ORTHOPEADICS

1. Complications of closed midshaft fracture of the femur include:

a) a. Fat embolism
b) b. Malunion
c) c. Delayed union
d) d. Femoral nerve palsy
e) e. Hypovolemic shock

2. A chronic slipped upper femoral epiphysis

a) a. Is associated with decreased internal rotation, flexion, abduction and true shortening
b) b. Is seen more commonly in boys than girls
c) c. Occurs most commonly between 10-15 years of age
d) d. Should be treated by reduction under general anaesthesia
e) e. May affect both hips

3. In children supracondylar fracture of the humerus are most frequently complicated

by
a) a. Injury of the ulnar nerve
b) b. Vascular compromise
c) c. Poor healing
d) d. Malunione.
e) e. Injury to radial nerve

4. The most useful symptom and sign of impending compartment syndrome are
a) a. Weakness and numbness
b) b. Tingling and swelling
c) c. Severe pain and pain on possible motion of the muscle in the compartment
d) d. Hematoma
e) e. None of the above

5. One of the complications of shoulder dislocation is injury to

a) a. Circumflex nerve
b) b. Brachial plexus
c) c. Long head of biceps
d) d. Cephalic vein torn
e) e. Long thoracic nerve neuropraxia

6. Osteoid osteoma
a) a. Consists of an area of dense cortical bone thickening with a central lucent area, the
nidus
b) b. Classically produces pain relieved by asprin
c) c. Occasionally becomes malignant
d) d. May show up on a technetium-99m bone scan when not obvious on routine
radiographs
e) e. Is treated by excision of the cortical thickening and nidus

7. The leading offending pathogen in acute primary hematogenous osteomyelitis of

children is:
a) a. Ecoli
b) b. Hemophillus influenza
c) c. Staphylococcus aureus
d) d. B-hemolytic streptococcus
e) e. None of the above

8. A solitary lytic bone lesion can be from

a) a. Hyperparathyroidism
b) b. Metastasis
c) c. Chronic osteitis
d) d. Osteoid osteoma

9. Chronic osteomyelitis is best treated by

a) a. Antibiotics
b) b. Surgery and antibiotics
c) c. Surgery
d) d. Radiotherapy
e) e. Antibiotics and radiotherapy

10. In osteogenic sarcoma the symptoms that leads to early clinical suspicion area.
a) Fever
b) b. Constant increasing pain
c) c. Anorexia
d) d. Swelling of limb and tenderness
e) e. Unable to walk

11. X-ray of pelvis

a) a. Is contraindicated in pregnant women
b) b. Can show stones in the bladder
c) c. Can show rapture of the bladder and ureter
d) d. Fracture of ramus and ileum will be obvious
e) e. Open reduction for fractures of ramus and ileus is the best

12. . Bone tumors

a) a. Bone marrow aspiration is a diagnostic technique in suspected malignances that
involve bone
b) b. With the exception of Ewig’s tumor, lymphoma, leukemia and myeloma most
malignant tumors are relatively radio resistant and surgery offers better local control than
radiotherapy
c) c. In unicameral cysts surgery is indicated primarily because of diminished strength of
bone and risk of sustaining s pathological fracture
d) d. Osteosarcoma is most frequently seen around the ankle and wrist
e) e. Multiple myeloma is a malignant neoplasm derived from the plasma cells and usually
a normal protein synthesis is seen

13. Bone tumors

a) The commonest malignant tumor of bone is osteogenic sarcoma
b) The prognosis is of osteosarcoma following Paget’s diseases is good
c) The osteosarcoma is the commonest benign tumor affecting long bones
d) The osteosarcoma seen in the teenage group may mimic acute osteomyelitis
e) Histologically it may be difficult to differentiate a Ewig’s sarcoma from high grade
lymphoma.

14. Pathological fractures occur in

a) a. Tumors
b) b. Developmental diseases
c) c. Metabolic conditions
d) d. Infections
e) e. Sarcoidosis

15. Initial treatment of a midshaft femoral fracture in an adolescent is

a) a. Open reduction and internal fixation
b) b. Closed reduction and internal fixation with Kuntscher nail
c) c. Skeletal traction
d) d. Cast brace
e) e. 1 ½ hip spica

16. The basic principle of treatment of fractures of both bones of the forearm is to
a) a. Reduce the angulation of the ulnar
b) b. Reduce the angulation of the radius
c) c. Prevent overriding the fragments
d) d. Restore the normal relationship of the radius and ulnar
e) e. Immobilise the elbow only

17. In congenital dislocation of the hip

a) a. The diagnosis is usually established at 3 years of age
b) b. Abducting the flexed hip causes a click
c) c. Abduction of the flexed hip is not limited
d) d. Apparent lengthening of the affected thigh with the hip and knees flexed may be seen
e) e. Initial treatment is by open reduction

18. Complications of pelvic fractures

a) a. Hemorrhage
b) b. Rupture of the bladder
c) c. Rupture of the urethra
d) d. Osteoarthritis of the hip
e) e. Leg length discrepancy

19. Traumatic infections of the joints

a) a. The lateral meniscus is more frequently injured than the medial
b) b. The majority of ligamentous sprains of the lateral ankle can be treated by
immobilization
c) c. A painful arc syndrome of the shoulder is the main clinical symptom of full ruptures of
the rotator cuff
d) d. Isolated anterior cruciate ligament ruptures of the knee are relatively rare
e) e. In tennis elbow the pain is localized to the medial epicondyle

20. Consider plaster casts

a) a. Fractures of the scaphoid should be immobilized with the thumb extension
b) b. Fractures of the tibia and fibula require a full leg plaster
c) c. Solitary fractures of the ulna mid shaft without displacement require a below elbow
plaster
d) d. It is good standard practice to take arm plasters as far distally as the proximal finger
crease
e) e. Colle’s fracture requires an above-elbow plaster

21. Amputations
a) a. When performing an amputation the periosteum should be stripped excessively to
avoid sequestra or reactive bone formation
b) b. Amputation of all toes causes severe disturbances in ordinary slow walking
c) c. The ideal level of amputation below the knee is 14cm below the knee
d) d. The stump after a knee disarticulation is an end-bearing stump
e) e. The ideal level of an above knee amputation is just above the condyles

22. Two hours after application of the plaster cast for supracondylar fracture the
patient comes with severe pain and swollen and cyanotic hand. The best course
would be to
a) a. Observe the patient
b) b. Administer vasodilators
c) c. Administer analgesics
d) d. Cut open the plaster cast near the fingers
e) e. Cut open the entire plaster cast immediately

23. Fractures- True or False

a) a. Greenstick fractures of the forearm usually require 8 to 10 weeks immobilization in a
plastercast
b) b. A displaced closed simple tibial fracture in an adult usually unites 6-8 weeks after an
injury
c) c. Isolated closed humeral fractures frequently result in non-union when conservative
treatment is applied
d) d. An impacted subcapital neck of humerus fracture is frequently complicated by
avascular necrosis
e) e. A fracture of a long bone in an adult is considered a “nonunion” if no union is present 3
months after the injury

24. Fractures :
a) a. Premature closure of the epiphysis is commonly seen after a Salter II fracture
b) b. Intra-articular fractures of the calcaneum often lead to post traumatic subtalar
osteoarthritis
c) c. Avascular necrosis of the Talus is a frequent complication of the complete dislocation
of the body of talus
d) d. Displaced intra-articular fractures are best treated by open reduction
e) e. A fracture fragment is insufficient size for attachment of rigid fixation is a relative
contra-indication to open reduction and internal fixation

25. . Bone tumors

a) a. The commonest malignant tumor of bone is osteogenic sarcoma
b) b. The prognosis osteosarcoma following paget’s disease is good
c) c. The osteochondroma is the commonest benign tumor affecting long bones
d) d. The osteosarcoma seen in the teenage group may mimic acute osteomyelitis
e) e. Histologically it may be difficult to differentiate an ewing’s sarcoma from
reticulosarcoma

26. . Fracture treatment

a) a. In a reduction of a fracture the undamaged soft tissues are brought into normal
relationship so that the bone fragments will return to their normal position
b) b. In a volar angulated fracture the volar perioteum can be used as a soft tissue hinge to
reduce the fracture
c) c. In fracture if short bones the displacement is the limited by the extent to which the
fibrous tissues in the vicinity have been torn and in the majority of cases no further
displacement will occur if the fracture is not splintered
d) d. In the reduction of an extension – supracondylar elbow fracture lateral displacement of
the distal fragment is corrected when the elbow is brought into flexed position
e) e. After reduction a Colles fracture is immobilized in flexion and radial deviation

27. Consider acute hematogenous osteomyelitis

a) a. The disease begins in the diaphysis of a long bone
b) b. There is commonly a history of injury
c) c. The infection in most patients, spreads to the nearest joint
d) d. The first step in management is to take blood for culture
e) e. X-ray diagnosis is possible in the acute case

28. Joints involved in a prolonged arthritic process tend to take up a classical position
of deformity. In the hip the positions most commonly seen are:
a) a. Extension
b) b. Flexion
c) c. Abduction
d) d. External rotation

29. Amputations
a) a. A severely crushed though viable limb may be an indication for amputation
b) b. You would use a tourniquet when amputating for gangrene due to vascular
insufficiency
c) c. If below knee amputation results in an end-bearing stump
d) d. Sites of election for amputation arose from limb-fitting consideration
e) e. The phantom limb phenomenon is common in those patients requiring amputation as
a result of trauma
30. A patient present with a hand newly crushed in a roller press. The hand looks
slightly swollen but otherwise intact. Which of the following actions would you
take”
a) a. Immediately call the micro vascular surgery team
b) b. Reprimand the patient for wasting everyone’s time by coming to the hospital
c) c. Give analgesics, if required, admit the patient and x-ray the hand
d) d. Test the urine quantitatively and qualitatively
e) e. Elevate the hand and immediately inform the hand surgeon on call

31. Pain and restriction of movement after total hip replacement may be due to
a) a. Infection
b) b. Dislocation
c) c. Prosthetic fracture due to mental fatigue
d) d. Loosening of either prosthesis
e) e. Acetabulo-Protrusion (or new bone formation)

32. If they have to be immobilized at all, metacarpophalangeal joints of the hand must
be immobilizeda.
a) 45 degree flexion
b) b. At 180 degree
c) c. Just short of 180 degree
d) d. At 90 degrees
e) e. Any of the above

33. 8. Aseptic necrosis after injury can occur in

a) a. The head of the humerus
b) b. The head of the femur
c) c. The lateral condyle of the tibia
d) d. The talus
e) e. The capitate

34. Fractures:
a) a. Greenstick fractures of the forearms usually require 8-10 weeks immobilization in a
plaster cast
b) b. A displaced closed simple tibia fracture in an adult usually unites 6-8 weeks after
injury
c) c. Isolated closed humeral fractures frequently give non-union when conservative
treatment is applied
d) d. An impacted subcapital neck of humerous fracture is frequently complicated by
avascular necrosis
e) e. Multiple myeloma is a malignant neoplasma derived from the plasma cells and usually
a normal protein synthesis is seen

35. Bone tumors

a) a. Bone marrow aspiration is a diagnostic technique in suspected malignancies that
involve bone marrow such as myeloma or lymphoma
b) b. With exceptions of Ewing’s tumor, lymphoma, leukemia and melanoma most
malignant tumors are relatively radio resistant and surgery offers better local control than
radiotherapy
c) c. In unicameral cysts surgery is indicated primarily because if diminished strength of the
bone and risk of sustaining pathological fracture
d) d. Osteosarcoma is most frequently seen around the ankle and wrist
e) e. Multiple melanoma is a malignant neoplasm derived from the plasma cells and usually
a normal protein synthesis is seen

36. Femur fractures

a) a. Posterior angulation is the distal fragment can be corrected by traction in the axis of
the femur
b) b. A transverse distal femoral fracture is a good indication for Kuntshener nail
c) c. In treating children with femoral fracture obtaining full correction of length advisable
d) d. In Perkins traction a Thomas splint is used to control alignment
e) e. In weight traction the length of the fracture depends on the amount of tearing of the
intermuscular septa and fibrous tissue of the thigh

37. Congenital anomalies

a) a. A resistant club food deformity in a child is usually connected by soft tissue
procedures rather than with bony procedures
b) b. The treatment of a club foot is at first non-surgical and should be started as soon as
possible after birth
c) c. Congenital pseudoarthrosis of the tibia is often seen in relation with neurofibrotosis
d) d. Radiographic features of congenital dislocation of the hip are an increased acetabular
angle and lateral displacement of the femoral neck
e) e. Limited adduction is a major clinical sign of a dislocated hip

38. Traumatic injuries of joints

a) a. The lateral meniscus is more frequently injured than medial
b) b. The majority of ligamentous sprains of the lateral ankle ligaments can be treated by
immobilization
c) c. A painful arch syndrome of the shoulder is the main clinical symptom of a full rupture
of the rotator cuff
d) d. Isolated anterior cruciate ligament lesions of the knee are relatively rare
e) e. In a tennis elbow the pain is localized to the medial epicondyle

39. Amputations
a) When performing an amputation the periosteum should be stripped excessively to avoid
sequestrums of reactive bone formation
b) Amputation of all toes causes severe disturbances in ordinary slow walking
c) The ideal level for amputation below the knee is the musculotendonous junction of the
gastronenius joint muscle
d) The stump after a knee disarticulation is an end bearing stump
e) The ideal level of an above knee amputation is just above condyles

40. Infections
a) Osteomyelitis caused salmonella organism should arouse suspicion for sickle cell
anemia or some other heamoglobinopathy
b) b. Penicillin G is the drug of choice for non penicillinase- producing staphylococci
c) If on radiological examination periosteum elevated or bone is destroyed, the
osteomyelitis is present for at least five days
d) Radionuclide bone scans have proved to be helpful in the early diagnosis of osteomyletis
e) When osteomyelitis is suspected in the metaphysis of the proximal femur in association
with septic arthritis of the hip it is better to decompress the intertrochanteric area
together with the hip joint

41. Hand
a) Active flexion of the DIP joint when the profundus flexor tendon is severed
b) Digital nerves are frequently severed when the wound is at the dorsal aspect of the
finger
c) A webspace infection is drained through an incision in the webspace
d) Open treatment and internal fixation followed by splinting in the positon of thefunction is
indicated for almost all stable fractures for metacarpals and phalanges
e) Kienbock’s disease is an avascular necrosis of the scaphoid

42. Typical deformity in a case of unimpacted fracture of the neck of femur is:

a) Shortening of external rotation

b) External rotation only
c) Flexion, adduction and internal rotation
d) Flexion, adduction and external rotation
e) Extension, adduction and external rotation
43. The knee
a) A medial meniscus tear usually give pain over the medial aspect of the joint line and
during hyperextension
b) A valgus force of the common mechanism if the injury causing a lesion of the lateral
collateral ligament of the knee
c) A loose body in the knee can be secondary to osteochondritis dissecans
d) Locking of the knee is a typical symptom of a bucket handle tear of the meniscus
e) Secondary medial compartment osteoarthritis can be a late complication of a full medial
menisectomy

44. . Which of the following can produce rotational scoliosis

A. a. Neurofibromatosis
B. b. Infection of the vertebral bodies
C. c. Poliomyelitis
D. d. Secondary malignant disease
E. e. Ankylosing spondylitis

