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Basic Science 2014 Flashcards

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1
Q

Question 9

Abnormal development of which structure leads to altered orientation of the upper limb in mirror hand?

  1. Sclerotome
  2. Resting zone
  3. Progress zone
  4. Apical ectodermal ridge
  5. Zone of polarizing activity
A
  1. Zone of polarizing activity

RECOMMENDED READINGS

Herring JA, Mihran O. Tachdjian. Disorders of the upper extremity. In:Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. Philadelphia, PA: Saunders Elsevier;2008:483-637.

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2
Q

Question 22

What role does collagen have in the viscoelastic properties of articular cartilage?

  1. Maintaining aggrecan orientation
  2. Restraining the swelling pressure of aggrecan
  3. Creating a barrier for synovial fluid entering the matrix
  4. Providing Arg-Gly-Asp (RDG) segments for cell membrane attachment
  5. Preventing water from being expressed under pressure
A
  1. Restraining the swelling pressure of aggrecan

RECOMMENDED READINGS

Maroudas A. Physio-chemical properties of articular cartilage. In: Mar F, ed. Adult Articular Cartilage. Tunbridge Wells, England:Pitman Medical;1979:215-90.

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3
Q

Question 24

The hierarchical structure of a peripheral nerve from inside out is correctly described as

  1. axon, endoneurium, perineurium, fascicles, epineurium, myelin sheath.
  2. axon, endoneurium, myelin sheath, perineurium, fascicles, epineurium.
  3. axon, myelin sheath, endoneurium, perineurium, fascicles, epineurium.
  4. endoneurium, axon, myelin sheath, perineurium, fascicles, epineurium.
  5. endoneurium, axon, perineurium, fascicles, epineurium, myelin sheath.
A
  1. axon, myelin sheath, endoneurium, perineurium, fascicles, epineurium.

RECOMMENDED READINGS

Bhandari, M. Statistics: practical applications for orthopaedics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA , eds. Orthopaedic Basic Science: Foundations of Clinical Practice, 4th ed. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013.

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4
Q

Question 52

After sustaining a muscle injury, the best initial rest and exercise approach involves immobilization for

  1. 3 to 5 days followed by eccentric exercise.
  2. 3 to 5 days followed by progressive strengthening and stretching.
  3. 2 weeks followed by eccentric exercise.
  4. 2 weeks followed by light concentric exercise.
  5. 4 weeks followed by gradual return to activity.
A
  1. 3 to 5 days followed by progressive strengthening and stretching.

RECOMMENDED READINGS

Menetrey J, Kasemkijwattana C, Fu FH, Moreland MS, Huard J. Suturing versus immobilization of a muscle laceration. A morphological and functional study in a mouse model. Am J Sports Med. 1999 Mar- Apr;27(2):222-9. PubMed PMID: 10102105.

Wright A, Gharaibeh B, Huard J. Form and function of skeletal muscle. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:229-237.

Järvinen MJ, Lehto MU. The effects of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Med. 1993 Feb;15(2):78-89. Review. PubMed PMID: 8446826.

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5
Q

Question 61

Proteoglycan content is highest in which portion of the intervertebral disk?

  1. Deep annulus
  2. Middle annulus
  3. Superficial annulus
  4. Nucleus pulposus
  5. Vertebral end plate
A
  1. Nucleus pulposus

RECOMMENDED READINGS

Bhandari, M. Statistics: practical applications for orthopaedics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013.

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6
Q

Question 67

A study was designed to compare the frequency of infection among patients who underwent arthroplasty; one group received antibiotic cement and the other group received standard cement. Which statistical test can be used to compare the proportions of patients with infection in the 2 groups?

  1. t test
  2. Paired t test
  3. Chi-square test
  4. Analysis of variance
  5. Pearson correlation
A
  1. Chi-square test

RECOMMENDED READINGS

Losina E, Reichmann W, Katz, JN. Biostatistics in clinical research. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2013:509-513.

Bhandari M. Statistics: practical applications for orthopaedics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

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7
Q

Question 72

Which group of molecules is essential for osteoclast attachment to the bone surface?

  1. Actin
  2. Laminin
  3. Vimentin
  4. Integrins
  5. G proteins
A
  1. Integrins

RECOMMENDED READINGS

Bikle DD. Integrins, insulin like growth factors, and the skeletal response to load. Osteoporos Int. 2008 Sep;19(9):1237-46. doi: 10.1007/s00198-008-0597-z. Epub 2008 Mar 29. Review. PubMed PMID: 18373051.

