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The JBJS Quiz of the Month is a collection of 10 relevant questions from each orthopaedic subspecialty. The questions are drawn from JBJS Clinical Classroom, which houses over 4,500 questions and 3,100 learning resources. Take the Quiz to see how you score against your peers!

NOTE: This quiz does not earn users CME credits. The questions must be answered within Clinical Classroom to earn CME credits.

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QUIZ of the Month Title Image with Orthopaedic Icons

May 2023

1 / 10

Trauma

Which of the following is considered a trauma-related risk factor for radioulnar synostosis?

Remediation:
A. A Monteggia fracture is a risk factor for radioulnar synostosis.
B. Head rather than chest trauma is a risk factor for radioulnar synostosis.
C. Fractures at the same level are a risk factor for radioulnar synostosis.
D. Comminution is a risk factor for radioulnar synostosis.

2 / 10

Sports Medicine

A 34-year-old male patient who is a baseball pitcher complains of pain in his throwing elbow. He has tenderness to palpation of the medial olecranon fossa and crepitus with motion of the elbow. An axial magnetic resonance image of the elbow is shown. Which of the following is the appropriate treatment?

Remediation:
A. Nonoperative treatment should be tried first.
B. Nonoperative treatment should be tried first.
C. Nonoperative treatment such as rest and strengthening exercises should always be tried before operative treatment is undertaken.
D. This could be considered after a course of rest and rehabilitation.

3 / 10

Spine

A 34-year-old male patient is visiting from out of the country and presents to the emergency department with a 3-month history of upper middle back pain, a dry cough, and unintended weight loss. Laboratory test results show a normal serum white blood-cell count. A chest radiograph shows a consolidation in the upper zone of the left lung with ipsilateral hilar enlargement suspicious for a tuberculous nodule. Which of the following radiographic characteristics helps distinguish tuberculous from pyogenic spinal infections?

Remediation:
A. Pott's disease was a common cause of acquired spinal kyphosis as TB tends to affect the anterior aspect of the spine, which leads to bony collapse and kyphosis.
B. This is a consistent feature of a tuberculous spine compared with pyogenic spinal infection.
C. Prior spinal surgery is a risk for pyogenic, not tuberculous, spinal infections. A TB spine comes from hematogenous spread of primary pulmonary TB.
D. Anterior column involvement is common for TB. Osteolysis and collapse leads to kyphosis.

4 / 10

Shoulder & Elbow

A 42-year-old male patient who is an internal medicine physician starts a new exercise program involving vigorous weightlifting, pull-ups, and rowing. He presents with 6 weeks of medial elbow pain. Plain radiographs are negative. Physical evaluation reveals pain with wrist flexion and tenderness over the medial distal humerus. A milking maneuver does not elicit pain. Initial treatment should be directed at which of the following diagnoses?

Remediation:
A. The patient has typical findings of tenderness over the medial epicondyle with pain with wrist flexion.
B. The patient has negative radiographic findings for any arthritis.
C. Although cubital tunnel syndrome can cause medial elbow pain, this patient has no paresthesias or neurogenic symptoms.
D. Although an ulnar collateral ligament tear can cause medial elbow pain, the patient has a negative milking maneuver, which would be indicative of an ulnar collateral ligament tear

5 / 10

Pediatrics

A 9-year-old boy presents with spontaneous left knee swelling and pain of 1-week duration (clinical photograph shown). The patient denies a history of trauma and his parents report low-grade fevers over the past 1 week. He has a knee range of motion from 10°to 90° with discomfort along this arc of motion. Left knee aspiration shows a nucleated cell count of 70,000 x 109/L with a negative Gram stain. A Lyme Western Blot test is positive. Which of the following is the most appropriate next step in treatment?

Remediation:
A. The clinical scenario suggests Lyme arthritis confirmed by Western Blot evaluation. The initial treatment for Lyme arthritis is antibiotics as operative debridement is unnecessary.
B. The clinical scenario suggests Lyme arthritis confirmed by Western Blot evaluation. The initial treatment for Lyme arthritis is antibiotics. Arthroscopic synovectomy is reserved for knee effusions that chronically recur despite antibiotic treatment.
C. The clinical scenario suggests Lyme arthritis confirmed by Western Blot evaluation. The initial treatment for Lyme arthritis is antibiotics. Simple observation will allow the infection to continue, with the potential of harming other organ systems.
D. The clinical scenario suggests Lyme arthritis confirmed by Western Blot evaluation. The initial treatment for Lyme arthritis is antibiotics and doxycycline is recommended.

