NEET-PG 2012 - Orthopaedics Practice Questions

Q: Which of the following statements about Pott's spine is false?

Always heals by chemotherapy. ***Always heals by chemotherapy*** - This statement is false because while **chemotherapy** (anti-tubercular drugs) is the primary treatment for **Pott's disease** (tuberculosis of the spine), healing is not always guaranteed and can sometimes require **surgical intervention** in cases of severe neurological deficit or instability. - The success of treatment depends on early diagnosis, patient compliance, and the severity of the disease, and not all cases resolve completely without residual issues. *Commonest at dorsolumbar junction* - **Pott's spine**, or **vertebral tuberculosis**, most frequently affects the **thoracic** and **lumbar regions**, particularly the **dorsolumbar junction** (T9-L1). - This predilection is attributed to the rich vascular supply and increased mechanical stress in this area. *Back pain is an early symptom* - **Back pain** is often one of the **earliest and most common symptoms** of Pott's spine, due to inflammation and destruction of vertebral bodies. - The pain is typically **localized**, progressive, and may worsen with movement. *There is disc space narrowing on x-ray* - **X-rays** of Pott's spine often show **disc space narrowing** along with vertebral destruction and collapse, differentiating it from pyogenic osteomyelitis where disc spaces might be initially preserved. - This narrowing is a consequence of the tuberculous infection spreading from the vertebral body to the adjacent **intervertebral disc**.

Q: Which of the following is NOT a symptom of carpal tunnel syndrome?

Ulnar nerve dysfunction. ***Ulnar nerve dysfunction*** - Carpal tunnel syndrome specifically involves compression of the **median nerve**, not the ulnar nerve. - Symptoms related to the median nerve include numbness and tingling in the **thumb, index, middle, and radial half of the ring finger**, along with **thenar muscle wasting**. *Tinel sign* - The **Tinel sign** is a common physical examination finding in carpal tunnel syndrome, elicited by tapping over the **median nerve** at the wrist. - A positive sign involves tingling or electric shock-like sensations in the **median nerve distribution**. *Phalen's sign* - **Phalen's sign** is another classic physical maneuver used to diagnose carpal tunnel syndrome, where exaggerated wrist flexion for 60 seconds reproduces symptoms. - This maneuver increases pressure within the **carpal tunnel**, exacerbating median nerve compression. *Pain & paraesthesia of wrist* - **Pain and paraesthesia (numbness and tingling)** in the wrist and hand are hallmark symptoms of carpal tunnel syndrome. - These symptoms are often worse at night or with repetitive hand movements, reflecting **median nerve irritation**.

Q: What is the primary reason for early stabilization of a femur shaft fracture?

To prevent fat embolism syndrome and systemic complications. ***To prevent fat embolism syndrome and systemic complications*** - Early stabilization of femur shaft fractures significantly **reduces the incidence of fat embolism syndrome (FES)**. Fat emboli released from the bone marrow can travel to the lungs and brain, causing severe respiratory distress and neurological deficits. - By stabilizing the fracture, the **release of fat globules is minimized**, thereby preventing FES and associated systemic complications such as acute respiratory distress syndrome (ARDS) and adult respiratory distress syndrome (ADRS). *To prevent significant blood loss.* - While femur fractures can cause significant blood loss, the primary reason for early stabilization is not solely to prevent it but to reduce complications. **Blood loss is a direct consequence**, but FES poses a greater immediate threat to life. - Furthermore, **blood loss can often be managed initially by other means**, such as fluid resuscitation and direct pressure, while FES requires prompt reduction of fracture movement. *To reduce pain and discomfort.* - Reducing pain and discomfort is an important benefit of stabilization, but it is **not the primary life-saving reason** for early intervention. Analgesics and proper splinting can also address pain. - The focus on early stabilization goes beyond symptomatic relief to actively prevent **potentially fatal systemic complications**. *To facilitate quicker healing.* - While stability is crucial for proper healing, **early stabilization primarily addresses acute, life-threatening complications** rather than long-term healing rates. Optimal healing depends on many factors, including blood supply and infection control, not solely on initial stabilization. - **Quicker healing is a secondary benefit**; the immediate priority is to prevent acute morbidity and mortality associated with the fracture.

