ROSH REVIEW Orthopedics UPDATED ACTUAL Questions and CORRECT
Answers
1. A young woman Correct Answer ( D )
presents with an- Explanation:
kle pain and ede- Fracture of the ankle may include injury to the medial malleolus (tibia), the
ma. While wearing lateral malleolus (fibula), the posterior malleolus (tibia), the talus and the
high-heel shoes, she collateral ligaments. Stability of the fracture depends on how many sides
twisted her ankle are injured. Stable fractures involve only one side of the joint, whereas
upon stepping off a unstable fractures include both sides of the joint. Stable fractures are
curb. She is ten- treated with 4-6 weeks of a weight-bearing cast or brace
der about the later-
al malleolus. Skin and
neurovascular exami-
nation are normal. She
has no medial tender-
ness. Ligament test-
ing is negative. Ra-
diographic examina-
tion reveals a non-dis-
placed lateral malleo-
lar fracture below the
ankle joint. The tibia
is unaffected. Which
of the following is the
most appropriate de-
finitive treatment for
this patient?
AClosed reduction
BDebridement
CNon-weight-bearing
orthosis
DWeight-bearing cast
,
,2. One Step Further Answer: The fibular head. External rotation forces at the ankle can cause
Question: Examina- a Maisonneuve fracture, a compilation of fibular head fracture, tear of
tion of which structure the ankle's medial collateral ligament and disruption of the tibiofibular
is important in any syndesmosis.
suspected ankle frac-
ture or injury?
3. Which of the follow- Correct Answer ( C )
ing maneuvers tests Explanation:
the meniscus of the Meniscal injuries occur frequently in patients with sudden rotary or ex-
knee? tension-flexion motions. The menisci have no sensory nerve fibers, and
the pain that results after these injuries is from irritation of the ligaments
Anterior drawer test near the joint line. Several symptoms suggest the presence of a meniscal
Lachman test tear including: joint line pain, joint effusion, locking, and giving way of the
McMurray test knee. The McMurray test is performed with the patient supine and the hip
Posterior drawer test and knee flexed. To check the medial meniscus, the examiner palpates the
posteromedial joint line with one hand while the other hand grasps the
foot. The leg is externally rotated to trap the medial meniscus, and the knee
is slowly extended. Conversely, the lateral meniscus is examined with the
clinician palpating the posterolateral joint line while internally rotating the
leg. A painful click, popping, or thud felt in early extension is considered
abnormal. It is 53% sensitive for a meniscal injury.
The Anterior Drawer (A) and Lachman tests (B) are used to assess anterior
cruciate ligament (ACL) instability.
4. One Step Further Answer: Anterior cruciate ligament (ACL) rupture.
Question: What is the
most common injury
associated with trau-
matic hemarthrosis of
the knee joint?
, 5. A 14-year-old girl Correct Answer ( B )
sprained her ankle. Explanation:
She rates her pain Ankle sprains are caused by partial or complete tearing of one or more
5/10. On examination, ligaments that support the ankle joint. Injuries are most often due to an
she has moderate ten- inversion mechanism, causing injury to the lateral ligaments. The anterior
derness and swelling talofibular ligament (ATFL) is the first ligament to be injured, followed by
with decreased range the calcaneofibular ligament (CFL), and finally, in the most severe lateral
of motion secondary sprains, the posterior talofibular ligament (PTFL). A syndesmotic ankle
to pain. Although sprain (high ankle sprain) involves the ligaments that connect the tibia
quite painful, she is and fibula. Ankle sprains are graded I, II or III based on exam findings
able to ambulate. and functional loss. The patient in the above scenario has a Grade II
What is the grade of ankle sprain (incomplete tear) characterized by moderate pain, swelling,
this ankle sprain? tenderness and ecchymosis with mild to moderate joint instability and
some loss of range and function. Typically these are painful with weight
Grade I bearing.
Grade II
Grade III
Grade IV
6. One Step Further Answer: Anterior drawer test and talar tilt test
Question: If a patient
has ankle instability,
what physical exam
tests should be posi-
tive?
7. A 67-year-old woman Correct Answer ( A )
presents with low back Explanation:
pain. She states that This patient's presentation is most consistent with spinal stenosis; a nar-
she has had pain for rowing of the spinal canal leading to radicular symptoms on exertion.
