2009 OITE ReviewMUSC Department of Orthopaedic Surgery

Question 125

Type II (beta) errors in clinical studies are minimized by performing which of the following

1- Power analysis2- Bonferroni correction3- Mann-Whitney U test4- Logistical regression analysis5- Increase sample size by 20

Preferred Response 1 Type I errormdashProbability of rejecting the null hypothesis when it is really true The probability

of making a type I error is denoted by the Greek letter α Type II errormdashProbability of failing to reject a null hypothesis that is really false The

probability of making a type II error is denoted by the Greek letter β PowermdashProbability that the sample mean will be sufficiently different from the mean under

null hypothesis to allow rejection of the null hypothesis Bonferroni correction is a method used to address the problem of multiple comparisons The

correction is based on the idea that if an experimenter is testing n dependent or independent hypotheses on a set of data then one way of maintaining the familywise error rate is to test each individual hypothesis at a statistical significance level of times what it would be if only one hypothesis were tested

MannndashWhitney U test a non-parametric test for assessing whether two independent samples of observations have equally large values

logistic regression (sometimes called the logistic model or logit model) is used for prediction of the probability of occurrence of an event by fitting data to a logit function logistic curve It is a generalized linear model used for binomial regression Like many forms of regression analysis it makes use of several predictor variables that may be either numerical or categorical For example the probability that a person has a heart attack within a specified time period might be predicted from knowledge of the persons age sex and body mass index

Question 125

Type II (beta) errors in clinical studies are minimized by performing which of the following

1- Power analysis2- Bonferroni correction3- Mann-Whitney U test4- Logistical regression analysis5- Increase sample size by 20

Preferred Response 1 Type I errormdashProbability of rejecting the null hypothesis when it is really true The probability

of making a type I error is denoted by the Greek letter α Type II errormdashProbability of failing to reject a null hypothesis that is really false The

probability of making a type II error is denoted by the Greek letter β PowermdashProbability that the sample mean will be sufficiently different from the mean under

null hypothesis to allow rejection of the null hypothesis Bonferroni correction is a method used to address the problem of multiple comparisons The

correction is based on the idea that if an experimenter is testing n dependent or independent hypotheses on a set of data then one way of maintaining the familywise error rate is to test each individual hypothesis at a statistical significance level of times what it would be if only one hypothesis were tested

MannndashWhitney U test a non-parametric test for assessing whether two independent samples of observations have equally large values

logistic regression (sometimes called the logistic model or logit model) is used for prediction of the probability of occurrence of an event by fitting data to a logit function logistic curve It is a generalized linear model used for binomial regression Like many forms of regression analysis it makes use of several predictor variables that may be either numerical or categorical For example the probability that a person has a heart attack within a specified time period might be predicted from knowledge of the persons age sex and body mass index

Preferred Response 1 Type I errormdashProbability of rejecting the null hypothesis when it is really true The probability

of making a type I error is denoted by the Greek letter α Type II errormdashProbability of failing to reject a null hypothesis that is really false The

probability of making a type II error is denoted by the Greek letter β PowermdashProbability that the sample mean will be sufficiently different from the mean under

null hypothesis to allow rejection of the null hypothesis Bonferroni correction is a method used to address the problem of multiple comparisons The

correction is based on the idea that if an experimenter is testing n dependent or independent hypotheses on a set of data then one way of maintaining the familywise error rate is to test each individual hypothesis at a statistical significance level of times what it would be if only one hypothesis were tested

MannndashWhitney U test a non-parametric test for assessing whether two independent samples of observations have equally large values

logistic regression (sometimes called the logistic model or logit model) is used for prediction of the probability of occurrence of an event by fitting data to a logit function logistic curve It is a generalized linear model used for binomial regression Like many forms of regression analysis it makes use of several predictor variables that may be either numerical or categorical For example the probability that a person has a heart attack within a specified time period might be predicted from knowledge of the persons age sex and body mass index

