Download PGI PG 2020 May Ortho Solved Question Paper

1.InapatientwithL4-L5discprolapse,which
ofthefollowingnerverootscanget
compressed?
a)L5
b)S1

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c)S2
d)S2-S4
e)L4
CorrectAnswer-A:E
Ans.is'a'i.e.,L5&'e'i.e.,L4

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Likeateverylevel,therearetwonerverootsatL4-L5-exitingnerve
rooti.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)Adduction
e)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,theheadofthefemurisdislocatedposteriortothe
acetabulumwhenthethighisflexed,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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thefemoralheadorshaftandsciaticnerveinjury

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3.Trueregardingachondroplasiais?
a)Autosomalrecessive
b)Disproportionatedwarfism

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c)Subnormalintelligence
d)Bulletshapedvertebralbodiesonradiology
e)Abnormalsexualdevelopment
CorrectAnswer-B:D
Ans.is'b'i.e.,Disproportionatedwarfism&'d'i.e.,Bullet

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shapedvertebralbodiesonradiology
ACHONDROPLASIA:
Achondroplasiaisadisorderofbonegrowththatpreventsthe
changingofcartilage(particularlyinthelongbonesofthearmsand
legs)tobone.

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SYMPTOMS:
80%-99%ofpeoplehavethesesymptoms
Abnormalityofthemetaphysis
Abnormalityoftheribs
Antevertednares

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Chronicotitismedia
Depressednasalbridge
Frontalbossing
Genuvarum
Hyperlordosis

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Macrocephaly
Neonatalshort-limbshortstature
Rhizomelia
Wormianbones

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30%-79%ofpeoplehavethesesymptoms

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Abnormalformofthevertebralbodies
Conductivehearingimpairment
Dentalcrowding
Dentalmalocclusion
Diaphysealthickening

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Hyperhidrosis
Intrauterinegrowthretardation
Jointhyperflexibility
Kyphosis
Longthorax

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Midfaceretrusion
Muscularhypotonia
Narrowchest
Narrowsacroiliacnotch
Obesity

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Obstructivesleepapnea
Ventriculomegaly
5%-29%ofpeoplehavethesesymptoms
Acanthosisnigricans
Deathininfancy

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Dysarthria
Elbowdislocation
Hydrocephalus
Jointstiffness
Spinalcanalstenosis

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Suddencardiacdeath
Percentofpeoplewhohavethesesymptomsisnotavailable
throughHPO
Autosomaldominantinheritance
Brachydactyly

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Brainstemcompression
Flaredmetaphysis
Generalizedjointlaxity
Infantilemuscularhypotonia
Limitedelbowextension

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Limitedhipextension

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Lumbarhyperlordosis
Lumbarkyphosisininfancy
Malarflattening
Megalencephaly

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Motordelay
Recurrentotitismedia
Shortfemoralneck
Smallforamenmagnum
Spinalstenosiswithreducedinterpediculardistance

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Tridenthand
RADIOLOGICALFINDING:
Theinnercontourofthepelvishasatypical,classic"champagne
glass"appearance
Largeskullwithrelativelyshortbaseandanarrowandfunnel-

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shapedforamenmagnum
Bulletshapedvertebralbodies
Longandshorttubularbonesareshortandthickwithapparent
increaseddiameter.
Metaphysisoflongbonesarewidenedandflared,physisare

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notchedorV-shaped.
Thespinalcanalisnarrowwithdecreasedinterpediculardistanceas
oneproceedsfromLItoL5.

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4.Signsofcompartmentsyndromeinclude?
a)Painonpassiveflexion

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b)Painonactiveflexion
c)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.

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5.Whichofthefollowingstatementis/are
correctaboutfracturemanagementin

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children?
a)Supracondylarfractureofhumeruscanbemanagedbyclosed
reduction
b)Lateralcondylarfractureofhumerusisknownasfractureof
necessity

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c)Lateralcondylarfractureofhumerusismanagedbyopen
reductionandscrewing
d)Forearmfractureinchildrencanbemanagedbyclosed
reductionandcasting
e)Femoralneckfractureinadultsismanagedbysurgeryand3

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screws
CorrectAnswer-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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condylarfractureofhumerusismanagedbyopenreduction
andscrewing,'d'i.e.,Forearmfractureinchildrencanbe
managedbyclosedreductionandcasting&`e'i.e.,Femoral
neckfractureinadultsismanagedbysurgeryand3screws
MANGEMENTOFSOMECOMMONPEDIATRICFRACTURES:

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LOCATIONOF
TYPE
MANAGEMENT
FRACTURE
Undisplaced(Gartland's Immobilizationin

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type1)
plasterfor3weeks.
Reduction(closed)

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Reduction(closed)
Angulated(Gartland's

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underanaesthesia
Supracondylar#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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Immobilizationin
aboveelbowcastin
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 displacementis
Closedreductionand
bones
minimal
elbowcast

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Conservative
treatmentby
immobilizationin
Undisplacedfractureor thomaskneesplint
valgusimpacted

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Insitufixationwith
threeparallel
cannulatedscrews
(preferred)
Femurneck

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<60years:CRIFwith
3parallelcannulated
screws>ORIF.
60-70years:CRIF
Displaced

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Displaced
>70YEARS:Bipolar
hemiarthroplasty;AMR
Headisviable:Mc-
Murry'sosteotomy;

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Meyer'sprocedure
Arthroplasty
Physiologicalage<65
:Bipolar
years

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Head hemiarthroplasty
OLD>3WEEKS
not
orAMR.
viable Witharthritis:

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Totalhip
replacement.
Bipolar
hemiarthroplastyor
Physiologicalage>65 AMR.

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years
Witharthritis:Totalhip
replacement.
#ofdistalthirdof
radiuswith

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Openreductionofthe
dislocationor
Galeazzifractures
radiusandthedistal
subluxationofinferior dislocation

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radio-ulnarjoint.
(distal)radio-ulnar
joint

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6.Allarefeaturesofinflammatoryarthritis
except?

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a)Morningstiffness
b)X-rayshowingsclerosis
c)ElevatedESR
d)Weightgain
e)Swellingofjoints

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CorrectAnswer-B:D
Ans.is`b'i.e.,X-rayshowingsclerosis&'d'i.e.,Weightgain
Featuresofinflammatoryarthritis:?
Presenceofsomeorallfourcardinalsignsofinflammation:
Erythema

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Pain
Warmth
Swelling
Systemicsymptoms
1. Prolongedmorningstiffness,oftenlastingforseveralhours.(Non

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inflammatoryarthritisareassociatedwithintermittentstiffness,
Stiffnessusuallylastslessthan1hr).
2. Fatigue
3. Fever
4. WeightLoss

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Laboratoryevidenceofinflammation
1. ElevatedESR
2. Thrombocytosis
3. ElevatedCreactiveprotein

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4. Anemiaofchronicdisease.

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X-ray
X-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-ray
featuresinnon-inflammatoryarthritisrevealssclerosis.

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7.Riskfactor(s)forLeg-Calf-Perthe'sdisease
is/are?

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a)Acceleratedskeletalgrowth
b)Growthhormoneabnormalities
c)Positivefamilyhistory
d)Femalesex
e)Passivesmoking

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CorrectAnswer-C:E
Ans.is'c'i.e.,Positivefamilyhistory&`e'i.e.,Passivesmoking
PERTHE'SDISEASE(LEGG-CALVEPERTHE'SDISEASE)
Perthe'sdiseaseisalsoknownasosteochondritisdeformans
juvenilisorCoxapianoorPseudocoxalgia.

