MCQ Questions on Orthopedics .
Answer are given in bold highlight .
1- Sudden, acute pain and sciatica
a- In young people, it is important to exclude prolapse disc.
b- In patients, aged 20–40 years are more likely to have a spinal instability.
c- In those under the age of 20, it is important to exclude infection.
d- In elderly patients may have spondylolysis.
e- In elderly patients may have spondylolisthesis.
2- Intermittent low back pain after exertion
a- Old Patients only may complain of recurrent backache following exertion.
b- Rest relieves this pain.
c- Features of disc prolapse are always present.
d- In those under 50 years, osteoarthritis of the facet joints is common.
e- In early cases, x-rays usually show signs of lumbar spondylosis.
3- Hip disorders at age between 10-20 years mostly
a- Neglected developmental dysplasia of the hip.
b- Infections
c- Perthes’ disease
d- Slipped epiphysis
e- Adults Arthritis.
4- The reported incidence of neonatal hip instability in northern Europe is approximately
a- One per 1000 live births.
b- Three per 1000 live birth.
c- Six per 1000 live birth.
d- 10 per 1000 live birth.
e- 20 per 1000 live birth.
5- Acetabular dysplasia
a- Always genetically determined.
b- Always follow incomplete reduction of a congenital dislocation.
c- Always follow damage to the lateral acetabular epiphysis or maldevelopment of the femoral head.
d- The socket is unusually shallow, the roof is sloping and there is deficient coverage of the femoral head.
e- Faulty load transmission in the lateral part of the joint may lead to primary osteoarthritis.
6- In people with mild acetabular dysplasia
a- The condition exists only as an ‘x-ray diagnoses.
b- May complain of pain over the lateral side of the hip.
c- Some experience episodes of sharp pain in the groin.
d- Complain of movement – particularly abduction in flexion – is restricted.
e- Complain of leg length asymmetry and the femoral head may be felt as a lump in groin.
7- The recurrence rate of irritable hip is
a- 5%.
b- 10%.
c- 15%.
d- 20%.
e- 25%.
8- Congenital coxa vara is
a- Uncommon developmental disorder of adolescent.
b- Due to a defect of enchondral ossification in the lateral part of femoral neck.
c- Corrected spontaneously with growth.
d- Associated with anteversion of femoral neck.
e- Bilateral in about one third of cases.
9- Perthes' disease is
a- Common.
b- Uncommon.
c- Rare.
d- Patients are usually 10-15 years.
e- The girls are affected two time as often as boy.
10- Adolescent with slipped capital femoral epiphysis
a- Have femoral neck retroversion.
b- There is femoral head anteversion.
c- The physis has decreased obliquity.
d- Have lessor than average body mass index.
e- Have no hormonal imbalance.
11- The treatment of Perthes' disease in children under 6 years of age is
a- Abduction brace.
b- Abduction spica.
c- Pelvic osteotomy.
d- Femoral osteotomy.
e- Symptomatic treatment.
12- Between 4 to 7 years of age, the femoral head depend for its blood supply venous drainage
a- On both metaphyseal and lateral epiphyseal vessels.
b- On both metaphyseal vessels and blood vessels in ligamentum teres.
c- Almost entirely on the metaphyseal vessels.
d- Almost entirely on the lateral epiphyseal vessels.
e- Almost entirely on the blood vessels in ligamentum teres.
13- The first x-ray change in Perthes' disease is
a- Increase density of the proximal femoral epiphysis.
b- Fragmentation of the proximal femoral epiphysis .
c- Rarefaction and cystic changes in metaphysis.
d- Widening of the joint space.
e- Enlargement of the proximal femoral epiphysis .
14- The most important prognostic factor in Perthes' disease is
a- The degree of femoral head collapse.
b- The degree of femoral head involvement.
c- The calcification lateral proximal femoral epiphyseal plate.
d- The age of child.
e- The sex of child.
15- In pre- slip in slipped capital femoral epiphysis
a- The child complains of gluteal pain particularly on rest.
b- There is limitation of movement.
c- Exertion, and there may be a limp
d- Examination may demonstrate reduced external rotation.
e- The x-ray may show widening or irregularity of the physis.
16- The chronic slip in slipped capital femoral epiphysis
a- The child complains of posterior hip pain lasting more than 3 weeks.
b- The pain is continuous without remission.
c- There is loss of internal rotation, abduction.
d- There is some extension and limb lengthening.
e- There is long prodromal history and a severe exacerbation.
17- Sever slip in slipped capital femoral epiphysis
a- Causes marked deformity which, untreated, will predispose to secondary OA.
b- Closed reduction by manipulation should be attempted.
c- Open reduction by Dunn’s method gives fair results.
d- The alternative treatment is to fix the epiphysis without osteotomy.
e- The patient should be told that this may result in 5–7 cm of shortening.
