ARAB BOARD ORTHOPEDIC MCQS ONLINE BANK 

PREFACE

 

Much effort has been put in this book, as every question was reviewed, analyzed and evaluated concerning the benefit, and information given to the student or Orthopedic Resident, that would allow one to realize his weak points.

The series of questions have been collected by the author over the last year. The material obtained was collected from the most up to date Journals and books in various subspecialties.

The material provided allows the student after having reviewed it, be considered well prepared for any examination in this field.

The questions are provided at random to create an examination atmosphere as though one was actually sitting for an examination.

This author would like to extend his sincere gratitude to all the Residents who trained with him, whom through their continuous stimulus allowed him to carry out the completion of this text.

I hope that it would be of benefit to all and that the time spent in preparing it has not gone in vain.

 

John Abdelnoor, MD., FRCS(C)

Professor Emeritus, Lebanese University Clinical Professor, Lebanese American University Clinical Associate, American University of Beirut

Previous: Head, Department of Orthopedics, and Acting Chairman of Department of Surgery Lebanese University

Senior Examiner & Head, of the Examining Board in Orthopedics, Arab Boards till 2018 &

Head of the Specialization Board at Present

 

Insert the most likely response within the empty space in between the brackets:

1-[ ] Which of the following is the most important structure, which when divided or resected would allow maximum seating of the femoral head within the acetabulum, following surgical reduction of a high riding DDH:

1. Pulvinar fat pad

2. Hip capsule

3. Limbus

4. Transverse ligament

5. Iliopsoas tendon

2-[ ] In what way does femoral shortening ease best the reduction of a high riding hip, in DDH:

1. Relaxes the two joint muscles

2. Derotates the hip

3. Promotes varus of the hip

4. Allows a better capsulorhaphy

5. Removes the hourglass capsular deformity

3-[ ] Should a flat acetabulum be present in patients with DDH (2-5years), the best surgical technique used in the management, would be:

1. A varus osteotomy of the hip

2. A Salter osteotomy

3. A Dega osteotomy

4. A Chiari osteotomy

5. A hip derotation osteotomy

4-[ ] An eight year old male with a Herring B/C hip is best treated with:

1. Traction

2. Atlanta brace

3. With a Petrie cast

4. Snyder sling

5. Surgically

5-[ ] In Legg-Calve’-Perthes disease ending with a Stulberg IV deformity is most likely to:

1. Have no problems throughout life

2. Have continuous hip pain throughout life

3. Have considerable stiffness in the hip throughout

4. Live normally but are expected to have degenerative arthrosis at the age of fifty

5. Are candidates for a Total Hip Arthroplasty, prior to the age of forty years

6-[ ] To distinguish between hips in patients with Gaucher’s disease and Legg Perthes (LCP)

disease is that:

1. The former (Gauchers Disease), both hips are involved at the same time while LCP disease (when bilateral) is involved at different times

2. The hips are more severely involved in Gaucher’s disease

3. LCP disease has an accumulation of cerebrosides within the hip and not in gauchers disease

4. Gaucher’s disease has various stages of hip involvement which is not present in LCP disease

5. LCP disease is always curable when treated with an abduction which is not present in

Gaucher’s disease

7-[ ] Any child presenting with severe back pain involving the whole spine prior to the age 6 years should be investigated for:

1. Leukemia

2. Discitis

3. Disc calcification

4. Syringomyelia

5. Tethered cord

8-[ ] An osteoid osteoma when located in the spine results in scoliosis that occurs at the wrong time and place. When so, the nidus is found in the:

1. Endvertebra

2. Neutral vertebra

3. Convex side of the curve

4. At the apex on the concave side of the curve

5. Vertebral body

   9-[ ] The organism that most commonly results in discitis is:

   1. Streptococci

   2. E. Coli

   3. Pseudomonaus

   4. Staph aureus

   5. Hemophilus influenza

10-[ ] Following a traumatic dislocation of the patella, the structure when injured would, Most

likely result in recurrent patella dislocation is:

1. The infrapatellar tendon

2. The vastus medialis

3. The lateral femoral condyle

4. The medial patellofemoral ligament

5. The vastus intermedius

11-[ ] In adolescents, the most likely mechanism of injury to the lumbosacral spine, that could lead to a spondylolysis, would be:

1. Acute flexion

2. Repetitive extension-rotation injuries

3. Repetitive flexion rotation injuries

4. Distraction injuries

5. Axial compression injuries

12-[ ] In acquired flat foot in an adult the tendon that is usually involved, would be:

1. Peroneus brevis

2. Peroneus longus

3. Posterior tibial tendon

4. Anterior tibial tendon

5. Flexor digitorum longus tendon

13-[ ] The parents of a 13 year old boy known to have tuberculosis, notice swelling in upper right buttocks. He was presumed to have migration of the abcess posteriorly. This would be through which path:

1. Triangle of the inguinal canal

2. The adductor triangle

3. The triangle of petit

4. The iliopsoas triangle

5. The sacroiliac joint

14-[ ] A ten year old boy presented with low back pain. Plain xrays revealed flattening of the vertebral bodies at level L2 and L4. Your first diagnosis, would be:

1. Osteoblastoma

2. Eosinophilic granuloma

3. Tuberculosis

4. Aneurysmal bone cyst

5. Neuroblastoma

15-[ ] When a Margeryl transarticular screw is inserted between C1-2 and is slightly long and passes anterior through the C1 facet, may lead to a unilateral deviation of the tongue. Which of the following nerves is injured:

1. Spinal accessory

2. Long thoracic

3. Hypoglossal

4. Glossopharyngeal

5. Vagus

16-[ ] During anterior spinal surgery, the left vertebral artery was injured. Should the artery be ligated, what would the incidence of brain stem infarction be:

1. 1%

2. 1.8%

3. 3.1%

4. 6%

5. 100%

17-[ ] During anterior spinal surgery when the esophagus is injured and detected late 48 hours postoperatively, the mortality risk is estimated to be:

1. 50%

2. 25%

3. 75%

4. 100%

5. 10%

18-[ ] in which of the following cervical vertebrae, the pedicle is of sufficient diameter to allow the insertion of a pedicle screw:

1. C1

2. C2

3. C3

4. C4

5. C5

19-[ ] The differential diagnosis of most bone tumors is derived from which of the following radioimaging techniques:

 

1. MRI

2. CT scan

3. Plain radiography

4. Scintigraphy

5. Ultrasonography

20-[ ] Patients with osteoid osteomas are known to have pain, more severe at night. This is most probably due to:

 

1. Sensory nerve fibers within the nidus

2. The accumulation of cyclooxygenases and prostaglandins within the lesion

3. Expanding nature of the lesion

4. Over accumulation of a parathyroid like substance within the lesion

5. Necrotizing effect of the lesion

 

21-[ ] With which of the following lesions listed below, osteoid osteoma, is very similar on pathologic analysis:

 

1. Osteomas

2. Enostosis

3. Osteoblastoma

4. Subperiosteal chondromas

5. Parosteal osteosarcoma

 

22-[ ] Telangiectatic osteosarcoma is most commonly confused with:

 

1. Unicameral bone cyst

2. Metaphyseal osseous defects

3. Fibrous dysplasia

4. Aneurysmal bone cyst

5. Periosteal chondromas

 

23-[ ] A focus of mature compact (cortical) bone within the cancellous bone is known to occur in:

 

1. Enostosis

2. Osteoid osteoma

3. Cavernous hemangioma

4. Heterotopic ossification

5. Enchondroma

 

24-[ ] A condition, associated with intestinal polyposis and multiple osteomas, would be:

 

1. Chrones disease

2. Gardners syndrome

3. Gauchers disease

4. Albrights syndrome

5. Whipples disease

25-[ ] Which of the following nerves is most likely to be injured on correction of cervical kyphosis:

 

1. C2

2. C3

3. C4

4. C5

5. C6

 

26-[ ] A 14 year old boy complains of pain along the medial aspect of the thigh, more severe at night. A bone scan reveals a double density sign with maximum uptake in the center of 1cm diameter lesion. The most likely diagnosis would be:

 

1. Sclerosing periostitis

2. Osteoblastoma

3. Osteoid osteoma

4. Stress fracture

5. Eosinophilic granuloma

 

27-[ ] When a patient presents with multiple exostosis and the direction of the stalk points

towards the joint, the diagnosis would be most likely:

 

1. Osteochondromatosis

2. Metachondromatosis

3. Multiple epiphyseal dysplasia

4. Morquio’s disease

5. Spondyloepiphyseal dysplasia

 

28-[ ] Absorption of phosphate from the intestine is mainly from:

 

1. The duodenum

2. Lower end of the jejunum

3. Upper end of the cecum

4. The stomach

5. The colon

 

29-[ ] Giving parathormone at alternate times is:

 

1. Anabolic

2. Catabolic

3. Of no effect on bone

4. Encourages endochondral bone growth

5. Thickens the periosteum

30-[ ] PTH increase results in:

 

1. Increased excretion of calcium from the kidneys

2. Increased excretion of phosphate from the kidneys

3. Increased excretion of vitamin D from the liver

4. Promotes deposition of calcium within the hydroxyapatite crystal

5. Decreases the absorption of calcium from the jejunum

 

31-[ ] The Hormone that in inhibits osteoclast mediated bone resorption is:

 

1. PTH

2. Thyroxin

3. Calcitonin

4. Thyroglobulin

5. Adrenaline

 

32-[ ] Which of the following conditions is known to be associated with an Erlenmeyer-flask deformity of the distal femur and bone necrosis:

 

1. Morquio’s disease

2. Hurlers syndrome

3. Gaucher’s disease

4. Osteopetrosis

5. Malreostosis

 

33-[ ] Parathormone is produced by which of the following cells:

 

1. Fat cells within the parathyroid gland

2. Follicular cells within the parathyroid gland

3. In the liver through the action of 25-hydroxylase

4. Chief cells within the parathyroid gland

5. In the kidney through the action of 1-25 hydroxylase on the proximal convoluted tubule 34-[ ] In the kidneys parathormone stimulates:

1. Resorption of phosphate through the tubules

2. Stimulates both resorption of calcium and phosphate through the tubules

3. Stimulates excretion of calcium through the tubules

4. Stimulates excretion of both calcium and phosphate through the tubules

5. Stimulates resorption of calcium and excretion of phosphate through the tubules

 

35-[ ] Intermittent administration of parathormone (1-34 parathormone) results in:

 

1. An overall anabolic effect on bone

2. A catabolic effect on bone

3. No effect on bone

4. Has no effect on 25-hydroxylase production in the liver

5. Bone fragility

 

36-[ ] Clearance of parathormone occurs mainly through the:

 

1. Intestines

2. Liver

3. Kidney

4. Parathyroids

5. Thyroid

 

37-[ ] the C-terminal of pathormone is cleared mainly in the:

 

1. Intestines

2. Liver

3. Kidney

4. Parathyroids

5. Thyroid

 

38-[ ] The main action of Vitamin D3 is on the:

 

1. Liver

2. Small intestine

3. Colon

4. Parathyroid gland

5. Thyroid gland

 

39-[ ] Which of the following interferes most with the absorption of calcium from the intestine:

 

1. Diazepam

2. Chelating agents

3. Ergosterol

4. Heparin

5. Diuretics

 

40-[ ] Phosphorous is absorbed into the body mainly through the:

 

1. Duodenum

2. Jejunum

3. Cecum

4. Colon

5. Stomach

 

41-[ ] Which of the following is most likely to interfere with the absorption of phosphorous from the intestines:

 

1. Antacids

2. Bisphosphonates

3. Fluorine

4. Steroids

5. Heparin

 

42-[ ] Which of the following peptide is secreted by the parafollicular cells of the thyroid gland:

 

1. Parathormone

2. Adrenaline

3. Noradrenaline

4. Calcitonin

5. Ergosterol

 

43-[ ] Which of the following when present, would result in shrinkage of the osteoclast:

 

1. Calcitonin

2. Parathormone

3. Prednisolone

4. Isoniazid

5. Methotrexate

 

44-[ ] PTHrP (parathormone related protein) is produced mainly in:

 

1. The liver

2. The kidney

3. The tumor

4. The Lung

5. The parathyroid gland

 

45-[ ] Fibroblast Growth Factor 23 (FGF23) is the principal phosphaturic hormone and is produced by:

 

1. The osteoblast

2. The osteocyte

3. The osteoclast

4. The mesenchymal cells

5. The fibroblast

46-[ ] The principal actions of FGF23 are:

 

1. To inhibit sodium dependent phosphate reabsorption and 1-a-hydroxylase activity in the proximal tubule of the kidney

2. To promote calcium excretion in the distal convoluted tubule

3. To inhibit the production of 25-hydroxylase in the kidney

4. To allow deposition of calcium on the surface of bone

5. To release nonorganic minerals in the extracellular fluid 47-[ ] Low-turnover osteoporosis is characterized most by:

 

1. Diminished osteoclastic activity

2. Diminished osteoclastic and osteoblastic activity

3. Diminished osteoblastic activity

4. Increased osteoblastic activity

5. Increased osteoclastic activity

 

48-[ ] Umbo Zonen occurring on the concave side of a deformed tibia in an adult is indicative of which of the following conditions:

 

1. Rickets

2. Vitamin D resistant rickets

3. Osteomalascia

4. Osteoporosis

5. Myeloma

 

49-[ ] Flaring of the wrist (clubbing) with widening of the physis is indicative of:

 

1. Rickets

2. Osteomalascia

3. Multiple epiphyseal dysplasia

4. Gaucher’s disease

5. Hyperthyroidism

 

50-[ ] All the following have been elicited as causes of rickets except:

 

1. Deficiency states (vitamin D, calcium, and phosphorus)

2. Gastrointestinal causes

3. Hyperthyroidism

4. Genetic disorders

5. Renal tubular causes

51-[ ] Phosphorous deficiency rickets is associated with the intake of which of the following medications:

1. Estrogen

2. Aluminium hydroxide

3. Heparin

4. Diuretics

5. Nonsteroidal anti-inflammatory medications

 

52-[ ] Which of the following has been associated with myopathy in osteomalascia:

1. 1 hydroxylase deficiency

2. 25 hydroxylase deficiency

3. Bicarbonate deficiency

4. Deficiency ATP

5. LDH deficiency

53-[ ] The most probable explanation for patients to have gastric rickets is:

1. Decreased gastric acidity

2. Increased acid secretion by the chief cells

3. A drop in liver enzymes

4. Lack of pancreatic enzymes

5. Excessive chelating substances interfering with absorption of vitamin D

 

54-[ ] The basic cause of biliary rickets is:

1. Failure of carbohydrate production

2. Failure of protein production

3. Decreased availability of ergosterol in the diet

4. Decreased production of biliary salts

5. Excessive chelating agents in the diet

 

55-[ ] All the following conditions are causes of enteric rickets except:

1. Celiac disease

2. Crohn’s disease

3. Short loop bowel

4. Gardener’s syndrome

5. Tropical sprue

56-[ ] Type I vitamin D-dependent rickets is related to:

1. Excessive extracellular calcitonin

2. Poor intake of viatamin D in the diet

3. Deficiency of 25 hydroxy vitamin D in the circulation

4. Poor exposure to sunlight

5. 1-alpha hydroxylase deficiency

57-[ ] When rickets is associated with Albright’s syndrome (X-linked dominant condition) is due to:

1. Diminished tubular resorption of phosphate

2. Increased tubular excretion of calcium

3. Decreased active absorption of calcium through the duodenum

4. Failure of bile salts to emulsify fats in the intestines

5. Excessive alkalinity of the gastric secretions

 

58-[ ] The Fanconi syndrome when it first presents in adults is most liked caused by:

1. Gastrectomy

2. Duodenal resection

3. Jejunal resection

4. Myeloma

5. Crohn’s disease

 

59-[ ] All the following have been associated with Fanconi syndrome, except:

1. Hyperchloremic rickets

2. Hyponatremia

3. Hypokalemic acidosis with alkaline urine

4. A notable loss of fixed base including calcium ion

5. Excessive bile salt excretion

 

60- [ ] Oncogenic osteomalascia is associated with:

1. Decreased Calcium absorption from the intestine

2. Phosphate wasting from the kidney

3. Increased calcitonin in the circulation

4. Increased parathyroid gland activity

5. Apoptosis of the osteoclast

 

61-[ ] All the following tumors have been associated with osteomalascia except:

1. Neurofibroma

2. Fibrous dysplasia

3. Primary malignant lung tumors

4. Chondroblastoma like lesions

5. Renal cell carcinoma

 

62-[ ] FGF23 produced by primary malignant tumors known to be associated with osteomalascia, results from:

1. The lowering of serum calcium

2. The lowering of serum phosphate

3. Drop in the level of dihandrenesterone levels in the skin

4. A drop in the production of bile salts in the liver

5. Interference with the active transport of calcium through the duodenal mucosal cells

 

63-[ ] Chronic anticonvulsant therapy leading to osteomalascia, is believed to be due to all the following, except:

1. Stimulates the over production of vitamin D

2. Have direct effects on bone cells

3. Promotes resistance to PTH

4. Inhibits calcitonin secretion

5. Impairs calcium absorption

 

64-[ ] A 3 year old boy following a minor fall and on plain xrays of the wrist, was noted to have pelkan spurs, Wimburger’s line and a Fraenkel line. Your most likely diagnosis would be:

1. Leukemia

2. Scurvy

3. Rickets

4. Hyperparathyroidism

5. Pseudo-pseudo hypoparathyroidism

 

65-[ ] A significant difference between balloon kyphoplasty and vertebroplasty is that:

1. A douphy cement is used in kyphoplasty rather than a liquid cement

2. Immobilization of an unstable fracture is more with a vertebroplasty

3. Kyphoplasty results in more trabecular fixation than in a vertebroplasty

4. Kyphoplasty results in more sensory nerve necrosis then in a vertebroplasty

5. Vertobroplasty results in more correction of spinal deformity

66-[ ] Absolute contraindications to both kyphoplasty and vertebroplasty include all except:

1. Coagulation disorders

2. Local infection in the proposed site of access

3. Neoplasms with involvement of the posterior vertebral wall

4. Recent compression fractures of the vertebral body

5. Complete vertebral body collapse

67-[ ] The extrapedicular approach in kyphoplasty is most commonly used at the:

1. Lower thoracic region

2. Mid-thoracic region

3. Upper lumbar region

4. Mid-lumbar region

5. Lower lumbar region

68-[ ] A 4ST (hamstring graft is estimated to be equivalent in strength to a normal ACL (in percent):

 

1. 100%

2. 120%

3. 160%

4. 280%

5. 320%

69-[ ] In which of the following injuries mechanoreceptor function is lost:

1. Osteochondritis dessicans of the medial condyle

2. Osteochondritis dessicans of the lateral condyle

3. ACL injuries

4. Medial meniscus injury

5. Lateral meniscus injury

70-[ ] Which of the following cancers metastasize least to bone:

1. Breast

2. Lungs

3. Adrenals

4. Prostate

5. Thyroid

71-[ ] Which of the following lesions in bone would benefit most from embolization:

1. Breast

2. Lungs

3. Renal

4. Prostate

5. Thyroid

72-[ ] Which of the following cancerous primary sites, is known to be associated with acro-metastases:

1. Breast

2. Lungs

3. Heart

4. Prostate

5. Thyroid

   73-[ ] Which of the following malignancies can present with the radiologic appearance of an ivory vertebra:

   1. Chondrosarcoma

   2. Breast

   3. myeloma

   4. Renal

   5. Thyroid

74-[ ] Which of the following conditions is associated with resorption of the tufts of the distal phalanges of the hand:

1. Hyperparathyroidism

2. Hyperthyroidism

3. Hypertrophy of the adrenal cortex

4. Adenomas of the testicles

5. Hirchsprungs disease

75-[ ] Osteosarcoma of the sacrum in a 60 year old man is most probably secondary to:

1. An osteochondroma

2. Paget’s disease

3. Hyperparathyroidism

4. Fibrous dysplasia

5. Bone infarct

76-[ ] When Ewing Sarcoma presents as a solitary lesion in the spine, it is most commonly located in the:

1. Cervical spine

2. Thoracic spine lumbar spine

3. Lumbar spine

4. Sacrum

5. Coccyx

77-[ ] In which of the spine sections does Ewings sarcoma (When present) have the worse prognosis:

1. Cervical spine

2. Thoracic spine lumbar spine

3. Lumbar spine

4. Sacrum

5. Coccyx

78-[ ] In infants younger than four months old, when clinical suspicion of DDH exists, the best radio-imaging used to assist in the diagnosis, would be:

1. MRI

2. CT scans

3. Ultrasound

4. Plain xrays

5. Scintigraphy

79-[ ] All the following are considered risk factors for DDH, except:

1. Female gender

2. First degree relative with DDH

3. Premature birth

4. Delayed skeletal maturity

5. Breech presentation

80-[ ] The incidence of club foot deformity is increased four times in which of the following:

1. Amniocentesis

2. Premature births

3. Breech delivery

4. Male sex

5. Primigravidas

81-[ ] Which of the following radio-imaging techniques is most useful to confirm reduction of DDH while in a hip spica:

1. MRI

2. Ultrasound

3. CT scan

4. Plain xrays

5. Scintigraphy

82-[ ] Indicate which of the following facets is the largest in the foot and is the major weight-bearing surface of the subtalar joint:

1. The anterior facet

2. Middle facet

3. Sustenticulum tali

4. The posterior facet

5. The os trigonum

83-[ ] Lateral ligamentous support of the subtalar joint arises from all, except:

1. The lateral talocalcaneal ligament

2. The posterior talocalcaneal ligament

3. The lateral aspect of the inferior extensor retinaculum

4. The spring ligament

5. The calcaneofibular ligament

84-[ ] On comparing pediatric spines less than 8 years of age, to those in adults, certain differences are noted which include all, except:

1. Pediatric spines have greater ligamentous flexibility and elasticity

2. Pediatric spines have shallower and more horizontal facets

3. The artery of Adamkiewicz is more prominent and has more blood flow to the spinal cord

4. Pediatric spines have relative paraspinal muscle immaturity

5. The nucleus pulposus in children has greater water content and a lesser amount of collagen cross-linking than does that in adults, providing more elasticity and a greater ability to dissipate force

85-[ ] The spinal cord ends at what level in newborns:

1. L1

2. L2

3. L3

4. L4

5. L5

86-[ ] In distraction injuries of the spine in children, the deforming tension force is commonly translated through which portion of the vertebra:

1. The physeal cartilage of the maturing vertebral body

2. The spinous processes

3. The interspinous ligament

4. The nucleus pulposus

5. The mid aspect of the vertebral body

87-[ ] The accepted explanation why children have a higher incidence of abdominal injuries following thoracolumbar distraction injuries, would be:

1. Younger patients have less protection from overlying muscles, and underdeveloped iliac crests

2. The vital structures are located at lower levels within the abdominal cavity

3. The liver and spleen are more superficial

4. The position of the seat belt though properly adjusted does not provide sufficient protection

5. The forces when applied to the abdomen in children are usually more severe than in adults

88-[ ] One of the following statements, does not stand as an advantage of a percutaneous biopsy:

1. Are optimal for initial sampling of lesions in anatomically inaccessible areas such as the spine or pelvis

2. They cause little soft tissue contamination

3. They require little or no anesthesia

4. They are frequently performed under CT scan or ultrasound guidance

5. It provides only a small amount of tissue for the pathologist to review

 

89-[ ] All the following are contraindications to limb salvage procedures, except:

 

1. Inability to achieve wide surgical margins

2. Invasion of major neurovascular structures

3. Pathologic fractures where the risk of recurrence increases several folds

4. Involvement or contamination of multiple compartments with extensive muscle involvement

5. Patients with extensive skin involvement

 

90-[ ] With the advent of neoadjuvant chemotherapy and advances in radiation therapy techniques, the 5-year survival rate of osteosarcoma has improved to:

 

1. 80%

2. 60–70%

3. 40-50%

4. 20-30%

5. 15%

 

91-[ ] The primary stabilizer of the elbow is:

 

1. The radial head

2. The olecranon process

3. The coronoid fossa

4. The coronoid process

5. The olecranon fossa

 

92-[ ] The primary constraint to valgus stress at the elbow joint is:

 

1. The anterior bundle of the medial collateral ligament

2. The lateral collateral ligament

3. The common origin of the flexor tendons of the elbow

4. The pronator teres tendon

5. The annular ligament

 

93-[ ] The secondary stabilizer against valgus stress of the elbow:

1. The medial collateral ligament

2. The radial head

3. The capitellum

4. The anterior bundle of the ulnar collateral ligament

5. The sigmoid fossa

 

94-[ ] The radial head articulates medially with:

 

1. The greater sigmoid notch

2. The lesser sigmoid notch

3. The capitellum

4. The coronoid fossa

5. The olecranon fossa

95-[ ] The proximal dorsal angulation located nearly 5 cm distal to the tip of the olecranon measures:

1. 10 degrees

2. 12 degrees

3. 8 degrees

4. 6 degrees

5. 3 degrees

96-[ ] The anterior band of the medial collateral ligament inserts on:

1. The tip of the coronoid process

2. The body of the coronoid process

3. The anteromedial facet of the coronoid process

4. The sublime tubercle

5. The anterolateral facet of the coronoid process

97-[ ] The structure that inserts on the crista supinatoris on the lateral proximal ulna at the point where the supinator crest blends with the radial notch would be:

1. The lateral ulnar collateral ligament

2. The brachialis muscle

3. The biceps tendon

4. The anterior bundle of the medial collateral ligament

5. The anconeus muscle

98-[ ] An isolated coronoid tip fracture seen on an otherwise normal radiograph is suggestive of:

1. Rupture of the anterior band of the medial collateral ligament

2. A dislocation or subluxation injury of the elbow that spontaneously reduced

3. Avulsion of the brachialis tendon

4. Avulsion of the biceps tendon insertion

5. An impaction of the coronoid process within the coronoid fossa

99-[ ] The terrible triad injury of the elbow results from a valgus with additional posterolateral force and consists of a combination of:

1. A coronoid fracture, radial head fracture, and dislocation of the elbow, resulting in collateral ligament injury

2. A olecranon, radial head and capitellum fracture

3. A lateral condylar, radial head and medial collateral ligament avulsion

4. Posterior elbow dislocation, capetellum and radial head fracture

5. Radio-ulnar dislocation, radial head and capitellar fracture

100-[ ] When a giant cell tumor arises in children, its primary site of location would be in the:

1. Epiphysis

2. physis

3. Metaphysis

4. Diaphysis

5. Intra-articular

101-[ ] Which of the following lesions does not occur in the epiphysis of long bones:

1. Chondroblastoma

2. intraosseous ganglia

3. Clear cell chondrosarcoma

4. Multiple myeloma

5. Giant cell tumor

102-[ ] Which of the following lesions on MRI does not have fluid-fluid levels:

1. GCT of bone

2. Aneurysmal bone cyst

3. Telangiectatic osteosarcoma

4. Fibrosarcoma of bone

5. Unicameral bone cyst

103-[ ] The lesion in the plain x-ray below, is suggestive of which of the following conditions:

 

 

 

 

1. Osteoid osteoma

2. Bone island

3. Osteoblastoma

4. Nonossifying fibroma

5. Chondroma

104-[ ] What is the most likely diagnosis in the x-ray below:

 

 

 

1. Osteoid osteoma

2. Bone island

3. Osteoblastoma

4. Nonossifying fibroma

5. Chondroma

105-[ ] A15 year old boy presents to your clinic with an x-ray revealing an irregularity in the posteromedial aspect of the distal metaphysis of the femur. The most likely diagnosis would be:

 

 

 

 

1. Parosteal osteosarcoma

2. Osteochondroma

3. Periosteal desmoid

4. Periosteal chondroma

5. Periosteal osteosarcoma

106-[ ] The x-ray below is that of the tibia of an adolescent boy. What is your most likely diagnosis:

1. Nonossifying fibroma

2. Osteofibrous dysplasia

3. Fibrous dysplasia

4. Adamantinoma

5. Fibrous-cortical defect

107-[ ] A seventeen year old male complained of severe neck pain localized to the posterior mid-aspect of the neck. A plain xray of the cervical spine was taken, and a lateral view is shown below. Your most likely diagnosis, would be:

 

 

 

 

1. Osteomyelitis

2. Osteoblastoma

3. Heterotopic ossification

4. Osteoid osteoma

5. Eosinophilic granuloma

108-[ ] A 13 year old girl presents with shoulder pain and limitation of all ranges of motion. A plain xray is shown below. What is your diagnosis:

 

 

 

 

1. Aneurysmal bone cyst

2. Chondroblastoma

3. Unicameral bone cyst

4. Giant cell tumor

5. Subacute osteomyelitis

109-[ ] Which of the following lesions is the counterpart of a chondroblastoma in adults:

1. Eosinophilic granuloma

2. Subacute osteomyelitis

3. Clear cell chondrosarcoma

4. Chondromyxoid fibroma

5. Telangiectatic osteosarcoma

110-[ ] Malignant fibrous histiocytoma of bone is known to occur secondary to all the following lesions, except:

1. Bone infarcts

2. Radiation

3. Pagets disease

4. Enchondromas

5. Giant cell tumor

111-[ ] Which of the following types of osteosarcoma has a microscopic picture that resembles a Ewings Sarcoma:

1. Parosteal osteosarcoma

2. Small cell osteosarcoma

3. Periosteal osteosarcoma

4. Didiferentiated osteosarcoma

5. Conventional osteosarcoma

112-[ ] All the following conditions can lead to chondrocalcinosis EXCEPT:

1. Hyperparathyroidism

2. Hemochromatosis

3. Hypomagnesemia

4. Hyperthyroidism

5. Ochronosis

113-[ ] Which of the following conditions leads to overgrowth of the epiphysis around a joint:

1. Hemophilia

2. Gout

3. Chondrocalcinosis

4. Ochronosis

5. Gauchers disease

114-[ ] A deficiency of homogentesic acid oxidase has been associated with which of the conditions, leading to joint involvement:

 

1. Hyperparathyroidism

2. Hemochromatosis

3. Hypomagnesemia

4. Hyperthyroidism

5. Ochronosis

 

115-[ ] A synovial arthropathy caused by an antigen-antibody reaction, or a state of hypersensitivity, resulting in an inflammatory process. Thus producing an antibody in the lymph nodes leading to an antigen antibody reaction in joints, is known as:

 

1. Tuberculous arthritidis

2. Hypomagnesemia

3. Gauchers disease

4. Rheumatoid arthritis

5. Ochronosis

116[ ] Which of the following, is a collagenase and is known to destroy cartilage:

 

1. TNF-alpha

2. IL1

3. IL6

4. Matrix metalloproteinase

5. Oncostatin M

117- [ ] A condition which is most often associated with sacroiliatis is:

1. Rheumatoid arthritis

2. Osteitis condensens ilia

3. Psoriatic spondyloarthritidis

4. Typhoid fever

5. Syphilis

118-[ ] The lesions shown in the x-ray below, are typical of which of the following conditions:

 

 

 

1. Hemochromatosis

2. Rheumatoiditis

3. Ochronosis

4. Hemophilia

5. Chondrocalcinosis

 

119-[ ] Which, other condition shows widening of the intercondylar notch of the knee, besides hemophilia?

1. Juvenile rheumatoid arthritis

2. Hemochromatosis

3. Ochronosis

4. Chondrocalcinosis

5. Thalassemia

 

120-[ ] An arthritidis known to occur in children and involve multiple organs, with systemic manifestations including fever and multiple lymphadenopathy, would be:

1. Psoriasis

2. Reiter’s syndrome

3. Eosinophilic granuloma

4. Still’s disease

5. Crohn’s disease

121-[ ] The organism, that is most commonly found in septic arthritis, in the young sexually active individual, would be:

1. Pseudomonous

2. Ecoli

3. Neisseria ghonorrea

4. Streptococci

5. Staphylococci

122-[ ] The organism that results in Lyme’s disease is:

1. Pseudomonous

2. Ecoli

3. Neisseria ghonorrea

4. Borrelia burgdorferi

5. Streptococci

123-[ ] On pathologic examination of the synovium of the knee joint , one notices: slender, long, needle like, and negatively birefringent structures. This is indicative of which of the following conditions:

 

1. Chondrocalcinosis

2. Gout

3. Calcium pyrophosphate deposition disease

4. Serronegative arthritidis

5. Ochronosis

 

124-[ ] Gouty arthritis of the first metatarsophalangeal joint of the foot is known as:

 

1. Morton’s arthritis

2. Podagra

3. Friebergs disease

4. Kohlers disease

5. Hallux rigidus

 

125-[ ] Arthritis mutilans with severe opera glass hand deformity (“main en lorgnette”) is known to occur in which of the following conditions:

 

1. Psoriasis

2. Crohn’s disease

3. Ulcerative colitis

4. Reiter’s syndrome

5. Whipple’s disease

126-[ ] Reactive arthritis occurs more commonly in young adults (20–40 years) with a male predominance and is strongly associated with:

 

1. HLA B-27

2. HLA B-24

3. HLA B-14

4. HLA B-4

5. HLA B-6

 

127-[ ] Which of the following arthropathies is the result of lack proprioception and deep sensation in the joint:

 

1. Rheumatoid arthritis

2. Psoriasis

3. Charcot arthropathy

4. Chondrocalcinosis

5. Gouty arthropathy

    

   128-[ ] Which of the following arthropathies results in maximum destruction of the joint:

    

   1. Rheumatoid arthritis

   2. Psoriasis

   3. Charcot arthropathy

   4. Chondrocalcinosis

   5. Gouty arthropathy

 

129-[ ] An arthrotididis that has one of its features squaring of the vertebral body, would be:

 

1. Rheumatoid spondylitis

2. Bechterews spondylitis

3. Ankylosing spondylitis

4. Psoriatic spondylitis

5. Tuberculous spondylitis

 

130-[ ] Which of the following conditions presents with cysts on either or both sides of the joint:

 

1. Villonodular synovitis

2. Hemangioma

3. Intra-articular lipomas

4. Chondrocalcinosis

5. Scurvy

 

131-[ ] All the following are well demonstrated by a pelvic inlet radiographic view except:

1. S1 body

2. Sacral ala

3. Posterior displacement

4. Vertical plane rotation

5. Anterior ring morphology

 

132-[ ] Which of the following structures is not well demonstrated by the Judet oblique views:

1. Acetabular fractures

2. Ramus morphology and displacement

3. Iliac fractures

4. Horizontal plane rotation

5. Sciatic notch

 

133-[ ] The structure that provides stability and behaves as a shock absorber in the spine would be:

1. The intervertebral disc

2. The annulus fibrosus

3. The anterior longitudinal ligament

4. The posterior longitudinal ligament

5. The ligamentum flavum

 

134-[ ] Vertebra prominens identifies which vertebra:

 

1. C2

2. C5

3. C7

4. T6

5. T12

135-[ ] A deformity in the spine that includes sagittal, lateral and rotational deviation from the normal, is known to be:

 

1. Scoliosis

2. Lordosis

3. Kyphosis

4. Spondylosis

5. Spondyloptosis

 

136-[ ] The thyroid cartilage is at what level:

 

1. C2

2. C3

3. C4

4. C5

5. C6

 

137-[ ] The tubercles of Chassaignac are known to be at what level in the cervical spine:

 

1. C2

2. C3

3. C4

4. C5

5. C6

 

138-[ ] All the following nerves may be injured following an acetabular fracture, Except:

1. Sciatic

2. Posterior tibial nerve

3. Femoral

4. Obturotor

5. Superior gluteal nerve

 

139-[ ] Which of the following arteries is most likely and rarely injured, following an acetabular fracture:

1. Corona mortis

2. External iliac artery

3. Superior gluteal artery

4. Internal iliac artery

5. Femoral artery

 

140-[ ] Which of the following acteabular fractures needs prompt reduction:

1. Anterior wall fractures

2. Posterior wall fractures involving more than 40% of the articulation

3. Fractures of the quadrilateral plate with medial displacement

4. Transverse fractures of the acetabulum

5. Fracture involving the iliopubic column

 

141-[ ] Why is it most important to apply traction in an unstable fracture of the acetabulum:

1. To prevent further damage to the joint

2. To prevent neurologic injury

3. To prevent osteonecrosis

4. To prevent vascular injury

5. To prevent further bleeding

 

142-[ ] Which of the following types of acetabular fractures can be operated on, with minimal blood loss, in the acute phase:

1. Posterior wall fractures

2. Anterior wall fractures

3. Transverse fracture

4. Anterior column fracture

5. Posterior column fractures

 

143-[ ] Which of the following measurements can be used to evaluate, a stable and congruous relationship between the femoral head and acetabulum:

1. Shenton’s line

2. Acetabular index

3. Roof arc measurement

4. CE angle

5. Tear drop position

 

144-[ ] The Roof Arc angle is measured on:

1. The anterior posterior view of the pelvis in neutral position

2. The obturator view alone

3. The iliac view alone

4. The combined anterior-posterior, obturator and iliac views

5. The pelvic inlet view

145-[ ] An angle created by a vertical line through the center of the femoral head and a second line between the center of the femoral head and to the fracture location at the articular surface, on each standard view, is known as the:

1. Subchondral arc angle

2. CE angle

3. Roof arc angle

4. Acetabular index

5. Shenton’s angle

 

146-[ ] Which of the following acetabular fractures may be considered for non-surgical management in the presence of secondary congruence, between the acetabulum and femoral head:

1. Both column fractures

2. Anterior column fractures

3. Posterior column fractures

4. High trans-tectoral fractures

5. Fractures of the quadrilateral plate

 

147-[ ] The best approach in evaluating hip instability following a fracture of the posterior wall of the acetabulum, would be by:

1. Taking a true anterior-posterior view of the acetabulum

2. A bi-dimensional CT scan of the acetabulum

3. Examination under anesthesia and fluoroscopic control

4. Judet views of the acetabulum

5. Inlet views of the pelvis

 

148-[ ] Listed below are all the approaches used to reduce fractures of the acetabulum. Which of these, allow direct access to all aspects of the acetabulum:

1. Kocher-Langenbeck

2. Ilio-inguinal

3. Iliofemoral

4. Stoppas approach

5. Extended iliofemoral approach

 

149-[ ] Instead of using the Kocher-Langenback approach which may risk the nerve supply to the anterior portion of the gluteus maximus, where one splits the gluteus maximus at the junction with the tensor fascia lata. This approach is known as:

1. The Gibson approach

2. Smith Peterson approach

3. Stoppa’s approach

4. The Steel approach

5. The Watson-Jones approach

 

150-[ ] A trochanteric-flip approach is used best to visualize which portion of the acetabulum on reducing a fracture:

1. Posterior wall

2. Anterior-superior wall

3. Anterior wall

4. Transverse fracture of the acetabulum

5. Inferior tectorial fractures

 

151-[ ] An alternative to the ilioinguinal approach being intra-pelvic, would be:

 

1. Trochanteric-flip

2. Extended iliofemoral

3. Iliofemoral

4. Stoppa’s

5. Langen-beck….approach

    

   152-[ ] Which of the following approaches of the acetabulum offer, improved exposure of the quadrilateral surface and posterior column and allow buttressing of the quadrilateral surface:

   1. Trochanteric-flip

   2. Extended iliofemoral

   3. Iliofemoral

   4. Stoppa’s

   5. Langen-beck….approach

 

153-[ ] Disruption of the transverse ligament of the atlas in adults occurs when the atlanto-dens interval is greater than:

1. 2mm

2. 4mm

3. 5mm

4. 7mm

5. 10mm

154-[ ] The muscle associated with avulsion of the anterior tubercle of the atlas, would be:

1. Multifidus

2. Semispinalis

3. Longus colli

4. Spinal accessory

5. Interspinous

 

155-[ ] Which of the following conditions is associated least, with the development of degenerative arthrosis of the hip, with time:

1. Congenital deformities

2. Acquired deformities

3. Meyers dysplasia

4. Trauma

5. Osteonecrosis

 

156-[ ] Which of the following conditions is associated with impingement of the femoral neck with and anterior acetabular rim:

1. Anterior crossover of the anterior rim of the acetabulum

2. Meyers dydplasia

3. Sickle cell disease

4. Coxa vara

5. Arthritis

 

157-[ ] Labral shearing and cartilage degeneration may occur in all the following activities as result of abnormal hip mechanics, except:

1. Martial arts

2. Ballet

3. Gymnastics

4. Swimming

5. TV seated positions

 

158-[ ] A deformity that features a bony prominence at the femoral head neck junction, is known as a:

1. Cam

2. Pincer

3. Combined pincer and Cam

4. Rose thorn sign

5. Spur

 

159-[ ] A pincer type of impingement occurs least in which of the following conditions:

1. Protrusion acetabulae

2. Coxa Profunda

3. Marfans syndrome

4. Centrally displaced fractures of the quadrilateral plate of the acetabulum

5. Slipped capital femoral epiphysis

 

160-[ ] An anterior impingement test includes, all of the following range of motion, except:

1. Flexion

2. Adduction

3. Internal rotation

4. Abduction

5. Adduction and internal rotation

 

161-[ ] Pincer impingement is associated with all the following radiographic signs radiographic signs except:

1. A lateral center-edge (LCE) angle of more than 40°

2. An acetabular index (AI) less than 0°

3. A positive tear drop sign

4. A positive crossover sign

5. A positive posterior wall sign

 

162-[ ] Coxa profunda is:

1. When the floor of the fossa acetabuli touches the ilioischial line

2. When the femoral head overlaps the ilioischial spine medially

3. When the epiphysis of the head protrudes laterally out of the circle around the head

4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

   163-[ ] Protrusio acetabulum is:

   1. When the floor of the fossa acetabuli touches the ilioischial line

   2. When the femoral head overlaps the ilioischial spine medially

   3. When the epiphysis of the head protrudes laterally out of the circle around the head

   4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

   5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

164-[ ] A pistol grip sign is:

1. When the floor of the fossa acetabuli touches the ilioischial line

2. When the femoral head overlaps the ilioischial spine medially

3. When the epiphysis of the head protrudes laterally out of the circle around the head

4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

   165-[ ] A double contour sign is:

   1. When the floor of the fossa acetabuli touches the ilioischial line

   2. When the femoral head overlaps the ilioischial spine medially

   3. When the epiphysis of the head protrudes laterally out of the circle around the head

   4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

   5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

 

166-[ ] The Bernese periacetabular osteotomy is indicated in all except:

1. Patients younger than 35 years

2. Round femoral heads

3. Intact articular cartilage as demonstrated on MRI

4. Crowe I dysplastic hips

5. On plain radiographs reveal a Tonnis grade 0 and I

 

167-[ ] Which of the alternative arthroplasty surfacing procedures has been associated with pseudotumor and ALVAL:

1. Metal on metal

2. Metal on ceramic

3. Ceramic on ceramic

4. Metal on highly cross-linked polyethylene

5. Metal on ultra-high molecular weight polyethylene

 

168-[ ] Patients with a THA, elevated serum ion levels greater than 5ug/liter were associated with a higher incidence of:

1. Aseptic loosening

2. Septic loosening

3. Pseudotumors

4. Squeaking

5. Dislocation

169-[ ] The most common position of the head in congenital muscular torticollis would be:

 

1. Tilts toward and rotates away from the side of the involved stercleidomastoid muscle

2. Tilts away and rotates away from the side of the involved stercleidomastoid muscle

3. Tilts toward and rotates toward the side of the involved stercleidomastoid muscle

4. Tilts away and rotates toward from the side of the involved stercleidomastoid muscle

5. The head only tilts toward the involved sternocleidomastoid muscle

170-[ ] Plagiocephaly is known to occur in which of the following conditions:

1. Charcot Marie Tooth disease

2. Congenital insensitivity to pain

3. Congenital muscular torticollis

4. Marfans syndrome

5. Gardener’s syndrome

171-[ ] Which of the following conditions is most likely associated with torticollis in a child:

1. Atlanto-axial rotatory subluxation

2. Marfans syndrome

3. Ehler-Danlos syndrome

4. Rheumatoid spondylitis

5. Ankylosing spondylitis

172-[ ] The best imaging used to diagnose atlanto-axial rotatory subluxation would be:

1. MRI

2. Ultrasound

3. CT scan

4. Plain x-ray tomograms

5. Scintigraphy

173-[ ] The most common cause of heel pain for patients between 40-60 years of age would be:

1. Plantar fasciitis

2. Heel pad atrophy

3. Baxter Nerve Entrapment

4. Tarsal Tunnel syndrome

5. Stress fracture of the calcaneus

 

174-[ ] The plantar fascia is a fibrous aponeurosis that originates from the plantar medial aspect of the calcaneal tuberosity and inserts distally on the:

1. Medial cuneiform

2. Midtarsal joint

3. Inferior suface of the navicular

4. Distally on each of the proximal phalanges

5. Inferior surface of the cuboid

175-[ ] The histologic appearance of a specimen obtained from a patient with plantar fasciitis, includes all the following except:

1. Myxoid degeneration

2. Disorientation of the collagen fibers

3. Angiofibroblastic hyperplasia

4. Numerous giant cells with hemosiderin inclusions

5. Calcification

176-[ ] The site of tenderness that is most likely associated with plantar fasciitis, would be:

1. At the site of the plantar fascial insertion on the medial calcaneal tuberosity

2. Within the heel pad

3. At the medial ankle just beneath the medial malleolus

4. At the insertion of the posterior tibial tendon

5. At the insertion of the Achilles tendon on the calcaneus

177-[ ] On Cadaveric sections the calcaneal spur was found in the:

1. Plantar fascia

2. Flexor digitorum brevis origin

3. Achilles tendon insertion

4. Plantar digiti minimi

5. Abductor halluces origin

178-[ ] An MRI of the foot in a patient with plantar fasciitis most likely shows:

1. Calcification

2. Splitting of the fascia

3. Thickening of the plantar fascia

4. Erosion of the medial calcaneal tuberosity

5. Rupture of the origin of the plantar fascia

179-[ ] A factors which does not hinder the heel pad function, as a shock absorber is:

1. Loss of water

2. Loss of collagen

3. Loss of elastic tissue

4. Slim people

5. Aging

180-[ ] The Baxter entrapment syndrome is associated with:

1. Abductor Hallucis compartment syndrome

2. Flexor digitorum brevis compartment syndrome

3. Compression of the first lateral plantar nerve

4. Compression of the sural nerve

5. Quadratus plantae compartment syndrome

 

181-[ ] Which of the following condition accentuates most the Baxter nerve entrapment syndrome:

1. Plantar fasciitis

2. Plantar spur

3. Posterior tibial insufficiency syndrome

4. Heel pad atrophy

5. Stress fractures of the calcaneum

182-[ ] The second most common site for stress fractures to occur in the foot, would be:

1. Calcaneus

2. Navicular

3. Metatarsal

4. Cuboid

5. Medial cuneiform

183-[ ] Tarsal Tunnel syndrome is:

1. Entrapment of the posterior tibial tendon within the tunnel

2. Entrapment of the posterior tibial nerve

3. Entrapment of the lateral plantar nerve

4. Entrapment of the medial planter nerve

5. Entrapment of the sural nerve

184-[ ] Which of the following statements does not apply to the tarsal tunnel:

1. It is a fibro-osseous space located distal and posterior to the medial malleolus

2. Its roof is formed by the flexor retinaculum

3. The floor is formed by the medial wall of the calcaneum

4. The tendons of tibialis posterior, flexor digitorum communis and flexor hallucis longus pass through the tunnel

5. The abductor hallucis forms the medial wall

185-[ ] Which of the following statements, least apply to Tarsal Tunnel Syndrome (TTS):

1. Pes planus is one of the most common cause of TTS

2. It (TTS) is most commonly bilateral

3. Is often associated with space occupying lesions

4. Rheumatoid arthritis is a common cause

5. Occurs often in diabetics

 

186-[ ] A fifty year old male presents to your clinic complaining of pain in the left heel. He gave no history suggesting an inflammatory process nor of any other systemic disease. He stated that he was overdoing work, this last month.

On examination, he was noted to have bimanual tenderness over the body of the calcaneus. An xray was requested and is shown below. What would be the most likely diagnosis:

 

 

 

1. Heel pad atrophy

2. Tarsal Tunnel syndrome

3. Baxter entrapment syndrome

4. Calcaneal stress fracture

5. Plantar fasciitis

 

187-[ ] On not seeing an apparent lesion on plain x-ray, in a patient with heel pain, localized by bimanual pressure applied to the body of the calcaneus, what further study may help in making the diagnosis:

1. Ultrasound

2. Technetium bone scan

3. Nerve conduction study

4. CT scan

5. Rheumatoid factor

 

188-[ ] A young adult falls on his left hip and sustains a fracture of the femoral head. The fracture line passes above the femoral head fovea. This corresponds to which type, in the Pipkin classification:

1. Type I

2. Type II

3. Type III

4. Type IV

5. Type V

 

189-[ ] Which of the following primary tumors which when metastasis occurs to the spine does not respond to any form of treatment other than surgery:

1. Prostate

2. Breast

3. Lymphoma

4. Renal cell

5. Myeloma

 

190-[ ] The bare area in which one could put a plate on the Radial head and not interfere with pronation or supination would be:

1. Between the radial styloid and listers tubercle

2. Between the posterior aspect of the radial and ulnar styloid

3. Between the insertion of the extensor carpi radialis and brevis

4. At the insertion of the caudate ligament

5. Between both attachments of the annulus fibrosus

 

191-[ ] A twenty year old male is brought to the Emergency room after being hit by a car. Xrays reveal a comminuted fracture (Winquist type IV fracture of the femur.

The patient was unconscious and the team refused any Emergency surgery. You decide to put him in traction. What is often missed while doing so and should be looked for:

1. Fracture of the epsilateral tibial shaft

2. A tibial plateau fracture

3. A large hematoma

4. Epsilateral fracture of the femoral neck

5. Sciatic nerve injury

192-[ ] The angle of Gissane measures:

1. 20-35 degrees

2. 40-60 degrees

3. 60-85 degrees

4. 95-105 degrees

5. 120-140 degrees

 

193-[ ] In an open book fracture of the pelvis which of the following ligaments is commonly torn:

1. Sacro-tuberous ligament

2. Sacro-spinous ligament

3. Posterior sacroiliac ligament

4. Iliolumbar ligament

5. Intertransverse ligament

 

194-[ ] What would be your initial management of an open book fracture of the pelvis with significant hypotension:

1. Arterial embolization

2. Application of a C-clamp

3. Surgical ligation of any bleeders

4. Intra-abdominal packing and tamponad

5. Abdominal paracentesis

 

195-[ ] A strict contraindication in the management of a patient with a diastasis of the symphysis pubis following trauma, would be:

1. Urethral catheterization

2. Application of a binder

3. Arterial embolization

4. Open plating of the symphysis pubis

5. Application of a bilateral hip spica with both hips internally rotated

 

196-[ ] Which of the following, is the preferred approach used, to reduce a displaced fracture of the iliopubic arch:

1. The extended iliofemoral

2. The Mercedes

3. The ilio-inguinal

4. The Kocher –Langenbeck

5. The pfannentiel approach

197-[ ] A Mortise view is an AP view of the ankle and is taken in:

1. 30 degrees of external rotation

2. 10-15 degrees of external rotation

3. Neutral rotation

4. 15-20 degrees of internal rotation

5. Taken in an oblique position of the ankle

198-[ ] The “Fleck sign” is often seen in which of the following conditions:

1. Tibial plateau fractures

2. Tibial plafond fractures

3. Lisfranc’s fracture

4. Snow Board fractures

5. Segond’s fracture

 

199-[ ] An open fracture with a vascular injury classified by the Gustillo-Anderson classification, would be

1. Type

2. Type II

3. Type III C

4. Type IV C

5. Type V B

200-[ ] What radiologic sign, indicates vascularization in a talar neck fracture:

1. Hawkins sign

2. Yergasons sign

3. Adsons sign

4. Wilsons sign

5. Herring sign

 

201-[ ] On aspiration of synovial fluid from a painful THA joint, what should be the WBC and percent of neutrophils be, to be considered a septic periprosthetic infection?

1. >30% neutrophils with 1000 WBC/HPF

2. >40% neutrophils with 800 WBC/HPF

3. >50% neutrophils with 600 WBC/HPF

4. >60% neutrophils with 1760 WBC/HPF

5. Totally non reliable and none of the measurements stand for an infection

    

   202-[ ] Draining serosities two weeks following a primary THA indicates a definite infection and should be drained. Is this statement true or false?

   True………..

   False……….

   203-[ ] Which of the following cytokines is involved in the production of C reactive protein?

   1. Interleukin 1

   2. Interleuken 11

   3. Interleuken 6

   4. Tumor necrosis factor

   5. PGA1

 

204-[ ] Should you want to prepare one batch (pack) of cement (40gms) loaded with antibiotics. How much tobramycin and vancomycin should be added to give you give coverage for 4 months (Masri)?

1. 3.6 gms tobramycin with 1.0 gm vancomycin

2. 4 gms tobramycin with 2.0 gms vancomycin

3. 5 gms tobramycin with 1.0 gm vancomycin

4. 3.6 gm tobramycin with 5 gms vancomycin

5. 3.6 gms tobramycin with 3.6 gms vancomycin

 

205-[ ] The direct diagnosis (by detection of organism and susceptibility tests) of late infection would be by all except:

1. Aspiration

2. Biopsy

3. Leucocyte esterase

4. Sonication

5. PCR

206-[ ] The intrinsic resistance of the biofilm depends on:

1. Reduced antibiotic activity at the cellular Level

2. Thickness of the biofilm layer

3. Contents of the biofilm

4. The type of metal of the prosthesis

5. The type of infection

207-[ ] All the following are in favor of a primary TKA, Except:

1. Decreased cumulative perioperative risks

2. Decreased functional impairment

3. Decreased cost

4. Immunocompetent patients

5. Particularly when effective antibiotics are not available

208-[ ] All the following are true concerning leucocyte esterase except:

1. It is found in activated PMN (infected bodily fluids)

2. The examination pad contains a detergent that lysis the PMN and releases the leucocyte esterase and combines with a salt to create a purple color

3. Is considered one of the most accurate tests in the diagnosis of periprosthetic infection

4. It is commonly used in UTI, peritonitis etc

5. It was first described by Parvizi

 

209-[ ] The technique that involves the identification and amplification of the bacterial ribosomal 16S fragment is associated with which of the following drawback?

 

1. It does not differentiate between live and dead bacteria, and a high number of false-positive results may occur

2. I does not account for the type of infective organism

3. It requires a long interval to arrive at a diagnosis

4. It is highly associated with a negative result

5. It does not differentiate between gram negative and positive organisms

 

210-[ ] Once aspirated, the joint fluid should be sent for all the following tests, and which is least accurate:

1. Cell count

2. Neutrophil differential count

3. Culture for aerobic and anaerobic bacteria and fungi

4. Gram stain

5. Acid fast stain

211-[ ] Approximately how much of the total fluid volume of the disc is exchanged daily:

1. 0-10%

2. 11-20%

3. 21-30%

4. 31-40%

5. 41-50%

212-[ ] Which of the following statements does not stand out as a function of the spine?

1. Protects the spinal cord

2. Provides mobility to the trunk

3. Transfers loads from the head and trunk to the pelvis

4. The trabecular bone bears the least of the vertical compressive loads

5. The facet joints guide and limit intersegmental motion

213-[ ] The removal of the vertebral body cortex decreases vertebral strength by only:

1. 5%

2. 10%

3. 15%

4. 20%

5. 25%

 

214-[ ] With its dense cartilage layer, the endplate serves as a semi-permeable membrane, which prevents the loss of which of the following substances from the disc:

1. Phospholipase A

2. Water

3. Proteoglycan

4. Sodium

5. Potassium

215-[ ] The largest avascular structure in the body is:

1. The hip

2. The scaphoid

3. The intervertebral disc

4. The infantile patella

5. The sesamoid bone f.

216-[ ] The most common site for a lumbar facet cyst to occur in would be:

1. Lumbar 1-2

2. Lumbar 2-3

3. Lumbar 3-4

4. Lumbar L4-5

5. Lumbar 5-S1

    

   217-[ ] A Test used to distinguish between an iliopsoas and a rectus femoris contracture would be:

    

   1. Ganslen test

   2. Patrick test

   3. Ely test

   4. Thomas test

   5. Hoover test

218-[ ] Which of the following is not associated with a congenital anomaly of the spine:

1. Cafe’ au lait spots

2. Dimpling of skin

3. Sinus tracts

4. Fatty masses

5. Tufts of hair

219-[ ] A shuffling gait is most commonly seen in:

1. Cerebral palsy

2. Tabes dorsalis

3. Parkinson’s disease

4. Hemiplegia

5. Cervical myelopathy

220-[ ] A waddling gait is associated most often with weakness of which muscle:

1. Gluteus minimus

2. Gluteus maximus

3. Gluteus medius

4. Rectus femoris

5. Iliopsoas

221-[ ] An “Anthropoid posture” is often noted in:

1. Vascular claudication

2. Neurogenic claudication

3. Spondylolisthesis

4. Sacroiliitis

5. Depression

    

   222-[ ] On flexion of the head a patient is noted to have paresthesia in both the arms and legs. Which of the following, indicates this test?

   1. Yergason’s test

   2. Lhermitte test

   3. Spurling test

   4. Hoffman test

   5. Hoover test

223-[ ] Which of the following test does not evaluate the sacroiliac joint for pain?

1. Patrick test

2. Faber test

3. Pelvic Rock test

4. Ely test

5. Ganslen test

224-[ ] The sensory nerve supply of the lateral forearm and thumb, is from:

1. C4-5

2. C5-6

3. C6-7

4. C7-T1

5. T1-2

225-[ ] The sensory nerve supply of the little finger is from:

1. C5

2. C6

3. C7

4. C8

5. T1

 

226-[ ] Indicate which motor nerve supplies the corresponding muscles in the following figure below:

 

 

 

1………………………………………………….

2…………………………………………………..

3……………………………………………………

4……………………………………………………

5……………………………………………………..

6……………………………………………………..

 

227-[ ] The most frequent weakness on compression of C6 radiculopathy, would be:

1. Forearm supination

2. Forearm pronation

3. Wrist flexion

4. Wrist extension

5. Finger abduction

228-[ ] What is the motor nerve supply of each of these muscles?

 

 

 

1……………………………………………………………………….

2………………………………………………………………………

3………………………………………………………………………

4………………………………………………………………………..

5…………………………………………………………………………

6…………………………………………………………………………

 

229-[ ] Sciatic symptoms (low back pain radiating in the buttock, thigh, calf, and foot) that do not originate from the lumbosacral plexus would most likely be due to:

1. Inguinal herniation

2. Pyriformis syndrome

3. Lumbar disc herniation

4. Hips disease

5. Greater trochanter bursitis

 

230-[ ] What does this muscle cause, if malfunctioned?

 

 

 

1. Peripheral neuropathy

2. Antalgic gait

3. Trendlenberg gait

4. Steppage gait

5. Pyriformis syndrome

 

231-[ ] Which is the weaker muscle in the gait demonstrated in the photo below:

 

 

 

1. Hamstrings

2. Gluteus minimus

3. Gluteus medius

4. Gluteus maximus

5. sartorius

32-[ ] The test shown below, is known as:

 

 

 

1. The Nafzigger test

2. The Hoover test

3. The Beever test

4. The Openheim test

5. The Bruzinski test

233-[ ] Insert the gait pattern in the space below for each of the demonstrated photos:

 

 

 

 

1. ………………………………………………………………

2. ………………………………………………………………

3. ………………………………………………………………

4. ………………………………………………………………

5. ………………………………………………………………

234-[ ] The adductor reflex of the thigh is indicative of which nerve:

1. The obturator

2. The femoral

3. The sciatic

4. The saphenous

5. The peroneal….nerve

 

235-[ ] Which of the following tests corresponds to the Patrick test in evaluating the sacroiliac joint:

1. Hover

2. Nafzigger

3. Thomas

4. Ganslen

5. Ely…..test

236-[ ] A Faun’s beard is known to be present when the patient has:

1. A vertebral fracture

2. Spina bifida occulta

3. Spondylolisthesis

4. Scheuermann’s disease

5. Scoliosis

237-[ ] A wide based gait is often not noted in which of the following conditions:

1. Cervical myelopathy

2. Parkinson’s disease

3. Vitamin B 12 deficiency

4. Tabes dorsalis

5. Cerebellar pathology

 

238-[ ] A circumduction gait is often seen in which of the following conditions:

1. Parkinson’s disease

2. Vitamin B12 deficiency

3. Hemiplegia

4. Cerebellar pathology

5. Cervical myelopathy

239-[ ] A steppage gait is seen in which of the following condions:

1. Drop foot

2. Cervical myelopathy

3. Parkinson’s disease

4. Cerebellar pathology

5. Tabes dorsalis

 

240-[ ] Patients with advanced lumbar stenosis and neurogenic claudication tend to walk in a flexed-forward position, and is commonly referred to as:

1. The “anthropoid posture”

2. Positive sagittal balance posture

3. Shuffling posture

4. Wide based posture

5. Staggering posture

241-[ ] Splaying of adjacent spinous processes or a palpable stepoff may indicate:

1. Spondylolisthesis

2. Scheuermanns disease

3. Spinal Bifida occulta

4. Spinal stenosis

5. Spinal syndesmosis

 

242-[ ] Flexion of the cervical spine in the setting of cord compression often causes paresthesia in both the arms and legs is known as:

1. Lhermitte sign

2. Romberg sign

3. Yergasons sign

4. Adson sign

5. Lift off sign

 

243-[ ] Knee extension and ankle dorsiflexion if lost corresponds to which of the following affected root at its origin:

1. L2

2. L3

3. L4

4. L5

5. S1

 

244-[ ] Great toe extension and ankle dorsiflexion if lost corresponds to which of the following affected root at its origin:

1. L2

2. L3

3. L4

4. L5

5. S1

 

245-[ ] If sensation is lost over the lateral malleolus and lateral and plantar aspect of the foot, would correspond to which of the following affected nerve root at its origin:

1. L2

2. L3

3. L4

4. L5

5. S1

 

246-[ ] With a typical paracentral L4-5 disc herniation, the root of origin (L5) is compressed as it courses toward the undersurface of which of the following pedicles:

1. L2

2. L3

3. L4

4. L5

5. S1

 

247-[ ] A far lateral disc herniation at the level L4-5 may compress the root of exit at which level:

 

1. L2

2. L3

3. L4

4. L5

5. S1

248-[ ] The nipple line corresponds to which thoracic vertebra:

1. T1

2. T2

3. T3

4. T4

5. T5

249-[ ] The Umbilicus level corresponds to which of the following vertebra:

1. T7

2. T8

3. T9

4. T10

5. T11

250-[ ] To confirm an incomplete lesion of the spine would be by demonstrating an intact:

1. Perianal sensation

2. Periumbilical sensation

3. Nipple line sensation

4. Bulbocavernous reflex

5. Cremasteric reflex

251-[ ] Which of the following is not included in “the double crush syndrome” in the neck:

1. Median nerve compression

2. C5

3. Ulnar nerve entrapment

4. C8

5. Radial nerve entrapment

252-[ ] A metabolic disorder that results in abnormal reflexes, would be:

1. Hyperparathyroidism

2. Hypothyroidism

3. Galactosemia

4. Hurler syndrome

5. Gaucher’s disease

253-[ ] The superficial reflexes are mediated by the:

1. Cerebellum

2. Brain stem

3. cerebral cortex

4. frontal hemisphere

5. temporal hemisphere

254-[ ] The superficial cremasteric reflex is mediated by which of the following nerve roots:

1. T9-10

2. T11-12

3. L1-2

4. L3-4

5. L5-S1

255-[ ] The “anal wink” is used to assess which of the following nerves:

1. S2,3,4

2. S1-2

3. S3-4

4. S4-5

5. L5-S1

 

256-[ ] Upper motor neuron (corticospinal tract) lesions should be suspected in all the following tests except:

1. Hoffmann sign

2. Babinski sign

3. Triple response sign

4. Froment’s sign

5. Oppenheim sign

257-[ ] A foraminal closing test is performed by:

1. Hyperextending the patient’s head and rotating it toward the affected side

2. Hyperflexing the patients head and rotating it toward the affected side

3. Lateral bending of the head towards the affected side

4. Lateral bending of the head away from the affected side

5. Rotating the head towards the affected side

258-[ ] The “Spurling sign” is elicited by:

1. A rotational force applied towards the affected side

2. A rotational force applied away from the affected side

3. A distraction force in extension

4. An axial load applied by pressing down on the patients head

5. A bracing force applied to both shoulders

259-[ ] When a patient gets relief by placing the affected extremity behind the head, is known as:

 

1. The distraction sign

2. The Spurling sign

3. The shoulder abduction relief sign

4. The foraminal closing test

5. The Chaddock test

260-[ ] The Fajersztajn sign (crossed straight leg raising test is positive when the patient has:

1. A far lateral disc

2. An isthmus disc

3. A lateral recess disc

4. A large central disc

5. A large posterolateral disc

 

261-[ ] Fill out the names of the branches in the Brachial plexus below:

 

 

 

1. ………………………………………………………………………………………………

   …………………………………

2. ………………………………………………………………………………………………

   …………………………………

3. ………………………………………………………………………………………………

   …………………………………

4. ………………………………………………………………………………………………

   …………………………………

5. ………………………………………………………………………………………………

   …………………………………

6. ………………………………………………………………………………………………

   …………………………………

7. ………………………………………………………………………………………………

   …………………………………

8. ………………………………………………………………………………………………

   ………………………………….

9. ………………………………………………………………………………………………

   ………………………………….

10. ………………………………………………………………………………………………

    ………………………………….

11. ………………………………………………………………………………………………

    ………………………………….

12. ………………………………………………………………………………………………

    …………………………………..

13. ………………………………………………………………………………………………

    ………………………………….

14. ………………………………………………………………………………………………

    ………………………………….…………………………………………………………

    ……………………………………………………………………….

     

    262-[ ] Fill out the names of the sensory branches to various areas of the upper extremity from the brachial plexus:

     

     

     

    1. ………………………………………………………………………………………………

       ………………………………………………..

    2. ………………………………………………………………………………………………

       …………………………………………………

    3. ………………………………………………………………………………………………

       …………………………………………………

    4. ………………………………………………………………………………………………

       ………………………………………………….

    5. ………………………………………………………………………………………………

       ………………………………………………….

    6. ………………………………………………………………………………………………

       ………………………………....................

    7. ………………………………………………………………………………………………

       ………………………………………………….

        

       263-[ ] Indicate the neurologic level, reflex and motor supply at each level:

        

        

       1. …………………………………………………………………………………………

          …………………………………………………….

       2. …………………………………………………………………………………………

          …………………………………………………….

       3. …………………………………………………………………………………………

          …………………………………………………….

       4. …………………………………………………………………………………………

          …………………………………………………….

       5. …………………………………………………………………………………………

          …………………………………………………….

