Page 184 SA Orthop J 2021;20(3)

CPD QUESTIONNAIRE. AUGUST 2021 VOL 20 NO 3

Positive patient experience of wide awake local anaesthesia 
no tourniquet (WALANT) hand surgery in the government 
setting: a prospective descriptive study (Naude JJ, Koch O, 
Schmidt LW, Le Roux TLB)
1. Techniques to decrease pain on injection include:
a. Pausing after 0.5 ml injection A
b. Staying within 10 mm of the indurated area with following 

injections B

c. Using a 27- or 30-gauge needle C
d. Adding 8.4 bicarbonate to the infiltration D
e. All of the above E
2. Select the false statement below:
a. Procaine usage in the 1950s caused isolated cases of finger 

ischaemia due to a low pH A

b. Clinical epinephrine can be used without inducing infarction B
c. Phentolamine, an alpha-blocker, reliably reverses 

epinephrine vasoconstriction in the finger C

d. Lignocaine and epinephrine infiltration in the finger has a 
high probability of causing finger infarction and necrosis D

e. In WALANT procedures, 1:100 000 epinephrine is used E
3. Select the false statement below:
a. LeBlanc et al. had a superficial infection rate of 0.4% and 

deep infection rate of 0% following minor hand surgical 
procedures outside of theatre in 1 504 patients

A

b. Outpatient minor hand procedures have an improved 
efficiency compared to in-theatre procedures B

c. Patients are given a resting period of 10 minutes to give the 
infiltration time to take effect C

d. Outpatient procedures may have a positive environmental 
impact by decreasing long-term refuse D

e. The safe limit of lignocaine injection is 7 mg/kg E
The prevalence of vascular injury utilising the lateral 
parapatellar approach for malignant distal femoral tumour 
resections: a case series (Van der Watt NP, Koch O,  
Le Roux TLB, Meijer JG, McLoughlin H)
4. Which one of the following malignancies does not occur 

frequently in the distal femur?
a. Chondrosarcoma A
b. Ewing’s sarcoma B
c. Conventional osteosarcoma C
d. Fibrosarcoma D
e. Telangiectatic osteosarcoma E
5. Which of the following surgical approaches has been 

considered to be the gold standard for distal femoral 
tumour resections?

a. Anteromedial A
b. Direct anterior B
c. Posteromedial C
d. Direct lateral D
e. Lateral parapatellar E

6. With regard to the lateral parapatellar approach for distal 
femur tumour resections, which of the following is not 
true?

a. Theoretical increased risk for vascular complications A
b. Decreased risk for inadequate soft tissue cover B
c. Potential to increase exposure to the greater trochanter C
d. The cruciate and collateral ligaments are spared D
e. An elliptical resection of the lateral biopsy site is performed E
The surgical management of metastatic lesions of the femur 
(Saini AK, Ferreira N)
7. What is the most common long bone destination of 

metastatic disease?
a. Humerus A
b. Femur B
c. Radius C
d. Tibia D
e. Ulna E
8. Simultaneous nailing of two or more long bones in the 

context of metastatic disease:
a. Can be performed safely if the medullary canals have been 

adequately reamed A

b. Can be performed safely if the patient has been receiving 
chemical thromboprophylaxis B

c. Is associated with a significant risk of intraoperative mortality C
d. Is associated with a significant risk of late postoperative 

death D

e. Is cost effective and allows for early mobilisation E
9. Which primary malignancy is associated with the worst 

five-year prognosis once bone metastasis has been 
diagnosed?

a. Lung A
b. Breast B
c. Thyroid C
d. Renal D
e. Prostate E
Correlation of the squat-and-smile test against other  
patient-reported outcome scores in knee pathology  
(Le Roux J, Dey R, Deichl AS, Torney O, Laubscher M, 
Graham SM, Held M)

10. The following score was not correlated with the squat-and-
smile test:

a. Tegner Lysholm score A
b. EQ-5D B
c. KOOS score C
d. WOMAC score D
e. None of the above E

