Revision Questions

Question 1

A complex fracture of the proximal fibula is likely to be associated with which clinical signs in the same lower limb?

Select one:

a. Numbness of the medial calf
b. Numbness of the sole of the foot
c. Numbness of the medial border of the foot
d. Numbness between the big and second toe on the dorsum of the foot
e. Numbness of the lateral border of the foot

Answer 1

d. Numbness between the big and second toe on the dorsum of the foot

Question 2

Which clinical finding is most consistently seen in patients suffering from carpal tunnel syndrome?

Select one:

a. Reduced sensation in the palm of the affected hand
b. Numbness of the tip of the little finger on the volar aspect of the affected hand
c. Weakness in the power of finger abduction in the affected hand
d. Weakness in the power of thumb abduction in the affected hand
e. Weakness of power of DIPJ flexion of the little finger of the affected hand

Answer 2

d. Weakness in the power of thumb abduction in the affected hand

Question 3

Which description is most typical of Dupuytren’s disease?
Select one:
a. A finger that occasionally sticks in flexion but can be passively fully extended, often with a clicking sensation and some discomfort
b. A small, spherical nodule palpable in the distal palm which moves as a finger is flexed and extended
c. A firm, discrete, subcutaneous, palpable band in the line of the ring finger which limits full extension of the MCP joint and is slowly progressive
d. A firm, round swelling of fluctuating size, at the central, volar aspect of the base of a finger that is painful on gripping
e. Pain associated with dysaesthesia of the radial 3 digits of the hand at night sometimes relieved by shaking the limb vigorously

Answer 3

c. A firm, discrete, subcutaneous, palpable band in the line of the ring finger which limits full extension of the MCP joint and is slowly progressive

Question 4

Which radiological feature is not characteristic of the presence of osteoarthritis affecting a joint?

Select one:

a. Congruent joint surfaces
b. Presence of peripheral osteophytes
c. Joint space narrowing
d. Sub-chondral sclerosis
e. Sub-chondral cysts

Answer 4

a. Congruent joint surfaces

Question 5

Which clinical history is least likely to predispose to osteoarthritis of the knee?

Select one:

a. A displaced intra-articular fracture of the distal femur on the same side
b. A mal-united tibial fracture of the tibial shaft on the same side
c. Competition in ultra-marathons over a 20 year period
d. A combined ligamentous injury to the knee with instability
e. A body mass index (BMI) of 23

Answer 5

e. A body mass index (BMI) of 23

Question 6

Which findings might you identify on the same side as compression of the lateral femoral cutaneous nerve?

Select one:

a. Numbness of the lateral calf
b. Absent knee reflex
c. Weakness of power of extension of the knee
d. Diminished skin sensation on the medial aspect of the thigh
e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)

Answer 6

e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)

Question 7

Where should an intra-muscular covid vaccination be sited in the buttock in order to minimise the risk of damage to the sciatic nerve?

Select one:

a. Centrally
b. Supero-lateral
c. Infero-medial
d. Supero-medial
e. Infero-lateral

Answer 7

b. Supero-lateral

Question 8

Which of the following scenarios is least likely to be associated with an isolated axillary nerve palsy?

Select one:

a. A comminuted fracture of the proximal humerus on the same side
b. An anterior dislocation of the humeral head on the same side
c. Inability to abduct the shoulder on the same side
d. Reduced skin sensation on the same side at the level of the deltoid insertion
e. Normal power of elbow flexion on the same side

Answer 8

e. Normal power of elbow flexion on the same side

Question 9

Which individual is least likely to develop septic arthritis?

Select one:

a. A neonate following a normal vaginal delivery
b. A healthy 30 year old adult on no medications
c. A patient with rheumatoid disease on disease modifying therapy injections
d. A 70 year old who requires regular courses of oral steroids for asthma exacerbations
e. An 8 year old who has recently had chicken pox

Answer 9

b. A healthy 30 year old adult on no medications

Question 10

Which clinical finding makes you suspect osteomyelitis or septic arthritis in a neonate?

Select one:

a. Sleeping between feeds
b. Maternal difficulty with initiating breast feeding
c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively
d. Waking during the night crying
e. Frequent loose stools

Answer 10

c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively

Question 11

Identify which statement about acute osteomyelitis is incorrect.

