Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) 2020 May Ortho Solved Question Paper
ofthefollowingnerverootscanget
compressed?
a)L5
b)S1
c)S2
d)S2-S4
e)L4
CorrectAnswer-A:E
Ans.is'a'i.e.,L5&'e'i.e.,L4
Likeateverylevel,therearetwonerverootsatL4-L5-exitingnerve
rooti.e.L4nerveroot&traversingnerverooti.e.L5nerveroot.
So,herniateddiscattheL4-L5level,cancreateanL5radiculopathy
oranL4radiculopathy,dependingonwherethedischerniation
occurs(tothesideortothebackofthedisc)andwhichnerverootis
affected:?
Posterolateral(paracentral)-mostcommon(90-95%),affectsthe
traversing/descending/lowernerverooti.e.L5nerveroot
Foraminal(farlateral,extraforaminal)-lesscommon(5-
10%),affectsexiting/uppernerverooti.e.L4nerveroot
2.Deformityassociatedwithposterior
dislocationofhipjoint?
a)Flexion
b)Extension
c)Abduction
d)Adduction
e)Internalrotation
CorrectAnswer-A:D:E
Ans.is'a'i.e.,Flexion,`d'i.e.,Adduction&'e'i.e.,Internal
rotation
Usually,theheadofthefemurisdislocatedposteriortothe
acetabulumwhenthethighisflexed,forexample,asmayoccurina
head-onautomobilecollisionwhenthekneeisdrivenviolently
againstthedashboard.
Thesignificantclinicalfindingsareshortening,adduction,and
internalrotationoftheextremity.
Anteroposterior,lateraland,iffractureoftheacetabulumis
demonstrated,obliqueradiographicprojections(Judetviews)are
required.
Commonassociatedinjuriesincludefracturesoftheacetabulumor
thefemoralheadorshaftandsciaticnerveinjury
3.Trueregardingachondroplasiais?
a)Autosomalrecessive
b)Disproportionatedwarfism
c)Subnormalintelligence
d)Bulletshapedvertebralbodiesonradiology
e)Abnormalsexualdevelopment
CorrectAnswer-B:D
Ans.is'b'i.e.,Disproportionatedwarfism&'d'i.e.,Bullet
shapedvertebralbodiesonradiology
ACHONDROPLASIA:
Achondroplasiaisadisorderofbonegrowththatpreventsthe
changingofcartilage(particularlyinthelongbonesofthearmsand
legs)tobone.
SYMPTOMS:
80%-99%ofpeoplehavethesesymptoms
Abnormalityofthemetaphysis
Abnormalityoftheribs
Antevertednares
Chronicotitismedia
Depressednasalbridge
Frontalbossing
Genuvarum
Hyperlordosis
Macrocephaly
Neonatalshort-limbshortstature
Rhizomelia
Wormianbones
30%-79%ofpeoplehavethesesymptoms
Abnormalformofthevertebralbodies
Conductivehearingimpairment
Dentalcrowding
Dentalmalocclusion
Diaphysealthickening
Hyperhidrosis
Intrauterinegrowthretardation
Jointhyperflexibility
Kyphosis
Longthorax
Midfaceretrusion
Muscularhypotonia
Narrowchest
Narrowsacroiliacnotch
Obesity
Obstructivesleepapnea
Ventriculomegaly
5%-29%ofpeoplehavethesesymptoms
Acanthosisnigricans
Deathininfancy
Dysarthria
Elbowdislocation
Hydrocephalus
Jointstiffness
Spinalcanalstenosis
Suddencardiacdeath
Percentofpeoplewhohavethesesymptomsisnotavailable
throughHPO
Autosomaldominantinheritance
Brachydactyly
Brainstemcompression
Flaredmetaphysis
Generalizedjointlaxity
Infantilemuscularhypotonia
Limitedelbowextension
Limitedhipextension
Lumbarhyperlordosis
Lumbarkyphosisininfancy
Malarflattening
Megalencephaly
Motordelay
Recurrentotitismedia
Shortfemoralneck
Smallforamenmagnum
Spinalstenosiswithreducedinterpediculardistance
Tridenthand
RADIOLOGICALFINDING:
Theinnercontourofthepelvishasatypical,classic"champagne
glass"appearance
Largeskullwithrelativelyshortbaseandanarrowandfunnel-
shapedforamenmagnum
Bulletshapedvertebralbodies
Longandshorttubularbonesareshortandthickwithapparent
increaseddiameter.
Metaphysisoflongbonesarewidenedandflared,physisare
notchedorV-shaped.
Thespinalcanalisnarrowwithdecreasedinterpediculardistanceas
oneproceedsfromLItoL5.
4.Signsofcompartmentsyndromeinclude?
a)Painonpassiveflexion
b)Painonactiveflexion
c)Swellingoffingers
d)Pallor
e)Paraesthesia
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Painonactiveflexion,'c'i.e.Swellingoffingers,
'd'i.e.Pallor&`e'i.e.Paresthesia
Clinicalfeaturesofcompartmentsyndrome
Foursignsarereliableindiagnosingacompartmentsyndrome:-
1. Paraesthesiaorhypesthesiainnervestraversingthecompartment
2. Painwithpassivestretchingoftheinvolvedmuscles(stretchpain)
3. Painwithactiveflexionofthemuscles
4. Tendernessoverthecompartment
Amongstthese,stretchpainistheearliestsignofimpending
compartmentsyndrome.Theischemicmuscles,whenstretched,
giverisetopain.
Passiveextensionoffingers(stretchingthefingers)producepainin
flexorcompartmentofforearm.
OtherfeaturesarePulselessness,paralysis,Pallorandpainoutof
proportiontophysicalfindings.
Peripheralpulses,arepresentinitiallyanddisappearlater.
Therefore,pulseisnotareliableindicatorforcompartment
syndrome.
5.Whichofthefollowingstatementis/are
correctaboutfracturemanagementin
children?
a)Supracondylarfractureofhumeruscanbemanagedbyclosed
reduction
b)Lateralcondylarfractureofhumerusisknownasfractureof
necessity
c)Lateralcondylarfractureofhumerusismanagedbyopen
reductionandscrewing
d)Forearmfractureinchildrencanbemanagedbyclosed
reductionandcasting
e)Femoralneckfractureinadultsismanagedbysurgeryand3
screws
CorrectAnswer-A:B:C:D:E
Ans.is'a'i.e.,Supracondylarfractureofhumeruscanbe
managedbyclosedreduction;'b'i.e.,Lateralcondylarfracture
ofhumerusisknownasfractureofnecessity;'c'i.e.,Lateral
condylarfractureofhumerusismanagedbyopenreduction
andscrewing,'d'i.e.,Forearmfractureinchildrencanbe
managedbyclosedreductionandcasting&`e'i.e.,Femoral
neckfractureinadultsismanagedbysurgeryand3screws
MANGEMENTOFSOMECOMMONPEDIATRICFRACTURES:
LOCATIONOF
TYPE
MANAGEMENT
FRACTURE
Undisplaced(Gartland's Immobilizationin
type1)
plasterfor3weeks.
Reduction(closed)
Reduction(closed)
Angulated(Gartland's
underanaesthesia
Supracondylar#of
type2)
followedby
humerus
percutaneouspinning.
Sameastype2/open
reductionifOpen
Completelydisplaced
(compoundfracture)
(Gartland'stypes3)
orassociatedvascular
injury(complicated
fracture).
Iffractureisstable:
Immobilizationin
aboveelbowcastin
90degreeflexion&
Lateralcondyle
undisplaced
neutralrotation.
fractureofhumerus
Iffractureisunstable:
Closedreductionand
percutaneouspinning
(kwirefixation)
Closedreductionand
Onlydisplaced
percutaneouspinning.
displacedandrotated ORIFwithscrews.
Shaftoftheforearm displacementis
Closedreductionand
bones
minimal
elbowcast
Conservative
treatmentby
immobilizationin
Undisplacedfractureor thomaskneesplint
valgusimpacted
Insitufixationwith
threeparallel
cannulatedscrews
(preferred)
Femurneck
<60years:CRIFwith
3parallelcannulated
screws>ORIF.
60-70years:CRIF
Displaced
Displaced
>70YEARS:Bipolar
hemiarthroplasty;AMR
Headisviable:Mc-
Murry'sosteotomy;
Meyer'sprocedure
Arthroplasty
Physiologicalage<65
:Bipolar
years
Head hemiarthroplasty
OLD>3WEEKS
not
orAMR.
viable Witharthritis:
Totalhip
replacement.
Bipolar
hemiarthroplastyor
Physiologicalage>65 AMR.
years
Witharthritis:Totalhip
replacement.
#ofdistalthirdof
radiuswith
Openreductionofthe
dislocationor
Galeazzifractures
radiusandthedistal
subluxationofinferior dislocation
radio-ulnarjoint.
(distal)radio-ulnar
joint
6.Allarefeaturesofinflammatoryarthritis
except?
a)Morningstiffness
b)X-rayshowingsclerosis
c)ElevatedESR
d)Weightgain
e)Swellingofjoints
CorrectAnswer-B:D
Ans.is`b'i.e.,X-rayshowingsclerosis&'d'i.e.,Weightgain
Featuresofinflammatoryarthritis:?
Presenceofsomeorallfourcardinalsignsofinflammation:
Erythema
Pain
Warmth
Swelling
Systemicsymptoms
1. Prolongedmorningstiffness,oftenlastingforseveralhours.(Non
inflammatoryarthritisareassociatedwithintermittentstiffness,
Stiffnessusuallylastslessthan1hr).
2. Fatigue
3. Fever
4. WeightLoss
Laboratoryevidenceofinflammation
1. ElevatedESR
2. Thrombocytosis
3. ElevatedCreactiveprotein
4. Anemiaofchronicdisease.
X-ray
X-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-ray
featuresinnon-inflammatoryarthritisrevealssclerosis.
