FMGE 2025 — Orthopaedics
11 Previous Year Questions with Answers & Explanations
A 23 year old male epileptic patient presented with pain in right shoulder region. Examination revealed that right upper limb was abducted and externally rotated and the movements could not be performed. Which of the following is the most likely diagnosis?
A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?
Which nerve will be involved in the following finding at rest?
Identify the instrument shown in the image:
A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?
A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?
A young adult patient presents with a fracture of the neck of the femur. What is the most appropriate management?
A patient presents with a ring-shaped (lytic) lesion in the bone. Which of the following is the most likely diagnosis?
An elderly woman involved in a road traffic accident presents with difficulty in breathing and altered mental status. D-Dimer is elevated. X-ray shows a long bone fracture. What is the most likely diagnosis?
The provided image displays a fracture. Based on the X-ray, identify the type of fracture shown.
FMGE 2025 - Orthopaedics FMGE Practice Questions and MCQs
Question 1: A 23 year old male epileptic patient presented with pain in right shoulder region. Examination revealed that right upper limb was abducted and externally rotated and the movements could not be performed. Which of the following is the most likely diagnosis?
- A. Luxation erecta
- B. Intrathoracic dislocation of shoulder
- C. Subglenoid dislocation of shoulder (Correct Answer)
- D. Posterior dislocation of shoulder
Explanation: ***Subglenoid dislocation of shoulder*** - The presentation of the upper limb held in **abduction** and **external rotation** is the hallmark clinical finding of an **anterior shoulder dislocation**, of which the **subglenoid type** is the most frequent variant. - Subglenoid dislocation accounts for approximately **60-75% of anterior dislocations** and occurs when the humeral head displaces anteriorly and inferiorly to rest below the glenoid fossa. - Although the patient has a history of **epilepsy** (a common cause of posterior dislocation during seizures), the current physical examination findings definitively point to an **anterior presentation**. *Incorrect: Posterior dislocation of shoulder* - **Posterior dislocation** is most commonly associated with events causing unopposed muscle contraction, such as **seizures**, **electric shock**, and **electroconvulsive therapy**. - However, the typical clinical presentation of a posterior dislocation is the arm held in **adduction** and **internal rotation**, directly contradicting the observed **external rotation** in this case. - Posterior dislocations represent only **2-4% of all shoulder dislocations**. *Incorrect: Luxation erecta* - This is an unstable **inferior shoulder dislocation** where the arm is fixed in a position of **extreme abduction** (pointing straight overhead, typically >110-160 degrees). - The humeral head is displaced inferiorly with the humeral shaft positioned vertically. - While it involves abduction, the specific combination of **abduction and external rotation** without explicit maximal elevation fits better with the common anterior (subglenoid) dislocation. *Incorrect: Intrathoracic dislocation of shoulder* - This is an **extremely rare** and severe type of shoulder dislocation resulting from massive trauma, where the humeral head penetrates the chest cavity. - It is not typically associated with muscle contractions from seizures and presents with **dramatic symptoms** including respiratory compromise and hemodynamic instability. - This diagnosis would require high-energy trauma and is inconsistent with the clinical presentation.
Question 2: A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?
- A. Osteosarcoma (Correct Answer)
- B. Ewing sarcoma
- C. Chondrosarcoma
- D. Gout
Explanation: ***Osteosarcoma*** - The X-ray shows a classic **sunburst appearance**, which represents spiculated periosteal new bone formation radiating outwards, a hallmark of osteosarcoma. - This diagnosis is supported by the patient's age (peak incidence in adolescence/young adulthood) and the tumor's location in the **metaphysis** of a long bone (distal tibia). *Ewing sarcoma* - This tumor typically presents with a lytic lesion and a lamellated, **"onion-skin" periosteal reaction**, which is different from the sunburst pattern seen here. - Ewing sarcoma most commonly arises in the **diaphysis** (shaft) of long bones or in flat bones like the pelvis. *Chondrosarcoma* - This is a malignant cartilage-forming tumor that typically affects older adults (usually >40 years), making it less likely in a 20-year-old. - Radiographically, it is characterized by **"ring-and-arc"** or **"popcorn" calcifications** within the tumor matrix, which are absent in this image. *Gout* - Gout is a form of inflammatory arthritis, not a bone tumor, and would present with acute joint pain and swelling rather than a gradual mass effect. - Radiographic findings in chronic gout include characteristic **"punched-out" erosions** with overhanging edges, which are completely different from the aggressive, bone-forming lesion shown.
