MedCom 2005

Orthopedics

Digitally signed by MedCom 2005

True/False Notes About SCFE (slipped capital femoral epiphysis): a) usually due to trauma F [ trauma is thought to have a role in the acute presentation ] b) Limb is internally rotated F [externally rotated] c) 70% are of acute onset F [30%] d) X-ray is necessary T 2) about MMT ( medial meniscal tear ): a) usually no acute swelling T b) due to twisting T c) locking T d) may cause osteochondritis if not treated F [ OA (osteoathritis)] 3) the muscle responsible for knee movement during heel stike: a) hamstrings b) calf muscles c) quadriceps T d) gastrocnemius 4) nerve injury in the axilla which is 1st to recover: a) ulnar b) radial ? c) median d) three together e) variability of predilection 5) after peripheral nerve injury , steppage gait & loss of eversion of the big toe indicates injury to: a) femoral nerve b) peroneal nerve T c) tibial nerve [ opposite picture ] d) sural nerve 6) one muscle is not attached to bone: a) lumbricals T [also palmaris brevis] b) palmar interossei c) dorsal interossei d) adductor pollicis brevis e) flexor digiti minimi 7) most common fractured bone in osteoporosis: a) femur b) vertebra T 8) about osteoporoseis : a) biochemistry is not normal F [ normal ] b) can cause spontaneous fracture T c) dietary treatment is helpful F [ is useful for prevention not trearment ] d) splintage is effective F [ increase regional osteoporosis ] 9) the fracture in children that needs operation: a) femur shaft [ can be treated conservatively under certain b) bilateral forearm fracture conditions ] c) tibia d) humerus e) femur neck T 10) about scaphoid fractures: a) clinical diagnosis is important T b) leads to axascular necrosis T [ appearance on x-ray can be delayed for c) X-ray is diagnostic early F weeks sometimes ] 11) in hand injury one is false : a) early operation ? b) elevation for edema T c) primary care for bone before skin F

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most important substance for bone growth is: a) PTH b) thyroxin

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c) androgen d) crtisol e) citrate has risk of malignancy : Ollier's disease T [30%] osteoclastoma T [= GCT] amyloidosis F [ it can result from myeloma or B-cell lymphoma ] multiple enchondroma T [= Ollier's disease] the most important slow growing killing tumor is: a) chondrosarcoma T b) Ewing's sarcoma c) malignant synovium [ rapidly growing tumors ] d) osteosarcoma e) rhabdomyosarcoma about secondary bone tumors : a) hematogenous spread T b) thyroid cancer is the most common primary F [breast then prostate ,kidney, lung, thyroid,] c) they may present with pathologic fracture : T about septic arthritis : a) mostly caused by Staph. pyogenes F [Staph. aureus] b) can cause necrosis & destruction of bone T c) cold lesions on bone scan has good prognosis F [ can be the result of severe osteomyelitis] which is more likely diagnosis for 45yr-old male with 2yr hx knee pain that's releived by walking around : a) osteomalacia b) osteoporosis c) OA d) osteochondroma e) osteopetrosis all can cause knee joint swelling except : a) OA b) osteochondritis dissecans c) prepatellar bursitis [ in front of the joint not in it] d) synovial chondromatosis e) peripheral meniscal tear all are cardinal signs of inflammation as described by Celsus except: a) color b) rubor c) tumor d) olor e) loss of function F [ described by Virchow ] about osteoid osteoma : a) can cause scoliosis T b) causes pain worse at night & releived by antidepressants F [ aspirin & NSAIDs(less) ] c) can result in leg-length discrepancy T all are supplied by ulnar nerve except : a) hypothenar muscles T b) adductor pollicis T c) all interossei T d) ulnar 2 lumbricals T e) superficial head of flexor pollicis brevis F [ median nerve ] abou osteocondritis dissecans : a) the most common cause for loose bodies in young adults T b) calcaneal apophysis could be involved T c) anteromedial corner of talus can be involved T d) when it occurs this is certain that cancer returned F [ not related to malignancy ] which is best exercise done during acute & subacute RA : a) isometric b) concentric c) isokinetic d) no exercise slould be done about osteochondritis dissecans: a) b) c) d)
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MedCom 2005

Orthopedics
T T T T F T F T T F T F T T F T T F T T F T T T F T F [ swing 40%, stance 60% ] [ for deceleration ] [ bilat. Involvement is 12-25% & always the hips are in different stages ] [ males 4-6:1 females ] [ thought to be related with DDH but new studies didn't support this ] [ in infancy ] [ >95% is posteriorly displaced ]
[ esp. ant.interosseous branch of median nerve ] [ about 1% but is v.important to be watched for ]

