CCOC Dag 3

Question 0

2. “What goes up must come down” refers to

A. Newton's first law of motion
B. Newton's second law of motion
C. Newton's third law of motion
D. All of the above 1-3
E. None of the above 1-3

Answer 0

2. “What goes up must come down” refers to

E. None of the above 1-3

Question 1

1. Observe the situation and free-body-diagrams presented in the figure. What’s true with any value for weight W0?

A. F muscle is always greater than F joint
B. F muscle is always smaller than F joint
C. F muscle can be greater or smaller than F joint depending on the magnitude of W0
D. F muscle can be greater or smaller than F joint depending on the flexion angle of the elbow
E. None of the above

Answer 1

1. Observe the situation and free-body-diagrams presented in the figure. What’s true with any value for weight W0?

A. F muscle is always greater than F joint

Question 2

3. During the normal level walking , the magnitude of the maximal joint force in the hip is

A. About half time body weight
B. About one time body weight
C. About two times body weight 
D. About three times body weight
E. About four times body weight

Answer 2

During the normal level walking , the magnitude of the maximal joint force in the hip is

D. About three times body weight

Question 3

4. What’s true for this figure ?

A. It depicts a free body diagram of the leg
B. It depicts a free diagram of the whole body minus the right leg
C. It depicts the force balance on the femoral head
D. It depicts the force balance on the acetabulum
E. None of the above

Answer 3

4. What’s true for this figure ?

E. None of the above

Question 4

5. Casting, forging and extrusion are well known methods for fabricatin of orthopedic implants. Selective laser sintering is a relative new technique to produce orthopedic implants. Rapid prototyping technologies are getting more interesting for the following reasons :

A. They are cheap
B. It is easier to make patient specific implants
C. A lesser amount of wear particles are generated form implants produced by rapid prototyping such as laser sintering
D. Implants produced by rapid prototyping are stronger
E. None of the above statements

Answer 4

5. Casting, forging and extrusion are well known methods for fabricatin of orthopedic implants. Selective laser sintering is a relative new technique to produce orthopedic implants. Rapid prototyping technologies are getting more interesting for the following reasons :

B. It is easier to make patient specific implants

Question 5

6. Biomaterials can be classified as based on their biocompatibility. Most Biomaterials are inert. This means that they do not elicit an adverse tissue reaction. Interactive Biomaterials are designed to elicit a specific beneficial response from the host in which they are implanted. A new class of Biomaterials is called biomimetic Biomaterials. Which statement is TRUE?

A. Biomimetic and interactive Biomaterials are a similar class of Biomaterials
B. Porous trabecular metal is a biomimetic material
C. Trabecular metal is a biomimetic biomaterial
D. Biomimetic and interactive Biomaterials are non-resorbable
E. Biomimetic Biomaterials can be considered as instructive Biomaterials

Answer 5

6. Biomaterials can be classified as based on their biocompatibility. Most Biomaterials are inert. This means that they do not elicit an adverse tissue reaction. Interactive Biomaterials are designed to elicit a specific beneficial response from the host in which they are implanted. A new class of Biomaterials is called biomimetic Biomaterials. Which statement is TRUE?

E. Biomimetic Biomaterials can be considered as instructive Biomaterials

Question 6

7. A polymers meniscus implant consisting of copolymer of caprolactone and polyactide is inserted in a patient as a pastoral replacement after a partial meniscectomy. The copolymer is probably degraded by hydrolysis of the ester bond between the caprolactone and polyactide. What will be the chemical and biomechanical condition of the polymer after 2 years?

A. Totally resorbed, no biomechanical properties left
B. Partly resorbed and retained some of its biomechanical properties
C. Not resorbed at all and retained all of its biomechanical properties
D. Not resorbed totally but lost all of its biomechanical properties
E. None of the above mentioned options

Answer 6

7. A polymers meniscus implant consisting of copolymer of caprolactone and polyactide is inserted in a patient as a pastoral replacement after a partial meniscectomy. The copolymer is probably degraded by hydrolysis of the ester bond between the caprolactone and polyactide. What will be the chemical and biomechanical condition of the polymer after 2 years?

D. Not resorbed totally but lost all of its biomechanical properties

Question 7

8. Wear rates is an important determinant of the success rate if an orthopedic implant. New implant designs are tested on simulators on which a number of representive gait cycles are performed. Ceramic bearings are popular due the low wear rates. Which of the following statements is correct?

A. Wear relates in wear simulators is always a reliable predictor of in vivo wear rates
B. The wear rate of zirconia on polyethylene is lower than the wear rate of alumina against polyethylene
C. Wear particles of alimunia are in the micro range and in the nano range
D. Revisions of failed ceramic head leads to similar clinical outcome compared to the incidence of revisions for others reasons
E. Microseparation is no concern the use of ceramic heads

Answer 7

8. Wear rates is an important determinant of the success rate if an orthopedic implant. New implant designs are tested on simulators on which a number of representive gait cycles are performed. Ceramic bearings are popular due the low wear rates. Which of the following statements is correct?

