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Orthopedic Board Certification Exam 1- Origin of bone is from: (A) (B) (C) (D) Ectoderm Mesoderm Endoderm All of the above 2- Acute osteomyelitis is commonly caused by (A) (B) (C) (D) Staph aureus S.pyogenes H.influenza Salmonella 3- Acute osteomyelitis usually begins at (A) (B) (C) (D) Epiphysis Metaphysis Diaphysis All of the above 4- Tuberculosis of the spine most likely originates from (A) (B) (C) (D) Intervertebral disc Cancellous vertebral body Ligamentous structures Paravertebral soft tissues 5- Melon seed bodies in joint fluid are characteristic of: (A) (B) (C) (D) Rheumatoid arthritis Tuberculosis arthritis Septic arthritis None of the above 6- Osteoid osteoma originates from : (A) (B) (C) (D) Periosteum Cortex Medullary cavity All of the above 7- Bone metastasis in males commonly arise from cancer of: (A) (B) (C) (D) Lung Prostate Kidney Thyroid 1 9/12/2011 Orthopedic Board Certification Exam 9/12/2011 8- Osteoblastic bone secondaries arise from cancer of: (A) (B) (C) (D) Breast Lung Prostate Adrenal 9- Multiple myeloma tumor calls resembles: (A) Granulocytes (B) Plasma cells (C) Lymphcytes (D) Chondrocytes 10-Osteomalacia predominantly affects the: (A) (B) (C) (D) Spine Pelvis Skull bones Metatarsals 11-A Gigli saw is: (A) (B) (C) (D) An electrically driven circular bone saw A pneumatically driven bone saw A short straight bone saw A long twisted wire saw 12- In Dupuytren’s contracture which of the following statements is correct: (A) (B) (C) (D) It is a contracture of the flexor tendons to the ring and little finger It is a contracture of the palmar fascia It may occur in the plantar fascia There is an association with cirrhosis of the liver 13- A greenstick fracture: (A) (B) (C) (D) Occurs chiefly in the elderly Does not occur in children Is a spiral fracture of the tubular bone Is a fracture where part of the cortex is intact and part is crumpled or cracked 14- Spiral fracture is due to: (A) (B) (C) (D) Blunt trauma Axial compression Twist Direct impact 2 Orthopedic Board Certification Exam 9/12/2011 15- The single most important factor in fracture healing is: (A) (B) (C) (D) Correct bone alignment Accurate reduction Immobilization Organization of clot 16- Immobilization is not required in fracture involving: (A) (B) (C) (D) (E) Scapula Wings of Ilium Ribs Proximal humerus in elderly Pulmonary Embolism 17- Trendelenburg’s sign is used in the diagnosis of: (A) Varicose Veins (B) Congenital dislocation of the hip (C) Carcinoma of the stomach (D) Pulmonary embolism 18- The essential examination of the hip in order to cinch the diagnosis of chronic slipped femoral epiphysis is: (A) (B) (C) (D) Measuring for shortening of the leg Palpation of the femoral head A-P plain x-ray view of the hip Lateral x-ray view of the hip 19- Shenton’s line is a sign applicable to: (A) The detection of the shortening of the leg on physical examination (B) A radiological feature of the pelvis applied to diagnosis of congenital dislocation of the hip. (C) A radiological feature of the lungs applied to the diagnosis of pulmonary vein thrombosis (D) A physical sign applied to the diagnosis of adrenal deficiency. 20- Perth’s disease is common tp age group of : (A) (B) (C) (D) 1- 5 6- 10 11 – 15 16 – 20 21- The average duration of Perth’s disease is : (A) (B) (C) (D) 1-2 years 3 -4 years 1- 6 months 6months – 1 year 3 Orthopedic Board Certification Exam 9/12/2011 22- The term delayed union is employed when the fracture fails to unite within: (A) (B) (C) (D) 1.5 times the normal union time Twice the normal union time 2.5 times the normal union time None of the above 23- What is true of the clavicle fracture ; (A) (B) (C) (D) Non-union is rare Malunion is of no functional significance Reduction even if achieved is difficult to maintain All are true 24- The joint most likely to have recurrent dislocation: (A) (B) (C) (D) Ankle Knee Shoulder Patella 25- Radial nerve palsy may occur in fracture of humerus involving : (A) (B) (C) (D) Surgical neck Shaft Lower end All of the above 