Orthopaedics

Correct Answer
C
Option

Correct Answer - C Ans. is 'c' i.e., Treated by simple curettage Aneurysmal bone cyst • Aneurysmal bone cyst occur in children and young adults (5-20 years). • The term aneurysmal is used because it causes expansion of overlying cortex like vascular expansion of an aneurysm. • The metaphysis of long bones is involved most commonly. Most common in femur and tibia; however any long bone can be involved. • Other common sites are posterior elements of vertebrae and pelvis athology • Cystic spaces of variable sizes & number which are filled with blood but not lined with vascular endothelium. The wall of vascular space is lined with fibroblast cells with collagen, giant cells, hemosiderin & osteoid (secondary to microfractures). Clinical features • With expanding lesions, pain may be a presenting feature. •Large cyst can also cause swelling • Pathological fracture may occur (but less frequent than simple bone cyst). Radiological features of aneurysmal bone cyst • Eccentric, expansile osteolytic lesion

Correct Answer - A

Hip flexion REF: Lange Instant Access: Orthopedics and Sports
Medicine, by Anil Patel, page 106
Thomas Test: With the patient lying supine, maximally flex both hips.
Allow the femur on the ipsilateral side to fall into as much extension
as possible, while holding the other hip up. The angle between the
femur and examining table is the residual flexion and represents the
flexion contracture

Correct Answer - A
Ans. is 'a' i.e., Type A
A useful classification is from the AO group: type A fractures have
no articular splits and are truly 'supra- condylar'; type B fractures are
simply shear fractures of one of the condyles; and type C fractures
have supra- condylar and intercondylar fissures

Correct Answer -C
85°

Correct Answer -C
Ans. is 'c' i.e., Open femur fracture
• Exsanguination is the process of blood loss, to a degree sufficient to
cause death.
• Shaft femur fracture out of the above is associated with maximum
blood loss and more blood loss is expected in cases of open
fracture. Thus, the most probable answer is open fracture shaft
femur.
• Ttwo important fractures which can cause significant blood loss are
Fracture pelvis
Fracture shaft femur

Correct Answer -B
Ans. is 'b' i.e., RA
Windswept deformity
.. Knee : - A valgus deformity of one knee in association of varus
deformity of other knee is know as windswept deformity. It is seen in
Rickets, Physeal oseochondromatosis, Hereditary dysplasia
(epiphyseal dysplasia) of bone and Rheumatoid arthritis.
2. Foot
Deviation of all - toes in one direction (usually laterally) is
known as windswept deformity. It is seen in Rheumatoid arthritis
3. Hand :- Deviation of all fingers (usually medialy) is know as
windswept deformity. It is seen in Rheumatoid arthritis,SLE, and
Jacoud's arthropathy

Correct Answer -C
• Brodie's abscess is a sub-acute form of osteomyelitis, presenting as
a collection of pus in bone, often with an insidious onset.
• Classically, this may present after progression to a
draining abscess extending from the tibia out through the skin.
• Occasionally acute osteomyelitis may be contained to a localized
area and walled off by fibrous and granulation tissue. This is
termed Brodie's abscess
.| Most frequent causative organism is Staphylococcus aureus.
• Usually occurs at the metaphysis of long bones. Distal tibia, proximal
tibia, distal femur, proximal or distal fibula, and distal radius
• Brodie's abscess is best visualized using computed
tomography (CT) scan.
• Associated atrophy of soft tissue near the site of infection and
shortening of the affected bone. Osteoblastoma may be a classic
sign for Brodie's abscess.
• In the majority of cases, surgery has to be performed.
• If the cavity is small then surgical evacuation and curettage are
performed under antibiotic cover.
. If the cavity is large then the abscess space may need packing
with cancellous bone chips after evacuation.

Correct Answer -C
Ans. is 'c" i.e., Supinated position
• Fracture proximal third - supination of forearm
• Fracture middle third - mid pronation offorearm
• Fracture distal third - pronation offorearm

Correct Answer- A
Ans. is 'c' i.e., Weaver's bottom
Prepatellar Hr,1semaid's
bursitis
knee
Infrapatellar Clergyman's
bursitis
knee
Olecranon Student's
bursitis
elbow
Ischia] bursitis Weaver's
bottom
On lateral
Tailor's ankle
malleolus
On great toe

Correct Answer - B
Ans. is 'b' i.e., Potts disease
. A term for significant involvement of the pelvic floor by malignancy,
usually carcinoma, or ttuberculosis; in which there is massive
extension of pathology to the urinary bladder, female genital tract,
and sigmoid colon. Adequate resection of a frozen pelvis is virtually
impossible; chemotherapy and radiation therapy are palliative at
best.

rrect Answer-C
Ans. is 'c' i.e., Scoliosis.
Name of the case
Minerva cast
Risser's cast
Turn-buckle cast
Shoulder spica
U-slab
Hanging cast
Colle's cast
Hip spica
Cylinder cast
PTB cast


Use
Cervical spine disease
Scoliosis
Scoliosis
Shoulder immobilisation
Fracture of the humerus
Fracture of the humerus
Colles' fracture
Fracture of the femur
Fracture of the patella
Fracture of the tibia

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Correct Answer - D
Ans. is 'd' i.e., Fracture shaft humerus
• Vascular injury may be seen in
.. Fracture supracondylar humerus ---> Brachial artery
Fracture shaft femur (especially distal 3rd)-->Popliteal artery
3. Fracture supracondylar femur --> Popliteal arter

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Correct Answer -C
Ans. is 'c' i.e., Dennis Brown splint
Treatment of CTEV at birth
• Ideally treatment should be begun immediately after birth, certainly
not more than 1 week later
• The principles of treatment are :-
1. Correction of deformity by manipulation
2. Maintenance of this correction by immobilizing the foot in over-
corrected position in between the manipulations. Three methods are
available for maintenance :-
A plaster of paris cast (most commonly used)
Metal splints (Denis brown splint)
3. Adhesive strapping
• Among these, retention in a plaster is much to be preferred, because
it holds the foot in the over-corrected position more efficiently and for
a longer period than do metal splints or strapping
• The plaster must extend to the upper thigh, with the knee flexed 900
• The plaster must be changed every week for the first 6 weeks and
then every 2 weeks until the correction is achieved.

