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MCQ on Orthopaedics
1. Which of the following methods accurately describes the measurement of tip — apex distance as it relates to placement of a lag screw in the femoral head?
(1) Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs
(2) Distance from the acetabular teardrop to the tip of the screw on an AP radiograph of the hip
(3) Multiplication of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs
(4) None of the above
2. Submuscular bridge plating is appropriate treatment for which of the following?
(1) A 2 month old female with displaced, spiral, mid-diaphyseal femur fracture
(2) A 26 month old boy with a displaced spiral mid-diaphyseal femur fracture with <2cm shortening
(3) A7 year old boy with a transverse, non-comminuted mid-diaphyseal femur fracture
(4) A 7 year old boy with a highly comminuted mid-diaphyseal femur fracture
3. A 32-year-old male sustains a 100% tear of his flexor tendon in the Zone 2 region after cutting his finger with a knife. Which of the following variables has the greatest effect on increasing the strength of the tendon repair?
(1) The size of the core suture
(2) Number of core strands crossing the repair site
(3) Use of epitendinous suture
(4) Repair of the flexor tendon sheath
4. An elderly patient falls and sustains an extensive injury to the neck that result in upper extremity weakness, spared perianal sensation and lower extremity spasticity. These findings best describe what syndrome?
(2) Cauda equina
(3) Anterior cord
(4) Central cord
5. Treatment of choice for fracture shaft femur in 3 month old child is –
(1) Gallow’s Traction
(2) Hip Spica
(3) Paediatric Thomas splint
(4) Russell Traction
6. A 42-year-old construction worker sustains a crush injury to the hand at a job site. He has immediate pain and significant swelling, and is taken to the local emergency department for evaluation. Radiographs do not demonstrate any fracture of dislocation. On examination, he experiences severe pain with passive motion at the metacarpal phalangeal joints and when the wrist is flexed and extended while sensation and capillary refill were normal. What is the next best step in diagnosis or treatment?
(1) Advanced imaging
(2) Arterial Doppler
(3) Surgical intervention
(4) Pain control
7. A 74-year-old female who has no significant medical comorbidities presents to the emergency department after sustaining a compression fracture of L2. The patient has moderate back pain but is neurologically intact. Radiographs of the entire spine reveal a L2 compression fracture with 30% loss of vertebral body height loss and 15 degrees of local kyphosis. What would be the appropriate management for this patient?
(1) Posterior percutaneous pedicular fixation from L1 to L5
(2) Anterior column reconstruction with strut grafting and plate fixation
(3) Bed rest for ten days
(4) Oral pain medications, thoracolumbosacral orthosis and progressive increase in activity level
8. What spinal nerves in the cauda equina are primarily responsible for innervations of the bladder?
(1) L1, L2 & L3
(2) L4 & L5
(3) L5 & S1
(4) S2, S3 & S4
9. What is an advantage of utilizing a 36 mm instead of a 28 mm femoral head in the setting of a revision total hip arthroplasty?
(1) Compensating for abductor deficiency
(2) Decreasing volumetric wear
(3) Decreasing trunnion stress
(4) Delaying neck-socket impingement
10. What is the most anatomic location for placement of the femoral tunnel in anterior cruciate ligament reconstruction?
(1) As far superior in the notch as possible
(2) As far posterior as possible on the lateral femoral condyle
(3) As far posterior as possible on the medial femoral condyle
(4) At resident’s ridge
11. A 10 year old girl has recurrent left ankle sprains for the past 9 months. She has tried immobilization in a cast for 5 weeks which has failed to provide relief. She is tender to palpation at the tarsal sinus. Radiographs and CT scan of the left foot show an isolated calcaneonavicular coalition and physical exam revealed a neutral hindfoot. What is the next best step in management?
(1) Resection of coalition at the middle facet if <20 degree hindfoot valgus is present
(2) Coalition resection and interposition of extensor digitorum brevis
(3) Complete excision of sustentaculum tali
(4) Triple arthrodesis
12. Which activity will be difficult to perform for a patient with anterior cruciate ligament deficient knee?
(1) Walk Uphill
(2) Walk Downhill
(3) Getting up from sitting
13. Which of the following statements regarding Polymethylmethacrylate (PMMA) cement is incorrect?
(1) It is strongest in compression
(2) It has poor tensile strength
(3) It exhibits a high Young’s modulus
(4) It exhibits viscoelastic properties
14. The function of which of the following structures is to resist internal tibial rotation with the knee in full extension?
