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WorksheetsOrtho-1
Total questions: 85
Worksheet time: 54mins
Type 1 Collagen fibres are predominantly found in which of the following structures -1.Meniscus 2.Annulus fibrosis 3.Articular hyaline cartilage 4.Nucleus pulposus
1 and 2
1,2 and 3
2 and 3
1 and 3
Regarding Basic anatomy and physiology of bone ,consider the following statements- 1. The principal inorganic mineral of bone matrix is Calcium hydroxyapatite 2. The major protein in bone matrix is Type II collagen 3. Osteoclasts are mononuclear cells derived from monocyte aggregates 4. Osteoblasts lay down osteoid matrix and are rich in alkaline phosphatase 5. Osteocytes are the least abundant bone cells with the shortest life span 6. Bones in children contain higher water content, which makes them softer 7. Bone strength depends on the balance between the activity of osteoblasts and osteoclasts. How many statements are correct
3 statements are correct
4 statements are correct
5 statements are correct
6 statements are correct
A 62-year-old postmenopausal woman presents with progressive back pain and height loss over the past 6 months. DEXA scan reveals a T-score of –3.2, consistent with severe osteoporosis. Laboratory workup shows hypercalciuria and increased bone turnover on metabolic panel.Her clinician suspects accelerated osteoclastic activity leading to increased bone resorption. Which biochemical marker will be elevated
Osteonectin
Procollagen-1
Osteocalcin
Tartarate resistant acid phosphatase
Regarding bone anatomy ,mark the incorrect statement
1. The periosteum is attached to cortex of long bones via Sharpey's fibres
2. The medullary cavity in children contains red marrow, whereas in adults it is predominantly fat
3. The periosteum consists of an outer fibrous layer providing nutrition and an inner cellular cambium layer important for bone growth
4. Periosteum is present on the articular surface of long bones
A 10-year-old boy sustains a metaphyseal fracture of the distal radius after a fall. He is treated conservatively with casting. At 3 weeks follow-up, X-ray shows rapid callus formation with good alignment.Which factor best explains the rapid healing in this fracture
A. Presence of woven bone with dense lamellar arrangement
B. Reduced vascularity in metaphyseal region
C. Cancellous bone structure with rich blood supply
D. Metaphysis contains abundant macrophages promoting repair
Regarding bone growth and growth plate physiology, which of the following statements is INCORRECT?
1. Longitudinal growth of bone occurs by interstitial growth at the physis
2. The germinal (reserve) layer of the physis is the most important layer and injury to it can permanently arrest growth
3. Hypertrophic zone is the weakest area of the growth plate and is most prone to injury
4. Complete growth plate damage causes cessation of growth on the involved side leading to limb length discrepancy
5. Appositional growth increases bone length and occurs by activity of periosteum and endosteum
Which of the following statements in true about Wolff's law
It states that compression along the physis will inhibit growth
It states that circumferential strain will increase bone girth
It states that bone remodels acoording to External stresses
It states that osteoclasts are responsible for bone remodelling
A tidal mark is seen in which of the following tissues
cancellous bone
cortical bone
woven bone
articular cartilage
Which of the following is considered the most reliable clinical diagnostic sign of a fracture?
Pain and swelling at the site
Tenderness
crepitus
Abnormal mobility
Butterfly fracture is typically produced due to which type of force?
A. Pure tensile force
B. Pure rotational (torsional) force
C. Axial compression combined with bending force
D. Shearing force only
Regarding pathological fractures, which of the following statements is INCORRECT?
1. Pathological fractures occur without significant trauma because the bone is already weak
2.Mirel's criteria is used to predict the risk of pathological fractures due to lesions. A score of more than 8 requires prophylactic fixation with internal fixation devices
3.Osteoporosis is the most common generalized cause of pathological fracture, commonly affecting the spine and hip
4.Anemia in females is also a common cause of pathological fracture
5.Pain before the fracture may be present due to microfractures
March fracture is a fracture of:
A. 2nd metatarsal
B. 2nd metacarpal
C. 5th metatarsal
D. Fibula
A patient presents with an extra-articular fracture of the shaft of radius and ulna. What is the most appropriate definitive treatment?
