1. Supracondylar fractures of the humerus are most common in children and can cause cubitus valgus. They do not cause compartment syndrome but can lead to vascular insufficiency if the brachial artery is compressed.
2. Colles' fractures present with a "dinner fork" deformity and ulnar displacement of the distal fragment. They are treated surgically in elderly patients to prevent stiffness.
3. Fractures of the femoral neck are common in elderly men and treated surgically. They can be seen on x-ray by distortion of Shenton's line.
Fracture Neck of the femur with a case presentation and theory background
reference:
Apley's System of Orthopaedics and Fractures
Oxford Handbook of Orthopaedics and Trauma
Fracture Neck of the femur with a case presentation and theory background
reference:
Apley's System of Orthopaedics and Fractures
Oxford Handbook of Orthopaedics and Trauma
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Ganyang Ortho questions
1. 1. Supracondylar # of the humerus :
A. Most common in children
B. Not cause compartment syndrome (forearm)
C. Can coz cubitus valgus
D. Vascular insufficiencyif brachial artery compressed
E. Ant. displacement of distal part
2. Colle’s #
A. ‘ dinner fork’ deformity T
B. Distal fragment show ulnar side displacement
C. Elderly patient treat by internal fixation
D. Coz stiffness if elderly patient afraid to move the joint
E. Tear of flexor pollicis longus (FPL) a few weeks after #
3. # femoral neck
A. Common in elderly man
B. Look distortion of Shenton”s line (x-ray)
C. Garden stage 11 ( show complete & minimal displaces)
D. Treat surgically
E. Increase incidence of AVN
4. Compartment syndrome
A. bleeding and edema increase pressure of osteofacial compartment
B. can still be present in the presence of palpable distal pulse
C. complication of tight cast
D. treated with analgesic and elevated limb
E. cause little long term disability
5. Indication of internal fixation
A. when fracture is unstable and prone to displace
B. open fracture with gross contamination
C. polytrauma, when to minimize risk of acute respiratory distress syndrome
D. pathological fracture, whereby bone disease may prevent healing
E. shortage hospital bed
6. Causes of pathological fracture
A. repetitive stress
B. osteomyelitis
C. bone cyst
D. previous traumatic fracture
E. secondary to bone tumour
7. The common sites of fractures in patients with osteoporosis are :
A. Femoral neck
B. Distal tibia
C. Sacrum
D. Distal radius
2. E. Vertebrae
8. Traumatic anterior dislocation of the shoulder :
A. Is caused by forced adduction and internal rotation
B. Causes the head of the humerus to end up just below the coracoids process
C. Is less common occurred as compare to posterior dislocation
D. Would result in axillary nerve injury as a complication
E. Would likely to become recurrent if occurred in younger patient
9 . Regarding fractured bone healing :
A. The process starts subsequently from inflammation stage,reparative stage and remodeling stage
B. Stabilization of the fracture ends is necessary for healing process to occur
C. Osteoprogenitor cells within the periosteum are mobilized
D. Healing is always associated with callus formation
E. Remodeling stage would take two weeks to complete the process
10. Factor associate in non-union fracture
A. Infection
B. Smoking
C. Splintage with POP
D. Interposition of periosteum between fragments
E. Excessive traction
11. Sports injuries of knee
A. Meniscus tear is most common
B. Haemarthrosis usually occur due to torn meniscus
C. Swelling of the knee for the next day commonly due to cruciate ligament tear
D. Positive posterior drawer test indicate anterior cruciate ligament tear
E. Lateral meniscus tear is more common rather than medial meniscus tear
12. Safety and road traffic accident :
A. Accident is misnomer term, because mostly accident caused by the negligence
B. Usage of technologies can cause the accident
C. Strict law totally abolish RTA
D. Accident can give give impact to economic growth and insurance
E. Road design itself can induce accident
13. TB spondylitis
A. Biopsy is a helpful diagnosis
B. Multiple drug regime is the treatment of choice for uncomplicated case
C. Destructive process caused by delayed hypersensitivity reaction
14. Spinal injury
A. Vertebral fracture commonly cause spinal cord injury
B. Neurovascular examination is performed to reveal the level of spinal cord injury
C. Resuscitation is the initial management of spinal cord injury
15. Hangman’s fracture
3. A. Known as traumatic spondylolisthesis of c2
B. First noted on crimal in death sentenced by hanging as post-mortem examination
C. Symptom – pain radiating along the course of greater occipital nerve