       6. …………………………………………………………………………………………

          …………………………………………………….

       7. …………………………………………………………………………………………

          …………………………………………………….

       8. …………………………………………………………………………………………

          …………………………………………………….

       9. …………………………………………………………………………………………

          …………………………………………………….

       10. …………………………………………………………………………………………

           …………………………………………………….

       11. …………………………………………………………………………………………

           …………………………………………………….

       12. …………………………………………………………………………………………

           …………………………………………………….

       13. …………………………………………………………………………………………

           …………………………………………………….

       14. …………………………………………………………………………………………

           …………………………………………………….

       15. …………………………………………………………………………………………

    …………………………………………………….

     

    64-[ ] Insert the major nerve to the region within the blocks below:

     

     

     

    1. ………………………………………………………………………………………………

       …………………………………………………

    2. ………………………………………………………………………………………………

       …………………………………………………

    3. ………………………………………………………………………………………………

       …………………………………………………

    4. ………………………………………………………………………………………………

       …………………………………………………

    5. ..……………………………………………………………………………………………

    …………………………………………………

     

    TOTAL KNEE ARTHROPLASTY

     

    265-[ ] Which is more safer to do cross a transverse incision at right angles or run a longitudinal incision to an already longitudinal incision, leaving a gap of:

    1. 1 cm between the two incisions

    2. 2 cms between the two incisions

    3. 4cms between the two incisions

    4. 5 cms between the two incisions

    5. 7cms between the two incisions

     

    266-[ ] During a total knee arthroplasty, what could possibly happen locally when the anesthesia is unstable without a complete motor block:

    1. Rupture of the patellar tendon

    2. Improper locations of cutting markers

    3. Excessive external rotation of the component to allow a proper fit of the cutting guides

    4. Inability to evert the patella

    5. Excessive bleeding

     

    267-[ ] Which of the following situations, is most feasible to have a subvastus approach while performing a Total Knee Arthroplasty?

    1. A slim individual

    2. A obese patient

    3. A stiff knee

    4. A muscular knee

    5. Revision surgery

     

    268-[ ] On resection of the articular portion of the patella in a Total Knee Arthroplasty, too much was resected resulting in a thickness less than 15mm. What could this lead most to:

    1. Recurrent dislocation

    2. Limitation of knee flexion

    3. Fracture of the patella

    4. Poor patellar tracking

    5. Hyperextension of the knee

     

    269-[ ] The problem that results from extending a posterior lumbar fusion to the sacrum, would be:

    1. Increased risk of pseudoarthrosis

    2. Decreases the surgical time

    3. Decreases the reoperations rate

    4. Decreased risk of sacral insufficiency fractures

    5. Does not alter the gait postoperatively

    270-[ ] A Smith Peterson osteotomy of the spine is best performed where:

    1. Disc degeneration exists with narrowing

    2. Limitation of motion (a rigid spine) exists

    3. The disc has adequate height and mobility

    4. In the thoracic spine

    5. More correction of the sagittal imbalance is expected to be obtained, by doing it in the thoracic spine

    271-[ ] What type of osteotomy of the spine is performed, shown in the figure below:

    1. Triple osteotomy

    2. Ponte’ osteotomy

    3. Smith Peterson Osteotomy

    4. Pedicle substraction Osteotomy

    5. Vertebral Column Resection Osteotomy

     

     

     

    272-[ ] Which of the following osteotomies of the spine provides the maximum amount of correction of a deformity

    1. Smith Peterson

    2. Pedicle Substraction

    3. Ponte”

    4. Vertebral column Resection

    5. Anterior discoidectomy

     

    273-[ ] In Brucellosis after the initial illness, which may last for several days to weeks, relapse occurs in approximately in what % of patients?

    1. 5%

    2. 15%

    3. 20%

    4. 30%

    5. 40%

    274-[ ] The Brucellar infection, originates within which portion of the vertebra

    1. The vertebral body

    2. The intervertebral disc

    3. The pedicle

    4. The facet

    5. The anterior longitudinal ligament

    275-[ ] The most common location for Brucellar infection to occur in the spine, would be:

    1. Cervical

    2. Upper thoracic

    3. Lower thoracic

    4. Lumbar

    5. Sacrum

    276-[ ] The posterior spinal arch is involved in what percent of cases of tuberculosis

    1. 5%

    2. 10%

    3. 20%

    4. 30%

    5. 40%

     

    277-[ ] Which of the following conditions is most commonly associated with caseation beneath the anterior longitudinal ligament?

    1. Brucellosis

    2. Tuberculosis

    3. Actinomycosis

    4. Schistosomiasis

    5. Coccidiodomycosis

     

    278-[ ] 1-[ ] Which of the following is most important, which when divided or resected would allow maximum seating of the femoral head within the acetabulum, following reduction of a high riding DDH:

    1. Pulvinar fat pad

    2. Hip capsule

    3. Limbus

    4. Ligamentum teres

    5. Transverse ligament

    279-[ ] The motion segment, or functional spinal unit of the spine, comprises:

    1. Two adjacent vertebrae and the intervening soft tissues

    2. Two adjacent discs and the intervening vertebra

    3. The vertebra combined with the intertransverse ligaments & nucleus pulposus

    4. The anterior and posterior longitudinal ligament together with the adkacent vertebrae

    5. The surrounding ligaments from the atlas down to the lumbosacral junction 280-[ ] The majority of vertical compressive loads on the spine is received by:

    1. The cortical bone

    2. The ligaments

    3. The surrounding muscles

    4. The disc

    5. The trabecular bone

    281-[ ] The horizontal trabeculae within the vertebral body:

    1. Bear the majority of load

    2. Stabilize the vertical trabeculae columns

    3. Are last to be removed in osteoporosis

    4. Maintain the cortical height

    5. Don’t exist within the vertebral body 282-[ ] The function of the endplate is to:

    1. Prevent extrusion of the disc into the porous vertebral body, and to evenly distribute load to the vertebral body

    2. Be the major axial load support of the spine

    3. Provide anterior and posterior stability

    4. Be the principle shock absorber of the disc

    5. Prevent nutrients from entering within the vertebral body

     

    283-[ ] Which of the following structures allows the transfer of water and solutes but prevents the loss of large proteoglycan molecules from the disc:

    1. The annulus fibrosus

    2. The nucleus pulposus

    3. The cartilage endplate

    4. The cortical bone

    5. The trabecular bone

        

       284-[ ] Which of the following structures is considered as the weak link in maintaining vertebral body integrity:

       1. The cortex

       2. The horizontal trabeculae

       3. The vertical trabeculae

       4. The endplate

       5. The nucleus pulposus

     

    285-[ ] Which of the following types of collagen is present within the deeper portion of the anulus fibrosus:

    1. Type I

    2. Type II

    3. Type III

    4. Type IV

    5. Type five….. collagen

     

    286-[ ] The stress in the anulus fibers is approximately how many times the applied stress in the nucleus:

    1. 1-2

    2. 2-3

    3. 3-4

    4. 4-5

    5. 5-6….times

    287-[ ] “Stress profilometry” is when:

    1. Loads are applied to the nucleus pulposus

    2. Loads are applied to the anulus fibrosus

    3. The shift of loads from the nucleus pulposus to the anulus fibrosus

    4. The surrounding ligaments of the vertebral body assume the function of axial support

    5. The horizontal trabeculae loose there function of compression support 288-[ ] Posterior disc bulging is greatest during:

    1. Flexion

    2. Rotation

    3. Extension

    4. Axial compression

    5. Lateral bending

     

    289-[ ] The type of collagen involved in ossification of the posterior longitudinal ligament of the cervical spine would be:

    1. Type I

    2. Type III

    3. Type VI A1

    4. Type IV B1

    5. Type V

    290-[ ] Up to 50% of Caucasian patients with OPLL also have:

    1. Diffuse idiopathic skeletal hyperostosis

    2. Pagets disease

    3. Osteopetrosis

    4. Prostate Ca

    5. Myositis ossificans

    291-[ ] The Finger Escape sign is most often associated with:

    1. Multiple sclerosis

    2. Tuberculous spondylitis

    3. Tabes dorsalis

    4. Cervical myelopathy

    5. Syringomyelia

    292-[ ] The Romberg test when positive is suggestive of:

    1. Posterior column dysfunction

    2. Anterior cord dysfunction

    3. Spinothalamic dysfunction

    4. Central cord dysfunction

    5. Brown-Sequard syndrome

    Questions on Hand & Elbow

     

    293-[ ] Which of the A pully”s of the flexor tendon sheath, lies at the level of the Metacarpophalangeal Joint:

    1. A1

    2. A2

    3. A3

    4. A4

    5. A5

    294-[ ] The lateral epicondyle is the originator of which of the following muscles:

    1. The flexor carpi ulnaris

    2. The pronator teres

    3. The digitorum profundus

    4. The brachioradialis and supinator

    5. The flexor digitorum sublimis and pronator quadratus 295-[ ] The golfer’s elbow is known to occur in the:

    1. Lateral epicondyle

    2. Medial epicondyle

    3. Medial condyle

    4. Medial epicondyle

    5. Coronoid process

    296-[ ] The biceps tendon is known to insert on the:

    1. Olecranon process

    2. Medial condyle of the humerus

    3. Listers tubercle

    4. Tuberosity of the radius

    5. Lateral epicondyle of the humerus

     

    297-[ ] Which of the following bones about the elbow is most involved with elbow instability following trauma:

    1. The coronoid process

    2. The olecranon process

    3. The lateral epicondyle

    4. The radial head

    5. Medial epicondyle

    298-[ ] The Popeye arm is known to occur in a rupture of which of the following tendons:

    1. The triceps

    2. The brachialis

    3. The biceps

    4. The brachioradialis

    5. The flexor carpi ulnaris

    299-[ ] The strongest supinator of the forearm is:

    1. The brachioradialis

    2. The biceps

    3. The extensor carpi radialis longus

    4. The extensor carpi radialis brevis

    5. The supinator

    300-[ ] Which of the following muscles is not innervated by the ulnar nerve:

    1. The flexor carpi ulnaris

    2. The hypothenar muscles

    3. The pronator quadratus

    4. The flexor digitorum profundus

    5. The lumbricals

    301-[ ] As the radial nerve divides in two parts as it reaches the elbow, which of the following is the branch that pierces the supinator muscle:

    1. The anterior interosseous

    2. Musculocutaneous

    3. The sensory branch of the radius

    4. The posterior interosseous

    5. The recurrent branch of the radial nerve

     

    302-[ ] A patient is noted to have weakness of wrist and finger extension together with pain on resisted supination and finger extension, most likely has a:

    1. Guyon tunnel syndrome

    2. Radial tunnel syndrome

    3. Carpal tunnel syndrome

    4. Anterior interosseous syndrome

    5. Supratrochlear syndrome

    303-[ ] Median nerve compression in the forearm may result from:

    1. Compression in the region of the ligament of struthers

    2. Compression at the transverse carpal ligament

    3. Compression in the region of the pisohamate ligament

    4. Compression in the region of the supinator

    5. Compression in the cubital tunnel

     

    304-[ ] Following injuries of the elbow which motion is most likely to be limited at the completion of treatment:

    1. Flexion

    2. Supination

    3. Extension

    4. Pronation

    5. Abduction

    305-[ ] The primary stabilizers of the elbow are:

    1. The medial and lateral collateral ligaments

    2. The transverse ligament

    3. The posterior bundle ligaments

    4. The anterior bundle ligaments

    5. The interosseous ligament

    306-[ ] The primary valgus stabilizer of the elbow is the:

    1. Posterior bundle of the MCL

    2. Transverse bundle of the MCL

    3. Anterior bundle of the MCL

    4. Interosseous bundle of the MCL

    5. Ulnar bundle of the MCL

    307-[ ] Name the components of the medial collateral ligaments of the elbow:

     

     

     

    1. Posterior bundle

    2. Transverse bundle

    3. Posterior head of anterior bundle

    4. Anterior head of posterior bundle

    5. Anterior head of anterior bundle

        

       308-[ ] All the following are components of the lateral collateral ligament complex of the elbow except:

       1. Radial collateral ligament

       2. Lateral ulnar collateral ligament

       3. Transverse collateral ligament

       4. Annular ligament

       5. Accessory lateral collateral ligament

    309-[ ] Insert the name of each of the following corresponding structures in blocks in the photo below:

     

     

    1. Articular capsule

    2. Lateral radial collateral ligament

    3. Annular ligament

    4. Accessory lateral collateral ligament

    5. Lateral ulnar collateral ligament

    310-[ ] The most important ligament in the lateral collateral liament of the elbow, would be:

    1. Articular capsule

    2. Lateral radial collateral ligament

    3. Annular ligament

    4. Accessory lateral collateral ligament

    5. Lateral ulnar collateral ligament

    311-[ ] Posterolateral instability of the elbow results from injury of which of the following ligaments:

    1. Articular capsule

    2. Lateral radial collateral ligament

    3. Annular ligament

    4. Accessory lateral collateral ligament

    5. Lateral ulnar collateral ligament

    312-[ ] All the following are secondary stabilizers of the elbow except:

    1. Radial head

    2. Joint capsule

    3. Coronoid process

    4. Extensor muscle origin

    5. Flexor muscle origin

    313-[ ] The most common dislocation about the elbow is:

    1. Anterior

    2. Medial

    3. Lateral

    4. Posterolateral

    5. Posterior

    314-[ ] In Baseball pitchers which of the following ligaments are at maximum strain:

    1. The medial collateral ligament

    2. The lateral collateral ligament

    3. The lateral accessory ligament

    4. The radio-ulnar interosseous ligament

    5. The annular ligament

     

    315-[ ] Which of the following structures is used as a substitute for medio-lateral ligament insufficiency of the elbow:

    1. Tensor fascia late

    2. Palmaris longus

    3. Plantaris

    4. Extensor carpi radialis longus tendon

    5. Extensor carpi radialis brevis tendon

    316-[ ] What is the test in the photograph below called:

    1. Flexion rotation test

    2. Moving valgus stress test

    3. Extension stability test

    4. Posterolateral instability test

    5. Flexion extension instability test

     

     

     

    317-[ ] Pitching at a very young age could result in:

    1. Preisers disease

    2. Kienbocks disease

    3. Panners disease

    4. Mauclaire’s disease

    5. Frieberg’s disease

     

    THE KNEE

     

    318-[ ] When multiple previous skin incisions are encountered on performing a total knee arthroplasty, it has traditionally been recommended that the most lateral incision be used. How much should be the minimal skin bridge be, between incisions to avoid postoperative skin complications… At least

    1. 5 or 6 cm

    2. 8cms

    3. 9cms

    4. 4cms

    5. 3cms

        

       319-[ ] At what ankle-brachial index should it be, to request a vascular consult, prior to a Total Knee Arthroplasty:

       1. < 0.7

       2. < 0.8

       3. < 0.9

       4. < 1.0

       5. < 1.2

     

    320-[ ] If you should decide to use a tourniquet while performing a total knee arthroplasty in an elderly patient, when would be the best time to do so:

    1. At the initiation of the procedure

    2. Intermittently as needed

    3. At the mid-aspect of the procedure

    4. When it is time to insert the prosthesis with cement

    5. At short intervals to avoid ischemia of mucle

    321-[ ] Proximal elevation of the joint line in Total Knee Arthroplasty leads to:

    1. Pseudo-patella baja

    2. Patella alta

    3. Decreased contact forces on the patella

    4. No effect on patella contact forces

    5. Medio-lateral joint instability

    322-[ ] Patellar maltracking can result from:

    1. Over resection of the distal femur

    2. Over resection of the proximal tibia

    3. A patellar bone-prosthesis construct that is thicker than the native patella

    4. Non-resurfacing of the patella

    5. Excessive resection of the patella

     

    323-[ ] The main purpose of reducing the posterior slope angle in Total Knee Arthroplasty, would be that:

    1. In posterior stabilized knee implants it prevents cam-post impingement

    2. It decreases medio-lateral instability in extension

    3. It decreases medio-lateral instability in flexion

    4. It allows more extension

    5. It promotes global stability of the knee

    324-[ ] Patients who have undergone a previous patellectomy are most likely to have least!

    1. Lose their extension strength by 20% to 70%

    2. Decreases the stability of the knee

    3. Can undergo knee replacement with the same outcome as in any other TKA

    4. Overloads the posterior cruciate ligament

    5. Should undergo TKA with a posterior stabilized knee implant

     

    325-[ ] Over-resection of the anterior condyles of the knee in a Total Knee Arthroplasty, may result in:

    1. Notching of the distal femur

    2. Maltracking of the patella

    3. Genou Recurvatum

    4. Medio-lateral instability

    5. Inequality between the extension and flexion gap

     

    326-[ ] Individuals presenting with a complete slip of one vertebra on the other are known to have a:

     

    1. Myerding II slip

    2. Petrosis

    3. Spondyloptosis

    4. Spondylitis

    5. Pseudospondylolisthesis

     

    327-[ ] Which of the following does not apply to the Wiltse’ classification of spondylolisthesis:

     

    1. dystrophy of the pedicles

    2. pathologic slips

    3. traumatic slips

    4. defects in the pars interarticularis

    5. degenerative spondylolisthesis

     

    328-[ ] Which of the following statements is least likely to provide us with an explanation, why the incidence of spondylolisthesis is less likely to occur at the lumbosacral junction, with respect to the L4-5 level:

     

    1. the iliolumbar ligaments maintain well the L5 and S1 levels

    2. the facets joints at the level of L5-S1 are more vertical and in the coronal plane, while at upper levels, are in the sagittal plane

    3. the upper and lower end plates lie in the horizontal plane at the level of L5-S1 when compared with those endplates above

    4. degenerative spondylosis is far less common at L5-S1 when compared to other levels

    5. L5-S1 interspace have a firmer fix or stability due to its position at the level of the sacroiliac joints

     

    329-[ ] A slip due to degenerative spondylolisthesis, never exceeds:

     

    a- 25%

    b- 40%

    c- 50%

    d- 75%

    e- 100%

     

    330-[ ] A mechanism or force resulting in an isthmic spondylolisthesis is most commonly in:

     

    1. hyperflexion

    2. rotation

    3. hyperextension

    4. axial compression

    5. combined rotation and flexion

     

    331-[ ] Fractures through the proximal tibial apophysis in children (age 10 years) are most commonly a:

     

    1. Salter Harris (SH) I

    2. SH II

    3. SH III

    4. SH IV

    5. SH V

     

    332-[ ] Injury of the popliteal artery or its branches, following high energy fractures about the knee, occurs most commonly in which of the following locations:

     

    1. arch of the soleus (origin)

    2. fibular neck

    3. semimembranous insertion

    4. popliteus tendon insertion

    5. musculotendinous junction of the gastrocnemius

     

    333-[ ] The mechanism of injury or force that would likely result in a proximal apophyseal injury (tibial tuberosity) in a 10 year old child would be:

     

    1. a force in extreme knee flexion

    2. a sudden abduction force

    3. a sudden hyperextension force

    4. a varus bumper injury

    5. an axial compression injury

     

    334-[ ] Traumatic dislocations of the patella have been associated with which of the following fractures of the patella:

     

    1. vertical

    2. transverse

    3. comminuted

    4. osteochondral (medial)

    5. superior lateral chip

     

    335-[ ] Plain radiography in a 13 year old girl diagnosed to have a triplane fracture of the ankle, would reveal:

     

    1. A Salter-Harris (S-H) III fracture on anterior-Posterior and SH II on lateral views

    2. A S-H II on AP and S-H III on lateral views

    3. A S-H IV on AP and S-H III on lateral views

    4. A S-H III on AP and S-H IV on lateral views

    5. A S-H II on both AP and lateral views…. Of the ankle joint

     

    336-[ ] A 50 year old woman presents to your clinic having a bilateral mass (8X10 cms in diameter) located each beneath the inferior angle of both scapulae. Each of the masses becomes more apparent on internally rotating and adducting the corresponding arm, and by doing so, she has pain. Your most likely diagnosis would be:

     

    1. Chondrosarcoma

    2. Ewings Sarcoma

    3. Breast metastasis

    4. Osteosarcoma

    5. Elastofibroma dorsi

     

    337-[ ] Following closed reduction and Hip spica application in a one year old girl, with bilateral dysplastic hips, the best imaging technique that would confirm the reduction would be:

     

    1. Hip arthrography

    2. Plain radiography

    3. CT scan

    4. MRI

    5. Plain X-ray tomograms

     

    338-[ ] Which of the following conditions is least associated with the incidence of DDH in new borns:

     

    1. primigravidas

    2. oligohydramious

    3. breech presentation

    4. osteopetrosis

    5. Congenital dislocation of the knee

     

    339-[ ] Which of the following innominate osteotomies listed below, follows the same principle as the Pemberton osteotomy, with less disturbances in growth of the tri-radiate cartilage:

     

    1. Salter

    2. Dega

    3. Ganz

    4. Howard Steel

    5. Dejour….osteotomy

     

    340-[ ] While performing an open reduction in a child with DDH, on exposing the acetabulum you note that the limbus is inverted and in the way of your reduction. Your next step would be, to:

     

    1. excise the limbus

    2. evert the limbus

    3. make circumferential radial parallel cuts in the limbus

    4. ignore it

    5. excise only a portion of the limbus, just enough to allow a successful reduction

     

    341-[ ] In a child aged 3 years with a unilateral high riding DDH, your best approach in management would be:

     

    1. skeletal traction followed by open reduction and capsulorrhaphy, spica application

    2. adductor tenotomy, skeletal traction, followed by closed reduction and spica cast application

    3. Gradual bilateral traction on a Bradform frame, followed by abduction of the hip and internal rotation till the hip is reduced, followed by a bilateral hip spica in abduction and full internal rotation (the stable position)

    4. Adductor tenotomy, open reduction, Salter osteotomy, capsulorraphy, subtrochanteric osteotomy with sufficient shortening and derotation if necessary with hip spica application in the human position

    5. Adductor tenotomy, open reduction and Salter osteotomy

     

    342-[ ] Which of the following is a dynamic hareness used for reduction of a DDH, before the age of eight months:

     

    1. a Craig device

    2. a Ponseti device

    3. a Pavlik device

    4. a Atlanta device

    5. a Von Rosen device

     

    343-[ ] In a newborn with a moderate club foot deformity, which of the following deformities should be corrected last:

     

    1. forefoot adduction

    2. forefoot equinus

    3. ankle equinus

    4. heel varus

    5. medial deviation of the navicular and toes

     

    344-[ ] A child presents to your clinic at the age of four months with the diagnosis of unilateral DDH. At this stage which of the following tests on examination is likely be present:

     

    1. a positive Barlow test

    2. a positive Ortoloni test

    3. limitation of abduction of the involved hip

    4. widening of the perineum

    5. a positive Trendlenberg test

    345-[ ] Black stains have been noted on the articular surface of the alumina shell in alumina-alumina THA. These have been found to be due to:

     

    1. fissurization of the alumina bearing

    2. metal debris deposited on the alumina endbearing surfaces

    3. oxidation of the acetabular alumina component

    4. ceramic debris deposits

    5. debonding of the alumina structure

     

    346-[ ] On comparing patients while performing a TKA where the patella was everted VS when not everted, the former was associated with a:

     

    1. a higher incidence of patella baja

    2. necrosis of the patella

    3. avulsion of the patella

    4. maltracking of the patella

    5. arthrofibrosis

     

    347-[ ] A middle aged patient presenting with a well contained hemorrhage, surrounded by a pseudocapsule with no ecchymosis, most likely has a:

     

    1. hematoma

    2. sarcoma or a metastatic lesion

    3. traumatic muscle avulsion

    4. a localized purulent infection

    5. hemophilia

     

    348-[ ] Total shoulder arthroplasty is an especially difficult procedure, since optimal function after surgery requires a great deal of skill in the reconstruction and rehabilitation. Good and durable results would least depend on:

     

    1. an intact rotator cuff

    2. a functioning deltoid

    3. orientation of the implants

    4. preservation of humeral and glenoid length

    5. constraining the implant

     

    349-[ ] The Tug test is used to locate which of the following structures during shoulder arthroplasty:

     

    1. the posterior humeral circumflex artery

    2. the axillary nerve

    3. the long head of the biceps

    4. the rotator interval

    5. the inferior laxity of the shoulder capsule

    350-[ ] The shoulder offset is measured from:

     

    1. the outer margin of the greater tuberosity till the outer margin of the base of the coracoid process

    2. the outer margin of the greater tuberosity till the rim of the glenoid

    3. the transverse width between the greater tuberosity and inner margin of the humeral head

    4. the margin of the spinoglenoid notch and outer margin of the greater tuberosity

    5. the diameter of the humeral head

     

    351-[ ] The arc of active function of a normal knee ranges between:

     

    1. 5 – 135 degrees of flexion

    2. 10-120 degrees of flexion

    3. 20 to 110 degrees of flexion

    4. 5 degrees of hyperextension till 135 degrees of flexion

    5. 0-90 degrees of flexion

     

    352-[ ] Quadriceps muscle relaxation during the stance phase “the arc of terminal extension,” occurs at:

     

    1. 10 degrees of flexion till 5 degrees hyperextension

    2. 5 degrees of flexion till 0 degrees extension

    3. 15 degrees of flexion till 10 degrees extension

    4. 25 degrees of flexion till 0 degrees extension

    5. 35 degrees of flexion till 5 degrees hyperextension

     

    353-[ ] During weight bearing on a flexed knee (15°), the quadriceps muscle force required to stabilize the knee is:

     

    1. 75% of the load on the femoral head at 15° of flexion

    2. 210% of the load on the femoral head at 15° of flexion

    3. 410% of the load on the femoral head at 15° of flexion

    4. 100% of the load on the femoral head at 15° of flexion

    5. 150% of the load on the femoral head at 15° of flexion

     

    354-[ ] All the following are risk factors for limitation of motion of knee during ligamentoplasties, except:

     

    1. Graft placement anterior to the native ACL insertion on the tibia results in impingement on the roof of the intercondylar notch in extension

    2. Medial placement on the tibia produces impingement on the lateral wall of the intercondylar notch

    3. Placement too far anteromedially has been shown to limit flexion

    4. On the femoral side, the most common error is graft placement too far anterior, which causes excessive strain on the graft

    5. Impingement of the ACL graft on the PCL also may limit flexion when the angle of the tibial tunnel is too steep (80°)

     

    355-[ ] A test performed by having the patient clench his or her thumb in a fist, followed by brisk deviation of the wrist ulnarly, elicits pain over the first dorsal compartment of the wrist, is known as the:

     

    1. Finkelstein test

    2. the Eichoff maneuver

    3. Wilsons test

    4. Terry Thompson test

    5. The Gilberman test

     

    356-[ ] A number of factors have been implicated in the process in the development of osteonecrosis of the hip except:

     

    1. alcohol use

    2. high-dose corticosteroid administration

    3. coagulation abnormalities

    4. over-weight

    5. impaired mesenchymal cellular differentiation

     

    357-[ ] Alcohol and corticosteroids most likely induce osteonecrosis of the hip by:

     

    1. a direct stimulus on the pancreas, leading it to secrete pancreatic enzymes in large quantities, with a direct action on the hip

    2. a profound effect on bone marrow stromal cell differentiation and blood supply

    3. Decreased sensation around the hip that results in microtrauma

    4. Altering the autonomic nerve supply around the hip, thus leading to algodystrophy that later proceeds to osteonecrosis

    5. Causing a rise in the marrow intra-compartmental pressure which could lead to osteonecrosis

     

    358-[ ] What should the “Kerboul angle” be in a patient with osteonecrosis of the hip, to favor a good prognosis:

     

    1. less than 50 degrees

    2. less than 75 degrees

    3. less than 100 degrees

    4. less than 150 degrees

    5. less than 190 degrees

     

    359-[ ] The most accurate imaging for detection of acute discitis in a child, would be:

     

    1. CT scan

    2. MRI

    3. Ultrasonography

    4. Scintigraphy

    5. Plain radiography

     

    360-[ ] A 6 year old boy presents with acute pain in the cervical spine region. He was noted to have stiffness, and local tenderness in the cervical region and an elevated temperature (38.0 deg centigrade). Lab studies revealed, an increased sedimentation rate (35mm/1hr), and a WBC of 10000/ HPF, your most likely diagnosis would be:

     

    1. Osteoblastoma

    2. Cervical disciitis

    3. Cervical disc calcification

    4. Ewings Sarcoma

    5. Prolapse of the cervical endplate

     

    361-[ ] All the following favor the diagnosis of scheuermanns disease, except:

     

    1. Endplate irregularity

    2. Schmorl's node formation

    3. narrowing of the disk space

    4. Widening of the interpedicular space

    5. wedging of three adjacent vertebrae by 5 degrees

     

    362-[ ] Scheuermann’s disease of the thoracolumbar region has been associated has been associated mostly with which of the following conditions:

     

    1. scoliosis

    2. spondylolysis

    3. ankylosing spondylitis

    4. sacroiliatis

    5. intradural tumors

     

    363-[ ] Which of the following benign tumors is most likely to lead to a gradual replacement of the vertebral body and gradual weakening and could precipitate a sudden collapse of the vertebral body and bleeding, initiating the onset of pain, in a child:

     

    1. Osteoid Osteoma

    2. Osteoblastoma

    3. Eosinophilic granuloma

    4. Chordoma

    5. Giant cell tumor

     

    364-[ ] In children, the most common skeletal metastases to the spine, would be:

     

    1. Neuroblastoma

    2. Teratoma

    3. Teratocarcinoma

    4. Wilm's tumor

    5. osteogenic sarcoma

     

    365-[ ] The most common soft tissue tumor to metastasize to the spine, in a child would be:

     

    1. Synovial sarcoma

    2. Epithelioid sarcoma

    3. Rhabdomyosarcoma

    4. Liposarcoma

    5. Angiosarcoma

     

    366-[ ] The primary blood supply for the femoral head, particularly the weight-bearing portion would be:

     

    1. The terminal branches from the deep branch of the medial femoral circumflex artery

    2. The artery of the ligamentum teres

    3. The medial epiphyseal artery

    4. The obturator artery

    5. The lateral femoral circumflex artery

     

    367-[ ] Which of the following anatomic variations in the proximal femur, is a risk factor for traumatic posterior hip dislocation:

     

    1. decrease in femoral anteversion

    2. decrease in femoral retroversion

    3. coxa vara

    4. protrusio acetabulae

    5. a horizontal proximal physis

     

    368-[ ] Which of the following tendons have been reported to block reduction of a posterior dislocation of the hip:

     

    1. Pyriformis

    2. Superior gamelli

    3. Obturator internis

    4. Inferior gamelli

    5. Quadratus femoris

     

    369-[ ] The preferred approach to fix a fracture of the femoral head, when associated with a posterior dislocation, would be:

     

    1. lateral, medial (Ludloff)

    2. posterior (Kocher-Langenbeck)

    3. anterior (Smith-Petersen)

    4. anterolateral (Watson-Jones)

    5. tri-radiate approach

     

    370-[ ] The factor that has contributed most (at the present date) to the increased rate of to tuberculosis is:

    1. the rise in the number of people who have suppression of the immune system

    2. the development of drug-resistant strains of Mycobacterium

    3. an aging population

    4. an increase in the number of health-care workers who are exposed to the disease

    5. Poverty

     

    371-[ ] The most frequent bone to be involved with tuberculosis, would be:

     

    1. spine

    2. hip

    3. knee

    4. foot

    5. elbow

     

    372-[ ] In Tuberculosis, fusion of numerous epithelioid cells are believed to form:

     

    1. macrophages

    2. Langhan’s cells

    3. Dorothy Reed Sternberg cells

    4. Berbeck’s macrophages

    5. Rolly bodies

     

    373-[ ] Which of the following is most diagnostic of Tuberculosis:

     

    1. elevated sedimentation rate

    2. elevated C reactive protein

    3. polymerase chain reaction test

    4. presence of caseation necrosis

    5. evidence of giant cells within a pus smear

     

    374-[ ] Which of the following is not a cranial tong used in cervical traction:

     

    1. Crutchfield

    2. Gardner wells

    3. Bradford

    4. Barton

    5. Halo

     

    375-[ ] While inserting the Halo screws in the region of the eyebrow, which of the following nerves could be injured:

    1. Abducens

    2. Glossopharyngeal

    3. Supratrochlear

    4. Facial

    5. Maxillary

     

    376-[ ] What area of the skull is weakest for insertion of a Halo screw?

     

    1. Occipital

    2. Frontal

    3. Parietal

    4. Temporal

    5. Supraorbital

     

    377-[ ] The “belly press test” “Napoleon sign” is used to evaluate which of the following muscles:

     

    1. Pectoralis major

    2. Latssimuss dorsi

    3. Subscapularis

    4. Teres minor

    5. Levator scapulae

     

    378-[ ] The “lift off test” is used to evaluate which of the following muscles:

     

    1. Pectoralis major

    2. Latssimuss dorsi

    3. Subscapularis

    4. Teres minor

    5. Levator scapulae

     

    379-[ ] Which of the following findings by MRI, when if present would indicate a poor prognostic sign for a successful repair of the subscapularis tendon?

     

    1. edema in the region of the subscapularis tendon insertion

    2. MRI evidence of a complete rupture of the subscapularis tendon

    3. Hemosiderin within the region of the tendon

    4. Severe fatty degeneration of the subscapularis tendon and muscle

    5. Long head of the biceps subluxation between the subscapularis and lesser tuberosity

     

    380-[ ] Should a patient present to your clinic with anterior shoulder pain with a good range of motion. You also note that this patient has excessive external rotation on comparing one shoulder with the opposite side. Which of the following muscles are likely to be ruptured:

     

    1. Pectoralis major

    2. Latssimuss dorsi

    3. Subscapularis

    4. Teres minor

    5. Levator scapulae

     

    381-[ ] During the first 4 degrees of knee flexion, the patella tilts:

     

    1. medially

    2. laterally

    3. sagitally

    4. coronally

    5. vertially

     

    382-[ ] A 30 year old male presents to your clinic with worsening of his anterior knee pain following a lateral retinacular release. The most likely cause would be:

     

    1. insufficient lateral release

    2. medial subluxation of the patella

    3. excessive rotation of the patella

    4. patella beja

    5. patella alta

     

    383-[ ]Which of the following muscles, while under normal function, contribute to 25% of the energy absorption on the lower extremity, during landing:

     

    1. Hip adductors

    2. Hip flexors

    3. Hip extensors

    4. Gastrocnemii

    5. Quadriceps

     

    384-[ ] Patellar instability is most commonly associated with:

     

    1. Torsional trauma

    2. An elevated Q angle

    3. Patella alta

    4. Patella beja

    5. Vastus medialis over action

     

    385-[ ] The sensation of knee collapsing or giving way in flexion is least caused by:

     

    1. quadriceps insufficiency

    2. pain

    3. deconditioning

    4. joint effusion

    5. patellar instability

    386-[ ] Free nerve endings have been associated with anterior knee pain. These are concentrated least in which of the following locations:

     

    1. patellar tendon

    2. popliteal tendon

    3. retinalar tissues

    4. pes anserinus

    5. fat pad

     

    387-[ ] Which of the following structures is aneural in the knee?

     

    1. synovial tissue

    2. articular cartilage

    3. retinacular tissue

    4. fat pad

    5. subchondral bone

     

    388-[ ] Which of the following ligaments is the strongest in the knee:

     

    1. Posterior cruciate

    2. Anterior cruciate

    3. Medial collateral

    4. Lateral collateral

    5. Fabellofibular

     

    389-[ ] In “Pavlik disease”, secondary to the use of a Pavlik hareness implies damage to which of the following anatomic locations:

     

    1. anterior column of the acetabulum

    2. anterior wall of the acetabulum

    3. posterior wall and posterior column

    4. erosion of the acetabular labrum

    5. necrosis of the femoral head

     

    390-[ ] The posterior sag test is used to evaluate which of the following structures:

     

    1. medial collateral ligament

    2. posterior cruciate ligament

    3. ligamentum teres

    4. calcaneo- fibular ligament

    5. sacrotuberous ligament

     

    391-[ ] Which of the following muscles about the knee has ligamentous extensions into the medial meniscus and is involved in moving the meniscus posteriorly during flexion:

     

    1. the semitendinosus

    2. the semimembranosus

    3. the sartorius

    4. the gracilus

    5. the biceps femoris

     

    392-[ ] Which of the following muscles about the knee, has extensions into the oblique popliteal ligament and adds to lateral capsular stability to the knee:

     

    1. the semitendinosus

    2. the semimembranosus

    3. the sartorius

    4. the gracilus

    5. the biceps femoris

     

    393-[ ] Should the posteromedial capsular structures of the knee be injured and torn, which of the following ligaments, would be at most risk for secondary injury?

     

    1. the anterior cruciate ligament

    2. the posterior cruciate ligament

    3. the oblique popliteal ligament

    4. the fabello-fibular ligament

    5. the medial retinacular ligament

     

    394-[ ] Through which of the following ligaments does the knee rotate in its long axis during the screw home movement?

     

    1. the anterior cruciate ligament

    2. the menisco femoral ligament

    3. the oblique popliteal ligament

    4. the fabello-fibular ligament

    5. the medial retinacular ligament

     

    395-[ ] When the meniscofemoral segments of the knee alone are disrupted, which of the following structures would prevent anterior displacement of the tibia?

     

    1. The ACL

    2. The PCL

    3. The wedge shape of the posterior horn of the medial meniscus

    4. The popliteus tendon

    5. The oblique popliteal ligament

     

    396- [ ] The iliotibial band extends from the iliac crest to the knee. In the knee region it attaches to all the following structures, except:

     

    1. The patella

    2. Gerdy’s tubercle

    3. Lateral epicondyle of the femur

    4. A portion of the long head of the biceps femoris (Answer: it attaches to the short head)

    5. A portion of the lateral head of the gastrocnemius

     

    397-[ ] Which of the following muscles lies mostly intrarticular within the knee joint:

     

    1. the semitendinosus

    2. the popliteus

    3. the sartorius

    4. the gracilus

    5. the biceps femoris

     

    398-[ ] The ligament that extends from the the posteromedial wall of the intercondylar notch and attaches to the posterior horn of the lateral meniscus is known as the:

     

    1. Steiner

    2. Caudate

    3. Oblique popliteal

    4. Gerdy’s

    5. Wrisberg…….ligament

     

    399-[ ] The fabellofibular ligament is an extension of which of the following tendons?

     

    1. short head of biceps femoris tendon

    2. long head of the biceps femoris tendon

    3. the popliteus tendon

    4. semimembranosus tendon

    5. semitendenosus tendon

     

    400-[ ] When the lateral collateral ligament and the posterolateral corner of the knee are torn, which of the following structures is most likely to be recruited to resist varus stress, while in extension?

     

    1. the PCL

    2. the ACL

    3. the oblique popliteal ligament

    4. the medial meniscus

    5. the semimembranous tendon

     

    401-[ ] When the lateral collateral ligament and the posterolateral corner of the knee are torn, which of the following structures is most likely to be recruited to resist varus stress, while beyond 45 degrees of flexion?

     

    1. the PCL

    2. the popleteal tendon

    3. the oblique popliteal ligament

    4. the medial meniscus

    5. the semimembranous tendon

     

    402-[ ] Symmetric instability in extension following a Total knee replacement arthroplasty is

    most likely caused, when:

     

    1. excessive medial release is performed

    2. excision of the PCL is performed

    3. the distal femoral cut was excessive with respect to the chosen size of the prosthesis

    4. Patella alta is present

    5. the total knee is performed in a patient with excessive ligament hyperlaxity

     

    403-[ ] Should too much resection of the proximal tibia cause symmetric instability in extension following a Total Knee Artrhoplasty is best dealt with by:

     

    1. by inserting a larger femoral component

    2. inserting a thicker tibial polyethylene component

    3. by adding distal femoral augments

    4. inserting a semiconstrained prosthesis

    5. inserting a hinged prosthesis

     

    404-[ ] Which of the following muscles takes its origin from A as in dicted in the figure below:

     

    1. the gluteus maximus

    2. the gluteus medius

    3. the gluteus minimus

    4. the iliacus

    5. the tensor fascia latae

     

     

     

    405-[ ] which of the following muscles takes its origin from B in the above figure:

     

    1. the gluteus maximus

    2. the gluteus medius

    3. the gluteus minimus

    4. the iliacus

    5. the tensor fascia latae

     

    406-[ ] Which of the following muscles passes through the greater sciatic foramen:

     

    1. the gluteus minimus

    2. the obturator internis

    3. the obturator externis

    4. the pyriformis

    5. the superior gamelli

     

    407-[ ] Aneurysmal bone cyst has been noted to occur secondary all of the following tumors

    except:

     

    1. non-ossifying fibroma

    2. chondroblastoma

    3. osteoblastoma

    4. rhabdomyosarcoma

    5. fibrous dysplasia

    408-[ ] Which of the following tumors is most likely to give a “blow out” appearance on plain radiography:

     

    1. Giant cell tumor

    2. Unicameral bone cyst

    3. Aneurysmal bone cyst

    4. Fibrous dysplasia

    5. Nonossifying fibroma

     

    409-[ ] Which of the following tumors is most likely to give a fluid-fluid level appearance on MRI or CT scan

     

    1. Giant cell tumor

    2. Unicameral bone cyst

    3. Aneurysmal bone cyst

    4. Fibrous dysplasia

    5. Nonossifying fibroma

     

    410-[ ] On viewing the plain xray of the pelvis on a 23 year old male, your most likely diagnosis would be:

     

     

     

     

    1. an aneurismal bone cyst

    2. gouty arthritis

    3. ankylosing spondylitis

    4. an osteoblastoma of the pedicle of lumbar 5

    5. stress fracture of the sacrum

     

    411-[ ] An inflammatory disease that is most associated with squaring of the vertebral bodies, would be:

     

    1. Rheumatoid arthritis

    2. Psoriasis

    3. Ankylosing spondylitis

    4. Ulcerative colitis

    5. Reiters syndrome

    412-[ ] The most likely age range for a calcaneonavicular coalition to become evident, would be:

     

    1. 4-6 years

    2. 6-8 years

    3. 8-12 years

    4. 12-16 years

    5. Older than 16 years of age

     

    413-[ ] Calcaneonavicular coalitions are best seen on:

     

    1. an oblique radiograph of the foot

    2. lateral radiograph of the foot

    3. Harris views of the foot

    4. Kite’s view of the foot

    5. Tangential views of the subtalar joint

     

    415-[ ] Which portion of the distal tibial physis is last to remain open, and is associated with a tillaux fracture:

     

    1. Centrally

    2. Medially

    3. Laterally

    4. Both central and medial

    5. Both central and lateral

     

    416-[ ] A child while walking with his sneakers on, stepped on a nail. This with time became infected. Should a culture be taken, the most likely organism to be detected, would be:

     

    1. staph aureus

    2. pseudomonas

    3. streptococcus

    4. E coli

    5. pneumococci

     

    417-[ ] The most likely mechanism of injury, for a Bennett’s fracture, would be:

     

    1. Axial loading of a partially flexed thumb metacarpal

    2. A hyperextension injury of the carpometacarpal joint

    3. A hyperextension injury of the metacarpo-phalangeal joint

    4. A valgus force localized to the carpometacarpal joint

    5. A varus force localized to the metacarpo-phalangeal joint

     

    418-[ ] Which of the following tendons is the source of the deforming force, in the Bennett’s fracture:

    1. The extensor pollicis longus

    2. The extensor pollicis brevis

    3. The abductor pollicis longus

    4. The abductor pollicis brevis

    5. The flexor pollicis

     

    419-[ ] The xray shown below is most likely, which of the following fractures:

     

     

     

     

    1. Rolando fracture

    2. Bennett’s fracture

    3. Steiner fracture

    4. Natatory fracture

    5. Jersey fracture

     

    420-[ ] A test that can be useful to determine whether a varus hindfoot is the primary problem or if it is secondary to forefoot valgus or a dropped first ray, would be:

     

    1. A Coleman block test

    2. A Jobe test

    3. A fleck test

    4. A Meary test

    5. A Pitch test

     

    421-[ ] The peroneal tubercle and retromalleolar groove are best evaluated with which of the following xray views of the foot:

     

    1. oblique views

    2. lateral views

    3. Harris views of the heel

    4. Kites views

    5. Lisfranc’s views

     

    422-[ ] Following an inversion injury of the ankle, radiographs taken revealed a small avulsion fracture of the lateral malleolus. This has been termed a:

    1. Romberg sign

    2. Romanous sign

    3. Fleck sign

    4. Lisfanc’s sign

    5. Struther’s sign

     

    423-[ ] A forty eight year old active male has narrowing of the medial joint line with a 5 degree varus deformity of the knee joint, on full weight bearing AP views.

    The most likely indicated surgical procedure, should it be performed, would be:

     

    1. a unicompartmental arthroplasty

    2. a total knee arthroplasty

    3. a high tibial valgus osteotomy

    4. a distal femoral valgus osteotomy

    5. a Magnuson’s abrasion and debridement of the knee

     

    424-[ ] What would the minimal knee contracture and range of motion of the knee be acceptable for a high tibial osteotomy to be successful:

     

    1. Contracture 20 degees, and 60 degrees knee flexion

    2. Contracture 30 degees, and 80 degrees knee flexion

    3. Contracture 30 degees, and 120 degrees knee flexion

    4. Contracture 10 degees, and 90 degrees knee flexion

    5. No contracture and 90 degrees knee flexion

     

    425-[ ] The most acceptable explanation why a varus osteotomy of the knee should be performed in the distal femur for correction of a valgus knee, would be:

     

    1. to prevent tilting of the knee joint

    2. to obtain adequate correction

    3. it is easier to perform

    4. lower incidence of nonunion

    5. easier post-operative rehabilitation

     

    426-[ ] Which of the following lesions is the most common malignant soft tissue tumor, to occur in the hand:

     

    1. Clear cell sarcoma

    2. Epithelioid sarcoma

    3. Synovial sarcoma

    4. Liposarcoma

    5. Rhabdomyosarcoma

     

    427-[ ] Which of the following malignant soft tissue tumors, has the highest rate of local recurrence following excision, when in the hand:

    1. Clear cell sarcoma

    2. Epithelioid sarcoma

    3. Synovial sarcoma

    4. Liposarcoma

    5. Rhabdomyosarcoma

     

    428-[ ] Which of the following terms best describes an apical vertebra?

     

    1. it is the vertebra which is most tilted in a primary curve in scoliosis

    2. is the vertebra which is most laterally deviated in a primary curve

    3. is the vertebra which is most rotated in a primary curve

    4. is the vertebra which is nonsegmented in a congenital curve

    5. is usually the vertebra which is located in an area of, failure of vertebral formation in a congenital scoliotic curve

     

    429-[ ] If a child were to have a congenital scoliotic curve, should one, were to choose surgical correction, which of the following investigations is most indicated, to avoid any complications following the surgical correction?

     

    1. a CT scan of the whole spine

    2. plain xrays of the spine

    3. MRI of the whole spine

    4. Chest X-ray

    5. EKG

     

    430-[ ] Which of the following conditions is known to be associated with laborers involved in drilling and vibration movements of the wrist?

     

    1. Preisers disease

    2. Panners disease

    3. Kienbock’s disease

    4. Freibergs disease

    5. Kohlers disease

     

    431-[ ] Which of the following radiologic terms describes a line passing through the two triradiate cartilages, in the pelvis of a child?

     

    1. Shentons line

    2. Cervicoobturator line

    3. Perkin’s line

    4. Helgenreiner’s line

    5. Von Rosen line

    432-[ ] Which of the following conditions results from a deficiency in the osteoclastic cell brush border and has a failure of remodeling?

     

    1. Osteoporosis

    2. Rickets

    3. Caffey’s disease

    4. Osteopetrosis

    5. Osteomalascia

     

    433-[ ] Which of the following conditions when present serves best as a recipient zone for a metastatic focus?

     

    1. Osteoporosis

    2. Osteopetrosis

    3. Paget’s disease

    4. Rickets

    5. Osteomalascia

     

    434-[ ] The disease that becomes chronic over the years with continuous flare ups and later with the possible development of squammous cell carcinoma at the lesion site, would be:

     

    1. Osteopetrosis

    2. Osteomyeltis

    3. Caffey’s disease

    4. Albright’s syndrome

    5. Osteoid Osteoma

     

    435-[ ] Which of the following conditions is least associated with a Compartment syndrome?

     

    1. Hemophilia

    2. Rheumatoid arthritis

    3. Rents or defects in the fascia surrounding muscle compartments that are repaired

    4. Bryants or Gallows traction of both femurs for a fracture on one side

    5. Supracondylar fractures of the elbow

     

    436-[ ] Which of the following Cardinal findings or evaluations is least reliable in a patient bound to have a Compartment syndrome?

     

    1. Pulselessness

    2. Paresthesia

    3. Pain

    4. Compartment Pressure

    5. Paralysis

     

    437-[ ] A patient following a Spine fracture, develops bradycardia with hypotension. The term that best describes his condition would be:

    1. Spinal shock

    2. Central cord syndrome

    3. Posterior cord syndrome

    4. Neurogenic shock

    5. Disdiadokinesis

     

    438-[ ] Following an axial compression force, a patient is noted to have a fracture of all arches of the atlas. This is bested described as a:

     

    1. Chance Fracture

    2. Hangman’s fracture

    3. Jefferson’s fracture

    4. Codman’s fracture

    5. Insufficiency fracture

     

    439-[ ] Injuries of the spine leading to paralysis without Radiologic evidence of a fracture are known to occur in:

     

    1. Children

    2. Ankylosing Spondylitis

    3. Osteoporotic women

    4. Osteopetrosis

    5. Rugger Jersy spine

     

    440-[ ] A lesion in bone, that often remains quiescent for years and may be followed by a flare up; and on X-rays resembles an Osteoid Osteoma, would be a:

     

    1. Ghon complex

    2. Glomus tumor

    3. Brodie’s abcess

    4. Fibrous dysplasia

    5. Sequestrum

     

    441-[ ] Which of the following reflexes, when present, signifies that the patient is past the stage of spinal shock:

     

    1. Cremasteric reflex

    2. Anal wink

    3. Bulbo-Cavernous reflex

    4. Beever’s reflex

    5. Babinski

     

    442-[ ] Which of the following fractures of the spine has been most commonly the result of a seat belt injury?

    1. Chance fracture

    2. Jefferson fracture

    3. Hangman fracture

    4. Burst fracture

    5. Diabalo fracture

     

    443-[ ] The two most important factors in predicting outcome in patients with Legg-Calvé-Perthes disease were found to be:

     

    1. the type of treatment and age of the patient

    2. the type of treatment and gender of the patient

    3. the age of the patient and the lateral pillar classification

    4. the lateral pillar classification and the Stulberg classification

    5. the age and gender of the patient

     

    444-[ ] Which of the following was found to be the strongest predictor of functional outcome one year after total knee arthroplasty?

     

    1. preoperative mental health status

    2. age

    3. gender

    4. preoperative functional status

    5. comorbid medical conditions

     

    445-[ ] Which of the following syndromes is most frequently associated with radial deficiency and thumb hypoplasia?

     

    1. Down syndrome

    2. Holt-Oram syndrome

    3. Streeter dysplasia

    4. trichorhinophalangeal syndrome

    5. Rett syndrome

     

    446-[ ] In hematogenous osteomyelitis of long bones, a single pathogenic organism is almost always recovered from the bone. Which of the following is most commonly isolated in adults?

     

    1. Streptococcus pyogenes

    2. Haemophilus influenzae

    3. Staphylococcus aureus

    4. Mycobacterium tuberculosis

    5. Escherichia coli

    447-[ ] Which of the following is the most important epidemiological factor in predicting the development of posttraumatic adult respiratory distress syndrome?

     

    1. presence of a thoracic injury

    2. genetic predisposition of the patient to inflammatory hyperreactivity

    3. severity of the injury as quantified by the Injury Severity Score

    4. age of the patient

    5. mechanism of injury

     

    448-[ ] Of the following imaging modalities, which was shown to have the best diagnostic accuracy for detection of a loose acetabular component?

     

    1. plain radiography

    2. subtraction arthrography

    3. nuclear arthrography

    4. bone scintigraphy

    5. magnetic resonance imaging

     

    449-[ ] Which of the following answers is correct concerning very small asymptomatic stage-I osteonecrotic lesions of the hip?

     

    1. they never collapse

    2. pain always proceeds progression to stage II

    3. most of the lesions collapse after five years of follow-up

    4. collapse occurs before symptoms

    5. small lesions never require surgery for pain

     

    450-[ ] In a comparison of the clinical results of bone-patellar tendon-bone and double-looped hamstring tendon grafts in reconstruction of the anterior cruciate ligament, what was the most frequently reported symptom in patients treated with the bone-patellar tendon bone graft:

     

    1. residual anterior knee laxity

    2. kneeling discomfort

    3. joint stiffness

    4. patellofemoral pain

    5. knee swelling

     

    451-[ ] Which of the following is the best indication for including arthrodesis as an adjunct to decompressive surgery for lumbar spinal stenosis?

     

    1. decompression performed through bilateral laminotomies

    2. mild degenerative scoliosis (<15°) in an elderly patient

    3. severe multilevel stenosis

    4. degenerative spondylolisthesis

    5. decompression requiring removal of <50% of the facet joints bilaterally

     

    452-[ ] Absence of which clinical sign or signs most reliably rules out the need to perform radiographic external rotation stress examination of the ankle following isolated fibular fracture?

     

    1. weak posterior tibialis function

    2. isolated medial tenderness

    3. medial-sided tenderness to palpation in association with medial-sided ecchymosis

    4. swelling of the ankle

    5. medial-sided swelling and tenderness to Palpation

     

    453-[ ] Spontaneous resolution of asymptomatic osteonecrosis of the femoral head was found to be associated with:

     

    1. younger age of the patient

    2. a small lesion

    3. low steroid dosage

    4. absence of tobacco usage

    5. female gender

     

    454-[ ] A seventy-year-old woman fell on her outstretched left hand and sustained an extraarticular fracture of the distal part of the radius. Using local anesthesia, you perform a successful, anatomical reduction and immobilize the fracture in a plaster cast. Under what circumstance would you perform a

    Kirschner wire osteosynthesis?

     

    1. a loss of reduction after four days

    2. persistent pain in the forearm

    3. an accident one week later resulting in a hip fracture

    4. a concomitant injury of the ipsilateral humerus

    5. Parkinson disease

     

    455-[ ] Regarding Legg-Calvé-Perthes disease and thrombosis, which of the following statements is correct?

     

    1. there is no etiologic relationship between Legg-Calvé-Perthes disease and thrombosis

    2. both familial and acquired risk factors for thrombosis have been shown to be associated with Legg-Calvé-Perthes disease

    3. Legg-Calvé-Perthes disease is associated with systemic thrombosis

    4. the recommended treatment for Legg-Calvé-Perthes disease is anticoagulation with heparin

    5. there are no studies associating Legg-Calvé-Perthes disease with an increased risk of thrombosis

    456-[ ] A fifty-year-old woman presented with pain and tenderness at the radial styloid of the left wrist of one month’s duration. The pain was aggravated when the thumb was clasped in the palm and the wrist was forced into ulnar deviation. A diagnosis of de Quervain disease was made. The most effective initial treatment of this condition was found to be:

     

    1. nonsteroidal anti-inflammatory drugs

    2. nonsteroidal anti-inflammatory drugs and splinting

    3. local steroid injection alone

    4. local steroid injection and nonsteroidal anti-inflammatory drugs

    5. surgical release

     

    457-[ ] Which branch of the axillary nerve lies closest to the inferior portion of the glenoid rim and is therefore most vulnerable to damage during surgery involving the inferior aspect of the shoulder capsule?

     

    1. anterior deltoid motor branch

    2. posterior deltoid motor branch

    3. branch to subscapularis

    4. teres minor and superior lateral cutaneous innervation branch

    5. teres minor branch

     

    458-[ ] Demineralized bone matrix contains all of the following except:

     

    1. acid-extracted bone

    2. collagen

    3. noncollagenous proteins

    4. bone morphogenetic proteins

    5. osteoprogenitor cells

     

    459-[ ] The elbow has both static and dynamic stabilizers against valgus torque. Muscle-splitting approaches to the medial aspect of the elbow have been developed to help maintain the dynamic stabilizing function of the flexor pronator mass when the medial ulnar collateral ligament is being reconstructed. On the basis of biomechanical studies, which structures are the primary static and dynamic stabilizers, respectively?

     

    1. anterior bundle of the medial ulnar collateral ligament and the pronator teres

    2. anterior bundle of the medial ulnar collateral ligament and the flexor digitorum superficialis

    3. anterior bundle of the medial ulnar collateral ligament and the flexor carpi ulnaris

    4. posterior bundle of the medial ulnar collateral ligament and the flexor carpi ulnaris

    5. posterior bundle of the medial ulnar collateral ligament and the pronator teres

     

    460-[ ] All of the following patients might be reasonable candidates for a proximal femoral valgus-producing intertrochanteric osteotomy, EXCEPT:

    1. an active fifty-year-old woman with a nonunion of a Pauwels type-III femoral neck fracture

    2. a twenty-eight-year-old man with mild osteoarthritis of the hip who is more comfortable with the hip in abduction than in adduction on examination

    3. a fifty-five-year-old man with osteoarthritis and joint-space loss at the superolateral edge of the hip joint

    4. a forty-five-year-old man with 2 cm of posttraumatic shortening of the ipsilateral lower limb who is otherwise asymptomatic

    5. a thirty-year-old woman with osteonecrosis affecting the superolateral aspect of the femoral head, with a Kerboul necrotic angle of 120°

     

    461-[ ] The optimal method for diagnosing osteonecrosis in asymptomatic patients is:

     

    1. taking the patient’s history

    2. technetium bone-scanning

    3. radiography

    4. computerized tomography

    5. magnetic resonance imaging

     

    462-[ ] Which of the following represents the most likely change in the gap detection threshold six weeks after a carpal tunnel release?

     

    1. improved tactile sensitivity in the index finger

    2. improved tactile sensitivity in the index and small fingers

    3. improved tactile sensitivity in the small finger

    4. no change in the tactile sensitivity of the index finger

    5. improved tactile sensitivity in the index finger but worse tactile sensitivity in the small finger

     

    463-[ ] Which of the following factors is the most important when selecting a patient with high-grade metaphyseal osteosarcoma of the knee for a partial epiphyseal preservation?

     

    1. metaphyseal intramedullary and soft-tissue tumor extension

    2. no intra-chemotherapy tumor progression and clear tumor margins, without involvement of the epiphysis, on magnetic resonance imaging

    3. no epiphyseal tumor extension detectable with radioisotope scanning and computer tomography

    4. a patient with an open growth plate who is less than ten years old

    5. a patient without an open growth plate who is more than fifteen years old

     

    464-[ ] The major disadvantage of the technique of lengthening of long bones over an intramedullary nail is:

     

    1. risk of intramedullary infection

    2. premature consolidation of callus

    3. refracture

    4. decreased range of motion

    5. malalignment of the limb

     

    465-[ ] Rotator cuff repair in patients fifty years of age and younger is associated with long term improvement in which of the following clinical parameters?

     

    1. active abduction

    2. external rotation

    3. adduction

    4. internal rotation

    5. pain

     

    466-[ ] If an os acromiale is obscured on the optimal single radiographic view, it can be detected on which of the following combinations of radiographic views of the shoulder?

     

    1. anteroposterior and supraspinatus outlet

    2. anteroposterior and apical oblique

    3. anteroposterior and Stryker notch

    4. supraspinatus outlet and apical oblique

    5. supraspinatus outlet and Stryker notch

     

    467-[ ] The factor most likely to be associated with a poor long-term outcome following proximal row carpectomy is:

     

    1. age of less than thirty-five years

    2. preoperative diagnosis of Kienböck disease

    3. failure to perform a radial styloidectomy

    4. patient occupation

    5. postoperative evidence of radiocapitate arthritis

     

    468-[ ] Which of the following molecules is a marker of chondrocyte dedifferentiation following human autologous chondrocyte transplantation?

     

    1. cathepsin B

    2. collagen II

    3. collagen X

    4. Egr-1

    5. Sox-9

     

    469-[ ] Which of the following factors is the main reason for loss of elbow and forearm strength following radial head resection because of a comminuted fracture of the radial head?

     

    1. wrist and forearm pain with resultant ulnar abutment

    2. valgus elbow deformity

    3. osteoarthrosis of the elbow

    4. lack of proximal support of the radiocapitellar articulation

    5. restricted elbow joint mobility

     

    470-[ ] Which of the following medications, when given intra-articularly, has been shown to be most effective in reducing postoperative pain following anterior cruciate ligament reconstruction?

     

    1. methadone

    2. morphine

    3. hyalogen

    4. corticosteroid

    5. saline solution

     

    471-[ ] Which of the following restrictions was found to be the most important in preventing early dislocation following total hip arthroplasty?

     

    1. abduction pillow

    2. no side-sleeping

    3. no driving

    4. limitation of hip flexion

    5. use of elevated chairs/toilet seats

     

    472-[ ] When patients with lower-extremity sarcoma were treated with limb-salvage surgery combined with high-dose postoperative external beam radiation therapy, they were noted to have:

     

    1. an increased rate of pulmonary metastases

    2. an increased rate of perioperative wound complications

    3. an increased rate of local recurrence

    4. a decreased rate of fractures

    5. an increased rate of fractures

     

    473-[ ] You make a diagnosis of posterior dislocation of the shoulder in a male patient within twenty-four hours after the injury. Radiographs show a small humeral head defect. All of the following statements are true, except:

     

    1. a good functional outcome is anticipated following relocation

    2. an osteochondral fracture of the anterior part of the humeral head is likely

    3. spontaneous relocation is unlikely

    4. closed reduction should not be attempted

    5. restriction of external rotation of the shoulder is a useful diagnostic sign

    474-[ ] Which of the following is considered to be the gold-standard suturing technique for meniscal repair?

     

    1. all-inside absorbable implant

    2. second-generation flexible all-inside tensioned absorbable implant

    3. horizontal mattress suture

    4. vertical mattress suture

    5. fibrin glue

     

    475-[ ] Following total hip arthroplasty with a metalon-metal articulation, hypersensitivity reactions to wear and repassivation products may develop in some patients. If hypersensitivity is established as the cause of bursa formation, pain, or bone resorption, a surgeon should consider:

     

    1. reassuring the patient and waiting for relief of symptoms

    2. suppressing the reactions with drug therapy

    3. replacing the articulation with a different articulation device that does not liberate nickel, cobalt, or chromium ions

    4. advising the patient to limit activity in order to reduce the rate of wear

    5. treating the osteolytic lesions (resecting the granuloma, refreshing the bone surfaces until bleeding occurs, bone-grafting, and using cementing techniques) so that implant stability is not jeopardized

     

    476-[ ] Which factor is least associated with patient satisfaction following surgical repair of the rotator cuff?

     

    1. tear size

    2. age

    3. forward elevation at the time of follow-up

    4. ASES (American Shoulder and Elbow Surgeons) score

    5. work disability

     

    477-[ ] When liquid gentamicin is added to cement, all but one of the following statements are true:

     

    1. it maintains bacteriocidal activity

    2. it is eluted effectively from cement

    3. it can be used in cement spacers

    4. it is cost-effective when compared with tobramycin

    5. it can be used to reimplant prosthetic components

     

    478-[ ] The effect of bisphosphonates in patients undergoing total hip and knee arthroplasty is best described as follows:

    1. bisphosphonates lead to significant decreases in bone mineral density when compared with control values

    2. bisphosphonates have no effect on bone mineral density in patients undergoing hip and knee arthroplasty

    3. patients taking bisphosphonates will have significantly greater bone mineral density values at one year after surgery compared with the bone mineral density at the time of surgery

    4. bisphosphonates lead to significantly less periprosthetic bone loss (bone mineral density) than that in controls

    5. bisphosphonates are contraindicated in any patient undergoing joint arthroplasty

     

    479-[ ] When a young patient with “cam-type” femoroacetabular impingement is treated with surgical resection of the head-neck junction, how much bone can be safely resected without significantly weakening the femoral neck?

     

    1. 5% of the neck diameter

    2. 10% of the neck diameter

    3. 30% of the neck diameter

    4. 50% of the neck diameter

    5. 75% of the neck diameter

     

    480-[ ] In a comparison of computed tomography and plain radiography for the assessment of periacetabular osteolysis following total hip arthroplasty, it was found that computed tomography has:

     

    1. an average relative error of volume measurements of 63.4%

    2. a detection rate that is the same as that of plain radiography

    3. a 100% detection rate

    4. a better detection rate than plain radiography

    5. a worse detection rate than multiple plain radiographic views 481-[ ] hormone produces which of the following effects:

    1. bone resorption

    2. bone formation

    3. hypercalcemia

    4. hypercalciuria

    5. heterotopic ossification

     

    482-[ ] All of the following are associated with a significantly increased risk of deep infection in patients with an orthopaedic oncological condition except:

     

    1. radiation therapy

    2. pediatric extendable prostheses

    3. chemotherapy

    4. pelvic prostheses

    5. revision surgery

     

    483-[ ] Extracorporeal shock wave therapy used to treat chronic lateral epicondylitis resulted in significant improvement in all of the following outcome end points except:

     

    1. pain scores

    2. scores on an upper-extremity functional scale

    3. patient activity scores

    4. grip strength

    5. overall impression of disease state

     

    484-[ ] A review of 121 ankle fractures treated with open reduction and internal fixation revealed that 21% of the patients were symptomatic as a result of a surgical injury to which nerve?

     

    1. sural

    2. saphenous

    3. superficial peroneal

    4. deep peroneal

    5. posterior tibial

     

    485-[ ] Hip arthroscopy can be performed with the patient in either the supine or the lateral decubitus position. An advantage of the lateral position is that:

     

    1. fluoroscopy is seldom needed

    2. the femoral head requires no distraction

    3. most aspects of the joint can be visualized through the anterior and superior paratrochanteric portals

    4. no special distraction equipment is needed

    5. muscle relaxation is not required

     

    486-[ ] In patients with metal-on-metal bearing hip prostheses:

     

    1. serum cobalt and chromium ion levels are unaffected by patient activity

    2. the majority of cobalt and chromium is excreted in sweat

    3. the majority of cobalt and chromium is excreted in stool

    4. serum cobalt and chromium levels tend to rise over time

    5. serum cobalt and chromium levels are independent of renal function

     

    487-[ ] Following the diagnosis of deep periprosthetic infection in a patient who was treated for an orthopaedic oncological condition, which treatment yields the best functional outcome and probability of eradicating the infection?

    1. one-stage revision

    2. antibiotics alone

    3. Girdlestone excision arthroplasty

    4. two-stage revision

    5. surgical débridement and insertion of gentamicin beads

     

    488-[ ] A diagnosis of pigmented villonodular synovitis of the hip can be made with magnetic resonance imaging. Which of the following findings is least consistent with this diagnosis?

