GRAMI

ALL IN ONE EXAM COLLECTION

1. Patient fall down on his lateral side  LAT compression pelvic fracture
2. When to remove external fixator(ilizarov) for lengthening : (OK)
 after corticalisation and regeneration
 after appearance of regenerate
 after disappear of fibrous tissue
3. Chauffeur fracture  distal end radius fracture (OK)
4. common site of metastasis  dorso-lumbre spine (OK)
5. pt with scoliosis and can set alone  treatment by brace
6. osis 35-degree  surgery
7. Trauma of Ankle treated by cast for 8 weeks but still having pain: (OK)
 MRI
 CT
 Stress view
 Mortise view
8. Common site of cordoma  sacrum (OK)
9. Contraindication of uni-condylar arthroplasty  rheumatoid arthritis (ok)
10. Old women drinker of alcohol get up in the morning with sever big Toe inflammation and pain, aspiration is
expecting to show  urate crystal
11. Less wear friction  ceramic on polyethylene (ok)
12. Inter-compartment pressure 35  fasciotomy (ok)
13. Polytrauma pt with bilateral femoral shaft fracture Hg is ok , BP 100/60, PULS =104, lactate is normal, chest
ans U\S is free (stable after resuscitation) TTT IS :
 Bilateral Reamed intra medullary nailing
 external fix
 DCO
14. cauda equina investigation  MRI(ok)
15. Patient with history of operation for recurrent shoulder dislocation 3 years ago, now he can’t external rotate his
shoulder beyond 40 degree and has posterior shoulder laxity, what is operation done before:  Putti-Platt (ok)
16. 40 years male had posterior hip dislocation reduced under G.A, CT done with no fragment in the joint post
reduction management is: (OK)
 Bed rest for 3 days then full weight bearing
 Skin traction for 3 weeks then FWB
 Skeletal traction for 3 weeks then gradual WB
17. 35 years old with displaced fracture neck of femur, what is the accurate statement about this patient: (ok)
 Closed reduction and screws fixation
 THA
 Hemi arthroplasty
 Later he will need THA
18. 30 years old with 4 parts radial head fracture with metaphysial loss ( some time : with DRUJ intact )  (ok)
 radial head replacement with rubber head
 radial head replacement with metal head (head with neck prosthesis if present )
 mini T plate
 fixation by hybrid screw
19. definitive management septic arthritis of the knee  aspiration
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20. tibial plateau with meniscal injury  repair at the same time (ok)
21. GCT histopathology  not affect the prognosis
22. crank shaft prevention :
 anterior + posterior Fusion
 posterior fusion
 bracing
 posterior instrumentation
23. dupuytren's contracture  Z plasty - partial fasciotomy
24. autologous (autogenous) ACT chondrocyte implantation:
 pervious cartilage biopsy and chondrocyte is the main item in the procedure should be taken first
 one stage surgery
25. TKA you do the osteotomy in the femur :
 7 degree valgus from anatomical axis
 7 degree varus from anatomical axis
 Neutral from anatomical axis
26. anterior epiphyseal tibial fracture (Tuberosity) , complication is  recurvatum
27. childe with osteopetrosis , intra operative critical phase  drilling (ok)
28. pelvic protrusion  External iliac – then femoral then common iliac (ok)
29. Acetabular safe zone of screw insertion  poster superior and poster inferior (ok)
30. case of pelvic fixation  hard ware impingement
31. common site of spinal stenosis  L4-L5 (ok)
32. lurch gait  L4-L5
33. Trendelenburg gait  sway the trunk to the affected side and drop pelvis on the opposite side (ok)
34. Weak dorsiflexion of big toe (EHL) , the root affected is  L5 root (L4-L5) (OK)
35. colle’s fracture treated conservative cause carpel tunnel syndrome (numbness in the lateral 3 fingers ): (OK)
 ORIF+ CT release
 Continue cast
 Repeat Close Reduction
36. compartment syndrome occur when intra-compartmental pressure is  absolute 30 mm\hg ( other form of
answer: the deference between diastolic pressure and compartment pressure < 30 mm\hg preparative )
because the anaesthesia drug change compartment pressure (ok)
37. polytrauma patient with BP= 70/40, temperature= 34, lactate = 3 : (ok)
 unstable patient
 stable
 extreme unstable
 boarder line
38. fracture of clavicle and scapula : (ok)
 scapula-humoral dissociation
 floating shoulder (defined as ipsilateral fractures of the midshaft of the clavicle and the neck of the glenoid)
39. most common complication of femoral shaft fracture  fat embolism (ok)
40. Common complication of blood transfusion  hyper sensitivity …..?? *
41. Case of ant. Compartment syndrome
42. Case of post. Compartment syndrome
43. Computarized gait analysis and physical examination is important for outcome of surgery incerebral
palsy(ok)
44. best diagnosis of ankle sprain with medial clearance space  full length xray \ stress view
 revised (https://www.orthobullets.com/foot-and-ankle/7028/ankle-sprain)
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45. base of coracoid  scapular view (ok)
46. case of Charcot joint or neuropathic joint  vein
47. nerve repair  1-3 days
48. best time to give corticoid in spinal injury (3 h but it its effective up to 8 h) (ok)
 3 H ( best time )
 8 h (time on general to give corticoid )
 Befor 6 h
49. infected TKA (9 or12 ) days post op with systemic and local and laboratory sign +ve: (ok)
 irrigation and debridement of soft tissue
 remove prosthesis
 replace prosthesis
 change PE liner or cup
50. whiplash injury  mechanism is hyperextension (sudden flexion)
51. Patient with osteoporosis the best marker is (bone resorption marker) : (ok)
 Urine N telopeptide
 hydroxyprolin
 Acid phosphatase
 Alkaline phosphatase
52. Pelvic tilted upward  area of patchy radiolucent & opacity pattern
53. 70 years old man male had knee dislocation treated by brace, on examination: mild valgus instability MRI shows
partial MCL tear and complete ACL and PCL tear and medial Meniscus tear with osteoarthritis. what is the most
suitable reconstruction : (ok)
 ACL + MCL +PCL reconstruction
 P.S TKR with MCL repair
 Constrained condylar TKR
54. sterilization of polyethylene by  GAMMA radiation (ok)
55. cervical pain relived by arm elevation  radiculopathy (ok)
56. alkaline phosphatase is a marker of (produced by) (ok)
 osteoblast activity
 osteoclast (marker is acid phosphatase)
57. The cause of osteolysis (failure stem in THA) : Polyethylene debris (ok)
58. best investigation of nerve injury  electro-physiological study (ok)
59. best investigation of nerve compression  nerve conduction study (ok)
60. percent of non-union after trochanteric osteotomy:  5 % (ok)
61. symptomatic plica  medial patellar plica (ok)
62. dynamic stabilization of patella during flexion with vastus medialis obliquus mainly by : (ok)
 medial patello-femoral ligament (MPFL)
 patellar tendon
63. 8 year old , fracture DIR , 15 degree dorsal angulation  observe and assurance (ok)
64. case: x-ray (LAT view of hip) patient 45 years old show Head femur sclerosis with outer collapse in patient with
renal transplantation (other Q: heavy worker or under corticoid therapy)
 Core decompression (IF there is no sclerosis in the x ray)
 Vascularised fibular graft (VFG) (in young age)
 THA as it is irreversible cause of AVN SO, cause is THR despite of stage or age of patient.
 Hyperbaric O2
65. AVN with multiple cyst in the head of femur.TTT IS:
 VFG
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 Core decompression
 Rotational head osteotomy
 THA
66. Hallux rigidus affect which stage of gait  push off (ok)
67. X-ray show hallux rigidus, arthrodesis in : (ok)
 Fixation in situ
 Fixation at 15 degree flexion
 Fixation at 15 extension
 Resection arthroplasty
68. Most common osteoblastic metastatic tumour :
 breast ca
 lung
 thyroid
 prostate ( this is the choice if present in the answer )
69. Most common site of metastatic bone disease : (ok)
 Dorso-lumber spine
 Proximal femur
 Proximal humerus
70. X-ray LAT talar tilt (medical clearance space widening + osteochondral fracture of talus :
 X-ray to whole tibia and fibula
 Stress view
 Syndesmotic view
71. lichtman classification kienbock's disease of lunate with sclerosis without collapse (ok)
 I
 II
 III
 IV
72. Radial arthritis with widening of scapho lunate distance SLAC  type 2
73. 45 years old, carpenter with elbow arthritis and sever pain. ROM 50-100, unable to hold object: (ok)
 Arthrodesis at 60 degree
 Arthrodesis at 100 degree
 Total elbow prosthesis
74. Ischemic index of diabetic foot to the stump of amputation to heel (ok)
 0.6
 <0.5
 <0.4
 <0.3
75. Brooker classification <1cm or 9mm  grade III (ok)
76. Mal united femur with 7 cm shortening and varus deformity of 24 degree, initial treatment is : (ok)
 Correction of rotational angle
 Buector angle
 Paly’s angle
77. (case) acetabular fracture fixed by 2 plates with fracture femoral neck and head resorption, the patient cannot
walk after operation the cause is : (ok)
 Missed injury
 AVN
78. Most common presenting symptom of osteosarcoma  pain (ok)
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79. Last structure to be repaired in re-implantation :

 Vein  Nerve
 Artery  tendon

80. Most common type of thumb polydactyl (ok)

 I  III
 II  IV

81. 12 years old scoliotic patient underwent posterior spinal fusion (D3-L3) was corrected then he developed
proximal and distal curve and recurrence of the original curve, the cause is : (ok)
 Crank shaft phenomena
 Junctional phenomena ( the Q must include LAT view to see this phenome)
 Scoliosis proximal and distal curve
82. Which region of the spine fracture has 30-50% incidence of spinal injury with 3% of neurological deficiency:*

 Lumber
 Cervical
 Dorsolumbre(not sure)
 Dorsal
83. (case) muscle dystrophy (weak muscle, recurrent falling, wide based gait, patient climbing when stand up from
sitting position), short calf muscle : (ok)
 Hypertrophy
 Atrophy
84. (case) patient with back pain , neurologically intact, showing peri-discal affection with abscess formation,
ESR=60 in 1st hour, to confirm the diagnosis  acid fast bacilli from tissue pathology (ok)
85. Cold abscess histology  acid bacilli, caseation and WBC (ok)
86. Crushed hand with degloved dorsal skin, good capillary refilling, after one day there is blue to black discoloration
the cause is: (ok)
 Intimal arterial tear
 Venus drainage inadequate
 Infection
 Allergy to administrated ATB
87. Pain in the index finger with history of crushing injury that was diagnosed to affect the radial nerve since 12
weeks ago, the diagnosis is neuroma , best treatment is :
 Corticosteroid injection
 Excision
 Exploration to repair radial nerve
88. 60 years old, trochanteric fracture fixed by DHS within 48 h after trauma, 5 days post op , the patient
complain of fever 38 degree , pulse: 95, he try to remove the urine catheter, the cause is :
 Primary septicaemia *
 Infected iv line
 UTI from catheter
 Lower respiratory tract infection
89. (case) child with lower limb discrepancy what is the radiological investigation :
 Scanogram with patella out word
 Scanogram with patella in word ???????
 Orthogonal x-ray (or orthorentogram or scanogram foreward if present in the option)
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90. 14 years old patient consult for lower limb discrepancy ( 2cm) in the lift femur after distal femoral epiphyseal
fracture , he felt good with elevation by 2 cm of the left shoes, he ask you about the future form of his foot,
what you should do :
 Epiphysiodesis of the right femur
 Left femoral lengthening at maturity
 Right femoral shortening at maturity
 Assurance and continue shoe lifting
91. patient with fracture both bone leg ( pic) complain of pain in passive dorsiflexion of the ankle, paraesthesia
along the sole of the foot , the cause is : (ok)
 posterior compartment syndrome
 anterior compartment syndrome
92. frame knee with T.B of hip joint means :
 plastering of the knee for 12 months with premature closure of the physis around the knee
 stiff knee due to immobilization of the knee for 3 months
 hip and knee stiffness due to Spica
93. patient use DENOSUMAB (Xgeva) developed hypocalcaemia, the treatment is :
 give oral vit D
 give parathyroid hormone
 do renal function test
 stop drug
94. patient with left thigh pain and tenderness 2 months ago, x-ray show lytic lesion with sclerotic margin suggesting
brodes abscess, treatment is :
 IV ATB for 6 weeks
 Open biopsy and curtage
 Tumour workup
95. Ankle and leg pain at night weaking him from sleep in 14 year old pt, not releaved by analgesic, x-ray and CT of
the leg shows sclerotic and periosteal reaction with no nidus histopathology:
 Osteoblast proliferation with necrotic bone ( in brodes abscess )
 Polymorph infiltration
 Histocytic cell
96. 6 months infant has swelling in the mandible and left leg proceeded by vomiting and diarrhoea 2 weeks earlier,
x-ray of the left leg show’s diaphysial spanning and periosteal elevation , the cause is :**
 Congenital syphilis
 Defuse osteomyelitis
97. Patent fall before 2 weeks came to you complaining of painful flexion and extension of the wrist. You suspect :
 Scaphoid fracture
 Radial styloid fracture
 Lunate fracture
98. Tennis player win the competence complain of sudden onset of shoulder pain, x-ray show calcific tendinitis
treatment is :
 Treatment of acute calcific tendinitis
 Arrange for arthroscopy
99. 60 years old male, with colles fracture treated by caste for 6 weeks, develops signs of sudeck’s atrophy ( pain,
warmth, loss of motion) the pain increase when he fight with care giver. 4 weeks after plaster removal , the
treatment is :
 Paracetamol 1G TD + tramdol 75 mg
 Psychological therapy + paracetamol + tramadol
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 Aggressive physiotherapy + paracetamol + tramadol (not sure)
 Sympathetic chain block
100. Prerequisite of Mitchel osteotomy in hallux valgus with angle of 25 degree :
 Congruent joint
 Subluxed joint
 Incongruent
 Dislocated
101. Hummer toe  slight extension of MP joint and flexed PIP joint
102. Swan neck deformity in rheumatoid hand  flexion of DIP joint and hyperextension of PIP joint
103. Rheumatoid hand DIP hyperextension. DIP hyper flexion and flexed MCP :
 Swan neck
 Bontonnier
104. Most common type of idiopathic scoliosis :
 Juvenile
 Infantile
 Adolescent
105. Most common cause of Morell la valley  after pelvic fracture
106. (x-ray) dislocation of bilateral THA (other Q: bipolar) immediately post op with will positioning prosthesis
due to  improper soft tissue repair (other Q ): dislocate after 2 weeks  the cause is vertical orientation of
acetabular component (cup) the treatment is revision
107. (pic) left bipolar dislocation in elderly patient, management is :
 Replaced (converted) to THA
 Reduction
108. 6 year old child with supra condylar humeral fracture, came with drop hand , after reduction and fixation on x-
ray : the fracture fixed by 2 LAT and 1 medial wires post OP pt enable to extend the thumb,the pulse is felt ,
what to do :
 Remove the one LAT weir
 Remove the one medial weir
 Observation (not sure)
 Surgical exploration
109. Patient with below knee amputation one year ago, complaining of pain and aching sensation on the foot skin,
the stump is normal on examination, with no point of tenderness, the cause is :
 Neuroma
 Unstable scar
 Phantom limb
 Seduck’s atrophy
110. 12 y\o with ehlar danlos criteria (skin hyper elasticity) with scoliosis 25 degree :
 surgery(posterior fusion)
 observe
 brace (orthosis)
 anterior fusion
111. transverse # phalanx → pinning
112. minimal Polyethylene thickness in TKA :
 8 - 10 mm
 6-8 mm
113. L5 root injury → loss of foot dorsiflexion
114. Duchenne characterized by  calf pseudo hypertrophy
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115. Gunshot injury 4 segement fracture tibia he had 1 cm but after I and D the wound become 4 cm without skin
loss  gustillo type 3A ( as it is a gunshot wound)
116. Tear drop cervical spine #  axial compression flexion
117. Glenoid fracture 1cm displacement  ORIF
118. Child with Salter Harris distal femur fracture most common complication  Growth arrest
119. Green stick Fracture proximal tibia and fibula in metaphysis zone in child age of 10 y\o, fracture was reduced
and treated by above knee cast , what is the possible deformity that may take place in the future
 Valgus deformity (cozen phenomena that resolved spontaneously )
 Varus deformity
 Shortening
 Lengthening
120. Fracture both bone forearm the surgeon choose Stainless steel plate , why → stronger than titanium weaker
than cobalt chrome
121. Most common organism in human bite  alpha-hemolytic streptococcus (S. viridans) 1st cause
:staphylococcus aureus 2nd cause: eikonella corrodens in 7-29%, other gram negative organisms
122. Pt with TKA get oral infection then he got infected prosthesis , the causative organism : strepto oralis
123. Most common organism in animal bite Pasteurella species
124. Carpal tunnel view used to diagnose → hook of hamate fracture.
125. protrusio acetabuli, which artery is affected → ext. iliac a. > femoral a. > common iliac artery (and external iliac
vein and sciatic N.)
126. In pavillic harness flexion more than 90 → femoral nerve palsy
127. In pavillic harness abduction more than 60→ high risk of AVN
128. Tillaux # represent salter Harris type → type 3
129. Titanum near to the cortical bone in → Young's modulus of elasticity (or stiffness) N.B ( Ceramic.>cobalt
chromium>stainless steel>titanium>cortical bone)
130. female patient , pregnant 3rd trimester with patches in neck of femur→ transient osteoporosis
131. most specific cell responsible for bone healing are present in
 periosteum
 cortical bone
 bone morrow
 osteoblast