Question 132

The immune response to metallic orthopaedic implants is typically what type

1- Type I (Ig-E mediated)2- Type II (antibody mediated)3- Type III (immune complex mediated)4- Type IV (delayed-type

hypersensitivity reaction)5- Type V (Ig-M mediated)

Preferred Response 4 Type I hypersensitivity is mediated by IgE which triggers degranulation of mast cells and

basophils when cross-linked by antigen[74] Type II hypersensitivity occurs when antibodies bind to antigens on the patients own cells

marking them for destruction This is also called antibody-dependent (or cytotoxic) hypersensitivity and is mediated by IgG and IgM antibodies[74]

Type III hypersensitivity reactions-Immune complexes (aggregations of antigens complement proteins and IgG and IgM antibodies) deposited in various tissues trigger[74]

Type IV hypersensitivity (also known as cell-mediated or delayed type hypersensitivity) usually takes between two and three days to develop Type IV reactions are involved in many autoimmune and infectious diseases but may also involve contact dermatitis (poison ivy) These reactions are mediated by T cells monocytes and macrophages

A routine skin test reveals a prevalence of metal sensitivity of 02 for chromium 13 for nickel and 18 for cobalt After placement of metal implants sensitization (change from negative to positive) occurs in 27 for chromium 38 for nickel and 38 for cobalt Desensitization (change from positive to negative) occurs in 0 for chromium 21 for nickel and 38 for cobalt Many patients with implanted metal hardware have positive skin test results for those metals but are completely asymptomatic

Type I hypersensitivity to latex involves IgE antibodies that are specific for proteins from the sap of the rubber tree (Hevea brasiliensis) used to make gloves

Wikiemedicine

Preferred Response 4 Type I hypersensitivity is mediated by IgE which triggers degranulation of mast cells and

basophils when cross-linked by antigen[74] Type II hypersensitivity occurs when antibodies bind to antigens on the patients own cells

marking them for destruction This is also called antibody-dependent (or cytotoxic) hypersensitivity and is mediated by IgG and IgM antibodies[74]

Type III hypersensitivity reactions-Immune complexes (aggregations of antigens complement proteins and IgG and IgM antibodies) deposited in various tissues trigger[74]

Type IV hypersensitivity (also known as cell-mediated or delayed type hypersensitivity) usually takes between two and three days to develop Type IV reactions are involved in many autoimmune and infectious diseases but may also involve contact dermatitis (poison ivy) These reactions are mediated by T cells monocytes and macrophages

A routine skin test reveals a prevalence of metal sensitivity of 02 for chromium 13 for nickel and 18 for cobalt After placement of metal implants sensitization (change from negative to positive) occurs in 27 for chromium 38 for nickel and 38 for cobalt Desensitization (change from positive to negative) occurs in 0 for chromium 21 for nickel and 38 for cobalt Many patients with implanted metal hardware have positive skin test results for those metals but are completely asymptomatic

Type I hypersensitivity to latex involves IgE antibodies that are specific for proteins from the sap of the rubber tree (Hevea brasiliensis) used to make gloves

Wikiemedicine

Question 139

Which of the following bone morphogenetic proteins (BMP) exhibits no osteogenic activity

1- BMP22- BMP33- BMP44- BMP65- BMP7

Preferred Response 2

Question 149

Marfan syndrome demonstrates what type of inheritance pattern

1- Autosomal dominant2- Autosomal recessive3- X-linked dominant4- X-linked recessive5- Germline mutation

Preferred Response 1

Autosomal Dominant 25 new mutations Mutation is fibrillin 1 gene on chromosome

15q21 (contrast with Ehlers-Danlos which is COL5A1 COL5A2 or COL3A1 defect is in Type V collagen may be AD or AR)

+ Walker sign (thumb amp small finger overlap when encircling contralateral wrist

+ Steinburg thumb sign (adduct thumb make fist and thumb protrudes from ulnar side of hand)

Scoliosis in 60-70 (hard to brace) 60 have dural ectasia so get MRI before OR

Mitral valve prolapse aortic root dilatation

Question 160

A patient sustains a fracture of the acetabulum An axial CT scan is shown in Figure 160 What structure takes origin from the region depicted by the arrow

