ofthefollowingnerverootscanget
compressed?
a)L5
b)S1
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c)S2d)S2-S4
e)L4
CorrectAnswer-A:E
Ans.is'a'i.e.,L5&'e'i.e.,L4
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Likeateverylevel,therearetwonerverootsatL4-L5-exitingnerverooti.e.L4nerveroot&traversingnerverooti.e.L5nerveroot.
So,herniateddiscattheL4-L5level,cancreateanL5radiculopathy
oranL4radiculopathy,dependingonwherethedischerniation
occurs(tothesideortothebackofthedisc)andwhichnerverootis
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affected:?Posterolateral(paracentral)-mostcommon(90-95%),affectsthe
traversing/descending/lowernerverooti.e.L5nerveroot
Foraminal(farlateral,extraforaminal)-lesscommon(5-
10%),affectsexiting/uppernerverooti.e.L4nerveroot
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2.Deformityassociatedwithposterior
dislocationofhipjoint?
a)Flexion
b)Extension
c)Abduction
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d)Adductione)Internalrotation
CorrectAnswer-A:D:E
Ans.is'a'i.e.,Flexion,`d'i.e.,Adduction&'e'i.e.,Internal
rotation
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Usually,theheadofthefemurisdislocatedposteriortotheacetabulumwhenthethighisflexed,forexample,asmayoccurina
head-onautomobilecollisionwhenthekneeisdrivenviolently
againstthedashboard.
Thesignificantclinicalfindingsareshortening,adduction,and
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internalrotationoftheextremity.Anteroposterior,lateraland,iffractureoftheacetabulumis
demonstrated,obliqueradiographicprojections(Judetviews)are
required.
Commonassociatedinjuriesincludefracturesoftheacetabulumor
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thefemoralheadorshaftandsciaticnerveinjury3.Trueregardingachondroplasiais?
a)Autosomalrecessive
b)Disproportionatedwarfism
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c)Subnormalintelligenced)Bulletshapedvertebralbodiesonradiology
e)Abnormalsexualdevelopment
CorrectAnswer-B:D
Ans.is'b'i.e.,Disproportionatedwarfism&'d'i.e.,Bullet
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shapedvertebralbodiesonradiologyACHONDROPLASIA:
Achondroplasiaisadisorderofbonegrowththatpreventsthe
changingofcartilage(particularlyinthelongbonesofthearmsand
legs)tobone.
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SYMPTOMS:80%-99%ofpeoplehavethesesymptoms
Abnormalityofthemetaphysis
Abnormalityoftheribs
Antevertednares
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ChronicotitismediaDepressednasalbridge
Frontalbossing
Genuvarum
Hyperlordosis
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MacrocephalyNeonatalshort-limbshortstature
Rhizomelia
Wormianbones
30%-79%ofpeoplehavethesesymptoms
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AbnormalformofthevertebralbodiesConductivehearingimpairment
Dentalcrowding
Dentalmalocclusion
Diaphysealthickening
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HyperhidrosisIntrauterinegrowthretardation
Jointhyperflexibility
Kyphosis
Longthorax
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MidfaceretrusionMuscularhypotonia
Narrowchest
Narrowsacroiliacnotch
Obesity
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ObstructivesleepapneaVentriculomegaly
5%-29%ofpeoplehavethesesymptoms
Acanthosisnigricans
Deathininfancy
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DysarthriaElbowdislocation
Hydrocephalus
Jointstiffness
Spinalcanalstenosis
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SuddencardiacdeathPercentofpeoplewhohavethesesymptomsisnotavailable
throughHPO
Autosomaldominantinheritance
Brachydactyly
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BrainstemcompressionFlaredmetaphysis
Generalizedjointlaxity
Infantilemuscularhypotonia
Limitedelbowextension
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LimitedhipextensionLumbarhyperlordosis
Lumbarkyphosisininfancy
Malarflattening
Megalencephaly
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MotordelayRecurrentotitismedia
Shortfemoralneck
Smallforamenmagnum
Spinalstenosiswithreducedinterpediculardistance
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TridenthandRADIOLOGICALFINDING:
Theinnercontourofthepelvishasatypical,classic"champagne
glass"appearance
Largeskullwithrelativelyshortbaseandanarrowandfunnel-
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shapedforamenmagnumBulletshapedvertebralbodies
Longandshorttubularbonesareshortandthickwithapparent
increaseddiameter.
Metaphysisoflongbonesarewidenedandflared,physisare
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notchedorV-shaped.Thespinalcanalisnarrowwithdecreasedinterpediculardistanceas
oneproceedsfromLItoL5.
4.Signsofcompartmentsyndromeinclude?
a)Painonpassiveflexion
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b)Painonactiveflexionc)Swellingoffingers
d)Pallor
e)Paraesthesia
CorrectAnswer-B:C:D:E
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Ans.is'b'i.e.,Painonactiveflexion,'c'i.e.Swellingoffingers,'d'i.e.Pallor&`e'i.e.Paresthesia
Clinicalfeaturesofcompartmentsyndrome
Foursignsarereliableindiagnosingacompartmentsyndrome:-
1. Paraesthesiaorhypesthesiainnervestraversingthecompartment
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2. Painwithpassivestretchingoftheinvolvedmuscles(stretchpain)3. Painwithactiveflexionofthemuscles
4. Tendernessoverthecompartment
Amongstthese,stretchpainistheearliestsignofimpending
compartmentsyndrome.Theischemicmuscles,whenstretched,
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giverisetopain.Passiveextensionoffingers(stretchingthefingers)producepainin
flexorcompartmentofforearm.
OtherfeaturesarePulselessness,paralysis,Pallorandpainoutof
proportiontophysicalfindings.
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Peripheralpulses,arepresentinitiallyanddisappearlater.Therefore,pulseisnotareliableindicatorforcompartment
syndrome.
5.Whichofthefollowingstatementis/are
correctaboutfracturemanagementin
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children?a)Supracondylarfractureofhumeruscanbemanagedbyclosed
reduction
b)Lateralcondylarfractureofhumerusisknownasfractureof
necessity
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c)Lateralcondylarfractureofhumerusismanagedbyopenreductionandscrewing
d)Forearmfractureinchildrencanbemanagedbyclosed
reductionandcasting
e)Femoralneckfractureinadultsismanagedbysurgeryand3
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screwsCorrectAnswer-A:B:C:D:E
Ans.is'a'i.e.,Supracondylarfractureofhumeruscanbe
managedbyclosedreduction;'b'i.e.,Lateralcondylarfracture
ofhumerusisknownasfractureofnecessity;'c'i.e.,Lateral
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condylarfractureofhumerusismanagedbyopenreductionandscrewing,'d'i.e.,Forearmfractureinchildrencanbe
managedbyclosedreductionandcasting&`e'i.e.,Femoral
neckfractureinadultsismanagedbysurgeryand3screws
MANGEMENTOFSOMECOMMONPEDIATRICFRACTURES:
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LOCATIONOFTYPE
MANAGEMENT
FRACTURE
Undisplaced(Gartland's Immobilizationin
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type1)plasterfor3weeks.
Reduction(closed)
Reduction(closed)
Angulated(Gartland's
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underanaesthesiaSupracondylar#of
type2)
followedby
humerus
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percutaneouspinning.Sameastype2/open
reductionifOpen
Completelydisplaced
(compoundfracture)
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(Gartland'stypes3)orassociatedvascular
injury(complicated
fracture).
Iffractureisstable:
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Immobilizationinaboveelbowcastin
90degreeflexion&
Lateralcondyle
undisplaced
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neutralrotation.fractureofhumerus
Iffractureisunstable:
Closedreductionand
percutaneouspinning
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(kwirefixation)Closedreductionand
Onlydisplaced
percutaneouspinning.
displacedandrotated ORIFwithscrews.
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Shaftoftheforearm displacementisClosedreductionand
bones
minimal
elbowcast
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Conservativetreatmentby
immobilizationin
Undisplacedfractureor thomaskneesplint
valgusimpacted
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Insitufixationwiththreeparallel
cannulatedscrews
(preferred)
Femurneck
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<60years:CRIFwith3parallelcannulated
screws>ORIF.
60-70years:CRIF
Displaced
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Displaced
>70YEARS:Bipolar
hemiarthroplasty;AMR
Headisviable:Mc-
Murry'sosteotomy;
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Meyer'sprocedureArthroplasty
Physiologicalage<65
:Bipolar
years
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Head hemiarthroplastyOLD>3WEEKS
not
orAMR.
viable Witharthritis:
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Totalhipreplacement.
Bipolar
hemiarthroplastyor
Physiologicalage>65 AMR.
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yearsWitharthritis:Totalhip
replacement.
#ofdistalthirdof
radiuswith
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Openreductionofthedislocationor
Galeazzifractures
radiusandthedistal
subluxationofinferior dislocation
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radio-ulnarjoint.(distal)radio-ulnar
joint
6.Allarefeaturesofinflammatoryarthritis
except?
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a)Morningstiffnessb)X-rayshowingsclerosis
c)ElevatedESR
d)Weightgain
e)Swellingofjoints
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CorrectAnswer-B:DAns.is`b'i.e.,X-rayshowingsclerosis&'d'i.e.,Weightgain
Featuresofinflammatoryarthritis:?
Presenceofsomeorallfourcardinalsignsofinflammation:
Erythema
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PainWarmth
Swelling
Systemicsymptoms
1. Prolongedmorningstiffness,oftenlastingforseveralhours.(Non
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inflammatoryarthritisareassociatedwithintermittentstiffness,Stiffnessusuallylastslessthan1hr).
2. Fatigue
3. Fever
4. WeightLoss
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Laboratoryevidenceofinflammation1. ElevatedESR
2. Thrombocytosis
3. ElevatedCreactiveprotein
4. Anemiaofchronicdisease.
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X-rayX-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-ray
featuresinnon-inflammatoryarthritisrevealssclerosis.
7.Riskfactor(s)forLeg-Calf-Perthe'sdisease
is/are?
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a)Acceleratedskeletalgrowthb)Growthhormoneabnormalities
c)Positivefamilyhistory
d)Femalesex
e)Passivesmoking
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CorrectAnswer-C:EAns.is'c'i.e.,Positivefamilyhistory&`e'i.e.,Passivesmoking
PERTHE'SDISEASE(LEGG-CALVEPERTHE'SDISEASE)
Perthe'sdiseaseisalsoknownasosteochondritisdeformans
juvenilisorCoxapianoorPseudocoxalgia.
