image Q. 110 - Testing times

Q.   Which among these is least helpful to diagnose any musculoskeletal disorder ?

a. Slocum test
b. Yocum test
c. Bolam test
d. Fulcrum test

Answer -
c

Slocum test is used in knee ligamentous injury.

It is a mofdification of anterior drawer test, it measures antrromedial and anterolateral rotatory instabilities (AMRI and ALRI).

Yocum test is atest for shoulder examination for rotator cuff injury.

Fulcrum test is used to test for stress fracture of hip and thigh.

Bolam test , on the other hand, is a medicolegal entity. Used for evaluation of medical negligence.

It states "The test is the standard of the ordinary skilled man exercising and professing to have that special
skill. A man need not possess the highest expert skill, it is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising' that particular art (a health care professional), is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical man skilled in the particular act"

image Q. 109 - 'When going gets 'tuft'....

Q.  Tuft fractures are related to ?

a. Pelvis
b. Sacrum
c. Hand
d. Ankle
e. Foot

Answer -
c

Distal phalanx fracture of fingers or digits is called tuft fracture (see image below)


It can be associated with nail bed injuries.

image Q. 108 - Coming of 'age'

Q.  Which if these is least valid procedure for joint or bone disorder?

a.  Forage
b. Circlage
c. Lavage
d. Remplissge
e. Barbotage

Answer -
e

Forage is core decompression procedure for relieving pressure from femoral head by bone drilling in cases of osteonecrosis.

 Circlage is procedure of fixing bones with the help of stainless steel wire or fibre wire etc. to secure them together. Commonly done in cases of periprosthetic fractures, patella fracture etc.

Lavage is washout with copius amount of fluid or daline. It is done for open injuries but intraarticular lavage can be done for joint pathologies with arthroscopic method. Also an option in osteoarthritis knee.

Remplissage is surgical procedure for management of shoulder instability with large and engaging humeral defect ( Hill Sach lesion) which is covered to avoid contact with glenoid and treated in this manner.

Barbotage involves multiple repeated injection of fluid or aspiration in various pathologies like spinal anasthesia, surgical biopsies, gastric lavage or calcific musculoskeletal lesions. This is not specific, thus the best option here

image Q. - 107 - Bad dish

Q.    'Dishwater fluid' is found in ?

a. Tubercular sinus
b. Gonococcal arthritis
c. Chronic osteomyelitis
d. Necrotising fasciitis
e. Morel Lavallee lesion

Answer -

d

Dishwater is the water after the dishes  have been washed in it.

Murky grayish colored fluid from soft tissue is suggestive if underlying necrosis and is characteristic feature of necrotising fasciitis.

Chronic osteomyelitis and tubercular in late stagfes show clear serious discharge.

Morel Lavallee lesion is internal degloving injury found after traumatic injury. This is associated with collected blood, lymph, and local debris.

image Q. 106 - 'Out'standing

Q.   Which of these is not a part of WHO safe surgery checklist ?

a. Time out
b. Pull out
c. Sign in
d. Sign out

Answer -

b

WHO safe surgery checklist has three broad categories ( refer to the image below the text)

Sign in -  Basic patient and surgical site identification along with anasthesia related  information.

Sign out -
Recall of relevant details after the procedure.

Time out -
Intraoperative confirmation of key details.

Pull out, on the other hand is related to screws. Pull out strength of screw is measure of its strength of  purchase inside bone and effort of its removal.

image Q. 105 - In fragments

Q.   All of these are associated with traumatic injuries except ?

a. Butterfly fragment
b. Thurston - Holland fragment
c. Free fragment
d. Constant fragment

Answer -
c

Comminuted fractures especially short oblique fractures are usually associated with a broken separate piece of bone on radiographs and it is called the butterfly fragment.

Physeal injuries in children if associated with a part of metaphyseal are fractured is classified as Salter Harris type 2 in the classification of same name. This small metaphyseal part is called Thurston - Holland fragment or sign.

Constant fragment is related to calcaneal fractures in which one broken part is considered constant and surgery was done to put together other parts to this one. This ,however, was an older concept.

Free fragment is extruded fragment of intervertebral disc that is broken and now lies free inside spinal canal.

image Q. 104 - Spare the spur

Q.  ' Butress' or 'spur' formation is a feature of

a. Periosteal chondrosarcoma
b. Periosteal osteosarcoma
c. Periosteal Chondroma
d. Parosteal osteosarcoma

Answer -
c


The 'Butress' refers to the part of the bone that is elevated at the base of the tumor looking like a spur and the saucer- shaped erosion of the bone above it (see image below)

This is characteristic feature of periosteal Chondroma.

Periosteal Chondroma ( or Juxtacortical Chondroma or ecchondroma) is rare benign cartilage growth beneath periosteum and mostly at tendon insertion sites.

Proximal humerus is common site.