Question 3: Which nerve will be involved in the following finding at rest?
- A. Ulnar (Correct Answer)
- B. Median
- C. Musculocutaneous
- D. None
Explanation: ***Ulnar*** - The image displays a classic **Ulnar Claw Hand**, a deformity that occurs at rest due to ulnar nerve palsy. It specifically affects the 4th and 5th digits. - This is caused by paralysis of the medial two **lumbricals** (3rd and 4th) and the **interossei** muscles, leading to unopposed extension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints of the ring and little fingers. *Median* - A **median nerve** injury typically results in an **“Ape Hand”** deformity (thenar atrophy) or a **“Hand of Benediction”** when the patient tries to make a fist, affecting the 1st, 2nd, and 3rd digits. - It does not cause the clawing of the 4th and 5th digits seen in the image. *Musculocutaneous* - The **musculocutaneous nerve** innervates the muscles of the anterior compartment of the arm, such as the **biceps brachii** and **brachialis**. - Injury to this nerve would lead to weakness in elbow flexion and supination, not a deformity of the hand. *None* - The deformity shown is a well-known clinical sign directly linked to a specific peripheral nerve injury. - As the presentation is characteristic of an ulnar nerve palsy, this option is incorrect.
Question 4: Identify the instrument shown in the image:
- A. Bohler braun splint (Correct Answer)
- B. Thomas splint
- C. Volkmann splint
- D. Cramer wire
Explanation: ***Bohler braun splint*** - The instrument shown is a **Bohler-Braun splint** (or frame), which is used to apply skeletal traction for fractures of the lower limb, particularly the **femur** and **tibia**. - Its design allows the limb to be elevated with the knee in a flexed position, which helps relax the muscles and facilitates the reduction of the fracture through a system of pulleys and weights. *Thomas splint* - A **Thomas splint** is primarily used for first-aid immobilization of **femoral shaft fractures**. It consists of a padded ring that fits into the groin and two long metal rods. - It provides fixed traction but does not have the elaborate pulley and frame system for bed-based skeletal traction seen in the image. *Volkmann splint* - A **Volkmann splint** is a type of gutter splint used for injuries to the **forearm, wrist, and hand**, not the lower leg. - It is specifically designed to prevent **Volkmann's ischemic contracture**, a deformity resulting from compartment syndrome in the forearm. *Cramer wire* - A **Cramer wire splint** is a flexible, ladder-like splint made of wire that can be bent and molded to fit a limb for temporary immobilization. - It is used for emergency splinting and is not strong enough to provide the definitive skeletal traction required for major long bone fractures.
Question 5: A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?
- A. Rheumatoid arthritis
- B. Gout
- C. Subdermal abscess
- D. Housemaid's knee (Correct Answer)
Explanation: ***Housemaid's knee*** - This condition, also known as **prepatellar bursitis**, involves inflammation and fluid accumulation in the bursa located directly in front of the patella, matching the MRI findings and the patient's clinical presentation. - It is frequently associated with occupations that require prolonged kneeling, such as being a laborer, leading to chronic irritation and swelling in this specific location. *Subdermal abscess* - A subdermal abscess would typically present with more pronounced signs of infection, such as significant warmth, **erythema** (redness), and systemic symptoms like fever, which are not mentioned in this case. - On MRI, an abscess often shows a more complex fluid collection with **rim enhancement** after contrast administration, distinguishing it from the simple bursal fluid seen here. *Gout* - Gout is an **intra-articular** arthritis caused by **urate crystal** deposition, which would cause swelling within the knee joint itself, not a localized collection in front of the patella. - The classic presentation is an acute, intensely painful, and red joint, most commonly the first **metatarsophalangeal joint** (podagra), which differs from this patient's presentation. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic inflammatory condition that typically causes **symmetric polyarthritis** of small joints in the hands and feet. - While it can affect the knee, it causes an **intra-articular** effusion (swelling within the joint space) and synovitis, not isolated prepatellar bursitis.