D. Initial management – immobilize with Philadelphia collar
16. In low back pain
A. Associated with cauda equine syndrome
B. Acute disc prolapsed can occur in patient between 40-50 years of age
C. Advice on care of the back is of great importance
D. Spinal claudication is typical of spondylolisthesis
E. X-ray of the spine do not usual show any abnormality in acute disc prolapsed
17. Loose body in the knee joint can be produced by
A. Synovial chondromatosis
B. Osteochondritis dissecans
C. Osteoarthritis
D. Pigmented villous nodular synovitis
E. Osteochondral fracture
18. The feature that should trigger more active investigation of TB of joint
A. A long history of joint swelling
B. Involvement of multiple joint
C. Marked synovial thickening
D. Periarticular osteoporosis
E. Marked muscle swelling
19. Factors/aetiology of DDD
A. Obesity
B. Genetic and hereditary
C. Frequent cracking the knuckles of finger
D. DM
E. Gout
20. Amputation
A. Diabetic gangrene of the foot require amputation at the distal tibia
B. Below knee amputation ,weight is taken on the stump
C. Above knee amputation,weight is taken on the ischial tuberosity
D. Elderly patient refuse to use above knee prostheses because of the high energy requirement
E. Pain due to neuroma formation is a complication
21. Bone tumour
A. Osteochondroma has tendency to develop into low grade chondrosarcoma
B. Giant cell tumor of bone will not metastases to the lung
C. Multiple echondromatosis also known as Ollier’s disease
D. Ewing’s tumor may associated with elevated ESR
E. Metastases tumor are the most common malignant tumor in elderly patient
24. The unfavourable long term prognostic indication for Perthes
4. A. Early onset
B. Premature closure of growth plate
C. Persistent lateral uncovering of femoral head
D. Deformed femoral head
E. Limited extension
25. Regarding the clubfoot
A. Can occur in the association with arthrogryposis
B. Female is more predominant
C. 50% bilateral involvement
D. Deformity described as fixed equines,heel varus,fore foot and mid foot adduction
E. Surgical correction is gold standard
26. Imaging of osteomyelitis
A. Earliest changes include minimal periosteal destruction and thickening
B. Usefulness of radionuclide scanning limited by an overall lack of specificity and marginal sensitivity
C. MRI can also evaluate extents of infectious problems
D. CT scan distinguish between soft tissue and bone infections and aids in biopsy and aspiration site
(MRI)
E. Sclerotic changes and periosteal new bone formation suggest acute OM
27. Achilles tendon rupture
A. Common in people > 40 years old
B. Simmond’s test positive
C. Result in difficult to walk tip-toe
D. Cannot be treat non-operatively
E. Treatment via surgical reconstruction will result in wound dehiscence as
28. Adhesive capsulitis (frozen shoulder) :
A. Commonly occurs in patient aged 40-60 years old
B. Is presented with loss of shoulder movement in all directions
C. Is caused by a trauma to the shoulder
D. Is a self limiting disease
E. In association with diabetes mellitus would result in poor recovery
29. Pseudogout
A. Is presented as an acute attack of arthritis which is self limiting
B. Is due to deposition of monosodium urate crystal
C. Is demonstrated by positive birefringent in polarized light microscopy
D. Can result in the formation of thopus
E. Is shown as chondrocalcinosis on plain x-ray
30. Trendelenburg’s sign in hip examination results is positive when conducted on patient with :
A. Non-union femoral neck fracture
B. Poliomyelitis affecting hip abductor muscles
C. Chronic hip joint dislocation
5. D. Fracture of lesser trochanter of the femur
E. Ankylosed hip
31. Fractures:
A. When due to repetitive stress are called pathological fractures
B. When due to forcible traction by a tendon are referred to as avulsion fractures.
C. Are classified to as comminuted when there is more than 1 fragment.
D. Will usually unite even the bone ends lie side by side with fractures surfaces making no contact at al.
E. In adults when incomplete are referred to as greenstick fractures.
32. Factors associated with non union of fractures include:
A. Fracture angulation
B. Smoking
C. Splintage with Plaster of Paris
D. Interposition of periosteum between the fragments.
E. Osteoporosis
33. In Monteggia fractures:
A. The upper half of the ulnar is fractured
B. The upper half of the radius is fractured
C. The radial head is dislocated
D. The distal radioulnar joint is dislocated
E. Open reduction and internal fixation is done in adults because it is an unstable fracture
34. Compartment Syndrome:
A. Occur when bleeding or edema increases the pressure in one of the osteofascial compartment
beyond systemic blob pressure.
