2010arab.pdf

DR/Nasser Holies 777321976
final written bxam. - orthop NOV 5010 PAl'
tH I
1 Which of the following bone luniors has u "thicken wire iippcar«ncf" iMF t
I'acUgrounil;
A. Ancurysmal bone cyst
B.
Unicamcral bone cyst
C.
Fibrous dysplasia
D, Chondroblastoina -
E. Ewings sarcoma
2.
Which oflhc rollowing luniors is known lo occur, most commonly in Ihc Ursl and
second decades, and involves most commonly the epiphysis and in its matrix has
small splculu of calctflcation;
A. Chondroblastoma <
B. Eosinophilic granuloma
C.
Unicamerul bone cyst
D.
Giant cell lumor
E.
Ostcosarcoma
3.
Which of Ihc following slatemcnls dues NOT apply lo an oslcuchondromu:
A. The medullary cavity is conlinuous with that oflhc bone of origin
B.
May be sessile or pcdunculated
C. Grows along the line of pull of the surrounding muscles
L D.Usually undergoes metaplasia prior to the termination of growth of the individual
E.
Is located in the meluphyscal region of bone
4. An osteochondroma with a carlilaginous cap thicker than 2cnis and is painful
should be investigated for:
A.
Tendon snapping
B.
Maligiuinl Iransformalion
C.
Nerve root irritation
D. Pseudo-ancurysm
E.
Pseudo-fraclures
5.
The most common location of a unicameral bone cysl, is in the:
A. The diaphysis
B, The humerus and femur
C. Innominate bone
D. Vertebral body
E.
Posierior arches of the vertebrae

FINAL WRITTEN EXAM. - ORTHOP
6. All the following stntcmcnls conccM-ning an osteoid ostcoma are true, EXCLPI .
A.
May be associated with synovitis
B,
May be a cause of growth abnormalities
C.
Often is associated with increased skin temperature and localized sweating
fUPain is always relieved by aspirin
E. When it involves the spine it is localized most commonly in the posterior arches
7. The least likely lesion to be confused with the radiological diagnosis of an osteoid
osteoma, would be:
A. Osteoblasloiiia
B.
Osteomyelitis
C.
Stress fracture
D. Bone island
/-"E. Fibrous dy splasia
/ A.Physaliferous cells
B. Reed-Sternberg cells
C.
Flame cells
D. Langerhans Giant cells
E.
Chondroblasts
9.
A tumor of the vertebral column that involves most frequently the spheno-
occipital and sacro-coccygeal region, would be:
A.
Osteosarcoma
B.
Chondrosarcoma
C. Chordoma
D.
Osteoblastoma
E.
Chondroblastoma
10. In which of the following tumors, the pathologist may face difficulty i
distinguishing histologically malignant from benign lesions:
A.
Giant cell tumor
B.
Osteosarcoma
C. Ewings Sarcoma
D. Chondrosarcoma
E.
Fibrosarcoma
8. The cell that helps in the diagnosis of a chordoma, would be:

I-INAL WRITTEN EXAM. - ORTIIOP NOV. 2010- PAPEI
11. Whii-h of Hie following tumors presciils us n Donut appeurnnce on
sclntlgraphy:
.
y Giant cell tumor
B.
Osteosarcoma
C. Ewings Sarcoma
D. Chondrosarcoma
E. Fibrosarcoma
12. Vascular cnibolizalion is least likely to be used, as part of the management1
A.
Giant cell tumor
B,
Aneurysmal bone cyst
C.
Renal cell carcinoma
>-- D.
Osteoid osteoma
E. Chordoma
13. What is the most likely diagnosis in the X-ray shown below:
A. Thalassemia
B.
Hyperparathyroidism
C. Pagefs disease
D.
Multiple Myelgma
E.
Sickle Cell Anemia
doughnut

Si
FINAL WRITTEN EXAM. - ORTHOP NOV. 2010-PAPER.
14. A 60 year old patient with back pain has on plain xrays and MRI a lytic
compression fracture involving LI, with no evidence of weakened bone elsewhere,
and a negative bone scan. He most Likely has:
A.,Ostcoporosis
t£/I Metastatic bone disease
C. Plasmacyloma ,
D.
Discitis
E. Spondylitis
15. Which of the following tumors of bone, has an unknown cell of origin:
.Ewings' Sarcoma
B.
Osteosarcoma
C.
Chondroblastoma
D. Chondromyxoid fibroma
E. Eosinophilic Granuloma
metestasis -GCT
-admantinoma-

16. A patient foiiowing a car accidciu having the iviRl shown beiow is niost likely
to have, which of (he following spinal cord injury:
'
A.
Anterior cord lesion S
Central cord lesion
C.
Posterior cord lesion
D. Brown sequard lesion
E. Burning hand lesion

P1NAI Wri t I i n KXAM ORTHOF nov.joiu PA S
n, Aii Inrvciiun of bone where tlie gradulnlloo fliiue Rtiacki the Rrlicular
curtilage un the turfacc and llirough the siihi'liunilriil cancelloili bone, would be
most likely:
A chislosomiasis
Tuberculosis
C. Histoplasmosis
D.
Syphilis
E.
Lyme's disease
18. The rollowing mieroseopic slide is taken froni a patient known lo have active
tuberculosis, the giant cell surrounding Ihe casealion necrosis is know as a:
A/Dorothy Rccd Stcmberg cell
J3. Lungcrhans giant cell
C. Epithclioid cell
D.
Birbecks cells
E. Spider web cell
19. Which of the following tendons raptures most often in Rhcumiitoid arthritis:
A. Extensor indicis proprius and Abducior pollicis brevis
B. Extensors of the ring and small fingers
C. Extensor pollicis brevis and abductor pollicis longus
D. Extensor carpi ulnaris
E. Extensor carpi radialis longus and brevis

i
I
I
'
FINAL WRITTEN EXAM. - OKTHOI' NOV. 2010 - PAPER 1
fHyperextcnsion of the proximal inlcrphakingeal (PIP) and flexion of both Ihe
metacarpophalangeal (MP) and distal interphalangeal(DiP) joints
B. Hyperextension of both the DIP and MP joints with flexion of the PIP
C. Hyperflexion ofthe first MP joint fc« /-*>- '-"
D, The ulnar drift deformity
E. The thumb in palm deformity
21. A 36-year-old woman sustained a tarsometatarsal joint fracture-dislocation in
a motor vehicle accident. The patient is treated with open reduction/ internal
fixation. What is the most common complication:
A. Posttraumatic arthritis
B.
Infection
C. Fixation failure
D.
Malunion
E.
Nonunion
22. What is the most appropriate indication for replantation in an otherwise
healthy 35-year-old man:
A.
Isolated transverse amputation of the thumb through the middle of the nail bed
B.
Isolated transverse amputation of the index finger through the proximal phalanx
/ C. Isolated transverse amputation of the ring finger through the proximal phalanx
o/n . Drfsolated transverse amputation ofthe hand at the level of the wrist
E.
Forearm amputation with a 10-hour warm ischemia time

H.
A 4o-Tiir-ol(i man I
'
fii from 6 meters heiyhi ami snstameu the injury shown
in the Figure below. The injury is closed; however, the soft tissues are swollen
ROd ecebymotlc with blisters. The most appropriate initial management should
consist of:
A.
A long leg cast.
B.
A short leg cast.
CJinmediate open reduction and internal Fixation.
u-EJTa temporizing spanning external fixator.
T.
Primary ankle Hi
24. A young golfer sustains a hook of the hamate fracture. After 12 weeks of
splinting and therapy, the hand is still symptomatic. What is the most
appropriate management to allow return to competitive activity:
A.
Continued observation
BJDpen reduction and internal fixation of the fracture
L/C- E
ByOpen reduction and internal fix
Excision of the hook of the hamate
D.
Carpal tunnel release
E. Guyon's canal release

FINAL WRITTEN EXAM - ORTHOP NOV. 2010 PaPKRI
25. A l.i-vi.n-u!i! hvy Iijiiimv.vIciuI.i lii» knee while pliiyiag basketball aod repons
u pop thai is followed by n rapid effusion. A lateral radiograph is shown in Figure-
below. Initial managemenl consists of attempted reduction with extension, w ith
no change in position of the fragment. What is the next most appropriate step in
management:
A. A long leg cast in 90° of knee flexion for 6 weeks
B. Open reduction and internal fixation with a transphyseal 6.5-mm screw and washer
C.
Arthroscopic anterior cruciate ligament reconstruction with hamstring tendons
D, Arthroscopic debridement and staged anterior cruciate ligament reconstruction
when skclctally mature
n reduction and inlernal fixation with suture or inlra-epiphyscal screw
placement
26. In an acute closed boutonnicrc injury, what is the most appropriate splinting
technique for the proximal interphulangeal joint:
A. Static splint in 30° of lloxion
'
-
JfrrStalic splint in full extension
C.
Dynamic extension splint
D.
300 extension block splint
E.
Buddy taping to the adjacent linger
27. A 20-year-old man raatained a closed libial fracture and Is treated with a
reamed iolramedullary nail. What is the most common comDllcation associated
with (hit Ircalment:
A. Nonunion
B.
Malunion
C.
Infection
j ytf.Knce pain
E. Compartment »yiidniinc

