Basic Science 2013 Flashcards
- Which treatment technique for segmental nerve defects leads to the best motor recovery?
- Silicon tube
- Collagen tube
- Nerve allograft
- Nerve autograft
- Direct repair with tension
- Nerve autograft
RECOMMENDED READINGS
Giusti G, Willems WF, Kremer T, Friedrich PF, Bishop AT, Shin AY. Return of motor function after
segmental nerve loss in a rat model: comparison of autogenous nerve graft, collagen conduit, and
processed allograft (AxoGen). J Bone Joint Surg Am. 2012 Mar 7;94(5):410-7. PubMed PMID: 22398734.
Surg. 2012 Feb;20(2):63-8. Review. PubMed PMID: 22302443.
- Figure 22 is the sagittal MRI scan of the spine of a 68-year-old woman with a history of chronic back painradiating into her right lower extremity. She reports paresthesias involving the right great toe and parts ofher shin. Nonsurgical treatment consisting of pain medications and epidural steroid injections has failed toprovide relief. Assessment of ambulation is most likely to reveal which pathologic gait pattern?
- Quadriceps avoidance gait attributable to L5 compression and radiculopathy
- Scissor gait attributable to spondylolisthesis at L4-5 and bilateral radiculopathy
- Trendelenburg gait attributable to L4 compression and weakness of the gluteus medius
- Trendelenburg gait attributable to L5 compression and weakness of the gluteus medius
- Varus thrust gait during stance attributable to L5 compression and posterolateral cornerweakness
- Trendelenburg gait attributable to L5 compression and weakness of the gluteus medius
RECOMMENDED READINGS
FJ, Bell GR, Balderston R, eds. Rothman-Simeone The Spine. 6th ed. Philadelphia, PA: WB Saunders;
2011:887-914.
Keenan MA. Normal and pathologic gait. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic
Review. Vol 1. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:163-170.
- Following laceration, peripheral nerves heal in which manner?
- Direct repair across the gap by Schwann cells
- Direct repair of the axon
- Antegrade growth of the axon
- Retrograde growth of the axon
- Formation of collagen bridges by fibroblasts
- Antegrade growth of the axon
RECOMMENDED READINGS
Dodds SD. Peripheral nervous system. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review.
Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:71-81.
Lee SK, Wolfe SW. Peripheral nerve injury and repair. J Am Acad Orthop Surg. 2000;8(4):243-52. PMID:
10951113.
Gupta R, Mozaffar T. Neuromuscular diseases. In: Einhorn TA, O’Keefe RJ, Buckwalter JA, eds.
Orthopaedic Basic Science: Foundations of Clinical Practice. 3rd ed. Rosemont, IL: American Academy
of Orthopaedic Surgeons; 2007:427-443.
38.
A 7-year-old boy with short stature, bowed legs, and back pain has 2 sisters whose appearances
are unremarkable. Laboratory studies show low serum phosphate; his serum calcium, and 25
levels are below normal. The boy has a male cousin with the same disorder. What type of rickets is the
most likely diagnosis?
- Renal
- Vitamin D-deficient
3. X-linked hypophosphatemic
- Type I vitamin D-dependent
- Type II vitamin D-dependen
3. X-linked hypophosphatemic
RECOMMENDED READINGS
Carpenter TO, Imel EA, Holm IA, Jan de Beur SM, Insogna KL. A clinician’s guide to X-linked
hypophosphatemia. J Bone Miner Res. 2011 Jul;26(7):1381-8. doi:10.1002/jbmr.340. Epub 2011 May 2.
Review. PubMed PMID: 21538511.
Dietz FR, Murray JC. Genetic basis of disorders with orthopaedic manifestations. In: Einhorn TA, O’Keefe
RJ, Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 3rd ed. Rosemont,
IL: American Academy of Orthopaedic Surgeons; 2007:25-47.
