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APMLE Part III study materials
APMLE Part III study resources

APMLE Part III practice questions

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Question 1Podiatric Medicine and Surgery

A patient has a painful, well-circumscribed, hyperkeratotic lesion on the plantar aspect of the first metatarsal head that contains a central translucent core. Which is the most likely diagnosis?

  1. Tinea pedis
  2. Porokeratosis
  3. Plantar wart Correct answer.
  4. Foreign body granuloma

Explanation

Verruca plantaris presents as a hyperkeratotic plaque that disrupts normal skin lines and often shows a central translucent core with thrombosed capillaries (the classic 'black dots'). It is caused by human papillomavirus and is common on pressure-bearing plantar sites such as the metatarsal heads.

Question 2Podiatric Medicine and Surgery

Which organism is the most common cause of a superficial fungal infection of the skin of the foot?

  1. Trichophyton rubrum Correct answer.
  2. Pseudomonas aeruginosa
  3. Candida albicans
  4. Malassezia furfur

Explanation

Dermatophytes of the genus Trichophyton, especially Trichophyton rubrum, are the leading cause of tinea pedis. They digest keratin and produce the scaling and erythema typical of the infection.

Question 3Podiatric Medicine and Surgery

A patient reports burning pain in the distribution of the third web space with a positive Mulder click. Which condition best fits this presentation?

  1. Morton neuroma Correct answer.
  2. Tarsal tunnel syndrome
  3. Plantar fasciitis
  4. Baxter nerve entrapment

Explanation

Morton neuroma is a perineural fibrosis of the interdigital nerve, most often in the third web space, producing forefoot pain and a palpable click on lateral compression (Mulder sign).

Question 4Podiatric Medicine and Surgery

Which finding on a radiograph is most characteristic of a hallux valgus deformity?

  1. Lateral subluxation of the sesamoids relative to the first metatarsal head Correct answer.
  2. Medial deviation of the first metatarsal head
  3. Increased first-second intermetatarsal angle
  4. Decreased hallux valgus angle

Explanation

In hallux valgus the sesamoids remain relatively fixed while the first metatarsal head drifts medially, so the sesamoids appear laterally displaced relative to the metatarsal head. The hallux valgus angle and intermetatarsal angle are both increased.

Question 5Podiatric Medicine and Surgery

A patient with diabetes has a deep, infected plantar ulcer over the first metatarsal head with exposed bone. Which initial step is most important in management?

  1. Immediate total contact casting
  2. Topical antibiotic ointment alone
  3. Sharp debridement and assessment for osteomyelitis Correct answer.
  4. Routine outpatient follow-up in one month

Explanation

A deep diabetic foot ulcer with exposed bone suggests possible osteomyelitis and requires prompt debridement, wound assessment, and imaging or bone biopsy. Offloading and antibiotics follow once the wound is properly evaluated.

Question 6Podiatric Medicine and Surgery

Which nerve is most commonly entrapped in tarsal tunnel syndrome?

  1. Tibial nerve Correct answer.
  2. Saphenous nerve
  3. Sural nerve
  4. Superficial peroneal nerve

Explanation

The tarsal tunnel is formed by the flexor retinaculum and medial malleolus, and the posterior tibial nerve passes through it. Compression there produces tarsal tunnel syndrome.

Question 7Podiatric Medicine and Surgery

Which laboratory value is most useful in monitoring glycemic control over the preceding two to three months in a patient with diabetes and foot complications?

  1. Hemoglobin A1c Correct answer.
  2. C-reactive protein
  3. Serum creatinine
  4. Fasting glucose

Explanation

Hemoglobin A1c reflects average blood glucose over the lifespan of red blood cells, roughly two to three months, making it the standard measure of long-term glycemic control.

Question 8Podiatric Medicine and Surgery

A patient develops acute monoarticular pain, swelling, and erythema of the first metatarsophalangeal joint. Aspiration reveals needle-shaped, negatively birefringent crystals. Which is the diagnosis?

  1. Gout Correct answer.
  2. Septic arthritis
  3. Pseudogout
  4. Reactive arthritis

Explanation

Negatively birefringent needle-shaped monosodium urate crystals confirm gout, which classically affects the first metatarsophalangeal joint (podagra). Pseudogout instead shows positively birefringent rhomboid calcium pyrophosphate crystals.

Question 9Podiatric Medicine and Surgery

Which is the most appropriate initial conservative treatment for plantar fasciitis?

