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Continuing podiatric medical education questionnaire
CONTINUING PODIATRIC MEDICAL EDUCATION QUESTIONNAIRE The Journal of Foot & Ankle Surgery Continuing Podiatric Medical Education (CPME) program is intended to be an 18credit-per-year program. Each issue will have 10 question s of Board Examination qual ity in a five-part (A-E) , multiplechoice format. Participants will receive a maximum of 3 credits per issue for each correctly completed CPME Answer Form submitted to Data Trace Publishing Company for scoring. There is a fee of $15.00 per issue ($12.00 for
D.
E.
2.
The most common type of calcification of the Achilles tendon is: A. A type I lesi on found 1 to 3 em from the inserti on with: dystrophic calcification B. A type I lesion that occurs within the tendon 's insertion with dystrophic calcification C. Type I and II lesions with metastatic calcification . D. Type I and II lesions with dystrophic calcification . Type II and III lesions with dystrophic E. calcification
3.
Two types of chroni c tend on disorders are described in the report by O loff and Schulhofe r regard ing flexor hallucis longus dysfu nct ion : A. Stenosi ng tenosynovitis, the development of adhesions that interfere with tendon gliding, and tendinosis, in situ tears with nodule development B. Stenosing tenosynovitis, in situ tears with nodule development thickening, mucoid degeneration or lengthening, and tendinosis, the development of adhesions that interfere with tend on gliding C. Tendinosis, whi ch is char acterized by tr aum atic nodule development, and dystrophic calcific ation ofthe tendon insertion that mterferes with gliding D . Stenosing tenosynovitis, which causes calcification and long itudinal tear s, and tendinosis, wh ich has been assoc iated with tendon adhesio ns and gliding abnormalities Stenosing tendinosis, in situ intern al tend on E. derangement, and tenosynovitis, which has also been described as in situ mucoid degeneration
4.
In Oloff and Schulhofers report on flexor hallucis longus dysfunction, magnetic resonance imaging demonstrated: A. Evidence of internal tendon derangement and effusion in more than 80% of patients B. Evidence of effusion in more than 80% of patients and internal tendon derangement in more than 50% of patients C. Effusion in more than 80 % of patients but no patients had internal tendon derangement D. Effusion in no patients and internal tendon derangement in more than 80% of pat ients E. Effusion and internal tendon derangement in more than half of all patients
5.
To correct Haglund 's deformity, Sella and co-workers suggest a desired osteotomy angle of: A. 61° B. 70° C. 54 ° D . 40° E. The angle must be individually determined fro m a lateral x-ray.
ACFAS members) for scoring and processing, payable in advance. Please make checks payable to Data Trace Publishing Company. All applicants for credit must be current subscribers to The Journal ofFoot & Ankle Surgery or current members of ACFA S in good standing. Participants must p ass the written examination material in order to receive credit, but may request one retake (within 90 days of receipt of results) of any issue for which they did not receive credit init ially. A passing grade is 70% corr ec t. The f ee for a retake exam is $5.00, payable in advance. The Journal of Foot & Ankle Surgery will notify state boards of participants ' credits only in those states that require such notification from a sponsoring organization; in most states it will be the responsibility of the individual to report CPME credit to the state boards in a timely manner. Data Trace Publishing Company and The Journal of Foot & Ankle Surgery are approved sponsors of continuing education programs by the Council on Podiatric Medical Education (CPME). The following states have approved The Journal ofFoot & Ankle Surgery program for credits: AK(l8), AL(l8), AR(l8), AZ(lO), CA(l8), CO(l8), DC(l8), DE(18), FL(8/biennium), GA(l8), HI(l8), ID(18 ), MA(l8), MD(l8), ME(l8), MI (18), MN (18 ), MO (6), ND( 6), NE(8/biennium), NH(l8), NM(l), NY ( 15/tri ennium), OHC20 IIB/biennium), OK( 18), ORC18), RIC18), SC(18), SD( 18), UTe 18) , WA( I0), WI (18).
Type III lesions are I to 3 cm proximal to the insertion and correlate with true retrocalcaneal exostosis. Type II lesions are up to 3 cm pro xim al to the iriferior aspect of the calcaneus and usually correlate WIth a true retrocalcaneal exostosis.
INSTRUCTIONS: The following questions are based on the material presented in the journal issue . Please select the best answer and mark the appropriate box with an X on the CPME An swer Form which follows. The Answer Form
should be returnedfor scoring to Data Trace Publishing Company, P.O. Box 1239, Brooklandville, MD 2102299 78.
CPME QUESTIONS I.
Morris and co-workers have described three locations of calcific ation within the Achilles tendon. Which of the following is tru e? A. Type I lesions are within the tendon at its insertion. B. Type II lesions are found 3 to 5 em proximal to the insertion. C. Type III lesions are a combination of type I and II.
