Page 117SA Orthop J 2021;20(2)

CPD QUESTIONNAIRE. MAY 2021 VOL 20 NO 2

Treatment outcomes of civilian gunshot tibia fractures at a 
major trauma centre (Gerafa M, Jakoet S, Van Heukelum M,  
Le Roux N, Van der Merwe S, Makhubalo O, Du Preez G, 
Burger M, Ferreira N)
1. Choose the correct statement regarding the management 

of civilian gunshot-induced tibia fractures:
a. No association was found between clinical outcome and HIV 

status A

b. A staged approach is preferred over single-stage surgery B
c. Delay to surgery did not affect outcome in terms of union and 

infection C

d. Intramedullary fixation showed poor outcomes with union 
rates below 20% D

e. External fixation produced the best outcome in terms of 
union and infection E

2. Which fractures are most frequently identified in civilian 
gunshot-induced fractures involving tibial fractures in 
young males? 

a. Articular injuries to the knee A
b. Articular injuries to the ankle B
c. Diaphyseal injuries C
d. Proximal metaphyseal injuries D
e. Distal metaphyseal injuries E
3. What is the most common complication in civilian  

gunshot-induced tibia fracture? 
a. Malunion A
b. Compartment syndrome B
c. Fracture-related infection C
d. Nonunion D
e. Fat embolism syndrome E
The association between HIV infection and periprosthetic 
joint infection following total hip replacement in young adults 
(Ngwazi M, Ryan P, Goga I, Marais LC)
4. With regard to the use of cemented implant in the  

HIV-positive patient, the correct statement is:
a. Always use cemented implants to prevent infection A
b. There is no risk involved and it is acceptable to use 

uncemented implants B

c. The results are the same with cemented and uncemented 
implants C

d. There is an increased rate of stem subsidence with 
uncemented implants D

e. Cementation has shown an increase in wear in the short- to 
mid-term E

5. With regard to joint arthroplasty:
a. There is evidence to show that the use of prolonged 

antibiotic prophylaxis will reduce infection A

b. The use of cemented implants helps in the prevention of 
infection post-joint arthroplasty B

c. Well-optimised patients with regard to CD4/viral load and 
comorbidities will have same outcomes as HIV-negative 
patients

C

d. We should avoid arthroplasty in HIV-positive patients as it is 
associated with increased complication rates D

e. Arthroplasty should only be reserved for elderly HIV-positive 
patients with well-controlled comorbidities E

Adherence to a standard operating procedure for patients 
with acute cervical spine dislocations: review of a tertiary, 
referral, academic hospital in South Africa (Ayik GDD, 
Mukabeta TDM, Nyandoro G, Osborne C, Kruger NA)
6. According to this article, what is the most common 

mechanism of injury of cervical dislocations associated 
with high-risk catastrophic long-term disabilities if not 
treated and addressed well?

a. MVA only A
b. Fall only B
c. MVA and fall C
d. Diving injuries D
e. Violent assault E
7. Groote Schuur Hospital introduced the standard operating 

procedure protocol in 2016 for early reduction of acute 
cervical dislocation injuries. According to this protocol, 
reduction should be done within how many hours?

a. 3 A
b. 4 B
c. 5 C
d. 1 D
e. 6 E
8. To reduce the potential risk of acute cervical dislocation 

injuries as stated in this article, what is the best 
intervention? 

a. Anterior cervical decompression and fusion A
b. Posterior cervical decompression and fusion B
c. Early reduction using skeletal traction to realign the 

vertebrae C

d. Both A and B D
e. No intervention is needed, only conservative management E
Growth modulation may decrease recurrence when used as 
an adjunct to osteotomy in infantile Blount’s disease  
(Maré PH, Thompson DM, Marais LC)
9. The approximate recurrence rate after proximal tibial 

osteotomy and acute realignment in infantile Blount’s 
disease is:

a. 100% A
b. 80–100% B
c. 60–80% C
d. 40–70% D
e. 0–20% E

10. Which of the following factors are associated with 
recurrent deformity after proximal tibial osteotomy and 
acute realignment in infantile Blount’s disease?

a. Age at osteotomy greater than 4 to 5 years A
b. Langenskiöld stage ≥4 B
c. Medial physeal slope ≥60° C
d. LaMont stage ≥C D
e. All of the above E

SOUTH AFRICAN ORTHOPAEDIC JOURNAL 



Page 118 SA Orthop J 2021;20(2)

