APMLE Part 2 Practice 2008 Questions With Complete
Solutions
. Which of the following is a typical radiographic finding in
cases of osteochondroma?
(A) Epiphyseal location
(B) Moth-eaten appearance
(C) Osseous protuberance that grows toward the joint
(D) Osseous protuberance with the cortex continuous with the
parent bone Correct Answers D
A key radiographic feature that defines an
osteochondroma is the continuity of the cortex of the
lesion with the cortex of the involved bone.
.A 12-year-old patient presents with pain on the lateral side of
the right ankle when standing. The subtalar joint is restricted in
motion, and pain is elicited on palpation of the fibular (peroneal)
tendons. If the medial oblique view of the foot is negative,
which of the following views will probably be positive?
(A) Harris-Beath (calcaneal axial)
(B) Anteroposterior
(C) Sesamoidal axial
(D) Mortise ankle Correct Answers A
The Harris-Beath (calcaneal axial) view can allow
visualization of the middle facet of the talocalcaneal
joint. The joint space is obliterated in the case of
osseous coalition. If there is fibrocartilaginous
coalition, the joint space appears narrow and
subchondral sclerosis may be present.
,A 12-year-old patient presents with pain on the lateral side of
the right ankle when standing. The subtalar joint is restricted in
motion, and pain is elicited on palpation of the fibular (peroneal)
tendons. A lateral x-ray would most probably demonstrate
(A) a large os trigonum
(B) a posteriorly broken cyma line
(C) an increased calcaneal inclination
(D) dorsal talar head and neck beaking Correct Answers D
X-ray findings in tarsal coalition include dorsal talar
head and neck beaking. Pain is a common symptom.
Limitations of subtalar motion and valgus deformity
vary in severity.
A 12-year-old patient who is being evaluated for hip pain of
several weeks' duration has other complaints that are more
acute. The patient complains of headache and fever, some
photophobia, and "just not feeling well." These symptoms began
yesterday and appear to be getting worse. The podiatric
physician notices that the patient moves slowly and carefully
and that the neck is painful and somewhat stiff. Temperature is
103°F. There is no sign of head trauma, and the pupils are equal
and reactive. The lungs and heart are normal. There is no skin
rash. The left hip is slightly tender over the trochanter but has
full range of motion. The patient appears neurologically intact.
Which of the following is the most likely diagnosis for these
acute symptoms?
(A) Osteomyelitis
(B) Lyme disease
(C) Meningitis
(D) Viral upper respiratory infection Correct Answers C
The symptoms of acute meningitis include fever,
,headache, and a stiff neck.
A 19-year-old male patient presents with an itchy and burning
rash on the bottom of his foot. Physical examination reveals
patchy scaling on an erythematous base. The lesions are dry and
extend to the sides of the foot in a moccasin distribution. Which
of the following would be an appropriate presumptive
diagnosis?
(A) Psoriasis
(B) Tinea pedis
(C) Lichen planus
(D) Pityriasis rubra pilaris Correct Answers B
Tinea pedis most often appears as dryness and
scaling in a moccasin distribution.
A 20-year-old male patient with hemophilia presents for
podiatric treatment of a paronychia. He is currently under
treatment by his physician and requires routine transfusion and
Factor VIII administration. Which of the following would
provide the most pertinent information?
(A) Platelet count
(B) Reticulocyte count
(C) Prothrombin time (PT)
(D) Partial thromboplastin time (PTT) Correct Answers D
PTT is elevated when an inadequate level of Factor
VIII is present.
A 21-year-old basketball player sustained a complete rupture of
the Achilles tendon. It is now 5 days after the injury and the
patient has been immobilized in a posterior splint. The most
appropriate treatment at this time is
, (A) a primary anastomosis with an augmentation graft if
necessary
(B) resection of the fibrous plug and an augmentation graft of
the defect
(C) a long leg cast for 4 weeks followed by a short leg cast for 4
weeks
(D) a short leg cast for 6 weeks followed by aggressive physical
therapy Correct Answers A
Young healthy athletes have a high rate of success
with surgical repair of an Achilles tendon rupture.
A 26-year-old patient presents to the emergency department
with a puncture wound of the right foot, sustained while
working in a construction zone. Emergency department records
confirm a similar injury 1 year ago, at which time the patient
was given a tetanus immunization. Which of the following is a
true statement about tetanus prophylaxis at this time?
(A) No additional tetanus immunization is necessary.
(B) The patient will require half of the normal dose of tetanus
toxoid.
(C) The patient will require tetanus immunoglobulin only.
(D) The patient will require tetanus immunoglobulin and
tetanus toxoid. Correct Answers A
Tetanus toxoid immunization booster administration
is recommended every 10 years by the CDC.
A 28-year-old female patient presents with pain in the left
forefoot that began after a long hike on a mountainous trail.
There is no history of trauma. Physical examination reveals
nontender range of motion of the metatarsophalangeal joints.