N.B : factor affect bone healing  stability

132. Myralagia parathesia  lateral cutaneous nerve of the thigh

133. percent of spontaneous bleeding in haemophilia with factor 8 less than  5%
134. male has increase in external rotation in both 30 and 90 degree flexed knee ( +ve dial test) mostly he has 
PCL + PLC
135. most common site for scaphoid#  waist
136. mal united femoral shaft # of 2 years old with 24 degree of varus deformity, what you look for and asses in
radiography while you prepare him for correction :
 CORA
 Bisector line
137. Hyperlaxity score  Beighton score
138. Tourus fracture zone  1ry spongiosa
139. Flexor tendon injuty zones….
140. Posterolateral herniation L4/L5 affect :
 L5
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 L4
 L3
 S1
141. Gruens classification of THA, zone 4 represent  stem
142. +ve reverse pivot shift test :
 injury PLC
 PCL
 Posteromedial instability
 Anterolateral instability
143. Xray + CT show tibial plataue # + posteromedial fragment, ttt  buttress plate by posteromedial approach
(similar Q show pure posterior fragment  antigliding plat by posteromedial approach )
144. Xray show An teater sign of tarsal bone  tarsal coleation. N.B (theatre pain due to prolonged sitting with knee
bent in Idiopathic Chondromalacia Patellae)
145. Common complication of tarsl neck #  arthritis
146. Multiple enchondromatosis  ollier disease
147. Newborn with bilateral talipus equinovarus When to start correction of  cast immediately
148. Child with TEV , DDH, scoliosis, what is first to be managed TEV
149. Alkaline Phosphatase is a activity marker of  osteoblast
150. Mallet finger  rupture of Extensor Digitorum Profundus (distal extensor)(terminal band)
151. Common site for spine fracture  dorsolumbar (T11-L3)
152. Common Age of Ewing sarcoma :
 10- 20 yeas old
 0-10
 20-30
 30-90
153. The bone tumour which has a tendency for duplicate most common before 10 years of age  Ewing sarcoma
154. Most common tumour in diaphysis in children < 10 year old  Ewing’s sarcoma
155. Tension band wiring of olecranon # with K-Weir penetrating anterior cortex  Anterior Interosseous N.injury
156. X-ray distal humerus fixed through the olecranon osteotomy with long K wire it can cause injury to :
 AIN anterior interosseous nerve
 PIN posterior interosseous nerve
 Medina N

157. Inlet view of pelvis25 – 30 degree caudal ( 30 cephalad )
158. In pelvic inlet view angle, the tube should tilted :
 30 degree caudal (down)
 40 degree tube from body
 60 degree tube from body
159. Café au lait patches  neurofibromatoses
160. Osteosarcoma transformation from  Pagtets disease
161. Old patient with the hat become not fit to his head  osteitis deformins (paget’s disease )
162. The patient develops osteoporosis and enlargement of bone , previous hut does not fit  osteitis deformins
(paget’s disease )
163. Ankyloses spondylitis affected gene  HLA B 27
164. Femoral Notch Width Index  0.231
165. Rickets affect : hypertrophic zone (calcification zone)
166. Supracondylar # type3 treatment  closed reduction + percutaneous pining
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167. Nerve entrapment in Gyoun canal  Ulnar nerve
168. Thoracic outlet syndrome diagnosed by  Adison test
169. Medical ttt of Paget’s disease  Bisphosphonate ( if patient can’t tolerate it then we give calcitonin)
170. Failed femoral nail with fracture  remove & replace with large diameter nail
171. Best prognosis (physiological) of congenital tibial bowing  posteromedial bowing.
172. Howeship lacuna present in  osteoclast
173. need two cortex for fixation  DCP
174. Pain in anatomical snuff box after trauma  scaphoid #
175. Cauda equine syndrome ttt  urgent decompression \ best investigation  MRI
176. Spinal stenosis not improved with medial ttt & epidural injection  decompression
177. Best anticoagulant in THA  fondapavenox
178. What is unusual organism (Common organism) of osteomyelitis in IV drug abuser :
 Staph
 Strept
 Pseudomonas
 MRSA
179. Physis around elbow fusion occur at 12 year  Lateral epicondyle
180. Knee arthrodesis  15 flexion , 5 valgus , 5 External Rotation
181. Hip arthrodesis  0-5 abduction, 5-10 external rotation , 20-35 flexion
182. Shoulder arthrodesis  20-30 abduction , 20 - 30 forward flexion , 20-30 Internal Rotation
183. Jüngling disease  Multiple cystic tuberculous lesions in the skeleton
184. Trauma of the Thumb followed by shortened thumb and painfull ROM in all direction x-ray shows dislocated
thumb, failed closed reduction. The cause of block :
 Sesamoid entrapment
 Anterior dislocation
 Posterior dislocation
 Complex dislocation
185. Indication of surgical ttt of hallux valgus, when valgus angle  more than 15 degree
186. Old age with crutches. nerve injury of  Radial nerve (crutch palsy )
187. Common site of degenerative spondylolisthesis: L4/5
188. Recurrent shoulder dislocation , best ttt  Arthroscopic Bankart repair
189. Weak hip abduction  L4/5 prolapse
190. Clay-shoveler Fracture :
 Cervical Spinous Process Fracture (classically at C6 or C7) most common in C7
 Transvers process of C7
 Pedicle of C7
191. Most common type of physeal injury  type 2
192. Common site of stress # in foot  2nd metatarsal
193. Nerve at risk with External fixator of pelvis #  lateral femoral cutaneous nerve
194. Lyme Disease is a systemic infection with  Borrelia burgdorferi
195. Most common soft tissue sarcoma of the hand  Epithelioid sarcoma
196. Most common deformity of sub-trochanteric #  Flexion & abduction
197. Medial meniscus injury with tibial plateau #  schatzker type 4
198. Highest bone in Y view of shoulder  clavicle
199. To differentiate between sickle cell anemia & osteomyelitis or bone infraction  MRI with gadolinium
200. The danger zone for Acetabular Screw Placement  anterior superior- anterior inferior quadrant.
201. The Safe Zones for Acetabular Screw Placement  posterior superior- posterior inferior
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202. Abduction contracture causes involved hemipelvis to be lower  creating apparent LONG leg
203. ADDuction contracture causes involved hemipelvis to be higher  creating apparent SHORT leg
204. Pelvic outlet view  25 caudal
205. delpet classification type 1 (sub capital fracture of femoral head) risk of AVN is  80- 100 %
206. most common malignant primary tumor of bone is :
 osteosarcoma
 fibro sarcoma
 osteoclastoma
 osteochondroma
207. the most common malignancy of bone is  metastatic disease
208. the most common primary malignancy of bone is  myeloma
209. The most common sarcoma in children  rhabdomyosarcoma
210. Sclerosis of lunate without collapse according to litchman classification this is type type 2
211. Most common complication after THA  DVT
212. 68 years old female with rheumatoid arthritis (x-ray: good acetabulum + #neck femur garden 4 ) treatment is :
 Bipolar THA
 Reduction and fixation
 Monopoler
 THA
213. 30 years old with non-union femoral neck fracture treated by 3 cannulated screws , next step is :
 Valgus femoral osteotomy with blad plat
 Revision reduction and fixation
 Bone graft and fixation
 Total hip replacement
214. X-ray of bilateral THA dislocation with aligned component, the cause of dislocation is : (N.B: if there is no
vertical cup) the answer is
 Vertical cup
 Soft tissue deficiency
 Improper Adductor
 Improper restoration of length
215. Low demand hemiplegia female , 80 years old , bed redden, nursing care 10 years ago with fracture right neck
of femur, what to do to the right leg :
 Palliative care
 Monopolar arthroplasty
 Bipolar arthroplasty
 THR
216. X-ray of Thompson prosthesis in protrusion, patient complaining of groin pain , the cause of pain is :
 Protrusion
 Osteoarthritis
 Incomputable component
217. Early prosthetic infection ( within days ) what to do  debridement + lavage + linear exchange
218. X-ray : bipolar prosthesis dislocation after trauma in 68 years old . what to do : (N.B: if it is first episode)
 Open reduction + traction
 Closed reduction + traction
 Convert to THR
219. X-ray of THA dislocation after trauma :
 Open reduction
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 Close reduction and early weight bearing (if it’s the 1st time)
 Revision THA
220. Hip arthrodesis with Back pain and deficient abductors :
 Convert to constrained THR
 Treatment of pain
 THR
221. 62 years old with Knee dislocation with ACL, PCL and partial MCL + osteoarthritic changes, what to do :
 Constrained condylar TKR
 Ligament repair for partial MCL and posterior substitute total knee
 PS (posterior stabilized )TKR
 Hinged TKR
222. (photo) obese female with right genu valgum ( ligament instability) and osteoarthritis, what type of prosthesis
you should use :
 Constrained TKR
 Highly constrained
 Hinged
 PS (posterior stabilized) TKR
223. X-ray giant cell tumor of upper tibia for investigation you should do :
 MRI
 Bone scan
 CT with contrast
224. 80 y\o female, hemiplegia and dementia with femoral neck fracture , treatment is :
 Unipolar hemi arthroplasty
 Bipolar hemi arthroplasty
 Conservative ttt
 THR
225. x-ray of wrist show mass (may be huge myositis ossificant) with deformed wrist swelling:
 bone scan
 MRI
226. Wrist trauma with severe pain and swelling (X-ray of lunate dislocation) diagnosis is :
 Lunate dislocation
 Scapholunat dissociation
 Wrist dislocation
227. MRI AXIAL section of shoulder : 2 Q ( bankart or hillschs lesion)
228. Solitary osteolytic lesion in the spine :
 Brace
 Posterior fixation
 Excision with fixation
229. RTA patient with fixation by sacroiliac screws come with foot drop (patient detected weakness if dorsiflexion of
big toe) the cause is :
 Sacroiliac screw anterior (L5 injury)
 Sacroiliac screw posterior
230. High cross linked Polyethylene versus conventional Polyethylene :
 High wear rate
 Low fatigue strength and less wear rate
 Low tension
231. Union rate old vs young  there is no deference. both united at the same time
GRAMI
232. Fracture both bone forearm, the surgeon choose to use stainless still plate, why he choose this type of plate
Titanium near to cortical bone in modulus of elasticity
233. Hypotension with cementing. the cause is:
 Fat embolism
 Air embolism
 Solvent enter circulation
 Monomer
234. During THA the cement gun machine (vacuum machine) stooped working and the surgeon wall mix and put the
cement manually, what is the ratio the cement mixed by the machine is better than (stronger then ) cement
mixed manually  20-30 %
235. Osteochondroma of scapula with increas cartilage cup + calcification + increase pain and size malignant
transformation
236. Neurofibroma, when to do surgery :
 Multiple lesion
 Site of lesion
 Presence of pain
237. Ankle fracture with osteopenia case of sympathetic dystrophy (sudcks atrophy). Best investigation : (ok)
 Bone scan
 MRI
238. X-ray ankle in diabetic patient  charcot ankle joint (or neuropathic joint )
239. Best Medical treatment of neuropathic pain :
 Corticoid ( in case of compressive neuropathic pain )
 NSAID
 Opioid

N.B (1st line  anti-depressant - 2nd line  opioid tramadol )

240. Patient with recurrent dislocation of 7 years done scop, now since 2 years he complain of painfull shoulder in
overhead activity, limited external rotation 40 degree, stress test post laxity. What to do :
 Putti plat (not sure)
 Bankart open
 Bankart scope (or latarjet)
241. 80 years old with 4 parts proximal humeral fracture, treatment is :
 Hemi arthroplasty (or conservative if present )
 Total shoulder arthroplasty
 ORIF
 CRPP
242. 12 years old with Fracture both bone forearm, 20 degree angulation after reduction :
 Plating
 Close reduction with Pining
243. Distal radius fracture with distal RUJ dislocation
 Repair ligament
 Pining ulna to radius in supination
244. Burst fracture L1, spinal cord intact :
 Brace and early mobilization
 Posterior fixation
 Anterior fixation
245. Common verterbral involvement in burst fracture :
GRAMI
 D10-L3
 L4-S1
 D1-D9
 Cervical spine
246. Tarsal coalation , best diagnosis :
 CT
 MRI
 Bone scan
247. Fibula move with dorsiflexion of the foot :
 Lateral and external rotation
 Medialy
248. (pic) T shaped open fracture of distal femur and open wound intra articular
 Restore articular surface
 Restore diaphysis
 Anti-grade nail
 Retrograde nail
249. Boy age > 18 months with Osteomylitis in metaphysis, spread to
 Epiphysis
 Medullary canal
 Sub periosteal
 No spreading
250. Patient came from aboard, has a fever and urethral discharge with painful erythema of knee joint, aspiration
and culture are –ve but stain –ve cocci. How the microbial diagnosis done next step : (case of gonococcal
infection)
 Oral and Vaginal swap ( ture if the patient is female)
 Responding to vancomycin
251. Osteophyte arthritis at radioscphoid, what is the stage according to SLAC
 I
 II
 III
252. Tumor in the clavicle, MRI of the lung show abnormal lesion :
 Osteosarcoma
 Metastasis

