NEET-PG 2013 Practice Questions

Q: Turn-buckle cast is used for ?

Management of spinal deformities. ***Management of spinal deformities*** - A **turn-buckle cast** is specifically designed to apply gradual, corrective forces for **spinal deformities** like scoliosis or kyphosis. - It allows for incremental adjustments to the cast to achieve progressive stretching and correction of the spinal curve. *Fracture of the humerus* - **Humerus fractures** are typically managed with hanging arm casts, coaptation splints, or surgical fixation, depending on the fracture type and location. - A turn-buckle cast is not suitable for immobilizing or reducing a **humeral fracture**. *Fracture of the femur* - **Femur fractures** in adults usually require surgical intervention, such as intramedullary nailing, due to the high biomechanical stress on the bone. - For conservative management in children, traction or spica casts might be used, but not a **turn-buckle cast**. *Cervical spine immobilization* - **Cervical spine immobilization** is typically achieved using rigid cervical collars, halo vests, or specialized orthoses designed to restrict head and neck movement. - A turn-buckle cast is too bulky and not anatomically suitable for effective **cervical spine stabilization**.

Q: What will the aspirated synovial fluid in a case of septic arthritis typically show?

Markedly increased polymorphonuclear leukocytes. ***Markedly increased polymorphonuclear leukocytes*** - **Septic arthritis** is characterized by an acute infection within the joint, leading to a profound inflammatory response with a significant influx of **neutrophils** (polymorphonuclear leukocytes) into the synovial fluid. - A synovial leukocyte count greater than **50,000 cells/mm³** with over **75% neutrophils** is highly suggestive of septic arthritis. *Clear and straw-colored fluid* - This description typically corresponds to **normal synovial fluid** or fluid from a mild **non-inflammatory condition**, which is not consistent with bacterial infection. - Normal synovial fluid is usually **transparent**, indicating the absence of significant cellular debris or inflammatory cells. *Low viscosity fluid* - While septic synovial fluid can have reduced viscosity due to the breakdown of **hyaluronic acid** by bacterial enzymes and inflammatory mediators, this characteristic alone is not the most definitive diagnostic feature. - Reduced viscosity is also observed in other inflammatory conditions, making it less specific than direct cellular analysis for diagnosing infection. *Cloudy or purulent fluid* - The presence of **cloudy** or **purulent (pus-like)** fluid *is* often seen in septic arthritis, reflecting the high cell count and protein content. - However, this is a **gross visual observation**, and a more precise and diagnostic indicator is the microscopic finding of markedly increased **polymorphonuclear leukocytes**.

Q: All are common sites of primary cancer for bone metastasis except:

Brain. ***Brain*** - The **brain** is not a common site for primary bone metastasis, as bone metastases typically originate from organs like the **breast**, **lung**, and **prostate**. - While brain tumors can metastasize to bone, the reverse (primary bone cancer) occurring here is rare. *Breast* - Breast cancer is one of the **most prevalent sources** of bone metastases, commonly affecting the spine and pelvis. - Symptoms often include **bone pain** and potential fractures due to metastasis. *Brain* - Similar to , while brain tumors can metastasize, **primary cancers** do not commonly originate in the bone. - The **metastatic spread** to the brain from other primary sites is common, but not the other way around. *Breast* - Again, breast cancer commonly leads to **bone metastasis**, accounting for a significant percentage of these cases. - It is important to identify busy metastasis to **manage** symptoms and improve patient outcomes.

Q: Which of the following fractures is least likely associated with vascular injury?

Fracture shaft of humerus. ***Fracture shaft of humerus*** - While any fracture can theoretically cause vascular injury, **mid-shaft humeral fractures** are less commonly associated with significant **vascular compromise** compared to those around major joints or near critical neurovascular bundles. - The **brachial artery** and its branches are often sufficiently mobile and protected by surrounding musculature in the mid-shaft region, reducing the incidence of direct laceration or entrapment. *Fracture supracondylar femur* - **Supracondylar femur fractures** are in close proximity to the **femoral artery** and its branches in the popliteal fossa. - Displacement of these fractures can easily **lacerate or compress** these vital vessels, leading to high rates of vascular injury. *Fracture supracondylar humerus* - **Supracondylar humerus fractures** in children are notoriously associated with **brachial artery injury** due to the artery's close proximity and fixated position over the joint. - The acute angulation and displacement often seen in these fractures put the artery at significant risk of **kinking, compression, or transection**. *Fracture shaft of femur* - **Femoral shaft fractures** can be associated with significant vascular injury, particularly from **large displaced fragments** or high-energy trauma. - The **superficial femoral artery** and its perforating branches can be torn, leading to substantial hemorrhage or arterial compromise.

