Bone Grafts and Substitutes Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Bone Grafts and Substitutes. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Bone Grafts and Substitutes Indian Medical PG Question 1: All of the following factors affect osseointegration EXCEPT:
- A. Biocompatibility of implant material.
- B. Implant design.
- C. Patient's blood type (Correct Answer)
- D. Status of the host bed.
Bone Grafts and Substitutes Explanation: ***Patient's blood type***
- A patient's **blood type** (e.g., A, B, AB, O) is determined by antigens present on red blood cells and plays no direct role in the biological processes of bone healing or the integration of a dental implant with bone.
- While systemic factors can influence osseointegration, blood type itself does not affect the cellular and molecular mechanisms required for direct bone-to-implant contact.
*Biocompatibility of implant material*
- The **biocompatibility** of the implant material (e.g., **titanium**) is crucial for osseointegration, as it must not elicit adverse reactions and must permit host bone growth on its surface.
- Materials that are cytotoxic or inflammatory will prevent bone apposition and lead to fibrous encapsulation rather than direct bone contact.
*Implant design*
- **Implant design**, including features like **surface roughness**, thread pitch, and macro-geometry, significantly influences the initial stability and long-term success of osseointegration.
- A greater surface area and appropriate surface treatments can enhance bone cell attachment and differentiation, promoting faster and stronger bone integration.
*Status of the host bed*
- The **status of the host bone bed** refers to its quality and quantity (e.g., bone density, vascularity), which are critical for the biological processes of osseointegration.
- Adequate bone volume and good bone quality provide a stable foundation and sufficient blood supply for bone regeneration around the implant.
Bone Grafts and Substitutes Indian Medical PG Question 2: All of the following are described surgical procedures for CTE V except -
- A. Dwyer's osteotomy
- B. Salter's osteotomy (Correct Answer)
- C. Posteromedial soft tissue release
- D. Triple Arthrodesis
Bone Grafts and Substitutes Explanation: ***Salter's osteotomy***
- **Salter's osteotomy** is a procedure primarily used for treating **developmental dysplasia of the hip (DDH)**, aiming to redirect the acetabulum.
- It is not a described surgical procedure for the correction of **congenital talipes equinovarus (CTEV)**.
*Dwyer's osteotomy*
- **Dwyer's osteotomy** is a surgical procedure performed on the **calcaneus** to correct **hindfoot varus**, typically seen in CTEV.
- It involves removing a wedge of bone from the lateral aspect of the calcaneus.
*Posteromedial soft tissue release*
- This is a common and traditional surgical procedure for correcting severe **CTEV** by addressing the contracted soft tissues on the medial and posterior aspects of the foot.
- It involves releasing structures such as the **tibial tendon**, **flexor digitorum longus**, **flexor hallucis longus**, and the **posterior ankle joint capsule**.
*Triple Arthrodesis*
- **Triple arthrodesis** is a salvage procedure that involves fusing three joints in the foot: the **talonavicular**, **calcaneocuboid**, and **subtalar** joints.
- It is used in older children or adolescents with severe, rigid, or recurrent CTEV, often after failed conservative or primary surgical treatments.
Bone Grafts and Substitutes Indian Medical PG Question 3: Consider the following :
1. Pain relief
2. Prevention of infection
3. Anaesthesia
4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4 (Correct Answer)
- D. 1, 2 and 4
Bone Grafts and Substitutes Explanation: **1, 3 and 4**
- **Priorities in fracture treatment** always include alleviating pain, which can be severe and debilitating.
- **Restoration of normal anatomy** is crucial for proper healing and optimal function of the fractured limb.
- **Anesthesia** is often required to facilitate reduction and fixation of a fracture, as well as to manage pain during the procedure.
*2, 3 and 4*
- While **anesthesia** and **restoration of anatomy** are priorities, **prevention of infection** is primarily a concern for **open fractures** or surgical interventions.
- **Pain relief** is a fundamental and immediate concern in all fracture cases, which is omitted in this option.