253. Position of ankle arthrodesis  neural dorsiflexion\ 5 degree valgus \ 5-10 degree external rotation
254. Transvers fracture of phalanx :
 Mini-plate
 Pining
255. The type of Hallux valgus which has tendency to progress rapidly and aggressively progress in type :
 Type 1
 Type 2
 Type 3
 Type 4
256. Locking and popping knee in patient 15 years old : (answer not confirmed ) case of discoid meniscus ?
 Scope better then MRI
 Incision of hyperplastic tissue
 Excision of hyperplastic tissue
GRAMI
257. 18 year old , female , x-ray show medial femoral condyle OCD less than 2 cm  drilling
258. X-ray old prosthesis THA patient complain of groin pain :
 bed rest, traction and follow up
 revision
259. 80 years old patient (xray) THA with osteolysis around femoral stem  revision THA
260. In Tourniquet pulsy the cause is :
 Pressure 250 mmhg
 Duration more than 2 H

N.B : in upper limb no more than 100 mmgh above systolic \ in lower limb no more than 150 above systolic \
duration: no more than 2h

261. Tibial fracture on bohler traction. what is the mechanism of this traction** :
 Gravity
 Skeletal
 Combined
 Balanced traction
262. Trochlear fracture fixed by K-weir can cause injure to :
Posterior interosseous nerve (PIN)
263. RTA with blunt trauma, there is ribs and scapular fracture with sever ecchymosis on scapula. X-ray show lung
patches, patient on tachypnea, tachycardia and cyanosis, and there is cardiac tamponade and pericardial
effusion the treatment is :
 Deep ventilation (O2) , suction and ionotropic (+ diuretic)
264. Case of GCT of proximal tibia , the treatment is :
265. 6 years old boy with Scaphoid fracture treated by cast , and still in pain , next step of investigation is :
 MRI
 MRI with contrast (to evaluate the viability of proximal fragment )
 CT
266. 50 years old female, diabetic with Charcot ankle and discharge sinus from sole of foot best investigation is :
 MRI
 MRI with contrast (if angiography no present in the option )
 Venography
 Peripheral angiography
267. RTA with femoral shaft fracture at night he developed dyspnea short breath, conjunctival petechia and fever
the cause is  fat embolism
268. non ambulatory 16 years old with Scoliosis 30 degree + Duchenne  surgery arthro post
269. Case describe sings of klippel fail syndrome (fused C5-C6 short neck – head near to shoulder )
270. Patient on vit D treatment, he has a fracture, he continue to use vit D. the patient became drowsy, confused,
altered mental state what is the cause  hyper calcinosis due to intake of vit D ( stop vit D before operation if
present)
271. High turnover osteoporosis and bone diease treatment  bisphosphonate
272. Boy with both bone forearm fracture came with deformity after 6 months accepted , what to do  reassurance
273. Glenoid fracture with 1 cm displacement  ORIF
274. (PIC) gunshot with no skin loss , which type of gastillo  A3
275. Common organism in septic arthritis in patient with sickle cell anemia:
 Salmonella (most specific \ characteristic )
 Staph aureus ( most common )
276. Boy with septic arthritis of the knee and resistance to antibiotic (MRSA), treated by  vancomycin
GRAMI
277. X-ray of subtalar dislocation, which joint is affected :
 Talo-calcaneal
 Calcaneo-navicular
 Talo-vavicular
 All
278. Neurofibroma in (radial or ulnar ) nerve, treatment is :
 Complete excision
 En-block excision
279. Hill sachs lesion site :
 Anterolateral
 Posteromedial
 Posterolateral (OR posterosuperior)
280. Dislocation knee with ACL, PCL, partial MCL. Treatment is  constrained TKR
281. Causative organism of FELON disease  staph aureus
282. 70 years old with colles fracture came after 6 weeks with pain, referred to shoulder and elbow investigation 
nerve conduction study (NCS)
283. Child has shallow acetabulum, small, anterolateral wall deficient l (DDH), which osteotomy  salter osteotomy
284. Female 20 years old , volleyball player (pic: boutonniere deformity) of middle finger with pain of proximal PIP,
what is the injury  central band slip (tendon )
285. To gain stability, distance from proximal one of the 2 distal screw of interlocking nail, the fracture must be at
least :
 1-2
 2-4
 3-6
 4-8
286. Most common source of metastasis :
 Lung
 Breast
 Prostate (common osteoblastic metastasis )
 Thyroid
 Renal
287. how to increase proximal loading of proximal femur (increase shielding stress ) in THA:
 stem with distal coated stem
 long stem
 stem with low modulus of elasticity
 large diameter stem
288. commonest site of cold abscess
 thoracic spine
 neck (not sure)
 Inguinal
289. Most common cause of bony ankyloses of hip :
 Rheumatoid arthritis
 Septic arthritis
 TB ( Fibrous ankylosing )
290. Spontaneous bleeding in hemophilia with factor VIII less than  5%
291. Case of lower cervical lesion since 4 months with mild fever and weight loss :
 T.B (not sure )
GRAMI
 Pyogenic (may be this option )
292. Most common site of metastasis  spine
293. 40 years male with metastasis in lumber spine most common cause  prostate cancer
294. Pte with trimalleolar fracture with , posterior malleolus displaced 25 % intra-articular with subluxation of
ankle treatment of posterior malleolus will be :
 ORIF by mini plate
 Cast
 Closed reduction percutaneous fixation by lag screw (not sure)
295. Mal united fracture radius with ulna plus (in neglected montaggia #)open reduction +\- ulnar shortening
osteotomy
296. 9 y\o with DIR treated conservatively since one year x-ray show shortening of radius  epiphysiodesis of ulna
+ correction osteotomy of radius
297. Hyper laxity score (Beighton score) from 0-9 ( important )
298. BROOKER classification of heterotopic ossificant ( important )
299. VAN COUVER classification (important)
300. Hand and thumb zone (important)
301. ASIA classification of spinal injury (important)
- Motor power < 3  grade (C)
- Motor power > 3  grade (D)
302. Type of HALLUX VALGUS (important)
303. Rheumatoid patient enable to move 3 fingers  rupture of extensor tendon
304. Salter harris fracture zone  hypertrophic
305. Case of wrist pain + PIC  scapholunate dissociation
306. Torus fracture zone  primary spongiosa (hypertrophic zone )
307. Posterolateral disc L4-L5  L5 root
308. GRUEN classification of THR (important)
- (case) cement at the stem tip in total hip which zone zone 4
- zone of loosening around the stem what is the zone 4 :
 Superomedial aspect of stem
 Distal to the tip
 Midlateral zone
309. X-ray show radiolucent nidus in proximal tibia  osteoid osteoma
310. Osteoid osteoma, pain at night, relive by NSAIDs, there is a nidus, best investigation: CT scan \ MRI
311. X-ray show proximal tibial lesion  GCT
312. Pt had lesion in distal radius which was excised his lung contain metastasis  GCT \ OSTEOSARCOMA
313. Patient with +ve reversed pivot shift test  PCL tear + PLC
314. Most common complication of fracture neck talus  osteoarthritis
315. Patient with steroid developed hip pain  AVN head femur
316. Multiple encondromatoisis  ollier disease
317. GROSS motor classification of cerebral pulsy (C.P) (IMPORTANT)
- Child need help in daily activity and need wheel chair in long distance  GRADE 3 (grade 2 = total self-
dependent)
318. Aitken classified proximal focal femoral deficiency (IMPORTANT)
319. Cause of osteolysis  wear dipres from PE
320. Type of collagin in the bone  type 1
321. Bilateral wrist arthrodesis  dominant : extension 10 degree non dominant: flexion
322. Cause of anterior knee pain in case of intra medullary nailing (IMN)  Pes anserine bursitis
GRAMI
323. Enneking classification of tumor, high grade malignant osteosarcoma extended soft tissue without metastasis
 IIB
324. Cervical trauma, patient can do extension of thumb and finger and wrist, there is no sensory or motor loss
below which level (intact C6) the lesion at C7
325. HIV detection :
 WATSON (most specific)
 RIBA
 Antigen (more rapid – early detection )
326. (Case) histology of patient with spindle nest  admantinoma
327. Osten Moore prosthesis with high greater tuberosity and Trendelenburg +ve :
 Hip abductor denervation
 Decrease abductor lever arm
328. 12 year old , both bone forearm fracture under hematoma block with unacceptable reduction ( 20 degree
angulation):
 Plating
 Nailing or Pining
329. X-ray: fluffy cotton-wool appearance appearance, single lesion :
 Ollier disease
 Maffuci syndrome
 Osteo chondroma
330. Multidirectional mal united tibia. Which type of osteotomy used for correction :
 Varus
 Valgus
 Transvers ( not sure)
 Oblique
331. Diagnosis of multiple myeloma :
 Protein uria
 MRI
 Sternal biopsy
 Bence Jones protein in uria.
332. Osteosarcoma can developed from  Paget disease
333. Young ptient with above knee swelling and no limitation ROM :
 X-RAY
 CT
 MRI
 Bone scan
334. DM pr with sole ulcer and Deep infection of foot in diabetic patient with Charcot joint, biopsy done , there is a
pus in midfoot , decrease in ABI and ischemic index best type of amputation :
 Syme’s (not sure)
 Boyd
 Transtibial with long posterior flab
 Transtibial with tenodesis
335. Charcot and distraction of distal tibio fibular  transtibial amputation
336. Amputation above the ankle joint 0.6 cn with the doom of the ankle
 Syme
 Boyd
 Pirogaff
GRAMI
 Cermianto
337. Gout of 1st MTP joint affect :
 Stance phase
 Swing phase
 Push off
338. Diabetic patient with swelling and unstable ankle joint with MRI show joint destruction :
 Neuropathic
 Pyogenic
339. X-ray show C5-C6 collapse, patient with sweating and weight loss
 T.B
 Pyogenic
 Brucellosis
 eosinophilic granuloma
340. Sickle cell pt with thigh infection the organism is :
 Salmonella (most specific )
 Satph aureus (most common )
 Strepto
341. Young patient following mild trauma come with discharge from T;HA, X-RAY show vertical cup treatment is :
 Close reduction
 Open reduction
 Revision
342. 55 y bipolar with Vancover type B fracture need revesion :
 change with long stem THA
 long stem bipolar
 ORIF
 Revision with circulage wire
343. Male 53 year old with fused hip on x-ray best test to examine hip flexion is :
 Thomas test
 Trendelenburg
 Lower limb discrepancy
344. 85 pte hemiplegia with nursing present with fracture neck femur
 Palliative TTT
 Hemi arthroplasty
 THA
 Fixation
345. 65 years old with fracture neck femur ( active) and mild ischemic and controlled diabetic :
 Hemi arthroplasty as will not live long
 Hemi arthroplasty as short rehabilitation
 THA as he is active
 THA as final treatment
346. Rheumatoid patient with fracture neck of femur ( old) on x-ray there is osteoarthritis
 THA
 Hemi arthroplasty
 DHS
347. Posterior hip dislocation with knee swelling :
 X-ray and revise
 Close reduction with iv analgesia
GRAMI
 Open reduction with anesthesia
 CT
348. Professional player with ACL grad (III) and MCL (I) treatment is :
 Immediate ACL and MCL repair (not sure)
 Observe MCL and delay ACL
 Delay ACL and MCL
 Immediate ACL with conservative treatment for MCL
349. Male with knee trauma (pic) show posterior drawer test in external rotation to detect :
 PCL and PLC
 ACL and MCL
 Meniscal
350. +ve apply test with pressure (grinding test)  for meniscal\ with traction  for collateral ligament
351. Female with genu valgum with Photo from x-ray and tibia showing mechanical and anatomic axis (A,B,C,D)
around knee the Q about the valgus angle of the femur  choose the angle between the anatomical axis and
mechanical axis of the knee
352. Ankylosing spondylitis  HLA B 27
353. Notch index of femur  0.231
354. 2 years old (or 6 y\o )with pain less limb and unstable DDH , during operation the hip is stable in flexion but
unstable in extension and abduction with femoral antiversion angle = 20 degree suitable operation Is :
 Shortening
 Femoral Varus derotation osteotomy
 Pelvic osteotomy
 Capsulorhaphy
355. 9 years old with increased limbing and pain what do you see on the x-ray
 defect in anterolateral ( if the case about Perth’s disease)
 altered patch opacity and lucency Other case with upward tilting of pelvic (if the case about T.B)
 dense epiphysis
 narrow joint space
356. 10 years old boy, history of trauma presinte with external rotation and flexion of right lower limb  SCFE
357. Q about scurvy (not clear) : - metaphysial fracture and osteopenia - enchondro.. cartilage defect
358. In parenteral fluid transfusion which element will be defected  ZINC
359. Boy with distal end radius fracture 18 months age came with deformity and epiphyseal defect (Q not clear) :
 Epiphysiolysis ( if the physial bar defect less then 50%)
 Epiphysiodesis ( if the physial bar defect more than 50% and the age near maturation of physis )
360. Madlung deformity ( read)
361. 8 y\o with # DIR with 15 degree of angulation  observe and reassurance
362. Supra condylar # type 3  close reduction and pining
363. Kienbock’s( type 2 ) with x-ray show sclerosis without osteoarthritis :
 STT fusion
 Wrist arthrodesis
 Proximal row carpectomy
 arthrodesis
364. 14 y\o with wrist trauma with DRUJ instability. next step is :
 Other form of Q : distal ulnar # with limited supination , routine c-ray after reduction not required , what next
step
 CT both wrist
 X-ray
GRAMI
 Arthroscopy
365. DRUJ pain best investigation : CT scan
366. Clavicular fracture with skin conflict  ORIF
367. Thoracic outlet syndrome test :
 ADDISON test
 Narrowing C5-C6
 Absent vascularity
368. Nerve in Guyon canal  ulnar nerve
369. Abraham classification?? (read)
370. Brocken plate in humerus with atrophic nonunion :
 exclude infection then graft +replating
 revision without bone graft (if the Q about hypertrophic nonunion)
 IMN
371. Case of ulna with atrophic nonunion in smoker patient, what is the effect of smoking on bone healing:
 Nicotine vasodilator and decrease healing
 Decrease blood supply to artificial graft
 Decrease blood supply to cancellous auto graft
NB: nicotine decrease healing by decrease osteoblast activity cause auto graft morbidity and decrease graft
mechanical property