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a) more common in young adults b) trauma is the cause most common site is the lateral part of the medial femoral c) condyle d) more in convex surfaces e) trochlea of elbow can be involved about subtrochanteric fractures exceot : a) extracapsular b) more in young adults c) commonly comminuted d) can be caused by malignancy about supracondylar humeral fractures exceot : a) distal fragment is displaced anteriorly b) can result in nerve injury c) compartment syndrome is common about metatarsus adductus : a) metatarsals are medially displaced over cuneiforms b) presents in the 1st year of life c) found in congenital vertical talus

[ has a major role ]

[ capitellum ]

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d) the most common congenital foot deformity about Perthes' disease : a) rare in blacks b) bilateral in males 7:1 females c) present mostly at 4-8 years of age all can cause back pain in children except : a) spondylolesthesis b) idiopathic scoliosis c) spinal cord tumors d) discitis e) eosinophilic granuloma about gait cycle : a) swing phase is longer than stance b) 20% double support c) hamstrings are the most important for midstance about use of ice packs in soft tissue unjury : a) applied for 20-30 min. b) freq Q 2-4 hours c) total period of 5-7 days d) not applied directly on skin e) needs also compression most important step in rehabilitaion after THR is a) muscle strengthening b) muscle stretching c) muscle reeducation d) sensry reeducation about meniscal injury: a) Dx can be made even in absence of clinical signs b) medial meniscus is the most commonly injured about ABC (aneurysmal bone cyst): a) cortical thinning b) metastatize c) air fluid level All can cause frozen shoulder except : a) DM b) antiepiletics c) Duputryen's contracture d) Hyperlipidemia

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T T T F F T T? T T

[ on MRI ] [ because its attachment to capsule makes it less mobile ]

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[ fluid-fluid level on MRI ]

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Orthopedics

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e) Repeated shoulder dislocation F All can be found in late diagnosed DDH except: a) Femoral anteversion b) Femoral head and neck in vulgus c) Dysplastic acetabulum d) Delayed ossification of femoral head epiphesis F? [as the head will have been devoloped by this time ] e) Fiborfatty substance in hip joint about shoulder dislocation : a) Posterior dislocation is the most common F [ anterior is 98% ] b) Avulsion of greater tuberosity can result T c) Results from fall on out stretched hand T about tibial shaft fracture: a) Ankle stiffness is uncommon F b) Foot lies outwards maybe c) Compartment syndrome is common T d) Common in youngs T The most common site for volar ganelion at ths wrist is: Between flexor carpiradialis and abductor policis longus at a) [ dorsal-dorsal scapholunate ligament ] scaphotrapezoid joint about compartment syndrome : a) Weakness in muscles of compartment T b) Tight skin T c) Present pulses doesn't rule it out T d) More in closed fractures T? [ also common in Gustilo III injuries ] e) No compartment syndrome in arm as a rule F A child victim of RTA with femoral shaft fracture and shortening what's the best treament: Skeletal traction Skin traction ORIF External fixation about cubitus valgus : a) This ugly deformity worsens when the elbow is flexed The best x-ray view for anterior column acetabular fracture : a) AP b) obturator oblique c) Inlet view about MMC (myelomrningocele): a) M > F b) Mostly lumbar c) due to environmental and genetic factors d) associated with Arnold-Chiari malfomatin type II in 100% of cases e) can occur due to carbamazepine treatment during pregnancy associated with LCS ( lumbar canal stenosis ) : a) old age b) restricted spinal flexion c) Spinal claudication d) Back pain radiating to LL a) b) c) d) differs according to : -age. -weight. associated injuries. -type of fracture.

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[ extended ]

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T T

[ >95%] [ valproic acid ]

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T F T T

[ extension increases pain while flexion decreases it ]

[ less constantly seen than in herniated disc ]

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a) b) c) d) e) 47)

indications for surgery on disc prolapse : urinary retention neurologic sign failure of medical treatment intermittent claudication severe scoliosis about chronic osteomyelitis ( COM ) : a) bacteria usually found b) may cause amyloidosis