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Perthe'sdiseaseisanosteochondritisoftheepiphysisofthefemoralhead(capitalfemoralepiphysis).Inthedisease,thefemoralhead
becomespartlyorwhollyavascularanddeformed.Thedisease
occurscommonlyinmalesintheagegroupof5-10years.
Perthe'sdiseaseisthemostcommonform
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ofosteochondrosis(osteochondrosisarecharacterizedbyavascularnecrosis(AVN)anddefectiveendochondralossificationofprimaryor
secondaryossificationcentres).
EtiologyofPerthe'sdisease
Theetiologyremainsunknown,butiscurrentlyacceptedthatthe
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disorderiscausedbyaninterruptionofthebloodsupplytothecapitalfemoralepiphysis,causingavascularnecrosis.
Riskfactors
RiskfactorsforLegg-Calve-Perthesdiseaseinclude:
Age.AlthoughLegg-Calve-Perthesdiseasecanaffectchildrenof
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nearlyanyage,itmostcommonlybeginsbetweenages4and8.Yourchild'ssex.Legg-Calve-Perthesisuptofivetimesmore
commoninboysthaningirls.
Race.Whitechildrenaremorelikelytodevelopthedisorderthan
areblackchildren.
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Geneticmutations.Inasmallnumberofcases,Legg-Calve-Perthesdiseaseappearstobelinkedtomutationsincertaingenes.
8.Allaretrueaboutsepticarthritisexcept?
a)Staphaureusisthemostcommoncause
b)MostcommoncauseisE.coli
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c)Commoninchildrend)Affectsgrowthplate
e)Aspirationofjointfluidusedfordiagnosis
CorrectAnswer-B
Ans.is'b'i.e.,MostcommoncauseisE.coli
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Septicarthritis(Acutesuppurativearthritis)Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionof
ajointbypyogenicorganism(bacteria).
Themicrobialspectrumisdiverseinsuppurativearthritis,but
staphylococcusaureusinfectionismostcommon.
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Thejointcanbecomeinfectedby:?1. Hematogenousspreadfromadistantsite(mostcommonroute).
2. Directinvasionthroughapenetratingwound,intraarticularinjection,
arthroscopy.
3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere
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Metaphysisisintraarticulare.g.,hipandshoulder.Clinicalfeatures
Diseaseismorecommoninchildren.
Kneejointisthemostcommonlyaffectedjoint.
Otherjointwhichareaffectedarehip,shoulderandelbow.
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Thechildistoxicwithfever,tachycardia,tachypnea.Thereisseverepain,swelling,andrednessoverthejoint.
Movementsareseverelyrestrictedandthejointisheldinthe
positionofease.
Weightbearingonlimbisnotpossible.
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Diagnosis:Aspiratedsynovialfluidinsepticarthritiswillhavemarkedly
increasedpolymorphonuclearleukocytes
9.Hangingcastisusedfor?
a)Femur#
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b)Radius#c)Humerus#
d)Tibia#
e)Fibula#
CorrectAnswer-C
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Ans.is'c'i.e.,Humerus#Cast/Brace UsedIn
Hangingcast&"Sugartong" Fractureshaft
orCoaptationsplints
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humerusCylindercast
Fracturepatella
Minnervacast,Halodevice Cervicalspine
Risser'scast,Milwaukee
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braceScoliosis
Bostonbrace
Palvicharness,VonRosen Congenital
splint,
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(Developmental)IlfeldorCraigsplint
DysplasiaofHip
Broomstick(Petrie)
cast,Snydersling,Pattern-
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bottombrace,Torontobracewithuniversaljoint,
LeggCalve-
Birminghambrace,
Perthes
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Tachdjianbrace(trilateralDisease
hipabductionorthosis),
Newingtonbrace,Atlanta
scottishRitebrace
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10.Trueaboutacuteosteomyelitis?
a)CannotbedetectedonX-raybefore2weeks
b)Bonescandetectafter2weeks
c)Severepain
d)Secondaryosteomyelitisassociatedwithcompoundfractureis
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morecommonthanprimaryvarietye)Limitationofmovements
CorrectAnswer-C:E
Ans.is'c'i.e.,Severepain&`e'i.e.,Limitationofmovements
ACUTEOSTEOMYELITIS:
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1. ItPrimary(hematogenous):-Organismsreachthebonethroughbloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
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andmostcommonsourceofboneandjointinfectionishematogenous.
Clinicalfeatures:
Metaphysisoflongboneistheearliestandmostcommonsite
involved.
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Mostcommoninchildren.Thebonesmostcommonly:
Proximaltibial
Distalfemur
Proximalhumerus.
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Features:Severepain,fever,malaise,chills&rigors,sweating,andeven
shock.
Localtenderness(fingertiptenderness),raisedlocaltemperature,
Localerythemaandlimitationofmovements(typicallythelimbis
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heldstill).Diagnosis:
X-rays
Earliestsign:periostealreaction(periostealnewboneformation)at
themetaphysis,whichtakesabout7-10days.
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BonescanIncreaseduptakebyboneinmetaphysiswithin24hoursofonsetof
symptoms(earliestsign.
11.Correctstatementabouthandinfection?
a)OpeningofFelonbyfishmonthincisionispreferredincision
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techniqueb)Felonismiddlevolarpulpinfection
c)Apicalsubungualinfection-V-shapedpieceisremovedfromthe
centerofthefreeedgeofthenailalongwithalittlewedgeofthe
fullthicknessoftheskinoverlyingtheabscess
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d)Whenthepusextendsbeneaththenail,itisnecessarytoremovethesomepartofnailforadequatedrainageofpus
e)None
CorrectAnswer-C:D
Ans.c.Apicalsubungualinfection-V-shapedpieceisremoved
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fromthecenterofthefreeedgeofthenailalongwithalittlewedgeofthefullthicknessoftheskinoverlyingtheabscess;
d.Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
Inapicalsubungualinfection:Fordrainage,asmallVshapedpiece
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lsremovedfromthecentreofthatfreeedgeofthenailalongwithalittlewedgeofthefullthicknessoftheskinoverlyingtheabscess.
Inacuteparonychia:Whenthepusextendsbeneaththenail,itis
necessarytoremovetheproximalone-thirdofthenailforadequate
drainage.
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DONOTperforma"fishmouth"incisionsincethismayresultsin:Unstablefingerpad,neuroma.,and/orlossofsensation"
Thefelonshouldbeincisedintheareaofmaximumswellingand
tenderness.
12.Whichofthefollowingarenotincludedin
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Gurd'scriteria?a)Centralnervoussystemdepressiondisproportionateto
hypoxaemia
b)Tachycardia<1l0bpm
c)Deepveinthrombosis
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d)Axillaryorsubconjunctivalpetechiaee)HypoxaemiaPao2<60mHg,Fio2=0.4
CorrectAnswer-C
Ans.c.Deepveinthrombosis
13.Cause(s)ofavascularnecrosisoffemoral
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Head:a)Fractureoffemoralneck
b)Steroiduse
c)alcoholuse
d)Sicklecelldisease
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e)CaissondiseaseCorrectAnswer-A:B:C:D:E
Answer:A,FractureoffemoralneckB,SteroiduseC,alcohol
useD,SicklecelldiseaseE,Caissondisease
Causeofavascularnecrosisoffemoralhead:
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ldiopathic-commonestAlcoholism
Steroidtherapy
Sicklecelldisease
Patientofrenaldialysis
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PatientonanticancerdrugPost-partumnecrosis
Goucher'sdisease
Caisson'sdisease
14.Spursignis/areseenin:
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a)Supracondylarfractureofhumerusb)Radialheadfracture
c)Acetabulumfractureofpelvis
d)Talusfracture
e)None
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CorrectAnswer-CAns.(c)Acetabulumfractureofpelvis
Spurcells-Theyareirregularlydistortedredcellscontainingseveral
irregularlydistributedthornlikeprojections.
Cellswiththismorphologicabnormalityarealsocalled
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acanthocytes.TheyareseeninSplenectomisedpatientsandpatientswithliver
disease.
15.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year
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b)Proximalfemurismostcommonsiteaffectedc)Pulmonarymetastasisoccurin<3%ofcases
d)Alocallyaggressivetumor
e)Mayinvolvesacrum
CorrectAnswer-A:C:D:E
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Ans.a.Mostcommonagegroupaffectedis20-40year;c.Pulmonarymetastasisoccurin<3%ofcases;d.Alocally
aggressivetumor;e.Mayinvolvesacrum
GCT:
Itperhapsrepresentsthemostaggressivebenigntumorand
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threatensthetruedefinitionofabenigncancerbecausebenignpulmonarymetastasisdevelopinapproximately1%to2%ofgiant
celltumors.
CLINICALFEATURES
Thetumourisseencommonlyintheagegroupof20-40yearsi.e.,
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afterepiphysealfusion.Thebonesaffectedcommonlyarethosearoundthekneei.e.,lower-
endofthefemurandupper-endofthetibia.
Lower-endoftheradiusisanothercommonsite.
Thetumourislocatedattheepiphysis.
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Itoftenreachesalmostuptothejointsurface.Commonpresentingcomplaintsareswellingandvaguepain.
Sometimes,thepatient,unawareofthelesion,presentsforthefirst
timewithapathologicalfracturethroughthelesion.
16.Allaretrueaboutanteriorcruciate
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ligamentexcept?a)Commonlyoccursasaresultoftwistingforce
b)MaybeassociatedwithSegondfracture
c)Rarelyassociatedwithmeniscalinjury
d)Lachmantestishighlysensitivetestfortear
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e)NoneCorrectAnswer-C
Ans.(c)Rarelyassociatedwithmeniscalinjury
Symptoms:
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SignsandsymptomsofanACLinjuryusuallyinclude:Aloud"pop"ora"popping"sensationintheknee
Severepainandinabilitytocontinueactivity
Rapidswelling
Lossofrangeofmotion
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Afeelingofinstabilityor"givingway"withweightbearingComplications
Higherriskofdevelopingosteoarthritisintheknee.Arthritismay
occurevenifyouhavesurgerytoreconstructtheligament.
