FRCS (Tr & Orth): MCQs and Clinical Cases Vikas Khanduja
INDEX
Note: Page numbers in bold or italic refer to tables or figures, respectively.
A
Aα (A alpha) fibre 16
Aβ (A beta) fibre 16
Abductor pollicis longus 24
Achondroplasia 26
Acromioclavicular ligament 74
Aδ (A delta) fibre 16
Aγ (A gamma) fibre 16
Allograft 151
Alpha angle 17
Ankle arthrodesis 19
Ankle fracture 149
Anterior cruciate ligament (ACL)
injury 76
reconstruction 25
Anterior humeral line 84
Antibiotics, pre-operative use of, joint replacement and 161162
Arthrogryposis multiplex congenita (AMC) 22, 22, 139, 140
Aspirin 149150
Autografts 150
Autotransfusion 26
Avulsion fracture of tibial spine 76
Axillary nerve 17
B
Bearing surfaces, in artificial joints 19
Biceps tendon rupture 106107
cause of 106
treatment options for 106107
Biofilm 164
antibiotics for 164
formation of 164
Bisphosphonates 73, 154
side-effects of 154
Bone grafts 150151
Bone mineral density (BMD) 152, 153
Bone morphogenic proteins (BMPs) 21, 151
Bone tumours 19
Brachialis tenodesis 24
Buford complex 21
Bunnell–Littler test 22
C
Caffey's disease 137138
Calcaneo-cavus foot 135
Calcaneovalgus deformity 137
Camptodactyly, infantile type 22
Cancellous bone graft 151
Capitellum fracture 85
classification of 85
complications of treatment 85
in females 85
Kocher's lateral approach in 85
Cement fracture, in Gruen zones 2 and 6 26
Cephalosporins 161
Ceramic-on-ceramic (COC) bearing surfaces 166
Ceramic-on-polyethylene (COP) couples 167
Ceramics 164167
biomechanical properties of 165166
complications with 166
manufacturing of 165
Chemical thromboprophylaxis, contraindications to 150
Clavicle fracture, midshaft 81
deforming forces in 81
malunions in, problems with 8283
non-union in 82
Cobb angle 44
Coccygectomy, for refractory coccygodynia 18
Comminuted fracture, of midshaft of right humerus 71
Complex dislocation, of MCPJ of index finger 114115
Compression test 19
Conoid ligament 74
Constriction band syndrome, of lower leg 136
Coracoclavicular ligaments 74
Cortical bone graft 151
Cozen's fracture, of proximal tibial metaphysis 134135
Creeping substitution 151
Cubital tunnel 99
Cubitus varus, supracondylar fracture and 134
D
Dabigatran 150
De Quervain's stenosing tenosynovitis 24
Developmental dysplasia of the hip 136
DEXA (dual energy X-ray absorptiometry) scan 43
Dexamethasone 54
Disc degeneration disease 26
Distraction osteogenesis 20
Dorsal intercalated segmental instability (DISI) deformity 101103
Doxycycline 24
Dupuytren's disease 110
pain in 110111
surgical complications 111
treatment for 111
Woodruff classification system for 111
E
Elbow injury, in children 15
Endobutton 107
Endothelial derived growth factor 21
Escobar syndrome 141142
Exostosis 137
Extensor carpi radialis longus (ECRL) 112
Extensor indicis proprius (EIP), transfer of 111112
Extensor pollicis brevis (EPB) 112
Extensor pollicis longus (EPL), rupture of 111112
Extracellular polymeric substance (EPS) 164
F
Facet joint ablation 18
Femoral fracture, peri-prosthetic 51
treatment and outcomes 5253
Vancouver classification of 51, 5152
Femoral head
blood supply to 43
from living donor 151
Femur, fracture of 4243
Fibrolipomatous hamartoma (FLH) 113
Fibrous dysplasia, malignant transformation in 20
Fish-tail vertebrae 140
Flexor digitorum proundus (FDP) avulsion 100
classification system for 101
diagnosis of 100101
ring finger and 101
treatment of 101
Flucloxacillin 161
Forefoot varus 137
Forest plots 23
Fracture healing 1516
Freeman-Sheldon syndrome 141
G
Gauchers disease 26
Genu varum 136137
Glenohumeral joint 71
Glucocorticoids, effects of, on bone mineral metabolism 16
Gram-negative bacteria 163
Gram-positive bacteria 163
Gram-staining technique 163
Growth plate arrest 141142
Guyon's canal 99
H
Hawkin's sign 49
Heterotopic ossification (HO) 45
Brooker classification for 45
conditions needed for 45
prevention of 4546