     

    1. intra-articular effusion

    2. low signal intensity on both T1 and T2-weighted images

    3. synovial hyperplasia

    4. bone erosions

    5. a diminished width of the joint space

     

    489-[ ] Which of the following factors decreases the likelihood of success of bracing for an adolescent with idiopathic scoliosis?

     

    1. higher Risser score

    2. older age

    3. overweight habitus

    4. increased number of hours of brace wear per day

    5. increased percent curve correction in the brace

     

    490-[ ] Acetabular chondral injuries are graded according to severity, and they influence surgical outcome. These lesions most often:

     

    1. occur in the posterior aspect of the acetabulum as a result of posterior dislocation

    2. are symptomatic

    3. occur only in patients with moderated dysplasia

    4. occur in the anterior aspect of the joint in association with a labral tear

    5. are easily detected by magnetic resonance imaging

     

    491-[ ] Eradication of bacteria is most difficult in which region of the foot?

     

    1. heel pad

    2. web spaces between the toes

    3. nail folds

    4. anterior aspect of the ankle

    5. dorsal aspect of the midfoot

    492-[ ] At a minimum of ten years following unicompartmental knee arthroplasty, the most frequent cause of failure was found to be:

     

    1. unexplained pain

    2. degeneration of the opposite compartment

    3. tibial loosening

    4. polyethylene wear

    5. patellofemoral degeneration

     

    493-[ ] After treatment of a distal tibial metaphyseal fracture with an intramedullary nail, which of the following is most predictive of a poorer outcome as determined by the Musculoskeletal Function Assessment Outcomes Instrument?

     

    1. time to fracture-healing

    2. intra-articular extension of the fracture

    3. age

    4. presence of an open fracture

    5. gender

     

    494-[ ] Which of the following is the best combination of tests for diagnosing a full-thickness rotator cuff tear?

     

    1. speed test, supraspinatus muscle test, and painful arc sign

    2. Neer impingement sign, supraspinatus muscle test, and painful arc sign

    3. infraspinatus muscle test, drop-arm sign, and painful arc sign

    4. infraspinatus muscle test, relocation test, and painful arc sign

    5. weakness in internal rotation, Hawkins-Kennedy impingement sign, and Speed test

     

    495-[ ] In a study of patients with adolescent idiopathic scoliosis, which of the following was found to be associated with the greatest adverse effect on pulmonary function?

     

    1. magnitude of the thoracic Cobb angle

    2. length of the thoracic curve (number of vertebrae within the curve)

    3. thoracic hypokyphosis

    4. coronal imbalance

    5. curve rigidity

     

    496-[ ] Metal-on-metal articulation has been used as a bearing surface in total hip arthroplasty. Which of the following statements is correct?

     

    1. a metal-on-metal articulation generates no wear particles

    2. implant fixation is more durable with a metal-on-metal articulation than with a metal-onpolyethylene

       coupling

    3. serum ion levels increase with increased patient activity

    4. histological evidence of hypersensitivity reaction has been observed in tissues retrieved from hips with a metal-on-metal articulation

    5. there is an increase in neoplasia in patients with a metal-on-metal articulation

     

    497-[ ] When performing total knee arthroplasty, the orthopaedic surgeon must decide whether or not to resurface the patella. Which of the following statements is most consistent with the results found in a recent meta-analysis?

     

    1. patellar resurfacing increases the risk of a reoperation and increases the prevalence of postoperative anterior knee pain

    2. patellar resurfacing decreases the risk of a reoperation only in the short term (less than five years postoperatively)

    3. data derived from the available trials show no difference in the rate of reoperations and the prevalence of postoperative anterior knee pain between resurfacing and nonresurfacing of the patella

    4. the mean improvement in the various knee scores is significantly greater when the patella is resurfaced

    5. patellar resurfacing decreases the risk of a reoperation and decreases the prevalence of postoperative anterior knee pain

     

    498-[ ] Which of the following is the most important factor in predicting the future extent of pelvic osteolysis adjacent to a cementless acetabular cup?

     

    1. type of communication pathway between the lesion and the joint space

    2. usage of screws

    3. number of screw holes

    4. location of the lesion

    5. presence of cortical erosion

     

    499-[ ] A seventy-four-year-old woman who lives independently sustained a displaced femoral neck fracture after a simple fall at the golf course. She has mild hypertension but is otherwise healthy. If you perform internal fixation rather than a total hip replacement, which of the following outcome measures

    would be most likely?

     

    1. a better possibility of independent living

    2. better hip function

    3. a reduced risk of hip complications

    4. an increased risk of revision surgery

    5. a better quality of life

    500-[ ] In a study comparing treatment with external fixation with treatment with an elastic stable intramedullary nail in children who sustained a tibial fracture, the children who had the latter procedure were found to have:

     

    1. a higher rate of union

    2. a shorter time to union

    3. a higher prevalence of residual deformity

    4. worse functional scores

    5. less patient satisfaction

     

    501-[ ] Which of the following is the most important factor in the evaluation of peroneal tendon pathology with diagnostic ultrasound?

     

    1. low cost

    2. low-frequency transducers

    3. ability to perform color Doppler imaging

    4. experience of the operator

    5. ability to differentiate peroneal tendon tears from ligament injuries

     

    502-[ ] Following triple arthrodesis, additional procedures are sometimes needed to fully correct acquired adult flatfoot deformity. Which of the following adjunctive procedures would help correct residual forefoot varus?

     

    1. calcaneocuboid distraction arthrodesis

    2. medial displacement calcaneal osteotomy

    3. plantar flexion opening wedge osteotomy of the first cuneiform

    4. flexor digitorum longus tendon transfer

    5. peroneus longus tendon transfer

     

    503-[ ] Which of the following statements regarding platelet-derived growth factor is most

    true?

     

    1. it has not been shown to improve healing in any tissue except bone

    2. it might increase the pool of undifferentiated mesenchymal cells in an ectopic muscle site, but the osteoinductive factors in demineralized bone matrix may not be present in sufficient quantity to move the cells into the endochondral pathway

    3. neither platelet-derived growth factor nor any other growth factor has been shown to augment the osteoinductive properties of demineralized bone matrix

    4. platelet-derived growth factor must be combined with the other growth factors in PRP before it becomes osteoinductive

    5. only osteoblasts and osteoclasts are responsive to platelet-derived growth factor

     

    504-[ ] Which nerve is at greatest risk of injury when an anterolateral portal is being established for arthroscopic surgery of the elbow?

    1. radial nerve

    2. ulnar nerve

    3. median nerve

    4. anterior interosseous nerve

    5. lateral antebrachial cutaneous nerve

     

    505-[ ] Bisphosphonate therapy has been shown to be beneficial in the management of all of the following skeletal conditions except:

     

    1. adult osteonecrosis

    2. hypercalcemia of malignancy

    3. Paget disease

    4. steroid-induced osteoporosis

    5. osteogenesis imperfecta

     

    506-[ ] With regard to the development and prognosis of spondylolisthesis, the term “pelvic incidence” is defined as:

     

    1. the same as sacral slope

    2. the same as pelvic tilt

    3. independent of sacral slope

    4. independent of pelvic tilt

    5. the sum of sacral slope and pelvic tilt

     

    507-[ ] A seventy-year-old patient who is generally healthy is scheduled to have a total hip replacement next week. The patient and his family want to know what to expect in terms of short-term and longer-term mortality. You should tell them that, compared with patients of the same age who do not have hip replacement, patients who have hip replacement have:

     

    1. essentially the same survival at one month, one year, and five years after surgery

    2. better survival at one month, one year, and five years after surgery

    3. worse survival at one month, one year, and five years after surgery

    4. worse survival at one month but better survival at one year and five years after surgery

    5. better survival at one month but worse survival at one year and five years after surgery

     

    508-[ ] The anticoagulant effect of the synthetic pentasaccharide fondaparinux occurs by which of the following mechanisms?

     

    1. direct thrombin inhibition

    2. direct factor-XA inhibition

    3. indirect thrombin inhibition

    4. vitamin-K antagonist

    5. inhibition of cyclooxygenase activity

    509-[ ] A group of surgeons is asked to classify a group of thoracolumbar fractures with the Denis system and the AO (Magerl) scheme to test the schemes’ interobserver reliability. Three months later, they are given the same radiographs in a different order to test intraobserver repeatability. The expected results are:

     

    1. high interobserver reliability but low intraobserver repeatability

    2. high interobserver reliability and substantial intraobserver repeatability

    3. fair-to-moderate interobserver reliability and substantial intraobserver repeatability

    4. low interobserver reliability and low intraobserver repeatability

    5. fair-to-moderate interobserver reliability and fair-to-moderate intraobserver repeatability 510-[ ] Which of the following is the least common type of peroneal tendon tear?

    1. rupture (grade-III tear) of the peroneus brevis tendon

    2. longitudinal tear of the peroneus longus tendon

    3. attritional tear of the peroneus brevis tendon in middle-aged women

    4. split tear of the peroneus brevis tendon

    5. tear associated with an accessory peroneus quartus tendon

     

    511-[ ] The etiology of fibrous dysplasia has been linked to:

     

    1. an autosomal dominant genetic trait

    2. a congenital anomaly

    3. a mutation in a guanine-nucleotide binding protein

    4. a decreased amount of cAMP produced by dysplastic cells

    5. a mutation of TRNA for alanine

     

    512-[ ] Which of the following statements regarding the indications for rotator cuff surgery is true?

     

    1. the indications for rotator cuff surgery are standardized

    2. the natural history of rotator cuff disease is known

    3. there is consensus among orthopaedic surgeons regarding the treatment of rotator cuff tears

    4. there is a lack of clinical agreement about the indications for rotator cuff surgery

    5. there is no regional variation among orthopaedic surgeons regarding clinical decisionmaking about rotator cuff disease

        

       512-[ ] As the disc degeneration proceeds, hypermobility of the segment can result in instability or degenerative arthritic changes or both. Hypertrophic changes are predominantly in the cervical spine at:

       1. The facet joints

       2. the uncovertebral joint

       3. at the anterior attachment of the anterior longitudinal ligament

       4. at the posterior attachment of the posterior longitudinal ligament

       5. at the interpedicular space

     

    513-[ ] Hypertrophic spurring anteriorly in the cervical spine can result in which of the following conditions:

     

    1. dysphagia

    2. vertigo

    3. dyspnea

    4. chest pain

    5. instabilityد

     

    514-[ ] Which of the following substances is not involved in the biochemistry of disc degeneration:

     

    1. matrix metalloproteinases

    2. nitric oxide

    3. fibrinogen growth factor

    4. prostaglandin E2

    5. interleukin-6

     

    515-[ ] When a cervical disc is punctured anteriorly for the purpose of discography pain is noted in the:

     

    1. neck and shoulder

    2. lateral aspect of the arm

    3. in hand on the side of the puncture

    4. anterior chest

    5. sternum

     

    516-[ ] Rupture of the C4-5 disc with compression of the C5 nerve root should result in weakness of the:

     

    1. supraspinatus and infraspinatus muscles

    2. deltoid and biceps muscles

    3. extensor carpi radialis and brevis

    4. brachioradialis muscle

    5. flexor carpi ulnaris muscle

     

    517-[ ] Rupture of the C5-6 disc with compression of the C6 root would result in:

     

    1. supraspinatus and infraspinatus muscles

    2. deltoid and biceps muscles

    3. extensor carpi radialis and brevis

    4. Weakness in the biceps, extensor carpi radialis longus and brevis muscles

    5. flexor carpi ulnaris muscle

     

    518-[ ] Rupture of the C5-6 disc with compression of the C6 root would result in:

     

    1. a decreased sensibility in the corresponding suprascapular region

    2. a decreased sensibility over the lateral proximal forearm, thumb, and index finger

    3. a decreased sensibility over the middle finger

    4. a decreased sensibility over the ring, small finger and medial aspect of forearm

    5. a decreased sensibility over the the medial arm

     

    519-[ ] Rupture between C7 and T1 disc with compression of the C8 nerve root results in no reflex changes and could lead to weakness in which of the following muscles:

     

    1. Biceps

    2. Brachioradialis

    3. Interossei

    4. Extensor carpi radialis and brevis

    5. Deltoid

     

    520-[ ] When the index finger is the predominant digit with sensory change, with evidence of hypalgesia is consistent with compression of which of the following cervical nerves:

     

    1. C1-2

    2. C3-4

    3. C4-5

    4. C6-7

    5. C8-T1

     

    521-[ ] If with shoulder abduction and elbow flexion while placing the hand on the top of the head, is allowed to persist for a minute or two, causing pain to be increased in the involved extremity, in a patient with cervical spondylosis, should rule out most which of following conditions:

     

    1. tardy ulnar nerve syndrome

    2. cubital tunnel syndrome

    3. primary shoulder pathological conditions

    4. cervical radicular compression

    5. carpal tunnel syndrome

     

    522-[ ] On distracting the cervical spine in the neutral position, can relieve root compression pain, but also can increase pain caused by:

     

    1. ligamentous injury

    2. thoracic outlet syndrome

    3. carpal tunnel syndrome

    4. tardy ulnar nerve palsy

    5. primary shoulder pathological conditions

     

    523-[ ] A Hoffman’s sign when present is typical of a:

     

    1. multiple sclerosis

    2. amyotrophic lateral sclerosis

    3. upper cervical cord compression

    4. C7-T1 compression

    5. Syrinx

     

    524-[ ] An inverted radial nerve reflex when present, is typical of which of the following area of compression:

     

    1. C2-3

    1. C3-4

    2. C5-6

    3. C6-7

    4. C8-T1

     

    525-[ ] In patients (age 35 Years) with persistent neck pain without localized neurological findings, what additional test besides MRI, CT & Myelogrphy (all being normal) could be used to help in localizing the cause:

     

    1. EMG

    2. Nerve conduction study

    3. Technetium scan

    4. Discography

    5. PET scans

     

    526-[ ] Which structure could be most injured by using a right sided anterior approach of the cervical spine:

     

    1. the omohyyoid muscle

    2. the longus colli muscle

    3. the sympathetic plexus

    4. the right recurrent laryngeal nerve

    5. the vagus nerve

     

    527-[ ] Which structure could be most injured by using a left sided anterior approach of the cervical spine:

     

    1. the omohyyoid muscle

    2. the thoracic duct

    3. the sympathetic plexus

    4. the left recurrent laryngeal nerve

    5. the vagus nerve

     

    528-[ ] Isthmic spondylolisthesis is believed to be caused by which of the following mechanisms:

     

    1. elongation of the pedicle of the slipped vertebra

    2. pathologic weakness of the pedicle of the cephalic vertebra

    3. Repetitive impacts in extension, where the inferior articular process of the cranial vertebra impacts on the pars interarticularis of the caudal vertebra

    4. Deficiency in the inferior facet of the vertebra above with respect to the superior facet of the vertebra below

    5. By an acute traumatic fracture of the posterior elements of vertebra above on the more caudad distal vertebra

     

    529-[ ] Which of the following conditions is most associated with isthmic spondylolisthesis:

     

    1. Scheuermann’s disease

    2. Klippel Fiel syndrome

    3. Hemivertebra

    4. Failure of vertebral segmentation

    5. Basilar impression

     

    530-[ ] High-grade spondylolisthesis has been associated with:

     

    1. Scheuermann’s disease

    2. Klippel Fiel syndrome

    3. abnormalities of the sacral growth plate

    4. Hemivertebra

    5. Failure of vertebral segmentation

     

    531-[ ] All the following comply to the progression of spondylolisthesis except:

     

    1. The trapezoid shape of the vertebral body

    2. Males are at higher risk of progression than females

    3. Patients with higher grades of spondylolisthesis

    4. Higher slip angles, a measure of lumbosacral kyphosis, have a higher risk of progression

    5. doming of the upper sacral plate

     

    532-[ ] The most common identifiable cause of back pain in a child is:

     

    1. spondylolysis

    2. scheuermann’s disease

    3. benign bone tumor

    4. discitis

    5. calcification of the discs

     

    533-[ ] A high grade spondylolisthesis is associated most with:

     

    1. lordosis

    2. scoliosis

    3. flattening in the lumbar area

    4. lateral lumbar list

    5. pot belly

     

    534-[ ] A heart-shaped buttocks is most associated with a:

     

    1. Sacral agenesis

    2. Spondyloptosis

    3. Lumbar Scheuermann’s disease

    4. Myelomeningocele

    5. Hemivertebra

     

    535-[ ] The most likely finding on physical examination of a patient with spondylolisthesis, would be:

     

    1. a positive babinski

    2. a positive Beavor sign

    3. a positive Trendlenberg sign

    4. hamstring tightness

    5. failure of eccentric elongation of the foot during heel strike

     

    536-[ ] The gait of a child diagnosed to have a high grade spondylolisthesis, would be, a:

     

    1. crouching

    2. pendulum

    3. hitch hyke

    4. antalgic

    5. trendlenberg…..gait

     

    537-[ ] Which of the following conditions is least associated with scoliosis:

     

    1. Scheuerrmann’s kyphosis

    2. Spondylolisthesis

    3. Klippel Fiel syndrome

    4. Syrinx

    5. platyspondyly

     

    538-[ ] Oblique lumbar views highlight the "Scotty dog."

    Which of the following does not fit with the description of the contents of the Scotty dog:

    1. the ear is formed by the superior articular process

    2. the eye is the pedicle

    3. the nose is the transverse process

    4. the neck is the lamina

    5. the front limb is the inferior articular process 539-[ ] The slip angle is:

    1. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

    2. the angle between the posterior aspect of the sacrum and the vertical

    3. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

    4. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

    5. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

     

    540-[ ] The sacral inclination is:

     

    1. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

    2. the angle between the posterior aspect of the sacrum and the vertical

    3. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

    4. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

    5. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

     

    541-[ ] The pelvic incidence is:

     

    1. the angle between a line drawn between the center of the femoral head to the midpoint of the sacral end plate and a line perpendicular to the center of the sacral end plate

    2. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

    3. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

    4. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

    5. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

     

    542-[ ] Single-Photon-Emission Computed Tomography is beneficial to a patient with spondylolisthesis. This is includes all except:

    1. Enables localization of signal to the posterior vertebral elements, specifically the pars interarticularis

    2. Facilitates the diagnosis of spondylolysis

    3. It helps in distinguishing between a stable and unstable pars defect

    4. Increased signal intensity suggests osseous activity and healing potential

    5. Absence of an increased signal suggests a nonunion and diminished healing potential

     

    543-[ ] Which of the following investigations is most useful to evaluate an atypical presentation, including pre-lysis of the pars interarticularis:

     

    1. Plain x-ray (lateral view)

    2. Plain x-ray (oblique view)

    3. CT scan

    4. MRI

    5. Flexion and extension lateral x-ray views of the lumbosacral region of the spine

     

    544-[ ] Which of the following provides the best information on the healing potential of a pars defect:

     

    1. CT scan

    2. A SPECT scan

    3. An MRI

    4. A technetium Scan

    5. Simple Plain Tomography

     

    545-[ ] The key role of spinal orthotics in the treatment of spondylolysis is:

     

    1. Reduction of the lumbar lordosis

    2. Reduction of thoracolumbar kyphosis

    3. Allowing extension of the lumbar spine

    4. Preventing extension of the hips

    5. Maintaining and preventing worsening of the deformity

     

    546-[ ] One of the major risks of an anterior interbody fusion of the lumbar spine, would be:

     

    1. retrograde ejaculation

    2. instability

    3. causalgia

    4. cord injury

    5. nonunion

     

    547-[ ] Long-tract clinical findings in the upper and lower extremities arising from involvement of the spinal cord by the spondylotic changes in the cervical spinal column is known as:

    1. cervical radiculopathy

    2. Cervical myelopathy

    3. Syrinx

    4. Amyotrophic lateral sclerosis

    5. Multiple sclerosis

        

       548-[ ] Low levels of high-energy phosphates such as adenosine triphosphate, adenosine diphosphate, and phosphoryl creatine have been found in trapezius muscles of patients with:

        

       1. Amyotrophic lateral sclerosis

       2. Multiple sclerosis

       3. Fibromyalgia with neck pain

       4. Syringomyelia

       5. Syrinx

     

    549-[ ] The biomechanical changes that occur with age result in a degenerative cascade. These include all, except:

     

    1. The intervertebral disc maintains its height

    2. The posterior portions of the disc bulge into the spinal canal and the neuroforamina

    3. The ligamentum flavum infold

    4. The facet joint capsule infold

    5. osteophytes form

     

    550-[ ] Patients who have cervical myelopathy with <40% compression are likely to have additional factors. Thes include all except:

     

    1. developmentally reduced anteroposterior diameter of the spinal canal

    2. dynamic cord compression

    3. dynamic changes in the intrinsic morphology of the spinal cord

    4. an impaired vascular supply of the spinal cord

    5. a cervical syrinx

     

    551-[ ] The normal anteroposterior diameter of the subaxial spine in normal adults measures:

    1. 11mm

    2. 13mm

    3. 14-16mm

    4. 17 to 18mm

    5. 20-21mm

     

    552-[ ] The segmental anteroposterior diameter as well as the volume of the cervical spinal canal have been found to be reduced in:

     

    1. Flexion

    2. Rotation

    3. Lateral compression

    4. Extension

    5. Distraction

     

    553-[ ] Retrolisthesis of which of the following levels in the cervical spine could accentuate cord compression in elderly individuals with myelopathy:

     

    1. C2 on C3

    2. C3 on C4

    3. C4 on C5

    4. C5 on C6

    5. C6 on C7

    554-[ ] Pain in the posterior neck muscles that is worsened by flexion of the head suggests: A discogenic component

    It is referred from the heart It is referred from the lungs A myofascial etiology

    It is referred from the abdominal viscera

     

    555-[ ] Pain in the posterior aspect of the neck that is aggravated by extension and especially by rotation of the head to one side suggests:

     

    A discogenic component It is referred from the heart It is referred from the lungs A myofascial etiology

    It is referred from the abdominal viscera

    556-[ ] Neck pain with fever, weight loss, or non-mechanical neck pain may point to a: Rheumatoid spondylitis

    Tumor

    Disc calcification Myofascial etiology Heart pathology

     

    557-[ ] The symptoms of cervical radiculopathy that are aggravated by extension or lateral rotation of the head to the side of the pain is known as:

     

    1. L’hermitte sign

    2. The Spurling maneuver

    3. The Beavor sign

    4. The Hoffman sign

    5. The Mcgregor sign

    558-[ ] A ”finger escape sign” is:

     

    1. loss of dexterity

    2. diffuse numbness

    3. wasting of the intrinsic hand muscles

    4. inability to rapidly grasp and release the fist

    5. ulnar and flexor drift of the ulnar two digits while attempting to keep the fingers adducted and extended

     

    559-[ ] A hyperactive scapulohumeral reflex is in favor of which of the following statements:

     

    1. Myelopathy resulting from a cord level C1 to C3

    2. Myelopathy resulting from a cord level C3 to C4

    3. Myelopathy resulting from a cord level C4 to C5

    4. Myelopathy resulting from a cord level C5 to C6

    5. Myelopathy resulting from a cord level C6 to C7

     

    560-[ ] Tapping of the spine of the scapula or acromion results in scapular elevation and/or abduction of the humerus is known as:

     

    1. Hoffmann reflex

    2. The inverted radial reflex

    3. The scapulohumeral reflex

    4. The shoulder abduction sign

    5. The Froment’s sign

     

    561-[ ] By dividing the anteroposterior diameter of the spinal canal by the anteroposterior diameter of the vertebral body, is known as:

     

    1. Powers ratio

    2. Pavlov’s ratio

    3. MacCreggors ratio

    4. Stulberg’s ratio

    5. Insall’s ratio

     

    562-[ ] What should the value of the Pavlov ratio be, to make the diagnosis of spinal stenosis:

     

    1. 1.2

    2. 1.6

    3. 0.8

    4. 1.0

    5. 1.5

     

    563-[ ] Translation of the cervical vertebra >3.5 mm and relative sagittal plane angulation of

    >11° is indicative of:

    1. spinal stenosis

    2. cervical myelopathy

    3. instability

    4. platybasia

    5. syrinx

     

    564-[ ] In the evaluation of a patient suspected to have cervical myelopathy computed tomography myelography may be preferable to magnetic resonance imaging because of all, except:

     

    1. Differentiation of bone and soft tissues

    2. It tended to upgrade the degree of spinal canal compromise

    3. Neural foraminal encroachment is well demonstrated

    4. Provides poor imaging detail in patients with postoperative metal artifacts or scoliotic deformity

    5. Cord diameter reduction is well demonstrated

     

    565-[ ] An MRI that shows a combination of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images indicates all the following, except:

     

    1. Severe lesions in gray matter

    2. Necrosis

    3. edema, which may resolve

    4. myelomalacia

    5. spongiform changes

     

    566-[ ] The pedicle diameter at the level of T4 is:

     

    1. 2.5mm

    2. 3.5mm

    3. 4.5mm

    4. 5.5mm

    5. 6.5mm

     

    567-[ ] The pedicle diameter at the level of L5 is:

     

    1. 6mm

    2. 8mm

    3. 9mm

    4. 11mm

    5. 18mm

     

    568-[ ] Besides C2 pedicle at what other level of the cervical spine, was the pedicle also of a larger diameter, than all other cervical vertebrae that would allow a pedicle screw:

    1. C3

    2. C4

    3. C5

    4. C6

    5. C7

     

    569-[ ] Which of the following cervical pedicles is the diameter, the smallest:

     

    1. C3

    2. C4

    3. C5

    4. C6

    5. C7

     

    570-[ ] At what level of the cervical spine is the vertebral artery least at risk while inserting a pedicle screw:

     

    1. C3

    2. C4

    3. C5

    4. C6

    5. C7

     

    571-[ ] The widest pedicle in the sagittal plane is at:

     

    1. T10

    2. T11

    3. T12

    4. L2

    5. L3

     

    572-[ ] Most pedicle fractures related to screw insertion occur:

     

    1. Medially

    2. Laterally

    3. Cephalad

    4. Caudad

    5. Through the vertebral body

     

    573-[ ] The artery of Adamkiewicz is the largest of feeders of the lumbar cord. It is most commonly located at which of the following levels:

     

    1. T5-6

    2. T6-7

    3. T8

    4. T9-11

    5. T12

     

    574-[ ] The blood supply to the spinal cord is rich, but the spinal canal is narrowest and the blood supply is poorest at:

     

    1. T1-2

    2. T2-4

    3. T4-9

    4. T10-11

    5. T12-L1

     

    575-[ ] A large and complex venous channel extending from the base of the skull to the coccyx, that communicates with the superior and inferior vena cava system and azygous system, would be:

     

    1. the anterior longitudinal vein

    2. the posterolateral longitudinal vein

    3. the vertebral vein

    4. the Batson plexus

    5. the portal vein

     

    576-[ ] During anterior spinal surgery all the following principles are followed except:

     

    1. Ligate the segmental spinal arteries only as necessary to gain exposure

    2. Ligate segmental spinal arteries near the aorta rather than near the vertebral foramina

    3. Dissect the segmental vessels carefully, and retract them in such a way as not to tear any. This would prevent damaging the artery of Adamkiewicz which is present on the right side

    4. Ligate segmental spinal arteries on one side only when possible, leaving circulation intact on the opposite side

    5. Limit dissection in the vertebral foramina to a single level when possible so that collateral circulation is disturbed as little as possible

        

       577-[ ] Pediatric trigger thumb after the age of three years is best treated by:

        

       1. Manipulation

       2. Local infiltration

       3. Operative release of the flexor sheath

       4. Operative lengthening of the flexor pollicis longus

       5. Observation, to be followed by surgery in the early teens if necessary 578-[ ] Rhabdomyosarcoma is a primary malignant tumor derived from:

    1. Smooth muscle

    2. Striated muscle

    3. Elastic tissue

    4. Collagen tissue

    5. Fibrous tissue

     

    579-[ ] With the development of electron microscopy and immunohistochemical techniques, more precise identification of striated myofibrils became possible in cases that were diagnosed to be Rhabdomysarcoma which allowed change of the diagnosis to:

     

    1. Synovial sarcoma

    2. Malignant fibrous histiocytoma

    3. Liposarcoma

    4. Fibrosarcoma

    5. myosarcoma

     

    580-[ ] Rhabdomyosarcoma accounts for what percent of all adult soft tissue sarcomas:

     

    a- 10%

    b- 20%

    c- 30%

    d- 40%

    e- 50%

     

    581-[ ] All the following statements apply well to Rhabdomyosarcoma, except:

     

    1. Age: Pleomorphic: the peak age incidence is 50-70 years

    2. Sex: Males are more involved than females

    3. In Pleomorphic rhabdomyosarcoma the proximal portions of the extremities are involved most with a predilection for the thigh

    4. Microscopic appearance of both the embryonal and pleomorphic rhabdomyosarcoma are identical

    5. In Embryonal Rhabdomyosarcoma the peak age incidence is 0-15 years

     

    582-[ ] In Rhabdomyosarcoma there is an associated chromosomal abnormality with translocation between:

     

    1. Chromosomes 2 and 13

    2. Chromosomes 11 and 21

    3. Chromosomes 5 and 15

    4. Chromosomes 11 and 12

    5. Chromosomes 15 and 17

     

    583-[ ] An intramuscular mass in a child is highly suggestive of a:

    1. Synovial sarcoma

    2. hematoma

    3. fibrosacoma

    4. rhabdomyosarcoma

    5. Malignant fibrous histiocytoma

     

    584-[ ] All the following are the predisposing conditions, may lead to a Septic Arthritis

    except?

     

    1. Malignancy

    2. Parentral drug abuse

    3. Legg Perthe’s disease

    4. Injection or aspiration

    5. Vascular insufficiency

     

    585-[ ] Which of the following joints is most commonly involved with septic arthritis?

     

    1. Knee

    2. Hip

    3. Elbow

    4. Shoulder

    5. Wrist

     

    586-[ ] All the following statements stand true for the clinical presentation in septic arthritis,

    Except:

     

    1. It varies with age

    2. Varies with immunocompetency

    3. Pain and swelling of the involved joint occurs in the older child

    4. Fever occurs in 50-78%

    5. Very few have limitation of motion, in particular the older child

     

    587-[ ] Which of the following statements concerning septic arthritis, does not apply to a Neonates:

     

    1. The immune system is immature

    2. The inflammatory response is absent

    3. The C-reactive protein (CRP) is always normal

    4. They may present with mild swelling, tenderness,and irritability

    5. Have discomfort with joint motion & pseudoparalysis

     

    588-[ ] In young adults which of the following organisms is known to cause septic arthritis besides staph aureus?

     

    1. E-coli

    2. Stretoccoccus

    3. N. gonorrhea

    4. Brucellosis

    5. Tuberculosis

    589-[ ] Which of the following primary bone tumors is least confused with a chondroblastoma?

     

    1. Eosinophilic Granuloma

    2. Chondrosarcoma

    3. Osteosarcoma

    4. Giant cell tumor

    5. Aneurismal bone cyst

     

    590-[ ] In which of the following pathologic specimens one often sees a “chicken wire” appearance on viewing different microscopic fields?

     

    1. Eosinophilic Granuloma

    2. Chondrosarcoma

    3. Osteosarcoma

    4. Giant cell tumor

    5. Chondroblastoma

     

    591-[ ] Unicompartmental Knee Arthroplasty is contraindicated in all of the following situations except:

     

    1. An ACL deficient knee

    2. Varus deformity of the knee of more than 15 degrees

    3. Valgus deformity of the knee of more than 20 degrees

    4. Significant ligamentous instability of the knee

    5. Extension lag of the knee of 10 degrees

     

    592-[ ] A mobile, meniscus bearing Oxford Unicompartmental knee Arthroplasty has been complicated most by which of the following:

     

    1. Limitation of flexion of the knee

    2. Dislocation of the polyethylene component

    3. Patellar impingement by the tibial endplate

    4. Patellar impingement by the femoral resurfacing component

    5. Overcorrection of the varus deformity of the knee

     

    593-[ ] Which of the following, has been noted to be least associated with a Unicompartmental knee Arthroplasty when strict indications have been applied?

     

    1. Progression of a patellofemoral degenerative disease

    2. Progression of the degenerative process in the opposite compartment of the knee

    3. Anterior posterior instability of the knee

    4. A progressive flexion contracture of the knee

    5. Quadriceps weakness with poor stair climbing

     

    594-[ ] In Grade II and III open tibial fractures the best and most acceptable prophylactic antibiotic therapy, would be:

    1. A first generation cephalosporin

    2. A second generation cephalosporin

    3. A combination of second generation cephalosporin with an aminoglycoside

    4. A first generation cephalosporin in combination with penicillin G

    5. An aminoglycoside

     

    595-[ ] A patient presents to the Emergency Room having sustained a severe compound fracture of the tibial shaft, that resulted from a fallen wall, during the bombardment that occurred in the recent (2006) Lebanese-Israeli war; which of the following antibiotics should be added to the accepted prophylactic regimen?

     

    1. Aminoglycoside

    2. Penicillin G

    3. First generation cephalosporin

    4. Vancomycin

    5. Dalacin C

     

    596-[ ] Lateral and anteroposterior views usually are sufficient to rule out a fracture in the elbow, with the exception of:

     

    1. a fracture of the posterior aspect of the radial head

    2. a fracture of the capitellum

    3. a fracture pf the lateral condyle

    4. a fracture of the medial condyle

    5. a fracture of the olecranon

     

    597-[ ] If radiographic examination in a child between four and eight years of age, following an injury to the elbow, reveals a bony structure in the region of the trochlea, most probably is in favor of:

     

    1. a fracture of the capitellum

    2. a fracture of the lateral epicondyle

    3. an avulsion of the ossification center of the olecranon

    4. avulsion the growth center of the olecranon

    5. avulsion of the medial epicondyle with the fragment within the joint

     

    598-[ ] If a line were drawn along the longitudinal axis of the proximal radius, it should pass through the center of:

     

    1. the capitellum

    2. the trochlea

    3. the humeral shaft

    4. the medial condyle

    5. the olecranon fossa

    599-[ ] A line drawn along the anterior margin or cortex of the longitudinal axis of the humeral shaft (lateral view), should pass through:

     

    1. the posterior third of the capitellum

    2. the middle third of the capitellum

    3. the anterior third of the capitellum

    4. the center of the radial head

    5. the center of the coronoid process

     

    600-[ ] Normally, the posterior fat pad, which lies deep in the olecranon fossa

     

    1. is not visible on the lateral view

    2. is apparent and appears like a sail

    3. is apparent and lies adjacent to the olecranon trochlea

    4. is more apparent on oblique views of the elbow

    5. is apparent on lateral views of the elbow and becomes more prominent when associated with a fracture

     

    601-[ ] The fibrous continuation of the spinal cord below Lumbar 1 vertebra is known as the:

     

    1. Conus Medullaris

    2. Filum terminal

    3. Cauda Equina

    4. Sine Quinus

    5. Basilar impression

     

    602-[ ] The most acceptable theory to explain the cause of congenital pseudoarthrosis of the clavicle, would be:

     

    1. Nonunion of a birth fracture

    2. A localized clavicular intra-uterine infection

    3. Pulsations of the subclavian artery and it effect on the middle aspect of the clavicle

    4. Neurofibromatosis of the clavicle

    5. Poor vascularity of the mid-clavicle at birth

     

    603-[ ] Congenital absence of the clavicle bilaterally is associated with which of the following conditions?

     

    1. Neurofibromatosis

    2. Cleidocranial dysostosis

    3. Diastrophic dwarfism

    4. Pyle’s syndrome

    5. Neiman Pick’s disease

    604-[ ] A four month’s old infant, is noted to have swelling in the region of the clavicle with fever and an elevated sedimentation rate of 60mm/1st hour. X-rays reveal, increased sclerosis of both clavicles and scapulae. Your most likely diagnosis would be:

     

    1. Ewing’s sarcoma

    2. Osteosarcoma

    3. Infantile cortical hyperostosis

    4. Eosinophilic Granuloma

    5. Hypogammaglobulenemia associated with multifocal osteomyelitis

     

    605-[ ] Bilateral congenital pseudoarthrosis of the clavicle has been associated with which of the following conditions:

     

    1. Neurofibromatosis

    2. Cleidocranial dysostosis

    3. Diastrophic dwarfism

    4. Pyle’s syndrome

    5. Trisomy 22

     

    606-[ ] Which of the following carpal bones is the key to stability (of all the carpal bones):

     

    1. The scaphoid

    2. The trapezium

    3. The capitate

    4. The trapezoid

    5. The lunate

     

    607-[ ] Dissociative carpal instability results most from division of which of the following ligaments:

     

    1. The scapho-lunate ligament

    2. The scapho-trapezium ligament

    3. The trapezium-trapezoid ligament

    4. The triquetro-hamate ligament

    5. The capito-lunate ligament

     

    608-[ ] Injury to which of the inter-carpal ligaments leads to a non-dissociative wrist instability pattern

     

    1. The scapho-lunate ligament

    2. The scapho-trapezium ligament

    3. The trapezium-trapezoid ligament

    4. The triquetro-hamate ligament

    5. The capito-lunate ligament

    609-[ ] Which of the following conditions, has been associated with phases of osteolysis followed by phases of osteoblastic bone formation, leading to a mosaic bone appearance?

     

    1. Osteomyelitis

    2. Sickle Cell Anemia

    3. Fluorosis

    4. Hypervitaminosis A

    5. Paget’s disease

     

    610-[ ] A condition which is most associated with a woven bone quality would be:

     

    1. Hyperparathyroidism

    2. Paget’s disease

    3. Trevors disease

    4. Osteosarcoma

    5. Sickle Cell Disease

     

    611-[ ] Which of the following sites is the third in frequency following metastasis from a primary carcinoma:

     

    1. Lung

    2. Liver

    3. Bone

    4. Skeletal muscle

    5. Subcutaneous fat

     

    612-[ ] Which of the following is least to have metastasis from a carcinoma at a different site:

     

    1. Lung

    2. Liver

    3. Bone

    4. Skeletal muscle

    5. Skull

     

    613-[ ] For a secondary tumor to infiltrate it usually secretes which of the following:

     

    1. Type I collagenase

    2. Type II collagenase

    3. Type III collagenase

    4. Type IV collagenase

    5. Type V collagenase

     

    614-[ ] Which of the following carpal bones is not located in the distal row of the wrist?

     

    1. Trapezium

    2. Trapezoid

    3. Capitate

    4. Pisiform

    5. Hamate

     

    615-[ ] What percent of wrist motion occurs at the mid-carpal level?

     

    a- 10%

    b- 25%

    c- 35%

    d- 50%

    e- 60%

     

    616-[ ] Which of the following structures does not pass through the carpal tunnel?

     

    1. Opponens pollicis

    2. Flexor digitorum sublimes

    3. Flexor digitorum profundus

    4. Flexor pollicis longus

    5. Median nerve

     

    617-[ ] At the wrist joint level, which of the following canals, does the ulnar nerve and artery traverse?

     

    1. Carpal tunnel

    2. Guyon’s tunnel

    3. Cubital tunnel

    4. The tunnel of Struther’s

    5. Henry’s canal

     

    618-[ ] Which of the following tendons passes through the third extensor compartment of the wrist?

     

    1. The Extensor Digiti Minimi

    2. The Abductor Pollicis Longus

    3. The Extensor Pollicis Longus

    4. The extensor digiti minimi

    5. The extensor indicis proprius

     

    619-[ ] All the following muscles are innervated by the median nerve distal to the carpal tunnel, Except:

     

    1. The lateral first lumbrical

    2. The abductor pollicis brevis

    3. The adductor pollicis

    4. The opponens pollicis

    5. The lateral second lumbrical

    620-[ ] The origin of the the lumbrical muscles is from:

     

    1. the proximal and volar base of the medial four metacarpal bones

    2. the proximal and dorsal base of the medial four metacarpal bones

    3. the flexor profundus tendons

    4. the distal row of carpal bones

    5. the flexor digitorum sublimes

     

    621-[ ] Which of the following structures forms the floor of the anatomical snuff box?

     

    1. the extensor digitorum longus

    2. the extensor carpi ulnaris

    3. the lunate bone

    4. the scaphoid bone

    5. the radial artery

     

    622-[ ] Which of the following tests evaluates both the radial and ulnar artery distal to the wrist?

     

    1. The Allen test

    2. The Phalen test

    3. The Finklestein test

    4. The Yergasons test

    5. The loosie test

     

    623-[ ] “No mans land” is located between:

     

    1. The wrist crease and proximal palmar crease

    2. The proximal and distal palmar crease

    3. The distal palmar crease and the insertion of the flexor sublimis at the mid-portion of the middle phalanx

    4. Zone II and III

    5. Zone III and IV

     

    624-[ ] Rupture of the central slip of the extensor expansion of the ulnar four digits results in a:

     

    1. Swan neck deformity

    2. Boutonnierre deformity

    3. Dupuytren’s contracture

    4. Dobyn’s deformity

    5. Terry Thomas deformity

     

    625-[ ] The most common site for a wrist ganglia to occur, would be at: a- The dorsal aspect and arises from the scapholunate ligament

    1. Dorsally and arises in connection with the triangular fibrocartilage

    2. Volarly and arises in connection with the lunotriquetral ligament

    3. Arises always in relation to the trapezio-metacarpal ligament

    4. Arises as a ganglia of the flexor tendon sheath at the A1 pulley

     

    626-[ ] Which of the following structures is most important in preventing bow stringing of the flexor tendons of the fingers?

     

    1. The A1 pulley

    2. The A2 pulley

    3. The A3 pulley

    4. The A5 pulley

    5. The vinculae tendinae

     

    627-[ ] In Talar neck fracture dislocations involving also the talo-navicular joint, the incidence of osteonecrosis of the body of the talus would be:

     

    a- 10%

    b- 25%

    c- 40%

    d- 70%

    e- 100%

     

    628-[ ] The cell that produces RANKL and is involved in bone metabolism, would be:

     

    1. Osteocyte

    2. Osteoblast

    3. Osteoclast

    4. Plasma cell

    5. Monocyte

     

    629- [ ] Which of the following, is known to stimulate P 450 action in the liver and thus leads to a deficiency in vitamin D?

     

    1. Hydantoin

    2. Estrogen

    3. Androgen

    4. Corticosteroids

    5. Residronate

     

    621-[ ] Calcitonin when given subcutaneously in a patient with a vertebral fracture, is known to lead to a:

     

    1. Increase in 25 vitamin D production in the proximal convoluted tubule

    2. Rise in the serum calcium

    3. Increase the osteoclastic ruffled border

    4. Significant decrease in the severity of pain

    5. Increase in the 1&hydoxylase activity in the kidney

     

    622-[ ] A rare condition known to have absence of the ruffled border of the osteoclast and a significant drop in the number of Howships lacunae, would be:

     

    1. Osteoporosis

    2. Osteopetrosis

    3. Paget’s disease

    4. Sickle cell anemia

    5. Osteomalascia

     

    623-[ ] Which of the following conditions is most likely to have a mosaic appearance, pathologic wise?

     

    1. Osteopetrosis

    2. Paget’s disease

    3. Alber’s Schonberg’s disease

    4. Hypothyroidism

    5. Rickets

     

    624-[ ] The osteoblast is known to produce:

     

    1. Type I collagen

    2. type II collagen

    3. type III collagen

    4. type IV collagen

    5. type V collagen

     

    625-[ ] Which of the following is least likely to be associated with Rickets?

     

    1. craniotabes

    2. basilar impression

    3. costochondral enlargement

    4. clubbing of the wrists

    5. subperiosteal hemorrhage and thickening

     

    626-[ ] With which of the following conditions Looser zones has been associated:

     

    1. Osteoporosis

    2. Paget’s disease

    3. Osteomalascia

    4. Sickle cell anemia

    5. Osteopetrosis

     

    627-[ ] Which of the following is least associated with a parathyroid adenoma?

    1. Salt and pepper lytic lesions of the skull

    2. Erosion of the outer end of the clavicle

    3. A tent chest

    4. Erosions of the outer end of the metacarpals

    5. Pseudo clubbing of the fingers

     

    629-[ ] In Pediatric Osteomyelitis, which of the following joints does not include the metaphysis and is not at risk of having a septic arthritic process, by a rupture of pus via the subperiosteal route?

     

    1. Elbow

    2. Hip

    3. Wrist

    4. Ankle

    5. Shoulder

     

    630-[ ] A line drawn tangential to the opisthion and also passes tangent to the upper and posterior margin of the odontoid, is known as a

     

    1. Wickenheim line

    2. Mcgregor line

    3. Mack’s line

    4. Wilson line

    5. Power line

     

    631-[ ] An elderly man fell and sustained as hyperextended injury to his neck. He was noted to have significant weakness in his upper extremities when compared to the lower.

    He most probably has a:

     

    1. Posterior cord syndrome

    2. Central cord syndrome

    3. Anterior cord syndrome

    4. Brown Sequard syndrome

    5. SCIWORA

     

    632-[ ] Both neurogenic and hemorrhagic shock have in common hypotension, what distinguishes these two conditions:

     

    1. Ventricular hypertrophy

    2. bradycardia

    3. auricular fibrillation

    4. dyspnea

    5. neurologic status

    633-[ ] Drug addicts using the intravenous route, are predisposed to which of the following organisms, should they have osteomyelitis:

     

    1. E-Coli

    2. Staph aureus

    3. Streptococcus

    4. Pseudomonas

    5. Gonococci

     

    634-[ ] The most frequent site to be involved in fractures of the atlas, would be:

     

    1. The anterior arch

    2. The lateral mass

    3. The posterior arch

    4. The anterior tubercle

    5. The posterolateral corner of the posterior arch

     

    635-[ ] At which level of the cervical spine in a child one often notices a pseudo subluaxtion of the facets?

     

    1. occiput-atlantal interval

    2. C1-2

    3. C2-3

    4. C4-5

    5. C6-7

     

    636-[ ] In Scoliosis, An apical vertebra would be:

     

    1. the vertebra which is most tilted

    2. the vertebra which is least rotated

    3. the vertebra which is most laterally deviated

    4. the vertebra which is least wedged

    5. the vertebra which is usually subluxed over that below

     

    637-[ ] A child who develops a painful scoliotic curve at the wrong time and place, would be most likely due to an:

     

    1. Osteoid osteoma

    2. Tethered cord

    3. Syringomyelia

    4. Neurofibromatosis

    5. Fibrous dysplasia

     

    638-[ ] In infantile scoliosis, the most likely predictable finding that would indicate most likely that a curve is going to progress, would be:

    1. Reisers sign

    2. Moes sign

    3. A rib vertebral angle difference of more than 20 degrees

    4. Tanner’s sign’s

    5. Powers ratio

     

    639-[ ] Should you be giving a lecture on “Osteochondritis Dessicans”, which of the following portion of the knee joint is most commonly the site of this lesion?

     

    1. patella

    2. lateral femoral condyle

    3. medial femoral condyle

    4. medial tibial plateau

    5. lateral tibial plateau

     

    640-[ ] Which of the following deformities is last to be corrected in a club foot deformity?

     

    1. Metatarsal adduction

    2. Equinus

    3. Lateral rotation of the talus

    4. Medial deviation of the talus

    5. Medial subluxation of the navicular

     

    641-[ ] The best radiologic marker that would indicate subluxation of the hip in an adult, would be:

     

    1. Acetabular Index

    2. Shentons line

    3. Cervico obturator index

    4. CE angle

    5. Von Rosen’s line

     

    642-[ ] Which of the following radiologic findings would favor most a poor result, should surgery be performed on a dysplastic hip?

     

    1. an acetabular index of more than 30 degrees

    2. a significantly wide tear drop

    3. A CE angle of 18 degrees

    4. A broken Shenton’s line

    5. An interrupted Von Rosen line

     

    643-[ ] Avascular necrosis of the tarsal navicular is known as:

     

    1. Kienbock’s disease

    2. Kohler’s disease

    3. Panner’s disease

    4. Brailfords disease

    5. Freiberg’s disease

     

    644-[ ] Which of the following is not a head at risk sign in Legg Perthe’s disease?

     

    1. Lateral subluxation of the hip

    2. Lateral column height

    3. Gage’s sign

    4. Horizontal proximal physis

    5. A wide tear drop

     

    645-[ ] Should you observe on radiologic evaluation of both hips in a patient with avascular necrosis, a bilateral symmetrical involvement, would put the diagnosis least in favor of:

     

    1. Gauchers disease

    2. Legg Perthe’s Disease

    3. Epiphyseal dysplasia

    4. Hypothyroidism

    5. Larsens dysplasia

     

    646-[ ] The best management of a child with Legg Perthe’s disease of the hip at the age of 3 years, would be:

     

    1. Salter osteotomy

    2. Chiari osteotomy

    3. Varus osteotomy

    4. No treatment, only observation

    5. Pemberton osteotomy

     

    647- [ ] Which of the following classifications of Legg Perthe’s disease corresponds to the height of the lateral epiphyseal ossification center?

     

    1. Salter and Thompson

    2. Catterall

    3. Pillar, Herring

    4. Mose’

    5. Steinberg

     

    648-[ ] One of the explanations for osteomyelitis to involve the metaphysis of a long bone,

    most often, in a child, would be:

     

    1. a drop in the reticular-endothelial cell system in the metaphysis

    2. is the most vulnerable to trauma

    3. is the most vascular area of bone

    4. it is localized within the joint

    5. it consists of a significant zone for lymphatic drainage

    649-[ ] Which of the following conditions has been associated with repeated attacks of avascular necrosis of the hip, in a child?

     

    1. Legg Perthe’s disease

    2. Epiphyseal dysplasia

    3. Diastrophic dwarfism

    4. Hypothyroidism

    5. Gauchers disease

     

    650-[ ] Fibrous dysplasia is known to have a disturbance in:

     

    1. fibrilin production

    2. collagen formation

    3. dystrophin production

    4. sphingomyelin

    5. p-450 formation

     

    651-[ ] Which of the following conditions is associated with a disturbance in fibrilin?

     

    1. Marfan’s syndrome

    2. Scheuermann’s disease

    3. Fibrous dysplasia

    4. Sanfillipo’s mucopolysaccharidoses

    5. Boeck’s sarcoid

     

    652-[ ] In a child, born to have a posteromedial bowing deformity of the tibia, with an apparent valgus deformity of the foot, should be managed best by:

     

    1. observation

    2. a varus osteotomy of the tibia

    3. repeated casting

    4. application of a brace

    5. application of a Denis brown splint

     

    653-[ ] In which of the following conditions, one should not consider at any time to perform an osteotomy for correction of the deformity of the tibia:

     

    1. posteromedial bowing

    2. anterolateral bowing

    3. Blount’ disease

    4. Medial compartment arthritis of the knee

    5. Osteonecrosis of the medial femoral condyle

     

    654-[ ] Which of the following conditions listed below has been associated with neurofibromatosis?

    1. Blounts disease

    2. Posteromedial bowing

    3. Anterolateral bowing

    4. Trevors disease

    5. Hypothyroidism

     

    655-[ ] Which of the following varieties of osteomyelitis has been transmitted by a tick?

     

    1. Tuberculosis

    2. Brucellosis

    3. Histoplasmosis

    4. Lymes disease

    5. Syphilis

     

    656-[ ] Young girls having a short first metatarsal bone on wearing high heels are predisposed to which of the following conditions?

     

    1. sesamoiditis

    2. hallux rigidus

    3. Freiberg’s disease

    4. Tailor’s bunion

    5. Over-riding second toe

     

    657-[ ] Epithelioid sarcoma of the hand is known to metastasize first to:

     

    1. The lung

    2. The liver

    3. Brain

    4. Lymph nodes

    5. Spleen

     

    658-[ ] Lesions within the nail bed that are Pin point sensitive resulting in pain are known as:

     

    1. Glomus tumors

    2. Mucinous cysts

    3. Heberdens nodes

    4. Felons

    5. paronychia

     

    659-[ ] Injuries to the thumb that result in avulsion of an ulnar collateral ligament which lies separated from its insertion by the adductor pollicis, is known as:

     

    1. Natatory ligament injury

    2. A Jones injury

    3. A Steiner lesion

    4. A Kienbocks lesion

    5. A Preisser lesion

     

    660-[ ] Pseudo-clubbing of the fingers is known to occur most commonly in which of the following conditions:

     

    1. Hypothyroidism

    2. Hyperparathyroidism

    3. Achondroplasia

    4. Acromegaly

    5. Enchondroma

     

    661-[ ] Spinal stenosis is known to occur most commonly in which of the following conditions:

     

    1. Morquio’s disease

    2. Hurler’s syndrome

    3. Panners disease

    4. Achondrosplasia

    5. Klippel Fiel syndrome

     

    662-[ ] At what level within the lumbar spine is spinal stenosis most likely to occur?

     

    1. L1-2

    2. L2-3

    3. L3-4

    4. L4-5

    5. L5-S1

     

    663-[ ] A 36 year old woman visited a psychiatrist who again referred her to an Internist, who requested X-rays of the Shoulder, skull and spine. She was noted to have drooping of the shoulders, salt and pepper lytic lesions of the skull and cod fish vertebrae. She most likely has:

     

    1. Rheumatoid arthritis

    2. Hyperparathyroidism

    3. Multiple myeloma

    4. Sickle cell disease

    5. sarcoidosis

     

    664-[ ] Which of the following conditions is known to have a tempo phenomenal involvement of the vertebrae and when the vertebral body is involved, is characterized by the silver dollar sign:

     

    1. Chondroblastoma

    2. Tuberculosis

    3. Eosinophilic granuloma

    4. Chordoma

    5. Brucellosis

     

    665-[ ] Which of the following applies least to Spinal stenosis:

     

    1. There is a mechanical compression on the neural tissue

    2. There is a mechanical vascular compression

    3. There is no instability of the adjacent spinal elements

    4. There is Percolation of CSF around the neural elements

    5. There is an alteration in the diffusion capabilities from the cells and axons

     

    666-[ ] Which of the following tumors microscopically gives a chicken wire appearance?

     

    1. Chondrosarcoma

    2. Eosinophilic Granuloma

    3. Chondroblastoma

    4. Multiple myeloma

    5. Osteosarcoma

     

    667-[ ] A fifty year old woman presents to you complaining that her right forefoot is pointing in a abducted position (extra toes appearance) with a depressed longitudinal arch on comparing it with the left foot. Your diagnosis would be most likely:

     

    1. Rheumatoid arthritis of the subtalar joint

    2. Degeneration and fibrillation of the tibialis posterior tendon

    3. Avascular necrosis of the cuboid with collapse

    4. Avascular necrosis of the navicular with collapse

    5. Avulsion of the flexor hallucis longus tendon

     

    668-[ ] In a malignant sarcoma, a nodular satellite lesion is characterized by:

     

    1. a lesion occurring at a distance proximal to the primary lesion with normal tissue in between both lesions

    2. a nodule within the same compartment of the primary, just outside the capsule or within the surrounding zone of the primary lesion

    3. a necrotic lesion lying within the primary lesion

    4. a dedifferentiated lesion within the primary lesion

    5. a multi-nodular primary lesion

     

    669-[ ] The most common soft tissue sarcoma of the hand would be:

     

    1. Giant cell tumor of the tendon sheath

    2. Synovial sarcoma

    3. Epithelioid sarcoma

    4. Liposarcoma

    5. Leiomyosarcoma

    670-[ ] A test performed to detect a slap lesion with the arm elevated to 160° in the scapular plane of the body, and loaded axially along the humerus and with maximal internal and external rotation is known as:

     

    1. Active Compression Test

    2. Biceps Load Test I

    3. Pain Provocation Test

    4. Crank Test

    5. Anterior Slide Test

     

    671-[ ] The first change that takes place in degenerative arthritis is:

    1. Increased production of proteoglycans

    2. Loss of collagen

    3. loss of the physical characteristic of compressibility as a result of increased polymerization of the proteoglycans

    4. loss of water passage via the synovial layers

    5. fragmentation of the collagen bonds 672-[ ] Weichselbaum's lacunae are:

    1. Proliferating clusters or clones of chondrocytes in large lacunae

    2. Necrotic chondrocytes

    3. Chondrocytes that undergo autolysis

    4. Hypertrophied chondrocytes

    5. Lacunae consisting of proteoglycans

    673-[ ] The joint in degenerative arthritis attempts to broaden its surface to decrease the load per area by:

    1. The primitive mesenchymal cells differentiate into chondroblasts and form reparative fibrocartilage

    2. Membranous ossification

    3. Reducing the production of osteophytes

    4. The increase secretion of proteoglycans

    5. Increasing the secretion of fluids thus reducing the friction 674-[ ] Fibrocartilage has a:

    1. Much higher collagen content than hyaline cartilage

    2. An equal amount of collagen with hyaline cartilage

    3. Less collagen than hyaline cartilage

    4. Less water than hyaline cartilage

    5. Less necrotic cartilage than hyaline cartilage

    675-[ ] The Cervico-thoracic junction is a transition zone from a:

    1. Kyphotic cervical region to a kyphotic rigid thoracic region

    2. Lordotic cervical spine to a kyphotic flexible thoracic region

    3. Lordotic cervical spine to a kyphotic rigid thoracic spine

    1. A rigid cervical spine to a rigid thoracic spine

    2. A flexible and lax cervical spine to a hypermobile thoracic spine 676-[ ] Which of the following statements is true:

    1. The diameter of the pedicles at the level of C6-7 are larger than those of the upper thoracic spine

    2. The lateral mass of C7 is larger than T1 vertebra

    3. The lower cervical spine has a low lever arm with respect to the upper thoracic spine

    4. Instrumentation at the level of C7-T1 has a high survival rate

    5. The vertebral artery is not a hindrance to surgery when performed at this level

    677-[ ] Which of the following radio-imaging is best for diagnosing Cervico-thoracic fracture dislocations:

    1. Swimmers views

    2. High resolution MRI

    3. Dynamic MRI

    4. High resolution, multidetector CT

    5. Plain x-ray tomography

    678-[ ] The common site for a fracture to occur in the spine would be at:

    1. Thoracic spine

    2. Lumbar spine

    3. Cervical-thoracic junction

    4. At the level of C6-7

    5. Thoraco-Lumbar junction

    679-[ ] The most common site for Rheumatoid Arthritis of the spine to occur in would be:

    1. Sacrum

    2. Cervical spine

    3. Thoracic spine

    4. Lumbar spine

    5. Coccyx

    680-[ ] Which of the following is least to occur in Rheumatoid arthritidis:-

    1. C1-C2 instability

    2. Basilar invagination

    3. Perched facets

    4. Subaxial subluxation

    5. Stepladder sign

    681-[ ] Subluxation of the atlas-dens interval of 10-12mm indicates:

    1. Tear of the basilar ligaments

    2. Tear of the apical ligament

    3. Tear of the apical, alar and transverse ligaments

    4. Tear of the transverse ligament

    5. Tear of the alar ligament

    682-[ ] At what diameter would the PADI be, to begin to suspect a cervical myelopathy, if the patient has an unstable gait?

    1. 20mm

    2. 13mm

    3. 15mm

    4. 17mm

    5. 18mm

    683-[ ] The diagnosis of Basilar impression is made when the tip of the dens projects more than:-

    1. 4.5 mm above the McGregor line

    2. 3.5mm above McGregor’s line

    3. 2.0mm above McGregor’s line

    4. 1.5mm above McGregor’s line

    5. 1.0mm above McGregor’s line

    684-[ ] The Stepladder deformity usually occurs at what level of the spine:

    1. C2-3-4 vertebrae

    2. C1-2 vertebra

    3. C4-5-6 vertebra

    4. T1-2-3-4 vertebra

    5. T4-5-6 vertebra

    685-[ ] In which area of the spine does enthesitis occur in ankylosing spondylitis:-

    1. In the endplate

    2. At the insertion of the annulus fibrosus on the vertebral body

    3. In the anterior longitudinal ligament

    4. In the posterior longitudinal ligament

    5. In the interspinous ligament

    686-[ ] The earliest radiologic findings are visible in which joints in patients diagnosed to have ankylosing spondylitis:-

    1. Costovertebral

    2. Atlanto-axial

    3. Cervicothoracic

    4. Sacroiliac

    5. Thoracolumbar………articulations

    687-[ ] Which of the following inflammatory diseases of the spine produces squaring of the vertebral body most:-

    1. Psoriasis

    2. Rheumatoid arthritis

    3. Ankylosing spondylitis

    4. Ulcerative colitis

    5. Reiter’s disease

    688-[ ] Loss of Lumbar lordosis in a patient with ankylosing spondylitis is best corrected by a pedicle substration osteotomy, at which of the following levels:-

    1. T12-L1

    2. L1-2

    3. L2-3

    4. L3-4

    5. L4-5

    689-[ ] In the correction of severe cervical kyphosis an extension osteotomy is best done at which level?

    1. C3-4

    2. C4-5

    3. C6-7

    4. C7-T1

    5. C2-3……levels

    700-[ ] Ankylosing Spondylitis is not characterized by which of the following statements:

    1. axial skeletal arthritis

    2. absence of rheumatoid factor in serum (seronegative)

    3. first involves the occipito-atlanto-axial joints

    4. the lack of rheumatoid nodules

    5. the presence of a tissue factor on host cells, human leukocyte antigen (HLA)-B27

    701-[ ] A male patient aged 55yrs presents with axial stiffness and generalized joint pain is most likely to have:

    1. Reiter’s disease

    2. Psoriasis

    3. Rheumatoid disease

    4. Ankylosing spondylitis

    5. Ulcerative colitis

    702-[ ] The most frequent site for a fracture to occur in a patient with ankylosing spondylitis would be:

    1. C3-4

    2. C5-6

    3. C6-7

    4. T3-4

    5. T8-9

    703-[ ] Which of the following does not abide to a teratologic hip dislocation, in a newborn:

    1. Commonly seen with arthrogryposis

    2. Common in myelomeningocele

    3. Often occurs in Larsen's syndrome

    4. The hip is dislocated in utero

    5. The hip is often reducible on neonatal exam

    704-[ ] DDH is common to occur in:

    1. Firstborn’s or in women with oligohydramnios

    2. Multiparida

    3. Insufficiency of the cervix opening

    4. Toxemia of pregnancy

    5. Uterine atonia

    705-[ ] DDH is least commonly associated with:

    1. congenital muscular torticollis

    2. metatarsus adductus

    3. congenital knee dislocation

    4. Multiple Epiphyseal Dysplasia

    5. conditions characterized by increased amounts of type III collagen

    706-[ ] Which of the following tests is positive in DDH, by the demonstration of inequality of the involved lower extremity on the same side?

    1. Ortolani

    2. Galleazi or Allis

    3. Barlow

    4. McEwen

    5. Cervico-obturator……test

    707-[ ] Which of the following tests is usually positive for DDH in a child aging 3 months and older:

    1. Ortolani

    2. Limitation of abduction

    3. Barlow

    4. McEwen

    5. Cervico-obturator……test 708-[ ] A Hilgenreiner’s line is:

    1. A line joining the upper margin of the acetabulum with the tri-radiate cartilage

    2. A line passing through the upper lateral margin of the acetabulum perpendicular to a horizontal line

    3. a horizontal line through right and left tri-radiate cartilage

    4. a line extending from the upper and outer margin of the acetabulum to the center of the hip

    5. another term, used to express Shenton’s line

    709-[ ] Acetabular index, is measured by:

    1. The angle formed by a line drawn from a point on the lateral triradiate cartilage to point on lateral margin of acetabulum and Hilgenreiners line

    2. A line joining the upper margin of the acetabulum with the tri-radiate cartilage

    3. A line passing through the upper lateral margin of the acetabulum perpendicular to a horizontal line

    4. a horizontal line through right and left tri-radiate cartilage

    5. a line extending from the upper and outer margin of the acetabulum to the center of the hip

    710-[ ] The center-edge angle (CEA) of Wiberg is measured by:

    1. a horizontal line through right and left tri-radiate cartilage

    2. The angle formed by a vertical line from the center of the femoral head and a line from the center of the femoral head to the lateral edge of the acetabulum

    3. A line joining the upper margin of the acetabulum with the tri-radiate cartilage

    4. A line passing through the upper lateral margin of the acetabulum perpendicular to a horizontal line

    5. a horizontal line through right and left tri-radiate cartilage

    711-[ ] Below which level would the CE angle of Wiberg be, to be considered abnormal in a child older than 5 years?

    1. 30°

    2. 28°

    3. 25°

    4. 22°

    5. 20°

    712-[ ] Which of the following structures if it becomes well developed following DDH reduction, indicates a good prognostic sign:

    1. acetabular teardrop

    2. triradiate cartilage

    3. Schenton’s line

    4. Perkin’s line

    5. Ossification of the head

    713-[ ] Which of the following is the primary imaging modality from birth to 4 months in children with DDH:

    1. MRI

    2. CT Scan

    3. Scintigraphy

    4. Ultrasound

    5. Plain x-rays

    714-[ ] The alpha angle in ultrasound Is:

    1. is the angle created by lines along the bony acetabulum and the ilium

    2. the normal angle is less than 60°

    3. Is the angle created by lines along the labrum and the ilium

    4. femoral head is normally trisected by a line drawn down from the ilium

    5. Does not allow the proper view of bony acetabular anatomy, femoral head, labrum, ligamentum teres, hip capsule

    715-[ ] All the following structures block the reduction of a DDH Except:

    1. Inverted labrum

    2. Pulvinar fat pad

    3. A tight pectinius tendon

    4. Transverse acetabular ligament

    5. Ligamentum teres

    716-[ ] Which of the following splints for DDH is a dynamic splint?

