Q-31. Which of the following statements about tubercular osteomyelitis is not true?
a) It is a type of secondary osteomyelitis
b) Sequestrum is uncommon
c) Periosteal reaction is characteristic
d) Inflammation is minimal
Answer: Periosteal reaction is characteristic
Explanation:
Tubercular infection of bone:
It is a type of secondary osteomyelitis caused by hematogenous dissemination from primary site.
Well defined area of bone destruction typically with minimal reactive bone formation (Periosteal reaction)
Sequestrum is very uncommon.
Abscess wall doesn’t show characteristic sign of inflammation.
Increased ESR and lymphocytic Leukocytosis
A confirm diagnosis can only be established by biopsy of the lesion.
Q-32. Coronary ligaments of the knee are
a) Ligaments connecting the menisci to femur
b) Ligaments connecting the menisci to tibia
c) Ligaments connecting the anterior horns of both menisci
d) Ligaments connecting the lateral meniscus to capsule
Answer: Ligaments connecting the menisci to tibia
Explanation:
The coronary ligaments of the knee (also known as menisco-tibial ligaments) are portions of the joint capsule which connect the inferior edges of the fibro-cartilaginous menisci to the periphery of the tibial plateaus.
Q-33. When a patient gets from sitting position which of the following events takes place in his knee joint?
a) Medial rotation of femur on a fixed tibia
b) Lateral rotation of femur on a fixed tibia
c) Medial rotation of tibia on a fixed femur
d) Lateral rotation of tibia on a fixed femur
Answer: Medial rotation of femur on a fixed tibia
Explanation:
Locking of knee: Knee in position of full extension as in standing
Locking is achieved by medial rotation/ internal rotation of femur on fixed tibia.
Quadriceps helps in locking of knee.
Unlocking of knee: flexion from fully extended position
Unlocking is achieved by external/ lateral rotation of femur on a fixed tibia.
Unlocking is brought about by the action of popliteal muscle.
Q-34. In acute knee injuries with swelling & hemarthrosis with muscle spasm, which of the following tests in most sensitive detect anterior cruciate ligament injury?
a) Lachman’s test
b) Pivot shift test
c) Apley’s grinding test
d) Anterior drawer test
Answer: Lachman’s test
Explanation:
The Lachman’s test is a clinical test used to diagnose injury of the anterior cruciate ligament.
It can be even performed in an acute painful knee.
It is recognized as reliable, sensitive, and usually superior to the anterior drawer test.
Q-35. The blood supply of anterior cruciate Ligament (ACL) is primarily derived from
a) Superior medial genicular artery
b) Descending genicular artery
c) Middle genicular artery
d) Circumflex fibular artery
Answer: Middle genicular artery
Explanation:
Primary blood supply of anterior crucial ligament is middle geniculate artery.
Primary nerve supply of anterior crucial ligament is posterior articular branch of tibial nerve.
Q-36. In which of the following meniscal tears will meniscectomy be a more suitable than meniscal repair?
a) Tears in the outer zone
b) Tears in the middle zone
c) Tears in the inner zone
d) Tears at the junction of anterior horn of medial meniscus & tibial collateral
Answer: Tears in the inner zone
Explanation:
Meniscal repair is recommended for tear in peripheral region (Tears in red zone or red-white zone).
Meniscal repair is not recommended for tears the central zone (White zone).
Important point:
The inner zone of the meniscus is avascular. So meniscal repair is not recommended for inner zone tears.
Q-37. A patient with HIV is on therapy with protease inhibitors. He presents with limitation of abduction and internal rotation of the hip. The most probable diagnosis is:
a) Tuberculosis of hip joint
b) Avascular necrosis of femoral head
c) Secondary osteoarthritis of hip
d) Septic arthritis of hip
Answer: Avascular necrosis of femoral head
Explanation:
Limitation of abduction and internal rotation:
Avascular necrosis of femoral head
Tuberculosis of hip joint
Osteoarthritis of hip
Important point:
Protease inhibitor as part of the highly active antiretroviral therapy (HAART) regimen has been implicated in causing avascular necrosis.
It causes avascular necrosis by inducing significant hyper-lipidemia with subsequent ischemia.
Q-38. A 65 year old type II diabetic presents with complaints of swelling in the left ankle with effusion but only minimal pain. X-ray shows severe osteopenia with bone destruction, extensive osteophytosis & loose bodies. The management of this patient includes all the following except
a) Resting & splinting
b) Aspiration & compression bandage
c) Total ankle replacement
d) Ankle arthrodesis
Answer: Total ankle replacement
Explanation:
Absolute contra-indication of total ankle replacement:
Neuropathic joint disease (Charcot’s joint)
Active or recent infection
Avascular necrosis of talus
Q-39. Pollicization can be best described as
a) Toe to thumb transfer
b) Thumb reconstruction
c) Finger shortening
d) Amputation of thumb
Answer: Thumb reconstruction
Explanation:
Pollicization substitutes a functioning finger for a deficient thumb.
The most common indication is thumb hypoplasia with absence or instability of the carpo-metacarpal joint.
Q-40. 16 year old male presents with extensive hetero-tropic ossification over the neck, back & shoulders and decreased chest movements. He gives history of progressive immobility since the age of 3 years. Which of the following statement about his affecting condition is not true?
a) They have a near normal life expectancy
b) They are predisposed to pneumonia
c) They have short hallux
d) Increased expression of BMP4 gene is seen.
Answer: They have a near normal life expectancy
Explanation:
Fibro-dysplasia ossificans progressiva is a disorder in which muscle tissue and connective tissue such as tendons and ligaments are gradually replaced by bone (ossified), forming bone outside the skeleton (extra-skeletal or hetero-topic bone) that constrains movement.
This process generally becomes noticeable in early childhood, starting with the neck and shoulders and proceeding down the body and into the limbs.
Affected individuals may also have short thumbs and other skeletal abnormalities.
Mutation in the ACVR1 gene (Inherited in an autosomal dominant pattern) causes fibro-dysplasia ossificans progressiva.
The ACVR1 gene provides instructions for producing a member of a protein family called bone morphogenetic protein (BMP) type I receptors.
The prognosis for fibro-dysplasia ossificans progressiva is poor because of the involvement of thoracic muscles and restrictive lung disease.