T T T

F T

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Orthopedics
F F ? T T F F T T T T [ this is Brodie's abscess, COM usually shows areas of destruction with hypersclerosis ] [ only as needed ]

c) usually hypodense with thin cortex d) surgery is required about understanding infection in children : a) intercostal artery supplying 2 vertebrae b) some bones are intracapsular c) thick periosteum d) pesistence of metaphyseal vessels for 5 years of age about club foot (CTEV): a) vertical talus b) inversion of hind foot c) supination d) adduction e) tight tendon of Achilles about flat foot : a) may occur in rickets b) causes severe pain after walking c) there are 5 arches d) may require correction e) associated with vertical talus most important feature for prosthesis is : a) cosmetic b) functions well c) cost about rotator cuff syndrome : a) mostly infraspinatus is involved drop arm after : a) complete rotator cuff tear b) calcified supraspinatus tendon c) coracoid process fracture about Perthes' disease : a) age usally 4-8 years b) severe & continous pain c) increas density is an early feature on x-ray 55) d) lateral subluxation is bad prognostic sign bilat. Intermittent claudication : a) low spinal tumors b) vascular injury c) vertebral osteoma d) central disc prolapse one is not in DDX of cystic bone lesion (small bone) : a) TB b) sarcoidosis c) prostatic neoplasm d) hyperPTH e) sickle cell disease the nerve injured in cubitus valgus: a) ulnar nerve b) median nerve c) radial nerve the view used to Dx anterior acetabular fracture: a) tangential b) oblique c) lateral d) inlet signs of osteosarcoma : a) sun-rays appearance b) egg-shell appearance c) calcification

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[ for 2-4 years of age ] [ talar neck deformity (med. & plantar rotation)] [ + equinus ] [ of forefoot ] [ of forefoot ]

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T F T T

[ mainly in symptomatic adults ] [ 2 1/2 arches in each foot ]

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F T

[ supraspinatus ] [ also in axillary nerve palsy ]

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T T F T T T F T [ normal femoral head but stops enlarging & increased joint space ] [ of Catterall's head at risk signs ]

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T T
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Orthopedics

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d) Codman's triangle T e) honey-comb false about clavicle : union between medial end and the rest ossifiscation center occurs between 13-25 years old false about pelvic fracture : injuries of the pelvis are more dangerous than the associated soft tissue injury most dangerous immediate complication ofpelvic fracture: hemorrhage best treatment for osteoporosis is : HRT best treatment for femoral shaft fractures is : internal fixation first carpal bone to ossify : capitate muscle inserted on 5th metatarsal bone : peroneus brevis most common tumor in the hand is enchondroma false about humeral supracondylar fracture rarely associated with nerve & vascular injury true about shoulder dislocation: axillary nerve injury false about ankle injuries: most common in 3rd degree ( complete ) tear of the lateral collateral ligament false about meniscal injury : total meniscectomy is best treatment

[ at 18-25 years ]

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in order to prevent the most important complication that results in the majority of deaths in spinal injury you should order ? respiratory therapy fakse regarding effusions : gout doesn't cause significant effusion indications for fasciotomy : a) nerve impairment T b) arterial/venous ligation T c) prolonged ischemia ( 6 hours ) T [ should not open the already necrotic tissue & d) missed compartment syndrome ( > 24-48 hours ) F expose it to risk of infection ] false about compartment syndrome : damage is not caused by ischemia of muscle most common fracture in elderly women is in the : vertebra

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Orthopedics

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fractures in children : the closer to the growth plate , the better the healing T The closer to the growth plate , the smaller the callus those with heel injury have better healing about GCT (giant cell tumor): a) more comon in females T [ unlike most bone tumors ] b) occur in epiphyseo-metaphyseal junction T [ after physeal closure ] c) rare mets to lungs T [ <2% ] d) Z-ray usually increase bone density F [ eccentric radiolucent lesion with thin cortex ] e) recurrence is common after curettage T shoud be present in prosthesis : a) safe b) affordable c) very light d) cosmetically accepted e) functional the point that lead the surgeon to be not very concerned about level of amputation is: a) development of prosthesis b) education of the pateint c) better diagnosis of the disease about osteosarcoma : a) sun-burst appearemce T b) tumor cells may perforate the cortex T c) subperiosteal new bone formation T d) lung mets via hematogenous spread T e) usually invades the growth plate F [ not usual but can destroy it ] about chondrosarcoma : a) grows very rapidly F [ slow growing ] b) radioressistant T one increases bone healing : a) tensile force b) compression T c) shearing force in histology of growth plate : a) resting chondrocytes T b) proliferating T c) maturing T d) calcified T e) superficial & tangential layer of chondrocytes F causes delayed or nonunion : a) extensive gap T b) infection T c) metabolic T d) abnormal biomechanics T e) sufficient immobilization F [ insufficient & rigid fixation can cause it ] about transient synovitis of the hip (irritable hip ): a) self-limiting acute disease of the hip T b) lab Ix: increase ESR .CRP & titer of Staph.aureus in blood F [not related to bacteria] septic hip vs. DDH : a) pain b) resistance of hip movments c) asymmetric skin crease d) fever about osteomyelitis: a) usually due to Strept. Infection F [ Staph. Aureus ] CP : a) chondromalacia b) patella alta T [ only in 7% would be painful ] c) fixed knee flexion T a) b) c) about spondylolesthesis : more in males degenerative type is usually > 30 years degenerative type in L5-S1