Segondfractureduetoavulsionattheanterolateralcapsular
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attachment.SegondfractureshaveaveryhighassociationwithACLtearsand,meniscalinjuries
Diagnosis:
Injurytotearofanteriorcruciateligamentcanbedetectedusing
lachmanandanteriordrawertest.
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Lachmanntestisasimilartesttoanteriordrawertestinwhichanteriorglideofthetibiaisjudgedwiththekneein10-15degreesof
flexion.
17.Whichofthefollowingis/aretrueabout
Ewingsarcoma:
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a)Vascularoriginb)Ewing'ssarcomaissecondmostcommonprimarymalignant
bonetumourinchildrenafterOsteosarcoma
c)Metaphysisoflongboneismostcommonsite
d)Feverandweightlossmaybepresent
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e)SurgeryisveryusefulinmanagementCorrectAnswer-B:D
Ans.b.Ewing'ssarcomaissecondmostcommonprimary
malignantbonetumourinchildrenandadolescentafter
Osteosarcoma;d.Feverandweightlossmaybepresent
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EwingSarcoma:Ewing'ssarcomaarisesfromprimitiveneuroectoderm.
MostcommonSite:Femurdiaphysis>tibiadiaphysis
Clinicalfeatures:
Occursbetween10-20yearsofage.
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Thepatientpresentswithpainandswelling.Historyoftraumaprecedingonset,butitisusuallyincidental.
Oftenthereisanassociatedfever,inwhichcaseitmaybeconfused
withosteomyelitis.
Treatment
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Thisisahighlyradio-sensitivetumourmeltsquicklybutrecurs.Treatmentconsistsofcontroloflocaltumourbyradiotherapy,and
controlofmetastasisbychemotherapy.
Themostcommonprimarymalignantbone
tumorsareosteosarcoma(35%),chondrosarcoma(25%),and
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Ewing'ssarcoma(16%).Lessfrequently(5%)occurringtumorsarechordoma,malignant
fibroushistiocytomaofbone,andfibrosarcomaofbone.
Themostcommonmalignantpediatricbonetumors
includeosteosarcomaandEwingsarcoma.
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18.Whichofthefollowingis/areindicationof
surgicalmanagementoffractureofshaft
ofhumerus:
a)Fractureinelderly
b)Radialnerveinvolvementaftermanipulation
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c)Pathologicalfracturesd)Vascularinjury
e)Multiplefractures
CorrectAnswer-B:C:D:E
Ans.(b)Radialnerveinvolvementaftermanipulation,(c)
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Pathologicalfractures,(d)Vascularinjury,(e)MultiplefracturesFracturedShaftofHumerus:OperativeTreatment-Indications:
Severemultipleinjures:
Anopenfracture.
Segmentalfractures.
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Displacedintra-articularextensionofthefractureApathologicalfracture.
Afloatingelbow(simultaneousunstablehumeralandforearm
fractures)
Radialnervepalsyaftermanipulation.
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Non-unionProblemswithnursingcareinadependentperson
19.PiraniscoringofCTEVincludesall
except?
a)Curvatureofthemedialborderofthefoot
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b)Severityofthemedialcreasec)Positionofthelateralpartoftheheadofthetalus
d)Emptinessoftheheel
e)Severityoftheposteriorcrease
CorrectAnswer-A
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Ans.(a)CurvatureofthemedialborderofthefootPIRANISCORING
ThePiraniscoreisasimple,easytousetoolforassessingthe
severityofeachofthecomponentsofaclubfoot.
PiraniScoring:
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Thecomponentsarescoredasfollows:Eachcomponentmayscore0,0.5or1
Hindfootcontracturescore(HCFS):
Midfootcontracturescore(MFCS):
1. Posteriorcrease
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2. Emptyheel3. Rigidequinus
Midfootcontracturescore(MFCS):
1. Medialcrease
2. Curvatureoflateralborder
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3. Positionofheadoftalus20.TrueabouttuberculosisofSpine:
a)Middlepathregimenisusedinmanagement
b)Posteriorelementsofthespineismostcommonlyaffected
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c)Commonlyspreadbyhematogenousroutefromlungd)Acuteonsetparaplegiahasworseprognosis
e)Lowerthoracicandupperlumbarismostcommonsite
CorrectAnswer-A:C:E
Ans.a.Middlepathregimenisusedinmanagement;C.
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Commonlyspreadbyhematogenousroutefromlunge.Lowerthoracicandupperlumbarismostcommonsite
Route:
Lymphogenousandhematogenousspreadhasbeenimplicated.in
thoracolumbarlesions.
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Site:UpperthoracicspinelsthemostcommonsiteofspinalTBin
children,thelowerthoracicandupperlumbarvertebraeareusually
affectedinadults
Paradiscalisthecommonesttype.
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AcuteonsetparaplegiahasabetterprognosisManagement:
1. Rest,
2. DrugsIntensivePhase:HRO(5-6months);ContinuationPhase:HZ
(3-4months)+HR(4-5months);ProphylacticPhase:HE(4-5
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months),3. RadiologicalFollow-up(X-ray,MRI),d.GradualMobilisation+/-
Spinalbraces.managementofAbscess/Sinuses,
4. ManagementofNeurologicalcomplications
5. Surgery(ExcisionalsurgeryDefinitiveSurgery:IndicationofSurgery
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inPott'sspine),6. Post-operativecare
21.A70yearoldladygotcompression
fractureofL1vertebra.Thereisno
neurologicaldeficittothispatient.What
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advisewillyougiveforthisPatient:a)VitaminDsupplementation
b)DoMRIscan
c)GoforscrewfixationofL1vertebra
d)TotakeDexamethasone
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e)TotakeAlendronateCorrectAnswer-A:E
Ans.a.VitaminDsupplementation;e.TotakeAlendronate
Itisacaseofosteoporoticfractureoflumbarspine
Treatmentcanbedividedintomedical&preventive.
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Medical:Highproteindiet,androgen,estrogen,VitaminD,fluoride,
alendronate,calcitonin,teripratide,denosumab&strontium(bothare
antiresorptiveagent).
Orthopaedictreatment:Exercise&Bracing(ASHbraceorTaylor
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brace)22.Forassessingtheinjuryofmeniscusof
kneejoint,whichofthefollowingtest
is/aredone:
a)Apley'stest
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b)Lachmanntestc)McMurray'stest
d)Thessalytest
e)Hamiltonrulertest
CorrectAnswer-A:C:D
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Ans.a.Apley'stest;c.McMurray'stest;d.ThessalytestTestsforMeniscalInjuries?
Apley'sgrindingtest:formeniscusinjury
McMurray'stest-Thisclassictestforatornmeniscusisseldomused
nowthatthediagnosiscaneasilybemadebyMRI.Apositivetestis
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helpfulbutnotpathognomonicanegativetestdoesnotexcludeatear.
Thessalytest:Thistesthasshownahighdiagnosticaccuracyrate
atthelevelof95%indetectingmeniscaltears
23.TrueaboutColle'sfracture:
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a)Occuratdistalendofradius,about2cmfromdistalarticularsurface
b)Fracturealsoinvolvesradiocarpaljoint
c)Fracturealsoinvolvesproximalradioulnarjoint
d)Causeulnardeviation
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e)CommoninwomenCorrectAnswer-A:E
Ans.a.Occuratdistalendofradius,about2cmfromdistal
articularsurface;e.Commoninwomen
Colle'sFracture:
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ThisisaFractureatthedistalendoftheradius,atitscorticocancellousjunction(about2cmfromthedistalarticular
surface),inadults,withtypicaldisplacement.
Itnearlyalwaysresultsfromafallonanout-stretchedhandcItis
commonestfractureinpeopleabovefortyyears
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Particularlycommoninwomenbecauseofpostmenopausalosteoporosis.
Displacement-dorsaldisplacement,dorsaltilt(mostcharacteristic),
lateraldisplacement,dorsaltilt,supination&impactionoffragments
Complication:Dinnerforkdeformity&Subluxationoftheinferior
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radio-ulnarjoint(distalradiocarpaljoint)Itismostcommonofallfractureinolderpeople.
24.Whichofthefollowingis/aretrueabout
simplebonecyst:
a)Mostcommonlyoccurinadult
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b)Commonestsiteistheupperendofthehumerusc)Cortexmaybethin
d)Causepathologicalfracture
e)Noriskofrecurrenceafterremoval
CorrectAnswer-B:C:D
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Ans.b.Commonestsiteistheupperendofthehumerusc.Cortexmaybethind.Causepathologicalfracture
SimpleBoneCyst(Alsok/aSolitaryorUnicameralCyst)
ltappearduringchildhood,inmetaphysisinoneofthelongbones&
mostcommonlylnproximalhumerusorfemur.
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ltisnotatumour,ittendtohealspontaneously.Itisseldomseeninadult
Thisconditionisusuallydiscoveredafterapathologicalfractureor
asanincidentalfindingonX-ray.
X-rayshowsawelldemarcatedradiolucentareainthemetaphysis
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oftenextendinguptothephysealplate;thecortexnaybethinned&theboneexpanded
Treatmentdependsonwhetherthecystissymptomatic,actively
growingorinvolvedinafracture
25.Trueaboutankylosingspondylitis:
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a)Romanuslesionmaybefoundb)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all
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CorrectAnswer-A:B:CAns.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)
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Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
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Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.
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JointsinvolvedinankylosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
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Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
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ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
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diminishedchestexpansion(normal_5cm)Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
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Pathologicalchangesproceedinthreestages?Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
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RadiologicalfeaturesofankylosingspondylitisRadiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints
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WideningofthesacroiliacjointspaceBonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
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aroundtheheel.X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
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ftLossofthelumbarlordosis.Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance
26.Trueaboutboutonnieredeformity:
a)Flexionofproximalinterphalangealjoint&hyperextensionof
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distalinterphalangealjointb)Hyperextensionofproximalinterphalangealjoint&flexionof
distalinterphalangealjoint
c)Flexionatproximalinterphalangeal&extensionat
metacarpophalangealjoint
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d)Flexiondeformityoftheproximalinterphalangealjointoccurduetotearincentralslipofextensortendon
e)Mayoccurinrheumatoidarthritis
CorrectAnswer-A:D:E
Ans.a.Flexionofproximalinterphalangealjoint&
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hyperextensionofdistalinterphalangealjoint;d.Flexiondeformityoftheproximalinterphalangealjointoccurdueto
tearincentralslipofextensortendon;e.Mayoccurin
rheumatoidarthritis
Boutonnieredeformityisadeformedpositionofthefingersortoes,
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inwhichthejointnearesttheknuckle(theproximalinterphalangealjoint,orPIP)ispermanentlybenttowardthepalmwhilethefarthest
joint(thedistalinterphalangealjoint,orDIP)isbentbackaway(PIP
flexionwithDIPhyperextension).
