FMGE 2019 - Orthopaedics PYQs Practice Questions

Q: Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Colles fracture. ***Colles fracture*** - This fracture commonly occurs in **post-menopausal women** due to **osteoporosis** and typically results from a fall onto an **outstretched hand**. - It involves a **distal radius fracture** with **dorsal displacement** and often radial angulation. *Smith fracture* - A Smith fracture involves a **distal radius fracture** with **volar displacement**, usually caused by a fall onto the back of the hand. - While it can occur in post-menopausal women, it is less common than a Colles fracture in such a scenario. *Monteggia's fracture* - This fracture involves a **fracture of the ulna** with **dislocation of the radial head**. - It usually results from a direct blow to the forearm or a fall with extreme pronation, which is less typical for a simple fall in a post-menopausal woman. *Galeazzi fracture* - A Galeazzi fracture involves a **fracture of the radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This injury is less common and typically results from a fall onto an outstretched hand with the forearm in pronation, and it is not the most common fracture in this demographic. [Practice more Orthopaedics PYQs on OnCourse]

Q: Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Medial meniscus. ***Medial meniscus*** - The **medial meniscus** is commonly injured in conjunction with the **medial collateral ligament** due to their anatomical proximity and shared role in knee stability. - The MCL is a primary restraint to **valgus stress**, and strong valgus forces that injure the MCL can also transmit stress to the medial meniscus, leading to tears. *Lateral meniscus* - The **lateral meniscus** is less frequently injured alongside the MCL because it is typically more mobile and not directly attached to the MCL. - Injuries to the lateral meniscus are more often associated with **anterior cruciate ligament (ACL) tears** or significant *rotational forces*. *Anterior cruciate ligament* - The **anterior cruciate ligament** is primarily injured by **non-contact pivoting** or **hyperextension injuries**, and while it can be part of the "unhappy triad" (along with MCL and medial meniscus tears), an isolated MCL injury does not most commonly implicate it. - ACL tears lead to **anterior instability** of the tibia relative to the femur, which is a different biomechanical mechanism than an isolated MCL injury. *Posterior Cruciate Ligament* - The **posterior cruciate ligament** is injured by a direct blow to the anterior tibia while the knee is flexed or during a dashboard injury, leading to **posterior instability**. - Its injury mechanism is distinct from that of the MCL, which is primarily due to **valgus stress**. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Fat embolism. ***Fat embolism*** - A **femur fracture** significantly increases the risk of **fat embolism**, where fat globules from the bone marrow enter the bloodstream and lodge in the pulmonary capillaries. - The classic triad of **fat embolism syndrome** includes respiratory distress, neurological symptoms, and a petechial rash, but respiratory symptoms (pulmonary infiltration and distress) are usually the first to appear. *Obstruction* - While an obstruction could cause respiratory distress, it typically wouldn't be associated with diffuse **pulmonary infiltrates** following a long bone fracture. - **Airway obstruction** would present with stridor or wheezing, and is usually localized rather than systemic. *Pulmonary embolism* - A **pulmonary embolism** (PE) can cause respiratory distress and infiltrates, but given the context of a recent femur fracture, fat embolism is a more specific and likely diagnosis. - PE is usually due to a **venous thromboembolism** and can be suspected in immobilized patients, but the question points more strongly to fat release. *Air embolism* - **Air embolism** usually results from iatrogenic causes (e.g., central line insertion, surgery) or trauma to large veins, allowing a significant amount of air into the circulation. - While it can cause respiratory distress, it doesn't typically cause the diffuse **pulmonary infiltrates** described, which are characteristic of fat embolism. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?

Compare with X-ray of left hand. ***Compare with X-ray of left hand*** - In pediatric elbow injuries, a seemingly **normal X-ray** in the presence of strong clinical suspicion (pain, swelling, suspected supracondylar fracture) often warrants a comparison view of the contralateral unaffected limb. - This helps identify subtle findings like **epiphyseal separations** or **minimally displaced fractures** that might otherwise be missed due to the developing osseous structures in children. *Cast* - Applying a cast without definitive diagnosis or clear radiographic evidence of a fracture can lead to **unnecessary immobilization** and potential complications if no fracture is present, or inadequate treatment if a specific type of fracture requires reduction. - While immobilization is appropriate for confirmed fractures, it's not the **initial diagnostic step** when X-rays are inconclusive. *Closed reduction with K wire fixation* - This is an **invasive procedure** reserved for **displaced or unstable fractures** after a clear diagnosis has been established. - Performing this without a confirmed and characterized fracture is inappropriate and carries risks of **iatrogenic injury** and complications. *Closed reduction and slab* - Similar to casting, this is a treatment for **confirmed fractures**, typically for acute, stable, or minimally displaced fractures that can be managed non-surgically after a reduction. - It is not a diagnostic step and should not be performed when initial imaging is **inconclusive** and the exact nature of the injury is unknown. [Practice more Orthopaedics PYQs on OnCourse]

Q: A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Axillary. ***Axillary*** - A fall forward onto the shoulder often results in an **anterior shoulder dislocation**, which commonly injures the **axillary nerve** due to its close proximity to the humeral head. - Injury to the axillary nerve would manifest as **deltoid muscle weakness** (impaired shoulder abduction) and **sensory loss over the lateral shoulder**. *Radial* - The radial nerve is more commonly injured in **midshaft humeral fractures** or compression injuries in the axilla (e.g., "crutch palsy"), not typically from a direct shoulder dislocation. - Radial nerve injury leads to **wrist drop** and difficulty extending the fingers and thumb. *Median* - The median nerve is generally protected in shoulder dislocations but can be affected by more severe trauma or **distal humeral fractures**, specifically around the elbow or wrist. - Injury to the median nerve affects **flexion of the wrist and fingers** and **thumb opposition**, along with sensory deficits in the first 3.5 digits. *Ulnar* - The ulnar nerve is most vulnerable at the **medial epicondyle of the humerus** (funny bone) or in compression injuries at the wrist (Guyon's canal). - Ulnar nerve injury results in **weakness of intrinsic hand muscles** (e.g., abducting/adducting fingers) and sensory loss to the little finger and half of the ring finger. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Accepted Answer

Colles fracture

Answer

Smith fracture

Answer

Monteggia's fracture

Answer

Galeazzi fracture

Question 2

Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Accepted Answer

Medial meniscus

Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Posterior Cruciate Ligament

Question 3

A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Obstruction

Answer

Pulmonary embolism

Answer

Air embolism

Question 4

A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?

Accepted Answer

Compare with X-ray of left hand

Answer

Cast

Answer

Closed reduction with K wire fixation

Answer

Closed reduction and slab

Question 5

A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Accepted Answer

Axillary

Answer

Radial

Answer

Median

Answer

Ulnar

Question 6

The shown apparatus is used for

Accepted Answer

Patella tendon bearing brace

Answer

Ankle knee stabilizer

Answer

Thomas splint

Answer

Knee brace

Question 7

An injury to the shown area can lead to fracture of which bone?

Accepted Answer

Scaphoid

Answer

Lunate

Answer

Hamate

Answer

Trapezium

FMGE 2019 — Orthopaedics