Free NEET PG & INI-CET Orthopedics MCQs

Explanation

Secondary (indirect) fracture healing proceeds through haematoma and inflammation, then soft (fibrocartilaginous) callus, hard (bony) callus, and finally remodelling. It occurs with relative stability, such as with a cast.

Explanation

Pain out of proportion to the injury and aggravated by passive stretching of the muscles in the compartment is the earliest and most reliable sign. Pulselessness and paralysis are late signs, by which time irreversible damage may have occurred. Treatment is urgent fasciotomy.

Explanation

Fat embolism syndrome typically follows long-bone fractures within 24 to 72 hours, with the triad of respiratory distress, neurological changes, and a petechial rash. Management is largely supportive; early fracture fixation reduces the risk.

Explanation

Open fractures require early antibiotics, tetanus prophylaxis, and urgent debridement of devitalised tissue with fracture stabilisation to reduce infection risk. The Gustilo-Anderson classification grades severity and guides management.

Explanation

Delayed union is healing that is slower than expected but still progressing. Non-union is failure of healing with no further progress, malunion is healing in a poor position, and pseudoarthrosis is a false joint at a non-union site.

Explanation

A pathological fracture occurs through bone weakened by underlying disease — metastasis, myeloma, osteoporosis, or cysts — with trivial or no trauma. Its presence should prompt a search for the underlying cause.

Explanation

A stress fracture results from repetitive loading, as in marching or running, and often has a normal early X-ray, showing only later or on MRI or bone scan. The metatarsals and tibia are common sites; rest is the mainstay of treatment.

Explanation

A Colles fracture is a distal radius fracture with dorsal displacement and angulation, producing the classic 'dinner-fork' deformity, typically from a fall on an outstretched hand. A Smith fracture has the opposite, volar, displacement.

Explanation

The scaphoid's blood supply enters distally and runs proximally (retrograde), so a proximal-pole fracture can devascularise the proximal fragment, risking avascular necrosis and non-union. Tenderness in the anatomical snuffbox is the classic sign.

Explanation

The anterior interosseous nerve, a branch of the median nerve, is the most commonly injured in supracondylar humeral fractures, classically causing a weak 'OK sign'. The brachial artery is also at risk, so distal pulses must be checked.

Explanation

Anterior dislocation accounts for the majority of shoulder dislocations, usually from abduction and external rotation. The axillary nerve may be injured, so sensation over the deltoid — the 'regimental badge' area — must be checked.

Explanation

The radial nerve runs in the spiral groove of the humerus and is at risk in mid-shaft fractures, causing wrist drop, the loss of wrist and finger extension. Most such neuropraxias recover spontaneously.

Explanation

The middle third is the most common site of clavicle fracture. Most are managed conservatively with a sling; surgery is considered for open, significantly displaced, or neurovascularly compromised fractures.

Explanation

A Monteggia injury is a fracture of the proximal ulna with dislocation of the radial head. A Galeazzi injury, by contrast, is a distal radius fracture with distal radioulnar joint dislocation.

Explanation

A femoral neck fracture in an elderly patient classically produces a shortened, externally rotated limb with inability to bear weight. Displaced intracapsular fractures risk avascular necrosis of the femoral head, often requiring arthroplasty.

Explanation

The femoral head is supplied mainly by the retinacular (medial circumflex femoral) vessels running along the neck. A displaced intracapsular fracture disrupts these, risking avascular necrosis — which is why arthroplasty is often preferred over fixation in the elderly.

Explanation

A posterior hip dislocation classically holds the limb flexed, adducted, internally rotated, and shortened. The sciatic nerve is at risk, so its function must be checked; urgent reduction reduces avascular necrosis risk.

Explanation

The anterior drawer and Lachman tests assess anterior cruciate ligament integrity; excessive anterior translation of the tibia indicates ACL rupture. ACL injury often occurs with a pivoting sports injury and an audible 'pop'.

Explanation

A meniscal tear typically follows a twisting injury on a loaded knee, causing joint-line tenderness, effusion, and mechanical 'locking'. McMurray's test may be positive; MRI confirms the diagnosis.

Explanation

The Ottawa ankle rules are a clinical decision tool that identifies which ankle-injury patients require X-rays, based on tenderness at specific sites and the ability to bear weight, reducing unnecessary imaging.

Explanation

The Thompson (Simmonds) test is positive in Achilles tendon rupture — squeezing the calf fails to produce plantarflexion because the tendon is no longer continuous. There is often a palpable gap and weak plantarflexion.

Explanation

A posterolateral L5-S1 disc prolapse typically compresses the S1 nerve root, causing pain radiating to the little toe, weak ankle plantarflexion, and a reduced ankle jerk. An L4-L5 prolapse usually affects the L5 root.

Explanation

Cauda equina syndrome — saddle anaesthesia, bladder or bowel dysfunction, and bilateral leg symptoms — is a surgical emergency requiring urgent MRI and decompression to prevent permanent neurological damage.

Explanation

A positive straight-leg-raise (Lasègue) test reproduces radicular leg pain on raising the straight leg, indicating lumbosacral nerve root irritation, typically from a prolapsed disc.

Explanation

Ankylosing spondylitis is a seronegative spondyloarthropathy associated with HLA-B27, causing inflammatory back pain — worse with rest, better with exercise, with morning stiffness — and progressive spinal fusion ('bamboo spine').

