During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
The Salter Harris classification is used for classifying which type of injuries?
In which condition is the Milwaukee Brace primarily used?
Vertebra Plana is associated with all of the following conditions except -
Which nerve is primarily affected by lunate dislocation in the carpal tunnel?
Adson's test is positive in -
Medial snapping knee syndrome is due to involvement of -
Greenstick/ Nightstick fractures are seen in -
What condition is characterized by a waddling gait?
Who devised the correction of CTEV by serial casting?
NEET-PG 2015 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 11: During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
- A. Osteolysis
- B. Osteomyelitis
- C. Osteonecrosis (Correct Answer)
- D. Osteogenesis
Explanation: ***Osteonecrosis*** - **Osteonecrosis**, also known as **avascular necrosis**, is characterized by the death of bone tissue due to a lack of blood supply, which leads to the collapse of the subchondral bone and articular cartilage destruction. - The description of **wedge-shaped subchondral depressions** and **articular cartilage destruction** is highly indicative of osteonecrosis, especially in the context of advanced hip joint pathology requiring total hip replacement. *Osteolysis* - **Osteolysis** refers to the active resorption of bone, often seen around implants in prosthetic joints due to wear particles, leading to bone loss. - While it involves bone destruction, it typically presents as diffuse bone loss rather than specific wedge-shaped subchondral depressions. *Osteomyelitis* - **Osteomyelitis** is an infection of the bone or bone marrow, often leading to bone destruction, but it is primarily characterized by inflammation and pus formation. - The presented scenario does not mention signs of infection (e.g., fever, pus, inflammation) but focuses purely on structural destruction consistent with vascular compromise. *Osteogenesis* - **Osteogenesis** is the process of bone formation or development. - This term describes the creation of bone tissue and is the opposite of bone destruction, making it an incorrect answer for a condition involving cartilage and bone deterioration.
Question 12: The Salter Harris classification is used for classifying which type of injuries?
- A. Soft tissue injuries in pediatric patients
- B. Long bone fractures without growth plate involvement
- C. Joint dislocations in pediatric orthopedics
- D. Fractures involving the physis in children (Correct Answer)
Explanation: ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.
Question 13: In which condition is the Milwaukee Brace primarily used?
- A. Spondylolisthesis
- B. Scheuermann's Disease
- C. Congenital Kyphosis
- D. Adolescent Idiopathic Scoliosis (Correct Answer)
Explanation: ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.
Question 14: Vertebra Plana is associated with all of the following conditions except -
- A. Leukemia
- B. Excessive use of systemic steroids
- C. Scheurmanns Disease (Correct Answer)
- D. Histiocytosis X
Explanation: ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.
Question 15: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?
- A. Ulnar
- B. Median nerve (Correct Answer)
- C. Radial nerve
- D. Median & ulnar nerve
Explanation: ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.
Question 16: Adson's test is positive in -
- A. Cervical rib (Correct Answer)
- B. Cervical spondylosis
- C. Cervical fracture
- D. Cervical dislocation
Explanation: ***Cervical rib*** - **Adson's test** assesses for **thoracic outlet syndrome (TOS)**, which can be caused by a cervical rib compressing the **subclavian artery** or **brachial plexus**. - A positive test occurs when the radial pulse diminishes or disappears upon specific head and arm maneuvers, indicating neurovascular compression. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, such as bone spurs and disc herniation. - While it can cause neurological symptoms, it typically does not lead to a positive Adson's test, as the compression site is different from that assessed by the test. *Cervical fracture* - A cervical fracture is a **traumatic injury** to the bones of the neck. - Adson's test is not indicated for diagnosing fractures and performing it could exacerbate the injury. *Cervical dislocation* - Cervical dislocation is a severe injury where cervical vertebrae are **displaced from their normal alignment**. - Similar to fractures, Adson's test is not appropriate for diagnosing or evaluating dislocations and carries a risk of further injury.
