Review Questions: The Journal of Bone & Joint Surgery Continuing Medical Education
Review Questions: The Journal of Bone & Joint Surgery Continuing Medical Education
Review Questions: The Journal of Bone & Joint Surgery Continuing Medical Education
CME
Review Questions
April, May, June
2005
The deadline to submit your answers for grading this set of questions is October 15, 2005.
6. A patient with recurrent posterior instability 11. It is impractical to isolate the toes during
of the shoulder is likely to have a history of forefoot surgery. Which of the following tech-
all of the following except: niques results in the greatest reduction in
A. posterior dislocation of the shoulder positive cultures of specimens obtained from
B. multidirectional instability of the shoulder the hallucal nail fold?
C. family history of joint hyperlaxity A. alcohol scrub and paint with use of bristles
D. generalized ligament laxity for the scrub
E. instability of other joints B. povidone-iodine scrub and paint with use of
sponges for the scrub
7. Removable cast walkers overwrapped C. alcohol prewash with sponges along with povi-
with a roll of fiberglass were used in place done-iodine scrub and paint
of conventional total contact casts for D. povidone-iodine scrub and paint with use of
insensate diabetic foot ulcers. The in- bristles for the scrub
vestigators observed all of the following E. single-step povidone-iodine paint
except:
A. the cast walkers were quicker to apply 12. A group of orthopaedic surgeons who invest
B. the cast walkers resulted in more in an orthopaedic surgery specialty hospital
complications are likely to experience:
C. the cast walkers were as effective as the total A. an increase in both patient volume and surgi-
contact casts cal volume
D. healing time was equal B. a decrease in patient volume but an increase
E. the cast walkers were cost-effective in surgical volume
C. an increase in patient volume but a decrease
8. One month after total knee arthroplasty, in surgical volume
patients had a profound loss of quadriceps D. no change in patient volume but an increase
strength. The main reason(s) for this weak- in surgical volume
ness was found to be: E. no change in either patient volume or surgical
A. knee pain volume
B. failure of voluntary activation
C. atrophy 13. Among 125,000 Medicare recipients who
D. effusion underwent unilateral primary total knee
E. B and C arthroplasty in 2000, the prevalence of
complications in the first ninety days was
9. All of the following statements are true ex- <1% for all of the following except:
cept: A. pneumonia
A. generation of particulate wear debris is inevi- B. pulmonary embolus
table during the normal use of a prosthetic C. myocardial infarction
joint D. deep wound infection
B. periprosthetic pseudomembranes usually E. death
contain macrophages, fibroblasts, foreign-
body giant cells, and numerous wear debris 14. Cost-utility analysis is:
particles A. an economic analysis that assesses the
C. debris-associated inflammation and bone re- value of an intervention in terms of improving
sorption contribute to the loosening process both quality and quantity of life
of a prosthetic joint B. an economic analysis that requires placement
D. therapy targeted to periprosthetic of a monetary value on human life
pseudomembranes could be a potential ap- C. an economic analysis that does not take into
proach to halting the loosening process account individuals’ preferences for health
E. gene therapy is readily available to treat pa- D. an economic analysis that only examines the
tients with signs of aseptic loosening costs of interventions and does not address
the health benefits
10. For the diagnosis of meniscal tears of the E. not a useful tool in health technology evalua-
knee, which clinical test was shown to have tion
accuracy comparable with that of magnetic
resonance imaging? 15. Extracorporeal shock wave therapy used to
A. the Apley compression and distraction test treat chronic lateral epicondylitis resulted in
B. the McMurray test significant improvement in all of the follow-
C. the medial and lateral joint-line tenderness ing outcome end points except:
test A. pain scores
D. the Thessaly test at 20° of knee flexion B. scores on an upper-extremity functional scale
E. the Thessaly test at 5° of knee flexion C. patient activity scores
cme 4
T HE JOUR NA L OF B ONE & JOINT SURGER Y · JBJS.OR G VO L U M E 87- A · CM E II · A P R , M AY , J U N 2005
racic nerve runs perpendicular to the bra- 29. A twenty-six-year-old carpenter being seen
chial plexus for a first-time evaluation reports a six-
B. the upper division of the long thoracic nerve month history of chronic shoulder pain and
is formed by the union of branches stemming weakness. Physical examination demon-
from the C5 and C6 roots. The upper division strates grade-3 weakness isolated to re-
presents a trajectory parallel to the brachial sisted external rotation with mild atrophy of
plexus the infraspinatus muscle. He also has mild
C. the union of the upper and lower divisions of tenderness in the subacromial region and
the long thoracic nerve occurs in the vicinity mild pain with impingement signs, but the
of the brachial plexus roots results of the examination are otherwise nor-
D. the long thoracic nerve is formed by branches mal. You perform an office-based ultrasound
stemming from the C3 and C4 roots examination, which shows a small partial ro-
E. the upper division of the long thoracic nerve tator cuff tear. Radiographs show a normal
is responsible for scapular retraction and coracoacromial arch. The next diagnostic
stabilization study that you would recommend is:
A. examination under anesthesia with diagnostic
26. When patients undergoing anterior lumbar arthroscopy
arthrodesis were treated with rhBMP-2 and B. impingement test with 10 mL of lidocaine
structural cortical allograft, their radio- C. magnetic resonance imaging of the shoulder
graphs demonstrated accelerated interbody with intra-articular gadolinium
healing that was: D. double-contrast arthrogram
A. not associated with an improved return-to- E. cervical magnetic resonance imaging
work status at twenty-four months
B. associated with improvement in all clinical 30. A finger with an unstable ununited fracture
end points studied and a permanent sensory loss distal to the
C. associated with improvement in Oswestry fracture is best treated with:
Disability Index scores at twenty-four months A. open reduction and internal fixation
only B. open reduction and internal fixation with
D. not associated with improved clinical outcomes autogenous bone graft
E. similar to the radiographic findings in the con- C. arthrodesis
trol group of patients (treated with autograft) D. electrical stimulation
E. amputation
27. Biomechanical studies have shown that the
tibial inlay technique of posterior cruciate 31. Radiographic evidence of glenohumeral ar-
ligament reconstruction is superior to the thritis develops in approximately what per-
tibial tunnel technique with regard to: centage of patients following open repair of
