PART- ONE

Select single most appropriate

1- The most common symptom in orthopaedics is

a- Loss of function.
b- Deformity.
c- Pain.
d- Swelling.
e- Stiffness
2- The Common sites of referred pain from shoulder is
a- Neck.
b- Scapular region.
c- Chest.
d- Arm.
e- Forearm and hand.
3- The Common sites of referred pain from hip is
a- Leg and foot.
b- Knee.
c- Gluteal region.
d- Lateral side of the thigh.
e- Sacroiliac region.
4- Grade 4 muscle power is
a- Normal power.
b- Movement against resistance.
c- Movement against gravity.
d- Movement with gravity eliminated.
e- Only a flicker of movement.
5- Deltoid muscle supplied by
a- C3,4.
b- C4,5.
c- C5,6.
d- C6,7.
e- C7,8.
6- Wrist flexors supplied by
a- C3,4.
b- C4,5.
c- C5,6.
d- C6,7.
e- C7,8.
7- Wrist extensor muscles supplied by
a- C3,4.
b- C4,5.
c- C5,6.
d- C6,7.
e- C7,8.
8- Ankle dorsiflexion muscles supplied by
a- L 2,3.
b- L 2,3.
c- L 3,4.
d- L 4,5.
e- L 5, S 1.
9- Ankle plantarflexion muscles supplied by
a- L 2,3.
b- L 2,3.
c- L 3,4.
d- L 4,5.
e- L 5, S 1.
10- Big toe flexion muscles supplied by
a- L 3.
b- L 3.
c- L 4.
d- L 5.
e- L S 1.
11- Big toe extension muscles supplied by
a- L 3.
b- L 3.
c- L 4.
d- L 5.
e- L S 1.
12- The most common cause of osteomyelitis in adults is
a- Acute haematogenous osteomyelitis.
b- Postoperative osteomyelitis.
c- Subacute osteomyelitis.
d- Diabetes mellitus.
e- Posttraumatic osteomyelitis.
13- Malignancy after use of metal implant
a- The risk related.
b- The risk probably discounted.
c- Large number of cases.
d- Occur commonly in site of implant.
e- Commonly giant cell tumors.
14- The disadvantage of ultra-high molecular weight polyethylene
a- Not susceptible to deformity.
b- Susceptible to deformity.
c- Crack development not occur.
d- Good hardness.
e- Had high coefficient of friction.
15- The metal implant
a- Cause infection.
b- Enhance drainage.
c- Titanium alloys more susceptible to infection in comparison with stainless
steel.
d- Stainless steel more susceptible to infection in comparison with titanium
alloys.
e- Impedes the formation of biofilm.
16- Emergency expenditure in amputee
a- Is 10- 30% percent for transtibial.
b- Is 5-10% percent for transtibial.
c- Is 10- 30% percent for transfemoral.
d- Is 30-40% percent for transfemoral.
e- Is 30-50% percent for transtibial.
17- Bone marrow edema
a- Gradual and progressive.
b- Acute and self-limiting.
c- MRI shows focal changes.
d- Scintigraphy shows reduced activity.
e- Histological examination shows marrow osteonecrosis.
18- Rapidly destructive osteoarthritis
a- Occurs mainly in elderly woman.
b- Associated with deposit of urate crystal.
c- Associated with deposit of pyrophosphate crystal.
d- There is no bone destruction.
e- It results from analgesic therapy.

19- The most common cause of Charcot's joint is

a- Myelomeningocele.
b- Tabes dorsalis.
c- Leprosy.
d- Syringomylia.
e- Diabetic neuropathy.
20- In surgical treatment of hemophilic arthropathy, the clotting factors
concentration should be raised postoperatively to above
a- 5%.
b- 15%.
c- 25%.
d- 50%.
e- 75%.
21- Gas in the joint indicate
a- Staphylococcus aureus (MRSA) infection.
b- Pseudomonas aeruginosa infection.
c- Proteus mirabilis infection.
d- Kingella kingae infection.
e- Escherichia coli infection.
22- The surgical drainage in suppurative arthritis indicated in
a- If the hip is involved.
b- If the knee is involved.
c- If the ankle involved in adult.
d- In shoulder of young children.
e- In elbow of young children.
23- The reliable investigation for diagnosis of tuberculosis is
a- Mantoux test.
b- ESR & CRP.
c- Synovial fluid culture.
d- Synovial fluid aspirate examination.
e- Synovial biopsy.
24- Synovial fluid examination shows rhomboid shape crystals in
a- Rheumatoid arthritis.
b- Osteoarthritis.
c- Gout.
d- Pseudo- gout.
e- Reiter's disease.
25- Uric acid lowering drugs indicated
a- Acute gout attack.
b- Chronic gout.
c- Hyperuricaemia.
d- Pseudo gout.
e- Recurrent acute attack.
26- Pseudo gout characterized by
a- Affect large joints.
b- Cause severe pain.
c- Affect small joint.
d- There is no joint swelling.
e- Osteophyte formation.
27- Polyarticular osteoarthritis
a- The patients is usually old man.
b- The patients is usually old woman.
c- The patients is usually middle age man.
d- The patients is usually middle age woman.
e- The patients is usually young woman.
28- Type I collagen make up to
a- 10% of unmineralized matrix.
b- 20% of unmineralized matrix.
c- 40% of unmineralized matrix.
d- 60% of unmineralized matrix.
e- 80% of unmineralized matrix.
29- In bone PTH act to promote osteoclastic resorption
a- It dose by direct action.
b- It dose by indirect action.
c- Through decrease expression of RANKL.
d- Through increase production of OPG.
e- Through decrease in 1, 25 ( OH)2 D.
30- In renal tubular rickets there is
a- Myopathy.
b- No growth defect.
c- Serum phosphate decreased.
d- Serum alkaline phosphatase decreased.
e- Urine calcium increased.
31- In renal glomerular rickets , there is
a- Positive family history.
b- Myopathy.
c- No growth defect.
d- Serum calcium increased.
e- Serum phosphate decreased.
32- The x-rays features of scurvy is
a- Localized bone rarefaction.
b- Lytic transverse band at the juxta-epiphyseal zone.
c- Epiphyseal ossification.
d- The ossific centers shows ring sign.
e- Increased density in the metaphyseal region
33- In Paget's disease
a- Serum calcium is high.
b- Serum phosphate is low.
c- Serum alkaline phosphatase is normal.
d- 24-hour urinary hydroxyproline decreased.
e- 24-hour urinary hydroxyproline increased.
34- Multiple epiphyseal dysplasia
a- Children are average height.
b- Walk with a waddling gait.
c- Head and face are normal.
d- Head and face are abnormal.
e- The lower limb had normal height.
35- The commonest form of abnormally short stature is
a- Osteogenesis imperfacta.
b- Metaphyseal dysplasia.
c- Achondroplasia.
d- Dyschondroplasia.
e- Hypochondroplasia.
36- Nail patella syndrome
a- Inherited as an autosomal recessive trait.
b- Inherited as sex linked dominant.
c- The radial head sublaxated medially.
d- There is bony protuberance on the lateral aspects of iliac blades.
e- There is bipartite patella.
37- Type I osteogenesis imperfacta
a- Usually appears at birth.
b- There is marked deformity.
c- The sclera is white.
d- Inherited autosomal dominant.
e- Teeth usually is abnormal.
38- Sprengel's shoulder deformity
a- The patient has short neck.
b- There is a failure of vertebral segmentation.
c- Associated vertebral anomalies is rare.
d- Inherited autosomal dominant.
e- The scapula is small and abnormally high.
39- Radioulnar synostosis is
a- Associated with anterior dislocation of the radial head.
b- Associated with medial dislocation of the radial head.
c- There is complete loss of pronation and supination.
d- There is some degree of pronation.
e- There is some degree of supination.
40- Wide excision of tumors
a- Dissection carried out through normal tissue.
b- The entire compartment in which the tumor removed.
c- Dissection goes beyond the tumor but only just.
d- It is appropriate for high-grade intra-compartmental lesion.
e- It is appropriate for low-grade extra-compartmental lesion.
41- Fibrous cortical defect
a- The commonest site is the diaphysis.
b- The commonest site is the epiphysis.
c- Recurrence is common.
d- The commonest benign lesion of bone.
e- Encountered in young adults.
42- Fibrous dysplasia
a- The common site is distal radius.
b- The cortical bone replaced by cellular fibrous tissue contain woven bone.
c- May affect one bone.
d- Small, single lesion cause local pain.
e- It is self-limiting after maturity.
43- Regarding malignant transformation in chondroma of adult
a- There is spot of calcification.
b- Foot bone affection.
c- There is lytic lesion.
d- The biopsy is very helpful.
e- The biopsy is not helpful.
44- In eosinophilic granuloma of bone
a- The patients is usually young adult.
b- Cause local pain and tenderness.
c- Usually heals spontaneously.
d- Usually treated by complete excision or curettage.
e- X-rays shows ill-define diffuse osteolytic lesions in long bone.
45- Simple bone cyst
a- Is benign tumor.
b- Diagnosis depends on biopsy.
c- Cause local ache.
d- Commonly affect metaphysis of proximal tibia.
e- Appears during childhood.
46- Aneurysmal bone cyst
a- Appears during childhood.
b- Almost any bone may be affected.
c- Usually discovered incidentally or after pathological fractures.
d- Is a subarticular in end of long bones.
e- The lesion is central in metaphysis.
47- Chondromyxoid fibroma
a- Affect adult.
b- Is more common in upper limb.
c- Presenting symptom is ache.
d- Malignant changes is not rare.
e- Treatment of choice is excision.
48- In enchondroma there is
a- Well-define eccentric osteolytic lesion.
b- Pain in site of lesion.
c- Flicks of calcification within lucent area is common features.
d- Solitary lesion.
e- A high risk of malignant changes.
49- Mesenchymal chondrosarcoma
a- Tend to occur in in older individual.
b- In about 10% of cases, the tumor lies in soft tissue.
c- In about 20% of cases, the tumor lies in soft tissue.
d- In about 50% of cases, the tumor lies in soft tissue.
e- Behavior is usually less aggressive.
50- Central chondrosarcoma
a- Develops either in tubular or flat bone.
b- X-rays shows osteolytic lesion without expansion.
c- X-rays shows no flicks of calcification.
d- X-rays shows no cortical destruction.
e- Sometime appears on surface of flat bone.
51- Osteosarcoma
a- Presented by pain increased by activity.
b- Affect most commonly long bone diaphysis.
c- Serum alkaline phosphatase is normal.
d- ESR is usually normal.
e- Characterized by malignant stromal cell showing osteoid formation.
52- Osteosarcoma
a- Usually graded as IA or IB.
b- Usually graded as IIA or IIB.
c- Usually graded as III.
d- Multi-agent neoadjuvent chemotherapy given for 8-12 weeks before biopsy.
e- Centrally, large pulmonary metastases may be completely resected.
53- Adamentinoma
a- Is low-grade tumor.
b- Has predilection to posterior cortex of tibia.
c- X-rays shows atypical bubble like defect in the posterior cortex of tibia.
d- X-rays shows bone rarefaction and punched-out defect in the posterior cortex
of tibia.
e- The patients is usually old female.
54- Periosteal osteosarcoma
a- May changed to more aggressive dedifferentiated Parosteal osteosarcoma.
b- Situated on the surface of the bone.
c- Occurs in the children.
d- X-rays shows defect of medullary canal.
e- X-rays shows thick periosteal reaction.
55- Paget's sarcoma
a- It is the commonest complication of Paget's disease.
b- Presented as a painless mass.
c- It is the commonest osteosarcoma in patients older than 50 years.
d- Metastasis is late.
e- Graded as IIA.
56- Hypercalcemia may treated by
a- Ensuring adequate hydration,
b- Reducing the phosphate intake,
c- Vit D supplement.
d- Increasing the phosphate intake.
e- Avoid administering bisphosphonates.
57- Spastic cerebral palsy
a- Associated with damage to the extra- pyramidal system.
b- Associated with damage to the pyramidal system.
c- Due to cerebellar damage.
d- Catheterized by increased muscle tone and hyporeflexia.
e- Appears in the form of muscular incoordination during voluntary movement.
58- Giant cell tumor of the tendon sheath identical to
a- Ganglion.
b- Giant cell tumor of bone.
c- Non-specific synovitis.
d- Pigmented villi- nodular synovitis.
e- Synovial sarcoma.
59- Synovial sarcoma involve the joint in
a- 10 %.
b- 20 %.
c- 40 %.
d- 60 %.
e- 80 %.
60- Operative correction is indicated if the hip flexion deformity in cerebral palsy
a- Is more than 10 degrees.
b- Is more than 20 degrees.
c- Is more than 30 degrees.
d- Is more than 40 degrees.
e- Is more than 50 degrees.
61- Preganglionic lesion of brachial plexus injuries
a- Is surgically repairable.
b- Potentially capable of recovery.
c- Have good prognosis.
d- Recovered spontaneously but mild residual symptoms may persist.
e- Cannot recover and it is surgically irreparable.
62- Spastic flexion deformity of knee in cerebral palsy may be revealed only when
a- The hip is flexed to 20 degrees.
b- The hip is flexed to 40 degrees.
c- The hip is flexed to 50 degrees.
d- The hip is flexed to 70 degrees.
e- The hip is flexed to 90 degrees.
63- In Erb’s palsy
a- A reliable indicator of recovery is return of biceps activity by the third month.
b- Absence of biceps activity by third month completely rule out later recovery.
c- Is due to injury of C8 and T1.
d- The baby lies with the arm supinated and the elbow flexed.
e- Reflexes are absent and there may be a unilateral Horner’s syndrome.
64- Winging of the scapula
a- Occur if the latissimus dorsi paralyzed.
b- Demonstrated by the patient pushing forwards against the wall.
c- Results from the injury of the long thoracic nerve (C8, T1).
d- It usually recovers spontaneously, though this may take a week or longer.
e- It usually requires operative stabilization by transferring pectoralis minor or
major to the lower part of the scapula.
65- Very high lesions radial nerve injury
a- May caused by fractures of the humerus or after prolonged tourniquet pressure.
b- Are usually due to fractures or dislocations at the elbow.
c- Cannot extend the metacarpophalangeal joints of the hand. There is an obvious
d- There is wrist drop, as well as inability to extend the metacarpophalangeal
joints or elevate the thumb.
e- There is wrist drop, the triceps paralyzed and the triceps reflex is absent.
66- Wrist drop following closed fracture
a- Is usually third degree lesions.
b- Can afford to wait for 4 weeks to see if it starts to recover.
c- If it does not recover by 4 weeks , then EMG should be performed
d- The nerve should explored, if the EMG at 12 weeks shows denervation
potentials and no active potentials.
e- Should be explored and the nerve repaired or grafted as soon as possible if
there is good surgical facilities.
67- Isolated anterior interosseous nerve lesions
a- Are extremely common.
b- The signs are similar to those of a high median nerve injury.
c- The usual cause is brachial neuritis.
d- There is no sensory loss.
e- The thenar eminence is wasted.
68- The femoral nerve injury
a- May be injured by a gunshot, shell, by pressure or traction during an operation.
b- The patient is able to extend the knee actively.
c- There is numbness of the anterior thigh and anterior aspect of the leg.
d- The knee reflex is normal.
e- Severe neurogenic pain is uncommon.
69- The superficial peroneal nerve
a- Innervating the tibialis anterior muscle.
b- Innervating the extensor digitorum longus.
c- Innervating the extensor hallux longus.
d- Descends along the fibula.
e- Injury resulting in paraesthesia and numbness on the dorsum around the first
web space.
70- Tourniquet pressure as cause of nerve injury
a- Is an uncommon cause of nerve injury in orthopedic operations.
b- Damage is due prolonged ischemia.
c- Damage is due to direct pressure.
d- Injury is therefore more likely with a pneumatic tourniquet.
e- Injury is therefore more likely with a wide cuff.
71- Chronic compartment syndrome
a- Long-distance runners sometimes develop pain along the postero-lateral aspect
of the calf.
b- Pain brought on night after muscular exertion.
c- Swelling of the postero-lateral calf muscles.
d- The condition diagnosed from the history and confirmed by measuring the
compartment pressure before exercise.
e- Release of the fascia is curative.
72- The thromboprophylaxis
a- DVT can reduced by one-thirds by prolonging thromboprophylaxis.
b- The ideal duration of thromboprophylaxis is not known.
c- Current evidence supports 30 days for knee replacement.
d- Current evidence supports 14 days for hip replacement and hip fracture.
e- Should not be prolonged after discharge from hospital.
73- The angle between the anatomical axis of the femur and the axis of the
femoral neck is
a- Approximately 128 degrees (±3 degrees).
b- Approximately 128 degrees (±5 degrees).
c- Approximately 125 degrees (±5 degrees).
d- Approximately 125 degrees (±3 degrees).
e- Approximately 122 degrees (±3 degrees).
74- The angle between the anatomical axis of the femur and a tangent to the joint
line of the knee is, On the lateral aspect
a- Approximately 75 degrees (±5 degrees).
b- Approximately 80 degrees (±2 degrees).
c- Approximately 85 degrees (±5 degrees).
d- Approximately 90 degrees (±2 degrees).
e- Approximately 90 degrees (±5 degrees).