FINAL WRITTEN EXAM, - OUTIIOP NOV. 2010-paper
28. An 6-yeni -ol(l boy sustained an isolated distal radial fracture that was
reduced and Immobilized with 10°
of residual dorsal tilt. What Is the next step in
management:
A. Percutaneous pinning
B. Open reduction and pin fixation
C. Follow-up in 6 weeks for conversion to a splint
D. A short arm cast and follow-up in 4 weeks
ijafk long arm cast and follow-up In 1 week
29. A 46-year-old man has Incomplete paraplegia after being involved in a motor
vehicle accident. The CT scan shown reveals marked canal compromise at L2.
What is the most appropriate management to improve neurologic status:
A. Postural reduction and application ofa hyperextension cast
B.
Posterior laminectomy alone
C. Laminectomy and posterior stabilization
D. Bed rest for 6 weeks
EsAnteiior L2 corpectomy and iliac crest strut grafting, with or without posterior
1/ instrumentation and fusion from LI to L3

I
I FINAL WRITTEN EXAM. - OKI HOI' NOV.2UIO->-Al'tK 1
o
30. Examination of a 25-yenr-ol(l man who was injured in a motor vehicle
accident reveals a fracture-dislocation ofC5-6 with a Frankel U spinal cord
Injury. He also has a closed right femoral shall fracture and a grade 11 open
ipsilatcral midshaft tibial fracture. Assessment of his vital signs reveals a pulse
rate of 45/inin, a blood pressure of 80/45 mm Hg, and respirations of 25/inin. A
general surgeon has assessed the abdomen, and a peritoneal lavage is negative.
His clinical presentation is most consistent with what type of shock:
l AfNeurogenic
B. Hemorrhagic
C.
Spinal »
D. Septic **"
E.
Hypovolcmic
31. An 18-month-old child sustains a crush amputation of the tip of the index
finger. Bone is exposed, but the nail is intact. Management should consist of:
y ItfDress'ing changes and healing by secondary inlenlion.
B.
A split-thickness skin graft.
C.
A full-thickness skin graft.
D.
A thenar flap.
-> E.
A V-Y flap.
32. An otherwise healthy 25-year-old man sustained a wound with a 1-cm by 1.
5-
cm soft-tissue loss over the volar aspect of the middle phalanx of his middle finger.
After appropriate debridement and irrigation, the flexor digitoruni profundus
tendon and neurovascular bundles are visible. The wound should be treated with:
A.
A split-thickness skin graft.
B.
A thenar flap.
y iP A cross-finger flap.
D.
A lateral arm flap.
E.
A Moberg (volar advancement) flap.
33. What structure is must often injured in a volar proximal interphalangeal
joint dislocation:
A Sagittal bands
vj/Central slip
C.
Lumbrical
D. Juncturae tendinum
E. Terminal extensor tendon

FINAL WRITIF.N liXAM. - OUTIIOI1 NOV. 2010- PApER
34. A patient sustained the injuries shown in Hie photo nipli ami radiographs
shown below. The neurovascular examination is normal. The first step in
emergent management of the extremity injuries should consist of:
A. Application of a femoral traction pin.
B. Intramcdullary nailing of the femur and tibia.
C. Surgical irrigation and debridemcnt.
.External fixation of the femoral fracture.
35. A 12-year-old boy sustains open comminuted midshaft tibial and fibular
fractures while playing indoor soccer. The wound is grossly clean and measures 7
cm with some periosteal stripping. Antibiotics and tetanus toxoid are
administered immediately in the emergency department. Following irrigation and
debridement of the wound in the operating room,
treatment should include:
A.
A long leg cast.
B. A reamed nail.
yyC. An unrcamed nail.
D. An external fixalor. <
E. Plates and screws.
-
t Rc
eduction of the femoral head.
i.

INAL WRITTEN EXAM. - OKTIIOI* NOV. 2010-I'AHF.R |
36. A 7-yenr-old boy has a swollen and deformed righl arm after falling off his
bicycle. Radiographs reveal a completely displaced posterolaleral supracondylar
humeral fracture. Examination reveals a warm, pink hand and forearm but
absent pulses. What is the next most appropriate step in management:
A.
Angiography
B. Immediate closed reduction and casting in extension
CSurgical exploration and repair of the artery, followed by skeletal stabilization
u/CTciosed reduction and pinning, followed by reassessment ofthe vascular status
E. Magnetic resonance angiography (MRA)
37. Figures 1 and 2 show the initial radiographs of an 18-year-old man who fell
during sport. Figures 3 and 4 show the radiographs obtained following closed
reduction. Examination reveals thai the elbow is stable with range of motion.
Management should now consist of:
A.hnmediale return to unrestricted activity.
(i JKA posterior long arm splint for 5 - 7 days, followed by elbow range-of-motion
exercises.
C.
A long arm cast for 4 weeks.
D. Immediate surgical repair of the collateral ligaments.
E. Immediate surgical repair of the collateral ligaments and placement of a hinged
external fixator.
a. mi

HNAl WRITTEN EXAM OH IMtir
NOV. 2010 - I'AHl |<
38. An mmto* Healthy JS-year-old womnn report* dorsal wrl»t pain and has
trouble tMiiuliiiK hir thumb afltr suslalnliiK minimally displaced fracture of
the distal radius 3 months ago. What is the next most appropriate step in
management:
A.bi&irophysiologic test to evaluate the posterior intcrosscous nerve
/ JiTlYansfcrofthe extensor indicis proprius to the extensor pollicis longus tendon
C. Interphalangeal joint arlhrodesis ofthe thumb
D. Extension splinting of the thumb
E.
Fine cut CT of the distal radius to evaluate Lister's tubercle
39. What is the major difference in outcome following open reduction and
internal fixation (ORIF) of the tibial plafond at 2 to 5 days versus 10 to 20 days:
A Jrfiproved ankle range of motion
/t-frlncreased risk ofwound complications
C. Decreased ankle pain
* D. Decreased risk of nerve injuries
r E. Decreased risk of development oftraumatic arthritis 2
40. Figure 1 shows the radiograph of a 34-year-old woman who sustained a
basicervical fracture of the femoral neck. The fracture was treated with a
compression screw and side plate. Seven months postoperatively,
she continues to
have significant hip pain and cannot bear full weight on her hip. A recent
radiograph is shown in Figure 2. Management should now consist of:
A Continued non-weight-bearing and a bone stimulator.
iJi. Removal of the hardware, bone grafting of the femoral neck, and refixation.
C.
Removal ofthe hardware and hemiarlhroplasty.
D.
Removal of the hardware and total hip arthroplasty.
E.
Removal of the hardware and a valgus osteotomy.

1INAI WRITTEN EXAM, - ORTHOP
NOV.2010-Pa|'eri
41. A 25-year-oiu man sustained a head injury after being ejected from his car.
Examination reveals a Glasgow Coma Scale score of 7 airtTa
-
WOnen right kllfF.
Clinical examination shows that the knee is very unstable, suggesting tears of the
medial collateral and anterior and posterior cruciate ligaments, as well as tin-
posterior lateral corner. What is the most appropriate first step to rule out a
vascular injury:
A.
Examination of the pedal pulses
B. Anlde-brachial pressure index
/ C. Duplex ultrasound
D.
Arteriography
E.
Exploration ot'lhc popliteal artery
42. Locked plating techniques have been shown to have bioniechanical
advantages over standard plating in which of the following scenarios:
A. All ostcoporotic fractures
B. All comminuted fractures
C. Spiral fractures
D. Ostcoporotic fractures with torsion
,
ui?rt3st.coporotic fractures without cortical contact

FINAL WKITTEN EXAM, - ORTHOP NOV. 2010 - Paper
43. Figure 1 shows the initial lateral radiograph ofa 6-year-old girl who
sustained a fracture in a motor vehicle accident and was treated in a cast 1 year
ago. She now has the valgus deformity seen in Figure 2. Treatment should consist
of:
fTObservation.
B.
High tibia! osteotomy.
C.
MRI and assessment for growth arrest and bar excision.
D.
Stapling of the lateral tibial physis.
E. External fixation and hemichondrodiastasis

.
A
NOV. 2010 - PAPER
FINAL WRITTEN EXAM. - ORTHOP *rtK
44. Figure below shows the radiograph ofa 45-yeai-oId woman who has a painful
nonunion 7 months post-op . Treatment should consist of:
A. Revision internal fixation with a longer side plate and bone grafting.
J Open reduction and internal fixation with a 95° fixed angle device and bone
grafting.
C. Hardware removal and retrograde intramedullary nailing.
D.
Placement of an implantablc bone stimulator.
E.
Proximal femoral resection and total hip arthroplasty .

