NEET-PG 2021 — Orthopaedics

Q: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

Posterior dislocation. **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question. [Practice more Orthopaedics PYQs on OnCourse]

Q: The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?

Giant Cell Tumor (GCT). ***Giant Cell Tumor (GCT)*** * The image shows a **lytic (lucid) lesion** located in the **epiphysis/metaphysis of the distal radius**, which is a classic presentation site for GCT. * GCTs are typically seen in individuals aged 20-40, often present with **pain, swelling, and reduced range of motion**, and can show a **soap bubble appearance** on X-ray even with cortical erosion as seen in the image. *Ewing's Sarcoma* * Ewing's Sarcoma commonly affects the **diaphysis of long bones** and may present with an **onion skin periosteal reaction**, none of which are clearly depicted. * It primarily affects children and young adults (5-20 years old), which does not align with the assumed adult presentation given the fused epiphysis. *Osteochondroma* * Osteochondromas are **bony prominences covered by cartilage** and grow **outward from the bone surface**, often away from the joint, unlike the intraosseous lytic lesion seen. * They typically appear as **pedunculated or sessile exostoses** and are benign growth plate abnormalities, not lytic lesions of the marrow cavity. *Osteoid Osteoma* * Osteoid osteomas are characterized by a **small lucent nidus** (usually <1.5 cm) surrounded by a significant margin of **sclerotic bone**, which is not seen here. * They classically cause **nocturnal pain** relieved by NSAIDs and are typically smaller than the lesion depicted, which appears expansile. [Practice more Orthopaedics PYQs on OnCourse]

3 Previous Year Questions with Answers & Explanations

Questions

A 60-year-old elderly female with a previous history of a Colles fracture is now complaining of backache. Which of the following statements regarding the treatment of this patient is incorrect?

A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?

NEET-PG 2021 - Orthopaedics NEET-PG Practice Questions and MCQs

Question 1: A 60-year-old elderly female with a previous history of a Colles fracture is now complaining of backache. Which of the following statements regarding the treatment of this patient is incorrect?

A. Oral vitamin D3 is given along with oral calcium
B. Teriparatide should be started before supplementing bisphosphonates (Correct Answer)
C. Calcium requirement is 1200 mg per day
D. Bisphosphonates can be given for 3-5 years depending on patient response and risk factors

Explanation: ***Teriparatide should be started before supplementing bisphosphonates*** - This statement is incorrect because **bisphosphonates are typically the first-line treatment** for osteoporosis, especially in patients with a history of fragility fractures like a Colles fracture. - **Teriparatide**, an anabolic agent, is usually reserved for patients with very severe osteoporosis, those who have failed bisphosphonate therapy, or those with highly accelerated bone loss. *Oral vitamin D3 is given along with oral calcium* - This is a routine and **correct practice in osteoporosis management** as calcium and vitamin D are essential for bone health. - **Vitamin D** aids in calcium absorption from the gut, and both are crucial for bone mineralization and density. *Calcium requirement is 1200 mg per day* - The recommended daily **calcium intake for postmenopausal women** and elderly individuals with osteoporosis is typically around 1200 mg. - This amount helps to maintain skeletal health and reduce the risk of fractures. *Bisphosphonates can be given for 3-5 years depending on patient response and risk factors* - This statement is correct, as **bisphosphonates are commonly prescribed for 3-5 years** to reduce fracture risk in osteoporosis. - A **"drug holiday"** may be considered after this period, depending on the patient's fracture risk and bone mineral density.

Question 2: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

A. Intertrochanteric fracture (IT fracture)
B. Transcervical fracture
C. Posterior dislocation (Correct Answer)
D. Anterior dislocation

Explanation: **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question.

Question 3: The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?

A. Ewings Sarcoma
B. Osteochondroma
C. Giant Cell Tumor (GCT) (Correct Answer)
D. Osteoid Osteoma

Explanation: ***Giant Cell Tumor (GCT)*** * The image shows a **lytic (lucid) lesion** located in the **epiphysis/metaphysis of the distal radius**, which is a classic presentation site for GCT. * GCTs are typically seen in individuals aged 20-40, often present with **pain, swelling, and reduced range of motion**, and can show a **soap bubble appearance** on X-ray even with cortical erosion as seen in the image. *Ewing's Sarcoma* * Ewing's Sarcoma commonly affects the **diaphysis of long bones** and may present with an **onion skin periosteal reaction**, none of which are clearly depicted. * It primarily affects children and young adults (5-20 years old), which does not align with the assumed adult presentation given the fused epiphysis. *Osteochondroma* * Osteochondromas are **bony prominences covered by cartilage** and grow **outward from the bone surface**, often away from the joint, unlike the intraosseous lytic lesion seen. * They typically appear as **pedunculated or sessile exostoses** and are benign growth plate abnormalities, not lytic lesions of the marrow cavity. *Osteoid Osteoma* * Osteoid osteomas are characterized by a **small lucent nidus** (usually <1.5 cm) surrounded by a significant margin of **sclerotic bone**, which is not seen here. * They classically cause **nocturnal pain** relieved by NSAIDs and are typically smaller than the lesion depicted, which appears expansile.