MCQ orthopedics posting

1. Regarding osteoarthritisa. It is a non-inflammatory joint dz T (degenerative disease)b. The pathogenesis involve increased hydration of articular cartilage Fc. The reparative process results in osteophyte formation Td. The primary generalized type involve small joint of hand Fe. Synovectomy is one of the treatment F (synovectomy is for RA)

2. Regarding osteoporosisa. Hypocalcaemia is a known cause Fb. The coupling action of osteoblast and osteoclats is lost Tc. Calcitonin is given in acute cases of fracture T (Calcitonin in a dose of 50

to 100 IU daily, given subcutaneously or intranasally, should be offered to all patients with serious pain related to acute vertebral fractures for symptom relief and to facilitate mobilization)

d. Selective estrogen receptor modulator have increased risk of venous thromboembolism T

e. Vertebroplasty is a therapy for fractures of vertebrae body T (Vertebroplasty is a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients)

3. Regarding carpal tunnel syndromea. It is known as ulnar neuropathy of the wrist Fb. Clinically the patient is unable to flex the PIPJ of index finger Fc. Compression test performed over the transverse carpal ligaments is

diagnostic Td. Pregnancy is one of its causes Te. In diabetics, carpal tunnel released is the preferred treatment T

4. Regarding anterior cruciate ligaments injurya. It is cause by a posteriorly directed force to the front of tibia Tb. Occurs more commonly among female athletes Tc. It predisposes to early osteoarthritis Td. It is usually associated with medial meniscus injury Te. The avulsion type is treated with screw fixation T

5. Regarding osteomyelitisa. Trauma is a predisposing factor Tb. In young children, haemohilus influenza is the common pathogen T-xc. Ceftazidime is the antibiotic of choice T (third gen)-xd. Sequestrum is a layer of new bone growth outside existing bone Fe. Joint dislocation is one of its complication F

6. Regarding developmental dysplasia of hip (DDH)

a. Female is commonly affected than male Tb. Strapping baby with extended hip is a predisposing factor Tc. Waddling gait is a presenting feature in unilateral DDH F (bilateral)d. Generalized joint laxity predispose to DDH Te. Barlow’s test is diagnostic for dislocatable hip T

7. Indication for internal fixation in children includea. Lateral condyle fracture of humerus F (unless displaced)b. Displaced acetabulum fracture Tc. Displaced tibia plateau fracture Td. Femoral neck fracture Te. Femoral shaft fracture F (unless in teenagers with unsatisfactory

reduction)-x

8. Indication of external fixation includea. Fracture a/w severe soft tissue damage Tb. Closed fracture midshaft of tibia Fc. Open book fracture of pelvis Td. Arthrodesis of ankle Te. Intraarticular fracture T-x

9. Regarding osteosarcomaa. It is a highly malignant osteoid forming tumor T

Usually presented with very painful mass around the knee F-xb. Codmanns triangle on plain radiograph is specific to osteosarcoma Fc. Neoadjuvant chemotherapy is given pre and post operatively Fd. Is frequently metastases to vertebral bone T-x

10.Regarding acute compartment syndromea. It occurs more commonly in lower limbs Tb. 20 mmHg difference between intracompartmental pressure and diastolic

pressure is diagnostic T (< 30)c. Volkmann’s contracture is its late sequalae Td. If cast is applied, it should be bivalve immediately Te. Left untreated it can lead to renal failure T

11.Regarding prolapsed intervertebral disca. Commonly occur at L4/L5 level Tb. Characterized by radiating pain to the anterior aspect of knee Fc. Listing to the opposite side of painful limb indicates a shoulder lesion Td. Loss of ankle reflex is seen in L5/S1 prolapse Te. Treatment is usually operative F

12.Features of FES includea. CNS depression tb. Occurs within 12 hr of skeletal trauma-f

c. Presence of fat globule in urine-fd. Sudden drop in platelet level-fe. Cannon ball appearance on chest xray-f

13.An elderly women was admitted with fracture neck of femura. The injury that causes the fracture is usually trivial-fb. The affected limb is usually in externally rotated position-tc. Sciatic nerve is commonly injured-td. Conservative treatment is the choice of treatment -fe. The fracture usually unites within 6 weeks-f

14.Regarding fracture non uniona. The fracture site is painful on movement-fb. Hyperthrophic non union have poor blood supply at the end of fragments-fc. Lower third of tibia is a common site of non union-td. External fixation is a known cause of non union-fe. Treatment of non union requires internal fixation and bone grafting-t

15.Regarding musculoskeletal tumora. GCT classically gives ‘soap-bubble’ appearance on xray-tb. Multiple enchondromas also known as Olliers dz-tc. Fibrous dysplasia causes shepherd crook deformity of proximal tumor-td. Osteoblastoma usually turn into malignancy-fe. Pain in osteoid osteoma typically relieve by aspirin-t

16.Regarding spine TBa. Narrowing disc space is the earliest sign seen on plain radiograph-fb. Drug therapy is given only after the culture is found to be positive with

mycobacterium-fc. PCR is diagnostic test for TB-td. Ethambutol has a bactericidal action against mycobacterium organism-fe. In children progressive kyphosis is one of its complication-t

17.Regarding durg used in orthopaedic practicea. COX-2 inhibitors is known to cause CVS complication-tb. Indometahcin is used to prevents myositis ossificans-tc. Gabapentin is used to treat neuropathic pain-td. Glucosamine is given in early OA case-fe. alendronate is used in osteoporotic fracture-t

