Arthroscopic Techniques — MCQs
Which of the following is the most commonly used extraoral orthodontic appliance:
The most common approach for total hip arthroplasty is
Watson Jones Operation is the procedure for which of the following conditions?
A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
What is the most effective management strategy for hemarthrosis?
All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
When using low-flow circle absorber techniques, the uptake of nitrous oxide must be considered. In a healthy 70 kg adult, the expected uptake of nitrous oxide, with a 70% inspired concentration, after 1.5 hours would be about
Expression and release of a repressed emotion is called as
Agnes hunt traction is used for which of the following conditions?
A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?
Arthroscopic Techniques Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is the most commonly used extraoral orthodontic appliance:
- A. Face mask.
- B. Head gear. (Correct Answer)
- C. None.
- D. Chin cup.
Explanation: **Head gear.** * **Headgear** is a widely recognized and utilized **extraoral orthodontic appliance** in dental practice due to its versatility in controlling maxillary growth, especially in patients with Class II malocclusion. * It consists of an **outer bow** (facebow) and an **inner bow**, connected to bands on the molars, which exerts orthopedic force on the maxilla and teeth. *Face mask.* * A **face mask** (or protraction headgear) is primarily used for **Class III malocclusions** to encourage maxillary protraction and inhibit mandibular growth. * While an important extraoral appliance, its usage is less common than headgear, as Class III skeletal patterns are less prevalent than Class II. *None.* * This option is incorrect because there are several commonly used extraoral orthodontic appliances, with **headgear** being a prime example. *Chin cup.* * A **chin cup** is an extraoral appliance used specifically for the orthopedic management of developing **Class III malocclusions** by restraining mandibular growth. * Its primary application is to redirect the growth of the mandible downward and backward, but it is less frequently prescribed compared to headgear for Class II correction.
Question 2: The most common approach for total hip arthroplasty is
- A. Anteromedial
- B. Posteromedial
- C. Anterolateral
- D. Posterolateral (Correct Answer)
Explanation: ***Posterolateral*** - The **posterolateral approach** is the most widely adopted and versatile surgical technique for **total hip arthroplasty (THA)**. - It offers excellent exposure of the hip joint, allowing for efficient component placement and often results in **lower blood loss** compared to other approaches. *Anteromedial* - The **anteromedial approach** is rarely used for THA due to poor exposure of the acetabulum and femoral canal. - It carries a higher risk of injury to crucial neurovascular structures, such as the **femoral artery** and **vein**. *Posteromedial* - The **posteromedial approach** is not a standard or commonly recognized surgical approach for total hip arthroplasty. - Surgical approaches are typically classified as anterior, anterolateral, direct lateral, or posterolateral. *Anterolateral* - The **anterolateral approach** involves splitting the **tensor fascia lata** and detaching the **gluteus medius** from the greater trochanter. - While it has a lower risk of posterior dislocation, it can be associated with a higher incidence of **abductor muscle weakness** and limping post-operatively.
Question 3: Watson Jones Operation is the procedure for which of the following conditions?
- A. Neglected Clubfoot
- B. Valgus deformity
- C. Recurrent shoulder dislocation (Correct Answer)
- D. Muscle paralysis
Explanation: ***Recurrent shoulder dislocation*** - The **Watson-Jones procedure** is a surgical technique primarily used to address **recurrent anterior shoulder dislocations**. - It involves transferring the **conjoint tendon** (coracobrachialis and short head of biceps) to reconstruct the anterior capsule and provide stability. *Neglected Clubfoot* - **Clubfoot**, or talipes equinovarus, is typically managed by the **Ponseti method** (serial casting) for congenital cases. - Surgical correction for neglected clubfoot usually involves extensive soft tissue releases or osteotomies, not the Watson-Jones procedure. *Valgus deformity* - A **valgus deformity** refers to an angulation away from the midline, commonly seen in the knee (genu valgum) or ankle. - Correction typically involves osteotomies or soft tissue balancing, not the Watson-Jones procedure. *Muscle paralysis* - **Muscle paralysis** is managed based on its cause, which can include nerve repair, tendon transfers (e.g., for wrist or foot drop), or assistive devices. - The Watson-Jones procedure is designed for joint stability, not for restoring muscle function in cases of paralysis.
Question 4: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
- A. Conservative management
- B. Total knee replacement (Correct Answer)
- C. Arthroscopic washing
- D. Partial knee replacement
Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.
Question 5: What is the most effective management strategy for hemarthrosis?
- A. Immobilization with a P.O.P. cast
- B. Application of a compression bandage
- C. Needle aspiration to remove excess blood (Correct Answer)
- D. All of the options
Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.
Question 6: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Explanation: ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.