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: What is the most common malignant tumor of the skeletal system?

Metastasis. ***Metastasis*** - **Skeletal metastasis** is overwhelmingly the most common malignant tumor involving bone, as many primary cancers (e.g., breast, prostate, lung) frequently spread to bone [1]. - While not originating in the bone, these metastatic deposits are malignant neoplasms within the skeletal system, making them the most prevalent. *Multiple myeloma* - This is a **primary malignancy of plasma cells** that arises in the bone marrow, causing destructive bone lesions. - It is the most common **primary malignant bone tumor** in adults, but still less common than metastatic disease. *Osteosarcoma* - This is the most common **primary malignant bone tumor** in **children and adolescents**, primarily affecting long bones [2]. - While a significant primary bone cancer, its incidence is lower than that of metastatic bone disease across all age groups [1]. *Chondrosarcoma* - This is a malignant tumor of **cartilage-forming cells** and is the second most common primary bone cancer in adults, after multiple myeloma [3]. - It is much less common than metastatic disease and osteosarcoma [1], [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1204.

Q: Which condition is characterized by a 'moth-eaten' appearance of the bones?

Multiple myeloma. ***Multiple myeloma*** [1][2] - Characterized by **punched-out lytic lesions** in bones, often described as **moth-eaten** appearance on imaging [1]. - Associated with **elevated serum proteins** and **Bence Jones proteins** in urine, confirming the diagnosis [2]. *Eosinophilic granuloma* - Usually presents with **solitary bone lesions** and is linked to **Langerhans cell histiocytosis** rather than the moth-eaten pattern. - Does not typically cause generalized **lytic bone lesions** seen in cases of multiple myeloma. *Chondromyxoid fibroma* - Generally appears as a **well-defined cortical lesion** and is not associated with a moth-eaten appearance. - It predominantly affects the **metaphysis** of long bones and shows a characteristic **cartilaginous matrix**. *Osteoid osteoma* - Presents with a **nidus** of osteoid formation, leading to localized bone pain, and does not exhibit a moth-eaten consistency. - Tends to cause **cortical bone thickening** rather than the diffuse lytic lesions associated with multiple myeloma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 608. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Question 1

Turn-buckle cast is used for ?

Accepted Answer

Management of spinal deformities

Answer

Fracture of the humerus

Answer

Fracture of the femur

Answer

Cervical spine immobilization

Question 2

What will the aspirated synovial fluid in a case of septic arthritis typically show?

Accepted Answer

Markedly increased polymorphonuclear leukocytes

Answer

Clear and straw-colored fluid

Answer

Low viscosity fluid

Answer

Cloudy or purulent fluid

Question 3

All are common sites of primary cancer for bone metastasis except:

Accepted Answer

Brain

Answer

Prostate

Answer

Lung

Answer

Thyroid

Question 4

Which of the following fractures is least likely associated with vascular injury?

Accepted Answer

Fracture shaft of humerus

Answer

Fracture supracondylar femur

Answer

Fracture supracondylar humerus

Answer

Fracture shaft of femur

Question 5

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 6

Bunion is commonly seen at ?

Accepted Answer

Great toe MTP joint

Answer

Medial malleolus

Answer

Lateral Malleolus

Answer

Shin of tibia

Question 7

What is another name for ischial bursitis?

Accepted Answer

Weaver's bottom

Answer

Trochanteric bursitis

Answer

Prepatellar bursitis

Answer

Olecranon bursitis

Question 8

Most common site of myositis ossificans ?

Accepted Answer

Quadriceps/Thigh

Answer

Shoulder

Answer

Wrist

Answer

Elbow

Question 9

What is the most common malignant tumor of the skeletal system?

Accepted Answer

Metastasis

Answer

Chondrosarcoma

Answer

Multiple myeloma

Answer

Osteosarcoma

Question 10

Which condition is characterized by a 'moth-eaten' appearance of the bones?

Accepted Answer

Multiple myeloma

Answer

Osteoid osteoma

Answer

Eosinophilic granuloma

Answer

Chondromyxoid fibroma

NEET-PG 2013

Dental

Internal Medicine

Orthopaedics

Pathology

Radiology