1- Pectineus2- Sartorius3- Iliopectineal fascia4- Direct (straight) head of the rectus femoris5- Indirect (reflected) head of the rectus

femoris

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Preferred Response 2

Question 149

Marfan syndrome demonstrates what type of inheritance pattern

1- Autosomal dominant2- Autosomal recessive3- X-linked dominant4- X-linked recessive5- Germline mutation

Preferred Response 1

Autosomal Dominant 25 new mutations Mutation is fibrillin 1 gene on chromosome

15q21 (contrast with Ehlers-Danlos which is COL5A1 COL5A2 or COL3A1 defect is in Type V collagen may be AD or AR)

+ Walker sign (thumb amp small finger overlap when encircling contralateral wrist

+ Steinburg thumb sign (adduct thumb make fist and thumb protrudes from ulnar side of hand)

Scoliosis in 60-70 (hard to brace) 60 have dural ectasia so get MRI before OR

Mitral valve prolapse aortic root dilatation

Question 160

A patient sustains a fracture of the acetabulum An axial CT scan is shown in Figure 160 What structure takes origin from the region depicted by the arrow

1- Pectineus2- Sartorius3- Iliopectineal fascia4- Direct (straight) head of the rectus femoris5- Indirect (reflected) head of the rectus

femoris

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 149

Marfan syndrome demonstrates what type of inheritance pattern

1- Autosomal dominant2- Autosomal recessive3- X-linked dominant4- X-linked recessive5- Germline mutation

Preferred Response 1

Autosomal Dominant 25 new mutations Mutation is fibrillin 1 gene on chromosome

15q21 (contrast with Ehlers-Danlos which is COL5A1 COL5A2 or COL3A1 defect is in Type V collagen may be AD or AR)

+ Walker sign (thumb amp small finger overlap when encircling contralateral wrist

+ Steinburg thumb sign (adduct thumb make fist and thumb protrudes from ulnar side of hand)

Scoliosis in 60-70 (hard to brace) 60 have dural ectasia so get MRI before OR

Mitral valve prolapse aortic root dilatation

Question 160

A patient sustains a fracture of the acetabulum An axial CT scan is shown in Figure 160 What structure takes origin from the region depicted by the arrow

1- Pectineus2- Sartorius3- Iliopectineal fascia4- Direct (straight) head of the rectus femoris5- Indirect (reflected) head of the rectus

femoris

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Preferred Response 1

Autosomal Dominant 25 new mutations Mutation is fibrillin 1 gene on chromosome

15q21 (contrast with Ehlers-Danlos which is COL5A1 COL5A2 or COL3A1 defect is in Type V collagen may be AD or AR)

+ Walker sign (thumb amp small finger overlap when encircling contralateral wrist

+ Steinburg thumb sign (adduct thumb make fist and thumb protrudes from ulnar side of hand)

Scoliosis in 60-70 (hard to brace) 60 have dural ectasia so get MRI before OR

Mitral valve prolapse aortic root dilatation

Question 160

A patient sustains a fracture of the acetabulum An axial CT scan is shown in Figure 160 What structure takes origin from the region depicted by the arrow

1- Pectineus2- Sartorius3- Iliopectineal fascia4- Direct (straight) head of the rectus femoris5- Indirect (reflected) head of the rectus

femoris

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 160

A patient sustains a fracture of the acetabulum An axial CT scan is shown in Figure 160 What structure takes origin from the region depicted by the arrow

1- Pectineus2- Sartorius3- Iliopectineal fascia4- Direct (straight) head of the rectus femoris5- Indirect (reflected) head of the rectus

femoris

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Preferred Response 4

Rectus femoris has 2 heads Directstraight takes origin from AIIS Indirectreflected takes origin from groove on the upper brim of the acetabulum Femoral nerve (L234) Arterial supply ascending branch of lateral

femoral circumflex Pectineusorigin from superior surface of

pubis innervated by femoral amp obturator (L234) acts to adduct thigh

Sartoriusorigin from ASIS innervated by femoral (L23) inserts into pes anserinus

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 165

Polymorphisms in the genes for the calcitonin receptor estrogen receptor-1 type I collagen alpha-1 chain or the vitamin D receptor have been shown to be associated with which of the following bone diseases

