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#	Code	QID	Subspecialty	Topic	Complexity	Importance
1	OBQ18.199	213095	During which surgical approach to the acetabulum is the sciatic nerve placed at risk, and how should the patient be positioned to minimize the risk of injury?	Trauma	Acetabular Fractures		A
2	SBQ18BS.4	211145	Which of the following is accurate regarding sclerostin?	Basic Science	Osteopenia & Osteoporosis	L 1	A
3	OBQ18.242	213138	An 85-year-old woman presents with severe back pain and the CT shown in Figure A. Her history is notable for prior vertebral compression fractures for which she underwent a cement augmentation procedure. She has been on bisphosphonates for the last 5 years, without improvement of her osteoporosis. She has no history of malignancy. What is the mechanism of action of the medication that should be prescribed for her refractory osteoporosis?	Basic Science	Osteopenia & Osteoporosis	L 2	A
4	OBQ17.79	210166	A 68-year-old woman presents to review the results of a dual-energy x-ray absorptiometry scan. She was found to have a T-score of -2.6. When discussing treatment options, the patient mentions that she saw a commercial advertising a medication that builds new bone. Which of the following is the correct description of this drug?	Basic Science	Osteopenia & Osteoporosis	L 4	A
5	OBQ18.22	212918	A 79-year-old patient underwent a right hip hemiarthroplasty after sustaining a femoral neck fracture 8 weeks ago. The patient fell down in the nursing home and noticed immediate pain and inability to bear weight. Figures A and B are the radiographs of the right femur. What is the best treatment approach?	Recon	Hip Hemiarthroplasty Periprosthetic Fracture	L 1	A
6	OBQ18.194	213090	Which of the following acetabular fractures is classified as an elementary fracture pattern that involves two columns?	Trauma	Acetabular Fractures	L 2	A
7	OBQ18.196	213092	What is the spur sign and on which view is it best seen?	Trauma	Acetabular Fractures	L 5	A
8	OBQ18.90	212986	A 59-year-old patient presents with increasing right hip pain of 8 months duration. The patient reports pain at night and during activities. The patient denies any weight loss or fevers. Figures A and B are the radiograph and MRI of the pelvis. Figure C is the biopsy of the lesion. What is the most likely diagnosis and next best step in treatment?	Pathology	Chondrosarcoma	L 1	A
9	SBQ18SP.57	211729	A 63-year-old male undergoes a C4-C7 posterior fusion and laminectomy secondary to significant spinal cord stenosis. Pre-operative examination reveals neck pain, spasticity signs, and finger clumsiness. Post-operative day one, he complains of significant weakness with raising his left arm overhead and on further examination, you notice a clear sensation deficit over the lateral shoulder. What is the most commonly affected structure?	Spine	Cervical Myelopathy	L 1	A
10	SBQ18BS.15	211266	Which of the following medications specifically target tumor necrosis factor alpha (TNF-a)?	Basic Science	Rheumatoid Arthritis	L 2	A
11	OBQ15.214	5899	A researcher is working on Medication A, a drug FDA-approved for the treatment of osteoporosis in men and women. It is an anti-resorptive agent that inhibits the formation, function and survival of osteoclasts. It does not bind to calcium hydroxyapatite. At 1-year after the initial dose, tissue levels are non-detectable. It can be used in the presence of cancer metastases to bone. What is Medication A?	Basic Science	Osteopenia & Osteoporosis	L 4	A
12	OBQ18.156	213052	A 23-year-old-male was involved in a motorcycle accident. Imaging is shown in Figure A. In order to prevent the most common deformity associated with intramedullary nailing of this injury, where should blocking screws be placed and what deformity are they trying to prevent?	Trauma	Proximal Third Tibia Fracture	L 3	A
13	OBQ17.97	210184	An 85-year-old woman sustains a ground level fall. Her THA was done 25 years ago. She was previously ambulatory but with a significant limp. With regard to the femur specifically, what is the Vancouver classification and preferred treatment option?	Recon	THA Periprosthetic Fracture	L 2	A
14	OBQ09.99	2912	During the ilioinguinal approach to the pelvis, the corona mortis artery must be identified and ligated if present. The corona mortis artery joins the external illiac artery with which other major artery?	Trauma	Acetabular Fractures	L 1	A
15	OBQ19.6	213908	A 36-year-old male sustained a posterior column acetabular fracture and traumatic brain injury following a motor vehicle accident. He underwent open reduction and internal fixation of the acetabular fracture with debridement of the gluteus minimus. Figure A is the 2-year postoperative radiograph. Which surgical approach has the highest association with the development of heterotopic ossification?	Trauma	Acetabular Fractures	L 3	A
16	OBQ19.191	214093	A study is performed comparing the mean operative times of total knee arthroplasty performed with traditional instrumentation versus robotic-assisted. The data is found to be normally distributed. Which of the following tests is most appropriate when comparing these two means?	Basic Science	Statistic Definitions	L 2	A
17	SBQ18BS.7	211178	Figures A through C are the radiographs and CT scan of a 33-year-old male who was treated 13-months ago for an open tibial shaft fracture. He has received several courses of intravenous antibiotics for chronic osteomyelitis. Despite continued treatment with IV antibiotics, his inflammatory markers remain elevated. The decision is made to proceed with irrigation and debridement, nail removal with exchange for a polymethylmethacrylate intramedullary nail with vancomycin and tobramycin. What is the primary mechanism of action of tobramycin?	Basic Science	Antibiotic Classification & Mechanism		A
18	OBQ19.5	213907	A 30-year-old male is brought to your emergency department following a motor vehicle collision at high speed. He is intubated in the field for airway protection but is hemodynamically stable. Subsequent workup shows a displaced acetabular fracture, in addition to an intra-cranial bleed and liver laceration which do not require surgery. When placing an antegrade anterior column screw, what radiographic view should be used to avoid intra-pelvic screw penetration?	Trauma	Acetabular Fractures		A
