1.Whichofthefollowingiscausedby congenital17hydroxylasedeficiency: a)Hyperkalemia b)Hermaphroditism c)Hypertension d)Virilism CorrectAnswer-CHypertension17-hydroxylase(17-OH)deficiencysyndromeisararegeneticdisorderofsteroidbiosynthesiscausingdecreasedproductionofglucocorticoidsandsexsteroidsandincreasedsynthesisofmineralocorticoidprecursors.Reducedorabsentlevelsofbothgonadalandadrenalsexhormonesresultinsexualinfantilismin46,XXfemalesandambiguousgenitaliain46,XVmales.ExcessivemineralocorticoidactivityproducesvaryingdegreesofhypertensionQandhypokalemiaQ.Patientsusuallyarediagnosedwiththisconditionduringanevaluationofdelayedpuberty.absentsecondarysexualcharacteristicsorprimaryamenorrhea.Q
2.Trueaboutlumbricalsis a)FlexIPjointsandextendsMCPjoint b)1stand2ndsuppliedbyradialnerve c)3and4suppliedbysuperficialbranchofulnar d)Originfromtendonsofflexordigitorumprofundus CorrectAnswer-DAnswer.DOriginfromtendonsofflexordigitorumprofundus*Thefourlumbricalmusclesarisefromthetendonsofflexordigitorumprofundus.Theyhavedifferentorigins:Eachpassesdistallytotheradialsideofitsnearestmetacarpophalangealjointofthefingerstobeinsertedintothedorsalextensorexpansionofdigitstwotofive.Theiractionsonthesedigitsareto:*Extendtheinterphalangealjoints*FlexthemetacarpophalangealjointsTheinnervationofthelumbricalsisdual:*Theradialfirstandsecondlumbricalsaresuppliedbythemediannerve(C8,T1)*Theulnarthirdandfourthlumbricalsaresuppliedbythedeepbranchoftheulnarnerve(C8,T1)*Occasionally,thethirdlumbricalcanreceiveitsinnervationfromthemediannerve.
3.Inpatientswithhypertrophic cardiomyopathymaximummutationsarefoundinwhichgene: a).-myosinheavychain b)Elastin c).-tropomyosin d)TroponinT CorrectAnswer-A-MyosinheavychainMutationsingenefor-Mysoinheavychainareassociatedwith40%ofthefamilieswithhypertrophiccardiomyopathy.TroponinTmutations-15%ofthefamilies-tropomyosinmutations~5%ofthefamilies
4.Whatisthevenoushematocritlevelat whichyouwilldiagnosepolycythemiainanewborn? a)55% b)60% c)65% d)70% CorrectAnswer-CDefinitionofpolycythemia:a.Venoushaematocritofover65%.b.Venoushaematocritofover64%at2hoursage.c.Anumbilicalvenousorarterialhaematocritover63%ormore.Themeanvenoushaematocritofterminfantsis53incordblood,60at2hoursofage,57at6hoursofageand52at12-18hoursofage.Asthehaematocritincreases,thereisincreasedviscosityanddecreasedbloodflow.Whenhaematocritincreasestomorethan60%thereisafallinO2transport.Definitionofhyperviscosity:Viscositygreaterthan14.6centiposeatashearrateof11.55asmeasuredbyaviscometer.(normalis1.4-1.8centipoise).
5.Thesignificanceofdifferencebetween proportionscanalsobetestedby- a).`t'test b)Chisquaretest c)ANOVA d)Correlationandregression CorrectAnswer-BAns.B.ChisquaretestChi-Squaretestoffersamethodoftestingthesignificanceofdifferencebetweentheproportions.Itsadvantageliesinthefactthatitcanalsobeusedwhenmorethantwogroupsaretobecompared.Byusingthistest,wecanfindoutifthedifferencebetweentwoproportionsorratioshasoccurredbychance.Thestepsinvolvedare- 1. Testingthenullhypothesis.2. Applyingchi-squaretest.3. Calculatingthedegreeoffreedom.4. Comparingwithprobabilitytables.
6.Peripheralandcentralchemoreceptors maybothcontributetotheincreasedventilationthatoccursasaresultofwhichofthefollowing? a)Adecreaseinarterialoxygencontent b)Adecreaseinarterialbloodpressure c)Anincreaseinarterialcarbondioxidetension d)Adecreaseinarterialoxygentension CorrectAnswer-CThecentralchemoreceptorslocatedonorneartheventralsurfaceofthemedullacauseanincreaseinventilationinresponsetoanincreaseinPacO2andtoalesserextenttoadecreaseinarterialpHbecausethebloodbrainbarrierisrelativelyimpermeabletohydrogenions.TheperipheralchemoreceptorsinthecarotidbodiescauseanincreaseinventilationinresponsetoanincreaseinPacO2adecreaseinarterialpH,andadecreaseinPaO2.NeitherthecentralchemoreceptorsnorthecarotidbodiesarestimulatedbyadecreaseinarterialbloodpressureorO2content.
7.Wirelesscapsuleendoscopyisdoneto visualizewhichofthefollowingcondition? a)Esophagealvarices b)Gastriccarcinoma c)Crohn'sdisease d)Ulcerativecolitis CorrectAnswer-CCrohn'sdiseaseWirelesscapsuleendoscopy(WCE)allowsdirectvisualizationoftheentiresmall-bowelmucosa.ThediagnosticyieldofdetectinglesionssuggestiveofactiveCDishigherwithWCEthanCTenterographyorsmall-bowelseries.WCEcannotbeusedinthesettingofasmall-bowelstricture.Capsuleretentionoccursin<1%ofpatientswithsuspectedCD,butretentionratesof4--6%areseeninpatientswithestablishedCD.
8.Thomastestisusedfortesting? a)Hipflexion b)Kneeflexion c)Hipabduction d)Hiprotation CorrectAnswer-AAHipflexionREF:LangeInstantAccess:OrthopedicsandSportsMedicine,byAnilPatel,page106ThomasTest:Withthepatientlyingsupine,maximallyflexbothhips.Allowthefemurontheipsilateralsidetofallintoasmuchextensionaspossible,whileholdingtheotherhipup.Theanglebetweenthefemurandexaminingtableistheresidualflexionandrepresentstheflexioncontracture.
9.Indicationforsurgicalcompartmentrelease incompartmentSyndromeinanycompartmentisabsolutepressuregreaterthan? a)15mmHg b)20mmHg c)30mmHg d)Variesfromcompartmenttocompartment CorrectAnswer-C30mmHgREF:Withtext"Settingthethresholdforfasciotomyataperfusionpressureof30mmHgcanbeconsideredsafe,butstillmayleadtoovertreatmentifusedroutinely"REF:Evidence-basedOrthopedics-MohitBhandariPage634Differentauthorsconsidersurgicalinterventionif:(REF:TiwariA,HaqAI,MyintF,HamiltonG.Acutecompartmentsyndromes.BrJSurg2002;89:397-412.) 1. AbsoluteICPgreaterthan30mmHg2. DifferencebetweendiastolicpressureandICPgreaterthan30 mmHg 3. DifferencebetweenmeanarterialpressureandICPgreaterthan40 mmHg"Intracompartmentalpressuremaybemeasuredbythewickcatheterinpatientssuspectedtohavecompartmentsyndrome.Bysuchmethodapressureof30mmHgormoresustainedfor6-8hoursormoreisalikelyindicationfordecompressivefasciotomy"REF:SkeletalinjuryinthechildbyJohnAnthonyOgdenPage317 Intracompartmental Comments
Intracompartmental Commentspressure Normalcompartmentpressureoflower <15mmHg limbsVenousdrainagefromclosedmyofascial >25mmHg spacesisimpaired. >30mmHg Completevenouscollapse >60mmFig Neuromuscularischemia REF:Masteryofvascularandendovascularsurgery-GeraldB.Zelenock,ThomasS.Huber,LouisM.MessinaPage507
10.WhichisnottrueofTabesdorsalis? a)Seeninneurosyphilis b)Paresthesiaisseen c)Deeptendonreflexesareretained d)Abdominalpainandvisceralsymptomsoccur CorrectAnswer-CDeeptendonreflexesareretainedREF:Harrison'sPrinciplesofInternalMedicine17thedchapter372TABESDORSALIS:Theclassicsyndromesoftabesdorsalisandmeningovascularsyphilisofthespinalcordarenowlessfrequentthaninthepastbutmustbeconsideredinthedifferentialdiagnosisofspinalcorddisorders.Thecharacteristicsymptomsoftabesarefleetingandrepetitivelancinatingpains,primarilyinthelegsorlessoftenintheback,thorax,abdomen,arms,andface.Ataxiaofthelegsandgaitduetolossofpositionsenseoccursinhalfofpatients.Paresthesias,bladderdisturbances,andacuteabdominalpainwithvomiting(visceralcrisis)occurin15-30%ofpatients.Thecardinalsignsoftabesarelossofreflexesinthelegs;impairedpositionandvibratorysense;Romberg'ssign;and,inalmostallcases,bilateralArgyllRobertsonpupils,whichfailtoconstricttolightbutaccommodate.Diabeticpolyradiculopathymaysimulatetabes.
11.Vitaminnotdeficientinceliacdiseaseis? a)VitaminD b)VitaminB12 c)Folicacid d)VitaminA CorrectAnswer-CFolkacidREF:SheilaCrowe-2010page384,Harrison17thedchapter288Vitaminsdeficientinceliacdiseaseare: 1. VitaminA2. VitaminD3. VitaminK4. VitaminB12
12.ABonemarrowtransplantrecipient patientdevelopedchestinfection.OnHRCT'Treeinbudappearance'isseen.Mostlikelycausativeagentis: a)Klebsiella b)Pneumocystis c)TB d)RSV CorrectAnswer-BPneumocystis[Ref:HarrisonI7/ep843;Article'Treeinbudsign'inJournal'Radiology'and'Radiographics7Tree-in-budisasignseeninHRCT,mostcommonlyseenwithendobronchialspreadofTuberculosis,butcanbeseenwithawidevarietyofconditions,mostcommonlyinfections.(Describedaheadindetail).Theoreticallyalltheoptionscancause'Tree-in-bud'sign(althoughKlebsiellahasnotbeenmentionedinthelist).SothenextclueisBonemarrowtransplant.Bonemarrowtransplantcausesatransientstateofimmunologicaldeficiencyleadingtoawidevarietyofopportunisticinfections.Amongthegivenoptions,accordingtothetableandtextofHarrison(17/echapter'InfectionsinTransplantRecipients')PneumocystisandRSVcancausepneumoniaaftertransplant:butPneumocystisisamuchmorecommonthanRSV. CommonSourcesofInfectionsafterHematopoieticSteinCellTransplantation PeriodafterTransplantation
Early(<1 Middle(1-4 InfectionSite Late(>6Months) Month) months) Disseminated Aerobicgram- Nocardia Encapsulated negative, Candida, bacteria grain-positive Aspergillus (Streptococcus bacteria pneumoniae,Haemophilusinfluenzae,Neisseriameningitidis) Skinand HSV- HHV-6 VZV mucousmembranesLungs Candida, CMV, Pneumocystis Aspergillus seasonal HSV respiratoryvirusesPneumocystisToxoplasma Gastrointestinal CMV tract BKvirus, Kidney BKvirus adenovirus Brain HHV-6 Toxoplasma ToxoplasmaJCvirus Bonemarrow HHV-6 Tree-in-budsignThetree-in-budsignisafindingseenonthin-sectioncomputedtomographicimagesofthelung(HRCT).(NotseenonX-rays)Peripheral,small,centrilobularnodulesareconnectedtolinear,branchingopacitiesthathavemorethanonecontiguousbranchingsite,thusresemblingabuddingor,fruitingtree:thisisknownastree-in-bud-pattern.Itrepresentsdilatedandimpacted(mucusorpus-filled)centrilobularbronchioles.Thepresenceoftree-in-budisindicativeofsmallairwaydisease.
ItismostcommonlyassociatedwithendobronchialspreadofMycobacteriumtuberculosis.Butitcanalsobeseeninalargenumberofconditions.Pulmonaryinfectiousdisordersinvolvingthesmallairwaysarethemostcommoncausesofthetree-in-budsign.Anyinfectiousorganism,includingbacterial,mycobacterial,viral,parasitic,andfungalagents,caninvolvethesmallairwaysandcauseatree-in-budpattern.CausesofTree-in-budappearance Congenitaldisorders Peripheralairwaydisease Cysticfibrosis Connectivetissue Infection Kartagener disorders Bacterial syndrome Rheumatoidarthritis Mycobacterium Idiopathic Sjo-grensyndrome tuberculosis disorders Peripheral Mavium-intracellulare Obliterative pulmonaryvascular complex bronchiolitis disease Staphylococcusaureus Diffuse Neoplasms Haemophilus panbronchiolitis Primarypulmonary influenzae A lymphoma Fungal spiration Neoplastic Aspergillus Inhalation pulmonaryemboli Pneumocystiscarinii, Toxicfumesand Gastriccancer (renamedPneumocystis gases Breastcancer jiroveci)Viral Immunologic Ewingsarcoma Cytomegalovirus disorders Renalcancer Respiratorysyncytialvirus Allergic bronchopulmonaryaspergillosis
13.Causeofvasodilatationinspidernevi- a)Estrogen b)Testosterone c)Hepatotoxins d)FSH CorrectAnswer-AEstrogen[Ref:Harrison171h/ep.1920;Robbin's7th/ep.882]Spidernevirefertodilated,visiblesmallbloodvesselsintheskin.-Itiscalledspidernevibecauseitconsistsofcentral"feeding"bloodvesselwithnumerousfineradiatinglegsemanating.fromthecentralbody.Spiderneviarecausedduetovasodilatationofvesselsandareusuallyassociatedwithcirrhosis.Cirrhosisisassociatedwithvasodilatationandhyperdynamiccirculation."Thecauseofvasodilatationinchrrhosisisuncertainbutitisbelievedtoberelatedtotheincreasedlevelofestrogenintheboth.Estrogenisafemalesexhormonewhichismetabolizedbyliver.Thusinliverdiseasesitsleveltendstoincreasewhichisbelievetocausevasodilatation,resultinginspidernaevi.
14.Strawberrygingivitisseenin a)Myelocyticinfiltration b)Phenytointoxicity c)Wegnergranulomatosis d)Klipelrenaunaysyndrome CorrectAnswer-CWegener'sgranulomatosis[Ref:IADVLTextbookofDermatology3r9ep.695]Wegener'sgranulomatosisisknowntocauseoralmucosallesions."Strawberrygingivitisischaracteristicorallesionassociatedwithwegener'sgranulomatosis".Straberrygingivitisclinicallypresentswith:?'Swollenerythematousgumsclinicallyresemblingoverripestrawberries"Histologicallystrawberrygingivitisischaracterizedby
15.WhichofthefollowingistrueofWilson's diseaseallexcept- a)Autosomalrecessive b)Serumceruloplasminlevel<20mg/d1 c)Urinarycopporexcretion<100microgram/c11 d)Zincacetateisusedasmaintencetherapy CorrectAnswer-CUrinarycopperexcretion<100microgram/di[Ref:Harrison17"'/ep.2450,2449]Symptomaticpts.ofWilsondiseaseinvariablyhaveurinecopperlevels>100pgperday.WilsondiseaseisanautosomalrecessivedisordercausedbymutationintheATP7Bgene(acoppertransportingATPase)Diagnosis-ThegoldstandardfordiagnosisisLiverbiopsywithquantitativecopperassayQ.Otherdiagnostictestsusedare?-SerumceruloplasminlevelQ-KFrings(2-Urinecopperexcretiono-DNAHelpful-yeanalysisQSerumcoppervalueshavenodiagnosticvalue,sincetheymaybelow,normalorelevateddependinguponthestageofevolutionofdisease. Table:UsefulDiagnosticTestsforWilsonDisease Normal Test Value WilsonDisease 180-350
180-350 Serum mg/L (18-35 ?Lowin85% ceruloplasmin mg/d1) ?Presentin99% -Ifneurologicorpsychiatric KFrings Absent symptomspresent. ?Presentin30-50% -inhepatic presentationand presymptomaticstate?Urinarycopper excretionis increased->1.6intnol(>100mg) 0.3-0.8 24-hurineCu insymptomatic mmol patients ?0.9to>mmol(60to >100mg) -inpresymptomatic patients 0.3--0.8 ?Livercopperis LiverCu mmol/g increased (20-50mg) ?>3.1mmol(200 tissue mg) Haplotype analysis 0Matches 2Matches TreatmentZincisthetreatmentofchoiceforWilsondiseaseQ.Itproducesanegativecopperbalance-Byblockingintestinalabsorptionofcopper-Byinducinghepaticmetallothioneinsynthesiswhichsequestersadditionaltoxiccopper. Table:RecommendedAnticopperTreatmentsforWilsonDiseaseDiseaseStatus FirstChoice SecondChoice
DiseaseStatus FirstChoice SecondChoice Initialhepaticmanifestations?Hepatitisorcirrhosiswithout decompensation Trientine ?HepatitisorCirrhosis Penicillainine with Zinc andzinc decompensation Trientineandzinc Hepatic -Mild Trientineandzinc transplantation -Moderate Hepatic Trientineand -Severe transplantation zinc Initial Tetraioinolybdate Trientineand neurologic/psychiatric andzinc zinc Maintenancetherapy Zinc Trientine Presymptomatictherapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine
16.Allaretrueaboutthrombotic thrombocytopenicpurpuraexcept? a)Microangiopathichemolyticanemia b)Thrombocytopenia c)Normalcomplementlevel d)Grosslyabnormalcoagulationtests CorrectAnswer-DAns:D.Grosslyabnormalcoagulationtest[Ref:Robbin's7m/ep.1010]*Thromboticthrombocytopenicpurpura(TTP)ischaracterizedbythepresenceofwidespreadthrombosisthroughoutthemicrocirculation.*Theuniquecharacteristicofthesethrombiisthattheyareprimarilycomposedofplateletsowithverylittle.fibrininit.*TheconsumptionofplateletleadstothrombocytopeniaandthepresenceofintravascularthrombicausesmicroangiopathichemolyticanemiaQandwidespreadorgandysfunction.*YoumusthavenoticedthatTTPandDICsharesomanysimilarfeaturessuchas4icrovascularocculsionandmicroangiopathichemolyticanemia,Buttheyarepathologicallydistinct.InTTP*Activationofcoagulationcascadeisnotofprimaryimportance.Thethrombipresentareessentiallyplateletthrombi,henceresultsoflaboratorytestsofcoagulationsuchasPTandPTTareusuallynormal.InD.I.C.*ThemaindefectisactivationofcoagulationsystemthereforePT
andPTTareabnormal.*PatientswithTTParedeficientinanenzymecalledADAMTSB.ThisenzymeisalsoknownasvWfinetalloprotease.*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregate.formationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Thromboticthrombocytopenicpurpuraisathromboticmicroangiopathy.*TheotherdisorderswhichisincludedinthisgroupincludeH.U.S.*Thediseasesarecharacterizedbywidespreadthrombosisinmicrocirculation.*ThevesselswhichareinvolvedareterminalarteriolesQandcapillaries.*Thesevesselshavethrombi.*ThecharacteristicofthisthrombusisthatitisprimarilyaplateletthrombusQi.e.thethrombiiscomposedmainlyofplateletsandvonWilebrandfactorwithverylittlefibrininit.Pathogenesis*PatientswithTTParedeficientinanenzymecalledADAMTSBQ.(ThisenzymeisalsoknownasvWfnielalloproteaSe.)*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregateformationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Plateletassociatedimmunoglobulin(IgG)andcomplementlevelsarenormalinT.T.P.
17.Mostcommonorganismassociatedwith reactivearthritisis: a)Staphylococcus b)Shigella c)Chlamydia d)Yersinia CorrectAnswer-CChlamydia[Ref:Harrison17/ep2113;http://www.emedicine.com/derm/TOPIC207.HTM;http://www.entedicine.com/med/TOPIC1998.11TM]Reactivearthritisisasystemicdisorderofunknownetiologythatisdefinedbythedevelopmentofconjunctivitis,urethritis,arthritis,andmucocutaneouslesionsfollowinganepisodeofinfectionelsewhereinthebody.In1916,HansReiterdescribedthetriadofnongonococcalurethritis,conjunctivitis,andarthritisinayoungGermanofficerwithbloodydysentery.Theclassictriadofthedisease,namelyurethritis,arthritis,andconjunctivitis,ispresentinonlyonethirdofthepatients.ReactivearthritisisfrequentlyassociatedwiththehumanleukocyteantigenB27(1-ILA-B27)haplotype.Theetiologyofreactivearthritisremainsuncertain.Themostacceptedtheoryaboutthepathophysiologyofreactivearthritisinvolvesinitialactivationbyamicrobialantigen,followedbyanautoimmunereactionthatinvolvestheskin,eyes,andjoints.Twoformsarerecognized:asexuallytransmittedformandadysentericform.GastrointestinalinfectionswithShigella,Salmonella,andCampylobacterspeciesandothermicroorganisms,andgenitourinaryinfectionsespeciallywithChlamydiatrachomatis
havebeenfoundtotriggerreactivearthritis.Youngchildrentendtohavethepostdysentericform,whereasadolescentsandyoungmenaremostlikelytoacquirereactivearthritisaftertheyhaveurethritis.It'snotclearwhichorganismismostcommonlyassociatedwithreactivearthritis.BothShigellaandChlamydiaappeartohemostcommon.Aftergoingthroughmanyarticlesfromjournalsonthenet,Chlamydiaappearstohethemostcommon.WewouldprefertogowithChlamydia.(Howeverifanyonefindsareliablereferencedocumentingthemostcommonorganism,pleasemailusatouremailid.ThearticleonReactiveArthritisinthejournal"BestPractice&ResearchClinicalRheumatology"Vol.20,No.6,pp.1119e1137,2006writes-"Theprevalenceisestimatedtobe30-40casesper100,000adults;theannualincidenceisestimatedtobe4.6/100,000 .forChlamydia-inducedarthritisand5/100,000.forenterobacteria-inducedreactivearthritis.4,5However,realnumbersmaybesignificantlyhigher?Thefollowingarticle"Frequencyoftriggeringbacteriainpatientswithreactivearthritisandundifferentiatedoligoarthritisandtherelativeimportanceofthetestsusedfordiagnosis"inAnnRheumDis.2001April;60(4):337343atthefollowingwebsite-http://www.pubmedcentralmih.gov/articlerenderfcgi?artid=1753604writesitsconclusionas:"CONCLUSIONS--Chlamydiatrachomatis,yersinia,andsalmonellacanbeidentifiedasthecausativepathogeninabout50%ofpatientswithprobableorpossibleReAiftheappropriatetestsareused."
18.AbsenceofCorpuscallosumleadsto a)Hemiparesis b)Hemisensoryloss c)Astereognosis d)Noneurologicalmanifestations CorrectAnswer-DNoneurologicalmanifestations[Ref:Internetreference]Agenesisofcorpuscallosumisararebirthdefect(congenitaldisorder)inwhichthereiscompleteorpartialabsenceofcorpuscallosum.Corpuscallosumisabandoftissueconnectingthetwohemispheresofthebrain.Fibresofcorpuscallosumarisefromthesuperficiallayersofthecerebralcortexandtheyprojecttothehomotypicregionsofthecontralateralcortexbypassingthroughthecorpuscollosumwhilecrossingthemidline.ClinicalfeaturesofAgenesisofcorpuscallosumSignsandsymptomsofagenesisofcorpuscallosumvarygreatlyamongindividuals.Patientsusuallydonothaveanyneurologicalmanifestations.However,somefeaturescommoninagenesisofcorpuscallosumare:-Visionimpairment*Lowmuscletone(hypotonia)Poormotorcoordination*Delayinmotormilestonessuchassittingandwalking.Lowperceptionofpain*Delayedtoilettraining*Chewingandswallowingdifficulties*Earlyspeechandlanguagedelays
SocialdifficultiesOthercharacteristicssometimesassociatedwithcallosaldisordersare:-Seizures*Spasticity*Early,feedingdifficultiesandorgastricreflux-.*Hearingimpairments*Abnormalheadandfacialfeatures*MentalretardationInvestigationCTandMRIreveal"Batwing"deformityoftheventricles.TreatmentTherearecurrentlynospecificmedicaltreatmentsforcallosaldisorders.AnimportantpointTheneurologicalabnormalitiesassociatedwithcorpuscallosumarenotcausedbyabsenceofcorpuscallosumperse.*Theseconditionsarebelievedtobecausedduetoassociatedcerebralanomaliesratherthanincorpuscallosumpersc.*Themostcommonassociatedbrainanomalieswithabsentcorpuscallosumare*Dandywalkermalformation*lnterhenfisphericcystwithhydrocephalus*Migrationaldisorder*Absenceoftheinferiorvertnis*Thechildrenwhohadthebestprognosiswithoutanysignificantneurologicalsequalewerethosewithisolatedagenesisofcorpuscollosum.*ThechildrenwiththeworstprognosisandneurologicalsequalewerethosewithagenesisofcorpuscallosumandmigrationaldisorderwithorwithoutDandy--walkermalformation.*Henceprognosisisdeterminedprimarilybytheunderlyingorassociatedmalformation.
19.Waterhammerpulseseenin a)>Aorticstenosis b)>Aorticregurgitation c)>AorticstenosisandAorticregurgitation d)>Mitralregurgitation CorrectAnswer-BAorticregurgitation[Ref.Harrison17h/ep1476&166/ep1400Kundu,bedsideclinicsinmedicine]WaterhammerpulseItisalargeboundingpulse,associatedwithincreasedstrokevolumeoftheleftventricleanddecreaseintheperipheralresistance,leadingtoawidepulsepressure.Thepulsestrikesthepalpatingfingerwitharapid,forcefidjerkandquicklydisappears.Itisbestfeltintheradialarterywiththepatientsarmelevated.ItisseeninAorticregurgitation.PathophysiologyofwaterhammerpulseInAorticregurgitationthestrokevolumeishigh,sothesystolicpressureishighandthisisresponsibleforsharpriseinthepulse.Thestrokevolumeishighbecausetheleftventriclegetsbloodfromtwosourcesduringthediastolei.e.bloodleakingfromtheAortaandtheblooditreceivesfromleftatria.ThecollapseoccursbecauseDiastolicleakofbloodintotheleftventriclefromtheAortaRapidrunofftotheperipheryasaresultoflowsystemicvascularresistance(theincreasedcardiacoutputstimulatesthebaroreceptorsintheaorticarchandtheresultisreflexvasodilatationoftheperipheralvesselsintowhichthebloodflowsrapidly).
Wiryarearmselevatedintheexamination?Whenthearmisraisedthereisfallofbloodcolumnresultinginvasodilationandthushelpstoreducethediastolicpressuremore,sothepulsepressurewidens.ItmaybesothatthearterypalpatedbecomesmoreinthelineofAortaafterelevationofthearmandthusallowsthedirectsystolicejectionanddiastolicbackwardflow.
20.Interstitialnephritisisseenwithall except a)Betalactaminhibitors b)INH c)Diuretics d)Allopurinol CorrectAnswer-BINH[Ref.Harrison17th/ep1806,1807&16th/ep1702,1703] DRUGSCAUSINGINTERSTITIALNEPHRITISAntibiotics Diuretics Anticonvulsants Miscellaneous .filactamso ?ThiazideQ ?Phenytoinu .Captopril0 . ? ? ?H2receptor SulfonamidesQ FurosemideQ PhenobarbitoneQ blockerse . ? ?QuinolonesQ .Omeprazole Triamterene Carbamazepine .Vancomycin .NSAIDS? ?Valproicacid .Mesalazine ? .Indinavir Erythromycin.Minocycline .Allopurinol .Rifampicin ?Ethambutol .Acyclovir
21.Apersonisnotabletoextendhismetacarpophalangealjoint.Injurytowhichof thefollowingnerveresultinthis? a)Ulnarnerve b)Radialnerveinjury c)Mediannerveinjury d)Post.Interosseousnerveinjury CorrectAnswer-DDamagetoposteriorinterosseousnerveresultininabilitytoextendthefingersatthemetacarpophalangealjointsandradialdeviationofthewristonwristextensioncausedbyweaknessofextensorcarpiulnarismuscle. Posteriorinterosseousnerveordeepulnarnerveisapuremotorbranchofradialnerve intheforearm.Itsuppliestheextensormusclesofforearmincludingtheextensorcarpi ulnaris. Ulnarnervepalsyresultinlossoffineintrinsicmotionsofhand.Itresultinanabduction deformityofthelittlefingerfromparalysisoftheinterossei,interosseousmusclewasting, andpartialclawhandfrominterphalangealflexiondeformitiesoftheringandlittlefingers. Radialnerveinjuryresultinwristdrop.Axillaryorproximalinjuryresultintriceps weaknessinadditiontowristdrop.Injuryintheaxillacausesdamagetotricepsbrachii, anconeus,brachioradialisandextensorcarpiradialislongus.Ref:NeurologyinClinicalPractice:Theneurologicaldisorders,Volume2editedbyWalterGeorgeBradleypage2315.LeBlondR.F.,DeGowinR.L.,BrownD.D.(2009).Chapter14.TheNeurologicExamination.InR.F.LeBlond,R.L.DeGowin,D.D.Brown(Eds),DeGowin'sDiagnosticExamination,9e.
22.Tensionbandwiringisindicatedinfractureofwhichofthefollowing? a)Fracturehumerus b)Olecranon c)Fracturetibia d)Fracturespine CorrectAnswer-BTensionbandwiringisindicatedinthetreatmentoftwotypesofolecranonfracture.Firsttypeisacleanbreakwithseparationofthefragments,andsecondtypeiscomminutedfractureoftheolecranonwithdisplcedfragments. Acrackintheolecranonwithoutdisplacementistreatedbyimmobilisingtheelbowinanaboveelbowplasterslabin30degreesofflexion.
23.Whichofthefollowingattitudewillbeseeninapatientwithposterior dislocationofhip? a)Flexion,Abduction,Internalrotation b)Flexion,Adduction,Internalrotation c)Flexion,Abduction,Externalrotation d)Flexion,Adduction,Externalrotation CorrectAnswer-BDislocationsareusuallyposterior,andoccasionallyanterior,orcentralthroughtheacetabulum. Posteriordislocation:Hipisflexed,adducted,andinternallyrotated,andlegisshortened. Anteriordislocation:Hipisflexed,abducted,andexternallyrotated,andlegisshortened. Centraldislocation:Trochanterisdisplacedmedially.Onemaybeabletofeeltheheadoffemurrectally.Thereisnoshortening.
24.Whichofthefollowingis/aretrueaboutperthesdisease? 1.Avascularnecrosisoffemoralhead2.Onsetbefore10yearsofage3.Osteotomyisusedfortreatment4.Limbshortening a)1,2true&3,4false b)2,3True&1,4false c)1,2,3true&4false d)Allaretrue CorrectAnswer-DItisalsoknownastheparsplanaandPseudoCoxalgia.Itisanosteochondritisofthefemoralhead.Thefemoralheadbecomespartlyorwhollyavascularanddeformed.Etiologyisnotdefinetlyknown.Itissupposedtobeduetoreccurentepisoedesofischemiaofthefemoralheadinthesuceptibleagegroup,probablyperecipitaedbyepisodesofsynovitis.Pathology:thediseaseprogressesinthreeilldefinedstages: Stageofsynovitis Stageoftrabecularnecrosis StageofhealingClinicalfeatures:Commonlyseenintheagegroupof5to10years.Childpresentwithpaininthehipwhichoftenradiatestothekneeormayalsopresentwithlimporhipstiffness.Onexamination,thefindingareminimal.sometimestheonlyfindingbeinglimitationofabductionandinternalrotationandshortening. X-rayshowscollapseandsclerosisoftheepiphysisofthefemoralhead.hipjointspaceisincreased.Bonescanmayshowadecreaseduptakebytheheadofthefemur.Treatment:Theprimaryaimistopreventtheheadfromillshapingwhiletheboneisinthesofteningphase.Theheadisrequiredtobekeptinsidetheacetabulumwhiletherevascularizationtakesplace(i.e.containment).Thismaybeachievedbycorrectivemethods(plaster,splintetc.)orbyoperation(containmentosteotomy).
Ref:Maheshwari3/e,Page269-70.
25.Blount'sdiseaseisassociatedwithallofthefollowing,EXCEPT: a)Genuvarum b)GenuRecurvatum c)InternalTibialTorsion d)ExternalTibialTorsion CorrectAnswer-DBlount'sdiseaseischaracterizedbyvarusandinternaltibialtorsionandgenurecurvatum,withvarusoftheproximaltibiabeingtheprimarydeformity.Itisnotassociatedwithexternaltibialtorsion.Ref:Operativetechniquesinpediatricorthopedics,byJohnM.Flynn,SamW.Wiesel,Page205,206.
26.Browntumorsareseenin: a)Hypeparathyroidism b)Pigmentedvillonodularsynovitis c)Osteomalacia d)Neurofibromatosis CorrectAnswer-A Browntumorsarehighlyvascularlyticlesionsoftheskeletonseeninbothprimaryandsecondaryhyperparathyroidism.Theyresultfromtheaccumulationofabundantfibrovasculartissueandosteoclastlikegiantcells.Ref:Robbin'sBasicPathology,7thEdition,Pages1186,1286;OrthopaedicPathologyByVincentJ.Vigorita,BernardGhelman,DouglasMintz,2007,Page187.
27.Liftofftestisdonetoassessthefunction of: a)Supraspinatus b)Infraspinatus c)TeresMinor d)Subscapularis CorrectAnswer-DDi.e.Subscapularis-Failuretoperformmaximuminternalrotation(astestedinbellypressandliftofftest)orinabilitytomaintainpositionofmaximalinternalrotation(internalrotationlagsign)indicatetearofsubscapularistendon.Liftofftestisdonetoassessthestrengthofsubscapularismuscleanddetectanisolatedruptureofsubscapularistendoninarotatorcufftear.
28.Themostcommonbonefracturedduring birth a)Clavicle b)Scapula c)Radius d)Humerus CorrectAnswer-AAi.e.ClavicleClavicleisthemostcommonbonetobefracturedinchildrenandduringbirth.
29.Themalunionofsupracondylarfractureof thehumerusmostcommonlyleadsto: a)Flexiondeformity b)Cubitusvarus c)Cubitusvalgus d)Extensiondeformity CorrectAnswer-BBi.e.CabitusVarusMalunion:-Itisthecommonestcomplicationofsupracondylarfractureandresultsincubitusvarus(Gunstockdeformity).Cubitusvalgusisrareandmayoccuroccasionallyinposterolateraldisplacement.
30.TreatmentofchoiceinAcutemyositis ossificansis: a)Immobilizationofelbow b)Shortwavediathermy c)Passivemovementsofarm d)Activeexercises CorrectAnswer-AAi.e.Immobilizationofelbow*Restoftheaffectedpartduringtheperiodwhiletheprocessisactiveisthebasicprincipleoftreatment(TN91).*Nomassageshouldbegiven.*Ifanyphysicaltherapyisgoingon,itshouldbediscontinuedimmediately.*Allpassivemovementsandvigorousexercisemustbestopped.Verygentleexercisemustbestarted.*Indomethacinandradiotherapypreventcalcification.However,radiotherapyshouldbeavoidedinchildren.-Surgicalexcisionisindicatedifmyositisossificansinterfereswithfunction.Itisworthnotingthatsurgicalexcisioniscontraindicatedduringactivephasewhencalcificationmatures.*Surgicalexcision,ifrequired,shouldbedoneonlyaftercompletematurationofossification.
31.PulledElbowis: a)Disarticulationofelbow b)Disarticulationofelbow c)Subluxationofproximalradioulnarjoint d)Noneoftheabove CorrectAnswer-CCi.e.subluxationofproximalradioulnarjointIfayoungchildisliftedbythewrist,theheadoftheradiusmaybepulledpartlyoutoftheannularligament,i.e.,subluxationoftheheadoftheradius.Itoccurswhenforearmispronated,elbowisextendedandlongitudinaltractionisappliedtothehandorwrist,e.g.,lifting,spinningorswingingachildwithwristorhand.Pulledelbowmostcommonlyoccursbetweentheageof2-5years
32.InMonteggiafracture,whichistrueabout ulnarfractureandheadofradius a)Bothulnarfractureandheadofradiusisdisplacedposteriorly b)Bothulnarfractureandheadofradiusisdisplacedanteriorly c)Ulnarfracturesisposteriorlyandheadofradiusisdisplaced anteriorly d)Ulnarfractureisanteriorlyandheadofradiusisdisplaced posteriorly CorrectAnswer-BAns:Bi.e.Bothulnarfractureandheadofradiusisdisplacedanteriorly*Thisisafractureoftheupper-thirdoftheulnawithdislocationoftheheadoftheradius.Itiscausedbyafallonanoutstretchedhand.Itmayalsoresultfromadirectblowonthebackoftheupperforearm.-Thesefallintotwomaincategoriesdependingupontheangulationoftheulnafracture-extensionandflexiontype.Theextensiontype,isthecommonerofthetwo,wheretheulnafractureangulatesanteriorly(extends)andtheradialheaddislocatesanteriorly.Theflexiontypeiswheretheulnafractureangulatesposteriorly(flexes)andtheradialheaddislocatesposteriorly.
33.Themostcommoncomplicationof intracapsularfractureneckoffemuris a)Malunion b)Osteoarthritis c)Non-Union d)Shortening CorrectAnswer-CCi.e.NonunionBothintracapsularneckfractureandextracapsularfracture(basicervicalandITfracture)havesamedeformities,i.e.externalrotationandshortening.Thesedisplacementsaremoremarkedinextracapsularfractures,becauseinanintracapsularfracture,thecapsuleofthehipjointisattachedtothedistalfragmentandpreventsextremerotationanddisplacementofthedistalfragment(andwithit,thelimb).Inextracapsularfracture,distalfragmentbeingoutsidethecapsuleisdisplacedmoremarkedly.
34.AVNisseeninwhichtypeof#offemur: a)Intertrochantric# b)Subcapital# c)Transcervical# d)BANDC CorrectAnswer-DB.i.e.Subcapital>C.i.e.TranscervicalFractureoftheneckoffemurFractureoftheScaphoid(Proximalpole>Waist)FractureneckoftalusPosteriordislocationofthehip
35.VascularsignofNarathisnoticedin a)Fractureneckoffemur b)Perthesdisease c)Posteriordislocationofhip d)Alloftheabove CorrectAnswer-CCi.e.PosteriordislocationofhipVascularsignofnarathispositiveinposteriordislocationofhipjoint.Duetoposteriordislocation,thehipjointfallsonthefemoralartery,andthiscausesfeebleorabsentfemoralpulse.
36.Seatbeltinjuryis a)Teardropfracture b)Wedgefracture c)Chancefracture d)Whiplashinjury CorrectAnswer-CCi.e.ChancefractureAhorizontalfractureofthevertebraextendingfrombodytotheposteriorelement,causedbyastrongdistractionforce
37.
WhichpartofthespineismostcommonlyaffectedinRheumatoidarthritis: a)Cervical b)Lumbar c)Thoracic d)Sacral CorrectAnswer-AAnswerisA(Cervical):Rheumatoidarthritiscommonlyinvolvesthejointsofhands,wrist,elbow,knees,ankle,andfeetinasymmetricalmanner.AxialskeletoninvolvementisusuallylimitedtoUpperCervicalSpine.
38.Complicationsofelbowdislocationareall EXCEPT:March2004 a)Vascularinjury b)Mediannerveinjury c)Myositisossificans d)Radialnerveinjury CorrectAnswer-DAns.di.e.Radialnerveinjury1)EarlycomplicationsVascularinjury:-Brachialarterymayinjured.ItmayresultincompartmentsyndromeandVolkmann'sischemiccontracture.Nerveinjury:-Medianandulnarnerveinjury2.Latecomplications.Stiffness?Myositisossificans.Unreduceddislocation?Recurrentdislocation
39.TrueregardingMonteggiafractureis: March2007,March2013(a,b,d,f) a)Upperulnarfracture&dislocatedradialhead b)Upperradialfracture&dislocatedulna c)Lowerradialfracture&dislocatedulna d)Lowerulnarfracture&dislocatedradius CorrectAnswer-AAns.A:Upperulnarfracture&dislocatedradialheadMonteggiafracture-dislocationsareclassifiedbytheBadosystemBadotypeIinjuriesarecharacterizedbyaproximalulnarfracturewithanteriordislocationoftheradialhead.Thisisduetoaforcefulpronationinjuryoftheforearmandisthemostcommontype.BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocationinjuries.Here,thereisposteriorangulationoftheulnarfracturesiteandposteriordislocationoftheradialhead.BadotypeIIIandIVarerareinjuries.
40.Marchfractureisfractureof: September2007 a)Calcaneus b)2ndmetatarsal c)Distalfibula d)Proximaltibia CorrectAnswer-BAns.B:2ndmetatarsalAstressfractureofthe2ndor3rdmetatarsalboneissometimescalleda'marchfracture'becausesoldiersrunninginbootsoftengetit.Thefracturehealsspontaneously,sotreatmentispurelysymptomatic.
41.Mostcommontypeofshoulder dislocationis:March2011 a)Posterior b)Anterior c)Inferior d)Superior CorrectAnswer-BAns.B:AnteriorShoulderjointisthecommonestjointinthebodytodislocateAnteriorshoulderdislocationismuchmorecommonthanposteriordislocationShoulderdislocation:MCjointtodislocateinbody:ShoulderMCtypeofshoulderdislocation:Subcoracoid/inferiorRaresttypeofshoulderdislocation:PosteriorPosteriortypeofshoulderdislocationisassociatedwith:EpilepticfitsBankart'slesionisrelatedwithavulsionofglenoidallabrumHillSach'slesionisfoundonhumeralheadTestfordislocationofshoulderjoint:-Duga'stest,-Hamiltonrulertest,-CallawaystestKocher'smanouevreisdonetoreduceadislocatedshoulder
42.Felon/Whitlowis: September2012 a)Midpalamrspaceinfection b)Terminalpulpspaceinfection c)Infectionoftheulnarbursa d)Infectionoftheradialbursa CorrectAnswer-BAns.Bi.e.Terminalpulpspaceinfectionapainfulabscessofthedeeptissuesofthepalmarsurfaceofthefingertipthatistypicallycausedbybacterialinfection(aswithastaphylococcus)andismarkedbyswellingandpain
43.Swanneckdeformityisseenin: March2013(a,c,e) a)Ankylosingspondylitis b)Rheumatoidarthritis c)Osteoarthritis d)Reiter'ssyndrome CorrectAnswer-BAns.Bi.e.RheumatoidarthritisRheumatoidarthritisRAisadiseaseof:Synovium/synovialmembraneRAstartsin:SynoviumBodytissuemostlyaffectedinRA:SynoviumCharacteristicfeature:-Persistentinflammatorysynovitis,-Peripheraljoint,-SymmetricaldistributionCauses:-Immunological,-Familial,?Infective(implicated)Mostlyaffects:Females(threetimes)Earliestlesioninrheumatoidsynovitis:?Microvascularinjury,?IncreaseinnumberofsynovialliningcellsJointscharacteristicallyinvolvedinRA:?MCP,?PIP(symmetricarthritis)Boutonnieredeformity:
?FlexioncontractureofthePIP?ExtensionofDIPCriteriafordiagnosis:Any4criteriamustbepresentPathognomicfeature:RheumatoidnoduleExtra-articularmanifestationsareseenin:IndividualswithhightitresofRF(autoantibodiestotheFccomponentofIgG)
44.Perthe'sdiseaseisOsteochondritisofthe epiphysisofthe:March2013(g) a)Capitulum b)Lunate c)Femoralhead d)Calacanealtuberosity CorrectAnswer-CAns.Ci.e.FemoralheadOsteochondritisPerthesdisease:-Osteochondritisoffemoralhead-Adductionisunaffected-IOCforPerthesdisease:MRIOsteochondritisoflunate:Kienbock'sdiseaseOsteochondritisoftibialtubercle:OschGood'sSchlatter'sdiseaseOsteochondritisofcalcaneum:Sever'sdisease
45.Bestdiagnosticmodalitytodiagnose avascularnecrosisis:March2007 a)MRIscan b)CTscan c)X-ray d)USG CorrectAnswer-AAns.A:MRIScanAvascularnecrosis/osteonecrosis/aseptic(bone)necrosis/ischemicbonenecrosisisadiseaseresultingfromthetemporaryorpermanentlossofthebloodsupplytothebones.Withoutblood,thebonetissuediesandcausesthebonetocollapse.Therearemanycausesofavascularnecrosissuchas:AlcoholismExcessivesteroidusePosttraumaCaissondisease(decompressionsickness)VascularcompressionVasculitisThrombosisDamagefromradiationBisphosphonates(particularlythemandible)SicklecellanaemiaGaucher'sDiseaseIdiopathic(nocauseisfound).RheumatoidarthritisandlupusarealsocommoncausesofAVN.Avascularnecrosismostcommonlyaffectstheheadoffemur.Other
Avascularnecrosismostcommonlyaffectstheheadoffemur.Othercommonsitesincludethetalus,scaphoidandthejaw.Avascularnecrosisusuallyaffectspeoplebetween30and50yearsofage.Whenitoccursinchildrenatthefemoralhead,itisknownasLegg-Calve-Perthessyndrome.Itismostoftenlydiagnoseclinically.BecauseearlyX-raysareusuallynormalintheearlystageofthedisease,bonescintigraphyandMRIarethediagnosticmodalityofchoicesincebothcandetectminimalchangesatearlystagesofthedisease.Lateradiographicsignsincludearadiolucencyareafollowingthecollapseofsubchondralbone(crescentsign)andringedregionsofradiodensity
46.Cubitaltunnelsyndromeinvolves: March2013(c,f) a)Radialnerve b)Ulnarnerve c)Mediannerve d)Axillarynerve CorrectAnswer-BAns.Bi.e.UlnarnerveWhentheulnarnervecompressionoccursattheelbow,itiscalled"cubitaltunnelsyndrome."
47.Footdropoccursduetotheinvolvement of:September2006,March2013(b,fg,h) a)Sciaticnerve b)Directinjurytothedorsiflexors c)Commonperonealnervepalsy d)Alloftheabove CorrectAnswer-DAns.D:AlloftheaboveFootdropmayfollowdirectinjurytothedorsiflexors.Afewcasesofruptureofthetibialisanteriortendonleadingtofootdropandsuspicionofperonealnervepalsyhaveoccurred.Thissubcutaneoustendonruptureusuallyoccursafteraminortraumawiththefootinplantarflexion.Compartmentsyndromesalsomayleadtofootdrop.Marchgangrene,aformofanteriorcompartmentsyndrome,isthoughttobeduetoedemaandsmallhemorrhagesinthemusclesoftheanteriorcompartmentoccurringafterstrenuousactivityinindividualsnotaccustomedtoit.Deepposteriorcompartmentsyndromealsomayresultinfootdropasalatesequeladuetoresultantcontractureformation.Neurologiccausesoffootdropincludemononeuropathiesofthedeepperoneal,commonperoneal,orsciaticnerves.Lumbosacralplexopathy,lumbarradiculopathy,motorneurondisease,orparasagittalcorticalorsubcorticalcerebrallesionsalsocanmanifestasfootdrop.Theselesionscanbedifferentiatedthroughclinicalandelectrodiagnosticexaminations.
Acommonbehavioralcauseoffootdropishabitualcrossingofthelegs.Thesecasestypicallyresolvewithdiscontinuationofthehabit.Footdropalsomaybeseenasacombinationofneurologic,muscular,andanatomicdysfunction.Charcotfootisoneexample.
48.Mostcommonnerveinjuredinfractureof medialepicondyleofhumerusis:March2007 a)Radialnerve b)Ulnarnerve c)Mediannerve d)Musculocutaneousnerve CorrectAnswer-BAns.B:UlnarNerveCertainlesionsarecommonlyassociatedwithfracturestospecificareasofthehumerus.Attheupperend,thesurgicalneckofthehumerusandanatomicalneckofhumeruscanbothbeinvolved,thoughfracturesofthesurgicalneckaremorecommon.Theaxillarynervecanbedamagedinfracturesofthistype.Mid-shaftfracturesmaydamagetheradialnerve,whichtraversesthelateralaspectofthehumeruscloselyassociatedwiththeradialgroove.Themediannerveisvulnerabletodamageinthesupracondylararea.Theulnarnerveisvulnerabletodamagenearthemedialepicondyle,aroundwhichitcurvestoentertheforearm.
49.Waddlinggaitdueto: March2009 a)Bilateralcongenitaldysplasiaofhip b)Coxavalga c)CTEV d)Bilateralcoxavalgum CorrectAnswer-AAns.A:BilateralcongenitaldysplasiaofhipAwaddlinggaitisthestyleofwalkingthatisseeninapatientwithproximalmyopathy.Itischaracterisedby:Abroad-basedgaitwithaduck-likewaddletotheswingphaseThepelvisdropstothesideofthelegbeingraisedForwardcurvatureofthelumbarspineMarkedbodyswingThisgaitmaybeseeninpatientswithbilateralcongenitalhipdislocationandpregnancy.
50.Knucklebendersplintisusedfor: September2009 a)Ulnarnervepalsy b)Radialnervepalsy c)Mediannervepalsy d)Axillarynervepalsy CorrectAnswer-AAns.A:UlnarNervePalsyCock-upsplint?RadialnervepalsyKnuckle-bendersplint?Ulnarnervepalsy
51.Maximumweightthatcanbegivenwith skeletaltractionis:September2009 a)5kg b)10kg c)15kg d)20kg CorrectAnswer-DAns.D:20kgTractionisusuallyappliedtothespine,pelvis,neck,arms,orlegs.Theforceisgeneratedbyweightorforceagainsttheweightofthebody.Thetwomaintypesoftractionareskintractionandskeletaltraction.Ofthesetwotypes,manyspecializedformshavebeendevelopedtotreatconditionsinspecificpartsofthebody.Withskintraction,weightsareattachedtotheskin,whichappliesthepullingforcetothebone.Itisusedwhenlight(3to4kg)orshort-termtractionisneeded.Withskeletaltraction,pinsareattachedtothebonesothatthepullingforceisapplieddirectlytothebone.Skeletaltractionisusedwhenskintractionisnotpossibleandwhengreaterweight(upto20kg)isneeded.
52.Cockupsplintisusedintreatmentof? a)Radialnervepalsy b)Ulnarnervepalsy c)Mediannervepalsy d)Posteriorinterosseousnervepalsy CorrectAnswer-AAns.is'a'i.e.,RadialnervepalsySplintsAnymaterialwhichisusedtosupportafractureiscalledsplint.Splintsareusedforimmobilizingfractures;eithertemporarilyduringtransportationorfordefinitivetreatment.Themostcommonlyemployedsplintsisplasterofparis(POP)splint.VariousPOPsplintsare. 1. Casts:-HerethePOProllcompletelyencirclesthelimb.2. Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalfor onethirdcircumference. 3. Spica:-Thisencirclesapartofthebody;e.g.,hipspicafor fracturesaroundhip.
53.Froment'ssignispositiveincasesof weaknessof? a)Thumbadduction b)Thumbabduction c)Thumbflexion d)Thumbextension CorrectAnswer-AAns.is'a'i.e.,ThumbadductionNormallywhenapersonisaskedtograspabookbetweenthethumbandindexfinger,hewillgraspthebookfirmlywiththumbextended,takingfulladvantageoftheadductorpollicisandthefirstdorsalinterosseousmuscles.Iftheulnarnerveisinjuredtheadductorpolliciswillbeparalysedandthepatientwillholdthebookbyusingtheflexorpollicislongus(suppliedbymediannerve)producingflexionattheinterphalangealjoint.Thisbecomesmorepronouncediftheexaminertriestopullthebookoutwhilethepatienttriestoholdit.Thissignisknownas`Froment'ssign'orthe'booktest'.
54.Mostcommoncauseofamputationin Indiais? a)Diabeticgangrene b)Gasgangrene c)Roadtrafficaccident d)Tumors CorrectAnswer-CAns.is'c'i.e.,RoadtrafficaccidentAmputationAmputationisaprocedurewhereapartofthelimbisremovedthroughoneormorebones.Disarticulationisaprocedurewherethelimbisremovedthroughajoint.IndicationsofamputationIndicationsofamputationsmaybeabsoluteorrelative:?A)AbsoluteindicationsGasgangreneDiabeticgangreneIrreparablelossofbloodsupplyduetotraumaordiseasePeripheralvasculardisease(Burger'sgangrene)B)RelativeindicationsTraumaTumorsSeverelossoffunctionoflimbNerveinjuriesCongenitalanomaliesOverallmostcommoncauseofamputationistrauma(injury)toalimb.
Mostcommoncauseoftraumaisroadtrafficaccident.
55.Allaretrueaboutcollesfractureexcept? a)Inoldage b)Dorsalshift c)Atcortico-cancellousjunction d)Gardenspadedeformity CorrectAnswer-DAns.is'd'i.e.,GardenspadedeformityCOLLESFRACTUREColle'sfractureisanextra-articularfractureatthedistalendofradius,atitscortico-cancellousjunction.Itisthemostcommonfractureinpersonover40yearsofageandespeciallyinwomenaftermenopause(Postmenopausalfemales).Theassociationofthefracturewithosteoporosisisnowwellestablishedanditisoneofthefragilityfracture,seeninosteoporosis.Thefracturenearlyalwayscausedbyfallonoutstretchedhand.Displacementincolle'sfractureThefracturelinerunstransverselyatthecortico-cancellousjunction.Inthemajorityofthecases,oneormoredisplacementsofthedistalfragmentoccur:- i. Dorsaldisplacement(Dorsalshift) ii. Lateraltilt(lateralangulation) iii. Dorsaltilt(Dorsalangulation) iv. Supination(externalrotation) v. Lateraldisplacement(lateralshift) vi. Impaction(proximalmigration) vii. Clinicalfeaturesofcollesfracture Painandswellingatthewrist.Typicaldeformity:Thereisadorsalhollowordepressionjust
proximaltothefractureandimmediatelydistaltothisthereisamarkedprominencecausedbylowerfragmentbeingdisplacedbackwards,carryingwithitthewholeofthecarpusandhand.Thisgivesappearanceofafork,Sonameddinnerfork/silverfork/spoonshapeddeformity.
56.Mostcommontypeofsupracondylar fractureinchildren? a)Posteromedialextension b)Posterolateralextension c)Anteromedialflexion d)Anterolateralflexion CorrectAnswer-AAns.is'a'i.e.,PosteromedialextensionSupracondylarfractureofhumerusSupracondylarhumeralfracturesarethemostcommonelbowfracturesinchildren.Mostcommonagegroupaffectedis5-8years.Boysareaffectedmorethangirls.Leftsideismorecommonthanright.MechanismofinjuryMostlyitoccursduetohyperextensioninjury.Fractureiscausedbyafallontotheoutstretchedhandwithhyperextensionatelbow.TypesofsupracondylarfractureSupracondylarfractureisbroadlyclassifiedintoextensiontypeandflexiontype.1)ExtensiontypeItisthemostcommontype(97-99%).Distalfragmentisextended(tiltedbackward/posteriorly)inrelationtoproximalfragment.Occursduetohyperextensioninjuryafterfallonoutstretchedhands.Generally,displacementofdistalfragmentmaybe:-i)Posteromedial(70-80%)ii)Posterolateral(20-30%)
2)FlexiontypeItislesscommontype(1-3%)Distalfragmentisflexed(tiltedforward/anteriorly)inrelationtoproximalfragments.Themechanismofinjurygenerallyisbelievedtobeafalldirectlyontotheelbowratherthanafallonoutstretchedhand.Astheextensiontypefractureismorecommon(97-99%),themostcommonelbowinjuryinchildrenisextensiontypeofsupracondylarfracture.ClinicalfeaturesofsupracondylarfractureFollowingafall,thechildisinpainandelbowisswollen.Inextensiontypeofinjury,`S'shapeddeformityoftheelbowisobvious.Thereislossofbothactiveandpassivemovementsofelbow.Symptomsrelatingtovascularandnerveinjurymaybeseen.Unusualposteriorprominenceofthepointofelbow(tipofolecrenon)becauseofbackwardtiltofthedistalfragment.Threepointbonyrelationshipismaintainedasthefractureisabovethelevelofcondyles.Dimplesignduetooneofthespikesofproximalfragmentpenetratingthemuscleandtethringtheskin.
57.Mostcommonjointinvolvedingoutis? a)Knee b)Hip c)MPjointofgreattoe d)MPjointofthumb CorrectAnswer-CAns.is'c'i.e.,MPjointofgreattoeGoutisthecommonendpointofagroupofdisordersthatproducehyperuricemia.Itismarkedbytransientattacksofacutearthritisintitiatedbycrystallizationofmonosodiumurateintothejoints,leadingeventuallytochronicgoutyarthritisanddepositionofmassesofuratesinjointsandothersites,creatingtophi.Mostcommonjointinvolvedingoutisbigtoe,i.e.metatarsophalangealjointofgreattoe.Tophiarepathognomicofgout.Theyareformedbylargeaggregationsofuratecrystals.Theuratecrystalsaresurroundedby-
58.Whichofthefollowingstructurearenot normallyvisualizedduringthearthroscopyoftheknee? a)Meniscus b)Cruciateligaments c)Collateralligaments d)Patellaarticularsurface CorrectAnswer-CAns.is'c'i.e.,CollateralligamentsThefollowingstructuresarevisualizedduringthekneearthroscopy:-i)Medialandlateralmeniscusii)Anteriorandposteriorcruciateligamentsiii)Kneearticularcartilageiv)Patello-femoraljointv)Loosebodiesinjoint
59.Notacomplicationoffractureneckof femur? a)Non-union b)Malunion c)AVN d)Osteoarthritis CorrectAnswer-BAns.is'b'i.e.,MalunionComplicationsoffemoralneckfractureFracturesoftheneckofthefemuraremorepronetoseriouscomplicationsthaninanyotherfracture.Allthecomplicationsaffectfractureswithdisplacementratherthanimpactedabducted(valgusimpacted)fractures.Theimportantcomplicationsare:1)AvascularnecrosisoffemoralheadAVNisthemostcommoncomplicationoffemoralneckfracture.Itoccursin15-35%ofcasesofdisplacedfracturesand2)Non-unionNon-unionisthesecondmostcommoncomplicationoffemoralneckfracture.Itoccursin10-30%ofcasesofdisplacedfracturesand3)SecondaryosteoarthritisItoccursafewyearsfollowingfractureneckfemur.Avascularnecrosisorcollapseoffemoralheadleadstosecondaryosteoarthritisofthehipjoint.
60.Mostcommonsiteofmetastasisin skeleton? a)Femur b)Tibia c)Vertebrae d)Skull CorrectAnswer-CAns.is'c'i.e.,VertebraeMetastasisMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.Certaintumorsareknowntobecommonsourcesofbonemetastasis.Thefollowingprimarytumorsarethemostcommontometastasizeinthebone;breast,prostate,lung,thyroid,kidney,andgastrointestinaltract.Thecommonestsourceofmetastaticbonediseaseiscarcinomaofthebreast.Inmalesmostcommonsourceisprostatecarcinoma.Bladderanduterinecarcinomasarelesscommonsources.Inchildren,skeletalmetastasesoriginatefromneuroblastoma,Ewing'ssarcoma,andosteosarcoma.
61.Perkin'slineonX-rayisusedfor diagnosisof- a)Perthe'sdisease b)CDH c)CTEV d)AVNHip CorrectAnswer-BAns.is'b'i.e.,CDHRadiologicalfeaturesofDDH/CDHInVonRosen'sviewfollowingparametersshouldbenotedPerkin'sline:VerticallinedrawnattheouterborderofacetabulumHilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiatecartilageShenton'sline:Smoothcurveformedbyinferiorborderofneckoffemurwithsuperiormarginofobturatorforamen.Acetabularindex:NormallyisS30?CEangleofWiberg:Normalvalueis15-30"Normallytheheadliesinthelowerandinnerquadrantformedbytwolines(Perkin's&Hilgenreiner's).InDDHtheheadliesinouter&upperquadrantShenton"slineisbrokenDelayedappearance&retardeddevelopmentofossificationofheadoffemurSlopingacetabulumSuperior&lateraldisplacementoffemoralheadVon-Rosen'slineThisisaline,whichhelpsinthediagnosisofDDHininfantslessthan6months.
ForthisAPviewofpelvisistakenwithbothlowerlimbin450abductionandfullinternalrotation.Upwardprolongationoflongaxisofshaftofthefemurpointstowardsthelateralmarginoftheacetabulumandcrossesthepelvisintheregionofsacroiliacjoint.InCDH,upwardprolongationofthislinepointstowardsanteriorsuperioriliacspineandcrossesthemidlineinthelowerlumberregionPositiveVon-Rosen'ssign.
62.Whichjointismostcommonlyaffectedin pseudogout- a)Knee b)Hip c)MPjointgreattoe d)MPjointthumb CorrectAnswer-AAns.is'a'i.e.,KneePseudogoutItisoneoftheformsof"Calciumpyrophosphatedihydrate"(CPPD)arthropathy.Pseudogoutcommonlyinvolvesthelargerjoints.Kneejointismostcommonlyinvolved;othersitesarewrist,elbow,shoulder,ankle.Involvementofsmalljointsisuncommon.Agegroupis>60yrs.InCPPDarthropathy,CPPDdepositionoccursinarticulartissues.Itcanpresentinanyofthefollowingthreeforms:?1)Asympatomaticchondrocalcinosis2)Acutesynovitis-Pseudogout3)ChronicpyrophosphatearthropathyTheradiologichallmarkofCPPDis"chondrocalcinosis.Chondrocalcinosisisseenaspunctateand/orlinearradiodensedepositsinfibrocartilaginousjointmenisciorarticularhyalinecartilage.Definitivediagnosisismadebysynovialfluidpolarisedlightmicroscopywhichshowsweaklypositive,birefringent,rhomboidcrystalsofCPPD.[Ingoutpolarizedlightshows-stronglynegativebirefringent,needleshapedcrystalsofmonosodiumurate]
63.Loosebodyinjointmostcommonsiteis- a)Knee b)Hip c)Elbow d)Ankle CorrectAnswer-AAns.is'a'i.e.,KneeLoosebodyinjointAloosebodyisafree-floatingpieceofbone,cartilageorforeignobjectinajoint.Thekneeisthemostcommonjointwhereonewouldfindaloosebody.Causesofloosebodiesinclude:-i)Osteoarthritisii)Osteochondritisdessicansiii)Osteochondralfracture(injury)iv)Charcot'sdiseasev)Synovialchondromatosis
64.Investigationofchoiceforentrapment neuropathyis? a)CTSCAN b)Clinicalexamination c)Ulrasonography d)EMGNCV CorrectAnswer-DAns.is'd'i.e.,EMGNCVThediagnosisofmononeuropathyinentrapmentneuropathyisbasedonelectrodiagnosticstudies(EMG/NCV)andMagneticresonanceimaging(MRI).Entrapmentneuropathyisamedicalconditioncausedbyentrapmentandcompressionofaperipheralnervewhereverittraversesfibro-osseoustunnels.Sitesofentrapmentneuropathyare:- i. Carpaltunnel:-Mediannerve(carpaltunnelsyndrome) ii. Cubitaltunnel:-Ulnarnerve(cubitaltunnelsyndrome) iii. Guyan'scanal:-Ulnarnerve(Guyan'scanalsyndrome) iv. Tarsaltunnel:-Posteriortibialnerve(Tarsaltunnelsyndrome) v. Inguinalligament:-Lateralcutaneousnerveofthigh(meralgia paraesthetica). vi. Suprascapularnotch:-Suprascapularnerve vii. Neckoffibula:-Commonperonealnerve viii. Fascialtunnelofsuperficialperonealnerve:-Superficialperoneal nerve ix. ArcaseofFrohse:-Posteriorinterosseoussyndrome x. Thoracicoutlet:-Lowertrunkofbrachialplexus xi. Compressioninthefoot:-Digitalnerve(Morten'smetatarsalgia)
65.Posteriorglidingoftibiaonfemuris preventedby? a)Anteriorcruciateligament b)Posteriorcruciateligament c)Medialcollateralligament d)Lateralcollateralligament CorrectAnswer-BAns.is'b'i.e.,PosteriorcruciateligamentPosteriorcruciateligamentPCLbeginsfromposteriorpartofintercondylarareaoftibiaandrunsupwards,forwardsandmediallytoattachtheanteriorpartofthelateralsurfaceofmedialcondyleoffemur.PCLisextrasynovialbutintracapsular,i.e.,liesbetweensynoviumandcapsuleofthekneejoint.Itprovidesantero-posteriorstabilityandpreventsposteriorglidingoftibiaonfemur.Itistautinflexion.Bloodsupplyofcruciate(anterior&posterior)ligamentsisfrom:- 1. Middlegenicularartery(majorsupply)2. Inferiorgenicular(medial&lateral)artery(lessimportant). Nervesupplyofcruciateligaments(ACL&PCL)isfromposteriorarticularbranchoftibialnerve.
66.Cozen'stestisusedforthediagnosisof? a)Tenniselbow b)Golfer'selbow c)Baseballer'spitcherelbow d)Carpaltunnelsyndrome CorrectAnswer-AAns.is'a'i.e.,TenniselbowSignsandTestsAdson'stest:forthoracicoutletsyndromeAllen'stest:fortestingpatencyofradialandulnararteriesAlli'stest:forCDHAnviltest:fortestingtendernessofthespineApethumb:formediannerveinjuryApley'sgrindingtest:formeniscusinjuryApprehensiontest:forrecurrentdislocationoftheshoulderBarlow'stest:forCDHBluesclera:OsteogenesisimperfectaBryant'stest:foranteriordislocationoftheshoulderCallways'test:foranteriordislocationoftheshoulderChovstek'ssign:fortetanyClawhand:forulnarnerveinjuryCointest:fordorsolumbartuberculosisofspineCozen'stest:fortenniselbowDrawertest:forACLandPCLinjutriesAnterior:forACLinjuryPosterior:forACLinjuryFinkelstein'stest:fordeQuervain'stenovaginitisFootdrop:forcommonperonealnerveinjury
Froment'ssign:forulnarnerveinjuryGaenslen'stest:forSIjointinvolvementGalleazzisign:forCDHGower'ssign:formusulardystrophyHamiltonrulertest:foranteriordislocationoftheshoulderKanavel'ssign:forinfectioninulnarbursaLasegue'stest:fordiscprolapseLachmanntest:forACLinjuryLudloffssign:foravulsionoflessertrochanterMcMurray'stest:formeniscusinjuryNagffzigertest:fordiscprolapseOber'stest:fortightilio-tibialband(e.g.,inpolio)O'Donoghuetriad:traidofMCL,ACL&medialmeniscusinjuriesoccurringtogetherOrtolani'stest:forCDHPivotshifttest:forACLinjuryPolicemantip:forErb'spalsyRunner'sknee:PatellartendinitisSulcussign:forinferiordislocationoftheshoulderThomas'test:forhipflexiondeformityTrendelenburg'stest:forunstablehipduetoanyreaseon(e.g.,CDH)Tinel'ssign:fordetectingimprovingnerveinjuryVolkmann'ssign:forischaemiccontractureofforearmmusclesWristdrop:forradialnerveinjury
67.Mostcommonsitefortheosteoporotic vertebralfractureis? a)Dorsolumbarspine b)Cervicalspine c)Lumbosacralspine d)Dorsalspine CorrectAnswer-AAns.is'a'i.e.,DorsolumbarspineOsteoporosisisanasymptomaticdisorderunlesscomplications(predominantlyfractures)occur.Mostcommonsymptomofosteoporosisisbackpainsecondarytovertebralcompressionfracture.Dorso-lumbarspineisthemostfrequentsite.Othercommonsitesoffracturearelowerendradius(Colle'sfracture)andfractureneckfemur.Osteoporoticfracture(fragilefractures)are:(i)Fracturevertebrae(mostcommon),(ii)Colle'sfracture,(iii)Fractureneckfemur.Serumcalcium,phosphateandalkalinephosphatasearenormalinosteoporosis.
