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Journal of Bone and Joint Surgery (British Volume)

CME questions July 2008

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

  1. Which of the following is the prime function of the tibiofibular interosseous membrane?
    1. Prevention of inferior tibiofibular diastasis
    2. Prevention of posterior bowing of the fibula during weight bearing
    3. Provision of an adequate area for attachment of the peroneal muscle group
    4. To limit the effect of compartment syndrome by separating the peroneal and superficial posterior compartments
    5. Transmission of a vascular supply to the distal 1/3 of the tibia
  2. Which ankle ligament forms a labrum that effectively deepens the articular surface of the distal tibia?
    1. Anterior tibiofibular ligament
    2. Calcaneofibular ligament
    3. Deep posterior tibiofibular ligament
    4. Interosseous tibiofibular ligament
    5. Superficial posterior tibiofibular ligament
  3. Which of the following statements concerning ankle movement is incorrect?
    1. As the ankle moves from full plantar flexion to full dorsiflexion the mortise widens by 1.5 mm
    2. During dorsiflexion the talus must supinate
    3. During normal walking up to 6° of rotation of the tibia on the talus occurs
    4. During plantar flexion the talus rotates internally
    5. Increasing plantarflexion results in increased wedging between the posterolateral trochlea and lateral malleolus
  4. Which of the following investigations has the highest diagnostic accuracy for tibiofibular syndesmotic injury?
    1. Ankle arthroscopy
    2. Anteroposterior radiograph
    3. Fluoroscopic examination with external rotation
    4. Mortise view radiograph
    5. MRI
  5. Which of the following results in the worst predicted outcome after syndesmotic injury?
    1. Associated medial malleolar fracture
    2. Associated ankle dislocation
    3. Inaccurate reduction of the syndesmosis before fixation
    4. Multiple fibular fractures
    5. Syndesmotic widening before reduction of > 1.5 cm
  6. What is the estimated half life for the turnover of type II collagen in articular cartilage?
    1. 1 year
    2. 5 years
    3. 10 years
    4. 25 years
    5. 100 years
  7. What is the likely function of Type VI collagen in articular cartilage?
    1. Forms rope like fibrils to increase tensile strength
    2. Mineralisation of cartilage
    3. Provides attachment for chondrocytes to matrix
    4. Provides cross links or bridges between type II molecules
    5. Stabilises proteoglycan molecules
  8. According to the Osteoarthritis Research Society International grading system, which description below best fits grade 4?
    1. Surface intact with matrix oedema, cell death with concomitant proliferation in clusters
    2. Surface and matrix discontinuity in superficial zone, cell death, proliferation and hypertrophy
    3. Vertical fissures into mid-zone, branched fissures, cell death, proliferation and hypertrophy
    4. Erosion, matrix loss with delamination, mid-layer cyst formation and excavation of superficial/mid-zones
    5. Denudation with sclerotic bone or reparative tissue (fibrocartilage) at surface
  9. Which MR imaging technique has shown potential to diagnose early osteoarthritis before structural deterioration, predict the likelihood of failure of periacetabular osteotomy for dysplasia and allow differentiation of disease within a single radiological grade?
    1. dGEMERIC
    2. FAST scan
    3. Sodium MRI
    4. T1 in the rotating frame
    5. T2 relaxation time mapping
  10. Which of the following biomarkers is being investigated as an indicator of aggrecan turnover?
    1. CTX-II
    2. C-Reactive Protein
    3. Cartilage Oligomeric Matrix Protein
    4. Helix-II
    5. Serun hyaluronan
  11. What radiological finding is pathognomic of a scapulothoracic dissociation?
    1. Coracoid fracture with shoulder dislocation
    2. PInferior depression of the coracoid by > 5 cm with respect to clavicle
    3. Ipsilateral acromioclavicular dislocation and glenohumeral dislocation
    4. Shoulder dislocation associated with clavicle fracture
    5. Widened scapular index
  12. What is pseudodislocation of the acromioclavicular joint?
    1. An acromioclavicular joint with a lax capsule, such that reduction is easily effected by the ‘piano key’ manoeuvre
    2. Constitutional prominence of the joint, usually symmetrical