18- Articular chondrolysis in slipped capital femoral epiphysis
a- Cartilage necrosis probably results from slipping.
b- In these cases, bone changes are marked.
c- There is progressive narrowing of the joint space and the hip becomes stiff.
d- This is a rare complication in SCFE.
e- All cases, the condition improves spontaneously
19- The diagnosis of pyogenic arthritis of the hip is confirmed
a- By the classical clinical picture.
b- By typical radiological features and joint effusion on ultrasonography.
c- By the detailed picture provided by MRI.
d- By aspirating pus or fluid from the joint and submitting it for laboratory examination and bacteriological culture.
e- By early CT scan of the hip.
20- The most important type of motion in the hip for optimal bipedal function is
a- Extension and abduction.
b- Extension and adduction.
c- Flexion and abduction.
d- Flexion and internal rotation.
e- Flexion and external rotation.
21- The cam type femoro-acetabular impingement
a- Affect young female,
b- Affect acetabulum mainly.
c- The main pathology is non-spherical extension of femoral head.
d- Associated with protrusion- acetabuli and acetabular retroversion.
e- The structure primarily damaged is labrum.
22- The changes of osteoarthritis of the hip are most marked
a- In margin of articular surface.
b- The top of the joint.
c- In the infero-medial part of the joint.
d- In the inferior part of the joint.
e- In the medial part of joint.
23- The common cause of primary OA of the hip is
a- Avascular necrosis.
b- Subluxation of the hip.
c- Dysplasia of the hip.
d- Femoro-acetabular impingement.
e- Coxa magna following Perthes' disease.
24- Rheumatoid arthritis of the hip
a- The hip joint is common site.
b- Characterized by other joints affection.
c- The hallmark is progressive bone destruction on both side of joint.
d- Characterized by reduction of joint space and osteophyte formation.
e- Pain behind hip and limping are earliest symptom.
25- Total hip arthroplasty for rheumatoid arthritis
a- Relieves pain but not restore a useful range of movement.
b- It advocated for old patients only.
c- Fracture during operation is rare.
d- The risk of infection is less.
e- Adolescent with juvenile rheumatoid arthritis may be treated by custom-made prosthesis.
26- Grade III osteonecrosis of the hip
a- The prognosis is good.
b- Decompression is valuable.
c- For young patients partial hip replacement is the treatment of choice.
d- Older patient treated by total hip replacement.
e- Older patient treated by arthrodesis.
27- Transient osteoporosis of the hip
a- Is common.
b- Characterized by pain and rapidly emerging osteoporosis.
c- Radionuclide scanning show decreased activity.
d- The changes last 1-3 months.
e- The x-ray not returns to normal after pain subside.
28- The best treatment for transient osteoporosis of the hip
a- Symptomatic treatment.
b- Calcitonin.
c- Alendronate.
d- Rest.
e- Osteotomy.
29- The indication to intertrochanteric osteotomy is
a- Wide spread osteoarthritis.
b- Sever collapse in avascular osteonecrosis.
c- Osteoarthritis with sever stiffness.
d- Young patient with osteoarthritis associated with joint dysplasia .
e- Rheumatoid arthritis.
30- The ‘bond’ between bone and the implant surface, or cement,
a- Is never perfect.
b- Optimized in new technique.
c- Improved by embedding the implant in methylmethacrylate cement.
d- Improved in recent technique of bone cementing.
e- Improved by fitting the implant closely to the bone bed without cement.
31- Postoperative dislocation following total hip replacement
a- Is uncommon if the prosthetic components are correctly placed.
b- Reduction is easy and traction in adduction.
c- Usually closed reduction and abduction allows the hip to stabilize.
d- If malposition of the femoral is sever, brace used to prevent recurrence.
e- If malposition of acetabular component is severe, augmentation of the socket may be needed.
32- Aseptic loosening after total hip arthroplasty
a- Is the third cause of long-term failure.
b- With modern methods of implant fixation, radiographic evidence of loosening in less than 2 per cent of patients 15 years after operation.
c- Radionuclide scanning shows decreased activity.
d- At microscopic level, symptomatic patients only show cellular reaction and membrane formation at the bone–cement interface.
e- Revision arthroplasty can be either cemented or uncemented, depending on the condition of the bone.
33- Highly cross-linked polyethylene (XLPE) acetabular prostheses
a- Gamma irradiation of polyethylene causes cross-linking, which greatly improves the wear resistance.
b- Gamma irradiation of polyethylene reduce the price of prostheses.
c- Gamma irradiation of polyethylene is directly proportional to the fracture toughness.
d- Encouraging clinical results with markedly increase wear reported with XLPE.
e- It should be noted that the commercially available XLPEs are the same.
34- Metal-on-metal bearing surfaces
a- Have very high wear rates
b- Are self-polishing, which allows for self-healing of surface scratches.
c- Metal is not brittle, and components therefore to be as thick.
d- Gives a smaller range of motion, and thus lesser mobility and greater stability.
e- Should not be used for patients want to return to vigorous recreational activities.