FiNAl WRITTEN BXAM.-ORTHOP
NOV. 2010-paper |
4< -in yeur old man was Involved In » motor vehicle accident and sustained ftt
"
pelvic injury seen in Figures below. Definitive management of the injury should
consist of reduction by:
A.
Skeielal iraction and bed rest.
B.
Anterior external fixation.
C. Internal
f
ixation of the symphysis pubis.
D. Internal fixation of the symphysis pubis with supplemental external fixation.
jj hftemal fixation ofthe 8J mphj sis pubis and sacral IVadurc.
46. A patient with no history of palellar instability sustains a traumatic lateral
patellar dislocation. What structure most likely has been torn:
A.
Vastus medialis
£/
£r. Medial palellofemoral ligament
C.
Medial patellolibial ligament
D.
Medial rctinaculum
E. Quadriceps tendon
47. This type of clavicle fracture is the least coinmoii but is associated with high
mortality rate because of the severity of the initial trauma:
A.
Fracture of the lateral end
B. Acromio Clavicular separation grade 111 with fracture ofthe lateral end ofthe
clavicle
C.
Mid shaft fracture with complete displacement
D. Mpdial fracture of the clavicle
EL omminuted compound fracture of the mid clavicle

NOV. 2010 - PAPER I
FINAL WRITTEN EXAM.-ORTHOP
48 Exnniinntion of a 23-year old female college basketball flayer who has had
anterior knee pain for the past 3 weeks reveals tenderness and fullness over the
inferior patella and proximal pafellar tendon. There is no patellofemoral crepitus,
patella apprehension sign, or anterior or posterior instability. Initial management
should include:
A. Bilateral shoe orlhotics to support the medial foot arch.
B. A very small dose of lidocaine and cortisone injected into the area of pain to assist
in diagnosis and treatment.
C.
Early lateral relinacuium release with medial soft-tissue tightening.
-
j J Hce, rest, avoidance of the offending activity,
and rehabilitation.
E.
No sports participation for a minimum of 6 weeks.
49. What pathology is most likely to result in failure of an arthroscopic Bankart
repair;
y. Greater than 25% anterior-inferior glenoid rim defect
Wi. Nonengaging moderate Hill-Sachs defect
C.
Associated type IV superior labrum anterior and posterior (SLAP) lesion
.
Absence of an intact cartilaginous labrum
E. Attenuated anterior-inferior capsule and glenohumeral ligament complex
50. What is the principal advantage of surgical repair for rupture of Achillies
tendon:
XA ess risk ofre- rupture
B.
Less pain
C. Greater motion
D.
Quicker recovery
E.
Greater dorsiflexion strength

FINAL WRITTHN EXAM. - OUTIIOP
NOV. 2010 PapEr
s i A i9-ycar-oiu footbal player has severe knee pain after being mjurea in a
game 2 weeks ago. Examination reveals a knee effusion, limited motion, and
increased 3+ Lachman's test and anterior drawer. There is also increased
external rotation at 30 degrees of knee flexion when the patient is placed in the
prone position. Based on these findings, which of the following actions would
most likely increase the risk of anterior cruciate ligament (ACL) reconstruction
failure:
A.
Inadvertent rotation of the graft 90 degrees internally prior to its final fixation
B.
L ck of full knee extension at the time of surgery
C/rersistent posterolatcral corner laxity
D.
Leaving 1 to 2 mm of bone posterior to the femoral tunnel at the time of the ACL
reconstruction
E.
Placing the tibial tunnel within the ACL footprint
52. What is the most reproducible landmark lor the accurate anatomic
placement of the tibial tunnel for an anterior cruciate ligament (ACL)
reconstruction:
A. Anterior border of the tibia
v TAnterior border of the posterior cruciate ligament (PCL)
C. Posterior border of the tibia
D. Posterior border of the anterior horn of the lateral meniscus
E. Posterior border of the anterior horn of the medial meniscus

NOV. 2010-PAPER!
53. A 6-year-oid giri is referred lor the elbow injury seen below. What is the
most appropriate treatment:
A. Immobilization in a long arm cast tor 3 weeks
B. Immobilization in a long arm cast tor 8 weeks
Cppen reduction and immobilization in a long-arm cast for 3 weeks
l Opcn reduction and internal fixation with smooth pins
E.
Open reduction and internal fixation with a screw

FINAL WRITTEN liXAM. -
v>ii
is lliat lit- felt a pilinJul pop in the left
54. An 11-.vein-old haskelhnll pliiycr Poi
iblc (o bear weight on Hit- txfremity and
knee wlicn he It'll while runninis. He is un
ExmniniiJion reveals a large knee
it! nclivcly exleiul the knee against gravity
i
-
.iiui
below. Management should consist of:
effusion. A laleral radiograph is shown
A. Physical therapy for quadriceps strengthening exercises.
B, A long leg cast with the knee fully extended.
C. Excision of the fragment.
D. Suture reattachment of the patellar tendon to the tibial tuberosity.
E. Repair of the anterior cruciate ligament with tension band fixation,
5. Damage control orthopedics is deflned as:
A.Controlling the fracture by rigid internal fixation by a compression plate and
immediate ambulation to prevent deep venous thrombosis
B. Controlling the fracture by a reamed intra medullary nail with proximal and distal
locking
C. Immediate repair ofall ligaments around a joint after internal fixation of the
fracture to allow direct stabilization of thejoint
D.Temporary containment and stabilization ofthe injuries so that the patient's
physiology can improve
E. Intramedullary nailing of both femur fractures immediately after admission and
preparing blood for the patient
22

NOV. 2010 I'APERfl

NAL WRIITliN EXAM - OKI HOI'
56. Hie mosl reliable marker of the magnl
following multiple trauma Is:
i.ude of systemic inllammalion
A.
Tumornccrosis factor alpha
B.
Intcrlcukin 6
C. C reactive protein
D.
Procalcitonin
E.
Intercellular adhesion molecule
57. The gf-S17"orthopedic tool to use in damage control orthopedic surgery
fracture femur fixation is:
A. A reamed intramedullary nail
B. A locking plate
D.
A dynamic compression plate
E.
An unreamed antigrade locked nail
58. The clinical parameters to describe multi trauma patients in borderline
condition include all the following EXCEPT:
A.
Injury severity score of6
B Hypothermia .
; u Bilateral femoral fractures
D.
Moderate head injury
E. Pulmonary contusion on chest X- rays
59. In the process of fracture healing, histological examination of the callus shows
osteoblasts. The main source of these osteoblasts is:
.ArSlem cells from the injured tissues
B.
The cartilaginous component of the bone
C.
The fibrous component of tiie bone
D.
The endothelial and perithclial cells from the capillaries invading the fracture
E,
The bone marrow at the damaged medullary canal
B.A
v/e.A
An cxlL'mal lixalor
fArSlem

