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Sergical Pathology I - Dr. Tha Puthratanak

1/ Tearing the insertion of the extensor tendon of the phalange is recognized by:

Attitude in demi-extension of the last phallange.

Attitude in demi-flexion of the last phalange.

Attitude of the index finger in extension 40˚

Attitude of the thumb in adduction 30˚

2/ Normal position of the hand is:

2nd and 3rd metacarpals are mobile

4th and 5th metacarpals are fixed

2nd and 3rd metacarpals are fixed

4th and 5th metacarpals are mobile

3/ BENNETT's fracture is:

Small fragment rests in place and articulates with the trapezoid

Fracture into 3 fragments

Small fragment rest in the diaphysis

Small fragment rests in extra-articular.

4/ Treatment of the phalangeal fracture (if absence of diaplacement at the 1st and 2nd phalanges at the neck and base diaphysis) is:

Stable osteosynthesis by screw

Stable osteosynthesis by plates

Stable osteosynthesis by pin (Broche)

Stable by Syndactylization with adhesion

5/ Treatment of epiphyseal fracture of the first 2 phalanges (Fracture of the head and neck) is:

Stable osteosynthesis by broche or screw

Stable osteosynthesis by cast

Stable by Syndactylization with adhesion

Stable by attelle palmaire (Splint)

6/ Treatment of the distal phalange fracture (fracture of P3) is:

Immobilized by small splint (petit attelle)

Fixation by Pin or Screw

Fixation by transosseous wire

All of above

7/ Etiology of the recent traumatic dislocation in children is:

Traumatic dislocation

Fracture and dislocation

Epiphyseal separation

Displacement of vessel and muscle

8/ Etiology of the recent traumatic dislocation in adult is:

Traumatic dislocation

Fracture and dislocation

Epiphyseal separation

Displacement of plate bone

9/ Etiology of the recent traumatic dislocation in old person:

Traumatic dislocation

Fracture

Epiphyseal separation

Displacement of the long bone

10/ Definition of the traumatic dislocation in general:

New articular in long bone

Displacement of the one articular surface to other

The bone is longer where it should be

The bone is normal but pain

11/ According to anatomic-pathology of traumatic dislocation, the capsule is

Normal

Detach from the weak point

Fixe with bone

Atrophy

12/ According to anatomic-pathology of traumatic dislocation, the synovial is:

Atrophy

Fixe with bone

Deformation and hematoma

Tear partially and blood effusion intra articular

13/ If the dislocation is not reduced, there are some problems will happen:

Sclerosis and fibrosis of the articular surface

Nonunion

Gangrene

Septicemia

14/ The recent traumatic dislocation of Elbow, in the inspection we see:

Normal

Deformation and hematoma

Hot skin

Sort tissue is blur

15/ We can confirm the diagnosis of dislocation by:

Echography

Hemogram (Blood Count)

Papation

Radiography

16/ In general, the treatment of the recent traumatic elbow dislocation is:

Surgery

Khmer traditional medicine

Reduction and immobilization immediately

Keep it for 1 month and immobilzation immediately

17/ We cann't do surgery for recent traumatic dislocation in case:

Open dislocation

Dislocation + Fracture

VN (Vasculo-Nervous) lesion

Close dislocation immediately without fracture

18/ Why we need to observe the patient who has traumatic dislocation that treated by Reduction and Immobilization:

To admire the patient

Afraid of patient does obey the doctor

Afraid of displacement after Reduction

Afraid of gangrene

19/ In traumatic dislocation, we can do surgery in case:

Function of the limb is sufficient

Elderly person

Organic tarre

Dislocation + Fracture

20/ We cann't do surgery for traumatic dislocation in case:

Open dislocation

VN Lesion

Dislocation + Fracture

Organic tarre

21/ The ancient traumatic dislocation, before the treatment we need to know about:

Date of the accident

Modality of the accident

History treatment

All of above

22/ The ancient traumatic dislocation, the anatomic-pathology shows that:

