1.

A study is proposed in which 50 patients with avascular necrosis (AVN) of the Hip are compared with 20
patients without AVN in terms of their Steroid Drug intake dose. This is an example of what type of study?
A. Case–control ***
B. Cohort
C. Cross-sectional
D. Randomized
E. Longitudinal

2. A patient with Pott’s disease presented to the Spine clinic, is more likely to have which of the following early
findings?
A. Acute-onset back pain and neurologic dysfunction
B. Preservation of the disk space between two affectedadjacent end plates***
C. Involvement of the cervical spine and torticollis
D. Elevated WBC count and markedly elevatederythrocyte sedimentation rate
E. Lordotic deformity in late stages of the disease

3. Post-traumatic physeal arrest is most common atwhich of the following locations?

A. Proximal tibia
B. Proximal humerus
C. Distal radius
D. Distal humerus
E. Distal tibia***

4. During normal human knee flexion (beginning withthe knee fully extended), which of the following statements
best describes tibial rotation with respect tothe femur?
A. Rotation is constantly occurring in both directionsduring the flexion cycle.
B. The tibia initially externally rotates, and thenprogressively internally rotates.
C. The tibia initially internally rotates, and thenprogressively externally rotates.
D. The tibia initially internally rotates, and then remainsin that rotational position until deep flexion, whenfurther internal
rotation occurs.***
E. The tibia initially externally rotates, and thenremains in that rotational position until

5. When compared with total hip arthroplasty, hipresurfacing offers which of the following advantages?
A. Better patient compliance with precautions
B. Increased patient activity in sports
C. Increased mobility of the hip
D. Improved pain relief
E. Preservation of proximal femoral bone***

6. This condition is caused by a point mutation for the gene encoding fibroblast growthfactor receptor 3 (FGFR3)?
A. Ehlers Danlos Syndrome
B. Marfan's Syndrome
C. Duchenne's Muscular Dystrophy
D. Achondroplasia***
E. Becker Muscular Dystrophy

7. Which of the following describes the relationship between intensity of an x-ray beamand the distance from its
source?
A. Attenuation coefficient
B. Bragg's law
C. Compton effect
D. Inverse square law ***
E. Photoelectric effect
8. The correct maximum dose of 0.5% bupivacaine (without adrenaline), that can beused for local analgesia
following a knee arthroscopy in an 80kg female patient is?
A. 16ml
B. 24ml
C. 32ml***
D. 48ml
E. 56ml

9. Which of the following does NOT lead to a thrombotic tendency?

A. Factor V Leiden
B. Antithrombin deficiency
C. Protein C and S deficiency
D. Heparininduced thrombocytopenia
E. Anti-Protein Z deficiency***

10. When selecting patients for 1st MTPJ cheilectomy, which factor has been shown tocorrelate with a poor
outcome
A. Onychogryphosis
B. Bilateral disease
C. >50% articular cartilage loss***
D. 25% articular cartilage loss
E. Previous hip or knee replacement surgery

11. Which one of the following statements is FALSE about trigger thumbs in childhood:
A. Under 9 months of age 30% resolve spontaneously
B. Over the age of 1 year, less than 10% resolve spontaneously.
C. 30% are bilateral.
D. Surgical release of the A1 pulley is the treatment of choice in children over the age of 1 year.
E. There is a strong familial inheritance pattern.***

12. Which structure is at most risk of damage in performing trans-articular C1/C2 screwfixation
A. C2 nerve root
B. Hypoglossal nerve
C. Carotid artery
D. Vertebral artery***
E. Vagus nerve

13. Which of the following would be an evidence based indication for operative intervention for a typical thoraco-
lumbar burst fracture of the spine?
A. Canal encroachment without neurological deficit
B. Kyphosis greater than 30 degrees***
C. Canal encroachment with static neurological deficit
D. Loss of anterior vertebral body height of less than 50%
E. Lack of posterior midline tenderness on examination

14. Which of the following statements concerning posterior shoulder dislocation is true?
A. The internal rotators are not as powerful as the external rotators
B. The inferior glenohumeral ligament will invariably be normal
C. Activities of daily living are affected in chronic cases
D. Reverse Hill Sachs is a risk factor for recurrence***
E. After closed reduction, the position of external rotation should be avoided.