  1. Corticosteroid injection as first-line therapy
  2. Prolonged immobilization in a non-weight-bearing cast
  3. Immediate surgical plantar fascia release
  4. Stretching, orthoses, and activity modification Correct answer.

Explanation

Plantar fasciitis is usually self-limited and responds to conservative measures such as Achilles and plantar fascia stretching, arch support, and activity modification. Injections and surgery are reserved for refractory cases.

Question 10Podiatric Medicine and Surgery

A patient has a painful callus under the second metatarsal head with transfer lesion formation. Which biomechanical factor most directly contributes to this presentation?

  1. Equinus contracture
  2. Cavus foot deformity
  3. First ray hypermobility Correct answer.
  4. Metatarsus adductus

Explanation

First ray hypermobility reduces the ability of the first metatarsal to bear load, shifting pressure to the lesser metatarsals and producing transfer calluses or ulcers under the second metatarsal head.

Question 11Podiatric Medicine and Surgery

Which imaging modality is most sensitive for early detection of osteomyelitis in a diabetic foot?

  1. Magnetic resonance imaging Correct answer.
  2. Computed tomography
  3. Plain radiography
  4. Ultrasonography

Explanation

MRI detects marrow edema and soft tissue infection early and is the most sensitive and specific modality for pedal osteomyelitis. Plain films may be normal early and show changes only after substantial bone loss.

Question 12Podiatric Medicine and Surgery

A patient presents with a hot, swollen, erythematous foot and a history of a minor puncture wound through a rubber-soled shoe. Which organism should be specifically covered?

  1. Streptococcus pyogenes
  2. Pseudomonas aeruginosa Correct answer.
  3. Staphylococcus aureus
  4. Clostridium perfringens

Explanation

Puncture wounds through athletic footwear classically inoculate Pseudomonas aeruginosa from the shoe lining, so antipseudomonal coverage is required.

Question 13Podiatric Medicine and Surgery

Which of the following best describes the function of the windlass mechanism during gait?

  1. It dorsiflexes the hallux to reduce tension on the Achilles tendon.
  2. It relaxes the plantar fascia to allow pronation at midstance.
  3. It tightens the plantar fascia at toe-off to elevate the arch and stabilize the midfoot. Correct answer.
  4. It plantarflexes the first metatarsal during swing phase.

Explanation

Dorsiflexion of the hallux during late stance winds the plantar fascia around the first metatarsal head, shortening the distance between the calcaneus and metatarsals and raising the medial arch. This stabilizes the midfoot and assists push-off.

Question 14Podiatric Medicine and Surgery

Which nail finding is most consistent with chronic onychomycosis?

  1. Transverse Beau lines
  2. Subungual hematoma
  3. Yellow-brown discoloration with subungual hyperkeratosis and distal onycholysis Correct answer.
  4. Pincer nail deformity

Explanation

Dermatophyte nail infection typically causes distal and lateral yellow-brown discoloration, thickening, subungual debris, and separation of the nail plate from the bed.

Question 15Podiatric Medicine and Surgery

A patient with a chronic plantar ulcer has a probe-to-bone test that is positive. What does this finding most strongly suggest?

  1. Superficial cellulitis
  2. Venous insufficiency
  3. Osteomyelitis Correct answer.
  4. Peripheral neuropathy alone

Explanation

A positive probe-to-bone test in a diabetic foot ulcer is highly suggestive of underlying osteomyelitis because the probe reaches bone through the wound tract. It should prompt imaging and possibly bone biopsy.

Question 16Podiatric Medicine and Surgery

Which antibiotic class is contraindicated in a patient with a documented history of tendon rupture on fluoroquinolone therapy?

  1. Macrolides
  2. Fluoroquinolones Correct answer.
  3. Tetracyclines
  4. Penicillins

Explanation

Fluoroquinolones carry a boxed warning for tendinopathy and tendon rupture, particularly Achilles tendon rupture, so they should be avoided in patients with prior fluoroquinolone-associated tendon injury.

Question 17Podiatric Medicine and Surgery

Which is the most appropriate initial management for an uncomplicated ingrown toenail with mild inflammation and no abscess?

  1. Oral antifungal therapy
  2. Conservative trimming with proper nail care and footwear modification Correct answer.
  3. Systemic corticosteroids
  4. Immediate partial nail avulsion with matricectomy

Explanation

Mild onychocryptosis without infection or abscess responds to conservative measures such as correct nail trimming, footwear changes, and hygiene. Surgical matricectomy is reserved for recurrent or severe cases.

