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Test yourself: MCQ and Extended Matching
MULTIPLE CHOICE QUESTIONS
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
3 Osteoarthritis and the inflammatory arthritides
1 Basic biomechanics and biomaterials
A
Gout is characterized by hyperuricaemia and monosodium urate crystal deposition; particularly the great toe, but commonly also in knee and ankle, wrist and hand.
When considering biomaterials
basic
biomechanics
When considering patients with osteoarthritis and the inflammatory arthritides
and
A
Dynamics is the science of pure motion, considered without reference to the objects moved, or to the force producing or changing the motion.
B
Calcium pyrophosphate arthropathy is the result of calcium pyrophosphate deposition in joint tissues which triggers inflammation in a similar way to gout.
B
Kinematics is the branch of mechanics that deals with the forces acting on an object and the changes they produce on the motion of the object.
C
Patients with rheumatoid arthritis develop joints which are chronically inflamed, and overgrown with a ‘tumourlike’ synovium (pannus) that destroys cartilage and bone.
C
Strain is the ratio between the deformation induced by the applied stress and the undeformed object.
D
D
The mechanical properties of most synthetic materials are uniform along any direction; such materials are defined as being isotropic as they exhibit the same stressestrain characteristics irrespective of the direction of loading.
Juvenile idiopathic arthritis (JIA) is significantly associated with chronic anterior uveitis and all children and young people with JIA should have regular ophthalmic screening.
E
The spondyloarthropathies (spondylitis, psoriatic, inflammatory bowel disease-associated and reactive arthritis) can all be associated with the HLA B27 tissue-type.
E
4 Metastatic tumours of bone
Fatigue is a phenomenon, in the presence of cyclic loading, whereby a material may fail at stress levels below the static yield stress.
For patients with metastatic tumours of bone A
About 10% of cancer patients develop metastases and a similar percentage have occult metastases, which manifest later.
B
The skeletal system is the second most common site for metastatic tumour spread, after the liver.
2 Disorders of bone metabolism When considering disorders of bone metabolism A
Osteoporosis is a condition of the mature skeleton characterized by impaired mineralization of bone.
C
B
Bisphosphonates are generally accepted as the firstline treatment for osteoporosis and several agents are licensed in most countries.
Prostate carcinoma is the commonest cause of metastatic deposits, and causes 50% of pathological fractures that are due to metastases.
D
Osteomalacia may be defined as a systemic skeletal disease characterized by reduced bone strength, resulting in an increased risk of fracture.
Analysis of osteolytic bone metastases indicates that the bone destruction is mediated by the osteoclast rather than directly by the tumour cells.
E
The 5-year survival rate for patients with metastatic thyroid, renal and prostate carcinoma is 30e40%.
C
D
E
The main actions of calcitriol are to increase intestinal absorption of calcium and phosphate and facilitate mineralization of bone.
5 Primary malignant tumours of the bone Theme: primary malignant tumours of the bone
Complications of Paget’s disease include the development of secondary osteoarthritis, fissure fractures and, very rarely, osteosarcomatous change (<1% of cases).
A
The tumour is composed of lobules separated by fibrous septae which contain strands, cords and solid nests of tumour cells. There is mild to moderate nuclear atypia and infrequent mitotic figures. see next page
SURGERY 30:2
92
Ó 2012 Published by Elsevier Ltd.
MULTIPLE CHOICE QUESTIONS
Questions cont. B
C
D
These tumours are divided into three grades of malignancy which correlate with prognosis. Grading is based on the features of cellularity, cytological atypia, chromasia and mitotic figures. This tumour is the prototypic malignant round cell tumour of childhood. Classically, it manifests as sheets of undifferentiated small round blue cells with a lack of distinct pattern, except for the occasional production of neuroectodermal type rosettes.
Accounts for less than 4% of this tumour type and is also a high-grade tumour. It usually arises in the metaphysis around the knee and may extend into the epiphysis in patients in the second decade of life.
F
This tumour is very similar to an osteosarcoma, but it does not produce osteoid. There are four types: undifferentiated sarcoma of bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma.
G
Osteosarcoma Telangiectatic osteosarcoma
3
Chondrosarcomas
SURGERY 30:2
6
Chordoma
7
Spindle cell sarcoma
C, D, E B, D, E All D, E 1-G, 2-E, 3-B, 4-D, 5-C, 6-A, 7-F
Answers to incorrect statements Question 1 A Kinematics is the science of pure motion, considered without reference to the objects moved, or to the force producing or changing the motion. B Dynamics is the branch of mechanics that deals with the forces acting on an object and the changes they produce on the motion of the object.
Question 2 A Osteomalacia is a condition of the mature skeleton characterized by impaired mineralization of bone. C Osteoporosis may be defined as a systemic skeletal disease characterized by reduced bone strength, resulting in an increased risk of fracture.
Question 4
When considering the primary malignant tumours of bone listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all. 2
Ewing sarcoma
1 2 3 4 5
The tumour is characterized by malignant mesenchymal cells that produce osteoid (immature bone), but can also contain variable amounts of cartilage and fibrous tissue matrix in variable proportion.
1
Mesenchymal chondrosarcoma
5
Answers
This tumour has a biphasic pattern with undifferentiated small round cells combined with islands of hyaline cartilage in various proportions. The majority of the tumour is composed of small, uniform, round to spindle cells arranged around vessels.
E
4
A About 30% of cancer patients develop metastases and a similar percentage have occult metastases, which manifest later. B The skeletal system is the third most common site for metastatic tumour spread, after the lungs and liver. C Breast carcinoma is the commonest cause of metastatic deposits, and causes 50% of pathological fractures that are due to metastases.
