Free Test MCQs/SBAs

Best Answer: C . <br>
Necrotising fasciitis is increased in IV drug users.

The structure shown is the exiting nerve root at the L3-4 disk, which is the right L3 root.

Best answer: B .

The arrows mark the subscapularis tendon. The subscapularis muscle is innervated by the upper and lower subscapular nerves. The upper and lower subscapular nerves are branches from the posterior cord of the brachial plexus.

Best Answer: E .

The MRI shows a disruption of the humeral attachment of the ulnar collateral ligament. The ulnar collateral ligament of the elbow is the most frequently observed ligamentous elbow injury in cricket players.

Recommended treatment in the throwing athlete is reconstruction of the ulnar collateral ligament with an autogenous palmaris longus graft .

Best Answer: A .

The arrows mark the subscapularis tendon.

Best answer: D .

If A2 or A4 pulleys were cut bowstringing will happen.

Best answer: D .

Wassel is the most common classification system for thumb polydactyly:
I: bifid distal phalanx .
II: duplicated distal phalanx .
III: bifid proximal phalanx .
IV: duplicated proximal phalanx .
V: bifid metacarpal .
VI: duplicated metacarpal .
VII: triphalangism.

Best answer: B .

All the above are recognised complication of hip dislocation.

Arthritis incidence is up to 20% and is dependent on the severity of dislocation and associated fractures.

Sciatic nerve injury is up to 20% and increases with longer time to reduction.

AVN incidence is up to 40% and recurrent dislocation is 2% .

Best answer: B .

The PCL extends from the medial femoral condyle to the tibial sulcus .

Overall the most common mechanism of PCL injury is a direct blow to the proximal aspect of the tibia such as dash board injury.

The most common mechanism of PCL injury in athletes is a fall onto the flexed knee with the foot in plantar flexion, which places posterior forces on the tibia and leads to rupture of the PCL.

Treatment of isolated PCL injury is mainly focused on protected weight bearing, followed with quadriceps rehabilitation.

Best Answer : B .

While the 1st-3rd tarsometatarsal joints are relatively immobile the 4th and 5th are mobile allowing accomodation to rough ground. As such arthrodesis of these joint is generally not well tolerated. However in a foot with either painful malunion or degeneration arthrodesing the 1st – 3rd joints may provide sustained pain relief and return to activity.

Post-operative management usually requires a period of non-weight-bearing and the conventional approach is dorsally.

Best Answer: D .

Although this is a fracture of the medial and lateral malleoli, the degree of displacement and comminution of the medial dome indicate that this injury is similar to a pilon fracture.

Initial management should consistent of stabilization to allow for soft-tissue healing. The use of temporizing spanning external fixation should be the initial step, followed by limited or more extensive open reduction and internal fixation when the soft-tissue status will allow.

Initial placement in either a short or long leg cast does not provide the needed stability and does not allow for care and monitoring of soft tissues. In addition, maintaining reduction of the talus may be very difficult.

Immediate open reduction and internal fixation through an injured soft-tissue envelope adds the risk of difficulties with incision healing and a higher risk of deep infection.

In the acute setting, a primary ankle fusion through this soft-tissue envelope is not indicated.

Best answer: B .
All the above are recognised complication of hip dislocation.
Arthritis incidence is up to 20% and is dependent on the severity of dislocation and associated fractures.

Sciatic nerve injury is up to 20% and increases with longer time to reduction.

AVN incidence is up to 40% and recurrent dislocation is 2% .

Best answer: B .

The humerus was treated with an intramedullary nail. Findings from two prospective randomized studies of intramedullary nailing or compression plating of acute humeral fractures have shown approximately a 30% incidence of shoulder pain with antegrade humeral nailing. This is the most common complication in both of these series. Nonunions are present in approximately 5% to 10% of humeral fractures treated with an intramedullary nail.

Infection has an incidence of approximately 1%.

Elbow injury is unlikely unless the nail is excessively long.

Rarely, injury to the radial nerve is possible if it is trapped in the intramedullary canal.

Best answer: D .

The patient has a displaced intra-articular tibial tuberosity fracture; therefore, the treatment of choice is open reduction and internal fixation. Periosteum is often interposed between the fracture fragments and prevents satisfactory closed reduction.

Fortunately, most patients with this injury are close to skeletal maturity and therefore, growth arrest and recurvatum are unusual.

Non displaced fractures can be treated with a cast, but displaced fractures are best treated with open reduction and internal fixation.

Intra-articular fractures can disrupt the joint surface and are sometimes associated with a meniscal tear; therefore, arthroscopy may be needed at the time of open reduction and internal fixation.

Best answer: D .

Congenital dislocation of the patella is present from birth and diagnosed in childhood. It is not reducible with the knee in extension.

Essential elements include contracture of the iliotibial band, vastus lateralis, hypoplasia of the vastus medialis, lateral insertion of the patellar tendon, decreased size of the patella, flexion contracture and valgus alignment of the knee, and hypoplasia of the patellar sulcus.

Operative treatment is usually successful, and the success rate is increased with early surgery.

Best Answer: B .

Synovial osteochondromatosis is a rare condition typically affecting middle-aged men. The computed tomogram demonstrates the osteocartilaginous nodules. Early in the disease, arthroscopic removal of loose bodies and synovectomy usually results in an acceptable outcome. In cases of progressive disease resulting in secondary shoulder arthrosis, shoulder arthroplasty may be required.

Best Answer : D .

Melorheostosis is a rare benign bone disease including dysostosis and sclerosis.

Dripping candle wax presence is a common and typical sign of melorheostosis. This sign appears as irregular hyperostosis of the cortical bone which is likened to melted wax flowing down one side of a candle.

It can sometimes cause pain, stiffness joint, or limitation of motion in the affected areas implicitly but mostly has no symptoms.

Correct Answer: A

Spinal stenosis involves narrowing of the spinal canal by a combination of factors.

Degeneration of the disk with dehydration allows loss of disk height and bulging posteriorly into the canal.

The ligamentum flavum becomes redundant at the segment due to loss of the disk height and buckling of the ligament.

Chief among the sources of compression, however, is the overgrowth of the facet joint, which acts to autostabilize the motion segment. The facets are oriented in an oblique plane, depending on the level involved.

The superior facet of the subjacent vertebral body lies anterior and lateral to its counterpart from the level above, forming a shingle configuration. The superior articular process, therefore, lies adjacent to the shoulder of the traversing nerve root and is a significant source of lateral recess stenosis.

Correct Answer: C

The lateral radiograph shows translation and kyphosis at the level of injury. The facets of C4 do not
superimpose on each to create a “double sail” sign. This patient has a unilateral facet dislocation. With
unilateral facet dislocations, there is usually 3 mm to 4 mm of forward translation and 5° to 7° of angulation.