45. Internal derangement of the knee :

A. a. An adduction and twisting force on a flexed knee would produce a bucket handle tear
of the medial meniscus
B. b. It is not unusual to get tears of the medial collateral ligament, medial meniscus and the
anterior cruciate ligament
C. c. Following tears of the menisci an immediate hemothrosis is rare
D. d. The squat test is useful in patients with tears of the meniscus
E. e. A ruptured lateral collateral ligament is more disabling than the medial one

46. Dislocations:
A. a. The direction of dislocated patella is usually lateral
B. b. Neurovascular injuries are uncommon in the knee dislocations
C. c. In a fracture- dislocation of the hip the integrity of the acetabula femoral head are
crucial prognostic factors
D. d. In an isolated displaced proximal ulnar fracture there is usually a dislocation of the
radius at wrist level

47. Concerning cysts of the “menisci”

A. a. The medial meniscus is more commonly affected
B. b. The cyst may be related to a tear of the meniscus
C. c. There may be familial tendency
D. d. Most cysts subside spontaneously

48. Compression fracture of the spine are most often associated with
A. a. Trauma
B. b. Osteoporosis
C. c. Metastatic disease
D. d. Hyperactivity
E. e. Hypercalcenosis

49. . A patient had a fracture of the tibia which was reduced and placed in a circular
plaster. He begins complaining of increasing pain in the leg unrelieved with
analgesics. You should:
A. a. Elevate leg and apply ice
B. b. Increase or change analgesics and reassure
C. c. Split the cast and check for compartment syndrome
D. d. Order increased activity and physiotherapy
E. e. Put up drip and infuse with saline

50. Fat embolism syndrome is associated with the following signs and symptoms
A. a. Apyrexia
B. b. Multiple lower limb fractures
C. c. Petechial hemorrhages
D. d. Pericarditis
E. e. Bradycardia

51. Complete laceration of the peroneal nerve at the neck of the fibula will result in:
A. a. Weakness of the aversion of the root
B. b. Inability to invert foot
C. c. Loss of activity in the extensor halluces and extensor of digitorum longus
D. d. Normal sensation in the affected foot
E. e. Normal power of plantar extension of the foot

52. Regarding osteogenic imperfect

A. a. There is evidence of hereditary disorder
B. b. All patients present within first year of life
C. c. Blood biochemistry shows low sodium calcium
D. d. Some patients have blue sclera

53. Which of the following are associated with leg length inequality
A. a. Neurofibromatosis
B. b. Achondroplasia
C. c. Infantile septic arthritis of the hip
D. d. Marfan’s syndrome
E. e. An arterio-venous fistula

54. The carpal tunnel syndrome may be associated

A. a. Diabetes
B. b. Supracondylar fracture
C. c. Rheumatoid arthritis
D. d. Syringomyelin
E. e. Acromegaly

55. Dupuytreins contracture is the result of thickening of the:

A. a. Flexor tendon
B. b. Extensor tendon
C. c. Palmar skin
D. d. Palmar fascia
E. e. None of the above

56. Fractures- True or False

A. a. Greenstick fractures of the forearm usually require 8 to 10 weeks immobilization in a
plaster-cast
B. b. A displaced closed simple tibial fracture in an adult usually unites 6-8 weeks after an
injury
C. c. Isolated closed humeral fractures frequently result in non-union when conservative
treatment is applied
D. d. An impacted subcapital neck of humerus fracture is frequently complicated by
avascular necrosis
E. e. A fracture of a long bone in an adult is considered a “nonunion” if no union is present 3
months after the injury

57. Sciatica from an actual prolapsed intervertebral disc

A. a. Most commonly occurs in the over 40 year age group
B. b. Rarely occurs in women
C. c. Is usually caused by a sudden twisting injury of the spine
D. d. Most commonly involves the second lumbar nerve root
E. e. Requires urgent operative treatment to relieve pain

58. The basic principle of treatment of fractures of both bones of the forearm is to
A. a. Reduce the angulation of the ulnar
B. b. Reduce the angulation of the radius
C. c. Prevent overriding the fragments
D. d. Restore the normal relationship of the radius and ulnar
E. e. Immobilise the elbow only

59. In congenital dislocation of the hip

A. a. The diagnosis is usually established at 3 years of age
B. b. Abducting the flexed hip causes a click
C. c. Abduction of the flexed hip is not limited
D. d. Apparent lengthening of the affected thigh with the hip and knees flexed may be seen
E. e. Initial treatment is by open reduction

60. Initial treatment of a midshaft femoral fracture in an adolescent is

A. a. Open reduction and internal fixation
B. b. Closed reduction and internal fixation with Kuntscher nail
C. c. Skeletal traction
D. d. Cast brace
E. e. 1 ½ hip spica

61. Pathological fractures occur in

A. a. Tumors
B. b. Developmental diseases
C. c. Metabolic conditions
D. d. Infections
E. e. Sarcoidosis

62. Bone tumors

A. a. The commonest malignant tumor of bone is osteogenic sarcoma
B. b. The prognosis is of osteosarcoma following Paget’s diseases is good
C. c. The osteosarcoma is the commonest benign tumor affecting long bones
D. d. The osteosarcoma seen in the teenage group may mimic acute osteomyelitis
E. e. Histologically it may be difficult to differentiate a Ewig’s sarcoma from high grade
lymphoma.

63. Bone tumors

A. a. Bone marrow aspiration is a diagnostic technique in suspected malignances that
involve bone
B. b. With the exception of Ewig’s tumor, lymphoma, leukemia and myeloma most
malignant tumors are relatively radio resistant and surgery offers better local control than
radiotherapy
C. c. In unicameral cysts surgery is indicated primarily because of diminished strength of
bone and risk of sustaining s pathological fracture
D. d. Osteosarcoma is most frequently seen around the ankle and wrist
E. e. Multiple myeloma is a malignant neoplasm derived from the plasma cells and usually
a normal protein synthesis is seen

64. In total transection of the spinal cord following vertebral injury there is immediate
A. a. Spastic paralysis and positive Babinski sign:in spinal cord injury
B. b. Loss of motor power but no to sensation
C. c. Loss of sensation but not motor power
D. d. Flaccid paralysis and loss of all modalities of sensation ?
E. e. Transitory loss of consciousness

65. Typical deformity in a case of unimpacted fracture of the neck of femur is:
A. a. Shortening of external rotation
B. b. External rotation only
C. c. Flexion, adduction and internal rotation
D. d. Flexion, adduction and external rotation
E. e. Extension, adduction and external rotation

66. Hand
A. a. Active flexion of the DIP joint when the profundus flexor tendon is severed
B. b. Digital nerves are frequently severed when the wound is at the dorsal aspect of the
finger
C. c. A webspace infection is drained through an incision in the webspace
D. d. Open treatment and internal fixation followed by splinting in the positon of the function
is indicated for almost all stable fractures for metacarpals and phalanges
E. e. Kienbock’s disease is an avascular necrosis of the scaphoid

67. Consider acute hematogenous osteomyelitis

A. a. The disease begins in the diaphysis of a long bone
B. b. There is commonly a history of injury
C. c. The infection in most patients, spreads to the nearest joint
D. d. The first step in management is to take blood for culture
E. e. X-ray diagnosis is possible in the acute case

68. Internal derangement of the knee :

A. a. An adduction and twisting force on a flexed knee would produce a bucket handle tear
of the medial meniscus
B. b. It is not unusual to get tears of the medial collateral ligament, medial meniscus and the
anterior cruciate ligament
C. c. Following tears of the menisci an immediate hemothrosis is rare
D. d. The squat test is useful in patients with tears of the meniscus
E. e. A ruptured lateral collateral ligament is more disabling than the medial one

69. Joints involved in a prolonged arthritic process tend to take up a classical position
of deformity. In the hip the positions most commonly seen are:
A. a. Extension
B. b. Flexion
C. c. Abduction
D. d. External rotation

70. 4. Amputations
A. a. A severely crushed though viable limb may be an indication for amputation
B. b. You would use a tourniquet when amputating for gangrene due to vascular
insufficiency
C. c. If below knee amputation results in an end-bearing stump
D. d. Sites of election for amputation arose from limb-fitting consideration
E. e. The phantom limb phenomenon is common in those patients requiring amputation as
a result of trauma

71. A patient present with a hand newly crushed in a roller press. The hand looks
slightly swollen but otherwise intact. Which of the following actions would you
take”
A. a. Immediately call the micro vascular surgery team
B. b. Reprimand the patient for wasting everyone’s time by coming to the hospital
C. c. Give analgesics, if required, admit the patient and x-ray the hand
D. d. Test the urine quantitatively and qualitatively
E. e. Elevate the hand and immediately inform the hand surgeon on call

72. Pain and restriction of movement after total hip replacement may be due to
A. a. Infection
B. b. Dislocation
C. c. Prosthetic fracture due to mental fatigue
D. d. Loosening of either prosthesis
E. e. Acetabulo-Protrusio (or new bone formation)

73. If they have to be immobilized at all, metacarpophalangeal joints of the hand must
be immobilized
A. a. 45 degree flexion
B. b. At 180 degree
C. c. Just short of 180 degree
D. d. At 90 degrees
E. e. Any of the above

74. Aseptic necrosis after injury can occur in

A. a. The head of the humerus
B. b. The head of the femur
C. c. The lateral condyle of the tibia
D. d. The talus
E. e. The capitate

75. Which of the following can produce rotational scoliosis

A. a. Neurofibromatosis
B. b. Infection of the vertebral bodies
C. c. Poliomyelitis
D. d. Secondary malignant disease
E. e. Ankylosing spondylitis

76. Fractures:
A. a. Greenstick fractures of the forearms usually require 8-10 weeks immobilization in a
plaster cast
B. b. A displaced closed simple tibia fracture in an adult usually unites 6-8 weeks after
injury
C. c. Isolated closed humeral fractures frequently give non-union when conservative
treatment is applied
D. d. An impacted subcapital neck of humerous fracture is frequently complicated by
avascular necrosis
E. e. Multiple myeloma is a malignant neoplasma derived from the plasma cells and usually
a normal protein synthesis is seen

77. Bone tumors

A. a. Bone marrow aspiration is a diagnostic technique in suspected malignancies that
involve bone marrow such as myeloma or lymphoma
B. b. With exceptions of Ewing’s tumor, lymphoma, leukemia and melanoma most
malignant tumors are relatively radio resistant and surgery offers better local control than
radiotherapy
C. c. In unicameral cysts surgery is indicated primarily because if diminished strength of the
bone and risk of sustaining pathological fracture
D. d. Osteosarcoma is most frequently seen around the ankle and wrist
E. e. Multiple melanoma is a malignant neoplasm derived from the plasma cells and usually
a normal protein synthesis is seen

78. The knee

A. a. A medial meniscus tear usually give pain over the medial aspect of the joint line and
during hyperextension
B. b. A valgus force of the common mechanism if the injury causing a lesion of the lateral
collateral ligament of the knee
C. c. A loose body in the knee can be secondary to osteochondritis dissecans
D. d. Locking of the knee is a typical symptom of a bucket handle tear of the meniscus
E. e. Secondary medial compartment osteoarthritis can be a late complication of a full
medial Menisectomy

79. Femur fractures

A. a. Posterior angulation is the distal fragment can be corrected by traction in the axis of
the femur
B. b. A transverse distal femoral fracture is a good indication for Kuntshener nail
C. c. In treating children with femoral fracture obtaining full correction of length advisable
D. d. In Perkins traction a Thomas splint is used to control alignment
E. e. In weight traction the length of the fracture depends on the amount of tearing of the
intermuscular septa and fibrous tissue of the thigh
80. Congenital anomalies
A. a. A resistant club food deformity in a child is usually connected by soft tissue
procedures rather than with bony procedures
B. b. The treatment of a club foot is at first non-surgical and should be started as soon as
possible after birth
C. c. Congenital pseudoarthrosis of the tibia is often seen in relation with neurofibrotosis
D. d. Radiographic features of congenital dislocation of the hip are an increased acetabular
angle and lateral displacement of the femoral neck
E. e. Limited adduction is a major clinical sign of a dislocated hip

81. Traumatic injuries of joints

A. a. The lateral meniscus is more frequently injured than medial
B. b. The majority of ligamentous sprains of the lateral ankle ligaments can be treated by
immobilization
C. c. A painful arch syndrome of the shoulder is the main clinical symptom of a full rupture
of the rotator cuff
D. d. Isolated anterior cruciate ligament lesions of the knee are relatively rare
E. e. In a tennis elbow the pain is localized to the medial epicondyle

82. Amputations
A. a. When performing an amputation the periosteum should be stripped excessively to
avoid sequestrums of reactive bone formation
B. b. Amputation of all toes causes severe disturbances in ordinary slow walking
C. c. The ideal level for amputation below the knee is the musculotendonous junction of the
gastronenius joint muscle
D. d. The stump after a knee disarticulation is an end bearing stump
E. e. The ideal level of an above knee amputation is just above condyles

83. Infections
A. a. Osteomyelitis caused salmonella organism should arouse suspicion for sickle cell
anemia or some other heamoglobinopathy
B. b. Penicillin G is the drug of choice for non penicillinase- producing staphylococci
C. c. If on radiological examination periosteum elevated or bone is destroyed, the
osteomyelitis is present for at least five days
D. d. Radionuclide bone scans have proved to be helpful in the early diagnosis of
osteomyletis
E. e. Khey osteomyelitis is suspected in the metaphysis of the proximal femur in association
with septic arthritis of the hip it is better to decompress the intertrochanteric area
together with the hip joint

84. Fracture treatment

A. a. In a reduction of a fracture the undamaged soft tissues are brought into normal
relationship so that the bone fragments will return to their normal position
B. b. In a volar angulated fracture the volar perioteum can be used as a soft tissue hinge to
reduce the fracture
C. c. In fracture if short bones the displacement is the limited by the extent to which the
fibrous tissues in the vicinity have been torn and in the majority of cases no further
displacement will occur if the fracture is not splintered
D. d. In the reduction of an extension – supracondylar elbow fracture lateral displacement of
the distal fragment is corrected when the elbow is brought into flexed position
E. e. After reduction a Colles fracture is immobilized in flexion and radial deviation

85. Tibia and ankle fractures

A. a. Segmental tibia fractures are best treated by open reduction
B. b. A calcaneal pin is best inserted 2 inches above and in front of the profile of the heel
C. c. In the conservative treatment of the tibia fracture no shortening more than 1 cm is
considered acceptable
D. d. The key factor in the reduction of the unstable fracture – dislocation of ankle is a
position of talus relation to the tibia
E. e. In the reduction of an unstable abduction fracture with talar shift “side to side”
compression at the same level over each malleolus will reduce the fracture

86. Fractures :
A. a. Premature closure of the epiphysis is commonly seen after a Salter II fracture
B. b. Intra-articular fractures of the calcaneum often lead to post traumatic subtalar
osteoarthritis
C. c. Avascular necrosis of the Talus is a frequent complication of the complete dislocation
of the body of talus
D. d. Displaced intra-articular fractures are best treated by open reduction
E. e. A fracture fragment is insufficient size for attachment of rigid fixation is a relative
contra-indication to open reduction and internal fixation

87. Dislocations:
A. a. The direction of dislocated patella is usually lateral
B. b. Neurovascular injuries are uncommon in the knee dislocations
C. c. In a fracture- dislocation of the hip the integrity of the acetabula femoral head are
D. crucial prognostic factors
E. d. In an isolated displaced proximal ulnar fracture there is usually a dislocation of the
radius at wrist level

88. Bone tumors

A. a. The commonest malignant tumor of bone is osteogenic sarcoma
B. b. The prognosis osteosarcoma following paget’s disease is good
C. c. The osteochondroma is the commonest benign tumor affecting long bones
D. d. The osteosarcoma seen in the teenage group may mimic acute osteomyelitis
E. e. Histologically it may be difficult to differentiate an ewing’s sarcoma from
reticulosarcoma

October 2020 paper

1. The following statements relate to open fractures

A. [ ] Treatment of the fracture must be prioritised over soft tissue injury

B. [ ] All patents must be started on antibiotics even if the wound looks clean
C. [ ] Wounds of Gustilo 1 fractures can be closed
D. [ ] In Gustilo type 2 the wound is 1cm long but there is no skin flap
E. [ ] Wound infection rates in Gustilo type 3 is more than 10%

2. A pathological fracture can be caused by the following conditions

A. [ ] Bone sclerosis
B. [ ] Bone implant
C. [ ] Monostotic fibrous dysplasia
D. [ ] Aneurysmal bone cysts
E. [ ] Butressing plate

3. With regard to dislocation of the hip

A. [ ] Anterior dislocation is more common compared with posterior

B. [ ] The leg lies externally rotated, abducted and slightly flexed
C. [ ] The lateral view is more confirmatory than the anteroposterior view
D. [ ] It is complicated by avascular necrosis in less than 10% of patients
E. [ ] Treatment is usually open reduction

4. The following are indications for amputations

A. [ ] Any poliomyelitic limb
B. [ ] Staphylococcal bone infections
C. [ ] Clostridial perfringens infections
D. [ ] Gangrene of the foot
E. [ ] Frostbite

5. Dislocations of the shoulder

A. [ ] Can occur with minimal trauma
B. [ ] Recurrent dislocations should always be surgically treated
C. [ ] Most dislocations are posterior
D. [ ] Brachial plexus may be injured
E. [ ] Avulsion of greater tuberosity can occur

50. The following is true of complications of long bone fractures:

A. [ ] Hypovolaemic shock is commoner in femur fractures than pelvic ones
B. [ ] Compound fractures are more likely to cause compartment syndrome than
closed ones
C. [ ] Stress fractures commonly occur after direct trauma in motor vehicle
accidents
D. [ ] Greenstick fractures of the clavicle in children need manipulation under
anesthaesia for better cosmetic outcome
E. [ ] Colles fractures are commoner in children than adults.

