AIIMS/ NEET-PG 2017: Orthopedics MCQs 41-50

Q-41. Milkman’s fracture is a type of
a) Metacarpal fracture
b) Humeral fracture
c) Clavicular fracture
d) Pseudo-fracture

Answer: Pseudo-fracture
Explanation:
Looser’s zones or Milkman’s pseudo-fractures
These lesions are stress fractures, composed of poorly mineralized osteoid matrix and are not true fractures.
They are oriented perpendicular to the long axis of the bone, and do not cross the entire bone.
Common sites include axillary margins of the scapulae, ribs, pubic rami, proximal femurs and proximal ulnae.

Q-42. All of the following statements about synovial fluid are true; except:
a) Secreted primarily by type A synovial cells
b) Follows Non – Newtonian Fluid kinetics
c) Contains hyaluronic acid
d) Viscosity is variable

Answer: Secreted primarily by type-A synovial cells
Explanation:
The joint capsule exhibits a unique cellular lining in the luminal surface of the synovial membrane.
Two types of synoviocytes, macrophagic cells (type-A cells) and fibroblast-like cells (type-B cells) have been identified.
Type-A synoviocytes are non-fixed cells that can phagocytose actively cell debris and wastes in the joint cavity, and possess an antigen-presenting ability.
Type B synoviocytes are characterized by the rich existence of rough endoplasmic reticulum, and dendritic processes which form a regular network in the luminal surface of the synovial membrane.
The type B cells, which are proper synoviocytes, are involved in production of specialized matrix constituents including hyaluronan, collagens and fibronectin for the intimal interstitium and synovial fluid.
Important points:
Non-Newtonian fluid is fluid whose viscosity changes as the rate of shear changes.
Synovial fluid viscosity decreases with increased rate of shear.

Q-43. In a patient with gouty arthritis, synovial fluid aspiration will show
a) Monosodium urate crystals
b) Calcium pyrophosphate crystals
c) Mononuclear Leukocytosis
d) Polymorphonuclear Leukocytosis

Answer: Monosodium urate crystals
Explanation:
Polymorphonuclear Leukocytosis: Acute gout
Calcium pyrophosphate crystals: Pseudo Gout
Intra-cellular monosodium urate crystals: Gout
Important point:
In gout, crystals of monosodium urate appear as needle-shaped intracellular and extracellular crystals.
Microscopic analysis in pseudo-gout shows calcium pyrophosphate crystals and often rhomboidal in shape.

Q-44. Which of the following is not recommended in the treatment of chronic low back pain?
a) NSAIDs
b) Bed rest for 3 months
c) Exercises
d) Epidural steroid injection

Answer: Bed rest for 3 months
Explanation:
Prolonged bed rest may lead to debilitating muscle atrophy and increased stiffness and therefore is not recommended in management of chronic low back pain.

Q-45. Recurrent dislocations are least commonly seen in
a) Ankle
b) Hip
c) Shoulder
d) Patella

Answer: Ankle
Explanation:
Recurrent dislocations of joints:
Shoulder
Elbow
Patella
Sternoclavicular joint
Hip
Important point:
Recurrent dislocations are extremely rare in the ankle joint.

Q-46. The primary pathology in athletic Pubalgia is
a) Abdominal muscle strain
b) Rectus medius strain
c) Gluteus medius strain
d) Hamstring strain

Answer: Abdominal muscle strain
Explanation:
Athletic pubalgia is a painful, soft tissue injury that occurs in the groin area. It most often occurs during sports.
With athletic pubalgia, there is disequilibrium between the upward and oblique pull of the abdominal muscles on the pubis against the downward and lateral pull of the adductors on the inferior pubis.
This imbalance of forces can lead to injuries of the lower central abdominal muscles and the upper aponeurotic common insertion of the adductor muscles.
Important point:
The primary pathology in athletic Pubalgia is the insertion of rectus abdominis muscle.

Q-47. Most common cause of death after total Hip replacement is:
a) Infection
b) Pneumonia
c) Anemia
d) Thrombo-embolism

Answer: Thrombo-embolism
Explanation:
Pulmonary embolism is most common cause of death after total Hip replacement.

Q-48. All of the following statements about high tibial osteotomy are true, except
a) Magnitude of correction achieved is greater than 30 degree.
b) Indicated in uni-compartmental osteoarthritis
c) Performed through cancellous bone
d) Recurrence is a long term complication

Answer: Magnitude of correction achieved is greater than 30 degree.
Explanation:
High tibial osteotomy is a procedure for the treatment of uni-compartmental osteoarthritis of the knee with pain and also correct varus less than 15 degree or valgus deformity less than 12 degree.
High tibial osteotomy is performed through cancellous bone.
Recurrence is established complication of high tibial osteotomy.

Q-49. Myodesis is employed in amputations for all of the following indications except:
a) Trauma
b) Tumor
c) Children
d) Ischemia

Answer: Ischemia
Explanation:
Myodesis refers to the anchoring of muscle or tendon to bone using sutures that are passed through small holes drilled in the bone.
Myodesis is contraindicated in cases of severe dys-vascularity in which blood supply to muscles compromised.

Q-50. All the following are involved in entrapment neuropathy except:
a) Femoral nerve
b) Median nerve
c) Ulnar nerve
d) Lateral cutaneous nerve of thigh

Answer: Femoral nerve
Explanation:
Nerve entrapment syndromes result from chronic injury to a nerve as it travels through an osseo-ligamentous tunnel; the compression is typically between the ligamentous canal and bony surfaces.
Other potential anatomical sites for entrapment include the muscular arcade of the supinator for the posterior interosseous nerve, and the thoracic outlet for the lower trunk of the brachial plexus.
Carpal tunnel syndrome, compression of the median nerve at the wrist, is the most common entrapment neuropathy.
Cubital tunnel syndrome is the second most common and is caused by a compression of ulnar nerve at the elbow.
Other rare nerve entrapment syndromes include the supra-scapular nerve of upper girdle pain symptoms, and meralgia paresthetica, which is a compression of the lateral femoral cutaneous nerve in the groin.