NEET-PG 2015 - Orthopaedics Practice Questions

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

Metacarpophalangeal joint. ***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**.

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.

Q: 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?

Thomas test. ***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.

Q: Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?

Subcapital fracture. ***Subcapital fracture*** - This fracture type occurs at the **neck of the femur**, very close to the femoral head's blood supply. - Due to the **intracapsular location**, it severely compromises the **medial and lateral circumflex femoral arteries**, leading to a high risk of **avascular necrosis (AVN)**. *Intertrochanteric fracture* - This fracture is **extracapsular**, occurring below the femoral neck between the greater and lesser trochanters. - While significant, its location generally leaves the **blood supply to the femoral head intact**, thus having a much lower risk of AVN compared to intracapsular fractures. *Transcervical fracture* - This is an **intracapsular fracture** of the femoral neck, but it is located more centrally within the neck. - While it does carry a significant risk of AVN due to disruption of blood supply, the subcapital fracture, being more proximate to the head, typically has an even higher risk due to a greater degree of compromise to the main blood vessels. *None of the options* - This option is incorrect because **subcapital fractures** are well-documented for having the highest risk of avascular necrosis among femur fractures due to their specific anatomical location and impact on blood supply.

Q: In which of the following deformities is the distal interphalangeal joint extended?

Boutonniere deformity. ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint**. - It often results from injury to the **central slip of the extensor tendon** at the PIP joint. *Swan neck deformity* - This deformity presents with **hyperextension of the PIP joint** and **flexion of the DIP joint**, which is the opposite of the question's premise. - It is commonly associated with underlying conditions like **rheumatoid arthritis** or **lupus**. *Z deformity* - This typically refers to the **thumb in rheumatoid arthritis**, where the carpometacarpal (CMC) joint is flexed, the metacarpophalangeal (MCP) joint is hyperextended, and the interphalangeal (IP) joint is flexed. - It does not primarily describe an extended DIP joint in the context of other fingers. *Claw Hand* - This deformity involves **hyperextension of the MCP joints** and **flexion of the PIP and DIP joints**, particularly of the fourth and fifth fingers. - It is caused by **ulnar nerve palsy**, leading to muscle imbalance.

Q: Which of the following statements is true regarding a Monteggia fracture?

Upper ulnar fracture with dislocated radial head.. ***Upper ulnar fracture with dislocated radial head.*** - A Monteggia fracture is classically defined as a fracture of the **proximal or middle third of the ulna** accompanied by an **anterior dislocation of the radial head**. - This injury pattern disrupts the alignment of the **forearm bones** and the **elbow joint**, requiring careful reduction and stabilization. *Upper radial fracture with dislocated ulna.* - This statement incorrectly identifies the fractured bone as the radius and the dislocated bone as the ulna. - The defining characteristic of a Monteggia fracture is the **ulnar fracture** and **radial head dislocation**. *Lower radial fracture with dislocated ulna.* - This describes a different type of injury, such as a **Galeazzi fracture**, which involves a **radial shaft fracture** with dislocation of the **distal radioulnar joint**. - It does not fit the criteria for a Monteggia fracture pattern. *Lower ulnar fracture with dislocated radius.* - This description is not consistent with a Monteggia fracture, which specifically involves the **proximal ulna** and **radial head dislocation**. - A lower ulnar fracture with distal radius dislocation is a distinct injury pattern.

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

Intertrochanteric fractures. ***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.

Q: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Hemiarthroplasty. ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.

Q: The Salter Harris classification is used for classifying which type of injuries?

Fractures involving the physis in children. ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.

Question 1

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

Accepted Answer

Metacarpophalangeal joint

Answer

Proximal Interphalngeal joint

Answer

Carpometacarpal joint

Answer

Distal Interphalangeal joint

Question 2

Adson's test is positive in -

Accepted Answer

Cervical rib

Answer

Cervical spondylosis

Answer

Cervical fracture

Answer

Cervical dislocation

Question 3

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?

Accepted Answer

Thomas test

Answer

Trendelenburgs test

Answer

Telescoping test

Answer

Nelaton's test

Question 4

Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?

Accepted Answer

Subcapital fracture

Answer

Intertrochanteric fracture

Answer

Transcervical fracture

Answer

None of the options

Question 5

In which of the following deformities is the distal interphalangeal joint extended?

Accepted Answer

Boutonniere deformity

Answer

Swan neck deformity

Answer

Claw Hand

Answer

Z deformity

Question 6

Which of the following statements is true regarding a Monteggia fracture?

Accepted Answer

Upper ulnar fracture with dislocated radial head.

Answer

Upper radial fracture with dislocated ulna.

Answer

Lower radial fracture with dislocated ulna.

Answer

Lower ulnar fracture with dislocated radius.

Question 7

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

Accepted Answer

Intertrochanteric fractures

Answer

Isthmic femur shaft fractures

Answer

Low subtrochanteric fractures

Answer

Distal femur shaft fractures

Question 8

Greenstick/ Nightstick fractures are seen in -

Accepted Answer

Children

Answer

Elderly

Answer

Common in all age groups

Answer

Young adults

Question 9

Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Accepted Answer

Hemiarthroplasty

Answer

Closed reduction and fixation with three cancellous screws

Answer

Longitudinal skin traction for 6 weeks

Answer

Excision arthroplasty

Question 10

The Salter Harris classification is used for classifying which type of injuries?

Accepted Answer

Fractures involving the physis in children

Answer

Soft tissue injuries in pediatric patients

Answer

Long bone fractures without growth plate involvement

Answer

Joint dislocations in pediatric orthopedics

NEET-PG 2015 — Orthopaedics