Revision Questions 2 Flashcards
Which statement regarding conservative treatment in orthopaedics is most appropriate?
Select one:
a. Should only be considered if operation is not possible
b. Usually requires the patient to be given a general anaesthetic
c. Can result in excellent outcome measures in appropriate cases
d. It usually results in a sub-optimal outcome for the patient
e. It is rarely appropriate for young patients
c. Can result in excellent outcome measures in appropriate cases
Making an accurate orthopaedic diagnosis for a patient
Select one:
a. Reduces patient confidence in the treating clinician
b. In the majority of patients is not required
c. Allows the clinician to research the most appropriate patient treatments
d. Is rarely a good use of medical resources
e. Is not required for many clinical research projects
c. Allows the clinician to research the most appropriate patient treatments
In treating a child with acute osteomyelitis of the tibia, which test is most helpful?
Select one:
a. A white cell count of 15x109/L
b. A C Reactive Protein (CRP) of 20mg/L (normal<4mg/L)
c. Positive blood cultures
d. Normal serum electrolytes
e. An Erythrocyte Sedimentation Rate (ESR) of 10mm/Hr
The correct answer is: Positive blood cultures
In a patient with chronic osteomyelitis where can cultures be most reliably obtained in order to identify the primary causative organism? Select one: a. Pus draining from the sinus b. The nose and pharynx of the patient c. The sinus tract d. Unbroken skin of the affected limb e. Biopsy of the affected bone
The correct answer is: Biopsy of the affected bone
Which treatment option is least appropriate in acute tibial osteomyelitis management
Select one:
a. Regular, appropriate analgesia
b. Commencing high dose IV antibiotics to cover likely organisms
c. Encouraging regular weight-bearing exercise on the limb
d. Optimising nutritional state
e. Immobilising the affected limb in a splint
The correct answer is: Encouraging regular weight-bearing exercise on the limb
In a patient with chronic osteomyelitis, which statement is most accurate
Select one:
a. This could be a life-long condition for them
b. Skin cancer arising from a dry sinus is very likely
c. A 2 week course of appropriate antibiotics is likely to cure the problem
d. Production of an involucrum will prevent pathological fracture
e. A sequestrum can usually be located by using an U/S scan
The correct answer is: This could be a life-long condition for them
Which complication of severe, distal femoral acute osteomyelitis in a child is least likely?
Select one:
a. Angular deformity of the limb
b. Limb length discrepancy
c. Bacterial endocarditis
d. Chronic localised osteomyelitis with a sinus
e. Arthritis of the hip
The correct answer is: Arthritis of the hip
What clinical presentation is least likely with TB of the knee joint?
Select one:
a. Involuntary weight loss over several months
b. Ongoing treatment of HIV
c. Swelling of the knee with restricted movement
d. Knee pain worse on exercise and relieved by rest
e. No close contact with a person known to have TB
The correct answer is: Knee pain worse on exercise and relieved by rest
In an established high brachial plexus (Erb’s) palsy, what clinical finding would you expect in a cooperative adult? Select one: a. Diminished power of wrist extension b. Diminished, power of elbow extension c. Normal power of elbow flexion d. Normal power of shoulder abduction e. Diminished power of wrist flexion
The correct answer is: Diminished power of wrist extension
In a patient with a fracture of the humeral mid-shaft with an associated, isolated, radial nerve palsy, which clinical findings are most likely in ipsilateral hand?
Select one:
a. Numbness over the dorsum of the little finger
b. Numbness over the volar aspect of the index finger
c. Numbness over the dorsum of the middle finger
d. Numbness over the dorsum of the hand in the first web space
e. Numbness over the volar aspect of the little finger
The correct answer is: Numbness over the dorsum of the hand in the first web space
Which clinical finding is most consistently seen in patients suffering from carpal tunnel syndrome?
Select one:
a. Weakness of power of DIPJ flexion of the little finger of the affected hand
b. Weakness in the power of finger abduction in the affected hand
c. Reduced sensation in the palm of the affected hand
d. Weakness in the power of thumb abduction in the affected hand
e. Numbness of the tip of the little finger on the volar aspect of the affected hand
The correct answer is: Weakness in the power of thumb abduction in the affected hand
In the primary treatment of osteoarthritis, which factor most contributes to personal ability to manage symptoms?
Select one:
a. Belief that avoidance of exercise with minimise disease progression
b. Unsympathetic employer and work colleagues
c. A natural optimistic outlook on life
d. Regular sleep disturbance because of symptoms
e. lack of family support
The correct answer is: A natural optimistic outlook on life
What is the most important factor in deciding if a patient requires surgery for an osteoarthritic joint?