SAI- WRITTEN EXAM. - ORTHOI'
NOV.20i
4
7
?
60. In ».n«B.ment of fracture mld-shaft of Hie dbia. functional bracingH
advisable in Presence of:
A.
Associated anterior cruciate ligament injury
B.
Associated medial collateral ligament injury
Associated axial instability
D. Associated angular deformity
E.
Associated skin abrasions
61. A multiply injured patient presented to the emergency room. A fracture
pelvis is suspected. That may need a pelvic C clamp. What is the essential image
you would like to obtain before applying the clamp:
A. Pelvis plain radiographs (AP)
B.
PJain radiographs of the lumbar spines
C Ultrasound for the pelvis
< u. CT scans of the pelvis
E.
MRI for the pelvis
62. Which of the following structures is most commonly injured with knee
dislocation:
A. Femoral nerve
B.
Common peroneal nerve
C. Xibial nerve
Popliteal artery
E.
Patella ligament
63. A forty year old patient treated conservatively with the foot in equinus for
complete rupture of the Achilles tendon.
The chance of re-rupture is:
A. Less than 3%
B.
4 to7%
C fo 11%
v 5.12tol5%
E. More than 15%

si/
v" i
-JAL WRITTEN EXAM. -
ORTHOI'
NOV. 2010-PA
64. A65 yearo.d .ady had b era.to ' --
"
|
ar.hri.is. There were no significant P""0' Pos °f X- for bo.h of them to
ESR are elevated af.er surgery. How long would it take .or
normalize:
A. Five days
B.
Two weeks
P-Ohe month
D,
Two month
E.
More than three months
65. In Total Hip Replacemen. movemen.s between stem and cement mantle is
incvi.able because of:
A.
Differences ofthe loads applied in different directions
Differences in the elasticity of the bone, cement and stem
C.
Differences of the loads during different gait cycles
,. D. Presence ofa centralizer at the lip of the stem
E. Presence of small diameter femoral head
66. Which of the following is a contraindication to hip arthroscopy:
A. Septic arthritis
B Swspected osteomyelitis of the femoral neck
VV. Morbid obesity
D. One month old labral tear
E.
Loose osteoehondial fragment of approximately one cm in diameter
67. Heterotropic ossification may occur after hip replacement arthroplasty.
Which of the following is not considered as a risk factor:
A.
Male patient with ankylosing spondylitis
B.
Presence of DISH (diffuse idiopalliic skeletal hyperoslosis)
Cgagets disease of bone
fyUsc of cement to fix the implant
E.
Recurrent hip surgery

FINAL WRITTEN UAam. - ~
Id boy cempMning ofrecurrenf attacks of pafn
68. An ovcnvclEht 12 year o
monllis tlii«« increased with
the medial aspect ol the rijjht knee for the last two
| knee with no svvtlluiK or lendtrness,
Is at school. Assissmenl reeali(l nonna
The patient has a normal plain radiograph
l lu' appropriate neM step is:
A Assessmcnt ofthe hipJoint
A.
Anhroscopy ofthe knee
B.
MR1 of the knees
C
yRadiograph of the oilier knee for comparison
E.
Appropriate assessment of the feel
69. 65 year old lady presented with osteoarthritis of the knee. Artliroscol>y of the
knee is most Justified:
A.
In presence ofsevere osleoarthritic changes with pain on any activitics. ?- *
B.
In mild osteoarthritic changes with minimal complaints
C fti presence of internal knee derangement with recurrent locking ofthe knee
U.
In presence of colialcral ligaments laxity
E.
When previous arthroscopy relieved the symptoms lor three months
7(h) On performing a total knee replacement arthroplasty, the surgeon decided to
perform a lateral retinacular release. Which artery if damage may cause patcllar
ischaemia:
A.
Superior medial genicular
B-Jj fiTriormedial genicular
D.
Inferior lateral genicular
E. Middle genicular
71. Which of the following is considered osteogenic when used as a graft:
A.
Ceramic
B. Melpl alloy
70,
L TSupi
It :rior medial gcmculai
Superior lateral genicular
E.
Bone cement

FINAL WRITTEN EXAM. - ORTIIOP
72. A subcutaneous nodule from a rheumatoid arthritis patient was examined
under the microscope. Which one of the following histological pictures is more
similar to that of a rheumatoid nodule:
A.
Pigmenled villonodular synovitis
l Granuloinatous lesion of tuberculosis
C. Giant cell tumor of bone
D.
Chronic osteomyelitis
E. Metastatic breast carcinoma
73. The minimum required stump length for functional below knee amputation
f Q A. Amputation proximal to the level ofthe tibial tuberosity
.
/ B. Apiputation at the level of tibial the tuberosity
0
7
i
.
gj mputationjust distal to the tibial the tuberosity
vfTAmputation 12 cm distal to the level of the ttbial tuberosity
E.
Amputation 15 cm distal to the level of the tibial tuberosity
74. An adult trauma patient required below elbow amputation,
the minimum
desired stump length to obtain functional pronation and supination is:
A.
2 cm
B.
6cm
CHcm
irf lgcm
E.
20 cm
75. In comparison to non-sicklers, patients with sickle cell disease are more
susceptible to osteomyelitis by:
A.
Streptococci
B. Staphylococci
C. Oonococci
l fT Salmonella species
E. Entcrobactcr species

'
"
NOV ."WHj-Papp,,
pinal wRrrrsN exam. - orthop a i>
76. Phmtar ftaoHls la moti Hkely nssoclaicd with:
A.
Hisioo' ofold fracture fifth metateraal bone
B slory ofold fracture talus
vJ2!Tightncss ofAchilles tendon
D. Laxity ofAchilles tendon
E.
Mal-united fracture cuboid bone
77. Which of the following bones is formed by mcmbrnnons bone formation
rather than by secondary cndocliondral ossification:
A.
Femur
B. Patella
u-i Clavicle
E.
Humerus
78. Liver diseases may cause osleomalacia. The main reason is failure to
synthesise:
A holecalciferol
vji. 25-Hydroxycholccalciferol
C.
1-25 Di-hydroxycholecalciferol
D.
Calciferol
E. Cholesterol
n9.) Osteolysis was seen in a patient who had total hip replacement.
The main cell
// -<ype to be seen at the osteolysis site is:
A. Osteoblast
B. Osteoclast
CJ ymphocyte *.
t E Macrophage
E.
Osteocytc
r
80. Which of the following is the most appropriate to quickly reverse the effect of
bleeding in a patient on warfarin:
A. Throinbin
Bufresh frozen plasma
C.
Vitamin K
D.
Whole blood
E.
Protaminc sulphate
3-> i
Of
r

cialcd wUh deled in synthesis of:
81. OMeoRcnesis Imperfecla is assoc
A,
Vitamin D
B.
Vitamin C
, l&lype 1 collagen
D. Typc II collagen
E.
Chodroilin sulfate
82. A 13 year old boy sustained supracondyiar fracture ofthe femur. Few weeks
later, the fracture site showed callus formation and myositis ossificans. Histlogica
examination of this new bone formation has similarity with:
ka)steogenic sarcoma
B.
Ewing's sarcoma
C.
Chondroma
D, Fibrous dysplasia
E. Chronic osteomyelitis
83. Which of the following bones is more liable to cause bony overgrowth in
children following traumatic amputation:
A.
Femur
B Jibia
V Humerus
D.
Radius
E.
Ulna
84. A 22-year-old man injures his neck in a motor vehicle accident. Examination
reveals no sensory or motor function below T8. Radiographs and an MRI scan
show a burst fracture at .T7. Forty-eight hours later, the bulbocaveniosus reflex is
present but there is no evidence of motor or sensory recovery in the lower
extremities. What is the most likely diagnosis:
A. Spinal shock
B. Anterior cord syndrome
C. CtMda equina syndrome
M'?XompIete cord syndrome
E. Brown-Sequard syndrome
Ml
t
Up
r7
*4
f
,
Of

LWHimNIA AM OK I HOI'
NOV. 2010
Ik
.-.tain, .m iiij"' . !- 'ii' tlbow,
8.. A 15-veHr-ol.i boy hlU froi b e) eh -nd .
|>rc-reducti0n radiographs arc thown in .he X-ray belo>v.
Closed reduction Is performed without difficulty and postrcdiiili<)ii radiographs are . n jt >**M , , ,5
e X-ray el lila cX t
What is the next most appropriate step in treatment
..Conversion to casl immobilization lor 6 weeks
. Application of an articulated external fixator
/Begin early motion as soon as pain resolves
COpen reduction
MRI to assess ligament integrity
C/Beg
i frOpc
E.
MR
.
1 K +

/ I 1
NOV. 2010 I'AI'URI
FINAL WRITFEN EXAM, - OR 11IOP
-
hit by a motor vehicle and sustains an isolated ipsilateral
A 7-year-old girl is
Injuries shown below. What is the optimal dclinitive method of treatment.
4bV
-
Aim
5W
i4
5
A 1
D.Rcumed nails oflhc lemur and libia
E.
Spanning external Bxator
1 3
4 sl
.i
Of

rttiM. WRI I T.
N EXAM,-OKI HOI'
NOV. 2010-
pAV
87. A30-y. ; I man who sustained a work-re'a.c
persislei
transverse |
e shown below. What is the B£ r treatment for hit injury.
A 30.year.old .nan who just-lned .
-
atJr|buted to
rsistent back and left-sided buttock P** CT gcans obtained 2 da
--
me process fractures. A pelvic radiogiapn an days
ago are s
A. Continued nonsurglcal management
B. Posterior open reduction and internal fixation with tension band platin
C. Postof&r iliosaeral screws
D
j rtferior open reduction and internal fixation
Anterior open reduction and internal fixation and poslerior fixation
.
3-

