image Q. 103 - Nervous

Q.    Painful neuropathy and intact nerve anatomy is called ?

a. Neuralgia
b. Neuropathic pain
c. Neuropraxia
d. Neurostenalgia
e. Neuroma

Answer -
d
Continuous irritation of an anatomically intact nerve by a noxious stimulus leading to neuropathic pain is called neurostenalgia.

Common causes are , compression , distortion ,ischemia and tethering of nerve and immediate relief following removal of offending cause.

The difference between neuropraxia is that neuropraxia commonly are due to acute causes leading to transient nerve compressions and usually are not painful.

image Q. 102 - Stronger

Q.    Which of these is the strongest structure?

a. Meniscofemoral ligament
b. Anterior cruciate ligament
c. Posterior cruciate ligament
d. Collateral ligament
e. Ligamentum mucosum



 

























































































Answer -
c

Posterior cruciate ligament ( PCL) is the strongest ligament in knee.

Ligamentum mucosum is not true ligament.  It results from remnant of synovial folds or septum (plicae) inside knee of some individuals.
 Infrapatellar plica is associated with it.

image Q. 101 - Harness blues

Q.     Pavlik harness is kind of brace used in conservative treatment of DDH (Developmental Dysplasia of Hip). Complications of this harness Pavlik harness disease includes which of these?

a. Brachial plexus palsy
b. Osteonecrosis of femoral head
c. Femoral nerve palsy
d. Dislocation of femoral head
e. All of the above

Answer -
d

Pavlik harness is a dynamic flexion abduction orthosis.

All of the above are serious complications of Pavlik harness.

Abnormal posture within harness can occasionally cause inferior or obturator dislocation of hip.

 Shoulder straps can cause brachial plexus complications in some cases.

image Q. 100 - Fluidity

Q.   Fluid - fluid level is found in ?

a. Unicameral bone cyst
b. Intraoseous lipoma
c. intra isseous ganglion cyst
d. Aneurysmal bone cyst

Answer -
d
Fluid fluid level is characteristic feature seen in MRI of bone lesion suggesting aneurysmal bone cyst.

Some notable features of common bone neoplasm are given here :

Fallen fragment sign - Simple / Unicameral bone cyst.

Blade of grass/ Flame appearance - Paget disease.

Stippled / Pop corn/ Punctate calcification - Enchondroma

Jailhouse appearance - (stripe vertical lines in vertebra) - Hemangioma

Chicken wire appearance ( microscopy) - Chondroblastoma

Split fat sign (MRI) - Scwannoma

Presence of hemosiderin - Pigmented villonodular synovitis ( PVNS)

image Q. 99 - Multiplicity

Q.   Multiple neoplastic  lesion are features of all except ?

a. Ollier's disease
b. Maffucci syndrome
c. Jaffe - Campanacci syndrome
d. Albright syndrome
e. Mazabraud syndrome
f. All of the above

Answer -

Multiple Enchondroma are features of Ollier's disease and those associated with soft tissue hemangiomas are termed Maffucci's syndrome.

Albright syndrome consists of polyostotic fibrous dysplasia with cafe au lait spots with endocrinopathies.

Mazabraud syndrome consists of fibrous dysplasia usually polyostotic along with multiple soft tissue or intramuscular myxomas.

Polyostotic non ossifying fibroma are features of Jaffe Campanacci syndrome along with cafe au lait spots and axillary freckling among others.

image Q. 98 - In the name of king

Q.    The KGMC score/index ( after King George's Medical College, Lucknow, India) was used for ?

a. Polio
b. Rheumatoid arthritis
c. Osteoarthritis
d. Ankylosing spondylitis
e. Nonunion

Answer -
c

The modification of WOMAC score ( Western Ontario and McMaster University score) for osteoarthritis was used in some studies as described in KGMC and was named so.

