NEET-PG 2013 - Orthopaedics Practice Questions

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Open femoral fracture. ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.

Q: Bunion is commonly seen at ?

Great toe MTP joint. ***Great toe MTP joint*** - A bunion, or **hallux valgus**, is a bump that forms on the outside of the **first metatarsophalangeal (MTP) joint** of the big toe. - This common foot deformity involves structural changes that result in the big toe pointing towards the smaller toes. *Medial malleolus* - The medial malleolus is the bony prominence on the **inside of the ankle**. - It is part of the tibia and forms the inner wall of the ankle joint, not typically where bunions occur. *Lateral Malleolus* - The lateral malleolus is the bony protrusion on the **outside of the ankle**. - It is part of the fibula and forms the outer wall of the ankle joint, unrelated to bunion formation. *Shin of tibia* - The shin refers to the **anterior crest of the tibia**, the large bone in the lower leg. - This area is prone to conditions like shin splints or fractures, but not bunions.

Q: What is another name for ischial bursitis?

Weaver's bottom. ***Weaver's bottom*** - This is a common **colloquial term** for ischial bursitis, describing the condition that can arise from prolonged sitting. - The **ischial bursa** lies between the ischial tuberosity and the gluteus maximus, which can become inflamed from pressure. *Prepatellar bursitis* - This refers to inflammation of the bursa located over the **kneecap**. - It is often called **"housemaid's knee"** due to its association with prolonged kneeling. *Trochanteric bursitis* - This is inflammation of the bursa located over the **greater trochanter of the femur**, on the outer side of the hip. - It causes pain in the **lateral hip region**, often radiating down the thigh. *Olecranon bursitis* - This involves inflammation of the bursa located at the **tip of the elbow** (olecranon process). - It is sometimes called **"student's elbow"** or **"miner's elbow"** due to repetitive trauma or pressure.

Q: Most common site of myositis ossificans ?

Quadriceps/Thigh. ***Quadriceps/Thigh*** - The **quadriceps and thigh** muscles are frequently affected due to their common involvement in sports injuries and trauma. - This region is prone to **hematoma formation** after contusions, which can predispose to ectopic bone formation. *Shoulder* - While the shoulder can be affected by myositis ossificans, it is **less common** than the quadriceps. - Traumatic myositis ossificans in the shoulder typically involves the **deltoid muscle**. *Wrist* - Myositis ossificans of the **wrist is rare** and usually occurs after severe trauma or crush injuries. - The small muscle mass and limited direct trauma to the wrist muscles make it an **unlikely primary site**. *Elbow* - Myositis ossificans can occur around the elbow, particularly in the **brachialis muscle**, often following dislocations or fractures. - However, the elbow is still **less commonly affected overall** compared to the large muscle groups of the thigh.

Q: Which of the following is an orthopedic emergency?

Septic arthritis. ***Septic arthritis*** - This is an **orthopedic emergency** due to the rapid destruction of cartilage and bone if not treated promptly. - It requires urgent **surgical washout** and intravenous antibiotics to prevent irreversible joint damage and systemic infection. *Intraarticular fracture* - While requiring careful management to optimize joint function, an **intraarticular fracture** is typically not an immediate emergency unless there's associated neurovascular compromise or compartment syndrome. - Surgical intervention can often be planned within a certain timeframe (days) rather than hours. *Fracture lateral condyle humerus* - This fracture in children is significant due to potential for non-union or avascular necrosis, but it is not considered an immediate **life- or limb-threatening emergency**. - Management usually involves **reduction and fixation** but does not carry the same degree of urgency as active joint infection. *Fracture neck femur* - A fractured neck of femur requires surgical intervention to prevent complications like **avascular necrosis** and optimize mobility, particularly in elderly patients. - While serious, it primarily presents a risk of long-term disability and complications, not an immediate destructive process like septic arthritis.

Q: What is the generally recommended maximum weight for skeletal traction in adult patients?

15 kg. ***15 kg*** - While the specific weight can vary based on the bone and patient, 10-15 kg is generally the **maximum recommended weight for skeletal traction** in adults to avoid complications. - Applying too much weight risks **damage to the bone, soft tissues, and nerves**, as well as potential pin site infections and neurovascular compromise. *5 kg* - This weight is typically more appropriate for **skin traction**, where the pulling force is applied externally to the skin, limiting the amount of weight that can be safely used without causing skin damage. - In skeletal traction, 5 kg is often used for **initial alignment or very tenuous fractures**, but it is generally insufficient for significant reduction or long-term stabilization. *10 kg* - 10 kg is a common starting point or moderate weight used in skeletal traction, particularly for **femur or tibia fractures**. - While often effective, it is not consistently the maximum safe weight, as some situations may allow or require slightly more weight up to 15 kg for optimal reduction. *20 kg* - Applying 20 kg of weight in skeletal traction is generally considered **excessive and dangerous** in most adult applications. - This high amount of weight significantly increases the risk of **pin loosening, osteomyelitis, neurovascular injury, and avascular necrosis**, especially in areas like the cervical spine or tibia.

