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January 2012 CME

 

1. Bisphosphonates are analogous to which naturally occurring substance?

a. Adenodine triphosphate
b. Appatite
c. Hydroxyappatite
d. Pyrophosphate
e. Tyrosine phosphate

2. Bisphosphonates inhibit an enzyme not only involved in a pathway regulating osteoclast function, but also which other metabolic pathway?
a. Cholesterol synthesis
b. DNA repair
c. Growth hormone regulation
d. Oxidative glycolysis
e. Vitamin D synthesis

3. Which of the following is least characteristic of insufficiency fractures associated with bisphosphonate treatment?
a. Asymptomatic until fracture
b. Beaking of the lateral cortex in the subtrochanteric region
c. Duration of treatment usually five years or more
d. Increased likelihood of the need for intramedullary fixation compared to hip fractures in general
e. Reduced incidence of vertebral fractures compared to untreated population

4. Where is bone bruising typically found on MRI investigation of a knee with a pivot shift injury?
a. Anterolateral femoral condyle and anterolateral tibial condyle
b. Anterolateral femoral condyle and posterolateral tibial condyle
c. Anterolateral tibial condyle and posteromedial femoral condyle
d. Posterolateral femoral condyle and anterolateral tibial condyle
e. Posteromedial femoral condyle and posteromedial tibial condyle

5. Which of the following procedures, used to treat the unstable knee, does not maintain the normal soft-tissue attachments to Gerdy’s tubercle?
a. Ellison’s distal transfer
b. The Lemaire operation
c. Losee’s sling and reef operation
d. The MacIntosh procedure
e. The Marcacci repair

6. Which of the following statements concerning pivot shift sign in the knee is incorrect?
a. As the knee is extended past 30° of flexion, the iliotibial band passes from behind to in front of the centre of rotation of the knee
b. At less than 30° the lateral tibial plateau is anteriorly subluxed
c. It can be positive with an intact ACL
d. It is less common when ACL rupture is combined with injury to the lateral structures than in isolated ACL injury
e. It occurs when there is a coupling of linear laxity in the sagittal plane with an axial rotatory abnormality

7. Which of the following structures lies in the most superficial layer of the lateral structures of the knee?
a. Biceps femoris
b. Joint capsule
c. Lateral patellofemoral ligament
d. Patellomeniscal ligament
e. Transverse fibres of lateral retinaculum

8. Which of the following descriptions of scaphoid fractures relates to an injury that has an approximately 20% chance of developing nonunion?
a. A fracture associated with perilunate dislocation
b. A fracture associated with with a scapholunate gap of more than 3 mm
c. A fracture with a step measured as 1.5 mm on radiographs
d. A fracture with no gap visible on radiographs
e. A vertical fracture pattern with no displacement

9. In assessing the scaphoid on imaging studies, which of the following is an abnormal value?
a. Anteroposterior intrascaphoid angle of 40°
b. Dorsal cortical angle 150°
c. Dorsal tilt angle of the lunate of 60°
d. Height to length ratio 0.60
e. Lateral intrascaphoid angle 50°

10. Which of the following statements concerning the clinical outcome of scaphoid fractures is incorrect?
a. Approximately 5% of scaphoid fractures that heal in a cast will develop osteoarthritic changes on radiographs at seven years minimum follow-up
b. Osteoarthritis is much more common following non-union than after satisfactory fracture healing
c. Overall, approximately 20% of patients still have some pain and tenderness at two years
d. Radiological outcome does not correlate with clinical result in displaced fractures
e. The development of a Dorsal Intercalated Segment Instability deformity is associated with poor functional results

11. If 1 000 patients with scaphoid fractures that are undisplaced on plain radiographs were simply treated by four weeks of immobilisation in a below-elbow cast, approximately how many would be expected to develop displacement and mal- or non-union?
a. 0
b. 30
c. 60
d. 90
e. 120

12. What term is used to describe the wrist of an individual with relative joint laxity in which the scaphoid flexes in the sagittal plane during radial deviation of the wrist?
a. Column type wrist
b. Congugated wrist
c. Intercalated wrist
d. Moberg type wrist
e. Row type wrist

13. A scaphoid fracture is displaced, with a gap that is seen on plain anteroposterior radiographs to measure 0.5 mm at one border of the waist and 2 mm on the other. What grade of instability does this represent?
a. Grade 0
b. Grade 1a
c. Grade 1b
d. Grade 2
e. Grade 3