MCQ 5
6. Extra articular manifestations of rheumatoid arthrirtis include:
A. Rheumatoid nodules typically seen oon the floor surfaces of joints
B. Nail bed of nail fold haemorrahges
C. A macrocytic and leucopenia
D. Splenomegally and leucopenia
E. A pericarditis which is often asymptomatic

7. Perthe’s disease
A. Usually presents with a painful limp
B. May present with pain in the knee
C. Frequently presnts with limitattion of all hip movements ,especailly internal rotation and
abduction
D. Is associated with an intermittent pyrexia in the early stages
E. May occasionally be an incidental finding on radiogrphs taken for an unrelated problem

8. Avascular necrosis of the upper femoral epiphysis may be caused by:

A. Fracture through the neck of the femur
B. Slipped upper femoral epiphysis
C. Septic arthritis of the hip
D. Fracture of the tibia and fibula
E. Juvenile diabetes

9. Volkmann’s ischaemic contacture:

A. Results in fixed contractures of the femur
B. Slipped upper femoral epiphysis
C. Septic arthritis of the hip
D. Fracture of the tibia and fibula
E. Juvenile diabetes

10. Fat embolism syndrome is associated with the following signs and symptoms
A. A pyrexia
B. Multiple lower limb fractures
C. Petechial hemorrhages
D. Pericarditis
E. A bradycardia

11. Factors associated with delayed or non union of a fracture are:

A. A low velocity type of injury
B. Soft tissue interposition between the fragments
C. The presence of large areas of cancellous bone
D. Excessive movement at fracture site
E. Interruption of the blood supply to the bone fragments

12. Osteochrodromata (multiple exostoses,diaphyseal aclasis)

A. Are benign without the capacity for malignant change
B. Occur most commonly in the diaphyseal area of long bone
C. May be a cause of leg length inequality
D. Are usually larger clinically than radiologically
E. Develop with the distal end of the bony outgrowth directed towards the adjacent joint

13. A 60 year old woman presents with malaise ,weight loss, anaemia and limp girdle
pain. Xrays shows vertebral collapse and “punched out” areas in the long bones
and skull. The following are likely diagnosis:
A. Secondary deposits from breast carcinoma
B. Osteoporosis
C. Myeloma
D. Rheumatoid arthritis
E. Diabetes mellitus

14. The following are complications of Colles fracture of the wrist

A. Rupture of the extensor tendon of thumb
B. Frequent non-union of the fracture
C. Median nerve compression
D. Mal-union
E. Inferior radio ulnar subluxation

15. The early clinical signs and symptoms of ischaemia in the forearm and hand
following closed reduction of a supracondylar fracture in the children are:
A. Paralysis of the median nerve
B. Gangrene of the tips of the fingers
C. Fixed contracture of the flexior muscles
D. Pain ,especailly on extension of the fingers
E. Absent radial pulse and porr capillary return

16. An acute anterior dislocation of the shoulder is associated with which of the
following complications?
A. Axillary nerve injury
B. Fracture of the neck of humerus
C. Fracture of greater tuberosity
D. Frequent rupture of axillary artery
E. A compression fracture in the head of humerus

17. The following fractures usually require open reduction and internal fixation:
A. An oblique fracture of the midshaft of hunerus
B. An oblique fracture of proximal third of ulan with anterior dislocation of the radial head in
an adult
C. A pathological fracture of the midshaft of femur in a 40 year old female with breast
carcinoma
D. A two part intertrochanteric fracture in an elderly female
E. A displaced fracture of the lateral condyle of elbow in 10 year old

18. Common complications of inter trochanteric fracture despite treatment are:

A. Mal union
B. Non union
C. Coxa vara
D. Avascular necrosis of the femoral head
E. Sciatic nerve palsy
19. A patient sustains an anterior dislocation of shoulder joint together with a
complete musculocutaneous nerve palsy. Which of the following will be present?
A. Diminished sensation of the skin over the deltoid muscle
B. Absence of contraction of the biceps muscle
C. Decreased power of supination in the forearm
D. Decreased sensation over the medial bordder of the forearm
E. Weakness of flexion at the elbow

20. Pathological long bone fractures associated with malignant disease:

A. Most commonly occur in breast carcinoma
B. Most frequently affect the femur and humerus
C. Should be treated by conservative means if possible
D. May be a presenting feature of malignancy
E. Invariably unite providing the fracture can be adequately immoblised

21. Following a fracture :

A. There is death of bone cells adjacent to the fracture
B. Woven bone is formed beneath the periosteum which bridges the fracture fragments
C. Excessive mobility at fracture site may disrupt the bridging callus
D. Cells within the medullary cavity take no part in fracture healing
E. Cortical bone and its cellular constituents take no part in fracture healing despite
apposition of the bone ends.

MCQ 3-1
22. About Osteogenesis imperfecta
A. It can be due to an autosomal dominant genea
B. It can be due to an autosomal recessive gen
C. Patients can have blue screlae
D. Hearing loss is a feature
E. Dentinogenensis is a feature

23. The following facts are true about multiple myeloma

A. Anemia is a common feature
B. Leucocytopenia can lead to infection
C. Solitary plasmacytoma is a similar disease
D. Hypercalcaemia can occur
E. Pathological fracture are common

24. Osteogenic sarcoma

A. It has a peak incidence at 15 years and 60-70years
B. Occurs most commonly around the knee
C. Pain is the earliest symptom
D. Fractures never occur
E. Ct scan of the cheat is not indicated

25. About bone healing

A. Pathological fractures do not heal
B. Remodelling occurs over months to years
C. Inflammation and revascularization occur in the first 2 weeks
D. Non steroidal anti inflammatory drugs can inhibit bone healing
E. Smoking does not affect bone healing

26. The following are features of perthe’s disease

A. It is due slip in the proximal femoral epiphysis
B. It is due to vascular necrosis of the head of femur
C. Most cases are considered idiopathic
D. Simple observation can be a form of treatment
E. Cases are from or after the age of 10

27. About supracondylar fractures of the femur

A. Plating is a treatment option
B. Intrameduallry nailing can be used
C. Dynamic condylar screw and plate can be used
D. K wire can be used
E. Traction should be used for definitive treatment

28. Haemoarthritis of the knee

A. Can be due to anterior cruciate ligament tear
B. Can be due to septic arthritis
C. Can be due to haemophilia
D. Can be due to pigmeneted villonodulr synovitis
E. Caan be due to trauma

29. A galleazi fracture

A. Is a fracture of the ulna with proximal radio-ulna dislocation
B. Is afracture of the radius with aproximal radio-ulna dislocation
C. Is treated conservatively
D. Is treated surgically
E. Exercises should be early after surgery

30. The following are ways to treat distal radial fractures

A. K wire fixation
B. Plating
C. Manipulation under anaesthesia
D. External fixation
E. Excision of distal radius

31. About pelvic fractures

A. Immediate catheteriaztion is mandatory
B. A urethrogram should be done in all cases
C. The position of the prostate should be assesed
D. 3 liters of blood can be lost in the peritoneal cavity
E. Pelvic fractures can be treated surgically

32. With hip dislocation

A. Avascular necrosis of the femoral head can occur
B. Reduction should be done very early
C. Most are anterior
D. Most are central
E. The sciatic nerve can be damaged

33. Fractures of the neck of femur

A. Can present with pain in the knee
B. Can occur with minimal trauma
C. A garden 3 fracture can be treated conservatively
D. A garden 1 fracture should be pinned
E. Intertrochanteric fractures predisposes to avascular necrosis

34. About fractures of the shaft of the femur

A. Shock is a common complication
B. Pathological fractures should be treated non operatively
C. Intramedullary fixation is the treatment of choice
D. Plating is the treatment of choice

35. About Acute osteomyelitis

A. Dental caries cause osteomyelitis
B. Trauma is not associated with the condition
C. Broches abscess is a feature
D. Sequestrum is new bone formed to replace dead bone
E. Mycobacteria does not cause osteomyelitis

36. Where large amounts of autogenous bone for the reconstruction of the maxilary
alveolar need the best sites to harvest the bone are:
A. Tibia
B. Skull
C. Small figure
D. Iliac crest
E. mandible

MCQ1
37. Osteogenic sarcoma
A. Has two age peaks of incidence
B. When affecting the limb,is treated by amputation in most cases
C. Has xrays features including “cod-man's triangles”
D. Most commonly affects the metaphysics of the femur
E. Develops in a third of patients with Paget’s disease of the bone

38. Complications of tibial fractures include

A. Leg shortening
B. Compartment syndrome
C. Delayed union
D. Tibial nerve damage
E. Fat embolism

39. The rotator cuff of the shoulder joint is formed by which of the following muscles?
A. Subscapularis
B. Teres major
C. Pectoralis major
D. Deltoid
E. infraspinatus

40. Avascular necrosis is particularly associated with fracture of the following bones
A. Third metacarpal
B. scaphoid
C. Talus
D. Mandibular condyle
E. Neck of femur

41. Anterior shoulder dislocation

A. Is less common than posterior dislocation
B. Can be treated using Kocher manoeuvre
C. Is a recognizes cause of axillary nerve palsy
D. Is usually subcoracoid
E. Usually presents with arm in the adduction position

42. The following statements are true about thoracolumbar fractures:

A. Denis type I fracture must be operated
B. Denis type II is likely to require an operation
C. Denis type III involves the anterior column
D. Denis type II involves the middle and posterior column
E. Denis type III is an unstable injury

43. Regarding cervical spine injuries

A. A bifacet dislocation has anterior vertebral body translation of 25%
B. A unifacet dislocation has anterior vertebral body translation of 50%
C. There is very high risk of spinal cord injury
D. A spine board is encouraged when nursing patients in the ward
E. The principle of log rolling when moving the patients is importantto reduce further rsidk of
injury to the spinal cord

44. Which of the following agents is the most common causative agent in
osteomyelitis ina 7year old with sickle cell disease?
A. Group A streptococcus
B. Staphylococcus aureus
C. Staphylococcus epidermidis
D. Pseudomona aeruginosa
E. Salmonella species

45. A 4month old girl is referred to the orthopaedic clinic . Her mother is concerned
about clicking left hip. Clinically Ortolani’s test is positive and the child’s
radiographs support a diagnosis of developmental dyphasia of the hip. Which of
the following is the most appropriate form of mananagement?
A. Application of a pavlik harness
B. Application of a hip spica
C. Closed reduction and application of a Pavlik harness
D. Closed reduction and application of a hip spica
E. Open reduction

46. Which of the following is the characteristic displacement in slipped upper femoral
epiphysis?
A. Anterior displacement of the femoral head
B. Lateral displacement of the femoral head
C. Medial displacement of the femoral head
D. Anteriror displacement and external rotation of the femoral neck
E. Posterior displcament and internal rotation of the femoral neck

47. In which area does osteomyelitis usually begin in children?

A. The joint
B. The epiphysis
C. The physis
D. The metaphysis
E. The diaphysis

48. According to the Salter and Harris classification of phseal injuries,how is a

fracture that extends through the metphysis,physis and epiphysis classified?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V

49. Fracture mid-shaft femur:

A. Commonly complications direct trauma in form of car accidents
B. It may be tranverse,spiral or comminuted fracture
C. Over riding ,angulation and rotations are common in this fracture
D. Usually complicate with hypovolemic shock due to big size of its haematoma (may be up
to two litres)
E. Proximal fragment is pulled forwards by quadriceps femoris muscle
F. Distal fragment is adducted,pulled upwards and backwards by the adductors and the
hamstring muscles

50. Fracture neck of femur:

F. Common fracture in old age
G. Trauma must be marked severe trauma
H. More commonly in the elderly
I. Intracapsular fractures are more likely to heal than extracapsular fractures
J. Usually leads to hypovolaemic shock

51. Recognized features of club foot include:

A. Erosion of the os clasis
B. Adduction of the bones of the forefoot
C. A small os calcis
D. Abnormal histology of the calf muscles
E. Valgus of os calcis

Gen Surg 2021

1) [Link] regard to ‘greenstick fracture’
a) a) It frequently occurs in adults
b) b) Rarely occurs in children
c) c) It‟s a complete fracture
d) d) It‟s a „hairline‟ fracture
e) e) Treatment involves immobilisation and analgesia

2) .Dislocations of the shoulder

a) Can occur with minimal trauma
b) Recurrent dislocations should always be surgically treated
c) Most dislocations are posterior
d) Brachial plexus may be injured
e) Avulsion of greater tuberosity can occur

3) The following are indications for amputations

a) a) Any poliomyelitic limb
b) b) Staphylococcal bone infections
c) c) Clostridialperfringens infections
d) d) Gangrene of the foot
e) e) Frostbite

4) With regard to dislocation of the hip

a) a) Anterior dislocation is more common compared with posterior
b) b) The leg lies externally rotated, abducted and slightly flexed
c) c) The lateral view is more confirmatory than the anteroposterior view
d) d) It is complicated by avascular necrosis in less than 10% of patients
e) e) Treatment is usually open reduction

5) .A fractured femur
a) a) May be treated by sketal traction with a Steinmann pin through the knee
b) b) Will mostly result in avascular necrosis of the femoral head in a
subcapital fracture
c) c) Should be treated by internal fixation if the bone has an osteolytic
d) metastatic deposit
e) d) In a young adult commonly gives rise to fat embolism
f) e) Treatment by Gallows traction is suitable up to the age of 4 years

