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Journal of Bone and Joint Surgery (British Volume)

CME questions April 2006

These papers have been set on the review articles and aspects of current management papers from the 2006 January, February and March issues of the JBJS-Br.

  1. Which of the following tests will detect the changes of heterotopic ossification after joint replacement earliest?
    1. Isotope Bone Scan
    2. Plain X Ray
    3. Venous BMP-4
    4. Venous CTX-1
    5. Venous PGE2
  2. Which of the following is not a risk factor for the development of heterotopic ossification around the hip after surgery ?
    1. Cemented implant
    2. Male sex
    3. Osteonecrosis
    4. Pagets disease
    5. Post traumatic arthritis
  3. On a plain AP X Ray taken 6 months after hip replacement, heterotopic bone is seen, with bony spurs forming only from the region of the acetabulum, with none apparent on the greater trochanter. The gap between the spurs and the outline of the greater trochanter is measured as 9mm. What Brooker grade would you assign?
    1. Grade 0
    2. Grade 1
    3. Grade 2
    4. Grade 3
    5. Grade 4
  4. Which cell is implicated in the genesis of heterotopic ossification
    1. Circulating macrophage
    2. Osteoblast
    3. Osteocyte
    4. Pluripotential mesenchymal stem cell
    5. Vascular endothelial cell
  5. Which movement improves most after excision of symptomatic heterotopic bone following hip replacement
    1. Abduction
    2. Adduction
    3. External rotation
    4. Flexion
    5. Internal rotation
  6. Which of the following statement correctly summarises the action of bisphosphonates when used as prophylaxis for heterotopic ossification after total hip replacement
    1. They increase the extent of heterotopic bone formation
    2. They have no effect on the appearance of heterotopic bone
    3. They delay the appearance of heterotopic bone until treatment is stopped
    4. They reduce the eventual extent of heterotopic bone formation if given for 6 months
    5. They prevent the formation of heterotopic bone
  7. Which of the following is the most effective form of prophylaxis against heterotopic ossification after hip replacement?
    1. Aspirin 75mg daily
    2. Ibuprofen 400mg thrice daily
    3. Indomethacin 25mg thrice daily
    4. Radiotherapy 7Gy 24hrs post-op
    5. Radiotherapy 7Gy 24 hrs pre-op
  8. Internalisation of which of the following is not facilitated by the transferrin receptor?
    1. Al III
    2. CrIII
    3. CrIV
    4. CrV
    5. FeIII
  9. Which of the following does not occur in response to circulation metal ions from orthopaedic implants?
    1. Depression of circulating CD20+ B cells
    2. Direct immunotoxicity
    3. Increased circulating CD8+ T cells
    4. Modification of cytokine release
    5. Reduction in circulating lymphocytes
  10. Which of the following statements is incorrect?
    1. An increased incidence of chromosomal aberrations has been found in the peripheral lymphocytes of arthroplasty patients
    2. Chromosomal aberrations in circulating lymphocytes result in a higher incidence of haematological malignancies
    3. Metal-induced DNA damage may lead to carcinogenesis
    4. Nordic THR patients show a small but significant excess in the incidence of various cancers, including malignant melanoma
    5. The International Agency for Research on Cancer has classified Cr(VI) and Ni(II) as carcinogenic
  11. Which of the following metals, used in orthopaedic alloys and implants, does not generate reactive oxygen species in vivo
    1. Aluminium
    2. Cobalt
    3. Chromium
    4. Nickel
    5. Titanium
  12. What is the characteristic pattern of inflammation in the tissues around a loose metal-on-metal prosthesis
    1. Giant cells scattered through the membrane
    2. Lack of any cellular inflammatory response
    3. Neutrophil migration through local capillary walls
    4. Perivascular lymphocyte infiltration with accumulation of plasma cells
    5. Reticulated giant cells in aggregates around metal particles
  13. Which of the following bone grafting materials is osteogenic
    1. Autogenous cancellous bone
    2. Bioglass
    3. Ceramic
    4. Demineralised bone matrix
    5. Freeze dried cancellous bone
  14. Application of which technology allows a reduction in the time between harvesting of a femoral head and its safe use as fresh frozen graft
    1. Enzyme linked immunosorbent assay
    2. Mass spectrometry
    3. Nucleic acid amplification
    4. Northern blotting
    5. Reverse transcriptase assay
  15. Which of the following infective agents has not, so far, been documented to transmit from human to human via bone grafts
    1. Creutzfeldt-Jakob disease
    2. Hepatitis B
    3. Hepatitis C
    4. HIV
    5. Staphylococcus Aureus
  16. Which of the folowing processes improves the osteoconductive properties of corticocancellous bone graft
    1. Delipidation
    2. Freeze drying
    3. Hydrogen peroxide treatment
    4. Machining into shapes with larger surface areas
    5. Rhesus factor matching
  17. Which of the following is not virucidal when used during the preparation of bone for grafting
    1. Acetone
    2. Ethanol
    3. Ether
    4. Hydrogen Peroxide
    5. Radiation at 25kGy
  18. Which of the following is absent from demineralised bone matrix
    1. Bone morphogenetic proteins
    2. Calcium sulphate
    3. Glycoprotein
    4. Proteoglycans
    5. Type I collagen
  19. Which of the following is not observed when using a step cut technique at the junction between host bone and a massive allograft, followed by internal fixation
    1. Better rotational control
    2. Greater surface area of contact
    3. Improved probability of union
    4. Improved union rates if gap between bone ends is less than 3mm
    5. Nonunion rates of 10% or more
  20. Which structure is thought to act in concert with the vastus medialis obliquus muscle as a combined dynamic unit, stabilising the patella during knee flexion
    1. Lateral sided fascial system
    2. Medial patellofemoral ligament
    3. Patellar tendon
    4. Patellomeniscal ligament
    5. Patellotibial ligament
  21. Which of the following procedures would be most appropriate for symptomatic patellofemoral instability with degenerative disease affecting both surfaces of the patellofemoral joint on arthroscopy
    1. Distalisation of the tibial tubercle
    2. Extended extrasynovial lateral release
    3. Lateral release with tibial tubercle elevation
    4. MPFL reconstruction with semitendinosus
    5. Trochleoplasty
  22. For which of the following is there least evidence for a beneficial effect when used to irrigate open fractures
    1. 1% aqueous betadine solution
    2. Lavage with fluid from a hand-held bulb syringe
    3. Normal Saline solution
    4. Pulse lavage at 75psi
    5. Soap solution
  23. Which of the following is not a normal step in the process of longitudinal growth at an epiphyseal plate
    1. Hypertrophic chondrocytes mineralise the transverse septae
    2. MMP expressing cells facilitate vascular invasion
    3. MMP expressing cells facilitate removal of apoptotic chondrocytes
    4. Osteoblastic cells lay down new bone on mineralised chondral remnants
    5. Proliferating chondrocytes produce a non-mineralised cartilage scaffold
  24. Which of the following is an anti-catabolic treatment in securing fracture union
    1. Autologous bone graft
    2. Bone morphogenetic protein
    3. Distraction osteogenesis
    4. Mesnchymal stem cell treatment
    5. Nitrogen containing bisphosphonates
  25. Which of the following is an anabolic agent in the context of experimental fracture healing
    1. Alendronate
    2. Cathepsin K inhibitors
    3. Denosumab
    4. inhibitors of ?v?3 integrin
    5. OP-1

Here are the answers to the April 2007 CME test paper.
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General