MCQ Questions on Orthopedics .
1- Holstein–Lewis fracture.
a- Fracture of proximal part of humerus.
b- Displaced fracture of proximal humerus in children.
c- Displaced transverse fracture of humeral shaft.
d- Oblique fractures at the junction of the middle and distal thirds of the bone.
e- Transverse fracture in lower third of humerus.
2- Fracture of the distal humerus in adult
a- Is often low-energy injuries.
b- May be associated with vascular and nerve damage.
c- Most of injuries can be treated conservatively.
d- Rarely need complex surgical techniques.
e- There is low tendency to stiffness of the elbow.
3- Fracture capitulum
a- Is a rare articular fracture, which occurs in any age.
b- The patient falls on the hand, usually with the elbow semi-flex.
c- The anterior part of the capitulum sheared off and displaced proximally.
d- Fullness behind the elbow is the most notable feature.
e- In the lateral view, the capitulum seen in front of the coronoid process.
4- Combined fractures of the radial head and coronoid process plus dislocation of the elbow
a- Are associated with rupture of the medial collateral ligament.
b- Are associated with rupture of the interosseous membrane
c- Are Essex Lopresti lesion.
d- Are the terrible triad .
e- Excision of the radial head is indicated.
5- Side-swipe injuries
a- Are severe fracture-dislocations of elbow
b- Are rarely associated with damage to the nerves.
c- The priorities are skeletal stabilization by cast.
d- The injuries stabilized by K- wires.
e- Surgery should done early in emergency theater.
6- Stiffness after dislocation of the elbow
a- Loss of 20 to 30 degrees of extension is common.
b- The most common cause of undue stiffness is prolonged immobilization.
c- The joint should be moved as soon as possible by passive stretching.
d- Persistent stiffness of severe degree can often be improved by arthroplasty.
e- Sometimes the stiffness is due to osteoarthritis.
7- Isolated dislocation of the radial head
a- Is uncommon.
b- Search carefully for an associated fracture of the capitulum.
c- In adult, the ulnar fracture may be difficult to detect.
d- Green-stick or mild plastic deformation of the radial shaft may be missed.
e- Bended ulnar bone may prevent full reduction of the radial head dislocation.
8- The average ages at which the ossific centers appear
a- Capitulum – 1 years.
b- Radial head – 3 years.
c- Medial epicondyle – 6 years.
d- Trochlea – 10 years.
e- Olecranon – 12 years.
9- The fat pad sign of elbow
a- Is seen most clearly in the anteroposterior view.
b- Seen in displaced supracondylar fracture.
c- Is diagnostic of undisplaced supracondylar fracture.
d- Arose suspicions undisplaced supracondylar fracture.
e- Is a triangular lucency behind the distal humerus, due to the fat pad being pushed backwards by a hematoma.
10- In the anteriorly displaced supracondylar fracture
a- The fracture line runs downwards and backwards.
b- Fracture line runs obliquely downwards and forwards.
c- The distal fragment tilted backwards.
d- The distal fragment shifted backwards.
e- The proximal fragment tilted forwards.
11- The incidence of vascular injuries in the displaced supracondylar fractures
a- Are probably less than one per thousand.
b- Are probably less than 1 percent.
c- Are probably less than 5 percent .
d- Are probably less than 8 percent .
e- Are probably less than 10 percent .
12- Ischemia following supracondylar fracture is suggested by
a- Pain and reduced capillary return on pressing the finger pulp.
b- Pain and blunted sensation.
c- Undue pain and pain on passive extension of the fingers.
d- Pain and a tense and tender forearm.
e- Pain and an absent pulse.
13- Fractured lateral condyle
a- A small fragment of bone and cartilage avulsed.
b- Even with reasonable reduction, malunion not inevitable.
c- Closed reduction with casting is often wise.
d- If left unreduced non-union is inevitable.
e- A varus deformity of the elbow with delayed ulnar palsy the likely sequel. -
14- Pulled elbow
a- Is a subluxation of the orbicular ligament, which slips up over the head of the radius.
b- A child aged 5-8 years brought with a painful, dangling arm.
c- The forearm held in supination and extension, and any attempt to flex it is resisted.
d- The x-ray shows subluxation of the radial head.
e- A dramatic cure is achieved by forcefully flexing the elbow; the ligament slips back with a snap.