75- General complication of osteotomy and deformity correction is
a- Under- and over - correction of the deformity.
b- Tension on a nearby nerve.
c- Compartment syndrome.
d- Infection.
e- Non-union.
76- Bone allografts
a- Cannot be stored.
b- There is no potential for transfer of infection.
c- Sterilization done by ethylene oxide without alteration in the physical
properties.
d- Sterilization done by ionizing radiation with alteration in the physical
properties.
e- Antigenicity cannot reduced by freezing, freeze-drying or by ionizing
radiation.
77- Hair removal
a- Shaving before surgery is useful.
b- Shaving before surgery is safe.
c- Shaving day before surgery reduced wound infection.
d- Depilatory creams used the day before surgery increased wound problems.
e- Depilatory creams used the day before surgery without an increase in wound
problems.
78- Risk of asymptomatic venous thromboembolism in hip fracture
a- 10%.
b- 20%.
c- 40%.
d- 60%.
e- 80%.
79- Low molecular weight heparin
a- Its safety similar to unfractionated heparin.
b- Need constant monitoring.
c- Effectively reduces the prevalence of venographic DVT in hip replacement
surgery.
d- Not reduces the prevalence of venographic DVT in knee replacement surgery.
e- It is effective as the unfractionated heparin.
80- Unlocked elastic intramedullary nails
a- Are rigid rods.
b- Increasingly used in the treatment of long-bone shaft fractures in children.
c- Inserted through the physes at either end of the long bone.
d- Function as rigid internal fixation.
e- Insufficient reaming potentially risks the bone splitting.
81- Cancellous autografts
a- Incorporated by a process analogous to fracture healing.
b- Carried risk for transfer of infection.
c- Induce an inflammatory response in the host
d- Incorporated more rapidly into host bone.
e- Are particularly useful when large defects to be filled.
82- Referred shoulder pain syndromes results from
a- Tendinitis.
b- Glenohumeral arthritis.
c- Suprascapular nerve entrapment.
d- Subluxation.
e- Cardiac ischaemia
83- Active shoulder movements are best examined
a- From left side the patient.
b- From right side the patient.
c- From both sides the patient.
d- From behind the patient.
e- From front the patient.
84- The commonest cause of pain around the shoulder is
a- A disorder of the rotator cuff.
b- Glenohumeral arthritis.
c- Nerves lesions.
d- Subluxation.
e- Cardiac ischaemia
85- Chronic shoulder tendinitis
a- Pain and slight stiffness would not restrict simple activities.
b- Pain persist and not affected by activities.
c- The patient usually aged between 20 and 30.
d- Characteristically pain is sever with activities.
e- Characteristically pain is worse at night.

86- A full thickness tear of rotator cuff of shoulder

a- Always follow a long period of chronic tendinitis.
b- Always follow a jerking injury of the shoulder.
c- There is sudden pain and the patient is unable to abduct the arm
d- There is sudden pain and the patient is able to abduct the arm.
e- Injecting a local anaesthetic into the sub-acromial space restore abduction.
87- Ultrasonography of shoulder
a- Is not accurate like MRI for identifying and measuring the size of rotator cuff
tears.
b- It has the advantage that it can identify the quality of the muscles.
c- Cannot always be accurate in predicting the reparability of the tendons.
d- Are usually normal in the early stages of the cuff dysfunction.
e- Is not save imaging.
88- Arthroscopic acromioplasty
a- Cannot achieve the same basic objectives as open acromioplasty.
b- This procedure has now become the gold standard.
c- The outer side of the acromion trimmed.
d- If a complete cuff tear encountered, then open repair indicated.
e- Delayed the postoperative rehabilitation.
89- Acute calcific tendinitis of shoulder
a- Acute pain always follow deposition of calcium hydroxyapatite crystals.
b- Affects 20–30 year-olds.
c- Is thought that vascular reaction leads to fibrocartilaginous metaplasia and
deposition of crystal.
d- Pain due to the calcification.
e- Affects 30–50 year-olds.
90- Asymptomatic calcification of the shoulder rotator cuff
a- Is uncommon.
b- It is painful after exercises.
c- Appears as an incidental finding in shoulder x-rays.
d- The tendon is thick and hypertrophies.
e- Treatment should directed to the calcification rather than the impingement.
91- Frozen shoulder
a- Is a well-defined disorder characterized by progressive painless stiffness of the
shoulder.
b- Stiffness become complete followed by pain.
c- Is usually resolves spontaneously after about 18 months.
d- The condition not associated with diabetes.
e- The condition not appears after recovery from neurosurgery.
92- Condensing osteitis of the clavicle
a- May be no more than a reaction to the mechanical stress.
b- Is usually seen in men of 40–60.
c- Present with pain at the lateral end of the clavicle.
d- Pain aggravated by adducting the arm.
e- X-rays reveal sclerosis and lytic lesion in the lateral end of the clavicle.
93- Sterno-costo-clavicular hyperostosis
a- Is seen in younger people.
b- Is usually unilateral.
c- Patients develops painless swelling.
d- The histological changes are non-specific.
e- The Microorganisms can be identified.
94- Indications for shoulder arthroplasty is
a- Osteoarthritis of acromioclavicular joint.
b- Early rheumatoid arthritis
c- Fracture- dislocation of the proximal humerus.
d- Early avascular necrosis of the humeral head.
e- Severe arthritis with cuff arthropathy.
95- The commonest complication for shoulder arthroplasty is
a- Infection
b- Loosening of the components.
c- Implant failure.
d- Peri-prosthetic fracture.
e- Rotator cuff failure.
96- Arthrodesis of the gleno-humeral joint
a- Is commonly performed.
b- Is still a useful operation for severe shoulder dysfunction.
c- Postoperative function is limited.
d- Caused painful restriction of gleno-humeral movement.
e- The optimal position is 10 degrees of flexion, 10 degrees of abduction and 10
degrees of internal rotation.
97- Medial epicondyle epiphysis appears at
a- 2 years.
b- 4 years.
c- 6 years.
d- 8 years.
e- 10 years.
98- Proximal radio-ulnar synostosis
a- Is acquired deformity.
b- Is uncommon.
c- Function is usually good.
d- Surgical separation improved forearm rotation.
e- A rotation osteotomy are more suitable.
99- Posttraumatic unreduced dislocation of the head of radius
a- Surgical treatment would not improve function.
b- Is usually associated with cubitus varus.
c- May follow unreduced old Monteggia fracture.
d- Is usually bilateral.
e- Is commonly associated with old supracondylar fracture.
100- Severe rheumatoid arthritis of the elbow
a- Treated by arthrodesis.
b- Joint replacement is usually successful.
c- Treated by arthroscopic debridement.
d- Synovectomy is worthwhile.
e- Treated by excision of the radial head.
101- Gout of elbow region
a- Affect ulno-humeral joint.
b- Affect radio-humeral joint.
c- The olecranon bursa is a favourite site.
d- Affect the common extensor origin.
e- Affect the common flexor origin.
102- The best non operative treatment for posttraumatic elbow stiffness is
a- Passive exercise.
b- Early active movement through a functional range.
c- Manipulation under anesthesia.
d- Manipulation under regional anesthesia.
e- Aggressive passive manipulation.
103- Recurrent elbow instability commonly associated with
a- Muscles weakness.
b- Posterior capsular injury.
c- Lateral collateral ligament injuries.
d- Fracture olecranon.
e- Fracture coronoid.
104- Tennis elbow characterized by
a- Localized tenderness at or just below the lateral epicondyle.
b- Pain radiate widely.
c- Damage to the bones.
d- Damage to soft-tissue attachments around the elbow.
e- The elbow flexion and extension are full and painless.
105- Semi-constrained elbow arthroplasty
a- Associated with instability.
b- Associated with dislocation.
c- Good results achieved in 90% of carefully selected patients.
d- Allow some of the forces to absorb by the soft tissues whilst maintaining some
intrinsic stability.
e- Had a high failure rate due to loosening.
106- Stability of the scapho-lunate joint is tested by
a- Gripping or pinching the lunate with one hand, the triquetral-pisiform with the
other, and then applying a sheer stress.
b- Pushing the pisiform radial wards against the triquetrum.
c- Pressing hard on the palmar aspect of the scaphoid tubercle while moving the
wrist alternately in abduction and adduction.
d- Pushing the wrist medially then flexing and extending it.
e- Holding the radius and then balloting the ulnar head up and down.
107- The normal radial deviation is about
a- 5°.
b- 15°.
c- 25°.
d- 35°.
e- 50°.
108- The embryonic arm buds appear about
a- Fourth week.
b- Sixth week.
c- Eighth week.
d- 10th week.
e- 12th week.
109- Digital rays begin to appear
a- By 6th week.
b- By 8th week.
c- By 10th week.
d- By 12th week.
e- By 14th week.
110- Secondary ulna dysplasia occur in children who had
a- Madelung's deformity.
b- Achondroplasia.
c- Hereditary multiple exostosis.
d- Ulnar club hand.
e- Symbrachydactyly.
111- Comptodactyly is
a- Conjoint digit.
b- Failure of embryological separation.
c- True cleft hand.
d- A bent finger.
e- Phocomelia.
112- The most unstable of the carpal bones is
a- Pisiform.
b- Lunate.
c- Hamate.
d- Trapezoid.
e- Scaphoid.
113- Clinodactyly is
a- A bent finger.
b- A digit bent sideways.
c- Complex polydactyly.
d- Multiple digits syndactyly.
e- Atypical cleft hand.
114- When there is severe pain and restriction of wrist movement in Kienböck’s
disease , the best treatment is
a- Vascular bone graft.
b- Radial shortening.
c- Radial dome osteotomy.
d- Radio-carpal arthrodesis.
e- Scapho- capitate fusion.
115- The cardinal feature of the ‘rheumatoid hand’ is
a- A reciprocal ulnar deviation of the fingers.
b- Combination of instability and erosive tenosynovitis eventually leads to
tendon rupture.
c- The erosion of distal radio-ulnar joint.
d- The erosion of radiocarpal joint and intercarpal joints.
e- Synovitis around the ulnar head with rupture of extensor digiti minimi.
116- The first x-rays changes in rheumatoid arthritis is
a- Peri-articular osteoporosis.
b- Diminution of the joint space.
c- Soft-tissue swelling.
d- Bony erosions.
e- Marked joint destruction.
117- Flexor tenosynovitis in rheumatoid hand
a- Is obvious as extensor tendon involvement.
b- Cause rupture of the flexor pollicis longus tendon.
c- Cause rupture of the flexor digitorum profundus tendon.
d- Cause rupture of the flexor digitorum superficialis tendon.
e- May presented as carpal tunnel syndrome.

118- Relative shortness of the ulna appears in association with

a- Carpal tunnel syndrome.
b- Kienböck’s disease.
c- Ulna-carpal impaction syndrome.
d- Central triangular fibrocartilage complex perforations.
e- Late ulno-carpal arthritis.
119- Early post traumatic boutonniere deformity treated by
a- Division of the extensor tendon distally.
b- Surgical repair and splintage for 6 weeks.
c- Surgical repair and fixation by K-wire for 6 weeks.
d- Splinting the PIP joint in full extension for 6 weeks.
e- Tendon transfer and splintage for 6 weeks.
120- The normal angle of distal radial tilt is
a- 6°.
b- 11°.
c- 22°.
d- 30°.
e- 65°.
121- The normal angle of palmar tilt in distal radius
a- 3°.
b- 5°.
c- 8°.
d- 11°.
e- 22°.
122- The jointed strut in the wrist formed by
a- The scaphoid, trapezoid and thumb.
b- The scaphoid, trapezium and thumb.
c- The scaphoid, trapezoid and second metacarpal.
d- The scaphoid, capitate and central metacarpal.
e- The scaphoid, trapezoid and central metacarpal.
123- The distal radial epiphysis appear at age of
a- First year.
b- Second year.
c- Fourth year.
d- Sixth year.
e- Eighth year.
124- With the wrist flexed, the thumb fall normally in
a- Flexion.
b- Supination.
c- Pronation.
d- Extension.
e- Ulnar deviation.
125- Functionally the thumb is
a- A 20% of the hand.
b- A 25% of the hand.
c- A 30% of the hand.
d- A 35% of the hand.
e- A 40% of the hand.
126- Intrinsic muscle of hand
a- Extend of the MCP and flex IP joints.
b- Extend of the MCP and extend IP joints.
c- Flexed of the MCP and extend IP joints.
d- Flexed of the MCP and flex IP joints.
e- Hyperextend of the MCP and flex IP joints.
127- Osteoarthritis in hand affect mainly the
a- Proximal interphalangeal joints.
b- Distal interphalangeal joints.
c- Metacarpophalangeal joints.
d- Carpometacarpal joints.
e- Intercarpal joints.
128- Abduction of the thumb is
a- Sideways movement in the plane of the palm.
b- Sideways movement across the palm.
c- Upward movement at the right angles to the palm.
d- Pressing against the palm.
e- Lifting the thumb backwards behind the plane of the hand.
129- The cause of hand intrinsic minus is
a- Cerebral palsy.
b- Poliomyelitis.
c- Scarring after trauma.
d- Scarring after infection.
e- Shrinkage due to ischaemia.
130- Agricultural injuries of hand usually treated by
a- Flucloxacillin or cephalosporin.
b- Flucloxacillin and fusidin.
c- A broad-spectrum penicillin and fusidin.
d- A broad-spectrum penicillin and metronidazole.
e- Cephalosporin and fusidin.
131- Mobile Boutonniere deformity in rheumatoid arthritis can be treated with
a- Tendon repair.
b- Tendon transfer.
c- Arthroplasty.
d- Arthrodesis.
e- Splint.
132- In combined median and ulnar nerve injuries
a- The thumb is in palm.
b- The thumb is flexed.
c- There is a clawing of thumb.
d- The thumb lie at the side of the hand.
e- The thumb adducted and rotated.
133- The most common finger affected by trigger finger is
a- Little finger.
b- Ring finger.
c- Middle finger.
d- Index.
e- Thumb.
134- The atlanto-dental interval in adult is
a- 1 or 2 mm.
b- 2 or 3mm.
c- 4 or 5 mm.
d- 6 or 8 mm.
e- 8 or 10 mm.
135- the normal synchondrosis between the dens and the body of C2
a- Fuses at about 4 years.
b- Fuses at about 6 years.
c- Fuses at about 8 years.
d- Fuses at about 10 years.
e- Fuses at about 12 years.
136- The most common site of cervical spondylosis is
a- C2/3 and C3/4.
b- C3/4 and C4/5.
c- C4/5 and C5/6.
d- C5/6 and C6/7.
e- C6/7 and C7/T1.
137- The sagittal diameter of the mid-cervical spinal canal suggestive of spinal
stenosis is less than
a- 9 mm.
b- 11 mm.
c- 13 mm.
d- 15 mm.
e- 17 mm.
138- the most common seronegative spondyloarthropathy to affect the cervical
spine is
a- Rheumatoid arthritis.
b- Ankylosis spondylitis.
c- Juvenile poly arthritis.
d- Reiter's disease.
e- Colitis associated arthropathy.
139- Scoliosis with pain suggests
a- A spinal infection until proved otherwise.
b- A spinal tumor until proved otherwise.
c- A prolapse disc until proved otherwise.
d- A structural scoliosis until proved otherwise.
e- A postural scoliosis until proved otherwise.
140- In structural scoliosis
a- Right thoracic curves are the commonest.
b- Left thoracic curves are the commonest .
c- Right lumbar curves are the commonest .
d- Left lumbar curves are the commonest .
e- Right cervical curves are the commonest .
141- Acute pyogenic infection of the spine
a- Is uncommon.
b- Diagnosis and treatment often early done.
c- The infection start in vertebral body with secondary spread to disc.
d- Children and young adult are at greatest risk.
e- The spinal canal is commonly involved.
142- MRI in acute pyogenic infection of spine
a- May show nonspecific changes in the vertebral end plate.
b- May show nonspecific changes in the intervertebral disc.
c- Is highly sensitive and highly specific.
d- Is highly sensitive and not specific.
e- Is highly specific but not sensitive.
143- Pott's paraplegia
a- Is the rarest complication of spinal tuberculosis.
b- Early onset paresis is due to pressure by direct cord compression.
c- Late onset paresis is due to pressure by inflammatory edema.
d- In early cases, the prognosis is good.
e- The prognosis of surgical decompression in late cases is good.
144- The disc space collapse is typical
a- Traumatic compression.
b- Infection.
c- Multiple myeloma.
d- Metastatic disease.
e- Osteoporosis.
145- Hydatid disease in spine
a- Usually picked in adulthood.
b- Take many months before diagnosis made.
c- X-rays may reveal translucent area with sclerotic margin.
d- X-rays may reveal local osteoporosis and periosteal reaction.
e- Surgical eradication prevent morbidity and recurrence.
146- Root canal stenosis result from
a- Degenerative changes of disc.
b- Osteoarthritis of facet joint.
c- Thickening of the ligamentum flavum.
d- Bulging of the disc annulus fibrosus.
e- New bone formation may narrow the lateral recesses of the spinal canal and
the intervertebral foramina.