35- The post-operative care of total hip arthroplasty
a- The length of inpatient stay reduced to 14–16 days in most hospitals.
b- Patients mobilized independently before discharge.
c- Car driving allowed 14 day.
d- Patients will have negotiated stairs independently 2 months.
e- Full weight bearing without support will usually take 6–8 weeks at the patient’s own pace.
36- A small, localized swelling on the anterolateral side of the knee joint
a- Makes one think of haemarthrosis.
b- Makes one think of knee effusion.
c- Makes one think of prepatellar bursa.
d- Makes one think of a cyst of the meniscus.
e- Makes one think of semimembranosus bursa.
37- The Q-angle (quadriceps angle) is
a- The angle subtended by a line drawn from the anterior inferior iliac spine to the tip of the patella and another from the tip of the patella to the tibial tubercle.
b- The angle subtended by a line drawn from the anterior inferior iliac spine to the lower pole of the patella and another from the lower pole the patella to the tibial tubercle.
c- An increased Q-angle regarded as a predisposing factor in the development of chondromalacia.
d- Normally averages about 4 degrees in men.
e- Normally average about 7 degrees in women.
38- The anterior cruciate ligament stability
a- The ‘sag sign’ is sensitive tests.
b- Anterior drawer test is sensitive.
c- Posterior drawer sign is sensitive.
d- Lachman test is sensitive.
e- Lachman test is sensitive and specific.
39- A unilateral genu varus is
a- Mostly physiological.
b- Rarely to be pathological.
c- Mostly congenital.
d- It is essential in all cases to look for signs of injury.
e- If angulation is severe, early operative correction is necessary.
40- X-ray of Blount's disease
a- The proximal tibial epiphysis flattened laterally and the adjacent metaphysis is beak-shaped.
b- The lateral cortex of the proximal tibia appears thickened.
c- There is internal rotation of the tibia.
d- The tibial epiphysis always look 'fragmented’; and the femoral epiphysis also is affected.
e- In the late stages, a bony bar forms across the medial half of the tibial physis.
41- Genu valgus in adult female results
a- May be secondary to rheumatoid arthritis.
b- May be secondary to osteoarthritis.
c- May be secondary to Paget's disease.
d- Corrected by varus high tibial osteotomy.
e- Stress x-rays are not essential in the assessment of these cases.
42- ‘Locking’ of the knee– that is, the sudden inability to extend the knee fully suggest
a- Anterior horn tear.
b- Posterior horn tear.
c- Horizontal tear.
d- Bucket handle tear.
e- Degeneration of the menisci.
43- Operative treatment of meniscus injuries
a- Indicated if the joint locked.
b- Indicated if symptoms are acute.
c- Tears close to the periphery, treated by meniscectomy.
d- In appropriate cases, the success rate for both open and arthroscopic repair is almost 60 per cent.
e- Total meniscectomy thought to cause more instability and so predispose to late secondary osteoarthritis.
44- Discoid lateral meniscus
a- A young patient complains of gives way and ‘thuds’ loudly with history of injury.
b- A characteristic clunk felt at 60 degrees flexion and at 30 degrees as straightened.
c- MRI cannot confirms the diagnosis.
d- If there is only a clunk, treatment is essential.
e- If pain is disturbing, arthroscopic partial excision leaving a normally shaped meniscus'.
45- The treatment of meniscal cyst.
a- Arthroscopic total excision of cyst and total meniscectomy.
b- Arthroscopic removal of damaged part pf meniscus and decompression of cyst within the joint.
c- Arthroscopic total excision of cyst and partial meniscectomy .
d- Open total excision of cyst and total meniscectomy .
e- Open total excision of cyst and partial meniscectomy .
46- The indication of urgent surgical treatment in recurrent dislocation of the patella
a- Tear of medial capsule
b- Multiple dislocation in knee flexion.
c- Presence of a large displaced osteochondral fracture.
d- Recurrent dislocation of patella with severe pain.
e- Unstable patella after reduction.
47- Patellofemoral disorders that cause anterior knee pain.
a- Patellar instability
b- Osteochondritis dissecans
c- Loose body in the joint
d- Synovial chondromatosis
e- Plica syndrome
48- The common knee joint disorders that cause anterior knee pain. .
a- Patellar instability.
b- Patello-femoral overload.
c- Patellar ligament strain
d- Synovial chondromatosis
e- Plica syndrome
49- Osteochondritis dissecans of the knee is
a- Females affected more often than males.
b- Bilateral in 50 per cent of cases.
c- Over 80 per cent of lesions occur on the medial part of the lateral femoral condyle.
d- A large, well-demarcated, vascular fragment of bone and overlying cartilage separates from the lateral femoral condyles.
e- The lesion better seen in the ‘tunnel view’.
50- Treatment of knee loss body
a- A loose body should be removed.
b- Finding the loose body may be difficult; it may be concealed in a synovial pouch or sulcus .
c- A loose body should be removed even the joint is severely osteoarthritic.
d- This usually done through the open arthrotomy.
e- A large loose body may even slip under the edge of one of the menisci.
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