High-efficiency particulate air (HEPA) filters 160
Hindfoot equinovarus 137
Hip arthrodesis, and back pain 15
Hip dislocation, right-sided 135136
Hip dysplasia 4142
Crowe classification of 42
Hip pain, and measurement of angles
acetabular inclination 41
anterior centre edge angle of Lequesne 42
lateral centre-edge angle of Wiberg 41
Sharp's angle 41
Humerus, undisplaced spiral fracture of 133, 133
Hyaluronic acid 2324
Hyperbaric oxygen therapy 25
Hypophosphataemic rickets 26
I
Infantile cortical hyperostosis see Caffey's disease
Insulin-like growth factor II 21
Intramedullary nails 72, 73
Isometric muscle contraction 21
J
Joint effusion 163
K
Kaplan's cardinal line 16
Key pinch grip 20
Klippel–Trenaunay–Weber syndrome 19
Knee
amputation 79
and foot orthoses 134
lateral compartment osteoarthritis of 4951
Kniest syndrome 20
Kocher–Langenbeck approach 28
Kruskal–Wallis test 27
L
Laminar airflow 160
ex-flow/exponential 160
horizontal 160
infection risk in joint replacements and 161
vertical 160
Larsen's syndrome 134, 134
Lateral clavicle fractures 7374
displacement of 74
risk of non-union in 74
Rockwood and Green classification of 73
treatment of 74
Lateral collateral ligament (LCL) 50
Latissimus dorsi transfer, male gender and 17
Leg length discrepancy 19, 46
Leri -Weill dyschondrosteosis 26
Ligament of Struthers 27
Limb salvage index (LSI) 80, 81
Limb-threatening injury, lower extremity 78
limb salvage scoring systems 7981
management of 79
soft-tissue injuries with closed fractures 79
Lipohaemarthrosis 76
Low molecular weight heparin (LMWH) 149, 150
Lumbar facet joint injections 18
Lumbosacral transitional vertebra (LSTV) 4748
M
Macrodactyly 112113
Macrodystrophia lipomatosa (ML) 112113
Mangled extremity severity score 7980, 81
Mean AOFAS Ankle-Hindfoot Scale score 19
Medial collateral ligament (MCL) 50
Medial stem pivot 26
Metacarpophalangeal joint (MCPJ), complex dislocation of 114115
Metal-on-polyethylene (MOP) couples 166, 167
Morquio-Brailsford disease 138, 138
MRI scan, in hip pain 42
Mucopolysaccharidosis type IVA see Morquio-Brailsford disease
Mucous cyst 105
causes of 105
complications of 106
excision of 105106, 106
Multiple pterygium syndrome see Escobar syndrome
Mumford procedure 25
Muscle contraction, types of 2122
Muscular dystrophy 26
Muscular torticollis 140
Myelomeningocele 136
N
Nail–patella syndrome 135
Nerve recovery, first sign of 27
Non-steroidal anti-inflammatory drugs (NSAIDs), in heterotopic ossification 45
Nonunion, surgical treatment of 138139, 139
O
Operating theatre
laminar airflow 160161
reducing risk of contamination in 159160
sources of contamination in 158159
ventilation system in 160
zones of 158
Osteoarthritis 16, 2324
glenohumeral 71
knee 4951
Osteoconductive grafts 151
Osteoinductive grafts 151
Osteomalacia 17, 153
Osteomyelitis, chronic 162163
Osteonecrosis of jaw 154
Osteopaenia 140
Osteoporosis 16, 17, 152
bisphosphonates in 154
classification of 153
investigations in 153
national screening programme 154
and osteomalacia 153
pathophysiology of 152
prevention of 153154
risk factors for 152
treatment of 154
WHO definition for 152
P
Paget's disease 155
Patellofemoral arthroplasty 58
Patellofemoral osteoarthritis 5558
aetiology of 5556
management of 57
patellofemoral arthroplasty in 58
total knee arthroplasty in 58
Pelvic avulsion fractures 86
Pelvic external fixator 78
Pelvic fractures 77
management of 78
risk of urological injury or impotence in 77
rotational and vertical instability in, radiological signs of 78
Tile classification of 77
Young and Burgess system of 77
Perrin's strain theory 1516
Pes cavus deformity 28
Pilon fracture 74
CT scan in 75
management of 75
Ruedi–Allgower principles of operative fixation for 7576
Piriformis fossa 72
Platelet derived growth factor 21
Polydactyly 142
Polydactyly of thumb with duplication of phalanges 104
inheritance patterns of 105
surgical treatment of 105