26- Myositis ossificans commonly occurs around (A) (B) (C) (D) Shoulder Elbow Wrist Knee 27- Volkmann’s ischemia commonly occurs following: (A) (B) (C) (D) Fracture shaft humerus Supracondylar fracture Colles’ fracture Monteggia fracture 28- Cubitus valgus of the elbow commonly follows fracture of : (A) (B) (C) (D) Lateral condyle Medial condyle Capitalum Lower third of humerus 4 Orthopedic Board Certification Exam 9/12/2011 29- The deformity of wrist in Colles’ fracture is called: (A) (B) (C) (D) Madelung’s deformity Dinner fork deformity Buttonaire deformity None of the above 30- Colles’ fracture can be complicated by the late rupture of: (A) (B) (C) (D) Extensor pollicis longus Abductor pollicis longus Adductor pollicis longus Flexor pollicis longus 31- What is true of Sudeck’s atrophy of hand? (A) (B) (C) (D) (E) Hand is painful and swollen Osteoporosis of carpals and metacarpals There is increased blood flow to para-articular areas Cervical aympathectomy may be of help All are true 32- The carpel bone most commonly fractured is: (A) (B) (C) (D) Triquetrum Hamate Capitate Scaphoid 33- Which nerve is compressed in carpal tunnel syndrome? (A) (B) (C) (D) Ulnar Median Radial All of the above 34- The most common injury following pelvic fracture is of: (A) (B) (C) (D) Bladder Urethra Rectum Vagina 35- Limb shortening with adduction and internal rotation occurs in which type of hip dislocation? (A) (B) (C) (D) Anterior Posterior Central All of the above 5 Orthopedic Board Certification Exam 9/12/2011 36- Normal neck-shaft angle femur is: (A) (B) (C) (D) 90° 120° 150° 170° 37- Fracture femoral neck can be diagnosed from: (A) (B) (C) (D) Limb shortening External rotation Abduction A and B 38- Which of the following if not true of intertrochanteric fracture of femur? (A) (B) (C) (D) Limb shortening Malunion Avascular necrosis of the femoral head Internal fixation is preferred 39- Spontaneous bleeding into joints in haemophilia occurs when factor VI level is less than: (A) (B) (C) (D) 50% 25% 10% 5% 40- Stenosing tenovaginitis commonly affects: (A) (B) (C) (D) Abductor pollicis Flexor pollicis Opponens pollicis All of the above 41- A sequestrum is: (A) (B) (C) (D) (E) A piece of soft dead tissue A piece of dead skin A dead tooth A piece of dead bone A retained swab 42- Union of a simple uncomplicated transverse fracture of the tibia in an adult normally takes: (A) (B) (C) (D) (E) 6 weeks 8 weeks 12 weeks 18 weeks 26 weeks 6 Orthopedic Board Certification Exam 43- Bennett’s fracture is: (A) (B) (C) (D) (E) Reversed Colles’ fracture Fracture of the scaphoid bone in the wrist Fracture of the radial styloid (chauffer’s fracture) Fracture dislocation of the first metacarpal Cause of mallet finger 44- Treatment of a severe comminuted fracture of the patella includes: (A) (B) (C) (D) (E) Physiotherapy alone Insertion of a figure of eight tension band Patellectomy Insertion screws or wire Skin traction 45- Malunion of a fracture is: (A) (B) (C) (D) (E) A fracture which unites in a position of deformity Delayed union of a fracture Non-union of a fracture Followed by pseudoarthrosis Due to tuberculosis 46- Volkmann’s contracture: (A) (B) (C) (D) (E) Affects the palmar fascia Develops at the ankle in a case of chronic venous ulcer Follows ischemia of the foreman Is due to excessive scarring of the skin of the axilla following a burn Follows ulnar nerve palsy 47- A benign tumor forming osteoid is: (A) (B) (C) (D) (E) A synovioma A chondroma An osteoma A fibroma An adenoma 48- Idiopathic scoliosis: (A) (B) (C) (D) (E) Lateral curvature of the spine Rotation of the spine Lateral curvature with rotation of the spine Flexion deformity of the spine Congenital disease with hemi vertebrae 7 9/12/2011 Orthopedic Board Certification Exam 9/12/2011 49- Milwaukee brace can be used in: (A) (B) (C) (D) (E) Sacro-iliac strain Derangement of the teeth A patient with an above knee amputation Scoliosis Fractured clavicle 50- The name associated with joint neuropathy is that of : (A) (B) (C) (D) (E) Cushing Osier Moon Charcot Addison 51- What two nerves