18.Regarding outpatient orthopaedica. DeQuervain’s tenosynovitis is diagnosed by Finkelstein’s test-tb. Lateral epicondylitis is also known as tennis elbow-tc. Plantar fasciitis commonly present with pins and needles over the hind

foot-td. Morton euroma is a cause of metatarsalgia-t

e. Trigger finger rarely occur in infants-t

19.Regarding metastatic bone dza. The pain is severe at night disturbing sleep pattern Tb. Osteolysis is commonly seen in prostate cancer pt Fc. Hypercalcaemia is a potential life-threatening complication Td. Internal fixation is contraindicated Fe. radiograph of spine shows pedicle erosions F (vertebral collapse)

20.Regarding peripheral nerve injurya. Wallerian degeneration occurs in proximal segment of injured nerve Fb. Causalgia is one of its complication Fc. Finger drop without wrist drop indicates that the lesion is at the radial

groove of the humerus F (PIN)d. Migrating positive tinel sign is an indication of nerve recovery Te. Gabapentin is given for painful condition resulting from this injury T

MCQ orthopedics (group6)

1. Open fracture tibiaa. Occur at high velocity injury Tb. Common infection is by Staph. epidermidis F (common in foreign implant)c. Anaerobic infection occur in farmer injury Td. Can have complication of fat embolism Fe. External fixator need for management T

2. Causes of impairment consciousness with bilateral femoral # include:a. Hypovolamic shock Tb. Pneumothoraxc. Subarachnoid hemorrhaged. Fat embolism syndrome T

3. The incidence of vessel injury is higher in the following:a. Scapulo-thoracic dislocationb. Shoulder dislocation -axillary ac. Supracondylar # of humerus (brachia artery)d. Knee dislocation (pop artery )e. # of shaft of humerus wrist drop –radial n

4. In the hand:a. Froment test is used to test adducted pollicis longus b. Abductor pollicis longus supplied by radial nervec. FDP of little finger supplied by median nerved. Tinel test is to test for carpal tunnel syndromee. Ulnar nerve supply extensor carpi ulnaris

5. Emergency cervical radiology include:a. Lateral view Tb. Oblique view c. Open mouth view Td. Swimmer viewe. Flexion and entension view

6. Unstable lumbar spine injury include:a. Chance #b. Anterior wedge #c. Burst # d. Spinous process #e. Transverse process#

7. What is true about hip?a. SLR is to test fixed abductionb. Thomas test is to test fixed adductionc. Hip is externally rotated in femoral neck # d. ?e. DDH present with true shortening

8. Which of the following condition is assciated with excessive osteoclastic activitya. Osteogenous imperfectab. Osteopetrosisc. Osteoporosisd. Uncompensated osteomalaciae. Hyperparathyroidism

9. Which of the following is true relating to femoral neck # in osteoporotic women:a. Happen in trivial injuryb. Presented as externally rotatedc. a/w AVNd. best treated with total hip replacemente. shenton line is disrupted

10. regarding RA:a. affects articular cartilageb. a/w HLA-DR4c. most commonly in womend. DIP joint most commonly affectede. Extraarticular manifestation in 10-20%

11.Regarding gouty athritis:a. Assymetrical involvement of jointb. Periarticular sclerosisc. Eccentric soft tissue swelling

12.Organism isolated in septic arthritis of IVDU:a. Staph. Aureusb. Pseudomonas aerugenosa Tc. Diplococcid. Streptococcie. Haemophilus influenza

13.Common occurance at knee jt:a. Osteoid osteomab. Osteosarcomac. Chondrosarcomad. Enchondromae. Bursitis

14.Regarding osteomalacia: a. Vit D deficiencyb. Cause prox myopathyc. Pseudo-#d. Serum Ca2+ increasee. Diagnose with bone biopsy

15.Radiological features in non-accidental injury include:a. Multiple # in different stage of healingb. Excessive callusc. Posterior rib #d. Metaphysis corner #e. Short oblique #

16.Common Fracture-dislocation and nerve injury:a. Hip – sciatic nerveb. Shoulder – radial nervec. Supracondylar of humerus – ulnar nerved. Wrist dislocation- median nervee. Fibula neck- peroneal nerve

17.Regarding# of femur in children:a. # in pre-walking child suggests child abuseb. Fat embolism common than in adultc. Shortening 2-3cm is acceptabled. Treated with traction and hip spicae. Surgery indicated wit polytrauma

18.Regarding archilles tendon injury:a. a/w inappropriate footwearb. pain is induced with plantar flexion against resistencec. tendon rupture is a complication

d. steroid injection is given in chronic casese. plantar heel pad is contraindicated?

