UPSC-CMS 2024 — Orthopaedics

Q: A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

Frozen shoulder. ***Frozen shoulder*** - The patient's presentation with **increasing pain** and **difficulty with overhead abduction** of the shoulder, especially in the context of long-standing **diabetes**, is highly characteristic of **adhesive capsulitis** (frozen shoulder). - This condition is marked by **progressive stiffness** and **restricted range of motion** in the shoulder joint due to inflammation and fibrosis of the joint capsule. *Bacterial arthritis* - **Bacterial arthritis** typically presents with an **acutely painful**, **swollen**, and **erythematous joint**, often accompanied by systemic symptoms like **fever** and **malaise**. - The chronic, progressive nature of the patient's symptoms and the absence of acute inflammatory signs or fever make bacterial arthritis less likely. *Osteoarthritis* - While **osteoarthritis** can cause shoulder pain and stiffness, it usually presents with **pain that worsens with activity** and is relieved by rest, often with **crepitus** and a more gradual loss of range of motion. - The pronounced restriction in **overhead abduction** in this patient, particularly given the diabetic history, points away from primary osteoarthritis as the most likely cause. *Rotator cuff tear* - A **rotator cuff tear** typically presents with pain and weakness, especially during **abduction** or **external rotation**, and may have a specific mechanism of injury. - While abduction can be difficult, the classic presentation of a frozen shoulder with severe, global restriction of both active and passive range of motion is a stronger fit for the described symptoms. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?

Ganglion cyst. ***Ganglion cyst*** - A **ganglion cyst** is the most common mass of the hand and wrist. It presents as a **smooth, firm, mobile cystic mass** that transilluminates. - It classically appears on the **dorsum of the wrist** and often becomes more prominent with wrist flexion (or plantar flexion of the wrist, as stated in the question, though dorsiflexion/flexion are more common terms for the wrist). *Dermoid cyst* - **Dermoid cysts** are congenital and result from entrapment of ectodermal and mesodermal elements. They are typically found in areas of **embryonic fusion lines** (e.g., face, scalp). - While they can be cystic, they are usually **immobile** and do not typically fluctuate in prominence with wrist movement. *Sebaceous cyst* - Also known as an **epidermoid cyst** (when arising from epidermis) or a **pilar cyst** (when arising from hair follicle), these are typically filled with keratin and sebum. - They tend to occur in areas with **hair follicles** (e.g., scalp, trunk, face) and often have a visible central punctum; they are less common on the dorsum of the wrist. *Epidermoid cyst* - **Epidermoid cysts** are subepidermal nodules formed by the cystic enclosure of epidermal cells. They are typically firm and mobile. - While they can occur anywhere, they are less characteristic of the dorsum of the wrist, and their prominence is generally **not affected by wrist movement**. [Practice more Orthopaedics PYQs on OnCourse]

Q: Consider the following : 1. Pain relief 2. Prevention of infection 3. Anaesthesia 4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

1, 3 and 4. **1, 3 and 4** - **Priorities in fracture treatment** always include alleviating pain, which can be severe and debilitating. - **Restoration of normal anatomy** is crucial for proper healing and optimal function of the fractured limb. - **Anesthesia** is often required to facilitate reduction and fixation of a fracture, as well as to manage pain during the procedure. *2, 3 and 4* - While **anesthesia** and **restoration of anatomy** are priorities, **prevention of infection** is primarily a concern for **open fractures** or surgical interventions. - **Pain relief** is a fundamental and immediate concern in all fracture cases, which is omitted in this option. *1, 2 and 3* - **Pain relief** and **anesthesia** are critical, and **prevention of infection** is important, but this option neglects the essential goal of **restoring anatomical alignment**. - **Restoring anatomy** directly impacts the long-term functional outcome and is a major goal of fracture management. *1, 2 and 4* - This option correctly identifies **pain relief**, **prevention of infection**, and **restoration of anatomy** as important. - However, it overlooks the immediate necessity of **anesthesia** to effectively manage pain during treatment procedures and allow for fracture reduction. [Practice more Orthopaedics PYQs on OnCourse]