Zuscik MJ, Drissi MH, Chen D, Rosier RN. Molecular and cell biology in orthopaedics. 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;2007:3-23.

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8
Q

Question 84

A 30-year-old man has pain and a mass aroudn his knee. Radiographs reveal a soft-tissue calcificiation and a soft-tissue mass around his knee. He underwent a biopsy and synovial sarcoma was diagnosed. Which test is most useful to determine the characteristic genetic abnormality associated with this malignancy?

  1. DNA ligation
  2. Genomic screening
  3. Cytogenetic analysis
  4. Polymerase chain reaction
  5. Restriction enzyme gel-electrophoresis
A
  1. Cytogenetic analysis

RECOMMENDED READINGS

Bhandari, M. Statistics: practical applications for orthopaedics. In: Lieberman JR, eds. AAOS Comprehensive Orthopaedic Review. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013.

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9
Q

Question 87

Which feature of noncollagenous bone extracellular proteins allows interaction with integrins on bone cells?

  1. Triple helix
  2. Ruffled boarder
  3. Proline hydroxylation
  4. Quarter-stagger orientation
  5. Arg-Gly-Asp (RGD) sequence
A
  1. Arg-Gly-Asp (RGD) sequence
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10
Q

Question 100

Which matrix component is responsible for the toe region of a tendon’s stress strain curve?

  1. Elastin
  2. Fibrillin
  3. Aggrecan
  4. Type II collagen
  5. Alpha smooth muscle actin
A
  1. Elastin

RECOMMENDED READINGS

Kastelic J, Palley I, Baer E. A structural mechanical model for tendon crimping. J Biomech. 1980;13(10):887-93. PubMed PMID: 7462263.

Hansen KA, Weiss JA, Barton JK. Recruitment of tendon crimp with applied tensile strain. J Biomech Eng. 2002 Feb;124(1):72-7. PubMed PMID: 11871607.

Poitout DG, ed. Biomechanics and Biomaterials in Orthopedics. New York,NY:Springer Publishing Company;2004:551-563.

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11
Q

Question 106

Aminoglycoside antibiotics work by which mechanism of action?

  1. Inhibiting DNA gyrase
  2. Inhibiting RNA polymerase
  3. Inhibiting polysaccharide cross-linking
  4. Binding to the 30S-ribosomal subunit
  5. Binding of the 50S-ribosomal subunit
A
  1. Binding to the 30S-ribosomal subunit

RECOMMENDED READINGS

Bhandari, M. Statistics: Practical Applications for Orthopaedics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

Gilbert DN, Moellering Jr RC, Eliopoulos GM, eds. The Sanford Guide to Antimicrobial Therapy, 40th ed. Sperryville, VA: Antimicrobial Therapy; 2010.

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12
Q

Question 115

What is the phenotype and mechanism of factor V Leiden disorder?

  1. Excessive bleeding attributable to protein C inactivation
  2. Excessive bleeding attributable to increased thrombin activation
  3. Excessive bleeding attributable to decreased thrombin activation
  4. Hypercoagulation attributable to increased thrombin activation
  5. Hypercoagulation attributable to decreased thrombin activation
A
  1. Hypercoagulation attributable to increased thrombin activation

RECOMMENDED READINGS

Conduah AH, Lieberman JR. Thromboembolism and pulmonary distress in thesetting of orthopaedic surgery. 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;2007:105-113.

Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de Ronde H, van der Velden PA, Reitsma PH. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature. 1994 May 5;369(6475):64-7. PubMed PMID: 8164741.

Vosmaer A, Pereira RR, Koenderman JS, Rosendaal FR, Cannegieter SC. Coagulation abnormalities in Legg-Calvé-Perthes disease. J Bone Joint Surg Am.2010 Jan;92(1):121-8. doi: 10.2106/JBJS.I.00157. PubMed PMID: 20048104.

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13
Q

Question 118

A 56-year-old woman has knee pain. Her degree of swelling and pain appears to exceed the relative appearance of radiographs, which show minimal change. Her body mass index is 38, and her current medical issues include hypertension, hypercholesterolemia, dyslipidemia, and insulin resistance. This condition is referred to as

  1. obesity syndrome.
  2. metabolic syndrome.
  3. inflammatory osteoarthritis syndrome
  4. insulin-fat disorder
  5. knee atherosclerosis disorder.
A
  1. metabolic syndrome.