Question 18Podiatric Medicine and Surgery

Which structure is at greatest risk of injury during a distal chevron osteotomy of the first metatarsal?

  1. Deep peroneal nerve at the ankle
  2. Peroneus longus tendon
  3. First metatarsal head vascular supply via the first dorsal metatarsal artery Correct answer.
  4. Posterior tibial tendon insertion

Explanation

The distal chevron osteotomy places the first metatarsal head blood supply, particularly the first dorsal metatarsal artery and capsular vessels, at risk, which can lead to avascular necrosis.

Question 19Podiatric Medicine and Surgery

A patient reports a sudden pop and pain at the posterior ankle while playing basketball, with a positive Thompson test. Which is the diagnosis?

  1. Achilles tendon rupture Correct answer.
  2. Plantar fasciitis
  3. Posterior tibial tendon dysfunction
  4. Ankle sprain

Explanation

A positive Thompson test (absence of plantarflexion on calf squeeze) indicates Achilles tendon rupture, often preceded by an audible pop and inability to push off.

Question 20Podiatric Medicine and Surgery

Which condition is characterized by a plantarflexed first ray in a rigidly cavus foot?

  1. Posterior tibial tendon dysfunction
  2. Tarsal coalition with pes planus
  3. Charcot-Marie-Tooth disease Correct answer.
  4. Pes planus

Explanation

Charcot-Marie-Tooth disease causes a hereditary motor and sensory neuropathy with intrinsic muscle weakness, producing a rigid cavus foot and a plantarflexed first ray.

Question 21Podiatric Medicine and Surgery

In a patient with a suspected compartment syndrome of the foot after crush injury, which finding is most concerning?

  1. Transient paresthesia
  2. Pain out of proportion to injury with passive stretch pain Correct answer.
  3. Localized ecchymosis
  4. Mild swelling

Explanation

Pain out of proportion and pain with passive stretch are the earliest and most reliable clinical signs of compartment syndrome. Compartment pressure measurement confirms the diagnosis and guides fasciotomy.

Question 22Podiatric Medicine and Surgery

Which is the recommended initial imaging study for a suspected acute ankle fracture in a patient who cannot bear weight?

  1. Diagnostic ultrasound
  2. Magnetic resonance imaging
  3. Plain radiographs of the ankle Correct answer.
  4. Bone scan

Explanation

Plain radiographs remain the first-line study for suspected ankle fracture and are used with clinical decision rules such as the Ottawa ankle rules to guide imaging.

Question 23Podiatric Medicine and Surgery

Which biomechanical effect results from an ankle equinus contracture?

  1. Compensatory subtalar pronation and increased forefoot pressure Correct answer.
  2. Reduced tension on the plantar fascia
  3. Decreased Achilles tendon load
  4. Increased dorsiflexion at the first metatarsophalangeal joint

Explanation

Limited ankle dorsiflexion forces the foot to compensate through subtalar pronation and early heel rise, which increases forefoot loading and is associated with plantar fasciitis and metatarsalgia.

Question 24Podiatric Medicine and Surgery

Which finding distinguishes a neuropathic (Charcot) joint from an infectious process in the acute phase?

  1. Absence of systemic signs with a history of neuropathy and a rocker-bottom deformity developing over weeks Correct answer.
  2. Presence of erythema
  3. Elevated skin temperature
  4. Elevated white blood cell count

Explanation

Acute Charcot arthropathy presents with a warm, swollen, erythematous foot in a neuropathic patient, often progressing to a rocker-bottom deformity, usually without the systemic toxicity seen in infection. Differentiating the two can be difficult and may require imaging and laboratory correlation.

Question 25Podiatric Medicine and Surgery

Which of the following is the most appropriate initial treatment for a patient with acute gout of the first metatarsophalangeal joint?

  1. NSAIDs or colchicine for acute symptom control Correct answer.
  2. Prophylactic antibiotics
  3. Allopurinol during the acute attack alone
  4. Immediate joint arthrodesis

Explanation

Acute gout is managed with anti-inflammatory therapy such as NSAIDs, colchicine, or corticosteroids. Urate-lowering therapy is generally not started or adjusted during an acute flare without anti-inflammatory coverage.

Question 26Podiatric Medicine and Surgery

A patient sustains a twisting injury to the ankle. Which physical examination maneuver assesses the integrity of the anterior talofibular ligament?

