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QUESTION 1 OF 39

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 2 OF 39

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 3 OF 39

A 45-year-old female fell whilst wall climbing and landed on her right forearm sustaining a closed displaced proximal 1/3rd to midshaft radius and midshaft ulna fracture.

What is the single best approach for open reduction and fixation of the radius and ulna fracture with plates and screws?

QUESTION ID: 1084

1. A. Approach the midshaft of the radius via the Brachioradialis/Flexor carpi radialis first with the forearm pronated during deep dissection and then work proximally between Brachioradiallis/Pronator teres with the forearm supinated. Then fix the ulna through a separate approach
2. B. Approach the midshaft of the radius via the Brachioradialis/Flexor carpi radialis first with the forearm pronated during deep dissection and then work proximally between Brachioradiallis/Pronator teres with the forearm supinated. Then fix the ulna through a separate approach
3. C. Approach the midshaft of the radius via the Brachioradialis/Flexor carpi radillis first with the forearm supinated during deep dissection and then work proximally between brachioradialis/Pronator teres with the forearm pronated. Then fix the ulna through a separate approach
4. D. Approach the proximal radius first through the Brachioradialis/Pronator teres interval with forearm supinated and then the midshaft of the radius via the brachioradialis/Flexor carpi radialis with the forearm pronated during deep dissection. Then fix the ulna through a separate approach
5. E. Approach the Ulna first and fix the fracture with plates and screws. Then approach the midshaft of the radius via the Brachioradialis/Flexor carpi radialis first with the forearm pronated and then work proximally between Brachioradialis/Pronator teres with the forearm supinated

QUESTION 4 OF 39

An 81-year-old gentleman has been admitted with a displaced intracapsular neck of femur fracture. He has been listed for a total hip arthroplasty.

Which one of the following factors confers an advantage towards a hemiarthroplasty rather than a total hip arthroplasty?

QUESTION ID: 1100

1. A. Dislocation rate (within 4 years of index procedure)
2. B. Mortality rate
3. C. Post-operative infection
4. D. Quality of life and functional scoring with the Harris Hip score
5. E. Reoperation rate

QUESTION 5 OF 39

A 20-year-old male is stabbed in the axilla. Surgical exploration is performed, and a bleeding artery is identified and repaired. 

When does the axillary artery nominally become the brachial artery?

QUESTION ID: 1110

1. A. At the inferior border of subscapularis
2. B. At the level of the fourth rib
3. C. At the level of the intertubercular groove of the humerus
4. D. At the lower border of teres major
5. E. At the origin of pectoralis minor

QUESTION 6 OF 39

During the posterior approach to the scapular body, excessive medial retraction of a muscle results in significant arterial bleeding and the surgeon is concerned there is associated nerve injury following this bleed. 

If this is true, which of the following movements will likely be chronically weakened?

QUESTION ID: 1111

1. A. Abduction and external rotation of the arm
2. B. Abduction of the arm
3. C. Adduction and internal rotation of the arm
4. D. Extension of the arm
5. E. Internal rotation of the arm

QUESTION 7 OF 39

A posterior portal is created to carry out a diagnostic shoulder arthroscopy. 

Which structure is most at risk of injury if a portal is created that is too medial than the typically described approach?

QUESTION ID: 1112

1. A. Axillary nerve
2. B. Infraspinatus
3. C. Posterior circumflex humeral artery
4. D. Radial nerve
5. E. Suprascapular nerve

QUESTION 8 OF 39

Which of the following shoulder muscles are innervated by a nerve that arises from the upper trunk of the brachial plexus?

QUESTION ID: 1113

1. A. Subscapularis
2. B. Deltoid
3. C. Supraspinatus
4. D. Teres minor
5. E. Teres major

QUESTION 9 OF 39

A bone reduction clamp is placed under the inferior surface of the clavicle, positioned between the clavicle and a slender muscle running along the inferior surface. 

The innervation to this specific muscle arises from which of the following root(s) of the brachial plexus?

QUESTION ID: 1114

1. A. C5
2. B. C6
3. C. C7
4. D. C5-6
5. E. C6-7

QUESTION 10 OF 39

You are assisting a consultant in exploring the brachial plexus at the axilla.  The part of the axillary artery below pectoralis minor is noted to have two nerve roots joining anterior to it to form a nerve which lies just lateral to the artery. 

What is this nerve?

