NEET-PG 2015 — Orthopaedics

Q: Blount's disease is associated with all of the following, except:

Genu recurvatum (hyperextension of the knee). ***Genu recurvatum (hyperextension of the knee)*** - Blount's disease is primarily characterized by **genu varum** (bowing of the legs) due to abnormal growth of the proximal tibia. - **Genu recurvatum** is not a typical feature or associated deformity of Blount's disease. *Genu varum (tibia vara)* - This is the **hallmark deformity** of Blount's disease, involving an inward bowing of the leg predominantly at the knee. - It results from a growth disturbance in the **medial portion of the proximal tibial physis**. *External tibial torsion (can occur in some cases)* - While less common than internal torsion, **external tibial torsion** can sometimes be a secondary or associated deformitry in complex cases of Blount's disease, especially with progressive bowing. - It involves an outward twisting of the tibia relative to the femur. *Internal tibial torsion (common in Blount's disease)* - **Internal tibial torsion** is a frequently observed deformity in patients with Blount's disease. - It results in an inward rotation of the lower leg, contributing to the overall malalignment alongside the genu varum. [Practice more Orthopaedics PYQs on OnCourse]

Q: What is the characteristic upper limb deformity seen in Erb's palsy?

Adduction and medial rotation of arm. ***Adduction and medial rotation of arm*** - Erb's palsy, resulting from injury to the **upper brachial plexus** (C5-C6 nerve roots), primarily affects the **deltoid**, **supraspinatus**, **infraspinatus**, and **biceps** muscles. - The unopposed action of unaffected muscles, such as the **pectoris major** and **latissimus dorsi**, leads to the characteristic **waiter's tip position**, involving **adduction** and **medial rotation** of the arm. *Adduction and lateral rotation of arm* - This position would imply weakness of the **pectoralis major** and **latissimus dorsi** and stronger activity of the **infraspinatus** and **teres minor**, which is contrary to the muscle deficits in Erb's palsy. - **Lateral rotation** of the arm is typically impaired in Erb's palsy due to weakness of the **infraspinatus** and **teres minor**. *Abduction and lateral rotation of arm* - **Abduction** is severely impacted in Erb's palsy due to paralysis of the **deltoid** and **supraspinatus**. - This position would suggest intact function of muscles that are explicitly weakened or paralyzed in Erb's palsy. *Abduction and medial rotation of arm* - While **medial rotation** can be a component of the deformity, **abduction** is a movement that is significantly impaired in Erb's palsy, making this option incorrect. - The inability to abduct the arm is a hallmark of the condition due to weakness of the **deltoid** and **supraspinatus**. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which ligament is most commonly damaged in knee injuries?

ACL. ***ACL*** - The **anterior cruciate ligament (ACL)** is highly susceptible to injury, especially during sports involving sudden stops, changes in direction, jumping, and awkward landings. - Its role in stabilizing the knee against **anterior tibial translation** and rotational forces makes it vulnerable to tears. *PCL* - The **posterior cruciate ligament (PCL)** is much stronger than the ACL and less frequently injured, typically requiring a direct blow to the flexed knee (e.g., dashboard injury). - It prevents **posterior tibial translation** relative to the femur. *MCL* - The **medial collateral ligament (MCL)** is commonly injured, often due to a direct blow to the outside of the knee causing a **valgus stress**. - While frequently damaged, it is often injured in conjunction with the ACL but the ACL is more frequently injured in isolation. *LCL* - The **lateral collateral ligament (LCL)** is the least commonly injured of the four major knee ligaments. - It usually results from a direct blow to the inside of the knee causing **varus stress**. [Practice more Orthopaedics PYQs on OnCourse]

Q: Medial snapping knee syndrome is due to involvement of -

Pes Anserinus. ***Pes Anserinus*** - The **pes anserinus bursa** and its associated tendons (sartorius, gracilis, semitendinosus) can cause medial knee pain and snapping if inflamed or irritated. - This is a common cause of **medial snapping knee syndrome**, particularly in athletes or individuals with valgus deformity. *Quadriceps Tendon* - The **quadriceps tendon** is located anteriorly, connecting the quadriceps muscles to the patella, and is not typically involved in medial snapping. - Issues with the quadriceps tendon usually present as anterior knee pain or tendinitis. *Gastrocnemius origin* - The **gastrocnemius origin** is at the distal femur and its involvement would typically cause posterior knee pain or symptoms related to calf muscle function. - It does not commonly cause medial knee snapping. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is on the lateral side of the knee and its involvement would cause lateral knee pain or instability. - It is not associated with medial snapping knee syndrome. [Practice more Orthopaedics PYQs on OnCourse]