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Perthe'sdiseaseisanosteochondritisoftheepiphysisofthefemoral
head(capitalfemoralepiphysis).Inthedisease,thefemoralhead
becomespartlyorwhollyavascularanddeformed.Thedisease
occurscommonlyinmalesintheagegroupof5-10years.
Perthe'sdiseaseisthemostcommonform

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ofosteochondrosis(osteochondrosisarecharacterizedbyavascular
necrosis(AVN)anddefectiveendochondralossificationofprimaryor
secondaryossificationcentres).
EtiologyofPerthe'sdisease
Theetiologyremainsunknown,butiscurrentlyacceptedthatthe

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disorderiscausedbyaninterruptionofthebloodsupplytothe
capitalfemoralepiphysis,causingavascularnecrosis.

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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.

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8.Allaretrueaboutsepticarthritisexcept?
a)Staphaureusisthemostcommoncause
b)MostcommoncauseisE.coli

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c)Commoninchildren
d)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.

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Weightbearingonlimbisnotpossible.

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Diagnosis:
Aspiratedsynovialfluidinsepticarthritiswillhavemarkedly
increasedpolymorphonuclearleukocytes

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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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humerus
Cylindercast
Fracturepatella
Minnervacast,Halodevice Cervicalspine
Risser'scast,Milwaukee

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brace
Scoliosis
Bostonbrace
Palvicharness,VonRosen Congenital
splint,

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(Developmental)
IlfeldorCraigsplint
DysplasiaofHip
Broomstick(Petrie)
cast,Snydersling,Pattern-

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bottombrace,Torontobrace
withuniversaljoint,
LeggCalve-
Birminghambrace,
Perthes

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Tachdjianbrace(trilateral
Disease

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hipabductionorthosis),
Newingtonbrace,Atlanta
scottishRitebrace

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10.Trueaboutacuteosteomyelitis?
a)CannotbedetectedonX-raybefore2weeks
b)Bonescandetectafter2weeks
c)Severepain
d)Secondaryosteomyelitisassociatedwithcompoundfractureis

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morecommonthanprimaryvariety
e)Limitationofmovements
CorrectAnswer-C:E
Ans.is'c'i.e.,Severepain&`e'i.e.,Limitationofmovements
ACUTEOSTEOMYELITIS:

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1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis

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andmostcommonsourceofboneandjointinfectionis
hematogenous.
Clinicalfeatures:
Metaphysisoflongboneistheearliestandmostcommonsite
involved.

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Mostcommoninchildren.
Thebonesmostcommonly:
Proximaltibial
Distalfemur
Proximalhumerus.

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Features:
Severepain,fever,malaise,chills&rigors,sweating,andeven

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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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Bonescan
Increaseduptakebyboneinmetaphysiswithin24hoursofonsetof
symptoms(earliestsign.

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11.Correctstatementabouthandinfection?
a)OpeningofFelonbyfishmonthincisionispreferredincision

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technique
b)Felonismiddlevolarpulpinfection
c)Apicalsubungualinfection-V-shapedpieceisremovedfromthe
centerofthefreeedgeofthenailalongwithalittlewedgeofthe
fullthicknessoftheskinoverlyingtheabscess

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d)Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
e)None
CorrectAnswer-C:D
Ans.c.Apicalsubungualinfection-V-shapedpieceisremoved

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fromthecenterofthefreeedgeofthenailalongwithalittle
wedgeofthefullthicknessoftheskinoverlyingtheabscess;
d.Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
Inapicalsubungualinfection:Fordrainage,asmallVshapedpiece

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lsremovedfromthecentreofthatfreeedgeofthenailalongwitha
littlewedgeofthefullthicknessoftheskinoverlyingtheabscess.
Inacuteparonychia:Whenthepusextendsbeneaththenail,itis
necessarytoremovetheproximalone-thirdofthenailforadequate
drainage.

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DONOTperforma"fishmouth"incisionsincethismayresultsin:
Unstablefingerpad,neuroma.,and/orlossofsensation"
Thefelonshouldbeincisedintheareaofmaximumswellingand
tenderness.

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12.Whichofthefollowingarenotincludedin

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Gurd'scriteria?
a)Centralnervoussystemdepressiondisproportionateto
hypoxaemia
b)Tachycardia<1l0bpm
c)Deepveinthrombosis

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d)Axillaryorsubconjunctivalpetechiae
e)HypoxaemiaPao2<60mHg,Fio2=0.4
CorrectAnswer-C
Ans.c.Deepveinthrombosis

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13.Cause(s)ofavascularnecrosisoffemoral

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Head:
a)Fractureoffemoralneck
b)Steroiduse
c)alcoholuse
d)Sicklecelldisease

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e)Caissondisease
CorrectAnswer-A:B:C:D:E
Answer:A,FractureoffemoralneckB,SteroiduseC,alcohol
useD,SicklecelldiseaseE,Caissondisease
Causeofavascularnecrosisoffemoralhead:

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ldiopathic-commonest
Alcoholism
Steroidtherapy
Sicklecelldisease
Patientofrenaldialysis

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Patientonanticancerdrug
Post-partumnecrosis
Goucher'sdisease
Caisson'sdisease

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14.Spursignis/areseenin:

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a)Supracondylarfractureofhumerus
b)Radialheadfracture
c)Acetabulumfractureofpelvis
d)Talusfracture
e)None

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CorrectAnswer-C
Ans.(c)Acetabulumfractureofpelvis
Spurcells-Theyareirregularlydistortedredcellscontainingseveral
irregularlydistributedthornlikeprojections.
Cellswiththismorphologicabnormalityarealsocalled

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acanthocytes.
TheyareseeninSplenectomisedpatientsandpatientswithliver
disease.

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15.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year

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b)Proximalfemurismostcommonsiteaffected
c)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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threatensthetruedefinitionofabenigncancerbecausebenign
pulmonarymetastasisdevelopinapproximately1%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.

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16.Allaretrueaboutanteriorcruciate

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ligamentexcept?
a)Commonlyoccursasaresultoftwistingforce
b)MaybeassociatedwithSegondfracture
c)Rarelyassociatedwithmeniscalinjury
d)Lachmantestishighlysensitivetestfortear

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e)None
CorrectAnswer-C
Ans.(c)Rarelyassociatedwithmeniscalinjury

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Symptoms:

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SignsandsymptomsofanACLinjuryusuallyinclude:
Aloud"pop"ora"popping"sensationintheknee
Severepainandinabilitytocontinueactivity
Rapidswelling
Lossofrangeofmotion

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Afeelingofinstabilityor"givingway"withweightbearing
Complications
Higherriskofdevelopingosteoarthritisintheknee.Arthritismay
occurevenifyouhavesurgerytoreconstructtheligament.
Segondfractureduetoavulsionattheanterolateralcapsular

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attachment.SegondfractureshaveaveryhighassociationwithACL
tearsand,meniscalinjuries
Diagnosis:
Injurytotearofanteriorcruciateligamentcanbedetectedusing
lachmanandanteriordrawertest.

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Lachmanntestisasimilartesttoanteriordrawertestinwhich

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anteriorglideofthetibiaisjudgedwiththekneein10-15degreesof
flexion.

