FMGE 2018 - Orthopaedics PYQs Practice Questions

Q: Adamantinoma affects

Tibia. ***Tibia*** - **Adamantinoma** is a rare, malignant bone tumor that almost exclusively affects the **tibia**, accounting for over 90% of cases. - It often presents as a **slow-growing mass** associated with pain and swelling in the shin. *Humerus* - While other primary bone tumors can affect the humerus, adamantinoma is **extremely rare** in this location. - The humerus is more commonly affected by tumors like **osteosarcoma** or **Ewing sarcoma**. *Femur* - The femur is a common site for various bone tumors, but **adamantinoma is not typically found** here. - Tumors like **osteosarcoma** and **chondrosarcoma** are much more prevalent in the femur. *Radius* - Similar to the humerus and femur, the radius is **not a characteristic location** for adamantinoma. - Tumors of the radius are generally less common than in the major long bones. [Practice more Orthopaedics PYQs on OnCourse]

Q: Most common site of osteomyelitis in children

Metaphysis. ***Metaphysis*** - The **metaphysis** is the most common site for osteomyelitis in children due to its rich, **slow-flowing sinusoidal blood supply**, which facilitates bacterial seeding. - The **nutrient arteries** in the metaphysis make sharp loops, creating a turbulent flow that slows circulation and allows bacteria to lodge more easily. *Epiphysis* - The **epiphysis** is less commonly affected in children because its separate blood supply is not as prone to bacterial seeding as the metaphysis. - In infants, however, infection can spread from the metaphysis to the epiphysis and joint space due to **transphyseal vessels**. *Growth plate* - The **growth plate** itself is generally resistant to infection due to its avascular nature. - However, infection in the adjacent metaphysis or epiphysis can potentially disrupt its function. *Diaphysis* - While the **diaphysis** has a blood supply, it is less common for osteomyelitis to originate here compared to the metaphysis. - It usually occurs as a secondary spread from a metaphyseal infection or in specific scenarios like in **sickle cell disease**. [Practice more Orthopaedics PYQs on OnCourse]

Q: Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Recurrent shoulder dislocation. ***Recurrent shoulder dislocation*** - The ability to **spontaneously reduce** a shoulder dislocation, and the history of it happening "again and again" strongly indicate **recurrent shoulder dislocation**. - This condition often results from **ligamentous laxity** or damage to the **labrum** (Bankart lesion) that fails to stabilize the shoulder joint after an initial dislocation. *Inferior shoulder dislocation* - This is a **specific type of shoulder dislocation** (luxatio erecta) where the humeral head is displaced inferiorly, but "inferior" alone does not explain the recurrent nature. - While possible in an individual, the key element here is the **recurrence** and self-reduction, not just the direction of a single dislocation. *Fracture upper end humerus* - A fracture of the upper end of the humerus is a **bony injury** and would typically present with severe pain, swelling, and inability to move the arm, not spontaneous reduction. - This injury would usually **prevent** the patient from repeatedly dislocating and reducing their shoulder. *Acute shoulder dislocation* - An acute shoulder dislocation refers to a **single, recent episode** of dislocation. - The patient's repeated ability to self-reduce the shoulder indicates a chronic problem rather than an initial, isolated event. [Practice more Orthopaedics PYQs on OnCourse]

Q: A lady had a trauma to the neck. X-ray is attached. What is the diagnosis?

Hangman's fracture. ***Hangman's fracture*** - A **Hangman's fracture** is a fracture of the **pars interarticularis of the C2 vertebra (axis)**, typically resulting from hyperextension and distractive forces, often seen in car accidents or judicial hangings. - The X-ray would show **bilateral pedicle fractures of C2**, with or without anterior displacement of C2 on C3. *Sciwora* - **SCIWORA** stands for **Spinal Cord Injury Without Radiographic Abnormality**, and it is primarily diagnosed when clinical signs of spinal cord injury are present but X-rays and CT scans show no bony abnormalities. - This patient's X-ray would show visible bony injury, ruling out SCIWORA. *Jefferson's fracture* - A **Jefferson's fracture** is a **burst fracture of the C1 vertebra (atlas)**, typically caused by axial loading with a compressive force, and involves fractures of the anterior and/or posterior arches of C1. - While it's also a cervical spine fracture, it specifically involves C1, not C2 as seen in a Hangman's fracture. *Clay shoveler fracture* - A **Clay shoveler's fracture** is an avulsion fracture of a **spinous process** in the lower cervical or upper thoracic spine, most commonly C6, C7, or T1. - It typically results from abrupt neck flexion and muscle pulling, and is a stable fracture that does not affect the C2 pars interarticularis. [Practice more Orthopaedics PYQs on OnCourse]

Q: A child presents with a limp and limb shortening. The X-ray is shown below. What is the diagnosis?

DDH. ***DDH*** - **DDH (Developmental Dysplasia of the Hip)** often presents with a **limp**, **limb shortening**, and characteristic X-ray findings showing a **dislocated or dysplastic hip joint**. - The image would likely show the **femoral head displaced** from the acetabulum, confirming the diagnosis. *SCFE* - **SCFE (Slipped Capital Femoral Epiphysis)** presents with pain and a limp, but typically involves the **femoral head slipping posteriorly and inferiorly** relative to the femoral neck. - It usually occurs in **adolescents** who are overweight or rapidly growing, and the X-ray would show the **epiphysis displaced** rather than a fully dislocated hip. *Fracture neck of femur* - A **fracture of the neck of the femur** in a child is a rare traumatic injury that would present with **acute pain** and inability to bear weight. - The X-ray would clearly show a **break in the continuity** of the femoral neck, which is distinct from the developmental abnormality seen in DDH. *Perthes* - **Perthes disease** involves **avascular necrosis of the femoral head** and typically presents with a limp and pain, often in younger children (4-10 years old). - X-rays would show signs of **collapse, fragmentation, and later reossification** of the femoral head, rather than a dislocated hip. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

Adamantinoma affects

Accepted Answer

Tibia

Answer

Humerus

Answer

Femur

Answer

Radius

Question 2

Most common site of osteomyelitis in children

Accepted Answer

Metaphysis

Answer

Epiphysis

Answer

Growth plate

Answer

Diaphysis

Question 3

Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Accepted Answer

Recurrent shoulder dislocation

Answer

Inferior shoulder dislocation

Answer

Fracture upper end humerus

Answer

Acute shoulder dislocation

Question 4

A lady had a trauma to the neck. X-ray is attached. What is the diagnosis?

Accepted Answer

Hangman's fracture

Answer

Sciwora

Answer

Jefferson's fracture

Answer

Clay shoveler fracture

Question 5

A child presents with a limp and limb shortening. The X-ray is shown below. What is the diagnosis?

Accepted Answer

DDH

Answer

SCFE

Answer

Fracture neck of femur

Answer

Perthes

Question 6

Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Accepted Answer

Game keepers thumb

Answer

Kaplan lesion

Answer

Mallet finger

Answer

Bennett fracture

Question 7

Which of the following statements about tubercular osteomyelitis is NOT true?

Accepted Answer

Periosteal reaction is characteristic

Answer

Sequestrum is uncommon

Answer

It is a type of secondary osteomyelitis

Answer

Inflammation is minimal

Question 8

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 9

Blount Disease is involvement of

Accepted Answer

Proximal tibia

Answer

Distal femur

Answer

Distal tibia

Answer

Proximal femur

Question 10

79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Accepted Answer

Hemiahroplasty

Answer

Hip spica

Answer

Nailing

Answer

Total Hip Replacement

FMGE 2018 — Orthopaedics