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January 2011 CME

1. Which of the following combinations generates an effective 'Fibrin glue'?
a. Aprotinin, calcium Chloride and Thrombin
b. Aprotinin, Fibrinogen and Tranexamic Acid
c. Aprotinin, Fibrinogen and Thrombin
d. Aprotinin, Thrombin and Tranexamic Acid
e. Calcium Chloride, Fibrinogen and Thrombin

2. With current technology for fluoroscopic navigation, which of the following procedures requires three, rather than two, fluoroscopic images for accurate performance without repeated screening?
a. Distal locking of an intramedullary nail
b. Medullary canal entry point creation for intramedullary nailing
c. Percutaneous fixation of iliac wing fractures
d. Percutaneous screw fixation of femoral neck fracture
e. Percutaneous fixation of sacroiliac joint separations

3. Which of the following correctly describes the citation index of a journal?
a. The number of different articles from the annual output of a journal that are cited in other journals during the following two years
b. The number of times articles from that journal are cited in the year after they are published
c. The number of times articles from the journal are cited in other journals in a given year divided by the number of articles published in the same year
d. The ratio of the number of citations in the current year to articles published in the two preceding years divided by the number of citable items in the same two years
e. The time taken for the average rate of citation of published articles to fall to half the rate observed in the first year after publication

4. How should a pelvic fracture that includes transverse fractures of the pubic rami, an ipsilateral sacral fracture and an iliac wing fracture be classified?
a. Anterior posterior compression Grade II
b. Anterior posterior compression grade III
c. Combined mechanical injury
d. Lateral compression grade II
e. Lateral compression grade III

5. Which of the following is the weakest predictor of major haemorrhage in patients with pelvic fractures?
a. Displaced fracture of the obturator ring
b. Emergency department haematocrit measured as <30%
c. Pulse >130 bpm
d. Vertical displacement of 1cm
e. Wide pubic symphyseal diastasis

6. Which of the following statements about pelvic binders is incorrect?
a. They can be used with open fractures
b. They can be used with all fracture patterns
c. They have largely replaced external fixation in the emergency management of pelvic fractures
d. They stabilise and compress fractures to restrict bleeding
e. They work by reducing the pelvic volume

7. In a study of 517 trauma patients with at least one risk factor for venous thromboembolism, who were followed with serial venous duplex scans, which of the following did not result in a higher incidence of DVT?
a. hip fracture
b. pelvic fracture
c. previous venous thromboembolism
d. significant head injury
e. spinal cord injury

8. Which of the following has the lowest incidence expressed as a percentage?
a. Absence of symptoms of DVT in pelvic fracture patients in who have DVT
b. Arterial injury as a cause of haemodynamic instability in pelvic fractures
c. Death in patients with haemodynamically unstable pelvic fractures
d. Mortality after open pelvic fracture
e. Sexual dysfunction in males after pelvic fractures

9. Which of the following has least influence on prognosis for soft tissue sarcomas?
a. Age of patient
b. Depth
c. Grade
d. Location
e. Size

10. Which of the following soft tissue lumps could be considered for excision biopsy?
a. A 1cm lump that recurs after excision of a previous similarly sized lump
b. A 2cm lump just beneath the deep fascia
c. A 4cm subcutaneous lump
d. A lump that has increased from 2 to 3cm over a 6 month period
e. A painful 1cm lump within a superficial muscle belly

11. Which of the following factors does not seem to be associated with a clinically important detrimental effect on the outcome of resurfacing hip replacement?
a. Abduction angle of more than 55 degrees
b. Acetabular component sector angle
c. Anteversion angle of more than 30 degrees
d. Avascular necrosis of the femoral head
e. Pseudotumour formation

12. What traverses the foramen formed at the articulation between the sacral and coccygeal cornuae?
a. First coccygeal nerve
b. Fifth sacral nerve
c. Posterior division of fifth sacral nerve
d. Posterior division of first coccygeal nerve
e. Terminal division of filum terminale

13. Which of the following structures does not attach to the coccyx?
a. Coccygeus muscle
b. Erector spinae
c. Gluteus maximus
d. Levator ani
e. Sacrosciatic ligaments

14. If 100 patients with coccydinia underwent conservative treatment and coccygectomy was carried out on all of those who did not respond, assuming results comparable with published experience, how many patients would be left with continuing pain?
a. One
b. Four
c. Seven
d. Ten
e. Fifteen