19.AVN occur in # of:a. Base of metacarpal Fb. Femoral neck Tc. Supracondylar d. Talus Te. Tibia plateu

Medic 5 group 1 (07/08)1. A 32 years old labourer complained of severe backache radiating down to the left leg. Features of L% nerve root compression includes A. Absence of left superficial cremasteric reflexF B. Weak extensor of the kneeF D. Loss of sensation over lateral calf dorsal foot left leg.T E. Elevated ESRF

2. Lumbar spondylosis A. Common in young adultF B. Weakness of the lower limb is very common C. Majority of the patients have significant history of trauma to the back D. Spondylolithesis is one of the complicationsT E. Most of the patients require surgical decompression.F

3. Causes of irritable hip A. Transient osteoporosisT B. Slipped capital femoral epiphysis C. Perthes’ diseaseT D. Acetabular fracture E. Rheumatoid arthritis

4. Frozen Shoulder A. Limitation of movement is the earliest presentationF D. Radiological of the shoulder helps in diagnosingF

5. Radiological features suggesting malignant disease includesA. Minimal periosteal reactionB. Obvious soft tissue shadowC. Narrow transition zoneD. Geographical lytic lesionE. Sclerosed cystic margin

6. Regarding osteoarthritis of the kneeA. Increase water content of the cartilageB. Valgus deformity is more common than varus deformity

C. Radiological features are similar to those of rheumatoid arthritisD. Corrective osteotomy is one of the treatment options

7. Regarding goutA. Joint aspiration fluid is cloudy, yellowish in colourB. Serum uric acid is always highC. X-Ray shows large periarticcular excavationD. Colchinine is used for prophylaxis following recurrent attack

8. Diabetic footA. most of the patients presented with painful ulcerB. May be associated with charcoat jointC. Foot infection is typically caused by staphylococcus aureusD. Ankle Brachial Index (ABSI) is a useful method of assessing level of amputationE. Dirty ulcer should be dressed with strong erosive chemical solution

9. Regarding elbow jointA. Pain on resistant (extension dorsiflex of the hand) in tennis elbowB. Early passive movement is encouraged in elbow injury

10. Fat embolismA. It takes place after 2nd week of long bone fractureB. Associated with petechial hemorrhage over the chest, neck and faceC. Arterial Blood Gases will show low pCO2D. Chest X-ray is normalE. Presence of fat globules in the sputum and in the urine

11. Early complication of isolated cervical spine fracture with tetraplegia includeA. Stress ulcerB. Hypovolemic shockC. BradycardiaD. Lung collapseE. Painful muscle spasm

12. In congenital Hip dislocationA. A baby with sign of hip instabily should be examined with ultrasonographyB. Barlow’s test is done by abduction and flexion of hip to reduce dislocationC. Untreated case lead to avascular necrosisD. More in breech presentationE. Operation should be done as soon as the diagnosis is made

13. Indication for external fixation includeA. Certain pelvic fractureB. Arthrodesis of kneeC. Closed communited unstable fracture of distal radiusD. Severe soft tissue damage

E. Correction of complex congenital limb deformity

14. OsteomyelitisA. In adult it is more common in vertebral bodyB. It often mimics osteoid osteoma in subacute typeC. It can cause limb length discrepancy in childrenTD. Diffuse periosteal reaction along the diaphysis is characteristic in syphilitic casesTE. Vancomycin is treatment of choice in MRSA

15. In spinal tuberculosisA. The infection develops in intervertebral discFB. New bone formation is minimal in active infectionTC. Radiograph shows gross vertebral body destructionTD. More extensive in childrenT

16. Regarding bone tumourA. Fibrous dysplasia is not a true tumourTB. Myositis ossificans mimics osteosarcoma histologicallyC. Chodroblastoma occurs in epiphysisTD. Benign tumour can be treated with irradiationFE. 20% eosinophilic granuloma can progress to Hand-Schuller syndrome

17. Penetrating wound with median nerve palsyA. Pointing index fingerB. There is loss of sensation over the thenar eminenceC. Loss of flexion of the lateral 3 fingersD. Weak hand grip

18. Regarding supracondylar fracture of humerus A. In children, is usually extraarticular

B. Anterior fat pad sign is the feature of fracture C. Cubitus valgus is more common than cubitus varus D. Posterior interosseous verve is commonly injured E. Percutaneous pinning is a treatment for open surgery

19. Regarding meniscus of the kneeA. Medial meniscus is more prone to be injuredB. Lachman test is positive

MCQ ORTHO GROUP 1 , 2

1. Regarding # of clavicleA. usually involves the middle 1/3 of the clavicleB. non-union is commonC. # is diagnosed from plain radiographD. cx include brachial plexus injury

E. usually treated conservatively with arm sling T,F,T,T,F

2. Regarding # of humerusA. surgical neck of humerus is a common # siteB. open # is treated w IF & antibioticC. radial nerve is the most common nerve to be injuredD. can be treated w U-slabE. lat. Condyle is # > common then medial condyle T,T,T,T,T

3. Shoulder dislocationC. Axillary view can diff. Between post dislc. & ant.E. Habitual dislocation is painless T,T

5. Regarding open #A. tibia > commonB. grade 3C high risk of amputationC. grade 1A can be primarily suturedD. external fixator can be use if skeletal traction not available T,T,T,T

6. About posterior dislocation of LLA. more common than antr dislocationB. leg held in internal rotation and abductionC. femoral artery injury is uncommonD. sciatic nerve injury causes foot dropE. failed close reduction need surgical reduction T,F,F,T,T

7. Regarding Perthe’s ds :A. genetic factor has a role in its pathogenesisB. occurs frequently in maleC. patient is typically obeseD. medial knee pain is one of its presentationE. worse prognosis in younger age F,T,F,F,F

8. Regarding # of tibia and fibula :A. Pilon # is a # of intraarticular T

9. # of tibiaA. a/w lower fibula # causes ankle instabilityB. # of distal tibia is a/w delayed or non-unionC. pilon # is an intraarticular # of distal tibiaD. PTB cast is appropriate for distal tibia #