- A 5-year-old boy has superficial heterotopic bone around his chest and difficutly breating. He has one sibling who died of respiratory distress at age 13. The most likely genetic cause of this disorder is a varient in
- SOX9
- matrilin 3
- the FGF3 receptor
- the BMP type 1 receptor
- the PTH-PTHrP receptor
- the BMP type 1 receptor
RECOMMENDED READINGS
Carvalho DR, Navarro MM, Martins BJ, Coelho KE, Mello WD, Takata RI, Speck-Martins CE.
Genet. 2010 Feb;77(2):171-6. Epub 2009 Oct 1. PubMed PMID: 19796185.
Seo SW, Lee FY. Cellular and molecular biology, immunology, and genetics. In: Lieberman JR, ed. AAOS
Comprehensive Orthopaedic Review. Vol 1. Rosemont, IL: American Academy of Orthopaedic Surgeons;
2009:3-13.
Medvecky MJ. Skeletal muscle. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Vol 1.
Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:83-91.
- Postnatal skeletal linear growth occurs most rapidly during
- puberty.
- prepuberty.
- preschool years.
- first year of life
- early elementary school years.
- preschool years
RECOMMENDED READINGS
Dimeglio A. Growth in pediatric orthopaedics. In: Morrissey RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:35-65.Herring JA. Limb length discrepancy. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 4th ed. Philadelphia, PA; WB Saunders; 2008:1191-1263.
- In the setting of skeletal muscle lacerations, which effect does transforming growth factor-beta have on scar tissue formation?
- Stimulates the proliferation of myocytes and enhances healing
- Stimulates the proliferation of myofibrobalsts and increases fibrosis
- Enhances the differentiation of myoblasts and enhances healing
- Decreases the proliferation of myofibroblasts and reduces fibrosis
- Decreases the proliferation of myocytes and reduces healing
- Stimulates the proliferation of myofibrobalsts and increases fibrosis
RECOMMENDED READINGS
Gulotta LV, Rodeo SA. Muscle, tendon, and ligament. In: Flynn JM, ed. Orthopaedic Knowledge Update10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:37-48.Pereira BP, Tan BL, Han HC, Zou Y, Aung KZ, Leong DT. Intramuscular nerve damage in lacerated Jul;113(7):2330-45. doi: 10.1002/jcb.24105. PubMed PMID: 22573552.
- What cell is responsible for the production of receptor activator of nuclear factor kappa beta ligand and
osteoprotegerin?
- Osteocyte
- Osteoclast
- Osteoblast
- Macrophage
- Preosteoclast
- Osteoblast
RECOMMENDED READINGS
Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature. 2003 May 15;423(6937):337-42. Review. PubMed PMID: 12748652. Miller JD, McCreadie BR, Alford AI, Hankenson KD, Goldstein SA. Form and function of bone. In: Einhorn TA, O’Keefe RJ, Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:129-159.
- Which change, if any, will most likely occur within the articular cartilage of the knee as a result of
nonweight bearing for 2 months?
- No change
- Cartilage thinning
- Decreased water content
- Increased collagen synthesis
- Increased proteoglycan concentration
- Cartilage thinning
RECOMMENDED READINGS
Hinterwimmer S, Krammer M, Krötz M, Glaser C, Baumgart R, Reiser M, Eckstein F. Cartilage atrophyin the knees of patients after seven weeks of partial load bearing. Arthritis Rheum. 2004 Aug;50(8):2516-20. PubMed PMID: 15334465.
Sun HB. Mechanical loading, cartilage degradation, and arthritis. Ann N Y Acad Sci. 2010 Nov;1211:37-50. doi: 10.1111/j.1749-6632.2010.05808.x. Review. PubMed PMID: 21062294.
Millward-Sadler SJ, Wright MO, Davies LW, Nuki G, Salter DM. Mechanotransduction via integrins andinterleukin-4 results in altered aggrecan and matrix metalloproteinase 3 gene expression in normal, but notosteoarthritic, human articular chondrocytes. Arthritis Rheum. 2000 Sep;43(9):2091-9. PubMed PMID:11014361.