1- Osteopetrosis2- Osteoporosis3- Osteomalacia4- Vitamin D-deficient rickets5- X-linked hypophosphatemic rickets

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Preferred Response 2 Osteopetrosis-failure of osteoclasts resulting in dense bone

with no medullary canal 3 deactivating mutations are known carbonic anhydrase II alpha 3 subunit of proton pump Chloride channel 7

Osteoporosis-normal bone in reduced quantity gt25 SDs below peak bone mass (T score lt-25 remember osteopenia is 10-25 SDs below peak or T score of -1 to -25) multifactorial disease but associated gene defects are Vit D receptor COL1A1 and LRP5 (low density lipoprotein receptor related protein)

Osteomalacia-adult form of rickets normal quantity but abnormal bone cause is related to Vit D pathway

Vitamin D-deficient rickets-low intake of Vit D produces bone with poor mineralization

X-linked hypophosphatemic rickets-X-linked dominant disorder that leads to phosphate wasting due to mutation in phosphate regulating endopeptidase (PHEX) gene

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate2- Calcium phosphate3- Tricalcium phosphate4- Coralline hydroxyapatite5- Collagen-based matrices

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 175

Of the available osteoconductive bone graft substitutes which is most rapidly resorbed

1- Calcium sulfate 1-3 Months2- Calcium phosphate 6-21 months3- Tricalcium phosphate 6-21 months4- Coralline hydroxyapatite upto 10 yrs5- Collagen-based matrices

De Long et al 2007 J Bone Joint Surg Am 200789649-658

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Preferred Response 1Bell WH Bell WH Oral Surgery Oral Medicine Oral PathologyOral Surgery Oral Medicine Oral Pathology 650-657 1964 650-657 1964 Resorption of ninety intramuscular implants of different types of bone Resorption of ninety intramuscular implants of different types of bone

and bone substitutes were studied radiographically in twenty-two and bone substitutes were studied radiographically in twenty-two adult mongrel dogs On the basis of mean resorption time the adult mongrel dogs On the basis of mean resorption time the implants were resorbed in the following order implants were resorbed in the following order

plaster of Paris (Calcium sulfate)plaster of Paris (Calcium sulfate) autogenous cancellous bone autogenous cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized canine cancellous bone cathode-ray-sterilized human cancellous bone cathode-ray-sterilized human cancellous bone homologous cancellous bone homologous cancellous bone fetal bovine bone fetal bovine bone bovine cancellous bone bovine cancellous bone freeze-dried cancellous bone freeze-dried cancellous bone collapatite collapatite anorganic bone and anorganic bone and polyurethane foampolyurethane foam

Question 180

Which of the following is an inhibitor of particle-induced osteolysis

1- Interleukin-1 alpha2- Interleukin-63- Osteoprotegerin4- Tumor necrosis factor (TNF)-alpha5- Receptor-activator of nuclear factor

KB(RANK) ligand

Q180 - Preferred Response 3

3- Osteoprotegerin

- Differentiation of bone marrow macrophages (osteoclast precursors) into mature osteoclasts requires recognition and binding of the osteoblast and T-cell secreted factor RANKL by its cognate receptor RANKL which is expressed on the surface of osteoclast precursors

- This process is regulated by an osteoblast-scereted factor Osteoprotegrin reducing its bioavailability

Einhornet al 2007 OBS book page 371

Question 188

Which of the following nerves serves as an anatomic landmark leading to the radial nerve during a paratricipital approach for humeral shaft fracture fixation

1- Musculocutaneous2- Lateral antebrachial cutaneous3- Medial antebrachial cutaneous4- Medial brachial cutaneous5- Posterior antebrachial cutaneous

Preferred Response 5 (posterior antebrachial cutaneous nerve)