  1. External rotation stress test with the knee flexed
  2. Cotton test with lateral translation of the talus
  3. Anterior drawer test with the foot in slight plantarflexion Correct answer.
  4. Squeeze test of the proximal tibia and fibula

Explanation

The anterior talofibular ligament is the most commonly injured lateral ankle ligament, and its integrity is assessed by the anterior drawer maneuver performed with the foot in slight plantarflexion to relax the stronger calcaneofibular ligament.

Question 27Podiatric Medicine and Surgery

A 55-year-old with diabetes has a chronic neuropathic ulcer over the plantar hallux. Which finding on the Semmes-Weinstein monofilament test best supports the diagnosis of protective sensation loss?

  1. Inability to feel the 100-gram monofilament at the tested site
  2. Inability to feel the 10-gram monofilament at the tested site Correct answer.
  3. Inability to feel a 128-Hz tuning fork at the tested site
  4. Inability to feel the 1-gram monofilament at the tested site

Explanation

The 10-gram (5.07) Semmes-Weinstein monofilament is the standard threshold for identifying loss of protective sensation in diabetic foot screening.

Question 28Podiatric Medicine and Surgery

Which organism is the most common cause of a superficial bacterial skin infection between the toes in an athlete with macerated web spaces?

  1. Corynebacterium minutissimum
  2. Staphylococcus aureus
  3. Streptococcus pyogenes Correct answer.
  4. Pseudomonas aeruginosa

Explanation

Interdigital maceration with fissuring in a moist environment is typically caused by beta-hemolytic streptococci or dermatophytes; among the bacterial choices, Streptococcus pyogenes is the classic cause of this superficial infection.

Question 29Podiatric Medicine and Surgery

A patient with a rigid flatfoot and a fixed forefoot varus deformity undergoes a medial column fusion. Which biomechanical goal is most important to restore?

  1. Reduce tension on the Achilles tendon
  2. Increase subtalar joint eversion range
  3. Increase ankle dorsiflexion range of motion
  4. Restore the longitudinal arch and medial column stability Correct answer.

Explanation

Medial column fusion addresses the collapsed longitudinal arch by stabilizing the talonavicular and naviculocuneiform joints, restoring the medial column and arch contour.

Question 30Podiatric Medicine and Surgery

A 62-year-old with a long-standing hallux valgus presents with lateral forefoot pain and a positive Mulder sign (a palpable click on squeezing the forefoot). What does this finding suggest?

  1. Synovitis of the first metatarsophalangeal joint
  2. Stress fracture of the second metatarsal
  3. Rupture of the plantar plate of the second toe
  4. Interdigital neuroma between the metatarsal heads Correct answer.

Explanation

The Mulder sign is a palpable click produced by squeezing the metatarsal heads together, which forces an interdigital neuroma between them and is a classic bedside finding for Morton neuroma.

Question 31Podiatric Medicine and Surgery

A patient sustains a laceration over the plantar aspect of the first metatarsal head. Which structure is most at risk of being lacerated at this location?

  1. Peroneus longus tendon
  2. Extensor hallucis longus tendon
  3. Flexor hallucis longus tendon Correct answer.
  4. Tibialis anterior tendon

Explanation

The flexor hallucis longus tendon courses along the plantar aspect of the hallux and first metatarsal, placing it at risk in a plantar laceration at that level.

Question 32Podiatric Medicine and Surgery

A 30-year-old runner has a positive fulcrum test of the lesser metatarsals with focal tenderness and a normal radiograph. Which is the most appropriate next step?

  1. MRI of the foot to evaluate for stress fracture Correct answer.
  2. Repeat radiograph in 6 weeks without activity modification
  3. Corticosteroid injection at the tender site
  4. Immediate open reduction and internal fixation

Explanation

Early metatarsal stress fractures are frequently radiographically occult, and MRI is the most sensitive modality for detecting marrow edema and confirming the diagnosis so that appropriate activity restriction can begin.

Question 33Podiatric Medicine and Surgery

Which condition is characterized by flattening and fragmentation of the navicular with medial midfoot pain in an adolescent?

  1. Freiberg infarction
  2. Sever disease
  3. Kohler disease Correct answer.
  4. Iselin disease

Explanation

Kohler disease is avascular necrosis of the navicular bone, presenting in children with medial midfoot pain, tenderness over the navicular, and radiographic flattening and sclerosis.

