INI-CET 2018 - Orthopaedics PYQs Practice Questions

Q: A 10-year-old child presents with fever and wound with discharging pus from right thigh for 4 months. Given below is the X -ray of the patient. Identify the marked area:

Sequestrum. ***Sequestrum*** - The arrow points to a dense, isolated fragment of **necrotic bone** within the bone shaft, which is a classic radiographic finding of a **sequestrum** in chronic osteomyelitis. - In chronic osteomyelitis, the host immune system attempts to wall off the infection, leading to bone necrosis and the formation of this devitalized bone fragment. *Cloacae* - A cloaca is an opening or channel in the **involucrum** (new bone formation) through which pus and necrotic debris (sequestrum) can drain from the infected bone. - The image does not clearly show an opening for drainage; rather, it highlights an internal bone fragment. *Involucrum* - The involucrum is a sheath of **new bone formation** that encapsulates the infected, necrotic bone (sequestrum) in chronic osteomyelitis. - While new bone formation is likely present, the arrow specifically indicates the denser, dead bone fragment rather than the surrounding reactive new bone. *Woven bone* - **Woven bone** is immature, rapidly formed bone, often seen during bone development, fracture healing, or in certain pathological conditions like fibrous dysplasia or Paget's disease. - The marked area is a distinct fragment of necrotic cortical bone, not indicative of diffuse woven bone formation. [Practice more Orthopaedics PYQs on OnCourse]

Q: Given is the X-ray of a 7-year-old child. Identify the deformity:

Perthe's disease. ***Perthe's disease*** - The X-ray shows changes consistent with **Perthe's disease**, characterized by **avascular necrosis of the femoral head**. Findings include **flattening of the femoral head**, **sclerosis**, and potential **fragmentation**. - This condition typically affects *children between 4 and 10 years old*, matching the age of the child in the question (7 years old). *Coxa vara* - **Coxa vara** is defined by a **decreased femoral neck-shaft angle** (less than 120 degrees), leading to a more horizontal orientation of the femoral neck. - While *Perthe's disease can lead to coxa vara* as a complication, the primary pathological changes (sclerosis, flattening, fragmentation of the femoral head) are distinctive of Perthe's. *Coxa valga* - **Coxa valga** is characterized by an **increased femoral neck-shaft angle** (greater than 135-140 degrees), causing the femoral neck to be more vertical. - This is the opposite of coxa vara and is not typically associated with the radiographic findings observed in the image. *Brodie's abscess* - A **Brodie's abscess** is a **subacute or chronic osteomyelitis**, often appearing as a **well-circumscribed luncency** with a sclerotic rim, commonly found in the metaphysis of long bones. - The X-ray does not show a focal lytic lesion suggestive of an abscess; instead, it presents diffuse changes to the femoral epiphysis. [Practice more Orthopaedics PYQs on OnCourse]

Q: Identify the lesion in the X-ray shown below:

Aneurysmal bone cyst. ***Aneurysmal bone cyst*** - The image shows a **lytic, expansile lesion** in the distal radius with a **"soap bubble" appearance**, characteristic of an aneurysmal bone cyst. - These are typically **benign, blood-filled lesions** that cause bone remodeling and expansion. *Giant cell tumour* - While also a **lytic lesion**, giant cell tumors are usually more aggressive and often show **cortical destruction** and less distinct margins without the typical septations seen here. - They tend to occur in the **epiphysis** of long bones after epiphyseal closure. *Osteoma* - An osteoma is a **benign, dense, sclerotic bone growth**, appearing as a very bright, compact lesion on X-ray, which is clearly not depicted in the image. - These are typically **asymptomatic** and found incidentally. *Osteosarcoma* - This is a **highly malignant primary bone tumor** that typically presents with a **blastic or mixed lytic-blastic appearance**, often with a **"sunburst" pattern** or **Codman's triangle**, characteristics not seen in this image. - It usually causes significant **cortical destruction** and a more aggressive soft tissue mass. [Practice more Orthopaedics PYQs on OnCourse]

Q: This diagnosis is?

Scaphoid fracture. ***Scaphoid fracture*** - Classic mechanism of **fall on outstretched hand (FOOSH)** with forced **dorsiflexion** of wrist, commonly affecting the **scaphoid waist**. - Clinical presentation includes **anatomical snuffbox tenderness** and pain with **axial loading** of thumb and **scaphoid compression test**. *Rheumatoid arthritis* - Systemic autoimmune condition affecting **multiple joints symmetrically**, not typically presenting as acute wrist trauma. - Characterized by **morning stiffness**, **synovial swelling**, and **positive rheumatoid factor** rather than focal bone fracture. *Scapholunate dissociation* - Results in **widening of scapholunate interval** on X-ray (>3mm) and **Terry Thomas sign** on PA view. - Presents with **dorsal wrist pain** and **Watson's test positivity** but lacks the specific fracture line seen in scaphoid injury. *Lunate dislocation* - Shows characteristic **spilled teacup sign** on lateral X-ray with **lunate tilted volarly** and loss of normal carpal alignment. - Presents as **severe wrist deformity** with **median nerve compression symptoms** rather than localized scaphoid area tenderness. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

A 10-year-old child presents with fever and wound with discharging pus from right thigh for 4 months. Given below is the X -ray of the patient. Identify the marked area:

Accepted Answer

Sequestrum

Answer

Cloacae

Answer

Involucrum

Answer

Woven bone

Question 2

Given is the X-ray of a 7-year-old child. Identify the deformity:

Accepted Answer

Perthe's disease

Answer

Coxa vara

Answer

Coxa valga

Answer

Brodie's abscess

Question 3

Identify the lesion in the X-ray shown below:

Accepted Answer

Aneurysmal bone cyst

Answer

Giant cell tumour

Answer

Osteoma

Answer

Osteosarcoma

Question 4

This diagnosis is?

Accepted Answer

Scaphoid fracture

Answer

Rheumatoid arthritis

Answer

Scapholunate dissociation

Answer

Lunate dislocation

INI-CET 2018 — Orthopaedics