April 25, 2011

GMS 826 Final Examination

James M. Losito, DPM

1. In the management of a Jones fracture, which of the following will allow for the most rapid return to sport ? A. Open reduction with a tubular plate B. Open reduction with solid screw C. Percutaneous reduction with a kirshner wire *D. Precutaneous reduction with a cannulated screw E. Cast immobilization only 2. The most common location for a metatarsal stress fracture in a dancer is: *A. Base of the second metatarsal B. Jones fracture C. Fifth metatarsal base fracture D. Spiral oblique fracture of the fifth metatarsal shaft E. Third metatarsal fracture 3. The most likely pediatric overuse anterior knee pain in the 10 20 y.o. age group is: A. Shin splints B. Tibial stress fracture C. Meniscal injury D. Patellofemoral dysfunction *E. Osgood Schlatters disease 4. Which of the following is not inflammatory in nature ? A. Parateneonitis *B. Tendinosis C. Tenosynovitis D. Osteochondritis E. Tendonitis 5. Runners knee is otherwise known as: A. Meniscal tear B. Illiotibial band friction syndrome C. Pre-patellar bursitis D. Patellar tendonitis *E. Patellofemoral dysfunction

6. A positive squeeze test when examining a painful heel is suggestive of: A. Plantar fasciitis B. Subtalar joint arthropathy *C. Calcaneal stress fracture D. Heel spur syndrome E. Achilles insertional calcific tendonosis 7. Management of a midfoot type I injury consists of: *A. Protection for 4 8 weeks B. Three weeks NWB cast and 1-3 weeks WB cast C. Cast immobilization for 6-8 weeks NWB and 2-4 weeks WB cast D. Surgical intervention, followed by cast immobilization E. None of the above 8. Exertional leg pain with no pain at rest and no pain with palpation during physical examination is most suggestive of: A. Popliteal artery entrapment syndrome B. Tibial fasciitis C. Tibial stress fracture *D. Chronic exertional compartment syndrome E. Deep venous thrombosis 9. A positive Lachmans maneuver is pathoneumonic for: A. Meniscal pathology B. Patellofemoral dysfunction *C. Anterior cruciate rupture D. Illio-tibial band friction syndrome E. Medial collateral ligament strain 10. A positive Clarks test is diagnostic for: *A. Chondromalacia patellae B. Meniscal injury C. Collateral ligament injury D. Illiotibial band friction syndrome E. Anterior cruciate ligament stability 11. A history of the knee locking-up or giving-way is indicative of; A. Anterior cruciate ligament tear B. Patellofemoral dysfunction *C. Meniscal pathology D. Patellar tendonitis E. Collateral ligament strain

12. Which of the following is a potential risk factor for tibial fasciitis (shin splints)? A. Tibialis anterior weakness B. Ankle equinus C. Overuse history D. A and C only *E. All of the above 13. In the management of __________ a pre-fabricated orthosis compares favorably with a custom orthotic device. A. Posterior tiibial tendonitis B. Tibial fasciitis *C. Plantar fasciitis D. Jones fracture prevention E. Metatarsal stress fracture 14. Which of the following stress fractures is most common ? A. First metatarsal neck B. Fifth metatarsal base *C. Second metatarsal neck D. Third metatarsal base E. Fourth metatarsal base 15. Ski boot neuropraxia is due to: A. Thermal injury to the cutaneous nerves of the foot B. Injury to the common peroneal nerve C. Tarsal tunnel syndrome *D. Compression of the dorsal cutaneous nerves of the foot E. Excessive subtalar joint pronation during skiing 16. Which of the following is true regarding the use of cannulated screws in the surgical management of a Jones fracture ? A. The cannulated screws have an increased failure rate B. The solid screws are commonly inserted percutaneously C. The cannulated screws require more surgical exposure D. Solid screws and cannulated screws are equally srrong *E. Patients return to activity sooner when cannulated screws are utilized 17. When posterior heel pain is present and achilles insertional calcific tendonosis is suspected, ____________ must be excluded. Your patient is an adult male. A. Calcaneal apophysitis B. Seronegative arthritis C. Nerve entrapment *D. Gout E. Infection

