Orthopaedic Techniques Practice Questions

Q: Which of the following bones is typically addressed with a tube cast?

Knee. **Explanation:** A **Tube Cast** (also known as a Cylinder Cast) is a specialized orthopedic cast that extends from the upper thigh to just above the malleoli of the ankle. **Why the Knee is Correct:** The primary purpose of a tube cast is to provide **immobilization of the knee joint** while allowing the patient to remain weight-bearing. It is specifically indicated for conditions where the knee must be kept in extension but the ankle and foot do not require stabilization. Common indications include: * Patellar fractures (undisplaced). * Rupture of the patellar tendon or quadriceps tendon (post-repair). * Reduced knee dislocations. * Stable tibial plateau fractures. **Why the other options are incorrect:** * **Ankle:** Injuries to the ankle require a **Below-Knee (Short Leg) Cast** or an **Above-Knee (Long Leg) Cast**. A tube cast is contraindicated here because it stops above the ankle, providing no stability to the joint. * **Shoulder:** The shoulder is typically immobilized using a **Shoulder Spica**, a U-slab, or a simple sling/immobilizer. A circular cast is rarely used due to the complexity of the joint. * **Elbow:** Elbow injuries are managed with an **Above-Elbow (Long Arm) Cast** or a posterior slab. The upper limb equivalent of a tube cast (immobilizing only the elbow) is rarely used because maintaining the cast's position without it slipping is difficult. **High-Yield NEET-PG Pearls:** * **Cylinder Cast Precaution:** Always ensure the cast is molded well above the femoral condyles and proximal to the malleoli to prevent "telescoping" (slipping down). * **Walking Cast vs. Tube Cast:** A walking cast includes the foot; a tube cast allows the patient to wear their own shoe. * **Position:** The knee is typically immobilized in **0–5° of flexion** to prevent stiffness in full extension while allowing for a functional gait.

Q: The Thomas test detects which of the following?

Flexion deformity of the hip. **Explanation:** The **Thomas Test** is a clinical maneuver used to detect and measure a **fixed flexion deformity (FFD) of the hip**. In a normal hip, the lumbar spine compensates for a hip flexion deformity by increasing its lordosis, which allows the leg to lie flat on the couch, masking the deformity. **Mechanism:** To perform the test, the patient lies supine, and the unaffected hip is flexed until the thigh touches the abdomen. This maneuver stabilizes the pelvis and **obliterates the compensatory lumbar lordosis**. If a flexion deformity is present in the contralateral (tested) hip, the thigh will spontaneously lift off the examination table. The angle between the table and the lifted thigh represents the degree of fixed flexion deformity. **Analysis of Options:** * **Option A & C:** Shortening or lengthening of the lower limb is assessed using **True and Apparent limb length measurements** (measuring from the ASIS or umbilicus to the medial malleolus), not the Thomas test. * **Option D:** Tightness of the Tendoachilles tendon is assessed using the **Silfverskiöld test**, which differentiates between gastrocnemius tightness and Achilles contracture. **NEET-PG High-Yield Pearls:** * **Prerequisite:** Before performing the Thomas test, ensure the patient does not have a fixed flexion deformity of the *opposite* hip, as this will prevent full stabilization of the pelvis. * **Trendelenburg Test:** Used to assess the stability of the hip and the strength of the abductors (Gluteus medius and minimus). * **Galeazzi Sign:** Used to identify femoral or tibial shortening (discrepancy in knee heights). * **Adams Forward Bend Test:** Used to clinical screening of Scoliosis.

Q: Which of the following statements is true regarding lag screw fixation?

Any threaded screw can be used in a lag screw fashion.. ### Explanation **1. Why Option A is Correct:** The term "lagging" refers to a **technique**, not necessarily a specific type of screw. Any screw (cortical or cancellous) can function as a lag screw if it achieves interfragmentary compression. This is done by ensuring the threads only engage the **distal fragment**, while the proximal fragment contains a "gliding hole" (where the screw slides through without gripping). When the screw head tightens against the near cortex, it pulls the distal fragment toward the proximal one, creating compression. **2. Why the Other Options are Incorrect:** * **Option B & C:** These are reversed. In lag screw technique, the **proximal segment** (near the screw head) must have the **gliding hole** (drilled to the same diameter as the screw's outer threads). The **distal segment** (far fragment) must have the **threaded hole** (drilled to the diameter of the screw's core/inner diameter) to allow the threads to "bite" and pull the fragment. * **Option D:** Lag screws should ideally be placed **perpendicular to the fracture line**, not the bone segments. Placing a screw perpendicular to the fracture ensures maximum interfragmentary compression and prevents shear forces that could cause the fracture to displace. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Lag screw fixation is the most effective method for achieving **interfragmentary compression**. * **Partially Threaded Screws:** These act as "inherent" lag screws because the smooth shank automatically creates a gliding effect in the proximal fragment. * **Fully Threaded Screws:** To use these in a lag fashion, the surgeon must manually over-drill the proximal cortex to create a gliding hole. * **Sequence of Drilling:** Gliding hole (near cortex) → Drill sleeve insertion → Pilot hole (far cortex) → Countersinking → Measuring → Tapping → Screw insertion.