Bone is normal (articular surface)

Discrete ecchymosis, swelling

Articular surface is flat, osteophytes

Muscles is trong

23/ In the recurent dislocation, the capsule is:

Detach from the weak point

Enlarges

Normal

Fixe with bone

24/ Find one sign that does not appear in recurrent dislocation:

Pain and moderate importence

No ecchymosis

Swelling

Vivid pain and absolute functional importance

25/ Definition of the ankylosis is:

The limitation is due to the periarticular

Justiciablity by the physiotherapy

The limitation is normal

The movement limitation is the consequence of articular alteration

26/ Definition of the stiffness is:

The limitation is due to the periarticular

Justiciablity by the physiotherapy

The limitation is normal

The movement limitation is the consequence of articular alteratioin

27/ Etiology of ankylosis is:

Traumatism, fracture, or dislocation

Swelling

Gangrene

Soft tissue injury

28/ We divide the ankylosis into two types:

Correct and Incorrect

Complete and Incomplete

Direct and Indirect

Normal and Abnormal

Treatment of ankylosis sequelae of tuberculous osteoarthritis by:

Surgery

Medical

Physiotherapy

Corticotherapy

30/ Stiffness, the limitation is due to the periarticuar lesion, treatment is:

Surgery

Medical

Physiotherapy

Corticotherapy

31/ Mechanism and etiology of open and closed fracture is

Complete and Incomplete

Direct blow and Indirect blow

Correct and Incorect

Displacement and without Displacement

32/ The type of fracture is:

Incomplete fracture

Complete fracture

Direct blow and Indiredt blow

Complete and Incomplete fracture

33/ In the open and close fracture, we divide the location of the fracure by:

Diaphysis, Metaphysis, and Epiphysis

Transverse, Oblique, Spiral, and Comminuted

Flexion, Extension, and Torsion

Displacement and without displacement

34/ In the open and close fracture, we divide the type of fracture line such as:

Diaphysis, Metaphysis, and Epiphysis

Transverse, Oblique, Spiral, and Comminuted

Flexion, Extension, and Torsion

Displacement and without displacement

35/ In bone fracture, evolution of the perifracture hematoma is:

6h after fracture

8h after fracture

48h after fracture

72h after fracture

36/ 35/ In bone fracture, evolution of the hard callus or osseous callus is in:

2 weeks - 3 weeks

4 weeks - 3 months

1 day - 6 days

8 days - 16 days

37/ In bone fracture, evolution of the bone remodeling is in:

6 months - 8 months

10 months - 12 months

1 year - 2 years

3 years - 5 years

38/ Early complication after the bone fracture, the general complication is:

Rupture of the nerve

Ischemia

Compartment Syndrom

Shock trauma

39/ Early complication after the bone fracture, the local complication

Shock trauma

Cardiac accident

Kidney failure

Broken bone, skin, DVT, fat embolism

40/ Secondary complication of the bon fracture is:

Cataneous open + Infection

Cardiac accident

Vascular wound

Malunion

41/ Late complication of bone fracture is:

Articular stiffness, Muscle atrophy

Vessel lesion

Shock trauma

Fat embolism

42/ When we meet the patient who has the bone fracture, we have to:

Immobilization on the accident place

Transport urgent to ICU immobilization

Surgery on the accident place

Injection antalgic medicament

43/ Indication for definitive of the open fracture is:

Plates and Screw

Intramedullay nailing

External Fixation

Prothesis

44/ Indication for definitive of the closed fracture is:

External Fixation

Pin (embrochage)

Plate, Screw, Intramedullary nailing

Traction continue

45/ In the open fracture, the evolution of infection depends on:

Sense opening

Extent of wound

VN lesion, time, age and general condition

All of above

46/ In the open fracture, how many hours to do surgery for getting the good result?