19	OBQ15.97	5782	A 74-year-old female who underwent a hemiarthroplasty 6 weeks ago now presents to the emergency department after a low energy fall while walking. Her x-ray is shown in Figure A. What is the optimal treatment for this injury?	Recon	Hip Hemiarthroplasty Periprosthetic Fracture	L 2	A
20	OBQ13.214	4849	Which of the following fractures would most likely require revision arthroplasty with a long-stemmed, uncemented prosthesis?	Recon	THA Periprosthetic Fracture	L 2	A
21	OBQ09.223	3036	A 37-year-old male sustains the injury shown in Figure A following a motorcycle crash. During the approach, what limb position minimizes tension placed on the sciatic nerve?	Trauma	Acetabular Fractures	L 1	A
22	SBQ18BS.9	211200	A randomized controlled trial is undertaken to investigate whether tourniquet use increases cement penetration during total knee arthroplasty. Approximately 40% of the patients that were initially randomized to the "no tourniquet" group had tourniquets placed intraoperatively due to difficulty with visualization. Intent-to-treat analysis was conducted and the results showed no difference in the rates of cement penetration. What statistical term best applies if these results are accepted at face value?	Basic Science	Statistic Definitions	L 4	A
23	OBQ15.84	5769	Which of the following treatments for osteoporosis is a direct inhibitor of RANK ligand (RANK-L)?	Basic Science	Osteopenia & Osteoporosis	L 1	A
24	OBQ17.9	210096	Which of the following disease-modifying antirheumatic drugs (DMARDs) acts on the cell membrane receptor illustrated in Figure A?	Basic Science	Rheumatoid Arthritis	L 3	A
25	OBQ07.3	664	In Figure A, the two red arrows point to which of the following two arteries?	Trauma	Acetabular Fractures	L 1	A
26	OBQ11.155	3578	A 74-year-old man falls, sustaining the injury shown in Figures A through C. In surgical planning, what is the best surgical approach to treat this injury?	Trauma	Acetabular Fractures	L 2	A
27	OBQ06.51	162	A 25-year-old patient presents with a posterior wall/ posterior column acetabular fracture. She is scheduled for open reduction internal fixation through a posterior approach. What position of the leg exerts the least amount of intraneural pressure on the sciatic nerve?	Trauma	Acetabular Fractures	L 1	A
28	OBQ18.163	213059	A 65-year-old man with a 20-pack-year tobacco history and a remote history of small cell lung carcinoma presents with thigh pain and radiographs demonstrated in Figure A. He undergoes a full femur MRI and a CT chest, abdomen, and pelvis, both of which reveal no other areas of disease. What is the next best step in management?	Pathology	Metastatic Disease of Extremity		A
29	OBQ10.180	3273	A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. Which of the following is the preferred approach for open treatment of this injury?	Trauma	Acetabular Fractures	L 1	A
30	OBQ18.45	212941	A 32-year-old man sustains a traumatic amputation of his right thumb (Figure A). He undergoes the soft-tissue coverage procedure shown in Figure B. What artery does this flap rely on, and which nerve is at risk during this procedure?	Hand	Extremity Flap Reconstruction	L 1	A
31	OBQ10.119	3213	Which of the following medications is a recombinant form of parathyroid hormone that has been found to stimulate new bone formation in patients with postmenopausal osteoporosis?	Basic Science	Osteopenia & Osteoporosis	L 1	A
32	OBQ16.27	8789	Figure A shows the upright lumbar radiographs of a 56-year-old patient with a history of substance abuse and bipolar disorder who fell down 6 stairs onto his back at home while intoxicated. In the ED, he reports continued back pain, but has been able to ambulate. On exam, he has normal sensation and motor function in his lower extremities. Rectal tone and peri-anal sensation are intact. A CT and MRI are obtained, which are shown in figures B and C, respectively. Which of the following treatments will provide the lowest risk of complications and residual back pain?	Spine	Thoracolumbar Burst Fractures	L 1	A
33	OBQ14.161	5571	Figures A and B demonstrate a proximal tibial metaphyseal fracture which will be treated with an intramedullary nail. Placing blocking screws at the sites marked with x's in the figures would help to prevent what type of malreduction deformity?	Trauma	Proximal Third Tibia Fracture	L 1	A
34	OBQ08.125	511	A 65-year-old healthy patient fell 18 years after a total hip arthroplasty and sustained the fracture shown in Figure A. Which of the following would be the most appropriate treatment?	Recon	THA Periprosthetic Fracture	L 1	A
35	OBQ18.183	213079	The outcomes of three novel interventions are investigated and the preliminary results are depicted in Figure A. Which of the following statements is most accurate?	Basic Science	Statistic Definitions	L 1	A
36	OBQ17.162	210249	After implanting trials during a primary cruciate retaining total knee arthroplasty, the surgeon decides to recut the proximal tibia with increased slope. What intra-operative examination findings in the operative knee would lead to this decision?	Recon	TKA Sagittal Plane Balancing	L 2	A
37	OBQ12.200	4560	The ability of a study to detect the difference between two interventions if one in fact exists describes which of the following?	Basic Science	Statistic Definitions	L 2	A
38	OBQ10.231	3330	Which of the following administered substances leads to net bone resorption?	Basic Science	Osteopenia & Osteoporosis	L 2	A
39	OBQ04.93	1198	A 45-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A-D. Which of the following is the most appropriate approach for surgical fixation of this fracture?	Trauma	Acetabular Fractures	L 1	A
40	OBQ12.6	4366	A 75-year-old-male presents after being struck by a vehicle while crossing the street. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. What is the proper blocking screw technique to prevent apex anterior and valgus deformity of the fracture?	Trauma	Proximal Third Tibia Fracture	L 3	A
41	OBQ18.75	212971	Which of the following patients sustaining a diaphyseal femoral shaft fracture would be most suitable for treatment with immediate spica casting?	Pediatrics	Femoral Shaft Fractures - Pediatric	L 1	A
42	SBQ12TR.67	3982	The anterior intrapelvic (modified Stoppa) approach is most appropriate for which of the following fractures?	Trauma	Acetabular Fractures	L 5	A