372.
373. X ray of THR with minimal displaced greater trochanteric fracture :
 Tension band
 Lag screw
 Revision
 Conservative and non-weight bearing
374. Young age with distorted elbow joint , ROM 50-100 , instability in Varus and valgus :
 Total elbow arthroplasty
 Arthrodesis ( not sure)
 Inter positional arthroplasty
375. History of trauma with radial nerve injury hand and finger free:
 Tendon transfer  if the injury is old
 Nerve repair  In recent injury  explore and repair
376. Early detection of knee swelling  U\S
377. Early detection of hip effusion (swelling) after plain x-ray  MRI
378. Mall alignment of patella detected by :
 CT axial
 Axial x-ray (not sure)
 MRI
379. LAT malleolus fracture type C  plate with syndesmosis fixation
380. Pt with flexion ext rotation abd. With sever TB, this position due to :
 Flexor Muscle contraction  early stage
 Damage articular surface ( joint distraction)  late
 Iliofemoral ligament affection
381. Howship lacuna  in osteoclast
382. Complication of fracture LAT condyle  valgus deformity
383. Treatment of neuropathic pain :
GRAMI
 Narcotic analgesia ( opiod )
 Cortisone (in compression type)
 NSAID
384. Proximal tibial fracture with pic show bulli. TTT  ext. fixator
385. Infant with idiopathic scoliosis, what angle differentiate between progressive and regressive type of scoliosis :
 Cobs angle
 RVA angle ( rib vertebral angle )
386. Multiple myeloma tumor cell resemble  plasma cell
387. Spinal stenosis not improved on medical treatment and injection  decompression
388. Best treatment for meniscal tear  in out suture
389. Period of anticoagulant in THA  4 weeks \ in TKA  2 weeks
390. Female with loss of appetite, muscle spasm and gastric upset investigation  PTH
391. Nurse punctured herself by needle. what is the most common transmitted organism :
 HIV
 HCV
 HBV
 HAV
392. X-ray of GCT what to do before grafting :
 Phenol
 Irradiation
393. Cyst in the dorsum of the hand, mobile and expansile  ganglion
394. 10 year old boy with fracture proximal humerus, x-ray show single lesion with no soft tissue invasion (ABC) 
Conservative treatment
395. hummer toe  flexion PIP and extension of DIP
396. pt TKA infected with sinus you treat hem by arthrodesis using :
 IMN
 Plate
 Ext. fixator
397. Heterotopic ossification after 3 months the treatment is :
 Radiation
 Indomethacin
 Observation
398. Obese patient with sever valgus knee and OA with ligament laxity :
 constrained TKA
 highly constrained
399. physes around elbow fusion at 12 year old  LAT epicondyle (N.B: other bone fused at the same age 
capitate- trochlea ) (head radius 14-16) ( olecranon 15-17) ( int. epicondyle  16-18)
400. snuff box tenderness after trauma , x-ray: free, ttt  cast 2 weeks
401. weber type B # treated by cast, after 2 days the patient came with mild pain in the toes with intact
neurovascular exam , next step :
 x-ray after 2 weeks
 x-ray after one week
 above knee cast for one week
 above knee cast for 3 weeks (not sure)
402. high tibial osteotomy you do correction of the varus deformity , later on the pt come by numbness and pain on
the lateral side of foot, what is the cause :
 you did a compression of common peroneal nerve
GRAMI
 you did fibular osteotomy
403. x-ray of # acetabulum with anterior and posterior Colom separated from ilum, the type is :
 transvers #
 T#
 Both colom # ( not sure)
404. Pt 9 y\o with # distal radius with growth arrest and ulna plus (madlung). the TTT is  epiphysiodesis distal ulna
+ osteotomy
405. Post traumatic scapular fracture with psudoparalysis of rotator cuff , what is the out come :
 Relived spontaneously
 Sub acromial bursitis
 Permanent paralysis
 Repair paralysis
406. ACL reconstruction by PTP graft before 3 years, came with pain during walking and squatting, on exam: +ve
Lachman and pivot shift test the cause of pain is :
 Mal position of tibial tunnel
 Missed diagnosis Meniscal injury
 Loss of fixation of graft (not sure)
 OA
407. Case of muscle dystrophy (Duchenne ) x-linked recessive
408. Most common cause of death in duchene  cardio pulmonary (due to scoliosis )
409. Polytrauma with missed diagnosed cervical spine injury after admitted to ICU what is the most common cause
of missed cervical injury  improper x-ray
410. Open # distal femur (pic) of wound 2 cm (or 1 cm) with unstable knee best treatment is :
 Debridement and slap (not sure)
 ATB
 Skeletal traction (contraindication in case of unstable knee)
 Splint
411. knee trauma with articular defect in weight bearing area of femur < 2 cm the ttt is  auto graft
412. above knee amputation, what is the type of orthosis :
 hip knee foot
 knee ankle foot
 pneumatic orthosis
 below knee cast
413. talus fracture with ankle dislocation it is HAWKEN type : III
414. septic arthritis best investigation  blood culture (aspiration if present in the Answer)
415. kinder procedure :
 transfer the posterior tibial ligament to more distally
 transfer the posterior tibial ligament to more planter position
416. Wrist pain after fall down on out stretched hand on x-ray: cystic reaction in scaphoid  Preiser disease (non-
traumatic AVN of scaphoid due to micro trauma or use of chemotherapy and cortisone )
417. Avulsion in proximal phalanx Thumb x-ray show which type of #:
 Game keeper #
 Bennete
 Mallet
 Rolando
418. Comminuted Distal end radius ttt  according to the case
GRAMI
419. Young female came with pain of hip, AP or LAT x-ray show no remarkable abnormality (case of femoral
acetabular impingement)  cross over sign\ next step  MRI
420. X-ray and CT of 9 y\o ( chronic OM) Q about the histology  necrotic bone surrounded by osteoblastic activity
421. Hawkin II of talus best management :
 ORIF by weir
 ORIF by lag screw
 CRIF by lag screw
 CRIF by weir
422. Treatment of type IV tibial plateau  medial buttress plate
423. Case of 5 y\o with vertical talus (talipus ) the cause is :
 Recurrent talipus
 Resistant talipus
 Over correction
 Under correction
424. 3 y\o TEV underwent treatment by Series of casting (3 time) by ponsiti method with tendoachilis lengthening
tenotomy he came with residual deformity of 20 degree equino varus and flexible and dynamic deformity next
step is :
 Ponseti alone (cast only)
 Posteromedial release
 Osteotomy
 Tibialis anterior transfer
425. Best investigation for collection of fluid in the knee  U\S, in the hip  MRI
426. TB of the hip , position of the hip in flexion and abduction , the cause is :
 Contraction of the muscle
 Destroyed head femur and acetabulum
427. indication of surgery in cervical myelopathy  motor weakness
428. Pt with fracture radius intraoperatively you found DRUJ subluxation (GALIAZZI), next step is  transfixing weir
between radius and ulna with above elbow cast in supination
429. 60 y\o with # neck of femur, the choice of treatment depend on :
 Age
 Level of activity
 Comorbidity
430. case of ACL ask about best diagnosis  luchmann test
431. female 40 y\o tennis player +ve macmurry test on MRI : radial tear of medial meniscus best treatment :
 meniscal repair
 partial menisectomy
 meniscal implantation
432. case of scapular fracture with pseudo rupture of rotator cuff best treatment is :
 arthroscopic repair
 open repair
 conservative (not sure)
433. # scapula with glenoid defect  ORIF (N.B: indication of ORIF of scapula: involved > 25% of articular surface –
step off > 5 mm – medial translation > 1 cm – angulation > 40 degree – fracture with rotator cuff tear)
434. Sone of hand extensor and flexor (important)
435. best investigation for compressive neuropathy  nerve conduction velocity (or electrophysiological study)
436. best treatment of compressive neuropathy :
 hot fomentation
GRAMI
 NSAID
 Corticosteroid
 Narcotic analgesia
437. ankle trauma , x-ray show talar tilt , best investigation :
 MRI
 CT
 Stress ankle view
438. Isolated open femur # firs aid  irrigation + debridement + ATB
439. Atlanto-occipital instability in x-ray , the line is  wackenheim line
440. Disc prolapse with weak abductor of hip  L4-L5
441. Trauma with retrobulsed fragment in # spin , the ttt is  surgery within 96 H
442. Management of eniken type II A : wide resections
443. 1st line treatment of osteosarcoma  neoadjuvent chemotherapy
444. 12 y\o with hip dysplasia under treatment came with limitation of movement and pain, suggestion of
recurrence is  broken shenton line with increase acetabular index
445. Ratio between height of 3ed Metacarpal Bone and the carpal bone :
 0.03
 0.54
 0.54 +\- 0.03
446. Dose of methotrexate in spinal injury : 30 mg loading dose then 5.4mg\kg\H
447. 9 y\o # both bone forearm treated by above elbow cast came with severe pain and edema , 1 st line of
management :
 Elevate the limb
 Fasciotomy
 Remove the cast
448. Pt with shoulder arthrodesis came with pain, x-ray show arthritis of AC joint , the ttt is :
 Conservative
 Arthroscopy
 Resection of lateral end of clavicle
449. Male Pt with swilling of the palm of the hand , index and middle finger since 2 days, there is no history of
trauma, best investigation is :
 MRI
 CT
 Fluoroscopy (used if there is history of trauma in the Q)
450. Cause of failure of porous coted stem
 Stress fracture around the stem
 Increase wear rate
- Same Q with other option, the answer is  PE dibbers inter inside the porous of coted stem
451. AP view with absence of pedicle in one side :
 TB
 Pyogenic infection
 Metastasis
 Discitis
452. Cross over sing of femoro acetabular impingement, best investigation is :
 CT
 MRI
453. MIREL classification metastasis in intertrochanteric 50% of cortex involved with soft tissue extension :
GRAMI
 9
 12
454. Meniscal injury with tibial plateau # ( read)
455. Associated # with elbow dislocation
 Medial epicondyle (not sure)
 Head radius
456. 40 y\o obese female walking for one hour (or 3km ) to decrease wright came with pane of the foot, x-ray:
normal  metatarsalgia ( other option in the Q stress fracture will be the answer)
457. Sacroiliac screw which view used to don’t injury to S1:
 Outlet view
 Inlet view (protect L5)
458. Skeletal muscle tension and contractile force, what determine  cross section area
459. Causative organism of Lyme disease  borrelia burgdorferi
460. Athlete 40 y\o feel pop on tendo Achilles rupture , treatment :
 Surgical repair
 Cast
461. Polytrauma pt with scapular # and short breathing after 24 H,X-ray show apical patchs the cause is :
 Lung contusion
 Pneumothorax
462. (case) fracture clavicle with lateral displaced scapula and paralyzed pulseless upper limb:
 Scapulo-thoracic dissociation
 Scapula-humeral dissociation
463. # clavicle with # scapular neck
 Flail chest
 Flail ribs
 Floating shoulder
 Flail shoulder

NB: The floating shoulder is defined as ipsilateral fractures of the midshaft of the clavicle and the neck of the
glenoid. \ Flail shoulder is characterized by painful subluxation of the glenohumeral joint and the inability to
independently position the hand in space (loss of motor and sensory in upper limb)

464. Bilateral facet dislocation of cervical spine what is the percentage of translation  > 50% (in unilateral: 25%)
465. Most common deformity of subtrochanteric #  flexion abduction (proximal fragment in abduction flexion
and external rot. And the distal fragment in adduction and shortening )
466. 40 y\o MRI show AVN femoral head with arthritis:
 THA
 Core decompression
 VFG (not sure)
 Arthrodesis
467. 33 y\o (x-ray) unicompartement OA knee with normal patellofemoral, the TTT is :
 Unicompartement knee arthroplasty
 High tibial valgus osteotomy
 NSAIDs
468. Best method to increase shielding stress of the proximal femur in THA :
 Distal coated stem (increase shielding)
 Use long stem
 Increase cross section diameter (increase stiffness increase 0 shielding )
GRAMI
 Decrease modulus elasticity of the stem (decrease stemincrease load to bone decrease stress
shielding)
469. 70 y\o TKA since 10 years came with pain and swelling of the knee, LAB for infection and aspiration is –ve. X-ray
show osteolytic lesion in femoral component. TTT is :
 Revision TKA
 Bone graft augmentation
 ATB
470. 12 y\o with LLD by measurement but the appearance is normal the cause is :
 ADD deformity
 Abduction (deformity) compensation
 Flexion
 Extension
471. Amputation level 14 cm below Greater trochanter, the patient has flexion ABD, the cause is :
 Weak hamstring and Adductors
 Level of amputation
 Tight abductors and quadriceps
 ADD tenodesis not done
472. Gunshot cause high level median nerve injury since several years, in nerve conduction study there is no
innervation in proximal muscles the treatment is :
 Neurolysis
 Exploration (if nerve injury since short period)
 Thumb arthrodesis
 Nerve transfer
473. # Neck radius in child with angle > 30 degree with # united. Came with decrease ROM in flexion and there is no
flexion and no supination , the TTT IS :
 CR
 CRIF
 Open reduction after failed closed reduction and K wire
 Israeli technique
474. # lateral malleolus with talar tilt = 4 mm the TTT is :
 Fixation of fracture
 Test syndesmosis
 Repair deltoid ligament
 Fixation and check syndesmosis the fix by screw
475. # acetabular fixed since long period , the pt underwent THA, x-ray are normal, the pt came with drop foot , the
cause is :
 Traction of sciatic
 Migration of prosthesis
 Impingement of hard ware
476. # sacroiliac fixed by screw, x-ray shows screw between S1-S2, pt cannot planter flex the big toe, the cause is 
injury to S1
477. Child with neck radius #, indication of fixation is :
 >10
 15
 25
 35
 45
GRAMI
478. Fracture of : neck talus, tibia, femur, both bone forearm, clavicle. Which one can cause complication later 
neck talus #
479. Case of bunnle test +ve ,MCP in extension, he cannot do flexion of PIP, the cause is :
 Intrinsic contracture
 Lateral band tightness
480. # pelvic (important)
481. Solder involved in RTA cause posterior hip dislocation then reduced within 6 H , Concentric , congruent and
walk normally, what you will tell to this patient :
 Change him to office job
 You will fell pain next period
 Continue your live as usual
 You will get a lot dislocation
 Stop sitting on low chair
482. Supra condylar type 3 # open grade 1 puls not not felt but hand is pink TTT is :
 ORIF
 CRIF and reassess
 Exploration of brachial A
 Debridement + ATB and fixation
483. Septic arthritis of the hip , 1st investigation is :
 CT
 X-RAY
 MRI
 US
484. 12 y\o female with genu varum 24 degree bilateral with lax soft tissue and joint, x-ray show increase Q angle
TTT is :
 Observation
 Hemiepiphysiodesis
 Distal femur osteotomy
 Proximal tibial osteotomy
485. Duschen scoliosis with 22 cobb angle 6 months ago , he is bedridden ,TTT is :
 Observe
 Posterior fusion with instrumentation ( prevent death due to cardiopulmonary failure )
 Observe 6 month if there is progression then do fusion
486. Case od short pedicle with canal stenosis :
 Achondroplasia
 Pseudo achondroplasia
487. Male, old , low demand with osteochondritis dessicance <2 cm TTT:
 Autograft
 Chondrocyte implantation
488. Case of male with knee pain and no ligament insufficiency, MRI sagittal view shows double PCL sign. This sign is
indication of :
 ACL
 PCL
 Bucket handle
 PHMM
489. Bonissi disease  polyarthritis in TB
490. Male pt with anterior Sternoclavicular. TTT :
GRAMI
 Observe
 Reduction by towel clamp
 Direct pressure
491. x-ray lateral C6-C7 distraction with fever pain and weight loss ( case of TB):
 CT guided biopsy
 MRI
 Anti TB
492. 14 y\o Case of back deformity with pain and deficult gait and decease spinal motion , popliteal angle 50
degree:
 Spondylolisithtis
 TB
 Ankylosing
493. RTA with hypotension, bradycardia , paralysis (bulbocavernus reflex not mentioned )
 Spinal shock
 Hypovolemic shock (hypotension with tachycardia )
 Neurogenic shock
494. Case of infection in thoracic spine with fever, weight loss and muscle wasting :
 TB
 Pyogenic infection
495. Child with thumb hypoplasia , hand defected radial :
 Cleft hand
 Radial club hand
 Ulnar club
496. Lung metastasis, in biopsy there is multinucleated, giant cell mononucleated , c-ray chow patches and swelling
of the wrist :
 Osteosarcoma
 Chondroplastoma
 GCT
497. Athelet with mid food pain :
 MRI
 X-ray
 CT
 Bone scam
498. Pt 10- 12 y\o X-ray and MRI shows osteolytic lesion in proximal femur multinucleated:
 ABC
 Osteosarcoma
 Chondroplastoma
499. Transvers acetabular injury affect which artery  obturator
500. RA patient use methotrexate will do TKA :
 Stop methotrexate
 Continue
 Take corticoid