7.Riskfactor(s)forLeg-Calf-Perthe'sdisease
is/are?
a)Acceleratedskeletalgrowth
b)Growthhormoneabnormalities
c)Positivefamilyhistory
d)Femalesex
e)Passivesmoking
CorrectAnswer-C:E
Ans.is'c'i.e.,Positivefamilyhistory&`e'i.e.,Passivesmoking
PERTHE'SDISEASE(LEGG-CALVEPERTHE'SDISEASE)
Perthe'sdiseaseisalsoknownasosteochondritisdeformans
juvenilisorCoxapianoorPseudocoxalgia.
Perthe'sdiseaseisanosteochondritisoftheepiphysisofthefemoral
head(capitalfemoralepiphysis).Inthedisease,thefemoralhead
becomespartlyorwhollyavascularanddeformed.Thedisease
occurscommonlyinmalesintheagegroupof5-10years.
Perthe'sdiseaseisthemostcommonform
ofosteochondrosis(osteochondrosisarecharacterizedbyavascular
necrosis(AVN)anddefectiveendochondralossificationofprimaryor
secondaryossificationcentres).
EtiologyofPerthe'sdisease
Theetiologyremainsunknown,butiscurrentlyacceptedthatthe
disorderiscausedbyaninterruptionofthebloodsupplytothe
capitalfemoralepiphysis,causingavascularnecrosis.
Riskfactors
RiskfactorsforLegg-Calve-Perthesdiseaseinclude:
Age.AlthoughLegg-Calve-Perthesdiseasecanaffectchildrenof
nearlyanyage,itmostcommonlybeginsbetweenages4and8.
Yourchild'ssex.Legg-Calve-Perthesisuptofivetimesmore
commoninboysthaningirls.
Race.Whitechildrenaremorelikelytodevelopthedisorderthan
areblackchildren.
Geneticmutations.Inasmallnumberofcases,Legg-Calve-
Perthesdiseaseappearstobelinkedtomutationsincertaingenes.
8.Allaretrueaboutsepticarthritisexcept?
a)Staphaureusisthemostcommoncause
b)MostcommoncauseisE.coli
c)Commoninchildren
d)Affectsgrowthplate
e)Aspirationofjointfluidusedfordiagnosis
CorrectAnswer-B
Ans.is'b'i.e.,MostcommoncauseisE.coli
Septicarthritis(Acutesuppurativearthritis)
Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionof
ajointbypyogenicorganism(bacteria).
Themicrobialspectrumisdiverseinsuppurativearthritis,but
staphylococcusaureusinfectionismostcommon.
Thejointcanbecomeinfectedby:?
1. Hematogenousspreadfromadistantsite(mostcommonroute).
2. Directinvasionthroughapenetratingwound,intraarticularinjection,
arthroscopy.
3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere
Metaphysisisintraarticulare.g.,hipandshoulder.
Clinicalfeatures
Diseaseismorecommoninchildren.
Kneejointisthemostcommonlyaffectedjoint.
Otherjointwhichareaffectedarehip,shoulderandelbow.
Thechildistoxicwithfever,tachycardia,tachypnea.
Thereisseverepain,swelling,andrednessoverthejoint.
Movementsareseverelyrestrictedandthejointisheldinthe
positionofease.
Weightbearingonlimbisnotpossible.
Diagnosis:
Aspiratedsynovialfluidinsepticarthritiswillhavemarkedly
increasedpolymorphonuclearleukocytes
9.Hangingcastisusedfor?
a)Femur#
b)Radius#
c)Humerus#
d)Tibia#
e)Fibula#
CorrectAnswer-C
Ans.is'c'i.e.,Humerus#
Cast/Brace UsedIn
Hangingcast&"Sugartong" Fractureshaft
orCoaptationsplints
humerus
Cylindercast
Fracturepatella
Minnervacast,Halodevice Cervicalspine
Risser'scast,Milwaukee
brace
Scoliosis
Bostonbrace
Palvicharness,VonRosen Congenital
splint,
(Developmental)
IlfeldorCraigsplint
DysplasiaofHip
Broomstick(Petrie)
cast,Snydersling,Pattern-
bottombrace,Torontobrace
withuniversaljoint,
LeggCalve-
Birminghambrace,
Perthes
Tachdjianbrace(trilateral
Disease
hipabductionorthosis),
Newingtonbrace,Atlanta
scottishRitebrace
10.Trueaboutacuteosteomyelitis?
a)CannotbedetectedonX-raybefore2weeks
b)Bonescandetectafter2weeks
c)Severepain
d)Secondaryosteomyelitisassociatedwithcompoundfractureis
morecommonthanprimaryvariety
e)Limitationofmovements
CorrectAnswer-C:E
Ans.is'c'i.e.,Severepain&`e'i.e.,Limitationofmovements
ACUTEOSTEOMYELITIS:
1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andmostcommonsourceofboneandjointinfectionis
hematogenous.
Clinicalfeatures:
Metaphysisoflongboneistheearliestandmostcommonsite
involved.
Mostcommoninchildren.
Thebonesmostcommonly:
Proximaltibial
Distalfemur
Proximalhumerus.
Features:
Severepain,fever,malaise,chills&rigors,sweating,andeven
shock.
Localtenderness(fingertiptenderness),raisedlocaltemperature,
Localerythemaandlimitationofmovements(typicallythelimbis
heldstill).
Diagnosis:
X-rays
Earliestsign:periostealreaction(periostealnewboneformation)at
themetaphysis,whichtakesabout7-10days.
Bonescan
Increaseduptakebyboneinmetaphysiswithin24hoursofonsetof
symptoms(earliestsign.
11.Correctstatementabouthandinfection?
a)OpeningofFelonbyfishmonthincisionispreferredincision
technique
b)Felonismiddlevolarpulpinfection
c)Apicalsubungualinfection-V-shapedpieceisremovedfromthe
centerofthefreeedgeofthenailalongwithalittlewedgeofthe
fullthicknessoftheskinoverlyingtheabscess
d)Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
e)None
CorrectAnswer-C:D
Ans.c.Apicalsubungualinfection-V-shapedpieceisremoved
fromthecenterofthefreeedgeofthenailalongwithalittle
wedgeofthefullthicknessoftheskinoverlyingtheabscess;
d.Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
Inapicalsubungualinfection:Fordrainage,asmallVshapedpiece
lsremovedfromthecentreofthatfreeedgeofthenailalongwitha
littlewedgeofthefullthicknessoftheskinoverlyingtheabscess.
Inacuteparonychia:Whenthepusextendsbeneaththenail,itis
necessarytoremovetheproximalone-thirdofthenailforadequate
drainage.
DONOTperforma"fishmouth"incisionsincethismayresultsin:
Unstablefingerpad,neuroma.,and/orlossofsensation"
Thefelonshouldbeincisedintheareaofmaximumswellingand
tenderness.
12.Whichofthefollowingarenotincludedin
Gurd'scriteria?
a)Centralnervoussystemdepressiondisproportionateto
hypoxaemia
b)Tachycardia<1l0bpm
c)Deepveinthrombosis
d)Axillaryorsubconjunctivalpetechiae
e)HypoxaemiaPao2<60mHg,Fio2=0.4
CorrectAnswer-C
Ans.c.Deepveinthrombosis
13.Cause(s)ofavascularnecrosisoffemoral
Head:
a)Fractureoffemoralneck
b)Steroiduse
c)alcoholuse
d)Sicklecelldisease
e)Caissondisease
CorrectAnswer-A:B:C:D:E
Answer:A,FractureoffemoralneckB,SteroiduseC,alcohol
useD,SicklecelldiseaseE,Caissondisease
Causeofavascularnecrosisoffemoralhead:
ldiopathic-commonest
Alcoholism
Steroidtherapy
Sicklecelldisease
Patientofrenaldialysis
Patientonanticancerdrug
Post-partumnecrosis
Goucher'sdisease
Caisson'sdisease
14.Spursignis/areseenin:
a)Supracondylarfractureofhumerus
b)Radialheadfracture
c)Acetabulumfractureofpelvis
d)Talusfracture
e)None
CorrectAnswer-C
Ans.(c)Acetabulumfractureofpelvis
Spurcells-Theyareirregularlydistortedredcellscontainingseveral
irregularlydistributedthornlikeprojections.
Cellswiththismorphologicabnormalityarealsocalled
acanthocytes.
TheyareseeninSplenectomisedpatientsandpatientswithliver
disease.
15.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year
b)Proximalfemurismostcommonsiteaffected
c)Pulmonarymetastasisoccurin<3%ofcases
d)Alocallyaggressivetumor
e)Mayinvolvesacrum
CorrectAnswer-A:C:D:E
Ans.a.Mostcommonagegroupaffectedis20-40year;c.
Pulmonarymetastasisoccurin<3%ofcases;d.Alocally
aggressivetumor;e.Mayinvolvesacrum
GCT:
Itperhapsrepresentsthemostaggressivebenigntumorand
threatensthetruedefinitionofabenigncancerbecausebenign
pulmonarymetastasisdevelopinapproximately1%to2%ofgiant
celltumors.
CLINICALFEATURES
Thetumourisseencommonlyintheagegroupof20-40yearsi.e.,
afterepiphysealfusion.
Thebonesaffectedcommonlyarethosearoundthekneei.e.,lower-
endofthefemurandupper-endofthetibia.
Lower-endoftheradiusisanothercommonsite.
Thetumourislocatedattheepiphysis.
Itoftenreachesalmostuptothejointsurface.
Commonpresentingcomplaintsareswellingandvaguepain.
Sometimes,thepatient,unawareofthelesion,presentsforthefirst
timewithapathologicalfracturethroughthelesion.
16.Allaretrueaboutanteriorcruciate
ligamentexcept?
a)Commonlyoccursasaresultoftwistingforce
b)MaybeassociatedwithSegondfracture
c)Rarelyassociatedwithmeniscalinjury
d)Lachmantestishighlysensitivetestfortear
e)None
CorrectAnswer-C
Ans.(c)Rarelyassociatedwithmeniscalinjury
Symptoms:
SignsandsymptomsofanACLinjuryusuallyinclude:
Aloud"pop"ora"popping"sensationintheknee
Severepainandinabilitytocontinueactivity
Rapidswelling
Lossofrangeofmotion
Afeelingofinstabilityor"givingway"withweightbearing
Complications
Higherriskofdevelopingosteoarthritisintheknee.Arthritismay
occurevenifyouhavesurgerytoreconstructtheligament.