Wassel classification of 104
Predictive salvage index (PSI) 80, 81
Pre-ganglionic plexus injury 17
Prosthetic joint infection, scanning method for 15
Proteoglycan 27
Proximal interphalangeal (PIP) fracture/dislocations 107109
injury, assessment of 107
treatment for 108, 108109, 110
Pseudohypoparathyroidism 21
Psoriatic arthritis 103104
natural history of 104
radiographic features of 103104
R
Radial head dislocation and fracture of ulna 8384, 135
chronic post-traumatic dislocation of radial head 84
management of 84
Monteggia equivalent fractures 84
Monteggia fracture classification 84
Radiocapitellar line 8384
Resection arthroplasty 54
Retropulsion 111
Rheumatoid arthritis (RA) 155
aetiology of 156
ARA criteria for classification of 156
extra-articular manifestations in 156
investigations in 157
poor prognostic indicators for 157
Rheumatoid factor (RF) 157
Riviroxiban 149
S
Sacro-iliac (SI) joint 77, 78
Salter-Harris Type II injury, of lower femur 141
Scapholunate advanced collapse (SLAC) wrist 102
Scapholunate (SL) injury
classification system for 102, 102
with DISI deformity 101103
natural history of 102
staging of 102
treatment of 103
Scapho-trapezio-trapezoid (STT) joint arthritis 46
causes of 46
complications of surgical treatment 47
treatment for 4647
Scapular neck fracture, displaced 83
Ideberg classification system for 83
injuries associated with 83
surgical treatment of 83
Scoliosis, adult 4445
Screws, orthopaedic 26
Secondary hyperparathyroidism 16
Segond fracture 76
Seinsheimer type V fracture 72
Septic arthritis 23
Silicone prosthesis 25
Speeds test 27
Spinal cord compression, metastatic 5455, 55
Spinal tumours 19
Spine, embryology of 48
Spondyloepiphyseal dysplasia see Kniest syndrome
Sprengel deformity 136
Stener lesion 20
Sternomastoid tumour 140
Stress fracture 42
Subtrochanteric fracture 72
bisphosphonates in 73
Fielding's classification system 72
implant for 73
management of 7273
Russell-Taylor system 72
Seinsheimer classification system 72
Subungual exostosis 137
Supraclavicular nerve, medial 17
Supracondylar osteotomy 134
Suprascapular nerve 17
Synovial biopsy from knee 163164
Synthetic bone grafts 151
T
Talar fractures 4849
blood supply to talus and 49
Hawkins classification of 49
Talipes equinovarus 140
Tarsal tunnel syndrome 1819
Tendons 18
Tendon transfers, principles of 112
Tetracycline-labelled bone biopsy 17
Thinner distal femoral augmentation wedge, use of 21
Thoracic curves 4445
Tibial bowing deformity 135
Tibialis posterior dysfunction 25
Tibial malunion 25
Tibio-femoral alignment, in children 18
Tinel's sign 19
Total ankle replacement 19
Total hip arthroplasty 164
ceramic liner in, damage to 164165
Total hip replacement
dislocation after 5354
thromboprophylaxis regime for 149
Total knee arthroplasty 58
Total knee replacement, thromboprophylaxis regime for 149
Tourniquets, in upper and lower limb surgery 157
complications of 158
contraindications to use of 157
inflation pressures in 157
post-tourniquet syndrome 158
principles for use of 157
Tranexamic acid 24
Transforming growth factor-β (TGF-β) 21
Trapezoid ligament 74
U
Ulnar collateral ligament of thumb, open repair of 20
Ulnar nerve entrapment 99
diagnosis of 99
investigation of 100
prognosis for 100
sites of 99
surgical intervention in 100
V
Valgus knee 50
Vancomycin 161162
Ventilation system 160
Vertical scapular osteotomy 136
Volar plate arthroplasty 108, 109, 110
Volar surgical approach, in complex dorsal MCPJ dislocations 114
W
Warfarin 150
Wartenberg's syndrome 27
Water and hyaline cartilage, interaction between 16
Weber C fractures, mechanism of injury for 28
Winged scapula 142
Wrist arthrodesis 24
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Chapter Notes

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SBA QuestionsChapter 1

 
For each question, select the single best answer from the five options listed.