B. Is characterized by excruciating pain
C. Is a complication of a tight plaster cast
D. Is adequately treated by analgesics and elevating the limb.
E. Cause little long term disability in untreated condition.
35. Regarding traumatic paraplegia.
A. Complete paralysis and anaesthesia is a consequence of spinal shock.
B. Bladder training is required T
C. Flexion contracture cannot be avoided.
D. Bedsore developed after 2 day.
E. Emotional rehabilitation is not vital
36. Neck of femur fracture
A. Avascular necrosis is late complication
B. Occur commonly in older men
C. Occur commonly in osteoporotic
D. Surgery is not indicated if displaced fracture
E. Garden type II is complete with minimal displacement.
37. Sports injury:
A. Lateral meniscus is commonly affected
6. B. Lateral collateral ligament injury is commonly cause bleeding.
C. ACL tear does not require surgical treatment
D. Cruciate ligament tear will cause joint swelling after 2 days.
E. Posterior tibia sagging is a sign of PCL tear.
38. Osteosarcoma
A. Present most commonly in the 6th decade of life.
B. Typically affects the diaphysis.
C. Affects males and females equally.
D. Is a tumour arising from bone and producing bone.
E. Spreads mainly to the regional lymph nodes.
39. In Peripheral nerve lesion:
A. Neuropraxia is a permanent lesion
B. Neurotmesis occurs when the nerve is completely divided
C. Recovery is unlikely when axonotmesis occurs
D. Axonal regeneration proceeds at a rate of 1mm a day.
E. Associated with a closed fracture is usually an axonotmesis or neurapraxia.
40. Gout
A. Rarely seen in young women
B. Most commonly due to myeloproliferative disease
C. Diagnosis beyond doubt by finding birefringent crystal in synovial fluid.
D. Can be confused with septic arthritis in an acute attack
E. Treatment with allopurinol in acute stage.
41. Rheumatoid arthritis
A. ESR increase T
B. Positive rheumatoid factors makes diagnosis certain
C. Periarticular erosions on xrays are characteristic
D. Diseases show relentless progression in majority of cases
E. Splintage of inflamed joint is contraindicated as it causes stiffness.
42. Traumatic posterior dislocation of the hip joint
A. Occur following a dashboard injury
B. Cause the hip to be positioned into externally rotated and flexed
C. Will result in avascular necrosis of the femoral head as its late complication
D. Will be associated with femoral nerve injury
E. Require an urgent open reduction
43. In acute hematogenous osteomyelitis:
A. Adults are more commonly affected than children
B. Can result in septic arthritis if occur in young children
C. Plain x-rays changes are evident within 1 week
D. C-reactive protein will be positive
E. Emphirical antibiotic is given without knowing the causative organism
44. The axillary nerve injury
7. A. associated with fracture of the humeral head
B. Is a complication following traumatic shoulder dislocation
C. Results in weakness in shoulder abduction
D. Results in numbness over the proximal forearm
E. Occur following a closed injury is often neupraxia
45. Prognostic features for Perthes disease in a child is based on:
A. Age
B. Sex
C. Degree of the head involvement
D. Duration of the hip pain
E. Present of Trendelenberg sign
46. Concerning limb amputation:
A. It is indicated in mangled limb.
B. In below knee amputations, the weight bearing is taken on the stump end.
C. The energy requirement to move the prosthesis is higher as the level of the amputation is more
distal.
