NEET-PG 2013 - Orthopaedics Practice Questions

Q: Bulge sign in the knee joint is seen after how much fluid accumulation?

< 30 ml. **< 30 ml** - The **bulge sign** is a sensitive test for detecting small amounts of **effusion** in the knee joint. - It is typically positive with as little as 4-8 mL to 10-30 mL of fluid, making "< 30 mL" the most appropriate answer. *100 ml* - An effusion of 100 mL is a **moderate to large amount** of fluid, which would typically elicit a positive **patellar tap test (ballottement)** rather than just a bulge sign. - The **bulge sign** is designed to detect much smaller effusions. *400 ml* - This represents a **very large effusion** that would be clinically obvious and cause significant swelling and discomfort, far exceeding the threshold for a simple bulge sign. - A knee with 400 mL of fluid would likely have a tense, bulging appearance and a very prominent **patellar tap**. *200 ml* - This is also a **significant effusion** that would easily be detected by a patellar tap test and would present with gross swelling. - The **bulge sign** is specifically for subtler fluid collections.

Q: Most common nerve injured in fracture of medial epicondyle of humerus is:

Ulnar nerve. ***Ulnar nerve*** - The **ulnar nerve** runs directly behind the **medial epicondyle** of the humerus in a groove called the **cubital tunnel**, making it highly vulnerable to injury during fractures of this bony prominence. - Injury to the ulnar nerve at this location can cause symptoms like **numbness and tingling** in the **little finger and half of the ring finger**, **weakness in certain hand muscles**, and eventually a **"claw hand" deformity**. *Radial nerve* - The **radial nerve** courses along the posterior aspect of the humerus in the **spiral groove** and is more commonly injured with **mid-shaft humeral fractures**. - Injury typically results in **wrist drop** and **sensory loss over the dorsum of the hand**. *Median nerve* - The **median nerve** travels more anteriorly in the arm and forearm and is most commonly injured with **supracondylar fractures of the humerus** or **carpal tunnel syndrome** at the wrist. - Damage leads to **ape hand deformity** and sensory deficits over the **thumb, index, middle, and radial half of the ring finger**. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles and provides sensation to the lateral forearm; it is **less commonly injured in elbow fractures**. - Injury would primarily affect **elbow flexion** and **sensation over the lateral forearm**, which is not the typical presentation for medial epicondyle fractures.

Q: Von-Rosen's sign is positive in which of the following conditions?

Developmental Dysplasia of the Hip (DDH). ***Developmental Dysplasia of the Hip (DDH)*** - **Von-Rosen's sign** is a clinical test used to detect **instability or dislocation** of the hip in newborns, a hallmark of DDH. - The test involves placing the infant **supine with hips flexed to 90 degrees**, then **externally rotating and abducting** the hips while applying gentle longitudinal traction; positive if abduction is limited to **less than 60 degrees**. *Perthe's disease* - This condition involves **avascular necrosis of the femoral head** in children, typically presenting with a limp and hip pain, not congenital instability. - Diagnosis is usually made by X-rays showing **sclerosis and fragmentation** of the femoral head, not by Von-Rosen's sign. *SCFE* - **Slipped Capital Femoral Epiphysis (SCFE)** is a condition where the femoral head epiphysis displaces from the femoral neck, common in adolescents. - Patients typically present with **hip or knee pain** and a characteristic external rotation of the affected limb, which is not detected by Von-Rosen's sign. *CTEV* - **Congenital Talipes Equinovarus (CTEV)**, or **clubfoot**, is a deformity of the foot and ankle, involving plantarflexion and inversion. - This condition affects the foot, not the hip, rendering tests for hip instability like Von-Rosen's sign irrelevant.

Q: What splint is used in CTEV after correction?

Dennis Brown splint. ***Dennis Brown splint*** - The **Dennis Brown splint** is specifically designed for maintaining the correction of **clubfoot (CTEV)** in infants to prevent recurrence. - It consists of a bar connecting two shoes that hold the feet in an **external rotation** and **abduction** position. *Bohler-Brown splint* - The **Bohler-Brown splint** is primarily used for the management of **tibial shaft fractures**. - It is a **traction splint** designed to maintain alignment and length of the fractured bone. *Thomas splint* - The **Thomas splint** is typically used for **femoral shaft fractures** to provide traction and reduce muscle spasm. - It is not indicated for the long-term management of clubfoot. *None of the options* - This option is incorrect as the **Dennis Brown splint** is a well-established and a primary splint used for CTEV after correction.

