Minimally Invasive Orthopaedic Surgery — MCQs

10 questions

The operative procedure known as "microfracture" is done for the

Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint

Discectomy can be performed using:

A 25 year old male with roadside accident underwent debridement and reduction of fractured both bones right forearm under axillary block. On the second postoperative day the patient complained of persistent numbness and paresthesia in the right forearm and the hand. The commonest cause of this neurological dysfunction could be all of the following except :

All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

The ideal indication for injection of sclerosing agents is:

What is the primary advantage of phacosurgery over extracapsular cataract extraction (ECCE)?

What is the treatment for asymptomatic gallstones greater than 3 cm?

Best method of treatment for segmental trichiasis

Q10

The appropriate choice for treatment of Nulliparous prolapse is :

Minimally Invasive Orthopaedic Surgery Indian Medical PG Practice Questions and MCQs

Question 1: The operative procedure known as "microfracture" is done for the

A. Delayed union of femur
B. Osteochondral defect of femur (Correct Answer)
C. Non union of tibia
D. Loose bodies of ankle joint

Explanation: ***Osteochondral defect of femur*** - **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**. - It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue. *Delayed union of femur* - **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery. - Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture. *Non union of tibia* - **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**. - This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses. *Loose bodies of ankle joint* - **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage. - This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.

Question 2: Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint

A. $1,2,3,4,5,6$
B. $3,5,6$ (Correct Answer)
C. $3,4,5$
D. $1,2,4$

Explanation: ***3,5,6*** - For **tibia traction** in a femoral shaft fracture, you would need a **Steinmann pin** for skeletal traction, a **Bohler's stirrup** to apply the traction force, and a **Bohler-Braun splint** to support the limb. - The **Steinmann pin** is inserted into the proximal tibia, the **Bohler's stirrup** attaches to the pin, and the **Bohler-Braun splint** provides a fixed structure for the traction system. *1,2,3,4,5,6* - This option incorrectly includes items not specifically used for applying **tibia traction** (e.g., K-wire is for internal fixation, Thomas splint is for early femur fracture management but not specifically for tibia traction application). - While some components might be used in general fracture management, not all are directly involved in setting up tibia traction as requested. *3,4,5* - This option correctly includes the **Steinmann pin** and **Bohler's stirrup** but incorrectly replaces the **Bohler-Braun splint** with a **Denham's pin**. - A **Denham's pin** is an alternative to a Steinmann pin for skeletal traction, but a **Bohler-Braun splint** is crucial for supporting the limb in this setup, which is missing here. *1,2,4* - This option includes a **Thomas splint** (used for femur fracture support, not tibia traction application), a **K-wire** (used for internal fixation, not traction), and a **Denham's pin** (an alternative to Steinmann pin, but lacks the necessary support and traction application equipment). - These items are not suitable for setting up comprehensive **tibia traction** for a femoral shaft fracture.

Question 3: Discectomy can be performed using:

A. Open surgery
B. Microdiscectomy
C. Endoscopic approach
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Discectomy** can be performed through various surgical approaches, including open surgery, minimally invasive techniques using a microscope, and endoscopic procedures. - The choice of method depends on factors such as the **location and size of the disc herniation**, patient anatomy, and surgeon’s preference and expertise. *Open surgery* - This involves a larger incision to directly visualize and access the spinal structures and remove the **herniated disc material**. - While effective, it typically involves more muscle dissection, leading to increased **postoperative pain** and a longer recovery time compared to minimally invasive approaches. *Microscope* - **Microdiscectomy** uses a surgical microscope to provide magnified visualization of the surgical field through a smaller incision. - This minimally invasive approach reduces tissue dissection, leading to less pain, smaller scars, and **faster recovery** than traditional open surgery. *Endoscope* - **Endoscopic discectomy** utilizes a small camera (endoscope) inserted through a tiny incision, allowing the surgeon to view the surgical area on a monitor. - This is a highly minimally invasive technique that typically results in even **less tissue damage** and a quicker return to normal activities compared to microdiscectomy.

