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October 2011 CME

1. Which of the following statements concerning percutaneous vertebroplasty is least supported by current evidence?
a. After vertebroplasty further wedge compression fractures occur in up to 50%
b. New fractures occurring after vertebroplasty affect an adjacent level in 90% of patients
c. Pain relief reaches a plateau within two days of the procedure then there is no significant change in pain levels for two years
d. Pain relief is rapid and benefits 80% of patients
e. The incidence of significant complications is less than 3%

2. 1000 patients who suffered an osteoporotic wedge compression fracture are reviewed three months after the fracture occurred. How many would you expect to be symptomatic at this time?
a. 900
b. 500
c. 250
d. 150
e. 50

3. Which of the following falls within the range of expected prevalence of new osteoporotic wedge compression fractures at a level adjacent to a level treated by percutaneous vertebroplasty?
a. 1%
b. 5%
c. 30%
d. 50%
e. 75%

4. What do CONSORT guidelines advise on?
a. The design of randomised trials, detailing the steps involved in setting up an appropriate trial
b. The information needed for a submission of potential research to a research ethics committee
c. The interpretation of a published paper reporting a trial involving human subjects
d. The reporting of randomised controlled trials, particularly the presentation of information related to methodology and findings
e. The structure of a research paper to be submitted for publication

5. In a review of the quality of research reporting in general orthopaedic journals, which of the following was found to occur at the highest rate, expressed as a percentage of the papers studied in detail?
a. Inadequate reporting of patient numbers
b. New statistical tests introduced in the results section that were not mentioned in the methods
c. No error measurements to accompany main outcome measurements
d. Proportion of CONSORT guidelines with which the paper complies
e. Reporting number of patients in Methods or Results, but not in both

6. Up to what age has successful correction of congentital talipes equinovarus using the Ponseti method been reported?
a. One year
b. Three years
c. Five years
d. Ten years
e. Eighteen years

7. What is the most common cause of relapse after treatment of congenital talipes equinovarus using the Ponseti method?
a. Avascular necrosis
b. No identifiable cause
c. Non-compliance with bracing
d. Muscle spasticity due to neurological disease
e. Recurrent deformity with skeletal growth

8. What is the approximate proportion of patients requiring percutaneous tenotomy of the Achilles tendon to correct residual equinus in patients beyond walking age after Ponseti treatment is complete?
a. Negligible
b. One in ten
c. One in five
d. One in three
e. Almost all

9. Which of the following statements concerning the use of antibiotics in the management of chronic osteomyelitis in children is incorrect?
a. Preoperative antibiotics may simply promote bacterial resistance
b. Routine antibiotic treatment has been shown to improve the outcome after sequestrectomy and curettage
c. Surgery to remove devitalised tissue is more important than antibiotic treatment
d. Treatment with antibiotics alone is futile
e. With a healthy, vascular involucrum and a good soft-tissue envelope in an immunocompetent patient antibiotic treatment may be unnecessary

10. Which of the following patient characteristics is least likely to indicate a useful role for antibiotic treatment in chronic osteomyelitis?
a. Associated physeal damage
b. Bone graft required for reconstruction
c. Immune compromised patients
d. Sclerotic involucrum with possible microsequestra
e. Type B3 osteomyelitis (Beit CURE classification)

11. Which of the following statements concerning the relationship between HIV infection and chronic osteomyelitis in children is most correct?
a. Antiretroviral treatment improves the outcome of chronic osteomyelitis in HIV positive patients  
b. HIV is a contra-indication to the use of implants in the treatment and reconstruction of chronic osteomyelitis
c. Patients with a low CD4 count have been shown to be more susceptible to osteomyelitis
d. The burden of osteomyelitis in patients affected by HIV is significantly greater than in those without HIV
e. Whether HIV infection has any bearing on the incidence and outcome of treatment of chronic osteomyelitis is unknown

12. What is the upper limit of volumetric wear per million cycles that defines a low wear rate in metal–on-metal bearing?
a. 0.1mm3
b. 1mm3
c. 10 mm3
d. 100 mm3
e. 1000 mm3

13. Approximately what proportion of patients with a metal-on-metal hip replacement fall into the low wear rate category with individual metal ion concentrations of less than 5 parts per billion?
a. 33%
b. 50%
c. 66%
d. 85%
e. 95%

14. Which of the following types of malpositioning in a metal-on-metal hip replacement is least likely to give rise to a volumetric wear rate of 10 mm3 per million cycles?
a. Excessive acetabular inclination
b. Medial translation of the centre of the acetabulum
c. Offset deficiency
d. Stem subsidence
e. Superior translation of the centre of the acetabulum

15. Which of the following mechanisms of lubrication is occurring in a metal on metal hip replacement that is accurately positioned, providing low wear conditions?
a. Boundary lubrication
b. Elastohydrodynamic lubrication
c. Microelastohydrodynamic lubrication
d. Thin film lubrication
e. Weeping lubrication

