Q-1. A 24 year old college student while playing hockey injured his right knee. This patient presents after 3 months with instability of knee joint in full extension without instability at 90 degree of flexion. The structure most commonly damaged is
a) Postero-lateral bundle of anterior cruciate ligament
b) Antero-medial bundle of anterior cruciate ligament
c) Posterior cruciate ligament
d) Anterior horn of medical meniscus
Answer: Postero-lateral bundle of anterior cruciate ligament
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-2. Which of the following is true about supra-condylar fracture of humerus?
a) Distal segment is dislocated anteriorly more than posterior
b) Cubitus valgus more common than cubitus varus during mal-union
c) Nerve injury related manifestations are transitory
d) Injury causes weakness of elbow flexion
Answer: Nerve injury related manifestations 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-3. In 2 year old child gallows traction is applied. Child is suffering from fracture of
a) Neck of femur
b) Greater trochanter of femur
c) Fracture shaft of femur
d) Shaft of tibia
Answer: Fracture 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-4. A 7 years old child comes with fever and tibial swelling exhibits on X-ray exhibits periosteal reaction. Laboratory results show raised ESR and TLC. What is the next step in diagnosis of the patient?
a) MRI
b) Pus culture
c) Bone biopsy
d) Blood 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-5. Which of the following is not a cause of clubfoot in newborns?
a) CTEV
b) Arthrogryposis Multiplex Congenita
c) Polio
d) Spina bifida
Answer: Polio
Explanation:
Common deformity in lower limb in poliomyelitis:
Quadriceps femoris paralysis
Flexion contracture of knee
Genu recurvatum
Flail knee
Equinus
Cavus
Ankle and sub-talar valgus
Important point:
Polio doesn’t cause clubfoot in newborn.
Q-6. A 40 years old man presented with acute onset and swelling of left great toe. On X-ray punched out lytic lesion is seen on phalanx with sclerotic margins and overhanging bony edges diagnosis is
a) Gout
b) Rheumatoid arthritis
c) Psoriatic arthritis
d) Reiter’s syndrome
Answer: Gout
Explanation:
Gout:
Accumulation of sodium biurate crystals in some soft tissues such as cartilage, tendon and bursa
Patient usually beyond 40 years of age
MP joint of the big toe being a favorite site
Bursitis- Commonly of the olecranon bursa
Tophi formation deposit of uric acid salt in the soft tissue
X-Ray finding: A punched out lytic lesion with sclerotic margins and overhanging bony edges
Q-7. Both bone and disc spaces are destroyed in
a) Tuberculosis
b) Metastasis
c) Lymphoma
d) Multiple myeloma
Answer: Tuberculosis
Explanation:
Tuberculosis of spine:
Early infection shows involvement of anterior vertebral body with sparing of disc space.
Late infection shows disc space destruction, lucency and compression of adjacent vertebral bodies.
Radiological examination:
Destruction of vertebral body
Reduction of disc space
Para-vertebral cold abscess
Rarefaction of the vertebrae above and below the lesion
Q-8. All of the following are true regarding osteoporosis except
a) Calcitonin decreases pain
b) Bisphophonates are work worse for treatment
c) T-score <1.5 in osteoporosis
d) PTH is used in severe osteoporosis
Answer: T-score <1.5 in osteoporosis
Explanation:
The T-score:
The T-score is a comparison of a person’s bone density with that of a healthy 30-year-old of the same sex.
Osteoporosis: A T-score of -2.5 or lower
Osteopenia: A T-score of -1.0 to -2.5
Normal is a T-score of −1.0 or higher