NEET-PG 2015 - Orthopaedics Practice Questions

Q: During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?

Osteonecrosis. ***Osteonecrosis*** - **Osteonecrosis**, also known as **avascular necrosis**, is characterized by the death of bone tissue due to a lack of blood supply, which leads to the collapse of the subchondral bone and articular cartilage destruction. - The description of **wedge-shaped subchondral depressions** and **articular cartilage destruction** is highly indicative of osteonecrosis, especially in the context of advanced hip joint pathology requiring total hip replacement. *Osteolysis* - **Osteolysis** refers to the active resorption of bone, often seen around implants in prosthetic joints due to wear particles, leading to bone loss. - While it involves bone destruction, it typically presents as diffuse bone loss rather than specific wedge-shaped subchondral depressions. *Osteomyelitis* - **Osteomyelitis** is an infection of the bone or bone marrow, often leading to bone destruction, but it is primarily characterized by inflammation and pus formation. - The presented scenario does not mention signs of infection (e.g., fever, pus, inflammation) but focuses purely on structural destruction consistent with vascular compromise. *Osteogenesis* - **Osteogenesis** is the process of bone formation or development. - This term describes the creation of bone tissue and is the opposite of bone destruction, making it an incorrect answer for a condition involving cartilage and bone deterioration.

Q: The Salter Harris classification is used for classifying which type of injuries?

Fractures involving the physis in children. ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.

Q: In which condition is the Milwaukee Brace primarily used?

Adolescent Idiopathic Scoliosis. ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.

Q: Vertebra Plana is associated with all of the following conditions except -

Scheurmanns Disease. ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.

Q: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Median nerve. ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.

Q: Adson's test is positive in -

Cervical rib. ***Cervical rib*** - **Adson's test** assesses for **thoracic outlet syndrome (TOS)**, which can be caused by a cervical rib compressing the **subclavian artery** or **brachial plexus**. - A positive test occurs when the radial pulse diminishes or disappears upon specific head and arm maneuvers, indicating neurovascular compression. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, such as bone spurs and disc herniation. - While it can cause neurological symptoms, it typically does not lead to a positive Adson's test, as the compression site is different from that assessed by the test. *Cervical fracture* - A cervical fracture is a **traumatic injury** to the bones of the neck. - Adson's test is not indicated for diagnosing fractures and performing it could exacerbate the injury. *Cervical dislocation* - Cervical dislocation is a severe injury where cervical vertebrae are **displaced from their normal alignment**. - Similar to fractures, Adson's test is not appropriate for diagnosing or evaluating dislocations and carries a risk of further injury.

Q: Medial snapping knee syndrome is due to involvement of -

Pes Anserinus. ***Pes Anserinus*** - The **pes anserinus bursa** and its associated tendons (sartorius, gracilis, semitendinosus) can cause medial knee pain and snapping if inflamed or irritated. - This is a common cause of **medial snapping knee syndrome**, particularly in athletes or individuals with valgus deformity. *Quadriceps Tendon* - The **quadriceps tendon** is located anteriorly, connecting the quadriceps muscles to the patella, and is not typically involved in medial snapping. - Issues with the quadriceps tendon usually present as anterior knee pain or tendinitis. *Gastrocnemius origin* - The **gastrocnemius origin** is at the distal femur and its involvement would typically cause posterior knee pain or symptoms related to calf muscle function. - It does not commonly cause medial knee snapping. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is on the lateral side of the knee and its involvement would cause lateral knee pain or instability. - It is not associated with medial snapping knee syndrome.

Q: What condition is characterized by a waddling gait?

