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April 2011 CME

1. Which of the following statements concerning staple hemiepiphysiodesis is incorrect
a. More than 10% may require revision for staple extrusion or migration
b. Rebound overgrowth is more common in younger patients treated using this method
c. The cells on the unstapled side of the physis are affected, with diminished growth
d. The perichondrium should be incised on insertion to ensure growth arrest
e. The staples should be removed within 2 years to allow normal growth to resume

2. A lateral X Ray of the wrist is repeated after rotating the forearm from a neutrl position into 5 degrees of supination. Which of the following will occur to measurements taken from the repeated radiographs
a. 1.6 degree increase in measured palmar tilt
b. 1 degree increase in measured palmar tilt
c. No change in measured palmar tilt
d. 1 degree decrease in measured palmar tilt
e. 1.6 degree decrease in measured palmar tilt

3. Which of the following values falls outside the normal range for radiological assessment of the wrist
a. Intersection of axis of radius and axis of capitate within the capitate
b. Radial height 8mm
c. Radial inclination 10 degrees
d. Ulnar variance +2mm
e. Zero palmar tilt

4. In a recent study of 108 patients with 38 years follow up after distal radius fractures in which only one case was treated by internal fixation there was an observed incidence of malunion of 65%, whilst the mean age at the time of injury was less than 30. What proportion of the patients reported any limitation of activities and/or underwent a salvage procedure.
a. None
b. 2%
c. 5%
d. 10%
e. 20%

5. In the various studies investigating the relationship between distal radius fracture classification and functional deficit, which of the following is the only group that is significantly linked to a measureable deficit, with which it is paired
a. AO C3 with loss of radial deviation
b. AO C2 with loss of palmar flexion
c. Frykman VII with loss of grip strength
d. FrykmanVI with loss of dorsiflexion
e. Melone type 4 with ulnar deviation

6. Over what timeframe is 95% of contained 'standard' gentamicin released from collagen fleece when used as a biodegradable antibiotic carrier
a. 1.5 hours
b. 15 hours
c. 1.5 days
d. 15 days
e. 1.5 weeks

7. What is the rationale for developing antibiotic tagged nanoparticles in an effort to combat osteomyelitis
a. They are concentrated by macrophages at the site of active infection
b. They can act against intracellular organisms
c. They can be used for imaging active sites of infection
d. They can be administered by intravenous injection on an outpatient basis
e. They persist for longer after delivery

8. Which of the following proposed antibiotic carriers is derived from marine algae
a. Amylose starch
b. Chitosans
c. Polyanhydrides
d. Polyglycolic acid
e. Polyuronate

9. Which of the following has not been used experimentally to simultaneously deliver antibiotics and stimulate new bone formation in defects resulting from osteomyelitis
a. Alginates impregnated with mesenchymal stem cells
b. Bioactive glass
c. Borate glass
d. Composite carriers
e. Plaster of Paris and hydroxyapatite

10. Which of the following is not true of the oblique retinacular ligament of Landsmeer
a. It inserts into the terminal extensor digitorum communis tendon
b. It is histologically similar to tendon tissue
c. It partly arises from the A2 pulley
d. It passes dorsal to the DIP joint
e. It passes volar to the PIP joint of the finger

11. Approximately what proportion of patients undergoing biceps tenotomy, without tenodesis, for biceps tendon pathology do not go on to develop cosmetic asymmetry - the 'popeye sign'
a. Less than 5%
b. 10%
c. 20%
d. 40%
e. 60%

12. What effect does tenotomy of the long head of biceps have on elbow function in active individuals
a. No measurable effect
b. No loss of flexion strength but loss of approximately 15% supination strength
c. Loss of less than 10% flexion strength but 20% of supination strength
d. Loss of 20% flexion and supination strength
e. Loss of 20% flexion strength and 40% of supination strength

13. Which of the following is the primary stabiliser of the distal radioulnar joint
a. Bony anatomy of the sigmoid notch
b. Extensor carpi ulnaris
c. Joint capsule
d. Triangular fibrocartilage
e. Volar ligaments

14. How many distinct ligaments have been shown to provide stabiliyty to the trapezium
a. 4
b. 8
c. 12
d. 16
e. 20

15. In the lateral band (Littler's) tenodesis, the course of which native structure is recreated by the lateral band
a. Clelands ligament
b. Lateral band
c. Oblique retinacular ligament
d. Transverse retinacular ligament
e. Volar plate