43	OBQ18.71	212967	A 9-year-old male sustained the injury shown in Figure A. Which of the following is true with respect to the treatment of this injury?	Pediatrics	Distal Femoral Physeal Fractures - Pediatric	L 5	A
44	OBQ18.214	213110	A 50-year-old male sustained a humeral shaft fracture treated operatively 6 months ago. He denies medical problems but smokes 10 cigarettes per day. His current radiograph is shown in Figure A. He continues to have pain in his arm that is affecting his quality of life. On physical examination, there is motion at the fracture site. C-reactive protein and erythrocyte sedimentation rate are within normal limits. Which is the most appropriate definitive treatment for this fracture?	Trauma	Humeral Shaft Nonunion		A
45	OBQ05.124	1010	An 82-year-old woman falls and sustains the fracture shown in figure A. She denies any history of dislocation or prodromal pain prior to her fall. What is the most appropriate treatment?	Recon	THA Periprosthetic Fracture	L 2	A
46	OBQ11.257	3680	A 55-year-old healthy female presents for a routine physical exam. When discussing bone health and osteoporosis prevention, what dose of calcium and vitamin D should be recommended for daily consumption?	Basic Science	Osteopenia & Osteoporosis	L 1	A
47	OBQ11.36	3459	A 52-year old woman who is not on any hormone replacement therapy (HRT) falls from standing height and sustains the injury seen in Figure A. Review of her medical history reveals that she carries a diagnosis of osteoporosis, and that her latest T-score was -3.0. How much calcium should she have been consuming on a daily basis prior to sustaining her injury?	Basic Science	Osteopenia & Osteoporosis	L 2	A
48	OBQ15.199	5884	In the treatment of rheumatoid arthritis, which medication is an antagonist of tumor necrosis factor-alpha?	Basic Science	Rheumatoid Arthritis	L 2	A
49	OBQ19.31	213933	A 73-year-old male sustains a ground-level fall onto his left side when he trips on his cat. The patient had immediate hip pain and inability to bear weight on the left side and is brought to the ER via EMS, where you are consulted. He has a history of a total hip arthroplasty on the same side. His baseline function is community ambulator with an assistive device. He did not have any antecedent hip pain. Laboratory studies were obtained which demonstrate a serum white blood cell of 9.0 (normal 4.5-10), CRP of 0.3 mg/L (normal <1.0 mg/L), and ESR of 21 mm/hr (normal 0-25 mm/hr). Figure A is an x-ray obtained in the ER. What is the most appropriate treatment?	Recon	THA Periprosthetic Fracture	L 1	A
50	OBQ12.212	4572	The posterior wall of the acetabulum is best visualized on which of the following radiographic views?	Trauma	Acetabular Fractures	L 2	A
51	OBQ19.1	213903	Which of the following adult patients is expected to have the slowest walking speed and highest relative energy cost while utilzing a prosthesis?	Trauma	Amputations	L 1	A
52	OBQ12.138	4498	Which of the following pharmacologic treatments for osteoporosis has been associated with the potential risk for osteosarcoma development?	Basic Science	Osteopenia & Osteoporosis	L 3	A
53	OBQ13.254	4889	Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. What is the mechanism of action of Infliximab?	Basic Science	Rheumatoid Arthritis	L 3	A
54	OBQ18.150	213046	You are planning on performing a study to determine if there is a difference in healing rates for distal femur fractures by placing patients on Vitamin D after injury. With regards to your study, the statistician mentions a power analysis. What is the purpose of power analysis and when should it be performed?	Basic Science	Statistic Definitions	L 1	A
55	OBQ17.15	210102	A pharmaceutical company is marketing a new intra-articular injectable therapy that they claim is superior to intra-articular steroid injection for the treatment of knee osteoarthritis. Patients undergoing this new therapy report a larger improvement in their Knee injury and Osteoarthritis Outcome Score (KOOS) when compared to patients undergoing intra-articular steroid injections. This difference is reported with a p-value of 0.04. Which of the following is true when considering whether or not to use this new therapy on your patients?	Basic Science	Outcome Measure Tools	L 2	A
56	OBQ19.4	213906	Which of the following cells involved in bone metabolism derives from a myeloid origin?	Basic Science	Bone Cells	L 1	A
57	OBQ17.128	210215	A 1-year-old girl is a restrained passenger in a low speed motor vehicle collision and presents with left leg pain. The patient weighs 25 pounds with an isolated closed deformity of the left thigh with mild swelling. Figures A and B are radiographs obtained in the emergency department. Work up reveals no other injuries, including abdominal trauma, and child services determines there is no concern for non-accidental trauma. Which of the following would be the most appropriate definitive treatment for her injured extremity?	Pediatrics	Femoral Shaft Fractures - Pediatric	L 1	A
58	SBQ18FA.25	211374	A 56-year-old male presents with pain over the medial eminence of his first metatarsal head. He has failed conservative management. He has minimal pain with 1st MTP range of motion and no hypermobility noted at his 1st TMT joint. A radiograph of his foot is shown in Figure A. The IMA is measured at 16 degrees. What is the most appropriate surgical plan?	Foot & Ankle	Hallux Valgus	L 4	A
59	OBQ14.168	5578	Which of the following fracture patterns (Figures A-E) would require revision of the femoral component to a long-stemmed, cementless prosthesis?	Recon	THA Periprosthetic Fracture	L 2	A
60	OBQ12.142	4502	A 52-year-old Asian male presents with pain in his right hip worse with activity. He is otherwise healthy and denies any history of trauma or constitutional symptoms. Radiographs, CT, and MRI are shown in Figure A, B, and C respectively. A CT guided biopsy is performed and low power and high power histology images are shown in Figure D and E respectively. A CT scan of the chest, abdomen, and pelvis is performed and there is no evidence of metastatic disease. Which of the following is the most appropriate treatment?	Pathology	Chondrosarcoma	L 3	A