10. Regarding # neck of femurA. extracapsular # carries better prognosisB. the affected leg is adductedC. garden 2 # is a partially displaced #

D. undisplaced # in elderly pt is treated conservativelyE. hemiarthroplasty is Rx of choice for neglected # in elderly T,F, F,F,T

10. Possible traction cx following conservative RxA. compartment syndrB. foot dropC. joint stiffnessD. press soreE. disuse osteoporosis T,T,T,T,T

11. Perthe’s dzA. present b4/after 10 yrB. d/t AVN of prox femoral epiphysesC. > femaleD. plain x-ray show femoral head smaller & flatterE. require surgical intervention F,T,F,T,F

12. Diabetic footA. sensory neuropathy coz dryness/fissures of footB. infection is superficialC. improper nail cutting disastreousD. level of amputation depend on its vascularity …….....E. charcot joints usually involved ankle joint F,F,T,T,T

13. Regarding knee painA. knee & hip x-ray requiredB. locked knee means inability to extend knee fullyC. immediate knee swelling suggest meniscus injuryD. hemarthrosis in haemophilic pt treated w knee aspirationE. meniscus calcification suggest gouty arthritis T,T,F,F,F

14. Diabetic footA. sensory neuropathy coz dryness/fissures of footB. infx is superficialC. improper nail cutting disastreousD. level of amputation depend on its vascularity E. charcot joints usually involved ankle joint F,F,T,T,T

15. Chronic OMA. chronic d/c is pathognomonicB. it may follow close # if treated w internal fixationC. radiologically may mimic Ewing sarcomaD. pathological # is a known cxE. prolonged antibiotic w/out surgery is usually sufficient for treatment F,T,F,T,F

16. Regarding OA of the knee

A. 20 OA occur following previous Septic arthritisB. valgus deformityC. blood ix-elevated ALPD. radiographically knee jt appear osteopenicE. TKR indicated for pt <45 y.o T,T,F,F,F

17. Peripheral nerve injury A. median nerve injury coz weakness of abduction muscleB. malunion of supracondylar # in children coz tardy ulnar nerve lesionC. Tinel’s sign indicate nerve regenerationD. injury of radial nerve at humerus unable to extend elbowE. in carpal tunnel syndr sensation in the thenar eminence is lost T,F,T,T,F

18. Regarding Spinal injuryA. hangman # is # of pedicle of C2B. posterior column injury alone is stable injuryC. cervical injury show decrease in prevertebral shadowD. overdose steroid lead upper GIT bleedingE. facet dislocation can be treated with skull traction T,T,F,T,T

19. Regarding capacityA. regarding pt ability to make decisionB. pt loss his right when involved life saving decisionC. severely depressed pt have no capacityD. ultimate judge of capacity is Hospital directive and consultant E. there is no aids to assess capacity T,F,T,F,T

20. Regarding moral principles of Dr-pt relationshipA. non-maleficience:dr should do everything possible to benefit pt’s healthB. beneficience:dr should not harm pt’s healthC. autonomy:pt should respect dr freedom to decide on RxD. justice:dr treat all pt fairlyE. capacity:ability to understand information relevant to decision making F,F,F,T,T

MCQ ORTHOPAEDICS GROUP 7 & 6

1. Regarding compartment syndromeA- can occur both upper and lower limbB- pain worsen on passive movementC- should bivalve immediatelyD- elective OT list

2. Chronic osteomylitisA- calceneum OM-pseudomonas infectionB- ESR usually > 100mm/hC- sequestrum help in diagnostic

D- technetium is diagnosticE- infected implant must removed eventhouh non-union

3- Septic arthritis A- is an emergencyB- X-ray of the hip helps in diagnosisD- ultrasonography is a diagnosticE- Tx with Ab and joint aspiration

4- Regarding diabetic footA- trauma ulcer d/t loss of sensoryB- Claw toes d/t autonomic neuropathyC- Blood sugar level hard to controlD- peripheral vascular pulse example reliable in diagnostic level of amputation

T,F,T,T

5. Recognised features of polymyalgia rheumatica includeA- weakness of distal muscle groupB- elevated serum creatinine kinase activityC- is associated with bronchial CA D- weight lossE- peak incidence in 4th decade of life

7. Regarding prolapsed intervertebral disc

10. Regarding MSK tumour A- most common bone tumour is osteosarcomaB- spine tenderness must always be excluded during physical examinationC- hypocalcemia is one of the common complication following 2 bone metastases D- CT scan delineates bone marrow extension of bone tumourE- Tx osteosarcoma is generally surgical excision and radiotherapy

11. regarding fracture of clavicleA- usually involve the middle 1/3 of the clavicleB- non-union is not commonC- fracture is diagnosed from plain radiographD- Cx include brachial plexus injuryE- usually treated conservatively

14. Management of major traumaA- peripheral circulation should be assessed before airway is assessedB- airway is assessed in cervical spine injuryC- CT-scanning is useful in unexplained shockD- Jaw thrust is done to maintain airway in suspected cervical spine injury

16. A motorcyclist was admitted with open fracture of the tibia and fibula. True

regarding managementA- IV antibiotic is started immediatelyB- wound debridement is done as soon as possibleC- the wound is sutured immediately to prevent contaminationD- IF is done when ext. fixator is not availableE- 10 amputation is one of the option for open fracture grade 3C in post tibial fracture injury