  1. Which of the following investigations is the most specific scanning method to detect infection in a total joint replacement?
    1. Bone scintigraphy
    2. A combination of white blood cell scan and a technetium bone scan
    3. White blood cell scan
    4. Sequential gallium-67 citrate scans
    5. Sequential technetium bone scans
  1. What proportion of patients will develop significant back or ipsilateral knee pain 25 years after arthrodesis of their hip?
    1. 0%
    2. 10%
    3. 45%
    4. 60%
    5. 75%
  1. With reference to “pulled elbow” injury in children, which of the following statements is true?
    1. Peak incidence is between 3 and 5 years of age
    2. It results from traction on the extended and supinated forearm
    3. Recurrence is seen in 5% of cases
    4. Pain is due to tearing of the lateral collateral ligament complex
    5. X-ray is essential for diagnosis
  1. During fracture healing, differentiation of the progenitor cells depends on local oxygen tension and strain. Based on this theory, the following promotes formation of woven bone during fracture healing:
    1. High strain and low oxygen tension
    2. Low strain and high oxygen tension
    3. Intermediate strain
    4. Low oxygen tension
    5. Intermediate strain and low oxygen tension
      2
  1. Which of the following statements regarding the effects of glucocorticoids on bone mineral metabolism is false?
    1. Supraphysiologic glucocorticoid levels do not cause secondary hyperparathyroidism
    2. Glucocorticoids inhibit gastrointestinal absorption of calcium
    3. Glucocorticoids preferentially affect trabecular bone and the cortical rim of the vertebral bodies
    4. Glucocorticoids inhibit osteoclastic activity
    5. Bisphosphonates are successful in the prevention of glucocorticoid-related osteoporosis
  1. The interaction between water and hyaline cartilage is beneficial because:
    1. Cartilage repels water
    2. Water is absorbed by cartilage
    3. Water lubricates the joint
    4. Water is imbibed by cartilage and has a passive role in resisting compression
    5. Water prevents the degradation of cartilage by matrix metalloproteinases
  1. The location of Kaplan's cardinal line is:
    1. Along the ulnar border of the ring finger (parallel to the metacarpophalangeal joints)
    2. From the first web space to the hook of the hamate
    3. From the hook of the hamate perpendicular to the proximal transverse palmar skin crease
    4. From the first carpometacarpal joint to the pisiform
    5. Along the distal palmar skin crease
  1. What type of afferent peripheral nerve fibre is responsible for transmitting vibration sense to the spinal cord?
    1. Aα (A alpha)
    2. Aβ (A beta)
    3. Aγ (A gamma)
    4. Aδ (A delta)
    5. C
  1. Which of the following investigations best distinguishes osteoporosis from osteomalacia?
    1. Bone biopsy from the iliac crest
    2. Serum calcium
    3. Serum phosphate
    4. Urinary calcium
    5. Tetracycline-labelled bone biopsy
      3
  1. The nerve supplying to teres minor is a branch of which of these nerves?
    1. Suprascapular nerve (C5, C6)
    2. Lower subscapular nerve (C5, C6)
    3. Upper subscapular nerve (C5, C6)
    4. Axillary nerve (C5, C6)
    5. Medial supraclavicular nerve (C3, C4)
  1. Which of the following clinical findings is least likely to be associated with a pre-ganglionic brachial plexus injury?
    1. Bruising in the anterior triangle of the neck
    2. Pain in an insensate hand
    3. Loss of sensation above the clavicle
    4. Ipsilateral Horner's syndrome
    5. Loss of muscle function of branches direct from the roots of the brachial plexus
  1. Following a latissimus dorsi transfer for chronic irreparable tears of the rotator cuff, which of the following factors has NOT been associated with a poor clinical outcome?