61	SBQ18SP.7	211179	A 56-year-old man undergoes the procedure depicted in Figure A for severe cervical myelopathy. Postoperatively, he develops 3 out of 5 weakness in one motor group in his right upper extremity. Which of the following is the nerve root and functional deficit that most likely describes this new deficit?	Spine	Cervical Myelopathy		A
62	OBQ18.203	213099	A 43-year-old male presents to the trauma bay with the injury sustained in Figure A after a motor vehicle collision. After appropriate resuscitation, you have decided to proceed with open reduction and internal fixation via a Kocher approach and percutaneous fixation of the anterior column. The inlet view can be used to help visualize which of the following during guidewire placement?	Trauma	Acetabular Fractures		A
63	OBQ18.256	213152	An 11-year-old boy falls on an outstretched hand and presents with the injury depicted in Figure A. What portion of the physis in Figure B does this injury most commonly occur?	Pediatrics	Physeal Considerations	L 3	A
64	OBQ13.226	4861	A 27-year-old man falls off of a bicycle at a high speed and is taken to the emergency department, where he is diagnosed with an acetabular fracture. Which of the following image sets accurately depicts a fracture that involves only one of the two columns of the acetabulum?	Trauma	Acetabular Fractures	L 5	A
65	OBQ13.59	4694	The perioperative use of which medication has been shown to increase the risk of post-operative infection following orthopaedic procedures in patients with rheumatoid arthritis (RA)?	Basic Science	Rheumatoid Arthritis	L 1	A
66	OBQ19.163	214065	A prospective, randomized controlled trial of 100 patients undergoing reverse total shoulder arthroplasty is performed to determine if lateralization of the glenoid baseplate increases external rotation compared with a medialized Grammont design. The study found no difference in external rotation motion between groups (p = .42). Since then, several multicenter prospective, randomized controlled trials have demonstrated a significant increase in external rotation motion with the use of a lateralized design (p = .03). Which of the following errors most likely occurred in the first study?	Basic Science	Statistic Definitions	L 3	A
67	OBQ05.8	45	A 32-year-old male sustains the injury shown in Figure A through D as the result of a high-speed motor vehicle collision. This particular injury is best treated with which of the following single approaches?	Trauma	Acetabular Fractures	L 4	A
68	OBQ12.146	4506	While conducting a retrospective review of patients undergoing two different techniques for open reduction and internal fixation of ankle fractures, the investigator would like to assess whether there is any significant difference between the mean patient age in the two groups. The two groups are normally distributed. Which of the following tests would be most appropriate?	Basic Science	Statistic Definitions	L 3	A
69	OBQ17.59	210146	What does a power analysis determine and when should it be performed?	Basic Science	Statistic Definitions	L 2	A
70	OBQ10.105	3199	You are seeing a 13-year-old girl for asymptomatic flat feet and recommend observation. In educating this patient/family about general bone health, you recommend what amount of daily dietary calcium for your patient?	Basic Science	Osteopenia & Osteoporosis	L 2	A
71	SBQ17SE.54	211699	A 25-year-old right-handed IV drug user presents with left forearm cellulitis and osteomyelitis of the radius. After a course of IV antibiotics and debridement of the radius, the patient is left with a 10cm bone defect. The patient is able to kick his drug habit. You consider a bone flap to span the defect and reconstruct the radius. Which artery will be used in the anastomosis for the required bone flap?	Hand	Extremity Flap Reconstruction	L 3	A
72	OBQ13.116	4751	A prospective randomized trial is conducted to test the efficacy of Vitamin C versus placebo in treating patients who develop complex regional pain syndrome (CRPS) after distal radius fractures. At first follow-up, the rates of CRPS are 1% and 9% in the study and placebo group, respectively. Which statistical test is most appropriate to determine significance?	Basic Science	Statistic Definitions	L 4	A
73	OBQ19.34	213936	A 63-year-old female underwent left total knee arthroplasty (TKA) 5 years ago. She was recently diagnosed with an infected left TKA and subsequently underwent a two-stage exchange arthroplasty. Based on the Musculoskeletal Infection Society (MSIS), which of the following, if present, can be used in isolation for the diagnosis of an infected TKA?	Recon	Prosthetic Joint Infection	L 1	A
74	OBQ18.23	212919	A 48-year-old woman who runs marathons has been having worsening foot pain. Her AP radiograph is shown in Figure A. She has been wearing the orthotic shown in Figure B. What type of motion is this orthosis designed to limit?	Foot & Ankle	Hallux Rigidus (MTP joint arthritis)	L 3	A
75	OBQ07.170	831	What effect does intermittent administration of parathyroid hormone have on bone?	Basic Science	Osteopenia & Osteoporosis	L 2	A
76	OBQ18.186	213082	Which of the following statistical tools is used to determine responsiveness?	Basic Science	Statistic Definitions	L 4	A
77	OBQ16.156	8918	An otherwise healthy 55-year-old male presents with right hip pain. The pain has progressively been worsening over the last six months. Radiographs are shown in Figures A and B. An MRI is shown in Figure C. A preoperative biopsy is obtained and shown in Figure D. What would be the most appropriate next step in management?	Pathology	Chondrosarcoma	L 2	A
78	OBQ10.136	3187	A 60-year-old female complains of progressive right hip pain. A pelvis radiograph is shown in Figure A and a biopsy specimen is shown in Figure B. What is the most appropriate treatment?	Pathology	Chondrosarcoma	L 2	A
79	SBQ11AN.78	4213	A 22-year-old man is brought to the emergency department by ambulance after a motor vehicle collision. He denies any subjective weakness in his arms or legs, and only complains of back pain. Examination reveals no palpable spinal step-offs, posterior spinal pain, and normal neurologic function in the lower extremities. Normal perineal sensation and normal rectal tone are present. A CT scan is performed and is shown in Figures A and B. An MRI is performed and shows no signal intensity in the posterior ligamentous complex on T2 weighted images. What is the most appropriate next step in treatment.	Spine	Thoracolumbar Burst Fractures	L 1	A
