Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. This complex system, which includes your bones, joints, ligaments, tendons, muscles, and nerves, allows you to move, work, and be active.
The Important Questions of Orthopaedics for NEET PG exam Part 1:
1.) In case of reimplantation of an amputated digit, which of the following structures is fixed first?
A. Nerve
B. Artery
C. Vein
D. Bone
Correct answer : D. Bone
REIMPLANTATION OF AN AMPUTATED DIGIT – PROCEDURE
- Debride the area and clean the wound
- Fixation of bone
- Repair of extensor tendons
- Repair of flexor tendons
- Arterial repair
- Nerve repair
- Venous repair
- Closure of the skin wound
2.) Agents which decrease bone resorption in osteoporosis are all except?
A. Risedronate
B. Teriparatide
C. Strontium ranelate
D. Raloxifene
Correct answer : B. Teriparatide
DRUGS USED FOR TREATMENT OF OSTEOPOROSIS
- Drugs which reduce bone resorption (anti resorptive drugs)
- Selective estrogen receptor modulators – Raloxifene
- Bisphosphonates – Etidronate, Risedronate, Pamidronate, Alendronate
- Hormone replacement therapy / estrogen
- Calcitonin
- Calcium supplements
- Vitamin D
- Denosumab -Monoclonal antibody which inhibits the maturation of osteoclasts by binding to and inhibiting RANKL.
- Drugs which increase bone formation
- Teriparatide
- Drugs with both effects (decreases bone resorption and increases bone formation)
- Strontium ranelate
3.) Blood supply to head and neck of femur is mainly from?
A. Superficial epigastric artery
B. Medial circumflex femoral artery
C. Lateral circumflex femoral artery
D. Artery of ligamentum teres
Correct answer : B. Medial circumflex femoral artery
BLOOD SUPPLY TO HEAD AND NECK OF FEMUR
- The blood supply to the head and neck of femur comes from:
- Extracapsular arterial ring located at the base of neck of femur
- Artery of ligamentum teres
- Epiphyseal arteries
- Metaphyseal arteries
- The extracapsular arterial ring is formed by:
- Posteriorly by branches of medial circumflex femoral artery (major part of blood supply)
- Anteriorly by branches of lateral circumflex femoral artery
- Smaller branches from superior and inferior gluteal artery
- Both medial and lateral circumflex femoral arteries are branches of profunda femoris artery.
- Artery of ligamentum teres
- It is a branch of obturator artery.
- It contributes a small but variable amount of blood supply.
4.) Which of the following is a characteristic feature of Blount’s disease?
A. Genu valgum
B. Genu varum
C. Coxa vara
D. Coxa valga
Correct answer: B. Genu varum
BLOUNT’S DISEASE
- It is named after Walter Putnam Blount
- It is also known as: Tibia vara, Mau-Nilsonne Syndrome, Blount-Barber syndrome, Erlacher-Blount syndrome, Osteochondrosis deformans tibiae
- It is a growth disorder of the tibia resulting in progressive bow leg deformity
- It is also associated with internal tibial torsion and genu recurvatum
- It is mainly seen in children and adolescents
- Treatment is by bracing and/or surgery
5.) Agnes Hunt traction is used for?
A. Flexion deformity of hip
B. Trochanteric fracture
C. Fracture shaft of femur in adults
D. Low backache
Correct answer : A. Flexion deformity of hip
- Agnes Hunt traction is used for correction of mild flexion deformity of hip joint in poliomyelitis.
- Traction used for trochanteric fracture – Russell’s traction
- Traction used for fracture shaft of femur in adults – Perkin’s traction
- Traction used for low backache – Buck’s traction
6.) Triad of Klippel Feil syndrome consists of all except?
A. Low hair line
B. Elevated scapula
C. Short neck
D. Limited neck movements
Correct answer : B. Elevated scapula
Elevated scapula can be seen as a part of Klippel Feil syndrome. But it does not constitute the characteristic triad.