A. Closed reduction and POP cast
B. Open reduction and internal fixation
C. Traction followed by POP
D. Intramedullary nailing only
Which type of splint / traction is commonly used for temporary stabilization in an intertrochanteric fracture of the femur?
Thomas Splint
Bohler and Braun Splint
Russell's traction
Cramer Wire splint
Which of the following fractures commonly undergo malunion
Lower one third tibia
Lateral condyle of humerus
Neck of talus
Clavicle
Which of the following statements regarding hypertrophic non-union is true?
A. Bone biology is poor
B. Callus formation is absent
C. Caused due to avascularity
D. Immobilisation is inadequate and callus formation is excessive
A 42-year-old farmer sustains a severe leg injury from a farm machine. On examination, there is a 12-cm wound, heavy contamination with mud and straw, and extensive periosteal stripping exposing the bone requiring soft-tissue flap coverage. Pulses are present.What is the correct type of this open fracture according to Gustilo Anderson classification
Type 1
Type 2
Type 3A
Type 3B
Type 3C
Which is the most stable external fixator device?
Rail fixator
limb reconstruction system
Spanning external fixator
Ilizarov ring fixator
Spanning external fixators are most commonly indicated in:
A. Diaphyseal fractures without soft tissue injury
B. Stable fractures of small bones
C. Periarticular open fractures with joint instability
D. Stress fractures
A patient with severe crush injury of the lower limb presents with prolonged ischemia and shock. MESS score is calculated as 8. What is the recommended management according to trauma scoring?
attempt limb salvage
external fixation followed by soft tissue reconstruction
primary amputation
conservative management with POP
Regarding amputation principles and techniques, consider the following statements:1. Use of tourniquet during amputation reduces bleeding and is contraindicated if the cause of amputation is ischemia or PVD 2. In disarticulation procedures, all tissues including bone are cut 3. During amputation, bone is cut 5 cm shorter than soft tissue 4. Myodesis refers to suturing muscle to muscle and is preferred in PVD cases 5. Skewed flap has a longer posterior flap and reduces problems with prosthesis fitting and wound dehiscence. Which statements are incorrect
1,3 and 5
2 and 4
2,4 and 5
1,2 and 3
A 14-year-old boy, congenitally blind, undergoes an upper-limb amputation following a severe crushing injury. During rehabilitation planning, the surgeon chooses a procedure in which the radius and ulna are surgically separated and reshaped to function as a pincer-like grasping mechanism, thereby enabling the patient to perform tactile discrimination using preserved sensation.What type of amputation is being described
Gritti Stokes amputation
Krukenberg amputation
Lisfranc amputation
Ray amputation
Regarding Jaipur Foot prosthesis, which one of the following statements is incorrect?
1. It allows barefoot walking and movement on uneven surfaces
2. It permits squatting and cross-leg sitting
3. It provides good ankle mobility including inversion and eversion
4. Dorsiflexion and plantarflexion are completely absent in Jaipur Foot
A 25-year-old male presents to the Emergency Department after falling on an outstretched hand during a football match. He complains of severe pain around the right shoulder and inability to lift the arm. On inspection, the shoulder shows loss of normal rounded contour with a prominent acromion, and the patient supports the injured limb with the opposite hand.During examination, the examiner performs a test in which the patient is asked to place the hand of the affected limb on the opposite shoulder and then attempt to bring the elbow down to touch the chest wall.Which clinical test is being performed by the examiner
Dugas Test
Callaway test
Bryant test
Jobe relocation test
A 22-year-old athlete presents with suspected anterior shoulder dislocation after a fall during a volleyball match. Considering the clinical features and mechanism, evaluate the following statements regarding anterior shoulder dislocation:1. The most common subtype is subcoracoid 2. There is loss of normal shoulder contour 3. The most commonly injured nerve is the radial nerve 4. In recurrent dislocation, Bankart lesion is seen on the posterolateral surface of the head of humerus 5. Mechanism of injury can be fall on an outstretched hand. How many of the given statements are correct
1 statement is correct
2 statements are correct
3 statements are correct
4 statements are correct
In recurrent posterior shoulder dislocation,reverse Hill Sach lesion is seen on
Antero-inferior glenoid labrum
postero inferior glenoid labrum
Antero medial surface of head of humerus
postero lateral surface of head of humerus
In Modified Kocher’s Technique for reduction of anterior shoulder dislocation, which of the following lists the correct sequence of steps?