make up the internervous plane in the Smith-Peterson anterior hip approach? (A) (B) (C) (D) (E) there is no internervous plane femoral nerve and inferior gluteal nerve femoral nerve and superior gluteal nerve obturator nerve and superior gluteal nerve obturator nerve and inferior gluteal nerve 52- The ascending branch of the lateral femoral circumflex artery is at risk with which of the following surgical approaches? (A) (B) (C) (D) Stoppa approach Kocher-Langenbach approach Ilioinguinal approach Watson-Jones approach (E) Smith-Peterson approach 8 Orthopedic Board Certification Exam 9/12/2011 53- A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. The occurrence of this injury increases her risk of sustaining a subsequent hip fracture for what amount of time? (A) (B) (C) (D) (E) Only until the humerus fracture is healed 1 year 5 years 10 years Lifelong increase in risk 54-Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture? (A) age of the patient (B) intrinsic stability of the fracture (C) tip-apex distance (D) quality of reduction (E) angle of the side plate 9 Orthopedic Board Certification Exam 9/12/2011 55- Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? (A) The use of intramedullary nail has increased in the last ten years (B) The use of sliding hip screws has increased in the last ten years (C) Medicare reimbursement is more for a sliding hip screw (D) Intramedullary nails have demonstrated superior outcomes in randomizedcontrolled studies (E) Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures 56- An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. What is the next appropriate step in treating the failure seen in figure A? (A) Non-weight bearing (B) Valgus proximal femoral osteotomy (C) Total hip arthroplasty (D) Revision open reduction and internal fixation (E) Proximal femoral resection 10 Orthopedic Board Certification Exam 9/12/2011 57- Appropriate implants for treatment of the fracture seen in figure A include all of the following EXCEPT (A) Cephalomedullary nail (B) Dynamic condylar screw (C) Proximal femoral locking plate (D) 95 degree blade plate (E) Sliding hip screw 58- Anterior perforation of the distal femur from ante grade femoral nailing has been attributed to what factor? (A) (B) (C) (D) (E) Non-anatomic reduction Mismatch of the radius of curvature of implant and bone Usage of too large an implant Lateral patient positioning Lateral proximal starting point 11 Orthopedic Board Certification Exam 9/12/2011 59- Following internal fixation for an intertrochanteric fracture which of the following factors has been shown to be associated with increased collapse or sliding displacement of the fracture? (A) (B) (C) (D) (E) Use of a long intramedullary device Use of a short intramedullary device Use of extramedullary sliding hip screw device Post operative weight bearing status fracture that involved the lateral femoral wall 60- Which of the following are predictors of mortality after hip fractures? (A) (B) (C) (D) (E) American Society of Anesthesiologist (ASA) classification younger patients fracture comminution fixation device used hip fracture type 61- A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury? (A) Total hip arthroplasty (B) Bipolar hemi-arthroplasty (C) Sliding hip screw (D) Percutaenous screw fixation (E) Cephalomedullary nail fixation 12 Orthopedic Board Certification Exam 9/12/2011 62- All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT: (A) (B) (C) (D) (E) trochanteric entry point cephalomedullary nail piriformis fossa entry point cephalomedullary nail dynamic hip screw fixed angle blade plate 95 degree dynamic condylar screw 63- When treating a stable 2-part intertrochanteric hip fracture with a sliding hip screw construct, how many screw holes are needed in the side plate for successful fixation? (A) (B) (C) (D) (E) One Two Three Four Five 13 Orthopedic Board Certification Exam 9/12/2011 64- Increased hip intracapusular pressures can lead to diminished femoral head perfusion. What leg position can decrease intracapsular hip pressures after