AIIMS/ NEET-PG 2017: Orthopedics MCQs 71-80

Q-71. Which of the following is the least likely complication of fracture neck of femur?
a) Shortening
b) Non-union
c) Mal-union
d) Avascular Necrosis

Answer: Mal-union
Explanation:
Complications of fracture neck of femur:
Fracture neck of femur is primarily associated with non union due to its precarious blood supply and secondary avascular necrosis.
Shortening is seen in almost all cases with non union and avascular necrosis.
Mal union is rare complication with fracture neck of femur as these fractures almost never unite unless they are anatomically reduced and fixed.

Q-72. All of the following statement about SACH feet are true except
a) SACH stands for solid ankle cushioned heal
b) Forms the base of a lower limb prosthesis
c) May wear out with time
d) Wooden keel absorbs the impact of heel strike

Answer: Wooden keel absorbs the impact of heel strike
Explanation:
SACH foot (Solid Ankle Cushion Heel):
SACH forms the base of lower limb prosthesis. It consists of a central wooden keel and cushioned heel. The impact of heel strike is absorbed by the cushioned heel.
It provides comfort at heel strike.
It is used for patients with low activity level (1 and 2).

Q-73. Tuberculosis of bone is characterized by
a) Pauci-bacillary and hematogenous
b) Multi-bacillary and hematogenous
c) Multi-bacillary and lymphatogenous
d) Pauci-bacillary and lymphatogenous

Answer: Pauci-bacillary and hematogenous
Explanation:
Osteo-articular tuberculosis is essentially a pauci-bacillary disease that results primarily from hematogenous spread of Mycobacterium from primary focus.
Hip joint tuberculosis is the second-most common location after spinal tuberculosis.

Q-74. A patient while lifting a heavy weight presents with sudden onset pain in the lower back radiating along the postero- lateral thigh and lateral leg to the big toe with numbness. The most likely diagnosis is
a) L5 –L4 Disc prolapse
b) L3 -L4 Disc prolapse
c) L4- L5 disc prolapse
d) L5- S1 disc prolapse

Answer: L4- L5 disc prolapse
Explanation:
Disc prolapse with corresponding nerve root and pain:
L3 -L4 Disc prolapse (L4 nerve root): Anterior thigh, Anterior/medial leg and medial ankle
L4- L5 disc prolapse (L5 nerve root): Postero-lateral hip, postero-lateral thigh, lateral leg
L5- S1 disc prolapse (S1 nerve root): Hip, buttock, posterior thigh, posterior leg and lateral foot
Disc prolapse with corresponding nerve root and reflex:
L3 -L4 Disc prolapse (L4 nerve root): Decreased knee jerk
L4- L5 disc prolapse (L5 nerve root): None or decreased posterior tibial reflex
L5- S1 disc prolapse (S1 nerve root): Decreased ankle jerk

Q-75. All of the following are included as yellow flag signs of low back pain except
a) History of systemic steroids use
b) Reliance on passive treatment
c) Social isolation
d) Belief that back pain is severely disabling

Answer: History of systemic steroids use
Explanation:
Red flag signs in back pain are signs that indicate serious spinal or general disorder.
Red flag signs:
Age of onset less than 20 yrs or more than 55yrs
Recent history of violent trauma
Constant progressive, non mechanical pain
Thoracic pain
Past medical history of malignant tumour
Prolonged use of corticosteroids
Drug abuse, immuno-suppression, HIV
Unexplained weight loss
Widespread neurological symptoms
Structural deformity
Fever
Yellow flag signs in back pain are signs that do not indicate a serious underlying spinal disorder but indicate high risk of developing chronic pain and disability.
Yellow flag signs:
A negative attitude that back pain is harmful or potentially severely disabling
Fear avoidance behavior and reduced activity levels
A tendency to depression, low morale, and social withdrawal
Reliance on passive treatment

Q-76. There are considerable morbidity and mortality due to bone diseases more frequently amongst women. The most common cause of bone disease in India is
a) Nutritional deficiency
b) Steroid induced osteoporosis
c) Paget’s disease
d) Sarcoidosis

Answer: Nutritional deficiency
Explanation:
Disorders of bone and mineral metabolism in India:
Nutritional bone disease: 52 %
Endemic skeletal fluorosis: 43 %
Metabolic bone disease: 5 %

Q-77. Drug induced Osteomalacia is known to be associated with the use of
a) Steroids
b) Heparin
c) Phenytoin
d) Gentamycin

Answer: Phenytoin
Explanation:
Drugs Causing Osteomalacia:
Phenytoin
Cholestyramine
Ifosfamide
Phenobarbitone
Carbamazepine
Phosphate binding antacid
Bis-phosphonate (First generation in higher dose)
Important point:
Steroid and heparin is associated with osteoporosis.

Q-78. Variant of giant cell tumor is
a) Ossifying fibroma
b) Non ossifying fibroma
c) Osteosarcoma
d) Chondro-blastoma

Answer: Chondro-blastoma
Explanation:
A chondro-blastoma is a rare, usually benign, tumor of bone.
In 1931, Codman classified it as a chondromatous variant of giant cell tumors, when he described these lesions in the proximal humerus.
Jaffe and Lichtenstein renamed the Codman tumor a benign chondroblastoma to emphasize the chondroblastic genesis of the lesion and to distinguish it from the classic giant cell tumor of bone.

Q-79. Percutaneous vertebroplasty is indicated in all except
a) Tuberculosis
b) Metastasis
c) Osteoporosis
d) Hemangioma

Answer: Tuberculosis
Explanation:
Indications of percutaneous vertebroplasty:
Osteoporotic vertebral compression fracture
Painful metastasis
Painful hemangioma
Vertebral osteo-necrosis
Important point:
Tubercular osteomyelitis is a contra-indication for percutaneous vertebroplasty.

Q-80. All true about high tibial osteotomy except
a) Can correct varus over 30 degree
b) Deformity recurs after a long time
c) Done through cancellous bone
d) Done in case of uni-compartmental disease

Answer: Can correct varus over 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.