NEET-PG 2015 Practice Questions

Q: In which condition is the Milwaukee Brace primarily used?

Adolescent Idiopathic Scoliosis. ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.

Q: Vertebra Plana is associated with all of the following conditions except -

Scheurmanns Disease. ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.

Q: Lift off test is done to assess the function of:

Subscapularis muscle function. ***Subscapularis muscle function*** - The **Lift-off test**, or Gerber's Lift-off test, specifically assesses the integrity and strength of the **subscapularis muscle** by evaluating its internal rotation and extension strength. - A positive test occurs when the patient is unable to lift their hand off their back, indicating a **subscapularis tear or weakness**. *Supraspinatus muscle function* - The **supraspinatus muscle** is primarily tested with the **empty can test** or full can test, which assess its role in shoulder abduction. - These tests evaluate for **impingement** or **tears** of the supraspinatus tendon. *Infraspinatus muscle function* - The **infraspinatus muscle** is mainly responsible for external rotation and is assessed using tests like the **resisted external rotation test** with the arm at the side. - This test is used to detect **infraspinatus tears** or weakness. *Teres Minor muscle function* - The **teres minor muscle** also contributes to external rotation of the shoulder, often tested in conjunction with the infraspinatus. - Its function can be isolated by testing resisted **external rotation** in 90 degrees of abduction and external rotation.

Q: The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -

Supracondylar Fracture of the humerus. ***Supracondylar Fracture of the humerus*** - **Anterior humeral line** passes through the **anterior cortex of the humerus** and should intersect the middle third of the capitellum in a normal elbow. - In supracondylar fractures, particularly those with **posterior displacement**, this line is often displaced **anteriorly or posteriorly**, failing to intersect the capitellum correctly. Additionally, the **radiocapitellar alignment** refers to the relationship between the **radius head** and the **capitellum**. Fractures and displacements around the elbow joint, such as supracondylar fractures, can disrupt this alignment. *Fracture lateral condyle of the humerus* - While a fracture of the lateral condyle can affect the elbow joint, it primarily involves a part of the **articular surface** and not necessarily the overall alignment of the entire distal humerus relative to the capitellum in the same way a supracondylar fracture does. - The **lateral condyle** is a smaller segment, and its fracture may not significantly alter the anterior humeral line **unless there is significant displacement** that indirectly affects the alignment of the capitellum. *Monteggia Fracture dislocation* - A **Monteggia fracture** involves a fracture of the **ulna** with dislocation of the **radial head** at the elbow. - While radiocapitellar alignment is severely disrupted, the **anterior humeral line** itself, which assesses the distal humerus, is typically **unaffected** as the primary injury is in the forearm bones and the radial head. *Fracture of Proximal Radius* - A fracture of the proximal radius (e.g., **radial head or neck fracture**) primarily affects the **radial articular surface** and its alignment with the capitellum. - While **radiocapitellar alignment** would clearly be disturbed, the position of the **distal humerus** relative to the capitellum, which the anterior humeral line evaluates, usually remains intact.

Q: In which condition is the Hamilton Ruler test sign positive?

Anterior dislocation of shoulder. ***Anterior dislocation of shoulder*** - The **Hamilton Ruler test** is positive when a straight edge, like a ruler, can be laid across the **lateral aspect of the deltoid prominence** from the acromion to the lateral epicondyle. - This is indicative of the **loss of the normal rounded contour of the shoulder**, which occurs due to the humeral head dislocating anteriorly. *Acromioclavicular joint dislocation* - This condition presents with a **"step-off" deformity** at the AC joint and pain directly over the joint, but the overall contour of the shoulder glenohumeral joint is preserved. - The deltoid prominence remains intact, making the Hamilton Ruler test negative. *Posterior dislocation of shoulder* - In posterior dislocation, the **humeral head moves posteriorly**, and the anterior contour of the shoulder might appear flattened, but the characteristic prominent anterior bulge seen in anterior dislocation is absent. - The Hamilton Ruler test specifically assesses for the loss of the lateral deltoid prominence, which is more typical of anterior displacement. *Luxatio erecta* - **Luxatio erecta** is an inferior dislocation of the shoulder where the arm is fixed in an **abducted and externally rotated position**, making it appear "erect". - While a severe type of shoulder dislocation, the specific anatomical changes that lead to a positive Hamilton Ruler test (loss of lateral deltoid prominence with the humeral head moving anteriorly and medially) are not typically present in this configuration.