68.SunrayappearanceonX-rayisseenin? a)Osteosarcoma b)Osteochondroma c)Osteoclastoma d)Chondroblastoma CorrectAnswer-AAns.is'a'i.e.,OsteosarcomaCodman'striangleandsunrayappearancearetypicalofosteosarcoma.However,youshouldkeepinyourmindfollowingveryimportantfacts:-Sunray(sunburst)appearanceandcodman'striangleindicatesperiostealreaction(periostealnewboneformation).Boththesearetypicalofosteosarcomabutmayalsooccurinotherrapidlygrowingbonetumors(Ewing'ssarcoma),andinfection(osteomyelitis).Similarly,onionpeelappearanceindicatesperiostealnewbone-formationandistypicalforEwing'ssarcoma.Butthiscanalsooccurinoseosarcomaandosteomyelitis.Thecruxisthat,aggresivelygrowingtumorsandinfectionstimulatetheperiosteumwhichthenreactbyformingnewbone,(thereforeitiscalledperiostealreaction)whichmaytakeanyoftheaboveform.
69.Puttiplatoperationisdonefor? a)Elbowinstability b)Shoulderinstability c)Rotatorcufftear d)BicepsTendinitis CorrectAnswer-BAns.is'b'i.e.,ShoulderinstabilityImportantsurgeriesforrecurrentanteriordislocationofshoulderare:i)Barkart'soperationiii)Bristow'soperationv)EdenHybinetteoperationii)Putti-Platt'soperationiv)McLaughin'soperationvi)Magnum&Stackoperation
70.Lachmann'stestisusedfor? a)ACLinjury b)PCLinjury c)MCLinjury d)LCLinjury CorrectAnswer-AAns.is'a'i.e.,ACLinjuryACLinjuryACListhemostcommonlyinjuredligamentofknee.Mostcommonmechanismofinjuryistwisting(medialrotation)withvalgusinjuryonsemiflexedknee.OftenwiththismechanismMCLandmedialmeniscusarealsoinjured.ThistripleinjuryofACL,MCLandmedialmeniscusiscalledO'Donghuetriad.IsolatedACLcanalsobeinjuredbyhyperextensioninjury.TestsforACLinjuryFollowingtestsareusedforACLinjury:? i. Lachman'stest ii. Pivotshifttest iii. Flexion-rotationdrawertest iv. Anteriordrawertest v. Jerktest vi. Loose'stest Lachman'stestisthemostsensitivetestforanteriorcruciateligamenttears.Itisdonewiththekneeflexedat20degrees.Soitcanbedoneinacuteaswellaschronicinjuries.(becauseinacutecaseswithhemarthrosismoreflexionisusuallynotpossiblesoperforminganteriordrawertestisdifficult).
71.Infectionofulnarbursaisdiagnosedby- a)Kanavel'ssign b)Chowstek'ssign c)Gower'ssign d)Ludloff'ssign CorrectAnswer-AAns.is'a'i.e.,Kanavel'ssignKanavel'ssignisforinfectionofulnarbursa.
72.Ringshapedepiphysesisseenin? a)Osteogenesisimperfecta b)Morquiossyndrome c)Zellwegersyndrome d)Multipleepiphysealdysplasia CorrectAnswer-AAns.is'a'i.e.,OsteogenesisimperfectaRingshapedepiphysisi)Hypothyroidism(healingphase)iv)Osteoporosisii)Osteogenesisimperfectav)Rickets(healingphase)iii)Osteopetrosisvi)Scurvy
73.DevelopmentofChondrosarcomasis relatedwith? a)Maffuccisyndrome b)Feltysyndrome c)aandbboth d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,MaffuccisyndromeChondrosarcomasdevelopinginpatientswithollier'sandmaffuccisyndromeiscalledsecondarychondrosarcoma.SecondarychondrosarcomaItisthechondrosarcomaarisinginbenignprecursoreitherosteochondromaandenchondroma.Therearenoreliablefiguresabouttheriskofdevelopingsecondarychondrosarcomainbenignprecursors.Theriskofchondrosarcomainsolitaryosteochondromais2%andthatforosteochondromatosisis5-25%.Patientswithollier'sdiseaseandmaffuccisyndromehavea25-30%riskofdevelopingchondrosarcoma.
74.CASPARcriteriaisusedindiagnosisof? a)Psoriaticarthritis b)Rheumatoidarthritis c)Ankyosingspondylitis d)Reactivesynnovitis CorrectAnswer-AAns.is'a'i.e.,PsoriaticarthritisClassificationcriteriaforpsoriaticarthritis(CASPAR)isusedforthediagnosisofpsoriaticarthropathy.TheCASPAR(classificationCriteriaforPsoriaticArthritis)CriteriaTomeettheCASPARcriteriaapatientmusthaveinflammatoryarticulardisease(joint,spine,orentheseal)with3pointsfromanyofthefollowingfivecategories: 1. Evidenceofcurrentpsoriasis,apersonalhistoryofpsoriasis,orfa familyhistoryofpsoriasis. 2. Typicalpsoriaticnaildystrophyobservedoncurrentphysical examination. 3. Anegativetestresultforrheumatoidfactor.4. Eithercurrentdactylitisorahistoryofdactylitisrecordedbya rheumatologist. 5. Radiographicevidenceofjuxtaarticularnewboneformationinthe handorfoot.
75.Drugofchoiceforthetreatmentofacute goutinpatientsinwhomNSAIDsarecontraindicatedis? a)Colchicine b)Allopurinol c)Xyloricacid d)Paracetamol CorrectAnswer-AAns.is'a'i.e.,ColchicineTreatmentofGout1)AcutegoutNSAIDsarethedrugsofchoiceColchicineisthefastestactingdrug.HoweveritisreservedforthepatientsinwhichNSAIDsarecontraindicated,becausecolchicinecancausegastrointestinaldisturbances.IfneitherNSAIDsnorcolchicinaretolerated,oralprednisoloneisused.Allopurinolanduricosuricdrugs(sulfinpyrazone,probenacid)arenoteffectiveinacutegoutbecausetheywillnotrelievesymptomsastheydon'thaveanti-inflammatoryproperty.2)ChronicgoutAllopurinalisthedrugofchoice.Otherdrugsaresulfinpyrazoneandprobenacid.
76.Causesofpainfularcsyndromeis/are? a)Supraspinatustendinitis b)Subacromialbursitis c)Fractureofgreatertuberosity d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheabovePainfulArcsyndromeThisisaclinicalsyndromeinwhichthereispainintheshoulderandupperarmduringthemidrangeofglenohumeralabduction.Followingarethecommoncauses: i. Minortearsofthesupraspinatustendon ii. Supraspinatustendinitis iii. Calcificationofsupraspinatustendon iv. Subacromialbursitis v. Fractureofthegreatertuberosity Inalltheseconditions,thespacebetweentheupper-endofthehumerusandtheacrominongetscompromised,sothatduringmid-abductionthetendonoftherotator-cuffgetsnippedbetweenthegreatertuberosityandacrominon.X-rayoftheshouldermayshowcalcificdeposit,orafractureofthegreatertuberosityoracromion.oTreatmentconsistsofultrasonicstothetenderpointandanti-inflammatorydrugs.Somecasesneedaninjectionofhydrocortisoneinthesubacromialspaceorexcisionoftheanterior,oftenprominentpartoftheacromion.
77.Fatembolismsyndromeismost commonlyseenafter? a)Femurfracture b)Acetabularfracture c)Pelvisfracture d)Calcanealfracture CorrectAnswer-AAns.is'a'i.e.,FemurfractureFatembolismmeanscirculationoffatglobuleawayfromitssiteoforigin.Whenfatembolismcausessymptomsitiscalledfatembolismsyndrome.Causesoffatembolism 1. Fractureoflongbone(mostcommon)-Blunttrauma2. RecentCorticosteroidadministration3. Softtissuetrauma4. Acutepancreatitis5. Burns6. D.M.7. Parenterallipidinfusion8. Liposuction9. Sicklecellcrisis 10. Decompressionsickness
78.Whataboutdurhampinistrue? a)Itisusedtogiveskeletaltraction b)Ithasthreadsinthecenterofpin c)Itisusedtogiveskeletaltractionthroughcalcaneum d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveDenhampinItisatypeofpinusedtogiveskeletaltraction.Threadedportionofthepinengagesthebonycorticesandreducesthechancesofpinsliding.Thistypeofpinisusedcommonlytogiveskeletaltractionthroughthecancellousbonei.e.calcaneum.Itcanalsobeusedtogivetractionthroughosteoporoticbones.
79.Zscoremeasuresthebonemineral densitycompredto? a)Age,Raceandsexmatchedindividuals b)Raceandsexmatchedindividuals c)Sexmatchedindividuals d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,Age,RaceandsexmatchedindividualsTScoreandZscorearethemeasuresofbonemineraldensity.Zscore:Measuresthebonemineraldensityintermsstandarddeviationfromthemeanbonemineraldensityofage,raceandsexmatchedindividuals.Tscore:Measuresthebonemineraldensityintermsstandarddeviationfromthemeanbonemineraldensityofraceandsexmatchedindividualsofnormalyoungeragegroup.
80.Osteoidosteomaconsistsof- a)Osteoblasts b)Osteoclasts c)Bothofabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothofaboveOsteoidOsteomaOsteoidosteomaisthemostcommontruebenigntumorofthebone.Thisisabenigncircumscribedlesionthatmayariseinthecortexoflongbonesoroccasionallyinthecancellousboneofspine.Thecharacteristicfeatureistheformationofasmallnidusofosteoidtissue,surroundedbyareactivezoneofdensesclerosis(Scleroticnewboneformation).Microscopically,thetumoriscomposedofthin,irregular,trabeculaewithinacellulargranulationtissuecontainingosteoblastsandosteoclasts.Trabeculaearemorematureinthecenter,whichisoftenpartiallycalcified.Reactive,scleroticbonesurroundsthenidus.ClinicalfeaturesofosteoidosteomaThetumoroccursbetween10-30yearsofageandismorecommoninmales.Thediaphysisoflongbonesisinvolved,mostcommonboneinvolvedisthetibiafollowedbyfemur.Posteriorelementsofthevertebraemayalsobeinvolved.Thepresentingcomplaintisanaggingpain,worstatnight,andisrelievedbysalicylatesorotherNSAIDs,adiagnosticfeature.OnX-ray,thereisasmallradiolucentarea(nidus)surroundedbydenssclerosis.
X-ray,insomecases,showlocalscleroticthickeningoftheshaftthatmayobscurethesmallcentralniduswithintheareaofrarefaction.Bonescanshowsincreaseduptakeinthenidus.Theonlytreatmentiswideenblockexcisionalongwithinternalfixationwithorwithoutbonegrafting.
81.Mostcommoncauseofacute compartmentsyndromeinchildrenis? a)Fracturesupracondylarhumerus b)Transphysealhumerusfracture c)Fractureradius/ulna d)Fractureshafthumerus CorrectAnswer-AAns.is'a'i.e.,FracturesupracondylarhumerusCompartmentsyndromeismostcommonlycausedbyextremityfractures:- i. Supracondylarfractureofhumerusisthemostcommoncauseis children. ii. Crushinjuriestoforearmarethemostcommoncauseinadults. iii. Otherinjuriesarefracturebothbonesforearm,elbowdislocation.
82.Thomassplintisusedforimmobilizing fracturesof? a)Femur b)Tibia c)Radius d)Ulna CorrectAnswer-AAns.is'a'i.e.,FemurSplintsAnymaterialwhichisusedtosupportafractureiscalledsplint.Splintsareusedforimmobilizingfractures;eithertemporarilyduringtransportationorfordefinitivetreatment.Themostcommonlyemployedsplintsisplasterofparis(POP)splint.VariousPOPsplintsare:-1)Casts:-HerethePOProllcompletelyencirclesthelimb.2)Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalforonethirdcircumference.3)Spica:-Thisencirclesapartofthebody;e.g.,hipspicaforfracturesaroundhip.
83.Whichofthefollowingisnottheextra- articularmanifestationsofankylosingspondylitis? a)Acuteanterioruveitis b)Aorticvalvedisease c)Pulmonaryfibrosis d)Dilatedcardiomyopathy CorrectAnswer-DAns.is'd'i.e.,DilatedcardiomyopathyExtraarticularmanifestationsofankylosingspondylitisareacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Ankylosingspondylitis(marie-strumpelldisease)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.Prototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.Maletofemaleratiois2-3:1StrongcorrelationwithHLA-B2790-95%ofcasesarepositiveforHLA-B27.JointsinvolvedinankylosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Rarelyknee(Ebenzar4th/e593)andankle(Apley's9th/e67)arealsoinvolved.PathologyEnthesitisi.e.inflammationoftheinsertionpointsoftendons,ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftentheearliestmanifestationofA.S..Involvementofcostovertebraljointsfrequentlyoccur,leadingtodiminishedchestexpansion(normal5cm)oPeripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rdpatients.Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Pathologicalchangesproceedinthreestages? 1. Inflammationwithgranulationtissueformationanderosionof adjacentbone. 2. Fibrosisofgranulationtissue3. Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
84.Whichofthefollowingdeformityis evidentincaseoferbspalsy? a)Policemantipdeformity b)Wingingofscapula c)Clawhand d)Wristdrop CorrectAnswer-AAns.is'a'i.e.,PolicemantipdeformityDeformity(positionofthelimb)inErb'spalsyi)Arm:Hangesbytheside;itisadductedandmediallyrotatedii)Forearm:ExtendedandpronatednThedeformityisknownas'policeman'stiphand'or'porter'stiphand'.
85.Functionalcastbracingnotusedin fractureof? a)Humerus b)Tibia c)Ulna d)Thoracolumbarspine CorrectAnswer-DAns.is'd'i.e.,ThoracolumbarspineFunctionalcastbracingisusedforthefractureof:- i. Humerus ii. Femur iii. Ulna iv. Tibia
86.Whatisnottrueaboutpulledelbow? a)Occursduetosuddenaxialpullonextendedelbow b)Forearmisheldinpronationandextention c)Mostcommonlyoccursbetween2-5yearsofage d)Treatmentisquickpronationandflexionofelbow CorrectAnswer-DAns.is'd'i.e.,TreatmentisquickpronationandflexionofelbowPulledelbowIfayoungchildisliftedbythewrist,theheadoftheradiusmaybepulledpartlyoutoftheannularligament,i.e.,subluxationoftheheadoftheradius.Itoccurswhenforearmispronated,elbowisextendedandlongitudinaltractionisappliedtothehandorwrist,e.g.,lifting,spinningorswingingachildwithwristorhand.Pulledelbowmostcommonlyoccursbetweentheageof2-5years.ClinicalfeaturesofpulledelbowHistoryofsuddenaxialpullonextendedelbow.Immediatelychildstartscryingandisunabletomovetheaffectedelbow.Theforearmisheldinpronationandextensionandanyattempttosupinateisresisted.Childdoesnotallowtotouchtheaffectedlimb.X-rayseemstobenormal.TreatmentofpulledelbowTreatmentissimple.Thechild'sattentionisdiverted,theelbowisquicklysupinatedandthenslightlyflexed.Thisreducesthesubluxationordislocationandtheradialheadis
relocatedwithasnap.
87.Heberdennodedenotesinvolvementof? a)Distalinetrphalangealjoint b)Proximalinterphalangeljoint c)Metacarpophalangealjoint d)Metatarsophalangealjoint CorrectAnswer-AAns.is'a'i.e.,DistalinetrphalangealjointInosteoarthritisofhand:i)Distalinterphalangealjoint:-Heberden'snodeii)Proximalinterphalangealjoint:-Bouchard'snode
88.De-quervian'stenovaginitisinvolves? a)Abductorpollicislongus b)Extensorpollicisbrevis c)Bothoftheabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothoftheaboveDe-Quervian'stenovaginitisischaracterizedbypainoverthestyloidprocessoftheradiusandpalpablethickeninginthecourseoftheabductorpollicislongusandextensorpollicisbrevistendons.Thefibroussheathsoftheabductorpollicislongusandextensorpollicisbrevistendonsarethickenedwheretheycrossthetipoftheradialsyloidprocess.Thetendonsthemselvesappearnormalasdoesthesynovialliningofsheath.Exactcauseisunknow.Excessivefrictionfromoverusemaybeafactor,becausetheconditionseemspronetofollowrepetitiveactionssuchaswringingclothes,orinmorerecenttimesexcessivetypingormanipulations.Theconditionisfivetimescommonerinwomenthanmen,predominantlyinmiddleage.Themainsymptomispainonusingthehand,especiallywhenmovementtensestheabductorpollicislongusandextensorspollicisbrevistendons(asinliftingasaucepanorateapot).Onexamination,thereislocaltendernessatthepointwherethetendonscrosstheradialstyloidprocess.Thethickenedfibroussheathareusuallypalpableasfirmnodule.Passiveadductionofthewristorthumbcausesthepatienttowince
withpain.Finkelstein'stestisusedtodiagnoseDe-Quervain'stenovaginitis.Toperformthetest,thepatientsasktoflextheirthumbandclenchtheirfistoverthethumbfollowedbyulnardeviation.Thisproducessharppainalongthedistalradius.
89.ThetypicaldeformityinCTEVis? a)Ankleequinus b)Subtalarinversion c)Forefootadduction d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.CTEVismorecommonmalesinthaninfemales(malestofemaleratio2.5:1).InhalfofthecasesCTEVisbilateral.Rightandleftfootareaffectedequally.Thedeformityconsistsoffollowingelements:?i)Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint).ii)Inversionoffootatsubtalarjoint(talocalcanealjoint).iii)Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicularjoint.iv)Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-tarsaljoints.
90.Ortolanitestispositivewhenthe examinerhearsthe? a)Clunkofentryonabductionandflexionofhip b)Clunkofentryonextensionandadductionofhip c)Clickofexitonabductionandflexionofhip d)Clickofexitonextensionandadductionofhip CorrectAnswer-AAns.is'a'i.e.,ClunkofentryonabductionandflexionofhipClinicaltestsforCDH/DDHIninfancytwotestsareused.Barlow'stestThistestisdonewithin2-3daysofbirth.Thetesthastwoparts:? 1. Part1:-Infantisinsupinepositionwithhipandkneein90?of flexion,Thehipisslowlyadducted&pushedtodislocatethehipandonecanhearaclunckofexitoffemoralheadoutoftheacetabulum. 2. Part2:-Nowthehipisgentelyabductedandpulledtoreducethe hip.Thiswillcause'clunk'indicatingreductionofhip.Itisquiteobviousthatpart1canbedoneonlydislocatablehip;butnotinalreadydislocatedhipastheheadisalreadyoutoftheacetabulum.Ortolani'stestThistestissimilarto2ndpartofBarlow'stest,i.e.slowabductionofhipinflexedpositionofhip&kneetoreducethehip.
91.Whendoyouoperateforprolapseddisc? a)Busyexecutiveneedsquicksurgery b)Onlywithweaknessnopain c)Severepaininterferingwithactivityandnotrelievedbyrestand treatmentof8weeks d)PatientofPIDwithdifficultyinambulation CorrectAnswer-CAns.is'c'i.e.,Severepaininterferingwithactivityandnotrelievedbyrestandtreatmentof8weeksIndicationsforsurgeryincasesofProlapsedintervertebraldiscare:-i)Failureofconservativetreatment(evenafter8weeksoftreatment).ii)Progressiveneurologicaldeficit.iii)Cauda-equinasyndrome.iv)Severesciatictilt.
92.Vertebralrotationinscoliosisischecked in a)Forwardbending b)Backwardbending c)Sideways d)Withoutbending CorrectAnswer-AAns.is'a'i.e.,ForwardbendingTheforwardbendingtestisverysensitiveindemonstratingthevertebralrotationthattakesplaceinastructuralscolioticcurve.Quantificationoftherotationisdonebymeasuringtheribhumpbyuseofinclinometerorscoliometer.Severityofthecurveinscoliosisismeasuredbycobb'sangle,i.e.ananglebetweenlinepassingthroughthemarginsofvertebraatendsofcurve.Tousethecobbmethod,onemustfirstdecidewhichvertebraearetheend-vertebraeofthecurve.Theseendvertebraearethevertebraeattheupperandlowerlimitsofcurvewhichtiltmostseverelytowardtheconavityofthecurve.OthermethodusedtomeasurescoliosisangleisFerguson'smethod.
93.Patientcomeswithcrushinjurytoupper limb,doctorisconcernedaboutgangreneandsepsiswhatcanhelpdecidebetweenamputationandlimbsalvage? a)MESS b)Gulitonscore c)GustiloAndersonclassification d)ASIAguidelines CorrectAnswer-AAns.is'a'i.e.,MESSMESS(MangledExtremitySeverityScore):Estimatesviabilityofanextremityaftertrauma,todetermineneedforsalvagevsempiricamputation.Followingparametersarelookedfor:-i)Limbischemiaii)Patientagerangeiii)Shockiv)Injurymechanism
94.Inabilitytopronateforearmisdueto injurytowhichnerve? a)Ulnar b)Radial c)Mediannerve d)Musculocutaneous CorrectAnswer-CAns.is'c'i.e.,MediannervePronationoftheforearmisbytwomusclespronatorteresandpronatorquadratus.Thesetwomusclesaresuppliedbymediannerve.Thusinjurytomediannerveproducesinabilitytopronateforearm.Themediannerveisalsocalledlabourer'snerve.Themediannervearisesbytworoots,onefromthelateralcord(C5,6,7)andtheotherfromthemedialcord(C8,T1).Thevariousmusclessuppliedbymediannerveare:?1)IntheforearmAlltheflexormusclesoftheforearm,excepttheflexorcarpiulnarisandthemedialhalfofflexordigitorumprofundustotheulnartwofingers.Thesemusclesare:- i. Pronaterteres ii. Flexordigitorumsuperficialis iii. Flexorpollicislongus iv. Flexorcarpiradialis v. Flexordigitorumprofundus(lateralhalf) vi. Pronatorquadratus vii. Pulmarislongus 2)Inhand
Mediannervesupplies:- i. Thenarmuscles(exceptadductorpollicis)-Flexorpollicisbrevis, opponenspollicisandabductorpollicisbrevis.Adductorpollicisissuppliedbyulnarnerve. ii. Firsttwolumbricals
95.Highsteppinggaitisseenin? a)CTEV b)Commonperonealnervepalsy c)Polio d)Cerebralpalsy CorrectAnswer-BAns.is'b'i.e.,CommonperonealnervepalsyFirsttotouchthegroundistheforefoot,andnottheheel.
96.Sectoralsignispositivein? a)Avascularnecrosisoffemurhead b)Osteoarthritisofhip c)Protrusioacetabuli d)Slippedcapitalfemoralepiphyses CorrectAnswer-AAns.is'a'i.e.,AvascularnecrosisoffemurheadClinicalfeaturesofAVNIntheearlierstagesofAVN,thepatientisasymptomatic,andbythetimepatientpresents,thelesioniswelladvanced.Commonhistoriespatientgives(Anyofthefollowing):-i)DislocationofHipii)Alcoholismiii)Steroidintakeforanydisorderiv)NephroticsyndromePainisacommoncomplaint.Painisfeltinthegrainandmayradiatetoknee.Decreasedrangeofmotionespeciallyinternalrotationfollowedbyabduction.SectoralsignorDifferentialrotation:-Internalrotationispossibleinextendedpositionofhip,butasseenasthehipisflexedto90?nointernalrotationispossible.ThisisthecharacteristicsignofAVN.oLimpwithantalgicgait.Trendelenberg'stestpositive.
97.Garden'sclassificationusedforwhich fracture? a)Surgicalneckhumerus b)Shafthumerus c)Neckoffemur d)Shaftfemur CorrectAnswer-CAns.is'c'i.e.,NeckoffemurGarden'sclassificationGarden'sclassificationisthemostusefulandmostacceptedclassificationoftheneckoffemur.Thisisbasedonthedegreeofdisplacementofthefracture.Following4stagesoffracturearethere:?1)Stage1:Thefractureisincomplete,withheadtiltedinpostero-lateraldirection,i.e.intovalgus,thereforeisknownasvalgus(abduction)impactedfracture.2)Stage2:Completefracturebutundisplaced.3)Stage3:Completefracturewithpartialdisplacement.4)Stage4:Completefracturewithtotaldisplacement.Thedegreeofdisplacement,inGarden'sclassification,isjudgedfromchangeinthedirectionofmedialtrabecularstreamoftheneck,inrelationtothebonytrabeculaeintheweightbearingpartoftheheadandinthecorrespondingpartoftheacetabulum.i)Stage1:-Thereisanobtuseanglelaterallyatthetrabecularstream.ii)Stage2:-Trebeculaebetweenheadandneckarebrokenbuttheyareinalignmentwitheachotherandwithtrabeculaeintheacetabulum.
iii)Stage3:-Allthreetrabeulaeareoutofalignment.iv)Stage4:-Acetabularandheadtrabeculaeareinalignmentbutheadandnecktrabeculaearenotaligned.
98.Oneofthecommonfracturesthatoccur duringboxingbyhittingwithaclosedfistis? a)Monteggiafracturedislocation b)Galeazzifracturedislocation c)Bennett'sfracturedislocation d)Smith'sfracture CorrectAnswer-CAns.is'c'i.e.,Bennett'sfracturedislocationThecommonmechanismofinjuryforBenett'sfractureisanaxialblowdirectedagainstthepartiallyflexedmetacarpal,inmostcasesduring'fistfights'.Benett'sfractureBenett'sfractureisanintra-articularfracturedislocationofthepalmarbaseoffirstmetacarpalboneofthethumbwitheithersubluxationordislocationoffirstcarpometacarpaljoint,i.e.trapezometacarpaljoint.Thecommonmechanismofinjuryisanaxialblowdirectedagainstthepartiallyflexedmetacarpal,inmostcasesduring"Fistfights".Patientcomplainsofpain,swellingandtendernessoverthebaseofthethumb.Movementsofthumbarerestricted.DisplacingforceinBennett'sfracturesFollowingarethedeformingforcesinBennett'sfracture:-i)Atthedistalfragment,itistheadductorpollicis.ii)Attheproximalfragment,itistheabductorpollicislongus.Baseofthethumbmetacarpalispulleddorsallyandmediallybytheabductorpollicislongus,whilethedistalattachmentofadductor
pollicisfurtherleversthebaseintoabduction.
99.CausesofCarpaltunnelsyndromeareall except? a)DM b)RA c)Leprosy d)Gout CorrectAnswer-CAns.is'c'i.e.,LeprosyCarpaltunnelsyndromeCarpaltunnelsyndromeisthemostcommonandwidelyknownentrapmentneuropathyinwhichthebody'speripheralnerveiscompressedortraumatized.Carpaltunnelsyndromeoccurswhenthemediannerveiscompressedinthecarpaltunnelbelowflexorretinaculum.Thecarpaltunnelisanarrowrigidpassagewayofligamentandbonesatthebaseofhand,infrontofdistalpartofwrist.Carpaltunnelhousesthemediannerveand9tendons(4FDS,4FDP&FPL).CausesofcarpaltunnelsyndromeTherearemanycausesofcarpaltunnelsyndrome:1)Idiopathic:-Thisisthemostcommoncause.2)Pregnancyandmenopause3)Metabolic:-Gout,Diabetesmellitus4)Endocrine:-Hypothyroidism,Myxedema,Acromegaly,Hyperparathyroidism.5)DepositiondisorderAmyloidosis,Sarcoidosis,Rheumatidarthritis,Leukemia,CRF,Mucopolysaccharoidosis.6)Alcoholism7)Localcauses:-Malunitedcolle'sfracture,osteo-arthritisofthe
carpalbones,synovititsofflexortendonsheath,hematoma.ClinicalfeaturesofcarpaltunnelsyndromeCarpaltunnelsyndromeismorecommoninwomenandoccursbetween35-50years.Symptomsusuallystartgradually,withfrequentburning,tingling,paresthesiaandnumbnessinthedistributionofmediannerve,i.e.,lateralthree&halfoffingersandlateral2/3rdofpalm.Thesymptomsoftenfirstappearduringnight,sincemanypeoplesleepwithflexedwrists.(Flexiondecreasesthespaceincarpaltunnelwhichresultsinincreasedpressureovermediannerve).Sensorysymptomscanoftenbereproducedbypercussingovermediannerve(Tinel'ssign)orbyholdingthewristfullyflexedforaminute(Phalen'stest).Asthediseaseprogresses,clumsinessofhandandimpairmentofdigitalfunctiondevelop.Laterinthedisease,thereissensorylossinmediannervedistributionandobviouswastingofthenareminence.ClinicalTestsforCarpaltunnelsyndromeTherearesomeprovocativetestswhichactasimportantscreeningmethods:?1)Wristflexion(Phalen'stest):-Thepatientisaskedtoactivelyplacethewristincompleteflexion.Iftinglingandnumbnessdevelopinthedistributionofmediannerve,thetestispositive.Thisisthemostsensitiveprovocativetest.2)Tourniquettest:-ApneumaticBPcuffisappliedproximaltotheelbowandinflatedhigherthanthepatient'ssystolicBP.Thetestispositiveifthereisparesthesiaornumbnessintheregionofmediannervedistributioninhand.3)Mediannervepercussiontest(Tinel'ssign):-Themediannerveisgentlytappedatthewrist.Thetestispositiveifthereistinglingsensation.4)Mediannervecompressiontest:-Directpressureisexertedequallyoverbothwristsbytheexaminer.Ifsymptomsofcarpaltunnelsyndromeappear,thetestispositive.
100.Radiologicalfactorsindicatingan unstablepelvisareallexcept? a)Posteriorsacroiliaccomplexdisplacementby>1cm b)Avulsionfractureofsacralorischialendofthesacrospinous ligament c)AvulsionfracturesoftheL5transverseprocess d)Isolateddisruptionofpubicsymphysiswithpubicdiastasisof2 cm. CorrectAnswer-DAns.is'd'i.e.,Isolateddisruptionofpubicsymphysiswithpubicdiastasisof2cmRadiographicfactorsindicatingunstablepelvisare:-Posteriorsacroiliaccomplexdisplacementby>lcmAvulsionfractureofsacralorischialendofthesacrospinousligamentAvulsionfracturesoftheL5transverseprocessDisruptionofpubicsymphysiswithpubicdiastasisof2cmwithposteriorpelvicinjuryorinjurytoanterior/posteriorsacroiliacligamentorsacrospinousligaments.Presenceofgapratherthanimpactionintheposteriorpelvicring.
101.Mostcommoncomplicationofmidshaft humerusfractureis? a)Radialnervepalsy b)Mediannervepalsy c)Nonunion d)Malunion CorrectAnswer-AAns.is'a'i.e.,RadialnervepalsyComplicationsofhumerusshaftfracture 1. Nerveinjury:-Radialnerveisthemostcommonlyinjurednervein fractureshafthumerus.Itisparticularlycommoninobliquefracturesatthejunctionofmiddleanddistalthirdofthebone(Holstein-Lewsfracture). 2. Vascularinjury:-Brachialarterydamage.3. Delayedunionornon-union:-Delayedunionornon-unionmay occur,especiallyintransversefractureofthemidshaft.Thecauseofnon-unionisdistractionatfracturesiteduetogravityandweightofplaster. 4. Jointstiffness:-Shoulder&elbowstiffness.
102.Deformityofhipinstageoftubercular synovitisstageis? a)Flexion,abductionexternalrotation b)Flexion,adductioninternalrotation c)Flexionadductionexternalrotation d)Flexionabductioninternalrotation CorrectAnswer-AAns.is'a'i.e.,Flexion,abductionexternalrotationSynovitis-Flexionabductionexternalrotationapparentlengthening
103.Needleshapedcrystalsnegatively birefringentonpolarizedmicroscopyischaracteristicofwhichcrystalassociatedarthropathy? a)Gout b)CPPD c)Neuropathicarthropathy d)Hemophilicarthropathy CorrectAnswer-AAns.is'a'i.e.,GoutCrystalofPseudogoutMadeupofcalciumpyrophosphateWeaklypositivebirefringent,rhomboidCrystalofgout:-Madeupofuricacid(monosodiumurate)Stronglynegativebirefringent,needleshaped
104.Whichofthefollowingisnotafeatureof rheumatoidarthritis? a)Heberdennodes b)Swanneckdeformity c)Ulnardeviationoffingersatmetacarpopalyngealjoint d)Symmetricreductionofjointspace CorrectAnswer-AAns.is'a'i.e.,HeberdennodesHeberdennodesisafeatureofosteoarthritisandnotrheumatoidarthritis.ImportanthanddeformitiesofhandinRABoutonnieredeformity:FlexioncontractureofPIPjointandextensionofDIPjoint.Swanneckdeformity:HyperextensionofPIPjointandflexionatDIPjoint.Z-deformity:Radialdeviationofwristwithulnardeviationoffingers.Hyperextensionof1stinterphalangealjointandflexionofMPjoint.
105.Keinbock'sdiseaseisosteochondritisof ? a)Scaphoid b)Lunate c)Calcaneum d)Tibialtuberosity CorrectAnswer-BAns.is'b'i.e.,LunatePerthes'sdisease-FemoralheadPanner'sdisease-CapitulumKienbock'sdisease-LunateboneOsgoodShlatter'sdisease-TibialtubercleSever'sdisease-CalcanealtuberosityKohler'sdisease-Navicularbone
106.Metaphysealfracturetouchingphysis butnotcrossingit,comesunderwhichtypeofSalterHarrisphysealinjury? a)I b)II c)III d)IV CorrectAnswer-BAns.is'b'i.e.,IISalterandHarrishaveclassifiedepiphysealinjuriesintofivetypes-TypeI:Completeseparationofepiphysisfromthemetaphysiswithoutfracture.Commoninrickets,scurvyandosteomyelitis.TypeII:Thefractureinvolvesthephysisandatriangleofmetaphysealbone(ThurstonHollandsign)i.e.metaphysealfracturetouchingthephysisbutnotcrossingit.Thisisthecommonesttypeofepiphysealinjuryaccountingfor73percentofcasesover10yearsofage.TypeIII:Thefractureisintra-articularandextendsalongthephysisandthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.TypeIV:Thefractureisintra-articularandextendsthroughtheepiphysis,physisandmetaphysis.Perfectreductionisnecessaryandopenreductionismoreoftennecessarytopreventgrowtharrest.TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrialring)injury.
107.Motorcyclist'sfractureis? a)Stellatefractureacrossbaseofskull b)Transversefractureacrossbaseofskull c)LaminafractureofCIvertebra d)SpinousprocessfractureofC7vertebra CorrectAnswer-BAns.is`b'i.e.,TransversefractureacrossbaseofskullMotorcyclist'sfractureBecauseoftheinherentinstabilityoftwowheeledvehicles,theriderandpassangerinevitablyfalltothegroundinacrash.Injuriescanoccurtoanypartofthebody,butthelimbsandheadareparticularlysusceptibletoseriousinjury.Impactwiththeroadsurfaceoranothervehicleatspeedoftencausesskullfracture,eveninthepresenceofahelmet.Atransversefractureacrosstheflooroftheskull,usuallycalleda"hingefracture",issometimesreferredtoasmotorcyclistfracture.Atautopsy,thebaseoftheskullmaybeappriciatedtohavedividedintotwohalves,eachmovingindependentlyofeachotherlikeahinge,theso-calledmotorcyclistfracture.
108.Whichamongthefollowingisnota featureofUnhappytriadof0'Donoghue? a)ACLinjury b)Medialmeniscusinjury c)Medialcollateralligamentinjury d)Fibularcollateralligamentinjury CorrectAnswer-DAns.is'd'i.e.,FibularcollateralligamentinjuryThemostcommonmechanismofligamentdisruptionofkneeisadduction(valgus),flexionandinternalrotationoffemurontibiawhichusuallyoccurinsportsinwhichthefootisplantedsolidlyonthegroundandlegistwistedbyrotatingbody(i.e.,football,soccer,basketball,skiing).Themedialstructuresmedial(tibial)collateralligament(MCL)andmedialcapsularligamentarefirsttofail,followedbyACLtears,iftheforceisofsufficientmagnitude.Themedialmeniscusmaybetrappedbetweencondylesandhaveaperipheraltear,thusproducingunhappytriadof0'Donoghue.
109.Whichisthecommonesttruebenign bonetumor? a)Osteoidosteoma b)Hemangioma c)Osteochondroma d)Enchondroma CorrectAnswer-AAns.is'a'i.e.,OsteoidosteomaOsteoidosteomaisthemostcommontruebenigntumorofthebone.Thisisabenigncircumscribedlesionthatmayariseinthecortexoflongbonesoroccasionallyinthecancellousboneofspine.Thecharacteristicfeatureistheformationofasmallnidusofosteoidtissue,surroundedbyareactivezoneofdensesclerosis(Scleroticnewboneformation).
110.Whichofthefollowingistrueabout halluxvalgus? a)Greattoepointslaterally b)Greattoepointsmedially c)Lateralangulationofthe1stmetatarsophalyngealjoint d)Dorsalangulationofthelstmetatarsophalyngealjoint CorrectAnswer-AAns.is'a'i.e.,GreattoepointslaterallyHalluxvalgusHalluxvalgusislateral(outward)deviationofgreattoeatthemetatarsophalangealjoint.Itisthecommonestfootdeformity.Itiscommoninwomenpastmiddleage,andisnotinfrequenteveninyoungwomen.Commoncausesare:RheumatoidarthritisWearingpointedshoeswithhighheelsHereditaryfactorsIdiopathicPathologyOutwarddeviationofthegreattoe.Afterseveralyearstwosecondarychangesoccur:-i)Formationofathickwalledbursa(bunion)overthemedialprominenceof1"metatarsalhead.ii)Osteoarthritisofmetatarsophalangealjoint.Itisworthnotingthatmedialprominenceovermetatarsalheadlookslikeanexostosis,butthereisnotrueexostosis.Lateraldeviationofgreattoecausesovercrowdingoflateraltoes
andsometimesoverridingofadjacenttoes.
111.Jaipurfootwasinventedby? a)P.K.Sethi b)S.K.Verma c)B.L.Sehgal d)H.R.Gupta CorrectAnswer-AAns.is'a'i.e.,P.K.SethiP.K.Sethi.PramodKaranSethi(28November1927-6January2008)wasanIndianorthopaedicsurgeon.WithRamChandraSharma,heco-inventedthe"Jaipurfoot",aninexpensiveandflexibleartificiallimb,in1969.
112.Testusedforprolapsedlumbar intervertebraldiscis- a)Activestraightlegraisingtest b)Laseguetest c)Thomastest d)Apley'sgrindingtest CorrectAnswer-BAns.is'b'i.e.,LaseguetestClinicalexaminationinPIDForwardstooping(bending),twistingorcoughingaggravatethepain.Thetrunkistiltedtooneside(sciaticscoliosisorsciatictilt).Movementsoflumbarspinearerestrictedespeciallyflexion.Straightlegraising(SLR)testispositive,i.e.straightlegraisingispossible40?orless(AIIMSO4).Laseguetest(amodificationofSLRtest)ispositive.
113.Lumbarcanalstenosispresentsas? a)Claudication b)Scolioticdeformity c)Kyphoticdeformity d)Radiculopathy CorrectAnswer-AAns.is'a'i.e.,ClaudicationThepatientoflumbarcanalstenosisisusuallyamanagedover50,complainsofaching,heaviness,numbnessandparaesthesiainthethighsandlegs;itcomesonafterstandinguprightorwalkingfor5-10minutes,andisconsistentlyrelievedbysitting,squattingorleaningagainstawalltoflexthespine(hencetheterm'spinalclaudication').
114.Callusformationisseenbetweenwhat durationoffracturehealing? a)0-2weeks b)2-4weeks c)4-12weeks d)12-16weeks CorrectAnswer-CAns.is'c'i.e.,4-12weeksHealingofafractureTheprocessoffracturehealingvariesaccordingtothetypeofboneinvolvedandtheamountofmovementatthefracturesite.Followinghealingprocessesarethere:?Indirectfracturehealing(healingbycallus)Thisisthe'natural'formofhealingintubularbonesandintheabsenceofrigidfixationwhenthereismicromovementatfracturesite.Thereisformationofinternalandexternalcallus.Thisstageisdividedinthreephaseswhicharefurthersubdividedintofivestages:
115.Inosteogenicsarcomapredominant histologicalfindingis? a)Giantcells b)Osteoidformingtumorcells c)Fibroblasticproliferation d)Chondroblasts CorrectAnswer-BAns.is'b'i.e.,OsteoidformingtumorcellsHistologicappearanceofosteosarcomaItappearspaleandextendingthroughthecortexongrosscutsectionexamination.Onhistologicalsectionsitconsistsofmalignantstromaltissueshowingosteoidformation.OsteoidboneformationbytumorcellsisdiagnosticofOGS.
116.Osteoporosisischaracterizedbyallthe followingexcept? a)Decreasedbonemineraldensity b)DecreasedSerumCalcium,phosphorusandalkaline phosphataseisseen c)Glucocorticoidscancauseosteoposis d)Dorsolumbarspineisthemostcoomonsiteofosteoporotic fracture CorrectAnswer-BAns.is'b'i.e.,DecreasedSerumCalcium,phosphorusandalkalinephosphataseisseenOsteoporosisisastateofdecreasedmassperunitvolumeofanormallymineralizedbone.Osteoporosisisthecommonestmetabolicbonedisease.Osteoporosisischaracterizedbyanabnormallylowbonemass(lowbonedensity)anddefectsinbonestructure,acombinationofwhichrenderstheboneunusuallyfragileandatgreaterthannormalriskoffracture.Bonedepletionmaybebroughtaboutbypredominantboneresorption,decreasedboneformationoracombinationofthetwo.
117.ArthritisinvolvingDIP,PIP,1st carpometacarpalwithsparingofMCPandwristjointsistypicalof? a)Osteoarthritis b)Rheumatoidarthritis c)Ankylosingspondylitis d)Psoriaticarthritis CorrectAnswer-AAns.is'a'i.e.,Osteoarthritis1stCarpometacarpaljointWrist-Osteoarthritis
118.Sunderlandclassificationisusedfor? a)Nerveinjury b)Muscleinjury c)Tendoninjury d)Ligamentinjury CorrectAnswer-AAns.is'a'i.e.,NerveinjurySunderlandisanextensionoftheseddonclassificationandincludes5typesofnerveinjuries.
119.Indexfingerinfectionspreadsto? a)Thenarspace b)Midpalmarspace c)Hypothenarspace d)Flexionspace CorrectAnswer-AAns.is'a'i.e.,ThenarspaceThenarspacecommunicateswiththeindexfingerwhilethemidpalmarspacecommunicateswiththemiddle,ringandlittlefingers.Thusinfectionofindexfingerleadstothenarspaceinfectionwhiletheinfectionofmiddle,ringorlittlefingerleadstomidpalmarspaceinfection.
120.Pipkin'sclassificationsystemisusedfor ? a)Fracturefemurhead b)Fracturefemurshaft c)Fractureproximaltibia d)Fracturecalcaneum CorrectAnswer-AAns.is'a'i.e.,FracturefemurheadPipikin'sclassificationoffemoralheadfractureTypeI:Femoralheadfractureinferior(caudal)tofovea.TypeII:Femoralheadfracturesuperior(cephalad)tofovea.TypeIII:Femoralheadfracturewithassociatedfemoralneckfracture.TypeIV:TypeI,IIorIIIwithassociatedacetabularfracture.
121.Tinelsignisseenin? a)Nervedegeneration b)Nerveregeneration c)Muscledegeneration d)Muscleregeneration CorrectAnswer-BAns.is'b'i.e.,NerveregenerationPathologicalchangesafternerveinjuryAfternerveinjury,nervefirstdegeneratesandthentriestoregenerate.NervedegenerationThepartoftheneuronedistaltothepointofinjuryundergoessecondaryorWalleriandegeneration;theproximalpartundergoesprimaryorretrogradedegenerationuptoasinglenode.NerveregenerationAsregenerationbegins,theaxonalstumpfromtheproximalsegmentbeginstogrowdistally.IftheendoneuraltubewithitscontainedSchwanncellsisintact,theaxonalsproutmayreadilypassalongitsprimarycourseandreinnervatetheend-organ.Therateofrecoveryofaxonis1mmperday.Themusclesnearesttothesiteofinjuryrecoversfirst,followedbyothersasthenervereinnervatesmusclesfromproximaltodistal,theso-calledmotormarch.Whentheskinoverthenerveispercussedgentlyfromdistaltoproximal,thepatientgetsatinglingsensationifthenerveisrecovering.ThisiscalledTinel'ssignandisasignofrecovery.
122.Dinnerforkdeformityisseenin? a)Colle'sfracture b)Marchfracture c)Lateralcondylefracture d)Supracondylarfracture CorrectAnswer-AAns.is'a'i.e.,Colle'sfractureComplicationsofcolle'sfractureComplicationsincolle'sfracturearehigh(50-60%).Followingcomplicationsmayoccur1)StiffnessoffingersandjointsStiffnessoffinger,wristandshoulderisthemostcommonavoidablecomplicationofcolle'sfracture.Thisoccursduetolackofexercise.Therefore,patientshouldbeencouragedforactiveexerciseoffingerandshoulder.2)MalunionItisthesecondmostcommoncomplicationItresultsindinnerforkdeformity3)Sudek'sosteodystrophy(reflexsympatheticdystrophy)4)Carpaltunnelsyndrome:Mediannervemaygetcompressedincarpaltunnel5)Carpalinstability6)Ruptureoftheextensorpollicislongustendon7)FrozenshouldersyndromeThisisatroublesomecomplicationwhichdevelopsduetounnecessoryvoluntaryshoulderimmobilizationbythepatientontheaffectedsideforfearoffracturedisplacement.8)TFCCinjury
9)Non-unionisveryrare
123.Tenniselbowischaracterizedby? a)Tendernessoverthemedialepicondyle b)Tendinitsofcommonextensororigin c)Tendinitisofcommonflexororigin d)Painfulflexionandextension CorrectAnswer-BAns.is'b'i.e.,TendinitsofcommonextensororiginTenniselbowisextraarticularaffectioncharacterizedbypainandacutetendernessattheoriginoftheextensormusclesoftheforearmfromthelateralepicondyle.Itisbelievedtobecausedbystrainoftheforearmextensormuscles,particularlytheextensorcarpiradialisbrevis,atthepointoftheiroriginfromlateralepicondyle.
124.Falseaboutosteoarthritisis? a)Involvessynovialjoints b)Progressivesofteningofthearticularcartilage c)Itisaninflammatoryarthritis d)Marginalosteophytesareproduced CorrectAnswer-CAns.is'c'i.e.,ItisaninflammatoryarthritisOsteoarthritis(OA)isachronicdisorderofsynovialjointsinwhichthereisprogressivesofteninganddisintegrationofarticularcartilageaccompaniedbynewgrowthofcartilageandboneatthejointmargins(osteophytes),cystformationandsclerosisinthesubchondralbone,mildsynovitisandcapsularfibrosis.Thetermosteoarthritisisamisnomerasitisanon-inflammatorycondition.Therighttermisosteoarthrosisordegenerativejointdisorderbecauseitisadegenerativewear-and-tearprocessoccuringinjoints.
125.Tardyulnarnervepalsyisseenin a)Medialcondyle#humerus b)Lateralcondyle#humerus c)Humerusshaftfracture d)Fractureshaftradius CorrectAnswer-BAns.is'b'i.e.,Lateralcondyle#humerusCausesoftardyulnarnervepalsyare:- 1. Malunitedlateralcondylehumerusfracture(cubitusvalgus)2. Displacedmedialepicondylehumerusfracture3. Cubitusvarusdeformity(duetosupracondylarfracturehumerus)4. Elbowdislocation5. Contusionsofulnarnerve6. Shallowulnargroove7. Hypoplasiaofhumeraltrochlea8. Jointdeformityafterprolongedarthritisofelbow
126.Anklesprainduetoforcedinversionofa plantarflexedfootisduetoinjuryto a)Anteriortalofibularligament b)Posteriortalofibularligament c)Calcaneofibularligament d)Posteriorfibresofdeltoid CorrectAnswer-AAns.a.Anteriortalofibularligament*Structuresdamagedduetoinversioninjury.-Peronealtendoninjury.-Avulsionfractureoftipoflateralmalleolus.-Avulsionfractureofanterolateralsurfaceoftalus&calcaneum(sustentaculumtali).-Fractureofbaseof5thmetatarsal.-Lateralcollateralligamentinjury(anteriortalofibular>calcaneofibular>posterior-talofibularligament).-Medialmalleolusfracture.
127.Gallowstractionisusedforfracture: a)Shaftfemur b)Neckfemur c)Shafttibia d)Tibialtuberosity CorrectAnswer-AAns.a.ShaftfemurGallow'stractionisusedfortreatmentoffractureshaftoffemur,ininfantsandchildrenGallow'sTractionGallow'stractionisusedfortreatmentoffractureshaftoffemur,ininfantsandchildrenWeightmustnotbe>12kgsBoththefracturedandthenormalfemurareplacedinskintractionandinfantissuspendedbythesefromaspecialframe.ThebuttocksshouldbeliftedjustoffthebedsothattheweightofthebodyprovidescountertractionandthefractureisreducedUsesofTractions Name Use Bryant's Fractureshaftoffemurin TractionQ children Gallow's Fractureshaftoffemurin TractionQ children Russel's Fractureshaftoffemurin TractionQ olderchildren Perkin's Fractureshaftoffemurin TractionQ adults Fractureshaftoffemurin
90?-90? Fractureshaftoffemurin TractionQ children Agnes-Hunt CorrectionofHipdeformit TractionQWell-Leg Correctionofadductionor TractionQ abductiondeformityofhip Dunlop Supracondylarfractureof TractionQ humerus Smith's Supracondylarfractureof TractionQ humerus UsesofTractions Name Use Calcaneal Openfracturesof Traction ankleorleg Metacarpal OpenforearmTraction fractures Head-Halter CervicalspineTraction injuries Crutchfield Cervicalspine TractionQ injuries Halo-Pelvic Scoliosis Traction
128.Trueaboutankylosingspondylitisareall except? a)Affectsmales b)30-40yrs c)90%HLA-B5 d)Bamboospine CorrectAnswer-CAns.is'c'i.e.,90%HLA-B5Ankylosingspondylitis(marie-strumpelldisease)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.rototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.Maletofemaleratiois2-3:1StrongcorrelationwithHLA-B270-95%ofcase9sarepositiveforHLA-B27.JointsinvolvedinankylosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)arealsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftentheearliestmanifestationofA.S..Involvementofcostovertebraljointsfrequentlyoccur,leadingtodiminishedchestexpansion(normal_5cm)Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rdpatients.Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Pathologicalchangesproceedinthreestages?Inflammationwithgranulationtissueformationanderosionofadjacentbone.FibrosisofgranulationtissueOssificationofthefibroustissue,leadingtoankylosisofthejoint.RadiologicalfeaturesofankylosingspondylitisRadiographicevidenceofsacroiliacjointisthemostconsistentfindinginankylosingspondylitisandiscrucialfordiagnosis.Thefindingsare:-SclerosisofthearticulatingsurfacesofSIjointsWideningofthesacroiliacjointspaceBonyankylosisofthesacroiliacjointsCalcificationofthesacroiliacligamentandsacro-tuberousligamentsEvidenceofenthesopathy-calcificationattheattachmentofthemuscles,tendonsandligaments,particularlyaroundthepelvisandaroundtheheel.X-rayoflumbarspinemayshow:-Squaringofvertebrae:Thenormalanteriorconcavityofthevertebralbodyislostbecauseofcalcificationoftheanteriorlongitudinalligament.ftLossofthelumbarlordosis.Bridging`osteophytes'(syndesmophytes)Bamboospineappearance
129.Inextensiontypeofsupracondylar fracture,theusualdisplacement a)Anterolateral b)Anterolateral c)Posteromedial d)Posterolateral CorrectAnswer-DAns.is'd'i.e.,PosterolateralTypesofsupracondylarfractureSupracondylarfractureisbroadlyclassifiedintoextensiontypeandflexiontype.1.ExtensiontypeItisthemostcommontype(97-99%).Distalfragmentisextended(tiltedbackward/posteriorly)inrelationtoproximalfragment.Occursduetohyperextensioninjuryafterfallonoutstretchedhands.Generally,displacementofdistalfragmentmaybe:?Posteromedial(70-80%)Posterolateral(20-30%)2.FlexiontypeItislesscommontype(1-3%)Distalfragmentisflexed(tiltedforward/anteriorly)inrelationtoproximalfragments.Themechanismofinjurygenerallyisbelievedtobeafalldirectlyontotheelbowratherthanafallonoutstretchedhand.Astheextensiontypefractureismorecommon(97-99%),themostcommonelbowinjuryinchildrenisextensiontypeofsupracondylarfracture.
130.InArticularcartilage,mostactive chondrocytesareseenin? a)Zone1 b)Zone2 c)Zone3 d)Zone4 CorrectAnswer-CAns.is'c'i.e.,Zone3oTherearefourzones(layers)ofarticularcartilagefromthearticularsurfacetosubchondralbone. 1. Superficialzone(Zone-1) Itisthethinnestzone.Itconsistsoftwolayers:(i)Asheetofdenslypackedcollagenwithlittlepolysaccharideandtocells,coversthejointsurface,and(ii)flattenedelipsoid-shapedchondrocytes,withtheirmajoraxisparalleltojointsurface.2.Transitionzone(Zone-2)Compositionisintermediatebetweensuperficialzoneandmiddlezone.3.Middlezoneorradialzoneordeepzone(Zone-3)Thechondrocytesarespheroidalinshapewiththeirmajoraxisperpendiculartojointsurface.Chondracytesaremostactivesyntheticallyinthiszone.Thiszonecontainsthelargestdiametercollagenfibrils,thehighestconcentrationofproteoglycansandthelowestconcentrationofwater.4.Calcifiedcartilagezone(Zone-4)Itseparatesthemiddlezonefromsubchondralbone.Thecellsaresmallwithsmallamountofendoplasmicreticulumand
golgiapparatuswithverylittlemetabolicactivity.Cellsaresurroundedbycalcifiedcartilage.
131.Mostcommoncauseofneuropathicjoint ? a)Leprosy b))Tabesdorsalis c)Diabetes d)Nerveinjury CorrectAnswer-CAns.is`c'i.e.,DiabetesNeuropathicjoint(Charcot'sjoint)oItisaprogressivedestructivearthritisassociatedwithlossofpainsensationx,proprioceptionorboth,inadditionnormalmuscularreflexesthatmodulatejointmovementsaredecreased.Withouttheseprotectivemechanisms,jointsaresubjectedtorepeatedtrauma,resultinginprogressivecartilageandbonedamage.oItismostcommonlycausedbydiabetesmellitus.CausesofNeuropathicjointdisease(Charcoat'sjoint) CausesofNeuropathicjointdisease(Charcoat'sjoint) Diabetesmellitus Amyloidosis (mostcommon)TabesDorsalis LeprosyCongenital Meningomyelocele indifference topainPeroneal Syringomyelia muscularatrophy
132.Mostcommonnerveusedfornerve conductionstudyinHreflex? a)Mediannerve b)Ulnarnerve c)Tibialnerve d)Peronealnerve CorrectAnswer-CAns.is'c'i.e.,TibialnerveItisrecordedoverthesoleusorgastrocnemiusmuscles.ItisusedmosTheHreflexisbasicallyanelectrophysiologicallyrecordedAchillestendonstretchreflex.oItisperformedbystimulatingthetibialnerveinpoplitealfossa.tcommonlytoevaluateSiradiculopathyortodistinguishitfromanL5radiculopathy.
133.Motheatenboneis? a)Osteoidosteoma b)Multiplemyeloma c)Eosinophilicgranuloma d)Chondromyxoidfibroma CorrectAnswer-BAns.is'b'i.e.,MultiplemyelomaPatternsofbonedestructionpresentinalyticlesion? 1. Geographic:Sharpclearlydefinedmargins.Lessaggressive, benign.Eg:nonossifyingfibroma,chondromyxoidfibroma,eosinophilicgranuloma. 2. Motheatenappearance:Holesindestroyedbone.Rapidgrowth, malignantEg:Myeloma,metastasis,lymphoma. 3. Permeative:Illdefined,diffuse,somewhatsubtledestructive processofbone.Eg:Lymphoma,leukemia,Ewing'ssarcoma,osteomyelitis.
134.Commonestligamentinjuredinankle injury? a)Anteriortalofibularligament b)Calcaneofibularligament c)Posteriortalofibularligament d)Springligament CorrectAnswer-AAns.is'a'i.e.,AnteriortalofibularligamentTheankleisoneofthemostcommonsitesforacutemusculoskeletalinjuries.Sprainsconstitute85%ofallankleinjuries,and85%ofthoseinvolvealateralinversionmechanism.InversionSprain-Inversionanklesprainsoccurwhenthefootturnsinorouttoanabnormaldegreerelativetotheankle.Themostcommonmechanismofananklesprainisacombinationofplantarflexionandinversionwherethefootispointingdownwardandinward.Thelateralligamentsareinvolvedinaninversionanklesprainandhencemostcommonlydamaged.Theseligamentsareontheoutsideoftheankle,whichincludestheanteriortalofibular(ATFL),calcaneofibular(CFL)andposteriortalofibularligaments(PTFL).InjurytotheATFListhemostcommon.WhenboththeATFLandCFLareinjuredtogether,ankleinstabilitywillbemorenoticeable.ThePTFListhestrongestofthethreeligamentsandisrarelyinjuredinaninversionsprain.
135.Flexortendongraftrepairgraftistaken from? a)Plantaris b)Palmarislongus c)Extensordigitorum d)Extensorindicis CorrectAnswer-DAns.is'd'i.e.,ExtensorindicisBesidecoveringtheboneandsharingsomeofitsbloodsupplywiththebone,periosteum(particularlycambiumlayer)alsoproducesbonewhenitisstimulated.Practicallyanythingthatbreaks,tears,stretches,inflamesoreventouchestheperiosteum,stimulatesthereactiveboneformationbyperiosteum.Thisiscalledperiostealreaction.DifferentialDiagnosisofPeriostealReactionArthritisPsoriaticarthritisReactivearthritisMetabolicHypertrophicpulmonaryosteoarthropathyThyroidacropathyCongenitalPachydermoperiostosisPeriostealreactionofnewbornTraumaStressfractureFractureDrugsFluorosis
DrugsFluorosisHypervitaminosisAProstaglandinsTumorsOsetosarcomaEwing'ssarcomaChondroblastomaEosinophilicgranulomaOsteoidosteomaLeukemiaandlymphomaInfectionGeneticCaffeydiseaseVascularVenousstasisNeuropathicarthropathyisalsoassociatedwithperiostealreaction.
136.Insal-Salvatiindexisusedfor? a)Olecranon b)Patella c)Talus d)Scaphoid CorrectAnswer-BAns.is'b'i.e.,PatellaTworadiologicalindicesarecommonlyusedfordeterminingthepositionofpatella-Insall-Salvatiindex 1. Itistheratioofpatellartendonlengthtopatellalength.2. Normallyitis1-0.3. Anindexof1.2ormoreisseeninpatellaalta(highridingpatella).4. Anindexof0.8orlessisseeninpatellabaja(lowlyingpatella). Blackbume-Peellindex 1. Itistheratioof(i)thedistanceoftibialplateautoinferiorarticular surfaceofpatella(numerator),to(ii)lengthofarticularsurfaceofpatella(denominator). 2. Normallyitis0.8.3. Anindexof1ormoreisseeninpatellaalta.
137.Intramembranousossificationisseenin whichbones? a)Pelvis b)Longbones c)Maxilla d)None CorrectAnswer-CAns.is'c'i.e.,MaxillaBoneformationBoneformation(ossification)occursbytwomethods:1)Endochondralossification,2)Intramembranousossification.Inboth,mesenchymalconnectivetissueisreplacedbybonebutbydifferentmechanics.Endochondralossification 1. Thistypeofossificationinvolvesthereplacementofacartilaginous modelbybone. 2. Boneformationtakesplaceinpre-existingcartilage.3. Mesenchymaltissuefirstformscartilagewhichislatterossifiedto becomebone. 4. Mostofthelongsbonesdevelopbyendochondralossification.5. Otherbonesarevertebrae,pelvis,skullbasebones.6. Interstitialgrowthoflongboneatepiphysealcartilageoccursby endochondralossification.Intramembranousossification 1. Mesenchymalcellsgiverisetoosteogeniccellswhichdevelopinto osteoblasts. 2. steoblastsbegintolaydownosteoidwhichlattermineralisedtoform bone
3. Thus,thereisdirectformationofbonefrommesenchymaltissue (withnocartilageformationasoccursinEndochondralossification). 4. Thistypeofossificationtransformsmembraneintobone.5. Theboneformationoccursattheperipherywithlayersofbone beinglaiddownanalogoustothering-likediameterofatree. 6. Thistypeofgrowthiscalledappositionalgrowth.7. Skullvault,maxilla,mostofthemandibleandclavicleareformedby intramembranousossification.
138.RadiologicalsignincaseofPerthe's disease? a)Epiphysealcalcification b)Organizedcalcification c)Lateralsubluxationfemurhead d)Restrictionofabduction CorrectAnswer-BAns.is'b'i.e.,OrganizedcalcificationSeronegativespondvloarthropathiesTheseronegativespondyloarthropathiesareagroupofdisordersthatsharecertainclinicalfeaturesandgeneticassociations.Thewordseronegativereferestotheabsenceofrheumatoidfactorinthisgroupofdisorders.Theseronegativespondyloarthropathiesinclude? 1. Ankylosingspondylitis2. Reactivearthritis-->Reitersyndromeandenteritisassociated arthritis 3. Psoriaticarthritis4. Arthritisassociatedwithinflammatoryboweldisease,i.e. enteropathicarthritisFeaturesofseronegativespondyloarthropathiesoOnsetusuallybefore40yearsAbsenceofRAfactorHLA-B27positivePresenceofuveitis
139.Trueaboutproximalfragmentin supratrochantricfractureis? a)Flexion b)Abduction c)Externalrotation d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveDeformityincasesoffracturesubtrochantericfemurTheproximalfemurissurroundedbyverylargeandpowerfulmuscles.Inthecaseofafracture,theirspatialarrangement,combinedwiththeiroriginandinsertion,resultsinaverycharacteristicdeformity.Theproximalfragment,asaresultofcontractionoftheabductors,theexternalrotators,andtheiliopsoasmuscle,isflexed,abducted,andexternallyrotated.Theadductorscausetheshafttobeadducted,andtheforceofgravitycausesthedistalfragmenttofallintosomeexternalrotation.Allthemusclesthatspanthefracturecombinetocauseshortening.Thus,theresultantdeformityisoneofananteriorandlateralbowingoftheproximalshaft,combinedwithconsiderableshorteningandvariabledegreesofexternalrotation.
140.Anterolateralarthroscopyofkneeisfor? a)Toseepatellafemoralarticulation b)Toseetheposteriorcruciateligament c)Toseetheanteriorportionoflateralmeniscus d)Toseetheperipheryoftheposteriorhornofmedial CorrectAnswer-AAns.is'a'i.e.,ToseepatellafemoralarticulationStandardPortalsInKneeArthroscopy:Anterolateralportal? 1. Almostallthestructureswithinthekneejointcanbeseenexcept theposteriorcruciateligament,theanteriorportionofthelateralmeniscusandtheperipheryoftheposteriorhornofthemedialmeniscusintightknees. 2. Located1cmabovethelateraljointlineand1cmlateraltothe marginofthepatellartendon.Anteromedialportal? 1. Usedforadditionalviewingoflateralcompartmentandinsertionof probeforpalpationofmedialandlateralcompartmentstructures. 2. Placed1cmabovethemedialjointline,1cminferiortothetipof patella,and1cmmedialtotheedgeofthepatellartendon.Posteromedialportal? 1. Locatedonthesofttriangularsoftspotformedbytheposteromedial edgeofthefemoralcondyleandtheposteromedialedgeoftibia. 2. Usedforviewingtheposteromedialstructuresandforrepairor removalofthedisplacedposteriorhornofmeniscaltearsandforposteromedialloosebodyremoval.Superolateralportal- 1. Usedfordiagnosticallyviewingthedynamicsofpatello-femoral
joint,excisionofmedialplicae. 2. Locatedjustlateraltothequadricepstendonandabout2.5cm superiortothesuperolateralcornerofpatella.
141.DrippingCandleWaxlesiononspine? a)Metastasis b)TBspine c)Osteopterosis d)Melorheostosis CorrectAnswer-DAns.is'd'i.e.,MelorheostosisMelorheostosisMelorheostosisisamedicaldevelopmentaldisorderandmesenchymaldysplasiainwhichthebonycortexwidensandbecomeshyperdenseinasclerotomaldistribution.CausedbyamutationoftheLEMD3gene.Canbedetectedbyradiographduetothickeningofbonycortexresembling"drippingcandlewax".Disordertendstobeunilateralandmonoostotic,withonlyonelimbtypicallyinvolved.Caseswithinvolvementofmultiplelimbs,ribs,andbonesinthespinehavealsobeenreported.Therearenoreportedcasesofinvolvementofskullorfacialbones.Melorheostosiscanbeassociatedwithpain,physicaldeformity,skinandcirculationproblems,contractures,andfunctionallimitation.Itisalsoassociatedwithabenigninnereardysplasiaknownasosteosclerosis.