15. Which one of following conditions is most suitable for ankle arthroplasty?
A. Ankle arthritis secondary to neuropathic joint disease
B. Ankle arthritis associated with severe mal-alignment of the ankle joint
C. Failed ankle arthrodesis
D. Rheumatoid ankle arthritis***
E. Ankle arthritis associated with osteonecrosis of the talus

16. Non-operative treatment of distal biceps tendon rupture results in

A. Elbow flexion is weaker than supination
B. Supination is weaker than elbow flexion***
C. Flexion strength is half that of supination
D. Equal weakness in both flexion and supination
E. No weakness in either flexion or supination

17. Which of the following is NOT a recognized technique for evaluating postero-lateral corner injuries?
A. Increased external rotation
B. Postero-lateral drawer test
C. Reverse pivot shift test
D. Dial test at 15o and 60o ***
E. External rotation recurvatum test

18. The following are true of acetabular fracture surgery except:

A. An arteriogram is required to check the patency of superior gluteal artery prior to undertaking an extended iliofemoral
approach
B. The Ilioinguinal approach is ideal for anterior column fracture fixation
C. The development of secondary arthritis has a correlation with degree of articular reduction
D. The incidence of heterotopic ossification is highest for Ilioinguinal approach***
E. Infratectal and Juxtatectal fractures are best managed by Kocher Langenback approach

19. An 86-year-old man falls and sustains a minimally displaced proximal humerusfracture. What is the best way
to manage him?
A. Physiotherapy and passive range of motion, 10 days following the injury.***
B. Immobilization for 4 weeks in a sling then mobilization.
C. Physiotherapy the following day, with range of motion exercises.
D. Intramedullary nail fixation.
E. Urgent open reduction and locking plate fixation.

20. When predicting the outcome after distal radius fractures, which of the following is false?
A. Age is an important factor if predicting early instability of minimally displaced fractures.
B. Age is an important factor if predicting late instability of minimally displaced fractures.
C. In the prediction of malunion, the presence or absence of comminution is not animportant factor.***
D. Age is an important factor if predicting malunion.
E. The dorsal angle at presentation is not important in predicting malunion indisplaced fractures.

21. An 11-year-old girl sustains a closed femoral shaft fracture, which is then treated withan anterograde
intramedullary nail via a piriformis fossa entry point. In follow-up, she is noted to have collapse of the femoral
head. This is most likely due to?
A. Missed concurrent subcapital fracture.
B. Infection.
C. Pressure changes within the capsule of the hip joint.
D. Perthes disease.
E. Injury to the lateral ascending vessels of the femoral neck.***

22. A 62-year-old woman with primary osteoarthritis is scheduled to undergo cementless total hip arthroplasty.
History reveals that she underwent pelvic irradiation for uterine cancer 10 years ago. The patient should be
considered at highest risk for which of the following complications of total hip arthroplasty?
A. Heterotopic Ossification.
B. Deep Venous Thromosis (DVT).
C. Aseptic Loosening .***
D. Hip Instability.
E. Osteolysis.

23. A 6-year-old has a posteriorly displaced supracondylar fracture, with absent pulses, but a warm, pink hand.
What is the optimal management?
A. Primarily Immediate reduction of the fracture in the emergency department. Then vascular assessment.
B. Open reduction with immediate exploration by a vascular surgeon.
C. Closed reduction in theatre, with reassessment of the vascularity.***
D. Urgent brachial angiography.
E. Exploration by a vascular surgeon followed by external fixation.

24. Which of the following would not increase the stability of an external fixator?
A. Increasing the diameter of the pins.
B. Increasing the distance between the rods and the bone.***
C. Increasing the number of pins.
D. Increasing the space between the pins.
E. Placing pins in different planes.

25. Which of the following is not a type of acetabular fracture according to the Judet andletournel classification?
A. Posterior column.
B. Anterior column and posterior hemitransverse.
C. Posterior wall and posterior column.
D. Posterior column and posterior hemitransverse.***
E. Posterior wall and transverse.

26. Which of the following is not a contraindication to functional brace treatment for ahumeral shaft fracture?
A. Ipsilateral radial shaft fracture.
B. Associated radial nerve palsy.***
C. Associated brachial plexus palsy.
D. Uncooperative patient.
E. Ipsilateral clavicle fracture.

27. Which of the following is the most common primary soft tissue malignancy of the foot?
A. Malignant melanoma.
B. Osteosarcoma.
C. Squamous cell carcinoma.
D. Synovial cell sarcoma.***
E. Chondrosarcoma.

