Ankle Instability and Sprains — MCQs
Which imaging modality is LEAST useful in the initial diagnosis of stress fractures?
The shown apparatus is used for
An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
Sudden dorsiflexion of the foot may lead to which of the following injuries?
Commonest ligament injured in ankle injury ?
A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?
Treatment of myositis ossificans includes all except -
The rephrased question is:What is the most common complication of a fractured talus?
Which of the following ligaments is injured in an ankle inversion injury?
Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)
Ankle Instability and Sprains Indian Medical PG Practice Questions and MCQs
Question 1: Which imaging modality is LEAST useful in the initial diagnosis of stress fractures?
- A. MRI
- B. Bone scan
- C. X ray
- D. CT (Correct Answer)
Explanation: ***Correct: CT*** - While **CT** can show bony details, it is **less sensitive** than MRI or bone scan for early stress fractures, which often involve subtle marrow edema or periosteal reaction - Its primary role is usually in defining **fracture geometry** or evaluating **fracture healing**, not initial detection - **CT is rarely used as a first-line imaging modality** for suspected stress fractures *Incorrect: MRI* - **MRI** is highly sensitive for **stress fractures**, detecting early changes such as **marrow edema** and **periosteal reaction** before they are visible on X-ray - It is considered the **gold standard** for confirming a stress fracture when initial X-rays are negative - This is one of the MOST useful modalities, not the least *Incorrect: Bone scan* - **Bone scintigraphy** (bone scan) is very sensitive for **stress fractures**, as it detects increased **osteoblastic activity** at the site of injury - It can identify stress fractures long before they are visible on plain radiographs, showing a focal area of increased radiotracer uptake - This is highly useful for initial diagnosis, not the least useful *Incorrect: X-ray* - **Plain radiographs (X-rays)** are often the **initial imaging modality** for suspected stress fractures due to availability and cost - However, they have **low sensitivity in the early stages** - early stress fractures may appear normal on X-ray - Visible signs such as **sclerosis, periosteal reaction**, or a **fracture line** only develop several weeks after symptom onset - Despite low sensitivity, X-ray is still more commonly used for initial evaluation than CT
Question 2: The shown apparatus is used for
- A. Ankle knee stabilizer
- B. Thomas splint
- C. Knee brace
- D. Patella tendon bearing brace (Correct Answer)
Explanation: ***Patella tendon bearing brace*** - This orthotic device is designed to **transfer weight-bearing load through the patella tendon**, reducing stress on the lower extremity during ambulation. - It features a **molded cuff** that fits snugly below the patella and distributes weight through the **patellar tendon bearing area**, commonly used in **prosthetic applications** and **below-knee amputees**. *Ankle knee stabilizer* - This device provides **combined support to both ankle and knee joints** simultaneously, typically used for **multi-joint injuries** or instability. - It features **dual bracing systems** with straps and supports extending from ankle to knee, unlike the focused patellar tendon bearing design. *Thomas splint* - A **rigid metal-framed splint** used primarily for **femur fracture stabilization** and maintaining **skeletal traction** in emergency situations. - It consists of a **ring that fits around the upper thigh** with extending metal bars, designed for **fracture immobilization** rather than weight distribution. *Knee brace* - A general **knee joint support device** used for **ligament injuries**, **post-surgical recovery**, or **osteoarthritis management**. - Available in various forms (**sleeve, hinged, or wraparound designs**) but lacks the specific **weight-bearing transfer mechanism** of a patella tendon bearing brace.
Question 3: An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
- A. Clinical examination
- B. Arthroscopy (Correct Answer)
- C. Arthrotomy
- D. X-ray
Explanation: ***Arthroscopy*** - **Arthroscopy** is the definitive investigation for **cartilage damage** as it allows for direct visualization of the knee joint's internal structures. - It not only confirms the diagnosis but can also facilitate simultaneous **repair or débridement** of damaged cartilage. *X-ray* - **X-rays** are primarily used to assess **bone structures** and detect fractures or significant joint space narrowing, not soft tissue injuries like cartilage. - They are generally **insufficient** for diagnosing subtle or early cartilage damage. *Clinical examination* - A **clinical examination** is crucial for initial assessment and suspicion of cartilage injury, but it cannot definitively diagnose the extent or type of cartilage damage. - It helps guide further investigations but is **not specific enough** to confirm cartilage integrity. *Arthrotomy* - **Arthrotomy** involves a larger incision to open the joint, which is more **invasive** than arthroscopy and typically reserved for open surgical repairs or complex reconstructions, not as a primary diagnostic tool for cartilage. - It carries a **higher risk of complications**, such as infection and prolonged recovery, compared to arthroscopy.
Question 4: Sudden dorsiflexion of the foot may lead to which of the following injuries?