142.CauseofCoxavera? a)Congenital b)Perthe'sdisease c)SCFE d)Alloftheabove CorrectAnswer-AAns.is'd'i.e.,AlloftheaboveCoxaveraCoxaverareferstoreducedanglebetweentheneckandshaftofthefemur.Coxaveramaybecongenitaloracquired.1.Congenital(developmental/Infantile)coxavera 1. Thisiscoxavararesultingfromsomeunknowngrowthanomalyat theupperfemoralepiphysis. 2. Itisnoticedasapainlesslimpinachildwhohasjuststarted walking. 3. Inseverecases,shorteningofthelegmaybeobvious.4. Onexamination,abductionandinternalrotationofthehiparelimited andthelegisshort. 5. X-rayswillshowareductioninneck-shaftangle.6. Theepiphysealplatemaybetoovertical.7. Theremaybeaseparatetriangleofboneintheinferiorportionof themetaphysis,calledFairbank'striangle. 8. Treatmentisbyasubtrochantericcorrectiveosteotomy. 2.Aquiredcoxa-veraAquiredcoxa-veraisseenin:- 1. SCFE(slippedcapitalfemoralepiphysis)2. Sequelaeofavascularnecrosisoffemoralepiphysis
Legg-CalvePerthe'sdiseaseFemoralneckfractureTraumatichipdislocationPostreductionofCDHSepticnecrosisAssociatedwithpathologicalbonedisorders 1. Osteogenesisimperfecta2. Fibrousdysplasia3. Osteopetrosis
143.Bunioniscommonlyseenat? a)GreattoeMTPjoint b)Medialmalleolus c)LateralMalleolus d)Shinoftibia CorrectAnswer-AAns.is'a'i.e.,GreattoeMTPjointBunionAhalluxabductovalgusdeformity,commonlycalledabunion,isadeformitycharacterizedbylateraldeviationofthegreattoe,oftenerroneouslydescribedasanenlargementofboneortissuearoundthejointattheheadofthebigtoe.Thebumpitselfispartlyduetotheswollenbursalsacoranosseous(bony)anomalyonthemetatarsophalangealjoint.Thelargerpartofthebumpisanormalpartoftheheadofthefirstmetatarsalbonethathastiltedsidewaystostickoutatitstop.
144.Mostcommontypeofshoulder dislocationis? a)Preglenoid b)Subcoracoid c)Subclavicular d)Posterior CorrectAnswer-AAns.is'a'i.e.,PreglenoidAnteriordislocationoftheshoulderisthemostcommontypeofshoulderdislocation.Headofthehumeruscomesoutoftheglenoidcavityandliesanteriorly.Anteriordislocationofshouldercouldbe:? 1. Preglenoid-Itisthemostcommontypeofanteriordislocationand headliesinfrontofglenoid. 2. Subcoracoid-Theheadliesbelowthecoracoidprocess.3. Subclavicular(infraclavicular)-Theheadliesbelowtheclavicle.4. Intrathoracic-Itisveryrare.
145.Pencilincupdeformityisseenin? a)Rheumatoidarthritis b)Ankylosingspondylitis c)AVN d)Psoriaticarthritis CorrectAnswer-DAns.is`Di.e.,PsoriaticarthritisGull'swingappearance-PsoriaticarthritisOperaglassdeformity-PsoriaticarthritisCupandpencildeformity-Psoriaticarthritis
146.Allaretrueaboutaneurismalbonecyst except? a)Eccentric b)Expansile&lytic c)Treatedbysimplecurettage d)Metaphysisoflongbones CorrectAnswer-CAns.is'c'i.e.,TreatedbysimplecurettageAneurysmalbonecystAneurysmalbonecystoccurinchildrenandyoungadults(5-20years).Thetermaneurysmalisusedbecauseitcausesexpansionofoverlyingcortexlikevascularexpansionofananeurysm.Themetaphysisoflongbonesisinvolvedmostcommonly.Mostcommoninfemurandtibia;howeveranylongbonecanbeinvolved.Othercommonsitesareposteriorelementsofvertebraeandpelvis.athologyCysticspacesofvariablesizes&numberwhicharefilledwithbloodbutnotlinedwithvascularendothelium.Thewallofvascularspaceislinedwithfibroblastcellswithcollagen,giantcells,hemosiderin&osteoid(secondarytomicrofractures).ClinicalfeaturesWithexpandinglesions,painmaybeapresentingfeature.LargecystcanalsocauseswellingPathologicalfracturemayoccur(butlessfrequentthansimplebonecyst).RadiologicalfeaturesofaneurysmalbonecystEccentric,expansileosteolyticlesion
Thecharacteristicfeatureis'blown-out'distensionofonesurfaceofthebone.Overlyingcortexmaybeintactordisrupted.Extensivesclerosisattheinterfacebetweennormalandexpandedcortex(buttersing)maybepresent.Delicatethintrabeculaeischaracteristicandanexpansileballooninglesionmayproducea'soap-bubbleappearance'.Lesionoccursatmetaphysisoflongbones.Othercommonlocationsincludetheposteriorelementsofthespine(pedicle,lamina,transverseprocess,spinousprocess)andpelvis.TreatmentSurgeryisthetreatmentofchoice.Curettageandbonegraftingistheprocedurecommonlyfollowed.
147.Painfularcsyndromeiscausedby impingementof? a)Subacromialbursa b)Subdeltoidbursa c)Rotatorcufftendon d)Bicepstendon CorrectAnswer-CAns.is'c'i.e.,RotatorcufftendonPainfularcsyndromePainintheshoulderandupperarmduringmidrangeofglenohumeralabduction.Causes-supraspinatustendontearortendinitis,subacromialbursitis,fractureofgreatertuberosity.Thespacebetweentheupperendofhumerusandtheacromiongetscompromisedsothatduringmidabductionthetendonofrotatorcuffgetsnippedbetweenthegreatertuberosityandacromion.
148.Thefatherofjointreplacementsurgeryis ? a)Manning b)Girdlestone c)Charnley d)Ponseti CorrectAnswer-CAns.is'c'i.e.,CharnleyFatherofthemodernhipreplacement:ProfessorSirJohnCharnley(1911-82).ProfessorSirJohnCharnleywasaBritishorthopaedicsurgeon,inventorandskilledcraftsman.Heisbestknownforhisdevelopmentofthefirsttrulysuccessfuloperationfortotalarthroplastyofthehip,thelow-frictionarthroplasty.Aswellaspublishingsignificantworksonclosedfracturemanagementandcompressionarthrodesis,hecanalsobeaccreditedwithpioneeringworkinthedevelopmentofclean-airoperatingconditionsandbody-exhaustsuits.
149.Halopelvictractionisusedforcorrecting whichdeformity a)Spine b)PectusCarinatum c)Spondyloptosis d)CoxaVara CorrectAnswer-AAns.is'a'i.e.,SpineHead-pelvicskeletaltractionwasfirstattemptedin1958.Withthedescriptionofthe"halo"skulltractionapparatusbyPerryandNickel(1959),amethodwasprovidedforimmobilisingtheunstablecervicalspine.Fromthisdeveloped"halo-femoral"traction,nowusedbysomesurgeonsforthecorrectionofspinaldeformitiesbeforeandafteroperation.
150.Gamekeepersthumbis? a)Thumbmetacarpophalangealjointulnarcollateralligament rupture b)Thumbmetacarpophalangealjointradialcollateralligament rupture c)Thumbinterphalangealjointulnarcollateralligamentrupture d)Thumbinterphalangealjointradialcollateralligamentrupture CorrectAnswer-AAns.is'a'i.e.,ThumbmetacarpophalangealjointulnarcollateralligamentruptureInjurytothethumbmetacarpophalangealjointulnarcollateralligamentiscommonlyreferredtoasgamekeeperthumborskier'sthumb,althoughtheoriginal"gamekeeper"description(Campbell,1955)referredtoanattritionalulnarcollat-eralligamentinjury.Snowskiingaccidentsandfallsonanoutstretchedhandwithforcefulradialandpalmarabductionofthethumbaretheusualcauses.
151.Von-Rosen'ssignispositivein? a)Perthe'sdisease b)SCFE c)DDH d)CTEV CorrectAnswer-CAns.is'c'i.e.,DDHRadiologicalfeaturesofDDH/CDHInVonRosen'sviewfollowingparametersshouldbenoted. 1. Perkin'sline:Verticallinedrawnattheouterborderofacetabulum2. Hilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiate cartilage 3. Shenton'sline:Smoothcurveformedbyinferiorborderofneckof femurwithsuperiormarginofobturatorforamen. 4. Acetabularindex:Normallyis30?5. CEangleofWiberg:Normalvalueis15-30? Normallytheheadliesinthelowerandinnerquadrantformedbytwolines(Perkin's&Hilgenreiner's).IuDDHtheheadliesinouter&upperquadrantShenton'slineisbrokenDelayedappearance&retardeddevelopmentofossificationofheadoffemurSlopingacetabulumSuperior&lateraldisplacementoffemoralheadVon-Rosen'slineThisisaline,whichhelpsinthediagnosisofDDHininfantslessthan6months.ForthisAPviewofpelvisistakenwithbothlowerlimbin45?
abductionandfullinternalrotation.Upwardprolongationoflongaxisofshaftofthefemurpointstowardsthelateralmarginoftheacetabulumandcrossesthepelvisintheregionofsacroiliacjoint.InCDH,upwardprolongationofthislinepointstowardsanteriorsuperioriliacspineandcrossesthemidlineinthelowerlumberregion--->PositiveVon-Rosen'ssign.
152.Whichofthefollowingisnota diarthrosis? a)Elbowjoint b)Interphalangealjoint c)Skullsutures d)Hipjoint CorrectAnswer-CAns.is'c'i.e.,SkullsuturesFunctionalclassificationofjoints(movement)Jointscanalsobeclassifiedfunctionallyaccordingtothetypeanddegreeofmovementtheyallow: 1. Synarthrosis-Permitslittleornomobility.Mostsynarthrosisjoints arefibrousjoints(e.g.,skullsutures). 2. Amphiarthrosis-Permitsslightmobility.Mostamphiarthrosisjoints arecartilaginousjoints(e.g.,intervertebraldiscs). 3. Diarthrosis-Freelymovable.Alldiarthrosisjointsaresynovialjoints (e.g.,shoulder,hip,elbow,knee,etc.),andtheterms"diarthrosis"and"synovialjoint"areconsideredequivalentbyTerminologiaAnatomica
153.Blockvertebraeareseenin? a)Pagetsdisease b)Leukemia c)TB d)Klippel-Feilsyndrome CorrectAnswer-DAns.isi.e.,Klippel-FeilsyndromeAblockvertebraisatypeofvertebralanomalywherethereisafailureofseparationoftwoormoreadjacentvertebralbodiesAssociations 1. Thereisafrequentassociationwithhemivertebrae/absentvertebra aboveorbelowblocklevel,posteriorelementfusion 2. FusionofmultiplecervicalvertebralbodiesisalsoseeninKlippel- FeilsyndromeandVACTRELanamoly.
154.Bulgesigninkneejointisseenafterhow muchfluidaccumulation? a)100m1 b)400m1 c)200m1 d)<30ml CorrectAnswer-DAns.isi.e.,<30mlThebulgetestisusedtodeterminethepresenceoffluidinthekneejoint.Itisusefulwhenonlyalittlefluidispresentinthejoint.Thesuprapatellarbursaisfirstemptiedoffluidbysqueezingdistallyfromabout15cmabovethepatella.Themedialcompartmentofthekneejoinisemptiedbypressingonthesideofthejointwiththefreehand.Thehandisthenliftedawayandthenthelateralsideissharplycompressed.Ifthetestispositive,arippleisseenontheflattened,medialsurface.Thetestisnegativeiftheeffusionistense-upto120ml.Thebulgetestisusedtodetermineminimalfluidinthekneejoint.Itcandetectaslittleas4-6mloffluidinthekneejoint.
155.SplintusedinCTEVaftercorrection? a)Bohler-Brownsplint b)Thomassplint c)DennisBrownsplint d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,DennisBrownsplintTreatmentofCTEVatbirthIdeallytreatmentshouldbebegunimmediatelyafterbirth,certainlynotmorethan1weeklaterTheprinciplesoftreatmentare:-1.Correctionofdeformitybymanipulation2.Maintenanceofthiscorrectionbyimmobilizingthefootinover-correctedpositioninbetweenthemanipulations.Threemethodsareavailableformaintenance:- 1. Aplasterofpariscast(mostcommonlyused)2. Metalsplints(Denisbrownsplint)3. Adhesivestrapping Amongthese,retentioninaplasterismuchtobepreferred,becauseitholdsthefootintheover-correctedpositionmoreefficientlyandforalongerperiodthandometalsplintsorstrapping.Theplastermustextendtotheupperthigh,withthekneeflexed90?.Theplastermustbechangedeveryweekforthefirst6weeksandthenevery2weeksuntilthecorrectionisachieved.
156.Whichofthefollowingisleastlikely associatedwithvascularinjury? a)Fracturesupracondylarfemur b)Fracturesupracondylarhumerus c)Fractureshaftoffemur d)Fractureshiafthumerus CorrectAnswer-DAns.is'd'i.e.,FractureshafthumerusVascularinjurymaybeseenin- 1. Fracturesupracondylarhumerus--->Brachialartery2. Fractureshaftfemur(especiallydistal3rd)--->Poplitealartery3. Fracturesupracondylarfemur-->Poplitealartery
157.Turn-bucklecastisusedfor? a)Fractureshafthumerus b)Fractureshaftfemur c)Scoliosis d)Cervicalspineinjury CorrectAnswer-CAns.is'c'i.e.,Scoliosis.NameofthecaseUseMinervacastCervicalspinediseaseRisser'scastScoliosisTurn-bucklecastScoliosisShoulderspicaShoulderimmobilisationU-slabFractureofthehumerusHangingcastFractureofthehumerusColle'scastColles'fractureHipspicaFractureofthefemurCylindercastFractureofthepatellaPTBcastFractureofthetibia
158.Frozenpelvisisseenin? a)Osteoarthritis b)Pottsdisease c)Actinomycosis d)Reitersdisease CorrectAnswer-BAns.is'b'i.e.,PottsdiseaseAtermforsignificantinvolvementofthepelvicfloorbymalignancy,usuallycarcinoma,orttuberculosis;inwhichthereismassiveextensionofpathologytotheurinarybladder,femalegenitaltract,andsigmoidcolon.Adequateresectionofafrozenpelvisisvirtuallyimpossible;chemotherapyandradiationtherapyarepalliativeatbest.
159.Allaretrueaboutchronicosteomyelitis except? a)Reactivenewboneformation b)Cloacaisanopeningininvolucrum c)Involucrumisdeadbone d)Sequestrumishardandporus CorrectAnswer-CAns.is'c'i.e.,InvolucrumisdeadbonePathologyinchronicosteomyelitisChronicosteomyelitisoccursmostcommonlyinlongbones.Boneisdestroyedordevitalizedintheaffectedpart.Cavitiescontainingpusandpiecesofdeadbone(sequestra)aresurroundedbyvasculartissue,andbeyondthatbyareasofsclerosisduetoreactionnewboneformation,whichmaytaketheformofadistinctbonysheath(involucrum)Oftensinustrackleadstotheskinsurface;thesinustendstohealandpresentdownrecurrently,butifasequestrumispresentitneverhealspermanently.Thisisbecausesequestraactassubstrateforbacterialadhesioninmuchthesamewayasforeignimplants,ensuringthepersistenceofinfectionuntiltheyareremovedordischargedthroughperforationsintheinvolucrumandsinusesthatdraintotheskin.SequestrumSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissuetryingtoeatthesequestrumaway.Thesequestrumishard,rough,porus,lightinweightandlighterincolourthannormal.Normalpatternofboneislost.(Note:SequestruminsyphilisandTBisheavierthannormalbonebecausesclerosisusuallyprecedesthedeathofthebone).
Onx-ray,sequestrashowupasunnaturaldensefragments,incontrasttothesurroundingosteopenicbone.InvolucrumInvolucrumisreactivenewboneoverlyingasequestrum.Theremaybesomeholesintheinvolucrumforpustodrainout.Theseholesarecalledcloaca.
160.Ischialbursitisisalsoknownas? a)Clergyman'sknee b)Housemaid'sknee c)Weaver'sbottom d)Studentselbow CorrectAnswer-AAns.is'c'i.e.,Weaver'sbottom Prepatellar Hr?,1semaid's bursitis knee Infrapatellar Clergyman's bursitis knee Olecranon Student's bursitis elbowWeaver's Ischia]bursitis bottomOnlateral Tailor'sankle malleolusOngreattoe Bunion
161.Articularcartilage,trueis? a)Veryvascularstructure b)Surroundedbythickperichondrium c)Hasnonervesupply d)Fibrocartilage CorrectAnswer-CAns.is'c'i.e.,HasnonervesupplyArticularcartilageThearticulatingsurfacesofasynovialjointarecoveredbyarticularcartilage.Thearticularcartilagehasfollowingfeatures:- 1. Itisahyalinecartilage2. Itisavascular3. Itisnon-nervous(nonervesupply)4. Doesnothaveperichondrium Articularcartilagelackstheabilitytoproperlyrepairandregenerateitself.Theregenerationcapacityofcartilageislimitedduetoitsisolationfromsystemicregulation,anditslackofofvasculatureandnervesupply.
162.Essexloprestilesioninupperlimb- a)Injurytointerosseousmembrane b)RadialheadandDERfracture c)Radialshaft d)Radialshaftandradio-ulnarjointfracture CorrectAnswer-AAns.is'a'i.e.,InjurytointerosseousmembraneTheEsscx-Ioprestifractureisafractureoftheradialheadwithconcomitantdislocationofthedistalradio-ulnarjointwithdisruptionoftheinterosseousmembrane
163.Brodie'sabscessis? a)Acuteosteomyelitis b)Subacuteosteomyelitis c)Chronicosteomyelitis d)Septicarthritis CorrectAnswer-CBrodie'sabscessisasub-acuteformofosteomyelitis,presentingasacollectionofpusinbone,oftenwithaninsidiousonset.Classically,thismaypresentafterprogressiontoadrainingabscessextendingfromthetibiaoutthroughtheskin.Occasionallyacuteosteomyelitismaybecontainedtoalocalizedareaandwalledoffbyfibrousandgranulationtissue.ThisistermedBrodie'sabscess.MostfrequentcausativeorganismisStaphylococcusaureus.Usuallyoccursatthemetaphysisoflongbones.Distaltibia,proximaltibia,distalfemur,proximalordistalfibula,anddistalradius.Brodie'sabscessisbestvisualizedusingcomputedtomography(CT)scan.Associatedatrophyofsofttissuenearthesiteofinfectionandshorteningoftheaffectedbone.OsteoblastomamaybeaclassicsignforBrodie'sabscess.Inthemajorityofcases,surgeryhastobeperformed.Ifthecavityissmallthensurgicalevacuationandcurettageareperformedunderantibioticcover.Ifthecavityislargethentheabscessspacemayneedpackingwithcancellousbonechipsafterevacuation.
164.Fractureofproximalforearmcast positionis? a)Pronatedflexion b)Neutralposition c)Supinatedposition d)Positiondoesnotmatter CorrectAnswer-CAns.is'c'i.e.,SupinatedpositionFractureproximalthird-supinationofforearmFracturemiddlethird-midpronationofforearmFracturedistalthird-pronationofforearm
165.Whichofthefollowingmovementsis restrictedinPerthe'sdisease- a)Adduction&externalrotation b)Abduction&externalrotation c)Adduction&internalrotation d)Abduction&internalrotation CorrectAnswer-DAns.is.'d'i.e.,Abduction&internalrotationClinicalfeaturesofPerthesdiseasePerthesdiseaseiscommoninmaleofagegroup5-10years.Paininthehip,oftenradiatingtoknee.Limp(antalgiclimp)Limitationofmovement:-Abduction,internalrotationandextensionarelimited,thereforethereisadduction,externalrotation,andflexiondeformity.Shorteningoflimb.Positivetrendelenburgtest.Duringthediseaseprocess,boneageis1-3yearslowerthanthenormal.Afterhealing,boneagereturnstonormal.
166.Windsweptdeformityinfootisseenin? a)Rickets b)RA c)Hyperparathyroidism d)Scurvy CorrectAnswer-BAns.is'b'i.e.,RAWindsweptdeformity 1. Knee:-Avalgusdeformityofonekneeinassociationofvarus deformityofotherkneeisknowaswindsweptdeformity.Itisseenin:Rickets,Physealoseochondromatosis,Hereditarydysplasia(epiphysealdysplasia)ofboneandRheumatoidarthritis. 2. Foot:-Deviationofall-toesinonedirection(usuallylaterally)is knownaswindsweptdeformity.ItisseeninRheumatoidarthritis. 3. Hand:-Deviationofallfingers(usuallymedialy)isknowas windsweptdeformity.ItisseeninRheumatoidarthritis,SLE,andJacoud'sarthropathy.
167.TrueSupracondylarfractureoffemur? a)TypeA b)TypeB c)TypeC d)TypeD CorrectAnswer-AAns.is'a'i.e.,TypeAAusefulclassificationisfromtheAOgroup:typeAfractureshavenoarticularsplitsandaretruly'supra-condylar';typeBfracturesaresimplyshearfracturesofoneofthecondyles;andtypeCfractureshavesupra-condylarandintercondylarfissures
168.Allaretrueaboutmenisciofkneejoint except a)Lateralmeniscuscoversmorearticularsurfaceoftibia- b)Lateralmeniscusismoremobile c)Lateralmeniscusismorepronetoinjury d)Lateralmeniscusissemicircular CorrectAnswer-CAns.is'c'i.e.,Lateralmeniscusismorepronetoinjury
169.Gardenspadedeformityisseenin? a)Barton'sfracture b)Colle'sfracture c)Smith'sfracture d)Bennet'sfracture CorrectAnswer-CAns.is'c'i.e.,Smith'sfractureSmithfracture(Reversecolle'sfracture)Itisafractureofdistalthirdofradiuswithpalmardisplacement.Hence,itiscalledasreversecollesfracture(Incollesfracturethereisdorsaldisplacement).Itislesscommonthancollesfractureandiscausedbyfallonthebackofhand.Thedeformityisoppositetothatofcolle'sfractureandiscalledthe'gardenspadedeformity'.Treatmentisclosedreductionandimmobilizationincastwithforearminsupinationandwristinextension.oPercutaneouspinningmaybedoneinunstablefractures.
170.Dignosticsignofafracture- a)Abnormalmobilityatfracturesite b)Painatthefracturesite c)Tenderness d)Swelling CorrectAnswer-AAns.is'a'i.e.,Abnormalmobilityatfracturesite1.Unfailingsigns(diagnosticorpathognonionic)-?Abnormalmobility?Crepitus?Tenderness2.Reliablesigns?Shortening?Bruise3.Importantsigns?Swelling?Lossoffiinction?Deformity?Blisters4.Lateorinconsistentsigns?Ecchymosis?Swellingduetocallus
171.Fractureneckfemurcauseofnon- union? a)Injurytobloodsupplywithshearingstress b)Poornutritionofthepatient c)Smoking d)Oldageandosteoporosis CorrectAnswer-AAns.is'a'i.e.,InjurytobloodsupplywithshearingstressCausesofnon-unioninfractureneckoffemurare:? 1. Fracturemorphology-highfractureangleandincreasedshear.2. Displacedfracturegrade3/4.3. Fracturecomminution.4. Inadequatereductionandstabilityoffixation.5. Poorbonequality.6. Injurytovascularity-directandtamponadeeffect.7. Absenceofcambiumlayerinperiosteum.8. Factorsinsynovialfluidwhichinhibitthecallusformation.9. Lackofhematoma. 10. Washingawayanddilutionofosteogenicfactors.
172.Exsanguinatingbloodlossin? a)Closedhumerusfracture b)Closedtibiafracture c)Openfemurfracture d)Openhumerusfracture CorrectAnswer-CAns.is'c'i.e.,OpenfemurfractureExsanguinationistheprocessofbloodloss,toadegreesufficienttocausedeath.Shaftfemurfractureoutoftheaboveisassociatedwithmaximumbloodlossandmorebloodlossisexpectedincasesofopenfracture.Thus,themostprobableanswerisopenfractureshaftfemur.Twoimportantfractureswhichcancausesignificantbloodlossare- 1. Fracturepelvis2. Fractureshaftfemur
173.Whichofthefollowingisanorthopedic emergency? a)Intraarticularfracture b)Septicarthritis c)Fracturelateralcondylehumerus d)Fractureneckfemur CorrectAnswer-BAns.is'b'i.e.,SepticarthritisTimingofsurgeryFracturesurgerycanbedividedintoemergency,urgencyorelective.EmergencyEmergencysurgeryisimmediateforlifeandlimbthreateningproblems.Examplesare:- 1. Fractureordislocationwithvascularinjury.2. Fractureswithcompartmentsyndrome3. Irreducibledislocationorfracturedislocationofmajorjoint.4. Compound(open)fractures5. Septicarthritis6. Spinalinjurieswithdeterioratingneurologicaldeficity. UrgencyUrgentsurgeryisthesurgery,whichshouldbedoneearly(within12-36hours),butafterarrangingpropersurgicalfacilities,Importantexamplesare:- 1. Intra-articularfractures2. Fractureneckfemur3. Fracturelateralcondylehumerusinchildren.4. Displacedsupracondylarfracturehumerusinchildren. Elective
Electivesurgeryisplannedproperlyandcanbedoneevenaftersomedelay(3-4daysto3-4weeks).Mostofthesurgeriesinorthopaedicsareelective.Exampleare:- 1. Closedfracturelongbone2. ITfracture3. Mostoftheorthroscopicprocedures4. Arthroplasty
174.Aeroplanesplintisusedin? a)Radialnerveinjury b)Ulnarnerveinjury c)Brachialplexusinjury d)Scoliosis CorrectAnswer-CAns.is'c'i.e.,Brachialplexusinjury Name Use Cramer-wiresplint Emergencyimmobilisation Thomassplint Fracturefemur-anywhere Bohler-Braunsplint Fracturefemur-anywhere Aluminiumsplint Immobilizationoffingers DennisBrownsplint CIEV Cock-upsplint Radialnervepalsy Knuckle-bendersplint UlnarnervepalsyToe-raisingsplint Footdrop Volkmann'ssplint Volkmann'sischaemiccontracture(VIC) Four-postcollar Neckimmbilisation Aeroplanesplint Brachialplexusinjury SOMIbrace Cervicalspineinjury ASHE(Anteriorspinal Dorso-lumbarspinalinjuryhyperextension) brace Taylor'sbrace Dorso-lumbarimmobilisation Milwaukeebrace Scoliosis Bostonbracet Scoliosis Lumbarcorset Backache
175.Commonestmalignanttumorofskeletal system? a)Multiplemyeloma b)Metastasis c)Osteosarcoma d)Chondrosarcoma CorrectAnswer-BAns.is`b'i.e.,MetastasisCommonestbonemalignanciesSecondariesCommonestprimarymalignanttumorA-MultiplemyelomaCommonestprimarymalignanttumorOsteosarcomaoflongbonesCommonestbenigntumorofbone-Osteochondroma(Osteochondromaisnottrueneoplasmsinceitsgrowthstopswithcessationofgrowthattheepiphysealplate)CommonesttruebenigntumorofboneOsteoidosteomaCommonestbenigntumorofhandEnchondroma
176.PoorprognosticindicatorofPott's paraplegia a)Earlyonset b)Activedisease c)Healeddisease d)Wetlesion CorrectAnswer-CAns.is'c'i.e.,HealeddiseasePrognosisofPott'sparaplegiaGoodPoorDegreePartial(onlysensoryormotor)Completeparaplegia(gradeIV)DurationShorterLonger(>12months)TypeEarly(acute)onsetLate(chronic)onsetSpeedofonsetSlow(insidious)Rapid(sudden)AgeYoungerOldGeneralconditionGoodPoorVertebraldiseaseActiveHealedKyphoticdeformity<600>60?CordonMRINormal
MyelomalaciaorsyringomyeliaPreoperativeWetlesionDrylesion
177.Pictureframevertebraisseenin? a)Paget'sdisease b)Osteopetrosis c)Osteoporosis d)Ankylosingspondylitis CorrectAnswer-AAns.is'a'i.e.,Paget'sdiseaseRadiologicalfeaturesofPaget'sdiseaseRadiographicfeaturesdependonthestageofthedisorder:?A.IntheearlyosteolyticphaseActiveboneresorptionisevidentasaradiolucentwedgedareainlongbonestermedas'candleflame'or`bladeofgrass'.Intheflatbonessuchasthecalvariumortheiliacbone,purelyosteolyticlesionisnoted,knownasosteoporosiscircumscripta.B.LaterphasesofnewboneformationBoneremodellingappearsradiographicallyasthickeningofthecortex,coarsetrabeculationandenlargementorexpansionofanentireboneorareaofalongbone.Vertebralcorticalthickeningofthesuperiorandinferiorendplatescreatesa'pictureframevertebra'.Diffuseradiodenseenlargementofavertebraisreferredtoas'ivoryvertebra'.Skullx-rayshowsfocalpatchydensities-cottonballappearance,whichisquitecharacteristicofPagetdisease.Pelvicradiographdemonstratedisruptionoffusionofthesaro-iliacjointsandsofteningwithprotrusioacetabuli.Longbonesrevealbowingdeformitiesandtypicalpageticchangesofcorticalthickeningandexpansionandareasoflucencyand
sclerosis.
178.Barton'sfractureis? a)Fracturedistalendhumerus b)Extra-articularfracturedistalendradius c)Intra-articularfracturedistalendradius d)Intra-articularfracturedistalendradiuswithcarpalbone subluxation CorrectAnswer-AAns.is'd'i.e.,Intra-articularfracturedistalendradiuswithcarpalbonesubluxationBarton'sfractureBarton'sfractureisanintra-articularfractureofdistalradiuswithsubluxationofcarpals.Whencarpalssubluxationoccursanteriorly(volar),itiscalledvolarBarton'sfracture.Itisthecommonesttype.Whencarpalssubluxateposteriorly(Dorsal),itiscalledDorsalBarton'sfracture.TheBarton'sfractureisdifficulttomanagebyconservativemethods:reductionisoftenimperfectandtendstobeunstable,sothatredisplacementoftenoccurs.Therefore,ofteninternalfixationbysmallbuttressplatingisrecommended.
179.Short4thmetacarpalisafeatureof a)Hyperparathyroidism b)Hyperparathyroidism c)Pseudohypoparathyroidism d)Scleroderma CorrectAnswer-CAns.is`c'i.e.,PseudohypoparathyroidismShort41kmetacarpal/metatassal(metacarpalsign)Post-traumaticPostinfection(fromsicklecellanemia)Turner'ssyndromePseudohypoparathyroidismPseudopseudohypoparathyroidismHereditarymultipleexostosisChondroectodermaldysplasia(Ellis-vanCreveldsyndrome)
180.Mostcommonsiteofosteochondritis dessicans? a)Lateralpartofthemedialfemoralcondyle b)Medialpartofthemedialfemoralcondyle c)Lateralpartofthelateralfemoralcondyle d)Medialpartofthelateralfemoralcondyle CorrectAnswer-AAns.is'a'i.e.,LateralpartofthemedialfemoralcondyleJointSiteofosteochondritisdessicansKneeLateralsurfaceofthemedialfemoralcondyleElbowCapitulumofhumerusHipFemoralheadAnkleTalus
181.Allarecommonsitesofprimaryforbone metastasisexcept a)Breast b)Breast c)Brain d)Brain CorrectAnswer-CAns.is`c'i.e.,BrainMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.Certaintumorsareknowntobecommonsourcesofbonemetastasis.Thefollowingprimarytumorsarethemostcommontometastasizeinthebone;breast,prostate,lung,thyroid,kidney,andgastrointestinaltract.ThecommonestsourceofmetastaticbonediseaseiscarcinomaofthebreastInmalesmostcommonsourceisprostatecarcinoma.Bladderanduterinecarcinomasarelesscommonsources.Inchildren,skeletalmetastasesoriginatefromneuroblastoma,Ewing'ssarcoma,andosteosarcoma.
182.Madelung'sdeformityinvolves- a)Humerus b)Proximalulna c)Distalradius d)Carpals CorrectAnswer-CAns.is'c'i.e.,DistalradiusMadelung'sdeformityMadelung'sdeformityisacongenitaldisorderthataffectsgrowthofdistalradius.Theprimarydefectisfailureofnormalgrowthofmedialandpalmarhalvesofthedistalradialphysis,leadingtocurvatureinanmedial(ulnar)andpalmardirection.Theulnaisrelativelylongandbecomesprominentdorsally.Thecarpus(carpalbones)sinks,alongwiththemedial(ulnar)halfofthedistalradialarticularsurface,intothegapsbetweenthetwoforearmbones.
183.Commoncausesofvertebraplana a)TB b)Eosinophilicgranuloma c)Metastasis d)Alloftheabove CorrectAnswer-AAns.is'd'i.e.,AlloftheaboveVertebraplanaThistermisusedtodescribeuniformcollapseofavertebralbodyintoathin,flatdisc.Themostcommoncauseiseosinophilicgranuloma,withthethoracicvertebraemostfrequentlyaffected.Causesare:? 1. Histocytosis-X(Eosinophilicgranuloma)2. Leukemia3. TB4. Metastasis,Multiplemyeloma,Ewing'ssarcoma,lymphoma5. Osteochondritisofvertebralbody(Calve'sdisease)6. Hemangioma7. Trauma8. Steroids
184.DISCprolapseiscommonatallsite except? a)L4-L5 b)L5-S1 c)C6-C7 d)T3-T4 CorrectAnswer-DAns.is'd'i.e.,T3-T4Herniationofintervertebraldiscisacommoncauseofcombinedbackpainandsciatica(Paininbackwithradiationtolowerlimb).Prolapsedintervertebraldiscisoftenprecipitatedbyinjury,butitmayalsooccurintheabsenceofanyrememberedinjury.ThediscbetweenLcandSpandbetweenL4andL5arethosemostoftenaffected(80%).Lowercervicalregion(C's-C6andC6_7)isaffectedin19-20%.
185.Aspiratedsynovialfluidinsepticarthritis willhave? a)Clearcolor b)Highviscosity c)Markedlyincreasedpolymorphonuclearleukocytes d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,MarkedlyincreasedpolymorphonuclearleukocytesAppearance-PurulentClarity-OpaqueViscocity-DecreasedCellcount->80000(>80%PMNs)Example-Bacterialarthritis
186.Whichcancauseloosebodyinthejoint- a)RA b)Ankylosingspondylitis c)OA d)SLE CorrectAnswer-CAns.is'c'i.e.,OACausesofloosebodiesinclude:- 1. Osteoarthritis2. Osteochondritisdessicans3. Osteochondralfracture(injury)4. Synovialchondromatosis5. Charcot'sdisease Amongthese,osteochondralfracturecausessingleloosebodies,whileallothercancausemultipleloosebodies,maximumbysynovialchondromatosis(uptohundrades).
187.Salter'spelvicosteotomyisdonefor treatmentof? a)CTEV b)SCFE c)DDH d)None CorrectAnswer-CAns.is'c'i.e.,DDHTreatmentofCDH/DDHTheaimoftreatmentinDDHistoachieveandmaintainanearlyconcentricreductionandmaintainituntilthehipbecomesclinicallystableandaroundacetabulumcoverit.Treatmentplanisaccordingtotheage:? 1. 1-6monthsofage:-Pavilkharnessand/orVon-rosensplintare usedtomaintainthereduction.Ifdislocationpersists,closedreductionortractionfollowedbycastingisdone. 2. 6-18monthsofage:-Closedreductionortractionfollowedby casting.Ifclosedreductionfails,openreductionfollowedbycastingisrecommended. 3. 18months-3years:-Openreductionwithfemoralshortening(if femoralsiteisinvolved)orsalterasteotomy(ifacetabulumisinvolved). 4. 3-8years:-Openreductionwithfemoralshorteningwithorwithout acetabularreconstructiveosteotomy.Acetabularreconstructionproceduresare:- 1. Salter'sosteotomy2. Chiari'spelvicdisplacementosteotomy3. Pemberton'spericapsularosteotomy
188.AllarefeaturesofPaget'sdiseaseexcept ? a)Defectinosteoclasts b)Commoninfemale c)Cancausedeafness d)Cancauseosteosarcoma CorrectAnswer-BAns.is'b'i.e.,CommoninfemalePagetdiseasePaget'sdiseaseischaracterizedbyincreasedboneturnoverandenlargementandthickeningofthebone,buttheinternalarchitectureisabnormalandtheboneisusuallybrittle.Primarydefectisinosteoclastswithincreasedosteoclasticactivity.Thisresultssecondarilyincreaseinosteoblasticactivity(normalosteoclastsandosteoblastsactinaco-ordinatedmanner).So,characteristiccellularchangeisamarkedincreaseinosteoclasticandosteoblasticactivity.Boneturnoverisacclerated,plasmaalkalinephosphataseisraised(asignofosteoblasticactivity)andthereisincreasedexcretionofhydroxyprolineinurine(duetoosteoclasticactivity).ClinicalfeaturesofPaget'sdiseasePaget'sdiseaseisslightlymorecommoninmalesandisseenafter40yearsofage.Thepelvisandtibiabeingthecommonestsites,andfemur,skull,spine(vertebrae)andclaviclethenextcommonestoMostofthepatientwithPaget'sdiseaseareasymptomatic,thedisorderbeingdiagnosedwhenanx-rayistakenforsomeunrelatedconditionoraftertheincidentaldiscoveryofraisedserumalkalinephosphatase.
Whenpatientsdoespresent,theypresentbecauseanyofthethree:- 1. Pain:-Dullconstantache2. Deformities:-Bowingoflongbones,platybasia.3. Complicationsofthedisease ComplicationsofPaget'sdiseaseFollowingcomplicationscanoccurinPaget'sdisease:- 1. Fracture:Arecommoninweightbearingbones2. Cranialnervecompression:-Maycauseimpairedvision,facial palsy,trigeminalneuralgiaordeafness. 3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.4. Spinalcanalstenosisandnerverootcompression5. Highoutputcardiacfailure6. Osteoarthritis:ofHipandknee7. Rarelyosteosarcoma
189.DeformityintransientsynovitisofHip? a)Abduction b)Flexion c)Externalrotation d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveTransientsynovitisofHipTransientsynovitisofhipisalsoknownasobservationhip,toxicsynovitisorirritablehip.Itsaself-limiting,inflammatoryconditionofthesynovium,thatlastsonlyashorttime(thereforeknownastransient)Itisthemostcommoncauseofhippainandlimpinchildrenunder10yrsofage.Causeisnotknownbutassociationhasbeenseenwitharecenthistoryofanupperrespiratorytractinfection.Presentationiswithhippainorlimp.Thelimbisinattitudeofslightflexion,abductionandexternalrotation.Thechildmayhavelowgradefever.TheESR,C-Reactiveprotein&WBCscountarenormal(ThisdifferentiatesTransientsynovitisfromSepticarthiritisaseriouscondition,inwhichpatienthashighgradefeverandelevatedESR,C-ReactiveproteinandWBCcount).RadiographorultrasoundmayshowwideningofthejointspaceHowever,mostofthetimex-rayisnormal.UsuallythetreatmentofaclinicallysuspectedcaseoftransientsynovitisofhipisBedrest,NSAIDSandobservation.USGguidedaspirationisindicatedfor:- 1. Temperature>99.5?F2. ESR>20(RaisedESR)
3. SeverehippainwithROM
190.Rockerbottomfootisdueto? a)OvertreatmentofCTEV b)Malunitedfracturecalcaneum c)Horizontaltalus d)Neuraltubedefect CorrectAnswer-AAns.is'a'i.e.,OvertreatmentofCTEVRockerbottomfootRockerbottomfootisafootwithaconvexplantarsurfacewithanapexofconvexityatthetalarhead(normalplantarsurfaceisconcave).CausesofRockerBottomfootare:- 1. Congenitalverticaltalus2. OvercorrectionofCTEV3. ImpropercorrectionofCTEV,i.e.forcefulcorrectionofequinesby dorsiflexionbeforecorrectionofadduction,varusandinversion. 4. Edward'ssyndrome,Escobarsyndrome,Apert'ssyndrome. Congenitalverticaltalusmaybeassociatedwitharthrogryposis,Prunebellysyndrome,neurofibromatosis,andspinalmusculardystrophy
191.Hangman'sfractureis? a)SubluxationofC5overC6 b)FracturedislocationofC2 c)Fracturedislocationofanklejoint d)Fractureofodontoid CorrectAnswer-BAns.is'b'i.e.,FracturedislocationofC2Hangman'sfractureHangman'sfractureisbilateralfractureoftheparsinterarticularisofaxis(C2)withtraumaticspondylolisthesisofaxis(C2)overC3vertebrae.ThusHangman'sfractureisnotsimplyafracture,butfracturedislocationofaxis(C2).Themechanismofinjuryisextensionwithdistraction(intrue,judicialhangman'sfracture)andhyper-extension,axialcompression&.flexion(incivilianinjuries,whicharenowmorecommon).ItissecondmostcommontypeofAxis(C2)fracture,secondonlytoodontoidfractures.Fatalatiesarecommon,However,neurologicaldeficitisunusualasthefractureofposteriorarchdecompressthespinalcord.Mostofthefatalitiesoccuratthesceneofinjury,acutepostadmissionmortalityislow.SuccessfulhealingofC2traumaticspondylolishesisisreportedtoapproach95%.Thisismostcommonlyachievedwithnon-operativemeasures,eveninthepresenceofdisplacementofparsinter-articularis.Undisplacedfracturesaretreatedinasemi-rigidorthosis,anddisplacedfractureareclosedreduced&treatedwithhalo-vest.
Occasionally,thehangman'sfractureisassociatedwithaC2/3facetdislocation.Thisisaseverelyunstableinjury;openreductionandstabilizationisrequired.
192.Mostcommoncauseofkyphotic deformity? a)Trauma b)Osteoporosis c)Ankylosingspondylitis d)Rickets CorrectAnswer-BAns.is'b'i.e.,OsteoporosisKvphosisKyphoticdeformitiesarecharacterizedbyonincreaseddorsalcurvatureinthesagittalplaneofspinalalignment.Posturalkyphosis(Posturalroundback)andscheuermann'sdiseasearethemostcommoncausesofkyphosis,particularlyinadolescents.Mostcommoncauseinolderpersonsisosteoporosis.Othercommoncausesaretuberculosisofthevertebralbodies,ankylosingspondylitis,rickets,cancersandspinabifida.Therearethreetypesofkyphoticdeformities: 1. KnuckleProminenceofonespinousprocess2. Gibbus-3Prominenceoftwoorthreespinousprocesses3. Kyphus--->Diffuseroundingofthevertebralcolumn
193.Saturdaynightpalsyiswhichtypeof nerveinjury? a)Neuropraxia b)Axonotemesis c)Neurotemesis d)Completesection CorrectAnswer-AAns.is'a'i.e.,NeuropraxiaSeddon'sclassificationofnerveinjuriesSeddonidentifiedthreetypesofinjuries1.NeuropraxiaThereiscontusionoftheperipheralnervewhichcausesreversiblephysiologicalnerveconductionblock.Theaxiscylinder(i.e.,axonwithitsendoneurium)ispreserved.Thus,thereisphysiologicalconductionblockwithoutanatomicdisruption.Theinjuryistemporaryandrecoveryiscomplete.Itisseenincrutchpalsy,tourniquetpalsy,andsaturdaynightpalsy.2.AxonotemesisThereisinjurytoaxonbutendoneuriumispreserved.Spontaneousrecoveryisexpectedinsomecases.Thisisseeninclosedfracturesanddislocations.3.NeurotemesisThereiscompleteanatomicalsectionofnerve.Norecoverypossible.Itisseeninopenwound.
194.Commonfracturesinchildrenareall except? a)Lacteralcondylehumerus b)Supracondylarhumerus c)Fractureofhand d)Radius-ulnafracture CorrectAnswer-CAns.is'c'i.e.,FractureofhandCommonfracturesinchildren 1. Forearmbonesfractures2. Supracondylarfractureofthehumerus3. Fractureoflateralcondyleofhumerus4. Epiphysealinjuries5. Spiralfractureoftibialshaft
195.Mostcommonsiteofmyositisossificans ? a)Knee b)Elbow c)Shoulder d)Wrist CorrectAnswer-BAns.is'b'i.e.,ElbowMyositisossificansistheextraskeletalhetrotropicossificationthatoccursinmusclesandothersofttissues.Traumaisthemostimportantcauseofmyositisossificans.Usuallythereishistoryofseveresingleinjury.Itismorecommoninchildren.Mostcommonlyinvolvedjointiselbowfollowedbyhip.Thereishistoryoftraumaaroundtheelbow,i.e.fracturesupracondylarhumerus,dislocationofelboworsurgerywithextensiveperiostealstripping.Massagetotheelbowandvigorouspassivestretchingtorestoremovementsareaggravatingfactor.Itoccursinmuscleswhicharevulnerabletotearunderheavyloads,suchasquadriceps,adductors,brachicilis,biceps,anddeltoid.X-rayfindingischaracteristicandshowsdistinctperipheralmarginofmatureossificationandaradiolucentcenterofimmatureosteoid&primitivemesenchymaltissue
196.ThurstonHollandsignisseenin? a)TypeI b)TypeII c)TypeIII d)TypeIV CorrectAnswer-BAns.is'b'i.e.,TypeIIEpiphyseal(PhyseallInjuriesoThejunctionbetweenthemetaphysisandepiphysis,i.e.physealplate/growthplate,istheweakestpointofalongboneinchildrenandis,therefore,mostvulnerabletoshearingforces.oSalterandHarrishaveclassifiedepiphysealinjuriesintofivetypes?TypeI:Completeseparationofepiphysisfromthemetaphysiswithoutfracture.Commoninrickets,scurvyandosteomyelitis.TypeII:Thefractureinvolvesthephysisandatriangleofmetaphysealbone(ThurstonHollandsign).Thisisthecommonesttypeofepiphysealinjuryaccountingfor73percentofcasesover10yearsofage.TypeIII:Thefractureisintra-articularandextendsalongthephysisandthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.TypeIV:Thefractureisintra-articularandextendsthroughtheepiphysis,physisandmetaphysis.Perfectreductionisnecessaryandopenreductionismoreoftennecessarytopreventgrowtharrest.TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrialring)injury.
197.
Whichpartofscaphoidfractureismostsusceptibletoavascularnecrosis? a)Distal1/3rd b)Middle1/3rd c)Proximal1/3rd d)ScaphoidTubercle CorrectAnswer-CAnswer.C.Proximal1/3rdScaphoidfractures(i.e.fracturesthroughthescaphoidbone)arecommon,insomeinstancescanbedifficulttodiagnose,andcanresultinsignificantfunctionalimpairment.EpidemiologyScaphoidfracturesaccountfor70-80%ofallcarpalbonefractures.Althoughtheyoccuressentiallyatanyage,adolescentsandyoungadultsaremostcommonlyaffected.Olderpatientsfallinginasimilarmanneraremorelikelytosustainadistalradialfracture(usuallyaCollesfracture).ClinicalPresentationClassicallytherecanbepaininanatomicalsnuffboxwhichisthoughttohaveasensitivityof~90%andaspecificity~40%Fracturescanoccuressentiallyanywherealongthescaphoid,butdistributionisnoteven: 1. waistofscaphoid:70-80%2. proximalpole:20%3. distalpole(orso-calledscaphoidtubercle):10%
198.Pott'spuffytumor: a)Subperiostealabscessoffrontalbone b)Subperiostealabscessofethmoidbone c)Mucoceleoffrontalbone d)Mucoceleofethmoidbone CorrectAnswer-AAnswer.A.SubperiostealabscessoffrontalbonePott'spuffytumor,firstdescribedbySirPercivallPottin1760,isarareclinicalentitycharacterizedbysubperiostealabscessassociatedwithosteomyelitis.Itischaracterizedbyanosteomyelitisofthefrontalbone,eitherdirectorthroughhaematogenousspread.Thisresultsinaswellingontheforehead,hencethename.Theinfectioncanalsospreadinwards,leadingtoanintracranialabscess.Pott'spuffytumorcanbeassociatedwithcorticalveinthrombosis,epiduralabscess,subduralempyema,andbrainabscess.
199.Scissorgaitisseeninwhichofthe followingcondition: a)Polio b)Cerebralpalsy c)Hyperbilirubinemia d)Hyponatremia CorrectAnswer-BAnswer.B.CerebralpalsyScissorgaitisaformofgaitabnormalityprimarilyassociatedwithspasticcerebralpalsy.Thatconditionandotherslikeitareassociatedwithanuppermotorneuronlesion.
200.Mostcommonjointinvolvedinseptic arthritis: a)Knee b)Hip c)Shoulder d)Elbow CorrectAnswer-AAnswer.A.KneeSepticarthritis(Acutesuppurativearthritis)Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionofajointbypyogenicorganism(bacteria).Thejointcanbecomeinfectedby:? 1. Hematogenousspreadfromadistantsite(mostcommonroute).2. Directinvasionthroughapenetratingwound,intraarticularinjection, arthroscopy. 3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere Metaphysisisintraarticulare.g.,hipandshoulder.ClinicalfeaturesDiseaseismorecommoninchildren.Kneejointisthemostcommonlyaffectedjoint.Otherjointwhichareaffectedarehip,shoulderandelbow.Thechildistoxicwithfever,tachycardia,tachypnea.Thereisseverepain,swelling,andrednessoverthejoint.Movementsareseverelyrestrictedandthejointisheldinthepositionofease.Weightbearingonlimbisnotpossible.
201.Painfularcsyndromepainisfeltduring? a)Midabduction b)Initialabduction c)Fullrangeofabduction d)Overheadabduction CorrectAnswer-AAnswer.A.MidabductionPAINFULARCSYNDROMEOtherNamesImpingementsyndromeSupraspinatussyndromeSwimmer'ssyndromeThrower'sshoulderClinicalsyndromecharacterizedbypainintheshoulderduringanarcofmovementbetween60?and120?ofabduction.
Etiology: 1. Minortearsofthesupraspinatustendon2. Supraspinatustendinitis3. Calcificationofsupraspinatustendon4. Subacromialbursitis5. Fractureofthegreatertuberosity6. Increaseinbulkofthecontentsinthesubacromialspace,seenin inflammationoftherotatorcuff
202.TrueaboutTenosynovitisoffinger? a)Fingersheldinmildextension/Extensiondeformityatthe involvedfingers. b)Tenosynovitisoflittlefingerwillspreadtothumbratherthanring finger. c)Withinvolvementoflittlefingertheinfectioncanspreadtothe indexfinger. d)Treatmentisconservative. CorrectAnswer-BAns.B.TenosynovitisoflittlefingerwillspreadtothumbratherthanringfingerInfectionofthesynovialsheaththatsurroundstheflexortendonInfectionfromtheflexortendonsheathofthethumbcanalsoextendalongtheradialbursatothespaceofParonaandthenintotheulnarbursaandtheflexortendonsheathofthelittlefinger--andviceversa--leadingtoa"horseshoe"abscess.Horseshoeabscess:Maydevelopfromspreadpyogenicflexortenosynovitis,ofmanyindividualshaveaconnectionbetweenthesheathsofthethumbandlittlefingersatthelevelofthewrist
203.Thelastdeformitytobecorrectedby Ponseti'smethodforCTEVis- a)HeelVarus b)Equinus c)FootAdduction d)Cavus CorrectAnswer-BAnswer-B.EquinusPonseti'stechniqueThisinvolvesfirstcorrectingthecavusdeformirythentheadductionandheelvarusandfinallytheequinusdeformity.ThistechniqueisnowmostlyacceptedtechniqueforCTEVcorrectionasitisbasedonbetterunderstandingofthepathoanatomyofthedeformedfoot.Thesuccessofreductionis90-98Percent.
204.Ossificationcentreofscaphoidappears at a)1-6months b)1to2years c)2to4years d)4to6years CorrectAnswer-DAnswer-D.4to6years
205.
Whichofthefollowingisthemostmetabolicallyactivepartoflongbone? a)Epiphysis b)Metaphysis c)Diaphysis d)Physis CorrectAnswer-DAnswer-D.PhysisThegrowthplate(physis)andtheadjacentterminaldiaphysisrepresentthemostmetabolicallyactivesegmentofthelongbone.Thispartchangesdramaticallyduringdevelopmentandhenceitiscalledthemetaphysis
206.Iliotibialbandcontractureinpatientsof poliomyelitiswillleadto a)Flexionathipandknee b)Flexionathip,extentionatknee c)Extentionathipflexionatknee d)Extentionathipandknee CorrectAnswer-AAnswer-A.FlexionathipandkneeDeformities:Iliotibialbandcontracturecanleadto:Flexion,abductionandexternalrotationdeformityathip(mostcommon).Flexonandvalgusatlcneeorsometimestripledeformityatknee(flexion,posteriorsubluxationandexternalroutationoftibiaonfemur).Equinovarusatankleandfoot.Lumbarscoliosisandpelvicobliquityatspineandpelvisrespectively.
207.Managementofdisplacednon comminutedintercondylarhumerusfractureis- a)Openreductioninternalfixation b)Aboveelbowplasterslabapplication c)Olecranonpintraction d)Externalfixation CorrectAnswer-AAnswer-A.OpenreductioninternalfixationItdependsuponthedisplacement.Anundisplacedfractureneedssupportinanabove-elbowplasterslabfor3-4weeks,followedbyexercises.Adisplacedfractureistreatedgenerallybyopenreductionandinternalfixation.Incaseswithseverecomminution,olecranonpintractionisgiventoreducethefractureandmaintainthereduction.
208.Jumpersknee a)Apophysitisofpatellartendonasitinsertsinpatella b)Apophysitisofpatellartendonasitinsertsintibia c)Apophysitisofquadricepstendonasitinsertsinpatella d)Apophysitisofhamstringtendonasitinsertsintibia CorrectAnswer-AAnswer-A.ApophysitisofpatellartendonasitinsertsinpatellaItisalsocalledPatellartendinitisThisisanapophysitis(inflammation)ofthepatellartendonasitinsertsintothepatella.Itisassociatedwithpain,swellingandcrepitus.
209.Proximaltibialepiphysisfusesat- a)12-14years b)14-16years c)16-18years d)18-20years CorrectAnswer-CAnswer-C.16-18yearsThetibiaossifiesfromthreecentres,oneintheshaftandoneineachepiphysis.Ossificationbeginsinmidshaftatabouttheseventhintrauterineweek.Theproximalepiphysialcentreisusuallypresentatbirth:atapproximately10yearsathinanteriorprocessfromthecentredescendstoformthesmoothpartofthetibialtuberosity.
210.Whatisthetreatmentforpatientwith hypertrophicnonunionwithdeformityatfracturesite? a)Notreatmentrequired b)Fixationonly c)Bonegraftingonly d)Fixationwithbonegrafting CorrectAnswer-BAnswer-B.FixationonlyPatientswithhypertrophicnonunionhavesufficientvascularitytohealbutstabilityislackingornormalaxialalignmenthasnotbeenrestored.Thusinacaseofhypertrophicnonunionwithoutdeformity,fixationalonewillprovidestabilityandwillleadtohealing.
211.Chauffeurfractureis- a)Extra-articularfractureofstyloidprocess b)Intra-articularfractureofstyloidprocess c)Intra-articularfractureofbaseof1stmetacarpal d)Extra-articularfractureofbaseof1stmetacarpal CorrectAnswer-BAnswer-B.Intra-articularfractureofstyloidprocessAnintra-articularobliquefractureofthestyloidprocessoftheradius.
212.Whichofthefollowingisnottrueabout Galeazzifracturedislocation? a)Fractureofdistalthirdofradiusanddislocationofdistalradio- ulnarjoint b)Resultsfromfallonoutstretchedhand c)Thedistalendofulnadislocatesvolarlyafterdisruptionofdistal radio-ulnarjoint d)Radiusisangulatedmediallyandanteriorly CorrectAnswer-CAnswer-C.Thedistalendofulnadislocatesvolarlyafterdisruptionofdistalradio-ulnarjointFractureofthedistalthirdoftheradiuswithdislocationofthedistalradioulnarjointThisinjuryisthecounterpartoftheMonteggiafracture-dislocation.Itcommonlyresultsfromafallonanoutstretchedhand.Theradiusfractureisangulatedmediallyandanteriorly.Thedistalradioulnarjointisdisrupted,resultingindorsaldislocationofthedistalendoftheulnaMalunionoccursbecauseofdisplacementofthefragment.Itresultsindeformityandlimitationofsupinationandpronation.
213.Whichofthefollowingisnottrueabout Jeffersonsfracture? a)Itisaburstfractureoftheringofatlasvertebra b)Itisthemostcommontypeofatlasfracture c)FracturedefinintionisparticularlyclearonCTScanimage d)Itisassociatedwithinjuryelsewhereinspinein25%ofthe cases CorrectAnswer-DAnswer-D.Itisassociatedwithinjuryelsewhereinspinein25%ofthecasesSuddensevereloadonthetopoftheheadmaycausea'bursting'forcewhichfracturestheringoftheatlas(Jefferson'sfracture).Thusitisatypeofaxialcompressionforce.ItisthemostcommontypeoffractureoftheAtlas.Thereisnoencroachmentontheneuralcanalandusuallynoneurologicaldamage.Withtheexceptionofpainorlossofsensationinthegreateroccipitalnervedistribution,neurologicalsequelaeareuncommonandmorelikelytoberelatedtoassociatedinjuries.Fractureofatlasareassociatedwithinjuryelsewhereincervicalspineinupto50%ofcases;odontoidfracturesandhangman'sfractureinparticularshouldbeexcluded
214.Whichofthefollowingshoulder movementsis/areweakinpatientsofsupraspinatustear? a)Abduction b)Adduction c)Externalrotation d)Internalrotation CorrectAnswer-AAnswer-A.AbductionPatientsmaytearthesupraspinatustendonacutelybyfallingonanoutstretchedarmorliftingaheavyobject.Symptomsarepainalongwithweaknessofabductionandexternalrotationoftheshoulder.Atrophyofthesupraspinatusmusclesdevelops.
215.Mostmobilesegmentofvertebral columnis- a)Cervical b)Thoracic c)Lumbar d)Sacral CorrectAnswer-AAnswer-A.CervicalThespinalcolumncanbedividedintothreemobile(cervical,thoracic,andlumbarregions)andtwofused(sacrumandcoccyx).Cervicalregion:Itisthemostmobileregionofthespinalcolumnwithrangeofmotionofapproximately80-90degreesofflexion,70degreesofextention,20-45degreesoflateralflexion,andupto90degreesofrotationtobothsides
216.Whichofthefollowingisnottrueabout impingementsyndrome? a)Itisthetendinitiscausedbyinflammationoftherotatorcuff tendons b)Supraspinatustendonismostofteninvolved c)Shoulderabductioninthearcof60-120degreesisparticularly painful d)Surgicaldecompressionofthesubacromialspaceisfrequently indicated CorrectAnswer-DAnswer-D.SurgicaldecompressionofthesubacromialspaceisfrequentlyindicatedImpingementsyndrome(painfularesyndrome)ismostcommonlyduetendinitsofsupraspinatuscomponentofrotatorcuffandischaracterizedbypainin60?-120"ofabduction.Treatmentisinitialyconservative.Surgicaldecompressionisrequiredinfailedcases.
217.Mostdangeroustypeofodontoid fractureasperAndersonandD'Alonzoclassificationanditsrespectivemanagementis a)TypeI-immobilizationinrigidcollar b)TypeII-screwfixation c)TypeIII-halovestimmmobilization d)TypeIV-opereductioninternalfixation CorrectAnswer-BAnswer-B.TypeII-screwfixationOdontoidfractureshavebeenclassifiedbyAndersonandD'Alonzo(1974)asfollows: 1. TypeI-Anavulsionfractureofthetipoftheodontoidprocessdueto tractionbythealarligaments.Thefractureisstable(abovethetransverseligament)anduniteswithoutdifficulty. 2. TypeII-Afractureatthejunctionoftheodontoidprocessandthe bodyoftheaxis.Thisisthemostcommon(andpotentiallythemostdangerous)type.Thefractureisunstableandpronetonon-union.Itrequiresfixationbyscrew. 3. TypeIII-Afracturethroughthebodyoftheaxis.Thefractureis stableandalmostalwaysuniteswithimmobilization.
218.IncreasedQanglepredisposesto a)Medialpatellarsubluxation b)Lateralpatellarsubluxation c)Superiorpatellarsubluxation d)Inferiorpatellarsubluxation CorrectAnswer-BAnswer-B.LateralpatellarsubluxationPatellaralignmentcanbeassessedbymeasuringtheQ-angle(quadricepsangle).Thisistheanglesubtendedbyalinedrawnfromtheanteriorsuperioriliacspinetothecentreofthepatellaandanotherfromthecentreofthepatellatothetibialtubercle.Itnormallyaveragesabout14degreesinmenand17degreesinwomen.Patellofemoralstabilityismaintainedbyacombinationofthearticularsurfacegeometryandsofttissuerestraints.
219.Falseaboutosteogenesisimperfectais- a)Defectivecollagenformation b)Associatedwithcataractformation c)Autosomaldominant d)KnownasBrittlebonedisease CorrectAnswer-BAnswer-B.AssociatedwithcataractformationOsteogenesisimperfecta,alsoknownasbrittlebonediseaseorLobsteinsyndrome,isahereditaryconditioncharacterizedbyfragilityofbones,deafness,bluesclera,laxityofjointsandtendencytoimprovewithage.Itisadiseaseofdefectivecollagenformation.Therefore,collagen-containingtissuesareaffected,e.g.bone,teeth,skin,tendonsandligaments.Primarydefectinboneisdefectiveosteoidformation.Itisusuallytransmittedasanautosomaldominant,butinaseverevariantofthediseasetheparentsarenormalandafreshgenemutationorautosomalrecessiveinheritanceispostulated.Radiologyshowswormianbonesintheskull.
220.ShentonslineisseeninXrayof- a)Antero-posteriorpelviswithbothhips b)Antero-posteriorshoulder c)Lateralcervicalspine d)Laterallumbosacralspine CorrectAnswer-AAnswer-A.Antero-posteriorpelviswithbothhipsWithanormalhipShenton'sline,whichcontinuesfromtheinferiorborderofthefemoralnecktotheinferiorborderofthepubicramus,lookscontinuous;anyinterruptioninthelinesuggestsanabnormalpositionofthefemoralhead.Narrowingofthejoint'space'isasignofarticularcartilageloss,afeatureofbothinflammatoryandnon-inflammatoryarthritis.
221.Apatientpresentswithwristtrauma.On investigationspatientisdiagnosedtohaveasprainedwrist,withoutanyevidenceoffracture.Thereistendernessinanatomicalsnuffbox.Whichligamentiscommonlyinvolved- a)Scapholunateligament b)Radialcollateralligament c)Lunotriquetralligament d)Ulnarcollateralligament CorrectAnswer-AAnswer-A.ScapholunateligamentLunateandscapholunateligmante-Tenderinlunatefractureandscapholunatedissociation
222.Palpablefemurheadonperrectalexam isafeatureofwhichofthefollowingconditions? a)Posteriorhipdislocation b)Anteriorhipdislocation c)Centralhipdislocation d)Inferiorhipdislocation CorrectAnswer-CAnswer-C.CentralhipdislocationIncentralfracture-dislocationofthehipthefemoralheadisdriventhroughthefloor(medialwall)oftheacetabulumtowardsthepelviccavity.Itoccursduetofallontheside,orablowoverthegreatertrochater.
223.Poplitealarteryinjuryiscommonlyseen inwhichtypeoftraumatickneedislocation? a)Anterior b)Posterior c)Medial d)Lateral CorrectAnswer-BAnswer-B.PosteriorPoplitealarteryinjuryiscommonwithbothanteriorandposteriordislocations.Posteriordislocationsmorelikelytoresultindirectinjuryandevenruptureofpoplitealartery(isolatedtransection).Anteriordislocationscausestretchingofpoplitealarterywhichmayleadtointimaldisruptionandthrombosis(damageisoveralongersegmentofartery).
224.Kochermanoeuverisusedfor a)Shoulderreduction b)Elbowreduction c)Ankledislocation d)Kneedislocation CorrectAnswer-AAnswer-A.ShoulderreductionKocher'smanoeuvre:Thisisthemostcommonlyusedmethod.Thestepsareasfollows: 1. Traction--withtheelbowflexedtoarightanglesteadytractionis appliedalongthelongaxisofthehumerus; 2. Externalrotation--thearmisrotatedexternally;3. Adduction--theexternallyrotatedarmisadductedbycarryingthe elbowacrossthebodytowardsthemidline;and 4. Internalrotation?thearmisrotatedinternallysothatthehandfalls acrosstotheoppositeshoulder.
225.Treatmentofscaphoidfracture a)Conservative b)CompressionScrews c)CompressionPlating d)Traction CorrectAnswer-AAnswer-A.ConservativeThetreatmentofascaphoidisessentiallyconservative.Thehandisimmobilizedinascaphoidcastwithwristinlittledorsiflexionandradialdeviation(glassholdingposition).
226.Allofthefollowingaretrueregarding fractureoflateralcondyleofhumerusexcept a)Usuallyseenat6-10yearsofage b)ResultsinGunstockdeformity c)Cubitusvalgusoccurs d)Tardyulnarnervepalsyisseen CorrectAnswer-BAnswer-B.ResultsinGunstockdeformityFractureLateralCondyleHumerus/JupiterfractureItisacommonfractureinchildren.Thelateralcondylar(orcapitular)epiphysisbeginstoossifyduringthefirstyearoflifeandfuseswithshaftat12-16years.Betweentheseagesitmaybeshearedofforavulsedbyforcefultraction.Themaximumchancesofinjuryisbetween6-10years.
227.Mostcommoncomplicationoffractureof tibia a)Infection b)Compartmentsyndrome c)Delayedunion d)Vascularinjury CorrectAnswer-CAnswer-C.DelayedunionThetibiahassomecharacteristicfeatureswhichareresponsiblefordelayedunionornon-unionoftibiafractures.Thedistalthirdoftibiaisparticularlypronefordelayedunionandnonunionbecauseofitsprecariousbloodsupply.
228.Whichofthefollowingisnottrueabout ACLinjury? a)Itisacomponentofthe0'Donoghuetriad b)ACLisintrasynovial c)ACLisimportantforproprioceptivefunction d)Anteriordrawertestisthemostsensitivetest CorrectAnswer-DAnswer-D.AnteriordrawertestisthemostsensitivetestLachman'stestisthemostsensitivetestforanteriorcruciateligamenttears.Itisdonewiththekneeflexedat20degrees.Soitcanbedoneinacuteaswellaschronicinjuries.(becauseinacutecaseswithhemarthrosismoreflexionisusuallynotpossiblesoperforminganteriordrawertestisdifficult).ACLisintrasynovial&hasproprioceptivefunction.
