FMGE 2025 - Orthopaedics PYQs Practice Questions

Q: 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?

Osteosarcoma. ***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. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which nerve will be involved in the following finding at rest?

Ulnar. ***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. [Practice more Orthopaedics PYQs on OnCourse]

Q: Identify the instrument shown in the image:

Bohler braun splint. ***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. [Practice more Orthopaedics PYQs on OnCourse]

Q: 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?

Housemaid's knee. ***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. [Practice more Orthopaedics PYQs on OnCourse]

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?

Accepted Answer

Subglenoid dislocation of shoulder

Answer

Luxation erecta

Answer

Intrathoracic dislocation of shoulder

Answer

Posterior dislocation of shoulder

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?

Accepted Answer

Osteosarcoma

Answer

Ewing sarcoma

Answer

Chondrosarcoma

Answer

Gout

Question 3

Which nerve will be involved in the following finding at rest?

Accepted Answer

Ulnar

Answer

Median

Answer

Musculocutaneous

Answer

None

Question 4

Identify the instrument shown in the image:

Accepted Answer

Bohler braun splint

Answer

Thomas splint

Answer

Volkmann splint

Answer

Cramer wire

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?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

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?

Accepted Answer

Aneurysmal bone cyst

Answer

Giant cell tumor

Answer

Chondroblastoma

Answer

Osteosarcoma

Question 7

A young adult patient presents with a fracture of the neck of the femur. What is the most appropriate management?

Accepted Answer

Internal fixation

Answer

Total hip replacement

Answer

External fixation

Answer

Hemiarthroplasty

Question 8

A patient presents with a ring-shaped (lytic) lesion in the bone. Which of the following is the most likely diagnosis?

Accepted Answer

Brodie's abscess

Answer

Aneurysmal bone cyst

Answer

Simple bone cyst

Answer

Osteoid osteoma

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?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Infection

Answer

Gas gangrene

Question 10

The provided image displays a fracture. Based on the X-ray, identify the type of fracture shown.

Accepted Answer

Intertrochanteric fracture

Answer

Pubic rami fracture

Answer

Femoral neck fracture

Answer

Subtrochanteric fracture

FMGE 2025 — Orthopaedics