at age 11. On a physical exam he Exhibits a rigid valgus deformity and TTP medially and plantarly. Radiographs demonstrate reduced joint space at STJ and talarbeaking. Recurrence of the CN bar is noted as well, which of the following is most appropriate? (A)Resection of the coalition and muscle interposition (B)STJ arthrodesis (C)STJ Arthroereisis (D)Double Arthrodesis Correct Answer: (D)Double Arthrodesis 31 A total ankle replacement has been performed intraoperative stressing of ankle reveals valgus instability what best treatment option next? (A)Plication of deltoid ligament (B)Insert larger polyurethane liner (C)Perform medial displacement calc osteotomy (D)Lengthen peroneus longus tendon Correct Answer: (A)Plication of deltoid ligament A six-month old child aggressively casted for equinus component of clubfoot deformity may result in which of the following conditions? (A)Dislocation of ankle (B)Subluxation of MTJ (C)Compression of STJ (D)Rupture of talotibial ligament Correct Answer: (B)Subluxation of MTJ Nondisplaced medial lesion of the talus best managed by which treatment? (A)Short leg cast (B)Resection through anterior approach (C)Resection through medial malleolar approach 32 (D)Resection through posterior approach Correct Answer: (C)Resection through medial malleolar approach Axial load force in diaphyseal fibular fracture may be dissipated by which of the following fixation techniques? (A)Tension band (B)Interfragmentary screw (C)Buttress plate (D)Neutralization plate Correct Answer: (D)Neutralization plate Patient with CMT with weak anterior group muscles which of the following tendons should be transferred to improve foot function? (A)Peroneus longus (B)Posterior Tibial (C)Tibialis Anterior (D)Peroneus Brevis Correct Answer: (B)Posterior Tibial What is the procedure of choice for spastic equinus? 33 (A)Anterior advancement of tendoachilles (B)Achilles tenotomy (C)Achilles tendon Lengthening (D)Posterior tibial tendon transfer Correct Answer: (A)Anterior advancement of tendoachilles Which of the following techniques is not appropriate fixation of a type III distal tibial physis? (A)One cancellous screw on the distal physis (B)Tension band wiring with K wire and screw (C)Non weight bearing cast (D)Smooth K-wires across the physis Correct Answer: (B)Tension band wiring with K wire and screw For Tarsal tunnel release which of the following is true: •A.Tibial vein is posterior to the artery •B.There are two veins parallel to the artery •C.The Most posterior structure is the nerve •D.The first structure encountered is the PT tendon Correct Answer: B. There are two veins parallel to the artery Identify Structure (Superior to lateral mal) 34 •A.Sural Nerve •B.Superficial Peroneal Nerve •C.Perforating peroneal artery •D.Saphenous Nerve Correct Answer: B.Superficial Peroneal Nerve What is the most sensitive test for CRPS A. MRI B. Ultrasound C. Bone Scan D. CT scan E. Plain Film XR Correct Answer: C. Bone Scan When there is an osteochondral defect with microfracture which of the following would not help the growth of cartilage, or improve symptoms? •A.Autogenous chondrocytes •B.Demineralized bone matrix •C.Platelet rich plasma •D.BMP-6 Correct Answer: B.Demineralized bone matrix 35 BMP-6 and PRP help chondrocytes Which of the following is true about ankle procurvatum •A. Coronal Plane deformity •B. Compensated with plantarflexion •C. Better compensated than Recurvatum •D. Less likely to result in ankle arthritis Correct Answer: D. Less likely to result in ankle arthritis Less tolerated due to limited dorsiflexion, up to 20 degrees can be compensated, leads to impingement Recurvatum which of the following is true •A. Shear is more common complication •B. Only up to 30 degrees of recurvatum can be compensated •C. Compensated with plantarflexion •D. Less tolerated than procurvatum Correct Answer: A. Shear is more common complication More likely to produce arthritis, more tolerated Which of the following is true about Varus ankle reconstruction 36 •A. Deltoid reconstruction may be necessary •B. Commonly causes nerve entrapment •C. Medial Osteotomy is recommended •D. PT tendon damage is common Correct Answer: B. Commonly causes nerve entrapment