28. A 22-year-old radiographer injures his ankle after a twisting injury whilstsnowboarding. He has been
diagnosed with a ligament injury, but 8 weeks afterinjury has continued lateral pain. The most likely diagnosis is?
A. Lateral malleolus fracture.
B. Fracture of the lateral process of the talus.***
C. Fracture of the body of the talus.
D. Fracture of the neck of the
E. Peroneus longus rupture.

29. A 27-year-old banker injures his foot and sustains a displaced divergent Lisfrancfracture-dislocation. The
optimal management would consist of?
A. Below knee plaster cast.
B. A bridging external fixator.
C. Closed or open reduction and K-wire stabilization.
D. Closed or open reduction and screw stabilization.
E. Closed or open reduction and combined screw and K-wire stabilization.***
30. A 12-year-old boy presents with a painful flatfoot. Lateral radiographs show an‘anteater’ sign. The most likely
diagnosis is?
A. Plantar fasciitis.
B. Accessory navicular.
C. Tibialis posterior rupture.
D. Talocalcaneal coalition.
E. Calcaneonavicular coalition***

31. Which of the following is not a compartment of the foot?

A. Calcaneal.
B. Interosseus.
C. Abductor.***
D. Medial.
E. Lateral.

32. Which structure is most likely to prevent reduction of an ankle dislocation aftera supination injury?
A. Anterior talofibular ligament.
B. Calcaneofibular ligament.
C. Posterior talofibular ligament.
D. Peroneus brevis tendon.***
E. Tibialis posterior tendon.

33. Which of the following is incorrect regarding Achilles tendon surgery?

A. A posteromedial incision is often used to prevent sural nerve injury.
B. An end-to-end repair is possible if the smallest gap achievable is 3 cm.
C. The optimum post-repair position of the foot is 20º plantarflexion.
D. A V-Y advancement of the gastrocnemius would be required if the smallest gapachievable is 6 cm.***
E. Percutaneous surgery increases the risk of sural nerve injury.

34. A 23-year-old presents with on-going pain and stiffness four months after a severeankle sprain. A radiograph
shows an Osteochondral type IV lesion of the lateraltalar dome. The optimal management would be?
A. Below knee weight-bearing plaster cast or protective boot.
B. Below knee non-weight-bearing plaster cast or protective boot.
C. Arthroscopy, excision and microfracture.***
D. Arthroscopy and internal fixation.
E. Open reduction and internal fixation.

35. When implanting a total hip prosthesis, the greatest strains occur at what part of the femoral implant?
A. Neck of the femoral anatomy.
B. Greater trochanteric.
C. Calcar
D. Midportion of the prosthesis
E. Tip of the prosthesis

36. All of the following patients with foot & ankle problems are good candidates for Arthroscopic
Interventions Except:
A. Lateral gutter impingment.
B. Anterior impingment.
C. Cartilage injury, eg flaps.
D. Loose Bodies.
E. Acute Synovitis***

37. Which of the following would not be advisable in the treatment of a 45-year-old man with isolated medial
compartment osteoarthritis( OA) of the knee?
A. Non-steroidal anti-inflammatory drugs.
B. Medial unicompartmental knee replacement
C. Autologous chondrocyte implantation.***
D. Opening wedge high tibial osteotomy.
E. Closing wedge high tibial osteotomy.

38. Regarding total knee replacement, which of the following is incorrect?

A. The joint line can be safely lowered 4mm without an adverse effect on motion andjoint instability.
B. The minimum recommended thickness of an ultra-high-molecular-weightpolyethylene insert is 6–8 mm.
C. A deficient extensor mechanism is a relative contraindication to a total kneereplacement.
D. There is a poorer implant survivorship in patients with rheumatoid arthritis.***
E. Following previous patellectomy, a posterior cruciate ligament-substituting implantis preferred.

39. The following are all considered predisposing factors for patellofemoral disorders,except?
A. Femoral anteversion.
B. Lateral patella tilt.
C. Patella baja.***
D. Reduced trochlea sulcus.
E. Lateral tibial tuberosity.

40. A 62-year-old man presents with a painful snapping sensation when extending his knee, 6 months after a
posterior stabilized total knee replacement. The most ppropriate treatment is?
A. Bracing.
B. Topical anti-inflammatory gels.
C. Revision of patellar component.
D. Arthroscopic or open debridement.***
E. Revision of femoral component.