    1. Fejka pillow

    2. Pavlik Hareness

    3. Craig splint

    4. DB slint

    5. Ponseti splint

    717-[ ] Open reduction and femoral osteotomy is indicated in all except:

    1. DDH > 2 yr with residual hip dysplasia

    2. anatomic changes on femoral side (e.g., femoral anteversion, coxa valga)

    3. femoral head should be congruently reduced with satisfactory ROM, and reasonable femoral sphericity

    4. Is performed in children < 1 year where no other procedure may be done

    5. best in younger children (< 4 yr)

    718-[ ] In a Pavlik in a child with DDH adduction of the hips is prevented by:

    1. Anterior straps

    2. Posterior straps

    3. Transverse straps

    4. Shoulder straps

    5. Waist straps

    719-[ ] Transient femeral nerve palsy occurs in an infant wearing a Pavlik hareness, when:

    1. When anterior straps are too tight that would allow flexion past 90°

    2. Posterior straps are too tight

    3. Transverse straps that press on the femoral nerve

    4. Shoulder straps are too tight

    5. Waist straps are very tight that could compress the genitofemoral nerve 720-[ ] Luxatio erecta is a known traumatic condition where:

    1. The patient sustains a tear in the glenoid labrum

    2. Patient sustains an inferior dislocation of the head of the humerus

    3. Is associated with an anterior dislocation of the shoulder

    4. Is associated with a Hill Sacks lesion of the humeral head

    5. Is associated with a Bankart lesion

    721-[ ] The position of the lower extremity, following an anterior dislocation of the hip, would be:

    1. Flexion, abduction, and external rotation

    2. Flexion, adduction and external rotation

    3. Flexion, abduction and internal rotation

    4. Flexion, adduction and internal rotation

    5. External rotation, and adduction 722-[ ] Ortolani’s test is done for:

    1. Dislocation of the patella

    2. DDH

    3. Tears of the meniscus

    4. Perthe’s disease

    5. Coxa vara

    723-[ ] The Waddling gait is caused by weakness of the:

    1. Paravertebral muscles

    2. Adductor muscle of the hip

    3. Gluteal muscle weakness

    4. Obturator nerve palsy

    5. Iliopsoas palsy

    724-[ ] Patients who have an antalgic hip gait, is most likely due to:

    1. Gluteal muscle weakness

    2. A painful hip

    3. Leg length discrepancy

    4. Fusion of the knee joint

    5. A fused ankle joint

    725-[ ] Which two muscles listed below function during the stance phase:

    1. Quadriceps

    2. Hamstrings

    3. Tibialis anterior

    4. Peroneus longus

    5. Soleus and gastrocnemius

    726-[ ] Which of the following is the strongest ligament within the body

    1. The ischio-femoral ligament

    2. The ilio-femoral ligament

    3. The transverse acetabular ligament

    4. The ligamentum teres

    5. The pubofemoral ligament

    727-[ ] The commonest cause of contracture of the quadriceps muscle is:

    1. Congenital

    2. Ischemic myositis

    3. Fracture of the femoral shaft

    4. Post-op surgery using the trans lateral approach through the vastus lateralis

    5. Post injection fibrosis

    728-[ ] A patient presenting with early Volkmann ischemic contracture is most likely to first present with:

    1. Pallor and poor capillary filling

    2. Pain not responsive to pain medications

    3. Paresthesias in the lateral 3&1/2 fingers

    4. Finger contraturs

    5. Onset of gangrene

    729-[ ] Death 4 days following a pelvic fracture is most likely to be due to:-

    1. Pulmonary embolism

    2. Hemorrhage

    3. Fat embolism

    4. Respiratory distress syndrome

    5. Infection

    730-[ ] During the process of healing of a fracture, excessive cartilage formation would best indicate:-

    1. Instability and excessive movement at the fracture site

    2. Rigid fixation

    3. Necrosis at the fracture site

    4. Infection

    5. Plasminogen formation within the callous

    731-[ ] Which of the following muscles is not a component of the rotator cuff:

    1. Trapezius

    2. Subscapularis

    3. Suprspinatus

    4. Infraspinatus

    5. Teres minor

    732-[ ] The commonest cause of cubitus varus following a malunited fracture of the supracondylar region of the distal humerus in a child, would be:

    1. Medial displacement of the distal fragment

    2. Rotational malalignment

    3. Proximal displacement and shortening

    4. Posterior angulation

    5. Synostosis of the epiphysis

    733-[ ] Which of the following carpal bones is most commonly fractured:-

    1. Scaphoid

    2. Capitate

    3. Lunate

    4. Triquetrum

    5. Hamate

    734-[ ] The tension caused by which of the following muscles of the hand, makes it difficult to

    maintain reduction of a Bennett’s fracture?

    1. Opponen’s pollicis

    2. Abductor pollicis longus

    3. Extensor pollicis longus

    4. Flexor pollicis brevis

    5. Flexor carpi ulnaris

    735-[ ] Two month’s following management of a Colle’s fracture, the patient was noted to be

    unable to extend the interphalangeal joint of the thumb. She most likely has:

    1. Compartment syndrome

    2. Posterior interosseous nerve injury

    3. Anterior interosseous nerve palsy

    4. Rupture of the extensor pollicis longus

    5. Intra-articular fracture of the interphalangeal joint of the thumb

    736-[ ] The best management of a chronic AC joint dislocation with continuous pain would be:

    1. Acromioplasty

    2. Arthrodesis of the AC joint

    3. Reduction and fixation with a K wire

    4. Fixation of the AC joint with a lag screw

    5. Resection of the outer end of the clavicle

    737-[ ] A “Gamekeepers thumb” injury involves:

    1. Rupture of the radial collateral ligament of the wrist

    2. Rupture of the ulnar collateral ligament of the MP joint of the thumb

    3. Fracture of the base of first metacarpal bone

    4. A boxers injury of the first metacarpal

    5. Avulsion of the ulnar interphalangeal ligament

    738-[ ] Which deformity in a malunited fracture is most likely to correct with remodeling:

    1. Angular deformity in the middle of diaphysis in the plane of motion of nearby joint

    2. Angular deformity in plane of motion of nearby joint when deformity is in metaphyseal area

    3. Rotational malalignment

    4. Angular deformity near end of bone when angulation is in a plane 90° to the plane of motion of nearby joint

    5. Shortening of bone length

    739-[ ] Commonest cause of refracture after removal of external fixator is:

    1. Pin tract infection

    2. Fracture through pin tract

    3. Absence of periosteal callus

    4. Destressing producing cancellation of cortex

    5. Avascular necrosis of bone fragments

    740-[ ] A patient develops a compartment syndrome (swelling, pain and numbness) following manipulation and plaster for fracture of both bones of leg. What is the best treatment:

    1. Split the plaster

    2. Elevate the leg

    3. Infusion of low molecular weight dextran

    4. Elevate the leg after splitting the plaster

    5. Undergo operative decompression of the facial compartments

    741-[ ] In an ankle sprain, the commonest ligament which is torn, is:

    1. Tibio-talar ligament

    2. Deltoid ligament

    3. Posterior talo-fibular ligament

    4. Calcaneo fibular ligament

    5. Anterior talo-fibular ligament

    742-[ ] Stability of knee joint depends mainly on:

    1. Bony configuration

    2. Muscles

    3. Ligaments

    4. Tendons

    5. Menisci

    743-[ ] How does paralytic scoliosis differ from idiopathic scoliosis:

    1. Progress of curve stops after maturity

    2. Scoliosis can progress even after maturity

    3. Curves are usually short

    4. Bracing is quite effective in controlling progress

    5. Curve never becomes very severe

    744-[ ] Which of the following substances is not stored within bone:

    1. Calcium

    2. Glycogen

    3. H2O

    4. Phosphorous

    5. Magnesium

    745-[ ] Woven bone is found in which of the following places:

    1. Fracture callus

    2. Adult femoral shaft (diaphysis)

    3. Adult femoral metaphysis

    4. The adult skull

    5. The adult calcaneum

    746-[ ] The periosteum, functions in all the following except:

    1. Is known to have two layers

    2. Provides a good supply to bone

    3. It is thicker in children

    4. It is continuous with the joint capsule

    5. It contains many cells 747-[ ] Articular cartilage

    1. Is a poorly structured substance

    2. Has eight distinct zones

    3. Is very good at resisting shear

    4. Generates high levels of friction to stabilize the joint

    5. Has an extremely good blood supply

    748-[ ] Pseudoarthrosis following a triple arthrodesis is most commonly seen at:

    1. Calcaneocuboid joint

    2. Talonavicular joint

    3. Talocalcaneal joint

    4. Naviculocuboid joint

    5. Naviculocuneiform joint 749-[ ] Phocomelia is:

    1. Absence of phalanges of the hand

    2. Complete absence of an extremity

    3. Partial absence of a bone of an extremity

    4. A deformity where the hand or foot is directly attached to the body

    5. Is not related to the management with thalidomide

    750-[ ] A shepherd’s crook deformity is known to occur in which of the following conditions:

    1. Achondroplasia

    2. Gaucher’s disease

    3. Hyperthyroidism

    4. Fibrous dysplasia

    5. Xanthomatosis

    751-[ ] A condition characterized by the absence of the clavicle’s is:

    1. Cleidocranial dysostosis

    2. Osteogenesis imperfect

    3. Apert’s syndrome

    4. Malrheostenosis

    5. Sprengle’s deformity

    752-[ ] Which of the following is not a characteristic of a child diagnosed to have Morquio’s disease:

    1. Kyphosis

    2. Normal to slightly low IQ

    3. Elevated keratosulfate in the urine

    4. Stress fractures

    5. Dwarfism

    753-[ ] In what condition is Marble bone disease related:

    1. Osteopetrosis

    2. Osteoporosis

    3. Osteogenesis imperfect

    4. Fibrous dysplasia

    5. Neurofibromatosis

    754-[ ] Diaphyseal achlasia represents:

    1. Multiple enchodromatosis

    2. Neurofibromatosis

    3. Multiple exostosis

    4. Fibrous dysplasia

    5. Osteoporosis

    755-[ ] Involucrum is found in all cases of osteomyelitis and is located:

    1. Beneath the sequestrum

    2. At metaphysis

    3. At the diaphysis

    4. Around the sequestrum

    5. In Volkmann’s canal

    756-[ ] The Greek meaning of the word involucrum is:

    1. To handle

    2. To connect

    3. To wrap

    4. To intermingle

    5. To dissolve

    757-[ ] A Madura foot is caused by:

    1. Tuberculosis

    2. Mycotic infection

    3. Parasitic infection

    4. Virus infection

    5. Water bone disease of the foot

    758-[ ] The first radiologic appearance of an infection involving bone, would be:

    1. One day

    2. 48 hours

    3. 72 hours

    4. One week

    5. Two weeks

    759-[ ] Which of the following sites of a long bone, would osteomyelitis first make its appearance:

    1. Epiphysis

    2. Physis

    3. Metaphysis

    4. Diaphysis

    5. Diaphysio-metaphyseal junction

    760-[ ] Anterior bowing of the tibia (sabre tibia) is seen in which of the following conditions:

    1. Tuberculosis

    2. Syphilis

    3. Rickets

    4. Paget’s disease

    5. Malrheostosis

    761-[ ] A patient known to have tuberculosis involving the knee joint, is most likely to end in a:

    1. Fibrous ankylosis

    2. Osseous ankylosis

    3. Charcot joint

    4. Unstable joint

    5. Enlargement of the joint diameter

    762-[ ] When Tuberculosis involves the spine in the lower thoracic region it first starts in the:

    1. Vertebral body

    2. Endplate

    3. Nucleosus pulposus

    4. Posterior longitudinal ligament

    5. In the facet joints

    763-[ ] Tuberculosis is most common to occur in which of the following sites:

    1. C5-6

    2. C7-T2

    3. T3-T5

    4. T10-L2

    5. L3-Sacrum

    764-[ ] The earliest radiologic finding in tuberculosis of the spine, would be:

    1. Disc narrowing

    2. Wedging of the vertebral body

    3. A paravertebral mass

    4. Calcification of the psoas tendon

    5. Subluxation of the facet joints

    765-[ ] A pott’s deformity of the spine is most common to occur at the:

    1. Cervical spine

    2. Cervico-thoracic junction

    3. Thoracic spine

    4. Thoracolumbar junction

    5. Lumbar spine

    766-[ ] A sudden onset of paraplegia in a patient with Tuberculosis, is most likely due to:

    1. Collapse of the vertebral body

    2. Thrombosis of the anterior spinal artery

    3. A granuloma compressing the cord

    4. A sudden gibbus formation with ischemia of the cord

    5. Epidural abcess

    767-[ ] Which of the following does not occur in Hand Schuller Christian disease:

    1. Diabetes insipidus

    2. Punched out osteolytic lesions of bone

    3. Numerous phsilliferous cells

    4. Proliferation of reticuloendothelial cells

    5. Exophthalmus

    768-[ ] Which of the following conditions is not associated with soft tissue calcification:

    1. Hyperparathyroidism

    2. Hyperthyroidism

    3. Scleroderma

    4. Tuberculosis

    5. Psoriasis

    769-[ ] Legg Calve’ Perthe’s disease is known to be bilateral in:

    1. 90%

    2. 75%

    3. 65%

    4. 28%

    5. 12%

    770-[ ] The process by which the collapsed head in Perthe’s disease is repaired is known as:

    1. Conduction

    2. Creeping substitution

    3. Convection

    4. Stress shielding

    5. Os in os bone formation

    771-[ ] Some form of coagulopathy occurs in children with Legg Calve Perthe’s disease, in:-

    1. 90%

    2. 75%

    3. 56%

    4. 40%

    5. 30%

    772-[ ] Which of the following has been found to be abnormal in children with Legg Calve’

    Perthes disease:

    1. Delayed bone age in 89% of patients

    2. Elevated ESR in 60%

    3. Upper respiratory tract infection in 60%

    4. History of trauma in all cases

    5. Vitamin D deficiency leading to weakened bone

    773-[ ] Which of the following ages is associated with a good prognosis in Legg Calve’ Perthe’s

    disease:

    1. 14 years

    2. 12 years

    3. 10 years

    4. 8 years

    5. 6 years

    774-[ ] All the following are related to the prognosis of Legg Calve’ Perthe’s disease, except:

    1. female sex

    2. decreased hip adduction (abduction contracture)

    3. heavy patient

    4. longer duration from onset to completion of healing

    5. stiffness with progressive loss of ROM

    775-[ ] In accordance with the Herring (lateral pillar classification) with maintenance >50% height of the lateral column, were associated with a poor outcome in patients older than:

    1. 6 years

    2. 8 years

    3. 10 years

    4. 12 years

    5. 14 years

    776-[ ] A V-shaped radiolucency in the lateral portion of the epiphysis and/or adjacent metaphysis is known as:

    1. Crescent sign

    2. Gage’s sign

    3. Tear drop sign

    4. Sea gull sign

    5. Morel Lavelle’ sign

    777-[ ] Head at risk signs in Legg Calve’ Perthe’s disease include all the following, except:

    1. Calcification lateral to the epiphysis

    2. Lateral subluxation of the femoral head

    3. Subchondral cleft

    4. Horizontal proximal femoral physis

    5. Metaphyseal cyst

    778-[ ] In the Salter-Thompson classification of Legg Calve Perthe’s disease, the main finding

    on which the classification depends on, would be:

    1. The amount of necrosis

    2. The crescent sign

    3. The amount of re-ossification

    4. The flattening of the head

    5. Acetabular changes

    779-[ ] All the following conditions can be confused with the diagnosis of Legg Calve’ Perthe’s

    disease except:

    1. Transient synovitis

    2. Hyperthyroidism

    3. Multiple epiphyseal dysplasia (MED)

    4. Gaucher disease

    5. Meyers dysplasia

    780-[ ] When Surgery is indicated in Legg Calve’ Perthe’s disease Pillar B and B/C the main

    rational would be is to:

    1. To shorten the hip

    2. To contain the hip

    3. To debride the hip

    4. To derotate the hip

    5. To abduct the hip

    781-[ ] A disease in infancy <6 months where one notices an increase in bone formation around the clavicle and scapula, would be:

    1. Morquio’s

    2. AlberSchonberg’s disease

    3. Caffey’s disease

    4. Malrheostosis

    5. Engelmann’s disease

    782-[ ] Absence of the Lamina Dura in teeth has been associated with which of the following conditions:

    1. Hyperparathyroidism

    2. Scurvy

    3. Osteomalascia

    4. Rickets

    5. Hypothyroidism

    783-[ ] A 7 year old boy is noted to have thoracic vertebra plana, your most likely diagnosis would be:

    1. Tuberculosis

    2. Osteoblastoma

    3. Eosinophilic granuloma

    4. Discitis

    5. Ewing’s sarcoma

    784-[ ] Subperiosteal erosions localized to the radial aspect of the middle phalanges of the hand is diagnostic of:

    1. Hypothyroidism

    2. Hyperparathyroidism

    3. Syphilis

    4. Psoriasis

    5. Reiter’s disease

    785-[ ] Stress fractures known as looser zones that occur on the concave side of a bowed tibia, is known to occur in:

    1. Rickets

    2. Osteomalascia

    3. Osteomyelitis

    4. Osteopetrosis

    5. Paget’s disease

    786-[ ] Which of the following cells is abnormal in Paget’s disease:

    1. Osteocyte

    2. Osteoblast

    3. Osteoclast

    4. Fibroblast

    5. Monocyte

    787-[ ] Multiple punched out osteolytic lesions in the skull and other bones in a child, age 2 years, is most likely due to:

    1. Neurofibromatosis

    2. Histiocytosis X

    3. Juvenile rheumatoid arthritis

    4. Psoriasis

    5. Hyperparathyroidism

    788-[ ] A Bamboo spine is typically found in patients diagnosed to have:

    1. Psoriasis

    2. Ankylosing spondylitis

    3. Reiter’s syndrome

    4. Hyperparathyroidism

    5. Hypothyroidism

    789-[ ] The nerve most commonly injured with fractures of the proximal end of the humerus, would be:

    1. Musculocutaneous nerve

    2. Axillary nerve

    3. Suprascapular nerve

    4. Long thoracic neve

    5. Subscapular nerve

    790-[ ] The minimal length of the calcar fragment in proximal humeral fractures, should be, that would minimize the incidence of avascular necrosis:

    1. Greater than 4 mm

    2. >6mm

    3. >8mm

    4. >10mm

    5. >12mm

    791-[ ] The route of the arcuate artery while in the proximal humerus is:

    1. Along the medial aspect of the long head of the biceps tendon

    2. Along the lateral aspect of the long head of the biceps tendon

    3. Along the medial aspect of the subscapularis tendon

    4. Beneath the Deltoid tendon

    5. Along the posterior aspect of the humerus and is a branch of the posterior humeral circumflex artery

    792- [ ] Recent studies indicate that the main blood supply to the humeral head is:

    1. Anterior humeral circumflex artery

    2. Posterior humeral circumflex artery

    3. Arcuate artery

    4. Cephalic artery

    5. Brachial artery

    793-[ ] Which fracture pattern has preservation of the blood supply to the head of the humerus most

    :

    1. Valgus impacted fracture of the proximal humerus

    2. Varus impacted fracture of the proximal humerus

    3. 3 part fractures

    4. Slit fractures of the humeral head

    5. 4 part fracture dislocations of the proximal humerus

    794-[ ] In greater tuberosity fractures of the humerus, the fragment is displaced:

    1. Medially

    2. Laterally

    3. Posterior and superior

    4. Inferiorly

    5. Sub coracoid

    795-[ ] Which of the following injuries is associated most with axillary nerve injury:

    1. Anterior dislocation of the shoulder

    2. Posterior shoulder dislocation of the shoulder

    3. Luxatio erecta

    4. Acromial fractures

    5. Coracoid fracture

    796-[ ] Greater tuberosity fractures are associated most with:

    1. Posterior dislocations of the shoulder

    2. Anterior dislocation of the shoulder

    3. Vertical dislocations of the shoulder

    4. Transthoracic dislocations of the shoulder

    5. Fracture dislocations of the shoulder

    797-[ ] The largest structure in the body without a vascular supply would be:

    1. The patella

    2. The intervertebral disc

    3. The scaphoid bone

    4. The infrapatellar tendon

    5. The odontoid process

    798-[ ] The annulus fibrosus consists of all the following substances except:

    1. Water

    2. Collagen

    3. Elastin

    4. Glucose

    5. Proteoglycans

    799-[ ] The strongest ligament of the spine would be:

    1. The anterior longitudinal ligament

    2. The ligamentum flavum

    3. The interspinous ligament

    4. The supraspinous ligament

    5. The posterior longitudinal ligament

    800-[ ] The first branch of the subclavian artery is:

    1. The vertebral artery

    2. The superior thyroid artery

    3. The inferior thyroid artery

    4. The anterior carotid artery

    5. The basilar artery

    801-[ ] The prominent anterior tubercle can be palpated beneath the longus colli muscle and provides a landmark to the:

    1. C3-4 disc space

    2. C4-5 disc space

    3. C5-6 disc space

    4. C6-7 disc space

    5. C7-T1 disc space

    802-[ ] At the level of the atlas, the odontoid process, the subarachnoid space, and spinal cord each occupy one third of the area of the spinal canal. This is known as:

    1. Hungerford rule

    2. The rule of Steele

    3. The Morelle Lavalle’ rule

    4. The Panjabi White rule

    5. The Terrier dog

    803-[ ] The axis is derived from:

    1. Two ossification centers

    2. Three ossification centers

    3. Four ossification centers

    4. Five ossification centers

    5. Six ossification centers

    804-[ ] The odontoid process fuses to the vertebral body by the:

    1. Seventh gestational month

    2. Fifth gestational month

    3. Eighth gestational month

    4. Sixth gestational month

    5. Third gestational month

    805-[ ] The craniocervical junction and the atlantoaxial joints are secured by both external and internal ligaments. Which of the following is not an internal ligament involved in securing the craniocervical junction:

    1. The Transverse ligament

    2. The alar ligaments

    3. The supraspinous ligament

    4. The apical ligaments

    5. The tectorial membrane

    806-[ ] The apical portion of the dens ossifies by age:

    1. 3-5 years and fuses with the rest of the structure around age 12 years

    2. 6-7 years and fuses with the rest of the structure around age 8 years

    3. 8-10 years and fuses with the rest of the structure around age 10 years

    4. 2-3 years and fuses with the rest of the structure around age 8 years

    5. Appears at 3-5 years and never fuses to the rest of the structure

    807-[ ] The continuation of the supraspinous ligament on to the occiput becomes known as the:

    1. The atlantooccipital membrane

    2. The tectorial membrane

    3. The ligamentum nuchae

    4. The cruciate ligament

    5. The apical ligament

    808-[ ] The echancrure or anvil is known to articulate with the:

    1. The superior facet

    2. The inferior facet

    3. The uncinated process

    4. The superior tubercle

    5. The inferior tubercle

    809-[ ] The uncovertebral bodies are referred to as:

    1. The synovial joints of lushka

    2. The cricoid cartilage

    3. The facet joints

    4. The pars interarticularis

    5. The isthmus

    810-[ ] Which of the following spinous processes is not bifid:

    1. C3

    2. C4

    3. C5

    4. C6

    5. C7

    811-[ ] Which of the following structures defines the lateral extent of surgical exposures:

    1. The synovial joints of Lushka

    2. The cricoid cartilage

    3. The facet joints

    4. The pars interarticularis

    5. The isthmus

    812-[ ] In the cervical spine the intervertebral foramina is largest at:

    1. C2-3

    2. C3-4

    3. C4-5

    4. C5-6

    5. C6-7

    813-[ ] Which structure is not included in the border of the intervertebral neural foramen:

    1. Anteromedially by the uncovertebral joints

    2. Posterolaterally by facet joints

    3. The ligamentum flavum

    4. Superiorly by the pedicle of the vertebra above

    5. Inferiorly by the pedicle of the lower vertebra 814-[ ] The facet joints in the cervical spine are:

    1. Fibrous joints

    2. Syndesmotic joints

    3. Synovial joints

    4. Synchondrosis

    5. Synostosis

    815-[ ] Mechanoreceptors are found most in the:

    1. Occipital region

    2. Cervical spine

    3. Thoracic spine

    4. Lumbar spine

    5. The sacrococcygeal….. region of the spine

    816-[ ] The cervical facets, C3-C4 to C7-T1, are supplied by the:

    1. Posterior rami medial branches that arise 1 level cephalad and caudad to the joint

    2. The anterior rami of the first and second cervical spinal nerves

    3. Both the anterior and posterior rami

    4. By 2 branches of the posterior ramus of the third cervical spinal nerve innervate

    5. By mechanoreceptors (types I, II, and III)

    817-[ ] Which of the following structures is not a component of the intervertebral disc:

    1. The nucleus pulposus

    2. The ligamentum flavum

    3. The annulus fibrosis

    4. The superior end plate

    5. The inferior endplate

    818-[ ] Cervical lordosis results mainly from:

    1. The vertebral body is longer anteriorly than posteriorly

    2. Widening and thickening of the disc anteriorly

    3. The pull of the supraspinous and interspinous ligament posterior

    4. The tension force in the posterior part of the cervical spine

    5. Lordosis of the cervical spine that results in balancing of the kyphotic thoracic spine

    819-[ ] Which of the following substances is found in the disc and is thought to be an inflammatory mediator

    1. Interleukin !

    2. Interleukin 6

    3. Phospholipase A2

    4. Leukocidenes

    5. Proteases

    820-[ ] The distal intramedullary canal of the humerus terminates at:

    1. 8cms proximal to the olecranon fossa

    2. 6-7cms proximal to the olecranon fossa

    3. 5cms proximal to the olecranon fossa

    4. 4cms proximal to the olecranon fossa

    5. 2-3cms proximal to the olecranon fossa

    821-[ ] The radial nerve courses along the spiral groove proximal to the lateral epicondyle by:

    1. 8cms

    2. 10cms

    3. 12cms

    4. 14cms

    5. 16cms

    822-[ ] A spiral fracture of the distal one-third of the humeral shaft commonly associated with neuropraxia of the radial nerve (22% incidence) is known as:

    1. Holstein-Lewis fracture

    2. A spike fracture

    3. A lateral intermuscular septum tension injury

    4. A distraction injury

    5. A shear injury

    823-[ ] Should a coaptation splint followed by functional brace be used in a humeral shaft fracture, which alignment would not be acceptable:

    1. < 20° anterior angulation

    2. < 30° varus

    3. < 30° valgus angulation

    4. >40° rotation

    5. < 3 cm shortening

    824-[ ] Absolute contraindications to conservative management of a humeral shaft fracture would include all, except:

     

    1. Severe soft tissue injury

    2. Severe bone loss

    3. Vascular injury requiring repair

    4. Radial nerve palsy

    5. Brachial plexus injury

       825-[ ] A common malunion deformity in the conservative management of humeral shaft fractures, would be:

       1. Valgus deformity

       2. Varus deformity

       3. Rotational deformity

       4. Extension deformity

       5. Flexion deformity

    826-[ ] Absolute indications for open reduction of a humeral shaft fracture would indicate all, except

    1. Open fracture

    2. Vascular injury requiring repair

    3. Brachial plexus injury

    4. Bilateral humerus fracture

    5. Ipsilateral forearm fracture (floating elbow)

    827-[ ] All the following are indications for IM nailing of a humeral fracture, except:

    1. Pathologic fracture

    2. Segmental fractures

    3. Infected fractures

    4. Severe osteoporotic bone

    5. Overlying skin compromise limits open approach

    828-[ ] The posterior approach to the humerus is indicated or used for all except:

    1. Used for distal to middle third shaft fractures although can be extensile

    2. Triceps may either be split or elevated with a lateral paratricipital exposure

    3. Radial nerve is found medial to the long and lateral heads and 2cm proximal to the deep head of the triceps

    4. Radial nerve exits the posterior compartment through lateral intramuscular septum 10 cm proximal to radiocapitellar joint

    5. The lateral brachial cutaneous/posterior antebrachial cutaneous nerve serves as an anatomic landmark does not lead to the radial nerve during a paratricipital approach

       829-[ ] The complication rate on comparing IM nailing with plating in fractures of the shaft humerus is:

       1. Higher

       2. Equal

       3. Lower

       4. Have less shoulder pain

       5. Nerve injury is higher in IM nailing

    830-[ ] When a Radial nerve palsy occurs following a humeral shaft fracture, all the following statements are true, except:

    1. Occurs in 25% of closed fractures

    2. increased incidence in distal one-third fractures

    3. Neuropraxia is most common injury in closed fractures

    4. Neurotomesis in open fractures

    5. 85-90% of improve with observation over 3 months

    831-[ ] On conservative management of a humeral shaft fracture what is not true among the following statements:

    1. Is Indicated as initial treatment in closed humerus fractures

    2. In radial palsies that occur and are present when the patient is first seen may be treated conservatively

    3. Obtain an EMG at 3-4 months

    4. Wrist extension in radial deviation is expected to be regained last

    5. The brachioradialis first to recover, extensor indicis is the last

    832-[ ] On asking a young boy to get up from a seated position and he uses his hands to support him to do so, what would be your most likely diagnosis:

     

     

     

    1. Alberschonberg’s disease

    2. Diaphyseal aclasis

    3. Pseudohypertrophic muscular dystrophy

    4. Cleidocranial dysostosis

    5. Stippled epiphysis

    833-[ ] Gower’s test when positive favor’s the diagnosis of:

    1. Hip dysplasia

    2. Coxa vara

    3. Pseudohypertrophic muscular dystrophy

    4. Slipped Capital Femoral Epiphysis

    5. Chondrolysis

    834-[ ] Which of the following statements does not apply to coxa vara:

    1. Congenital or developmental coxa vara is a painless disorder that is similar in clinical presentation to DDH

    2. If the condition is unilateral, the patient may have an abductor lurch resulting from functional weakness of the abductor muscles (Trendelenburg gait)

    3. If the disorder is bilateral, the patient may have a waddling gait

    4. During examination when the patient is in the supine position, hip abduction is limited, and the child usually has increased external rotation and decreased internal rotation of the hip

    5. The diagnosis is readily confirmed with radiographs of the hip, which show a horizontal orientation of the physis

    835-[ ] Slipped capital femoral epiphysis is when:

    1. Slippage may occur acutely or gradually and is usually seen in boys between 12 and 15 years of age or in girls between 10 and 13 years of age

    2. Not caused by trauma

    3. Often occurs following an episode of Upper respiratory tract infection

    4. The sedimentation rate is always elevated

    5. The child has a painless limp

    836-[ ] A 12 year old obese boy is brought to your clinic complaining of knee pain and on observing his gait you realize he has an antalgic gait with external rotation of the whole lower extremity. Your diagnosis at first site would be:

    1. DDH

    2. Osteochondritis of the medial femoral condyle

    3. Slipped Capital femoral epiphysis

    4. Septic arthritis of the hip

    5. Coxa Vara

    837-[ ] An uncommon hip disorder that is seen most often in African Americans, in girls, and in adolescents 12 to 14 years of age. It is frequently associated with SCFE (with a reported incidence of up to 8%), but the exact cause is not known. This would be most likely:

    1. Chondrolysis of the hip

    2. Septic arthritis

    3. Legg Calve’ Perthe’s disease

    4. Gaucher’s disease

    5. Osteopetrosis

    838-[ ] A toddler’s fracture is:

    1. Fracture of the midshaft of the clavicle resulting from a direct impact of the shoulder on the floor

    2. A spiral fracture of the tibia, without concomitant fibular fracture, and may result from a torsion type of injury to the lower extremity

    3. Fracture of the femoral neck without significant trauma

    4. Is common in metabolic bone disorders with deficiency of vitamin C

    5. Commonly located at the midshaft of the femur

    839-[ ] Contracture of the peroneal muscles in a 13 year old boy, resulting in a stiff, everted Flatfoot would suggest a diagnosis of:

    1. Club foot

    2. Calcaneovalgus foot

    3. Kohler’s disease

    4. Tarsal coalition

    5. Freiberg’s disease

    840-[ ] The best way to measure a leg length discrepancy in a child, would be:

    1. With a measurement tape from anterior superior iliac spine to the medial malleolus

    2. With a measurement tape from umbilicus to the medial malleolus

    3. The child stands with the shorter extremity on blocks until the pelvis is level

    4. The child lie supine and measure the height of the femur and tibia

    5. Allow the child stand full weight bearing on the extremities and measure the lower anterior superior iliac spine from the true horizontal line

    841-[ ] In children younger than 5 years of age diagnosed to have a malignant bone tumor, which of the following would be the most likely diagnosis:

    1. Leukemia

    2. Ewings sarcoma

    3. Osteosarcoma

    4. Giant cell tumor

    5. Eosinophilic granuloma

    842-[ ] A sudden deterioration of gait or loss of previously achieved motor milestones in a child would suggest a:

    1. Guillian Barre’ syndrome

    2. A central nervous system tumor

    3. Poliomyelitis

    4. A cerebral palsy

    5. An osteochondroma arising from the transverse process

    843-[ ] Which of the following types of Leukemia most commonly involves bone, in a child:

    1. Acute lymphatic leukemia

    2. Myelogenous leukemia

    3. Lymphoblastic leukemia

    4. Monoblastic leukemia

    5. Eosinophilic leukemia

    844-[ ] Which of the following radiologic findings in bone is often seen in leukemia:

    1. Transverse zones of lucent metaphyseal bands adjacent to the growth plate

    2. Pelkan spurs

    3. Wimbergers rings

    4. Umbozonen

    5. Epiphysiolysis

    845-[ ] Back pain in children younger than 5 years of age should be taken seriously especially when a five year old child refuses to stand or flexes the hip to fetch an object from the floor. This could most likely be due to:

    1. A spondylolysis

    2. A spondylolisthesis

    3. An osteoid osteoma

    4. A spondylodiscitis

    5. Scheuermann’s disease

    846-[ ] The most common cause of identifiable lumbar back pain in active adolescents would be:

     

    1. Spondylolysis

    2. Scheuermann’s disease

    3. Discitis

    4. Spondylitis

    5. Osteoid osteoma

    847-[ ] In older adolescents complaining of back pain with an onset commonly occurring during the adolescent growth spurt and is more frequent in boys, would be:

    1. Tuberculosis

    2. Lumbar Scheuermann disease

    3. Brucellosis

    4. Discopathy

    5. Spondylolisthesis

    848-[ ] A more precise imaging modality for localizing spinal lesions, and for diagnosing spondylolysis

    and stress fractures in the lumbar spine, would be:

    1. MRI

    2. CT scan

    3. Single-photon emission computed

    4. Scintigraphy

    5. Ultrasonography

    849-[ ] Cavitation of the spinal cord involving pathways that carry impulses of pain and temperature sensations is known as:

    1. Guillian Barre’ disease

    2. Tabes dorsalis

    3. Syringomyelia

    4. Syrinx

    5. Basilar impression

    850-[ ] A 6 year old child presents to your clinic having low back pain, recently progressive scoliosis, spasticity with contractures, and a decrease in motor function.

    He also had bladder dysfunction and a positive Babinski sign. Your most likely diagnosis on a plain x-ray would be:

    1. Diastematomyelia or spina bifida occulta with a tethered spinal cord

    2. An Osteiod osteoma

    3. Hemivertebrae

    4. Failure of segmentation of the vertebral body

    5. Epidural abcess

    851-[ ] A disease that occurs in children younger than 10 years and have back pain, long bone pain from compression fractures, and difficulty walking, that should be differentiated from Leukemia, would be:

    1. Osteogenesis imperfecta

    2. Alberschonbergs disease

    3. Juvenile osteoporosis

    4. Juvenile rheumatoid arthritis

    5. Vitamin D Resistant Rickets

    852-[ ] The most common organism to cause infectious spondylitis would be:

    1. Streptococcus

    2. Staph aureus

    3. Staph epididymis

    4. Proteus vulgaris

    5. Pseudomonas

    853-[ ] A lesion that is extremely vascular, where preoperative angiography with Gelfoam embolization can decrease the amount of intraoperative blood loss, would be:

    1. Osteosarcoma

    2. Ewing’s sarcoma

    3. Aneurysmal bone cyst

    4. Giant cell tumor

    5. Fibrous dysplasia

    854-[ ] The most frequent site of Ewing’s sarcoma of the spine would be, in which of the

    following regions:

    1. The sacrum

    2. The lumbar region

    3. The thoracic region

    4. The cervical spine

    5. The spheno-occipital region

    855-[ ] Which of the following lesions are known to metastasize to the spine in children:

    1. Wilm’s tumor

    2. Rhabdomyosarcoma

    3. Fibrosarcoma

    4. Osteosarcoma

    5. Ewing’s sarcoma

    856-[ ] Plain radiographs of thoracic spine in a child with back pain shows thin and absent pedicles in adjacent regions, and widening of the intervertebral foramen, and scoliosis with rotation. Your most likely presumptive diagnosis would be:

    1. Infectious spondylitis

    2. Scheuermann’s disease

    3. Eosinophilic granuloma

    4. Ependymoma

    5. Syringomyelia

    857-[ ] A child is noted to have a large head, short neck; dwarfism; kyphoscoliosis; hepatosplenomegaly; cardiac valvular abnormalities; coronary artery disease; severe mental retardation; prone to respiratory infections; pulmonary hypertension; usually die before 10 years of age from respiratory and cardiac failure, would be:

    1. Holt-Oram syndrome

    2. Hunter syndrome

    3. Hurler syndrome

    4. Klinefelter syndrome

    5. Klippel-Feil syndrome

    858-[ ] Congenital muscular torticollis may occur in all the following conditions except:

    1. Vertebral anomalies, Failure of segmentation

    2. Klippel-Feil syndrome

    3. A tethered cord

    4. Occipitalization of C1

    5. Failure of formation, Congenital hemiatlas

    859-[ ] The presence of calcified deposits delineating the nucleus pulposus on a lateral radiograph of the cervical spine and the presence of torticollis and may be associated with fever is best treated by:

    1. Surgical debridement

    2. Conservatively, with antibiotics, with a collar, bed rest and traction

    3. A two level arthrodesis of the cervical spine

    4. The calcific deposits regress and disappear in approximately 90% of children with no treatment

    5. Degenerative disc disease does not occur

    860-[ ] A combination of ligamentous laxity and congenital abnormalities of the craniovertebral junction (50%) predisposes children with Down syndrome to atlantoaxial and occipitocervical instability. Should one decide to operate and stabilize this instability, what should the surgeon least expect:

    1. The surgeon must anticipate a high complication rate with significant risk for nonunion, loss of reduction

    2. Neurologic deterioration

    3. Early and an uneventful fusion rate of the occipito-cervical junction of 86%

    4. Infection, wound dehiscence

    5. Potential need for reoperation, and death

    861-[ ] A 5 year old boy with a short, broad neck; low hairline; and restricted cervical motion would be most likely to be diagnosed as:

    1. Diastrophic dwarfism

    2. Klippel-fiel syndrome

    3. Myelodysplasia

    4. Cleidocranial dysostosis

    5. Down’s syndrome

    862-[ ] Aplasia and hypoplasia of the odontoid occur routinely in a variety of skeletal dysplasias, and occurs most notably in:

    1. The spondyloepiphyseal dysplasia group

    2. Osteogenesis imperfecta

    3. Neurofibromatosis

    4. Multiple epiphyseal dysplasia

    5. Trevor’s disease

    863-[ ] A radiographic measurement based on ossification of the iliac apophysis, in scoliosis would be:

    1. Risser sign

    2. Moe sign

    3. Cobb sign

    4. Panjabi sign

    5. Tear drop sign

    864-[ ] The degree of rotation in an idiopathic scoliotic curve would be:

    1. Risser sign

    2. Moe sign

    3. Cobb sign

    4. Panjabi sign

    5. Tear drop sign

    865-[ ] Progression of a curve formation following fusion in a child for scoliotic correction, is known as a:

    1. Frontal modifier

    2. Adding on phenomenon

    3. Crankshaft deformity

    4. Adjacent disc disease phenomenon

    5. Decompensation phenomenon

    866-[ ] Adams forward-bending test is most useful in:

    1. Kyphosis

    2. Scoliosis

    3. Scheuermanns disease

    4. Spina bifida

    5. Tethered cord

    867-[ ] In the thoracic spine the scoliometer is used to assess:

    1. Paravertebral muscle asymmetry

    2. Rib asymmetry

    3. Incomplete completion of growth

    4. The degree of kyphosis

    5. The degree of lateral deviation

    868-[ ] Lateral trunk shift in scoliosis is measured by:

    1. Drawing a horizontal line to the edges of the ribs of the trunk and a perpendicular line that bisects this horizontal line; the distance between this perpendicular line and the center of the pelvis represents lateral trunk shift

    2. The horizontal distance between the midpoint of C7 and the center of the pelvis

    3. Forward translation of the thoracic cage

    4. Rotation of the thoracic cage

    5. Degree of Risser apophysis maturity

    869-[ ] Under normal circumstances, the vertebral artery can be compromised with rotation, thus collapsing the contralateral vertebral artery. The amount of rotation would be:

    1. From 30-45°

    2. From 10-15°

    3. From 20-25°

    4. From 45-60°

    5. From 60-70°

    870-[ ] Compression of the subclavian artery may arise from all with the exception of:

    1. Hypertrophy or spasm of the anterior scalene muscle

    2. Atherosclerotic plaque

    3. Sternocleidomastoid spasm

    4. Apical lung masses

    5. Accessory cervical rib

    871-[ ] Arm pain, cold limb, supraclavicular region pain, and paresthesias is suggestive of:

    1. Acute cervical disc

    2. Thoracic outlet syndrome

    3. Axillary artery aneurysm

    4. Horner’s syndrome

    5. Tumor at the apex of the lung

    872-[ ] The nerve supply of the deltoid muscle would be:

    1. C-3

    2. C-4

    3. C-5

    4. C-6

    5. C-7

    873-[ ] Wrist extension is predominantly mediated by the extensor carpi ulnaris and radialis which is supplied by which of the following nerve roots:

    1. C-3

    2. C-4

    3. C-5

    4. C-6

    5. C-7

    874-[ ] A positive test elicited during acute cervical flexion that produces a sudden electrical tingling or shocks down the spine and/or extremities is:

    1. Spurling

    2. Beevor

    3. Schoberg

    4. L’hermitte’

    5. Froment……test

    875-[ ] A test used with the patient in the sitting position, and the examiner instructs the patient to place his hand over his head – thus keeping his arm in abduction is known as:

    1. Spurling

    2. Beevor

    3. Bakody

    4. Schoberg

    5. L’hermitte’ …….test

    876-[ ] Low back pain radiating in the buttock, thigh, calf, and foot that does not originate from the lumbosacral plexus and/or from disc herniation and pain is made worse with activity such as prolonged sitting and walking is caused by a

    1. Piriformis syndrome

    2. Iliopsoas inflammation

    3. Sacroiliatis

    4. Hip osteoarthritis

    5. Scheuerrman’s disease

    877-[ ] The pyriformis muscle obtains its nerve supply from:

    1. L2-3

    2. L3-4

    3. L4-5

    4. S1-2

    5. S2-4

    878-[ ] In the piriformis syndrome, the examination confirming its presence is when:

    1. The examiner flexes, adducts, and internally rotates the proximal leg

    2. The examiner extends, adducts, and internally rotates the proximal leg

    3. The examiner flexes, abducts, and internally rotates the proximal leg

    4. The examiner flexes, adducts, and externally rotates the proximal leg

    5. The examiner places the patient in a prone position and flexes the knee 879-[ ] A test used to confirm the presence of lumbar discopathy, would be:

    1. The Romberg

    2. The Beevor

    3. Hoover

    4. Spurling

    5. Ganslen…..test

    880-[ ] All the following are known to cause spinal stenosis, Except:

    1. The aging process

    2. Osteoarthritis

    3. Disc degeneration

    4. Vitamin D deficiency

    5. Thickened spinal ligaments

    881-[ ] Which of the following is most important, which when divided or resected would allow maximum seating of the femoral head within the acetabulum, following reduction of a high riding DDH:

    1. Pulvinar fat pad

    2. Hip capsule

    3. Limbus

    4. Transverse ligament

    5. Iliopsoas tendon

    882-[ ] In what way does femoral shortening ease best the reduction of a high riding hip in DDH:

    1. Relaxes the two joint muscles

    2. Derotates the hip

    3. Promotes varus of the hip

    4. Allows a better capsulorhaphy

    5. Removes the hourglass capsular deformity

    883-[ ] Should a flat acetabulum be present in patients with DDH (2-5years), the best surgical management would be:

    1. A varus osteotomy of the hip

    2. A Salter osteotomy

    3. A Dega osteotomy

    4. A Chiari osteotomy

    5. A hip derotation osteotomy

    884-[ ] An eight year old male with a Herring B/C hip is best treated with:

    1. Traction

    2. Atlanta brace

    3. With a Petrie cast

    4. Snyder sling

    5. Surgically

    885-[ ] In Legg-Calve’-Perthes disease ending with a Stulberg IV deformity is most likely to:

    1. Have no problems throughout life

    2. Have continuous hip pain throughout life

    3. Have considerable stiffness in the hip throughout

    4. Live normally but are expected to have degenerative arthrosis at the age of fifty

    5. Are candidates to have a Total Hip Arthroplasty prior to the age of forty years

    886-[ ] To distinguish between both hips being involved in patients with Gaucher’s disease

    and Legg Perthes (LCP) disease is that:

    1. The former (Gauchers Disease), both hips are involved at the same time while LCP disease (when bilateral) is at different times

    2. The hips are more severely involved in Gaucher’s disease

    3. LCP disease has an accumulation of cerebrosides within the hip and not in gauchers disease

    4. Gaucher’s disease has various stages of hip involvement which is not present in LCP

       disease

    5. LCP disease is curable when treated with an abduction which is not present in Gaucher’s

    disease

    887-[ ] Any child presenting with severe back pain involving the whole spine prior to the age 6 years should be investigated for:

    1. Leukemia

    2. Discitis

    3. Disc calcification

    4. Syringomyelia

    5. Tethered cord

    888-[ ] An osteoid osteoma when located in the spine results in scoliosis that occurs at the wrong time and place. When so, the nidus is found in the:

    1. Endvertebra

    2. Neutral vertebra

    3. Convex side of the curve

    4. At the apex on the concave side of the curve

    5. Vertebral body

       889-[ ] The organism that most likely results in discitis is:

       1. Streptococci

       2. E. Coli

       3. Pseudomonaus

       4. Staph aureus

       5. Hemophilus influenza

    890-[ ] Following traumatic dislocation of the patella, the structure when injured would Most

    likely result in recurrent patella dislocation is:

    1. The infrapatellar tendon

    2. The vastus medialis

    3. The lateral femoral condyle

    4. The medial patellofemoral ligament

    5. The vastus intermedius

    891-[ ] In adolescents, the most likely mechanism of injury to the lumbosacral spine, that could lead to a spondylolysis, would be:

    1. Acute flexion

    2. Repetitive extension-rotation injuries

    3. Repetitive flexion rotation injuries

    4. Distraction injuries

    5. Axial compression injuries

    892-[ ] In acquired flat foot in an adult the tendon that is usually involved would be:

    1. Peroneus brevis

    2. Peroneus longus

    3. Posterior tibial tendon

    4. Anterior tibial tendon

    5. Flexor digitorum longus tendon

    893-[ ] The parents of a 13 year old boy known to have tuberculosis, notice swelling in upper right buttocks. He was presumed to have migration of the abcess posteriorly. This would be through which path:

    1. Triangle of the inguinal canal

    2. The adductor triangle

    3. The triangle of petit

    4. The iliopsoas triangle

    5. The sacroiliac joint

    894-[ ] A ten year old boy presented with low back pain. Plain xrays revealed flattening of the vertebral bodies at level L2 and L4. Your first diagnosis would be:

    1. Osteoblastoma

    2. Eosinophilic granuloma

    3. Tuberculosis

    4. Aneurysmal bone cyst

    5. Neuroblastoma

    895-[ ] When a Margeryl transarticular screw is inserted between C1-2 and is slightly long and passes anterior through the C1 facet, may lead to a unilateral deviation of the tongue. Which of the following nerves is injured:

    1. Spinal accessory

    2. Long thoracic

    3. Hypoglossal

    4. Glossopharyngeal

    5. Vagus

    896-[ ] During anterior spinal surgery, the left vertebral artery was injured. Should the artery be ligated, it is associated with what incidence of brain stem infarction:

     

    a-	1%
    b-	1.8%
    c-	3.1%
    d-	6%
    e-	100%
    897-[	] During anterior spinal surgery when the esophagus is injured and detected 48 hours
    postoperatively the mortality risk is estimated to be:
    a.	50%
    b.	25%
    c.	75%
    d.	100%
    e.	10%
    898-[	] Which of the following cervical vertebrae, the pedicle is of sufficient diameter to allow
    the insertion of a pedicle screw:

    1. C1

    2. C2

    3. C3

    4. C4

    5. C5

    899-[ ] The differential diagnosis of most bone tumors is derived from which of the following:

     

    1. MRI

    2. CT scan

    3. Plain radiography

    4. Scintigraphy

    5. Ultrasonography

     

    900-[ ] Patients with osteoid osteomas are known to have pain the explanation given, would be:

    1. Sensory nerve fibers within the nidus

    2. The accumulation of cyclooxygenases and prostaglandins within the lesion

    3. Expanding nature of the lesion

    4. Over accumulation of a parathyroid like substance within the lesion

    5. Necrotizing effect of the lesion

     

    901-[ ] With which of the following lesions is osteoid osteoma similar on pathologic evaluation:

     

    1. Osteomas

    2. Enostosis

    3. Osteoblastoma

    4. Subperiosteal chondromas

    5. Parosteal osteosarcoma

     

    902-[ ] Telangiectatic osteosarcoma is most commonly confused with:

     

    1. Unicameral bone cyst

    2. Metaphyseal osseous defects

    3. Fibrous dysplasia

    4. Aneurysmal bone cyst

    5. Periosteal chondromas

     

    903-[ ] A focus of mature compact (cortical) bone within the cancellous bone is known to occur in:

     

    1. Enostosis

    2. Osteoid osteoma

    3. Cavernous hemangioma

    4. Heterotopic ossification

    5. Enchondroma

     

    904-[ ] A condition associated with intestinalpolyposis and multiple osteomas, would be:

     

    1. Chrones disease

    2. Gardners syndrome

    3. Gauchers disease

    4. Albrights syndrome

    5. Whipples disease

     

    905-[ ] Which of the following nerves is most likely to be injured on correction of cervical kyphosis:

     

    1. C2

    2. C3

    3. C4

    4. C5

    5. C6

     

    906-[ ] A 14 year old boy complains of pain along the medial aspect of the thigh, more severe at night. A bone scan reveals a double density sign with maximum uptake in the center of 1cm diameter lesion. The most likely diagnosis would be:

     

    1. Sclerosing periostitis

    2. Osteoblastoma

    3. Osteoid osteoma

    4. Stress fracture

    5. Eosinophilic granuloma

     

    907-[ ] When a patient presents with multiple exostosis and the direction of the stalk points towards the joint, the diagnosis would be most likely:

     

    1. Osteochondromatosis

    2. Metachondromatosis

    3. Multiple epiphyseal dysplasia

    4. Morquio’s disease

    5. Spondyloepiphyseal dysplasia

     

    908-[ ] Absorption of phosphate from the intestine is mainly from:

     

    1. The duodenum

    2. Lower end of the jejunum

    3. Upper end of the cecum

    4. The stomach

    5. The colon

     

    909-[ ] Giving parathormone at alternate times is:

     

    1. Anabolic

    2. Catabolic

    3. Of no effect on bone

    4. Encourages endochondral bone growth

    5. Thickens the periosteum 910-[ ] PTH increase results in:

    1. Increased excretion of calcium from the kidneys

    2. Increased excretion of phosphate from the kidneys

    3. Increased excretion of vitamin D from the liver

    4. Promotes deposition of calcium within the hydroxyapatite crystal

    5. Decreases the absorption of calcium from the jejunum

     

    911-[ ] The Hormone that in inhibits osteoclast mediated bone resorption is:

     

    1. PTH

    2. Thyroxin

    3. Calcitonin

    4. Thyroglobulin

    5. Adrenaline

     

    912-[ ] Which of the following conditions is known to be associated with an Erlenmeyer-flask deformity of the femur and bone necrosis:

     

    1. Morquio’s disease

    2. Hurlers syndrome

    3. Gaucher’s disease

    4. Osteopetrosis

    5. Malreostosis

     

    913-[ ] Parathormone is produced by which of the following:

     

    1. Fat cells within the parathyroid gland

    2. Follicular cells within the parathyroid gland

    3. In the liver through the action of 25-hydroxylase

    4. Chief cells within the parathyroid gland

    5. In the kidney through the action of 1-25 hydroxylase on the proximal convoluted tubule 914-[ ] In the kidneys, parathormone stimulates:

    1. Resorption of phosphate through the tubules

    2. Stimulates both resorption of calcium and phosphate through the tubules

    3. Stimulates excretion of calcium through the tubules

    4. Stimulates excretion of both calcium and phosphate through the tubules

    5. Stimulates resorption of calcium and excretion of phosphate through the tubules

        

       915-[ ] Intermittent administration of parathormone results in:

        

       1. An overall anabolic effect on bone

       2. A catabolic effect on bone

       3. No effect on bone

       4. Has no effect on 25-hydroxylase production in the liver

       5. Bone fragility

    916-[ ] Clearance of parathormone occurs mainly through the:

     

    1. Intestines

    2. Liver

    3. Kidney

    4. Parathyroids

    5. Thyroid

     

    917-[ ] the C-terminal of pathormone is cleared mainly in the:

     

    1. Intestines

    2. Liver

    3. Kidney

    4. Parathyroids

    5. Thyroid

     

    918-[ ] The main action of Vitamin D3 is on the:

     

    1. Liver

    2. Small intestine

    3. Colon

    4. Parathyroid gland

    5. Thyroid gland

     

    919-[ ] Which of the following interferes most with the absorption of calcium from the intestine:

     

    1. Diazepam

    2. Chelating agents

    3. Ergosterol

    4. Heparin

    5. Diuretics

     

    920-[ ] Phosphorous is absorbed into the body mainly through the:

     

    1. Duodenum

    2. Jejunum

    3. Cecum

    4. Colon

    5. Stomach

     

    921-[ ] Which of the following is most likely to interfere with the absorption of phosphorous from the intestines:

    1. Antacids

    2. Bisphosphonates

    3. Fluorine

    4. Steroids

    5. Heparin

     

    922-[ ] Which of the following peptide is secreted by the parafollicular cells of the thyroid gland:

     

    1. Parathormone

    2. Adrenaline

    3. Noradrenaline

    4. Calcitonin

    5. Ergosterol

     

    923-[ ] Which of the following when present, would result in shrinkage of the osteoclast:

     

    1. Calcitonin

    2. Parathormone

    3. Prednisolone

    4. Isoniazid

    5. Methotrexate

     

    924-[ ] PTHrP (parathormone related protein) is produced mainly in:

     

    1. The liver

    2. The kidney

    3. The tumor

    4. The Lung

    5. The parathyroid gland

     

    925-[ ] Fibroblast Growth Factor 23 (FGF23) is the principal phosphaturic hormone and is produced by:

     

    1. The osteoblast

    2. The osteocyte

    3. The osteoclast

    4. The mesenchymal cells

    5. The fibroblast

     

    926-[ ] The principal actions of FGF23 are:

    1. To inhibit sodium dependent phosphate reabsorption and 1-a-hydroxylase activity in the proximal tubule of the kidney

    2. To promote calcium excretion in the distal convoluted tubule

    3. To inhibit the production of 25-hydroxylase in the kidney

    4. To allow deposition of calcium on the surface of bone

    5. To release nonorganic minerals in the extracellular fluid 927-[ ] Low-turnover osteoporosis is characterized most by:

     

    1. Diminished osteoclastic activity

    2. Diminished osteoclastic and osteoblastic activity

    3. Diminished osteoblastic activity

    4. Increased osteoblastic activity

    5. Increased osteoclastic activity

     

    928-[ ] Umbo Zonen occurring on the concave side of a deformed tibia in an adult is indicative of which of the following conditions:

     

    1. Rickets

    2. Vitamin D resistant rickets

    3. Osteomalascia

    4. Osteoporosis

    5. Myeloma

     

    929-[ ] Flaring of the wrist (clubbing) with widening of the physis is indicative of:

     

    1. Rickets

    2. Osteomalascia

    3. Multiple epiphyseal dysplasia

    4. Gaucher’s disease

    5. Hyperthyroidism

     

    930-[ ] All the following have been elicited as causes of rickets except:

     

    1. Deficiency states (vitamin D, calcium, and phosphorus)

    2. Gastrointestinal causes

    3. Hyperthyroidism

    4. Genetic disorders

    5. Renal tubular causes

    931-[ ] Phosphorous deficiency rickets is associated with the intake of which of the following medications:

    1. Estrogen

    2. Aluminium hydroxide

    3. Heparin

    4. Diuretics

    5. Nonsteroidal anti-inflammatory medications

     

    932-[ ] Which of the following has been associated with myopathy in osteomalascia:

    1. 1 hydroxylase deficiency

    2. 25 hydroxylase deficiency

    3. Bicarbonate deficiency

    4. Deficiency ATP

    5. LDH deficiency

       933-[ ] The most probable explanation for patients to have gastric rickets is:

       1. Decreased gastric acidity

       2. Increased acid secretion by the chief cells

       3. A drop in liver enzymes

       4. Lack of pancreatic enzymes

       5. Excessive chelating substances interfering with absorption of vitamin D

     

    934-[ ] The basic cause of biliary rickets is:

    1. Failure of carbohydrate production

    2. Failure of protein production

    3. Decreased availability of ergosterol in the diet

    4. Decreased production of biliary salts

    5. Excessive chelating agents in the diet

     

    935-[ ] All the following conditions are causes of enteric rickets except:

    1. Celiac disease

    2. Crohn’s disease

    3. Short loop bowel

    4. Gardener’s syndrome

    5. Tropical sprue

    936-[ ] Type I vitamin D-dependent rickets is related to:

    1. Excessive extracellular calcitonin

    2. Poor intake of viatamin D in the diet

    3. Deficiency of 25 hydroxy vitamin D in the circulation

    4. Poor exposure to sunlight

    5. 1-alpha hydroxylase deficiency

       937-[ ] When rickets is associated with Albright’s syndrome (X-linked dominant condition) is due to:

       1. Diminished tubular resorption of phosphate

       2. Increased tubular excretion of calcium

       3. Decreased active absorption of calcium through the duodenum

       4. Failure of bile salts to emulsify fats in the intestines

       5. Excessive alkalinity of the gastric secretions

        

       938-[ ] The Fanconi syndrome when it first presents in adults is most liked caused by:

       1. Gastrectomy

       2. Duodenal resection

       3. Jejunal resection

       4. Myeloma

       5. Crohn’s disease

        

       939-[ ] All the following have been associated with Fanconi syndrome, except:

       1. Hyperchloremic rickets

       2. Hyponatremia

       3. Hypokalemic acidosis with alkaline urine

       4. A notable loss of fixed base including calcium ion

       5. Excessive bile salt excretion

        

       940- [ ] Oncogenic osteomalascia is associated with:

       1. Decreased Calcium absorption from the intestine

       2. Phosphate wasting from the kidney

       3. Increased calcitonin in the circulation

       4. Increased parathyroid gland activity

       5. Apoptosis of the osteoclast

        

       941-[ ] All the following tumors have been associated with osteomalascia except:

       1. Neurofibroma

       2. Fibrous dysplasia

       3. Primary malignant lung tumors

       4. Chondroblastoma like lesions

       5. Renal cell carcinoma

       942-[ ] FGF23 produced by primary malignant tumors know to be associated with osteomalascia results from:

       1. The lowering of serum calcium

       2. The lowering of serum phosphate

       3. Drop in the level of dihandrenesterone levels in the skin

       4. A drop in the production of bile salts in the liver

       5. Interference with the active transport of calcium through the duodenal mucosal cells

        

       943-[ ] Chronic anticonvulsant therapy leading to osteomalascia, is believed to be due to all the following, except:

       1. Stimulates the over production of vitamin D

       2. Have direct effects on bone cells

       3. Promotes resistance to PTH

       4. Inhibits calcitonin secretion

       5. Impairs calcium absorption

        

       944-[ ] A 3 year old boy following a minor fall and on plain xrays of the wrist, was noted to

       have pelkan spurs, Wimburger’s line and a Fraenkel line. Your most likely diagnosis would be:

       1. Leukemia

       2. Scurvy

       3. Rickets

       4. Hyperparathyroidism

       5. Pseudo-pseudo hypoparathyroidism

        

       945-[ ] A significant difference between balloon kyphoplasty and vertebroplasty is that:

       1. A douphy cement is used in kyphoplasty rather than a liquid cement

       2. Immobilization of an unstable fracture is more with a vertebroplasty

       3. Kyphoplasty results in more trabecular fixation than in a vertebroplasty

       4. Kyphoplasty results in more sensory nerve necrosis then in a vertebroplasty

       5. Vertobroplasty results in more correction of spinal deformity

       946-[ ] Absolute contraindications to both kyphoplasty and vertebroplastyinclude all except:

       1. Coagulation disorders

       2. Local infection in the proposed site of access

       3. Neoplasms with involvement of the posterior vertebral wall

       4. Recent compression fractures of the vertebral body

       5. Complete vertebral body collapse

       947-[ ] The extrapedicular approach in kyphoplasty is most commonly used at the:

       1. Lower thoracic region

       2. Mid-thoracic region

       3. Upper lumbar region

       4. Mid-lumbar region

       5. Lower lumbar region

       948-[ ] A 4ST (hamstring graft is estimated to be equivalent in strength to a normal ACL (in percent):

        

       1. 100%

       2. 120%

       3. 160%

       4. 280%

       5. 320%

       949-[ ] In which of the following injuries mechanoreceptor function is lost:

        

       1. Osteochondritis dessicans of the medial condyle

       2. Osteochondritis dessicans of the lateral condyle

       3. ACL injuries

       4. Medial meniscus injury

       5. Lateral meniscus injury

       950-[ ] Which of the following cancers metastasize least to bone:

       1. Breast

       2. Lungs

       3. Adrenals

       4. Prostate

       5. Thyroid

       951-[ ] Which of the following lesions in bone would benefit most from embolization:

       1. Breast

       2. Lungs

       3. Renal

       4. Prostate

       5. Thyroid

       952-[ ] Which of the following cancerous primary sites, is known to be associated with acro-metastases:

       1. Breast

       2. Lungs

       3. Heart

       4. Prostate

       5. Thyroid

       953-[ ] Which of the following malignancies can present with the radiologic appearance of an ivory vertebra:

    6. Chondrosarcoma

    7. Breast

    8. myeloma

    9. Renal

    10. Thyroid

        954-[ ] Which of the following conditions is associated with resorption of the tufts of the distal

        phalanges of the hand:

        1. Hyperparathyroidism

        2. Hyperthyroidism

        3. Hypertrophy of the adrenal cortex

        4. Adenomas of the testicles

        5. Hirchsprungs disease

    955-[ ] Osteosarcoma of the sacrum in a 60 year old man is most probably secondary to:

    1. An osteochondroma

    2. Paget’s disease

    3. Hyperparathyroidism

    4. Fibrous dysplasia

    5. Bone infarct

    956-[ ] When Ewing Sarcoma presents as a solitary lesion in the spine, it is most commonly located in the:

    1. Cervical spine

    2. Thoracic spine lumbar spine

    3. Lumbar spine

    4. Sacrum

    5. Coccyx

    957-[ ] In which portion of the spine does Ewings sarcoma (When present) has the worse prognosis:

    1. Cervical spine

    2. Thoracic spine lumbar spine

    3. Lumbar spine

    4. Sacrum

    5. Coccyx

    958-[ ] In infants younger than four months old, when clinical suspicion of DDH exists, the best radio-imaging used to assist in the diagnosis, would be:

    1. MRI

    2. CT scans

    3. Ultrasound

    4. Plain xrays

    5. Scintigraphy

    959-[ ] All the following are considered risk factors for DDH, except:

    1. Female gender

    2. First degree relative with DDH

    3. Premature birth

    4. Delayed skeletal maturity

    5. Breech presentation

    960-[ ] The incidence of club foot deformity is increased four times in which of the following:

    1. Amniocentesis

    2. Premature births

    3. Breech delivery

    4. Male sex

    5. Primigravidas

    961-[ ] Which of the following radio-imaging techniques is most useful to confirm reduction of DDH while in a hip spica:

    1. MRI

    2. Ultrasound

    3. CT scan

    4. Plain xrays

    5. Scintigraphy

    962-[ ] Indicate which of the following facets is the largest and the major weight-bearing surface of the subtalar joint:

    1. The anterior facet

    2. Middle facet

    3. Sustenticulum tali

    4. The posterior facet

    5. The os trigonum

    963-[ ] Lateral ligamentous support of the subtalar joint arises from all, except:

    1. The lateral talocalcaneal ligament

    2. The posterior talocalcaneal ligament

    3. The lateral aspect of the inferior extensor retinaculum

    4. The spring ligament

    5. The calcaneofibular ligament

    964-[ ] On comparing pediatric spines less than 8 years of age, to those in adults, certain differences are noted which include all, except:

    1. Pediatric spines have greater ligamentous flexibility and elasticity

    2. Pediatric spines have shallower and more horizontal facets

    3. The artery of Adamkiewicz is more prominent and has more blood flow to the spinal cord

    4. Pediatric spines have relative paraspinal muscle immaturity

    5. The nucleus pulposus in children has greater water content and a lesser amount of collagen cross-linking than does that in adults, providing more elasticity and a greater ability to dissipate force

    965-[ ] The spinal cord ends at what level in newborns:

    1. L1

    2. L2-3

    3. S1-2

    4. L4

    5. L5

    966-[ ] In distraction injuries of the spine in children, the deforming tension force is commonly translated through which portion of the vertebra:

    1. The physeal cartilage of the maturing vertebral body

    2. The spinous processes

    3. The interspinous ligament

    4. The nucleus pulposus

    5. The mid aspect of the vertebral body

    967-[ ] The accepted explanation why children have a higher incidence of abdominal injuries following thoracolumbar distraction injuries, would be:

    1. Younger patients have less protection from overlying muscles, and underdeveloped iliac crests

    2. The vital structures are located at lower levels within the abdominal cavity

    3. The liver and spleen are more superficial

    4. The position of the seat belt though properly adjusted does not provide sufficient protection

    5. The forces when applied to the abdomen in children are usually more severe than in adults

    968-[ ] One of the following statements, does not stand up as an advantage of a percutaneous biopsy:

    1. Are optimal for initial sampling of lesions in anatomically inaccessible areas such as the spine or pelvis

    2. They cause little soft tissue contamination

    3. They require little or no anesthesia

    4. They are frequently performed under CT scan or ultrasound guidance

    5. It provides only a small amount of tissue for the pathologist to review

     

    969-[ ] All the following are contraindications to limb salvage procedures, except:

     

    1. Inability to achieve wide surgical margins

    2. Invasion of major neurovascular structures

    3. Pathologic fractures where the risk of recurrence increases several folds

    4. Involvement or contamination of multiple compartments with extensive muscle involvement

    5. Patients with extensive skin involvement

     

    970-[ ] With the advent of neoadjuvant chemotherapy and advances in radiation therapy techniques, the 5-year survival rate of osteosarcoma has improved to:

     

    1. 80%

    2. 60–70%

    3. 40-50%

    4. 20-30%

    5. 15%

     

    971-[ ] The primary stabilizer of the elbow is:

     

    1. The radial head

    2. The olecranon process

    3. The coronoid fossa

    4. The coronoid process

    5. The olecranon fossa

     

    972-[ ] The primary constraint to valgus stress at the elbow joint is:

     

    1. The anterior bundle of the medial collateral ligament

    2. The lateral collateral ligament

    3. The common origin of the flexor tendons of the elbow

    4. The pronator teres tendon

    5. The annular ligament

     

    973-[ ] The secondary stabilizer against valgus stress of the elbow:

     

    1. The medial collateral ligament

    2. The radial head

    3. The capitellum

    4. The anterior bundle of the ulnar collateral ligament

    5. The sigmoid fossa

    974-[ ] The radial head articulates medially with:

     

    1. The greater sigmoid notch

    2. The lesser sigmoid notch

    3. The capitellum

    4. The coronoid fossa

    5. The olecranon fossa

    975-[ ] The proximal dorsal angulation located nearly 5 cm distal to the tip of the olecranon measures:

    1. 10 degrees

    2. 12 degrees

    3. 8 degrees

    4. 6 degrees

    5. 3 degrees

    976-[ ] The anterior band of the medial collateral ligament inserts on:

    1. The tip of the coronoid process

    2. The body of the coronoid process

    3. The anteromedial facet of the coronoid process

    4. The sublime tubercle

    5. The anterolateral facet of the coronoid process

    977-[ ] The structure that inserts on the crista supinatoris on the lateral proximal ulna at the point where the supinator crest blends with the radial notch, would be:

    1. The lateral ulnar collateral ligament

    2. The brachialis muscle

    3. The biceps tendon

    4. The anterior bundle of the medial collateral ligament

    5. The anconeus muscle

    978-[ ] An isolated coronoid tip fracture seen on an otherwise normal radiograph is suggestive of:

    1. Rupture of the anterior band of the medial collateral ligament

    2. A dislocation or subluxation injury of the elbow that spontaneously reduced

    3. Avulsion of the brachialis tendon

    4. Avulsion of the biceps tendon insertion

    5. An impaction of the coronoid process within the coronoid fossa

    979-[ ] The terrible triad injury of the elbow results from a valgus with additional posterolateral force and consists of a combination of:

    1. A coronoid fracture, radial head fracture, and dislocation of the elbow, resulting in collateral ligament injury

    2. A olecranon, radial head and capitellum fracture

    3. A lateral condylar, radial head and medial collateral ligament avulsion

    4. Posterior elbow dislocation, capetellum and radial head fracture

    5. Radio-ulnar dislocation, radial head and capitellar fracture

    980-[ ] When a giant cell tumor arises in children, its primary site of location would be in the:

    1. Epiphysis

    2. physis

    3. Metaphysis

    4. Diaphysis

    5. Intra-articular

    981-[ ] Which of the following lesions does not occur in the epiphysis of long bones:

    1. Chondroblastoma

    2. intraosseous ganglia

    3. Clear cell chondrosarcoma

    4. Multiple myeloma

    5. Giant cell tumor

    982-[ ] Which of the following lesions on MRI does not have fluid-fluid levels:

    1. GCT of bone

    2. Aneurysmal bone cyst

    3. Telangiectatic osteosarcoma

    4. Fibrosarcoma of bone

    5. Unicameral bone cyst

    983-[ ] The lesion shown in the plain x-ray below, is most probably which of the following conditions listed below:

     

     

     

     

    1. Osteoid osteoma

    2. Bone island

    3. Osteoblastoma

    4. Nonossifying fibroma

    5. Chondroma

    984-[ ] What is your most likely diagnosis of the lesion shown in the x-ray below:

     

     

     

    1. Osteoid osteoma

    2. Bone island

    3. Osteoblastoma

    4. Nonossifying fibroma

    5. Chondroma

       985-[ ] A15 year old boy presents to your clinic having an x-ray that reveals an irregularity in the posteromedial aspect of the distal metaphysis of the femur. Your most likely diagnosis would be:

        

        

        

        

    6. Parosteal osteosarcoma

    7. Osteochondroma

    8. Periosteal desmoid

    9. Periosteal chondroma

    10. Periosteal osteosarcoma

    986-[ ] The x-ray below is that of the tibia of an adolescent boy. What is your most likely diagnosis:

    1. Nonossifying fibroma

    2. Osteofibrous dysplasia

    3. Fibrous dysplasia

    4. Adamantinoma

    5. Fibrous-cortical defect

     

     

    987-[ ] A seventeen year old male complained of severe neck pain localized to the posterior mid-aspect of the neck. A plain xray of the cervical spine was taken, and a lateral view is shown below. Your most likely diagnosis, would be:

     

     

     

     

    1. Osteomyelitis

    2. Osteoblastoma

    3. Heterotopic ossification

    4. Osteoid osteoma

    5. Eosinophilic granuloma

    988-[ ] A 13 year old girl presents with shoulder pain and limitation of all ranges of motion. A plain xray is shown below. What is your diagnosis:

     

     

     

    1. Aneurysmal bone cyst

    2. Chondroblastoma

    3. Unicameral bone cyst

    4. Giant cell tumor

    5. Subacute osteomyelitis

    989-[ ] Which of the following lesions is the counterpart of a chondroblastoma in adults:

    1. Eosinophilic granuloma

    2. Subacute osteomyelitis

    3. Clear cell chondrosarcoma

    4. Chondromyxoid fibroma

    5. Telangiectatic osteosarcoma

    990-[ ] Malignant fibrous histiocytoma of bone is known to occur secondary to all the following lesions, except:

    1. Bone infarcts

    2. Radiation

    3. Pagets disease

    4. Enchondromas

    5. Giant cell tumor

    991-[ ] Which of the following types of osteosarcoma has a microscopic picture that resembles a Ewings Sarcoma:

    1. Parosteal osteosarcoma

    2. Small cell osteosarcoma

    3. Periosteal osteosarcoma

    4. Didiferentiated osteosarcoma

    5. Conventional osteosarcoma

    992-[ ] All the following conditions can lead to chondrocalcinosis EXCEPT:

    1. Hyperparathyroidism

    2. Hemochromatosis

    3. Hypomagnesemia

    4. Hyperthyroidism

    5. Ochronosis

    993-[ ] Which of the following conditions leads to overgrowth of the epiphysis around a joint:

    1. Hemophilia

    2. Gout

    3. Chondrocalcinosis

    4. Ochronosis

    5. Gauchers disease

    994-[ ] A deficiency of homogentesic acid oxidase has been associated with which of the conditions, leading to joint involvement:

    1. Hyperparathyroidism

    2. Hemochromatosis

    3. Hypomagnesemia

    4. Hyperthyroidism

    5. Ochronosis

     

    995-[ ] A synovial arthropathy caused by an antigen-antibody reaction, or a state of hypersensitivity, resulting in an inflammatory process. Thus producing an antibody in the lymph nodes leading to an antigen antibody reaction in joints, is known as:

     

    1. Tuberculous arthritidis

    2. Hypomagnesemia

    3. Gauchers disease

    4. Rheumatoid arthritis

    5. Ochronosis

    996[ ] Which of the following, is a collagenase and is known to destroy cartilage:

     

    1. TNF-alpha

    2. IL1

    3. IL6

    4. Matrix metalloproteinase

    5. Oncostatin M

    997- [ ] A condition which is most often associated with sacroiliatis is:

    1. Rheumatoid arthritis

    2. Osteitis condensens ilia

    3. Psoriatic spondyloarthritidis

    4. Typhoid fever

    5. Syphilis

    998-[ ] The lesions shown in the x-ray below, are typical of which of the following conditions:

     

     

     

     

    1. Hemochromatosis

    2. Rheumatoid arthritidis

    3. Ochronosis

    4. Hemophilia

    5. Chondrocalcinosis

     

    999-[ ] Which, other condition shows widening of the intercondylar notch of the knee, besides hemophilia?