229.Cubitusvalgusdevelopsascomplication of- a)Jupitorfracture b)Smithsfracture c)Malgaignefracture d)Staddlefracture CorrectAnswer-AAnswer-A.JupitorfractureFractureoflateralcondyleofhumerus(Jupitorfracture)
230.X-rayappearanceofsequestrumis- a)Unnaturalradiodensefragments b)Osteopenicfragment c)Fragmentwithhoneycombloculatedappearance d)Radiolucentareawithspeckledcalcification CorrectAnswer-AAnswer-A.UnnaturalradiodensefragmentsSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissuetryingtoeatthesequestrumaway.Onx-ray,sequestrashowupasunnaturaldensefragments,incontrasttothesurroundingosteopenicbone
231.Continuousfixedtractionisprovidedby - a)Thomassplint b)BBsplint c)HamiltonRussel d)Gallows CorrectAnswer-AAnswer-A.ThomassplintCombinedtraction-IfaThomas'splintisused,thetapesaretiedtotheendofthesplintandtheentiresplintisthensuspended,asinbalancedtraction
232.Cobraheadplateisusedfor a)Hiparthrodesis b)Kneearthrodesis c)Elbowarthrodesis d)Anklearthrodesis CorrectAnswer-AAnswer-A.HiparthrodesisSpecialimplantsSPnail-plantsDynamichipscrew(DHS)-IntertrochantericfractureCondylarblade-plate-InterochantericfractureT-plate-CondylarfractureoffemurSpoonplatetibia-CondyarfractureoftibiaCobraplate-FractureofloweraendofHiparthrodesis
233.A20yearoldmalepresentswithhistory ofgradualonsetpainandswellinginleftkneesince6months.Nowsincelast1monthpatienthasstartedlimpingwhilewalkingandalsohasflexiondeformityofknee.Ultrasonographyshowspresenceofsynovialthickening.Whatisthemostprobablediagnosis? a)Tuberculosisofknee b)Pigmentedvillonodularsynovitis c)Synovialsarcoma d)Hemarthrosis CorrectAnswer-AAnswer-A.TuberculosisofkneeUnilateralmonoarticularkneeinvolvementwithgradualonsetpainswellingandflexiondeformity,withsynovialthickeningismostprobablysuggestiveoftuberculosisofknee.Presentingcomplaints:Thepatient,usuallyintheagegroupof10-25years,presentswithcomplaintsofpainandswellinginthekneeOnExamination: 1. Swelling:Thejointisswollen,whichmaybeduetosynovial hypertrophyoreffusion. 2. Muscleatrophy3. Coldabscess
4. Sinus5. Deformity6. Themovementsatthejointarelimited
234.Lockingcompressionplatingforis commonlyindicatedinthefollowingfracturetypes a)Periarticularfractures b)Transverseorobliquefracturesoflongbones c)Intertrochantericfractures d)Fractureoflongbones CorrectAnswer-AAnswer-A.PeriarticularfracturesLockingcompressionplatesarecommonlyusedinperiarticularfractures
235.Tuberculosisofspinemostcommonly affectswhichvertebralsegment? a)Upperdorsal b)Lowerdorsal c)Lumbar d)Cervical CorrectAnswer-BAnswer-B.LowerdorsalThespineisthecommonestsiteofboneandjointtuberculosis.ThemostcommonsiteisDorsolumbarregion.Lowerdorsal(thoracic)regionisthemostcommonsegmentinvolvedfollowedbylumbarsegment.Thetuberculosisofspineisalsocalledpott'sdiseaseortubercularspondylytis.
236.Dunloptractionisatypeoftractionused inmanagementof a)Fracturehumerus b)Fractureradius c)Fracturefemur d)FractureTibia CorrectAnswer-AAnswer-A.FracturehumerusItisusedinmanagementoffracturehumerus.Itisaskintractionappliedtothearmwiththechildsupine.Tractionstrapsareappliedtotheforearmwiththearmsupinated.Acounterweightishungfromtheupperpartofthearmtohelppulltheproximalfragmentofthehumerusposteriorly,toapproximatethedistalfragment.Longitudinaltractionisthenappliedtothesupinatedforearmwiththeelbowflexedtoabout45degrees
237.Whichofthefollowingisnottrueabout themanagementofpottsparaplegia? a)Chemotherapyisthemainstayofconservativemanagement b)Paraplegianotimprovingwithconservativetreatmentevenafter 3-6monthsisanindicationforoperativeintervention c)Decompressionviaanterolateralapproachismostpreferred d)Posteriorfusionandinstrumentationcanbeusedtocorrectthe deformity CorrectAnswer-CAnswer-C.DecompressionviaanterolateralapproachismostpreferredThefollowingmeasuresareadoptedinthetreatmentofPott'sparaplegia:1)ConservativetreatmentChemotherapy(ATTs)isthemainstayofconservativetreatment.Immobilizationbytraction(incervicalspine)orbrace(indorsalregion).Physiotherapyofparalysedlimb.2)Surgicaltreatment 1. Followingarethemainindicationsforsurgery.2. Failedconservativetreatment:-Paraplegiadoesnotshow improvementbyconservativetreatmentevenafter3-6months. 3. Patientdevelopsparaplegiawhileonconservativetreatment.4. Paraplegiagettingworsedespiteadequateconservativetreatment.5. Indoubtfuldiagnosis.6. Rapidonsetparaplegia7. Recurrenceofparaplegiaafterimprovementinitialy. OperativeprocedureforPott'sparaplegia
Therearevariousprocedures,themostcommonlyusedprocedureisanteriordecompressionbysurgicaldebridement(removaldead,necrotic&caseousmaterial)followedbyautogenousstrutgrafting.Thelogiciswellunderstood;thecompressionisfromanteriorsidemostofthetimebecausetuberculosisoccursinvertebralbodywhichliesanteriortothespinalcord.So,anteriordecompressionisthebestprocedure.Anteriordecompressioncanbecausedby: 1. Anteriorapproach:-Calledanteriordecompression.Itisthemost preferredprocedure. 2. Anterolateralapproach:-Calledanterolateraldecompression. Othersurgicalprocedures(otherthananteriordecompression)are: 1. Costo-transversectomy2. Posteriorfusionandinstrumentationtocorrectkyphoticdeformity.3. Laminectomy
238.Firstradiologicalsignforactive tuberculararthritisis- a)Localizedosteoporosis b)Sclerosis c)Jointspacereduction d)Osteophytes CorrectAnswer-AAnswer-A.LocalizedosteoporosisIntuberculararthritis,localizedosteoporosisisthefirstradiologicalsignofactivedisease.
239.33yroldfemalepresentswithaslow growingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasion.Whatistheusualtreatmentforthesame? a)Localresection b)Amputaion c)Chemotherapy d)Radiotherapy CorrectAnswer-AAnswer-A.LocalresectionSlowgrowingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasioninanindividualinthe3rdorLIthdecadeoflifeissuggestiveof-parostealosteosarcoma.Localresectionofthelesionistheusualtreatmentforparostealosteosarcoma.
240.Whichisintramendullarytumoramong carcinomaofbone- a)ClassicalOsteosarcoma b)Parostealosteosarcoma c)Periostealosteosarcoma d)Noneoftheabove CorrectAnswer-AAnswer-A.ClassicalOsteosarcomaInitsclassic(intramedullary)form,osteosarcomaisahighlymalignanttumorarisingwithintheboneandspreadingrapidlyoutwardstotheperiosteumandsurroundingsofttissue.Thetumormostcommonlybeginsinthemetaphysis.Osteosarcomaarisesfromprimitivebone-formingcells.Tumordestroysthebonestructureandeventuallyburstsintothesurroundingsofttissues.
241.Agegroupaffectedbyosteosarcoma- a)Upto10years b)10-20years c)30-40years d)Olderthan45years CorrectAnswer-BAnswer-B.10-20yearsOsteogenicsarcomaisthemostcommonprimarymalignanttumorofboneinchildren.Thisispredominantlyatumorofchildhoodoradolescence,occuringmostcommonlyinthe10-25years.Themostcommonsiteofinvolvementismetaphysisoflongbonearoundknee:-Lowerendoffemur(45%)UpperendofTibia(25%)
242.Anklereflexisaffectedinprolapsed intervertebraldiscatwhatlevel? a)L3-L4 b)L4-L5 c)L5-S1 d)S1-S2 CorrectAnswer-CAnswer-C.L5-S1S1root-Weaknessofplantarflexorsofroot-Overlateralsideoffoot
243.CTEVshoetrueis a)Itisthesameasnormalshoe b)Ithasstraightmedialborder c)Ithasmedicalshoeraise d)Ithasheelwithextralength CorrectAnswer-BAnswer-B.IthasstraightmedialborderIthasstraightinner(medial)borderwhichhelpspreventforefootadduction.Ithasoutershoeraisewhichhelpspreventforefootinversion.Thereisnoheelwhichhelpspreventequinus.
244.Mostcommonlylesionassociatedwith pathologicalfractureinhandis- a)Enchondroma b)Metastases c)Osteoidosteoma d)Osteochondroma CorrectAnswer-AAnswer-A.EnchondromaInhandpathologicalfracturesaremostcommonlyassociatedwithbenignbonetumors.About23%ofthebonetumorsinhandpresentwithpathologicalfractures.Theaverageageofpresentationis37years.Themostcommonboneaffectedistheproximalphalynx,thefifthraywasinvolvedin44%ofthepatients.Majority(approximately88%)ofthepathologicalfracturesarecausedbyenchondromas.
245.Allarefeaturesofinflammatoryarthritis except? a)Morningstiffness b)X-rayshowingsclerosis c)ElevatedESR d)Weightgain CorrectAnswer-BAnswer-B.X-rayshowingsclerosisX-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-rayfeaturesinnon-inflammatoryarthritisrevealssclerosis.
246.AllaretrueaboutMarie-strumpell diseaseexcept: a)Mostcommonlyinvolvesthesacro-iliacjoints b)Enhesitisiscommon c)Morecommoninmales d)Roentgenogramisthemostsensitiveinvestigation CorrectAnswer-DAnswer-D.RoentgenogramisthemostsensitiveinvestigationMarie--StrumpelldiseaseisalsoknownasAnkylosingSpondylitisIntheearlydiseaseprocess,plainx-rays(Roentgenogram)maybereadasnormal-->notverysensitive.Ankylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Itismorecommoninmales(maletofemaleratio2-3:1)
247.Whichofthefollowingisnottrueabout thetestsforhipinstabilityinneonates? a)Ortolanistesthastwoparts b)Theyareperformedat2-3daysofbirth c)Inortolanistestexaminersfingersrestonthegreatertrochanter d)Inbarlowstestexaminersthumbisplacedinthegroin CorrectAnswer-AAnswer-A.OrtolanistesthastwopartsInOrtolani'stest,thebaby'sthighsareheldwiththethumbsmediallyandthefingersrestingonthegreatertrochanters;thehipsareflexedto90degreesandgentlyabducted.Normallythereissmoothabductiontoalmost90degrees.Incongenitaldislocationthemovementisusuallyimpeded,butifpressureisappliedtothegreatertrochanterthereisasoft'clunk'asthedislocationreduces,andthenthehipabductsfully(the'jerkofentry').Ifabductionstopshalfwayandthereisnojerkofentry,theremaybeanirreducibledislocation.
248.Oncogenicosteomalaciaismediatedby a)Phosphatonin b)Calcitonin c)Interleukin2 d)Interleukin6 CorrectAnswer-AAnswer-A.PhosphatoninOncogenicosteomalaciaismediatedbyphosphatoninincertaintumors,particularlyvasculartumourslikehemangiopericytomasandalsofibrohistocyticlesions
249.Whichofthefollowingis/arefeature/sof sprengelsdeformity? a)Elevatedshoulderonaffectedside b)Smallerthanusualscapula c)Shortneck d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveSprengel'sdeformity:Deformityistheonlysymptomanditmaybenoticedatbirth.Theshoulderontheaffectedsideiselevated;thescapulalooksandfeelsabnormallyhigh,smallerthanusualandsomewhatprominent;occasionallybothscapulaeareaffected.
250.Whichofthefollowingistrueabout CTEV a)Itismorecommoninfemales b)Rightfootisusuallymoreaffectedthantheleft c)Talusisdisplacedmedialandplantarwards d)Tibiausuallyshowslateraltorsion CorrectAnswer-CAnswer-C.TalusisdisplacedmedialandplantarwardsCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.CTEVismorecommonmalesinthaninfemales(malestofemaleratio2.5:1).InhalfofthecasesCTEVisbilateral.Rightandleftfootareaffectedequally.
251.Whichofthefollowingisnottrueabout themanipulationmethodstocorrectCTEV? a)Involvesserialcastingandbelowkneeplastercasting b)Inkitesmethoddeformitiesarecorrectedsequentially adductioninversionequinus c)Ponseti'stechniquehassuccessrateof90-98% d)Ponseti'smethodofcorrectioninvolvescavus-->adduction--> heelvarus-->equinus CorrectAnswer-AAnswer-A.InvolvesserialcastingandbelowkneeplastercastingSerialmanipulationandabovekneeplastercastingisdoneweeklyforthefirst6weeks.Otheroptionsarecorrect.
252.Psoriaticarthritismostcommonly involveswhichjoint- a)Distalinterphalangealjoint b)Proximalinterphalangealjoint c)Wristjoint d)Metacarpophalangealjoint CorrectAnswer-AAnswer-A.DistalinterphalangealjointTheseinclude: 1. Arthritisofdistalinterphalangeal(DIP)joints2. Assymetricaloligoarthritis:Mostcommonpattern3. SymmetricalpolyarthritissimilartoRA4. Axialinvolvement(sacroiliacandspine)similartoankylosing spondylitis 5. Arthritismultilans
253.Whichofthefollowingisthe managementforneglectedcaseofCTEVinapatient>10yearsofage? a)Triplearthrodesis b)Anklearthrodesis c)Jessfixation d)Ponseticasting CorrectAnswer-AAnswer-A.Triplearthrodesis*Alltheserequiresurgicalcorrectionandthesurgerydependsupontheageofthepatient.-<4yearsofage:-Postero-medialsofttissuerelease->4years:-Postero-medialsofttissuereleasewithabonyprocedure:-*4-8years:-Dilwyn-Evansprocedure(PMR+Calcaneo-cuboidfusion)*8-10years:-PMR+Wedgetarsectomy*>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,andtalonavicularjoints)
254.Whichofthefollowingisnottrueabout SCFE? a)Malesareaffectedmorefrequently b)Extensionisrestricted c)Commonlyoccursduringadolescence d)Varus,adductionandexternalrotationdeformitiesarepresent CorrectAnswer-BAnswer-B.ExtensionisrestrictedSCFEistheseparationofproximalfemoralcapitalepiphysis(head)atgrowthplate.SCFEoccursduetoweaknessofgrowthplateandoccursduringadolescentperiod(11-15years)whenthegrowthplateisweakduetoacceleratedgrowth.Malesareaffectedmorefrequentlythanfemales.Movementsarerestrictedparticularlyabductionandinternalrotation.Flexionisalsorestrictedandextensionisincreased.AndthisclinicalfeaturedifferentiatesSCFEwithallotherhippathologiesbecausemostofthehippathologieshaveoppositedeformity,i.e.flexiondeformitywithrestrictedextension.Varus,adductionandexternalrotationdeformitiesarepresent.Externalrotationisincreasedalongwithextension.Whenhipisflexeditgoesintoexternalrotation,i.e.obligatoryexternalrotation.ItisaveryimportantsignofSCFE.Waddlinggaitispresent.Trendelenburg'stestispositive.
255.Genurecurvatumisseenin- a)Rheumatoidarthritis b)Poliomyelitis c)Rickets d)Alltheabove CorrectAnswer-DAnswer-D.Alltheabovea)CongenitalrecurvatumThismaybeduetoabnormalintra-uterineposture;itusuallyrecoversspontaneously.Rarely,grosshyperextensionistheprecursoroftruecongenitaldislocationoftheknee.b)LaxligamentsNormalpeoplewithgeneralizedjointlaxitytendtostandwiththeirkneesbackset.Prolongedtraction,especiallyonaframe,orholdingthekneehyperextendedinplaster,mayoverstretchligaments,leadingtopermanenthyperextensiondeformity.Ligamentsmayalsobecomeoverstretchedfollowingchronicorrecurrentsynovitis(especiallyinrheumatoidarthritis),thehypotoniaofrickets,theflailnessofpoliomyelitisortheinsensitivityofCharcot'sdisease.
256.Calcificationinosteosarcomaisdueto presenceof a)Osteoidmatrix b)Osteoblasts c)Highcalciumlevelsinserum d)Highcalcitonin CorrectAnswer-AAnswer-A.OsteoidmatrixThepatternofmineralization(calcification)onradiographmaybehelpfulinidentifyingtumormatrix.Dense,homogenousmineralization(calcification)istypicalofosteoidmatrix,formedbybenignandmalignantbone-forminglesionsCalcifiedringsandarcs,densepunctatecalcification,andflocculentcalcification(small,looselyaggregatedmasses)arepatternofmineralizationofchondroidmatrix,formedbybenignandmalignantcartilageformingtumors.
257.Osteoclastshaveallofthefollowing except- a)Boneresorption b)Receptorforparathormone c)Ruffledborder d)RANKligand CorrectAnswer-BAnswer-B.ReceptorforparathormoneOsteoclastsarefoundinsitesinwhichboneisbeingremodeledThesecellsaretheprincipalmediatorofboneresorptionThecharacteristicfeatureistheareaofinfoldedplasmamembraneknownasruffledborderwhichissurroundedbyanorganellefreeclearzonethroughwhichosteoclastattachestobone&whichisthesiteofboneresorption.RANKbindstoRANKLigandwhichstimulatesboneresorption.Parathormonearepresentonosteoblasts(notonosteoclasts).
258.PTHactsdirectlyonwhichcells? a)Osteoclasts b)Osteocytes c)Osteoblasts d)Macrophages CorrectAnswer-CAnswer-C.OsteoblastsParathormoneactivatesosteoblastswhichthensecretemediatorsofosteoclastogenesisthatstimulateosteoclastsforboneresorption.
259.Mostvascularzoneoftheboneis- a)Metaphysis b)Diaphysis c)Epiphysis d)MedullaryCavity CorrectAnswer-AAnswer-A.MetaphysisMetaphysisisthemostvascularzoneoftheboneespeciallyinchildrenasithaslonghairpinlooparrangedarteriolesandvenulesrunningthroughit.
260.Snappingkneesyndromeisdueto involvementof- a)PesAnserinus b)QuadriepsTendon c)Gastrocnemiusorigin d)lateralcollateralligament CorrectAnswer-AAnswer-A.PesAnserinusSnappingkneesyndromeischaracterizedbypainfulclicks/catchingsensationsexperiencedduringeverymovementofflexionandextension.Itisexperiencedusuallyattheposteromedialcornerofthekneeandususallyisduetoinvolvementofsemitendinosusandgracilistendons.
261.FlexorDigitorumProfundustendon avulsioninjuryleadsto- a)JerseyFinger b)MalletFinger c)GamekeepersThumb d)BoutonierreDeformity CorrectAnswer-AAnswer-A.JerseyFingerJerseyFinger-FlexordigitorumprofundusInjuryMalletFinger-AvulsioninjuryofextensordigitorumtendonGamekeepersThumb-chronicinjurytoulnarcollateralligamentofthumbBennetsFracture-Intraarticularfractureatthebaseof1stmetacarpal
262.Knailcanbeusedforallofthefollowing fracturesexcePt- a)Isthmicfemurshaftfractures b)Intertrochantericfractures c)Lowsubtrochantericfractures d)Distalfemurshaftfractures CorrectAnswer-BAnswer-B.IntertrochantericfracturesKnailisacloverleafshapednailthatreliesontheprincipleofthreepointfixationKnailcanneverbeusedforintertrochantericfracturesasitcannotprovidestabilityinthisfracture.
263.ExtensorCarpiRadialisLongusis- a)Extensorandulnardeviatorofthewrist b)ExtensorandradialDeviatorofthewrist c)InjuredinPosteriorinterosseusnerveinjury d)Weakextensorofthewrist CorrectAnswer-BAnswer-B.ExtensorandradialDeviatorofthewristExtensorcarpiRadialisLongusisaprimaryextensorandradialdeviatorofthewrist.Lossoffunctioncauseswristdrop.
264.Achildpresentedtoanorthopaedic clinicwithalimp.Thesurgeonsuspectedhimtohaveafixedfledondeformityofthehip.Whichtestshouldthesurgeonperformtoconfirmhisfinding? a)Thomastest b)Trendelenburgstest c)Nelatonstest d)Telescopingtest CorrectAnswer-AAnswer-A.ThomastestThomastestisdoneforflexiondeformityofhip.
265.TriggerFingerInvolvesWhichjoint? a)ProximalInterphalngealjoint b)DistalInterphalngealfoint c)Metacarpophalangealjoint d)Carpometacarpaljoint CorrectAnswer-CAnswer-C.MetacarpophalangealjointThemouthofthefibrousdigitalsheathisatthelevelofmetacarpo-phalangealjoint.
266.Effectofhypoparathyroidisrnonbones include- a)Browntumours b)SubperiostealResorptionofBone c)MultipleCystsinBone d)NoneoftheAbove CorrectAnswer-DAnswer-D.NoneoftheAboveFeaturesofHypoparathyroidismPrematureclosureofepiphysesGeneralizedincreaseinbonedensity(Osteosclerosis)CalvarialthickeningSacroiliacsclerosisBandlikedensityinmetaphysicThickenedlaminadura+wideneddiploeDeformedhip(thickening&Sclerosisoffemoralhead&acetabulum)IntracranialcalcificationCalcificationofspinal&OtherligamentsSubcutaneouscalcificationEctopicboneformationOssificationofmuscleinsertions
267.Bonetransportcanbeusedinthe managementof- a)Gapnonunion b)DeformityCorrection c)Communitedshaftfemurfracture d)AvscularNecrosisofFemoralHead CorrectAnswer-AAnswer-A.GapnonunionBonetransporttechniqueisprimarilyusedinthemanagementofgapnonunions.Anosteotomyismadeinthenormalboneandasegamntofboneistransportedtothenonunionsite
268.AIIofthefollowingaretrueregarding applicationofPOPCastexcept- a)PuttingthePlasterrollinwarmwaterhastenssettingtime b)ItisanhydrousCalciumphosphate c)Itcanappliedinpresenceofextremeswelling d)Gangreneisknowncomplicationofatightplastercast CorrectAnswer-BAnswerB.ItisanhydrousCalciumphosphatePOPischemicallyhemihydrouscalciumsulphate.Warmwaterhastenswhilecoldwaterslowsthesettingtime.Plastercastshouldbeavoidedwhenthereisextremeswelling.Commoncomplicationsofplastercastsincludecompartmentsyndrome,gangreneandplastersores.
269.Inuncementedarthroplastyofthehip, thestemremainsattachedtotheboneby- a)BoneIngrowth/ongrowthoverthesurfaceofthestem b)Mechanicalbondingbetweenthestemandbone c)Pressfittingofthesteminthetightcanal d)Adhesionbetweenthestemandboneduetoashesive propertiesofthestem CorrectAnswer-AAnswer-A.BoneIngrowth/ongrowthoverthesurfaceofthestemBoneingrowth-Overporoussurface.Optimalporesizeshouldbe100to400microns.Fibermeshorbeadsarepresentoverthestemsurface.Stemcreatedbysinteringordiffusionbondingprocesses.
270.Duringperfomingatotalhip replacement,thesurgeonfounddestructionofthearticularcartilageandrnultiplewedgeshapedsubchondraldepressions.Whatisthiscalled? a)Osteolysis b)Osteomyelitis c)Osteonecrosis d)Osteogenesis CorrectAnswer-CAnswer-C.OsteonecrosisPresenceofdensewedgeshapedopacitiesintheanterolateralquadrantofthefemoralheadthisiscalledsectoralinvolvement.PresenceofmultiplecysticandscleroticareasAcetabularinvolvementleadstodevelopmentofseverearthritis
271.Suddendorsiflexionoffootmayleadto whichofthefollowinginjuries- a)Anteriortalofibularligamentinjury b)TendoAchillesavulsioninjury c)Ruptureofdeltoidligament d)Tarsaltunnelsyndrome CorrectAnswer-BAnswer-B.TendoAchillesavulsioninjuryAruptureoftheAchillestendonoccurswhenthetendonisstretchedoutsidebeyonditscapacity.Themostcommonsiteofruptureisthe"watershed"lessvascularareaoftendon,whichis4cmproximaltoitsinsertiononcalcaneum.
272.SalterHarrisclassificationisusedfor- a)Supracondylarhumerusfracturesinchildren b)Estimationofgrowthofthephyses c)Physealinjuries d)Severityofdeglovinginjuriestothelimb CorrectAnswer-CAnswer-C.Physealinjuries
273.MilwaukeeBraceisusedin- a)CongenitalKyphosis b)ScheurmannsDisease c)AdolescentldiopathicScoliosis d)Spondylolisthesis CorrectAnswer-AAnswer-A.CongenitalKyphosisTheMilwaukeebraceisaplasticbodyjacketusedinthetreatmentofadolescentswithidiopathicscoliosisandScheuermann'sdisease.TheMilwaukeebrace,alsorefferredtoasaCervico-Thoraco-Lumbo-Sacral-Orthosisbrace,issimilartobracesforthelowerback,butalsoincludesaneckringheldinplacebyverticalbarsattachedtothebodyofthebrace.
274.VertebraPlanaisseeninallexcept- a)HistioctosisX b)Leukemia c)Excessiveuseofsystemicsteroids d)ScheurmannsDisease CorrectAnswer-DAnswer-D.ScheurmannsDiseaseCausesofVertebraPlana 1. Histocytosis-X(Eosinophilicgranuloma)2. Leukemia3. TB4. Metastasis,Multiplemyeloma,Ewing'ssarcoma,lymphoma5. Osteochondritisofvertebralbody(Calve'sdisease)6. Hemangioma7. Trauma8. Steroids
275.Whatisluxatioerecta? a)AnteriorDislocationoftheshoulderjoint b)InferiorDislocationoftheshoulderjoint c)AnteriorDislocationoftheHIPjoint d)PosteriorDislocationofHipjoint CorrectAnswer-BAnswer-B.InferiorDislocationoftheshoulderjointTheheadofthehumerusisbelowtheglenoidcavityandthehumeralshaftispointingoverhead.Itisduetohyperabductioninjury.Itisrareandalsocalledluxatioerectabecausethehumeralheadissubluxated(dislocatedinferiorly)andhumerusshaftpointsupwards(erected).
276.Whichofthefollowingcasts/splintsis usedforfractureshafthumerus? a)Hangingcasts b)Knucklebendersplint c)AeroplaneSplint d)Aboveelbowcast CorrectAnswer-AAnswer-A.HangingcastsHangingcast-FractureofthehumerusTurn-bucklecast-Scoliosis
277.Threepointbonyrelationshipofthe elbowisdisturbedin- a)SupracondylarFractureofthehumerus b)Fracturelateralcondyleofthehumerus c)MonteggiaFracturedislocation d)FractureofProximalRadius CorrectAnswer-BAnswer-B.FracturelateralcondyleofthehumerusThreeprominentbonypointsaroundelbowaremedialepicondyle,lateralepicondyleandtipoftheolecranon.Inelbowinjuries,followingisseeninthreebonyrelationship: 1. Maintained2. Disturbed
278.HamiltonRulertestsignispositivein whichoftheabovementionedconditions? a)Anteriordislocationofshoulder b)Acrornioclavivularjointdislocation c)Posteriordislocationofshoulder d)luxatioerecta CorrectAnswer-AAnswer-A.AnteriordislocationofshoulderHamiltonrulertest:Becauseofflatteningofshoulder,itispossibletoplacearuleronthelateralsideofarmandittouchesacromian&lateralcondyleofhumerussimultaneously(innormalitwouldnotduetoshouldercontour).
279.CubitusValgusDeformityiscommonly seeninwhichofthefollowingconditions- a)MalunitedLateralCondylarfractureofHumerus b)MalunitedSupracondylarFractureofHumerus c)Posteriordislocationofelbow d)Fracturemedialcondyleofhumerus CorrectAnswer-AAnswer-A.MalunitedLateralCondylarfractureofHumerusFracturescommonlyshowingcubitusvalgusdeformityduetomalunion:FracturelateralcondylehumerusMonteggiaFractureDislocation
280.AVNfollowingtranscervicalneckfemur fracturesoccursduetodamagetowhichofthefollowingbloodvessels? a)Lateralretinacularbranchoflateralcircumflexfemoralartery b)Lateralretinacularbranchofmedialcircumflexfemoralartery c)Medialretinacularbranchoflateralcircumflexfemoralartery d)Obduratorartery CorrectAnswer-AAnswer-A.LateralretinacularbranchoflateralcircumflexfemoralarteryLateralcircumflexfemoralarteryItsuppliesthroughanteriorretinacularartery.
281.Lockingofthekneeinvolves- a)Externalrotationoffemurwiththefootofftheground b)Internalrotationofthetibiawiththefootontheground c)Contractionofpopliteus d)Internalrotationoffemurwithfootontheground CorrectAnswer-DAnswer-D.InternalrotationoffemurwithfootonthegroundPhysiologicallockingoccursinextensionwhenthefemurisinternally(medially)rotatedonafixedtibia.Lockingisamechanismthatallowsthekneetoremaininthepositionoffullextensionasinstandingwithoutmuchmusculareffortsandiscausedbyquadricepsfemoris.
282.Fractureneckoffemurin80yearold malesustained1weekbackThetreatmentofchoiceis- a)Hemiarthroplasty b)ExcisionarthroPlastY c)Closedreductionandfixationwiththreecancellousscrews d)Longitudinalskintractionfor6weeks CorrectAnswer-AAnswer-A.HemiarthroplastyClosedreduction&screwfixationIf2attemptsofclosedreductionfail,hemiarthroplastyisdone
283.Whichofthefollowingfracturesofthe neckoffemurareassociatedwithmaximalcompromiseinbloodsupply? a)Intertrochantericfractures b)Basicervicalfracture c)Transcervicalfracture d)SubCapitalfractures CorrectAnswer-DAnswer-D.SubCapitalfracturesThenon-unionandAVNwillbemostcommoninsubcapitalfractureandleastinbasicervicalfracture.
284.Tinelssignisseenin- a)AvascularnecrosisofscaPhoid b)KienbocksDisease c)lstcarpometacarpaljointarthritis d)Carpaltunnelsyndrome CorrectAnswer-DAnswer-D.CarpaltunnelsyndromeMediannervepercussiontest(Tinel'ssign):-Themediannerveisgentlytappedatthewrist.Thetestispositiveifthereistinglingsensation
285.Whichofthefollowingisusedasa substituteforwristextensorsinradialnervePalsY? a)PronatorTeres b)PalmarisLongus c)FlexorDigitorumSuPerficialis d)FlexorDigitorumProfundus CorrectAnswer-AAnswer-A.PronatorTeresPronatorteresisacommonmuscleusedasasubstituteforwristextensorsincaseofwristdropoccurringasaresultofradialnervepalsy.PronatorteresisapronatoroftheforearmsuppliedbyMediannerve.
286.Mostcommoncauseofca4raltunnel syndromeis? a)Pregnancy b)Idiopathic c)Alcoholism d)Occupational-Excessiveuseofvibratoryinstruments CorrectAnswer-BAnswer-B.IdiopathicMostcommontypeofcarpaltunnelsyndromeisidiopathicnoknowncause.
287.A45yearoldcarpenterwithablunt traumatohisarmsustainedafracturefollowingwhichhedevelopedwristdrop,lossofextensionatfingersandlossofsensationsonthelateralaspectofthewristjoint.Whichofthefollowingistrue? a)Patienthasaninjurytothemediannerve b)Heshouldhavealsolostextentionoftheforearm c)Patienthasinjuredtheradialnerveinthespirdgroove d)Thereiscombinedinvolvementoftheradialnerveandmedian nerve CorrectAnswer-CAnswer-C.PatienthasinjuredtheradialnerveinthespirdgrooveRadialnerveinjurymaybehighorlow.1)HighradialnervepalsyInjuryisbeforethespiralgrooveAllmusclessuppliedbyradialnerveareparalysed2)IflesionishighWristdrop,thumbdropandfingerdrop.Inabilitytoextendelbow,wrist,thumb&fingers(MPjoint)Patientcanextendinterphalangealjointsduetoactionoflumbricalsandinterossei.Sensorylossoverposteriorsurfaceofarm&forearmandlowerlateralhalfofforearm.
288.Inwhichofthefollowingdeformitiesis thedistalinterphalangealjointextended? a)Boutonnieredeformity b)Swanneckdeformity c)Zdeforrnity d)ClawHand CorrectAnswer-AAnswer-A.BoutonnieredeformityBoutonnieredeformity:FlexioncontractureofPIPjointandextensionofDIPjoint.
289.Clubfootclinicallypresentaswhat deformity? a)Calcaneovalgus b)Equinovarus c)EquinoCavovarus d)Calcaneovarus CorrectAnswer-CAnswer-C.EquinoCavovarusCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.Thedeformityconsistsoffollowingelements: 1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)2. Inversionoffootatsubtalarjoint(talocalcanealjoint)3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular joint. 4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid- tarsaljoints
290.4yearoldchildpresentedtotheclinic withahistoryoffallonoutstretchedhand.RadiographsrevealedabrokenanteriorcortexwithanintactposteriorcortexOftheradiuswithanexaggeratedbowingoftheradius.Thefracturesustainedisknownas- a)TorusFracture b)Greenstickfracture c)GalleaziFracture d)MonteggiaFrtactureDislocation CorrectAnswer-BAnswer-B.GreenstickfractureGreenstickFracture:Incompletefractureofthebonewithplasticdeformationontheconcavesideofthebone.Thefractureneedstobecompletedtoobtainreduction.
291.Greenstick/Nightstickfracturesareseen in- a)Children b)Elderly c)Youngadults d)Commoninallagegroups CorrectAnswer-AAnswer-A.Children
292.WhodevisedcorrectionofCTEVby serialcastinga- a)IgnasioPonseti b)GerhardtKuntscher c)GavrilIlizarov d)HughOwenThomas CorrectAnswer-AAnswer-A.IgnasioPonsetiIgnasioPonsetipropoundedthetechniqueofserialweeklycasts.
293.Osteosclerosisisafeatureofwhichof thefollowinga- a)Rickets b)Hyperparathyroidism c)PagetsDisease d)OsteogenesisImperfecta CorrectAnswer-CAnswer-C.PagetsDiseasePaget'sdiseaseischaracterizedbyincreasedboneturnoverandenlargementandthickeningofthebone,buttheinternalarchitectureisabnormalandtheboneisusuallybrittle.Primarydefectisinosteoclastswithincreasedosteoclasticactivity.Thisresultssecondarilyincreaseinosteoblasticactivity(normalosteoclastsandosteoblastsactinaco-ordinatedmanner).
294.Allofthefollowingaretrueregarding PagetsDiseaseexcept- a)Pelvisisthemostcommonsite b)Cranialnerveinvolvementmaybeseen c)Highoutputcardiacfailureisoneofthecomplications d)Itmayprogresstoasecondarychondrosarcoma CorrectAnswer-DAnswer-D.ItmayprogresstoasecondarychondrosarcomaPagetsdiseasemayprogresstoasecondaryosteosarcomanotchondrosarcoma
295.Commonestsiteofoccurrenceof chondrosarcomais- a)Pelvis b)Ribs c)Femur d)Proximaltibia CorrectAnswer-AAnswer-A.PelvisAchondrosarcomaisamalignanttumorderivedfromcartilagecellsandittendstomaintainitscartilaginouscharacterthroughoutitsevolutionMostcommonlyinvolvedbonesarepelvis(mostcommon),femur(2ndmostcommon),humerus,ribsandshouldergirdles.Itmaybeatmetaphysisordiaphysis.
296.OnionpeelappearanaceonXrayisseen inwhichofthefollowingconditions? a)EwingsSarcoma b)Osteosarcoma c)Giantcelltumour d)Eosinophilicgranuloma CorrectAnswer-AAnswer-A.EwingsSarcoma OnionPeelAppearance EwingsSarcomaCodmansTriangle Osteosarcoma SunBurstAppearance Osteosarcoma SoapBubbleappearance GCT
297.Hammertoedeformityisseenin- a)Rheumatoidarthritis b)Fracturedistalphalanxofgreattoe c)Bunion d)Osteochondritis CorrectAnswer-AAnswer-A.RheumatoidarthritisFootHalluxvalgus,Hammertoe,etc.
298.Pionfractureis a)Bimalleolar b)Trimalleolar c)DistalfemurIntraarticular d)DistaltibiaIntraarticular CorrectAnswer-DAnswer-D.DistaltibiaIntraarticularPilonfracture-Comminutedintra-articularfractureofdistaltibialend
299.Latecomplicationofelbowdislocation a)Mediannerveinjury b)Brachialarteryinjury c)Myositisossificans d)Alloftheabove CorrectAnswer-CAnswer-C.MyositisossificansLatecomplicationsStiffnessMyositisossificansUnreduceddislocationRecurrentdislocation
300.Whicharthritiscausesnoperiosteal reaction a)Psoriaticathritis b)Reactivearthritis c)Neropathicarthritis d)Rheumatoidarthritis CorrectAnswer-DAnswer-D.RheumatoidarthritisArthritiswithPeriostealReactionarePsoriaticarthritis,ReactiveArthritisAndNeuropathicArthropathy.
301.Proximalhumerusfracturewhichhas maximumchancesofavascularnecrosis a)Onepart b)Twopart c)Threepart d)Fourpart CorrectAnswer-DAnswer-D.FourpartNeer'sclassifiedproximalhumerusfractureinto4types,basedonthesefoursegments:1.Onepartfracture:-Fracturewithminimaldisplacement.2.Twopartfracture:-Onesegmentisdisplacedinrelationtoother.Importanttwopartfracturesare:(i)surgicalneckfracture(mostcommon)(ii)GTfracture,(iii)LTfracture,(iv)anatomicalneckfracture.3.Threepartfracture:-Twosegmentsaredisplacedinrelationtoothertwo.4.Fourpartfracture:-Allfourmajorfragmentsaredisplaced.ChancesofAVNofhumeralheadarehigherinfourpartfracture.
302.Mostcommonmuscledamagedin rotatorcuff a)Supraspinatus b)Infraspinatus c)Subscapularis d)Teresminor CorrectAnswer-AAnswer-A.SupraspinatusDuringinjurytorotatorcuff,tendonsareaffected,notthemuscle.Supraspinatustendonisaffectedmostfrequently.
303.Trueaboutsupracondylarfractureof humerus a)Commoninadults b)Extensiontypemostcommon c)Flexiontypeismostcommon d)None CorrectAnswer-BAnswer-B.ExtensiontypemostcommonSupracondylarhumeralfracturesarethemostcommonelbowfracturesinchildren.Mostcommonagegroupaffectedis5-8years.Boysareaffectedmorethangirls.Leftsideismorecommonthanright.Extensiontypeismostcommon
304.Whatisseenonx-raywithposterior elbowdislocation a)Coronoidprocessposteriortohumerus b)Coronoidprocessanteriortohumerus c)Coronoidprocessbelowhumerus d)None CorrectAnswer-AAnswer-A.CoronoidprocessposteriortohumerusAPview:Greatersuperimpositionofdistalhumeruswithproximalulnaandolecranon(normally,onlyterminalpartofhumerusissuperimposed).
305.
Inposteriordislocationofelbow,mostprominentpart a)Coronoid b)Radialhead c)Olecranon d)None CorrectAnswer-CAnswer-C.OlecranonThereisexaggratedprominenceoftheOlecranon
306.Mostcommoncomplicationoflateral condylehumerusfracture a)Malunion b)Nonunion c)VIC d)Mediannerveinjury CorrectAnswer-BAnswer-B.NonunionLateralspur(Lateralcondylarspurorlateralcondylarovergrowth)isoneofthemostcommoncomplication.Delayedunionornon-unioncanoccuriffractureisundetectedorleftuntreated.CubitusvalgusisacommoncomplicationTardyulnarnervepalsyseenafterseveralyears.Rarelyavascularnecrosisandmyositisossificans.
307.MostcommoncomplicationofCones# a)Malunion b)Avascularnecrosis c)Fingerstiffness d)RuptureofEPLtendon CorrectAnswer-CAnswer-C.FingerstiffnessThecomplicationrateis55%,withthemostcommoncomplicationbeingsomedegreeofresidualfingerandwriststiffness(39%).Mostcommoncomplicationofcolle'sfracture-Fingerstiffness
308.Mostcommoncomplicationoffracture neckoffemur a)Malunion b)AVN c)Nonunion d)Arthritis CorrectAnswer-BAnswer-B.AVNAVNisthemostcommoncomplicationoffemoralneckfracture.Non-unionisthesecondmostcommoncomplicationoffemoralneckfracture.
309.Whichofthefollowingdescribesgrade2 fractureneckfemur? a)Incompletefracture,medialtrabeculaeintact b)Completefracturewithundisplacedneck c)Completefracturewithischemichead d)Moderatedisplacementofneck,vascularitydamaged CorrectAnswer-BAnswer-B.CompletefracturewithundisplacedneckGardenstageI:undisplacedincomplete,includingvalgusimpactedfracturesmedialgroupoffemoralnecktrabeculaemaydemonstrateagreenstickfractureGardenstageII:undisplacedcompletenodisturbanceofthemedialtrabeculae
310.Treatmentofchoiceforfractureneck femurina40yearsoldfemale a)Multiplescrewfixation b)Bipolarhemiarthroplasty c)THR d)None CorrectAnswer-AAnswer-A.MultiplescrewfixationPlacementofmultiplescrewsacrossthefracturedfemoralneckisthetreatmentofchoiceforfemoralneckfractures,andmaybeperformedfollowingeitherclosedoropenreductionusingastandardlateralapproachoramorelimitedpercutaneoustechnique.
311.Talusissuppliedby a)Anteriortibialartery b)Posteriortibialartery c)Dorsalpedisartery d)All CorrectAnswer-DAnswer-D.AllExtraosseousbloodsupply 1. Posteriortibialartery:-Deltoidbranch,arteryofthetarsalcanal.2. Anteriortibialartery:-SuperiorneckbranchfromDorsalpedisartery, Arteryoftarsalcanal. 3. Paronealartery:-Arteryoftarsalsinus.
312.Posteriorscallopingofvertebraeisnot seen a)Neurofibromatosis b)Astrocytoma c)Aorticaneurysm d)Ependymoma CorrectAnswer-CAnswer-C.AorticaneurysmPosteriorscallopingistheconcavitytotheposterioraspectofthevertebralbody.AnteriorScallopingistheconcavitytotheanterioraspectofthevertebralbody.
313.Incervicalspineinjury,firsttobedone a)Trunhead b)Maintainairway c)Immobilizationofspine d)None CorrectAnswer-BAnswer-B.Maintainairway"Initialcareattheaccidentscenemaybecriticaltosurvival.Thefirststepsaretoestablishanairway,maintainoxygenationandimmobilizethecervicalspine".
314.Inscoliosisdegreeofdeformityis calculatedby a)Cobbsmethod b)Hamburgermethod c)Haldanemethod d)Milwaukeemethod CorrectAnswer-AAnswer-A.CobbsmethodCobbangleisameasurementofthedegreeofside-to-sidespinalcurvature,whichisadeformityyoumayknowasscoliosis.
315.Partialanteriordislocationofone segmentofthespineoveranotheris a)Spondylosis b)Spondylolisthesis c)Kyphosis d)Scoliosis CorrectAnswer-BAnswer-B.SpondylolisthesisDisplacement(partial)ofonevertebraeoverotheriscalledSpondylolisthesis.Spondylolisthesisisadefectintheparsinterarticularis.
316.InEMG/NCVstudy,H.reflexcorrelates with a)L3radiculopathy b)L4radiculopathy c)L5radiculopathy d)SIradiculopathy CorrectAnswer-DAnswer-D.SIradiculopathyH-ReflexhasitsutilityininvestigatingpatientswithS1radiculopathy.
317.Inaxillarynerveparalysis,allthe followingaretrueexcept a)Deltoidmuscleiswasted b)Extensionofshoulderwitharmabductedto90degreesis impossible c)Smallareaofnumbnessispresentovertheshoulderregion d)Patientcannotinitiateabduction CorrectAnswer-DAnswer-D.PatientcannotinitiateabductionInitial15?ofabductioniscausedbysupraspinatuswhichissuppliedbysuprascapularnerve(notaxillarynerve)."Attheinitiationofabductionfromneutralposition,thesupraspinatusismoreimportantthandeltoid,whereasdeltoid(middleportion)isofgreaterimportanceforelevationofarmatthehigherangleofabduction,suchas60?".
318.Carpaltunnelsyndromeallarepresent except a)Ulnarnervedysfunction b)Tinelsign c)Phalenssign d)Pain¶esthesiaofwrist CorrectAnswer-AAnswer-A.UlnarnervedysfunctionThesymptomsoftenfirstappearduringnight,sincemanypeoplesleepwithflexedwrists.(Flexiondecreasesthespaceincarpaltunnelwhichresultsinincreasedpressureovermediannerve).Sensorysymptomscanoftenbereproducedbypercussingovermediannerve(Tina'ssign)orbyholdingthewristfullyflexedforaminute(Phalen'stest).Asthediseaseprogresses,clumsinessofhandandimpairmentofdigitalfunctiondevelop.
319.Fairbanktriangleisseenin a)CDH b)Congenitalcoxavara c)Perthe'sdisease d)SCFE CorrectAnswer-BAnswer-B.CongenitalcoxavaraTheepiphysealplatemaybetoovertical.Theremaybeaseparatetriangleofboneintheinferiorportionofthemetaphysis,calledFairbank'striangle[RefEbnezar4th/ep.410]
320.Dysplastichipinachild,investigationof choice a)X-ray b)MRI c)USG d)CTScan CorrectAnswer-CAnswer-C.USGUltrasonographyistheinvestigationofchoiceforDDH.Itvisualizesthecartilageandallowsdynamictestingofthehipjoint.
321.PrimarypathologyinCDH a)Largeheadoffemur b)Shallowacetabulum c)Excessiveretroversion d)Evertedlimbus CorrectAnswer-BAnswer-B.ShallowacetabulumFollowingchangesareseenindislocatedhip: 1. Thefemoralheadisdislocatedupwardandlaterally.Itsbony nucleusappearslateanditsdevelopmentisretarded,thereforeheadissmall. 2. Femoralneckisexcessivelyanterverted.3. Acetabulumisshallow,withasteepslopingroof(Thisisconsidered tobetheprimarypathology).
322.InneglectedcasesofCTEV,jointfused are a)Calcaneocuboid,talonavicularandtalocalcaneal b)Tibiotalar,calcaneocuboidandtalonavicular c)Anklejoint,calcaneocuboidandtalonavicular d)Noneoftheabove CorrectAnswer-AAnswer-A.Calcaneocuboid,talonavicularandtalocalcanealJointsfusedintriplearthrodesisforCTEVarei)Subtalar(tolocalcaneal)joint,ii)Calcaneocuboidjoint,iii)Tolonavicularjoint.
323.Osteonerosisisseeninallexcept a)Fractureneckfemur b)Sicklecellanemia c)Perthe'sdisease d)Paget'sdisease CorrectAnswer-DAnswer-D.Paget'sdiseaseStoragedisorders:-Gaucher'sdiseaseCaissondisease:-DysbaricosteonecrosisHemoglobinopathy&Coagulationdisorder:-Sickelcelldisease,Familialthrombophilia,Hypofibrinolysis,Hypolipoproteinemia.Congenitaldisorders:-Perthe'sdisease,Slippedcapitalfemoralepiphysis.Hematologicalmalignancies:-Leukemia,lymphoma,Polycythemia.Hyperlipedemia:-Nephroticsyndrome
324.Afterchronicuseofsteroidsseverepain inrighthipwithimmobilityisdueto a)Avascularnecrosis b)Perthesdisease c)Hipdislocation d)Osteoarthritis CorrectAnswer-AAnswer-A.AvascularnecrosisPaininhipandlimitatationofmovement(immobility)ofterchronicuseofsteroidssuggestthediagnosisofAVNoffemoralhead.
325.Inelbow,osteochondritisusually involves a)Olecranon b)Trochlea c)Radialhead d)Capitulum CorrectAnswer-DAnswer-D.CapitulumKnee-LateralsurfaceofthemedialfemoralcondyleElbow-CapitulumofhumerusHip-FemoralheadAnkle-Talus
326.Mostcommonorganismcausing infectionafteropenfracture a)Pseudomonas b)Staphylococcusaureus c)Klebsiella d)Gonococcus CorrectAnswer-AAnswer-A.Pseudomonasstaphylococcusaureuswasthemostcommonorganismcausinginfectioninopenfractures.MorerecentstudieshaveshownthatgramnegativeorganismssuchaspseudomonasaeruginosaandE.coliarebecomingmorecommon
327.Septicarthritisisdiagnosedby a)X-ray b)Jointaspiration c)USG d)MRI CorrectAnswer-BAnswer-B.JointaspirationQuickestandbestmethodofdiagnosisofsepticarthritisisaspirationofjoint.
328.Sequestrumisbestdefinedas a)Apieceofdeadbone b)Apieceofdeadbonesurroundedbyinfectedtissue c)Apieceofbonewithpoorvascularity d)None CorrectAnswer-BAnswer-B.ApieceofdeadbonesurroundedbyinfectedtissueSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissue.
329.Cloacaearepresentin a)Sequestrum b)Involucrum c)Normalbone d)Myositis CorrectAnswer-BAnswer-B.InvolucrumInvolucrumisreactivenewboneoverlyingasequestrum.Theremaybesomeholesintheinvolucrumforpustodrainout.Theseholesarecalledcloaca.
330.ComplicationofjointTB a)Fibrousankylosis b)Bonyankylosis c)Normalhealing d)None CorrectAnswer-AAnswer-A.FibrousankylosisTheoutcomeoftuberculararthritisisfibrousankylosis,exceptinspine.Spineistheonlysitewheretuberculosishealswithbonyankylosis.
331.FalseaboutPott'sspine a)Commonestatdorsolumbarjunction b)Alwayshealsbychemotherapy c)Backpainisanearlysymptom d)Thereisdiscspacenarrowingonx-ray CorrectAnswer-BAnswer-B.AlwayshealsbychemotherapyChemotherapyisthemainstayoftreatment.Butitisnoteffectivealways,surgeryisoftenrequiredinsomecases.Commonestsiteofpott'sspineisdorsolumbarjunction.Backpainistheearliestsymptomandnarrowingofdiscspaceistheearliestradiologicalsign.
332.Apparentlengtheningisseeninwhich stageofTBHip a)StageI b)StageII c)StageIII d)None CorrectAnswer-AAnswer-A.StageIStageofsynovitis(Stage1):-Threeiseffusioninthehipjointwhichdemandsthehiptobeinapositionofmaximumcapacity.Thispositionisacquiredbyflexion,abductionandexternalrotation.Becauseofabductiondeformity,thereisapparentlengthening.
333.Tuberculosisspine;mostcommonsite is a)Sacral b)Cevical c)Dorsolumbar d)Lumbosacral CorrectAnswer-CAnswer-C.DorsolumbarThemostcommonsiteisDorsolumbarregion.Lowerdorsal(thoracic)regionisthemostcommonsegmentinvolvedfollowedbylumbarsegment.Thetuberculosisofspineisalsocalledpott'sdiseaseortubercularspondylytis.
334.Anterolateraldecompressionisdonefor a)Spinaltuberculosis b)ChestTB c)HandTB d)FootTB CorrectAnswer-AAnswer-A.SpinaltuberculosisAnteriordecompressioncanbecausedby:- 1. Anteriorapproach:-Calledanteriordecompression.Itisthemost preferredprocedure. 2. Anterolateralapproach:-Calledanterolateraldecompression.
335.Tumorwithmaximumbonematrix a)Osteoidosteoma b)Chondrosarcoma c)Enchondroma d)None CorrectAnswer-AAnswer-A.OsteoidosteomaDense,homogenousmineralization(calcification)istypicalofosteoidmatrix,formedbybenignandmalignantboneforminglesions.
336.Whichofthefollowingistrueabout Giantcelltumor a)Usuallypresentsasalyticlesionwithscleroticrim b)Alwaysbeingn c)Epiphysealorigin d)Seeninagelessthan15years CorrectAnswer-CAnswer-C.EpiphysealoriginGCTisanosteolytictumorarisingfromtheepiphysisandiscommonbetweentheageof20-40years.Thecommonestsitesarelowerendoffemurandupperendoftibia.Othercommonsitesarelowerendradiusandupperendofhumerus.Itmayalsooccurinthespineandsacrum.Theradiologicalfeaturesare:- 1. Asolitarymaybeloculated,lyticlesion.2. Eccentriclocation,oftensubchondral.3. Expansionoftheoverlyingcortx(expansilelesion).4. Soap-bubble'appearance
337.Striatedvertebraisseenin a)TBspine b)Haemangioma c)Chordoma d)Metastasis CorrectAnswer-BAnswer-B.HaemangiomaHaemangiomaofthevertebrahasatypicalradiographicpictureintheformoflossofhorizontalstriationsandprominenceofvertebralstriations.ThereisPolkadotappearanceonCT.Intheskull,hemangiomagenerallyaffectsthecalveriumandisseenasanexpansilelyticlesionwhichhasasunburstappearancewithstriationradiatingfromthecentre.Ahemangiomamaybeidentifiedduetoassociatedphlebolithanditmaycauselocalgigantismoftheinvovledarea.
338.Metastasisnotfoundin a)Femur b)Humerus c)Fibula d)Spine CorrectAnswer-CAnswer-C.FibulaMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.
339.Periostealreactionsisseenin a)Osteomyelitis b)Syphilis c)Tumor d)All CorrectAnswer-DAnswer-D.AllInfection:-Osteomyelitis,Brodie'sabscess,syphilisNeoplasmsBenign:OsteoidosteomaMalignant:Ewing'ssarcoma,osteosarcomaEosinophilicgranulomaHealedstressfractureHypertrophicpulmonaryosteoarthropathy
340.Volkmannscontracture,whicharteryis involved a)Radial b)Brachial c)Ulnar d)Interosseus CorrectAnswer-BAnswer-B.BrachialInjurytobrachialarterymaycausenerveandmuscleischemia(Volkmann'sischemiaofflexorcompartment)ormayresultinpostischemicswellingduetoedemaorhemorrhage,therebycausingcompartmentsyndrome,whichcancause,ifnottreatedimmediatealy,Volkmann'sischaemiccontracturelateron.
341.Castsyndromeisdueto a)Aboveelbowcast b)Belowelbowcast c)HipSpica d)Abovekneecast CorrectAnswer-CAnswer-C.HipSpicaCastsyndrome(Superiormesentricarterysyndrome)isgastricdilatationwithpartialorcompleteobstructionoftheduodenum.Itismostfrequentlyseeninorthopaedicspatientswhohavehadspinalsurgeryorwhoareinhipspicaorbodycasts.
342.Heterotopicossificationoccursin a)Bone b)Joint c)Softtissue d)None CorrectAnswer-CAnswer-C.SofttissueHeterotopicossificationistheprocessbywhichbonetissueisformedinsofttissueoutsidetheskeleton.
343.Felonmostcommoncomplication a)Osteomyelitis b)Subungualhematoma c)Infectivearthritis d)None CorrectAnswer-AAnswer-A.OsteomyelitisFelonistheinfectionofdistalpulpspace.Nexttoacuteparanychia,thisisthemostcommonhandinfection.Itusuallyfollowsapinprick,withindexfingerandthumbbeingthecommonunfortunatevictim.Thepatientinitiallycomplainsofdullpainandswelling.Complicationsareosteomyelitis(mostcommon),skinnecrosis,osteonecrosisofdigitsandrarelytenosynovitisorinfectivearthritisofDIPjoint.
344.Mostcommonboneforwhichnailingis done a)Radius b)Ulna c)Tibia d)Humerus CorrectAnswer-CAnswer-C.TibiaMostcommonbonesforwhichintramedullarynailingisdoneareTibiaandfemur.
345.Whyfractureshaftfemurisearly stabilised a)Topreventbloodloss b)ARDS c)Nonunion d)Compartmentsyndrome CorrectAnswer-AAnswer-A.TopreventbloodlossFractureshaftfemurcancauseupto2Lofbloodlossandseverehypotension,ifnotimmoblizedearly.thefractureshaftfemurshouldbeimmoblizedearly.ThiscanbetemporaryimmobilizationbyTTsplintfollowedbysurgeryorcanbebyimmediatesurgery.
346.Drugusedinosteoarthritis a)Methotrexate b)Glucosamine c)Sulfasalizine d)All CorrectAnswer-BAnswer-B.GlucosamineChondroitinsufateDiseasemodifyinganti-osteoarthritisdrugs(DMAOAD)Diacerin(IL-1antagonist),Licofelone(combinedCOX-LOXinhibitors)Steroids(inacuteexacerbations).
347.Pannusisseenin a)OA b)RA c)Gout d)None CorrectAnswer-BAnswer-B.RAPannusisseeninrheumatoidarthritis.Itisneoplasm-likegrowthofinflammedsynovialtissuethatleadstodestructionofjointstructures.Thearticularcartilageatpannusinterfaceappeartoundergochondrolysis.Pannusappeartodevelopwithinandaroundthesynovium,subsequentlycreepingintoandoverthearticularcartilageandenvelopingitandtheunderlyingboneinadeathlikegrasp.
348.Sausagedigitsisseenin a)Lymearthritis b)Osteoarthritis c)Psoriaticarthritis d)None CorrectAnswer-CAnswer-C.PsoriaticarthritisSausagedigitreferstodiffusefusiformswellingofthedigitduetosofttissueinflammationfromunderlyingarthritisordactylitis.Causesare:-PsoriaticarthritisOsteomyelitisSicklecellanemiaSarcoidosisTuberculardactylitis(spinaventosa)
349.Greenstickfractureis a)Fractureinadults b)Completefracture c)Incompletefracture d)Fracturespine CorrectAnswer-CAnswer-C.IncompletefractureAgreenstickfractureisanincompletetransversefracturepatternseeninchildren.
350.Resorptionofdistalphalanxisseenin a)Scleroderma b)Hyperparathyroidism c)Reiter'ssyndrome d)All CorrectAnswer-DAnswer-D.AllAcro-osteolysisisthetermusedtodescriberesorptionofthedistalphalangealtufts.Causesare:- 1. Scleroderma2. Trauma&thermalinjury3. Hyperparathyroidism4. Epidermolysisbullosa5. Arthropathy(RA,Psoriasis)6. Neuropathy(diabetes,syringomyelia)7. Raynaud'sdisease8. Reiter'ssyndrome
351.Footdropiscausedbyinjurytowhich nerveinvolvement: a)Femoralnerve b)Tibialnerve c)Commonperonealnerve d)Sciaticnerve CorrectAnswer-CAnswerC)CommonPeronealNerveFootdrop,sometimescalleddropfoot,isageneraltermfordifficultyliftingthefrontpartofthefoot.CausesFootdropiscausedbyweaknessorparalysisofthemusclesinvolvedinliftingthefrontpartofthefoot.Causesoffootdropmightinclude: 1. Nerveinjury.Themostcommoncauseoffootdropiscompression ofanerveinyourlegthatcontrolsthemusclesinvolvedinliftingthefoot(peronealnerve).Thisnervecanalsobeinjuredduringhiporkneereplacementsurgery,whichmaycausefootdrop. 2. Anerverootinjury--"pinchednerve"--inthespinecanalso causefootdrop.Peoplewhohavediabetesaremoresusceptibletonervedisorders,whichareassociatedwithfootdrop. 3. Muscleornervedisorders.Variousformsofmusculardystrophy, aninheriteddiseasethatcausesprogressivemuscleweakness,cancontributetofootdrop.Socanotherdisorders,suchaspolioorCharcot-Marie-Toothdisease. 4. Brainandspinalcorddisorders.Disordersthataffectthespinal cordorbrain--suchasamyotrophiclateralsclerosis(ALS),multiplesclerosisorstroke--maycausefootdrop.
352.MusclesaffectedinDequervain tenosynovitis- a)Abductorpollicislongusandextensorpollicisbrevis b)Adductorpollicislongusandextensorpollicisbrevis c)AbductorpollicislongusandFlexorpollicisbrevis d)AdductorpollicislongusandFlexorpollicisbrevis CorrectAnswer-AAns.A.AbductorpollicislongusandextensorpollicisbrevisDeQuervainsyndrome,isatenosynovitisofthesheathortunnelthatsurroundstwotendonsthatcontrolmovementofthethumb.DeQuervainsyndromeinvolvesnon-inflammatorythickeningofthetendonsandthesynovialsheathsthatthetendonsrunthrough.Thetwotendonsconcernedarethoseoftheextensorpollicisbrevisandabductorpollicislongusmuscles.
353.WhatismeantbyPerilunatedislocations ? a)Lowerradius,scaphoidandlunateandcapitateallinsame plane b)Lowerradius,scaphoidandcapitateinalignment,lunatealone outofplane c)Lowerradius,scaphoidandLunateinalignment,capitatealone isoutofplane d)Bothlunateandcapitateareoutofplane CorrectAnswer-BAns.B.Lowerradius,scaphoidandcapitateinalignment,lunatealoneoutofplanePerilunatedislocationandperilunatefracturedislocationareinjuriesthatinvolvetraumaticruptureoftheradioscaphocapitate(RSC)ligament,thescapholunateinterosseousligament,andthelunotriquetralinterosseousligament.Lateralradiographswillreveallossofcollinearitybetweenthecapitate,lunate,andradiusTypicallythecapitateislocateddorsaltothelunateandisalignedwiththeradius
354.Fallenfragmentsign- a)Simplebonecyst b)Osteosarcoma c)Adamantinoma d)Aneurysmalbonecyst CorrectAnswer-AAns.A.SimplebonecystThefallenfragmentsignreferstothepresenceofabonefracturefragmentrestingdependentlyinacysticbonelesion.Thisfindingissaidtobepathognomonicforasimple(unicameral)bonecystfollowingapathologicalfracture.Althoughithasoccasionallybeenreportedwithothercysticlesions,e.g.eosinophilicgranuloma
355.Youarepostedasaninternin causality.Whichamongthefollowingpatientswithfracturewillbeyour1stprioritytocallorthoPGandinform? a)Patient'sfingerisblackening b)Patientcan'textendhisarm c)A10cmabrasion d)IntraarticularfractureofElbowJoint CorrectAnswer-AAns.A.Patient'sfingerisblackeningBlackeningoffingerafterFractureisanindicationofcutofofbloodsupplythatmayleadtoseverecomplicationlikegangrene.SothisshouldbethefirstPrioritytotreatamongalltheaboveoptions
356.InRheumatoidarthritis,whichtypeof cellsareprominentlypresent? a)Bcells b)Tcells c)Macrophages d)Dendriticcells CorrectAnswer-CAns.C.MacrophagesSynovialliningorintimallayer:Normally,thislayerisonly1-3cellsthick.InRA,thisliningisgreatlyhypertrophied(8-10cellsthick).Primarycellpopulationsinthislayerarefibroblastsandmacrophages.
357.8thand9thribcostalcartilageforms whichtypeofjoint? a)Costochondraljoint b)Interchondraljoint c)Synovialjoint d)Costovertebraljoint CorrectAnswer-CAns.C.SynovialjointThesixth,seventh,eighth,ninthandtenthcostalcartilagesarejointedwitheachotheralongthebordersbysynovialjoints.Costochondraljointmeansthejointbetweentheribanditscostalcartilage.Thefirstcostalcartilageofbothsidesattachtothemanubriumsterni.Atthisjoint,nomovementispossible.Thesecondcostalcartilagearticulateswiththebodyofsternumandthemanubriumsternibyasynovialjointwheremovementispossible.Thethirdtoseventhcostalcartilagesarticulatewithlateralborderofthebodyofsternumatmobilesynovialjoints.
358.Tomsmithsepticarthritisis- a)AcuteGonococcalarthritis b)Smallpoxarthritis c)Septicarthritisofinfancy d)Chronicpyogenicarthritis CorrectAnswer-CAns.C.SepticarthritisofinfancySepticarthritisofinfancy(Tomsmithsepticarthritis)ItisasepticarthritisofhipseenininfantsTheonsetisacutewithrapidabscessformation,whichmayburstoutorbeincisedandhealsrapidly.TelescopetestispositiveClinicallythisconditionresemblesacongenitaldislocationofhip
359.Awomandevelopedpainandcrawling sensationonherlegsatnight.Clinicalhistoryofrestlesslegsyndrome.Drugofchoice?. a)Pramipexole b)Gabapentin c)VitaminB12 d)Irontablets CorrectAnswer-AAns.apramipexoleRestlesslegsyndrome:Subjectivesensation"creepy-crawly"feelinginthelimbs,andirresistibleurgetomovethelegswhenatrestorwhiletryingtofallasleep.Whentheindividualislyinginbedandrelaxing,heorsheisdisturbedbythesesensations.Thenheorshemovesthelegsandagaintriestofallasleep.Thiscyclesometimescontinuesforhoursandresultsinprofoundinsomnia.Treatment:Thedopaminergicagonists'pramipexoleandropiniroleareFDAapprovedandrepresentthetreatmentsofchoice.Ref.KaplanandSadock'sSynopsisofPsychiatry-11thEdition(Pageno559)
360.HistoryofArthritisinvolving1stMCP joint,otherPIP&DIPjoints,spareswristandankle.Whatcouldbethediagnosis a)Osteoarthritis b)Rheumatoidarthritis c)Psoriaticarthritis d)Gout CorrectAnswer-AAns:a.Osteoarthritis>Thedistalinterphalangeal(DIP)jointisactuallythemostcommonlocationonthebodyforosteoarthritis(OA).>Thefrequencyofhandarthritis,OAattheDIPjointoccursinapproximately58%ofindividuals.>ThesymptomsofOAattheDIPjointcommonlyincludepainandchangestothesizeandshapeofthejoint.https://www.3pointproducts.com/blog/health-arthritis-finger-and-toe-conditions/dip-joint-osteoarthritis-how-to-treat-this-common-form-of-arthritis
361.12yroldChildadmittedtoICUwithblunt traumaandfemurfracture-Pao260%despite100%o2andrebreathermask,CXRshowslungfieldsclearbutthepatientremainsconfused.Whatismostlikelythediagnosis- a)Pulmonarycontusion. b)Fatembolismsyndrome. c)Hypovolaemicshock. d)Pulmonaryembolism. CorrectAnswer-BAns:b.Fatembolism.Inthispatient,basedonthecasepresentationthereisRespiratorySysteminvolvedaspao2is60,andCNSinvolvementasheisinaconfusedstate.>So,thediagnosishereisFatembolismsyndrome.>Embolizedfatwithincapillarybedscausedirecttissuedamageaswellasinduceasystemicinflammatoryresponseresultinginpulmonary,cutaneous,neurological,andretinalsymptoms.>Gurd'sclinicaldescriptionoftheFESrenewedinterestinstudyingthissyndromehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665122/
362.A4yroldchildwhileplayingsuddenly spunaroundhiselbowfromherservantmaid'shandandnowcontinuouslycryingnotallowinganyonetotouchhiselbow.Heiskeepinghiselbowextended.whatismostlikelythediagnosis- a)Radialheadfracture b)Pulledelbow c)supracondylarfracture d)Elbowdislocation CorrectAnswer-BAns:b.Pulledelbow>Pulledelbow,alsocallednursemaid'selbow,isaradialheadsubluxationcausedbyaxialtractionorasuddenpulloftheextendedpronatedarm,anditisaverycommonphenomenon.>Inthiscaseofpulledelbow,thechildusuallyavoidsmovingtheaffectedarm,holdingitclosetohisorherbody,withoutconsiderablepain,andnoobviousswellingordeformitycanbeseen.>Whileafractureshouldbeexcluded,thepulledelbowcanusuallybeidentifiedbasedonthispresentation.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999240/
2.Trueaboutlumbricalsis a)FlexIPjointsandextendsMCPjoint b)1stand2ndsuppliedbyradialnerve c)3and4suppliedbysuperficialbranchofulnar d)Originfromtendonsofflexordigitorumprofundus CorrectAnswer-DAnswer.DOriginfromtendonsofflexordigitorumprofundus*Thefourlumbricalmusclesarisefromthetendonsofflexordigitorumprofundus.Theyhavedifferentorigins:Eachpassesdistallytotheradialsideofitsnearestmetacarpophalangealjointofthefingerstobeinsertedintothedorsalextensorexpansionofdigitstwotofive.Theiractionsonthesedigitsareto:*Extendtheinterphalangealjoints*FlexthemetacarpophalangealjointsTheinnervationofthelumbricalsisdual:*Theradialfirstandsecondlumbricalsaresuppliedbythemediannerve(C8,T1)*Theulnarthirdandfourthlumbricalsaresuppliedbythedeepbranchoftheulnarnerve(C8,T1)*Occasionally,thethirdlumbricalcanreceiveitsinnervationfromthemediannerve.
