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Hope Orthopedics Final Exam
Exam was 45 Questions. Answers marked with * are answers we are unsure of
1. All of the following are true about fractures in children except:
A. 10% of all fractures occur in growth plate
B. Growth may be affected
C. Diagnosis of fractures is more difficult than adults
D. Green - stick fracture is a unicortical fracture
E. Non-union is common
Answer: E. Non-union is common
2. All of the following are true concerning compartment syndrome except:
A. Muscle necrosis leads to Volkmann's contracture of the hand
B. Nerve ischemia is reversible
C. Traction test of the tendon is insignificant
D. Increase pressure inside osteofascial compartment
E. Fasciotomy is the treatment
Answer: C. Traction test of the tendon is insignificant*
Explanation: The reversibility of nerve injury will depend on duration of ischemia becoming
irreversible after 8 hours. If traction test of the tendon means stretching the muscle groups
then it is significant
3. All of the following are true concerning carpal tunnel syndrome except:
A. Carpal tunnel syndrome during pregnancy always needs surgery
B. Nerve conduction study is indicated for diagnosis
C. Severe cases cause thenar muscle atrophy
D. Paresthesia of the thumb, index, and middle finger
E. Cole's fracture can result in carpal tunnel syndrome
Answer: A. Carpal tunnel syndrome during pregnancy always needs surgery*
Note: This answer was sourced from an article on the AAFP dating back to 2003, which
states that conservative management should be administered in pregnant females with
carpal tunnel syndrome.
4. All of the following are true regarding fractures and mechanism except:
A. Bending results in oblique fracture
B. Direct blow results in neck of femur fracture
C. Flexion compression results in facet joint fracture
D. Twisting results in spiral fracture
E. Traction results in avulsion fracture
Answer: B. Direct blow results in neck of femur fracture
5. All of the following are true regarding management of knee osteoarthritis except:
A. Oral corticosteroids can be used in treatment
B. Total knee arthroplasty is the last choice
C. Intra-articular injection may improve symptoms
D. Weight bearing AP x-ray should be done
E. Non-steroidal anti-inflammatory drugs can be used
Answer: A. Oral corticosteroids can be used in treatment
6. All of the following are true regarding septic arthritis except:
A. It's an emergency
B. The least joint to be infected is the hip
C. It may become complicated with osteomyelitis
D. It damages the articular cartilage
E. High doses of intravenous antibiotics is mandatory
Answer: B. The least joint to be infected is the hip*
7. All of the following are considered in examination of a mass of forearm except:
A. Mobility
B. Skin status
C. Innervation
D. Location
E. Tenderness
Answer: C. Innervation
8. All of the following are deformities of the foot except:
A. Hallux valgus
B. Pes cavus
C. Vertical talus
D. Calcanio varus
E. Plantar fasciitis
Answer: E. Plantar fasciitis
9. One of the following statements is true regarding congenital scoliosis
A.
B.
C.
D.
E.
Progressive curve cannot be operated until puberty
Failure of formation resulted in bony bar
May be associated with cardiac anomalies
Spinal cord is normal
Failure of segmentation resulted in wedge vertebra
Answer: C. May be associated with cardiac anomalies
Explanation: Congenital scoliosis is often frequented with cardiac anomalies- Medscape
10. Regarding anterior dislocation of the shoulder, all of the following are true except:
A. It's more common than other types
B. It is most common at young age
C. The humeral head is palpated at the infraclavicular fossa
D. Brachial artery is vulnerable to injury
E. It may be complicated with injury of anterior branch of axillary nerve
Answer: D. Brachial artery is vulnerable to injury*
Explanation: Review of a few sources on the internet showed that ant dislocation of the
shoulder is related to axillary artery injury rather than brachial artery injury.