Reference :
Dad SK et al. J Ind Them Assoc 1998;6:46-9

image Q. 97 - Plastered

Q.   Which of these is common of all given complications during removal of plaster ?

a. Iatrogenic fracture
b. Pressure necrosis
c. Thermal burn
d. Skin erythema

Answer -
c

Thermal burn can be a common complication out of all other options.
Thermal burn results from inadvertent contact of plaster cutting saw ( motorised) into the skin.

As these saw do not usually give sharp incisive cuts, their rotational blades may produce heat and therefore thermal superficial burns.

Pressure complications are common complication but not that of removal of plaster.

Iatrogenic injuries may result due to excessive forceful technique but is relatively uncommon.

image Q. 96 - Meter down

Q.    Which of these is clinical aspects of musculoskeletal quality ?

a. Arthrometer
b. Goniometer
c. Telescopy
d. Dynamometer

Answer -

c

Arthrometer is used in assessment of  ligament tension or laxity etc. It is measured by various arthrometer like KT- 1000, KT - 2000.

Goniometer is used to measure joint angles to calculate range of motion.

Dynamometer is used to assess hand grip strength. Popular ones are Jamar dynamometer etc.

Telescopy on the other hand is clinical examination method used to assess normal joint excursion along force vector. It is commonly used to assess hip pathologies resulting in instability or after checking stability following hip arthroplasty procedure 

image Q. 95 - Footwork

Q.   All of these are described techniques for serial plaster management of clubfoot except?


a. Ponseti technique
b. Accelerated Ponseti technique
c. Modified Ponseti technique
d. Reverse Ponseti technique

Answer -
d
 Ponseti method of manipulation and casting is widely used method of conservative treatment of clubfoot.
 It requires serial corrective casting every seven days (weekly).

When Ponseti technique is used every five days, then it is called accelerated Ponseti technique.

Modified Ponseti technique is used for complex or atypical clubfoot.

Reverse Ponseti technique, on the other hand has been tried in clinically different foot deformity known as CVT ( congenital vertical talus) by some workers.

image Q. 94 - Game theory

Q.   All are stress/ strain related injuries except?

a. Gymnast wrist
b. Javellin thrower's injury
c. Atheletr's foot
d. Jumper's knee

Answer -
c

Gymnast's wrist is stress related physeal injuries.

Javellin thrower's injury is strain of ulnar collateral ligament in thrwing sports like javellin.

Jumper's knee is patellar tendinitis.

Atheletes foot on the other hand is a fungal infection of toes. It is also called tenia pedis

image Q. 93 - High AIIMS

Q.  ' AIIMS test' is related to clinical assessment of which of these?

a. Vascular examination of upper extremity
b. Nerve entrapment
c. Test for tendon assessment
d. Test for neoplastic lesion

Answer -
c

Evaluation of presence of palmarus longus tendon is essential for it's use as tendon graft as it is not present in every individual. One of the many test is AIIMS test devised and used first in AIIMS, New Delhi.

image Q. 92 - Full plate

Q.   Which of these is not anatomical structure ?

a. Subchondral plate
b. Side plate
c. Endplate
d. Quadrilateral plate
e. Base plate

Answer -

b and e

Subchondral plate is found immediately beneath calcified cartilage. Thickness of this plate is noted in various disorders like osteoarthritis and osteoporosis.

End plate is part of vertebral body and makes its superior and inferior surface.

Quadrilateral plate is part of acetabular anatomy in pelvis.

Side plate or barrel plate is part of DHS ( dynamic hip screw) used for fracture fixation of stable intertrochanteric fractures.

Base plate as in tibia base plate is part of total knee replacement.

image Q. 91 - Love hurts

Q.   "Lover's fracture" is related to ?

a. Head
b. Chest
c. Pubis
d. Heel

Answer -
d

Lover's fracture is fracture of calcaneum, termed after fall of a lover from height.

The associated injuries like that of spine should also be excluded.