3.Inpatientswithhypertrophic cardiomyopathymaximummutationsarefoundinwhichgene: a).-myosinheavychain b)Elastin c).-tropomyosin d)TroponinT CorrectAnswer-A-MyosinheavychainMutationsingenefor-Mysoinheavychainareassociatedwith40%ofthefamilieswithhypertrophiccardiomyopathy.TroponinTmutations-15%ofthefamilies-tropomyosinmutations~5%ofthefamilies
4.Whatisthevenoushematocritlevelat whichyouwilldiagnosepolycythemiainanewborn? a)55% b)60% c)65% d)70% CorrectAnswer-CDefinitionofpolycythemia:a.Venoushaematocritofover65%.b.Venoushaematocritofover64%at2hoursage.c.Anumbilicalvenousorarterialhaematocritover63%ormore.Themeanvenoushaematocritofterminfantsis53incordblood,60at2hoursofage,57at6hoursofageand52at12-18hoursofage.Asthehaematocritincreases,thereisincreasedviscosityanddecreasedbloodflow.Whenhaematocritincreasestomorethan60%thereisafallinO2transport.Definitionofhyperviscosity:Viscositygreaterthan14.6centiposeatashearrateof11.55asmeasuredbyaviscometer.(normalis1.4-1.8centipoise).
5.Thesignificanceofdifferencebetween proportionscanalsobetestedby- a).`t'test b)Chisquaretest c)ANOVA d)Correlationandregression CorrectAnswer-BAns.B.ChisquaretestChi-Squaretestoffersamethodoftestingthesignificanceofdifferencebetweentheproportions.Itsadvantageliesinthefactthatitcanalsobeusedwhenmorethantwogroupsaretobecompared.Byusingthistest,wecanfindoutifthedifferencebetweentwoproportionsorratioshasoccurredbychance.Thestepsinvolvedare- 1. Testingthenullhypothesis.2. Applyingchi-squaretest.3. Calculatingthedegreeoffreedom.4. Comparingwithprobabilitytables.
6.Peripheralandcentralchemoreceptors maybothcontributetotheincreasedventilationthatoccursasaresultofwhichofthefollowing? a)Adecreaseinarterialoxygencontent b)Adecreaseinarterialbloodpressure c)Anincreaseinarterialcarbondioxidetension d)Adecreaseinarterialoxygentension CorrectAnswer-CThecentralchemoreceptorslocatedonorneartheventralsurfaceofthemedullacauseanincreaseinventilationinresponsetoanincreaseinPacO2andtoalesserextenttoadecreaseinarterialpHbecausethebloodbrainbarrierisrelativelyimpermeabletohydrogenions.TheperipheralchemoreceptorsinthecarotidbodiescauseanincreaseinventilationinresponsetoanincreaseinPacO2adecreaseinarterialpH,andadecreaseinPaO2.NeitherthecentralchemoreceptorsnorthecarotidbodiesarestimulatedbyadecreaseinarterialbloodpressureorO2content.
7.Wirelesscapsuleendoscopyisdoneto visualizewhichofthefollowingcondition? a)Esophagealvarices b)Gastriccarcinoma c)Crohn'sdisease d)Ulcerativecolitis CorrectAnswer-CCrohn'sdiseaseWirelesscapsuleendoscopy(WCE)allowsdirectvisualizationoftheentiresmall-bowelmucosa.ThediagnosticyieldofdetectinglesionssuggestiveofactiveCDishigherwithWCEthanCTenterographyorsmall-bowelseries.WCEcannotbeusedinthesettingofasmall-bowelstricture.Capsuleretentionoccursin<1%ofpatientswithsuspectedCD,butretentionratesof4--6%areseeninpatientswithestablishedCD.
8.Thomastestisusedfortesting? a)Hipflexion b)Kneeflexion c)Hipabduction d)Hiprotation CorrectAnswer-AAHipflexionREF:LangeInstantAccess:OrthopedicsandSportsMedicine,byAnilPatel,page106ThomasTest:Withthepatientlyingsupine,maximallyflexbothhips.Allowthefemurontheipsilateralsidetofallintoasmuchextensionaspossible,whileholdingtheotherhipup.Theanglebetweenthefemurandexaminingtableistheresidualflexionandrepresentstheflexioncontracture.
9.Indicationforsurgicalcompartmentrelease incompartmentSyndromeinanycompartmentisabsolutepressuregreaterthan? a)15mmHg b)20mmHg c)30mmHg d)Variesfromcompartmenttocompartment CorrectAnswer-C30mmHgREF:Withtext"Settingthethresholdforfasciotomyataperfusionpressureof30mmHgcanbeconsideredsafe,butstillmayleadtoovertreatmentifusedroutinely"REF:Evidence-basedOrthopedics-MohitBhandariPage634Differentauthorsconsidersurgicalinterventionif:(REF:TiwariA,HaqAI,MyintF,HamiltonG.Acutecompartmentsyndromes.BrJSurg2002;89:397-412.) 1. AbsoluteICPgreaterthan30mmHg2. DifferencebetweendiastolicpressureandICPgreaterthan30 mmHg 3. DifferencebetweenmeanarterialpressureandICPgreaterthan40 mmHg"Intracompartmentalpressuremaybemeasuredbythewickcatheterinpatientssuspectedtohavecompartmentsyndrome.Bysuchmethodapressureof30mmHgormoresustainedfor6-8hoursormoreisalikelyindicationfordecompressivefasciotomy"REF:SkeletalinjuryinthechildbyJohnAnthonyOgdenPage317 Intracompartmental Comments
Intracompartmental Commentspressure Normalcompartmentpressureoflower <15mmHg limbsVenousdrainagefromclosedmyofascial >25mmHg spacesisimpaired. >30mmHg Completevenouscollapse >60mmFig Neuromuscularischemia REF:Masteryofvascularandendovascularsurgery-GeraldB.Zelenock,ThomasS.Huber,LouisM.MessinaPage507
10.WhichisnottrueofTabesdorsalis? a)Seeninneurosyphilis b)Paresthesiaisseen c)Deeptendonreflexesareretained d)Abdominalpainandvisceralsymptomsoccur CorrectAnswer-CDeeptendonreflexesareretainedREF:Harrison'sPrinciplesofInternalMedicine17thedchapter372TABESDORSALIS:Theclassicsyndromesoftabesdorsalisandmeningovascularsyphilisofthespinalcordarenowlessfrequentthaninthepastbutmustbeconsideredinthedifferentialdiagnosisofspinalcorddisorders.Thecharacteristicsymptomsoftabesarefleetingandrepetitivelancinatingpains,primarilyinthelegsorlessoftenintheback,thorax,abdomen,arms,andface.Ataxiaofthelegsandgaitduetolossofpositionsenseoccursinhalfofpatients.Paresthesias,bladderdisturbances,andacuteabdominalpainwithvomiting(visceralcrisis)occurin15-30%ofpatients.Thecardinalsignsoftabesarelossofreflexesinthelegs;impairedpositionandvibratorysense;Romberg'ssign;and,inalmostallcases,bilateralArgyllRobertsonpupils,whichfailtoconstricttolightbutaccommodate.Diabeticpolyradiculopathymaysimulatetabes.
11.Vitaminnotdeficientinceliacdiseaseis? a)VitaminD b)VitaminB12 c)Folicacid d)VitaminA CorrectAnswer-CFolkacidREF:SheilaCrowe-2010page384,Harrison17thedchapter288Vitaminsdeficientinceliacdiseaseare: 1. VitaminA2. VitaminD3. VitaminK4. VitaminB12
12.ABonemarrowtransplantrecipient patientdevelopedchestinfection.OnHRCT'Treeinbudappearance'isseen.Mostlikelycausativeagentis: a)Klebsiella b)Pneumocystis c)TB d)RSV CorrectAnswer-BPneumocystis[Ref:HarrisonI7/ep843;Article'Treeinbudsign'inJournal'Radiology'and'Radiographics7Tree-in-budisasignseeninHRCT,mostcommonlyseenwithendobronchialspreadofTuberculosis,butcanbeseenwithawidevarietyofconditions,mostcommonlyinfections.(Describedaheadindetail).Theoreticallyalltheoptionscancause'Tree-in-bud'sign(althoughKlebsiellahasnotbeenmentionedinthelist).SothenextclueisBonemarrowtransplant.Bonemarrowtransplantcausesatransientstateofimmunologicaldeficiencyleadingtoawidevarietyofopportunisticinfections.Amongthegivenoptions,accordingtothetableandtextofHarrison(17/echapter'InfectionsinTransplantRecipients')PneumocystisandRSVcancausepneumoniaaftertransplant:butPneumocystisisamuchmorecommonthanRSV. CommonSourcesofInfectionsafterHematopoieticSteinCellTransplantation PeriodafterTransplantation
Early(<1 Middle(1-4 InfectionSite Late(>6Months) Month) months) Disseminated Aerobicgram- Nocardia Encapsulated negative, Candida, bacteria grain-positive Aspergillus (Streptococcus bacteria pneumoniae,Haemophilusinfluenzae,Neisseriameningitidis) Skinand HSV- HHV-6 VZV mucousmembranesLungs Candida, CMV, Pneumocystis Aspergillus seasonal HSV respiratoryvirusesPneumocystisToxoplasma Gastrointestinal CMV tract BKvirus, Kidney BKvirus adenovirus Brain HHV-6 Toxoplasma ToxoplasmaJCvirus Bonemarrow HHV-6 Tree-in-budsignThetree-in-budsignisafindingseenonthin-sectioncomputedtomographicimagesofthelung(HRCT).(NotseenonX-rays)Peripheral,small,centrilobularnodulesareconnectedtolinear,branchingopacitiesthathavemorethanonecontiguousbranchingsite,thusresemblingabuddingor,fruitingtree:thisisknownastree-in-bud-pattern.Itrepresentsdilatedandimpacted(mucusorpus-filled)centrilobularbronchioles.Thepresenceoftree-in-budisindicativeofsmallairwaydisease.
ItismostcommonlyassociatedwithendobronchialspreadofMycobacteriumtuberculosis.Butitcanalsobeseeninalargenumberofconditions.Pulmonaryinfectiousdisordersinvolvingthesmallairwaysarethemostcommoncausesofthetree-in-budsign.Anyinfectiousorganism,includingbacterial,mycobacterial,viral,parasitic,andfungalagents,caninvolvethesmallairwaysandcauseatree-in-budpattern.CausesofTree-in-budappearance Congenitaldisorders Peripheralairwaydisease Cysticfibrosis Connectivetissue Infection Kartagener disorders Bacterial syndrome Rheumatoidarthritis Mycobacterium Idiopathic Sjo-grensyndrome tuberculosis disorders Peripheral Mavium-intracellulare Obliterative pulmonaryvascular complex bronchiolitis disease Staphylococcusaureus Diffuse Neoplasms Haemophilus panbronchiolitis Primarypulmonary influenzae A lymphoma Fungal spiration Neoplastic Aspergillus Inhalation pulmonaryemboli Pneumocystiscarinii, Toxicfumesand Gastriccancer (renamedPneumocystis gases Breastcancer jiroveci)Viral Immunologic Ewingsarcoma Cytomegalovirus disorders Renalcancer Respiratorysyncytialvirus Allergic bronchopulmonaryaspergillosis
13.Causeofvasodilatationinspidernevi- a)Estrogen b)Testosterone c)Hepatotoxins d)FSH CorrectAnswer-AEstrogen[Ref:Harrison171h/ep.1920;Robbin's7th/ep.882]Spidernevirefertodilated,visiblesmallbloodvesselsintheskin.-Itiscalledspidernevibecauseitconsistsofcentral"feeding"bloodvesselwithnumerousfineradiatinglegsemanating.fromthecentralbody.Spiderneviarecausedduetovasodilatationofvesselsandareusuallyassociatedwithcirrhosis.Cirrhosisisassociatedwithvasodilatationandhyperdynamiccirculation."Thecauseofvasodilatationinchrrhosisisuncertainbutitisbelievedtoberelatedtotheincreasedlevelofestrogenintheboth.Estrogenisafemalesexhormonewhichismetabolizedbyliver.Thusinliverdiseasesitsleveltendstoincreasewhichisbelievetocausevasodilatation,resultinginspidernaevi.
14.Strawberrygingivitisseenin a)Myelocyticinfiltration b)Phenytointoxicity c)Wegnergranulomatosis d)Klipelrenaunaysyndrome CorrectAnswer-CWegener'sgranulomatosis[Ref:IADVLTextbookofDermatology3r9ep.695]Wegener'sgranulomatosisisknowntocauseoralmucosallesions."Strawberrygingivitisischaracteristicorallesionassociatedwithwegener'sgranulomatosis".Straberrygingivitisclinicallypresentswith:?'Swollenerythematousgumsclinicallyresemblingoverripestrawberries"Histologicallystrawberrygingivitisischaracterizedby
15.WhichofthefollowingistrueofWilson's diseaseallexcept- a)Autosomalrecessive b)Serumceruloplasminlevel<20mg/d1 c)Urinarycopporexcretion<100microgram/c11 d)Zincacetateisusedasmaintencetherapy CorrectAnswer-CUrinarycopperexcretion<100microgram/di[Ref:Harrison17"'/ep.2450,2449]Symptomaticpts.ofWilsondiseaseinvariablyhaveurinecopperlevels>100pgperday.WilsondiseaseisanautosomalrecessivedisordercausedbymutationintheATP7Bgene(acoppertransportingATPase)Diagnosis-ThegoldstandardfordiagnosisisLiverbiopsywithquantitativecopperassayQ.Otherdiagnostictestsusedare?-SerumceruloplasminlevelQ-KFrings(2-Urinecopperexcretiono-DNAHelpful-yeanalysisQSerumcoppervalueshavenodiagnosticvalue,sincetheymaybelow,normalorelevateddependinguponthestageofevolutionofdisease. Table:UsefulDiagnosticTestsforWilsonDisease Normal Test Value WilsonDisease 180-350
180-350 Serum mg/L (18-35 ?Lowin85% ceruloplasmin mg/d1) ?Presentin99% -Ifneurologicorpsychiatric KFrings Absent symptomspresent. ?Presentin30-50% -inhepatic presentationand presymptomaticstate?Urinarycopper excretionis increased->1.6intnol(>100mg) 0.3-0.8 24-hurineCu insymptomatic mmol patients ?0.9to>mmol(60to >100mg) -inpresymptomatic patients 0.3--0.8 ?Livercopperis LiverCu mmol/g increased (20-50mg) ?>3.1mmol(200 tissue mg) Haplotype analysis 0Matches 2Matches TreatmentZincisthetreatmentofchoiceforWilsondiseaseQ.Itproducesanegativecopperbalance-Byblockingintestinalabsorptionofcopper-Byinducinghepaticmetallothioneinsynthesiswhichsequestersadditionaltoxiccopper. Table:RecommendedAnticopperTreatmentsforWilsonDiseaseDiseaseStatus FirstChoice SecondChoice
DiseaseStatus FirstChoice SecondChoice Initialhepaticmanifestations?Hepatitisorcirrhosiswithout decompensation Trientine ?HepatitisorCirrhosis Penicillainine with Zinc andzinc decompensation Trientineandzinc Hepatic -Mild Trientineandzinc transplantation -Moderate Hepatic Trientineand -Severe transplantation zinc Initial Tetraioinolybdate Trientineand neurologic/psychiatric andzinc zinc Maintenancetherapy Zinc Trientine Presymptomatictherapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine
16.Allaretrueaboutthrombotic thrombocytopenicpurpuraexcept? a)Microangiopathichemolyticanemia b)Thrombocytopenia c)Normalcomplementlevel d)Grosslyabnormalcoagulationtests CorrectAnswer-DAns:D.Grosslyabnormalcoagulationtest[Ref:Robbin's7m/ep.1010]*Thromboticthrombocytopenicpurpura(TTP)ischaracterizedbythepresenceofwidespreadthrombosisthroughoutthemicrocirculation.*Theuniquecharacteristicofthesethrombiisthattheyareprimarilycomposedofplateletsowithverylittle.fibrininit.*TheconsumptionofplateletleadstothrombocytopeniaandthepresenceofintravascularthrombicausesmicroangiopathichemolyticanemiaQandwidespreadorgandysfunction.*YoumusthavenoticedthatTTPandDICsharesomanysimilarfeaturessuchas4icrovascularocculsionandmicroangiopathichemolyticanemia,Buttheyarepathologicallydistinct.InTTP*Activationofcoagulationcascadeisnotofprimaryimportance.Thethrombipresentareessentiallyplateletthrombi,henceresultsoflaboratorytestsofcoagulationsuchasPTandPTTareusuallynormal.InD.I.C.*ThemaindefectisactivationofcoagulationsystemthereforePT
andPTTareabnormal.*PatientswithTTParedeficientinanenzymecalledADAMTSB.ThisenzymeisalsoknownasvWfinetalloprotease.*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregate.formationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Thromboticthrombocytopenicpurpuraisathromboticmicroangiopathy.*TheotherdisorderswhichisincludedinthisgroupincludeH.U.S.*Thediseasesarecharacterizedbywidespreadthrombosisinmicrocirculation.*ThevesselswhichareinvolvedareterminalarteriolesQandcapillaries.*Thesevesselshavethrombi.*ThecharacteristicofthisthrombusisthatitisprimarilyaplateletthrombusQi.e.thethrombiiscomposedmainlyofplateletsandvonWilebrandfactorwithverylittlefibrininit.Pathogenesis*PatientswithTTParedeficientinanenzymecalledADAMTSBQ.(ThisenzymeisalsoknownasvWfnielalloproteaSe.)*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregateformationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Plateletassociatedimmunoglobulin(IgG)andcomplementlevelsarenormalinT.T.P.
17.Mostcommonorganismassociatedwith reactivearthritisis: a)Staphylococcus b)Shigella c)Chlamydia d)Yersinia CorrectAnswer-CChlamydia[Ref:Harrison17/ep2113;http://www.emedicine.com/derm/TOPIC207.HTM;http://www.entedicine.com/med/TOPIC1998.11TM]Reactivearthritisisasystemicdisorderofunknownetiologythatisdefinedbythedevelopmentofconjunctivitis,urethritis,arthritis,andmucocutaneouslesionsfollowinganepisodeofinfectionelsewhereinthebody.In1916,HansReiterdescribedthetriadofnongonococcalurethritis,conjunctivitis,andarthritisinayoungGermanofficerwithbloodydysentery.Theclassictriadofthedisease,namelyurethritis,arthritis,andconjunctivitis,ispresentinonlyonethirdofthepatients.ReactivearthritisisfrequentlyassociatedwiththehumanleukocyteantigenB27(1-ILA-B27)haplotype.Theetiologyofreactivearthritisremainsuncertain.Themostacceptedtheoryaboutthepathophysiologyofreactivearthritisinvolvesinitialactivationbyamicrobialantigen,followedbyanautoimmunereactionthatinvolvestheskin,eyes,andjoints.Twoformsarerecognized:asexuallytransmittedformandadysentericform.GastrointestinalinfectionswithShigella,Salmonella,andCampylobacterspeciesandothermicroorganisms,andgenitourinaryinfectionsespeciallywithChlamydiatrachomatis
havebeenfoundtotriggerreactivearthritis.Youngchildrentendtohavethepostdysentericform,whereasadolescentsandyoungmenaremostlikelytoacquirereactivearthritisaftertheyhaveurethritis.It'snotclearwhichorganismismostcommonlyassociatedwithreactivearthritis.BothShigellaandChlamydiaappeartohemostcommon.Aftergoingthroughmanyarticlesfromjournalsonthenet,Chlamydiaappearstohethemostcommon.WewouldprefertogowithChlamydia.(Howeverifanyonefindsareliablereferencedocumentingthemostcommonorganism,pleasemailusatouremailid.ThearticleonReactiveArthritisinthejournal"BestPractice&ResearchClinicalRheumatology"Vol.20,No.6,pp.1119e1137,2006writes-"Theprevalenceisestimatedtobe30-40casesper100,000adults;theannualincidenceisestimatedtobe4.6/100,000 .forChlamydia-inducedarthritisand5/100,000.forenterobacteria-inducedreactivearthritis.4,5However,realnumbersmaybesignificantlyhigher?Thefollowingarticle"Frequencyoftriggeringbacteriainpatientswithreactivearthritisandundifferentiatedoligoarthritisandtherelativeimportanceofthetestsusedfordiagnosis"inAnnRheumDis.2001April;60(4):337343atthefollowingwebsite-http://www.pubmedcentralmih.gov/articlerenderfcgi?artid=1753604writesitsconclusionas:"CONCLUSIONS--Chlamydiatrachomatis,yersinia,andsalmonellacanbeidentifiedasthecausativepathogeninabout50%ofpatientswithprobableorpossibleReAiftheappropriatetestsareused."
18.AbsenceofCorpuscallosumleadsto a)Hemiparesis b)Hemisensoryloss c)Astereognosis d)Noneurologicalmanifestations CorrectAnswer-DNoneurologicalmanifestations[Ref:Internetreference]Agenesisofcorpuscallosumisararebirthdefect(congenitaldisorder)inwhichthereiscompleteorpartialabsenceofcorpuscallosum.Corpuscallosumisabandoftissueconnectingthetwohemispheresofthebrain.Fibresofcorpuscallosumarisefromthesuperficiallayersofthecerebralcortexandtheyprojecttothehomotypicregionsofthecontralateralcortexbypassingthroughthecorpuscollosumwhilecrossingthemidline.ClinicalfeaturesofAgenesisofcorpuscallosumSignsandsymptomsofagenesisofcorpuscallosumvarygreatlyamongindividuals.Patientsusuallydonothaveanyneurologicalmanifestations.However,somefeaturescommoninagenesisofcorpuscallosumare:-Visionimpairment*Lowmuscletone(hypotonia)Poormotorcoordination*Delayinmotormilestonessuchassittingandwalking.Lowperceptionofpain*Delayedtoilettraining*Chewingandswallowingdifficulties*Earlyspeechandlanguagedelays
SocialdifficultiesOthercharacteristicssometimesassociatedwithcallosaldisordersare:-Seizures*Spasticity*Early,feedingdifficultiesandorgastricreflux-.*Hearingimpairments*Abnormalheadandfacialfeatures*MentalretardationInvestigationCTandMRIreveal"Batwing"deformityoftheventricles.TreatmentTherearecurrentlynospecificmedicaltreatmentsforcallosaldisorders.AnimportantpointTheneurologicalabnormalitiesassociatedwithcorpuscallosumarenotcausedbyabsenceofcorpuscallosumperse.*Theseconditionsarebelievedtobecausedduetoassociatedcerebralanomaliesratherthanincorpuscallosumpersc.*Themostcommonassociatedbrainanomalieswithabsentcorpuscallosumare*Dandywalkermalformation*lnterhenfisphericcystwithhydrocephalus*Migrationaldisorder*Absenceoftheinferiorvertnis*Thechildrenwhohadthebestprognosiswithoutanysignificantneurologicalsequalewerethosewithisolatedagenesisofcorpuscollosum.*ThechildrenwiththeworstprognosisandneurologicalsequalewerethosewithagenesisofcorpuscallosumandmigrationaldisorderwithorwithoutDandy--walkermalformation.*Henceprognosisisdeterminedprimarilybytheunderlyingorassociatedmalformation.
19.Waterhammerpulseseenin a)>Aorticstenosis b)>Aorticregurgitation c)>AorticstenosisandAorticregurgitation d)>Mitralregurgitation CorrectAnswer-BAorticregurgitation[Ref.Harrison17h/ep1476&166/ep1400Kundu,bedsideclinicsinmedicine]WaterhammerpulseItisalargeboundingpulse,associatedwithincreasedstrokevolumeoftheleftventricleanddecreaseintheperipheralresistance,leadingtoawidepulsepressure.Thepulsestrikesthepalpatingfingerwitharapid,forcefidjerkandquicklydisappears.Itisbestfeltintheradialarterywiththepatientsarmelevated.ItisseeninAorticregurgitation.PathophysiologyofwaterhammerpulseInAorticregurgitationthestrokevolumeishigh,sothesystolicpressureishighandthisisresponsibleforsharpriseinthepulse.Thestrokevolumeishighbecausetheleftventriclegetsbloodfromtwosourcesduringthediastolei.e.bloodleakingfromtheAortaandtheblooditreceivesfromleftatria.ThecollapseoccursbecauseDiastolicleakofbloodintotheleftventriclefromtheAortaRapidrunofftotheperipheryasaresultoflowsystemicvascularresistance(theincreasedcardiacoutputstimulatesthebaroreceptorsintheaorticarchandtheresultisreflexvasodilatationoftheperipheralvesselsintowhichthebloodflowsrapidly).
Wiryarearmselevatedintheexamination?Whenthearmisraisedthereisfallofbloodcolumnresultinginvasodilationandthushelpstoreducethediastolicpressuremore,sothepulsepressurewidens.ItmaybesothatthearterypalpatedbecomesmoreinthelineofAortaafterelevationofthearmandthusallowsthedirectsystolicejectionanddiastolicbackwardflow.
20.Interstitialnephritisisseenwithall except a)Betalactaminhibitors b)INH c)Diuretics d)Allopurinol CorrectAnswer-BINH[Ref.Harrison17th/ep1806,1807&16th/ep1702,1703] DRUGSCAUSINGINTERSTITIALNEPHRITISAntibiotics Diuretics Anticonvulsants Miscellaneous .filactamso ?ThiazideQ ?Phenytoinu .Captopril0 . ? ? ?H2receptor SulfonamidesQ FurosemideQ PhenobarbitoneQ blockerse . ? ?QuinolonesQ .Omeprazole Triamterene Carbamazepine .Vancomycin .NSAIDS? ?Valproicacid .Mesalazine ? .Indinavir Erythromycin.Minocycline .Allopurinol .Rifampicin ?Ethambutol .Acyclovir
21.Apersonisnotabletoextendhismetacarpophalangealjoint.Injurytowhichof thefollowingnerveresultinthis? a)Ulnarnerve b)Radialnerveinjury c)Mediannerveinjury d)Post.Interosseousnerveinjury CorrectAnswer-DDamagetoposteriorinterosseousnerveresultininabilitytoextendthefingersatthemetacarpophalangealjointsandradialdeviationofthewristonwristextensioncausedbyweaknessofextensorcarpiulnarismuscle. Posteriorinterosseousnerveordeepulnarnerveisapuremotorbranchofradialnerve intheforearm.Itsuppliestheextensormusclesofforearmincludingtheextensorcarpi ulnaris. Ulnarnervepalsyresultinlossoffineintrinsicmotionsofhand.Itresultinanabduction deformityofthelittlefingerfromparalysisoftheinterossei,interosseousmusclewasting, andpartialclawhandfrominterphalangealflexiondeformitiesoftheringandlittlefingers. Radialnerveinjuryresultinwristdrop.Axillaryorproximalinjuryresultintriceps weaknessinadditiontowristdrop.Injuryintheaxillacausesdamagetotricepsbrachii, anconeus,brachioradialisandextensorcarpiradialislongus.Ref:NeurologyinClinicalPractice:Theneurologicaldisorders,Volume2editedbyWalterGeorgeBradleypage2315.LeBlondR.F.,DeGowinR.L.,BrownD.D.(2009).Chapter14.TheNeurologicExamination.InR.F.LeBlond,R.L.DeGowin,D.D.Brown(Eds),DeGowin'sDiagnosticExamination,9e.
22.Tensionbandwiringisindicatedinfractureofwhichofthefollowing? a)Fracturehumerus b)Olecranon c)Fracturetibia d)Fracturespine CorrectAnswer-BTensionbandwiringisindicatedinthetreatmentoftwotypesofolecranonfracture.Firsttypeisacleanbreakwithseparationofthefragments,andsecondtypeiscomminutedfractureoftheolecranonwithdisplcedfragments. Acrackintheolecranonwithoutdisplacementistreatedbyimmobilisingtheelbowinanaboveelbowplasterslabin30degreesofflexion.
23.Whichofthefollowingattitudewillbeseeninapatientwithposterior dislocationofhip? a)Flexion,Abduction,Internalrotation b)Flexion,Adduction,Internalrotation c)Flexion,Abduction,Externalrotation d)Flexion,Adduction,Externalrotation CorrectAnswer-BDislocationsareusuallyposterior,andoccasionallyanterior,orcentralthroughtheacetabulum. Posteriordislocation:Hipisflexed,adducted,andinternallyrotated,andlegisshortened. Anteriordislocation:Hipisflexed,abducted,andexternallyrotated,andlegisshortened. Centraldislocation:Trochanterisdisplacedmedially.Onemaybeabletofeeltheheadoffemurrectally.Thereisnoshortening.
24.Whichofthefollowingis/aretrueaboutperthesdisease? 1.Avascularnecrosisoffemoralhead2.Onsetbefore10yearsofage3.Osteotomyisusedfortreatment4.Limbshortening a)1,2true&3,4false b)2,3True&1,4false c)1,2,3true&4false d)Allaretrue CorrectAnswer-DItisalsoknownastheparsplanaandPseudoCoxalgia.Itisanosteochondritisofthefemoralhead.Thefemoralheadbecomespartlyorwhollyavascularanddeformed.Etiologyisnotdefinetlyknown.Itissupposedtobeduetoreccurentepisoedesofischemiaofthefemoralheadinthesuceptibleagegroup,probablyperecipitaedbyepisodesofsynovitis.Pathology:thediseaseprogressesinthreeilldefinedstages: Stageofsynovitis Stageoftrabecularnecrosis StageofhealingClinicalfeatures:Commonlyseenintheagegroupof5to10years.Childpresentwithpaininthehipwhichoftenradiatestothekneeormayalsopresentwithlimporhipstiffness.Onexamination,thefindingareminimal.sometimestheonlyfindingbeinglimitationofabductionandinternalrotationandshortening. X-rayshowscollapseandsclerosisoftheepiphysisofthefemoralhead.hipjointspaceisincreased.Bonescanmayshowadecreaseduptakebytheheadofthefemur.Treatment:Theprimaryaimistopreventtheheadfromillshapingwhiletheboneisinthesofteningphase.Theheadisrequiredtobekeptinsidetheacetabulumwhiletherevascularizationtakesplace(i.e.containment).Thismaybeachievedbycorrectivemethods(plaster,splintetc.)orbyoperation(containmentosteotomy).
Ref:Maheshwari3/e,Page269-70.
25.Blount'sdiseaseisassociatedwithallofthefollowing,EXCEPT: a)Genuvarum b)GenuRecurvatum c)InternalTibialTorsion d)ExternalTibialTorsion CorrectAnswer-DBlount'sdiseaseischaracterizedbyvarusandinternaltibialtorsionandgenurecurvatum,withvarusoftheproximaltibiabeingtheprimarydeformity.Itisnotassociatedwithexternaltibialtorsion.Ref:Operativetechniquesinpediatricorthopedics,byJohnM.Flynn,SamW.Wiesel,Page205,206.
26.Browntumorsareseenin: a)Hypeparathyroidism b)Pigmentedvillonodularsynovitis c)Osteomalacia d)Neurofibromatosis CorrectAnswer-A Browntumorsarehighlyvascularlyticlesionsoftheskeletonseeninbothprimaryandsecondaryhyperparathyroidism.Theyresultfromtheaccumulationofabundantfibrovasculartissueandosteoclastlikegiantcells.Ref:Robbin'sBasicPathology,7thEdition,Pages1186,1286;OrthopaedicPathologyByVincentJ.Vigorita,BernardGhelman,DouglasMintz,2007,Page187.
27.Liftofftestisdonetoassessthefunction of: a)Supraspinatus b)Infraspinatus c)TeresMinor d)Subscapularis CorrectAnswer-DDi.e.Subscapularis-Failuretoperformmaximuminternalrotation(astestedinbellypressandliftofftest)orinabilitytomaintainpositionofmaximalinternalrotation(internalrotationlagsign)indicatetearofsubscapularistendon.Liftofftestisdonetoassessthestrengthofsubscapularismuscleanddetectanisolatedruptureofsubscapularistendoninarotatorcufftear.
28.Themostcommonbonefracturedduring birth a)Clavicle b)Scapula c)Radius d)Humerus CorrectAnswer-AAi.e.ClavicleClavicleisthemostcommonbonetobefracturedinchildrenandduringbirth.
29.Themalunionofsupracondylarfractureof thehumerusmostcommonlyleadsto: a)Flexiondeformity b)Cubitusvarus c)Cubitusvalgus d)Extensiondeformity CorrectAnswer-BBi.e.CabitusVarusMalunion:-Itisthecommonestcomplicationofsupracondylarfractureandresultsincubitusvarus(Gunstockdeformity).Cubitusvalgusisrareandmayoccuroccasionallyinposterolateraldisplacement.
30.TreatmentofchoiceinAcutemyositis ossificansis: a)Immobilizationofelbow b)Shortwavediathermy c)Passivemovementsofarm d)Activeexercises CorrectAnswer-AAi.e.Immobilizationofelbow*Restoftheaffectedpartduringtheperiodwhiletheprocessisactiveisthebasicprincipleoftreatment(TN91).*Nomassageshouldbegiven.*Ifanyphysicaltherapyisgoingon,itshouldbediscontinuedimmediately.*Allpassivemovementsandvigorousexercisemustbestopped.Verygentleexercisemustbestarted.*Indomethacinandradiotherapypreventcalcification.However,radiotherapyshouldbeavoidedinchildren.-Surgicalexcisionisindicatedifmyositisossificansinterfereswithfunction.Itisworthnotingthatsurgicalexcisioniscontraindicatedduringactivephasewhencalcificationmatures.*Surgicalexcision,ifrequired,shouldbedoneonlyaftercompletematurationofossification.
31.PulledElbowis: a)Disarticulationofelbow b)Disarticulationofelbow c)Subluxationofproximalradioulnarjoint d)Noneoftheabove CorrectAnswer-CCi.e.subluxationofproximalradioulnarjointIfayoungchildisliftedbythewrist,theheadoftheradiusmaybepulledpartlyoutoftheannularligament,i.e.,subluxationoftheheadoftheradius.Itoccurswhenforearmispronated,elbowisextendedandlongitudinaltractionisappliedtothehandorwrist,e.g.,lifting,spinningorswingingachildwithwristorhand.Pulledelbowmostcommonlyoccursbetweentheageof2-5years
32.InMonteggiafracture,whichistrueabout ulnarfractureandheadofradius a)Bothulnarfractureandheadofradiusisdisplacedposteriorly b)Bothulnarfractureandheadofradiusisdisplacedanteriorly c)Ulnarfracturesisposteriorlyandheadofradiusisdisplaced anteriorly d)Ulnarfractureisanteriorlyandheadofradiusisdisplaced posteriorly CorrectAnswer-BAns:Bi.e.Bothulnarfractureandheadofradiusisdisplacedanteriorly*Thisisafractureoftheupper-thirdoftheulnawithdislocationoftheheadoftheradius.Itiscausedbyafallonanoutstretchedhand.Itmayalsoresultfromadirectblowonthebackoftheupperforearm.-Thesefallintotwomaincategoriesdependingupontheangulationoftheulnafracture-extensionandflexiontype.Theextensiontype,isthecommonerofthetwo,wheretheulnafractureangulatesanteriorly(extends)andtheradialheaddislocatesanteriorly.Theflexiontypeiswheretheulnafractureangulatesposteriorly(flexes)andtheradialheaddislocatesposteriorly.
33.Themostcommoncomplicationof intracapsularfractureneckoffemuris a)Malunion b)Osteoarthritis c)Non-Union d)Shortening CorrectAnswer-CCi.e.NonunionBothintracapsularneckfractureandextracapsularfracture(basicervicalandITfracture)havesamedeformities,i.e.externalrotationandshortening.Thesedisplacementsaremoremarkedinextracapsularfractures,becauseinanintracapsularfracture,thecapsuleofthehipjointisattachedtothedistalfragmentandpreventsextremerotationanddisplacementofthedistalfragment(andwithit,thelimb).Inextracapsularfracture,distalfragmentbeingoutsidethecapsuleisdisplacedmoremarkedly.
34.AVNisseeninwhichtypeof#offemur: a)Intertrochantric# b)Subcapital# c)Transcervical# d)BANDC CorrectAnswer-DB.i.e.Subcapital>C.i.e.TranscervicalFractureoftheneckoffemurFractureoftheScaphoid(Proximalpole>Waist)FractureneckoftalusPosteriordislocationofthehip
35.VascularsignofNarathisnoticedin a)Fractureneckoffemur b)Perthesdisease c)Posteriordislocationofhip d)Alloftheabove CorrectAnswer-CCi.e.PosteriordislocationofhipVascularsignofnarathispositiveinposteriordislocationofhipjoint.Duetoposteriordislocation,thehipjointfallsonthefemoralartery,andthiscausesfeebleorabsentfemoralpulse.
36.Seatbeltinjuryis a)Teardropfracture b)Wedgefracture c)Chancefracture d)Whiplashinjury CorrectAnswer-CCi.e.ChancefractureAhorizontalfractureofthevertebraextendingfrombodytotheposteriorelement,causedbyastrongdistractionforce
37.
WhichpartofthespineismostcommonlyaffectedinRheumatoidarthritis: a)Cervical b)Lumbar c)Thoracic d)Sacral CorrectAnswer-AAnswerisA(Cervical):Rheumatoidarthritiscommonlyinvolvesthejointsofhands,wrist,elbow,knees,ankle,andfeetinasymmetricalmanner.AxialskeletoninvolvementisusuallylimitedtoUpperCervicalSpine.
38.Complicationsofelbowdislocationareall EXCEPT:March2004 a)Vascularinjury b)Mediannerveinjury c)Myositisossificans d)Radialnerveinjury CorrectAnswer-DAns.di.e.Radialnerveinjury1)EarlycomplicationsVascularinjury:-Brachialarterymayinjured.ItmayresultincompartmentsyndromeandVolkmann'sischemiccontracture.Nerveinjury:-Medianandulnarnerveinjury2.Latecomplications.Stiffness?Myositisossificans.Unreduceddislocation?Recurrentdislocation
39.TrueregardingMonteggiafractureis: March2007,March2013(a,b,d,f) a)Upperulnarfracture&dislocatedradialhead b)Upperradialfracture&dislocatedulna c)Lowerradialfracture&dislocatedulna d)Lowerulnarfracture&dislocatedradius CorrectAnswer-AAns.A:Upperulnarfracture&dislocatedradialheadMonteggiafracture-dislocationsareclassifiedbytheBadosystemBadotypeIinjuriesarecharacterizedbyaproximalulnarfracturewithanteriordislocationoftheradialhead.Thisisduetoaforcefulpronationinjuryoftheforearmandisthemostcommontype.BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocationinjuries.Here,thereisposteriorangulationoftheulnarfracturesiteandposteriordislocationoftheradialhead.BadotypeIIIandIVarerareinjuries.
40.Marchfractureisfractureof: September2007 a)Calcaneus b)2ndmetatarsal c)Distalfibula d)Proximaltibia CorrectAnswer-BAns.B:2ndmetatarsalAstressfractureofthe2ndor3rdmetatarsalboneissometimescalleda'marchfracture'becausesoldiersrunninginbootsoftengetit.Thefracturehealsspontaneously,sotreatmentispurelysymptomatic.
41.Mostcommontypeofshoulder dislocationis:March2011 a)Posterior b)Anterior c)Inferior d)Superior CorrectAnswer-BAns.B:AnteriorShoulderjointisthecommonestjointinthebodytodislocateAnteriorshoulderdislocationismuchmorecommonthanposteriordislocationShoulderdislocation:MCjointtodislocateinbody:ShoulderMCtypeofshoulderdislocation:Subcoracoid/inferiorRaresttypeofshoulderdislocation:PosteriorPosteriortypeofshoulderdislocationisassociatedwith:EpilepticfitsBankart'slesionisrelatedwithavulsionofglenoidallabrumHillSach'slesionisfoundonhumeralheadTestfordislocationofshoulderjoint:-Duga'stest,-Hamiltonrulertest,-CallawaystestKocher'smanouevreisdonetoreduceadislocatedshoulder
42.Felon/Whitlowis: September2012 a)Midpalamrspaceinfection b)Terminalpulpspaceinfection c)Infectionoftheulnarbursa d)Infectionoftheradialbursa CorrectAnswer-BAns.Bi.e.Terminalpulpspaceinfectionapainfulabscessofthedeeptissuesofthepalmarsurfaceofthefingertipthatistypicallycausedbybacterialinfection(aswithastaphylococcus)andismarkedbyswellingandpain
43.Swanneckdeformityisseenin: March2013(a,c,e) a)Ankylosingspondylitis b)Rheumatoidarthritis c)Osteoarthritis d)Reiter'ssyndrome CorrectAnswer-BAns.Bi.e.RheumatoidarthritisRheumatoidarthritisRAisadiseaseof:Synovium/synovialmembraneRAstartsin:SynoviumBodytissuemostlyaffectedinRA:SynoviumCharacteristicfeature:-Persistentinflammatorysynovitis,-Peripheraljoint,-SymmetricaldistributionCauses:-Immunological,-Familial,?Infective(implicated)Mostlyaffects:Females(threetimes)Earliestlesioninrheumatoidsynovitis:?Microvascularinjury,?IncreaseinnumberofsynovialliningcellsJointscharacteristicallyinvolvedinRA:?MCP,?PIP(symmetricarthritis)Boutonnieredeformity:
?FlexioncontractureofthePIP?ExtensionofDIPCriteriafordiagnosis:Any4criteriamustbepresentPathognomicfeature:RheumatoidnoduleExtra-articularmanifestationsareseenin:IndividualswithhightitresofRF(autoantibodiestotheFccomponentofIgG)
44.Perthe'sdiseaseisOsteochondritisofthe epiphysisofthe:March2013(g) a)Capitulum b)Lunate c)Femoralhead d)Calacanealtuberosity CorrectAnswer-CAns.Ci.e.FemoralheadOsteochondritisPerthesdisease:-Osteochondritisoffemoralhead-Adductionisunaffected-IOCforPerthesdisease:MRIOsteochondritisoflunate:Kienbock'sdiseaseOsteochondritisoftibialtubercle:OschGood'sSchlatter'sdiseaseOsteochondritisofcalcaneum:Sever'sdisease
45.Bestdiagnosticmodalitytodiagnose avascularnecrosisis:March2007 a)MRIscan b)CTscan c)X-ray d)USG CorrectAnswer-AAns.A:MRIScanAvascularnecrosis/osteonecrosis/aseptic(bone)necrosis/ischemicbonenecrosisisadiseaseresultingfromthetemporaryorpermanentlossofthebloodsupplytothebones.Withoutblood,thebonetissuediesandcausesthebonetocollapse.Therearemanycausesofavascularnecrosissuchas:AlcoholismExcessivesteroidusePosttraumaCaissondisease(decompressionsickness)VascularcompressionVasculitisThrombosisDamagefromradiationBisphosphonates(particularlythemandible)SicklecellanaemiaGaucher'sDiseaseIdiopathic(nocauseisfound).RheumatoidarthritisandlupusarealsocommoncausesofAVN.Avascularnecrosismostcommonlyaffectstheheadoffemur.Other
Avascularnecrosismostcommonlyaffectstheheadoffemur.Othercommonsitesincludethetalus,scaphoidandthejaw.Avascularnecrosisusuallyaffectspeoplebetween30and50yearsofage.Whenitoccursinchildrenatthefemoralhead,itisknownasLegg-Calve-Perthessyndrome.Itismostoftenlydiagnoseclinically.BecauseearlyX-raysareusuallynormalintheearlystageofthedisease,bonescintigraphyandMRIarethediagnosticmodalityofchoicesincebothcandetectminimalchangesatearlystagesofthedisease.Lateradiographicsignsincludearadiolucencyareafollowingthecollapseofsubchondralbone(crescentsign)andringedregionsofradiodensity
46.Cubitaltunnelsyndromeinvolves: March2013(c,f) a)Radialnerve b)Ulnarnerve c)Mediannerve d)Axillarynerve CorrectAnswer-BAns.Bi.e.UlnarnerveWhentheulnarnervecompressionoccursattheelbow,itiscalled"cubitaltunnelsyndrome."
47.Footdropoccursduetotheinvolvement of:September2006,March2013(b,fg,h) a)Sciaticnerve b)Directinjurytothedorsiflexors c)Commonperonealnervepalsy d)Alloftheabove CorrectAnswer-DAns.D:AlloftheaboveFootdropmayfollowdirectinjurytothedorsiflexors.Afewcasesofruptureofthetibialisanteriortendonleadingtofootdropandsuspicionofperonealnervepalsyhaveoccurred.Thissubcutaneoustendonruptureusuallyoccursafteraminortraumawiththefootinplantarflexion.Compartmentsyndromesalsomayleadtofootdrop.Marchgangrene,aformofanteriorcompartmentsyndrome,isthoughttobeduetoedemaandsmallhemorrhagesinthemusclesoftheanteriorcompartmentoccurringafterstrenuousactivityinindividualsnotaccustomedtoit.Deepposteriorcompartmentsyndromealsomayresultinfootdropasalatesequeladuetoresultantcontractureformation.Neurologiccausesoffootdropincludemononeuropathiesofthedeepperoneal,commonperoneal,orsciaticnerves.Lumbosacralplexopathy,lumbarradiculopathy,motorneurondisease,orparasagittalcorticalorsubcorticalcerebrallesionsalsocanmanifestasfootdrop.Theselesionscanbedifferentiatedthroughclinicalandelectrodiagnosticexaminations.
Acommonbehavioralcauseoffootdropishabitualcrossingofthelegs.Thesecasestypicallyresolvewithdiscontinuationofthehabit.Footdropalsomaybeseenasacombinationofneurologic,muscular,andanatomicdysfunction.Charcotfootisoneexample.
48.Mostcommonnerveinjuredinfractureof medialepicondyleofhumerusis:March2007 a)Radialnerve b)Ulnarnerve c)Mediannerve d)Musculocutaneousnerve CorrectAnswer-BAns.B:UlnarNerveCertainlesionsarecommonlyassociatedwithfracturestospecificareasofthehumerus.Attheupperend,thesurgicalneckofthehumerusandanatomicalneckofhumeruscanbothbeinvolved,thoughfracturesofthesurgicalneckaremorecommon.Theaxillarynervecanbedamagedinfracturesofthistype.Mid-shaftfracturesmaydamagetheradialnerve,whichtraversesthelateralaspectofthehumeruscloselyassociatedwiththeradialgroove.Themediannerveisvulnerabletodamageinthesupracondylararea.Theulnarnerveisvulnerabletodamagenearthemedialepicondyle,aroundwhichitcurvestoentertheforearm.
49.Waddlinggaitdueto: March2009 a)Bilateralcongenitaldysplasiaofhip b)Coxavalga c)CTEV d)Bilateralcoxavalgum CorrectAnswer-AAns.A:BilateralcongenitaldysplasiaofhipAwaddlinggaitisthestyleofwalkingthatisseeninapatientwithproximalmyopathy.Itischaracterisedby:Abroad-basedgaitwithaduck-likewaddletotheswingphaseThepelvisdropstothesideofthelegbeingraisedForwardcurvatureofthelumbarspineMarkedbodyswingThisgaitmaybeseeninpatientswithbilateralcongenitalhipdislocationandpregnancy.
50.Knucklebendersplintisusedfor: September2009 a)Ulnarnervepalsy b)Radialnervepalsy c)Mediannervepalsy d)Axillarynervepalsy CorrectAnswer-AAns.A:UlnarNervePalsyCock-upsplint?RadialnervepalsyKnuckle-bendersplint?Ulnarnervepalsy
51.Maximumweightthatcanbegivenwith skeletaltractionis:September2009 a)5kg b)10kg c)15kg d)20kg CorrectAnswer-DAns.D:20kgTractionisusuallyappliedtothespine,pelvis,neck,arms,orlegs.Theforceisgeneratedbyweightorforceagainsttheweightofthebody.Thetwomaintypesoftractionareskintractionandskeletaltraction.Ofthesetwotypes,manyspecializedformshavebeendevelopedtotreatconditionsinspecificpartsofthebody.Withskintraction,weightsareattachedtotheskin,whichappliesthepullingforcetothebone.Itisusedwhenlight(3to4kg)orshort-termtractionisneeded.Withskeletaltraction,pinsareattachedtothebonesothatthepullingforceisapplieddirectlytothebone.Skeletaltractionisusedwhenskintractionisnotpossibleandwhengreaterweight(upto20kg)isneeded.
52.Cockupsplintisusedintreatmentof? a)Radialnervepalsy b)Ulnarnervepalsy c)Mediannervepalsy d)Posteriorinterosseousnervepalsy CorrectAnswer-AAns.is'a'i.e.,RadialnervepalsySplintsAnymaterialwhichisusedtosupportafractureiscalledsplint.Splintsareusedforimmobilizingfractures;eithertemporarilyduringtransportationorfordefinitivetreatment.Themostcommonlyemployedsplintsisplasterofparis(POP)splint.VariousPOPsplintsare. 1. Casts:-HerethePOProllcompletelyencirclesthelimb.2. Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalfor onethirdcircumference. 3. Spica:-Thisencirclesapartofthebody;e.g.,hipspicafor fracturesaroundhip.
53.Froment'ssignispositiveincasesof weaknessof? a)Thumbadduction b)Thumbabduction c)Thumbflexion d)Thumbextension CorrectAnswer-AAns.is'a'i.e.,ThumbadductionNormallywhenapersonisaskedtograspabookbetweenthethumbandindexfinger,hewillgraspthebookfirmlywiththumbextended,takingfulladvantageoftheadductorpollicisandthefirstdorsalinterosseousmuscles.Iftheulnarnerveisinjuredtheadductorpolliciswillbeparalysedandthepatientwillholdthebookbyusingtheflexorpollicislongus(suppliedbymediannerve)producingflexionattheinterphalangealjoint.Thisbecomesmorepronouncediftheexaminertriestopullthebookoutwhilethepatienttriestoholdit.Thissignisknownas`Froment'ssign'orthe'booktest'.
54.Mostcommoncauseofamputationin Indiais? a)Diabeticgangrene b)Gasgangrene c)Roadtrafficaccident d)Tumors CorrectAnswer-CAns.is'c'i.e.,RoadtrafficaccidentAmputationAmputationisaprocedurewhereapartofthelimbisremovedthroughoneormorebones.Disarticulationisaprocedurewherethelimbisremovedthroughajoint.IndicationsofamputationIndicationsofamputationsmaybeabsoluteorrelative:?A)AbsoluteindicationsGasgangreneDiabeticgangreneIrreparablelossofbloodsupplyduetotraumaordiseasePeripheralvasculardisease(Burger'sgangrene)B)RelativeindicationsTraumaTumorsSeverelossoffunctionoflimbNerveinjuriesCongenitalanomaliesOverallmostcommoncauseofamputationistrauma(injury)toalimb.
Mostcommoncauseoftraumaisroadtrafficaccident.
55.Allaretrueaboutcollesfractureexcept? a)Inoldage b)Dorsalshift c)Atcortico-cancellousjunction d)Gardenspadedeformity CorrectAnswer-DAns.is'd'i.e.,GardenspadedeformityCOLLESFRACTUREColle'sfractureisanextra-articularfractureatthedistalendofradius,atitscortico-cancellousjunction.Itisthemostcommonfractureinpersonover40yearsofageandespeciallyinwomenaftermenopause(Postmenopausalfemales).Theassociationofthefracturewithosteoporosisisnowwellestablishedanditisoneofthefragilityfracture,seeninosteoporosis.Thefracturenearlyalwayscausedbyfallonoutstretchedhand.Displacementincolle'sfractureThefracturelinerunstransverselyatthecortico-cancellousjunction.Inthemajorityofthecases,oneormoredisplacementsofthedistalfragmentoccur:- i. Dorsaldisplacement(Dorsalshift) ii. Lateraltilt(lateralangulation) iii. Dorsaltilt(Dorsalangulation) iv. Supination(externalrotation) v. Lateraldisplacement(lateralshift) vi. Impaction(proximalmigration) vii. Clinicalfeaturesofcollesfracture Painandswellingatthewrist.Typicaldeformity:Thereisadorsalhollowordepressionjust
proximaltothefractureandimmediatelydistaltothisthereisamarkedprominencecausedbylowerfragmentbeingdisplacedbackwards,carryingwithitthewholeofthecarpusandhand.Thisgivesappearanceofafork,Sonameddinnerfork/silverfork/spoonshapeddeformity.
56.Mostcommontypeofsupracondylar fractureinchildren? a)Posteromedialextension b)Posterolateralextension c)Anteromedialflexion d)Anterolateralflexion CorrectAnswer-AAns.is'a'i.e.,PosteromedialextensionSupracondylarfractureofhumerusSupracondylarhumeralfracturesarethemostcommonelbowfracturesinchildren.Mostcommonagegroupaffectedis5-8years.Boysareaffectedmorethangirls.Leftsideismorecommonthanright.MechanismofinjuryMostlyitoccursduetohyperextensioninjury.Fractureiscausedbyafallontotheoutstretchedhandwithhyperextensionatelbow.TypesofsupracondylarfractureSupracondylarfractureisbroadlyclassifiedintoextensiontypeandflexiontype.1)ExtensiontypeItisthemostcommontype(97-99%).Distalfragmentisextended(tiltedbackward/posteriorly)inrelationtoproximalfragment.Occursduetohyperextensioninjuryafterfallonoutstretchedhands.Generally,displacementofdistalfragmentmaybe:-i)Posteromedial(70-80%)ii)Posterolateral(20-30%)
2)FlexiontypeItislesscommontype(1-3%)Distalfragmentisflexed(tiltedforward/anteriorly)inrelationtoproximalfragments.Themechanismofinjurygenerallyisbelievedtobeafalldirectlyontotheelbowratherthanafallonoutstretchedhand.Astheextensiontypefractureismorecommon(97-99%),themostcommonelbowinjuryinchildrenisextensiontypeofsupracondylarfracture.ClinicalfeaturesofsupracondylarfractureFollowingafall,thechildisinpainandelbowisswollen.Inextensiontypeofinjury,`S'shapeddeformityoftheelbowisobvious.Thereislossofbothactiveandpassivemovementsofelbow.Symptomsrelatingtovascularandnerveinjurymaybeseen.Unusualposteriorprominenceofthepointofelbow(tipofolecrenon)becauseofbackwardtiltofthedistalfragment.Threepointbonyrelationshipismaintainedasthefractureisabovethelevelofcondyles.Dimplesignduetooneofthespikesofproximalfragmentpenetratingthemuscleandtethringtheskin.
57.Mostcommonjointinvolvedingoutis? a)Knee b)Hip c)MPjointofgreattoe d)MPjointofthumb CorrectAnswer-CAns.is'c'i.e.,MPjointofgreattoeGoutisthecommonendpointofagroupofdisordersthatproducehyperuricemia.Itismarkedbytransientattacksofacutearthritisintitiatedbycrystallizationofmonosodiumurateintothejoints,leadingeventuallytochronicgoutyarthritisanddepositionofmassesofuratesinjointsandothersites,creatingtophi.Mostcommonjointinvolvedingoutisbigtoe,i.e.metatarsophalangealjointofgreattoe.Tophiarepathognomicofgout.Theyareformedbylargeaggregationsofuratecrystals.Theuratecrystalsaresurroundedby-
58.Whichofthefollowingstructurearenot normallyvisualizedduringthearthroscopyoftheknee? a)Meniscus b)Cruciateligaments c)Collateralligaments d)Patellaarticularsurface CorrectAnswer-CAns.is'c'i.e.,CollateralligamentsThefollowingstructuresarevisualizedduringthekneearthroscopy:-i)Medialandlateralmeniscusii)Anteriorandposteriorcruciateligamentsiii)Kneearticularcartilageiv)Patello-femoraljointv)Loosebodiesinjoint
59.Notacomplicationoffractureneckof femur? a)Non-union b)Malunion c)AVN d)Osteoarthritis CorrectAnswer-BAns.is'b'i.e.,MalunionComplicationsoffemoralneckfractureFracturesoftheneckofthefemuraremorepronetoseriouscomplicationsthaninanyotherfracture.Allthecomplicationsaffectfractureswithdisplacementratherthanimpactedabducted(valgusimpacted)fractures.Theimportantcomplicationsare:1)AvascularnecrosisoffemoralheadAVNisthemostcommoncomplicationoffemoralneckfracture.Itoccursin15-35%ofcasesofdisplacedfracturesand2)Non-unionNon-unionisthesecondmostcommoncomplicationoffemoralneckfracture.Itoccursin10-30%ofcasesofdisplacedfracturesand3)SecondaryosteoarthritisItoccursafewyearsfollowingfractureneckfemur.Avascularnecrosisorcollapseoffemoralheadleadstosecondaryosteoarthritisofthehipjoint.
60.Mostcommonsiteofmetastasisin skeleton? a)Femur b)Tibia c)Vertebrae d)Skull CorrectAnswer-CAns.is'c'i.e.,VertebraeMetastasisMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.Certaintumorsareknowntobecommonsourcesofbonemetastasis.Thefollowingprimarytumorsarethemostcommontometastasizeinthebone;breast,prostate,lung,thyroid,kidney,andgastrointestinaltract.Thecommonestsourceofmetastaticbonediseaseiscarcinomaofthebreast.Inmalesmostcommonsourceisprostatecarcinoma.Bladderanduterinecarcinomasarelesscommonsources.Inchildren,skeletalmetastasesoriginatefromneuroblastoma,Ewing'ssarcoma,andosteosarcoma.
61.Perkin'slineonX-rayisusedfor diagnosisof- a)Perthe'sdisease b)CDH c)CTEV d)AVNHip CorrectAnswer-BAns.is'b'i.e.,CDHRadiologicalfeaturesofDDH/CDHInVonRosen'sviewfollowingparametersshouldbenotedPerkin'sline:VerticallinedrawnattheouterborderofacetabulumHilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiatecartilageShenton'sline:Smoothcurveformedbyinferiorborderofneckoffemurwithsuperiormarginofobturatorforamen.Acetabularindex:NormallyisS30?CEangleofWiberg:Normalvalueis15-30"Normallytheheadliesinthelowerandinnerquadrantformedbytwolines(Perkin's&Hilgenreiner's).InDDHtheheadliesinouter&upperquadrantShenton"slineisbrokenDelayedappearance&retardeddevelopmentofossificationofheadoffemurSlopingacetabulumSuperior&lateraldisplacementoffemoralheadVon-Rosen'slineThisisaline,whichhelpsinthediagnosisofDDHininfantslessthan6months.
ForthisAPviewofpelvisistakenwithbothlowerlimbin450abductionandfullinternalrotation.Upwardprolongationoflongaxisofshaftofthefemurpointstowardsthelateralmarginoftheacetabulumandcrossesthepelvisintheregionofsacroiliacjoint.InCDH,upwardprolongationofthislinepointstowardsanteriorsuperioriliacspineandcrossesthemidlineinthelowerlumberregionPositiveVon-Rosen'ssign.
62.Whichjointismostcommonlyaffectedin pseudogout- a)Knee b)Hip c)MPjointgreattoe d)MPjointthumb CorrectAnswer-AAns.is'a'i.e.,KneePseudogoutItisoneoftheformsof"Calciumpyrophosphatedihydrate"(CPPD)arthropathy.Pseudogoutcommonlyinvolvesthelargerjoints.Kneejointismostcommonlyinvolved;othersitesarewrist,elbow,shoulder,ankle.Involvementofsmalljointsisuncommon.Agegroupis>60yrs.InCPPDarthropathy,CPPDdepositionoccursinarticulartissues.Itcanpresentinanyofthefollowingthreeforms:?1)Asympatomaticchondrocalcinosis2)Acutesynovitis-Pseudogout3)ChronicpyrophosphatearthropathyTheradiologichallmarkofCPPDis"chondrocalcinosis.Chondrocalcinosisisseenaspunctateand/orlinearradiodensedepositsinfibrocartilaginousjointmenisciorarticularhyalinecartilage.Definitivediagnosisismadebysynovialfluidpolarisedlightmicroscopywhichshowsweaklypositive,birefringent,rhomboidcrystalsofCPPD.[Ingoutpolarizedlightshows-stronglynegativebirefringent,needleshapedcrystalsofmonosodiumurate]
63.Loosebodyinjointmostcommonsiteis- a)Knee b)Hip c)Elbow d)Ankle CorrectAnswer-AAns.is'a'i.e.,KneeLoosebodyinjointAloosebodyisafree-floatingpieceofbone,cartilageorforeignobjectinajoint.Thekneeisthemostcommonjointwhereonewouldfindaloosebody.Causesofloosebodiesinclude:-i)Osteoarthritisii)Osteochondritisdessicansiii)Osteochondralfracture(injury)iv)Charcot'sdiseasev)Synovialchondromatosis
64.Investigationofchoiceforentrapment neuropathyis? a)CTSCAN b)Clinicalexamination c)Ulrasonography d)EMGNCV CorrectAnswer-DAns.is'd'i.e.,EMGNCVThediagnosisofmononeuropathyinentrapmentneuropathyisbasedonelectrodiagnosticstudies(EMG/NCV)andMagneticresonanceimaging(MRI).Entrapmentneuropathyisamedicalconditioncausedbyentrapmentandcompressionofaperipheralnervewhereverittraversesfibro-osseoustunnels.Sitesofentrapmentneuropathyare:- i. Carpaltunnel:-Mediannerve(carpaltunnelsyndrome) ii. Cubitaltunnel:-Ulnarnerve(cubitaltunnelsyndrome) iii. Guyan'scanal:-Ulnarnerve(Guyan'scanalsyndrome) iv. Tarsaltunnel:-Posteriortibialnerve(Tarsaltunnelsyndrome) v. Inguinalligament:-Lateralcutaneousnerveofthigh(meralgia paraesthetica). vi. Suprascapularnotch:-Suprascapularnerve vii. Neckoffibula:-Commonperonealnerve viii. Fascialtunnelofsuperficialperonealnerve:-Superficialperoneal nerve ix. ArcaseofFrohse:-Posteriorinterosseoussyndrome x. Thoracicoutlet:-Lowertrunkofbrachialplexus xi. Compressioninthefoot:-Digitalnerve(Morten'smetatarsalgia)
65.Posteriorglidingoftibiaonfemuris preventedby? a)Anteriorcruciateligament b)Posteriorcruciateligament c)Medialcollateralligament d)Lateralcollateralligament CorrectAnswer-BAns.is'b'i.e.,PosteriorcruciateligamentPosteriorcruciateligamentPCLbeginsfromposteriorpartofintercondylarareaoftibiaandrunsupwards,forwardsandmediallytoattachtheanteriorpartofthelateralsurfaceofmedialcondyleoffemur.PCLisextrasynovialbutintracapsular,i.e.,liesbetweensynoviumandcapsuleofthekneejoint.Itprovidesantero-posteriorstabilityandpreventsposteriorglidingoftibiaonfemur.Itistautinflexion.Bloodsupplyofcruciate(anterior&posterior)ligamentsisfrom:- 1. Middlegenicularartery(majorsupply)2. Inferiorgenicular(medial&lateral)artery(lessimportant). Nervesupplyofcruciateligaments(ACL&PCL)isfromposteriorarticularbranchoftibialnerve.
66.Cozen'stestisusedforthediagnosisof? a)Tenniselbow b)Golfer'selbow c)Baseballer'spitcherelbow d)Carpaltunnelsyndrome CorrectAnswer-AAns.is'a'i.e.,TenniselbowSignsandTestsAdson'stest:forthoracicoutletsyndromeAllen'stest:fortestingpatencyofradialandulnararteriesAlli'stest:forCDHAnviltest:fortestingtendernessofthespineApethumb:formediannerveinjuryApley'sgrindingtest:formeniscusinjuryApprehensiontest:forrecurrentdislocationoftheshoulderBarlow'stest:forCDHBluesclera:OsteogenesisimperfectaBryant'stest:foranteriordislocationoftheshoulderCallways'test:foranteriordislocationoftheshoulderChovstek'ssign:fortetanyClawhand:forulnarnerveinjuryCointest:fordorsolumbartuberculosisofspineCozen'stest:fortenniselbowDrawertest:forACLandPCLinjutriesAnterior:forACLinjuryPosterior:forACLinjuryFinkelstein'stest:fordeQuervain'stenovaginitisFootdrop:forcommonperonealnerveinjury
Froment'ssign:forulnarnerveinjuryGaenslen'stest:forSIjointinvolvementGalleazzisign:forCDHGower'ssign:formusulardystrophyHamiltonrulertest:foranteriordislocationoftheshoulderKanavel'ssign:forinfectioninulnarbursaLasegue'stest:fordiscprolapseLachmanntest:forACLinjuryLudloffssign:foravulsionoflessertrochanterMcMurray'stest:formeniscusinjuryNagffzigertest:fordiscprolapseOber'stest:fortightilio-tibialband(e.g.,inpolio)O'Donoghuetriad:traidofMCL,ACL&medialmeniscusinjuriesoccurringtogetherOrtolani'stest:forCDHPivotshifttest:forACLinjuryPolicemantip:forErb'spalsyRunner'sknee:PatellartendinitisSulcussign:forinferiordislocationoftheshoulderThomas'test:forhipflexiondeformityTrendelenburg'stest:forunstablehipduetoanyreaseon(e.g.,CDH)Tinel'ssign:fordetectingimprovingnerveinjuryVolkmann'ssign:forischaemiccontractureofforearmmusclesWristdrop:forradialnerveinjury
67.Mostcommonsitefortheosteoporotic vertebralfractureis? a)Dorsolumbarspine b)Cervicalspine c)Lumbosacralspine d)Dorsalspine CorrectAnswer-AAns.is'a'i.e.,DorsolumbarspineOsteoporosisisanasymptomaticdisorderunlesscomplications(predominantlyfractures)occur.Mostcommonsymptomofosteoporosisisbackpainsecondarytovertebralcompressionfracture.Dorso-lumbarspineisthemostfrequentsite.Othercommonsitesoffracturearelowerendradius(Colle'sfracture)andfractureneckfemur.Osteoporoticfracture(fragilefractures)are:(i)Fracturevertebrae(mostcommon),(ii)Colle'sfracture,(iii)Fractureneckfemur.Serumcalcium,phosphateandalkalinephosphatasearenormalinosteoporosis.