10h after open fracture

8h after open fracture

12h after open fracture

2oh after open fracture

47/ In the open fracture, subacute infection is:

Osteitis

Osteomyelitis

Tetanus, gangrene, septicemai

Infection non-union

48/ In the open fracture, the local infection is:

Osteitis, Osteomyelitis

Tetanus

Gangrene

Septicemia

49/ The principle treatment of early open fracture that they never practice is:

General treatment

Wound treatment

Fracture treatment

Physiotherapy treatment

50/ In the open fracture, the treatment is:

General treatment

Anti-tetanus

Antibiotic and shock treatment

All of above

51/ Interphalangeal joint of the hand in flexion is:

Proximal interphalangeal 120˚

Distal interphalangeal 120˚

Mid interphalangeal 120˚

Extension 120˚

52/ Movement of the thumb (trapeziometacarpal, opposition of the thumb) is:

Adduction 30˚

Extension 30˚

Flexion 30˚

Abduction 120˚

53/ The traumatic lesion of the thumb in fracture of the 1st metacarpal, the name of fracture into 3 fragments is:

BENNETT Fracture

ROLANDO Fracture

COLLE Fracture

POTT Fracture

54/ The name of fracture of the radius associates with inferior radioulnar dislocation is:

GALEAZZI Fracture

MONTEGGIA Fracture

COLLE Fracture

POTT Fracture

55/ The name of fracture of the ulnar associates with inferior radial head dislocation is:

GALEAZZI Fracture

MONTEGGIA Fracture

COLLE Fracture

POTT Fracture

56/ Anatimy of the carpal bone contain:

Scapoid, Lunate, Trapezoid

Triquetrum, Pisiform

Hamate, Capitate, Trapezium

All of above

57/ Examination of the wrist, palpation of the radial styloid is from:

8 to 15 mm lower than the ulnar styloid

30 to 45 mm lower than the ulnar styloid

125 to 135 mm lower than the ulnar styloid

25 to 30 mm lower than the ulnar styloid

58/ Alarm signs of Volkmann's Syndrome have:

Pain, Disorders of sensibility

Tense edema and disability of finger

Functionall disability

All of above

59/ The symptoms of Volkmann's Syndrome occure in:

12 to 24 early hours after traumatic

48 to 72 early hours after traumatic

1 to 2 early hours after traumatic

60 to 92 early hours after traumatic

60/ Diverse types of olecranon fracture have:

Proximal fracture

Middle fracture

Distal fracture

All of above

#Complications of Fracture

Mr. XS age 37 years old was admitted to our service in this morning by both bone fractures of the right leg caused by accident.

61/ A skin wound is 7cm at the fracture site with a slightly comminuted fracture line, according to Gustilo's Classification:

Open Fracture: type I

Open Fracture: type II

Open Fracture: type IIIA

Open Fracture: type IIIB

Open Fracture: type IIIC

62/ A skin wound is 1cm at the fracture site, the fracture line is simple, according to Gustilo's Classification:

Open Fracture: type I

Open Fracture: type II

Open Fracture: type IIIA

Open Fracture: type IIIB

Open Fracture: type IIIC

63/ The fracture is located at the proximal extremity of the both bones of the leg, near the neck of the fibula, which nerve could be reached?

Crural Nerve

Tibial Nerve

Peroneal Nerve

Interosseous Nerve

Saphenous Nerve

64/ One day after, it is presented by tense edema of the leg, pain cannot relieve by the usual analgesics, cutaneous hyperesthesia on the fracture leg, what is the most likely diagnosis?

Compartment syndrome

Crushing muscle

Rupture of the nerve

Arterial rupture

A leg ischemia

65/ On the fourth day, the patient has fever and shiver, the probable diagnosis is:

Infection of the fracture site

The resorption of hematoma

A decleared tetanus

Infected non-union

A phlebitis

66/ If on the 4th day, the patient has a calf swelling, pain in dorsiflexion of the foot, the febrile state is 38.5 degree, what do you suspect?

The resorption of hematoma

A phlebitis

Bone infection

Ischemia of the affected limb

Compartment syndrome

67/ What is the most serious secondary compartment?