Question 215 The Heuter-Volkmann Law is summarized best by

which of the following statements1- Bone remodels in response to mechanical stimuli2- Bone formation is induced in an electronegative zone

and resorbed in an electropositive zone3- Compression across the growth plate slows

longitudinal growth4- Tensile load across the growth plate increases

longitudinal growth5- The bending strength of diaphyseal bone is determined

by its diameter raised to the third power

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Q180 - Preferred Response 3

3- Osteoprotegerin

- Differentiation of bone marrow macrophages (osteoclast precursors) into mature osteoclasts requires recognition and binding of the osteoblast and T-cell secreted factor RANKL by its cognate receptor RANKL which is expressed on the surface of osteoclast precursors

- This process is regulated by an osteoblast-scereted factor Osteoprotegrin reducing its bioavailability

Einhornet al 2007 OBS book page 371

Question 188

Which of the following nerves serves as an anatomic landmark leading to the radial nerve during a paratricipital approach for humeral shaft fracture fixation

1- Musculocutaneous2- Lateral antebrachial cutaneous3- Medial antebrachial cutaneous4- Medial brachial cutaneous5- Posterior antebrachial cutaneous

Preferred Response 5 (posterior antebrachial cutaneous nerve)

Question 215 The Heuter-Volkmann Law is summarized best by

which of the following statements1- Bone remodels in response to mechanical stimuli2- Bone formation is induced in an electronegative zone

and resorbed in an electropositive zone3- Compression across the growth plate slows

longitudinal growth4- Tensile load across the growth plate increases

longitudinal growth5- The bending strength of diaphyseal bone is determined

by its diameter raised to the third power

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Question 188

Which of the following nerves serves as an anatomic landmark leading to the radial nerve during a paratricipital approach for humeral shaft fracture fixation

1- Musculocutaneous2- Lateral antebrachial cutaneous3- Medial antebrachial cutaneous4- Medial brachial cutaneous5- Posterior antebrachial cutaneous

Preferred Response 5 (posterior antebrachial cutaneous nerve)

Question 215 The Heuter-Volkmann Law is summarized best by

which of the following statements1- Bone remodels in response to mechanical stimuli2- Bone formation is induced in an electronegative zone

and resorbed in an electropositive zone3- Compression across the growth plate slows

longitudinal growth4- Tensile load across the growth plate increases

longitudinal growth5- The bending strength of diaphyseal bone is determined

by its diameter raised to the third power

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Preferred Response 5 (posterior antebrachial cutaneous nerve)

Question 215 The Heuter-Volkmann Law is summarized best by

which of the following statements1- Bone remodels in response to mechanical stimuli2- Bone formation is induced in an electronegative zone

and resorbed in an electropositive zone3- Compression across the growth plate slows

longitudinal growth4- Tensile load across the growth plate increases

longitudinal growth5- The bending strength of diaphyseal bone is determined

by its diameter raised to the third power

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Question 215 The Heuter-Volkmann Law is summarized best by

which of the following statements1- Bone remodels in response to mechanical stimuli2- Bone formation is induced in an electronegative zone

and resorbed in an electropositive zone3- Compression across the growth plate slows

longitudinal growth4- Tensile load across the growth plate increases

longitudinal growth5- The bending strength of diaphyseal bone is determined

by its diameter raised to the third power

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Preferred Response 3

The Hueter-Volkmann law Compression across the growth plate slows longitudinal growth (and tensile load across the growth plate increases longitudinal growth according to every source I can findhellipnot sure why this was not also correct)

Wolffrsquos Law bone remodels in response to mechanical stimuli

Peizoelectric Theory Bone formation is induced in an electronegative zone and resorbed in an electropositive zone

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Question 239 An otherwise healthy 17-year-old wrestler suspects

that he has been bitten on the neck by a spider He has no recent history of hospitalization Other members of his wrestling team have also recently reported skin lesions Examination reveals superficial abscess formation on the right side of his neck No other skin lesions are noted The patient is afebrile What is the most likely cause of the abscess

1- Highly drug-resistant Pseudomonas aeruginosa2- Extremely drug-resistant Mycobacterium tuberculosis3- Vancomycin-resistant Enterococcus faecium4- Penicillin-resistant Clostridium perfringens5- Methicillin-resistant Staphylococcus aureus