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17.Whichofthefollowingis/aretrueabout
Ewingsarcoma:

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a)Vascularorigin
b)Ewing'ssarcomaissecondmostcommonprimarymalignant
bonetumourinchildrenafterOsteosarcoma
c)Metaphysisoflongboneismostcommonsite
d)Feverandweightlossmaybepresent

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e)Surgeryisveryusefulinmanagement
CorrectAnswer-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

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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)Pathologicalfractures
d)Vascularinjury
e)Multiplefractures
CorrectAnswer-B:C:D:E
Ans.(b)Radialnerveinvolvementaftermanipulation,(c)

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Pathologicalfractures,(d)Vascularinjury,(e)Multiplefractures
FracturedShaftofHumerus:OperativeTreatment-Indications:
Severemultipleinjures:
Anopenfracture.
Segmentalfractures.

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Displacedintra-articularextensionofthefracture
Apathologicalfracture.
Afloatingelbow(simultaneousunstablehumeralandforearm
fractures)
Radialnervepalsyaftermanipulation.

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Non-union
Problemswithnursingcareinadependentperson

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19.PiraniscoringofCTEVincludesall
except?
a)Curvatureofthemedialborderofthefoot

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b)Severityofthemedialcrease
c)Positionofthelateralpartoftheheadofthetalus
d)Emptinessoftheheel
e)Severityoftheposteriorcrease
CorrectAnswer-A

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Ans.(a)Curvatureofthemedialborderofthefoot
PIRANISCORING
ThePiraniscoreisasimple,easytousetoolforassessingthe
severityofeachofthecomponentsofaclubfoot.
PiraniScoring:

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Thecomponentsarescoredasfollows:
Eachcomponentmayscore0,0.5or1
Hindfootcontracturescore(HCFS):
Midfootcontracturescore(MFCS):
1. Posteriorcrease

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2. Emptyheel
3. Rigidequinus
Midfootcontracturescore(MFCS):
1. Medialcrease
2. Curvatureoflateralborder

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3. Positionofheadoftalus

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20.TrueabouttuberculosisofSpine:
a)Middlepathregimenisusedinmanagement
b)Posteriorelementsofthespineismostcommonlyaffected

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c)Commonlyspreadbyhematogenousroutefromlung
d)Acuteonsetparaplegiahasworseprognosis
e)Lowerthoracicandupperlumbarismostcommonsite
CorrectAnswer-A:C:E
Ans.a.Middlepathregimenisusedinmanagement;C.

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Commonlyspreadbyhematogenousroutefromlunge.Lower
thoracicandupperlumbarismostcommonsite
Route:
Lymphogenousandhematogenousspreadhasbeenimplicated.in
thoracolumbarlesions.

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Site:
UpperthoracicspinelsthemostcommonsiteofspinalTBin
children,thelowerthoracicandupperlumbarvertebraeareusually
affectedinadults
Paradiscalisthecommonesttype.

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Acuteonsetparaplegiahasabetterprognosis
Management:
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

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5. Surgery(ExcisionalsurgeryDefinitiveSurgery:IndicationofSurgery

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inPott'sspine),
6. Post-operativecare

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21.A70yearoldladygotcompression
fractureofL1vertebra.Thereisno
neurologicaldeficittothispatient.What

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advisewillyougiveforthisPatient:
a)VitaminDsupplementation
b)DoMRIscan
c)GoforscrewfixationofL1vertebra
d)TotakeDexamethasone

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e)TotakeAlendronate
CorrectAnswer-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)

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22.Forassessingtheinjuryofmeniscusof
kneejoint,whichofthefollowingtest
is/aredone:
a)Apley'stest

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b)Lachmanntest
c)McMurray'stest
d)Thessalytest
e)Hamiltonrulertest
CorrectAnswer-A:C:D

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Ans.a.Apley'stest;c.McMurray'stest;d.Thessalytest
TestsforMeniscalInjuries?
Apley'sgrindingtest:formeniscusinjury
McMurray'stest-Thisclassictestforatornmeniscusisseldomused
nowthatthediagnosiscaneasilybemadebyMRI.Apositivetestis

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helpfulbutnotpathognomonicanegativetestdoesnotexcludea
tear.
Thessalytest:Thistesthasshownahighdiagnosticaccuracyrate
atthelevelof95%indetectingmeniscaltears

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23.TrueaboutColle'sfracture:

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a)Occuratdistalendofradius,about2cmfromdistalarticular
surface
b)Fracturealsoinvolvesradiocarpaljoint
c)Fracturealsoinvolvesproximalradioulnarjoint
d)Causeulnardeviation

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e)Commoninwomen
CorrectAnswer-A:E
Ans.a.Occuratdistalendofradius,about2cmfromdistal
articularsurface;e.Commoninwomen
Colle'sFracture:

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ThisisaFractureatthedistalendoftheradius,atits
corticocancellousjunction(about2cmfromthedistalarticular
surface),inadults,withtypicaldisplacement.
Itnearlyalwaysresultsfromafallonanout-stretchedhandcItis
commonestfractureinpeopleabovefortyyears

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Particularlycommoninwomenbecauseofpostmenopausal
osteoporosis.
Displacement-dorsaldisplacement,dorsaltilt(mostcharacteristic),
lateraldisplacement,dorsaltilt,supination&impactionoffragments
Complication:Dinnerforkdeformity&Subluxationoftheinferior

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radio-ulnarjoint(distalradiocarpaljoint)
Itismostcommonofallfractureinolderpeople.

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24.Whichofthefollowingis/aretrueabout
simplebonecyst:
a)Mostcommonlyoccurinadult

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b)Commonestsiteistheupperendofthehumerus
c)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

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25.Trueaboutankylosingspondylitis:

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a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all

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CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)

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Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.

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Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.

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Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.

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Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint

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isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,

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ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
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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Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints

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Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
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

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26.Trueaboutboutonnieredeformity:
a)Flexionofproximalinterphalangealjoint&hyperextensionof

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distalinterphalangealjoint
b)Hyperextensionofproximalinterphalangealjoint&flexionof
distalinterphalangealjoint
c)Flexionatproximalinterphalangeal&extensionat
metacarpophalangealjoint

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d)Flexiondeformityoftheproximalinterphalangealjointoccur
duetotearincentralslipofextensortendon
e)Mayoccurinrheumatoidarthritis
CorrectAnswer-A:D:E
Ans.a.Flexionofproximalinterphalangealjoint&

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hyperextensionofdistalinterphalangealjoint;d.Flexion
deformityoftheproximalinterphalangealjointoccurdueto
tearincentralslipofextensortendon;e.Mayoccurin
rheumatoidarthritis
Boutonnieredeformityisadeformedpositionofthefingersortoes,

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inwhichthejointnearesttheknuckle(theproximalinterphalangeal
joint,orPIP)ispermanentlybenttowardthepalmwhilethefarthest
joint(thedistalinterphalangealjoint,orDIP)isbentbackaway(PIP
flexionwithDIPhyperextension).
Itcanbecausedbyacutonthetopofthefinger,whichcansever

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thecentralslip(tendon)fromitsattachmenttothebone.Thetear
lookslikeabuttonhole("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/smoothingofplasterisdonebyfingers
CorrectAnswer-B:C:D
Ans.is'b'i.e.,Takenoutfromwateroncebubblesstopcoming
out;'c'i.e.,Settingisdelayedincoldwater;'d'i.e.,Cotton
paddingisoverlappedbyonethird

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Forsecuring,eachturnisoverlappedbyonethirdtoonehalfin
ordertosecurelayers.
Ifabandageisimmersedincoldwatertheinitialsetwillbedelayed
andthus"workingtime"lengthened.However,ifaveryrapidis
requiredsoakingthebandageinwarmwaterwillacceleratetherate

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ofreaction.
Mouldingofthebandagestothecontoursofthelimbshouldbedone
byconstantsmoothingwiththepalms(notbyfingers)ofthewet
hands.

