128 - which of the following is the fracture of atlas vertebrae ?
a- jefferson's fracture
b- bennet's fracture
c- essex loprestti frx
d- green stick fracture
answer is a .
129 - bankart's lesion involves the ______ of the glenoid labrum ?
a- anterior lip
b- superior lip
c- anterosuperior lip
d- anteroinferior lip
answer is a . ANTERIOR LIP . refer campbell's operative orthopedics 10 th edition , page - 2399 and 2400 .
130 - which bone tumor occurs in the epiphysis ?
a- osteoclastoma
b- ewing's sarcoma
c- chondromyxoid fibroma
d- osteosarcoma
answer is a . osteoclastoma . the two tumors which occur in the epiphysis are osteoclastoma and chodroblastoma .
131 - Paget's disease of bone
(a) May present with neurological complications or a pathological fracture
(b) Causes an increase in both serum calcium and phosphate
(c) Causes an increase in serum alkaline phosphatase
(d) Malignant change occurs in 1% of patients
(e) The commonest malignant tumour in patients with Paget's disease is a chondrosarcoma
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b and e are false . Paget's disease was first described as 'osteitis deformans' by Sir James Paget in 1877. It is often asymptomatic and an incidental finding seen during radiological investigations. If symptomatic it presents with bone pain, neurological symptoms or a pathological fracture. In those patients who develop malignant change 50% are osteosarcomas, 25% fibrosarcomas and 25% giant-cell tumours. The median survival following malignant change is less than one year.
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132. Regarding osteomalacia
(a) Is due to vitamin A deficiency
(b) Can cause a distal myopathy
(c) May present with pseudo-fractures
(d) Serum calcium is increased
(e) A bone biopsy would show an increase in mineralised osteoid
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only c is true . Osteomalacia is due to vitamin D deficiency. It can result from malabsorption, renal disease (familial hypophosphataemic rickets), chronic renal failure and anticonvulsant therapy. It often presents with bone pain and a proximal myopathy. Serum calcium is low. A bone biopsy would show an increase in the amount of unmineralised osteoid.
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133. Perthe's disease
(a) Usually presents before 10 years of age
(b) Is due to avascular necrosis of the distal femoral epiphysis
(c) Is more common in girls
(d) Plain x-ray may show the capital femoral epiphysis to be smaller, denser and flatter
(e) May require surgical containment with a subtrochanteric osteotomy
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a , d , e are true . Perthe's disease is due to avascular necrosis of the capital femoral epiphysis. It presents with hip pain and a limp usually before the age of 10 years. The male to female ratio is 4:1. X-rays shows the capital femoral eiphysis to be small, dense and flattened. A bone scan shows a cold spot within the epiphysis.
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134. Regarding upper limb peripheral nerve injuries
(a) Injury to the median nerve results in a wrist drop
(b) Injury to the median nerve results in loss of sensation over the palmar aspect of the index finger
(c) Injury to the radial nerve results in loss of sensation in the anatomical snuffbox
(d) Injury to the ulnar nerve results in a claw hand
(e) Injury to the ulnar nerve results in loss of sensation over the thumb
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b , c , d are true . Radial nerve injury results in a wrist drop and a variable amount of sensory loss. The anatomical snuffbox is usually involved. Median nerve injury results in loss of sensation over the thumb, index, middle and the lateral half of the ring finger. Ulnar nerve injury results in a claw hand deformity and loss of sensation over the medial half of the ring finger and little finger.
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135. Regarding osteomyelitis
(a) Is most commonly due to a staphylococcus aureus infection
(b) Can be due to salmonella infection in patients with sickle cell anaemia
(c) Infection usually involves the metaphysis of long bones
(d) Dead bone within the medullary canal is known as the involucrum
(e) New bone forming beneath the periosteum is known a the sequestrum
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a , b , c are true . Osteomyelitis is usually due to staphylococcus aureus infection. Streptococcus pyogenes, Haemophilis influenza and gram-negative organisms can also infect bone. In children the infection is usually aquired by haematogenous spread to the metaphysis of long bones. The dead bone within the medullary canal is the sequestrum. New subperiosteal bone formation is the involucrum.
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136. Regarding bone metastases
(a) Less than 5% of patients with malignant disease develop bone metastases
(b) 10% of patients with bone metastases develop a pathological fracture
(c) Breast cancer is the commonest cause of bone metastases in women
(d) Radiological changes are seen early in the disease process
(e) Prostate cancer can cause osteosclerotic lesions
-------------------------------------
b , c , e are true . Bone metastases occur in 30% of patients with malignant disease. The commonest tumours causing bone metastases are breast (35%), prostate (30%), bronchus (10%), kidney (5%) and thyroid (2%). They usually present with bone pain, a lump. pathological fracture, hypercalcaemia or cord compression. 10% of patients with bone metastases will develop a pathological fracture. Radiological changes usually occur late and bone scintigraphy is the most sensitive investigation available to detect metastatic spread. Most metastases are osteolytic but some tumours, particularly prostate carcinoma, causes osteosclerotic lesions.
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137. Regarding osteoid osteoma
(a) It is a benign bone tumour
(b) The femur and tibia are the commonest bones involved
(c) Presents with severe pain that is typically relieved by aspirin
(d) Radiologically appears as a radiolucent lesion surrounded by dense bone
(e) Local excision or currettage is curative
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all are true . Osteoid osteoma is a benign tumour that mainly affects young adults. The femur and tibia are the commonest bones involved. Pain is often the presenting feature and relief by asprin is almost diagnostic. Local surgery is curative.