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Preferred Response 5

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008

See dirty rednecks from Colleton and call room showers

See JB

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Question 262

Which of the following conditions is a contraindication to the use of most bisphosphonates

1- Pagetrsquos disease2- Osteomyelitis3- Bone infarct4- Myasthenia gravis5- Severe renal insufficiencyfailure

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Preferred Response 5 Approximately 50 to 80 of disphosphanates

are cleared from the blood stream by renal excretion and approx 1 through biliary excretion

Remainder of the drug is incorporated into the crystalline structure of bone and may persist for the lifetime of the patient with an estimated half-life in bone of 10 years

Risks Osteonecrosis of Jaw Subtroch fractures (look for this one on upcoming tests

The orthopaedic implications of diphosphonate therapyWeaver MJ Miller MA Vrahas MSJ Am Acad Orthop Surg 2010 Jun18(6)317-8

Question 275

Osteoclasts are the primary cells involved in bone resorption What is one of the most critical factors for osteoclast differentiation and activation

1- PTH2- BMP23- RANKL4- Calcitonin5- TNF-alpha

Preferred Response 3

Question 59

Pagetrsquos disease of bone is associated with abnormal function of which of the following cell types

1- Osteoblasts2- Osteoclasts3- Osteocytes4- Histiocytes5- Megakarocytes

Preferred Response 2 Histology

- demonstrates excess osteoclasts resorptive activity (occurs predominantly in the early resorptive phase) - bone marrow is replaced by fibrous tissue and disorganized trabeculae - paratrabecular fibrosis - irregular - highly celluar lamellar bone w irregular cement lines - woven bone with osteoblastic rimming - occasional prominent cement lines

Radiographs - aggressive bone resorption - lytic lesions w sharp borders that destroy the cortex - new bone formation and sclerosis which causes thickening of the cortex and course trabeculae - cortices will appear thickened and trabeculae will appear coarse

Labs ndash increased alk phos increase urine and serum hydroxyproline

Treament ndash bisphosphonates calcitonin prior to elective surgery

Preferred Response 3

Question 59

Pagetrsquos disease of bone is associated with abnormal function of which of the following cell types

1- Osteoblasts2- Osteoclasts3- Osteocytes4- Histiocytes5- Megakarocytes

Preferred Response 2 Histology

- demonstrates excess osteoclasts resorptive activity (occurs predominantly in the early resorptive phase) - bone marrow is replaced by fibrous tissue and disorganized trabeculae - paratrabecular fibrosis - irregular - highly celluar lamellar bone w irregular cement lines - woven bone with osteoblastic rimming - occasional prominent cement lines

Radiographs - aggressive bone resorption - lytic lesions w sharp borders that destroy the cortex - new bone formation and sclerosis which causes thickening of the cortex and course trabeculae - cortices will appear thickened and trabeculae will appear coarse

Labs ndash increased alk phos increase urine and serum hydroxyproline

Treament ndash bisphosphonates calcitonin prior to elective surgery

Question 59

Pagetrsquos disease of bone is associated with abnormal function of which of the following cell types

1- Osteoblasts2- Osteoclasts3- Osteocytes4- Histiocytes5- Megakarocytes

Preferred Response 2 Histology

- demonstrates excess osteoclasts resorptive activity (occurs predominantly in the early resorptive phase) - bone marrow is replaced by fibrous tissue and disorganized trabeculae - paratrabecular fibrosis - irregular - highly celluar lamellar bone w irregular cement lines - woven bone with osteoblastic rimming - occasional prominent cement lines

Radiographs - aggressive bone resorption - lytic lesions w sharp borders that destroy the cortex - new bone formation and sclerosis which causes thickening of the cortex and course trabeculae - cortices will appear thickened and trabeculae will appear coarse