MCQ 2
1) Fractures of the calcaneum sre commonly associated with which of the
following Fractures of the other bones
a) Pelvis
b) Femur
c) Forearm bones
d) Colles’ fracture
e) Spine

2) Loose bodies in the knee joint maybe due to

a) Osteochondral fractures
b) Osgood-schlatter’s disease
c) Osteochondritis dissecans
d) Osteoarthrits
e) Synovial chondromatosis

3) Pathology of bone in rickets include the following

a) Widening of epiphyseal line
b) Broad and irregular metaphysis
c) Fragility of blood vessels
d) Proliferation of cartilage
e) Unmolded costochondrial junctions

4) Osteomyelitis
a) Pathologcal /iatrogenic fra is brought to your child by ctures results from early
sequestrectomy
b) Antibiotic therapy is usually brief (less than 2weeks)
c) The hip joint is at risk with proximal metaphyseal involvement of the femur
d) The knee joint will likely exhibit a marked sterile sympathetic effusion with distal
metaphyseal involvement of the femur
e) Periosteal reactions/bone mottling on Xray is a relatively late sign

S6
6) The carpal tunnel syndrome may be associated with
a) Diabetes
b) Supracondylar fractures
c) Rheumatoid arthritis
d) Syringomyelia
e) Acromegally

7) Cystic swelling in the popliteal fossa

a) Do not occur children
b) May be associated with osteoarthritis affecting the knee joint
c) Occurs in patients with rheumatoid arthritis of the knee joint
d) Must be differentiated from popliteal aneurysm in adults
e) Should always be excised

8) Monteggia fracture of the fore arm

a) Is a combination of fracture of the proximal ulna with dislocation of the radial head
b) Is a combination of a fracture of the radius with dislocation of distal radio-ulnar joint
c) Is not seen in children
d) Can usually be treated conservatively in adults
e) Is frequently associated with a posterior interosseous nerve palsy

9) Consider compound fractures of the tibia and fibula. True or False

a) Debridement is adviable
b) The skin must always be closed
c) The deep fascia may need to be opened up
d) The fracture should be plated
e) External fixators are used as method of choice
10) The following are complications of chronic osteomyelitis
a) Pathological fractures
b) Acute oesteomyelitis
c) Brodie’s abscess
d) Septicaemia
e) Amyloidosis

11) Dislocation of the shoulder

a) Can occur with minimal trauma
b) Recurrent dislocations should always be surgically treated
c) Most dislocations are posterior
d) Brachial plexus may be injured
e) Avulsion of greater tuberosity can occur

MCQ 5
1. About Pott’s Puffy Tumour:
a) It is a tuberculosis of skull
b) The most common organisms are staphylococcus
c) Antibiotics alone are curative
d) Surgery alone is the best
e) It affects mostly teenagers

2. Extra articular manifestation of rheumatoid arthritis include

a) Rheumatoid nodules typically seen on the flexor surfaces of joints
b) Nail bed of nail fold hemorrhages
c) A macrocytic and leucopenia
d) Splenomegally and leucopenia
e) A pericarditis which is often asymptomatic

3. Perthe’s disease
a) Usually prsents with a painful limp
b) May present with pain in the knee
c) Frequently prsents with limitation of all hip movements especially internal rotation and
abduction
d) Is associated with an intermittent pyrexia in the early stages
e) May occasionally be an incidental finding on radiograph for an unrelated problem

4. A compression fracture of the vertebral body caused by minor injury may be

associated with
a) Cushing’s disease
b) Osteoporosis
c) A solitary myeloma
d) A haemangioma
e) Osteoarthritis of the lumbar spine

5. The following are positive supportive signs of a recent torn medial meniscus of
the knee joint
a) An effusion
b) An inabilty to fully extend the knee
c) Retropatellar tenderness
d) The circumference of the quadriceps muscle increases
e) Medial joint lie tenderness

6. Avascular necrosis of the upper femoral epiphysis may be caused by

a) Fracture through the neck of the femur
b) Slipped upper femoral epiphysis
c) Septic arthritis of the hip
d) Fracture of the tibia and fibula
e) Juvenile diabetes

7. Volkman’s ischaemic contracture

a) Results in fixed contacture of the flexor muscles of the forearm
b) Is solely the effect of ischaemia on the median and ulnar nerves
c) May be precipiated by a displced supracondylar fracture of the elbow
d) Is atype of compartment syndrome
e) Results in hyperextension of the wrist and clawing of the fingers

8. The Carpal tunnel syndrome may be associated with:

a) Diabetes
b) Supracondylar fractures
c) Rheumatoid arthritis
d) Syringomyelia
e) Acromegally

9. Osteochondromata (multiple exostoses,diaphyseal aclasia)

a) Are benign without the capacity for malignant change
b) Occur most commonly in the diaphyseal area of a long bone
c) May be a cause of leg length inequally
d) Are usually larger clinically than radiologically
e) Develop with the distal end of the bony outgrowth directed towards the adjacent

10. A 60 year old woman presents with malaise,weight loss,aneamia and limp girdle
pain.X-rays show vertebral collapse and punched out areas in the long bones and
skull. The following are likely diagnosis:
a) Secondary deposits from breast carcinoma
b) Osteoporosis
c) Myeloma
d) Rheumatoid arthritis
e) Diabetes mellitus

11. The following are complications of Colles fracture of the wrist

a) Rupture of the extensor-tendon of the thumb
b) Frequently non-union of the fracture
c) Median nerve compression
d) Mal -union
e) Inferior radio-ulnar subluxation

12. The early clinical signs and symptoms of ischaemia in the forearm and hand
following closed reduction of a supracondylar fracture in children are:
a) Paralysiss of the median nerve
b) Gangrene of the tips of the fingers
c) Fixed contracture of the flexor muscles
d) Pain,especially on extension of the fingers
e) Absent radial pulse and poor capillary return

13. An acute anterior dislocation of shouder is associated with which of following

complications
a) Axillary nerve injury
b) Fracture of the neck of the humerus
c) Fracture of the greater tuberosity
d) Frequent rupture-of the axillary artery
e) A compression fracture in the head of the humerus

14. The following fractures usually require open reduction and internal fixation
a) An oblique fracture of the midshaft of the humerus
b) An oblique fracture of the proxiamal third of the ulna with anterior dislocation of the radial
head in an adult
c) A pathological fracture of the midshaft of the femur in a 40 year old female with breast
carcinoma
d) A two part intertrochanteric fracture in an elderly female
e) A displaced fracture of the lateral condyle of the elbow in a 10 year old

15. Common complications of inter trochanteric fractures despite treatment are:

a) Mal -union
b) Non-union
c) Coxa vara
d) Avascular necrosis of the femoral head
e) Sciatic nerve palsy

16. A patient sustains an anterior dislocation of the shoulder joint together with a
complete musculocutaneous nerve palsy. Which of the following willl be present?
a) Diminished sensation of the skin over the deltoid muscle
b) Absence of contraction of the biceps muscle
c) Decreased power of supination in the forearm
d) Decreased sensation over the medial border of the forearm
e) Weakness of flexion at the elbow

17. Pathological long bone fractures associated with malignant disease

a) Most commonly occur in breast carcinoma
b) Most frequently affect the femur and humerus
c) Should be treated by conservative means if possible
d) May be a presenting feature of malignancy
e) Invariably unite providing the fracture can be adequately immobilized

18. Following a fracture

a) There is death of bone cells adjacent to the fracture
b) Woven bone is formed beneath the periosteum which bridges the fractures fragements
c) Excessive mobilty at the fracture site may disrupt the bridging callus
d) Cells within the medullary cavity take no part in fracture healing
e) Cortical bone and its cellular constituents take no part in fracture healing despite
apposition of the bone ends

19. Factors associated with delayed or non union of a fracture are:

a) A low velocity type of injury
b) Soft tissues interposition between the fragments
c) The presence of large areas of cancellous bone
d) Excessive movement at th fracture site
e) Interruption of the blood supply to th bone fragments

20. Fat embolism syndrome is associated with the following signs and symptoms
a) A pyrexia
b) Multiple lower limb fractures
c) Petechial haemorrhages
d) Pericarditis
e) A bradycardia

MCQ 3
21. Fat embolism syndrome is associated with the following signs and symptoms
a) Pyrexia
b) Multiple lower limb fractures
c) Petechail haemorrhages
d) Pericarditis
e) Bradycardia
22. A 19 year man self inflicted a laceration to his left wrist with division of the
median nerve .The presentation is:
a) Wrist drop inability
b) Anaesthesia of the domain of hand
c) Inability to oppose thumb
d) Inabilty to abduct of adduct fingers
e) Paralysis of finger flexion

23. In children supracondylar fractures of the humerus are most frequently

complicated by
a) Injury to ulna nerve
b) Vascular compromise
c) Poor healing
d) Malunion
e) Injury to radial nerve

24. The following are indications for amputation

a) Any poliomyelitis limb
b) Staphylococcal bone infection
c) Clostridial perfringens infections
d) Gangrene of the foot
e) Frostbite

25. The following are complications of amputations

a) Wound infection
b) Joint ctraction
c) Skin excoriation
d) Bone overgrowth
e) Phantom limb

26. The following are complications of fractures

a) Compartment syndrome
b) Shock
c) Sudeck atrophy
d) Fat embolism syndrome
e) Infection and septicaemia

27. The carpal tunnel syndrome may be associated with:

a) Diabetes
b) Supracondylar fractures
c) Rheumatoid arthritis
d) Syringomyelia
e) Acromegally

28. Cystic swelling in the popliteal fossa

a) Do not occur in children
b) May be associated with osteoarthritis affecting the knee joint
c) Occurs in patients with rheumatoid arthritis of the knee joint
d) Must be differentated from popliteal aneurysm in adults
e) Should always be excised

29. Monteggia fracture of the forearm

a) Is a combination of a fracture of the proximal ulna with dislocation of the radial head
b) Is a combination of fracture of the radius with dislocation of distal radio-ulnar joint
c) Is not seen in chldren
d) Can usually be treated conservatively in adults
e) Is frequently associated with a posterior interroseous nerve palsy

30. Consider compound fractures of the tibia and fibula .True or false
a) Debridement is advisable
b) The skin must always be closed
c) The deep fascia may need to be opened up
d) The fracture should be plated
e) External fixators are used as method of choice

31. The following are complications of chronic oesteomyelitis

a) Pathological fractures
b) Acute oesteomyelitis
c) Brodie’s abscess
d) Septicaemia
e) Amyloidosis

32. Dislocation of the shoulder

a) Can occur with minimal trauma
b) Recurrent dislocation should always be surgically treated
c) Most dislocation are posterior
d) Brachial plexus may be injured

e) Avulsion of greater tuberosity can occur

GEN SURG 2021

1. With regard to ‘greenstick fracture’
a) It frequently occurs in adults
b) b) Rarely occurs in children
c) c) It‟s a complete fracture
d) d) It‟s a „hairline‟ fracture
e) e) Treatment involves immobilisation and analgesia

2. The following are indications for amputations

a) Any poliomyelitic limb
b) b) Staphylococcal bone infections
c) c) Clostridialperfringens infections
d) d) Gangrene of the foot
e) e) Frostbite

3. Dislocations of the shoulder

a) Can occur with minimal trauma
b) b) Recurrent dislocations should always be surgically treated
c) c) Most dislocations are posterior
d) d) Brachial plexus may be injured
e) e) Avulsion of greater tuberosity can occur

4. A fractured femur
a) a) May be treated by sketal traction with a Steinmann pin through the knee
b) b) Will mostly result in avascular necrosis of the femoral head in a subcapital fracture
c) c) Should be treated by internal fixation if the bone has an osteolytic metastatic deposit
d) d) In a young adult commonly gives rise to fat embolism
e) e) Treatment by Gallows traction is suitable up to the age of 4 years

5. With regard to dislocation of the hip

a) Anterior dislocation is more common compared with posterior
b) b) The leg lies externally rotated, abducted and slightly flexed
c) c) The lateral view is more confirmatory than the anteroposterior view
d) d) It is complicated by avascular necrosis in less than 10% of patients
e) e) Treatment is usually open reduction
SURG 1
1. 101. In spinal injury patients
a) a) The sensory level always corresponds to the spinal vertebral level of injury
b) b) Priapism is a sign of spinal injury
c) c) Paradoxical breathing occurs in high paraplegia of quadriplegia
d) d) Motor vehicle accidents are the commonest cause
e) e) Exclusion of other systemic injuries is very important

2. Nerve injury
a) a) Nerve injury is associated with closed fractures are usually neuropraxias
b) b) Ulnar nerve injury at wrist level is more of functional loss than median nerve injury
c) c) Clean incised nerves injury can be repaired immediately
d) d) Anaesthesia over the lateral aspect of the proximal upper arm indicates circumflex
nerve damage in anterior shoulder dislocation
e) e) Brachial plexus lesions following motor cycle injuries carry a poor prognosis 100.

3. The following are indications for amputation:

a) a) Any poliomyelitic limb
b) b) Staphylococcal bone infection
c) c) Clostridial perfringens infection
d) d) Gangrene of the foot
e) e) Frostbite

4. 7. The following are complications of amputation:

a) a) Wound infection
b) b) Joint contractures
c) c) Skin excoriations
d) d) Bone overgrowth
e) e) Phantom limb

5. . In children, suprachondylar fractures of the humerus are most frequently

complicated by:
a) a) Injury to the ulnar nerve
b) b) Vascular compromise
c) c) Poor healing
d) d) Malunion
e) e) Injury to radial nerve

6. A 19 year old man self-inflicted a laceration to his left wrist with division of the
median nerve. The presentation is:
a) a) Wrist drop
b) b) Inability to oppose the thumb
c) c) Anaesthesia of the dorsum of hand
d) d) Inability to abduct or adduct fingers
e) e) Paralysis of finger flexion

7. . Fat embolism syndrome is associated with the following signs and symptoms:
a) Pyrexia
b) b) Multiple lower limb fractures
c) c) Petechial haemorrhages
d) d) Pericarditis
e) e) Bradycardia

8. The following are complications of fractures:

a) a) Compartment syndrome
b) b) Shock
c) c) Sudeck’s atrophy
d) d) Fat embolism syndrome
 e) e) Infection and septicaemia

9. The carpal tunnel syndrome may be associated with

a) a) Diabetes
b) b) Supracondylar fracture
c) c) Rheumatoid arthritis
d) d) Syringomyelia
e) e) Acromegaly

10. Cystic swelling of the popliteal fossa

a) a) Do not occur in children
b) b) May be associated with osteoarthritis affecting the knee joint
c) c) Occurs in patients with rheumatoid arthritis of the knee joint
d) d) Must be differentiated from popliteal aneurysm in adults
e) e) Should always be excised

11. Monteggia fracture of the forearm:

a) a) It is a combination of a fracture of the proximal ulna with dislocation of the radial
head
b) b) It is a combination of a fracture of the radius with dislocation of distal radio-ulnar
joint
c) c) Is not seen in children
d) d) Can usually be treated conservatively in adults
e) e) Is frequently associated with a posterior interosseous nerve palsy

12. 12. Consider compound fractures of the tibia and fibula. True or false:
a) a) Debridement is advisable
b) b) The skin must always be closed
c) c) The deep fascia may need to be opened up
d) d) The fracture should be plated
e) e) External fixators are used as a method of choice