14. Which of the following is the most common position of deformity of the malunited scaphoid?
a. Extension
b. Flexion
c. Pronation
d. Radial translation
e. Ulnar translation

15. When conducting a meta-analysis it is observed that smaller trials appeared to have a greater influence on the overall results than larger trials. Investigation suggested that this may be due to the appearance of more small negative trials than small positive trials in the literature. What sort of bias is this?
a. Confirmation bias
b. File drawer effect
c. Publication bias
d. Reporting bias
e. Selection bias

16. An analysis of trials into the benefits and side effects of tranexamic acid in total knee replacement was carried out. It demonstrated that deep vein thrombosis and pulmonary embolism rates were lower in the pooled tranexamic acid data than in controls. However this did not reach statistical significance. How many patients would have to be recruited into a trial capable of detecting a 1% increase in risk of thromboembolic events in this patient group?
a. 500
b. 2 000
c. 5 000
d. 20 000
e. 50 000

17. What combination of hip movements is most likely to provoke pain in patients with ischiofemoral impingement?
a. Abduction, extension, internal rotation
b. Abduction, flexion, internal rotation
c. Adduction, extension, external rotation
d. Adduction, extension, internal rotation
e. Adduction, flexion, external rotation

18. Which of the following structures normally occupies the space between the lesser trochanter and the ischium?
a. Obturator externus
b. Obturator internus
c. Piriformis
d. Quadratus femoris muscle
e. Sciatic nerve

19. What is the most appropriate name for a robotic system that allows the surgeon to control the robotic device to execute very precisely a preoperative plan based on 3D imaging?
a. Computer navigation system
b. Haptic robotic system
c. MBARS robot
d. ROBODOC
e. Semi autonomous robotic system

20. Which of the following has not, to date, been associated with the use of robotic systems in knee replacement surgery?
a. Decreased blood loss
b. Decreased operative time
c. Decreased risk of nerve injury
d. Increased blood loss
e. Increased litigation

1. Bisphosphonates are analogous to which naturally occurring substance?
d. Pyrophosphate

2. Bisphosphonates inhibit an enzyme not only involved in a pathway regulating osteoclast function, but also which other metabolic pathway?
a. Cholesterol synthesis

3. Which of the following is least characteristic of insufficiency fractures associated with bisphosphonate treatment?
a. Asymptomatic until fracture

4. Where is bone bruising typically found on MRI investigation of a knee with a pivot shift injury?
b. Anterolateral femoral condyle and posterolateral tibial condyle

5. Which of the following procedures, used to treat the unstable knee, does not maintain the normal soft-tissue attachments to Gerdy’s tubercle?
a. Ellison’s distal transfer

6. Which of the following statements concerning pivot shift sign in the knee is incorrect?
d. It is less common when ACL rupture is combined with injury to the lateral structures than in isolated ACL injury

7. Which of the following structures lies in the most superficial layer of the lateral structures of the knee?
a. Biceps femoris

8. Which of the following descriptions of scaphoid fractures relates to an injury that has an approximately 20% chance of developing nonunion?
c. A fracture with a step measured as 1.5 mm on radiographs

9. In assessing the scaphoid on imaging studies, which of the following is an abnormal value?
e. Lateral intrascaphoid angle 50°

10. Which of the following statements concerning the clinical outcome of scaphoid fractures is incorrect?
e. The development of a Dorsal Intercalated Segment Instability deformity is associated with poor functional results

11. If 1 000 patients with scaphoid fractures that are undisplaced on plain radiographs were simply treated by four weeks of immobilisation in a below-elbow cast, approximately how many would be expected to develop displacement and mal- or non-union?
b. 30

12. What term is used to describe the wrist of an individual with relative joint laxity in which the scaphoid flexes in the sagittal plane during radial deviation of the wrist?
e. Row type wrist

13. A scaphoid fracture is displaced, with a gap that is seen on plain anteroposterior radiographs to measure 0.5 mm at one border of the waist and 2 mm on the other. What grade of instability does this represent?
d. Grade 2

14. Which of the following is the most common position of deformity of the malunited scaphoid?
b. Flexion

15. When conducting a meta-analysis it is observed that smaller trials appeared to have a greater influence on the overall results than larger trials. Investigation suggested that this may be due to the appearance of more small negative trials than small positive trials in the literature. What sort of bias is this?
c. Publication bias