RECOMMENDED READINGS

Inoue R, Ishibashi Y, Tsuda E, Yamamoto Y, Matsuzaka M, Takahashi I, Danjo K, Umeda T, Nakaji S, Toh S. Medical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population. J Orthop Sci. 2011 Nov;16(6):704-9. doi: 10.1007/s00776- 011-0157-9. Epub 2011 Sep 14. PubMed PMID: 21915668.

Engström G, Gerhardsson de Verdier M, Rollof J, Nilsson PM, Lohmander LS. C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study. Osteoarthritis Cartilage. 2009 Feb;17(2):168-73. doi: 10.1016/j.joca.2008.07.003. Epub 2008 Aug 29. PubMed PMID: 18760940.

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14
Q

Question 126

A patient who undergoes surgery for shoulder instability has increased CO2 production, tachycardia, and a core body temperature that rises soon after an inhalational anesthetic agent is used to induce anesthesia. This rare syndrome is associated with which inheritance pattern?

  1. Sporadic mutation
  2. X-linked recessive
  3. X-linked dominant
  4. Autosomal recessive
  5. Autosomal dominant
A
  1. Autosomal dominant

RECOMMENDED READINGS

Glahn KP, Ellis FR, Halsall PJ, Müller CR, Snoeck MM, Urwyler A, Wappler F; European Malignant Hyperthermia Group. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth. 2010 Oct;105(4):417-20. doi: 10.1093/bja/ aeq243. PubMed PMID: 20837722.

MacLennan DH, Phillips MS. Malignant hyperthermia. Science. 1992 May 8;256(5058):789-94. Review. PubMed PMID: 1589759.

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15
Q

Question 134

A 50-year-old man had severe pain in his right neck and shoulder for 1 week, which resulted in an inability to abduct his right shoulder. Examination revealed winging of the scapula and weakness of the supraspinatus. There was no evidence of infection or glenohumeral pathology on the MR image. However, the supraspinatus had some fatty infiltration change. Electromyography (EMG) at 3 weeks showed acute denervation with positive sharp waves and fibrillation potentials (both peripheral nerve and nerve root distribution). By 6 weeks, he was improving. A repeat EMG performed 3 months after onset shows early reinnervation with polyphasic motor unit potentials. What is the most likely diagnosis?

  1. Pancost tumor
  2. C5 radiculopathy
  3. Postpolio syndrome
  4. Neuralgic amyotrophy
  5. Amyotrophic lateral sclerosis
A
  1. Neuralgic amyotrophy

RECOMMENDED READINGS

Tjoumakaris FP, Anakwenze OA, Kancherla V, Pulos N. Neuralgic amyotrophy (Parsonage-Turner syndrome). J Am Acad Orthop Surg. 2012 Jul;20(7):443-9. doi: 10.5435/JAAOS-20-07-443. Review. PubMed PMID: 22751163.

Stutz CM. Neuralgic amyotrophy: Parsonage-Turner Syndrome. J Hand Surg Am. 2010 Dec;35(12):2104- 6. doi: 10.1016/j.jhsa.2010.09.010. Epub 2010 Oct 30.Review. PubMed PMID: 21035964.

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16
Q

Question 142

Sheathed tendons receive their blood supply from

  1. fibrils
  2. vincula.
  3. paratenon.
  4. synovial cells.
  5. Sharpey fibres
Study These Flashcards
A
  1. vincula.

RECOMMENDED READINGS

Reuther KE, Gray CF, Soslowsky LJ. Form and function of tendon and ligament. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2013:213-229.

Herring JA, Mihran O. Disorders of the upper extremity. In Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. Philadelphia, PA:Saunders Elsevier;2008:483-637.

17
Q

Question 148

A physically active 64-year-old woman with no history of fracture sustains a fragility fracture. She has no constitutional symptoms. Her bone mineral density (BMD) value at age 55 was normal (T-scores: spine +0.1, hip -0.1). A repeat BMD is now reported as osteopenic (T-scores: spine -2.0, hip -1.9). Her serum calcium alkaline phosphatase levels are elevated and serum phosphorus level is low. Considering this information, what is the most appropriate next test?

  1. Urinary hydroxyproline
  2. Serum thyroid hormone panel
  3. Serum protein electrophoresis
  4. Serum 25 hydroxycholecalciferol
  5. Serum parathyroid hormone
Study These Flashcards
A
  1. Serum parathyroid hormone

RECOMMENDED READINGS

Bukata SV, Tyler WK. Metabolic bone disease. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2013:229-237.

Fraser WD. Hyperparathyroidism. Lancet. 2009 Jul 11;374(9684):145-58. doi: 10.1016/S0140- 6736(09)60507-9. Review. PubMed PMID: 19595349.

