NEET-PG 2015 - Orthopaedics Practice Questions

Q: Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Sub Capital fractures. ***Sub Capital fractures*** - These fractures occur at the anatomical **neck of the femur**, very close to the femoral head. - Due to their location, they disrupt the main blood supply to the femoral head, primarily from the **retinacular arteries**, leading to a high risk of **avascular necrosis**. *Trans cervical fracture* - This fracture occurs through the **midneck of the femur**, which is still within the intracapsular region. - While it has a significant risk of **ischemia**, the compromise is generally less severe than in subcapital fractures. *Intertrochanteric fractures* - These are **extracapsular fractures** occurring between the greater and lesser trochanters. - They tend to have an **excellent blood supply** and thus a low risk of avascular necrosis, but are associated with more significant blood loss and malunion issues. *Basicervical fracture* - This is an **intracapsular fracture** that occurs at the base of the femoral neck, near the junction with the trochanters. - Although intracapsular, its position is slightly more proximal than subcapital fractures, potentially leaving more of the **retinacular vessels** intact, resulting in a somewhat lower risk of avascular necrosis compared to subcapital fractures.

Q: Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?

Subcapital fracture. ***Subcapital fracture*** - This fracture type occurs at the **neck of the femur**, very close to the femoral head's blood supply. - Due to the **intracapsular location**, it severely compromises the **medial and lateral circumflex femoral arteries**, leading to a high risk of **avascular necrosis (AVN)**. *Intertrochanteric fracture* - This fracture is **extracapsular**, occurring below the femoral neck between the greater and lesser trochanters. - While significant, its location generally leaves the **blood supply to the femoral head intact**, thus having a much lower risk of AVN compared to intracapsular fractures. *Transcervical fracture* - This is an **intracapsular fracture** of the femoral neck, but it is located more centrally within the neck. - While it does carry a significant risk of AVN due to disruption of blood supply, the subcapital fracture, being more proximate to the head, typically has an even higher risk due to a greater degree of compromise to the main blood vessels. *None of the options* - This option is incorrect because **subcapital fractures** are well-documented for having the highest risk of avascular necrosis among femur fractures due to their specific anatomical location and impact on blood supply.

Q: In which of the following deformities is the distal interphalangeal joint extended?

Boutonniere deformity. ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint**. - It often results from injury to the **central slip of the extensor tendon** at the PIP joint. *Swan neck deformity* - This deformity presents with **hyperextension of the PIP joint** and **flexion of the DIP joint**, which is the opposite of the question's premise. - It is commonly associated with underlying conditions like **rheumatoid arthritis** or **lupus**. *Z deformity* - This typically refers to the **thumb in rheumatoid arthritis**, where the carpometacarpal (CMC) joint is flexed, the metacarpophalangeal (MCP) joint is hyperextended, and the interphalangeal (IP) joint is flexed. - It does not primarily describe an extended DIP joint in the context of other fingers. *Claw Hand* - This deformity involves **hyperextension of the MCP joints** and **flexion of the PIP and DIP joints**, particularly of the fourth and fifth fingers. - It is caused by **ulnar nerve palsy**, leading to muscle imbalance.

Q: 4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -

Greenstick fracture. ***Greenstick fracture*** - This fracture type involves a **broken anterior cortex** but an **intact posterior cortex**, leading to an exaggerated bowing of the bone, characteristic of a greenstick fracture. - It occurs predominantly in **children** due to their softer, more flexible bones, which tend to bend rather than fully break when subjected to force like a fall on an outstretched hand. *Torus Fracture* - A torus fracture, or **buckle fracture**, involves compression of the bone leading to a bulging or buckling of the cortex, usually on one side, without a complete break in the bone. - While it occurs in children, it presents as a compression injury and not with a broken cortex and intact posterior cortex with bowing. *Galleazi Fracture* - A Galleazi fracture is a fracture of the **distal radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This fracture pattern involves two bones and two distinct injuries (fracture and dislocation), which is fundamentally different from the described single-bone incomplete fracture. *Monteggia Fracture Dislocation* - A Monteggia fracture involves a fracture of the **proximal ulna** with **dislocation of the radial head** at the elbow. - This injury also involves two bones and two distinct components (fracture and dislocation) and affects a different anatomical location (ulna and elbow) than described.

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: 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: 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.

Q: Undertaker's fracture is seen at the level of cervical vertebra:

C6-C7. **C6-C7** - An **undertaker's fracture** is a post-mortem injury typically seen in cases of hanging, resulting from the neck's hyperextension. - It commonly affects the lower cervical spine, most frequently at the **C6-C7 level**, due to the biomechanics of the forces involved. *C5-C6* - While cervical fractures can occur at various levels, **C5-C6** is less common for an undertaker's fracture specifically. - This level is more frequently associated with **cervical spondylosis** or traumatic injuries from falls. *C3-C4* - Fractures at the **C3-C4 level** can be life-threatening as they are close to the phrenic nerve origin, but they are not characteristic of "undertaker's fracture." - Injuries at this level are less common in the specific context of post-mortem hyperextension. *C1-C2* - Fractures of **C1 (atlas) and C2 (axis)**, such as a Jefferson fracture or hangman's fracture, are distinct and result from different mechanisms. - They are not typically referred to as "undertaker's fracture," which implies a specific post-mortem injury pattern.

Question 1

Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Accepted Answer

Sub Capital fractures

Answer

Basicervical fracture

Answer

Trans cervical fracture

Answer

Intertrochanteric fractures

Question 2

Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?

Accepted Answer

Subcapital fracture

Answer

Intertrochanteric fracture

Answer

Transcervical fracture

Answer

None of the options

Question 3

In which of the following deformities is the distal interphalangeal joint extended?

Accepted Answer

Boutonniere deformity

Answer

Swan neck deformity

Answer

Claw Hand

Answer

Z deformity

Question 4

4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -

Accepted Answer

Greenstick fracture

Answer

Torus Fracture

Answer

Galleazi Fracture

Answer

Monteggia Fracture Dislocation

Question 5

Greenstick/ Nightstick fractures are seen in -

Accepted Answer

Children

Answer

Elderly

Answer

Common in all age groups

Answer

Young adults

Question 6

What condition is characterized by a waddling gait?

Accepted Answer

Bilateral congenital dysplasia of hip

Answer

Coxa valga

Answer

CTEV

Answer

Muscular dystrophy

Question 7

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 8

Adson's test is positive in -

Accepted Answer

Cervical rib

Answer

Cervical spondylosis

Answer

Cervical fracture

Answer

Cervical dislocation

Question 9

Who devised the correction of CTEV by serial casting?

Accepted Answer

Ignacio Ponseti

Answer

Gerhardt Kuntscher

Answer

Gavril Ilizarov

Answer

Hugh Owen Thomas

Question 10

Undertaker's fracture is seen at the level of cervical vertebra:

Accepted Answer

C6-C7

Answer

C5-C6

Answer

C3-C4

Answer

C1-C2

NEET-PG 2015 — Orthopaedics