NOV. 2010-PAPER 1
.
t lins the Injury shown in the
88. A 9-year-okl boy falls from t*0**** Mobilization, what is the most
radiographs. After closed reduction and cast
likely complicafion that can result:
fei Growth arrest of the distal ulna
B.
Growth arrest of the distal radius
C.
Compartment syndrome
D.
Radioulnar synostosis
E.
Entrapment of the extensor pollicis longus (EPL) tendon
89. A 32-year-old man has an open comminuted humeral shaft fracture.
Examination reveals absence of sensation in the fu st web space and he is unable to
fully extend the thumb, fiiigcrs,
and wrist. What is the recommended treatment
following irrigation anddebridemenl of the fracture:
A.
Functional bracing
B. Hsnging long arm cast immobilization
C/uilramedullary nailing
5.
Open reduction and internal fixation, radial nerve exploration
E. External bone stimulator

i m m ORTHOP
NOV 20io.
''
AIM,,,
90. A 19-ytiii-oiii man sustained the isolated injury ofthe pelvis for which xrays
wer performed sis shown in the first xray below. He is adequately resuscitated, a
closed reduction was performed in the emergency department, and postreductfon
radiographs are shown in the latter 2 X-rays below. What is the next most
appropriate step in management:
1

//
m FINAL WRITTHN EXAM. - ORTHOP
NOV. 2010-PAPER 1
w- CTUrgent open reduction and internal fixation
B.
Placement ofa knee immobilizer and delayed open reduction and internal tixation
C.
Placement ofa distal femoral traction pin and delayed open reduction and internal
fixation
D. Delayed open reduction and internal fixation
E. Nonsurgicai management and restricted weight bearing
91. The iliopectineal fascia runs between which of the following structures:
A.
liiopsoas muscle and the iliac vessels/femoral nerve
BJ teral femoral cutaneous nerve and the iliac vessels
( -CTlliopsoas muscle/femoral nerve and the iliac vessels
D.
Iliac wing and the iliopsoas muscle
E.
Pubic symphysis and the iliac vessels
.
..4

NOV. 2010 |.ApER1
FINAL WRITTEN EXAM, ORTHOI
'
i ........ ,,1 a lO-veor-okl boy wii<» injured his
92. The X-ray below shows the radiograph ol .1 IU yem
knee playing fool ball.
What is the most appropriate initial treatment:
A. Closed reduction and casting
B.
Flexible nailing
C Wade plate fixation
Anatomic reduction and smooth pin fixation with supplemental casting
E.
Open or closed reduction and screw fixation

FINAL WRITFEN EXAM. - ORTIIOP
nov. 2010 - paperi
93. The radiographs below is of a 13-year-old right hand-domlnanl boy who
sustained a closed Salter-Harris type II fracture of the proximal humerus during a
hockey game. The shoulder has significant swelling, but is neurovascularly intact.
What treatment offers the best chance of reestablishing normal shoulder motion:
A. Closed reduction and application of a shoulder spica cast in the outpatient setting
B. Closed reduction under fluoroscopy and application ofa shoulder spica cast in the
operating room
C. No active reduction and placement ofthe upper extremity in a shoulder
ipuliobilizer
V* Closed or open reduction and percutaneous pin stabilization
E. Open reduction and internal fixation

NOV. 2010-.pApFR
« j ,i«c,.i-ihi's the acetabuiar fracture shown
94. Which ot the following tmdings best describes ine
in the CT cut below:
A. Posterior column w ith articular impaction and a free fragment
B.
Anterior column with articular impaction
C.
Jfc tcrior wall with an intra-articular fragment
ti Posterior wall with articular impaction and a free inlia-anicular fiagmcnl
E.
Posterior wall with articular impaction
95. A 24-ycar-old woman fell from a horse and landed on her outstretched right
arm. Radiographs reveal an elbow dislocation with a type II coronoid fracture
and a nonreconstructable comminuted radial head fracture. What is the must
appropriate management:
A.
Radial head resection, open reduction and internal fixation of the coronoid, and
medial collateral ligament repair
B.
Radial head resection and lateral collateral ligament repair
C.
Radial head arthroplast) alone
D/Radial head arthroplast) and lateral collateral ligament repair
A Radial head aithroplasty. open reduction and internal fixation of the coronoid. and
lateral collateral ligament repair
ev
'

n
NOV. 2010 - PAPFU
FINAL WRITTEN EXAM, - ORTHOP
" 1
96. A 50 Kg, 9-year-old boy has a closed midshaft femoral fracture. The oblique
fracture is shortened by 3 cm with a lO-degree varus angulation. Surgical
management consists of intramedullary, retrograde flexible titanium nailing. To
optimizp'fracture stability, the surgeon should:
Insert the largest diameter nails possible.
B. Place asymmetric nails, with the smaller nail placed medially.
C. Impact the distal ends ofthe nail into the medullary canal.
D.
Open the fracture to permit anatomic alignment.
E.
Apply a hinged knee orthosis.
97. Which of the following is an absolute contraindication to laminoplasty In a
patient with cervical spondylotic myelopathy:
A. Spapcavailable for the cord of less than 8 mm
B.
Gasification of the posterior longitudinal ligament
. Fixcd cervical kyphosis
D.
Previous posterior surgery
E.
Concomitant cervical radiculopathy

FINAt WRITTEN EXAM, OUTTIOI
' NOV. 2010- PAPER I
98. A 44-yeni -ol(l man reports persistent lelt leg pain lollowing a LSS1
bemllamihotomy and partial dlskectomy. Examination shows a grade 4 weakness
of the left extensor hallucis longus and a positive left straight leg raise. A
radiograph is shown, and sagittal and axial MR! scans are shown.
Nonsurgical management consisting of medication, physical therapy, and injections
has failed to provide relief.
Surgical management should consist of:
A.
Revision L5-S1 hemilaminotomy.
B.
L5-S1 total disk arlliropiasly.
CLS Gill latninectomy.
/ETPosterior foraminul decompression and fusion at L5-S1 with Instrumentation and
bone graft.
E.
Stand-alone posterior lumbar intcrbody fusion
1
9
-
.
4
>v
'


FINAL WRITTEN EXAM. -
ORTHOP NOV
99. A 45-year-oI(l man reports that he woke up 2 weeks ago with severe pai
his right arm. Examination reveals weakness in the biceps, brachialis, and w
extensors. There is decreased sensation in the thumb and index finger and a
diminished brachioradialis reflex. Assuming this patient has a posterolateral
herniated nucleus pulposus, what level is involved?
A.
C2-3
B.
C3-
E. C6-7

llriiiiiiolu ii tjlii.iiinii iv imlii.
ii.il ImIom surgical inu i m niiiin Foi wlm-h i'"
iMlluwinC ciiiiiliiiiin '.
'
it ulil {i.ilu nl lltlllri U<illl : (frtAtr*<tctr * rnilinl In ll.lt <' .1 Uucititf li.iinlli
iMtTnT ilic pi i i|ilu r;il tliinl iif fhv jnlmnr Iftu n iiiul limlv of the Itttuyal
ini'iiisrux. M;Mi:it;t'ini'nl slnnilij hhimnI nl:
;; p::i,i1:;,;ri::;,:;:::
/4wcnMUM ul il tficu fii fn miM iHI(;»H4»t* hijli Sitl I ftflili lc MMill'. |Hl
Ml
11 fr«i .M *«n>i<-i |iiilKMkf lMirw4% Ihruutfh in«l ti«bt'ltt»llMd

FINAL WRITTEN EXAM ORTHOI1 NOV 2010 - PAPER II
5 Regaining full uctivt knee extension and functional quadriceps power is must
(liffitull in Hit prostheli Upaticnl following surgical correction of a:
t-Ar Quadriceps tendon teat
B,
Patellar fracture
C.
Patellar tendon rupture
D.
Patellar prosthetic component dislodgement
E.
Patellar dislocation
6- A 35-ycar-old man undergoes knee ar(hroscop> for a lorn meniscus.
Examination reveals 1+ Lachman and a negative pivol-shifl test. During the
procedure, a partial tear involving 50% of the fibers of the anterior cruciate
ligament (ACL) is noted. What is the most appropriate next step in
management:
isA. Observation
B.
Debridement of the ACL
C.
Reconstruction of the ACL
D. Radiofrequeno thermal shrinkage
E, Semitendinosus augmentation
7- A woman with degenerative arthritis and a fixed genii algum deformity of 17"
undergoes primary total knee arthroplasty under general anesthesia. In the
recoven room, she is unable to dorsiflex her fool. Immediate management
should include:
A.
Fasciotomies
B.
Surgical nerve decompression
j/
Flexion of the knee
D.
Continuous passive motion
E.
Electromyography
8- Which of the following is considered an advantage of the inside-out technique
for meniscal repairs compared with the outside-in technique:
A,
Improved ultimate knee motion
B.
Increased rate ofhealing
C. Diminished infection rates
The ability to achieve proper suture orientation in posterior horn tears
E.
Decreased risk of neurologic injury