Explanation

Spinal tuberculosis usually begins in the anterior vertebral body, leading to vertebral collapse and a gibbus (kyphotic) deformity, and may form a cold paravertebral abscess. It is the most common site of skeletal TB.

Explanation

The Ortolani test (relocating a dislocated hip) and the Barlow test (dislocating an unstable hip) screen newborns for developmental dysplasia of the hip. Ultrasound confirms it; early Pavlik harness treatment gives the best outcome.

Explanation

A greenstick fracture is an incomplete fracture where one cortex breaks and the other bends, occurring in children because their bones are more pliable. It usually heals well with immobilisation.

Explanation

The Salter-Harris classification (types I to V) describes physeal, or growth plate, fractures in children. Higher types involve more of the epiphysis and metaphysis and carry greater risk of growth disturbance.

Explanation

Legg-Calve-Perthes disease is idiopathic avascular necrosis of the femoral head in children, typically aged 4 to 8 years, causing a limp and hip or knee pain. Management aims to keep the femoral head contained within the acetabulum while it revascularises.

Explanation

Slipped capital femoral epiphysis occurs in adolescents, often overweight, where the femoral head slips at the growth plate, causing hip or referred knee pain and external rotation. Treatment is urgent surgical fixation, pinning in situ.

Explanation

The Ponseti method — serial manipulation and casting, often with a percutaneous tenotomy of the Achilles tendon, followed by bracing — is the standard first-line treatment for clubfoot, avoiding extensive surgery in most cases.

Explanation

Staphylococcus aureus is the most common cause of acute haematogenous osteomyelitis. In sickle cell disease, Salmonella is a notable additional cause. Treatment is prolonged antibiotics, with surgery if there is abscess or dead bone.

Explanation

Septic arthritis is an emergency — a hot, swollen, very painful joint that the patient will not move, with fever, needs urgent joint aspiration and washout with antibiotics. Delay causes rapid cartilage destruction.

Explanation

Osteosarcoma is the most common primary malignant bone tumour, arising in adolescents around the knee (distal femur or proximal tibia), with a 'sunburst' appearance and Codman's triangle on X-ray. Treatment combines chemotherapy and surgery.

Explanation

Ewing sarcoma is a small round blue cell tumour of children and adolescents, showing an 'onion-skin' periosteal reaction and the characteristic t(11;22) translocation. It commonly affects the diaphysis of long bones and the pelvis.

Explanation

Breast, prostate, lung, kidney, and thyroid cancers are the classic sources of bone metastases. Metastases are far more common than primary bone tumours in adults, and prostate lesions are typically sclerotic.

Explanation

A giant cell tumour (osteoclastoma) is a benign but locally aggressive tumour arising at the epiphysis and metaphysis of long bones in young adults, with a characteristic 'soap-bubble' lytic appearance. It can recur and occasionally metastasise.

Explanation

Osteoarthritis shows joint space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts on X-ray. Rheumatoid arthritis instead shows periarticular osteopenia and erosions with a symmetrical distribution.

Explanation

Rheumatoid arthritis typically causes symmetrical involvement of the metacarpophalangeal and proximal interphalangeal joints, characteristically sparing the distal interphalangeal joints, which osteoarthritis often affects. Morning stiffness lasting over an hour is typical.

Explanation

Gout results from deposition of monosodium urate crystals — needle-shaped and negatively birefringent — in the joint, classically the first metatarsophalangeal joint (podagra). Pseudogout, by contrast, involves calcium pyrophosphate crystals.

Explanation

A DEXA scan measures bone mineral density and gives the T-score used to diagnose osteoporosis, at or below -2.5. Plain X-rays only show osteopenia once bone loss is advanced.

Explanation

Carpal tunnel syndrome is compression of the median nerve beneath the flexor retinaculum, causing tingling and numbness in the thumb, index, middle, and radial half of the ring finger, often worse at night. Tinel's and Phalen's tests may be positive.

Explanation

Ulnar nerve injury causes a claw hand — hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints of the ring and little fingers — with wasting of the interossei and hypothenar muscles, and sensory loss over the little finger.

Explanation

Dupuytren's contracture is a progressive fibrosis and thickening of the palmar fascia, causing flexion contractures typically of the ring and little fingers. It is associated with diabetes, alcohol, and a positive family history.

Explanation

Volkmann's ischaemic contracture is a permanent flexion deformity of the wrist and fingers resulting from muscle necrosis and fibrosis after untreated compartment syndrome, classically following a supracondylar humeral fracture. It is preventable by timely fasciotomy.

Explanation

Trigger finger (stenosing flexor tenosynovitis) causes the finger to catch or lock in flexion and release with a snap, due to a nodule on the flexor tendon catching at the pulley. It is managed with splinting, steroid injection, or release surgery.

Explanation

Adhesive capsulitis (frozen shoulder) causes painful, progressive restriction of both active and passive shoulder movement, notably external rotation, and is more common in diabetics. It typically resolves over months to a couple of years.

Explanation

Lateral epicondylitis (tennis elbow) causes pain over the lateral epicondyle, aggravated by resisted wrist extension, from overuse of the common extensor origin. Golfer's elbow (medial epicondylitis) affects the medial side, with pain on resisted wrist flexion.

Explanation

The supraspinatus is the most commonly involved rotator cuff muscle in impingement and tears, as its tendon passes beneath the acromion. A painful arc of abduction, between 60 and 120 degrees, is characteristic.