Dag 3

Question 1

The tarsometatarsal joint is also referred to as:

1. Chopart’s line
2. Chartcot’s line
3. Lisfranc’s line
4. Bohler’s line
5. Midtarsal line

Answer 1

3. Lisfranc’s line

Question 2

The deep posterior compartment of the lower leg contains (it contains more, but which two muscles are also in the compartment):

1. posteroir tibial muscle and soleus muscle
2. flexor digitorum longus and flexor hallucis longus muscle
3. flexor digitorum longus and plataris muscle
4. triceps surae and plantaris muscle
5. triceps surae and posterior tibial muscle

Answer 2

2. flexor digitorum longus and flexor hallucis longus muscle

Question 3

Which nerve is sensory only?

1. medial plantaris nerve
2. deep peroneal nerve
3. suralis nerve
4. superficial peronel nerve
5. lateral plantaris nerve

Answer 3

3. suralis nerve

Question 4

In post CVA and CP a common finding is:

1. hyporeflexia
2. equinus
3. valgus deformity
4. clawtoes
5. dorsiflexion of the hallux

Answer 4

2. equinus

Question 5

A 25-year-old balletdanser has a possible fracture of her medial sesamoid. Which statement is right?

1. You need a bilateral X-ray in case of a bipartita
2. The extensor hallucis longus will be painful
3. A bone scan will be conclusive in diagnosis
4. 3/4 X-rays and an axial view are helpful
5. The patient will tiptoe into your room

Answer 5

4. 3/4 X-rays and an axial view are helpful

Question 6

A 60-year-old lady with a moderate hallux valgus complains of the bunion and pain when walking barefoot. There is no co-morbidity. Conservative treatment is not succesful. Which operation is preferred?

1. Artrodesis MTP 1
2. Hemiprothesis
3. Distal osteotomy and soft tissue release
4. TMT 1 fusion with soft tissue release
5. Akin procedure with soft tissue release

Answer 6

1. Artrodesis MTP 1

Question 7

The X-ray showed belongs to a 54-year-old woman. She complains about the bunion and has a shoeproblem. Physical examination shows a stable TMT 1 joint and a painless, full ROM of the MTP joint. What is the preferred surgical treatment?

1. Proximal osteotomy, bunionectomy and distal soft tissue release
2. Bunionectomy
3. Distal osteotomy and distal soft tissue release
4. TMT 1 fusion and distal soft tissue release
5. Bunionectomy, Akin and distal soft tissue release

Answer 7

3. Distal osteotomy and distal soft tissue release

Question 8

Which statement is the characteristc of a classic hammertoe?

1. Is is always flexible
2. Hyperextension MTP combined with flexion in PIP and DIP
3. Isolated flexion in DIP regardless flexible or rigid
4. Flexion PIP in combination with hyperextension MTP and DIP
5. Collagen loss in the ligamentum transversum

Answer 8

4. Flexion PIP in combination with hyperextension MTP and DIP

Question 9

Het percentage acute enkel distories dat geneest met RICE en functioneel behandelen is

1. 100%
2. 90%
3. 80%
4. 70%
5. 60%

Answer 9

2. 90%

Question 10

Excisie en opboren is de aanbevolen behandeling van osteochondraal laesies van de talus van

1. > 2,5 cm
2. > 2 cm
3. 1,5 cm
4. < 1 cm
5. < 0,5 cm

Answer 10

4. < 1 cm

Question 11

Een volledige loslating en verplaatsing van een osteochondritis dissecans laesie van de talus is op een rontgenfoto volgens Berndt en Harty geclassificeerd als:

1. 4
2. 3
3. 2
4. 1
5. 0

Answer 11

1. 4

Question 12

Ganglion on the foot

1. has a low recurrence rate after surgical incision
2. are mostly located on the plantar side of the foot
3. will increase and decrease in size over time
4. are seldom painfull
5. are mostly bilateral

Answer 12

3. will increase and decrease in size over time

Question 13

Foot infections are common in Rheumatoid Arthritis, which is an important risk factor for postoperative wound infections in the foot in RA.