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28.RadiologicalfeaturesofPerthe'sdisease

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is/are?
a)Decreasedmedialjointspace
b)Lateralsubluxation
c)VerticalPhysis
d)Speckledcalcification

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e)Widefemoralneck
CorrectAnswer-B:D:E
Ans.is,b'i.e.,Lateralsubluxation;'d'i.e.,Speckled
calcification&'e'i.e.,Widefemoralneck
Radiologicalfindingsinperthe'sdiseaseare:-

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Increasedmedialjointspace
Wideningoffemoralneck
Lateralextrusion(lateralsubluxation)
Metaphysealcystsandrarefactionofmetaphysis
Horizontalphysiswithspeckledcalcifcationlateraltoit

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Fragmentationoffemoralheadwithincreaseddensity(irregular
densitiesintheepiphysis).

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29.Latecomplicationofsupracondylar
fractureis?
a)Ulnarnervepalsy

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b)Cubitusvarus
c)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),Cubitus
valgusisrareandmayoccuroccasionallyinposterolateral
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)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

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ComplicationsofLateralcondyleofhumerusfracture
Lateralspur
Cubitusvalgus
Rarely,cubitusvarus
Tardyulnarnervepalsy

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Rarelyavascularnecrosisandmyositisossificans
Posterolateralinstabilityandrecurrentinstability

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31.Followingaretrueregardinghangmans
fracture?
a)FractureofspinousprocessofC7

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b)FractureofC2vertebra
c)Listhesisofthefracturevertebra
d)Knotisplacedundernapeofneck
e)None
CorrectAnswer-B:C

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Ans.is'b'i.e.,FractureofC2vertebra;'c'i.e.,Listhesisofthe
fracturevertebra
Hangman'sfracture
Hangman'sfractureisbilateralfractureoftheparsinterarticularisof
axis(C2)withtraumaticspondylolisthesisofaxis(C2)over

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C3vertebrae.ThusHangman'sfractureisnotsimplyafracture,but
fracturedislocationofaxis(C2).
Themechanismofinjuryisextensionwithdistraction(intrue,judicial
hangman'sfracture)andhyper-extension,axialcompression&.
flexion(incivilianinjuries,whicharenowmorecommon).

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ItissecondmostcommontypeofAxis(C2)fracture,secondonlyto
odontoidfractures.
Fatalatiesarecommon,However,neurologicaldeficitisunusualas
thefractureofposteriorarchdecompressthespinalcord.
Mostofthefatalitiesoccuratthesceneofinjury,acutepost

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admissionmortalityislow.
SuccessfulhealingofC2traumaticspondylolisthesisisreportedto
approach95%.Thisismostcommonlyachievedwithnon-operative

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measures,eveninthepresenceofdisplacementofparsinter-
articularis.

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Undisplacedfracturesaretreatedinasemi-rigidorthosis,and
displacedfractureareclosedreduced&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)Maycausecarpaltunnelsyndrome
CorrectAnswer-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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Lossofmotion
Weakness
Carpaltunnelsyndrome
Persistentpain
Instability

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Degenerationinadjacentjoints

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33.Trueaboutlocation(s)oftumoris/are?
a)Osteosarcomaisdiaphyseal
b)Ewingsarcomaisdiaphyseal
c)Chondrosarcomaismetaphyseal

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d)Fibrosarcomaisdiaphyseal
e)Osteoclastomaisepiphyseal
CorrectAnswer-B:C:D:E
Ans.b)Ewingsarcomaisdiaphysealc)Chondrosarcomais
metaphyseald)Fibrosarcomaisdiaphyseale)Osteoclastoma

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isepiphyseal
Epiphysealtumor:
Chondroblastoma
Giantcelltumor(osteoclastoma)
Clearcellchondrosarcoma

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Metaphyseallesion:
Osteogenicsarcoma.
Unicameral(simple)bonecyst.
Aneurysmalbonecyst.
Fibrouscorticaldefect.

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Chondrosarcoma
Osteochondroma
Enchondroma.
Osteoblastoma
Diaphyseallesion:

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Ewingsarcoma
Lymphomas
Fibrousdysplasia

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Adamantinoma
Histiocytosis

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Osteoidosteoma
Chondromyxoidfibroma
Fibrosarcoma
Fibrouscorticaldefect
Nonossifyingfibroma

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34.A28yearsoldladypresentedwithwrist
pain.X-raywristisshowinglyticeccentric
lesioninlowerendofradiuswithsoap
bubbleappearance.Whatisthenextplan
ofmanagement?

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a)Bonecurettageandbonegrafting
b)Extendedcurettagewithphenol
c)Biopsyofthelesion
d)Extendedcurettagewithphenolandbonegrafting
e)Parathyroidandserumcalciumlevelsmeasurement

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CorrectAnswer-C
Ans.is'c'1.e.,Biopsyofthelesion
28yearsfemalewithlyticeccentriclesioninlowerendofradiusand
soapbubbleappearancesuggestthediagnosisofGCT.
Nextplanofmanagementwouldbebiopsyoflesiontoconfirmthe

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diagnosis.

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35.Trueaboutthesitesinvolvedin
osteomyelitisis/are?
a)Mainlyinvolvesmetaphysis
b)Distaltibiaisinvolvedcommonly

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c)Proximalhumerusisinvolvedcommonly
d)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',Reachestositeby
hematogenousroute
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andalmostcommonsourceofboneandjointinfectionis
hematogenous.

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Itiscausedmostcommonlybystaphylococcusaureus.
Othercausativeorganismsarestreptococcus,pneumococcus,and
gramnegativebacilli.
Infectionbypseudomonasbecomesproportionallymuchmore
commoninIVdrugabuser.But,themostcommonorganismis

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staphylococcusaureus.

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36.Compoundpalmarganglioniscausedby
?
a)Trauma
b)Overuse

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c)RA
d)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.

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37.Trueaboutcompoundpalmarganglion?

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a)Duetodegenerationofflexorretinaculum
b)Hour-glassinshape
c)Surgeryisthemainstayoftreatment
d)Intrasynovialsteroidisthemainstayoftreatment
e)Maybeseeninrheumatoidarthritis

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CorrectAnswer-A:D
Ans.is'a'i.e.,Duetodegenerationofflexorretinaculum;'d'i.e.,
Intrasynovialsteroidisthemainstayoftreatment
Compoundpalmarganglionisamisnomerbecauseitisneithera
ganglionnorcompound.

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Chronicinflammationdistendsthecommonsheathofflexortendons
bothaboveandbelowtheflexorretinaculum.
Thereishourglassswelling,bulgingaboveandbelowtheflexor
retinaculum
Tubercularandrheumatoidcompoundpalmerganglionis

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characterizedbypresenceofricebodise,milletbodiesandmelon
seeds
Rheumatoidarthritisandtuberculosisarethecommonestcauses.

