MedCom 2005

Orthopedics

Digitally
signed by
MedCom 2005

True/False
Notes
About SCFE (slipped capital femoral epiphysis):
a) usually due to trauma
F
[ trauma is thought to have a role in the acute presentation ]
b) Limb is internally rotated
F
[externally rotated]
c) 70% are of acute onset
F
[30%]
d) X-ray is necessary
T
2)
about MMT ( medial meniscal tear ):
a) usually no acute swelling
T
b) due to twisting
T
c) locking
T
d) may cause osteochondritis if not treated
F
[ OA (osteoathritis)]
3)
the muscle responsible for knee movement during heel stike:
a) hamstrings
b) calf muscles
c) quadriceps
T
d) gastrocnemius
4)
nerve injury in the axilla which is 1st to recover:
a) ulnar
b) radial
?
c) median
d) three together
e) variability of predilection
5)
after peripheral nerve injury , steppage gait & loss of eversion of the big toe indicates injury to:
a) femoral nerve
b) peroneal nerve
T
c) tibial nerve
[ opposite picture ]
d) sural nerve
6)
one muscle is not attached to bone:
a) lumbricals
T
[also palmaris brevis]
b) palmar interossei
c) dorsal interossei
d) adductor pollicis brevis
e) flexor digiti minimi
7)
most common fractured bone in osteoporosis:
a) femur
b) vertebra
T
8)
about osteoporoseis :
a) biochemistry is not normal
F
[ normal ]
b) can cause spontaneous fracture
T
c) dietary treatment is helpful
F
[ is useful for prevention not trearment ]
d) splintage is effective
F
[ increase regional osteoporosis ]
9)
the fracture in children that needs operation:
a) femur shaft
[ can be treated conservatively under certain
b) bilateral forearm fracture
conditions ]
c) tibia
d) humerus
e) femur neck
T
10)
about scaphoid fractures:
a) clinical diagnosis is important
T
b) leads to axascular necrosis
T
[ appearance on x-ray can be delayed for
c) X-ray is diagnostic early
F
weeks sometimes ]
11)
in hand injury one is false :
a) early operation
?
b) elevation for edema
T
c) primary care for bone before skin
F

1)

12)

most important substance for bone growth is:

a) PTH
b) thyroxin
1

MedCom 2005

13)

Orthopedics

c) androgen
d) crtisol
e) citrate
has risk of malignancy :
Ollier's disease
T
[30%]
osteoclastoma
T
[= GCT]
amyloidosis
F
[ it can result from myeloma or B-cell lymphoma ]
multiple enchondroma
T
[= Ollier's disease]
the most important slow growing killing tumor is:
a) chondrosarcoma
T
b) Ewing's sarcoma
c) malignant synovium
[ rapidly growing tumors ]
d) osteosarcoma
e) rhabdomyosarcoma
about secondary bone tumors :
a) hematogenous spread
T
b) thyroid cancer is the most common primary
F
[breast then prostate ,kidney, lung, thyroid,]
c) they may present with pathologic fracture :
T
about septic arthritis :
a) mostly caused by Staph. pyogenes
F
[Staph. aureus]
b) can cause necrosis & destruction of bone
T
c) cold lesions on bone scan has good prognosis
F
[ can be the result of severe osteomyelitis]
which is more likely diagnosis for 45yr-old male with 2yr hx knee pain that's releived by walking around :
a) osteomalacia
b) osteoporosis
c) OA
d) osteochondroma
e) osteopetrosis
all can cause knee joint swelling except :
a) OA
b) osteochondritis dissecans
c) prepatellar bursitis
[ in front of the joint not in it]
d) synovial chondromatosis
e) peripheral meniscal tear
all are cardinal signs of inflammation as described by Celsus except:
a) color
b) rubor
c) tumor
d) olor
e) loss of function
F
[ described by Virchow ]
about osteoid osteoma :
a) can cause scoliosis
T
b) causes pain worse at night & releived by antidepressants
F
[ aspirin & NSAIDs(less) ]
c) can result in leg-length discrepancy
T
all are supplied by ulnar nerve except :
a) hypothenar muscles
T
b) adductor pollicis
T
c) all interossei
T
d) ulnar 2 lumbricals
T
e) superficial head of flexor pollicis brevis
F
[ median nerve ]
abou osteocondritis dissecans :
a) the most common cause for loose bodies in young adults
T
b) calcaneal apophysis could be involved
T
c) anteromedial corner of talus can be involved
T
d) when it occurs this is certain that cancer returned
F
[ not related to malignancy ]
which is best exercise done during acute & subacute RA :
a) isometric
b) concentric
c) isokinetic
d) no exercise slould be done
about osteochondritis dissecans:
a)
b)
c)
d)

14)

15)

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20)

21)

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23)
?

