Q-1. Osgood Schlatters disease involves
a) Tibial tuberosity
b) Femoral condyle
c) Lateral malleolus
d) Medial malleolus
Answer: Tibial tuberosity
Explanation:
Osgood Schlatters disease is a traction phenomenon resulting from repetitive quadriceps contraction through the patellar tendon at its insertion upon the skeletally immature tibial tubercle.
This occurs in preadolescence during a time when the tibial tubercle is susceptible to strain.
OSD is a very common cause of knee pain in children aged 10-15 years.
Q-2. Charlie Chaplin gait is seen in
a) Congenital coxa vara
b) Tibial torsion
c) Genu valgus
d) CDH
Answer: Tibial torsion
Explanation:
Charlie – Chaplin gait: Occurs in tibial torsion.
Circumduction gait: Occurs in hemiplegia
High stepping gait: Occurs in foot drop
Q-3. Keller’s operation done for
a) Hallux valgus
b) Hallux varus
c) Genu varus
d) CTEV
Answer: Hallux valgus
Explanation:
The Keller procedure is an excision arthroplasty of the 1st MTP joint, which can be used for both Hallux rigidus and valgus.
Hallux valgus is considered to be a medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux, with or without medial soft-tissue enlargement of the first metatarsal head.
Q-4. Hawkins sign denotes
a) Retained vascularity
b) Decreased vascularity
c) Non union
d) Avascular necrosis
Answer: Retained vascularity
Explanation:
The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view.
The Hawkins sign is a good indicator of talus vascularity following fracture.
Q-5. Tumor sensitive to NSAID is
a) Osteosarcoma
b) Osteoclastoma
c) Osteoid osteoma
d) Bone cyst
Answer: Osteoid osteoma
Explanation:
Osteoid osteoma is a benign osteoblastic tumor. Osteoid osteoma can occur anywhere. Osteoid osteoma is reported to occur in the cortex of the shafts of long bones. The lower extremities are the most common sites of osteoid osteomas.
It can cause pain (usually worse at night, reflecting increased nocturnal prostaglandin-mediated inflammation).
Pain is typically relieved by mild NSAIDs that target prostaglandins.
Characteristic appearance on imaging studies is a small radiolucent zone surrounded by a larger sclerotic zone.
Q-6. Most common site of Osteogenic sarcoma is
a) Upper end of femur
b) Lower end of femur
c) Upper end of tibia
d) Lower end of tibia
Ans: b
Explanation:
Osteosarcoma derives from primitive bone-forming mesenchymal cells and is the most common primary bone malignancy.
Osteosarcoma commonly occurs in the long bones of the extremities near the metaphyseal growth plates.
The most common sites are the femur (42%, with 75% of tumors in the distal femur), the tibia (19%, with 80% of tumors in the proximal tibia), and the humerus (10%, with 90% of tumors in the proximal humerus).
Q-7. Carpel tunnel syndrome is due to compression of
a) Radial nerve
b) Ulnar nerve
c) Median nerve
d) Palmar branch of the ulnar nerve
Ans: c
Explanation:
Flexor Retinaculum
Flexor retinaculum is a strong fibrous band which bridges the anterior concavity of the anterior concavity of the carpus and converts it into a tunnel, the carpal tunnel.
The structures passing deep to the flexor retinaculum are: (i) the median nerve, (ii) the tendons of the flexor digitorum superficialis, (iii) the tendons of the flexor digitorum profundus, (iv) the tendon of the flexor pollicis longus, (v) the ulnar bursa, and (v) the radial bursa.
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.
Q-8. Kinebock’s disease due to avascular necrosis of
a) Femoral neck
b) Median cuneiform bone
c) Lunate bone
d) Scaphoid bone
Ans: c
Explanation:
Kinebock’s disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted.
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called Osteo-necrosis.
Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.
Q-9. Tuberculosis of spine commonly effects all of the following parts of vertebra except
a) Body
b) Lamina
c) Spinous process
d) Pedicle
Ans: c (?)
