SBA

1. A 33-year-old male patient is brought to the emergency department, 2 hours after a

high-speed MVA complaining of right hip pain. On exam, his right lower extremity is
slightly flexed, adducted, and internally rotated. The neurovascular of the right lower
limb is intact. Which of the following is the most likely diagnosis?
a. Fracture proximal shaft of the femur
b. Posterior dislocation of hip joint
c. Fracture neck of femur
d. Intertrochanteric fracture

2. A 70-year-old man has noticed increasing back and leg pain for 3 years. He has
greater difficulty hearing in the left ear. On physical examination, he has decreased
range of motion at the hips. Radiographs reveal bony sclerosis of the sacroiliac,
lower vertebral, and upper tibial regions with cortical thickening, but without mass
effect or significant bony destruction. If that weren't enough trouble, he says his hats
don’t even fit him anymore. He now has osteopenia and pedal edema. Laboratory
studies show a serum alkaline phosphatase of 264 U/L. Which of the following is the
most likely diagnosis?
a. Decreased bone mass
b. Paget disease of bone
c. Metastatic adenocarcinoma
d. Renal failure with renal osteodystrophy

3. A 50-year-old man with a history of rheumatoid arthritis presents to the emergency

department with a 2-day history of right knee pain and swelling after corticosteroid
intraarticular injection of his right knee by a general practitioner. He denies a history
of trauma. On examination, he is febrile with a temperature of 39. The right knee is
swollen, erythematous, and painful with passive motion. An arthrocentesis is
performed, which shows purulent fluid and a leucocyte count of 90,000/uL with 90%
neutrophils. No crystals are seen on polarized microscopy. What is the most likely
cause of this patient’s symptoms?
a. Chondromalacia of patella
b. Gout
c. Osteoarthritis
d. Septic arthritis

4. Mr. Chandra is a 44-year-old teacher. He is brought to the ED of HKL after he was

involved in MVA. He is in severe pain with diffuse swelling around his right knee. On
local examination, the right leg is cold with pallor, and the pulse around his ankle is
absent. Which of the following investigations is appropriate to check the vascular
status of his right lower limb?
a. CT scan
b. Duplex ultrasound
c. X-ray
d. Bone scintigraphy
5. A 7-year-old boy had a fall on his right outstretched hand and sustained a painful
swelling of his elbow. The most likely injury is:
a. Fracture olecranon
b. Dislocation of the elbow
c. Fracture neck of the radius
d. Supracondylar fracture of humerus

6. Mr. David is a 50-year-old Grab driver and is admitted to the hospital after he was
involved in MVA. He sustained a closed injury in his right thigh. X-ray showing
fracture mid shaft right femur. One day after his admission, he looks confused with
dyspnea and tachycardia with skin rash. Which of the following is the most likely
diagnosis?
a. Compartment syndrome
b. Hypovolemic shock
c. Pulmonary embolism
d. Fat embolism

7. A 25-year-old man presents in the outpatient clinic with complaints of instability in his
right knee for the last 6 months. He gives a history of injury to his right knee when
playing basketball. On examination, he has a positive “sag sign”. Which of the
following is the most likely diagnosis?
a. Posterior cruciate ligament tear
b. Anterior cruciate ligament tear
c. Medial collateral ligament tear
d. Lateral collateral ligament tear

8. A 60-year-old lady presented to the ortho clinic with complaints of pain in the right
knee for the last 3 months. The pain increased on walking and climbing stairs. She is
unable to sit cross leg or squat. There is a history of swelling off and on. The skin
over the knee is normal with swelling and crepitus on palpation. X-ray shows
decreased joint space with loose bodies and osteophytes. Which of the following is
the most likely diagnosis?
a. Osteoarthritis of the knee
b. Rheumatoid arthritis
c. Psoriatic arthritis of the knee
d. Gouty arthritis of the knee
9. Chon is a 3-year-old child brought to the ED suffering from pain, swelling, and
deformity in his right forearm. The skin of his forearm is intact after a fall while playing
in the garden of the house. X-ray shoes displaced oblique fracture at the shaft of right
radius and ulna. Which of the following is the appropriate treatment for this injury?
a. Closed reduction and POP
b. Open reduction and internal fixation by plate
c. Closed reduction and external fixation
d. Open reduction and internal fixation by interlocking nail

10. An 85-year-old last was diagnosed with an osteoporotic fracture of L2 after she fell
down in a sitting position at home. In order to confirm that the fracture was caused by
osteoporosis, which of the following investigations would you like to order?
a. DEXA scan
b. RBS (random blood sugar)
c. Calcium and protein level
d. Scintigraphy

11. A 25-year-old man had MVA and sustained a closed fracture midshaft of the right
femur. The best choice for internal fixation is:
a. Dynamic compression plate
b. Interlocking nail
c. One-third tubular plate
d. Skeletal traction

