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Journal of Bone and Joint Surgery (British Volume)

CME questions January 2008

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

  1. What is the principal cause of avascular necrosis of the femoral head in patients after renal transplantation?
    1. Azathioprine therapy
    2. Chronic steroid use
    3. Cyclosporine A therapy
    4. Hyperlipidaemia
    5. Secondary Hypoparathyroidism
  2. Two weeks after renal transplantation a patient develops early changes of avascular necrosis of the femoral heads visible on an MRI scan. Which of the following statements is not correct?
    1. Early changes are indicative of progressive disease
    2. Discontinuing steroid use will not prevent progression of the avascular necrosis
    3. SPECT is more sensitive than MRI at picking up avascular necrosis after renal transplantation
    4. The changes can progress to become critical changes by three months after transplantation
    5. Two weeks is too early for the avascular necrosis to be related to the renal transplant
  3. Concerning experimental work on fracture healing in diabetic animals, which of the following statements is not correct?
    1. Delivering insulin to the fracture site has no effect on fracture healing in diabetic animals
    2. In the early phases of healing there is a 50% reduction in the collagen content of callus in diabetic animals
    3. Once fracture has occurred, healing is improved with better glycaemic control
    4. The DNA content of callus is less in diabetic animals
    5. Two weeks after fracture, the callus from diabetic animals has lower tensile strength and stiffness
  4. What is the risk of nonunion in a patient suffering injury to one or two of the three main limb vessels at the time of tibial fracture compared with an individual with all three vessels intact?
    1. Thirty times greater risk with vessel injury
    2. Ten times greater risk with vessel injury
    3. Three times greater risk with vessel injury
    4. No difference
    5. Nonunion is less common if vessel injury occurs, provided at least one vessel is intact
  5. Which of the following age-related effects on fracture healing in rats has been shown experimentally not to occur in humans?
    1. Delayed onset of periosteal reaction
    2. Delay in cell differentiation
    3. Delayed angiogenesis
    4. Protracted period of endochondral ossification
    5. Impaired bone remodelling
  6. Which of the following statements concerning fracture healing in diabetic patients is incorrect?
    1. Decreased expression of platelet derived growth factor has been implicated as a cause of reduced cell proliferation in the early stages of healing
    2. Once a fracture has occurred, glycaemic control has no effect on healing
    3. The consequences of diabetes on bone healing are thought to be related to inhibition of growth factors
    4. There is a higher incidence of delayed and nonunion in diabetic patients
    5. The time to healing is approximately doubled in diabetics compared with non-diabetic patients
  7. Which of the following is least likely to be associated with delayed fracture healing?
    1. Hypothyroidism
    2. Iron deficiency anaemia
    3. Long term corticosteroid treatment
    4. Non-steroidal anti-inflammatory treatment
    5. Statin treatment for hyperlipidaemia
  8. Which of the following agents that might be administered to patients after fracture has presently not been shown to impair fracture healing in animal models?
    1. Ciprofloxacin
    2. Gentamicin
    3. Heparin
    4. Tetracycline
    5. Warfarin
  9. Which of the following statements concerning low energy tibial shaft fractures in smokers is true?
    1. Fractures occur with the same incidence as non-smokers, but healing takes 4 times as long
    2. Fractures occur with the same incidence as non-smokers and the healing rate is not significantly different
    3. Fractures are 1.5 times more common in smoker and take twice as long to heal
    4. Fractures are 4 times more common in smokers and the rate of healing is not significantly different
    5. Fractures are 4 times more come in smokers and healing takes significantly longer
  10. Which of the following cell types produces cytokines in response to trauma?
    1. Endothelial cells
    2. Erythrocytes
    3. Myocardium
    4. Pulmonary alveocytes
    5. Striated muscle cell
  11. Which of the following is encoded as two sequences on the same chromosome?