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38.Apersonhasinjuryondorsalsurfaceof
proximalinterphalangealjointofright

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middlefinger.Whichofthefollowingcan
occur
a)Ruptureoflateralligament
b)Buttonholedeformity
c)Malletfinger

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d)Lacerationofthecentralslipoftheextensor
e)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(zone
II)maycause:-
Ruptureofcentralslipofextensorexpansion-causingButtonhole
deformity.
ThisresultsinlossofactiveextensionofthePIPjointandpersistent

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flexionofthePIPjoint.
AnteriordislocationofPIPjointmaycauseruptureofbothcentral
clipaswellaslateralligament.

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39.Trueaboutpectusexcavatum
a)Morecommoninfemale

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b)Inseverecases,mitralvalveprolapsemayoccur
c)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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Depressionmayrangefrommildlydepressedsternumtosternal
depressionabuttingthevertebralcolumnwithdisplacementsof
mediastinalstructures.
OtherconditionsassociatedwithPectusExcavatum:
Scoliosis

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Marfan'ssyndrome
Mitralvalveprolapse
Congenitalheartdiseases

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40.Inponsetitechniquelastdeformityinto
getcorrectedinCTEV-

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a)Equinus
b)Talipus
c)Varus
d)Cavus
e)Alldeformitycorrectedsimultaneously

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CorrectAnswer-A
Ans(a)Equinus
Ponseti'stechnique
Thisinvolvesfirstcorrectingthecavusdeformitythentheadduction
andheelvarusandfinallytheequinusdeformity.

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ThistechniqueisnowmostlyacceptedtechniqueforCTEV
correctionasitisbasedonbetterunderstandingofthe
pathoanatomyofthedeformedfoot.
Thesuccessofreductionis90-98Percent.

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41.Trueaboutavascularnecrosisoffemur

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a)Affectedsidehipallowsweightbearing
b)Asymptomaticcasesmayoccur
c)Radionucleotidescanshowincreaseduptakeduetonewbone
formationintheareaaroundtheinfarct
d)Trendelenburgsigninnegative

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e)Noneoftheabove
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Affectedsideofhipallowwt.bearing;'b'i.e.,
Asymptomaticcasesmayoccur&'c'i.e.,Radionucleotidescan
showincreaseduptakeduetonewboneformationinthearea

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aroundtheinfarct
CausesofAVN
ldiopathic(mostcommon)
Infection-septicarthritis,osteomyelitis
Hematologicalmalignancies-leukemia,lymphoma

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Alcohol,corticosteroids
SLE
Pregnancy
Cassionsdisease
Hyperlipidemia

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Perthesdiseas
Ionisingradiation
CLINICALFEATURES:
Pain
Deceaserangeofmotionespeciallyinternalrotationfollowedby

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abduction.

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SectoralsignorDifferentialrotation:-Internalrotationispossiblein
extendedpositionofhip,butasseenasthehipisflexedto900no
internalrotationispossible.ThisisthecharacteristicsignofAVN.
Trendelenburg'stestpositive

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Radiologicalfindings:
MRIisthemostreliablewayofdiagnosingmarrowchangesand
boneischaemia

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42.Trueaboutganglioncyst?
a)Mostcommoninyoungmale

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b)Containsynovialfluid
c)Arisefromextensorretinaculum
d)Itusuallyarisefromthelunotriquetraljoint
e)Surgicaltreatmentisexcisionofcyst
CorrectAnswer-B:E

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Ans.is'b'i.e',Containsynovialfluid;'e'i.e.,Surgicaltreatmentis
excisionofcyst
Aganglionisthecommonestcysticswellingattheback(Dorsal
aspect)ofthewrist.
Unilocularcyst

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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.

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43.Testforanteriorcruciateligamentis/are

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a)Lachmanntest
b)Apley'sgrindingtest
c)Pivotshifttest
d)Anteriordrawer
e)KT-1000kneearthrometerisanobjectiveinstrumentforACL

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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

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FollowingtestsareusedforACLinjury:-
Lachman'stest
Pivotshifttest
Anteriordrawertest
Jerktest

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Flexion-rotationdrawertest
Loose'stest

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44.Trueaboutosteomalacia?
a)Morecommoninmale
b)LowPTH

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c)Increasealkalinephosphatase
d)Decreasedcalciumlevel
e)Looser'szoneonX-ray
CorrectAnswer-C:D:E
Ans.(c)Increasealkalinephosphatase;(d)Decreasedcalcium

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level;(e)Looser'szoneonX-ray
Osteomalacia
Looser'szone(pseudofractures)areradiolucentzonesoccurringat
thesitesofstressinosteomalacia(commonlyatpubicrami)
Osteomalaciaismorecommoninwomenwholivein"purdah"&lack

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exposuretosunlight
Serumcalcium&phosphateislow&alkalinephosphataseishigh
Muscularweakness(Thepatientfeelsveryweak.Hemaydifficulty
inclimbingup&downthestairs)

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45.Trueaboutcomplexregionalpain

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syndrome:
a)Sudeck'satrophyisanexample
b)Painisoutofproportiontoprecipitatingcause
c)Hyperaesthesiaofskinmaybepresent
d)Adultsareusualsufferer

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e)Parasympatheticmediatedenhancementofpain
CorrectAnswer-A:B:C:D
Ans.a.Sudeck'satrophyisanexample;b.Painisoutof
proportiontoprecipitatingcause;c.Hyperaesthesiaofskin
maybepresent;d.Adultsareusualsufferer

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ComplexRegionalPainSyndrome
Anumberofclinicalsyndromesappearunderthisheading,including
Sudeck'satrophy,reflexsympatheticdystrophy,algodystrophy,
shoulder-handsyndrome&particularlyafteranerveinjury-
causalgia.

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Precipitatingcausesaretrauma(oftentrivial),operationor
arthroscopy,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)Involvesneckflexors
CorrectAnswer-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)Flexionatthemetacarpophalangeal
e)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(perfusionpressure
Musclessuppliedbyanteriorinterosseusarteryaremost
susceptible,asitisanendartery.
Mostcommonlyaffectedmuscle:flexorpollicislongus&medial
halfofflexordigitorumprofundus.

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Mediannerveismostcommonlyinvolved.
Treatment:fasciotomy

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48.Allaretrueaboutsupracondylarfracture
ofhumerusexcept:
a)Posteriorshiftofdistalfragment

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b)Mediannerveismostcommonnervedamaged
c)Injuryofbrachialarterymayoccur
d)Commoninelderly
e)Volkmann'sischemiccontracturemayoccur
CorrectAnswer-D

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Ans.d.Commoninelderly
SupracondylarFractureoftheHumerus:
Complications:
Immediate-injurytobrachialartery&injurytonerve(mediannerve-
mostcommon,radialnerve-sometimeaffected)

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Early-Volkmann'sischemia
Latecomplication-Malunion(cubitusvarusdeformity),myositis
ossificans&Volkmann\ischemiccontracture.
Displacement:Thedistalfragmentmaybedisplacedinthefollowing
direction

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Posteriororbackwardshift
Posteriororbackwardtilt
Proximalshift
Medialorlateralshift
Medialtilt

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Internalrotation

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49.NotanIntra-articularfracture:
a)Rolandofracture
b)Marchfracture
c)Bennett'sfracture

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d)Barton'sfracture
e)Hoffafracture
CorrectAnswer-B
Ans.b.Marchfracture
Marchfracture:Fatiguefractureofshaftofsecondorthird