(1) Anterior cruciate ligament
(2) Wiotibial band
(3) Popliteus tendon
(4) Posterior oblique ligament
15. The lift off test is an examination in particular of which muscle?
(2) Pectoralis major
(3) Pectoralis minor
16. The biomechanical advantage f a reverse total shoulder arthroplasty compared to a standard arthroplasty is what?
(1) Centre of rotation more superior
(2) Centre of rotation more medial
(3) Centre of rotation more lateral
(4) Increased lateral humeral offset
17. The increased radiographic bone density is osteonecrosis in most likely secondary to –
(1) Calcification of the necrotic bone marrow
(2) Creeping substitution on the dead trabeculae
(3) Resorption of the Haversian canal bone
(4) Necrotic cortical bone
18. Which of the following enzyme deficiencies occurs in patients with Gaucher disease?
(1) Alpha —L —iduronidase
(3) Beta — glucuronidase
(4) Acid phosphatase
19. Which of the following is the best diagnostic test to establish the diagnosis of cubital tunnel syndrome?
(1) Sensory nerve conduction velocity, finger to wrist
(2) Mixed nerve conduction velocity, finger to wrist
(3) Motor nerve conduction velocity across the elbow
(4) Motor conduction, elbow to axilla
20. Which of the following occurs with myopathies?
(1) Focal demyelination
(2) High amplitude — long duration motor unit potentials
(3) Small amplitude — short duration motor unit potentials
(4) Nerve conduction velocity slowing
21. Loosening of the acetabular component in a cemented total hip arthroplasty most often occurs at –
(1) Bone cement interface
(2) Within the cement
(3) Prosthesis — cement interface
(4) Within the bone
22. The best index to measure acetabular deficiency in the coronal plane is –
(1) Tear drop ratio
(2) Hilgenreiner angle
(3) Center edge angle of Wiberg
(4) Leg-length measurement
23. The anterolateral (Watson – Jones) approach to the hip dissects. in an interval between –
(1) Gluteus medius & gluteus minimus
(2) Tensor fasciae latae and rectus femoris
(3) Gluteus medius and tensor fascia latae muscles
(4) Gluteus maximus
24. The position putting a total hip arthroplasty most at risk for an anterior dislocation is –
(1) flexion, adduction, internal rotation
(2) extension, adduction, external rotation
(3) flexion, abduction, internal rotation
(4) flexion, adduction, external rotation
25. The most common complication following high tibial osteotomy for treatment of medial compartment knee arthrosis is –
(1) Neurovascular injury
(4) Patella Baja
26. During the implantation of a cementless acetabular component in total hip arthroplasty, placement of a screw in the anterior superior quadrant puts which of the following structure at risk for damage?
(1) Sciatic nerve
(2) Internal iliac vessels
(3) External iliac vessels
(4) Femoral vessels
27. Varus intertrochanteric osteotomy for coxa valga commonly produces which of the following results?
(1) Decreased abductor lever arm
(2) Increased hip joint reaction force
(3) Increased center edge angle
(4) Abductor lag and lurch
28. After cementing in a total knee replacement for a valgus knee, you find that it remains tight laterally in extension. The next most appropriate step is to?
(1) Carry out a medial release.
(2) Carry out a medial release and increase the size of the polyethylene insert.
(3) Release the iliotibial band.
(4) Release popliteus.
29. The term internal impingement is used in throwers to describe a condition where the posterosuperior glenoid labrum impinges on which structure?
(1) The anterior glenohumeral ligaments.
(2) The posterior glenohumeral ligaments.
(3) The biceps tendon.
(4) The posterior rotator cuff.
30. Which of the following benign bone tumor may occasionally (about 22) metastasize to the lungs?
(1) Chondromyxoid fibroma
(2) Giant cell tumor grade II
(4) Fibrous dysplasia
31. A 30-year-old male presents with a bony growth arising from the proximal phalanx of his left middle finger which appeared 3 months ago and is steadily increasing in size, and now causing discomfort. He denies a history of trauma. Radiographs demonstrate an irregular bony mass arising from the dorsolateral surface of the proximal phalanx. The matrix of the lesion contains mature bone. What is the diagnosis?
(2) Nora’s disease
(3) Periosteal chondroma
(4) Parosteal osteosarcoma
32. Curettage and grafting is acceptable treatment for all of the following lesions, EXCEPT –
(2) Aneurysmal bone cyst
(3) Osteofibrous dysplasia
(4) Chondromyxoid fibroma
33. Compared to historical causes of revision. after total knee replacement, which of the following statement is most accurate?
