October 13, 2009 GMS 738 Midterm Examination

James M. Losito, DPM

1. Which of the following is considered the reducing test for a dislocated hip ? A. Barlows’ maeuver B. Ortilanis’ maneuver C. Galeazzis’ maneuver D. Abduction and external rotation of the hip E. Internal rotation of the hip 2. The most significant history regarding the potential for congenitally dislocated hip (CDH) is: A. A history of ligamentous laxity B. Premature birth C. A delay in the onset of ambulation D. Breech delivery E. Low birth weight delivery 3. Which of the following is the most common gait abnormality seen in CDH ? A. Circumductory gait B. Scissors gait C. Toe-walking gait D. Steppage gait E. Trendelenburg gait 4. When evaluating CDH radiographically, which of the following is not true ? A. Hilgenriener’s line is drawn horizontally B. Ombredranne’s line is drawn directly vertical to the upper lateral ossifying roof of the acetabulum C. The acetabular index should be < 30 degrees D. Menard’s line should be continuous E. The femoral epiphysis should be located in the upper medial quadrant as defined by Hilgenriener’s and Ombredranne’s lines 5. Which of the following is true regarding Charcot – Marie – Tooth disease ? A. Dropfoot deformity is often present B. Steppage gait may be seen C. An ankle foot orthosis may be indicated D. A and B only E. All of the above

> 20 degrees E.20 9. 10 degrees B.2 months B. Apophysitis C. Fracture B. Removing shoes 8. Tripping C. Weeks 1 . 15 degrees C. Ambulation is normally initiated by: A.6. Fatigue D. A 12 year old girl complains of acute .5 months C. The minimum ankle joint dorsiflexion (knee extended) available in a 18 year old should normally be: A. 9 – 16 months E. The radiograph is significant for a bone fragment with longitudinal orientation to the shaft. Weeks 14 .onset lateral foot pain with a history of an ankle sprain. Neoplasm E. Falling B. Weeks 4 – 6 C.9 months D. The most reliable indicator of a biomechanical abnormality is a history of: A.4 B. The critical period of intrauterine lower extremity development occurs during: A. Weeks 6 – 10 D. Night cramps E. Weeks 10 – 14 C. Your primary suspicion is: A. 20 degrees D. Infection . 3 . 7 . None of the above 10. 1 . Avascular necrosis D. 16 – 20 months 7.

The talar declination angle normally increases with age E. Varus. 9 oz. Which of the following is true regarding calcaneal apophysitis ? A. The calcaneal inclination angle normally decreases with development D. weighed 5 lbs.11. 6 degrees everted 16. Meniscal tear E. and began to ambulate at 14 months. Blount’s disease C. straight D. Kite’s angle normally reduces with development C. Which of the following is most likely in an active 15 y. Bone contusion C. She was full term. straight B. What is your primary suspicion ? A. varus E. female with insidious onset anterior knee pain ? A. The metatarsus adductus angle normally reduces to the adult value by age 7 B. Tibial varum reduces to < 5 degrees by age 15 years 14. Plantar heel pain may be present B. Varus. valgus C. In a 3 year old child. Patellar tendinitis D. Neoplasm affecting the left hip 12. 0 degrees everted B. 5 degrees everted E. At fifteen (15) months of age the position of the knee and tibia should normally be: A. Rearfoot vagus is generally present D. Osgood-Schlatter’s disease E. Her gait is antalgic and her left limb is externally rotated. An orthotic device is essential in the management C. High-top shoes are recommended E. the maximum allowable RCSP should be (normally): A. Valgus. Varus. 3 degrees everted C. Valgus. Slipped capital femoral epiphysis B. Jumper’s knee 13. valgus 15.. A heavy 12 year old girl presents with left knee pain and no history of trauma or night pain. Which of the following is true regarding pediatric radiographic alignment ? A. 4 degrees everted D. Patellofemoral dysfunction B. Injectable corticosteroids may be indicated .o. Coxa plana D.