femoral neck fracture? (A) (B) (C) (D) (E) flexion and internal rotation extension and external rotation flexion, abduction, and external rotation extension, adduction, and internal rotation there are no differences in hip pressures with any position 65- An intern who is taking primary call in the emergency room reports to you, the attending physician, that he has been consulted for a 73 year old male in the ER with a hip fracture. He says he has seen the AP pelvis x-ray and thinks it is a "neck fracture". Which of the following x-rays should he be instructed to obtain to best determine the classification of hip fracture in order to guide surgical planning? (A) (B) (C) (D) (E) Cross table lateral of the hip with the leg externally rotated 10° AP of the hip with the leg externally rotated 30° Frog-leg lateral of the hip Traction AP of the hip with the leg internally rotated 15° Cross table lateral of the hip with the leg internally rotated 10° 66- A 69-year-old cyclist is involved in an accident and sustains a displaced femoral neck fracture. What is the optimal treatment? (A) (B) (C) (D) (E) Open reduction internal fixation Bipolar hemiarthroplasty Unipolar hemiarthroplasty Total hip arthoplasty Nonoperative treatment 67- A 27-year-old man sustains a displaced femoral neck fracture and undergoes urgent open reduction internal fixation. What is the most prevalent complication after this injury? (A) (B) (C) (D) (E) Flexion contracture Hip instability Nonunion Abductor lurch Osteonecrosis 68- A 70-year-old woman trips on the grass while playing golf and sustains a displaced comminuted femoral neck fracture. What is the optimal treatment for this patient? (A) (B) (C) (D) (E) Open reduction internal fixation Bipolar hemiarthroplasty Total hip arthroplasty Unipolar hemiarthroplasty Traction and non operative treatment 14 Orthopedic Board Certification Exam 9/12/2011 69- A 65-year-old male falls from a standing height and sustains the injury seen in Figure A and undergoes the treatment seen in Figure B. Compared to a total hip arthroplasty, this treatment is associated with which of the following. (A) (B) (C) (D) (E) Increased blood loss Lower incidence of revision surgery Increased risk of peri-prosthetic fracture Lower dislocation risk Increased risk deep venous thrombosis 15 Orthopedic Board Certification Exam 9/12/2011 70- A 30-year-old male sustains the following isolated injury after a motor vehicle collision; an AP pelvis in the trauma bay is shown in Figure A. Of the listed complications, what is the most likely complication at long term followup? (A) (B) (C) (D) (E) Avascular necrosis Femoroacetabular impingement Post-traumatic arthritis Chondrolysis Ipsilateral medial knee degenerative changes 16 Orthopedic Board Certification Exam 9/12/2011 71- An 82-year-old female sustains a valgus-impacted sub capital femoral neck fracture and undergoes cannulated screw fixation. She returns for her first follow-up visit one week later after a fall and now has severe hip pain and is unable to bear weight on the limb. Management should now consist of which of the following? (A) (B) (C) (D) (E) Traction Revision fixation of the femoral neck fracture Hardware removal and placement of a sliding hip screw device Hardware removal and calcar replacing hip hemiarthroplasty Resection hip arthroplasty 72- The cricoids cartilage lies opposite which vertebral level? (A) (B) (C) (D) (E) C3 C4 C5 C6 C7 17 Orthopedic Board Certification Exam 9/12/2011 73- In a posterolateral approach to the femur for fixation of an intertrochanteric fracture, bleeding is encountered as vastus lateralis muscle is dissected from the linea aspera. The bleeding vessels are most likely branches of which of the following arteries? (A) (B) (C) (D) (E) Medial femoral circumflex Transverse branch of the lateral femoral circumflex Deep femoral Superficial femoral Descending branch of the lateral femoral circumflex 74- Which of the following signs or symptoms is LEAST likely to result from herniation of the L4-L5 disk? (A) (B) (C) (D) (E) Weakness of the extensor