18. Fat embolism syndromeA- CNS depressionB- hypoxemiaC- presence of fat in urine and sputumD- Unexplained drop in Hct or platelet valueE- usually within 72 hr after injury19. Regarding finger injuryA- industrial causes most common causesB- should be operated 6-8 hours if not preservedC- should direct preserved with iceD- nerve neuroma is the most complication

20. Regarding supracondylar fractureof the humerusA- in children,it usually intraarticularB- anterior fat pad sign is a feature in X-rayC- cubitus valgus is common compared to cub. VarusD- post. Interossioeus veins is the commonly injuredE- percutaneous pinning is a tx for open surgery

MCQ Orthopedic Year 4 Group 4 09/10

1. Acute compartment syndromea. Lower limb most commonly affectedb. 20mmHg difference between intracompartmental pressure and diastolic

blood pressure is diagnosticc. Volkmann’s contracture is a late complicationd. Cast should bivalve immediatelye. Renal failure if left untreated

2. Prolapsed intervertebral disca. L4-L5 is the most commonly affected siteb. Pain radiating to the anterior of kneec. L5-S1 causes ankle reflex lossd. Surgery is the main treatmente. Listing to the side opposite to the painful side indicates a shoulder lesion

3. Fat emboli syndromea. Causes CNS depression

b. Occurs in 12 hours in skeletal traumac. Acute reduce in platelet leveld. Urine containing fat globulee. Canon ball lesion on chest X-ray

4. Fracture of femoral neck in elderlya. Caused by trivial injuryb. Usually cause sciatic nerve injuryc. Leg is in the externally rotated positiond. Should treat conservativelye. Union in 6 week

5. Non-uniona. Painful on moving the fracture siteb. Low blood supply in hypertrophic non-unionc. Distal 1/3 tibia is commond. External fixation is a known causee. Treat with internal fixation and bone graft

6. Musculoskeletal tumoura. Pain caused by Osteoid osteoma is characteristically relieved by aspirinb. Fibrous dysplasia causes shepherd crook deformity in proximal femurc. Osteoblastoma usually change to malignantd. Giant cell tumour causes soap bubble appearance in X-ray e. Multiple enchondroma is also known as olliers disease

7. Spine TBa. Reduce intervertebral space is the earliest manifestation in X-rayb. Start treatment after the culture come back positivec. PCR is diagnosticd. Ethambuthol is bactericidale. Progressive kyphosis in children

8. Drug in musculoskeletala. COX-2 causes cardiovascular problemb. gabapentin is used for neuropathic painc. Indomethacine is used for myositis ossificansd. Alendronite is used for osteoporotic fracturee. Glucosamine is used for early OA

9. Development dysplasia of hipa. Female is more common than maleb. Waddling gait is a presenting feature In unilateral hip dislocationc. Generalized joint laxity is predispose to DDHd. Barlow test is diagnostic for dislocatable hipe. Strapping baby in an extended leg is a risk factor

10. Internal fixation in childrena. Displaced fracture of acetabulumb. Fracture of lateral condyle of humerusc. Fracture of tibial plateaud. Fracture neck of femure. Femur shaft fracture

11.External fixation indicationa. Severe soft tissue injuryb. Pelvic Open book fracturec. Arthrodesis of ankled. Intra-articular fracturee. Closed fracture of tibia

12.Osteosarcomaa. Characteristic highly malignant osteoid forming tumourb. Codmans triangle is specific feature for osteosarcomac. Neoadjuvant chemotherapy is given pre and post operativelyd. Commonly metastasis to vertebrae. A young patient usually presented with painful knee

13.Osteoarthritisa. Non-inflammatory synovial joint diseaseb. Increased hydration of hyaline cartilage is the early pathologyc. Generalized primary osteoarthritis commonly affects small joint of handd. Osteophyte formation is due to the reparative processe. Synovectomy is the early treatment in osteoarthritis

14.Osteoporosisa. Hypocalcemia is a causeb. Loss of coupling of osteoclastic and osteoblastic activityc. Calcitonin is used for treatment of fracture of femoral neckd. Selective estrogen receptor modulator increases the risk of

thromboembolisme. Vertebral collapse is treated with vertebroplasty

15.Carpal tunnel syndromea. Is an Ulnar nerve entrapment diseaseb. Compression on the transverse carpal ligament is diagnosticc. Unable to flex the proximal interphalangeal joint of index fingerd. Pregnancy is a causee. Carpal tunnel release is preferred in diabetic patient

16.Anterior cruciate ligament injurya. More common in female athleteb. Posteriorly directed force on the anterior of tibia

c. Causes early osteoarthritisd. Avulsion type treat with screw fixatione. Associated with medial meniscus injury

17.Osteomyelitisa. Haemophilus influenza is a common cause in childrenb. Trauma is a predisposing factorc. Cef….?? (should be a third generation cephalosporin) is the preferred

treatmentd. Dislocation is a complicatione. Sequestrum is the new bone formation

18.Out patient orthopaedicsa. Dequervain disease is confirmed by finkelsteinb. Lateral epicondilytis is also known as tennis elbowc. Plantar fasciitis causes pin and needle sensation on hindfootd. Morton’s disease is a cause of metatarsalgiae. Trigger finger is rare in infant