68.SunrayappearanceonX-rayisseenin? a)Osteosarcoma b)Osteochondroma c)Osteoclastoma d)Chondroblastoma CorrectAnswer-AAns.is'a'i.e.,OsteosarcomaCodman'striangleandsunrayappearancearetypicalofosteosarcoma.However,youshouldkeepinyourmindfollowingveryimportantfacts:-Sunray(sunburst)appearanceandcodman'striangleindicatesperiostealreaction(periostealnewboneformation).Boththesearetypicalofosteosarcomabutmayalsooccurinotherrapidlygrowingbonetumors(Ewing'ssarcoma),andinfection(osteomyelitis).Similarly,onionpeelappearanceindicatesperiostealnewbone-formationandistypicalforEwing'ssarcoma.Butthiscanalsooccurinoseosarcomaandosteomyelitis.Thecruxisthat,aggresivelygrowingtumorsandinfectionstimulatetheperiosteumwhichthenreactbyformingnewbone,(thereforeitiscalledperiostealreaction)whichmaytakeanyoftheaboveform.
69.Puttiplatoperationisdonefor? a)Elbowinstability b)Shoulderinstability c)Rotatorcufftear d)BicepsTendinitis CorrectAnswer-BAns.is'b'i.e.,ShoulderinstabilityImportantsurgeriesforrecurrentanteriordislocationofshoulderare:i)Barkart'soperationiii)Bristow'soperationv)EdenHybinetteoperationii)Putti-Platt'soperationiv)McLaughin'soperationvi)Magnum&Stackoperation
70.Lachmann'stestisusedfor? a)ACLinjury b)PCLinjury c)MCLinjury d)LCLinjury CorrectAnswer-AAns.is'a'i.e.,ACLinjuryACLinjuryACListhemostcommonlyinjuredligamentofknee.Mostcommonmechanismofinjuryistwisting(medialrotation)withvalgusinjuryonsemiflexedknee.OftenwiththismechanismMCLandmedialmeniscusarealsoinjured.ThistripleinjuryofACL,MCLandmedialmeniscusiscalledO'Donghuetriad.IsolatedACLcanalsobeinjuredbyhyperextensioninjury.TestsforACLinjuryFollowingtestsareusedforACLinjury:? i. Lachman'stest ii. Pivotshifttest iii. Flexion-rotationdrawertest iv. Anteriordrawertest v. Jerktest vi. Loose'stest Lachman'stestisthemostsensitivetestforanteriorcruciateligamenttears.Itisdonewiththekneeflexedat20degrees.Soitcanbedoneinacuteaswellaschronicinjuries.(becauseinacutecaseswithhemarthrosismoreflexionisusuallynotpossiblesoperforminganteriordrawertestisdifficult).
71.Infectionofulnarbursaisdiagnosedby- a)Kanavel'ssign b)Chowstek'ssign c)Gower'ssign d)Ludloff'ssign CorrectAnswer-AAns.is'a'i.e.,Kanavel'ssignKanavel'ssignisforinfectionofulnarbursa.
72.Ringshapedepiphysesisseenin? a)Osteogenesisimperfecta b)Morquiossyndrome c)Zellwegersyndrome d)Multipleepiphysealdysplasia CorrectAnswer-AAns.is'a'i.e.,OsteogenesisimperfectaRingshapedepiphysisi)Hypothyroidism(healingphase)iv)Osteoporosisii)Osteogenesisimperfectav)Rickets(healingphase)iii)Osteopetrosisvi)Scurvy
73.DevelopmentofChondrosarcomasis relatedwith? a)Maffuccisyndrome b)Feltysyndrome c)aandbboth d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,MaffuccisyndromeChondrosarcomasdevelopinginpatientswithollier'sandmaffuccisyndromeiscalledsecondarychondrosarcoma.SecondarychondrosarcomaItisthechondrosarcomaarisinginbenignprecursoreitherosteochondromaandenchondroma.Therearenoreliablefiguresabouttheriskofdevelopingsecondarychondrosarcomainbenignprecursors.Theriskofchondrosarcomainsolitaryosteochondromais2%andthatforosteochondromatosisis5-25%.Patientswithollier'sdiseaseandmaffuccisyndromehavea25-30%riskofdevelopingchondrosarcoma.
74.CASPARcriteriaisusedindiagnosisof? a)Psoriaticarthritis b)Rheumatoidarthritis c)Ankyosingspondylitis d)Reactivesynnovitis CorrectAnswer-AAns.is'a'i.e.,PsoriaticarthritisClassificationcriteriaforpsoriaticarthritis(CASPAR)isusedforthediagnosisofpsoriaticarthropathy.TheCASPAR(classificationCriteriaforPsoriaticArthritis)CriteriaTomeettheCASPARcriteriaapatientmusthaveinflammatoryarticulardisease(joint,spine,orentheseal)with3pointsfromanyofthefollowingfivecategories: 1. Evidenceofcurrentpsoriasis,apersonalhistoryofpsoriasis,orfa familyhistoryofpsoriasis. 2. Typicalpsoriaticnaildystrophyobservedoncurrentphysical examination. 3. Anegativetestresultforrheumatoidfactor.4. Eithercurrentdactylitisorahistoryofdactylitisrecordedbya rheumatologist. 5. Radiographicevidenceofjuxtaarticularnewboneformationinthe handorfoot.
75.Drugofchoiceforthetreatmentofacute goutinpatientsinwhomNSAIDsarecontraindicatedis? a)Colchicine b)Allopurinol c)Xyloricacid d)Paracetamol CorrectAnswer-AAns.is'a'i.e.,ColchicineTreatmentofGout1)AcutegoutNSAIDsarethedrugsofchoiceColchicineisthefastestactingdrug.HoweveritisreservedforthepatientsinwhichNSAIDsarecontraindicated,becausecolchicinecancausegastrointestinaldisturbances.IfneitherNSAIDsnorcolchicinaretolerated,oralprednisoloneisused.Allopurinolanduricosuricdrugs(sulfinpyrazone,probenacid)arenoteffectiveinacutegoutbecausetheywillnotrelievesymptomsastheydon'thaveanti-inflammatoryproperty.2)ChronicgoutAllopurinalisthedrugofchoice.Otherdrugsaresulfinpyrazoneandprobenacid.
76.Causesofpainfularcsyndromeis/are? a)Supraspinatustendinitis b)Subacromialbursitis c)Fractureofgreatertuberosity d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheabovePainfulArcsyndromeThisisaclinicalsyndromeinwhichthereispainintheshoulderandupperarmduringthemidrangeofglenohumeralabduction.Followingarethecommoncauses: i. Minortearsofthesupraspinatustendon ii. Supraspinatustendinitis iii. Calcificationofsupraspinatustendon iv. Subacromialbursitis v. Fractureofthegreatertuberosity Inalltheseconditions,thespacebetweentheupper-endofthehumerusandtheacrominongetscompromised,sothatduringmid-abductionthetendonoftherotator-cuffgetsnippedbetweenthegreatertuberosityandacrominon.X-rayoftheshouldermayshowcalcificdeposit,orafractureofthegreatertuberosityoracromion.oTreatmentconsistsofultrasonicstothetenderpointandanti-inflammatorydrugs.Somecasesneedaninjectionofhydrocortisoneinthesubacromialspaceorexcisionoftheanterior,oftenprominentpartoftheacromion.
77.Fatembolismsyndromeismost commonlyseenafter? a)Femurfracture b)Acetabularfracture c)Pelvisfracture d)Calcanealfracture CorrectAnswer-AAns.is'a'i.e.,FemurfractureFatembolismmeanscirculationoffatglobuleawayfromitssiteoforigin.Whenfatembolismcausessymptomsitiscalledfatembolismsyndrome.Causesoffatembolism 1. Fractureoflongbone(mostcommon)-Blunttrauma2. RecentCorticosteroidadministration3. Softtissuetrauma4. Acutepancreatitis5. Burns6. D.M.7. Parenterallipidinfusion8. Liposuction9. Sicklecellcrisis 10. Decompressionsickness
78.Whataboutdurhampinistrue? a)Itisusedtogiveskeletaltraction b)Ithasthreadsinthecenterofpin c)Itisusedtogiveskeletaltractionthroughcalcaneum d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveDenhampinItisatypeofpinusedtogiveskeletaltraction.Threadedportionofthepinengagesthebonycorticesandreducesthechancesofpinsliding.Thistypeofpinisusedcommonlytogiveskeletaltractionthroughthecancellousbonei.e.calcaneum.Itcanalsobeusedtogivetractionthroughosteoporoticbones.
79.Zscoremeasuresthebonemineral densitycompredto? a)Age,Raceandsexmatchedindividuals b)Raceandsexmatchedindividuals c)Sexmatchedindividuals d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,Age,RaceandsexmatchedindividualsTScoreandZscorearethemeasuresofbonemineraldensity.Zscore:Measuresthebonemineraldensityintermsstandarddeviationfromthemeanbonemineraldensityofage,raceandsexmatchedindividuals.Tscore:Measuresthebonemineraldensityintermsstandarddeviationfromthemeanbonemineraldensityofraceandsexmatchedindividualsofnormalyoungeragegroup.
80.Osteoidosteomaconsistsof- a)Osteoblasts b)Osteoclasts c)Bothofabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothofaboveOsteoidOsteomaOsteoidosteomaisthemostcommontruebenigntumorofthebone.Thisisabenigncircumscribedlesionthatmayariseinthecortexoflongbonesoroccasionallyinthecancellousboneofspine.Thecharacteristicfeatureistheformationofasmallnidusofosteoidtissue,surroundedbyareactivezoneofdensesclerosis(Scleroticnewboneformation).Microscopically,thetumoriscomposedofthin,irregular,trabeculaewithinacellulargranulationtissuecontainingosteoblastsandosteoclasts.Trabeculaearemorematureinthecenter,whichisoftenpartiallycalcified.Reactive,scleroticbonesurroundsthenidus.ClinicalfeaturesofosteoidosteomaThetumoroccursbetween10-30yearsofageandismorecommoninmales.Thediaphysisoflongbonesisinvolved,mostcommonboneinvolvedisthetibiafollowedbyfemur.Posteriorelementsofthevertebraemayalsobeinvolved.Thepresentingcomplaintisanaggingpain,worstatnight,andisrelievedbysalicylatesorotherNSAIDs,adiagnosticfeature.OnX-ray,thereisasmallradiolucentarea(nidus)surroundedbydenssclerosis.
X-ray,insomecases,showlocalscleroticthickeningoftheshaftthatmayobscurethesmallcentralniduswithintheareaofrarefaction.Bonescanshowsincreaseduptakeinthenidus.Theonlytreatmentiswideenblockexcisionalongwithinternalfixationwithorwithoutbonegrafting.
81.Mostcommoncauseofacute compartmentsyndromeinchildrenis? a)Fracturesupracondylarhumerus b)Transphysealhumerusfracture c)Fractureradius/ulna d)Fractureshafthumerus CorrectAnswer-AAns.is'a'i.e.,FracturesupracondylarhumerusCompartmentsyndromeismostcommonlycausedbyextremityfractures:- i. Supracondylarfractureofhumerusisthemostcommoncauseis children. ii. Crushinjuriestoforearmarethemostcommoncauseinadults. iii. Otherinjuriesarefracturebothbonesforearm,elbowdislocation.
82.Thomassplintisusedforimmobilizing fracturesof? a)Femur b)Tibia c)Radius d)Ulna CorrectAnswer-AAns.is'a'i.e.,FemurSplintsAnymaterialwhichisusedtosupportafractureiscalledsplint.Splintsareusedforimmobilizingfractures;eithertemporarilyduringtransportationorfordefinitivetreatment.Themostcommonlyemployedsplintsisplasterofparis(POP)splint.VariousPOPsplintsare:-1)Casts:-HerethePOProllcompletelyencirclesthelimb.2)Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalforonethirdcircumference.3)Spica:-Thisencirclesapartofthebody;e.g.,hipspicaforfracturesaroundhip.
83.Whichofthefollowingisnottheextra- articularmanifestationsofankylosingspondylitis? a)Acuteanterioruveitis b)Aorticvalvedisease c)Pulmonaryfibrosis d)Dilatedcardiomyopathy CorrectAnswer-DAns.is'd'i.e.,DilatedcardiomyopathyExtraarticularmanifestationsofankylosingspondylitisareacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Ankylosingspondylitis(marie-strumpelldisease)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.Prototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.Maletofemaleratiois2-3:1StrongcorrelationwithHLA-B2790-95%ofcasesarepositiveforHLA-B27.JointsinvolvedinankylosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Rarelyknee(Ebenzar4th/e593)andankle(Apley's9th/e67)arealsoinvolved.PathologyEnthesitisi.e.inflammationoftheinsertionpointsoftendons,ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftentheearliestmanifestationofA.S..Involvementofcostovertebraljointsfrequentlyoccur,leadingtodiminishedchestexpansion(normal5cm)oPeripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rdpatients.Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Pathologicalchangesproceedinthreestages? 1. Inflammationwithgranulationtissueformationanderosionof adjacentbone. 2. Fibrosisofgranulationtissue3. Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
84.Whichofthefollowingdeformityis evidentincaseoferbspalsy? a)Policemantipdeformity b)Wingingofscapula c)Clawhand d)Wristdrop CorrectAnswer-AAns.is'a'i.e.,PolicemantipdeformityDeformity(positionofthelimb)inErb'spalsyi)Arm:Hangesbytheside;itisadductedandmediallyrotatedii)Forearm:ExtendedandpronatednThedeformityisknownas'policeman'stiphand'or'porter'stiphand'.
85.Functionalcastbracingnotusedin fractureof? a)Humerus b)Tibia c)Ulna d)Thoracolumbarspine CorrectAnswer-DAns.is'd'i.e.,ThoracolumbarspineFunctionalcastbracingisusedforthefractureof:- i. Humerus ii. Femur iii. Ulna iv. Tibia
86.Whatisnottrueaboutpulledelbow? a)Occursduetosuddenaxialpullonextendedelbow b)Forearmisheldinpronationandextention c)Mostcommonlyoccursbetween2-5yearsofage d)Treatmentisquickpronationandflexionofelbow CorrectAnswer-DAns.is'd'i.e.,TreatmentisquickpronationandflexionofelbowPulledelbowIfayoungchildisliftedbythewrist,theheadoftheradiusmaybepulledpartlyoutoftheannularligament,i.e.,subluxationoftheheadoftheradius.Itoccurswhenforearmispronated,elbowisextendedandlongitudinaltractionisappliedtothehandorwrist,e.g.,lifting,spinningorswingingachildwithwristorhand.Pulledelbowmostcommonlyoccursbetweentheageof2-5years.ClinicalfeaturesofpulledelbowHistoryofsuddenaxialpullonextendedelbow.Immediatelychildstartscryingandisunabletomovetheaffectedelbow.Theforearmisheldinpronationandextensionandanyattempttosupinateisresisted.Childdoesnotallowtotouchtheaffectedlimb.X-rayseemstobenormal.TreatmentofpulledelbowTreatmentissimple.Thechild'sattentionisdiverted,theelbowisquicklysupinatedandthenslightlyflexed.Thisreducesthesubluxationordislocationandtheradialheadis
relocatedwithasnap.
87.Heberdennodedenotesinvolvementof? a)Distalinetrphalangealjoint b)Proximalinterphalangeljoint c)Metacarpophalangealjoint d)Metatarsophalangealjoint CorrectAnswer-AAns.is'a'i.e.,DistalinetrphalangealjointInosteoarthritisofhand:i)Distalinterphalangealjoint:-Heberden'snodeii)Proximalinterphalangealjoint:-Bouchard'snode
88.De-quervian'stenovaginitisinvolves? a)Abductorpollicislongus b)Extensorpollicisbrevis c)Bothoftheabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothoftheaboveDe-Quervian'stenovaginitisischaracterizedbypainoverthestyloidprocessoftheradiusandpalpablethickeninginthecourseoftheabductorpollicislongusandextensorpollicisbrevistendons.Thefibroussheathsoftheabductorpollicislongusandextensorpollicisbrevistendonsarethickenedwheretheycrossthetipoftheradialsyloidprocess.Thetendonsthemselvesappearnormalasdoesthesynovialliningofsheath.Exactcauseisunknow.Excessivefrictionfromoverusemaybeafactor,becausetheconditionseemspronetofollowrepetitiveactionssuchaswringingclothes,orinmorerecenttimesexcessivetypingormanipulations.Theconditionisfivetimescommonerinwomenthanmen,predominantlyinmiddleage.Themainsymptomispainonusingthehand,especiallywhenmovementtensestheabductorpollicislongusandextensorspollicisbrevistendons(asinliftingasaucepanorateapot).Onexamination,thereislocaltendernessatthepointwherethetendonscrosstheradialstyloidprocess.Thethickenedfibroussheathareusuallypalpableasfirmnodule.Passiveadductionofthewristorthumbcausesthepatienttowince
withpain.Finkelstein'stestisusedtodiagnoseDe-Quervain'stenovaginitis.Toperformthetest,thepatientsasktoflextheirthumbandclenchtheirfistoverthethumbfollowedbyulnardeviation.Thisproducessharppainalongthedistalradius.
89.ThetypicaldeformityinCTEVis? a)Ankleequinus b)Subtalarinversion c)Forefootadduction d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.CTEVismorecommonmalesinthaninfemales(malestofemaleratio2.5:1).InhalfofthecasesCTEVisbilateral.Rightandleftfootareaffectedequally.Thedeformityconsistsoffollowingelements:?i)Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint).ii)Inversionoffootatsubtalarjoint(talocalcanealjoint).iii)Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicularjoint.iv)Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-tarsaljoints.
90.Ortolanitestispositivewhenthe examinerhearsthe? a)Clunkofentryonabductionandflexionofhip b)Clunkofentryonextensionandadductionofhip c)Clickofexitonabductionandflexionofhip d)Clickofexitonextensionandadductionofhip CorrectAnswer-AAns.is'a'i.e.,ClunkofentryonabductionandflexionofhipClinicaltestsforCDH/DDHIninfancytwotestsareused.Barlow'stestThistestisdonewithin2-3daysofbirth.Thetesthastwoparts:? 1. Part1:-Infantisinsupinepositionwithhipandkneein90?of flexion,Thehipisslowlyadducted&pushedtodislocatethehipandonecanhearaclunckofexitoffemoralheadoutoftheacetabulum. 2. Part2:-Nowthehipisgentelyabductedandpulledtoreducethe hip.Thiswillcause'clunk'indicatingreductionofhip.Itisquiteobviousthatpart1canbedoneonlydislocatablehip;butnotinalreadydislocatedhipastheheadisalreadyoutoftheacetabulum.Ortolani'stestThistestissimilarto2ndpartofBarlow'stest,i.e.slowabductionofhipinflexedpositionofhip&kneetoreducethehip.
91.Whendoyouoperateforprolapseddisc? a)Busyexecutiveneedsquicksurgery b)Onlywithweaknessnopain c)Severepaininterferingwithactivityandnotrelievedbyrestand treatmentof8weeks d)PatientofPIDwithdifficultyinambulation CorrectAnswer-CAns.is'c'i.e.,Severepaininterferingwithactivityandnotrelievedbyrestandtreatmentof8weeksIndicationsforsurgeryincasesofProlapsedintervertebraldiscare:-i)Failureofconservativetreatment(evenafter8weeksoftreatment).ii)Progressiveneurologicaldeficit.iii)Cauda-equinasyndrome.iv)Severesciatictilt.
92.Vertebralrotationinscoliosisischecked in a)Forwardbending b)Backwardbending c)Sideways d)Withoutbending CorrectAnswer-AAns.is'a'i.e.,ForwardbendingTheforwardbendingtestisverysensitiveindemonstratingthevertebralrotationthattakesplaceinastructuralscolioticcurve.Quantificationoftherotationisdonebymeasuringtheribhumpbyuseofinclinometerorscoliometer.Severityofthecurveinscoliosisismeasuredbycobb'sangle,i.e.ananglebetweenlinepassingthroughthemarginsofvertebraatendsofcurve.Tousethecobbmethod,onemustfirstdecidewhichvertebraearetheend-vertebraeofthecurve.Theseendvertebraearethevertebraeattheupperandlowerlimitsofcurvewhichtiltmostseverelytowardtheconavityofthecurve.OthermethodusedtomeasurescoliosisangleisFerguson'smethod.
93.Patientcomeswithcrushinjurytoupper limb,doctorisconcernedaboutgangreneandsepsiswhatcanhelpdecidebetweenamputationandlimbsalvage? a)MESS b)Gulitonscore c)GustiloAndersonclassification d)ASIAguidelines CorrectAnswer-AAns.is'a'i.e.,MESSMESS(MangledExtremitySeverityScore):Estimatesviabilityofanextremityaftertrauma,todetermineneedforsalvagevsempiricamputation.Followingparametersarelookedfor:-i)Limbischemiaii)Patientagerangeiii)Shockiv)Injurymechanism
94.Inabilitytopronateforearmisdueto injurytowhichnerve? a)Ulnar b)Radial c)Mediannerve d)Musculocutaneous CorrectAnswer-CAns.is'c'i.e.,MediannervePronationoftheforearmisbytwomusclespronatorteresandpronatorquadratus.Thesetwomusclesaresuppliedbymediannerve.Thusinjurytomediannerveproducesinabilitytopronateforearm.Themediannerveisalsocalledlabourer'snerve.Themediannervearisesbytworoots,onefromthelateralcord(C5,6,7)andtheotherfromthemedialcord(C8,T1).Thevariousmusclessuppliedbymediannerveare:?1)IntheforearmAlltheflexormusclesoftheforearm,excepttheflexorcarpiulnarisandthemedialhalfofflexordigitorumprofundustotheulnartwofingers.Thesemusclesare:- i. Pronaterteres ii. Flexordigitorumsuperficialis iii. Flexorpollicislongus iv. Flexorcarpiradialis v. Flexordigitorumprofundus(lateralhalf) vi. Pronatorquadratus vii. Pulmarislongus 2)Inhand
Mediannervesupplies:- i. Thenarmuscles(exceptadductorpollicis)-Flexorpollicisbrevis, opponenspollicisandabductorpollicisbrevis.Adductorpollicisissuppliedbyulnarnerve. ii. Firsttwolumbricals
95.Highsteppinggaitisseenin? a)CTEV b)Commonperonealnervepalsy c)Polio d)Cerebralpalsy CorrectAnswer-BAns.is'b'i.e.,CommonperonealnervepalsyFirsttotouchthegroundistheforefoot,andnottheheel.
96.Sectoralsignispositivein? a)Avascularnecrosisoffemurhead b)Osteoarthritisofhip c)Protrusioacetabuli d)Slippedcapitalfemoralepiphyses CorrectAnswer-AAns.is'a'i.e.,AvascularnecrosisoffemurheadClinicalfeaturesofAVNIntheearlierstagesofAVN,thepatientisasymptomatic,andbythetimepatientpresents,thelesioniswelladvanced.Commonhistoriespatientgives(Anyofthefollowing):-i)DislocationofHipii)Alcoholismiii)Steroidintakeforanydisorderiv)NephroticsyndromePainisacommoncomplaint.Painisfeltinthegrainandmayradiatetoknee.Decreasedrangeofmotionespeciallyinternalrotationfollowedbyabduction.SectoralsignorDifferentialrotation:-Internalrotationispossibleinextendedpositionofhip,butasseenasthehipisflexedto90?nointernalrotationispossible.ThisisthecharacteristicsignofAVN.oLimpwithantalgicgait.Trendelenberg'stestpositive.
97.Garden'sclassificationusedforwhich fracture? a)Surgicalneckhumerus b)Shafthumerus c)Neckoffemur d)Shaftfemur CorrectAnswer-CAns.is'c'i.e.,NeckoffemurGarden'sclassificationGarden'sclassificationisthemostusefulandmostacceptedclassificationoftheneckoffemur.Thisisbasedonthedegreeofdisplacementofthefracture.Following4stagesoffracturearethere:?1)Stage1:Thefractureisincomplete,withheadtiltedinpostero-lateraldirection,i.e.intovalgus,thereforeisknownasvalgus(abduction)impactedfracture.2)Stage2:Completefracturebutundisplaced.3)Stage3:Completefracturewithpartialdisplacement.4)Stage4:Completefracturewithtotaldisplacement.Thedegreeofdisplacement,inGarden'sclassification,isjudgedfromchangeinthedirectionofmedialtrabecularstreamoftheneck,inrelationtothebonytrabeculaeintheweightbearingpartoftheheadandinthecorrespondingpartoftheacetabulum.i)Stage1:-Thereisanobtuseanglelaterallyatthetrabecularstream.ii)Stage2:-Trebeculaebetweenheadandneckarebrokenbuttheyareinalignmentwitheachotherandwithtrabeculaeintheacetabulum.
iii)Stage3:-Allthreetrabeulaeareoutofalignment.iv)Stage4:-Acetabularandheadtrabeculaeareinalignmentbutheadandnecktrabeculaearenotaligned.
98.Oneofthecommonfracturesthatoccur duringboxingbyhittingwithaclosedfistis? a)Monteggiafracturedislocation b)Galeazzifracturedislocation c)Bennett'sfracturedislocation d)Smith'sfracture CorrectAnswer-CAns.is'c'i.e.,Bennett'sfracturedislocationThecommonmechanismofinjuryforBenett'sfractureisanaxialblowdirectedagainstthepartiallyflexedmetacarpal,inmostcasesduring'fistfights'.Benett'sfractureBenett'sfractureisanintra-articularfracturedislocationofthepalmarbaseoffirstmetacarpalboneofthethumbwitheithersubluxationordislocationoffirstcarpometacarpaljoint,i.e.trapezometacarpaljoint.Thecommonmechanismofinjuryisanaxialblowdirectedagainstthepartiallyflexedmetacarpal,inmostcasesduring"Fistfights".Patientcomplainsofpain,swellingandtendernessoverthebaseofthethumb.Movementsofthumbarerestricted.DisplacingforceinBennett'sfracturesFollowingarethedeformingforcesinBennett'sfracture:-i)Atthedistalfragment,itistheadductorpollicis.ii)Attheproximalfragment,itistheabductorpollicislongus.Baseofthethumbmetacarpalispulleddorsallyandmediallybytheabductorpollicislongus,whilethedistalattachmentofadductor
pollicisfurtherleversthebaseintoabduction.
99.CausesofCarpaltunnelsyndromeareall except? a)DM b)RA c)Leprosy d)Gout CorrectAnswer-CAns.is'c'i.e.,LeprosyCarpaltunnelsyndromeCarpaltunnelsyndromeisthemostcommonandwidelyknownentrapmentneuropathyinwhichthebody'speripheralnerveiscompressedortraumatized.Carpaltunnelsyndromeoccurswhenthemediannerveiscompressedinthecarpaltunnelbelowflexorretinaculum.Thecarpaltunnelisanarrowrigidpassagewayofligamentandbonesatthebaseofhand,infrontofdistalpartofwrist.Carpaltunnelhousesthemediannerveand9tendons(4FDS,4FDP&FPL).CausesofcarpaltunnelsyndromeTherearemanycausesofcarpaltunnelsyndrome:1)Idiopathic:-Thisisthemostcommoncause.2)Pregnancyandmenopause3)Metabolic:-Gout,Diabetesmellitus4)Endocrine:-Hypothyroidism,Myxedema,Acromegaly,Hyperparathyroidism.5)DepositiondisorderAmyloidosis,Sarcoidosis,Rheumatidarthritis,Leukemia,CRF,Mucopolysaccharoidosis.6)Alcoholism7)Localcauses:-Malunitedcolle'sfracture,osteo-arthritisofthe
carpalbones,synovititsofflexortendonsheath,hematoma.ClinicalfeaturesofcarpaltunnelsyndromeCarpaltunnelsyndromeismorecommoninwomenandoccursbetween35-50years.Symptomsusuallystartgradually,withfrequentburning,tingling,paresthesiaandnumbnessinthedistributionofmediannerve,i.e.,lateralthree&halfoffingersandlateral2/3rdofpalm.Thesymptomsoftenfirstappearduringnight,sincemanypeoplesleepwithflexedwrists.(Flexiondecreasesthespaceincarpaltunnelwhichresultsinincreasedpressureovermediannerve).Sensorysymptomscanoftenbereproducedbypercussingovermediannerve(Tinel'ssign)orbyholdingthewristfullyflexedforaminute(Phalen'stest).Asthediseaseprogresses,clumsinessofhandandimpairmentofdigitalfunctiondevelop.Laterinthedisease,thereissensorylossinmediannervedistributionandobviouswastingofthenareminence.ClinicalTestsforCarpaltunnelsyndromeTherearesomeprovocativetestswhichactasimportantscreeningmethods:?1)Wristflexion(Phalen'stest):-Thepatientisaskedtoactivelyplacethewristincompleteflexion.Iftinglingandnumbnessdevelopinthedistributionofmediannerve,thetestispositive.Thisisthemostsensitiveprovocativetest.2)Tourniquettest:-ApneumaticBPcuffisappliedproximaltotheelbowandinflatedhigherthanthepatient'ssystolicBP.Thetestispositiveifthereisparesthesiaornumbnessintheregionofmediannervedistributioninhand.3)Mediannervepercussiontest(Tinel'ssign):-Themediannerveisgentlytappedatthewrist.Thetestispositiveifthereistinglingsensation.4)Mediannervecompressiontest:-Directpressureisexertedequallyoverbothwristsbytheexaminer.Ifsymptomsofcarpaltunnelsyndromeappear,thetestispositive.
100.Radiologicalfactorsindicatingan unstablepelvisareallexcept? a)Posteriorsacroiliaccomplexdisplacementby>1cm b)Avulsionfractureofsacralorischialendofthesacrospinous ligament c)AvulsionfracturesoftheL5transverseprocess d)Isolateddisruptionofpubicsymphysiswithpubicdiastasisof2 cm. CorrectAnswer-DAns.is'd'i.e.,Isolateddisruptionofpubicsymphysiswithpubicdiastasisof2cmRadiographicfactorsindicatingunstablepelvisare:-Posteriorsacroiliaccomplexdisplacementby>lcmAvulsionfractureofsacralorischialendofthesacrospinousligamentAvulsionfracturesoftheL5transverseprocessDisruptionofpubicsymphysiswithpubicdiastasisof2cmwithposteriorpelvicinjuryorinjurytoanterior/posteriorsacroiliacligamentorsacrospinousligaments.Presenceofgapratherthanimpactionintheposteriorpelvicring.
101.Mostcommoncomplicationofmidshaft humerusfractureis? a)Radialnervepalsy b)Mediannervepalsy c)Nonunion d)Malunion CorrectAnswer-AAns.is'a'i.e.,RadialnervepalsyComplicationsofhumerusshaftfracture 1. Nerveinjury:-Radialnerveisthemostcommonlyinjurednervein fractureshafthumerus.Itisparticularlycommoninobliquefracturesatthejunctionofmiddleanddistalthirdofthebone(Holstein-Lewsfracture). 2. Vascularinjury:-Brachialarterydamage.3. Delayedunionornon-union:-Delayedunionornon-unionmay occur,especiallyintransversefractureofthemidshaft.Thecauseofnon-unionisdistractionatfracturesiteduetogravityandweightofplaster. 4. Jointstiffness:-Shoulder&elbowstiffness.
102.Deformityofhipinstageoftubercular synovitisstageis? a)Flexion,abductionexternalrotation b)Flexion,adductioninternalrotation c)Flexionadductionexternalrotation d)Flexionabductioninternalrotation CorrectAnswer-AAns.is'a'i.e.,Flexion,abductionexternalrotationSynovitis-Flexionabductionexternalrotationapparentlengthening
103.Needleshapedcrystalsnegatively birefringentonpolarizedmicroscopyischaracteristicofwhichcrystalassociatedarthropathy? a)Gout b)CPPD c)Neuropathicarthropathy d)Hemophilicarthropathy CorrectAnswer-AAns.is'a'i.e.,GoutCrystalofPseudogoutMadeupofcalciumpyrophosphateWeaklypositivebirefringent,rhomboidCrystalofgout:-Madeupofuricacid(monosodiumurate)Stronglynegativebirefringent,needleshaped
104.Whichofthefollowingisnotafeatureof rheumatoidarthritis? a)Heberdennodes b)Swanneckdeformity c)Ulnardeviationoffingersatmetacarpopalyngealjoint d)Symmetricreductionofjointspace CorrectAnswer-AAns.is'a'i.e.,HeberdennodesHeberdennodesisafeatureofosteoarthritisandnotrheumatoidarthritis.ImportanthanddeformitiesofhandinRABoutonnieredeformity:FlexioncontractureofPIPjointandextensionofDIPjoint.Swanneckdeformity:HyperextensionofPIPjointandflexionatDIPjoint.Z-deformity:Radialdeviationofwristwithulnardeviationoffingers.Hyperextensionof1stinterphalangealjointandflexionofMPjoint.
105.Keinbock'sdiseaseisosteochondritisof ? a)Scaphoid b)Lunate c)Calcaneum d)Tibialtuberosity CorrectAnswer-BAns.is'b'i.e.,LunatePerthes'sdisease-FemoralheadPanner'sdisease-CapitulumKienbock'sdisease-LunateboneOsgoodShlatter'sdisease-TibialtubercleSever'sdisease-CalcanealtuberosityKohler'sdisease-Navicularbone
106.Metaphysealfracturetouchingphysis butnotcrossingit,comesunderwhichtypeofSalterHarrisphysealinjury? a)I b)II c)III d)IV CorrectAnswer-BAns.is'b'i.e.,IISalterandHarrishaveclassifiedepiphysealinjuriesintofivetypes-TypeI:Completeseparationofepiphysisfromthemetaphysiswithoutfracture.Commoninrickets,scurvyandosteomyelitis.TypeII:Thefractureinvolvesthephysisandatriangleofmetaphysealbone(ThurstonHollandsign)i.e.metaphysealfracturetouchingthephysisbutnotcrossingit.Thisisthecommonesttypeofepiphysealinjuryaccountingfor73percentofcasesover10yearsofage.TypeIII:Thefractureisintra-articularandextendsalongthephysisandthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.TypeIV:Thefractureisintra-articularandextendsthroughtheepiphysis,physisandmetaphysis.Perfectreductionisnecessaryandopenreductionismoreoftennecessarytopreventgrowtharrest.TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrialring)injury.
107.Motorcyclist'sfractureis? a)Stellatefractureacrossbaseofskull b)Transversefractureacrossbaseofskull c)LaminafractureofCIvertebra d)SpinousprocessfractureofC7vertebra CorrectAnswer-BAns.is`b'i.e.,TransversefractureacrossbaseofskullMotorcyclist'sfractureBecauseoftheinherentinstabilityoftwowheeledvehicles,theriderandpassangerinevitablyfalltothegroundinacrash.Injuriescanoccurtoanypartofthebody,butthelimbsandheadareparticularlysusceptibletoseriousinjury.Impactwiththeroadsurfaceoranothervehicleatspeedoftencausesskullfracture,eveninthepresenceofahelmet.Atransversefractureacrosstheflooroftheskull,usuallycalleda"hingefracture",issometimesreferredtoasmotorcyclistfracture.Atautopsy,thebaseoftheskullmaybeappriciatedtohavedividedintotwohalves,eachmovingindependentlyofeachotherlikeahinge,theso-calledmotorcyclistfracture.
108.Whichamongthefollowingisnota featureofUnhappytriadof0'Donoghue? a)ACLinjury b)Medialmeniscusinjury c)Medialcollateralligamentinjury d)Fibularcollateralligamentinjury CorrectAnswer-DAns.is'd'i.e.,FibularcollateralligamentinjuryThemostcommonmechanismofligamentdisruptionofkneeisadduction(valgus),flexionandinternalrotationoffemurontibiawhichusuallyoccurinsportsinwhichthefootisplantedsolidlyonthegroundandlegistwistedbyrotatingbody(i.e.,football,soccer,basketball,skiing).Themedialstructuresmedial(tibial)collateralligament(MCL)andmedialcapsularligamentarefirsttofail,followedbyACLtears,iftheforceisofsufficientmagnitude.Themedialmeniscusmaybetrappedbetweencondylesandhaveaperipheraltear,thusproducingunhappytriadof0'Donoghue.
109.Whichisthecommonesttruebenign bonetumor? a)Osteoidosteoma b)Hemangioma c)Osteochondroma d)Enchondroma CorrectAnswer-AAns.is'a'i.e.,OsteoidosteomaOsteoidosteomaisthemostcommontruebenigntumorofthebone.Thisisabenigncircumscribedlesionthatmayariseinthecortexoflongbonesoroccasionallyinthecancellousboneofspine.Thecharacteristicfeatureistheformationofasmallnidusofosteoidtissue,surroundedbyareactivezoneofdensesclerosis(Scleroticnewboneformation).
110.Whichofthefollowingistrueabout halluxvalgus? a)Greattoepointslaterally b)Greattoepointsmedially c)Lateralangulationofthe1stmetatarsophalyngealjoint d)Dorsalangulationofthelstmetatarsophalyngealjoint CorrectAnswer-AAns.is'a'i.e.,GreattoepointslaterallyHalluxvalgusHalluxvalgusislateral(outward)deviationofgreattoeatthemetatarsophalangealjoint.Itisthecommonestfootdeformity.Itiscommoninwomenpastmiddleage,andisnotinfrequenteveninyoungwomen.Commoncausesare:RheumatoidarthritisWearingpointedshoeswithhighheelsHereditaryfactorsIdiopathicPathologyOutwarddeviationofthegreattoe.Afterseveralyearstwosecondarychangesoccur:-i)Formationofathickwalledbursa(bunion)overthemedialprominenceof1"metatarsalhead.ii)Osteoarthritisofmetatarsophalangealjoint.Itisworthnotingthatmedialprominenceovermetatarsalheadlookslikeanexostosis,butthereisnotrueexostosis.Lateraldeviationofgreattoecausesovercrowdingoflateraltoes
andsometimesoverridingofadjacenttoes.
111.Jaipurfootwasinventedby? a)P.K.Sethi b)S.K.Verma c)B.L.Sehgal d)H.R.Gupta CorrectAnswer-AAns.is'a'i.e.,P.K.SethiP.K.Sethi.PramodKaranSethi(28November1927-6January2008)wasanIndianorthopaedicsurgeon.WithRamChandraSharma,heco-inventedthe"Jaipurfoot",aninexpensiveandflexibleartificiallimb,in1969.
112.Testusedforprolapsedlumbar intervertebraldiscis- a)Activestraightlegraisingtest b)Laseguetest c)Thomastest d)Apley'sgrindingtest CorrectAnswer-BAns.is'b'i.e.,LaseguetestClinicalexaminationinPIDForwardstooping(bending),twistingorcoughingaggravatethepain.Thetrunkistiltedtooneside(sciaticscoliosisorsciatictilt).Movementsoflumbarspinearerestrictedespeciallyflexion.Straightlegraising(SLR)testispositive,i.e.straightlegraisingispossible40?orless(AIIMSO4).Laseguetest(amodificationofSLRtest)ispositive.
113.Lumbarcanalstenosispresentsas? a)Claudication b)Scolioticdeformity c)Kyphoticdeformity d)Radiculopathy CorrectAnswer-AAns.is'a'i.e.,ClaudicationThepatientoflumbarcanalstenosisisusuallyamanagedover50,complainsofaching,heaviness,numbnessandparaesthesiainthethighsandlegs;itcomesonafterstandinguprightorwalkingfor5-10minutes,andisconsistentlyrelievedbysitting,squattingorleaningagainstawalltoflexthespine(hencetheterm'spinalclaudication').
114.Callusformationisseenbetweenwhat durationoffracturehealing? a)0-2weeks b)2-4weeks c)4-12weeks d)12-16weeks CorrectAnswer-CAns.is'c'i.e.,4-12weeksHealingofafractureTheprocessoffracturehealingvariesaccordingtothetypeofboneinvolvedandtheamountofmovementatthefracturesite.Followinghealingprocessesarethere:?Indirectfracturehealing(healingbycallus)Thisisthe'natural'formofhealingintubularbonesandintheabsenceofrigidfixationwhenthereismicromovementatfracturesite.Thereisformationofinternalandexternalcallus.Thisstageisdividedinthreephaseswhicharefurthersubdividedintofivestages:
115.Inosteogenicsarcomapredominant histologicalfindingis? a)Giantcells b)Osteoidformingtumorcells c)Fibroblasticproliferation d)Chondroblasts CorrectAnswer-BAns.is'b'i.e.,OsteoidformingtumorcellsHistologicappearanceofosteosarcomaItappearspaleandextendingthroughthecortexongrosscutsectionexamination.Onhistologicalsectionsitconsistsofmalignantstromaltissueshowingosteoidformation.OsteoidboneformationbytumorcellsisdiagnosticofOGS.
116.Osteoporosisischaracterizedbyallthe followingexcept? a)Decreasedbonemineraldensity b)DecreasedSerumCalcium,phosphorusandalkaline phosphataseisseen c)Glucocorticoidscancauseosteoposis d)Dorsolumbarspineisthemostcoomonsiteofosteoporotic fracture CorrectAnswer-BAns.is'b'i.e.,DecreasedSerumCalcium,phosphorusandalkalinephosphataseisseenOsteoporosisisastateofdecreasedmassperunitvolumeofanormallymineralizedbone.Osteoporosisisthecommonestmetabolicbonedisease.Osteoporosisischaracterizedbyanabnormallylowbonemass(lowbonedensity)anddefectsinbonestructure,acombinationofwhichrenderstheboneunusuallyfragileandatgreaterthannormalriskoffracture.Bonedepletionmaybebroughtaboutbypredominantboneresorption,decreasedboneformationoracombinationofthetwo.
117.ArthritisinvolvingDIP,PIP,1st carpometacarpalwithsparingofMCPandwristjointsistypicalof? a)Osteoarthritis b)Rheumatoidarthritis c)Ankylosingspondylitis d)Psoriaticarthritis CorrectAnswer-AAns.is'a'i.e.,Osteoarthritis1stCarpometacarpaljointWrist-Osteoarthritis
118.Sunderlandclassificationisusedfor? a)Nerveinjury b)Muscleinjury c)Tendoninjury d)Ligamentinjury CorrectAnswer-AAns.is'a'i.e.,NerveinjurySunderlandisanextensionoftheseddonclassificationandincludes5typesofnerveinjuries.
119.Indexfingerinfectionspreadsto? a)Thenarspace b)Midpalmarspace c)Hypothenarspace d)Flexionspace CorrectAnswer-AAns.is'a'i.e.,ThenarspaceThenarspacecommunicateswiththeindexfingerwhilethemidpalmarspacecommunicateswiththemiddle,ringandlittlefingers.Thusinfectionofindexfingerleadstothenarspaceinfectionwhiletheinfectionofmiddle,ringorlittlefingerleadstomidpalmarspaceinfection.
120.Pipkin'sclassificationsystemisusedfor ? a)Fracturefemurhead b)Fracturefemurshaft c)Fractureproximaltibia d)Fracturecalcaneum CorrectAnswer-AAns.is'a'i.e.,FracturefemurheadPipikin'sclassificationoffemoralheadfractureTypeI:Femoralheadfractureinferior(caudal)tofovea.TypeII:Femoralheadfracturesuperior(cephalad)tofovea.TypeIII:Femoralheadfracturewithassociatedfemoralneckfracture.TypeIV:TypeI,IIorIIIwithassociatedacetabularfracture.
121.Tinelsignisseenin? a)Nervedegeneration b)Nerveregeneration c)Muscledegeneration d)Muscleregeneration CorrectAnswer-BAns.is'b'i.e.,NerveregenerationPathologicalchangesafternerveinjuryAfternerveinjury,nervefirstdegeneratesandthentriestoregenerate.NervedegenerationThepartoftheneuronedistaltothepointofinjuryundergoessecondaryorWalleriandegeneration;theproximalpartundergoesprimaryorretrogradedegenerationuptoasinglenode.NerveregenerationAsregenerationbegins,theaxonalstumpfromtheproximalsegmentbeginstogrowdistally.IftheendoneuraltubewithitscontainedSchwanncellsisintact,theaxonalsproutmayreadilypassalongitsprimarycourseandreinnervatetheend-organ.Therateofrecoveryofaxonis1mmperday.Themusclesnearesttothesiteofinjuryrecoversfirst,followedbyothersasthenervereinnervatesmusclesfromproximaltodistal,theso-calledmotormarch.Whentheskinoverthenerveispercussedgentlyfromdistaltoproximal,thepatientgetsatinglingsensationifthenerveisrecovering.ThisiscalledTinel'ssignandisasignofrecovery.
122.Dinnerforkdeformityisseenin? a)Colle'sfracture b)Marchfracture c)Lateralcondylefracture d)Supracondylarfracture CorrectAnswer-AAns.is'a'i.e.,Colle'sfractureComplicationsofcolle'sfractureComplicationsincolle'sfracturearehigh(50-60%).Followingcomplicationsmayoccur1)StiffnessoffingersandjointsStiffnessoffinger,wristandshoulderisthemostcommonavoidablecomplicationofcolle'sfracture.Thisoccursduetolackofexercise.Therefore,patientshouldbeencouragedforactiveexerciseoffingerandshoulder.2)MalunionItisthesecondmostcommoncomplicationItresultsindinnerforkdeformity3)Sudek'sosteodystrophy(reflexsympatheticdystrophy)4)Carpaltunnelsyndrome:Mediannervemaygetcompressedincarpaltunnel5)Carpalinstability6)Ruptureoftheextensorpollicislongustendon7)FrozenshouldersyndromeThisisatroublesomecomplicationwhichdevelopsduetounnecessoryvoluntaryshoulderimmobilizationbythepatientontheaffectedsideforfearoffracturedisplacement.8)TFCCinjury
9)Non-unionisveryrare
123.Tenniselbowischaracterizedby? a)Tendernessoverthemedialepicondyle b)Tendinitsofcommonextensororigin c)Tendinitisofcommonflexororigin d)Painfulflexionandextension CorrectAnswer-BAns.is'b'i.e.,TendinitsofcommonextensororiginTenniselbowisextraarticularaffectioncharacterizedbypainandacutetendernessattheoriginoftheextensormusclesoftheforearmfromthelateralepicondyle.Itisbelievedtobecausedbystrainoftheforearmextensormuscles,particularlytheextensorcarpiradialisbrevis,atthepointoftheiroriginfromlateralepicondyle.
124.Falseaboutosteoarthritisis? a)Involvessynovialjoints b)Progressivesofteningofthearticularcartilage c)Itisaninflammatoryarthritis d)Marginalosteophytesareproduced CorrectAnswer-CAns.is'c'i.e.,ItisaninflammatoryarthritisOsteoarthritis(OA)isachronicdisorderofsynovialjointsinwhichthereisprogressivesofteninganddisintegrationofarticularcartilageaccompaniedbynewgrowthofcartilageandboneatthejointmargins(osteophytes),cystformationandsclerosisinthesubchondralbone,mildsynovitisandcapsularfibrosis.Thetermosteoarthritisisamisnomerasitisanon-inflammatorycondition.Therighttermisosteoarthrosisordegenerativejointdisorderbecauseitisadegenerativewear-and-tearprocessoccuringinjoints.
125.Tardyulnarnervepalsyisseenin a)Medialcondyle#humerus b)Lateralcondyle#humerus c)Humerusshaftfracture d)Fractureshaftradius CorrectAnswer-BAns.is'b'i.e.,Lateralcondyle#humerusCausesoftardyulnarnervepalsyare:- 1. Malunitedlateralcondylehumerusfracture(cubitusvalgus)2. Displacedmedialepicondylehumerusfracture3. Cubitusvarusdeformity(duetosupracondylarfracturehumerus)4. Elbowdislocation5. Contusionsofulnarnerve6. Shallowulnargroove7. Hypoplasiaofhumeraltrochlea8. Jointdeformityafterprolongedarthritisofelbow
126.Anklesprainduetoforcedinversionofa plantarflexedfootisduetoinjuryto a)Anteriortalofibularligament b)Posteriortalofibularligament c)Calcaneofibularligament d)Posteriorfibresofdeltoid CorrectAnswer-AAns.a.Anteriortalofibularligament*Structuresdamagedduetoinversioninjury.-Peronealtendoninjury.-Avulsionfractureoftipoflateralmalleolus.-Avulsionfractureofanterolateralsurfaceoftalus&calcaneum(sustentaculumtali).-Fractureofbaseof5thmetatarsal.-Lateralcollateralligamentinjury(anteriortalofibular>calcaneofibular>posterior-talofibularligament).-Medialmalleolusfracture.
127.Gallowstractionisusedforfracture: a)Shaftfemur b)Neckfemur c)Shafttibia d)Tibialtuberosity CorrectAnswer-AAns.a.ShaftfemurGallow'stractionisusedfortreatmentoffractureshaftoffemur,ininfantsandchildrenGallow'sTractionGallow'stractionisusedfortreatmentoffractureshaftoffemur,ininfantsandchildrenWeightmustnotbe>12kgsBoththefracturedandthenormalfemurareplacedinskintractionandinfantissuspendedbythesefromaspecialframe.ThebuttocksshouldbeliftedjustoffthebedsothattheweightofthebodyprovidescountertractionandthefractureisreducedUsesofTractions Name Use Bryant's Fractureshaftoffemurin TractionQ children Gallow's Fractureshaftoffemurin TractionQ children Russel's Fractureshaftoffemurin TractionQ olderchildren Perkin's Fractureshaftoffemurin TractionQ adults Fractureshaftoffemurin
90?-90? Fractureshaftoffemurin TractionQ children Agnes-Hunt CorrectionofHipdeformit TractionQWell-Leg Correctionofadductionor TractionQ abductiondeformityofhip Dunlop Supracondylarfractureof TractionQ humerus Smith's Supracondylarfractureof TractionQ humerus UsesofTractions Name Use Calcaneal Openfracturesof Traction ankleorleg Metacarpal OpenforearmTraction fractures Head-Halter CervicalspineTraction injuries Crutchfield Cervicalspine TractionQ injuries Halo-Pelvic Scoliosis Traction
128.Trueaboutankylosingspondylitisareall except? a)Affectsmales b)30-40yrs c)90%HLA-B5 d)Bamboospine CorrectAnswer-CAns.is'c'i.e.,90%HLA-B5Ankylosingspondylitis(marie-strumpelldisease)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.rototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.Maletofemaleratiois2-3:1StrongcorrelationwithHLA-B270-95%ofcase9sarepositiveforHLA-B27.JointsinvolvedinankylosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)arealsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftentheearliestmanifestationofA.S..Involvementofcostovertebraljointsfrequentlyoccur,leadingtodiminishedchestexpansion(normal_5cm)Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rdpatients.Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Pathologicalchangesproceedinthreestages?Inflammationwithgranulationtissueformationanderosionofadjacentbone.FibrosisofgranulationtissueOssificationofthefibroustissue,leadingtoankylosisofthejoint.RadiologicalfeaturesofankylosingspondylitisRadiographicevidenceofsacroiliacjointisthemostconsistentfindinginankylosingspondylitisandiscrucialfordiagnosis.Thefindingsare:-SclerosisofthearticulatingsurfacesofSIjointsWideningofthesacroiliacjointspaceBonyankylosisofthesacroiliacjointsCalcificationofthesacroiliacligamentandsacro-tuberousligamentsEvidenceofenthesopathy-calcificationattheattachmentofthemuscles,tendonsandligaments,particularlyaroundthepelvisandaroundtheheel.X-rayoflumbarspinemayshow:-Squaringofvertebrae:Thenormalanteriorconcavityofthevertebralbodyislostbecauseofcalcificationoftheanteriorlongitudinalligament.ftLossofthelumbarlordosis.Bridging`osteophytes'(syndesmophytes)Bamboospineappearance
129.Inextensiontypeofsupracondylar fracture,theusualdisplacement a)Anterolateral b)Anterolateral c)Posteromedial d)Posterolateral CorrectAnswer-DAns.is'd'i.e.,PosterolateralTypesofsupracondylarfractureSupracondylarfractureisbroadlyclassifiedintoextensiontypeandflexiontype.1.ExtensiontypeItisthemostcommontype(97-99%).Distalfragmentisextended(tiltedbackward/posteriorly)inrelationtoproximalfragment.Occursduetohyperextensioninjuryafterfallonoutstretchedhands.Generally,displacementofdistalfragmentmaybe:?Posteromedial(70-80%)Posterolateral(20-30%)2.FlexiontypeItislesscommontype(1-3%)Distalfragmentisflexed(tiltedforward/anteriorly)inrelationtoproximalfragments.Themechanismofinjurygenerallyisbelievedtobeafalldirectlyontotheelbowratherthanafallonoutstretchedhand.Astheextensiontypefractureismorecommon(97-99%),themostcommonelbowinjuryinchildrenisextensiontypeofsupracondylarfracture.
130.InArticularcartilage,mostactive chondrocytesareseenin? a)Zone1 b)Zone2 c)Zone3 d)Zone4 CorrectAnswer-CAns.is'c'i.e.,Zone3oTherearefourzones(layers)ofarticularcartilagefromthearticularsurfacetosubchondralbone. 1. Superficialzone(Zone-1) Itisthethinnestzone.Itconsistsoftwolayers:(i)Asheetofdenslypackedcollagenwithlittlepolysaccharideandtocells,coversthejointsurface,and(ii)flattenedelipsoid-shapedchondrocytes,withtheirmajoraxisparalleltojointsurface.2.Transitionzone(Zone-2)Compositionisintermediatebetweensuperficialzoneandmiddlezone.3.Middlezoneorradialzoneordeepzone(Zone-3)Thechondrocytesarespheroidalinshapewiththeirmajoraxisperpendiculartojointsurface.Chondracytesaremostactivesyntheticallyinthiszone.Thiszonecontainsthelargestdiametercollagenfibrils,thehighestconcentrationofproteoglycansandthelowestconcentrationofwater.4.Calcifiedcartilagezone(Zone-4)Itseparatesthemiddlezonefromsubchondralbone.Thecellsaresmallwithsmallamountofendoplasmicreticulumand
golgiapparatuswithverylittlemetabolicactivity.Cellsaresurroundedbycalcifiedcartilage.
131.Mostcommoncauseofneuropathicjoint ? a)Leprosy b))Tabesdorsalis c)Diabetes d)Nerveinjury CorrectAnswer-CAns.is`c'i.e.,DiabetesNeuropathicjoint(Charcot'sjoint)oItisaprogressivedestructivearthritisassociatedwithlossofpainsensationx,proprioceptionorboth,inadditionnormalmuscularreflexesthatmodulatejointmovementsaredecreased.Withouttheseprotectivemechanisms,jointsaresubjectedtorepeatedtrauma,resultinginprogressivecartilageandbonedamage.oItismostcommonlycausedbydiabetesmellitus.CausesofNeuropathicjointdisease(Charcoat'sjoint) CausesofNeuropathicjointdisease(Charcoat'sjoint) Diabetesmellitus Amyloidosis (mostcommon)TabesDorsalis LeprosyCongenital Meningomyelocele indifference topainPeroneal Syringomyelia muscularatrophy
132.Mostcommonnerveusedfornerve conductionstudyinHreflex? a)Mediannerve b)Ulnarnerve c)Tibialnerve d)Peronealnerve CorrectAnswer-CAns.is'c'i.e.,TibialnerveItisrecordedoverthesoleusorgastrocnemiusmuscles.ItisusedmosTheHreflexisbasicallyanelectrophysiologicallyrecordedAchillestendonstretchreflex.oItisperformedbystimulatingthetibialnerveinpoplitealfossa.tcommonlytoevaluateSiradiculopathyortodistinguishitfromanL5radiculopathy.
133.Motheatenboneis? a)Osteoidosteoma b)Multiplemyeloma c)Eosinophilicgranuloma d)Chondromyxoidfibroma CorrectAnswer-BAns.is'b'i.e.,MultiplemyelomaPatternsofbonedestructionpresentinalyticlesion? 1. Geographic:Sharpclearlydefinedmargins.Lessaggressive, benign.Eg:nonossifyingfibroma,chondromyxoidfibroma,eosinophilicgranuloma. 2. Motheatenappearance:Holesindestroyedbone.Rapidgrowth, malignantEg:Myeloma,metastasis,lymphoma. 3. Permeative:Illdefined,diffuse,somewhatsubtledestructive processofbone.Eg:Lymphoma,leukemia,Ewing'ssarcoma,osteomyelitis.
134.Commonestligamentinjuredinankle injury? a)Anteriortalofibularligament b)Calcaneofibularligament c)Posteriortalofibularligament d)Springligament CorrectAnswer-AAns.is'a'i.e.,AnteriortalofibularligamentTheankleisoneofthemostcommonsitesforacutemusculoskeletalinjuries.Sprainsconstitute85%ofallankleinjuries,and85%ofthoseinvolvealateralinversionmechanism.InversionSprain-Inversionanklesprainsoccurwhenthefootturnsinorouttoanabnormaldegreerelativetotheankle.Themostcommonmechanismofananklesprainisacombinationofplantarflexionandinversionwherethefootispointingdownwardandinward.Thelateralligamentsareinvolvedinaninversionanklesprainandhencemostcommonlydamaged.Theseligamentsareontheoutsideoftheankle,whichincludestheanteriortalofibular(ATFL),calcaneofibular(CFL)andposteriortalofibularligaments(PTFL).InjurytotheATFListhemostcommon.WhenboththeATFLandCFLareinjuredtogether,ankleinstabilitywillbemorenoticeable.ThePTFListhestrongestofthethreeligamentsandisrarelyinjuredinaninversionsprain.
135.Flexortendongraftrepairgraftistaken from? a)Plantaris b)Palmarislongus c)Extensordigitorum d)Extensorindicis CorrectAnswer-DAns.is'd'i.e.,ExtensorindicisBesidecoveringtheboneandsharingsomeofitsbloodsupplywiththebone,periosteum(particularlycambiumlayer)alsoproducesbonewhenitisstimulated.Practicallyanythingthatbreaks,tears,stretches,inflamesoreventouchestheperiosteum,stimulatesthereactiveboneformationbyperiosteum.Thisiscalledperiostealreaction.DifferentialDiagnosisofPeriostealReactionArthritisPsoriaticarthritisReactivearthritisMetabolicHypertrophicpulmonaryosteoarthropathyThyroidacropathyCongenitalPachydermoperiostosisPeriostealreactionofnewbornTraumaStressfractureFractureDrugsFluorosis
DrugsFluorosisHypervitaminosisAProstaglandinsTumorsOsetosarcomaEwing'ssarcomaChondroblastomaEosinophilicgranulomaOsteoidosteomaLeukemiaandlymphomaInfectionGeneticCaffeydiseaseVascularVenousstasisNeuropathicarthropathyisalsoassociatedwithperiostealreaction.
136.Insal-Salvatiindexisusedfor? a)Olecranon b)Patella c)Talus d)Scaphoid CorrectAnswer-BAns.is'b'i.e.,PatellaTworadiologicalindicesarecommonlyusedfordeterminingthepositionofpatella-Insall-Salvatiindex 1. Itistheratioofpatellartendonlengthtopatellalength.2. Normallyitis1-0.3. Anindexof1.2ormoreisseeninpatellaalta(highridingpatella).4. Anindexof0.8orlessisseeninpatellabaja(lowlyingpatella). Blackbume-Peellindex 1. Itistheratioof(i)thedistanceoftibialplateautoinferiorarticular surfaceofpatella(numerator),to(ii)lengthofarticularsurfaceofpatella(denominator). 2. Normallyitis0.8.3. Anindexof1ormoreisseeninpatellaalta.
137.Intramembranousossificationisseenin whichbones? a)Pelvis b)Longbones c)Maxilla d)None CorrectAnswer-CAns.is'c'i.e.,MaxillaBoneformationBoneformation(ossification)occursbytwomethods:1)Endochondralossification,2)Intramembranousossification.Inboth,mesenchymalconnectivetissueisreplacedbybonebutbydifferentmechanics.Endochondralossification 1. Thistypeofossificationinvolvesthereplacementofacartilaginous modelbybone. 2. Boneformationtakesplaceinpre-existingcartilage.3. Mesenchymaltissuefirstformscartilagewhichislatterossifiedto becomebone. 4. Mostofthelongsbonesdevelopbyendochondralossification.5. Otherbonesarevertebrae,pelvis,skullbasebones.6. Interstitialgrowthoflongboneatepiphysealcartilageoccursby endochondralossification.Intramembranousossification 1. Mesenchymalcellsgiverisetoosteogeniccellswhichdevelopinto osteoblasts. 2. steoblastsbegintolaydownosteoidwhichlattermineralisedtoform bone
3. Thus,thereisdirectformationofbonefrommesenchymaltissue (withnocartilageformationasoccursinEndochondralossification). 4. Thistypeofossificationtransformsmembraneintobone.5. Theboneformationoccursattheperipherywithlayersofbone beinglaiddownanalogoustothering-likediameterofatree. 6. Thistypeofgrowthiscalledappositionalgrowth.7. Skullvault,maxilla,mostofthemandibleandclavicleareformedby intramembranousossification.
138.RadiologicalsignincaseofPerthe's disease? a)Epiphysealcalcification b)Organizedcalcification c)Lateralsubluxationfemurhead d)Restrictionofabduction CorrectAnswer-BAns.is'b'i.e.,OrganizedcalcificationSeronegativespondvloarthropathiesTheseronegativespondyloarthropathiesareagroupofdisordersthatsharecertainclinicalfeaturesandgeneticassociations.Thewordseronegativereferestotheabsenceofrheumatoidfactorinthisgroupofdisorders.Theseronegativespondyloarthropathiesinclude? 1. Ankylosingspondylitis2. Reactivearthritis-->Reitersyndromeandenteritisassociated arthritis 3. Psoriaticarthritis4. Arthritisassociatedwithinflammatoryboweldisease,i.e. enteropathicarthritisFeaturesofseronegativespondyloarthropathiesoOnsetusuallybefore40yearsAbsenceofRAfactorHLA-B27positivePresenceofuveitis
139.Trueaboutproximalfragmentin supratrochantricfractureis? a)Flexion b)Abduction c)Externalrotation d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveDeformityincasesoffracturesubtrochantericfemurTheproximalfemurissurroundedbyverylargeandpowerfulmuscles.Inthecaseofafracture,theirspatialarrangement,combinedwiththeiroriginandinsertion,resultsinaverycharacteristicdeformity.Theproximalfragment,asaresultofcontractionoftheabductors,theexternalrotators,andtheiliopsoasmuscle,isflexed,abducted,andexternallyrotated.Theadductorscausetheshafttobeadducted,andtheforceofgravitycausesthedistalfragmenttofallintosomeexternalrotation.Allthemusclesthatspanthefracturecombinetocauseshortening.Thus,theresultantdeformityisoneofananteriorandlateralbowingoftheproximalshaft,combinedwithconsiderableshorteningandvariabledegreesofexternalrotation.
140.Anterolateralarthroscopyofkneeisfor? a)Toseepatellafemoralarticulation b)Toseetheposteriorcruciateligament c)Toseetheanteriorportionoflateralmeniscus d)Toseetheperipheryoftheposteriorhornofmedial CorrectAnswer-AAns.is'a'i.e.,ToseepatellafemoralarticulationStandardPortalsInKneeArthroscopy:Anterolateralportal? 1. Almostallthestructureswithinthekneejointcanbeseenexcept theposteriorcruciateligament,theanteriorportionofthelateralmeniscusandtheperipheryoftheposteriorhornofthemedialmeniscusintightknees. 2. Located1cmabovethelateraljointlineand1cmlateraltothe marginofthepatellartendon.Anteromedialportal? 1. Usedforadditionalviewingoflateralcompartmentandinsertionof probeforpalpationofmedialandlateralcompartmentstructures. 2. Placed1cmabovethemedialjointline,1cminferiortothetipof patella,and1cmmedialtotheedgeofthepatellartendon.Posteromedialportal? 1. Locatedonthesofttriangularsoftspotformedbytheposteromedial edgeofthefemoralcondyleandtheposteromedialedgeoftibia. 2. Usedforviewingtheposteromedialstructuresandforrepairor removalofthedisplacedposteriorhornofmeniscaltearsandforposteromedialloosebodyremoval.Superolateralportal- 1. Usedfordiagnosticallyviewingthedynamicsofpatello-femoral
joint,excisionofmedialplicae. 2. Locatedjustlateraltothequadricepstendonandabout2.5cm superiortothesuperolateralcornerofpatella.
141.DrippingCandleWaxlesiononspine? a)Metastasis b)TBspine c)Osteopterosis d)Melorheostosis CorrectAnswer-DAns.is'd'i.e.,MelorheostosisMelorheostosisMelorheostosisisamedicaldevelopmentaldisorderandmesenchymaldysplasiainwhichthebonycortexwidensandbecomeshyperdenseinasclerotomaldistribution.CausedbyamutationoftheLEMD3gene.Canbedetectedbyradiographduetothickeningofbonycortexresembling"drippingcandlewax".Disordertendstobeunilateralandmonoostotic,withonlyonelimbtypicallyinvolved.Caseswithinvolvementofmultiplelimbs,ribs,andbonesinthespinehavealsobeenreported.Therearenoreportedcasesofinvolvementofskullorfacialbones.Melorheostosiscanbeassociatedwithpain,physicaldeformity,skinandcirculationproblems,contractures,andfunctionallimitation.Itisalsoassociatedwithabenigninnereardysplasiaknownasosteosclerosis.
142.CauseofCoxavera? a)Congenital b)Perthe'sdisease c)SCFE d)Alloftheabove CorrectAnswer-AAns.is'd'i.e.,AlloftheaboveCoxaveraCoxaverareferstoreducedanglebetweentheneckandshaftofthefemur.Coxaveramaybecongenitaloracquired.1.Congenital(developmental/Infantile)coxavera 1. Thisiscoxavararesultingfromsomeunknowngrowthanomalyat theupperfemoralepiphysis. 2. Itisnoticedasapainlesslimpinachildwhohasjuststarted walking. 3. Inseverecases,shorteningofthelegmaybeobvious.4. Onexamination,abductionandinternalrotationofthehiparelimited andthelegisshort. 5. X-rayswillshowareductioninneck-shaftangle.6. Theepiphysealplatemaybetoovertical.7. Theremaybeaseparatetriangleofboneintheinferiorportionof themetaphysis,calledFairbank'striangle. 8. Treatmentisbyasubtrochantericcorrectiveosteotomy. 2.Aquiredcoxa-veraAquiredcoxa-veraisseenin:- 1. SCFE(slippedcapitalfemoralepiphysis)2. Sequelaeofavascularnecrosisoffemoralepiphysis
Legg-CalvePerthe'sdiseaseFemoralneckfractureTraumatichipdislocationPostreductionofCDHSepticnecrosisAssociatedwithpathologicalbonedisorders 1. Osteogenesisimperfecta2. Fibrousdysplasia3. Osteopetrosis
143.Bunioniscommonlyseenat? a)GreattoeMTPjoint b)Medialmalleolus c)LateralMalleolus d)Shinoftibia CorrectAnswer-AAns.is'a'i.e.,GreattoeMTPjointBunionAhalluxabductovalgusdeformity,commonlycalledabunion,isadeformitycharacterizedbylateraldeviationofthegreattoe,oftenerroneouslydescribedasanenlargementofboneortissuearoundthejointattheheadofthebigtoe.Thebumpitselfispartlyduetotheswollenbursalsacoranosseous(bony)anomalyonthemetatarsophalangealjoint.Thelargerpartofthebumpisanormalpartoftheheadofthefirstmetatarsalbonethathastiltedsidewaystostickoutatitstop.
