MCQ’S
1. All of the following causes make metaphysis the commonest area of osteomyelitis except?
I. Deficient phagocytes
II. Sluggish blood flow
III. Decreased blood flow
IV. Better collateral circulation
2. Which part of the vertebra is usually involved in Osteomyelitis?
i. Body
ii. Spinous process
iii. Lamina
iv. Pedicle
3. Most common organism causing osteomyelitis in Older children and adults?
i. Salmonella
ii. Pseudomonas A
iii. Streptococci A
iv. Staphylococcus A
4. Most common organism causing osteomyelitis in infants between 2 to 4weeks of age?
I. Staphylococcus Aureus
II. Haemophilus Influenzae
III. Group B Streptococci
IV. Pseudomonas Aeruginosa
5. When should Antibiotic therapy be started before surgery and when should it be repeated
intra operatively?
I. 60min and 4hrs
II. 30min and 2hrs
III. 60min and 2hrs
IV. 30min and 4hrs
6. Mortality rate associated with invasive MRSA ?
I. 30%
II. 20%
III. 40%
IV. 10%
7. ESR & CRP reaches peak value in how many days post infection?
I. 3-5days – ESR , 2days – CRP
II. 5-7days – ESR, 3days – CRP
III. 3-5days – ESR, 3days – CRP
IV. 5-7days – ESR, 2days – CRP
8. While taking a bone scan for osteomyelitis, uptake is noted in which amongst the flow (F),
immediate equilibrium (E) and delayed (D) phase?
I. All 3 phases
II. F & E, Decreased D
III. E & D, Decreased F
IV. D only
9. Best investigation for Chronic Osteomyelitis of axial skeleton ?
I. MRI
II. X-RAY
III. FDG – PET
IV. USG
10. Most common opportunistic disease associated with AIDS?
I. P. jiroveci pneumonia
II. Kaposi sarcoma
III. Candidiasis
IV. All of the above
11. Condition that can be mistaken for Osteomyelitis on plain radiograph?
I. Osteoid Osteoma
II. Ewings sarcoma
III. Paget’s disease
IV. Aneurysmal Bone cyst
12. Which of the following is not according to the Nade principles for treatment of Acute
hematogenous Osteomyelitis?
I. Antibiotics do not sterilize avascular tissue or abscess
II. An appropriate antibiotic is effective before abscess formation
III. Surgery should not damage further already ischemic bone and soft tissue
IV. If removal is effective, antibiotic should prevent reformation and primary wound
closure is not safe
13. Classification for subacute osteomyelitis was initially given and later modified by ?
I. Given by Robert and modified by Gledhill
II. Given by Gledhill and modified by Robert
III. Both given and modified by Gledhill
IV. Both given and modified by Robert
14. Cierny and Mader classification for Chronic Osteomyelitis is based on?
I. Anatomical type & Pathological type
II. Pathological type & Physiological class
III. Anatomical type & Physiological class
IV. Anatomical type, Pathological type and Physiological class
15. Most commonly employed antibiotics for use with PMMA beads?
I. Aminoglycosides
II. Cephalosporins
III. Beta Lactams
IV. None of the above
16. Not a criteria for diagnosing Chronic Recurrent Multifocal Osteomyelitis ?
I. No bone lesion mimicking osteomyelitis
II. 6 months or more of chronic and relapsing symptoms
III. Failure of response to atleast 1month of appropriate therapy
IV. Lack of other identifiable cause
17. A dead piece of bone is known as?
I. Involucrum
II. Sequestrum
III. Cloacae
IV. All of the above
18. Sabre Tibia is seen in?
I. TB Osteomyelitis
II. Syphilitic Osteitis
III. Rickets
IV. Paget’s disease
19. Involucrum is found
I. Underneath the sequestrum
II. Around the sequestrum
III. At metaphysis
IV. Beneath the periosteum
20. About sequestrum, not true is
I. Infection nidus
II. Lighter than live bone
III. Dead piece of bone
IV. Heavier than live bone & trabeculae
21. Bony ankylosis occurs with ?
I. TB Arthritis
II. Osetoarthritis
III. Rheumatoid Arthritis
IV. Pyogenic Arthritis
22. Acute suppurative arthritis is associated with all except
I. Maybe caused by penetrating wound
II. Maybe caused by by a compound fracture involving a joint
III. Maybe due to blood borne infection
IV. Causes the joint to be held in the position of ease
V. Tends to end with the formation of a fibrous ankylosis
23. Non-healing sinus is a common clinical feature of chronic osteomyelitis. The most common
cause for this is :-
I. Resistant organisms
II. Retained foreign body
III. Presence of sequestrum
IV. Intraosseous cavities
24. What test will be most sensitive for determining long term response to antibiotic therapy in
a child with diagnosis of hematogenous osteomyelitis?
I. MRI
II. ESR
III. BONE SCAN
IV. WBC COUNT
V. CRP
25. A 65/M with long standing osteomyelitis of right tibia, small vessel peripheral vascular
disease and DM presents with increasing drainage and pain from a sinus tract in his mid
tibia. He has received antibiotics, but there is no improvement, and drainage and pain is
becoming more severe. The best treatment option is ?
