October 13, 2009 James M.

Losito, DPM
GMS 738
Midterm Examination

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
6. Ambulation is normally initiated by:

A. 1 - 2 months
B. 3 - 5 months
C. 7 - 9 months
D. 9 – 16 months
E. 16 – 20 months

7. The most reliable indicator of a biomechanical abnormality is a history of:

A. Falling
B. Tripping
C. Fatigue
D. Night cramps
E. Removing shoes

8. The critical period of intrauterine lower extremity development occurs during:

A. Weeks 1 - 4
B. Weeks 4 – 6
C. Weeks 6 – 10
D. Weeks 10 – 14
C. Weeks 14 - 20

9. The minimum ankle joint dorsiflexion (knee extended) available in a 18 year old should
normally be:

A. 10 degrees
B. 15 degrees
C. 20 degrees
D. > 20 degrees
E. None of the above

10. A 12 year old girl complains of acute - onset lateral foot pain with a history of an ankle
sprain. The radiograph is significant for a bone fragment with longitudinal orientation to the
shaft. Your primary suspicion is:

A. Fracture
B. Apophysitis
C. Avascular necrosis
D. Neoplasm
E. Infection
11. A heavy 12 year old girl presents with left knee pain and no history of trauma or night pain.
She was full term, weighed 5 lbs. 9 oz., and began to ambulate at 14 months. Her gait is antalgic
and her left limb is externally rotated. What is your primary suspicion ?

A. Slipped capital femoral epiphysis

B. Blount’s disease
C. Coxa plana
D. Meniscal tear
E. Neoplasm affecting the left hip

12. Which of the following is most likely in an active 15 y.o. female with insidious onset anterior
knee pain ?

A. Patellofemoral dysfunction
B. Bone contusion
C. Patellar tendinitis
D. Osgood-Schlatter’s disease
E. Jumper’s knee

13. Which of the following is true regarding pediatric radiographic alignment ?

A. The metatarsus adductus angle normally reduces to the adult value by age 7
B. Kite’s angle normally reduces with development
C. The calcaneal inclination angle normally decreases with development
D. The talar declination angle normally increases with age
E. Tibial varum reduces to < 5 degrees by age 15 years

14. At fifteen (15) months of age the position of the knee and tibia should normally be:

A. Varus, straight
B. Varus, valgus
C. Valgus, straight
D. Varus, varus
E. Valgus, valgus

15. In a 3 year old child, the maximum allowable RCSP should be (normally):

A. 0 degrees everted
B. 3 degrees everted
C. 4 degrees everted
D. 5 degrees everted
E. 6 degrees everted

16. Which of the following is true regarding calcaneal apophysitis ?

A. Plantar heel pain may be present

B. An orthotic device is essential in the management
C. Rearfoot vagus is generally present
D. High-top shoes are recommended
E. Injectable corticosteroids may be indicated
17. A 4 y.o. male presents with mid - foot pain and an antalgic gait. There is a history of trauma
to the area five days previous. The midfoot is warm and erythematous . Night pain is denied. His
vital signs are significant for a temperature of 99.8 F.. Radiographs are unremarkable. Your most
likely diagnosis is

A. Bushke’s disease
B. Kohler’s Disease
C. Navicular stress fracture
D. Osteomyelitis
E. Neoplasm

18.. In the surgical management of peroneal muscular atrophy, which of the following procedures
is common ?

A. Tibialis anterior tendon transfer

B. Peroneus brevis tendon transfer
C. Subtalar joint arthrodesis
D. Tibialis posterior tendon transfer
E. Achilles tendon lengthening

19. In which of the following is fractures is avascular necrosis most likely ?

A. Intraarticular calcaneal fractures

B. Extraarticular calcaneal fractures
C. Talar neck fractures
D. Talar body fractures
E. Metatarsal fractures

20. Gower’s sign occurs due to:

A. Weakness of the quadriceps musculature

B. Weakness of the bicepts femoris
C. Spasticity of the gastrocnemius / soleus
D. Spasticity of the quadriceps musculature
E. Weakness of the semitendinosis