    1. Interferon gamma
    2. Interleukin-1beta
    3. Interleukin-6
    4. Interleukin-10
    5. Tumour necrosis factor
  12. Which of the following has been most closely linked to the development of a systemic inflammatory response syndrome and to the outcome of trauma and sepsis?
    1. Interferon gamma
    2. Interleukin-6
    3. Interleukin-18
    4. Platelet count
    5. Tumour necrosis factor
  13. If a study investigating the effects of weakly penetrant genes is underpowered, what is the significant error that can occur?
    1. False negative
    2. False positive
    3. Observer bias
    4. Reporting bias
    5. True negative
  14. Which of the following statements concerning intramedullary veins is incorrect?
    1. Centrifugal flow is unrestricted
    2. Intramedullary flow depends on local pressure
    3. There are more veins than arteries in the medullary canal
    4. Veins have approximately six times the diameter of arteries
    5. Venous outflow is via the nutrient vein
  15. After experimental ligation of the femoral vein there is no real change in muscle blood flow in the lower limb – what happens concurrently in the intramedullary circulation?
    1. There is a period of stasis
    2. Flow falls to a tenth of its normal value
    3. Flow falls to half its normal value
    4. There is no change
    5. There is hyperaemia
  16. What is the normal intramedullary pressure in the femora of man, measured experimentally??
    1. 0 to 4 mmHg
    2. Approx. 5 mmHg
    3. Approx. 15 mmHg
    4. Approx. 35 mmHg
    5. Approx. 65 mmHg
  17. At which of the following stages during reaming of a femur with a mid shaft fracture does the highest intramedullary pressure occur?
    1. On opening the canal with an awl
    2. On passage of the guidewire
    3. On passing the first reamer towards the isthmus
    4. On passing the first reamer into the distal fragment
    5. On passing the largest reamer to be used across the fracture site
  18. What is the critical temperature for thermal injury to bone?
    1. 46 °C
    2. 51 °C
    3. 56 °C
    4. 61 °C
    5. 70 °C
  19. When reaming a bone during exchange nailing for non-union, when can reaming cease?
    1. When a reamer 1 mm greater in diameter than the removed nail has been used
    2. When a reamer 1 mm greater in diameter than the nail to be used has been employed, the replacement nail being 2 mm greater in diameter than the removed nail
    3. When a reamer 4 mm larger than the removed nail has been used
    4. When osseous tissue appears in the reamer flutes
    5. When the thinnest part of remaining cortex measures 1 mm
  20. What is meant by the term ‘neuronal plasticity’ in reference to brain injury?
    1. Manipulating tissue turgor to reduce secondary injury
    2. The ability of nerve roots to course around fragments of bone in the canal where cord transection has occurred
    3. The ability of areas of the brain in the opposite hemisphere to assume functions previously assigned to areas of brain that have been destroyed by injury
    4. The compliance of brain tissue
    5. The establishment of new neuronal connections in the white matter after injury
  21. What cell type is predominant in a glial scar?
    1. Angiocytes
    2. Astrocytes
    3. Neurons
    4. Neutrophils
    5. Oligodendrocytes
  22. Which of the following experimental treatments promote axonal regeneration, rather than remove an inhibitory influence?
    1. Anti Nogo
    2. ATI355
    3. Cethrin
    4. Chondroitinase
    5. Olfactory ensheathing cell transplantation
  23. At what age does a dramatic reduction in central nervous system plasticity occur?
    1. 6 months
    2. 2 years
    3. 6 years
    4. 12 years
    5. 20 years
  24. Regeneration of what proportion of corticospinal tract axons has been associated with improved forepaw function in rats?
    1. 0.1%
    2. 1%
    3. 5%
    4. 10%
    5. 25%
  25. What happens to the weight of a muscle as a consequence of changes in extracellular fluid distribution after vigorous exercise?
    1. Fluid is extruded resulting in a 10% decrease in weight
    2. There is no change in muscle weight
    3. There is an approximately 10% increase in weight
    4. There is an approximately 20% increase in weight
    5. There is an approximately 33% increase in weight

    Find the answers to the January 2008 CME here.
    Feel ready for the next challenge? Take July's CME here
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General