*1, 2 and 3*
- **Pain relief** and **anesthesia** are critical, and **prevention of infection** is important, but this option neglects the essential goal of **restoring anatomical alignment**.
- **Restoring anatomy** directly impacts the long-term functional outcome and is a major goal of fracture management.
*1, 2 and 4*
- This option correctly identifies **pain relief**, **prevention of infection**, and **restoration of anatomy** as important.
- However, it overlooks the immediate necessity of **anesthesia** to effectively manage pain during treatment procedures and allow for fracture reduction.
Bone Grafts and Substitutes Indian Medical PG Question 4: The best material for below-inguinal arterial graft is:
- A. Saphenous vein graft (upside-down) (Correct Answer)
- B. Cryopreserved vein
- C. Dacron
- D. PTFE
Bone Grafts and Substitutes Explanation: ***Saphenous vein graft (upside-down)***
- The **autologous saphenous vein** is the material of choice for below-inguinal arterial bypasses due to its superior patency rates compared to synthetic grafts.
- It is often harvested and implanted **'upside-down' (reversed)** to ensure the valves do not obstruct blood flow, or can be used *in situ* after rendering the valves incompetent.
- Five-year patency rates for autologous vein grafts exceed 70-80% for femoropopliteal bypasses.
*Cryopreserved vein*
- **Cryopreserved saphenous vein allografts** are an alternative when autologous vein is unavailable or inadequate.
- However, they have **significantly lower patency rates** compared to autologous vein grafts due to immunological responses and structural degradation.
- They are generally reserved for salvage situations or as a bridge in limb-threatening ischemia.
*Dacron*
- **Dacron (polyethylene terephthalate)** grafts are primarily used for large-diameter arterial replacements, such as in **aortic bypasses**, and are less suitable for smaller, high-resistance vessels below the inguinal ligament.
- They tend to have higher rates of **thrombosis** and infection when used in infra-inguinal positions compared to vein grafts.
*PTFE*
- **Polytetrafluoroethylene (PTFE)** grafts have lower patency rates than autologous vein grafts, particularly in smaller diameter vessels and below-knee positions, due to issues like **intimal hyperplasia** at the anastomoses.
- While suitable when autologous vein is unavailable, it is generally considered inferior for below-inguinal peripheral arterial disease, with 3-year patency rates around 50-60% for above-knee and 30-40% for below-knee positions.
Bone Grafts and Substitutes Indian Medical PG Question 5: A patient presents with a 5th metatarsal fracture. How many days would he/she need to wear a cast?
- A. 6-8 weeks (Correct Answer)
- B. 2-3 weeks
- C. 16-20 weeks
- D. 3-5 weeks
Bone Grafts and Substitutes Explanation: ***6-8 weeks***
- For most **5th metatarsal fractures**, especially **Jones fractures** or more significant avulsion fractures, **non-weight-bearing** immobilization in a cast, boot, or splint is typically required for **6 to 8 weeks** to allow for proper bone healing.
- The **poor vascular supply** to the metaphyseal-diaphyseal junction of the 5th metatarsal (in Jones fractures) often necessitates a longer immobilization period.
*2-3 weeks*
- This duration is generally too short for the adequate healing of most 5th metatarsal fractures, especially those that are **displaced** or involve the **watershed zone**.
- A shorter period might be considered for very minor, stable **avulsion fractures** with minimal pain, but even then, a slightly longer protection might be advised.
*16-20 weeks*
- This length of time is typically reserved for **severe, complex fractures**, open fractures with complications, or cases requiring **multiple surgical interventions** and prolonged rehabilitation, which is not the standard for an uncomplicated 5th metatarsal fracture.
- Such an extended period of immobilization could also lead to **significant muscle atrophy** and joint stiffness.
*3-5 weeks*
- While sometimes considered for **stable avulsion fractures** of the 5th metatarsal base or mild stress fractures, this period is often insufficient for complete healing of the more common and problematic **Jones fracture**.
- Rushing the return to weight-bearing can increase the risk of **non-union** or refracture.
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