Q-61. All of the following statements about synovial cell sarcoma are true, except:
a) Originate from synovial lining
b) Occur more often at extra articular sites
c) Usually seen in patients less than 50 year of age
d) Knee and foot are common sites involved
Answer: Originate from synovial lining
Explanation:
Synovial cell sarcoma is not associated with synovial joints. The basis for the name synovial cell sarcoma is the similarity between cells of this tumor and primitive synoviocytes.
Synovial cell sarcoma is characterized by a specific chromosomal translocation, t (X: 18).
Most Synovial cell sarcomas are extra-articular.
Most commonly, it is situated around the knee and feet.
Synovial sarcoma typically produces a spotty calcification (snowstorm) within the matrix of the soft tissue tumor that may be visualized on plain radiographs.
Q-62. Lift off test is done to assess the function of:
a) Supra-spinatus
b) Infra-spinatus
c) Teres Minor
d) Sub-scapularis
Answer: Sub-scapularis
Explanation:
Lift off test or Gerber’s test:
Lift off test or Gerber’s test is done to access the strength of sub-scapularis muscle and detect a rupture of the sub0scapularis tendon.
Important point:
Sub-scapularis function primarily as a internal rotator of the shoulder.
Q-63. Median nerve lesion at the wrist causes all of the following, except:
a) Thenar atrophy
b) Weakness of adductor pollicis
c) Weakness of 1st and 2nd lumbricals
d) Weakness of flexor pollicis brevis
Answer: Weakness of adductor pollicis
Explanation:
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.
Important point:
Adductor pollicis is supplied by ulnar nerve.
Q-64. Blount’s disease is:
a) Meniscal injury
b) Genu recurvatum
c) Genu varum
d) Genu valgum
Answer: Genu varum
Explanation:
Blount’s disease occurs in young children and adolescents. The inner part of the tibia just below the knee fails to develop normally, causing angulation of the bone.
Blount’s disease is a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg. It is also known as “tibia vara”.
Q-65. Treatment of choice for painful amputation stump neuroma is
a) Ultrasound therapy
b) Infrared rays
c) Interferential therapy
d) Re-excision of neuroma
Answer: Re-excision of neuroma
Explanation:
Numerous medical interventions have been proposed over the years but tricyclic antidepressants (TCA) and sodium channel blockers are currently considered to be the drug treatments of choice for neuropathic pain.
Medical treatment can be combined with various non‐invasive techniques such as trans-cutaneous electrical nerve stimulation (TENS), vibration therapy, acupuncture, hypnosis, biofeedback, and electroconvulsive therapy.
Large neuromas buried in a scar or located in an exposed position may be so painful that the amputee is severely impaired.
Although surgical removal is the treatment of choice in these cases, this technique has failed to yield uniform results.
Pain relief is often temporary due to the eventual development of a new neuroma.
So resection of a neuroma should be undertaken in cases of persistent pain.
Q-66. A patient with history of recurrent posterior dislocation of humerus is evaluated for a Hill-Sach’s lesion. Which aspect of the head of humerus is likely to show this lesion in the above patient?
a) Anterior
b) Antero-medial
c) Postero-lateral
d) Posterior
Answer: Antero-medial
Explanation:
Anterior dislocation and Hill-Sach’s lesion:
Impression/impaction fracture of postero-lateral aspect of humeral head
Posterior dislocation and Reverse Hill-Sach’s lesion:
Impression/impaction fracture of antero-medial aspect of humeral head
Q-67. A 20 year old male involved in single vehicle rollover accident presented with inability to abduct the shoulder and flex the elbow. There was associated wasting of the supra-spinatus, deltoid and biceps muscle. Which of the following is the most likely diagnosis?
a) Shoulder dislocation
b) Upper trunk injury
c) Lateral cord injury
d) Medial cord injury
Answer: Upper trunk injury
Explanation:
Manifestation of upper trunk injury:
Branches:
Supra-scapular nerve supplies supra-spinatus and infra-spinatus.
Manifestation of Supra-scapular nerve > Weakness of shoulder abduction
Posterior division of upper trunk:
Axillary nerve supplies deltoid muscle.
Manifestation of axillary nerve injury > Weakness of shoulder abduction
Anterior division of upper trunk:
Musculocutaneous nerve supplies biceps.
Manifestation of axillary nerve injury > Weakness of elbow flexion
Important point:
Weakness of shoulder abduction (Supra-spinatus and deltoid), weakness of elbow flexion (Biceps) with weakness and atrophy of the effected muscles also suggests C5 nerve root injury.
Q-68. The proximal fragment of scaphoid fracture is predisposed for avascular necrosis because
a) Retrograde blood flow to the proximal fragment
b) Difficulty in immobilizing the proximal fragment
c) Fracture configuration of the proximal fragment is usually comminuted
d) Proximal fragment articulates with the radius
Answer: Retrograde blood flow to the proximal fragment
Explanation:
Scaphoid receives retro-grade intra-osseous blood flow from distal to proximal fragment leaving the proximal fragment with tenuous blood supply.
Avascular necrosis of proximal fragment is thus a common complication seen in fracture waist of scaphoid or through its proximal pole.
Q-69. A 30 year old lady presents with pain and tenderness in the index finger, which is worse on exposure to cold. On examination there is bluish discoloration of nail bed. There is on associated history of trauma. Which of the following are the likely associated findings?
a) Sausage shaped terminal phalanx
b) Pinhead shaped lesion beneath the nail
c) Slipping of nail over the nail bed
d) Hardening of finger
Answer: Pinhead shaped lesion beneath the nail
Explanation:
Glomus tumor of the fingers:
Proximal pain with cold sensitivity
Point tenderness with pressure sensitivity
Bluish discoloration of nail bed
Small red blue nodule of size of pin head beneath the nail
Important point:
Glomus tumor is benign tumors that arise from the neuro-myo-arterial glomus.
Q-70. A 12 years old with rapid increase in weight and height over the past one year presents with difficulty in sitting cross legged and squatting. The knee would go into axilla every time she flexes her hip and knee. The most likely disease
a) Perth’s disease
b) Slipped capital femoral epiphysis
c) Congenital Coxa Vera
d) Synovitis of knee
Answer: Slipped capital femoral epiphysis
Explanation:
Slipped capital femoral epiphysis:
Usually seen in peri-pubertal period (12-16 years) in association with rapid growth
Also associated with endocrinopathies and obesity
Limitation of hip movements (Difficulty in squatting and sitting cross legged)
Limb is usually in extension
Obligate external rotation on attempted hip flexion (Knee axilla sign) seen in all patients
Perth’s disease:
Usually seen before onset of puberty and not related to growth spurt
Limitation of hip movements (Difficulty in squatting and sitting cross legged)
Limb is usually in flexion
Obligate external rotation on attempted hip flexion (Knee axilla sign) may be seen