147- Acute disc prolapse
a- Is uncommon in young adults.
b- Is rare in old age.
c- Presented as sciatica only.
d- The patients usually stand with a slight kyphosis.
e- May cause muscle weakness and wasting.
148- The major postoperative complication of disc surgery
a- Is bleeding from epidural veins.
b- Is recurrent prolapse with sciatica is more common and may require revision
decompression surgery.
c- Is injury to the dura and CSF leakage.
d- Is disc space infection.
e- Is injuries to nerve root and spinal cord.
149- The characteristic feature of ‘segmental instability of lumbar spine’ is
a- Intervertebral disc degeneration.
b- Mainly flattening of the ‘disc space’.
c- Marginal osteophytes.
d- The appearance of a ‘traction spur’.
e- Arthritis of facet joint.
150- Lytic or isthmic spondylolisthesis forms
a- 5%.
b- 10%.
c- 20%.
d- 25%.
e- 50%.
151- Sudden, acute pain and sciatica
a- In young people, it is important to exclude prolapse disc.
b- In patients, aged 20–40 years are more likely to have a spinal instability.
c- In those under the age of 20, it is important to exclude infection.
d- In elderly patients may have spondylolysis.
e- In elderly patients may have spondylolisthesis.
152- Intermittent low back pain after exertion
a- Old Patients only may complain of recurrent backache following exertion.
b- Rest relieves this pain.
c- Features of disc prolapse are always present.
d- In those under 50 years, osteoarthritis of the facet joints is common.
e- In early cases, x-rays usually show signs of lumbar spondylosis.
153- Hip disorders at age between 10-20 years mostly
a- Neglected developmental dysplasia of the hip.
b- Infections
c- Perthes’ disease
d- Slipped epiphysis
e- Adults Arthritis.
154- The reported incidence of neonatal hip instability in northern Europe is
approximately
a- One per 1000 live births.
b- Three per 1000 live birth.
c- Six per 1000 live birth.
d- 10 per 1000 live birth.
e- 20 per 1000 live birth.
155- Acetabular dysplasia
a- Always genetically determined.
b- Always follow incomplete reduction of a congenital dislocation.
c- Always follow damage to the lateral acetabular epiphysis or maldevelopment
of the femoral head.
d- The socket is unusually shallow, the roof is sloping and there is deficient
coverage of the femoral head.
e- Faulty load transmission in the lateral part of the joint may lead to primary
osteoarthritis.
156- People with mild acetabular dysplasia
a- The condition exists only as an ‘x-ray diagnoses.
b- May complain of pain over the lateral side of the hip.
c- Some experience episodes of sharp pain in the groin.
d- Complain of movement – particularly abduction in flexion – is restricted.
e- Complain of leg length asymmetry and the femoral head may be felt as a lump
in groin.
157- The recurrence rate of irritable hip is
a- 5%.
b- 10%.
c- 15%.
d- 20%.
e- 25%.
158- Congenital coxa vara
a- Is uncommon developmental disorder of adolescent.
b- Due to a defect of enchondral ossification in the lateral part of femoral neck.
c- Corrected spontaneously with growth.
d- Associated with anteversion of femoral neck.
e- Is bilateral in about one third of cases.
159- Perthes' disease
a- Is common.
b- Is uncommon.
c- Is rare.
d- Patients are usually 10-15 years.
e- The girls are affected two time as often as boy.
160- Adolescent with slipped capital femoral epiphysis
a- Have femoral neck retroversion.
b- There is femoral head anteversion.
c- The physis has decreased obliquity.
d- Have lessor than average body mass index.
e- Have no hormonal imbalance.
161- The treatment of Perthes' disease in children under 6 years of age is
a- Abduction brace.
b- Abduction spica.
c- Pelvic osteotomy.
d- Femoral osteotomy.
e- Symptomatic treatment.
162- Between 4 to 7 years of age, the femoral head depend for its blood supply
venous drainage
a- On both metaphyseal and lateral epiphyseal vessels.
b- On both metaphyseal vessels and blood vessels in ligamentum teres.
c- Almost entirely on the metaphyseal vessels.
d- Almost entirely on the lateral epiphyseal vessels.
e- Almost entirely on the blood vessels in ligamentum teres.
163- The first x-rays change in Perthes' disease
a- Increased density of the proximal femoral epiphysis.
b- Fragmentation of the proximal femoral epiphysis.
c- Rarefaction and cystic changes in metaphysis.
d- Widening of the joint space.
e- Enlargement of the proximal femoral epiphysis.
164- The most important prognostic factor in Perthes' disease is
a- The degree of femoral head collapse.
b- The degree of femoral head involvement.
c- The calcification lateral proximal femoral epiphyseal plate.
d- The age of child.
e- The sex of child.
165- Pre- slip in slipped capital femoral epiphysis
a- The child complains of gluteal pain particularly on rest.
b- There is limitation of movement.
c- Exertion, and there may be a limp
d- Examination may demonstrate reduced external rotation.
e- The x-ray may show widening or irregularity of the physis.
166- The chronic slip in slipped capital femoral epiphysis
a- The child complains of posterior hip pain lasting more than 3 weeks.
b- The pain is continuous without remission.
c- There is loss of internal rotation, abduction.
d- There is some extension and limb lengthening.
e- There is long prodromal history and a severe exacerbation.
167- Sever slip in slipped capital femoral epiphysis
a- Causes marked deformity which, untreated, will predispose to secondary OA.
b- Closed reduction by manipulation should be attempted.
c- Open reduction by Dunn’s method gives fair results.
d- The alternative treatment is to fix the epiphysis without osteotomy.
e- The patient should be told that this may result in 5–7 cm of shortening.
168- Articular chondrolysis in slipped capital femoral epiphysis
a- Cartilage necrosis probably results from slipping.
b- In these cases, bone changes are marked.
c- There is progressive narrowing of the joint space and the hip becomes stiff.
d- This is a rare complication in SCFE.
e- All cases, the condition improves spontaneously
169- The diagnosis of pyogenic arthritis of the hip is confirmed
a- By the classical clinical picture.
b- By typical radiological features and joint effusion on ultrasonography.
c- By the detailed picture provided by MRI.
d- By aspirating pus or fluid from the joint and submitting it for laboratory
examination and bacteriological culture.
e- By early CT scan of the hip.
170- The most important type of motion in the hip for optimal bipedal function is
a- Extension and abduction.
b- Extension and adduction.
c- Flexion and abduction.
d- Flexion and internal rotation.
e- Flexion and external rotation.
171- The cam type femoro-acetabular impingement
a- Affect young female,
b- Affect acetabulum mainly.
c- The main pathology is non-spherical extension of femoral head.
d- Associated with protrusion- acetabuli and acetabular retroversion.
e- The structure primarily damaged is labrum.
172- The changes of osteoarthritis of the hip are most marked
a- In margin of articular surface.
b- The top of the joint.
c- In the infero-medial part of the joint.
d- In the inferior part of the joint.
e- In the medial part of joint.
173- The common cause of primary OA of the hip is
a- Avascular necrosis.
b- Subluxation of the hip.
c- Dysplasia of the hip.
d- Femoro-acetabular impingement.
e- Coxa magna following Perthes' disease.
174- Rheumatoid arthritis of the hip
a- The hip joint is common site.
b- Characterized by other joints affection.
c- The hallmark is progressive bone destruction on both side of joint.
d- Characterized by reduction of joint space and osteophyte formation.
e- Pain behind hip and limping are earliest symptom.
175- Total hip arthroplasty for rheumatoid arthritis
a- Relieve pain but not restore a useful range of movement.
b- It advocated for old patients only.
c- Fracture during operation is rare.
d- The risk of infection is less.
e- Adolescent with juvenile rheumatoid arthritis may be treated by custom-made
prosthesis.
176- Grade III osteonecrosis of the hip
a- The prognosis is good.
b- Decompression is valuable.
c- For young patients partial hip replacement is the treatment of choice.
d- Older patient treated by total hip replacement.
e- Older patient treated by arthrodesis.
177- Transient osteoporosis of the hip
a- Is common.
b- Characterized by pain and rapidly emerging osteoporosis.
c- Radionuclide scanning show decreased activity.
d- The changes last 1-3 months.
e- The x-ray not returns to normal after pain subside.
178- The best treatment for transient osteoporosis of the hip
a- Symptomatic treatment.
b- Calcitonin.
c- Alendronate.
d- Rest.
e- Osteotomy.
179- The indication to intertrochanteric osteotomy is
a- Wide spread osteoarthritis.
b- Sever collapse in avascular osteonecrosis.
c- Osteoarthritis with sever stiffness.
d- Young patient with osteoarthritis associated with joint dysplasia .
e- Rheumatoid arthritis.
180- The ‘bond’ between bone and the implant surface, or cement,
a- Is never perfect.
b- Optimized in new technique.
c- Improved by embedding the implant in methylmethacrylate cement.
d- Improved in recent technique of bone cementing.
e- Improved by fitting the implant closely to the bone bed without cement.
181- Postoperative dislocation following total hip replacement
a- Is uncommon if the prosthetic components are correctly placed.
b- Reduction is easy and traction in adduction.
c- Usually closed reduction and abduction allows the hip to stabilize.
d- If malposition of the femoral is sever, brace used to prevent recurrence.
e- If malposition of acetabular component is severe, augmentation of the socket
may be needed.
182- Aseptic loosening after total hip arthroplasty
a- Is the third cause of long-term failure.
b- With modern methods of implant fixation, radiographic evidence of loosening
in less than 2 per cent of patients 15 years after operation.
c- Radionuclide scanning shows decreased activity.
d- At microscopic level, symptomatic patients only show cellular reaction and
membrane formation at the bone–cement interface.
e- Revision arthroplasty can be either cemented or uncemented, depending on the
condition of the bone.
183- Highly cross-linked polyethylene (XLPE) acetabular prostheses
a- Gamma irradiation of polyethylene causes cross-linking, which greatly
improves the wear resistance.
b- Gamma irradiation of polyethylene reduce the price of prostheses.
c- Gamma irradiation of polyethylene is directly proportional to the fracture
toughness.
d- Encouraging clinical results with markedly increase wear reported with XLPE.
e- It should be noted that the commercially available XLPEs are the same.
184- Metal-on-metal bearing surfaces
a- Have very high wear rates
b- Are self-polishing, which allows for self-healing of surface scratches.
c- Metal is not brittle, and components therefore to be as thick.
d- Gives a smaller range of motion, and thus lesser mobility and greater stability.
e- Should not be used for patients want to return to vigorous recreational
activities.
185- The post-operative care of total hip arthroplasty
a- The length of inpatient stay reduced to 14–16 days in most hospitals.
b- Patients mobilized independently before discharge.
c- Car driving allowed 14 day.
d- Patients will have negotiated stairs independently 2 months.
e- Full weight bearing without support will usually take 6–8 weeks at the
patient’s own pace.
186- A small, localized swelling on the anterolateral side of the knee joint
a- Makes one think of haemarthrosis.
b- Makes one think of knee effusion.
c- Makes one think of prepatellar bursa.
d- Makes one think of a cyst of the meniscus.
e- Makes one think of semimembranosus bursa.
187- The Q-angle (quadriceps angle) is
a- The angle subtended by a line drawn from the anterior inferior iliac spine to
the tip of the patella and another from the tip of the patella to the tibial
tubercle.
b- The angle subtended by a line drawn from the anterior inferior iliac spine to
the lower pole of the patella and another from the lower pole the patella to the
tibial tubercle.
c- An increased Q-angle regarded as a predisposing factor in the development of
chondromalacia.
d- Normally averages about 4 degrees in men.
e- Normally average about 7 degrees in women.
188- The anterior cruciate ligament stability
a- The ‘sag sign’ is sensitive tests.
b- Anterior drawer test is sensitive.
c- Posterior drawer sign is sensitive.
d- Lachman test is sensitive.
e- Lachman test is sensitive and specific.
189- A unilateral genu varus
a- Mostly physiological.
b- Is rarely to be pathological.
c- Mostly congenital.
d- It is essential in all cases to look for signs of injury.
e- If angulation is severe, early operative correction is necessary.
190- X-ray of Blount's disease
a- The proximal tibial epiphysis flattened laterally and the adjacent metaphysis is
beak-shaped.
b- The lateral cortex of the proximal tibia appears thickened.
c- There is internal rotation of the tibia.
d- The tibial epiphysis always look 'fragmented’; and the femoral epiphysis also
is affected.
e- In the late stages, a bony bar forms across the medial half of the tibial physis.
191- Genu valgus in adult female results
a- May be secondary to rheumatoid arthritis.
b- May be secondary to osteoarthritis.
c- May be secondary to Paget's disease.
d- Corrected by varus high tibial osteotomy.
e- Stress x-rays are not essential in the assessment of these cases.
192- ‘Locking’ of the knee– that is, the sudden inability to extend the knee fully
suggest
a- Anterior horn tear.
b- Posterior horn tear.
c- Horizontal tear.
d- Bucket handle tear.
e- Degeneration of the menisci.
193- Operative treatment of meniscus injuries
a- Indicated if the joint locked.
b- Indicated if symptoms are acute.
c- Tears close to the periphery, treated by meniscectomy.
d- In appropriate cases, the success rate for both open and arthroscopic repair is
almost 60 per cent.
e- Total meniscectomy thought to cause more instability and so predispose to late
secondary osteoarthritis.
194- Discoid lateral meniscus
a- A young patient complains of gives way and ‘thuds’ loudly with history of
injury.
b- A characteristic clunk felt at 60 degrees flexion and at 30 degrees as
straightened.
c- MRI cannot confirms the diagnosis.
d- If there is only a clunk, treatment is essential.
e- If pain is disturbing, arthroscopic partial excision leaving a normally shaped
meniscus'.
195- The treatment of meniscal cyst.
a- Arthroscopic total excision of cyst and total meniscectomy.
b- Arthroscopic removal of damaged part pf meniscus and decompression of cyst
within the joint.
c- Arthroscopic total excision of cyst and partial meniscectomy.
d- Open total excision of cyst and total meniscectomy.
e- Open total excision of cyst and partial meniscectomy.
196- The indication of urgent surgical treatment in recurrent dislocation of the
patella
a- Tear of medial capsule
b- Multiple dislocation in knee flexion.
c- Presence of a large displaced osteochondral fracture.
d- Recurrent dislocation of patella with severe pain.
e- Unstable patella after reduction.
197- Patellofemoral disorders that cause anterior knee pain.
a- Patellar instability
b- Osteochondritis dissecans
c- Loose body in the joint
d- Synovial chondromatosis
e- Plica syndrome
198- The common knee joint disorders that cause anterior knee pain. .
a- Patellar instability.
b- Patello-femoral overload.
c- Patellar ligament strain
d- Synovial chondromatosis
e- Plica syndrome
199- Osteochondritis dissecans of the knee is
a- Females affected more often than males.
b- Bilateral in 50 per cent of cases.
c- Over 80 per cent of lesions occur on the medial part of the lateral femoral
condyle.
d- A large, well-demarcated, vascular fragment of bone and overlying cartilage
separates from the lateral femoral condyles.
e- The lesion better seen in the ‘tunnel view’.
200- Treatment of knee loss body
a- A loose body should be removed.
b- Finding the loose body may be difficult; it may be concealed in a synovial
pouch or sulcus.
c- A loose body should be removed even the joint is severely osteoarthritic.
d- This usually done through the open arthrotomy.
e- A large loose body may even slip under the edge of one of the menisci.
201- Synovial chondromatosis
a- Is a common disorder in which the joint comes to contain multiple loose
bodies.
b- The usual explanation is that synovium undergo cartilage neoplasia and may
ossify.
c- X-rays reveal few loose bodies.
d- Arthrography shows multiple ossified loose bodies.
e- The loose bodies removed arthroscopically; an attempt should be made to
remove all abnormal synovium.
202- The Plica syndrome of knee
a- An adult complains of an ache in the side of the knee (occasionally both
knees).
b- Characteristic feature is tenderness near the upper pole of the patella and over
the femoral condyle.
c- There is no history of trauma or markedly increased activity.
d- Exercise or climbing stairs relieve symptoms.
e- Movement of the knee may cause loud painful click in joint line.
203- Rheumatoid arthritis of knee distinguished from osteoarthritis by
a- Diminution of the joint space,
b- Osteopenia.
c- Marginal erosions.
d- The complete absence of osteophytes.
e- Subchondral cystic changes.
204- If only the patello-femoral joint is affected, suspect
a- Gout.
b- Pyrophosphate arthropathy.
c- Osteoarthritis.
d- Reiter's disease.
e- Rheumatoid arthritis.
205- Charcot’s disease (neuropathic arthritis) of knee treated by
a- Moulded splint.
b- Arthroscopic debridement.
c- Open debridement and synovectomy.
d- Arthrodesis.
e- Arthroplasty.
206- Rupture of extensor mechanism above patella
a- Patient is usually young.
b- Patient had history of long steroid treatment.
c- There is diffuse swelling of the anterior part of thigh.
d- Function of quadriceps muscle usually bad.
e- Patient need early surgical repair.