Q: Most common bone for which nailing is done

Tibia. ***Tibia*** - The **tibia** is the most common long bone for which **intramedullary nailing** (IM nailing) is performed, particularly for fractures of the **tibial shaft**. - Its subcutaneous location and strong cortical bone make it amenable to this type of internal fixation, promoting stability and healing. *Radius* - Fractures of the **radius**, especially distal radial fractures, are more commonly treated with **plate and screw fixation** or external fixation, rather than intramedullary nailing. - While IM nailing can be used for some radial shaft fractures, it is not the most common bone for this procedure. *Ulna* - Like the radius, the **ulna** is less frequently fixed with intramedullary nails; **plate and screw fixation** is generally preferred for ulnar shaft fractures. - Its triangular cross-section and the presence of the interosseous membrane complicate IM nailing in some cases. *Humerus* - While **humeral shaft fractures** can be treated with intramedullary nailing, especially in comminuted or pathological fractures, it is overall less common than tibial nailing. - The risk of shoulder and elbow stiffness, as well as radial nerve injury, are considerations with humeral nailing.

Q: What is a common complication of joint tuberculosis?

Fibrous ankylosis. ***Fibrous ankylosis*** - Joint tuberculosis commonly leads to **fibrous ankylosis** due to chronic inflammation and destruction of articular cartilage, promoting the formation of fibrous tissue that limits joint movement. - This complication results from the body's attempt to heal the persistent inflammatory process, creating a stiff and immoveable joint. *Bony ankylosis* - While possible in severe, long-standing cases, **bony ankylosis** (fusion of bones) is less common in joint tuberculosis than fibrous ankylosis. - It typically occurs in diseases like **ankylosing spondylitis** or advanced rheumatoid arthritis, where new bone formation bridges joint spaces. *Normal healing* - **Normal healing** with full restoration of joint function is rare in untreated or late-diagnosed joint tuberculosis due to the destructive nature of the infection. - The disease often causes significant damage to cartilage and bone, precluding complete recovery without sequelae. *None of the options* - This option is incorrect because **fibrous ankylosis** is a well-recognized and frequent complication of joint tuberculosis. - The chronic inflammatory response and tissue destruction inherent to the disease make complications highly probable.

Q: After chronic use of steroids severe pain in right hip with immobility is due to

Avascular necrosis. ***Avascular necrosis*** - Chronic **steroid use** is a major risk factor for avascular necrosis (AVN), particularly affecting the **femoral head** of the hip. - Reduced blood supply leads to bone death, resulting in severe pain and impaired mobility. *Perthes disease* - This is a condition of idiopathic **avascular necrosis of the femoral head** occurring in **children**, primarily between ages 4-10. - It is not associated with steroid use and typically presents in a different age group. *Hip dislocation* - Hip dislocation presents with **acute, severe pain** and an inability to bear weight or move the hip, often due to significant trauma. - While it causes immobility, it is an **acute traumatic event** rather than a chronic consequence of steroid use. *Osteoarthritis* - Osteoarthritis is a degenerative joint disease characterized by **cartilage breakdown** and joint pain that typically **worsens with activity** and improves with rest. - While chronic hip pain can be due to osteoarthritis, its direct link to steroid use for severe pain and immobility as described is less prominent than AVN.

Q: What is the primary use of a knuckle bender splint?

Ulnar nerve palsy. ***Ulnar nerve palsy*** - A knuckle bender splint is primarily used to counteract the characteristic **claw hand deformity** seen in ulnar nerve palsy [1] by maintaining the **metacarpophalangeal (MCP) joints** in flexion. - This splint helps improve function by preventing hyperextension of the MCP joints, which commonly occurs due to the unopposed action of the extensor muscles when the ulnar nerve is compromised. *Radial nerve palsy* - Radial nerve palsy typically results in **wrist drop** and an inability to extend the wrist and fingers, which is managed with wrist extension splints, not knuckle benders. - The primary goal of splinting in radial nerve palsy is to support the wrist in extension to facilitate grasping and carrying objects. *Median nerve palsy* - Median nerve palsy causes problems with thumb opposition and sensation in the first three and a half digits, often leading to an **ape hand deformity**. - Splints for median nerve palsy focus on maintaining the thumb in opposition, such as a **thumb spica splint**, which differs from a knuckle bender. *Axillary nerve palsy* - Axillary nerve palsy primarily affects the **deltoid muscle**, leading to weakness in shoulder abduction and external rotation. - Splinting for axillary nerve palsy typically involves shoulder immobilizers or abduction splints, which address shoulder joint positioning rather than hand function.