A phlebitis

Fat embolism

A secondary displacement

Algonerurodystrophy syndrome

Skin necrosis

68/ One year later, the patient presents a non-union, what is the most evocative sign?

Pain while walking

Persistence the mobility of the fracture site

Fracture site rests hot

Shortening of the fracture limb

Hypotenicity of the fracture limb

69/ What is the consequence of the malunion?

Limb shortening

Difficulty walking

Over and underlying arthrosis

The trouble with growth

Over and underlying arthritis

70/ What is the immediate general complication after the fracture?

Skin opening

Phlebitis

Displacement of fracture

Shock

Hemorrhage

#Clavicle Fracture

Patient SD age 27 years old comes to consult at hospital because of right shoulder traumatism in this morning caused by accident. The right hand is supported by the left hand and the deformation at the relief of the right clavicle.

71/ According to the clavicle anatomy, we can say that:

It articulates laterally by hmeral head

It is the superficial bone, expose to the direct blow

It forms with the 1st rib, the shoulder girdle

It has 2 faces and 3 edges

It exerts the movement of rotation

72/ The mechanism of the direct traumatism is:

Falling on the hand

Falling on the clavicle

Falling on the sholder

Falling on the elbow

Intense muscular contraction

73/ According to the location of clavicle fracture:

30% at the 1/3 middle

5% at the 1/3 middle

20% at the 1/3 middle

80% at the 1/3 middle

50% at the 1/3 middle

74/ Rx demonstrated the location of the fracture is

At the 1/3 middle

At the 1/3 medial

At the 1/3 lateral

At the 1/3 superior

At the 1/3 inferior

75/ Rx demonstrated the displacement of the fracture is:

Overlapping

Angulation

Rotation

Translation

Decalage

76/ Rx demonstrated the fracture line is

Oblique

Spiral

Transverse

Comminuted

Greenstick

77/ On the examination we found that:

Abasement of the reached sholder

Functonal importance of absolute right arm

Movement of the right hand is impossible

Sick hand supported the healthy hand

Touching the piano sign for fracture 1/3 middle

78/ We demand the radiography to clarify

Vascular complication

Reached the coracoclavicular ligament

The displacement of the fraacture

Reached the pleural dome

Nerve injury

79/ After clinical examination, we found the absence of the right radial pulsation, the hand is cold. What is the most likly diagnosis?

Shock

Nerve complication

Vascular complication underlying

Emphysema

Pleural injury

80/ After one month, the patient presented neuralgia of the upper right limb, what is the probable cause?

Malunion

Nonunion

Nerve tupture

Secondary nerve lesion with a contusion

The callus compresses the nerv

81/ If the fracture is at the internal extremity, we can find:

Dyspnea

Touching the piano sign

Pain during palpation of the acromion

Ecchymosis at the supraclavicular fossa

Swelling of the sternal extremity

#Olecranon Fractures

Mrs. ED age 39 years old was admitted to our service in this morning by an elbow trauma with swelling and the extension of the forearm is impossible. Rx demonstrated the fracture at the middle part of the olecranon?

82/ According to the olecranon anatomy, we can say that:

Olecranon is the proximal part of the radius

Formed by apophysis and the great sigmoid cavity

2 ailerons at the front

It is inserted by the biceps tendon

Effectuate the movements of pronosupination

83/ The fracture is caused by a direct mechanism:

Fall on the shoulder

Fall on the hand in extension

Fall on the elbow in flexion

Shock on the foream

Shock on the arm

84/ For the associated lesion of the olecranon fracture, which the nerve is more often reached?

Musculocutaneuos Nerve

Median Nerve

Radial Nerve

The medial cataneus nerve of the forearm

Ulnar Nerve

85/ Clinical examination, we find one sign that does not exist in the fracture?