24)

MedCom 2005

25)

26)

27)

Orthopedics

a) more common in young adults

b) trauma is the cause
most common site is the lateral part of the medial femoral
c) condyle
d) more in convex surfaces
e) trochlea of elbow can be involved
about subtrochanteric fractures exceot :
a) extracapsular
b) more in young adults
c) commonly comminuted
d) can be caused by malignancy
about supracondylar humeral fractures exceot :
a) distal fragment is displaced anteriorly
b) can result in nerve injury
c) compartment syndrome is common
about metatarsus adductus :
a) metatarsals are medially displaced over cuneiforms
b) presents in the 1st year of life
c) found in congenital vertical talus

28)

29)

30)

31)

32)
?

33)

34)

35)

d) the most common congenital foot deformity

about Perthes' disease :
a) rare in blacks

T
T

[ has a major role ]

T
T
F

[ capitellum ]

T
F
T
T
F
T
F

[ >95% is posteriorly displaced ]

[ esp. ant.interosseous branch of median nerve ]
[ about 1% but is v.important to be watched for ]

T
T
F
T

[ thought to be related with DDH but new

studies didn't support this ]
[ in infancy ]

b) bilateral in males 7:1 females

c) present mostly at 4-8 years of age

all can cause back pain in children except :
a) spondylolesthesis
b) idiopathic scoliosis
c) spinal cord tumors
d) discitis
e) eosinophilic granuloma
about gait cycle :
a) swing phase is longer than stance
b) 20% double support
c) hamstrings are the most important for midstance
about use of ice packs in soft tissue unjury :
a) applied for 20-30 min.
b) freq Q 2-4 hours
c) total period of 5-7 days
d) not applied directly on skin
e) needs also compression
most important step in rehabilitaion after THR is
a) muscle strengthening
b) muscle stretching
c) muscle reeducation
d) sensry reeducation
about meniscal injury:
a) Dx can be made even in absence of clinical signs

b) medial meniscus is the most commonly injured

about ABC (aneurysmal bone cyst):
a) cortical thinning
b) metastatize
c) air fluid level
All can cause frozen shoulder except :
a) DM
b) antiepiletics
c) Duputryen's contracture
d) Hyperlipidemia

[ bilat. Involvement is 12-25% & always the

hips are in different stages ] [ males 4-6:1
females ]

T
F
T
T
T
F
T
F

[ swing 40%, stance 60% ]

T
T

[ on MRI ]
[ because its attachment to capsule makes it
less mobile ]

T
F
F

[ fluid-fluid level on MRI ]

[ for deceleration ]

T
T?
T
T
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MedCom 2005

36)

37)

38)

39)
?
40)

41)

42)
43)

44)

45)

46)

e) Repeated shoulder dislocation

F
All can be found in late diagnosed DDH except:
a)
Femoral anteversion
b) Femoral head and neck in vulgus
c)
Dysplastic acetabulum
d) Delayed ossification of femoral head epiphesis
F?
[as the head will have been devoloped by this time ]
e) Fiborfatty substance in hip joint
about shoulder dislocation :
a) Posterior dislocation is the most common
F
[ anterior is 98% ]
b) Avulsion of greater tuberosity can result
T
c) Results from fall on out stretched hand
T
about tibial shaft fracture:
a) Ankle stiffness is uncommon
F
b) Foot lies outwards
maybe
c) Compartment syndrome is common
T
d) Common in youngs
T
The most common site for volar ganelion at ths wrist is:
Between flexor carpiradialis and abductor policis longus at
a)
[ dorsal-dorsal scapholunate ligament ]
scaphotrapezoid joint
about compartment syndrome :
a) Weakness in muscles of compartment
T
b) Tight skin
T
c) Present pulses doesn't rule it out
T
d) More in closed fractures
T?
[ also common in Gustilo III injuries ]
e) No compartment syndrome in arm as a rule
F
A child victim of RTA with femoral shaft fracture and shortening what's the best treament:
a)
b)
c)
d)