Q: In elbow, osteochondritis usually involves

Capitulum. ***Capitulum*** - The **capitulum** of the humerus is the most common site for **osteochondritis dissecans (OCD)** in the elbow, especially in throwing athletes and gymnasts. - This condition involves an avascular necrosis of the subchondral bone leading to a detachment of a cartilage fragment. *Olecranon* - The **olecranon** is part of the ulna and is more commonly affected by **stress fractures** or **bursitis**, not typically osteochondritis. - While it articulates with the trochlea, it does not bear the primary compressive forces that lead to osteochondritis in the same way the capitulum does. *Trochlea* - The **trochlea** of the humerus articulates with the trochlear notch of the ulna and is less frequently involved in primary osteochondritis compared to the capitulum. - Pathologies here are more likely related to **instability** or **fractures**. *Radial head* - The **radial head** articulates with the capitulum and is more prone to **fractures** or degenerative changes like **osteoarthritis**. - While it can be affected by **osteochondral lesions**, the capitulum is the classic site for elbow osteochondritis dissecans.

Q: Which of the following statements is true regarding supracondylar fractures of the humerus?

Extension type most common. **Extension type most common** - **Extension-type supracondylar fractures** account for the vast majority (about 95%) of all supracondylar humerus fractures. - This type typically results from a fall on an **outstretched hand** with the elbow in extension, forcing the distal fragment posteriorly. *More common in adults* - **Supracondylar fractures of the humerus** are predominantly observed in children, especially between 5 and 10 years of age. - They are the **most common elbow fracture in children**, making this statement incorrect. *Flexion type is less common than extension type* - While flexion-type fractures do occur, they are significantly less common, representing only about 5% of all supracondylar fractures. - This type typically results from a direct blow to the posterior aspect of the elbow, with the distal fragment displaced anteriorly. *Both types are equally common* - As established, extension-type fractures are far more prevalent than flexion-type fractures, making them not equally common. - The significant disparity in incidence confirms that this statement is incorrect.

Q: In the context of bone metastasis, which of the following bones is least likely to be a site of metastasis?

Fibula. ***Fibula*** - The **fibula** is not commonly involved in **metastatic disease**, primarily due to its low blood supply compared to other bones. - While it can occasionally show metastatic lesions, it's **rare** when compared to more commonly affected sites. *Humerus* - The **humerus** can be affected by metastasis, often from lung or breast cancers [1], as it is one of the long bones involved in **hematogenous spread**. - Common presentations include **lytic or blastic lesions**, which indicate bone damage from metastatic processes. *Femur* - The **femur** is frequently involved in metastatic lesions, particularly in patients with malignancies like **prostate or breast cancer** [1]. - Symptoms may include **pain** and **pathologic fractures** due to the weakening of the bone structure from metastasis [1]. *Spine* - The **spine** is a common site for metastases, especially from cancers such as **lung, breast, and prostate** [1]. - Bone scans often reveal **vertebral body lesions**, leading to complications like **spinal cord compression** [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 674-675.

Question 1

Which of the following statements about Pott's spine is false?

Accepted Answer

Always heals by chemotherapy

Answer

There is disc space narrowing on x-ray

Answer

Back pain is an early symptom

Answer

Commonest at dorsolumbar junction

Question 2

Which of the following is NOT a symptom of carpal tunnel syndrome?

Accepted Answer

Ulnar nerve dysfunction

Answer

Phalen's sign

Answer

Pain & paraesthesia of wrist

Answer

Tinel sign

Question 3

What is the primary reason for early stabilization of a femur shaft fracture?

Accepted Answer

To prevent fat embolism syndrome and systemic complications

Answer

To prevent significant blood loss.

Answer

To reduce pain and discomfort.

Answer

To facilitate quicker healing.

Question 4

Most common bone for which nailing is done

Accepted Answer

Tibia

Answer

Radius

Answer

Ulna

Answer

Humerus

Question 5

What is a common complication of joint tuberculosis?

Accepted Answer

Fibrous ankylosis

Answer

Bony ankylosis

Answer

Normal healing

Answer

None of the options

Question 6

After chronic use of steroids severe pain in right hip with immobility is due to

Accepted Answer

Avascular necrosis

Answer

Perthes disease

Answer

Hip dislocation

Answer

Osteoarthritis

Question 7

What is the primary use of a knuckle bender splint?

Accepted Answer

Ulnar nerve palsy

Answer

Radial nerve palsy

Answer

Median nerve palsy

Answer

Axillary nerve palsy

Question 8

In elbow, osteochondritis usually involves

Accepted Answer

Capitulum

Answer

Olecranon

Answer

Trochlea

Answer

Radial head

Question 9

Which of the following statements is true regarding supracondylar fractures of the humerus?

Accepted Answer

Extension type most common

Answer

Flexion type is less common than extension type

Answer

Both types are equally common

Answer

More common in adults

Question 10

In the context of bone metastasis, which of the following bones is least likely to be a site of metastasis?

Accepted Answer

Fibula

Answer

Femur

Answer

Humerus

Answer

Spine

NEET-PG 2012 — Orthopaedics