Segondfractureduetoavulsionattheanterolateralcapsular
attachment.SegondfractureshaveaveryhighassociationwithACL
tearsand,meniscalinjuries
Diagnosis:
Injurytotearofanteriorcruciateligamentcanbedetectedusing
lachmanandanteriordrawertest.
Lachmanntestisasimilartesttoanteriordrawertestinwhich
anteriorglideofthetibiaisjudgedwiththekneein10-15degreesof
flexion.
17.Whichofthefollowingis/aretrueabout
Ewingsarcoma:
a)Vascularorigin
b)Ewing'ssarcomaissecondmostcommonprimarymalignant
bonetumourinchildrenafterOsteosarcoma
c)Metaphysisoflongboneismostcommonsite
d)Feverandweightlossmaybepresent
e)Surgeryisveryusefulinmanagement
CorrectAnswer-B:D
Ans.b.Ewing'ssarcomaissecondmostcommonprimary
malignantbonetumourinchildrenandadolescentafter
Osteosarcoma;d.Feverandweightlossmaybepresent
EwingSarcoma:
Ewing'ssarcomaarisesfromprimitiveneuroectoderm.
MostcommonSite:Femurdiaphysis>tibiadiaphysis
Clinicalfeatures:
Occursbetween10-20yearsofage.
Thepatientpresentswithpainandswelling.
Historyoftraumaprecedingonset,butitisusuallyincidental.
Oftenthereisanassociatedfever,inwhichcaseitmaybeconfused
withosteomyelitis.
Treatment
Thisisahighlyradio-sensitivetumourmeltsquicklybutrecurs.
Treatmentconsistsofcontroloflocaltumourbyradiotherapy,and
controlofmetastasisbychemotherapy.
Themostcommonprimarymalignantbone
tumorsareosteosarcoma(35%),chondrosarcoma(25%),and
Ewing'ssarcoma(16%).
Lessfrequently(5%)occurringtumorsarechordoma,malignant
fibroushistiocytomaofbone,andfibrosarcomaofbone.
Themostcommonmalignantpediatricbonetumors
includeosteosarcomaandEwingsarcoma.
18.Whichofthefollowingis/areindicationof
surgicalmanagementoffractureofshaft
ofhumerus:
a)Fractureinelderly
b)Radialnerveinvolvementaftermanipulation
c)Pathologicalfractures
d)Vascularinjury
e)Multiplefractures
CorrectAnswer-B:C:D:E
Ans.(b)Radialnerveinvolvementaftermanipulation,(c)
Pathologicalfractures,(d)Vascularinjury,(e)Multiplefractures
FracturedShaftofHumerus:OperativeTreatment-Indications:
Severemultipleinjures:
Anopenfracture.
Segmentalfractures.
Displacedintra-articularextensionofthefracture
Apathologicalfracture.
Afloatingelbow(simultaneousunstablehumeralandforearm
fractures)
Radialnervepalsyaftermanipulation.
Non-union
Problemswithnursingcareinadependentperson
19.PiraniscoringofCTEVincludesall
except?
a)Curvatureofthemedialborderofthefoot
b)Severityofthemedialcrease
c)Positionofthelateralpartoftheheadofthetalus
d)Emptinessoftheheel
e)Severityoftheposteriorcrease
CorrectAnswer-A
Ans.(a)Curvatureofthemedialborderofthefoot
PIRANISCORING
ThePiraniscoreisasimple,easytousetoolforassessingthe
severityofeachofthecomponentsofaclubfoot.
PiraniScoring:
Thecomponentsarescoredasfollows:
Eachcomponentmayscore0,0.5or1
Hindfootcontracturescore(HCFS):
Midfootcontracturescore(MFCS):
1. Posteriorcrease
2. Emptyheel
3. Rigidequinus
Midfootcontracturescore(MFCS):
1. Medialcrease
2. Curvatureoflateralborder
3. Positionofheadoftalus
20.TrueabouttuberculosisofSpine:
a)Middlepathregimenisusedinmanagement
b)Posteriorelementsofthespineismostcommonlyaffected
c)Commonlyspreadbyhematogenousroutefromlung
d)Acuteonsetparaplegiahasworseprognosis
e)Lowerthoracicandupperlumbarismostcommonsite
CorrectAnswer-A:C:E
Ans.a.Middlepathregimenisusedinmanagement;C.
Commonlyspreadbyhematogenousroutefromlunge.Lower
thoracicandupperlumbarismostcommonsite
Route:
Lymphogenousandhematogenousspreadhasbeenimplicated.in
thoracolumbarlesions.
Site:
UpperthoracicspinelsthemostcommonsiteofspinalTBin
children,thelowerthoracicandupperlumbarvertebraeareusually
affectedinadults
Paradiscalisthecommonesttype.
Acuteonsetparaplegiahasabetterprognosis
Management:
1. Rest,
2. DrugsIntensivePhase:HRO(5-6months);ContinuationPhase:HZ
(3-4months)+HR(4-5months);ProphylacticPhase:HE(4-5
months),
3. RadiologicalFollow-up(X-ray,MRI),d.GradualMobilisation+/-
Spinalbraces.managementofAbscess/Sinuses,
4. ManagementofNeurologicalcomplications
5. Surgery(ExcisionalsurgeryDefinitiveSurgery:IndicationofSurgery
inPott'sspine),
6. Post-operativecare
21.A70yearoldladygotcompression
fractureofL1vertebra.Thereisno
neurologicaldeficittothispatient.What
advisewillyougiveforthisPatient:
a)VitaminDsupplementation
b)DoMRIscan
c)GoforscrewfixationofL1vertebra
d)TotakeDexamethasone
e)TotakeAlendronate
CorrectAnswer-A:E
Ans.a.VitaminDsupplementation;e.TotakeAlendronate
Itisacaseofosteoporoticfractureoflumbarspine
Treatmentcanbedividedintomedical&preventive.
Medical:
Highproteindiet,androgen,estrogen,VitaminD,fluoride,
alendronate,calcitonin,teripratide,denosumab&strontium(bothare
antiresorptiveagent).
Orthopaedictreatment:Exercise&Bracing(ASHbraceorTaylor
brace)
22.Forassessingtheinjuryofmeniscusof
kneejoint,whichofthefollowingtest
is/aredone:
a)Apley'stest
b)Lachmanntest
c)McMurray'stest
d)Thessalytest
e)Hamiltonrulertest
CorrectAnswer-A:C:D
Ans.a.Apley'stest;c.McMurray'stest;d.Thessalytest
TestsforMeniscalInjuries?
Apley'sgrindingtest:formeniscusinjury
McMurray'stest-Thisclassictestforatornmeniscusisseldomused
nowthatthediagnosiscaneasilybemadebyMRI.Apositivetestis
helpfulbutnotpathognomonicanegativetestdoesnotexcludea
tear.
Thessalytest:Thistesthasshownahighdiagnosticaccuracyrate
atthelevelof95%indetectingmeniscaltears
23.TrueaboutColle'sfracture:
a)Occuratdistalendofradius,about2cmfromdistalarticular
surface
b)Fracturealsoinvolvesradiocarpaljoint
c)Fracturealsoinvolvesproximalradioulnarjoint
d)Causeulnardeviation
e)Commoninwomen
CorrectAnswer-A:E
Ans.a.Occuratdistalendofradius,about2cmfromdistal
articularsurface;e.Commoninwomen
Colle'sFracture:
ThisisaFractureatthedistalendoftheradius,atits
corticocancellousjunction(about2cmfromthedistalarticular
surface),inadults,withtypicaldisplacement.
Itnearlyalwaysresultsfromafallonanout-stretchedhandcItis
commonestfractureinpeopleabovefortyyears
Particularlycommoninwomenbecauseofpostmenopausal
osteoporosis.
Displacement-dorsaldisplacement,dorsaltilt(mostcharacteristic),
lateraldisplacement,dorsaltilt,supination&impactionoffragments
Complication:Dinnerforkdeformity&Subluxationoftheinferior
radio-ulnarjoint(distalradiocarpaljoint)
Itismostcommonofallfractureinolderpeople.
24.Whichofthefollowingis/aretrueabout
simplebonecyst:
a)Mostcommonlyoccurinadult
b)Commonestsiteistheupperendofthehumerus
c)Cortexmaybethin
d)Causepathologicalfracture
e)Noriskofrecurrenceafterremoval
CorrectAnswer-B:C:D
Ans.b.Commonestsiteistheupperendofthehumerusc.
Cortexmaybethind.Causepathologicalfracture
SimpleBoneCyst(Alsok/aSolitaryorUnicameralCyst)
ltappearduringchildhood,inmetaphysisinoneofthelongbones&
mostcommonlylnproximalhumerusorfemur.
ltisnotatumour,ittendtohealspontaneously.
Itisseldomseeninadult
Thisconditionisusuallydiscoveredafterapathologicalfractureor
asanincidentalfindingonX-ray.
X-rayshowsawelldemarcatedradiolucentareainthemetaphysis
oftenextendinguptothephysealplate;thecortexnaybethinned&
theboneexpanded
Treatmentdependsonwhetherthecystissymptomatic,actively
growingorinvolvedinafracture
25.Trueaboutankylosingspondylitis:
a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all
CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint
isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
diminishedchestexpansion(normal_5cm)
Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
ftLossofthelumbarlordosis.