Which of the following is true about Valgus ankle reconstruction •A. Focal dome osteotomy cannot be used for this •B. Opening wedge is recommended •C. Syndesmosis is usually involved •D. Lateral Collateral Ligaments usually involved Correct Answer: C. Syndesmosis is usually involved Which of the following is false about CORA, leg angulation •A. When the axis of correction of angulation passes through the CORA, but the osteotomy is at a level different than that of the CORA, the axes of the bone will realign with angulation and translation at the osteotomy site. •B. When the osteotomy and the axis of correction of angulation are at a level different from that of the CORA, a rotational deformity will result.C. Syndesmosis is usually involved •C. When the osteotomy and the axis of correction of angulation pass through a CORA, the bone ends and axis lines will not realign by angulation without translation. 37 Correct Answer: A. When the axis of correction of angulation passes through the CORA, but the osteotomy is at a level different than that of the CORA, the axes of the bone will realign with angulation and translation at the osteotomy site. You are about to place the medial port for an ankle scope what structure are you worried about? •A. Tibial Nerve •B. Superficial peroneal nerve •C. Intermediate Dorsal Cutaneous Nerve •D. Deltoid Ligament •E. Saphenous Vein Correct Answer: E. Saphenous Vein You just performed an ankle arthroscopic synovectomy what is the most common complication •A. Tibial Neuritis •B. Superficial peroneal neuritis •C. Intermediate Dorsal Cutaneous Nerve •D. Deltoid Ligament damage •E. Saphenous Vein damage •F. Stress Fracture •G. CRPS Correct Answer: B. Superficial peroneal neuritis 38 You performed an arthroscopic os trigonum excision what procedure is essential during the surgery? •A. Arthroscopic Synovectomy •B. Flexion of the hallux •C. ATFL Repair •D. Ankle Stress Test Correct Answer: B. Flexion of the hallux In order to locate the shaver what technique would you use? •A. Pistoning •B. Triangulation •C. Sweeping •D. 21 Point Exam Correct Answer: B. Triangulation A 1 year old presents to you with congenital vertical talus that cannot be reduced what should you do? •A.Serial casting then ORIF of the TNJ with a TLA •B. Talectomy with serial casting and pinning NC joint •C. Await until skeletal maturity then do a triple 39 •D. ORIF of the TNJ and TAL Correct Answer: A.Serial casting then ORIF of the TNJ with a TLA Ankle arthroscopy posterior portal placement what vital structures? •A.6-7 mm of the tibial nerve and 3-4 mm from the sural nerve •B. 10-12 mm from the tibial nerve and 3-4 mm from sural •C. 5-6 mm from the tibial nerve and 4-5 mm from the sural nerve •D. 10-12 mm from the tibial nerve and 4-5 mm from the sural nerve Correct Answer: A. 6-7 mm of the tibial nerve and 3-4 mm from the sural nerve A patient 31 y/o with dorsiflexed and inverted foot has overpowering of the anterior tibial tendon what tendon transfer would you do? •A.young tenosuspension •B. Peroneus longus transfer •C. lateral transfer of the tibialis anterior tendon to cuneiforms •D. release of the tibialis anterior followed by PT transfer Correct Answer: C. lateral transfer of the tibialis anterior tendon to cuneiforms For the following acute fracture what would be the best fixation (Calc displaced tongue fracture)? •A. 1 Bicroticalscrew 40 •B. Ex Fix •C. 2 x Steinmann pins •D. 2-3 bicortical screws Correct Answer: D. 2-3 bicortical screws What is true about this injury (calc displaced tongue fracture)? •A. Associated with open fractures •B. Soft tissue involvement is not a factor •C. Typically urgent ORIF required •D. Requires Extensile incision •E. Should be treated conservatively Correct Answer: C. Typically urgent ORIF required (to avoid skin necrosis) An infant with a primary deformity at the TNJ and secondary deformity at the CCJ child has rigid pronation and increased kites angle what would be the most likely condition? •A. Talipes equinovarus •B. Poliomyelitis •C. Arthrogryposis •D. Turner syndrome Correct Answer: C. Arthrogryposis 41 Rapid dorsiflexion of an inverted foot patient developed ankle pain what is the most likely pathology (fleck sign off distal fibula)? •A. Malposition of peroneal tendon •B. Rupture of the lateral ankle ligaments •C. Rupture of the Inferior peroneal retinaculum •D. Rupture of the syndesmosis Correct Answer: A. Malposition of peroneal tendon Technique shown below is used to identify which structure (medially placed scope with light under skin laterally)? •A. Saphenous Nerve •B. Saphenous Vein •C. Deep Peroneal Artery •D. Superficial Peroneal nerve •E. Tibial Nerve Correct Answer: D. Superficial Peroneal nerve A 40 y/o patient underwent ankle arthroscopy 6 months ago for a talar OCD. He continues to have pain on the lateral portal states pain is more superficial that the original pain. He has a shooting pain to his distal foot radiates to the medial foot and ankle when the lateral portal is tapped. A diagnostic injection around that area previously afforded relief. What treatment would best eliminate the pain? 42 •A. Sural nerve neuroplasty •B. Neuroplasty of the deep peroneal nerve •C. Neuroplasty of medial branch of superficial peroneal nerve •D. Repeat arthroscope •E. Physical therapy Correct Answer: C. Neuroplasty of medial branch of superficial peroneal nerve A 46 y/o male in 2.5 years out from a closed STJ dislocation treated with reduction and casting. His radiograph shown (collapsing talus). His MRI demonstrates significant talar AVN, bracing and injections has failed. What is the most appropriate management for this patient? •A. TTC using anterior approach •B. Ankle arthrodesis using anterior approach •C. TTC using lateral transfibular approach •D. Total ankle arthroplasty with STJ arthrodesis •E. Total Talectomy using lateral approach Correct Answer: C. TTC using lateral transfibular approach As an alternative to ORIF for the injury pattern what treatment would be most effective for the injury shown (lis franc 2-5 dislocation)? •A. Open reduction arthrodesis medial and middle column with pinning of the lateral column •B. Open reduction with primary arthrodesis of the medial, middle and lateral column 43 •C. Closed percutaneous pinning of the medial middle and lateral column •D. Closed reduction of midfoot with casting •E. Partial weight bearing in removable cast Correct Answer: A. Open reduction arthrodesis medial and middle column with pinning of the lateral column Figure shows XR of a 45 y/o female (unremarkable) underwent resection of interdigital neuroma through dorsal approach 1 year ago. The neuroma was excised 5 mm proximal to the intermetatarsal ligament he continued to have interspace pain with a well healed incision and positive Tinel's sign from the interspace. What is the most common cause of the persistent pain? •A. Painful scar •B. Infection •C. Frieberg's disease •D. MPJ arthritis •E. Inadequate proximal resection Correct Answer: E. Inadequate proximal resection 35 y/o female presents with lateral sided ankle pain and bruising after rolling her ankle. T2 weighted image of the ankle are shown what is the diagnosis? •A. Dislocation of the peroneus longus at the SPR •B. Dislocation of the peroneus brevis at the SPR •C. Dislocation of the Peroneus Longus and Peroneus brevis at SPR 44 •D. Dislocation of the peroneus longus tendon at the level of the IPR •E. Dislocation of the peroneus brevis at the IPR Correct Answer: A. Dislocation of the peroneus longus at the SPR Which of the following tendon transfers best suited to deal with the peroneal muscle atrophy? •A. FHL •B. EDB •C. Achilles Tendon •D. PT •E. PL •F. FDL Correct Answer: D. PT Patient 22 y/o female sustained open fracture of the midfoot to the forefoot which is 8 cm in length from lawnmower what would the gustillo and Anderson be for this? •A. I •B. II •C. III •D. IV Correct Answer: C. III 45 What is the most appropriate reperfusion time prior to re-inflating the ankle tourniquet for surgery that has passed the 2 hour mark? •A. 5 minutes / 10 minutes tourniquet time •B. 5 minutes / 15 minutes of tourniquet time •C. 5 minutes / 30 minutes of tourniquet time •D. 5 minutes / 60 minutes of tourniquet time Correct Answer: C. 5 minutes / 30 minutes of tourniquet time Which inflammatory marker is the most sensitive within the first 48 hours following postoperative implant