Answers
1. A young woman Correct Answer ( D )
presents with an- Explanation:
kle pain and ede- Fracture of the ankle may include injury to the medial malleolus (tibia), the
ma. While wearing lateral malleolus (fibula), the posterior malleolus (tibia), the talus and the
high-heel shoes, she collateral ligaments. Stability of the fracture depends on how many sides
twisted her ankle are injured. Stable fractures involve only one side of the joint, whereas
upon stepping off a unstable fractures include both sides of the joint. Stable fractures are
curb. She is ten- treated with 4-6 weeks of a weight-bearing cast or brace
der about the later-
al malleolus. Skin and
neurovascular exami-
nation are normal. She
has no medial tender-
ness. Ligament test-
ing is negative. Ra-
diographic examina-
tion reveals a non-dis-
placed lateral malleo-
lar fracture below the
ankle joint. The tibia
is unaffected. Which
of the following is the
most appropriate de-
finitive treatment for
this patient?
AClosed reduction
BDebridement
CNon-weight-bearing
orthosis
DWeight-bearing cast
,
,2. One Step Further Answer: The fibular head. External rotation forces at the ankle can cause
Question: Examina- a Maisonneuve fracture, a compilation of fibular head fracture, tear of
tion of which structure the ankle's medial collateral ligament and disruption of the tibiofibular
is important in any syndesmosis.
suspected ankle frac-
ture or injury?
3. Which of the follow- Correct Answer ( C )
ing maneuvers tests Explanation:
the meniscus of the Meniscal injuries occur frequently in patients with sudden rotary or ex-
knee? tension-flexion motions. The menisci have no sensory nerve fibers, and
the pain that results after these injuries is from irritation of the ligaments
Anterior drawer test near the joint line. Several symptoms suggest the presence of a meniscal
Lachman test tear including: joint line pain, joint effusion, locking, and giving way of the
McMurray test knee. The McMurray test is performed with the patient supine and the hip
Posterior drawer test and knee flexed. To check the medial meniscus, the examiner palpates the
posteromedial joint line with one hand while the other hand grasps the
foot. The leg is externally rotated to trap the medial meniscus, and the knee
is slowly extended. Conversely, the lateral meniscus is examined with the
clinician palpating the posterolateral joint line while internally rotating the
leg. A painful click, popping, or thud felt in early extension is considered
abnormal. It is 53% sensitive for a meniscal injury.
The Anterior Drawer (A) and Lachman tests (B) are used to assess anterior
cruciate ligament (ACL) instability.
4. One Step Further Answer: Anterior cruciate ligament (ACL) rupture.
Question: What is the
most common injury
associated with trau-
matic hemarthrosis of
the knee joint?
, 5. A 14-year-old girl Correct Answer ( B )
sprained her ankle. Explanation:
She rates her pain Ankle sprains are caused by partial or complete tearing of one or more
5/10. On examination, ligaments that support the ankle joint. Injuries are most often due to an
she has moderate ten- inversion mechanism, causing injury to the lateral ligaments. The anterior
derness and swelling talofibular ligament (ATFL) is the first ligament to be injured, followed by
with decreased range the calcaneofibular ligament (CFL), and finally, in the most severe lateral
of motion secondary sprains, the posterior talofibular ligament (PTFL). A syndesmotic ankle
to pain. Although sprain (high ankle sprain) involves the ligaments that connect the tibia
quite painful, she is and fibula. Ankle sprains are graded I, II or III based on exam findings
able to ambulate. and functional loss. The patient in the above scenario has a Grade II
What is the grade of ankle sprain (incomplete tear) characterized by moderate pain, swelling,
this ankle sprain? tenderness and ecchymosis with mild to moderate joint instability and
some loss of range and function. Typically these are painful with weight
Grade I bearing.
Grade II
Grade III
Grade IV
6. One Step Further Answer: Anterior drawer test and talar tilt test
Question: If a patient
has ankle instability,
what physical exam
tests should be posi-
tive?
7. A 67-year-old woman Correct Answer ( A )
presents with low back Explanation:
pain. She states that This patient's presentation is most consistent with spinal stenosis; a nar-
she has had pain for rowing of the spinal canal leading to radicular symptoms on exertion.