    1. Juvenile rheumatoid arthritis

    2. Hemochromatosis

    3. Ochronosis

    4. Chondrocalcinosis

    5. Thalassemia

     

    1000-[ ] An arthritidis known to occur in children and involve multiple organs, with systemic manifestations including fever and multiple lymphadenopathy, would be:

    1. Psoriasis

    2. Reiter’s syndrome

    3. Eosinophilic granuloma

    4. Still’s disease

    5. Crohn’s disease

    1001-[ ] The organism, that is most commonly found in septic arthritis, in the young sexually active individual, would be:

    1. Pseudomonous

    2. Ecoli

    3. Neisseria ghonorrea

    4. Streptococci

    5. Staphylococci

    1002-[ ] The organism that results in Lyme’s disease is:

    1. Pseudomonous

    2. Ecoli

    3. Neisseria ghonorrea

    4. Borrelia burgdorferi

    5. Streptococci

    1003-[ ] On pathologic examination of the synovium of the knee joint , one notices: slender, long, needle like, and negatively birefringent structures. This is indicative of which of the following conditions:

     

    1. Chondrocalcinosis

    2. Gout

    3. Calcium pyrophosphate deposition disease

    4. Serronegative arthritidis

    5. Ochronosis

     

    1004-[ ] Gouty arthritis of the first metatarsophalangeal joint of the foot is known as:

     

    1. Morton’s arthritis

    2. Podagra

    3. Friebergs disease

    4. Kohlers disease

    5. Hallux rigidus

     

    1005-[ ] Arthritis mutilans with severe opera glass hand deformity (“main en lorgnette”) is known to occur in which of the following conditions:

     

    1. Psoriasis

    2. Crohn’s disease

    3. Ulcerative colitis

    4. Reiter’s syndrome

    5. Whipple’s disease

     

    1006-[ ] Reactive arthritis occurs more commonly in young adults (20–40 years) with a male predominance and is strongly associated with:

     

    1. HLA B-27

    2. HLA B-24

    3. HLA B-14

    4. HLA B-4

    5. HLA B-6

     

    1007-[ ] Which of the following arthropathies is the result of lack proprioception and deep sensation in the joint:

     

    1. Rheumatoid arthritis

    2. Psoriasis

    3. Charcot arthropathy

    4. Chondrocalcinosis

    5. Gouty arthropathy

        

       1008-[ ] Which of the following arthropathies results in maximum destruction of the joint:

        

       1. Rheumatoid arthritis

       2. Psoriasis

       3. Charcot arthropathy

       4. Chondrocalcinosis

       5. Gouty arthropathy

     

    1009-[ ] An arthrotididis that has one of its features as squaring of the vertebral body, would be:

     

    1. Rheumatoid spondylitis

    2. Bechterews spondylitis

    3. Ankylosing spondylitis

    4. Psoriatic spondylitis

    5. Tuberculous spondylitis

     

    1010-[ ] Which of the following conditions presents with a radiologic picture of cysts on either or both sides of the joint:

     

    1. Villonodular synovitis

    2. Hemangioma

    3. Intra-articular lipomas

    4. Chondrocalcinosis

    5. Scurvy

     

    1011-[ ] All the following are well demonstrated by a pelvic inlet radiographic view, except:

     

    1. S1 body

    2. Sacral ala

    3. Posterior displacement

    4. Vertical plane rotation

    5. Anterior ring morphology

     

    1012-[ ] Which of the following structures is not well demonstrated by the Judet oblique views:

    1. Acetabular fractures

    2. Ramus morphology and displacement

    3. Iliac fractures

    4. Horizontal plane rotation

    5. Sciatic notch

     

    1013-[ ] The structure that provides stability and behaves as a shock absorber in the spine would be:

    1. The intervertebral disc

    2. The annulus fibrosus

    3. The anterior longitudinal ligament

    4. The posterior longitudinal ligament

    5. The ligamentum flavum

     

    1014-[ ] Vertebra prominens, identifies which of the following vertebrae:

     

    1. C2

    2. C5

    3. C7

    4. T6

    5. T12

    1015-[ ] A deformity in the spine that includes sagittal, lateral and rotational deviation from the normal, is known to be:

     

    1. Scoliosis

    2. Lordosis

    3. Kyphosis

    4. Spondylosis

    5. Spondyloptosis

     

    1016-[ ] The thyroid cartilage is at what level:

     

    1. C2

    2. C3

    3. C4

    4. C5

    5. C6

     

    1017-[ ] The tubercle of Chassaignac is known to be at what level in the cervical spine:

     

    1. C2

    2. C3

    3. C4

    4. C5

    5. C6

     

    1018-[ ] All the following nerves may be injured following an acetabular fracture, Except:

    1. Sciatic

    2. Posterior tibial nerve

    3. Femoral

    4. Obturotor

    5. Superior gluteal nerve

     

    1019-[ ] Which of the following arteries is most likely and rarely injured, following an acetabular fracture:

    1. Corona mortis

    2. External iliac artery

    3. Superior gluteal artery

    4. Internal iliac artery

    5. Femoral artery

     

    1020-[ ] Which of the following acetabular fractures needs prompt reduction:

    1. Anterior wall fractures

    2. Posterior wall fractures involving more than 40% of the articulation

    3. Fractures of the quadrilateral plate with medial displacement

    4. Transverse fractures of the acetabulum

    5. Fracture involving the iliopubic column

     

    1021-[ ] Why is it most important to apply traction in an unstable fracture of the acetabulum:

    1. To prevent further damage to the joint

    2. To prevent neurologic injury

    3. To prevent osteonecrosis

    4. To prevent vascular injury

    5. To prevent further bleeding

     

    1022-[ ] Which of the following types of acetabular fractures can be operated on, with minimal blood loss, in the acute phase:

    1. Posterior wall fractures

    2. Anterior wall fractures

    3. Transverse fracture

    4. Anterior column fracture

    5. Posterior column fractures

     

    1023-[ ] Which of the following measurements can be used to evaluate, a stable and congruous relationship between the femoral head and acetabulum:

    1. Shenton’s line

    2. Acetabular index

    3. Roof arc measurement

    4. CE angle

    5. Tear drop position

    1024-[ ] The Roof Arc angle is measured on:

    1. The anterior posterior view of the pelvis in neutral position

    2. The obturator view alone

    3. The iliac view alone

    4. The combined anterior-posterior, obturator and iliac views

    5. The pelvic inlet view

     

    1025-[ ] An angle created by a vertical line through the center of the femoral head and a second line between the center of the femoral head and to the fracture location at the articular surface, on each standard view, is known as the:

    1. Subchondral arc angle

    2. CE angle

    3. Roof arc angle

    4. Acetabular index

    5. Shenton’s angle

     

    1026-[ ] Which of the following acetabular fractures may be considered for non-surgical management in the presence of secondary congruence, between the acetabulum and femoral head:

    1. Both column fractures

    2. Anterior column fractures

    3. Posterior column fractures

    4. High trans-tectoral fractures

    5. Fractures of the quadrilateral plate

     

    1027-[ ] The best approach in evaluating hip instability following a fracture of the posterior wall of the acetabulum, would be by:

    1. Taking a true anterior-posterior view of the acetabulum

    2. A bi-dimensional CT scan of the acetabulum

    3. Examination under anesthesia and fluoroscopic control

    4. Judet views of the acetabulum

    5. Inlet views of the pelvis

     

    1028-[ ] Listed below are all the approaches used to reduce fractures of the acetabulum. Which of these, allow direct access to all aspects of the acetabulum:

    1. Kocher-Langenbeck

    2. Ilio-inguinal

    3. Iliofemoral

    4. Stoppas approach

    5. Extended iliofemoral approach

     

    1029-[ ] Instead of using the Kocher-Langenback approach which may risk the nerve supply to the anterior portion of the gluteus maximus, where one splits the gluteus maximus at the junction with the tensor fascia lata. This alternate approach is known as:

    1. The Gibson approach

    2. Smith Peterson approach

    3. Stoppa’s approach

    4. The Steel approach

    5. The Watson-Jones approach

     

    1030-[ ] A trochanteric-flip approach is used best to visualize which portion of the acetabulum on reducing a fracture:

    1. Posterior wall

    2. Anterior-superior wall

    3. Anterior wall

    4. Transverse fracture of the acetabulum

    5. Inferior tectorial fractures

     

    1031-[ ] An alternative to the ilioinguinal approach being intra-pelvic, would be:

    1. Trochanteric-flip

    2. Extended iliofemoral

    3. Iliofemoral

    4. Stoppa’s

    5. Langen-beck….approach

        

       1032-[ ] Which of the following approaches of the acetabulum offer, improved exposure of the quadrilateral surface and posterior column and allow buttressing of the quadrilateral surface:

       1. Trochanteric-flip

       2. Extended iliofemoral

       3. Iliofemoral

       4. Stoppa’s

       5. Langen-beck….approach

     

    1033-[ ] Disruption of the transverse ligament of the atlas in adults occurs when the atlanto-dens interval is greater than:

    1. 2mm

    2. 4mm

    3. 5mm

    4. 7mm

    5. 10mm

     

    1034-[ ] The muscle associated with avulsion of the anterior tubercle of the atlas, would be:

    1. Multifidus

    2. Semispinalis

    3. Longus colli

    4. Spinal accessory

    5. Interspinous

     

    1035-[ ] Which of the following conditions is associated least, with the development of degenerative arthrosis of the hip, with time:

    1. Congenital deformities

    2. Acquired deformities

    3. Meyers dysplasia

    4. Trauma

    5. Osteonecrosis

     

    1036-[ ] Which of the following conditions is associated with impingement of the femoral neck with and anterior acetabular rim:

    1. Anterior crossover of the anterior rim of the acetabulum

    2. Meyers dydplasia

    3. Sickle cell disease

    4. Coxa vara

    5. Arthritis

    1037-[ ] Labral shearing and cartilage degeneration may occur in all the following activities as result of abnormal hip mechanics, except:

    1. Martial arts

    2. Ballet

    3. Gymnastics

    4. Swimming

    5. TV seated positions

     

    1038-[ ] A deformity that features a bony prominence at the femoral head neck junction, is known as a:

    1. Cam

    2. Pincer

    3. Combined pincer and Cam

    4. Rose thorn sign

    5. Spur

     

    1039-[ ] A pincer type of impingement occurs least in which of the following conditions:

    1. Protrusion acetabulae

    2. Coxa Profunda

    3. Marfans syndrome

    4. Centrally displaced fractures of the quadrilateral plate of the acetabulum

    5. Slipped capital femoral epiphysis

     

    1040-[ ] An anterior impingement test includes, all of the following range of motion, except:

    1. Flexion

    2. Adduction

    3. Internal rotation

    4. Abduction

    5. Adduction and internal rotation

     

    1041-[ ] Pincer impingement is associated with all the following radiographic signs radiographic signs except:

     

    1. A lateral center-edge (LCE) angle of more than 40°

    2. An acetabular index (AI) less than 0°

    3. A positive tear drop sign

    4. A positive crossover sign

    5. A positive posterior wall sign

    1042-[ ] Coxa profunda is:

    1. When the floor of the fossa acetabuli touches the ilioischial line

    2. When the femoral head overlaps the ilioischial spine medially

    3. When the epiphysis of the head protrudes laterally out of the circle around the head

    4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

    5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

       1043-[ ] Protrusio acetabulum is:

       1. When the floor of the fossa acetabuli touches the ilioischial line

       2. When the femoral head overlaps the ilioischial spine medially

       3. When the epiphysis of the head protrudes laterally out of the circle around the head

       4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

       5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

    1044-[ ] A pistol grip sign is:

    1. When the floor of the fossa acetabuli touches the ilioischial line

    2. When the femoral head overlaps the ilioischial spine medially

    3. When the epiphysis of the head protrudes laterally out of the circle around the head

    4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

    5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

       1045-[ ] A double contour sign is:

       1. When the floor of the fossa acetabuli touches the ilioischial line

       2. When the femoral head overlaps the ilioischial spine medially

       3. When the epiphysis of the head protrudes laterally out of the circle around the head

       4. Lateral contour of the femoral head extends into a convex shape to the base of the neck

       5. Ossification of the rim caused by bone apposition resulting in a double projection of the anterior and posterior walls

     

    1046-[ ] The Bernese periacetabular osteotomy is indicated in all except:

    1. Patients younger than 35 years

    2. Round femoral heads

    3. Intact articular cartilage as demonstrated on MRI

    4. Crowe I dysplastic hips

    5. On plain radiographs reveal a Tonnis grade 0 and I

     

    1047-[ ] Which of the alternative arthroplasty surfacing procedures has been associated with pseudotumor and ALVAL:

    1. Metal on metal

    2. Metal on ceramic

    3. Ceramic on ceramic

    4. Metal on highly cross-linked polyethylene

    5. Metal on ultra-high molecular weight polyethylene

     

    1048-[ ] Patients with a THA, elevated serum ion levels greater than 5ug/liter were associated with a higher incidence of:

    1. Aseptic loosening

    2. Septic loosening

    3. Pseudotumors

    4. Squeaking

    5. Dislocation

    1049-[ ] The most common position of the head in congenital muscular torticollis would be:

     

    1. Tilts toward and rotates away from the side of the involved stercleidomastoid muscle

    2. Tilts away and rotates away from the side of the involved stercleidomastoid muscle

    3. Tilts toward and rotates toward the side of the involved stercleidomastoid muscle

    4. Tilts away and rotates toward from the side of the involved stercleidomastoid muscle

    5. The head only tilts toward the involved sternocleidomastoid muscle

    1050-[ ] Plagiocephaly is known to occur in which of the following conditions:

    1. Charcot Marie Tooth disease

    2. Congenital insensitivity to pain

    3. Congenital muscular torticollis

    4. Marfans syndrome

    5. Gardener’s syndrome

    1051-[ ] Which of the following conditions is most likely associated with torticollis in a child:

    1. Atlanto-axial rotatory subluxation

    2. Marfans syndrome

    3. Ehler-Danlos syndrome

    4. Rheumatoid spondylitis

    5. Ankylosing spondylitis

    1052-[ ] The best imaging used to diagnose atlanto-axial rotatory subluxation would be:

    1. MRI

    2. Ultrasound

    3. CT scan

    4. Plain x-ray tomograms

    5. Scintigraphy

     

    1053-[ ] The most common cause of heel pain for patients between 40-60 years of age would be:

     

    1. Plantar fasciitis

    2. Heel pad atrophy

    3. Baxter Nerve Entrapment

    4. Tarsal Tunnel syndrome

    5. Stress fracture of the calcaneus

     

    1054-[ ] The plantar fascia is a fibrous aponeurosis that originates from the plantar medial aspect of the calcaneal tuberosity and inserts distally on:

    1. Medial cuneiform

    2. Midtarsal joint

    3. Inferior suface of the navicular

    4. Each of the proximal phalanges

    5. Inferior surface of the cuboid

     

    1055-[ ] The histologic appearance of a specimen obtained from a patient with plantar fasciitis, includes all the following, except:

    1. Myxoid degeneration

    2. Disorientation of the collagen fibers

    3. Angiofibroblastic hyperplasia

    4. Numerous giant cells with hemosiderin inclusions

    5. Calcification

    1056-[ ] The site of tenderness that is most likely associated with plantar fasciitis, would be:

    1. At the site of the plantar fascial insertion on the medial calcaneal tuberosity

    2. Within the heel pad

    3. At the medial ankle just beneath the medial malleolus

    4. At the insertion of the posterior tibial tendon

    5. At the insertion of the Achilles tendon on the calcaneus

    1057-[ ] On Cadaveric sections, the calcaneal spur was found in the:

    1. Plantar fascia

    2. Flexor digitorum brevis origin

    3. Achilles tendon insertion

    4. Plantar digiti minimi

    5. Abductor halluces origin

    1058-[ ] An MRI of the foot in a patient with plantar fasciitis most likely shows:

    1. Calcification

    2. Splitting of the fascia

    3. Thickening of the plantar fascia

    4. Erosion of the medial calcaneal tuberosity

    5. Rupture of the origin of the plantar fascia

    1059-[ ] A factor which does not hinder the heel pad function, as a shock absorber is:

    1. Loss of water

    2. Loss of collagen

    3. Loss of elastic tissue

    4. Slim people

    5. Aging

    1060-[ ] The Baxter entrapment syndrome is associated with:

    1. Abductor Hallucis compartment syndrome

    2. Flexor digitorum brevis compartment syndrome

    3. Compression of the first lateral plantar nerve

    4. Compression of the sural nerve

    5. Quadratus plantae compartment syndrome

     

    1061-[ ] Which of the following condition accentuates most the Baxter nerve entrapment syndrome:

    1. Plantar fasciitis

    2. Plantar spur

    3. Posterior tibial insufficiency syndrome

    4. Heel pad atrophy

    5. Stress fractures of the calcaneum

    1062-[ ] The second most common site for stress fractures to occur in the foot, would be:

    1. Calcaneus

    2. Navicular

    3. Metatarsal

    4. Cuboid

    5. Medial cuneiform

    1063-[ ] Tarsal Tunnel syndrome is:

    1. Entrapment of the posterior tibial tendon within the tunnel

    2. Entrapment of the posterior tibial nerve

    3. Entrapment of the lateral plantar nerve

    4. Entrapment of the medial planter nerve

    5. Entrapment of the sural nerve

    1064-[ ] Which of the following statements does not apply to the tarsal tunnel:

    1. It is a fibro-osseous space located distal and posterior to the medial malleolus

    2. Its roof is formed by the flexor retinaculum

    3. The floor is formed by the medial wall of the calcaneum

    4. The tendons of tibialis posterior, flexor digitorum communis and flexor hallucis longus pass through the tunnel

    5. The abductor hallucis forms the medial wall

    1065-[ ] Which of the following statements, least apply to Tarsal Tunnel Syndrome (TTS):

    1. Pes planus is one of the most common cause of TTS

    2. It (TTS) is most commonly bilateral

    3. Is often associated with space occupying lesions

    4. Rheumatoid arthritis is a common cause

    5. Occurs often in diabetics

     

    1066-[ ] A fifty year old male presents to your clinic complaining of pain in the left heel. He gave no history suggesting an inflammatory process nor of any other systemic disease. He stated that he was overdoing work, this last month.

    On examination, he was noted to have bimanual tenderness over the body of the calcaneus. An xray was requested and is shown below. What would be the most likely diagnosis:

     

     

     

    1. Heel pad atrophy

    2. Tarsal Tunnel syndrome

    3. Baxter entrapment syndrome

    4. Calcaneal stress fracture

    5. Plantar fasciitis

    1067-[ ] On not seeing an apparent lesion on plain x-ray, in a patient with heel pain, localized by bimanual pressure applied to the body of the calcaneus, what further study may help in making the diagnosis:

    1. Ultrasound

    2. Technetium bone scan

    3. Nerve conduction study

    4. CT scan

    5. Rheumatoid factor

    1688-[ ] A young adult falls on his left hip and sustains a fracture of the femoral head. The fracture line passes above the femoral head fovea. This corresponds to which type, in the Pipkin classification:

    1. Type I

    2. Type II

    3. Type III

    4. Type IV

    5. Type V

    1069-[ ] Which of the following primary tumors when metastasis occurs to the spine, responds least to any form of treatment other than surgery:

    1. Prostate

    2. Breast

    3. Lymphoma

    4. Renal cell

    5. Myeloma

     

    1070-[ ] The bare area in which one could put a plate on the Radial head and not interfere with pronation or supination would be:

    1. Between the radial styloid and listers tubercle

    2. Between the posterior aspect of the radial and ulnar styloid

    3. Between the insertion of the extensor carpi radialis and brevis

    4. At the insertion of the caudate ligament

    5. Between both attachments of the annulus fibrosus

     

    1071-[ ] A twenty year old male is brought to the Emergency room after being hit by a car. Xrays reveal a comminuted fracture (Winquist type IV fracture of the femur.

    The patient was unconscious and the team refused any Emergency surgery. You decide to put him in traction. What is often missed while doing so and should be looked for:

    1. Fracture of the epsilateral tibial shaft

    2. A tibial plateau fracture

    3. A large hematoma

    4. Epsilateral fracture of the femoral neck

    5. Sciatic nerve injury

    1072-[ ] The angle of Gissane measures:

    1. 20-35 degrees

    2. 40-60 degrees

    3. 60-85 degrees

    4. 95-105 degrees

    5. 120-140 degrees

     

    1073-[ ] In an open book fracture of the pelvis which of the following ligaments is commonly torn:

    1. Sacro-tuberous ligament

    2. Sacro-spinous ligament

    3. Posterior sacroiliac ligament

    4. Iliolumbar ligament

    5. Intertransverse ligament

     

    1074-[ ] What would be your initial management of an open book fracture of the pelvis with significant hypotension:

    1. Arterial embolization

    2. Application of a C-clamp

    3. Surgical ligation of any bleeders

    4. Intra-abdominal packing and tamponad

    5. Abdominal paracentesis

     

    1075-[ ] A strict contraindication in the management of a patient with a diastasis of the symphysis pubis following trauma, would be:

    1. Urethral catheterization

    2. Application of a binder

    3. Arterial embolization

    4. Open plating of the symphysis pubis

    5. Application of a bilateral hip spica with both hips internally rotated

     

    1076-[ ] Which of the following, is the preferred approach used, to reduce a displaced fracture of the iliopubic arch:

    1. The extended iliofemoral

    2. The Mercedes

    3. The ilio-inguinal

    4. The Kocher –Langenbeck

    5. The pfannentiel approach

    1077-[ ] A Mortise view is an AP view of the ankle and is taken in:

    1. 30 degrees of external rotation

    2. 10-15 degrees of external rotation

    3. Neutral rotation

    4. 15-20 degrees of internal rotation

    5. Taken in an oblique position of the ankle

    1078-[ ] The “Fleck sign” is often seen in which of the following conditions:

    1. Tibial plateau fractures

    2. Tibial plafond fractures

    3. Lisfranc’s fracture

    4. Snow Board fractures

    5. Segond’s fracture

     

    1079-[ ] An open fracture with a vascular injury as classified by the Gustillo-Anderson classification, would be

    1. Type

    2. Type II

    3. Type III C

    4. Type IV C

    5. Type V B

    1080-[ ] What radiologic sign, indicates vascularization in a talar neck fracture:

    1. Hawkins sign

    2. Yergasons sign

    3. Adsons sign

    4. Wilsons sign

    5. Herring sign

     

    1081-[ ] On aspiration of synovial fluid from a painful THA joint, what should be the WBC and percent of neutrophils be, to be considered a septic periprosthetic infection?

    1. >30% neutrophils with 1000 WBC/HPF

    2. >40% neutrophils with 800 WBC/HPF

    3. >50% neutrophils with 600 WBC/HPF

    4. >60% neutrophils with 1760 WBC/HPF

    5. Totally non reliable and none of the measurements stand for an infection

        

       1082-[ ] Draining serosities two weeks following a primary THA indicates a definite infection and should be drained. Is this statement true or false?

        

       True………..

       False……….

       1083-[ ] Which of the following cytokines is involved in the production of C reactive protein?

       1. Interleukin 1

       2. Interleuken 11

       3. Interleuken 6

       4. Tumor necrosis factor

       5. PGA1

     

    1084-[ ] Should you want to prepare one batch (pack) of cement (40gms) loaded with antibiotics. How much tobramycin and vancomycin should be added to give you coverage for 4 months (Masri)?

    1. 3.6 gms tobramycin with 1.0 gm vancomycin

    2. 4 gms tobramycin with 2.0 gms vancomycin

    3. 5 gms tobramycin with 1.0 gm vancomycin

    4. 3.6 gm tobramycin with 5 gms vancomycin

    5. 3.6 gms tobramycin with 3.6 gms vancomycin

     

    1085-[ ] The direct diagnosis (by detection of organism and susceptibility tests) of late infection would be by all, except:

    1. Aspiration

    2. Biopsy

    3. Leucocyte esterase

    4. Sonication

    5. PCR

    1086-[ ] The intrinsic resistance of the biofilm depends on:

    1. Reduced antibiotic activity at the cellular Level

    2. Thickness of the biofilm layer

    3. Contents of the biofilm

    4. The type of metal of the prosthesis

    5. The type of infection

    1087-[ ] All the following are in favor of a primary TKA, Except:

    1. Decreased cumulative perioperative risks

    2. Decreased functional impairment

    3. Decreased cost

    4. Immunocompetent patients

    5. Particularly when effective antibiotics are not available

    1088-[ ] All the following are true concerning leucocyte esterase except:

    1. It is found in activated PMN (infected bodily fluids)

    2. The examination pad contains a detergent that lysis the PMN and releases the leucocyte esterase and combines with a salt to create a purple color

    3. Is considered one of the most accurate tests in the diagnosis of periprosthetic infection

    4. It is commonly used in UTI, peritonitis etc

    5. It was first described by Parvizi

     

    1089-[ ] The technique that involves the identification and amplification of the bacterial ribosomal 16S fragment is associated with which of the following drawback?

     

    1. It does not differentiate between live and dead bacteria, and a high number of false-positive results may occur

    2. I does not account for the type of infective organism

    3. It requires a long interval to arrive at a diagnosis

    4. It is highly associated with a negative result

    5. It does not differentiate between gram negative and positive organisms

     

    1090-[ ] Once aspirated, the joint fluid should be sent for all the following tests, and which is least accurate:

    1. Cell count

    2. Neutrophil differential count

    3. Culture for aerobic and anaerobic bacteria and fungi

    4. Gram stain

    5. Acid fast stain

    1091-[ ] Approximately how much of the total fluid volume of the disc is exchanged daily:

    1. 0-10%

    2. 11-20%

    3. 21-30%

    4. 31-40%

    5. 41-50%

    1092-[ ] Which of the following statements does not stand out as a function of the spine?

    1. Protects the spinal cord

    2. Provides mobility to the trunk

    3. Transfers loads from the head and trunk to the pelvis

    4. The trabecular bone bears the least of the vertical compressive loads

    5. The facet joints guide and limit intersegmental motion

    1093-[ ] The removal of the vertebral body cortex decreases vertebral strength by only:

    1. 5%

    2. 10%

    3. 15%

    4. 20%

    5. 25%

     

    1094-[ ] With its dense cartilage layer, the endplate serves as a semi-permeable membrane, which prevents the loss of which of the following substances from the disc:

    1. Phospholipase A

    2. Water

    3. Proteoglycan

    4. Sodium

    5. Potassium

    1095-[ ] The largest avascular structure in the body is:

    1. The hip

    2. The scaphoid

    3. The intervertebral disc

    4. The infantile patella

    g. The sesamoid bone

    1096-[ ] The most common site for a lumbar facet cyst to occur in would be:

    1. Lumbar 1-2

    2. Lumbar 2-3

    3. Lumbar 3-4

    4. Lumbar L4-5

    5. Lumbar 5-S1

        

       1097-[ ] A Test used to distinguish between an iliopsoas and a rectus femoris contracture would be:

       1. Ganslen test

       2. Patrick test

       3. Ely test

       4. Thomas test

       5. Hoover test

    1098-[ ] Which of the following is not associated with a congenital anomaly of the spine:

    1. Cafe’ au lait spots

    2. Dimpling of skin

    3. Sinus tracts

    4. Fatty masses

    5. Tufts of hair

    1099-[ ] A shuffling gait is most commonly seen in:

    1. Cerebral palsy

    2. Tabes dorsalis

    3. Parkinson’s disease

    4. Hemiplegia

    5. Cervical myelopathy

    1100-[ ] A waddling gait is associated most often with weakness of which muscle:

    1. Gluteus minimus

    2. Gluteus maximus

    3. Gluteus medius

    4. Rectus femoris

    5. Iliopsoas

    1101-[ ] An “Anthropoid posture” is often noted in:

    1. Vascular claudication

    2. Neurogenic claudication

    3. Spondylolisthesis

    4. Sacroiliitis

    5. Depression

        

       1102-[ ] On flexion of the head a patient is noted to have paresthesia in both the arms and legs. Which of the following, indicates this test?

       1. Yergason’s test

       2. Lhermitte test

       3. Spurling test

       4. Hoffman test

       5. Hoover test

    1103-[ ] Which of the following tests does not evaluate the sacroiliac joint for pain?

    1. Patrick test

    2. Faber test

    3. Pelvic Rock test

    4. Ely test

    5. Ganslen test

    1104-[ ] The sensory nerve supply of the lateral forearm and thumb, is from:

    1. C4-5

    2. C5-6

    3. C6-7

    4. C7-T1

    5. T1-2

    1105-[ ] The sensory nerve supply of the little finger is from:

    1. C5

    2. C6

    3. C7

    4. C8

    5. T1

     

    1106-[ ] Indicate which motor nerve supplies the corresponding muscles in the following figure below:

     

     

     

    1………………………………………………….

    2…………………………………………………..

    3……………………………………………………

    4……………………………………………………

    5……………………………………………………..

    6……………………………………………………..

     

    1107-[ ] The most frequent weakness on compression of C6 radiculopathy, would be:

    1. Forearm supination

    2. Forearm pronation

    3. Wrist flexion

    4. Wrist extension

    5. Finger abduction

    1108-[ ] What is the motor nerve supply of each of these muscles?

     

     

     

    1……………………………………………………………………….

    2………………………………………………………………………

    3………………………………………………………………………

    4………………………………………………………………………..

    5…………………………………………………………………………

    6…………………………………………………………………………

     

    1109-[ ] Sciatic symptoms (low back pain radiating in the buttock, thigh, calf, and foot) that do not originate from the lumbosacral plexus would most likely be due to:

    1. Inguinal herniation

    2. Pyriformis syndrome

    3. Lumbar disc herniation

    4. Hips disease

    5. Greater trochanter bursitis

     

    1110-[ ] What does this muscle cause, if malfunctioned?

     

     

     

    1. Peripheral neuropathy

    2. Antalgic gait

    3. Trendlenberg gait

    4. Steppage gait

    5. Pyriformis syndrome

     

    1111-[ ] Which is the weaker muscle in the gait demonstrated in the photo below:

     

     

     

    1. Hamstrings

    2. Gluteus minimus

    3. Gluteus medius

    4. Gluteus maximus

    5. sartorius

    1112-[ ] The test shown below, is known as:

     

     

     

    1. The Nafzigger test

    2. The Hoover test

    3. The Beever test

    4. The Openheim test

    5. The Bruzinski test

    1113-[ ] Insert the gait pattern in the space below for each of the demonstrated photos:

     

     

     

     

    1. ………………………………………………………………

    2. ………………………………………………………………

    3. ………………………………………………………………

    4. ………………………………………………………………

    5. ………………………………………………………………

    1114-[ ] The adductor reflex of the thigh is indicative of which nerve:

    1. The obturator

    2. The femoral

    3. The sciatic

    4. The saphenous

    5. The peroneal….nerve

     

    1115-[ ] Which of the following tests corresponds to the Patrick test in evaluating the sacroiliac joint:

    1. Hover

    2. Nafzigger

    3. Thomas

    4. Ganslen

    5. Ely…..test

    1116-[ ] A Faun’s beard is known to be present when the patient has:

    1. A vertebral fracture

    2. Spina bifida occulta

    3. Spondylolisthesis

    4. Scheuermann’s disease

    5. Scoliosis

    1117-[ ] A wide based gait is often not noted in which of the following conditions:

    1. Cervical myelopathy

    2. Parkinson’s disease

    3. Vitamin B 12 deficiency

    4. Tabes dorsalis

    5. Cerebellar pathology

     

    1118-[ ] A circumduction gait is often seen in which of the following conditions:

    1. Parkinson’s disease

    2. Vitamin B12 deficiency

    3. Hemiplegia

    4. Cerebellar pathology

    5. Cervical myelopathy

    1119-[ ] A steppage gait is seen in which of the following condions:

    1. Drop foot

    2. Cervical myelopathy

    3. Parkinson’s disease

    4. Cerebellar pathology

    5. Tabes dorsalis

     

    1120-[ ] Patients with advanced lumbar stenosis and neurogenic claudication tend to walk in a flexed-forward position, and is commonly referred to as:

    1. The “anthropoid posture”

    2. Positive sagittal balance posture

    3. Shuffling posture

    4. Wide based posture

    5. Staggering posture

    1121-[ ] Splaying of adjacent spinous processes or a palpable stepoff may indicate:

    1. Spondylolisthesis

    2. Scheuermanns disease

    3. Spinal Bifida occulta

    4. Spinal stenosis

    5. Spinal syndesmosis

     

    1122-[ ] Flexion of the cervical spine in the setting of cord compression often causes paresthesia in both the arms and legs is known as:

    1. Lhermitte sign

    2. Romberg sign

    3. Yergasons sign

    4. Adson sign

    5. Lift off sign

     

    1123-[ ] Knee extension and ankle dorsiflexion if lost corresponds to which of the following affected root at its origin:

    1. L2

    2. L3

    3. L4

    4. L5

    5. S1

     

    1124-[ ] Great toe extension and ankle dorsiflexion if lost corresponds to which of the following affected root at its origin:

    1. L2

    2. L3

    3. L4

    4. L5

    5. S1

     

    1125-[ ] If sensation is lost over the lateral malleolus and lateral and plantar aspect of the foot, would correspond to which of the following affected nerve root, at its origin:

    1. L2

    2. L3

    3. L4

    4. L5

    5. S1

    1126-[ ] With a typical paracentral L4-5 disc herniation, the root of origin (L5) is compressed as it courses toward the undersurface of which of the following pedicles:

    1. L2

    2. L3

    3. L4

    4. L5

    5. S1

     

    1127-[ ] A far lateral disc herniation at the level L4-5 may compress the root of exit at which level:

     

    1. L2

    2. L3

    3. L4

    4. L5

    5. S1

    1128-[ ] The nipple line corresponds to which thoracic vertebra:

    1. T1

    2. T2

    3. T3

    4. T4

    5. T5

    1129-[ ] The Umbilicus level corresponds to which of the following vertebra:

    1. T7

    2. T8

    3. T9

    4. T10

    5. T11

     

    1130-[ ] To confirm that an incomplete lesion of the spine is present would be by, demonstrating an intact:

    1. Perianal sensation

    2. Periumbilical sensation

    3. Nipple line sensation

    4. Bulbocavernous reflex

    5. Cremasteric reflex

    1131-[ ] Which of the following is not included in “the double crush syndrome” in the neck:

    1. Median nerve compression

    2. C5

    3. Ulnar nerve entrapment

    4. C8

    5. Radial nerve entrapment

    1132-[ ] A metabolic disorder that results in abnormal reflexes, would be:

    1. Hyperparathyroidism

    2. Hypothyroidism

    3. Galactosemia

    4. Hurler syndrome

    5. Gaucher’s disease

    1133-[ ] The superficial reflexes are mediated by the:

    1. Cerebellum

    2. Brain stem

    3. cerebral cortex

    4. frontal hemisphere

    5. temporal hemisphere

    1134-[ ] The superficial cremasteric reflex is mediated by which of the following nerve roots:

    1. T9-10

    2. T11-12

    3. L1-2

    4. L3-4

    5. L5-S1

    1135-[ ] The “anal wink” is used to assess which of the following nerves:

    1. S2,3,4

    2. S1-2

    3. S3-4

    4. S4-5

    5. L5-S1

     

    1136-[ ] Upper motor neuron (corticospinal tract) lesions should be suspected in all the following tests, except:

    1. Hoffmann sign

    2. Babinski sign

    3. Triple response sign

    4. Froment’s sign

    5. Oppenheim sign

    1137-[ ] A foraminal closing test is performed by:

    1. Hyperextending the patient’s head and rotating it toward the affected side

    2. Hyperflexing the patients head and rotating it toward the affected side

    3. Lateral bending of the head towards the affected side

    4. Lateral bending of the head away from the affected side

    5. Rotating the head towards the affected side

    1138-[ ] The “Spurling sign” is elicited by:

    1. A rotational force applied towards the affected side

    2. A rotational force applied away from the affected side

    3. A distraction force in extension

    4. An axial load applied by pressing down on the patients head

    5. A bracing force applied to both shoulders

     

    1139-[ ] When a patient gets relief by placing the affected extremity behind the head, is known as:

     

    1. The distraction sign

    2. The Spurling sign

    3. The shoulder abduction relief sign

    4. The foraminal closing test

    5. The Chaddock test

    1140-[ ] The Fajersztajn sign (crossed straight leg raising test is positive when the patient has:

    1. A far lateral disc

    2. An isthmus disc

    3. A lateral recess disc

    4. A large central disc

    5. A large posterolateral disc

     

    1141-[ ] Fill out the names of the branches in the Brachial plexus below:

     

     

     

15. ………………………………………………………………………………………………

    …………………………………

16. ………………………………………………………………………………………………

    …………………………………

17. ………………………………………………………………………………………………

    …………………………………

18. ………………………………………………………………………………………………

    …………………………………

19. ………………………………………………………………………………………………

    …………………………………

20. ………………………………………………………………………………………………

    …………………………………

21. ………………………………………………………………………………………………

    …………………………………

22. ………………………………………………………………………………………………

    ………………………………….

23. ………………………………………………………………………………………………

    ………………………………….

24. ………………………………………………………………………………………………

    ………………………………….

25. ………………………………………………………………………………………………

    ………………………………….

26. ………………………………………………………………………………………………

    …………………………………..

27. ………………………………………………………………………………………………

………………………………….

bb. ………………………………………………………………………………………………

………………………………….…………………………………………………………

……………………………………………………………………….

 

1142-[ ] Fill out the names of the sensory branches to various areas of the upper extremity from the brachial plexus:

 

 

 

1. ………………………………………………………………………………………………

   ………………………………………………..

2. ………………………………………………………………………………………………

   …………………………………………………

3. ………………………………………………………………………………………………

   …………………………………………………

4. ………………………………………………………………………………………………

   ………………………………………………….

5. ………………………………………………………………………………………………

   ………………………………………………….

6. ………………………………………………………………………………………………

   ………………………………....................

7. ………………………………………………………………………………………………

………………………………………………….

 

1143-[ ] Indicate the neurologic level, reflex and motor supply at each level:

 

 

1. …………………………………………………………………………………………

   …………………………………………………….

2. …………………………………………………………………………………………

   …………………………………………………….

3. …………………………………………………………………………………………

   …………………………………………………….

4. …………………………………………………………………………………………

   …………………………………………………….

5. …………………………………………………………………………………………

   …………………………………………………….

6. …………………………………………………………………………………………

   …………………………………………………….

7. …………………………………………………………………………………………

   …………………………………………………….

8. …………………………………………………………………………………………

   …………………………………………………….

9. …………………………………………………………………………………………

   …………………………………………………….

10. …………………………………………………………………………………………

    …………………………………………………….

11. …………………………………………………………………………………………

    …………………………………………………….

12. …………………………………………………………………………………………

…………………………………………………….

bb. …………………………………………………………………………………………

…………………………………………………….

cc. …………………………………………………………………………………………

…………………………………………………….

dd. …………………………………………………………………………………………

…………………………………………………….

 

1144-[ ] Insert the major nerve to the region within the blocks below:

 

 

 

1. ………………………………………………………………………………………………

   …………………………………………………

2. ………………………………………………………………………………………………

   …………………………………………………

3. ………………………………………………………………………………………………

   …………………………………………………

4. ………………………………………………………………………………………………

   …………………………………………………

5. ..……………………………………………………………………………………………

…………………………………………………

 

TOTAL KNEE ARTHROPLASTY

 

1145-[ ] Which is more safer to do cross a transverse incision at right angles or run a longitudinal incision to an already longitudinal incision, leaving a gap of:

1. 1 cm between the two incisions

2. 2 cms between the two incisions

3. 4cms between the two incisions

4. 5 cms between the two incisions

5. 7cms between the two incisions

 

1146-[ ] During a total knee arthroplasty, what could possibly happen locally, when the anesthesia is unstable without a complete motor block:

1. Rupture of the patellar tendon

2. Improper locations of cutting markers

3. Excessive external rotation of the component to allow a proper fit of the cutting guides

4. Inability to evert the patella

5. Excessive bleeding

 

1147-[ ] Which of the following situations, is most feasible to have a subvastus approach while performing a Total Knee Arthroplasty?

1. A slim individual

2. A obese patient

3. A stiff knee

4. A muscular knee

5. Revision surgery

 

1148-[ ] On resection of the articular portion of the patella in a Total Knee Arthroplasty, too much was resected resulting in a thickness less than 15mm. What could this lead most to:

1. Recurrent dislocation

2. Limitation of knee flexion

3. Fracture of the patella

4. Poor patellar tracking

5. Hyperextension of the knee

 

1149-[ ] The problem that results from extending a posterior lumbar fusion to the sacrum, would be:

1. Increased risk of pseudoarthrosis

2. Decreases the surgical time

3. Decreases the reoperations rate

4. Decreased risk of sacral insufficiency fractures

5. Does not alter the gait postoperatively

1150-[ ] A Smith Peterson osteotomy of the spine is best performed where:

1. Disc degeneration exists with narrowing

2. Limitation of motion (a rigid spine) exists

3. The disc has adequate height and mobility

4. In the thoracic spine

5. More correction of the sagittal imbalance is expected to be obtained, by doing it in the thoracic spine

1151-[ ] What type of osteotomy of the spine is performed, in the figure below:

1. Triple osteotomy

2. Ponte’ osteotomy

3. Smith Peterson Osteotomy

4. Pedicle substraction Osteotomy

5. Vertebral Column Resection Osteotomy

 

 

 

1152-[ ] Which of the following osteotomies of the spine provides the maximum amount of correction of a deformity

1. Smith Peterson

2. Pedicle Substraction

3. Ponte”

4. Vertebral column Resection

5. Anterior discoidectomy

 

1153-[ ] In Brucellosis after the initial illness, which may last for several days to weeks, relapse occurs in approximately in what % of patients?

1. 5%

2. 15%

3. 20%

4. 30%

5. 40%

1154-[ ] The Brucellar infection, originates within which portion of the vertebra

1. The vertebral body

2. The intervertebral disc

3. The pedicle

4. The facet

5. The anterior longitudinal ligament

1155-[ ] The most common location for Brucellar infection to occur in the spine, would be:

1. Cervical

2. Upper thoracic

3. Lower thoracic

4. Lumbar

5. Sacrum

1156-[ ] The posterior spinal arch is involved in what percent of cases of tuberculosis?

1. 5%

2. 10%

3. 20%

4. 30%

5. 40%

 

1157-[ ] Which of the following conditions is most commonly associated with caseation beneath the anterior longitudinal ligament?

1. Brucellosis

2. Tuberculosis

3. Actinomycosis

4. Schistosomiasis

5. Coccidiodomycosis

 

1158-[ ] 1-[ ] Which of the following is most important, which when divided or resected would allow maximum seating of the femoral head within the acetabulum, following reduction of a high riding DDH:

1. Pulvinar fat pad

2. Hip capsule

3. Limbus

4. Ligamentum teres

5. Transverse ligament

 

1159-[ ] Which of the following surgical approaches is known to have the least complications in reducing a Essex-Leprosty I and Saunders I & II fractures of the calcaneum:

1. The straight L approach

2. The curved L approach

3. The sinus tarsi lateral approach

4. The dorsal approach

5. The posteromedial approach

 

1160-[ ] Which of the following components of a calcaneal fracture is most important, to act as an anchor to rebuild an anatomic calcaneal fracture:

1. The anterior facet of the calcaneus

2. The middle facet of the calcaneus

3. The posterior facet of the calcaneus

4. The sustentaculum tali

5. The anterior process of the calcaneus

 

1161-[ ] A four year old boy has low grade fever with pain and limitation of motion of the left

hip. An ESR, CRP and WBC are “slightly elevated”.

The mother claims that her son had a mild upper respiratory infection one week ago. Your most likely diagnosis would be:

1. Septic arthritis of the left hip

2. Proximal femoral osteomyelitis

3. Transient synovitis

4. Proximal femoral Slipped capital epiphysis

5. Upper idiopathic femoral cartilage necrosis

1162-[ ] The most likely organism to be associated with a septic arthritis of the hip would be:

 

1. Homophiles influenza

2. Staph aureus

3. B Hemolytic strep

4. Pseudomonas

5. Kingella kingae

1163-[ ] A four year old child was diagnosed to have Legg Calve’ Perthe’s disease, Pillar A. the

best management would be:

 

1. A Salter osteotomy

2. A varus osteotomy

3. A derotation osteotomy of the hip

4. No treatment

5. To evaluate for endocrine anomalies

 

1164-[ ] A 6 year old male presents to your clinic having severe generalized aches of all his bones and joints, of two weeks duration. On examination, motion of the left hip elicited severe protective pain. An x-ray of the left hip revealed effusion in the joint with the presence of a definit Frankels radioluscent line in the metaphysis.

A Bone Marrow aspiration revealed a round cell infiltrate. Your most likely diagnosis would be:

1. Neuroblastoma

2. Leukemia

3. Eosinophilic granuloma

4. Proximal femoral osteomyelitis

5. Gouty arthritis

 

1165-[ ] Which of the following conditions has the highest incidence avascular necrosis as a complication:

1. Transient synovitis

2. Femoral anteversion

3. DDH

4. Unstable Slipped Capital femoral Epiphysis

5. Renal osteodystrophy

 

1166-[ ] Usually when a slip occurs in the upper femoral epiphysis, the cleavage zone would be at the:

1. Junction of the resting and zone of hypertrophy

2. Junction of the resting and proliferative zone

3. Junction of the proliferative and zone of hypertrophy

4. Mid-aspect of the proliferative zone

5. Proximal femoral metaphysis

 

1167-[ ] Which of the following nerves are involved, in the transfer of pain from the hip to the mid-aspect of the knee joint:

1. Sciatic nerve

2. Abducens nerve

3. Femoral and obturator nerve

4. Lateral femoral cutaneous nerve

5. Corona mortis

 

1168-[ ] The vascular supply of the lateral hindfoot is dependent on which of the following arterial blood supply:

1. The lateral calcaneal branch of the peroneal artery

2. The calcaneal branch of the posterior tibial artery

3. The dorsalis pedis artery

4. The interosseous artery

5. The artery of the sinus tarsi

 

1169-[ ] The extended L-shaped lateral approach of the calcaneus provides a vulnerable risk of injury to which of the following arteries:

1. The lateral calcaneal branch of the peroneal artery

2. The calcaneal branch of the posterior tibial artery

3. The dorsalis pedis artery

4. The interosseous artery

5. The artery of the sinus tarsi

    

   1170-[ ] Less invasive approaches in fractures of the calcaneus are indicated “least” in:

   1. Displaced Essex-Lopresti fractures

   2. Sanders type II fractures

   3. Sanders type III fractures in patients with multiple comorbidities

   4. Fracture variants with minimal posterior facet fragment comminution

   5. Fractures of more than 2 weeks duration

 

1171-[ ] Which of the following calcaneal fractures could benefit “most” from a primary subtalar arthrodesis:

 

1. Displaced Essex-Lopresti fracture

2. Sanders type II fracture

3. Sanders type III fracture

4. Sanders type IV fracture

5. Fracture variants with minimal posterior facet fragment comminution

    

   1172-[ ] Anterior process fractures of the calcaneus are caused by:

    

   1. A Valgus force on the ankle

   2. An inversion and plantar flexion force on the foot causing an avulsion of the bifurcate ligament

   3. An eversion and dorsiflexionof the foot

   4. An axial compression force applied to the calcaneocuboid joint

   5. A severe external force applied to the ankle resulting in avulsion of the bifurcate ligament

 

1173-[ ] The most common fragment found in a calcaneal fracture, known as an axial loading column, during reduction, would be the:

 

1. Superomedial fragment

2. Superolateral fragment

3. Secondary fracture lines

4. Extra-articular fractures

5. Gastrocnemius-soleus with concomitant avulsion at its insertion site

 

1174-[ ] A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. What is the most likely etiology of this finding?

 

1. Use of a lateral extensile approach to the calcaneus

2. Calcaneal tuberosity varus malalignment

3. Use of screws that are too long

4. Missed foot compartment syndrome

5. Plantar nerve palsy

 

1175-[ ] The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw during fixation of what structure?

 

1. Lisfranc fracture-dislocation

2. Navicular body fracture

3. Intra-articular calcaneus fracture

4. Nutcracker cuboid fracture

5. Talar neck fracture

 

1176-[ ] A 48-year-old female sustains a injury resulting in a Sanders type IV fracture of the calcaneus. Which of the following preoperative variables has been shown to be associated with improved outcomes following surgical treatment of this injury pattern?

 

1. Patients with a heavier workload

2. Patients receiving Worker's Compensation

3. Gissane angle of 140°

4. Böhler angle of > 15°

5. Comminuted posterior facet

 

1177-[ ] A hematoma that extends distally to the sole of the foot is pathognomonic for calcaneal fracture and is known as:

 

1. The “Mondor sign”

2. The Morel Levalle’ sign

3. The Mulder sign

4. The Yergason sign

5. The Beever’s sign

 

1178-[ ] Initial assessment of suspected calcaneal fractures is usually performed with conventional radiography. Recommended views include all except:

 

1. An axial view of the heel (Harris view)

2. Anteroposterior views of the calcaneocuboid joint

3. Oblique views of the foot for assessment of the calcaneocuboid joint

4. Lateral wall displacement and views with dorsiflexion and internal rotation of the foot to better visualize the subtalar joint and posterior facet

5. Mortise views

 

1179-[ ] A six year old boy sustained displaced supracondylar fracture of the elbow. On physical examination he is noted to lack flexion of the index finger. Your immediate diagnosis would be:

 

1. Posterior interosseous palsy

2. Ulnar nerve injury at the cubital tunnel

3. Ulnar nerve injury at the wrist

4. Anterior interosseus nerve palsy

5. Median nerve injury at the level of the Carpal Tunnel

 

1180-[ ] The first ossification center to appear about the elbow would be:

 

1. The radial head

2. The capitellum

3. The medial epicondyle

4. The olecranon

5. The trochlea

 

1181-[ ] Which of the following radiographic signs is most accurate in diagnosing a supracondylar fracture in children:

 

1. The sail sign

2. The Baumann’s sign

3. The posterior fat pad sign

4. The anterior fat pad sign

5. The lateral pad sign

 

1182-[ ] The incidence of a flexion supracondylar fracture in children is:

 

1. 90%

2. 75%

3. 2%

4. 15%

5. 35%

 

1183-[ ] The function of the horizontal trabeculae within the vertebral body is to:

 

1. Stabilize the vertical trabeculae

2. Allow the element of rotation within the vertebral body

3. Prevent widening and stretching the medio-lateral diameter of the vertebral body

4. Prevent fragility fractures under loads in vertical compression

5. Retain any element of load once the vertical trabeculae fail in osteomalascia

 

1184-[ ] The most common mechanism of injury in a supracondylar fracture in a child, would be a:

 

1. A pronation force applied to the elbow

2. A hyperflexion injury of the elbow

3. A fall on the elbow in full extension

4. A supination force applied to the elbow

5. A valgus force applied on the lateral aspect of the elbow

 

1185-[ ] A lytic lesion of bone associated with hypercalcemia, hypophosphatemia with an elevated PTH level is most likely a:

 

1. Giant cell tumor of bone

2. Aneurysmal bone cyst

3. Unicameral bone cyst

4. Brown tumor

5. Chondroblastoma

 

1186-[ ] A RANKL inhibitor known to inhibit osteoclastic resorption in Giant Cell Tumors of bone, would be:

 

1. Calcitonin

2. Erythropoietin

3. Denosumab

4. Vitamin D

5. Methotrexate

 

1187-[ ] The most common site for a Giant Cell tumor to occur in, would be:

 

1. Distal femur

2. Distal tibia

3. Distal radius

4. Spine

5. Proximal femur

 

1188-[ ] On Examination of a patient with Cervical Radiculopathy you note that he has weakness in abduction of the fingers. Which of the following roots is involved:

 

1. C5

2. C6

3. C7

4. C8

5. T1

 

1189-[ ] Which of the following tests would help distinguish a true cervical root etiology from other potential sources of pain?

 

1. A whipple test

2. A Spurling test

3. Lhermitte sign

4. Brudzinski’ test

5. Kernig’s test

 

1190-[ ] Which of the following is not a long tract sign in Cervical Myelopathy?

 

1. Clonus

2. the Babinski sign

3. the Hoffman sign

4. the Biceps reflex

5. the Lhermitte sign

1191-[ ] A 20 years old male is brought to the Emergency Room following a car accident. The radio-imaging of your choice to rule out a disk disruption, hematoma and intrinsic cord signal changes, would be:

1. Plain X-ray

2. MRI

3. CT scan

4. Scintigraphy

5. Myelography

 

1192-[ ] The best radio-imaging used in the detection of an occipital condyle fracture would be:

 

1. MRI

2. CT scan

3. Dynamic MRI

4. Plain x-ray

5. Scintigraphy

 

1193-[ ] A lower cranial nerve palsy that may be associated with an occipital condyle fracture, would be:

 

1. Trigeminal nerve

2. Glossopharyngeal nerve

3. Vagus nerve

4. Hypoglossal nerve

5. Abduscens nerve

 

1194-[ ] The basion-Dens interval should be more than what amount, to indicate occipitocervical dissociation?

 

1. 4mm

2. 6mm

3. 8mm

4. 12mm

5. 14mm

 

1195-[ ] An incomplete spinal cord injury that occurs in the elderly following a hyperextension injury of the cervical spine, would be:

 

1. Anterior cord syndrome

2. Central cord syndrome

3. Posterior cord syndrome

4. Brown-Sequard Syndrome

5. Brachial plexus avulsion

 

1196-[ ] A 79-year old man falls sustaining a hyperextension injury to his neck. On motor examination, he has 3/5 strength in his deltoids, elbow and wrist flexors and extensors. He has

4/5 strength in his hip flexors, knee flexors, extensors, ankle dorsiflexors and plantarflexors. Sensation is preserved in both his upper and lower extremities as well as his sacral segments. Injury to which of the following tracts contributes greatest to his motor function deficits?

 

1. Fasciculus gracilis

2. Fasciculus cuneatus

3. Anterior corticospinal

4. Lateral corticospinal

5. Lateral spinothalamic

 

1197-[ ] In which of the following conditions, a minor trivial injury most often, could result in a severe devastating repercussion?

 

1. Ankylosing Spondylitis

2. Pagets disease

3. Diffuse Idiopathic skeletal hyperostosis

4. Degenerative spondylitis

5. Rheumatoid spondylitis

    

   1198-[ ] An x-ray of a 10-year-old boy taken to rule out an ankle fracture reveals a 4-mm, well-circumscribed lytic lesion in the cortex of the tibia, which is away from where he is having symptoms

   • What is the most likely diagnosis?

1. Aneurysmal bone cyst

2. A desmoid tumor

3. Nonossifying fibroma

4. Enchondroma

5. Chondroblastoma

 

1199-[ ] Aneurysmal Bone Cysts has not been associated with:

1. Giant cell tumor

2. Fibrous dysplasia

3. Periosteal chondroma

4. Chondroblastoma

5. Osteosarcoma

 

1200-[ ] A ten years old girl is noted to have a fibrous dysplasia like lesion of the tibia, Café au lait spots, and precocious puberty. Your most likely diagnosis would be:

1. Neurofibromatosis

2. McCune-Albright syndrome

3. Non-ossifying fibroma

4. Fibrous cortical defect

5. Ollier’s disease

1201-[ ] What would be the maximum acceptable leg length discrepancy to not require treatment?

1. 5mm

2. 10mm

3. 15mm

4. 20mm

5. 25mm

1202-[ ] The most common Congenital foot abnormality, would be:

1. Metatarsus adductus

2. Congenital vertical talus

3. Club foot

4. Calcaneus heel

5. Hammer toe

 

1203-[ ] A 10-year-old boy is known to have recurrent ankle sprains and painful flat feet

should be evaluated for what possible diagnosis?

 

1. Club foot

2. Tarsal coalition

3. Hyper mobile flat foot

4. Femoral anteversion

5. Genou valgum

 

1204-[ ] A child diagnosed at the age of 3months to have DDH would most likely have a:

 

1. Limitation of abduction of the involved hip

2. Ortoloni sign

3. Barlow sign

4. Galeazy sign

5. A positive hip clunk

 

1205-[ ] A twelve years old obese boy is comes to your clinic with his mother who claims that her son has been complaining of pain in the right knee (medial aspect), has a limb and walks with his right lower extremity externally rotated. On Examination what area would you expect the pathology would be?

 

1. Spine

2. Sacroiliac joint

3. Hip

4. Knee

5. foot

 

1206-[ ] Which of the following conditions should be ruled out while evaluating a patient suspected to have a Slipped Capital Femoral Epiphysis?

1. Juvenile Rheumatoid arthritis

2. Sjogren’s syndrome

3. Hypothyroidism and hypogonadism

4. Psoriasis

5. Tuberculosis

 

1207-[ ] A 14 years old boy while playing tennis on a sandy ground felt as though a nail penetrated his shoe, one week ago. At present he has swelling, redness and drainage from his sole. You request a culture and sensitivity. If it proves to be an infection what would be the most likely organism?

1. Staph aureus

2. Pseudomonous

3. Ecoli

4. Streptococcus veridans

5. Streptococcus epididimus

 

1208-[ ] Which of the following organisms have dropped in incidence, as a cause of septic arthritis in children, following vaccination?

1. Staph aureus

2. Streptococci

3. Ecoli

4. Hemophilus influenza

5. Kingella kingae

1209-[ ] The most common site for metastasis to occur in the spine, would be:

1. Cervical

2. Thoracic

3. Lumbar

4. Sacrum

5. coccyx

    

   1210-[ ] In an acute cervical spine injury what would be the best method of demonstrating instability between occiput and C2 vertebra?

   1. CT scan

   2. MRI

   3. Cervical traction test

   4. Lateral flexion-extension views

   5. Scintigraphy

1211-[ ] The posterior longitudinal ligament of the spine ends at the base of the cranium as the:

1. Tectorial membrane

2. Alar ligament

3. Apical ligament

4. Transverse ligament

5. Spino-laminar ligament

1212-[ ] The most common type of carpal instability is:

1. DISI

2. VISI

3. Pisotriquetral Instability

4. Luno-triquetral instability

5. Distal radio-ulnar instability

1213-[ ] The normal scapho-lunate angle on a lateral view of the wrist, is:

1. 30

2. 45

3. 60

4. 75

5. 85….degrees

 

1214-[ ] The “scaphoid stress test” is performed by applying pressure on the scaphoid tubercle, with the wrist in:

1. Extension

2. Flexion

3. Supination

4. Radial deviation

5. Ulnar deviation

1215-[ ] A scapho-lunate advanced collapse (a SLAC lesion) occurs with a chronic:

1. DISI

2. VISI

3. Pisotriquetral Instability

4. Luno-triquetral instability

5. Distal radio-ulnar instability…..lesion

 

1216-[ ] When multiple previous skin incisions are encountered on performing a total knee arthroplasty, it has traditionally been recommended that the most lateral incision be used. How much should be the minimal skin bridge be, between incisions to avoid postoperative skin complications… At least

1. 5 or 6 cm

2. 8cms

3. 9cms

4. 4cms

5. 3cms

   1217-[ ] At what ankle-brachial index should it be, to request a vascular consult, prior to a Total Knee Arthroplasty:

   1. < 0.7

   2. < 0.8

   3. < 0.9

   4. < 1.0

   5. < 1.2

1218-[ ] If you should decide to use a tourniquet while performing a total knee arthroplasty in an elderly patient, when would be the best time to do so:

1. At the initiation of the procedure

2. Intermittently as needed

3. At the mid-aspect of the procedure

4. When it is time to insert the prosthesis with cement

5. At short intervals to avoid ischemia of mucle

1219-[ ] Proximal elevation of the joint line in Total Knee Arthroplasty leads to:

1. Pseudo-patella baja

2. Patella alta

3. Decreased contact forces on the patella

4. No effect on patella contact forces

5. Medio-lateral joint instability

1220-[ ] Patellar maltracking can result from:

1. Over resection of the distal femur

2. Over resection of the proximal tibia

3. A patellar bone-prosthesis construct that is thicker than the native patella

4. Non-resurfacing of the patella

5. Excessive resection of the patella

1221-[ ] The main purpose of reducing the posterior slope angle in Total Knee Arthroplasty, would be that:

1. In posterior stabilized knee implants it prevents cam-post impingement

2. It decreases medio-lateral instability in extension

3. It decreases medio-lateral instability in flexion

4. It allows more extension

5. It promotes global stability of the knee

1222-[ ] Patients who have undergone a previous patellectomy are most likely to have least!