6 / 10

Basic Science

You are asked to evaluate a newborn who was born at 39 weeks to a 42-year-old gravida 1, para 1 mother after the newborn was found to have hypotonia and a poor Moro reflex. Physical examination shows hypoplasia of the middle phalanx and clinodactyly of the small fingers, a single palmar crease, a wide gap and plantar crease between the great and second toes, and hypermobility of the joints. Which of the following axial skeletal conditions may also be present in a patient with this diagnosis?

Remediation:
A. This can cause coronal plane deformities of the thoracic spine regardless of syndromic presentation, but is not typical of Down syndrome.
B. While patients with Down syndrome may have atlantoaxial abnormalities, a fusion at the occipitoatlantal joint is not typical.
C. Twelve to 20% of individuals with Down syndrome (trisomy 21) have instability at the atlantoaxial joint. Screening for this instability is with flexion and extension lateral radiographs of the cervical spine.
D. This is not typical of patients with Down syndrome. Kyphosis specifically is typical of Scheuermann disease.

7 / 10

Hand & Wrist

A 2-year-old girl, recently adopted from outside the United States, presents with her parents for an initial evaluation. The diagnosis of a type IV radial longitudinal deficiency is made. Which of the following is the initial step in management?

Remediation:
A. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes.
B. The priority in a patient newly diagnosed with radial longitudinal deficiency is to evaluate for associated syndromes. This requires obtaining laboratory studies, including a complete blood-cell count and a chromosomal breakage analysis. Early detection of Fanconi's anemia can be lifesaving.
C. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes.
D. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes. Creation of a one-bone forearm is not an option in type IV radial longitudinal deficiency, where the radius is completely absent.

8 / 10

Foot & Ankle

A 20-year-old female patient who is a collegiate soccer player presents for evaluation of posterolateral ankle pain. She reports that the pain started with a slide-tackle injury during a game 3 months ago. She did not initially seek evaluation because she thought it was "just a sprain," but the pain has persisted and continues to limit her ability to compete. She denies any prior significant injuries to either ankle. On physical examination, she has tenderness at the retrofibular groove and posterolateral border of the fibula. She has no other areas of tenderness about the ankle or foot. She has pain with resisted eversion of the foot but demonstrates symmetric eversion strength. Inspection and palpation of the tendons during which of the following actions will best discriminate between a tendon tear and tendon instability?

Remediation:
A. Tendon subluxation or dislocation during circumduction indicates peroneal tendon instability. Symmetric eversion strength suggests that the tendons are not torn.
B. Forced passive inversion will typically produce peroneal tendon pain that is more consistent with a tendon tear.
C. A single-leg heel rise does not discriminate between peroneal tendon tear and instability.
D. Anterior drawer testing is used to assess the competency of the anterior talofibular ligament.

9 / 10

Knee

Which of the following concepts is most consistent with kinematic alignment in total knee arthroplasty?

Remediation:
A. The transverse axis of the femoral component is aligned with the transverse axis of the native prearthritic femur.
B. The distal femoral cut is in valgus and ranges from 5° to 9°of valgus. Kinematic alignment usually has a 7° to 5° valgus distal femoral cut.
C. The tibia is cut perpendicular to the mechanical axis in the mechanically aligned knee.
D. Kinematic alignment is based on the 3-dimensional motion of the knee. It is designed to recreate the more natural kinematics of the knee about the axis of rotation of the femoral condyles.

10 / 10

Hip

A 56-year-old female patient presents for evaluation of her left hip pain. She has tried outpatient and home physical therapy, nonsteroidal anti-inflammatory drugs, and acetaminophen, with little relief. She had a corticosteroid injection 5 weeks ago, which relieved >90% of her pain for approximately 2 weeks. She has hypothyroidism and a body mass index of 30 kg/m2. When discussing operative treatment with the patient, you tell her that if she has surgery within 3 months after receiving a corticosteroid injection, she is at risk for which of the following? "

Remediation:
A. There is no evidence showing an increased risk of calcar fracture or Vancouver fracture when a corticosteroid is administered prior to total hip arthroplasty.
B. There is no evidence showing an association between length of hospital stay and when a corticosteroid is administered prior to total hip arthroplasty.
C. There are no reported increased rates of dislocation if a patient receives a corticosteroid injection within 3 months of total hip arthroplasty.
D. Multiple studies have demonstrated that an intra-articular corticosteroid injection within 3 months of a total hip arthroplasty results in significantly higher rates of infection.

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