80	OBQ04.52	1382	The approach shown in Figure A is most indicated for which of the following acute fracture patterns?	Approaches	Extensile (extended iliofemoral) Approach to Acetabulum	L 4	A
81	SBQ07HK.62	1647	A 88-year-old female fell onto her right hip sustaining the fracture shown in Figure A. Past medical history is significant for mild dementia and moderate coronary artery disease. At baseline, she ambulates with a walker. There are concerns about her ability to maintain weight-bearing precautions following surgery. Which of the following is most appropriate for management of the femoral side?	Recon	THA Periprosthetic Fracture	L 1	A
82	OBQ19.244	214146	A patient sustains a Weber C ankle injury with a posterior malleolus fracture and fluoroscopic examination confirms the presence of a syndesmosis injury. Which of the Figures A-E represents the fixation pattern that has shown to contribute most to syndesmosis stability?	Trauma	Ankle Fractures	L 3	A
83	OBQ09.140	2953	A previously healthy 68-year-old woman falls and sustains the fracture seen in Figure A. Her index procedure was approximately 10 years ago. The patient is taken to surgery, and the femoral stem is found to be loose. The acetabular component is found to be well fixed in good position. In addition to using a new poly liner, what other procedure(s) is now indicated in this patient?	Recon	THA Periprosthetic Fracture	L 1	A
84	OBQ17.121	210208	An orthopaedic surgeon published an article on double-bundle ACL reconstruction. He describes his current surgical technique developed over the course of 25 years of experience. Which of the following is the most accurate representation of this study's level of evidence?	Basic Science	Level of Evidence	L 2	A
85	OBQ09.176	2989	A 38-year-old male sustains the closed injury shown in Figures A and B. When treating this injury with an intramedullary nail, addition of blocking screws into which of the following positions can prevent the characteristic malunion deformity?	Trauma	Proximal Third Tibia Fracture	L 2	A
86	OBQ19.21	213923	Which of these soft tissue sarcomas is most likely to spread via lymphatics?	Pathology	Epithelioid Sarcoma	L 1	A
87	OBQ19.134	214036	Figure A is the radiograph of a 79-year-old female with elbow pain following a fall. Compared with a total elbow arthroplasty, open reduction and internal fixation would most likely result in?	Trauma	Distal Humerus Fractures	L 3	A
88	OBQ09.41	2854	What is the preferred definitive treatment for biopsy proven grade-2 chondrosarcoma of the distal femur without evidence of metastases?	Pathology	Chondrosarcoma	L 1	A
89	OBQ19.164	214066	When compared with primary arthrodesis for the treatment of ligamentous Lisfranc injuries, open reduction and internal fixation has which of the following?	Foot & Ankle	Lisfranc Injury	L 2	A
90	OBQ08.74	460	What is the equation for determining specificity of a clinical test?	Basic Science	Statistic Definitions	L 3	A
91	OBQ17.133	210220	A 2-month-old boy presents to the emergency room with the radiographs seen in Figure A. Appropriate evaluation for non-accidental trauma is negative and no other injuries are found. Which of the following figures (B-F) represents the next best step in treatment?	Pediatrics	Femoral Shaft Fractures - Pediatric	L 2	A
92	SBQ16HK.3	211141	A 67-year-old man presents with aseptic loosening of a primary total knee arthroplasty (TKA). He has a history of a prior tibial plateau fracture which was treated with open reduction and internal fixation via an anterolateral approach and subsequently was converted to a primary posterior-stabilized TKA utilizing a standard midline, medial parapatellar approach. He is scheduled for revision TKA and the more medial incision is used, leaving a small lateral skin bridge. He presents a few weeks later with wound necrosis and after multiple rounds of debridement and negative pressure wound therapy, he is left with the lateral defect seen in Figure A. Which of the following surgical options would best address his defect?	Hand	Extremity Flap Reconstruction	L 2	A
93	OBQ10.47	3135	In patients with a stable thoracolumbar burst fracture and no neurologic deficits, operative treatment has what long term outcome when compared to nonoperative management.	Spine	Thoracolumbar Burst Fractures	L 2	A
94	OBQ07.261	922	Which of the following is NOT included in the best management of a elderly female newly diagnosed with a fragility fracture?	Basic Science	Osteopenia & Osteoporosis	L 2	A
95	OBQ18.231	213127	A 35-year-old athlete presents with chronic left shoulder pain with worsening external rotation weakness when his elbow is at his side. He has full external rotation when his arm is elevated. His clinical picture is depicted in Figure A. If an MRI is obtained, which of the following images (Figures B-F) would most likely be found?	Shoulder & Elbow	Suprascapular Neuropathy	L 2	A
96	OBQ09.112	2925	A 33-year-old male sustains the injury seen in Figure A as a result of a high-speed motor vehicle collision. Based on this image, what is the most likely acetabular fracture pattern?	Trauma	Acetabular Fractures	L 3	A
97	OBQ10.26	3114	In his first day home after undergoing a total hip arthroplasty a 65-year-old male falls down the stairs and sustains the fracture seen in Figure A and B. Intra-operative examination reveals the stem to be loose. What is the preferred treatment for this injury?	Recon	THA Periprosthetic Fracture	L 3	A
98	OBQ17.77	210164	An investigator is conducting a randomized, controlled trial to determine if there are any differences in patient-reported outcomes (PROs) between two implants used to treat displaced proximal humerus fractures. An a priori power analysis reveals that 84 patients will be required in each arm to show a difference between groups with a beta of 0.2 and an alpha of 0.05. After enrolling 88 patients in each arm, the results are analyzed and no difference (p=0.28) in PROs are found between the two groups. What is the chance that the null hypothesis is accepted when it is actually false?	Basic Science	Statistic Definitions	L 2	A
99	OBQ19.250	214152	Which of the following fracture patterns depicted in figures A-E is associated with the highest risk of radial nerve palsy?	Trauma	Humeral Shaft Fractures	L 1	A