D. Formation of neuroma will occur if the nerve is severed near the stump end
E. Phantom limb is a known complication following amputation
47. Ganglion
A. Occurs most commonly on the anterior aspect of the wrist
B. Is due to cystic degeneration in the joint capsule or tendon sheath
C. Sometimes disappears after some months
D. Must be incised to prevent pressure necrosis of the underlying bone
E. On the dorsum of the hand is often tender
48. Injuries to the physis
A. Commonly occur along the germinal zone of the growth plate
B. Are classifieds as Salter Harris Type 2 when fracture occur through the physis and
metaphysic
C. Is associated with haemathrosis
D. Do not warrant treatment via open reduction and internal fixation
E. May result in premature fusion of the growth plate
49. Features suggesting tuberculosis of the joints include
A. Involvement of multiple joints
B. A short history
C. Marked synovial thickening
D. Marked muscle wasting
E. Periarticular osteoporosis on plain x-rays
50. In De Quervein’s disease
A. The sheath containing the extensor pollicis longus is inflamed and thickened
B. Tenderness is felt at the ulnar styloid
C. Abduction of the thumb againt resistant is painful
8. D. Passive abduction of the thumb cross the palm is painful
E. Resistant ……..surgical sitting of the thickened tendon sheath
51. Complication of plaster immobilization
A. Vascular compression
B. Pressure sores
C. Nonunion
D. Allergy
E. Skin abrasion or laceration
52. In injuries of the spine:
A. Fracture of the pedicle C1 is known as Hangman’s fracture
B. Anterior wedge compression fractures will affect the anterior, the middle, and posterior column of
the vertebra
C. Fracture dislocation are unstable
D. A fall from height landing on the feet is associated with fractures at the thoracolumbar junction
E. Neurological deficit occur in the majority of patient
53. Acute lumbar disc prolapse
A. Commonly occur at the level of L4/L5
B. At the level of L4/L5 will compress the L4 nerve
C. Can result in sciatica
D. Can be diagnosed through plain X-Rays
E. Is treated surgically in the presence of cauda equina.
54. Congenital Talipes Equino Varus (CTEV)
A. Is a polygenic inheritance
B. Occur more in female compare to male
C. Bilateral involvement is 1/3
D. Pathoanatomy talus is pointing upwards
E. Correction after 5 years old is difficult
55. Tredelenburg sign is positive in this condition
A. Femoral neck fracture
B. Poliomyelitis affecting abductor muscle
C. Dislocated hip
D. Fracture of lesser trochanter of femur
E. Synovitis of hip joint
56. Foot disorder in Diabetes mellitus
A. Clawing toes as result from intrinsic muscle imbalance
B. Dry gangrene of toes following angiopathy may need urgent amputation
C. Ulcer formation around pressure area suggestive of neuropathic complication
D. ABSI is useful parameter to assess peripheral angiopathy
E. Loss of proprioception may lead to charcot joint
57. Median nerve palsy
A. Thumb opposition weak
9. B. Loss of sensation of ulnar three and a half fingers
C. Low lesion due to carpal dislocation ?
D. High lesion, long flexor of little finger is paralysed
E. High lesion has pointing index sign when clinch the hand
58. Degenerative spine disease
A. Hyperthropied facet joint may cause nerve compression in lateral canal stenosis
B. Positive Babinski may be the only manifestation of cord myelopathy
C. Neurogenic claudication can be relieved by sitting or squatting down
D. Surgery is main choice of treatment
E. Osteophytic formation induced by vertebral instability
59. Indication of internal fixation
A. Gustilo type 3
B. Wound >5cm with massive tissues destruction
C. Unstable joint fracture with large articular surface involvement need accurate reduction
D. Polytrauma with comminuted fracture that need nursing care
E. Availability of surgeon expert in internal fixation
60. Compartment syndrome…
A. Bleeding and edema can increase at one of the osteofascial compartment
B. Can be present in the presence of pulse distal to the fracture site
C. The limb distal to the fracture became parasthesia
D. Can adequately treated by elevating the limb and antibiotics
E. Can lead to muscle contracture if not appropriately treated
