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  • Question 1 - An elderly, diabetic man has firm, tender nodules at the base of his...

    Correct

    • An elderly, diabetic man has firm, tender nodules at the base of his left middle and ring fingers, which he can't extend fully. What's the most likely diagnosis?

      Your Answer: Fibromatosis

      Explanation:

      This case is suggestive of Dupuytren’s contracture due to palmar fibromatosis. Its incidence is higher in men over the age of 45 years, and it increases in patients with diabetes, alcoholism, or epilepsy. These nodules are benign, usually appearing as a tender nodule in the palm which becomes painless. The disease has an aggressive clinical behaviour and recurs frequently.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      2.8
      Seconds

  • Question 2 - In multiple myeloma, which of these cell types confirms the diagnosis when found...

    Correct

    • In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?

      Your Answer: Plasma cells

      Explanation:

      A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      1
      Seconds

  • Question 3 - An amateur body-builder complains of increasing pain in his right shoulder after a...

    Correct

    • An amateur body-builder complains of increasing pain in his right shoulder after a few days of intense training. A surgeon aspirates clear fluid from his subdeltoid region. What's the most likely diagnosis?

      Your Answer: Bursitis

      Explanation:

      Bursae are potential cavities that contain synovial fluid, found in areas where friction occurs. Their function is to minimise friction and facilitate movement. Bursitis is the inflammation of one or more bursae, and they can occur in the shoulder, elbow, knee, ischium, amongst other joints. Acute bursitis can appear after strenuous exercise or activity, and chronic bursitis can develop following previous bursitis or trauma. Acute bursitis causes pain, tenderness, and swelling.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      3.1
      Seconds

  • Question 4 - A 73-year-old woman goes to the doctor complaining of pain and stiffness in...

    Correct

    • A 73-year-old woman goes to the doctor complaining of pain and stiffness in her shoulders and hips for 4 months, which is worst in the mornings. She has also been suffering from fatigue, weight loss and depression. There were no abnormal findings on physical examination. The erythrocyte sedimentation rate was 110 mm/hour, and serum rheumatoid factor and antinuclear antibody assays were negative. Mild normochromic normocytic anaemia was also found. What is the most likely diagnosis in this case?

      Your Answer: Polymyalgia rheumatica

      Explanation:

      Polymyalgia rheumatica (PMR) affects older adults, with an acute or subacute onset. Symptoms include severe pain and stiffness of the neck and pectoral or pelvic girdles, which is worse in the morning or after a period of inactivity and is usually bilateral. Other symptoms can include fatigue, weight loss, depression and fever. The erythrocyte sedimentation rate is usually elevated, and normochromic normocytic anaemia can occur. Other tests are usually normal in this disease.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      4.4
      Seconds

  • Question 5 - Which of the following diseases can cause paraesthesia along the distribution of the...

    Correct

    • Which of the following diseases can cause paraesthesia along the distribution of the median nerve of the hand, especially after activities which require flexion and extension of the wrist?

      Your Answer: Carpal tunnel syndrome

      Explanation:

      Carpal tunnel syndrome tends to occur in women between the ages of 30-50. There are many risk factors, including diabetes, hypothyroidism, obesity, pregnancy, and repetitive wrist work. Symptoms include pain in the hand and wrist, tingling, and numbness distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger), which worsens at night.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      2.2
      Seconds

  • Question 6 - Which of these HLA alleles is most likely to be present in ankylosing...

    Correct

    • Which of these HLA alleles is most likely to be present in ankylosing spondylitis?

      Your Answer: HLA-B27

      Explanation:

      Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      1.3
      Seconds

  • Question 7 - A 60-year-old man complains of pain in his left thigh. An X-ray reveals...

    Correct

    • A 60-year-old man complains of pain in his left thigh. An X-ray reveals bowing of the affected femur, increased bone density, bony enlargement, abnormal bone architecture with coarse cortical trabeculations, and stress microfractures. Which is the most likely diagnosis in this case?

      Your Answer: Paget’s disease of bone

      Explanation:

      Paget’s disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localised areas, replacing normal matrix with softened and enlarged bone and causing gradual pain and deformity in some cases. It is more predominant in men over the age of 40. Characteristic X-ray findings include increased bone density, abnormal architecture with coarse cortical trabeculation or cortical thickening, bowing and bony enlargement; there might also be stress microfractures of the tibia or femur.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      5.1
      Seconds

  • Question 8 - A 13-year-old girl has complained of pain in her left arm for 4...

    Correct

    • A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?

      Your Answer: Ewing’s sarcoma

      Explanation:

      Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      3.5
      Seconds

  • Question 9 - A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint:...

    Correct

    • A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?

      Your Answer: Gout

      Explanation:

      Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      3.8
      Seconds

  • Question 10 - A teenager presents with pain and swelling in a limb which increases after...