THE JOURNAL OF FOOT & ANKLE SURGERY Cop yright © 1998 by the American College of Foot and Ankle Surgeons Volume 37, Number 2, March/April 1998
6.
The primarydisadvantages of the Mitek Anchor System are: A. High rate of pullout from bone compared to other stems B. i~ .rate of removal following surgery due to so -tissue imtation C. H~ risk of soft-tissue and bone infection D. D ' iculty retrieving the bone anchor E. Prolonged tendon healing
n
7.
8.
In the study by Dawson and co-workers utilizin the Mitek bone anchor in a modified Kidner froce ure, which of the following statements is correct. A. Patient outcomes were the same in patients treated with and without the Mitek bone anchor. B. The time it took patients postoperatively to amb ulate with assistance devices and return to normal shoes was significantly shorter in patients treated with the Mitek bone anchor. C. The time it took patients posto peratively to ambulate with assistance devices and return to normal shoes was siftficantly longer in patients treated with the Mite bone anchor. D. The time it took patients to ambulate with assistance devices was the same but return to normal shoes was shorter in patients treated with the Mitek bone anchor. E. The time it took patients to ambulate with assistance devices was the same but return to normal shoes was longer in patients treated with the Mitek bone anchor.
a
Synthetic plastic models of the first metatarsal bone : Cannot simulate the mechanical properties of human cadaver bone because they are uniformly weaker than human bone B. Can simulate bendin~ strength using a cantilever load and three-point ending models A.
c. D. E.
Are probably most appropriate in studies that compare the orientation of osteotomy designs and allow for paired comparisons Can simulate human bone in studies that load specimens to failure Are consistently stronger than cadaver specimens and therefore cannot be used to simulate human bone
9. In their retrospective evaluation of Silastic implants, Bonet and co-workers identified the most common reason for patients rating their result as "fair" or "unsatisfied" I year after surgery as: A. Detritic synovitis causing pain and deformity B. Limited joint motion associated with bone hypertrophy C. Complications requiring implant removal D . Implant fracture and residual deformity E. Increased activity that was associated with selecting patients less than 40 years of age 10. Grumbine and co-workers found that intralesionaJ steroid injections: A. Provided subjective improvement in pain and inflammation, but significantly delayed wound healing B. Delayed wound heal ing that was associated with high doses of Celestone Soluspan C. Delayed healing that was found with both dexamethasone (in doses greater than 5 mg) and Celestone Solu span D . Delayed healing that was associated with steroid treatment , but only in immunocompromised patients E. Overall there was not a significant difference in wound healing based on treatment with intralesional steroids.
D.
E.
2.
The most common type of calcification of the Achilles tendon is: A. A type I lesi on found 1 to 3 em from the inserti on with: dystrophic calcification B. A type I lesion that occurs within the tendon 's insertion with dystrophic calcification C. Type I and II lesions with metastatic calcification . D. Type I and II lesions with dystrophic calcification . Type II and III lesions with dystrophic E. calcification
3.
Two types of chroni c tend on disorders are described in the report by O loff and Schulhofe r regard ing flexor hallucis longus dysfu nct ion : A. Stenosi ng tenosynovitis, the development of adhesions that interfere with tendon gliding, and tendinosis, in situ tears with nodule development B. Stenosing tenosynovitis, in situ tears with nodule development thickening, mucoid degeneration or lengthening, and tendinosis, the development of adhesions that interfere with tend on gliding C. Tendinosis, whi ch is char acterized by tr aum atic nodule development, and dystrophic calcific ation ofthe tendon insertion that mterferes with gliding D . Stenosing tenosynovitis, which causes calcification and long itudinal tear s, and tendinosis, wh ich has been assoc iated with tendon adhesio ns and gliding abnormalities Stenosing tendinosis, in situ intern al tend on E. derangement, and tenosynovitis, which has also been described as in situ mucoid degeneration
4.
In Oloff and Schulhofers report on flexor hallucis longus dysfunction, magnetic resonance imaging demonstrated: A. Evidence of internal tendon derangement and effusion in more than 80% of patients B. Evidence of effusion in more than 80% of patients and internal tendon derangement in more than 50% of patients C. Effusion in more than 80 % of patients but no patients had internal tendon derangement D. Effusion in no patients and internal tendon derangement in more than 80% of pat ients E. Effusion and internal tendon derangement in more than half of all patients
5.
To correct Haglund 's deformity, Sella and co-workers suggest a desired osteotomy angle of: A. 61° B. 70° C. 54 ° D . 40° E. The angle must be individually determined fro m a lateral x-ray.