N.B:

-Hydroxychloroquin \ sulfasalazine  continue

-aspirin stop 7 days befor op

GRAMI
-leflunamide  cont. for minor and stop 1-2 days before major ans restart 1-2 weeks after op

- TNF antagonist cont. for minor and stop 1 week before major restart 2 weeks post op

- Interleukin 1 antagonist  cont. for minor and stop 1-2 day before major restart 10 post op

501. X-ray ankle with hagland lesion with pain ttt:

 INJECTION
 Medication and physiotherapy (1st line TTT)
 Debridement and reinsertion (2 line TTT)
502. Best suture to repair tendon :
 Breaded natural
 Breaded synthetic
 Non breaded natural
 Non breaded synthetic
503. TB in the knee, 1st management :
 Anti TB
 Splinting
 Biopsy
504. Early sign seen in x-ray in hemophilic arthritis :
 subchondral Sclerosis
 calcification
 cartilage erosion( 2nd sign)
 peri articular osteoporosis
505. x-ray of hallux valgus angle 25 degree not respond to conservative TTT , pain in medial soft tissue and in the
bunion which surgery
 akin osteotomy
 chevron
 mcbride
 lipidus
506. pt with pes cavus deformity, coleman block test done to look for :
 evaluate flexibility of subtalar joint
 ankyloses subtalar
 rigid subtalar
 subtalar arthrodesis
507. x-ray of periprosthetic # (just distal to the tip) for cemented THA, what to do :
 ORIF with wire
 ORIF with srut graft
 ORIF + long stem
 Revesion with cement less component (not sure)
508. pt with fracture medial tibial plateau extended posteriorly :
 posteromedial approach using posterior antiglide plat
 medial approach using medial plating
 anterior approach using medial and lateral plat
 medial approach using anterior plating
509. cut wound at the MCP joint of thumb which tendon is damaged :
 ADD polices
 ADD policis brevis
GRAMI
 Extensor policis longus
 Extensor polilicis brevis
510. Mallet finger with >30 % of bony avulsion TTT is :
 CR + mallet finger splint
 CR + K-wire fixation
 ORIF + K-wire
511. # DIR (colles) treated by CR and cast, he developed numbness in the lateral 3 fingers TTT is
 ORIF with K-wire + carpel tunnel release
 Cont. cast
 Repeat CR
512. Unstable pelvic # died after aggressive resuscitation, why :
 Bleeding form presacral plexus (not sure)
 Inadequate tamponade
 Bleeding from corona mortis
513. Pt with gluteus medius weakness nerve root affected is  L4-L5
514. The malaphlan is a chemotherapeutic agent used for treatement of :
 Osteosarcoma
 Multiple myeloma
 Ewing sarcoma
 Metastatic tumor
515. 45 y\o female complain of pain while climbing stair and walking, THA done before 9 years , the cause is :
 Loosening
 Trauma
 Osteolysis
 Dislocation
516. 35 y\o pt (x-ray) showing femoroacetabular impingement (CAM type) the TTT is
 Acetabuloplasty (osteotomy)
 Anterior decompression of hip
 Posterior decompression of hip
517. Wheel chair with duchine, muscle dystrophy for 1 year . scoliosis with cobb angle 20 degree . TTT :
 Conservative
 Anterior spinal fusion
 Posterior spinal fusion
 Anterior and posterior fusion
518. Ossification of iliac crest used to asses :
 Progression of scoliosis
 Progression of kyphosis
 Progression of scoliosis treatment
 Progression of kyphosis treatment
519. 35 y\o male with fracture NOF pawell angle more than 5 degree how to treat :
 Hemi arthroplasty
 THR
 CRIF with screw
 ORIF with screw
520. 55 y\o male x-ray showing nonunited #NOF with fracture line verticlal pawel angle > 50 degree , TTT :
 THR
 Hemi arthroplasty
GRAMI
 In situ bone graft
 Valgus osteotomy + fixation with blade plate + bone graft
521. X-ray if elbow of adult pt with sever comminuted supracondylar fracture with no thumb extension :
 Immediate ORIF
 Delayed ORIF
 Slab
 Screw
522. Neglecter head radius dislocation in child :
 CR
 OR and repair of LCL
 OR and repair annular ligament + ulnar osteotomy
523. X-ray of pt after # scaphoid with sclerosis of styloid radius , norrowing between radius and scaphoid (SNAC)
stage :
 I
 II
 III
 IV
524. Compound ganglion on palmar side of wrist  TB
525. Planovalgus , hallux valgus , toes valgus lateral deviated of the toes
 Hallux valgus
 Metatarsus Primus varus
 Laso foot
 Flat foot
526. TEV corrected then he came with dorsal banion. The cause is :
 Tibialis anterior over action
 Peroneus brevis
 Peroneus longus
527. Common site of degenerative canal stenosis  L4-L5
528. 40 y\o X-ray hip resurfacing , sever pseudo tumor around hip with severe pain :
 wide resection
 THA
 Hemi arthroplasty
 THA ceramic
529. Flexion and valgus of knee after correction pt has weak extension of four lateral foot , the cause is :
 Stretch of common peroneal
 Stretch of deep peroneal
 Stretch of tibial peroneal
530. Supra condylar # the he came with cubetus varus, the deformity are in which plane :
 Sagittal
 Axial
 Coronal
 Anteroposterior
531. Rhabdomyosarcoma TTT :
 Wide resection (chemo in pediatric \ radio in adult)
 Enblock resection
 Remove hole muscle
532. 30 y\o with distal radius osteolytic lesion  GCT
GRAMI
533. X-ray humerus boy 12 y\ o , fracture aligned , came with U shap slab , LAB: low CA and P , high PTH , TTT is :
 Slap
 ORIF
 Delay TTT until you finish the evaluation of the case
534. Pt complain of muscle weakness , Trendelenburg gait +ve, if the pt will die , what will be the cause (this is a case
of duchen) :
 Infection
 Low BP
 Renal failure from myoglobin urea
 Cardio pulmonary failure
535. 40 y\o has osteochondral lesion with locking, pain and effusion middle of LAT condyle TTT:
 Micro fracture
 Mozaique palsty
 Osteochondral graft
536. 45 y\o throw something into basket then he feel pop and pain in anterolateral aspect of the shoulder , x-ray is
normal , MRI : AC osteoarthritis . you suspect :
 Complete supraspinatus tear
 Bursitis
 Bunkart tear
537. Pt with bilateral TKR with history of DVT , how to prevent DVT :
 no inhalation anesthesia
 operate without tourniquet
538. # BB forearm after fixation , he cannot extend MCP, the lesion in :
 Radial
 Ulnar
 AIN
 PIN
539. RA female has swilling in the back of knee (talk about backer cyst) then he came with severe pain , swelling and
ecchymosis , TTT :
 Arthroscopic aspiration
 Excision of cyst
 DVT
 Analgesic and conserve
540. Patient in RTA and unconcious and multiple trauma .he will do operation for treatment of bleeding ..what are
the reason that make us miss a spinal injury :
 Can’t so MRI
 Can’t read x-ray
 Inadequate xrays and views and inadequate interpretation.
541. Tennis player has giving off knee once came by swelling , pain at proximal aspect of patella , loss of extensor
mechanism :
 Immediate repair
 Delay repair
542. Acute Lumber disk prolapse, pain radiate to knee. MRI: posterolateral pulg disk medial to nerve root :
 Pt tilt toward pain side
 Pt tilt away pain side
 Back ward
 forewarde
GRAMI
543. Player with Anterior drawer and pivot shift +ve with history of knee trauma 3 weks ago , what to do :
 Arthroscopic Debridement of ACL and reconstruction
 Arthroscopic Debridement with corticosteroid
 Debridement of ACL alone
 Delay repair
544. Pt with spinal cord injury and quadriplegia want to improve his hand function , when to repair :
 Immediate
 Later on
 When improve other organ
545. Pt with pain in the palm of hand and nodules appear and buckling of skin, his father has same condition :
 TB
 Deputran contracture
546. Pt has # talus Hawkin type 2 fixed by screw after 8 weeks in the x-ray you see lucency in the dome talus, next
step :
 Protected weight bearing
 Graft
 ORIF
 Triple arthrodesis
547. Foot pain and plano valgus , x-ray (show anti eter sign) : talar pedking bony band between calcaneum and
navicular , next investigation :
 MRI
 CT
 Stress view
548. Avulsion of base 5th metatarsal  jones #
549. Female twisting injury, has base 5th metatarsal # extended to articular surface of 4 th metatarsal . TTT :
 CRIF K-wire
 Fix by scerew
 Cast and protected weight bearing

NB : non athlete , non weight bearing cast 6-8 weeks

550. 55 Y\O Tibial plateau type 5 with pic show hemorrhagic blister on the knee(x-ray and pic) , TTT :
 Spanning external fixator
 Cast and elevation of foot
 ORIF
 Calcaneal traction
551. X-ray THA, the GT fracture and absorbed, fixed by tension band. the pt has high ER , IR , how to protect this
patient from dislocation  constrained
552. X-ray of cement less of THA in 70 y patient , stress shielding , want to revision , sever osteoporosis :
 Cement less long stem fully coted
 Bone graft
 Cemented long stem
 Cemented short stem
553. Pt has nerve injury , best time of repair to memic biologic healing of nerve :
 1-3 day
 1-3 week
 1-3 month
554. Case of congenital vertical talus x-ray show :
GRAMI
 Dislocation of talo navicular
 Planter flexed calcaneus and talus
555. Pt fall on hand , has palm swelling , with pain on ring and little finger , can flex :
 CT
 X-RAY
 US
 MRI
556. Worst thing for IMN insertion  comminuted #
557. # NOF , when fixing this fracture , what is the best :
 Index 150 degree
 Neck shaft 150 degree
 Gaping of lateral cortex
558. # NOF , in screw fixation , what is the best number of screw :
 1
 2
 3
 4
559. bed side diagnosis if cauda equine  rectal examination with loss of peri anal sensation
560. 40 y\o female , anorexia , nausea , depression, abdominal pain , muscle weakness , x-ray head of humerus show
erosion of the head , the cause is :
 Hypercalcemia
 Hyperparathyroidism
 Metastasis
561. Young ROM of elbow 30-120 with instability in varus and valgus , x-ray show destroyed joint , the TTT :
 Soft tissue inter position
 Total elbow
 Arthrodesis 45- 65 (not sure )
 Arthrodesis 20-110
562. Low grade osteosarcoma  wide resection
563. 12 y\o with # mid shaft ulna and radius , after trail of reduction twice under hematoma block , the angle was 20
degree :
 ORIF + PLAT
 CR+ nail
 Conservative ‘
564. TEV TTT:
 Lengthening of tendo achilis
 Correction foot put in foot abduction orthosis
 Correction of varus deformity by more supination
 Serial cast

