Journal of Bone and Joint Surgery (British Volume)

CME questions October 2007

These papers have been set on the review articles and aspects of current management papers from the 2007 July, August and September issues of the JBJS-Br.

1. What is the material structure of the deep surface of the long head of the biceps tendon in its groove adjacent to the lesser tuberosity.
1. Elastic cartilage
2. Fibrocartilage
3. Hyalne cartilage
4. Type I Collagen
5. Type III Collagen
2. What are the clinical signs of an ‘hourglass’ biceps tendon
1. Loss of the last 10-20 degrees of active and passive shoulder external rotation
2. Loss of the last 10-20 degrees of active and passive shoulder internal rotation
3. Loss of the last 10-20 degrees of active but not passive shoulder abduction
4. Loss of the last 10-20 degrees of active but not passive shoulder flexion
5. Loss of the last 10-20 degrees of both active and passive shoulder abduction and elevation
3. What loss of elbow strength occurs as a result of tenotomy of the long head of the biceps tendon in patients who already have a massive, irreparable rotator cuff tear.
1. None
2. 8% loss of flexion, 20% loss of supination
3. 8% loss of flexion, 40% loss of supination
4. 20% loss of both flexion and supination
5. 40% loss of both flexion and supination
4. Which of the following is not a usual constituent of either the powder or liquid components of a bone cement pack
1. Acryllic acid
2. Benzoyl peroxide
3. Barium Sulphate
4. Chlorophyll
5. Hydroquinone
5. Which of the following pairs of materials has, numerically, the greatest mis-match in stiffness.
1. Bone cement – Cobalt Chrome
2. Bone cement – polyethylene
3. Bone cement – titanium
4. Cancellous bone – Bone cement
5. Cortical bone – bone cement
6. According to Charnley, what is the approximate area of the bone/cement interface of a cemented femoral stem
1. 30cm2
2. 50cm2
3. 80cm2
4. 110cm2
5. 140cm2
7. Which of the following statements concerning bone cement is true
1. It becomes saturated with water in vivo, which has a plasticisng effect
2. It is a very elastic material, with low notch-sensitivity
3. It has an intermediate Young’s modulus between bone and metal, allowing a smooth transition of stresses
4. It has a high glass transition temperature, measured as between 70 and 120 degrees Celsius
5. Warming cement decreases its elasticity
8. For how long does the polymerisation process continue after mixing powder and liquid constituents of a bone cement pack
1. 15 minutes
2. 1 hour
3. 3 days
4. 6 weeks
5. 1 year
9. What is the main adverse effect when Rifampicin is added to bone cement
1. It delays cement setting for several days
2. It dramatically increases the brittleness of the cement
3. It is rendered ineffective by heat and increases the porosity of cement so that other antibiotics elute too quickly
4. It works antagonistically with other antistaphyllococcal antibiotics
5. There is a very high incidence of multiresistant bacterial infection after 5 years
10. Approximately what proportion of the antibiotic added to cement is ever released
1. 2.5%
2. 7.5%
3. 25%
4. 50%
5. 75%
11. Which of the following preparation techniques for antibiotic loaded cement should be avoided
1. Add 1g cloxacillin powder to 20g cement powder before adding the liquid
2. Add 1g gentamicin powder to 20g cement powder before adding the liquid
3. Add 2g cefazolin powder to 40g cement powder before adding the liquid
4. Add 2g gentamicin powder to 40g cement powder mix before adding the liquid
5. Add 2g liquid gentamicin to liquid component of cement before mixing with powder
12. Which of the following properties of bone cement is not governed by International standards
1. Compressive strength
2. Doughing time
3. Fatigue resistance
4. Package and labelling
5. Stability of liquid component
13. Which of the following has the greatest risk of congenital talipes equinovarus (CTEV)
1. A child of two parents both affected by CTEV
2. A child of two parents, both affected by CTEV with a sibling also affected by CTEV
3. A male child with a horseshoe kidney
4. A male sibling of a female child with CTEV
5. The monozygotic twin of a child with CTEV
14. Which of the following is most commonly associated with CTEV
1. Arthrogryposis
2. Hypothyroidism
3. Maternal salicylate use
4. Spina Bifida
5. Tibial dysplasia
15. Which of the following structures contributes to the biceps pulley’
1. Anterior third of supraspinatus tendon
2. Biceps groove
3. Coracohumeral ligament
4. Middle glenohumeral ligament
5. Subscapularis tendon
16. In what position of the arm can the long head of the biceps dislocate into the empty footprint of supraspinatus in the presence of a supraspinatus tear?
1. Abduction and external rotation
2. Abduction and internal rotation
3. Adduction and external rotation
4. Adduction and internal rotation
5. Flexion
17. What are the clinical signs of an entrapped hourglass biceps tendon
1. Loss of supination in a position of abduction and external rotation
2. Loss of the last 20 degrees of active and passive elevation with normal rotation
3. Loss of the last 30 degrees of elbow flexion and supination
4. Loss of the last 45 degrees of flexion with the arm in supination
5. Loss of the last 20 degrees of both active and passive shoulder elevation and elbow supination
18. In which of the following structures have nerve fibres from the sinuvertebral nerves not been observed
1. Anterior Dura Mater
2. Outer fibres of the annulus
3. Outer region of the nucleus pulposus
4. Perivascular speces in the intervertebral foramen
5. Posterior longitudinal ligament
19. Which part of the intervertebral disc has been shown to have a primarily, if not wholly, sympathetic nerve supply
1. Anterior disc
2. Endplate regions
3. Lateral parts of the disc
4. Nucleus pulposus
5. Posterior disc
20. In the degenerate disc, which of the following is true
1. A delta and C fibres penetrate to a depth of approximately 3mm
2. Nerve fibres penetrate further towards the central region than in healthy discs
3. Sympathetic fibres growth into annular tears
4. Sympathetic innervation is increased in all parts of the disc
5. The disc becomes aneural
21. For what purpose were the Oxford hip and knee scores designed
1. As economic indicators in registries
2. As general health measures in patients undergoing hip or knee surgery
3. As outcome measures in cohort studies
4. As outcome measures in randmised controlled trials
5. As reference scores for audit purposes
22. What range of scores do the originators of the Oxford hip and knee scores recommend to be used
1. 0 to 48
2. 0 to 60
3. 12 to 48
4. 12 to 60
5. 0 to 100
23. If the Oxford knee score is used in an intervention such as osteotomy, which of the following is an example of the sort of parameter that should be measured to confirm that appropriate measurement properties have been maintained
1. ANOVA
2. Cronbachs Alpha
3. EuroQol
4. Pearsons correlation coefficient
5. U score
24. In patient reported outcome measures, which of the following can be used to estimate the minimal clinically important different between pre and post intervention scores
1. Half the range of changes observed
2. Half the standard deviation of the change observed
3. The change observed in pain questions only
4. The mean of the change observed
5. The median figure for change observed
25. What does an accurate estimation of the minimal clinically important change most usefully feed into when setting up a trial
1. A, Choice of statistic for analysing outcome
2. Chosing outcome measures
3. Patient consent and information sheets
4. Power calculation
5. Randomisation method

Here are the answers to the October 2007 CME test paper.