144.Mostcommontypeofshoulder dislocationis? a)Preglenoid b)Subcoracoid c)Subclavicular d)Posterior CorrectAnswer-AAns.is'a'i.e.,PreglenoidAnteriordislocationoftheshoulderisthemostcommontypeofshoulderdislocation.Headofthehumeruscomesoutoftheglenoidcavityandliesanteriorly.Anteriordislocationofshouldercouldbe:? 1. Preglenoid-Itisthemostcommontypeofanteriordislocationand headliesinfrontofglenoid. 2. Subcoracoid-Theheadliesbelowthecoracoidprocess.3. Subclavicular(infraclavicular)-Theheadliesbelowtheclavicle.4. Intrathoracic-Itisveryrare.
145.Pencilincupdeformityisseenin? a)Rheumatoidarthritis b)Ankylosingspondylitis c)AVN d)Psoriaticarthritis CorrectAnswer-DAns.is`Di.e.,PsoriaticarthritisGull'swingappearance-PsoriaticarthritisOperaglassdeformity-PsoriaticarthritisCupandpencildeformity-Psoriaticarthritis
146.Allaretrueaboutaneurismalbonecyst except? a)Eccentric b)Expansile&lytic c)Treatedbysimplecurettage d)Metaphysisoflongbones CorrectAnswer-CAns.is'c'i.e.,TreatedbysimplecurettageAneurysmalbonecystAneurysmalbonecystoccurinchildrenandyoungadults(5-20years).Thetermaneurysmalisusedbecauseitcausesexpansionofoverlyingcortexlikevascularexpansionofananeurysm.Themetaphysisoflongbonesisinvolvedmostcommonly.Mostcommoninfemurandtibia;howeveranylongbonecanbeinvolved.Othercommonsitesareposteriorelementsofvertebraeandpelvis.athologyCysticspacesofvariablesizes&numberwhicharefilledwithbloodbutnotlinedwithvascularendothelium.Thewallofvascularspaceislinedwithfibroblastcellswithcollagen,giantcells,hemosiderin&osteoid(secondarytomicrofractures).ClinicalfeaturesWithexpandinglesions,painmaybeapresentingfeature.LargecystcanalsocauseswellingPathologicalfracturemayoccur(butlessfrequentthansimplebonecyst).RadiologicalfeaturesofaneurysmalbonecystEccentric,expansileosteolyticlesion
Thecharacteristicfeatureis'blown-out'distensionofonesurfaceofthebone.Overlyingcortexmaybeintactordisrupted.Extensivesclerosisattheinterfacebetweennormalandexpandedcortex(buttersing)maybepresent.Delicatethintrabeculaeischaracteristicandanexpansileballooninglesionmayproducea'soap-bubbleappearance'.Lesionoccursatmetaphysisoflongbones.Othercommonlocationsincludetheposteriorelementsofthespine(pedicle,lamina,transverseprocess,spinousprocess)andpelvis.TreatmentSurgeryisthetreatmentofchoice.Curettageandbonegraftingistheprocedurecommonlyfollowed.
147.Painfularcsyndromeiscausedby impingementof? a)Subacromialbursa b)Subdeltoidbursa c)Rotatorcufftendon d)Bicepstendon CorrectAnswer-CAns.is'c'i.e.,RotatorcufftendonPainfularcsyndromePainintheshoulderandupperarmduringmidrangeofglenohumeralabduction.Causes-supraspinatustendontearortendinitis,subacromialbursitis,fractureofgreatertuberosity.Thespacebetweentheupperendofhumerusandtheacromiongetscompromisedsothatduringmidabductionthetendonofrotatorcuffgetsnippedbetweenthegreatertuberosityandacromion.
148.Thefatherofjointreplacementsurgeryis ? a)Manning b)Girdlestone c)Charnley d)Ponseti CorrectAnswer-CAns.is'c'i.e.,CharnleyFatherofthemodernhipreplacement:ProfessorSirJohnCharnley(1911-82).ProfessorSirJohnCharnleywasaBritishorthopaedicsurgeon,inventorandskilledcraftsman.Heisbestknownforhisdevelopmentofthefirsttrulysuccessfuloperationfortotalarthroplastyofthehip,thelow-frictionarthroplasty.Aswellaspublishingsignificantworksonclosedfracturemanagementandcompressionarthrodesis,hecanalsobeaccreditedwithpioneeringworkinthedevelopmentofclean-airoperatingconditionsandbody-exhaustsuits.
149.Halopelvictractionisusedforcorrecting whichdeformity a)Spine b)PectusCarinatum c)Spondyloptosis d)CoxaVara CorrectAnswer-AAns.is'a'i.e.,SpineHead-pelvicskeletaltractionwasfirstattemptedin1958.Withthedescriptionofthe"halo"skulltractionapparatusbyPerryandNickel(1959),amethodwasprovidedforimmobilisingtheunstablecervicalspine.Fromthisdeveloped"halo-femoral"traction,nowusedbysomesurgeonsforthecorrectionofspinaldeformitiesbeforeandafteroperation.
150.Gamekeepersthumbis? a)Thumbmetacarpophalangealjointulnarcollateralligament rupture b)Thumbmetacarpophalangealjointradialcollateralligament rupture c)Thumbinterphalangealjointulnarcollateralligamentrupture d)Thumbinterphalangealjointradialcollateralligamentrupture CorrectAnswer-AAns.is'a'i.e.,ThumbmetacarpophalangealjointulnarcollateralligamentruptureInjurytothethumbmetacarpophalangealjointulnarcollateralligamentiscommonlyreferredtoasgamekeeperthumborskier'sthumb,althoughtheoriginal"gamekeeper"description(Campbell,1955)referredtoanattritionalulnarcollat-eralligamentinjury.Snowskiingaccidentsandfallsonanoutstretchedhandwithforcefulradialandpalmarabductionofthethumbaretheusualcauses.
151.Von-Rosen'ssignispositivein? a)Perthe'sdisease b)SCFE c)DDH d)CTEV CorrectAnswer-CAns.is'c'i.e.,DDHRadiologicalfeaturesofDDH/CDHInVonRosen'sviewfollowingparametersshouldbenoted. 1. Perkin'sline:Verticallinedrawnattheouterborderofacetabulum2. Hilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiate cartilage 3. Shenton'sline:Smoothcurveformedbyinferiorborderofneckof femurwithsuperiormarginofobturatorforamen. 4. Acetabularindex:Normallyis30?5. CEangleofWiberg:Normalvalueis15-30? Normallytheheadliesinthelowerandinnerquadrantformedbytwolines(Perkin's&Hilgenreiner's).IuDDHtheheadliesinouter&upperquadrantShenton'slineisbrokenDelayedappearance&retardeddevelopmentofossificationofheadoffemurSlopingacetabulumSuperior&lateraldisplacementoffemoralheadVon-Rosen'slineThisisaline,whichhelpsinthediagnosisofDDHininfantslessthan6months.ForthisAPviewofpelvisistakenwithbothlowerlimbin45?
abductionandfullinternalrotation.Upwardprolongationoflongaxisofshaftofthefemurpointstowardsthelateralmarginoftheacetabulumandcrossesthepelvisintheregionofsacroiliacjoint.InCDH,upwardprolongationofthislinepointstowardsanteriorsuperioriliacspineandcrossesthemidlineinthelowerlumberregion--->PositiveVon-Rosen'ssign.
152.Whichofthefollowingisnota diarthrosis? a)Elbowjoint b)Interphalangealjoint c)Skullsutures d)Hipjoint CorrectAnswer-CAns.is'c'i.e.,SkullsuturesFunctionalclassificationofjoints(movement)Jointscanalsobeclassifiedfunctionallyaccordingtothetypeanddegreeofmovementtheyallow: 1. Synarthrosis-Permitslittleornomobility.Mostsynarthrosisjoints arefibrousjoints(e.g.,skullsutures). 2. Amphiarthrosis-Permitsslightmobility.Mostamphiarthrosisjoints arecartilaginousjoints(e.g.,intervertebraldiscs). 3. Diarthrosis-Freelymovable.Alldiarthrosisjointsaresynovialjoints (e.g.,shoulder,hip,elbow,knee,etc.),andtheterms"diarthrosis"and"synovialjoint"areconsideredequivalentbyTerminologiaAnatomica
153.Blockvertebraeareseenin? a)Pagetsdisease b)Leukemia c)TB d)Klippel-Feilsyndrome CorrectAnswer-DAns.isi.e.,Klippel-FeilsyndromeAblockvertebraisatypeofvertebralanomalywherethereisafailureofseparationoftwoormoreadjacentvertebralbodiesAssociations 1. Thereisafrequentassociationwithhemivertebrae/absentvertebra aboveorbelowblocklevel,posteriorelementfusion 2. FusionofmultiplecervicalvertebralbodiesisalsoseeninKlippel- FeilsyndromeandVACTRELanamoly.
154.Bulgesigninkneejointisseenafterhow muchfluidaccumulation? a)100m1 b)400m1 c)200m1 d)<30ml CorrectAnswer-DAns.isi.e.,<30mlThebulgetestisusedtodeterminethepresenceoffluidinthekneejoint.Itisusefulwhenonlyalittlefluidispresentinthejoint.Thesuprapatellarbursaisfirstemptiedoffluidbysqueezingdistallyfromabout15cmabovethepatella.Themedialcompartmentofthekneejoinisemptiedbypressingonthesideofthejointwiththefreehand.Thehandisthenliftedawayandthenthelateralsideissharplycompressed.Ifthetestispositive,arippleisseenontheflattened,medialsurface.Thetestisnegativeiftheeffusionistense-upto120ml.Thebulgetestisusedtodetermineminimalfluidinthekneejoint.Itcandetectaslittleas4-6mloffluidinthekneejoint.
155.SplintusedinCTEVaftercorrection? a)Bohler-Brownsplint b)Thomassplint c)DennisBrownsplint d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,DennisBrownsplintTreatmentofCTEVatbirthIdeallytreatmentshouldbebegunimmediatelyafterbirth,certainlynotmorethan1weeklaterTheprinciplesoftreatmentare:-1.Correctionofdeformitybymanipulation2.Maintenanceofthiscorrectionbyimmobilizingthefootinover-correctedpositioninbetweenthemanipulations.Threemethodsareavailableformaintenance:- 1. Aplasterofpariscast(mostcommonlyused)2. Metalsplints(Denisbrownsplint)3. Adhesivestrapping Amongthese,retentioninaplasterismuchtobepreferred,becauseitholdsthefootintheover-correctedpositionmoreefficientlyandforalongerperiodthandometalsplintsorstrapping.Theplastermustextendtotheupperthigh,withthekneeflexed90?.Theplastermustbechangedeveryweekforthefirst6weeksandthenevery2weeksuntilthecorrectionisachieved.
156.Whichofthefollowingisleastlikely associatedwithvascularinjury? a)Fracturesupracondylarfemur b)Fracturesupracondylarhumerus c)Fractureshaftoffemur d)Fractureshiafthumerus CorrectAnswer-DAns.is'd'i.e.,FractureshafthumerusVascularinjurymaybeseenin- 1. Fracturesupracondylarhumerus--->Brachialartery2. Fractureshaftfemur(especiallydistal3rd)--->Poplitealartery3. Fracturesupracondylarfemur-->Poplitealartery
157.Turn-bucklecastisusedfor? a)Fractureshafthumerus b)Fractureshaftfemur c)Scoliosis d)Cervicalspineinjury CorrectAnswer-CAns.is'c'i.e.,Scoliosis.NameofthecaseUseMinervacastCervicalspinediseaseRisser'scastScoliosisTurn-bucklecastScoliosisShoulderspicaShoulderimmobilisationU-slabFractureofthehumerusHangingcastFractureofthehumerusColle'scastColles'fractureHipspicaFractureofthefemurCylindercastFractureofthepatellaPTBcastFractureofthetibia
158.Frozenpelvisisseenin? a)Osteoarthritis b)Pottsdisease c)Actinomycosis d)Reitersdisease CorrectAnswer-BAns.is'b'i.e.,PottsdiseaseAtermforsignificantinvolvementofthepelvicfloorbymalignancy,usuallycarcinoma,orttuberculosis;inwhichthereismassiveextensionofpathologytotheurinarybladder,femalegenitaltract,andsigmoidcolon.Adequateresectionofafrozenpelvisisvirtuallyimpossible;chemotherapyandradiationtherapyarepalliativeatbest.
159.Allaretrueaboutchronicosteomyelitis except? a)Reactivenewboneformation b)Cloacaisanopeningininvolucrum c)Involucrumisdeadbone d)Sequestrumishardandporus CorrectAnswer-CAns.is'c'i.e.,InvolucrumisdeadbonePathologyinchronicosteomyelitisChronicosteomyelitisoccursmostcommonlyinlongbones.Boneisdestroyedordevitalizedintheaffectedpart.Cavitiescontainingpusandpiecesofdeadbone(sequestra)aresurroundedbyvasculartissue,andbeyondthatbyareasofsclerosisduetoreactionnewboneformation,whichmaytaketheformofadistinctbonysheath(involucrum)Oftensinustrackleadstotheskinsurface;thesinustendstohealandpresentdownrecurrently,butifasequestrumispresentitneverhealspermanently.Thisisbecausesequestraactassubstrateforbacterialadhesioninmuchthesamewayasforeignimplants,ensuringthepersistenceofinfectionuntiltheyareremovedordischargedthroughperforationsintheinvolucrumandsinusesthatdraintotheskin.SequestrumSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissuetryingtoeatthesequestrumaway.Thesequestrumishard,rough,porus,lightinweightandlighterincolourthannormal.Normalpatternofboneislost.(Note:SequestruminsyphilisandTBisheavierthannormalbonebecausesclerosisusuallyprecedesthedeathofthebone).
Onx-ray,sequestrashowupasunnaturaldensefragments,incontrasttothesurroundingosteopenicbone.InvolucrumInvolucrumisreactivenewboneoverlyingasequestrum.Theremaybesomeholesintheinvolucrumforpustodrainout.Theseholesarecalledcloaca.
160.Ischialbursitisisalsoknownas? a)Clergyman'sknee b)Housemaid'sknee c)Weaver'sbottom d)Studentselbow CorrectAnswer-AAns.is'c'i.e.,Weaver'sbottom Prepatellar Hr?,1semaid's bursitis knee Infrapatellar Clergyman's bursitis knee Olecranon Student's bursitis elbowWeaver's Ischia]bursitis bottomOnlateral Tailor'sankle malleolusOngreattoe Bunion
161.Articularcartilage,trueis? a)Veryvascularstructure b)Surroundedbythickperichondrium c)Hasnonervesupply d)Fibrocartilage CorrectAnswer-CAns.is'c'i.e.,HasnonervesupplyArticularcartilageThearticulatingsurfacesofasynovialjointarecoveredbyarticularcartilage.Thearticularcartilagehasfollowingfeatures:- 1. Itisahyalinecartilage2. Itisavascular3. Itisnon-nervous(nonervesupply)4. Doesnothaveperichondrium Articularcartilagelackstheabilitytoproperlyrepairandregenerateitself.Theregenerationcapacityofcartilageislimitedduetoitsisolationfromsystemicregulation,anditslackofofvasculatureandnervesupply.
162.Essexloprestilesioninupperlimb- a)Injurytointerosseousmembrane b)RadialheadandDERfracture c)Radialshaft d)Radialshaftandradio-ulnarjointfracture CorrectAnswer-AAns.is'a'i.e.,InjurytointerosseousmembraneTheEsscx-Ioprestifractureisafractureoftheradialheadwithconcomitantdislocationofthedistalradio-ulnarjointwithdisruptionoftheinterosseousmembrane
163.Brodie'sabscessis? a)Acuteosteomyelitis b)Subacuteosteomyelitis c)Chronicosteomyelitis d)Septicarthritis CorrectAnswer-CBrodie'sabscessisasub-acuteformofosteomyelitis,presentingasacollectionofpusinbone,oftenwithaninsidiousonset.Classically,thismaypresentafterprogressiontoadrainingabscessextendingfromthetibiaoutthroughtheskin.Occasionallyacuteosteomyelitismaybecontainedtoalocalizedareaandwalledoffbyfibrousandgranulationtissue.ThisistermedBrodie'sabscess.MostfrequentcausativeorganismisStaphylococcusaureus.Usuallyoccursatthemetaphysisoflongbones.Distaltibia,proximaltibia,distalfemur,proximalordistalfibula,anddistalradius.Brodie'sabscessisbestvisualizedusingcomputedtomography(CT)scan.Associatedatrophyofsofttissuenearthesiteofinfectionandshorteningoftheaffectedbone.OsteoblastomamaybeaclassicsignforBrodie'sabscess.Inthemajorityofcases,surgeryhastobeperformed.Ifthecavityissmallthensurgicalevacuationandcurettageareperformedunderantibioticcover.Ifthecavityislargethentheabscessspacemayneedpackingwithcancellousbonechipsafterevacuation.
164.Fractureofproximalforearmcast positionis? a)Pronatedflexion b)Neutralposition c)Supinatedposition d)Positiondoesnotmatter CorrectAnswer-CAns.is'c'i.e.,SupinatedpositionFractureproximalthird-supinationofforearmFracturemiddlethird-midpronationofforearmFracturedistalthird-pronationofforearm
165.Whichofthefollowingmovementsis restrictedinPerthe'sdisease- a)Adduction&externalrotation b)Abduction&externalrotation c)Adduction&internalrotation d)Abduction&internalrotation CorrectAnswer-DAns.is.'d'i.e.,Abduction&internalrotationClinicalfeaturesofPerthesdiseasePerthesdiseaseiscommoninmaleofagegroup5-10years.Paininthehip,oftenradiatingtoknee.Limp(antalgiclimp)Limitationofmovement:-Abduction,internalrotationandextensionarelimited,thereforethereisadduction,externalrotation,andflexiondeformity.Shorteningoflimb.Positivetrendelenburgtest.Duringthediseaseprocess,boneageis1-3yearslowerthanthenormal.Afterhealing,boneagereturnstonormal.
166.Windsweptdeformityinfootisseenin? a)Rickets b)RA c)Hyperparathyroidism d)Scurvy CorrectAnswer-BAns.is'b'i.e.,RAWindsweptdeformity 1. Knee:-Avalgusdeformityofonekneeinassociationofvarus deformityofotherkneeisknowaswindsweptdeformity.Itisseenin:Rickets,Physealoseochondromatosis,Hereditarydysplasia(epiphysealdysplasia)ofboneandRheumatoidarthritis. 2. Foot:-Deviationofall-toesinonedirection(usuallylaterally)is knownaswindsweptdeformity.ItisseeninRheumatoidarthritis. 3. Hand:-Deviationofallfingers(usuallymedialy)isknowas windsweptdeformity.ItisseeninRheumatoidarthritis,SLE,andJacoud'sarthropathy.
167.TrueSupracondylarfractureoffemur? a)TypeA b)TypeB c)TypeC d)TypeD CorrectAnswer-AAns.is'a'i.e.,TypeAAusefulclassificationisfromtheAOgroup:typeAfractureshavenoarticularsplitsandaretruly'supra-condylar';typeBfracturesaresimplyshearfracturesofoneofthecondyles;andtypeCfractureshavesupra-condylarandintercondylarfissures
168.Allaretrueaboutmenisciofkneejoint except a)Lateralmeniscuscoversmorearticularsurfaceoftibia- b)Lateralmeniscusismoremobile c)Lateralmeniscusismorepronetoinjury d)Lateralmeniscusissemicircular CorrectAnswer-CAns.is'c'i.e.,Lateralmeniscusismorepronetoinjury
169.Gardenspadedeformityisseenin? a)Barton'sfracture b)Colle'sfracture c)Smith'sfracture d)Bennet'sfracture CorrectAnswer-CAns.is'c'i.e.,Smith'sfractureSmithfracture(Reversecolle'sfracture)Itisafractureofdistalthirdofradiuswithpalmardisplacement.Hence,itiscalledasreversecollesfracture(Incollesfracturethereisdorsaldisplacement).Itislesscommonthancollesfractureandiscausedbyfallonthebackofhand.Thedeformityisoppositetothatofcolle'sfractureandiscalledthe'gardenspadedeformity'.Treatmentisclosedreductionandimmobilizationincastwithforearminsupinationandwristinextension.oPercutaneouspinningmaybedoneinunstablefractures.
170.Dignosticsignofafracture- a)Abnormalmobilityatfracturesite b)Painatthefracturesite c)Tenderness d)Swelling CorrectAnswer-AAns.is'a'i.e.,Abnormalmobilityatfracturesite1.Unfailingsigns(diagnosticorpathognonionic)-?Abnormalmobility?Crepitus?Tenderness2.Reliablesigns?Shortening?Bruise3.Importantsigns?Swelling?Lossoffiinction?Deformity?Blisters4.Lateorinconsistentsigns?Ecchymosis?Swellingduetocallus
171.Fractureneckfemurcauseofnon- union? a)Injurytobloodsupplywithshearingstress b)Poornutritionofthepatient c)Smoking d)Oldageandosteoporosis CorrectAnswer-AAns.is'a'i.e.,InjurytobloodsupplywithshearingstressCausesofnon-unioninfractureneckoffemurare:? 1. Fracturemorphology-highfractureangleandincreasedshear.2. Displacedfracturegrade3/4.3. Fracturecomminution.4. Inadequatereductionandstabilityoffixation.5. Poorbonequality.6. Injurytovascularity-directandtamponadeeffect.7. Absenceofcambiumlayerinperiosteum.8. Factorsinsynovialfluidwhichinhibitthecallusformation.9. Lackofhematoma. 10. Washingawayanddilutionofosteogenicfactors.
172.Exsanguinatingbloodlossin? a)Closedhumerusfracture b)Closedtibiafracture c)Openfemurfracture d)Openhumerusfracture CorrectAnswer-CAns.is'c'i.e.,OpenfemurfractureExsanguinationistheprocessofbloodloss,toadegreesufficienttocausedeath.Shaftfemurfractureoutoftheaboveisassociatedwithmaximumbloodlossandmorebloodlossisexpectedincasesofopenfracture.Thus,themostprobableanswerisopenfractureshaftfemur.Twoimportantfractureswhichcancausesignificantbloodlossare- 1. Fracturepelvis2. Fractureshaftfemur
173.Whichofthefollowingisanorthopedic emergency? a)Intraarticularfracture b)Septicarthritis c)Fracturelateralcondylehumerus d)Fractureneckfemur CorrectAnswer-BAns.is'b'i.e.,SepticarthritisTimingofsurgeryFracturesurgerycanbedividedintoemergency,urgencyorelective.EmergencyEmergencysurgeryisimmediateforlifeandlimbthreateningproblems.Examplesare:- 1. Fractureordislocationwithvascularinjury.2. Fractureswithcompartmentsyndrome3. Irreducibledislocationorfracturedislocationofmajorjoint.4. Compound(open)fractures5. Septicarthritis6. Spinalinjurieswithdeterioratingneurologicaldeficity. UrgencyUrgentsurgeryisthesurgery,whichshouldbedoneearly(within12-36hours),butafterarrangingpropersurgicalfacilities,Importantexamplesare:- 1. Intra-articularfractures2. Fractureneckfemur3. Fracturelateralcondylehumerusinchildren.4. Displacedsupracondylarfracturehumerusinchildren. Elective
Electivesurgeryisplannedproperlyandcanbedoneevenaftersomedelay(3-4daysto3-4weeks).Mostofthesurgeriesinorthopaedicsareelective.Exampleare:- 1. Closedfracturelongbone2. ITfracture3. Mostoftheorthroscopicprocedures4. Arthroplasty
174.Aeroplanesplintisusedin? a)Radialnerveinjury b)Ulnarnerveinjury c)Brachialplexusinjury d)Scoliosis CorrectAnswer-CAns.is'c'i.e.,Brachialplexusinjury Name Use Cramer-wiresplint Emergencyimmobilisation Thomassplint Fracturefemur-anywhere Bohler-Braunsplint Fracturefemur-anywhere Aluminiumsplint Immobilizationoffingers DennisBrownsplint CIEV Cock-upsplint Radialnervepalsy Knuckle-bendersplint UlnarnervepalsyToe-raisingsplint Footdrop Volkmann'ssplint Volkmann'sischaemiccontracture(VIC) Four-postcollar Neckimmbilisation Aeroplanesplint Brachialplexusinjury SOMIbrace Cervicalspineinjury ASHE(Anteriorspinal Dorso-lumbarspinalinjuryhyperextension) brace Taylor'sbrace Dorso-lumbarimmobilisation Milwaukeebrace Scoliosis Bostonbracet Scoliosis Lumbarcorset Backache
175.Commonestmalignanttumorofskeletal system? a)Multiplemyeloma b)Metastasis c)Osteosarcoma d)Chondrosarcoma CorrectAnswer-BAns.is`b'i.e.,MetastasisCommonestbonemalignanciesSecondariesCommonestprimarymalignanttumorA-MultiplemyelomaCommonestprimarymalignanttumorOsteosarcomaoflongbonesCommonestbenigntumorofbone-Osteochondroma(Osteochondromaisnottrueneoplasmsinceitsgrowthstopswithcessationofgrowthattheepiphysealplate)CommonesttruebenigntumorofboneOsteoidosteomaCommonestbenigntumorofhandEnchondroma
176.PoorprognosticindicatorofPott's paraplegia a)Earlyonset b)Activedisease c)Healeddisease d)Wetlesion CorrectAnswer-CAns.is'c'i.e.,HealeddiseasePrognosisofPott'sparaplegiaGoodPoorDegreePartial(onlysensoryormotor)Completeparaplegia(gradeIV)DurationShorterLonger(>12months)TypeEarly(acute)onsetLate(chronic)onsetSpeedofonsetSlow(insidious)Rapid(sudden)AgeYoungerOldGeneralconditionGoodPoorVertebraldiseaseActiveHealedKyphoticdeformity<600>60?CordonMRINormal
MyelomalaciaorsyringomyeliaPreoperativeWetlesionDrylesion
177.Pictureframevertebraisseenin? a)Paget'sdisease b)Osteopetrosis c)Osteoporosis d)Ankylosingspondylitis CorrectAnswer-AAns.is'a'i.e.,Paget'sdiseaseRadiologicalfeaturesofPaget'sdiseaseRadiographicfeaturesdependonthestageofthedisorder:?A.IntheearlyosteolyticphaseActiveboneresorptionisevidentasaradiolucentwedgedareainlongbonestermedas'candleflame'or`bladeofgrass'.Intheflatbonessuchasthecalvariumortheiliacbone,purelyosteolyticlesionisnoted,knownasosteoporosiscircumscripta.B.LaterphasesofnewboneformationBoneremodellingappearsradiographicallyasthickeningofthecortex,coarsetrabeculationandenlargementorexpansionofanentireboneorareaofalongbone.Vertebralcorticalthickeningofthesuperiorandinferiorendplatescreatesa'pictureframevertebra'.Diffuseradiodenseenlargementofavertebraisreferredtoas'ivoryvertebra'.Skullx-rayshowsfocalpatchydensities-cottonballappearance,whichisquitecharacteristicofPagetdisease.Pelvicradiographdemonstratedisruptionoffusionofthesaro-iliacjointsandsofteningwithprotrusioacetabuli.Longbonesrevealbowingdeformitiesandtypicalpageticchangesofcorticalthickeningandexpansionandareasoflucencyand
sclerosis.
178.Barton'sfractureis? a)Fracturedistalendhumerus b)Extra-articularfracturedistalendradius c)Intra-articularfracturedistalendradius d)Intra-articularfracturedistalendradiuswithcarpalbone subluxation CorrectAnswer-AAns.is'd'i.e.,Intra-articularfracturedistalendradiuswithcarpalbonesubluxationBarton'sfractureBarton'sfractureisanintra-articularfractureofdistalradiuswithsubluxationofcarpals.Whencarpalssubluxationoccursanteriorly(volar),itiscalledvolarBarton'sfracture.Itisthecommonesttype.Whencarpalssubluxateposteriorly(Dorsal),itiscalledDorsalBarton'sfracture.TheBarton'sfractureisdifficulttomanagebyconservativemethods:reductionisoftenimperfectandtendstobeunstable,sothatredisplacementoftenoccurs.Therefore,ofteninternalfixationbysmallbuttressplatingisrecommended.
179.Short4thmetacarpalisafeatureof a)Hyperparathyroidism b)Hyperparathyroidism c)Pseudohypoparathyroidism d)Scleroderma CorrectAnswer-CAns.is`c'i.e.,PseudohypoparathyroidismShort41kmetacarpal/metatassal(metacarpalsign)Post-traumaticPostinfection(fromsicklecellanemia)Turner'ssyndromePseudohypoparathyroidismPseudopseudohypoparathyroidismHereditarymultipleexostosisChondroectodermaldysplasia(Ellis-vanCreveldsyndrome)
180.Mostcommonsiteofosteochondritis dessicans? a)Lateralpartofthemedialfemoralcondyle b)Medialpartofthemedialfemoralcondyle c)Lateralpartofthelateralfemoralcondyle d)Medialpartofthelateralfemoralcondyle CorrectAnswer-AAns.is'a'i.e.,LateralpartofthemedialfemoralcondyleJointSiteofosteochondritisdessicansKneeLateralsurfaceofthemedialfemoralcondyleElbowCapitulumofhumerusHipFemoralheadAnkleTalus
181.Allarecommonsitesofprimaryforbone metastasisexcept a)Breast b)Breast c)Brain d)Brain CorrectAnswer-CAns.is`c'i.e.,BrainMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.Certaintumorsareknowntobecommonsourcesofbonemetastasis.Thefollowingprimarytumorsarethemostcommontometastasizeinthebone;breast,prostate,lung,thyroid,kidney,andgastrointestinaltract.ThecommonestsourceofmetastaticbonediseaseiscarcinomaofthebreastInmalesmostcommonsourceisprostatecarcinoma.Bladderanduterinecarcinomasarelesscommonsources.Inchildren,skeletalmetastasesoriginatefromneuroblastoma,Ewing'ssarcoma,andosteosarcoma.
182.Madelung'sdeformityinvolves- a)Humerus b)Proximalulna c)Distalradius d)Carpals CorrectAnswer-CAns.is'c'i.e.,DistalradiusMadelung'sdeformityMadelung'sdeformityisacongenitaldisorderthataffectsgrowthofdistalradius.Theprimarydefectisfailureofnormalgrowthofmedialandpalmarhalvesofthedistalradialphysis,leadingtocurvatureinanmedial(ulnar)andpalmardirection.Theulnaisrelativelylongandbecomesprominentdorsally.Thecarpus(carpalbones)sinks,alongwiththemedial(ulnar)halfofthedistalradialarticularsurface,intothegapsbetweenthetwoforearmbones.
183.Commoncausesofvertebraplana a)TB b)Eosinophilicgranuloma c)Metastasis d)Alloftheabove CorrectAnswer-AAns.is'd'i.e.,AlloftheaboveVertebraplanaThistermisusedtodescribeuniformcollapseofavertebralbodyintoathin,flatdisc.Themostcommoncauseiseosinophilicgranuloma,withthethoracicvertebraemostfrequentlyaffected.Causesare:? 1. Histocytosis-X(Eosinophilicgranuloma)2. Leukemia3. TB4. Metastasis,Multiplemyeloma,Ewing'ssarcoma,lymphoma5. Osteochondritisofvertebralbody(Calve'sdisease)6. Hemangioma7. Trauma8. Steroids
184.DISCprolapseiscommonatallsite except? a)L4-L5 b)L5-S1 c)C6-C7 d)T3-T4 CorrectAnswer-DAns.is'd'i.e.,T3-T4Herniationofintervertebraldiscisacommoncauseofcombinedbackpainandsciatica(Paininbackwithradiationtolowerlimb).Prolapsedintervertebraldiscisoftenprecipitatedbyinjury,butitmayalsooccurintheabsenceofanyrememberedinjury.ThediscbetweenLcandSpandbetweenL4andL5arethosemostoftenaffected(80%).Lowercervicalregion(C's-C6andC6_7)isaffectedin19-20%.
185.Aspiratedsynovialfluidinsepticarthritis willhave? a)Clearcolor b)Highviscosity c)Markedlyincreasedpolymorphonuclearleukocytes d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,MarkedlyincreasedpolymorphonuclearleukocytesAppearance-PurulentClarity-OpaqueViscocity-DecreasedCellcount->80000(>80%PMNs)Example-Bacterialarthritis
186.Whichcancauseloosebodyinthejoint- a)RA b)Ankylosingspondylitis c)OA d)SLE CorrectAnswer-CAns.is'c'i.e.,OACausesofloosebodiesinclude:- 1. Osteoarthritis2. Osteochondritisdessicans3. Osteochondralfracture(injury)4. Synovialchondromatosis5. Charcot'sdisease Amongthese,osteochondralfracturecausessingleloosebodies,whileallothercancausemultipleloosebodies,maximumbysynovialchondromatosis(uptohundrades).
187.Salter'spelvicosteotomyisdonefor treatmentof? a)CTEV b)SCFE c)DDH d)None CorrectAnswer-CAns.is'c'i.e.,DDHTreatmentofCDH/DDHTheaimoftreatmentinDDHistoachieveandmaintainanearlyconcentricreductionandmaintainituntilthehipbecomesclinicallystableandaroundacetabulumcoverit.Treatmentplanisaccordingtotheage:? 1. 1-6monthsofage:-Pavilkharnessand/orVon-rosensplintare usedtomaintainthereduction.Ifdislocationpersists,closedreductionortractionfollowedbycastingisdone. 2. 6-18monthsofage:-Closedreductionortractionfollowedby casting.Ifclosedreductionfails,openreductionfollowedbycastingisrecommended. 3. 18months-3years:-Openreductionwithfemoralshortening(if femoralsiteisinvolved)orsalterasteotomy(ifacetabulumisinvolved). 4. 3-8years:-Openreductionwithfemoralshorteningwithorwithout acetabularreconstructiveosteotomy.Acetabularreconstructionproceduresare:- 1. Salter'sosteotomy2. Chiari'spelvicdisplacementosteotomy3. Pemberton'spericapsularosteotomy
188.AllarefeaturesofPaget'sdiseaseexcept ? a)Defectinosteoclasts b)Commoninfemale c)Cancausedeafness d)Cancauseosteosarcoma CorrectAnswer-BAns.is'b'i.e.,CommoninfemalePagetdiseasePaget'sdiseaseischaracterizedbyincreasedboneturnoverandenlargementandthickeningofthebone,buttheinternalarchitectureisabnormalandtheboneisusuallybrittle.Primarydefectisinosteoclastswithincreasedosteoclasticactivity.Thisresultssecondarilyincreaseinosteoblasticactivity(normalosteoclastsandosteoblastsactinaco-ordinatedmanner).So,characteristiccellularchangeisamarkedincreaseinosteoclasticandosteoblasticactivity.Boneturnoverisacclerated,plasmaalkalinephosphataseisraised(asignofosteoblasticactivity)andthereisincreasedexcretionofhydroxyprolineinurine(duetoosteoclasticactivity).ClinicalfeaturesofPaget'sdiseasePaget'sdiseaseisslightlymorecommoninmalesandisseenafter40yearsofage.Thepelvisandtibiabeingthecommonestsites,andfemur,skull,spine(vertebrae)andclaviclethenextcommonestoMostofthepatientwithPaget'sdiseaseareasymptomatic,thedisorderbeingdiagnosedwhenanx-rayistakenforsomeunrelatedconditionoraftertheincidentaldiscoveryofraisedserumalkalinephosphatase.
Whenpatientsdoespresent,theypresentbecauseanyofthethree:- 1. Pain:-Dullconstantache2. Deformities:-Bowingoflongbones,platybasia.3. Complicationsofthedisease ComplicationsofPaget'sdiseaseFollowingcomplicationscanoccurinPaget'sdisease:- 1. Fracture:Arecommoninweightbearingbones2. Cranialnervecompression:-Maycauseimpairedvision,facial palsy,trigeminalneuralgiaordeafness. 3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.4. Spinalcanalstenosisandnerverootcompression5. Highoutputcardiacfailure6. Osteoarthritis:ofHipandknee7. Rarelyosteosarcoma
189.DeformityintransientsynovitisofHip? a)Abduction b)Flexion c)Externalrotation d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveTransientsynovitisofHipTransientsynovitisofhipisalsoknownasobservationhip,toxicsynovitisorirritablehip.Itsaself-limiting,inflammatoryconditionofthesynovium,thatlastsonlyashorttime(thereforeknownastransient)Itisthemostcommoncauseofhippainandlimpinchildrenunder10yrsofage.Causeisnotknownbutassociationhasbeenseenwitharecenthistoryofanupperrespiratorytractinfection.Presentationiswithhippainorlimp.Thelimbisinattitudeofslightflexion,abductionandexternalrotation.Thechildmayhavelowgradefever.TheESR,C-Reactiveprotein&WBCscountarenormal(ThisdifferentiatesTransientsynovitisfromSepticarthiritisaseriouscondition,inwhichpatienthashighgradefeverandelevatedESR,C-ReactiveproteinandWBCcount).RadiographorultrasoundmayshowwideningofthejointspaceHowever,mostofthetimex-rayisnormal.UsuallythetreatmentofaclinicallysuspectedcaseoftransientsynovitisofhipisBedrest,NSAIDSandobservation.USGguidedaspirationisindicatedfor:- 1. Temperature>99.5?F2. ESR>20(RaisedESR)
3. SeverehippainwithROM
190.Rockerbottomfootisdueto? a)OvertreatmentofCTEV b)Malunitedfracturecalcaneum c)Horizontaltalus d)Neuraltubedefect CorrectAnswer-AAns.is'a'i.e.,OvertreatmentofCTEVRockerbottomfootRockerbottomfootisafootwithaconvexplantarsurfacewithanapexofconvexityatthetalarhead(normalplantarsurfaceisconcave).CausesofRockerBottomfootare:- 1. Congenitalverticaltalus2. OvercorrectionofCTEV3. ImpropercorrectionofCTEV,i.e.forcefulcorrectionofequinesby dorsiflexionbeforecorrectionofadduction,varusandinversion. 4. Edward'ssyndrome,Escobarsyndrome,Apert'ssyndrome. Congenitalverticaltalusmaybeassociatedwitharthrogryposis,Prunebellysyndrome,neurofibromatosis,andspinalmusculardystrophy
191.Hangman'sfractureis? a)SubluxationofC5overC6 b)FracturedislocationofC2 c)Fracturedislocationofanklejoint d)Fractureofodontoid CorrectAnswer-BAns.is'b'i.e.,FracturedislocationofC2Hangman'sfractureHangman'sfractureisbilateralfractureoftheparsinterarticularisofaxis(C2)withtraumaticspondylolisthesisofaxis(C2)overC3vertebrae.ThusHangman'sfractureisnotsimplyafracture,butfracturedislocationofaxis(C2).Themechanismofinjuryisextensionwithdistraction(intrue,judicialhangman'sfracture)andhyper-extension,axialcompression&.flexion(incivilianinjuries,whicharenowmorecommon).ItissecondmostcommontypeofAxis(C2)fracture,secondonlytoodontoidfractures.Fatalatiesarecommon,However,neurologicaldeficitisunusualasthefractureofposteriorarchdecompressthespinalcord.Mostofthefatalitiesoccuratthesceneofinjury,acutepostadmissionmortalityislow.SuccessfulhealingofC2traumaticspondylolishesisisreportedtoapproach95%.Thisismostcommonlyachievedwithnon-operativemeasures,eveninthepresenceofdisplacementofparsinter-articularis.Undisplacedfracturesaretreatedinasemi-rigidorthosis,anddisplacedfractureareclosedreduced&treatedwithhalo-vest.
Occasionally,thehangman'sfractureisassociatedwithaC2/3facetdislocation.Thisisaseverelyunstableinjury;openreductionandstabilizationisrequired.
192.Mostcommoncauseofkyphotic deformity? a)Trauma b)Osteoporosis c)Ankylosingspondylitis d)Rickets CorrectAnswer-BAns.is'b'i.e.,OsteoporosisKvphosisKyphoticdeformitiesarecharacterizedbyonincreaseddorsalcurvatureinthesagittalplaneofspinalalignment.Posturalkyphosis(Posturalroundback)andscheuermann'sdiseasearethemostcommoncausesofkyphosis,particularlyinadolescents.Mostcommoncauseinolderpersonsisosteoporosis.Othercommoncausesaretuberculosisofthevertebralbodies,ankylosingspondylitis,rickets,cancersandspinabifida.Therearethreetypesofkyphoticdeformities: 1. KnuckleProminenceofonespinousprocess2. Gibbus-3Prominenceoftwoorthreespinousprocesses3. Kyphus--->Diffuseroundingofthevertebralcolumn
193.Saturdaynightpalsyiswhichtypeof nerveinjury? a)Neuropraxia b)Axonotemesis c)Neurotemesis d)Completesection CorrectAnswer-AAns.is'a'i.e.,NeuropraxiaSeddon'sclassificationofnerveinjuriesSeddonidentifiedthreetypesofinjuries1.NeuropraxiaThereiscontusionoftheperipheralnervewhichcausesreversiblephysiologicalnerveconductionblock.Theaxiscylinder(i.e.,axonwithitsendoneurium)ispreserved.Thus,thereisphysiologicalconductionblockwithoutanatomicdisruption.Theinjuryistemporaryandrecoveryiscomplete.Itisseenincrutchpalsy,tourniquetpalsy,andsaturdaynightpalsy.2.AxonotemesisThereisinjurytoaxonbutendoneuriumispreserved.Spontaneousrecoveryisexpectedinsomecases.Thisisseeninclosedfracturesanddislocations.3.NeurotemesisThereiscompleteanatomicalsectionofnerve.Norecoverypossible.Itisseeninopenwound.
194.Commonfracturesinchildrenareall except? a)Lacteralcondylehumerus b)Supracondylarhumerus c)Fractureofhand d)Radius-ulnafracture CorrectAnswer-CAns.is'c'i.e.,FractureofhandCommonfracturesinchildren 1. Forearmbonesfractures2. Supracondylarfractureofthehumerus3. Fractureoflateralcondyleofhumerus4. Epiphysealinjuries5. Spiralfractureoftibialshaft
195.Mostcommonsiteofmyositisossificans ? a)Knee b)Elbow c)Shoulder d)Wrist CorrectAnswer-BAns.is'b'i.e.,ElbowMyositisossificansistheextraskeletalhetrotropicossificationthatoccursinmusclesandothersofttissues.Traumaisthemostimportantcauseofmyositisossificans.Usuallythereishistoryofseveresingleinjury.Itismorecommoninchildren.Mostcommonlyinvolvedjointiselbowfollowedbyhip.Thereishistoryoftraumaaroundtheelbow,i.e.fracturesupracondylarhumerus,dislocationofelboworsurgerywithextensiveperiostealstripping.Massagetotheelbowandvigorouspassivestretchingtorestoremovementsareaggravatingfactor.Itoccursinmuscleswhicharevulnerabletotearunderheavyloads,suchasquadriceps,adductors,brachicilis,biceps,anddeltoid.X-rayfindingischaracteristicandshowsdistinctperipheralmarginofmatureossificationandaradiolucentcenterofimmatureosteoid&primitivemesenchymaltissue
196.ThurstonHollandsignisseenin? a)TypeI b)TypeII c)TypeIII d)TypeIV CorrectAnswer-BAns.is'b'i.e.,TypeIIEpiphyseal(PhyseallInjuriesoThejunctionbetweenthemetaphysisandepiphysis,i.e.physealplate/growthplate,istheweakestpointofalongboneinchildrenandis,therefore,mostvulnerabletoshearingforces.oSalterandHarrishaveclassifiedepiphysealinjuriesintofivetypes?TypeI:Completeseparationofepiphysisfromthemetaphysiswithoutfracture.Commoninrickets,scurvyandosteomyelitis.TypeII:Thefractureinvolvesthephysisandatriangleofmetaphysealbone(ThurstonHollandsign).Thisisthecommonesttypeofepiphysealinjuryaccountingfor73percentofcasesover10yearsofage.TypeIII:Thefractureisintra-articularandextendsalongthephysisandthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.TypeIV:Thefractureisintra-articularandextendsthroughtheepiphysis,physisandmetaphysis.Perfectreductionisnecessaryandopenreductionismoreoftennecessarytopreventgrowtharrest.TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrialring)injury.
197.
Whichpartofscaphoidfractureismostsusceptibletoavascularnecrosis? a)Distal1/3rd b)Middle1/3rd c)Proximal1/3rd d)ScaphoidTubercle CorrectAnswer-CAnswer.C.Proximal1/3rdScaphoidfractures(i.e.fracturesthroughthescaphoidbone)arecommon,insomeinstancescanbedifficulttodiagnose,andcanresultinsignificantfunctionalimpairment.EpidemiologyScaphoidfracturesaccountfor70-80%ofallcarpalbonefractures.Althoughtheyoccuressentiallyatanyage,adolescentsandyoungadultsaremostcommonlyaffected.Olderpatientsfallinginasimilarmanneraremorelikelytosustainadistalradialfracture(usuallyaCollesfracture).ClinicalPresentationClassicallytherecanbepaininanatomicalsnuffboxwhichisthoughttohaveasensitivityof~90%andaspecificity~40%Fracturescanoccuressentiallyanywherealongthescaphoid,butdistributionisnoteven: 1. waistofscaphoid:70-80%2. proximalpole:20%3. distalpole(orso-calledscaphoidtubercle):10%
198.Pott'spuffytumor: a)Subperiostealabscessoffrontalbone b)Subperiostealabscessofethmoidbone c)Mucoceleoffrontalbone d)Mucoceleofethmoidbone CorrectAnswer-AAnswer.A.SubperiostealabscessoffrontalbonePott'spuffytumor,firstdescribedbySirPercivallPottin1760,isarareclinicalentitycharacterizedbysubperiostealabscessassociatedwithosteomyelitis.Itischaracterizedbyanosteomyelitisofthefrontalbone,eitherdirectorthroughhaematogenousspread.Thisresultsinaswellingontheforehead,hencethename.Theinfectioncanalsospreadinwards,leadingtoanintracranialabscess.Pott'spuffytumorcanbeassociatedwithcorticalveinthrombosis,epiduralabscess,subduralempyema,andbrainabscess.
199.Scissorgaitisseeninwhichofthe followingcondition: a)Polio b)Cerebralpalsy c)Hyperbilirubinemia d)Hyponatremia CorrectAnswer-BAnswer.B.CerebralpalsyScissorgaitisaformofgaitabnormalityprimarilyassociatedwithspasticcerebralpalsy.Thatconditionandotherslikeitareassociatedwithanuppermotorneuronlesion.
200.Mostcommonjointinvolvedinseptic arthritis: a)Knee b)Hip c)Shoulder d)Elbow CorrectAnswer-AAnswer.A.KneeSepticarthritis(Acutesuppurativearthritis)Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionofajointbypyogenicorganism(bacteria).Thejointcanbecomeinfectedby:? 1. Hematogenousspreadfromadistantsite(mostcommonroute).2. Directinvasionthroughapenetratingwound,intraarticularinjection, arthroscopy. 3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere Metaphysisisintraarticulare.g.,hipandshoulder.ClinicalfeaturesDiseaseismorecommoninchildren.Kneejointisthemostcommonlyaffectedjoint.Otherjointwhichareaffectedarehip,shoulderandelbow.Thechildistoxicwithfever,tachycardia,tachypnea.Thereisseverepain,swelling,andrednessoverthejoint.Movementsareseverelyrestrictedandthejointisheldinthepositionofease.Weightbearingonlimbisnotpossible.
201.Painfularcsyndromepainisfeltduring? a)Midabduction b)Initialabduction c)Fullrangeofabduction d)Overheadabduction CorrectAnswer-AAnswer.A.MidabductionPAINFULARCSYNDROMEOtherNamesImpingementsyndromeSupraspinatussyndromeSwimmer'ssyndromeThrower'sshoulderClinicalsyndromecharacterizedbypainintheshoulderduringanarcofmovementbetween60?and120?ofabduction.
Etiology: 1. Minortearsofthesupraspinatustendon2. Supraspinatustendinitis3. Calcificationofsupraspinatustendon4. Subacromialbursitis5. Fractureofthegreatertuberosity6. Increaseinbulkofthecontentsinthesubacromialspace,seenin inflammationoftherotatorcuff
202.TrueaboutTenosynovitisoffinger? a)Fingersheldinmildextension/Extensiondeformityatthe involvedfingers. b)Tenosynovitisoflittlefingerwillspreadtothumbratherthanring finger. c)Withinvolvementoflittlefingertheinfectioncanspreadtothe indexfinger. d)Treatmentisconservative. CorrectAnswer-BAns.B.TenosynovitisoflittlefingerwillspreadtothumbratherthanringfingerInfectionofthesynovialsheaththatsurroundstheflexortendonInfectionfromtheflexortendonsheathofthethumbcanalsoextendalongtheradialbursatothespaceofParonaandthenintotheulnarbursaandtheflexortendonsheathofthelittlefinger--andviceversa--leadingtoa"horseshoe"abscess.Horseshoeabscess:Maydevelopfromspreadpyogenicflexortenosynovitis,ofmanyindividualshaveaconnectionbetweenthesheathsofthethumbandlittlefingersatthelevelofthewrist
203.Thelastdeformitytobecorrectedby Ponseti'smethodforCTEVis- a)HeelVarus b)Equinus c)FootAdduction d)Cavus CorrectAnswer-BAnswer-B.EquinusPonseti'stechniqueThisinvolvesfirstcorrectingthecavusdeformirythentheadductionandheelvarusandfinallytheequinusdeformity.ThistechniqueisnowmostlyacceptedtechniqueforCTEVcorrectionasitisbasedonbetterunderstandingofthepathoanatomyofthedeformedfoot.Thesuccessofreductionis90-98Percent.
204.Ossificationcentreofscaphoidappears at a)1-6months b)1to2years c)2to4years d)4to6years CorrectAnswer-DAnswer-D.4to6years
205.
Whichofthefollowingisthemostmetabolicallyactivepartoflongbone? a)Epiphysis b)Metaphysis c)Diaphysis d)Physis CorrectAnswer-DAnswer-D.PhysisThegrowthplate(physis)andtheadjacentterminaldiaphysisrepresentthemostmetabolicallyactivesegmentofthelongbone.Thispartchangesdramaticallyduringdevelopmentandhenceitiscalledthemetaphysis
206.Iliotibialbandcontractureinpatientsof poliomyelitiswillleadto a)Flexionathipandknee b)Flexionathip,extentionatknee c)Extentionathipflexionatknee d)Extentionathipandknee CorrectAnswer-AAnswer-A.FlexionathipandkneeDeformities:Iliotibialbandcontracturecanleadto:Flexion,abductionandexternalrotationdeformityathip(mostcommon).Flexonandvalgusatlcneeorsometimestripledeformityatknee(flexion,posteriorsubluxationandexternalroutationoftibiaonfemur).Equinovarusatankleandfoot.Lumbarscoliosisandpelvicobliquityatspineandpelvisrespectively.
207.Managementofdisplacednon comminutedintercondylarhumerusfractureis- a)Openreductioninternalfixation b)Aboveelbowplasterslabapplication c)Olecranonpintraction d)Externalfixation CorrectAnswer-AAnswer-A.OpenreductioninternalfixationItdependsuponthedisplacement.Anundisplacedfractureneedssupportinanabove-elbowplasterslabfor3-4weeks,followedbyexercises.Adisplacedfractureistreatedgenerallybyopenreductionandinternalfixation.Incaseswithseverecomminution,olecranonpintractionisgiventoreducethefractureandmaintainthereduction.
208.Jumpersknee a)Apophysitisofpatellartendonasitinsertsinpatella b)Apophysitisofpatellartendonasitinsertsintibia c)Apophysitisofquadricepstendonasitinsertsinpatella d)Apophysitisofhamstringtendonasitinsertsintibia CorrectAnswer-AAnswer-A.ApophysitisofpatellartendonasitinsertsinpatellaItisalsocalledPatellartendinitisThisisanapophysitis(inflammation)ofthepatellartendonasitinsertsintothepatella.Itisassociatedwithpain,swellingandcrepitus.
209.Proximaltibialepiphysisfusesat- a)12-14years b)14-16years c)16-18years d)18-20years CorrectAnswer-CAnswer-C.16-18yearsThetibiaossifiesfromthreecentres,oneintheshaftandoneineachepiphysis.Ossificationbeginsinmidshaftatabouttheseventhintrauterineweek.Theproximalepiphysialcentreisusuallypresentatbirth:atapproximately10yearsathinanteriorprocessfromthecentredescendstoformthesmoothpartofthetibialtuberosity.
210.Whatisthetreatmentforpatientwith hypertrophicnonunionwithdeformityatfracturesite? a)Notreatmentrequired b)Fixationonly c)Bonegraftingonly d)Fixationwithbonegrafting CorrectAnswer-BAnswer-B.FixationonlyPatientswithhypertrophicnonunionhavesufficientvascularitytohealbutstabilityislackingornormalaxialalignmenthasnotbeenrestored.Thusinacaseofhypertrophicnonunionwithoutdeformity,fixationalonewillprovidestabilityandwillleadtohealing.
211.Chauffeurfractureis- a)Extra-articularfractureofstyloidprocess b)Intra-articularfractureofstyloidprocess c)Intra-articularfractureofbaseof1stmetacarpal d)Extra-articularfractureofbaseof1stmetacarpal CorrectAnswer-BAnswer-B.Intra-articularfractureofstyloidprocessAnintra-articularobliquefractureofthestyloidprocessoftheradius.
212.Whichofthefollowingisnottrueabout Galeazzifracturedislocation? a)Fractureofdistalthirdofradiusanddislocationofdistalradio- ulnarjoint b)Resultsfromfallonoutstretchedhand c)Thedistalendofulnadislocatesvolarlyafterdisruptionofdistal radio-ulnarjoint d)Radiusisangulatedmediallyandanteriorly CorrectAnswer-CAnswer-C.Thedistalendofulnadislocatesvolarlyafterdisruptionofdistalradio-ulnarjointFractureofthedistalthirdoftheradiuswithdislocationofthedistalradioulnarjointThisinjuryisthecounterpartoftheMonteggiafracture-dislocation.Itcommonlyresultsfromafallonanoutstretchedhand.Theradiusfractureisangulatedmediallyandanteriorly.Thedistalradioulnarjointisdisrupted,resultingindorsaldislocationofthedistalendoftheulnaMalunionoccursbecauseofdisplacementofthefragment.Itresultsindeformityandlimitationofsupinationandpronation.
213.Whichofthefollowingisnottrueabout Jeffersonsfracture? a)Itisaburstfractureoftheringofatlasvertebra b)Itisthemostcommontypeofatlasfracture c)FracturedefinintionisparticularlyclearonCTScanimage d)Itisassociatedwithinjuryelsewhereinspinein25%ofthe cases CorrectAnswer-DAnswer-D.Itisassociatedwithinjuryelsewhereinspinein25%ofthecasesSuddensevereloadonthetopoftheheadmaycausea'bursting'forcewhichfracturestheringoftheatlas(Jefferson'sfracture).Thusitisatypeofaxialcompressionforce.ItisthemostcommontypeoffractureoftheAtlas.Thereisnoencroachmentontheneuralcanalandusuallynoneurologicaldamage.Withtheexceptionofpainorlossofsensationinthegreateroccipitalnervedistribution,neurologicalsequelaeareuncommonandmorelikelytoberelatedtoassociatedinjuries.Fractureofatlasareassociatedwithinjuryelsewhereincervicalspineinupto50%ofcases;odontoidfracturesandhangman'sfractureinparticularshouldbeexcluded
214.Whichofthefollowingshoulder movementsis/areweakinpatientsofsupraspinatustear? a)Abduction b)Adduction c)Externalrotation d)Internalrotation CorrectAnswer-AAnswer-A.AbductionPatientsmaytearthesupraspinatustendonacutelybyfallingonanoutstretchedarmorliftingaheavyobject.Symptomsarepainalongwithweaknessofabductionandexternalrotationoftheshoulder.Atrophyofthesupraspinatusmusclesdevelops.
215.Mostmobilesegmentofvertebral columnis- a)Cervical b)Thoracic c)Lumbar d)Sacral CorrectAnswer-AAnswer-A.CervicalThespinalcolumncanbedividedintothreemobile(cervical,thoracic,andlumbarregions)andtwofused(sacrumandcoccyx).Cervicalregion:Itisthemostmobileregionofthespinalcolumnwithrangeofmotionofapproximately80-90degreesofflexion,70degreesofextention,20-45degreesoflateralflexion,andupto90degreesofrotationtobothsides
216.Whichofthefollowingisnottrueabout impingementsyndrome? a)Itisthetendinitiscausedbyinflammationoftherotatorcuff tendons b)Supraspinatustendonismostofteninvolved c)Shoulderabductioninthearcof60-120degreesisparticularly painful d)Surgicaldecompressionofthesubacromialspaceisfrequently indicated CorrectAnswer-DAnswer-D.SurgicaldecompressionofthesubacromialspaceisfrequentlyindicatedImpingementsyndrome(painfularesyndrome)ismostcommonlyduetendinitsofsupraspinatuscomponentofrotatorcuffandischaracterizedbypainin60?-120"ofabduction.Treatmentisinitialyconservative.Surgicaldecompressionisrequiredinfailedcases.
217.Mostdangeroustypeofodontoid fractureasperAndersonandD'Alonzoclassificationanditsrespectivemanagementis a)TypeI-immobilizationinrigidcollar b)TypeII-screwfixation c)TypeIII-halovestimmmobilization d)TypeIV-opereductioninternalfixation CorrectAnswer-BAnswer-B.TypeII-screwfixationOdontoidfractureshavebeenclassifiedbyAndersonandD'Alonzo(1974)asfollows: 1. TypeI-Anavulsionfractureofthetipoftheodontoidprocessdueto tractionbythealarligaments.Thefractureisstable(abovethetransverseligament)anduniteswithoutdifficulty. 2. TypeII-Afractureatthejunctionoftheodontoidprocessandthe bodyoftheaxis.Thisisthemostcommon(andpotentiallythemostdangerous)type.Thefractureisunstableandpronetonon-union.Itrequiresfixationbyscrew. 3. TypeIII-Afracturethroughthebodyoftheaxis.Thefractureis stableandalmostalwaysuniteswithimmobilization.
218.IncreasedQanglepredisposesto a)Medialpatellarsubluxation b)Lateralpatellarsubluxation c)Superiorpatellarsubluxation d)Inferiorpatellarsubluxation CorrectAnswer-BAnswer-B.LateralpatellarsubluxationPatellaralignmentcanbeassessedbymeasuringtheQ-angle(quadricepsangle).Thisistheanglesubtendedbyalinedrawnfromtheanteriorsuperioriliacspinetothecentreofthepatellaandanotherfromthecentreofthepatellatothetibialtubercle.Itnormallyaveragesabout14degreesinmenand17degreesinwomen.Patellofemoralstabilityismaintainedbyacombinationofthearticularsurfacegeometryandsofttissuerestraints.
219.Falseaboutosteogenesisimperfectais- a)Defectivecollagenformation b)Associatedwithcataractformation c)Autosomaldominant d)KnownasBrittlebonedisease CorrectAnswer-BAnswer-B.AssociatedwithcataractformationOsteogenesisimperfecta,alsoknownasbrittlebonediseaseorLobsteinsyndrome,isahereditaryconditioncharacterizedbyfragilityofbones,deafness,bluesclera,laxityofjointsandtendencytoimprovewithage.Itisadiseaseofdefectivecollagenformation.Therefore,collagen-containingtissuesareaffected,e.g.bone,teeth,skin,tendonsandligaments.Primarydefectinboneisdefectiveosteoidformation.Itisusuallytransmittedasanautosomaldominant,butinaseverevariantofthediseasetheparentsarenormalandafreshgenemutationorautosomalrecessiveinheritanceispostulated.Radiologyshowswormianbonesintheskull.
220.ShentonslineisseeninXrayof- a)Antero-posteriorpelviswithbothhips b)Antero-posteriorshoulder c)Lateralcervicalspine d)Laterallumbosacralspine CorrectAnswer-AAnswer-A.Antero-posteriorpelviswithbothhipsWithanormalhipShenton'sline,whichcontinuesfromtheinferiorborderofthefemoralnecktotheinferiorborderofthepubicramus,lookscontinuous;anyinterruptioninthelinesuggestsanabnormalpositionofthefemoralhead.Narrowingofthejoint'space'isasignofarticularcartilageloss,afeatureofbothinflammatoryandnon-inflammatoryarthritis.
221.Apatientpresentswithwristtrauma.On investigationspatientisdiagnosedtohaveasprainedwrist,withoutanyevidenceoffracture.Thereistendernessinanatomicalsnuffbox.Whichligamentiscommonlyinvolved- a)Scapholunateligament b)Radialcollateralligament c)Lunotriquetralligament d)Ulnarcollateralligament CorrectAnswer-AAnswer-A.ScapholunateligamentLunateandscapholunateligmante-Tenderinlunatefractureandscapholunatedissociation
222.Palpablefemurheadonperrectalexam isafeatureofwhichofthefollowingconditions? a)Posteriorhipdislocation b)Anteriorhipdislocation c)Centralhipdislocation d)Inferiorhipdislocation CorrectAnswer-CAnswer-C.CentralhipdislocationIncentralfracture-dislocationofthehipthefemoralheadisdriventhroughthefloor(medialwall)oftheacetabulumtowardsthepelviccavity.Itoccursduetofallontheside,orablowoverthegreatertrochater.
223.Poplitealarteryinjuryiscommonlyseen inwhichtypeoftraumatickneedislocation? a)Anterior b)Posterior c)Medial d)Lateral CorrectAnswer-BAnswer-B.PosteriorPoplitealarteryinjuryiscommonwithbothanteriorandposteriordislocations.Posteriordislocationsmorelikelytoresultindirectinjuryandevenruptureofpoplitealartery(isolatedtransection).Anteriordislocationscausestretchingofpoplitealarterywhichmayleadtointimaldisruptionandthrombosis(damageisoveralongersegmentofartery).
224.Kochermanoeuverisusedfor a)Shoulderreduction b)Elbowreduction c)Ankledislocation d)Kneedislocation CorrectAnswer-AAnswer-A.ShoulderreductionKocher'smanoeuvre:Thisisthemostcommonlyusedmethod.Thestepsareasfollows: 1. Traction--withtheelbowflexedtoarightanglesteadytractionis appliedalongthelongaxisofthehumerus; 2. Externalrotation--thearmisrotatedexternally;3. Adduction--theexternallyrotatedarmisadductedbycarryingthe elbowacrossthebodytowardsthemidline;and 4. Internalrotation?thearmisrotatedinternallysothatthehandfalls acrosstotheoppositeshoulder.
225.Treatmentofscaphoidfracture a)Conservative b)CompressionScrews c)CompressionPlating d)Traction CorrectAnswer-AAnswer-A.ConservativeThetreatmentofascaphoidisessentiallyconservative.Thehandisimmobilizedinascaphoidcastwithwristinlittledorsiflexionandradialdeviation(glassholdingposition).
226.Allofthefollowingaretrueregarding fractureoflateralcondyleofhumerusexcept a)Usuallyseenat6-10yearsofage b)ResultsinGunstockdeformity c)Cubitusvalgusoccurs d)Tardyulnarnervepalsyisseen CorrectAnswer-BAnswer-B.ResultsinGunstockdeformityFractureLateralCondyleHumerus/JupiterfractureItisacommonfractureinchildren.Thelateralcondylar(orcapitular)epiphysisbeginstoossifyduringthefirstyearoflifeandfuseswithshaftat12-16years.Betweentheseagesitmaybeshearedofforavulsedbyforcefultraction.Themaximumchancesofinjuryisbetween6-10years.
227.Mostcommoncomplicationoffractureof tibia a)Infection b)Compartmentsyndrome c)Delayedunion d)Vascularinjury CorrectAnswer-CAnswer-C.DelayedunionThetibiahassomecharacteristicfeatureswhichareresponsiblefordelayedunionornon-unionoftibiafractures.Thedistalthirdoftibiaisparticularlypronefordelayedunionandnonunionbecauseofitsprecariousbloodsupply.
228.Whichofthefollowingisnottrueabout ACLinjury? a)Itisacomponentofthe0'Donoghuetriad b)ACLisintrasynovial c)ACLisimportantforproprioceptivefunction d)Anteriordrawertestisthemostsensitivetest CorrectAnswer-DAnswer-D.AnteriordrawertestisthemostsensitivetestLachman'stestisthemostsensitivetestforanteriorcruciateligamenttears.Itisdonewiththekneeflexedat20degrees.Soitcanbedoneinacuteaswellaschronicinjuries.(becauseinacutecaseswithhemarthrosismoreflexionisusuallynotpossiblesoperforminganteriordrawertestisdifficult).ACLisintrasynovial&hasproprioceptivefunction.
