FOR EACH OF THE FOLLOWING MULTIPLE CHOICHE QUESTION, SELECT

THE ONE APPROPIATE ANSWER!

1. A 25-year-old man is brought to the emergency department following a motor vehicle

accident. Extrication time was 2 hours, and in the fi eld he had a systolic blood pressure
by palpation of 90 mmHg. Intravenous therapy was started, and on arrival to the
emergency department his systolic blood pressure is 90 mm Hg with a pulse rate of 130.
Examination reveals a flail chest and a femoral diaphyseal fracture. Ultrasound of the
abdomen is positive. The trauma surgeons take him to the operating room for an
exploratory laparotomy. At the conclusion of the procedure, systolic pressure is 100 mm
Hg with a pulse rate of 110. Oxygen saturation is 90% on 100% oxygen, and the patient’s
temperature is 95.0OF (35OC). What is the recommended treatment of the femoral fracture
at this time?
A. Reamed intramedullary nail
B. Unreamed intramedullary nail
C. Percutaneous plate fixation
D. Skeletal traction
E. External fixation

2. A 14-year-old boy undergoes application of a circular frame with tibial and fibular
osteotomy for gradual limb lengthening. He initiates lengthening 7 days after surgery.
During the first week of lengthening, he reports that turning of the distraction device is
becoming increasingly difficult. On the 9th day of lengthening, he is seen in the
emergency department after feeling a pop in his leg and noting the acute onset of severe
pain. What complication has most likely occurred?
A. Joint subluxation and acute ligament rupture
B. Incomplete corticotomy at the time of surgery with spontaneous completion
and acute distraction
C. Premature consolidation of the osteotomy with breakage of bone transfixation wire
D. Fracture through the bone regenerate
E. Fracture of the tibia through a unicortical half-pin track

3. A 49-year-old woman with serologically proven rheumatoid arthritis has Larsen grade II
radiographic changes in the elbow. Examination reveals a preoperative arc of flexion of
less than 90O and there is no instability. Nonsurgical management has failed to provide
relief. What is the best treatment option?
A. Semiconstrained total elbow arthroplasty
B. Unlinked total elbow arthroplasty
C. Fascial arthroplasty
D. Open synovectomy
E. Arthroscopic synovectomy

4. A 30-year-old man who sustained a tibial fracture with a peroneal nerve palsy 2 years ago
now has foot drop and weak eversion of the foot. He reports success with stretching
exercises, but he catches his toes when his foot tires. Examination reveals that the foot is
plantigrade and supple. What is the most appropriate next step in management?
A. Posterior tibial tendon transfer to the cuboid
B. Anterior tibial tendon transfer to the cuboid
C. Achilles tendon lengthening
D. Ankle-foot orthosis with dorsiflexion assist
E. Nerve grafting
5. A 25-year-old man has a midshaft femoral fracture with 25% comminution and is
undergoing closed intramedullary nailing. Proximal locking is performed uneventfully;
however, during distal locking screw insertion, only one of the screws is noted to have
bone purchase. Which of the following procedures is the best solution to this problem?
A. Leave only one distal screw; this will provide adequate fixation
B. Exchange the nail for one either longer or shorter, and relock at a new level
C. Insert methylmethacrylate cement into the hole and redrill when the cement
hardens
D. Insert a screw through the hole either anterior or posterior to the intramedullary
nail locking hole
E. Insert a small-diameter threaded pin at a different angle through the locking hole

6. A 23-year-old man has an isolated open tibial fracture without distal neurologic or
vascular compromise following a motorcycle accident. After under going skeletal
stabilization and several debridements, a clean 6x6-cm wound remains over the
anteromedial surface of the distal third of the tibia. The tibia is exposed throughout the
length of the wound and the periosteum has been stripped. What is the best option for
wound management at this time?
A. Splint-thickness skin graft
B. Free muscle transfer
C. Soleus muscle flap
D. Medial gastroncnemius muscle flap
E. Cross-leg gastrocnemius flap