It is also called Dan Juan fracture.

image Q. 90 - Battle of bulge

Q.   What is denoted by the arrow in the below imaging?

a. Modic change
b. High intensity zone
c. Scmorl node
d. End plate cyst
e. Intradiscal cleft

Answer -
c

The bulge or prolapse of the disc usually takes place posteriorly or posterolaterally toward spinal canal. The bulge or prolapse of disc toward vertebral body above or downward may also be found at times. This is termed as Scmorl's node.

Modic changes are MRI based changes in end plate of vertebra.

High intensity zone (HIZ) is found in MRI in early disc prolapse when annular tear has just started and that is seen as focus of high signal intensity area adjacent to affected annular tear site.

Other two options are not correct.

image based Q. 89 - Enchondroma Inc.

Q.  Enchondroma is component of all of these disorders except?

a. Ollier syndrome
b. Maffucci syndrome
c. Metachondromatosis
d. Dyschondrosteosis

Answer -
d

Enchondroma is associated with first three disorders -

Ollier syndrome - Multiple enchondroma, the condition is also called dyschondroplasia

Maffucci syndrome - Enchondroma with sift tissue hemangioma

Metachondromatosis - Enchondroma with osteochondroma

Dyschondrosteosis  is genetic disorder of mesomelic shortening and forearm disorder like madelung disease. Leri- Weill syndrome is part of disorder.

image Q. 88 - Homolog

Q.  meniscal homolog is found in ?

a. Wrist
b. Spine
c. Shoulder
d. Knee
e. Ankle

Answer -
a

Ulnar aspect of wrist ( below ulnar styloid as depicted in image below by area marked with asterisk*) contains sift tissue part known as TFCC ( Triangular Fibro- Cartilaginous Complex).

 It is composed of many structures and provides stability to ulnar Wrist and distal radioulnar joint.

The parts of TFCC are -

Articular disc
Ulnar collateral ligament
Meniscal homolog
Extensor carpi ulnaris
radioulnar ligaments

image Q. 87 - Throw it all

Q.    Thrower's fracture is related to which of these?


a. Acromion
b. Humerus
c. Coronoid
d. Carpal bones

Answer -
b

Fracture of humerus are sometimes reported in sportspersons engaged in throwing activities.

Mostly these fractures are spiral and result of torque and muscle forces during the activity.

image Q. 86 - Typecast

Q.  How would you classify below fracture with 2 cm. wound over it by Gustilo Anderson classification ?

a. Grade 1
b. Grade 2
c. Grade 3 a
d. Grade 3 b

Answer -
c
The fracture here is segmental fracture femur. The segmental fracture is classifies as Grade 3 a irrespective of wound size.

Below is snapshot of Gustilo-Anderson classification -

image Q. 85 - Going Sleeve less

Q.   'Sleeve fracture' is related to which bone in children ?

a. Iliac apophysis
b. Calcaneum apophysis
c. Tibial tuberosity
d. Distal radius metaphysis
e. Patella
f. Ribs

Answer -
e

The sleeve fracture results when outer rim of the bone is separated from main body of bone and results in dusplacement and deformity like proper fracture ( below image)

This type of injury is found in Patella in children and is termed Patella sleeve fractures.

image Q. 84 - Full circle

Q.  The marked structure in AP view of spine may be useful to radiologically assess all given entities except?

a. Burst fracture
b. Tumor
c. Fixation of spine
d. Scoliosis
e. Scheurmann disease

Answer -
e

The marked round to oval structure is pedicle.

 The burst fracture of vertebrae that results in decrease vertebral height can be seen with increase in distance between two pedicles ( interpedicular distance) in AP view. However the injury is clearer in lateral views.

Tumor of the spine especially at posterior location, are sometimes involve ipsilateral pedicle and the affected side pedicle is not clearly similar to normal opposite one thus displaying radiological sign known as ' winking owl sign'.


Pedicle screw fixation is popular method of fixing spine fractures and screws inside the pedicle can be appreciated in AP view.

In scoliosis like adolescent idiopathic scoliosis, there is asymmetry of size and orientation noted when comparin pedicles of convex and concave side of the scoliotic curve.

