FMGE Orthopedics questions with answers

1. Q1. A pedestrian struck by a car sustains fractures of the tibia and fibula at the same level, at the height of the vehicle's bumper. What is the eponym for this injury pattern?

   • A. Pilon fracture
   • B. Maisonneuve fracture
   • C. Bumper fracture
   • D. Toddler's fracture

   Answer: C. Bumper fracture

1. Q1. After a dashboard injury the hip lies fixed in flexion, adduction and internal rotation, and both internal and external rotation are blocked and painful. What has happened?

   • A. Anterior dislocation of the hip
   • B. Intracapsular fracture of the femoral neck
   • C. Posterior dislocation of the hip
   • D. Fracture of the pubic ramus

   Answer: C. Posterior dislocation of the hip

1. Q1. An older woman falls onto an outstretched hand and the wrist shows a dorsal prominence with fullness on the volar side. Which displacement of the distal radial fragment produces this appearance?

   • A. Volar displacement with ulnar deviation
   • B. Dorsal displacement of the distal ulna alone
   • C. Dorsal displacement with radial shortening and supination
   • D. Volar angulation with lengthening of the radius

   Answer: C. Dorsal displacement with radial shortening and supination

1. Q1. A young man falls on an outstretched hand and is tender in the anatomical snuffbox, but initial radiographs appear normal. Why must he still be immobilised and re-imaged?

   • A. A scaphoid fracture may be radiographically occult, and its retrograde blood supply risks avascular necrosis of the proximal pole
   • B. A Colles fracture is often missed on a single view
   • C. A lunate dislocation is only visible on stress views
   • D. A hook of hamate fracture needs a carpal tunnel view

   Answer: A. A scaphoid fracture may be radiographically occult, and its retrograde blood supply risks avascular necrosis of the proximal pole

2. Q2. A young man with ulcerative colitis has six months of low back pain and morning stiffness lasting an hour that improves with exercise. Radiographs show bilateral sacroiliitis. What is the diagnosis, and which HLA is associated?

   • A. Rheumatoid arthritis, associated with HLA-DR4
   • B. Psoriatic arthritis, associated with HLA-Cw6
   • C. Ankylosing spondylitis, associated with HLA-B27
   • D. Tuberculous spondylitis, with no HLA association

   Answer: C. Ankylosing spondylitis, associated with HLA-B27

1. Q1. A posterior hip dislocation is reduced. Which nerve must be examined before and after reduction, and what deficit would it produce?

   • A. The femoral nerve, causing loss of knee extension
   • B. The obturator nerve, causing loss of hip adduction
   • C. The sciatic nerve, causing foot drop and loss of sensation below the knee laterally
   • D. The superior gluteal nerve, causing a Trendelenburg gait

   Answer: C. The sciatic nerve, causing foot drop and loss of sensation below the knee laterally

2. Q2. A 9-year-old has six months of gradually worsening hip pain and a limp, with limited abduction and internal rotation, but is otherwise well with normal growth. Radiographs show a small, sclerotic, fragmented femoral capital epiphysis. What is the diagnosis?

   • A. Developmental dysplasia of the hip
   • B. Slipped capital femoral epiphysis
   • C. Septic arthritis of the hip
   • D. Legg-Calve-Perthes disease

   Answer: D. Legg-Calve-Perthes disease

1. Q1. Which spinal orthosis provides three-point fixation to limit flexion of the thoracolumbar spine and is used after a stable compression fracture?

   • A. Milwaukee brace
   • B. Boston brace
   • C. Halo vest
   • D. Taylor brace

   Answer: D. Taylor brace

2. Q2. After a road accident a man's leg lies in flexion, abduction and external rotation, and appears lengthened. Which injury is this, and how does its posture differ from the commoner variety?

