Q-1. Most common site of Osteogenic sarcoma is
a) Upper end of femur
b) Lower end of femur
c) Upper end of tibia
d) Lower end of tibia
Ans: b
Explanation:
Osteosarcoma derives from primitive bone-forming mesenchymal cells and is the most common primary bone malignancy.
Osteosarcoma commonly occurs in the long bones of the extremities near the metaphyseal growth plates.
The most common sites are the femur (42%, with 75% of tumors in the distal femur), the tibia (19%, with 80% of tumors in the proximal tibia), and the humerus (10%, with 90% of tumors in the proximal humerus).
Q-2. Carpel tunnel syndrome is due to compression of
a) Radial nerve
b) Ulnar nerve
c) Median nerve
d) Palmar branch of the ulnar nerve
Ans: c
Explanation:
Flexor Retinaculum:
Flexor retinaculum is a strong fibrous band which bridges the anterior concavity of the anterior concavity of the carpus and converts it into a tunnel, the carpal tunnel.
The structures passing deep to the flexor retinaculum are: (i) the median nerve, (ii) the tendons of the flexor digitorum superficialis, (iii) the tendons of the flexor digitorum profundus, (iv) the tendon of the flexor pollicis longus, (v) the ulnar bursa, and (v) the radial bursa.
CARPAL TUNNEL SYNDROME
This syndrome consists of motor, sensory, vasomotor and trophic symptoms in the hand caused by compression of the median nerve in the carpal tunnel.
Examination reveals wasting of thenar eminence (ape like hand) hypo-aesthesia to light touch on the palmar aspect of lateral 3.5 digits. However, the skin over the thenar eminence is not affected as the branch of median nerve supplying it arises in the forearm.
Q-3. Kinebock’s disease due to avascular necrosis of
a) Femoral neck
b) Median cuneiform bone
c) Lunate bone
d) Scaphoid bone
Ans: c
Explanation:
Kinebock’s disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted.
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called Osteo-necrosis.
Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.
Q-4. Tuberculosis of spine commonly effects all of the following parts of vertebra except
a) Body
b) Lamina
c) Spinous process
d) Pedicle
Ans: c (?)
Explanation:
There are four common sites of vertebral tuberculosis: para-discal type, central type, anterior type, appendicial type.
Spinal tuberculosis is initially apparent in the anterior inferior portion of the vertebral body. Later on it spreads into the central part of the body or disk.
Para-discal, anterior, and central lesions are the common types of vertebral involvement. In the central lesion, the disk is not involved, and collapse of the vertebral body produces vertebra plana.
Appendicial lesion: Isolated Pedicles & laminae (neural arch), transverse processes & spinous process are the uncommon types of vertebral involvement.
In younger patients, the disk is primarily involved because it is more vascularized. In old age, the disk is not primarily involved because of its age-related avascularity.
In spinal tuberculosis, there is involvement of more than one vertebra because its segmental arteries bifurcate to supply two adjacent vertebrae. Spread of the disease beneath the anterior or posterior longitudinal ligaments involves multiple contiguous vertebrae.
Q-5. Heberden’s arthropathy affects
a) Lumbar spine
b) Symmetrical large joints
c) Sacro-iliac joints
d) Distal interphalangeal joints
Ans: d
Explanation:
Heberden’s nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP). They are a sign of osteoarthritis.
Bouchard’s nodes may also be present; these are similar bony growths in the proximal interphalangeal (PIP) joints and are also associated with osteoarthritis.
Q-6. The ideal treatment of bilateral idiopathic clubfoot in a newborn is
a) Manipulation by mother
b) Manipulation and Dennis brown splint
c) Manipulation and casts
d) Surgical release
Answer: Manipulation by mother
Explanation:
Manipulation by mother is only recommended treatment in a new born till the child is about one month of age when infant can tolerate strapping or corrective plaster application.
Q-7. All of the following statements are true about developmental dysplasia of hip (DDH) except?
a) It is more common in females
b) Oligo-hydramnios is associated with a higher risk of DDH
c) The hourglass appearance of the capsule may prevent a successful closed reduction
d) Twin pregnancy is known risk factor
Answer: Twin pregnancy is known risk factor
Explanation:
Developmental dysplasia of hip:
It is more common in females
Oligo-hydramnios is associated with a higher risk of DDH
The classic examination finding is revealed with the Ortolani maneuver, in which a palpable “clunk” is present when the hip is directed in and out of the acetabulum and over the neo-limbus.
The Galeazzi sign is a classic identifier of unilateral hip dislocation.
The hourglass appearance of the capsule may prevent a successful closed reduction.
Q-8. All are true regarding brachial plexus injury, except:
a) Pre-ganglionic lesions have a better prognosis than postganglionic lesions.
b) Erb’s palsy causes paralysis of the abductors and external rotators of the shoulder.
c) In Klumpke’s palsy, Horner’s syndrome may be present on the ipsilateral side.
d) Histamine test is useful to differentiate between the pre-ganglionic and postganglionic lesions
Answer: Pre-ganglionic lesions have a better prognosis than postganglionic lesions.
Explanation:
Re-ganglionic brachial plexus injury:
Cannot recover
Surgically irreparable
Histamine test is positive
Post-ganglionic brachial plexus injury:
Have potential recovery
Surgically reparable
Histamine test is negative
Erb’s palsy:
C5-6 roots affected
Abductors and external rotators of the shoulder are paralyzed.
Upper obstetric palsy
Klumpke’s palsy:
C8-T1 roots affected
Involvement of T1 root may cause a Horner’s syndrome
Lower obstetric palsy
Important point:
Post-ganglionic lesions have better prognosis than pre-ganglionic lesions.
Q-9. Which of the following conditions is least likely to present as an eccentric osteolytic lesion?
a) Aneurysmal bone cyst
b) Giant cell tumor
c) Fibrous cortical defect
d) Simple bone cyst
Answer: Simple bone cyst
Explanation:
Simple bone cyst characteristically presents as a central lytic lesion.
Radiolucent or lytic and eccentric lesions:
Aneurysmal bone cyst
Giant cell tumor
Fibrous cortical defect
Q-10. All the statements are true about exotosis, except:
a) It occurs at the growing end of bone
b) Growth continues after skeletal maturity
c) It is covered by cartilaginous cap
d) Malignant transformation may occur
Answer: Growth continues after skeletal maturity
Explanation:
Exotosis is not a true bone tumor as its growth stops with cession of growth at the epiphyseal plate.