100	OBQ19.16	213918	Which of the following images (Figures A-E) is associated with the EXT1/2 gene mutation?	Pathology	Osteochondroma & Multiple Hereditary Exostosis	L 1	A
101	OBQ05.227	1113	A 44-year-old male reports a mass at his right iliac crest that bothers him when he wears a belt. He denies constitutional symptoms and has no bowel function disturbance. His ESR and CRP are normal. His chest CT is normal. Pelvis radiograph, CT, and MRI images are shown in Figures A-D. A biopsy is performed with histology shown in Figure E. What is the next most appropriate step in management?	Pathology	Chondrosarcoma	L 2	A
102	SBQ18SP.55	211707	A 43-year-old female undergoes posterior occipitocervical fusion due to significant instability secondary to Rheumatoid Arthritis. During placement of screws in C1 the drill penetrates through the anterior cortex, which places what structure at the greatest risk of injury?	Spine	Occipitocervical Instability	L 4	A
103	OBQ18.139	213035	A latissimus dorsi tendon transfer is indicated for which of the following clinical scenarios?	Shoulder & Elbow	Rotator Cuff Tears		A
104	OBQ18.138	213034	A 70-year-old right-hand dominant female presents to your office complaining of continued right shoulder pain 12 weeks after falling from a ladder, despite participating in a rigorous physical therapy program. She was initially reduced in the emergency department and her injury films are shown in Figures 1 and 2. On exam, she has weakness on active elevation and external rotation, but full passive range of motion and intact sensation. New radiographs reveal no acute osseous abnormalities and a concentric reduction. What is best next step and which diagnosis will most likely be revealed?	Shoulder & Elbow	Rotator Cuff Tears	L 1	A
105	OBQ19.96	213998	A 61-year-old male presents to your office for evaluation of his right shoulder. He sustained the injury shown in Figure A three weeks ago after trying to catch himself as he fell off a dock. He was subsequently treated in the emergency department and discharged home. Which of the following provocative maneuvers indicates the most common associated pathology in this age cohort?	Shoulder & Elbow	Traumatic Anterior Shoulder Instability (TUBS)	L 2	A
106	OBQ18.161	213057	A 70-year-old man is scheduled to undergo a procedure to address a symptomatic left proximal femur solitary lesion. Plain radiographs are depicted in Figure A and histopathology in Figure B. Which of the following procedures is associated with improved survivorship in this patient?	Pathology	Metastatic Disease of Extremity	L 3	A
107	OBQ18.160	213056	A 45-year-old woman presents with concerns of a painful knee that has rapidly progressed in the last 9 months. Axial T1 and T2 MRI images are depicted in Figures A and B. The treating surgeon elects to proceed with a biopsy. How should the biopsy be performed?	Pathology	Biopsy Principles	L 1	A
108	OBQ19.248	214150	A 45-year-old male presents to your clinic with a left ankle injury. He sustained a fall down the stairs 12 weeks prior and was unable to seek care immediately due to a lack of insurance. Radiographs are shown in figures A through C. A radiograph of his right ankle is shown in Figure D. Which of the following is the next best step in management?	Trauma	Ankle Fractures	L 2	A
109	OBQ19.11	213913	A 24-year-old man presents with increasing left thigh deformity and swelling that started at a young age. Radiographs are obtained and demonstrate peripheral bone formation with a central lucent area. He is found to have an ACVR1 mutation. Which of the following is the most likely diagnosis?	Pathology	Myositis Ossificans	L 2	A
110	OBQ08.119	505	A 42-year-old female sustains the injury seen in the computed tomography images seen in Figures A and B. According to the Letournel classification, what is the injury pattern shown?	Trauma	Acetabular Fractures	L 3	A
111	OBQ11.193	3616	A 45-year-old male sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. Post-operative radiographs show excessive procurvatum deformity. Which of the following operative techniques would have helped to best avoid the procurvatum deformity?	Trauma	Proximal Third Tibia Fracture	L 3	A
112	OBQ19.189	214091	Which of the following cytokines inhibits the process depicted in Figure A?	Recon	Wear & Osteolysis Basic Science	L 4	A
113	OBQ07.203	864	A 72-year-old male presents with increasing thigh pain. Radiographs and high power biopsy are shown in Figures A and B. Staging studies demonstrate no further sites of disease. What is the next step in treatment?	Pathology	Chondrosarcoma	L 2	A
114	OBQ19.98	214000	A 38-year old unrestrained man is involved in a motor vehicle collision and presents with the injury depicted in Figures A and B. The patient undergoes the operative intervention depicted in Figure C through the extended iliofemoral approach. Which of the following variables below is a protective factor against early conversion of the fixation to total hip arthroplasty for this patient?	Trauma	Acetabular Fractures	L 1	A
115	OBQ19.59	213961	A 40-year-old male presents to your clinic for evaluation of 8 months of left shoulder pain and weakness after a fall while skiing. MRI studies are shown in Figures A and B. Which of the following physical exam findings would be highly probable in this patient?	Shoulder & Elbow	Rotator Cuff Tears	L 1	A
116	OBQ19.69	213971	A 65-year-old woman presents to your clinic for evaluation of her right shoulder. She tripped and fell on ice 2 weeks prior and sustained an anterior shoulder dislocation. She underwent a reduction at a local emergency room on the day of the injury and now presents to your clinic in a sling. Which of the following structures is most likely to be injured in this patient?	Shoulder & Elbow	Rotator Cuff Tears	L 4	A
117	OBQ19.229	214131	Figures A and B are the MRI images of a 51-year-old male who presents with complaints of severe low back pain with radiation in the left posterior thigh for the past 5 days after working out. He denies any numbness, weakness, or bowel/bladder dysfunction. Which treatment modality is indicated at this time for the pathology evident on MRI?	Spine	Lumbar Disc Herniation	L 3	A