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metatarsal
Rolandofractureisathreepartorcomminutedintraarticular
fracture-dislocationofthebaseofthumb.
Pilonfracture:Itisacommunicatedintra-articularfractureofthe
distalendofthetibia

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Bennett'sfracture:Ifisanobliqueintra-articularfractureofthebase
ofthefirstmetacarpalwithsubluxationofthetrapezoid'metacarpal
joint"
Barton'sfracture(Marginalfracture):Intra-articularfracturesthrough
thedistalarticularsurfaceoftheradius,takingamargin,anterioror

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posterior,ofthedistalradiuswiththecarpals,displacedanteriorlyor
posteriorly
Hoffafracturesareintra-articularandarecharacterisedbyafracture
inthecoronalplane

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50.TrueaboutLockingcompressionplate:

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a)Insteoporoticpatients,itshouldnotbeused
b)Canbeusedasbuttressplate
c)Usuallycauseperostealinjury
d)Mechanicallysuperiortoaconventionalplate
e)Cannotbeusedascompressionplate

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CorrectAnswer-B:D
Ans.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&fracturesin
osteoporoticbones

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51.Osteoscleroticmetastasesis/arecommon
incancerof:
a)Prostate

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b)Breast
c)Lung
d)Malignantmelanoma
e)Renalcellcarcinoma
CorrectAnswer-A:B

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Ans.a.Prostate;b.Breast
Metastasesaremostcommonlyseeninthepelvis,ribs,vertebral
bodies,andproximallimbs.
Theselesionstypicallyhavealyticappearanceonplain
radiographs,althoughbreastandprostatemetastasescanbe

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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)Compartmentsyndrome
e)Avascularnecrosis
CorrectAnswer-A:B
Ans.a.Vascularischemia;b.Neuronalinjury
ImmediateComplications:

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Systemic:
Hypovolaemicshock
Local
Injurytomajorvessels
Injurytomuscles&tendon

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Injurytojoints
Injurytoviscera
Earlycomplications:
Systemic:
Hypovolaemicshock

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ARDS:Fatembolismsyndrome
DVT&Pulmonaryembolism;
Aseptictraumaticfever;
Septicaemia;
Crushsyndrome

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Local

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Infection
Compartmentsyndrome
Latecomplications:
Imperfectunionoffracture:

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Delayedunion;Non-union;Malunion;Crossunion
Others:
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)Softtissueinterposition
e)Properalignmentoffracture
CorrectAnswer-C:E
Ans.c.Bonegrafting;e.Properalignmentoffracture
Bonegraftingisusedintreatmentofmalunion

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Infection:Bothbiology&stabilityofbonehealingarehamperedby
activeinfection

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54.TrueaboutatypicalCTEV
a)Footisflexeddownward
b)Solecreasearenotfound

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c)Difficulttotreatthantypicalvariety
d)Mayoccurduetoneurologicaldisorder
e)MaybeassociatedwithMeningomyelocele
CorrectAnswer-A:C:D:E
Ans.a.Footisflexeddownward;c.Difficulttotreatthantypical

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variety;d.Mayoccurduetoneurologicaldisorder;e.Maybe
associatedwithMeningomyelocele
AtypicalIdiopathicClubfoot:
Ashortandfatorswollenfoot.
Thebigtoeisshortandpointsupward

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Acreaserunsacrossthebottom(sole)ofthefootfromsidetoside.
Thereisadeepcreaseintheskinabovetheheel.
Theheelareaisrigidlytiltedinward.
Thefootisrigidlyflexeddownwardand,theheelcordisverytight,
wide,andlong.

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Thecalfmuscleisverysmallandbunchedupunderthebackofthe
knee.
CausesofCTEV
CTEVmaybeeitherprimaryorsecondary
1.PrimaryorIdiopathic

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ItisthemostcommontypeofCTEV
Footdeformity(CTEV)istheonlymanifestation,otherwise
musculoskeletalsystemisnormal.
2.Secondary

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CTEVisalocalmanifestationofasystemicsyndrome.

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Causesare:-
1. Neurologicaldisorders&neuraltubedefectsegmyelomeningocele,
&spinaldysraphism
2. Paralyticdisorder(duetomuscularimbalance)aspolio,spinabifida,
myelodysplasia,&Fredreich'sataxia

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3. Arthrogiyposismultiplexa
4. Larsensyndrome
5. Freeman-Sheldonsyndrome
6. Diastrophicdwarfism
7. Sacralagenesis,tibialdeficiency,constrictionrings&amniotic

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bands

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55.Inyoungpersonmostcommoncancer
amongfollowingis:
a)Giantcell
b)Osteosarcoma

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c)Chondrosarcoma
d)Ewingsarcoma
e)All
CorrectAnswer-B
Ans.b.Osteosarcoma

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Osteosarcomaisthesecondmostcommontumour.
Thesetumoursoccurb/wtheagesof15-25years,constitutingthe
commonestmusculo-skeletaltumouratthatage

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56.Allaretrueaboutsepticarthritisexcept:
a)Staph.Aureusismostcommoncausativeorganism

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b)Commoninchildren
c)Affectgrowthplate
d)E.coliisthecommonestcausativeorganism
e)Aspirationofjointfluidisusedfordiagnosis
CorrectAnswer-D

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Ans.d.E.coliisthecommonestcausativeorganism
Itismorecommoninchildren&males
Staphylococcusaureusisthecommonestcausativeorganism,other
organismarestrepto-pneumo&Gonococcus.
Aspiratethejoint&examinethefluid.AWBC&gramstainshould

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becarriedoutimmediately.Sampleoffluidarealsosentforfull
microbiologicalexamination&testsforantibioticsensitivity.

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57.Featuresoffatembolism:
a)Bradycardia
b)Hypoxia

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c)Hypotension
d)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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Tachypnoea
Petechialrash
Respiratoryfailure
Drowsy
Restless

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Coma

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58.Straightlegraisingtestis/arepositivein:
a)Spinalstenosis
b)Spinalabscess
c)AlsocalledasTrendelenburgtest

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d)Prolapsedintervertebraldisc
e)Sciatica
CorrectAnswer-D:E
Ans.d.Prolapsedintervertebraldisc;e.Sciatica
Pain&limitationofStraightlegraising(SLR)isafeatureof

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prolapsedintervertebraldiscwhenthereisirritationorcompression
ofoneoftherootsofthesciaticnerve.
Straightlegraisingtest:Thisisatesttodetectnerveroot
compression.

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59.Whichofthefollowingis/aretrueabout

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thegaitinsensorydeficit
a)Antalgicgait
b)Apraxia
c)Trendelenburg
d)PositiveRombergsign

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e)Apraxiagait
CorrectAnswer-D
Ans.d.PositiveRombergsign
Insensoryataxiathepatientisabletomaintaintheupright
positionwhiletheeyesareopen,butwhentheeyesareclosed

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hesways.ThisisapositiveRombergsign.
ABNORMALGAIT:
Antalgicgait:occursinpainfulconditionsofthelowerlimb.
Charlie-Chaplingait:Occursintibialtorsion.
Circumductiongait:Occursinhemiplegia

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Waddlinggait:Occursinbilateralcongenitalhipdislocation
Highsteppinggait:Occursinfootdrop
Scissoringgait:Occursincerebralpalsy
Stiffhipgait:Occursinankylosisofthehip
Trendelenburggait:Occursinunstablehipduetocongenital

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dislocationofhip,gluteusmediusmuscleweakness

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60.TrueaboutTrichomonasvaginitis:
a)Importantcauseofrecurrentabortion
b)T.vaginalisisaflagellatedprotozoa
c)Metronidazoleisusedfortreatment

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d)Strawberrycervix
e)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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Infectioningenitaltractmayberesponsibleforsporadic
spontaneousabortionbutitsrelationtorecurrentabortionis
inconclusive.

