image Q. 119 - Index case

Q.    The first arthroscopic surgery was done for?

a. Loose body removal from joint
b. Drainage of effusion
c. Baker's cyst
d. Synovial biopsy
e. Villonodular synovitis

Answer -
e

First arthroscopic surgery was done for removal of  PVNS (Pigmented VilloNodular Synovitis) from knee in 1969 by Masaki, Watanabe and colleagues.

image Q.118 - Inheritance of flaws

Q.  Which of these is commonest inherited neurological disorders ?

a. Cerebral palsy
b. Neurofibromatosis
c. Down's syndrome
d. Charcot- Married - Tooth disease
e. Multiple sclerosis

Answer -
d

Charcot -Marrie-Tooth is the most common inherited neurological disorder affecting nerves. It results in muscle imbalance.

It is also called Hereditary Motor Sensory Neuropathy (HMSN).

It's incidence on 1 in 2500 in U.S.

Common features include family history and features like cavovarus feet, scoliosis, hammer toe etc.

Down syndrome is common genetic disorder and cerebral palsy is caused mostly by birth related complications.

image Q. 117 - Elbow room

Q.    Which of the bony structure should be assessed in a child with elbow dislocation?

a. Lateral condyle
b. Trohlea
c. Capitellum
d. Medial epicondyle
e. Radial neck

Answer -
d

Medial epicondyle is the most common fracture associated with elbow dislocation in children.

Sometimes the medial epicondyle is displaced and incarcerated into elbow joint blocking the reduction.

So, if the medial epicondyle is not visible in radiograph then we must suspect displacement of it into elbow joint.

So the answer is medial epicondyle that should be assessed in radiograph.

image Q. 116. - Namesake

Q.  All of these are synonyms that are interchangeably used except?

a. Cotyloid fossa AND acetabular fossa
b. Caput collum diaphysis angle AND neck shaft angle
c. Scarpa's triangle AND femoral triangle
d. Promontory AND ala
e. Plafond AND dome

Answer -
d and e

Cotyloid fossa is found in acetabulam and is synonymous with acetabulam fossa.

CCD ( caput collum diaphysis angle) is nothing but another name for neck shaft angle of proximal femur.

Scarpa's triangle is femoral triangle. Pain and tenderness over this triangle suggests hip joint or femur neck pathology.

Promontory and ala are part of sacrum but they are not the same ( see image below first)

Plafond is distal tibia articular surface that is like roof of ankle joint over the dome of talus  and thus are not the same ( image second).

image Q. 115 - Test of curves

Q.  The radiograph of spine below displays slight abbormal curve. Which if the clinical test below will confirm benign nature of the curve?

a. Allen's test
b. Adam's test
c. Adson's test
d. Anderson's test
e. Eden test

Answer -
b

The abnormal curve mentioned in the question is scoliosis as the radiograph is an anteroposterior view.

The question intends to ask about the test that suggests that the deformity is benign or not structural.
The test to ensure that the scoliosis is functional ( benign) and not structural is the one that is asked here.

The patient is asked to bend forward upto ninety degrees and the back is inspected from behind of patient. If there is improvement and there is no bump visible then the deformity is non-structural and if a bump or rib hump is seen then the deformity is fixed and structural.
This is called Adam's forward bending test.

Adson's test is for thoracic outlet syndrome. It is provocative test to create posture that puts pressure over neurovascular bundles in neck in conditions like cervical rib (cervical rib syndrome) or between scaleneus muscles ( scaleneus anticus syndrome)

Eden test is also for a variant of thoracic outlet syndrome symptoms. It is called costoclavicular syndrome as the compression site is between firts rib and clavicle.

Allen test is used to measure patency of radial and ulnar arteries before many procedures like hand surgeries, radial artery bypass graft or cannulation or arterial blood gas analysis etc.

image Q. 114 - Real Steel

Q.   Orthopaedic implants usually are  made of stainless steel 316 L. The letter 'L'  stands for  which of these?

a. Lightweight
b. Longevity
c. Lead content
d. Large molecular weight
e. Low carbon content

Answer -

e

The stainless steel grade 316L is used in steel implants. The L stands for low carbon. Lesser carbon makes inplant better resistant to corrosion.
Another variant of it is 316 LVM that is 316 L Vacuum Melted.

image Q. 113 - Tilted

Q.   Lateral tilt of the spine is called ?

a. Lumbago
b. Scoliosis
c. List
d. Listhesis
e. Pisa syndrome

Answer -
c


List is a lateral tilt of the spine.

 A plumb line dropped from the spinous process of T1
falls to one side of the gluteal cleft.
Thus attitude may follow a symptomatic herniated disk and painful
spasms of the paravertebral muscles.

Lumbago is lower back pain.

Listhesis is displacement of one vertbra over the other in front ( anterolisthesis) or back (retrolisthesis). This is identified in lateral or oblique radiograph. Common site is lumbosacral junction.

Pisa syndrome is involuntary flexion muscular dystonia and lateral flexion of trunk with some rotational element. It may be complication of long term drugs like  antipsychotic treatment.

image Q. 112 - Healed by bug

Q.    Localised administration of Collagenase injection is sometimes used to treat Dupuytren's contracture. Which of these is usual source of it?

a. Clostridium histolyticuml
b. Botilunum toxin
c. Vibrio species
d. Sachomyces boulardii
e. Lactobacillus acidophilus

Answer -
a

Collagenase derived from  is one of the option to treat Dupuytren's contracture as it is given as intralesional injection over diseased cords.

Botulinum toxin extracted from Clostridium botulinum is another matter that is used in various piroses in musculoskeletal care like in spasticity management etc.

Last two options are used as probiotics.

image Q. 111 - Curvaceous

Q.   Primary curve of the spine is ?

a. Straight
b. Kyphosis
c. Scoliosis
d. Lordosis
e. Circular

Answer -
b

The primary curve if the spine is one which is in the beginning and in newborn the spine is overall kyphosis.

The lordosis is later developed.

As the newborn has head holding the cervical lordosis develops.

 As the child starts standing then lumbar lordosis develops.
 Thus at only thoracic level, the primary curve persists as normal thoracic kyphosis.