11. One of the following are true regarding spondylolithiasis
A. Pathological type is associated with vertebral body fracture
B. Traumatic type is most common
C. Degenerative type is associated with facet fracture
D. Isthmic type is associated with fatigue fracture of the pedicle
E. Dysplastic type is associated with facet joint hypoplasia
Answer: E. Dysplastic type is associated with facet joint hypoplasia
12. All of the following are true regarding posterior traumatic hip dislocation except:
A. May result from dash-board injury with hip in abduction
B. It is an emergency case to avoid avascular necrosis of the femoral head
C. Is the most common type
D. May be associated with posterior acetabular wall fracture
E. May be complicated with sciatic nerve injury
Answer: A. May result from dash-board injury with hip in abduction
Explanation: to dislocate the hip posteriorly, the hip needs to be adducted rather than
abducted
Note: All the others support the arches of the foot according to Moore’s Clinical Anatomy
7th edition
13. All of the following statements are true regarding coxa vara except:
A. Unilateral coxa vara resulta in trendelenburg gate
B. Coxa vara means neck-shaft angle > 135 degree
C. Bilateral coxa vara results in waddling gait
D. Coxa vara results in ineffective contraction of the hip abductors
E. Coxa vara results in shortness of the lower limb
Answer: B. Coxa vara means neck-shaft angle >135 degree
14. All of the following are true regarding osteoid osteoma except:
A. Occurs in younger age group
B. Characterized by the presence of nidus
C. Patient has night pain usually disappear by Acetyl Salicylate
D. If not treated early, there is a high risk of malignant transformation
E. CT is superior to MRI in reaching the diagnosis
Answer: D. If not treated early, there is a high risk of malignant transformation
15. The most important stabilizer of the spine is:
A. Intervertebral disk
B. Thoracic cage
C. Facet joint
D. Anterior & posterior longitudinal ligaments
E. Paraspinal muscles
Answer: E. Paraspinal muscles*
Note: It is mentioned in Moore’s clinical anatomy that the intrinsic muscles of the back are
important stabilizers of the back. Nevertheless this doesn’t mean that the answer above is
correct.
16. One of the following is not a support of the plantar arch
A. Spring ligament
B. Tibialis anterior
C. Flexor hallucis longus
D. Metatarsal bones
E. Peronius longus muscle
Answer: C. Flexor hallucis longus
17. Falling on an outstretched hand will result in all of the following fractures except
A. Elbow fracture or dislocation
B. Sternoclavicular joint dislocation
C. Posterior shoulder dislocation
D. Humeral surgical neck fracture
E. Scaphoid fracture
Answer: B. Sternoclavicular joint dislocation*
18. Stages of bone healing consist of all of the following except
A. Re-epithelization
B. Inflammation
C. Hematoma
D. Callus
E. Remodeling
Answer: A. Re-epithelization
19. In acute hematogenous osteomyelitis, all of the following contribute in bone sequestration
except
A. Subperiosteal abscess
B. Periosteal rupture
C. Increased intra-medullary pressure
D. Bacterial toxin that causes bone death
E. Intra-medullary blood thrombosis
Answer: **
20. Antibiotic given to treat acute hematogenous osteomyelitis should be characterized by all of
the following except
A. Reaching bone in high concentration
B. Given intravenous
C. Broad spectrum and covering Staphylococcus Aureus
D. In early osteomyelitis can be given orally
E. Maximum dose
Answer: D. In early osteomyelitis can be given orally
21. All of the following are stabilizers of the knee joint except
A. Anterior and posterior cruciate ligaments
B. Medial and lateral collateral ligaments
C. Medial and lateral menisci
D. Popliteus muscle
E. Bony contour of the joint
Answer: D. Popliteus muscle*
Note: Found in past year questions where it is mentioned that this is one of the key
answers for this question
22. All of the following statements are true regarding osteoarthritis of the hip joint except
A. Pain is located at groin area
B. Arthrodesis is indicated in old age cases
C. Avascular necrosis may be the cause
D. Total hip arthroplasty is the last solution
E. Limitation of joint movement
Answer: B. Arthrodesis is indicated in old age cases
Note: According to Wheeless’ textbook of Orthopedics, surgical fusions are performed for
young individuals with advanced arthritis
23. All of the following are unfavorable factors that affect bony union, except
A. Impairment of blood supply
B. Infection
C. Immobilization
D. Intra articular fracture
E. Comminuted fracture
Answer: C. Immobilization
24. All of the following are radiological signs of osteoarthritis except
A. Capsular calcifications
B. Subchondral cyst
C. Osteophyte formation
D. Narrow joint space
E. Joint subluxation
Answer: E. Joint subluxation*
25. All statements are true regarding upper limb injuries except
A. Median nerve results in pointed hand
B. Ulnar nerve resulted in claw hand
C. Musculoskeletal nerve resulted in weak elbow flexion (corrected in the exam to
musculocutaneous)
D. Dorsal interosseous hand results in club hand
E. Radial nerve resulted in wrist drop
Answer: D. Dorsal interosseous hand results in club hand
