Q-1. An elderly female is on treatment with alendronate for 7 years. She now presents with complaints of pain in the thigh. The best investigation for her would be
a) X-ray
b) DEXA
c) Vitamin D levels
d) ALP levels
Answer: X-ray
Explanation:
Long term alendronate therapy and pain in thigh> Spontaneous or low impact fracture in femoral sub-trochanteric or diaphyseal region> X-Ray of thigh to confirm diagnosis
Q-2. An elderly female falls and is diagnosed with Colle’s fracture. After proper treatment, she now complains of stiffness and severe pain in the wrist with cold sensation and cyanosis of the finger. X-ray of the hand shows spotty de-ossification. She is most likely suffering from
a) Tubercular arthritis
b) Traumatic tenosynovitis
c) Sudeck’s dystrophy
d) Non union
Answer: Sudeck’s dystrophy
Explanation:
Complex regional pain syndrome or Sudeck’s atrophy:
This condition is often the result of trauma or surgery.
Complex regional pain syndrome type 1 occurs in the absence of definable nerve injury while Type 2 develops after nerve injury.
Pain, often burning in nature, is one of the first symptoms that initially limits function.
Swelling, redness with vasomotor instability that worsens with dependency, hyperhidrosis, and coolness to the touch are common physical findings.
Pronounced demineralization in the underlying bony skeleton of the involved extremity
Q-3. A 22 year old young male suffered a left knee injury while playing football. On examination, there was anterior laxity in full extension but it was normal at 90º flexion. Which of the following is the most likely injured part?
a) Posterior cruciate ligament
b) Anterior horn of medial meniscus
c) Antero-medial bundle of ACL
d) Postero-lateral bundle of ACL
Answer: Postero-lateral bundle of ACL
Explanation:
The anterior cruciate ligament consists of two major fiber bundles, namely the antero-medial and postero-lateral bundle.
Antero-medial bundle is responsible for the posterior translation of the femur at 30 degrees flexion, and the Postero-lateral bundle resists hyperextension and prevents posterior translation of the femur in extension.
Important points:
Instability of knee joint in full extension> Damage of postero-lateral bundle of anterior cruciate ligament
Stability of knee joint at 90 degree of flexion> Normal function of antero-medial bundle of anterior cruciate ligament
Q-4. After trauma, lower limb is noted to be shortened with abduction and internal rotation. Which of the following type of hip dislocation is present?
a) Anterior
b) Posterior
c) Central
d) Lateral
Answer: Central
Explanation:
Posterior dislocation of the hip: Adduction, Internal rotation and flexion with limb shortening
Anterior dislocation of the hip: Abduction, External rotation and flexion with limb lengthening
Central fracture hip dislocation– Abducted or adducted and internally or externally rotated depending upon the type and extent of penetration into the pelvis with limb shortening
Fracture neck of femur– Adduction, External rotation and flexion
Q-5. A person was found lying in the right lateral position by the police. He had injuries on his right face, hand and on the right knee. Which of the following nerve injuries can explain the injuries caused in the patient?
a) Femoral nerve
b) Common peroneal nerve
c) Radial nerve
d) Trigeminal nerve
Answer: Femoral nerve
Explanation:
Q-6. A child presented with a fracture in his leg. He was admitted and was given Gallow’s traction. He is most likely suffering from fracture of
a) Neck of femur
b) Shaft of femur
c) Shaft of tibia
d) Supra-condylar femur
Answer: Shaft of femur
Explanation:
Gallows traction is useful for children younger than 2 years for Fracture shaft of femur.
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. Which of the following is true about supra-condylar fractures in children?
a) The neurological complications are transitory
b) Anterior displacement of the distal fragment is more common than posterior
c) Weakness of elbow flexion is a common complication
d) Cubitus valgus is more common than cubitus varus deformity
Answer: The neurological complications are transitory
Explanation:
Supra-condylar fractures are typically seen in younger children, and are uncommon in adults.
Typically supra-condylar fracture occurs as a result of a fall on a hyper-extended elbow or is caused by a fall on out-stretched hand.
The extension type fracture is commoner than flexion type. In this the distal fragment is extended or tilted backward in relation to proximal fragment.
Complications:
Mal-union (Commonest complication) – Resulting in cubitus varus (varus deformity of the elbow, also known as gunstock deformity)
Ischemic contracture (Volkmann contracture) due to damage / occlusion to the brachial artery and resulting in volar compartment syndrome
The radial nerve is the most commonly injured nerve and spontaneous recovery occurs in most cases.
Myositis ossificans
Q-8. A 2 year old child presents with rickets and limb deformity. He is treated with vitamin D and calcium. When is the best time for surgery to correct the limb deformity?
a) When serum calcium level becomes normal
b) When bone specific alkaline phosphatase is normal
c) When growth plate haling is seen on X-ray
d) When vitamin D level becomes normal
Answer: When bone specific alkaline phosphatase is normal
Explanation:
Orthopedic treatment should only be considered after complete biochemical and radiological healing of rickets.
Radiological improvement occurs in two to three weeks but serum alkaline phosphatase may not return to normal for many months.