NEET-PG 2018 - Orthopaedics PYQs Practice Questions

Q: Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Distal radius. ***Distal radius*** - The **distal radius** is the bone most frequently fractured when a person falls on an **outstretched hand**. This is commonly known as a **Colles fracture** if the fragment is displaced dorsally. - The force of impact is transmitted directly to the distal end of the radius, making it susceptible to fracture, especially in cases of **osteoporosis**. *Scaphoid* - The **scaphoid** bone is also commonly fractured with a fall on an outstretched hand, but it is less frequent than the distal radius. - A scaphoid fracture is concerning due to its **precarious blood supply**, which can lead to **avascular necrosis** and non-union. *Lunate* - The **lunate** bone is centrally located in the wrist and is less commonly fractured but can be dislocated or injured in high-impact trauma. - Injuries to the lunate are often associated with **perilunate dislocations**, which are severe wrist injuries. *Capitate* - The **capitate** is the largest carpal bone, located in the center of the wrist, and is rarely fractured in isolation from a fall on an outstretched hand. - Fractures of the capitate are often associated with more extensive carpal injuries due to its robust nature and central, protected position. [Practice more Orthopaedics PYQs on OnCourse]

Q: A patient has a history of RTA 2 years ago. He developed pain and swelling at the same site. What will be the diagnosis based on the provided X-ray features?

Chronic osteomyelitis. ***Chronic osteomyelitis*** - The history of an **RTA 2 years ago** suggests a prior injury or open fracture, which is a common predisposing factor for chronic osteomyelitis. - The X-ray shows changes consistent with chronic infection, such as **bony sclerosis**, **lytic areas** (abscesses/sequestration), and possibly **periosteal reaction**, indicating persistent inflammation and bone destruction. *Osteogenic sarcoma* - This is a **primary malignant bone tumor** typically presenting with aggressive periosteal reaction (**sunburst** or **Codman's triangle**) and rapid bone destruction, which are not the predominant features here. - While it can cause pain and swelling, the history of a remote RTA followed by a chronic course makes osteogenic sarcoma less likely than infection. *Ewing's sarcoma* - This is another **highly malignant bone tumor** known for its characteristic **onion-skin periosteal reaction** and lytic lesions, often presenting in younger individuals. - The X-ray features do not clearly depict the characteristic onion-skin appearance, and the temporal history suggests a chronic inflammatory process rather than an aggressive de novo tumor. *Multiple myeloma* - This is a **plasma cell malignancy** characterized by multiple punched-out lytic lesions in the bone, often affecting the axial skeleton. - The X-ray image shows a more localized and heterogeneous pattern of bone changes, including sclerosis and reactive bone formation, which are not typical for multiple myeloma. [Practice more Orthopaedics PYQs on OnCourse]

Q: A patient had osteomyelitis in their left tibia 2 years ago. They now present with pain and swelling at the same site. X-ray shows bone destruction, sequestrum, and involucrum. What is the most likely diagnosis?

Chronic osteomyelitis. ***Chronic osteomyelitis*** - The presence of **bone destruction**, **sequestrum** (dead bone), and an **involucrum** (new bone formation around infected tissue) is pathognomonic for **chronic osteomyelitis**. - A history of prior osteomyelitis at the same site, followed by recurrent pain and swelling, indicates a **chronic, persistent infection**. *Ewing's sarcoma* - This is a **highly malignant primary bone tumor** that typically presents with a **"onion skin" appearance** on X-ray due to periosteal reaction, which is not described here. - While it causes pain and swelling, the specific radiological findings of sequestrum and involucrum are not characteristic of Ewing's sarcoma. *Osteogenic sarcoma* - Also known as **osteosarcoma**, this is a **primary bone malignancy** characterized by the production of **osteoid**. X-rays often show a **"sunburst" pattern** or Codman's triangle. - While it causes bone destruction and pain, the presence of sequestrum and involucrum points away from a primary bone tumor and towards a chronic infectious process. *Multiple myeloma* - This is a **hematologic malignancy** involving plasma cells, leading to **punched-out lytic lesions** in bones. - It does not typically present with sequestrum and involucrum, nor does it have a direct causal link to prior osteomyelitis in this manner. [Practice more Orthopaedics PYQs on OnCourse]