Itcanbecausedbyacutonthetopofthefinger,whichcansever
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thecentralslip(tendon)fromitsattachmenttothebone.Thetearlookslikeabuttonhole("boutonni?re"inFrench).Insomecases,the
boneactuallycanpopthroughtheopening.
Boutonni?redeformitiesmayalsobecausedbyarthritis.
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27.Trueaboutapplyingaplasterisare?
a)Takenoutfromwateroncebubblesstartcoming
b)Takenoutfromwateroncebubblesstopcomingout
c)Settingisdelayedincoldwater
d)Cottonpaddingisoverlappedbyonethird
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e)Molding/smoothingofplasterisdonebyfingersCorrectAnswer-B:C:D
Ans.is'b'i.e.,Takenoutfromwateroncebubblesstopcoming
out;'c'i.e.,Settingisdelayedincoldwater;'d'i.e.,Cotton
paddingisoverlappedbyonethird
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Forsecuring,eachturnisoverlappedbyonethirdtoonehalfinordertosecurelayers.
Ifabandageisimmersedincoldwatertheinitialsetwillbedelayed
andthus"workingtime"lengthened.However,ifaveryrapidis
requiredsoakingthebandageinwarmwaterwillacceleratetherate
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ofreaction.Mouldingofthebandagestothecontoursofthelimbshouldbedone
byconstantsmoothingwiththepalms(notbyfingers)ofthewet
hands.
28.RadiologicalfeaturesofPerthe'sdisease
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is/are?a)Decreasedmedialjointspace
b)Lateralsubluxation
c)VerticalPhysis
d)Speckledcalcification
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e)WidefemoralneckCorrectAnswer-B:D:E
Ans.is,b'i.e.,Lateralsubluxation;'d'i.e.,Speckled
calcification&'e'i.e.,Widefemoralneck
Radiologicalfindingsinperthe'sdiseaseare:-
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IncreasedmedialjointspaceWideningoffemoralneck
Lateralextrusion(lateralsubluxation)
Metaphysealcystsandrarefactionofmetaphysis
Horizontalphysiswithspeckledcalcifcationlateraltoit
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Fragmentationoffemoralheadwithincreaseddensity(irregulardensitiesintheepiphysis).
29.Latecomplicationofsupracondylar
fractureis?
a)Ulnarnervepalsy
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b)Cubitusvarusc)Cubitusvalgus
d)Myositisossificans
e)Volkmann'sischemiccontracture
CorrectAnswer-B:D:E
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Ans.'b'1.e.,CubitusVarus'd'i.e.,Myositisossificans'e'i.e.,Volkmannischemiccontracture
LateComplications:
Occurringweekstomonthsafterthefractureandinclude:
Malunion:-Itisthecommonestcomplicationofsupracondylar
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fractureandresultsincubitusvarus(Gunstockdeformity),Cubitusvalgusisrareandmayoccuroccasionallyinposterolateral
displacement.
Myositisossificansandelbowstiffness.
Volkmann'sischemiccontracture
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30.Complication(s)offractureoflateral
condylehumerusis/are?
a)Cubitusvarusdeformity
b)Tardyulnarnervepalsy
c)Cubitusvalgusdeformity
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d)Mediannerveinjurye)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
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ComplicationsofLateralcondyleofhumerusfractureLateralspur
Cubitusvalgus
Rarely,cubitusvarus
Tardyulnarnervepalsy
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RarelyavascularnecrosisandmyositisossificansPosterolateralinstabilityandrecurrentinstability
31.Followingaretrueregardinghangmans
fracture?
a)FractureofspinousprocessofC7
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b)FractureofC2vertebrac)Listhesisofthefracturevertebra
d)Knotisplacedundernapeofneck
e)None
CorrectAnswer-B:C
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Ans.is'b'i.e.,FractureofC2vertebra;'c'i.e.,Listhesisofthefracturevertebra
Hangman'sfracture
Hangman'sfractureisbilateralfractureoftheparsinterarticularisof
axis(C2)withtraumaticspondylolisthesisofaxis(C2)over
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C3vertebrae.ThusHangman'sfractureisnotsimplyafracture,butfracturedislocationofaxis(C2).
Themechanismofinjuryisextensionwithdistraction(intrue,judicial
hangman'sfracture)andhyper-extension,axialcompression&.
flexion(incivilianinjuries,whicharenowmorecommon).
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ItissecondmostcommontypeofAxis(C2)fracture,secondonlytoodontoidfractures.
Fatalatiesarecommon,However,neurologicaldeficitisunusualas
thefractureofposteriorarchdecompressthespinalcord.
Mostofthefatalitiesoccuratthesceneofinjury,acutepost
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admissionmortalityislow.SuccessfulhealingofC2traumaticspondylolisthesisisreportedto
approach95%.Thisismostcommonlyachievedwithnon-operative
measures,eveninthepresenceofdisplacementofparsinter-
articularis.
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Undisplacedfracturesaretreatedinasemi-rigidorthosis,anddisplacedfractureareclosedreduced&treatedwithhalo-vest.
Occasionally,thehangman'sfractureisassociatedwithaC2/3facet
dislocation.Thisisaseverelyunstableinjury;openreductionand
stabilizationisrequired.
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32.Trueaboutkeinbock'sdiseaseis/are?
a)AVNofscaphoid
b)Morecommoninmales
c)Maybeassociatedwithcerebralpalsy
d)Stage-IshowsnormalX-ray
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e)MaycausecarpaltunnelsyndromeCorrectAnswer-B:C:D:E
Ans.b)Morecommoninmalesc)Maybeassociatedwith
cerebralpalsyd)Stage-IshowsnormalX-raye)Maycause
carpaltunnelsyndrome
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Keinbock'sdisease:Itisavascularnecrosisoflunatebone.Itisrelatedtooveruseand
ulnarnegativewristvarianceandmaybeassociatedwithsicklecell
anemia,steroidabuse,goutandcerebralpalsy.
Itusuallyoccursin2ndto5decadewithmalepreponderance'
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Patientscomplainsofdorsalwristpain,swelling,warmth,tendernessovertheradiolunatejointreducedROManddecreased
gripstrength.
Complications:
Stiffness
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LossofmotionWeakness
Carpaltunnelsyndrome
Persistentpain
Instability
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Degenerationinadjacentjoints33.Trueaboutlocation(s)oftumoris/are?
a)Osteosarcomaisdiaphyseal
b)Ewingsarcomaisdiaphyseal
c)Chondrosarcomaismetaphyseal
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d)Fibrosarcomaisdiaphyseale)Osteoclastomaisepiphyseal
CorrectAnswer-B:C:D:E
Ans.b)Ewingsarcomaisdiaphysealc)Chondrosarcomais
metaphyseald)Fibrosarcomaisdiaphyseale)Osteoclastoma
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isepiphysealEpiphysealtumor:
Chondroblastoma
Giantcelltumor(osteoclastoma)
Clearcellchondrosarcoma
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Metaphyseallesion:Osteogenicsarcoma.
Unicameral(simple)bonecyst.
Aneurysmalbonecyst.
Fibrouscorticaldefect.
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ChondrosarcomaOsteochondroma
Enchondroma.
Osteoblastoma
Diaphyseallesion:
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EwingsarcomaLymphomas
Fibrousdysplasia
Adamantinoma
Histiocytosis
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OsteoidosteomaChondromyxoidfibroma
Fibrosarcoma
Fibrouscorticaldefect
Nonossifyingfibroma
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34.A28yearsoldladypresentedwithwrist
pain.X-raywristisshowinglyticeccentric
lesioninlowerendofradiuswithsoap
bubbleappearance.Whatisthenextplan
ofmanagement?
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a)Bonecurettageandbonegraftingb)Extendedcurettagewithphenol
c)Biopsyofthelesion
d)Extendedcurettagewithphenolandbonegrafting
e)Parathyroidandserumcalciumlevelsmeasurement
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CorrectAnswer-CAns.is'c'1.e.,Biopsyofthelesion
28yearsfemalewithlyticeccentriclesioninlowerendofradiusand
soapbubbleappearancesuggestthediagnosisofGCT.
Nextplanofmanagementwouldbebiopsyoflesiontoconfirmthe
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diagnosis.35.Trueaboutthesitesinvolvedin
osteomyelitisis/are?
a)Mainlyinvolvesmetaphysis
b)Distaltibiaisinvolvedcommonly
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c)Proximalhumerusisinvolvedcommonlyd)Proximalfemurisinvolvedcommonly
e)Reachestositebyhematogenousroutes
CorrectAnswer-A:C:E
Ans.is,a,i.e.,Mainlyinvolvesmetaphysis;'c'i.e.,Proximal
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humerusisinvolvedcommonly'e'i'e',Reachestositebyhematogenousroute
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andalmostcommonsourceofboneandjointinfectionis
hematogenous.
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Itiscausedmostcommonlybystaphylococcusaureus.Othercausativeorganismsarestreptococcus,pneumococcus,and
gramnegativebacilli.
Infectionbypseudomonasbecomesproportionallymuchmore
commoninIVdrugabuser.But,themostcommonorganismis
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staphylococcusaureus.36.Compoundpalmarganglioniscausedby
?
a)Trauma
b)Overuse
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c)RAd)TB
e)SLE
CorrectAnswer-C:D
Ans.is'c'i.e.,RA'd'i.e.,TB
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Rheumatoidarthritisandtuberculosisarethecommonestcauses.Tubercularandrheumatoidcompoundpalmerganglionis
characterizedbypresenceofricebodies,milletbodiesandmelon
seeds.
37.Trueaboutcompoundpalmarganglion?