61. Fracture of the forearm bones
A. Galleazi fracture is a fracture of the proximal ulna with dislocation of the radial head
B. Fracture neck of radius can cause posterior interosious nerve injury
C. Malunion of the Monteggia fracture can lead limitation of the supination and pronation.
D. Proximal forearm fracture usually leads to compartment syndrome
E. Displace fracture of the shaft of the radius need the ORIF
62. Colles fracture
A. Extraarticular fracture of the distal radius
B. The distal fragment will displace anteriorly
C. Most common type of all fractures in elderly
D. Need the ORIF
E. malunion can cause ‘gunstock’ deformity.
63. Regarding Tuberculosis, which statement is true:-
A. Start as synovitis
B. Pain at night is worse and is called as “nightmare cries”
C. May result ankylosis
D. Treat by Arthrotomy
64. Regarding ulnar Nerve:-
A. More clawed in higher lesion
10. B. Ulnar 3 fingers sensation is loss
C. Cause loss of adduction of thumb
D. Affect lumbrical which cause metacarpophalangeal extend
65. Ankylosing Sponylitits
A. Associated with HLABRA 7
B. Always associated with false positive rheumatoid factor
C. Common in Africans
66. In stenosing tenovaginitis (trigger finger):
A. The extensor tendon is commonly involved
B. The usual cause is thickening of the fibrous tendon sheath
C. The triggering occurs during flexion of the involved finger
D. A tender nodule can be felt in front of the affected area
F. The ring and middle fingers are most commonly affected
67. Gas gangrene:
A. Is caused by Streptococcus pyogenes infection
B. Is characterized by myonecrosis
C. Often manifests itself within 24 hours of injury
D. Causes little pyrexia but increases pulse rate
E. Is treated mainly by strong antibiotics
68. Rotator cuff tears:
A. May occur as a complication of chronic tendinitis
B. Is mostly presentable as limitation of glenohumeral joint movement in all directions
C. Is associated with ‘hook’ shaped acromion
D. Is commonly occur to supraspinatus tendon
E.Is ideally repair surgically in all elderly patients
69. Developmental dislocation of the hip
A. Can be demonstrated by Ortoloni test.
B. Trendelenburg test is positive in a child who is able to stand.
C. It is common in a child who presented with breech position during intrauterine.
D. Boys are more common than girls.
E. Increase acetabular angle in plain x-ray.
70. Regarding malignant bone tumours
A. Fibrosarcoma can arise from giant cell tumour
B. Ewing tumour presented with ‘onion peeling’ in plain x-ray.
C. Osteoblastic activity in prostate carcinoma
71. Management of diabetic foot ulcer (risk of amputation)
A. Superficial ulcer
B. Uncontrolled hyperglycaemia
C. Previous amputation
D. Uncontrolled infection
E. ABSI > 1.1
11. 72. Radiological features of OA
A. Subchondral cyst
B. Osteophyte formation
C. Widening of joint space
D. Ankylosis
E. Periosteal osteoporosis
73. Ganglion cyst around wrist:
A. Common in male
B. Present as solitary nodule only
C. Mucoid degeneration of collagen and connective tissue
D. Contain mucin, albumin and globulin
E. Common in volar aspect of wrist
74. In crystal deposition disorder
A. Exclusively in gout
B. Gout can be diagnosed by characteristics of crystals in joint fluid
C. Intake of purine can diminish the symptom of gout
D. Pseudogout characterized by calcium pyrophosphate deposition
E. Acute symptom of gout can be treated by NSAIDs
75. Amputation
A. Diabetic gangrene of the foot require amputation at the distal tibia
B. Below knee amputation ,weight is taken on the stump
C. Above knee amputation,weight is taken on the ischial tuberosity
D. Elderly patient refuse to use above knee prostheses because of the high energy requirement
E. Pain due to neuroma formation is a complication
76. Regarding tenosynovitis:
A. In the proliferative type, it starts within the synovial lining of tendon sheath or invades the
tendon from involvement of a contagious joint.
B. In crystalline type, precipitation of crystalline outside the confines of an enclosed space triggers
fulminant inflammatory reaction.
C. Calcium pyrophosphate deposition disease can cause acute inflammatory tenosynovitis within
carpal tunnel.