41. A 58-year-old man is listed for a total knee replacement. He underwent a closingwedge high tibial osteotomy 10
years prior. The most likely problem one would encounter during the total knee replacement is?
A. Difficult surgical exposure.
B. Lateral ligament laxity.
C. Difficult tibial stem placement.
D. Non-union of the osteotomy.
E. Patella baja.**

42. Which of the following is true regarding meniscal repair?

A. Simultaneous reconstruction of a deficient anterior cruciate ligament has noinfluence on the success of meniscal repair.
B. Capsule exposure for an inside-out lateral meniscal repair is performed throughthe iliotibial band and biceps tendon
interval, followed by retraction of the lateralhead of the gastrocnemius anteriorly.
C. Degenerative meniscal tears are a relative contraindication to repair.***
D. Saphenous nerve injury is more common with an all-inside technique compared toan inside-out technique for medical
meniscus repair.
E. Capsule exposure for an inside-out lateral meniscal repair is performed throughthe lateral head of the gastrocnemius
and biceps tendon interval, followed byretraction of the biceps tendon anteriorly.

43. The surgical approach for the posterior cruciate ligament insertion site during an open inlay technique is?
A. A posteromedial approach between medial gastrocnemius and semimembranosus.***
B. A posteromedial approach between medial gastrocnemius and semitendinosus.
C. A posteromedial approach between semimembranosus and semitendinosus.
D. A posteromedial approach between splitting medial gastrocnemius.
E. A posteromedial approach between splitting semimembranosus.

44. Control of refractory pain in diffuse blastic metastatic CA can be accomplished with systemic IV
administration of
A. iodine.
B. Strontium .***
C. tamoxifen.
D. gold.
E. selenium.

45. A patient undergoes a hemiarthroplasty for a femoral neck fracture. Routine pathologic examination reveals
lymphoma. Staging reveals that the proximal femur is an isolated lesion. What is the best course of action?
A. Wide resection of the proximal femur
B. Wide resection of the proximal femur and chemotherapy
C. Chemotherapy and radiation therapy to the femur.***
D. Hip disarticulation
E. Bone marrow transplant

46. Low- grade chondrosarcoma can best be distinguished rdaiographically from benign enchondroma based on
which of the following findings?
A. Increased tracer uptake on bone scan
B. Endosteal erosion of one fourth of the inner cortex
C. Stippled calcification
D. Increased radiolucency on follow-up radiographs .***
E. size of more than 5 cm

47. Which of the following prognostic indicators is associated with the least favorable outcome for patients newly
diagnosed with osteosarcoma?
A. High histologic grade
B. Tumor size greater than 8 cm
C. Extracompartmental growth
D. Solitary pulmonary metastasis
E. Solitary bone metastasis .***

48. What is the most common MRI appearance of malignant soft-tissue sarcoma?
A. Well defined, hemogenous, and deep to fascia
B. Well defined, hetrogenous, and deep to fascia .***
C. Ill defined, homogenous, and deep to fascia
D. Ill defined, hetrogenous, and superficial to fascia
E. Ill defined, homogenous, and superficial to fascia

49. All of the following principles must be adhered to when performing a biopsy of a bone tumour except?
A. The selection of the biopsy path should be made in consultation with the surgeon who will perform the definitive
excision.
B. The biopsy tract should be marked to allow excision at the time of definitive surgery.
C. The biopsy should ideally be performed at the centre where the definitive excision is likely to be carried out.
D. The tumour should be approached through normal tissue before entering the reactive zone..***
E. Use of frozen section to ensure that diagnostic tissue has been obtained.

50. Which of the following disorders most commonly places a patient at risk for malignancy?
A. McCune-Albright syndrome
B. Ollier`s disease
C. Mafucci syndrome .***
D. Neurofibromatosis
E. Hereditary multiple exostoses

51. A 14-year-old boy has an asymptomatic mass on the right arm. MRI and biopsy reveal a rhabdomyosarcoma.
Additional staging studies should include
A. a bone scan and thallium scan
B. Axillary node and bone marrow biopsy .***
C. MRI of the brain
D. intravenous pyelogram and renal ultrasound
E. parathyroid hormron and serum calcium levels

52. One of the following findings is indicative of instability requiring surgical stabilization in a patient with a
thoracolumbar injury:
A. Upper or lower endplate fracture.
B. More than 40 degrees of kyphosis on the radiograph. .***
C. Bony encroachment of the spinal canal of 25% on a CT scan.
D. Loss of 20% of the height of the vertebral body.
E. Narrowed adjacent disk space.