7. A 12-year-old boy has a solitary osteochondroma arising from the medial cortex of the
distal femur. The lesion is not painful, nor is it causing any disability. What surgical stage
would be assigned according to the system of the Musculoskeletal Tumor Society:
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage I
E. Stage II

8. A 2-year-old boy will not bear weight after tripping over a curb. He is afebrile.
Laboratory studies show a WBC count of 6,000/mm3 (normal 3,500 to 10,500/mm3) and
an erythrocyte sedimentation rate of 10 mm/h (normal up to 20 mm/h). Examination
reveals reproducible tenderness over the midshaft of the right tibia. AP and lateral
radiographs of the right femur and tibia are negative. What is the next most appropriate
step in management?
A. MRI of the femur
B. Ca++, alkaline phosphatase, and vitamin D levels
C. CT to rule out occult fracture
D. Long leg cast
E. Skeletal survey

9. A 20-year-old man used his fist to hit another man in the mouth. Examination 3 hours
after the injury shows a 1-cm laceration over the third metacapophalangeal joint.
Treatment should consist of which of the following?
A. Superficial debridement and oral antibiotics
B. Superficial debridement and IV antibiotics
C. Superficial debridement, secondary closure, and IV antibiotics
D. Immediate wound closure and oral antibiotics
 E. Exploration of the joint and IV antibiotics

10. An 8 year old boy fell off a playground structure and sustained a closed Galeazzi fracture
with apex dorsal angulation of radius. What is the best initial treatment?
A. Well-molded short arm cast
B. Immediate open reduction and internal fixation of the fracture with fixation of the
radioulnar joint
C. Long arm cast in pronation
D. Long arm cast in supination
E. Long arm cast in extension

11. A 47-year-old woman with a history of Olliver’s disease reports right knee pain and a
mass along the lateral aspect of her right distal thigh. Assuming that staging studies reveal
no evidence of metastases, what is the most appropriate treatment?
A. Chemotherapy only
B. Chemotherapy followed by wide resection
C. Wide resection only
D. Wide resection followed by radiation therapy
E. Radiation therapy only

12. The use of multiagent adjuvant chemotherapy is associated with a clear survival benefit in
which of the following diseases?
A. Renal Carcinoma
B. Osteosarcoma
C. Dedifferentiated chondrosarcoma
D. Adult soft-tissue sarcoma
E. Melanoma

13. Which of the following factors is associated with the worst prognosis in soft-tissue
sarcomas?
A. Size greater than 15 cm
B. Extra-compartmental involvement
C. Number of mitotic figures per high-power field (grade)
D. Large size in a proximal location
E. Presence of metastases

14. During an anterior approach to the shoulder, excessive traction on the conjoined tendon is
most likely to result in loss of
A. Elbow flexion
B. Shoulder flexion
C. Shoulder internal rotation
D. Shoulder abduction
E. Forearm pronation

15. What structure(s) course(s) through the quadrangular (quadrilateral) space)

A. Circumflex scapular artery
B. Radial nerve, posterior humeral circumflex artery
C. Axillary nerve, posterior humeral circumflex artery
D. Radial nerve, circumflex scapular artery
 E. Axillary nerve, profunda brachii artery

16. The primary stabilizer to valgus stress in the elbow is the

A. Radiocapitellar joint
B. Anterior oblique band of the medial collateral ligament
C. Transverse band of the medial collateral ligament
D. Posterior oblique band of the medial collateral ligament
E. Ulnar trochlear articulation

17. A patient has a large T11 –T12 disk herniation that is causing substantial compression of
the spinal cord. The patients report walking imbalance over the past view weeks.
Examination of the patient’s reflexes is likely to show :
A. normal reflexes in the upper extremities and hyperreflexia in the lower
extremities
B. hyperreflexia in the upper extremities and normal reflexes in the lower
extremities
C. hyperreflexia in the upper extremities and hyporeflexia in the lower extremities
D. hyperreflexia in the upper extremities and lowe extremities
E. hyporeflexia in the upper and lower extremities