Select one:

a. It is more frequently seen in children than adults
b. If diagnosed early, it is usually treated surgically
c. The infection often has spread from a different site (Haematogenous spread)
d. Often it initially presents with localised pain and few clinical signs
e. Staphylococcus aureus is the most frequent causative organism

Answer 11

b. If diagnosed early, it is usually treated surgically

Question 12

Which patient profile is most typical of an osteosarcoma?
Select one:
a. An 11 year old boy with pain localised to the tibial tuberosity related to activity
b. A 7 year old boy with heel pain when playing football, relieved by rest
c. An 18 year old with swelling, pain and instability of the knee after a significant injury
d. A 15 year old highland dancer with shin pain during and immediately after classes
e. A 17 year old girl with progressive, deep pain around the knee with no injury

Answer 12

e. A 17 year old girl with progressive, deep pain around the knee with no injury

Question 13

Which feature is most common with an osetoid osteoma?
Select one:
a. Pain made worse during exercise
b. A strong family history of similar problems
c. Relief of symptoms after administration of Ibuprofen
d. A normal MRI scan of the affected area
e. Continued long-term symptoms after resection

Answer 13

c. Relief of symptoms after administration of Ibuprofen

Question 14

Which statement about hip joint anatomy is most accurate?
Select one:
a. Articular cartilage, if damaged, will slowly regenerate
b. Gluteus medius is inserted into the greater trochanter and is a major hip abductor
c. Short external rotators are the main external rotators of the hip
d. Labrum deepens the acetabulum but does not contribute to stability of the hip joint
e. Ligamentum teres has an important role in hip stability

Answer 14

b. Gluteus medius is inserted into the greater trochanter and is a major hip abductor

Question 15

The predominant blood supply to the head of femur is from?
Select one:
a. Lateral circumflex femoral artery
b. Medial circumflex femoral artery
c. Artery of ligamentum teres
d. Profunda femoris artery
e. Obturator artery

Answer 15

b. Medial circumflex femoral artery

Question 16

Regarding the Trochanteric bursa and bursitis, which statement is incorrect?
Select one:
a. The trochanteric bursa is a normal anatomical structure
b. With bursitis, there is usually localised tenderness over the trochanteric prominence
c. Physiotherapy has little role in the treatment of trochanteric bursitis
d. Trochanteric bursitis can occur after total hip replacement
e. An MRI scan can often demonstrate an inflamed trochanteric bursa

Answer 16

c. Physiotherapy has little role in the treatment of trochanteric bursitis

Question 17

Which condition does not increase the risk for AVN of the hip?
Select one:
a. Alcoholism
b. Systemic steroid use
c. Osteoporosis
d. Irradiation
e. Fracture of the femoral neck

Answer 17

C. Osteoporosis

Question 18

Which statement about hip arthritis and management is least accurate?

Select one:

a. There is progressive loss of articular cartilage
b. Presence of osteophytes is a common radiographic finding
c. XRay is often the only investigation required to confirm the clinical diagnosis
d. Most individuals with radiological evidence of hip arthritis require a hip replacement
e. Peri-articular expanding cysts are often seen on radiographs

Answer 18

d. Most individuals with radiological evidence of hip arthritis require a hip replacement

Question 19

Which action is least appropriate for a patient with 1 week of typical sciatica and no cauda equina symptoms?

Select one:

a. Advice that the majority settle without surgery within 3 months
b. Referral for physiotherapy assessment
c. Advise on appropriate analgesia
d. Refer urgently for an MRI scan of the lumbar region
e. Carry out a focused neurological examination

Answer 19

d. Refer urgently for an MRI scan of the lumbar region

Question 20

If cauda equina syndrome is diagnosed and surgically treated within 48 hours of onset, which residual symptoms are most unlikely?

