Lower limb multiple choice questions.pptx

Lower limb multiple choice questions

1. According to Sandersâ computed tomography (CT) classification for calcaneus fractures, a Sanders III fracture has: 1) One fracture line in the posterior facet 3) Three fracture lines in the posterior facet 2) Two fracture lines in the posterior facet 5) Five fracture lines in the posterior facet 4) Four fracture lines in the posterior facet Answer: Two fracture lines in the posterior facet

2. Which of the following statements is incorrect regarding ankle fractures? a. On a mortise view, the tibiofibular overlap should normally be more than 4 mm. b. A Maisonneuve fracture is a high fibular fracture and involves disruption of syndesmosis. c. A Dupuytren’s fracture is a fracture-dislocation with a high fibular fracture. d. On an anteroposterior (AP) radiograph, the medial clear space should be less than 4 mm. e. The talocrural angle can be used to assess shortening. Ans : a. On a mortise view, the tibiofibular overlap should normally be more than 4 mm.

3. Deep infection following open reduction internal fixation (ORIF) for tibial pilon fractures is most commonly associated with: 1) Open fractures 3) Anterior incision 2) Postoperative wound dehiscence 5) Low energy injury 4) Medial and lateral plating Deep infection following ORIF of pilon fractures is correlated with postoperative wound dehiscence or skin slough but not with the presence of an open fracture in a series of 60 pilon fractures treated by ORIF. Answer: Postoperative wound dehiscence

4. The mechanism of action of linezolid is: 1) Inhibition of cell wall synthesis 3) Inhibition of deoxyribonucleic acid synthesis 2) Inhibition of ribonucleic acid synthesis 5) Inhibition of protein prehylation 4) Inhibition of the 70S initiation complex Correct Answer: Inhibition of the 70S initiation complex

5. Which of the following groups of muscles are located in the first layer of the foot muscles: 1) Abductor hallucis , flexor digitorum brevis, quadratus plantae 3) Abductor, hallucis , flexor digitorum brevis, abductor digiti minimi 2) Flexor hallucis brevis, adductor hallucis , flexor digiti , minimi 5) Abductor hallucis , quadratus plantae, lumbricals 4) Quadratus plantae, lumbricals Answer: Abductor, hallucis , flexor digitorum brevis, abductor digiti minimi

6. Which of the following is the most useful sign in diagnosing a foot compartment syndrome: 1) Numbness in the lateral plantar nerve distribution 3) Weakness with toe dorsiflexion 2) Numbness in the medial plantar nerve distribution 5) Severe pain with passive toe flexion 4) Weakness when testing ankle plantarflexion Answer: Severe pain with passive toe flexion

7. Antegrade femoral nailing in polytrauma patients with chest injuries should be: 1) Performed without reaming 3) Avoided acutely 2) Performed with reaming 5) None of the above 4) Delayed until the pulmonary injury has completed resolved. Reamed femoral nailing in a patient with an acute pulmonary injury does not add to pulmonary complications or the incidence of acute respiratory distress syndrome (ARDS). Answer: Performed with reaming

8. Which of the following structures is not found in the greater sciatic foramen: 1) Superior gluteal nerve 3) Piriform muscle 2) Inferior gluteal nerve 5) Internal pudendal artery 4) Obturator nerve Answer: Obturator nerve

9. An external fixator pin must not exceed what percentage of the diameter of the diaphysis: 1) 10% 3) 30% 2) 20% 5) 50% 4) 40% The diameter of any screw hole should be limited to no more than 30% of the diameter of the diaphysis. Studies show that a hole more than 30% of the diameter markedly increases the risk of fracture. A screw hole equal to 30% of the diameter weakens the torsional strength of a bone by 45%. Over 6 to 8 weeks, the bone will remodel about the implant and restore its strength. Upon removal of the screw, however, the weakening recurs until the bone has remodeled again. Answer: 30%

10. The critical blood supply to the majority of the weight bearing superior portions of the femoral head is supplied by the: 1) Terminal branch of the lateral femoral circumflex artery 3) Lateral epiphyseal artery 2) Artery of the ligamentum teres 5) Foveolar artery 4) First branch of the medial femoral circumflex artery The critical blood supply to the majority of the weight bearing superior portions of the femoral head is supplied by the terminal branch of the medial femoral circumflex artery, or lateral epiphyseal artery.Correct Answer: Lateral epiphyseal artery

11. The location of the lisfranc ligament is between: 1) Middle cuneiform and base of the second metatarsal 3) Medial cuneiform and middle cuneiform 2) Base of second metatarsal and the medial cuneiform 5) Medial cuneiform and base of first metatarsal 4) Base of first metatarsal and middle cuneiform Answer: Base of second metatarsal and the medial cuneiform

12. Which of the following is the most common complication associated with the treatment of a closed diaphyseal tibia fracture with an intramedullary nail: 1) Nonunion 3) Infection 2) Compartment syndrome 5) Knee pain 4) Symptomatic hardware Court-Brown and associates identified anterior knee pain as the most common complication associated with treatment of a closed diaphyseal tibia fracture with an intramedullary nail. Answer: Knee pain

13. In the fixation of a diaphyseal closed tibia fracture with an intramedullary nail, peaks in intracompartmental pressures occur with: 1) Nail passage 3) Insertion of the awl at the starting point 2) Placement of distal locking screws 5) Placement of the proximal locking screw 4) Placement of the guide wire Tornetta and associates showed that peaks in intracompartmental pressures occur in the fixation of a diaphyseal closed tibia fracture with an intramedullary nail during fracture reduction and nail passage. However, generally, these peaks are not sustained and return to baseline during unreamed nailing. Answer: Nail passage