    1. Male gender
    2. Poor pre-operative shoulder function
    3. Generalised muscle weakness
    4. Absence of electrical activity at follow-up
    5. Previous failed rotator cuff repair
  1. The alpha angle on the ultrasound of an infant's hip is defined as:
    1. The angle between the acetabular roof and the midline of the pelvis
    2. The acute angle between the lateral wall of the ilium and the bony acetabular roof
    3. The angle between the centre of the femoral head and the lateral wall of the ilium
    4. The angle of the thigh required to produce subluxation of the hip on the sonogram
    5. The angle between the acetabular roof and the transverse plane
  1. Which of these values reflects the normal tibiofemoral axis for a child aged three years?
    1. Varus of 20°
    2. Varus of 10°
    3. Neutral alignment
    4. Valgus of 10°
    5. Valgus of > 20°
      4
  1. Which of the following constituent accounts for 65–80% of the dry mass of flexor tendons?
    1. Collagen type I
    2. Collagen type II
    3. Collagen type III
    4. Collagen type IV
    5. Elastin
  1. Which of the following statements is correct with regard to a therapeutic intra-articular facet joint injection in the lumbar region for low back pain?
    1. Pain relief on two occasions after a facet joint injection is an indication for facet joint ablation
    2. It aims to relieve back pain during flexion of the lumbar spine
    3. Steroid injection in the facet joint gives good pain relief, beyond six months
    4. The best visualisation of the facet is on the lateral image intensifier view
    5. It has a high risk of haematoma and infection
  1. What percentage of success would you quote to patients being offered a coccygectomy for coccygodynia that has been refractory to conservative management?
    1. < 20%
    2. 20% to 30%
    3. 40% to 50%
    4. 60% to 70%
    5. > 80%
  1. Which one of the following statements is false with regard to the clinical presentation of patients with tarsal tunnel syndrome?
    1. Symptoms are variable
    2. There is sensory disturbance along the big toe
    3. There is atrophy of the intrinsic muscles of the foot
    4. There is hind-foot varus deformity
    5. Symptoms accentuate on eversion and dorsiflexion of the foot
      5
  1. Meta-analysis comparing the intermediate and long-term outcome after total ankle replacement and ankle arthrodesis has shown all of the following except:
    1. Mean AOFAS (American Orthopaedic Foot and Ankle Society) Ankle–Hindfoot Scale score is higher for patients with ankle arthrodesis
    2. A greater number of patients have poor results after ankle replacement compared with ankle arthrodesis
    3. The revision rates for both procedures are similar
    4. Five and ten year survival after ankle replacement are more than 75%
    5. Below knee amputation rate is higher for patients with ankle arthrodesis
  1. With regard to bearing surfaces in artificial joints:
    1. Equatorial bearing is ideal
    2. Polar bearing is more conducive to fluid film lubrication
    3. Subhemispherical sockets are always advantageous
    4. Sacrificial bearings will always fail before hard-on-hard bearings
    5. The synovial fluid in prosthetic joints is indistinguishable from normal synovial fluid
  1. Which of the following statements regarding spinal tumours is false?
    1. About 15% of all bone tumours are primary spine tumours
    2. Combined surgical decompression and radiotherapy is generally superior to radiotherapy alone in the treatment of metastatic spinal cord compression
    3. Spinal metastases from renal cell carcinoma tend to be hypervascular
    4. Spinal tumours often present with pain and weakness
    5. Ependymoma is the most common type of intramedullary tumour in adults
  1. Which of the following is NOT a cause of leg length shortening?
    1. Epiphysiodesis
    2. Coxa vara
    3. Fracture
    4. Klippel–Trénaunay–Weber syndrome
    5. Poliomyelitis
  1. In monostotic fibrous dysplasia, the prevalence of malignant transformation (chondrosarcoma or osteosarcoma) is about:
    1. 0.4%
    2. 0.8%
    3. 1%
    4. 2%
    5. 4%
      6
  1. Which of the following statements is true regarding an open repair of the ruptured ulnar collateral ligament of the thumb?