infection ? •A. CRP •B. ESR •C. WBC •D. Tmax Correct Answer: A. CRP What's the recommended time to hold heparin prior to surgery? •A. 2 hours •B. 8 hours •C. 24 hours •D. 48 hours Correct Answer: B. 8 hours 46 What is true about coumadin (warfarin)? •A. Inhibits extrinsic pathway •B. regulated by PTT •C. Short term therapeutic •D. reversed by protamine sulfate Correct Answer: A. Inhibits extrinsic pathway A 30 y/o male has a lawn mower injury to the right foot he exhibits a wound that is 11 cm wide with extensive periosteal stripping that will likely require some soft of rotational flap coverage how should the injury be classified and treated? •A. GustilloAnderson II -Ancef + Clindamcin •B. GustilloAnderson IIIA -Ancef/PCN/Aminoglycoside •C. GustilloAnderson IIIB -Ancef/PCN/Aminoglycoside •D. GustilloAnderson IIIC -Ancef/PCN/Aminoglycoside Correct Answer: C. GustilloAnderson IIIB -Ancef/PCN/Aminoglycoside An MRI is ordered to evaluate for Osteomyelitis which sequence would be the most sensitive for the infection? (A)STIR (B)T1 47 (C)Proton density (D)FLAIR Correct Answer: (A)STIR Patient had a bowling ball dropped on their foot. Comes to the ER with 10/10 pain, you do not have a wick catheter. What is the best test to indicate compartment syndrome? (A)Absent pulses (B)Fracture Blisters (C)Parasthesia (D)Pain with passive dorsiflexion Correct Answer: (D)Pain with passive dorsiflexion Patient has chronic hepatitis C with end stage liver disease which anesthetic is most appropriate? (A)Prilocaine (B)Procaine (C)Lidocaine (D)Marcaine Correct Answer: (B)Procaine 48 Patient had a bowling ball dropped on their foot. Comes to the ER with 10/10 pain, same patient what would be the first symptom that would happen? (A)Absent pulses (B)Fracture Blisters (C)Paresthesia (D)Pain with passive dorsiflexion Correct Answer: (C)Paresthesia All of the following are true of the PT tendon transfer except? (A)Used to treat dropfoot (B)Phasic transfer (C)Transferred through interosseous membrane (D)Tendon inserted on 3rdcuneiform Correct Answer: (B)Phasic transfer What is true about the following (pic of fracture blister)? (A)Associated with low energy trauma (B)Hemorrhagic fracture blisters are low severity (C)Associated with increased interstitial pressure (D)Fixation of any type is contraindicated 49 Correct Answer: (C)Associated with increased interstitial pressure What is true about the Evans Osteotomy? (A)Osteotomy made between middle and posterior facet (B)Osteotomy should be made distal to the anterior facet (C)1 -1.5 cm make the osteotomy (D)1.5 -2 cm make the osteotomy Correct Answer: (C)1 -1.5 cm make the osteotomy Between anterior and middle facet Most common complication from a calcaneal slide osteotomy? (A)Sural Neuritis (B)Undercorrection (C)Peroneal tendon irritation (D)Troughing of capital fragment Correct Answer: (B)Undercorrection Open ankle fracture -what solution would be the best to prevent cartilage damage to irrigate the surgical site? 50 (A)Pulse lavage (B)Bacitracin with pulse lavage (C)Irrigation with bulb syringe and betadine irrigant (D)Sterile saline with gravity irrigation Correct Answer: (D)Sterile saline with gravity irrigation What would be the most appropriate treatment if there was no pulse (in an open fracture)? (A)Vascular surgery consult (B)CT Angiogram (C)Angiogram (D)Emergent OR anastomosis (E)Prompt Reduction Correct Answer: (E)Prompt Reduction What would be the most appropriate fixation in this patient (open fracture)? (A)Syndesmotic Screws (B)IM Nail (C)90-90 Plating (D)CirclageWire (E)Percutaneous Steinmann pins 51 Correct Answer: (E)Percutaneous Steinmann pins For this fracture (weber c) what would be the best steps for reduction? (A)Internal Rotation, supination of foot (B)External rotation supination of foot (C)External rotation pronation of foot (D)Internationrotation pronation of foot Correct Answer: Best Fixation for reduction of this fracture (weber c)? (A)Circlagewire (B)Locking plate (C)Tension band plate (D)Syndesmotic screws (E)IM nail Correct Answer: (D)Syndesmotic screws Which of the following fractures has the most stability? a. Oblique b. Transverse c. Comminuted 52 d. Spiral Correct Answer: b. Transverse