15- Fractures of radius and ulna in adults
a- Displaced fractures treated by closed reduction and cast for 4 weeks.
b- The comminuted type held by intramedullary fixation.
c- Bone grafting is not advisable if there is comminution.
d- If the interosseous membrane is severely damaged, plating prevent cross-union.
e- The deep fascia left open to prevent a build-up of pressure in the muscle compartments and only the skin is sutured.
16- Open fractures of the forearm
a- In late presentation antibiotics and tetanus prophylaxis; the wounds are washed.
b- The wounds are excised and extended and the bone ends are exposed and thoroughly cleaned.
c- Are primarily fixed with intramedullary nails.
d- If bone grafting is necessary, it should be done early in treatment.
e- If there is major soft-tissue loss, the bones are better stabilized K- wires.
17- Removal of plates and screws from radius and ulna
a- Regarded as a completely innocuous procedure.
b- Complications are uncommon.
c- The damage to vessels and nerves are not expected
d- Infection is extremely rare.
e- Postoperative fracture through a screw-hole may occur.
18- ‘Nightstick fracture’ is
a- Is fracture of the radius alone.
b- Fracture of radius with wrist subluxation.
c- Direct fracture of the ulna alone.
d- Fracture of ulna and proximal radioulnar subluxation.
e- Fracture of both the radius and ulna with tear of interosseous membrane.
19- Isolated fracture of the radius
a- Is prone to rotary displacement.
b- To achieve reduction in children the forearm needs to be pronated for upper third fractures.
c- To achieve reduction in adult the forearm needs to be supinated for middle third fractures
d- To achieve reduction in children the forearm needs to be supinated for lower third fractures.
e- Internal fixation with an intramedullary nail and screws in adults.
20- Treatment of Monteggia fracture dislocation of ulna in adult is
a- By closed reduction and cast splintage for 8 weeks.
b- By open reduction and intramedullary fixation.
c- By open reduction through an anterior approach, the ulnar fracture accurately reduced with the bone restored to full length, and then fixed with a plate and screws; bone grafts may be added for safety.
d- By open reduction through a posterior approach, the ulnar fracture accurately reduced, with the bone restored to full length, and then fixed with a plate and screws; bone grafts may be added for safety .
e- The radial head reduced always after open reduction.
21- The Galeazzi fracture
a- Is much less common than the Monteggia.
b- Prominence or tenderness over the lower end of the radius is the striking feature.
c- It may be possible to demonstrate the instability of the radio-ulnar joint by ‘ballotting’ the distal end of the ulna (the ‘piano-key sign’).
d- It is important also to test for a radial nerve lesion, which may occur.
e- X-ray a transverse or short oblique fracture seen in the lower third of the ulna, with angulation or overlap.
22- Colles' fracture splinted after reduction
a- In 5 degrees flexion and 5 degrees ulnar deviation.
b- In 10 degrees flexion and 10 degrees ulnar deviation .
c- In 15 degrees flexion and 15 degrees ulnar deviation .
d- In 20 degrees flexion and 20 degrees ulnar deviation .
e- In 25 degrees flexion and 25 degrees ulnar deviation .
23- In ‘Dorsal Barton’s fracture’.
a- The line of fracture runs obliquely across the dorsal lip of the radius and the carpus carried anteriorly.
b- The fracture is not easy to control than the volar Barton’s fracture is.
c- The fracture can be easily reduced and to hold.
d- Is reduced closed like Colles' fracture and the forearm is immobilized in a cast for 3 weeks.
e- If it re-displaces closed K-wiring or open reduction and plating is advisable.
24- Comminuted intra-articular fracture of distal radius in young adult
a- Is a low energy injury.
b- A good outcome will result even there is intra-articular congruity.
c- CT scans must be used to show the fragment alignment.
d- The most successful option is a manipulation and cast.
e- Open reduction and a combination of wires, plates, screws and bone grafts may be used.
25- The commonest wrist injuries are
a- Fracture scaphoid.
b- Lunate dislocation.
c- Sprains of the capsule and ligaments.
d- Injury of the triangular fibrocartilage complex.
e- Injury of the distal radio-ulnar joint.