207- Osgood Schlatter disease
a- Is uncommon disease of adolescent.
b- Always there is history of trauma.
c- Is usually unilateral.
d- Patients is a young adult complain of pain without activity and of a lump.
e- Spontaneous recovery is usual.
208- Pellegrini-Stieda disease
a- X-ray shows osteolytic lesion on lateral condyle.
b- X-ray shows osteolytic lesion on medial condyle.
c- X-rays show a plaque of bone lying next to the femoral condyle under the
lateral collateral ligament.
d- X-rays show a plaque of bone lying next to the femoral condyle under the
medial collateral ligament.
e- Occasionally this is a source of pain on the lateral side of knee.
209- In chronic knee swelling, the most important condition to exclude is
a- Pseudogout.
b- Tuberculosis.
c- Pigmented Villonodular synovitis.
d- Rheumatoid arthritis.
e- Synovial chondromatosis.
210- Prepatellar bursitis
a- There is hard swelling confined to the front of the patella.
b- The knee joint itself is abnormal.
c- This is an infected bursitis due to constant friction between skin and bone.
d- Seen mainly in carpet layers, floor cleaners and miners who use protective
kneepads.
e- In chronic cases, the best treatment is lump excision.
211- The semimembranosus bursa
a- It presents usually as a painful lump behind the knee, slightly to the medial
side of the midline.
b- Is most conspicuous with the knee flexed.
c- The lump is fluctuant and the fluid can pushed into the joint.
d- The knee joint is normal.
e- The best treatment is excision through a transverse incision.
212- The knee varus osteotomy
a- Is required for active patients with isolated medial compartment disease.
b- This performed at the upper proximal part of tibia.
c- The method most commonly employed is a medial opening wedge osteotomy,
d- The fragments should firmly fixed with a blade-plate.
e- In many cases postoperative cast immobilization not needed.
213- The most important early complication of tibial osteotomy is
a- Compartment syndrome in the leg.
b- Peroneal nerve palsy.
c- Failure to correct the deformity.
d- Delayed union and non-union.
e- Mechanical failure of internal fixation.
214- Contraindications to knee arthrodesis
a- Failed knee replacement.
b- Problems in the ipsilateral hip or ankle.
c- Osteoarthritis of contralateral knee.
d- Rheumatoid arthritis.
e- Limited peri-articular bone loss.
215- Unicompartmental knee replacement
a- Has firmly established.
b- Early results for medial compartment osteoarthritis were excellent.
c- Longer-term studies have highlighted the need to avoid low revision rates.
d- Following a successful operation, restoration of function is not impressive.
e- Is reserved for older patients.
216- Patellar resurfacing.
a- A kind of partial replacement performed in osteoarthritis.
b- A kind of partial replacement rheumatoid arthritis.
c- A kind of partial replacement rarely performed alone.
d- A kind of partial replacement, performed alone.
e- Used in treatment of chondromalacia patella.
217- Infection in total knee replacement
a- Prevention is the most important.
b- For established infection treated by antibiotics.
c- The safest salvage procedure is by exchange replacement in one stage.
d- The safest salvage procedure is by exchange replacement in two stage.
e- Intractable infection treated by debridement.
218- Meniscus are prone to injury
a- Particularly during unguarded movements of extension and rotation on the
weight bearing leg.
b- Particularly during unguarded movements of flexion and rotation on the
weight bearing leg.
c- Particularly during unguarded movements of hyperextension and rotation on
the weight bearing leg.
d- In maximum flexion of knee.
e- In maximum internal rotation.
219- Lateral collateral ligaments
a- Attached to the lateral meniscus.
b- Situated more anteriorly.
c- Blend with capsule of knee.
d- Separated from lateral collateral by popliteus tendon.
e- Is fan shape.
220- Forward subluxation of lateral tibial condyles is prevented by
a- Lateral collateral ligament.
b- Posterolateral capsule.
c- Posterior cruciate ligament.
d- Posterior cruciate ligament and arcuate ligament.
e- Anterior cruciate ligament.
221- The tibia sublaxated forward when
a- Anterior cruciate ligament and medial collateral ligament.
b- Anterior cruciate ligament and posterior cruciate ligament.
c- Posterior cruciate ligament
d- Anterior cruciate ligament.
e- Medial collateral ligament.
222- Backward subluxation of the tibia is prevented by
a- The anterior cruciate ligament.
b- The posterior cruciate ligament.
c- The posterior cruciate ligament with the arcuate ligament and the posterior
oblique ligament.
d- Anterior cruciate ligament and medial collateral ligament.
e- The posterior cruciate ligament and lateral collateral ligament.
223- The gait may be disturbed by
a- Pain.
b- Muscles weakness.
c- Deformity.
d- Stiffness.
e- All of above.
224- Pain and tenderness posterior to medial malleolus
a- Fracture of medial malleolus.
b- Tarsal tunnel syndrome.
c- Tibialis posterior tendinitis.
d- Impingement from osteophyte.
e- Achilles Para tendonitis.
225- The last deformity to be corrected in conservative treatment of idiopathic club
foot
a- Fore foot adduction.
b- Forefoot supination.
c- Forefoot varus.
d- Hindfoot equinus.
e- Hindfoot varus.
226- Metatarsus adductus
a- There is varus of hindfoot.
b- There is equinus of hindfoot.
c- Deformity is limited to the forefoot.
d- Had classical pattern of severity.
e- Most of cases need surgical treatment.
227- Congenital vertical talus
a- Passive correction is impossible .
b- The hindfoot is in calcaneus and valgus.
c- The talus points almost horizontally towards the sole.
d- The forefoot is abducted, supinated and dorsiflexed.
e- The tendons and ligaments on the dorsolateral side of the foot are usually
lengthened.
228- Peroneal spastic flatfoot
a- Young children sometimes present with a painful, rigid flatfoot.
b- Flexor tendons are in spasm.
c- X-rays show typical talonavicular coalitions.
d- Pain may be due to abnormal tarsal stress or even fracture of an ossified bar.
e- The picture differs from that of the more common ‘idiopathic’ flatfoot by the
small concave foot.
229- Flexible flatfoot in young children
a- Required no treatment.
b- Treated by stretching and plaster splint.
c- Treated by orthotic splintage.
d- Treated by physiotherapy.
e- Treated by insole and moulded heel-cup.
230- Accessory navicular
a- Associated with rigid flatfoot.
b- Complain of tenderness on medial border of the midfoot.
c- Symptoms are due to bone.
d- Treated by surgical removal.
e- Treated by below knee orthosis and insole.
231- Acquired painful flatfoot in adult commonly due to
a-Ligament laxity.
b-Tarsal coalition.
c-Tibialis posterior dysfunction.
d-Neuropathy.
e-Degenerative arthritis.
232- Surgical treatment of painful flatfoot include
a-Reconstruction of tendon Achilles.
b-Tenosynovectomy of peroneal tendons.
c-Pantalar arthrodesis.
d-Ankle arthrodesis.
e-Triple arthrodesis.
233- Hallux valgus
a-Is one of the common foot deformity.
b-Result from valgus angulation of the first metatarsal bone.
c-Is uncommon in rheumatoid arthritis.
d-There is excessive lateral angulation of big toe.
e-Positive family history obtained in 30% of cases.
234- When hallux valgus exceed 40 degrees
a-The great toe rotate in supination.
b-The great toe rotates in pronation.
c-The sesamoid bone displaced medially.
d-The extensor tendon stretched.
e-The intact adductor halluces prevent progress of deformity.
235- The hallux valgus in elderly is best treated by
a-Shoes modification.
b-Arthrodesis.
c-Arthroplasty.
d-Distal osteotomy.
e-Proximal osteotomy.
236- In adolescent with hallux valgus less than 25 degrees treated by
a-Bunionectomy.
b-A soft tissue rebalancing operation.
c-A distal osteotomy combined with a corrective osteotomy of the base of the
proximal phalanx.
d- Keller’s operation.
e- Arthrodesis.
237- Diagnostic feature of hallux rigidus
a- A pain on walking, especially on slopes.
b- The patient develop altered gait.
c- The great toe is straight with callosity.
d- The MTP joint feel knobby with tender dorsal bunion.
e- The MTP joint dorsiflexion is restricted and painful.
238- Hammer toe characterized by
a- Hyperextension at the MTP joint and flexion of both IP joint
b- Acute flexion deformity of proximal IP joint only and hyperextension of MTP
joint.
c- Flexion of the distal IP joint and extension of proximal IP joint.
d- The MTP joint is dislocated and the little toe sits on the dorsum of the
metatarsal head.
e- An irritating or painful bunionette may form over an abnormally prominent
fifth metatarsal head.
239- A 40 years old patients with rheumatoid arthritis suddenly develop a painful
valgus foot, the most probable cause is
a- Midtarsal subluxation.
b- Subtalar arthritis.
c- Rupture of peroneus longus tendon.
d- Rupture of tibialis posterior tendon.
e- Rupture of planter fascia.
240- The common site for osteochondritis of the ankle is
a- Anterolateral part of the articular part of talus.
b- Anteromedial part of the articular part of talus.
c- Posteromedial part of the articular part of talus.
d- Posterolateral part of the articular part of talus.
e- Central part of the articular part of talus.
241- The atraumatic osteonecrosis of talus involving
a- Posterolateral part of the talar dome.
b- Posteromedial part of the talar dome.
c- Anterolateral part of the talar dome.
d- Anteromedial part of the talar dome.
e- Central part of the talar dome.
242- Insufficiency fracture in diabetic foot should be treated
a- By prolonged cast.
b- Without immobilization.
c- By internal fixation.
d- By internal fixation with bone cement.
e- By external fixation.
243- The foot rotates about an axis running through
a- Fifth metatarsal.
b- Fourth metatarsal.
c- Third metatarsal.
d- Second metatarsal.
e- First metatarsal.
244- The plantar fascia
a- Is a dense fibrous structure that originates from the calcaneum, superficial to
the heel fat pad.
b- Runs distally to the dome of the foot, with slips to each toe distal phalanx.
c- The plantar fascia stiffens and becomes more pliable with age.
d- There may be micro-tears in the fascia, and the fascia thickens.
e- The condition is not associated with gout, ankylosing spondylitis and Reiter’s
disease.
245- Painful fat pad
a- Acute pain and tenderness directly over the fat pad under the heel.
b- Sometimes follows a direct blow to the area, e.g. in a fall from a height.
c- The condition seen in old patients and has been attributed variously to
separation of the fat pad from the bone.
d- Chronic specific ‘inflammation’ has been blamed.
e- Treatment is surgical by debridement of necrotic and inflamed tissue.
246- Heel nerve entrapment
a- Entrapment of the second branch of the lateral plantar nerve has been reported
as a cause of heel pain.
b- The commonest complaint is pain and numbness at rest.
c- Characteristically, tenderness is maximal on the medial aspect of the heel.
d- Diagnosis is easy, because the symptoms and signs differ from plantar
fasciitis.
f- Treatment should be surgical decompression of the nerve.
247- Kohler's disease
a- Is common cause of pain in the midtarsal region in children.
b- The bony nucleus of the medial cuneiform becomes dense and fragmented.
c- The child, over the age of 10 year, has a painful limp.
d- On examination, a tender warm thickening over navicular bone.
e- If symptoms are severe, a surgical decompression of bone helps.
248- Metatarsalgia
a- Is a common expression of foot strain.
b- It result from bone osteopenia.
c- Result from foot neuropathy.
d- Aching felt under the forefoot and the foot arch may have flattened out.
e- There may even be callosities over IP joint of toes.
249- Brailsford’s disease
a- A ridge of bone develops on the dorsal surfaces of the medial cuneiform.
b- The navicular becomes dense, then altered in shape, and later the midtarsal
joint may degenerate.
c- In children, especially if the arch is high, the overbone develop.
d- A lump behind heel, which feels bony and may become bigger and tender if
the shoe presses on it.
e- Surgical removal of heel lump provide relief of the symptom.
250- Sesamoiditis
a- Is part of rheumatoid arthritis manifestation of foot.
b- May be initiated by direct trauma or unaccustomed stress.
c- Acute sesamoid pain and tenderness should signal the possibility of sesamoid
displacement.
d- Sudden pain may result from local infection (particularly in a diabetic patient).
e- Acute pain result from avascular necrosis.
251- Sesamoid chondromalacia
a- Is a term coined by Apley at 1966.
b- Used to explain changes such as fragmentation and cartilage fibrillation of the
lateral sesamoid.
c- X-rays show a sclerosis medial sesamoid.
d- Is often mistaken for a gout.
e- Treated by application of cast for 3 months.
252- Freiberg’s disease
a- Osteochondritis of first metatarsal head in young children.
b- Is probably a type of atraumatic osteonecrosis of the subarticular bone.
c- It usually affects the second metatarsal head (rarely the third) in young adults,
mostly women.
d- The patient complains of pain at the IP joint.
e- A bony lump is palpable and tender at the MTP joint of big toe.
253- Stress fracture
a- Usually of the first metatarsal, occurs in young adults after unaccustomed
activity.
b- Usually of the first metatarsal, occurs in in women with postmenopausal
osteoporosis.
c- The sole of the foot may be edematous and the affected shaft tender.
d- The x-ray appearance is at first normal, but later shows fusiform callus around
a fine transverse fracture.
e- Long before x-ray signs appear, a radioisotope scan will show decreased
activity.
254- The ABC system for resuscitation of sock with catastrophic external bleeding
a- A for airway is the first.
b- B for breathing is second step.
c- The C for circulation is the third
d- Control of the external bleeding takes precedence.
e- Follow the ABC sequence.
255- The majority of patients presenting with shock following a major injury will
be suffering from
a- Hypovolemic shock.
b- Septic shock.
c- Neurogenic shock.
d- Anaphylactic shock.
e- Cardiogenic shock.
256- The systolic blood pressure may not drop significantly
a- Until 10 per cent of the patient’s blood volume has been lost.
b- Until 15 per cent of the patient’s blood volume has been lost.
c- Until 20 per cent of the patient’s blood volume has been lost.
d- Until 25 per cent of the patient’s blood volume has been lost.
e- Until 30 per cent of the patient’s blood volume has been lost.
257- Fracture of the pelvis
a- Can result in devastating retroperitoneal hemorrhage.
b- Bleeding cannot reduced by compressing the pelvis to approximate the
bleeding fracture sites.
c- Compression to reduce hemorrhage cannot achieved manually with a towel or
blanket.
d- Compression by external fixation of the pelvis is useless.
e- MAST trousers are practicable and commonly used.
258- High-energy (velocity) fractures
a- Cause only moderate soft-tissue damage.
b- Cause severe soft-tissue damage, no matter whether the fracture is open or
closed.
c- There is little or no displacement.
d- The displacement does not matter initially.
e- The reduction is unlikely to succeed.
259- Open reduction
a- Is the first step to internal fixation.
b- Used for most fractures in children
c- For fractures that are stable after reduction
d- Can held in some form of splint or cast.
e- Avoids direct manipulation of the fracture site.
260- Contraindications to nonoperative methods of fracture treatment is
a- Fracture of long bones.
b- Inherently unstable fractures.
c- Rotated fractures.
d- Fracture in metaphyseal region.
e- Supracondylar fractures of lower humerus.
261- Soft tissue edema following fracture can be treated by
a- Elevation of limb.
b- Firm support.
c- Elevation and firm support.
d- Exercise.
e- Coban wrap around a limb to control swelling during treatment.
262- The incidence of wound infection in open fractures correlates directly with
a- The type of antibiotics used.
b- Duration of injury.
c- The extent of soft-tissue damage.
d- The site of injury in the limbs.
e- The type and quality of treatment in open fracture.
263- Antibiotics at debridement for open fractures grade II is
a- Gentamicin and vancomycin.
b- Co-amoxiclav.
c- Penicillin and gentamicin.
d- Penicillin and cefuroxime.
e- Gentamicin and clindamycin.
264- In wound debridement viable muscle can be recognized by
a- Its purplish colour.
b- Its mushy consistency.
c- Its failure to contract when stimulated.
d- Its failure to bleed when cut.
e- Its tone preserved.
265- To irrigate open fracture grade II, use
a- 1- 2 liters of normal saline.
b- 2- 4 liters of normal saline.
c- 3- 6 liters of normal saline.
d- 6- 12 liters of normal saline.
e- 12- 24 liters of normal saline.
266- If wound cover is delayed in open fracture
a- The external fixation is safer.
b- The skeletal traction is safer.
c- The back slab splint is safer.
d- The non-reamed intramedullary nail is safer.
e- The minimal contact plate is safer.
267- Early infection of open fracture presented as
a- Discharging wound.
b- Inflamed wound with discharge.
c- Inflamed wound without discharge.
d- Black discoloration of wound surface.
e- Red and swollen tissue with yellowish slough.
268- Gunshot injuries are contaminated by
a- Metallic forging body.
b- Necrotic tissue.
c- Derbies sucked into wound.
d- Tract of bullet.
e- Hematoma inside wound.
269- The common nerve injury in Monteggia fracture dislocation
a- Median nerve.
b- Radial nerve.
c- Ulnar nerve.
d- Anterior interosseous.
e- Posterior interosseous.