93
Ó 2012 Published by Elsevier Ltd.
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
3 Osteoarthritis and the inflammatory arthritides
1 Basic biomechanics and biomaterials
A
Gout is characterized by hyperuricaemia and monosodium urate crystal deposition; particularly the great toe, but commonly also in knee and ankle, wrist and hand.
When considering biomaterials
basic
biomechanics
When considering patients with osteoarthritis and the inflammatory arthritides
and
A
Dynamics is the science of pure motion, considered without reference to the objects moved, or to the force producing or changing the motion.
B
Calcium pyrophosphate arthropathy is the result of calcium pyrophosphate deposition in joint tissues which triggers inflammation in a similar way to gout.
B
Kinematics is the branch of mechanics that deals with the forces acting on an object and the changes they produce on the motion of the object.
C
Patients with rheumatoid arthritis develop joints which are chronically inflamed, and overgrown with a ‘tumourlike’ synovium (pannus) that destroys cartilage and bone.
C
Strain is the ratio between the deformation induced by the applied stress and the undeformed object.
D
D
The mechanical properties of most synthetic materials are uniform along any direction; such materials are defined as being isotropic as they exhibit the same stressestrain characteristics irrespective of the direction of loading.
Juvenile idiopathic arthritis (JIA) is significantly associated with chronic anterior uveitis and all children and young people with JIA should have regular ophthalmic screening.
E
The spondyloarthropathies (spondylitis, psoriatic, inflammatory bowel disease-associated and reactive arthritis) can all be associated with the HLA B27 tissue-type.
E
4 Metastatic tumours of bone
Fatigue is a phenomenon, in the presence of cyclic loading, whereby a material may fail at stress levels below the static yield stress.
For patients with metastatic tumours of bone A
About 10% of cancer patients develop metastases and a similar percentage have occult metastases, which manifest later.
B
The skeletal system is the second most common site for metastatic tumour spread, after the liver.
2 Disorders of bone metabolism When considering disorders of bone metabolism A
Osteoporosis is a condition of the mature skeleton characterized by impaired mineralization of bone.
C
B
Bisphosphonates are generally accepted as the firstline treatment for osteoporosis and several agents are licensed in most countries.
Prostate carcinoma is the commonest cause of metastatic deposits, and causes 50% of pathological fractures that are due to metastases.
D
Osteomalacia may be defined as a systemic skeletal disease characterized by reduced bone strength, resulting in an increased risk of fracture.
Analysis of osteolytic bone metastases indicates that the bone destruction is mediated by the osteoclast rather than directly by the tumour cells.
E
The 5-year survival rate for patients with metastatic thyroid, renal and prostate carcinoma is 30e40%.
C
D
E
The main actions of calcitriol are to increase intestinal absorption of calcium and phosphate and facilitate mineralization of bone.
5 Primary malignant tumours of the bone Theme: primary malignant tumours of the bone
Complications of Paget’s disease include the development of secondary osteoarthritis, fissure fractures and, very rarely, osteosarcomatous change (<1% of cases).
A
The tumour is composed of lobules separated by fibrous septae which contain strands, cords and solid nests of tumour cells. There is mild to moderate nuclear atypia and infrequent mitotic figures. see next page
SURGERY 30:2
92
Ó 2012 Published by Elsevier Ltd.
MULTIPLE CHOICE QUESTIONS
Questions cont. B
C
D
These tumours are divided into three grades of malignancy which correlate with prognosis. Grading is based on the features of cellularity, cytological atypia, chromasia and mitotic figures. This tumour is the prototypic malignant round cell tumour of childhood. Classically, it manifests as sheets of undifferentiated small round blue cells with a lack of distinct pattern, except for the occasional production of neuroectodermal type rosettes.
Accounts for less than 4% of this tumour type and is also a high-grade tumour. It usually arises in the metaphysis around the knee and may extend into the epiphysis in patients in the second decade of life.
F
This tumour is very similar to an osteosarcoma, but it does not produce osteoid. There are four types: undifferentiated sarcoma of bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma.
G
Osteosarcoma Telangiectatic osteosarcoma
3
Chondrosarcomas
SURGERY 30:2
6
Chordoma
7
Spindle cell sarcoma
C, D, E B, D, E All D, E 1-G, 2-E, 3-B, 4-D, 5-C, 6-A, 7-F
Answers to incorrect statements Question 1 A Kinematics is the science of pure motion, considered without reference to the objects moved, or to the force producing or changing the motion. B Dynamics is the branch of mechanics that deals with the forces acting on an object and the changes they produce on the motion of the object.
Question 2 A Osteomalacia is a condition of the mature skeleton characterized by impaired mineralization of bone. C Osteoporosis may be defined as a systemic skeletal disease characterized by reduced bone strength, resulting in an increased risk of fracture.
Question 4
When considering the primary malignant tumours of bone listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all. 2
Ewing sarcoma
1 2 3 4 5
The tumour is characterized by malignant mesenchymal cells that produce osteoid (immature bone), but can also contain variable amounts of cartilage and fibrous tissue matrix in variable proportion.
1
Mesenchymal chondrosarcoma
5
Answers
This tumour has a biphasic pattern with undifferentiated small round cells combined with islands of hyaline cartilage in various proportions. The majority of the tumour is composed of small, uniform, round to spindle cells arranged around vessels.
E
4
A About 30% of cancer patients develop metastases and a similar percentage have occult metastases, which manifest later. B The skeletal system is the third most common site for metastatic tumour spread, after the lungs and liver. C Breast carcinoma is the commonest cause of metastatic deposits, and causes 50% of pathological fractures that are due to metastases.
93
Ó 2012 Published by Elsevier Ltd.