Labs ndash increased alk phos increase urine and serum hydroxyproline

Treament ndash bisphosphonates calcitonin prior to elective surgery

Preferred Response 2 Histology

- demonstrates excess osteoclasts resorptive activity (occurs predominantly in the early resorptive phase) - bone marrow is replaced by fibrous tissue and disorganized trabeculae - paratrabecular fibrosis - irregular - highly celluar lamellar bone w irregular cement lines - woven bone with osteoblastic rimming - occasional prominent cement lines

Radiographs - aggressive bone resorption - lytic lesions w sharp borders that destroy the cortex - new bone formation and sclerosis which causes thickening of the cortex and course trabeculae - cortices will appear thickened and trabeculae will appear coarse

Labs ndash increased alk phos increase urine and serum hydroxyproline

Treament ndash bisphosphonates calcitonin prior to elective surgery

Question 116

Which of the following postoperative modalities to prevent deep venous thrombosis is associated with the highest risk of hematoma

1- Aspirin2- Dipyridamole3- Compression device4- Clopidogrel bisulfate5- Low-molecular-weight heparin

Question 116

Which of the following postoperative modalities to prevent deep venous thrombosis is associated with the highest risk of hematoma

1- Aspirin2- Dipyridamole3- Compression device4- Clopidogrel bisulfate5- Low-molecular-weight heparin

Preferred Response 5 Compression stockings- increases peak venous flow and decreases the activty of the fibrinolytic

system Unfractionated heparin- ie heparin binds AT III which decreases the activity of thrombin and

Xa Higher risk of bleeding than with others Lovenox Aka fractionated heparin heparin broken down into smaller molecules Binds to AT

III and thrombin Longer half-life improved bioavailibility compared with coumadin there is a higher risk of bleeding but a lower risk of venographically identified DVTs

Warfarin- inhibits vitamin K (II VII IX X)- must be monitored ASA- irreversibly binds and inactivates COX Blocks the production of thromboxane A2 which is

required for platelet aggregation More likley to develop venographically evident DVT but need randomized trials

Dipyrimidole- decreases activity of thromboxane A2 thereby decreasing platelet aggregation Plavix- inhibits ADP receptors on platelets and therefore inhibits activation

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 116

Which of the following postoperative modalities to prevent deep venous thrombosis is associated with the highest risk of hematoma

1- Aspirin2- Dipyridamole3- Compression device4- Clopidogrel bisulfate5- Low-molecular-weight heparin

Preferred Response 5 Compression stockings- increases peak venous flow and decreases the activty of the fibrinolytic

system Unfractionated heparin- ie heparin binds AT III which decreases the activity of thrombin and

Xa Higher risk of bleeding than with others Lovenox Aka fractionated heparin heparin broken down into smaller molecules Binds to AT

III and thrombin Longer half-life improved bioavailibility compared with coumadin there is a higher risk of bleeding but a lower risk of venographically identified DVTs

Warfarin- inhibits vitamin K (II VII IX X)- must be monitored ASA- irreversibly binds and inactivates COX Blocks the production of thromboxane A2 which is

required for platelet aggregation More likley to develop venographically evident DVT but need randomized trials

Dipyrimidole- decreases activity of thromboxane A2 thereby decreasing platelet aggregation Plavix- inhibits ADP receptors on platelets and therefore inhibits activation

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Preferred Response 5 Compression stockings- increases peak venous flow and decreases the activty of the fibrinolytic

system Unfractionated heparin- ie heparin binds AT III which decreases the activity of thrombin and

Xa Higher risk of bleeding than with others Lovenox Aka fractionated heparin heparin broken down into smaller molecules Binds to AT

III and thrombin Longer half-life improved bioavailibility compared with coumadin there is a higher risk of bleeding but a lower risk of venographically identified DVTs

Warfarin- inhibits vitamin K (II VII IX X)- must be monitored ASA- irreversibly binds and inactivates COX Blocks the production of thromboxane A2 which is

required for platelet aggregation More likley to develop venographically evident DVT but need randomized trials

Dipyrimidole- decreases activity of thromboxane A2 thereby decreasing platelet aggregation Plavix- inhibits ADP receptors on platelets and therefore inhibits activation

