DMA's ORTHO PG Q & A 16 - 12 - 2017
Published on Dec. 16, 2017, 11:41 a.m.

1. The Thomas test is used to reveal

 

(A) Flexion deformity at the hip joint

 

(B) Abduction deformity at the hip

 

(C) Adduction deformity at the hip

 

(D) Internal rotation deformity at the hip.

 

2. All the following are causes of coxa vara except:

 

(A) Malunion of trochanteric fracture

 

(B) Congenital

 

(C) Rickets and osteomalacia.

 

(D) Dislocation of hip.

 

3. Differential diagnosis of irritable hip in a child will include all ex­cept

 

(A) Slipped capital femoral epiphysis

 

(B) Snapping hip

 

(C) Perthe's disease

 

(D) Tuberculosis of the hip

 

4. The greater trochanter of the femur is thickened in all the fol­lowing conditions except

 

(A) Malunited trochanteric fractures

 

(B) Fibrous dysplasia involving the trochanter

 

(C) Avulsion of the iliopsoas tendon

 

(D) Trochanteric bursitis.

 

5. Weakness of which of the following muscles is not seen with root avulsion:

 

(A) Rhomboids             

 

(B) Serratus anterior

 

(C) Supraspinatus         

 

(D) Trapezius


6. Nursemaid's elbow is:

 

(A) Elbow dislocation

 

(B) Radial head subluxation (Pulled elbow)

 

(C) Radial head fracture

 

(D) Lateral epicondylitis

 

7. Krukenberg amputation is in:

(A). Fore-arm                

 

(B). Arm

 

(C). Leg                       

 

(D). Thigh

 

8. 63-year-old woman presents for treatment of pain and a burning/tingling sensation along the medial aspect of the foot and hallux. She underwent a tarsal tunnel release 12 months ago, but she has not experienced much symptomatic relief. Upon clinical examination, she has a positive percussion test (Tinel sign) along the course of the distal tibial nerve and pain upon pressure of the tarsal canal. There are no other pertinent clinical findings and a magnetic resonance image does not reveal any pathologic lesion. The next course of treatment is:

 

(A) Multiple cortisone injections

 

(B) Implantation of a peripheral nerve stimulator

 

(C) Repeat release of the tarsal tunnel, specifically of the medial plantar nerve

 

(D) Multiple sessions of physical therapy

 

9. A 6-month-old boy had posteromedial bowing of the tibia. The most appropriate treatment is

 

(A) Observation

 

(B) Application of a cylinder cast

 

(C) Application of a total contact orthosis

 

(D) Osteotomy, intramedullary nailing, and bone grafting

 

10. In high lesions of ulnar nerve like elbow fractures or dislocations the degree of clawing is markedly less than in low ulnar lesions this is called ULNAR PARADOX and is due to

 

(A) The fact that the ulnar half of the FDP is paralysed and hence there is no flexion at the IP joints.

 

(B) The lumbricalis are spared and hence there is no clawing

 

(C) The Median nerve compensates for the ulnar nerve

 

(D) The interossei increase their tone and extend the IP joint.

 


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1. Ans. (A). Flexion deformity at the hip joint

   

The aim of the Thomas test is to remove the compensatory lumbar lordosis so that the flexion deformity becomes obvious at the hip.

 

2. Ans. (D). Dislocation of hip.

 

The normal neck shaft angle in a femur is 160' at birth decreasing to about 125 degrees in adult life. An angle less than 120o is called Coxa Vara. Dislocation does not cause coxa vara.

 

3. Ans. (B). Snapping hip

 

The term irritable hip is attached to a well recognized syndrome of tran­sient hip pain and restriction of movement in an otherwise healthy child, generally the symptoms last for 1-2 weeks and tl:1en subside spontane­ously hence the synonym 'transient synovitis".

 

4. Ans. (C). Avulsion of the iliopsoas tendon

 

The iliopsoas tendon inserts on the lesser trochanter and has no role whatever in the thickening of the greater trochanter.

 

5. Ans.  (D) Trapezius

 

Trapezius is innervated by spinal accessory nerve and thus will not be involved in a brachial plexus lesion. In the case of a preganglionic lesion, ALL muscles innervated by the nerve roots will be affected.

 

6. Ans. (B). Radial head subluxation (Pulled elbow)

 

Common in children usually 2-4 years. Usually following child being pulled or swung by the hand or the forearm, annular ligament stretches and there is tenderness over the radial head. Reduction is gentle flexion and full supination.

 

7. Ans. (A). Fore-arm

 

BK Amputation…………best performed at junction of upper and middle third of calf

Syme's amputation……………performed at foot

Krukenberg amputation……..performed at forearm

 

8. Ans. (B) Implantation of a peripheral …….

   

This patient presents with symptoms of a tarsal tunnel syndrome, specifically involving the medial plantar nerve. Because she did not experience any initial pain relief from her surgery, one may suspect that an inadequate release was initially performed. Cortisone injection and physical therapy have no role in the management of a recurrent tarsal tunnel syndrome, although desensitization treatments with neuroleptic medication and manual massage are beneficial following surgery. It is important to rule out a sympathetically mediated pain syndrome prior to embarking on repeat surgery.  

 

 

9. Ans. (A). Observation

 

Posteromedial bowing of the tibia is not associated with other musculoskeletal conditions and is not likely to result in fracture or pseudarthrosis. The posterior bowing eventually corrects, while the medial bowing may persist. In the older child, osteotomy is occasionally necessary to correct residual medial bowing. Orthotics are unnecessary.

 

10. Ans. (A). The fact that the ulnar half of the ……..

 

Claw hand basically is because of paralysis of the lumbricals whose action is flexion at the MCP joint and extension at the IP joints. A claw hand is extended at the MCP and flexed at the IP because of unopposed action of the long flexors, since in the High ulnar lesion the long flexor is paraly­sed, there is less clawing.