FMGE 2018 - Orthopaedics PYQs Practice Questions

Q: Adamantinoma affects

Tibia. ***Tibia*** - **Adamantinoma** is a rare, malignant bone tumor that almost exclusively affects the **tibia**, accounting for over 90% of cases. - It often presents as a **slow-growing mass** associated with pain and swelling in the shin. *Humerus* - While other primary bone tumors can affect the humerus, adamantinoma is **extremely rare** in this location. - The humerus is more commonly affected by tumors like **osteosarcoma** or **Ewing sarcoma**. *Femur* - The femur is a common site for various bone tumors, but **adamantinoma is not typically found** here. - Tumors like **osteosarcoma** and **chondrosarcoma** are much more prevalent in the femur. *Radius* - Similar to the humerus and femur, the radius is **not a characteristic location** for adamantinoma. - Tumors of the radius are generally less common than in the major long bones. [Practice more Orthopaedics PYQs on OnCourse]

Q: Most common site of osteomyelitis in children

Metaphysis. ***Metaphysis*** - The **metaphysis** is the most common site for osteomyelitis in children due to its rich, **slow-flowing sinusoidal blood supply**, which facilitates bacterial seeding. - The **nutrient arteries** in the metaphysis make sharp loops, creating a turbulent flow that slows circulation and allows bacteria to lodge more easily. *Epiphysis* - The **epiphysis** is less commonly affected in children because its separate blood supply is not as prone to bacterial seeding as the metaphysis. - In infants, however, infection can spread from the metaphysis to the epiphysis and joint space due to **transphyseal vessels**. *Growth plate* - The **growth plate** itself is generally resistant to infection due to its avascular nature. - However, infection in the adjacent metaphysis or epiphysis can potentially disrupt its function. *Diaphysis* - While the **diaphysis** has a blood supply, it is less common for osteomyelitis to originate here compared to the metaphysis. - It usually occurs as a secondary spread from a metaphyseal infection or in specific scenarios like in **sickle cell disease**. [Practice more Orthopaedics PYQs on OnCourse]

Q: Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Recurrent shoulder dislocation. ***Recurrent shoulder dislocation*** - The ability to **spontaneously reduce** a shoulder dislocation, and the history of it happening "again and again" strongly indicate **recurrent shoulder dislocation**. - This condition often results from **ligamentous laxity** or damage to the **labrum** (Bankart lesion) that fails to stabilize the shoulder joint after an initial dislocation. *Inferior shoulder dislocation* - This is a **specific type of shoulder dislocation** (luxatio erecta) where the humeral head is displaced inferiorly, but "inferior" alone does not explain the recurrent nature. - While possible in an individual, the key element here is the **recurrence** and self-reduction, not just the direction of a single dislocation. *Fracture upper end humerus* - A fracture of the upper end of the humerus is a **bony injury** and would typically present with severe pain, swelling, and inability to move the arm, not spontaneous reduction. - This injury would usually **prevent** the patient from repeatedly dislocating and reducing their shoulder. *Acute shoulder dislocation* - An acute shoulder dislocation refers to a **single, recent episode** of dislocation. - The patient's repeated ability to self-reduce the shoulder indicates a chronic problem rather than an initial, isolated event. [Practice more Orthopaedics PYQs on OnCourse]

Q: Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Game keepers thumb. ***Gamekeeper's thumb*** - A **Gamekeeper's thumb**, or **skier's thumb**, is an injury to the **ulnar collateral ligament (UCL)** of the thumb's metacarpophalangeal (MCP) joint. - This injury commonly occurs due to a **forceful abduction** and hyperextension of the thumb. *Kaplan lesion* - A **Kaplan lesion** refers to an avulsion fracture of the radial styloid process, usually associated with scaphoid fractures. - This lesion is typically related to wrist injuries, not primarily thumb abduction. *Bennett fracture* - A **Bennett fracture** is an intra-articular fracture at the base of the first metacarpal bone. - It usually results from an axial load applied to a partially flexed thumb, rather than pure abduction. *Mallet finger* - A **mallet finger** is an injury to the **extensor tendon** of the finger, causing the fingertip to remain in a flexed position. - This injury typically affects the distal interphalangeal (DIP) joint of any finger and is not directly related to thumb abduction. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which of the following statements about tubercular osteomyelitis is NOT true?

Periosteal reaction is characteristic. ***Periosteal reaction is characteristic*** - This statement is **NOT true** for tubercular osteomyelitis; periosteal reaction is generally **minimal or absent** due to the insidious and less florid inflammatory response. - Unlike pyogenic osteomyelitis, which causes significant periosteal new bone formation, tuberculosis typically results in **slow bone destruction** without marked reactive bone changes. *Sequestrum is uncommon* - This statement is **true** because **sequestrum** (a piece of dead bone separated from healthy bone) is less frequently observed in tubercular osteomyelitis compared to pyogenic osteomyelitis. - The **granulomatous inflammation** of tuberculosis tends to cause slow bone necrosis rather than the rapid, liquefactive necrosis that leads to large sequestra. *It is a type of secondary osteomyelitis* - This statement is **true** as tubercular osteomyelitis is almost always secondary to a **primary focus of tuberculosis** elsewhere in the body, typically the lungs [1]. - The infection spreads **hematogenously** to the bone, making it a manifestation of disseminated tuberculosis rather than a primary bone infection [1]. *Inflammation is minimal* - This statement is **true** in the sense that the **acute inflammatory response** in tubercular osteomyelitis is often less pronounced than in pyogenic infections. - While it is a chronic infectious process, the characteristic **granulomatous inflammation** develops over time, and the initial or acute inflammatory signs might be subtle or "minimal" compared to bacterial osteomyelitis [1]. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

Adamantinoma affects

Accepted Answer

Tibia

Answer

Humerus

Answer

Femur

Answer

Radius

Question 2

Most common site of osteomyelitis in children

Accepted Answer

Metaphysis

Answer

Epiphysis

Answer

Growth plate

Answer

Diaphysis

Question 3

Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Accepted Answer

Recurrent shoulder dislocation

Answer

Inferior shoulder dislocation

Answer

Fracture upper end humerus

Answer

Acute shoulder dislocation

Question 4

Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Accepted Answer

Game keepers thumb

Answer

Kaplan lesion

Answer

Mallet finger

Answer

Bennett fracture

Question 5

Which of the following statements about tubercular osteomyelitis is NOT true?

Accepted Answer

Periosteal reaction is characteristic

Answer

Sequestrum is uncommon

Answer

It is a type of secondary osteomyelitis

Answer

Inflammation is minimal

Question 6

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 7

Blount Disease is involvement of

Accepted Answer

Proximal tibia

Answer

Distal femur

Answer

Distal tibia

Answer

Proximal femur

Question 8

Primary osteoarthritis affects all except:

Accepted Answer

Metacarpophalangeal joint

Answer

Hip Joint

Answer

Distal interphalangeal joint

Answer

Knee joint

Question 9

79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Accepted Answer

Hemiahroplasty

Answer

Hip spica

Answer

Nailing

Answer

Total Hip Replacement

Question 10

Blow out fracture can be due to:

Accepted Answer

Tennis ball injury

Answer

Punch at the chin from below

Answer

Sudden fall

Answer

Chisel and hammer injury

FMGE 2018 — Orthopaedics