53. The biggest contribution to lumbar lordosis:

A. Occurs mostly within the disk spaces.***
B. Occurs mostly within the vertebral bodies
C. Is normally 70°
D. Increases with increasing age
E. Can be visualized best on an anteroposterior plain radiograph

54. Regarding the goals of scoliosis surgery,which of the following is false:

A. Complete correction of the deformity while maintaining sagittal balance.***
B. Preserving or improving pulmonary function.
C. Minimizing morbidity or pain.
D. Maximizing postoperative function.
E. Improving or at least not harming the function of the lumbar spine.

55. In ankylosing spondylitis, the first part of the spine to be involved in the disease is:
A. Lumbar spine.
B. Cervical spine.
C. Thoracic spine.
D. Thoracolumbar spine.***
E. Cervicothoracic spine.

56. One of the following is not a cause of gibbus:

A. Infection.
B. Scheuermann’s disease.***
C. TB.
D. Tumors.
E. Eosinophilic granuloma.

57. Congenital scoliosis may be associated with all of the following except:
A. Cardiac anomaly.
B. Hyperlaxity of the joints.***
C. Urogenital anomaly.
D. Spinal cord anomaly.
E. Chiari malformation.

58. When performing a neurological examination, if a surgeon has a patient resist thigh adduction against
resistance, the surgeon is testing which nerve(s):
A. Segmental nerves from T1-L1
B. Femoral nerve
C. Obturatornerve .***
D. Sciatic nerve
E. Segmental nerves from L5-S1

59. Which of the following investigations is the most specific scanning method to detect infection in a total joint
replacement?
A. Bone scintigraphy
B. A combination of white blood cell scan and a Technetium bone scan ***
C. White blood cell scan
D. Sequential Gallium-67 citrate scans
E. Sequential Technetium bone scans

60. Which of the following statements is true? The endurance limit of a material is:
A. The total stress applied to a material before failure
B. The same as the ultimate tensile strength
C. The stress beneath which a material will not fail through fatigue ***
D. The area under a stress-strain curve
E. Independent of the manufacturing process.

61. If the quality of the tendon is poor at the lateral attachment of a partial articular side rotator cuff tear (more
than 6 mm of footprint exposure or greater than 50% thickness), what should the surgeon do?
A. Use an autogenousfascial graft.
B. Use an allograft augmentation
C. Complete the tear and then repair the tendon.***
D. Perform a trans-tendon repair.
E. Biopsy the tissue.

62. Which of the following statements concerning a total knee replacement in patients with Pigmented
VillonodularSynovitis (PVNS) of the knee is true?
A. Aseptic loosening secondary to recurrent disease is common
B. Recurrence rates are higher than in patients treated with synovectomyalone
C. Post-operative stiffness is unlikely to occur
D. Post-operative results are acceptable with good knee and functional scores ***
E. Recurrence rates are low

63. A 15 year old child presents with back pain, plain radiographs show collapse of the L1 vertebrae, which is the
most likely diagnosis?
A. Discitis
B. Esinophilic granuloma.***
C. Osteoblastoma
D. Scheuermann’s disease
E. Rickets

64. A 12 years old underwent in-situ fixation of slipped upper femoral epiphysis and was asymptomatic following
surgery, develops pain, stiffness and flexion deformity, the most likely diagnosis is:
A. A vascular necrosis of the femoral head
B. Chondrolysis.***
C. Normal
D. Further slip
E. Pin penetration

65. Which of the following statements is true about adductor tenotomy in a child with cerebral palsy:
A. Usually involves division of the adductor brevis
B. Usually involves division of the adductor longus.***
C. Usually involves division of the adductor magnus
D. Is a common cause of hip subluxation
E. Should include a neurectomy of the anterior branch of the obturator nerve

66. Which of the following is INCORRECT regarding valgus proximal femoral osteotomy:
A. At least 15 of preoperative abduction is necessary
B. The limb is inevitably lengthened
C. It is indicated for post-Perthes-disease deformity
D. It involves a medially based closed wedge.***
E. The abductor lever arm is lengthened