    3. Displacement of the distal clavicle in children leaving an intact periosteal sleeve and coracoclavicular ligaments
    4. Painful prominence of the acromioclavicular joint due to crystal arthropathy
    5. Swelling caused by ejection of a shoulder effusion through a degenerate acromioclavicular joint
  13. Which of the following structures is not part of the superior shoulder suspensory complex?
    1. Acromioclavicular ligament
    2. Coracoclavicular ligaments
    3. Coracoid process
    4. Distal clavicle
    5. Superior glenoid
  14. A patients arm is elevated to 90° and adducted by 15°. With the forearm in pronation, downward pressure is applied to the hand and the patient reports pain felt deep within the shoulder. What pathology does this suggest may be present?
    1. Acromioclavicular joint arthritis
    2. Acromioclavicular sprain
    3. HAGL lesion
    4. Multidirectional instability
    5. SLAP lesion
  15. Which of the following has the strongest association with the development of neuralgic amyotrophy?
    1. Infection
    2. Pregnancy
    3. Recent immunisation
    4. Recent strenuous exercise
    5. Recent surgery, even remote from the shoulder girdle
  16. Which investigation is most useful in the diagnosis of neuralgic amyotrophy?
    1. Chest radiograph
    2. Conventional MRI of the shoulder
    3. Gadolinium enhanced MRI of the brachial plexus
    4. Nerve conduction studies after 4 weeks
    5. Serum Liver enzyme estimation
  17. Which of the following statements least accurately reflects current evidence concerning the effect of lumbar disc pathology on nerve function?
    1. Mild motor paresis occurs in about 50% of cases of lumbar diac herniation
    2. Mild to moderate paresis will recover after surgery in 75% of cases and most of this recovery will occur during the first year
    3. Where mild to moderate weakness fails to improve there is little detriment to late function and quality of life
    4. Marked extensor weakness (including complete footdrop) occurs in 5% to 10% of cases and all will recover with or without treatment
    5. In those with severe extensor weakness, especially painless footdrop, discectomy does not improve the outcome
  18. Which muscle is most important in stabilising the sternoclavicular joint?
    1. Clavicular head of pectoralis major
    2. Deltotrapezius
    3. Sternomastoid (clavicular head)
    4. Sternomastoid (sternal head)
    5. Subclavius
  19. Which of the following is the strongest passive stabiliser of the sternoclavicular joint?
    1. Costoclavicular ligament
    2. Inferior sternoclavicular joint capsule
    3. Interclavicular ligament
    4. Intra articular disc ligament
    5. Sternomastoid aponeurosis
  20. A 40-year-old woman presents with pain and swelling at the medial end of the clavicle. MRI shows patchy enhancement of the medial clavicle on T2 images but the sternoclavicular joint appears normal. Which of the following is the most likely diagnosis?
    1. Condensing osteitis
    2. Ewings sarcoma
    3. Friedrich’s disease
    4. SAPHO syndrome – stage 1
    5. SAPHO syndrome – stage 3
  21. Concerning outcome measures, which of the following cannot be measured with a statistical test?
    1. Construct validity
    2. Content validity
    3. Criterion validity
    4. Reliability
    5. Reproducibility
  22. Which of the following is not one of the dimensions that the WHO recommended for assessment in generic quality of life surveys?
    1. Function
    2. Pain perception
    3. Physical health
    4. Psychological health
    5. Social relationship perceptions
  23. Which of the following statements concerning the SF-36 survey is incorrect?
    1. Each question has a choice of 2 – 6 answers
    2. assesses the patient at the moment of time at which it is administered
    3. It is suitable for self-administration
    4. Questions cover 8 health concepts
    5. Scores are aggregated without weighting
  24. Which of the following can contain a visual analogue assessment of pain?
    1. EuroQol
    2. Nottingham Health Profile
    3. SF12
    4. SF36
    5. WOMAC
  25. Which of the following is a criterion for a positive score in the Post Operative morbidity survey?
    1. Clinical chest infection with positive sputum culture
    2. Intolerance of enteral diet for any reason
    3. Pre-operative presence of neurological deficit due to stroke
    4. Serous wound leakage
    5. Severe headache after spinal anaesthesia

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