1. the use of prednisone peri operative
2. the use of methotrexate peri operative
3. the use of biologicals peri operative
4. the use of NSAID’s peri operative
5. the use of gold injections peri operative

Answer 13

1. the use of prednisone peri operative

Question 14

Which statement is true for cellulitis?

1. temperature is typically between 38 and 38.5
2. coagulase negative staphylococci are the most important pathogens
3. cellulitis after a puncture are potential infected with pseudomonas
4. can be treated with flucloxacilin
5. white blood cell count is elevated

Answer 14

3. cellulitis after a puncture are potential infected with pseudomonas

Question 15

Giant cell tumour of the tendon sheath is

1. mostly very painfull
2. is a highly malignant tumor
3. should be radically resected
4. has a high recurrence rate
5. only located in the foot

Answer 15

4. has a high recurrence rate

Question 16

Which of the following items is not a characteristic of the neuropathic diabetic foot?

1. Callus at pressure points
2. Palpable peripheral pulses
3. Normal temperature or warm
4. Painful ulcera
5. High ankle- brachial Index

Answer 16

4. Painful ulcera

Question 17

This X-ray is taken after 5 months of treatment of a Charcot foot. Which statement is not true.

1. It’s a Brodsky type 2 Charcot foot
2. High dose Biphosphanates can influence the stability
3. Total Contact Casting was a good treatment in the acute phase
4. In time: the medial column needs stabilisation
5. After surgery a prolonged period of protected weightbearing is important

Answer 17

2. High dose Biphosphanates can influence the stability

Question 18

Which of the following bone bruise patterns seen on MRI is most consistent with an anterior cruciate ligament (anterior cruciate ligament) tear?

1. Medial tibial spine and medial femoral condyle
2. Medial facet of patella and lateral femoral condyle
3. Posterolateral tibia and lateral femoral condyle
4. Posterolateral tibia and medial femoral condyle
5. Medial tibial spine and lateral femoral condyle

Answer 18

3. Posterolateral tibia and lateral femoral condyle

Question 19

When comparing autologous graft options for anterior cruciate ligament reconstruction, a hamstring graft is associated with which of the following findings whem compared to a patellar tendon graft?

1. Decreased tunnel widening
2. Decreased pivot shift
3. Decreased incidence of anterior knee pain
4. Incresed knee flexion strength on isokinectic testing
5. Increased stability on KT-1000

Answer 19

3. Decreased incidence of anterior knee pain

Question 20

At what angle of knee flexion should the graft be tensioned at during posterior cruciate ligament reconstruction with a single bundle graft?

1. 5 degrees hyperextension
2. 0 degrees flexion
3. 15 degrees flexion
4. 30 degrees flexion
5. 90 degrees flexion

Answer 20

5. 90 degrees flexion

Question 21

A football player sustains an isolated posterior cruciate ligament tear. Which of the following mechanisms is most likely to have caused this injury?

1. Fall on the flexed knee with the foot in plantarflexion
2. Fall on the flexed knee with the foot in dorsiflexion
3. Non-contact twist causing knee external rotation and valgus
4. Non-contact twist causing knee internal rotation and varus
5. Direct contact blow tot the posterior knee

Answer 21

1. Fall on the flexed knee with the foot in plantarflexion

Question 22

The most important function of the meniscus is:

1. Providing stability and limits flexion/extension extremes
2. Load-sharing across the knee joint
3. Increase in articulas congruity
4. Shock absorption
5. Aid in lubrication

Answer 22

2. Load-sharing across the knee joint

Question 23

Clinical success rates for all types of meniscal repair techniques in stable knees range from

1. 40%-50%
2. 40%-55%
3. 55%-65%
4. 55%-70%
5. 70%-95%

Answer 23

5. 70%-95%

Question 24

Not all meniscal tears cause symptoms; tear types that are commonly treated surgical are:

1. Stable longitudinal tears <10 mm in length
2. Degenerative tears associated with significant osteoarthritis
3. Short (<3 mm in length) radial tears
4. Flap tears
5. Stable partial tears

