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.