Q-1. A newborn child presents with inverted foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is
a) Congenital vertical talus
b) Arthrogryposis multiplex
c) CTEV
d) Flat foot
Answer: CTEV
Explanation:
Dorsi-flexion test:
In a newborn child, the dorsum of foot can be brought in contact with the tibia anteriorly by passive dorsi-flexion but not in CTEV.
Q-2. A patient met with road traffic accident with injury to the left knee. Dial test was positive. What could be the cause?
a) Medial collateral ligament injury
b) Postero-lateral corner injury
c) Lateral meniscus tear
d) Medial meniscal injury
Answer: Postero-lateral corner injury
Explanation:
Dial test or tibial external rotation test:
Dial test is the test for postero-lateral instability.
More than 10 degree external rotation asymmetry at 30 degree only consistent with isolated postero-lateral corner injury
More than10 degree external rotation asymmetry at 30 degree & 90 degree consistent with postero-lateral corner and posterior cruciate ligament injury
Q-3. A middle aged lady presents with complaints of lower back pain. On examination there is weakness of extension of right great toe with no sensory impairment. An MRI of the lumbo-sacral spine would most probably reveal a prolapsed inter-vertebral disc at what level?
a) L3-L4
b) L4-L5
c) L5-S1
d) S1-S2
Answer: L4-L5
Explanation:
Neurological deficit in disc prolapse:
L3-4 (L4 root):
Motor weakness: Weakness of extensor of knee
Sensory loss: Over great toe and medial side of the leg
Reflexes: Knee jerk sluggish or absent
L4-L5 (L5 root):
Motor weakness: Weakness of EHL and dorsi-flexion of the foot
Sensory loss: Over dorsum of foot and lateral side of leg
Reflexes: Ankle jerks normal
L5-S1 (S1 root):
Motor weakness: Weakness of plantar-flexors of the foot
Sensory loss: Over lateral side of foot
Reflexes: Ankle jerks normal or sluggish
Q-4. 8 year old child has fever with pain and swelling in mid-thigh. Lamellated appearance and Codman’s triangle is seen on X-Ray. Histopathology shows small round cell tumor positive for MIC-2. Diagnosis is
a) Osteo-sarcoma
b) Ewing’s sarcoma
c) Chondro-blastoma
d) Multiple myeloma
Answer: Ewing’s sarcoma
Explanation:
Ewing’s sarcoma:
Peak incidence in the second decay of life
MIC-2 is a specific marker for Ewing’s sarcoma and peripheral primitive neuro-ectodermal tumors.
Glycogen filled cytoplasm detected by staining with periodic acid Schiff is also characteristic of Ewing’s sarcoma cells.
The plain radiograph may show a characteristic onion peel periosteal reaction with a generous soft tissue mass.
Codman’s triangle although typical of osteosarcoma, can also be seen in Ewing’s sarcoma.
Q-5. An old lady had a history a fall in bathroom once and couldn’t move. Afterwards she had leg in externally rotated position. There was tenderness in Scarpa’s triangle and limb movement could not been done due to pain. No hip fracture was seen on X-ray. Next step
a) MRI
b) Repeat X-ray after one week
c) Joint aspiration
d) Give analgesic and manipulate
Answer: MRI
Explanation:
Impacted fracture of neck femur:
Impacted fracture may be extremely difficult to discern on plain X-ray.
If standard radiograph findings are negative and hip fracture still is strongly suspected, MRI and bone scan have high sensitivity in identifying impacted fracture.
Q-6. Gallow’s traction is used or fracture
a) Shaft femur
b) Neck femur
c) Shaft tibia
d) Tibial tuberosity.
Answer: Shaft femur
Explanation:
Gallows traction is useful for children younger than 2 years for Fracture shaft of femur (Weight must not be more than 12 kgs).
The traction should be enough to just lift the buttocks of the child off the bed. Body weight provides counter traction and fracture is reduced.
Older children have a risk of compartment syndrome, vascular insufficiency, peroneal nerve palsy, and skin breakdown when treated with this method.
Q-7. A patient comes to the emergency department after alcohol binge previous night and sleeping on arm chair. In the morning he is unable to move his hand and diagnosis of ulnar nerve palsy is made. What is the next line of management?
a) Wait and watch
b) Knuckle bender splint
c) Immediately operate and explore the nerve
d) Do EMG study after 2 days
Answer: Knuckle bender splint
Explanation:
Neuropraxia of nerve:
Mildest form of nerve injury
Reversible physiological nerve conduction block
Recovery occurs spontaneously within week and is complete.
Recovery occurs spontaneously within weeks and is complete.
Splint is used to maintain a relaxed position of the paralyzed muscle.
Nerve injured and respective splint:
Axillary nerve- Shoulder abduction splint
Radial nerve palsy- Cock up splint
Ulnar nerve palsy- Knuckle bender splint
Sciatic nerve palsy or common nerve palsy- Foot drop splint
Q-8. A person is able to abduct his arm, internally rotate it, place the back of hand on the lumbo-sacral joint but is not able to lift it from back. What is the etiology?
a) Sub-scapularis tendon tear
b) Teres major tendon tear
c) Long head of biceps tendon tear
d) Acromio-clavicular joint Dislocation
Answer: Sub-scapularis tendon tear
Explanation:
Gerber’s test (Lift-off test):
Place the shoulder to be examined in extension and internal rotation with the hand on the back (elbow at 90 degree).
Then, ask the patient to lift hand from back. The inability to perform the maneuver indicates an altered test, and probable inflammation/rupture of the sub-scapular tendon.