‫نبوي وامير واعمارة‬

565. X-ray view to show fracture base of coracoid :
GRAMI
 striker notch (lateral)
 lateral axial view
 scapular view
566. (pic) anterior shoulder dislocation with MRI (show hill sach lesion), this injury is commonly associated with :
 Impression fracture
 Proximal humeros fracture
 Lesser trochanter fracture
567. Segmented tibail fracture fixed by plate, now one end of the segment had united , the other end non united ,
the cause is :
 Improper technique
 The segment had poor blood supply
 The tibia has poor blood supply as it’s subcutaneous
568. How to diagnose gydatic cyst in the spine :
 MRI
 CT (if there is no MRI in the option)
 Plain x-ray
 Myelograph
569. What is the valgus osteotomy angle in case of TKA for short patient :
 5:7 degree
 <4
 >=8
570. Young adult male with trauma of left shoulder prominent lateral end of the clavicle with the arm dropped
inferiorly , the deformity is reducible by pushing the humeros upward from the elbow what type is the AC injury:
 Type II
 Type III
 Type IV
 Type V
571. Q about comatose patient followed RTA and want to put hem under ventilator or PEEP ???
572. Case of AVN head of femur with some analysis detail in CBC (Hb normal\ TLC normal\ RBC (MCV=110 um). LFT:
increase AST and ALT the cause is :
 Alcohol
 Thalassemia (review MCP in thalassemia)
 Sickle cell anemia
 TB
573. Case of fracture NOF with ipsilateral shaft femur, best method for fixation :
 Screw for the neck and retrograde nail
 DHS and broad DCP
 Long cephalo-medullar nail for both fracture
574. 30 y\o male had ORIF for distal radius fracture by T plat and screws. With x-ray (N.B: there is 2 Q with 2
different x-ray ) he complain of decrease supination and pronation with wrist pain , the surgery done 1 years
ago, what you will do for hem :
 Plate and screw removal (the x-ray of intact ulna but the screw pass through DRUJ)
 Distal ulna excision
 Ulnar shortening osteotomy in ( the x-ray of ulna +ve with # of the tip of ulna )
 Physiotherapy
575. What is the most important diagnostic sign of supportive tenosynovitis of the finger :
 Fixed flexion
GRAMI
 Tenderness all over the tendon sheath (Kanavel's sign)
 Increase pain with passive extension
 Fusiform swelling of the finger
576. Kanavel's sign of flexor tenosynovitis :
 Flexion posture of digit
 Pain with passive extension
 Tenderness to palpation on tendon sheath
 Fusiform swelling of the digit
577. Q about # talus with talo navicular dislocation the type is : type 4
578. Direct trauma to right knee followed by anterior knee pain, there is no effusion (x-ray) show superolateral
fragment of right patella with smooth edge left patellar side is complete fragment (stellate patella or bipartite
patella), no pain or limited ROM :
 Excision
 Closed reduction and wire fixation
 ORIF
 Ask patient to decrease activity and Observation
579. Knee dislocation , MRI show medial and lateral meniscal tear ACL and PCL tear the treatment steps will be 
menisci and PCL with ACL delay repair
580. (pic) open fracture # in proximal 3ed GIII type B , Which type of graft :
 Full thickness skin graft
 Split thickness skin graft
 Soleus graft ( or gastrocnemius flap if present)
581. Infected nonunion tibial shaft was cleaned and a defect of 7\9 cm resulted from debridement, bifocal
lengthening using ilizarov technique was planned, what is the expected problem :
 Soft tissue problem
 Nonunion at the socking site
 Mal alignment
582. How can you make femoral stem fixed rigidly in THA from the beginning?
583. Q about SCIWRA spinal cord injury without radiological abnormality
584. OCD best seen  MRI
585. Q about tibial bowing and pseudo arthrosis
586. Axillary nerve from tip of acromion :
 5 cm
 10 cm
 7cm
587. 18 y shoulder dislocation definitive TTT is  bankart repair
588. Knee dislocation reduced in ER ,MRI done shows tear of ACL, PCL and MCL the knee is stable in 30 degree of
flexion, management is :
 Spanning external fixator
 Immediate repair
 splint then MRI then ligamentous reconstruction after 3 weeks
589. 13 y with lateral patellar dislocation table after reduction, 2 days later he developed knee swelling and flexion
range 70 degree , the management is :
 Knee arthroscopy
 Cast
 Repair reticulum
GRAMI
590. Pt 54 y\o osteoblastic lesion in humeral shaft involving 1\3 of diameter, the pain is mild according to mirels
classification its score is : (read mirels classification)
 4
 6
 8
 10
591. photo of foot and ankle with multiple skin bullae), fracture calcaneus, what`s the best timing for operative
intervention: when wrinkles appear.
592. (pic) of skin wrinkle , Q is : what this does it mean  you can do surgery now with less complication
593. Pt has wound on the anterior aspect of his leg and the knee is unstable , what to do :
 Irrigation and debridement and splint
 Iv ATB and skeletal traction
594. X-ray of 28 years old male patient showing nonunion proximal pole scaphoid, after a fall 4 months ago.:
 ORIF + bone graft
 Proximal row carpectomy
 Wrist arthrodesis
 cast
595. Lunate came after 1 month of injury and you suspect AVN , next step :
 remove slab and do MRI now
 remove slab + physiotherapy then MRI later (not sure)
 Continue slap for other 2 weeks then MRI
 Leave slab + MRI now
596. Open book # of pelvic the pt recive iv fluid and become stable, pelvic C clump done then, after 15 min he
become unstable what to do :
 CT abdominal and pelvic
 Urgent laparotomy
 External fixator
597. Open book # pelvic, what to do systematic for that pt :
 IV fluid resuscitation
 Pelvic binder
 External fixator
598. Claw hand flexion contracture in MCP joint of 2 medial fingers (4 th and 5th ) for 2 years, neurological intact with
stiffness(this is a case of Dupuytren's contracture) , what to do :
 Limited ulnar tunnel release
 Z plasty in the skin or partial fasciotomy
 Flexor tendon lengthening by Z plasty
 Partial fasciotomy Needle release pf fascia (this is the A if present in the option)
599. Meniscal tear repair, best :
 Red zone, acute, 1.5 cm in length
 Chronic read white zone
 Red, red zone, acute , 4.5 cm
600. most common criteria in MARFFAN syndrome :
 scoliosis
 mitral valve prolapse
601. female pt, 8 y\o with # femur 3 years ago on top of chronic osteomyelitis with non-union (x-ray: nonunion
femur, shortening up to 6 cm) what to do :
 scanogram
GRAMI
 ESR, CRP
602. Healing of hyaline cartilage :
 Immobilization and passive exercise
 Immobilization and active exercise
603. Pt with psoriatic arthritis with pain increase at end of the day and by walking (x-ray show THA with heterotopic
ossification) what is the most common complication :
 Periprosthatic infection
 Heterotopic ossification
604. After reduction of Posterior hip dislocation with # head of femur (pipkin type 1 below fovea ) treatment is :
 Closed reduction then CT to Assis congruity of joint
 Open Fixation of head by Herbert screw
 Percutanus fixation of head by Herbert screw
 Leave it as such
605. posterior hip dislocation 2 weeks after reduction , x-ray done , the hip is stable and congruent but there is intra
articular fragment:
 do nothing
 open removal
 analgesic
 arthroscopic removal of fragment
606. insertional tendoachilis tendinitis in sportive patient 33 y\o, definitive management is  debridement and
reinsertion of tendoachilis
607. acute anterior compartment syndrome in acute blown syndrome (zinc deficiency )  thick fascia and injury
near to the fascia
608. Neglected DDH in 2 y\o the best inv. Is :
 CT
 MRI
 Ultra sound
 X-ray
609. Neurofibromatosis with pseudoarthrosis in x-ray is positive in :
 25%
 50%
 75%
 100%
610. 9 y\o with flexion deformity and upward tilt of pelvic (migration) limited ROM , you see in thex-ray:
 Anterolateral defect ( seen in Perth’s disease )
 Patchy sclerosis and lucence of head
 Dysplastic acetabulum
611. 9 year boy with Trendelenburg gait , hip pain with flexion and extension of hip which become constant , x-ray
will show(perhtes) :
 Anterolateral head defect
 Sclerosis with lucency of head
 Epiphyseal sclerosis
612. Waddling gait with decrease of lumber lordosis you will do (in case of paget disease):
 Alkaline phosphatase
 Acid phosphatase
 Creatinine propokinase
613. 20 degree of Flexion to the knee with supporting apply distraction  collateral injury
GRAMI
614. AVN 30 y\o with advanced OA of hip  THA
615. THR 68 y\o after 3 days when trying to sitting she has a foot drop  hip extension (decreas tension on sciatic
N) lying flat in bed
616. Case of TKR which is loose in flexion and stable in extension during surgery, what you will do  postirolisation
of femoral component (up size)
617. Type B wedge # what type of plate to use :
 Bridging
 Neutralizing
 Compression (not sure)
618. Which incision will you select while doing for revision TKA for patient who has previous scar in the midline,
medial and lateral aspect of the knee :
 Midline incision
 Most medial possible scar
 Most lateral possible scar
619. Q about littler  release

N.B: littler release: release the intrinsic distal to MP joint and should only preformed if full passive extension to MP
joint is possible

- ZANCOLI release : release at the MT junction of intrinsic muscle and release the intrinsic from the proximal phalanx

620. Pt had THA with infection then he did many surgery, now he has 5 cm shortening in the affected limb what you
will do :
 Spacer
 Revision arthroplasty
 Girdle stone procedure
621. +ve blood culture in hematogenous OM for the organism :
 10%
 20%
 50%
 90%
622. Case of hypertrophic nonunion in tibia with gap and you will do distraction osteogenesis using ilizarov ring
fixator :
 You will put inlay graft
 You will put onlay graft
 You will do osteotomy using electric saw
 You will do osteotomy using low power osteotome sub periosteal
623. Pt with cancer bladder has osteolytic lesion in the acetabulum then he had # acetabulum, what is the cause of
fracture :
 AVN head femur
 AVN acetabulum
 Metastasis
 Secondary osteoporosis (due to Radiation )
624. X-ray spin and pic show complete distraction of the vertebra (vertebera plana) what is the cause :
 TB
 Brucella
 eosinophilic granuloma
625. most sensitive test for multiple myeloma  bone morrow biopsy
GRAMI
626. elderly pt has right shoulder pain with decrease ROM with CT and MRI show part of chest of the pt with lesion
the diagnosis is  metastatic tumor
627. child with progressive hip pain and with increase extremes of hip movement the child has no constitutional
symptom, x-ray chow proximal femur osteolytic lesion, MRI show proximal femur with multiple fluid level.
Diagnosis is  aneurysmal bone cyst
628. 60 y\o pt with Austin Moore hemi arthroplasty of right hip (x-ray shows osteolysis ) the cause is :
 miss match between head and acetabulum
 use of non-cemented implant
629. 35 y\o female had hip arthrodesis want to change to THA  its pores roughness should not be more than
50:70 % (if present in the option  use of constrained cup )
630. most common complication of shoulder dislocation 
631. most common site of chondroma 
632. in posterolateral approach (proximal lateral approach ) of upper radius to protect PIN you should pot the
elbow in elbow flexion + pronation
633. worst nerve in repair  motor N
634. Percentage of sciatic N pulsy After posterior hip dislocation  8-20%
635. Percentage of AVN in type I # head femur in children  20-100%
636. If the plate in the compression side of bone not tension side  implant failure
637. Cavus foot, the Meary's angle and calcaneal pitch  20-40%
638. Photo of GCT diagnosis by  MRI (chest metastasis )
639. Rocker buttom deformity  talonavicular fixation
640. DDH investigation  CT

641. Child 3 y\o with his parent delayed or failure to thrive with swelling of the distal radius, x-ray: sub-periosteal
erosion of the lateral board of radius and ulna :

 Arthrogryposis
 Rickets
 Scurvy
642. Female Patient with mild foot pain increase during activity and local press diagnosis is :
 Morton’s neuroma
 Stress fracture
 Gouty arthritis
 Burger disease
643. Child 9 y\o with his parents with unilateral genu varum 20 degree and shortening, the surgeon noted that
there is a scar on the medial aspect of the knee, and the parents told him that it’s an old operation that was
done shortly after birth and he was feverish with local sign of inflammation ( x-ray similar to blount disease) :
 surgery delay with high risk of recurrence
 brace is an essential step in TTT
 physiological bowing
 vit D therapy and CA monitoring +follow up
644. diagram about correction osteotomy and where will be the apex of osteotomy for tibial osteotomy :