Select one:
a. The patient has a full understanding of the recovery process
b. The patient has a complete understanding of the risks involved
c. The patient often limps at work
d. The patient has required to limit sporting activities
e. The patient has exhausted conservative strategies but still exhibits persistent, intrusive symptoms
The correct answer is: The patient has exhausted conservative strategies but still exhibits persistent, intrusive symptoms
What is the most important reason for MSK being a core component of medical undergraduate training?
Select one:
a. MSK pathology forms the basis for a large proportion of GP consultations
b. Many students are asked questions by family members on MSK conditions
c. Orthopaedics wish to stay the largest surgical speciality in the UK
d. It allows sporting students to manage their own injuries
e. The government wish spending on MSK conditions to be minimised
The correct answer is: MSK pathology forms the basis for a large proportion of GP consultations
When examining a suspicious mass which characteristic is most suggestive of malignancy?
Select one:
a. A hard, irregular swelling that has expanded over a short period
b. A well circumscribed, smooth outline
c. A superficial swelling near a joint that transilluminates
d. Non tender on palpation
e. A soft, lobulated, non-tender 1cm swelling superficial to deep fascia
The correct answer is: A hard, irregular swelling that has expanded over a short period
Which characteristic is not typical of a benign bone tumour?
Select one:
a. The lesion is well circumscribed on x-ray
b. An aggressive periosteal reaction around the lesion without a trauma history
c. A fractures occurring through the lesion after minimal trauma
d. A sclerotic margin between the lesion and surrounding bone
e. No evidence of surrounding tissue infiltration on MRI scanning
The correct answer is: An aggressive periosteal reaction around the lesion without a trauma history
What information can you not obtain from an MRI scan of a malignant bone tumour?
Select one:
a. An assessment of the reaction of the surrounding structures to the tumour
b. The likelihood of tumour involvement of near-by joints
c. The anatomical relationship of the tumour to vital neurovascular structures
d. The definitive diagnosis
e. The local extent of the tumour
The correct answer is: The definitive diagnosis
Which patient with a known primary malignancy is least likely to develop bone metastasis? Related to the original pathology?
Select one:
a. A 60 year old man 1 year after resection of a renal tumour with local spread
b. An 80 year old man with known prostate cancer on no treatment
c. A 45 year old lady with a large breast tumour and axillary lymph node involvement
d. A 70 year old man with a treated, superficial bladder transitional cell tumour
e. A 50 year old smoker receiving palliative radiotherapy for lung cancer
The correct answer is: A 70 year old man with a treated, superficial bladder transitional cell tumour
Which metastatic bone tumour is most likely to require prophylactic surgical stabilisation?
Select one:
a. A lytic, painful lesion of the trochanteric hip region involving the whole bone width
b. A lytic, painless lesion of the midshaft tibia occupying <1/3 of the bone width
c. A painless, sclerotic (blastic) lesion on one rib occupying > 2/3 of the bone width
d. A painful sclerotic (blastic) humeral lesion occupying < 1/3 of the bone width
e. A painful, lytic lesion of the iliac blade about 2cm diameter
The correct answer is: A lytic, painful lesion of the trochanteric hip region involving the whole bone width
Identify which statement about acute osteomyelitis is incorrect
Select one:
a. Often it initially presents with localised pain and few clinical signs
b. Staphylococcus aureus is the most frequent causative organism
c. If diagnosed early, it is usually treated by surgery alone
d. It is more frequently seen in children than adults
e. The infection often has spread from a different site (Haematogenous spread)
The correct answer is: If diagnosed early, it is usually treated by surgery alone
Which of the following statements about DeQuervain’s tenosynovitis is true?
Select one:
a. It is commoner in males
b. It occurs most frequently in people aged 25-35
c. Occurs on the ulnar side of the wrist
d. Can be treated with steroid injection
e. Involves Extensor Pollicis Longus
The correct answer is: Can be treated with steroid injection
Which of the following statements is untrue when considering a ganglion in the hand. A ganglion
Select one:
a. is usually firm and non-tender
b. may change in size
c. is occasionally lobulated
d. is usually fixed to the overlying skin
e. edges are usually smooth
The correct answer is: is usually fixed to the overlying skin
Which of the following statements is untrue when considering the normal treatment of osteoarthritis of the base of the thumb. Most patients with OA base of thumb will be treated with Select one: a. Life style modifications b. NSAIDS c. Splint d. Joint replacement e. Steroid injection
The correct answer is: Joint replacement
A radial nerve palsy
Select one:
a. May be described as a midweek palsy
b. Produces weakness in the finger flexors
c. Produces an area of sensory loss over the thenar eminence
d. Produces weakness in the lumbricals muscle of the hand
e. Produces an area of sensory loss in the dorsal first web space of the hand
The correct answer is: Produces an area of sensory loss in the dorsal first web space of the hand
The predominant blood supply to the head of femur is from?