   • A. Anterior hip dislocation, whereas the commoner posterior dislocation lies flexed, adducted and internally rotated with shortening
   • B. Posterior hip dislocation, whereas anterior dislocation is shortened
   • C. Intertrochanteric fracture, which shortens and externally rotates
   • D. Femoral neck fracture, which shortens and internally rotates

   Answer: A. Anterior hip dislocation, whereas the commoner posterior dislocation lies flexed, adducted and internally rotated with shortening

1. Q1. A man in a plaster cast for a tibial fracture has escalating pain worsened by passive stretch of the toes, with tense swelling. What is the diagnosis, and what is the definitive treatment?

   • A. Deep vein thrombosis, treated with anticoagulation
   • B. Compartment syndrome, treated by urgent fasciotomy
   • C. Cast pressure sore, treated by windowing the cast
   • D. Arterial injury, treated by embolectomy

   Answer: B. Compartment syndrome, treated by urgent fasciotomy

2. Q2. A child with chronic osteomyelitis passes a fragment of dead bone through a discharging sinus. What is this fragment called, and what is the sleeve of new bone around it called?

   • A. Involucrum, surrounded by a sequestrum
   • B. A cloaca, surrounded by periosteum
   • C. A Brodie abscess, surrounded by sclerosis
   • D. A sequestrum, surrounded by an involucrum

   Answer: D. A sequestrum, surrounded by an involucrum

1. Q1. A teenager has knee pain and a radiograph shows an aggressive metaphyseal lesion with periosteal elevation forming a Codman triangle and a sunburst pattern. What is the diagnosis?

   • A. Ewing sarcoma
   • B. Osteoid osteoma
   • C. Osteosarcoma
   • D. Giant cell tumour

   Answer: C. Osteosarcoma

2. Q2. A woman treated in a cast for a Colles fracture develops numbness of the thumb, index and middle fingers with weak thumb abduction. Which complication has occurred?

   • A. Ulnar nerve compression at Guyon's canal
   • B. Median nerve compression in the carpal tunnel
   • C. Radial nerve palsy from the cast
   • D. Extensor pollicis longus rupture

   Answer: B. Median nerve compression in the carpal tunnel

1. Q1. A 6-year-old has elbow pain and swelling after a fall, and the radiograph appears normal apart from a raised posterior fat pad. What does this indicate?

   • A. A normal variant needing no treatment
   • B. An occult supracondylar fracture with a haemarthrosis, which should be splinted and re-imaged
   • C. A dislocated elbow requiring reduction
   • D. A pulled elbow requiring supination manoeuvre

   Answer: B. An occult supracondylar fracture with a haemarthrosis, which should be splinted and re-imaged

2. Q2. A man has mild weakness with a normal alkaline phosphatase, raised calcium, raised phosphate and a normal parathyroid hormone. What is the most likely cause?

   • A. Primary hyperparathyroidism
   • B. Osteomalacia
   • C. Vitamin D toxicity, which raises both calcium and phosphate while suppressing PTH into the normal or low range
   • D. Osteoporosis

   Answer: C. Vitamin D toxicity, which raises both calcium and phosphate while suppressing PTH into the normal or low range

1. Q1. A woman has bony swelling of the distal and proximal interphalangeal joints with sparing of the metacarpophalangeal joints and wrists. Which arthritis, and what are the nodes called?

   • A. Rheumatoid arthritis, with Bouchard nodes
   • B. Psoriatic arthritis, with dactylitis
   • C. Gout, with tophi
   • D. Osteoarthritis, with Heberden nodes at the DIP and Bouchard nodes at the PIP

   Answer: D. Osteoarthritis, with Heberden nodes at the DIP and Bouchard nodes at the PIP

2. Q2. A tennis player repeatedly dislocates his shoulder and can reduce it himself each time. What is this, and what lesion usually underlies it?

   • A. An acute first-time dislocation, with a rotator cuff tear
   • B. Recurrent anterior dislocation, usually with a Bankart lesion of the anteroinferior labrum
   • C. Inferior dislocation, with axillary nerve injury
   • D. A fracture of the upper humerus

   Answer: B. Recurrent anterior dislocation, usually with a Bankart lesion of the anteroinferior labrum

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.