Pain

Functional impotence

Swelling

Deformation

Without crepitation while mobilization

86/ We can differentiate with the elbow dislocation by:

The deformation

The intensity of pain

Possibility to do the fingers movements

Important ecchymosis

Vicious attitude

87/ Rx demonstrated

Fracture at 1/3 middle of the olecranon

Fracture with overlapping of the olecranon

Fracture with transverse line of the olecranon

Fracture of the olecranon process

Fracture of the base of olecranon

88/ During the accident, it presented a complication, the proposition that indicates the complication is:

Fracture with large displacement

Fracture at 1/3 middle

Internal fragment perforates the skin

External fragment displaces downwards

Fracture with oblique line

89/ 4 months later, the elbow is in position of flexion to 60 degree, it presents:

Fibrous callus

Arthrosis

Stiffness

Nerve compression

Muscular contraction

90/ In the fracture if the bone does not consolidate, the patient will lose:

Extension

Flexion

Adduction

Retropulsion

Abduction

91/ In the 2nd month, if the 4th and 5th finger presents the paresthesia, what is the most likely cause?

Rupture the tendon of 4th and 5th finger

Ulnar nerve is compressed by the callus

Radial nerve is compressed by the callus

The interosseous muscle of the 4th interphalangeal space is atrophied

The median nerve is encompassed by the callus

#Shaft Fracture of both bone Forearm

Patient was admitted to trauma service in this morning by traumatism of the left forearm caused by accident. It has a swelling at 1/3 middle of the forearm with a deformation and shortening. Rx demonstrated the fracture of both bone forearm at 1/3 middle.

92/ Shaft Fracture of both bone forearm is the fracture that the line is: in upwards at bicipital tuberosity plane and in downwards the horizontal from:

4 cm over the inferior radioulnar joint

2 cm over the inferior radioulnar joint

6 cm over the inferior radioulnar joint

8 cm over the inferior radioulnar joint

10 cm over the inferior radioulnar joint

92/ According to anatomy of both bone forearm, we can just say that:

Ulnar situates laterally by connection with radius

Radial head unites with ulnar head by annular ligament

Radial styloid and ulnar styloid situate distally at the same level

Triangular ligament fixes the 2 diaphysises, radial and ulnar

Olecranon is the proximal part of the ulnar

93/ According to the movement of prono-supination of the forearm, we can say that:

Ulnar turn around radius

Rotation axis situates in upwards between the 2 proximal extremities of the both bone

Radial head makes the movement of rotation in place

To turn, these both bone must have the same longer

The distal extremity of radius situates at the middle position in supination

94/ Rx demontrates the image of:

Shaft fracture of both bone forearm at the 1/3 middle

Fracture with a little displacement

Agulation displacement

Fracture with spiral line

Subperiosteal fracture

95/ According to the fracture line:

Oblique

Transverse

Spiral

Subperiosteal fracture

Comminuted

96/ What is the sign that caused the complication?

Ecchymosis

Shortening

Angulation

Absence the pulse

Functional impotence

97/ To confirm the diagnosis, it must:

Palpation

Measurement

Radiography

Percussion

Inspection

98/ For the good contention, the consolidation is at least:

1 month

2 months

3 months

4 months

5 months

99/ If there is a muscular interposition between the 2 fragments, it can progess to:

Muscle atrophy

Malunion

Muscular contraction

Joint stiffness

Nonunion

100/ In the 6th month, the patient returns to consult for abnormal mobilization of the forearm with a little pain and heat at the fracture site, what is your diagnostic hypothesis?

Secondary displacement

Malunion

Nonunion

Retardation of consolidation

Algoneurodystrophy syndrome

101/ For the fracture of both bone forearm in children who present on 2nd day: a tense edema, pain that does not respond to usual analgestic, cutaneous hypoesthesia, what is your diagnostic hypothesis?

Vascular rupture

Nerve compression

Muscular contusion

Compartment syndrome

Crash injury

#Acute Osteomyelitis in Adolescent

The young PS age 12 years old was admitted to the hospital in this morning by fever for 2 days accompanied with the distal pain of the left thigh, his mother told us that her son has the distal osteomyelitis of the left femur diagnosed by a doctor in countryside.

