image based Q.15- swollen limb

Q. All of the these rule out compartment syndrome in below patient  except -

1. Pink hand

2. Pulses present

3. no pain on stretching

4. no paralysis of muscles










Answer - 2

Pain on passive stretch is earliest sign of clinical impending compartment syndrome.

Other signs are Pallor, parasthesia, paralysis

Pulse may be  present in severe compartment pressure and is unpredictable sign. Presence of pulse does not rule out impending or confirmed compartment syndrome.

image based Q.14- A lady with swelling in arm

 Q. An old lady developed acute pain in the forearm with weakness in the use of upper extremity  after trying to lift a heavy object from ground. Which of these is best suitable for her condition in clinical picture?

1. Muscle hernia

2. Popeye sign

3. Bulge sign

4. Locked elbow sign

Answer –

Popeye sign is bulge of biceps as prominent deformity following rupture of one of its tendon or insertion. There is also history of heavy weight lifting leading to over-contracted biceps and  concomitant old age lead to degenerative tear of its either end. Popeye sign is named after famous cartoon character Popeye which is shown often with bulging biceps.

Muscle hernia usually follows violent trauma leading to fascia rupture leading to muscle bulge during contraction out of the defect or following surgery with inadequate fascia closure. It usually is reported in lower limbs.

Bulge sign and locked elbow sign are no genuine terms and used here  as misleading options.

image based Q.13- implant for deformity.

Q. The following image shows a small plate implant (held with a K wire ) for treatment of knee deformity in an adolescent male on medial side of the knee. Select the appropriate diagnosis of the patient's deformity?

1. genu valgum
2. ganu varum
3. genu recurvatum
4. congenital dislocation of knee

Answer - 1

The plate, in the shape of letter '8' is also called 'Eight plate' and better known as ' Tension band plate' . It is used for Hemi-epiphysiodesis (unilateral fusion of growth plate) and growth modulation. The other implants used for this purpose in older times were 'bone staples'.
The plate acts as reversible epiphysiodesis implant as the removal of it may resume the growth if desired.

Usually the angular deformities of lower limbs are managed - medial side plating in genu valgum and lateral side plating for genu varum. ( pnemonic lateRal - genu vaRum)

 It is intended to stop growth of attached side of limb , thus unopposed side growth corrects or neutralises the deformity.

In this manner it can also be used for retroversion , as posterior plating.

Image based Q.12- abnormal sitting posture.

Q. Parents of a young girl complain of abnormal sitting posture of their daughter (pic below). Which of these might not be applicable in her case?


1. external tibial torsion
2. femoral retroversion
3. valgus feet
4. flexion- internal rotation hip

Answer - 2

The characteristic position of sitting mimics english letter 'W' and thus called 'W position'

This is result of normal increased femoral anteversion; that is increased in very young children  and gradually it corrects to normal anteversion of 15 degrees in adulthood.
Increased anteversion presents with this position of sitting as well as an 'in-toeing gait'.

In pathologic hip with flexion-internal rotation deformity as in case with CP (cerebral palsy), all other options may be accompanied.

image based Q.11- radio-opaque material in beads

Q.  Which of these antibiotic is least likely to be used in this patient with open fracture operatively managed (radiograph below )?

1. vancomycin

2. tobramycin

3. gentamicin

4. doxycycline

Answer – 

The radiograph shows a femur fracture fixed with interlocking nail and a radio-opaque chain of beads of certain radio-opaque material (most probably bone cement or PMMA, poly methyle metha acrylate). As it is open fracture, the cement might be used with mixed antibiotics for higher local concentration and delivery of antibiotics. 

The antibiotics should be heat stable as the bone cement maturation is exothermic process and the heat generated might diminish potency of antibiotics that are not heat stable.

Commonly used antibiotics for this purpose are-

Gentamicin

Tobramycin

Vancomycin

Certain cephalosporins

Daptomycin

 Thus doxycycline is the correct answer.

image based Q.10- recurrent knee problem

Q. which of these is not a risk factor for recurrent condition shown in the radiograph below ?

1. Decreased Q angle
2. female sex
3. genu valgum
4. family history






Answer - 1

This is a skyline radiograph  of knee showing patella subluxation.

 Increased Q angle is associated with recurrent patella subluxation/dislocation
Other common factors  are -

family history
trochlear dysplasia , causing shallow trochlea
patella alta or high riding ptella
female sex
defromity of femur or tibia

image based Q.9- A child with abnormal gait

Q. The parents of a child with CP (cerebral palsy)complain of abnormal gait of their child. All of the following  may be steps in surgery for its correction except

1. release Adductor longus

2. release Adductor brevis

3. release Gracilis

4. procedure done bilaterally

Answer -

The abnormal gait in the picture appears to be scissoring gait. It is due to adductor tightness and surgery involves adductor tenotomy.

The adductor brevis is partially removed. Anterior half is usually released as full release might injure obturator nerve branches over it.

Adductor longus is released and gracilis released in severe cases  and

 procedure is done bilaterally to avoid ‘windswept pelvis’

image based Q.8- neglected humerus injury

Q. Which one of these is not a possible modality to treat a 9 moth old injury (below radiograph) in a young male. 

1. Extracorporeal shock wave

2. Ultrasound

3. Electromagnetic frequency

4. Iontophoresis

Answer –

The radiograph of an old trauma here is suggestive of ‘nonunion’.

 The various non-operative physical modalities to enhance union described are –

1.       LIPUS (Low intensity pulsed ultrasound)

2.       Pulsed EMF (Electromagnetic frequency)

3.       extracorporeal shock wave therapy (ESWT)

4.       DC (direct current) stimulation

Iontophoresis is a method used in physiotherapy and fomentation procedures.