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138. Regarding osteosarcomas
(a) Affects the epiphyses of long bones
(b) Are most commonly seen around the knee and in the proximal humerus
(c) Haematogenous spread can result in pulmonary metastases
(d) Is exclusively a disease of adolescence and early adult life
(e) X-ray shows a 'sunburst' appearance due to soft tissue involvement
-------------------------------------
a and d are false . Osteosarcomas affect the metaphyses of long bones. They are most commonly seen around the knee and in the proximal humerus. They often occur in young adults but are also seen in the elderly in association with Paget's disease. They usually present as bone pain and a palpable lump. X-ray shows periosteal elevation (Codman's triangle) and a 'sunburst' appearance due to soft tissue involvement. Early haematogenous spread occurs and the 5-year survival rate is approximately 50%.
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139. Regarding eponymous fractures
(a) Bennett's fractures involves the distal ulna
(b) Colle's fracture involves the distal radius
(c) Galeazzi' s fracture involves the radial shaft & dislocation of the proximal radioulnar joint
(d) Monteggia' s fracture involves the proximal ulna & anterior dislocation of the head of the radius.
(e) Pott's fracture is a general term applied to fractures around the knee
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only b and d are false . A Bennett's fracture is an intra-articular fracture of the base of the first metacarpal. A Galeazzi's fracture involves the radial shaft with dislocation of the distal radioulnar joint. A Pott's fracture is a general term applied to fractures around the ankle.
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140. Regarding rheumatoid arthritis
(a) Is a disease primarily of the articular cartilage
(b) Is associated with the HLA antigens DR4 and DW4
(c) Occurs more often in women
(d) The hand, elbows, knees and cervical spine are the commonest joints involved
(e) Extra-articular manifestations occur in 20% of patients
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a is false . Rheumatoid arthritis is a disease of the synovial membrane. It results in joint destruction, pannus formation and periarticular erosion. The female to male ratio is 3:1. The hand, elbows and knees are the commonest joints involved. Extra-articular manifestasions occurs in 20% patients and include keratoconjuctivitis sicca, episcleritis, pulmonary nodules, pleural effusions, pericarditis and subcutaneous rheumatoid nodules.
Saturday, January 5, 2008
57 - orthopedics mcqs - 113 to 127 - rheumatoid arthritis
Question 113
Typical rheumatoid arthritis is characterized by
Symmetric inflammatory polyarthritis
Sparing of axial skeleton except cervical spine
Sparing of distal interphalangeal joints
All of the above--------------
Question 114
Which of these is not a feature of rheumatoid arthritis?
Swollen joints
Painful joints
Morning stiffness
Headache---------------
Question 115
The exact etiology of rheumatoid arthritis is not known but all the following have been implicated as having a role in its causation ,except
Genetic factors
Autoimmunity
Microbial infection
Low calcium levels in the body-----------
Question 116
Rheumatoid arthritis is a mutisystem disorder. It can involve any of the following, except
Eyes
Lungs
Heart
Ear---------------
Question 117
What is true regarding the prevalence of rheumatoid arthritis?
More common in females but difference reduces in older age group-------------
More common in females but difference is less in younger age group
More common in males but difference reduces in older age group
More common in males but difference is less in younger age group
Question 118
Rheumatoid factors are autoantibodies found in many individuals. Their importance in rheumatoid arthritis is as a
Prognostic factor---------------
Screening factor
Diagnostic factor
None of the above
Question 119
Features that signify a bad prognosis in rheumatoid arthritis are
High titer of rheumatoid factor
Presence of subcutaneous nodules
Radiographic evidence of erosion at the time of initial evaluation
All of the above----------------
Question 120
The goals of therapy of rheumatoid arthritis are
Reduction of pain and inflammation
Maintenance of function and movement
Control of systemic involvement
All of the above-------------
Question 121
NSAID are used as the first line of treatment for rheumatoid arthritis because of their
Anti-inflammatory properties----------
Immunosuppresive properties
Cytotoxic properties
Tumor necrosis factor inhibitor properties
Question 122
The newly discovered COX-2 inhibitors are considered superior to standard NSAID because they have
Less gastro-intestinal side effects------------
Minimal renal toxicity
Slow the progress of the disease
None of the above
Question 123
Corticosteroids used for management of rheumatoid arthritis have all these properties, except
Reduce inflammation and swelling
Beneficial for systemic involvement in rheumatoid arthritis
Can be taken orally or as an injection
Delayed onset of action----------------
Question 124
DMARDs are a group of diverse agents that slow down the progress of rheumatoid arthritis. All is true with regard to DMARDs, except
Benefit is noticed after 2-6 months
These are generally prescribed along with NSAID or steroids
Work by slowing the immune system from attacking the joint
None of these are used for treating disorders other than rheumatoid arthritis----------------
Question 125
Leflunomide is a newly approved DMARD. It should not be prescribed to
Elderly men
Children
Pregnant women-----------
Elderly women
Question 126
Biologic response modifiers are drugs that target the immune factors, particularly Tumor Necrosis Factor (TNF) which play a major role in the destructive process. Which of these drugs belong to this class of drugs?
Etanercept------------
Celecoxib
Rofecoxib
Penicillamine
Question 127
Agents that are being studied for benefits in rheumatoid arthritis are
Soluble collagen
Thalidomide
Protease inhibitors
All the above-----------------
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