18. The dorsal (Thompson) approach to the proximal forearm uses which of the following
intermuscular intervals?
A. Extensor carpi radialis longus and the extensor carpi radialis brevis
B. Extensor pollicis longus and the extensor pollicis brevis
C. Extensor digitorum communis and the extensor carpi radialis brevis
D. Extensor carpi ulnaris and the extensor carpi radialis brevis
E. Abductor pollicis longus and the extensor carpi radialis brevis

19. Which of the following muscles attaches to the coracoid process of the scapula?
A. Subscapularis
B. Supraspinatus
C. Pectoralis minor
D. Long head of the biceps brachii
E. Serratus anterior

20. The main arterial supply to the humeral head is provided by which of the following
arteries?
A. Anterior humeral circumflex
B. Posterior humeral circumflex
C. Thoracoacromial
D. Subscapular
E. Deep (profunda) brachial

21. Which of the following anatomic structures is most commonly injured after an elbow
dislocation?
A. Anterior band of the medial collateral ligament
B. Lateral ulnar collateral ligament
 C. Radial head
D. Coronoid process
E. Olecranon

22. Which of the following statements regarding congenital pseudoarthrosis of the clavicle is
not true ?
A. Congenital pseudoarthrosis of the clavicle occurs primarily on the right, rarely
bilaterally, and when occurring on the left, congenital pseudoarthrosis of the
clavicle is usually associated with dextrocordia.
B. Congenital pseudoarthrosis of the clavicle is strongly associated with
neurofibromatosis and patients often have other pseudoarthroses with the
tibia being the most commonly affected site.
C. Congenital pseudoarthrosis of the clavicle is thought to occur due to pressure on
the clavicle from the subclavian artery or prominent cervical ribs.
D. Treatment for congenital pseudoarthrosis of the clavicle involves intercalary bone
grafting, plate, and screws.
E. Impairment of the upper trunk of the brachial plexus rarely develops over time.

23. Which of the following procedures is used for acute repair of dislocated peroneal
tendons?
A. Deepening the fibular groove with an osteotome
B. Borrowing fascia to create new retinacula
C. Repairing the periosteal tendon sheath attachment
D. Creating a fibular bone-block extension
E. Rerouting the tendon through the fibula

24. Talar compression syndrome in ballet dancer typically involves injury to which of the
following structures?
A. Sustentaculum tali
B. Lateral process of the talus
C. Posterior process of the calcaneus
D. Os tibialis externum
E. Ostrigonum

25. The abductor digiti quinti muscle of the foot is most frequently innervated by what
peripheral nerve?
A. Medial plantar
B. Deep peroneal
C. Saphenous
D. Sural
E. Lateral plantar

26. The dorsal-medial aspect of the great toe receives sensory innervations from which
nerve?
A. Deep peroneal
B. Saphenous
 C. Posterior tibial
D. Superficial peroneal
E. Medial plantar

27. Which of the following ligaments is intracapsular?

A. Lisfranc
B. Deltoid
C. Calcaneofibular
D. Anterior talofibular
E. Inferior tibiofibular

28. Sensation on the plantar aspect of the great toe is derived from which of the following
nerves?
A. Sural
B. Lateral plantar
C. Medial plantar
D. Lesser saphenous
E. Greater saphenous

29. Which of the following nerves is most likely responsible for symptoms associated with
plantar fasciitis?
A. Medial plantar
B. Medial calcaneal
C. First branch of lateral plantar
D. Lateral plantar
E. Lateral calcaneal

30. The so-called high ankle sprain from an external rotation mechanism of injury typically
involves injury to which of the following structures?
A. Posterior talofibular ligament
B. Deltoid ligament
C. Anterior inferior tibiofibular ligament
D. Calcaneofibular ligament
E. Extensor retinaculum

31. The administration of ciprofloxacin is contraindicated in which of the following patient

populations?
A. Diabetics
B. Alcoholics
C. Intravenous drug abusers
D. Patients with renal failure
E. Children

32. The pharmacologic effect of warfarin is caused by what mechanism?

A. Inhabition of platelet aggregation
B. Inhibition of hepatic enzymes that activate vitamin K
 C. Binding to vitamin K-dependent clotting factors II,VII,IX,and X
D. Binding to antithrombin II, which increases its affinity for activated Factor X and
thrombin
E. Direct binding to vitamin K