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a)Duetodegenerationofflexorretinaculumb)Hour-glassinshape
c)Surgeryisthemainstayoftreatment
d)Intrasynovialsteroidisthemainstayoftreatment
e)Maybeseeninrheumatoidarthritis
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CorrectAnswer-A:DAns.is'a'i.e.,Duetodegenerationofflexorretinaculum;'d'i.e.,
Intrasynovialsteroidisthemainstayoftreatment
Compoundpalmarganglionisamisnomerbecauseitisneithera
ganglionnorcompound.
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Chronicinflammationdistendsthecommonsheathofflexortendonsbothaboveandbelowtheflexorretinaculum.
Thereishourglassswelling,bulgingaboveandbelowtheflexor
retinaculum
Tubercularandrheumatoidcompoundpalmerganglionis
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characterizedbypresenceofricebodise,milletbodiesandmelonseeds
Rheumatoidarthritisandtuberculosisarethecommonestcauses.
38.Apersonhasinjuryondorsalsurfaceof
proximalinterphalangealjointofright
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middlefinger.Whichofthefollowingcanoccur
a)Ruptureoflateralligament
b)Buttonholedeformity
c)Malletfinger
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d)Lacerationofthecentralslipoftheextensore)Noneoftheabove
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Ruptureoflateralligament;'b'i.e.,Buttonhole
deformity;'d'i.e.,Lacerationofthecentralskipoftheextensor
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Injurytodorsalsurfaceofproximalinterphalangealjoint(zoneII)maycause:-
Ruptureofcentralslipofextensorexpansion-causingButtonhole
deformity.
ThisresultsinlossofactiveextensionofthePIPjointandpersistent
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flexionofthePIPjoint.AnteriordislocationofPIPjointmaycauseruptureofbothcentral
clipaswellaslateralligament.
39.Trueaboutpectusexcavatum
a)Morecommoninfemale
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b)Inseverecases,mitralvalveprolapsemayoccurc)Maybepresentatbirth
d)Seeninmarfansyndrome
e)Impairmentofrespiratoryfunction
CorrectAnswer-B:C:D:E
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Ans.is'b'i.e.,Inseverecases,mitralvalveprolapsemayoccur;'c'i.e.,Maybepresentatbirth;'d'i.e.,SeeninMarfansyndrome
i'e'i.e.,Impairmentofrespiratoryfunction
PectusExcavatum
Alsocalledfunnelchest'isthemostcommonchestwalldeformity.
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Malesareaffectedmorethanfemales(4:1).Pectusexcavatumarisesfromimbalancedorexcessivegrowthof
thelowercostalcartilages.
Typicallythedefectisdiagnosedwithinthefirstyroflifeand
worsensovertime.
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Depressionmayrangefrommildlydepressedsternumtosternaldepressionabuttingthevertebralcolumnwithdisplacementsof
mediastinalstructures.
OtherconditionsassociatedwithPectusExcavatum:
Scoliosis
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Marfan'ssyndromeMitralvalveprolapse
Congenitalheartdiseases
40.Inponsetitechniquelastdeformityinto
getcorrectedinCTEV-
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a)Equinusb)Talipus
c)Varus
d)Cavus
e)Alldeformitycorrectedsimultaneously
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CorrectAnswer-AAns(a)Equinus
Ponseti'stechnique
Thisinvolvesfirstcorrectingthecavusdeformitythentheadduction
andheelvarusandfinallytheequinusdeformity.
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ThistechniqueisnowmostlyacceptedtechniqueforCTEVcorrectionasitisbasedonbetterunderstandingofthe
pathoanatomyofthedeformedfoot.
Thesuccessofreductionis90-98Percent.
41.Trueaboutavascularnecrosisoffemur
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a)Affectedsidehipallowsweightbearingb)Asymptomaticcasesmayoccur
c)Radionucleotidescanshowincreaseduptakeduetonewbone
formationintheareaaroundtheinfarct
d)Trendelenburgsigninnegative
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e)NoneoftheaboveCorrectAnswer-A:B:C
Ans.is'a'i.e.,Affectedsideofhipallowwt.bearing;'b'i.e.,
Asymptomaticcasesmayoccur&'c'i.e.,Radionucleotidescan
showincreaseduptakeduetonewboneformationinthearea
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aroundtheinfarctCausesofAVN
ldiopathic(mostcommon)
Infection-septicarthritis,osteomyelitis
Hematologicalmalignancies-leukemia,lymphoma
--- Content provided by FirstRanker.com ---
Alcohol,corticosteroidsSLE
Pregnancy
Cassionsdisease
Hyperlipidemia
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PerthesdiseasIonisingradiation
CLINICALFEATURES:
Pain
Deceaserangeofmotionespeciallyinternalrotationfollowedby
--- Content provided by FirstRanker.com ---
abduction.SectoralsignorDifferentialrotation:-Internalrotationispossiblein
extendedpositionofhip,butasseenasthehipisflexedto900no
internalrotationispossible.ThisisthecharacteristicsignofAVN.
Trendelenburg'stestpositive
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Radiologicalfindings:MRIisthemostreliablewayofdiagnosingmarrowchangesand
boneischaemia
42.Trueaboutganglioncyst?
a)Mostcommoninyoungmale
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b)Containsynovialfluidc)Arisefromextensorretinaculum
d)Itusuallyarisefromthelunotriquetraljoint
e)Surgicaltreatmentisexcisionofcyst
CorrectAnswer-B:E
--- Content provided by FirstRanker.com ---
Ans.is'b'i.e',Containsynovialfluid;'e'i.e.,Surgicaltreatmentisexcisionofcyst
Aganglionisthecommonestcysticswellingattheback(Dorsal
aspect)ofthewrist.
Unilocularcyst
--- Content provided by FirstRanker.com ---
Arisesduetoleakageofsynovialfluidfromajointortendonsheath.Filledwithmucinousfluidandlinedbyfibroustissue
Usuallydevelopsonthedorsalsurfaceofthescapho-lunate
ligament.
Palmarwristgangliausuallyarisefromthevolarscapholunateor
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scapho-trapezio-trapezoidjoint.Morecommoninyoung(20-40years)female.
Nocommunicationbetweenthejointcavityortendonsheathandthe
interiorofcyst.
Painlesssmallswellingsometimesitmaycausepain.
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Treatment:Notrequired.
ForpainNSAIDs
Swellingincreaseinsizeitmaybeaspiratedorsurgicallyexcised.
43.Testforanteriorcruciateligamentis/are
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a)Lachmanntestb)Apley'sgrindingtest
c)Pivotshifttest
d)Anteriordrawer
e)KT-1000kneearthrometerisanobjectiveinstrumentforACL
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reconstructionCorrectAnswer-A:C:D:E
Ans.is'a'i.e.,Lachmanntest'c'i.e.,Pivotshifttest;'d'i.e.,
Anteriordrawer&'e'i.e.,KT-1000kneearthrometerisan
objectiveinstrumentforACLreconstruction
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FollowingtestsareusedforACLinjury:-Lachman'stest
Pivotshifttest
Anteriordrawertest
Jerktest
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Flexion-rotationdrawertestLoose'stest
44.Trueaboutosteomalacia?
a)Morecommoninmale
b)LowPTH
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c)Increasealkalinephosphatased)Decreasedcalciumlevel
e)Looser'szoneonX-ray
CorrectAnswer-C:D:E
Ans.(c)Increasealkalinephosphatase;(d)Decreasedcalcium
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level;(e)Looser'szoneonX-rayOsteomalacia
Looser'szone(pseudofractures)areradiolucentzonesoccurringat
thesitesofstressinosteomalacia(commonlyatpubicrami)
Osteomalaciaismorecommoninwomenwholivein"purdah"&lack
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exposuretosunlightSerumcalcium&phosphateislow&alkalinephosphataseishigh
Muscularweakness(Thepatientfeelsveryweak.Hemaydifficulty
inclimbingup&downthestairs)
45.Trueaboutcomplexregionalpain
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syndrome:a)Sudeck'satrophyisanexample
b)Painisoutofproportiontoprecipitatingcause
c)Hyperaesthesiaofskinmaybepresent
d)Adultsareusualsufferer
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e)ParasympatheticmediatedenhancementofpainCorrectAnswer-A:B:C:D
Ans.a.Sudeck'satrophyisanexample;b.Painisoutof
proportiontoprecipitatingcause;c.Hyperaesthesiaofskin
maybepresent;d.Adultsareusualsufferer
--- Content provided by FirstRanker.com ---
ComplexRegionalPainSyndromeAnumberofclinicalsyndromesappearunderthisheading,including
Sudeck'satrophy,reflexsympatheticdystrophy,algodystrophy,
shoulder-handsyndrome&particularlyafteranerveinjury-
causalgia.
--- Content provided by FirstRanker.com ---
Precipitatingcausesaretrauma(oftentrivial),operationorarthroscopy,aperipheralnervelesion,myocardialinfarction,stroke
&hemiplegia
Adultsaretheusualsufferersbuttheconditionoccasionallyoccurin
children
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46.TrueaboutDupuytren'scontracture;
a)Commonlyaffectring&smallfinger
b)Mayinvolvepenis
c)Involvesmetacarpo-phalangealjoint
d)Kneereflexdiminished
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e)InvolvesneckflexorsCorrectAnswer-A:B:C
Ans.a.Commonlyaffectring&smallfinger;b.Mayinvolve
penis;c.Involvesmetacarpo-phalangealjoint
ClinicalFeaturesofDupuytren'scontracture:
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Thickenedfibrousbandsfeltovertheulnarsideofthepalm.Thickeningofplantarfasciaorthatofthepenilefascia(Peyronie's
disease).
Tendernessovertheinvolvedareaatthebaseofthedigits.
FlexiondeformityattheMCPandPIPjointsofinvolvedfingers
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47.AllaretrueVolkmannischemic
contractureexcept
a)Ischemicmuscleisreplacedbyfibrous
b)Ulnarnervepalsymaybepresent
c)Extensiondeformityofthewrist&fingers
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d)Flexionatthemetacarpophalangeale)Tendontransferhelpsinrestoringmovements
CorrectAnswer-C
Ans.c.Extensiondeformityofthewrist&fingers
VOLKMANN'SISCHEMIA
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Earlycomplicationofsupracondylarfracture.Ischemicinjurytothemusclesandnervesoftheflexor
compartmentoftheforearm.
D/tocclusionofbrachialartery.