18. The most commonly encountered pediatric overuse sports-related foot or ankle injury is: *A. Severs disease B. Islens disease C. Osgood-Schlatters disease D. Tarsal coalition E. None of the above 19. The shoes which are notorious for contributing to calcaneal apophysitis are: *A. Soccer cleats B. Tight-fitting dress shoes C. Running shoes D. Baseball cleats E. High-heeled (>1 inch) shoes 20. A 10 y.o boy sustains a lateral ankle (inversion) injury and is unable to weight-bear immediately after. Radiographs are largely unremarkable but there is significant edema and pain upon palpation of the ankle one week later. The best initial management is: A. CAM walking boot for 4 weeks B. Fiberglass NWB immobilization for 6 weeks *C. MRI and non-weight bearing in a Jones compression cast D. Aircast ankle brace E. ASO ankle brace and initiate physical therapy 21. Which of the following constitute appropriate conservative initial management of achilles insertional calcific tendonosis ? A. Ice massage B. Dexamethasone iontophoresis C. Achilles stretching D. Friction massage *E. All of the above 22. A hyperextension injury of the first metatarsal phalangeal joint is referred to as: A. Runners toe B. Tennis toe C. Dancers toe *D. Turf toe E. Sand toe 23. Following intramedullary screw fixation of a Jones fracture, when is it most appropriate for the athlete to return to full activity ? A. Following 8-12 weeks of immobilization B. Absence of any symptoms following 8-12 weeks of immobilization C. Depends on the screw size utilized *D. Following radiographic evidence of complete osseous union E. Depends on weather or not bone graft was utilized

24. Which of the following is most important in the initial management of proximal plantar fasciitis ? A. Corticosteroid injection B. Custom orthotic device C. Pre-fabricated orthotic device *D. Achilles stretching E. Physical therapy 25. Which if the following is not true regarding achilles paratenonitis *A. Focal point of tenderness along the achilles tendon B. Most common area is 2 5 cm from the insertion C. Pain is worse while palpating the tendon with the ankle dorsiflexed D. Inflammation of the covering of the achilles tendon E. Surgical management may be necessary 26. In which of the following is orthotic management generally not indicated ? A. Runners knee *B. Jumpers knee C. Illio-tibial banding friction syndrome D. Anterior cruciate injury E. Medial collateral ligament strain 27. Which of the following is not true regarding achilles tendinopathy ? *A. Achilles tendon ruptures generally occur spontaneously with no pre-existing disease B. Achilles tendon ruptures are secondary to intrinsic degenerative changes C. Achilles paratenonitis may be identified via MRI D. Achilles tendon ruptures are more common in males than in females E. Fluoroquinolone antibiotics may predispose to tendon rupture 28. Which of the following is the most essential aspect of rehabilitation of tibial fasciitis ? A. Ultrasound *B. Muscular strengthening / achilles stretching C. Friction massage D. Iontophoresis E. Achilles strengthening / hamstring stretching 29. Which of the following would be appropriate in the management of achilles tendinosis when the standard initial conservative management fails ? A. ESWT B. PRP (platlet-rich plasma) C. Corticosteroid injection *D. A and B only E. All of the above

30. Which of the following symptoms is not consistent with the initial diagnosis of chronic exertional compartment syndrome? A. Sensory deficit B. Motor deficit *C. Loss of pedal pulses D. Extreme pain E. Swelling of the leg 31. Which of the following is not true regarding lower leg intracompartmental pressures? A. Pre-exercise resting pressure is normally between 5-15 mm Hg B. Intracompartmental pressure during exercise should be less than 35 mm Hg *C. 5 minute post-exercise pressure should be less than 30 mm Hg D. Post-exercise intracompartmental pressure should return to pre-exercise level in 6 minutes or less E. Elevation in resting blood pressure may affect intracompartmental pressure 32. The classic diagnostic test for a ruptured achilles tendon is: A. Homans test B. Gordons test C. Squeeze test *D. Thompson test E. Jacks test 33. When performing a closed reduction of a subtalar joint dislocation, which of the following is true ? A. The hip is flexed B. The knee is extended C. General anesthesia is required D. The ankle joint is plantarflexed *E. The patient is prone 34. When performing a superficial and deep posterior compartment release for chronic compartment syndrome, one must carefully avoid the: A. Intermuscular septum B. Common peroneal nerve C. Superficial peroneal nerve D. Superficial fascia *E. Saphenous vein and nerve