13. The following are complications of chronic osteomyelitis

a) a) Pathological fractures
b) b) Acute osteomyelitis
c) c) Brodie’s abscess
d) d) Septicaemia
e) e) Amyloidosis

14. 14. Dislocations of the shoulder

a) a) Can occur with minimal trauma
b) b) Recurrent dislocations should always be surgically treated
c) c) Most dislocations are posterior
d) d) Brachial plexus may be injured
e) e) Avulsion of greater tuberosity can occur

PRATICE 2A
67. The basic principle in the treatment of fractures of both bones of the forearm is to:
A. Reduce the angulation of the ulna
B. Reduce the angulation of the radius
C. Prevent overriding of fragments
D. Restore the normal relationship of the radius and ulna
E. Immobilise the elbow only

68. In congenital dislocation of the hip:

a) The diagnosis is usually established at 3 years of age
b) Abducting the flexed hip causes a click
c) Abduction of the flexed hip is not limited
d) Apparent lengthening of the affected thigh with the hip and knees flexed may be seen
e) Initial treatment is by open reduction

69. Initial treatment of a midshaft femoral fracture in an adolescent is:

a) Open reduction and internal fixation
b) Closed reduction and internal fixation with a Kuntscher nail
c) Skeletal traction
d) Cast brace
e) 1½ hip spica

70. Pathological fractures occur in:

a) Tumours
b) Developmental diseases of bone
c) Metabolic conditions
d) Infections
e) Sarcidosis

71. Bone tumours:

a) The commonest malignant tumour of bone is osteogenic sarcoma
b) The prognosis of osteosarcoma following Paget‟s disease is good
c) The osteochondroma is the commonest benign tumour affecting long bones
d) The osteosarcoma seen in the teenage group may mimic acute osteomyelitis
e) Histologically it may be difficult to differentiate an Ewing sarcoma from high grade
lymphoma

72. Bone tumours – true or false:

a) Bone marrow aspiration is a diagnostic technique in suspected malignancies that involve
bone marrow such as myeloma or lymphoma.
b) With the exception of Ewing‟s tumour, lymphoma ,leukemia and myeloma, most malignant
tumours are relatively radio resistant and surgery offers better local control than radiotherapy
c) In unicameral cysts surgery is indicated primarily because of diminished strength of bone
and risk of sustaining a pathological fracture
d) Osteosarcoma is most frequently seen around the ankle and wrist
e) Multiple myeloma is a malignant neoplasm derived from the plasma cells and usually a
normal protein synthesis is seen.

59. Fractures – true or false:

a) Greenstick fracture of the forearm usually require 8 to 10 weeks immobilisation in a
plastercast
b) A displaced closed simple tibial fracture in an adult usually unites 6 - 8 weeks after injury
c) Isolated cloed humeral fractures frequently result in non-union when conservative
treatment is applied.
d) An impaired subcapital neck of humerus fracture is frequently complicated by avascular
necrosis
e) A fracture of a long bone in an adult is considered a “non-union” if no union is present
3months after the Injury

60. Two hours after application of the plaster cast for supracondylar fracture patient
comes with
severe pain and swollen and cyanotic hand. The best course would be to:
a) Observe the patient
b) Administer vasodilators
c) Administer analgesics
d) Cut open the plaster cast near the fingers
e) Cut open the entire plaster cast immediately

61. Infections – true or false:

a) Osteomyelitis caused by salmonella species should arouse suspicion of sickle cell anemia
or some other hemoglobinopathy.
b) Penicillin G is the drug of choice for non-penicillinase producing staphylococci
c) If on radiological examination the periosteum is elevated or bone destroyed, then
osteomyelitis has been present for at least 5 days.
d) Radionuclide bone scans have proved to be helpful in the early diagnosis of osteomyelitis
e) When osteomyelitis is suspected in the metaphysic of the proximal femur in association
with a septic arthritis of the hip it is better to decompress the intertrochanteric area together
with the hip joint.

62. Amputations –true or false:

a) When performing an amputation the periosteum should be stripped excessively to avoid
sequestra or reactive bone formation
b) Amputation of all toes causes severe disturbances in ordinary slow walking
c) The ideal level for amputation below the knee is 14cm below the knee
d) The stump after a knee disarticulation is an end-bearing stump
e) The ideal level of an above knee amputation is just above the condyles

63. Traumatic affections of the joints – true or false:

a) The lateral meniscus is more frequently injured than the medial
b) The majority of ligamentous sprains of the lateral ankle ligaments can be treated by
immobilisation
c) A painful arc syndrome of the shoulder is the main clinical symptom of a full rupture of the
rotator cuff
d) Isolated anterior cruciate ligament ruptures of the knee are relatively rare
e) In tennis elbow the pain is localised to the medial epicondyle

64. Consider plaster casts – true or false:

a) Fractures of the scaphoid should be immobilised with the thumb in extension
b) Fractures of the tibia and fibula require a full length leg plaster
c) Solitary fractures of the ulna mid shaft without displacement require a below elbow plaster
d) It is good standard practice to make arm plasters as far distally as the proximal finger
crease
e) Colle‟s fracture requires an above-elbow plaster

65. Complications of pelvic fractures include:

a) Haemorrhage
b) Rupture of the bladder
c) Rupture of the urethra
d) Osteoarthritis of the hip
e) Leg length discrepancy

66. Sciatica from an acute prolapsed intervertebral disc:

a) Most commonly occurs in the over 40 year age group
b) Rarely occurs in women
c) Is usually caused by a sudden twisting injury of the spine
d) Most commonly involves the second lumbar nerve root
e) Requires urgent operative treatment to relieve pain

MDPZ SURGERY
15. The carpal tunnel syndrome may be associated with
A. [ ] Diabetes
B. [ ] Supracondylar fractures
C. [ ] Rheumatoid arthritis
D. [ ] Syringomyelia
E. [ ] Acromegally

16. Cystic swelling in the popliteal fossa

A. [ ] Do not occur in children
B. [ ] May be associated with osteoarthritis affecting the knee joint
C. [ ] Occurs in patients with rheumatoid arthritis of the knee joint
D. [ ] Must be differentiated from popliteal aneurysm in adults
E. [ ] Should always be excised

17. Monteggia fracture of the forearm

A. [ ] Is a combination of a fracture of the proximal ulna with dislocation of the radial
head
B. [ ] Is a combination of a fracture of the radius with dislocation of distal radio-ulna joint
C. [ ] Is not seen in children
D. [ ] Can usually be treated conservatively in adults
E. [ ] Is frequently associated with a posterior interosseous nerve palsy

18. Consider compound fractures of the tibia and fibula. True or false
19. [ ] Debridement is advisable
20. [ ] The skin must always be closed
21. [ ] The deep fascia may need to be opened up
22. [ ] The fracture should be plated
23. [ ] External fixators are used as method of choice

24. The following are complications of chronic osteomyelitis

25. [ ] Pathological fractures
26. [ ] Acute osteomyelitis
27. [ ] Brodie’s abscess
28. [ ] Septicemia
29. [ ] Amyloidosis

30. Dislocations of the shoulder

A. [ ] Can occur with minimal trauma
B. [ ] Recurrent dislocations should always the surgically treated
C. [ ] Most dislocations are posterior
D. [ ] Brachial plexus may injured
E. [ ] Avulsion of great tuberosity can occur

31. Fat embolism syndrome is associated with the following is associated with the
following signs and symptoms
A. [ ] Pyrexia
B. [ ] Multiple lower limb fractures
C. [ ] Petechial hemorrhages
D. [ ] Pericarditis
E. [ ] Bradycardia

32. A 19yr old man self inflicted a laceration to his left wrist with division of the
median nerve. The presentation is
A. [ ] Wrist drop
B. [ ] Inability to oppose thumb
C. [ ] Anaesthesia of the dorsum of the hand
D. [ ] Inability to abduct of adduct fingers
E. [ ] Paralysis of finger flexion
 33. In children supracondylar fractures of the humerus are most frequently
complicated by
A. [ ] injury to ulna nerve
B. [ ]Vascular compromise
C. [ ] Poor healing
D. [ ] Malunion
E. [ ] Injury to radial nerve

34. The following are indications for amputations

A. [ ] Any poliomyelitic limb
B. [ ] Staphylococcal bone infections
C. [ ] Clostridial perfringens infections
D. [ ] Gangrene of the foot
E. [ ] frostbite

35. The following are complications of amputations

A. [ ] Wound infection
B. [ ] Joint contractures
C. [ ] Skin excoriations
D. [ ] Bone overgrowth
E. [ ] Phantom limb

36. The following are complications of fractures

A. [ ] Compartment syndrome
B. [ ] Shock
C. [ ] Sudeck’s atrophy
D. [ ] Fat embolism
E. [ ] Infection and septicaemia

SURGERY MDPZ 2021

37. On mandibular fractures:
A. a) Commonly caused by road traffic accidents
B. b) Most do not require active treatment
C. c) Fracture reduction is rarely indicated
D. d) Establishing a proper occlusal relationship is the key to management
E. e) Teeth in fracture line result in infection

38. A child of 5 years of age has osteomyelitis of the upper humerus. On the third
day of the illness he has pyrexia. Which of the following treatments would be
appropriate?
A. a) Subperiosteal resection of all infected bone
B. b) Blood culture followed by immediate commencement of broad spectrum antibiotic
C. c) Sequestrectomy
D. d) Exposure of the infected bone by periosteal incision and drilling of the marrow
cavity
E. e) Application of a shoulder spica under general anaesthesia

39. Treatment of fractured shaft of femur:

A. a) In infants – gallows traction
B. b) In children and adolescents – balanced traction
C. c) In adults and elderly – locked nail
D. d) Always by closed reduction
E. e) In an emergency procedure

40. . In spinal tuberculosis:

 A. a) The infection develops in bone adjacent to each other
B. b) New bone formation is minimal in active infection
C. c) Radiographs usually show destruction of the body of a vertebra without
involvement of the disc
D. d) An abscess in the lumbar region may track down the psoas sheath and produce a
swelling in the groin
E. e) Paraplegia may occur due to formation of an abscess within the spinal cord

MDPZ SURGERY
41. FRACTURES
A. Greenstick fracture are common in the elderly
B. Comminuted fractures present with several fragments
C. Compression fractures common in the mandilbe
D. Spiral fracture long bone is twisted along its axis
E. Transverse fractures common in the mandible

42. COMPLICATIONS OF FRACTURE HEALING

A. Non-union
B. Mal-union
C. Infection
D. Malignant transformation
E. pain

43. Osteomyelitis
A. The usual cause is haematogenous spread
B. There is a history of antcedal trauma’
C. Subperioosteal bone formation produces a involucrum
D. Pus should be drained
E. There is tenderness over the involved area

44. Complications of amputation

A. Pain
B. Reactionary hemorrhage
C. Phantom pain
D. Infection
E. Recurrenc of gas gangrene

S6
1) Fat embolism syndrom is associated with the following signs and symptoms
a) Pyrexia
b) Multiple lower limb fractures
c) Petechial hemorrhage
d) Pericarditis
e) bradycadia

2) A 19year old man self conflicted a laceration to his left wrist with division of
the median [Link] presentation is
a) Wrist drop
b) Inability to oppose thumb
c) Anaesthesia of the dorsum of hand
d) Inabilty to abduct of adduct fingers
e) Paralysis of finger flexion
 3) In children, supracondylar fractures of the humerus are must frequently
comlplicated by
a) Injury to ulnar nerve
b) Vascular compromise
c) Poor healing
d) Malunion
e) Injury to radial nerve

4) The following are indications for amputations

a) Any poliomyelitic limb
b) Staphylococcal bone infections
c) Clodtridial perfringens infection
d) Gangrene of the foot
e) Frostbite

5) The following are complications of amputations

a) Wound infections
b) Joint contractures
c) Skin excoriations
d) Bone overgrowth
e) Phantom limb

6) The following are complications of fractures

a) Compartment syndrome
b) Shock
c) Suddeck’s atrophy
d) Fat embolism syndrome
e) Infections and septicaemia

SURG4
1. Which of the following is the characteristic displacement in slipped upper femoral
epiphysis
A. a) Anterior displacement of the femoral head
B. b) Lateral displacement of the femoral head
C. c) Medial displacement of the femoral head
D. d) Anterior displacement and external rotation of the femoral neck
E. e) Posterior displacement and internal rotation of the femoral neck

2. In which area does osteomyelitis usually begin in children

A. a) Joint
B. b) Epiphysis
C. c) Physis
D. d) Metaphysic
E. e) Diaphysis

3. Avascular necrosis is particularly associated with fracture of the following bones

A. a) Third metacarpal
B. b) Scaphoid
C. c) Talus
D. d) Mandibular condyle
E. e) Neck of femur

4. The rotator cuff of the shoulder joint is formed by the following muscles
A. a) Deltoid
B. b) Teres major
C. c) Pectoralis major
D. d) Pectoralis minor
E. e) Subscapularis

5. Which of the following agents is the most common causative agent in

osteomyelitis in a 7 year old with sickle cell disease
A. a) GAS
B. b) [Link]
C. c) [Link]
D. d) Pseudomonas aeruginosa
E. e) Salmonella species

6. Anterior shoulder dislocation

A. a) Is less common than posterior dislocation
B. b) Can be treated using Kocher manoeuvre
C. c) Is a recognised cause of axillary nerve palsy
D. d) Is usually subcoracoid
E. e) Usually presents with arm in the adduction position

7. Complications of tibial fractures include

A. a) Short leg
B. b) Compartment syndrome
C. c) Delayed union
D. d) Tibial nerve damage
E. e) Fat embolism

8. Osteogenic sarcoma
A. a) Has two age peaks of incidence
B. b) When affecting the limb, is treated by amputation in most cases
C. c) Has xray features including codman triangle
D. d) Most commonly affects the mertaphysis of the femur
E. e) Develops in a third of patients with pagets disease of the bone

9. Fracture neck of femur

A. a) Common fracture in old age
B. b) Trauma must be marked severe trauma
C. c) Most common in the elderly
D. d) Intracapsular fractures are more likely to heal than extracapsular fractures
E. e) Usually leads to hypovolemic shock

10. Recognised features of club foot include

A. a) Erosion of the os clacis
B. b) Adduction of the bones of the forefoot
C. c) A small os calcis
D. d) Abnormal histology of the calf muscle
E. e) Valgus of os calcis