16. Which of the following is not a recognised association or feature of Scheuermann’s hyperkyphosis?
a. Anterior wedging reverses during bracing
b. Elevated growth hormone
c. Scoliosis affecting the thoracic region
d. Strong genetic contribution to aetiology
e. Thickening of anterior longitudinal ligament

17. Which of the following is not a diagnostic radiological criterion for Scheuermann’s disease?
a. Anterior wedging of any 3 or more thoracic vertebrae by more than 5° each
b. Irregular vertebral end plates
c. Kyphosis angle >45°
d. Narrowing of disc spaces between wedged vertebrae
e. Schmorl’s nodes

18. When patients with Scheuermann’s disease were compared to age matched individuals, in which of the following parameters was a difference found between the two study groups?
a. Inspiratory capacity
b. Marriage rate
c. Restriction of leisure activities
d. Self consciousness
e. Sick leave due to pain

19. A line is drawn on an AP pelvic radiograph from the centre of the femoral head to the midpoint of the scaral endplate. A second line is drawn perpendicular to the sacral endplate. What is described by the angle subtended between these two?
a. Pelvic incidence
b. Pelvic retroversion angle
c. Pelvic tilt
d. Sacral inclination
e. Sacral slope

20. If Scheuermann’s disease is treated surgically through the currently recommended approach, which of the following is the commonest expected complication?
a. Bladder injury
b. Haemothorax
c. Paraplegia
d. Pneumothorax
e. Wound infection

 

1. Which of the following statements concerning percutaneous vertebroplasty is least supported by current evidence?
b. New fractures occurring after vertebroplasty affect an adjacent level in 90% of patients

2. 1 000 patients who suffered an osteoporotic wedge compression fracture are reviewed three months after the fracture occurred. How many would you expect to be symptomatic at this time?
d. 150

3. Which of the following falls within the range of expected prevalence of new osteoporotic wedge compression fractures at a level adjacent to a level treated by percutaneous vertebroplasty?
c. 30%

4. What do CONSORT guidelines advise on?
d. The reporting of randomised controlled trials, particularly the presentation of

5. In a review of the quality of research reporting in general orthopaedic journals, which of the following was found to occur at the highest rate, expressed as a percentage of the papers studied in detail?
d. Proportion of CONSORT guidelines with which the paper complies

6. Up to what age has successful correction of congentital talipes equinovarus using the Ponseti method been reported?
e. Eighteen years

7. What is the most common cause of relapse after treatment of congenital talipes equinovarus using the Ponseti method?
b. No identifiable cause

8. What is the approximate proportion of patients requiring percutaneous tenotomy of the Achilles tendon to correct residual equinus in patients beyond walking age after Ponseti treatment is complete?
e. Almost all

9. Which of the following statements concerning the use of antibiotics in the management of chronic osteomyelitis in children is incorrect?
b. Routine antibiotic treatment has been shown to improve the outcome after sequestrectomy and curettage

10. Which of the following patient characteristics is least likely to indicate a useful role for antibiotic treatment in chronic osteomyelitis?
a. Associated physeal damage

11. Which of the following statements concerning the relationship between HIV infection and chronic osteomyelitis in children is most correct?
e. Whether HIV infection has any bearing on the incidence and outcome of treatment of chronic osteomyelitis is unknown

12. What is the upper limit of volumetric wear per million cycles that defines a low wear rate in metal–on-metal bearing?
b. 1mm3

13. Approximately what proportion of patients with a metal-on-metal hip replacement fall into the low wear rate category with individual metal ion concentrations of less than 5 parts per billion?
d. 85%

14. Which of the following types of malpositioning in a metal-on-metal hip replacement is least likely to give rise to a volumetric wear rate of 10 mm3 per million cycles?
a. Excessive acetabular inclination

15. Which of the following mechanisms of lubrication is occurring in a metal on metal hip replacement that is accurately positioned, providing low wear conditions?
a. Boundary lubrication

16. Which of the following is not a recognised association or feature of Scheuermann’s hyperkyphosis?
c. Scoliosis affecting the thoracic region

17. Which of the following is not a diagnostic radiological criterion for Scheuermann’s disease?
a. Anterior wedging of any 3 or more thoracic vertebrae by more than 5° each

18. When patients with Scheuermann’s disease were compared to age matched individuals, in which of the following parameters was a difference found between the two study groups?
a. Inspiratory capacity

19. A line is drawn on an AP pelvic radiograph from the centre of the femoral head to the midpoint of the scaral endplate. A second line is drawn perpendicular to the sacral endplate. What is described by the angle subtended between these two?
a. Pelvic incidence

20. If Scheuermann’s disease is treated surgically through the currently recommended approach, which of the following is the commonest expected complication?
e. Wound infection