Question 7: When using low-flow circle absorber techniques, the uptake of nitrous oxide must be considered. In a healthy 70 kg adult, the expected uptake of nitrous oxide, with a 70% inspired concentration, after 1.5 hours would be about
- A. 500 ml/min
- B. 250 ml/min
- C. 1000 ml/min
- D. 100 ml/min (Correct Answer)
Explanation: ***100 ml/min*** - The uptake of **nitrous oxide (N2O)** decreases significantly over time as the blood and tissue compartments become saturated. After 1.5 hours, the uptake slows considerably. - At this point, the uptake rate for a 70 kg adult with 70% N2O is expected to be approximately **100 ml/min**, reflecting the near-saturation of less vascular tissues. *500 ml/min* - An uptake of **500 ml/min** is typical during the **initial, rapid uptake phase** of nitrous oxide (first 5-15 minutes) as it quickly equilibrates with the blood and highly perfused tissues. - This rate would be too high after 1.5 hours, as the body's capacity to absorb N2O has decreased significantly. *250 ml/min* - This rate represents an **intermediate phase** of N2O uptake, typically occurring within the first 30-60 minutes, when the drug is still being absorbed into moderately perfused tissues. - After 1.5 hours, the uptake would have slowed down further than this rate due to continued saturation of tissue compartments. *1000 ml/min* - An uptake of **1000 ml/min** (or 1 L/min) is an **extremely high rate** of N2O uptake, far exceeding what is physiologically possible in a 70 kg adult even during the initial rapid phase. - This would imply a massive, unsustainable absorption, which is not clinically relevant for N2O in a healthy individual.
Question 8: Expression and release of a repressed emotion is called as
- A. Dissociation
- B. Confabulation
- C. Abreaction (Correct Answer)
- D. Regression
Explanation: **Abreaction** - This term refers to the **expression and release of a repressed emotion**, often in a therapeutic context, providing psychological relief. - It involves re-experiencing a traumatic event or repressed emotions to alleviate their negative impact. - Also known as **catharsis** in psychoanalytic therapy. *Dissociation* - **Dissociation** involves a disruption in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. - It describes a mental process that causes a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity, rather than an active release of emotion. *Confabulation* - **Confabulation** is the creation of false memories in the absence of an intention to deceive. - It is often seen in individuals with specific neurological or psychiatric conditions, where they unconsciously fill in gaps in their memory with fabricated details. *Regression* - **Regression** is a defense mechanism in which an individual faced with anxiety or stress retreats to an earlier developmental stage. - It involves reverting to immature patterns of behavior, rather than the release of a specific, repressed emotion.
Question 9: Agnes hunt traction is used for which of the following conditions?
- A. Flexion deformity of the hip (Correct Answer)
- B. Trochanteric fracture
- C. Fracture of the shaft of the humerus
- D. Low backache
Explanation: **Explanation:** **Agnes Hunt Traction** is a specialized form of traction used specifically for the correction of **Flexion Deformity of the Hip**. The underlying medical concept involves applying traction to the affected limb while the contralateral (normal) limb is immobilized in a plaster cast in a position of maximum flexion. This stabilizes the pelvis and prevents compensatory lumbar lordosis, allowing the traction to act directly on the hip joint to gradually stretch the flexor contractures. **Analysis of Options:** * **A. Flexion deformity of the hip (Correct):** It is the classic indication. By neutralizing pelvic tilt, it effectively reduces fixed flexion deformities (FFD). * **B. Trochanteric fracture:** These are typically managed with skeletal traction (like Hamilton Russell traction) or, more commonly, surgical fixation (DHS or PFN). * **C. Fracture shaft of humerus:** This is managed using a U-slab, hanging cast, or skin traction like **Dunlop’s traction** (though Dunlop's is primarily for supracondylar fractures). * **D. Low backache:** This is usually managed with **Pelvic traction**, which helps in relieving muscle spasms and distracting the neural foramina. **High-Yield Clinical Pearls for NEET-PG:** * **Thomas Splint:** Used for immobilization of fractures of the shaft of the femur. * **Bryant’s Traction (Gallows):** Used for femur fractures in children below 2 years of age (weight <15-18kg). * **Russell’s Traction:** Used for trochanteric and subtrochanteric fractures; it uses a sling under the knee. * **Buck’s Traction:** A simple skin traction used for temporary immobilization of hip fractures or to reduce muscle spasms. * **90-90 Traction:** Commonly used in pediatric femoral shaft fractures to maintain the hip and knee at 90 degrees of flexion.
Question 10: A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?
- A. Decortication
- B. Marsupialisation (Correct Answer)
- C. Saucerization
- D. Enucleation
Explanation: **Explanation:** The procedure described is **Marsupialisation**. This technique involves opening the cyst (deroofing), evacuating its contents, and suturing the edges of the remaining cyst wall to the adjacent soft tissue or periosteum. This creates a permanent "pouch" or window, allowing the cavity to remain open to the exterior and heal by secondary intention. It is typically used for large cysts where complete removal (enucleation) might risk damaging vital structures or causing a pathological fracture. **Analysis of Options:** * **Decortication:** This involves the removal of the outer shell or "cortex" of a bone. In orthopaedics, it is often performed in cases of chronic osteomyelitis or non-union to improve vascularity and promote healing. * **Saucerization:** This is the surgical excavation of a bone cavity (usually in chronic osteomyelitis) to create a shallow, saucer-like depression. Unlike marsupialisation, it involves removing the overlying bone to allow the wound to heal from the base upwards, but it does not involve suturing the cyst wall to the periosteum. * **Enucleation:** This refers to the complete removal of a cyst in its entirety (shelling it out) without rupture. It is the treatment of choice for smaller, well-defined cystic lesions. **High-Yield Facts for NEET-PG:** * **Marsupialisation** is most commonly associated with the treatment of **Odontogenic Keratocysts (OKC)** in the jaw or large unicameral bone cysts. * **Brodie’s Abscess:** The surgical treatment of choice for this chronic localized bone abscess is **Saucerization** and curettage. * **Orr’s Technique:** A classic treatment for chronic osteomyelitis involving debridement, saucerization, and packing the wound open.
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