1.

Figure below show the clinical photograph of the

foot of a who has had diabetes mellitus
controlled with oral medication for past 10 years.
He wears soft soled shoes for important business
meeting. Examination reveals palpable dorsalis
pedis and posterior tibial pulses, although they
are somewhat diminished. He is insensate to
pressure with the 5.07 SenunesWeinstein
monofilament. The ulcer heals after treatment
with a full contact cast. What is the best course of action at
this time?
a. Referral to his primary care physician
b. Foot-specific patient education, depth-inlay shoes,
custom accommodative foot orthoses, and follow-up
observation
c. Dorsoflexion osteotomy of the first and third metatarsal
d. Excision of the second and third metatarsal head.
e. Achilles tendon lengthening and dorsiflexion osteotomy
of the first and third metatarsal
2. A 62 year old man with diabetes mellitus has had a persistent
2 cm ulcer under the third metatarsal head for past 4 month.
He reports that he has had similar ulcers twice before, and
both healed with non-surgical management. He has used
multiple types of commercial walking braces, shoe, and
commercial dressing without resolution. He is insensate to the
5.07 Semmes Weinstein monofilament. When the wound is
probed with culture swab there is no communication with
metatarsal head. Radiographs, bone scans, and laboratory
studies reveal no evidence of osteomyelitis. What is the most
predictable method of accomplishing wound healing without
recurrence?
a. Transmetatarsal amputation
b. Excision of the third metatarsal head
c. Percutaneous Achilles tendon lengthening and a total
contact cast
d. Viral recombinant growth factor and a commercial
removable walking boot
e. A non weight bearing total contact cast that is changed
every week until the ulcer is healed.
3. The coleman block test is used to evaluate the cavovarus foot.
What is the most important information obtained from the
test?
a. Determines the patients ability to balance
b. Determines hind foot flexibility
c. Determines forefoot flexibility
d. Assesses the patient for Achilles tendon contractures
e. Evaluates peroneus longus strength
4. A 28 year old female present to your clinic with progressively
increasing pain in her left wrist. She has also recently been

having repeated episodes of abdominal discomfort, nausea

and vomiting. A plain radiograph of the wrist reveals an
eccentrically placed lytic lesion in the metaphysis and
epiphysis with thinning of the cortex. You suspect a giant cell
tumor of bone. What is the most appropriate next step in
management of this patient?
a. Perform a bone biopsy
b. Curettage alone
c. Curettage and phenolization
d. Curettage, high-speed burr, cement and bone graft
e. Check serum parathyroid (PTH) and calcium
5. All the following principles must be adhered to who performing
a biopsy of a bone tumor except?
a. The selection of the biopsy path should be made in
consultation with surgeon who will perform the definitive
incision
b. The biopsy tract should be marked to allow excision at
the time definitive surgery
c. The biopsy should ideally performed at the centre where
the definitive excision is likely to be carried out
d. The tumor should be approached trough normal tissue
before entering the reactive zone
e. Use of frozen section to ensure that diagnostic tissue
has been obtained
6. What is the World Health Organization (WHO) definition of
osteoporosis?
a. Bone mineral density less than 1 standard deviation
below the mean of a young healthy adult
b. Bone mineral density at least 2.5 standard deviation
below the mean of a young healthy adult
c. T score less than -2.5
d. T score is more than v2.5
e. B and C
7. The husband of a 22 year old woman has hypophosphatemic
rickets. The woman has no orthopedic abnormalities. But she
is concerned about her chances at having a child with the
same disease. What should they told regarding this disorder?
a. Their sons will have a 50% chances of having this x
linked dominant disorder
b. All of their daughters will be carrier or will have this
disorder
c. They should be advised to not have any children
because the risk of boys with the disorder and girl who
will be carrier is too hard for any parent
d. As long as the woman does not carry the crat the
children will not be affected because the husband has
the disease and this is x linked dominant disorder
e. Their sons or daughters may be born with this disorder,
but males are more severely affected

