NEET-PG 2013 - Orthopaedics Practice Questions

Q: What is the purpose of the Insall-Salvati index?

To assess patellar height and tendon length ratio. ***To assess patellar height and tendon length ratio*** - The **Insall-Salvati index** is a radiographic measurement used to determine **patellar height** by comparing the length of the patellar tendon to the greatest diagonal length of the patella. - It helps in diagnosing conditions like **patella alta** (high-riding patella) or **patella baja** (low-riding patella), which can contribute to knee pain and instability. *To evaluate elbow joint stability* - **Elbow joint stability** is typically assessed through clinical examination for ligamentous integrity (e.g., UCL, RCL) and sometimes dynamic imaging, not by the Insall-Salvati index. - The Insall-Salvati index is specific to the **knee joint** and **patellar position**. *To measure ankle dorsiflexion range* - **Ankle dorsiflexion range** is measured clinically using a goniometer or in 3D motion analysis, not with the Insall-Salvati index. - This index is a specialized measurement for the **patellofemoral joint**. *To assess wrist bone alignment* - **Wrist bone alignment** is evaluated using various radiographic measurements such as the scaphoid-lunate angle or carpal height ratio. - The Insall-Salvati index has no application in the assessment of the **wrist**.

Q: Most common site of osteochondritis dissecans?

Lateral part of the medial femoral condyle. ***Lateral part of the medial femoral condyle*** - This is the **most common site** for osteochondritis dissecans in the knee, accounting for about 85% of cases. - The condition involves a localized area of **osteonecrosis and subchondral bone separation** from the epiphysis, typically afflicting this specific load-bearing region. *Medial part of the medial femoral condyle* - This location is **less common** for osteochondritis dissecans compared to the lateral aspect of the medial femoral condyle. - While osteochondral lesions can occur on any part of the condyle, the specific biomechanical stresses make the lateral part more susceptible. *Lateral part of the lateral femoral condyle* - Osteochondritis dissecans is **rarely found** in this location. - The lateral femoral condyle is generally less involved in osteochondritis dissecans of the knee. *Medial part of the lateral femoral condyle* - This site is also an **uncommon location** for osteochondritis dissecans. - The disease has a strong predilection for the medial femoral condyle, particularly its lateral aspect.

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: Which of the following is an orthopedic emergency?

Septic arthritis. ***Septic arthritis*** - This is an **orthopedic emergency** due to the rapid destruction of cartilage and bone if not treated promptly. - It requires urgent **surgical washout** and intravenous antibiotics to prevent irreversible joint damage and systemic infection. *Intraarticular fracture* - While requiring careful management to optimize joint function, an **intraarticular fracture** is typically not an immediate emergency unless there's associated neurovascular compromise or compartment syndrome. - Surgical intervention can often be planned within a certain timeframe (days) rather than hours. *Fracture lateral condyle humerus* - This fracture in children is significant due to potential for non-union or avascular necrosis, but it is not considered an immediate **life- or limb-threatening emergency**. - Management usually involves **reduction and fixation** but does not carry the same degree of urgency as active joint infection. *Fracture neck femur* - A fractured neck of femur requires surgical intervention to prevent complications like **avascular necrosis** and optimize mobility, particularly in elderly patients. - While serious, it primarily presents a risk of long-term disability and complications, not an immediate destructive process like septic arthritis.

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: What is another name for ischial bursitis?

Weaver's bottom. ***Weaver's bottom*** - This is a common **colloquial term** for ischial bursitis, describing the condition that can arise from prolonged sitting. - The **ischial bursa** lies between the ischial tuberosity and the gluteus maximus, which can become inflamed from pressure. *Prepatellar bursitis* - This refers to inflammation of the bursa located over the **kneecap**. - It is often called **"housemaid's knee"** due to its association with prolonged kneeling. *Trochanteric bursitis* - This is inflammation of the bursa located over the **greater trochanter of the femur**, on the outer side of the hip. - It causes pain in the **lateral hip region**, often radiating down the thigh. *Olecranon bursitis* - This involves inflammation of the bursa located at the **tip of the elbow** (olecranon process). - It is sometimes called **"student's elbow"** or **"miner's elbow"** due to repetitive trauma or pressure.

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: 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: 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: 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.

Question 1

What is the purpose of the Insall-Salvati index?

Accepted Answer

To assess patellar height and tendon length ratio

Answer

To measure ankle dorsiflexion range

Answer

To evaluate elbow joint stability

Answer

To assess wrist bone alignment

Question 2

Most common site of osteochondritis dissecans?

Accepted Answer

Lateral part of the medial femoral condyle

Answer

Medial part of the medial femoral condyle

Answer

Lateral part of the lateral femoral condyle

Answer

Medial part of the lateral femoral condyle

Question 3

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 4

Which of the following is an orthopedic emergency?

Accepted Answer

Septic arthritis

Answer

Intraarticular fracture

Answer

Fracture lateral condyle humerus

Answer

Fracture neck femur

Question 5

How is Brodie's abscess classified?

Accepted Answer

Chronic osteomyelitis (Brodie's abscess)

Answer

Acute osteomyelitis

Answer

Subacute osteomyelitis

Answer

Septic arthritis

Question 6

What is another name for ischial bursitis?

Accepted Answer

Weaver's bottom

Answer

Trochanteric bursitis

Answer

Prepatellar bursitis

Answer

Olecranon bursitis

Question 7

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 8

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 9

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 10

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

NEET-PG 2013 — Orthopaedics