26- Scaphoid fractures account for
a- Almost 75 per cent of all carpal fractures.
b- Almost 60 per cent of all carpal fractures .
c- Almost 50 per cent of all carpal fractures .
d- Almost 35 per cent of all carpal fractures .
e- Almost 25 per cent of all carpal fractures .
27- Scaphoid non-union or avascular necrosis of the proximal fragment.
a- This accounts for the fact that 5 per cent of distal third fractures.
b- Develops in 10 per cent of middle third fractures
c- Develops in 20 per cent of proximal fractures.
d- Relative translucency of the proximal fragment is pathognomonic of avascular necrosis.
e- Bone grafting may be successful,
28- Triquetro- lunate dissociation
a- A lateral sprain followed by weakness of grip and tenderness distal to radius.
b- X-rays shows overlapped between the triquetrum and the lunate.
c- Acute tears should be repaired with interosseous sutures and a cast for 4–6 weeks.
d- Acute tears should be repaired with interosseous sutures Supported by temporary K-wires for 3 weeks and a cast for 4–6 weeks.
e- In chronic injuries, a ligament substitution or a limited intercarpal fusion may be considered.
29- Midcarpal dislocation
a- The extrinsic ligaments, which bind the proximal to the distal row, can rupture.
b- The diagnosis is easy clinically.
c- The patient complains of a painless, recurrent snap in the wrist.
d- If an acute ligament rupture diagnosed, then treated by reduction and cast for 4 weeks.
e- In a chronic lesion, stabilization by K-wire is the most effective treatment.
30- Splintage in hand injuries
a- Splintage is not a cause of stiffness.
b- It must be appropriate and it must be kept to a minimum length of time.
c- If a finger has to be splinted, a rigid cast used.
d- Internal fixation should be avoided.
e- If the entire hand needs splinting, this must always be in the position of rest.
31- Multiple metacarpal fractures
a- Can adequately held by the surrounding muscles and ligaments.
b- Allows free early mobilization.
c- Should be fixed with rigid plates.
d- Should be held by cast.
e- Treated by multiple longitudinal wires.
32- Transverse fracture of the shaft of phalanges,
a- Often with backward angulation.
b- Often with medial angulation.
c- Often with lateral angulation .
d- Often with forward angulation .
e- Result from a twisting injury.
33- A mallet finger
a- Is best treated with a splint for 8 weeks.
b- Surgery is good alternative.
c- Surgery carries a low rate wound failure.
d- Metalwork problems is also rare.
e- Using a special mallet-finger splint make the outcome worse.
34- Avulsion of the flexor tendon of finger is
a- Caused by direct trauma.
b- Caused by sudden hyperextension of the distal joint.
c- The little finger is most commonly affected.
d- The flexor digitorum superficialis tendon is avulsed.
e- Even If the diagnosis delayed, repair is likely to be successful.
35- Carpo-metacarpal dislocation
a- The thumb is less frequently affected and clinically resembles a Bennett’s fracture dislocation;
b- The displacement of the thumb is easily reduced by traction and supination.
c- The reduction is stable.
d- A K-wire fixation is not recommended to prevent the joint from dislocating again.
e- Chronic instability can occur.
36- Complex metacarpophalangeal dislocation
a- The avulsed palmar plate sits in the joint, blocking reduction.
b- The phalangeal base clasped between the flexor tendon and lumbrical tendon.
c- The finger extended only about 10 degrees and there is usually a telltale dimple in the palm.
d- Usually the fracture reduced closed by hyperextending the MCP joint and flexing the IP joints.
e- A volar approach is safest.
37- The complete rupture of ulnar collateral ligament of thumb
a- Is very common.
b- Only the ligament proper is torn.
c- The thumb is unstable in flexion only.
d- The thumb is unstable in all positions.
e- It will heal without surgical repair.
38- The zone II of hand injury is
a- Proximal to the carpal tunnel.
b- Within the carpal tunnel.
c- Between the opening of the flexor sheath (the distal palmar crease) and the insertion of flexor superficialis.
d- Between the end of the carpal tunnel and the beginning of the flexor sheath.
e- Distal to the insertion of flexor digitorum superficialis.
39- Nail bed injuries
a- Are often seen as isolated injury.
b- If appearance is important, meticulous repair of the nail bed under magnification.
c- Healing will be quicker with a split-skin graft.
d- Replacing any loss with a split skin graft from one of the toes, will give the best cosmetic result.
e- In children, these injuries are associated with dislocation of DIJ.
