Exam:2013 UKITE

Question 1

A sixty-eight year old female patient sustains a simple trip while doing her shopping. She
sustains a fracture of the distal radius that is dorsally displaced. It is treated with manipulation
under regional anaesthesia and a full below elbow plaster cast is applied. What factor is NOT
associated with the risk of secondary displacement.

1. Increasing age
2. Dorsal comminution
3. Associated ulnar fracture
4. Dorsal tilt over ten degrees
5. Radial shortening

Question 2

A patient slipped while cutting an object with a sharp knife and sustains a wound to the volar
surface of her left index finger. Exploration of the wound shows complete division of both FDS
and FDP tendons over the proximal phalanx. With respect to flexor tendon repair, which ONE of
the following statements is TRUE?

1. Poor tendon handling does not lead to adhesion formation

2. The number of core suture strands affects the repair strength
3. The number of grasping loops affects the repair strength
4. The tendon sheath must always be repaired
5. The digit should be immobilised for three weeks

Question 3

The rotator cuff is a group of muscles which originate from the scapula and stabilises the
shoulder. It consists of supraspinatus, infraspinatus, teres minor and subscapularis. Which nerve
supplies the teres minor?

1. Axillary nerve
2. Lower subscapular
3. Suprascapular
4. Thoracodorsal
5. Upper subscapular
Question 4

A 45-year-old man complains of tingling in the little and ring fingers of his right hand overnight.
There are no motor symptoms. Where is the most common anatomical site of ulnar nerve
compression?

1. Ligament of Struthers
2. Guyon's Canal
3. Arcade of Struthers
4. Cubital tunnel
5. Intermuscular septum

Question 5

In PCL reconstruction where should the tibial tunnel exit the tibia?

1. 20 mm below the joint line anteriorly

2. At the level of the joint line anteriorly
3. 5 - 10 mm below the joint line posteriorly
4. 10 - 20 mm below the joint line posteriorly
5. Up to 5 mm below the joint line anteriorly

Question 6

The following radiological findings in a patient with a fracture of the distal radius would prompt
surgical intervention.

1. Radial shortening of 2 mm
2. Radial inclination of 11 degrees
3. An articular step off of 1mm
4. Volar tilt of 11 degrees
5. Scapholunate angle of 45 degrees

Question 7

A 68-year-old man undergoes a total shoulder arthroplasty for osteoarthritis. He slips on the
stairs accidently, catching onto the stair railing with his operative arm 3 weeks after surgery and
thereafter complains of anterior shoulder pain. Radiographs demonstrate an anterior dislocation
of the prosthesis. What is the most likely mechanism for this complication?
 1. Long head biceps rupture
2. Supraspinatus rupture
3. Subscapularis rupture
4. Infraspinatus rupture
5. Labral tear

Question 8

A patient is found to have suffered an EPL rupture after treatment in a cast for an undisplaced
distal radius fracture. A tendon transfer of EIC to EPL is being considered. Which ONE option is
NOT a basic principle of tendon transfer?

1. The gain in function must be greater than the potential loss

2. The joint must be actively mobile
3. The motor must be of sufficient power and excursion
4. One motor per joint to be moved
5. Transfers should be synergistic

Question 9

What is the insertion of the last structure to fail in a terrible triad of the elbow (postero-lateral
dislocation of the elbow with associated radial head fracture and coronoid fracture)?

1. The antero-medial facet of the coronoid (sublime tubercle)

2. The radial tuberosity
3. The sigmoid notch
4. The supinator crest distal
5. The tip of the coronoid

Question 10

Which one of the following is the most suitable graft for a delayed flexor tendon reconstruction
of the hand?
1. Flexor carpi radialis
2. Tensor fascia lata
3. Plantaris
4. Flexor carpi ulnaris
5. Extensor digiti minimi

Question 11
A patient presents with midfoot pain and swelling after falling down stairs. The following
finding on a plain radiograph is NOT suggestive of an injury to the Lisfranc joint

1. Avulsion fracture of the second metatarsal base

2. Dorsal displacement of the first metatarsal base
3. Medial edge of the second metatarsal base aligned with medial edge of middle cuneiform
4. Medial edge of fourth metatarsal base aligned with medial edge of lateral cuneiform
5. Plantar displacement of second metatarsal base

Question 12

Which of the following nerves is LEAST useful as a nerve transfer/graft for brachial plexus
injuries?

1. Hypoglossal nerve
2. Intercostal nerves
3. Medial pectoral nerve
4. Sural nerve
5. Ulnar nerve

Question 13

Following arterial injury at the wrist, the patency of radial or ulna artery repair at follow-up is in
the region of:

1. 0%
2. 25%
3. 50%
4. 75%
5. 100%

Question 14

What structure is deep to the semitendinosis at the level of the knee joint

1. Gracilis
2. Iliotibial tract
3. Pes anserinus bursa
4. Sartorius
5. Semimembranosus
Question 15

A 10-year old girl presents with an isolated fracture to her elbow. Radiographs reveal a medial
epicondyle fracture which has 6mm of displacement. On examination, she has symptoms and
signs of ulnar nerve dysfunction. Which is the most appropriate management option?

1. Application of cast
2. MUA + application of cast
3. Closed reduction and K-wire fixation
4. Open reduction and internal Fixation
5. Excision of fragment

Question 16

What is the optimum range of pore size for cementless porous implants to allow for bony
ingrowth?

1. 10 to 50 microns
2. < 10 microns
3. 50 to 150 microns
4. 200 to 300 microns
5. 300 to 500 microns

Question 17

Regarding split thickness skin graft which one of the following is true

1. Consists of epidermis, dermis and subcutaneous fat

2. Can be used to cover exposed bone or tendon
3. The donor area heals within 5-7 days
4. Usually harvested using a specially designed knife or powered dermatome
5. All of the above

Question 18

In open fixation of talar fractures, disrupting the deltoid ligament insertion may also disrupt the
blood supply to which one of the following
 1. Head of the talus
2. Lateral talus
3. Medial body of the talus
4. Posterior body of talus
5. Sustentaculum tali

Question 19

A 45-year-old man with ankylosing spondylitis presents with fixed sagittal imbalance and
difficulty with horizontal gaze. His kyphotic deformity is localized to the thoracolumbar spine.
Which of the following procedures allows the most correction in the sagittal plane at a single
level without having to resect the intevertebral disc?

1. Smith-Petersen osteotomy
2. Pedicle subtraction osteotomy (PSO)
3. Vertebral column resection (VCR)
4. Single-level opening wedge osteotomy
5. Multi-level opening wedge osteotomy

Question 20

Following internal fixation of an intracapsular fractured neck of femur (Garden 3 or 4) what is

the rate of non-union seen at 2 years?

1. 30%
2. 90%
3. 5%
4. 10%
5. 75%

Question 21

Which one of the following nerves is at the greatest risk to be injured whilst establishing the
anterior portal used in hip arthroscopy?

1. Femoral nerve
2. Ilioinguinal nerve
3. Lateral cutaneous nerve of the thigh
4. Obturator nerve
5. Sciatic nerve
Question 22

What is the primary restraint to lateral patellar translation in the first 20 degrees of knee flexion?

1. Vastus medialis obliquus

2. Medial patello-femoral ligament
3. Femoral trochlear groove
4. Medial patellar retaniculum
5. Lateral third of patellar tendon

Question 23

Which one of the following is true regarding TLIF (transforaminal lumbar interbody fusion)?

1. Higher iatrogenic nerve root injury compared to PLIF (posterior lumbar interbody fusion)
2. Involves a wide laminectomy through the posterior approach
3. Lower fusion rates compared to posterolateral inter-transverse fusion
4. Less retraction of neural elements than PLIF
5. More destruction of posterior elements than PLIF

Question 24

In what circumstance is the use of an MRI contraindicated?

1. Intramedullary femoral nail in situ

2. Pregnancy
3. Chronic kidney disease
4. Endoscopy capsule camera in the last week
5. Recent cataract surgery

Question 25

Which muscle groups are responsible for the flexion abduction deformity of the proximal
fragment in subtrochanteric hip fractures?

1. Gluteus medius and rectus femoris

2. Gluteus maximus and gluteus medius
3. Gluteus medius and the hamstrings
4. Gluteus medius and iliopsoas
5. Rectus femoris and iliopsoas
Question 26

Which level in the cervical spine contributes the most to sagital plane mobility?