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance
26.Trueaboutboutonnieredeformity:
a)Flexionofproximalinterphalangealjoint&hyperextensionof
distalinterphalangealjoint
b)Hyperextensionofproximalinterphalangealjoint&flexionof
distalinterphalangealjoint
c)Flexionatproximalinterphalangeal&extensionat
metacarpophalangealjoint
d)Flexiondeformityoftheproximalinterphalangealjointoccur
duetotearincentralslipofextensortendon
e)Mayoccurinrheumatoidarthritis
CorrectAnswer-A:D:E
Ans.a.Flexionofproximalinterphalangealjoint&
hyperextensionofdistalinterphalangealjoint;d.Flexion
deformityoftheproximalinterphalangealjointoccurdueto
tearincentralslipofextensortendon;e.Mayoccurin
rheumatoidarthritis
Boutonnieredeformityisadeformedpositionofthefingersortoes,
inwhichthejointnearesttheknuckle(theproximalinterphalangeal
joint,orPIP)ispermanentlybenttowardthepalmwhilethefarthest
joint(thedistalinterphalangealjoint,orDIP)isbentbackaway(PIP
flexionwithDIPhyperextension).
Itcanbecausedbyacutonthetopofthefinger,whichcansever
thecentralslip(tendon)fromitsattachmenttothebone.Thetear
lookslikeabuttonhole("boutonni?re"inFrench).Insomecases,the
boneactuallycanpopthroughtheopening.
Boutonni?redeformitiesmayalsobecausedbyarthritis.
27.Trueaboutapplyingaplasterisare?
a)Takenoutfromwateroncebubblesstartcoming
b)Takenoutfromwateroncebubblesstopcomingout
c)Settingisdelayedincoldwater
d)Cottonpaddingisoverlappedbyonethird
e)Molding/smoothingofplasterisdonebyfingers
CorrectAnswer-B:C:D
Ans.is'b'i.e.,Takenoutfromwateroncebubblesstopcoming
out;'c'i.e.,Settingisdelayedincoldwater;'d'i.e.,Cotton
paddingisoverlappedbyonethird
Forsecuring,eachturnisoverlappedbyonethirdtoonehalfin
ordertosecurelayers.
Ifabandageisimmersedincoldwatertheinitialsetwillbedelayed
andthus"workingtime"lengthened.However,ifaveryrapidis
requiredsoakingthebandageinwarmwaterwillacceleratetherate
ofreaction.
Mouldingofthebandagestothecontoursofthelimbshouldbedone
byconstantsmoothingwiththepalms(notbyfingers)ofthewet
hands.
28.RadiologicalfeaturesofPerthe'sdisease
is/are?
a)Decreasedmedialjointspace
b)Lateralsubluxation
c)VerticalPhysis
d)Speckledcalcification
e)Widefemoralneck
CorrectAnswer-B:D:E
Ans.is,b'i.e.,Lateralsubluxation;'d'i.e.,Speckled
calcification&'e'i.e.,Widefemoralneck
Radiologicalfindingsinperthe'sdiseaseare:-
Increasedmedialjointspace
Wideningoffemoralneck
Lateralextrusion(lateralsubluxation)
Metaphysealcystsandrarefactionofmetaphysis
Horizontalphysiswithspeckledcalcifcationlateraltoit
Fragmentationoffemoralheadwithincreaseddensity(irregular
densitiesintheepiphysis).
29.Latecomplicationofsupracondylar
fractureis?
a)Ulnarnervepalsy
b)Cubitusvarus
c)Cubitusvalgus
d)Myositisossificans
e)Volkmann'sischemiccontracture
CorrectAnswer-B:D:E
Ans.'b'1.e.,CubitusVarus'd'i.e.,Myositisossificans'e'i.e.,
Volkmannischemiccontracture
LateComplications:
Occurringweekstomonthsafterthefractureandinclude:
Malunion:-Itisthecommonestcomplicationofsupracondylar
fractureandresultsincubitusvarus(Gunstockdeformity),Cubitus
valgusisrareandmayoccuroccasionallyinposterolateral
displacement.
Myositisossificansandelbowstiffness.
Volkmann'sischemiccontracture
30.Complication(s)offractureoflateral
condylehumerusis/are?
a)Cubitusvarusdeformity
b)Tardyulnarnervepalsy
c)Cubitusvalgusdeformity
d)Mediannerveinjury
e)Non-union
CorrectAnswer-A:B:C:E
Ans.is'a'i.e.,Cubitusvarusdeformity'b'i.e.,Tardyulnarnerve
palsy;'c'i.e.,Cubitusvalgusdeformity;'e'i.e.,Non-union
ComplicationsofLateralcondyleofhumerusfracture
Lateralspur
Cubitusvalgus
Rarely,cubitusvarus
Tardyulnarnervepalsy
Rarelyavascularnecrosisandmyositisossificans
Posterolateralinstabilityandrecurrentinstability
31.Followingaretrueregardinghangmans
fracture?
a)FractureofspinousprocessofC7
b)FractureofC2vertebra
c)Listhesisofthefracturevertebra
d)Knotisplacedundernapeofneck
e)None
CorrectAnswer-B:C
Ans.is'b'i.e.,FractureofC2vertebra;'c'i.e.,Listhesisofthe
fracturevertebra
Hangman'sfracture
Hangman'sfractureisbilateralfractureoftheparsinterarticularisof
axis(C2)withtraumaticspondylolisthesisofaxis(C2)over
C3vertebrae.ThusHangman'sfractureisnotsimplyafracture,but
fracturedislocationofaxis(C2).
Themechanismofinjuryisextensionwithdistraction(intrue,judicial
hangman'sfracture)andhyper-extension,axialcompression&.
flexion(incivilianinjuries,whicharenowmorecommon).
ItissecondmostcommontypeofAxis(C2)fracture,secondonlyto
odontoidfractures.
Fatalatiesarecommon,However,neurologicaldeficitisunusualas
thefractureofposteriorarchdecompressthespinalcord.
Mostofthefatalitiesoccuratthesceneofinjury,acutepost
admissionmortalityislow.
SuccessfulhealingofC2traumaticspondylolisthesisisreportedto
approach95%.Thisismostcommonlyachievedwithnon-operative
measures,eveninthepresenceofdisplacementofparsinter-
articularis.
Undisplacedfracturesaretreatedinasemi-rigidorthosis,and
displacedfractureareclosedreduced&treatedwithhalo-vest.
Occasionally,thehangman'sfractureisassociatedwithaC2/3facet
dislocation.Thisisaseverelyunstableinjury;openreductionand
stabilizationisrequired.
32.Trueaboutkeinbock'sdiseaseis/are?
a)AVNofscaphoid
b)Morecommoninmales
c)Maybeassociatedwithcerebralpalsy
d)Stage-IshowsnormalX-ray
e)Maycausecarpaltunnelsyndrome
CorrectAnswer-B:C:D:E
Ans.b)Morecommoninmalesc)Maybeassociatedwith
cerebralpalsyd)Stage-IshowsnormalX-raye)Maycause
carpaltunnelsyndrome
Keinbock'sdisease:
Itisavascularnecrosisoflunatebone.Itisrelatedtooveruseand
ulnarnegativewristvarianceandmaybeassociatedwithsicklecell
anemia,steroidabuse,goutandcerebralpalsy.
Itusuallyoccursin2ndto5decadewithmalepreponderance'
Patientscomplainsofdorsalwristpain,swelling,warmth,
tendernessovertheradiolunatejointreducedROManddecreased
gripstrength.
Complications:
Stiffness
Lossofmotion
Weakness
Carpaltunnelsyndrome
Persistentpain
Instability
Degenerationinadjacentjoints
33.Trueaboutlocation(s)oftumoris/are?
a)Osteosarcomaisdiaphyseal
b)Ewingsarcomaisdiaphyseal
c)Chondrosarcomaismetaphyseal
d)Fibrosarcomaisdiaphyseal
e)Osteoclastomaisepiphyseal
CorrectAnswer-B:C:D:E
Ans.b)Ewingsarcomaisdiaphysealc)Chondrosarcomais
metaphyseald)Fibrosarcomaisdiaphyseale)Osteoclastoma
isepiphyseal
Epiphysealtumor:
Chondroblastoma
Giantcelltumor(osteoclastoma)
Clearcellchondrosarcoma
Metaphyseallesion:
Osteogenicsarcoma.
Unicameral(simple)bonecyst.
Aneurysmalbonecyst.
Fibrouscorticaldefect.
Chondrosarcoma
Osteochondroma
Enchondroma.
Osteoblastoma
Diaphyseallesion:
Ewingsarcoma
Lymphomas
Fibrousdysplasia
Adamantinoma
Histiocytosis
Osteoidosteoma
Chondromyxoidfibroma
Fibrosarcoma
Fibrouscorticaldefect
Nonossifyingfibroma
34.A28yearsoldladypresentedwithwrist
pain.X-raywristisshowinglyticeccentric
lesioninlowerendofradiuswithsoap
bubbleappearance.Whatisthenextplan
ofmanagement?
a)Bonecurettageandbonegrafting
b)Extendedcurettagewithphenol
c)Biopsyofthelesion
d)Extendedcurettagewithphenolandbonegrafting
e)Parathyroidandserumcalciumlevelsmeasurement
CorrectAnswer-C
Ans.is'c'1.e.,Biopsyofthelesion
28yearsfemalewithlyticeccentriclesioninlowerendofradiusand
soapbubbleappearancesuggestthediagnosisofGCT.
Nextplanofmanagementwouldbebiopsyoflesiontoconfirmthe
diagnosis.
35.Trueaboutthesitesinvolvedin
osteomyelitisis/are?
a)Mainlyinvolvesmetaphysis
b)Distaltibiaisinvolvedcommonly
c)Proximalhumerusisinvolvedcommonly
d)Proximalfemurisinvolvedcommonly
e)Reachestositebyhematogenousroutes
CorrectAnswer-A:C:E
Ans.is,a,i.e.,Mainlyinvolvesmetaphysis;'c'i.e.,Proximal
humerusisinvolvedcommonly'e'i'e',Reachestositeby
hematogenousroute
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andalmostcommonsourceofboneandjointinfectionis
hematogenous.
Itiscausedmostcommonlybystaphylococcusaureus.
Othercausativeorganismsarestreptococcus,pneumococcus,and
gramnegativebacilli.