    Correct

    • A teenager presents with pain and swelling in a limb which increases after activity. X-rays reveal an expansible, eccentric, lytic lesion in the metaphysis distally in the affected bone surrounded by new bone. What is the most likely diagnosis?

      Your Answer: Aneurysmal bone cyst

      Explanation:

      Aneurysmal bone cysts tend to develop in patients younger than 20 years old. They usually occur in the metaphyseal region of long bones, and are cystic lesions composed of numerous blood filled channels that grow slowly. In X-rays, they show up as circumscribed lesions, sometimes surrounded by new bone.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      16.3
      Seconds

  • Question 11 - Which of the following diseases is caused by intra-articular and/or extra-articular deposition of...

    Correct

    • Which of the following diseases is caused by intra-articular and/or extra-articular deposition of calcium pyrophosphate dihydrate (CPPD) crystals, due to unknown causes?

      Your Answer: Pseudogout

      Explanation:

      Pseudogout or chondrocalcinosis is a rheumatological disease caused by the accumulation of crystals of calcium pyrophosphate dihydrate (CPPD) in the connective tissues. It is frequently associated with other conditions, such as trauma, amyloidosis, gout, hyperparathyroidism and old age, which suggests that it is secondary to degenerative or metabolic changes in the tissues. The knee is the most commonly affected joint. It causes symptoms similar to those of rheumatoid arthritis or osteoarthritis.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      2.1
      Seconds

  • Question 12 - Osteomyelitis is most commonly caused by which microbe in adults? ...

    Correct

    • Osteomyelitis is most commonly caused by which microbe in adults?

      Your Answer: Staphylococcus aureus

      Explanation:

      Osteomyelitis is most commonly caused by S. aureus in all age groups.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      1.7
      Seconds

  • Question 13 - A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning...

    Correct

    • A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning sensation that radiates from her left hip to her toes. What's the most likely diagnosis?

      Your Answer: Herniated nucleus pulposus

      Explanation:

      A herniated disk will produce sensory disturbances, causing pain that radiates along the course of the sciatic nerve which is typically burning or stabbing, with or without back pain. The herniation is usually caused by age-related degeneration although trauma, injuries, or straining may also trigger it.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      1.7
      Seconds

  • Question 14 - Which of the following statements is true of Colles’ fracture? ...

    Correct

    • Which of the following statements is true of Colles’ fracture?

      Your Answer: Is a cause of carpal tunnel syndrome

      Explanation:

      Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      1.8
      Seconds

  • Question 15 - Which tumour occurs in young adults, affecting the epiphyses of the bones and...

    Correct

    • Which tumour occurs in young adults, affecting the epiphyses of the bones and sometimes extending to the soft tissues?

      Your Answer: Benign giant-cell tumour

      Explanation:

      Benign giant-cell tumours tend to affect adults in their twenties and thirties, occur in the epiphyses and can erode the bone and extend into the soft tissues. These tumours have a strong tendency to recur.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      4.8
      Seconds

  • Question 16 - A 55-year-old woman complains of pain in the proximal and distal interphalangeal joins,...

    Correct

    • A 55-year-old woman complains of pain in the proximal and distal interphalangeal joins, and back pain which has increased over the last 4 years and worsens after activity. X-rays reveal Heberden’s and Bouchard’s nodes in her interphalangeal joints and the presence of osteophytes in her spine. What is the most likely diagnosis?

      Your Answer: Osteoarthritis

      Explanation:

      Osteoarthritis is most common in older adults, predominating in women between the ages of 40 and 70; after this age, men and women are affected equally. It affects an entire joint, with disruption and potential loss of joint cartilage, along with other joint changes, including bone hypertrophy (osteophyte formation). The pain is usually gradual and is worse after activity, with occasional joint swelling. X-ray findings include marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodelling and joint effusions.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      3.4
      Seconds

  • Question 17 - Which of the following diseases affects young adults, causing pain in any bone...

    Correct

    • Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?

      Your Answer: Osteoid osteoma

      Explanation:

      Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      2
      Seconds

  • Question 18 - A 13-year-old boy's mother notices he has a lump in his arm, near...

    Correct

    • A 13-year-old boy's mother notices he has a lump in his arm, near his right shoulder. An X-ray reveals a lateral projection in the metaphyseal region of his humerus. The lesion is removed and it is found to be composed of bony cortex, capped by cartilage. What's the most likely diagnosis in this case?

      Your Answer: Osteochondroma

      Explanation:

      Osteochondromas, or osteocartilaginous exostoses, are the most common benign bone tumours, and tend to appear near the ends of long bones. The overgrowth can occur in any bone where cartilage forms bone, and they are capped by cartilage. They are most common in people between the ages of 10-20 years old.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      11.1
      Seconds

  • Question 19 - If a patient takes long-term corticosteroid therapy, which of the following diseases is...

    Correct

    • If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?

      Your Answer: Osteoporosis

      Explanation:

      One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Orthopaedics (19/19) 100%
Pathology (19/19) 100%
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