19.Metastasis bone diseasea. Pedicle erosion is a finding of spine X-rayb. Metastasis from prostate causes osteolytic lesionc. Hypercalcemia is a life threatening complicationd. Night pain disturbing sleepe. internal fixation for the fracture

20.Peripheral nerve injurya. gabapentin is a treatmentb. finger drop without wrist drop is due to radial nerve injury at radial groove

of humerus]c. wallerian degeneration occurs proximal to the injury sited. causes causalgiae. migratory tinnel sign indicates healing

Ortho MCQ group 5 (10/11)1.compartment syndromea)tight case is a causeb)ischemic pain is the earliest signc)opiod in high dose is a treatment if detected earlyd)compartment release is indicatede)rest,ice,compression,elevated before surgery2. fat embolisma) present with CNS depressionb) within 12 hours of skeletal traumac)presence of fat globule in urine

d) sudden drop in platlet levele) cannon ball appearances in xray3. Regarding scaphoid #a)commonest carpal bone fractureb)fracture of prox part of scaphoid can cause AVNc)Tenderness over anatomical snuffboxd) treated in glass holding caste)normal x-ray changes can exlude diagnosis of #4) upper limb peripheral nerve injuriesa) injury in median nerve results in wrist dropb) injury in musculocutaneous nerve results in weakness in shoulder abductionc) injury in radial nerve results in loss of sensation in anatomical snuffboxd) injury to ulnar nerve results in claw hande) injury to axillary nerve results in loss of sensation in axillary region

5. osteosarcomaa) it affects epiphysis of long bonesb) it is common in flat bonesc) hematogenous spread results in pulmonary metastasisd) it is exclusive to adolescencee) x-ray shows a sunburst appearance

6. lumbar spinal stenosisa) claudication pain is the hallmark of conditionb) pain is referred to gluteal regionc) clinical signs is commonly minimal or absentd) commonly needs surgical treatmente) symptoms is relieved with stooping position

7. perthe's diseasea) usually presents before 10 years of age.b) d/t avascular necrose of distal femoral epiphysis.c) is more common in girlsd)plain-x-ray shows flatting of the capital femoral epiphysis.e) is related to childhood obesity.8. regarding developmental dysplasia of hip DDHa) more common in girlsb) more common in left hipc) 80% unilaterald) generalised joint laxity predisposed to DDHe) breech position with leg extended during birth is a risk factor.9. cause of primary osteoporosis:a) senileb) oophorectomyc) postmenopausal

d) corticosteroidse) rheumatoid arthritis10. regarding # of the femoral neck in osteoporosisa) caused by trivial injuryb) affected limb is externally rotatedc) cause AVN of femoral headd) best treated by hip replacement

11. x ray changes in gouty arthritisA. asymmetrical joints involvementB. Eccentric soft tissue swellingC. sclerotic margin around bony erosionD. subluxated jointsE. severe osteoporosis

12. OA of hipa) limitation of movement in early OAb) fibrillation of aritcular cartilage is late stagec) a walking aid is used on the same side of the OA hipd) hip replacement surgery is surgical optione) hip arthrodesis is indicated in severe OA in young patient

13. Radiological changes in osteomyelitis:a) changes from previous xrayb)poor defined areas of osteolysis c) thin linear periosteal reactiond) sequestrume) onion peel effect

14. synovial aspitate analysis:Viscosity – lowWBC- 20000PMN- 50%Findings compatible with:a) degenerative joint diseaseb) pigmented villo-nodular synovitisc) septic arthritis d) RAe) gouty arthritis15.osteosarcomaa)common in epipyhsisb)common in flat bonec)haematogenous spread cause lung metastasisd)exclusively in adolesenscee)sunburst appearance in x ray

16. # non union a. painful on movementb. hypertropic non-union has poor blood supply at its bone endsc. most common site at distal 1/3 of tibiad. external fixator is a known causee. treat with internal fixation and bone graft17. supracondylar # of humerus in children causesa) cubital carusb) distal fragment displaces posteriorly by action of the tricepsc) elbow triangle relationship is disruptedd) forearm compartment syndromee) non-union

18. Early emergency operation includea) dislocated kneeb) #neck of femurc) #proximal 1/3 of tibiad) displaced # of acetabulume) lock dislocation of hip 19. ankle spraina) medial side is more commonb) inversion type of injuryc) anterior drawer test is one of diagnostic assessmentd) cast is indicatede) rest, ice, compression and elevation therapy is needed in early20. regarding P.E in orthopaedica.contraction is weak but able to move against gravity graded MRC 3b.thomas test is to test fixed flexion of the knee jointc. scissory gait is due to tightness of adductor in the thighd.sensory loss at C6 dermatome due to Ulnar nerve lesion/palsy?e.antalgic gait due to short stance of the ipsilateral leg21.component of Colles' fracturea.impactionb.dorsal angulationc.intra-articular extensiond.ulna deviatione.pronation22. growth plate # in childrena) more commonly than joint dislocationb) metaphyseal extension type requites surgeryc) causes overgrowthd) causes angular deformity