Skeletal traction
Skin traction
ORIF
External fixation
about cubitus valgus :
a) This ugly deformity worsens when the elbow is flexed
The best x-ray view for anterior column acetabular fracture :
a) AP
b) obturator oblique
c) Inlet view
about MMC (myelomrningocele):
a) M > F
b) Mostly lumbar
c) due to environmental and genetic factors
d) associated with Arnold-Chiari malfomatin type II in 100% of cases
e) can occur due to carbamazepine treatment during pregnancy
associated with LCS ( lumbar canal stenosis ) :
a) old age
b) restricted spinal flexion
c) Spinal claudication
d) Back pain radiating to LL

indications for surgery on disc prolapse :

urinary retention
neurologic sign
failure of medical treatment
intermittent claudication
severe scoliosis
about chronic osteomyelitis ( COM ) :
a) bacteria usually found
b) may cause amyloidosis

a)
b)
c)
d)
e)
47)

Orthopedics

differs according to : -age. -weight. associated injuries. -type of fracture.

[ extended ]

T
T

T
F
T
T

[ >95%]
[ valproic acid ]

[ extension increases pain while flexion decreases it ]

[ less constantly seen than in herniated disc ]

T
T
T

F
T

MedCom 2005

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49)

50)

51)
?
52)
53)

54)

55)

57)
?

58)

59)

60)

Orthopedics

c) usually hypodense with thin cortex

[ this is Brodie's abscess, COM usually shows

areas of destruction with hypersclerosis ]

d) surgery is required
about understanding infection in children :
a) intercostal artery supplying 2 vertebrae
b) some bones are intracapsular
c) thick periosteum
d) pesistence of metaphyseal vessels for 5 years of age
about club foot (CTEV):
a) vertical talus
b) inversion of hind foot
c) supination
d) adduction
e) tight tendon of Achilles
about flat foot :
a) may occur in rickets
b) causes severe pain after walking
c) there are 5 arches
d) may require correction
e) associated with vertical talus
most important feature for prosthesis is :
a) cosmetic
b) functions well
c) cost
about rotator cuff syndrome :
a) mostly infraspinatus is involved
drop arm after :
a) complete rotator cuff tear
b) calcified supraspinatus tendon
c) coracoid process fracture
about Perthes' disease :
a) age usally 4-8 years
b) severe & continous pain

[ only as needed ]

?
T
T
F

[ for 2-4 years of age ]

F
T
T
T
T

[ talar neck deformity (med. & plantar rotation)]

[ + equinus ]
[ of forefoot ]
[ of forefoot ]

T
F
T
T

[ mainly in symptomatic adults ]

[ 2 1/2 arches in each foot ]

[ supraspinatus ]

[ also in axillary nerve palsy ]

T
T

c) increas density is an early feature on x-ray

d) lateral subluxation is bad prognostic sign

bilat. Intermittent claudication :
a) low spinal tumors
b) vascular injury
c) vertebral osteoma
d) central disc prolapse
one is not in DDX of cystic bone lesion (small bone) :
a) TB
b) sarcoidosis
c) prostatic neoplasm
d) hyperPTH
e) sickle cell disease
the nerve injured in cubitus valgus:
a) ulnar nerve
b) median nerve
c) radial nerve
the view used to Dx anterior acetabular fracture:
a) tangential
b) oblique
c) lateral
d) inlet
signs of osteosarcoma :
a) sun-rays appearance
b) egg-shell appearance
c) calcification

[ normal femoral head but stops enlarging &

increased joint space ]
[ of Catterall's head at risk signs ]

T
T
F
T

T
T
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MedCom 2005

61)

62)
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65)
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68)
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71)
72)

73)

74)
75)
77)

78)
79)