Select one:

a. Ongoing urinary continence issues
b. Persistent numbness in parts of the feet
c. Altered sexual function
d. Persistent weakness of foot and ankle muscles
e. Unresolved sciatica

Answer 20

e. Unresolved sciatica

Question 21

Which structures contribute least to the development of lumbar spinal stenosis?
Select one:
a. The pre-existing shape of the spinal canal
b. Hypertrophy of the facet joints
c. Calcification of the Anterior longitudinal ligament
d. Hypertrophy of the ligamentum flavum
e. Posterior disc bulging

Answer 21

c. Calcification of the Anterior longitudinal ligament

Question 22

Which statement about acute compartment syndrome is correct?
Select one:
a. It does not occur unless there is a long bone fracture
b. It occurs in the lower leg because there are 4 compartments
c. A normal systolic blood pressure is required for the syndrome to occur
d. Peripheral pulses are often palpable in the early stages
e. Use of a backslab with adequate padding prevents the problem

Answer 22

d. Peripheral pulses are often palpable in the early stages

Question 23

For an adult with an open fracture, which statement is most likely to be correct?
Select one:
a. The presence of intact dermis excludes this injury
b. This is likely to be the result of a low energy injury
c. If systemic antibiotics are given, complications are unlikely
d. The environment the injury occurs in alters the prognosis for the injury
e. Internal fixation of the fracture is contra-indicated

Answer 23

d. The environment the injury occurs in alters the prognosis for the injury

Question 24

Indicate the single answer that is most likely to be correct. After reducing a forearm fracture a cast, curved in the sagittal plane is applied because:
Select one:
a. It reduces tension on the intact periosteum more than a straight cast
b. It is less likely to crack than a straight cast
c. It is much easier to apply than a straight cast
d. The peripheral circulation to the limb is improved relative to a straight cast
e. The fracture reduction is more likely to be maintained than in a straight cast

Answer 24

e. The fracture reduction is more likely to be maintained than in a straight cast

Question 25

Which of the following statements is most appropriate to the management of open fractures?
Select one:
a. They require surgical internal fixation immediately
b. Prompt, appropriate, surgical debridement in theatre is strongly advised
c. In young adults these injuries are often caused by a simple trip indoors
d. Knowledge of previous immunization for tetanus is irrelevant
e. IV antibiotics should be avoided because of C. difficile risk

Answer 25

b. Prompt, appropriate, surgical debridement in theatre is strongly advised

Question 26

Which statement is untrue with regard to CT scanning?

Select one:

a. It exposes the patient to less radiation than a standard chest x-ray
b. It can be used to produce 3 dimensional images
c. Imaging may increase risk for cancers subsequently
d. Acquisition times are much shorter compared to MRI
e. It can be combined with IV contrast injections

Answer 26

a. It exposes the patient to less radiation than a standard chest x-ray

Question 27

An otherwise fit 40 year old man has right, posterior lower limb radicular pain and has undergone an MRI confirming a L5/S1 disc proplapse. Which signs are you most likely to find on examination?

Select one:

a. A positive femoral stretch test
b. Numbness in the L3 dermatome of the right leg
c. A diminished right knee reflex
d. A positive right sciatic stretch test
e. Grade 4/5 weakness of right knee extension

Answer 27

d. A positive right sciatic stretch test

Question 28

If you were a GP evaluating a patient with symptoms consistent with acute cauda equina compression, which response is least appropriate?

Select one:

a. A careful focused examination of lower limb neurology
b. Obtaining an accurate history of the timing of symptom onset
c. Question the patient specifically about perineal and bladder function
d. Examining for altered perineal sensation
e. Making a routine referral to the local spinal service

Answer 28

e. Making a routine referral to the local spinal service

Question 29

A 60 year old man falls whilst working in his garden fracturing his left hip. Once he has recovered from the fracture which of the following would be the next step in his management?

Select one:

a. Reassure him that this is was simply bad luck as men of his age at not at risk of osteoporosis
b. Commence him on bisphosphonate therapy
c. Refer for a bone density scan
d. Advise him to avoid working in the garden
e. Commence calcium and Vitamin D supplements

Answer 29

c. Refer for a bone density scan

Question 30

A 75 year old man presents with acute sudden onset unilateral headache, scalp tenderness and pain in his jaw on eating on a background of 2-month history of pain and stiffness of the shoulder girdle.
Which of the following investigations would be the most likely to help towards a diagnosis?

Select one:

a. ESR
b. Rheumatoid factor (RF)
c. CT head
d. Temporal artery biopsy
e. Anti-neutrophil cytoplasmic antibodies (ANCA)

Answer 30

d. Temporal artery biopsy

Question 31

A 50 year old man attends his GP complaining of swelling of his toes. He has just returned from a holiday to celebrate his birthday. He has high blood pressure and his BMI is 32. This is a picture of his foot.