Q: What is the most common structural deformity associated with transient synovitis of the hip?

None of the options. ***None of the options:*** - Transient synovitis of the hip is an inflammatory condition that does not inherently cause a **structural deformity** of the hip joint. - While it causes pain and limited range of motion, these are functional rather than structural changes, and the hip joint's **anatomical structure remains intact**. *Abduction* - Abduction is a **movement**, not a structural deformity. Although the hip may be held in a position of slight abduction to relieve pain, this is a postural adaptation, not a permanent structural change. - Hip abduction contractures can occur in various conditions (e.g., neuromuscular disorders) but are not characteristic of transient synovitis. *Flexion* - Similar to abduction, flexion is a **movement**, not a structural deformity. Patients with transient synovitis often hold the hip in a flexed position (along with abduction and external rotation) for comfort to minimize pressure within the joint capsule. - A fixed flexion deformity can be seen in other conditions like septic arthritis or Legg-Calvé-Perthes disease, but not typically in transient synovitis. *External rotation* - External rotation is also a **movement**, not a structural deformity. Patients may adopt an externally rotated position of the leg to ease pain and reduce intracapsular pressure. - While certain conditions can cause a fixed external rotation (e.g., slipped capital femoral epiphysis), transient synovitis does not lead to this type of structural change.

Q: Which of the following is NOT a common fracture in children?

Fracture of hand. ***Fracture of hand*** - While hand fractures can occur in children, they are generally **less common** compared to fractures of the long bones, especially those of the **upper extremity**, due to the types of activities and falls children typically experience. - The small bones of the hand are often better protected or less frequently exposed to severe direct trauma in routine childhood activities that lead to fractures elsewhere. *Lateral condyle humerus* - This is a common and often challenging fracture in children, particularly affecting those aged 6-10 years. - It usually results from a fall on an **outstretched hand**, with the elbow in extension. *Supracondylar humerus* - This is one of the **most common elbow fractures** in children and is typically due to a fall on an **outstretched hand** with the elbow extended or hyperextended. - Its significance lies in the potential for neurovascular complications due to its proximity to vital structures. *Radius-ulna fracture* - **Forearm fractures** involving the radius, ulna, or both are extremely common in children, often resulting from falls onto an **outstretched hand**. - The **distal radius** is a particularly frequent site of fracture in this age group.

Q: Thurston Holland sign is seen in ?

Type II. ***Type II*** - The **Thurston Holland sign** is characteristic of a **Salter-Harris Type II fracture**, often described as a metaphyseal fragment (the "Thurston Holland fragment") remaining attached to the epiphyseal plate. - This fragment typically occurs at the corner of the **metaphysis**, making the fracture line extend obliquely through the physis and then along the metaphysis. *Type I* - A **Salter-Harris Type I fracture** involves a clean horizontal separation through the **growth plate (physis)** without involving the metaphysis or epiphysis. - No metaphyseal fragment is seen in Type I fractures, distinguishing it from the Thurston Holland sign. *Type III* - **Salter-Harris Type III fractures** extend from the **physis into the epiphysis**, creating an intra-articular fracture involving the joint surface. - These fractures do not involve a metaphyseal fragment, as they solely affect the physis and epiphysis. *Type IV* - **Salter-Harris Type IV fractures** involve a fracture line extending through the **epiphysis, physis, and metaphysis**, effectively dividing the bone into three parts. - While complex, Type IV injuries do not specifically describe the characteristic metaphyseal fragment that defines the Thurston Holland sign.

Q: How is Brodie's abscess classified?

Chronic osteomyelitis (Brodie's abscess). ***Chronic osteomyelitis (Brodie's abscess)*** - Brodie's abscess is a **subacute or chronic localized osteomyelitis**, characterized by an intraosseous abscess often surrounded by a thick layer of sclerotic bone. - It represents a **contained infection** within the bone, lacking the widespread inflammatory response seen in acute forms. *Acute osteomyelitis* - Characterized by a **rapid onset** of severe pain, fever, and inflammation, usually within days to weeks of infection. - It involves a **widespread inflammatory process** and potential for bone destruction, differentiated from the contained and indolent nature of Brodie's abscess. *Subacute osteomyelitis* - This term describes an osteomyelitis with a more gradual onset and less severe symptoms than acute osteomyelitis, typically lasting several weeks to a few months. - While Brodie's abscess can present subacutely, it is specifically classified as a **form of chronic osteomyelitis** due to its localized, walled-off nature and prolonged course. *Septic arthritis* - Involves an infection within a **joint space**, leading to inflammation and destruction of articular cartilage. - It is distinct from Brodie's abscess, which is an infection of the **bone tissue itself**, not the joint.