Scheurmann disease is osteochondritis or vertebral epiphysitis also known as Scheurmann or juvenile kyphosis.

image Q. 83 - Book for life

Q.    Which of these is the underlying pathology of lump lesion known in historic times as 'Bible Bump'?

a. Bunion
b. Ganglion
c. Baker cyst
d. Prepatellar bursitis
e. nodular fascitis

Answer -
b

The ganglion cyst with viscous fluid filled nodular growths were called Bible bumps or  Bible cysts as these cyst were hit by Bible in order to cure them. 

image Q. 82 - 'Egg'cellent medium

Q.   Egg- based culture media is used to diagnose which if these?


a. Syphillis
b. Gonnorrhoea
c. Tetanus
d. Tuberculosis
e. Genital warts

Answer -
d

Lowenstein - Jensen ( LJ) medium is most commonly used for mycobacteria, both tubercular or non-tubercular mycobacteria.

It is an egg based medium. Samples are incubated at 30 and 37 degrees.

Mycobacterium tuberculosis grows at 37 degrees while some non tubercular bacteria grow at 30 degrees like M. marinum and M. chelonea.

image Q. 81 - Name game

Q.   Which of these is the structure indicated by arrowmark?

a. Ischial tuberosity
b. Pubic tubercle
c. Ischial spine
d. pelvic Exostosis

Answer -
c

The projected part in radiographs is ischial spine. Normally it is not that much prominent in pelvic radiograph but here may be due to improper positioning. The opposite side ischial spine is not well appreciated.

image Q. 80 - Bisphosphonate blues

Q.  Which of these is advocated after taking bisphosphonates for management of osteoporosis?


a. Drug to be taken with meal
b. Immediate supine position to counter postural hypotension
c. Upright posture after medication
d. Continuous blood pressure monitoring

Answer -
c
The patient is advised to take these medicines empty stomach with a glass of water and be upright for half to an hour and not to lie supine to avoid esophageal irritation or gastric ulcers.
Intravenous bisphosphonates are used in cases with gastrointestinal morbidities.

No food or water is taken for one to two hour after medication.

Other unique side effects of bisphosphonates are -

*Osteonecrosis of jaw ( ONJ)
*Uveitis
*Atypical fractures ( especially in proximal femur)

image Q. 79 - Clockwise

Q.   Pendulum exercises are advised for rehabilitation of which of these?

a. Ankle
b. Hip
c. Knee
d. Elbow
e. Shoulder

Answer -
e

One of the common exercises for shoulder rehab is pendulum, in which patient moves the shoulder freely in a described manner resembling the motion of pendulum.

All other joint except hip are devoid of circumduction movement.

image Q. 78 - In the same boat

Q.   Tarsal scaphoid is which bone?

a. Medial cuneiform
b. Intermediate cuneiform
c. Cuboid
d. Navicular
e. Lateral cuneiform

Answer -
d

Navicular bone resembles scaphoid as both are boat-shaped. Thus navicular is sometimes referred to as tarsal scaphoid and scaphoid as carpal navicular.

 (Greek: skaphos- boat)

image Q. 77 - Hell- bent to unbend

Q.  The intraoperative below image of a malunited fracture ( the apex of deformity pointed by a forceps) is planned for correction. Straightening of this malunited fracture to normal alignment would require which of these procedure ?

a. Arthrodiastasis
b. Arthrtokatadysis
c. Osteoclasis
d. Osteosynthesis

Answer -
c
Destruction of old site of callus is called osteoclasis and is prerequisite to correction of maluniting/ malunited fracture. It can be done by multiple drilling or using osteotomes over cortex at the apex of deformity to create fracture and then straightening the bone to desired shape.

Osteosynthesis is procedure of fixation of fractures with suitable implants.

Arthrodiastasis is procedure where the diseased joint is distracted with the help of external fixators to assist in local healing.