26. Regarding osteosarcoma, all of the following are true, except:
A. It is associated with venous dilation
B. It is associated with normal temperature
C. Most common location is around the knee joint
D. It is more common at an early age
E. It is very painful
Answer: *
27. All of the following are principles of fracture treatment except
A. Rehabilitation
B. Maintenance of reduction
C. Reduction
D. Callus formation
E. Prevent complications
Answer: D. Callus formation
28. All of the following statements regarding Developmental Dislocation of the Hip(DDH)
treatment except
A. Closed reduction and abduction splint at first 6 months
B. Soft tissue surgery and abduction splint before the age of 1.5 years
C. Pavlik harness at first 6 months
D. Bony procedures are indicated after the age of 1.5 years
E. None surgical treatment is the best choice at the age before 2 years
Answer: *
29. Rotator cuff syndrome is characterized by all of the following except
A. Acute type is associated with paresthesia
B. Tenderness at the tip of the shoulder
C. Shoulder rotation is painful
D. Flexion and internal rotation of the shoulder is the cause
E. Shoulder abduction is painful
Answer: *
30. All of the following are radiological and MRI signs of anterior dislocation of the shoulder
except
A. Hill Sachs lesion of the humeral head is seen posterolaterally
B. Bankart lesion is seen on X-ray and MRI
C. Avulsion the insertion of the subscapularis tendon
D. Absence of the oval crossed area between glenoid and humeral head
E. Avulsion fracture of the greater tuberosity
Answer: C. Avulsion the insertion of the subscapularis tendon*
31. One of the following is the most important complication of the posterior dislocation of the
hip
A. Sciatic nerve injury
B. Recurrent dislocation
C. Obturator nerve injury
D. Osteoarthritis
E. Femoral artery injury
Answer: C. Obturator nerve injury
32. Twisting injury of the knee can cause
A. Dislocation of the patella
B. Collateral ligament injury
C. Anterior cruciate ligament injury
D. Meniscal injury
E. Posterior cruciate ligament injury
Answer: D. Meniscal injury
33. All of the following are clinical signs of lower motor neuron except
A. Muscle atrophy
B. Negative Hoffman sign
C. Atonia of the muscles
D. Absence of scrotal reflex
E. Decrease of tendon reflexes
Answer: D. Absence of scrotal reflex
34. All of the following differ between true and pseudo sciatica except
A. True sciatica is associated with positive Straight Leg Raising Leg Test
B. True sciatica is caused by spinal cord compression
C. True sciatica is associated with sensory disturbance
D. Pseudosciatica is a referred pain
E. Pseudosciatica is not associated with myotome distribution
Answer: B. True sciatica is caused by spinal cord compression
35. In scoliosis all of the following are true except:
A. There is lateral curvature of the spine
B. Loss of sagittal balance
C. Rotation is resulted rib hump
D. Side of scoliosis is related to the concavity
E. Vertebral bodies are normal on X-ray
Answer: D. Side of scoliosis is related to the concavity*
36. Treatment of open fracture include all of the following except
A. Tetanus prophylaxis
B. Immediate skin closure
C. Intra venous antibiotics
D. Wound debridement
E. Stabilization of fracture
Answer: B. Immediate skin closure
37. All of the following are malignant or premalignant disease of the bone except
A. Osteosarcoma
B. Multiple hereditary exostoses
C. Giant cell tumor
D. Paget’s disease
E. Chondroma
Answer: E. Chondroma
38. All of the following lines are done on antero-posterior X-ray of the pelvis and hips except
A. Burkin’s line
B. Shenton’s line
C. Acetabular Index
D. Hilgenreiner’s line
E. Neck-shaft line
Answer: **
39. All the following pathologies of the spine need surgery except
A. Congenital spondylolisthesis
B. Muscular torticollis
C. Scoliosis due to pelvic tilt
D. Neurogenic claudication <50-100 m
E. Severe congenital kyphosis
Answer: B. Muscular torticollis
40. All of the following should be considered in reading X-ray except
A. Always look for dynamic views
B. Role of two (2 joints, 2 limbs…. Etc..)
C. Looking for pathology
D. Patient profile
E. Quality of X-ray (Exposure)
Answer: A. Always look for dynamic views
41. The first area of long bone to be affected by infection in acute hematogenous osteomyelitis
is
A. Physis
B. Cortex
C. Metaphysis
D. Diaphysis
E. Epiphysis
Answer: C. Metaphysis
Note: Check the spine seminar for the different types mentioned above
42. The least important stabilizer of the shoulder joint is
A. Labrum and capsule
B. Ligaments
C. Rotator cuff muscles
D. Glenoid cavity
E. Articular surface negative pressure
Answer: D. Glenoid cavity*
43. The most important pathology of DDH involves
A. Increased femoral anteversion
B. Acetabular dysplasia
C. Hypertrophied ligamentum terres
D. Inverted labrum
E. Capsular laxity
Answer: E. Capsular laxity
44. All of the following are signs of rigid clubfoot except
A. Deep skin creases
B. Forefoot adduction
C. Atrophied leg
D. Small heel
E. Uncorrectable deformity
Answer: E. Uncorrectable deformity
45. All of the following are general complications of fracture except
A. Pulmonary Embolism
B. Shock
C. Tetanus
D. Fat embolism
E. Compartment syndrome
Answer: E. Compartment syndrome