Deep palpation of the intermetatarsal spaces does not reproduce
Solutions
. Which of the following is a typical radiographic finding in
cases of osteochondroma?
(A) Epiphyseal location
(B) Moth-eaten appearance
(C) Osseous protuberance that grows toward the joint
(D) Osseous protuberance with the cortex continuous with the
parent bone Correct Answers D
A key radiographic feature that defines an
osteochondroma is the continuity of the cortex of the
lesion with the cortex of the involved bone.
.A 12-year-old patient presents with pain on the lateral side of
the right ankle when standing. The subtalar joint is restricted in
motion, and pain is elicited on palpation of the fibular (peroneal)
tendons. If the medial oblique view of the foot is negative,
which of the following views will probably be positive?
(A) Harris-Beath (calcaneal axial)
(B) Anteroposterior
(C) Sesamoidal axial
(D) Mortise ankle Correct Answers A
The Harris-Beath (calcaneal axial) view can allow
visualization of the middle facet of the talocalcaneal
joint. The joint space is obliterated in the case of
osseous coalition. If there is fibrocartilaginous
coalition, the joint space appears narrow and
subchondral sclerosis may be present.
,A 12-year-old patient presents with pain on the lateral side of
the right ankle when standing. The subtalar joint is restricted in
motion, and pain is elicited on palpation of the fibular (peroneal)
tendons. A lateral x-ray would most probably demonstrate
(A) a large os trigonum
(B) a posteriorly broken cyma line
(C) an increased calcaneal inclination
(D) dorsal talar head and neck beaking Correct Answers D
X-ray findings in tarsal coalition include dorsal talar
head and neck beaking. Pain is a common symptom.
Limitations of subtalar motion and valgus deformity
vary in severity.
A 12-year-old patient who is being evaluated for hip pain of
several weeks' duration has other complaints that are more
acute. The patient complains of headache and fever, some
photophobia, and "just not feeling well." These symptoms began
yesterday and appear to be getting worse. The podiatric
physician notices that the patient moves slowly and carefully
and that the neck is painful and somewhat stiff. Temperature is
103°F. There is no sign of head trauma, and the pupils are equal
and reactive. The lungs and heart are normal. There is no skin
rash. The left hip is slightly tender over the trochanter but has
full range of motion. The patient appears neurologically intact.
Which of the following is the most likely diagnosis for these
acute symptoms?
(A) Osteomyelitis
(B) Lyme disease
(C) Meningitis
(D) Viral upper respiratory infection Correct Answers C
The symptoms of acute meningitis include fever,
,headache, and a stiff neck.
A 19-year-old male patient presents with an itchy and burning
rash on the bottom of his foot. Physical examination reveals
patchy scaling on an erythematous base. The lesions are dry and
extend to the sides of the foot in a moccasin distribution. Which
of the following would be an appropriate presumptive
diagnosis?
(A) Psoriasis
(B) Tinea pedis
(C) Lichen planus
(D) Pityriasis rubra pilaris Correct Answers B
Tinea pedis most often appears as dryness and
scaling in a moccasin distribution.
A 20-year-old male patient with hemophilia presents for
podiatric treatment of a paronychia. He is currently under
treatment by his physician and requires routine transfusion and
Factor VIII administration. Which of the following would
provide the most pertinent information?
(A) Platelet count
(B) Reticulocyte count
(C) Prothrombin time (PT)
(D) Partial thromboplastin time (PTT) Correct Answers D
PTT is elevated when an inadequate level of Factor
VIII is present.
A 21-year-old basketball player sustained a complete rupture of
the Achilles tendon. It is now 5 days after the injury and the
patient has been immobilized in a posterior splint. The most
appropriate treatment at this time is
, (A) a primary anastomosis with an augmentation graft if
necessary
(B) resection of the fibrous plug and an augmentation graft of
the defect
(C) a long leg cast for 4 weeks followed by a short leg cast for 4
weeks
(D) a short leg cast for 6 weeks followed by aggressive physical
therapy Correct Answers A
Young healthy athletes have a high rate of success
with surgical repair of an Achilles tendon rupture.
A 26-year-old patient presents to the emergency department
with a puncture wound of the right foot, sustained while
working in a construction zone. Emergency department records
confirm a similar injury 1 year ago, at which time the patient
was given a tetanus immunization. Which of the following is a
true statement about tetanus prophylaxis at this time?
(A) No additional tetanus immunization is necessary.
(B) The patient will require half of the normal dose of tetanus
toxoid.
(C) The patient will require tetanus immunoglobulin only.
(D) The patient will require tetanus immunoglobulin and
tetanus toxoid. Correct Answers A
Tetanus toxoid immunization booster administration
is recommended every 10 years by the CDC.
A 28-year-old female patient presents with pain in the left
forefoot that began after a long hike on a mountainous trail.
There is no history of trauma. Physical examination reveals
nontender range of motion of the metatarsophalangeal joints.
Deep palpation of the intermetatarsal spaces does not reproduce