Arthrokatadysis is disorder known as protrusion acetabuli or Otto pelvis ( named after German doctor) and has primary and secondary etiologies.

image Q. 76 - TB Triad

Q.  Which of the following radiological feature in below radiograph of a patient with right hip pain and limp is least suggestive of osteoarticular tuberculosis ?

a. Reduced joint space
b. Juxtaarticular osteoporosis
c. peripheral osseous erosion/lesion
d. Mono articular disease

Answer -
d

Osteoporosis around the affected joint, gradual decrease in joint space and destructive peripherally located lesion are common features of tubercular arthritis and this is called 'Phemister triad'.

The classic pattern of disease was mono- articular but this is a commoner presentation and not a rule.
Tuberculosis can affect immunocompetent individual, and can involve more than one joint ( oligo or poly arthritis) or may preaent without constitutional features.

image Q. 75 - Deep impact

Q.   The pattern of fractures as in below  case is related to various given factors except?

a. Direction of force
b. Magnitude of the injury
c. Position of limb during injury
d. Impact factor of injury
e. Velocity of trauma

Answer -
d

All other factors may determine the pattern of musculoskeletal injury. Impact factor is not related to trauma.

It is related to scientific study and research and is applied to journals.
Journal are considered authentic and peer reviewed in respective specialityspeciality and have its own impact factor eg. journal with high impact factor is considered better journal by scholars to read or contribute to in a particular field. 

image Q. 74 - WHO cares

Q.  The term ' Ebola with wings' is used for which of these diseases also affecting musculoskeletal health?

a. Viral hammorhagic fever
b. Japanese encephalitis
c. H1N1 flu
d. Dengue
e. Zika virus
f. None of the above

Answer -
e

Recently multidrug resistant tuberculosis was termed ' ebola with wings' by a
WHO official.
All other options are old names for the disease.


Tuberculosis is also known for various adjectives. Some of the other fascinating terms related to tuberculosis infection are -

Red King
Consumption
White plague
King' s evil
The captain of all men of death
Phthisis

image Q.73 - Microfracture

Q.  Treatment of injury in which of these disorders, micro fracture is done at affected site?

a. Nonunion
b. Avascular necrosis
c. Exposed bone
d. Cartilage lesion
e. Physeal growth arrest

Answer -

d
' microfracture' is term used for treatment of early cartilage lesion in which microdrilling is done to induce localised hematoma with resultant growth factors to induce  healing.

In avascular necrosis drilling is done with larger diameter drills and the term is core decompression and not microfracture.

Similarly in nonunion drills are used for freshening the nonunion end and opening the obliterated medullrt cavity.

Exposed bone is sometimes drilled to stimulate medullary granulation tissue to cover the defect.

Drilling epiphysiodesis is old technique of physeal growth arrest in the management of angular growth deformities.

image Q. 72 - Disassociation

Q.   Dislocation and diastasis are common orthopaedic injuries.  'Disassociation' injury is related to which of these?

a. Talus
b. Lunate
c. Ribs
d. Scapula
e. Acromioclavicular joint

Answer -
d

The scapulothoracic disassociation is uncommon injury in which scapula is separated by posterior chest wall usually following high velocity accidents.

 It has higher chances of associated neurovascular injury like that of brachial plexus.

This injury is like internal forequarter amputation.

image Q. 71 - Location

Q.  Brodie abscess is commonly found at which of these?

a. Distal femur
b. Proximal tibia
c. Distal tibia
d. Proximal humerus

Answer -
c
Commonest location of Bridie abscess is metaphyseal area.

Distal tibia metaphysis is most common location.

This is subacute variety of bone infection with milder clinical and lab features.
Radiologically they present as lytic lesions and may mimic neoplasm and MRI is helpful and shows extent of lesion and presence of  abscess within it.

The management constitutes bone drilling and currettage and pus drainage.

image Q. 70 - Watch the wrist

Q.   What is below injury of radius also referred to as?


a. Puckering
b. Dimpling
c. Buckling
d. Step
e. Depression fracture

Answer -
c

The periosteal 'buckling' seen commonly in pediatric metaphyseal injury is also called Torus fracture or buckle fracture.

