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QUESTION 1 OF 21

A 24 year old male sustained a grade III PLC injury of his knee following a skiing injury 2 years previously.He is listed for surgery for chronic pain and instability. Which of the following is the most essential structure to identify while performing a posterolateral corner reconstruction?

QUESTION ID: 40

1. A. Common peroneal nerve
2. B. ITB
3. C. LCL
4. D. Popliteus
5. E. Tibial nerve

QUESTION 2 OF 21

A colleague has performed a knee arthroscopy on a 45-year-old male 6 weeks ago. The operation note states the only abnormal finding was mild cartilage thinning medially (grade I). He continues to complain of knee pain. What is the most appropriate next step in management?

QUESTION ID: 41

1. A. Anteroposterior(AP) radiograph hip
2. B. List for further knee arthroscopy
3. C. MRI knee
4. D. Physiotherapy
5. E. Standing long leg alignment x-ray

QUESTION 3 OF 21

You are supervising a trainee perform a knee arthroscopy on a 25-year-old female.  You notice they have made their anterolateral arthroscopy portal quite inferior to where you had wanted.  A complication occurs due to this portal placement. What piece of equipment will you ask for to deal with this complication?

QUESTION ID: 42

1. A. ACL repair kit
2. B. All inside meniscal repair kit
3. C. Chondral fixation kit
4. D. Microfracture kit
5. E. Outside in meniscal repair kit

QUESTION 4 OF 21

You review a young female with the results of her MRI after a twisting knee injury.  You are pleased to see she is now asymptomatic but note that within the lateral compartment of the knee her MRI demonstrates “a minimal meniscal width to maximal tibial width (on coronal slice) of 40%, and a ratio of the sum of the width of both lateral horns to the maximal meniscal diameter (on sagittal slice) of 80%”. What is your management plan?

QUESTION ID: 43

1. A. Discharge to physio
2. B. Discharge with no follow up
3. C. List for arthroscopic meniscal repair
4. D. List for arthroscopic saucerisation
5. E. List for diagnostic arthroscopy

QUESTION 5 OF 21

You review a 10-year-old boy with lateral knee pain.  MRI shows 5 sagittal slices of 5mm thick contiguous lateral meniscus from anterior to posterior horns. Which of the following x-ray findings is associated with the diagnosis?

QUESTION ID: 44

1. A. Hypoplastic patella
2. B. Lateral tibial plateau fracture
3. C. Segond fracture
4. D. Tibial spine fracture
5. E. Widening lateral joint space

QUESTION 6 OF 21

“Too many toes” sign would most likely be seen in which case?

QUESTION ID: 45

1. A. Charcot Marie Tooth Disease
2. B. Fibular Hemimelia
3. C. Grade IIA Tibialis Posterior Tendon Dysfunction
4. D. Grade IIB Tibialis Posterior Tendon Dysfunction
5. E. Iselin’s disease

QUESTION 7 OF 21

A patient attends your clinic after transfer of care. They attend with an in shoe orthotic in a bag, it is built up on the lateral side of the heel and contains a depressed section at the medial aspect of the forefoot. What condition would the likely pathology be associated with?

QUESTION ID: 46

1. A. Charcot Marie Tooth disease with foot drop.
2. B. Diastematomyelia with grade 5 power all muscle groups
3. C. Rheumatoid arthritis
4. D. Tarsal coalition
5. E. Varus malunion of Os Calcis with post traumatic osteoarthritis subtalar joint

QUESTION 8 OF 21

A patient attends clinic for the results of an excision biopsy performed from a discrete firm lesion in the foot. Histopathology report included no cell atypia, myofibroblast proliferation and collagen proliferation of Type 3 collagen more so than Type 1 collagen. What is the likely diagnosis?

QUESTION ID: 47

1. A. Fibromyxoma
2. B. Gardner’s disease
3. C. Ledderhose disease
4. D. Lipoma
5. E. Synovial sarcoma

QUESTION 9 OF 21

Choose below the most likely diagnosis for the following clinical caveat. A 42 year female with a bunion presents with pain on shod weight bearing originating at the 2nd  and 3rd metatarsal heads.

