image based Q. 142 - Brow blow

Q.    'Sourcil sign' is seen in ?

a. Cuff tear arthropathy
b. Calcific tendinitis
c. Adhesive capabilities
d. Avascular necrosis humeral head

Answer -
a

'Sourcil sign' is a radiological sign.
The erosion of undersurface if acromion leading to subacromial sclerosis (image below ).

Cuff tear arthropathy results from end stage rotator cuff tear disease.

Superior subluxation and shear forces of humeral head lead to articular degeneration.

Similar sign is also seen in cases of hip disorders causing impingement and leading to radiological sclerosis of acetabular margin.

'Sourcil' refers and translates into the word 'eyebrows'.

image based Q. 141 - Knocked out

Q.    'Boxer`s knuckle' results from injury to which of these?

a. Juncturae tendinum
b. Sagittal band
c. MCP joint
d. Extensor tendon
e. Osteochondral fracture

Answer -
b

Sagittal band rupture is also called Boxers knuckle.

It clinically presents as dropped finger as the band helps in MCP extension.

The injury is most commonly noted in middle finger and least in ring finger.

image based Q. 140 - Attachment

Q.    Which one of these is attached to crista supinatoris?

a. Supinator edge
b. Part of annular ligament
c. Lateral ulnar collateral ligament
d. Biceps Lacertus fibrosus
e. Radial collateral ligament

Answer -
c
The crista supinatoris is area over proximal ulna lateral aspect where lateral ulnar collateral ligament (LUCL) is attached.
LUCL is important stabilizer of elbow joint.

image based Q. 139 - Fault in the stars

Q.    A discrete soft tissue swelling over forearm of a young man was diagnosed elsewhere and was treated conservatively. He did CT scan of head for headache and 'starry sky pattern was noted . Which of these is best possibility?


a. Neurosarcoidosis
b. Milliary tuberculosis
c. Neurocysticercosis
d. Benign calcification
e. Multiple sclerosis

Answer -
c

The presence of forearm soft tissue swelling and involvement of head may be feature of disseminated neurocysticercosis as these can be found in both sites.

As these were managed conservatively with medicines probably for neurocysticercosis.

'Starry sky' pattern in head contrast CT (CECT) is found in this disorder with multiple white pocks, multiple hyperdensities and calcific foci.

 The gadolinium enhanced MRI of brain of the lesion shows intracystic nodules some of them with head of larva as eccentric spots as 'hole- with-dot' appearance.

image based Q. 138 - Tug of war

Q.   Tug lesion refers to which of these?
a. Cortical desmoid
b. Bone island
c. Bone infarction
d. Marrow conversion

Answer -
a

Irregularities over distal femur posteriorly on medial condyle may be due to cortical desmoid (or periosteal desmoid). Thus is supposed to result from repetitive strain of adductor magnus aponeurosis.

image based Q. 137 - Clast act

Q.   Marble bone disease has problem with which of these compound at cellular level?

a. Phosphate
b. Calcium sulphate
c. Hydrochloric acid
d. Bicarbonates
e. Phosphoric acid
f. Anhydrase

Answer -
c

Marble bone disease is also called osteoporosis and presents as hard sclerotic bones on radiographs.

Osteopetrosis or Albert Schoenberg disease presents as bones with thick, disorganised and incomplete remodelling.  Osteoblastic activity is intact while osteoclastic activity is hampered.

Lack of hydrochloric acid leading to abnormal dissolution of hydroxyapatite leads to improper remodeling.

Osteoclasts are not able to acidify Howship lacunae.

image based Q. 136 - Screw screwed

Q.    Which site of below implant is prone for failure/ breakage or weakest region ?

a. Head shaft junction ( red line)
b. Shaft of screw. (green line)
c. Shaft thread junction (yellow line)
d. Thread area (orange line)
e. Tip (blue line)

Answer -
c

In a partially threaded screw the area where shaft ends and thread begins is weakest.

This area is also called 'Run Out' of the screw.

inag based Q. 135 - Necrosis

Q.   Most common disorder associated with increased risk of necrotising fasciitis is ?

a. Diabetes
b. Nicotine ause
c. Intravenous drug abuse
d. Berger's disease.

Answer -
a

Diabetes mellitus is commonest co- morbid condition associated with necrotising fasciitis ( more than 40 % cases are diabeteic).

Diabetic cases have been associated with polymicrobial infection, poorer outcome and more chances of amputation.

It is divided into 4 subtypes:

type 1 - polymicrobial, most common, immunocompetent and diabetic patient's.

type 2 - Strep. pyogenes, Staph. aureus.
immunocompetent, higher fatality than type 1. Associated with Streptococcus toxic shock syndrome (STSS).

type 3 - less common, Vibrio species

type 4 - less common, fungal infection.

image based Q. 134 - Name game

Q.    Camapanacci is associated with all these disorders except?

a. Giant cell tumor
b. Osteofibrous dysplasia
c. Fibrous cortical defect
d. Malignant fibrous histiocytoma

Answer -
d

Campanacci has given radiological grading of giant cell tumor ( GCT) and divided into three grades.

Osteofibrous dysplasia is uncommon neoplasm mostly affecting tibia. It is sometimes referred as Campanacci disease.

Multiple fibrous cortical defect ( also called non ossifying fibroma or fibroxanthoma)  of long bones and jaw along with cafe au lait spots ( CALS), intellectual disability and other features are noted in Jeff- Campanacci syndrome.

image based Q. 133 - Under the lens

Q.   Which of these is not a feature of  arthroscopic importance ?

a. Pits pit
b. Resident ridge
c. Cyclops lesion
d. Buford complex

Answer -
a
Buford complex is an anomalous variant in shoulder region that consists of cord like middle glenohumeral ligament with deficient glenoid labrum at particular location.

Cyclops lesion are diagnosed in arthroscopic knee surgery as complication of ACL repair. It represents as painful fibtotic anterior mass.

Residents ridge is an arthroscopic landmark for anatomical femoral tunneling in AVL surgeries.

Pitt's pit (after Michael Pitt) or herniation pits are synovial pits found in proxomal femur as asymptomatic, benign and incidental oval or round lucencies.