Q: Adson's test is positive in -

Cervical rib. ***Cervical rib*** - **Adson's test** assesses for **thoracic outlet syndrome (TOS)**, which can be caused by a cervical rib compressing the **subclavian artery** or **brachial plexus**. - A positive test occurs when the radial pulse diminishes or disappears upon specific head and arm maneuvers, indicating neurovascular compression. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, such as bone spurs and disc herniation. - While it can cause neurological symptoms, it typically does not lead to a positive Adson's test, as the compression site is different from that assessed by the test. *Cervical fracture* - A cervical fracture is a **traumatic injury** to the bones of the neck. - Adson's test is not indicated for diagnosing fractures and performing it could exacerbate the injury. *Cervical dislocation* - Cervical dislocation is a severe injury where cervical vertebrae are **displaced from their normal alignment**. - Similar to fractures, Adson's test is not appropriate for diagnosing or evaluating dislocations and carries a risk of further injury. [Practice more Orthopaedics PYQs on OnCourse]

32 Previous Year Questions with Answers & Explanations

Questions

Blount's disease is associated with all of the following, except:

What is the characteristic upper limb deformity seen in Erb's palsy?

Which ligament is most commonly damaged in knee injuries?

Medial snapping knee syndrome is due to involvement of -

Adson's test is positive in -

The K nail can be used for all of the following types of fractures except -

Flexor Digitorum Profundus tendon avulsion injury leads to -

The A1 pulley involved in trigger finger is located at the level of which joint?

Thomas test is used for testing?

Q10

A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?

NEET-PG 2015 - Orthopaedics NEET-PG Practice Questions and MCQs

Question 1: Blount's disease is associated with all of the following, except:

A. External tibial torsion (can occur in some cases)
B. Genu varum (tibia vara)
C. Genu recurvatum (hyperextension of the knee) (Correct Answer)
D. Internal tibial torsion (common in Blount's disease)

Explanation: ***Genu recurvatum (hyperextension of the knee)*** - Blount's disease is primarily characterized by **genu varum** (bowing of the legs) due to abnormal growth of the proximal tibia. - **Genu recurvatum** is not a typical feature or associated deformity of Blount's disease. *Genu varum (tibia vara)* - This is the **hallmark deformity** of Blount's disease, involving an inward bowing of the leg predominantly at the knee. - It results from a growth disturbance in the **medial portion of the proximal tibial physis**. *External tibial torsion (can occur in some cases)* - While less common than internal torsion, **external tibial torsion** can sometimes be a secondary or associated deformitry in complex cases of Blount's disease, especially with progressive bowing. - It involves an outward twisting of the tibia relative to the femur. *Internal tibial torsion (common in Blount's disease)* - **Internal tibial torsion** is a frequently observed deformity in patients with Blount's disease. - It results in an inward rotation of the lower leg, contributing to the overall malalignment alongside the genu varum.

Question 2: What is the characteristic upper limb deformity seen in Erb's palsy?

A. Adduction and lateral rotation of arm
B. Adduction and medial rotation of arm (Correct Answer)
C. Abduction and lateral rotation of arm
D. Abduction and medial rotation of arm

Explanation: ***Adduction and medial rotation of arm*** - Erb's palsy, resulting from injury to the **upper brachial plexus** (C5-C6 nerve roots), primarily affects the **deltoid**, **supraspinatus**, **infraspinatus**, and **biceps** muscles. - The unopposed action of unaffected muscles, such as the **pectoris major** and **latissimus dorsi**, leads to the characteristic **waiter's tip position**, involving **adduction** and **medial rotation** of the arm. *Adduction and lateral rotation of arm* - This position would imply weakness of the **pectoralis major** and **latissimus dorsi** and stronger activity of the **infraspinatus** and **teres minor**, which is contrary to the muscle deficits in Erb's palsy. - **Lateral rotation** of the arm is typically impaired in Erb's palsy due to weakness of the **infraspinatus** and **teres minor**. *Abduction and lateral rotation of arm* - **Abduction** is severely impacted in Erb's palsy due to paralysis of the **deltoid** and **supraspinatus**. - This position would suggest intact function of muscles that are explicitly weakened or paralyzed in Erb's palsy. *Abduction and medial rotation of arm* - While **medial rotation** can be a component of the deformity, **abduction** is a movement that is significantly impaired in Erb's palsy, making this option incorrect. - The inability to abduct the arm is a hallmark of the condition due to weakness of the **deltoid** and **supraspinatus**.

Question 3: Which ligament is most commonly damaged in knee injuries?

