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Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 4

25 Apr 2026 19 min read 1 Views
Orthopedic Prometric MCQs - Chapter 3 Part 4

Welcome to Chapter 3 Part 4 of our comprehensive Orthopedic Prometric Exam Simulator. This interactive test features 20 high-yield multiple-choice questions designed to help you prepare for the Saudi Prometric (SCFHS), DHA, HAAD, SLE, and OMSB orthopedic surgery exams.

Use the Study Mode to view detailed explanations instantly, or switch to Exam Mode to test your speed and accuracy under simulated testing conditions.

Prometric Exam Simulator


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Question 1

The recommended interval for changing wound vacuum assisted closure (VAC ) dressings is:





Explanation

The preferred interval for changing VAC dressings is every 2 days. Patients may have significant discomfort with initial dressing changes; however, the pain usually diminishes rapidly.

Question 2

In children with Ewingâ s sarcoma, the risk of local recurrence at the tumor site after treatment is greatest in which region:





Explanation

The risk of local recurrence is greatest for Ewings sarcomas arising in the pelvis. The prognosis is poor. Many centers attempt resection of the pelvis if there is a good response to chemotherapy.

Question 3

What is the histological difference between avascular necrosis of the femoral head in children versus adults:





Explanation

Avascular necrosis models of the femoral head in immature animals show more osteoclastic resorption, fibroblastic response, and little creeping substitution when compared to models of mature animals. Osseous collapse is common, and there are often longterm residual changes in the shape of the femoral head.

Question 4

Which of the following is a principle of the Ponseti technique for correction of a clubfoot:





Explanation

The Ponseti technique, which was developed and tested by Ignacio Ponseti, MD, involves slow, gradual correction of a clubfoot using casts, a tenotomy if necessary to release the Achilles tendon, and maintenance of correction using braces (foot abduction orthoses) for several years. The technique avoids dissection of the growing bones and joints of a childs foot because of the associated risks of stiffness and growth disturbance.

Question 5

Which of the following pulse sequences is best for showing anatomy on magnetic resonance imaging (MRI):





Explanation

T1-weighted images generally display the best anatomical detail. Fat is bright, and muscle is dark, giving excellent contrast. Cortical bone, tendons, and ligaments are low signal.

Question 6

Which of the following pulse sequences is best for imaging the pediatric growth plate:





Explanation

The gradient echo sequence involves a short relaxation and excitation time. It shows both fat and water as intermediate signals. The gradient echo sequence is excellent for imaging physeal and articular cartilage. When imaging for a physeal bar, the physician ordering the magnetic resonance imaging should specify this sequence.

Question 7

Motion artifact in magnetic resonance imaging of the pediatric spine is caused by all of the following except:





Explanation

Motion artifact affects magnetic resonance imaging of the spine and can result from patient movement (common in children under 8 years old), cardiac activity, respiration, and cerebrospinal fluid flow. Presence of a titanium rod in a childs femur, while causing a local signal void, does not affect spinal imaging.

Question 8

There are no internal moments in the lower extremity during which phase of gait:





Explanation

Preswing is the only phase of gait in which all muscle groups are silent in the ipsilateral lower extremity. In the next phase (initial swing), internal moments are generated at the hip and ankle to initiate swing.

Question 9

The protein neurofibromin normally acts in which of the following ways:





Explanation

If defective, neurofibromin is the protein that causes neurofibromatosis. Neurofibroma is coded on chromosome 17, and it acts as a tumor suppressor by downregulating Ras protein, which enhances cell growth and proliferation.

Question 10

According to National Institutes of Health (NIH) criteria, what is the minimum number of 15-mm cafa-au-lait macules required as a diagnostic criterion for neurofibromatosis in postpubertal patients:





Explanation

The NIH criteria require at least six 15-mm cafa-au-lait macules in postpubertal patients. Cafa-au-lait macules must be larger than 5 mm in prepubertal patients.

Question 11

A 7-year-old girl presents with an acute fracture of her proximal radial metaphysis. Although a line down the shaft of the radius intersects the center of the capitellum, the articular surface of the radial head is angled 20° from the anatomic position as compared with the other elbow. You recommend:





Explanation

Proximal radial fractures have excellent remodeling potential, especially if the angulation is less than 30°. Manipulation is not necessary, and the risk of stiffness from any invasive procedure is not worthwhile.