Tissuepressurereadingswithin30mmHgofthepatient's
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diastolicbloodpressure(perfusionpressureMusclessuppliedbyanteriorinterosseusarteryaremost
susceptible,asitisanendartery.
Mostcommonlyaffectedmuscle:flexorpollicislongus&medial
halfofflexordigitorumprofundus.
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Mediannerveismostcommonlyinvolved.Treatment:fasciotomy
48.Allaretrueaboutsupracondylarfracture
ofhumerusexcept:
a)Posteriorshiftofdistalfragment
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b)Mediannerveismostcommonnervedamagedc)Injuryofbrachialarterymayoccur
d)Commoninelderly
e)Volkmann'sischemiccontracturemayoccur
CorrectAnswer-D
--- Content provided by FirstRanker.com ---
Ans.d.CommoninelderlySupracondylarFractureoftheHumerus:
Complications:
Immediate-injurytobrachialartery&injurytonerve(mediannerve-
mostcommon,radialnerve-sometimeaffected)
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Early-Volkmann'sischemiaLatecomplication-Malunion(cubitusvarusdeformity),myositis
ossificans&Volkmann\ischemiccontracture.
Displacement:Thedistalfragmentmaybedisplacedinthefollowing
direction
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PosteriororbackwardshiftPosteriororbackwardtilt
Proximalshift
Medialorlateralshift
Medialtilt
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Internalrotation49.NotanIntra-articularfracture:
a)Rolandofracture
b)Marchfracture
c)Bennett'sfracture
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d)Barton'sfracturee)Hoffafracture
CorrectAnswer-B
Ans.b.Marchfracture
Marchfracture:Fatiguefractureofshaftofsecondorthird
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metatarsalRolandofractureisathreepartorcomminutedintraarticular
fracture-dislocationofthebaseofthumb.
Pilonfracture:Itisacommunicatedintra-articularfractureofthe
distalendofthetibia
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Bennett'sfracture:Ifisanobliqueintra-articularfractureofthebaseofthefirstmetacarpalwithsubluxationofthetrapezoid'metacarpal
joint"
Barton'sfracture(Marginalfracture):Intra-articularfracturesthrough
thedistalarticularsurfaceoftheradius,takingamargin,anterioror
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posterior,ofthedistalradiuswiththecarpals,displacedanteriorlyorposteriorly
Hoffafracturesareintra-articularandarecharacterisedbyafracture
inthecoronalplane
50.TrueaboutLockingcompressionplate:
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a)Insteoporoticpatients,itshouldnotbeusedb)Canbeusedasbuttressplate
c)Usuallycauseperostealinjury
d)Mechanicallysuperiortoaconventionalplate
e)Cannotbeusedascompressionplate
--- Content provided by FirstRanker.com ---
CorrectAnswer-B:DAns.b.Canbeusedasbuttressplate;d.Mechanicallysuperior
toaconventionalplate
LockingCompressionPlate:
Thelatestdevelopmentinplatingtechniqueislockingcompression
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plate(LCP).Ithasrigidplate,Screwconstruct,whichhasbeenfoundtobe
mechanicallysuperiortoconventionalplate.
LCPcanbeusedascompressionplate,asneutralizationplate,asa
buttressplate,asabridgingplate&asalockedplate.
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ItisParticularlysuitableforperiarticularfractures&fracturesinosteoporoticbones
51.Osteoscleroticmetastasesis/arecommon
incancerof:
a)Prostate
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b)Breastc)Lung
d)Malignantmelanoma
e)Renalcellcarcinoma
CorrectAnswer-A:B
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Ans.a.Prostate;b.BreastMetastasesaremostcommonlyseeninthepelvis,ribs,vertebral
bodies,andproximallimbs.
Theselesionstypicallyhavealyticappearanceonplain
radiographs,althoughbreastandprostatemetastasescanbe
--- Content provided by FirstRanker.com ---
scleroticormixedwithlyticandscleroticfeatures.Overall,metastasesarethemostcommontumorofbones.
Adults:Approximately75%ofmetastasestothebonearederived
fromprostate,breast,kidney,andlungcarcinomas.
Children:Neuroblastoma,Wilmstumor,osteosarcoma,andEwing
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sarcoma.Kidneyandthyroidneoplasmsareknownforproducingasolitary
metastasis.
Metastasestohandandfootbonesareuncommonand,ifpresent,
thesourceisusuallyalung,colon,orrenalneoplasm.
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52.Followingareimmediatecomplicationsof
fracture:
a)Vascularischemia
b)Neuronalinjury
c)Malunion
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d)Compartmentsyndromee)Avascularnecrosis
CorrectAnswer-A:B
Ans.a.Vascularischemia;b.Neuronalinjury
ImmediateComplications:
--- Content provided by FirstRanker.com ---
Systemic:Hypovolaemicshock
Local
Injurytomajorvessels
Injurytomuscles&tendon
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InjurytojointsInjurytoviscera
Earlycomplications:
Systemic:
Hypovolaemicshock
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ARDS:FatembolismsyndromeDVT&Pulmonaryembolism;
Aseptictraumaticfever;
Septicaemia;
Crushsyndrome
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LocalInfection
Compartmentsyndrome
Latecomplications:
Imperfectunionoffracture:
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Delayedunion;Non-union;Malunion;CrossunionOthers:
Avascularnecrosis;Shortening;Jointstiffness;Sudeck'sdystrophy;
Osteomyelitis;ischaemiccontracture;Myositisossificans;
Osteoarthritis
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53.Whichofthefollowingcausemalunion
except:
a)Open#
b)Infection
c)Bonegrafting
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d)Softtissueinterpositione)Properalignmentoffracture
CorrectAnswer-C:E
Ans.c.Bonegrafting;e.Properalignmentoffracture
Bonegraftingisusedintreatmentofmalunion
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Infection:Bothbiology&stabilityofbonehealingarehamperedbyactiveinfection
54.TrueaboutatypicalCTEV
a)Footisflexeddownward
b)Solecreasearenotfound
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c)Difficulttotreatthantypicalvarietyd)Mayoccurduetoneurologicaldisorder
e)MaybeassociatedwithMeningomyelocele
CorrectAnswer-A:C:D:E
Ans.a.Footisflexeddownward;c.Difficulttotreatthantypical
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variety;d.Mayoccurduetoneurologicaldisorder;e.MaybeassociatedwithMeningomyelocele
AtypicalIdiopathicClubfoot:
Ashortandfatorswollenfoot.
Thebigtoeisshortandpointsupward
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Acreaserunsacrossthebottom(sole)ofthefootfromsidetoside.Thereisadeepcreaseintheskinabovetheheel.
Theheelareaisrigidlytiltedinward.
Thefootisrigidlyflexeddownwardand,theheelcordisverytight,
wide,andlong.
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Thecalfmuscleisverysmallandbunchedupunderthebackoftheknee.
CausesofCTEV
CTEVmaybeeitherprimaryorsecondary
1.PrimaryorIdiopathic
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ItisthemostcommontypeofCTEVFootdeformity(CTEV)istheonlymanifestation,otherwise
musculoskeletalsystemisnormal.
2.Secondary
CTEVisalocalmanifestationofasystemicsyndrome.
--- Content provided by FirstRanker.com ---
Causesare:-1. Neurologicaldisorders&neuraltubedefectsegmyelomeningocele,
&spinaldysraphism
2. Paralyticdisorder(duetomuscularimbalance)aspolio,spinabifida,
myelodysplasia,&Fredreich'sataxia
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3. Arthrogiyposismultiplexa4. Larsensyndrome
5. Freeman-Sheldonsyndrome
6. Diastrophicdwarfism
7. Sacralagenesis,tibialdeficiency,constrictionrings&amniotic
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bands55.Inyoungpersonmostcommoncancer
amongfollowingis:
a)Giantcell
b)Osteosarcoma
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c)Chondrosarcomad)Ewingsarcoma
e)All
CorrectAnswer-B
Ans.b.Osteosarcoma
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Osteosarcomaisthesecondmostcommontumour.Thesetumoursoccurb/wtheagesof15-25years,constitutingthe
commonestmusculo-skeletaltumouratthatage
56.Allaretrueaboutsepticarthritisexcept:
a)Staph.Aureusismostcommoncausativeorganism
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b)Commoninchildrenc)Affectgrowthplate
d)E.coliisthecommonestcausativeorganism
e)Aspirationofjointfluidisusedfordiagnosis
CorrectAnswer-D
--- Content provided by FirstRanker.com ---
Ans.d.E.coliisthecommonestcausativeorganismItismorecommoninchildren&males
Staphylococcusaureusisthecommonestcausativeorganism,other
organismarestrepto-pneumo&Gonococcus.
Aspiratethejoint&examinethefluid.AWBC&gramstainshould
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becarriedoutimmediately.Sampleoffluidarealsosentforfullmicrobiologicalexamination&testsforantibioticsensitivity.
57.Featuresoffatembolism:
a)Bradycardia
b)Hypoxia
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c)Hypotensiond)Tachypnoea
e)Petechialrash
CorrectAnswer-B:D:E
Ans.b.Hypoxia;d.Tachypnoea;e.Petechialrash
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Fatembolismsyndrome:Tachycardia
Slightriseoftemperature
Breathlessness
Hypoxiafrominvolvementoflung
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TachypnoeaPetechialrash
Respiratoryfailure
Drowsy
Restless
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Coma58.Straightlegraisingtestis/arepositivein:
a)Spinalstenosis
b)Spinalabscess
c)AlsocalledasTrendelenburgtest
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d)Prolapsedintervertebraldisce)Sciatica
CorrectAnswer-D:E
Ans.d.Prolapsedintervertebraldisc;e.Sciatica
Pain&limitationofStraightlegraising(SLR)isafeatureof
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prolapsedintervertebraldiscwhenthereisirritationorcompressionofoneoftherootsofthesciaticnerve.
Straightlegraisingtest:Thisisatesttodetectnerveroot
compression.
59.Whichofthefollowingis/aretrueabout
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thegaitinsensorydeficita)Antalgicgait
b)Apraxia
c)Trendelenburg
d)PositiveRombergsign
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e)ApraxiagaitCorrectAnswer-D
Ans.d.PositiveRombergsign
Insensoryataxiathepatientisabletomaintaintheupright
positionwhiletheeyesareopen,butwhentheeyesareclosed
--- Content provided by FirstRanker.com ---
hesways.ThisisapositiveRombergsign.ABNORMALGAIT:
Antalgicgait:occursinpainfulconditionsofthelowerlimb.