QUESTION ID: 48

1. A. Claw toe
2. B. Freiberg’s disease
3. C. Plantar plate rupture
4. D. Morton neuroma
5. E. MTP joint synovitis

QUESTION 10 OF 21

A 46-year-old man presents with pain in the right 1st metatarsal phalangeal joint (MTPJ). He recalls a rugby injury to the joint 20 years ago. On examination he has moderate pain on end range of motion, reduced range of motion (10o dorsiflexion, 50o plantar flexion) and pain on axial loading of the 1st MTPJ. Radiographs demonstrate around 40% joint space narrowing with dorsal osteophyte on the metatarsal and phalanx.  He has failed conservative treatment and still wishes to play rugby. What is the most appropriate treatment?

QUESTION ID: 49

1. A. Dorsal cheilectomy
2. B. Keller’s procedure
3. C. MTPJ arthrodesis
4. D. MTPJ arthroplasty
5. E. Synovectomy

QUESTION 11 OF 21

In an otherwise normally aligned foot when performing a scarf osteotomy, to avoid shortening or lengthening the first metatarsal what landmark or reference point should be used for your distal transverse cut?

QUESTION ID: 50

1. A. Parallel to proximal phalanx base joint surface
2. B. Parallel with the 5th metatarsal phalangeal (MTP) joint
3. C. Perpendicular to 1st metatarsal
4. D. Perpendicular to 2nd metatarsal
5. E. Perpendicular to cut surface after removing medial eminence

QUESTION 12 OF 21

A patient is brought into the emergency department after sustaining an ankle injury whilst playing basketball. The ankle is grossly swollen and tender. Radiographs show a pronation external rotation injury pattern. Which answer best describes the sequence of injury?

QUESTION ID: 51

1. A. ATFL disruption, oblique fibula fracture at the level of the syndesmosis, PITFL disruption or posterior malleolus fracture, transverse medial malleolus fracture or deltoid ligament injury.
2. B. Medial malleolus transverse fracture or deltoid disruption, ATFL disruption, lateral short oblique fracture/ spiral fracture of fibula above the syndesmosis, PITFL avulsion or posterior malleolus fracture
3. C. Medial malleolus transverse fracture or deltoid disruption, ATFL disruption, lateral short oblique/ spiral fracture of fibula below the syndesmosis, PITFL avulsion or posterior malleolus fracture
4. D. Medial malleolus transverse fracture or deltoid disruption, ATFL disruption, transverse or comminuted fibula fracture above the level of the syndesmosis.
5. E. Vertical medial malleolus fracture, ATFL disruption or fibula fracture below the joint line

QUESTION 13 OF 21

A 49-year-old male patient with a history of type 2 diabetes, neuropathy and retinopathy presents to the diabetic foot and ankle MDT clinic with a chronic foot ulcer. Which of the following is a negative predictor for diabetic ulcer wound healing?

QUESTION ID: 52

1. A. Arterial Brachial Pressure Index ratio of 0.5
2. B. Inability to feel a 5.07 Semmes-Weinstein monofilament around the ulcerated area.
3. C. Serum Albumin 2.9 g/dL
4. D. Total Lymphocyte Count 2.8 (x109/L)
5. E. Transcutaneous Oxygen pressure 41mmHg

QUESTION 14 OF 21

Which of the following is weakest predictor of associated osteomyelitis in diabetic foot ulcers?

QUESTION ID: 53

1. A. MRI with Gadolinium demonstrating contrast enhancement
2. B. Positive organism and sensitivity following ulcer wound swab
3. C. Radiographs demonstrating cortical erosions
4. D. Ulcer that probes to bone
5. E. White blood cell scan

QUESTION 15 OF 21

A 72-year-old man presents with increasing pain in the pelvis. A plain radiograph shows expanded bone in the superior pubic ramus, with coarse “purposeful” trabeculae. Further investigation with MRI shows an associated soft tissue mass arising from the area of abnormal bone.

