August 2008--orthopaedics.

CPD questionnaires must be completed online via www.cpdjournals.org.za. After submission you can check the answers and print your certificate. Questions may be answered up to 6 months after publication of each issue.

MANAGEMENT OF OSTEOARTHRITIS OF THE HIP AND KNEE

1. Which one of the following is NOT a radiological sign of osteoarthritis:

A. Peri-articular cysts

B. Subchondral sclerosis

C. Focal narrowing of the joint line

D. Osteopenia

E. Osteophytes.

2. Core treatment involves (choose one):

A. Non-steroidal anti-inflammatory drugs, education, weight loss

B. Education, weight loss and physical therapy

C. Orthotics, weight loss and opioids

D. Topical non-steroidal anti-inflammatory drugs, opioids and acupuncture

E. Paracetamol, viscosupplementation and dietary supplements.

3. True (A) or false (B)--fill in only block A or B: Hip pathology usually presents with buttock pain. THE INJURED KNEE

4. True (A) or false (B)--fill in only block A or B: In all cases of a dislocated knee arteriography is performed.

5. True (A) or false (B)--fill in only block A or B: The patella usually dislocates laterally.

6. True (A) or false (B)--fill in only block A or B: A pop or snap at the time of the injury usually signifies an ACL tear while a crunch or tearing sensation may mean a meniscal, ligamentous or articular injury.

AN APPROACH TO LOW BACK PAIN

7. With regard to back pain, which one of the following is NOT true:

A. A specific diagnosis is only possible in a minority of patients with acute lumbar pain

B. An MRI should be performed in all suspected acute disc herniations

C. The majority of acute disc herniations heal on conservative treatment

D. The only indications for emergency disc surgery are a cauda equina syndrome and severe or progressive neurological deficit

E. Surgery does not improve the 2-year outcome of acute disc herniation.

8. With regard to back pain, which one of the following is NOT true:

A. A pathological pain pattern suggests serious underlying pathology, e.g. tumour, infection, fracture

B. Pain referred from the back does not extend below the knee

C. Mechanical pain responds poorly to analgesics and is worst at night

D. The straight leg-raising test examines the sciatic nerve for nonspecific nerve root irritation

E. Radicular (root) pain is accompanied by neurological symptoms and/or signs and usually extends below the knee.

9. Which one of the following is NOT a 'red flag' indication for immediate further investigation of back pain:

A. Continuous pain for more than 6 weeks

B. Complaint of numb sensation foot with normal reflexes and power

C. History of previous malignancy and trauma

D. Spinal deformity

E. History of rigors and weight loss.

DEFORMITIES OF THE LOWER LIMB IN THE GROWING CHILD

10. True (A) or false (B)--fill in only block A or B: Deformities of angular alignment are most commonly seen around the knee.

11. True (A) or false (B)--fill in only block A or B: Rotational malalignment may occur at the hip or tibia: it is rare to have rotational malalignment at other levels.

12. True (A) or false (B)--fill in only block A or B: Physiological knock-knee typically occurs between the ages of 3 and 5 years when the femoral-tibial angle is at its maximum, and spontaneous correction is expected by 7 years.

THE PAINFUL SHOULDER

13. Regarding calcifying tendinitis, select the correct statement:

A. It is more common in men

B. It is best diagnosed on MRI

C. The majority of patients are treated with surgery

D. It has no relationship to endocrine problems

E. It can look like septic arthritis.

14. Select the correct statement regarding frozen shoulder:

A. It usually resolves within 3 months

B. Good external rotation should be maintained

C. Steroids should never be used

D. The shoulder is seldom tender

E. Surgery is the mainstay of treatment.

ACUTE OSTEITIS AND SEPTIC ARTHRITIS

15. True (A) or false (B)--fill in only block A or B: The most important investigation to diagnose acute osteitis is radiography.

16. True (A) or false (B)--fill in only block A or B: The treatment of acute osteitis or septic arthritis is usually emergency surgical drainage and intravenous antibiotics.

SARCOMA OF THE EXTREMITIES

17. True (A) or false (B)--fill in only block A or B: Biopsy to establish a histological diagnosis should always be performed before referring a patient with a malignant tumour.

18. True (A) or false (B)--fill in only block A or B: Bone sarcomas occur mainly in children and young adults.

OSTEOPOROTIC FRACTURES

19. True (A) or false (B)--fill in only block A or B: Treatment of osteoporosis is only indicated if the bone density falls in the osteoporotic range.

20. True (A) or false (B)--fill in only block A or B: Medical treatment is the only important measure to prevent further fragility fractures.