33. What factor is most likely the rigidity of an external fixation system?
A. Increased pin diameter
B. Increased pin number
C. Decreased pin separation
D. Decreased pin group separation
E. Increased distance of the side bar to the bone

34. Which of the following functions primarily as an osteoconductive as opposed to an

osteoinductive material?
A. Autogenous cortical bone
B. Demineralized bone matrix
C. Freeze-dried cortical allogenic bone
D. Autogenous cancellous bone
E. Bone morphogenetic protein

35. Which the following is the most appropriate treatment for an acute comminuted radial
head fracture, in association with an Essex-Lopresti injury (radioulnar dissociation)?
A. Radial head preservation
B. Radial head excision
C. Suave-Kapandji procedure
D. Darrach procedure
E. Radioulnar synostosis

36. When a long time bone is subjected to a bending moment, the greatest tensile stresses are
located
A. Within the cortex
B. At the neutral axis
C. At a periosteral surface
D. At an endosteal surface
E. Along the bending axis

37. Which is the dominant component of articular cartilage extracellular matrix by weight?
A. Water
B. Collagen
C. Keraton sulfate
D. Chondroitin sulfate
E. Nerve and lymphatic tissue

38. Which of the following is a relative contraindication to performing laminoplasty in a

patient with cervical myelopathy ?
A. Ossification of the posterior longitudinal ligament. (OPLL)
 B. Cervical kyphosis measuring 20 degrees.
C. 30 degrees of sagittal mobility on flexion extension views
D. Multilevel canal stenosis
E. Patient age older than 55 years

39. The spinal cord terminates as the conus medullaris at what vertebral level in adults?
A. T12
B. L1
C. L2
D. L3
E. L4

40. What is the main disadvantage of using antibiotic-impregnated polymethylmethacrylate

beads to treat infected or contaminated wounds?
A. Local toxicity
B. Systemic toxicity
C. Inadequate antibiotic elution
D. Foreign body reaction
E. Allergic reaction

41. A 30 year-old man underwant an intramedullary nailing for a closed midthird tibial
fracture 2 months ago. He has had pain and erythema in the area of the fracture for the
past 3 days, and radiographs show a midthird tibia fracture with an interlocking nail in
place. Which of the following tests would be most appropriate to obtain a diagnosis?
A. Erythrocyte sedimentation rate
B. MRI scan
C. CT scan
D. Aspiration of the fracture site
E. Indium-labeled white blood cell scan

42. Which of the following is not a cause of a swan neck deformity?

A. Mallet deformity
B. Flexor tendon tenosynovitis
C. Volar Plate rupture
D. Central slip rupture
E. Lateral band subluxation

43. When performing a replant of an amputated finger, wich of the following is the correct
order of surgery?
A. Bone, Artery, Extensor, Flexor, Nerve, Vein
B. Artery, Bone, Vein, Extensor, Flexor, Nerve
C. Artery, Bone, Extensor, Flexor, Vein, Nerve
D. Bone, Extensor, Flexor, Artery, Nerve, Vein
E. Bone, Extensor, Flexor, Artery, Vein, Nerve
44. When Performing flexor tendon repair, wich of the following pulleys must be preserved?
A. A2 and A4
B. A2 only
C. A2 and C2
D. A2 and A3
E. A3 only

45. A Stener lesion is significant because?

A. Adductor aponeurosis interposition between the proximally based avulsed
ligament impairs ligament healing
B. Adductor aponeurosis interposition between the distally based avulsed
ligament impairs ligament healing
C. Skiing is an increasingly popular sport
D. It involves partial and complete ulnar collateral ligament rupture
E. It is associated with a fleck sign on the X-ray

46. Wich of the following regarding metacarpal neck fractures is true?

A. Up to 35° of angulation of the index and middle finger can be accepted
B. Up to 40° of angulation of the little and ring finger can be accepted
C. Metacarpal neck fractures should never be operated upon unless it is an open
injury
D. The Jahss position is the correct position to immobilize a manipulated metacarpal
neck fracture
E. Up to 15° of angulation of the index and midle finger can be accepted