(1) Infection is now the most frequent cause for late revision.
(2) Polyethylene wear is no longer the major cause for revision.
(3) Aseptic loosening is now the most frequent cause for early revision.
(4) The percentage of revisions for instability and malalignment has increased.
34. A 78 year-old female undergoes total hip arthroplasty through a minimally invasive surgical approach During insertion of a metaphyseal fixation stem with a cementless press — fit technique, a crack in the calcar is identified. The stem is removed, two cable wires are passed around the calcar, and the same stem is reinserted. Which of the following statement is true?
(1) The patient should be advised she is at greater risk of stem subsidence and early revision.
(2) Female sex is a risk factor for intra-operative calcar fracture.
(3) A better outcome would be expected if a long — stem diaphyseal fixation stem had been inserted after recognition of the calcar fracture.
(4) Minimally invasive surgical approach is not a risk factor for intraoperative fracture.
35. Which of the following best describes normal tibiofemoral joint kinematics?
(1) The femur undergoes internal rotation with knee flexion.
(2) The lateral femoral condyle remains stationary on the lateral tibia plateau during knee flexion from 0 to 120 degrees.
(3) The tibia undergoes internal rotation with knee flexion.
(4) Beyond 120 degrees of flexion only the lateral femoral condyle participates in femoral rollback.
36. Resection of the posterior cruciate ligament during total knee arthroplasty simulates which of the following techniques below?
(1) Excessive distal femur resection
(2) Excessive distal femur augmentation
(3) Excessive posterior femur resection
(4) Oversized femoral component
37. What medication has been shown to decrease osteolysis after total joint replacement surgery?
(3) TNF – alpha inhibitors
(4) Calcium and vitamin D supplementation
38. In a patient undergoing total knee arthroplasty, the femoral and tibial bone resections can be done using intra-or extra-medullary alignment systems. Extra-medullary guidance systems have what benefit over intra-medullary guidance systems?
(1) Decreased fracture risk
(2) Decreased embolization risk
(3) Decreased surface area available for cement interdigitation
(4) Increased risk of blood loss and/or transfusion requirement
39. Which of the following is true of the scapula during an overhead throwing motion?
(1) It maximally retracts on ball release.
(2) It protracts during late cocking to prevent impingement on the rotator cuff.
(3) It must rotate in the cocking and acceleration phases to prevent impingement on the rotator cuff.
(4) It must remain fixed during the throwing motion to impart maximal energy.
40. When performing an arthroscopic distal clavicle excision for acromioclavicular joint arthrosis, which of the following structures must be preserved to prevent post-operative anteroposterior instability of the clavicle?
(1) Trapezoid ligament
(2) Anterior and inferior acromioclavicular joint capsule
(3) Superior and posterior acromioclavicular joint capsule
(4) Coracohumeral ligament
41. The saphenous nerve is most likely to be injured with which of the following steps during an Anterior Cruciate Ligament (ACL) reconstruction with hamstring autograft?
(1) Incision for an anteromedial portal with the knee flexed
(2) Incision for an anteromedial portal with the knee extended
(3) Incision for an accessory medial portal with the knee flexed
(4) Hamstring harvest with the knee extended
42. A 20-year-old Division 1 football player is injured in practice. His treatment regimen includes immobilization of the knee in 120 degrees of flexion. What injury has this patient most likely Sustained?
(1) Iliac crest contusion
(2) Avulsion fracture of the lesser trochanter
(3) Quadriceps contusion
(4) Hamstring rupture
43. Which of the following rehabilitation exercises provides for restoration of range of motion while limiting stress on the repair of a ruptured patellar tendon?
(1) Active open chain flexion, active closed chain extension
(2) Passive flexion, active closed chain extension
(3) Active closed chain flexion, active open chain extension
(4) Active flexion, passive extension
44. Which of the following is true regarding closure of the rotator interval in patients undergoing arthroscopic shoulder stabilization?
(1) It can lead to recurrent instability.
(2) It restricts external rotation predominately in the “arm cocking” phase of throwing.
(3) It restricts combined flexion and cross-body adduction.
(4) It restricts external rotation predominately with the arm at 0 degrees of shoulder abduction.
45. Following ACL reconstruction, which of the following tests most closely correlate with patient satisfaction with their reconstructed knee?
(1) KT-1000 manual maximum value
(2) Lachman’s test
(3) Anterior drawer test
(4) Pivot shift test