Infectionbypseudomonasbecomesproportionallymuchmore
commoninIVdrugabuser.But,themostcommonorganismis
staphylococcusaureus.
36.Compoundpalmarganglioniscausedby
?
a)Trauma
b)Overuse
c)RA
d)TB
e)SLE
CorrectAnswer-C:D
Ans.is'c'i.e.,RA'd'i.e.,TB
Rheumatoidarthritisandtuberculosisarethecommonestcauses.
Tubercularandrheumatoidcompoundpalmerganglionis
characterizedbypresenceofricebodies,milletbodiesandmelon
seeds.
37.Trueaboutcompoundpalmarganglion?
a)Duetodegenerationofflexorretinaculum
b)Hour-glassinshape
c)Surgeryisthemainstayoftreatment
d)Intrasynovialsteroidisthemainstayoftreatment
e)Maybeseeninrheumatoidarthritis
CorrectAnswer-A:D
Ans.is'a'i.e.,Duetodegenerationofflexorretinaculum;'d'i.e.,
Intrasynovialsteroidisthemainstayoftreatment
Compoundpalmarganglionisamisnomerbecauseitisneithera
ganglionnorcompound.
Chronicinflammationdistendsthecommonsheathofflexortendons
bothaboveandbelowtheflexorretinaculum.
Thereishourglassswelling,bulgingaboveandbelowtheflexor
retinaculum
Tubercularandrheumatoidcompoundpalmerganglionis
characterizedbypresenceofricebodise,milletbodiesandmelon
seeds
Rheumatoidarthritisandtuberculosisarethecommonestcauses.
38.Apersonhasinjuryondorsalsurfaceof
proximalinterphalangealjointofright
middlefinger.Whichofthefollowingcan
occur
a)Ruptureoflateralligament
b)Buttonholedeformity
c)Malletfinger
d)Lacerationofthecentralslipoftheextensor
e)Noneoftheabove
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Ruptureoflateralligament;'b'i.e.,Buttonhole
deformity;'d'i.e.,Lacerationofthecentralskipoftheextensor
Injurytodorsalsurfaceofproximalinterphalangealjoint(zone
II)maycause:-
Ruptureofcentralslipofextensorexpansion-causingButtonhole
deformity.
ThisresultsinlossofactiveextensionofthePIPjointandpersistent
flexionofthePIPjoint.
AnteriordislocationofPIPjointmaycauseruptureofbothcentral
clipaswellaslateralligament.
39.Trueaboutpectusexcavatum
a)Morecommoninfemale
b)Inseverecases,mitralvalveprolapsemayoccur
c)Maybepresentatbirth
d)Seeninmarfansyndrome
e)Impairmentofrespiratoryfunction
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Inseverecases,mitralvalveprolapsemayoccur;
'c'i.e.,Maybepresentatbirth;'d'i.e.,SeeninMarfansyndrome
i'e'i.e.,Impairmentofrespiratoryfunction
PectusExcavatum
Alsocalledfunnelchest'isthemostcommonchestwalldeformity.
Malesareaffectedmorethanfemales(4:1).
Pectusexcavatumarisesfromimbalancedorexcessivegrowthof
thelowercostalcartilages.
Typicallythedefectisdiagnosedwithinthefirstyroflifeand
worsensovertime.
Depressionmayrangefrommildlydepressedsternumtosternal
depressionabuttingthevertebralcolumnwithdisplacementsof
mediastinalstructures.
OtherconditionsassociatedwithPectusExcavatum:
Scoliosis
Marfan'ssyndrome
Mitralvalveprolapse
Congenitalheartdiseases
40.Inponsetitechniquelastdeformityinto
getcorrectedinCTEV-
a)Equinus
b)Talipus
c)Varus
d)Cavus
e)Alldeformitycorrectedsimultaneously
CorrectAnswer-A
Ans(a)Equinus
Ponseti'stechnique
Thisinvolvesfirstcorrectingthecavusdeformitythentheadduction
andheelvarusandfinallytheequinusdeformity.
ThistechniqueisnowmostlyacceptedtechniqueforCTEV
correctionasitisbasedonbetterunderstandingofthe
pathoanatomyofthedeformedfoot.
Thesuccessofreductionis90-98Percent.
41.Trueaboutavascularnecrosisoffemur
a)Affectedsidehipallowsweightbearing
b)Asymptomaticcasesmayoccur
c)Radionucleotidescanshowincreaseduptakeduetonewbone
formationintheareaaroundtheinfarct
d)Trendelenburgsigninnegative
e)Noneoftheabove
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Affectedsideofhipallowwt.bearing;'b'i.e.,
Asymptomaticcasesmayoccur&'c'i.e.,Radionucleotidescan
showincreaseduptakeduetonewboneformationinthearea
aroundtheinfarct
CausesofAVN
ldiopathic(mostcommon)
Infection-septicarthritis,osteomyelitis
Hematologicalmalignancies-leukemia,lymphoma
Alcohol,corticosteroids
SLE
Pregnancy
Cassionsdisease
Hyperlipidemia
Perthesdiseas
Ionisingradiation
CLINICALFEATURES:
Pain
Deceaserangeofmotionespeciallyinternalrotationfollowedby
abduction.
SectoralsignorDifferentialrotation:-Internalrotationispossiblein
extendedpositionofhip,butasseenasthehipisflexedto900no
internalrotationispossible.ThisisthecharacteristicsignofAVN.
Trendelenburg'stestpositive
Radiologicalfindings:
MRIisthemostreliablewayofdiagnosingmarrowchangesand
boneischaemia
42.Trueaboutganglioncyst?
a)Mostcommoninyoungmale
b)Containsynovialfluid
c)Arisefromextensorretinaculum
d)Itusuallyarisefromthelunotriquetraljoint
e)Surgicaltreatmentisexcisionofcyst
CorrectAnswer-B:E
Ans.is'b'i.e',Containsynovialfluid;'e'i.e.,Surgicaltreatmentis
excisionofcyst
Aganglionisthecommonestcysticswellingattheback(Dorsal
aspect)ofthewrist.
Unilocularcyst
Arisesduetoleakageofsynovialfluidfromajointortendonsheath.
Filledwithmucinousfluidandlinedbyfibroustissue
Usuallydevelopsonthedorsalsurfaceofthescapho-lunate
ligament.
Palmarwristgangliausuallyarisefromthevolarscapholunateor
scapho-trapezio-trapezoidjoint.
Morecommoninyoung(20-40years)female.
Nocommunicationbetweenthejointcavityortendonsheathandthe
interiorofcyst.
Painlesssmallswellingsometimesitmaycausepain.
Treatment:
Notrequired.
ForpainNSAIDs
Swellingincreaseinsizeitmaybeaspiratedorsurgicallyexcised.
43.Testforanteriorcruciateligamentis/are
a)Lachmanntest
b)Apley'sgrindingtest
c)Pivotshifttest
d)Anteriordrawer
e)KT-1000kneearthrometerisanobjectiveinstrumentforACL
reconstruction
CorrectAnswer-A:C:D:E
Ans.is'a'i.e.,Lachmanntest'c'i.e.,Pivotshifttest;'d'i.e.,
Anteriordrawer&'e'i.e.,KT-1000kneearthrometerisan
objectiveinstrumentforACLreconstruction
FollowingtestsareusedforACLinjury:-
Lachman'stest
Pivotshifttest
Anteriordrawertest
Jerktest
Flexion-rotationdrawertest
Loose'stest
44.Trueaboutosteomalacia?
a)Morecommoninmale
b)LowPTH
c)Increasealkalinephosphatase
d)Decreasedcalciumlevel
e)Looser'szoneonX-ray
CorrectAnswer-C:D:E
Ans.(c)Increasealkalinephosphatase;(d)Decreasedcalcium
level;(e)Looser'szoneonX-ray
Osteomalacia
Looser'szone(pseudofractures)areradiolucentzonesoccurringat
thesitesofstressinosteomalacia(commonlyatpubicrami)
Osteomalaciaismorecommoninwomenwholivein"purdah"&lack
exposuretosunlight
Serumcalcium&phosphateislow&alkalinephosphataseishigh
Muscularweakness(Thepatientfeelsveryweak.Hemaydifficulty
inclimbingup&downthestairs)
45.Trueaboutcomplexregionalpain
syndrome:
a)Sudeck'satrophyisanexample
b)Painisoutofproportiontoprecipitatingcause
c)Hyperaesthesiaofskinmaybepresent
d)Adultsareusualsufferer
e)Parasympatheticmediatedenhancementofpain
CorrectAnswer-A:B:C:D
Ans.a.Sudeck'satrophyisanexample;b.Painisoutof
proportiontoprecipitatingcause;c.Hyperaesthesiaofskin
maybepresent;d.Adultsareusualsufferer
ComplexRegionalPainSyndrome
Anumberofclinicalsyndromesappearunderthisheading,including
Sudeck'satrophy,reflexsympatheticdystrophy,algodystrophy,
shoulder-handsyndrome&particularlyafteranerveinjury-
causalgia.
Precipitatingcausesaretrauma(oftentrivial),operationor
arthroscopy,aperipheralnervelesion,myocardialinfarction,stroke
&hemiplegia
Adultsaretheusualsufferersbuttheconditionoccasionallyoccurin
children
46.TrueaboutDupuytren'scontracture;
a)Commonlyaffectring&smallfinger
b)Mayinvolvepenis
c)Involvesmetacarpo-phalangealjoint
d)Kneereflexdiminished
e)Involvesneckflexors
CorrectAnswer-A:B:C
Ans.a.Commonlyaffectring&smallfinger;b.Mayinvolve
penis;c.Involvesmetacarpo-phalangealjoint
ClinicalFeaturesofDupuytren'scontracture:
Thickenedfibrousbandsfeltovertheulnarsideofthepalm.
Thickeningofplantarfasciaorthatofthepenilefascia(Peyronie's
disease).
Tendernessovertheinvolvedareaatthebaseofthedigits.