102/ Osteomyelitis is a suppurative necrotizing infection:

Muscles

Vessels

Nerves

Skeletons

Brain

103/ The most frequent responsible germ are:

Stretococcus

Pneumococcus

Staphylococcus

Gonococcus

Friedlander's bacillus

104/ What is its probable portal of entry?

Urinary infection

Pulmonary infection

Gynecological infection

Whitlow (Panaris)

Diabetic foot infection

105/ What is its preferential localization?

Iliac wing

Scapular body

The diaphysis of clavicle

The diaphysis of femur

Scaphoid

106/ The disease that probably the prediaposing cause:

Hyperthyroidism

Obesity

Diabetes

Rheumatism

Gastric ulcer

107/ In the pathophysiology of the disease, the evolution is done by:

Infection is followed by the stage of a bone destruction

Infection is followed by the stage of a bone reconstruction

Bone reconstruction is followed by the stage of suppuration

Bone reconstruction is followed by the stage of destruction

Suppuration is follwed by the stage of infection

108/ Acute osteomyelitis progesses to chronic osteomyelitis by successive relapse phenomenon that are responsible by:

Intramedullary germ persist

Intramuscular germ persist

Infected by new germ

Bone infection persists

Sequestrum persist

109/ Osteomyelitis of the distal metaphysis of the left femur, which is the classic pain at the distal extremity of the left thigh?

Anaterior pain

Posterior pain

Lateral pain

Anterior and Posterior pain

Circular pain

110/ At the state period we found:

Somnolence

Slow pulse

Patient is comatose

Knee in extension

Circular swelling

111/ Evolution to the skin opening, the patient is in the state of:

The infection get worse

Complicated to the other bone site

Improve (get better)

Viscera suppuration

Skin injury

#Proximal Humeral Fracture

112/ Proximal humeral fracture is a fracture that locates:

At the greater tuberosity

At the lesser tuberosity

Above the inferior border of the pectoralis major tendon

Above the superior border of the pectoralis major tendon

Above the inferior border of the pectoralis minor tendon

113/ The proximal humerus fracture is:

Frequent in man than woman

Frequent in children than adult

Frequent in newborn

Frequent in old people

Frequent in athletes

114/ The direct mechanism of the proximal humeral fracture is:

Fall on the shoulder stump

Fall on the elbow

Fall on the arm in adduction

Fall on the in extension

Fall on the in abduction

115/ Trans-tuberosity fracture is:

The superior fracture of anatomical neck

The superior fracture of surgical neck

Subtrochanteric fracture

Fracture of the head

Trochanteric diaphyseal fracture

116/ The base fracture of surgical neck is:

Trans-tuberosity fracture

Fracture of anatomical neck

Sub-tuberosuty fracture

The cervical-trochanteric fracture

Isolated fracture of the greater tuberosity

117/ The Neer's classification, 2 parts fractures, it is a proximal fracture of the humerus with:

Fracture into 2 fragments, no fragment displaced

Fracture into 3 fragments, 2 fragment displaced

Fracture into 4 fragments, 2 fragment displaced

Fracture into 3 fragments, 1 fragment displaced

Fracture into 4 fragments, 3 fragment displaced

118/ Scapulohumeral dislocation is differentiated from proximal humeral fracture by:

Swelling

Without ecchymosis

Deformation of the soulder

Functional Importence

Attitude of the traumatized upper limb

119/ Vicious attitude of a patient traumatized the upper limb:

Head turns to the healthy side

Shoulder of the sick side raise

The sick limb is supported by the healthy hand

Arm at the sick side side is in abducted position

Pronosupination in impossible for proximal femeral fracture

120/ Etiology of the recent traumatic dislocation in children is:

Traumatic dislocation

Fracture and dislocation

Epiphyseal separation

Displacement of vessel and muscle

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