    1. It is unusual to see the superficial radial nerve
    2. One should aim to identify the extensor pollicis brevis tendon
    3. A Stener lesion will be found, if present, proximal to the adductor aponeurosis
    4. The ligament will have ruptured from its insertion into the metacarpal in most cases
    5. A Stener lesion will be found in 50% of the cases
  1. Which one of the following is necessary for a good key grip?
    1. Extension of the thumb metacarpophalangeal joint
    2. Extension of the thumb interphalangeal joint
    3. Function of the first interosseous muscles
    4. Function of the radial nerve
    5. Function of the median nerve
  1. All of these are examples of enchondral bone formation except:
    1. Embryonic long-bone formation
    2. Fracture callus
    3. Bone formation after use of demineralised bone matrix
    4. During distraction osteogenesis
    5. Longitudinal growth
  1. All of these are diseases that involve the proliferative zone of the growth plate except:
    1. Kniest syndrome
    2. Achondroplasia
    3. Gigantism
    4. Malnutrition
    5. Irradiation injury
  1. Which one of these regulates cartilage and bone formation in the fracture callus?
    1. Bone morphogenic protein
    2. Transforming growth factor-β
    3. Insulin-like growth factor II
    4. Platelet derived growth factor
    5. Endothelial derived growth factor
      7
  1. What is the diagnosis in a patient who presents with reduced serum calcium, raised serum phosphate, normal alkaline phosphatase and parathormone level and a reduced urinary calcium excretion?
    1. Nutritional rickets
    2. Hypoparathyroidism
    3. Pseudohypoparathyroidism
    4. Secondary hyperparathyroidism
    5. Nutritional calcium deficiency
  1. During revision knee arthroplasty with the trial components in place, the knee is tight in extension and loose in flexion. Correction involves which of the following changes?
    1. Use of a thinner tibial insert
    2. Use of a thinner distal femoral augmentation wedge
    3. Use of a smaller femoral component
    4. Resection of more proximal tibia
    5. Shifting the femoral component anteriorly with an offset stem
  1. A 26-year-old basketball player was noted to have an absent anterosuperior labrum during a shoulder MRI arthrogram. Which of the following would be true for a Buford complex?
    1. The patient needs further assessment with shoulder arthroscopy
    2. Biceps insertion site will usually be involved
    3. Presence of a cord-like middle glenohumeral ligament actually represents the torn labrum
    4. Sites of insertion of anterior and middle glenohumeral ligament are often abnormal
    5. Reattaching the complex will lead to painful restriction of rotation
  1. Which one of the following exercise regime would you recommend to someone who wishes to improve his/her muscle bulk?
    1. Isometric
    2. Isotonic
    3. Isokinetic
    4. Plyometric
    5. Aerobic
      8
  1. With regards to the Bunnell-Littler test, which of the following statements is false:
    1. An increase in proximal interphalangeal (PIP) joint flexion with flexion of metacarpophalangeal (MCP) joint indicates intrinsic tightness
    2. Reduced flexion of PIP joint in extended and flexed attitude of the MCP joint would indicate a capsular contracture of the joint
    3. Extension of PIP joint with attempted flexion of MCP joint may indicate lumbrical tightness
    4. Reduced PIP joint flexion with flexion of MCP joint may indicate contracture of the extensor tendons
    5. Flexor digitorum profundus laceration distal to lumbrical origin may give a false positive test
  1. A 13-year-old girl presents with a flexion deformity of the little finger PIP joint (camptodactyly). Which one of the following statements is true?
    1. The deformity is usually due to an abnormality in the lumbrical or flexor digitorum superficialis insertion
    2. The deformity is commonly associated with Down's syndrome
    3. The deformity will usually respond to splinting and stretching
    4. Capsular release and tendon transfer is indicated if full PIP extension cannot be achieved with MCP held in flexion
    5. Corrective osteotomy is indicated
  1. Which one of the following is true about arthrogryposis?
    1. It results from defect in the motor unit
    2. It is commonly myopathic in origin
    3. It leads to a contracture of the joint
    4. Joint contractures are progressive
    5. The involvement of other organ systems is unusual
  1. Which one of the following statements is false regarding septic arthritis in children?
    1. Males are affected twice as often as females
    2. A lower extremity (hip) is affected in 80% of patients
    3. Polyarticular involvement is in fewer than 10% of patients
    4. Loss of proteoglycan starts at five days from the bacteria entering the joint
    5. An aspirate white blood cell count of > 50 000/mm3 with 75% polymorphonuclear leucocytes is diagnostic of sepsis in 60% to 70% of patients
      9
  1. Which one of the following statements is true regarding the use of forest plots in systematic reviews? They:
    1. Summarise treatment efficacies (risk ratio) across trials
    2. Detect publication bias in literature
    3. Are a quantifiable way to test prospective studies for homogeneity
    4. Are a measure of odds of failure against the size of the study
    5. Detect outliers in the literature in terms of study inclusion criteria
  1. Which of the following statements is false for the AAOS grades of recommendation for summaries or reviews of orthopaedic studies?