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Page 186 SA Orthop J 2021;20(3)

11. The squat-and-smile test was originally developed to 
assess:

a. Knee pathology A
b. Hip pathology B
c. Femur shaft fracture union C
d. Tibia shaft fracture union D
e. Ankle pathology E
12. The individual component of the squat-and-smile test that 

showed the best correlation with the KOOS score was:
a. Depth of squat A
b. Need for arm support during squat B
c. ‘Smiley face’ during squat C
d. Duration of squat D
e. None of the above E
A computer tomography-based anthropomorphic study 
of forearm osteology: implications for prosthetic design 
(Pretorius HS, Ferreira N, Burger MC)

13. The radius of curvature refers to which structure in the 
anatomy of the radius?

a. The length of the radius (w) in the formula A
b. The height of the radius arc (h) B
c. The radius of the circle that the arc of the radius is a portion of C
d. The angle of the proximal radius D
e. The radial head size from side to side E
14. The proposed nail design will have a diameter of 4.5 mm, 

which is related to the:
a. Distal width of the radius for implantation A
b. Proximal ulna width for implantation B
c. Cortical thickness of the radius and ulna combined C
d. Combined minimum radius and ulna shaft diameter D
e. Radius of curvature of the radius E
15. The mean height of the distal radius is 23 mm and the max 

95% CI is 24. This has implications for:
a. Distal radius styloid screw length A
b. Distal radius maximum screw length for locking plates B
c. Shaft screw length for radius plates C
d. Correction of volar tilt in distal radius fixation D
e. Correction of radial height distal radius fixation E
Patella dislocations and patellofemoral instability: a current 
concepts review (Garrett BR, Grundill ML)

16. The MPFL is tightest in which position?
a. Deep flexion A
b. Full extension into early flexion B
c. Mid-flexion C
d. Completely isometric D
e. 30–60° flexion E

17. When using a lateral radiograph to access for patella alta, 
which ratio is least affected by the flexion position of the 
knee?

a. Blackburne-Peel ratio A
b. Insall-Salvati ratio B
c. Koshino ratio C
d. Caton-Deschamps ratio D
e. Blumensaats line E

18. A 19-year-old netball player presents with recurrent 
episodes of patellofemoral dislocations. After detailed 
assessment, her radiographic findings are as follows:  
TT-TG distance <20 mm, Dejour type A trochlear dysplasia, 
Caton-Deschamps index <1.2, and a patella tilt <20°. Which 
management strategy would be most appropriate?

a. Aggressive physiotherapy and re-assessment A
b. Isolated MPFL reconstruction B
c. MPFL reconstruction with associated tibial tubercle transfer C
d. MPFL reconstruction with associated trochleoplasty D
e. Isolated trochleoplasty E
Phosphaturic mesenchymal tumour, ‘non-phosphaturic’ 
variant: a case report and review of the literature (Wadee R, 
Linda Z, Ismail A)

19. Which of the following is false regarding phosphaturic 
mesenchymal tumours?

a. They are rare neoplasms that are usually associated with 
renal phosphate loss A

b. Tumour-induced osteomalacia (TIO) occurs secondary to 
excessive production of tumour-associated fibroblast growth 
factor-23 (FGF23)

B

c. Patients often present with nonspecific symptoms and signs 
of tumour-induced osteomalacia C

d. The majority of these tumours have been diagnosed in 
middle-aged adults D

e. Phosphaturic mesenchymal tumours are commonly 
diagnosed tumours E

20. Which of the following is correct?
a. Fibroblast growth factor-23 (FGF23) is a peptide that has an 

important role in phosphate reuptake in the kidneys A

b. Phosphaturic mesenchymal tumours are rare neoplasms that 
are never associated with renal phosphate loss B

c. The histogenesis of phosphaturic mesenchymal tumours is 
well-documented C

d. PMTs have a specific immunohistochemical profile D
e. Fibroblast growth factor-23 (FGF23) is a hormone that is 

only secreted by fibroblasts E

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