47. The term internal impingement is used in throwers to describe a condition where the
posterosuperior glenoid labrum impinges on wich structure?
A. The anterior glenohumeral lagaments
B. The posterior glenohumeral ligaments
C. The biceps tendon
D. The anterior rotator cuff
E. The posterior rotator cuff

48. The biomechanical advantage of a reverse total shoulder arthroplasty compared to a

standard arthroplasty is what?
A. Centre of rotation more superior
B. Centre of rotation more medial
C. Centre of rotation more lateral
D. Increased lateral humeral offset
E. Decreased deltoid muscle fibre tension

49. Posterior glenohumeral dislocation occur more frequently than anterior dislocations in
which group of patients?
A. Rugby players
B. Ehlers-Danlos patients
C. Hypermobile patients
 D. Epileptics
E. None of the above

50. A football player sustains a suspected acromioclavicular joint (ACJ) separation. Wich of
the following is the most appropriate radiographic view to evaluate the ACJ?
A. Stryker notch view
B. Serendipity view
C. Zanca view
D. Supraspinatus outlet view
E. Garth view

51. When compared to the non-dominat side, which oh the following shoulder motions is
characteristically decreased in the throwing arm of athletes?
A. Internal rotation (IR)
B. External rotation (ER)
C. Forward elevation
D. Abduction
E. Adduction

52. All of the following statements regarding thoracolumbar trauma are true except?
A. Instability of a vertebral fracture can be determined by loss of vertebral
height>50%
B. There is no direct relationship between canal compromise and neurological deficit
C. Instability of injuries can be determined by further neurological deteriorationunder
normal physiological load
D. Widening of the interpedicular distance on plain radiograph can indicate a burst
fracture
E. In a thoracic burst fracture, a thoracolumbar orthosis is indicated if there is
<50% loss of vertebral body height and >30% kyphosis

53. All of the following statements regarding curve progression in adolescent idiopathic
scoliosis are true except?
A. With curves of 20-29°, 40% of patients who are Risser 0-1 are at risk of curve
progression
B. With curves of 20-29°, 22% of patients who are Risser 2-4 progress
C. After skeletal maturity, a lumbar curve >35° can progress by 1-2°/year
D. A late curve pregression in males is more common than in females
E. A rapid curve progression in females occurs before menarche and before Risser 1

54. During an anterior instrumented fusion of the lumbar spine through a left-sided
retroperitoneal approach, all the following statements are correct except?
A. The ureter is adherent to the posterior peritoneum and falls away from the psoas
through the dissection
B. The sympathetic trunk, lying longitudinally along the lateral border of the
psoas, is at risk during this procedure
 C. The ilioinguinal nerve emerges from the lateral border of the psoas and travels to
the quadratus lumborium
D. A cold and pale right foot is a recognized post-operative examination finding
E. The genitofemoral nerve lies on the anteromedial surface of the psoas

55. All the following statements regarding scoliosis in neurofibromatosis (NF) are true
except?
A. Non-dystrophic deformities are indistibguishable from idiopathic scoliosis
B. The typical curve of NF-1 is characterized by a short and sharp curvature
C. Scalloping of the vertebral bodies with enlargement of the neural foramina are
features of a dystrophic curve
D. Marked rotation of the apical vertebra with pencilling of the ribs can often be
found in dystrophic curves
E. Neurological deficit associated with compression from neurofibromata or
kyphoscoliosis is uncommon

56. Which of the following is true regarding superior mesenteric artery (SMA) syndrome?
A. The condition often occurs in overweight female patients
B. This syndrome is also known as cast syndrome
C. This condition occurs following curve correction as a result of an increse in the
angle between the aorta and the superior mesentric artery
D. The condition is due to an ischaemic event of the SMA
E. This is a surgical emergency requiring an early laparotomy +/-
duodenojejunostomy

57. If surgery for intracapsular fracture fixation is not carried out within 12 hours, avascular
necrosis (AVN) and non-union rates affected in this way?
A. No difference between AVN and non-union rates
B. AVN higher, no change in non-union
C. No change in AVN, non-union higher
D. AVN and non-union both higher
E. AVN higher but non-union lower

