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
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
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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