A. External rotation → Traction → Internal rotation → Adduction
B. Traction → Adduction → External rotation → Internal rotation
C. Traction → External rotation → Adduction → Internal (medial) rotation
D. Adduction → Traction → Internal rotation → External rotation
Neer's classification is for
supracondylar fracture of humerus
Lateral epicondyle fracture of humerus
fracture of distal part of radius
proximal humerus fracture
In which of the following fractures ,3 point bony relationship is maintained
Lateral condyle fracture of humerus
Olecranon fracture
transcondylar fracture of humerus
supracondylar humerus fracture
According to Gartland classification for supracondylar humerus fracture ,fat pad/sail sign is seen in
type 1
type 2
type 3
none of these
In compartment syndrome, the first muscle to undergo ischemia in the forearm is:
flexor carpi radialis
flexor digitorum superficialis
flexor digitorum profundus
flexor policis longus
Gunstock deformity results from malunion of:
Colle's fracture
Smith fracture
Supracondylar humerus fracture
Olecranon fracture
A 25-year-old male presents after a road traffic accident. X-ray shows fracture of proximal one-third of ulna with anterior dislocation of the radial head. What is the most likely diagnosis?
A. Galeazzi fracture
B. Monteggia fracture
C. Nightstick fracture
D. Essex-Lopresti injury
BADO Type I Monteggia fracture is associated with radial head displacement:
Anteriorly
posteriorly
medially
laterally
Which statement is incorrect regarding Galeazzi fracture?
A. Fracture of radius + DRUJ disruption
B. Also called Pied Mont Fracture
C. ORIF is the treatment
D. Radial head dislocation is essential feature
How many statements regarding Scaphoid fracture are correct? 1. The most common mechanism of injury is fall on an outstretched hand (FOOSH) 2. Pain and tenderness in the anatomical snuffbox is a key clinical finding 3. Oblique view X-ray is the best initial radiological investigation 4. Proximal pole fracture has the highest risk of avascular necrosis 5. POP immobilization in glass-holding position is used in displaced fractures
2 statements are correct
3 statements are correct
4 statements are correct
5 statements are correct
Mallet finger is caused by
hyperflexion injury
hyperextension injury
crush injury
rotational injury
Regarding Colle's fracture ,mark the incorrect statement
Extra articular fracture of radius with volar displacement of distal fragement
Common in elderly post menopausal female
Mechanism of injury is fall on an outstretched hand with wrist in extension
Malunion leads to dinner fork deformity
A 66-year-old postmenopausal woman presents with complaints of progressive back pain and loss of height over the past year. She has a history of early menopause at 41 years and no history of hormone replacement therapy. A DEXA (Dual-Energy X-ray Absorptiometry) Scan of her lumbar spine reveals a T-score of –3.5. Which of the following is the most appropriate diagnosis based on her T-score?
A) Normal bone density
B) Age-appropriate bone loss
C) Osteopenia
D) Osteoporosis
When treating osteoporosis with alendronate, what is the most common side effect?
