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.