M.WWTDW8)fA ' nil iiini'
mtOm liiinl ktm ml ««, irin«doii n mm »i .i-
liivMlmtHl In Ikiv. .WfUtUv-iMi.
; iililili>ilv.impri'i:ii>ih'>l c«im>iii Mjl*t
ilir iliiu< ill mmphmiil Ininfait memliriinconlliim iiik n r«MOiirl» .h il»
itme.,1 ihr rcMlinn w aAe tM':"!' ' inisiiilvcfHupliyln. irfftity-n.-
ui'iii'i-v, V|>j""|'i iiiii'muiiimiiiu ni nininnrfi '
10- W| ycui nlil 111:111 iimli-nvciil unli-rioi i-ruciiilv liUiiini'Ml ii'i'ihisIi ih Ihui l."
ni-fk.i agli, CMiiiin.iliiiM nl 1 In' l.iin nun n 1 .til iiclivc ,ii > ui iiiuiinn limn | Stb
Kll uiul pnii ll.ii mull1In l>i llinln !. ilcN|iilr mi mlinu .1 rrli:iliililil.liiiii pi iijti lim
Iv.iilio niplis rc* cal uppi uprliili in 11 m l plm i mi ill. M.iii:i;;riiii
'
iil »Iiiiii|iI imw
iiiiisiM nl:
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(lltlUid I'llllSlsl '.I
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.
>' y>*imo4*cJkt.)tyi»uA .in i

AL WRITTEN EXAM - ORTHOP, PAPER II I
1 <- n hile performing a revision total knee replacement with a trial component in
place, it is noted that the kn J8>ha5 full extension but is loose in flexion. To resolve
this flexion-extension discrcpanc>. the surgeon should:
A. Use a thicker polyethylene insert
Use a larger femoral component with posterior condyle metallic wedges
C Use a more constrained polyethylene insert
D. Release the posterior capsule
E. Cut more posterior slope on the tibia
14- Tears of the posterior horn of the lateral menieus next to the popliteus tendon:
A.
Should always be repaired by inside-out technique
MT
-
Should always he repaired by all inside technique
C.
Can be left alone in the majority of cases
D. Should always be resected v
E.
Inside-out repair involves no neuro-vascular risk
15- in postesoiateral knee reconstruction:
l -Tf The common peroneal nerve should always be explored and protected
B.
The common peroneal nerve should be explored only if it is "in the way"
C.
The common peroneal nerve should never be explored in these cases
because it is out of danger zone
D.
The tibia] nerve only should always be explored
E,
Both the tibial nerve and the common peroneal nerv e should always be
explored and protected.
16- Which one is the commonest nerve entrapmenl in the upper extremity in order
of decreasing frequency:
k< Ulnor > Median > Radial
B Median > ulnar > Radial
C. Ulnar > median radial
D. Radial median ulnar
E. Median radial ulnar

I-U-I H II
ID w.ii nlil iihin mull i »< ni in ii ilunsi'iipiu KunUiii i i |imii willi tuturv
.
iiirlniis ( ii iU-, i,;,, u lith ilir iMiinii ii'iiiuik iliul ili< .IihiiIiIi i'
is tiahh: In
iiiiIia Miilrnni ihiillllln pi ml iir|<il.
iliiiii. Vn Ul'llll'uti'itllll'vlrM ill lln'
niilvHor nIhiiiIiIi-i |iirni » lln iii'i mosl U|i|irii|ii'i>ili ih p m iimiuu'no
tllOllkl nniMM ,,1
l -< I'
rinn'. ,il of awiWr-
II VllllllWCIipu ICIvilMVi
I Kxchunucitl'tlu'iiifinllic .uulii'i tm i iiniiliMiiliiil'li'ilcyicc
IS v»> "l'l wiiihsiii falls 'Hi III* leu Hiul suslalm mi Innluli
ilispl.unl railial Ii«mI fraciure. Mana||cnical ihuuld mcip
mi pi m and iliii« it ill iiitic
mill i uliolofpO Uflion Is i' hn
i vani in
'
to lO tiayi
l Mill'.;. I dhow orlllOMl !' I

FINl WRITTEN EXAM - ORTHOP. NOV. 2010-PAPER II
19-The radiograph of a 24-year old ivoman who has ulnar-sided w risi pain is
shown. Nonsurgical mai ~ nt consisting of splinting, physical therapy. and
activity modifications has failed to provide relief. Examination reveals a stable
distal radioulrar joint and a negative triangular fibro-cartilage complex grind.
Pain is reproduced by ulnar deviation and w hen the wrist is dorsidexed and the
forearm is then supinaled but not when the forearm is pronated. Treatment
should now consist of:
a: Partial ulnar styloiaectonn
B.
Triangular fibrocartilagc complex rim repair
.
C Debridemeni of the extensor carpi ulnaris tendon sheath
D.
A radial lengthening osteotomy
E. An ulnar shortening osieotomv

.r A
V Ml <
I .' I 11 < 11
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I Imiiia n v i il . Ili.il I i i iii-lii iirnximnl liniiiriui rracliirc i" ycin
i pin in ii ilicrsiii). I- ttimlnailon rtveaw
lllil w :r. IK Hi il Im:
,
1. in . Im i ii il i I li i n il inClllim ill II , .lllil p. MM
hmii <>i imi ,
.1, ii
iln- s.inii'. I'l.iin i :iiliin(n»pli>
ill. : II.ll I liMlnill III I 1' I -n I .li.Hiliii i iii'ilniii
iimsI nf:
I im ill shmili mit
I iln .liiiiilili i ii il in r-iii

(il/An ankle fracture heals with an anatomicall> aligned mortise and 2mm of
displacement of the distal fibula fracture. What effect will these findings have on
the tihintalar Joint:
A. Decrease contact loadiny
B. Increased contact loading
C.
Increased external rotation
D.
Increased medial-lateral translation
Normal loading, rotation, and translation
22-What is the most common complication seen in patients undergoing surgen on
the Achilles tendon for chronic rcfracton tendonitis:
A.
Deep vein thrombosis
B/Tartlal complele tendon rupture
Skin edge necrosis
D Infection
E.
Complex regional pain syndrome
**
***
m

23- ''lie usoof fiili iiini mil Hut i) Mi|i|ilriiii'iiis «hiiiiiil tit
0 '
I Disnnli'r ol |>i ii> Islminl esiU'iriciilioii /ihm' nl (In ki ill iilnli' »ill li'ii'l <>.
,
( lii'iiilriiplaMii
li. |}j;r.iiii|i|iii iIVvmiITmh
Rickcls
25- Ositoiicnosis iiii|u i Ii . I ri'Mill?i frnm a ili frcc in iiillimi n imiiIii'Ms i:iui>c<I l>
26- Vrici il
lilc MU
W "l IJye***-.'.y »
'
lllatliir*rlhi mo t-gr-
'
l lir iiioxl I'liiiniiiin ri'MMin (m »ii|ii ;n'iiinl>lar oiicuinim r<illiiMiiit nuiluiiiuii iikI
"imsliu'lt ill im iiiiin h

omnof
jN-Whni i» tht mfcliunlmn of Injury In Tlllemn fmctort:
:
B.
Adduciion injun
CyAMerm rolaiion injury
j
i? External rolaiion injur>
'
E.
Abduciion and Iniernal rotation injury
29-An Il-vcar-old girl fractures the lateral condyle of her didai humeruk.
According lo the Sailer-Harris classification. This fracture i» most often what
type?
B III
D.
V
E.
VI
30- Which fracture in children if not accuraltly reduced has very little
remodeling potential:
A.
Proximal huniems fractutL-
B.
Distal hunicrus fracture
C
'
.
.
Proximal fbreanc fracture
0.
Middle foranr. fracture
E.
Distal forearm fracture
31- The following parameter is the most useful in predicting the need for surgical
correction of developmental coxa ara:
A. The range ol aciivc abduction
B.
The epiphy seal extrusion index
C. The acetabular index
,
D. The Hilgenreiner-epiphyseal angle
E. Presence ofa Trendelenburg gait.
32- All the followings are true in a 5 days old baby with a dislocated hip.
EXCEPT:
A.
Ortolan! tesi positive
B.
Barlow test positive
y C. The hip would be reducible ai tins siaue
D. Decreased abduciion.
E. Hourglass shape of the capsule

