AIIMS/ NEET-PG 2017: Orthopedics MCQs 51-60

Q-51. Muscle most commonly affected by congenital absence is
a) Pectoralis major
b) Semi minor
c) Teres minor
d) Gluteus maximus

Answer: Pectoralis major
Explanation:
Pectoralis major and minor muscles are the most common congenital absent muscle.
Poland syndrome refers to a congenital unilateral absence of the pectoralis major and minor muscles and is a recognized cause of unilateral hyper-lucent hemi-thorax or lung.

Q-52. ‘T- 10 protocol’ for treatment of osteosarcoma includes all of the following, except
a) High dose methotrexate
b) Bleomycin, Cyclophosphamide, Doxorubicin (BCD)
c) Vincristine
d) Etoposide

Answer: Etoposide
Explanation:
‘T- 10 protocol’ for treatment of osteosarcoma:
High dose methotrexate
Vincristine
Bleomycin, Cyclophosphamide, Dactinomycin
Doxorubicin
Cisplatin

Q-53. Brown tumor seen in
a) Hypothyroidism
b) Hyperthyroidism
c) Hypo-parathyroidism
d) Hyper- parathyroidism

Answer: Hyper- parathyroidism
Explanation:
The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.
Most of brown tumors are associated with secondary hyperparathyroidism.
Hemosiderin imparts the brown color (hence the name of the lesions). It is not a true neoplasm.
Brown tumors are radiolucent on x-ray.

Q-54. Which of the following statements about ‘Menisci’ is not true?
a) Medial meniscus is more mobile than lateral
b) Lateral meniscus covers more tibial articular surface than lateral
c) Medial meniscus is more commonly injured than lateral
d) Menisci are predominantly made up of type I collagen

Answer: Medial meniscus is more mobile than lateral
Explanation:
Medial meniscus is less mobile, more prone to injury and cover less area of the tibial articular surface in comparison to the lateral meniscus.

Q-55. Which of the following statements about changes in articular cartilage with aging is not true?
a) Total proteoglycans content is decreased
b) Synthesis of proteoglycans is decreased
c) Enzymatic degradation of proteoglycans is increased
d) Total water content of cartilage is decreased

Answer: Enzymatic degradation of proteoglycans is increased
Explanation:
Age related changes in articular cartilage:
Decrease in total proteoglycans content
Decreases in total water content/ hydration of cartilage resulting in reduced resilience
Decreases synthetic activity of chondrocytes> decreased synthesis of proteoglycans
Accumulation of advanced glycation end products in articular cartilage
Important point:
Degradative enzyme activity is increased in osteoarthritis but not in normal aging cartilage.

Q-56. Metal on metal articulation should be avoided in:
a) Osteo-necrosis
b) Young female
c) Inflammatory arthritis
d) Revision surgery

Answer: Young female
Explanation:
Contra-indications of metal on metal bearing surfaces:
Patient with metal hypersensitivity
Young female with child bearing age
Patients with renal insufficiency

Q-57. A patient developed breathlessness and chest pain, on second postoperative day after a total hip replacement. Echocardiography showed right ventricular dilatation and tricuspid regurgitation.
What is the most likely diagnosis?
a) Acute MI
b) Pulmonary embolism
c) Hypotensive shock
d) Cardiac tamponade

Answer: Pulmonary embolism
Explanation:
Findings of pulmonary embolism after a high risk procedure for thrombo-embolism like THR:
Breathlessness
Chest pain
Right ventricular dilatation
Tricuspid regurgitation
Mild elevation of pulmonary artery pressure

Q-58. The characteristic triad of Klippel –Feil syndrome includes all of the following, except:
a) Short neck
b) Low hair line
c) Limited neck movements
d) Elevated scapula

Answer: Elevated scapula
Explanation:
Klippel-Feil syndrome is a rare skeletal disorder primarily characterized by abnormal union or fusion of two or more cervical vertebrae.
The characteristic triad of Klippel –Feil syndrome:
Short web neck
Low hair line
Restriction of neck motion

Q-59. Progression of congenital scoliosis is least likely in which of the following vertebra anomalies:
a) Fully segmented hemi-vertebra
b) Wedge vertebra
c) Block vertebra
d) Unilateral un-segmented bar with hemi-vertebra

Answer: Block vertebra
Explanation:
Block vertebra have no growth potential, remain stable and cause least severe scoliosis or best prognosis.
Un-segmented bar with hemi-vertebra carries the worst prognosis and greatest risk of progression.

Q-60. A patient involved in a road traffic accident presents with quadriparesis, sphincter disturbance, sensory level up to the upper border of sternum and a respiratory rate of 35/minutes. The likely level of lesion is:
a) C1-C2
b) C4-C5
c) T1-T2
d) T3-T4

Answer: C4-C5
Explanation:
Lesion to cervical level C4-5:
Quadriparesis > C1-2 OR C4-5
Sensory loss up to upper border of sternum> C4
Preserved respiratory function and increased respiratory rate> Lesion at C4-5