ACFAS members) for scoring and processing, payable in advance. Please make checks payable to Data Trace Publishing Company. All applicants for credit must be current subscribers to The Journal ofFoot & Ankle Surgery or current members of ACFA S in good standing. Participants must p ass the written examination material in order to receive credit, but may request one retake (within 90 days of receipt of results) of any issue for which they did not receive credit init ially. A passing grade is 70% corr ec t. The f ee for a retake exam is $5.00, payable in advance. The Journal of Foot & Ankle Surgery will notify state boards of participants ' credits only in those states that require such notification from a sponsoring organization; in most states it will be the responsibility of the individual to report CPME credit to the state boards in a timely manner. Data Trace Publishing Company and The Journal of Foot & Ankle Surgery are approved sponsors of continuing education programs by the Council on Podiatric Medical Education (CPME). The following states have approved The Journal ofFoot & Ankle Surgery program for credits: AK(l8), AL(l8), AR(l8), AZ(lO), CA(l8), CO(l8), DC(l8), DE(18), FL(8/biennium), GA(l8), HI(l8), ID(18 ), MA(l8), MD(l8), ME(l8), MI (18), MN (18 ), MO (6), ND( 6), NE(8/biennium), NH(l8), NM(l), NY ( 15/tri ennium), OHC20 IIB/biennium), OK( 18), ORC18), RIC18), SC(18), SD( 18), UTe 18) , WA( I0), WI (18).
Type III lesions are I to 3 cm proximal to the insertion and correlate with true retrocalcaneal exostosis. Type II lesions are up to 3 cm pro xim al to the iriferior aspect of the calcaneus and usually correlate WIth a true retrocalcaneal exostosis.
INSTRUCTIONS: The following questions are based on the material presented in the journal issue . Please select the best answer and mark the appropriate box with an X on the CPME An swer Form which follows. The Answer Form
should be returnedfor scoring to Data Trace Publishing Company, P.O. Box 1239, Brooklandville, MD 2102299 78.
CPME QUESTIONS I.
Morris and co-workers have described three locations of calcific ation within the Achilles tendon. Which of the following is tru e? A. Type I lesions are within the tendon at its insertion. B. Type II lesions are found 3 to 5 em proximal to the insertion. C. Type III lesions are a combination of type I and II.
THE JOURNAL OF FOOT & ANKLE SURGERY Cop yright © 1998 by the American College of Foot and Ankle Surgeons Volume 37, Number 2, March/April 1998
6.
The primarydisadvantages of the Mitek Anchor System are: A. High rate of pullout from bone compared to other stems B. i~ .rate of removal following surgery due to so -tissue imtation C. H~ risk of soft-tissue and bone infection D. D ' iculty retrieving the bone anchor E. Prolonged tendon healing
n
7.
8.
In the study by Dawson and co-workers utilizin the Mitek bone anchor in a modified Kidner froce ure, which of the following statements is correct. A. Patient outcomes were the same in patients treated with and without the Mitek bone anchor. B. The time it took patients postoperatively to amb ulate with assistance devices and return to normal shoes was significantly shorter in patients treated with the Mitek bone anchor. C. The time it took patients posto peratively to ambulate with assistance devices and return to normal shoes was siftficantly longer in patients treated with the Mite bone anchor. D. The time it took patients to ambulate with assistance devices was the same but return to normal shoes was shorter in patients treated with the Mitek bone anchor. E. The time it took patients to ambulate with assistance devices was the same but return to normal shoes was longer in patients treated with the Mitek bone anchor.
a
Synthetic plastic models of the first metatarsal bone : Cannot simulate the mechanical properties of human cadaver bone because they are uniformly weaker than human bone B. Can simulate bendin~ strength using a cantilever load and three-point ending models A.
c. D. E.
Are probably most appropriate in studies that compare the orientation of osteotomy designs and allow for paired comparisons Can simulate human bone in studies that load specimens to failure Are consistently stronger than cadaver specimens and therefore cannot be used to simulate human bone
9. In their retrospective evaluation of Silastic implants, Bonet and co-workers identified the most common reason for patients rating their result as "fair" or "unsatisfied" I year after surgery as: A. Detritic synovitis causing pain and deformity B. Limited joint motion associated with bone hypertrophy C. Complications requiring implant removal D . Implant fracture and residual deformity E. Increased activity that was associated with selecting patients less than 40 years of age 10. Grumbine and co-workers found that intralesionaJ steroid injections: A. Provided subjective improvement in pain and inflammation, but significantly delayed wound healing B. Delayed wound heal ing that was associated with high doses of Celestone Soluspan C. Delayed healing that was found with both dexamethasone (in doses greater than 5 mg) and Celestone Solu span D . Delayed healing that was associated with steroid treatment , but only in immunocompromised patients E. Overall there was not a significant difference in wound healing based on treatment with intralesional steroids.