21. Which of the following does not correctly characterize normal immature (1 - 2 y.o.) gait ?

A. Asynchronous arm and leg movement

B. Flat foot (pronation) during gait
C. Wide base of gait
D. Decreased cadence
E. Decreased stride length

22. The best indication for an ankle foot orthosis (AFO) is:

A. Severe subtalar joint pronation

B. Femoral anteversion
C. Dropfoot deformity
D. Cavus foot deformity
E. Weak gastrocnemius / soleus
23. A stiff – knee gait often requires ___________ as compensation:

A. Steppage gait
B. Circumduction
C. Subtalar joint pronation
D. A and C only
E. All of the above

24. Other than overuse, which of the following factors is most contributory to calcaneal
apophysitis ?

A. Ankle equinus
B. Excessive subtalar joint pronation
C. Intoed gait
D. Trauma
E. High-top shoes

25. Compensation for a weak tibialis anterior may consist of:

A. Knee hyperextension
B .Foot slap / drop
C. Trendelenburg gait
D. Steppage gait-circum, and vaulting
E. Scissor gait

26. The clinical presentation in a patient with a spastic gastrocnemius / soleus is ?

A. Stiff knee gait

B. Scissors gait
C. Knee hyperextension
D. Foot drop
E. None of the above

27. In which of the following is difficulty using a knife and fork frequently the presenting
symptom?

A. Roussy – Levy syndrome

B. Friedreich’s ataxia
C. Dejerine – Sottas disease
D. Poliomyelitis
E. Cerebral palsy

28. The most common type of gait abnormality observed in cerebral palsy is:

A. Toe walking
B. Scissor gait
C. Circumductory gait
D. Steppage gait
E. None of the above
29. Thurston-Holland sign is seen in which of the following Salter-Harris fracture?

A. I
B. II
C. III
D. IV
E. V

30. Which of the following fractures may occasionally result in an acceleration of growth ?

A. Salter-Harris I
B. Salter-Harris II
C. Salter-Harris IV
D. A and B only
E. All of the above

31. Injury to which of the following regions of the growth plate may result in
cessation of growth ?

A. Resting zone
B. Zone of provisional calicification
C. Zone of proliferation
D. Zone of maturation
E. Zone of calcification

32. A supination – lateral rotation type I ankle injury is most likely to result in:

A. Salter – Harris I fracture

B. Salter – Harris II fracture
C. Salter – Harris III fracture
D. A or B only
E. B or C only

33. Which of the following is not true regarding the anatomic differences between the adult and
pediatric patient ?

A. Pediatric patients are more likely to sustain a fracture

B. Pediatric patients tend to heal fractures more rapidly than adults
C. The pediatric periosteum is more resilient and vascular than in the adult
D. Non-union fractures are more common in pediatric patients
E. Ligamentous injury is less common in children than in adults

34. In a newborn male you would expect to see which of the following tarsal bones, given normal
ossification.

A. Calcaneus, talus, navicular and cuboid

B. Calcaneus, talus, cuboid and lateral cuneiform
C. Calcaneus, talus, cuboid, medial and lateral cuneiforms
D. Calcaneus, talus and cuboid only
E. All tarsal bones should be present.
35. Which of the following does not represent a true avascular necrosis?

A. Frieberg’s disease
B. Kohlers’s disease
C. Osgood- Schlatter’s disease
D. Legg-clave-perthe’s disease
E. Treve’s disease

36. The most obvious radiographic finding in Friebergs’ infraction is:

A. Periosteal reaction of the metatarsal head

B. “Squaring” of the metatarsal head
C. Joint space narrowing
D. Metatarsal head fracture
E. Metatarsal phalangeal joint subluxation

37. In a 5 year old child, the malleolar position should be (normally):

A. 0 - 2 degrees external
B. 4 - 6 degrees external
C. 6 - 8 degrees internal
D. 10 - 15 degrees external
E. 13 - 18 degrees external

38. Which of the following would be most appropriate in the initial management a cerebral palsy
child with a painful spastic flatfoot deformity ?