D. In stenosing tenovaginitis synovial proliferation is common
E. De Quervain’s disease involves first compartment of the extensor part of the wirst.
77. Gene therapy:
A. Used to replace the non functional gene to become functional
B. RNA interference is used to activate a silent gene
C. Rota-viruses are used as carriers for the gene to be inserted into genome
D. Gene therapy is used to treat multifactorial gene problem
E. Gene therapy is used to produce bone growth.
78. Bone cells:
A. Osteoblast is a polynucleated cell
B. Osteocyte is a mature bone cell trapped in matrix
12. C. Bone lining cells are immature cells
D. Osteoclast is used for bone resorption
E. Osteoclasts found in ‘ruffled border’
79. Rheumatoid Arthritis
A. Incidence is peak in 20-30 years of age
B. HLA-DR is occurs in 70% of people with RA
C. T-cell produced anti-IgG auto antibody, which is detected as Rheumatoid factor
D. Muscle weakness common present
E. In early stage, plain X-ray can show periarticular osteopenia
80. Charcoat joint caused by
A. Neurosyphilis
B. RA
C. Multiple myeloma
D. Peripheral neuritis
E. Gouty arthritis
81. DVT
A. Homan’s sign reliable clinical sign toward the diagnosis
B. Present with pain in calf region
C. Followed hip arthroplasty
D. Confirmed by Doppler ultrasound
E. LMW heparin are used as prophylaxis and treatment
82. In slipped capital femoral epiphysis
A. Affects girls more than boys
B. In 30% of acute slip with history of trauma
C. Slip occur in the proliferative zone of epiphysis plate
D. Confined to prepubertal growth age
83. in fracture of phalanges and metaphalanges
A. Undisplaced # of phalanges can be splinted to its neighbor
B. It is important to correct malrotation
C. Bernett # occur at the base of 5th metacarpal
D. Immobilization should be at least 6/52
E. Stiffness is the most important complication
84. Regarding CTEV
A. Hindfoot is dorsiflexed
B. Forefoot is internally rotated
C. Forefoot is everted
D. Calf muscle is underdeveloped
E. Treatment begin within 2-3 days after birth
85. Regarding Amputation
A. Diabetic gangrene of the foot require amputation at the distal tibia
B. Below knee amputation ,weight is taken on the stump
13. C. Above knee amputation, weight is taken on the ischial tuberosity
D. Elderly patient refuse to use above knee prostheses because of the high energy requirement
E. Pain due to neuroma formation is a complication
86. Fat embolism
A. Occurs after 3 days
B. Treatment mainly oxygen therapy
C. Shortness of breath, mild confusion and restlessness
D. Commonly seen in elderly patient followed minor trauma
E. Due to circulating fat globules
87. Archilles tendon rupture
A. Occurs in degenerate tendon
B. Positive Simmon’s test
C. Cannot be treated conservatively
D. Patient have difficulty in walking tiptoe
E. Complicated with wound dehiscence of surgical treatment
88. Carpal tunnel syndrome
A. More common in men than women
B. Caused hypothenar muscle wasting in late case
C. Happened in hypothyroid
D. Paraesthesia of fingers after fully palmarflexion in 1 minute
E. Treated surgically with incision of anterior carpal ligament
89. regarding examination of the knee
A. Anterior drawer test indicate PCL instability
B. Lachman tset is elicit in 90o flexion of knee
C. Q angle is required for patella subluxation
D. Positive patella tap indicate grossly knee effusion
E. Mc Murray classically for bucket handle tear of knee menisci
90. posterior hip dislocation
A. Less commonly than anterior dislocation
B. Lies in extension, abduction and externally rotated
C. Occur in dashboard injury
D. If involved with # of femoral head, closed reduction will be fail
E. Sciatic nerve injury is a complication
91. acute lumbar disc prolapsed
A. Common at L4 and L5
B. If occur at L4 & L5, L4 will be compressed
C. Plain xray is diagnostic
D. Sciatic nerve injury
E. Surgical intervention if involves cauda equine
92. spondylolisthesis
14. A. Is forward shift displacement of vertebrae above on stable vertebrae below
B. Common at L4,L5 and L5,S1
C. Cannot occur in degenerative process
D. In childhood is painful
E. Operation is indicated in neurological deficit
93. multiple myeloma
A. Malignant B cell lymphoproliferative disorder of marrow
B. Sclerotic lesion is seen through out skeleton
C. Associated with increase blood viscosity
D. Bensen Jenssn protein in urine in 90% of patient
E. Sensitive to ankylating cytotoxic agents
94. bone healing
A. The process starts subsequently from inflammation stage,reparative stage and
remodeling stage
B. Stabilization of the fracture ends is necessary for healing process to occur
C. Osteoprogenitor cells within the periosteum are mobilized
D. Healing is always associated with callus formation
E. Remodeling stage would take two weeks to complete the process
95. # in children
A. Rotational malalignment of # bone corrected by remodeling process
B. Metaphyseal alignment avulsion # lead to premature closure of adjacent growth plate
C. Apophysis injury lead to longitudinal growth arrest of bone
D. Salter Harris type IV treated by conservative treatment
E. Displaced supracondylar # of humerus treated by close reduction and percutaneous pin under image
intensifier
96. definite indication for internal fixation
A. When # is unstable and prone to displace after closed reduction
B. Open # with gross contamination
C. Polytrauma, afraid of ARDS
D. Pathological # which bone disease prevent healing process
E. Humeral # associate without radial nerve injury
97. frozen shoulder (shoulder tendinitis)
A. Commonly found in younger age
B. Restrict movement in forward flexion only
C. Cause by trauma to shoulder
D. Self limiting disease
E. Recover process is difficult in DM
98. Causes of pathological fracture
A. repetitive stress
B. osteoporosis
C. bone cyst
D. previous traumatic fracture
15. E. secondary to bone
99. anterior shoulder instability
A. Commonly occur in elderly men followed by an acute traumatic event
B. Can cause humeral head articular damage
C. Is associated with Bankart lesion
D. Positive Apprehension test
E. Mainly treated by conservative treatment
100. Late complications of fracture include
A. Non-union
B. Joint contracture
C. Osteomyelitis
D. Muscle atrophy
E. Bleeding