270- If vascular repair undertaken in close fracture
a- The fracture should reduce and hold by POP.
b- The fracture should reduce and hold by traction.
c- The fracture should reduce and hold by internal fixation.
d- The fracture should reduce and hold by external fixation.
e- The fracture should reduce and hold by cast brace.
271- The early symptom of compartment syndrome is
a- Sever pain.
b- Paresthesia.
c- Pallor,
d- Paralysis.
e- Pulslessness.
272- The earliest sings of compartment in upper limb
a- Pallor of finger.
b- Painful dorsiflexion of finger.
c- Anesthesia.
d- Pulslessness.
e- Paralysis.
273- Symptomatic hypertrophic nonunion treated by
a- Bone graft.
b- Bone graft and rigid internal fixation.
c- Rigid internal fixation.
d- Low frequency pulsed ultrasound with cast brace.
e- Pulsed electromagnetic field and cast brace.
274- Hypertrophic non-union –treatment by the Ilizarov technique
a- Treated by compression.
b- Treated by compression and realignment in external fixator.
c- Treated by bone transposition in external fixator.
d- Treated by gradual distraction and realignment in an external fixator.
e- Treated by rigid external fixation and bone grafting.
275- Early treatment of myositis ossificans
a- Muscles stretching exercise.
b- Splintage in position of rest followed by active exercise.
c- Splintage in position of function followed active exercise.
d- Manipulation under anesthesia followed by passive exercise.
e- Manipulation under anesthesia followed by active exercise.
276- In rupture of extensor pollicis longus tendon, all true except
a- May occur 2–4 weeks after a fracture of the lower radius.
b- Cause mallet index.
c- Follow displaced lower radius fracture.
d- Direct suture is possible.
e- Treated by transferring the extensor indicis proprius tendon to the distal stump
of the ruptured tendon.
277- The common cause of joint stiffness are , except
a- Injuries of articular.
b- Injuries of synovial membrane and capsule.
c- Haemarthrosis of joint lead to synovial adhesion.
d- Edema and fibrosis of capsule and muscles.
e- Complex regional pain syndrome.
278- Characteristic x-ray feature of complex regional pain syndrome
a- Generalized reduction in bone density.
b- Localized increase in bone density.
c- Patchy rarefaction in the affected part.
d- Regional osteoporosis of affected part.
e- Patchy osteosclerosis in affected part.
279- Localized disease cause pathological fracture are
a- Osteoporosis.
b- Osteomalacia.
c- Paget's disease.
d- Infection.
e- Myelomatosis.
280- In children, the physeal injuries forms
a- Five% of children fractures.
b- Ten % of children fractures.
c- 15 % of children fractures.
d- 20 % of children fractures.
e- 25 % of children fractures.
281- Middle-aged men with pathological fracture, may result from
a- Severe osteoporosis.
b- Osteomalacia.
c- Skeletal metastases or myeloma.
d- Paget's disease.
e- Hyperparathyroidism.
282- Secondary metastases in femur mostly result from
a- Kidney tumor.
b- Breast carcinoma.
c- Bronchogenic carcinoma.
d- Prostate carcinoma.
e- Thyroid carcinoma.
283- Secondary metastases fracture near a bone end can often be treated by
a- Internal fixation.
b- Internal fixation and bone graft.
c- Prophylactic internal fixation and arthrodesis.
d- Excision and prosthetic replacement; this is especially true of femoral neck
fractures.
e- Internal fixation; if necessary the site packed with acrylic cement.
284- Femoral fracture in Paget's disease treated
a- Systemic medical treatment for Paget's disease.
b- Internal fixation is almost essential.
c- Custom made prosthesis.
d- Bone cement with plate and screws.
e- Bisphosphonate, calcium, Vit D, fluoride and external fixation.
285- Battered baby syndrome
a- The history fit with injuries.
b- The fractures are pathological
c- The fracture caused by accident.
d- There is only fractures.
e- The fractures at different stage of healing.
286- Types 5 and 6 epiphyseal fractures
a- If properly reduced, have an excellent prognosis.
b- Bone growth is not adversely affected.
c- The size and position of the bony bridge across the physis assessed by x-ray.
d- Complications such as malunion or non-union may also occur
e- If the bridge is relatively small, it excised and replaced by a fat graft.
287- sprain is
a- Ligaments tear.
b- Any painful wrenching (twisting or pulling) movement of a joint.
c- Associated with articular cartilage damage.
d- Compression of articular surfaces.
e- Associate with physis fracture separation in children.
288- Displaced lateral third fractures of clavicle
a- Are stable injuries.
b- Have a lower than usual rate of non-union if treated non-operatively.
c- Surgery to stabilize the fracture is rarely recommended.
d- Operations for these fractures have a high complication rate.
e- The best surgical treatment is intramedullary fixation.
289- The incidence of nonunion in clavicle is higher in
a- Displaced middle third fracture.
b- Comminuted middle third fracture.
c- Lateral part fracture.
d- Medial part fracture.
e- Comminuted medial part.
290- Malunion of clavicle with shortening of more than 2 cm
a- Is rare.
b- Do not produce symptoms.
c- Some may go on to develop periscapular pain.
d- Treated by physiotherapy.
e- Operative treatment not indicated.
291- The finding arose suspicion of scapulothoracic dissociation is
a- The scapula exposed to indirect trauma.
b- The limb abducted end externally rotated.
c- The diagnosis depend on CT scan finding.
d- There is swelling below the scapula.
e- A distraction of more than 1 cm of a fractured clavicle in x-ray.
292- Posterior sternoclavicular dislocation
a- Is common and less serious.
b- There is mild discomfort.
c- There may be pressure on the trachea or large vessels.
d- Reduction is not necessary.
e- Open reduction is not justified.
293- After reduction of anterior dislocation of shoulder, the arm is rested in a sling
for
a- About one week in those under 30 years of age.
b- About two weeks in those under 30 years of age.
c- For only three weeks in those over 30.
d- For only two weeks in those over 30.
e- For only one week in those over 30.
294- The axillary nerve injury after anterior dislocation of the shoulder
a- Is uncommon injury.
b- The patient is able to contract the deltoid muscle and there may be a large
patch of anesthesia over the muscle.
c- The inability to abduct must be distinguished from a rotator cuff tear.
d- The nerve lesion is usually a neurotemesis, which recovers after a few months.
e- The results of surgical repair are satisfactory if the delay is less than a few
months.
295- To reduce incidence of recurrence in anterior dislocation of shoulder
a- The use of external rotation splints.
b- The use of immobilization.
c- Continue their sports (particularly contact sports).
d- Arthroscopic anterior stabilization surgery after early detection of Bankart's
e- The value of early surgery had been confirmed.
296- Postural downward displacement of the humerus
a- It is similar to true inferior dislocation.
b- The condition is harmful.
c- Not resolves as muscle tone regained.
d- May results quite commonly from tear of ligaments and following laxity of the
muscles around the shoulder.
e- Occur after trauma and shoulder splintage.
297- The Neer classification of proximal neck fracture based on x-ray appearances
a- Fragment displacement defined as greater than 25 degrees of angulation or 0.5
cm of separation.
b- However many fracture lines there are, if the fragments are undisplaced it is
regarded as a one-part fracture;
c- If one segment is separated from the others, it is a one-part fracture;
d- If two fragments are displaced, that is a two-part fracture;
e- The observers do usually agree with each other on which class a particular
fracture falls into.
298- Four part fracture of proximal humerus
a- The both tuberosities displaced.
b- These are severe injuries with some risk of complications.
c- In older patients, open reduction and fixation is advisable.
d- In young patients, an attempt should be made at closed treatment.
e- The results of hemiarthroplasty are unpredictable.
299- Fractured shaft of humerus
a- Bruising is always extensive.
b- Closed transverse fracture treated by internal fixation.
c- Ready-made braces are usually not adequate in moderate displacement.
d- The conservative methods is suitable for all cases.
e- The complication rate after internal fixation of the humerus is rare.
300- Fractured shaft of humerus is well to remember
a- The complication rate after internal fixation of the humerus is high
b- The great majority of humeral fractures need operative treatment.
c- There is good evidence that the union rate is higher with fixation.
d- The rate of union may be better if there is distraction with nailing
e- The rate of union may be better if there is periosteal stripping with plating.
301- Holstein–Lewis fracture.
a- Fracture of proximal part of humerus.
b- Displaced fracture of proximal humerus in children.
c- Displaced transverse fracture of humeral shaft.
d- Oblique fractures at the junction of the middle and distal thirds of the bone.
e- Transverse fracture in lower third of humerus.
302- Fracture of the distal humerus in adult
a- Are often low-energy injuries.
b- May associated with vascular and nerve damage.
c- Most of injuries can be treated conservatively.
d- Rarely need complex surgical techniques.
e- There is low tendency to stiffness of the elbow.
303- Fracture capitulum
a- Is a rare articular fracture, which occurs in any age.
b- The patient falls on the hand, usually with the elbow semiflex.
c- The anterior part of the capitulum sheared off and displaced proximally.
d- Fullness behind the elbow is the most notable feature.
e- In the lateral view, the capitulum seen in front of the coronoid process.
304- Combined fractures of the radial head and coronoid process plus dislocation of
the elbow
a- Is associated with rupture of the medial collateral ligament.
b- Is associated with rupture of the interosseous membrane
c- Is Essex Lopresti lesion.
d- Is the terrible triad.
e- Excision of the radial head is indicated.
305- Side-swipe injuries
a- These severe fracture-dislocations of elbow
b- Are rarely associated with damage to the nerves.
c- The priorities are skeletal stabilization by cast.
d- The injuries stabilized by K- wires.
e- Surgery should done early in emergency theater.
306- Stiffness after dislocation of the elbow
a- Loss of 20 to 30 degrees of extension is common.
b- The most common cause of undue stiffness is prolonged immobilization.
c- The joint should be moved as soon as possible by passive stretching.
d- Persistent stiffness of severe degree can often be improved by arthroplasty.
e- Sometimes the stiffness is due to osteoarthritis.
307- Isolated dislocation of the radial head
a- Is uncommon.
b- Search carefully for an associated fracture of the capitulum.
c- In adult, the ulnar fracture may be difficult to detect.
d- Green-stick or mild plastic deformation of the radial shaft may be missed.
e- Bended ulnar bone may prevent full reduction of the radial head dislocation.
308- The average ages at which the ossific centres appear
a- Capitulum – 1 years.
b- Radial head – 3 years.
c- Medial epicondyle – 6 years.
d- Trochlea – 10 years.
e- Olecranon – 12 years.
309- The fat pad sign of elbow
a- Is seen most clearly in the anteroposterior view.
b- Seen in displaced supracondylar fracture.
c- Is diagnostic of undisplaced supracondylar fracture.
d- Arose suspicions undisplaced supracondylar fracture.
e- Is a triangular lucency behind the distal humerus, due to the fat pad being
pushed backwards by a hematoma.
310- In the anteriorly displaced supracondylar fracture the
a- The fracture line runs downwards and backwards.
b- Fracture line runs obliquely downwards and forwards.
c- The distal fragment tilted backwards.
d- The distal fragment shifted backwards.
e- The proximal fragment tilted forwards.
311- The incidence of vascular injuries in the displaced supracondylar fractures
a- Is probably less than one per thousand.
b- Is probably less than 1 percent.
c- Is probably less than 5 percent.
d- Is probably less than 8 percent.
e- Is probably less than 10 percent.
312- Ischemia following supracondylar fracture suggested by
a- Pain and reduced capillary return on pressing the finger pulp.
b- Pain and blunted sensation.
c- Undue pain and pain on passive extension of the fingers.
d- Pain and a tense and tender forearm.
e- Pain and an absent pulse.
313- Fractured lateral condyle
a- A small fragment of bone and cartilage avulsed.
b- Even with reasonable reduction, malunion not inevitable.
c- Closed reduction with casting is often wise.
d- If left unreduced non-union is inevitable.
e- A varus deformity of the elbow with delayed ulnar palsy the likely sequel. -
314- Pulled elbow
a- Is a subluxation of the orbicular ligament, which slips up over the head of the
radius.
b- A child aged 5-8 years brought with a painful, dangling arm.
c- The forearm held in supination and extension, and any attempt to flex it is
resisted.
d- The x-ray shows subluxation of the radial head.
e- A dramatic cure is achieved by forcefully flexing the elbow; the ligament slips
back with a snap.
315- Fractures of radius and ulna in adults
a- Displaced fractures treated by closed reduction and cast for 4 weeks.
b- The comminuted type held by intramedullary fixation.
c- Bone grafting is not advisable if there is comminution.
d- If the interosseous membrane is severely damaged, plating prevent cross-
union.
e- The deep fascia left open to prevent a build-up of pressure in the muscle
compartments, and only the skin is sutured.
316- Open fractures of the forearm
a- In late presentation antibiotics and tetanus prophylaxis; the wounds are
washed.
b- The wounds are excised and extended and the bone ends are exposed and
thoroughly cleaned.
c- Are primarily fixed with intramedullary nails.
d- If bone grafting is necessary, it should be done early in treatment.
e- If there is major soft-tissue loss, the bones are better stabilized K- wires.
317- Removal of plates and screws from radius and ulna
a- Regarded as a completely innocuous procedure.
b- Complications are uncommon.
c- The damage to vessels and nerves are not expected
d- Infection is extremely rare.
e- Postoperative fracture through a screw-hole may occur.
318- ‘Nightstick fracture’ is
a- Is fracture of the radius alone.
b- Fracture of radius with wrist subluxation.
c- Direct fracture of the ulna alone.
d- Fracture of ulna and proximal radioulnar subluxation.
e- Fracture of both the radius and ulna with tear of interosseous membrane.
319- Isolated fracture of the radius
a- Are prone to rotary displacement.
b- To achieve reduction in children the forearm needs to be pronated for upper
third fractures.
c- To achieve reduction in adult the forearm needs to be supinated for middle
third fractures
d- To achieve reduction in children the forearm needs to be supinated for lower
third fractures.
e- Internal fixation with an intramedullary nail and screws in adults.
320- Treatment of Monteggia fracture dislocation of ulna in adult
a- By closed reduction and cast splintage for 8 weeks.
b- By open reduction and intramedullary fixation.
c- By open reduction through an anterior approach, the ulnar fracture accurately
reduced, with the bone restored to full length, and then fixed with a plate and
screws; bone grafts may be added for safety.
d- By open reduction through a posterior approach, the ulnar fracture accurately
reduced, with the bone restored to full length, and then fixed with a plate and
screws; bone grafts may be added for safety.
e- The radial head reduced always after open reduction.
321- The Galeazzi fracture
a- Is much less common than the Monteggia.
b- Prominence or tenderness over the lower end of the radius is the striking
feature.
c- It may be possible to demonstrate the instability of the radio-ulnar joint by
‘ballotting’ the distal end of the ulna (the ‘piano-key sign’).
d- It is important also to test for a radial nerve lesion, which may occur.
e- X-ray a transverse or short oblique fracture seen in the lower third of the ulna,
with angulation or overlap.
322- Colles' fracture splinted after reduction in
a- In 5 degrees flexion and 5 degrees ulnar deviation.
b- In 10 degrees flexion and 10 degrees ulnar deviation.
c- In 15 degrees flexion and 15 degrees ulnar deviation.
d- In 20 degrees flexion and 20 degrees ulnar deviation.
e- In 25 degrees flexion and 25 degrees ulnar deviation.
323- ‘Dorsal Barton’s fracture’.
a- The line of fracture runs obliquely across the dorsal lip of the radius and the
carpus carried anteriorly.
b- The fracture is not easy to control than the volar Barton’s fracture is.
c- The fracture can be easily reduced and to hold.
d- Is reduced closed like Colles' fracture and the forearm is immobilized in a cast
for 3 weeks.
e- If it re-displaces closed K-wiring or open reduction and plating is advisable.
324- Comminuted intra-articular fracture of distal radius in young adult
a- Is a low energy injury.
b- A good outcome will result even there is intra-articular congruity.
c- CT scans must be used to show the fragment alignment.
d- The most successful option is a manipulation and cast.
e- Open reduction and a combination of wires, plates, screws and bone grafts
may be used.
325- The commonest wrist injuries is
a- Fracture scaphoid.
b- Lunate dislocation.
c- Sprains of the capsule and ligaments.
d- Injury of the triangular fibrocartilage complex.
e- Injury of the distal radio-ulnar joint.
326- Scaphoid fractures account for
a- Almost 75 per cent of all carpal fractures.
b- Almost 60 per cent of all carpal fractures.
c- Almost 50 per cent of all carpal fractures.
d- Almost 35 per cent of all carpal fractures.
e- Almost 25 per cent of all carpal fractures.
327- Scaphoid non-union or avascular necrosis of the proximal fragment.
a- This accounts for the fact that 5 per cent of distal third fractures.
b- Develop in 10 per cent of middle third fractures
c- Develop in 20 per cent of proximal fractures.
d- Relative translucency of the proximal fragment is pathognomonic of avascular
necrosis.
e- Bone grafting may be successful,
328- Triquetro- lunate dissociation
a- A lateral sprain followed by weakness of grip and tenderness distal to radius.
b- X-rays show overlapped between the triquetrum and the lunate.
c- Acute tears should be repaired with interosseous sutures and a cast for 4–6
weeks.
d- Acute tears should be repaired with interosseous sutures Supported by
temporary K-wires for 3 weeks and a cast for 4–6 weeks.
e- In chronic injuries, a ligament substitution or a limited intercarpal fusion may
be considered.