118	OBQ15.164	5849	To be most effective at preventing post-operative sagittal plane deformity, poller blocking screws should be placed at which location labeled A-E in Figure A?	Trauma	Proximal Third Tibia Fracture	L 1	A
119	OBQ19.25	213927	A 48-year-old male is referred to your clinic for progressive left hip and thigh pain for the past three weeks. His pain is causing him to walk with a significant limp and he is no longer able to do his job as a carpenter. Two months ago, he found a lump in his neck, however, he never saw his doctor due to concerns about missing work. A radiograph obtained in your office is shown in Figure A. A biopsy slide obtained from the lesion is shown in Figure B. What is this patient's Mirel's score, and what would be the next best step in treatment?	Pathology	Metastatic Disease of Extremity	L 2	A
120	SBQ18SP.22	211344	An MRI is shown in Figure 1. Which of the following patients with the MRI findings shown would be most likely to require surgical management?	Spine	Spinal Epidural Abscess	L 2	A
121	OBQ19.38	213940	Figure A is the radiograph of a male who fell down the stairs. He is 8 years status post right total hip arthroplasty. All of the following are indications for a proximal femoral replacement EXCEPT?	Recon	THA Revision	L 3	A
122	OBQ19.230	214132	A 55-year-old male presents for evaluation of chronic back pain. The pain has been present for 10 years and has not improved with physical therapy or NSAIDs. He has a 60-degree main thoracolumbar scoliosis curve. His spinal alignment radiographs reveal a lumbar lordosis of 45, a pelvic incidence of 70 degrees, a sacral slope of 50, and a pelvic tilt of 20. He is interested in surgical management. Which of the following equations, if met post-operatively, will likely lead to the best clinical outcome in this patient?	Spine	Adult Spinal Deformity	L 3	A
123	OBQ19.231	214133	A 68-year-old male patient presents with back pain and inability to walk more than 1 city block distance. He underwent a previous L3-S1 posterior instrumented fusion and decompression for multilevel spinal stenosis with associated degenerative spondylolisthesis. Current standing with full hip and knee extension radiographs are shown in figure A. His lumbar lordosis is measured at 22°, pelvic incidence of 55°, and thoracic kyphosis of 35°. What would be the best approach to addressing this patient's spinal deformity?	Spine	Adult Spinal Deformity	L 3	A
124	OBQ19.127	214029	Which of the following fixation constructs would achieve fracture healing through enchondral ossification?	Basic Science	Fracture Healing	L 2	A
125	SBQ18FA.24	211363	A 53-year-old woman has had progressive hallux valgus deformity of her right great toe for the last 12 years. She has failed nonoperative management including shoe modifications and padded inserts. Her surgeon recommends a Lapidus procedure (1st metatarsal cuneiform arthrodesis). Which of the following is an indication for this procedure?	Foot & Ankle	Hallux Valgus	L 2	A
126	OBQ19.173	214075	You are reviewing a systematic review on the 90-day complication rate and outcome for same day total joint arthroplasty for publication. After you analyze the methodology of the 6 randomized controlled trials included in the review, you conclude that the patient populations and outcomes measure are homogenous and you do not have any concerns with randomization. You notice one of the studies included had 70% follow-up, yet the remaining studies had >80% follow-up. Knowing this, you appropriately assign what level of evidence to the systematic review?	Basic Science	Level of Evidence		A
127	OBQ14.208	5618	When treating a proximal tibia fracture, the surgeon decides to (1) use blocking screws in the proximal fragment, and (2) pick the intramedullary nail based on the location of the Herzog curve. Which of the following combinations will best prevent the classic deformity associated with this fracture?	Trauma	Proximal Third Tibia Fracture	L 3	A
128	OBQ19.36	213938	A 64-year-old male underwent an uncomplicated right total hip arthroplasty (THA) eight years ago. He now reports the insidious onset of right groin pain that has been present for 10 months and recalcitrant to anti-inflammatory medications and physical therapy. You suspect he has a local soft tissue reaction caused by the main articulation that is mainly lymphocyte driven. Assuming physiologic range of motion and adequate positioning of the components, which of the following articulations does this patient most likely have?	Recon	Wear & Osteolysis Basic Science	L 1	A
129	OBQ18.224	213120	An active 60-year-old woman falls from her attic and presents with the injury in Figure A. She undergoes successful closed reduction and sling immobilization. At follow up, she is unable to move her shoulder. New radiographs are depicted in Figures B and C. What is the next best step?	Trauma	Proximal Humerus Fractures	L 1	A
130	OBQ19.103	214005	A 34-year-old man presents with the closed injury depicted in Figure A after a high energy twisting injury. Which of the other injuries below is most commonly associated with his known injury?	Trauma	Tibial Shaft Fractures	L 1	A
131	OBQ09.217	3030	A 22-year-old female is involved in a motor vehicle collision and sustains the injury shown in Figures A through D. According to these images, what is the acetabular fracture classification?	Trauma	Acetabular Fractures	L 3	A
132	OBQ09.137	2950	The pelvic spur sign on plain radiography is indicative of the following injuries?	Trauma	Acetabular Fractures	L 1	A
133	OBQ19.2	213904	Type II collagen is the most abundant type of collagen in all the following EXCEPT?	Basic Science	Collagen	L 3	A
134	OBQ19.242	214144	A 4-year-old healthy male sustained the closed injury shown in Figures A and B after falling from the monkey bars at 9:30 AM while at school. He underwent the procedure shown in Figure C the following day at 11 AM. No peri-operative antibiotics were given. Postoperatively, he was placed in a long arm splint and instructed to follow up in 3 weeks. When the splint was removed at follow up the patient was found to have a pin site infection. Which of the following aspects of his treatment is associated with the highest risk of developing this complication?	Pediatrics	Supracondylar Fracture - Pediatric	L 2	A