1. Lose their extension strength by 20% to 70%

2. Decreases the stability of the knee

3. Can undergo knee replacement with the same outcome as in any other TKA

4. Overloads the posterior cruciate ligament

5. Should undergo TKA with a posterior stabilized knee implant

1223-[ ] Over-resection of the anterior condyles of the knee in a Total Knee Arthroplasty, may result in:

1. Notching of the distal femur

2. Maltracking of the patella

3. Genou Recurvatum

4. Medio-lateral instability

5. Inequality between the extension and flexion gap

1224-[ ] Integrity of the popliteus tendon in a Total knee arthroplasty, helps maintain:

1. Extension stability

2. Flexion stability

3. Proper patella tracking

4. The sciatic buttressPosterior cruciate ligament integrity

5. The posterior tibial slope

1225-[ ] Anteroposterior stability, following a Total Knee Arthroplasty depends on:

1. Femoral component size

2. Tibial component thickness

3. Balanced flexion and extension gaps

4. Over stuffing of the patella

5. The degree of external rotation of the distal femoral cut

 

1226-[ ] Which of the following would result “most” in asymmetry of the flexion space, in a Total Knee Arthroplasty:

1. Internal rotation of the femur

2. Excessive varus of the distal femur

3. Notching of the distal femur

4. Use of a PCL retaining prosthesis

5. Using the IM guide, in performing the distal femoral cut 1227-[ ] The Sciatic buttress is:

1. Is the thickening in the proximal end of the iliopubic ramus

2. Is the thickening in the proximal end of the ilioischial column

3. Is the thickening at the proximal apex of the Lambda (sciatic notch)

4. Is the thickened buttress joining both Lambda’s of the pelvis in transverse and horizontal direction

5. The weakest zone of the pelvis

1228-[ ] Most dislocations of the hip that follow a fractured acetabulum, are in the:

1. Anterior

2. Posterior

3. Medial

4. Anterolateral

5. Vertical……direction

1229-[ ] The Iliac 45 degree (Judet) view of the acetabulum demonstrates best:

1. The posterior column of the acetabulum

2. The posterior rim of the acetabulum

3. The superior wall of the acetabulum

4. The quadrilateral plate

5. The tear drop

1230-[ ] In accordance with the Judet elementary classification of acetabular fractures, which of the following does not apply to the elementary form?

1. Posterior wall

2. Anterior wall

3. Transverse

4. Posterior wall and posterior column

5. Anterior column

1231-[ ] Heterotopic ossification is least seen in:

1. The Kocher Langenbeck approach

2. The anterior ilioinguinal approach

3. The triradiate approach

4. The extended iliofemoral approach

5. The Watson Jones approach

1232-[ ] Infantile idiopathic scoliosis has been reported to be associated with:

1. Brachicephali

2. Plagiocephaly

3. Club foot

4. Genou valgum

5. Proximal focal femoral deficiency

 

1233-[ ] In progressive infantile scoliosis, the rib vertebral angle difference should be more than:

1. 5 degrees

2. 10 degrees

3. 15 degrees

4. 20 degrees

5. 25 degrees

1234-[ ] Patients diagnosed to have either infantile or even juvenile scoliosis should have a:

1. A chiropractor view of the spine

2. Ultrasound of the spine

3. CT scan of the whole spine

4. MRI of the spine

5. Scanogram of the spine

1235-[ ] An atypical pattern of thoracic curve presentation, is an indication for:

1. A chiropractor view of the spine

2. Ultrasound of the spine

3. CT scan of the whole spine

4. MRI of the spine

5. Scanogram of the spine

 

1236-[ ] Which of the following vertebrae are most rotated in a idiopathic major scoliotic curve:

1. End vertebra

2. Apical vertebra

3. Neutral vertebra

4. The vertebra through which the central sacral line intersects between the pedicles

5. The vertebra located at the level of the apex of thoracic kyphosis

 

1237-[ ] Rotation of a vertebra is assessed based on the radiographic appearance of the vertebral pedicle shadow in reference to the lateral margins of the vertebral body. This is known as the:

1. Nash-Moe classification

2. Wilson classification

3. Panjabi-White classification

4. Vaccaro classification

5. Lenke classification

1238-[ ] The vertebra bisected by the central sacral line is known as the:

1. End vertebra

2. Stable vertebra

3. Neutral vertebra

4. Apical vertebra

5. The locking vertebra

 

1239-[ ] Curves measuring 50° to 75° in scoliosis, at maturity progress steadily at a rate of approximately:

 

1. One degree per a year

2. Three degrees per a year

3. Five degrees per a year

4. 7 degrees per a year

5. 8 degrees per a year

1240-[ ] Which of the following braces is not used in patients with idiopathic scoliosis:

1. CTLSO (Milwaukee brace)

2. Jewett brace

3. Charleston brace

4. TLSO (e.g. Boston brace)

5. Flexible brace (e.g. Spine Cor brace)

1241-[ ] Which of the following nerves does not supply the elbow joint:

1. The suprascapular nerve

2. The median nerve

3. The ulnar nerve

4. The radial nerve

5. The musculocutaneous nerve

 

1242-[ ] In shoulder arthroscopy the posterior portal landmark is:

1. 2 cm inferior and 1 cm medial to the posterolateral corner of the acromion

2. 4cms inferior and 2cms medial to the posterolateral corner of the acromion

3. 3cms posterior and inferior to the acromioclavicular joint

4. 1 cm inferior to the outer third of the clavicle

5. none of the above

 

1243-[ ] In the posterior portal of the shoulder during arthroscopy, its route is usually through:

 

1. the posterior third of the deltoid and through the infraspinatous muscle

2. the posterior third of the deltoid and in between the infraspinatous and teres minor muscles

3. the posterior third of the deltoid and the interval between the supraspinatus and infraspinatus muscles

4. a or b

5. just lateral and posterior to the insertions of the supraspinatus and infraspinatus tendons

 

1244-[ ] The structures likely to be injured while performing the posterior portal in shoulder arthroscopy, is or are:

 

1. the posterior humeral circumflex artery

2. the axillary nerve

3. the scapular circumflex artery

4. all of the above

5. the musculo-cutaneous nerve

 

1245-[ ] The anterior portal during shoulder arthroscopy is located:

 

1. lateral to the tip of the coracoid process

2. inferior to the anterolateral corner of the acromion

3. just anterior and inferior to the origin of the deltoid muscle

4. just inferior to the coracoid process

5. all of the above

6. both a and b

 

1246-[ ] The structures liable to be injured while using the superior portal in shoulder arthroscopy is or are:

 

1. the suprascapular nerve

2. the suprascapular artery

3. the musculo-cutaneous nerve

4. the axillary nerve

5. both a and b

1247-[ ] While going through the posterior portal with the sheath of the arthroscope, which structure should you aim for to be sure that you are entering the joint along a right path:

 

1. the lesser tuberosity

2. the coracoid process

3. the antero-inferior border of the glenoid

4. The quadrangular space that lies between the muscles

5. The triangular space

 

1248-[ ] While performing shoulder arthroscopy, one notices an area of bare bone with multiple fenestration’s on the posterolateral aspect of the humeral head, between the capsular insertion and articular lining of the head. This is most probably due:

 

1. To an avulsion of the infraspinatous tendon

2. To a Hill-Sachs lesion

3. To a normal finding

4. To a hemangioma resulting in multiple fenestration’s

5. None of the above

 

1249-[ ] On arthroscopy of the shoulder which of the following findings will confirm the diagnosis of shoulder instability:

 

1. a labral tear

2. damage to the inferior glenohumeral ligament

3. a Bankart lesion

4. the presence of a loose body

5. all of the above

 

1250-[ ] If following shoulder a patient is found to develop neuropraxia of the brachial plexus. This could be most likely due to:

 

1. an extreme position of the arm

2. too much traction on the extremity

3. too much intra-articular distention

4. all of the above

5. a direct nerve injury by the instruments

6. all of the above

 

1251-[ ] The most common cause of shoulder instability is:

 

1. glenoid avulsions of the glenohumeral-labral complex

2. diffuse capsular laxity

3. humeral avulsions of the glenohumeral complex

4. avulsion of the long head of the biceps

5. none of the above

   1252-[ ] Which of the following terms best describes an apical vertebra?

    

   1. It is the vertebra which is most tilted in a primary curve in scoliosis

   2. Is the vertebra which is most laterally deviated in a primary curve

   3. Is the vertebra which is most rotated in a primary curve

   4. Is the vertebra which is nonsegmented in a congenital curve

   5. Is usually the vertebra which is located in an area of, failure of vertebral formation in a congenital scoliotic curve

 

1253-[ ] If a child were to have a congenital scoliotic curve, should one, were to choose surgical correction, which of the following investigations is most indicated, to avoid any complications following the surgical correction?

 

1. a CT scan of the whole spine

2. plain xrays of the spine

3. MRI of the whole spine

4. Chest X-ray

5. EKG

 

1254-[ ] Which of the following conditions is known to be associated with laborers involved in drilling and vibration movements of the wrist?

 

1. Preisers disease

2. Panners disease

3. Kienbock’s disease

4. Freibergs disease

5. Kohlers disease

 

1255-[ ] Which of the following radiologic terms describes a line passing through the two triradiate cartilages, in the pelvis of a child?

 

1. Shentons line

2. Cervicoobturator line

3. Perkin’s line

4. Helgenreiner’s line

5. Von Rosen line

 

1256-[ ] Which of the following conditions results from a deficiency in the osteoclastic cell brush border and has a failure of remodeling?

 

1. Osteoporosis

2. Rickets

3. Caffey’s disease

4. Osteopetrosis

5. Osteomalascia

1257-[ ] Which of the following conditions when present serves best as a recipient zone for a metastatic focus?

 

1. Osteoporosis

2. Osteopetrosis

3. Paget’s disease

4. Rickets

5. Osteomalascia

 

1258-[ ] The disease that becomes chronic over the years with continuous flare ups and later with the possible development of squammous cell carcinoma at the lesion site, would be:

 

1. Osteopetrosis

2. Osteomyeltis

3. Caffey’s disease

4. Albright’s syndrome

5. Osteoid Osteoma

 

1259-[ ] Which of the following conditions is least associated with a Compartment syndrome?

 

1. Hemophilia

2. Rheumatoid arthritis

3. Rents or defects in the fascia surrounding muscle compartments that are repaired

4. Bryants or Gallows traction of both femurs for a fracture on one side

5. Supracondylar fractures of the elbow

 

1260-[ ] Which of the following Cardinal findings or evaluations is least reliable in a patient bound to have a Compartment syndrome?

 

1. Pulselessness

2. Paresthesia

3. Pain

4. Compartment Pressure

5. Paralysis

 

1261-[ ] A patient following a Spine fracture, develops bradycardia with hypotension. The term that best describes his condition would be:

 

1. Spinal shock

2. Central cord syndrome

3. Posterior cord syndrome

4. Neurogenic shock

5. Disdiadokinesis

1262-[ ] Following an axial compression force, a patient is noted to have a fracture of all arches of the atlas. This is best described as a:

 

1. Chance Fracture

2. Hangman’s fracture

3. Jefferson’s fracture

4. Codman’s fracture

5. Insufficiency fracture

 

1263-[ ] Injuries of the spine leading to paralysis without Radiologic evidence of a fracture and in the past were known to occur in:

 

1. Children

2. Ankylosing Spondylitis

3. Osteoporotic women

4. Osteopetrosis

5. Rugger Jersy spine

 

1264-[ ] A lesion in bone, that often remains quiescent for years and may be followed by a flare up; and on X-rays resembles an Osteoid Osteoma, would be a:

 

1. Ghon complex

2. Glomus tumor

3. Brodie’s abcess

4. Fibrous dysplasia

5. Sequestrum

 

1265-[ ] Which of the following reflexes, when present, signifies that the patient is past the stage of spinal shock:

 

1. Cremasteric reflex

2. Anal wink

3. Bulbo-Cavernous reflex

4. Beever’s reflex

5. Babinski

 

1266-[ ] Which of the following fractures of the spine has been most commonly the result of a seat belt injury?

 

1. Chance fracture

2. Jefferson fracture

3. Hangman fracture

4. Burst fracture

5. Diabalo fracture

   1267-[ ] The two most important factors in predicting outcome in patients with Legg-Calvé-Perthes disease were found to be:

    

   1. the type of treatment and age of the patient

   2. the type of treatment and gender of the patient

   3. the age of the patient and the lateral pillar classification

   4. the lateral pillar classification and the Stulberg classification

   5. the age and gender of the patient

       

      1268-[ ] Which of the following was found to be the strongest predictor of functional outcome one year after total knee arthroplasty?

       

      1. preoperative mental health status

      2. age

      3. gender

      4. preoperative functional status

      5. comorbid medical conditions

          

         1269-[ ] Which of the following syndromes is most frequently associated with radial deficiency and thumb hypoplasia?

          

         1. Down syndrome

         2. Holt-Oram syndrome

         3. Streeter dysplasia

         4. trichorhinophalangeal syndrome

         5. Rett syndrome

             

            1270-[ ] In hematogenous osteomyelitis of long bones, a single pathogenic organism is almost always recovered from the bone. Which of the following is most commonly isolated in adults?

             

            1. Streptococcus pyogenes

            2. Haemophilus influenzae

            3. Staphylococcus aureus

            4. Mycobacterium tuberculosis

            5. Escherichia coli

                

               1271-[ ] Which of the following is the most important epidemiological factor in predicting the development of posttraumatic adult respiratory distress syndrome?

                

               1. presence of a thoracic injury

               2. genetic predisposition of the patient to inflammatory hyperreactivity

               3. severity of the injury as quantified by the Injury Severity Score

               4. age of the patient

               5. mechanism of injury

                  1272-[ ] Of the following imaging modalities, which was shown to have the best diagnostic accuracy for detection of a loose acetabular component?

                   

                  1. plain radiography

                  2. subtraction arthrography

                  3. nuclear arthrography

                  4. bone scintigraphy

                  5. magnetic resonance imaging

                      

                     1273-[ ] Which of the following answers is correct concerning very small asymptomatic stage-I osteonecrotic lesions of the hip?

                      

                     1. they never collapse

                     2. pain always proceeds progression to stage II

                     3. most of the lesions collapse after five years of follow-up

                     4. collapse occurs before symptoms

                     5. small lesions never require surgery for pain

                         

                        1274-[ ] In a comparison of the clinical results of bone-patellar tendon-bone and double-looped hamstring tendon grafts in reconstruction of the anterior cruciate ligament, what was the most frequently reported symptom in patients treated with the bone-patellar tendon bone graft:

                         

                        1. residual anterior knee laxity

                        2. kneeling discomfort

                        3. joint stiffness

                        4. patellofemoral pain

                        5. knee swelling

 

1275-[ ] Which of the following is the best indication for including arthrodesis as an adjunct to decompressive surgery for lumbar spinal stenosis?

 

1. decompression performed through bilateral laminotomies

2. mild degenerative scoliosis (<15°) in an elderly patient

3. severe multilevel stenosis

4. degenerative spondylolisthesis

5. decompression requiring removal of <50% of the facet joints bilaterally

 

1276-[ ] Absence of which clinical sign or signs most reliably rules out the need to perform radiographic external rotation stress examination of the ankle following isolated fibular fracture?

 

1. weak posterior tibialis function

2. isolated medial tenderness

3. medial-sided tenderness to palpation in association with medial-sided ecchymosis

4. swelling of the ankle

5. medial-sided swelling and tenderness to Palpation

 

1277-[ ] Spontaneous resolution of asymptomatic osteonecrosis of the femoral head was found to be associated with:

 

1. younger age of the patient

2. a small lesion

3. low steroid dosage

4. absence of tobacco usage

5. female gender

 

1278-[ ] A seventy-year-old woman fell on her outstretched left hand and sustained an extraarticular fracture of the distal part of the radius. Using local anesthesia, you perform a successful, anatomical reduction and immobilize the fracture in a plaster cast. Under what circumstance would you perform a

Kirschner wire osteosynthesis?

 

1. a loss of reduction after four days

2. persistent pain in the forearm

3. an accident one week later resulting in a hip fracture

4. a concomitant injury of the ipsilateral humerus

5. Parkinson disease

    

   1279-[ ] Regarding Legg-Calvé-Perthes disease and thrombosis, which of the following statements is correct?

    

   1. there is no etiologic relationship between Legg-Calvé-Perthes disease and thrombosis

   2. both familial and acquired risk factors for thrombosis have been shown to be associated with Legg-Calvé-Perthes disease

   3. Legg-Calvé-Perthes disease is associated with systemic thrombosis

   4. the recommended treatment for Legg-Calvé-Perthes disease is anticoagulation with heparin

   5. there are no studies associating Legg-Calvé-Perthes disease with an increased risk of thrombosis

       

      1280-[ ] A fifty-year-old woman presented with pain and tenderness at the radial styloid of

      the left wrist of one month’s duration. The pain was aggravated when the thumb was clasped in the palm and the wrist was forced into ulnar deviation. A diagnosis of de Quervain disease was made. The most effective initial treatment of this condition was found to be:

      1. nonsteroidal anti-inflammatory drugs

      2. nonsteroidal anti-inflammatory drugs and splinting

      3. local steroid injection alone

      4. local steroid injection and nonsteroidal anti-inflammatory drugs

      5. surgical release

 

1281-[ ] Which branch of the axillary nerve lies closest to the inferior portion of the glenoid rim and is therefore most vulnerable to damage during surgery involving the inferior aspect of the shoulder capsule?

 

1. anterior deltoid motor branch

2. posterior deltoid motor branch

3. branch to subscapularis

4. teres minor and superior lateral cutaneous innervation branch

5. teres minor branch

    

   1282-[ ] Demineralized bone matrix contains all of the following except:

    

   1. acid-extracted bone

   2. collagen

   3. noncollagenous proteins

   4. bone morphogenetic proteins

   5. osteoprogenitor cells

 

1283-[ ] The elbow has both static and dynamic stabilizers against valgus torque. Muscle-splitting approaches to the medial aspect of the elbow have been developed to help maintain the dynamic stabilizing function of the flexor pronator mass when the medial ulnar collateral ligament is being reconstructed. On the

basis of biomechanical studies, which structures are the primary static and dynamic stabilizers, respectively?

 

1. anterior bundle of the medial ulnar collateral ligament and the pronator teres

2. anterior bundle of the medial ulnar collateral ligament and the flexor digitorum superficialis

3. anterior bundle of the medial ulnar collateral ligament and the flexor carpi ulnaris

4. posterior bundle of the medial ulnar collateral ligament and the flexor carpi ulnaris

5. posterior bundle of the medial ulnar collateral ligament and the pronator teres

 

1284-[ ] All of the following patients might be reasonable candidates for a proximal femoral valgus-producing intertrochanteric osteotomy, EXCEPT:

 

1. an active fifty-year-old woman with a nonunion of a Pauwels type-III femoral neck fracture

2. a twenty-eight-year-old man with mild osteoarthritis of the hip who is more comfortable with the hip in abduction than in adduction on examination

3. a fifty-five-year-old man with osteoarthritis and joint-space loss at the superolateral edge of the hip joint

4. a forty-five-year-old man with 2 cm of posttraumatic shortening of the ipsilateral lower limb who is otherwise asymptomatic

5. a thirty-year-old woman with osteonecrosis affecting the superolateral aspect of the femoral head, with a Kerboul necrotic angle of 120°

 

1285-[ ] The optimal method for diagnosing osteonecrosis in asymptomatic patients is:

 

1. taking the patient’s history

2. technetium bone-scanning

3. radiography

4. computerized tomography

5. magnetic resonance imaging

    

   1286-[ ] Which of the following represents the most likely change in the gap detection threshold six weeks after a carpal tunnel release?

    

   1. improved tactile sensitivity in the index finger

   2. improved tactile sensitivity in the index and small fingers

   3. improved tactile sensitivity in the small finger

   4. no change in the tactile sensitivity of the index finger

   5. improved tactile sensitivity in the index finger but worse tactile sensitivity in the small finger

 

1287-[ ] Which of the following factors is the most important when selecting a patient with high-grade metaphyseal osteosarcoma of the knee for a partial epiphyseal preservation?

 

1. metaphyseal intramedullary and soft-tissue tumor extension

2. no intra-chemotherapy tumor progression and clear tumor margins, without involvement of the epiphysis, on magnetic resonance imaging

3. no epiphyseal tumor extension detectable with radioisotope scanning and computer tomography

4. a patient with an open growth plate who is less than ten years old

5. a patient without an open growth plate who is more than fifteen years old

    

   1288-[ ] The major disadvantage of the technique of lengthening of long bones over an intramedullary nail is:

    

   1. risk of intramedullary infection

   2. premature consolidation of callus

   3. refracture

   4. decreased range of motion

   5. malalignment of the limb

 

1289-[ ] Rotator cuff repair in patients fifty years of age and younger is associated with long term improvement in which of the following clinical parameters?

 

1. active abduction

2. external rotation

3. adduction

4. internal rotation

5. pain

    

   1290-[ ] If an os acromiale is obscured on the optimal single radiographic view, it can be detected on which of the following combinations of radiographic views of the shoulder?

    

   1. anteroposterior and supraspinatus outlet

   2. anteroposterior and apical oblique

   3. anteroposterior and Stryker notch

   4. supraspinatus outlet and apical oblique

   5. supraspinatus outlet and Stryker notch

       

      1291-[ ] The factor most likely to be associated with a poor long-term outcome following proximal row carpectomy is:

       

      1. age of less than thirty-five years

      2. preoperative diagnosis of Kienböck disease

      3. failure to perform a radial styloidectomy

      4. patient occupation

      5. postoperative evidence of radiocapitate arthritis

          

         1292-[ ] Which of the following molecules is a marker of chondrocyte dedifferentiation following human autologous chondrocyte transplantation?

          

         1. cathepsin B

         2. collagen II

         3. collagen X

         4. Egr-1

         5. Sox-9

             

            1293-[ ] Which of the following factors is the main reason for loss of elbow and forearm strength following radial head resection because of a comminuted fracture of the radial head?

             

            1. wrist and forearm pain with resultant ulnar abutment

            2. valgus elbow deformity

            3. osteoarthrosis of the elbow

            4. lack of proximal support of the radiocapitellar articulation

            5. restricted elbow joint mobility

 

1294-[ ] Which of the following medications, when given intra-articularly, has been shown to be most effective in reducing postoperative pain following anterior cruciate ligament reconstruction?

 

1. methadone

2. morphine

3. hyalogen

4. corticosteroid

5. saline solution

    

   1295-[ ] Which of the following restrictions was found to be the most important in preventing early dislocation following total hip arthroplasty?

    

   1. abduction pillow

   2. no side-sleeping

   3. no driving

   4. limitation of hip flexion

   5. use of elevated chairs/toilet seats

       

      1296-[ ] When patients with lower-extremity sarcoma were treated with limb-salvage surgery combined with high-dose postoperative external beam radiation therapy, they were noted to have:

       

      1. an increased rate of pulmonary metastases

      2. an increased rate of perioperative wound complications

      3. an increased rate of local recurrence

      4. a decreased rate of fractures

      5. an increased rate of fractures

          

         1297-[ ] You make a diagnosis of posterior dislocation of the shoulder in a male patient within twenty-four hours after the injury. Radiographs show a small humeral head defect. All of the following statements are true, except:

          

         1. a good functional outcome is anticipated following relocation

         2. an osteochondral fracture of the anterior part of the humeral head is likely

         3. spontaneous relocation is unlikely

         4. closed reduction should not be attempted

         5. restriction of external rotation of the shoulder is a useful diagnostic sign

1298-[ ] Which of the following is considered to be the gold-standard suturing technique for meniscal repair?

 

1. all-inside absorbable implant

2. second-generation flexible all-inside tensioned absorbable implant

3. horizontal mattress suture

4. vertical mattress suture

5. fibrin glue

 

1299-[ ] Following total hip arthroplasty with a metalon-metal articulation, hypersensitivity reactions to wear and repassivation products may develop in some patients. If hypersensitivity is established as the cause of bursa formation, pain, or bone resorption, a surgeon should consider:

 

1. reassuring the patient and waiting for relief of symptoms

2. suppressing the reactions with drug therapy

3. replacing the articulation with a different articulation device that does not liberate nickel, cobalt, or chromium ions

4. advising the patient to limit activity in order to reduce the rate of wear

5. treating the osteolytic lesions (resecting the granuloma, refreshing the bone surfaces until bleeding occurs, bone-grafting, and using cementing techniques) so that implant stability is not jeopardized

 

1300-[ ] Which factor is least associated with patient satisfaction following surgical repair of the rotator cuff?

 

1. tear size

2. age

3. forward elevation at the time of follow-up

4. ASES (American Shoulder and Elbow Surgeons) score

5. work disability

    

   1301-[ ] When liquid gentamicin is added to cement, all but one of the following statements are true:

    

   1. it maintains bacteriocidal activity

   2. it is eluted effectively from cement

   3. it can be used in cement spacers

   4. it is cost-effective when compared with tobramycin

   5. it can be used to reimplant prosthetic components

 

1302-[ ] The effect of bisphosphonates in patients undergoing total hip and knee arthroplasty is best described as follows:

1. bisphosphonates lead to significant decreases in bone mineral density when compared with control values

2. bisphosphonates have no effect on bone mineral density in patients undergoing hip and knee arthroplasty

3. patients taking bisphosphonates will have significantly greater bone mineral density values at one year after surgery compared with the bone mineral density at the time of surgery

4. bisphosphonates lead to significantly less periprosthetic bone loss (bone mineral density) than that in controls

5. bisphosphonates are contraindicated in any patient undergoing joint arthroplasty

    

   1303-[ ] When a young patient with “cam-type” femoroacetabular impingement is treated with surgical resection of the head-neck junction, how much bone can be safely resected without significantly weakening the femoral neck?

    

   1. 5% of the neck diameter

   2. 10% of the neck diameter

   3. 30% of the neck diameter

   4. 50% of the neck diameter

   5. 75% of the neck diameter

 

1304-[ ] In a comparison of computed tomography and plain radiography for the assessment of periacetabular osteolysis following total hip arthroplasty, it was found that computed tomography has:

 

1. an average relative error of volume measurements of 63.4%

2. a detection rate that is the same as that of plain radiography

3. a 100% detection rate

4. a better detection rate than plain radiography

5. a worse detection rate than multiple plain radiographic views 1305-[ ] Calcitonin hormone produces which of the following effects:

   1. bone resorption

   2. bone formation

   3. hypercalcemia

   4. hypercalciuria

   5. heterotopic ossification

       

      1306-[ ] All of the following are associated with a significantly increased risk of deep infection in patients with an orthopaedic oncological condition, except:

       

      1. radiation therapy

      2. pediatric extendable prostheses

      3. antibiotic therapy

      4. pelvic prostheses

      5. revision surgery

          

         1307-[ ] Extracorporeal shock wave therapy used to treat chronic lateral epicondylitis resulted in significant improvement in all of the following outcome end points except:

          

         1. pain scores

         2. scores on an upper-extremity functional scale

         3. patient activity scores

         4. grip strength

         5. overall impression of disease state

 

1308-[ ] A review of 121 ankle fractures treated with open reduction and internal fixation revealed that 21% of the patients were symptomatic as a result of a surgical injury to which nerve?

 

1. sural

2. saphenous

3. superficial peroneal

4. deep peroneal

5. posterior tibial

    

   1309-[ ] Hip arthroscopy can be performed with the patient in either the supine or the lateral decubitus position. An advantage of the lateral position is that:

    

   1. fluoroscopy is seldom needed

   2. the femoral head requires no distraction

   3. most aspects of the joint can be visualized through the anterior and superior paratrochanteric portals

   4. no special distraction equipment is needed

   5. muscle relaxation is not required

       

      1310-[ ] In patients with metal-on-metal bearing hip prostheses:

       

      1. serum cobalt and chromium ion levels are unaffected by patient activity

      2. the majority of cobalt and chromium is excreted in sweat

      3. the majority of cobalt and chromium is excreted in stool

      4. serum cobalt and chromium levels tend to rise over time

      5. serum cobalt and chromium levels are independent of renal function

          

         1311-[ ] Following the diagnosis of deep periprosthetic infection in a patient who was treated for an orthopaedic oncological condition, which treatment yields the best functional outcome and probability of eradicating the infection?

         1. one-stage revision

         2. antibiotics alone

         3. Girdlestone excision arthroplasty

         4. two-stage revision

         5. surgical débridement and insertion of gentamicin beads

 

1312-[ ] A diagnosis of pigmented villonodular synovitis of the hip can be made with magnetic resonance imaging. Which of the following findings is least consistent with this diagnosis?

 

1. intra-articular effusion

2. low signal intensity on both T1 and T2-weighted images

3. synovial hyperplasia

4. bone erosions

5. a diminished width of the joint space

 

1313-[ ] Which of the following factors decreases the likelihood of success of bracing for an adolescent with idiopathic scoliosis?

 

1. higher Risser score

2. older age

3. overweight habitus

4. increased number of hours of brace wear per day

5. increased percent curve correction in the brace

    

   1314-[ ] Acetabular chondral injuries are graded according to severity, and they influence surgical outcome. These lesions most often:

    

   1. occur in the posterior aspect of the acetabulum as a result of posterior dislocation

   2. are symptomatic

   3. occur only in patients with moderated dysplasia

   4. occur in the anterior aspect of the joint in association with a labral tear

   5. are easily detected by magnetic resonance imaging

       

      1315-[ ] Eradication of bacteria is most difficult in which region of the foot?

       

      1. heel pad

      2. web spaces between the toes

      3. nail folds

      4. anterior aspect of the ankle

      5. dorsal aspect of the midfoot

1316-[ ] At a minimum of ten years following unicompartmental knee arthroplasty, the most frequent cause of failure was found to be:

 

1. unexplained pain

2. degeneration of the opposite compartment

3. tibial loosening

4. polyethylene wear

5. patellofemoral degeneration

 

1317-[ ] After treatment of a distal tibial metaphyseal fracture with an intramedullary nail, which of the following is most predictive of a poorer outcome as determined by the Musculoskeletal Function Assessment Outcomes Instrument?

 

1. time to fracture-healing

2. intra-articular extension of the fracture

3. age

4. presence of an open fracture

5. gender

    

   1318-[ ] Which of the following is the best combination of tests for diagnosing a full-thickness rotator cuff tear?

    

   1. speed test, supraspinatus muscle test, and painful arc sign

   2. Neer impingement sign, supraspinatus muscle test, and painful arc sign

   3. infraspinatus muscle test, drop-arm sign, and painful arc sign

   4. infraspinatus muscle test, relocation test, and painful arc sign

   5. weakness in internal rotation, Hawkins-Kennedy impingement sign, and Speed test

 

1319-[ ] In a study of patients with adolescent idiopathic scoliosis, which of the following was found to be associated with the greatest adverse effect on pulmonary function?

 

1. magnitude of the thoracic Cobb angle

2. length of the thoracic curve (number of vertebrae within the curve)

3. thoracic hypokyphosis

4. coronal imbalance

5. curve rigidity

    

   1320-[ ] Metal-on-metal articulation has been used as a bearing surface in total hip arthroplasty. Which of the following statements is correct?

    

   1. a metal-on-metal articulation generates no wear particles

   2. implant fixation is more durable with a metal-on-metal articulation than with a metal-onpolyethylene coupling

   3. serum ion levels increase with increased patient activity

   4. histological evidence of hypersensitivity reaction has been observed in tissues retrieved from hips with a metal-on-metal articulation

   5. there is an increase in neoplasia in patients with a metal-on-metal articulation

 

1321-[ ] When performing total knee arthroplasty, the orthopaedic surgeon must decide whether or not to resurface the patella. Which of the following statements is most consistent with the results found in a recent meta-analysis?

 

1. patellar resurfacing increases the risk of a reoperation and increases the prevalence of postoperative anterior knee pain

2. patellar resurfacing decreases the risk of a reoperation only in the short term (less than five years postoperatively)

3. data derived from the available trials show no difference in the rate of reoperations and the prevalence of postoperative anterior knee pain between resurfacing and nonresurfacing of the patella

4. the mean improvement in the various knee scores is significantly greater when the patella is resurfaced

5. patellar resurfacing decreases the risk of a reoperation and decreases the prevalence of postoperative anterior knee pain

    

   1322-[ ] Which of the following is the most important factor in predicting the future extent of pelvic osteolysis adjacent to a cementless acetabular cup?

    

   1. type of communication pathway between the lesion and the joint space

   2. usage of screws

   3. number of screw holes

   4. location of the lesion

   5. presence of cortical erosion

       

      1323-[ ] A seventy-four-year-old woman who lives independently sustained a displaced femoral neck fracture after a simple fall at the golf course. She has mild hypertension but is otherwise healthy. If you perform internal fixation rather than a total hip replacement, which of the following outcome measures

      would be most likely?

       

      1. a better possibility of independent living

      2. better hip function

      3. a reduced risk of hip complications

      4. an increased risk of revision surgery

      5. a better quality of life

          

         1324-[ ] In a study comparing treatment with external fixation with treatment with an elastic stable intramedullary nail in children who sustained a tibial fracture, the children who had the latter procedure were found to have:

         1. a higher rate of union

         2. a shorter time to union

         3. a higher prevalence of residual deformity

         4. worse functional scores

         5. less patient satisfaction

 

1325-[ ] Which of the following is the most important factor in the evaluation of peroneal tendon pathology with diagnostic ultrasound?

 

1. low cost

2. low-frequency transducers

3. ability to perform color Doppler imaging

4. experience of the operator

5. ability to differentiate peroneal tendon tears from ligament injuries

    

   1326-[ ] Following triple arthrodesis, additional procedures are sometimes needed to fully correct acquired adult flatfoot deformity. Which of the following adjunctive procedures would help correct residual forefoot varus?

    

   1. calcaneocuboid distraction arthrodesis

   2. medial displacement calcaneal osteotomy

   3. plantar flexion opening wedge osteotomy of the first cuneiform

   4. flexor digitorum longus tendon transfer

   5. peroneus longus tendon transfer

 

1327-[ ] Which of the following statements regarding platelet-derived growth factor is most

true?

 

1. it has not been shown to improve healing in any tissue except bone

2. it might increase the pool of undifferentiated mesenchymal cells in an ectopic muscle site, but the osteoinductive factors in demineralized bone matrix may not be present in sufficient quantity to move the cells into the endochondral pathway

3. neither platelet-derived growth factor nor any other growth factor has been shown to augment the osteoinductive properties of demineralized bone matrix

4. platelet-derived growth factor must be combined with the other growth factors in PRP before it becomes osteoinductive

5. only osteoblasts and osteoclasts are responsive to platelet-derived growth factor

 

1328-[ ] Which nerve is at greatest risk of injury when an anterolateral portal is being established for arthroscopic surgery of the elbow?

 

1. radial nerve

2. ulnar nerve

3. median nerve

4. anterior interosseous nerve

5. lateral antebrachial cutaneous nerve

    

   1329-[ ] Bisphosphonate therapy has been shown to be beneficial in the management of all of the following skeletal conditions except:

    

   1. adult osteonecrosis

   2. hypercalcemia of malignancy

   3. Paget disease

   4. steroid-induced osteoporosis

   5. osteogenesis imperfecta

 

1330-[ ] With regard to the development and prognosis of spondylolisthesis, the term “pelvic incidence” is defined as:

 

1. the same as sacral slope

2. the same as pelvic tilt

3. independent of sacral slope

4. independent of pelvic tilt

5. the sum of sacral slope and pelvic tilt

 

1331-[ ] A seventy-year-old patient who is generally healthy is scheduled to have a total hip replacement next week. The patient and his family want to know what to expect in terms of short-term and longer-term mortality. You should tell them that, compared with patients of the same age who do not have hip replacement, patients who have hip replacement have:

 

1. essentially the same survival at one month, one year, and five years after surgery

2. better survival at one month, one year, and five years after surgery

3. worse survival at one month, one year, and five years after surgery

4. worse survival at one month but better survival at one year and five years after surgery

5. better survival at one month but worse survival at one year and five years after surgery

    

   1332-[ ] The anticoagulant effect of the synthetic pentasaccharide fondaparinux occurs by which of the following mechanisms?

    

   1. direct thrombin inhibition

   2. direct factor-XA inhibition

   3. indirect thrombin inhibition

   4. vitamin-K antagonist

   5. inhibition of cyclooxygenase activity

1333-[ ] A group of surgeons is asked to classify a group of thoracolumbar fractures with the Denis system and the AO (Magerl) scheme to test the schemes’ interobserver reliability. Three months later, they are given the same radiographs in a different order to test intraobserver repeatability. The expected results are:

 

1. high interobserver reliability but low intraobserver repeatability

2. high interobserver reliability and substantial intraobserver repeatability

3. fair-to-moderate interobserver reliability and substantial intraobserver repeatability

4. low interobserver reliability and low intraobserver repeatability

5. fair-to-moderate interobserver reliability and fair-to-moderate intraobserver repeatability

 

1334-[ ] Which of the following is the least common type of peroneal tendon tear?

 

1. rupture (grade-III tear) of the peroneus brevis tendon

2. longitudinal tear of the peroneus longus tendon

3. attritional tear of the peroneus brevis tendon in middle-aged women

4. split tear of the peroneus brevis tendon

5. tear associated with an accessory peroneus quartus tendon 1335-[ ] The etiology of fibrous dysplasia has been linked to:

   1. an autosomal dominant genetic trait

   2. a congenital anomaly

   3. a mutation in a guanine-nucleotide binding protein

   4. a decreased amount of cAMP produced by dysplastic cells

   5. a mutation of TRNA for alanine

       

      1336-[ ] Which of the following statements regarding the indications for rotator cuff surgery is true?

       

      1. the indications for rotator cuff surgery are standardized

      2. the natural history of rotator cuff disease is known

      3. there is consensus among orthopaedic surgeons regarding the treatment of rotator cuff tears

      4. there is a lack of clinical agreement about the indications for rotator cuff surgery

      5. there is no regional variation among orthopaedic surgeons regarding clinical decisionmaking about rotator cuff disease

 

1337-[ ] As disc degeneration proceeds in the cervical spine, hypermobility of the segment can result in instability or degenerative arthritic changes or both. Hypertrophic changes are predominantly in the cervical spine at:

1. The facet joints

2. The uncovertebral joint

3. At the anterior attachment of the anterior longitudinal ligament

4. At the posterior attachment of the posterior longitudinal ligament

5. At the interpedicular space

 

1338-[ ] Hypertrophic spurring in the anterior aspect of the cervical spine can result in which of the following conditions:

 

1. dysphagia

2. vertigo

3. dyspnea

4. chest pain

5. instabilityد

1339-[ ] Which of the following substances is not involved in the biochemistry of disc degeneration:

 

1. Matrix metalloproteinases

2. Nitric oxide

3. Fibrinogen growth factor

4. Prostaglandin E2

5. Interleukin-6

 

1340-[ ] When a cervical disc is punctured anteriorly for the purpose of discography, pain is noted in the:

 

1. Neck and shoulder

2. Lateral aspect of the arm

3. In hand on the side of the puncture

4. Anterior chest

5. Sternum

 

1341-[ ] Rupture of the C4-5 disc with compression of the C5 nerve root should result in weakness of the:

 

1. Supraspinatus and infraspinatus muscles

2. Deltoid and biceps muscles

3. Extensor carpi radialis and brevis

4. Brachioradialis muscle

5. Flexor carpi ulnaris muscle

 

1342-[ ] Rupture of the C5-6 disc with compression of the C6 root would result in weakness of:

 

1. Supraspinatus and infraspinatus muscles

2. Deltoid and biceps muscles

3. Extensor carpi radialis and brevis

4. Biceps, extensor carpi radialis longus and brevis muscles

5. Flexor carpi ulnaris muscle

 

1343-[ ] Rupture of the C5-6 disc with compression of the C6 root would result in:

 

1. Decreased sensibility in the corresponding suprascapular region

2. Decreased sensibility over the lateral proximal forearm, thumb, and index finger

3. Decreased sensibility over the middle finger

4. Decreased sensibility over the ring, small finger and medial aspect of forearm

5. Decreased sensibility over the the medial arm

    

   1344 -[ ] Rupture o C7-T1 disc with compression of the C8 nerve root results in no reflex changes but leads to weakness in which of the following muscles:

    

   1. Biceps

   2. Brachioradialis

   3. Interossei

   4. Extensor carpi radialis and brevis

   5. Deltoid

 

1345-[ ] The index finger is the predominant digit with sensory change, with evidence of hypalgesia in compression of which of the following cervical nerves:

 

1. C1-2

2. C3-4

3. C4-5

4. C6-7

5. C8-T1

 

1346-[ ] On distraction of the cervical spine in the neutral position, would relieve root compression pain, but also can increase pain in other areas as is caused by:

 

1. ligamentous injury

2. thoracic outlet syndrome

3. carpal tunnel syndrome

4. tardy ulnar nerve palsy

5. primary shoulder pathological conditions

 

1347-[ ] A Hoffman’s sign when present is typical of a:

 

1. multiple sclerosis

2. amyotrophic lateral sclerosis

3. upper cervical cord compression

4. C7-T1 compression

5. Syrinx

   1348-[ ] An inverted radial nerve reflex when present, is typical of which of the following area of compression:

    

   1. C2-3

   2. C3-4

   3. C5-6

   4. C6-7

   5. C8-T1

 

1349-[ ] In patients (age 35 Years) with persistent neck pain without localized neurological findings, what additional test besides MRI, CT & Myelogrphy (all being normal) could be used to help in localizing the cause:

 

1. EMG

2. Nerve conduction study

3. Technetium scan

4. Discography

5. PET scans

 

1350-[ ] Which structure may be most likely injured by using a right sided anterior approach, in the cervical spine:

 

1. The omohyyoid muscle

2. The longus colli muscle

3. The sympathetic plexus

4. The right recurrent laryngeal nerve

5. The vagus nerve

 

1351-[ ] Which structure could be most likely injured by using a left sided anterior approach in the cervical spine:

 

1. The omohyyoid muscle

2. The thoracic duct

3. The sympathetic plexus

4. The left recurrent laryngeal nerve

5. The vagus nerve

 

1352-[ ] Isthmic spondylolisthesis is believed to be caused which of the following mechanisms:

 

1. Elongation of the pedicle of the slipped vertebra

2. Pathologic weakness of the pedicle of the cephalic vertebra

3. Repetitive impacts in extension, where the inferior articular process of the cranial vertebra impacts on the pars interarticularis of the caudal vertebra

4. Deficiency in the inferior facet of the vertebra above with respect to the superior facet of the vertebra below

5. By an acute traumatic fracture of the posterior elements of vertebra above on the more caudad distal vertebra

 

1353-[ ] Which of the following conditions is most associated with isthmic spondylolisthesis:

 

1. Scheuermann’s disease

2. Klippel Fiel syndrome

3. Hemivertebra

4. Failure of vertebral segmentation

5. Basilar impression

 

1354-[ ] High-grade spondylolisthesis has been associated with:

 

1. Scheuermann’s disease

2. Klippel Fiel syndrome

3. Abnormalities of the sacral growth plate

4. Hemivertebra

5. Failure of vertebral segmentation

 

1355-[ ] All the following comply to the progression of spondylolisthesis except:

 

1. Patients with low dysplastic spondylolisthesis have a lower prevalence of progression than those with high dysplastic spondylolisthesis

2. Males are at higher risk of progression than females

3. Patients with higher grades of spondylolisthesis

4. Higher slip angles, a measure of lumbosacral kyphosis, have a higher risk of progression

5. Doming of the upper sacral plate

 

1356-[ ] The most common identifiable cause of back pain in a child is:

 

1. Spondylolysis

2. Scheuermann’s disease

3. Benign bone tumor

4. Discitis

5. Calcification of the discs

 

1357-[ ] A high grade spondylolisthesis is associated most with:

 

1. Lordosis

2. Scoliosis

3. Flattening in the lumbar area

4. Lateral lumbar list

5. Pot belly

 

1358-[ ] A heart-shaped buttocks is most associated with a:

1. Sacral agenesis

2. Spondyloptosis

3. Lumbar Scheuermann’s disease

4. Myelomeningocele

5. Hemivertebra

 

1359-[ ] The most likely finding on physical examination of a patient with spondylolisthesis, would be:

 

1. A positive babinski

2. A positive Beavor sign

3. A positive Trendlenberg sign

4. Hamstring tightness

5. Failure of eccentric elongation of the foot during heel strike

 

1360-[ ] The gait of a child diagnosed to have a high grade spondylolisthesis, would be, a:

 

1. Crouching

2. Pendulum

3. Hitch hyke

4. Antalgic

5. Trendlenberg…..gait

 

1361-[ ] Which of the following conditions is least associated with scoliosis:

 

1. Scheuerrmann’s kyphosis

2. Spondylolisthesis

3. Klippel Fiel syndrome

4. Syrinx

5. platyspondyly

 

1362-[ ] Oblique lumbar views highlight the "Scotty dog."

Which of the following does not fit with the description of the contents of the Scotty dog:

1. the ear is formed by the superior articular process

2. the eye is the pedicle

3. the nose is the transverse process

4. the neck is the lamina

5. the front limb is the inferior articular process 1363-[ ] The slip angle is:

1. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

2. the angle between the posterior aspect of the sacrum and the vertical

3. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

4. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

5. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

 

1364-[ ] The sacral inclination is:

 

1. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

2. the angle between the posterior aspect of the sacrum and the vertical

3. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

4. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

5. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

 

1365-[ ] The pelvic incidence is:

 

1. the angle between a line drawn between the center of the femoral head to the midpoint of the sacral end plate and a line perpendicular to the center of the sacral end plate

2. the angle between a line drawn tangential to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

3. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn perpendicular to the inferior end plate of L5

4. the angle between the upper end plate of the sacrum and the vertical line perpendicular to the lower endplate of L5

5. the angle between a line drawn perpendicular to the posterior aspect of the sacrum and a line drawn along the inferior end plate of L5

 

1366-[ ] Single-Photon-Emission Computed Tomography is beneficial to a patient with spondylolisthesis. This is includes all except:

 

1. Enables localization of signal to the posterior vertebral elements, specifically the pars interarticularis

2. Facilitates the diagnosis of spondylolysis

3. It helps in distinguishing between a stable and unstable pars defect

4. Increased signal intensity suggests osseous activity and healing potential

5. Absence of an increased signal suggests a nonunion and diminished healing potential

 

1367-[ ] Which of the following investigations is most useful to evaluate an atypical presentation, including pre-lysis of the pars interarticularis:

 

1. Plain x-ray (lateral view)

2. Plain x-ray (oblique view)

3. CT scan

4. MRI

5. Flexion and extension lateral x-ray views of the lumbosacral region of the spine

 

1368-[ ] Which of the following provides the best information on the healing potential of a pars defect:

 

1. CT scan

2. A SPECT scan

3. An MRI

4. A technetium Scan

5. Simple Plain Tomography

 

1369-[ ] The key role of spinal orthotics in the treatment of spondylolysis is:

 

1. Reduction of the lumbar lordosis

2. Reduction of thoracolumbar kyphosis

3. Allowing extension of the lumbar spine

4. Preventing extension of the hips

5. Maintaining and preventing worsening of the deformity

 

1370-[ ] One of the major risks of an anterior interbody fusion of the lumbar spine, would be:

 

1. retrograde ejaculation

2. instability

3. causalgia

4. cord injury

5. nonunion

    

   1371-[ ] Long-tract clinical findings in the upper and lower extremities arising from involvement of the spinal cord by the spondylotic changes in the cervical spinal column is known as:

    

   1. cervical radiculopathy

   2. Cervical myelopathy

   3. Syrinx

   4. Amyotrophic lateral sclerosis

   5. Multiple sclerosis

       

      1372-[ ] Low levels of high-energy phosphates such as adenosine triphosphate, adenosine diphosphate, and phosphoryl creatine have been found in trapezius muscles of patients with:

      1. Syrinx

      2. Amyotrophic lateral sclerosis

      3. Multiple sclerosis

      4. Fibromyalgia with neck pain

      5. Syringomyelia

         1373-[ ] The biomechanical changes that occur with age result in a degenerative cascade. These include all, except:

          

         1. The intervertebral disc maintains its height

         2. The posterior portions of the disc bulge into the spinal canal and the neuroforamina

         3. The ligamentum flavum infold

         4. The facet joint capsule infold

         5. osteophytes form

 

1374-[ ] Patients who have cervical myelopathy with <40% compression are likely to have additional factors. Thes include all except:

 

1. developmentally reduced anteroposterior diameter of the spinal canal

2. dynamic cord compression

3. dynamic changes in the intrinsic morphology of the spinal cord

4. an impaired vascular supply of the spinal cord

5. a cervical syrinx

 

1375-[ ] The normal anteroposterior diameter of the subaxial spine in normal adults measures:

 

1. 11mm

2. 13mm

3. 14-16mm

4. 17 to 18mm

5. 20-21mm

 

1376-[ ] The segmental anteroposterior diameter as well as the volume of the cervical spinal canal have been found to be reduced in:

 

1. Flexion

2. Rotation

3. Lateral compression

4. Extension

5. Distraction

 

1377-[ ] Retrolisthesis of which of the following levels in the cervical spine could accentuate cord compression in elderly individuals with myelopathy:

 

1. C2 on C3

2. C3 on C4

3. C4 on C5

4. C5 on C6

5. C6 on C7

    

   1378-[ ] Pain in the posterior neck muscles that is worsened by flexion of the head suggests:

   1. A discogenic component

   2. It is referred from the heart

   3. It is referred from the lungs

   4. A myofascial etiology

   5. It is referred from the abdominal viscera

       

      1379-[ ] Pain in the posterior aspect of the neck that is aggravated by extension and especially by rotation of the head to one side suggests:

       

      1. A discogenic component

      2. It is referred from the heart

      3. It is referred from the lungs

      4. A myofascial etiology

      5. It is referred from the abdominal viscera

          

         1380-[ ] Neck pain with fever, weight loss, or non-mechanical neck pain may point to a:

          

         1. Rheumatoid spondylitis

         2. Tumor

         3. Disc calcification

         4. Myofascial etiology

         5. Heart pathology

 

1381-[ ] The symptoms of cervical radiculopathy that are aggravated by extension or lateral rotation of the head to the side of the pain is known as:

 

1. L’hermitte sign

2. The Spurling maneuver

3. The Beavor sign

4. The Hoffman sign

5. The Mcgregor sign

 

1382-[ ] A ”finger escape sign” is:

 

1. loss of dexterity

2. diffuse numbness

3. wasting of the intrinsic hand muscles

4. inability to rapidly grasp and release the fist

5. ulnar and flexor drift of the ulnar two digits while attempting to keep the fingers adducted and extended

 

1383-[ ] A hyperactive scapulohumeral reflex is in favor of which of the following statements:

 

1. Myelopathy resulting from a cord level C1 to C3

2. Myelopathy resulting from a cord level C3 to C4

3. Myelopathy resulting from a cord level C4 to C5

4. Myelopathy resulting from a cord level C5 to C6

5. Myelopathy resulting from a cord level C6 to C7

 

1384-[ ] Tapping of the spine of the scapula or acromion results in scapular elevation and/or abduction of the humerus is known as:

 

1. Hoffmann reflex

2. The inverted radial reflex

3. The scapulohumeral reflex

4. The shoulder abduction sign

5. The Froment’s sign

    

   1385-[ ] By dividing the anteroposterior diameter of the spinal canal by the anteroposterior diameter of the vertebral body, is known as:

    

   1. Powers ratio

   2. Pavlov’s ratio

   3. MacCreggors ratio

   4. Stulberg’s ratio

   5. Insall’s ratio

 

1386-[ ] What should the value of the Pavlov ratio be, to make the diagnosis of spinal stenosis:

 

1. 1.2

2. 1.6

3. 0.8

4. 1.0

5. 1.5

 

1387-[ ] Translation of the cervical vertebra >3.5 mm and relative sagittal plane angulation of

>11° is indicative of:

 

1. spinal stenosis

2. cervical myelopathy

3. instability

4. platybasia

5. syrinx

 

1388-[ ] In the evaluation of a patient suspected to have cervical myelopathy computed tomography myelography may be preferable to magnetic resonance imaging because of all, except:

 

1. Differentiation of bone and soft tissues

2. It tended to upgrade the degree of spinal canal compromise

3. Neural foraminal encroachment is well demonstrated

4. Provides poor imaging detail in patients with postoperative metal artifacts or scoliotic deformity

5. Cord diameter reduction is well demonstrated

 

1389-[ ] An MRI that shows a combination of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images indicates all the following, except:

 

1. Severe lesions in gray matter

2. Necrosis

3. edema, which may resolve

4. myelomalacia

5. spongiform changes

 

1390-[ ] The pedicle diameter at the level of T4 is:

 

1. 2.5mm

2. 3.5mm

3. 4.5mm

4. 5.5mm

5. 6.5mm

 

1391-[ ] The pedicle diameter at the level of L5 is:

 

1. 6mm

2. 8mm

3. 9mm

4. 11mm

5. 18mm

 

1392-[ ] Besides C2 pedicle at what other level of the cervical spine, was the pedicle also of a larger interdiameter, than all other cervical vertebrae and a pedicle screw can be inserted:

 

1. C3

2. C4

3. C5

4. C6

5. C7

 

1393-[ ] Which of the cervical pedicle interdiameter was the smallest:

 

1. C3

2. C4

3. C5

4. C6

5. C7

1394-[ ] At what level of the cervical spine is the vertebral artery least at risk while inserting a pedicle screw:

 

1. C3

2. C4

3. C5

4. C6

5. C7

 

1395-[ ] The widest pedicle in the sagittal plane is at:

 

1. T10

2. T11

3. T12

4. L2

5. L3

 

1396-[ ] Most pedicle fractures related to screw insertion occur:

 

1. Medially

2. Laterally

3. Cephalad

4. Caudad

5. Through the vertebral body

 

1397-[ ] The artery of Adamkiewicz is the largest of feeders of the lumbar cord. It is most commonly located at which of the following levels:

 

1. T5-6

2. T6-7

3. T8

4. T9-11

5. T12

 

1398-[ ] The blood supply to the spinal cord is rich, but the spinal canal is narrowest and the blood supply is poorest at:

 

1. T1-2

2. T2-4

3. T4-9

4. T10-11

5. T12-L1

 

1399-[ ] A large and complex venous channel extending from the base of the skull to the coccyx, that communicates with the superior and inferior vena cava system and azygous system, would be:

1. the anterior longitudinal vein

2. the posterolateral longitudinal vein

3. the vertebral vein

4. the Batson plexus

5. the portal vein

 

1400-[ ] During anterior spinal surgery all the following principles are followed, except:

 

1. Ligate the segmental spinal arteries only as necessary to gain exposure

2. Ligate segmental spinal arteries near the aorta rather than near the vertebral foramina

3. Dissect the segmental vessels carefully, and retract them in such a way as not to tear any. This would prevent damaging the artery of Adamkiewicz which is present on the right side

4. Ligate segmental spinal arteries on one side only when possible, leaving circulation intact on the opposite side

5. Limit dissection in the vertebral foramina to a single level when possible so that collateral circulation is disturbed as little as possible

 

Questions on Bone Infection:

 

1401-[ ] The most common site for infection to settle down in bone would be:

 

1. Epiphysis

2. Metaphysis

3. Diaphysis

4. Perichondral region

5. Periosteum

 

1402-[ ] Should Infection settle in the metaphyseal region of bone, it would be explained least, due to:

 

1. lowered PH

2. Lowered oxygen tension

3. Fewer phagocytic cells

4. Thinned periosteum

5. Excessive edicurrents at the capillary venule loop level

 

1403-[ ] At what age, common circulation ceases to exist between the metaphysis and epiphysis, through the physis?

 

1. 6 months

2. One year

3. 18 months

4. 26 months

5. 3 years

1404-[ ] In which of the the following bones, the epiphysis and metaphyses do not lie within a common joint capsule?

 

1. the hip

2. the proximal humerus

3. distal radius

4. radial neck

5. distal fibula

 

1405-[ ] The bacterial organism isolated in drug abusers is most commonly:

 

1. Staph aureus

2. E coli

3. Pseudomonas

4. Hemophilus influenza

5. Aspergillus

 

1406-[ ] Chronically ill patients receiving long-term intravenous therapy or parenteral nutrition are known to have osteomyelitis harboring which of the following organisms:

 

1. Staph aureus

2. Candida albicans

3. E coli

4. Pseudomonas

5. Hemophilus influenza

 

1407-[ ] Which of the following Bacterial organisms has dropped considerably in infants following the use of a vaccine against it:

 

1. Staph aureus

2. Candida albicans

3. E coli

4. Pseudomonas

5. Hemophilus influenza

 

1408-[ ] The causative organism that can be identified in what percent of patients, suspecting to have septic arthritis, following a blood culture?

 

a- 10%

b- 25%

c- 50%

d- 60%

e- 80%

1409-[ ] Skeletal changes, such as periosteal reaction or bony destruction, generally are not seen on plain films until which of the following days into the infection (osteomyelitis)?

 

1. 2 days

2. 4-6 days

3. 7-10 days

4. 14 days 21 days

5. The first day

 

1410-[ ] All of the following statements are true concening Indium 111 scintigraphy except:

 

1. delays the detection of infection

2. Ninety cc’s of blood from infant

3. Is the most accurate scintigraphic technique

4. Scanning is done after 18-24hrs

5. Only is 60% specific

 

1411-[ ] Which of the following statements is least true concerning the use of CT scans in osteomyelitis:

 

1. Both Sagittal & Coronal reformatting is particularly useful in identifying sequestra in Chronic osteomyelitis

2. Defines well, the soft tissue inflammation

3. Asseses well the mechanical integrity of bone

4. Determines well the extent of fracture healing even in the presence of metal

5. Is very helpful in the spine, & pelvis

 

1412-[ ] The best test, used to follow the success of treatment in a patient with septic arthritis, would be:

 

1. WBC

2. Sedimentation rate

3. C reactive protein

4. Blood culture

5. Gram stain

 

1413-[ ] Should prevalence of MRSA occur in a community, the antibiotics of choice would be:

 

1. clindamycin and vancomycin

2. oxacillin

3. cephalosporin

4. gentamycin

5. ciprofloxin

1414-[ ] The most common organism seen in nail puncture wounds through tennis shoes, would be:

 

1. B Hemolytic strep

2. Candida albicans

3. E coli

4. Pseudomonas

5. Hemophilus influenza

 

1415-[ ] The most common site for a discitis to appear, would be:

 

1. Lumbar region

2. Thoracic region

3. Cervical region

4. Thoracolumbar region

5. Lumbosacral region

 

1416-[ ] All the following are complications of chronic osteomyelitis except:

 

1. Nonunion

2. pathologic fractures

3. osteosarcoma

4. squammous cell carcinoma

5. amyloidosis

 

1417-[ ] When tuberculosis involves the spine the most common location would be at:

 

1. Lumbar region

2. Thoracic region

3. Cervical region

4. Thoracolumbar region

5. Lumbosacral region

 

1418- The most sensitive test to detect discitis would be:

 

1. technetium bone scan

2. gallium bone scan

3. MRI

4. CT scan

5. Plain Xray

 

1419- The most common site for a discitis to occur, would be at the:

 

1. cervical spine

2. upper thoracic spine

3. mid-thoracic spine

4. lower thoracic spine

5. lumbar spine

    

   1420- The most common organism found in discitis would be:

    

   1. Staph aureus

   2. Pseudomonaus

   3. Ecoli

   4. Proteus

   5. Salmonella

       

      1421-[ ] A 12-year-old boy sustained a grade III open tibial fracture 1 week ago and underwent multiple debridements and fracture fixation. He now has a soft-tissue defect that measures 6 cm × 6 cm, with an area of exposed bone and muscle on the distal medial leg that is a few centimeters proximal to the ankle. Management of the soft-tissue defect should now consist of

      1. a gastrocnemius flap.

      2. a split-thickness skin graft.

      3. vacuum-assisted closure (VAC), followed by possible skin graft.

      4. wet-to-dry dressing, followed by possible skin graft.

      5. below-knee amputation

          

         1422-[ ] A 6-year-old child sustained a closed nondisplaced proximal tibial metaphyseal fracture 1 year ago. She was treated with a long leg cast with a varus mold, and the fracture healed uneventfully. She now has a 15-degree valgus deformity. What is the next step in management?

         1. Proximal tibial/fibular osteotomy with acute correction and pin fixation

         2. Proximal tibial/fibular osteotomy with gradual correction and external fixation

         3. MRI of the proximal tibial physis

         4. Medial proximal tibial hemiepiphysiodesis e.Continued observation

             

            1423-[ ] A patient who underwent closed reduction of the hips as an infant now reports pain. An abduction internal rotation view shows an incongruous joint. Based on the findings shown in the Figure below, what is the most appropriate type of pelvic osteotomy for the right hip?

            1. Salter-type innominate

            2. Pemberton-type

            3. Triple innominate

            4. Ganz or Bernese periacetabular

            5. Chiari

       

       

       

       

      1424-[ ] An 18-month-old boy with obstetric brachial plexus palsy is being evaluated for limited right shoulder motion. Physical therapy for the past 6 months has failed to result in improvement of the contracture. Which of the following studies is necessary prior to any shoulder reconstruction?

      1. Electromyography

      2. MRI of the shoulder joint

      3. MRI of the brain

      4. Radiograph of the elbow

      5. Aspiration of the right shoulder

          

         1425-[ ] Where is the underlying defect in a rhizomelic dwarf with the findings shown in the Figure below?

          

         1. Type I collagen

         2. Type II collagen

         3. Collagen oligomeric protein (COMP)

         4. Sulfate transport

         5. Fibroblast growth factor receptor 3

       

       

       

       

       

      1426-[ ] A 2-year-old boy has complete absence of the sacrum and lower lumbar spine. What is the most likely long-term outcome if no spinal pelvic stabilization is performed?

      1. Progressive paralysis b.Neck extension contracture

      c.Inability to sit without using the hands for support

      d.Progressive hip dislocation e.Sexual dysfunction

       

      1427-[ ] Which of the following findings is most prognostic for the ability of a young child with cerebral palsy to walk?

       

      1. Ability to sit independently by age 2 years

      2. Ability to creep by age 2 years

      3. Ability to roll by age 2 years

      4. Pattern of cerebral palsy (quadriplegia, diplegia, hemiplegia)

      5. Type of motor dysfunction (spastic, ataxic, dyskinetic, hypotonic)

          

         1428-[ ] A 2-year-old girl has had a 2-day history of fever and refuses to move her left shoulder following varicella. Laboratory studies show an erythrocyte sedimentation rate of 75 mm/h and a peripheral WBC count of 18,000/mmP3P. What is the most common organism in this scenario?

         1. Kingella kingae

         2. Group A beta-hemolytic streptococcus

         3. Group B streptococcus

         4. Staphylococcus epidermidis

         5. Staphylococcus aureus

       

      1429-[ ] Which of the following is considered the best method to measure limb-length discrepancy in a patient with a knee flexion contracture?

      1. Obtain a standard scanogram

      2. Obtain a lateral CT scanogram

      3. Measure the distance from the anterior superior iliac spine to the medial malleolus

      4. Measure the distance from the umbilicus to the medial malleolus

      5. Stand the patient on blocks to measure the difference in the heights of the iliac wings

       

      1430-[ ] What is the most important consideration in the preoperative evaluation of a child with polyarticular or systemic juvenile rheumatoid arthritis (JRA)?

      1. Cervical spine assessment

      2. Temporomandibular joint (TMJ)/jaw assessment

      3. Dental assessment

      4. Stress dosing with corticosteroids e.Opthalmology examination

         1431-[ ] A 15-year-old boy has a mass at the knee. Radiographs show an aggressive tumor involving the proximal tibia, and biopsy findings reveal a high-grade osteosarcoma. Staging studies show that the tumor invades the neurovascular bundle. The tumor enlarged during preoperative chemotherapy. Management should now consist of

         1. prolonged chemotherapy.

         2. radiation therapy.

         3. amputation.

         4. marginal excision, sparing the neurovascular bundle

         5. wide excision, including the neurovascular bundle.

             

            1432-[ ] Of the following clinical situations, which is most likely to lead to osteonecrosis associated with a slipped capital femoral epiphysis (SCFE)?

            a.A girl younger than age 15 years

            b.A boy younger than age 15 years c.An unstable SCFE

            d.A stable SCFE

            e.A stable SCFE associated with morbid obesity

             

            1433-[ ] An 8-year-old boy has had pain and swelling around the right knee for the past 4 weeks. He recalls bumping it about 4 weeks ago. He has no pain in other joints, and denies any fevers, chills, or other symptoms. A radiograph is shown in the Figure below. Laboratory studies show a WBC count of 9,700/mmP3P, an erythrocyte sedimentation rate of 18 mm/h, and a C-reactive protein level of 3.7 mg/L. What is the next most appropriate step

            in management?

            1. Chemotherapy and radiation therapy

            2. Intravenous antibiotics, protected weight bearing, and a repeat C-reactive protein after improvement

            3. Open biopsy and debridement of the site, followed by intravenous antibiotics

            4. Technetium Tc 99m bone scan

      5. Empiric oral antibiotics and repeat laboratory studies in 1 week

       

       

       

       

      1434-[ ] A 12½-year-old boy reports intermittent knee pain and limping that interferes with his ability to participate in sports. He actively participates in football, basketball, and

      baseball. He denies any history of injury. Examination shows full range of motion without effusion. Radiographs reveal an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI scans are shown in the Figures below. Initial treatment should consist of:

      1. immobilization.

      2. arthroscopic evaluation of fragment stability.

      3. transarticular drilling of the lesion with 0.045 Kirschner wire.

      4. arthroscopic excision of the fragment and microfracture of underlying cancellous bone.

      5. excision of the fragment and mosaicplasty

          

          

          

          

          

          

         1435- [ ] What is the most common primary malignant bone or cartilage tumor in children?

         1. Ewing’s sarcoma

         2. Giant cell tumor

         3. Osteosarcoma

         4. Chondrosarcoma

         5. Osteochondroma

          

         1436-[ ] In obstetrical brachial plexus palsy, which of the following signs is associated with the poorest prognosis for recovery in a 2-month-old infant?