Charlie-Chaplingait:Occursintibialtorsion.
Circumductiongait:Occursinhemiplegia
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Waddlinggait:OccursinbilateralcongenitalhipdislocationHighsteppinggait:Occursinfootdrop
Scissoringgait:Occursincerebralpalsy
Stiffhipgait:Occursinankylosisofthehip
Trendelenburggait:Occursinunstablehipduetocongenital
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dislocationofhip,gluteusmediusmuscleweakness60.TrueaboutTrichomonasvaginitis:
a)Importantcauseofrecurrentabortion
b)T.vaginalisisaflagellatedprotozoa
c)Metronidazoleisusedfortreatment
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d)Strawberrycervixe)Curdydischarge
CorrectAnswer-B:C:D
Ans.b.T.vaginalisisaflagellatedprotozoa;c.Metronidazoleis
usedfortreatment;d.Strawberrycervix
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Trichomonasvaginits:Itiscausedbytrichomonasvaginalis,apear-shapedunicellular
flagellateprotozoa
Onspeculumexamination,mucosaoftheportiovaginalispartof
cervixappearlikestrawberry
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Infectioningenitaltractmayberesponsibleforsporadicspontaneousabortionbutitsrelationtorecurrentabortionis
inconclusive.
61.AllaretrueaboutPott'sspineexcept:
a)ThoracicvertebraeT6-T8ismostcommonlyaffectedsite
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b)Paradiscaliscommonestvarietyc)Muscularrigidity&stiffnessiscommon
d)Posteriorpartofvertebraeismoreaffectedthananteriorpart
e)BackpainisthecommonestPresentingsymptom
CorrectAnswer-A:D
--- Content provided by FirstRanker.com ---
Ans.a.ThoracicvertebraeT6-T8ismostcommonlyaffectedsite;d.Posteriorpartofvertebraeismoreaffectedthananterior
part
Tuberculosis(TB)ofthespine(Pott'sdisease)isthemostcommon
siteofboneinfectioninTB.
--- Content provided by FirstRanker.com ---
Thelowerthoracicandupperlumbarvertebraearetheareasofthespinemostoftenaffected.
Pott'sdiseaseresultsfromhaematogenousspreadoftuberculosis
fromothersites,oftenpulmonary.Theinfectionthenspreadsfrom
twoadjacentvertebraeintotheadjoiningdiscspace.
--- Content provided by FirstRanker.com ---
Ifonlyonevertebraisaffected,thediscisnormal,butiftwoareinvolvedtheintervertebraldisc,whichisavascular,cannotreceive
nutrientsandcollapses(seenasnarrowingofintervertebralspace
onX-rays)
CommonestspineinvolvedinspineTBis
--- Content provided by FirstRanker.com ---
Thoracolumbar/DorsolumbarT12-L1(Lowerthoracictobeprecise.Thediseaseprogressesslowly.Signsandsymptomsinclude:
Localisedbackpainistheearliestandcommonestcomplaint
Paravertebralswellingmaybeseen
Neurologicalsignsmayoccur,leadingtoparaplegia.
--- Content provided by FirstRanker.com ---
Stiffness
Deformity
Constitutionalsymptoms
Diagnosis:
SpinalX-raymaynotshowearlydiseaseas50%ofbonemassmust
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belostforchangestobevisibleonx-ray.However,plainradiographscanshowvertebraldestructionandnarroweddisc
space.
MRIisusefultodemonstratetheextentofspinalcompressionand
canshowchangesatanearlierstagethanplainradiographs.Bone
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elementsvisiblewithintheswelling,orabscesses,arestronglyindicativeofPott'sdiseaseasopposedtomalignancy.
CTscansandnuclearbonescanscanalsobeused.
62.TrueaboutClubfoot:
a)Abductionofforefoot
--- Content provided by FirstRanker.com ---
b)Associatedwithbreechpresentationc)Dennis-Brownsplintused
d)Adductionofforefoot
e)Associatedwithspinabifida
CorrectAnswer-C:D:E
--- Content provided by FirstRanker.com ---
Ans.c.Dennis-Brownsplintusedd.Adductionofforefoote.Associatedwithspinabifida
CTEVisthecommonestandmostimportantcongenitaldeformityof
thefoot.
Thedeformityconsistsoffollowingelements:-
--- Content provided by FirstRanker.com ---
1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)2. Inversionoffootatsubtalarjoint(talocalcanealjoint)
3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular
joint.
4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-
--- Content provided by FirstRanker.com ---
tarsaljoints.Treatment:
Tendontransfer:-Transferoftibialis-anteriorontheoutersideof
foot.Thiscanbedoneonlyafter5years.
Dwyerosteotomy:-Medialopenwedgeosteotomyofcalcaneumto
--- Content provided by FirstRanker.com ---
correctheelvarus.Gradualdifferentialdistraction:-Inthisanexternalfixator(JESSor
Illizarov)isappliedandgradualcorrectionofdeformity
>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,and
talonavicularjoints)
--- Content provided by FirstRanker.com ---
63.TrueaboutOsteosarcoma:
a)Primaryosteosarcomaismostcommonlyoccurinagegroup
oflessthan20yr
b)Periostealreactionispresent
c)Presentaselevatedsofttissuemass
--- Content provided by FirstRanker.com ---
d)Commonlyassociatedwithosteoidosteomae)Formationofbonebythetumorcellsischaracteristic
CorrectAnswer-A:B:C:E
Ans.a.Primaryosteosarcomaismostcommonlyoccurinage
groupoflessthan20yr;b.Periostealreactionispresent;c.
--- Content provided by FirstRanker.com ---
Presentaselevatedsofttissuemass;e.Formationofbonebythetumorcellsischaracteristic
Osteosarcomaisprimarymalignantbonetumorofbone,derived
fromprimitiveboneformingmesenchymaandcharacterizedby
osteoidformation.
--- Content provided by FirstRanker.com ---
Itisoftwotypes1. Primary
2. Secondary
Associatedfeature:
Pagetdisease
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RadiationFibrousdysplasia
Enchondromatosis
Multipleosteochondroma
Boneinfarction
--- Content provided by FirstRanker.com ---
ChronicosteomyelitisRadiology:
TheX-rayappearancesarevariable:hazyosteolyticareasmay
alternatewithunusuallydenseosteoblasticareas.
Oftenthecortexisbreachedandthetumourextendsintothe
--- Content provided by FirstRanker.com ---
adjacenttissues;whenthishappens,streaksofnewboneappear,radiatingoutwardsfromthecortexthesocalled'sunburst'
effect.
Wherethetumouremergesfromthecortex,reactivenewboneforms
attheanglesofperiostealelevation(Codman'striangle).
--- Content provided by FirstRanker.com ---
WhileboththesunburstappearanceandCodman'strianglearetypicalofosteosarcoma.
64.Commonestcauseofacuteosteomyelitis:
a)Trauma
b)Surgery
--- Content provided by FirstRanker.com ---
c)Fungalinfectiond)Hematogenousroute
e)Tubercularinfection
CorrectAnswer-D
Ans.d.Hematogenousroute
--- Content provided by FirstRanker.com ---
ACUTEOSTEOMYELITIS:1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
--- Content provided by FirstRanker.com ---
Hematogenousosteomyelitisisthecommonestformofosteomyelitisandmostcommonsourceofboneandjointinfectionis
hematogenous.
65.Distalinterphalangealjointinvolvement
occurin:
--- Content provided by FirstRanker.com ---
a)Boutonnieredeformityb)Swanneckdeformity
c)Malletfinger
d)Triggerfinger
e)Dupuytren'scontracture
--- Content provided by FirstRanker.com ---
CorrectAnswer-A:B:CAns.a.Boutonnieredeformity;b.Swanneckdeformity;c.
Malletfinger
Inmedicine,malletfinger,alsobaseballfinger,droppedfingerand
(moregenerally)extensortendoninjury,isaninjuryoftheextensor
--- Content provided by FirstRanker.com ---
digitorumtendonofthefingersatthedistalinterphalangealjoint(DIP).
Swan-neckdeformity(PIPjointshyperextendedandDIPjoints
flexed),enlargedknuckles,andsubcutaneousnodulesareclassic
cluesforrheumatoidarthritis.
--- Content provided by FirstRanker.com ---
Distalinterphalangealjoint-Osteoarthritis,Psoriaticarthritis,Reactivearthritis
Proximalinterphalangealjoint-Osteoarthritis,RA,SLE,Psoriatic
arthritis
66.Pathologicalfracturearefoundin:
--- Content provided by FirstRanker.com ---
a)Bonecystb)Osteoporosis
c)Chronicosteomyelitis
d)Osteochondroma
e)Osteogenesisimperfecta
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CorrectAnswer-A:C:D:EAns.a.Bonecyst;b.Osteoporosis;c.Chronicosteomyelitis;d.
Osteochondroma;e.Osteogenesisimperfecta
PathologicalFracture
Afractureinanabnormalboneisreferredtoaspathological
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fracture.Abnormalbonemeansabonerenderedweakbyadiseaselocalizedtoaparticularhone,orbyageneralisedbone
disorder.Bonethatfracturesspontaneously,oraftertrivialtrauma
mustberegardedasabnormaluntilprovenotherwise.Vertebral
bodies(thoracic&lumbar)arethemostoftenaffectedbonesf/b
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neckfemur&lowerendradius(colle's#).Mostcommoncauseisosteoporosis
Othercausesofpathologicalfracturesare:
LocalizedDiseases
Chronicinfectioneg.tubercular&pyogenic
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osteomyelitis.Eosinophilicgranuloma
Benignneoplasticlesions
Solitarybonecyst
Aneurysmalbonecyst
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FibrouscorticaldefectMonostoticfibrousdysplasia
Chondromyxoidfibroma
Chondroma(Enchondroma)
Osteoclastoma(giantcelltumor)
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MalignantbonetumorOsteosarcoma
Ewing'stumor
Chondrosarcoma
Atrophicbonedueto
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PolioRadiation(Radiotherapy)
GeneralisedDiseases
Congenital/Developmental
Osteogenesisimperfecta
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Osteopetrosis011iersdisease(multipleenchondromatosis/dyschondroplasia).