A. ease of graft implantation an isolated subscapularis tendon tear?
B. avoidance of graft abrasion A. 0%
C. faster postoperative rehabilitation B. 10%
D. fewer intraoperative complications C. 30%
E. superior functional results D. 50%
E. 90%
28. In a study of patients with articular cartilage
degeneration associated with postcollapse 32. In patients with metal-on-metal bearing hip
osteonecrosis in the femoral head, which of prostheses:
the following statements was found to be A. serum cobalt and chromium ion levels are un-
most correct? affected by patient activity
A. the mechanical properties of articular carti- B. the majority of cobalt and chromium is ex-
lage are degraded in advanced radiographic creted in sweat
stages of the disease C. the majority of cobalt and chromium is ex-
B. cartilage in the late stages of osteonecrosis creted in stool
may maintain mechanical properties even af- D. serum cobalt and chromium levels tend to
ter collapse of the articular surface rise over time
C. the gross appearance of the articular surface E. serum cobalt and chromium levels are inde-
is a poor indicator of the mechanical proper- pendent of renal function
ties of the cartilage
D. the success of head-sparing procedures in pa- 33. Following the diagnosis of deep periprosthetic
tients with osteonecrosis is unrelated to the infection in a patient who was treated for an
radiographic stage of the disease orthopaedic oncological condition, which
E. cartilage in the late stages of osteonecrosis treatment yields the best functional outcome
rarely shows signs of degeneration and probability of eradicating the infection?
cme 6
T HE JOUR NA L OF B ONE & JOINT SURGER Y · JBJS.OR G VO L U M E 87- A · CM E II · A P R , M AY , J U N 2005
RESPONSE FORM
EXAMINATION EVALUATION ANSWER KEY
Did the July 2005 CME Review Questions meet these ed- Black out the correct answers
ucational objectives*: 1. 18. 35.
1. Provide a broad-based review and update specifically 2. 19. 36.
in the areas of foot and ankle surgery and pediatric
orthopaedics? Yes No 3. 20. 37.
2. Strengthen your problem-solving abilities related 4. 21. 38.
to patient care particularly in the areas of 5. 22. 39.
shoulder and hand trauma? Yes No
6. 23. 40.
3. Make you aware of new advances in orthopaedic
7. 24. 41.
surgical techniques and technology? Yes No
Comments (please comment on the quality of the ques- 8. 25. 42.
tions and their relationship to your practice): ____________ 9. 26. 43.
_______________________________________________________ 10. 27. 44.
_______________________________________________________ 11. 28. 45.
*Note: These objectives will change every quarter.
12. 29. 46.
SURVEY (optional)
13. 30. 47.
1. Which of the following best describes your practice type?
14. 31. 48.
General orthopaedics
General orthopaedics with subspecialty interest 15. 32. 49.
Exclusively subspecialty 16. 33. 50.
Resident or student 17. 34. CME Credits
Researcher
Claimed* _________
Other: __________________________________________
*Required. Please enter the number of CME credit hours you are claiming
2. What are your specialty interests? Please rank in
for this exam. You must complete this field to receive CME credit.
order of importance (1 = highest importance).
____ Adult ____ Spine AAOS Member Number _______________________________________
____ Geriatric ____ Hand (Without this number, the AAOS will not track your CME credits.)
____ Pediatric ____ Rheumatology
____ Rehabilitation ____ Foot and Ankle Last Name First Name Degree
____ Sports ____ Other: ________________
____ Trauma Mailing Address
3. Which is your number-one priority to read when you
receive The Journal (American volume only) each State Zip Code
month?
Commercial advertising Current Concepts
Phone Number
Classified advertising Letters to The Editor
Clinical scientific articles Basic scientific articles
Orthopaedic Forum Instructional Course Fax Number E-mail Address (optional)
Lectures PAYMENT OPTIONS
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The deadline to submit your answers for grading this set Expiration date: ______ /_______
of questions is October 15, 2005.
Name as it appears on card: ___________________________
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