Answer 24

4. Flap tears

Question 25

Meniscal transplantation has been reserved for specific patients. Which of the items is not a contraindication for meniscal transplantation 1. uncorrected lower extremity malalignment 2. uncorrected ligamentous instability 3. significant chondral changes in the treated compartment 4. no pain after total meniscectomy 5. symptomatic patient after partial or total meniscectomy

Answer 25

5. symptomatic patient after partial or total meniscectomy

Question 26

A female elite marathon runner (age 27, height 168 cm and bodyweight 47 kg) presents with progessive pain in her left mid foot. She has continued to run. On physical examination there is a slight swelling and an area of 1 cm wth tenderness on palpation in the 4th metatarsal bone. The X-ray shows a stress fracture of the 4th metatarsal bone. What should no be forgotten in the management of this problem? 1. Ask whether she is a barefoot runner 2. An MRI investigation to increase the likelihood of the diagnosis 3. Check for amenorrhea, disordered eating and osteoporosis 4. Surgical fixation tot guarantee bone healing 5. Provide Low Intensity Pulsed Ultrasound (LIPUS) for quich return to sport

Answer 26

3. Check for amenorrhea, disordered eating and osteoporosis

Question 27

A soccer player presents with pain over the anterolateral region of both his lower legs. He reports no trauma. Pain starts and increases when he is running but readily disappears when he stops running. There is no pain at rest and physical examination shows no abnormalities. What is the most likely diagnosis and preferred most succesful treatment? 1. Skin-splints - insoles to correct foot position 2. Medial tibia stress syndrome - activity modification and shockwave therapy 3. Exertional anterior compartment syndrome - deep transverse frictions 4. Exertional anterior compartment syndrome - fasciotomy of anterior compartment 5. Exertional deep compartment syndrome - fasciotomy of the deep compartement

Answer 27

4. Exertional anterior compartment syndrome - fasciotomy of anterior compartment

Question 28

A 19 year old volleyball player presents with anterior knee pain in the proximal part of his patellar tendon. Pre-season training has just started a few weeks ago. No trauma. He had no knee problems before. On physical examination there is tenderness over the patellar apex. Knee loading exercises provoke pain. It seems he is suffering from a "jumpers's knee". How would you describe this stage of his tendon problem? 1. Reactive tendinopathy 2. Tendon disrepair 3. Tendon degeneraton 4. Peritendnitis 5. Tendinosis

Answer 28

1. Reactive tendinopathy

Question 29

For which of the following interventions does strong evidence exist that it is effective in the treatment of patellar tendinopathy? 1. Immobilization and complete rest 2. Eccentric training 3. Intratendinous platelet-rich-plasma injections 4. Shackwave therapy 5. None of the aformentioned interventions

Answer 29

5. None of the aformentioned interventions

Question 30

Subchondral bone and cartilage have a combined function which is illustrated by 1. The role of subchondral bone in vascularization of cartilage 2. The subchondral sclerosis that causes cartilage damage to occur 3. Clear responsiveness of bone to cartilage damage and detrimental role in repair if bone dirturbed 4. Cystic defects in OCD 5. Formation of intra lesional osteofytes

Answer 30

3. Clear responsiveness of bone to cartilage damage and detrimental role in repair if bone dirturbed

Question 31

For a 3 cm² symptomatic condylar defect in a 25 year old male cyclist with no other joint pathology the treatement of choice is 1. Autologous Chondrocyte Implantation 2. Microfracture (reserving ACI for case of insufficient effect of initial treatement) 3. Debridement of instable cartilage rim and loose body removal 4. OATS/Mozaik 5. BioCartilage Implantation

Answer 31

1. Autologous Chondrocyte Implantation

Question 32

Articular cartilage damage is most frequently diagnosed 1. Based on history of effusion and locking 2. During arthroscopy as additional finding in suspected meniscal damage 3. Using T1rho and T2 Mapping 4. On sensitive x ray (mammo setting) evaluation 5. More than 3 years after blunt trauma injury

Answer 32

2. During arthroscopy as additional finding in suspected meniscal damage

Question 33

The etiology of Osteochondritis Dissecans is: 1. Unknown 2. Inflammation 3. Genetic 4. Ischeamia 5. Ossification deficit

Answer 33

1. Unknown