1. Occiput - C1 articulation
2. C1 - C2 articulation
3. C3 - C4 articulation
4. C4 - C7 levels
5. C7 - T1 articulation

Question 27

Which one of the following is true with regards to the approach for posterior decompression /
fusion of the thoracic spine?

1. The plane between the two erector spinae muscles is used

2. Cord can be retracted beyond mid line
3. The paraspinal muscles should not be subperiosteally stripped
4. Pedicle screws should be angled laterally at 15 degrees
5. Segmental vessels are at risk

Question 28

A 20-year old woman sustains a C6 Burst fracture after a fall from a height resulting in a
complete spinal cord injury. Which one of the following options provides optimum fracture
management?
1. Anterior corpectomy, strut grafting and instrumentation
2. Halo vest immobilisation
3. Laminectomy and posterior wiring
4. Laminectomy followed by halo vest immobilisation
5. Posterior lateral mass plating and fusion

Question 29

A 40-year old man sustains a mid diaphyseal humerus fracture which fails a trial of conservative
treatment. The fracture is subsequently treated by open reduction and internal fixation with a
dynamic compression plate. In comparison to fixing the fracture with an intramedullary nail,
plating will result in:
 1. A higher incidence of shoulder impingement
2. A lower risk of re-operation
3. A lower risk of infection
4. An increased incidence of radial nerve injury
5. An increased rate of non-union

Question 30

With regards to unifacet dislocations of the cervical spine, which one of the following is correct

1. Disc herniation usually occurs

2. Are not visible on plain x-rays
3. Requires open surgery to reduce
4. May present with torticollis following injury
5. Shows greater than a 50% listhesis in the vertebral body alignment on plain x-ray

Question 31

Which one of the following is an absolute contraindications for endoprosthetic replacement in

bone malignancy?

1. Active infection
2. Limited life expectancy
3. Metastatic disease
4. Periarticular disease
5. Inability to achieve adequate resection margins

Question 32

Which problem is most prevalent in patients with adolescent idiopathic scoliosis?

1. Difficulty with pregnancy

2. Increased risk of right sided cardiac failure
3. Increased acute and chronic back pain
4. Increased risk of cancer
5. Chronic respiratory problems in early life
Question 33

Damage to the cervical sympathetic trunk of ganglia will result in which one of the following
complication.

1. Pupillary constriction, hyperhidrosis and ptosis

2. Pupillary constriction, anhidrosis and ptosis
3. Pupillary dilatation, hyperhidrosis and ptosis
4. Pupillary dilatation, anhidrosis and ptosis
5. Enophlamos, anhidrosis and ptosis

Question 34

Regarding cervical laminoplasty, which one of the following is true

1. When performed at multiple levels cervical laminoplasty is associated with a higher rate
of post operative kyphosis than laminectomy alone
2. Cervical laminoplasty is proven to maintain range of motion post-operatively
3. The overall clinical results of cervical laminoplasty are similar to laminectomy and fusion
4. A common complication is C8 nerve palsy
5. Has been shown to prevent cervical muscle atrophy post op

Question 35

What nerve is most at risk during a Kocher approach while performing a radial head
replacement?

1. Anterior Interosseous Nerve

2. Posterior Interosseous Nerve
3. Ulnar Nerve
4. Radial nerve
5. Median Nerve

Question 36

Which of the following meniscal tears is most likely to heal with meniscal repair

1. A degenerative tear
2. A radial tear confined to the white and red-white zones
3. A radial tear extending to 5 mm from the periphery of the meniscus
 4. A central longitudinal tear 0.5 cm long
5. A peripheral longitudinal tear 1.5 cm in length

Question 37

What is the most lateral structure in the superior portion of the popliteal fossa?

1. Common peroneal nerve

2. Long saphenous vein
3. Popliteal vein
4. Short saphenous vein
5. Tibial nerve

Question 38

Which form of imaging is most sensitive for detecting labral damage following shoulder
instability?
1. Radiograph
2. MRI
3. CT
4. CT arthrogram
5. MRI arthrogram

Question 39

Injury to which nerve can commonly lead to paraesthesia lateral to a midline incision over the
knee?
1. Lateral sural cutaneous nerve
2. Common peroneal nerve
3. Obturator nerve
4. Lateral cutaneous nerve of the thigh
5. Infrapatellar branch of the saphenous nerve

Question 40

Which one of the following is true with regards central cord syndrome
 1. The most common injury mechanism is hyperflexion of the cervical spine
2. Upper limb motor function is usually relatively spared
3. The (sensory) "sacral tracts" of the spinal cord are usually affected
4. Flaccid paralysis (lower motor neurone lesion) of the upper limbs, and spastic paralysis
of the lower limbs may result
5. Is less common in patients with cervical spondylosis

Question 41

Which of the following is NOT a potential site of entrapment of the ulnar nerve at the elbow?

1. Arcade of Struthers
2. Between the two heads of FCU
3. Flexor digitorium superficialis arcade
4. Medial intermuscular septum
5. Osbourne's ligament

Question 42

With regards the anterior approach to the cervical spine which one of the following is true
1. Recurrent laryngeal nerve is more vulnerable on the left side during exposure
2. Deep dissection utilises the plane between sternocleidomastoid muscle (facial nerve) and
strap muscles (segmental innervation C1,C2,C3)
3. Sympathetic chain is at risk during deep dissection of longus colli muscles
4. Prevertebral fascia is formed by investing layer of superficial cervical fascia
5. The anterior tubercle of the transverse process of C7 vertebra (Carotid tubercle) is an
important landmark

Question 43

Regarding the Kocher-Langenbeck approach to the acetabulum which one of the following is
true
1. During the approach, the hip should be held in extension with the knee flexed
2. The superior gluteal artery is rarely at risk as it emerges beneath the piriformis muscle
3. The Kocher-Langenbeck approach is a nonextensile approach to the anterior acetabular
column
4. Detachment of the short external rotators of the hip is not required
5. In order to reduce tension on the sciatic nerve during the approach, the leg should be
adducted and internally rotated
Question 44

Regarding slipped upper femoral epiphysis, which of the following statements is true?

1. Clinical examination of the hip often elicits internal rotation during flexion
2. The condition is associated with obesity and persistent femoral anteversion
3. When pinning in situ, the screw should not enter through the anterior cortex of the
femoral neck
4. SUFE is bilateral in less than 20% of cases
5. In acute unstable slips, AVN is less common if surgery is delayed beyond 7 days after
onset of symptoms

Question 45

A 15-month old child presents febrile, non-weight-bearing and holding his hip flexed, abducted,
and external rotated. The hip is aspirated and microbiological analysis confirms septic arthritis.
What is the most common causative organism?

1. Neisseria gonorrhoeae
2. Group A Streptococcus
3. Staphylococcus aureus
4. Haemophilus influenza type B
5. Strep. pneumoniae

Question 46

Regarding the assessment of a child with in-toeing gait, which of the following statements is
true?
1. A normal foot progression angle is between 0 and -30 degrees
2. Missed slipped upper femoral epiphysis may present as in-toeing
3. Internal hip rotation should decrease as the child grows
4. Medial tibial torsion is more likely to require surgical intervention than lateral tibial
torsion
5. Treatment with reverse last shoes is often required to correct metatarsus adductus

Question 47

In a patient with vascular concerns, which of the following is NOT a reason for performing a
trans-radial amputation at the junction of the middle and distal third, rather than a more distal
site?
1. The distal subcutaneous tissue is scant and less ideal for fashioning a stump
2. The forearm skin is thinner distally
 3. Underlying soft tissue structures are relatively more avascular distally
4. Prosthesis fitting is easier
5. High incidence of complications with distal site

Question 48

In the knee, the ligament of Wrisberg runs from which structures.

1. Lateral meniscus to the medial femoral condyle
2. Lateral meniscus to the inter-condylar prominence
3. Medial meniscus to the popliteus tendon
4. Medial meniscus to the lateral femoral condyle
5. Medial meniscus to the posterior cruciate ligament

Question 49

Regarding the Kocher-Langerbeck approach to the acetabulum which one of the following is true

1. It is commonly used for anterior column fractures

2. It is performed with the patient supine
3. It does not place the superior gluteal nerve at risk
4. Further exposure can be gained by reflecting the origins of the hamstrings from the
ischial tuberosity
5. Flexing the hip draws the sciatic nerve away from the operative field

Question 50

You are asked to review a 62-year old gentleman with ankylosing spondylitis who has new neck
pain following a fall. He is tender throughout his cervical spine but has no neurological
compromise. What investigation is the most important in the inital assessment of his spine ?