329- Midcarpal dislocation
a- The extrinsic ligaments, which bind the proximal to the distal row, can
rupture.
b- The diagnosis is easy clinically.
c- The patient complains of a painless, recurrent snap in the wrist.
d- If an acute ligament rupture diagnosed, then treated by reduction and cast for 4
weeks.
e- In a chronic lesion, stabilization by K-wire is the most effective treatment.
330- Splintage in hand injuries
a- Splintage is not a cause of stiffness.
b- It must be appropriate and it must be kept to a minimum length of time.
c- If a finger has to be splinted, a rigid cast used.
d- Internal fixation should be avoided.
e- If the entire hand needs splinting, this must always be in the position of rest.
331- Multiple metacarpal fractures
a- Can adequately held by the surrounding muscles and ligaments.
b- Allows free early mobilization.
c- Should be fixed with rigid plates.
d- Should be held by cast.
e- Treated by multiple longitudinal wires.
332- Transverse fracture of the shaft of phalanges,
a- Often with backward angulation.
b- Often with medial angulation.
c- Often with lateral angulation.
d- Often with forward angulation.
e- Result from a twisting injury.
333- A mallet finger
a- Is best treated with a splint for 8 weeks.
b- Surgery is good alternative.
c- Surgery carries a low rate wound failure.
d- Metalwork problems is also rare.
e- Using a special mallet-finger splint make the outcome worse.
334- Avulsion of the flexor tendon of finger
a- Caused by direct trauma.
b- Caused by sudden hyperextension of the distal joint.
c- The little finger is most commonly affected.
d- The flexor digitorum superficialis tendon is avulsed.
e- Even If the diagnosis delayed, repair is likely to be successful.
335- Carpo-metacarpal dislocation
a- The thumb is less frequently affected and clinically resembles a Bennett’s
fracture dislocation;
b- The displacement of the thumb is easily reduced by traction and supination.
c- The reduction is stable.
d- A K-wire fixation is not recommended to prevent the joint from dislocating
again.
e- Chronic instability can occur.
336- Complex metacarpo-phalangeal dislocation
a- The avulsed palmar plate sits in the joint, blocking reduction.
b- The phalangeal base clasped between the flexor tendon and lumbrical tendon.
c- The finger extended only about 10 degrees and there is usually a telltale
dimple in the palm.
d- Usually the fracture reduced closed by hyperextending the MCP joint and
flexing the IP joints.
e- A volar approach is safest.
337- The complete rupture of ulnar collateral ligament of thumb
a- Is very common.
b- Only the ligament proper is torn.
c- The thumb is unstable in flexion only.
d- The thumb is unstable in all positions.
e- It will heal without surgical repair.
338- The zone II of hand injury is
a- Proximal to the carpal tunnel.
b- Within the carpal tunnel.
c- Between the opening of the flexor sheath (the distal palmar crease) and the
insertion of flexor superficialis.
d- Between the end of the carpal tunnel and the beginning of the flexor sheath.
e- Distal to the insertion of flexor digitorum superficialis.
339- Nail bed injuries
a- Are often seen as isolated injury.
b- If appearance is important, meticulous repair of the nail bed under
magnification.
c- Healing will be quicker with a split-skin graft.
d- Replacing any loss with a split skin graft from one of the toes, will give the
best cosmetic result.
e- In children, these injuries are associated with dislocation of DIJ.
340- The commonest cause of stiffness in hand injuries is
a- The presence of fractures.
b- Tendon injures.
c- Failure to use splintage in safety position.
d- The presence of edema.
e- The prolonged immobilization in volar slab.
341- After primary flexor tendon suture , the hand splinted in
a- The wrist held in about 20 degrees of flexion, the metacarpo-phalangeal joints
are flexed to only about 70 degrees but the interphalangeal joints must remain
straight.
b- The wrist held with a dorsal splint in about 50 degrees of flexion but the
interphalangeal joints must remain in 20 degrees of flexion.
c- The metacarpo-phalangeal joints flexed at least 70 degrees and the
interphalangeal joints almost straight.
d- The metacarpo-phalangeal joints extended and flexion of the interphalangeal
joints
e- The wrist extended to 30 degrees the metacarpo-phalangeal joints are flexed to
only about 30 degrees, and the interphalangeal joints remain straight.
342- After extensor tendon repair, the hand splinted in
a- The wrist held in about 20 degrees of flexion, the metacarpo-phalangeal joints
flexed to only about 70 degrees but the interphalangeal joints must remain
straight.
b- The wrist held with a dorsal splint in about 50 degrees of flexion but the
interphalangeal joints must remain in 20 degrees of flexion.
c- The metacarpo-phalangeal joints flexed at least 70 degrees and the
interphalangeal joints almost straight.
d- The metacarpo-phalangeal joints extended and flexion of the interphalangeal
joints
e- The wrist extended to 30 degrees, the metacarpo-phalangeal joints are flexed
to only about 30 degrees, and the interphalangeal joints remain straight.
343- MRI is the method of choice for
a- Showing structural damage to individual vertebrae.
b- Showing displacement of bone fragments into the vertebral canal.
c- Displaying the intervertebral discs, ligamentum flavum and neural structures.
d- Provides information on the dimensions of the spinal canal.
e- provides information on impingement by fracture fragments or intervertebral
disc
344- Stable injuries of spine treated
a- By supporting the spine in a position that will cause no further strain.
b- By prolonged splintage.
c- By traction for 2 months.
d- By stabilization by internal fixation followed by exercise and physiotherapy.
e- By decompression of spine and inter-spinal fusion.
345- Odontoid fractures can be fixed
a- With small plates between the lateral masses.
b- With lag screws.
c- With a halo-vest.
d- Anteriorly with plates between the vertebral bodies.
e- Posteriorly with wires between the spinous processes.
346- The anterior approach to the spine
a- Is suitable for wedge fractures.
b- The vertebral body preserved and a bone graft added.
c- Is suitable for burst fracture with significant canal impingement.
d- Suitable for flexion-compression injuries.
e- Suitable for seat-belt injuries and fracture-dislocations.
347- In the lateral view of cervical spine
a- Not all irregularity suggests a fracture or displacement.
b- Forward shift of the vertebral body by 50 per cent suggests a unilateral facet
dislocation.
c- Forward shift of the vertebral body by 40 per cent suggests a unilateral facet
dislocation.
d- Forward shift of the vertebral body by 25 per cent suggests a unilateral facet
dislocation
e- Forward shift of the vertebral body by 25 per cent suggests a bilateral facet
dislocation.
348- The distance between the odontoid peg and the back of the anterior arch of the
atlas should be
a- No more than 2 mm in adults and 2 mm in children .
b- No more than 3 mm in adults and 3 mm in children .
c- No more than 5 mm in adults and 5 mm in children .
d- No more than 3 mm in adults and 2.5 mm in children .
e- No more than 3 mm in adults and 4.5 mm in children.
349- Hangman's fracture
a- Treatment in a semi-rigid orthosis for 2-3 weeks.
b- Fractures with more than 3mm displacement need treatment in collar for 6
weeks.
c- In the treatment, traction must be avoided.
d- If displaced, reduced and the neck is held in Minerva jacket for 6 weeks.
e- If associated with a C2/3 facet dislocation Minerva jacket applied for 9 weeks.
350- C2 Odontoid process fracture
a- Odontoid fractures are not uncommon.
b- Occur as extension injuries in young adults after high velocity accidents or
severe falls.
c- A displaced fracture is really a fracture-dislocation of the atlanto-axial joint.
d- There is no room for displacement without neurological injury.
e- Cord damage is common.
351- Odontoid fractures Type II
a- Is stable.
b- Unites without difficulty.
c- Is the most uncommon.
d- Is potentially the most dangerous type.
e- The fracture is in tip of odontoid.
352- Posterior ligament injury of cervical spine
a- Sudden extension of the mid-cervical spine can result in damage to the
posterior ligament complex.
b- The upper vertebra tilts backwards on the one below, opening up the
interspinous space posteriorly.
c- The patient complains of pain and there may be localized tenderness
anteriorly.
d- It is always advisable to obtain a lateral view with the neck in the extension
position.
e- Flexion should not be permitted in the early post-injury period.
353- Wedge compression fracture of cervical spine
a- A pure extension injury.
b- The middle and posterior elements injured.
c- Is unstable.
d- Treated by a comfortable collar for 6–12 weeks.
e- Is potentially dangerous.
354- Burst fractures of cervical spine
a- Are due to flexion compression.
b- Vertebral body crushed by axial compression in neutral position of the neck.
c- There is no risk of posterior displacement of the vertebral body fragment and
spinal cord injury.
d- Soft collar applied for 6 weeks.
e- X-ray is sufficient to look for retropulsion of bone fragments into the spinal
canal.
355- Tear-drop fracture of cervical spine
a- Is comminuted vertebral body fracture has produced a large anterior fragment.
b- Obvious anterior displacement of the posterior fragment.
c- The severity of the injury can estimated well.
d- Treated effectively by a collar for 3 weeks is sufficient.
e- Neurological deficits is rare.
356- Bilateral facet joint dislocations are caused by
a- A sever hyperextension.
b- A flexion compression.
c- A vertical compression.
d- A sever flexion distraction.
e- A severe flexion–rotation.
357- Patients with minimal wedging of thoracolumbar spine treated by
a- Cast brace followed by bed rest for 4 weeks.
b- Bed rest for a week or two until pain subsides and are then mobilized.
c- Immobilization and back support needed for 6 weeks.
d- Thoracolumbar brace used for 6 weeks and are then mobilized.
e- Body cast applied with the back in extension and are then mobilized.
358- Wedge fracture with loss of anterior vertebral height is greater than 40 per cent
a- Is stable fracture.
b- It resist further collapse and deformity.
c- Treated by thoracolumbar brace.
d- Surgical correction and internal fixation is the preferred treatment.
e- Body cast applied with the back in extension and are then mobilized.
359- Thoracolumbar fracture-dislocation
a- In fracture-dislocation with paraplegia, surgery will facilitate nursing, and help
the patient’s rehabilitation.
b- In fracture-dislocation with a partial neurological deficit, there is evidence that
surgical stabilization provides a better neurological outcome.
c- If surgical decompression and stabilization are performed, this may require a
combined posterior and anterior approach.
d- In fracture-dislocation without neurological deficit, surgical stabilization will
not prevent future neurological complications.
e- Usually can be managed non-operatively with postural reduction, bed rest and
bracing.
360- Complete and incomplete paralysis in spinal injuries
a- The patient must be transported with great care to prevent further damage.
b- Bladder training begun at 2nd week.
c- The bowel training is more difficult.
d- Heterotopic ossification is a rare complication.
e- If bedsores have allowed developing, usually heal by postural treatment.
361- The morale of a paraplegic patient
a- Not liable to reach a low ebb.
b- The restoration of self-confidence is not an important part of treatment.
c- Constant encouragement by doctors, physiotherapists and nurses is not
essential.
d- The unpleasant smells of bowel accidents, or those associated with skin or
urinary infection cannot prevented.
e- The patient should find a hobby or be trained for a new job as quickly as
possible.
362- Fractures of the pelvis
a- Account for less than 1 per cent of all skeletal injuries.
b- Is important because of the high incidence of associated soft tissue injuries and
the risks of severe blood loss
c- Like other serious injuries, they demand an isolated approach by expert's
surgeon.
d- About one-thirds of all pelvic fractures occur in road accidents involving
pedestrians.
e- Over 1 per cent of these patients will have associated visceral injuries.
363- The patient with pelvic fracture with suspected urethral injury
a- Should not be encouraged to void.
b- If he is able void, there is no damage.
c- No attempt should be made to pass a catheter, as this could convert a partial to
a complete tear of the urethra.
d- The absence of blood at the meatus exclude a urethral injury.
e- Can be diagnosed more accurately by cystography.
364- The ilium and acetabulum is well defined in
a- Anteroposterior view.
b- Lateral view.
c- Oblique view.
d- Inlet view.
e- Outlet view.
365- Avulsion fractures of pelvis.
a- A apiece of bone is broken direct trauma.
b- This is usually seen old patients.
c- All are essentially impact injury.
d- Treated by skin traction and rest for a few weeks.
e- Biopsy of the callus in site of injury, may lead to an erroneous diagnosis.
366- Vertical shear pelvic fracture
a- The innominate bone on both side displaced vertically.
b- Fracturing the pubic rami and disrupting the sacroiliac region on the same
side.
c- This occurs typically when someone falls from a height onto both leg.
d- Are usually stable.
e- Rarely complicated with gross tearing of the soft tissues and retroperitoneal
hemorrhage.
367- High-energy fractures of the pelvis
a- Are stables injuries.
b- Carrying a low risk of associated visceral damage.
c- Carry low risk of intra-abdominal and retroperitoneal hemorrhage.
d- Carrying great risk of shock, sepsis and ARDS.
e- The mortality rate is low.
368- The main cause of death following high-energy pelvic fractures is
a- Airway obstruction.
b- Respiratory system injury.
c- Severe bleeding.
d- Fat embolism.
e- Respiratory distress syndrome.
369- Pelvic fracture with a large retroperitoneal hematoma
a- It should be evacuated by laparotomy.
b- It should be evacuated by laparoscopy.
c- It should be controlled by selective embolization.
d- It should not be evacuated.
e- It should be controlled by vascular repair.
370- Urological injury in pelvic ring fracture
a- Occurs in about 10 per cent of patients.
b- Occurs in about 15 per cent of patients.
c- Occurs in about 20 per cent of patients.
d- Occurs in about 25 per cent of patients.
e- Occurs in about 30 per cent of patients.
371- Treatment of open book fracture with the anterior gap is more than 2 cm
a- By bed rest.
b- By a posterior sling to ‘close the book’.
c- By a pelvic binder to ‘close the book’.
d- By external fixation with pins in both iliac blades connected by an anterior
bar.
e- By plating anteriorly and ilio-sacral screw fixation posteriorly.
372- Types IV Thompson and Epstein classification of hip dislocations is
a- Dislocation with no more than minor chip fractures.
b- Dislocation with single large fragment of posterior acetabular wall.
c- Dislocation with comminuted fragments of posterior acetabular wall.
d- Dislocation with fracture through acetabular floor.
e- Dislocation with fracture through acetabular floor and femoral head.
373- Type I posterior hip dislocation
a- Reduction is usually unstable.
b- Apply traction after reduction and maintain it for a few weeks.
c- Movement and exercises are begun as soon as pain allows.
d- The terminal ranges of hip movements are avoided to allow healing of the
capsule and ligaments.
e- The patient is allowed to walk with crutches about 2 weeks but without taking
weight on the affected side.
374- The period of hip ‘protection’ after posterior hip dislocation
a- Varies according to the age of the patient.
b- If the reduction was performed promptly (within 6 hours), then no more than
16 weeks should suffice.
c- If there was a longer delay then an extended period of 22 weeks may be wiser.
d- Progression of weight bearing should be graduated and the hip joint monitored
by x-ray.
e- The rationale for not bearing weight is to prevent avascular change.
375- Anterior dislocation of the hip
a- Is not rare compared with other types.
b- The usual cause is a fall from height.
c- The femoral head will then lie superiorly (type I - pubic) or inferiorly (type II -
obturator).
d- The leg lies externally rotated, adducted and slightly flexed.
e- The prominent head is easy to feel posteriorly.
376- Central dislocation of the hip
a- Is commonest type of dislocation.
b- The usual cause is dashboard injury.
c- A blow over the greater trochanter, may force the floor of the acetabulum
laterally.
d- It is really a fracture of the acetabulum.
e- Commonly complicated by sciatic nerve injury.
377- The fractures of femoral neck
a- Occasionally results from a simple fall.
b- Usually result from car accident or fall from height.
c- Some patients may have experienced minor symptoms.
d- In younger individuals, the usual cause is a fall on ground.
e- Stress fractures of the femoral neck occur in runners is common.
378- In Garden III fractures of femoral neck
a- The femoral head is in its normal position or tilted into valgus and impacted
on the femoral neck stump.
b- The femoral head trabeculae are normally aligned with those of the innominate
bone.
c- The femoral head trabecular markings are not in line with those of the
innominate bone.
d- The proximal fragment has lost contact with the femoral neck.
e- The anteroposterior x-ray shows that the femoral head is tilted out of position.
379- Displaced femoral neck fracture treatment
a- Displaced fractures will unite without internal fixation.
b- Operative treatment is almost mandatory.
c- Non-operative treatment used in patients with advanced dementia.
d- Non-operative treatment used in patients with little discomfort.
e- The fractures united if traction applied for 4 months.
380- In young patients with fracture neck femur
a- The longer the delay, the lesser is the likelihood of complication.
b- Operation is urgent.
c- Displaced fractures will unite without internal fixation.
d- Non-operative treatment can be used.
e- There is low incidence of complications.