135	OBQ19.82	213984	A 5-year-old female patient sustains the fracture shown in Figures A and B. You perform closed reduction and casting. You measure your post-reduction cast index at 0.95. What is the patient at risk for?	Pediatrics	Both Bone Forearm Fracture - Pediatric	L 1	A
136	OBQ19.178	214080	A 22-year-old football offensive lineman presents with deep and dull shoulder pain for the last 5 weeks. During the examination the surgeon holds the arm in a flexed and internally rotated position. The flexed elbow is then pushed posteriorly while the shoulder girdle is pushed anteriorly, there is an audible clunk. Which of the following structures in Figure A is most likely injured?	Shoulder & Elbow	Posterior Labral Tear	L 3	A
137	OBQ13.34	4669	A 65-year-old male patient presents with pain and swelling in his thigh for 1 year. Radiographs and biopsy findings are seen in Figures A through C. What is the most appropriate treatment?	Pathology	Chondrosarcoma	L 3	A
138	OBQ17.138	210225	You are planning on performing a distal femur and proximal tibia percutaneous epiphysiodesis for a limb length discrepancy (LLD) confirmed by scanogram. Which of the following patient examples would result in the most equal limb lengths at skeletal maturity?	Pediatrics	Leg Length Discrepancy (LLD)	L 3	A
139	OBQ19.251	214153	A 60-year-old male with a history of diabetes presents to the trauma bay after sustaining a ground-level fall onto his right arm. His injury films are shown in Figures A and B. He is treated conservatively with closed reduction and his post-reduction radiographs are shown in Figures C and D. At 6 weeks followup he presents with persistent fracture site motion. His current imaging studies are shown in Figures E and F. Which of the following is the best next step in management?	Trauma	Humeral Shaft Fractures	L 1	A
140	OBQ19.135	214037	Figure A is the AP radiograph of a 74-year-old female who fell and complains of arm pain. She was initially seen in the ED and placed into a coaptation splint. At her first office appointment she was transitioned to a functional brace. The radiograph obtained 8-weeks following her injury demonstrates 8mm of gapping at the fracture site. Which of the following treatment modalities would be most indicated at this time?	Trauma	Humeral Shaft Fractures	L 2	A
141	OBQ18.253	213149	What is the function of the structure indicated by the arrow in Figure A, visualized through the posterior portal in the lateral decubitus position?	Shoulder & Elbow	Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics		A
142	SBQ18SP.36	211498	At a morbidity and mortality conference, two cases of a postoperative nerve palsy are presented following cervical decompression for myelopathy. The first patient was a 60-year-old female who underwent a C3/4, C4/5, and C5/6 anterior cervical discectomy and fusion who presented with symptoms on post-op day 1 and the other patient was a 72-year-old male who underwent a C3-T1 posterior cervical laminectomy and fusion who presented with symptoms on post-op day 2. Which of the following describes the most likely deficit found in these patients?	Spine	Cervical Myelopathy	L 1	A
143	OBQ19.179	214081	Figures A-C are the CT images of a 20-year-old basketball player who is referred to your office due to recurrent shoulder dislocations. The humeral-sided lesion is determined to be "off-track." His initial dislocation occurred 3-years-ago during a basketball game. He has since had 9 recurrent episodes and is able to self-reduce the shoulder. He has trialed two courses of formal phyical therapy without improvement. The decision is made to proceed with surgical treatment. At the first postoperative visit, he complains of lateral forearm numbness and examination reveals forearm supination weakness. Which neuropraxia was encountered and which procedure was indicated?	Shoulder & Elbow	Traumatic Anterior Shoulder Instability (TUBS)	L 2	A
144	SBQ18SP.73	211905	A 67-year-old man presents with a metastatic lesion in the right proximal femur. A biopsy is performed. Which of the following histological images corresponds to a lesion that would benefit from preoperative embolization?	Pathology	Metastatic Disease of Extremity		A
145	OBQ19.193	214095	Which of the following parameters supports early definitive treatment of the injury identified in figures A, B & C for a multiply-injured patient responding to resuscitation without the use of vasopressors?	Trauma	Evaluation, Resuscitation & DCO	L 5	A
146	OBQ19.166	214068	A 29-year-old man is involved in a motorcycle collision and is transported to the emergency department for evaluation. The primary survey reveals a right-side tension hemothorax and a Glasgow Coma Scale score of 14. The secondary survey reveals an open right-side femur fracture and a closed left-side humerus fracture. The hemothorax is appropriately managed by the trauma service with placement of a chest tube. Which of the following meets the definition of the development of systemic inflammatory response syndrome (SIRS)?	Trauma	Evaluation, Resuscitation & DCO	L 4	A
147	SBQ18SP.53	211685	A 65-year-old female undergoes the surgery depicted in Figure A. While performing the lateral aspect of the discectomy, brisk bleeding is encountered. What structure was likely injured during the procedure?	Spine	Cervical Radiculopathy	L 4	A
148	OBQ19.102	214004	Which of the following proximal humerus fractures has the highest likelihood of developing humeral head ischemia?	Trauma	Proximal Humerus Fractures	L 2	A
149	OBQ19.118	214020	The point on a stress-strain curve that separates the plastic and elastic regions is defined as which of the following:	Basic Science	Material Properties	L 1	A
150	SBQ11OS.20.1	214224	A 91-year-old, minimally ambulatory male presents with acute on chronic progressive right thigh pain. Fifteen years ago, he underwent a right total hip replacement and he had been having progressive thigh start-up pain over the prior 5 months. He sustained a ground-level fall yesterday and he is now unable to bear any weight on the right leg. His current radiograph is shown in Figure A. His labs, including CBC, ESR, and CRP are all within normal limits. Which of the following represents the most appropriate next step in definitive management?	Recon	THA Periprosthetic Fracture	L 2	A

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