FlexiondeformityattheMCPandPIPjointsofinvolvedfingers
47.AllaretrueVolkmannischemic
contractureexcept
a)Ischemicmuscleisreplacedbyfibrous
b)Ulnarnervepalsymaybepresent
c)Extensiondeformityofthewrist&fingers
d)Flexionatthemetacarpophalangeal
e)Tendontransferhelpsinrestoringmovements
CorrectAnswer-C
Ans.c.Extensiondeformityofthewrist&fingers
VOLKMANN'SISCHEMIA
Earlycomplicationofsupracondylarfracture.
Ischemicinjurytothemusclesandnervesoftheflexor
compartmentoftheforearm.
D/tocclusionofbrachialartery.
Tissuepressurereadingswithin30mmHgofthepatient's
diastolicbloodpressure(perfusionpressure
Musclessuppliedbyanteriorinterosseusarteryaremost
susceptible,asitisanendartery.
Mostcommonlyaffectedmuscle:flexorpollicislongus&medial
halfofflexordigitorumprofundus.
Mediannerveismostcommonlyinvolved.
Treatment:fasciotomy
48.Allaretrueaboutsupracondylarfracture
ofhumerusexcept:
a)Posteriorshiftofdistalfragment
b)Mediannerveismostcommonnervedamaged
c)Injuryofbrachialarterymayoccur
d)Commoninelderly
e)Volkmann'sischemiccontracturemayoccur
CorrectAnswer-D
Ans.d.Commoninelderly
SupracondylarFractureoftheHumerus:
Complications:
Immediate-injurytobrachialartery&injurytonerve(mediannerve-
mostcommon,radialnerve-sometimeaffected)
Early-Volkmann'sischemia
Latecomplication-Malunion(cubitusvarusdeformity),myositis
ossificans&Volkmann\ischemiccontracture.
Displacement:Thedistalfragmentmaybedisplacedinthefollowing
direction
Posteriororbackwardshift
Posteriororbackwardtilt
Proximalshift
Medialorlateralshift
Medialtilt
Internalrotation
49.NotanIntra-articularfracture:
a)Rolandofracture
b)Marchfracture
c)Bennett'sfracture
d)Barton'sfracture
e)Hoffafracture
CorrectAnswer-B
Ans.b.Marchfracture
Marchfracture:Fatiguefractureofshaftofsecondorthird
metatarsal
Rolandofractureisathreepartorcomminutedintraarticular
fracture-dislocationofthebaseofthumb.
Pilonfracture:Itisacommunicatedintra-articularfractureofthe
distalendofthetibia
Bennett'sfracture:Ifisanobliqueintra-articularfractureofthebase
ofthefirstmetacarpalwithsubluxationofthetrapezoid'metacarpal
joint"
Barton'sfracture(Marginalfracture):Intra-articularfracturesthrough
thedistalarticularsurfaceoftheradius,takingamargin,anterioror
posterior,ofthedistalradiuswiththecarpals,displacedanteriorlyor
posteriorly
Hoffafracturesareintra-articularandarecharacterisedbyafracture
inthecoronalplane
50.TrueaboutLockingcompressionplate:
a)Insteoporoticpatients,itshouldnotbeused
b)Canbeusedasbuttressplate
c)Usuallycauseperostealinjury
d)Mechanicallysuperiortoaconventionalplate
e)Cannotbeusedascompressionplate
CorrectAnswer-B:D
Ans.b.Canbeusedasbuttressplate;d.Mechanicallysuperior
toaconventionalplate
LockingCompressionPlate:
Thelatestdevelopmentinplatingtechniqueislockingcompression
plate(LCP).
Ithasrigidplate,Screwconstruct,whichhasbeenfoundtobe
mechanicallysuperiortoconventionalplate.
LCPcanbeusedascompressionplate,asneutralizationplate,asa
buttressplate,asabridgingplate&asalockedplate.
ItisParticularlysuitableforperiarticularfractures&fracturesin
osteoporoticbones
51.Osteoscleroticmetastasesis/arecommon
incancerof:
a)Prostate
b)Breast
c)Lung
d)Malignantmelanoma
e)Renalcellcarcinoma
CorrectAnswer-A:B
Ans.a.Prostate;b.Breast
Metastasesaremostcommonlyseeninthepelvis,ribs,vertebral
bodies,andproximallimbs.
Theselesionstypicallyhavealyticappearanceonplain
radiographs,althoughbreastandprostatemetastasescanbe
scleroticormixedwithlyticandscleroticfeatures.
Overall,metastasesarethemostcommontumorofbones.
Adults:Approximately75%ofmetastasestothebonearederived
fromprostate,breast,kidney,andlungcarcinomas.
Children:Neuroblastoma,Wilmstumor,osteosarcoma,andEwing
sarcoma.
Kidneyandthyroidneoplasmsareknownforproducingasolitary
metastasis.
Metastasestohandandfootbonesareuncommonand,ifpresent,
thesourceisusuallyalung,colon,orrenalneoplasm.
52.Followingareimmediatecomplicationsof
fracture:
a)Vascularischemia
b)Neuronalinjury
c)Malunion
d)Compartmentsyndrome
e)Avascularnecrosis
CorrectAnswer-A:B
Ans.a.Vascularischemia;b.Neuronalinjury
ImmediateComplications:
Systemic:
Hypovolaemicshock
Local
Injurytomajorvessels
Injurytomuscles&tendon
Injurytojoints
Injurytoviscera
Earlycomplications:
Systemic:
Hypovolaemicshock
ARDS:Fatembolismsyndrome
DVT&Pulmonaryembolism;
Aseptictraumaticfever;
Septicaemia;
Crushsyndrome
Local
Infection
Compartmentsyndrome
Latecomplications:
Imperfectunionoffracture:
Delayedunion;Non-union;Malunion;Crossunion
Others:
Avascularnecrosis;Shortening;Jointstiffness;Sudeck'sdystrophy;
Osteomyelitis;ischaemiccontracture;Myositisossificans;
Osteoarthritis
53.Whichofthefollowingcausemalunion
except:
a)Open#
b)Infection
c)Bonegrafting
d)Softtissueinterposition
e)Properalignmentoffracture
CorrectAnswer-C:E
Ans.c.Bonegrafting;e.Properalignmentoffracture
Bonegraftingisusedintreatmentofmalunion
Infection:Bothbiology&stabilityofbonehealingarehamperedby
activeinfection
54.TrueaboutatypicalCTEV
a)Footisflexeddownward
b)Solecreasearenotfound
c)Difficulttotreatthantypicalvariety
d)Mayoccurduetoneurologicaldisorder
e)MaybeassociatedwithMeningomyelocele
CorrectAnswer-A:C:D:E
Ans.a.Footisflexeddownward;c.Difficulttotreatthantypical
variety;d.Mayoccurduetoneurologicaldisorder;e.Maybe
associatedwithMeningomyelocele
AtypicalIdiopathicClubfoot:
Ashortandfatorswollenfoot.
Thebigtoeisshortandpointsupward
Acreaserunsacrossthebottom(sole)ofthefootfromsidetoside.
Thereisadeepcreaseintheskinabovetheheel.
Theheelareaisrigidlytiltedinward.
Thefootisrigidlyflexeddownwardand,theheelcordisverytight,
wide,andlong.
Thecalfmuscleisverysmallandbunchedupunderthebackofthe
knee.
CausesofCTEV
CTEVmaybeeitherprimaryorsecondary
1.PrimaryorIdiopathic
ItisthemostcommontypeofCTEV
Footdeformity(CTEV)istheonlymanifestation,otherwise
musculoskeletalsystemisnormal.
2.Secondary
CTEVisalocalmanifestationofasystemicsyndrome.
Causesare:-
1. Neurologicaldisorders&neuraltubedefectsegmyelomeningocele,
&spinaldysraphism
2. Paralyticdisorder(duetomuscularimbalance)aspolio,spinabifida,
myelodysplasia,&Fredreich'sataxia
3. Arthrogiyposismultiplexa
4. Larsensyndrome
5. Freeman-Sheldonsyndrome
6. Diastrophicdwarfism
7. Sacralagenesis,tibialdeficiency,constrictionrings&amniotic
bands
55.Inyoungpersonmostcommoncancer
amongfollowingis:
a)Giantcell
b)Osteosarcoma
c)Chondrosarcoma
d)Ewingsarcoma
e)All
CorrectAnswer-B
Ans.b.Osteosarcoma
Osteosarcomaisthesecondmostcommontumour.
Thesetumoursoccurb/wtheagesof15-25years,constitutingthe
commonestmusculo-skeletaltumouratthatage
56.Allaretrueaboutsepticarthritisexcept:
a)Staph.Aureusismostcommoncausativeorganism
b)Commoninchildren
c)Affectgrowthplate
d)E.coliisthecommonestcausativeorganism
e)Aspirationofjointfluidisusedfordiagnosis
CorrectAnswer-D
Ans.d.E.coliisthecommonestcausativeorganism
Itismorecommoninchildren&males
Staphylococcusaureusisthecommonestcausativeorganism,other
organismarestrepto-pneumo&Gonococcus.
Aspiratethejoint&examinethefluid.AWBC&gramstainshould
becarriedoutimmediately.Sampleoffluidarealsosentforfull
microbiologicalexamination&testsforantibioticsensitivity.
57.Featuresoffatembolism:
a)Bradycardia
b)Hypoxia
c)Hypotension
d)Tachypnoea
e)Petechialrash
CorrectAnswer-B:D:E
Ans.b.Hypoxia;d.Tachypnoea;e.Petechialrash
Fatembolismsyndrome:
Tachycardia
Slightriseoftemperature
Breathlessness
Hypoxiafrominvolvementoflung
Tachypnoea
Petechialrash
Respiratoryfailure
Drowsy
Restless
Coma
58.Straightlegraisingtestis/arepositivein:
a)Spinalstenosis
b)Spinalabscess
c)AlsocalledasTrendelenburgtest
d)Prolapsedintervertebraldisc
e)Sciatica
CorrectAnswer-D:E
Ans.d.Prolapsedintervertebraldisc;e.Sciatica
Pain&limitationofStraightlegraising(SLR)isafeatureof
prolapsedintervertebraldiscwhenthereisirritationorcompression
ofoneoftherootsofthesciaticnerve.