12. Mr. Ali is brought to the ED suffering from anterior dislocation of the right shoulder
after falling from a tree. Which of the following is the appropriate treatment for this
injury?
a. Shoulder arthroplasty
b. Arm sling
c. Open reduction
d. Immediate closed reduction

13. A 20-year-old athlete sustained trauma to his right shoulder resulting in obvious
deformity and pain, with an AP radiograph of the right shoulder demonstrating
dislocation and osseous defect of the posterolateral aspect of the humeral head.
Which of the following is the most common nerve injured?
a. Radial nerve
b. Median nerve
c. Axillary nerve
d. Ulnar nerve
14. Sanjiv is a 19-year-old long-distance runner is referred to an orthopedics outpatient
clinic due to a dull aching pain around his right knee for 2 months. He has no history
of trauma. On physical examination, there is tender swelling at the distal part of the
right thigh. X-ray shows a periosteal reaction, Codman triangle, and sunray
appearance at the distal end of the femur. Which of the following is the most likely
diagnosis?
a. Aneurysmal bone cyst
b. Enchondroma
c. Osteochondroma
d. Osteosarcoma

15. A 60-year-old, right-hand dominant female sustained a wrist injury after falling on an
outstretched hand. She has pain and a dorsally angulated deformity at her right wrist.
Which of the following is the most probable diagnosis?
a. Galeazzi fracture
b. Barton fracture
c. Colles fracture
d. Smith fracture

16. A 13-year-old boy is referred to your office with a right-sided SUFE after workup over
several weeks by his pediatrician for insidious right knee pain. On exam, he has
obligatory external rotation with hip flexion and is refusing to bear weight. Which of
the following is the most appropriate treatment for this patient?
a. Open reduction and capsulotomy of the right hip with plate and screws
b. Fixation in situ by percutaneous screws of the right hip
c. Right hip arthroplasty
d. Skin traction of right lower limb

17. A 55-year-old woman is noted to have a traumatic injury to her right leg. Which of the
following is the first and most sensitive symptom for the diagnosis of compartment
syndrome?
a. Paresthesia
b. Pain out of proportion to the injury
c. Pallor of foot
d. Pulselessness of foot

18. An 85-year-old man presented with a fractured neck of femur Garden stage 3, three
days after the fall. Which of the following is the most appropriate treatment?
a. Traction
b. Osteotomy
c. Hemiarthroplasty
d. Screw fixation
19. A 25-year-old man is brought to the trauma center after MVA. He has a significantly
deformed right lower extremity with an 11-cm wound over the posteromedial portion
of his leg with soil particles in the wound. X-ray showed a comminuted fracture of
mid-shaft of tibia and fibula. The neurovascular status of his right leg is intact. Which
of the following is his Gustilo open fracture classification?
a. Grade 2
b. Grade 1
c. Grade 3A
d. Grade 3B

20. A 17-year-old boy who had just been operated on on his right radius and ulna
fracture 24 hours ago, complains of excruciating pain in the right forearm. The right
forearm was tense, there was an increased reading in the compartment-measuring
device (Stryker) in the right forearm. Which of the following treatment is the best
treatment for this patient?
a. Opioid analgesics
b. Observation
c. Ice compression
d. Fasciotomy
MEQ 1
A 7-year-old schoolboy fell from a rambutan tree in the compound of his house and landed
on his right palm. He had severe pain in his right upper limb. The mother was unable to
locate the area of injury as the boy was crying uncontrollably. He was brought to the ED at
HKL. You were the doctor seeing the patient in the ED. He was in severe pain, crying, and
holding his right arm with his elbow slightly flexed. The elbow was swollen and he would not
allow you to touch or move it.

PART 1
1. What is your provisional and differential diagnosis from the history and physical
appearance of the swollen, tender right elbow?
2. What immediate physical examination will you carry out on the right upper limb to
determine if there are any complications from the injury, requiring urgent care?

PART 2

3. What is your diagnosis based on the radiographs?

4. How do you classify the injury?
5. Discuss the principles of management of this injury.
MEQ 2
A 35-year-old motorcyclist is involved in a road crash, knocked down by a car, on the way to
work. His right ankle gets caught between his vehicle and the road, with bleeding from a
laceration, deformity, and exposed bone. He is in severe pain and unable to stand up on his
right leg. He is taken to the ED of HKL, where you are the doctor on call. He is conscious but
in severe pain.

PART 1
1. What are the possible injuries he could have sustained?
2. What are the quick general examinations you will perform on the patient to conclude
that he is in a stable condition?

PART 2

3. Describe your findings on this radiograph.

4. What are the principles of management of this patient with this injury?
5. What are the complications of the injury?