58. Injury to which artery is most likely to cause uncontrollable bleeding during the posterior
approach to the hip?
A. Inferior gluteal
B. Superior gluteal
C. Pudendal
D. Ascending branch of lateral circumflex femoral
E. Popliteal

59. With regard to closed suction drains used in surgery, which of the following is true?
A. Wound infection is higher with use of drains
B. Haematoma formation is lower with use of drains
C. Wound dehiscence is more likely without the use of drains
D. Blood transfusion is more likely with the use of drains
 E. Bruising is more likely with the use of drains

60. What is the predominant source of femoral head perfusion?

A. Lateral circumflex artery
B. Obturator artery
C. Medial circumflex artery
D. Descending brach of lateral circumflex artery
E. Superior gluteal artery

61. The main internal rotators of the hip are?

A. Gluteus minimus and tensor fascia lata
B. Obturator internus, superior and inferior gemelli
C. Iliopsoas
D. Piriformis and quadratus femoris
E. Piriformis and gluteus medius

62. After cementing in a total knee replacement for a valgus knee, you find that it remains
tight laterally in extension. The next most appropriate step is to?
A. Carry out a medial release
B. Carry out a medial release and increase the size of the polythylene insert
C. Release the iliotibial band
D. Release popliteus
E. Decrease the size of the polythylene insert

63. Which of the following statements regarding anterior cruciate ligament (ACL) grafts is
false?
A. The maximum load to failure of patellar tendon graft is approximately 2600
newtons
B. The use of an autologus hamstring graft results ina 50% loss of hamstring
strength
C. The maximum load to failure of a quadruple hamstring graft is approximately
4500 newtons
D. Allograft processing does not always alter the mechanical properties of the graft
E. The maximum load to failure of the native ACL is approximately 2100 newtons

64. Which of the following is considered to be the primary stabilizer of knee to external
rotation?
A. Anterior cruciate ligament (ACL)
B. Posterior cruciate ligament (PCL)
C. Lateral collateral ligament (LCL)
D. Medial collateral ligament (MCL)
E. Patellar tendon

65. A 34 year old man presents with a 3 month history of knee pain, with an inability to
squat. The most likely diagnosis is?
A. Primary osteoarthritis
 B. Osteochondral defect
C. Loose body
D. Posterior horn meniscal tear
E. Pigmented villonodular synovitis

66. Dduring trialling of a total knee replacemnt, the knee is tight in a extension but correct in
flexion. The appropriate step is to?
A. Decrease the size of the polythylene insert
B. Resect more distal femur
C. Decrease the size of the femoral component
D. Resect more proximal tibia
E. Reszurface the patella to balance the difference

67. Which of the following nerves supply the greatest area of sensibility of the foot?
A. Sural
B. Saphenous
C. Tibial
D. Deep peroneal
E. Superficial peroneal

68. A 32 year old man sustains a Lisfranc fracture dislocation. Which of the following is the
most important factor in predicting a satisfactory outcome?
A. Severity of initial injury
B. The state of the articular cartilage
C. The age of the patient
D. The smoking status of the patient
E. Whether or not a compensation claim is involved

69. Which of the following is not typically associated with a ball and socket ankle joint?
A. Absent fibula
B. Deficient knee ligaments
C. An equinovarus deformity
D. Talocalcaneal coalition
E. Proximal femoral focal deficiency

70. A vertical talus is most commonly associated with which of the following?
A. Oligohydramnios
B. Arthrogryposis
C. Congenital talipes equinovarus
D. Tarsal coalition
E. Developmental dysplasia of the hip

71. A 13 year old girl who enjoys ballet presents with a painful big toe whilst performing.
The likely diagnosis is?
A. Hallux valgus
B. Hallux rigidus
 C. Sesamoid fracture
D. Turf toe
E. Extensor hallucis longus rupture