C. Wear particles of alimunia are in the micro range and in the nano range

Question 8

9. Growth: during endochondral ossification in the developmental process chondrocytes proliferate and thereby realize longitudal growth. Which of the following statements is TRUE?

A. In endochondral ossification all chondrocytes die (terminal differentiation)
B. In endochondral ossification the chondrocytes stay alive and differentiate into osteoblasts
C. In endochondral ossification stay alive until they are resorbed by osteoclasts
D. In endochondral ossification most chondrocytes die except the ones at the edge that become part of the hyaline cartilage of the joint
E. In endochondral ossification chondrocytes different outta into osteocytes and become part of the bone matrix

Answer 8

9. Growth: during endochondral ossification in the developmental process chondrocytes proliferate and thereby realize longitudal growth. Which of the following statements is TRUE?

D. In endochondral ossification most chondrocytes die except the ones at the edge that become part of the hyaline cartilage of the joint

Question 9

10. Fracture healing: which of the following statements is FALSE?

A. Inflammation during the early phase of fracture healing prevents proper healing
B. Motion induces endochondral bone formation
C. Distraction osteogenesis is an example of fracture healing with intramembranous bone formation
D. A stable fracture site helps to form osteoid
E. Cells in the fracture hematoma produce collagen that stabilizes the fracture

Answer 9

10. Fracture healing: which of the following statements is FALSE?

A. Inflammation during the early phase of fracture healing prevents proper healing

Question 10

11. Fracture healing : after how many hours the first sign of calcification can be expected in endochondral fracture healing?

A. 1 day
B. 2 days
C. 4 days
D. 8 days
E. 20 days

Answer 10

11. Fracture healing : after how many hours the first sign of calcification can be expected in endochondral fracture healing?

D. 8 days

Question 11

12. Bone signaling - sclerostin.
    Which of the following statements is FALSE?

A. Sclerostin is a paracrine factor made by osteocytes
B. Sclerostin inhibits osteoblasts activity
C. Sclerostin blocks osteoclast activity
D. Too much sclerostin leads to sclerosteosis
E. Sclerostin defets leads to sclerosteosis

Answer 11

12. Bone signaling - sclerostin.
    Which of the following statements is FALSE?

D. Too much sclerostin leads to sclerosteosis

Question 12

13. Osteocyte biology
    Osteocytes are part of a network connected by:

A. Haversion canals
B. Canaliculi
C. Lining cells
D. Blood vessels
E. Howship lacunae

Answer 12

13. Osteocyte biology
    Osteocytes are part of a network connected by:

B. Canaliculi

Question 13

14. PTH is involved in calcium metabolism and increases upon a low calcium level. Which of the following statements is FALSE?

A. PTH levels rise during fracture healing
B. High PTH levels stimulate bone remodeling
C. PTH can also be used as a medication for osteoporosis
D. PTH has a stimulating effect on osteoblast
E. PTH has a stimulating effect on osteoclast

Answer 13

14. PTH is involved in calcium metabolism and increases upon a low calcium level. Which of the following statements is FALSE?

A. PTH levels rise during fracture healing

Question 14

15. The tidemark in healthy articular cartilage is the transition of:

A. Superficial zone with the joint space
B. Superficial zone with the middle zone
C. Middle zone with the deep zone
D. Calcified cartilage with the non-calcified cartilage
E. Sub honorable bone with the calcified zone

Answer 14

15. The tidemark in healthy articular cartilage is the transition of:

D. Calcified cartilage with the non-calcified cartilage

Question 15

16. Which of the factors enlisted below are not increased in osteoarthritis ?

A. Metalloproteinases (MMP's)
B. Cathepsin B
C. Cathepsin D
D. Keratan sulfate
E. Nitric oxide synthase

Answer 15

16. Which of the factors enlisted below are not increased in osteoarthritis ?

D. Keratan sulfate

Question 16

17. Which of the processes enlisted below is not applicable during the normal aging process of healthy articular cartilage?

A. Chondrocytes become larger
B. The amount of water in the cartilage decreases
C. Cartilage becomes hypocellular compared to immature cartilage
D. Cartilage becomes stiffer
E. The mass and size of the proteoglycans increases

Answer 16

17. Which of the processes enlisted below is not applicable during the normal aging process of healthy articular cartilage?

