image Q. 18 - Elbow room

Q.  Name the structure at risk in fracture given below?


a. Brachial artery
b. Median nerve
c. Radial nerve
d. Ulnar nerve
e. Distal biceps tendon

Answer -
c
The fracture shown here is distal humerus with oblique or spiral pattern.

The bony spike of proximal part of bone is pointing lateral. The radial nerve as it lies laterally near distal part of humerus may get injured with thus fracture pattern.

This characteristic fracture with radial nerve injury is termed 'Holstein Lewis fracture'.

image Q. 17 - Backstabbed

Q. - Which of these spinal cord injury syndromes is not a documented clinical condition?

a. Posterior cord syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Lateral cord syndrome

Answer -
d

The incomplete spinal cord injuries are all described except option d.

Central cord syndrome is most common.
Brown -Sequard syndrome is injury to one side of spinal cord but that is not called lateral syndrome.

Besides these Conus medullaris syndrome , Cauda equina syndromes and Bell's cruciate palsy are other syndromes.

image Q. 16 - Knee jerked

Q. The CT section of knee joint is showing which injury of distal femur bone in
 below image?


a. Posterior tuberosity fracture
b. Hoffa fracture
c. Tri-plane fracture
d. Corner fracture

Answer -
b

The posterior cindyke fracture in coronal plane of distal femur as in thus case is termed 'Hoffa fracture'

Corner fracture are also commonly found in distal femur but are found in children and that too in battered babies/ child abuse injuries.

Triplane fractures are paediatric ankle fractures as three dimensional physeal injuries.

image Q. 15 - Broken marrow

Q.  The arrow points toward a fracture in knee MRI coronal section below, which clinical test is least valuable to ascertain associated injuries ?


a. Valgus/varus test
b. Anterior drawer test
c. Lachman test
d. Pivot shift test

Answer -
a

The tibial tubercle/ tibial spine avulsion fracture shown here is likely to be associated with Anterior cruciate ligament injury as the attachment site of this ligament is involved.

All clinical tests except option a relate to this ligament.

If question is asked in different way like 'which test to be performed in this case' then the choice between anterior drawer and lachman is there.
Lachman is better test than anterior drawer and it is less painful also in trauma settings as the knee flexion required to do the test is 45degrees as compared to 90 degrees in anterior drawer test.

image Q. 14 - Sticking around

Q.  The arrow points toward which structure in knee MRI saggital cut below?


a. Posterior corner ligament
b. Posterior collateral ligament
c. Posterior cruciate ligament
d. Anterior cruciate ligament
e. Popliteus tendon

Answer
c

The ' inverted ice-hockey stick' appearance of posterior cruciate ligament is seen here that is attaching to posterior aspect of tibia.
There are no ligaments of the names as in option a and b.
Posterior corner, however is area described in knee having many structures like lateral collateral ligament etc. and now considered an important region in knee injury management.

image Q. 13 - Season's greetings

Q.  The 'namastey/ namaskar' (indian way of greeting or salutation with folded hands) position is also a clinical test for which condition or function?

a. Dorsiflexion of wrist
b. Nerve function
c. Temperature of palm
d. Power of muscles of hand

Answer-
b

The 'reverse Phalen test' used in diagnosing carpal tunnel syndrome requires similar posture for some time to reproduce sensory problems of increased carpal tunnel pressure ( median nerve symptoms).

The opposite test 'Phalen test' also used for the same purpose and the hand position is reversed.

image Q. 12 - Back to basics- 2

Q.   The structures  below indicated by arrow is -

a. Spinal cord
b. Conus medullaris
c. Cauda equina
d. Degenerated disc

Answer -
c

The multiple pointed structures actually are cut section are cut section of nerve roots that make cauda equina ( Latin- horse tail).

Spinal cord ends at L1 level as conus medullaris and thereafter proceeds down as cauda equina.