23. regarding anterior cruciate ligament injuries at the kneea. it causes a positive anterior drawers testb. presents with delayed haemarthosis

c. twisting injuries on a static foot is a caused. mid substance injury is repaired primarilye. lachman test is diagnostic24. radio feature in non-accidental injury include:a) multiple # in different stage of healingb) excessive callusc) posterior rib #d) metaphysis corner #e) short oblique # 25)shoulder dislocationa) posterior are more commonb) prolong immobilisation is treatment in the elderlyc) axillary view is diagnosticd) hill-sachs lesion - recurrent dislocatione) Kocher's method- closed reductionOrtho MCQ Sclerotic bone lesion include

a. Osteoid osteoma tb. Solitary bone cyst fc. Paget disease fd. Aneurismal bone cyst fe. Osteopetrosis t

Causes of aggressive periosteal reaction includea. Osteoid osteoma fb. Brodie’s abscess fc. Acute osteomyelitis td. Ewing sarcoma te. Chrondosarcoma t

Lytic bone lesion includea. Prostate metastasis fb. Breast metastasis tc. Thyroid metastasis td. Renal metastasis te. Lung metastasis t

Regarding radiological investigation in orthopaedic practicea. Haemangioma often shows calcification on plain radiograph fb. MRI cannot identify a skip lesion in long bone affected with osteosarcomac. Loss of end plate and preservation of pedicle on plain radiograph of spine are

suggestive of spine metastasisd. Normal finding on ultrasound examination of hip excludes septic arthritise. MRI is able to detect changes of vascular necrosis of the femoral earlier than

bone scan

Pertaining to benign bone tumors a. Bone pain secondary to osteoid osteoma is not easily reduce by aspirin fb. Fibrous dysplasia gives ‘soup-bubble’ appearance on plain radiograph tc. Solitary bone cyst shows multiple septations on radiological examination td. Osteochondroma has no malignant potential fe. Giants cell tumors is hardly seen before closure of the physis t

Pertaining to musculocutaneous nervea. It supplies sensation over the medial aspect of the arm fb. It does not have sensory supply to the elbow joint c. Forearm supination is weakened if it is injured td. It is the nerve paralysed in ‘Saturday-night palsy’ fe. Wallerian degeneration occurs in axonotmesis of musculocutaneous nerve t

Regarding orthopaedic infection a. Cloaca seen on radiological investigation indicates chronic osteomylitis fb. The commonest organism causing septic arthritis in newborn is haemophilus

influenza fc. Healing of tuberculosis arthritis is by bony ankylosis td. Brodie’s abcess needs emergency drainage and debridement fe. Brown tumor is a malignant sequel of chronic osteomyelitis f

Regarding fracture or dislocation around the elbowa. Salter harris fracture type III is an extra articular fracture fb. Fracture of the radial head causes loss of isosceles elbow triangle fc. ‘fat- pad sign’ seen on plain radiograph indicates a complete triangle fd. Anterior elbow dislocation is more common than posterior dislocation te. Volkmann’s ischemic of the forearm is a potential complication of supracondylar

fracture

Regarding fracture of the upper limbsa. Monteggia fracture is a fracture of the radius associated with distal radioulnar

joint dislocation fb. Supracondylar fracture of the humerus is intraarticular fc. Cubitus varus is a recognized potential complication of supracondylar fracture of

humerusd. ‘dinner-fork’ deformity is a typical features associated with Coller’s fracture t e. Tenderness over the anatomical snuff box is suggestive of scaphoid fracture t

Regarding open fracturea. The wound of the open fracture is primarily closed fb. Internal fixation is used to stabilized the fracture during debridement fc. Antibiotics administration and proper irrigation and debridement are important to

prevent contamination to become an established infection td. Osteomyelitis is a recognized late complication te. Open fracture occurring at farm yard is considered as grade III open fracture t

Regarding osteoarthritis a. It is more common in obese patients tb. It is associated with raised serum calcium fc. Intercondylar distance is measured in supine position fd. Intraarticular steroid injection is recommended for acute exacerbation te. Total knee replacement is indicated in young active patient f

Regarding bioethics in orthopaedics practicea. Patient’s religious belief should be respected although contraindicating with the

treatment plan b. Patient is allowed to discuss with his/her family before giving consent tc. Informed consent is irreversible td. In life threatening event, a surgeon can perform a life-saving surgery in

unconscious patient even without any consent from anyone te. Treatment options are given and patient is allowed to choose based on

discussion with the treating practitioner t

Regarding paediatric hip disordera. Waddling gait is seen in unilateral neglected congenital hip dislocation fb. Excessive hip abduction in treating Developmental Dysplasia of Hip with hip

spica leads to avascular necrosis of femoral head tc. Positive Barlow test signifies that the hip is totally dislocated but reducible d. Transient synovitis of hip commonly shows joint effusion on ultrasounde. Slipped capital femoral epiphysis is common in age less than 8 years

Regarding orthopaedic infectionsa. Staphylococcus aureus is the predominant causative organism in necrotic

fasciitisb. Streptococcus Group A is the predominant causative organism in gas gangrenec. Streptococcus Group B is the predominant causative organism in cellulitisd. Pseudomonas sp is the predominant causative organism in penetrative in injury

of the foote. Staphylococcus epidermidis is the predominant causative organism in abscess

Ortho MCQ 2009 group 3

1) Regarding ACL injurya. It is cause by a posteriorly directed force to the front of tibia b. It is common among femalec. It is usually associated with lateral collateral ligament injuryd. It is usually associated with medial meniscus injurye. It can be treated with patella tendon autograft( T,T,F,T,T)