Q: Immobilization of the cervical spine with a plaster jacket is known as?

Minerva jacket.. **Explanation:** The **Minerva jacket** (or Minerva cast) is a specialized orthopedic plaster or fiberglass cast used to immobilize the **cervical and upper thoracic spine**. It typically extends from the head (incorporating the forehead or chin) down to the rib cage or waist. By stabilizing the head, neck, and trunk as a single unit, it prevents flexion, extension, and rotation of the cervical vertebrae. It is clinically indicated for stable cervical fractures, ligamentous injuries, or post-operative stabilization when a halo vest is not used. **Analysis of Options:** * **Minerva jacket (Correct):** Named after the Roman goddess of wisdom (often depicted wearing a helmet), this cast provides rigid immobilization of the neck and upper back. * **Maneuver jacket (Incorrect):** This is a distractor term. While "maneuvers" are common in orthopedics (e.g., Kocher’s maneuver for shoulder dislocation), there is no standard orthopedic cast known as a "Maneuver jacket." * **Sistrunk’s jacket (Incorrect):** This is a distractor. Sistrunk is a name associated with a surgical procedure for a **thyroglossal cyst** (Sistrunk’s operation), not an orthopedic immobilization technique. **High-Yield Clinical Pearls for NEET-PG:** * **Risser’s Cast:** Used for the treatment of Scoliosis (incorporates a localizer to apply pressure). * **Turnbuckle Cast:** Used for correcting lateral curvatures (Scoliosis). * **Hip Spica:** Used for pediatric femoral shaft fractures or Developmental Dysplasia of the Hip (DDH). * **Halo Vest:** The most rigid form of cervical immobilization, utilizing pins fixed into the skull; it is superior to the Minerva jacket for unstable fractures.

Q: Cozen test is used in the diagnosis of which condition?

Tennis elbow. **Explanation:** **Cozen’s Test** is a clinical provocative test used to diagnose **Lateral Epicondylitis (Tennis Elbow)**. The underlying medical concept involves the provocation of pain at the common extensor origin (lateral epicondyle) when the involved muscles are stressed. **Why Option A is Correct:** Tennis elbow involves inflammation or microtearing of the **Extensor Carpi Radialis Brevis (ECRB)** muscle. To perform Cozen’s test, the clinician stabilizes the patient's elbow and palpates the lateral epicondyle. The patient is then asked to make a fist, pronate the forearm, and **radially deviate and extend the wrist against resistance**. A positive test is indicated by sudden, sharp pain at the lateral epicondyle. **Why Other Options are Incorrect:** * **B. Golfer’s Elbow (Medial Epicondylitis):** This involves the common flexor origin. It is diagnosed using the **Medial Epicondylitis Test** (passive wrist extension with elbow extension). * **C. Jumper’s Knee (Patellar Tendonitis):** This is an overuse injury of the patellar tendon. Diagnosis is clinical, based on tenderness at the inferior pole of the patella, not upper limb provocative tests. * **D. Osteochondritis Dissecans (OCD):** This involves joint cartilage and underlying bone (commonly the knee or capitellum). Diagnosis is confirmed via X-ray or MRI; the **Wilson Test** is specifically used for OCD of the knee. **NEET-PG High-Yield Pearls:** * **Mill’s Test:** Another common test for Tennis Elbow involving passive stretching of the extensors (elbow extension, forearm pronation, and wrist flexion). * **Maudsley’s Test:** Pain on resisted extension of the **middle finger** (stresses the ECRB and Extensor Digitorum). * **Most common muscle involved in Tennis Elbow:** Extensor Carpi Radialis Brevis (ECRB).

Q: What is the probable diagnosis in a patient presenting with bilious vomiting while wearing a spinal POP cast?

Duodenal obstruction. ### Explanation The correct diagnosis is **Duodenal Obstruction**, specifically a condition known as **Cast Syndrome** (also called Superior Mesenteric Artery Syndrome). **1. Why Duodenal Obstruction is Correct:** When a patient is in a tight spinal POP cast (especially in hyperextension), the third part of the duodenum can become compressed between the **Superior Mesenteric Artery (SMA)** anteriorly and the **Aorta/Vertebral column** posteriorly. This mechanical compression leads to high intestinal obstruction, manifesting as **bilious vomiting**, abdominal distension, and pain. It is a recognized complication of scoliosis surgery and body casting. **2. Why Incorrect Options are Wrong:** * **Acute Dilation of the Stomach (Option A):** While this can occur secondary to duodenal obstruction, the primary pathology triggered by the cast itself is the vascular compression of the duodenum. * **Peritonitis (Option C):** This presents with guarding, rigidity, and rebound tenderness, usually due to a perforated viscus or infection. It is not a direct complication of spinal casting. * **Acute Pancreatitis (Option D):** While it causes vomiting and epigastric pain, it is not etiologically linked to the mechanical pressure of a spinal cast. **3. NEET-PG High-Yield Pearls:** * **Cast Syndrome:** Also known as Wilkie’s syndrome or SMA syndrome. * **Clinical Presentation:** Persistent bilious vomiting after application of a hip spica or body cast. * **Immediate Management:** The first step is to **remove or bivalve the cast** to relieve pressure. Keep the patient NPO (nothing by mouth) and insert a nasogastric tube for decompression. * **Positioning:** Placing the patient in the **prone position** or **left lateral decubitus** can sometimes relieve the SMA compression.

