NEET-PG 2012 - Orthopaedics Practice Questions

Q: What is the most common type of dislocation of the elbow joint?

Posterolateral dislocation. ***Posterolateral dislocation*** - This is the **most common type of elbow dislocation**, accounting for over 90% of cases. - The **radius and ulna displace posterior and lateral** relative to the humerus. *Posterior dislocation* - While common, **pure posterior dislocations are less frequent** than posterolateral disruptions. - In a pure posterior dislocation, the **forearm bones move directly backward**, without a significant lateral component. *Posteromedial dislocation* - This is a **less common type of elbow dislocation**, involving the ulna and radius displacing posterior and medial. - Often associated with **more complex soft tissue and bony injuries**. *Lateral dislocation* - **Pure lateral dislocations of the elbow are rare** and usually involve significant disruption of the medial collateral ligament. - It occurs when the **forearm bones move directly lateral** to the humerus.

Q: What is a Pulled Elbow?

Partial dislocation of the radial head. ***Partial dislocation of the radial head*** - A pulled elbow, also known as **nursemaid's elbow**, specifically refers to a **subluxation of the radial head** from the annular ligament. - This injury typically occurs in young children when their arm is suddenly pulled or jerked, causing the **radial head** to slip out of the **annular ligament**. *Complete separation of the elbow joint* - A complete separation of the elbow joint would involve a **full dislocation** of the humeroulnar or humeroradial joints, a much more severe injury than a pulled elbow. - This would present with more significant deformity and instability compared to the subtle presentation of a pulled elbow. *Subluxation of proximal radio ulnar joint* - While the injury involves the radius and ulna, the specific subluxation in a pulled elbow is that of the **radial head** at the **humero-radial joint**, not primarily the proximal radio-ulnar joint itself. - The focus is on the annular ligament's integrity around the radial head, rather than direct forces acting on the proximal radio-ulnar articulation. *No injury present* - A pulled elbow is a recognized and common **pediatric orthopedic injury** requiring intervention to reduce the radial head. - The child will typically present with pain, refusal to use the affected arm, and a characteristic holding posture.

Q: How is the degree of deformity in scoliosis calculated?

Cobb's method. ***Cobb's method*** - This is the **standard radiographic measurement** used to assess the severity of spinal curvature in scoliosis. - It involves drawing lines along the **most tilted vertebrae** at the ends of the curve and measuring the angle formed by their intersection. *Hamburger method* - This is not a recognized method for calculating the degree of deformity in scoliosis. - There is **no established medical or orthopedic technique** bearing this name for scoliosis assessment. *Haldane method* - This method is primarily used in **biochemistry** to describe **enzyme kinetics** and is unrelated to scoliosis measurement. - It describes the relationship between reaction rates and reactant concentrations in biological systems. *Milwaukee method* - The **Milwaukee brace** is a historical type of orthotic device used to treat scoliosis, but it is not a method for calculating the degree of deformity. - While it is associated with scoliosis treatment, it does not involve the measurement of the curve itself.

Q: What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Shallow acetabulum. ***Shallow acetabulum*** - A **shallow or dysplastic acetabulum** is the primary pathological feature in CDH, leading to an unstable or dislocated femoral head. - This anatomical abnormality prevents the femoral head from seating properly, causing **instability** and potential **dislocation**. *Large head of femur* - While femoral head abnormalities can occur, a **disproportionately large femoral head** is not the primary or most common pathological feature causing CDH. - The issue primarily lies with the **acetabular socket** rather than the size of the femoral head itself. *Excessive retroversion* - **Femoral retroversion** (backward twisting of the femoral neck relative to the femoral condyles) can be a contributing factor or an associated finding, but it is not the primary anatomical defect. - The principal pathology is the **inadequate containment** of the femoral head by a poorly formed acetabulum. *Coxa vara deformity* - **Coxa vara** is a deformity where the angle between the head and shaft of the femur is decreased. - While it can be associated with or contribute to hip instability in some conditions, it is not the primary or defining pathological feature of CDH.

Q: In neglected cases of CTEV, which joints are fused?

Calcaneocuboid, talonavicular, and talocalcaneal joints. ***Calcaneocuboid, talonavicular, and talocalcaneal joints*** - In neglected cases of **clubfoot (CTEV)**, a **triple arthrodesis** is performed to correct the deformity. - This procedure involves the fusion of the **subtalar (talocalcaneal)**, **talonavicular**, and **calcaneocuboid joints** to provide a stable, plantigrade foot. *Tibiotalar, calcaneocuboid, and talonavicular joints* - The **tibiotalar joint (ankle joint)** is generally preserved in triple arthrodesis for CTEV to maintain ankle motion. - Fusing the tibiotalar joint would significantly **reduce ankle dorsiflexion and plantarflexion**, leading to a stiff ankle. *None of the above joints* - This option is incorrect because the fusion of specific joints is a recognized surgical treatment for severe, neglected CTEV. - **Triple arthrodesis** is a well-established procedure for correcting rigid foot deformities. *Ankle joint, calcaneocuboid, and talonavicular joints* - As mentioned, fusion of the **ankle joint (tibiotalar joint)** is generally avoided in triple arthrodesis for CTEV to preserve functional ankle motion. - The goal is to stabilize the foot while retaining as much articulation as possible in the ankle itself.

Q: What is the primary reason for early stabilization of a femur shaft fracture?