7.) Brown tumour is characteristic of?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hyperthyroidism
D. Hypopituitarism
Correct answer : A. Hyperparathyroidism
Brown tumour occurs due to the increased osteoclastic activity in hyperparathyroidism. It is a benign mass of reactive tissue.
8.) Which of the following is tested using the ‘Lift off test’ ?
A. Teres Minor
B. Subscapularis
C. Supraspinatus
D. Infraspinatus
Correct answer : B. Subscapularis
Lift off test, also know as Gerber’s test is used to assess the function of the subscapularis muscle. For performing this test, the arm is extended and internally rotated so that the dorsum of hand rests on the lower back. The patient is asked to lift the hand off the back. This requires internal rotation of the arm brought about by the subscapularis. If the patient is able to perform the maneuver, the subscapularis function is normal and the test is negative.
9.) All are true regarding synovial sarcoma except?
A. More common at extra articular sites
B. Knee and foot are commonly involved
C. Usually seen in individuals less than 50 years of age
D. Originates from the synovial lining
Correct answer: D. Originates from the synovial lining
- The name synovial sarcoma is a misnomer
- It does not arise from the synovial lining
- The name arises from the fact that it histologically resembles synovial tissue
- Most commonly seen in those between 15 and 35 years of age
- Males and females are equally affected
- Most commonly seen in the lower limbs, around knee and foot
- It is a slow growing tumour with an indolent course (It may be aggressive in later stages)
10.) Clavicular fracture is treated by?
A. Fixation with plate and screw
B. Open reduction and internal fixation
C. Skeletal traction
D. Figure of eight bandage
Correct answer : D. Figure of eight bandage
- Clavicular fracture heals with good functional results even if there is moderate displacement of the fracture ends
- Perfect reduction is not essential
- Treatment consists of a ‘Figure of Eight’ bandage which is periodically tightened
- A sling can be used initially to support the upper limb
- In case of elderly patients with risk of axillary neurovascular compression, only a sling is used instead of the ‘figure of eight’ bandage
- Open reduction is done in case of non union, neurovascular damage, floating shoulder and wide separation of the fracture ends with interposition of soft tissue.
11.) True statement about involucrum and sequestrum:
a) Involucrum is a piece of dead bone
b) Sequestrum is a sheath of new bone formation
c) Sequestrum is surrounded by involucrum
d) Involucrum is surrounded by sequestrum
Correct answer: c) Sequestrum is surrounded by involucrum
12.) A joint is innervated by the articular branches of the nerves which supply the muscles which move the joint. This law is known as:
a) Hilton’s law
b) Andry’s law
c) Wolff’s law
d) Cushing’s law
Correct answer: a) Hilton’s law.
13.) Bone remodeling in response to stress was described by:
a) Harvey Cushing
b) William Osler
c) Julius Wolff
d) Nicolas Andry
Correct answer: c) Julius Wolff
Bone remodeling in response to stress was described by German Anatomist/Surgeon Julius Wolff (1836-1902) in the 19th century. Wolff’s law states that bone in a healthy person or animal will adapt to the loads it is placed under.
14.) Gallow’s traction is used for ?
a) Fracture shaft of femur
b) Fracture neck of femur
c) Fracture humerus
d) Fracture tibia
(Repeat AIIMS Nov 2010)
Correct answer : a) Fracture shaft of femur
Gallow’s traction is used in infants and children with femoral fractures.
Indications Gallows Traction
- Child must weigh less than 12 kg
- Femoral fractures
- Skin must be intact
15.) Most common nerve injured in supracondylar fracture humerus?
A. Median
B. Radial
C. Ulnar
D. Anterior interosseous nerve
Correct answer : D. Anterior interosseous nerve
In order studies, the radial nerve was found to be the one most commonly injured. But recent studies have shown that the median nerve, particularly the anterior interosseous branch is the most commonly damaged in supracondylar fracture of humerus.