Orthopedics

d) Codman's triangle
T
e) honey-comb
false about clavicle :
union between medial end and the rest ossifiscation center occurs
between 13-25 years old
false about pelvic fracture :
injuries of the pelvis are more dangerous than the associated soft tissue injury
most dangerous immediate complication ofpelvic fracture:
hemorrhage
best treatment for osteoporosis is :
HRT
best treatment for femoral shaft fractures is :
internal fixation
first carpal bone to ossify :
capitate
muscle inserted on 5th metatarsal bone :
peroneus brevis
most common tumor in the hand is
enchondroma
false about humeral supracondylar fracture
rarely associated with nerve & vascular injury
true about shoulder dislocation:
axillary nerve injury
false about ankle injuries:
most common in 3rd degree ( complete ) tear of the lateral
collateral ligament
false about meniscal injury :
total meniscectomy is best treatment

[ at 18-25 years ]

in order to prevent the most important complication that results in the majority of deaths in spinal injury you should order
?
respiratory therapy
fakse regarding effusions :
gout doesn't cause significant effusion
indications for fasciotomy :
a) nerve impairment
T
b) arterial/venous ligation
T
c) prolonged ischemia ( 6 hours )
T
[ should not open the already necrotic tissue &
d) missed compartment syndrome ( > 24-48 hours )
F
expose it to risk of infection ]
false about compartment syndrome :
damage is not caused by ischemia of muscle
most common fracture in elderly women is in the :
vertebra

MedCom 2005

80)

Orthopedics

fractures in children :
the closer to the growth plate , the better the healing
T
The closer to the growth plate , the smaller the callus
those with heel injury have better healing
about GCT (giant cell tumor):
a)
more comon in females
T
[ unlike most bone tumors ]
b)
occur in epiphyseo-metaphyseal junction
T
[ after physeal closure ]
c)
rare mets to lungs
T
[ <2% ]
d)
Z-ray usually increase bone density
F
[ eccentric radiolucent lesion with thin cortex ]
e)
recurrence is common after curettage
T
shoud be present in prosthesis :
a)
safe
b)
affordable
c)
very light
d)
cosmetically accepted
e)
functional
the point that lead the surgeon to be not very concerned about level of amputation is:
a)
development of prosthesis
b)
education of the pateint
c)
better diagnosis of the disease
about osteosarcoma :
a)
sun-burst appearemce
T
b)
tumor cells may perforate the cortex
T
c)
subperiosteal new bone formation
T
d)
lung mets via hematogenous spread
T
e)
usually invades the growth plate
F
[ not usual but can destroy it ]
about chondrosarcoma :
a)
grows very rapidly
F
[ slow growing ]
b)
radioressistant
T
one increases bone healing :
a)
tensile force
b)
compression
T
c)
shearing force
in histology of growth plate :
a)
resting chondrocytes
T
b)
proliferating
T
c)
maturing
T
d)
calcified
T
e)
superficial & tangential layer of chondrocytes
F
causes delayed or nonunion :
a)
extensive gap
T
b)
infection
T
c)
metabolic
T
d)
abnormal biomechanics
T
e)
sufficient immobilization
F
[ insufficient & rigid fixation can cause it ]
about transient synovitis of the hip (irritable hip ):
a)
self-limiting acute disease of the hip
T
b)
lab Ix: increase ESR .CRP & titer of Staph.aureus in blood
F
[not related to bacteria]
septic hip vs. DDH :
a)
pain
b)
resistance of hip movments
c)
asymmetric skin crease
d)
fever
about osteomyelitis:
a)
usually due to Strept. Infection
F
[ Staph. Aureus ]
CP :
a)
chondromalacia
b)
patella alta
T
[ only in 7% would be painful ]
c)
fixed knee flexion
T
a)
b)
c)

81)

82)

83)
?
84)

85)

86)

87)

88)

89)

90)

?
91)
92)

93)
a)
b)
c)

about spondylolesthesis :
more in males
degenerative type is usually > 30 years
degenerative type in L5-S1

F
F
F

[ equal ]
[ >50 years ]
[ L4/5 ]

MedCom 2005

d)
94)
a)
b)
c)
95)
?

a)
b)
c)
d)

96)
a)
b)
c)
d)
97)

Orthopedics

isthmic type is due to spondylolysis

most common cause of kyphosis in 0-10 years :
hemivertebrae
juvenile TB
apophysitis
most common disability in polio in Jordan :
hip disability
drop foot
affection of thoracic muscles
thoracic kyphoscliosis
about OA:
increased bone formation
loss of cartilage
capsule usually normal
treatment should releive pain ,increase mobility & decreases load