229.Cubitusvalgusdevelopsascomplication of- a)Jupitorfracture b)Smithsfracture c)Malgaignefracture d)Staddlefracture CorrectAnswer-AAnswer-A.JupitorfractureFractureoflateralcondyleofhumerus(Jupitorfracture)
230.X-rayappearanceofsequestrumis- a)Unnaturalradiodensefragments b)Osteopenicfragment c)Fragmentwithhoneycombloculatedappearance d)Radiolucentareawithspeckledcalcification CorrectAnswer-AAnswer-A.UnnaturalradiodensefragmentsSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissuetryingtoeatthesequestrumaway.Onx-ray,sequestrashowupasunnaturaldensefragments,incontrasttothesurroundingosteopenicbone
231.Continuousfixedtractionisprovidedby - a)Thomassplint b)BBsplint c)HamiltonRussel d)Gallows CorrectAnswer-AAnswer-A.ThomassplintCombinedtraction-IfaThomas'splintisused,thetapesaretiedtotheendofthesplintandtheentiresplintisthensuspended,asinbalancedtraction
232.Cobraheadplateisusedfor a)Hiparthrodesis b)Kneearthrodesis c)Elbowarthrodesis d)Anklearthrodesis CorrectAnswer-AAnswer-A.HiparthrodesisSpecialimplantsSPnail-plantsDynamichipscrew(DHS)-IntertrochantericfractureCondylarblade-plate-InterochantericfractureT-plate-CondylarfractureoffemurSpoonplatetibia-CondyarfractureoftibiaCobraplate-FractureofloweraendofHiparthrodesis
233.A20yearoldmalepresentswithhistory ofgradualonsetpainandswellinginleftkneesince6months.Nowsincelast1monthpatienthasstartedlimpingwhilewalkingandalsohasflexiondeformityofknee.Ultrasonographyshowspresenceofsynovialthickening.Whatisthemostprobablediagnosis? a)Tuberculosisofknee b)Pigmentedvillonodularsynovitis c)Synovialsarcoma d)Hemarthrosis CorrectAnswer-AAnswer-A.TuberculosisofkneeUnilateralmonoarticularkneeinvolvementwithgradualonsetpainswellingandflexiondeformity,withsynovialthickeningismostprobablysuggestiveoftuberculosisofknee.Presentingcomplaints:Thepatient,usuallyintheagegroupof10-25years,presentswithcomplaintsofpainandswellinginthekneeOnExamination: 1. Swelling:Thejointisswollen,whichmaybeduetosynovial hypertrophyoreffusion. 2. Muscleatrophy3. Coldabscess
4. Sinus5. Deformity6. Themovementsatthejointarelimited
234.Lockingcompressionplatingforis commonlyindicatedinthefollowingfracturetypes a)Periarticularfractures b)Transverseorobliquefracturesoflongbones c)Intertrochantericfractures d)Fractureoflongbones CorrectAnswer-AAnswer-A.PeriarticularfracturesLockingcompressionplatesarecommonlyusedinperiarticularfractures
235.Tuberculosisofspinemostcommonly affectswhichvertebralsegment? a)Upperdorsal b)Lowerdorsal c)Lumbar d)Cervical CorrectAnswer-BAnswer-B.LowerdorsalThespineisthecommonestsiteofboneandjointtuberculosis.ThemostcommonsiteisDorsolumbarregion.Lowerdorsal(thoracic)regionisthemostcommonsegmentinvolvedfollowedbylumbarsegment.Thetuberculosisofspineisalsocalledpott'sdiseaseortubercularspondylytis.
236.Dunloptractionisatypeoftractionused inmanagementof a)Fracturehumerus b)Fractureradius c)Fracturefemur d)FractureTibia CorrectAnswer-AAnswer-A.FracturehumerusItisusedinmanagementoffracturehumerus.Itisaskintractionappliedtothearmwiththechildsupine.Tractionstrapsareappliedtotheforearmwiththearmsupinated.Acounterweightishungfromtheupperpartofthearmtohelppulltheproximalfragmentofthehumerusposteriorly,toapproximatethedistalfragment.Longitudinaltractionisthenappliedtothesupinatedforearmwiththeelbowflexedtoabout45degrees
237.Whichofthefollowingisnottrueabout themanagementofpottsparaplegia? a)Chemotherapyisthemainstayofconservativemanagement b)Paraplegianotimprovingwithconservativetreatmentevenafter 3-6monthsisanindicationforoperativeintervention c)Decompressionviaanterolateralapproachismostpreferred d)Posteriorfusionandinstrumentationcanbeusedtocorrectthe deformity CorrectAnswer-CAnswer-C.DecompressionviaanterolateralapproachismostpreferredThefollowingmeasuresareadoptedinthetreatmentofPott'sparaplegia:1)ConservativetreatmentChemotherapy(ATTs)isthemainstayofconservativetreatment.Immobilizationbytraction(incervicalspine)orbrace(indorsalregion).Physiotherapyofparalysedlimb.2)Surgicaltreatment 1. Followingarethemainindicationsforsurgery.2. Failedconservativetreatment:-Paraplegiadoesnotshow improvementbyconservativetreatmentevenafter3-6months. 3. Patientdevelopsparaplegiawhileonconservativetreatment.4. Paraplegiagettingworsedespiteadequateconservativetreatment.5. Indoubtfuldiagnosis.6. Rapidonsetparaplegia7. Recurrenceofparaplegiaafterimprovementinitialy. OperativeprocedureforPott'sparaplegia
Therearevariousprocedures,themostcommonlyusedprocedureisanteriordecompressionbysurgicaldebridement(removaldead,necrotic&caseousmaterial)followedbyautogenousstrutgrafting.Thelogiciswellunderstood;thecompressionisfromanteriorsidemostofthetimebecausetuberculosisoccursinvertebralbodywhichliesanteriortothespinalcord.So,anteriordecompressionisthebestprocedure.Anteriordecompressioncanbecausedby: 1. Anteriorapproach:-Calledanteriordecompression.Itisthemost preferredprocedure. 2. Anterolateralapproach:-Calledanterolateraldecompression. Othersurgicalprocedures(otherthananteriordecompression)are: 1. Costo-transversectomy2. Posteriorfusionandinstrumentationtocorrectkyphoticdeformity.3. Laminectomy
238.Firstradiologicalsignforactive tuberculararthritisis- a)Localizedosteoporosis b)Sclerosis c)Jointspacereduction d)Osteophytes CorrectAnswer-AAnswer-A.LocalizedosteoporosisIntuberculararthritis,localizedosteoporosisisthefirstradiologicalsignofactivedisease.
239.33yroldfemalepresentswithaslow growingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasion.Whatistheusualtreatmentforthesame? a)Localresection b)Amputaion c)Chemotherapy d)Radiotherapy CorrectAnswer-AAnswer-A.LocalresectionSlowgrowingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasioninanindividualinthe3rdorLIthdecadeoflifeissuggestiveof-parostealosteosarcoma.Localresectionofthelesionistheusualtreatmentforparostealosteosarcoma.
240.Whichisintramendullarytumoramong carcinomaofbone- a)ClassicalOsteosarcoma b)Parostealosteosarcoma c)Periostealosteosarcoma d)Noneoftheabove CorrectAnswer-AAnswer-A.ClassicalOsteosarcomaInitsclassic(intramedullary)form,osteosarcomaisahighlymalignanttumorarisingwithintheboneandspreadingrapidlyoutwardstotheperiosteumandsurroundingsofttissue.Thetumormostcommonlybeginsinthemetaphysis.Osteosarcomaarisesfromprimitivebone-formingcells.Tumordestroysthebonestructureandeventuallyburstsintothesurroundingsofttissues.
241.Agegroupaffectedbyosteosarcoma- a)Upto10years b)10-20years c)30-40years d)Olderthan45years CorrectAnswer-BAnswer-B.10-20yearsOsteogenicsarcomaisthemostcommonprimarymalignanttumorofboneinchildren.Thisispredominantlyatumorofchildhoodoradolescence,occuringmostcommonlyinthe10-25years.Themostcommonsiteofinvolvementismetaphysisoflongbonearoundknee:-Lowerendoffemur(45%)UpperendofTibia(25%)
242.Anklereflexisaffectedinprolapsed intervertebraldiscatwhatlevel? a)L3-L4 b)L4-L5 c)L5-S1 d)S1-S2 CorrectAnswer-CAnswer-C.L5-S1S1root-Weaknessofplantarflexorsofroot-Overlateralsideoffoot
243.CTEVshoetrueis a)Itisthesameasnormalshoe b)Ithasstraightmedialborder c)Ithasmedicalshoeraise d)Ithasheelwithextralength CorrectAnswer-BAnswer-B.IthasstraightmedialborderIthasstraightinner(medial)borderwhichhelpspreventforefootadduction.Ithasoutershoeraisewhichhelpspreventforefootinversion.Thereisnoheelwhichhelpspreventequinus.
244.Mostcommonlylesionassociatedwith pathologicalfractureinhandis- a)Enchondroma b)Metastases c)Osteoidosteoma d)Osteochondroma CorrectAnswer-AAnswer-A.EnchondromaInhandpathologicalfracturesaremostcommonlyassociatedwithbenignbonetumors.About23%ofthebonetumorsinhandpresentwithpathologicalfractures.Theaverageageofpresentationis37years.Themostcommonboneaffectedistheproximalphalynx,thefifthraywasinvolvedin44%ofthepatients.Majority(approximately88%)ofthepathologicalfracturesarecausedbyenchondromas.
245.Allarefeaturesofinflammatoryarthritis except? a)Morningstiffness b)X-rayshowingsclerosis c)ElevatedESR d)Weightgain CorrectAnswer-BAnswer-B.X-rayshowingsclerosisX-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-rayfeaturesinnon-inflammatoryarthritisrevealssclerosis.
246.AllaretrueaboutMarie-strumpell diseaseexcept: a)Mostcommonlyinvolvesthesacro-iliacjoints b)Enhesitisiscommon c)Morecommoninmales d)Roentgenogramisthemostsensitiveinvestigation CorrectAnswer-DAnswer-D.RoentgenogramisthemostsensitiveinvestigationMarie--StrumpelldiseaseisalsoknownasAnkylosingSpondylitisIntheearlydiseaseprocess,plainx-rays(Roentgenogram)maybereadasnormal-->notverysensitive.Ankylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Itismorecommoninmales(maletofemaleratio2-3:1)
247.Whichofthefollowingisnottrueabout thetestsforhipinstabilityinneonates? a)Ortolanistesthastwoparts b)Theyareperformedat2-3daysofbirth c)Inortolanistestexaminersfingersrestonthegreatertrochanter d)Inbarlowstestexaminersthumbisplacedinthegroin CorrectAnswer-AAnswer-A.OrtolanistesthastwopartsInOrtolani'stest,thebaby'sthighsareheldwiththethumbsmediallyandthefingersrestingonthegreatertrochanters;thehipsareflexedto90degreesandgentlyabducted.Normallythereissmoothabductiontoalmost90degrees.Incongenitaldislocationthemovementisusuallyimpeded,butifpressureisappliedtothegreatertrochanterthereisasoft'clunk'asthedislocationreduces,andthenthehipabductsfully(the'jerkofentry').Ifabductionstopshalfwayandthereisnojerkofentry,theremaybeanirreducibledislocation.
248.Oncogenicosteomalaciaismediatedby a)Phosphatonin b)Calcitonin c)Interleukin2 d)Interleukin6 CorrectAnswer-AAnswer-A.PhosphatoninOncogenicosteomalaciaismediatedbyphosphatoninincertaintumors,particularlyvasculartumourslikehemangiopericytomasandalsofibrohistocyticlesions
249.Whichofthefollowingis/arefeature/sof sprengelsdeformity? a)Elevatedshoulderonaffectedside b)Smallerthanusualscapula c)Shortneck d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveSprengel'sdeformity:Deformityistheonlysymptomanditmaybenoticedatbirth.Theshoulderontheaffectedsideiselevated;thescapulalooksandfeelsabnormallyhigh,smallerthanusualandsomewhatprominent;occasionallybothscapulaeareaffected.
250.Whichofthefollowingistrueabout CTEV a)Itismorecommoninfemales b)Rightfootisusuallymoreaffectedthantheleft c)Talusisdisplacedmedialandplantarwards d)Tibiausuallyshowslateraltorsion CorrectAnswer-CAnswer-C.TalusisdisplacedmedialandplantarwardsCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.CTEVismorecommonmalesinthaninfemales(malestofemaleratio2.5:1).InhalfofthecasesCTEVisbilateral.Rightandleftfootareaffectedequally.
251.Whichofthefollowingisnottrueabout themanipulationmethodstocorrectCTEV? a)Involvesserialcastingandbelowkneeplastercasting b)Inkitesmethoddeformitiesarecorrectedsequentially adductioninversionequinus c)Ponseti'stechniquehassuccessrateof90-98% d)Ponseti'smethodofcorrectioninvolvescavus-->adduction--> heelvarus-->equinus CorrectAnswer-AAnswer-A.InvolvesserialcastingandbelowkneeplastercastingSerialmanipulationandabovekneeplastercastingisdoneweeklyforthefirst6weeks.Otheroptionsarecorrect.
252.Psoriaticarthritismostcommonly involveswhichjoint- a)Distalinterphalangealjoint b)Proximalinterphalangealjoint c)Wristjoint d)Metacarpophalangealjoint CorrectAnswer-AAnswer-A.DistalinterphalangealjointTheseinclude: 1. Arthritisofdistalinterphalangeal(DIP)joints2. Assymetricaloligoarthritis:Mostcommonpattern3. SymmetricalpolyarthritissimilartoRA4. Axialinvolvement(sacroiliacandspine)similartoankylosing spondylitis 5. Arthritismultilans
253.Whichofthefollowingisthe managementforneglectedcaseofCTEVinapatient>10yearsofage? a)Triplearthrodesis b)Anklearthrodesis c)Jessfixation d)Ponseticasting CorrectAnswer-AAnswer-A.Triplearthrodesis*Alltheserequiresurgicalcorrectionandthesurgerydependsupontheageofthepatient.-<4yearsofage:-Postero-medialsofttissuerelease->4years:-Postero-medialsofttissuereleasewithabonyprocedure:-*4-8years:-Dilwyn-Evansprocedure(PMR+Calcaneo-cuboidfusion)*8-10years:-PMR+Wedgetarsectomy*>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,andtalonavicularjoints)
254.Whichofthefollowingisnottrueabout SCFE? a)Malesareaffectedmorefrequently b)Extensionisrestricted c)Commonlyoccursduringadolescence d)Varus,adductionandexternalrotationdeformitiesarepresent CorrectAnswer-BAnswer-B.ExtensionisrestrictedSCFEistheseparationofproximalfemoralcapitalepiphysis(head)atgrowthplate.SCFEoccursduetoweaknessofgrowthplateandoccursduringadolescentperiod(11-15years)whenthegrowthplateisweakduetoacceleratedgrowth.Malesareaffectedmorefrequentlythanfemales.Movementsarerestrictedparticularlyabductionandinternalrotation.Flexionisalsorestrictedandextensionisincreased.AndthisclinicalfeaturedifferentiatesSCFEwithallotherhippathologiesbecausemostofthehippathologieshaveoppositedeformity,i.e.flexiondeformitywithrestrictedextension.Varus,adductionandexternalrotationdeformitiesarepresent.Externalrotationisincreasedalongwithextension.Whenhipisflexeditgoesintoexternalrotation,i.e.obligatoryexternalrotation.ItisaveryimportantsignofSCFE.Waddlinggaitispresent.Trendelenburg'stestispositive.
255.Genurecurvatumisseenin- a)Rheumatoidarthritis b)Poliomyelitis c)Rickets d)Alltheabove CorrectAnswer-DAnswer-D.Alltheabovea)CongenitalrecurvatumThismaybeduetoabnormalintra-uterineposture;itusuallyrecoversspontaneously.Rarely,grosshyperextensionistheprecursoroftruecongenitaldislocationoftheknee.b)LaxligamentsNormalpeoplewithgeneralizedjointlaxitytendtostandwiththeirkneesbackset.Prolongedtraction,especiallyonaframe,orholdingthekneehyperextendedinplaster,mayoverstretchligaments,leadingtopermanenthyperextensiondeformity.Ligamentsmayalsobecomeoverstretchedfollowingchronicorrecurrentsynovitis(especiallyinrheumatoidarthritis),thehypotoniaofrickets,theflailnessofpoliomyelitisortheinsensitivityofCharcot'sdisease.
256.Calcificationinosteosarcomaisdueto presenceof a)Osteoidmatrix b)Osteoblasts c)Highcalciumlevelsinserum d)Highcalcitonin CorrectAnswer-AAnswer-A.OsteoidmatrixThepatternofmineralization(calcification)onradiographmaybehelpfulinidentifyingtumormatrix.Dense,homogenousmineralization(calcification)istypicalofosteoidmatrix,formedbybenignandmalignantbone-forminglesionsCalcifiedringsandarcs,densepunctatecalcification,andflocculentcalcification(small,looselyaggregatedmasses)arepatternofmineralizationofchondroidmatrix,formedbybenignandmalignantcartilageformingtumors.
257.Osteoclastshaveallofthefollowing except- a)Boneresorption b)Receptorforparathormone c)Ruffledborder d)RANKligand CorrectAnswer-BAnswer-B.ReceptorforparathormoneOsteoclastsarefoundinsitesinwhichboneisbeingremodeledThesecellsaretheprincipalmediatorofboneresorptionThecharacteristicfeatureistheareaofinfoldedplasmamembraneknownasruffledborderwhichissurroundedbyanorganellefreeclearzonethroughwhichosteoclastattachestobone&whichisthesiteofboneresorption.RANKbindstoRANKLigandwhichstimulatesboneresorption.Parathormonearepresentonosteoblasts(notonosteoclasts).
258.PTHactsdirectlyonwhichcells? a)Osteoclasts b)Osteocytes c)Osteoblasts d)Macrophages CorrectAnswer-CAnswer-C.OsteoblastsParathormoneactivatesosteoblastswhichthensecretemediatorsofosteoclastogenesisthatstimulateosteoclastsforboneresorption.
259.Mostvascularzoneoftheboneis- a)Metaphysis b)Diaphysis c)Epiphysis d)MedullaryCavity CorrectAnswer-AAnswer-A.MetaphysisMetaphysisisthemostvascularzoneoftheboneespeciallyinchildrenasithaslonghairpinlooparrangedarteriolesandvenulesrunningthroughit.
260.Snappingkneesyndromeisdueto involvementof- a)PesAnserinus b)QuadriepsTendon c)Gastrocnemiusorigin d)lateralcollateralligament CorrectAnswer-AAnswer-A.PesAnserinusSnappingkneesyndromeischaracterizedbypainfulclicks/catchingsensationsexperiencedduringeverymovementofflexionandextension.Itisexperiencedusuallyattheposteromedialcornerofthekneeandususallyisduetoinvolvementofsemitendinosusandgracilistendons.
261.FlexorDigitorumProfundustendon avulsioninjuryleadsto- a)JerseyFinger b)MalletFinger c)GamekeepersThumb d)BoutonierreDeformity CorrectAnswer-AAnswer-A.JerseyFingerJerseyFinger-FlexordigitorumprofundusInjuryMalletFinger-AvulsioninjuryofextensordigitorumtendonGamekeepersThumb-chronicinjurytoulnarcollateralligamentofthumbBennetsFracture-Intraarticularfractureatthebaseof1stmetacarpal
262.Knailcanbeusedforallofthefollowing fracturesexcePt- a)Isthmicfemurshaftfractures b)Intertrochantericfractures c)Lowsubtrochantericfractures d)Distalfemurshaftfractures CorrectAnswer-BAnswer-B.IntertrochantericfracturesKnailisacloverleafshapednailthatreliesontheprincipleofthreepointfixationKnailcanneverbeusedforintertrochantericfracturesasitcannotprovidestabilityinthisfracture.
263.ExtensorCarpiRadialisLongusis- a)Extensorandulnardeviatorofthewrist b)ExtensorandradialDeviatorofthewrist c)InjuredinPosteriorinterosseusnerveinjury d)Weakextensorofthewrist CorrectAnswer-BAnswer-B.ExtensorandradialDeviatorofthewristExtensorcarpiRadialisLongusisaprimaryextensorandradialdeviatorofthewrist.Lossoffunctioncauseswristdrop.
264.Achildpresentedtoanorthopaedic clinicwithalimp.Thesurgeonsuspectedhimtohaveafixedfledondeformityofthehip.Whichtestshouldthesurgeonperformtoconfirmhisfinding? a)Thomastest b)Trendelenburgstest c)Nelatonstest d)Telescopingtest CorrectAnswer-AAnswer-A.ThomastestThomastestisdoneforflexiondeformityofhip.
265.TriggerFingerInvolvesWhichjoint? a)ProximalInterphalngealjoint b)DistalInterphalngealfoint c)Metacarpophalangealjoint d)Carpometacarpaljoint CorrectAnswer-CAnswer-C.MetacarpophalangealjointThemouthofthefibrousdigitalsheathisatthelevelofmetacarpo-phalangealjoint.
266.Effectofhypoparathyroidisrnonbones include- a)Browntumours b)SubperiostealResorptionofBone c)MultipleCystsinBone d)NoneoftheAbove CorrectAnswer-DAnswer-D.NoneoftheAboveFeaturesofHypoparathyroidismPrematureclosureofepiphysesGeneralizedincreaseinbonedensity(Osteosclerosis)CalvarialthickeningSacroiliacsclerosisBandlikedensityinmetaphysicThickenedlaminadura+wideneddiploeDeformedhip(thickening&Sclerosisoffemoralhead&acetabulum)IntracranialcalcificationCalcificationofspinal&OtherligamentsSubcutaneouscalcificationEctopicboneformationOssificationofmuscleinsertions
267.Bonetransportcanbeusedinthe managementof- a)Gapnonunion b)DeformityCorrection c)Communitedshaftfemurfracture d)AvscularNecrosisofFemoralHead CorrectAnswer-AAnswer-A.GapnonunionBonetransporttechniqueisprimarilyusedinthemanagementofgapnonunions.Anosteotomyismadeinthenormalboneandasegamntofboneistransportedtothenonunionsite
268.AIIofthefollowingaretrueregarding applicationofPOPCastexcept- a)PuttingthePlasterrollinwarmwaterhastenssettingtime b)ItisanhydrousCalciumphosphate c)Itcanappliedinpresenceofextremeswelling d)Gangreneisknowncomplicationofatightplastercast CorrectAnswer-BAnswerB.ItisanhydrousCalciumphosphatePOPischemicallyhemihydrouscalciumsulphate.Warmwaterhastenswhilecoldwaterslowsthesettingtime.Plastercastshouldbeavoidedwhenthereisextremeswelling.Commoncomplicationsofplastercastsincludecompartmentsyndrome,gangreneandplastersores.
269.Inuncementedarthroplastyofthehip, thestemremainsattachedtotheboneby- a)BoneIngrowth/ongrowthoverthesurfaceofthestem b)Mechanicalbondingbetweenthestemandbone c)Pressfittingofthesteminthetightcanal d)Adhesionbetweenthestemandboneduetoashesive propertiesofthestem CorrectAnswer-AAnswer-A.BoneIngrowth/ongrowthoverthesurfaceofthestemBoneingrowth-Overporoussurface.Optimalporesizeshouldbe100to400microns.Fibermeshorbeadsarepresentoverthestemsurface.Stemcreatedbysinteringordiffusionbondingprocesses.
270.Duringperfomingatotalhip replacement,thesurgeonfounddestructionofthearticularcartilageandrnultiplewedgeshapedsubchondraldepressions.Whatisthiscalled? a)Osteolysis b)Osteomyelitis c)Osteonecrosis d)Osteogenesis CorrectAnswer-CAnswer-C.OsteonecrosisPresenceofdensewedgeshapedopacitiesintheanterolateralquadrantofthefemoralheadthisiscalledsectoralinvolvement.PresenceofmultiplecysticandscleroticareasAcetabularinvolvementleadstodevelopmentofseverearthritis
271.Suddendorsiflexionoffootmayleadto whichofthefollowinginjuries- a)Anteriortalofibularligamentinjury b)TendoAchillesavulsioninjury c)Ruptureofdeltoidligament d)Tarsaltunnelsyndrome CorrectAnswer-BAnswer-B.TendoAchillesavulsioninjuryAruptureoftheAchillestendonoccurswhenthetendonisstretchedoutsidebeyonditscapacity.Themostcommonsiteofruptureisthe"watershed"lessvascularareaoftendon,whichis4cmproximaltoitsinsertiononcalcaneum.
272.SalterHarrisclassificationisusedfor- a)Supracondylarhumerusfracturesinchildren b)Estimationofgrowthofthephyses c)Physealinjuries d)Severityofdeglovinginjuriestothelimb CorrectAnswer-CAnswer-C.Physealinjuries
273.MilwaukeeBraceisusedin- a)CongenitalKyphosis b)ScheurmannsDisease c)AdolescentldiopathicScoliosis d)Spondylolisthesis CorrectAnswer-AAnswer-A.CongenitalKyphosisTheMilwaukeebraceisaplasticbodyjacketusedinthetreatmentofadolescentswithidiopathicscoliosisandScheuermann'sdisease.TheMilwaukeebrace,alsorefferredtoasaCervico-Thoraco-Lumbo-Sacral-Orthosisbrace,issimilartobracesforthelowerback,butalsoincludesaneckringheldinplacebyverticalbarsattachedtothebodyofthebrace.
274.VertebraPlanaisseeninallexcept- a)HistioctosisX b)Leukemia c)Excessiveuseofsystemicsteroids d)ScheurmannsDisease CorrectAnswer-DAnswer-D.ScheurmannsDiseaseCausesofVertebraPlana 1. Histocytosis-X(Eosinophilicgranuloma)2. Leukemia3. TB4. Metastasis,Multiplemyeloma,Ewing'ssarcoma,lymphoma5. Osteochondritisofvertebralbody(Calve'sdisease)6. Hemangioma7. Trauma8. Steroids
275.Whatisluxatioerecta? a)AnteriorDislocationoftheshoulderjoint b)InferiorDislocationoftheshoulderjoint c)AnteriorDislocationoftheHIPjoint d)PosteriorDislocationofHipjoint CorrectAnswer-BAnswer-B.InferiorDislocationoftheshoulderjointTheheadofthehumerusisbelowtheglenoidcavityandthehumeralshaftispointingoverhead.Itisduetohyperabductioninjury.Itisrareandalsocalledluxatioerectabecausethehumeralheadissubluxated(dislocatedinferiorly)andhumerusshaftpointsupwards(erected).
276.Whichofthefollowingcasts/splintsis usedforfractureshafthumerus? a)Hangingcasts b)Knucklebendersplint c)AeroplaneSplint d)Aboveelbowcast CorrectAnswer-AAnswer-A.HangingcastsHangingcast-FractureofthehumerusTurn-bucklecast-Scoliosis
277.Threepointbonyrelationshipofthe elbowisdisturbedin- a)SupracondylarFractureofthehumerus b)Fracturelateralcondyleofthehumerus c)MonteggiaFracturedislocation d)FractureofProximalRadius CorrectAnswer-BAnswer-B.FracturelateralcondyleofthehumerusThreeprominentbonypointsaroundelbowaremedialepicondyle,lateralepicondyleandtipoftheolecranon.Inelbowinjuries,followingisseeninthreebonyrelationship: 1. Maintained2. Disturbed
278.HamiltonRulertestsignispositivein whichoftheabovementionedconditions? a)Anteriordislocationofshoulder b)Acrornioclavivularjointdislocation c)Posteriordislocationofshoulder d)luxatioerecta CorrectAnswer-AAnswer-A.AnteriordislocationofshoulderHamiltonrulertest:Becauseofflatteningofshoulder,itispossibletoplacearuleronthelateralsideofarmandittouchesacromian&lateralcondyleofhumerussimultaneously(innormalitwouldnotduetoshouldercontour).
279.CubitusValgusDeformityiscommonly seeninwhichofthefollowingconditions- a)MalunitedLateralCondylarfractureofHumerus b)MalunitedSupracondylarFractureofHumerus c)Posteriordislocationofelbow d)Fracturemedialcondyleofhumerus CorrectAnswer-AAnswer-A.MalunitedLateralCondylarfractureofHumerusFracturescommonlyshowingcubitusvalgusdeformityduetomalunion:FracturelateralcondylehumerusMonteggiaFractureDislocation
280.AVNfollowingtranscervicalneckfemur fracturesoccursduetodamagetowhichofthefollowingbloodvessels? a)Lateralretinacularbranchoflateralcircumflexfemoralartery b)Lateralretinacularbranchofmedialcircumflexfemoralartery c)Medialretinacularbranchoflateralcircumflexfemoralartery d)Obduratorartery CorrectAnswer-AAnswer-A.LateralretinacularbranchoflateralcircumflexfemoralarteryLateralcircumflexfemoralarteryItsuppliesthroughanteriorretinacularartery.
281.Lockingofthekneeinvolves- a)Externalrotationoffemurwiththefootofftheground b)Internalrotationofthetibiawiththefootontheground c)Contractionofpopliteus d)Internalrotationoffemurwithfootontheground CorrectAnswer-DAnswer-D.InternalrotationoffemurwithfootonthegroundPhysiologicallockingoccursinextensionwhenthefemurisinternally(medially)rotatedonafixedtibia.Lockingisamechanismthatallowsthekneetoremaininthepositionoffullextensionasinstandingwithoutmuchmusculareffortsandiscausedbyquadricepsfemoris.
282.Fractureneckoffemurin80yearold malesustained1weekbackThetreatmentofchoiceis- a)Hemiarthroplasty b)ExcisionarthroPlastY c)Closedreductionandfixationwiththreecancellousscrews d)Longitudinalskintractionfor6weeks CorrectAnswer-AAnswer-A.HemiarthroplastyClosedreduction&screwfixationIf2attemptsofclosedreductionfail,hemiarthroplastyisdone
283.Whichofthefollowingfracturesofthe neckoffemurareassociatedwithmaximalcompromiseinbloodsupply? a)Intertrochantericfractures b)Basicervicalfracture c)Transcervicalfracture d)SubCapitalfractures CorrectAnswer-DAnswer-D.SubCapitalfracturesThenon-unionandAVNwillbemostcommoninsubcapitalfractureandleastinbasicervicalfracture.
284.Tinelssignisseenin- a)AvascularnecrosisofscaPhoid b)KienbocksDisease c)lstcarpometacarpaljointarthritis d)Carpaltunnelsyndrome CorrectAnswer-DAnswer-D.CarpaltunnelsyndromeMediannervepercussiontest(Tinel'ssign):-Themediannerveisgentlytappedatthewrist.Thetestispositiveifthereistinglingsensation
285.Whichofthefollowingisusedasa substituteforwristextensorsinradialnervePalsY? a)PronatorTeres b)PalmarisLongus c)FlexorDigitorumSuPerficialis d)FlexorDigitorumProfundus CorrectAnswer-AAnswer-A.PronatorTeresPronatorteresisacommonmuscleusedasasubstituteforwristextensorsincaseofwristdropoccurringasaresultofradialnervepalsy.PronatorteresisapronatoroftheforearmsuppliedbyMediannerve.
286.Mostcommoncauseofca4raltunnel syndromeis? a)Pregnancy b)Idiopathic c)Alcoholism d)Occupational-Excessiveuseofvibratoryinstruments CorrectAnswer-BAnswer-B.IdiopathicMostcommontypeofcarpaltunnelsyndromeisidiopathicnoknowncause.
287.A45yearoldcarpenterwithablunt traumatohisarmsustainedafracturefollowingwhichhedevelopedwristdrop,lossofextensionatfingersandlossofsensationsonthelateralaspectofthewristjoint.Whichofthefollowingistrue? a)Patienthasaninjurytothemediannerve b)Heshouldhavealsolostextentionoftheforearm c)Patienthasinjuredtheradialnerveinthespirdgroove d)Thereiscombinedinvolvementoftheradialnerveandmedian nerve CorrectAnswer-CAnswer-C.PatienthasinjuredtheradialnerveinthespirdgrooveRadialnerveinjurymaybehighorlow.1)HighradialnervepalsyInjuryisbeforethespiralgrooveAllmusclessuppliedbyradialnerveareparalysed2)IflesionishighWristdrop,thumbdropandfingerdrop.Inabilitytoextendelbow,wrist,thumb&fingers(MPjoint)Patientcanextendinterphalangealjointsduetoactionoflumbricalsandinterossei.Sensorylossoverposteriorsurfaceofarm&forearmandlowerlateralhalfofforearm.
288.Inwhichofthefollowingdeformitiesis thedistalinterphalangealjointextended? a)Boutonnieredeformity b)Swanneckdeformity c)Zdeforrnity d)ClawHand CorrectAnswer-AAnswer-A.BoutonnieredeformityBoutonnieredeformity:FlexioncontractureofPIPjointandextensionofDIPjoint.
289.Clubfootclinicallypresentaswhat deformity? a)Calcaneovalgus b)Equinovarus c)EquinoCavovarus d)Calcaneovarus CorrectAnswer-CAnswer-C.EquinoCavovarusCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.Thedeformityconsistsoffollowingelements: 1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)2. Inversionoffootatsubtalarjoint(talocalcanealjoint)3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular joint. 4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid- tarsaljoints
290.4yearoldchildpresentedtotheclinic withahistoryoffallonoutstretchedhand.RadiographsrevealedabrokenanteriorcortexwithanintactposteriorcortexOftheradiuswithanexaggeratedbowingoftheradius.Thefracturesustainedisknownas- a)TorusFracture b)Greenstickfracture c)GalleaziFracture d)MonteggiaFrtactureDislocation CorrectAnswer-BAnswer-B.GreenstickfractureGreenstickFracture:Incompletefractureofthebonewithplasticdeformationontheconcavesideofthebone.Thefractureneedstobecompletedtoobtainreduction.
291.Greenstick/Nightstickfracturesareseen in- a)Children b)Elderly c)Youngadults d)Commoninallagegroups CorrectAnswer-AAnswer-A.Children
292.WhodevisedcorrectionofCTEVby serialcastinga- a)IgnasioPonseti b)GerhardtKuntscher c)GavrilIlizarov d)HughOwenThomas CorrectAnswer-AAnswer-A.IgnasioPonsetiIgnasioPonsetipropoundedthetechniqueofserialweeklycasts.
293.Osteosclerosisisafeatureofwhichof thefollowinga- a)Rickets b)Hyperparathyroidism c)PagetsDisease d)OsteogenesisImperfecta CorrectAnswer-CAnswer-C.PagetsDiseasePaget'sdiseaseischaracterizedbyincreasedboneturnoverandenlargementandthickeningofthebone,buttheinternalarchitectureisabnormalandtheboneisusuallybrittle.Primarydefectisinosteoclastswithincreasedosteoclasticactivity.Thisresultssecondarilyincreaseinosteoblasticactivity(normalosteoclastsandosteoblastsactinaco-ordinatedmanner).
294.Allofthefollowingaretrueregarding PagetsDiseaseexcept- a)Pelvisisthemostcommonsite b)Cranialnerveinvolvementmaybeseen c)Highoutputcardiacfailureisoneofthecomplications d)Itmayprogresstoasecondarychondrosarcoma CorrectAnswer-DAnswer-D.ItmayprogresstoasecondarychondrosarcomaPagetsdiseasemayprogresstoasecondaryosteosarcomanotchondrosarcoma
295.Commonestsiteofoccurrenceof chondrosarcomais- a)Pelvis b)Ribs c)Femur d)Proximaltibia CorrectAnswer-AAnswer-A.PelvisAchondrosarcomaisamalignanttumorderivedfromcartilagecellsandittendstomaintainitscartilaginouscharacterthroughoutitsevolutionMostcommonlyinvolvedbonesarepelvis(mostcommon),femur(2ndmostcommon),humerus,ribsandshouldergirdles.Itmaybeatmetaphysisordiaphysis.
296.OnionpeelappearanaceonXrayisseen inwhichofthefollowingconditions? a)EwingsSarcoma b)Osteosarcoma c)Giantcelltumour d)Eosinophilicgranuloma CorrectAnswer-AAnswer-A.EwingsSarcoma OnionPeelAppearance EwingsSarcomaCodmansTriangle Osteosarcoma SunBurstAppearance Osteosarcoma SoapBubbleappearance GCT
297.Hammertoedeformityisseenin- a)Rheumatoidarthritis b)Fracturedistalphalanxofgreattoe c)Bunion d)Osteochondritis CorrectAnswer-AAnswer-A.RheumatoidarthritisFootHalluxvalgus,Hammertoe,etc.
298.Pionfractureis a)Bimalleolar b)Trimalleolar c)DistalfemurIntraarticular d)DistaltibiaIntraarticular CorrectAnswer-DAnswer-D.DistaltibiaIntraarticularPilonfracture-Comminutedintra-articularfractureofdistaltibialend
299.Latecomplicationofelbowdislocation a)Mediannerveinjury b)Brachialarteryinjury c)Myositisossificans d)Alloftheabove CorrectAnswer-CAnswer-C.MyositisossificansLatecomplicationsStiffnessMyositisossificansUnreduceddislocationRecurrentdislocation
300.Whicharthritiscausesnoperiosteal reaction a)Psoriaticathritis b)Reactivearthritis c)Neropathicarthritis d)Rheumatoidarthritis CorrectAnswer-DAnswer-D.RheumatoidarthritisArthritiswithPeriostealReactionarePsoriaticarthritis,ReactiveArthritisAndNeuropathicArthropathy.
301.Proximalhumerusfracturewhichhas maximumchancesofavascularnecrosis a)Onepart b)Twopart c)Threepart d)Fourpart CorrectAnswer-DAnswer-D.FourpartNeer'sclassifiedproximalhumerusfractureinto4types,basedonthesefoursegments:1.Onepartfracture:-Fracturewithminimaldisplacement.2.Twopartfracture:-Onesegmentisdisplacedinrelationtoother.Importanttwopartfracturesare:(i)surgicalneckfracture(mostcommon)(ii)GTfracture,(iii)LTfracture,(iv)anatomicalneckfracture.3.Threepartfracture:-Twosegmentsaredisplacedinrelationtoothertwo.4.Fourpartfracture:-Allfourmajorfragmentsaredisplaced.ChancesofAVNofhumeralheadarehigherinfourpartfracture.
302.Mostcommonmuscledamagedin rotatorcuff a)Supraspinatus b)Infraspinatus c)Subscapularis d)Teresminor CorrectAnswer-AAnswer-A.SupraspinatusDuringinjurytorotatorcuff,tendonsareaffected,notthemuscle.Supraspinatustendonisaffectedmostfrequently.
303.Trueaboutsupracondylarfractureof humerus a)Commoninadults b)Extensiontypemostcommon c)Flexiontypeismostcommon d)None CorrectAnswer-BAnswer-B.ExtensiontypemostcommonSupracondylarhumeralfracturesarethemostcommonelbowfracturesinchildren.Mostcommonagegroupaffectedis5-8years.Boysareaffectedmorethangirls.Leftsideismorecommonthanright.Extensiontypeismostcommon
304.Whatisseenonx-raywithposterior elbowdislocation a)Coronoidprocessposteriortohumerus b)Coronoidprocessanteriortohumerus c)Coronoidprocessbelowhumerus d)None CorrectAnswer-AAnswer-A.CoronoidprocessposteriortohumerusAPview:Greatersuperimpositionofdistalhumeruswithproximalulnaandolecranon(normally,onlyterminalpartofhumerusissuperimposed).
305.
Inposteriordislocationofelbow,mostprominentpart a)Coronoid b)Radialhead c)Olecranon d)None CorrectAnswer-CAnswer-C.OlecranonThereisexaggratedprominenceoftheOlecranon
306.Mostcommoncomplicationoflateral condylehumerusfracture a)Malunion b)Nonunion c)VIC d)Mediannerveinjury CorrectAnswer-BAnswer-B.NonunionLateralspur(Lateralcondylarspurorlateralcondylarovergrowth)isoneofthemostcommoncomplication.Delayedunionornon-unioncanoccuriffractureisundetectedorleftuntreated.CubitusvalgusisacommoncomplicationTardyulnarnervepalsyseenafterseveralyears.Rarelyavascularnecrosisandmyositisossificans.
307.MostcommoncomplicationofCones# a)Malunion b)Avascularnecrosis c)Fingerstiffness d)RuptureofEPLtendon CorrectAnswer-CAnswer-C.FingerstiffnessThecomplicationrateis55%,withthemostcommoncomplicationbeingsomedegreeofresidualfingerandwriststiffness(39%).Mostcommoncomplicationofcolle'sfracture-Fingerstiffness
308.Mostcommoncomplicationoffracture neckoffemur a)Malunion b)AVN c)Nonunion d)Arthritis CorrectAnswer-BAnswer-B.AVNAVNisthemostcommoncomplicationoffemoralneckfracture.Non-unionisthesecondmostcommoncomplicationoffemoralneckfracture.
309.Whichofthefollowingdescribesgrade2 fractureneckfemur? a)Incompletefracture,medialtrabeculaeintact b)Completefracturewithundisplacedneck c)Completefracturewithischemichead d)Moderatedisplacementofneck,vascularitydamaged CorrectAnswer-BAnswer-B.CompletefracturewithundisplacedneckGardenstageI:undisplacedincomplete,includingvalgusimpactedfracturesmedialgroupoffemoralnecktrabeculaemaydemonstrateagreenstickfractureGardenstageII:undisplacedcompletenodisturbanceofthemedialtrabeculae
310.Treatmentofchoiceforfractureneck femurina40yearsoldfemale a)Multiplescrewfixation b)Bipolarhemiarthroplasty c)THR d)None CorrectAnswer-AAnswer-A.MultiplescrewfixationPlacementofmultiplescrewsacrossthefracturedfemoralneckisthetreatmentofchoiceforfemoralneckfractures,andmaybeperformedfollowingeitherclosedoropenreductionusingastandardlateralapproachoramorelimitedpercutaneoustechnique.
311.Talusissuppliedby a)Anteriortibialartery b)Posteriortibialartery c)Dorsalpedisartery d)All CorrectAnswer-DAnswer-D.AllExtraosseousbloodsupply 1. Posteriortibialartery:-Deltoidbranch,arteryofthetarsalcanal.2. Anteriortibialartery:-SuperiorneckbranchfromDorsalpedisartery, Arteryoftarsalcanal. 3. Paronealartery:-Arteryoftarsalsinus.
312.Posteriorscallopingofvertebraeisnot seen a)Neurofibromatosis b)Astrocytoma c)Aorticaneurysm d)Ependymoma CorrectAnswer-CAnswer-C.AorticaneurysmPosteriorscallopingistheconcavitytotheposterioraspectofthevertebralbody.AnteriorScallopingistheconcavitytotheanterioraspectofthevertebralbody.
313.Incervicalspineinjury,firsttobedone a)Trunhead b)Maintainairway c)Immobilizationofspine d)None CorrectAnswer-BAnswer-B.Maintainairway"Initialcareattheaccidentscenemaybecriticaltosurvival.Thefirststepsaretoestablishanairway,maintainoxygenationandimmobilizethecervicalspine".
314.Inscoliosisdegreeofdeformityis calculatedby a)Cobbsmethod b)Hamburgermethod c)Haldanemethod d)Milwaukeemethod CorrectAnswer-AAnswer-A.CobbsmethodCobbangleisameasurementofthedegreeofside-to-sidespinalcurvature,whichisadeformityyoumayknowasscoliosis.
315.Partialanteriordislocationofone segmentofthespineoveranotheris a)Spondylosis b)Spondylolisthesis c)Kyphosis d)Scoliosis CorrectAnswer-BAnswer-B.SpondylolisthesisDisplacement(partial)ofonevertebraeoverotheriscalledSpondylolisthesis.Spondylolisthesisisadefectintheparsinterarticularis.
316.InEMG/NCVstudy,H.reflexcorrelates with a)L3radiculopathy b)L4radiculopathy c)L5radiculopathy d)SIradiculopathy CorrectAnswer-DAnswer-D.SIradiculopathyH-ReflexhasitsutilityininvestigatingpatientswithS1radiculopathy.
317.Inaxillarynerveparalysis,allthe followingaretrueexcept a)Deltoidmuscleiswasted b)Extensionofshoulderwitharmabductedto90degreesis impossible c)Smallareaofnumbnessispresentovertheshoulderregion d)Patientcannotinitiateabduction CorrectAnswer-DAnswer-D.PatientcannotinitiateabductionInitial15?ofabductioniscausedbysupraspinatuswhichissuppliedbysuprascapularnerve(notaxillarynerve)."Attheinitiationofabductionfromneutralposition,thesupraspinatusismoreimportantthandeltoid,whereasdeltoid(middleportion)isofgreaterimportanceforelevationofarmatthehigherangleofabduction,suchas60?".
318.Carpaltunnelsyndromeallarepresent except a)Ulnarnervedysfunction b)Tinelsign c)Phalenssign d)Pain¶esthesiaofwrist CorrectAnswer-AAnswer-A.UlnarnervedysfunctionThesymptomsoftenfirstappearduringnight,sincemanypeoplesleepwithflexedwrists.(Flexiondecreasesthespaceincarpaltunnelwhichresultsinincreasedpressureovermediannerve).Sensorysymptomscanoftenbereproducedbypercussingovermediannerve(Tina'ssign)orbyholdingthewristfullyflexedforaminute(Phalen'stest).Asthediseaseprogresses,clumsinessofhandandimpairmentofdigitalfunctiondevelop.
319.Fairbanktriangleisseenin a)CDH b)Congenitalcoxavara c)Perthe'sdisease d)SCFE CorrectAnswer-BAnswer-B.CongenitalcoxavaraTheepiphysealplatemaybetoovertical.Theremaybeaseparatetriangleofboneintheinferiorportionofthemetaphysis,calledFairbank'striangle[RefEbnezar4th/ep.410]
320.Dysplastichipinachild,investigationof choice a)X-ray b)MRI c)USG d)CTScan CorrectAnswer-CAnswer-C.USGUltrasonographyistheinvestigationofchoiceforDDH.Itvisualizesthecartilageandallowsdynamictestingofthehipjoint.
321.PrimarypathologyinCDH a)Largeheadoffemur b)Shallowacetabulum c)Excessiveretroversion d)Evertedlimbus CorrectAnswer-BAnswer-B.ShallowacetabulumFollowingchangesareseenindislocatedhip: 1. Thefemoralheadisdislocatedupwardandlaterally.Itsbony nucleusappearslateanditsdevelopmentisretarded,thereforeheadissmall. 2. Femoralneckisexcessivelyanterverted.3. Acetabulumisshallow,withasteepslopingroof(Thisisconsidered tobetheprimarypathology).
322.InneglectedcasesofCTEV,jointfused are a)Calcaneocuboid,talonavicularandtalocalcaneal b)Tibiotalar,calcaneocuboidandtalonavicular c)Anklejoint,calcaneocuboidandtalonavicular d)Noneoftheabove CorrectAnswer-AAnswer-A.Calcaneocuboid,talonavicularandtalocalcanealJointsfusedintriplearthrodesisforCTEVarei)Subtalar(tolocalcaneal)joint,ii)Calcaneocuboidjoint,iii)Tolonavicularjoint.
323.Osteonerosisisseeninallexcept a)Fractureneckfemur b)Sicklecellanemia c)Perthe'sdisease d)Paget'sdisease CorrectAnswer-DAnswer-D.Paget'sdiseaseStoragedisorders:-Gaucher'sdiseaseCaissondisease:-DysbaricosteonecrosisHemoglobinopathy&Coagulationdisorder:-Sickelcelldisease,Familialthrombophilia,Hypofibrinolysis,Hypolipoproteinemia.Congenitaldisorders:-Perthe'sdisease,Slippedcapitalfemoralepiphysis.Hematologicalmalignancies:-Leukemia,lymphoma,Polycythemia.Hyperlipedemia:-Nephroticsyndrome
324.Afterchronicuseofsteroidsseverepain inrighthipwithimmobilityisdueto a)Avascularnecrosis b)Perthesdisease c)Hipdislocation d)Osteoarthritis CorrectAnswer-AAnswer-A.AvascularnecrosisPaininhipandlimitatationofmovement(immobility)ofterchronicuseofsteroidssuggestthediagnosisofAVNoffemoralhead.
325.Inelbow,osteochondritisusually involves a)Olecranon b)Trochlea c)Radialhead d)Capitulum CorrectAnswer-DAnswer-D.CapitulumKnee-LateralsurfaceofthemedialfemoralcondyleElbow-CapitulumofhumerusHip-FemoralheadAnkle-Talus
326.Mostcommonorganismcausing infectionafteropenfracture a)Pseudomonas b)Staphylococcusaureus c)Klebsiella d)Gonococcus CorrectAnswer-AAnswer-A.Pseudomonasstaphylococcusaureuswasthemostcommonorganismcausinginfectioninopenfractures.MorerecentstudieshaveshownthatgramnegativeorganismssuchaspseudomonasaeruginosaandE.coliarebecomingmorecommon
327.Septicarthritisisdiagnosedby a)X-ray b)Jointaspiration c)USG d)MRI CorrectAnswer-BAnswer-B.JointaspirationQuickestandbestmethodofdiagnosisofsepticarthritisisaspirationofjoint.
328.Sequestrumisbestdefinedas a)Apieceofdeadbone b)Apieceofdeadbonesurroundedbyinfectedtissue c)Apieceofbonewithpoorvascularity d)None CorrectAnswer-BAnswer-B.ApieceofdeadbonesurroundedbyinfectedtissueSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissue.
329.Cloacaearepresentin a)Sequestrum b)Involucrum c)Normalbone d)Myositis CorrectAnswer-BAnswer-B.InvolucrumInvolucrumisreactivenewboneoverlyingasequestrum.Theremaybesomeholesintheinvolucrumforpustodrainout.Theseholesarecalledcloaca.
330.ComplicationofjointTB a)Fibrousankylosis b)Bonyankylosis c)Normalhealing d)None CorrectAnswer-AAnswer-A.FibrousankylosisTheoutcomeoftuberculararthritisisfibrousankylosis,exceptinspine.Spineistheonlysitewheretuberculosishealswithbonyankylosis.
331.FalseaboutPott'sspine a)Commonestatdorsolumbarjunction b)Alwayshealsbychemotherapy c)Backpainisanearlysymptom d)Thereisdiscspacenarrowingonx-ray CorrectAnswer-BAnswer-B.AlwayshealsbychemotherapyChemotherapyisthemainstayoftreatment.Butitisnoteffectivealways,surgeryisoftenrequiredinsomecases.Commonestsiteofpott'sspineisdorsolumbarjunction.Backpainistheearliestsymptomandnarrowingofdiscspaceistheearliestradiologicalsign.
332.Apparentlengtheningisseeninwhich stageofTBHip a)StageI b)StageII c)StageIII d)None CorrectAnswer-AAnswer-A.StageIStageofsynovitis(Stage1):-Threeiseffusioninthehipjointwhichdemandsthehiptobeinapositionofmaximumcapacity.Thispositionisacquiredbyflexion,abductionandexternalrotation.Becauseofabductiondeformity,thereisapparentlengthening.
333.Tuberculosisspine;mostcommonsite is a)Sacral b)Cevical c)Dorsolumbar d)Lumbosacral CorrectAnswer-CAnswer-C.DorsolumbarThemostcommonsiteisDorsolumbarregion.Lowerdorsal(thoracic)regionisthemostcommonsegmentinvolvedfollowedbylumbarsegment.Thetuberculosisofspineisalsocalledpott'sdiseaseortubercularspondylytis.
334.Anterolateraldecompressionisdonefor a)Spinaltuberculosis b)ChestTB c)HandTB d)FootTB CorrectAnswer-AAnswer-A.SpinaltuberculosisAnteriordecompressioncanbecausedby:- 1. Anteriorapproach:-Calledanteriordecompression.Itisthemost preferredprocedure. 2. Anterolateralapproach:-Calledanterolateraldecompression.
335.Tumorwithmaximumbonematrix a)Osteoidosteoma b)Chondrosarcoma c)Enchondroma d)None CorrectAnswer-AAnswer-A.OsteoidosteomaDense,homogenousmineralization(calcification)istypicalofosteoidmatrix,formedbybenignandmalignantboneforminglesions.
336.Whichofthefollowingistrueabout Giantcelltumor a)Usuallypresentsasalyticlesionwithscleroticrim b)Alwaysbeingn c)Epiphysealorigin d)Seeninagelessthan15years CorrectAnswer-CAnswer-C.EpiphysealoriginGCTisanosteolytictumorarisingfromtheepiphysisandiscommonbetweentheageof20-40years.Thecommonestsitesarelowerendoffemurandupperendoftibia.Othercommonsitesarelowerendradiusandupperendofhumerus.Itmayalsooccurinthespineandsacrum.Theradiologicalfeaturesare:- 1. Asolitarymaybeloculated,lyticlesion.2. Eccentriclocation,oftensubchondral.3. Expansionoftheoverlyingcortx(expansilelesion).4. Soap-bubble'appearance
337.Striatedvertebraisseenin a)TBspine b)Haemangioma c)Chordoma d)Metastasis CorrectAnswer-BAnswer-B.HaemangiomaHaemangiomaofthevertebrahasatypicalradiographicpictureintheformoflossofhorizontalstriationsandprominenceofvertebralstriations.ThereisPolkadotappearanceonCT.Intheskull,hemangiomagenerallyaffectsthecalveriumandisseenasanexpansilelyticlesionwhichhasasunburstappearancewithstriationradiatingfromthecentre.Ahemangiomamaybeidentifiedduetoassociatedphlebolithanditmaycauselocalgigantismoftheinvovledarea.
338.Metastasisnotfoundin a)Femur b)Humerus c)Fibula d)Spine CorrectAnswer-CAnswer-C.FibulaMetastaticbonediseaseisthecommonestmalignancyofbonesandismuchmorecommonthanprimarybonetumors.Thecommonestsitesforbonemetastasesarevertebrae(mostcommon),pelvis,theproximalhalfofthefemurandthehumerus.Extremitiesdistaltoelbowandkneeareleastcommonlyinvolvedsites.Spreadisusuallyviathebloodstream;occasionally,visceraltumorsspreaddirectlyintoadjacentbonese.g.,thepelvisandribs.
339.Periostealreactionsisseenin a)Osteomyelitis b)Syphilis c)Tumor d)All CorrectAnswer-DAnswer-D.AllInfection:-Osteomyelitis,Brodie'sabscess,syphilisNeoplasmsBenign:OsteoidosteomaMalignant:Ewing'ssarcoma,osteosarcomaEosinophilicgranulomaHealedstressfractureHypertrophicpulmonaryosteoarthropathy
340.Volkmannscontracture,whicharteryis involved a)Radial b)Brachial c)Ulnar d)Interosseus CorrectAnswer-BAnswer-B.BrachialInjurytobrachialarterymaycausenerveandmuscleischemia(Volkmann'sischemiaofflexorcompartment)ormayresultinpostischemicswellingduetoedemaorhemorrhage,therebycausingcompartmentsyndrome,whichcancause,ifnottreatedimmediatealy,Volkmann'sischaemiccontracturelateron.
341.Castsyndromeisdueto a)Aboveelbowcast b)Belowelbowcast c)HipSpica d)Abovekneecast CorrectAnswer-CAnswer-C.HipSpicaCastsyndrome(Superiormesentricarterysyndrome)isgastricdilatationwithpartialorcompleteobstructionoftheduodenum.Itismostfrequentlyseeninorthopaedicspatientswhohavehadspinalsurgeryorwhoareinhipspicaorbodycasts.
342.Heterotopicossificationoccursin a)Bone b)Joint c)Softtissue d)None CorrectAnswer-CAnswer-C.SofttissueHeterotopicossificationistheprocessbywhichbonetissueisformedinsofttissueoutsidetheskeleton.
343.Felonmostcommoncomplication a)Osteomyelitis b)Subungualhematoma c)Infectivearthritis d)None CorrectAnswer-AAnswer-A.OsteomyelitisFelonistheinfectionofdistalpulpspace.Nexttoacuteparanychia,thisisthemostcommonhandinfection.Itusuallyfollowsapinprick,withindexfingerandthumbbeingthecommonunfortunatevictim.Thepatientinitiallycomplainsofdullpainandswelling.Complicationsareosteomyelitis(mostcommon),skinnecrosis,osteonecrosisofdigitsandrarelytenosynovitisorinfectivearthritisofDIPjoint.
344.Mostcommonboneforwhichnailingis done a)Radius b)Ulna c)Tibia d)Humerus CorrectAnswer-CAnswer-C.TibiaMostcommonbonesforwhichintramedullarynailingisdoneareTibiaandfemur.
345.Whyfractureshaftfemurisearly stabilised a)Topreventbloodloss b)ARDS c)Nonunion d)Compartmentsyndrome CorrectAnswer-AAnswer-A.TopreventbloodlossFractureshaftfemurcancauseupto2Lofbloodlossandseverehypotension,ifnotimmoblizedearly.thefractureshaftfemurshouldbeimmoblizedearly.ThiscanbetemporaryimmobilizationbyTTsplintfollowedbysurgeryorcanbebyimmediatesurgery.
346.Drugusedinosteoarthritis a)Methotrexate b)Glucosamine c)Sulfasalizine d)All CorrectAnswer-BAnswer-B.GlucosamineChondroitinsufateDiseasemodifyinganti-osteoarthritisdrugs(DMAOAD)Diacerin(IL-1antagonist),Licofelone(combinedCOX-LOXinhibitors)Steroids(inacuteexacerbations).
347.Pannusisseenin a)OA b)RA c)Gout d)None CorrectAnswer-BAnswer-B.RAPannusisseeninrheumatoidarthritis.Itisneoplasm-likegrowthofinflammedsynovialtissuethatleadstodestructionofjointstructures.Thearticularcartilageatpannusinterfaceappeartoundergochondrolysis.Pannusappeartodevelopwithinandaroundthesynovium,subsequentlycreepingintoandoverthearticularcartilageandenvelopingitandtheunderlyingboneinadeathlikegrasp.
348.Sausagedigitsisseenin a)Lymearthritis b)Osteoarthritis c)Psoriaticarthritis d)None CorrectAnswer-CAnswer-C.PsoriaticarthritisSausagedigitreferstodiffusefusiformswellingofthedigitduetosofttissueinflammationfromunderlyingarthritisordactylitis.Causesare:-PsoriaticarthritisOsteomyelitisSicklecellanemiaSarcoidosisTuberculardactylitis(spinaventosa)
349.Greenstickfractureis a)Fractureinadults b)Completefracture c)Incompletefracture d)Fracturespine CorrectAnswer-CAnswer-C.IncompletefractureAgreenstickfractureisanincompletetransversefracturepatternseeninchildren.
350.Resorptionofdistalphalanxisseenin a)Scleroderma b)Hyperparathyroidism c)Reiter'ssyndrome d)All CorrectAnswer-DAnswer-D.AllAcro-osteolysisisthetermusedtodescriberesorptionofthedistalphalangealtufts.Causesare:- 1. Scleroderma2. Trauma&thermalinjury3. Hyperparathyroidism4. Epidermolysisbullosa5. Arthropathy(RA,Psoriasis)6. Neuropathy(diabetes,syringomyelia)7. Raynaud'sdisease8. Reiter'ssyndrome
351.Footdropiscausedbyinjurytowhich nerveinvolvement: a)Femoralnerve b)Tibialnerve c)Commonperonealnerve d)Sciaticnerve CorrectAnswer-CAnswerC)CommonPeronealNerveFootdrop,sometimescalleddropfoot,isageneraltermfordifficultyliftingthefrontpartofthefoot.CausesFootdropiscausedbyweaknessorparalysisofthemusclesinvolvedinliftingthefrontpartofthefoot.Causesoffootdropmightinclude: 1. Nerveinjury.Themostcommoncauseoffootdropiscompression ofanerveinyourlegthatcontrolsthemusclesinvolvedinliftingthefoot(peronealnerve).Thisnervecanalsobeinjuredduringhiporkneereplacementsurgery,whichmaycausefootdrop. 2. Anerverootinjury--"pinchednerve"--inthespinecanalso causefootdrop.Peoplewhohavediabetesaremoresusceptibletonervedisorders,whichareassociatedwithfootdrop. 3. Muscleornervedisorders.Variousformsofmusculardystrophy, aninheriteddiseasethatcausesprogressivemuscleweakness,cancontributetofootdrop.Socanotherdisorders,suchaspolioorCharcot-Marie-Toothdisease. 4. Brainandspinalcorddisorders.Disordersthataffectthespinal cordorbrain--suchasamyotrophiclateralsclerosis(ALS),multiplesclerosisorstroke--maycausefootdrop.
352.MusclesaffectedinDequervain tenosynovitis- a)Abductorpollicislongusandextensorpollicisbrevis b)Adductorpollicislongusandextensorpollicisbrevis c)AbductorpollicislongusandFlexorpollicisbrevis d)AdductorpollicislongusandFlexorpollicisbrevis CorrectAnswer-AAns.A.AbductorpollicislongusandextensorpollicisbrevisDeQuervainsyndrome,isatenosynovitisofthesheathortunnelthatsurroundstwotendonsthatcontrolmovementofthethumb.DeQuervainsyndromeinvolvesnon-inflammatorythickeningofthetendonsandthesynovialsheathsthatthetendonsrunthrough.Thetwotendonsconcernedarethoseoftheextensorpollicisbrevisandabductorpollicislongusmuscles.
353.WhatismeantbyPerilunatedislocations ? a)Lowerradius,scaphoidandlunateandcapitateallinsame plane b)Lowerradius,scaphoidandcapitateinalignment,lunatealone outofplane c)Lowerradius,scaphoidandLunateinalignment,capitatealone isoutofplane d)Bothlunateandcapitateareoutofplane CorrectAnswer-BAns.B.Lowerradius,scaphoidandcapitateinalignment,lunatealoneoutofplanePerilunatedislocationandperilunatefracturedislocationareinjuriesthatinvolvetraumaticruptureoftheradioscaphocapitate(RSC)ligament,thescapholunateinterosseousligament,andthelunotriquetralinterosseousligament.Lateralradiographswillreveallossofcollinearitybetweenthecapitate,lunate,andradiusTypicallythecapitateislocateddorsaltothelunateandisalignedwiththeradius
354.Fallenfragmentsign- a)Simplebonecyst b)Osteosarcoma c)Adamantinoma d)Aneurysmalbonecyst CorrectAnswer-AAns.A.SimplebonecystThefallenfragmentsignreferstothepresenceofabonefracturefragmentrestingdependentlyinacysticbonelesion.Thisfindingissaidtobepathognomonicforasimple(unicameral)bonecystfollowingapathologicalfracture.Althoughithasoccasionallybeenreportedwithothercysticlesions,e.g.eosinophilicgranuloma
355.Youarepostedasaninternin causality.Whichamongthefollowingpatientswithfracturewillbeyour1stprioritytocallorthoPGandinform? a)Patient'sfingerisblackening b)Patientcan'textendhisarm c)A10cmabrasion d)IntraarticularfractureofElbowJoint CorrectAnswer-AAns.A.Patient'sfingerisblackeningBlackeningoffingerafterFractureisanindicationofcutofofbloodsupplythatmayleadtoseverecomplicationlikegangrene.SothisshouldbethefirstPrioritytotreatamongalltheaboveoptions
356.InRheumatoidarthritis,whichtypeof cellsareprominentlypresent? a)Bcells b)Tcells c)Macrophages d)Dendriticcells CorrectAnswer-CAns.C.MacrophagesSynovialliningorintimallayer:Normally,thislayerisonly1-3cellsthick.InRA,thisliningisgreatlyhypertrophied(8-10cellsthick).Primarycellpopulationsinthislayerarefibroblastsandmacrophages.
357.8thand9thribcostalcartilageforms whichtypeofjoint? a)Costochondraljoint b)Interchondraljoint c)Synovialjoint d)Costovertebraljoint CorrectAnswer-CAns.C.SynovialjointThesixth,seventh,eighth,ninthandtenthcostalcartilagesarejointedwitheachotheralongthebordersbysynovialjoints.Costochondraljointmeansthejointbetweentheribanditscostalcartilage.Thefirstcostalcartilageofbothsidesattachtothemanubriumsterni.Atthisjoint,nomovementispossible.Thesecondcostalcartilagearticulateswiththebodyofsternumandthemanubriumsternibyasynovialjointwheremovementispossible.Thethirdtoseventhcostalcartilagesarticulatewithlateralborderofthebodyofsternumatmobilesynovialjoints.
358.Tomsmithsepticarthritisis- a)AcuteGonococcalarthritis b)Smallpoxarthritis c)Septicarthritisofinfancy d)Chronicpyogenicarthritis CorrectAnswer-CAns.C.SepticarthritisofinfancySepticarthritisofinfancy(Tomsmithsepticarthritis)ItisasepticarthritisofhipseenininfantsTheonsetisacutewithrapidabscessformation,whichmayburstoutorbeincisedandhealsrapidly.TelescopetestispositiveClinicallythisconditionresemblesacongenitaldislocationofhip
359.Awomandevelopedpainandcrawling sensationonherlegsatnight.Clinicalhistoryofrestlesslegsyndrome.Drugofchoice?. a)Pramipexole b)Gabapentin c)VitaminB12 d)Irontablets CorrectAnswer-AAns.apramipexoleRestlesslegsyndrome:Subjectivesensation"creepy-crawly"feelinginthelimbs,andirresistibleurgetomovethelegswhenatrestorwhiletryingtofallasleep.Whentheindividualislyinginbedandrelaxing,heorsheisdisturbedbythesesensations.Thenheorshemovesthelegsandagaintriestofallasleep.Thiscyclesometimescontinuesforhoursandresultsinprofoundinsomnia.Treatment:Thedopaminergicagonists'pramipexoleandropiniroleareFDAapprovedandrepresentthetreatmentsofchoice.Ref.KaplanandSadock'sSynopsisofPsychiatry-11thEdition(Pageno559)
360.HistoryofArthritisinvolving1stMCP joint,otherPIP&DIPjoints,spareswristandankle.Whatcouldbethediagnosis a)Osteoarthritis b)Rheumatoidarthritis c)Psoriaticarthritis d)Gout CorrectAnswer-AAns:a.Osteoarthritis>Thedistalinterphalangeal(DIP)jointisactuallythemostcommonlocationonthebodyforosteoarthritis(OA).>Thefrequencyofhandarthritis,OAattheDIPjointoccursinapproximately58%ofindividuals.>ThesymptomsofOAattheDIPjointcommonlyincludepainandchangestothesizeandshapeofthejoint.https://www.3pointproducts.com/blog/health-arthritis-finger-and-toe-conditions/dip-joint-osteoarthritis-how-to-treat-this-common-form-of-arthritis
361.12yroldChildadmittedtoICUwithblunt traumaandfemurfracture-Pao260%despite100%o2andrebreathermask,CXRshowslungfieldsclearbutthepatientremainsconfused.Whatismostlikelythediagnosis- a)Pulmonarycontusion. b)Fatembolismsyndrome. c)Hypovolaemicshock. d)Pulmonaryembolism. CorrectAnswer-BAns:b.Fatembolism.Inthispatient,basedonthecasepresentationthereisRespiratorySysteminvolvedaspao2is60,andCNSinvolvementasheisinaconfusedstate.>So,thediagnosishereisFatembolismsyndrome.>Embolizedfatwithincapillarybedscausedirecttissuedamageaswellasinduceasystemicinflammatoryresponseresultinginpulmonary,cutaneous,neurological,andretinalsymptoms.>Gurd'sclinicaldescriptionoftheFESrenewedinterestinstudyingthissyndromehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665122/
362.A4yroldchildwhileplayingsuddenly spunaroundhiselbowfromherservantmaid'shandandnowcontinuouslycryingnotallowinganyonetotouchhiselbow.Heiskeepinghiselbowextended.whatismostlikelythediagnosis- a)Radialheadfracture b)Pulledelbow c)supracondylarfracture d)Elbowdislocation CorrectAnswer-BAns:b.Pulledelbow>Pulledelbow,alsocallednursemaid'selbow,isaradialheadsubluxationcausedbyaxialtractionorasuddenpulloftheextendedpronatedarm,anditisaverycommonphenomenon.>Inthiscaseofpulledelbow,thechildusuallyavoidsmovingtheaffectedarm,holdingitclosetohisorherbody,withoutconsiderablepain,andnoobviousswellingordeformitycanbeseen.>Whileafractureshouldbeexcluded,thepulledelbowcanusuallybeidentifiedbasedonthispresentation.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999240/