1. MRI
2. CT
3. Plain Xray (AP, Lat, PEG)c-spine
4. Isotope Bone Scan
5. Plain Xray whole spine

Question 51
In total hip replacement increasing the perpendicular distance from centre line of femur to the
centre of rotation of femoral head (femoral offset) results in

1. Decreased tissue tension

2. Decreased joint reaction force
3. Decreased abductor lever arm
4. Increased body weight lever arm
5. Increased wear of polyethylene

Question 52

Which vessel is usually the most reliable for distally based fasciocutaneous flaps and should
therefore be avoided when performing fasciotomy incisions in the leg?

1. 15cm medial perforator

2. 10cm medial perforator
3. 5cm medial perforator
4. 10cm lateral perforator
5. 5cm lateral perforator

Question 53

Regarding Legg-Calve-Perthes Disease, which of the following statements is true?

1. Onset at less than six years of age is associated with a worse prognosis
2. Calcification lateral to the epiphysis is an indicator of a good prognosis
3. It would be appropriate to treat a 10 year old child with hinge abduction and a lateral
pillar classified as Herring C with a proximal femoral varus osteotomy
4. Perthes disease appears cold on an isotope bone scan
5. Herring classification can only be judged at the end of the fragmentation stage

Question 54

The activation of which factor will not be affected by Warfarin

1. Prothrombin
2. Stable Factor, Proconvertin
3. Christmas Factor
4. Factor X
5. Fibrinogen
Question 55

In an extended lateral (deltoid-splitting) approach to the shoulder, there is a significant risk of

injury to which one of the following

1. The musculocutaneous nerve

2. The long head of biceps tendon
3. The cephalic vein
4. The axillary nerve
5. The axillary artery

Question 56

Which of the following is NOT associated with childhood torticollis?

1. Plagiocephaly
2. Metatarsus adductus
3. Upper respiratory tract infection
4. Duchenne muscular dystrophy

Question 57

Haemophilia A is typically a recessive sex linked inherited condition, but what percentage of
new cases occur without a family history?

1- Zero percent
2- 0.1 percent
3- 1 percent
4- 25 percent
5- 70 percent

Question 58

Regarding lumbar spine decompression with or without fusion for degenerative spondylolisthesis
all are true EXCEPT

1- Bone regrowth was noted commonly after surgical decompression.

2- Patients who have a laminectomy and fusion do better than patients who have a laminectomy
alone.
3- Maintaining at least 50% of the facet joints and the interspinous ligaments during
decompression will help to preserve inherent stability in lumbar spine.
4- Fusion was achieved more reliably with internal fixation.
5- Using instrumentation with the fusion showed an advantage in short-term follow-up

Question 59

With regards lumbar spinal stenosis, which one of the following is FALSE?

1- Cycling relieves pain compared with walking

2- Neural dysfunction is mediated by ischaemia
3- Non-operative management inevitably results in deterioration of symptoms for the majority
of patients
4- Lateral stenosis affects the lower lumbar roots more commonly, as the foraminae are smaller
at these levels
5- There is an association with Achondroplasia

Question 60

Which one of these diagnoses predisposes the patient to lateral patellar instability?
1- Vastus lateralis dysplasia
2- Excess femoral retroversion
3- Male gender
4- Patella infera
5- Lateral femoral hypoplasia

Question 61

Which ONE of the following muscles is supplied by the FIRST branch of the lateral plantar
nerve?
1- Abductor digiti minimi
2- Abductor hallucis
3- Adductor hallucis
4- First lumbrical
5- Flexor hallucis brevis
Question 62

Sever's Disease is...

1- An osteochondrosis of the tibial tubercle.
2- A calcaneal apophysitis.
3- Avascular necrosis of the navicular.
4- Avascular necosis of the metatarsal head.
5- Stress fracture of the metatarsal.

Question 63

The vertebral body develops from which ossification centre?

1- Neural arch
2- Tip of transverse process
3- Myotome
4- The centrum
5- Notochord

Question 64

Your are the on-call Orthopaedic Doctor. You are bleeped for a trauma call in A & E resus. The
patient is a 31-year-old fit healthy male who has been involved in a RTC. He is a motor cyclist
and has been hit head on by a van travelling at 50 mph. His GCS is 11/15 and he has at least 2
open long bone fractures which you can grade at least IIIa on entering resus. As the leader of the
trauma team, your initial treatment is concerned with?

1- Fracture reduction and wound debridement

2- Airway management and cervical spine immobilisation
3- Wound coverage
4- Call for senior help
5- Urgent CT brain

Question 65

A 40-year-old man presents to your clinic 3 months after injuring his calf whilst playing squash.
An ultrasound confirms a chronic achilles tendon rupture with a 5cm gap between tendon ends.
What is the most appropriate treatment in this otherwise healthy individual?

1- Non-operative management with sequential casting technique

2- Tendon repair with 8 strand core suture
3- Gastrocnemius turndown augmented with flexor hallucis longus
4- Tendo achilles allograft
5- Gastrocnemius turndown augmented with peroneus longus tendon

Question 66

Regarding paediatric tibial eminence avulsions, which one of the following statements is true?

1. Occur most commonly in children under 8 years old

2. Meyers and McKeever Type 3 are best treated with surgical fixation
3. ACL laxity is more common in injuries managed operatively
4. The equivalent injury in an adult is a PCL tear
5. Malunion causes a block to flexion

Question 67

Regarding Darrach's procedure, which one of the following statements is true?

1. It is the surgical management of choice in chronic distal radio-ulnar joint disruption in

young, fit adults
2. The attachments of the TFCC to the carpi should be excised
3. The Henry approach provides the best access
4. It may be associated with painful subluxation of the ECU tendon
5. It may be associated with instability of the distal radius

Question 68

Which of the following hormones has the greatest effect in stimulating epiphyseal growth?

1. Testosterone
2. Oestrogen
3. Parathyroid hormone
4. Somatotropin
5. Thyroxine
Question 69

With reference to medial displacement calcaneal osteotomy as part of the treatment of flat foot
deformity, which ONE of the following is true?

1. Can be performed even in the presence of severe subtalar arthritis.

2. Can only be used to treat acquired and not congenital pes planus.
3. Converts the gastro-soleus complex to an evertor of the heel.
4. In isolation will address talar head uncovering.
5. May be used in combination with lateral column lengthening procedures to correct
forefoot abduction.

Question 70

With regards to articular cartilage repair techniques in the knee, mosaicplasty has the advantage
that:
1. Small articular cartilage defects are filled with mature hyaline articular cartilage
2. Donor site morbidity is usually not a problem
3. Enables early weight bearing and physical activity
4. It is equally successful in any age group
5. It restores the cartilage defect with uniform formation of fibrocartilage

Question 71

A 14-year girl complains of pain on the medial side of her foot. She has a normal medial
longitudinal arch. There is a tender prominence at the medial midfoot in the area of posterior
tibial tendon insertion. She can perform a unilateral heel rise without difficulty. AP and Lateral
radiographs reveal an accessory navicular. MRI scan is inconclusive. Conservative measures
have failed, what would be your most appropriate next step?

1. Flexor digitorum longus tendon transfer.

2. Kidner procedure.
3. Cobb's procedure.
4. Simple excision of the accessory navicular.
5. Tibialis posterior tendon tenosynovectomy.

Question 72

Regarding the impaired ability of elderly patients to compensate for acute blood loss, which of
the following explanations is NOT a cause?

1. Decreased beta-adrenergic receptors in the heart,

2. Decreased volume of pacing myocytes in the sinoatrial node
3. Effects of cardiotropic medications
4. Relative hypersensitivity to Antidiuretic hormone
5. Reduced creatinine clearance in the presence of near-normal serum creatinine
Question 73

Which one of the following is correct about low molecular weight heparin

1. Acts through the extrinsic pathway of the clotting cascade

2. Its use in chronic renal failure causes no concern.
3. It affects factors II, VII, IX and X to reduce coagulability
4. It is monitored by APTT
5. Principally inhibits factor Xa

Question 74

Which ONE of the following tendons lies in the groove on the plantar surface of the cuboid?

1. Flexor digitorum longus

2. Peroneus tertius
3. Peroneus brevis
4. Peroneus longus
5. Tibialis posterior

Question 75

Which statement is true regarding fasciotomy of the leg for compartment syndrome?