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inMlvriiirnml l ih i.ii .nui.!.;, i Dm .lyiHiml
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|»<ni Ugg <!«*"*»' 11111 '
.?5-Wlial is tin-.miIu si i-4tifiil"Kl«"<l
epiphyib?
1
36- Ml llic rililiininu .in liur in ll.il.. i . . > «|t ill -IiiMIi I . / < /
A IfiiUij i
B ii l-clvM-on Ihc >ciiiiim.iiiii.imi.iii .iii.U.i,!!...iii-iiiia»Mi.l.«,i
C
I" VII lilt-ri>ll<>»lll'M ll> 11 lit III llli-|l:lllliili>i; nl l lillil.ml. / < / /'/
Mi, U W J eUJt
W' M|, (v.-n,.
!,. ,
,
(,,
-A'1, wilt,
li t. pM<lj»f ii|,<sl . 1,11. ..< I' dglK*tl«A-M4

PINM WRinjN EXAM - ORTHOP.
-
''
APER D
*
38- All Iht folliming* »tmeiii«iil» am nirmci In i«loc»lciniiil (T-C| C«8liiion«,
'
EXCEPT:
A Usuallv involve ihe middli: facet ofthe siibtalar joim.
B Conventional radiographs are often normal.
C. A special calcaneal or Harris view may show the fusion,
D.
The coalition is best demonstrated b CT scans of the foot.
E.
Heel valgus will decrease b> resection.
39- Which web space is enlarged in metatarsus adduclus:
First vveb space
B. Second web space
C. Third web space
D. Fourth web space
E.
Third and fourth
40- Residual dynamic nielalursu-. adduclus after correclion of a club foot due to
imbalance of:
0
A, Tibialis posterior tendon
'B Tibialis anterior tendon
C.
Tibialis anterior and posterior tendon
D.
Adductor hallucis tendon
E.
Abductor hallucis muscle
41-All Ihe follon ings arc true In congenital vertical talus.
EXCEPT:
0
i A; Associated with arthrogryposis and myeloinenisgocele
Occur as an isolated congenital anomaly
-tT Can be delected al birth
-
f-D.
The talus is distorted plantarward nnd laterally as to be almost vertical
E The forefoot is dorsillexed al the midtarsal joints,
and the na icular lies on
the dorsal aspect of the head of the talus
42- .All the following are true in Posteromedial bowing of the tibia. EXCEPT.
A.
Characterized by apex posterior and medial bowing of the middle or distal
portioji of the tibia and fibula.
'3
0j*
1<'ool is typically In li cplcatWOValgUS position.
rThc decision to perlV.rm corrective osteotomy should he deferred at least 2
;ted if osteotomy

Cm.
II llli'lml (hi I»IIi>miiii: Iji IcIrtmiNiMhi lii. hi Inf j iliilil mill
4
45-W liiilmulcin. in » ' <'/. «' ' ' i......iil« ljI ibeamrMfmlnMM i" « «
(6- mi Hi- ri.iii.<
ilrl in. i.
r; ll tin- IiiIIiih.ic: i jiluilni;..';.! rimlins' can In Iminil n
ol initial IiiiiiI / M / Vf .
(v>i>i> r iUM omihii
.
{vwMiki k..l Milm

.EX"
NOV 3010- PaPE
48- All the following arc radiological flndingl of Madelunp s dtformit)
0
A Wide mlcrosseoiis spucc
B. Pyramiding ofcarpal bones
C. /Dorsal position ofthe distal ulna
, Exaggerated palmar and ulnar till ofthe distal articular surface ofIh
radius
-
fc E. The distal radius presents a volar convexity
.
19-Macrodactyly is associated with all of the following syndromes. EXCEPT.
A,
Neurofibromaiosis
B. Proteus syndrome
C.
Klippel-Trenaimay pndrome
r LB Marian syndrome
E.
Multiple enchondromatosis
50-Surgery is approprlatth performed in polydactj Ij al the following age:
A.
}A months
,
3-6 months
6-12 months
'
D,
12-18 months
J8-24 months
51-Codman's tumor is linked to:
0
WA. Chondroblastoma
jfc Osteosarcoma.
C. Osteoid ostcoma.
D. Giant cell tumor,
t.
Fibrous histiocyioma.
52-All the following are true in osleofibn.us dvsplasia (Campanacci disease).
EXCEPT:.
A Uwiallj affects the tibia and fibula
PrJsua progresses alter puk-nx
C. The lesion li-a|ui-nll recurs ulta curctiage or subperiosteal resection.
D. Delorniiis fnun bowing,
can be corrected at an age b osteotomy.
E I'aiients with typical roentgenogroms should not be subiccted to biopsy

FINAL WRITTEN EXAM - ORTHOP.
58- An asymplumatk lO-year -old bo> is referred for eN alunti"ii «(11 limb-length 1
discrepancy that measures less than 2 cm. Examination reveals that tl . 0
"
lateral ray of the ipsilaieral foot is absent, and the ipsilaieral knee is unstable to
Lachman and anterior drawer test. An AP radiograph of the ankle is shown
belou. Managtment of the knee should consist of:
A. Anterior cruciate ligament reconstruction using a quadruple hamstring
technique
B. Anterior cruciate ligament reconstruction using an allograft in the ovcr-lhe
-
top position
V_
£»- rtrservation
D.
An aggressive physical therapy program that emphasizes open chain
techniques
'
Functional knee bracing until skeletal maturity, followed by anterior
cruciate ligament reconstruction
/

r
1
1
r

FINAL WRITTEN EXAM - ORTHOP.
NOV. 2010- PAPER II
59- Figures below show the radiographs of an 8-year old bo> who has a traumatic
recurrent lateral dislocation of the left'patella. Examination reveals no fi ed'
genu varum or valgum. and lower extremity lengths are equal. The Q angle is
25°. The extended hips show internal rotation of 40"and external rotation of 60°.
with the neutral thigh-foot angle. There is no generalized ligamentous laxity.
Treatment should consist of:
A.
Femoral rotational osteotomy
B.
Tibia! rotational osteotomy
C JibiaTtuberosity transfer (Fulkerson. Elmslie-Triliat. or Hauser)
i Tenodesis of the semitendinous to the patella ,
E.
Patellectomv and vastus medialis advancement

1
r m i U II
hi,hi li.i-. Ii.
ul .1 I n ai ! I.n
li'l llli- |i;lM I 1 i .nlmiii 'l"' >lii'" .i ii'iimiim i ali/cil snn ii%mh
'
11
.ll.lllllW.
j mil I »»H I'.
hii il Mid t» am .ii p <lio»» n in I itfin . > I'rloM Iii.i|im
I
I" I IIIU II is .Imwii in | iunir liilnw I II. I III Ml IIII nil 1 1 hi In III I sll is |H "Mil* i I""
iuKi i .iliii .mil S
I -'ii mini U' i< iin. .mil iliMinn, .mil ni'itnln1 1,11
mi
li.ii is iin inn.i hi,. iIi.iuiiimIi
M.ili'ii.m: ibi ii-.Iini Mum
1!.
1 inn ..iti nm.i
I .
SVI|1I l.ll .ll> Hill I
I). I lbli.'.Iirnlll.l
ir, im
i HI
v.

V
1
1.
...
s
62- To prevent abnormal paicllofemoral contact loading after insertion of a
retrograde femoral nail through an intra-arlieular starting portal, the surgeon
ihooM
K Soai the nail beneath 111. arucn a; surlace
B.
IJse a palcllar tendoii-spliliinu approach
C.
Use an under-reamed technique
D.
I'erform a lateral release
t. Perform a medial parapatellar arthrotom
1

ii IS vimi -iiii iiiiin iln iti'ovimiil fcinui rrtivliiri' 'ii
hrloW. OuFmillvr inm hm mi'ivl hIiuiiIiI I'onsitil i)l
I
(
'
1 ' .uiv'.
K- .llilili!' i K"
t fT
"
A Hsctl in"k- pi UC
V. Amcgrailc iiiiling

FINAl W'HITTEK EXAM - ORTHOPi
0 I'APEH II
64- A 23-ycar old woman who wns struck bj a motor vehicle has » < .las«ow Coma
S ..Jfcicore of If and a systolic blood pressure ofl 10 mm Hg on arrival. B
emergency department. Examination reveals a rotationalh unstable pelvic ring
injun anil multiple long bone fractures. Initial management consists of I
administration of? L of lactated ringer
'
s solution over 2 hours. Keexamination
now reveals that Ihc patient is tachycardic and her systolic blood pressure has
dropped to 60 mm Hg. What is the most like cause of this event:
A, Insufficient fluid resuscitation
B. Unrecognized spinal trauma
C. Unrecognized brain injury
D. Myocardial infarction
Failure to stabilize the pelvic ring injurj
65- What is the most likely cause of mortality within the first 48 hours in patients
w ho sustain a pelvic fracture from lateral compression mechanism:
A. Aortic rupture
B Pelvic arterial injury
C.
Pelvic venous injury
Hollow viscous injun
Head injury
66- What type of major pelvic ring injury has the greatest average transfusion
requirement:
A.
Lateral compression
B Vertical shear
Anteroposterior compression
D.
Fractures through the sacrum
E.
Fractures through the iliac wing