381- Garden’s index for assessing reduction in subcapital fractures
a- On the anteroposterior x-ray, the medial femoral shaft and the axis of
trabecular markings over the medial aspect of the femoral neck lie at an angle
less than 155°.
b- On the anteroposterior x-ray, the medial femoral shaft and the axis of
trabecular markings over the medial aspect of the femoral neck lie between
160° and 180°.
c- On the lateral view, the trabecular markings would be in angle about 90°, if
the fracture perfectly reduced.
d- On the lateral view, the trabecular markings would be in angle about 120°, if
the fracture perfectly reduce
e- On the lateral view, the trabecular markings would be in angle about 150°, if
the fracture perfectly reduced.
382- Hip prostheses used for femoral neck fractures
a- This procedure carries a shorter operating time.
b- This procedure carries a less blood loss.
c- This procedure carries a lower infection rate than internal fixation.
d- Usually of the femoral part only (hemiarthroplasty) and may be inserted with
or without cement.
e- Uncemented prostheses have better mobility and less thigh pain.
383- Total hip replacement for femoral neck fractures may be indicated
a- If treatment not delayed.
b- If acetabular damage is not suspected.
c- In patients with metastatic disease.
d- If there is no Paget’s disease.
e- Old patient with impacted fracture.
384- The mortality rate in elderly patients with femoral neck fracture
a- May be as high as 5 per cent at 4 months after injury.
b- May be as high as 10 per cent at 4 months after injury.
c- May be as high as 15 per cent at 4 months after injury.
d- May be as high as 20 per cent at 4 months after injury.
e- May be as high as 25 per cent at 4 months after injury.
385- Ischemic necrosis of the femoral head after femoral neck fracture
a- Occurs in about 10 per cent of patients with displaced fractures.
b- Occurs in about 20 per cent of patients with displaced fractures.
c- Occurs in about 20 per cent of those with undisplaced fractures.
d- A few weeks later, an isotope bone scan may show increased vascularity.
e- Core decompression has no place in the management.
386- A ‘tip-apex’distance is described to identify a ‘sweet-spot’ for positioning the
sliding screw in intertrochanteric
a- If within 5 mm, there is a lower risk of the screw cutting out of the femoral
head.
b- If within 10 mm, there is a lower risk of the screw cutting out of the femoral
head .
c- If within 15 mm, there is a lower risk of the screw cutting out of the femoral
head .
d- If within 20 mm, there is a lower risk of the screw cutting out of the femoral
head .
e- If within 25 mm, there is a lower risk of the screw cutting out of the femoral
head .
387- Pathological intertrochanteric fractures
a- May be due to metastatic disease or myeloma.
b- These fractures seldom fail to unite.
c- Fracture fixation is essential in order to ensure union.
d- Methylmethacrylate cement is contraindicated.
e- Cementless total hip replacement may be preferable.
388- Hip fractures in children
a- Are commonly occur and potentially very serious.
b- The fracture is usually due to mild trauma.
c- Pathological fractures sometimes occur through a bone cyst or benign tumor.
d- In children over two years, the possibility of child abuse considered.
e- There is a low risk of complications.
389- Type IV fracture neck femur in children
a- Is a fracture-separation of the epiphysis.
b- The epiphyseal fragment is dislocated from the acetabulum.
c- The transcervical fracture; this is the least variety.
d- Is a basal (cervico-trochanteric) fracture.
e- Is an intertrochanteric fracture
390- Avulsion of the lessor trochanter
a- In the elderly, may occur by the pull of the psoas muscle.
b- The injury nearly always occurs swimming.
c- Treatment is rest, followed by return to activity when comfortable.
d- In the young adult, the lessor trochanteric fixed by screw.
e- In the adolescent, separation of the lesser trochanter should arouse suspicions
of metastatic malignant disease.
391- Fracture of the greater trochanter
a- In the elderly, a direct blow can fracture it after a fall.
b- In the elderly, treatment is operative and functional recovery is usually good.
c- The greater trochanter fractured by direct trauma in a young individual.
d- It can be treated conservatively by bed rest and analgesia.
e- Full weight bearing allowed early.
392- Intramedullary nails in subtrochanteric fractures
a- Are generally weaker.
b- Preferable for a pathological fracture.
c- Can tolerate stresses for shorter period if healing is slow.
d- Used for simple stable fracture.
e- Used with wide operative dissection.
393- Femoral shaft fractures in elderly patients should be considered
a- Open fracture.
b- Transverse fracture.
c- Oblique fractures.
d- Pathological fracture.
e- Comminuted fracture.
394- In proximal femoral shaft fractures
a- The proximal fragment is flexed, adducted and externally rotated.
b- The distal fragment is frequently abducted.
c- The distal fragment is frequently adducted.
d- The distal fragment is tilted by gastrocnemius pull.
e- The distal fragment adducted by gastrocnemius pull.
395- An ipsilateral femoral neck fracture associated with femoral shaft fracture is
occur in about
a- Two per cent of cases.
b- Four per cent of cases.
c- Six per cent of cases.
d- Eight per cent of cases.
e- Ten per cent of cases.
396- The risk of systemic complications in femoral shaft fracture can be
significantly reduced by
a- By use of Thomas splint.
b- By skin traction.
c- Early stabilization of the fracture, usually by a locked intramedullary nail.
d- Early stabilization of the fracture, usually by a plate and screws.
e- Early stabilization of the fracture, usually by reamed K nail.
397- In the multiply injured patient, particularly one with severe chest trauma,
prompt stabilization with
a- A cast splintage.
b- A skin traction.
c- A plate and screws.
d- An external fixator.
e- An intramedullary nail.
398- Ipsilateral fractures of the femur and tibia may leave the knee joint ‘floating’.
a- This is a very serious situation.
b- One of fractures will need immediate stabilization.
c- A lateral approach to the knee joint will allow both fractures to be stabilized
by plate.
d- Retrograde for the tibia and antegrade for the femur.
e- It is usual to fix the tibia first.
399- Pathological fractures through femoral shaft should be fixed by intramedullary
nailing
a- Provided the patient is fit enough to tolerate the operation.
b- A short life expectancy is a contraindication.
c- Prophylactic fixation is indicated, if a lytic lesion is greater than quarter the
diameter of the bone.
d- Prophylactic fixation is also indicated if a lytic lesion is longer than one cm on
any view.
e- The femur is likely to be bowed in the case of Paget’s disease, an osteotomy to
straighten the femur is contraindicated.
400- Femoral shaft fractures around a hip implant
a- Are common.
b- Occurs years later.
c- There are no x-ray signs of osteolysis.
d- There are no x-ray signs of implant loosening.
e- They may happen during primary hip surgery.
401- When a comminuted femoral fracture is plated
a- Early weight bearing allowed.
b- The rate of union is high and knee stiffness is less.
c- Custom brace applied and weight bearing delayed.
d- Bone grafts should be added and weight bearing delayed.
e- Bone grafts should be added and weight bearing allowed early.
402- Fractures of the femur in children
a- Are uncommon in older children.
b- Are usually due to indirect violence.
c- Healing is slow and complications are high.
d- Pathological fractures are rare in generalized disorders such as spina bifida and
osteogenesis imperfecta,
e- Pathological fracture may occur in cyst or tumor.
403- Femoral shaft fracture in children under 2 years of age
a- The commonest cause is fall from height.
b- The commonest cause is car accident.
c- The commonest cause is child abuse.
d- Malunion is common and serious in this age.
e- Nonunion is common after cast application.
404- The principles of treatment of femoral shaft fractures in children
a- Are different from in adults.
b- Open treatment is rarely necessary.
c- The choice of closed method depends largely type of fracture.
d- As children get smaller, fractures take longer to heal.
e- As children get smaller, there is a greater risk of malunion.
405- Infants with femoral shaft fractures
a- Treated by a 2 weeks in fixed traction.
b- Treated by a spica cast for another 2 –3 weeks.
c- Angulation of up to 30 degrees can be accepted.
d- Immediate spica casting is bad choice.
e- Surgery had low risk of complications.
406- Operative treatment with internal fixation for femoral supracondylar fracture
a- If the fracture is only slightly displaced.
b- If it reduces easily with the knee in flexion.
c- Enable accurate fracture reduction.
d- If the patient is young.
e- If the facilities and skill are limited.
407- Retrograde locked intramedullary nails for femoral supracondylar fracture are
suitable for
a- The type B fracture.
b- The type A fracture.
c- Comminuted type C fractures.
d- Severe osteoporotic bone.
e- Undisplaced fracture or is only slightly displaced.
408- For severely comminuted type C femoral supracondylar fracture
a- Traditional angled blade-plates used.
b- A 95-degree condylar screw-plate.
c- Retrograde locked intramedullary nails
d- The minimal contact plate with locking screws.
e- Unprotected early weight bearing is advisable.
409- Knee stiffness after operative treatment of femoral supracondylar fracture
a- Due to scarring from the injury and the operation.
b- Can prevented easily by early exercises.
c- A short period of exercise needed in all cases.
d- Full range of movement regained after physiotherapy.
e- Arthroscopic division of adhesions in the joint is contraindicated.
410- Fracture-separation of the distal femoral epiphysis
a- Is nearly as common as physeal fractures at the elbow.
b- In the childhood equivalent of a supracondylar fracture .
c- Is important because of its potential for nonunion.
d- Rarely caused growth and deformity of the knee.
e- Is usually a Salter–Harris type IV.
411- The femur’s length is derived from the distal physis in about
a- 40%.
b- 50%.
c- 60%.
d- 70%.
e- 80%.
412- Fracture-separation of the distal femoral epiphysis treatment
a- Rarely perfectly reduced manually.
b- Salter–Harris types 2 should be accurately reduced and fixed.
c- A flap of periosteum may be trapped in the fracture line.
d- The metaphyseal fragments should not be stabilized with percutaneous
Kirschner wires or lag.
e- The limb immobilized in plaster for 2-3 weeks postoperatively.
413- The primary stabilizer for valgus stress at 30 degrees of flexion is
a- The MCL.
b- The LCL.
c- The PCL.
d- The ACL .
e- Posterior oblique ligaments.
414- The cruciate ligaments provide
a- Anteroposterior stability.
b- Rotary stability.
c- Both anteroposterior and rotary stability.
d- Mainly resist excessive valgus angulation.
e- Mainly resist excessive varus angulation.
415- Triad of O’Donoghue is
a- MCL, LCL and medial meniscal injury.
b- MCL, ACL and medial meniscal injury.
c- MCL, PCL and medial meniscal injury.
d- PCL, ACL and medial meniscal injury.
e- PCL, LCL and medial meniscal injury.
416- Posterior sag of the proximal tibia is a reliable sign of injury in
a- ACL.
b- MCL.
c- LCL.
d- PCL.
e- Both cruciate damage.
417- A positive anterior drawer test is diagnostic of
a- ACL.
b- MCL.
c- LCL.
d- PCL.
e- Both cruciate damage.
418- Avulsed a small piece of bone from the near edge of the lateral tibial condyle
by
a- Lateral collateral ligament.
b- Iliotibial tract.
c- Lateral collateral and ACL.
d- Lateral collateral and posterolateral structures.
e- Posterior oblique ligaments .
419- Arthroscopy should not be attempted
a- Anterior cruciate ligaments.
b- Posterior cruciate ligaments.
c- Meniscus injuries.
d- Collateral ligaments.
e- Osteochondral injuries.
420- Isolated tears of the MCL
a- The knee is unstable in full extension.
b- Usually heal well enough to permit near-normal function.
c- Operative repair is necessary.
d- arthroscopy should be attempted.
e- A long cast-brace worn for 3 weeks.
421- Locking is feature of chronic
a- Anterior cruciate ligament injury.
b- Posterior cruciate ligament injury.
c- Anteromedial instability.
d- Posterolateral instability.
e- Meniscal tear.
422- The most reliable test for anterior cruciate ligament injury is
a- Anterior drawer test.
b- Posterior drawer test.
c- Lachman's test.
d- Pivot shift test.
e- Reverse pivot shift test.
423- The reliable method of diagnosing central meniscus injury
a- Pivot shift test.
b- Revers pivot test.
c- Apley's compression test.
d- MRI.
e- Arthroscopy.
424- Arteriography in dislocation of knee
a- It is essential in all cases.
b- It must be done in all cases with nerve injury.
c- Is not essential if the clinical assessment of the circulation is normal.
d- If the ankle/brachial arterial pressure index more than 0.9.
e- If there is, any associated fracture an arteriogram obtained.
425- Popliteal artery damage in dislocation of knee
a- Occurs in nearly 40 per cent of patients.
b- Occurs in nearly 50 per cent of patients.
c- Needs elevation and closed observation.
d- Needs an immediate repair.
e- Delay and an extended warm ischemic period can reduce risk of amputation.
426- Nerve injury in dislocation of knee
a- The posterior popliteal nerve may be injured.
b- Spontaneous recovery is rare.
c- About 60 per cent of patients can be expected to improve.
d- If there is no sign of recovery, a transfer of tibialis posterior tendon may help
restore ankle dorsiflexion.
e- If there is no sign of recovery, a transfer of tibialis anterior tendon may help
restore ankle plantarflexion.
427- Adolescents suffer disruption of the extensor apparatus in
a- The quadriceps tendon.
b- The attachment of the quadriceps tendon to the proximal surface of the patella.
c- Through the patella and retinacular expansions.
d- The junction of the patella and the patellar ligament.
e- The insertion of the patellar ligament to the tibial tubercle.
428- Fracture of the tibial tubercle
a- Usually occurs in old people.
b- The area over the tubercle is swollen but active extension painless.
c- The anteroposterior x-ray shows the fracture.
d- Sometimes the patella is abnormally high.
e- Complete separation treated by applying a long-leg cast with the knee in
extension for 6 weeks.
429- Osgood–Schlatter disease
a- Single trauma is the cause.
b- Give rise to a painful, tender swelling over the tibial tubercle.
c- The condition is uncommon in adolescents who are keen on sport.
d- X-ray show cystic lesion in tibial tubercle.
e- Treatment consists of a long-leg brace for 5 weeks.
430- Fractured patella
a- The patella is not a sesamoid bone.
b- The patella is the only insertion site of quadriceps muscle.
c- The mechanical function of the patella is to reduce the efficiency of the
quadriceps.
d- The key to the management of patellar fractures is the state of the entire
extensor mechanism.
e- If the patella is fractured, active knee extension is impossible.
431- Direct fracture of patella
a- Is a transverse fracture with a gap between the fragments.
b- Occurs, when contracts the quadriceps muscle forcefully.
c- Patient cannot lift the straight leg.
d- Occur usually when fall onto the knee or a blow against the dashboard of a car .
e- Operative treatment is essential.
432- Bipartite patella
a- Is often unilateral.
b- The line is sharp and irregular.
c- The line is transverse.
d- The lines are longitudinal.
e- The line running obliquely across the superolateral corner of the patella.
433- Type 1 – a vertical split of the lateral condyle
a- This is a fracture through dense bone.
b- Usually occur in older people.
c- May be virtually undisplaced, or the condylar fragment may be pushed
superiorly and tilted.
d- The lateral meniscus protected from damage.
e- The depressed fragments may be wedged firmly into the subchondral bone.
434- The most reliable imaging of tibial plateau fracture
a- Anteroposterior x-ray.
b- Lateral x-ray.
c- Oblique x-rays.
d- CT scan.
e- MRI.
435- Treatment of Type 1 tibial plateau fractures
a- Undisplaced fractures treated operatively.
b- Weight bearing not allowed for 12 weeks.
c- The aim is for an accurate reduction.
d- Displaced fractures treated by bone graft.
e- The femoral condylar surface examined and trapped fragments removed.
436- Type 3 tibial plateau fractures principles of treatment
a- The knee is usually unstable.
b- A satisfactory outcome is less predictable.
c- The depressed fragments may need to be elevated through joint.
d- The elevated fragments supported with bone grafts and the whole segment
fixed in position with ‘raft’ screws.
e- Postoperatively, exercises delayed.
437- Medial tibial condylar split fracture-
a- Usually occur in older people.
b- Caused by low-energy trauma.
c- The fracture itself is simple.
d- Good lateral x-rays or CT are needed to define the fracture pattern.
e- There is often an underlying ligament injury on the medial side.
438- Deformity following tibial plateau fracture
a- Some residual valgus or varus deformity is quite common.
b- Result only from incompletely reduced
c- Result only from re-displaced fracture during treatment.
d- Moderate deformity is not compatible with good function.
e- Predispose to osteoarthritis early after treatment.
439- Fracture of the proximal end of the fibula
a- Caused only by direct injury.
b- An isolated fracture of the proximal fibula is common.
c- It may be part of a more extensive rotational injury of the leg.
d- X-ray of the ankle not indicated.
e- The fracture need open reduction and internal fixation.
440- Dislocation of proximal tibiofibular joint
a- Twisting injury is the only cause dislocation of the distal tibio-fibular joint.
b- Isolated injuries are common.
c- Occasionally the condition is habitual and associated with generalized
ligamentous laxity.
d- The fibular head displaces downwards.
e- Always check for posterior tibial nerve injury.