- At the time of heel strike in normal gait, what is the pattern of activation of the anterior tibialis?
- Relaxation
- Isotonic contraction until midstance
- Concentric contraction followed by relaxation
- Eccentric contraction throughout the stance phase
- Eccentric contraction followed by concentric muscle activity
- Eccentric contraction followed by concentric muscle activity
RECOMMENDED READINGS
Perry J. Normal gait. In: Smith DG, Michael JW, Bowker JH, eds. Atlas of Amputations and Limb. 3rd ed. Rosemont, IL: AmericanAcademy of Orthopaedic Surgeons; 2004:353-365.
Winter DA. Energy generation and absorption at the ankle and knee during fast, natural, and slowcadences. Clin Orthop Relat Res. 1983 May;(175):147-54. PubMed PMID: 6839580.
- In performing a study comparing infection rates for patients undergoing elective orthopaedic surgery whoreceived irrigation with or without the addition of antibiotics in the solution, what is the most appropriate statistical test to determine whether the proportion of patients developing infection is significant?
- ANOVA
- Paired t test
- Unpaired t test
- Chi-square test
- Bonferroni correction
- Chi-square test
RECOMMENDED READINGS
Bhandari M. Evidence-based orthopaedics: issues in research design, analysis, and critical appraisal.In: Einhorn TA, O’Keefe RJ,
Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of ClinicalPractice. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:87-101.
Kocher MS, Zurakowski D. Clinical epidemiology and biostatistics: a primer for orthopaedic surgeons. J Bone Joint Surg Am. 2004 Mar;86-A(3):607-20. Review. PubMed PMID: 14996892.
- What component of bone is most responsible for tensile strength?
- Hydroxyapatite
- Type I collagen
- Type II collagen
- Type X collagen
- Tricalcium phosphate
- Type I collagen
RECOMMENDED READINGS
Miller JD, McCreadie BR, Alford AI, Hankenson KD, Goldstein SA. Form and function of bone. In:
Einhorn TA, O’Keefe RJ, Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of ClinicalPractice. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:129-159.
Clohisy JC, Lindskog D, Abu-AmerY. Bone and joint biology. In: Lieberman JR, ed. AAOSComprehensive Orthopaedic Review. Rosemont, IL: American Academy of Orthopaedic Surgeons;2009:41-51.
- A randomized placebo-controlled study of 100 patients was performed to test the hypothesis that Drug A would improve the rate of fracture healing. The study found that patients who received Drug A had a shorter time to fracture healing (P < .05). A subsequent multicenter follow-up study with 1000 patients showed that there was no real difference in fracture healing rates when comparing the drug to the placebo (P=.25). Which kind of error occured in the first study?
1. Type 1
- Type 2
- Design
- Surgeon bias
- Underpowered study
1. Type 1
RECOMMENDED READINGS
Fosgate GT. Practical sample size calculations for surveillance and diagnostic investigations. J Vet DiagnInvest. 2009 Jan;21(1):3-14. Review. PubMed PMID: 19139495.
Petrisor BA, Bhandari M. Orthopaedic research: health research methodology. In: Flynn JM, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons;2011:167-177.
- What is the etiology of fretting corrosion?
- Oxidation
- Differences in oxygen tension
- Micromotion at contact sites under load
- Impurities entering metal during manufacturing
- Electrochemical potential between 2 metals in a conductive medium
- Micromotion at contact sites under load
RECOMMENDED READINGS
Singh K. Biomaterials. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons; 2009:21-28.
Srinivasan A, Jung E, Levine BR. Modularity of the femoral component in total hip arthroplasty. J AmAcad Orthop Surg. 2012 Apr;20(4):214-22. Review. PubMed PMID: 22474091.