35. Exertional leg pain and swelling with weakness during ankle joint dorsiflexion and subtalar joint eversion along with sensory loss to the dorsal aspect of the foot is consistent with a diagnosis of: A. Anterior compartment syndrome *B. Lateral compartment syndrome C. Deep posterior compartment syndrome D. Superficial posterior compartment syndrome E. None of the above 36. Which of the following has the best prognosis for successful conservative management? A. Jones fracture B. Navicular stress fracture *C. Calcaneal stress fracture D. Comminuted sesamoid fracture E. Chronic tibial stress fracture 37. The most common overuse leg pain in swimming is: *A. Extensor tendonitis B. Tibialis anterior tendonitis C. Peroneal tendonitis D. Posterior tibialis tendonitis E. Achilles tendonitis 38. In which type of exertional lower leg pain may the knee become warm and pedal paraesthesias common ? A. Common peroneal nerve entrapment B. Flexor hallucis longus tendonitis *C. Popliteal artery entrapment syndrome D. Chronic compartment syndrome E. Deep venous thrombosis 39. A positive Theater sign is suggestive of: A. Patellar tendonitis B. Anterior cruciate injury *C. Patellofemoral dysfunction D. Meniscal pathology E. Pes anserinus bursitis / tendonitis 40. Following surgical repair of an achilles tendon rupture, which is the best initial post-operative management ? *A. Weight-bearing (WB), below the knee (BK) immobilization for 8 12 weeks B. Weight-bearing, BK immobilization for 4 6 weeks C. Non-weight-bearing (NWB), above the knee (AK) immobilization for 8 12 weeks D. NWB, AK immobilization for 4 8 weeks, WB, BK immobilization for 4 8 weeks E. NWB, BK immobilization for 4 8 weeks, WB, BK immobilization for 4 weeks

41. The cruciate ligaments of the foot consists of: A. Interosseous talo-calcaneal and spring ligaments *B. Interosseous talo-calcaneal and Cervical ligaments C. Interosseous talo-calcaneal and bifurcate ligaments D. Bifurcate and Cervical ligaments E. Lisfrancs and Cervical ligaments 42. When a painful tennis toe is encountered 10 hours following the initial injury and the nail is not separated from the nail bed, the most appropriate management would be: (consider that the athlete must play a tennis match the next day) A. Avulse the nail *B. Evacuate the hematoma and accommodate C. Accommodate with padding only D. Splint the digit to the adjacent toe E. Change to a larger shoe size 43. Appropriate management of an acute blister during athletic competition consists of: A. Evacuation B. Application of moleskin C. De-roof the blister and begin soaks *D. A and B only E. B and C only 44. The primary proposed mechanism of action of extracorporeal shock wave therapy (ESWT) in the management of proximal plantar fasciitis is: A. Increased scar tissue *B. Angiogenesis with increased vascularity C. Decalcification D. Osteolysis E. Nerve desensitization 45. The Dancers fracture is: A. Head of the second metatarsal B. Base (tuberosity) of the fifth metatarsal C. Base of the second metatarsal *D. Distal shaft of the fifth metatarsal E. Head of the fourth metatarsal 46. Which of the following metatarsal stress fractures has the worst prognosis for healing with conservative care ? A. Head of the second metatarsal B. Base (tuberosity) of the fifth metatarsal C. Base of the second metatarsal D. Shaft of the third metatarsal *E. Base of the fourth metatarsal

47. In which of the following is surgical intervention the treatment of choice in the competitive / professional athlete ? A. Medial malleolar stress fracture B. Comminuted sesamoid fracture C. Jones fracture D. A and C only *E. All of the above 48. Which of the following would be appropriate in the management of chronic turf toe? A. Turf toe taping technique B. An orthotic with a rigid extension plantar to the metatarsal phalangeal joint C. A shoe with a flexible toe box *D. A and B only E. All of the above 49. Tennis leg is defined as: A. Injury to the extensor tendons B. Partial tear of the achilles tendon C. Plantaris tendon rupture *D. A tear of the gastrocnemius E. Myositis of the gastrocnemius / soleus 50. When differentiating tibial periostitis from a tibial stress fracture, which of the following is not true? A. The Tc 99 scan is positive in all three phases when a stress fracture is present B. Focal tenderness upon palpation is noted when a stress fracture is present *C. The Tc 99 uptake is longitudinal (linear) when a stress fracture is present. D. The Tc 99 scan is positive in the delayed images only when shin splints is present. E. When the dreaded black line is present, surgery is often required