a) lat circumflex femoral artery
b) med circumflex femoral artery
c) artery of ligament teres
d) profunda femoris artery
e) obturator artery
medial circumflex femoral artery
Which statement about hip joint anatomy is most accurate?
a) articular cartilage if damaged will slowly regenerate
b) gluteus medius is inserted into greater trochanter and is major hip abductor
c) short external rotators are main external rotators of hip
d) labrum deeps the acetabulum but does not contribute to stability of hip joint
e) ligamentum teres has important role in hip stability
b) gluteus medius is inserted into greater trochanter and is major hip abductor
Which of the following scenarios is least likely to be associated with isolated axillary nerve palsy?
a) communicated fracture of proximal humerus on same side
b) anterior dislocation of humeral head on same side
c) inability to abduct shoulder on same side
d) reduced skin sensation on same side at level of deltoid insertion
e) normal power of elbow flexion on same side
e) normal power of elbow flexion on same side
Where should an intra-muscular covid vaccination be sited in buttock to minimise risk of damage to sciatic nerve?
a) central
b) superolateral
c) inferomedial
d) superomedial
e) inferolateral
b) superolateral
what findings might you identify on same side as compression of lateral femoral cutaneous nerve?
a) numbness of lateral calf
b) absent knee reflex
c) weakness of power of extension of knee
d) diminished skin sensation on medial aspect of thigh
e) reproduction of symptoms pressing medial to antero-superior iliac spine (ASIS)
e) reproduction of symptoms pressing medial to antero-superior iliac spine (ASIS)
Which radiological feature is not characteristic of presence of osteoarthritis affecting joint?
a) congruent joint surface
b) presence of peripheral oesteophytes
c) joint space narrowing
d) sub-chondral slcerosis
e) sub chondral cysts
a) congruent joint surface
Tendons from which muscles form achilles tendon?
a) lat and medial head of gastrocnemius
b) gastrocnemius, soleus and plantaris
c) gastrocnemius, soles and popliteus
d) gastrocnemius and plantaris
e) none of above
b) gastrocnemius, soleus and plantaris
Anterior compartment leg muscles are innervated by superficial fibular nerve?
a) true
b) false
false
Innervation of muscle extensor carpi ulnas is ulnar nerve?
a) true
b) false
false
Which important structure can be damaged at anatomical snuff box during accident?
a) cephalic vein
b) radial artery
c) ulnar artery
d) ulnar nerve
e) radial nerve
radial artery
The cephalic vein empties into which of the following veins?
a) axillary
b) subclavian
c) brachial
d) ulnar
e) radial
Axillary
Which muscles inferior border is used as landmark to describe termination of axillary artery and beginning of brachial artery?
a) lat dorsi
b) teres major
c ) pec minor
d) pec major
e) teres minor
Teres Major
There are five principal groups of axillary lymph nodes - pectoral, sub scapular, humeral, central and apical.
Which one of these groups receives lymph from infection at little finger?
a) humeral
b) subscapular
c) central
d) apical
e) pectoral
Humeral
What type of synovial joint is sternoclavicular articulation?
Saddle
Which nerve supplies adductor group of muscles that act on hip?
Obturator
A right sided dipping gait could indicate damage to which muscle?
a) left glute max
b) left glute minimis
c) left piriformis
d) right glute max
e) right glute minimus
Left Glute Minimus
In the femoral triangle where does femoral artery lie in relation to femoral vein?
a) anterosuperior
b) lateral
c) posterior
d) medial
e) anterior
Lateral
The superficial inguinal lymph nodes will receive infections from external genitalia?
a) true
b) false
True
which muscle is main flexor of hip?
a) glute maximus
b) iliacus
c) ilipsoas
d) quad lumborum
e) quad femoris
Ilipsoas
The iliotibial tract is nothing but thickening of fascia lata on lateral thigh?
True
What is correct for subtalar joint?
a) flex and extend
b) medial and lateral rotate
c) inversion and eversion
d) abduct and adduct
e) all of above
inversion and eversion
Which is the commonest direction in which the shoulder joint dislocates?
Anterior
A 25 year old epileptic attends the GP after a prolonged Grand Mal seizure complaining of pain around his shoulder and difficulty moving it. What would be the single most important part of the examination you carry out.
Select one:
a. Examining power of the deltoid (axillary nerve)
b. Examining external rotation of the shoulder
c. Looking for bruising around the shoulder and clavicle
d. Examining for sensation around the shoulder regimental badge area
e. Examining abduction of the shoulder
b. Examining external rotation of the shoulder