E. The mass and size of the proteoglycans increases

Question 17

18. Synovial fluid of healthy articular cartilage contains?

A. Red blood cells
B. Hemoglobulin
C. Clotting factors
D. Hyaluronic acid
E. Blood plates

Answer 17

18. Synovial fluid of healthy articular cartilage contains?

D. Hyaluronic acid

Question 18

19. Which of the following statements is correct?

A. Paget disease, Diabetes mellitus and Ochronosis are causes of secondary osteoarthritis.
B. Paget disease, Diabetes mellitus and Ochronosis are no causes of secondary osteoarthritis.
C. Paget disease is a cause of secondary osteoarthritis ; Diabetes mellitus and Ochronosis are not
D. Diabetes mellitus is a cause of secondary osteoarthritis ; paget disease and Ochronosis are not
E. Ochronosis is a cause of secondary osteoarthritis ; paget disease and DM are not

Answer 18

19. Which of the following statements is correct?

A. Paget disease, Diabetes mellitus and Ochronosis are causes of secondary osteoarthritis.

Question 19

20. Opening versus closing wedge valgus HTO:
    I: decreasing the tibial slope is more common after opening wedge compared with the closing wedge HTO
    II: patella Baja is more common after closing wedge compared with the opening wedge HTO
    III: size of the wedge depends on the width of the tibia

A. All statements are correct
B. All statements are wrong
C. Only statement I is correct
D. Only statement II is correct
E. Only statement III is correct

Answer 19

20. Opening versus closing wedge valgus HTO:
    I: decreasing the tibial slope is more common after opening wedge compared with the closing wedge HTO
    II: patella Baja is more common after closing wedge compared with the opening wedge HTO
    III: size of the wedge depends on the width of the tibia

E. Only statement III is correct

Question 20

21. Factors influencing long term results of a HTO in patients with varus OA:
    I: gender
    II: preoperative alignment
    III: postoperative alignment

A. All above factors influence long term results
B. None of the above factors influence long term results
C. Only factor I influences long term results
D. Only factor II influences long term results
E. Only factor III influences long term results

Answer 20

21. Factors influencing long term results of a HTO in patients with varus OA:
    I: gender
    II: preoperative alignment
    III: postoperative alignment

A. All above factors influence long term results

Question 21

22. Which of the following statements are correct?

A. Acupuncture, glucosamine and tramadol can be recommended for the treatment of symptomatic knee OA
B. Acupuncture can be recommended for the treatment of symptomatic knee OA; glucosamine and tramadol can not
C. Glucosamine can be recommended for the treatment of symptomatic knee OA; acupuncture and tramadol not
D. Tramadol can be recommended for the treatment of symptomatic knee OA; acupuncture and glucosamine not
E. Acupuncture, glucosamine and tramadol cannot be recommended for the treatment of symptomatic knee OA

Answer 21

22. Which of the following statements are correct?

D. Tramadol can be recommended for the treatment of symptomatic knee OA; acupuncture and glucosamine not

Question 22

23. Balancing the TKA
    During the trial reduction you find a knee loose in extension and stable in flexion, medial and lateral well balanced. What kind of solution will you choose?

A. Change the tibial insert
B. Choose for a smaller femoral component
C. Choose for a posterior stabilized implant
D. Accept the situation , physiotherapy will help
E. Change the tibial insert for a thinks one in combination with a smaller femoral component

Answer 22

23. Balancing the TKA
    During the trial reduction you find a knee loose in extension and stable in flexion, medial and lateral well balanced. What kind of solution will you choose?

E. Change the tibial insert for a thinks one in combination with a smaller femoral component

Question 23

24. Balancing the TKA
    During trial reduction you find the knee tight in extension (10 degrees extension leg) and stable in flexion. Medial/lateral well balanced. What kind of solution will you choose?

A. Recut the distal femur with more distal femoral resection
B. Choose a thinner tibial insert
C. Choose for a smaller femoral component
D. Give the tibial baseplate more posterior slope
E. Choose for a thicker tibial insert

Answer 23

24. Balancing the TKA
    During trial reduction you find the knee tight in extension (10 degrees extension leg) and stable in flexion. Medial/lateral well balanced. What kind of solution will you choose?

A. Recut the distal femur with more distal femoral resection

Question 24

25. You consider to do a UKA. Which answer is NOT a contraindication for a UKA? A. Rupture of the ACL B. Flexion 15 degrees

Answer 24

25. You consider to do a UKA. Which answer is NOT a contraindication for a UKA? D. Isolated lateral arthrosis

Question 25

26. Primary TKA Which item is the MOST important predictor of the post operative ROM? ``` A. Use of a patella prosthesis B. Use of a mobile bearing knee prosthesis C. Use of a high flexion knee design D. Pre-operative ROM E. Use of a CR knee prosthesis ```