Polyostoticfibrousdysplasia
HistiocytosisX
Gaucher'sdisease
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AcquiredDisordersproducingosteopeniaOsteoporosis(mostcommoncause)
Osteomalacia
Hyperparathyroidism
Renalosteodystrophy
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Paget'sdiseaseMyeloma
Othermetabolicbonediseases
Rickets
Scurvy
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DisseminatedmalignancyinbonesMultiplemyeloma
Myelomatosis
Metastaticcarcinoma
67.AllaretrueaboutSlippedcapitalfemoral
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epiphysisexcept:a)Avascularnecrosismayoccur
b)Usuallyoccurafterl0yearofage
c)Obesityisariskfactor
d)Frog-leglateralviewishelpful
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e)MorecommoningirlsCorrectAnswer-E
Ans.e.Morecommoningirls
SLIPPEDFEMORALCAPITALEPIPHYSIS(SFCE)
Seeninadolescentchildreninagegroupof13-15yrs
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EitheroverweightorsexuallyimmaturePresentswithendocrinopathies
Hypothyroidism
Growthhormoneexcess
CRF
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CraniopharyngiomaHypogonadism
Klinefelter'ssyndromemaypresentasSFCE
Treethowan'ssignonx-ray
USGorCTmoresensitiveindetectingearlyslip
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Tc99scanshowsincreaseduptakeRxispromptsurgery
68.FracturesiteofMonteggiafractureis
a)Proximalulna
b)Distalendofradius
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c)Distalradiusd)Dislocationofradialhead
e)Lowerradio-ulnarjointdislocation
CorrectAnswer-A:D
Ans.a.Proximalulna;d.Dislocationofradialhead
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Monteggiafracture-dislocationsareclassifiedbytheBadosystem
BadotypeIinjuriesarecharacterizedbyaproximalulnarfracture
withanteriordislocationoftheradialhead.Thisisduetoaforceful
pronationinjuryoftheforearmandisthemostcommontype.
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BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocationinjuries.
Here,thereisposteriorangulationoftheulnarfracturesiteand
posteriordislocationoftheradialhead.
BadotypeIIIandIVarerareinjuries.
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69.Trueaboutosteoclastoma
a)Mostlymalignant
b)Mostcommonsite-mandible&vertebrae
c)Recurrenceiscommonafterexcision
d)Locatedatepiphysis
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e)AllCorrectAnswer-C:D
Ans.c.Recurrenceiscommonafterexcision;d.Locatedat
epiphysis
Giantcelltumor(Osteoclastoma)
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GCTisanosteolytictumorarisingfromtheepiphysisandiscommonbetweentheageof20-40years.
ThoughGCTisabenigntumor,itislocallyveryaggressive.
Femalesareaffectedmorethanmales.
Pathologicalfeatures
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Thecommonestsitesarelowerendoffemurandupperendoftibia.Othercommonsitesarelowerendradiusandupperendof
humerus.Itmayalsooccurinthespineandsacrum.
Thetumorisencompassedbyafibrouscapsuleatperiphery.
Thepresenceoftumorgiantcellsisthehallmarkofthistumor.
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ClinicalfeaturesPainatthesiteofthetumour.
Graduallyincreasinglocalswelling
Pathologicalfracturesmayoccur.
"Eggshell-crackling"sensationonpalpation.
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RadiologicalfeaturesGCTisoneofthecommoncauseofasolitarylyticlesionofthe
bone.oTheradiologicalfeaturesare:-
1. Asolitarymaybeloculated,lyticlesion.
2. Eccentriclocation,oftensubchondral.
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3. Expansionoftheoverlyingcortex(expansilelesion).4. 'Soap-bubble'appearance-Thetumorishomogenouslylyticwith
trabeculaeoftheremnantsofbonetraversingit,givingrisetoa
loculatedappearance.
5. Nocalcificationwithinthetumor.
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6. Noneorminimalreactivesclerosisaroundthetumor.7. Cortexmaybethinnedout,orperforatedatplaces.
8. Tumourusuallydoesnotentertheadjacentjoint.
70.TrueaboutfractureneckTalus:
a)Avascularnecrosisofbodyiscommoncomplication
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b)LateralviewX-rayisimportantfordiagnosisc)Displacedfracturerequirebelowkneeplasteronly
d)Displacedfracturerequireopenreduction&internalfixation
e)All
CorrectAnswer-A:B:D
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Ans.a.Avascularnecrosisofbodyiscommoncomplication;b.LateralviewX-rayisimportantfordiagnosis;d.Displaced
fracturerequireopenreduction&internalfixation
FractureTalus(Neck)
Talusisthemajorweightbearingstructure(thesuperiorarticular
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surfacecarriesagreaterloadperunitareathananyotherboneinbody),andithasavulnerablebloodsupplyandisacommonsite
forposttraumaticischemicnecrosis.
Thebodyoftalusissuppliedmainlybyvesselswhichenterthetalar
neckfromthetarsalcanal.Infracturesofthetalarneckthese
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vesselsaredivided;ifthefractureisdisplacedtheextraoseousplexustoomaybedamagedandbodyoftalusbecomesischemic.
Fractureofthetalarneckisproducedbyviolenthyperextensionof
ankle.Bodyoftalusfractureisusuallyacompressioninjurydue
tofallfromheight.
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ComplicationsAvascularnecrosisofbodyismostcontinuumcomplication.The
incidencevarieswiththeseverityofdisplacement:intypeI<10%,
intypeII-40%,intypeIII>90%.
Malunionpredisposetoosteoarthritis.
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SecondaryOsteoarthritisofankleand/orsubtalarjointoccurs
someyearsafterinjuryinover50%ofpatients.Thereareseveral
causes:articulardamaged/tintialtrauma,malunion,distortionof
articularsurfaceandAVN.
HawkinsClassification
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TypeI UndisplacedTypeII Displacedassociatedwithdislocationofsubtalarjoint
Displacedassociatedwithdislocationatankleaswellas-
TypeIII atsubtalarjoint
TypeIV Type3+Talonavicular-subluxationordislocation
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TreatmentBelowkneecastwithfootinplantarflexionX4weeksFurther
plasterchangewillallowthefoottobebroughtupslowlyto
plantigradeClose/openreduction&internalfixation
71.Whichofthefollowingis/arenotfeature(s)
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ofrheumatoidarthritisa)Pannusformationinjoint
b)Osteosclerosisosteoclasticactivityinunderlyingbone
c)Erosionofcartilage
d)Osteophyte
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e)PlasmacellinfiltrationofsynovialstromaCorrectAnswer-D
Ans.d.Osteophyte
Thecharacteristichistologicfeaturesinclude:
Infiltrationofsynovialstromabydenseperivascularinflammatory
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cells,consistingofBcellsandCD4+helperT,plasmacellsandmacrophages;
Increasedvascularityowingtovasodilationandangiogenesis,with
superficialhemosiderindeposits;
Aggregationoforganizingfibrincoveringportionsofthesynovium
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andfloatinginthejointspaceasricebodies;Accumulationofneutrophilsinthesynovialfluidandalongthe
surfaceofsynoviumbutusuallynotdeepinthesynovialstroma;
Osteoclasticactivityinunderlyingbone,allowingthesynoviumto
penetrateintotheboneformingjuxta-articularerosions,subchondral
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cysts,andosteoporosis;Pannusformation-Pannusisamassofsynoviumandsynovial
stromaconsistingofinflammatorycellsgranulationtissue,and
fibroblasts,whichgrowsoverthearticularcartilageandcausesits
erosion.
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72.Carpaltunnelsyndromeisassociated
withallexcept:
a)Dupuytren'scontracture
b)Myxoedema
c)Idiopathic
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d)Rheumatoidarthritise)Acromegaly
CorrectAnswer-A
Ans.a.Dupuytren'scontracture
Associatedconditionsthatcanleadstocarpaltunnelsyndrome
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are:1.Idiopathic(mostcommon)
2.Pregnancy
3.Endocrinedisorders
Hypothyroidism
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DiabetesmellitusMyxedema
Acromegaly
Hyperparathyroidism
4.Depositiondisorders
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RheumatoiddisorderGout
Rheumaticdisorder
Amyloidosis
Sarcoidosis
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LeukemiaChronicrenalfailure
73.A65yearoldmalepresentedwithfemur
neckfracture.Hewasmanagedwith
closedreduction+cancellousscrew.6
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monthlaterX-raywasdoneinlateralview.X-rayshowsnon-union&legshorting.
Now,appropriatemanagementoptions
is/are:
a)Unipolarhemiarthroplasty
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b)Bipolarhemiarthroplastyc)Subtrochantericosteotomy
d)Osteosynthesis
e)Totalhiparthroplasty
CorrectAnswer-A:B:E
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Ans.a.Unipolarhemiarthroplasty;b.Bipolarhemiarthroplasty;e.Totalhiparthroplasty
Ingeneral,operationsforununitedfracturesofthefemoral
neckcanbegroupedintoffvegeneralclasses:
Osteosynthesis,inwhichafractureisrefixedwithnewinternal
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fixationdevices;Subtrochantericosteotomy
Prostheticreplacement(hemiarthroplasty)
Totalhiparthroplasty
Arthrodesis.
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Somegeneralguidelinesareasfollows:Inadults<60yearsold,nonunionsinwhichthefemoralheadis
viablecanbetreatedbyangulationosteotomy.Thisprovidesaline
ofweightbearingmoredirectlybeneaththefemoralhead.
Inchildrenandinadults<21yearsold,nonunionsinwhichthe
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femoralheadisnotviablecanbetreatedwithanarthrodesis.Inexceptionalcircumstances'ayoungadultmaybetreatedwitha
prosthesis.
Inadults2lto60yearsold,nonunionsinwhichthefemoralheadis
notviablecanbetreatedwithaprosthesis,atotalhiparthroplasty,
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oranarthrodesis,dependingonthecircumstancesinthegivenPatientandontheexperienceandpreferenceofthesurgeon.Rarely
isanarthrodesisindicatedinpatientsolderthan50yearsofageor
inpatientswithasedentaryoccupation.
lnpatients>60years,non-union,regardlessoftheviabilityofthe
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femoralhead,usuallyaretreatedwithahemiarthroplastyoratotalhiparthroplasty'