8.

MEQ

matrix no.........................

A lady accidently cut her right hand with a knife. There was transverse cut
along the distal palmer crease and she was unable to flex all 4 fingers. All
the digital nerves and arteries were intact.
a

Name the structures that were injured.

(2marks)
Answer Flexor digitorum superficialis and or Flexor digitorum profundus

What is the surgical treatment for this lady?

(1mark)

Answer - Flexor tendon repair/tenorrhaphy

How would you immobilise the injured hand post operatively and for how
long?
(2marks)
Answer POP dorsal slab and arm sling
Four to six weeks

9. MEQ

matrix no....................

A 15-year-old boy presented with history of fast growing, painful lump over
the distal part of his right thigh. The plain radiograph was suggestive of
malignant primary bone tumour.
a

Mention four radiological features of primary malignant bone tumours.

(2marks)
An ill-defined border with a broad zone of transition is a sign of aggressive growth
A periosteal reaction
Cortical destruction is a common finding, and not very useful in distinguishing between malignant
and benign lesions.

"Moth-eaten" and permeative patterns are indicative of destruction

involving both medullary and cortical bone. They are seen in highgrade
malignant neoplasms and in osteomyelitis.
He had MRI done as part on the management plan.
b

Mention four MRI data needed for treatment planning.

(2marks)
Answer soft tissue infiltration, skip lesion, extent of the wound,
neurovascular involvement

He was plan for limb salvage surgery.

c

Name two surgical procedures to reconstruct the limb.

(1mark)
Answer Total joint arthroplasty, Reconstruction by bone and
myocutaneous graft

10.MEQ

matrix no.........................

A young lady, a known case of SLE on steroid therapy for the last 3 years
presented with bilateral hip pain. She was diagnosed as bilateral avascular
necrosis of the femoral head (right side Ficats stage I; left side Ficats stage
IV).
a

Mention two hypotheses of the pathogenesis of AVN.

(2marks)
Answer Fat hypertrophy: the fat cells in the bone marrow become
hypertrophy, compress the blood vessels leading to circulatory
compromise with bone death
Vasculitis: autoimmune reaction in connective tissue disease
causes vasculitis in the blod vessels leading to bone necrosis

Describe the radiological changes in AVN stage IV.

(1mark)

Answer - radiolucency area following the collapse of subchondral bone

(crescent sign) and ringed regions of radiodensity resulting from
saponification and calcification of marrow fat following medullary infarcts

What is the surgical treatment for her right and left hip?
(2marks)
Answer Core decompression on right hip
THA for left hip

11.MEQ

matrix no.........................

A young man injured his left knee while playing football. He was diagnosed
clinically to have anterior cruciate ligament tear.
a

Mention two clinical tests to diagnose the above injury.

(1mark)
Answer Anterior drawer test
Lachmann test

Mention two investigations to confirm the above diagnosis.

(1mark)
Answer MRI
Arthroscopy

He was plan for ACL reconstruction surgery.

c

Mention two grafts that could be used for ACL reconstruction.

(2marks)
Answer Bone patellar tendon bone graft
Hamstring tendon/Quadriceps tendon/Semitendonosus tendon----

How long will the patient need to avoid contact sport post
reconstruction? (1mark)
Answer At least 9 months

12.MEQ

matrix no...........................

A 60-year old male was referred to rehabilitation medicine department with

complaint
of both knees pain for 3 years. He was diagnosed as having
osteoarthritis.
a. Mention the type of heat therapy he needs and name the heat therapy
you will prescribe.
(1
mark)
Answer- Deep heat therapy (0.5 mark)
Ultrasound / Shortwave diathermy (0.5mark)
b. Write 4 contraindications / precautions of heat therapy.
marks)

(2

Answer - Any 4 contraindications / precautions. 0.5 mark for each.

Acute inflamation, trauma or haemorrhage

Bleeding disorders
Ischaemia
Reduced sensation
Atrophic skin
Scar tissue
Inability to communicate
Malignancy
Edema

c. Name the muscle you need to train for stability of knee joints. What type
of exercise would you prescribe?
(1 mark)
Answer- Quadriceps muscle on both sides (0.5mark)
Strengthening exercise (Active resisted exercise) quadriceps static
exercise (0.5 mark)
d. The patient needs walking aid to reduce weight bearing. The patients
stability is good. His hand function and hand grip is normal. Name the
walking aid you would prescribe.
(1 mark)

Answer- Cane