1. Should only be performed after compartment pressure measurement

2. BOA / Bapras guidelines recommend a 2 incision technique for leg fasciotomy
3. Does not need to be performed if there is an open wound on the leg as it decompresses
itself
4. Is only indicated for severe pain unrelieved by morphine
5. Wound can be closed primarily after releasing the fascia

Question 76

Radial nerve neuropraxia can occur following a humeral midshaft fracture. What percentage
improve within 3 months following conservative management?

1. 25 to 30%
2. 40 to 50%
3. 55 to 60%
 4. 75 to 80%
5. 85 to 90%

Question 77

A 45-year old patient is referred to you with an acutely dislocated elbow that has been reduced in
the emergency department. Which feature on the post-reduction radiographs would favour non-
operative management of this injury?

1. Osteochondral fragment under 5mm wide within the joint

2. Coronoid fracture involving 40%
3. Severely comminuted radial head fracture
4. Terrible triad
5. Abnormal appearance of the distal radio-ulnar joint

Question 78

Which ONE of the following statements is the MOST accurate regarding traumatic
osteochondral lesions of the talar dome?

1. All separate fragments are excised.

2. Berndt & Harty classification is based on the intra-operative appearance.
3. Do not warrant futher investigation.
4. Medial lesions are generally more posterior and lateral more anterior
5. Postero-medial lesions occur in dorsiflexion and inversion.

Question 79

A 25-year old previously fit and well patient is involved in a high speed RTA. His pulse on
arrival in A & E is 130 bpm, respiratory rate is 35 and he is looking very irritable. As per the
ATLS guidelines which class of shock is he in?

1. Class 1
2. Class 2
3. Class 3
4. Class 4
5. Class 5
Question 80

A 35-year old sports person is diagnosed with a cam impingement lesion of the left hip on a CT
scan performed for groin pain. What is the typical position of the hip that is likely to exacerbate
this patients symptoms?

1. Extension, abduction and internal rotation

2. Extension, adduction and external rotation
3. Flexion, abduction and internal rotation
4. Flexion, adduction and external rotation
5. Flexion, adduction and internal rotation

Question 81

You suspect a 28-year old patient has developed a DVT following a simple upper limb
procedure. You wish to investigate her for possible thrombophilia. The LEAST useful
investigation is:

1. Prothrombin time
2. Blood Film
3. D-Dimer
4. FBC
5. Thrombin time

Question 82

Which one of the following factors is believed to contribute most to fracture stability following
ORIF of the proximal humerus?

1. Increasing the plate length

2. Use of calcar screws
3. Use of diaphyseal locking screws
4. Cement augmentation
5. Additional suture fixation of the tuberosities

Question 83

Which of the following tests is postive in thoracic outlet syndrome?

1. Obrien’s test
 2. Speed’s test
3. Hawkin's sign
4. Hornblower’s sign
5. Adson's test

Question 84

In the radiographic assessment of acetabular fractures which view shows the anterior column and
posterior wall best

1. Obturator oblique view

2. Iliac oblique view
3. Pelvic inlet view
4. Pelvic outlet view
5. False profile view

Question 85

New bone growth in bone remodeling occurs by which of the following mechanisms?

1. Endochondral ossification
2. Ruffled border inhibition
3. Ossification of cartilage
4. Appositional ossification
5. Intramembranous ossification

Question 86

A 40-year old male presents with a 3 month history of right L4 radicular pain. Which
investigation has the highest specificity for diagnosing nerve root entrapment?

1. CT
2. MRI
3. Discography
4. Neurophysiology
5. Caudal injection
Question 87

The most common causative organism in deep joint infection in total hip replacement is?

1. E Coli
2. Proteus
3. Pseudomonas
4. Staph aureus
5. Staph epidermidis

Question 88

The optimal position for ankle arthrodesis is neutral flexion (plantigrade) and which ONE of the
following?

1. 5-10 degrees of external rotation and 5 degrees of hindfoot valgus.

2. 5-10 degrees of external rotation and 20 degrees of hindfoot valgus.
3. 5-10 degrees of external rotation and 5 degrees of hindfoot varus.
4. 5-10 degrees of internal rotation and 5 degrees of hindfoot valgus.
5. 20 degrees of external rotation and 10 degrees of hindfoot valgus.

Question 89

A 19-year old rugby player sustains a bifacet fracture dislocation of C4. Manipulation under
anaesthesia has failed to reduce the fracture. The most common cause of this is

1. Posterior longitudinal ligament

2. Intervertebral disc
3. Muscle interposition
4. Anterior longitudinal ligament
5. Spasm and other associated fractures / fragments

Question 90

Which ONE of the following is defined as the angle between the long axis of the talus and the
long axis of the first metatarsal.

1. Distal Metatarsal Articular Angle.

2. Meary's angle.
3. The Hallux Valgus Angle.
 4. The Hallux Valgus Interphalangeal Angle.
5. The Intermetatarsal angle.

Question 91

A 35-year-old right hand dominant labourer falls onto an outstretched thumb at work sustaining a
closed four-part intrarticular fracture dislocation of his right thumb metacarpal base. Which one
of the following options is correct?

1. This Bennett fracture requires closed reduction and thumb spica immobilisation
2. This Bennett fracture requires articular reduction and percutaneous Kirschner wire
fixation
3. This Bennett fracture requires articular reduction and internal fixation with screws or T
plate
4. This Rolando fracture requires closed reduction and thumb spica immobilisation
5. This Rolando fracture requires articular reduction and fixation

Question 92

Which of the following is not an indication for surgical treatment of a little finger metacarpal
fracture

1. Open fracture
2. Multiple metacarpal fractures
3. Displaced intra articular fracture
4. Fractures with severe soft tissue loss
5. Neck angulation of 25 degrees

Question 93

Which of the following sutures is non-absorbable?

1. Polydioxone (PDS)
2. Polyglactin (Vicryl)
3. Polypropylene (Prolene)
4. Polyglyconate (Maxon)
5. Catgut
Question 94

Which of the following statements regarding shock is FALSE?

1. Spinal shock does not refer to circulatory collapse

2. In neurogenic shock one typically encounters hypotension and bradycardia
3. Histamine and kinins released decrease capillary permeability
4. Splanchnic blood flow is decreased in hypovolaemic shock
5. A V/Q mismatch may occur in all forms of shock

Question 95

In the Smith-Peterson approach to the hip the superficial dissection exploits the internervous
plane between sartorius and tensor fasciae latae. Tensor fasciae latae is innervated by?

1. Femoral nerve
2. Inferior gluteal Nerve
3. Lateral femoral cutaneous nerve
4. Sciatic nerve
5. Superior gluteal nerve

Question 96

A patient is admitted to hospital with a closed tibia fracture and you diagnose compartment
syndrome. In theatre you decide to decompress the superficial and deep posterior compartments
through an incision 2cm behind the posteromedial border of the tibia.You do this to avoid which
one of the following

1. The dorsalis pedis artery

2. The saphenous vein and nerve
3. The superficial branch of the common peroneal nerve
4. The sural nerve
5. All of the above
Question 97

With regard to structures at risk during pelvic fracture fixation:

A : L5 nerve root
B : Femoral artery
C : Urinary bladder
D : Piriformis
E : Inferior gluteal nerve
F : Sacrotuberous ligament
G : Lateral cutaneous nerve of the thigh
H : Obturator internus
I : Sartorius
J : Posterior cutaneous nerve of the thigh

1 : Which structure is most likely to be injured during percutaneous iliosacral screw fixation?
2 : What is most likely to be injured during an anterior stabilisation of the pelvis ?
3 : Which structure is most likely to be injured during dissection around the ASIS ?

Question 98

For each of the following dislocations described, choose the ONE structure that may block
attempts at closed reduction
A : Extensor digitorum brevis muscle
B : Extensor digitorum longus tendon
C : Flexor hallucis longus tendon
D : Plantar fascia
E : Plantar plate
F : Posterior tibial tendon
G : 'Spring' ligament
H : Tibialis anterior tendon
I : Flexor digitorum longus tendon
J : Transverse intermetatarsal ligament

1 : Medially displaced ankle fracture/ dislocation.

2 : Medial subtalar joint dislocation.
3 : Dorsal dislocation of a lesser metatarsophalangeal joint.

Question 99

As per Rockwood’s classification of AC joint injuries

A : Type II
B : Type III
C : Type IV
D : Type V
E : Type VI
F : Types IV, V and VI
G : Types IV and VI
H : Type I

1 : In which type is the clavicle displaced posteriorly?