    1. A high-quality prospective prognostic study investigating the effect of a patient characteristic on the outcome of disease would constitute a good evidence study (Grade A)
    2. A systematic review of Level I studies investigating the results of treatment with inconsistent results would constitute a fair evidence study (Grade B)
    3. A prospective comparative study investigating the results of a surgery with consistent findings would constitute a fair evidence study (Grade B)
    4. A retrospective comparative study investigating the results of an intervention would constitute a fair evidence study (Grade B)
    5. An expert opinion from someone who has performed more than 1000 complex surgical intervention would constitute a poor evidence study (Grade C)
  1. All of the following have been shown to slow disease progress in osteoarthritis except:
    1. Glucosamine sulphate
    2. Chondroitin sulphate
    3. Diacetylrhein
    4. Hyaluronic acid
    5. Doxycycline
  1. Which of the following statements is true regarding the use of tranexamic acid in orthopaedic surgery?
    1. It increases the prothrombin time
    2. Meta-analysis has shown that it increases the risk of thromboembolic events
    3. It reduces the need for transfusion after joint replacement
    4. It is only effective when given intravenously
    5. It should only be used in high risk cases
      10
  1. Which of the following statements is true when performing a unilateral wrist arthrodesis?
    1. 15° ulnar deviation is preferred
    2. 10° to 20° of dorsiflexion is ideal to preserve grip strength
    3. Ulna–triquetral abutment cannot be avoided
    4. An open epiphyseal plate in the distal radius is not a contraindication
    5. The most common surgical approach is volar
  1. In the surgical treatment of de Quervain's stenosing tenosynovitis, which one of the following tendons should be decompressed?
    1. Abductor pollicis longus
    2. Adductor pollicis
    3. Extensor pollicis longus
    4. Flexor pollicis longus
    5. Opponens pollicis
  1. Which one of the following is true when comparing non-anatomical (reattachment to the brachialis muscle) with anatomical reinsertion of the distal biceps brachii tendon following rupture?
    1. No difference in strength of flexion or supination
    2. Improved strength of flexion and supination
    3. Improved strength of supination
    4. Decreased strength of flexion and supination
    5. Decreased strength of supination
  1. Which of the following is not a recognised technique for delayed posterolateral corner reconstruction?
    1. Popliteal bypass (Muller's procedure)
    2. Figure of eight reconstruction (Larsen's procedure)
    3. Two-tailed (Warren's procedure)
    4. Three-tailed (Warren/Miller procedure)
    5. Mumford procedure
  1. Which of the following is not a cause for failed anterior cruciate ligament reconstruction?
    1. Associated posterolateral corner injury
    2. Cyclops lesion impingement
    3. Tibial tunnel placement 10 mm to 11 mm anterior to posterior cruciate ligament insertion
    4. Arthrofibrosis of graft
    5. Returning to full sporting activities at three months
      11
  1. Which one of the following statements is false with regards to hyperbaric oxygen therapy for the treatment of chronic osteomyelitis?
    1. It promotes collagen formation
    2. It improves healing of ischaemic wounds
    3. It promotes angiogenesis
    4. An 85% remission rate has been reported
    5. It has no direct bactericidal effect
  1. With regards to metacarpophalangeal joint arthritis of the fingers, which of the following statements is true?
    1. It is more common in osteoarthritis than rheumatoid arthritis
    2. Silicone prostheses have a high rate of fracture requiring revision surgery
    3. Silicone prostheses have been shown to improve range of movement in the longer term
    4. Overall long-term patient satisfaction after implantation of silicone prostheses is below 50%
    5. Unconstrained metal–polyethylene prostheses have good predictable results in all patients
  1. Which of the following statements is false with regards to tibial malunion?
    1. Defined as an angulation of more than 10° in the coronal or the sagittal plane
    2. Coronal plane malalignment is more symptomatic
    3. Up to 20° of malalignment can be tolerated without significantly increasing the pressure on the cartilage
    4. Tibial lengthening should be considered for leg-length discrepancy of more than one inch
    5. Rotational malunion of more than 10° has been shown in up to 22% after tibial nailing
  1. Which one of the following is true with regards to the stages of posterior tibial tendon insufficiency?
    1. Forefoot abduction is noted in Stage I
    2. Dynamic hind foot deformity is noted in Stage II
    3. Hindfoot valgus is correctable in Stage III
    4. Correctable ankle valgus is noted in Stage III
    5. Forefoot pronation is present in Stage IV
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  1. Which one of the following is the strongest factor leading to symptomatic degenerative disc disease?