Question 34Podiatric Medicine and Surgery

A patient with peripheral arterial disease has a nonhealing toe ulcer. Which finding on vascular assessment most strongly suggests inadequate perfusion for healing?

  1. Ankle-brachial index of 1.10
  2. Palpable popliteal pulse
  3. Capillary refill of 2 seconds in the toe
  4. Ankle-brachial index of 0.45 Correct answer.

Explanation

An ankle-brachial index below 0.5 indicates severe arterial insufficiency and predicts poor wound healing, whereas values of 1.0 to 1.4 are generally normal.

Question 35Podiatric Medicine and Surgery

Which surgical approach provides the best exposure for a lateral column lengthening in a patient with a severe flexible flatfoot?

  1. Medial approach to the naviculocuneiform joint
  2. Lateral approach to the calcaneus with an opening wedge osteotomy Correct answer.
  3. Posterior approach to the ankle with Achilles lengthening
  4. Dorsal approach to the first metatarsophalangeal joint

Explanation

Lateral column lengthening is performed through a lateral approach to the anterior calcaneus, where an opening wedge osteotomy lengthens the lateral column and corrects forefoot abduction.

Question 36Podiatric Medicine and Surgery

A patient presents with a painful, swollen, and erythematous first metatarsophalangeal joint after a high-purine meal. Which finding on joint aspiration is most specific for gout?

  1. Elevated synovial white blood cell count without crystals
  2. Negatively birefringent needle-shaped crystals Correct answer.
  3. Positively birefringent rhomboid crystals
  4. Gram-positive cocci in clusters

Explanation

Monosodium urate crystals are needle-shaped and exhibit negative birefringence under polarized light, which is diagnostic of gout.

Question 37Podiatric Medicine and Surgery

A patient with a suspected Achilles tendon rupture has a positive Thompson test. Which finding on the test confirms the diagnosis?

  1. Dorsiflexion of the foot when the calf is squeezed
  2. Plantarflexion of the foot when the calf is squeezed
  3. Absence of plantarflexion when the calf is squeezed Correct answer.
  4. Pain over the posterior heel when the calf is squeezed

Explanation

The Thompson test is positive when squeezing the calf fails to produce plantarflexion, indicating discontinuity of the Achilles tendon.

Question 38Podiatric Medicine and Surgery

Which finding best distinguishes a diabetic foot infection from a Charcot arthropathy in the acute phase?

  1. Presence of bounding pulses in the affected foot
  2. Presence of purulent drainage or an open wound with systemic signs Correct answer.
  3. Presence of warmth and erythema over the midfoot
  4. Presence of a rocker-bottom deformity

Explanation

Charcot arthropathy can produce warmth, erythema, and swelling, but purulent drainage, an open wound, and systemic inflammatory signs favor infection.

Question 39Podiatric Medicine and Surgery

Which is the most appropriate initial management for a patient with a plantar wart that is painful and refractory to topical salicylic acid?

  1. Wide surgical excision of the lesion
  2. Systemic antifungal therapy
  3. Oral acyclovir
  4. Cryotherapy with liquid nitrogen Correct answer.

Explanation

Verrucae are caused by human papillomavirus, and cryotherapy is a standard second-line treatment after topical keratolytics fail.

Question 40Podiatric Medicine and Surgery

A patient with a rigid cavus foot and claw toes undergoes a dorsiflexion osteotomy of the first metatarsal. What is the primary goal of this procedure?

  1. Increase medial column flexibility
  2. Increase subtalar eversion
  3. Lengthen the Achilles tendon
  4. Reduce plantar pressure under the first metatarsal head Correct answer.

Explanation

A dorsiflexion osteotomy elevates the plantarflexed first ray, redistributing pressure away from the first metatarsal head in a cavus foot.

Question 41Podiatric Medicine and Surgery

Which is the most appropriate initial treatment for a patient with an acute, minimally displaced fracture of the fifth metatarsal base (Jones fracture)?

  1. Weight-bearing in a soft shoe
  2. Corticosteroid injection at the fracture site
  3. Immediate intramedullary screw fixation
  4. Non-weight-bearing cast immobilization Correct answer.

Explanation

Acute Jones fractures are initially treated with non-weight-bearing immobilization because of the watershed blood supply at that location and the risk of nonunion.

Question 42Podiatric Medicine and Surgery

Which nerve is at greatest risk during a distal tibial nerve decompression at the tarsal tunnel?