Question 6: A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?
- A. Aneurysmal bone cyst (Correct Answer)
- B. Giant cell tumor
- C. Chondroblastoma
- D. Osteosarcoma
Explanation: ***Aneurysmal bone cyst*** - This diagnosis is highly suggested by the patient's age (young adult) and the finding of an **expansile and lytic metaphyseal lesion** in a long bone like the distal radius. - The fine needle aspiration finding of a bloody aspirate containing numerous **hemosiderin-laden macrophages** is characteristic, reflecting the hemorrhagic, non-neoplastic, multicystic nature of an aneurysmal bone cyst (ABC). *Giant cell tumor* - While GCT is also lytic and occurs in young adults, it classically arises in the **epiphysis** (subarticular region) of long bones, especially around the knee (distal femur, proximal tibia). - Histologically, GCT shows numerous evenly distributed **multinucleated giant cells** and mononuclear stromal cells, which would dominate the aspirate rather than just blood and macrophages. *Osteosarcoma* - Osteosarcoma is typically an aggressive malignant tumor that often presents with mixed lytic and **sclerotic** features and frequently shows significant periosteal reaction (e.g., **Codman triangle** or **sunburst pattern**). - Cytology would reveal highly **anaplastic malignant cells** actively producing osteoid, which is the defining characteristic. *Chondroblastoma* - This is an uncommon benign tumor that characteristically arises in the **epiphysis** of long bones (e.g., proximal humerus, femoral condyles). - Histology is defined by compact polygonal cells called **chondroblasts** often surrounded by deposits of **chondroid matrix** and characteristic **"chicken-wire" calcification**. - The metaphyseal location and bloody aspirate with hemosiderin-laden macrophages do not fit this diagnosis.
Question 7: A young adult patient presents with a fracture of the neck of the femur. What is the most appropriate management?
- A. Internal fixation (Correct Answer)
- B. Total hip replacement
- C. External fixation
- D. Hemiarthroplasty
Explanation: ***Internal fixation*** - This is the treatment of choice in young adults to **preserve the native femoral head**, which is crucial for long-term function and avoiding prosthetic complications. - It involves stabilizing the fracture with hardware like **cannulated screws** or a **sliding hip screw**, promoting bone healing while maintaining the patient's own joint. *External fixation* - Primarily used for **temporary stabilization** in polytrauma patients or for highly comminuted or open fractures, not as a definitive treatment for a simple femoral neck fracture. - It provides less rigid fixation compared to internal methods and carries a significant risk of **pin-site infections**. *Hemiarthroplasty* - This procedure, which replaces only the femoral head, is typically reserved for **elderly patients** with displaced fractures and lower functional demands. - In a young, active patient, it can lead to **acetabular erosion** and pain, making preservation of the native joint the preferred approach. *Total hip replacement* - Reserved for patients with pre-existing severe **osteoarthritis** or for some active elderly patients, not for an acute fracture in a young individual. - Due to the **limited lifespan of the prosthesis**, performing a total hip replacement in a young patient would likely necessitate multiple complex **revision surgeries** in the future.
Question 8: A patient presents with a ring-shaped (lytic) lesion in the bone. Which of the following is the most likely diagnosis?