Question 4: A 25 year old male with roadside accident underwent debridement and reduction of fractured both bones right forearm under axillary block. On the second postoperative day the patient complained of persistent numbness and paresthesia in the right forearm and the hand. The commonest cause of this neurological dysfunction could be all of the following except :

A. Tourniquet pressure
B. Crush injury to the hand and lacerated nerves
C. A tight cast or dressing
D. Systemic toxicity of local anaesthetics (Correct Answer)

Explanation: ***Systemic toxicity of local anaesthetics*** - This typically presents with **acute neurological symptoms** (e.g., seizures, metallic taste, tinnitus) or **cardiovascular collapse** during or immediately after local anesthetic administration. - Persistent numbness and paresthesia on the second postoperative day are **not characteristic** of systemic local anesthetic toxicity, which is a transient effect. *Tourniquet pressure* - **Prolonged or excessively high tourniquet pressure** can lead to nerve ischemia and damage, causing paresthesia and numbness in the limb distal to the tourniquet. - These symptoms often persist for some time post-operatively, consistent with the patient's presentation. *Crush injury to the hand and lacerated nerves* - The initial **roadside accident** involving a severely injured limb could directly cause **nerve lacerations or crush injuries**, leading to immediate and persistent neurological deficits like numbness and paresthesia. - Such direct nerve trauma would manifest immediately and continue post-operatively, aligning with the patient's complaints. *A tight cast or dressing* - A **tight cast or dressing** applied to the forearm can compress nerves, leading to **ischemia and neuropathy**. - This mechanical compression can cause persistent numbness and paresthesia, which might become more noticeable as swelling increases post-surgery.

Question 5: 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 6: The ideal indication for injection of sclerosing agents is:

A. External hemorrhoids
B. Internal hemorrhoids (Correct Answer)
C. Immediate surgery for strangulated hemorrhoids
D. Surgical intervention for prolapsed hemorrhoids

Explanation: ***Internal hemorrhoids*** - Sclerotherapy is most effective for **first- and second-degree internal hemorrhoids**, where symptomatic bleeding is the primary concern. - The injected agent causes **fibrosis** and **scarring**, leading to fixation of the hemorrhoidal tissue and reduced blood flow. *External hemorrhoids* - External hemorrhoids are located **below the dentate line** and are covered by sensitive anoderm. - Sclerosing agents can cause **significant pain** and are generally ineffective for external hemorrhoids. *Immediate surgery for strangulated hemorrhoids* - **Strangulated hemorrhoids** are a medical emergency requiring **urgent surgical intervention** to prevent tissue necrosis. - Sclerotherapy is absolutely **contraindicated** in this scenario due to the risk of exacerbating ischemia and complications. *Surgical intervention for prolapsed hemorrhoids* - While sclerotherapy can be used for some early-stage prolapsed internal hemorrhoids (second degree), **surgical intervention** is more appropriate for **third- and fourth-degree prolapsed hemorrhoids**. - These more advanced hemorrhoids often require techniques like **hemorrhoidectomy** or stapling for definitive treatment.

Question 7: What is the primary advantage of phacosurgery over extracapsular cataract extraction (ECCE)?

A. Rapid recovery
B. Small incision size (Correct Answer)
C. Lower risk of complications
D. All of the options

Explanation: ***Small incision size*** - Phacosurgery utilizes a **micro-incision technique**, typically 2-3 mm, which is significantly smaller than the 10-12 mm incision required for ECCE. - This smaller incision is key to many of phacoemulsification's advantages, including faster healing and reduced astigmatism. *Rapid recovery* - While phacosurgery does lead to a **more rapid recovery** compared to ECCE, this is largely a *consequence* of the smaller incision size, not its primary advantage. - The reduced surgical trauma from a small incision allows for quicker visual rehabilitation and less post-operative discomfort. *Lower risk of complications* - Phacosurgery generally has a **lower risk of certain complications** like surgically induced astigmatism and wound-related issues due to its small incision. - However, it can have its own set of complications, such as posterior capsular rupture and corneal edema, and the overall complication rate is often technique-dependent. *All of the options* - While phacosurgery offers advantages in terms of rapid recovery and generally a lower risk of certain complications, the **small incision size** is the *primary* driver of these benefits. - Therefore, it is more precise to identify the small incision as the fundamental advantage from which many other benefits stem.

