Department of Orthopedics by 1Vs4Xt

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									                              KING SAUD UNIVERSITY
                              COLLEGE OF MEDICINE
                               Department of Orthopedics
                                  Final examination
                                      Time two hours

Section One.
(answer with true or false)

1.   Displaced compression fracture of the second Lumbar spine:
a.   Is usually associated with vascular injury. F
b.   Patient is unable to do active extension of the knee. T
c.   Loss of sensation is commonly present in the lower limbs. T
d.   Treatment of choice is open reduction and internal fixation. T
e.   Is seen in flexion injury of the spine. T

2.   Prolapsed intervertebral disc:
a.   Is commonest at the L4/L5 and L5/S1 levels. T
b.   Rarely present with pain below knee. F
c.   Is usually treated conservatively. T
d.   Is common above 60 years of age. F
e.   At L5/S1 level presents with absent ankle jerk. T

3.   In pelvic fractures:
a.   Superior and/or inferior pubic ramai are commonly involved. T
b.   Bladder injury is frequently due to fracture of the acetabulum. F
c.   Open book injury is due to vertical force. F
d.   Single AP X-ray makes accurate diagnosis of acetabular fracture. F
e.   Open reduction and internal fixation is the usual treatment. F

4.   Multiple myeloma:
a.   Is a primary bone tumor, which arises from plasma cells of bone marrow. T
b.   Affects mainly the diaphysis of long bones. T
c.   Typically appears as an area of osteosclerosis on X-ray. F
d.   Is completely excluded by a negative Bence Jones protein in the urine. F
e.   Lesion can be localized by isotope bone scan. T

5.   In Supracondylar (elbow) fracture in children:
a.   Cubitus varus is a known complication. T
b.   Cubitus varus is the result of malunion. T
c.   Cubitus varus appears immedately. F
d.   Cubitus varus is treated surgically. T
e.   Is mainly treated by closed reduction and splinting by cast. F




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Section Two. (Choose the most appropriate answer.)

Tuberculosis of the spine:

1.   Investigation will demonstrate:
a.   Normal ESR.
b.   Radiological evidence of destruction of the affected vertebral bodies.
c.   Normal bone (technetium) scans.
d.   Polymorphonuclear leucocytosis.
e.   All of the above.

2.   Initial treatment of choice in TB spine without paraplegia is:
a.   Chemotherapy and rest.
b.   Laminectomy.
c.   Immediate surgical exploration.
d.   Aspiration of pus.
e.   Bed rest only.

A one and half-year old girl presented in the emergency room with clinical evidence
of acute septic arthritis of her right hip.

3.   The gait in this patient will reveal:
a.   Trendelenburg gait.
b.   Waddling gait.
c.   Antalgic gait.
d.   Normal gait.
e.   Non of the above.

4.   Physical examination will demonstrate:
a.   Full abduction of the both hips.
b.   Shortening of right lower limb.
c.   Abnormal thigh creases.
d.   Gross limitation of right hip motion.
e.   Non of the above.

5.   The treatment of choice for this child is:
a.   Skeletal traction.
b.   Skin traction and rest followed by hip spica.
c.   Intravenous antibiotics and possible surgery.


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d. Observation.
e. Non of the above.


A 25-year-old patient presented in the clinic with established non-union of the tibia
for the last two years.

6.   In such patient, the presenting features will be:
a.   Pain at rest.
b.   Severe bony tenderness at the non-union site.
c.   Radiographic sclerosis and narrowing of the bony ends in hypertrophic non-union.
d.   Only a) and c).
e.   Non of the above.

7.   The common cause of this problem is/are:
a.   Inadequate immobilization of the fracture.
b.   Soft tissue interposition at the fracture site.
c.   Poor blood supply at the fracture site.
d.   All of the above.
e.   Only a) and b).

8.   The treatment of choice for this problem is:
a.   Skeletal traction followed by cast immobilization.
b.   Open reduction and internal fixation with bone grafting.
c.   External fixation alone.
d.   All of the above.
e.   Non of the above.


A 75-year-old lady was admitted to the hospital following a fall. Her radiograph of
the right hip joint demonstrated undisplaced intracapsular fracture of the femoral
neck.

9.   Treatment of choice for her will be:
a.   Skin traction.
b.   Hip spica immobilization.
c.   Skeletal traction on Thomas splint.
d.   Open reduction and internal fixation.
e.   Hip replacement.

10. The common complications of this fracture are:
a. Deep vein thrombosis.
b. Delayed union and nonunion.
c. Avascular necrosis of the femoral head.
d. All of the above.
e. Only (b) and (c).



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GOOD LUCK….




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