Spasticity of the quadriceps musculature E. Your most likely diagnosis is A. Subtalar joint arthrodesis D. Neoplasm 18. Weakness of the quadriceps musculature B. Dropfoot deformity D.8 F. Weakness of the bicepts femoris C. Gower’s sign occurs due to: A. Cavus foot deformity E. Osteomyelitis E. Tibialis posterior tendon transfer E. The best indication for an ankle foot orthosis (AFO) is: A. In the surgical management of peroneal muscular atrophy. Flat foot (pronation) during gait C. Talar body fractures E. Spasticity of the gastrocnemius / soleus D. There is a history of trauma to the area five days previous. Talar neck fractures D. Femoral anteversion C. A 4 y. Tibialis anterior tendon transfer B. Navicular stress fracture D.. Radiographs are unremarkable.o.2 y. The midfoot is warm and erythematous . Asynchronous arm and leg movement B. In which of the following is fractures is avascular necrosis most likely ? A. Kohler’s Disease C. Decreased cadence E. Peroneus brevis tendon transfer C. Wide base of gait D. Which of the following does not correctly characterize normal immature (1 . His vital signs are significant for a temperature of 99.17. male presents with mid . Weakness of the semitendinosis 21.. Intraarticular calcaneal fractures B. Weak gastrocnemius / soleus .o. Bushke’s disease B. Decreased stride length 22. Metatarsal fractures 20. Achilles tendon lengthening 19. which of the following procedures is common ? A. Extraarticular calcaneal fractures C. Severe subtalar joint pronation B.) gait ? A. Night pain is denied.foot pain and an antalgic gait.

Dejerine – Sottas disease D. Steppage gait-circum. Scissor gait C. Compensation for a weak tibialis anterior may consist of: A. Trauma E. None of the above . Subtalar joint pronation D.23. A and C only E. Ankle equinus B. In which of the following is difficulty using a knife and fork frequently the presenting symptom? A. Knee hyperextension B . Cerebral palsy 28. A stiff – knee gait often requires ___________ as compensation: A. Roussy – Levy syndrome B. Scissor gait 26. Trendelenburg gait D. Excessive subtalar joint pronation C. Scissors gait C. Circumductory gait D. High-top shoes 25. Steppage gait B. Circumduction C. Knee hyperextension D. None of the above 27. Foot drop E. Stiff knee gait B. Intoed gait D. and vaulting E. Steppage gait E. All of the above 24. Other than overuse. The clinical presentation in a patient with a spastic gastrocnemius / soleus is ? A. Poliomyelitis E.Foot slap / drop C. Toe walking B. which of the following factors is most contributory to calcaneal apophysitis ? A. The most common type of gait abnormality observed in cerebral palsy is: A. Friedreich’s ataxia C.

V 30. Calcaneus. Calcaneus. Which of the following fractures may occasionally result in an acceleration of growth ? A. talus. A and B only E. A or B only E. medial and lateral cuneiforms D. The pediatric periosteum is more resilient and vascular than in the adult D. cuboid. In a newborn male you would expect to see which of the following tarsal bones. talus. Salter-Harris I B. IV E. Pediatric patients are more likely to sustain a fracture B. B or C only 33. Resting zone B. A supination – lateral rotation type I ankle injury is most likely to result in: A. navicular and cuboid B. talus. Calcaneus. Which of the following is not true regarding the anatomic differences between the adult and pediatric patient ? A. All tarsal bones should be present. I B. Non-union fractures are more common in pediatric patients E. Zone of proliferation D. Salter-Harris IV D. II C. Zone of calcification 32. Zone of provisional calicification C. Zone of maturation E. cuboid and lateral cuneiform C. A. Calcaneus. Salter – Harris I fracture B. talus and cuboid only E. All of the above 31. Thurston-Holland sign is seen in which of the following Salter-Harris fracture? A. Salter-Harris II C. Pediatric patients tend to heal fractures more rapidly than adults C. Salter – Harris II fracture C. .29. Ligamentous injury is less common in children than in adults 34. given normal ossification. III D. Injury to which of the following regions of the growth plate may result in cessation of growth ? A. Salter – Harris III fracture D.