  1. Superficial peroneal nerve
  2. Medial calcaneal branch Correct answer.
  3. Sural nerve
  4. Deep peroneal nerve

Explanation

The medial calcaneal branch arises from the tibial nerve within or just proximal to the tarsal tunnel and is vulnerable during release.

Question 43Podiatric Medicine and Surgery

A patient with a suspected deep space infection of the foot has pain out of proportion to findings and a tense dorsal compartment. Which is the most appropriate next step?

  1. Aspiration alone with culture and observation
  2. Elevation and oral antibiotics with outpatient follow-up
  3. Application of a compressive dressing and NSAIDs
  4. Emergent surgical decompression and irrigation Correct answer.

Explanation

A tense compartment with pain out of proportion suggests a deep space infection or compartment syndrome requiring emergent surgical decompression and debridement.

Question 44Podiatric Medicine and Surgery

Which is the most appropriate initial conservative treatment for a patient with an acute ankle sprain without fracture?

  1. Prolonged bed rest for 2 weeks
  2. Immediate cast immobilization for 6 weeks
  3. Protected weight-bearing with early range of motion and functional rehabilitation Correct answer.
  4. Immediate surgical ligament repair

Explanation

Functional rehabilitation with early mobilization and protected weight-bearing produces better outcomes than prolonged immobilization for uncomplicated ankle sprains.

Question 45Podiatric Medicine and Surgery

A patient with a suspected osteomyelitis of the toe has a plain radiograph that is normal. What is the most appropriate interpretation?

  1. A normal radiograph reliably excludes osteomyelitis
  2. A normal radiograph does not exclude early osteomyelitis Correct answer.
  3. A normal radiograph confirms a stress fracture instead
  4. A normal radiograph indicates a soft tissue infection only

Explanation

Plain radiographs may remain normal for 10 to 14 days after the onset of osteomyelitis because bone demineralization must reach a threshold before it becomes visible.

Question 46Podiatric Medicine and Surgery

Which is the most appropriate initial management for a patient with a painful, inflamed bunion with no ulceration or infection?

  1. Wider shoegear with accommodative padding Correct answer.
  2. Immediate first metatarsal osteotomy
  3. Long-term oral corticosteroids
  4. Antibiotic therapy

Explanation

Symptomatic hallux valgus without complications is initially managed with accommodative footwear and padding to reduce pressure over the medial eminence.

Question 47Podiatric Medicine and Surgery

A patient with a suspected stress fracture of the navicular has persistent medial midfoot pain despite rest. Which imaging modality is most appropriate to confirm the diagnosis?

  1. Repeat plain radiograph in 48 hours
  2. MRI of the foot Correct answer.
  3. Ultrasound of the midfoot
  4. Bone scan with a single phase

Explanation

MRI detects bone marrow edema and is the most sensitive modality for early navicular stress fractures, which are frequently occult on plain films.

Question 48Podiatric Medicine and Surgery

Which finding on examination best supports a diagnosis of posterior tibial tendon dysfunction in a patient with an acquired flatfoot?

  1. Positive Thompson test
  2. Positive Mulder sign
  3. Positive anterior drawer of the ankle
  4. Inability to perform a single-heel raise on the affected side Correct answer.

Explanation

Posterior tibial tendon dysfunction impairs the ability to invert the heel and raise the arch, so a single-heel raise is difficult or impossible on the affected side.

Question 49Podiatric Medicine and Surgery

A patient with a chronic plantar heel ulcer and a positive probe-to-bone test is referred for further evaluation. Which additional study is most useful to confirm underlying bone involvement?

  1. Repeat probe-to-bone testing
  2. Erythrocyte sedimentation rate alone
  3. MRI of the foot Correct answer.
  4. Serum uric acid level

Explanation

A positive probe-to-bone test raises suspicion for osteomyelitis, and MRI is the imaging study of choice to confirm bone involvement and define its extent.

Question 50Podiatric Medicine and Surgery

Which is the most appropriate initial management for a patient with an acute first metatarsophalangeal joint dislocation without fracture?

  1. Closed reduction with post-reduction radiographs Correct answer.
  2. Application of a walking boot without reduction
  3. Corticosteroid injection into the joint
  4. Immediate open reduction

Explanation

Acute MTP dislocation without fracture is managed initially with closed reduction under appropriate analgesia, followed by post-reduction radiographs to confirm alignment.