QUESTION ID: 1115

1. A. Axillary nerve
2. B. Median nerve
3. C. Musculocutaneous nerve
4. D. Radial nerve
5. E. Ulnar nerve

QUESTION 11 OF 39

With respect to the muscles of the pectoral girdle, which muscle inserts into the lateral lip of the intertubercular (bicipital) sulcus of the humerus and receives its innervation that is derived from both the medial and lateral cords of the brachial plexus?

QUESTION ID: 1116

1. A. Latissimus dorsi
2. B. Pectoralis major
3. C. Pectoralis minor
4. D. Serratus anterior
5. E. Trapezius

QUESTION 12 OF 39

The subscapularis muscle is dually innervated, and these nerves arise as two branches from the same cord of the brachial plexus. 

Of the following nerves, which nerve also originates from this specific cord of the brachial plexus?

QUESTION ID: 1117

1. A. Medial pectoral nerve
2. B. Lateral pectoral nerve
3. C. Musculocutaneous nerve
4. D. Medial cutaneous nerve of the arm
5. E. Thoracodorsal nerve

QUESTION 13 OF 39

A male patient presents to clinic after a game of rugby with pain over the volar surface of the distal phalanx to the ring finger; examination has confirmed no active flexion at the distal interphalangeal joint, and this joint was held in slight relative extension to the other digits. 

Which zone does this injury correspond to?

QUESTION ID: 1118

1. A. I
2. B. II
3. C. III
4. D. IV
5. E. V

QUESTION 14 OF 39

A patient develops acute radial nerve palsy following closed reduction of a humeral shaft fracture. A posterior approach to the humeral shaft is performed to explore the radial nerve. 

Which statement best describes the typical distal location of the radial nerve with respect to the medial head of the triceps brachii?

QUESTION ID: 1119

1. A. Deep to and lateral
2. B. Deep to and medial
3. C. Deep to and midline
4. D. Superficial to and lateral
5. E. Superficial to and medial

QUESTION 15 OF 39

A patient presents with signs consistent with medial scapular winging. 

The injured nerve is a branch from which of the following nerve root(s)?

QUESTION ID: 1120

1. A. C4
2. B. C5
3. C. C3-5
4. D. C5-6
5. E. C5-7

QUESTION 16 OF 39

A 50-year-old male presents with acute arm pain, swelling, bruising, and weakness on resisted forearm supination and flexion.

What are the nerve root fibres to this affected muscle?

QUESTION ID: 1121

1. A. C8-T1
2. B. C1-3
3. C. C3-5
4. D. C5-7
5. E. C7-8

QUESTION 17 OF 39

A young patient sustains an intracapsular neck of femur fracture and you are explaining the rationale of management, with respect to the blood supply, to a medical student. 

Which artery does not contribute towards the trochanteric anastomosis:

QUESTION ID: 1127

1. E. Transverse branch of the medial circumflex femoral artery
2. A. Ascending branch of the lateral circumflex femoral artery
3. B. Ascending branch of the medial circumflex femoral artery
4. C. Descending branch of the superior gluteal artery
5. D. Inferior gluteal artery

QUESTION 18 OF 39

During the posterior approach to the hip, a major structure is at risk. 

As this structure passes though the gluteal region, it lies anterior and inferior to which of the following external rotators: 

QUESTION ID: 1128

1. A. Inferior gemellus
2. B. Obturator internus
3. C. Piriformis
4. D. Quadratus femoris
5. E. Superior gemellus

QUESTION 19 OF 39

A two-incision leg fasciotomy is performed for compartment syndrome. 

During fasciotomy of the posterior compartments, which of the following structures are at risk of injury:

QUESTION ID: 1130

1. A. Anterior tibial vein
2. B. Deep peroneal nerve
3. C. Great saphenous vein
4. D. Short saphenous vein
5. E. Superficial peroneal nerve

QUESTION 20 OF 39

Which one of the following gait patterns is typical of an antalgic gait pattern?

QUESTION ID: 1133

1. A. Patient leans their trunk laterally over the contralateral side in ipsilateral hip arthritis
2. B. Patient’s contralateral step length is increased in ipsilateral ankle arthritis
3. C. Patients adopt a hamstring avoidance in ipsilateral knee arthritis
4. D. The affected knee is maintained in slight flexion with ipsilateral toe walking
5. E. The swing phase of gait on the ipsilateral side is decreased in hip arthritis

QUESTION 21 OF 39

Which of the following is correct regarding the increase in metabolic demand in lower limb amputations:

(TF – Transfemoral, BKA- Below knee Amputation)

QUESTION ID: 1134

1. A. The metabolic demand is 100% above normal in TF amputations related to Peripheral Vascular Disease
2. B. The metabolic demand is 50% above baseline in Transfemoral Amputation
3. C. The metabolic demand is 50% above baseline in Transtibial Amputations
4. D. The metabolic demand is the same in TF and a short BKA
5. E. The metabolic demand is the same in vascular BKA versus Traumatic BKA

QUESTION 22 OF 39

Which of the following describes the fastest gait pattern?