Standard pronated orthotic E.Schlatter’s disease D. Standard neutral orthotic 39. 6 . Metatarsal phalangeal joint subluxation 37.8 degrees internal D. Denis – Brown bar C. Gait plate D. 10 . Treve’s disease 36. Which of the following does not represent a true avascular necrosis? A. In a 5 year old child. Frieberg’s disease B. Ankle foot orthosis (AFO) C. Osgood. Which of the following rotational devices maintains the knee in a flexed position ? A.6 degrees external C.15 degrees external E. Filauer bar B. Metatarsal head fracture E.2 degrees external B. A varus wedge or orthosis supinates the subtalar joint and prevents iatrogenic pes planus C. Which of the following would be most appropriate in the initial management a cerebral palsy child with a painful spastic flatfoot deformity ? uA.35. the malleolar position should be (normally): A. UCBL orthosis B. A 10 degree varus bend supinates the subtalar joint and prevents iatrogenic pes planus B. Counter rotational splint D. One must remain at least 10 degrees from the hip end range of transverse plane motion when setting the bar D. Kohlers’s disease C.18 degrees external 38. The bars and splints are usually tolerated up to age 6 E. Ganley splint E. Joint space narrowing D. The length of the bar may be the shoulder width of the child . Tibial torsion transformer 40. The most obvious radiographic finding in Friebergs’ infraction is: A. “Squaring” of the metatarsal head C. 0 . Legg-clave-perthe’s disease E. Which of the following is not true regarding the usage of the torsional bars and splints ? A. 4 . 13 . Periosteal reaction of the metatarsal head B.

Given this information. Normal development C. Intoeing secondary to equinus E. Rotational osteotomy 42. Mom and Dad bring their 2 year old daughter into your office concerned about her “pigeon toed” walking. the best conservative management would be: A. High-top shoes B.o. Intoeing secondary to femoral anteversion D. 40 degrees of ankle joint dorsiflexion bilateral and 5 degrees of external malleolar position bilateral. Exercises. The child is their first. They claim that their child also gets tired easily and prefers to be carried but does not trip. Brachman skate C. Management of the aforementioned patient (Q # 43) should include: A. Exercises only C. When intoed gait is causes significant disability / pain in an older (>7 yrs) child. A night splint of some kind only C. A night splint and gait plate only . child ? A. A night splint and orthosis D. Twister cables E. Intoeing secondary to low malleolar position B. Which of the following would be indicated in the management of intoed gait secondary to low malleolar position in a 16 m. Significant late midstance pronation of the subtalar joint is noted bilateral. Intoeing secondary to pseudolack of malleolar position 44. which of the following is true ? A. Tibial torsion transformer 43. A functional orthoses only E. was full term and began to ambulate at 13 months. Denis-Brown bar D. Ganley splint E. 4 degrees of transverse plane knee rotation bilateral. Twister cables D.41. Counter rotational splint B. orthoses and observation B. Your examination reveals 60 degrees of internal and 30 degrees of external hip rotation bilateral. Her angle of gait is 5 degrees adducted and the patella adducts at foot contact during gait.

What is your best option ? A. Your examination reveals a malleolar position of 5 degrees external B/L. Exercises and a functional orthosis 47. Ganley splint C. His angle of gait is 7 degrees adducted. Genu varum D. Charcot – Marie – Tooth disease 49. Which of the following would be most appropriate: A. Denis – Browne bar D. Which of the following therapeutic splints allows for correction of the forefoot and rearfoot ? A. He denies any tripping or clumsiness. A and C E. Fillauer bar C. He does not want to use the twister cables at this time. accompanied by his parents presents with B/L intoeing and “flat feet”. the result is: A. Functional orthosis C.45. Femoral anteversion E. An 8 year old boy. In which of the following is proliferation of shcwann cells present ? A. Duchenne muscular dystrophy E. Coxa valga C. When the angle of femoral inclination exceeds 128 degrees. A night splint and functional orthosis D. Roussy – Levy syndrome C. Filauer bar E. Exercises and a gait plate E. Dejerine – Sottas disease D. A 6 year old boy presents with a chief complaint of intoeing with frequent tripping / falling. His resting calcaneal stance position is 3 degrees everted. Denis-Browne bar B. Twister cables D. Your examination reveals intoeing secondary to femoral anteversion. Poliomyelitis B. midstance subtalar pronation during gait and a resting calcaneal stance position of 5 degrees everted. Functional orthosis only B. midstance subtalar pronation during gait with the patella deviating internally and an 8 degree adducted gait. Friedman counter splint . Counter rotational splint B. Femoral retroversion 48. B and C 46. Coxa vara B.

Tremor D. Spastic E. Athetosis . Rigid B.50. Ataxic C. The least common pattern of motor dysfunction seen in cerebral palsy is: A.

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