uA. UCBL orthosis

B. Ankle foot orthosis (AFO)
C. Gait plate
D. Standard pronated orthotic
E. Standard neutral orthotic

39. Which of the following rotational devices maintains the knee in a flexed position ?

A. Filauer bar
B. Denis – Brown bar
C. Counter rotational splint
D. Ganley splint
E. Tibial torsion transformer

40. Which of the following is not true regarding the usage of the torsional bars and splints ?

A. A 10 degree varus bend supinates the subtalar joint and prevents iatrogenic pes planus
B. A varus wedge or orthosis supinates the subtalar joint and prevents iatrogenic pes planus
C. One must remain at least 10 degrees from the hip end range of transverse plane motion when
setting the bar
D. The bars and splints are usually tolerated up to age 6
E. The length of the bar may be the shoulder width of the child
41. Which of the following would be indicated in the management of intoed gait secondary to low
malleolar position in a 16 m.o. child ?

A. High-top shoes
B. Exercises only
C. Denis-Brown bar
D. Twister cables
E. Rotational osteotomy

42. When intoed gait is causes significant disability / pain in an older

(>7 yrs) child, the best conservative management would be:

A. Counter rotational splint

B. Brachman skate
C. Twister cables
D. Ganley splint
E. Tibial torsion transformer

43. Mom and Dad bring their 2 year old daughter into your office concerned about her “pigeon -
toed” walking. They claim that their child also gets tired easily and prefers to be carried but does
not trip. The child is their first, was full term and began to ambulate at 13 months. Your
examination reveals 60 degrees of internal and 30 degrees of external hip rotation bilateral, 4
degrees of transverse plane knee rotation bilateral, 40 degrees of ankle joint dorsiflexion bilateral
and 5 degrees of external malleolar position bilateral. Her angle of gait is 5 degrees adducted and
the patella adducts at foot contact during gait. Significant late midstance pronation of the subtalar
joint is noted bilateral. Given this information, which of the following is true ?

A. Intoeing secondary to low malleolar position

B. Normal development
C. Intoeing secondary to femoral anteversion
D. Intoeing secondary to equinus
E. Intoeing secondary to pseudolack of malleolar position

44. Management of the aforementioned patient (Q # 43) should include:

A. Exercises, orthoses and observation

B. A night splint of some kind only
C. A night splint and orthosis
D. A functional orthoses only
E. A night splint and gait plate only
45. An 8 year old boy, accompanied by his parents presents with B/L intoeing and “flat feet”. He
denies any tripping or clumsiness. Your examination reveals a malleolar position of 5 degrees
external B/L, midstance subtalar pronation during gait with the patella deviating internally and an
8 degree adducted gait. His resting calcaneal stance position is 3 degrees everted. Which of the
following would be most appropriate:

A. Denis-Browne bar
B. Functional orthosis
C. Twister cables
D. A and C
E. B and C

46. A 6 year old boy presents with a chief complaint of intoeing with frequent tripping / falling.
Your examination reveals intoeing secondary to femoral anteversion, midstance subtalar
pronation during gait and a resting calcaneal stance position of 5 degrees everted. His angle of
gait is 7 degrees adducted. He does not want to use the twister cables at this time. What is your
best option ?

A. Functional orthosis only

B. Fillauer bar
C. A night splint and functional orthosis
D. Exercises and a gait plate
E. Exercises and a functional orthosis

47. When the angle of femoral inclination exceeds 128 degrees, the result is:

A. Coxa vara
B. Coxa valga
C. Genu varum
D. Femoral anteversion
E. Femoral retroversion

48. In which of the following is proliferation of shcwann cells present ?

A. Poliomyelitis
B. Roussy – Levy syndrome
C. Dejerine – Sottas disease
D. Duchenne muscular dystrophy
E. Charcot – Marie – Tooth disease

49. Which of the following therapeutic splints allows for correction of the forefoot and rearfoot ?

A. Counter rotational splint

B. Ganley splint
C. Denis – Browne bar
D. Filauer bar
E. Friedman counter splint
50. The least common pattern of motor dysfunction seen in cerebral palsy is:

A. Rigid
B. Ataxic
C. Tremor
D. Spastic
E. Athetosis