What test would be most helpful to establish a diagnosis?

Select one:

a. Serum urate
b. HLA-B27 status
c. CRP
d. Aspirate joint
e. X-ray foot

Answer 31

D. Aspirate Joint

Question 32

A 78 year old healthy woman on no medications, presents acutely with a hot, swollen left knee. She was previously well with only mild knee pain on descending stairs. No other joints are involved. She is struggling to weight bear on her knee.

What is the most likely diagnosis?

Select one:

a. Rheumatoid arthritis
b. Psoriatic arthritis
c. Pseudogout
d. Trauma
e. Osteoarthritis

Question 33

A 35 year old Asian computer programmer presented to his GP with widespread muscle pain and weakness, and difficulty rising from his chair. His alkaline phosphatase is elevated at 2000 and serum calcium is just below the reference range.

Which of the following tests would be diagnostic for the underlying cause of his problems?

Select one:

a. Creatinine kinase
b. Rheumatoid Factor
c. Ultrasound of his muscles
d. Vitamin D status
e. Isotope bone scan

Question 34

A 50 year old lady attends her GP. She is concerned that she has osteoporosis as her mother has been diagnosed with this. How should her GP proceed initially?

Select one:

a. Perform a fracture risk assessment
b. Refer for a bone density scan
c. Explain that she is too young for osteoporosis and ask her to return in 5 years
d. Commence therapy with HRT
e. Commence calcium and Vitamin D supplements

Question 35

A 23 year student sees his GP with a several year history back pain and stiffness. The pain is worse at night, first thing in the morning and if he has been sitting for long periods studying. He is otherwise well apart from a previous episode of a red, painful eye for which he received some steroid eye drops. On examination he has a reduced Schober’s test and is tender over his right sacroiliac joint.

Which investigation would be most helpful in reaching a diagnosis?

Select one:

a. CRP
b. HLA B27
c. MRI whole spine
d. Anti-CCP antibody
e. Trial of non-steroidal anti-inflammatory medication

Answer 35

C. MRI Whole Spine

Question 36

A 67 year old female patient presents with 3 month history of proximal weakness of the upper and lower limbs. She struggles to lift her arms above the shoulder level and to stand from sitting unaided. Her blood tests show elevated ESR at 80 and raised creatine kinase at 5 times the upper limit of normal range.

What is the most likely diagnosis?

Select one:

a. Polymyalgia rheumatica
b. Rheumatoid arthritis
c. Osteoarthritis
d. Polymyositis
e. Giant cell arteritis

Question 37

The most important muscle providing plantar flexion of the foot is?

Select one:

a. Plantaris
b. Tibialis anterior
c. Flexor digitorum longus
d. Gastrocnemius
e. Flexor hallucis longus

Question 38

A 40 year old woman attends your surgery complaining of shooting pains in the 3rd web space of her foot made worse by wearing high heeled shoes. Which clinical sign is not consistent with the diagnosis of Morton’s neuroma?

Select one:

a. Reduced sensation in the 3rd web space
b. Reproduction of symptoms by transverse compression of the metatarsal heads
c. A positive Mulder’s click
d. Slight widening of the space between the 3rd and 4th toes
e. Capillary return of 4 seconds in the toes

Answer 38

e. Capillary return of 4 seconds in the toes

Question 39

In a patient with forefoot pain (metatarsalgia) which conservative measure is likely to be least effective?

Select one:

a. Advice on types of footwear to avoid
b. Advice to regularly flex and extend the toes
c. Advice on weight loss if BMI >40Kg/M2
d. Advice on activity modification
e. Advise on suitable orthotic insoles

Question 40

A 50 year old diabetic woman presents with a painful clicking sensation at the volar aspect of her ring ringer when flexing the digit. There has been no traumatic episode.

What is the most likely diagnosis?

Select one:

a. Osteoarthritis of the ring finger metacarpophalangeal joint
b. Dupuytren’s disease
c. A trigger finger
d. A ruptured flexor tendon
e. A flexor tendon sheath ganglion

Answer 40

C. Trigger Finger