A B C
GRAMI

645. Infected THA 12 days post op  any answer include change cup
646. Adult with history of patellar dislocation, reduced then came to A and E department with pain and effusion
with no flexion more then 70 :
 Arthroscopy
 HTO
 Repair MPFL
 Knee cast
647. Adult player he received an injury to back of the knee while playing with inability to continue the game and
immediate swelling TTT:
 Cold compression + PT
 Knee cast for 6 week
648. Assessment of hip subluxation or dislocation of CP patient by  Gross Motor Function Classification System
(GMFCS) not sure because this is the score of cp grading
649. Importance of iliac physis in scoliosis:
 progression of scoliosis
 scoliosis surgery
650. Photo pf Anterior talofibular ligament (ATFL) + chronic pain , what’s the operation Broostorm operation
651. Child with history of trauma of the knee, few days later he came with sudden pain while he was setting up,
there is tenderness on the lateral joint aspect ans loosening in flexor and extensor, the investigation is :
MRI
Sun raise appearance
Valgus varus stress
CT
652. Child with supracondylar humeral fracture type III open G1, his hand are cold and poor capillary refilling
conserved  wound debraidement + brachial A exploration + fixation with 2 wires
653. # calcaneus\ x-ray + CT + photo  ecchymosis, TTT is :
 Urgent fixation
 Delayed fixation after 14 days
 Conservative
 Ext. fixator
654. (Photo)  skin wrinkle sign importance  low … of wound compression
655. female child born with deficiency of fibula and half of foot according to classification it is considered 
terminal axial
656. best sign for DDH in newborn is : ortolani no US
657. Case scenario 25 y\o male, Tourniquet in upper limb operation. You put it for 60 minute and for 250 pressure.
The systolic pressure was 100. Post op he has radial nerve pulsy, The cause of nerve injury is :
 High pressure.
 Preexisting vascular disease
 Time is long
658. optimum time for tourniquet is  120 minutes
659. Patient with persistent dorsal pain with H/O loss of weight, fever and malaise. there`s a lesion in dorsal spine.
What`s the next step  CT guided biopsy.
660. Patient have anterior hip dislocation and fracture neck femur. Closed reduction failed and now you need to do
open reduction. What incision will you done  anterior smith Paterson.
GRAMI
661. History of fracture scaphoid treated by cast and healed three years ago. Patient now presented by pain during
manipulation of daily activity; on examination there is tenderness on deep palation of anatomical snuff box;
what proper investigation to reveal diagnosis:\
 X-ray
 CT
 MRI
 MRI with contrast
662. 10 years old female complaining of painless limb in rt leg. On measurement, you discovered 4 cm shortening in
this limb. Best ttt epiphysiodesis in the other leg .
663. First bone in intrauterine: 5th week.
664. Retro pulsed fragment in spine what should you do (he did not mention if the patient were neurologically free
or not)  brace within 24 hrs.
665. HIV  Western blot.
666. Patient with hip dislocation and have knee edema ..What you should do  make x-ray on knee and assess
again.
667. Bearing surface with least coefficient of friction Is  ceramic on PE.(OK)
668. Commonest site for malignant fibrous histocytoma  thigh.
669. what`s the cause of osteoarthritis after tibial plateau fracture with articular step off (x-ray photo with severe
depression  malalignment.
670. patient RTA, unstable, resuscitation, pelvic fixator was done, u/s there`s intra-abdominal fluid collection.
What`s the next step in management  urgent laparotomy.
671. (X-ray photo of cross over sign), in female who has pain and difficulty with hip flexion and internal rotation.
What`s the next step in management MRI.
672. old patient had TKA 7 yrs ago, now there`s pain, infection investigations are normal,(x-ray showing osteolysis
around the prosthesis).what`s the management  Revision TKA.
673. Open G3 fracture humerus with wrist drop and planned for debridement and fixation, what is the best time to
explore radial nerve  hours – days-weeks-months.
674. Fracture shaft tibia fixed by ILN 2 months ago, now there is infection and the fracture is uniting, planned for
debridement and antibiotics  wait until complete union then remove the nail.
675. DDH with transverse acetabular lig. Injury and bleeding  obturator artery.
676. type 5 tibial plateau fracture  malignement.
677. distal femoral osteolytic lesion  wide resection
678. disc prolapse cervical spine when to do surgery  muscle power weakness with myelopathy
679. sequestrum :
 Dead bone surrounded by unhealthy granulation tissue.
 Dead bone surrounded by healthy bone.
680. in perilunate dislocation  disturbed gilula lines
681. Acute fracture head radius in old child angulated more than 80 degree  ORIF.
682. CP with reamer index 25  continue PT.
683. TB caseation  pus, bacilli, bone debris.
684. Middle age male, carpenter, with severe arthritis elbow with range of motion 30-100, stable  arthroplasty.
685. another case of elbow pain, unstable, ROM 20- 130 flexion  arthrodesis in 20-120
686. occipito-axial subluxation , how to diagnosed  Wachenhim line - Mcgeorge line
687. child with myelodysplasia had operated, the pt are warred about the future of the surgery :
 pt walk with AOF (Ankle foot orthosis)
 pt walk without AOF
688. 3 Y\O boy with history of treated DDH, what is x-ray finding that confirm your diagnosis :
GRAMI
 Disturbed shenton line and increase acetabular index
 Disturbed shenton line and decrease acetabular index
 Preserve shenton line with increase acetabular index
 Preserve shenton line with decrease acetabular index
689. 6 months boy with DDH safe zone of Ramsey is 20 degree .... next step in management :
 Hip spica
 Pavillek harness
 Open reduction
690. Pt with congenital short limb , x-ray of affected knee at level of contralateral hip and level of the ankle at the
level of contralateral knee, according to classification , it is (aitken type C ) management is :
 Van Ness rotationplasty (the foot and ankle are surgically removed, then attached to the femur)
 Amputation
 Lengthening
691. Case of 45 y\o female male with pain at base of the thumb , (x-ray and pic) of hand show arthritis of 1 st
carpometacarpal joint , the diagnosis is :
 1st carpometacarpal arthritis
 DEQURVAIN syndrome
 Mal united ROLANDO fracture
692. Case of child with history … trauma of the knee ,pain at the lateral joint line , x-ray is free but the patient after
sitting he stay about 15 min he cannot bear weight, he mention the diagnosis in the case (discoid meniscus )
- 1st Q : what is the diagnosis  discoid meniscus
- 2nd Q: what it the management  partial menisectomy
- 3rd Q : what is the most common complication :
 Instability
 Hemarthrosis
 Post op fibrosis
693. Case of segond fracture  ACL injury
694. Case with MRI show double PCL sign , the diagnosis is  bucket handle tear
695. MRI shoulder  HILL SACHS LESION
696. Pt with old bankart lesion treated with open repair , he had recent trauma the same side by sudden stop when
he was hanging his hand up, he cannot elevate his arm , the management is (what to do ) :
 Petit plat
 Subscapular transfer
 Capsulorhaphy
697. (pic) of x-ray of fracture head radius and the head of radius displaced anteriorly, the elbow is putted in the …
what to do  metal prosthesis
698. Case of histoy of hip pain , x-ray : free , MRI : no fracture, (pic) of some think like # neck of femur with arrow,
what to do  urgent penning
699. 30 y\o male pt , alcoholic with x-ray show < 15 % affection of femoral head , the management is :
 VFG
 THR
700. 30 y\o x-ray : severe femoral head collapse , management is :
 VFG
 THR
701. Case of osteonecrosis of femoral head involved < 15% seen in MRI , x-ray is normal  stage IIA
702. X-ray : bipolar with dislocated head , what to do :
 THA
GRAMI
 OR
703. THA x-ray ( the acetabulum component is eroded ) . what do you see  acetabular component degenerating )
704. X-ray of stem failure (broken stem ) , what is the cause  fixed distal and not fixed proximal part
705. X-ray of THA with osteolysis in the base of stem on the medial cortex the cause is  cement mantle
706. X-RAY of case with severe OA of the knee with varus deformity TTT hinged TK
707. What you need when you do high tibial osteotomy  ARC 90 degree knee flexion
708. Case of 60 y\o male with quadriceps tendon rupture
- Q1 : diagnosis  quadriceps rapture
- Q2 : management  - acute repair - casting
709. Case of neurofibromatosis with anterolateral …. And pseudathrosis with cyst  type 3
710. X-ray of AVN navicular bone  kohlere disease
711. X-ray  lunate dislocation
712. Case of athlete with pain in tibia x-ray normal, after 3 weeks there is periosteal reaction  stress #
713. Child 13 y\o fall down , pain in the tibial tuberosity with edema and swelling x-ray : normal but there is +ve
valgus test TTT  hinged knee brace
714. Case of 60 y\o male , fell popping sound at his ankle MRI : rupture achilis tendon at mid substance, pt want to
return his planter flexion early, what to do :
 Serial casting
 End to end repair
 Ice packs and physiotherapy
715. Case of trauma to the leg , x-ray : fracture proximal shaft of tibia and fibula, on exam : there is pain, swelling ,
tingling and paresthesia at the dorsum of the foot , sever pain in passive planter flexion , what to do :
 Selective compartment fasciotomy
 Fasciotomy to all compartment
 Vascular surgery consultation
 Follow up in OPD
716. Case of spiral fracture of distal shaft humerus , CR done with U shap slab , now he developed wrist drop , what
to do :
 ORIF
 Surgical exploration
 Urgent nerve conduction study
 General anesthesia then U-shaped slab , and close reduction again
717. Case 3 y\o child with # supra condylar humerus extremely displaced type IV pulseless and paresthesia , what
to do :
 Open reduction and exploration (ORIF with K-wire )
 CR
718. Child with # distal radius treated by cast, came now with angulation 15 degree angulation after 3 weeks , what
to do :
 Observation and follow up
 Pining
 Continue cast
719. 30 y\o with old mal united colles #, how to managed : radial dorsal osteotomy with radial deviation and bone
graft
720. Fracture of base 5th metatarsal bone with displacement 3 mm , how to treat :
 Walking cast for 8 weeks
 Intra medullary screw
 K-wire fixation
GRAMI
 CKP bandage
721. Case adolescent with recurrent ankle sprain and chronic pain  tarsal coalition
722. (pic) anterior ankle drawer test +ve
- How to diagnosed  MRI
- Management  …………
723. Young pt with osteolytic lesion , central at proximal tibia crossing the physis , with …. Classification , will
defined cortex , diagnosis is :
 Osteoblastoma
 Osteosarcoma
 GCT
724. GCT :
- What you will do after x-ray  MRI
- Management  curtage and bone graft
725. Rhabdomyosarcoma in single muscle , the management is :
 Amputation
 Wide local resection
 Excision of the affected muscle only
726. Case : CT of osteoid oasteoma what you see in histology  woven bone surrounding by osteoblast
727. X-ray : showing arthropathy of shoulder with history of new trauma , now he cannot abduct his arm , the
cause is : rotator cuff tear
728. X-ray of case of female patient 45 years old, asking about the disease in her childhood that cause this
deformity (x-ray of knee and ankle ) show total fusion and there is no joint line with osteopenic bone :
 TB
 Pyogenic
 R.A
729. Case: # neck femur + anterior dislocation , approach  anterior smith Peterson
730. Pt with THA , abductor lost , what approach  direct lateral
731. Child with amputation in upper limb , the most common complication causing premature bony stump 
opposition bone graft
732. Adult pt after fracture shaft ulna for 6 months ago managed by cast now he came with hypertrophic nonunion
, management is : ORIF by plate without graft
733. Case of child with open tibial # Gastello tyoe IIIA , according to ATLS what is the 1 st thing to do :
 Irrigation and debridement
 Debridement and remove the died tissue with in 24 H
 Start penicillin injection 1500.000 IU
734. Old man solider with old open # of mid shaft tibia healed but with old scar discharge , now there is no
discharge, there is chronic ulcer with everted edge resistant to healing  malignant transformation
735. X-ray , pelvic # (acetabular) bilateral fixation with reconstruction plate , will reduced , he came now by Rt hip
pain (AVN appearance on x-ray)  osteoarthritis of the hip
736. Old pt , Hypertension , DM, he take antihypertension drug and bisphosphonate (x-ray : sub trochanteric
fracture) what is the cause of this #  bisphosphonate over use
737. Case : adult ACL tear +ve luchman and anterior drawer , the management is : ACL reconstruction
738. X-ray : # NOF trascervical fixed with 3 screw , after 10 months he came with pain , what is the cause :
 AVN
 Implant failure
739. Child with # proximal humerus ( pathological – cyst ) , with picture of hyperparathyroidism ( low CA, high ALP,
HIGH parathormon ) what to do :
GRAMI
 ORIF
 Continue same treatment
 Treat hyperparathyroidism
 More investigation
740. Adult , with septic arthritis of hip , to diagnosed  aspiration
741. Case of hip septic arthritis , next step :
 Urgent debridement and drainage
 Aspiration and C&S
 FOLLOW UP
742. # ankle with transvers # of LAT malleolus and vertical # in medial malleolus , the mechanism is :
 Supination adduction
 Supination abduction
 Pronation adduction
 Pronation abduction
743. Old pt with multiple wedge fracture in lumber region with no history of trauma , what to do  DEXA
744. RTA with # L1 , posterior element with weakness in lower limb and paresthesia  urgent fixation
745. Case of distal femoral chronic osteomyelitis treated by curtage and debridement and use of ATB beads
Cement put in , what make patient improve :
 Early removed ATB beads
 Manipulation with dead space
746. Case of # femur with COPD , had operation, now developed fever , tachypnea, hot lower limb and tender (DVT
and embolism) , what is the cause :
 Immobilization
 COPD
747. Stable heel pad amputation  the boyd amputation
748. Old patient with R.A for long period he came to your clinic suffer of burning pain and numbness in the thumb
and index finger , the diagnosis is  CTS
749. 35 Y\O pt suffer from four parts head of humerus the TTT is :
 Conservative
 Hemi arthroplasty
 Total shoulder replacement
 Reduction and fixation
750. Functional arthrodesis of the hand  carpometacarpal = 30 \ metacarpophalangeal = 90\
751. Cause of DHS failure  loss of calcar reduction
752. Tear of distal tibio-fibular syndesmosis show complete tear of the syndesmosis above tibial plafond by 
more than 4.5 cm
753. Pain more at night relived by aspirin  osteoid osteoma
754. Good prognosis after neck femur fixation  accuracy of reduction
755. Description of malleolar screw drilling of calcaneus screw size is  2.5 mm
756. 12 y\o boy fall on his knee which diagnosed lateral patellar dislocation which reduced by orthopedician the
he returned to ER with pain and tenderness, with flexion to 70 degree. next step  aspiration
757. X-ray of 66 y\o pt with union of hip and acetabulum as one mass , complaining of back pain, gluteus medius
not acting  constrained THA
758. X-ray and pic of black discoloration of 2 nd and 3rd toes after operation of fixation by k-wire after 12 hours ,
treatment is  remove k-wire
759. TEV treated by ponsitti maneuver , third step of management is  varus
GRAMI
760. Acute lower back pain and paresthesia in Rt lower limb with weakness of big toe extension , management is
 urgent decompression
761. Osteoid osteoma in the pedicle of L4  excision
762. Indication of immediate discectomy in  cauda equina
763. To gain stability, the distance from the proximal one of the 2 distal screw of the interlocking nail and the
fracture must be at least  2cm
764. 5 days post op of THR , the pt suffered from sever pain in the thig and calf , redness and fever diffuse in the leg
but with normal walking the diagnosis is  DVT
765. Bamboo spine seen in  ankylosing spondylitis
766. Picture of anterior drawer test , and other of apply test , what does those exam for  ACL – MCL
767. 15 y\o soccer player complain of bilateral hip pain that worsen by activity. She notice that she had fatigue and
pain that extend to thig and knee after the soccer match she had a tender in the symphysis pubis and there is no
pain with resisted abduction . no pain in adduction of hip , or hip flexion , there is normal rotation the best
surgical indication is  GANZ
768. Most common injury in ankle sprain  anterior tibiofibular ligament
769. Peripheral nerve injury , lost its function within :
 3 min
 30 min
 60 min
 120 min

770. Operation for tetraplegic pt to restore elbow extension or key pinch with wrist extension
771. 13 y\o with Bilateral vertical talus  triple arthrodesis
772. Antero lateral Pseudo arthrosis wich type  according to boyed classification ( TYPE 2), according to Crawford
(type 4)
773. X-ray of intertrochanteric lesion , what is the histology  woven bone
774. Neer classification according to  number of displaced fragment
775. X-ray of 1st carpometacarpal pain since 1 year with flexion and extension thumb  O.A (rhizarthrois )
776. Oral anticoagulant in pt with history of DVT  (RIVASOXABAN= XARELTO) decrease rat of DVT (prophylaxis)
777. Definition of biofilm:
 Hydroxy…..  to resist ATB in serum
 Barrier around plate
778. GLASGOW COMMA SCALE + BP + respiratory rate  revised trauma scale
779. X-ray of external fixator and acetabular plate , what is the most frequent complication :
 DVT ( 60%)
 Infection
 Fat embolism (27%)
780. Twisting ankle with # fibula + deltoid tear grade 3 , management Is  fixation of fibula , repair deltoid
781. Fatal zone in acetabulum screw insertion in THA  antero superior
782. Melph alan is a drug used in treatment of  multiple myeloma
783. child age 3 months, with unilateral DDH , the success rate of treatment by pavlik harness is :
 75-85 % (if he came within 1st 6 weeks )
 40-60% (after 6 weeks)
784. Transvers acetabular ligament  injury to obturator
785. 2 y\o with waddling gait( DDH?) , best investigation is  x-ray
786. Pic of back of child  sprengel deformity
787. Old age with osteomyelitis, got teeth problem after 2 months. the causative organism is :
GRAMI
Strepto arginosus
Staph epidermedis
788. Wrist trauma with pain , investigation  MRI without contrast
789. X-ray , adult with distal radius with minimal angulation and limitation of movement the TTT:
 Correction osteotomy
 Wrist fixation
 Scaphoid fixation
 Open reduction of DRUJ
790. 32 Y\O with hip pain (pic) and MRI show stress # NOF , TTT :
 Absolut N.W.B
 Controlled weight bearing
 DHS with open reduction
 Pining
791. x-ray S.C humerus # Grade III , open G1 hand cold , poor refill  Open reduction, exploration and pinning
792. 13 y\o Lt side distal radius mass , x-ray show soup bubble image management :
 Chemotherapy
 Radio therapy
 Extended curettage
793. Patient with sinus in leg. Pouring pus and serous. X-ray show sequestrum..best method to take sample 
deep aspiration
794. You did ORIF for fracture both bone forearm, then at night your resident call you and tell you that there is
sever edema at the fingers of your case. What will you do  Release the cast.
795. The most affected epiphysis at the body by sepsis femoral head epiphysis.
796. The claw toes deformity is due to  Neurological disorder (not sure)
797. question about shoulder instability classification (important)
798. A question about future of baby after closure of myelomeningocele:
 will walk alone
 will need assist

799. in Panjabi , what radiological finding not reliable in :?????

 child 7 y\o
 adult with cervical trauma
 teen ager
 disc space aren’t equal
800. Ewing sarcoma in 20 y\o male with history of chemotherapy and radiotherapy, now he has recurrence of
lesion in fibula , 5 years survival less then :
 10 %
 20%
 30%
801. Female with hypercalcemia punched out lesion skull bone pain , mostly she has  multiple myeloma
802. Male 16 y\o has lesion in head femur and pain , most likely type pf lesion is :
 Chondroblastoma
 Osteosarcoma
 Aneurysmal cyst
803. 12 y\o female with painful swelling in inferiomedial femur , there Is mild redness , x-ray show periosteal
reaction and new bone formation , ALP : 1170 best investigation :
 MRI to detect intra compartmental affection (first )
GRAMI
 Biopsy to stage lesion (best)
804. Patient with osteoid osteoma (2 x-ray and bone scan ) , you decide to operate this patient least invasive :
 Radiofrequency ablation
 Excision
 Intra lesion curtage
805. Female obese has extension knee injury came with swelling in the back of knee (2 picture: clinical post. Drawer
, and 2 x-ray) mostly she has :
 Avulsion PCL
 ACL TEAR
 Meniscal tear
806. Player has sever eversion and dorsiflexion ankle trauma and diagnosed as sprain splinted , now he has pain
and locking and inflammation , next step:
 MRI
 CT
 Syndesmotic view
 X-ray
807. 45 y\o Male pt has knee pain , x-ray show multiple radio opaque loose body (mostly he has:
 osteocondritis dissicance
 synovial chondromatosis
808. why the anterior leg compartment more liable to ICS :
 anterior compartment has a single dominant artery
 inadequate fascial release
 anterior compartment near to proximal fracture
 thick fascia (not sure)
809. common blood supply of head of femur in child age 4-7 y\o :
 metaphyseal vessel
 …. Epiphyseal (terminal branch of medial femoral circumflex artery
 Ligamentus teres
 Synovial
810. Middle age female tow many toes laterally , weakness of hind foot, inability to stand on forefoot , mostly she
has :
 Tibialis posterior rupture
 Rupture tendoachilis
811. Pt has pain in the back of the ankle with swelling ( x-ray and photo) mostly has :
 Insertional tendoachilis tendinitis with hagland deformity
 Non insertional tendoachilis tendinitis with hagland deformity
812. GOWER SIGN is seen in  duchen muscle dystrophy
813. Pt 70 y\o, blind and hemiparesis has # NOF (contralateral form hemiparesis ) limited activity , TTT IS :
 Unipolar
 Bipolar
 THA
 ORIF
814. Male pt has # distal radius since 6 months ago , treated conservatively, now he has pain and limited extension
and rotation of wrist ( 2 x-ray : pre and post treatment of both side, there is no ulna +ve) :
 Corrective osteotomy
 Repair of DRUJ
 Ulnar shortening
GRAMI
815. driver has an accident came to ER with adduction and internal rotation of Lt lower limb, with knee swelling,
hip x-ray show dislocation of hip , what you will do :
 reduction of hip with IV analgesia
 open reduction of hip under G.A
 X-ray knee and reassurance
 CT hip
816. Pt has cut wound on dorsal aspect of thumb , with cut extensor (pic: wound on MCP) , which zone affected 
ZONE 3