67. A 7-year-old child has pain in his left thigh. Extensive pigmentation is seen on the left trunk. X-ray of his hip
showed coxa vara and ground glass appearance. This child is at increased risk for:
A. Patellar instability and nail abnormalities.
B. Involvement of other bones and precocious puberty. ***
C. Cardiac abnormalities and hearing loss.
D. Syndactyly and fibular hypoplasia.
E. Recurrent shoulder dislocation

68. Physical examination of a 6-week-old infant revealed a positive left Galeazzi sign. With hip abduction to 80
degrees, there was a palpable clunk on the left but none on the right. Ultrasound imaging showed a right hip alpha
angle of 60 degrees with 50% coverage of the femoral head; the left hip alpha angle was 40 degrees with 10%
coverage of the femoral head. What is the most appropriate treatment for this problem?
A. Full-time placement of a Pavlik harness with follow-up in 1 week .***
B. Full-time placement of a Pavlik harness with follow-up examination and ultrasound in 3 months
C. Observation with follow-up at age 6 months with hip radiographs
D. Double diapering with follow-up examination and ultrasound in 1 month
E. Day time abduction splint

69. The physis with the highest growth rate (in mm per year) is located at:
A. Proximal humerus
B. Distal femur .***
C. Distal tibia
D. Distal radius
E. Distal humeus

70. Which one of the following is the most important stabilizer of the elbow in 90 degrees of flexion?
A. Ulno humeral articulation
B. Radial head
C. Posterior band of Ulnar collateral ligament
D. Anterior band of Ulnarcollateral ligament.***
E. Radial ulnar collateral ligament

71. Which of the following 1S not a sign of an unstable scaphoidfracture ?

A. Vertical oblique fracture.
B. Comminuted fracture.
C. >1mm displacement.
D. Associated perilunate injury.
E. Scapholunate angle < 60.***

72. A 30-year-old woman is involved in a road traffic accident and isfound to have a pelvic symphysis separation of
4 cm and sacral fracture. She undergoes a normal secondary survey and is hemo dynamically stable. Definitive
treatment should involve which of the following?
A. Skeletal traction for 3 months.
B. Internal fixation of the symphysis pubis with anterior external fixation
C. Internal fixation of the symphysis pubis and internal fixation of the sacrum***
D. Posterior only external fixation.
E. Anterior only external fixation.

73. When preoperatively templating a radiograph in preparation for thefemoral component in total hip
arthroplasty, the leg should be positioned in:
A. Neutral rotation
B. 15@ internal rotation***
C. 30@ internal rotation
D. 15@ external rotation
E. 30@ external rotation

74. A five-year-old boy with cerebral palsy presents to the clinic with a dislocated right hip, what quadrant of the
acetabulum is most likely deficient?
A. Anterior-inferior
B. Anterior-superior
C. Posterior-superior ***
D. Posterior-inferior
E. Anterior-inferior and anterior-

75. A patient who sustained type 2 talar neck fracture and treated with open reduction and internal fixation now
has residual decreased subtalar motion and is unable to evert the foot. What is the most likely cause of loss of
motion?
A. Peroneal nerve injury
B. Talar collapse secondery to osteonecrosis
C. Valgus malunion
D. Varus malunion***
E. Nonunion

76. What is the most important component of a successful discussion to obtain an informed consent?
A. A full disclosure of all potential complications
B. A complete discussion of alternative treatments
C. The patient demonstrates a full understanding***
D. The patient’s family is involved in the discussion

77. The type of pediatric distal humerus fracture most commonly associated with child abuse is
A. lateral condyle.
B. Supracondylar.
C. medialepicondyle.
D. transphyseal.***
E. posterior dislocation of elbow

78. After total hip arthroplasty, an infection can be classified as a surgical-site infection for how long?
A. 30 days
B. 60 days
C. 90 days
D. 180 days
E. 356 days***

79. What is a primary manifestation of cerebral palsy?

A. Joint instability
B. Bony deformities
C. Muscle contractures***
D. Abnormal muscle tone
E. all of the mention

80. The figures below show the initial radiographs and MR images of a 13-year-old girl who has a 2-month history
of acute ankle sprain. She has not returned to athletic activity because of weakness and functional instability. What
is the best treatment option?
<IMAGE>pic01.jpg
A. Cast immobilization
B. Ankle strengthening program and return to activity***
C. Corticosteroid injection under ultrasound guidance
D. Arthroscopic debridement with drilling
E. open debridement and drilling with possible Osteochondral grafting

81. Miserable malalignment refers to the combination of

A. genuvalgum and pesplanovalgus.
B. coxavara and distal femoral valgus.
C. femoralanteversion and external tibial torsion.***
D. proximaltibialvarus and distal femoral varus.
E. Patient usualy Adviced to take part in certain sports, for example, long distance running.

