Journal of Bone and Joint Surgery (British Volume)

CME questions April 2008

Refresh your memory with the April 2008 CME questions and then click on the link at the bottom of the page to find out the answers.

1. In a systematic review comparing the use of spanning external fixation with sparing external fixation in the management of fractures of the tibial plafond, which of the following best represents findings of the review?
1. After spanning external fixation nonunion, malunion and minor infections are more common than after sparing external fixation
2. After spanning external fixation malunion and nonunion are more common than after sparing external fixation but there is no difference in minor infection rate
3. After spanning external fixation malunion is more common and minor infection less common than after sparing external fixation but the nonunion rate is no different
4. After spanning external fixation malunion is less common but minor infections are more common than after sparing fixation, whilst the nonunion rate is no different
5. After spanning external fixation nonunion, malunion and minor infections are less common than after sparing external fixation
2. Which of the following patients has the greatest ongoing risk of developing lymphoma?
1. An osteoarthritic patient with bilateral metal-on-polyethylene total hip replacements
2. A patient with rheumatoid disease with a ceramic-on-polyethylene total hip replacement
3. A patient with rheumatoid disease taking anti-TNF treatment who is being considered for total hip replacement
4. A patient with Sjogrens syndrome who is being considered for total hip replacement
5. A patient with osteoarthritis who has undergone a unilateral metal-on-metal (Cobalt-chrome-moly alloy) total hip replacement
3. Which of the following is the least significant immunological risk factor for patients being considered for metal–on–metal hip replacement?
1. Female gender
2. Advanced rheumatoid disease
3. Ongoing anti-TNF treatment
4. Severely impaired renal function
5. Systemic connective tissue disease
4. What is the most important parameter determining the quality of data in a national joint registry?
1. The number of procedures entered per year
2. The proportion of qualifying procedures carried out that are entered into the register
3. The range of prostheses used in that country
4. The number of different prostheses implanted above a threshold frequency
5. The availability of adequate rehabilitation services
5. Which of the following is not indicated in the treatment of posterolateral instability of the elbow?
1. Grafting palmaris longus between the lateral epicondyle and supinator crest of the ulna
2. Grafting to restore the coronoid process
3. Imbrication of the lateral ligament complex
4. Excision of the radial head
5. Arthroscopic electrothermal shrinkage of the lateral ligament
6. After total hip replacement, when is the peak incidence of mortality and from what cause?
1. On the day of surgery due to a thrombotic event
2. Within the first 48 hours of surgery due to cardiac complications
3. Within the first 5 days due to respiratory infection
4. 7 to 14 days after surgery due to cardiorespiratory failure
5. 10 to 21 days after surgery due to a thrombotic event
7. Select the least appropriate statement from the list below concerning thromboprophylaxis for patients with a demonstrable risk of thromboembolism
1. It should only be used if it does not introduce equal or greater complications that it is devised to prevent
2. It should be started when the risk of bleeding complications has reduced, approximately 2 days after surgery
3. It should start in as close temporal relationship to the thrombogenic insult as possible
4. It should be continued until the risk of thromboembolist reduces to a clinically negligible rate
5. Administration should depend on a consideration of the patients own risk factors
8. Which of the following represents the most common pattern of blood supply to the lunate?
1. A single palmar vessel
2. A single dorsal vessel
3. Palmar and dorsal vessels with independent territories
4. Palmar and dorsal vessels with an area of independent territory for the dorsal vessel but anastamoses elsewhere
5. Palmar and dorsal vessels with anastamoses and no independent territory
9. Where is the greatest proportion of total load transmitted across the normal wrist?
1. Between distal pole of scaphoid and radial styloid
2. Between proximal pole of scaphoid and scaphoid fossa of distal radius
3. Between the lunate and lunate fossa of the distal radius
4. Between the lunate and triangular fibrocartilaginous complex
5. Between the lunate and ulnar styloid process
10. According to Lichtman, how would the following description of carpal changes be classified: there is collapse of the lunate but carpal height is preserved and there is no fixed palmar flexion of the scaphoid.
1. Stage I
2. Stage II
3. Stage IIIA
4. Stage IIIB
5. Stage IV
11. Which of the following is the least common as a cause of pain after knee replacement?
1. Infection
2. Patellar problems
3. Maltracking
4. Soft-tissue impingement
5. Prosthetic loosening
12. Which of the following is the least common cause of pain in the first month after knee replacement?
1. Infection
2. Stress Fracture
3. Prosthetic malalignment
4. Soft-tissue impingement
5. Instability with poor soft tissue balancing
13. Which of the following factors is most prevalent in patients with significant pain 12 months after knee replacement?
1. Infection
2. Patellar fracture
3. Malalignment
4. Diabetes
5. History of pre-operative depression and anxiety
14. What is most commonly seen to occur on plain radiographs as a femoral component of a total knee replacement loosens?
1. The implant tips into flexion
2. The implant tips into extension
3. The implant drifts into varus
4. The implant drifts into valgus
5. The implant maintains alignment but the joint line alters due to shortening
15. What is most commonly seen to occur on plain radiographs as a tibial component of a total knee replacement loosens?
1. The implant tips into flexion
2. The implant tips into extension
3. The implant drifts into varus
4. The implant drifts into valgus
5. The implant maintains alignment but the joint line alters due to shortening
16. After injection of the radioactive tracer when performing a bone scan, after what interval do the scans obtained demonstrate the relative vascularity of the tissue or region under investigation?
1. During injection of the tracer
2. Within a minute of the injection
3. 5 minutes after the injection
4. 1 to 2 hours after the injection
5. 24 hours after the injection
17. How long after hip replacement does a technetium bone scan return to normal?
1. 3 weeks
2. 6 weeks
3. 3 to 6 months
4. 6 to 12 months
5. Never
18. How long after knee replacement does a technetium bone scan return to normal?
1. 3 weeks
2. 6 weeks
3. 3 to 6 months
4. 6 to 12 months
5. Never
19. Which of the following statements is the least accurate after knee replacement?
1. Osteolysis due to polyethylene debris on bone scans has the same appearance as infection
2. The lack of increased uptake in the first 2 phases of a technetium scan mitigates strongly against infection
3. There can be a physiological increase in uptake of indium around a healthy prosthesis when indium labelled white cells are injected
4. A positive indium labelled white cell scan is of limited values
5. A negative indium labelled white cell scan is of limited use in ruling out infection
20. To what does the concept of a ‘phantom joint’ refer?
1. The perception of arthritic pain distal to the radiologically affected joint
2. The perception of pain attributed to arthritis in a joint that is radiologically normal
3. The continued perception of pain in an arthritic joint after replacement, probably due to centrally mediated mechanisms
4. The disproportionate pain reported after surgery that has a negative influence on outcomes in patients pursuing compensation claims
5. A joint affected by skin colour and temperature changes with burning pain and stiffness after radiologically successful joint replacement

Find the answers to the April CME here.
Feel ready for the next challenge? Take July's CME here