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61.AllaretrueaboutPott'sspineexcept:
a)ThoracicvertebraeT6-T8ismostcommonlyaffectedsite

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b)Paradiscaliscommonestvariety
c)Muscularrigidity&stiffnessiscommon
d)Posteriorpartofvertebraeismoreaffectedthananteriorpart
e)BackpainisthecommonestPresentingsymptom
CorrectAnswer-A:D

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Ans.a.ThoracicvertebraeT6-T8ismostcommonlyaffected
site;d.Posteriorpartofvertebraeismoreaffectedthananterior
part
Tuberculosis(TB)ofthespine(Pott'sdisease)isthemostcommon
siteofboneinfectioninTB.

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Thelowerthoracicandupperlumbarvertebraearetheareasofthe
spinemostoftenaffected.
Pott'sdiseaseresultsfromhaematogenousspreadoftuberculosis
fromothersites,oftenpulmonary.Theinfectionthenspreadsfrom
twoadjacentvertebraeintotheadjoiningdiscspace.

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Ifonlyonevertebraisaffected,thediscisnormal,butiftwoare
involvedtheintervertebraldisc,whichisavascular,cannotreceive
nutrientsandcollapses(seenasnarrowingofintervertebralspace
onX-rays)
CommonestspineinvolvedinspineTBis

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Thoracolumbar/DorsolumbarT12-L1(Lowerthoracictobeprecise.
Thediseaseprogressesslowly.Signsandsymptomsinclude:
Localisedbackpainistheearliestandcommonestcomplaint
Paravertebralswellingmaybeseen
Neurologicalsignsmayoccur,leadingtoparaplegia.

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Stiffness
Deformity
Constitutionalsymptoms
Diagnosis:
SpinalX-raymaynotshowearlydiseaseas50%ofbonemassmust

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belostforchangestobevisibleonx-ray.However,plain
radiographscanshowvertebraldestructionandnarroweddisc
space.
MRIisusefultodemonstratetheextentofspinalcompressionand
canshowchangesatanearlierstagethanplainradiographs.Bone

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elementsvisiblewithintheswelling,orabscesses,arestrongly
indicativeofPott'sdiseaseasopposedtomalignancy.
CTscansandnuclearbonescanscanalsobeused.

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62.TrueaboutClubfoot:
a)Abductionofforefoot

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b)Associatedwithbreechpresentation
c)Dennis-Brownsplintused
d)Adductionofforefoot
e)Associatedwithspinabifida
CorrectAnswer-C:D:E

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Ans.c.Dennis-Brownsplintusedd.Adductionofforefoote.
Associatedwithspinabifida
CTEVisthecommonestandmostimportantcongenitaldeformityof
thefoot.
Thedeformityconsistsoffollowingelements:-

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1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)
2. Inversionoffootatsubtalarjoint(talocalcanealjoint)
3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular
joint.
4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-

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tarsaljoints.
Treatment:
Tendontransfer:-Transferoftibialis-anteriorontheoutersideof
foot.Thiscanbedoneonlyafter5years.
Dwyerosteotomy:-Medialopenwedgeosteotomyofcalcaneumto

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correctheelvarus.
Gradualdifferentialdistraction:-Inthisanexternalfixator(JESSor
Illizarov)isappliedandgradualcorrectionofdeformity
>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,and
talonavicularjoints)

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63.TrueaboutOsteosarcoma:
a)Primaryosteosarcomaismostcommonlyoccurinagegroup
oflessthan20yr
b)Periostealreactionispresent
c)Presentaselevatedsofttissuemass

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d)Commonlyassociatedwithosteoidosteoma
e)Formationofbonebythetumorcellsischaracteristic
CorrectAnswer-A:B:C:E
Ans.a.Primaryosteosarcomaismostcommonlyoccurinage
groupoflessthan20yr;b.Periostealreactionispresent;c.

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Presentaselevatedsofttissuemass;e.Formationofboneby
thetumorcellsischaracteristic
Osteosarcomaisprimarymalignantbonetumorofbone,derived
fromprimitiveboneformingmesenchymaandcharacterizedby
osteoidformation.

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Itisoftwotypes
1. Primary
2. Secondary
Associatedfeature:
Pagetdisease

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Radiation
Fibrousdysplasia
Enchondromatosis
Multipleosteochondroma
Boneinfarction

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Chronicosteomyelitis
Radiology:

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TheX-rayappearancesarevariable:hazyosteolyticareasmay
alternatewithunusuallydenseosteoblasticareas.
Oftenthecortexisbreachedandthetumourextendsintothe

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adjacenttissues;whenthishappens,streaksofnewbone
appear,radiatingoutwardsfromthecortexthesocalled'sunburst'
effect.
Wherethetumouremergesfromthecortex,reactivenewboneforms
attheanglesofperiostealelevation(Codman'striangle).

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WhileboththesunburstappearanceandCodman'striangleare
typicalofosteosarcoma.

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64.Commonestcauseofacuteosteomyelitis:
a)Trauma
b)Surgery

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c)Fungalinfection
d)Hematogenousroute
e)Tubercularinfection
CorrectAnswer-D
Ans.d.Hematogenousroute

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ACUTEOSTEOMYELITIS:
1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.

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Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andmostcommonsourceofboneandjointinfectionis
hematogenous.

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65.Distalinterphalangealjointinvolvement
occurin:

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a)Boutonnieredeformity
b)Swanneckdeformity
c)Malletfinger
d)Triggerfinger
e)Dupuytren'scontracture

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CorrectAnswer-A:B:C
Ans.a.Boutonnieredeformity;b.Swanneckdeformity;c.
Malletfinger
Inmedicine,malletfinger,alsobaseballfinger,droppedfingerand
(moregenerally)extensortendoninjury,isaninjuryoftheextensor

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digitorumtendonofthefingersatthedistalinterphalangealjoint
(DIP).
Swan-neckdeformity(PIPjointshyperextendedandDIPjoints
flexed),enlargedknuckles,andsubcutaneousnodulesareclassic
cluesforrheumatoidarthritis.