16.) In Klippel-Feil syndrome, the patient has all of the following clinical features except:
A. Low hair line
B. Bilateral Neck webbing
C. Bilateral shortness of sterno mastoid muscles
D. Gross limitations of neck movements
Correct answer : C. Bilateral shortness of sterno mastoid muscles
17.) Heberden’s Arthropathy affects:
A. Lumbar spine
B. Symmetrically large joints
C. Sacroiliac joints
D. Distal interphalangeal joints
Correct answer : D. Distal interphalangeal joints
Heberden’s nodes seen in distal interphalangeal joints is a characteristic feature of idiopathic osteoarthritis.
18.) The most common sequelae of tuberculous spondylitis in an adolescent is:
A. Fibrous Ankylosis
B. Bony Ankylosis
C. Pathological dislocation
D. Chronic osteomyelitis
Correct answer : B. Bony Ankylosis
All tuberculous joints except spine usually heal with fibrous ankylosis. Whereas in the spinal joints, bony ankylosis is seen.
19.) A young woman met with an accident and had mild quadriparesis. Her lateral X-ray cervical spine revealed C5-C6 fracture dislocation. Which of the following is the best line of management?
A. Immediate anterior decompression
B. Cervical traction followed by instrument fixation
C. Hard cervical collar and bed rest
D. Cervical laminectomy
Correct answer : B. Cervical traction followed by instrument fixation
The fracture is an unstable injury because there is dislocation and neurological deficit. The initial management should be closed reduction and traction. Definitive management is instrument fixation after spinal cord edema is decreased.
20.) All of the following are true about fracture of the atlas vertebra, except:
A. Jefferson fracture is the most common type
B. Quadriplegia is seen in 80% cases
C. Atlantooccipital fusion may sometimes be needed
D. CT scans should be done for diagnosis
Correct answer : B. Quadriplegia is seen in 80% cases
Usually, there is no neurological damage in atlas fractures.
21.) All of the following areas are commonly involved sites in pelvic fracture except:
A. Pubic rami
B. Alae of ileum
C. Acetabulum
D. Ischial tuberosities
Correct answer : D. Ischial tuberosities
Ischial tuberosity fracture is the rarest among the options given.
22.) Subtrochanteric fractures of femur can be treated by all of the following methods except:
A. Skeletal traction on Thomas splint
B. Smith Patersen Nail
C. Condylar blade plate
D. Ender’s nail
Correct answer : B. Smith Patersen Nail
Smith Patersen Nail was previously used for internal fixation of fracture neck of femur.
23.) Which one of the following is the investigation of choice for evaluation of suspected Perthes disease?
A. Plain X-ray
B. Ultrasonography (US)
C. Computed Tomography (CT)
D. Magnetic Resonance Imaging (MRI)
Correct answer : D. Magnetic Resonance Imaging (MRI)
MRI is the investigation of choice for Perthe’s disease
24.) A 45 year old was given steroids after renal transplant. After 2 years he had difficulty in walking and pain in both hips. Which one of the following is most likely cause?
A. Primary Osteoarthritis
B. Avascular necrosis
C. Tuberculosis
D. Aluminum toxicity
Correct answer : B. Avascular necrosis
Mnemonic for causes of avascular necrosis other than fracture – SCLERA
- S – Steroids
- C – Caisson’s disease
- LE – Lupus Erythematosus
- R – Radiation
- A – Alcohol
25.) A 30 year old man had a road traffic accident and sustained fracture of femur. Two days later he developed sudden breathlessness. The most probable cause can be:
A. Pneumonia
B. Congestive heart failure
C. Bronchial asthma
D. Fat Embolism
Correct answer : D. Fat Embolism
The fat globules released from the bone marrow (due to trauma / orthopedic procedures) are deposited in the pulmonary capillary bed. This causes ischemia and inflammation. The symptoms appear 12-72 hours after the trauma. Initial symptoms are tachycardia and tachypnoea. There may be high spiking fever and non palpable petichae, especially over upper body. Neurological symptoms like agitation, delirium, stupor and coma can occur. (The fat globules may cross the pulmonary circulation via arteriovenous connections).
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