Orthopaedic 'mini' examination

Attempt all questions. Check the box next to the answers that you believe to be true. Leave unchecked all answers that you believe to be false. Once you have completed each question it can be marked. One point is scored for a correct answer. Incorrect answers score zero. There is no negative marking. The answers to each question can then be explained. You can not change the answers after they have been marked! 1. Paget's disease of bone (a) fracture (b) (c) (d) May present with neurological complications or a pathological Causes an increase in both serum calcium and phosphate Causes an increase in serum alkaline phosphatase Malignant change occurs in 1% of patients

(e) The commonest malignant tumour in patients with Paget's disease is a chondrosarcoma 2. Regarding osteomalacia (a) (b) (c) (d) (e) Is due to vitamin A deficiency Can cause a distal myopathy May present with pseudo-fractures Serum calcium is increased A bone biopsy would show an increase in mineralised osteoid

3. Perthe's disease (a) (b) (c) Usually presents before 10 years of age Is due to avascular necrosis of the distal femoral epiphysis Is more common in girls

(d) Plain x-ray may show the capital femoral epiphysis to be smaller, denser and flatter (e) May require surgical containment with a subtrochanteric osteotomy 4. Regarding upper limb peripheral nerve injuries (a) Injury to the median nerve results in a wrist drop

(b) Injury to the median nerve results in loss of sensation over the palmar aspect of the index finger (c) Injury to the radial nerve results in loss of sensation in the anatomical snuffbox

(d) (e) thumb

Injury to the ulnar nerve results in a claw hand Injury to the ulnar nerve results in loss of sensation over the

5. Regarding osteomyelitis (a) Is most commonly due to a staphylococcus aureus infection

(b) Can be due to salmonella infection in patients with sickle cell anaemia (c) (d) Infection usually involves the metaphysis of long bones Dead bone within the medullary canal is known as the involucrum

(e) New bone forming beneath the periosteum is known a the sequestrum 6. Regarding bone metastases (a) Less than 5% of patients with malignant disease develop bone metastases (b) fracture (c) women (d) (e) 10% of patients with bone metastases develop a pathological Breast cancer is the commonest cause of bone metastases in Radiological changes are seen early in the disease process Prostate cancer can cause osteosclerotic lesions

7. Regarding osteoid osteoma (a) (b) (c) It is a benign bone tumour The femur and tibia are the commonest bones involved Presents with severe pain that is typically relieved by aspirin

(d) Radiologically appears as a radiolucent lesion surrounded by dense bone (e) Local excision or currettage is curative

8. Regarding osteosarcomas (a) Affects the epiphyses of long bones

(b) Are most commonly seen around the knee and in the proximal humerus (c) (d) Haematogenous spread can result in pulmonary metastases Is exclusively a disease of adolescence and early adult life

(e) X-ray shows a 'sunburst' appearance due to soft tissue involvement

9. Regarding eponymous fractures (a) (b) Bennett's fractures involves the distal ulna Colle's fracture involves the distal radius

(c) Galeazzi' s fracture involves the radial shaft & dislocation of the proximal radioulnar joint (d) Monteggia' s fracture involves the proximal ulna & anterior dislocation of the head of the radius. (e) knee Pott's fracture is a general term applied to fractures around the

10. Regarding rheumatoid arthritis (a) (b) (c) Is a disease primarily of the articular cartilage Is associated with the HLA antigens DR4 and DW4 Occurs more often in women

(d) The hand, elbows, knees and cervical spine are the commonest joints involved (e) Extra-articular manifestations occur in 20% of patients

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Authored in CALnet