Answer 25

26. Primary TKA Which item is the MOST important predictor of the post operative ROM? D. Pre-operative ROM

Question 26

27. In a lecture concerning revision arthroplasty of the knee you make the following statements. Which one is NOT true? A. Use a hinged prosthesis in case of an active extension lag B. In case of an insufficient posterior cruciate ligament choose a posterior stabilized design C. Go for more constrained design if the collaterals are weak D. A painful knee sec is not a reason to revise E. You probably have to use a postero lateral wedge on the femur if the femoral component was endorotated

Answer 26

27. In a lecture concerning revision arthroplasty of the knee you make the following statements. Which one is NOT true? A. Use a hinged prosthesis in case of an active extension lag

Question 27

28. During a revision you ran into trouble concerning flexion and extension gap mismatch. The flexion gap is too large. You want to put in a PS prosthesis in a young active 56 year old patient. What's a possible solution ? A. Put in total wedge under the tibial component to close the flexion gap B. Put more slope in your tibial component C. Use a larger femoral component in combination with posterior wedges D. Go for a thicker insert E. Do a reefplasty of the medial collateral band in flexion to stabilize the flexion gap

Answer 27

28. During a revision you ran into trouble concerning flexion and extension gap mismatch. The flexion gap is too large. You want to put in a PS prosthesis in a young active 56 year old patient. What's a possible solution ? C. Use a larger femoral component in combination with posterior wedges

Question 28

29. Which factors do not increase the risk at arthro fibrosis ? ``` A. A pre-operative restricted knee function B. A history of multiple knee operations C. A large post op heamatoma D. Pre-existent patella Baja E. Depressive women with red hair ```

Answer 28

29. Which factors do not increase the risk at arthro fibrosis ? E. Depressive women with red hair

Question 29

Case: a 68 year old female patient presents to you in your outpatient clinic because of pain in the right groin after an admission for S aureus bacteremia 2weeks ago on the infectious diseases-ward. Past medical history reveals diabetes, RA, AF and revision THA 6 years ago. You consider a prosthetic joint infection (PJI). 30. In case of PJI pain is one of the presenting symptoms in: ``` A. 45-55% B. 55-65% C. 65-75% D. 75-85% E. 85-95% ```

Answer 29

30. In case of PJI pain is one of the presenting symptoms in: E. 85-95%

Question 30

31. Which of the mentioned factors is NOT a risk for PJI? ``` A. Age of >65 years B. Diabetes C. RA D. Atrial fibrillation with anticoagulation E. Revision THA ```

Answer 30

31. Which of the mentioned factors is NOT a risk for PJI? A. Age of >65 years

Question 31

32. Assuming there is a PJI, how would you classify this infection ? ``` A. Early, per continuitum B. Early, RA induced C. Late, per continuitum D. Late, hematogenously E. Late, RA induced ```

Answer 31

32. Assuming there is a PJI, how would you classify this infection ? D. Late, hematogenously

Question 32

33. Which lab test(s) is (are) contributory in making the diagnosis PJI? ``` A. INR B. CRP + ESR C. Interleukin 2 D. White bloodcell count E. LDH +CK ```

Answer 32

33. Which lab test(s) is (are) contributory in making the diagnosis PJI? B. CRP + ESR

Question 33

34. Perisprosthetic acetabular fractures: which one is not a risk factor? ``` A. Elliptical monoblock components B. Cemented acetabular components C. Paget's disease D. Underreaming by more than 2 mm E. Osteopenia or osteoporosis ```

Answer 33

34. Perisprosthetic acetabular fractures: which one is not a risk factor? B. Cemented acetabular components

Question 34

35. You have a patient with a type I fracture of the distal femur, with on the same side a TKA, seems to be a model "x 27". You consider retrograde nailing. What's the first step to know whether it's possible? A. "x 27" is just made for retrograde nailing, as I read in the brochure B. I make additional x rays to be sure that we are dealing with an open box C. Ask the manufacturer of "x 27" if nailing is possible D. Ask the manufacturer of the nail whether it fits with "x 27" E. Try to get the old medical record

Answer 34

35. You have a patient with a type I fracture of the distal femur, with on the same side a TKA, seems to be a model "x 27". You consider retrograde nailing. What's the first step to know whether it's possible? E. Try to get the old medical record

Question 35

36. What's a major pitfall in diagnosing periprosthetic fracture by plane radiograph? A. There may be increased uptake up ton2 years after surgery in the absence of a fracture B. Judet views are difficult to obtain C. Underestimating bone loss D. Late fractures are difficult to detect E. The Vancouver classification is based on CT

Answer 35

36. What's a major pitfall in diagnosing periprosthetic fracture by plane radiograph? C. Underestimating bone loss

Question 36

37. Risk factors for patella fracture after TKA: which is not true? ``` A. Resurfaced patella B. Cement less fixation C. Metal backing D. Three-peg component E. Inset patellar component ```

Answer 36

37. Risk factors for patella fracture after TKA: which is not true? D. Three-peg component