14. Which of the following types of tibial fracture is most likely associated with compartment syndrome: 1) Closed 3) Grading of the fractures is irrevelant 2) Grade IIIA open 5) Grade IIIB open 4) Grade I or II open A common fallacy is that the degree of open wound will prevent compartment syndrome by tearing the fascia. The amount of energy initially imparted to the tissues is the greatest determinant of a subsequent compartment syndrome. Answer:Grade IIIB open

15. What factor most accurately determines functional outcomes after adequately reducing closed low-energy fractures of the tibial plateau: 1) Fracture classification 3) Age 2) Further reduction of the fracture 5) Activity level 4) Mechanism of injury After an adequate reduction is attained in relatively low-energy plateau fractures, age determines functional outcome. According to a study by Stevens and colleagues, 40 years of age is the reported cut-off for determining functional outcome. This study points out the importance of age in prognosis.Correct Answer: Age

16. The most important factor in predicting cutout of an implant to repair intertrochanteric fractures of the hip is: 1) Size of the chosen screw 3) Tip/apex distance 2) Posterior/inferior placement 5) Angle of the plate 4) Pitch of the chosen screw The most important factor in predicting cutout of an implant is the tip/apex distance. Screw design is a consideration but is limited by the anatomy of the proximal femur. Posterior/inferior placement was a factor used with old devices that did not purchase adequately in the femoral head. Answer: Tip/apex distance

17. Injury to which artery is most likely to cause uncontrollable bleeding during the posterior approach to the hip? a. Inferior gluteal.
b. Superior gluteal.
c. Pudendal .
d. Ascending branch of lateral circumflex femoral.
e. Popliteal. Ans. Inferior gluteal

18. Which of the following is not one of the trabecular patterns in the proximal femur? a. Greater trochanter group. b. Lesser trochanter group. c. Principle compressive group. d. Secondary compressive group. e. Principle tensile group. Ans . Lesser trochanter group.

19. What effect would doubling the diameter of a solid intramedullary nail have on its torsional rigidity? a. No effect. b. Increase by 2-fold. c. Increase by 4-fold. d. Increase by 8-fold. e. Increase by 16-fold. Ans. Increase by 16-fold.

20. Which of the following is false with reference to the Kocher– Langenbeck approach for pelvic fractures? a. It is recommended for isolated posterior column injuries. b. The superior neurovascular bundle is at greatest risk during exposure of the greater sciatic notch.
c. The pudendal nerve is at risk as it enters the pelvis through the greater sciatic notch. d. Branches of the medial femoral circumflex artery are within the quadratus femoris muscle.
e. It has been associated with abductor weakness. Ans. The pudendal nerve is at risk as it enters the pelvis through the greater sciatic notch.

21. Which of the following is not a type of acetabular fracture according to the Judet and Letournel classification? a. Posterior column. b. Anterior column and posterior hemitransverse . c. Posterior wall and posterior column. d. Posterior column and posterior hemitransverse . e. Posterior wall and transverse. Ans. Posterior column and posterior hemitransverse .

22. Which type of pelvic injury is most likely to result in urethral/bladder injury? a. Vertical shear >2 cm. b. Lateral compression. c. Bilateral obturator ring fractures. d. Anterior pelvic arch displaced >1 cm. e. Inwardly displaced parasymphyseal fracture >1 cm. Ans. e. Inwardly displaced parasymphyseal fracture >1 cm.

23. Which of the following best describes a Jones fracture? a. Avulsion flake fracture from the base of the fifth metatarsal. b. Proximal metaphyseal fracture of the fifth metatarsal at the level of the tarsometatarsal joint. c. Fracture at the metaphyseal – diaphyseal junction of the fifth metatarsal at the level of the fourth–fifth intermetatarsal articulation. d. Fracture at the distal diaphysis of the fifth metatarsal distal to the level of the fourth–fifth intermetatarsal articulation. Ans. Fracture at the metaphyseal – diaphyseal junction of the fifth metatarsal at the level of the fourth–fifth intermetatarsal articulation

24. Considering Schatzker’s classification of fractures of the tibial plateau, which of the following statements is false? a. Type I fractures are wedge fractures of the lateral plateau, displaced or undisplaced . B. Type III fractures show depression of the lateral plateau without an associated wedge fracture. c. Type II fractures are often seen in patients whose average age is over 50. d. Anterior cruciate ligament injuries are commonly seen in type V and VI injuries. e. A type V fracture consists of a wedge fracture of the medial and lateral plateau with metaphyseal – diaphyseal discontinuity. Ans. e. A type V fracture consists of a wedge fracture of the medial and lateral plateau with metaphyseal – diaphyseal discontinuity.

25. Concerning Pipkin’s classi fication of femoral head and neck fractures, which of the following is not true? a. Posterior dislocation of the hip with fracture of the femoral head caudal to the fovea centralis is a type I fracture. b. A type III fracture is rare, in conjunction with femoral neck fracture. c. Posterior dislocation of the hip with fracture of the femoral head cephalad to the fovea centralis is a type II fracture. d. A femoral head fracture with associated fracture of the acetabulum is a type III fracture. e. A and D. Ans. D. A femoral head fracture with associated fracture of the acetabulum is a type III fracture.