Q: The following gait abnormality is seen in:

Polio. The image shows **foot drop**, characterized by inability to dorsiflex the foot, requiring the patient to lift the leg higher during walking to clear the ground. ***Polio*** - **Polio** commonly causes **flaccid paralysis** affecting anterior horn cells, frequently resulting in foot drop due to weakness of **dorsiflexor muscles**. - This is a well-recognized complication, especially in countries like India where polio cases occurred historically, making it a clinically relevant cause. *Leprosy* - While **leprosy** can affect peripheral nerves including the **common peroneal nerve**, foot drop is a less common presentation compared to other nerve involvement patterns. - More typically seen in **advanced, untreated cases** and is relatively rare compared to other causes of foot drop. *Avascular necrosis Hip* - **Avascular necrosis (AVN) of the hip** causes **antalgic gait** due to hip pain but does not cause foot drop. - It affects the **hip joint** rather than the neural pathways controlling dorsiflexion of the foot. *Spastic hemiplegia* - **Spastic hemiplegia** results in spastic gait patterns with **circumduction**, not the flaccid foot drop pattern shown. - Characterized by **spasticity and hyperreflexia** rather than the flaccid weakness seen in foot drop. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which of the following diseases will lead to the following appearance?

Paget's disease. ***Paget's disease*** - The image depicts a bowing of the legs and a generalized stooped posture, which are characteristic findings in advanced **Paget's disease of bone**. - **Paget's disease** is a chronic bone disorder characterized by abnormal bone remodeling, leading to enlarged and misshapen bones that can cause **kyphosis** and **bowed limbs**. *Polio* - **Polio** (poliomyelitis) primarily affects the nervous system, leading to **muscle weakness** and **paralysis**, which can result in limb deformities, but not typically the widespread bone enlargement and bowing seen here. - While polio can cause limb asymmetry and deformities due to muscle wasting, it does not involve the characteristic bone remodeling and generalized skeletal changes seen in the image. *Cerebellar lesion* - A **cerebellar lesion** primarily affects coordination, balance, and motor control, leading to ataxia, tremors, and gait disturbances. - It does not directly cause the skeletal deformities or bone bowing illustrated in the image. *Ankylosing Spondylitis* - **Ankylosing spondylitis** is a chronic inflammatory disease primarily affecting the axial skeleton, leading to progressive spinal stiffness and fusion (a "bamboo spine"). - While it can cause a significant **kyphosis** (forward curvature of the spine), it does not typically lead to the wide-set bowed legs or general bone enlargement often seen in Paget's disease. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Accepted Answer

Distal radius

Answer

Scaphoid

Answer

Lunate

Answer

Capitate

Question 2

A patient has a history of RTA 2 years ago. He developed pain and swelling at the same site. What will be the diagnosis based on the provided X-ray features?

Accepted Answer

Chronic osteomyelitis

Answer

Osteogenic sarcoma

Answer

Ewing's sarcoma

Answer

Multiple myeloma

Question 3

A patient had osteomyelitis in their left tibia 2 years ago. They now present with pain and swelling at the same site. X-ray shows bone destruction, sequestrum, and involucrum. What is the most likely diagnosis?

Accepted Answer

Chronic osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteogenic sarcoma

Answer

Multiple myeloma

Question 4

The following gait abnormality is seen in:

Accepted Answer

Polio

Answer

Avascular necrosis Hip

Answer

Spastic hemiplegia

Answer

Leprosy

Question 5

Which of the following diseases will lead to the following appearance?

Accepted Answer

Paget's disease

Answer

Polio

Answer

Cerebellar lesion

Answer

Ankylosing Spondylitis

Question 6

Identify the deformity seen in this child with rickets:

Accepted Answer

Genu varum (Bow legs)

Answer

Genu valgum (knock knees)

Answer

Windswept deformity

Answer

Gunstock deformity

NEET-PG 2018 — Orthopaedics