INI-CET 2023 - Orthopaedics PYQs Practice Questions

Q: A 40 year male patient presented to the ER with a history of fall and C/O pain and swelling in right shoulder region. The x-ray of the patients suggests tear in which of the following ligament?

Acromioclavicular ligament. ***Acromioclavicular ligament*** - A fall on an outstretched arm or direct trauma to the shoulder can cause an **acromioclavicular joint separation**, leading to a tear in the acromioclavicular ligament. - Pain and swelling in the right shoulder region are classic symptoms, and an X-ray can confirm the **widening of the AC joint space**. *Coracoacromial ligament* - This ligament forms the roof of the **subacromial space** and is rarely torn in isolation from trauma. - Tears are more commonly associated with **impingement syndrome** or **rotator cuff pathology**, not primarily with a traumatic fall leading to joint pain and swelling. *Coracoclavicular ligament* - While it helps stabilize the acromioclavicular joint, a tear of the **coracoclavicular ligament** is usually present in more severe acromioclavicular joint dislocations (Type III and above). - Its rupture would result in a more pronounced **superior displacement of the clavicle** compared to an isolated AC ligament tear. *Glenohumeral ligament* - These ligaments reinforce the **glenohumeral joint capsule** and are primarily involved in stabilizing the shoulder against dislocation. - A tear would typically present with symptoms of **shoulder instability** or a **dislocation**, rather than just pain and swelling from a fall focused on the AC joint. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 14 year old male presents with mushroom like tumor in the distal femur for past 2 years. Which of the following features suggest malignant transformation?

Cartilage thickness $>2 \mathrm{~cm}$. ***Cartilage thickness >2 cm*** - A **cartilage cap thickness greater than 2 cm** in an osteochondroma in an adult (or >3 cm in children) is a strong indicator of **malignant transformation** into a secondary peripheral **chondrosarcoma**. [2], [3] - **Key imaging finding:** Cartilage cap measured on MRI or CT scan - Other features suggesting malignant transformation include continued growth after skeletal maturity, new or increasing pain, cortical destruction, and new soft tissue mass. [2], [3] *Presence of cartilage cap* - All osteochondromas have a cartilage cap by definition - this is a normal feature, not a sign of malignancy. [1] - The **thickness** of the cap, not its presence, is what matters. *Location in metaphysis* - Osteochondromas typically arise from the metaphysis near the growth plate - this is a normal location. [3] - Location alone does not indicate malignant transformation. *Size less than 1 cm* - Small size suggests a benign, stable lesion. - Malignant transformation is suggested by **increasing size** and growth after skeletal maturity, not small size. [2] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1202-1204. [Practice more Orthopaedics PYQs on OnCourse]

Q: What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Use Pelvic Binders. **Use Pelvic Binders** - **Pelvic binders** apply circumferential compression, which helps to stabilize the fracture and reduce the pelvic volume. - This mechanical stabilization significantly reduces ongoing hemorrhage from venous and bone surface bleeding in unstable pelvic fractures. *Rapid blood transfusion* - While critically important for managing **hemorrhagic shock**, blood transfusion alone does not address the source of ongoing bleeding. - It is a supportive measure, not an immediate means to stop the bleeding from an unstable pelvic fracture. *Internal definitive fixation* - **Internal definitive fixation** is a surgical procedure aimed at permanently stabilizing the fracture and would typically be performed after initial resuscitation and bleeding control. - It is not an immediate measure for **ongoing life-threatening hemorrhage** and carries procedural risks. *External fixation* - **External fixation** can stabilize an unstable pelvic fracture and helps in controlling bleeding, but applying a **pelvic binder** is a quicker and less invasive initial step. - External fixation is usually performed by a surgeon in a controlled environment, not as the very first immediate bedside measure to stop bleeding. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

A 40 year male patient presented to the ER with a history of fall and C/O pain and swelling in right shoulder region. The x-ray of the patients suggests tear in which of the following ligament?

Accepted Answer

Acromioclavicular ligament

Answer

Coracoacromial ligament

Answer

Coracoclavicular ligament

Answer

Glenohumeral ligament

Question 2

A 14 year old male presents with mushroom like tumor in the distal femur for past 2 years. Which of the following features suggest malignant transformation?

Accepted Answer

Cartilage thickness $>2 \mathrm{~cm}$

Answer

Presence of cartilage cap

Answer

Location in metaphysis

Answer

Size less than 1 cm

Question 3

What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Accepted Answer

Use Pelvic Binders

Answer

Rapid blood transfusion

Answer

External fixation

Answer

Internal definitive fixation

INI-CET 2023 — Orthopaedics