Question 12

Which of the following findings is typical in patients with Marfan syndrome as opposed to patients with Ehlers-Danlos syndrome:





Explanation

All of the findings presented, with the exception of lens dislocation, are seen in both syndromes at a frequency that exceeds the general population. Lens dislocation is common in patients with Marfan syndrome but not those with Ehlers-Danlos syndrome.

Question 13

Ehlers-Danlos syndrome is caused by a defect in which of the following:





Explanation

There are 11 subtypes of Ehlers-Danlos syndrome. Each of the subtypes is caused by defects in collagen types 1, 3, or 5, or their processing. Defects in a component of elastic microfibrils (fibrillin) are responsible for Marfan syndrome. Defects in dermatan sulfate processing cause Hurler syndrome. Defects in fibroblast growth factor cause achondroplasia. Defects in proteoglycan processing cause diastrophic dysplasia.

Question 14

A 4-year-old boy with macrodactyly of the foot has involvement of the second and third rays. He undergoes debulking of the soft tissues of the phalanges and amputation of the distal phalanges. Two years later, he returns with a dramatic increase in the width and length of the involved regions. You recommend:





Explanation

The increase in width of the involved regions can be handled only by ray resection. Additional proximal levels of amputation are not required.

Question 15

A 14-year-old girl is kicking a soccer ball when she feels a â popâ in her hip. The most likely diagnosis is:





Explanation

This is a classic description of avulsion of the anterior inferior iliac spine. When this patient hyperextended her hip and flexed her knee simultaneously to kick a ball, the rectus femoris was stretched at both joints. In a skeletally immature patient, this apophysis is not fully ossified and is vulnerable to avulsion. Treatment is symptomatic, with return to sports in about 6 weeks.

Question 16

A 3-year-old boy has a progressive anterior bow of the right tibia. He experiences intermittent aching. His physical examination is otherwise unremarkable. Radiographs reveal 25° of anterior bow of the tibia just distal to the midshaft and 20° of lateral bow. There is some narrowing of the medullary canal around the bow and thinning of the anterior cortex. You recommend which course of action:





Explanation

This patient has a congenitally dysplastic tibia. The tibia is at risk for fracture, but orthotic protection is sometimes successful in preventing fracture. Operative intervention should be reserved for fracture because there is a significant risk of nonunion or delayed union.

Question 17

An 8-year-old patient with cerebral palsy has an equinovarus foot on the right side. The varus is worse during push-off. He also holds his right upper extremity stiffly when he walks. He is developing a pressure callus on the lateral side of his foot in the region of the calcaneocuboid joint. Passively, the foot can be corrected to a neutral position of varus-valgus but lacks 12° from neutral dorsiflexion. Your recommendation is:





Explanation

An equinovarus foot is commonly found in patients with hemiplegic cerebral palsy. The varus aspect is difficult to brace. In this patient with fixed equinus, an AFO would not be a successful treatment option. A lengthening of the triceps surae would be indicated, and it could be done at the level of the Achilles tendon or by a gastrocnemius-soleus recession, depending on the clinical examination. In addition, another procedure is necessary to deal with the varus. The best way to accomplish this would be by split posterior tibial tendon transfer. This patient is too young for a triple arthrodesis, as this procedure is appropriate in patients at or near skeletal maturity with rigid deformity.

Question 18

Hip subluxation is most commonly seen in which type of cerebral palsy:





Explanation

Neuromuscular subluxation of the hips is caused by muscle imbalance over time. It is most common in patients with greatest imbalance â total body involvement. Hip subluxation is rare in patients with spastic hemiplegia.

Question 19

Which group of cerebral palsy patients is most likely to sustain a pathologic fracture:





Explanation

Pathologic fracture is most common in cerebral palsy patients with total involvement, presumably because they have little stress on the bone from either muscle tone or standing.

Question 20

Which is the most common location of pathologic fracture in patients with cerebral palsy:





Explanation

Pathologic fracture is a common problem in patients with cerebral palsy. Pathologic fracture most commonly involves the femur, especially the shaft and distal metaphysis. This should be the first diagnostic consideration in a nonambulatory patient with a warm or swollen knee.

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Dr. Mohammed Hutaif
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