Question 17: Medial snapping knee syndrome is due to involvement of -
- A. Gastrocnemius origin
- B. Lateral collateral ligament
- C. Quadriceps Tendon
- D. Pes Anserinus (Correct Answer)
Explanation: ***Pes Anserinus*** - The **pes anserinus bursa** and its associated tendons (sartorius, gracilis, semitendinosus) can cause medial knee pain and snapping if inflamed or irritated. - This is a common cause of **medial snapping knee syndrome**, particularly in athletes or individuals with valgus deformity. *Quadriceps Tendon* - The **quadriceps tendon** is located anteriorly, connecting the quadriceps muscles to the patella, and is not typically involved in medial snapping. - Issues with the quadriceps tendon usually present as anterior knee pain or tendinitis. *Gastrocnemius origin* - The **gastrocnemius origin** is at the distal femur and its involvement would typically cause posterior knee pain or symptoms related to calf muscle function. - It does not commonly cause medial knee snapping. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is on the lateral side of the knee and its involvement would cause lateral knee pain or instability. - It is not associated with medial snapping knee syndrome.
Question 18: Greenstick/ Nightstick fractures are seen in -
- A. Children (Correct Answer)
- B. Elderly
- C. Common in all age groups
- D. Young adults
Explanation: ***
Question 19: What condition is characterized by a waddling gait?
- A. Bilateral congenital dysplasia of hip (Correct Answer)
- B. Coxa valga
- C. CTEV
- D. Muscular dystrophy
Explanation: ***Bilateral congenital dysplasia of hip*** - A **waddling gait**, also known as a **Trendelenburg gait**, occurs due to weakness of the hip abductor muscles (gluteus medius and minimus) on both sides. - In bilateral congenital dysplasia of the hip, the **femoral heads are poorly seated** or dislocated, leading to ineffective abductor function and the characteristic gait. *Coxa valga* - This condition involves an **increased angle** between the femoral neck and shaft, which can alter biomechanics but does not typically cause a waddling gait in isolation. - While it can be associated with other hip pathologies, **coxa valga itself is not the primary cause** of a waddling gait. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It affects the patient's ability to walk normally, but results in a different type of gait abnormality, typically involving limping or walking on the outer edge of the foot, **not a waddling gait**. *Muscular dystrophy* - While many forms of muscular dystrophy can lead to a waddling gait due to **proximal muscle weakness**, it is a broad category of genetic disorders. - Without further context or specific type of muscular dystrophy, **bilateral congenital hip dysplasia is a more direct and specific cause** for the symptom described.
Question 20: Who devised the correction of CTEV by serial casting?
- A. Gerhardt Kuntscher
- B. Gavril Ilizarov
- C. Hugh Owen Thomas
- D. Ignacio Ponseti (Correct Answer)
Explanation: ***Ignacio Ponseti*** - Dr. Ignacio Ponseti developed the **Ponseti method**, a non-surgical technique for correcting **congenital talipes equinovarus (CTEV)**, commonly known as clubfoot. - This method involves a series of **gentle manipulations** and **serial casting**, followed by the use of a foot abduction brace. *Gerhardt Kuntscher* - **Gerhardt Kuntscher** was a German surgeon known for developing the **intramedullary nail** for fixing long bone fractures. - His contributions revolutionized the surgical management of fractures, but he did not develop the method for CTEV correction. *Gavril Ilizarov* - **Gavril Ilizarov** was a Soviet orthopedic surgeon famous for inventing the **Ilizarov apparatus**, an external fixator used for limb lengthening and complex fracture treatment. - His work focused on osteogenesis and bone regeneration, not the non-surgical correction of clubfoot. *Hugh Owen Thomas* - **Hugh Owen Thomas** was a Welsh orthopedic surgeon regarded as the "father of British orthopaedic surgery," known for the development of the **Thomas splint**. - His contributions were primarily in managing fractures and tuberculosis of the joints, independent of CTEV correction techniques.