40- The commonest cause of stiffness in hand injuries is
a- The presence of fractures.
b- Tendon injures.
c- Failure to use splintage in safety position.
d- The presence of edema.
e- The prolonged immobilization in volar slab.
41- After primary flexor tendon suture , the hand splinted in
a- The wrist held in about 20 degrees of flexion, the metacarpo-phalangeal joints are flexed to only about 70 degrees but the interphalangeal joints must remain straight.
b- The wrist held with a dorsal splint in about 50 degrees of flexion but the interphalangeal joints must remain in 20 degrees of flexion.
c- The metacarpophalangeal joints flexed at least 70 degrees and the interphalangeal joints almost straight.
d- The metacarpophalangeal joints extended and flexion of the interphalangeal joints
e- The wrist extended to 30 degrees the metacarpophalangeal joints are flexed to only about 30 degrees, and the interphalangeal joints remain straight.
42- After extensor tendon repair, the hand splinted in
a- The wrist held in about 20 degrees of flexion, the metacarpophalangeal joints flexed to only about 70 degrees but the interphalangeal joints must remain straight.
b- The wrist held with a dorsal splint in about 50 degrees of flexion but the interphalangeal joints must remain in 20 degrees of flexion.
c- The metacarpophalangeal joints flexed at least 70 degrees and the interphalangeal joints almost straight.
d- The metacarpophalangeal joints extended and flexion of the interphalangeal joints
e- The wrist extended to 30 degrees, the metacarpophalangeal joints are flexed to only about 30 degrees, and the interphalangeal joints remain straight.
43- MRI is the method of choice for
a- Showing structural damage to individual vertebrae.
b- Showing displacement of bone fragments into the vertebral canal.
c- Displaying the intervertebral discs, ligamentum flavum and neural structures.
d- Provides information on the dimensions of the spinal canal.
e- provides information on impingement by fracture fragments or intervertebral disc
44- Stable injuries of spine treated
a- By supporting the spine in a position that will cause no further strain.
b- By prolonged splintage.
c- By traction for 2 months.
d- By stabilization by internal fixation followed by exercise and physiotherapy.
e- By decompression of spine and inter-spinal fusion.
45- Odontoid fractures can be fixed
a- With small plates between the lateral masses.
b- With lag screws.
c- With a halo-vest.
d- Anteriorly with plates between the vertebral bodies.
e- Posteriorly with wires between the spinous processes.
46- The anterior approach to the spine
a- Is suitable for wedge fractures.
b- The vertebral body preserved and a bone graft added.
c- Is suitable for burst fracture with significant canal impingement.
d- Suitable for flexion-compression injuries.
e- Suitable for seat-belt injuries and fracture-dislocations.
47- In the lateral view of cervical spine
a- Not all irregularity suggests a fracture or displacement.
b- Forward shift of the vertebral body by 50 per cent suggests a unilateral facet dislocation.
c- Forward shift of the vertebral body by 40 per cent suggests a unilateral facet dislocation.
d- Forward shift of the vertebral body by 25 per cent suggests a unilateral facet dislocation
e- Forward shift of the vertebral body by 25 per cent suggests a bilateral facet dislocation.
48- The distance between the odontoid peg and the back of the anterior arch of the atlas should be
a- No more than 2 mm in adults and 2 mm in children .
b- No more than 3 mm in adults and 3 mm in children .
c- No more than 5 mm in adults and 5 mm in children .
d- No more than 3 mm in adults and 2.5 mm in children .
e- No more than 3 mm in adults and 4.5 mm in children.
49- Hangman's fracture
a- Treatment in a semi-rigid orthosis for 2-3 weeks.
b- Fractures with more than 3mm displacement need treatment in collar for 6 weeks.
c- In the treatment, traction must be avoided.
d- If displaced, reduced and the neck is held in Minerva jacket for 6 weeks.
e- If associated with a C2/3 facet dislocation Minerva jacket applied for 9 weeks.
50- C2 Odontoid process fracture
a- Odontoid fractures are not uncommon.
b- Occur as extension injuries in young adults after high velocity accidents or severe falls.
c- A displaced fracture is really a fracture-dislocation of the atlanto-axial joint.
d- There is no room for displacement without neurological injury.
e- Cord damage is common .
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