2 : Operative fixation is most commonly indicated in
3 : Operative fixation is controversial in

The Upper limb, (Nicholas Barton and Patrick Mulligan) Question 100

You are in a quiet outpatient clinic and you are being grilled by your consultant on eponymous
orthopaedic signs. Select the sign being described.
A : Trethowan's sign
B : Lasegue's sign
C : Kanavel's sign
D : Codman's triangle
E : Ortolani's sign
F : Trendelenburg's sign
G : Gage's sign
H : Dupuytren sign
I : Hueter sign
J : Gower's Sign

1 : Indicates a slipped upper femoral epiphysis

2 : Is often a sign of an osteosarcoma
3 : Would suggest a lower lumbar/sacral radiculopathy

Question 101

Which is the ONE most likely diagnosis for each scenario described below?
A : Freiberg’s disease
B : Hammertoe deformity
C : Inflammatory arthritis
D : Lis Franc fracture dislocation
E : Metatarsal stress fracture
F : Metatarsophalangeal tenosynovitis
G : Morton’s neuroma
H : Osteomyelitis
I : Pes Cavus
J : Sesamoiditis.
K : Tarsal tunnel syndrome

1 : A 45-year old lady with pain and dysasthesia in the 3rd & 4th toes, with a positive Mulder
click
2 : A 26-year old athelete with longstanding pain on weightbearing and point tenderness over the
shaft of the second metatarsal
3 : A 24-year old footballer with plantar pain on weightbearing, exacerbated with dorsiflexion of
the great toe

Question 102

Match the following physical findings to the mechanism of knee injury. Which test will be most
useful in ruling out the likely underlying injury?
A : Pivot shift test
B : Posterior sag sign
C : Valgus instability
D : McMurray's Test
E : Dial Test
F : Patellar crepitus
G : Varus instability
H : Patellar apprehension

1 : Fall onto a plantarflexed foot followed by knee swelling.

2 : Non-contact twisting injury with imediate haemarthrosis.
3 : Twisting injury to knee followed by delayed knee swelling, pain at medial joint line
4 : Bruising along medial aspect of knee following direct blow to the lateral aspect of the knee.

Question 103

Open reduction and internal fixation of acetabular fractures is complex and can result in
significant co-morbidity. The timing of intervention and its planning are vital. Please choose the
most appropriate response for the following
A : Between 2 and 10 days
B : 48 hours
C : As soon as possible
D : 3 weeks
E : 10 days
F : One month
G : 3 months
H : One week

1 : When is the optimal time to perform ORIF of an acetabulum fracture?

2 : How long should a patient be afebrile for prior to ORIF of an acetabular fracture?
3 : When is the best time to perform angiography with or without embolisation?

Question 104

Several surgical options exist in the treatment of shoulder instability. Select the most relevant
procedure for each question.
A : Bankart procedure
B : Staple capsulorrhaphy
C : Putti-Platt procedure
D : McLaughlin procedure
E : Capsular shift procedure
F : Bristow/Laterjet procedure
G : Thermal capsular shrinkage
H : Magnuson and Stack operation
I : Remplissage procedure
J : Interval release

1 : Is considered the gold standard surgical treatment for multidirectional instability

2 : Is indicated in significant anterior/inferior glenoid bone loss
3 : Is used in the reconstruction of a posterior dislocation

Question 105

What management option would be most favourable in the following circumstances?

A : Non-operative, toe-touch weight bearing
B : Non-operative, weight bearing as able
C : Percutaneous sacroiliac screw fixation
D : Open reduction and posterior plate fixation
E : Open foraminal decompression
F : Transiliac sacral bars
G : Bed rest for 6 weeks
H : Repeat imaging
I : Bone Scan
J : Lumbo-sacral fusion

1 : A 37-year old man with an undisplaced Denis (I) sacral fracture

2 : A 46-year old woman with a stable Denis (II) sacral fracture, presenting with associated
weakness in the S1 root distribution
3 : A 62-year old woman with a two week old undispaced Denis (II) sacral fracture being treated
non-operatively who has experienced increasing pain in the last 48hrs

Question 106

Regarding Lateral Epiconylitis (Tennis Elbow) match the most appropriate statement with the
possible treatment options.
A : Tubigrip
B : Off loading brace
C : NSAIDs
D : Deep tissue massage
E : Steroid injections to the common extensor origin
F : Open surgical release of common extensor origin
G : Extracorporeal Shock Wave Therapy
H : Standard physiotherapy
I : Eccentric Exercises
J : Modification of activities
1 : This is only indicated if pain has been continuing for over a year and other treatments have
been unsuccessful
2 : Recent trials have shown that this improves pain and function in the short term but increases
overall duration of symptoms
3 : This has been shown to slightly improve pain, function and grip strength in the short term but
further evidence is needed to confirm this. Side effects include reddening of the skin and pain.
4 : There have been no effective trials to show improvement but this treatment is thought to alter
the biomechanics to alleviate symptoms.

Question 107

Regarding ligaments of the foot and ankle, select the correct answer for each of the following
statements:
A : Anterior inferior tibiofibular ligament
B : Anterior talofibular ligament
C : Bifurcate ligament
D : Deltoid ligament
E : Interosseous membrane
F : Flexor retinaculum
G : Posterior talofibular ligament
H : Posterior tibiofibular ligament
I : Superior peroneal retinaculum
J : Extensor retinaculum
K : Calcaneofibular ligament

1 : This ligament secures the calcaneus to the cuboid and navicular bones anteriorly
2 : This ligament prevents subluxation of the tendons on the lateral side of the ankle
3 : The ligament most commonly torn in acute ankle sprain

Question 108

The following is a list of complications associated with an elbow dislocation. Select the
complication being described.
A : Radial head/neck fracture
B : Medial epicondyle fracture
C : Coronoid fracture
D : Varus instability
E : Median nerve injury
F : Ulnar nerve injury
G : Radial nerve injury
H : Posterolateral instability
I : Heterotopic ossification

1 : Can be assessed by asking the patient to touch the thumb to the little finger
2 : Can lead to difficulty when pushing up from a chair
3 : May prevent a closed reduction

Question 109

What is the most likely cause of osteonecrosis (avascular necrosis) for each of the cases listed
below?
A : Alcohol abuse
B : Cortisone administration
C : Cushing’s Disease
D : Freiberg’s disease
E : Gaucher’s disease
F : Osteochondritis dissecans
G : Perthes’ disease
H : Trauma
I : Septic arthritis
J : Sickle-cell disease

1 : A 6-year-old boy is referred with a painful limp. His right hip is painful with limitation of
movement in all directions. The pain has been present for 4 weeks. X-ray demonstrates increased
density at the bony epiphysis and apparent widening of the joint space.
2 : A woman of Caribbean descent is referred by her GP. She had been admitted to ITU with a
severe asthma attack some 6 weeks earlier. She had required significant mechanical and
pharmacological support but was discharged after a 3 week in-patient stay. She now complains
of pain in her left shoulder and X-rays show sclerosis and distortion of the humeral head.
3 : A woman of Ashkenazi Jewish origin is admitted with a painful left knee. Her white cell
count and CRP are moderately raised. Aspiration of her knee reveals 5mls of straw-coloured
fluid. This fails to grow any pathogen. X-rays show a flask-like appearance of her distal femur.
Her serum acid phosphatase is raised.

Question 110

Meniscal repair is indicated in young patients with peripheral longitudinal tears. Open repair is a
recognised technique. Which nerve is at risk during the following approaches?
A : Common peroneal nerve
B : Obturator nerve
C : Sural nerve
D : Femoral nerve
E : Sciatic nerve
F : Superficial peroneal nerve
G : Saphenous nerve
H : Deep peroneal nerve
I : Lateral sural cutaneous nerve
J : Tibial nerve
1 : Medial approach
2 : Postero-lateral approach
3 : Postero-medial approach

Question 111

The following patients are booked for arthroscopic removal of loose bodies from the knee. Give
the most likely diagnosis in each case:
A : Displaced medial meniscus bucket handle tear
B : Osteoarthritis
C : Synovial osteochondromatosis
D : Osteochondritis dissecans
E : Spontaneous osteonecrosis of the knee (SONK)
F : Anterior fat pad syndrome (Hoffa's disease)
G : Pigmented villo-nodular synovitis (PVNS)
H : Acute osteochondral fracture
I : Loose interference screw from prior ACL reconstruction
J : Patello-femoral dislocation

1 : 22-year-old footballer with multiple previous injuries to the same knee and a further twisting
injury. Plain radiographs reveal a lucency on the medial femoral condyle.
2 : 24-year-old waiter with exuberant synovitis and a blood-stained effusion. Well-defined
juxtacortical erosions with sclerotic margins are present on plain radiographs.
3 : 26-year-old lawyer with fine, stippled calcification around the knee present on plain
radiographs. Synovial biopsy reveals cartilaginous metaplasia.