82. A 21 year old collegiate football player requests a meniscectomy rather than a meniscal repair for an isolated
symptomatic medial meniscus tear to allow him to return to play sooner. He wants to compete this year in order to
be evaluated by professional scouts. Proceeding with a partial meniscectomy and not performing a meniscal repair
would violate which bioethical principle?
A. Autonomy (an individual’s right to live life consistent with personal needs)
B. Paternalism (the physician identifies the “best” treatment and advises the patient on what should be done)
C. Beneficence (obligates the physician to help patient do well, respecting the patient’s autonomy)
D. Nonmaleficence (don’t harm)***

83. A 42-year-old man sustained a wrist injury years ago and now has wrist pain. Radiographs reveal stage III
scapholunate-advanced collapse. What is the most appropriate option to alleviate his pain?
A. Scaphoid excision
B. Scaphoid excision 4-corner fusion
C. Scaphoid-lunate association and reconstruction***
D. Pcroximal row carpectomy

84. What is the most important factor when attempting to minimize risk for nonunion and osteonecrosis in young
patients with displaced femoral neck fractures?
A. Surgery timing
B. Quality of fracture reduction***
C. Choice of fixation implant
D. Use of the Smith-Peterson surgical approach
E. Haematoma decompression of the joint

85. A 2000-kilogram metal plate crushed the bilateral lower extremities of a 52-year-old man 8 hours ago. His right
ankle is open and displaced with a large soft-tissue defect. His toes are cool and dusky and there is no improvement
with ankle reduction and no plantar sensation. He is awake and able to answer questions and his wounds are clean.
Radiographs show significant bone loss from the distal tibia, and the foot is grossly deformed with multiple
fractures. For this patient, which finding is an absolute indication for amputation?
A. Loss of plantar sensation
B. Warm ischemia lasting 8 hours***
C. Extensive bone and soft-issue loss
D. Mangled extremity in patient in shock

86. After Bankart repair for recurrent anterior shoulder instability is performed, osteoarthritis progression most
closely correlates with
A. The number of preoperative subluxations and dislocations***
B. female gender
C. isolated humeral head defect after anatomic capsular and labral repair
D. a preoperative anterior inferior labral tear without bony lesion
E. Number of suture anchors used

87. A 47-year-old woman who is treated with cast immobilization for a minimally displaced distal radius fracture
sustained 3 months ago develops a sudden inability to extend her thumb interphalangeal joint. The most
appropriate next step is
A. arthrodesis of the interphalangeal joint.
B. evaluation for posterior interosseous nerve palsy.
C. primary repair of the extensor pollicislongus (EPL) tendon.
D. extensorindicisproprius (EIP) tendon transfer to the EPL.***

88. The Figures below are the radiographs of an adolescent who has knee pain. Based on these findings, what is the
most likely etiology?
<IMAGE>pic02.jpg
A. Vitamin D deficiency
B. Dysfunction of collagen 1
C. Dysfunction of osteoclasts***
D. Dysfunction of osteoblasts
E. Dysfunction of fibroblast

89. A woman has breast cancer that has metastasized to bone and a lesion in the subtrochanteric region. The lesion
measures 3 cm in length and has eroded 70% of the medial cortex in the proximal femur. She has functional pain
with ambulation. What is the most appropriate treatment option?
A. A 4-hole sliding hip screw; the surgeon must ensure there are 2 holes of fixation below the area of concern
B. A 15-cm trochanteric entry fixation nail that ends about 5 cm below the lesion and has a lag screw into the femoral
head
C. A 15-cm uncementedhemiarthroplasty in which the stem ends 2 cm below the lesion
D. A 40-cm antegrade femoral nail with lag screw fixation into the formal head***
E. A long Proximal Femur Plate

90. Which factor associated with fractures of the acetabulum indicates the need for early conversion to a total hip
arthroplasty (THA)?
A. Age younger than 40
B. Initial displacement less than 20 mms
C. Use of the extended iliofemoral approach***
D. Anatomic reduction with congruence of the acetabular roof
E. Use of the psterio lateral approach to the Hip joint

91. in the setting of persistent anterior knee pain following total knee replacement with patellar resurfacing, what
can you accurately tell a patient regarding further surgery?
A. Removal of the patellar component is generally successful.
B. Arthroscopic lateral retinacular release is generally successful.
C. Patellectomy is required for pain relief.
D. Isolated patellar revision is associated with poor results.***
E. Non operative intervention is the best treatment modality for this complaint.