Q: Most common nerve injured in fracture of medial epicondyle of humerus is:

Ulnar nerve. ***Ulnar nerve*** - The **ulnar nerve** runs directly behind the **medial epicondyle** of the humerus in a groove called the **cubital tunnel**, making it highly vulnerable to injury during fractures of this bony prominence. - Injury to the ulnar nerve at this location can cause symptoms like **numbness and tingling** in the **little finger and half of the ring finger**, **weakness in certain hand muscles**, and eventually a **"claw hand" deformity**. *Radial nerve* - The **radial nerve** courses along the posterior aspect of the humerus in the **spiral groove** and is more commonly injured with **mid-shaft humeral fractures**. - Injury typically results in **wrist drop** and **sensory loss over the dorsum of the hand**. *Median nerve* - The **median nerve** travels more anteriorly in the arm and forearm and is most commonly injured with **supracondylar fractures of the humerus** or **carpal tunnel syndrome** at the wrist. - Damage leads to **ape hand deformity** and sensory deficits over the **thumb, index, middle, and radial half of the ring finger**. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles and provides sensation to the lateral forearm; it is **less commonly injured in elbow fractures**. - Injury would primarily affect **elbow flexion** and **sensation over the lateral forearm**, which is not the typical presentation for medial epicondyle fractures.

Q: Bulge sign in the knee joint is seen after how much fluid accumulation?

< 30 ml. **< 30 ml** - The **bulge sign** is a sensitive test for detecting small amounts of **effusion** in the knee joint. - It is typically positive with as little as 4-8 mL to 10-30 mL of fluid, making "< 30 mL" the most appropriate answer. *100 ml* - An effusion of 100 mL is a **moderate to large amount** of fluid, which would typically elicit a positive **patellar tap test (ballottement)** rather than just a bulge sign. - The **bulge sign** is designed to detect much smaller effusions. *400 ml* - This represents a **very large effusion** that would be clinically obvious and cause significant swelling and discomfort, far exceeding the threshold for a simple bulge sign. - A knee with 400 mL of fluid would likely have a tense, bulging appearance and a very prominent **patellar tap**. *200 ml* - This is also a **significant effusion** that would easily be detected by a patellar tap test and would present with gross swelling. - The **bulge sign** is specifically for subtler fluid collections.

Q: Windswept deformity is seen in which condition?

Rickets. ***Rickets*** - **Windswept deformity** is characterized by bilateral knee deformities where one knee is in **valgus** and the other is in **varus**. - This condition is caused by a deficiency in **vitamin D**, **calcium**, or **phosphate**, leading to improper bone mineralization and subsequent bone deformities. *Rheumatoid Arthritis* - Rheumatoid arthritis is a **chronic autoimmune inflammatory disease** primarily affecting the synovial joints. - While it can cause joint deformities, they typically involve symmetric joint swelling, pain, and stiffness, with characteristic deformities like **ulnar deviation** or **swan-neck deformities**, rather than windswept deformity. *Hyperparathyroidism* - Hyperparathyroidism leads to excessive production of **parathyroid hormone**, which causes increased bone resorption and elevated blood calcium levels. - It can result in bone fragility, **osteitis fibrosa cystica**, and kidney stones, but it does not cause specific windswept deformity. *Scurvy* - Scurvy results from a severe deficiency of **vitamin C**, which is essential for collagen synthesis. - It presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages, but it does not typically cause windswept deformity of the knees.

Q: Most common site of osteochondritis dissecans?

Lateral part of the medial femoral condyle. ***Lateral part of the medial femoral condyle*** - This is the **most common site** for osteochondritis dissecans in the knee, accounting for about 85% of cases. - The condition involves a localized area of **osteonecrosis and subchondral bone separation** from the epiphysis, typically afflicting this specific load-bearing region. *Medial part of the medial femoral condyle* - This location is **less common** for osteochondritis dissecans compared to the lateral aspect of the medial femoral condyle. - While osteochondral lesions can occur on any part of the condyle, the specific biomechanical stresses make the lateral part more susceptible. *Lateral part of the lateral femoral condyle* - Osteochondritis dissecans is **rarely found** in this location. - The lateral femoral condyle is generally less involved in osteochondritis dissecans of the knee. *Medial part of the lateral femoral condyle* - This site is also an **uncommon location** for osteochondritis dissecans. - The disease has a strong predilection for the medial femoral condyle, particularly its lateral aspect.

Question 1

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Open femoral fracture

Answer

Closed tibial fracture

Answer

Open humeral fracture

Answer

Closed humeral fracture

Question 2

Bunion is commonly seen at ?

Accepted Answer

Great toe MTP joint

Answer

Medial malleolus

Answer

Lateral Malleolus

Answer

Shin of tibia

Question 3

What is another name for ischial bursitis?

Accepted Answer

Weaver's bottom

Answer

Trochanteric bursitis

Answer

Prepatellar bursitis

Answer

Olecranon bursitis

Question 4

Most common site of myositis ossificans ?

Accepted Answer

Quadriceps/Thigh

Answer

Shoulder

Answer

Wrist

Answer

Elbow

Question 5

Which of the following is an orthopedic emergency?

Accepted Answer

Septic arthritis

Answer

Intraarticular fracture

Answer

Fracture lateral condyle humerus

Answer

Fracture neck femur

Question 6

What is the generally recommended maximum weight for skeletal traction in adult patients?

Accepted Answer

15 kg

Answer

5 kg

Answer

10 kg

Answer

20 kg

Question 7

Most common nerve injured in fracture of medial epicondyle of humerus is:

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 8

Bulge sign in the knee joint is seen after how much fluid accumulation?

Accepted Answer

< 30 ml

Answer

200 ml

Answer

100 ml

Answer

400 ml

Question 9

Windswept deformity is seen in which condition?

Accepted Answer

Rickets

Answer

Hyperparathyroidism

Answer

Scurvy

Answer

Rheumatoid Arthritis

Question 10

Most common site of osteochondritis dissecans?

Accepted Answer

Lateral part of the medial femoral condyle

Answer

Medial part of the medial femoral condyle

Answer

Lateral part of the lateral femoral condyle

Answer

Medial part of the lateral femoral condyle

NEET-PG 2013 — Orthopaedics