Q-1. A young male after sudden unconsciousness on awakening finds that both of his arms were adducted and internally rotated. The most probable diagnosis is
a) Anterior dislocation
b) Posterior dislocation
c) Inferior dislocation
d) Rotator cuff injury
Answer: Posterior dislocation
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-2. Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to
a) Deltoid ligament
b) Anterior talo-fibular ligament
c) Calcaneo-fibular ligament
d) Posterior talo-fibular ligament
Answer: Anterior talo-fibular ligament
Explanation:
The anterior talo-fibular ligament and the Calcaneo-fibular ligament are sequentially the most commonly injured ligaments when a plantar-flexed foot is forcefully inverted.
The posterior talo-fibular ligament is rarely injured, except in association with a complete dislocation of the talus.
Q-3. 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-4. A young man involved in a fist-cuff, injured his middle finger and noticed slight flexion of DIP joint. X-rays were normal the most appropriate management at this stage is
a) Ignore
b) Splint the finger in hyperextension
c) Surgical repair of the flexor tendon
d) Buddy strapping
Answer: Splint the finger in hyperextension
Explanation:
Mallet finger or baseball finger:
Results from the sudden passive flexion of the distal inter-phalangeal join so that the extensor tendon of the distal inter-phalangeal (DIP) joint is avulsed from its insertion at the base of the distal phalanx.
Sometime it takes a fragment of bone with it.
Clinically distal phalanx is in slight flexion.
Treatment is by immobilizing the DIP joint in hyperextension
Q-5. A 12 years old boy presents with a central expansile cystic lesion without any periosteal reaction in proximal humerus on X ray. All of the following can be done for his treatment except
a) Radiotherapy
b) Curettage
c) Intralesional steroids
d) Intralesional sclerosing agents
Answer: Radiotherapy
Explanation:
The simple bone cyst is a common, benign, fluid-containing lesion, most commonly found in the metaphysis of long bones, typically the proximal humerus or femur.
Pathologic fractures are common, often with minor trauma.
These cysts are not typically associated with bone tumors.
X-Ray findings of simple bone cyst:
Radiolucent, centrally located, well circumscribed lesion with sclerotic margins
No periosteal reaction
Treatment:
Small asymptomatic lesions: Observation with serial plain radiography
Large symptomatic lesions: Aspiration and injection or curettage
Q-6. Denis stability concept is based on which of the following?
a) 2 Column concept
b) 3 column concept
c) 4 column concept
d) 5 column concept
Answer: 3 column concept
Explanation:
Denis’ Three-Column Theory:
Proposed by Francis Denis, three-column concept divides a spinal segment into three parts: anterior, middle, and posterior columns.
The anterior column comprises the anterior longitudinal ligament and the anterior half of the vertebral body; the middle column comprises the posterior half of the vertebral body and the posterior longitudinal ligament; the posterior column comprises the pedicles, the facet joints and the supra-spinous ligaments.
Each column has different contribution to stability, and their damages may affect stability differently.
Generally, if two or more of these columns are damaged, then the spine is unstable. However, it depends on the characteristics of the fracture.
Q-7. A pedestrian is hit by a moving vehicle on the lateral aspect of the knee. On x-ray a fracture line is seen running through the inter-condylar eminence. Which of the following structures will most likely be injured?
a) Medial collateral ligament
b) Lateral collateral ligament
c) Medial meniscus
d) Anterior cruciate ligament
Answer: Anterior cruciate ligament
Explanation:
Fractures of the tibial inter-condylar eminence are commonly associated with injury to anterior cruciate ligament.
Fractures of the tibial inter-condylar eminence are observed mostly in children and adolescents, often after minimal trauma; good results are expected with treatment by anatomic reduction.
Q-8. A 7 yrs old child presents with fever and swelling of tibia. ESR and TLC both are raised. Plain X-ray shows periosteal reaction. The next best investigation should be
a) Bone biopsy
b) MRI
c) Blood culture
d) Pus culture
Answer: MRI
Explanation:
Investigations of Osteomyelitis:
Blood examination
X-Ray
CT/MRI: MRI is modality of choice when imaging other than plain radiography is needed to establish the diagnosis of osteomyelitis or delineate the location and extent of bone involvement.
A confirm diagnosis can only be established by biopsy of the lesion.
Important point:
Increased ESR and lymphocytic Leukocytosis in case of tuberculosis
Well defined area of bone destruction typically with minimal reactive bone formation in tuberculosis
Periosteal reaction present in osteomyelitis
Q-9. A 2 yr 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 healing 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.