BOOKS: BAILEY AND LOVE MCQ AND EMQ REVISION GUIDE

➜ Musculoskeletal history
1. Regarding history taking, which of the
following are not routinely part of the
process?
A Introduce yourself.
B Confirm the patient’s name and date
of birth.
C Obtain details of the patient’s past
medical history.
D Ask about any previous surgical procedures.
E Assess for tenderness.
➜ Musculoskeletal examination
2. Regarding the Apley system of
examination, which of the following
statements are true?
A It is a four-stage system.
B The ‘look’ stage only starts once the
patient has been fully exposed.
C It requires exposure only of the affected
limb and one joint above and below.
D Assessing the skin for scars, wounds
and redness is part of the ‘feel’ stage.
E It requires that the distal neurovascular
status be checked in all cases.
3. Regarding the Apley system of
examination, which of the following
statements are false in relation to the
‘move’ stage?
A ‘Move’ is the third stage of the Apley
system of examination.
B The physician should move the limb first
(passive movement).
C Stability includes checking muscle
power, joint stability and special tests.
D Abduction is movement of the limb
away from the midline.
E Muscle power is measured on a six-level
scale (0–5).
➜ Spine examination
4. Regarding examination of the spine,
which of the following statements are
true?
A Forward bend accentuates the rib hump
of idiopathic thoracic scoliosis.
B The thoracic spine normally has a
lordosis.
C A hairy tuft at the base of the spine is
diagnostic of Down syndrome.
D The Lasègue straight-leg raise test is a
special test for fixed flexion deformity
of the hip.
E Palpation of the spinous processes does
not detect a spondylolisthesis.
➜ Hand and wrist examination
5. Regarding examination of the hand
and wrist, which of the following
statements are false?
A Tight bands on the volar surface are
indicate of Dupuytren’s disease.
B Wasting of the thenar eminence is
diagnostic of an ulnar nerve palsy.
C Froment’s sign assesses the power of
adductor pollicis.
D Median nerve neuropathy can be
assessed with Phalen’s test.
E Allen’s test determines the efficacy of
the blood supply to the hand.
Shoulder and elbow
examination
6. Regarding examination of the
shoulder and elbow, which of the
following statements are true?
A The physiological carrying angle of the
elbow is less than five degrees.
B Tenderness over the common flexor
origin is diagnostic of tennis elbow.
C A positive Jobe’s test can be indicative
of rotator cuff impingement.
D Internal rotation of the shoulder is
normal if the patient can reach L2.
E A painful arc is diagnostic for a rotator
cuff tear.
➜ Hip examination
7. Regarding examination of the hip,
which of the following statements are
false?
A A broad based gait can be caused by
cerebellar ataxia.
B Leg-length discrepancy can be divided
into true and apparent.
C Thomas’s test assess for a fixed flexion
deformity of the hip.
D Trendelenburg test positive is indicative
of weak adductors.
E Impingement can be assessed with hip
flexion, adduction and internal rotation.
➜ Knee examination
8. Regarding examination of the knee,
which of the following statements are
true?
A The patellar tap test is a test for patellar
femoral osteoarthritis.
B The lag test assesses the integrity of the
flexor mechanism.
C The integrity of the collateral ligaments is
assessed with the knee in full extension.
D A posterior cruciate deficient knee will
have a positive Lachmann test.
E A positive apprehension test could
indicate a previously dislocated patella.
➜ Foot and ankle examination
9. Regarding examination of the foot
and ankle, which of the following
statements are false?
A Pes cavus is associated with Charcot
Marie Tooth disease.
B Loss of sensation in a glove-and-stocking
distribution is associated with diabetes.
C Inversion and eversion occur at the
ankle joint.
D The windlass test distinguishes
physiological from spastic flat foot.
E Patients with a ruptured tendo Achilles
might still be able to stand on their
tiptoes
Tendon disease
1. Regarding tendon injuries and repair,
which of the following statements are
true?
A The strength of a damaged tendon
returns to normal within 3 months
following injury.
B Tendons heal by degeneration of the
distal end followed by regrowth from
the proximal end.
C Paratendinitis has a poor prognosis.
D Tendinosis can be painless.
E Tendons consist of type-2 collagen
fibres.
➜ Ligaments
2. A patient who has a suspected
anterior cruciate ligament (ACL)
injury with pain around the knee and
some laxity to the ACL but with a firm
end-point on testing, has which grade
of injury?
A Grade 0
B Grade 1
C Grade 2
D Grade 3
E Not enough information
➜ Bursae
3. Regarding bursae, which of the
following statements are true?
A They are normal structures designed to
reduce friction.
B They do not contain synovium.
C They are unable to become inflamed
and infected.
D They do not have a nerve supply.
E None of the above.
➜ Stress fractures
4. Regarding stress fractures, which of
the following statements are true?
A They most frequently present acutely
following a high-intensity, high-load sport.
B Pain is very well localised.
C They are easy to diagnose with radiographs.
D MRI is a useful adjunct in the diagnosis.
E They heal at the same rate as acute fractures.
➜ Soft tissue injuries
5. Regarding soft tissue injuries, which of
the following statements are true?
A Soft tissue haematomas do not resolve
spontaneously.
B A cyst following a soft tissue haematoma
never requires surgical excision.
C Quadriceps tears routinely affect the
vastus lateralis muscle.
D Meniscal tears of the knee lead to a
rapid onset effusion.
E Damaged muscle can be replaced with
cartilage.
➜ Ankle injuries
6. Regarding the anatomic reduction of
displaced unstable ankle fractures
(Figure 34.1), which of the following
statements are true?
A It guarantees a full range of motion in
the long term.
B It guarantees full strength in the ankle in
the long term.
C It aims to avoid the premature onset of
osteoarthritis.
D It aims to avoid the premature onset of
osteoporosis.
E It aims to improve proprioception
1. Regarding the epidemiology of spinal
pathology, which of the following
statements are false?
A The lifetime prevalence of lower back
pain is 60%–80%.
B 80%–90% of acute low back pain
episodes resolve.
C 5%–7% of 45- to 64-year-olds report
back problems as a chronic illness.
D The lifetime prevalence of sciatica is
10%–15%.
E 70% of acute episodes of sciatica resolve
within three months.
➜ Clinical anatomy
2. Regarding clinical spinal anatomy,
which of the following statements are
false?
A Cervical lordosis is normally between 35
and 45 degrees.
B Most lumbar lordosis is between L4-S1.
C The spinal nerve roots comprise 7
cervical, 12 thoracic, 5 lumbar and
5 sacral.
D The spinal cord terminates at L1.
E The radicular artery of Adamkiewicz
is the main blood supply to the lower
spinal cord.
➜ History
3. Regarding the spinal patient history,
which of the following is not a
recognised finding in cauda equina
syndrome?
A History of malignant disease
B Unilateral or bilateral sciatica
C Saddle anaesthesia
D Lower-extremity motor weakness
E Bladder or bowel disturbance
➜ Physical examination
4. Regarding spinal physical examination,
which of the following nerve roots is
associated with an absent ankle jerk
reflex?
A L4
B L5
C S1
D S2
E S3
5. Regarding spinal physical
examination, which of the following
is a characteristic finding of an upper
motor neurone lesion?
A Decreased tone
B Hyper-reflexia
C Fasciculation
D Down-going plantars
E Sensory loss
➜ Investigations
6. Regarding spinal investigations, which
of the following statements are true?
A Plain radiographs of the spine should be
taken only if there is a history of trauma.
B Early tumour and infection can be
diagnosed on plain radiographs.
C MRI is the optimal method of visualising
the disc and nerve roots.
D CT is best for assessing soft tissue
pathology.
E Bone scintigraphy is used to diagnose
osteoporosis.
of the spine
7. Figure 35.1 is a sagittal MRI that
demonstrates spondylolisthesis
at the L4/5 level, with associated
disc pathology, facet joint arthrosis
and spinal stenosis. The patient
has had previous surgery to the
spine. How would you classify this
spondylolisthesis according to the
Wiltse classification?
A Dysplastic
B Isthmic type 2A
C Degenerative
D Isthmic type 2C
E Pathological
➜ Anatomy
1. Regarding anatomy of the shoulder,
which of the following is not a muscle
of the rotator cuff?
A Infraspinatus
B Subscapularis
C Supraspinatus
D Teres major
E Teres minor
2. Regarding anatomy of the hand,
which of the following muscles would
you find within the first extensor
compartment?
A Extensor pollicis brevis
B Extensor carpi radialis brevis
C Extensor pollicis longus
D Extensor carpi ulnaris
E Extensor digiti minimi
➜ Shoulder pathology,
assessment and management
3. Regarding adhesive capsulitis of the
shoulder, the loss of which of the
following shoulder movements is
pathognomonic?
A Abduction
B Flexion
C Extension
D Internal rotation
E External rotation
4. Regarding shoulder replacement
surgery, which of the following are
recognised benefits or options of the
procedure?
A Pain relief is always guaranteed.
B Range of movement will improve
dramatically.
C Deficiency to the rotator cuff is not
important.
D Shoulder arthrodesis gives a much
inferior range of movement.
E A partial shoulder replacement can be
an option.
➜ Elbow pathology, assessment
and management
5. Regarding compression of nerves
around the elbow, which nerve is
associated with weakness of finger
abduction?
A Anterior interossoues nerve
B Median nerve
C Ulnar nerve
D Posterior interosseous nerve
E Musculocutaneous nerve
➜ Hand pathology, assessment
and management
6. Regarding the general principles of
managing hand pathology, which of
the following is false?
A Avoid swelling and stiffness.
B Edinburgh position of safety is MCPJ
extension, PIPJ and DIPJ flexion at 90o .
C Elevation aids with swelling.
D Movement prevents stiffness.
E Splints aim to prevent contractures.
7. Regarding rheumatoid arthritis of the
hand, which of the following is not
a recognised manifestation of the
disease?
A Boutonnière deformity
B Extensor tendon rupture
C Prominent ulnar head
D Radial deviation of the metacarpopha
langeal (MCP) joints
E Swan neck deformity
➜ Hip joint – applied anatomy
1. Regarding the anatomy of the hip joint,
which of the following statements are
false?
A The hip joint is a ball-and-socket joint.
B The static stabilisers of the hip include
the capsule.
C The dynamic stabilisers are short
external rotators, iliopsoas and hip
abductors.
D The primary blood supply to the femoral
head is the lateral circumflex femoral artery.
E The labrum contributes to joint stability.
➜ Hip joint – biomechanics
2. Regarding the biomechanics of the
hip joint, which of the following
statements are false?
A The hip joint reaction force is influenced
by the body weight.
B The abductor muscles play a vital role in
supporting the pelvis.
C Standing on one leg results in a joint
reaction force of ~3 to 5 times body
weight.
D Running and jumping results in a joint
reaction force of ~8 to 10 times body
weight.
E A stick in the ipsilateral hand helps
to reduce the joint reaction force on
the hip.
➜ Conditions affecting
the hip joint
3. Regarding avascular necrosis of the
hip, which of the following is not a
recognised cause?
A Alcohol excess
B Caisson disease
C Chronic liver disease
D Sickle cell disease
E Smoking
4. Regarding osteoarthritis of the
hip joint, which of the following is
not a recognised finding on plan
radiographs?
A Joint space narrowing
B Osteophytes
C Subchondral collapse
D Subchondral cysts
E Subchondral sclerosis
➜ Hip joint – surgical
procedures
5. Regarding total hip replacement,
which of the following is a
recognised peri-operative
complication?
A Compartment syndrome risk of 2%.
B Dislocation rate of 2%–5%.
C Leg length inequality of more than
10 cm.
D Mortality from any cause of 2%–5%.
E Pulmonary embolus risk of 10%.
6. Regarding surgical approaches to
the hip, a Trendelenburg gait with
abductor weakness could be caused
by an injury to which nerve?
A Inferior gluteal nerve
B Superior gluteal nerve
C Pudendal nerve
D Sciatic nerve
E Femoral nerve
Knee joint – applied
anatomy
7. Regarding the anatomy of the knee
joint, which of the following is not a
dynamic stabiliser?
A Anterior cruciate ligament.
B Biceps femoris.
C Rectus femoris.
D Semitendinosus.
E Sartorius.
➜ Knee joint – surgical
procedures
8. Regarding arthroscopy of the knee,
which of the following is not an
indication for surgery?
A Anterior cruciate ligament reconstruction.
B Diagnose and treat meniscal tear.
C Loose body removal.
D Repair a ruptured patella tendon.
E Washout for septic arthritis.
Anatomy
1. Regarding foot and ankle anatomy,
which of the following statements are
true?
A The subtalar joint is responsible for
inversion and eversion of the hindfoot.
B The third metatarsal head is recessed to
act as a ‘keystone’ in the transverse arch.
C The windlass test assesses the integrity of
the flexor muscles in the sole of the foot.
DThe saphenous artery contributes to the
blood supply of the foot.
E The first dorsal web space of the foot is
supplied by the superficial peroneal nerve.
2. Regarding compartments of the leg,
which of the following structures
are not found within the anterior
compartment of the leg?
A Deep peroneal nerve
B Extensor hallucis longus
C Peroneus tertius
DTibial nerve
E Tibialis anterior
➜ Pathology in the adult
forefoot
3. Regarding hallux valgus, which of the
following statements are false?
A Deviation of the hallux is away from the
midline.
B It is more commonly seen in men.
C There is a genetic component.
D It can be associated with pain.
E Hammering of the second toe can occur.
➜ Pathology in the adult –
midfoot and hindfoot
4. Regarding acquired pes planus, which
of the following is not classically
associated with the deformity?
A Tibialis posterior tendon dysfunction
B Tarsometatarsal osteoarthritis
C Charcot–Marie Tooth
D Hindfoot osteoarthritis
E Tarsal coalition
5. Regarding arthritis of the ankle
(tibiotalar joint) and hindfoot, which of
the following statements are false?
A Ankle replacement is indicated in
low-demand patients with mild to
moderate deformity.
B Arthrodesis is indicated in high-demand
patients.
C Osteophyte removal can be effective
for impingement with no significant
osteoarthritis.
D For single joint hindfoot arthritis, triple
fusion is still the treatment of choice.
E Knee deformities should be assessed
and treated prior to surgery for foot or
ankle problems.
➜ General principles
1. Regarding malignant bone tumours,
which of the following is the most
common primary bone malignancy?
A Chondrosarcoma
B Ewing’s sarcoma
C Metastases
D Multiple myeloma
E Osteosarcoma
➜
Metastases
2. Regarding bone metastases, which of
the following is a common primary
site?
A Brain
B Breast
C Colonic
D Gastric
E Pancreatic
➜ Osteogenic and
chondrogenic tumours
3. Regarding osteogenic and
chondrogenic tumours, which of the
following is associated with Ollier’s
disease?
A Chondroblastoma
B Chondrosarcoma
C Enchondroma
D Osteoid osteoma
E Osteosarcoma
➜ Bone tumour classification
4. Regarding the Enneking staging
system for malignant bone tumours,
what stage is a high-grade extra
compartmental osteosarcoma?
A IA
B IB
C IIA
D IIB
E III
➜ Soft tissue tumours
5. Regarding soft tissue tumours, which
of the following is not a common
warning symptom or sign?
A Increasing in size
B Larger than 5 cm
C Pain
D Recurrence of previous excision
E Superficial to the fascia
➜ Treatment
6. Regarding the classification of surgical
resection margins, which of the
following defines a resection through
the reactive zone of the tumour?
A Biopsy
B Intralesional
C Marginal
D Radical
E Wide
General principles
1. Regarding bone and joint infection,
which of the following is not a Gram
positive organism?
A Staphylococcus aureus
B Coagulase-negative staphylococci
C Haemophilus influenzae
D Streptococci pneumonia
E Streptococci viridans
2. Regarding acute bone and joint
infections, which of the following is
not routinely part of the investigative
work up?
A Bloods including CRP and ESR
B Radiographs of affected bone or joint
C Ultrasound
D MRI
E Bone scan
➜ Native joint septic arthritis
3. Regarding native joint septic arthritis,
which of the following is not a
recognised risk factor?
A Bacteraemia
B Intravenous drug abuse
C Nonsteroidal anti-inflammatory drugs
(NSAIDs)
D Rheumatoid arthritis
E Steroids
➜ Implant-related infection
4. Regarding implant related infection,
which of the following statements is false?
A Loose implants require removal.
B In the presence of infection, well-fixed
prostheses should still always be removed.
C Multiple microbiological samples are
taken at the time of revision surgery.
D Revision can be a one-stage or two-stage
procedure.
E Long-term antibiotics are sometimes
required in patients unfit for revision
surgery.
➜ Acute osteomyelitis
5. Regarding acute osteomyelitis,
which of the following statements
is true?
A In young children, refusal to weight
bear alone is not consistent with
osteomyelitis.
B Haemophilus influenzae is the
most common causative organism in
children.
C Inflammatory markers are routinely
normal.
D Radiographic changes can take over 1
week to develop.
E In the acute phase, surgery is usually
required.
➜ Chronic osteomyelitis
6. Regarding chronic osteomyelitis,
infection confined to the cortical
bone is denoted by which stage of
osteomyelitis according to the Cierny
and Mader classification?
A Stage 1
B Stage 2
C Stage 3
D Stage 4
E Stage 5
General paediatric
orthopaedics
1. Which of the following statements
are false regarding development and
normal variants seen in paediatric
orthopaedics?
A Limb bud embryogenesis commences at
4 weeks after fertilisation.
B An in-toeing gait is associated with a
negative foot progression angle.
C In-toeing can be caused by persistent
femoral neck retroversion.
D All children start with bowlegs and progress
to knock-knees by 2 to 3 years of age.
E Children under the age of 3 years
commonly have flat feet.
➜ Congenital and developmental
skeletal abnormalities
2. In relation to congenital and
developmental skeletal abnormalities,
which of the following statements are
false?
A Fibular hemimelia is a transverse failure
of formation of parts.
B Congenital constriction band syndrome
often affects the hands and feet.
C Gigantism is an example of an
overgrowth malformation.
D Achondroplasia is associated with a
defect in the FGFR3 gene.
E Reduced intake of vitamin D and calcium
is associated with rickets.
➜ Abnormalities of the hip
(Developmental dysplasia
of the hip [DDH])
3. In relation to DDH, which of the
following statements are false?
A It is more common in boys than in girls.
B It is associated with a breech presentation.
C It is more common in first born.
D It can be assessed clinically using Ortolani
and Barlow examination manoeuvres.
E Ultrasonography is the best diagnostic
tool in the neonate.
➜ Abnormalities of the
hip (Perthes)
4. In relation to Legg-Calvé-Perthes’
disease, which of the following
statements are false?
A Perthes’ disease is an idiopathic
avascular necrosis (AVN) of the proximal
femoral epiphysis.
B It commonly affects boys.
C Low birth weight is a risk factor.
D Sickle cell disease could lead to a similar
presentation.
E Age of onset does not influence
prognosis.
➜ Abnormalities of the hip
(slipped upper femoral
epiphysis [SUFE])
5. In relation to slipped upper femoral
epiphysis, which of the following
statements are true?
A The peak age of onset is 6 years.
B Pain in the knee is uncommon.
C Hypothyroidism is a risk factor for SUFE.
D A mild slip is when <50% of the
metaphysis is uncovered.
E Anatomical reduction and pinning is the
optimal treatment.
➜ Abnormalities of the foot
and ankle (clubfoot)
6. In relation to congenital taclipes
equinovarus (CTEV), which of the
following statements are false?
A It is more common in boys.
B Spina bifida is associated with CTEV.
C Deformity is characterised by hindfoot
equinus or varus and forefoot abduction
or supination.
D Pirani scoring system is used to
assess the severity of CTEV and guide
prognosis.
E The Ponseti method for correcting
deformity is successful in over ~90%
cases.
➜ Spinal deformities
and back pain
7. A child presents with chronic lower
back pain and subsequent x-rays
reveal a spondylolisthesis of L5/S1,
with a 60% slip. What is the Grade of
this patient’s slip?
A1
B2
C3
D4
E5