- A. Aneurysmal bone cyst
- B. Simple bone cyst
- C. Osteoid osteoma
- D. Brodie's abscess (Correct Answer)
Explanation: ***Brodie's abscess*** - This is a localized, subacute or chronic form of **osteomyelitis** that presents radiographically as a well-circumscribed, **lytic lesion** with a thick, **sclerotic** rim, perfectly matching the “ring-shaped” appearance in the image. - It most commonly affects the **metaphysis** of long bones, particularly the tibia, and is often caused by *Staphylococcus aureus*. *Simple bone cyst* - A **simple bone cyst** (or unicameral bone cyst) is a fluid-filled lesion that typically appears as a central, lytic lesion causing **cortical thinning**, but it usually lacks the prominent sclerotic margin seen in a Brodie's abscess. - It is most common in the proximal **humerus** and **femur** of children and may show a **"fallen leaf" sign** if a pathological fracture has occurred. *Aneurysmal bone cyst* - An **aneurysmal bone cyst** (ABC) is a blood-filled, **expansile** lytic lesion that often has a multiloculated or **"soap bubble"** appearance on radiographs. - Unlike the contained lesion shown, an ABC is typically more aggressive, causing significant bony expansion and cortical thinning. *Osteoid osteoma* - An **osteoid osteoma** is a benign bone tumor characterized by a small radiolucent **nidus** (less than 1.5 cm) surrounded by a large area of extensive, dense reactive **sclerosis**. - Clinically, it is associated with characteristic **night pain** that is promptly relieved by **NSAIDs**, a key diagnostic feature not mentioned here.
Question 9: An elderly woman involved in a road traffic accident presents with difficulty in breathing and altered mental status. D-Dimer is elevated. X-ray shows a long bone fracture. What is the most likely diagnosis?
- A. Fat embolism (Correct Answer)
- B. Pulmonary embolism
- C. Infection
- D. Gas gangrene
Explanation: ***Fat embolism*** - The patient's presentation of **respiratory distress** (difficulty breathing) and **altered mental status** following a significant long bone fracture (femur, as seen on X-ray) is classic for **Fat Embolism Syndrome (FES)**. - This syndrome occurs when fat globules from the fractured bone marrow enter the bloodstream, leading to microvascular occlusion and inflammation in the lungs and brain. An elevated **D-Dimer** is also a common, albeit non-specific, finding. *Gas gangrene* - This is a rapidly progressing soft tissue infection caused by **Clostridium perfringens**, characterized by severe pain, swelling, **crepitus** (gas in tissues), and foul-smelling discharge at the wound site, which are not described here. - The primary symptoms in this case are systemic (pulmonary and neurological), not localized to the fracture site with signs of a necrotizing infection. *Infection* - While infection is a risk with fractures, the acute onset of severe respiratory and neurological symptoms is not a typical presentation for a post-traumatic wound infection or **osteomyelitis**. - Sepsis could cause these symptoms, but FES is a more direct and common complication specifically linked to the mechanics of a long bone fracture in the immediate post-trauma period. *Pulmonary embolism* - A pulmonary **thromboembolism** (from a blood clot) is a valid concern after trauma and can cause shortness of breath and an elevated D-Dimer. - However, the prominent **altered mental status** is less characteristic of a typical pulmonary embolism and points more strongly towards the cerebral effects of fat microemboli in FES.
Question 10: The provided image displays a fracture. Based on the X-ray, identify the type of fracture shown.
- A. Intertrochanteric fracture (Correct Answer)
- B. Pubic rami fracture
- C. Femoral neck fracture
- D. Subtrochanteric fracture
Explanation: ***Intertrochanteric fracture*** - The fracture line is located in the region between the **greater** and **lesser trochanters** of the femur, which is the defining characteristic of this fracture type. - These are **extracapsular** fractures, common in the elderly, and often present with a **shortened** and **externally rotated** limb due to the unopposed pull of the iliopsoas on the lesser trochanter. *Subtrochanteric Fracture* - A subtrochanteric fracture occurs in the proximal femoral shaft, beginning at or up to 5 cm distal to the **lesser trochanter**. The fracture shown is located superior to this region. - These fractures are often associated with high-energy trauma in younger individuals or can be pathological fractures related to long-term **bisphosphonate** use. *Femoral Neck Fracture* - This is an **intracapsular** fracture occurring in the area between the femoral head and the greater trochanter. The fracture in the image is located distal to the femoral neck. - Femoral neck fractures carry a high risk of **avascular necrosis (AVN)** of the femoral head due to disruption of the retinacular arteries, a complication less common in intertrochanteric fractures. *Pubic Rami Fracture* - This fracture involves the **pelvic girdle**, specifically the superior or inferior pubic ramus. The radiograph clearly shows the fracture is located in the proximal **femur**. - Patients with pubic rami fractures typically present with groin pain and inability to bear weight, but the femur itself is not fractured.