A. PCL
B. LCL
C. MCL
D. ACL (Correct Answer)

Explanation: ***ACL*** - The **anterior cruciate ligament (ACL)** is highly susceptible to injury, especially during sports involving sudden stops, changes in direction, jumping, and awkward landings. - Its role in stabilizing the knee against **anterior tibial translation** and rotational forces makes it vulnerable to tears. *PCL* - The **posterior cruciate ligament (PCL)** is much stronger than the ACL and less frequently injured, typically requiring a direct blow to the flexed knee (e.g., dashboard injury). - It prevents **posterior tibial translation** relative to the femur. *MCL* - The **medial collateral ligament (MCL)** is commonly injured, often due to a direct blow to the outside of the knee causing a **valgus stress**. - While frequently damaged, it is often injured in conjunction with the ACL but the ACL is more frequently injured in isolation. *LCL* - The **lateral collateral ligament (LCL)** is the least commonly injured of the four major knee ligaments. - It usually results from a direct blow to the inside of the knee causing **varus stress**.

Question 4: Medial snapping knee syndrome is due to involvement of -

A. Gastrocnemius origin
B. Lateral collateral ligament
C. Quadriceps Tendon
D. Pes Anserinus (Correct Answer)

Explanation: ***Pes Anserinus*** - The **pes anserinus bursa** and its associated tendons (sartorius, gracilis, semitendinosus) can cause medial knee pain and snapping if inflamed or irritated. - This is a common cause of **medial snapping knee syndrome**, particularly in athletes or individuals with valgus deformity. *Quadriceps Tendon* - The **quadriceps tendon** is located anteriorly, connecting the quadriceps muscles to the patella, and is not typically involved in medial snapping. - Issues with the quadriceps tendon usually present as anterior knee pain or tendinitis. *Gastrocnemius origin* - The **gastrocnemius origin** is at the distal femur and its involvement would typically cause posterior knee pain or symptoms related to calf muscle function. - It does not commonly cause medial knee snapping. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is on the lateral side of the knee and its involvement would cause lateral knee pain or instability. - It is not associated with medial snapping knee syndrome.

Question 5: Adson's test is positive in -

A. Cervical rib (Correct Answer)
B. Cervical spondylosis
C. Cervical fracture
D. Cervical dislocation

Explanation: ***Cervical rib*** - **Adson's test** assesses for **thoracic outlet syndrome (TOS)**, which can be caused by a cervical rib compressing the **subclavian artery** or **brachial plexus**. - A positive test occurs when the radial pulse diminishes or disappears upon specific head and arm maneuvers, indicating neurovascular compression. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, such as bone spurs and disc herniation. - While it can cause neurological symptoms, it typically does not lead to a positive Adson's test, as the compression site is different from that assessed by the test. *Cervical fracture* - A cervical fracture is a **traumatic injury** to the bones of the neck. - Adson's test is not indicated for diagnosing fractures and performing it could exacerbate the injury. *Cervical dislocation* - Cervical dislocation is a severe injury where cervical vertebrae are **displaced from their normal alignment**. - Similar to fractures, Adson's test is not appropriate for diagnosing or evaluating dislocations and carries a risk of further injury.

Question 6: The K nail can be used for all of the following types of fractures except -

A. Isthmic femur shaft fractures
B. Intertrochanteric fractures (Correct Answer)
C. Low subtrochanteric fractures
D. Distal femur shaft fractures

Explanation: ***Intertrochanteric fractures*** - The K nail (specifically, the Kuntscher nail) is a **straight intramedullary nail** primarily designed for diaphyseal fractures. - It is **not suitable for intertrochanteric fractures** as these are metaphyseal and involve the proximal femur, requiring implants that offer greater stability in this region, such as cephalomedullary nails or plates. *Isthmic femur shaft fractures* - The **Kuntscher nail** was originally developed for and is well-suited for **isthmic femur shaft fractures** due to the narrow canal providing good cortical fixation. - Its design as a straight, broad nail fits snugly in the isthmus, providing excellent stability. *Low subtrochanteric fractures* - While more challenging, **K nails can be used for low subtrochanteric fractures**, especially if the fracture extends into the diaphyseal region. - However, newer implants like **cephalomedullary nails** are often preferred due to better biomechanical stability in this region. *Distal femur shaft fractures* - **K nails can be employed for distal femoral shaft fractures** if the fracture pattern allows for adequate fixation distal to the isthmus without compromising knee joint function. - The nail must be long enough to achieve stability, and the lack of proper locking mechanisms in traditional K nails may be a limiting factor compared to locked intramedullary nails.