BOOKS: BAILEY AND LOVE MCQ AND EMQ COMPANION

GUIDE
Musculoskeletal history
1. Introducing yourself to a patient
includes:
A Giving your own name
B Checking the patient’s name
C Explaining what is to happen
D Obtaining the patient’s consent to
proceed.
E Washing your hands
F Obtaining adequate exposure
G Checking for tenderness.
➜ Musculoskeletal examination
2. Which of the following statements
about the Apley system of examination
are true?
A It is a four-stage system.
B The ‘look’ stage only starts once the
patient has been undressed.
C It requires exposure only of the affected
limb and one joint above and below.
D It starts with checking the skin for scars,
wounds and redness.
E It then moves to bone-checking for
deformity.
F It requires that the distal neurovascular
status is checked in all cases.
3. Which of the following statements
regarding the ‘feel’ stage of the Apley
system of examination are true?
A The ‘feel’ stage is the second stage of the
Apley system.
B It is wise to ask the patient if anywhere is
tender before starting ‘feeling’.
C When feeling, the same triad is used as
in looking.
D Distal neurovascular status must
be checked in all musculoskeletal
examinations.
E Examiners should not watch their hands
when feeling.
4. Which of the following statements
regarding the ‘move’ stage of the Apley
system of examination are true?
A ‘Move’ is the third stage of the Apley
system of examination.
B You should move the limb first.
C Stability includes checking power of
muscles, stability of joints and special
tests.
D Abduction is a movement away from the
midline.
E Muscle power is measured on a 6-level
scale.
➜ Spine examination
5. Which of the following statements are
true?
A Asking the patient to bend forward
accentuates the rib hump of idiopathic
scoliosis.
B The thoracic spine normally has a
lordosis.
C A hairy tuft at the base of the spine is
diagnostic of Down’s syndrome.
D The Lasègue straight-leg raise test
specifically tests the range of movement
in the hip joint.
E Palpation of the spinous processes allows
you to feel a spondylolisthesis.
➜ Hand and wrist examination
6. Which of the following statements are
true?
A Dupuytren’s contracture is seen as tight
bands in the skin, usually pulling down
the fingers on the ulnar side of the
hand
B Wasting of the thenar eminence is
diagnostic of an ulnar nerve palsy.
C Two point discrimination provides an
accurate way of detecting sensory loss in
the hand.
D Allen’s test should always be performed
before performing surgery in the hand.
E Transection of flexor digitorum
superficialis can be tested by holding the
patient’s finger firmly and asking them to
flex the distal interphalangeal joint
alone.
F A useful test for median nerve
compression in the carpal tunnel is to
tap over the flexor retinaculum and see
if the patient feels lightning pains in the
fingers.
➜ Elbow and shoulder
examination
7. Which of the following statements are
true?
A The physiological carrying angle of the
elbow is the degree of flexion a patient
finds most comfortable.
B Tenderness over the common flexor
origin is diagnostic of tennis elbow.
C The rotator cuff in the shoulder runs
under the tip of the acromion.
D In dislocation of the shoulder the
humeral head usually moves anteriorly.
E Jobe’s empty can test is specific for
rotator cuff impingement.
F The shoulder apprehension test is
diagnostic of the shoulder being out of
joint.
➜ Hip examination
8. Which of the following statements are
true?
A Fixed abduction deformity is characteristic
of osteoarthritis of the hip.
B Leg-length discrepancy can be divided
into true and apparent.
C Patients with weak abductor muscles
bob up and down as they walk.
D Asking the patient to stand on one leg
with their hands resting on yours is
called the Trendelenburg test.
E Rotation of the hip is best tested with
the hip flexed to 45º and the knee
flexed to 90º.
➜ Knee examination
9. Which of the following statements are
true?
A A small effusion in the knee is most
easily seen on the medial side when a
stroke test is performed.
B The lag test checks for loss of extension
in the knee joint.
C The integrity of the collateral ligaments
is tested with the knee in full extension.
D A patient with a posterior cruciate
ligament disruption will have a positive
draw test.
E A patient who has previously dislocated
their patella will have a positive
apprehension test.
➜ The foot and ankle
10. Which of the following statements are
true?
A Pes cavus is associated with Marfan’s
syndrome.
B Loss of sensation in a glove-and
stocking distribution is associated with
diabetes.
C Inversion and eversion occur at the
ankle joint.
D The windlass test distinguishes
physiological from spastic flat foot.
E Patients with a ruptured tendo Achilles
can still stand on their toes.
Case study – shin injury
1. A cricketer complains of pain in his
shin which has been present for
several months but which got worse
today after a prolonged bout of fast
bowling. The shin is slightly red, a little
swollen and tender to touch.
(a) What class of injury is this likely to
belong to?
A Acute extrinsic
B Acute intrinsic
C Chronic.
(b) What is the physical treatment plan?
A Immediate intensive physiotherapy
B Plaster of Paris immobilisation
C Continue sport, by controlling symptoms
with analgesics
D Steroid injection
E Find alternative exercise plan which does
not load the tibia.
(c) Give two reasons why non-steroidal
anti-inflammatories might be helpful.
A To reduce pain
B To reduce oedema
C To enable immediate return to sport
before the injury is healed
D To prevent the problem spreading to the
other leg.
➜ Soft-tissue haematoma
2. Which of the following statements
regarding soft-tissue haematomas are
true?
A Most resolve spontaneously.
B If a cyst develops, surgical excision may
be needed.
C The changes can become malignant.
D The bruised muscle may sometimes be
replaced with cartilage.
➜ Tendon injuries
3. Which of the following statements
regarding tendon repair are true?
A The strength of a damaged tendon
decreases for some time after injury
and only returns back to normal after 6
months.
B Tendons heal by degeneration of the
distal portion followed by regrowth from
the proximal end.
C Paratendinitis has a poor prognosis.
D Tendinosis can be painless.
E Tendons consist of type 1 fibres.
➜ Case study – ligament injury
4. A sportsman presents having sprained
his thumb. There is slight painless
laxity in the ulna collateral ligament.
What grade of ligament injury is this?
A Grade 0
B Grade 1
C Grade 2
D You cannot tell until you have compared
it with the other side.
➜ Bursae
5. What are the characteristics of bursae?
A They are normal structures designed to
reduce friction.
B They are lined with synovial membrane
and connected to the joint beneath.
C They are able to become inflamed and
infected.
D They have no nerve supply.
➜ Bone healing
6. Which of the following statements are
true?
A The first phase of bone healing is the
laying down of bone in the fracture cleft
B Callus is mature bone laid down around
the fracture area.
C Remodelling of the bone goes on for
many months after the fracture.
D Stress on bone stimulates more bone to
be laid down.
➜ Stress fractures
7. Stress fractures:
A Are most common in high intensity high
load sports
B Produce highly localised pain
C Are difficult to see on X-ray
D Show up well on magnetic resonance
imaging (MRI)
E Heal quickly.
➜ Ankle injury
8. Why is the anatomical reduction of an
ankle fracture so important?
A To enable return of a full range of
movement
B To allow full strength in the ankle
C To improve proprioception
D To avoid premature onset of
osteoarthritis
E To avoid the onset of premature
osteoporosis.
➜ Injuries to the plantarflexor
mechanism of the ankle
9. Which of the following statements
regarding plantarflexor mechanism
injury are true?
A Musculotendinous junction tears of the
Achilles tendon do not require surgery.
B Re-rupture of the Achilles tendon within
1 year of injury occurs in less than 10 per
cent of cases however they are treated.
C Simmond’s test involves squeezing the
calf and looking to see if the foot moves.
D Surgical repair of the ruptured tendo
Achilles carries a significant risk of
causing nerve damage.
➜ Case studies – shoulder
injury
10. A 20-year-old man sustains a dislo
cation of the shoulder playing rugby.
(a) What would you tell him is the
chance of this shoulder dislocating
again?
A _x0007_50 per cent
B 50 per cent
C 80 per cent.
(b) The man asks what is the chance of
the other shoulder dislocating. What
answer would you give him?
A _x0007_50 per cent
B 50 per cent
C 80 per cent.
11. A 25-year-old suffers a tear of the
rotator cuff in a bad fall. You offer to
repair it. What would you offer him
as the chances of the repair being
successful?
A _x0007_50 per cent
B 50 per cent
C 80 per cent.
12. A rugby player fell onto his shoulder
some weeks ago. He now presents
with a painful lump about 4 cm in
diameter on the top of his shoulder.
What has he injured?
A Common extensor origin
B The acromioclavicular joint
C The head of the humerus
D The sternoclavicular joint
E The rotator cuff.
➜ Case studies – elbow injury
13. A sportsman complains of pain over
the lateral side of his elbow. What is
the source of the problem?
A Common extensor origin
B Acromioclavicular joint
C The radiohumeral joint
D The radioulnar joint
E The ulnar nerve.
14. A weight-lifter complains of
numbness and tingling in his fingers.
What has he injured?
A Common extensor origin
B Acromioclavicular joint
C The ulnar nerve
D The median nerve
E The brachial plexus.
➜ Epidemiology, anatomy and
physiology of back pain
1. Which of the following statements
regarding back pain are true?
A The chances of anyone having back pain
at some time in their life is around 50
per cent.
B Over 80 per cent of episodes of back
pain settle within 6 weeks.
C The radicular artery of Adamkiewicz
is the main blood supply to the lower
spinal cord.
D Onset of back pain after the age of 55 is
a ‘red flag’ sign.
E ‘Yellow flags’ are worrying but less critical
than ‘red flags’.
➜ Case study – sudden onset
of urinary incontinence
2. A 30-year-old nurse lifting in the
ward experiences sudden pain in her
back. She goes to Sister’s office to sit
down. The pain eases but now she
notices that she has difficulty standing
and walking (her legs feel weak and
wobbly, and she has been incontinent
of urine).
(a) What is the rare but very dangerous
diagnosis which needs excluding?
A Collapsed vertebral body secondary to
occult myeloma
B Central disc prolapse
C Transverse myelitis
D Dissecting aneurysm blocking off the
blood supply to the spinal cord.
(b) What physical tests (when present)
would help to exclude this diagnosis?
A Testing for weakness of extensor hallucis
longus
B Unilateral loss of ankle reflex
C Saddle anaesthesia
D Loss of anal tone
E Increase in pain.
(c) What action needs to be taken?
A Analgesia and bed rest
B Immediate lumbar spine X-ray
C Lumbar puncture
D Urgent referral to a neurologist
E Immediate referral to a spine surgeon.
➜ Imaging in back disorders
3. Which of the following statements
about imaging are true?
A Plain X-rays of the spine should only be
taken if there is a history of trauma.
B Magnetic resonance imaging (MRI) is the
best way of visualising the disc and nerve
roots.
C CT scan is best for looking for patients
with multiple vertebral body collapses
secondary to myeloma.
D Bone densitometry is needed to
diagnose osteoporosis.
E Bone scintigraphy is a simpler method
for measuring bone density.
➜ Case study – collapsed
vertebrae
4. A 70-year-old man who has smoked
all his life now presents feeling unwell
and with weight loss. He also has
backache which wakes him at night.
Chest X-ray is normal but plain X-ray
of the spine shows several collapsed
vertebrae. Blood tests have already
been sent.
(a) What investigation is likely to be most
useful for identifying the cause of the
collapses?
A Computed tomography (CT)-guided
biopsy
B Barium enema
C CT of lung
D Barium meal and follow-through
E Intravenous pyelogram.
(b) The man’s lesion is thought to be an
adenocarcinoma of unknown origin
(probably bowel). What treatment
options are available?
A Radiotherapy
B Chemotherapy
C Harrington rods to the spine
D Steroids
E Embolisation of tumours
➜ Case study – pain which
wakes at night
5. A 65-year-old man who has lived all
his life in Britain presents with severe
and constant back pain at L3, which
does not radiate down the legs. It
wakes him at night and he has night
sweats. X-rays show destruction of the
disc space at L2/L3 with invasion of the
destruction into the adjacent vertebral
bodies. What would you expect to find
on needle biopsy?
A Tumour cells (metastases)
B Primary chondrosarcoma cells
C Mycobacterium tuberculosis
D Escherichia coli
E Sterile avascular necrosis.
➜ Case study – sciatica
6. A 40-year-old labourer presents with
backache radiating down the left leg
to the foot. His left foot drags and
on examination he has weakness in
extensor hallucis longus. There is also
diminished sensation over the dorsum
of the foot and the lateral side of the
calf. What is the likely diagnosis?
A Prolapse of the L5/S1 disc pressing on
the S1 nerve root
B Prolapse of the L5/S1 disc pressing on
the L5 nerve root
C Facet joint arthritis
D Infective discitis
E Neuroma of a nerve root.
➜ Claudication
7. How can spinal claudication
be distinguished from vascular
claudication?
A Only vascular claudication is initiated by
exercise.
B Spinal claudication is worse in extension
vascular in flexion.
C Distal pulses are present only in spinal
claudication.
D Spinal claudication progresses in less
than 50 per cent; vascular progresses in
more than 50 per cent of cases.
E Spinal claudication can be treated by
spinal decompression.
➜ Case study – low back pain
8. A young rower complains of sudden
onset of low back pain when weight
lifting. There is no radiation of the pain
and there is no neurological deficit.
There is considerable lordosis of the
lumbar spine with a step palpable
at L5/S1. What is the most likely
diagnosis?
A Prolapsed intervertebral disc
B Spondylolisthesis
C Collapsed vertebra
D Muscle strain.
➜ Case study – rib hump in
teenager
9. A 13-year-old female presents with a
rib hump. She has had no problems
previously. Abdominal reflexes are
equal and normal.
(a) What is the likely diagnosis?
A Neuromuscular scoliosis
B Lipoma