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Distalinterphalangealjoint-Osteoarthritis,Psoriaticarthritis,
Reactivearthritis
Proximalinterphalangealjoint-Osteoarthritis,RA,SLE,Psoriatic
arthritis

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66.Pathologicalfracturearefoundin:

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a)Bonecyst
b)Osteoporosis
c)Chronicosteomyelitis
d)Osteochondroma
e)Osteogenesisimperfecta

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CorrectAnswer-A:C:D:E
Ans.a.Bonecyst;b.Osteoporosis;c.Chronicosteomyelitis;d.
Osteochondroma;e.Osteogenesisimperfecta
PathologicalFracture
Afractureinanabnormalboneisreferredtoaspathological

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fracture.Abnormalbonemeansabonerenderedweakbya
diseaselocalizedtoaparticularhone,orbyageneralisedbone
disorder.Bonethatfracturesspontaneously,oraftertrivialtrauma
mustberegardedasabnormaluntilprovenotherwise.Vertebral
bodies(thoracic&lumbar)arethemostoftenaffectedbonesf/b

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neckfemur&lowerendradius(colle's#).Mostcommoncauseis
osteoporosis
Othercausesofpathologicalfracturesare:
LocalizedDiseases
Chronicinfectioneg.tubercular&pyogenic

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osteomyelitis.
Eosinophilicgranuloma
Benignneoplasticlesions
Solitarybonecyst
Aneurysmalbonecyst

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Fibrouscorticaldefect

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Monostoticfibrousdysplasia
Chondromyxoidfibroma
Chondroma(Enchondroma)
Osteoclastoma(giantcelltumor)

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Malignantbonetumor
Osteosarcoma
Ewing'stumor
Chondrosarcoma
Atrophicbonedueto

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Polio
Radiation(Radiotherapy)
GeneralisedDiseases
Congenital/Developmental
Osteogenesisimperfecta

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Osteopetrosis
011iersdisease(multipleenchondromatosis/dyschondroplasia).
Polyostoticfibrousdysplasia
HistiocytosisX
Gaucher'sdisease

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AcquiredDisordersproducingosteopenia
Osteoporosis(mostcommoncause)
Osteomalacia
Hyperparathyroidism
Renalosteodystrophy

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Paget'sdisease
Myeloma
Othermetabolicbonediseases
Rickets
Scurvy

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Disseminatedmalignancyinbones
Multiplemyeloma
Myelomatosis
Metastaticcarcinoma

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67.AllaretrueaboutSlippedcapitalfemoral

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epiphysisexcept:
a)Avascularnecrosismayoccur
b)Usuallyoccurafterl0yearofage
c)Obesityisariskfactor
d)Frog-leglateralviewishelpful

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e)Morecommoningirls
CorrectAnswer-E
Ans.e.Morecommoningirls
SLIPPEDFEMORALCAPITALEPIPHYSIS(SFCE)
Seeninadolescentchildreninagegroupof13-15yrs

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Eitheroverweightorsexuallyimmature
Presentswithendocrinopathies
Hypothyroidism
Growthhormoneexcess
CRF

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Craniopharyngioma
Hypogonadism
Klinefelter'ssyndromemaypresentasSFCE
Treethowan'ssignonx-ray
USGorCTmoresensitiveindetectingearlyslip

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Tc99scanshowsincreaseduptake
Rxispromptsurgery

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68.FracturesiteofMonteggiafractureis
a)Proximalulna
b)Distalendofradius

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c)Distalradius
d)Dislocationofradialhead
e)Lowerradio-ulnarjointdislocation
CorrectAnswer-A:D
Ans.a.Proximalulna;d.Dislocationofradialhead

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Monteggiafracture-dislocationsareclassifiedbytheBado
system
BadotypeIinjuriesarecharacterizedbyaproximalulnarfracture
withanteriordislocationoftheradialhead.Thisisduetoaforceful
pronationinjuryoftheforearmandisthemostcommontype.

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BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocation
injuries.
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)All
CorrectAnswer-C:D
Ans.c.Recurrenceiscommonafterexcision;d.Locatedat
epiphysis
Giantcelltumor(Osteoclastoma)

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GCTisanosteolytictumorarisingfromtheepiphysisandis
commonbetweentheageof20-40years.
ThoughGCTisabenigntumor,itislocallyveryaggressive.
Femalesareaffectedmorethanmales.
Pathologicalfeatures

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Thecommonestsitesarelowerendoffemurandupperendoftibia.
Othercommonsitesarelowerendradiusandupperendof
humerus.Itmayalsooccurinthespineandsacrum.
Thetumorisencompassedbyafibrouscapsuleatperiphery.
Thepresenceoftumorgiantcellsisthehallmarkofthistumor.

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Clinicalfeatures
Painatthesiteofthetumour.
Graduallyincreasinglocalswelling
Pathologicalfracturesmayoccur.
"Eggshell-crackling"sensationonpalpation.

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Radiologicalfeatures
GCTisoneofthecommoncauseofasolitarylyticlesionofthe

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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.

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70.TrueaboutfractureneckTalus:
a)Avascularnecrosisofbodyiscommoncomplication

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b)LateralviewX-rayisimportantfordiagnosis
c)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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surfacecarriesagreaterloadperunitareathananyotherbonein
body),andithasavulnerablebloodsupplyandisacommonsite
forposttraumaticischemicnecrosis.
Thebodyoftalusissuppliedmainlybyvesselswhichenterthetalar
neckfromthetarsalcanal.Infracturesofthetalarneckthese

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vesselsaredivided;ifthefractureisdisplacedtheextraoseous
plexustoomaybedamagedandbodyoftalusbecomesischemic.
Fractureofthetalarneckisproducedbyviolenthyperextensionof
ankle.Bodyoftalusfractureisusuallyacompressioninjurydue
tofallfromheight.

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Complications
Avascularnecrosisofbodyismostcontinuumcomplication.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 Undisplaced
TypeII Displacedassociatedwithdislocationofsubtalarjoint
Displacedassociatedwithdislocationatankleaswellas-
TypeIII atsubtalarjoint
TypeIV Type3+Talonavicular-subluxationordislocation

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Treatment
BelowkneecastwithfootinplantarflexionX4weeksFurther
plasterchangewillallowthefoottobebroughtupslowlyto
plantigradeClose/openreduction&internalfixation

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71.Whichofthefollowingis/arenotfeature(s)

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ofrheumatoidarthritis
a)Pannusformationinjoint
b)Osteosclerosisosteoclasticactivityinunderlyingbone
c)Erosionofcartilage
d)Osteophyte

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e)Plasmacellinfiltrationofsynovialstroma
CorrectAnswer-D
Ans.d.Osteophyte
Thecharacteristichistologicfeaturesinclude:
Infiltrationofsynovialstromabydenseperivascularinflammatory

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cells,consistingofBcellsandCD4+helperT,plasmacellsand
macrophages;
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)Rheumatoidarthritis
e)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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Diabetesmellitus
Myxedema
Acromegaly
Hyperparathyroidism
4.Depositiondisorders

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Rheumatoiddisorder
Gout
Rheumaticdisorder
Amyloidosis
Sarcoidosis

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Leukemia

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Chronicrenalfailure

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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)Bipolarhemiarthroplasty
c)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:

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Inadults<60yearsold,nonunionsinwhichthefemoralheadis
viablecanbetreatedbyangulationosteotomy.Thisprovidesaline
ofweightbearingmoredirectlybeneaththefemoralhead.
Inchildrenandinadults<21yearsold,nonunionsinwhichthe

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femoralheadisnotviablecanbetreatedwithanarthrodesis.In
exceptionalcircumstances'ayoungadultmaybetreatedwitha
prosthesis.
Inadults2lto60yearsold,nonunionsinwhichthefemoralheadis
notviablecanbetreatedwithaprosthesis,atotalhiparthroplasty,

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oranarthrodesis,dependingonthecircumstancesinthegiven
Patientandontheexperienceandpreferenceofthesurgeon.Rarely
isanarthrodesisindicatedinpatientsolderthan50yearsofageor
inpatientswithasedentaryoccupation.
lnpatients>60years,non-union,regardlessoftheviabilityofthe

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femoralhead,usuallyaretreatedwithahemiarthroplastyoratotal
hiparthroplasty'

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