QUESTION ID: 1136

1. A. 3-point gait
2. B. 4-point gait
3. C. Normal walking
4. D. Swing-through gait
5. E. Swing-to gait

QUESTION 23 OF 39

When stabilising a mid-diaphyseal femoral fracture using an intra-medullary nail, locking bolts are passed proximal and distal to the fracture.

The main function of these locking bolts is to:

QUESTION ID: 1138

1. A. Allow for easier nail extraction
2. B. Increase the bending stiffness of the construct
3. C. Increase the torsional stiffness of the construct
4. D. Increase the working length of the construct
5. E. Reduce the risk of proximal / distal nail migration

QUESTION 24 OF 39

A Cobalt-chrome and ceramic femoral head are being tested in a lab. During one test a sharp object is run along each material’s surface.

The size and depth of the resultant scratch is assessed. What material property is being tested for in this scenario:

QUESTION ID: 1141

1. A. Hardness
2. B. Stiffness
3. C. Strength
4. D. Toughness
5. E. Elasticity

QUESTION 25 OF 39

A surgeon doing a total hip replacement decides to use a larger diameter femoral head to reduce the risk of future dislocation.

How does increasing head diameter most improve hip stability:

QUESTION ID: 1145

1. A. Increases jump distance
2. B. Moves the centre of rotation medially
3. C. Reduces the head-neck ratio
4. D. Reduces the range of the primary arc
5. E. Tightens surrounding soft tissue restraints

QUESTION 26 OF 39

A surgeon inserting a femoral broach into a tight femoral canal decides to pause between each strike of the hammer for 10 seconds in order to reduce the risk of femoral fracture.

Which of the following viscoelastic features best explains the surgeon’s logic:

QUESTION ID: 1146

1. A. Stress-relaxation
2. B. Creep
3. C. Hysteresis
4. D. Strain-rate dependence
5. E. Strain-relaxation

QUESTION 27 OF 39

A surgeon wishes to maximise the stability of a total hip replacement by increasing the primary arc range of motion, and thus reducing the risk of impingement.

Which of the following does NOT increase the primary arc:

QUESTION ID: 1147

1. A. Increasing femoral head size
2. B. Removing acetabular osteophytes
3. C. Reducing femoral neck diameter
4. D. Using a liner with a 10 degree posterior lip
5. E. Increasing head neck ratio

QUESTION 28 OF 39

With regard to Normal distribution which of the following is true:

QUESTION ID: 1150

1. A. 50% of samples in the dataset lie above the mean value.
2. B. Mean ± 1 standard deviation would capture 95% of the data.
3. C. Mean and interquartile range is the best parameter to describe the data.
4. D. Normal distribution is useful to plot categorical variables.
5. E. There is minor difference between mean, median and mean.

QUESTION 29 OF 39

A paired sample t test is appropriate for which of the following situation:

QUESTION ID: 1151

1. A. Comparing bone mineral density between those with and without ankylosing spondylitis.
2. B. Comparing patient satisfaction with radiological outcome after ankle fracture fixation.
3. C. Comparing visual analogue scale scores after total hip arthroplasty and hip hemiarthroplasty following hip fracture.
4. D. Investigating pain relief with visual analogue scale before and after hip arthroplasty.
5. E. Investigating proportion of pain relief with visual analogue scale before and after hip arthroplasty.

QUESTION 30 OF 39

Researchers investigated pain relief and functional outcome before and after resection arthroplasty of the shoulder. The level of pain was significantly decreased (t-test, p < 0.001).

      Which of the following is true:

QUESTION ID: 1152

1. A. Pain relief following resection arthroplasty was noticeable.
2. B. Resection arthroplasty can be recommended as a treatment option.
3. C. Resection arthroplasty has a strong effect on pain relief.
4. D. The very low p value is indicative of very low bias of the study.
5. E. There is < 1% probability that the observed differences in pain relief is due to chance.

QUESTION 31 OF 39

Which of the following is true?

