NEET-PG 2012 - Orthopaedics Practice Questions

Q: What type of cast is primarily associated with the development of Cast syndrome?

Hip spica cast. ***Hip spica cast*** - A **hip spica cast** encases the trunk and one or both legs, increasing intra-abdominal pressure due to its extensive coverage. - This pressure can compress the **superior mesenteric artery** against the **duodenum**, leading to Cast syndrome (also known as superior mesenteric artery syndrome). *Full arm cast* - A full arm cast does not cover the abdomen and therefore does not exert pressure on the **superior mesenteric artery** or duodenum. - It is associated with complications like compartment syndrome or nerve impingement in the upper extremity, but not Cast syndrome. *Short arm cast* - Similar to a full arm cast, a short arm cast is limited to the forearm and hand and poses no risk for **abdominal compression**. - Complications are localized to the distal upper limb, such as carpal tunnel syndrome or skin breakdown. *Above knee cast* - An above knee cast covers the lower leg and thigh but does not extend to the abdomen. - It does not contribute to the increased intra-abdominal pressure necessary for the development of **superior mesenteric artery syndrome**.

Q: Green stick fracture is

Incomplete fracture. ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

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: 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: 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: 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.

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: Osteonecrosis is seen in all except

Paget's disease. ***Paget's disease*** - **Paget's disease of bone (osteitis deformans)** is a localized disorder of bone remodeling, characterized by excessive and disorganized bone formation, leading to enlarged, softened, and misshapen bones, but not directly causing osteonecrosis. - While complications like **pathological fractures** and **osteosarcoma** can occur, primary osteonecrosis is not a typical feature of Paget's disease itself. *Fracture neck femur* - **Fractures of the femoral neck** can disrupt the blood supply to the femoral head, particularly the medial circumflex femoral artery, leading to **avascular necrosis** (osteonecrosis) of the femoral head. - This is a well-known and common complication, especially in displaced fractures. *Sickle cell anemia* - **Sickle cell anemia** causes sickling of red blood cells, leading to **vaso-occlusion** and impaired blood flow to bones, resulting in **bone infarcts** (osteonecrosis). - This can affect various bones, including the femoral head, humeral head, and vertebrae. *Perthe's disease* - **Perthe's disease** (Legg-Calvé-Perthes disease) is a childhood condition characterized by **idiopathic osteonecrosis** of the femoral head. - It involves the collapse and subsequent re-ossification of the femoral epiphysis due to an interruption of its blood supply.

Q: What is the most common type of dislocation of the elbow joint?

Posterolateral dislocation. ***Posterolateral dislocation*** - This is the **most common type of elbow dislocation**, accounting for over 90% of cases. - The **radius and ulna displace posterior and lateral** relative to the humerus. *Posterior dislocation* - While common, **pure posterior dislocations are less frequent** than posterolateral disruptions. - In a pure posterior dislocation, the **forearm bones move directly backward**, without a significant lateral component. *Posteromedial dislocation* - This is a **less common type of elbow dislocation**, involving the ulna and radius displacing posterior and medial. - Often associated with **more complex soft tissue and bony injuries**. *Lateral dislocation* - **Pure lateral dislocations of the elbow are rare** and usually involve significant disruption of the medial collateral ligament. - It occurs when the **forearm bones move directly lateral** to the humerus.

Q: What condition is primarily diagnosed using Von Rosen's view?

Congenital dislocation of the hip (CDH). ***Congenital dislocation of the hip (CDH)*** - **Von Rosen's view** is a specialized X-ray projection used specifically to assess for **developmental dysplasia of the hip (DDH)**, also known as CDH, in infants. - This view helps visualize the relationship between the **femoral head** and the **acetabulum** by positioning the infant's hips in extension, abduction, and internal rotation. *Perthes disease* - **Perthes disease** is an avascular necrosis of the femoral head, typically diagnosed with standard **frog-leg lateral** and **AP pelvic X-rays**. - While it affects the hip, Von Rosen's view is not the primary diagnostic imaging for this condition, which usually presents later in childhood. *Congenital Talipes Equinovarus (CTEV)* - **CTEV**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It is primarily diagnosed clinically and then confirmed with **AP and lateral X-rays of the foot** to assess bone alignment. *None of the options* - This option is incorrect because **Congenital dislocation of the hip (CDH)** is indeed primarily diagnosed using Von Rosen's view, among other methods.

Question 1

What type of cast is primarily associated with the development of Cast syndrome?

Accepted Answer

Hip spica cast

Answer

Full arm cast

Answer

Short arm cast

Answer

Above knee cast

Question 2

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 3

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 4

In elbow, osteochondritis usually involves

Accepted Answer

Capitulum

Answer

Olecranon

Answer

Trochlea

Answer

Radial head

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

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

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

Osteonecrosis is seen in all except

Accepted Answer

Paget's disease

Answer

Fracture neck femur

Answer

Perthe's disease

Answer

Sickle cell anemia

Question 9

What is the most common type of dislocation of the elbow joint?

Accepted Answer

Posterolateral dislocation

Answer

Posterior dislocation

Answer

Posteromedial dislocation

Answer

Lateral dislocation

Question 10

What condition is primarily diagnosed using Von Rosen's view?

Accepted Answer

Congenital dislocation of the hip (CDH)

Answer

Perthes disease

Answer

Congenital Talipes Equinovarus (CTEV)

Answer

None of the options

NEET-PG 2012 — Orthopaedics