UPSC-CMS 2020 - Orthopaedics PYQs Practice Questions

Q: Indications for fasciotomy in compartment syndrome include all EXCEPT:

Palpable distal pulses. ***Palpable distal pulses*** - The presence of **palpable distal pulses is NOT an indication for fasciotomy** and does not rule out compartment syndrome. - **Vascular compromise is a late sign** in compartment syndrome - pulses often remain palpable even with significant nerve and muscle ischemia. - Fasciotomy decisions should be based on **clinical signs** (pain, sensory changes) and **pressure measurements**, not the presence of pulses. - This is the correct answer because it is NOT an indication for the procedure. *Compartment pressure > 30 mm Hg* - **Absolute indication for fasciotomy** when compartment pressure exceeds 30 mmHg, or when the **delta pressure** (diastolic BP minus compartment pressure) is less than 30 mmHg. - This pressure level impairs capillary perfusion and leads to tissue ischemia. *Distal sensory disturbance* - **Early and reliable indication** for fasciotomy showing nerve ischemia. - Paresthesia or numbness in the distribution of nerves running through the affected compartment indicates neurological compromise from elevated intracompartmental pressure. *Pain on passive movement of affected muscles* - **Most sensitive and earliest clinical sign** of compartment syndrome (part of "the 6 P's"). - Pain on passive stretch is typically **out of proportion to the injury** and indicates underlying muscle ischemia. - This is a clear indication for fasciotomy. [Practice more Orthopaedics PYQs on OnCourse]

Q: The most common site for osteosarcoma is:

Distal femur. ***Distal femur*** - The **distal femur** is the most frequent site of involvement for **osteosarcoma**, accounting for approximately 40% of all cases [1]. - This region, along with the proximal tibia and proximal humerus, constitutes the most common locations for this primary malignant bone tumor [1]. *Proximal humerus* - While the **proximal humerus** is a common site for osteosarcoma, it is less frequent than the distal femur [1]. - It ranks third in incidence after the distal femur and proximal tibia [1]. *Proximal femur* - The **proximal femur** can be affected by osteosarcoma, but it is a relatively less common site compared to the distal femur. - Osteosarcomas tend to occur around the **growth plates** of long bones [1]. *Distal humerus* - The **distal humerus** is an uncommon site for the development of osteosarcoma. - It is much less frequently involved than the other major long bone metaphyses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1200-1202. [Practice more Orthopaedics PYQs on OnCourse]

Q: Kohler's disease is avascular necrosis of :

Navicular. ***Navicular*** - **Kohler's disease** specifically refers to **osteochondrosis** or **avascular necrosis** of the **navicular bone** in the foot. - It primarily affects **children** and is characterized by pain and tenderness over the medial aspect of the foot. *First metatarsal head* - Avascular necrosis of the first metatarsal head is known as **Freiberg's infraction**. - This condition typically affects **adolescent girls** and causes pain in the forefoot, especially during weight-bearing. *Capitellum of humerus* - Avascular necrosis of the capitellum of the humerus is called **Panner's disease**. - It is an **osteochondrosis** that primarily affects **young athletes** involved in repetitive overhead activities, leading to elbow pain and stiffness. *Lunate* - Avascular necrosis of the lunate bone in the wrist is known as **Kienbock's disease**. - This condition typically affects **adults** and is associated with wrist pain, stiffness, and weakness. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

Indications for fasciotomy in compartment syndrome include all EXCEPT:

Accepted Answer

Palpable distal pulses

Answer

Compartment pressure > 30 mm Hg

Answer

Distal sensory disturbance

Answer

Pain on passive movement of affected muscles

Question 2

The most common site for osteosarcoma is:

Accepted Answer

Distal femur

Answer

Proximal humerus

Answer

Proximal femur

Answer

Distal humerus

Question 3

Which one of the following statements about Compartment Syndrome is NOT correct?

Accepted Answer

Pain is on active movement but not on passive movement of muscles

Answer

Fasciotomy is the treatment of choice

Answer

It is commonest in a closed fracture

Answer

Volkmann's Ischaemic contracture is a late complication

Question 4

Kohler's disease is avascular necrosis of :

Accepted Answer

Navicular

Answer

First metatarsal head

Answer

Capitellum of humerus

Answer

Lunate

UPSC-CMS 2020 — Orthopaedics