NEET-PG 2017 - Orthopaedics PYQs Practice Questions

Q: What is correct about the fracture shown in the figure?

A= Bennett fracture, B= Rolando fracture. ***A= Bennett fracture, B= Rolando fracture*** * **Bennett fracture** (A) is an **intra-articular fracture** of the base of the first metacarpal bone with a characteristic **two-part fracture** pattern. It involves a small fragment of the metacarpal base remaining attached to the carpometacarpal joint, while the rest of the metacarpal is dislocated. * **Rolando fracture** (B) is a **comminuted intra-articular fracture** at the base of the first metacarpal. It is characterized by a **Y or T-shaped fracture pattern**, indicating a more complex, three-part or more fragment involvement compared to a Bennett fracture. *A= Rolando fracture, B= Bennett fracture* * This option incorrectly identifies A as a Rolando fracture; Image A clearly shows a **two-part fracture** typical of a Bennett fracture, not the comminuted pattern of a Rolando. * Similarly, B is incorrectly identified as a Bennett fracture as it depicts a **multi-fragmented, Y-shaped fracture**, which defines a Rolando fracture. *A= Boxer's fracture, B= Bennett fracture* * **Boxer's fracture** is a fracture of the **neck of the fifth metacarpal**, which is not depicted in either image A or B. Both images show fractures at the base of the first metacarpal. * Image A is a **Bennett fracture**, not a Boxer's fracture, and B is a **Rolando fracture**, not a Bennett fracture. *A= Bennett fracture, B= Boxer's fracture* * While A is correctly identified as a **Bennett fracture**, B is incorrectly identified as a Boxer's fracture. * As previously stated, a **Boxer's fracture affects the fifth metacarpal**, whereas image B clearly shows a fracture of the first metacarpal base with multiple fragments. [Practice more Orthopaedics PYQs on OnCourse]

Q: The given nature of injury will lead to the development of:

Mallet finger. ***Mallet finger*** - The image shows a **rupture of the extensor tendon** at its insertion into the distal phalanx, or an avulsion fracture of the distal phalanx, causing an inability to extend the distal interphalangeal (DIP) joint. - This injury results in the characteristic **flexion deformity** of the DIP joint, known as mallet finger. *Jersey finger* - This injury involves the **rupture of the flexor digitorum profundus tendon** from its insertion at the base of the distal phalanx. - Patients cannot actively **flex their DIP joint**, unlike the extensor tendon injury shown. *Jammed finger* - This is a general term for an **axial load injury** to the finger, usually causing a sprain or mild fracture without a specific tendon rupture as depicted. - It typically results from impact on the fingertip, leading to **ligamentous injury** or joint capsule damage. *Boxer knuckle* - **Boxer's knuckle** refers to a sagital band rupture at the metacarpophalangeal (MCP) joint, affecting the central slip of the extensor tendon. - This injury primarily involves the **MCP joint** and not the DIP joint, as shown in the image. [Practice more Orthopaedics PYQs on OnCourse]

Q: The contracture shown in the image is associated with all except:

Table top test is negative. ***Table top test is negative*** - The image shows a hand affected by **Dupuytren's contracture**, characterized by fixed flexion deformities of the finger joints. - In Dupuytren's contracture, the **tabletop test** is typically **positive** (meaning the hand cannot be laid flat on a table) when the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint contracture exceeds 30 degrees, indicating significant fascial thickening and shortening. *Seen in cirrhosis* - **Dupuytren's contracture** is indeed associated with conditions like **alcoholism** and **liver cirrhosis**, though the exact pathophysiological link is not fully understood. - Other associated conditions include diabetes mellitus, manual labor, and certain anti-epileptic medications. *Involves the ring and little finger* - Dupuytren's contracture most commonly affects the **ulnar side of the hand**, particularly the **ring finger** and **little finger**, due to fibrosis and shortening of the palmar fascia. - It can also involve the middle finger and rarely the index finger and thumb. *Clostridial collagenase for resolution* - **Collagenase clostridium histolyticum (CCH)**, derived from *Clostridium histolyticum*, is an approved non-surgical treatment for Dupuytren's contracture. - It works by injecting the enzyme directly into the palmar cord to **dissolve the collagen fibers** responsible for the contracture, allowing for manipulation to release the contracture. [Practice more Orthopaedics PYQs on OnCourse]