         1. Persistent inability to bring the hand to the mouth with the elbow stabilized at the side

         2. Persistent inability to actively abduct the arm past 90 degrees c.Persistent inability to externally rotate the shoulder past 20 degrees d.Persistent unilateral ptosis, myosis, and anhydrosis

      6. History of clavicle fracture at birth

         1437-[ ] A 6-year-old boy with acute hematogenous osteomyelitis of the distal femur is being treated with intravenous antibiotics. The most expeditious method to determine the early success or failure of treatment is by serial evaluations of which of the following studies?

         1. CBC count with differential

         2. MRI

         3. CT

         4. Radiographs

         5. C-reactive protein (CRP)

       

      1438-[ ] The Figure below shows the radiograph of a 7-year-old boy who sustained a pathologic fracture of the left humerus 1 day ago. Initial management should consist of:

      1. a sling and swathe.

      2. needle biopsy of the lesion.

      3. a corticosteroid injection of the lesion.

      4. curettage and bone packing of the lesion.

      5. insertion of an intramedullary rod.

          

          

          

         1439-[ ] The Figure below shows the AP radiograph of a 5-year old child who has mild short stature and a painless bilateral gluteus medius lurch. Initial work-up should include

         1. a bone scan.

         2. a skeletal survey.

         3. MRI of the hips.

         4. CT of the hips.

         5. a CBC count and a C-reactive protein

       

       

       

       

       

      1440-[ ] A 14-year-old boy reports a 4-month history of increasing backache with difficulty walking long distances. His parents state that he walks with his knees slightly flexed and is unable to bend forward and get his hands to his knees. He denies numbness, tingling, and weakness in his legs and denies loss of bladder and bowel control. A lateral

      radiograph of the lumbosacral spine is shown in the Figure below. What is the best surgical management for this condition?

      1. Vertebrectomy of L5

      2. Posterior spinal fusion with or without instrumentation from L4 to S1

      3. Posterior spinal fusion without instrumentation from L5 to S1

      4. Anterior spinal fusion from L4 to L5

      5. Direct repair of the spondylolysis defect

       

       

       

       

      1441-[ ] Duchenne’s muscular dystrophy is a genetic disorder that is transmitted by which of

      the following modes of inheritance?

      1. X-linked

      2. Autosomal-dominant

      3. Autosomal-recessive

      4. Chromosomal duplication

      5. Chromosomal deletion

      1442-[ ] A 12-year-old boy reports limping and chronic knee pain that is now inhibiting his ability to participate in sports. Clinical examination and radiographs of the knee are normal. Additional evaluation should include:

      a.mechanical alignment radiographs. b.stress radiographs of the knee. c.comparison radiographs of both knees.

      d.an erythrocyte sedimentation rate and a C-reactive protein. e.examination of the hip.

      1443-[ ] In children with moderate to severe osteogenesis imperfecta (OI), intravenous pamidronate therapy has been shown to increase the thickness of cortical bone. This occurs primarily as a consequence of:

      1. increased bone turnover in the cortical area.

      2. inhibition of osteoclast-mediated bone resorption.

      3. improved mineralization of cortical bone.

      4. improved osteoblast organic matrix production.

      5. improved organization of collagen matrix.

         1444-[ ] Split posterior tibial tendon transfer is used in the treatment of children with cerebral palsy. Which of the following patients is considered the most appropriate candidate for this procedure?

         a.A 6-year-old child with athetosis and a flexible equinovarus deformity of the foot

         b.A 6-year-old child with spastic hemiplegia and a rigid equinovarus deformity of the foot

         c.A 6-year-old child with spastic hemiplegia and a flexible equinovarus deformity of the foot

         d.A 10-year-old child with spastic quadriplegia and rigid valgus deformities of the feet

         e.A 15-year-old child with spastic diplegia and rigid equinovalgus deformities of the feet

         1445-[ ] A 3-year-old child has bilateral genu varum and short stature. Radiographs show physeal widening and generalized osteopenia. The femora and tibiae show anterolateral bowing. Laboratory studies show low normal serum calcium values, significantly decreased serum phosphate levels, and normal parathyroid hormone (PTH), alkaline phosphatase, and vitamin-D levels. These findings are consistent with:

         1. nutritional rickets.

         2. renal osteodystrophy.

         3. primary hyperparathyroidism.

         4. hypophosphatasia.

         5. vitamin D-resistant rickets.

      1446-[ ] During the early swing phase of the normal gait cycle, what lower extremity muscle is primarily contracting?

      1. Tibialis posterior

      2. Tibialis anterior

      3. Vastus medialis

      4. Adductor longus

      5. Gastrocnemius

      1447-[ ] A 6-month-old child is seen in the emergency department with a spiral fracture of the tibia. The parents are vague about the etiology of the injury. There is no family history of a bone disease. In addition to casting of the fracture, initial management should include:

      1. a skeletal survey to rule out other fractures.

      2. a punch biopsy of the skin for collagen analysis to rule out osteogenesis imperfecta.

      3. DNA testing for osteogenesis imperfecta.

      4. blood studies for calcium, phosphorus, and alkaline phosphate levels.

      5. blood studies for parathyroid hormone levels.

         1448-[ ] The rate of complications after in situ pinning of a chronic slipped capital femoral epiphysis is highest with placement of the screw in what quadrant of the femoral head?

         1. Anterior superior

         2. Anterior inferior

         3. Central

         4. Posterior superior

         5. Posterior inferior

      1449-[ ] A full-term newborn has webbing at the knees, rigid clubfeet, a Buddha-like posture of the lower extremities, and no voluntary or involuntary muscle action at and below the knees. Radiographs of the spine and pelvis reveal an absence of the lumbar spine and sacrum. What maternal condition is associated with this diagnosis?

      1. Alcoholism

      2. Drug abuse

      3. Down syndrome

      4. Diabetes mellitus

      5. Idiopathic scoliosis

         1450-[ ] A 3-year-old child has refused to walk for the past 2 days. Examination in the emergency department reveals a temperature of 102.2 degrees F (39 degrees C) and limited range of motion of the left hip. An AP pelvic radiograph is normal. Laboratory studies show a WBC count of 9,000/mmP3P, an erythrocyte sedimentation rate (ESR) of

         65 mm/h, and a C-reactive protein level of 10.5 mg/L (normal < 0.4). What is the next most appropriate step in management?

          

         1. Technetium Tc 99m bone scan

         2. Intravenous antibiotics

         3. Oral antibiotics

         4. CT of the hips

         5. Aspiration of the left hip

      1451-[ ] The Figure below shows the radiograph of an otherwise healthy Caucasian 5-year-old boy who has a painless limp. What is the best treatment option?

      1. Shelf procedure

      2. Salter osteotomy

      3. Chiari osteotomy

      4. Varus derotation osteotomy

      5. Physical therapy and range-of-motion exercises

       

       

       

       

       

      1452-[ ] What acetabular procedure for developmental dysplasia of the hip does not require a concentric reduction of the femoral head in the acetabulum?

      1. Salter innominate osteotomy b.Pemberton innominate osteotomy

      1. Dega innominate osteotomy

      2. Triple innominate osteotomy

      3. Staheli shelf procedure

      1453-[ ] A 5-year-old boy has had pain in the right foot for the past month. Examination reveals tenderness and mild swelling in the region of the tarsal navicular. Radiographs are shown in the Figure below. Management should consist of:

      a.biopsy of the tarsal navicular.

      b.curettage and bone grafting of the tarsal navicular.

      1. CBC count, C-reactive protein level, erythrocyte sedimentation rate, blood cultures, and IV antibiotics.

      2. symptomatic treatment with restriction of weight bearing or application of short leg cast.

      3. medial column lengthening of the foot through the tarsal navicular

          

          

          

          

          

         1454-[ ] A 9-year-old child sustained a fracture-dislocation of C-5 and C-6 with a complete spinal cord injury. What is the likelihood that scoliosis will develop during the remaining years of his growth?

         1. 10%

         2. 20%

         3. 50%

         4. 70%

         5. 100%

            1455-[ ] The Figures below show the radiograph and MRI scan of an otherwise normal

            1. month-old infant who has a spinal deformity. MRI reveals no intraspinal anomalies. What is the next step in management?

               1. Posterior spinal fusion with instrumentation

               2. Anterior-posterior hemiepiphysiodesis

               3. Brace management

               4. Cardiac and renal evaluation

               5. Hemivertebrectomy and fusion

       

       

       

      1456-[ ] A 22-month-old girl has cerebral palsy. Which of the following findings is a good

      prognostic indicator of the child’s ability to walk in the future?

      1. Asymmetric tonic neck reflex

      2. Moro reflex

      3. Extensor thrust

      4. Positive parachute reaction

      5. Absent foot placement

      1457-[ ] The Figure below shows the oblique radiograph of an 11-year-old boy who has a mild left flatfoot deformity. Examination reveals that subtalar motion is limited and painful. Despite casting for 6 weeks, the patient reports foot pain that limits participation in sport activities. A CT scan shows no subtalar joint abnormalities. Management should

      now include:

      1. manipulation of the foot under general anesthesia.

      2. peroneal lengthening.

      3. coalition resection with interposition of fat or muscle.

      4. distal calcaneal lengthening osteotomy.

      5. triple arthrodesis

       

       

       

       

       

      1458-[ ] The Figure below shows the radiograph of a 14-year-old boy who has been treated in the past for Perthes’ disease with an abduction brace. He now has hip pain that limits his activity, and nonsteroidal anti-inflammatory drugs have failed to provide relief. What is the most appropriate treatment?

      1. Proximal femoral varus osteotomy

      2. Salter innominate osteotomy

      3. Distal transfer of the greater trochanter

      4. Cheilectomy and valgus osteotomy

      5. Hip arthrodesis

       

       

       

      1459-[ ] A newborn girl is referred for evaluation of suspected hip instability. What information from her history would place her in the highest risk category?

      1. History of maternal diabetes mellitus

      2. Frank breech presentation

      3. Female gender

      4. Concomitant metatarsus adductus

      5. Twin gestation

      1460-[ ] A 4-year-old child was born with bilateral congenital radial clubhands. Which of the following associated conditions is a contraindication to centralization of the hands on the ulna?

      a.Congenital scoliosis b.Hypoplastic thumb c.Tracheoesophageal fistula d.Imperforate anus

      e.Lack of elbow flexion

      1461-[ ] A 7-year-old boy with spastic diplegia is a limited community ambulator. He has a moderately severe crouched gait. The parents request a treatment that will result in a permanent decrease in lower extremity muscle tone. This is best accomplished with:

      1. tone-reduction ankle-foot orthoses (AFOs).

      2. intramuscular injections of botulinum-A toxin.

      3. an intrathecal baclofen injection.

      4. selective posterior rhizotomy.

      5. fractional tendon lengthening of bilateral hamstring and gastrocnemius muscles 1462-[ ] Where is the most common site for tuberculosis (TB) spondylitis in children?

      1. Anterior aspect of the lower thoracic region

      2. Anterior aspect of the cervical spine c.Posterior elements of the lower thoracic region d.Posterior elements of the cervical spine e.Transverse process of the lower lumbar spine

          

         1463-[ ] What is the most important sign of impending modulation with rapid progression of a spinal deformity in neurofibromatosis?

         1. Apical curve rotation

         2. Anterior vertebral body erosions

         3. Cervical spine involvement

         4. Penciling of three or more ribs

         5. Curve magnitude of more than 50 degrees

       

      1464-[ ] A 6-year-old child has a fixed flexion deformity of the interphalangeal (IP) joint of the right thumb. The thumb is morphologically normal, with a nontender palpable nodule at the base of the metacarpophalangeal joint. Clinical photographs are shown in the Figures below. Based on these findings, what is the treatment of choice?

      1. Complete release of the proximal annular pulley of the flexor sheath

      2. Removal of the nodule in the flexor pollicis longus

      3. Fractional lengthening of the flexor pollicis longus tendon at the musculotendinous junction

      4. Steroid injection into the palpable nodule

      5. No treatment because this condition normally spontaneously resolves

          

          

          

          

          

          

         1465-[ ] A 3-year-old boy had been treated with serial casting for a right congenital idiopathic clubfoot deformity. The parents are concerned because the child now walks on the lateral border of the right foot. Examination shows that the foot passively achieves a plantigrade position with neutral heel valgus and ankle dorsiflexion to 15 degrees. The forefoot inverts during active ankle dorsiflexion. Mild residual metatarsus adductus is present.

         Management should now consist of:

         1. additional serial casting.

         2. a floor-reaction ankle-foot orthosis.

         3. closing wedge cuboid osteotomy.

         4. lateral transfer of the anterior tibialis tendon.

         5. posterior tibial tendon transfer through the interosseous membrane to the third metatarsal.

      1466-[ ] What is the preferred treatment of a symptomatic curly toe deformity in a 6-year-old child?

      1. Observation

      2. Tape the toe to the adjacent toes for 8 weeks

      3. Tenotomy of the flexor tendons

      4. Transfer of the flexor tendons to the extensor mechanism

      5. Arthrodesis of the proximal interphalangeal joint

       

      1467-[ ] What zone of the physis is widened in rickets?

      1. Proliferative

      2. Hypertrophic

      3. Maturation

      4. Primary spongiosa

      5. Reserve

      1468-[ ] Individuals presenting with a complete slip of one vertebra on the other are known to have a:

      1. Myerding II slip

      2. Petrosis

      3. Spondyloptosis

      4. Spondylitis

      5. Pseudospondylolisthesis

       

      1469-[ ] Which of the following does not apply to the Wiltse’ classification of

      spondylolisthesis:

      1. dystrophy of the pedicles

      2. pathologic slips

      3. traumatic slips

      4. defects in the pars interarticularis

      5. degenerative spondylolisthesis

       

      1470-[ ] Which of the following statements is least likely to provide us with an explanation, why the incidence of spondylolisthesis is less likely to occur at the lumbosacral junction, with respect to the L4-5 level:

       

      1. the iliolumbar ligaments maintain well the L5 and S1 levels

      2. the facets joints at the level of L5-S1 are more vertical and in the coronal plane, while at upper levels, are in the sagittal plane

      3. the upper and lower end plates lie in the horizontal plane at the level of L5-S1 when compared with those endplates above

      4. degenerative spondylosis is far less common at L5-S1 when compared to other levels

      5. L5-S1 interspace have a firmer fix or stability due to its position at the level of the sacroiliac joints

      1471-[ ] A slip due to degenerative spondylolisthesis, never exceeds:

       

      1. 25%

      2. 40%

      3. 50%

      4. 75%

      5. 100%

       

      1472-[ ] A mechanism or force resulting in an isthmic spondylolisthesis is most commonly in:

       

      1. hyperflexion

      2. rotation

      3. hyperextension

      4. axial compression

      5. combined rotation and flexion

       

      1473-[ ] Fractures through the proximal tibial apophysis in children (age 10 years) are most commonly a:

      1. Salter Harris (SH) I

      2. SH II

      3. SH III

      4. SH IV

      5. SH V

       

      1474-[ ] Injury of the popliteal artery or its branches, following high energy fractures about the knee, occurs most commonly in which of the following locations:

       

      1. arch of the soleus (origin)

      2. fibular neck

      3. semimembranous insertion

      4. popliteus tendon insertion

      5. musculotendinous junction of the gastrocnemius

       

      1475-[ ] The mechanism of injury or force that would likely result in a proximal apophyseal injury (tibial tuberosity) in a 10 year old child would be:

      1. a force in extreme knee flexion

      2. a sudden abduction force

      3. a sudden hyperextension force

      4. a varus bumper injury

      5. an axial compression injury

       

      1476-[ ] Traumatic dislocations of the patella have been associated with which of the following fractures of the patella:

       

      1. vertical

      2. transverse

      3. comminuted

      4. osteochondral (medial)

      5. superior lateral chip

       

      1477-[ ] Plain radiography in a 13 year old girl diagnosed to have a triplane fracture of the ankle, would reveal:

       

      1. A Salter-Harris (S-H) III fracture on anterior-Posterior and SH II on lateral views

      2. A S-H II on AP and S-H III on lateral views

      3. A S-H IV on AP and S-H III on lateral views

      4. A S-H III on AP and S-H IV on lateral views

      5. A S-H II on both AP and lateral views…. Of the ankle joint

       

      1478-[ ] A 50 year old woman presents to your clinic having a bilateral mass (8X10 cms in diameter) located each beneath the inferior angle of both scapulae. Each of the masses becomes more apparent on internally rotating and adducting the corresponding arm, and by doing so, she has pain. Your most likely diagnosis would be:

      1. Chondrosarcoma

      2. Ewings Sarcoma

      3. Breast metastasis

      4. Osteosarcoma

      5. Elastofibroma dorsi

       

      1479-[ ] Following closed reduction and Hip spica application in a one year old girl, with bilateral dysplastic hips, the best imaging technique that would confirm the reduction would be:

      1. Hip arthrography

      2. Plain radiography

      3. CT scan

      4. MRI

      5. Plain X-ray tomograms

       

      1480-[ ] Which of the following conditions is least associated with the incidence of DDH in new borns:

      1. primigravidas

      2. oligohydramious

      3. breech presentation

      4. osteopetrosis

      5. Congenital dislocation of the knee

       

      1481-[ ] Which of the following innominate osteotomies listed below, follows the same principle as the Pemberton osteotomy, with less disturbances in growth of the tri-radiate cartilage:

      1. Salter

      2. Dega

      3. Ganz

      4. Howard Steel

      5. Dejour….osteotomy

       

      1482-[ ] While performing an open reduction in a child with DDH, on exposing the acetabulum you note that the limbus is inverted and in the way of your reduction. Your next step would be, to:

      1. excise the limbus

      2. evert the limbus

      3. make circumferential radial parallel cuts in the limbus

      4. ignore it

      5. excise only a portion of the limbus, just enough to allow a successful reduction

       

      1483-[ ] In a child aged 3 years with a unilateral high riding DDH, your best approach in management would be:

      1. skeletal traction followed by open reduction and capsulorrhaphy, spica application

      2. adductor tenotomy, skeletal traction, followed by closed reduction and spica cast application

      3. Gradual bilateral traction on a Bradform frame, followed by abduction of the hip and internal rotation till the hip is reduced, followed by a bilateral hip spica in abduction and full internal rotation (the stable position)

      4. Adductor tenotomy, open reduction, Salter osteotomy, capsulorraphy, subtrochanteric osteotomy with sufficient shortening and derotation if necessary with hip spica application in the human position

      5. Adductor tenotomy, open reduction and Salter osteotomy

       

      1484-[ ] Which of the following is a dynamic hareness used for reduction of a DDH, before the age of eight months:

      1. a Craig device

      2. a Ponseti device

      3. a Pavlik device

      4. a Atlanta device

      5. a Von Rosen device

       

      1485-[ ] In a newborn with a moderate club foot deformity, which of the following deformities should be corrected last:

      1. forefoot adduction

      2. forefoot equinus

      3. ankle equinus

      4. heel varus

      5. medial deviation of the navicular and toes

       

      1486-[ ] A child presents to your clinic at the age of four months with the diagnosis of unilateral DDH. At this stage which of the following tests on examination is likely be present:

      1. a positive Barlow test

      2. a positive Ortoloni test

      3. limitation of abduction of the involved hip

      4. widening of the perineum

      5. a positive Trendlenberg test

       

      1487-[ ] Black stains have been noted on the articular surface of the alumina shell in alumina-alumina THA. These have been found to be due to:

      1. fissurization of the alumina bearing

      2. metal debris deposited on the alumina endbearing surfaces

      3. oxidation of the acetabular alumina component

      4. ceramic debris deposits

      5. debonding of the alumina structure

      1488-[ ] On comparing patients while performing a TKA where the patella was everted VS when not everted, the former was associated with a:

       

      1. a higher incidence of patella baja

      2. necrosis of the patella

      3. avulsion of the patella

      4. maltracking of the patella

      5. arthrofibrosis

       

      1489-[ ] A middle aged patient presenting with a well contained hemorrhage, surrounded by a pseudocapsule with no ecchymosis, most likely has a:

      1. hematoma

      2. sarcoma or a metastatic lesion

      3. traumatic muscle avulsion

      4. a localized purulent infection

      5. hemophilia

       

      1490-[ ] Total shoulder arthroplasty is an especially difficult procedure, since optimal function after surgery requires a great deal of skill in the reconstruction and rehabilitation. Good and durable results would least depend on:

       

      1. an intact rotator cuff

      2. a functioning deltoid

      3. orientation of the implants

      4. preservation of humeral and glenoid length

      5. constraining the implant

       

      1491-[ ] The Tug test is used to locate which of the following structures during shoulder arthroplasty:

      1. the posterior humeral circumflex artery

      2. the axillary nerve

      3. the long head of the biceps

      4. the rotator interval

      5. the inferior laxity of the shoulder capsule 1492-[ ] The shoulder offset is measured from:

      1. the outer margin of the greater tuberosity till the outer margin of the base of the coracoid process

      2. the outer margin of the greater tuberosity till the rim of the glenoid

      3. the transverse width between the greater tuberosity and inner margin of the humeral head

      4. the margin of the spinoglenoid notch and outer margin of the greater tuberosity

      5. the diameter of the humeral head

       

      1493-[ ] The arc of active function of a normal knee ranges between:

      1. 5 – 135 degrees of flexion

      2. 10-120 degrees of flexion

      3. 20 to 110 degrees of flexion

      4. 5 degrees of hyperextension till 135 degrees of flexion

      5. 0-90 degrees of flexion

       

      1495-[ ] Quadriceps muscle relaxation during the stance phase “the arc of terminal extension,” occurs at:

      1. 10 degrees of flexion till 5 degrees hyperextension

      2. 5 degrees of flexion till 0 degrees extension

      3. 15 degrees of flexion till 10 degrees extension

      4. 25 degrees of flexion till 0 degrees extension

      5. 35 degrees of flexion till 5 degrees hyperextension

       

      1496-[ ] During weight bearing on a flexed knee (15°), the quadriceps muscle force required to stabilize the knee is:

      1. 75% of the load on the femoral head at 15° of flexion

      2. 210% of the load on the femoral head at 15° of flexion

      3. 410% of the load on the femoral head at 15° of flexion

      4. 100% of the load on the femoral head at 15° of flexion

      5. 150% of the load on the femoral head at 15° of flexion

       

      1497-[ ] All the following are risk factors for limitation of motion of knee during ligamentoplasties, except:

      1. Graft placement anterior to the native ACL insertion on the tibia results in impingement on the roof of the intercondylar notch in extension

      2. Medial placement on the tibia produces impingement on the lateral wall of the intercondylar notch

      3. Placement too far anteromedially has been shown to limit flexion

      4. On the femoral side, the most common error is graft placement too far anterior, which causes excessive strain on the graft

      5. Impingement of the ACL graft on the PCL also may limit flexion when the angle of the tibial tunnel is too steep (80°)

       

      1498-[ ] A test performed by having the patient clench his or her thumb in a fist, followed by brisk deviation of the wrist ulnarly, elicits pain over the first dorsal compartment of the wrist, is known as the:

      1. Finkelstein test

      2. the Eichoff maneuver

      3. Wilsons test

      4. Terry Thompson test

      5. The Gilberman test

       

      1499-[ ] A number of factors have been implicated in the process in the development of osteonecrosis of the hip except:

   6. alcohol use

   7. high-dose corticosteroid administration

   8. coagulation abnormalities

   9. over-weight

   10. impaired mesenchymal cellular differentiation

    

   1500-[ ] Alcohol and corticosteroids most likely induce osteonecrosis of the hip by:

   1. a direct stimulus on the pancreas, leading it to secrete pancreatic enzymes in large quantities, with a direct action on the hip

   2. a profound effect on bone marrow stromal cell differentiation and blood supply

   3. Decreased sensation around the hip that results in microtrauma

   4. Altering the autonomic nerve supply around the hip, thus leading to algodystrophy that later proceeds to osteonecrosis

   5. Causing a rise in the marrow intra-compartmental pressure which could lead to osteonecrosis

    

   1501-[ ] What should the “Kerboul angle” be in a patient with osteonecrosis of the hip, to favor a good prognosis:

   1. less than 50 degrees

   2. less than 75 degrees

   3. less than 100 degrees

   4. less than 150 degrees

   5. less than 190 degrees

    

   1502-[ ] The most accurate imaging for detection of acute discitis in a child, would be:

   1. CT scan

   2. MRI

   3. Ultrasonography

   4. Scintigraphy

   5. Plain radiography

    

   1503-[ ] A 6 year old boy presents with acute pain in the cervical spine region. He was noted to have stiffness, and local tenderness in the cervical region and an elevated temperature (38.0 deg centigrade). Lab studies revealed, an increased sedimentation rate (35mm/1hr), and a WBC of 10000/ HPF, your most likely diagnosis would be:

   1. Osteoblastoma

   2. Cervical disciitis

   3. Cervical disc calcification

   4. Ewings Sarcoma

   5. Prolapse of the cervical endplate

    

   1504-[ ] All the following favor the diagnosis of scheuermanns disease, except:

   1. Endplate irregularity

   2. Schmorl's node formation

   3. narrowing of the disk space

   4. Widening of the interpedicular space

   5. wedging of three adjacent vertebrae by 5 degrees

    

   1505-[ ] Scheuermann’s disease of the thoracolumbar region has been associated has been

   associated mostly with which of the following conditions:

   1. scoliosis

   2. spondylolysis

   3. ankylosing spondylitis

   4. sacroiliatis

   5. intradural tumors

    

   1506-[ ] Which of the following benign tumors is most likely to lead to a gradual replacement of the vertebral body and gradual weakening and could precipitate a sudden collapse of the vertebral body and bleeding, initiating the onset of pain, in a child:

   1. Osteoid Osteoma

   2. Osteoblastoma

   3. Eosinophilic granuloma

   4. Chordoma

   5. Giant cell tumor

    

   1507-[ ] In children, the most common skeletal metastases to the spine, would be:

   1. Neuroblastoma

   2. Teratoma

   3. Teratocarcinoma

   4. Wilm's tumor

   5. osteogenic sarcoma

    

   1508-[ ] The most common soft tissue tumor to metastasize to the spine, in a child would be:

6. Synovial sarcoma

7. Epithelioid sarcoma

8. Rhabdomyosarcoma

9. Liposarcoma

10. Angiosarcoma

 

1509-[ ] The primary blood supply for the femoral head, particularly the weight-bearing portion would be:

1. The terminal branches from the deep branch of the medial femoral circumflex artery

2. The artery of the ligamentum teres

3. The medial epiphyseal artery

4. The obturator artery

5. The lateral femoral circumflex artery

 

1510-[ ] Which of the following anatomic variations in the proximal femur, is a risk factor for traumatic posterior hip dislocation:

1. decrease in femoral anteversion

2. decrease in femoral retroversion

3. coxa vara

4. protrusio acetabulae

5. a horizontal proximal physis

 

1511-[ ] Which of the following tendons have been reported to block reduction of a posterior dislocation of the hip:

1. Pyriformis

2. Superior gamelli

3. Obturator internis

4. Inferior gamelli

5. Quadratus femoris

 

1512-[ ] The preferred approach to fix a fracture of the femoral head, when associated with a posterior dislocation, would be:

1. lateral, medial (Ludloff)

2. posterior (Kocher-Langenbeck)

3. anterior (Smith-Petersen)

4. anterolateral (Watson-Jones)

5. tri-radiate approach

 

1513-[ ] The factor that has contributed most (at the present date) to the increased rate of to tuberculosis is:

1. the rise in the number of people who have suppression of the immune system

2. the development of drug-resistant strains of Mycobacterium

3. an aging population

4. an increase in the number of health-care workers who are exposed to the disease

5. Poverty

 

1514-[ ] The most frequent bone to be involved with tuberculosis, would be:

 

1. spine

2. hip

3. knee

4. foot

5. elbow

 

1516-[ ] In Tuberculosis, fusion of numerous epithelioid cells are believed to form:

 

1. macrophages

2. Langhan’s cells

3. Dorothy Reed Sternberg cells

4. Berbeck’s macrophages

5. Rolly bodies

1517-[ ] Which of the following is most diagnostic of Tuberculosis:

 

1. elevated sedimentation rate

2. elevated C reactive protein

3. polymerase chain reaction test

4. presence of caseation necrosis

5. evidence of giant cells within a pus smear

 

1518-[ ] Which of the following is not a cranial tong used in cervical traction:

1. Crutchfield

2. Gardner wells

3. Bradford

4. Barton

5. Halo

 

1519-[ ] While inserting the Halo screws in the region of the eyebrow, which of the following nerves could be injured:

1. Abducens

2. Glossopharyngeal

3. Supratrochlear

4. Facial

5. Maxillary

 

1520-[ ] What area of the skull is weakest for insertion of a Halo screw?

1. Occipital

2. Frontal

3. Parietal

4. Temporal

5. Supraorbital

 

1521-[ ] The “belly press test” “Napoleon sign” is used to evaluate which of the following

muscles:

1. Pectoralis major

2. Latssimuss dorsi

3. Subscapularis

4. Teres minor

5. Levator scapulae

 

1522-[ ] The “lift off test” is used to evaluate which of the following muscles:

1. Pectoralis major

2. Latssimuss dorsi

3. Subscapularis

4. Teres minor

5. Levator scapulae

1523-[ ] Which of the following findings by MRI, when if present would indicate a poor prognostic sign for a successful repair of the subscapularis tendon?

1. edema in the region of the subscapularis tendon insertion

2. MRI evidence of a complete rupture of the subscapularis tendon

3. Hemosiderin within the region of the tendon

4. Severe fatty degeneration of the subscapularis tendon and muscle

5. Long head of the biceps subluxation between the subscapularis and lesser tuberosity

 

1524-[ ] Should a patient present to your clinic with anterior shoulder pain with a good range of motion. You also note that this patient has excessive external rotation on comparing one shoulder with the opposite side. Which of the following muscles are likely to be ruptured:

1. Pectoralis major

2. Latssimuss dorsi

3. Subscapularis

4. Teres minor

5. Levator scapulae

 

1525-[ ] During the first 4 degrees of knee flexion, the patella tilts:

1. medially

2. laterally

3. sagitally

4. coronally

5. vertially

 

1526-[ ] A 30 year old male presents to your clinic with worsening of his anterior knee pain following a lateral retinacular release. The most likely cause would be:

1. insufficient lateral release

2. medial subluxation of the patella

3. excessive rotation of the patella

4. patella beja

5. patella alta

 

1527-[ ]Which of the following muscles, while under normal function, contribute to 25% of the energy absorption on the lower extremity, during landing:

1. Hip adductors

2. Hip flexors

3. Hip extensors

4. Gastrocnemii

5. Quadriceps

 

1528-[ ] Patellar instability is most commonly associated with:

1. Torsional trauma

2. An elevated Q angle

3. Patella alta

4. Patella beja

5. Vastus medialis over action

 

1529-[ ] The sensation of knee collapsing or giving way in flexion is least caused by:

1. quadriceps insufficiency

2. pain

3. deconditioning

4. joint effusion

5. patellar instability

 

1530-[ ] Free nerve endings have been associated with anterior knee pain. These are concentrated least in which of the following locations:

1. patellar tendon

2. popliteal tendon

3. retinalar tissues

4. pes anserinus

5. fat pad

 

1531-[ ] Which of the following structures is aneural in the knee?

1. synovial tissue

2. articular cartilage

3. retinacular tissue

4. fat pad

5. subchondral bone

 

1532-[ ] Which of the following ligaments is the strongest in the knee:

1. Posterior cruciate

2. Anterior cruciate

3. Medial collateral

4. Lateral collateral

5. Fabellofibular

 

1533-[ ] In “Pavlik disease”, secondary to the use of a Pavlik hareness implies damage to

which of the following anatomic locations:

1. anterior column of the acetabulum

2. anterior wall of the acetabulum

3. posterior wall and posterior column

4. erosion of the acetabular labrum

5. necrosis of the femoral head

 

1534-[ ] The posterior sag test is used to evaluate which of the following structures:

1. medial collateral ligament

2. posterior cruciate ligament

3. ligamentum teres

4. calcaneo- fibular ligament

5. sacrotuberous ligament

 

1535-[ ] Which of the following muscles about the knee has ligamentous extensions into the medial meniscus and is involved in moving the meniscus posteriorly during flexion:

1. the semitendinosus

2. the semimembranosus

3. the sartorius

4. the gracilus

5. the biceps femoris

 

1536-[ ] Which of the following muscles about the knee, has extensions into the oblique popliteal ligament and adds to lateral capsular stability to the knee:

1. the semitendinosus

2. the semimembranosus

3. the sartorius

4. the gracilus

5. the biceps femoris

 

1537-[ ] Should the posteromedial capsular structures of the knee be injured and torn, which of the following ligaments, would be at most risk for secondary injury?

1. the anterior cruciate ligament

2. the posterior cruciate ligament

3. the oblique popliteal ligament

4. the fabello-fibular ligament

5. the medial retinacular ligament

 

1538-[ ] Through which of the following ligaments does the knee rotate in its long axis during the screw home movement?

1. the anterior cruciate ligament

2. the menisco femoral ligament

3. the oblique popliteal ligament

4. the fabello-fibular ligament

5. the medial retinacular ligament

 

1539-[ ] When the meniscofemoral segments of the knee alone are disrupted, which of the following structures would prevent anterior displacement of the tibia?

1. The ACL

2. The PCL

3. The wedge shape of the posterior horn of the medial meniscus

4. The popliteus tendon

5. The oblique popliteal ligament

 

1540- [ ] The iliotibial band extends from the iliac crest to the knee. In the knee region it attaches to all the following structures, except:

 

1. The patella

2. Gerdy’s tubercle

3. Lateral epicondyle of the femur

4. A portion of the long head of the biceps femoris (Answer: it attaches to the short head)

5. A portion of the lateral head of the gastrocnemius

 

1541-[ ] Which of the following muscles lies mostly intrarticular within the knee joint:

1. the semitendinosus

2. the popliteus

3. the sartorius

4. the gracilus

5. the biceps femoris

 

1542-[ ] The ligament that extends from the the posteromedial wall of the intercondylar notch and attaches to the posterior horn of the lateral meniscus is known as the:

1. Steiner

2. Caudate

3. Oblique popliteal

4. Gerdy’s

5. Wrisberg…….ligament

 

1543-[ ] The fabellofibular ligament is an extension of which of the following tendons?

1. short head of biceps femoris tendon

2. long head of the biceps femoris tendon

3. the popliteus tendon

4. semimembranosus tendon

5. semitendenosus tendon

 

1544-[ ] When the lateral collateral ligament and the posterolateral corner of the knee are torn, which of the following structures is most likely to be recruited to resist varus stress, while in extension?

1. the PCL

2. the ACL

3. the oblique popliteal ligament

4. the medial meniscus

5. the semimembranous tendon

 

1545-[ ] When the lateral collateral ligament and the posterolateral corner of the knee are torn, which of the following structures is most likely to be recruited to resist varus stress, while beyond 45 degrees of flexion?

1. the PCL

2. the popleteal tendon

3. the oblique popliteal ligament

4. the medial meniscus

5. the semimembranous tendon

1546-[ ] Symmetric instability in extension following a Total knee replacement arthroplasty is

most likely caused, when:

1. excessive medial release is performed

2. excision of the PCL is performed

3. the distal femoral cut was excessive with respect to the chosen size of the prosthesis

4. Patella alta is present

5. the total knee is performed in a patient with excessive ligament hyperlaxity

 

1547-[ ] Should too much resection of the proximal tibia cause symmetric instability in extension following a Total Knee Artrhoplasty is best dealt with by:

1. by inserting a larger femoral component

2. inserting a thicker tibial polyethylene component

3. by adding distal femoral augments

4. inserting a semiconstrained prosthesis

5. inserting a hinged prosthesis

 

1548-[ ] Which of the following muscles takes its origin from A as in dicted in the figure below:

1. the gluteus maximus

2. the gluteus medius

3. the gluteus minimus

4. the iliacus

5. the tensor fascia latae

 

 

 

1549-[ ] which of the following muscles takes its origin from B in the above figure:

1. the gluteus maximus

2. the gluteus medius

3. the gluteus minimus

4. the iliacus

5. the tensor fascia latae

 

1550-[ ] Which of the following muscles passes through the greater sciatic foramen:

1. the gluteus minimus

2. the obturator internis

3. the obturator externis

4. the pyriformis

5. the superior gamelli

 

1551-[ ] Aneurysmal bone cyst has been noted to occur secondary to all of the following tumors except:

 

1. non-ossifying fibroma

2. chondroblastoma

3. osteoblastoma

4. rhabdomyosarcoma

5. fibrous dysplasia

 

1552-[ ] Which of the following tumors is most likely to give a “blow out” appearance on plain

radiography:

 

1. Giant cell tumor

2. Unicameral bone cyst

3. Aneurysmal bone cyst

4. Fibrous dysplasia

5. Nonossifying fibroma

 

1553-[ ] Which of the following tumors is most likely to give a fluid-fluid level appearance on MRI or CT scan:

1. Giant cell tumor

2. Unicameral bone cyst

3. Aneurysmal bone cyst

4. Fibrous dysplasia

5. Nonossifying fibroma

 

1554-[ ] On viewing the plain xray of the pelvis on a 23 year old male, your most likely diagnosis would be:

 

 

 

 

 

1. an aneurismal bone cyst

2. gouty arthritis

3. ankylosing spondylitis

4. an osteoblastoma of the pedicle of lumbar 5

5. stress fracture of the sacrum

 

1555-[ ] The most likely age range for a calcaneonavicular coalition to become evident, would be:

1. 4-6 years

2. 6-8 years

3. 8-12 years

4. 12-16 years

5. Older than 16 years of age

 

1556-[ ] Calcaneonavicular coalitions are best seen on:

1. an oblique radiograph of the foot

2. lateral radiograph of the foot

3. Harris views of the foot

4. Kite’s view of the foot

5. Tangential views of the subtalar joint

 

1557-[ ] Which portion of the distal tibial physis is last to remain open, and is associated with a tillaux fracture:

1. Centrally

2. Medially

3. Laterally

4. Both central and medial

5. Both central and lateral

 

1558-[ ] A child while walking with his sneakers on, stepped on a nail. This with time became infected. Should a culture be taken, the most likely organism to be detected, would be:

1. staph aureus

2. pseudomonas

3. streptococcus

4. E coli

5. pneumococci

 

1559-[ ] The most likely mechanism of injury, for a Bennett’s fracture, would be:

1. Axial loading of a partially flexed thumb metacarpal

2. A hyperextension injury of the carpometacarpal joint

3. A hyperextension injury of the metacarpo-phalangeal joint

4. A valgus force localized to the carpometacarpal joint

5. A varus force localized to the metacarpo-phalangeal joint

 

1560-[ ] Which of the following tendons is the source of the deforming force, in the Bennett’s

fracture:

1. The extensor pollicis longus

2. The extensor pollicis brevis

3. The abductor pollicis longus

4. The abductor pollicis brevis

5. The flexor pollicis

 

1561-[ ] The xray shown below is most likely, which of the following fractures:

 

 

 

 

 

1. Rolando fracture

2. Bennett’s fracture

3. Steiner fracture

4. Natatory fracture

5. Jersey fracture

 

1562-[ ] A test that can be useful to determine whether a varus hindfoot is the primary problem or if it is secondary to forefoot valgus or a dropped first ray, would be:

1. A Coleman block test

2. A Jobe test

3. A fleck test

4. A Meary test

5. A Pitch test

1563-[ ] The peroneal tubercle and retromalleolar groove are best evaluated with which of the following xray views of the foot:

1. oblique views

2. lateral views

3. Harris views of the heel

4. Kites views

5. Lisfranc’s views

 

1564-[ ] Following an inversion injury of the ankle, radiographs taken revealed a small avulsion fracture of the lateral malleolus. This has been termed a:

1. Romberg sign

2. Romanous sign

3. Fleck sign

4. Lisfanc’s sign

5. Struther’s sign

 

1565-[ ] A forty eight year old active male has narrowing of the medial joint line with a 5 degree varus deformity of the knee joint, on full weight bearing AP views.

The most likely indicated surgical procedure, should it be performed, would be:

1. a unicompartmental arthroplasty

2. a total knee arthroplasty

3. a high tibial valgus osteotomy

4. a distal femoral valgus osteotomy

5. a Magnuson’s abrasion and debridement of the knee

 

1566-[ ] What would the minimal knee contracture and range of motion of the knee be acceptable for a high tibial osteotomy to be successful:

1. Contracture 20 degees, and 60 degrees knee flexion

2. Contracture 30 degees, and 80 degrees knee flexion

3. Contracture 30 degees, and 120 degrees knee flexion

4. Contracture 10 degees, and 90 degrees knee flexion

5. No contracture and 90 degrees knee flexion

 

1567-[ ] The most acceptable explanation why a varus osteotomy of the knee should be performed in the distal femur for correction of a valgus knee, would be:

1. to prevent tilting of the knee joint

2. to obtain adequate correction

3. it is easier to perform

4. lower incidence of nonunion

5. easier post-operative rehabilitation

 

1568-[ ] Which of the following lesions is the most common malignant soft tissue tumor, to occur in the hand:

1. Clear cell sarcoma

2. Epithelioid sarcoma

3. Synovial sarcoma

4. Liposarcoma

5. Rhabdomyosarcoma

 

1569-[ ] Which of the following malignant soft tissue tumors, has the highest rate of local recurrence following excision, when in the hand:

 

1. Clear cell sarcoma

2. Epithelioid sarcoma

3. Synovial sarcoma

4. Liposarcoma

5. Rhabdomyosarcoma

    

   1570-[ ] The spinal column consists of:

    

   1. 30 vetebrae

   2. 33 vertebrae

   3. 34 vetebrae

   4. 36 vertebrae

   5. 38 vertebrae

 

1571-[ ] The ideal location for insertion of screws and platein the occipital area, would be:

 

1. In the midline below the inion

2. Along the lateral aspect of the inion

3. Above the inion

4. Along the path of the transverse sinus

5. In the occiput just above the occipital condyles

    

   1572-[ ] Which of the following vertebrae are considered atypical vertebrae:

    

   1. Sacrum

   2. Coccyx

   3. Atlas, axis and C7

   4. C3-C6

   5. L1-2……vertebrae

       

      1573-[ ] Bony ridges that extend upward from the lateral margin of the superior surface of the vertebral body, are known as:

       

      1. Neurocentral joints

      2. Anterior tubercles

      3. Posterior tubercles

      4. Lateral masses

      5. Pars interarticularis

 

1574-[ ] The spinous process originates in the midsagittal plane at the junction of the lamina and is bifid between:

 

1. C2-C4

2. C3-C5

3. C2-C6

4. C2-C7

5. C4-C7

    

   1575-[ ] The dens has an anterior articular surface for articulation with the anterior arch of C1 as well as a posterior articular surface for articulation with the transverse ligament. Both zones consist of what type of cartilage:

    

   1. Fibrocartilage

   2. Hyaline cartilage

   3. Elastic cartilage

   4. Mucinous cartilage

   5. Synovial cartilage

       

      1576-[ ] Hyperflexion or hyperextension injuries may subject the axis to shear stresses. This could lead to a fracture through what region of the axis:

       

      1. The transverse process

      2. The anterior tubercle

      3. The foramen transversarium

      4. The pars region

      5. Sinoatrial joint

          

         1577-[ ] Normal adult and childhood measurements concerning the atlanto-dens interval would be:

         1. 2mm and 4mm

         2. 1mm and 3mm

         3. 6mm and 7mm

         4. 3 mm and 5 mm

         5. 4mm and 7mm

             

            1578-[ ] A long non-bifid spinous process is typically found in the:

             

            1. The axis

            2. The atlas

            3. C7

            4. T12

            5. L1

 

1579-[ ] At which of the following levels does the foramen transversarium not often contain a vertebral artery:

 

1. C1

2. C2

3. C3

4. C6

5. C7

    

   1580-[ ] Which of the following structures does not play a role in cervical spine rotation?

   1. Facet joint orientation

   2. Bony architecture

   3. Transverse foramen

   4. Intervertebral discs

   5. Uncovertebral joints

      1581-[ ] Which of the following ligaments restrict rotation at the occipital-cervical junction:

      1. Apical ligaments

      2. Alar ligament

      3. Transverse ligament

      4. Ligamentum nuchae

      5. Cruciform ligament

1582-[ ] A ligament that extends from the posterior aspect of C2 body to the anterior part of foramen magnum and occiput, would be:

1. Ligamentum nuchae

2. Tectorial membrane

3. Cruciform ligament

4. Apical ligament

5. Alar ligament

 

1583-[ ] Which of the following ligaments does not hold the dens firmly against the anterior arch of the atlas?

 

1. Cruciform ligament

2. Anterior atlantoaxial ligament

3. Posterior atlantoaxial ligament

4. Apical ligament

5. Alar ligament

 

1584-[ ] The typical cervical facet joints are oriented in the sagittal and the coronal plane by what angle in each, respectively:

 

1. 20° and 10°

2. 30° and 5°

3. 45° and 0°

4. 60° and 20°

5. 50° and 10°

1585-[ ] Flexion and extension of the cervical spine are greatest at the:

 

1. C5–C6 and C6–C7

2. C1-2

3. C2-3 and C3-4

4. C4-5

5. Occiput C1… level

    

   1586-[ ] The uncinate process or synovial joint of Lushka, unique to the cervical spine, serves as a:

    

   1. “rail” to limit lateral translation or bending and as a guiding mechanism for flexion & extension

   2. Zone of protection for the vertebral artery

   3. Function to allow rotation of one vertebral body on the one below

   4. As a initiation of a degenerative process within the cervical spine

   5. Zone for lateral attachment of the longus colli muscle which would further stabilize the cervical spine

       

      1587-[ ] Which of the following substances is present in the nucleus pulposus that bind large amounts of water:

      1. Glycosaminoglycans and type 2 collagen

      2. Type I collagen

      3. Elastin

      4. Interleukin 11 and elastin

      5. Prostaglandin A2 and type 2 collagen

          

         1588-[ ] Infantile idiopathic scoliosis differs from adolescent idiopathic scoliosis in that:

          

         1. It has a right thoracic pattern

         2. It is more common in males

         3. Plagiocephaly is absent

         4. Has café’ au lait spots

         5. Is often associated with congenital anomalies

             

            1589-[ ] Infantile idiopathic scoliosis differs from adolescent idiopathic scoliosis in that: a.

             

            1. It has a left thoracic pattern

            2. It is more common in females

            3. Plagiocephaly is absent

            4. Has café’ au lait spots

            5. Is often associated with congenital anomalies

                

               1590-[ ] All the following are associated with infantile idiopathic scoliosis except:

                

               1. Plagiocephaly

               2. Developmental delay

               3. The thoracic curve is convex to the right

               4. Congenital heart disease

               5. Developmental hip dysplasia

                   

                  1591-[ ] The rib vertebral angle is determined by:

                   

                  1. A line perpendicular to the endplate of the apical vertebra and a line drawn along the center of the rib

                  2. By the intersection of the two lines drawn longitudinally through the wings of the concavity

                  3. The intersection of both perpendiculars to the endplates of the endvertebrae

                  4. By a line drawn perpendicular to the endplate of the neutral vertebra and the longitudinal axis of the rib

                  5. The angle formed by the intersection of the longitudinal axis of the vertebra and that of the rib

 

1592-[ ] The rib vertebral angle difference is calculated by:

 

1. The difference between the cobb angle measurement of the major and minor curve

2. Subtracting the angle of the convex side from the concave side, measured at the apex of the curve

3. When measured to be more than 30° indicates that the curve would not progress

4. The amount of overlap between the convex rib head and the apical vertebral body

5. When the convex rib does not overlap the vertebral body and no angle difference can be measured

    

   1593-[ ] It has been proven that sleeping in which of the following positions has been associated with a lower incidence of infantile idiopathic scoliosis:

    

   1. Prone

   2. Supine

   3. Oblique

   4. Lateral

   5. Tilted …..position

       

      1594-[ ] The vertically expandable prosthetic titanium rib (VEPTR) is indicated in:

       

      1. Adolescent idiopathic scoliosis to obtain more correction of the curve

      2. Increses the chances for a solid fusion

      3. Is indicated in infantile idiopathic scoliosis to delay the timing of fusion

      4. Promotes early immobilization and curve correction thus preventing curve progression

      5. Allows additional fixation of the curvere during fusion

 

1595-[ ] Posterior spinal instrumentation and fusion are not recommended in infantile idiopathic scoliosis due to:

 

1. Incresed rate of pseudoarthrosis

2. Restriction of thoracic cage and lung development

3. Higher rates of infection

4. Difficulty in instrumentation

5. High rates of failure of instrumentation

    

   1596-[ ] A female diagnosed to have idiopathic adolescent scoliosis is strongly advised to have an MRI when:

    

   1. The curve is rapidly progressing

   2. The major curve is convex to the left

   3. The major curve is short

   4. An associated leg length discrepancy is present

   5. The curve measures over 60°

1597-[ ] The top and bottom vertebra that tilt maximally into the concavity of the curve are termed:-

 

1. Apical vertebra

2. Neutral vertebra

3. End vertebra

4. Slipped vertebra

5. Step ladder vertebra

 

1598-[ ] The apical vertebra are:

 

1. Least tilted and are located at the upper and lower most position of the curve

2. Least rotated and horizontally located

3. Most central and are anchors on which to build the correction of a curve

4. The least tilted, most rotated, and most horizontally displaced vertebra within a curve

5. The least laterally deviated and often is located areas of attachment of the ribs tot the vertebrae

    

   1599-[ ] The ossification of the iliac apophysis is know as:

    

   1. The Moe index

   2. The Risser sign

   3. The Ganslen sign

   4. The Pavlov sign

   5. The Sea Gull sign

       

      1600-[ ] A nonstructural curve is known to be a:

       

      1. Compensatory curve

      2. Absent element of rotation

      3. Absence of lateral displacement

      4. Found only at the lower end of the structural curve

      5. Found only at the upper end of the structural curve 1601-[ ] All the following concerning a lipoma are true Except:-

1. It is composed of mature adipocytes

2. Consists of uniform nuclei identical to cells of normal adult fat

3. The nuclei are round in shape and central in location

4. The most common benign soft tissue tumor

5. Incidence in males and females are equal

1602-[ ] A soft tissue that has high signal on T1, T2 intermediate, low signal with fat suppression and minimal or no enhancement gadolinium is most likely a:

 

1. Lipoma

2. Neurofibroma

3. Schwanoma

4. Hemangioma

5. Myoma

 

1603-[ ] In a lipoma the signal intensity on MRI is:

 

1. Increased with respect to subcutaneous fat

2. The same as subcutaneous tissue

3. Is decreased when compared to subcutaneous tissue

4. Changes with the chronicity of the lipoma

5. Is very variable and both should not be compared

 

1604-[ ] An Intramuscular Lipoma is known mainly by being more:

 

1. Fibrous

2. Cellular

3. Nonuniform sizes of the fat cells

4. More necrosis than the ordinary lipoma

5. More calcification

    

   1605-[ ] 27-[ ] Which of the following is an important factor in performing a proper biopsy?

   1. Staying carefully in the proper intermuscular planes

   2. Placing multiple drains

   3. Dissecting and protecting critical neurovascular structures

   4. Using longitudinal incisions in the extremity

   5. Avoiding the use of a tourniquet

1606-[ ] What is the most common location for localized pigmented villonodular synovitis (PVNS) to occur?

1. Ankle

2. Anterior knee

3. Posterior knee

4. Hip

5. Elbow

1607-[ ] What are the four most common soft-tissue sarcomas to spread via the lymph node system?

1. Rhabdomyosarcoma, malignant fibrous histiocytoma, epithelioid sarcoma, clear cell sarcoma

2. Malignant fibrous histiocytoma, synovial sarcoma, clear cell sarcoma, epithelioid sarcoma

3. Liposarcoma, rhabdomyosarcoma, synovial sarcoma, clear cell sarcoma

4. Rhabdomyosarcoma, clear cell sarcoma, epithelioid sarcoma, synovial sarcoma

5. Liposarcoma, clear cell sarcoma, rhabdomyosarcoma, epithelioid sarcoma

1608-[ ] During a retroperitoneal approach to the L4-5 disk, what structure must be ligated to safely mobilize the common iliac vessels toward the midline laterally and gain exposure?

1. Obturator vein

2. Iliolumbar vein

3. External iliac vein

4. Middle sacral artery

5. Hypogastric artery

 

1609-[ ] The injection shown in Figures A and B below would most benefit a patient who

reports which of the following symptoms?

1. Dorsal foot pain extending into the great toe

2. Foot pain extending along the lateral border of the foot

3. Pain extending into the foot in a stocking distribution

4. Anterior thigh and shin pain ending at the ankle

5. Lateral foot paresthesias

 

1610-[ ] The most common site of involvement of tuberculosis within the spine would be:

1. Occipitocervical region

2. Upper three cervical vertebrae

3. Thoracic spine

4. Lumbar spine

5. Sacrum

1611-[ ] On histologic specimens which of the following condition would have calcific deposition within the caseous material:

1. Echinoccocosis

2. Actinomycosis

3. Tuberculosis

4. Syphilis

5. Nocardiosis

 

1612-[ ] If a child were to have a congenital scoliosis, should you decide to undergo surgical correction, which of the following investigations is most important to undergo, prior to surgery:

 

1. a CT scan of the whole spine

2. plain xrays of the spine

3. MRI of the whole spine

4. Chest X-ray

5. EKG

 

1613-[ ] Which of the following conditions listed below, is common to occur in laborers, involved in drilling and vibratory movements in the wrist?

1. Preisers disease

2. Panners disease

3. Kienbock’s disease

4. Freibergs disease

5. Kohlers disease

 

1614-[ ] Which of the following conditions listed below, lack a brush border along the osteoclastic cell membrane and is associated with a failure of remodeling?

1. Osteoporosis

2. Rickets

3. Caffey’s disease

4. Osteopetrosis

5. Osteomalascia

 

1615-[ ] Which of the following Cardinal findings or evaluations, is least reliable, in a patient bound to have a Compartment syndrome?

1. Pulselessness

2. Paresthesia

3. Pain

4. Compartment Pressure

5. Paralysis

 

1616-[ ] A patient immediately following a Spine fracture, develops bradycardia and hypotension. Your diagnosis would be:

1. Spinal shock

2. Central cord syndrome

3. Posterior cord syndrome

4. Neurogenic shock

5. Disdiadokinesis

 

1617-[ ] Following an axial vertical force, a patient sustains a fracture involving all the arches of the atlas. This is known as a:

1. Chance Fracture

2. Hangman’s fracture

3. Jefferson’s fracture

4. Codman’s fracture

5. Insufficiency fracture

 

1618-[ ] A seat belt injury, is a flexion distraction injury of the spine, and is known as a?

1. Jefferson fracture

2. Hangman fracture

3. Chance fracture

4. Burst fracture

5. Diabalo fracture

 

1619-[ ] The medial and central portions of the plantar fascia arise from the:

1. Calcaneal tuberosity at the lateral half of the calcaneus

2. Calcaneal tuberosity at the medial half of the calcaneus

3. Central half of the calcaneus

4. Os trigonum

5. Sustentaculum tali

 

1620-[ ] All the following statements are true concerning the plantar Fascia, Except:

1. It extends via slips to the transverse metatarsal ligaments

2. Indirectly attaches to the metatarsal heads

3. Slips continue distally to the base of the toes on both side of the flexor tendon sheaths

4. Does not protect the neurovascular structures

5. The fascia covers and is attached to the intrinsic muscles of the foot

 

1621-[ ] All the following are functions of the plantar fascia, Except:

1. It stabilizes the longitudinal arch

2. Prevents the calcaneum from everting

3. Is tightened during push off

4. Has a windglass effect on the medial arch of the foot

5. Allows supination of the forefoot

1622-[ ] Running requires the foot to accept how much of the body weight during heel strike:

1. The whole body weight

2. Half the body weight

3. One and a half the body weight

4. Two times the body weight

5. 2.5 times the body weight

 

1623-[ ] During the initial impact on heel strike, what function helps most in absorbing the initial impact:

1. Eccentric elongation of the quadriceps muscle

2. Eccentric elongation of the tibialis anterior

3. Eccentric elongation of the peroneus longus tendon

4. Tightening of the plantar fascia

5. Pronation of the heel and forefoot

 

1624-[ ] All the following statements concerning children diagnosed to have Friedreich’s

ataxia, are true Except:

1. Have cavus feet early in the second decade

2. Are ataxic

3. Have a dropped foot gait

4. Plantar babinski response is present

5. Areflexia exists

 

1625-[ ] Disruption of the deltoid ligament is caused mainly by

1. an eversion injury

2. a combined eversion and abduction of the foot

3. an inversion injury of the ankle

4. an external rotation injury of the ankle

5. an internal rotational force about the ankle

 

1626-[ ] The most important portion of the deltoid ligament would be:

1. The tibionavicular portion

2. The deep portion of the deltoid ligament

3. The anterior talotibial

4. The calcaneotibial

5. The talotibial component

1627-[ ] Which of the following components of the Deltoid ligament attaches to the undersurface of the medial malleolus and the body of the talus:

1. The tibionavicular portion

2. The deep portion of the deltoid ligament

3. The anterior talotibial

4. The calcaneotibial

5. The talotibial component

 

1628-[ ] All the following are components of the lateral ligaments of the foot and ankle,

Except:

1. The anterior talofibular ligament

2. The calcaneofibular ligament

3. Posterior talofibular ligament

4. The lateral talocalcaneal ligament

5. The anterior talotibial ligament

 

1629-[ ] Which of the following lateral ligaments of the ankle is totally extra-articular:

1. The anterior talofibular ligament

2. Posterior talofibular ligament

3. The calcaneofibular ligament

4. The lateral talocalcaneal ligament

5. The anterior talotibial ligament

 

1630-[ ] What percent of acute injured ankle lateral ligaments, is associated with an articular cartilage lesion, that may be the cause of pain after healing or stabilization of the joint.

a- 10%

b- 30%

c- 50%

d- 70%

e- 90%

 

1631-[ ] The most frequent nerve to be injured during a Total Knee Replacement Arthroplasty, would be:

1. the infrapatellar branch of the saphenous nerve

2. the superior genicular nerve

3. the posterior tibial nerve

4. the peroneal nerve

5. the anterior tibial nerve

1632-[ ] The best antibiotic to be given to a patient with an infected total knee Arthroplasty due to staph aureus coagulase negative Staph, would be:

 

1. Gentamycin

2. Vancomycin

3. Tobramycine

4. Tetracycline

5. Rifampin

 

1633-[ ] Acute Hematogenous infections following TKA are most frequently caused by:

 

1. enterococcus

2. gram positive staph

3. gram negative staph

4. pseudomonaus

5. Ecoli

 

1634-[ ] Cortical bone makes up to what percent of the bone of the skeleton:

1. 5%

2. 20%

3. 35%

4. 50%

5. 80%

 

1635-[ ] Bone cells include all EXCEPT:

1. osteoblasts

2. bone lining cells

3. osteoclasts

4. osteoprogenitor cells

5. reticulocytes

 

1636-[ ] All the following are present in the mentioned quantities in the bone matrix EXCEPT:

1. the bone tissue wet weight is 70% of mineralized matrix

2. 25% organic matrix

3. cells

4. 90-95% type II collagen

5. 5% water

 

1637-[ ] All the following are bone growth factors EXCEPT:

1. transform growth factor beta

2. prostaglandin F2

3. insulin like growth factor

4. interleukins

5. bone morphogenic proteins 1-6

 

1638-[ ] The non-collageneous proteins in bone matrix include all, EXCEPT:

1. dermaton sulfate

2. heparan sulfate

3. phosphoproteins

4. keratan sulfate

5. chondroitan sulfate

 

1639-[ ] The most abundant non-collageneous protein is:

1. dermaton sulfate

2. heparan sulfate

3. phosphoproteins

4. keratan sulfate

5. chondroitan sulfate

    

   1640-[ ] The calcium hydroxyapatite crystal consists of what percent of dry weight of bone:

   a- 15%

   b- 30%

   c- 45%

   d- 60%

   e- 85%

    

   1641-[ ] Which of the following is responsible for the tensile strength of bone:

   1. the hydroxy-apatite crystal

   2. chondroitan sulfate

   3. prostaglandins

   4. collagen

   5. BMP

1642-[ ] The compression side of bone has the following Piezo electric charge:

1. neutral

2. negative

3. positive

4. combined positive and negative charge, positive being more frequent

5. combined positive and negative charge, negative being more frequent

 

1643-[ ] All the following have a beneficial effect on bone formation, EXCEPT:

1. sex hormone

2. prostaglandin E2

3. transforming growth factor beta

4. insulin growth factor

5. colony stimulating factor

 

1644-[ ] All the following factors have an inhibitory effect on bone formation, EXCEPT:

1. thyroid hormones

2. glucorticoid hormones

3. tumor necrosis factor alpha

4. interleukin 1&6

5. leukotreines

 

1645-[ ] The yield strain of bone is approximately:

1. 1000 micro strain

2. 3000 micro strain

3. 5000 micro strain

4. 7000 micro strain

5. 9000 micro strain

 

1646-[ ] The growth plate synthesizes which of the following types of collagen most:

1. type I

2. type II

3. type X

4. type III

5. type VII

1647- [ ] Which of the following types of collagen is second most common to occur within the growth plate:

1. type I

2. type II

3. type X

4. type III

5. type VII

 

1648-[ ] The law, stating that increased pressure causes decreased growth and decrease pressure causes increased growth in the epiphysis, is known as the:

1. the Heuter Vokmann’s law

2. the Wolf law

3. the Newton law

4. the Van Ness law

5. the William Harris law

 

1649-[ ] Which of the following has disturbance of the provisional zone of calcification, MOST:

1. Mucopolysaccharidosis

2. Rickets

3. Achondroplasia

4. Pseudoachondroplasia

5. Osteopetrosis

 

1650-[ ] Which of the following affects the maturation and degenerative part of the hypertrophic zone of the physis:

1. Mucopolysaccharidosis

2. Rickets

3. Achondroplasia

4. Pseudoachondroplasia

5. Osteopetrosis

 

1651-[ ] Which of the following affects the proliferative zone of the physis most:

1. Mucopolysaccharidosis

2. Rickets

3. Achondroplasia

4. Pseudoachondroplasia

5. Osteopetrosis

1652-[ ] Which of the following affects the reserve zone of the physis, most:

1. Mucopolysaccharidosis

2. Rickets

3. Achondroplasia

4. Pseudoachondroplasia

5. Osteopetrosis

 

1653-[ ] All the following conditions affect the secondary spongiosa zone of the metaphyses,

EXCEPT:

1. Osteopetrosis

2. Achondroplasia

3. Osteogenesis imperfecta

4. Scurvy

5. Metaphyseal dysplasias

 

1654-[ ] The normal PH of articular cartilage is:

a- 6.5

b- 6.7

c- 7.0

d- 7.2

e- 7.4

 

1655-[ ] The most frequent type of collagen in articular cartilage, would be:

1. type I

2. type II

3. type III

4. type IV

5. type X

 

1656-[ ] Which of the following types of collagen, is associated with the calcification of cartilage:

1. type I

2. type II

3. type III

4. type IV

5. type X

1657-[ ] Which of the following plays an important role in the inhibition of the calcification of articular cartilage:

1. Proteoglycan

2. Interleukin

3. Prostaglandin

4. Insulin like growth factor

5. Transforming growth factor beta

 

1658-[ ] Which of the following layers is not a component of articular cartilage:

1. Gliding zone

2. Transitional zone

3. Radial zone

4. Tide mark

5. Reserve zone

 

1659-[ ] Which of the following is increased in the articular cartilage of joints, in patients with degenerative osteoarthritis:

1. chondroitan sulfate

2. keratan sulfate

3. haparatan sulfate

4. dermaton sulfate

5. proteoglycan

 

1660-[ ] Synovial fluid is produced by which of the following cells of the synovium:

1. type B fibroblast like cells

2. type A fibroblast like cells

3. type C fibroblast like cells

4. type D fibroblast like cells

5. type E fibroblast like cells

 

1661-[ ] Synovial fluid is made up of all EXCEPT:

1. proteinase

2. collagenase

3. hyaluronic acid

4. prostaglandins

5. interleukins

1662-[ ] A joint is diagnosed to be degenerative, all the following statements concerning it, are true, EXCEPT:

1. failed attempts of chondrocytes to repair damaged cartilage

2. decreased water content

3. alterations in the proteoglycans

4. collagen abnormalities

5. binding of proteoglycans to hyaluronic acid

 

1663-[ ] Which of the following in the list below has not been associated with a Charcot joint:

 

1. Diabetes mellitus

2. Tabes dorsalis

3. Gaucher’s disease

4. Syringomyelia

5. Syphilis

 

1664-[ ] Which of the following conditions listed below can lead to a Charcot joint:

 

1. Meningocoele

2. Sickle cell anemia

3. Thalassemia

4. Gout

5. Rheumatoid arthritis

 

1665-[ ] All the following are major Jones criteria for acute rheumatic fever, EXCEPT:

 

1. Carditis

2. Polyarthritis

3. fever

4. Erythema marginatum

5. Subcutaneous nodules

 

1666-[ ] All the following are minor Jones criteria for acute rheumatic fever, EXCEPT:

 

1. chorea

2. Arthralgia

3. Previous rheumatic fever

4. Elevated ESR

5. Prolonged PR interval on ECG

 

1667-[ ] All the following arthropathies are characterized by positive HLA-B27 and negative rheumatoid factor, EXCEPT:

 

1. Ankylosing spondylosis

2. Reiter's syndrome

3. Psoriatic arthropathy

4. Enteropathic arthritis

5. Still’s disease

 

1668-[ ] A condition that presents with fever, butterfly malar rash, pan cytopenia, pericarditis, nephritis and polyarthritis and the joint destruction is not as destructive as rheumatoid arthritis is most likely:

 

1. Ankylosing spondylosis

2. Systemic lupus erythematosus

3. Reiter's syndrome

4. Psoriatic arthropathy

5. Enteropathic arthritis

 

In the questions below list which of the following tissues contains most, the type of collagen:

1669-[ a ] bone 1670-[ a ] tendon

1671-[ b ] Articular cartilage

1672-[ b ] nucleus pulposus of the disc 1673-[ a ] meniscus

1674-[ a ] intervertebral disc annulus 1675-[a&c] skin

1676-[ c ] blood vessels

1677-[ f ] Abnormal cartilage with calcification 1678-[g ] Endothelial cells

1. Type I

2. Type II

3. Type III

4. Type V & VI

5. Type IX & XI

6. Type X

7. Type XIII

 

1679-[ ] The thick filament of the sarcomere consists of mainly:

 

1. troponin

2. tropomycin

3. myosin

4. creatinine

5. nectin

 

1680-[ ] The thin filament of the sarcomere consists of:

 

1. troponin and tropomycin

2. troponin and myosin

3. tropomycin and myosin

4. myosin

5. troponin

 

1681-[ ] All the following are true concerning isotonic contraction of muscle, EXCEPT:

 

1. it is constant tension in the muscle

2. it can be concentric

3. it can be eccentric

4. it can occur where the length of the muscle remains the same

5. it can occur when muscle is shortening

 

1682-[ ] The pseudo fracture’s (looser’s zone) that occurs in osteomalascia, occurs mainly on the:

 

1. convex side

2. concave side

3. coronal side

4. sagittal side

5. vertical side of bone

 

1683-[ ] The pseudo fracture’s (looser’s zone) that occurs in osteogenesis imperfecta occurs mainly on the:

 

1. convex side

2. concave side

3. coronal side

4. sagittal side

5. vertical side of bone

 

1684-[ ] Type II osteoporosis is known as:

 

1. insufficiency osteoporosis

2. fragility osteoporosis

3. low turnover osteoporosis

4. calcium insufficiency osteoporosis

5. collagen deficiency osteoporosis

1685-[ ] The osteoporosis associated with hyperparathyroidism, is known as:

 

1. insufficiency osteoporosis

2. fragility osteoporosis

3. high turnover osteoporosis

4. calcium insufficiency osteoporosis

5. collagen deficiency osteoporosis

 

1686-[ ] Which of the following has been identified in patients with Paget’s disease and could be a possible etiology:

 

1. Paramyxo virus antibodies

2. Adeno-viruses

3. Nasocomial viruses

4. Coxsackie viruses

5. chlamydia

 

1687-[ ] All the following have been associated with Paget’s disease, EXCEPT:

 

1. Arthritis

2. decreased blood flow

3. pain

4. Cranial nerve compression

5. Deformity

 

1688-[ ] The arthritis that occurs in patients with Paget’s disease may occur as a result of all,

EXCEPT:

 

1. Articular bone deformation

2. Abnormal joint bio-mechanic

3. Sub capital support loss or

4. Gout

5. Sepsis

 

1689-[ ] Which of the following conditions is most likely to be associated with an enlarged vertebral body:

 

1. hyperparathyroidism

2. hyperthyroidism

3. Gauchers disease

4. Lymphoma

5. Paget’s disease

    

   1690-[ ] Which of the following muscles does not originate from the medial epicondyle:

   1. pronator teres

   2. flexor carpi radialis

   3. Abductor pollicis longus

   4. FDS

   5. FCU

      1691-[ ] Which of the following muscles does not originate from the lateral epicondyle:

      1. anconeus

      2. pronator teres

      3. Extensor carpi radialis longus

      4. Extensor carpi radialis brevis

      5. extensor digitorum comminus

         1692-[ ] The anterior bundle of the medial collateral ligament of the elbow is:

         1. primary restraint to valgus stress at the elbow from 30 to 120 deg

         2. Is lax in pronation

         3. inserts on crista supinatorus

         4. stabilizer against posterolateral rotational instability

         5. taut in supination

            1693-[ ] Which of the following statements does not apply to the radial nerve:

            1. Resides in spiral groove 15cm proximal to distal humeral articular surface

            2. Courses between the brachioradialis and brachialis proximal to elbow

            3. Resides in the cubital tunnel in a subcutaneous position below the medial condyle

            4. Divides into the posterior interosseous nerve and superficial radial nerve at level of radial head

            5. Supplies the brachioradialis muscle

               1694-[ ] The medial column of the distal humerus diverges from the central humeral axis at an angle of:

               1. 45 degrees

               2. 35 degrees

               3. 20 degrees

               4. 25 degrees

               5. 15 degrees

                  1695-[ ] The lateral column of the distal humerus diverges from the central humeral axis at an angle of:

                   

                  1. 45 degrees

                  2. 35 degrees

                  3. 20 degrees

                  4. 25 degrees

                  5. 15 degrees

                     1696-[ ] The distal articular surface of the elbow lies in how much of valgus:

                     1. 1-3°

                     2. 4 – 8°

                     3. 8-10°

                     4. 10-12°

                     5. 12-14° …….of valgus to the central axis of the humerus

                        1697-[ ] The distal articular surface of the elbow lies in how much of external rotation to the central axis of the humerus:-

                        1. 1-2°

                        2. 3-4°

                        3. 5-6°

                        4. 7-8°

                        5. 8-10°

1698-[ ] The capitellum and trochlea are translated anteriorly relative to the humeral diaphysis, creating an angle between the central humeral axis and the distal articular segment of:-

 

a. 5-10°

b. 10-20°

c. 20-30°

d. 30-40°

e. 40-50°

1699-[ ] The greatest exposure of the articular surface following a distal humeral intraarticular fracture would be:

a. Bryan-Morrey Approach

b. Triceps-Reflecting Anconeus Pedicle Approach

c. Van Gordner Approach

d. Olecranon Osteotomy approach

e. Campbell Triceps-Splitting Approach

1700-[ ] Treatment of supracondylar fractures of the elbow is complex and difficult, due, mainly to all except:

1. low fracture line of one or both columns

2. metaphyseal fragmentation of one or both columns

3. commonly associated elbow dislocations (floating elbow)

4. articular comminution

5. poor bone quality

   1701-[ ] The distinguishing feature and size that distinguishes an osteoid osteoma from an osteoblastoma would msbe:

   1. 0.5cms

   2. 1.0cms

   3. 1.5cms

   4. 2cms

   5. 3cms

      1702-[ ] The chromosomal alteration that involve the genes controlling osteogenesis and are implicated to have a role in the development of several solid malignancies are:

      1. 22q

      2. 26q

      3. 29q

      4. 32q

      5. 36q

1703-[ ] Osteoid osteomas are common lesions that account for about what percent of all

benign bone tumors:

1. 2%

2. 6%

3. 10-12%

4. 20%

5. 25%

   1704-[ ] Osteoid osteoma occurs least in which of the following bones:

   1. Femoral neck

   2. Distal femur

   3. Innominate bone

   4. Spine

   5. Fibular bone

1705-[ ] Enclosed are x-rays and a pathologic specimen of a lesion within bone. What is your most likely diagnosis?