Q: Which of the following fractures is least likely associated with vascular injury?

Fracture shaft of humerus. ***Fracture shaft of humerus*** - While any fracture can theoretically cause vascular injury, **mid-shaft humeral fractures** are less commonly associated with significant **vascular compromise** compared to those around major joints or near critical neurovascular bundles. - The **brachial artery** and its branches are often sufficiently mobile and protected by surrounding musculature in the mid-shaft region, reducing the incidence of direct laceration or entrapment. *Fracture supracondylar femur* - **Supracondylar femur fractures** are in close proximity to the **femoral artery** and its branches in the popliteal fossa. - Displacement of these fractures can easily **lacerate or compress** these vital vessels, leading to high rates of vascular injury. *Fracture supracondylar humerus* - **Supracondylar humerus fractures** in children are notoriously associated with **brachial artery injury** due to the artery's close proximity and fixated position over the joint. - The acute angulation and displacement often seen in these fractures put the artery at significant risk of **kinking, compression, or transection**. *Fracture shaft of femur* - **Femoral shaft fractures** can be associated with significant vascular injury, particularly from **large displaced fragments** or high-energy trauma. - The **superficial femoral artery** and its perforating branches can be torn, leading to substantial hemorrhage or arterial compromise.

Q: Bunion is commonly seen at ?

Great toe MTP joint. ***Great toe MTP joint*** - A bunion, or **hallux valgus**, is a bump that forms on the outside of the **first metatarsophalangeal (MTP) joint** of the big toe. - This common foot deformity involves structural changes that result in the big toe pointing towards the smaller toes. *Medial malleolus* - The medial malleolus is the bony prominence on the **inside of the ankle**. - It is part of the tibia and forms the inner wall of the ankle joint, not typically where bunions occur. *Lateral Malleolus* - The lateral malleolus is the bony protrusion on the **outside of the ankle**. - It is part of the fibula and forms the outer wall of the ankle joint, unrelated to bunion formation. *Shin of tibia* - The shin refers to the **anterior crest of the tibia**, the large bone in the lower leg. - This area is prone to conditions like shin splints or fractures, but not bunions.

Question 1

Bulge sign in the knee joint is seen after how much fluid accumulation?

Accepted Answer

< 30 ml

Answer

200 ml

Answer

100 ml

Answer

400 ml

Question 2

Most common nerve injured in fracture of medial epicondyle of humerus is:

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 3

Von-Rosen's sign is positive in which of the following conditions?

Accepted Answer

Developmental Dysplasia of the Hip (DDH)

Answer

Perthe's disease

Answer

SCFE

Answer

CTEV

Question 4

What splint is used in CTEV after correction?

Accepted Answer

Dennis Brown splint

Answer

Bohler-Brown splint

Answer

Thomas splint

Answer

None of the options

Question 5

What is the most common structural deformity associated with transient synovitis of the hip?

Accepted Answer

None of the options

Answer

Abduction

Answer

Flexion

Answer

External rotation

Question 6

Which of the following is NOT a common fracture in children?

Accepted Answer

Fracture of hand

Answer

Supracondylar humerus

Answer

Radius-ulna fracture

Answer

Lateral condyle humerus

Question 7

Thurston Holland sign is seen in ?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 8

How is Brodie's abscess classified?

Accepted Answer

Chronic osteomyelitis (Brodie's abscess)

Answer

Acute osteomyelitis

Answer

Subacute osteomyelitis

Answer

Septic arthritis

Question 9

Which of the following fractures is least likely associated with vascular injury?

Accepted Answer

Fracture shaft of humerus

Answer

Fracture supracondylar femur

Answer

Fracture supracondylar humerus

Answer

Fracture shaft of femur

Question 10

Bunion is commonly seen at ?

Accepted Answer

Great toe MTP joint

Answer

Medial malleolus

Answer

Lateral Malleolus

Answer

Shin of tibia

NEET-PG 2013 — Orthopaedics