8. A 4 month old infant is unable to flex her elbow as a result of

obstructive brachial plexus palsy. This most likely illustrated a
predominant injury of what structure?
a. C4
b. Upper trunk
c. Posterior cord
d. Lateral cord
e. Musculocutaneous nerve
9. On an anteroposterior (AP) radiograph, wich of the following
defines a B/C border hip according to Herrings modified
classification of Perthes disease?
a. A very narrow lateral pillar which is <50% of the original
height
b. A lateral pillar with very little ossification with at least
50% of the original height
c. A lateral pillar with increased ossification with at least
50% of the original height
d. A lateral pillar with exactly 50% of the original height
that is higher than the central pillar
e. Gages sign
10.
A supracondylar fracture of the distal humerus with
posterolateral displacement should be reduced by performing
reduction manouvers in the following order?
a. Valgus Flexion Pronation
b. Varus Extension Supination
c. Valgus Extension Pronation
d. Traction Pronation Flexion
e. Varus Extension Pronation
11.
observation at the time of surgery reveals that the
mass has yellowish brown tint and lobulated areas. Histology
demonstrates bland fibrous stroma with scattered hisiocytes,
giant cell, and hemosiderin. What is the most likely diagnosis?
a. Ephiteloid sarcoma
b. Giant cell tumor of tendon sheath
c. Gouty tophus
d. Hemangioma
e. Epithellial inclusion cyst
12.
What syndrome is characterized by polycystic fibrous
dysplasia, caf-au-lait spots with serrated borders, endocrine
abnormalities and unilaterally?
a. Jaffe-Campanacci syndrome
b. Hunters syndrome
c. Mafuccis syndrome
d. Multiple hereditary exostoses
e. Mc Cune Albright syndrome
13.
Which is the following tumors has best prognosis (least
risk of pulmonary metastases)
a. Parosteal osteosarcoma
b. Periosteal osteosarcoma

c. Classic (or ordinary) osteosarcoma

d. Osteosarcoma in Pagets disease
e. Osteosarcoma following irradiation
14.
A 26 year old man is involved in a high speed
motorcycle accident. He is sustains a grade IIIB open tibia
fracture. Examination reveals a large soft tissue defect and
insensate foot. What is the expected occur in this secenario?
a. Equal functional outcome when limb salvage is
compared with amputation
b. Worse functional outcome with limb salvage than with
primary amputation
c. Better functional outcome when amputation is
compared with limb salvage
d. Amputation within 6 month of injury
e. Permanent loss of plantar sensation
15.
function in the lower extremities. Normal perineal
sensation and normal rectal present. What is the best
management?

a.
b.
c.
d.
e.

Bed rest
External orthosis
Anterior corpectomy and arthrodesis
Posterior insrumented arthrodesis
Posterior decompression and instrumented arthrodesis
16.
A 28 year old man has decrease finger proximal
interphangeal (PIP) joint range of motion after open reduction
and internal fixationof a proximal phalange fracture with the
use of a slide plate. Examination shows greater passive PIP
joint flexion with metatarsophalangeal (MP) joint extension,
then when the PIP joint is flexed. This finding demonstrate
contracture/scarring of which of the following structure?
a. Flexor tendons
b. Extensor tendons
c. Oblique retinacular ligament
d. Intrinsic muscle
e. PIP joint stiffness
17.
Bone destruction as a result of multiple myeloma is
primary caused by which of the following cell types?
a. Myeloma cells
b. Macrophages

c.
d.
e.
18.
a 47 year old man sustained a degloving injury ober the
peritibial surface and anterior ankle regiaon in motor vehicle
accident. After debridement and irrigation, there is inadequate
tissue for closure of the exposed anterior tibial tendon and
tibia. Prior to the definitive soft tissue coverage, management
should consist of
a. immediate split thickness skin grafting
b. immediate xenograft application
c. a vacuum assisted closure device
d. dressing changes with sulfasalazine cream
e. a cross leg flap
19.
A 30 year old man reports pain and weakness in his
right arm. Examination reveal grade 6 strength in wrist flexion
and elbow extension, decreased sensation over the middle
finger, and decreased triceps reflex. These symptoms are
most compatible with impigment on what spinal nerve root?
a. C5
b. C6
c. C7
d. C8
e. T1
20.
What gene is expressed the earliest during the
differentiation of a chondrocyte during endhochondral
ossification?
a. Aggrecan
b. Sox-9
c. Collagen type II
d. Collagen type IV
e. Collagen type XI
21.
What is the region of the thoracic curve is most
dangerous for pedicle screw insertion while performing a
posterior fusion for adolescent idiopathic scoliosis?
a. Concave side at stable vertebra
b. Concave side at the apex of the curve
c.
d.
e.