92. What is the most important component of a successful discussion to obtain an informed consent?
A. A full disclosure of all potential complications
B. A complete discussion of alternative treatments
C. The patient demonstrates a full understanding***
D. The patient’s family is involved in the discussion

93. A 29-year-old professional female bodybuilder who has shoulder pain that limits her workouts and causes pain
at night. The pain has been gradual in onset and she has not lost any strength. She cannot sleep on the affected side
and cannot perform chest presses with a close grip on the bar. Her pain has failed to respond to injections and rest.
The preferred treatment is:
<IMAGE>pic03.jpg
A. shoulder replacement.
B. distal clavicle resection.***
C. clavicular-coracoid ligament reconstruction.
D. subcoracoid decompression.
E. subacromial decompression
94. In 2012, the American College of Chest Physicians made which recommendation regarding the use of aspirin
for anticoagulation?
A. An option for use following total knee or hip arthroplasty***
B. Recommended against its use following orthopaedic surgery
C. Recommended for use in all patients following knee arthroscopy
D. Recommended for patients following lower-extremity fracture fixation
E. Recommended for use in upper limb fracture fixation.

95. Anti-osteoporosis medication should be considered for which of the following patients.
A. A 67-year-old man with an osteoporotic femoral neck fracture***
B. A 71-year-old man with a 15% 10-year probability of a major osteoporosis-related fracture based on the WHO
algorithm
C. A 77-year-old woman with a T-score of 0.8 and a compression fracture following a motor vehicle collision
D. An 82-year-old woman with a T-score of 1.3
E. An 60-year-old woman with family history of Osteoporotic fracture.

96. A 42-year-old man injured the dorsal aspect of his long finger between the proximal and distal interphalangeal
joints. The wound measures 2 x 1.5 cm, with abrasion into the tendon substance and exposed periosteum and bone.
Which soft-tissue coverage option is most appropriate?
A. Full-thickness skin graft
B. Split thickness skin graft
C. Cross-finger flap***
D. Reversed cross-finger flap
E. Mesh graft

97. A 15-year-old boy seen in the emergency department has left chest pain after sustaining an injury at football
practice. Chest CT imaging reveals a posteriorly displaced sternoclavicular dislocation. What is the most
appropriate treatment?
A. Open reduction and locked plating.
B. Open reduction and suture fixation of the injury.***
C. Nonsurgical treatment with a sling for comfort and early mobilization.
D. Closed reduction and percutaneous pinning with smooth Kirschner wires (K-Wires).
E. Closed reduction and fixation with percutaneous minifragment screws.

98. When using an intramedullary device for fixation of a pertrochanteric hip fracture, risk for anterior cortical
perforation is increased by which circumstance?
A. Taller patient stature
B. Decreased femoral bow
C. Posterior one-third trochanteric starting point***
D. Intramedullary device with a smaller radius of curvature
E. Using of traction table.

99. An 11-year-old boy who is brought to the emergency department with left knee pain after being involved in a
motor vehicle crash. He has no other injuries. His left knee is edematous and tender and his leg is noted to be in
valgus alignment. Neurovascular status of the limb is unremarkable. What is the appropriate treatment for this
injury?
<IMAGE>pic04.jpg
A. Closed reduction and long-leg cast application
B. Closed reduction and spanning external fixation
C. Open reduction and internal fixation (ORIF) with a lateral locked plate
D. ORIF with lag screws in the metaphysis***
E. Retrograde with small radius intramedullary nailing.

100. Acquired valgus following simple a proximal tibia (Cozen) fracture in children :
A. can be prevented with early bracing.
B. often corrects spontaneously.***
C. is treated with varus osteotomy prior to physeal closure.
D. reaches maximal deformity approximately 4 years after injury