digitorum longus Pain radiating to the first web space of the foot Decreased sensation on the medial aspect of the ankle Decreased tibialis posterior reflex Weakness of extensor hallucis longus 75- When posterolateral bone grafting is performed for nonunion of the tibia, the structure at most risk for injury is the A) B) C) D) E) Posterior tibial nerve Sural nerve Superficial peroneal nerve Lesser saphenous vein Peroneal artery 76- All the following statements about the cubital tunnel are true EXCEPT that A) B) C) D) E) The proximal ulna forms one border The medial epicondyle of the humerus forms one border Osborne's fascia covers the tunnel The ulnar nerve enters the flexor carpi ulnaris in the tunnel It decreases in volume with elbow flexion 77- Which of the following features is most consistently seen in osteoporosis? A) B) C) D) E) Increased serum alkaline phosphatase Decreased serum calcium Increased serum parathyroid hormone Impaired mineralization of osteoid Increased susceptibility to fractures 78- Heparin prevents thrombosis by the molecular action of A) B) C) D) E) Inhibiting activation of factor X Inhibiting activation of factor VIII Inhibiting activation of factor VIII and X Enhancing the action of antithrombin III Inhibiting platelet aggregation 18 Orthopedic Board Certification Exam 9/12/2011 79- Osteogenesis imperfecta is associated with a defect in the synthesis of A) B) C) D) E) Type I collagen Type II collagen Type IV collagen Chondroitin sulfate Keratan sulfate 80- A 36-years-old man has had osteonecrosis of the femoral head for 1 year. Histological examination of the marrow in the part of the femoral head that had undergone creeping substitution would reveal A) B) C) D) E) Necrosis Regeneration to normal marrow Loose fibrous tissue with numerous vessels Dense scarring with few blood vessels Replacement by cartilage 81- In Paget’s disease, progressive osteolysis is most likely to be encountered in the A) B) C) D) E) Vertebrae Pelvis Skull Tibiae Metatarsals 82- On histological examination, an aneurysmal bone cyst can most easily be confused with A) B) C) D) E) An osteogenic sarcoma A nonossifying fibroma A chondroblastoma A hemangioendothelioma A giant cell tumor 83- The best method to assess congruity of the hip joint following closed reduction of a traumatic dislocation of the hip is A) B) C) D) E) AP radiograph of the pelvis AP radiograph of the hip CT of the pelvis MRI of the pelvis Polytomography of the pelvis 19 Orthopedic Board Certification Exam 9/12/2011 84- An obese, 13-year-old boy complained of intermittent left knee pain of 6 weeks' duration. He denied swelling, giving way, or trauma. After examination of the knee, the most appropriate next step in evaluation is A) Examination of the left hip B) Anteroposterior, lateral, tunnel, and Merchant radiographs of the left knee C) Anteroposterior, lateral, tunnel, and Merchant radiographs of the left knee; anteroposterior and frog lateral views of the pelvis. D) An MRI scan of the left knee E) Aspiration of the left knee 85- The most important aspect of treatment in the earliest stages of Legg-CalvéPerthes disease is A) B) C) D) E) Frequent observation Administration of anti-inflammatory medications Restoration of motion in the hip Containment of the femoral head within the acetabulum Aspiration of the hip 86- A 2-year-old boy had the acute onset of pain and swelling in his left knee and refused to walk. His temperature was 39°C (102.2 °F),WBC 16,000/mm³, and ESR 90 mm/h. aspiration of the knee yielded cloudy fluid with a nucleated cell count of 75,000/mm³ . What is the most likely cause of this infection? A) B) C) D) E) Staphylococcus aureus Haemophilus influenza Streptococcus species Pneumococcus species Meningococcus species 87- The most common complication following treatment of acute slipped capital femoral epiphyses is A) B) C) D) E) Degenerative joint disease Overgrowth of the greater trochanter Avascular necrosis Chondrolysis Coxa magna 88- Klippel-Feil syndrome results from A) B) C) D) E) Congenital contracture of the sternocleidomastoid