1. A patient with numbers of the anterior thigh and shin, weakness of the quadriceps, and loss of patella reflex has involvement of what nerve root?
    a.-L1
    b.-L2
    c.-L3
    d.-L4
    e.-L5


  2. Indirect reduction of the intracranal fragment secondary to a burst fracture is accomplished by which of the following forces?
    a.-Flexion
    b.-Distraction
    c.-Compression
    d.-Extension
    e.-Rotation


  3. A 9-year-old girl has had an aching pain in her left for the past 4 months. Plain radiographs of the tibia are shown in Figures a and b, a coronal T¹-weighted MRI scan is shown in Figure c, and a sagittal T²-weighted image is shown in Figure d. A bone scan shows this to be the only area with increased uptake. An incisional biopsy yields histology as shown in Figure e. An electron microscopic study is shown in Figure f. What is the most likely diagnosis?


    Fig. a
    Fig. b
    Fig. c
    Fig. d

    a.-Primitive neuroectodermal tumor
    (PNET).
    b.-Eosinophilic granuloma (Langerhans histiocytosis).
    c.-Metastatic neuroblastoma
    d.-Ewing sarcoma
    e.-Osteosarcoma


  4. A 42-year-old man presents with a long history of right arm pain over the thumb and forearm and the recent onset of morning stiffness in his legs. Physical examination reveals sustained clonus in the left leg, several beats of clonus in the right leg, but no demonstrable weakness of his arms or legs. A plain radiograph and MRI scans are shown in Figure a through Figure c. Treatment should consist of


    Fig. a
    Fig. b
    Fig. c

    a.-A physical therapy strengthening program.
    b.-Epidural steroid injection.
    c.-Posterior cervical fusion.
    d.-Cervical laminectomy.
    e.-Anterior cervical vertebrectomy and fusion.


  5. A 65-year-old man with a history of lumbar spinal stenosis now has hyperreflexia in his upper extremities. The most likely cause of this patient's condition is
    a.-Increased lumbar stenosis.
    b.-Herniated disk at C7-T1.
    c.-Cervical spinal stenosis.
    d.-Cerebral vascular insufficiency.
    e.-Instability at C1-2.


  6. An asymptomatic 15-year-old girl was recently found to have idiopathic scoliosis. Menarche was 2 1/2 years ago. Radiographs reveal a thoracic curve with a Cobb angle of 37 degrees, and the patient is Risser 5. Recommended management should consist of
    a.-Posterior spinal fusion and instrumentation.
    b.-Anterior spinal fusion, followed by posterior spinal fusion and instrumentation.
    c.-Cervical thoracolumbosacral orthosis (Milwaukee brace).
    d.-Thoracolumbosacral orthosis.
    e.-Observation.


  7. The molecular basis for achondroplasia has recently been established as a mutation within a receptor for what substance?
    a.-Fibroblast growth factor.
    b.-Insulin-like growth factor.
    c.-Parathyroid-related protein.
    d.-Somatomedin.
    e.-Vitamin D.


  8. An otherwise healthy 11-year-old girl has a 3-month history of increasing knee pain that is absent at night. An anteroposterior radiograph of the proximal tibia is shown in Figure a, the coronal and transverse T²-MRI scans are shown in Figures b and c, respectively. Low- and high-power photomicrographs of the biopsy specimen are shown in Figures d and e, respectively. The most likely diagnosis is


    Fig. a
    Fig. b
    Fig. c


    Fig. d
    Fig. e
    a.-Giant cell tumor.
    b.-Chondroblastoma.
    c.-Aneurysmal bone cyst.
    d.-Unicameral bone cyst.
    e.-Osteosarcoma.


  9. A 4-year-old girl falls and fractures her femur. Radiographs obtained after closed reduction and hip spica cast application are shown in Figures a and b. The physician should now recommend


    Fig. a
    Fig. b
    a.-Cast removal, then skin traction.
    b.-Continued use of the current cast.
    c.-Wedging of the cast.
    d.-External fixation.
    e.-Internal fixation with a plate.


  10.Spondylolisthesis at the L4-5 level in adults is most likely secondary to what condition?
a.-Trauma.
b.-Pars defect.
c.-Degenerative disease.
d.-Congenital abnormality of the pars.
e.-Elongation of the pars.


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