817. Patient has consult with knife on the palmer aspect of hand at distal crease level, he cant flex distal phalanx of
finger of ring and middle :
 Cut flexor digitorum superfescialis
 Cut flexor digitorum profundus
 Cut flexor digitorum superfescialis and profundus
818. Patient wide bike he fall down on hand and has wound of the hand with distaly based skin flap (proximal
dethatched ) the edges not bleed , treatment is
 Distal based palmar flap
 Distal based dorsal flap
 Suture subcutaneous in separate layer
 Secondary intention
819. Saver’s disease  calcaneus
820. Female patient has THR after neglected DDH , post op the pt has drop foot when sitting , what to do (with x-
ray) :
 Flat a bed with hip extension
 Pillion under knee joint
821. Female pt has R.A and developed flexion contracture in the knee joint with no osteoarthritis, during gradual
correction of knee deformity , the pt has drop foot , what is the cause :
 Common peroneal pulsy
 Rupture tendon
822. Femal pt had a skin lesion with bulla that rupture and scar with clear change also has buccal ulcer, with
eruption and skin test diagnosed as pemphigus vulgaris, she has Lt hip pain with tenderness on greater
trochanteric and AVN of hip(x-ray (2 arrow): head sclerosis with no collapse , what to do :
 Core decompression
 VFG
 THR
GRAMI
823. Male pt 40 y\o complain of Rt elbow pain when carrying heavy object with instability, the pt has pain free
elbow, ROM 30-120 with instability and free pronation and supination what to do :
 Arthrodesis in 110 degree
 Interposition soft tissue …..?
824. Which weber type mostly has syndesmotic injury :
1
2
3
4
825. Pt has cervical spine injury , he has intact sesation in radial aspect of forearme, intact wrist extension,
brachioradialis and shoulder abduction , other motor lost below the level , the pt level :
 C4
 C5
 C6
 C7
826. Pt had cementless THR had greater trochanterc # minmal displaced , how to managed :
 Conservative with protective weight bearing
 Tension band
 Revision
827. Pt with # calcaneus with ecchymosis ( x-ray: decrease bohler angle ) :
 Internal fixation within 6 hours
 Internal fixation after 10 days
 Cast for 3 months
828. Child has above knee amputation , after one year , the x-ray show conical bone and distal end stump ( bone
felt ) and difficult prosthesis fitting , the cause is :
 Epiphyseal bone growth
 Oppositional bone growth
829. Percentage of nonunion humeral fracture treated conservatively :
 Less than 5%
 15-20 %
830. Female pt has history of bone pain with x-ray show multiple lesion in pubis rami with # neck femur with
sclerosis , she felt a pain when she stand up and she felt down , whats the type of fracture :
 Pathological #
 Stress #
 Fatigue #
831. X-ray and MRI show lesion in femur ( big OCD triangular shape ) , best TTT:
 Arthroscopy
 Arthrotomy and capsular fixation
832. Basketball player fall down on his ankle , x-ray : talar dislocation, what is the joint involved in this injury :
 Subtalar
 Talonavicular
 Ankle
 The 3 joint involved ( not sure)
833. Incidence of AVN in hip dislocation which reduced after 24 H from injury:
 >40%
 10% (if reduced < 6H)
834. Case of infected degloved limb stumb win diabetic pt in uncontrolled diabetes, 0.5 , how to treat :
GRAMI
 Glycemic state control
 Wound care
 Level of amputation ( if there is no vascular state in the option )
835. Benefit of femoral shortening osteotomy in DDH :
 Decrease risk of AVN
 Decrease acetabular index
 Decrease femoral abduction
836. Injury to radial nerve at elbow level , the action will be lost of :
 Wrist extension
 Thumb extension
 Thumb abduction
 Finger extension (not sure)

837. 30 Years old male presented in ER with history of RTA, pain in cervical region. O/e he has weakness of both
upper limbs & complete paralysis of lower limbs. The diagnosis is :
 Complete cord injury.
 Brown sequared syndrome.
 Central cord syndrome.
838. 5-year-old child presented with X-ray showing fracture through the cyst in sub trochanteric region. ttt is :
 Bone grafting.
 Internal fixation
 Close reduction and fixation.
 Curettage, bone grafting and internal fixation
839. X-ray of hand: Lytic lesion in proximal metacarpal :
 Enchondroma.
 Osteocondroma.
 Fibrous dysplasia.
840. 18 years old boy. 90th percentile, presented with pain on walking.MRI of knee is normal. Parents noticed that
he is walking with foot moving outward. O/E flexion of hip produce abduction and external rotation of hip. Most
appropriate investigation  MRI
841. 56 years old female, known case DM controlled. Complaining of pain in radial side of hand. Pain increases after
falling sleep and improve with gentle exercise of hand. What is most appropriate action:
 X-ray of hand.
 MRI cervical spine
 Nerve study. (CTS)
842. which cell has no mitotic figure:
 Osteoblast
 Osteoclast.
 Osteocytes.
 Chondrocyte
843. 26 yrs. old male victim of RTA had fracture femur, fracture humerus. Hb % 8.2, pulse 80/minutes, B.P 120/70,
was transfused 1unit of blood. At night, the nurse called you and informed that patient’s oxygen saturation is
90% and B.P is 90/60 with jaundice. What is the most likely diagnosis:
 Dvt.
 Fat embolism.
 Hypersensitivity reaction.
844. 12.X-ray showing non cemented THR with cerclage. Bone integration will takes place in:
GRAMI
 One month.
 Two months.
 Three months.
 One year.
845. 26 year patient with fracture of coronoid with 65 % involvement , the best treatment option is:
 Leave alone.
 Close reduction and cast.
 ORIF with plate
 Excision
846. 27 years old male presented with type 3 open fracture of tibia. The best treatment is :
 ORIF
 Debridement of wound and devitalized muscles.
 Irrigation, debridement and culture after debridement.
 Irrigation, debridement and fixation.
847. In Pavlik harness, flexion of hip more than 90 degrees will result in:
 AVN.
 Femoral nerve neuroparaxia.
 Re dislocation.
848. 25 year presented to E/R with pain and swelling of wrist patient , the X-ray shows extra articular fracture of
distal radius with shortening , Treatment option is :
 Close reduction and casting.
 Open reduction
 Close reduction and percutaneous pinning.
 ORIF with bone grafting.
849. 38 years female, with x-ray showing knee joint with decreased joint space, subchondral sclerosis , Patello
femoral joint normal. Treatment options :
 High tibial osteotomy.(not sure)
 Unicondylar arthroplasty.
 TKA.
 conservative.
850. Young athlete presented with pain (recurrent) over right heel. X-ray showing calcification at the attachment of
tendon Achilles. Best ttt is :
 Steroid injection.
 Exercise.
 Debridement.
851. The Most common complication of V-Y flap failure of fingertip injury :
 Necrosis.(not sure)
 Parrot deformity.
 Insensate finger.
852. Club foot at third week what correction will be done :
 Cavus
 Pronation
 Equinus.
 Adduction.
853. Short stature and asymmetrical limb and trunk :
 Achondroplasia.
 Kinest syndrome.
GRAMI
854. ABI required for the flap healing :
 0.6
 0.4
 0.5
 0.25
855. Degenerative spondylolisthesis is most common at :
 L4-5
 L5-S1
 L2-3
 L51-2
856. Scoliosis can be differentiated between structural and nonstructural curves by measuring :
 RVA
 Kobb’s angle.
 Sagittal balance.
 Coronal balance.
857. Trauma with distal ulna prominence (no fracture) diagnostic tool:
 X-ray with oblique views.
 C.T
 Arthrography.
 Arthroscopy
858. Radial head replacement:
 Head size need be larger than original head.
 Should not go beyond coronoid process.
 Use rubber implant.
859. Low radial nerve palsy , which movement will be preserved :
 Wrist extension.
 Thumb adduction.
 Abduction of thumb.
 Finger extension.
860. case scenario. female patient 55 years old live sedentary life and have sever valgus and oseoarthritis and she
refuse to do TKR so best management is :
 high tibial osteotomy
 distal femur valgus osteotomy
 distal femur varus osteotomy
861. case scinario female child ..12 years old..have rigid flat foot and cannot do heel raise signs and showing to
many fingers lateral on examination..she has :
 arthritis
 tibialis posteror rupture
 tendoachillis rupture
862. Child 2 years old. Have painless limb on walking. With barlow and orlatoni signs positive.best way to confirm
the diagnosis :
 x ray
 U/S
 Arthrogram
 CT
863. case scenario patient with renal cell carcinoma..had severe pain in forearm after closing the car door ..on
doing x ray there is fracture proximal radius in an osteolytic lesion.. best management :
GRAMI
 radiotherapy
 radius removal and resection
 neoadjuvant chemotherapy
 fixation with implant & cement
864. case scenario..tourniquet in upper limb operation..you put it for 60 minute and for 250 pressure..the patient
pressure was 100 ..the reason of nerve injury is :
 long time
 high pressure
 unkown vascular disease
865. when you do fasciotomy when the compartmental pressure is :
 above 50 mm hg
 pressure difference below 30 between it and diastolic pressure before operation
866. xray fracture tibia and there is oedma and pain on passive extension of toes:
 anterior compartmental
 posterior compartemental (not sure)
867. 22 years old on playing basket ball falls on his leg>>there is pain on medial side and anterolateral ankle..(x ray
shows wide medial clear space ) what to do :
 X ray for whole limb (whole tibia and fibula )
 MRI
 stress view ankle
 CT
868. xray fracture lateral malleolus ( medial clear space open about 4 mm ) management :
 plate fibula + syndosmotic repair
 plate fibula + deltoid ligament repair
 plate fibula +check syndosmosis intraoperative
869. best mangement in intertrochantric fracture :
 proximal fragment in valgus and imoacted in AP view
 reduction with angle 150 in ap and 170 in lateral
870. patient 18 years old , had shoulder dislocation , best management after reduction is :
 cast for 3 monthes
 artheoscopic bankart repair
 physiotherapy from next day (not sure)
871. Patient with elbow dislocation and radial nerve injury at elbow..patient will not be able to do all of the
following actions except :
 Extension of wrist
 Extension of fingers
 Abduction of the thumb
872. patient 30 years old with pain in shoulder and arm and loss of weight (xray with normal shoulder ..MRI
showing lung tumor )..the shoulder pain is due to:
 O.A
 Neuritis
 Metastasis
873. Case scenario..Patient with pain in dorsolumbar ..tenderness , and signs of infection with laboratory
investigation..most likely investigation to confirm the diagnosis (TB) :
 CT guided biobsy
 Open biobsy
 MRI
GRAMI

874. x-ray knee joint ( show avulsion of latera tibial condyle i.e segound fracture ) this pic indicate :
 ACL
 PCL
 Meniscus injury
875. old age male 65 years old had knee dislocation , after reduction put in slab for 3 weeks..after doing MRI there
is tear ACL and PCL and partial tear of medial collateral ligament, the management is:
 constrained TKA
 hinged TKA
 Arthroscopic repair
876. Patient have punched out lesion and other indicator in urine ..diagnosis :
 Ewing sarcoma
 multiple myeloma
 osteosarcoma
 GCT
877. Female patient had tumor in her radius two years ago..and now presented by multiple lesions in the lungs
..diagnosis :
 Osteosarcoma
 osteochondroma
 GCT
878. pain in chin of tibia in male..examination reveals no proplem..after 3 weeks the patient still have pain and
there is periosteal reaction on xray ...diagnosis :
 Osteosarcoma
 Chin tibial reaction" some thing like this !!"
 Ewing sarcoma
879. Neglected hip dislocation in old unconcious patient , reduction was done after 24 hours ..percentage of AVN in
that patient :
 7
 8
 9
 More than 10

(normaly it's between 8 to 40 ..and increase if reduction done after 24 hours .so i choose more than 10

880. patient 50 years (have strange disease name ???? ) there is xray with arrow on greater trochanter ??? the
patient have AVN . what to do :
 THR (constraind )
 Vasculrized fibular graft
881. female patient have mild pain in chin of tibia relieved after taking ibuprofen you have to do :
 CT without contrast
 CT with contrast
 MRI with contrast
 MRI without contrast
882. Patient with flat foot (or proplem in foot ) with seen bony bar..best image to diagnose and decide how to
operate :
 CT
 MRI
GRAMI
 X RAY
883. male farmer 43 years old..have problem in his elbow 2 years ago..have severe pain and didn't feel relief till
now ..xray was done there is angulated head radius and sever O.A reaction between olecranon and
humerus..best management :
 Total arthrodesis
 Arthrodesis in functional position (not sure)
 Interpositional arthroplasty
 Removal of head radius
884. Case scenario..male child had contusion knee two days ago presented now with severe pain and tenderness in
knee joint and inflammation best to do to diagnose :
 ESR
 X ray
 Blood culture
885. patien with trauma to hand ..oedema and palpable lump..tendon examination revealed normal
movement..best diagnostic tool to done :
 X-RAY
 MRI
 CT
886. patient have plate and screw titanium in upper femur and you need to check vascularity in head femur :
 XRAY
 MRI
 CT
887. patient have anterior hip dislocation and fracture neck femur..closed reduction failed and now you need to do
open reduction..what incision will you done:
 anterior smith approach
 posterior
 lateral
888. Old patient had THR 3 month ago..on routine visit you find heterotropic ossification...best management :
 Indomethacin
 Radiation
 Reassurance & see again after 6 monthes
 Surgical excision
889. fracture scaphoid since 4 months (xray show proximal pole fracture avulsed ) ttt:
 closed reduction & Herbert screw fixation
 removal of the fragment
 ORIF with Herbert screw & bone graft
890. Operation to fix radius and in operation you find missed ulna fracture that displace in rotation..best
management :
 Cast in pronation
 Open repair of DRUJ
 Transfixation of distal radius & ulna with K.W in supination
891. old patient have THR five years ago and come complaining from pain..this patient had many dislocations last
year and there is weakness in this limb muscle ttt :
 Revision
 Constrained cup
 Medication
GRAMI
892. Patient with patellar dislocation reduced 3 days ago..Come with pain..Inflammation..decrease range of
movement ttt :
 Arthroscope
 Medication
 Orthosis
893. 9 years old male child..start to complain of limping in right lower limb >>it was interrupted first and become
constant..when we do xray :
 ense epiphysis
 altered patches of lucency and opacity
 antero lateral head defect
894. shoe lace stitches ..when you do it in compartement faschiotomy :
 not able to close the wound
 to monitor the compartment pressure and vascular status
895. Patient in RTA accident and have lung injury and have fracture femur .. the capacity and prognosis of lung
injury will mostly affected by :
 reamed interlocking femur fixation
 non reamed interlocking femur fixation
 the initial injury that allready happened to the lung
896. retropulsed fragment in spine what should you do ( he did not mention if the patient were neurologically free
or not ) :
 posterior fixation
 intervention in first 24 hour
 intervention in first 96 hour
897. Case scenario .. (the patient have another disease..talking cortisone or had irradiation..i don't remember
exactly ) ..he fall and have fracture of acetabulum..what is the causes of the fracture :
 avn head
 osteomalicia
 osteoporosis (2ry)
 Fatigue fracture (or something like this ???? )
898. Patient have trauma while driving a car. X-rays done but it was free. He visit you later with neck pain not
respond to medication. most likely diagnosis: (ok)
 whiplash
 schiwora
 stable ligament injury need fixation
 unstable ligament injury need fixation
928. must sensitive test to diagnosed CTS  durckan test
929. lateral malleolus fracture weber type B  ORIF + assess syndesmosis