441- The incidence of infection in tibial Gustilo type I is
a- 1 per cent.
b- 2 per cent.
c- 3 per cent.
d- 4 per cent.
e- 5 per cent.
442- The incidence of infection in tibial Gustilo type III Cis
a- 5 per cent.
b- 10 per cent.
c- 20 per cent.
d- 30 per cent.
e- 40 per cent.
443- The least stable fracture of tibia is
a- Long spiral fracture.
b- A butterfly fracture.
c- Severely comminuted fractures.
d- Long oblique fracture.
e- Transverse fracture .
444- Tscherne’s IC4 fracture of tibia is associated with
a- Necrosis from contusion.
b- Extensive, closed degloving.
c- Circumscribed degloving.
d- Skin contusion.
e- No skin lesion
445- Gustilo’s IIIA open tibial fractures
a- Wound usually <1 cm long.
b- Bone injury is simple low-energy.
c- Moderate comminution.
d- Comminuted but soft-tissue cover possible.
e- Requires soft-tissue reconstruction for cover.
446- Gustilo’s IIIC open tibial fractures
a- Wound Usually >10 cm long.
b- Moderate soft tissue injury, some muscle damage.
c- Moderate comminution.
d- Comminuted fracture, but soft-tissue cover possible.
e- Severe loss of soft-tissue cover with need for vascular repair
447- Gustilo’s II open tibial fractures
a- Wound usually <1 cm long.
b- Minimal soft tissue injury.
c- Bone injury is simple low-energy.
d- Moderate contamination.
e- Requires soft-tissue reconstruction for cover.
448- The method of choice for internal fixation of displaced fracture of tibia in
adults is
a- Plate and screws.
b- Open intramedullary nailing.
c- Closed intramedullary nailing.
d- External fixation.
e- Submuscular plating.
449- Large bone defects in open tibia fractures treated by
a- Plate and bone graft.
b- Closed intramedullary nail and bone graft.
c- Open intramedullary nail and bone graft.
d- External fixation and bone graft.
e- Bone transport or compression-distraction with an external fixator.
450- The safest temporary stabilization for Gustilo grades IIIB and C is
a- A spanning external fixator.
b- Plate and screws.
c- Open intramedullary nailing.
d- Closed intramedullary nailing.
e- Submuscular plating.
451- Postoperative management of open tibial fractures
a- The limb should be elevated and frequent checks made for signs of
compartment syndrome.
b- With locked intramedullary nails, weight bearing delayed.
c- If the fracture comminuted, full weight bearing permitted when callus seen on
x-ray.
d- With plate fixation, early weigh bearing permitted without cast application.
e- Patient with transverse fracture stabilized by external fixation, weight bearing
delayed.
452- Patients with open tibial fractures stabilized with external fixators
a- Cannot weight-bear early.
b- Weight bearing through the fractured tibia increased when callus is visible on
x-ray.
c- The fixator is ‘dynamized’ early to allow greater load transfer through the
bone.
d- When fracture consolidated the external fixator exchanged to a plate.
e- If the pin sites are in poor condition, a change to plate is helpful.
453- The diagnosis of compartment syndrome is usually suspected on
a- Doppler examination.
b- Ultrasonography.
c- Leg radiological examination.
d- Measurement of compartment pressure.
e- Clinical grounds.
454- Warning symptom of compartment syndrome in the leg is
a- Increasing pain.
b- Numbness.
c- Hypoesthesia.
d- Anesthesia.
e- Loss of function.
455- Warning sign of compartment syndrome in the leg is
a- Swelling.
b- Bruises.
c- Pallor of the toes ends.
d- Pain provoked by muscle stretching.
e- Changes of skin colour in dependent position.
456- The diagnosis of compartment syndrome can be confirmed by
a- Angiography.
b- Doppler examination of the leg blood vessels.
c- Measuring the compartment pressures in the leg.
d- Skin oxygen tension.
e- The leg venography.
457- The tibial fracture associated with decompression fasciotomy is treated as
a- A grade I open fracture by closed intramedullary nailing.
b- A grade I open fracture by open intramedullary nailing.
c- A grade II open fracture by closed intramedullary nailing.
d- A grade III open fracture by a spanning external fixator.
e- A grade III open fracture by closed intramedullary nailing.
458- Compartment decompression of leg should be performed within
a- Within 4 hours of the onset of symptoms.
b- Within 6 hours of the onset of symptoms.
c- Within 8 hours of the onset of symptoms.
d- Within 10 hours of the onset of symptoms.
e- Within 12 hours of the onset of symptoms.
459- Hypertrophic non-union of tibia can be treated by
a- Intramedullary nailing (or exchange nailing).
b- Neutral plating.
c- Neutral plating and bone grafting.
d- Compression plating and bone grafting.
e- External fixation and bone grafting
460- Fracture of tibia alone
a- An indirect injury may cause a transverse fracture of the tibia alone at the site
of impact.
b- In children, the fracture is usually caused by a direct injury.
c- Local bruising and swelling are usually evident.
d- A fracture of the tibia alone takes half of the time of both leg bones to unite.
e- In children at least 12 weeks is needed for union
461- Fracture of fibula alone
a- Isolated spiral fractures is safe injury.
b- A long oblique fracture may be due to a direct blow.
c- There is local tenderness, but the patient is able to stand and to move the knee
and ankle.
d- Cast applied for 8 week for undisplaced transverse fracture.
e- In displaced transverse fracture, plating is preferable.
462- Fatigue fractures of tibia and fibula
a- Single stress may cause a fatigue fracture of the tibia or the fibula.
b- This injury seen in army recruits, mountaineers, and runners, who complain of
pain in the leg.
c- There is no local tenderness and swelling.
d- In the first week, periosteal new bone formation seen.
e- Treated usually by casting for 8–10 weeks.
463- During running and jumping, the loads transmitted through the ankle and foot.
a- Two times body weight.
b- Four times body weight
c- Six times body weight
d- Eight times body weight.
e- Ten times body weight.
464- The ankle moves in
a- Flexion / extension plane.
b- A complex axis of rotation.
c- A rolling forward.
d- A sideways movement.
e- Inversion / eversion plane.
465- The most common of all sport related injuries is
a- Meniscus injuries.
b- Anterior cruciate ligament injuries.
c- Anterior shoulder dislocation.
d- Ankle sprain.
e- Wrist sprain.
466- Lateral collateral injuries in ankle sprain forms more than
a- 35%.
b- 45%.
c- 55%.
d- 65%.
e- 75%.
467- In planter flexion of ankle, the vulnerable ligament for injury is
a- The posterior talofibular ligament.
b- The calcaneofibular ligaments.
c- The anterior talofibular ligament.
d- The talocalcaneal ligament.
e- The deep part of medial collateral ligament.
468- The deep portion of medial collateral ligament of ankle principal effect is to
a- Resist eversion of the hindfoot.
b- Prevent external rotation of the talus.
c- Restraining eversion of ankle.
d- Restraining inversion of ankle.
e- Restraining external rotation.
469- The first ligament injured in twisted ankle is
a- The talocalcaneal ligaments.
b- The anterior talofibular ligament.
c- The posterior talofibular ligament.
d- The calcaneofibular ligament.
e- The medial collateral ligament.
470- Sprain of lateral collateral of ankle
a- A history of a twisting injury followed by pain and swelling.
b- Is the third common type of sport injuries.
c- Extensive bruising appear early.
d- The patient unable to put any weight on the foot.
e- The x-ray is essential to confirm the diagnosis.
471- The lateral ligament injuries of ankle may mimic
a- Displaced fractures of the fibula
b- Displaced fractures of the tarsal bones.
c- The injuries of the distal tibiofibular joint.
d- The injuries of the tibialis posterior tendon sheath.
e- The injuries of the tibialis anterior tendon sheath.
472- For patients with ankle sprain, who have had persistent pain, swelling,
instability and impaired function over 6 weeks
a- Repeat x- ray examination.
b- Stress film x-ray examination.
c- Magnetic resonance imaging.
d- Ultrasonography examination of ankle.
e- Arthrography of ankle joint.
473- Recurrent ankle sprains occur after acute lateral collateral ligament tears in
about
a- Five per cent of cases.
b- Ten per cent of cases.
c- Fifteen per cent of cases.
d- Twenty per cent of cases.
e- Twenty five per cent of cases.
474- Recurrent dislocation of peroneal tendons treated by
a- A below knee cast for 3 weeks.
b- A below knee cast for 6 weeks.
c- Leg-ankle splint with lateral bar.
d- Operative treatment.
e- Physiotherapy and electrical muscles stimulation.
475- Complete diastasis of inferior tibiofibular ligaments tear
a- Result from tearing of both the anterior and posterior ligaments.
b- Follows a severe adduction strain.
c- Result from tearing of only the anterior tibiofibular ligament.
d- Rarely associated with fractures of the malleoli or rupture of the collateral
ligaments.
e- X-ray shows narrowing of the ankle mortise.
476- Type A Denis and Weber ankle fracture
a- Is due to severe abduction or a combination of abduction and external rotation.
b- Is a transverse fracture of the fibula below the tibiofibular syndesmosis,
associated with vertical fracture of the medial malleolus.
c- Is an oblique fracture of the fibula at the level of the syndesmosis; often there
is also an avulsion injury on the medial side.
d- Is probably an external rotation injury and it may be associated with a tear of
the anterior tibiofibular ligament.
e- Associated injuries are a posterior malleolar fracture and diastasis of the
tibiofibular joint.
477- Non-union of the medial malleolus due to
a- Sever trauma.
b- Skin blister and skin necrosis.
c- Periosteal flap interposition.
d- Delayed reduction.
e- Use of screw fixation.
478- Joint stiffness following ankle fractures
a- Stiffness of the ankle are usually the result of neglect in treatment of the bone.
b- The patient must walk correctly in plaster.
c- Delaying operative treatment minimized stiffness.
d- Avoid wearing crepe bandage when the plaster removed.
e- Avoid elevation of the leg when the plaster removed.
479- Rüedi type 1 Pilon fracture
a- There is severe disruption of the articular surface but without very marked
comminution.
b- There is an intra-articular fracture with little or no displacement of the
fragments.
c- There is a severely comminuted fracture with displacement of the fragments.
d- There is gross articular irregularity.
e- The assessment is far better with plain x-ray examination.
480- The frequent late complications of Pilon fractures is
a- Late foot edema.
b- Postoperative osteomyelitis.
c- Implant failure.
d- Secondary osteoarthritis.
e- Shortening and malunion.
481- Ankle fractures in children
a- Physeal injuries are rare in children.
b- The tibial (or fibular) physis wrenched apart, usually resulting in a Salter–
Harris type 4 fracture.
c- Type 1 and 2 fractures are uncommon.
d- With severe external rotation, the fibula may also fracture more proximally.
e- With abduction injuries, the tip of the fibula may be avulsed.
482- Tillaux fracture
a- Is a simple triplane fracture.
b- Is an avulsion of a fragment of tibia by the posterior tibiofibular ligament.
c- Occur in the old age group.
d- The fragment is the medial part of the epiphysis.
e- Is a Salter–Harris type 3 fracture.
483- Asymmetrical growth in ankle epiphyseal fractures
a- Fractures through the epiphysis may result in generalized fusion of the physis.
b- The bony bridge is usually in the lateral half of the growth plate.
c- The medial half goes on growing and the distal tibia gradually veers into
varus.
d- MRI and CT are helpful in showing precisely where physeal arrest has
occurred.
e- If the bony bridge is large, it can be excised and replaced by a pad of fat in the
hope that physeal growth may be restored.
484- CT is especially useful for evaluating
a- Fracture of the talus.
b- Fractures of the calcaneum.
c- Fractures of the navicular.
d- Osteochondral fractures of the talus.
e- Stress fractures.
485- MRI is helpful in diagnosing
a- Osteochondral fractures of the talus.
b- Fractures of the calcaneum.
c- Fractures of the navicular.
d- Fracture of the medial the cuneiform.
e- Stress fractures.
486- The superior articular surface carries a greater load per unit area in
a- The femoral head.
b- The Proximal tibia.
c- The Proximal fibula.
d- The talus.
e- The calcaneum.
487- Fractures of the neck of the talus Type IV by Hawkins is
a- Associated with subluxation or dislocation of the subtalar joint.
b- Displaced, with dislocation of the body of the talus from the ankle joint.
c- Displaced vertical talar neck fracture with associated talonavicular joint
disruption.
d- Undisplaced.
e- Little displaced.
488- The incidence of avascular necrosis in type 3 of fracture talus is
a- More than 50 per cent.
b- More than 60 per cent.
c- More than 70 percent.
d- More than 80 per cent.
e- More than 90 per cent.
489- Osteoarthritis of the ankle and/or subtalar joints occurs some years after talar
neck fractures
a- In over 40 per cent of patients.
b- In over 50 per cent of patients.
c- In over 60 per cent of patients.
d- In over 70 per cent of patients.
e- In over 80 per cent of patients.
490- The calcaneum
a- Is the most commonly fractured tarsal bone.
b- Fracture in 28 % of cases both heels injured simultaneously.
c- Crush injuries; always heal with little long-term disability.
d- “The man who breaks his heel-bone is finished”, still applicable.
e- Open reduction and internal fixation of crush fractures not improve the
outcome.
491- Fracture calcaneum suffer associated injuries of the spine, pelvis or hip in
a- Over 5 per cent of these patients.
b- Over 10 per cent of these patients.
c- Over 15 per cent of these patients.
d- Over 20 per cent of these patients.
e- Over 25 per cent of these patients.
492- Extra-articular fractures of calcaneum
a- Account for 50 per cent of calcaneal injuries.
b- They usually follow complex patterns.
c- Associated with crushing of the anterior process, the sustentaculum tali, the
tuberosity or the inferomedial process.
d- Fractures of the posterior (extra-articular) part of the body caused by
compression.
e- Extra-articular fractures are usually difficult to manage and have a bad
prognosis.
493- Compartment syndrome following fracture calcaneum develop in
a- About 2 per cent of patients.
b- About 5 per cent of patients.
c- About 10 per cent of patients.
d- About 15 per cent of patients.
e- About 20 per cent of patients.
494- The undisplaced fractures of navicular bone
a- Percutaneous fixation by K-wire used followed by cast.
b- Need open reduction and screw fixation.
c- Cast brace applied immediately and continue for 8 weeks.
d- The foot is elevated to counteract swelling, after 3 or 4 days a below-knee cast
for 4–6 weeks.
e- The foot is elevated to counteract swelling, after 3 or 4 days a percutaneous
fixation by K-wire used.
495- Even with accurate reduction of midtarsal fracture–dislocations, post-
traumatic osteoarthritis may develop and
a- About 10 per cent of patients fail to regain normal function.
b- About 20 per cent of patients fail to regain normal function.
c- About 30 per cent of patients fail to regain normal function.
d- About 40 per cent of patients fail to regain normal function.
e- About 50 per cent of patients fail to regain normal function.
496- The best treatment for the first metatarsal fracture with significant
displacement in the sagittal plane is
a- Reduction and cast brace.
b- Elevation for few days followed by cast splintage.
c- Open reduction and internal fixation.
d- By removable boot splint, the foot is elevated and partial weight bearing for
about 4–6 weeks.
e- A below-knee cast is applied and weight bearing avoided for 7 weeks.
497- The fracture at metaphyseal/diaphyseal junction of 5th metatarsal
a- Is avulsion fracture of the base of the fifth metatarsal – the pot-hole injury.
b- Has a higher rate of non-union, probably because of the relatively poor blood
supply in that region.
c- Examination will disclose a point of tenderness directly over the prominence
at the base of the fifth metatarsal bone.
d- Treated symptomatically, with initial rest and support, but with early
mobilization and return to function.
e- A normal peroneal ossicle or apophyseal ossification centre in the tuberosity
may be mistaken for a fracture.
498- The proximal avulsion fractures of base of 5th metatarsal treated
a- By closed reduction under anesthesia followed by cast for 6 weeks.
b- Symptomatically, with initial rest and support.
c- Nonoperatively, but there is a greater risk of non-union and slower return to
function.
d- Fixed internally by with an interfragmentary screw.
e- Fixed internally by plate and screws.
499- Fractured toes
a- A twisting force is the commonest cause of fracture phalanges.
b- If the skin is broken it must be covered with a sterile dressing, and antibiotics
are given.
c- An associated contaminated wound will require percutaneous Kirschner wire.
d- The wound is disregarded and the patient encouraged walking in a supportive
boot or shoe.
e- If pain is marked, the toe splinted plaster of Paris.
500- Fractured sesamoids bone of big toe
a- One of the sesamoids (usually the lateral) may fracture from either a direct
injury or sudden traction.
b- The patient complains of pain in tip of toe.
c- There is a tender spot in medial side of first MP joint.
d- The pain exacerbated by passive hyperflexion of the big toe.
e- Treated by walking cast for 6 weeks.
501- The bipartite sesamoid of big toe
a- X-rays will usually show the sharp fracture.
b- X-rays will usually show a smooth- edged two-bone segment.
c- Treated by support in a removable boot/splint for 2–3 weeks.
d- Treated by an insole with differential padding to speed recovery.
e- Occasionally, intractable symptoms call for excision of the offending ossicle.