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F F F

[ equal ] [ >50 years ] [ L4/5 ]

MedCom 2005

Orthopedics
T T

d) 94) a) b) c) 95) ? a) b) c) d) a) b) c) d) 97) a) b) c)

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isthmic type is due to spondylolysis most common cause of kyphosis in 0-10 years : hemivertebrae juvenile TB apophysitis most common disability in polio in Jordan : hip disability drop foot affection of thoracic muscles thoracic kyphoscliosis about OA: increased bone formation loss of cartilage capsule usually normal
treatment should releive pain ,increase mobility & decreases load

T T F T

[ fibrosed ]

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about chondromalacia patella : hemarthrosis F [ recurrent hemarthrosis can cause it ] locking T anterior knee pain T about meniscal tear : a) best Dx by arthrography F [ MRI then arthroscopy ] b) sometimes presents with knee swelling T c) peripheral tear has better prognosis T [ red zone] about flat foot : a) short tendon of Achilles T b) Hallux valgus later on T the muscle that contracts intermittently during standing is: a) quadriceps b) hamstring c) sloeus T d) tibialis anterior e) tibialis posterior about scaphoid fractures : a) occur due to hyperextension & radial deviation T b) may only be seen on oblique x-ray T c) usually arm looks normal T d) the proximal segment may undergo necrosis T e) usually in children F [ in young adults ] about swan neck deformity : a) MP joint is hyperextended F [ PIP] b) DIP joint is flexed T c) can occur due to intrinsic muscle disease T d) can occur due to flexor sublemis (superficialis) injury T e) can occur due to central slip of extensor digitorum injury F [ buttonnier's deformity ] most important in bone healing : a) clot organization T b) immobilization c) good alignment a 7-year old child with 6months old fracture of femur that healed with 30o rotation, Mx should be : a) surgery T b) hip spica c) plaster of Paris

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all fractures in children has ability of remodeling except: neck of femur eppiphyseal separation of tibia fracture of mid-ulna fracture of mid-femur 106) one would undergo AVN if not treated properly: a) capitulum a) b) c) d)

F T T T T
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Orthopedics

b) c) d) 107) a) b) c) d) e) 108) a) 109) a) b) c) 110) a) b) c) 111) a) b) c) d) 112) a) b) c) 113) a) b) c) 114) a) b) c) 115) a) b) c) d) 116) a) b) c) d) 117) a) b) c) d)

olecranon lateral condyle of humerus supracondylar humeral fracture may have had bad healing : lower tibia ribs scaphoid segmental tibial fracture femoral neck anterior humeral line should pass through: middle 1/3 of capitellum will lead to AVN of humeral head : surgical neck fracture anatomical neck fracture surgical neck fracture + avulsion of greater tuberosity poliomyelitis can lead to knee flexion equinus structural scoliosis scoliosis can undergo rapid deterioration during after menopause infantile scoliosis juvenile scoliosis at puberty between budding of breast & menarche about acute supraspinatus calcification joint movement is normal during acute phase usually improves in few days due to decrease blood supply ( ischemia ) osteochondritis dissecans due to trauma uasually lateral condyle is affected usually affects youmg males about Perthes bone scan is useless usually no pain lateral subluxation is poor prognosis about SCFE females > males 70% gradual onset lateral view is important in Dx limbs are externally rotated most effective in treatment of CP : tenotomy muscle shortening close observation in hospitals home phydiotherapy about loose bodies Hx of locking almost always symptomatic usually seen on x-ray maybe caused by ostecondritis dissecans

T F T T T T [ due to continous micromotion & adequate splintage by adjacent ribs ]

T F F T T F T F F T F T T T [ males > females ] [ immobile ] [ weeks ]

[ lateral aspect of medial femoral condyle ]

T T F T T

118) a) b) c) d) e)

sprain of ATFL ( anterior talofibular ligament) is due to : inversion eversion plantar flexion & inversion dorsiflexion & eversion dorsiflexion & eversion & pronation

? = either answer not verified from a text book or question has a defect in its form. all other answers were confirmed from a text book.
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