Explanation:
There are four common sites of vertebral tuberculosis: para-discal type, central type, anterior type, appendicial type.
Spinal tuberculosis is initially apparent in the anterior inferior portion of the vertebral body. Later on it spreads into the central part of the body or disk.
Para-discal, anterior, and central lesions are the common types of vertebral involvement. In the central lesion, the disk is not involved, and collapse of the vertebral body produces vertebra plana.
Appendicial lesion: Isolated Pedicles & laminae (neural arch), transverse processes & spinous process are the uncommon types of vertebral involvement.
In younger patients, the disk is primarily involved because it is more vascularized. In old age, the disk is not primarily involved because of its age-related avascularity.
In spinal tuberculosis, there is involvement of more than one vertebra because its segmental arteries bifurcate to supply two adjacent vertebrae. Spread of the disease beneath the anterior or posterior longitudinal ligaments involves multiple contiguous vertebrae.
Q-10. Heberden’s arthropathy affects
a) Lumbar spine
b) Symmetrical large joints
c) Sacro-iliac joints
d) Distal interphalangeal joints
Ans: d
Explanation:
Heberden’s nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP). They are a sign of osteoarthritis.
Bouchard’s nodes may also be present; these are similar bony growths in the proximal interphalangeal (PIP) joints and are also associated with osteoarthritis.
Q-11. Rugger Jersey spine is seen in
a) Fluorosis
b) Achondroplasia
c) Marfan’s syndrome
d) Renal Osteo-dystrophy
Ans: d
Explanation:
Renal Osteo-dystrophy is the constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure, due to concurrent and superimposed:
Osteomalacia/ rickets
Secondary hyperparathyroidism (abnormal calcium and phosphate metabolism)
Aluminum intoxication, e.g. if the patient is on dialysis
Radiographic features
Imaging findings
Osteopaenia: often seen early
Thinning of cortices and trabeculae
Salt and pepper skull
Sub-periosteal re-sorption: characteristic sub-periosteal re-sorption may be seen on radial aspects of middle phalanges of index and long fingers.
Rugger-jersey spine: sclerosis of the vertebral body end plates
Demineralization
Soft tissue calcification
Amyloid deposition
Fractures
Q-12. Which of the following is a marker of new bone formation?
a) Acid phosphatase
b) Alkaline phosphatase
c) Telo-peptidase
d) Hydroxy-proline
Answer: Alkaline phosphatase
Explanation:
List of bone formation markers is as follows:
Serum total alkaline phosphatase
Serum bone–specific alkaline phosphatase
Serum osteocalcin
Serum type 1 pro-collagen (C-terminal/N-terminal): C1NP or P1NP
List of bone re-sorption markers is as follows:
Urinary hydroxy-proline
Urinary total pyridinoline (PYD)
Urinary free deoxy-pyridinoline (DPD)
Urinary collagen type 1 cross-linked N-telo-peptide (NTX)
Urinary or serum collagen type 1 cross-linked C-telo-peptide (CTX)
Bone sialo-protein (BSP)
Tartrate-resistant acid phosphatase 5b
Q-13. Autologous bone graft is commonly taken from
a) Tibial tuberosity
b) Iliac crest
c) Greater trochanters
d) Fibula
Answer: Iliac crest
Explanation:
Autogenous bone grafting is often done in orthopedic surgery for a variety of conditions. The iliac crest is currently the most common donor site for obtaining autogenous bone graft.
The ilium has been identified as an excellent source of both cortical and cancellous bone. Both the anterior and posterior portions of the iliac crest are often used for the purpose of bone grafting.
Autologous bone is typically harvested from extra-oral sources as the iliac crest, the fibula, the ribs, the mandible and even parts of the skull or intra-oral sources as the chin.
Bone can be harvested in oral and maxillofacial surgery, from the mandibular symphysis (chin area) or anterior mandibular ramus (the coronoid process); this is particularly true for block grafts, in which a small block of bone is placed whole in the area being grafted.
Q-14. 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-15. 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-16. 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”.