- A. Anterior talofibular ligament injury
- B. Tendo Achilles avulsion injury (Correct Answer)
- C. Rupture of deltoid ligament
- D. Tarsal tunnel syndrome
Explanation: ***Tendo Achilles avulsion injury*** - **Sudden dorsiflexion** of the foot, especially if forced or excessive, can cause extreme stretch on the **Achilles tendon**, potentially leading to its avulsion or rupture. - This mechanism often occurs during activities requiring a forceful push-off or landing with the foot in dorsiflexion, placing significant tensile stress on the tendon. *Anterior talofibular ligament injury* - This injury typically results from an **inversion sprain** of the ankle, where the foot is forcefully turned inward, causing damage to the lateral ankle ligaments. - **Dorsiflexion** alone is not the primary mechanism for injury to the **anterior talofibular ligament**. *Rupture of deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and is most commonly injured with an **eversion sprain**, where the foot rolls outward. - While extreme dorsiflexion can put some strain on anterior fibers, it is not the primary mechanism, and a concomitant eversion force would likely be required for rupture. *Tarsal tunnel syndrome* - This condition involves **compression of the tibial nerve** as it passes through the tarsal tunnel, typically causing pain, numbness, and tingling in the sole of the foot. - It is often caused by chronic factors such as swelling, repetitive stress, or structural abnormalities, rather than an acute traumatic event like sudden dorsiflexion.
Question 5: Commonest ligament injured in ankle injury ?
- A. Anterior talofibular ligament (Correct Answer)
- B. Calcaneofibular ligament
- C. Posterior talofibular ligament
- D. Spring ligament
Explanation: ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the **most frequently injured ligament** in ankle sprains because it is the weakest and most commonly stretched during **inversion injuries**. - Its position makes it vulnerable during movements where the foot rolls inward, a common mechanism for ankle sprains. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is stronger than the ATFL and is typically injured with more severe inversion forces, often in conjunction with ATFL rupture. - While it plays a crucial role in ankle stability, it is not the *most* commonly injured ligament. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the lateral ankle ligaments and is rarely injured in isolated ankle sprains. - Its injury usually signifies a **severe ankle sprain** with significant talar displacement or dislocation. *Spring ligament* - The **spring ligament**, also known as the **plantar calcaneonavicular ligament**, is located on the medial side of the foot and supports the medial longitudinal arch. - It is not directly involved in typical ankle sprains, which primarily affect the lateral collateral ligaments.
Question 6: A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?
- A. Posterior drawer for PCL
- B. McMurray
- C. Lachman (Correct Answer)
- D. Anterior drawer for ACL
Explanation: ***Lachman*** - The image shows the examiner holding the distal thigh and proximal tibia, with the knee flexed at a **20-30 degree angle**, applying an **anterior translational force** to the tibia. This specific maneuver is characteristic of the Lachman test. - The Lachman test is highly sensitive for detecting **anterior cruciate ligament (ACL) tears**, particularly in acute injuries, due to the reduced hamstring spasm compared to the anterior drawer test. *Posterior drawer for PCL* - The posterior drawer test involves flexing the knee to **90 degrees** and applying a **posterior force** to the tibia to assess the integrity of the **posterior cruciate ligament (PCL)**. - The position of the knee in the image (flexed at a shallower angle) and the direction of the applied force (anteriorly towards the femur) do not match the technique for a posterior drawer test. *McMurray* - The McMurray test is performed to evaluate **meniscal tears** by flexing, extending, and rotating the knee while applying a varus or valgus stress. - The maneuver in the image, involving direct anterior translation of the tibia with the knee in slight flexion, is not consistent with the McMurray test. *Anterior drawer for ACL* - While also testing the **ACL**, the anterior drawer test typically involves flexing the knee to **90 degrees** and sitting on the foot, then pulling the tibia anteriorly. - The knee flexion angle in the image is much shallower than 90 degrees, making it inconsistent with the standard anterior drawer test.
Question 7: Treatment of myositis ossificans includes all except -
- A. Splinting elbow
- B. Indometacin
- C. Gentle active movements
- D. Vigorous passive massage (Correct Answer)
Explanation: ***Vigorous passive massage*** - **Vigorous passive massage** is contraindicated in myositis ossificans as it can exacerbate the condition by causing further trauma and promoting heterotopic bone formation. - The goal of treatment is to prevent progression and reduce inflammation, not to aggressively manipulate the affected area. *Splinting elbow* - **Splinting the elbow** in a functional position is a common treatment to help prevent contractures and allow the heterotopic bone to mature. - This immobilization can reduce microtrauma and facilitate healing in the acute phase. *Indometacin* - **Indomethacin**, a non-steroidal anti-inflammatory drug (NSAID), is often used to prevent and treat myositis ossificans. - It works by inhibiting prostaglandin synthesis, which is believed to play a role in the formation of heterotopic bone. *Gentle active movements* - **Gentle active movements** are generally encouraged once the acute inflammatory phase has subsided and the lesion begins to mature. - These movements help maintain range of motion and prevent stiffness without causing excessive trauma that could worsen the condition.