Q: The Trendelenburg test is performed to assess the function of which muscles?

Gluteus medius and minimus. ### Explanation **1. Why Gluteus Medius and Minimus are correct:** The Trendelenburg test assesses the **abductor mechanism** of the hip. The primary hip abductors are the **Gluteus medius** (the main abductor) and the **Gluteus minimus**, both of which are innervated by the **Superior Gluteal Nerve**. When a person stands on one leg (the "stance leg"), these muscles must contract to stabilize the pelvis and prevent the opposite side (the "swing leg") from sagging. If these muscles are weak or paralyzed, or if the fulcrum (hip joint) is unstable, the pelvis drops on the unsupported side. This is a **Positive Trendelenburg Sign**, indicating abductor insufficiency on the **weight-bearing side**. **2. Why the other options are incorrect:** * **Gluteus Maximus (Options B, C, D):** This is the primary **extensor** of the hip and is innervated by the Inferior Gluteal Nerve. While it is vital for climbing stairs and rising from a seated position, it does not play a primary role in lateral pelvic stabilization during the Trendelenburg test. Including it in the answer is a common distractor. **3. High-Yield Clinical Pearls for NEET-PG:** * **The "Sound-Side" Drop:** In a positive test, the pelvis drops toward the **normal/healthy** side when standing on the **affected** side. * **Causes of Positive Trendelenburg:** 1. **Neuromuscular:** Superior gluteal nerve palsy, Polio. 2. **Muscular:** Myopathy, Gluteus medius tear. 3. **Structural (Lever arm issues):** Congenital Dislocation of the Hip (CDH/DDH), Coxa Vara, Slipped Capital Femoral Epiphysis (SCFE). 4. **Pain:** Antalgic gait due to osteoarthritis. * **Trendelenburg Gait:** Also known as a "lurching gait." If bilateral, it is called a **Waddling gait**.

Question 1

Tapping is required in a screw which is:

Accepted Answer

Non fluted

Answer

Fluted

Answer

Self drilling

Answer

Self tapping

Question 2

Which of the following bones is typically addressed with a tube cast?

Accepted Answer

Knee

Answer

Ankle

Answer

Shoulder

Answer

Elbow

Question 3

The Thomas test detects which of the following?

Accepted Answer

Flexion deformity of the hip

Answer

Shortening of the lower limb

Answer

Lengthening of the lower limb

Answer

Tightness of the tendoachilles tendon

Question 4

Which of the following statements is true regarding lag screw fixation?

Accepted Answer

Any threaded screw can be used in a lag screw fashion.

Answer

The proximal bone segment has the threaded hole.

Answer

The distal bone segment has the gliding hole.

Answer

Lag screws are placed perpendicular to the bone segments that they fix.

Question 5

Immobilization of the cervical spine with a plaster jacket is known as?

Accepted Answer

Minerva jacket.

Answer

Maneuver jacket.

Answer

Sistrunk's jacket.

Answer

All of the above.

Question 6

What is the action of an intramedullary 'K' nail?

Accepted Answer

Three-point fixation

Answer

Two-point fixation

Answer

Compression

Answer

Weight concentration

Question 7

Cozen test is used in the diagnosis of which condition?

Accepted Answer

Tennis elbow

Answer

Golfer's elbow

Answer

Jumper's knee

Answer

Osteochondritis dissecans

Question 8

What is the probable diagnosis in a patient presenting with bilious vomiting while wearing a spinal POP cast?

Accepted Answer

Duodenal obstruction

Answer

Acute dilation of the stomach

Answer

Peritonitis

Answer

Acute pancreatitis

Question 9

Which of the following statements is NOT true?

Accepted Answer

Crutchfield traction for lumbar spine injuries

Answer

Cock-up splint for radial nerve palsy

Answer

Russel traction for trochanteric fractures

Answer

Boston Brace for scoliosis

Question 10

The Trendelenburg test is performed to assess the function of which muscles?

Accepted Answer

Gluteus medius and minimus

Answer

Gluteus maximus and minimus

Answer

Gluteus maximus and medius

Answer

Gluteus maximus, medius, and minimus

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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