 

 

 

 

1. Ewings Sarcoma

2. Osteoblastoma

3. Osteoid osteoma

4. Osteoma

5. Chondroblastoma

   1706-[ ] Which of the following lesions which when exists close to a physis often leads to a leg length discrepancy:

   1. Chondroblastoma

   2. Osteobastoma

   3. Osteoid osteoma

   4. Osteosarcoma

   5. Aneurysmal bone cyst

      1707-[ ] High levels of which of the following substances have been found to be present within the nidus of an osteoid osteoma:

      1. Prostacyclin

      2. Calcitonin

      3. Interleuckine

      4. TGF

      5. TNF

         1708-[ ] All the following enter the differential diagnosis of an osteoid osteoma except:

         1. Osteomyelitis

         2. intracortical hemangioma

         3. bone island

         4. stress fracture

         5. desmoid tumor

            1709-[ ] Reported success rates for treatment by thermocoagulation with radiofrequency electrodes have ranged between:

            1. 80% & 90%

            2. 65 & 75%

            3. 55 & 60%

            4. 45 & 55%

            5. 30 & 40%

1710-[ ] When Osteoid osteoma involves the spine, it is most commonly located in which of the following locations:

1. Upper cervical

2. Lower cervical

3. Upper thoracic

4. Lower thoracic

5. Lumbar spine

1711-[ ] All are virtually essential for early detection of a nidus except:

1. Bone scintigraphy

2. computed tomography

3. magnetic resonance imaging

4. plain radiography

5. Ultrasonography

1712.[ ] A cementoblastoma is located in the:

1. mandible

2. distal radius

3. femur

4. phalanx

5. innominate bone

   1713-[ ] which of the following conditions is occasionally associated with an aneurysmal bone cyst?

   1. Osteoblastoma

   2. Desmoid lesion

   3. Osteoid osteoma

   4. Eosinophilic granuloma

   5. Unicameral bone cyst

1714-[ ] Tumors that are characterized microscopically by the presence of so-called epithelioid osteoblasts are known to be:

1. Aggressive osteoblastomas

2. Giant osteoid osteomas

3. Eosinophilic granuloma

4. Hand Schuller Christian disease

5. Epithelioid sarcomas

1715-[ ] Aggressive osteoblastomas has been associated with wish of the following conditions?

1. Osteoporosis

2. Vitamin D resistant rickets

3. Hypothyroidism

4. Hypopituitarism

5. Ankylosing spondylitis

1716-[ ] All the following are findings of an epithelioid osteoblast except:

1. Round

2. Twice the size of ordinary osteoblasts

3. Show an abundant eosinophilic cytoplasm and an eccentric large, oval or round nucleus

4. Very difficult to distinguish it from a cell having birbecks granules within the cytoplasm

5. Have a prominent nucleolus

1717-[ ] Which of the following tumors has been associated with Gardner’s syndrome

1. Enostosis

2. Osteoma

3. Giant osteoblastoma

4. Osteoid Osteoma

5. Aggressive osteoblastoma

1817-[ ] The motion segment, or functional spinal unit of the spine, comprises:

1. Two adjacent vertebrae and the intervening soft tissues

2. Two adjacent discs and the intervening vertebra

3. The vertebra combined with the intertransverse ligaments & nucleus pulposus

4. The anterior and posterior longitudinal ligament together with the adkacent vertebrae

5. The surrounding ligaments from the atlas down to the lumbosacral junction

 

1818-[ ] The majority of vertical compressive loads on the spine is received by:

1. The cortical bone

2. The ligaments

3. The surrounding muscles

4. The disc

5. The trabecular bone

 

1819-[ ] The horizontal trabeculae within the vertebral body:

1. Bear the majority of load

2. Stabilize the vertical trabeculae columns

3. Are last to be removed in osteoporosis

4. Maintain the cortical height

5. Don’t exist within the vertebral body

 

1820-[ ] The function of the endplate is to:

1. Prevent extrusion of the disc into the porous vertebral body, and to evenly distribute load to the vertebral body

2. Be the major axial load support of the spine

3. Provide anterior and posterior stability

4. Be the principle shock absorber of the disc

5. Prevent nutrients from entering within the vertebral body

1821-[ ] Which of the following structures allows the transfer of water and solutes but prevents the loss of large proteoglycan molecules from the disc:

1. The annulus fibrosus

2. The nucleus pulposus

3. The cartilage endplate

4. The cortical bone

5. The trabecular bone

    

   1822-[ ] Which of the following structures is considered as the weak link in maintaining vertebral body integrity:

   1. The cortex

   2. The horizontal trabeculae

   3. The vertical trabeculae

   4. The endplate

   5. The nucleus pulposus

 

1823-[ ] Which of the following types of collagen is present within the deeper portion of the anulus fibrosus:

1. Type I

2. Type II

3. Type III

4. Type IV

5. Type five….. collagen

 

1824-[ ] The stress in the anulus fibers is approximately how many times the applied stress in the nucleus:

1. 1-2

2. 2-3

3. 3-4

4. 4-5

5. 5-6….times

 

1825-[ ] “Stress profilometry” is when:

1. Loads are applied to the nucleus pulposus

2. Loads are applied to the anulus fibrosus

3. The shift of loads from the nucleus pulposus to the anulus fibrosus

4. The surrounding ligaments of the vertebral body assume the function of axial support

5. The horizontal trabeculae loose there function of compression support

1826-[ ] Posterior disc bulging is greatest during:

1. Flexion

2. Rotation

3. Extension

4. Axial compression

5. Lateral bending

 

1827-[ ] The type of collagen involved in ossification of the posterior longitudinal ligament of the cervical spine would be:

1. Type I

2. Type III

3. Type VI A1

4. Type IV B1

5. Type V

 

1828-[ ] Up to 50% of Caucasian patients with OPLL also have:

1. Diffuse idiopathic skeletal hyperostosis

2. Pagets disease

3. Osteopetrosis

4. Prostate Ca

5. Myositis ossificans

 

1829-[ ] The Finger Escape sign is most often associated with:

1. Multiple sclerosis

2. Tuberculous spondylitis

3. Tabes dorsalis

4. Cervical myelopathy

5. Syringomyelia

 

1830-[ ] Which of the A pully”s of the flexor tendon sheath, lies at the level of the Metacarpophalangeal Joint:

1. A1

2. A2

3. A3

4. A4

5. A5

 

1831-[ ] The golfer’s elbow is known to occur in the:

1. Lateral epicondyle

2. Medial epicondyle

3. Medial condyle

4. Medial epicondyle

5. Coronoid process

1832-[ ] The biceps tendon is known to insert on the:

1. Olecranon process

2. Medial condyle of the humerus

3. Listers tubercle

4. Tuberosity of the radius

5. Lateral epicondyle of the humerus

 

1833-[ ] Which of the following bones about the elbow is most involved with elbow instability following trauma:

1. The coronoid process

2. The olecranon process

3. The lateral epicondyle

4. The radial head

5. Medial epicondyle

 

1834-[ ] The Popeye arm is known to occur in a rupture of which of the following tendons:

1. The triceps

2. The brachialis

3. The biceps

4. The brachioradialis

5. The flexor carpi ulnaris

 

1835-[ ] The strongest supinator of the forearm is:

1. The brachioradialis

2. The biceps

3. The extensor carpi radialis longus

4. The extensor carpi radialis brevis

5. The supinator

 

1836-[ ] Which of the following muscles is not innervated by the ulnar nerve:

1. The flexor carpi ulnaris

2. The hypothenar muscles

3. The pronator quadratus

4. The flexor digitorum profundus

5. The lumbricals

 

1837-[ ] As the radial nerve divides in two parts as it reaches the elbow, which of the following is the branch that pierces the supinator muscle:

1. The anterior interosseous

2. Musculocutaneous

3. The sensory branch of the radius

4. The posterior interosseous

5. The recurrent branch of the radial nerve

 

1838-[ ] A patient is noted to have weakness of wrist and finger extension together with pain on resisted supination and finger extension, most likely has a:

1. Guyon tunnel syndrome

2. Radial tunnel syndrome

3. Carpal tunnel syndrome

4. Anterior interosseous syndrome

5. Supratrochlear syndrome

 

1839-[ ] Median nerve compression in the forearm may result from:

1. Compression in the region of the ligament of struthers

2. Compression at the transverse carpal ligament

3. Compression in the region of the pisohamate ligament

4. Compression in the region of the supinator

5. Compression in the cubital tunnel

 

1840-[ ] Following injuries of the elbow which motion is most likely to be limited at the completion of treatment:

 

1. Flexion

2. Supination

3. Extension

4. Pronation

5. Abduction

 

1841-[ ] The primary stabilizers of the elbow are:

 

1. The medial and lateral collateral ligaments

2. The transverse ligament

3. The posterior bundle ligaments

4. The anterior bundle ligaments

5. The interosseous ligament

 

1842-[ ] The primary valgus stabilizer of the elbow is the:

 

1. Posterior bundle of the MCL

2. Transverse bundle of the MCL

3. Anterior bundle of the MCL

4. Interosseous bundle of the MC

5. Ulnar bundle of the MCL

 

1843-[ ] All the following are components of the lateral collateral ligament complex of the elbow except:

 

1. Radial collateral ligament

2. Lateral ulnar collateral ligament

3. Transverse collateral ligament

4. Annular ligament

5. Accessory lateral collateral ligament

 

1844-[ ] The most important ligament in the lateral collateral liament of the elbow, would be:

 

1. Articular capsule

2. Lateral radial collateral ligament

3. Annular ligament

4. Accessory lateral collateral ligament

5. Lateral ulnar collateral ligament

 

1845-[ ] Posterolateral instability of the elbow results from injury of which of the following ligaments:

1. Articular capsule

2. Lateral radial collateral ligament

3. Annular ligament

4. Accessory lateral collateral ligament

5. Lateral ulnar collateral ligament

 

1846-[ ] All the following are secondary stabilizers of the elbow except:

 

1. Radial head

2. Joint capsule

3. Coronoid process

4. Extensor muscle origin

5. Flexor muscle origin

 

1847-[ ] The most common dislocation about the elbow is:

1. Anterior

2. Medial

3. Lateral

4. Posterolateral

5. Posterior

1848-[ ] In Baseball pitchers which of the following ligaments are at maximum strain:

 

1. The medial collateral ligament

2. The lateral collateral ligament

3. The lateral accessory ligament

4. The radio-ulnar interosseous ligament

5. The annular ligament

 

1849-[ ] Which of the following structures is used as a substitute for medio-lateral ligament insufficiency of the elbow and is used as a graft:

 

1. Tensor fascia late

2. Palmaris longus

3. Plantaris

4. Extensor carpi radialis longus tendon

5. Extensor carpi radialis brevis tendon

 

1850-[ ] Pitching at a very young age could result in:

 

1. Preisers disease

2. Kienbocks disease

3. Panners disease

4. Mauclaire’s disease

5. Frieberg’s disease

 

1851-[ ] Which of the following types of osteogenesis imperfecta is associated particularly with coxa vara:

 

1. Type I

2. Type III

3. Type IV

4. Type VII

5. Type VI

 

1852-[ ] Which of the following types of osteogenesis imperfects is associated particularly with a blue sclera:

 

1. Type I

2. Type III

3. Type VI

4. Type IV

5. Type VII

 

1853-[ ] Which type of Osteogenesis Imperfecta is characterized by in utero fractures and is often lethal at birth:

 

1. Type I

2. Type II

3. Type III

4. Type IV

5. Type V

 

1854-[ ] Which type of collagen is deficient in Osteogenesis Imperfecta:

 

1. Type I

2. Type II

3. Type III

4. Type IV

5. Type V…Collagen

 

1855-[ ] Surgical treatment of ruptures of the Achilles tendon has been shown to provide:

 

1. Minimal complications

2. Better functional results than when treated nonsurgically

3. Earlier return to work and slightly stronger plantar flexion strength than when treated nonsurgically

4. Should not be considered in athletes due to risks of infection

5. Biologic adjuncts, such as PRP and bone marrow–derived stem cells, currently have a proven role in the surgical management of Achilles tendon ruptures.

 

1856-[ ] Nonsurgical functional rehabilitation in Achilles tendon ruptures offers:-

 

1. Rerupture rates and outcomes similar to those of surgical management while avoiding postoperative complications

2. Has a minimal rerupture rate when compared to surgical management

3. Is totally not indicated in the management of Achilles tendon ruptures

4. Is indicated particularly in older and nonathlete patients

5. Would be beneficial if combined with PRP infiltrations around the tendon

 

1857-[ ] All the following are mechanisms that provide joint stability in the knee, except

1. Passive mechanisms that control the location of the joint contact force by the geometry of the articular surfaces

2. The constraining forces generated by the stretching of ligaments that span the joint

3. The compressive forces generated across the joint by the action of the muscles

4. The degree of femoral anteversion

 

1858-[ ] The MSIS definition of infection is:

 

1. Is when a sinus tract exists that communicates with the prosthesis

2. A pathogen is isolated by culture from at least five separate tissue or fluid samples obtained from the affected prosthetic joint

3. An elevated serum erythrocyte sedimentation rate (ESR) even though the CRP is not elevated

4. A negative leucocyte esterase test strip

5. Greater than three neutrophils per high-power field in five highpower fields 1859-[ ] The staph aureus biofilms act or behave in the following way:

1. S aureus biofilms interfere with microbicidal immune responses, in part, are not done by polarizing macrophages toward an anti-inflammatory, profibrotic phenotype

2. While gene-expression profiles in S aureus biofilms are transiently but globally repressed following macrophage exposure

3. While gene-expression profiles in S aureus biofilms are transiently but globally repressed following macrophage exposure

4. Secreted proteins enriched during S aureus biofilm growth, including a-toxin and LukAB, are capable of inducing macrophage dysfunction

5. Further investigation into the role of biofilm molecules that are actively secreted or released following bacterial lysis that promotes MDSC recruitment/activity will shed light on critical biofilm processes that contribute to the establishment of chronic PJIs.

    

   1860-[ ] A method used to redirect the biofilm formation would be by the:-

    

   1. Revision procedure to a less friendly biofilm prosthesis

   2. The depletion of myeloid derived suppressor cells and skewing macrophages toward a proinflammatory state lead to significant reductions in staphylococcal biofilm burdens, suggesting that redirecting the anti-inflammatory biofilm milieu may prove beneficial for the PJI treatment in combination with conventional antibiotic therapy

   3. Staphylococcus aureus decolonization protocols have not been proven to be cost-effective

   4. Prevention of the emergence of resistant bacteria, particularly methicillin-resistant Staphylococcus (S epidermidis and S aureus), is a major challenge to the success of preventing and treating patients with a PJI

   5. Both the depletion of myeloid derived suppressor cells and skewing macrophages toward a proinflammatory state lead to significant reductions in staphylococcal biofilm burdens, suggesting that redirecting the anti-inflammatory biofilm milieu may prove beneficial for the PJI treatment in combination with conventional antibiotic therapy

       

      1861-[ ] The ulnar tunnel syndrome is distinguished from a cubital tunnel syndrome by:

       

      1. absence of any deformity around the tunnel

      2. Sparing the sensation of the dorsum and palmar aspect of the hand

      3. Lack of compression in guyons tunnel

      4. Lack of compression within the cubital tunnel

      5. In the cubital tunnel an element of stretching of the nerve exists that is not present in the ulnar tunnel

          

         1862-[ ] Patients with radial tunnel syndrome have no paresthesias in the dorsoradial hand but one should include other diagnostic problems in the differential diagnosis of this situation. These include all except:

          

         1. lateral epicondylosis

         2. an extensor carpi radialis brevis tear

         3. osteoarthritis and/or synovitis of the radiocapitellar joint

         4. posterior plica impingement. In contrast to carpal tunnel and cubital tunnel syndromes, the pathophysiology of RTS is less straightforward

         5. pronator teres syndrome

 

1863-[ ] Which of the following nerves has no nerve supply proximal to the elbow

 

1. radial nerve

2. median nerve

3. ulnar nerve

4. musculocutaneous nerve

5. axillary nerve

    

   1864-[ ] Other sites of entrapment of the median nerve around the elbow (besides the pronator teres syndrome) includes all except:

    

   1. Entrapment at the lacertus fibrosus

   2. Entrapment at the the FDS aponeurotic arch

   3. Entrapment at the aberrant radial artery; the variant muscles

   4. Entrapment between both heads of the flexor carpi ulnaris

   5. Entrapment at the ligament of Struthers, which is an anomalous extension from the supracondylar process of the humerus to the medial epicondyle

       

      1865-[ ] The predominant organism to be found in nontuberculous infections of the spine, would be:

       

      1. Brucella melitensis

      2. Staphyllococcus Aureus

      3. Proteus mirabilis

      4. Ecoli

      5. Pseudomonous

          

         1866-[ ] The indications for the surgical management of a patient diagnosed to have a nontuberculous infection of the spine, would be all the following, EXCEPT:

          

         1. Neurologic deficit from spinal cord injury or progressive root-level deficit

         2. Significant deformity, Instability, or bone destruction/pathologic fracture

         3. Medical comorbidities

         4. Persistent sepsis or abcess formation

         5. Inability to identify the offending pathogen by closed methods

             

            1867-[ ] The Imaging modality best used for the diagnosis of infections of the spine, would be:

            1. CT scan

            2. Technetium bone scan

            3. PET scan

            4. MRI

 

1868-[ ] Spinal infections are often treated by chemotherapy, in the absence of neurologic deficit, spinal deformity and instability.Which of the following would tell you that you should intervene surgically:

 

1. Delayed diagnosis

2. Follow up x-rays reveals a progressive positive sagittal balance

3. Lesions appearing elsewhere in the spine

4. Extension of the lesion in the posterior arch

5. All of the above

    

   1869-[ ] Computed Tomography is more accurate than MRI in which of the following:

   1. Demonstrates better a paraspinal soft-tissue masses

   2. Details better a vertebral destruction and collapse

   3. Localizes better an epidural abscess

   4. Has better spatial resolution, multiplanar capabilities and tissue contrast than a MRI

   5. Is less helpful in planning the surgical approach & technique than a MRI

       

      1870-[ ] The Best radio-imaging to distinguish between Spinal infection and degenerative disc disease would be:

       

      1. Technitum bone scan

      2. PET Scans

      3. CT scans

      4. MRI

      5. Plain radiography

          

         Chance Fracture

          

         1871-[ ] The axis of rotation of a Chance fracture is:

          

         1. Along the posterior margin of the spinous processes in the involved area

         2. Along the pars Interarticularis

         3. In front of the involved vertebral body

         4. In the middle column

         5. In the anterior column

             

            1872-[ ] In Children, the axis of rotation in a Chance fracture is:

             

            1. At T12

            2. L1

            3. L2

            4. L3

            5. L4

               Hangman’s Fracture

                

               1873-[ ] A significant reason why one could miss a traumatic spondylolisthesis on a plain lateral x-ray view, would be:

               1. The fracture does not pass through the pars

               2. The injury is through the disc which is not apparent on plain xrays

               3. The fracture through the pars interarticularis is not at the same level on both sides

               4. The pars fracture is at C3 rather than C2

               5. Dislocation of the facets would obstruct the radiologic appearance of a pars fracture

                   

                  1874-[ ] In a type IIa according to the Effendi Classification, is characterized by an:

                  1. Intact anterior longitudinal ligament (ALL), rupture disc, torn Posterior Longitudinal ligament (PLL) and significant angulation

                  2. Intact PLL, torn ALL, ruptured disc and no angulation

                  3. Intact PLL, intact ALL, ruptured disc and no angulation

                  4. Torn ALL & PLL, ruptured disc with a rotational element

                  5. Bilateral facet dislocation, ruptured ALL, PLL, and disc

 

1875-[ ] Which of the following contributes most significantly to the normal sagittal alignment of the lumbar region?

1. Posterior wedging of the intervertebral discs

2. Posterior wedging of the vertebral body

3. Posterior inclination of the pedicles

4. Posterior inclination of the pedicles

5. Constriction of the posterior longitudinal ligaments

    

   1876-[ ] The sacroiliac joint is a:

   1. Fibrinous joint

   2. Syndesmosis

   3. Synovial joint

   4. Synchondrosis

   5. Pivot joint

       

      1877-[ ] During anterior surgery in the lumbosacral region, which of the following structures at most risk for injury?

      1. External iliac artery

      2. Internal iliac artery

      3. Superior hypogastric plexus

      4. Sciatic nerveve

      5. Obturator nerve

1878-[ ] Injury of which of the following structures result in retrograde ejaculation:

 

1. Superior gluteal nerve

2. Pudendal nerve

3. The sympathetic plexus

4. The superior hypogastric plexus

5. Obturator nerve

 

1879-[ ] At what level is the bifurcation of the aorta located:

1. L2-3

2. L3-4

3. L4-5

4. L5-S1

5. Sacral promontory

 

1880-[ ] What is responsible for the normal kyphosis of the thoracic spine:

1. Wedging of the disc anteriorly

2. Wedging of the vertebral body anteriorly

3. Excessive tightness of the anterior longitudinal ligament

4. Narrowing of the intervertebral foramen

5. Enlargement of the pedicles posteriorly

 

1881-[ ] At what level is the pedicle diameter least in the thoracic spine?

1. T4-T6

2. T1-2

3. T3

4. T7-9

5. T10-12

 

1882-[ ] The pedicle wall in the thoracic spine is thickest in which of the following regions?

1. Superior

2. Medial

3. Inferior

4. Lateral

5. Inferolateral aspect

1883-[ ] At what age does the conus equinus reach the level of the lower end of L1 vertebra?

1. 5 years

2. 6 years

3. 8 years

4. 9 years

5. 10 years

 

1884-[ ] In patients older than 21 years presenting with a lesion in the vertebral body is most likely a:

1. Benign lesion

2. Malignant lesion

3. Infection

4. Myelomatous lesion

5. Lymphomatous lesion

 

1885-[ ] The Martin-Gruber anastomosis is a connection between the:

1. Median and radial nerve just distal to the elbow joint

2. Median and radial nerve just proximal to the wrist joint over the water shed area of the radius

3. Median and ulnar nerve 3-10cms distal to the medial epicondyle

4. Radial and ulnar artery anastomosis

5. Ulnar and radial nerve anastomosis in the anatomical snuff box

 

1886-[ ] The Guyon’s canal lies between which of the following bones?

1. Pisiform and lunate

2. Pisiform and hamate

3. Scaphoid and lunate

4. Scaphoid and trapezium

5. Capitate and scaphoid

 

1887-[ ] Which of the following malignant soft tissue tumors can be quiescent for years and than become aggressive:

1. Alveolar sarcoma

2. Rhabdomyosarcoma

3. Synovial cell sarcoma

4. Epithelioid sarcoma

5. Malignant melanoma

1888-[ ] Which of the following sarcomas spreads least to lymph nodes?

 

1. Alveolar sarcoma

2. Rhabdomyosarcoma

3. Synovial cell sarcoma

4. Chondrosarcoma

5. Epithelioid sarcoma

 

1889-[ ] A soft tissue mass that can be considered a malignancy until proven otherwise would be:

 

1. A doughy and superficial mass

2. Any mass >5 cm that is firm and deep

3. A mass with fluid within the lesion

4. A mass that initially develops after trauma

5. A mass that increases in size on proximal compression

 

1890-[ ] Lactate dehydrogenase levels can be elevated most in the setting of which of the following sarcomas

1. Alveolar sarcoma

2. Rhabdomyosarcoma

3. Synovial cell sarcoma

4. Small round blue cell tumors

5. Epithelioid sarcoma

 

1891-[ ] Which of the following is considered the imaging modality of choice for localization, characterization, and staging of soft-tissue tumors:

1. Radiography

2. Ultrasonography (US)

3. CT

4. MRI

5. Positron-emission tomography with CT (PET-CT)

 

1892-[ ] Which of the following substances when used with MRI helps distinguish between cystic and none cystic masses:

1. Technitium

2. Molibdinum

3. Gadolinium

4. Yttrium

5. F-18 fluorodeoxyglucose

1893-[ ] PET-CT is useful in the evaluation of soft tissue sarcomas through:

 

1. Assessment of treatment response after systemic therapy or to identify recurrence in a previously radiated bed

2. Evaluates distant metastasis

3. Distinguishes well between edema and marginal tumor growth

4. Demonstrates well the skip lesions within the medullary cavity

5. Its ability to demonstrate calcification within the lesion

 

1894-[ ] The Bearnese periacetabular osteotomy in the early phases of surgical experience was associated least with:

1. Ischial fractures

2. Recurrent dislocations of the hip

3. Pubic nonunions

4. Heterotopic ossification (two with type I, two with type II, and one with type III)

5. Peroneal neuralgia

 

1895-[ ] Which of the following ligaments functions most as the major stabilizer ,of the sternoclavicular joint:

1. The posterior sternoclavicular ligament and the costoclavicular ligament

2. The anterior sternoclavicular ligament

3. The costoclavicular ligament

4. The interclavicular ligament

5. The intra-articular discoligamentous complex

 

1896-[ ] The most common nerve injury following a nondisplaced supracondylar fracture of the elbow would be:

1. Radial nerve

2. Median nerve

3. Posterior interosseous nerve

4. Anterior interosseous nerve

5. Ulnar nerve….injury

 

1897-[ ] The Duncan Ely test is used to distinguish between:

1. Flexion contractures secondary to iliopsoas contraction and quadriceps shortening

2. Various types of flexion contractures of the knee

3. Structural and non-structural scoliosis

4. Various stages of subluxation of the hip

5. Ankylosing spondylitis and osteitis condensens ilii

 

1898-[ ] A Test used to distinguish between a fixed varus deformity and a mobile varus deformity of the subtalar joint, would be:

1. Ortoloni test

2. Colman block test

3. Anterior drawer test

4. Beaver test

5. Extra toe test

 

1900-[ ] On examination of a patient diagnosed to have plantar fasciitis, the maximum site of tenderness would be localized to:

1. The insertion of the Achilles tendon

2. The lateral aspect of the origin of the plantar fascii

3. The insertion of the five strands of plantar fascii

4. Plantar medial heel pain

5. The mid tarsal joint

 

1901-[ ] Which of the following structures elevates the longitudinal arch most during gait:

1. Peroneus brevis

2. Plantar fascia

3. Extensor digitorum brevis

4. Spring ligament

5. Bifurcate ligament

 

1902-[ ] A primary gastrocnemius muscle contracture is demonstrated best by which of the following tests:

1. The Silfverskiöld test

2. The Thomas test

3. Colemans test

4. Duncan Ely test

5. Ganslens test

 

1903-[ ] Calcaneal spurs are localized within which of the following muscles:

1. Flexor digitorum sublimis

2. Flexor digitorum brevis

3. Tibialsis posterior

4. Flexor Hallucis longus

5. Abductor halluces

 

1904-[ ] Patients with plantar fasciitis, an MRI would show most commonly:

1. Edema of the origin of the plantar fascia

2. Thickening of the medial origin of the plantar fascia

3. Thickening the distal strands of the plantar fascia

4. Osteoporosis at the calcaneal origin of the plantar fascia

5. Swelling and clumping of the origin of the plantar fascia

 

1905-[ ] Baxter Nerve Entrapment is when the first branch of the lateral plantar nerve becomes compressed, under which of the following muscles:

1. Abductor Hallucis muscle

2. Quadratus plantae (QP) muscle

3. Flexor digitorum muscle

4. Abductor digiti minimi muscle

5. Peroneus tertius muscle

 

1906-[ ] Is idiopathic osteonecrosis of the hip in adults secondary only to high doses of corticosteroids alone or other additional factors are involved, as is?

1. Vitamin D deficiency

2. Fatty infiltration

3. Inflammatory conditions

4. Additional genetic factors are necessary for a patient to develop symptomatic disease

5. Vascular malformations

 

1907-[ ] In osteonecrosis of the hip, the motion that is most commonly lost is:

1. External rotation

2. Abduction

3. Adduction

4. Internal rotation

5. Circumduction

 

1908-[ ] A distinguishing factor between osteonecrosis and transient osteoporosis, would be:

1. Earlier collapse of the femoral head in transient osteoporosis

2. Marked limitation of all ranges of motion in transient osteoporosis

3. MRI demonstrates bone marrow edema extending into the femoral neck and metaphysis transient osteoporosis

4. The amount of pain is more in transient osteoporosis

5. Transient osteoporosis when it occurs in males, occurs at an age between 30 and 40 years while osteonecrosis is common to occur in the mid sixties

 

1909-[ ] Results of Core decompression of an osteonecrotic hip in several studies was:

1. Very effective in the surgical management of early stages of osteonecrosis

2. No difference was noted between untreated hips and hips undergoing core decompression

3. Was effective when the collapse was large and the core was made directly in the defect

4. Was ineffective when done prior to any collapse of the hip

5. Effective especially in all stages preventing Total Hip Replacement

 

1910-[ ] Which of the following is not a major risk factor in the production of osteonecrosis of the hip:

1. corticosteroid use

2. excessive alcohol intake

3. vitamin D deficiency

4. trauma

5. coagulation abnormalities

 

1911-[ ] Which of the following is not a static stabilizer of the shoulder joint:

1. The labrum

2. Glenohumeral ligaments

3. The rotator cuff and the deltoid muscle

4. Rotator cuff interval

5. Glenohumeral articulation

 

1912-[ ] In an acute anterior shoulder dislocation, which of the following structures is most important to evaluate for function, in a young adult:

1. Rotator cuff interval

2. Axillary nerve function

3. Vascular patency

4. Suprascapular nerve function

5. Subscapularis function

 

1913-[ ] Which of the following radiologic views evaluates best the Hill-Sach’s-lesion:

1. A true anteroposterior view

2. A scapular Y-view

3. An axillary view

4. A Stryker notch view

5. A West Point axillary view

 

1914-[ ] The transfer of the coracoid process on the side to fill in a defect following recurrent anterior dislocation of the shoulder, is known as the:

1. The Bristow procedure

2. The Trillat procedure

3. The Latarjet procedure

4. The Bankart procedure

5. The Putti-Platt procedure

 

1915-[ ] A tenodesis of the infraspinatus into a Hill-Sacks defect in the humeral head is known as a:

1. A remplissage procedure

2. A Bankart procedure

3. A Bristow procedure

4. A Trillat procedure

5. A Latarjet procedure

 

1916-[ ] Throughout the literature, open reduction and locking plate osteosynthesis in 3-part and 4-part fractures of the humeral head, in osteoporotic patients, has been least associated with:

1. Humeral head ischemia

2. Residual varus displacement

3. Quick recovery and early motion, especially in osteoporotic patients

4. Insufficient restoration of the medial column

5. Nonanatomic reduction that promotes failure of fixation and impaired functional outcome

 

1917-[ ] Vascular injuries are more likely to occur after severe displacement and fracture-dislocation of the proximal humerus. These can be best assessed by which of the following investigations:

1. Doppler ultrasound examination

2. Digital subtraction angiography

3. CT angiography

4. MRI angiography

5. Arteriogram

1918-[ ] Which of the following primary sites of a malignant lesion metastasizes most to the spine:

1. Prostate

2. Breast adenocarcinoma

3. Lung adenocarcinoma

4. Renal cell carcinoma

5. Gastric carcinoma

 

1919-[ ] Ossification (capping) of the iliac apophysis informs us of the termination of growth in females, at what stage?

1. Stage I

2. Stage II

3. Stage III

4. Stage IV

5. Stage V

 

1920-[ ] Curves that correct completely when the patient bends toward the convexity of the curve are termed:

1. Nonstructural

2. Fractional

3. Structural

4. Full

5. Minor………curves

 

1921-[ ] The vertebra bisected by the center sacral line (a vertical line extending cephalad from the center of the sacrum and through the S1 spinous process) is known as the:

1. Neutral vertebra

2. End vertebra

3. Stable vertebra

4. Apical vertebra

5. Junctional vertebra

1922-[ ] Which of the following is not a risk factor for curve progression in skeletally immature patients with idiopathic scoliosis?

1. Male sex

2. Risser stage

3. Tanner stage

4. Menarche

5. Peak height velocity

1923-[ ] Diabetes with an elevated blood sugar greater than 150 mL/dL will decrease scan sensitivity in which of the following:

1. Technitium

2. Indium

3. Gallium

4. PET

5. SPECT…..scans

 

1924-[ ] Demonstration of a pseudoarthrosis following a spinal fusion would be best by:

1. MRI

2. CT scans

3. PET scans

4. SPECT scans

5. Gallium scans f.

1925-[ ] A phenomenon that occurs when the distribution of disease is so widespread and uniformly distributed that the technetium scan is incorrectly interpreted as negative is known as a:

1. Galium scan

2. Indium scan

3. Superscan

4. PET scan

5. SPECT scan

1926-[ ] The most common primary malignant spinal tumor in adults between 50-60 years, would be:

 

1. Osteosarcoma

2. Chordoma

3. Chondrosarcoma

4. Myeloma

5. Leukemia

 

1927-[ ] An explanation why Chordomas are central in location, would be:

 

1. It is of notochordal origin

2. Always involves the vertebral body

3. It is a rapidly growing tumor and being that the body is consistent of loose cancellous bone, would make it easy to grow there

4. Being that it’s a malignant lesion, all such lesions are found in the anterior aspect of the

   spine

5. The cell of origin arises from colon like mucosal cells located most in this area 1928-[ ] Chordomas are managed best by:

1. Chemotherapy

2. Radiation therapy

3. proton-photon beam radiation

4. wide surgical resection

5. Intralesional currettement

 

1929-[ ] What is the most common cervical spine injury in children?

 

1. Jefferson’s fracture

2. Hangman’s fracture

3. Fractures of the odontoid

4. C2-3 subluxation to dislocation

5. Avulsion of the C7 spinous process

 

1930-[ ] At what spinal level do thoracic disc herniations most commonly occur?

 

1. Thoracic one and two

2. Thoracic 3-4

3. Thoracic 11-12

4. Thoracic ten

5. Thoracic 7&8

 

1931-[ ] A significant difference between ankylosing spondylitis and Forestiers disease (DISH) would be:

 

1. Forestiers disease (DISH) does not involve the disc or sacroiliac joint

2. DISH does not have calcification of the anterior longitudinal ligament

3. HLA B 27 is always elevated in DISH

4. DISH usually involves the whole spine

5. Dish is always with the patient having uveitis

 

QUESTIONS ON TOTAL HIP ARTHROPLASTY

 

1932-[ ] The stem, where bone ongrowth occurs on the stem of a prosthesis would be:

 

1. Titanium

2. Chromium cobalt alloy

3. Proximally porous coated stainless steel stems

4. Grit blasted coated stems

5. Totally porous coated stems

 

1933-[ ] Proximally coated stems were designed to:

 

1. Allow better fixation of the stem

2. Due to concerns of thigh pain & osteolysis

3. Permit early weight bearing in elderly patients

4. To be primarily indicated for proximal defects in revision hips

5. Allow better distal stem fixation in primary hip replacement

 

1934-[ ] In irradiated hips, requiring a Total Hip Arthroplasty, the best stem fixation, would be, with the use of a:

 

1. Cemented stem

2. Grit blasted stem

3. Proximally porous coated stem

4. Distally porous coated stem

5. Hydroxyapatite coated stem

 

1935-[ ] Which of the following is not included in the third generation phase of cementation, of the stem, in a total hip arthroplasty:

 

1. vacuum-mixing to reduce cement porosity

2. cement pressurization

3. no cement restrictor

4. femoral canal preparation

5. pulsatile lavage

 

1936-[ ] A flexible cemented stem is most likely associated with which of the following:

 

1. Better bone ingrowth

2. Creates excessive stress on the cement mantle

3. Better transfer of loads from sacrum to the hips

4. Longer durability than stiff implants

5. better bone ongrowth

 

1937-[ ] On using a cemented stem, what should be the optimal thickness of the cement mantle throughout be:

 

1. 2-3mm

2. 4mm

3. 5mm

4. 6mm

5. 7mm

 

1938-[ ] Which of the following, is most likely to result in fibrous ingrowth in a porous coated stem:

 

1. pore size 50-300um

2. porosity of 40-50%

3. maximal contact of the stem with cortical bone

4. micromotion < 150um

5. malposition of the stem

 

1939-[ ] The unique articulation at C1-C2 is well-suited for allowing what motion?

 

1. shrugging the shoulders

2. nodding the head (flexion/extension)

3. turning the head from side to side (axial rotation)

4. lateral bending

5. belching (eructation)

 

1940-[ ] What is the major component of the nucleus pulposus in a teenager?

 

1. collagen

2. mucopolysaccharides

3. water

4. proteoglycans

5. Ferrous sulfate

 

1941-[ ] A 53 yr. old man presents to the ED w/ severe back pain after a fall from his roof. The radiograph shown is his only injury.

The AP view demonstrates an ileus but is otherwise unremarkable. He is hemodynamically stable and neurologically normal.

You should recommend:

 

1. L1 laminectomy

2. Progressive mobilization as tolerated in a TLSO

3. Bedrest w/ Q 2 hrs. logrolling x 6 weeks then mobilization as tolerated

4. L1 corpectomy and ASF T12-L2 w/ cage and anterior plating

5. PSF T11-L3 w/ segmental instrumentation and iliac bone graft

 

1942-[ ] Flexion-distraction injuries of the thoracolumbar spine are most frequently associated with injury to what organ system?

 

1. Neurologic

2. Cardiac

3. Gastrointestinal

4. Vascular

5. Lymphatic

 

1943-[ ] A 41 yr-old man is admitted w/ a lumbar spine injury as seen. He has urinary retention, 3/5 weakness of his quadriceps and 2/5 weakness of his ankle motors. No improvement is seen after 24 hrs. Appropriate treatment would include:

 

 

 

 

 

1. posterolateral decompression and fusion w/ segmental instrumentation

2. placement in a spica cast

3. bilateral femoral traction at 70% body-weight

4. laminectomy

5. kyphoplasty

 

1944-[ ] In a retroperitoneal approach to the lumbar spine, what structure runs along the medial aspect of the psoas along the lateral border of the spine?

 

1. lioinguinal nerve

2. Genitofemoral nerve

3. Sympathetic trunk

4. Ureter

5. Aorta

 

1945-[ ] What region of the spine is most susceptible to changes in the vascular supply to the spinal cord during an anterior approach?

 

1. C7-T1

2. T1-T3

3. T4-T7

4. T8-T12

5. L1-L3

    

   1946-[ ] A 60-year-old woman with rheumatoid arthritis has atlanto-axial instability. What MRI findings would suggest the need for occipito-cervical fusion?

    

   1. Cervico-medullary angle of 125°

   2. Space available for the cord of 15 mm

   3. Cord diameter in flexion of 11 mm

   4. Fixed C3-4 subluxation of 2 mm

   5. Erosion of the tip of the odontoid

 

1947-[ ] A 60-year-old woman with rheumatoid arthritis presents with worsening neck pain. She is neurologically normal. Flexion/extension radiographs demonstrate motion of C1 on C2. In flexion she has an anterior ADI of 8 mm and a posterior ADI of 13 mm. You should recommend:

 

1. a program of cervical isometric strengthening

2. C1-C2 posterior fusion

3. transoral resection of the odontoid and C1-C2 fusion

4. bilateral C1-C2 facet blocks

5. Halo immobilization x 6 weeks then repeat radiography

 

1948-[ ] An otherwise healthy 70-year-old man has back and bilateral leg pain in an L5 distribution that is aggravated by standing more than 10 minutes or walking more than 1 block. He has to sit to get relief. Neurologic and pulse examinations are normal. A radiograph and MRI scan are shown. Treatment should consist of:

 

1. laminectomy.

2. bilateral hemilaminotomy.

3. laminectomy and posterolateral fusion.

4. anterior interbody fusion.

5. bilateral L4-5 discectomy

 

 

 

 

 

1949-[ ] -[ ] In the surgical treatment of thoracic disk herniations, which approach has the highest reported rate of neurologic complications:

1. Video-assisted thoracoscopic (VATS)

2. Posterior

3. Endoscopic

4. Transthoracic

5. Transpedicular

 

1950-[ ] A 30-year-old man relates a 3-day history of severe, incapacitating lower back pain with radiation into the right buttock. He reports some relief with rest. He denies any history of trauma, has no constitutional symptoms, and his neurologic examination is normal. What is the best course of action?

 

1. Facet injections

2. Local tender-point injection

3. MRI of the lumbar spine

4. Bed rest for 2 weeks with continued restrictions

5. Early return to activities as his symptoms allow

 

1951-[ ] A 39-year-old man reports low back pain, bilateral posterior thigh numbness, and difficulty with urination 1 day after hurting his back working in his yard. He is able to walk but is in pain. A straight leg raise results in increased back pain, and examination reveals that perianal sensation is decreased. Placement of a urinary catheter results in 500 mL of urine. What is the next most appropriate step in management?

 

1. Emergent MRI

2. Urology consultation

3. Pain control with narcotics

4. Pain control with a lumbar epidural steroid injection

5. Physical therapy

 

1952-[ ] What is the most common complication following total disk arthroplasty in the lumbar spine?

 

1. Implant loosening

2. Deep venous thrombosis

3. Transient retrograde ejaculation

4. Transient radicular leg pain

5. Adjacent segment instability

1953-[ ] If a 75 year-old man, with no prior history of back or leg pain, were to undergo an MRI of the lumbar spine, what is the chance that the study would demonstrate disc degeneration and/or bulging?

 

1. 10%

2. 25%

3. 40%

4. 66%

5. 90%

 

1954-[ ] If a laminectomy for spinal stenosis is performed, which of the following is most widely accepted as an indication for concomitant arthrodesis at that level?

 

1. Prior laminectomy at an adjacent level

2. Ten degrees of degenerative scoliosis

3. Removal of 25% of each facet joint at surgery

4. Degenerative spondylolisthesis at the level of the laminectomy

5. Foraminal stenosis at the level of the laminectomy

 

1955-[ ] A pedicle screw can be inserted in the cervical spine at which of the following levels:

1. C1& C3

2. C3&C4

3. C4&C5

4. C5&C^

5. C2&C7

 

1956-[ ] A long bone which does not lie along the long axis of the body would be:

1. Metatarsal

2. Metacarpal

3. Clavicle

4. Tibia

5. Femur

    

   1957-[ ] A long bone which does not have a medullary cavity in the human body would be:

   1. Metatarsal

   2. Metacarpal

   3. Clavicle

   4. Tibia

   5. Femur

       

      1958-[ ] The first bone to ossify during embryonic development would be:

       

      1. Metatarsal

      2. Metacarpal

      3. Clavicle

      4. Tibia

      5. Femur

 

1959-[ ] A 20 years old girl presents to your clinic with a lytic lesion located in the epiphyseal metaphyseal region of the distal femur, having had a biopsy that revealed a field of monocyte like and spindle cells. Interspersed among these cells are numerous giant cells. The most likely diagnosis would be a:

1. Chondrosarcoma

2. Giant cell tumor

3. Telangiectatic Osteosarcoma

4. Chondromyxoid Fibroma

5. Ewings Sarcoma

 

1960-[ ] A Chondroblastoma may be confused most, radiologically, with which of the following tumors:

1. Ewings Sarcoma

2. Osteosarcoma

3. Giant Cell tumor

4. Fibrous dysplasia

5. Periosteal chondroid tumor

 

1961-[ ] A Giant cell tumor of bone can co-exist with which of the following lesions:

1. Squamous cell carcinoma

2. Aneurysmal bone cyst

3. Unicameral bone cyst

4. Adamantinoma

5. Fibrous dysplasia

1962-[ ] Which of the following lesions is known to give the “Donut sign” on scintigraphy:

1. Ewings Sarcoma

2. Osteosarcoma

3. Giant Cell tumor

4. Fibrous dysplasia

5. Periosteal chondroid tumor

 

1963-[ ] Which of the following demonstrates best a talocalcaneal bar:

 

1. Scintigraphy

2. CT scan

3. Plain xray

4. Utrasound

5. Densitometry

 

1964-[ ] The “finger escape sign” is a test used most commonly in patients with:

1. Extensor digiti minimi tendonitis

2. Cervical myelopathy

3. Cervical cord injuries

4. Brachial plexus injuries

5. Thoracic outlet syndrome

 

1965-[ ] Which of the following primary tumors of the bony spine responds poorly to both radiation and chemotherapy:

1. Chordoma

2. Osteosarcoma

3. Ewings Sarcoma

4. Multiple Myeloma

5. Neuroblastoma

 

1966-[ ] The dural sac ends usually at:

 

1. Lumbar 1

2. Lumbar 2

3. Lumbar 2-3 disc

4. S2

5. Lumbar 3-4 disc…levels

1967-[ ] The outer portion of the annulus fibrosus is composed mostly of which type of Collagen?

1. Type I

2. Type II

3. Type III

4. Type IV

5. Type V

 

1968-[ ] A 20 year old male presents to the ER claiming to have sustained an vertical axial compression injury to the vertex of the head. An antero-posterior view of the upper cervical spine, reveals an overhang of the lateral masses of the atlas on the axis. Your diagnosis would be:

1. A Jeffersons fracture

2. A Hangmans fracture

3. A tear drop fracture

4. Fractures of both occipital condyles

5. A clay shovel fracture

 

1969-[ ] In the sketch below, what would be the proper name for this type of fracture:

 

 

 

 

1. Jeffersons fracture

2. Hangmans fracture

3. A tear drop fracture

4. Fractures of both occipital condyles

5. A clay shovel fracture

    

   1970-[ ] The most common fracture of the spine in children, would be:

   1. Fracture of the occipital condyles

   2. Hangmans fracture

   3. Jeffersons fracture

   4. Fracture of the odontoid process

   5. Clay shovel fracture

 

1971-[ ] A pediatrician refers a child to your clinic with an upper respiratory infection and neck pain associated with limitation of motion of the neck in all directions. A cervical CT scan, with reconstruction is shown in the diagram below. Your most likely diagnosis would be:

 

 

 

 

1. Fracture of the atlas

2. Atlantoaxial rotatory subluxation

3. Odontoid fracture

4. Discitis

5. Spondylitis

 

1972-[ ] A 7 year old boy presents to your clinic having lordosis, with a short trunk and Hamstring tightness. Your most likely diagnosis at first site, would be:

 

1. Scheuermanns disease

2. Failure of L3 vertebral body formation

3. Isthmic spondylolisthesis

4. A tethered cord

5. Lumbar scheuermanns disease

 

1973-[ ] The most common site for a unicameral bone cyst (solitary bone cyst) to occur, would be in:

1. Proximal humerus

2. Proximal femur

3. Calcaneum

4. Distal radius

5. Proximal tibia

 

1974-[ ] A primary malignant lesion of bone that is often confused with an aneurysmal bone cyst, would be:

 

1. Adamantinoma

2. Nonossifying fibrous dysplasia

3. Telangiectatic osteosarcoma

4. Solitary myeloma

5. Periosteal chondroma

 

1975-[ ] A malignant primary tumor of bone that is frequently the result of a translocation between chromosomes 11 and 22, would be:

 

1. Osteosarcoma

2. Osteochondroma

3. Ewings Sarcoma

4. Chondrosarcoma

5. Chondroblastoma

 

1976-[ ] The most common location for a simple ganglion to occur, would be:

 

1. The dorsal aspect of the wrist near the scapholunate (SL) joint

2. The volar wrist near the radioscaphoid joint

3. The pisotriquetral joint region

4. The volar retinaculum between the A1 and A2 pulleys

5. The dorsomedial aspect of the wrist in the region of the lunotriquetral joint

    

   1977-[ ] The main composition of the liquid within a ganglion, is:

   1. Hyaluronic acid

   2. Interleukens

   3. Prostaglandin E

   4. Tumor necrosis factor

   5. Citrovine factor

       

      1978-[ ] A 26-year-old man falls off a motorcycle and injures his left wrist. There are no open wounds and the neurovascular examination is normal. Radiographs are shown in Figure below. Definitive management should consist of:

       

       

       

       

      1. closed reduction and casting.

      2. external fixation and percutaneous pinning of the distal radius.

      3. open reduction and internal fixation of the distal radius with a locked plate.

      4. open reduction and internal fixation of the distal radius and open repair of the ulnar styloid.

      5. nonbridging external fixation of the distal radius

 

1979-[ ] A 32-year-old man has an open comminuted humeral shaft fracture. Examination reveals absence of sensation in the first web space and he is unable to fully extend the thumb, fingers, and wrist. What is the recommended treatment following irrigation and debridement of the fracture?

 

1. Functional bracing

2. Hanging long arm cast immobilization

3. Intramedullary nailing

4. Open reduction and internal fixation, radial nerve exploration

5. External bone fixator

 

1980-[ ] A 7-year-old boy is seen in the emergency department with an isolated and displaced supracondylar fracture of the humerus with absent radial and ulnar pulses. Despite a moderately painful attempt of reduction in the ER, examination reveals that his hand remains pulseless.

What is the next most appropriate step in management?

 

1. Order an urgent angiogram and then proceed to the OR.

2. Repeat the reduction in the emergency department and reassess.

3. Perform open reduction through an anterior approach.

4. Perform closed reduction and pinning in the OR and reassess the vascular status

5. Perform arterial repair and then stabilize the fracture 1981-[ ] The ossification center of the capitellum first appears at:

   1. 1 year

   2. 2 years

   3. 4 years

   4. 6 years

   5. 8 years

 

1982-[ ] The ossification center of the radial head first appears at:

 

1. 1 year

2. 2 years

3. 3 years

4. 5 years

5. 7 years

    

   1983-[ ] The ossification center of the medial epicondyle first appears at:

    

   1. 3 years

   2. 5 years

   3. 7 years

   4. 8 years

   5. 9 years

       

      1984-[ ] The ossification center of the trochlea first appears at:

       

      1. 3 years

      2. 5 years

      3. 7 years

      4. 8 years

      5. 9 years

 

1985-[ ] The ossification center of the olecranon first appears at:

 

1. 1 year

2. 3 years

3. 7 years

4. 8 years

5. 9 years

    

   1986-[ ] The number of compartments present in the foot is controversial. The most acceptable number of compartments would be:

   1. 3

   2. 5

   3. 7

   4. 9

   5. 12 compartments

       

      1987-[ ] On operating on a olecranon fracture, while using pinning and wiring to reduce the fragment, the k wire passed through the anterior and proximal cortex of the ulnar bone for a distance of 1 cm. Which of the following nerves would most likely be injured:

      1. Posterior interosseous nerve

      2. Ulnar nerve

      3. Median nerve

      4. Anterior interosseous nerve

      5. Radial nerve

 

1988-[ ] Which type of malunion is most common to occur, following a distal fracture of the shaft of the humerus, when treated conservatively:

1. Valgus

2. Varus

3. External rotation of the distal fragment

4. Internal rotation of the distal fragment

5. Shortening

   1989-[ ] Following anterior cervical spinal surgery, a patient is noted to have poor wound healing with suggestive signs of infection. In addition he was noted to have an anterior neck mass and significant dysphagia. Your most likely diagnosis would be:

   1. Improper disc removal

   2. Loosening of the anterior cervical plate

   3. Missed dural tear

   4. Condiderable post-operative instability

   5. Thoracic duct tear

       

      1990-[ ] The highest incidence of cervical degeneration would be at which of the following levels listed below:

      1. C5-6

      2. C3-4

      3. C2-3

      4. C1-2

      5. C7-T1

 

1991-[ ] All the following are predisposing factors to cervical disc degeneration, except:

 

1. excessive driving

2. smoking

3. lifting

4. swimming

5. professional athletes

 

1992-[ ] Which of the following is not included in the cervical disc degeneration cycle:

 

1. disc dessication, loss of disc height, disc bulging, and possible disc hernaition

2. uncinate spurring and facet arthrosis

3. segmental fusion of C6-7

4. ligamentum flavum thickening and infolding secodary to loss of disc height

5. kyphosis secondary to loss of disc height with resulting transfer of load to the facet and uncovertebral joints, leading to further uncinate spurring and facet arthrosis

1993-[ ] Central cervical stenosis is when the canal diameter is equal or less than:

 

1. 9mm

2. 11mm

3. 13mm

4. 14mm

5. 15mm

 

1994-[ ] MRI axial imaging is the modality of choice and gives needed information on the status of the soft tissues. It may show all of the following statements with the exception of:

 

1. disc degeneration

2. spinal cord changes (myelomalacia)

3. preoperative planning

4. has high rate of false positive (28% greater than 40 will have findings of HNP or foraminal stenosis)

5. always localizes the symptomatic region of the cervical spine

    

   1995-[ ] A significant risk arising, following a discography in the cervical spine, would be:

    

   1. Esophageal puncture and disc infection

   2. Wrong level information

   3. Adjacent disc degeneration

   4. Vascular injuries

   5. Wrong indication for surgery

      1996-[ ] Forward subluxation (intersegmental instability) of vertebral body in the lumbar spine is allowed by all except:

      1. facet joint degeneration

      2. facet joint sagittal orientation

      3. intervertebral disc degeneration

      4. insufficiency fractures through the facets

      5. ligamentous laxity (possibly from hormonal changes)

         1997-[ ] A degenerative slip at L4/5 will affect which of the following nerve roots as it is compressed in the foramen:

         1. L2

         2. L3

         3. L4

         4. L5

         5. S1

            1998-[ ] Weakness to quadriceps best seen with sit to stand exam maneuver, weakness to ankle dorsiflexion, best seen with heel-walk exam maneuver, decreased patellar reflex are all the result of which of the following nerves when compressed:

            1. L2

            2. L3

            3. L4

            4. L5

            5. S1

1999-[ ] Weakness to ankle dorsiflexion, best seen with heel-walk exam maneuver, weakness to EHL (great toe extension), weakness to gluteus medius function is best seen secondary to compression of which of the following nerves:

1. L2

2. L3

3. L4

4. L5

5. L6

   2000-[ ] Neurologic complications resulting from surgery on the lumbar spine while in the prone position, would be:

   1. Pneumonia

   2. Esophageal injuries

   3. Palsy of the lateral femoral cutaneous and ulnar nerve

   4. Massive bleeding

   5. Retrograde ejaculation

      2001-[ ] Which of the following arteries located in the cervical region, when compressed causes a cervical myelopathy:

      1. Vertebral artery

      2. Anterior cervical artery

      3. Posterior cervical artery

      4. Basilar artery

      5. Subclavian artery

2002-[ ] Which of the following does not apply to the Nurrich classification on cervical myelopathy:

1. Grade 0 Root symptoms only or normal

2. Grade 1 Signs of cord compression; unstable and clumsy gait

3. Grade 2 Gait difficulties but fully employed

4. Grade 3 Gait difficulties prevent employment, walks unassisted

5. Grade 4 Unable to walk without assistance

2003-[ ] On comparing patellar tendon (bone-tendon-bone [BTB]) autograft, quadrupled hamstring tendon autograft, and double-bundle reconstruction using hamstring autograft revealed:

1. There was no significant difference in patient-reported quality-of-life (Anterior Cruciate Ligament-Quality of Life [ACL-QOL]) score at 5 years between any of the reconstruction groups

2. There was a significant difference in patient-reported quality-of-life (Anterior Cruciate Ligament-Quality of Life [ACL-QOL]) score at 5 years between any of the reconstruction groups

3. Revealed a significant difference in patient-reported quality-of-life (Anterior Cruciate Ligament-Quality of Life [ACL-QOL]) score at 5 years between BTBG autograft and Double Hamsting bundle autograft any of the reconstruction groups

4. Revealed a significant improvement of quadrupled 4 bundle autograft over all other techniques

5. All depended on the technique and experience of the surgeon

 

2004-[ ] The rupture rate (reinjuries) on comparing the BTBG (autograft) to both the hamstring tendon group was:

1. The same

2. Higher

3. Less

4. No difference

5. The same with quadruple bundle autograft but less than the double bundled autograft group

 

2005-[ ] Which of the following ACL substituting techniques is associated with more knee pain:-

1. Quadruple strand Hamstring autograft

2. Double strand Hamstring autograft

3. BTBG (autograft)

4. No difference between either

2006-[ ] A meta-analysis of previously performed RCTs (randomized control study) was performed to assess whether early ACL reconstruction leads to more complications in early surgery compared with delayed surgery revealed:-

1. More Motion loss in Early surgery

2. Arthrofibrosis is significantly higher in early surgery

3. Risk of retear in early surgery

4. Instrumented laxity in early surgery

5. No significant difference

 

2007-[ ] Spinal TB affects which region of the vertebra most:

1. Vertebral body

2. Laminae

3. Spinous process

4. Pedicle

5. Facet joints

 

2008-[ ] The incidence of skip lesions in Mycobacterium Tuberculosis of the spine would be:

1. 2%

2. 7%

3. 15%

4. 20%

5. 35%

 

2009-[ ] In which condition does this cell shown in the figure below exist in a microscopic field:

 

 

 

1. Candida Albicans

2. Blastomycosis

3. Actinomycosis

4. Tuberculosis

5. All of the above

 

2010-[ ] Which of the following tests would provide the best and earliest diagnosis of tuberculosis of the spine:

1. Blood culture

2. Mantoux test

3. Acid fast stain

4. Molecular test

5. None of the above

 

2011-[ ] Which of the following tests can differentiate between living and dead organisms and can be a predictor of the activity of the disease:-

1. Blood culture

2. Mantoux test

3. Acid fast stain

4. Molecular test

5. None of the above

2012-[ ] Which of the following tests are based on the nucleic acid amplification of the M. tuberculosis bacilli using polymerase chain reaction (PCR) followed by its detection using certain markers in its genetic material-

1. The cartridge-based nucleic acid amplification test (CBNAAT)

2. Blood culture

3. Mantoux test

4. Acid fast stain

5. None of the above

 

2013-[ ] Which of the following tests is based on reverse hybridization of DNA to identify members of M. tuberculosis and simultaneously to identify strains with resistance to both rifampicin and isoniazid by detecting the most common single nucleotide polymorphism after DNA extraction and PCR amplification

1. The cartridge-based nucleic acid amplification test (CBNAAT)

2. Blood culture

3. LPA

4. Mantoux test

5. Acid fast stain

 

2014-[ ] A test that detects first-line drug resistance, especially in smear-positive specimens in Tuberculosis, would be:

1. The cartridge-based nucleic acid amplification test (CBNAAT)

2. Blood culture

3. LPA

4. Mantoux test

5. Acid fast stain

 

2015-[ ] Which of the following Disc disease in a forty year old male is resorbed first:

1. Protruded disc

2. Central disc protrusion

3. Sequestrated disc

4. Foraminal disc

5. Extraforaminal disc

 

2016-[ ] The most likely cause of back pain following a extruded disc would be from:

1. Pressure on the nerve

2. Irritation of the nociceptive sinuvertebral nerve fibers

3. Narrowing of the spinal canal

4. Inflammatory response in response to the rupture disc

5. None of the above

 

2017-[ ] What is the minimal acceptable shortening of a tibial fracture in a toddler:

1. 1cm

2. 1.5cms

3. 2cms

4. 2.5cms

5. 3cms

 

2018-[ ] A fracture in a child involving both the tibia and fibula would most likely result in what type of deformity:

1. Varus

2. Valgus

3. Anterior angulation

4. Posterior angulation

5. Rotation

2019-[ ] Which muscles are most likely to be the cause of the deformity in question 17 ie following a fracture of the midshaft of the tibia and fibula:

1. The anterior and lateral compartments of the lower leg

2. The upper lateral compartment muscles

3. The posterior compartment muscles

4. The deep compartment muscles of the leg

5. The pull of the tibialis posterior, flexor digitorum and halluces longus muscles

 

2020-[ ] In younger children, diaphyseal tibia fractures typically occur as a result of:

1. Torsional forces

2. Abduction directed forces

3. Adduction directed forces

4. Forced extension forces

5. Forced flexion forces

 

2021-[ ] All the following are indications for surgical treatment of tibial fractures in children Except:

1. Open fractures

2. Fractures in the context of poly trauma

3. Floating knee

4. Transverse fractures of the shaft with rotational deformity

5. Vascular injury

 

2022-[ ] The fracture line in a tibial shaft fracture will typically start in:-

1. The distal anteromedial aspect of the bone and propagate proximally in a posterolateral direction

2. The distal anterolateral aspect of the bone and propagate proximally in a posteromedial direction

3. The distal anterior aspect of the bone and propagate proximally in a posterior direction

4. The distal posterior aspect of the bone and propagate proximally in a posterolateral direction

 

2023-[ ] If you reduce a tibial fracture closed in a toddler (8 years old), an acceptable reduction would be:-

1. Less than 10 degrees of varus or valgus angulation, less than 15 degrees of anterior or posterior angulation, and less than 5 degrees of rotational deformity

2. Less than 5 degrees of varus or valgus angulation, less than 10 degrees of anterior or posterior angulation, and less than 10 degrees of rotational deformity

3. Less than 5degrees of varus or valgus angulation, less than 3 degrees of anterior or posterior angulation, and less than 15 degrees of rotational deformity

4. Less than 5degrees of varus or valgus angulation, 0 degrees of anterior or posterior angulation, and less than 5 degrees of rotational deformity

5. None of the above