Question 8: What is the treatment for asymptomatic gallstones greater than 3 cm?

A. Dissolution therapy
B. ERCP
C. Laparoscopic cholecystectomy (Correct Answer)
D. Observation/watchful waiting

Explanation: ***Laparoscopic cholecystectomy*** - For **asymptomatic gallstones ≥3 cm**, prophylactic cholecystectomy is **recommended** due to significantly increased risk of gallbladder carcinoma - **Large stone size (≥3 cm)** is an established risk factor for malignant transformation of the gallbladder epithelium - Current guidelines recommend **prophylactic surgery** for high-risk features including stones >3 cm, porcelain gallbladder, and gallbladder polyps >10 mm - **Laparoscopic approach** is preferred as it offers minimal morbidity with excellent outcomes *Observation/watchful waiting* - This approach is appropriate for **small to medium-sized asymptomatic gallstones** (<3 cm) where risk of complications is low - However, for stones **≥3 cm**, the increased malignancy risk makes observation inappropriate - Patient should not be left with untreated large gallstones given the oncological risk *Dissolution therapy* - Ursodeoxycholic acid therapy is only effective for **small cholesterol stones** (<1.5 cm) in select non-surgical candidates - **Completely ineffective** for large stones (>1.5 cm) and has high recurrence rates - Not a viable option for 3 cm stones *ERCP* - **Endoscopic retrograde cholangiopancreatography** is used for **common bile duct stones** or biliary obstruction - **Not indicated** for gallstones confined to the gallbladder - Does not address gallbladder pathology or malignancy risk

Question 9: Best method of treatment for segmental trichiasis

A. Argon laser destruction
B. Cryoepilation (Correct Answer)
C. Electrolysis
D. Epilation

Explanation: ***Cryoepilation*** - Cryoepilation is effective for **segmental trichiasis** because it destroys the **hair follicle** and the associated melanocytes, preventing regrowth. - It utilizes **freezing temperatures** to create a zone of necrosis, leading to permanent destruction of misdirected eyelashes. *Argon laser destruction* - Argon laser destruction is generally **less effective** for trichiasis because it primarily targets pigmented structures and may not reliably destroy the entire **hair follicle**. - It has a higher risk of **collateral damage** to surrounding tissues compared to cryotherapy, especially in non-pigmented lashes. *Electrolysis* - Electrolysis is useful for **solitary** or a few misplaced lashes but is **time-consuming** and less practical for segmental involvement. - The procedure involves inserting a **fine needle** into each follicle to deliver an electric current, which can be tedious and prone to recurrence if the follicle isn't fully destroyed. *Epilation* - Epilation, or **plucking**, offers only **temporary relief** as the lash will regrow in 3-6 weeks. - Repeated epilation can lead to **follicular distortion** and ultimately worsen trichiasis or cause secondary complications like infection.

Question 10: The appropriate choice for treatment of Nulliparous prolapse is :

A. Manchester repair
B. Ward Mayo's operation
C. Pessary treatment (Correct Answer)
D. Sling operation

Explanation: ***Pessary treatment*** - For **nulliparous women** with prolapse, **conservative management** with a pessary is usually the first-line treatment, especially if they desire future fertility or surgery is not indicated. - Pessaries provide **mechanical support** to pelvic organs, alleviating symptoms without surgical intervention. *Manchester repair* - This procedure involves **cervical amputation**, uterine shortening, and repair of the anterior and posterior vaginal walls. - It is generally performed for **elongated cervix with uterine prolapse**, and is overly aggressive for prolapse in nulliparous women, especially if they wish to preserve fertility. *Ward Mayo's operation* - This refers to a **vaginal hysterectomy with anterior and posterior colporrhaphy**, often accompanied by sacrouterine ligament plication. - It is a **definitive surgical treatment** for advanced prolapse, which is typically not indicated for nulliparous women who have not completed childbearing. *Sling operation* - Sling operations, such as **mid-urethral slings**, are primarily used to treat **stress urinary incontinence**, not uterine or vaginal prolapse itself. - While prolapse can co-exist with incontinence, a sling alone would not address the prolapse in a nulliparous woman.

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