Q: Hangman's fracture is

traumatic spondylolisthesis of axis vertebra (C2). ***traumatic spondylolisthesis of axis vertebra (C2)*** - A Hangman's fracture is a specific type of **traumatic spondylolisthesis** involving the **C2 (axis) vertebra**. - It results from bilateral fractures of the **pars interarticularis** of C2, often due to hyperextension and distractive forces. *traumatic spondylolisthesis of atlas vertebra (C1)* - A fracture of the atlas (C1) is typically called a **Jefferson fracture**, not a Hangman's fracture. - A Jefferson fracture usually involves ruptures of facets or arches, often caused by **axial loading**. *traumatic spondylolisthesis of lumbar vertebra (L1)* - **Spondylolisthesis** can occur in the lumbar spine, but it most commonly affects L5-S1 or L4-L5, and is usually a **fatigue fracture** not a traumatic spondylolisthesis. - Fractures in the lumbar region have different causes and clinical implications than cervical fractures, and are not termed a Hangman's fracture. *traumatic spondylolisthesis of thoracic vertebra (T1)* - While traumatic spine fractures can occur in the **thoracic spine**, spondylolisthesis is much less common due to the rib cage's stabilizing effect. - Fractures in this region are distinctly different from the characteristic C2 pars interarticularis fracture of a Hangman's fracture. [Practice more Orthopaedics PYQs on OnCourse]

4 Previous Year Questions with Answers & Explanations

Questions

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A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?

Consider the following : 1. Pain relief 2. Prevention of infection 3. Anaesthesia 4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

Hangman's fracture is

UPSC-CMS 2024 - Orthopaedics UPSC-CMS Practice Questions and MCQs

Question 1: A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

A. Frozen shoulder (Correct Answer)
B. Bacterial arthritis
C. Osteoarthritis
D. Rotator cuff tear

Explanation: ***Frozen shoulder*** - The patient's presentation with **increasing pain** and **difficulty with overhead abduction** of the shoulder, especially in the context of long-standing **diabetes**, is highly characteristic of **adhesive capsulitis** (frozen shoulder). - This condition is marked by **progressive stiffness** and **restricted range of motion** in the shoulder joint due to inflammation and fibrosis of the joint capsule. *Bacterial arthritis* - **Bacterial arthritis** typically presents with an **acutely painful**, **swollen**, and **erythematous joint**, often accompanied by systemic symptoms like **fever** and **malaise**. - The chronic, progressive nature of the patient's symptoms and the absence of acute inflammatory signs or fever make bacterial arthritis less likely. *Osteoarthritis* - While **osteoarthritis** can cause shoulder pain and stiffness, it usually presents with **pain that worsens with activity** and is relieved by rest, often with **crepitus** and a more gradual loss of range of motion. - The pronounced restriction in **overhead abduction** in this patient, particularly given the diabetic history, points away from primary osteoarthritis as the most likely cause. *Rotator cuff tear* - A **rotator cuff tear** typically presents with pain and weakness, especially during **abduction** or **external rotation**, and may have a specific mechanism of injury. - While abduction can be difficult, the classic presentation of a frozen shoulder with severe, global restriction of both active and passive range of motion is a stronger fit for the described symptoms.

Question 2: A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?