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: 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: Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Sub Capital fractures. ***Sub Capital fractures*** - These fractures occur at the anatomical **neck of the femur**, very close to the femoral head. - Due to their location, they disrupt the main blood supply to the femoral head, primarily from the **retinacular arteries**, leading to a high risk of **avascular necrosis**. *Trans cervical fracture* - This fracture occurs through the **midneck of the femur**, which is still within the intracapsular region. - While it has a significant risk of **ischemia**, the compromise is generally less severe than in subcapital fractures. *Intertrochanteric fractures* - These are **extracapsular fractures** occurring between the greater and lesser trochanters. - They tend to have an **excellent blood supply** and thus a low risk of avascular necrosis, but are associated with more significant blood loss and malunion issues. *Basicervical fracture* - This is an **intracapsular fracture** that occurs at the base of the femoral neck, near the junction with the trochanters. - Although intracapsular, its position is slightly more proximal than subcapital fractures, potentially leaving more of the **retinacular vessels** intact, resulting in a somewhat lower risk of avascular necrosis compared to subcapital fractures.

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: Locking of the knee involves which of the following?

Internal rotation of the femur with the foot on the ground. ***Internal rotation of the femur with the foot on the ground*** - When the foot is on the ground (closed kinematic chain), the **femur rotates internally on the tibia** during the end stages of knee extension. This creates a more stable, "locked" position of the knee. - This **terminal rotation of the femur** increases the contact area and tension in the cruciate ligaments, enhancing joint stability for weight-bearing. *Internal rotation of the tibia with the foot on the ground* - This describes the action of the **popliteus muscle** when "unlocking" the knee from full extension, not the locking mechanism itself. - With the foot on the ground, the tibia is fixed, and internal rotation would typically be a movement for unlocking, not locking. *Contraction of the popliteus muscle* - The **popliteus muscle** is primarily responsible for **unlocking the knee** from full extension, by causing internal rotation of the tibia (or external rotation of the femur). - Its contraction would lead to initial flexion of the knee, releasing the locked position, not establishing it. *External rotation of femur with the foot off the ground* - With the foot off the ground (open kinematic chain), **external rotation of the tibia** occurs during the final degrees of extension to lock the knee, not external rotation of the femur. - The locking mechanism requires specific relative rotation between femur and tibia; external rotation of the femur alone would not achieve the screw-home mechanism necessary for knee locking.

Question 1

In which condition is the Milwaukee Brace primarily used?

Accepted Answer

Adolescent Idiopathic Scoliosis

Answer

Spondylolisthesis

Answer

Scheuermann's Disease

Answer

Congenital Kyphosis

Question 2

Vertebra Plana is associated with all of the following conditions except -

Accepted Answer

Scheurmanns Disease

Answer

Leukemia

Answer

Excessive use of systemic steroids

Answer

Histiocytosis X

Question 3

Lift off test is done to assess the function of:

Accepted Answer

Subscapularis muscle function

Answer

Supraspinatus muscle function

Answer

Infraspinatus muscle function

Answer

Teres Minor muscle function

Question 4

The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -

Accepted Answer

Supracondylar Fracture of the humerus

Answer

Monteggia Fracture dislocation

Answer

Fracture of Proximal Radius

Answer

Fracture lateral condyle of the humerus

Question 5

In which condition is the Hamilton Ruler test sign positive?

Accepted Answer

Anterior dislocation of shoulder

Answer

Posterior dislocation of shoulder

Answer

Luxatio erecta

Answer

Acromioclavicular joint dislocation

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

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 8

Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Accepted Answer

Sub Capital fractures

Answer

Basicervical fracture

Answer

Trans cervical fracture

Answer

Intertrochanteric fractures

Question 9

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 10

Locking of the knee involves which of the following?

Accepted Answer

Internal rotation of the femur with the foot on the ground

Answer

Internal rotation of the tibia with the foot on the ground

Answer

Contraction of the popliteus muscle

Answer

External rotation of femur with the foot off the ground

NEET-PG 2015

Orthopaedics

Physiology