16. An analysis of trials into the benefits and side effects of tranexamic acid in total knee replacement was carried out. It demonstrated that deep vein thrombosis and pulmonary embolism rates were lower in the pooled tranexamic acid data than in controls. However this did not reach statistical significance. How many patients would have to be recruited into a trial capable of detecting a 1% increase in risk of thromboembolic events in this patient group?
c. 5 000

17. What combination of hip movements is most likely to provoke pain in patients with ischiofemoral impingement?
d. Adduction, extension, internal rotation

18. Which of the following structures normally occupies the space between the lesser trochanter and the ischium?
d. Quadratus femoris muscle

19. What is the most appropriate name for a robotic system that allows the surgeon to control the robotic device to execute very precisely a preoperative plan based on 3D imaging?
b. Haptic robotic system

20. Which of the following has not, to date, been associated with the use of robotic systems in knee replacement surgery?
c. Decreased risk of nerve injury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Bisphosphonates are analogous to which naturally occurring substance?
d. Pyrophosphate

2. Bisphosphonates inhibit an enzyme not only involved in a pathway regulating osteoclast function, but also which other metabolic pathway?
a. Cholesterol synthesis

3. Which of the following is least characteristic of insufficiency fractures associated with bisphosphonate treatment?
a. Asymptomatic until fracture

4. Where is bone bruising typically found on MRI investigation of a knee with a pivot shift injury?
b. Anterolateral femoral condyle and posterolateral tibial condyle

5. Which of the following procedures, used to treat the unstable knee, does not maintain the normal soft-tissue attachments to Gerdy’s tubercle?
a. Ellison’s distal transfer

6. Which of the following statements concerning pivot shift sign in the knee is incorrect?
d. It is less common when ACL rupture is combined with injury to the lateral structures than in isolated ACL injury

7. Which of the following structures lies in the most superficial layer of the lateral structures of the knee?
a. Biceps femoris

8. Which of the following descriptions of scaphoid fractures relates to an injury that has an approximately 20% chance of developing nonunion?
c. A fracture with a step measured as 1.5 mm on radiographs

9. In assessing the scaphoid on imaging studies, which of the following is an abnormal value?
e. Lateral intrascaphoid angle 50°

10. Which of the following statements concerning the clinical outcome of scaphoid fractures is incorrect?
e. The development of a Dorsal Intercalated Segment Instability deformity is associated with poor functional results

11. If 1 000 patients with scaphoid fractures that are undisplaced on plain radiographs were simply treated by four weeks of immobilisation in a below-elbow cast, approximately how many would be expected to develop displacement and mal- or non-union?
b. 30

12. What term is used to describe the wrist of an individual with relative joint laxity in which the scaphoid flexes in the sagittal plane during radial deviation of the wrist?
e. Row type wrist

13. A scaphoid fracture is displaced, with a gap that is seen on plain anteroposterior radiographs to measure 0.5 mm at one border of the waist and 2 mm on the other. What grade of instability does this represent?
d. Grade 2

14. Which of the following is the most common position of deformity of the malunited scaphoid?
b. Flexion

15. When conducting a meta-analysis it is observed that smaller trials appeared to have a greater influence on the overall results than larger trials. Investigation suggested that this may be due to the appearance of more small negative trials than small positive trials in the literature. What sort of bias is this?
c. Publication bias

16. An analysis of trials into the benefits and side effects of tranexamic acid in total knee replacement was carried out. It demonstrated that deep vein thrombosis and pulmonary embolism rates were lower in the pooled tranexamic acid data than in controls. However this did not reach statistical significance. How many patients would have to be recruited into a trial capable of detecting a 1% increase in risk of thromboembolic events in this patient group?
c. 5 000

17. What combination of hip movements is most likely to provoke pain in patients with ischiofemoral impingement?
d. Adduction, extension, internal rotation

18. Which of the following structures normally occupies the space between the lesser trochanter and the ischium?
d. Quadratus femoris muscle

19. What is the most appropriate name for a robotic system that allows the surgeon to control the robotic device to execute very precisely a preoperative plan based on 3D imaging?
b. Haptic robotic system

20. Which of the following has not, to date, been associated with the use of robotic systems in knee replacement surgery?
c. Decreased risk of nerve injury