Straightlegraisingtest:Thisisatesttodetectnerveroot
compression.
59.Whichofthefollowingis/aretrueabout
thegaitinsensorydeficit
a)Antalgicgait
b)Apraxia
c)Trendelenburg
d)PositiveRombergsign
e)Apraxiagait
CorrectAnswer-D
Ans.d.PositiveRombergsign
Insensoryataxiathepatientisabletomaintaintheupright
positionwhiletheeyesareopen,butwhentheeyesareclosed
hesways.ThisisapositiveRombergsign.
ABNORMALGAIT:
Antalgicgait:occursinpainfulconditionsofthelowerlimb.
Charlie-Chaplingait:Occursintibialtorsion.
Circumductiongait:Occursinhemiplegia
Waddlinggait:Occursinbilateralcongenitalhipdislocation
Highsteppinggait:Occursinfootdrop
Scissoringgait:Occursincerebralpalsy
Stiffhipgait:Occursinankylosisofthehip
Trendelenburggait:Occursinunstablehipduetocongenital
dislocationofhip,gluteusmediusmuscleweakness
60.TrueaboutTrichomonasvaginitis:
a)Importantcauseofrecurrentabortion
b)T.vaginalisisaflagellatedprotozoa
c)Metronidazoleisusedfortreatment
d)Strawberrycervix
e)Curdydischarge
CorrectAnswer-B:C:D
Ans.b.T.vaginalisisaflagellatedprotozoa;c.Metronidazoleis
usedfortreatment;d.Strawberrycervix
Trichomonasvaginits:
Itiscausedbytrichomonasvaginalis,apear-shapedunicellular
flagellateprotozoa
Onspeculumexamination,mucosaoftheportiovaginalispartof
cervixappearlikestrawberry
Infectioningenitaltractmayberesponsibleforsporadic
spontaneousabortionbutitsrelationtorecurrentabortionis
inconclusive.
61.AllaretrueaboutPott'sspineexcept:
a)ThoracicvertebraeT6-T8ismostcommonlyaffectedsite
b)Paradiscaliscommonestvariety
c)Muscularrigidity&stiffnessiscommon
d)Posteriorpartofvertebraeismoreaffectedthananteriorpart
e)BackpainisthecommonestPresentingsymptom
CorrectAnswer-A:D
Ans.a.ThoracicvertebraeT6-T8ismostcommonlyaffected
site;d.Posteriorpartofvertebraeismoreaffectedthananterior
part
Tuberculosis(TB)ofthespine(Pott'sdisease)isthemostcommon
siteofboneinfectioninTB.
Thelowerthoracicandupperlumbarvertebraearetheareasofthe
spinemostoftenaffected.
Pott'sdiseaseresultsfromhaematogenousspreadoftuberculosis
fromothersites,oftenpulmonary.Theinfectionthenspreadsfrom
twoadjacentvertebraeintotheadjoiningdiscspace.
Ifonlyonevertebraisaffected,thediscisnormal,butiftwoare
involvedtheintervertebraldisc,whichisavascular,cannotreceive
nutrientsandcollapses(seenasnarrowingofintervertebralspace
onX-rays)
CommonestspineinvolvedinspineTBis
Thoracolumbar/DorsolumbarT12-L1(Lowerthoracictobeprecise.
Thediseaseprogressesslowly.Signsandsymptomsinclude:
Localisedbackpainistheearliestandcommonestcomplaint
Paravertebralswellingmaybeseen
Neurologicalsignsmayoccur,leadingtoparaplegia.
Stiffness
Deformity
Constitutionalsymptoms
Diagnosis:
SpinalX-raymaynotshowearlydiseaseas50%ofbonemassmust
belostforchangestobevisibleonx-ray.However,plain
radiographscanshowvertebraldestructionandnarroweddisc
space.
MRIisusefultodemonstratetheextentofspinalcompressionand
canshowchangesatanearlierstagethanplainradiographs.Bone
elementsvisiblewithintheswelling,orabscesses,arestrongly
indicativeofPott'sdiseaseasopposedtomalignancy.
CTscansandnuclearbonescanscanalsobeused.
62.TrueaboutClubfoot:
a)Abductionofforefoot
b)Associatedwithbreechpresentation
c)Dennis-Brownsplintused
d)Adductionofforefoot
e)Associatedwithspinabifida
CorrectAnswer-C:D:E
Ans.c.Dennis-Brownsplintusedd.Adductionofforefoote.
Associatedwithspinabifida
CTEVisthecommonestandmostimportantcongenitaldeformityof
thefoot.
Thedeformityconsistsoffollowingelements:-
1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)
2. Inversionoffootatsubtalarjoint(talocalcanealjoint)
3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular
joint.
4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-
tarsaljoints.
Treatment:
Tendontransfer:-Transferoftibialis-anteriorontheoutersideof
foot.Thiscanbedoneonlyafter5years.
Dwyerosteotomy:-Medialopenwedgeosteotomyofcalcaneumto
correctheelvarus.
Gradualdifferentialdistraction:-Inthisanexternalfixator(JESSor
Illizarov)isappliedandgradualcorrectionofdeformity
>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,and
talonavicularjoints)
63.TrueaboutOsteosarcoma:
a)Primaryosteosarcomaismostcommonlyoccurinagegroup
oflessthan20yr
b)Periostealreactionispresent
c)Presentaselevatedsofttissuemass
d)Commonlyassociatedwithosteoidosteoma
e)Formationofbonebythetumorcellsischaracteristic
CorrectAnswer-A:B:C:E
Ans.a.Primaryosteosarcomaismostcommonlyoccurinage
groupoflessthan20yr;b.Periostealreactionispresent;c.
Presentaselevatedsofttissuemass;e.Formationofboneby
thetumorcellsischaracteristic
Osteosarcomaisprimarymalignantbonetumorofbone,derived
fromprimitiveboneformingmesenchymaandcharacterizedby
osteoidformation.
Itisoftwotypes
1. Primary
2. Secondary
Associatedfeature:
Pagetdisease
Radiation
Fibrousdysplasia
Enchondromatosis
Multipleosteochondroma
Boneinfarction
Chronicosteomyelitis
Radiology:
TheX-rayappearancesarevariable:hazyosteolyticareasmay
alternatewithunusuallydenseosteoblasticareas.
Oftenthecortexisbreachedandthetumourextendsintothe
adjacenttissues;whenthishappens,streaksofnewbone
appear,radiatingoutwardsfromthecortexthesocalled'sunburst'
effect.
Wherethetumouremergesfromthecortex,reactivenewboneforms
attheanglesofperiostealelevation(Codman'striangle).
WhileboththesunburstappearanceandCodman'striangleare
typicalofosteosarcoma.
64.Commonestcauseofacuteosteomyelitis:
a)Trauma
b)Surgery
c)Fungalinfection
d)Hematogenousroute
e)Tubercularinfection
CorrectAnswer-D
Ans.d.Hematogenousroute
ACUTEOSTEOMYELITIS:
1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andmostcommonsourceofboneandjointinfectionis
hematogenous.
65.Distalinterphalangealjointinvolvement
occurin:
a)Boutonnieredeformity
b)Swanneckdeformity
c)Malletfinger
d)Triggerfinger
e)Dupuytren'scontracture
CorrectAnswer-A:B:C
Ans.a.Boutonnieredeformity;b.Swanneckdeformity;c.
Malletfinger
Inmedicine,malletfinger,alsobaseballfinger,droppedfingerand
(moregenerally)extensortendoninjury,isaninjuryoftheextensor
digitorumtendonofthefingersatthedistalinterphalangealjoint
(DIP).
Swan-neckdeformity(PIPjointshyperextendedandDIPjoints
flexed),enlargedknuckles,andsubcutaneousnodulesareclassic
cluesforrheumatoidarthritis.
Distalinterphalangealjoint-Osteoarthritis,Psoriaticarthritis,
Reactivearthritis
Proximalinterphalangealjoint-Osteoarthritis,RA,SLE,Psoriatic
arthritis
66.Pathologicalfracturearefoundin:
a)Bonecyst
b)Osteoporosis
c)Chronicosteomyelitis
d)Osteochondroma
e)Osteogenesisimperfecta
CorrectAnswer-A:C:D:E
Ans.a.Bonecyst;b.Osteoporosis;c.Chronicosteomyelitis;d.
Osteochondroma;e.Osteogenesisimperfecta
PathologicalFracture
Afractureinanabnormalboneisreferredtoaspathological
fracture.Abnormalbonemeansabonerenderedweakbya
diseaselocalizedtoaparticularhone,orbyageneralisedbone
disorder.Bonethatfracturesspontaneously,oraftertrivialtrauma
mustberegardedasabnormaluntilprovenotherwise.Vertebral
bodies(thoracic&lumbar)arethemostoftenaffectedbonesf/b
neckfemur&lowerendradius(colle's#).Mostcommoncauseis
osteoporosis
Othercausesofpathologicalfracturesare:
LocalizedDiseases
Chronicinfectioneg.tubercular&pyogenic
osteomyelitis.
Eosinophilicgranuloma
Benignneoplasticlesions
Solitarybonecyst
Aneurysmalbonecyst
Fibrouscorticaldefect
Monostoticfibrousdysplasia
Chondromyxoidfibroma
Chondroma(Enchondroma)
Osteoclastoma(giantcelltumor)
Malignantbonetumor
Osteosarcoma
Ewing'stumor
Chondrosarcoma
Atrophicbonedueto
Polio
Radiation(Radiotherapy)
GeneralisedDiseases
Congenital/Developmental
Osteogenesisimperfecta
Osteopetrosis
011iersdisease(multipleenchondromatosis/dyschondroplasia).