I. IV Antibiotics and observation
II. Local debridement and IV Antibiotics
III. Observation
IV. Amputation
26. The most common organism identified in bone cultures taken from patients with sickle cell
disease with osteomyelitis is:
I. Salmonella typhimurium
II. Haemophilus influenzae
III. Staphylococcus aureus
IV. Staphylococcus epidermis
27. Which of the following by itself is not an indication for surgery in a child with acute
hematogenous osteomyelitis:
I. Fever higher than 38.5°
II. Presence of a sequestrum
III. Subperiosteal abscess
IV. Adjacent septic arthritis
V. Intramedullary abscess
28. Chronic recurrent multifocal osteomyelitis is caused by which of the following:
I. Staphylococcus epidermidis
II. Spirochetal infection
III. Corynebacterium
IV. No organism has been isolated
V. Viral infection
29. Which of the following is the hallmark distinguishing feature of vertebral osteomyelitis when
compared to a neoplastic process on imaging:
I. Uniform enhancement after administration of gadolinium in the neoplasia
II. Lack of endplate involvement in the neoplastic process
III. Destruction of disk space and encroachment of adjacent vertebral body in vertebral
osteomyelitis
IV. There are no distinguishing radiographic features between vertebral osteomyelitis
and a tumor
V. Evidence of a compression fracture in vertebral osteomyelitis
30. Which of the following is the most common presentation of vertebral osteomyelitis:
I. Fever of unknown origin
II. Unrelenting back pain not relieved by rest
III. Lower extremity pain and weakness
IV. None of the above. It is usually an incidental finding during an unrelated work
V. Urinary incontinence
EMQ
(1) Organisms responsible for infected total hip replacements
1. Methicillin-resistant Staphylococcus aureus (MRSA)
2. Escherichia coli
3. Methicillin-sensitive Staphylococcus aureus
4. Salmonella
5. Enterococcus
6. Streptococci
7. Coagulase-negative staphylococcus
8. Klebsiella
9. Acinetobacter
10. Pseudomonas
From the list of options above, choose the most appropriate option for each of the following
scenarios. Each option may be used once, more than once or not at all.
1. The commonest infecting organism in total hip replacements.
2. The second commonest infecting organism in total hip replacements.
3. The third commonest infecting organism in total hip replacements.
(2) Mechanism of action of antibiotics used in orthopaedics
a. Aminoglycosides
b. Penicillins
c. Cephalosporins
d. Clindamycin
e. Imipenem/Meropenem f. Vancomycin
g. Tetracyclines
h. Macrolides
i. Fluoroquinolones
j. Rifampicin
k. Trimethoprim l. Linezolid
Which one of the options above is best described in each of the following statements? Each option
may be used once, more than once or not at all.
1. Inhibits DNA-dependent RNA polymerase and can give red-orange urine.
2. Blocks the attachment of aminoacyl-tRNA to the acceptor site on the 30S ribosomal subunit,
thus preventing prokaryotic protein synthesis.
3. Works as an antimetabolite by inhibiting dihydrofolate reductase.
(3) Organisms in orthopaedics
1. Methicillin-resistant Staphylococcus aureus
2. Pseudomonas aeruginosa
3. Brucella
4. Bartonella henselae
5. Staphylococcus epidermidis
6. Peptostreptococcus
7. Borrelia burgdorferi
8. Candida albicans
9. Treponema pallidum
10. Nocardia
11. Vibrio vulnificus
12. Streptococcus viridans
13. Pasteurella multocida
14. Eikenella corrodens
Which one of the options above is best described in each of the following statements? Each option
may be used once, more than once or not at all.
1. A 56-year-old female has recently had a dental procedure. She presents with an infected
total hip replacement which was performed 11 years ago.
2. A 24-year-old male presents to the emergency department with a ‘fight bite’ wound over
the middle finger metacarpal.
3. A 45-year-old male presents a red rash on his back and an effusion in his shoulder. The
causative organism is transmitted by the Ixodes tick.
(4) Osteomyelitis
1. Acute haematogenous osteomyelitis
2. Subacute osteomyelitis
3. Brodie’s abscess
4. Garre’s sclerosing osteomyelitis
5. Multifocal osteomyelitis
6. Tuberculous osteomyelitis
7. Epiphyseal osteomyelitis
8. Contiguous-focus osteomyelitis
9. Chronic osteomyelitis
10. B,C
Which one of the options above is best described in each of the following statements? Each option
may be used once, more than once or not at all.
1. An otherwise fit and well 11-year-old boy presents with a 3 month history of pain in his left
tibia and right clavicle. There is no history of trauma. The affected bones are tender and
warm to touch. Blood tests are normal apart from an elevated erythrocyte sedimentation
rate (ESR). Radiographs show radiolucent lesions in the tibia and clavicle with radiodense
borders and minimal periosteal reaction.
2. A 7-year-old girl presents with a 6 month history of a progressively painful limp. There is no
history of trauma. She is systemically well and has mild tenderness over the lateral aspect of
the right femur. White blood cell count, ESR and C-reactive protein (CRP) are normal.
Radiographs reveal a localized radiolucency in the right distal femoral metaphysis with
surrounding sclerosis.
3. A 17-year-old male presents with intense pain in his right lower leg, after recovering from a
recent infection of his right first molar. Localized tenderness is noted over the midshaft of
the right tibia. Radiographs show an ‘onion-skin’ appearance of the tibial diaphysis. A biopsy
rules out malignancy, but shows the presence of anaerobes.
(5) Causative pathogens
1. Salmonella
2. Herpes simplex virus
3. Streptococcus viridans
4. Group B streptococci
5. Staphylococcus aureus
6. Streptococcus pneumoniae
7. Neisseria gonorrhoeae
8. Haemophilus influenzae
9. Enterobacter
10. Mycobacterium tuberculosis
Which of the options above is best described in each of the following statements? Each option may
be used once, more than once or not at all.
1. Commonest pathogen causing bone and joint infections in the neonate.
2. Commonest pathogen causing bone and joint infections in a 5-year-old.
3. Commonest pathogen causing bone and joint infections in a patient with sickle cell disease.