Question 8: The rephrased question is:What is the most common complication of a fractured talus?
- A. Avascular necrosis (AVN) (Correct Answer)
- B. Osteoarthritis of the subtalar joint
- C. Nonunion of the talus
- D. Osteoarthritis of the ankle joint
Explanation: ***Avascular necrosis (AVN)*** - The talus has a **precarious blood supply**, with arterial branches entering at multiple points but often centrally, making it vulnerable to **ischemia** after fracture. - Fractures, especially neck fractures, can disrupt these delicate vessels, leading to **osteonecrosis** and collapse of the bone. *Nonunion of the talus* - While possible, talar nonunion is **less common** than AVN due to the talus's dense cortical bone and limited muscle attachments. - Nonunion is more frequently seen with fractures of other bones, such as the **scaphoid**. *Osteoarthritis of the subtalar joint* - **Subtalar osteoarthritis** can occur post-talar fracture, often as a **secondary complication** of disrupted articular surfaces or AVN. - However, the **initial and most common direct complication** stemming from the blood supply disruption is AVN. *Osteoarthritis of the ankle joint* - **Ankle osteoarthritis** can also develop after certain talar fractures, particularly those involving the talar dome or leading to incongruity of the ankle joint. - Similar to subtalar arthritis, it is often a **later or secondary sequela**, rather than the immediate and most frequent direct complication like AVN.
Question 9: Which of the following ligaments is injured in an ankle inversion injury?
- A. Calcaneofibular ligament
- B. Posterior talofibular ligament
- C. Deltoid ligament
- D. Anterior talofibular ligament (Correct Answer)
Explanation: ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the most commonly injured ligament in an **ankle inversion sprain** due to its position and weaker structure. - It connects the **fibula** to the **talus** anteriorly, and when the foot inverts, this ligament is stretched and often torn first. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is also an important lateral ankle ligament that can be injured in **severe inversion sprains**. - It is often damaged in conjunction with the ATFL, but typically only after the ATFL has already been compromised through an ankle inversion injury. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the **lateral collateral ligaments** and is rarely injured in isolation. - Injury to the PTFL usually occurs in cases of **severe, high-grade ankle dislocations** or very forceful inversion injuries, often involving other ligaments. *Deltoid ligament* - The **deltoid ligament** is a strong, fan-shaped ligament located on the **medial side of the ankle**. - It resists **eversion** of the ankle, meaning it is more commonly injured in **eversion sprains**, not inversion sprains.
Question 10: Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)
- A. A→4 B→3 C→1 D→2
- B. A→3 B→2 C→4 D→1
- C. A→4 B→3 C→2 D→1 (Correct Answer)
- D. A→3 B→2 C→1 D→4
Explanation: ***A→4 B→3 C→2 D→1*** - **Atrial fibrillation** is characterized by **irregularly irregular rhythm** without distinct P waves, making the R-R interval highly variable. It is a supraventricular tachyarrhythmia, originating above the ventricles. - **Ventricular tachycardia** typically presents with a **wide QRS complex** (>0.12 s) and a **rapid, regular heart rate**, as it originates from the ventricles. - **Complete heart block** is characterized by complete dissociation between **P waves and QRS complexes**, meaning the atria and ventricles beat independently. This is reflected in an irregular P-P interval and a regular but slower R-R interval often due to an escape rhythm. - **Ventricular fibrillation** is an ECG emergency characterized by chaotic, **irregular electrical activity** and an absence of discernible P waves, QRS complexes, or T waves, leading to cardiac arrest. *A→4 B→3 C→1 D→2* - This option correctly matches A (Atrial fibrillation) with 4 (Irregular R-R interval without P waves) and B (Ventricular tachycardia) with 3 (Wide QRS complexes and regular rapid rate). However, it incorrectly matches C (Complete heart block) with 1 (Chaotic rhythm) and D (Ventricular fibrillation) with 2 (Dissociation of P and QRS waves). - **Complete heart block** involves **dissociation of P and QRS waves**, and **Ventricular fibrillation** is defined by a **chaotic rhythm**, not the other way around as suggested by C→1 and D→2. *A→3 B→2 C→4 D→1* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate), which describes ventricular tachycardia. - It also incorrectly matches C (Complete heart block) with 4 (Irregular R-R interval without P waves) and D (Ventricular fibrillation) with 1 (Chaotic rhythm), instead of the correct associations. *A→3 B→2 C→1 D→4* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate) which is characteristic of ventricular tachycardia. - It also incorrectly matches B (Ventricular tachycardia) with 2 (Dissociation of P and QRS waves), which is a characteristic of complete heart block, not ventricular tachycardia.
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