Which of the following statements is true:

QUESTION ID: 54

1. A. Biopsy is not required
2. B. Bisphosphonate treatment has minimal role in the treatment of Paget disease
3. C. On isotope bone scan, the abnormal area in the pelvis is unlikely to show increased uptake
4. D. Osteosarcoma secondary to Paget disease has a different biological potential
5. E. The serum alkaline phosphatase is likely to be normal

QUESTION 16 OF 21

You are seeing an otherwise well pre-menarchal 12-year-old schoolgirl referred in with a thoracic scoliosis. She is otherwise well. Examination is unremarkable aside from the left thoracic scoliosis with a small rib hump.She has a normal neurological examination. Whole spine x-rays confirm the scoliosis with apex at T8 with Cobb angle of 20° and normal segmentation. The most appropriate next step in management is:

QUESTION ID: 55

1. A. Application of CTLSO brace
2. B. Application of TLSO brace
3. C. MRI scan whole spine
4. D. Observation with repeat x-ray in 3-6 months
5. E. Posterior instrumented correction and fusion

QUESTION 17 OF 21

A 65-year-old otherwise well Caucasian female presents with right brachialgia.  On questioning she has noticed increasing difficulty with her sewing and some unsteadiness on her feet. Examination findings include an inverted supinator reflex. The pathology underlying this presentation is most likely:

QUESTION ID: 56

1. A. Atlanto-axial instability (AAI)
2. B. Calcified central thoracic disc prolapse
3. C. Cervical disc/osteophyte complex
4. D. Neoplasia
5. E. Ossification of the posterior longitudinal ligament (OPLL)

QUESTION 18 OF 21

An 8-year-old boy has come to orthopaedics clinic with back pain and scoliosis. The boys mum mentions that the pain is more prevalent at night and has responded to anti-inflammatory agents. The following is the only TRUE statement about this condition:

QUESTION ID: 57

1. A. Fine cuts of CT and MRI scan best help in determining treatment plan
2. B. It is larger than 2 cm in diameter
3. C. Most often present with neurological deficit.
4. D. Radiofrequency is the first line of treatment in all lesions.
5. E. The lesion is typically present on the convex side of the scoliosis

QUESTION 19 OF 21

A 50-year-old diabetic patient undergoes posterior spinal fusion for a spinal pathology. She has bone graft taken from right anterior iliac crest. Post operatively, she is put in a TLSO and mobilised. She complains of right anterior thigh pain and paraesthesia immediately after surgery. CT scan confirms no screw malposition and pelvis x rays are normal. Which of the following is the least likely differential diagnosis?

QUESTION ID: 58

1. A. Diabetes
2. B. Epidural hematoma at L4 level
3. C. Graft site morbidity
4. D. Position during surgery
5. E. TLSO

QUESTION 20 OF 21

A 68 year old female sustains a osteoporotic fracture . After failure of conservative treatment, she undergoes vertebroplasty. Which of the following statements  is a correct regarding this procedure?

QUESTION ID: 59

1. A. Chemical destruction of the nerve endings due to chemical composition of the cement has been proposed
2. B. Has more advantages as compared to kyphoplasty.
3. C. Indicated in patient with ongoing pain after recent unhealed fracture, pain confirmed at the level of fracture by examination and MRI showing low signal on T2
4. D. It works by destruction of the nerve endings due to extreme low temperature reached by the polymerisation of the injected cement
5. E. It works by stabilisation of the fractured bone by forming a chemical bond.

QUESTION 21 OF 21

A 36-year-old sportsman attends the clinic complaining of left shoulder weakness and deep seated pain. Examination reveals wasting below the spine of scapula affecting the infraspinous fossa only. The most useful investigation would be:

QUESTION ID: 60

1. A. CT
2. B. MRI
3. C. MRI arthrogram
4. D. USS
5. E. X-ray