T
T

T
T
F
T

[ fibrosed ]

about chondromalacia patella :

hemarthrosis
F
[ recurrent hemarthrosis can cause it ]
locking
T
anterior knee pain
T
about meniscal tear :
a)
best Dx by arthrography
F
[ MRI then arthroscopy ]
b)
sometimes presents with knee swelling
T
c)
peripheral tear has better prognosis
T
[ red zone]
about flat foot :
a)
short tendon of Achilles
T
b)
Hallux valgus later on
T
the muscle that contracts intermittently during standing is:
a)
quadriceps
b)
hamstring
c)
sloeus
T
d)
tibialis anterior
e)
tibialis posterior
about scaphoid fractures :
a)
occur due to hyperextension & radial deviation
T
b)
may only be seen on oblique x-ray
T
c)
usually arm looks normal
T
d)
the proximal segment may undergo necrosis
T
e)
usually in children
F
[ in young adults ]
about swan neck deformity :
a)
MP joint is hyperextended
F
[ PIP]
b)
DIP joint is flexed
T
c)
can occur due to intrinsic muscle disease
T
d)
can occur due to flexor sublemis (superficialis) injury
T
e)
can occur due to central slip of extensor digitorum injury
F
[ buttonnier's deformity ]
most important in bone healing :
a)
clot organization
T
b)
immobilization
c)
good alignment
a 7-year old child with 6months old fracture of femur that healed with 30o rotation, Mx should be :
a)
surgery
T
b)
hip spica
c)
plaster of Paris
a)
b)
c)

98)

99)

100)

101)

102)

103)

104)

105)

all fractures in children has ability of remodeling except:

neck of femur
eppiphyseal separation of tibia
fracture of mid-ulna
fracture of mid-femur
106)
one would undergo AVN if not treated properly:
a)
capitulum
a)
b)
c)
d)

F
T
T
T
T
8

MedCom 2005

b)
c)
d)

Orthopedics

a)

olecranon
lateral condyle of humerus
supracondylar humeral fracture
may have had bad healing :
lower tibia

b)

ribs

c)
d)
e)

scaphoid
segmental tibial fracture
femoral neck
anterior humeral line should pass through:
middle 1/3 of capitellum
will lead to AVN of humeral head :
surgical neck fracture
anatomical neck fracture
surgical neck fracture + avulsion of greater tuberosity
poliomyelitis can lead to
knee flexion
equinus
structural scoliosis
scoliosis can undergo rapid deterioration during
after menopause
infantile scoliosis
juvenile scoliosis
at puberty between budding of breast & menarche
about acute supraspinatus calcification
joint movement is normal during acute phase
usually improves in few days
due to decrease blood supply ( ischemia )
osteochondritis dissecans
due to trauma
uasually lateral condyle is affected
usually affects youmg males
about Perthes
bone scan is useless
usually no pain
lateral subluxation is poor prognosis
about SCFE
females > males
70% gradual onset
lateral view is important in Dx
limbs are externally rotated
most effective in treatment of CP :
tenotomy
muscle shortening
close observation in hospitals
home phydiotherapy
about loose bodies
Hx of locking
almost always symptomatic
usually seen on x-ray
maybe caused by ostecondritis dissecans

T
T
T

107)

108)
a)
109)
a)
b)
c)
110)
a)
b)
c)
111)
a)
b)
c)
d)
112)
a)
b)
c)
113)
a)
b)
c)
114)
a)
b)
c)
115)
a)
b)
c)
d)
116)
a)
b)
c)
d)
117)
a)
b)
c)
d)

118)
a)
b)
c)
d)
e)

sprain of ATFL ( anterior talofibular ligament) is due to :

inversion
eversion
plantar flexion & inversion
dorsiflexion & eversion
dorsiflexion & eversion & pronation

[ due to continous micromotion & adequate

splintage by adjacent ribs ]

T
F
F
T
T
F
T

[ immobile ]
[ weeks ]

[ lateral aspect of medial femoral condyle ]

F
F
T
F
T
T
T

[ males > females ]

T
T
F
T
T

? = either answer not verified from a text book or question has a defect in its form.
all other answers were confirmed from a text book.
9