11. Which of the following strategies to decrease the 
recurrence rate after proximal tibial osteotomy and acute 
realignment in infantile Blount’s disease have been 
investigated?

a. Overcorrection to 5°–10° mechanical valgus alignment A
b. Lateral proximal tibial epiphysiolysis B
c. Postoperative ambulatory medial unloader knee bracing C
d. Medial proximal tibial epiphysiodesis D
e. Bisphosphonate therapy E
Polio-like deformity: a diagnostic dilemma (Ben Salem KA, 
Maré PH, Goodier M, Marais LC, Thompson DM)

12. Relating to polio vaccination, which statement(s) is/are 
true?

a. Vaccination has eradicated polio worldwide A
b. OPV cannot cause vaccination-associated paralytic 

poliomyelitis (VAPP) B

c. IPV has been associated with VAPP C
d. All of the above D
e. None of the above E
13. Clinical features of poliomyelitis include:
a. Over 90% are associated with acute flaccid paralysis A
b. Symmetrical lower motor neuron paralysis B
c. Tibialis anterior muscle is commonly involved C
d. All of the above D
e. None of the above E
Culturally competent patient–provider communication  
with Zulu patients diagnosed with osteosarcoma: an 
evidence-based practice guideline (Brown O, Van Rooyen 
DRM, Aldous C, Marais LC)

14. Cultural competence requires the application of:
a. Self-reflection skills for managing cultural differences A
b. Awareness, attitudes, knowledge and skills about cultural 

differences B

c. Knowledge of others’ prejudice and awareness of patients’ 
prejudice C

d. Expert care and detailed knowledge of the medical condition D
e. Communication skills that demonstrate knowledge of cultural 

bias E

15. When delivering prognostic information, it is recommended 
that:

a. Patients are informed regarding treatment limitations and 
poor prognoses A

b. Mortality timelines are specifically and clearly communicated B
c. Patients are not burdened with metastatic information C
d. Treatment limitations are not specified so that patients don’t 

lose hope D

e. Healthcare providers do not talk about death E
16. It is recommended that healthcare professionals 

demonstrate an understanding of patients’ cultural  
beliefs by:

a. Acknowledging patients’ need to discuss treatment with their 
family A

b. Encouraging patients to engage in their cultural traditions 
and rituals B

c. Encouraging patients to combine Western and traditional 
approaches C

d. Respecting patients’ cultural health beliefs and their desire to 
consult a traditional healer D

e. All of the above E
Chronic lateral ankle instability: a current concepts review 
(Mayet Z, Ferrao PNF, Saragas NP, Paterson R, Magobotha 
SKM, Alexander A, Eshragi H, Ettehadi H, Khademi MA, 
Mehtar M, Tladi MJ, Strydom A, Workman M)

17. Which statement regarding lateral ankle ligament injuries is 
incorrect?

a. This accounts for 85% of all ankle sprains A
b. Acute injuries are best managed conservatively B
c. This injury occurs when the foot is forced into inversion while 

the ankle is dorsiflexed C

d. Up to 20% of acute injuries can progress to chronic instability D
e. Chronic instability can be either mechanical or functional E

18. Which statement regarding functional instability is 
incorrect?

a. The patients complain of a perceived sense of instability A
b. These patients may have weak peroneal muscles B
c. These patients have decreased postural control C
d. These patients have a positive anterior drawer stress 

radiograph D

e. This can be caused by disruption of capsular 
mechanoreceptors E

Mycobacterium xenopi osteomyelitis of the spine: a case 
report (Ukunda FUN)

19. Which one of the statements is correct with regard to typical 
radiological spinal TB manifestations?

a. Two adjacent vertebrae irregularities or collapse on X-rays A
b. Double heart-shadow or ‘heart within a heart’ sign on 

thoracic spine is seen on lateral view X-rays B

c. MRI scan is mandatory in all spinal TB cases C
d. The disc is first to be affected in spinal M. tuberculosis 

infection D

e. Only follow-up X-rays are required in assessing disease 
progression and response to TB treatment E

20. Regarding M. xenopi, which one of the following statements 
is correct?

a. It is a rapid-growing, nonchromogenic or scotochromogenic 
nontuberculous mycobacterium (NTM) A

b. Increasingly, rRNA nucleic acid probe testing for M. xenopi is 
performed to confirm the diagnosis B

c. The microbiologic criterion for NTM of bones requires a 
positive culture from at least two separate tissue samples C

d. In HIV-reactive patients, low CD4 counts has no role to play D
e. A positive culture for M. xenopi cannot be a contaminant E

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