Step is also discontinuity in cortex suggesting fracture but better answer is buckling.

Puckering results from displaced fracture end piercing muscle or subcutaneous tissue following which the overlying skin appears to be puckered eg. in supracondylar humerus fracture.

image Q. 69 - Braced Up

Q.   What is the splint applied below to stabilise fracture ?

a. Metal board
b. Knee brace
c. Krammer splint
d. Bohler splint
e. Thomas splint
f. Braun splint

Answer -
c
The splint applied in the image for fracture femur apears to be made of multiple wires  across a frame forming a supporting splint and that is called Krammer wire or splint.

Bohler splint better called Bohler's modification of Braun splint and that is metallic frame aiming knee flexion and multiple pulleys for various sorts of traction and is heavier and bulkier.

Thomas splint on the other hand consists of a ring attached to two metal bars longer than the extremity in a specific arrangement. 

image Q. 68 - Grand slam.

Q.  'Tennis leg' is injury to which of these ?

a. Tendo Achilles
b. Soleus
c. Gastrocnemius
d. Fibula
e. Deltoid ligament

Answer -
c

Rupture of medial gastrocnemius during forceful activities is called tennis leg.

The rupture of plantaris tendon is also associated with this but is rare.

image Q. 67 - Finding fixation

Q.   Identify the implant used in below image for treatment of given fracture ?

a. Bent K- wire
b. Enders' nail
c. Rush pin
d. Flexible nail
e. Guide wire

Answer -
d

The below image shows fixation of forearm fracture in pediatric case. They are best managesd by intramedullary nails in children.

An implant with bent tip in the shape of 'hockey stick' is TENS ( titanium elastic nailing system - see in image below the answer). These are also called flexible nails or ESIN ( elastic stable intramedullary nails).

Rush nails are also bend at one end and bevelled at other ,but it is not the end to be inserted, it is the end that remains outside bone.

Enders' nail are straight and bevelled like rush with a hole at other non-inserting  end.

K wire is pointed at both ends and usually is serted as it is so never is bent for that purpose.

imge Q. 66 - Colors of life

Q.  The tubings shown in the images carry necessary gases in hospital supply to opertaion theatres, ICU etc.. Which gas is likely to pass through pipe with blue bonet?

a. Oxygen
b. Ether
c. Nitrous
d. LPG

Answer -
c
The gas cylinder of common gases have colour coding for their ease of identification. Blue colour is associated with nitrous oxide and is best option here. Oxygen cylinders are black/white.  Carbon dioxide oxide is grey and nitrogen is black.

image Q.65 - Free world

Q.   'Free hand technique' is used for which implant ?

a. Nails
b. Plates
c. Wires
d. Screws

Answer -
d

Distal screws or bolts of intramedullary nails are fixed usually with manual method with free hand technique'. The other method is by using dedicated jigs for distal screws.

image Q. 64 - Push your luck

Q.  The intraoperative imaging of the orthopaedic procedure requires less contrast to be required - which of these buttons would you push to achieve the purpose?

a.  a
b.  b
c.  c
d.  d

( click over the image to enlarge)























































































































































Answer -
d

The kVp (kilo-volt peak) and mAs (milliamperage - second) are usual modes to control the presentation of radiographic image.
kVp is associated with ' radiographic contrast' and increasing it decreases the contrast and vice versa.
mAs usually is indicator of ' density' of the film. kVp also affects density but indirectly.

image Q. 63 - Y so serious ?

Q.  Which of these is known as yellow ligament ?


a. posterior longitudinal ligament
b. Interspinous ligament
c. patellar ligament
d. ligamentum flavum
e. Y ligament

Answer -
d

Ligamentum flavum found in spine in Latin translates into the ' yellow ligament'.

Y ligament is found in hip and is one of the strongest ligament also known as ligament of Bigelow.