Question 112

Regarding osteotomies around the hip joint, which of the procedures listed below is the most
appropriate for the following clinical cases?
A : Chiari osteotomy
B : Steele osteotomy
C : Ganz osteotomy
D : Dunn osteotomy
E : Imhauser osteotomy
F : Salter osteotomy
G : Pemberton osteotomy
H : Dega osteotomy
I : Fish Osteotomy

1 : A 10 year old boy with severe Perthes disease with an uncontainable femoral head due to
lateral extrusion requires a salvage procedure.
2 : A 30 year old woman with symptomatic hip dysplasia due to acetabular anteversion and
femoral head uncovering
3 : In addition to a varus derotational femoral osteotomy, a 12 year old girl with cerebral palsy
(GMFCS 3) and a painful subluxing hip requires a pelvic osteotomy to correct posterior
acetabular deficiency.

Question 113

In the context of shoulder region injuries, what is the most likely diagnosis for each of the
following scenarios
A : Fracture of the surgical neck of the humerus
B : Midshaft clavicle fracture
C : Type 3 ACJ disruption
D : Midshaft humeral fracture
E : Posterior dislocation of the glenohumeral joint
F : Scapular body fracture
G : Fracture of the anatomical neck of the humerus
H : Sternoclavicular joint dislocation
I : Type 1 ACJ disruption
J : Anterior dislocation of the glenohumeral joint
K : Coracoid fracture

1 : Young patient with a painful shoulder held in adduction & internal rotation with limited
external rotation & abduction
2 : Adducted arm, "dropped" shoulder complex with prominent lateral end of clavicle
3 : Limitation of shoulder movement, bruised, tender posterior chest wall with associated
pneumothorax

Question 114

The following questions refer to different scenarios involving clavicle fractures. What is the best
method of treatment in each case?
A : Arm sling
B : Smooth K-Wires
C : Hook Plate
D : Collar & Cuff
E : 1/3 rd Tubular Plate
F : Threaded K-Wires
G : 4.5mm Dynamic Compression Plate
H : Low Profile, Precontoured Plate
I : 3.5mm Dynamic Compression Plate

J : 3.5mm LCDCP Locking Plate

1 : A 22-year old female presents with a comminuted, shortened, midshaft clavicular fracture.
2 : A 44-year old male presents with a displaced fracture of the distal clavicle.
3 : A 26-year old professional rugby player presents with an minimally displaced midshaft
fracture of his clavicle.
Question 115

A 26-year old semi-professional footballer presents 4 weeks following a sports injury to his right
knee. Which of these clinical tests, if positive, would confirm the following pathology?
A : Increased passive external rotation of the tibia with the knee at 30 degrees flexion only.
B : Knee is flexed to 90 degrees, examiner sits on the feet and attempts to draw the tibia
anteriorly
C : The fully extended lower leg is internally rotated and a valgus force is applied to the knee.
The knee is then flexed gently.
D : With the knee in full extension a valgus force is applied
E : With the knee in 20 degrees of flexion a valgus force is applied
F : With the knee in full extension and varus force is applied
G : With the knee in 20 degrees of flexion a varus force is applied
H : The lower leg is externally rotated and a valgus force is applied to the knee. The knee is then
flexed gently
I : Quadriceps active test
J : Increased passive external rotation of the tibia with the knee at 30 degrees and 90 degrees
flexion

1 : Isolated posterolateral corner injury

2 : Isolated anterior cruciate ligament tear
3 : Isolated posterior cruciate ligament Injury

Question 116

With regards metabolic bone disease please choose the most appropriate options from below
A : Paget's Disease
B : Hyperparathyroidism
C : Osteomalacia
D : Renal osteodystrophy
E : Osteoporosis
F : Hypoparathyroidism
G : Pseudohypoparathyroidism
H : Hypophosphatasia

1 : Associated with an increase in plasma phosphate, decreased plasma calcium and increased
renal tubular reabsorption of phosphate.
2 : A combination of secondary hyperparathyroidism, osteomalacia and osteosclerosis.
3 : A condition associated with a lack of available calcium, phosphate (or both) for
mineralisation of newly formed osteoid.
4 : A condition where bone marrow is replaced by fibrous tissue and disorganised trabeculae.

Question 117

The syndromes listed are all associated with spinal abnormalities. Which corresponds best to the
following descriptions?
A : Klippel Feil syndrome
B : Turner's syndrome
C : Hurler's syndrome
D : Larsen's syndrome
E : Down's syndrome
F : Morquio's syndrome
G : Friedrich's ataxia
H : Marfan's syndrome
I : Spondylo-epiphyseal dysplasia
J : Prader-Willi syndrome

1 : C1-2 instability due to odontoid hyperplasia, proportional dwarfism, normal intelligence,

genu valgum, thoracic kyphosis
2 : Low posterior hairline, short webbed neck and reduced cervical spine range of movement
3 : Web neck, associated with idiopathic scoliosis, osteoporosis, short stature, cubitus valgus and
malignant hyperthermia

References

www.orthobullets.com

Question 118

Which is the best type of bone graft in the following cases?

A : Cancellous allograft
B : Cortical autograft
C : Cortical allograft
D : Tri-cortical graft
E : Bone morphogenetic proteins
F : Bone cement (PMMA)
G : Vascularised fibular graft
H : Xenograft
I : Fresh frozen femoral head
J : Platelet derived growth factor

1 : A scaphoid non-union in flexion

2 : Acetabular impaction grafting
3 : Excision of Ewing's sarcoma of tibia

Question 119

Which layers of the paediatric physis corresponds best to the following descriptions
A : Reserve zone
B : Proliferative zone
C : Maturation zone
D : Degenerative zone
E : Zone of provisional calcification
F : Primary spongiosa
G : Secondary spongiosa
H : None of the above
I : Epiphysis
J : Metaphysis

1 : The layer affected in achondroplasia

2 : The layer in which acute haematogenous osteomyelitis originates
3 : The layer affected in lysosomal storage disorders such as Gaucher's disease

Question 120

Regarding paediatric bone tumours, which of the following options corresponds best to the
following radiological findings?
A : Brown tumour (hyperparathyroidism)
B : Enchondroma
C : Aneurysmal bone cyst
D : Non-ossifying fibroma
E : Telangiectatic osteosarcoma
F : Giant Cell Tumour
G : Chondromyoid fibroma
H : Osteoblastoma
I : Chondroblastoma
J : Simple / Unicameral bone cyst

1 : On X-ray, a central, lytic, well-demarcated metaphyseal lesion that rarely crosses the physis,
with symmetric thinning of cortices. Dark on T1 MRI sequence, bright on T2
2 : On X-ray, an eccentric, lytic, expansive lesion with bony septae ("bubbly appearance"),
usually in metaphysis, classic cases have thin rim of periosteal new bone surrounding lesion
3 : On X-ray, an eccentric, lytic epiphyseal/metaphyseal lesion that often extends into the distal
epiphysis and borders subchondral bone, with "neo-cortex" formation. Clear demarcation on
MRI T1 sequence between tumour and marrow,

Question 121

While performing a routine knee arthroscopy, there are loose bodies. What can you do to help
retrieve these in the following situations?
A : Patella medial and lateral manipulation
B : Knee flexion, valgus and external rotation force to knee with scope looking medially
C : Knee flexion, valgus and external rotation force to knee with scope looking laterally
D : Knee flexion, varus and external rotation force to knee
E : Knee flexion, hip abduction and placing the lateral malleolus on the contralateral knee
F : Knee arthrotomy
G : Joint distraction
H : Request for x-ray guidance
I : Superolateral knee approach
J : Free drainage from an extended wound

1 : Loose body settled in posteromedial compartment

2 : Loose body settled in posterolateral compartment
3 : Multiple ‘rice-bodies’ which you encountered difficulty with using available instruments

Question 122

Choose the most appropriate treatment for the following cases of Slipped Upper Femoral
Epiphysis
A : Pinning in situ with single cannulated screw on planned list, no attempt at reduction, late
osteotomy if required
B : Pinning in situ with multiple cannulated screws on planned list, no attempt at reduction, late
osteotomy if required
C : Pinning in situ with single screw following formal closed reduction
D : Open reduction with surgical hip dislocation and long retinacular flap
E : Osteotomy on a semi-urgent list
F : Pinning in situ after 4 days bed rest, with or without 'fortuitous' reduction
G : Immediate pinning in situ on emergency list, with or without 'fortuitous' reduction

1 : 2 week history of pain, able to walk with crutches, slip angle of 50 degrees.
2 : 1 day history of pain, child can not walk (even with crutches), slip angle of 60 degrees.
3 : 5 week history of pain, child can not walk (even with crutches), slip angle of 80 degrees.