    1. Heavy lifting
    2. Vibration forces
    3. Torsional loads
    4. Tobacco exposure
    5. Genetic predisposition
  1. In relation to orthopaedic screws:
    1. Pitch is directly proportional to thread angle
    2. Locking screws achieve stability by cold welding to the plate
    3. The correct drill bit size for the threaded hole for a 4.5 mm cortical screw is 3.5 mm
    4. Reducing shank diameter increasing the risk of fatigue failure
    5. A larger ratio of core diameter to outer diameter leads to higher pull out strength
  1. Which one of the following statements is false with regards to the use of autotransfusion in orthopaedic surgery?
    1. Should be used only if the transfusion risk is more than 10%
    2. Should not be used if bone cement is being used during joint replacement surgery
    3. Contraindicated in infected cases
    4. Contraindicated in the presence of malignancy
    5. Is a good source of clotting factors
  1. What is the probable mechanism of failure of a cemented total hip replacement with radiolucent lines on the anteroposterior radiograph in Gruen zones two and six?
    1. Medial stem pivot
    2. Calcar pivot
    3. Cantilever failure
    4. Pistoning between cement and bone
    5. Pistoning between cement and implant
  1. Regarding genetic transmission, which one of the following inheritance patterns is seen in patients with familial hypophosphataemic rickets?
    1. Autosomal recessive
    2. Autosomal dominant
    3. X-linked recessive
    4. X-linked dominant
    5. Mixed pattern
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  1. Delayed gadolinium-enhanced MR imaging to detect articular cartilage degeneration relies on the content and depletion of which one of the following in the hyaline cartilage?
    1. Proteoglycan
    2. Chondroitin sulphate
    3. Keratin sulphate
    4. Collagen
    5. Water
  1. During the process of nerve regeneration, which one of the following modalities is the first to return?
    1. Fine touch
    2. Deep touch
    3. Vibration
    4. Pain
    5. Motor
  1. A 25-year-old weight-lifter had an MRI examination of his shoulder, which shows a SLAP lesion with a cyst in the spinoglenoid notch. Which one of the following clinical signs/tests would be expected to be positive in this scenario?
    1. Jobe
    2. Horn blower
    3. Lift-off
    4. Belly push
    5. Speed
  1. All of the following are possible sites for compression of the radial nerve except:
    1. Fascial band at radial head
    2. Edge of extensor carpi radialis brevis
    3. Recurrent leash of Henry
    4. Arcade of Frohse
    5. Ligament of Struthers
  1. Which one of the following statements is true about Wartenberg's syndrome?
    1. Pain along the ulnar side of forearm
    2. Paraesthesiae along the dorso-radial side of the hand
    3. Aggravated by forearm supination
    4. Surgery is usually required
    5. Typically associated with weakness of wrist dorsiflexion
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  1. Which one of the following would be the most suitable test to detect a difference between the grade of Perthes’ disease (Herring classification) in two different population groups belonging to the rural or urban areas?
    1. Paired t-test
    2. ANOVA
    3. Mann–Whitney U test
    4. Wilcoxon signed rank test
    5. Kruskal–Wallis test
  1. Which one of the following would be the most suitable approach to stabilise a T-type fracture of the acetabulum?
    1. Kocher–Langenbeck
    2. Ilioinguinal
    3. Modified Smith–Petersen
    4. Ilio-femoral approach
    5. Combined anterior and posterior approach
  1. What is the mechanism of injury for a typical Weber C fracture as per the Lauge–Hansen classification?
    1. Supination–abduction
    2. Supination–external rotation
    3. Pronation–abduction
    4. Pronation–external rotation
    5. Pronation–dorsiflexion
  1. All of these are associated with a pes cavus deformity except?
    1. Forefoot adduction
    2. Forefoot supination
    3. Hindfoot varus
    4. Plantar flexion of first metatarsal
    5. Clawing of the great toe