15. When Larrey and Desault described débridement, to what were they referring?
a. Extending open wounds to allow free drainage
b. Release of compartment syndrome
c. Removing bone fragments and reducing the fracture
d. Removal of foreign material from open wounds
e. Removing dead and devitalised tissue

16. Immediately prior to the introduction of the Thomas splint in World War I the mortality of open femoral fractures was 80%. What was it for the remainder of the war, after introduction of the splint?
a. 66%
b. 50%
c. 33%
d. 26%
e. 16%

17. What did Sherman's care regime include after the internal fixation of femoral shaft fractures using a plate during World War I?
a. Wounds closed and patient rested in bed for 6 weeks then mobilised with crutches as symptoms allowed
b. Wounds closed and patient mobilised immediately without bearing weight, allowing weight bearing as callus formed
c. Wounds closed, patient rested in bed for six weeks then non-weight bearing until radiological union
d. Wounds left open and patient mobilised as soon as drainage stops
e. Wounds left open and plate removed at six weeks

18. The mortality from wounds complicated by gas gangrene was 10-12% in World War I - what was it in the Vietnam war?
a. 3.2%
b. 1.6%
c. 0.32%
d. 0.16%
e. 0.032%

19. What was, approximately, the total rate of amputation following ballistic limb fractures in the Gulf war 2003?
a. 50%
b. 25%
c. 15%
d. 10%
e. 5%

20. When looking at the Oxford score in knee arthroplasty register data, how much more likely is a unicompartmental knee replacement to be revised than a total knee arthroplasty of an identical outcome score?
a. Similar likelihood
b. Twice as likely
c. Three times more likely
d. Five times more likely
e. Ten times more likely

1. Which of the following combinations generates an effective 'Fibrin glue'
c. Aprotinin, Fibrinogen and Thrombin

2. With current technology for fluoroscopic navigation, which of the following procedures requires three, rather than two, fluoroscopic images for accurate performance without repeated screening
e. Percutaneous fixation of sacroiliac joint separations

3. Which of the following correctly describes the citation index of a journal
d. The ratio of the number of citations in the current year to articles published in the two preceding years divided by the number of citable items in the same two years

4. How should a pelvic fracture that includes transverse fractures of the pubic rami, an ipsilateral sacral fracture and an iliac wing fracture be classified
d. Lateral compression grade II

5. Which of the following is the weakest predictor of major haemorrhage in patients with pelvic fractures
d. Vertical displacement of 1cm

6. Which of the following statements about pelvic binders is incorrect
d. They stabilise and compress fractures to restrict bleeding

7. In a study of 517 trauma patients with at least one risk factor for venous thromboembolism, who were followed with serial venous duplex scans, which of the following did not result in a higher incidence of DVT
a. hip fracture

8. Which of the following has the lowest incidence expressed as a percentage
c. Death in patients with haemodynamically unstable pelvic fractures

9. Which of the following has least influence on prognosis for soft tissue sarcomas
d. Location

10. Which of the following soft tissue lumps could be considered for excision biopsy
c. A 4cm subcutaneous lump

11. Which of the following factors does not seem to be associated with a clinically important detrimental effect on the outcome of resurfacing hip replacement
d. Avascular necrosis of the femoral head

12. What traverses the foramen formed at the articulation between the sacral and coccygeal cornuae
c. Posterior division of fifth sacral nerve

13. Which of the following structures does not attach to the coccyx
b. Erector spinae

14. If 100 patients with coccydinia underwent conservative treatment and coccygectomy was carried out on all of those who did not respond, assuming results comparable with published experience, how many patients would be left with continuing pain
a. One

15. When Larrey and Desault described débridement, to what were they referring
a. Extending open wounds to allow free drainage

16. Immediately prior to the introduction of the Thomas splint in World War I the mortality of open femoral fractures was 80%. What was it for the remainder of the war, after introduction of the splint
e. 16%

17. What did Sherman's care regime include after the internal fixation of femoral shaft fractures using a plate during World War I
e. Wounds left open and plate removed at six weeks

18. The mortality from wounds complicated by gas gangrene was 10-12% in World War I - what was it in the Vietnam war
d. 0.16%

19. What was, approximately, the total rate of amputation following ballistic limb fractures in the Gulf war 2003
b. 25%

20. When looking at the Oxford score in knee arthroplasty register data, how much more likely is a unicompartmental knee replacement to be revised than a total knee arthroplasty of an identical outcome score
d. Five times more likely