Correct Answer- A Ans. is 'a'i.e., Great toe MTP joint Bunion • A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe • The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its top.

Correct Answer -C
Ans. is 'c' i.e., Dennis Brown splint
Treatment of CTEV at birth
• Ideally treatment should be begun immediately after birth, certainly
not more than 1 week later
• The principles of treatment are :-
1. Correction of deformity by manipulation
2. Maintenance of this correction by immobilizing the foot in over-
corrected position in between the manipulations. Three methods are
available for maintenance :-
A plaster of paris cast (most commonly used)
Metal splints (Denis brown splint)
3. Adhesive strapping
• Among these, retention in a plaster is much to be preferred, because
it holds the foot in the over-corrected position more efficiently and for
a longer period than do metal splints or strapping.
• The plaster must extend to the upper thigh, with the knee flexed 90°
• The plaster must be changed every week for the first 6 weeks and
then every 2 weeks until the correction is achieved

D
Ans. is i.e., < 30 ml
• The bulge test is used to determine the presence of fluid in the knee
joint. It is useful when only a little fluid is present in the joint.
• The suprapatellar bursa is first emptied of fluid by squeezing distally
from about 15 cm above the patella. The medial compartment of the
knee join is emptied by pressing on the side of the joint with the free
hand. The hand is then lifted away and then the lateral side is
sharply compressed
• If the test is positive, a ripple is seen on the flattened, medial
surface.
• The test is negative if the effusion is tense - up to 120 ml.
• The bulge test is used to determine minimal fluid in the knee joint. It
can detect as little as Ax
O ml of fluid in the knee join

Correct Answer - D
Ans. is i.e., Klippel - Feil syndrome
. A block vertebra is a type of vertebral anomaly where there is a
failure of separation of two or more adjacent vertebral bodies
. Associations
.. There is a frequent association with hemivertebrae / absent vertebra
above or below block level, posterior element fusion
. Fusion of multiple cervical vertebral bodies is also seen in Klippel-
Feil syndrome and VACTREL anamoly.

Correct Answer - A
Ans. is 'a' i.e., To see patella femoral articulation Standard Portals In Knee Arthroscopy : • Anterolateral portal ? Almost all the structures within the knee joint can be seen except the posterior cruciate ligament, the anterior portion of the lateral meniscus and the periphery of the posterior horn of the medial meniscus in tight knees. 2. Located 1 cm above the lateral joint line and 1 cm lateral to the margin of the patellar tendon. • Anteromedial portal? .. Used for additional viewing of lateral compartment and insertion of probe for palpation of medial and lateral compartment structures >. Placed 1 cm above the medial joint line, 1 cm inferior to the tip of patella, and 1 cm medial to the edge of the patellar tendon • Posteromedial portal ? .. Located on the soft triangular soft spot formed by the posteromedial edge of the femoral condyle and the posteromedial edge of tibia. `. Used for viewing the posteromedial structures and for repair or removal of the displaced posterior horn of meniscal tears and for posteromedial loose body removal. • Superolateral portal .. Used for diagnostically viewing the dynamics of patello - femoral
joint, excision of medial plicae ". Located just lateral to the quadriceps tendon and about 2.5 cm superior to the superolateral corner of patella.

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Correct Answer - B Ans. is "b' i.e., Organized calcification Seronegative spondvloarthropathies • The seronegative spondyloarthropathies are a group of disorders that share certain clinical features and genetic associations. The word seronegative referes to the absence of rheumatoid factor in this group of disorders. The seronegative spondyloarthropathies include? .. Ankylosing spondylitis ?. Reactive arthritis -_-> Reiter syndrome and enteritis associated arthritis Psoriatic arthritis 5. I. Arthritis associated with inflammatory bowel disease, i.e. enteropathic arthritis Features of seronegative spondyloarthropathies • Onset usually before 40 years .Absence of RA factor • HLA - B27 positive • Presence of uveitis

Correct Answer - B Ans. is 'b' i.e., Patella • Two radiological indices are commonly used for determining the position of patella • Insall-Salvati index It is the ratio of patellar tendon length to patella length ". Normally it is 1-0. An index of 1:2 or more is seen in patella alta (high riding patella). An index of 0-8 or less is seen in patella baja (low lying patella). • Blackbume-Peel lindex It is the ratio of (i) the distance of tibial plateau to inferior articular -"| surface of patella (numerator), to (ii) length of articular surface of patella (denominator) 2. Normally it is 0.8. An index of 1 or more is seen in patella alta.

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[9.2] A 59-year-old man is admitted to the intensive care unit for a myocar- dial infarction. He is given a ẞ-adrenergic antagonist and instructed to avoid emotional turmoil to decrease sympathetic stimulation of the heart. From a cellular perspective, sympathetic stimulation of the heart does which of the following?