72. A 12-year old boy presents with a 2 month history of right knee pain after a fall. He has
lost 3 kg in weight but is otherwise well. He is pale, apyrexial and his right knee is
alightly swollen and warm on examination. Plain radiographs reveal areas of dense
sclerosis admixed with areas of radiolucency in the distal femoral metaphysis. Aggresive
periosteal new bone formation is also noted. Which of the following is the most likely
diagnosis?
A. Parosteal osteosarcoma
B. Periosteal osteosarcoma
C. High-grade intramedullary osteosarcoma
D. Telangiectatic osteosarcoma
E. Osteomyelitis

73. Prognostic factors that adversely affect survival in osteosarcoma include expression of all
the following except?
A. Anti-shock protein 90 antibodies
B. Chemokine receptor type 4 (CXCR-4)
C. Alkaline phosphatase (ALP)
D. Vascular endothelial growth factor (VEGF)
E. P-glycoprotein

74. A 28 year old female to your clinic with progressively increasing pain in her left wrist.
She has also recently been having repeated episodes of abdominal discomfort, nausea and
vomiting. A plain radiograph of the wrist reveals an eccentrically placed lytic lesion in
the metaphysis and epiphysis with thinning of the cortex. You suspect a giant cell tumor
of bone. What is the most appropriate next step in the management of this patient?
A. Perform a bone biopsy
B. Curettage alone
C. Curettage and phenolization
D. Curettage, high-speed burr, cement and bone graft
E. Check serum parathyroid hormone (PTH) and calcium

75. A 55 year old male is diagnosed with a dedifferentiated chondrosarcoma of the femur
which appears on MRI to have a significant extraosseous component. Distant staging has
not revealed any metastases. What surgical stage would be assigned to this tumour
according to the system of the musculoskeletal tumour society (MSTS)
A. IA
B. IB
C. IIA
D. IIB
E. IIIB
76. Which of the following describes the signal sequences on T1 and T2 weighted MRI
imaging of a soft tissue sarcoma?
A. High (T1).Moderate (T2)
B. Low (T1)/Moderate (T2)
C. Low (T1)/Low (T2)
D. Low (T1)/High (T2)
E. High (T1)/Low (T2)

77. Which of the following is the most sensitive clinical sign for detection of development
dysplasia of the hip (DDHI) in a baby aged 6 months?
A. Galeazzi test
B. Asymmetric skin folds in the thights
C. Limited hip abduction in flexion
D. Ortolani’s test
E. Barlow’s test

78. On an anteroposterior (AP) radiograph, which of the following defines a B/C border hip
according to Herring’s modified clasification of Perthes disease?
A. A very narrow lateral pillar which is <50% of the original height
B. A lateral pillar with very little ossification with at least 50% of the original
height
C. A lateral pillar with increased ossification with at least 50% of the original height
D. A lateral pillar with exactly 50% of the original height that is higher than the
central pillar
E. Gage’s sign

79. When treating slipped upper femoral epiphysis (SUFE), which of the following might be
at the sole indication for subcapital osteotomy?
A. Metaphyseal blanch sign
B. Southwick angle >60°
C. Avascular necrosis (AVN)
D. Femoral retroversion
E. Endocrinopathy

80. When investigating for the presence of femoracetabular impingement (FAI), which of the
following radigraphic views is most likely to identify a cam lesion?
A. Cross table lateral
B. False profile
C. Frog lateral
D. Billings lateral
E. Dunn lateral
81. Which of the following is the best predictor of avasular necrosis (AVN) following hip
fracture in children?
A. Fracture type and patient age
B. Open anatomical reduction and rigid internal fixation
C. Surgery within 36 hours and capsular decompression
D. Initial displacement and associated injuries
E. Hospital type and grade of surgeon

82. During anterior surgery on the cervical spine, at what level would the lateral dissection of
the longus colli muscle most likely cause Horner syndrome ?
A. C3
B. C4
C. C5
D. C6
E. C7

83. .Subluxation caused by rheumatoid arthritis is most commonly seen at what level of the
cervical spine ?
A. Occiput – C1
B. C1-C2
C. C2-C3
D. C3-C4
E. C4-C5