18
Q

Question 153

For ductile materials, what is the point beyond which permanent deformation occurs?

  1. Equilibrium
  2. Yield point
  3. Failure point
  4. Ultimate strain
  5. Ultimate stress
Study These Flashcards
A
  1. Yield point

RECOMMENDED READINGS

Caffrey JP, Sah RL. Biomechanics of musculoskeletal tissues. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:55-69.

Singh K. Biomaterials. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL: American Academy of Orthopaedic Surgeons;2009:29-41.

19
Q

Question 155

Relative to the null hypothesis, a type II error

  1. is equal to 1- beta
  2. correctly rejects a false null hypothesis.
  3. correctly accepts a true null hypothesis.
  4. incorrectly rejects a true null hypothesis.
  5. incorrectly accepts a false null hypothesis.
Study These Flashcards
A
  1. incorrectly accepts a false null hypothesis

RECOMMENDED READINGS

Bhandari M. Statistics: practical applications for orthopaedics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:199-207.

O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA (eds): Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL, American Academy of Orthopaedic Surgeons; 2013.

20
Q

Question 166

A physician reviewed 35 studies on a medication’s effect on knee osteoarthritis pain. Available data included degrees of positive or negative effects of the drug and numbers and ages of patients. There is suspicion for bias in some of these reports. The best way to determine possible bias is to use

  1. a forest plot.
  2. a funnel plot.
  3. power analysis.
  4. regression analysis.
  5. a receiver operator characteristic curve.
Study These Flashcards
A
  1. a funnel plot.

RECOMMENDED READINGS

Vavken P, Dorotka R. The prevalence and effect of publication bias in orthopaedic meta-analyses. J Orthop Sci. 2011 Mar;16(2):238-44. doi:10.1007/s00776-011-0040-8. Epub 2011 Mar 2. PubMed PMID: 21360256.

Schmidt AH, Leopold SS, Stovitz SD. Detection of bias in clinical research. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2013:43-53.

21
Q

Question 170

To determine a gene’s importance in a cellular process, a loss-of-function experiment is designed. Which molecular method can be used to block the translation of mRNA?

  1. Southern blot
  2. Western blot
  3. Northern blot
  4. siRNA application
  5. Restriction digestion
Study These Flashcards
A
  1. Northern blot

RECOMMENDED READINGS

Lee FY, Drissi HM, Zuscik, MJ, Chen D, Nizami S, Goto H. Molecular and cell biology in orthopaedics. In: O’Keefe R, Jacobs JJ, Chu DR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:3-43.

22
Q

Question 176

The bone erosion associated with rheumatoid arthritis is attributable to production of

  1. osteoprotegerin (OPG) by B cells.
  2. OPG by T cells.
  3. OPG by macrophages.
  4. receptor activator of nuclear factor kappa beta ligand (RANKL) by B cells.
  5. RANKL by T cells.
Study These Flashcards
A
  1. RANKL by T cells.

RECOMMENDED READINGS

Schett G, Gravallese E. Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment. Nat Rev Rheumatol. 2012 Nov;8(11):656-64. doi: 10.1038/nrrheum.2012.153. Epub 2012 Sep 25. Review. PubMed PMID: 23007741.

Mensah KA, O’Keefe RJ. Basic science of immunology in orthopaedics. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:103-117.

Fischer, CD, Ludwig SC. (2009) Rheumatoid Arthritis: Spinal Manifestations and Surgical Treatment. Orthopaedic Knowledge Online Journal, Subspecialty:Spine. Retrieved from:http://orthoportal.aaos.org/ oko/article.aspx?article=OKO_SPI030#article. Last accessed 9/8/2014.

23
Q

Question 186

What is the mechanism of action of bupivicaine?

  1. Sodium channel blockade
  2. Calcium channel blockade
  3. Acetylchoine receptor blockade
  4. Endogenous opiate release
  5. Blocking acetylcholine release
Study These Flashcards
A
  1. Sodium channel blockade

RECOMMENDED READINGS

Wong, J, Gupta, R (2010)Nerve Repair: Basic Science and Current Concepts, Orthopaedic Knowledge Online Journal. Retrieved from: http://orthoportal.aaos.org/oko/article.aspx?article=OKO_HAN028#article. Last accessed 9/8/2014.

24
Q

Question 192

What type of antigen is recognized by innate immunity?