Question 123

In paediatric osteochondritis dissecans of the knee, choose the most appropriate treatment for the
following clinical scenarios
A : Microfracture
B : Autologous Chondrocyte Implantation
C : Osteochondral graft
D : Mosaicplasty
E : Arthroscopic debridement
F : Non-operative management
G : Fixation with buried variable pitch screw
H : Antegrade drilling
I : Partial resurfacing arthroplasty (eg Hemicap)
J : Allograft plug
K : Autograft OATS
L : Periosteal patch
1 : Open distal femoral physis and no fluid signal behind the lesion on MRI
2 : Unstable lesion on MRI of 2 cm square area
3 : Detached lesion of 3 cm square area

Question 124

Different imaging techniques are more sensitive at recognising orthopaedic pathology. Please
select the most appropriate from the options below.
A : Plain x-ray
B : CT scan
C : MRI scan
D : Bone scan
E : Venous duplex
F : CT myelogram
G : Arteriogram
H : CT pulmonary angiogram
I : Ultrasound

1 : A 42-year old man presents with sudden pain in his calf during his squash match
2 : An 80-year old lady with COPD complains of sudden onset chest pain and breathlessness
after her knee replacement
3 : An 8-year old boy falls off his skateboard sustaining an elbow fracture. His radial pulse is
impalpable intraopertively after fixation.

Question 125

Regarding developmental hip dysplasia, what is the most appropriate treatment in the following
scenarios
A : Application of Pavlik harness
B : Observation and ultrasound at 6 weeks of age
C : Closed reduction and hip spica
D : Medial approach open reduction and hip spica
E : Abduction 'Cruiser' splint
F : Serial casting
G : Double nappies and physiotherapy
H : Inpatient traction prior to application of Pavlik harness
I : Anterior open reduction, shortening derotation femoral osteotomy, pelvic osteotomy and hip
spica

1 : 7-month-old with dislocated but reducible hip and 'rose thorn sign' on hip arthrography
2 : 10-month-old with dislocated hip and 'hour glass appearance' on hip arthrography
3 : 'Clicky' hip found on routine baby check at birth

Question 126
The healing of fractures is influenced by a multitude of factors. What is the optimum
management for the following diaphyseal humeral fracture scenarios?
A : Treatment in a functional humeral brace
B : Antegrade humeral nailing
C : Retrograde humeral nailing
D : Exchange antegrade humeral nailing
E : Open reduction and internal fixation
F : Open reduction and internal fixation with bone grafting
G : Exchange antegrade to retrograde humeral nailing
H : Ultrasound treatment
I : Bisphosphonate treatment
J : Removal of nail followed by open reduction and internal fixation with bone grafting

1 : A thirty-year old man with an isolated fracture with minimal pain but radiographs showing no
callus formation at 6 weeks.
2 : A thirty-five year old woman treated initially with antegrade nailing after sustaining a fracture
in a simple fall. Six months after injury, she complains of pain at fracture site. Radiographs show
no evidence of callus.
3 : A twenty-five year old man 8 months since injury with pain and mobility of fracture on
examination. Radiographs show some callus initially but no progression for the last 6 months.

Question 127

For the given clinical scenario, choose the best treatment option
A : Open reduction internal fixation
B : Plate fixation using minimally invasive technique
C : Femoral nailing
D : Figure of 8 bandage
E : Closed reduction and immobilisation
F : Closed reduction K-Wire fixation
G : Temporary external fixator
H : Joint replacement

1 : A 75-year old female with a past history of chronic arthritis and bilateral THR with a
comminuted fracture (AO type C3) of the distal humerus with no neurovascular deficit
2 : A 90-year old female with severe osteoporosis and Type 2 Diabetes with a closed, displaced
supra-condylar fracture of her right distal femur fracture (AO type A3) who is neuro-vascular
intact distally.
3 : A 32-year old motor cyclist with a closed femoral shaft fracture, bilateral lung contusions and
a grade 2 splenic injury.
4 : A 27-year old motor cyclist with a displaced fracture of his clavicle and an undisplaced
fracture of his glenoid, who is complaining of intermittent tingling in thumb and index finger,
but has no motor deficit.

Question 128
Which radiological description best matches the following eponymous terms?
A : Avulsion of the base of the proximal phalanx of the thumb by the ulnar collateral ligament
B : Fracture of the anterolateral tibial epiphysis by the anterior tibiofibular ligament
C : Avulsion of the volar-ulnar corner of the 1st metacarpal base by the volar oblique ligament
D : Comminuted intra-articular fracture of the 1st metacarpal base
E : Fracture of the distal third of the humerus associated with increased risk of radial nerve injury
F : Fracture of the lateral process of the talus
G : Fracture of the radial head with longitudinal radio-ulnar dissociation
H : Fracture of the radial neck with associated posterior interosseous nerve palsy
I : Fracture of the base of the 5th metatarsal at metaphyseal-diaphyseal junction involving the
intermetatarsal joint
J : Unicondylar fracture of the distal femur in the coronal plane

1 : Holstein-Lewis fracture
2 : Tillaux-Chaput fracture
3 : Jones Fracture

Question 129

With regards to acetabular fractures, match the following statements with the correct answer.
A : Posterior Wall
B : Posterior Column
C : Anterior Wall
D : Anterior Column
E : Transverse
F : Associated Posterior Column and Posterior Wall
G : Associated Transverse and Posterior Wall
H : T-shaped
I : Associated Anterior Wall or Column and Posterior Hemitransverse
J : Both Columns

1 : Disruption of iliopectineal line on both and AP and Obturator Oblique radiographs occurs in
fractures involving
2 : The "Gull" sign (lateral spike) on obturator oblique view is characteristic of a fracture of
which part of the acetabulum?
3 : Which fracture pattern is associated with the highest percentage of good to excellent results?

Question 130

Several syndromes are associated with congenital spinal deformity. Which syndrome is
described by the following clinical features?
A : Kabuki Syndrome
B : Down Syndrome
C : Deletion 5p syndrome
D : Noonan Syndrome
E : Aarskog Syndrome
F : Wildervanck Syndrome
G : VACTERL Syndrome
H : Proteus Syndrome
I : Myerding Syndrome
J : Jarcho-Levin Syndrome

1 : Patients are born without clinical signs. Progression occurs with hemihypertrophy,
subcutaneous tumours, scoliosis and skull bony prominences
2 : Webbed neck, flat nose bridge, pulmonary valve stenosis, short stature and pectus excavatum
3 : Cat like cries in infancy, micro-cephaly and scoliosis or hemivertebrae

Question 131

Looking at the following case scenarios, please choose the best treatment from the list below.
A : Posterior Instrumentation & fusion
B : Anterior instrumentation & fusion
C : Anterior and posterior instrumentation
D : Functional bracing
E : Serial bracing
F : Reduction from posterior side, then anterior instrumentation
G : Bed rest
H : Posterior instrumentation
I : Radiotherapy

1 : An adolescent male has been diagnosed with an idiopathic thoracic scoliosis. His Cobb angle
is 55 degrees and has been deteriorating with growth
2 : A 54-year old man presents to clinic with a cervical myelopathy. MRI scans show a C5/6 disc
prolapse, with pressure on the spinal cord.
3 : A 75-year old man with known metastatic prostate cancer presents with worsening localised
pain. His MRI scan shows involvement of T5 and T6, but no significant collapse.