1a
INM WKII II I Ml I III 11
Ml" I'
hi llifh
I 'Mil l i. m
ii
pnlllllll;', In I, ,, i mi
rcilln|i|ii I
KM
I in imu-n In 111" 'I' i'P
Ii8- lia( muscle onijiiiairn frniii Gfird) i lubcrcl
ium ncn r
v,
Paoncui l-rru,
li Pen ncui ii-i'm
nbialii mtcn
1), liln.hi. i-.'.i.ii"!
E. Extensor .liiiiii'iiiin limiiin

oy- hico or ine luliowing ifrm-- hc*i oescnhtk a muscle contraction that occurs as
"-
I hi arrov m thi avial NIRI scan of mid thish shown in fisun hi-low fminlin
li. «ha( muvrk

I - ' I IISS Sl'l II .l( ll
h.il in i III
'" li"iiri'N In! I l ie MM ill il
h.il 11 n
ill >il i
f
01
llli. Illf iriniilnl .11
liunliil iiiiIm lln li'
M 1
I
lll.im lllllllilu li i
Unlnl .11 III
i"
o4
i

ORTHOf. PAfER II
.
Lndurancc slienglh (raining has been shown lo have which n( thtfollouing
dtmontiraled phiiologic efTectt:
-
M hat lii«ur trcretev calcilonin:
A J2 -*e«r -«ild mun nolr* a lump on (hi- *idf of hi* neck and undergoes
hmph nodt bi")p<>. FoiMmml (hi prAcrdurt. ilu paiieni rcpon* pain in id
»bo<ilder girdle and ht i* unahlr in elea(t hi* shoulder. Ubich of Ik
following »(ruc(urev ha* mii likel> beta in)urcd"
'
Mi. iMfranc I .4mtD( cunnccu Mhai (wo bones:

:
1/
/

i
1 Mill mI.I rtiiiil.111, ImtMlii iii|iiii'i| |u>r nulil lliuiiili. Vwwwna ..«
Hi. nlnui Imnlci ihc Ujili..uiiM.iii. rtnlnniiiin uniiv ibumli rr»r
nil Irnviiin alfm itm« imniu hiiIi iln iiiimtm|i"i>i»<l>iMit<.'ul 1*1 i"
In lull t xii iiMnn rtvnih ilrKrm -.1 .iukhUi Wuh iln M« I' i"iiii m
ittwrrt ni il.Xiim. llirff h M .I.kmo ..I inttiibiinii Wlii.li ..( iln LilUmi
ImiiiN nl iii.m.ii-
niuiii ttinil.l In in,,,! ii|i|ir«|iriillr7
79-A 30 yeni old clwf wMains "i irtnUitliil. wir-inllii-lnl viiliii I.i.i kiii.
wilhin zonv J »l lll i (liilillniinl luml Uln. li uf tin- rnllawliiK »laim?lils
nuisl accuraii;
'
Sll Ml nl llli' I..11,mm;; iirr .ommi i .I.MMIIIN / M //'/
It L«<e»»'l(>*»J,w'il.ii iiihluA li'1!!
V i : : i .i .1 divfail iiilijpli.il.ir.'.i.il |<»llll'lh . Mmi
Dtp
Wlinli m| ill.' I
'
iillowini; l mil iiv>iifi;iU-
il "iili N.;i|ili" liin.ilr i.m.

FINAL WRITTEN EXAM - ORTHOC
NOV 2010 - PAPER II
83-A 39 year-old truck driver presents with right wrist pain 5 weeks after a
motor vehicle accident. He isMinnble to do his job without pi.in..On physical
examination, there is tenderness over the scapholunate region with a positive
atson lest. He has decreased pinch and grip on the right side as compared
with the left. Radiographs reveal a scapho-lunate gap of more than 4mm.All
the following treatment options are acceptable EXCEPT:
)(,. Closed reduction and pinning
B. Blait capsulodesis
C. Open reduction and internal fixation
j r
'
Troximal row carpectorm
Primary repair ofli»!aments ?
83- Current recommendations for the repair of flexor tendons call for the use of
which of the following:
A. Four-sirand core stitch
i B. Four-sirand core stitch with continuous peripheral epitendinous suture.
C. Two-strand core stitch
T). Two-slrand core stitch with cominuous peripheral epitendinous suiure
E.
Six-strand core stitch
84- Which pulleys should be preserved for the best function of"the flexor tendons
after repair:
A. A1 and A2
B. A2and A3
C. A3 and A5
/D. A2andA4
E. Al and A5
15- Dorsal intercalated segment instabilin alwavs has which one of the
following:
A scapho-iunate angle of more than 70 degrees,
A scapho-lunate angle of less than 30 degrees
A scapho-lunate gap ofmore than 3mm
'
Palmar flexion of the lunate
Dorsal rotation of the scaphoid
x/A.
B.
C.
D.
E.

I'M I II II
Mu.h '
I
I %l| ii.l, llllll ill |<.ll IIIMIII I
Ml ihr !. t i* I iIh (din ,i i i.
) mi Ml
< il it K.m.n
linn rl| ll
llllll! 'Mt i- oi ill. . !-
.:..ii .li.Mili
ill uilli .1 . ..iniil.mil <il iilllil *
|i.iiii in u . . i- iii in iln t'liu'rccno
0
A
UMIIC 4 ll
r mm 11. ii i rri'i'iilh sliirtnl il ihI ILIIIllt'l III .1 fill I
mi Mi' fills lli.ll lie iii.i li.i iil|i'il(-il villlr li.lilil lillo lli> n
ll n.ilin I In nil . in 11 iiiiiii mi
V Ml .ll r.lllllll,
ll|ii|| lr ll.l IIIUl
ill mnic iinM iirilrmu Viiiiimiii i.iii' irrnlHirnl -il ilii« iiun
[ . -I I in
'
I |> v/»
m*4 "iii.ii miiii ii.i « i iimi
MMMiuM ml III ill.hi in i

NOV . 2010-I
'
APeR II
90-With pom Ihunih iteblllzillg ihe luberonry of the stiiphoirt ai the volar
ipeol of the curpiis, the wrl»i is moved from ulmir W radial liMMon. If pain
or a clunk is .lleited, then the lesi is positive. What i" the name for this
nuinoi'iivrc:
A.
Bouvier lest
B.
Martin-Grubcr test
C.
Sheer lesi
D. Terry Thomas sign
E.
Watson lest
I
91- A 24 year-old carptnler presenls 2 weeks after a trivial fall with a tomplainl
of dorsal wrist pain and swelling. Examination reveals moderate tenderness
over the dorsuni of the wrist, and mild swelling. Range of motion is 20
degrees of dorsiflexion and 35 degrees of palmar flexion. Radiographs reveal
sclerosis of the lunate bone, with subchondral lucency. but no collapse.
Measurements reveal 3 mm of negative ulnar variance. The physician should
recommend which of the following:
A.
Lunate replacement with a silicone prosthesis
B. Short ami cast immobilisation for 6 weeks
.
J Ulnat lengthening osteotomy
D. Proximal row carpectomj
E,
Four-comer arthrodesis
92- All the following radiographic findings arc suggestive for Diastomatomvelia
,
EXCEPT:
A.
Widening of the pedicles*' i
O
B. Midline bon abnormalin / x'"
-
C. Decreased disc space height 1/
D.
Progressive congenital scoliosis
E. Loss ofkimbar lordosis
93- Morquio syndrome is caused by a deficiencj in:
A, Alpha-L-iduronidase
<J Galfictose-6-sulfatase
C.
Beta-glucuronidasc
D. Fibrohlast growth factor receptor protein
E Sulfate transport protein

- ORTHOP.
AV. -ORTHOP. NOV. 2010-PAPER II
BEST lime for operali>e inlenentinn In Rlonni* disease is:
100- Mallet deformities in a 5 vear old are most commonlv caused bv:
1
A. Salter I or II injuries.
B. Salter II or III injuries
C. Salter III or IV injuries
D.
Sailor I or injuries.
E.
Salter Vor ' injuries.
tU; . GOOD LUCK '
i -


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