muscle Failure of descent of the scapula Failure of closure of the third branchial arch Failure of segmentation of mesodermal somites Arrested development of the cervical musculature 20 Orthopedic Board Certification Exam 9/12/2011 89- Following 6 months of manipulation and casting, an infant with talipes equinovarus has residual, fixed equinus and approximation of the navicular to the medial malleolus. The midfoot is supple, but there is posterior displacement of the fibular malleolus. Preferred treatment is A) B) C) D) E) Continued manipulation and casting Use of a Denis Browne splint 23 h per day Use of a hinged ankle-foot orthosis Medial and posterior release Posterior, plantar, and lateral release 90 - The most appropriate treatment for a 6 year-old boy with a displaced fracture of the lateral humeral condyle is A) B) C) D) E) Closed reduction and application of an above-elbow cast A collar and cuff Skeletal traction Open reduction and internal fixation Excision of the fracture fragment 91 - The incidence of avascular necrosis of the femoral head following fracture of the femoral neck in children is most directly related to the A) B) C) D) E) Age of the child Displacement of the fracture Time to treatment Type of treatment Location of the fracture line ( physeal, transcervical, cervicotochanteric) 92- Scapholunate advanced collapse (SLAC) typically involves all the following areas EXCEPT the A) B) C) D) E) Radiolunate joint Radial styloid Radioscaphoid joint Capitolunate joint Scaphocapitate joint 93- The muscles most severely affected in Volkmann's ischemic contracture are the A) B) C) D) E) Flexor digitorum superficialis and flexor carpi radialis Flexor digitorum superficialis and flexor pollicis longus Flexor carpi ulnaris and pronator teres Flexor digitorum profundus and flexor pollicis longus Flexor digitorum profundus and flexor carpi ulnaris 21 Orthopedic Board Certification Exam 9/12/2011 94- Acute lumbar disk herniation occurs most commonly in patients in the age group A) B) C) D) E) Under 20 years 20 to 30 years 31 to 50 years 51 to 70 years Over 70 years 95- Failure of total knee arthroplasties incorporating the latest prosthetic designs is most often attributable to A) B) C) D) E) Malposition Loosening Infection Subluxation Errors in technique 96- Loosening of the tibial component following total knee arthroplasty has been associated primarily with A) B) C) D) E) Poor surgical technique Poor prosthetic design Marked preoperative varus deformity Marked preoperative valgus deformity preoperative recurvatum deformity 97- The amount of blood loss a healthy 70-kg man must sustain before a significant drop in systolic pressure occurs is approximately A) B) C) D) E) 500 mL 1000 mL 1500 mL 2000 mL 3000 mL 98- Optimal internal fixation of a femoral neck fracture is achieved by A) B) C) D) E) Three cancellous screws or pins Five to seven cancellous screws or pins A sliding hip screw A sliding hip screw supplemented with pins Ender's nails 22 Orthopedic Board Certification Exam 9/12/2011 99- A 32-year-old unbelted driver involved in a head-on motor vehicle accident had a blood pressure of 110/60 mmHg, a pulse of 110 beats per minute, and a P o₂ of 90 mmHg in the emergency department. The patient had multiple facial lacerations and bruising over his right clavicle. The chest radiograph was unremarkable. A radiograph should now be obtained of the A) B) C) D) E) Skull Face Cervical spine Abdomen Pelvis 100- A posterior dislocation of the shoulder is most commonly associated with a fracture of the A) B) C) D) E) Surgical neck of the humerus Greater tuberosity Lesser tuberosity Neck of the scapula Clavicle 23 Orthopedic Board Certification Exam 9/12/2011 Palestinian Board Orthopaedic |Specialisation Examination Friday,9th of December, 2011 Answering Sheet: Fill in the blank boxes with the correct answer Candidate No 24 Orthopedic Board Certification Exam 25 9/12/2011 Orthopedic Board Certification Exam 26 9/12/2011 Orthopedic Board Certification Exam 27 9/12/2011 Orthopedic Board Certification Exam 28 9/12/2011