MUSCULOSKELETAL TEST 10 MEI 2013

SBQ

Question 1 A 12-year-old boy had a history of recurrent left leg cellulitis. He was treated with multiple doses of antibiotics but no recovery. He came with pain and swelling of the lateral side of the left lower knee. On examination, there are multiple sinuses on the left leg. On radiography, it shows multiple sequestra on the left tibia. (a) Outline the blood supply of the tibia and fibula. (b) State the most likely diagnosis. (c) Describe the pathophysiology of the diagnosis.

Question 2 A man fell on wrist from the balcony. He came with laceration of wrist exposing the radius bone. On radiography, there is fracture of the distal third of radius extending into wrist. (a) Grade the type of fracture according to the Gustilla grading of the open fracture. (b) Principle for 3 intra-articular fracture. (c) Breifly describe physiology of the fracture union. (d) Question 3 A 36-year-old female has a history of rheumatoid arthritis for 2 years. She was treated with oral prednisolone 6mg/day. On follow up, she complained of weight gain and easy bruising. On physical examination Round, puffy face Blood pressure: 150/110mmHg Weight : 90 kg Height : 1.65m (a) (b) (c) (d) (e) Calcualte BMI and interprete the result. State the most likely diagnosis. Briefly describe the clinical features. State the endocrine emergency when prednisolone is stopped suddenly.

MCQ TEST 1. Regarding inguinal region A. Female inguinal canal contains round ligament of uterus. B. Deep inguinal ring is lateral to inferior epigastric artery. C. Persistance of processus vaginalis cause direct inguinal hernia. D. The hernial sac of indirect inguinal hernia enters into deep inguinal ring. E. represented by first lumbar spinal nerve dermatome. 2. Regarding gouty arthritis A. Monosodium urate crystal are present in synovial fluid B. Its presentation is similar to chondrocalcinosis C. Probenecid block uric acid production D. It is caused by failure of purine metabolism E. Obesity is a risk factor 3. Fibrous joint include articulation between A. Scaphoid and trapezium B. Vertebral bodies C. Tooth and alveolar bone D. Parietal and temporal bone E. Distal ends of tibia and fibula 4. Injury to L4 nerve roots cause A. Paralysis of ankle dorsiflexion B. Sensory loss C. Pain over posterior compartment of the thigh D. Urinary incontinence E. High stepping gait 5. Regarding osteomyelitis A. It follows trauma in majority causes B. It is most commonly due to Clostridium Welchis. C. Sequestrum is feature in chronic osteomyelitis D. Intravenous gentamycin is and antibiotic of choice. E. Recurrent cellulitis is an early presentation in children. 6. Regarding structure of peripheral nerves A. Perineurium encircles each individual axon B. Each fascicle contains several axon and endoneurium C. Endoneurium forms blood nerve barrier D. Perineurium contains blood vessels of nerve E. Fascicle is more distinct distally than medially

7. In an intra-articular fractures A. Anatomical reduction is important B. Stable fixation is more important than early motion C. Degenrative disease is a sequela D. Physiotherapy is started after fracture united E. Union takes a longer time compared to diaphyseal fractures. 8. Cyclooxygenase inhibitor of NSAIDs have the effect of A. Anti pyretic B. Anti inflammatory effect C. Increased platlet aggregation D. Analgesia E. Increased gastrointestinal motility 9. Neuromuscular blocking agents are used for A. Skeletal muscle relaxation during surgical anesthesia B. Tracheal intubation C. Treating myasthenia gravis D. Relieving spasmositis during spinal cord injury E. Treating burns 10. Osteoarthritis A. Is a chronic inflammatory disease of joints B. Causes genu valgus C. Is caused by trauma in young people D. In lower limbs, it is usually due to obesity E. One of the treatment is joint replacement 11. Complications of fracture include A. Hypoluemic shock B. Fat embolism syndrome C. Neurovascular injury D. Stroke E. Compartment syndrome 12. Fracture healing retracted in A. Osteoporosis B. Malignant bone tumour C. Infection D. Elderly E. Ricket 13. Ricket A. Is due to vitamin K deficiency B. Is characterized by delayed bone matrix mineralization C. Is associated with osteoporosis D. Produced frontal bossing of the skull E. Known to occur in chronic renal failure

14. Regarding rheumatoid arthritis A. Individual with HLA-B27 allele are susceptible for the disease B. Pannus is formed by mass of articular cartilage C. Juxta-articular osteopenia is a radiological finding D. Rheumatoid nodule is characterized by granuloma with central fibrinoid necrosis E. Large joint is more affected in early stage. 15. Causes of bleeding in DIC include A. defect in vWF function B. Defect in platlet function C. Consumption of coagulation factor D. Dysfibrinogenemia E. Thrombin inhibition 16. Anticoagulant warfarin overdose A. Vitamin E as an antidote for warfarin overdose B. Heparin is given parenterally C. Low molecular weight is contraindicated in pregnancy D. Anti coagulant activity warfarin is monitored by INR test E. Heparin lyses thrombus 17. Deficiency in coagulation factor will cause A. Haemarthroses B. Hematoma C. Petechiea D. Delayed bleeding after trauma E. Epitaxis 18. Features of chronic phase of chronic myelocytic leukemia A. Thrombocytopenia B. Eosinophilia C. Normal cytogenetic analysis D. Purpuric rashes E. Hepatosplenomegaly