Polyostoticfibrousdysplasia
HistiocytosisX
Gaucher'sdisease
AcquiredDisordersproducingosteopenia
Osteoporosis(mostcommoncause)
Osteomalacia
Hyperparathyroidism
Renalosteodystrophy
Paget'sdisease
Myeloma
Othermetabolicbonediseases
Rickets
Scurvy
Disseminatedmalignancyinbones
Multiplemyeloma
Myelomatosis
Metastaticcarcinoma
67.AllaretrueaboutSlippedcapitalfemoral
epiphysisexcept:
a)Avascularnecrosismayoccur
b)Usuallyoccurafterl0yearofage
c)Obesityisariskfactor
d)Frog-leglateralviewishelpful
e)Morecommoningirls
CorrectAnswer-E
Ans.e.Morecommoningirls
SLIPPEDFEMORALCAPITALEPIPHYSIS(SFCE)
Seeninadolescentchildreninagegroupof13-15yrs
Eitheroverweightorsexuallyimmature
Presentswithendocrinopathies
Hypothyroidism
Growthhormoneexcess
CRF
Craniopharyngioma
Hypogonadism
Klinefelter'ssyndromemaypresentasSFCE
Treethowan'ssignonx-ray
USGorCTmoresensitiveindetectingearlyslip
Tc99scanshowsincreaseduptake
Rxispromptsurgery
68.FracturesiteofMonteggiafractureis
a)Proximalulna
b)Distalendofradius
c)Distalradius
d)Dislocationofradialhead
e)Lowerradio-ulnarjointdislocation
CorrectAnswer-A:D
Ans.a.Proximalulna;d.Dislocationofradialhead
Monteggiafracture-dislocationsareclassifiedbytheBado
system
BadotypeIinjuriesarecharacterizedbyaproximalulnarfracture
withanteriordislocationoftheradialhead.Thisisduetoaforceful
pronationinjuryoftheforearmandisthemostcommontype.
BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocation
injuries.
Here,thereisposteriorangulationoftheulnarfracturesiteand
posteriordislocationoftheradialhead.
BadotypeIIIandIVarerareinjuries.
69.Trueaboutosteoclastoma
a)Mostlymalignant
b)Mostcommonsite-mandible&vertebrae
c)Recurrenceiscommonafterexcision
d)Locatedatepiphysis
e)All
CorrectAnswer-C:D
Ans.c.Recurrenceiscommonafterexcision;d.Locatedat
epiphysis
Giantcelltumor(Osteoclastoma)
GCTisanosteolytictumorarisingfromtheepiphysisandis
commonbetweentheageof20-40years.
ThoughGCTisabenigntumor,itislocallyveryaggressive.
Femalesareaffectedmorethanmales.
Pathologicalfeatures
Thecommonestsitesarelowerendoffemurandupperendoftibia.
Othercommonsitesarelowerendradiusandupperendof
humerus.Itmayalsooccurinthespineandsacrum.
Thetumorisencompassedbyafibrouscapsuleatperiphery.
Thepresenceoftumorgiantcellsisthehallmarkofthistumor.
Clinicalfeatures
Painatthesiteofthetumour.
Graduallyincreasinglocalswelling
Pathologicalfracturesmayoccur.
"Eggshell-crackling"sensationonpalpation.
Radiologicalfeatures
GCTisoneofthecommoncauseofasolitarylyticlesionofthe
bone.oTheradiologicalfeaturesare:-
1. Asolitarymaybeloculated,lyticlesion.
2. Eccentriclocation,oftensubchondral.
3. Expansionoftheoverlyingcortex(expansilelesion).
4. 'Soap-bubble'appearance-Thetumorishomogenouslylyticwith
trabeculaeoftheremnantsofbonetraversingit,givingrisetoa
loculatedappearance.
5. Nocalcificationwithinthetumor.
6. Noneorminimalreactivesclerosisaroundthetumor.
7. Cortexmaybethinnedout,orperforatedatplaces.
8. Tumourusuallydoesnotentertheadjacentjoint.
70.TrueaboutfractureneckTalus:
a)Avascularnecrosisofbodyiscommoncomplication
b)LateralviewX-rayisimportantfordiagnosis
c)Displacedfracturerequirebelowkneeplasteronly
d)Displacedfracturerequireopenreduction&internalfixation
e)All
CorrectAnswer-A:B:D
Ans.a.Avascularnecrosisofbodyiscommoncomplication;b.
LateralviewX-rayisimportantfordiagnosis;d.Displaced
fracturerequireopenreduction&internalfixation
FractureTalus(Neck)
Talusisthemajorweightbearingstructure(thesuperiorarticular
surfacecarriesagreaterloadperunitareathananyotherbonein
body),andithasavulnerablebloodsupplyandisacommonsite
forposttraumaticischemicnecrosis.
Thebodyoftalusissuppliedmainlybyvesselswhichenterthetalar
neckfromthetarsalcanal.Infracturesofthetalarneckthese
vesselsaredivided;ifthefractureisdisplacedtheextraoseous
plexustoomaybedamagedandbodyoftalusbecomesischemic.
Fractureofthetalarneckisproducedbyviolenthyperextensionof
ankle.Bodyoftalusfractureisusuallyacompressioninjurydue
tofallfromheight.
Complications
Avascularnecrosisofbodyismostcontinuumcomplication.The
incidencevarieswiththeseverityofdisplacement:intypeI<10%,
intypeII-40%,intypeIII>90%.
Malunionpredisposetoosteoarthritis.
SecondaryOsteoarthritisofankleand/orsubtalarjointoccurs
someyearsafterinjuryinover50%ofpatients.Thereareseveral
causes:articulardamaged/tintialtrauma,malunion,distortionof
articularsurfaceandAVN.
HawkinsClassification
TypeI Undisplaced
TypeII Displacedassociatedwithdislocationofsubtalarjoint
Displacedassociatedwithdislocationatankleaswellas-
TypeIII atsubtalarjoint
TypeIV Type3+Talonavicular-subluxationordislocation
Treatment
BelowkneecastwithfootinplantarflexionX4weeksFurther
plasterchangewillallowthefoottobebroughtupslowlyto
plantigradeClose/openreduction&internalfixation
71.Whichofthefollowingis/arenotfeature(s)
ofrheumatoidarthritis
a)Pannusformationinjoint
b)Osteosclerosisosteoclasticactivityinunderlyingbone
c)Erosionofcartilage
d)Osteophyte
e)Plasmacellinfiltrationofsynovialstroma
CorrectAnswer-D
Ans.d.Osteophyte
Thecharacteristichistologicfeaturesinclude:
Infiltrationofsynovialstromabydenseperivascularinflammatory
cells,consistingofBcellsandCD4+helperT,plasmacellsand
macrophages;
Increasedvascularityowingtovasodilationandangiogenesis,with
superficialhemosiderindeposits;
Aggregationoforganizingfibrincoveringportionsofthesynovium
andfloatinginthejointspaceasricebodies;
Accumulationofneutrophilsinthesynovialfluidandalongthe
surfaceofsynoviumbutusuallynotdeepinthesynovialstroma;
Osteoclasticactivityinunderlyingbone,allowingthesynoviumto
penetrateintotheboneformingjuxta-articularerosions,subchondral
cysts,andosteoporosis;
Pannusformation-Pannusisamassofsynoviumandsynovial
stromaconsistingofinflammatorycellsgranulationtissue,and
fibroblasts,whichgrowsoverthearticularcartilageandcausesits
erosion.
72.Carpaltunnelsyndromeisassociated
withallexcept:
a)Dupuytren'scontracture
b)Myxoedema
c)Idiopathic
d)Rheumatoidarthritis
e)Acromegaly
CorrectAnswer-A
Ans.a.Dupuytren'scontracture
Associatedconditionsthatcanleadstocarpaltunnelsyndrome
are:
1.Idiopathic(mostcommon)
2.Pregnancy
3.Endocrinedisorders
Hypothyroidism
Diabetesmellitus
Myxedema
Acromegaly
Hyperparathyroidism
4.Depositiondisorders
Rheumatoiddisorder
Gout
Rheumaticdisorder
Amyloidosis
Sarcoidosis
Leukemia
Chronicrenalfailure
73.A65yearoldmalepresentedwithfemur
neckfracture.Hewasmanagedwith
closedreduction+cancellousscrew.6
monthlaterX-raywasdoneinlateralview.
X-rayshowsnon-union&legshorting.
Now,appropriatemanagementoptions
is/are:
a)Unipolarhemiarthroplasty
b)Bipolarhemiarthroplasty
c)Subtrochantericosteotomy
d)Osteosynthesis
e)Totalhiparthroplasty
CorrectAnswer-A:B:E
Ans.a.Unipolarhemiarthroplasty;b.Bipolarhemiarthroplasty;
e.Totalhiparthroplasty
Ingeneral,operationsforununitedfracturesofthefemoral
neckcanbegroupedintoffvegeneralclasses:
Osteosynthesis,inwhichafractureisrefixedwithnewinternal
fixationdevices;
Subtrochantericosteotomy
Prostheticreplacement(hemiarthroplasty)
Totalhiparthroplasty
Arthrodesis.
Somegeneralguidelinesareasfollows:
Inadults<60yearsold,nonunionsinwhichthefemoralheadis
viablecanbetreatedbyangulationosteotomy.Thisprovidesaline
ofweightbearingmoredirectlybeneaththefemoralhead.
Inchildrenandinadults<21yearsold,nonunionsinwhichthe
femoralheadisnotviablecanbetreatedwithanarthrodesis.In
exceptionalcircumstances'ayoungadultmaybetreatedwitha
prosthesis.
Inadults2lto60yearsold,nonunionsinwhichthefemoralheadis
notviablecanbetreatedwithaprosthesis,atotalhiparthroplasty,
oranarthrodesis,dependingonthecircumstancesinthegiven
Patientandontheexperienceandpreferenceofthesurgeon.Rarely
isanarthrodesisindicatedinpatientsolderthan50yearsofageor
inpatientswithasedentaryoccupation.
lnpatients>60years,non-union,regardlessoftheviabilityofthe
femoralhead,usuallyaretreatedwithahemiarthroplastyoratotal
hiparthroplasty'
This post was last modified on 11 August 2021