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 131

In the case of a mother (who is a carrier for Duchennersquos muscular dystrophy gene) and a father (who does not have the Duchennersquos muscular dystrophy gene) what is the chance that the son will be affected by Duchennersquos muscular dystrophy

1- 252- 503- 754- 1005- Unable to determine since the father may

be a carrier

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

DMD X linked recessive muscular dystrophy 13500 males Only males are affected from female

carriers Xp21 chromosome Abnormal coding of the dystrophin which stabilizes the dystroglycan complex

Progressive muscle wasting and weakness starting in infancy and progressing to wheelchair dependency by age 12 Pseudohypertrophy- enlargement of the calves and deltoids by fatty replacement and fibrosis

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 152

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 152

A newborn infant is brought to the office with the features shown in Figure 152 Many children with this condition have multiple systemic anomalies Which of the following body sites is most likely to have associated abnormalities

1- Vertebral complex2- Renal system3- Cardiac system4- Hematopoetic system5- Central nervous system

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Preferred Response 4 Radial longitudinal deficiency aka radial dysplasia or

radial clubhand Range from thumb hypoplasia to complete radial absence 130k-100k MgtF (32) Bilateral 40-60 RgtL 21 when unilateral

Thrombocytopenia absent radius (TAR)

Autosomal recessive1q211 gene deletion

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 179

Rheumatoid factors are antibodies directed against

1- multiple immunoglobulins2- IgA3- IgE4- IgM5- IgG

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Preferred Response 5 RF is an IgM antibody directed against the Fc portion of the

patientrsquos own IgG Purpose of RF is unknown but though to help clear immune

complexes through stabilization and opsinization RF is commonly secreted during acute infections and probably is part

of the normal immune response RF is present in 70 to 90 of patients with RA a negative RF result

does not rule out rheumatoid arthritis Sensitive but not specific RF may take several months to appear in the serum after arthritis

develops

The level of RF is prognostic that is the higher the level the worse the prognosis

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Question 274

Disease modifying antirheumatic drug therapy such as infliximab is primarily targeted against

1- leukocytes2- rheumatoid factor3- antinuclear antibodies4- C-reactive protein5- tumor necrosis factor-alpha

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)

Preferred Response 5 (TNF-alpha)

Rheumatoid Arthritis 90 positive for RF Morning stiffness pain joint swelling hand deformities

such as subluxation ulnar drift swan-neck deformity Periarticular osteopenia Juxta-articular erosion Joint space narrowing

Treatment NSAIDS Aspirin Disease-modifying antirheumatic drugs

Methotrexate (inhibits dihydrofolate reductase and folate metabolism is current treatment choice)

Cytokine-neutralizing Etanercept (soluble p75 TNF receptor immunoglobulin G

fusion protein) Infliximab (chimeric monoclonal antibody to TNf-alpha) Rituximab (monoclonal antibody to CD20 antigeninhibits

B-cells)

From COR Book

• 2009 OITE Review
• Question 125
• Preferred Response 1
• Question 132
• Preferred Response 4
• Question 139
• Preferred Response 2
• Question 149
• Slide 9
• Question 160
• Slide 11
• Slide 12
• Question 165
• Slide 14
• Question 175
• Slide 16
• Slide 17
• Question 180
• Q180 - Preferred Response 3
• Question 188
• Preferred Response 5 (posterior antebrachial cutaneous nerve)
• Slide 22
• Question 215
• Preferred Response 3
• Question 239
• Preferred Response 5
• Community-acquired Methicillin-resistant Staphylococcus aureus An Emerging Pathogen in Orthopaedics J Am Acad Orthop Surg Marcotte and Trzeciak 16 (2) 98 2008
• Question 262
• Slide 29
• Question 275
• Slide 31
• Slide 32
• Question 59
• Slide 34
• Question 116
• Slide 36
• Slide 37
• Slide 38
• Question 131
• Slide 40
• DMD
• Question 152
• Slide 43
• Slide 44
• Slide 45
• Question 179
• Slide 47
• Slide 48
• Question 274
• Preferred Response 5 (TNF-alpha)