To prevent fat embolism syndrome and systemic complications. ***To prevent fat embolism syndrome and systemic complications*** - Early stabilization of femur shaft fractures significantly **reduces the incidence of fat embolism syndrome (FES)**. Fat emboli released from the bone marrow can travel to the lungs and brain, causing severe respiratory distress and neurological deficits. - By stabilizing the fracture, the **release of fat globules is minimized**, thereby preventing FES and associated systemic complications such as acute respiratory distress syndrome (ARDS) and adult respiratory distress syndrome (ADRS). *To prevent significant blood loss.* - While femur fractures can cause significant blood loss, the primary reason for early stabilization is not solely to prevent it but to reduce complications. **Blood loss is a direct consequence**, but FES poses a greater immediate threat to life. - Furthermore, **blood loss can often be managed initially by other means**, such as fluid resuscitation and direct pressure, while FES requires prompt reduction of fracture movement. *To reduce pain and discomfort.* - Reducing pain and discomfort is an important benefit of stabilization, but it is **not the primary life-saving reason** for early intervention. Analgesics and proper splinting can also address pain. - The focus on early stabilization goes beyond symptomatic relief to actively prevent **potentially fatal systemic complications**. *To facilitate quicker healing.* - While stability is crucial for proper healing, **early stabilization primarily addresses acute, life-threatening complications** rather than long-term healing rates. Optimal healing depends on many factors, including blood supply and infection control, not solely on initial stabilization. - **Quicker healing is a secondary benefit**; the immediate priority is to prevent acute morbidity and mortality associated with the fracture.

Q: Treatment of choice for displaced fracture neck femur in a 40 years old female

Multiple screw fixation. ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.

Q: Sequestrum is best defined as

A piece of dead bone surrounded by infected tissue. ***A piece of dead bone surrounded by infected tissue*** * A sequestrum is a fragment of **necrotic (dead) bone** that has become separated from the surrounding living bone in the context of **chronic osteomyelitis**. * The dead bone is typically surrounded by **infected granulation tissue and pus**, making it the classic definition taught in the context of bone infections. * The sequestrum acts as a **nidus for persistent infection**, as antibiotics cannot penetrate the avascular dead bone, making surgical removal often necessary. *A piece of dead bone without surrounding infection* * While a sequestrum is fundamentally dead bone, in clinical practice and standard teaching, it is **intrinsically associated with infection** in osteomyelitis. * The phrase "without surrounding infection" makes this option incorrect, as the classic sequestrum occurs in the **inflammatory milieu of chronic osteomyelitis**. *A piece of bone with compromised blood supply* * This describes **ischemic or avascular bone**, which is the **initial pathological event** that leads to bone death. * However, this is not the definition of sequestrum itself—the sequestrum is the **end result** (dead bone fragment) rather than bone with compromised vascularity. * A sequestrum has **no blood supply** (completely avascular), not merely compromised supply. *None of the options* * This is incorrect because the first option accurately captures the **standard definition of sequestrum** as taught in the context of chronic osteomyelitis in medical education.

Q: Cloacae are openings found in which of the following?

Involucrum. ***Involucrum*** - **Cloacae** are openings or sinuses that develop in the **involucrum**, which is the new bone formation that surrounds a segment of necrotic bone (sequestrum) during osteomyelitis. - These openings act as channels for the discharge of **pus** and inflammatory debris from the infected bone to the external environment. *Sequestrum* - A **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from the surrounding healthy bone due to osteomyelitis. - While central to the pathology, the cloacae are openings *through the involucrum* that encases the sequestrum, not in the sequestrum itself. *Normal bone* - **Normal bone** does not contain cloacae; these structures are a pathological feature indicative of chronic osteomyelitis. - Healthy bone remodels and resorbs normally, without the formation of channels for pus drainage. *Myositis* - **Myositis** is an inflammation of the **muscles**, not bone, and does not involve the formation of cloacae. - While it can be caused by infection, the pathological changes are localized to muscle tissue.

Question 1

What is the most common type of dislocation of the elbow joint?

Accepted Answer

Posterolateral dislocation

Answer

Posterior dislocation

Answer

Posteromedial dislocation

Answer

Lateral dislocation

Question 2

What is a Pulled Elbow?

Accepted Answer

Partial dislocation of the radial head

Answer

Subluxation of proximal radio ulnar joint

Answer

Complete separation of the elbow joint

Answer

No injury present

Question 3

How is the degree of deformity in scoliosis calculated?

Accepted Answer

Cobb's method

Answer

Hamburger method

Answer

Haldane method

Answer

Milwaukee method

Question 4

What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Accepted Answer

Shallow acetabulum

Answer

Large head of femur

Answer

Excessive retroversion

Answer

Coxa vara deformity

Question 5

In neglected cases of CTEV, which joints are fused?

Accepted Answer

Calcaneocuboid, talonavicular, and talocalcaneal joints

Answer

Tibiotalar, calcaneocuboid, and talonavicular joints

Answer

None of the above joints

Answer

Ankle joint, calcaneocuboid, and talonavicular joints

Question 6

Volkmann's contracture: which artery is involved in this condition?

Accepted Answer

Brachial artery

Answer

Radial

Answer

Ulnar

Answer

Anterior interosseous artery

Question 7

What is the primary reason for early stabilization of a femur shaft fracture?

Accepted Answer

To prevent fat embolism syndrome and systemic complications

Answer

To prevent significant blood loss.

Answer

To reduce pain and discomfort.

Answer

To facilitate quicker healing.

Question 8

Treatment of choice for displaced fracture neck femur in a 40 years old female

Accepted Answer

Multiple screw fixation

Answer

None of the options

Answer

Bipolar hemiarthroplasty

Answer

THR

Question 9

Sequestrum is best defined as

Accepted Answer

A piece of dead bone surrounded by infected tissue

Answer

A piece of dead bone without surrounding infection

Answer

A piece of bone with compromised blood supply

Answer

None of the options

Question 10

Cloacae are openings found in which of the following?

Accepted Answer

Involucrum

Answer

Sequestrum

Answer

Normal bone

Answer

Myositis

NEET-PG 2012 — Orthopaedics