16. According to data from national joint register datasets, which of the following has the lowest rate of revision per 100 cumulative components years
a. Primary ankle replacement
b. Primary total knee replacement
c. Primary total hip replacement
d. Revision total knee replacement
e. Revision total hip replacement

17. Approximately how many patients would be required for a study with 95% confidence limits and a power of 80% to detect a 2% difference in outcome between two joint replacements
a. 100
b. 300
c. 1000
d. 3000
e. 10000

18. According to pooled national registry data, after how many ankle replacements performed by an individual does his/her revision rate fall
a. 5
b. 10
c. 30
d. 50
e. 100

19. Which of the following statements concerning shoulder stiffness after fracture is not correct
a. Arthroscopic arthrolysis can be used to improve the range of movement
b. Complex regional pain syndrome should be included in the differential diagnosis
c. Distension injections of the capsule usually improve the range of movement significantly
d. Implant impingement can be a cause, treated by implant removal after union
e. It is most often caused by capsular contracture

20. Which of the following statements concerning avascular necrosis of the tuberosities after shoulder fractures is not correct
a. It can occur without avascular necrosis of the humeral head
b. It is associated with rotator cuff dysfunction
c. It is associated with significant pain and debility
d. It responds well to rotator cuff rehabilitation
e. The rotator cuff is usually weak on testing

1. Which of the following statements concerning staple hemiepiphysiodesis is incorrect?
c. The cells on the unstapled side of the physis are affected, with diminished growth

2. A lateral X Ray of the wrist is repeated after rotating the forearm from a neutrl position into 5 degrees of supination. Which of the following will occur to measurements taken from the repeated radiographs?
a. 1.6 degree increase in measured palmar tilt

3. Which of the following values falls outside the normal range for radiological assessment of the wrist?
c. Radial inclination 10 degrees

4. In a recent study of 108 patients with 38 years follow up after distal radius fractures in which only one case was treated by internal fixation there was an observed incidence of malunion of 65%, whilst the mean age at the time of injury was less than 30. What proportion of the patients reported any limitation of activities and/or underwent a salvage procedure?
a. None

5. In the various studies investigating the relationship between distal radius fracture classification and functional deficit, which of the following is the only group that is significantly linked to a measureable deficit, with which it is paired?
b. AO C2 with loss of palmar flexion

6. Over what timeframe is 95% of contained 'standard' gentamicin released from collagen fleece when used as a biodegradable antibiotic carrier?
a. 1.5 hours

7. What is the rationale for developing antibiotic tagged nanoparticles in an effort to combat osteomyelitis?
b. They can act against intracellular organisms

8. Which of the following proposed antibiotic carriers is derived from marine algae?
e. Polyuronate

9. Which of the following has not been used experimentally to simultaneously deliver antibiotics and stimulate new bone formation in defects resulting from osteomyelitis?
b. Bioactive glass

10. Which of the following is not true of the oblique retinacular ligament of Landsmeer?
c. It partly arises from the A2 pulley

11. Approximately what proportion of patients undergoing biceps tenotomy, without tenodesis, for biceps tendon pathology do not go on to develop cosmetic asymmetry - the 'popeye sign'?
e. 60%

12. What effect does tenotomy of the long head of biceps have on elbow function in active individuals?
c. Loss of less than 10% flexion strength but 20% of supination strength

13. Which of the following is the primary stabiliser of the distal radioulnar joint?
d. Triangular fibrocartilage

14. How many distinct ligaments have been shown to provide stabiliyty to the trapezium?
d. 16

15. In the lateral band (Littler's) tenodesis, the course of which native structure is recreated by the lateral band?
c. Oblique retinacular ligament

16. According to data from national joint register datasets, which of the following has the lowest rate of revision per 100 cumulative components years?
b. Primary total knee replacement

17. Approximately how many patients would be required for a study with 95% confidence limits and a power of 80% to detect a 2% difference in outcome between two joint replacements?
d. 3000

18. According to pooled national registry data, after how many ankle replacements performed by an individual does his/her revision rate fall?
c. 30

19. Which of the following statements concerning shoulder stiffness after fracture is not correct?
c. Distension injections of the capsule usually improve the range of movement significantly

20. Which of the following statements concerning avascular necrosis of the tuberosities after shoulder fractures is not correct?
d. It responds well to rotator cuff rehabilitation