Bilateral congenital dysplasia of hip. ***Bilateral congenital dysplasia of hip*** - A **waddling gait**, also known as a **Trendelenburg gait**, occurs due to weakness of the hip abductor muscles (gluteus medius and minimus) on both sides. - In bilateral congenital dysplasia of the hip, the **femoral heads are poorly seated** or dislocated, leading to ineffective abductor function and the characteristic gait. *Coxa valga* - This condition involves an **increased angle** between the femoral neck and shaft, which can alter biomechanics but does not typically cause a waddling gait in isolation. - While it can be associated with other hip pathologies, **coxa valga itself is not the primary cause** of a waddling gait. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It affects the patient's ability to walk normally, but results in a different type of gait abnormality, typically involving limping or walking on the outer edge of the foot, **not a waddling gait**. *Muscular dystrophy* - While many forms of muscular dystrophy can lead to a waddling gait due to **proximal muscle weakness**, it is a broad category of genetic disorders. - Without further context or specific type of muscular dystrophy, **bilateral congenital hip dysplasia is a more direct and specific cause** for the symptom described.

Q: Who devised the correction of CTEV by serial casting?

Ignacio Ponseti. ***Ignacio Ponseti*** - Dr. Ignacio Ponseti developed the **Ponseti method**, a non-surgical technique for correcting **congenital talipes equinovarus (CTEV)**, commonly known as clubfoot. - This method involves a series of **gentle manipulations** and **serial casting**, followed by the use of a foot abduction brace. *Gerhardt Kuntscher* - **Gerhardt Kuntscher** was a German surgeon known for developing the **intramedullary nail** for fixing long bone fractures. - His contributions revolutionized the surgical management of fractures, but he did not develop the method for CTEV correction. *Gavril Ilizarov* - **Gavril Ilizarov** was a Soviet orthopedic surgeon famous for inventing the **Ilizarov apparatus**, an external fixator used for limb lengthening and complex fracture treatment. - His work focused on osteogenesis and bone regeneration, not the non-surgical correction of clubfoot. *Hugh Owen Thomas* - **Hugh Owen Thomas** was a Welsh orthopedic surgeon regarded as the "father of British orthopaedic surgery," known for the development of the **Thomas splint**. - His contributions were primarily in managing fractures and tuberculosis of the joints, independent of CTEV correction techniques.

Question 1

During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?

Accepted Answer

Osteonecrosis

Answer

Osteolysis

Answer

Osteomyelitis

Answer

Osteogenesis

Question 2

The Salter Harris classification is used for classifying which type of injuries?

Accepted Answer

Fractures involving the physis in children

Answer

Soft tissue injuries in pediatric patients

Answer

Long bone fractures without growth plate involvement

Answer

Joint dislocations in pediatric orthopedics

Question 3

In which condition is the Milwaukee Brace primarily used?

Accepted Answer

Adolescent Idiopathic Scoliosis

Answer

Spondylolisthesis

Answer

Scheuermann's Disease

Answer

Congenital Kyphosis

Question 4

Vertebra Plana is associated with all of the following conditions except -

Accepted Answer

Scheurmanns Disease

Answer

Leukemia

Answer

Excessive use of systemic steroids

Answer

Histiocytosis X

Question 5

Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Accepted Answer

Median nerve

Answer

Ulnar

Answer

Radial nerve

Answer

Median & ulnar nerve

Question 6

Adson's test is positive in -

Accepted Answer

Cervical rib

Answer

Cervical spondylosis

Answer

Cervical fracture

Answer

Cervical dislocation

Question 7

Medial snapping knee syndrome is due to involvement of -

Accepted Answer

Pes Anserinus

Answer

Gastrocnemius origin

Answer

Lateral collateral ligament

Answer

Quadriceps Tendon

Question 8

Greenstick/ Nightstick fractures are seen in -

Accepted Answer

Children

Answer

Elderly

Answer

Common in all age groups

Answer

Young adults

Question 9

What condition is characterized by a waddling gait?

Accepted Answer

Bilateral congenital dysplasia of hip

Answer

Coxa valga

Answer

CTEV

Answer

Muscular dystrophy

Question 10

Who devised the correction of CTEV by serial casting?

Accepted Answer

Ignacio Ponseti

Answer

Gerhardt Kuntscher

Answer

Gavril Ilizarov

Answer

Hugh Owen Thomas

NEET-PG 2015 — Orthopaedics