  1. HLA class I
  2. HLA class II
  3. Fragments on antigen-presenting cells
  4. Structures common to multiple microbes
  5. Only specific antigens previously encountered
Study These Flashcards
A
  1. Structures common to multiple microbes

RECOMMENDED READINGS

Mensah KA, O’Keefe RJ. Basic science of immunology in orthopaedics. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:103-117.

Seo SW, Lee, FY. Cellular and molecular biology, immunology, and genetics. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL:American Academy of Orthopaedic Surgeons;2009:3-15.

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**Question 198** **Which molecule of the cartilage extracellular matrix is primarily responsible for hydrophilic behavior?** 1. Decorin 2. Aggrecan 3. Matrilin 1 4. Type IX collagen 5. Cartilage oligomeric matrix protein
2. Aggrecan RECOMMENDED READINGS Ulrich-Vinther M, Maloney MD, Schwarz EM, Rosier R, O’Keefe RJ. Articular cartilage biology. J Am Acad Orthop Surg. 2003 Nov-Dec;11(6):421-30. Review. PubMed PMID: 14686827.
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**Question 203** **Rods with equal diameters composed of which metal are most stiff?** 1. Tantalum 2. Pure titanium 3. Titanium alloy 4. Stainless steel alloy 5. Cobalt-chromium alloy
5. Cobalt-chromium alloy RECOMMENDED READINGS Mann KA, Allen MJ. Biomaterials in orthopaedic practice. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons;2013:69-87. Singh K. Biomaterials. In: Lieberman JR, ed. AAOS Comprehensive Orthopaedic Review. Rosemont, IL: American Academy of Orthopaedic Surgeons;2009:29-41.
27
**Question 207** **The tensile strength of nerves is mostly attributable to** 1. actin. 2. myelin. 3. collagen I. 4. neurofilaments 5. galactocerebroside.
3. collagen I. RECOMMENDED READINGS Jackson WM, Diao E. Peripheral nerves: form and function. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL:American Academy of Orthopaedic Surgeons, 2013:239-253. Wong, J, Gupta, R (2010)Nerve Repair: Basic Science and Current Concepts, Orthopaedic Knowledge Online Journal. Retrieved from: http://orthoportal.aaos.org/oko/article.aspx?article=OKO\_ HAN028#article. Last accessed 9/8/2014.
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Questio 227 Figure 227 is the clinical photograph of a patietn with scoliosis who has a 27-degree curvature. What is the most likley genetic defect? 1. Elastin 2. Fibrillin 3. Collagen I 4. Collagen II 5. Chondroitin sulfate
2. Fibrillin RECOMMENDED READINGS Sponseller PD, Erkula G, Skolasky RL, Venuti KD, Dietz HC 3rd. Improving clinical recognition of Marfan syndrome. J Bone Joint Surg Am. 2010 Aug 4;92(9):1868-75. doi: 10.2106/JBJS.I.00892. PubMed PMID: 20686061. Cook PC, Sanders JO. Genetic disease in orthopaedics. In: O’Keefe R, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2013:43-55.
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**Question 237** **The sequence of changes shown in Figure 237 is associated with which change in collagen composition in the nucleus pulposis?** 1. Decreased type I 2. Decreased type II 3. Decreased type X 4. Increased type III 5. Increased type IX
2. Decreased type II RECOMMENDED READINGS Moss, IL. Form and function of the intervertebral disk. In:RJ O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL. American Academy of Orthopaedic Surgeons;2013:253-261. Kepler CK, Anderson DG, Tannoury C, Ponnappan RK. Intervertebral disk degeneration and emerging biologic treatments. J Am Acad Orthop Surg. 2011Sep;19(9):543-53. Review. PubMed PMID: 21885700. Lotz, JC (2013) Biologic Repair of the Intervertebral Disk. Orthopaedic Knowledge Online Journal. Retrieved from:http://orthoportal.aaos.org/oko/article.aspx?article=OKO\_SCI002§ion=4&#article Last accessed 9/8/2014
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**Question 274** **An elderly woman has the fracture pattern shown in Figures 274a and 274b. Which medication do you suspect she had been taking for her bone health?** 1. Calcitonin 2. Estrogen 3. Bisphosphonate 4. Parathyroid hormone 5. Calcium and vitamin D
3. Bisphosphonate RECOMMENDED READINGS Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B, van der Meulen MC, Lorich DG, Lane JM. Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2009 Aug;20(8):1353-62. doi: 10.1007/s00198-008-0805-x. Epub 2008 Dec 9. PubMed PMID: 19066707. Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014 Sep 4;371(10):974-6. doi: 10.1056/NEJMc1403799. PubMed PMID: 25184886.
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