Question 7: Flexor Digitorum Profundus tendon avulsion injury leads to -

A. Jersey Finger (Correct Answer)
B. Extensor tendon injury
C. Ulnar collateral ligament injury
D. Central slip injury

Explanation: ***Jersey Finger*** - **Jersey finger** is a common name for an avulsion injury of the **flexor digitorum profundus (FDP) tendon** from its insertion on the distal phalanx. - This injury typically occurs when the finger is forcibly extended while the FDP tendon is contracting, often seen in sports where a player grabs an opponent's jersey. *Extensor tendon injury* - An **extensor tendon injury** involves the tendons on the dorsal side of the hand, responsible for extending the fingers. - This is distinct from a **flexor tendon injury**, which involves tendons on the palmar side. *Ulnar collateral ligament injury* - An **ulnar collateral ligament (UCL) injury** most commonly affects the thumb's metacarpophalangeal (MCP) joint, often called **"skier's thumb"**. - This injury involves damage to the ligament supporting the joint, not an avulsion of a flexor tendon. *Central slip injury* - A **central slip injury** affects the middle slip of the extensor digitorum communis tendon over the proximal interphalangeal (PIP) joint. - Untreated, it can lead to a **Boutonnière deformity**, which is characterized by PIP joint flexion and distal interphalangeal (DIP) joint hyperextension.

Question 8: The A1 pulley involved in trigger finger is located at the level of which joint?

A. Proximal Interphalngeal joint
B. Metacarpophalangeal joint (Correct Answer)
C. Carpometacarpal joint
D. Distal Interphalangeal joint

Explanation: ***Metacarpophalangeal joint*** - The **A1 pulley** is located at the base of the finger, overlying the **metacarpophalangeal (MCP) joint**. - Its pathological thickening or narrowing can impede the smooth gliding of **flexor tendons**, causing **trigger finger**. *Proximal Interphalangeal joint* - The **A2** and **A3 pulleys** are located at the level of the **proximal phalanx** and **proximal interphalangeal (PIP) joint**, respectively. - While essential for tendon function, they are not primarily involved in typical **trigger finger**. *Distal Interphalangeal joint* - The **A4** and **A5 pulleys** are located at the level of the **middle phalanx** and **distal interphalangeal (DIP) joint**, respectively. - Pathologies at these pulleys are less common in trigger finger and typically affect the **distal tendon glide**. *Carpometacarpal joint* - The **carpometacarpal (CMC) joints** are located at the base of the hand, between the carpal bones and metacarpals. - There are no A pulleys associated with the CMC joints, and they are not directly involved in the mechanism of **trigger finger**.

Question 9: Thomas test is used for testing?

A. Knee flexion
B. Hip abduction
C. Hip rotation
D. Hip flexor tightness (Correct Answer)

Explanation: ***Hip flexor tightness*** - The **Thomas test** is a diagnostic maneuver used specifically to assess for the presence of **flexion contractures** within the hip joint. - It helps identify tightness in muscles such as the **iliopsoas**, rectus femoris, and tensor fasciae latae. *Knee flexion* - While hip flexor tightness can indirectly affect knee position, the Thomas test does not primarily measure the range of motion of **knee flexion** itself. - **Other tests**, such as goniometric measurements of the knee joint, are used to assess knee flexion directly. *Hip abduction* - The Thomas test is not designed to evaluate **hip abduction** range of motion. - Hip abduction is tested through maneuvers that move the leg away from the midline of the body, often with the patient in a side-lying or supine position, assessing muscles like the **gluteus medius** and minimus. *Hip rotation* - The Thomas test does not assess **hip rotation** (internal or external). - Hip rotation is typically evaluated with the hip and knee flexed to 90 degrees, assessing the rotational range of the **femoral head within the acetabulum**.

Question 10: A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?

A. Thomas test (Correct Answer)
B. Trendelenburgs test
C. Telescoping test
D. Nelaton's test

Explanation: ***Thomas test*** - The **Thomas test** is specifically designed to detect a **fixed flexion deformity of the hip**, where the hip cannot fully extend. - During the test, the patient's hip is flexed to flatten the lumbar spine, and if the contralateral leg then rises off the table, it indicates a fixed flexion deformity. *Trendelenburg's test* - The **Trendelenburg's test** assesses the strength and function of the **hip abductor muscles**, primarily the gluteus medius. - A positive result indicates weakness of the abductors on the standing leg, causing the pelvis to drop on the unsupported side, which is unrelated to fixed flexion deformity. *Nelaton's test* - **Nelaton's test** is used to determine the relative position of the **greater trochanter** in relation to the **ischial tuberosity** and **anterior superior iliac spine (ASIS)**, primarily in cases of hip dislocation or fracture. - It would not specifically identify a fixed flexion deformity of the hip joint itself. *Telescoping test* - The **telescoping test** is used to evaluate for hip instability, particularly in infants with **developmental dysplasia of the hip (DDH)**. - It involves applying axial pressure to the femur while moving the hip, assessing for abnormal movement of the femoral head within the acetabulum, and does not directly detect fixed flexion deformity.