- An 85-year-old woman with osteoarthritis of the knee wants to discuss treatment options for her pain.Which drug is most likely to result in serious renal impairment?
- Tramadol
- Ibuprofen
- Oxycodone
- Hydrocodone
- Acetaminophen
- Ibuprofen
- Figure 152 is an arthroscopic view of a reconstructive procedure performed on a 28-year-old man who had a medial femoral osteochondral lesion that measured 1.5 cm x 1.5 cm. The grafts were harvested fromthe superolateral aspect of the trochlea. What is the most accurate description for the process of graftincorporation?
- The bone graft will be incorporated into the subchondral bone, and the overlying cartilageremains viable.
- The bone graft will be incorporated into the subchondral bone, but the overlying cartilage isnonviable.
- The bone graft will be incorporated while the overlying cartilage is used as a scaffold to generate a new cartilage layer.
- The bone graft will not be incorporated; healing will occur only within the cartilage layer.
- The bone graft and cartilage will both be resobred and replaced by fibrocartilaginous matrix
- The bone graft will be incorporated into the subchondral bone, and the overlying cartilageremains viable.
RECOMMENDED READINGS
O’Driscoll SW, Saris DBF. Articular cartilage repair. In: Einhorn TA, O’Keefe RJ, Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 3rd ed. Rosemont, IL: American Academyof Orthopaedic Surgeons; 2007:349-364.
Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med. 2010 Jun;38(6):1125-33. Epub 2010 Apr 1. PubMed PMID: 20360608.
- Figure 179 is a recent pelvic radiograph of a 73-year-old woman who cannot ambulate. She developed blindness as an infant and has a history of difficulty with healing of limb fractures. What defect is associated with her disorder?
- PEX gene
- Fibrillin 1
- Collagen I
- Collagen oligomeric protein
- Carbonic anhydrase
- Carbonic anhydrase
RECOMMENDED READINGS
Dietz FR, Mathews KD. Update on the genetic bases of disorders with orthopaedic manifestations. J Bone Joint Surg Am. 1996 Oct;78(10):1583-98. Review. PubMed PMID: 8876589.
Einhorn TA. Metabolic bone disease. In: Einhorn TA, O’Keefe RJ, Buckwalter JA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:415-426.
- Figures 185a through 185c are the biopsy specimen and radiographs of a 43-year-old man with a slowly enlarging mass in his right proximal tibia. He has normal kidney function. Examination reveals a firm mass with slight tenderness. Which laboratory value is most likely elevated?
- Serum calcium
- Serum phosphorous
- Serum gamma globulin
- Serum creatine phosphokinase
- Prostate-specific angiten
- Serum calcium
RECOMMENDED READINGS
Singhal S, Johnson CA, Udelsman R. Primary hyperparathyroidism: what every orthopedic surgeon should know. Orthopedics. 2001 Oct;24(10):1003-9; quiz 1010-1. Review. PubMed PMID: 11688768.
Mankin HJ, Mankin CJ. Metabolic bone disease: a review and update. Instr Course Lect. 2008;57:575-93.Review. PubMed PMID: 18399611.
- Figures 270a through 270c are the MRI scans of a 65-year-old man who has pain in his right groin and buttocks. He had a metal-on-metal hip replacement 3 years ago. What is the most likely cause of hispain?
- Infection
- Lymphoma
- Sarcomatous change
- Large-particle wear debris disease
- Pseudotumor hypersensitivity response
- Pseudotumor hypersensitivity response
RECOMMENDED READINGS
Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res. 2010 Sep;468(9):2321-7.PubMed PMID: 20458645.
Kwon YM, Thomas P, Summer B, Pandit H, Taylor A, Beard D, Murray DW, Gill HS. Lymphocyte proliferation responses in patients with pseudotumors following metal-on-metal hip resurfacing arthroplasty. J Orthop Res. 2010 Apr;28(4):444-50. PubMed PMID: 19834954.