A) Osteonecrosis of jaw bone
B) Stomach ulcer
C) Dry mucus membrane
D) Insomnia
A 64-year-old man presents with dull aching pain in the left thigh and an increase in the size of his femur. There is no history of trauma. X-ray of the femur shows a well-demarcated advancing wedge-shaped area of radiolucency, as given. Paget’s disease was diagnosed. Which phase of Paget’s disease is most likely responsible for this radiographic finding?
osteolytic phase
mixed lytic and sclerotic phase
sclerotic phase
malignant transformation phase
A 30-year-old female presents to the OPD with generalized body pain and fatigue. Blood investigations show normal calcium, decreased phosphate, elevated PTH and elevated ALP. What is the most probable diagnosis?
A) Vitamin D deficiency
B) Primary hyperparathyroidism
C) Osteoporosis
D) Paget’s disease
A 69-year-old postmenopausal woman presents with complaints of chronic lower back pain and a recent low-impact fracture of the distal radius. She has a sedentary lifestyle and no history of steroid use. DEXA scan reveals a T-score of −2.9. Her blood workup is ordered to investigate the cause of her bone fragility. Which of the following best describes the expected biochemical profile in this patient?
A) Decreased Ca, phosphate and alkaline phosphatase
B) Increased Ca, phosphate and alkaline phosphatase
C) Decreased Ca and phosphate but increased alkaline phosphatase
D) Normal Ca, phosphate and alkaline phosphatase
What laboratory findings would you expect to find in a patient newly diagnosed with renal osteodystrophy?
A) Decreased PTH secretion, hypophosphatemia and hypocalcemia
B) Increased PTH secretion, hyperphosphatemia and hypocalcemia
C) Decreased PTH secretion, hyperphosphatemia and hypercalcemia
D) Increased PTH secretion, hypophosphatemia and hypercalcemia
Anti Sclerosing Antibody that increases bone formation
Denosumab
Romosumab
Teriparatide
Strontium Ranelate
A 3 year old child presented with progressive anemia, hepatosplenomegaly and osteomyelitis of the jaw with pathological fracture. His x-rays show diffuse sclerosis of bones. What is the probable diagnosis?
(a)
The active form of Vitamin D (calcitriol) is produced by the enzyme 1-alpha-hydroxylase. What hormone activates this enzyme?
(a)
Which metabolic bone disorders shows the finding shown in x ray
(a)
Most common dislocation of shoulder joint
(a)
Regimental badge sign seen in anterior shoulder dislocation is due to damage of which nerve
(a)
A 30-year-old man presents after a fall on an outstretched hand with pain and deformity in the arm.X-ray shows a spiral fracture at the junction of the middle and distal third of the humerus (Holstein-Lewis fracture).He is unable to extend his wrist, and a cock-up splint was applied for support.Which nerve is most likely injured?
(a)
A 7-year-old boy fell on his outstretched hand while playing and presents with severe pain and swelling around the elbow.On examination, the elbow is held in flexion with marked tenderness above the condyles of the humerus.X-ray shows a displaced supracondylar fracture of the humerus (extension type).Which nerve is most commonly injured in this fracture?
(a)
The definitive treatment of acute compartment syndrome is:
(a)
A 12-year-old boy presents with pain and deformity in the forearm following a fall on an outstretched hand.X-ray shows a fracture of the proximal ulna with posterior dislocation of the radial head.According to Bado classification, what type of Monteggia fracture is this?
(a)
Last carpal bone to ossify
(a)
most common carpal bone to dislocate
(a)
A 65-year-old postmenopausal woman presents with chronic back pain and decreased height over the past year.She has a history of low-trauma wrist fracture and leads a sedentary lifestyle with poor calcium intake.X-ray spine shows vertebral body compression fractures suggestive of osteoporosis.What is the investigation of choice for screening osteoporosis?