C Steroid-induced rib hump
D Idiopathic scoliosis
E Undescended scapular.
(b) What test can be used to measure the
severity of the problem?
A Lung function test
B Cobb’s angle on a spine X-ray
C Rib X-rays with intercostal measurement
D Self-esteem questionnaire
E Coronal section MRI chest.
(c) What method can be used to predict
the prognosis (likely progression of the
curve)?
A Age of the patient
B Risser’s sign
C Further growth potential as calculated
from parental height
D Degree of curvature
E Plasma calcium
Rotator cuff
1. Which muscles control the rotator cuff?
A Supraspinatus
B Teres major
C Teres minor
D Infraspinatus
E Pectoralis minor
F Subscapularis.
➜ Shoulder replacement
2. What benefits are offered by a
shoulder replacement?
A Pain relief is guaranteed.
B Range of movement will improve
dramatically.
C An absence of the rotator cuff makes no
difference.
D An arthrodesis would give a much worse
range of movement.
E A partial shoulder replacement is also an
option.
➜ Case studies – shoulder
dislocation
3. A young woman notices that her
shoulder comes out of joint sometimes
when she is asleep. She is able to
put it back by jiggling her shoulder
carefully.
(a) What type of dislocation is this most
likely to be?
A Habitual
B Traumatic anterior
C Traumatic posterior
D Atraumatic subluxation.
(b) What is the best treatment?
A Physiotherapy and re-education
B Physiotherapy first but if that fails then
surgical repair of the Bankart lesion
34
The upper limb
Multiple choice questions
C Physiotherapy first but if that fails then
reefing of the capsule.
4. A child develops a habit (party trick) of
subluxing her shoulder backwards.
(a) What type of dislocation is this most
likely to be?
A Habitual
B Traumatic anterior
C Traumatic posterior
D Atraumatic subluxation.
(b) What is the best treatment?
A Physiotherapy and re-education
B Physiotherapy first but if that fails then
surgical repair of the Bankart lesion
C Physiotherapy first but if that fails then
reefing of the capsule.
5. A rugby player puts his shoulder out
falling in a scrum.
(a) What type of dislocation is this most
likely to be?
A Habitual
B Traumatic anterior
C Traumatic posterior
D Atraumatic subluxation.
(b) What is the best treatment?
A Physiotherapy and re-education
B Physiotherapy first but if that fails then
surgical repair of the Bankart lesion
C Physiotherapy first but if that fails then
reefing of the capsule.
➜ Rheumatoid arthritis
6. Which of the following deformities
are seen in a patient with chronic and
severe rheumatoid arthritis?
A Swan neck deformity
B Boutonnière deformity
C Heberden’s nodes
D Extensor tendon rupture
E Trigger finger
F Dupuytren’s contracture
G Radial deviation of the
metacarpophalangeal (MCP) joints
H Subluxation and dislocation of the MCP
joints
I Ulnar deviation of the wrist
J Prominent ulnar head
K Extensor tenosynovitis.
7. Which of the following treatments give
reliable results in rheumatoid arthritis
of the hand?
A Synovectomy
B Excision of the distal ulna
C Prosthetic replacement of the wrist
D Prosthetic replacement of the MCP and
interphalangeal joints
E Arthrodesis of the wrist
F Tendon repair
G Tendon transfer
Anatomy and physiology of
the hip
1. Which of the following are involved
in blood supply to the adult femoral
head?
A Artery of the ligamentum teres
B Retinacular branches of the medial
circumflex femoral artery
C Capsular branches of superior gluteal
artery.
2. Which of the following structures are
involved in static stability of the hip
joint?
A Capsule
B Labrum
C Gemelli
D Pectineus
E Iliopsoas
F Ligamentum teres
G Anterior inferior iliac spine
H Cup and socket shape of hip joint
I Abductor muscles
J Hamstrings
K Gluteals.
3. Which of the following structures are
involved in supporting the pelvis when
standing on one leg?
A Capsule
B Labrum
C Gemelli
D Pectineus
E Iliopsoas
F Ligamentum teres
G Anterior inferior iliac spine
H Cup and socket shape of hip joint
I Abductor muscles
J Hamstrings
K Gluteals.
35
The hip and knee
Multiple choice questions
➜ Radiological features in
osteoarthritis
4. Which of the following are radiological
features of osteoarthritis of the hip?
A Subchondral sclerosis
B Multiple microfractures
C Subchondral cysts
D Coarsening of the trabecular pattern
E Narrowing of the joint space
F Osteophyte formation
G Periarticular osteoporosis.
➜ Total hip replacement
5. If you had to explain to a patient the
complications of total hip replacement,
which of the following would you
mention?
A Infection
B Deep vein thrombosis
C Renal failure
D Urinary tract infection
E Nerve damage
F Synergistic gangrene
G Chest infection
H Stroke
I Dislocation
J Fracture
K Severe bleeding requiring transfusion
L Death from any cause less than
1 per cent
M Leg length inequality more than 10 cm
N Compartment syndrome.
➜ Knee stability
6. Which of the following are dynamic
stabilisers of the knee?
A Biceps femoris
B Anterior cruciate ligament
C Posterior cruciate ligament
D Sartorius
E Gracilis
F Semitendinosus
G Medial meniscus
H Lateral meniscus
I Quadriceps femoris
J Adductor longus.
➜ Arthroscopy of the knee
7. Which of the following are indications
for arthroscopy of the knee?
A Diagnose and treat torn meniscus
B Check for avascular necrosis
C Repair ruptured patella tendon
D Remove loose bodies
E Repair cruciate ligament rupture
F Decompress Osgood–Schlatter disease
G Relieve a joint effusion.
1. Which of the following statements are
true?
A The talus is narrower posteriorly so that
as the foot comes into dorsiflexion the
talus locks in the mortice between the
medial malleolus on the tibia and the
lateral malleolus on the fibula. The foot
then rotates externally.
B The subtalar joint is responsible for
inversion and eversion of the hindfoot.
C The third metatarsal head is recessed to
act as a ‘keystone’ in the transverse arch.
D The windlass test is performed to check
the integrity of the flexor muscles in the
sole of the foot.
E The skin on the dorsum of the foot
is mainly supplied by the superficial
peroneal nerve.
➜ Midfoot and hindfoot
2. Which of the following statements are
true?
A Surgery to deal with deformity in the
knee should only be undertaken once
problems of pain, stiffness and deformity
in the foot have been resolved.
B Surgery in the foot should be undertaken
early and aggressively, not once all
non-operative possibilities have been
exhausted.
C Ankle replacement is a good option for
arthritis of the tibiotalar joint in the low
demand patient, providing there is not
severe deformity.
D Arthrodesis is the treatment of choice for
an ankle joint which has severe arthritis
and which is painful in a high-demand
patient.
E Osteophyte removal is a good alternative
in the painful ankle where it can be
shown that impingement is causing pain
and there is no significant osteoarthritis.
F When only one joint of the hindfoot
complex is involved, it is nevertheless
best to perform a triple fusion because
all the joints are interrelated.
G Rupture of tibialis posterior leads to a
valgus flatfoot, which is painful.
H Pes cavus is a common presentation of a
neurological condition such as Charcot–
Marie–Tooth or of diastomatomyelia.
I Osteomyelitis in the diabetic foot does
not usually spread and so can be treated
with minimal local interference.
J Charcot joints tend to be painful, with
X-ray changes minimal compared with
the pain experienced by the patient.
Rheumatoid arthritis
1. Which of the following statements
regarding rheumatoid arthritis are
true?
A It is much commoner in women than in
men.
B A negative rheumatoid factor excludes
this diagnosis.
C The disease appears to be based on a
T-cell autoimmune response.
D The disease usually attacks large joints,
such as the hip.
E Joints are destroyed by an inflammatory
pannus.
2. Which of the following are extra
articular manifestations of rheumatoid
arthritis?
A Retinal detachment
B Subcutaneous nodules
C Myocardial infarction secondary to
atherosclerosis
D Renal failure secondary to nephritis
E Sarcoidosis
F Heberden’s nodes
G Early malignancies in affected tissues
H Asthma.
3. Which of the following are
characteristic features of rheumatoid
arthritis of the hands?
A Ulnar deviation of the wrist
B Spontaneous ruptures of the flexor
tendons
C Ulnar deviation and subluxation of the
metacarpophalangeal joints
D W-deformity of the thumb
E Carpal tunnel syndrome
F Hyperflexion of the proximal
interphalangeal joint with hyperextension
of the distal interphalangeal joint
G Hyperextension of the proximal
interphalangeal joint with hyperflexion of
the distal interphalangeal joint
H Dupuytren’s contracture.
➜ Gout and pseudogout
4. Which of the following statements
regarding gout are true?
A Gout leads to pyrophosphate deposition.
B Gout and septic arthritis are similar and
can coexist in the same joint.
C Gout is associated with renal calculi.
D The key to the treatment of gout is to
lower the plasma urate levels as quickly
as possible.
E Gout is the commonest cause of acute
monoarthropathy in the elderly.
F The metatarsophalangeal joint is the
first joint to be attacked in most cases of
gout.
G Pyrophosphate crystals are positively
birefringent under polarised light.
➜ Bone tumours
5. Which of the following statements
about bone tumours are true?
A Patients with a past history of malignancy
who present with backache have
metastases until otherwise proven.
B The extent of metastases can best be
demonstrated on a bone scan.
C All patients with suspected bone tumours
should have plain X-rays.
D Pathological fractures through metastases
should be fixed but patients should not
be given radiotherapy as this will prevent
healing.
E Biopsy should be performed at the same
time as staging to minimise delay
The biopsy track should be kept well
away from any possible future surgical
approach
G Local en bloc excision of primary bone
and soft-tissue tumours has no worse a
survival rate than primary amputation.
H Metastases from the prostate are
notoriously vascular and so should be
embolised if at all possible before any
surgical approach is attempted.
I In patients with pathological fracture
through metastases, the normal rule
that the medical condition should be
optimised is ignored.
Paediatric orthopaedics –
general
1. Which of the following statements are
true?
A The Heuter–Volkmann principle states
that compressive forces stimulate growth.
B Wolff’s law states that bone is deposited
and resorbed according to the loads
placed on it.
C Limb bud embryogenesis starts at
month 4.
D In-toeing can be caused by persistent
femoral neck anteversion.
E All children start with knock-knees which
then become bow legs by the time that
they are 2 or 3 years old.
F All children under the age of 3 years
have flat feet.
G If toe-walking develops after the child has
started walking normally, a neurological
problem should be suspected.
➜ Developmental dysplasia of
the hip
2. Which of the following statements
regarding developmental dysplasia of
the hip are true?
A It is more common in boys than in
girls.
B It occurs in up to 20 per cent of breech
deliveries.
C It is more common in the first-born.
D It does not run in families.
E It is not associated with spina bifida.
F It is best diagnosed by X-ray.
G It is best treated early by non-operative
means.
H The goal of surgery is to get the head
concentric within the acetabulum.
➜ Perthes’ disease
3. Which of the following statements
regarding Perthes’ disease are true?
A Perthes’ disease is a spontaneous
avascular necrosis of the hip.
B It is most common in boys around
puberty.
C The condition frequently settles
spontaneously.
D A similar problem can occur in children
with sickle cell disease.
E The prognosis is best in those children in
whom the condition develops late.
➜ Slipped upper femoral
epiphysis
4. Which of the following statements
regarding slipped upper femoral
epiphysis are true?
A It may present with pain in the knee.
B It can best be diagnosed on an
anteroposterior (AP) X-ray.
C It occurs in boys around the age of
puberty.
D Perfect reduction must be obtained.
E The other hip is also commonly involved.
➜ Hand abnormalities
5. Which of the following statements
regarding hand abnormalities are true?
A Surgery to correct hand abnormalities
should be deferred until it is clear how
much disability the problem is causing.
B Radial club hand tends to occur in
isolation of other deformities.
C Radioulnar synostosis requires surgery to
restore pronation and supination.
D Congenital radial head dislocation is
anterior.
Case study – shoulder pain
6. A young child presents with pain in
her shoulder. There is no history of
trauma. She screams if the arm is
moved. She is toxic and pyrexial.
(a) What is the likely diagnosis?
A Gout
B Irritable joint
C Septic arthritis
D A fracture
E A dislocation.
(b) What investigations would you
organise?
A Serum urate
B Full blood count
C Erythrocyte sedimentation rate (ESR) and
C-reactive protein (CRP)
D Gamma-globulins
E Blood cultures
F Ultrasound
G X-ray.
(c) What treatment should be started?
A Splintage
B Aspiration
C Analgesia
D Anti-inflammatories
E Intravenous antibiotics
F Steroids.
➜ Osteomyelitis
7. Which of the following statements
regarding osteomyelitis are true?
A It is usually caused by haematogenous
spread.
B In neonates, septic arthritis of the
hip is effectively synonymous with
osteomyelitis.
C Pus forming in medullary bone cannot
penetrate cortical bone and so tracks
centrally.
D If a sterile aspirate is obtained from what
appears to be a septic joint, there may be
osteomyelitis nearby.
E Pus collection in bone should not under
any circumstances be drained as bone
necrosis will result.
F An involucrum is a dead fragment of
bone following an attack of osteomyelitis.
➜ Case study – injury in a child
8. A 2-year-old disabled child is brought
to the A&E department with a bucket
handle metaphyseal fracture of the
distal femur. There is also callus from
a previous tibial fracture. The parents
did not see exactly what happened but
think he fell from a sofa onto the floor
the day before when playing with his
older brothers. On examination he is
a quiet child who has more than his
fair share of bruises on him, of varying
ages. What is the diagnosis that must
be most carefully investigated?
A Osteogenesis imperfecta
B Non-accidental injury (NAI)
C Exuberant older brothers
D Fracture through a benign bone cyst
E Pathological fracture through a metastasis
from a nephroblastoma.