Q: Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Volkmann ischemic contracture. ***Volkmann ischemic contracture*** - The images show a **fixed flexion deformity of the wrist and fingers**, along with **forearm pronation**, which is characteristic of Volkmann's ischemic contracture. - This condition results from **ischemia to the forearm muscles**, leading to muscle necrosis and subsequent fibrosis and contracture. *Ulnar tunnel syndrome* - This syndrome involves compression of the **ulnar nerve** at the wrist. - Symptoms typically include **numbness and tingling in the ring and little fingers**, and hand weakness, which are not depicted as the primary finding here. *Cubital tunnel syndrome* - This condition involves compression of the **ulnar nerve** at the elbow. - It presents with similar sensory and motor deficits to ulnar tunnel syndrome but specifically related to the elbow, not the characteristic fixed deformity shown. *Wartenberg's syndrome* - Also known as **superficial radial nerve entrapment**, it involves compression of the superficial branch of the radial nerve. - This typically causes **sensory symptoms** (pain, numbness, paresthesia) on the back of the hand and thumb, without the gross motor contracture seen in the images. [Practice more Orthopaedics PYQs on OnCourse]

Q: A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Monteggia fracture. ***Monteggia fracture*** - This classic injury pattern shows **fracture of the ulnar shaft** with **dislocation of the radial head**, more commonly seen in children due to their ligamentous laxity and softer bones. - Diagnosis is confirmed using the **radiocapitellar line test** - a line drawn through the center of the radial head should pass through the capitellum on all X-ray views; disruption indicates radial head dislocation. *Colles fracture* - A Colles fracture involves a **fracture of the distal radius** with **dorsal displacement** of the distal fragment, typically occurring from a fall on an outstretched hand in elderly patients. - The X-ray findings clearly show an **ulnar shaft fracture** with **radial head dislocation**, not a distal radial fracture pattern. *Smith's fracture* - A Smith's fracture is a **distal radius fracture** with **volar (palmar) displacement** of the distal fragment, sometimes called a "reverse Colles fracture." - This diagnosis is incorrect because the image demonstrates a **midshaft ulnar fracture** with **proximal radioulnar joint disruption**, not distal radial pathology. *Galeazzi's fracture* - A Galeazzi fracture involves a **fracture of the radius** (usually distal third) combined with **dislocation of the distal radioulnar joint (DRUJ)**. - This pattern is distinct from the current case, which shows **ulnar fracture** with **radial head dislocation** at the **proximal radioulnar joint**, making it a Monteggia rather than Galeazzi injury. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

What is correct about the fracture shown in the figure?

Accepted Answer

A= Bennett fracture, B= Rolando fracture

Answer

A= Rolando fracture, B= Bennett fracture

Answer

A= Boxer's fracture, B= Bennett fracture

Answer

A= Bennett fracture, B= Boxer's fracture

Question 2

The given nature of injury will lead to the development of:

Accepted Answer

Mallet finger

Answer

Jersey finger

Answer

Jammed finger

Answer

Boxer knuckle

Question 3

The contracture shown in the image is associated with all except:

Accepted Answer

Table top test is negative

Answer

Seen in cirrhosis

Answer

Involves the ring and little finger

Answer

Clostridial collagenase for resolution

Question 4

Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Accepted Answer

Volkmann ischemic contracture

Answer

Ulnar tunnel syndrome

Answer

Cubital tunnel syndrome

Answer

Wartenberg's syndrome

Question 5

A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Monteggia fracture

Answer

Colles fracture

Answer

Smith's fracture

Answer

Galeazzi's fracture

Question 6

All the following statements regarding this image are true except: (Recent NEET Pattern 2016-17)

Accepted Answer

This is a soft tissue tumor

Answer

This condition could result from student's elbow

Answer

It is secondary to trauma

Answer

This condition is due to inflammation of the sub-cutaneous fat

Question 7

What is the grade of fracture according to Garden's classification?

Accepted Answer

Grade III

Answer

Grade I

Answer

Grade II

Answer

Grade IV

Question 8

A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?

Accepted Answer

Anterior cruciate ligament tear

Answer

Posterior cruciate ligament tear

Answer

Medial meniscus tear

Answer

Medial collateral ligament tear

Question 9

Which of the following spine deformities is seen in the image?

Accepted Answer

Gibbus

Answer

Kyphosis

Answer

Lordosis

Answer

Scoliosis

Question 10

Comment on the diagnosis of the presentation shown below:

Accepted Answer

Unicameral bone cyst

Answer

Aneurysmal bone cyst

Answer

Osteoblastoma

Answer

Osteoclastoma

NEET-PG 2017 — Orthopaedics