84. Contraindication to cervical laminectomy as a treatment for cervical spondylotic

myelopathy include which of the following finding?
A. Multilevel disease with spinal cord compression
B. Anterior spinal cord compression
C. Posterior spinal cord compression
D. Cervical kyphosis
E. Ossification of the posterior longitudinal ligament

85. The artery of Adamkiewicz (arteria radicularis, Arteria magna) is most commonly found
on the :
A. Right side between T5 and T7
B. Right side between T9 and T11
C. Left side between T5 and T7
D. Left side between T9 and T11
E. Left side between L1 and L3

86. In adult cervical instability most commonly results from

A. degenerative disk disease
B. a flexion – extension injury
C. a rotational injury
D. increased ligamentsous laxity
E. hypoplastic facet joints
87. Cervical traction and compression test are most useful in the diagnosis of
A. Vascular insufficiency of the cervical cord
B. cervical radiculopathy
C. Cervical myelopathy
D. Arthritis of the facet joints
E. intra spinal tumors of the cervical region

88. Which of the following is most important in the early management of cervical
radiculopathy?
A. Immobilization
B. Traction
C. NSAIDs
D. Exercises to strengthen the paravertebral musculature
E. Trigger point injections

89. X – ray examination of cervical spine of a patient who injured his neck showed a tear
drop fracture. This is
A. An unstable fracture
B. Due to whiplash injury
C. Accompanied by injury to the cord
D. A minor injury
E. Treated with analgesic and exercise to neck

90. You are planning a pre op work up for an adolescent idiopathic scoliosis patient. Which
type of scoliosis curve must always be evaluated wirh an MRI Scan ?
A. Left thoracic
B. Right thoracic
C. Left lumbar
D. Right lumbar
E. Double major

91. A patient has cervical spondylotic myelopathy. Which one of the following features is
not associated with cervical myelopathy?
A. Positive Hoffman’ s sign.
B. Positive spurling’s test
C. Positive plantar response
D. Inverted radial/ supinator reflex
E. Finger escape sign

92. A syringomyelia patient sustained burns of the arm while working in a factory. Which
one of the following spinal cord tracts is responsible for tranmission of temperature
sensation ?
A. Dorsal column.
B. Lateral sphino thalamic tract
C. Anterior spinothalamic tract
D. Lateral cortico spinal tract
E. Anterior cortico spinal tract
93. Soft-tissue sarcomas most commonly metastasize to the
A. Liver
B. Lung
C. Bone
D. Regional nodes
E. Distant nodes

94. Following preoperative chemotherapy, the percent of tumor necrosis has been shown to
be of prognostic value for which of the following tumors?
A. Rhabdomyosarcoma
B. Chondrosarcoma
C. Metastatic adenocarcinoma
D. Osteosarcoma
E. Giant cell tumor of bone

95. What is the most common clinical presentation of a patient with a malignant bone tumor?
A. Incidental finding
B. Pain
C. Pathologic fracture
D. Deformity
E. Presence of a mass

96. What is the current 5-year survival rate for patients with classic non metastatic, high
grade osteosarcoma of the extremity?
A. 10%
B. 20%
C. 40%
D. 70%
E. 90%

97. What malignant disease most commonly develops in conjunction with chronic
osteomyelitis?
A. Fibrosarcoma
B. Basal cell carcinoma
C. Lymphoma
D. Osteosarcoma
E. Squamous cell carcinoma

98. Chemotherapy is routinely included in the treatment of which of the following soft-tissue
sarcomas?
A. Angiosarcoma
B. Malignant fibrous histiocytoma
C. Liposarcoma
D. Rhabdomyosarcoma
E. Clear cell sarcoma
99. Eosinophilic granuloma frequently occurs as a solitary lesion in the tubular long bones.
After biopsy, what is the best course of the action?
A. Neoadjuvant chemotherapy
B. En bloc resection
C. Observation
D. Amputation
E. Chemotherapy followed by radiation therapy

100. Which of the following tumors is most likely to present with pathologic fracture in a
child?
A. Unicameral bone cyst
B. Fibrous cortical defect
C. Osteosarcoma
D. Ewing sarcoma
E. Giant cell tumor