2) Regarding PCL injuriesa. It is more common compare to ACL injury

b. It is usually an isolated tearc. It is associated with dashboard injuryd. In grade 3 injury the tibia subluxates posterior to the anterior aspect of the

femoral condyle.e. Surgical reconstruction is the treatment of choice of most case

(F,N,F,N,T)

3) This factor predict wound healinga. Albumin level of 20g/dl F(>35)b. Transcutaneous oxygen tension of 305c. Ankle brachial systolic index of 0.9Td. HBa1c level of 6%Te. Toe pressure measurement of 20mmhg (T,T,T,T,F)

4) Regarding the diabetic foot ulcera. Can be treated with antibiotic onlyb. Wagner 2 ulcer associated with osteomyelitisc. Associated with painful neuropathyd. Wound debridement is frequently needede. Wegner 5 probably need below knee amputation (F,F,F,T,T)

5) Regarding the carpal tunnel syndromea. There is presence of hypoaesthesia at the palm Fb. There is presence of chondroid metaplasia of the tunnel liningc. Pointing index finger is a sign (severe case)d. Phalen sign positivee. Injection of steroid into wrist joint is a treatment (F,T,F,T,T)

6) Regarding trigger finger and its treatmenta. Stenosing of A5 pulley is a causeb. The flexor digitorum profundus gets trapped at A1 pulleyc. Release of the A1 pulley causes bowstringingd. Fibrous metaplasia occur at the pulleyTe. Occur in rheumatoid arthritis (F,T,F,N,T)

7) Regarding rheumatoid arthritisa. Causes symmetrical arthritisb. Affect the intervertebral discc. Rheumatoid factor is an abnormal immunoglobulind. Periarticular osteoporosis is a radiological featuree. Methotrexate is a disease modifying drug of choice (T,F,T,T,T)

8) In relation to gouta. Abnormal protein metabolism is a causeb. Tophi is a feature of acute casec. Dietary restriction of white meat is part of the treatment

d. Consumption of fish oil is contraindicatede. NSAIDs is the treatment of acute gout (T,F,F,F,T)

9) Regarding osteomyelitisa. The causal organism is usually staphylococcus aureusb. In young children, Hemophilus influenza is the most common agent

causing osteomyelitisc. Sequestrum are often found within the thickened cortex and are boared by

the reactive bone and chronic granulationd. Involucrum contains the sequestered, necrotic marrow and the endosteal

bonee. Chronic abscess can violate the skin by means of sinus tract lead to

chronic ulceration and drainage (T,T,T,T,T)

10)Regarding the bone massa. Peaks at age 30 yrs oldb. 0.3% bone loss per yr in men after peak bone massc. 0.5% bone loss per yr in female after peak bone massd. In early menopause, bone loss is cause by excessive osteoclast-mediated

reabsorption(estrogen loss,less restrained osteoclastic resorption)e. In late postmenopausel, bone loss is due to suppression of osteoblast

activity (T,N,N,T,T)

11)Regarding osteoporosisa. Serum calcium is normalb. Associated with poor fracture healingc. Early premature menopause is a high riskd. Can be treated successfully with calcium supplement alonee. Osteoporotic related fracture usually occur in metaphyseal region

(T,T,T,F,F)

12)Non-modifiable factor of osteoporosis includesa. Family history of osteoporosis in first degree relativesTb. Advancing ageTc. Personal history of fracture as an adultTd. Excessive alcohol intakeFe. Corticosteroid medication (T,T,T,T,T)

13)Specific investigation of osteoporosis includes:a. Dual-energy X-ray absorptiometry (DEXA)b. Quantitative computer tomography (QCT)c. Single energy X-ray absorptiometry (SXA)d. Quantitative ultrasound (QUS)e. Urinary deoxypyridinoline (DPD) (T,T,N,N,T)

14)Regarding Developmental Dysplasia of the Hip (DDH)a. Female is commonly affected than male

b. Left hip is more commonly affected then right hipc. 80% is unilaterald. Generalize joint laxity predispose to DDHe. A breech position with extended legs predispose to DDH

(T,T,T,T,T)

15)Pathoanatomy of DDH includea. Shallow acetabulumb. Femoral anteversionc. Inverted labrumd. Formation of Pulvinare. Contracted transverse acetabular ligament

(T,N,N,N.N)

16)Secondary osteoarthritis is cause bya. Obesityb. Septic arthritisc. Recurrent dislocationd. Pseudogoute. Perthe’s disease (F,T,T,T,T)

17)Indication of internal fixation includesa. Open fracture grade 3Ab. Displaced acetabulum fracturec. Displaced tibial plateau fractured. Femoral neck fracture in young adulte. Pathological fracture

(F,T,T,T,T)

18)Indication of external fixation includesa. Fracture associated with severe soft tissue damageb. Closed fracture midshaft of tibiac. Open book fracture of pelvisd. Aseptic non-union of femure. Intraarticular fracture

(T,F,T,F,F)

19)Regarding osteosarcomaa. It is a highly malignant primary bone forming tumorb. More common in males compared to femalesc. Peak incidents 10 – 20 yearsd. Commonest at metaphyseal of long bonee. Classical osteosacroma is extramedullary

(T,T,T,T,F)

20)Plain x-ray features commonly seen in osteosarcoma includes

a. Osteoclastic changesb. Wide zone of transitionc. Sun ray spiculesd. Codman’s trianglee. Cortical breach

(F,T,T,T,T)