orthopaedics quiz

Quiz Type

Practice

Subject

Surgery

Level

Level 400

Questions

10 questions

Created By

Nathaniel Kwame Brenyah

Quick Rules

Time limit: 10 minutes
Multiple attempts are not allowed
All questions must be answered to submit

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Question 1 of 10

Question 1

Multiple choice

A 45-year-old female presents with a history of a fall leading to right wrist pain. X-rays reveal a nondisplaced fracture of the distal radius. The patient is concerned about the implications of her injury. What is your best approach to manage her treatment considering her active lifestyle?

Recommend complete immobilization for 6 weeks with minimal movement.

Suggest a removable splint that allows for limited range of motion exercises.

Correct

Prescribe pain management and advise her to avoid using her wrist entirely for 3 weeks.

Advise immediate surgical intervention due to the risk of displacement.

Explanation

Using a removable splint that allows limited motion facilitates early rehabilitation and respects the healing process, especially given her active lifestyle. Complete immobilization could lead to stiffness and loss of function.

Question 2

Multiple choice

During surgery, a long bone fracture is identified with major soft tissue damage surrounding it. The fracture appears comminuted and unstable. What is the most appropriate immediate surgical approach to ensure proper healing?

Perform primary healing with plates and screws without addressing soft tissues.

Utilize external fixation to stabilize while allowing soft tissue recovery.

Correct

Apply a cast immediately after reduction to limit movement and promote healing.

Conduct a thorough debridement and then allow for natural healing without fixation.

Explanation

Using external fixation provides stability for the unstable comminuted fracture while allowing necessary soft tissue healing. Immediate plating could compromise soft tissue integrity.

Question 3

Multiple choice

A 30-year-old athlete presents with persistent leg pain after increasing training intensity. Physical examination reveals tenderness at the tibial plateau, and X-rays did not reveal any fractures. What is the most likely diagnosis and subsequent management?

Acute fracture; advise prolonged rest and immobilization.

Stress fracture; initiate a rehabilitation program while gradually increasing load.

Correct

Soft tissue contusion; order an MRI and recommend anti-inflammatory medication.

Tendinopathy; suggest cortisone injections for pain relief.

Explanation

The athlete's symptoms and training history suggest a stress fracture. Gradual rehabilitation is key to safely returning to activity.

Question 4

Multiple choice

A 60-year-old male with a history of osteoporosis presents following a fall, resulting in a fracture of the femur. Considering his condition, what factors should be prioritized in planning treatment?

Focus on immediate surgical intervention without regard for bone quality.

Consider a less invasive surgical technique to minimize soft tissue damage and promote healing.

Correct

Delay surgery until the patient's bone quality improves through medication.

Opt for hip arthroplasty as the first choice for all such fractures regardless of the specifics.

Explanation

Utilizing a less invasive surgical technique reduces soft tissue damage, which is critical for older patients with poor bone quality. Immediate aggressive treatment may further compromise the fragile structure of the bone.

Question 5

Multiple choice

A 28-year-old pregnant female presents with a fracture of the tibia in a high-energy incident. Her medical history shows a mild pelvic bone pathology. What should be the primary focus before surgical intervention?

Administer general anesthesia to ensure patient comfort during surgery.

Evaluate and stabilize the pelvic pathology before addressing the fracture.

Correct

Perform surgery as planned without any further imaging.

Suggest conservative treatment approaches for the fracture to avoid surgery.

Explanation

Evaluating and stabilizing the underlying pelvic pathology is crucial due to its potential impact on surgical outcomes and recovery, particularly in a pregnant patient.

Question 6

Multiple choice

You are in the OR prepping a patient for surgery on a complex, comminuted fracture of the humerus. During the pre-op assessment, the X-ray shows significant soft tissue injury surrounding the fracture. What surgical strategy would best address this situation?

Proceed with internal fixation immediately after debridement.

Use an external fixator initially to stabilize while observing soft tissue condition further.

Correct

Apply a cast post-debridement to ensure stability regardless of soft tissue condition.

Suggest waiting for 2 weeks before any surgical intervention to allow healing.

Explanation

Using an external fixator allows proper stabilization while giving soft tissues time to heal. Immediate internal fixation may exacerbate soft tissue compromise.

Question 7

Multiple choice

A 36-year-old male client, who is a firefighter, has returned after 4 months of conservative treatment for a non-union of a pediatric-type greenstick fracture in his forearm. His activity has not improved. What is the recommended next step for management?

Avoid any further surgical intervention and continue conservative treatment.

Consider surgical intervention to facilitate healing, possibly including bone grafting.

Correct

Encourage complete rest and immobilization for another 6 weeks.

Advise the cessation of any physical activity to promote healing.

Explanation

Considering the complications arising from a non-union, surgical intervention including techniques like bone grafting is critical to rectify the healing process.

Question 8

Multiple choice

A patient comes to the clinic with a history of recurrent fractures, which began after starting long-term corticosteroid therapy for an autoimmune disorder. Upon examination, the patient shows signs of osteopenia. What is your most immediate intervention for this case?

Discontinue corticosteroids immediately as they are the only cause.

Initiate bisphosphonate therapy to strengthen bone density while assessing corticosteroid risks.

Correct

Recommend increased calcium and vitamin D supplements without further evaluation.

Anticipate surgical restoration for previous fractures regardless of other treatment.

Explanation

Initiating bisphosphonate therapy helps counteract the osteoporosis effects of corticosteroids, offering a comprehensive approach to managing fracture risk.

Question 9

Multiple choice

An 18-year-old sports player presents with persistent pain in the ankle after an injury that was initially diagnosed as a sprain. Repeat X-rays have not shown any clear fractures. What strategy should be employed to ensure appropriate diagnosis and care?

Conduct an MRI to assess for potential stress fractures or cartilage injury.

Correct

Reassess the ankle with repeat X-rays after 6 weeks of rest and immobilization.

Advise complete cessation of all sporting activities indefinitely.

Reverse initial treatment and use a rigid cast to ensure complete immobilization.

Explanation

An MRI is essential for accurately diagnosing soft tissue injuries or stress fractures that may not be visible on regular X-rays, ensuring proper management and recovery.

Question 10

Multiple choice

A 45-year-old male presents to the emergency department after a motorcycle accident. X-rays reveal a comminuted fracture of the femur with significant soft tissue damage. The patient exhibits signs of compartment syndrome, including severe pain and swelling in the affected limb. As the surgical team, your immediate concern is addressing the fractured femur while also preventing permanent damage to the affected muscles and nerves. What should be your priority in this scenario?

Apply a long leg cast to immobilize the limb and decompress the fracture site.

Perform an emergency fasciotomy to relieve compartment pressure before any definitive fixation of the fracture.

Correct

Use closed reduction techniques to realign the bone and monitor compartment pressures continuously.

Schedule the patient for surgery the next day to allow for further evaluation of soft tissue status.

Explanation

The priority in this scenario is to perform an emergency fasciotomy to relieve the pressure from compartment syndrome, as failure to do so could lead to irreversible muscle and nerve damage. While immobilization is important for fracture management, it should not compromise the immediate need to address the compartment syndrome. Closed reduction could further endanger the limb's viability, and scheduling surgery for later is inappropriate considering the urgency of the situation.