QUESTION ID: 1153

1. A. A wide confidence interval gives more precise estimate.
2. B. A small trial would result in a narrow confidence interval.
3. C. The range of the confidence interval can be used to test the null hypothesis.
4. D. If confidence interval of two different interventions do not overlap this would suggest that there is a clinically significant difference in treatment effect.
5. E. A 95% confidence interval is always used in research.

QUESTION 32 OF 39

Which of the following is true:

QUESTION ID: 1154

1. A. P=0.001 means the intervention has a stronger effect than p=0.01
2. B. P<0.05 suggests that the treatment effect was clinically significant.
3. C. The lower the p value the greater the strength of evidence against the null hypothesis.
4. D. Threshold for P value is always <0.05.
5. E. P value is constant and is not affected by multiple statistical testing.

QUESTION 33 OF 39

Researchers were interested to investigate risk factors for deep infection in patients with a hip arthroplasty. They employed a case-control design. 47 consecutive patients with a deeply infected hip arthroplasty were compared with 200 randomly selected patients, operated in the same hospital and period of time, with no deep infection in their hip arthroplasty along follow-up.

Which of the following is true?

QUESTION ID: 1155

1. A. The study was free of allocation bias.
2. B. The study was free of assessor bias.
3. C. The study was free of confounding.
4. D. The study was free of selection bias.
5. E. This was a retrospective study.

QUESTION 34 OF 39

The parents of a 6-year-old child with cerebral palsy ask you about selective dorsal rhizotomy.

After reviewing the case, which of the following findings is most suggestive of a contraindication for the procedure?

QUESTION ID: 1156

1. A. Attends private mainstream school education
2. B. Child uses walker indoor independently
3. C. Clonus in both lower limbs
4. D. History of hypoxic ischemic encephalopathy during birth
5. E. MRI findings of lesions in basal ganglia

QUESTION 35 OF 39

A 14-year-old girl presents with short stature and has previous surgeries for bowing of and knee tibia. X-ray of the knee shows widened physis and metaphyseal cupping. There is elevated phosphate urine excretion. Her brother also is afflicted by the same condition.

What is the underlying cause of her condition?

QUESTION ID: 1157

1. A. Neurofibromin deficiency
2. B. Type II collagen dysfunction
3. C. Vitamin D deficiency
4. D. Vitamin D resistance
5. E. a-L-iduronidase deficiency

QUESTION 36 OF 39

A 9-year-old boy has recently migrated to your area from a conflict zone country. His family doctor was concerned about his shorter right leg. Investigations show he has fibular hemimelia.

Whilst planning surgery for his leg length discrepancy, which of these methods is leas   likely to predict the final length difference?

QUESTION ID: 1158

1. A. Green and Anderson chart
2. B. Menelaus rule of thumb
3. C. Moseley straight line graph
4. D. Paley’s multiplier
5. E. Shapiro developmental patterns

QUESTION 37 OF 39

You are seeing a 5-year-old girl in clinic with leg length discrepancy. The longer leg also has a bigger leg and thigh circumference compared to the contralateral side. You also notice asymmetry in the tongue. The appropriate next course of action is:

QUESTION ID: 1159

1. A. Arrange for the patient to undergo 8-plate epiphyseodesis on the longer side
2. B. Plan for limb lengthening on the shorter side
3. C. Refer for MRI lower limbs to determine cause of soft tissue volume difference
4. D. Refer for the patient to have ascreening abdominal ultrasound
5. E. This condition is benign and can be monitored. Surgery for leg length discrepancy can be done just before puberty

QUESTION 38 OF 39

Anteroposterior(AP) pelvis x-ray of a 7-year-old with bilateral hip pain is shown.

ap xray.jpg

Which of the following is true?

QUESTION ID: 1160

1. A. Children with this condition predominantly walk with in toeing
2. B. The Hilgenreiner-epiphyseal angle can be used to monitor and guide treatment plan
3. C. This condition can be managed non-operatively with long term Vitamin D supplement
4. D. This is sequela of previous severe systemic sepsis
5. E. When planning surgery for the femur, a 90-degree angled construct is most commonly used

QUESTION 39 OF 39

A surgeon is performing in-situ fixation of a slipped upper femoral epiphysis using an unthreaded device over the physis.

Which patient characteristic will benefit the most from the chosen fixation device?

QUESTION ID: 1161

1. A. A 9 year old boy
2. B. A girl with BMI of 35
3. C. Acute slip presenting less than 24 hour of symptom
4. D. Head-shaft angle of 40°
5. E. Open greater trochanter growth plate