Question 132

Select the single best option with regards to the nerve root involved in various spinal pathologies
A : L3 nerve root
B : L4 nerve root
C : L5 nerve root
D : Both L4 and L5 nerve roots
E : Both L3 and L4 nerve roots
F : Both L5 and S1 nerve roots
G : L3, L4 and S1 nerve roots
H : None of the above

1 : Foraminal (far lateral) disc herniation at L4/5 affects this nerve root
2 : A degenerative slip at L4/5 will commonly affect
3 : Adult isthmic spondylolithesis at L5/S1 often leads to radiculopathy involving

Question 133

Please choose the most appropriate option for each of the following statements?
A : Dorsal scapular nerve
B : Suprascapular nerve
C : Axillary nerve
D : Radial nerve
E : Circumflex scapular artery
F : Suprascapular artery
G : Supraspinatus
H : Infraspinatus
I : Long thoracic nerve
J : Ulnar nerve

1 : Passes under the superior transverse scapular ligament

2 : Compression in the spinoglenoid notch will selectively affect
3 : Found in the quadrangular space
4 : Found in the triangular space

Question 134

Select the best option for each patient with a painful shoulder
A : Open rotator cuff repair
B : Arthroscopic rotator cuff debridement
C : Woodward procedure
D : Total shoulder replacement
E : Isolated humeral resurfacing
F : Isolated glenoid resurfacing
G : Pectoralis major transfer
H : Latissimus dorsi transfer
I : Reverse shoulder replacement
J : Arthroscopic rotator cuff repair

1 : A 40-year old brick-layer with a massive rotator cuff tear, atrophied supraspinatus and
infraspinatus on MRI and negative belly-press test
2 : A 75-year old female with atrophied supraspinatus and infraspinatus muscle bellies on MRI
and pseudoparalytic shoulder with proximal humeral migration
3 : A 70-year old female with no proximal humeral migration with evidence of head and
concentric glenoid wear

Question 135

Choose the most appropriate response for the following surgical approaches to the lumbar spine
A : Genito femoral nerve
B : Sympathetic chain
C : Ureter
D : L2
E : L3
F : Multifidus
G : Dorsal root ganglion
H : Dorsolumbar fascia
I : Erector spinae

1 : In the Wiltse approach this structure is at higher risk of damage

2 : In the retroperitoneal approach to the lumbar spine, this structure lies between psoas fascia
and the peritoneum and must be retracted with the peritoneum
3 : This structure is found at the lateral aspect of the vertebral bodies

Question 136

Which option is best for the management of the following injuries.

A : Primary wound closure
B : Secondary wound healing
C : Split skin graft
D : Local flap
E : Free flap
F : Second look and further debridement
G : Repeated daily wound debridements
H : Negative pressure dressings to reduce extent of soft-tissue debridement
I : Undermine tissue and skin flaps to allow primary closure
J : Remove viable bone to facilitate wound closure without tension

1 : Multiplanar degloving injury associated with an open fracture where the zone of injury is not
clearly demarcated
2 : After debridement and lower leg fasciotomies, a large tissue defect over the lower third tibia
(10cm X 15cm) needs to be dealt with
3 : After debridement a wound defect (3cm X 4cm) down to fracture site needs to be dealt (the
zone of injury is small)

Question 137

Regarding the following wrist pathologies please select the most appropriate surgical treatment.
A : Joint levelling procedure
B : Proximal row carpectomy
C : Wrist fusion
D : Arthroscopic debridement
E : Wafer procedure
F : Ulnar shortening osteotomy
G : Scapho-lunate ligament repair
H : Scaphoid non-union vascularised bone graft

1 : Stage II Kienbock's disease with ulnar negative variance

2 : Acute perilunate dislocation
3 : Watson stage III SLAC wrist

Question 138

When performing a percutaneous sacroiliac joint fixation

A : Lateral view
B : AP pelvis
C : Inlet view
D : Intraoperative CT scan
E : 3D CT scan
F : Judet views
G : Outlet view
H : Muller's view
I : Obturator Oblique view
J : Iliac Oblique View

1 : This view is used to assess the screw position in Antero-Posterior (coronal) plane.
2 : This view is a true AP view of the sacrum.
3 : This view helps to avoid screw position in the sacral foramina.

Question 139

For each of the following surgical approaches to the shoulder, identify the associated
internervous plane:
A : Axillary nerve and suprascapular nerve
B : Axillary nerve and thoracodorsal nerve
C : Axillary nerve and medial & lateral pectoral nerve
D : Axillary nerve and musculocutaneous nerve
E : There are no internervous planes for this approach
F : Radial nerve and ulnar nerve
G : Musculocutaneous nerve and radial nerve
H : Musculocutaenous nerve and ulnar nerve
I : Median nerve and radial nerve
J : Axillary nerve and infrascapular nerve

1 : Anterior (deltopectoral) approach to the shoulder

2 : Lateral approach to the shoulder
3 : Judet approach to the scapula

Question 140
With regards to type I human skeletal muscle fibres, please fill in the blanks with the most
appropriate response from the options below
A : Fast-twitch
B : Fast speed of contraction
C : Fatiguable
D : Glycolytic
E : High
F : Larger
G : Low
H : Red, fast oxidative
I : Smaller
J : White, fast oxidative

1 : Type I human skeletal muscle have …… anaerobic capacity.

2 : Type I human skeletal muscle have ….. motor units in comparison to type II muscle fibres.
3 : Type I human skeletal muscle have ….. capillary density.

Question 141

Select the ONE most appropriate syndrome or nerve entrapment suggested by each of the
following findings
A : Baxter's nerve (1st branch of the lateral plantar nerve) compression
B : Charcot-Marie-Tooth Type 1
C : Charcot-Marie-Tooth Type 2
D : Common peroneal nerve compression
E : Friedrich's ataxia
F : L5 spina bifida
G : Medial plantar nerve compression
H : Superficial peroneal nerve compression
I : Sural nerve compression
J : Tarsal tunnel syndrome

1 : Spastic cavo-varus foot with increased peroneal nerve latency

2 : Increased motor latency in abductor digiti quinti alone
3 : Increased motor latency in both adductor digiti quinti and adductor hallucis

Question 142

Regarding the treatment for nerve injuries around the shoulder, choose the most appropriate
answer for each scenario:
A : Transfer of levator scapula
B : Long thoracic nerve decompression
C : Release at spinoglenoid fossa
D : Release at suprascapular notch
E : Latissmus Dorsi transfer
F : Lesser tuberosity transfer
G : Repair of subscapularis
H : Capsular plication
I : Shoulder fusion
J : Interval release
K : Biceps tenotomy
L : ACJ Excision

1 : Accessory nerve injury

2 : Isolated infraspinatus muscle wasting
3 : Both supraspinatus and infraspinatus wasting

Question 143

For the following scenarios, choose the most appropriate treatment option
A : Coalition excision
B : Dwyer calcaneal osteotomy and posterior tibial tendon transfer
C : Lateral column lengthening
D : Medialising os calcis osteotomy and FDL to tibialis posterior transfer
E : Non operative treatment initially
F : Plantar Fascial release, dorsal closing wedge osteotomy of the first metatarsal and peroneus
longus to peroneus brevis tendon transfer
G : Split tibialis anterior tendon transfer
H : Subtalar arthroereisis
I : Subtalar joint arthrodesis
J : Triple arthrodesis

1 : A 14-year old with a talocalcaneal coalition (involving 40% of the subtalar joint surface area
on CT) after failure of non operative treatment.
2 : A 45-year old with a rigid pes planovalgus deformity without ankle involvement and after
failure of non operative management.
3 : Type 1 tibialis posterior dysfunction in a 50-year old.

Question 144

Regarding Glenohumeral stabilisers

A : Corocohumeral ligament
B : Glenoid labrum
C : Superior glenohumeral ligament
D : Middle glenohumeral ligament
E : Inferior glenohumeral ligament complex
F : Biceps tendon
G : Trapezoid ligament
H : Conoid ligament
I : Coracoacromial ligament
J : Conjoined tendon
K : Deltoid

1 : What is the primary restraint to inferior translation of the adducted arm?

2 : What is the primary restraint in external rotation of the adducted arm?
3 : What is absent in up to 30% of shoulders?
4 : What is the primary stabiliser for anterior and inferior translation in abduction?

Question 145

Which is the most appropriate definitive treatment for the following fractures of the humerus?
A : Collar and cuff
B : Functional humeral brace
C : Intramedullary nail
D : Bridging external fixator
E : Long arm cast
F : Open reduction and internal fixation
G : Broad arm sling
H : Flexible intramedullary nailing
I : Radiotherapy

1 : A 30-year-old lady with an undisplaced diaphyseal humerus fracture with associated radial
nerve palsy at presentation
2 : A 40-year-old man who presents with a displaced diaphyseal humerus fracture with normal
distal neurology, who develops a wrist drop after application of a hanging cast
3 : A 50-year-old lady with a pathological diaphyseal humerus fracture secondary to metastatic
breast carcinoma