A. Ganglion cyst (Correct Answer)
B. Dermoid cyst
C. Sebaceous cyst
D. Epidermoid cyst

Explanation: ***Ganglion cyst*** - A **ganglion cyst** is the most common mass of the hand and wrist. It presents as a **smooth, firm, mobile cystic mass** that transilluminates. - It classically appears on the **dorsum of the wrist** and often becomes more prominent with wrist flexion (or plantar flexion of the wrist, as stated in the question, though dorsiflexion/flexion are more common terms for the wrist). *Dermoid cyst* - **Dermoid cysts** are congenital and result from entrapment of ectodermal and mesodermal elements. They are typically found in areas of **embryonic fusion lines** (e.g., face, scalp). - While they can be cystic, they are usually **immobile** and do not typically fluctuate in prominence with wrist movement. *Sebaceous cyst* - Also known as an **epidermoid cyst** (when arising from epidermis) or a **pilar cyst** (when arising from hair follicle), these are typically filled with keratin and sebum. - They tend to occur in areas with **hair follicles** (e.g., scalp, trunk, face) and often have a visible central punctum; they are less common on the dorsum of the wrist. *Epidermoid cyst* - **Epidermoid cysts** are subepidermal nodules formed by the cystic enclosure of epidermal cells. They are typically firm and mobile. - While they can occur anywhere, they are less characteristic of the dorsum of the wrist, and their prominence is generally **not affected by wrist movement**.

Question 3: Consider the following : 1. Pain relief 2. Prevention of infection 3. Anaesthesia 4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

A. 2, 3 and 4
B. 1, 2 and 3
C. 1, 3 and 4 (Correct Answer)
D. 1, 2 and 4

Explanation: **1, 3 and 4** - **Priorities in fracture treatment** always include alleviating pain, which can be severe and debilitating. - **Restoration of normal anatomy** is crucial for proper healing and optimal function of the fractured limb. - **Anesthesia** is often required to facilitate reduction and fixation of a fracture, as well as to manage pain during the procedure. *2, 3 and 4* - While **anesthesia** and **restoration of anatomy** are priorities, **prevention of infection** is primarily a concern for **open fractures** or surgical interventions. - **Pain relief** is a fundamental and immediate concern in all fracture cases, which is omitted in this option. *1, 2 and 3* - **Pain relief** and **anesthesia** are critical, and **prevention of infection** is important, but this option neglects the essential goal of **restoring anatomical alignment**. - **Restoring anatomy** directly impacts the long-term functional outcome and is a major goal of fracture management. *1, 2 and 4* - This option correctly identifies **pain relief**, **prevention of infection**, and **restoration of anatomy** as important. - However, it overlooks the immediate necessity of **anesthesia** to effectively manage pain during treatment procedures and allow for fracture reduction.

Question 4: Hangman's fracture is

A. traumatic spondylolisthesis of atlas vertebra (C1)
B. traumatic spondylolisthesis of axis vertebra (C2) (Correct Answer)
C. traumatic spondylolisthesis of lumbar vertebra (L1)
D. traumatic spondylolisthesis of thoracic vertebra (T1)

Explanation: ***traumatic spondylolisthesis of axis vertebra (C2)*** - A Hangman's fracture is a specific type of **traumatic spondylolisthesis** involving the **C2 (axis) vertebra**. - It results from bilateral fractures of the **pars interarticularis** of C2, often due to hyperextension and distractive forces. *traumatic spondylolisthesis of atlas vertebra (C1)* - A fracture of the atlas (C1) is typically called a **Jefferson fracture**, not a Hangman's fracture. - A Jefferson fracture usually involves ruptures of facets or arches, often caused by **axial loading**. *traumatic spondylolisthesis of lumbar vertebra (L1)* - **Spondylolisthesis** can occur in the lumbar spine, but it most commonly affects L5-S1 or L4-L5, and is usually a **fatigue fracture** not a traumatic spondylolisthesis. - Fractures in the lumbar region have different causes and clinical implications than cervical fractures, and are not termed a Hangman's fracture. *traumatic spondylolisthesis of thoracic vertebra (T1)* - While traumatic spine fractures can occur in the **thoracic spine**, spondylolisthesis is much less common due to the rib cage's stabilizing effect. - Fractures in this region are distinctly different from the characteristic C2 pars interarticularis fracture of a Hangman's fracture.