Journal of Bone and Joint Surgery (British Volume)

CME questions July 2009

Refresh your memory with the July 2009 CME questions and then click on the link at the bottom of the page to find out the answers.

1. What grade of tibial plateau fractures, according to the Schatzker classification, is most commonly associated with injury to the menisci and ligaments of the knee?
1. II
2. III
3. IV
4. V
5. VI
2. With which of the following associated injuries is anteromedial compression fracture of the tibial plateau most strongly associated?
1. Medial meniscal tear
2. Lateral meniscal tear
3. Anterior cruciate ligament rupture
4. Posterior cruciate ligament rupture
5. Posterolateral corner injury
3. Which of the following factors is most useful in determining whether a separate medial plate will be required when a bicondylar tibial plateau fracture has been fixed using a lateral locking plate?
1. The degree of lateral depression that has been corrected
2. The volume of bone graft used
3. The degree of accurate cortical contact between fracture fragment and metaphyseal bone medially
4. The number of locked screws in the subarticular zone
5. The distance between medial joint line and the medial metaphyseal fracture line at the medial cortex
4. According to the Schatzker classification, which of the following tibial plateau fracture types is most suitably treated by arthroscopic techniques?
1. I
2. II
3. III
4. IV
5. V
5. When using an Ilizarov frame to treat tibial plateau fractures, how far away from the joint line as a minimum should wires be placed to avoid an increased risk of septic arthritis?
1. Below the level of the tip of the fibula
2. Distal to the proximal end of the patellar tendon insertion
3. Distal to the MCL attachment
4. 5mm
5. 15mm
6. What overall rate of radiologically detected osteoarthrosis can be expected 2 years after the treatment of tibial plateau fractures, according to the Canadian Orthopaedic Trauma Society trial?
1. 5%
2. 10%
3. 20%
4. 30%
5. 50%
7. What is the minimal degree of injury implied by dislocation of the metacarpophalangeal joint of a finger?
1. Volar plate rupture
2. Avulsion of the volar lip of the proximal phalanx
3. Rupture of the volar plate and one collateral ligament
4. Rupture of both collateral ligaments
5. Rupture of the volar plate and both collateral ligaments
8. After the treatment of unicondylar fractures of the proximal phalanx, which pattern is likely to result in the stiffest joint?
1. Volar coronal
2. Oblique volar
3. Long sagittal
4. Dorsal coronal
5. Oblique sagittal
9. Which of the following fragments of proximal surface of the middle phalanx would include the greatest proportion of the collateral ligament zone of insertion?
1. A volar fragment of 20%
2. A volar fragment of 40%
3. A dorsal fragment of 20%
4. A dorsal fragment of 40%
5. The central 20%
10. If the structures of the cervical spine are divided progressively from anterior backwards, at what point does significant instability develop in extension?
1. After division of the anterior longitudinal ligament
2. After division of the above plus the intervertebral disc annulus
3. After division of the above plus the posterior longitudinal ligament
4. After division of the above plus the facet joint capsules
5. After division of the above plus the ligamenta flava
11. Which structure is believed to contribute most to segmental stability in the cervical spine?
1. The anterior longitudinal ligament
2. The annulus
3. The posterior longitudinal ligament
4. The facet joint capsules
5. The interspinous ligament
12. What is felt to be responsible for the majority of symptoms in degenerative cervical spine disease?
1. Anterior marginal osteophytes
2. Annular tears
3. Prolapse of the nucleus
4. Posterior marginal osteophytes
5. Facet joint osteophytes
13. Which of the following would be the most suitable pore size for a biomaterial scaffold intended to stimulate cellular ingrowth?
1. 100nm
2. 1µm
3. 20µm
4. 200µm
5. 1mm
14. Which of the following statements concerning mesenchymal stem cells, used to repair articular cartilage defects, is incorrect?
1. They are immunoprivileged
2. They are the main cellular component of bone marrow aspirate
3. They produce cytokines
4. They can dedifferentiate to fibroblasts
5. They can terminally dedifferentiate to a hypertrophic phenotype
15. Which of the following is not an effect of TGF-ß1 in articular cartilage?
1. It induces fibroblastic differentiation of mesenchymal stem cells
2. It promotes cell proliferation
3. It promotes protein synthesis
4. It inhibits the action of matrix metalloproteinases
5. It induces osteophytosis in higher doses
16. Which of the following effects of a growth factor would be most beneficial to the development of articular cartilage in a stimulated cell population?
1. Increased type I collagen formation
2. Increased type IV collagen formation
3. Inhibition of type II collagen formation
4. Inhibition of type I collagen formation
5. Increase in the ratio of type II:type I collagen
17. What is the main anabolic growth factor for articular cartilage?
1. Bone morphogenetic protein-2
2. Insulin like growth factor-1
3. Platelet derived growth factor
4. Transforming growth factor-ß1
5. Fibroblast growth factor-2
18. Which of the following growth factors seems to have the least significant impact in articular cartilage development?
1. Platelet derived growth factor
2. Insulin like growth factor-1
3. Vascular endothelial growth factor
4. Fibroblast growth factor-2
5. Transforming growth factor-ß1
19. What is the cell source for induced pluripotential stem cells?
1. The blastocyst
2. Umbilical cord cells
3. Bone marrow cells
4. The nude mouse
5. Somatic cells
20. Which of the following scaffold materials is a bicopolymer?
1. Hyaluronan
2. Alginate
3. Chitosan
4. Polylactic acid
5. Fibrin

Find the answers to the July 2009 CME here.
Feel ready for the next challenge? Take October's CME here