(a)
First line drugs for treatment of osteoporosis
(a)
Method of closure in amputation in which muscle is sutured to muscle is called as
(a)
tarsometatarsal joint amputation is called as (a) amputation
Mark the correct statements
Osteoblast are monoclear bone forming cells that lay down osteoid matrix and are rich in ALP
Osteoclast are multinucleated giant cells rich in TRAP and carbonic anhydrase
Type 1 Collagen fibres are present in articular hyaline cartilage
hydroxyproline and hydroxylysine are bone formation markers
Metaphyseal fractures undergo healing more commonly by non union
Mark the correct pairs
March fracture:-Fracture of 2nd metacarpal
Boxer fracture:-Fracture of 5th metatarsal
Runner fracture:-Fracture of fibula
Shin splints-Medial perostitis of tibia
Regarding the Mangled Extremity Severity Score (MESS) used in decision-making for limb salvage vs amputation, which of the following criteria are included in the scoring system?
A. Age of the patient
B.Velocity of injury
C. Ischemia time
D. Blood pressure and shock status
E. Presence of compartment syndrome
Mark the true statements about lateral condyle humerus fracture in children
A) Results in cubitus varus deformity
B) Occurs in children between 5–10 years of age
C) Cubitus valgus deformity occurs
D) Tardy ulnar nerve palsy can be seen
seen in anterior shoulder dislocation
A) Inability to touch the opposite shoulder
B) Elevated anterior axillary fold
C) Flattening of the shoulder
D) Paresthesia of the upper lateral arm
Regarding posterior shoulder dislocation, which of the following statements are TRUE?
A. It commonly occurs following seizures or electrocution
B. The arm is held in adduction and external rotation
C. Loss of external rotation is a classical finding
D. X-ray may show the “Electric light bulb sign
E. Reverse Hill-Sachs lesion is seen on the posterior aspect of the humeral head
The 3 points bony relationship is maintained in
supracondylar fracture humerus
lateral condylar fracture humerus
Jupiter fracture
monteggia fracture
radial head fracture
A 14-year-old boy presents with gradually increasing painful swelling over the anterior aspect of the arm following a supracondylar fracture treated conservatively 3 weeks ago. On examination, the swelling is firm and mildly tender with restricted elbow motions. X-ray shows well-defined ossified mass in the soft tissues anterior to the humerus. Which of the following statements regarding this condition are correct
A) Massage and repeated manipulation are known risk factors
B) It matures from the periphery to the center
C) It is commonly associated with neurological conditions
D) Inflammation of the muscle is a precursor to ossification
True statements
A) Rolando fracture is intra-articular
B) Bennett fracture is always displaced
C) APL pull is insignificant in the Rolando fracture
D) Extensive comminution is the hallmark of Bennett fracture
Mark the correct statements for Rickets
Nutritional Vitamin D deficiency is the most common cause
Earliest change is craniotabes
Rachitic rosary is painful
Most common long bone deformity in weight bearing children is bilateral genu varum
serum ALP is markedly decreased
A 7 month old child is brought to the OPD with signs, symptoms and biochemical changes of rickets. Which of the following findings are likely to be found in this child?
wide open fontanelle
bow legs
rachitic rosary
craniotabes
Which of the following are treatment options for osteoporosis
denosumab
Hormone replacement therapy
vertebroplasty
corticosteroids
A 68-year-old man presents with persistent bone pain in the pelvis and increasing hat size over the last year. He also complains of hearing difficulty. On examination, there is localized warmth over the tibia. X-ray pelvis shows thickened cortical bone with mixed lytic and sclerotic areas and coarse trabeculae. Laboratory investigations reveal normal calcium and phosphate levels with markedly elevated alkaline phosphatase (ALP).Which of the following statements about the disease are correct
It is associated with elevated ALP
Commonly involves pelvis , skull and spine
Calcium and phosphate levels are typically decreased
bisphosphonates are the main stay of treatment
Which of the following are actions of PTH
increases calcium reabsorption in kidney
increases phosphate reabsorption in kidney
increases 1 alpha hydroxylation of vit D
increases calcium absorption in intestine
A 45-year-old woman presents with diffuse bone pain, difficulty walking, and proximal muscle weakness. She follows a strict vegetarian lifestyle and has a history of poor nutrition. Biochemical investigations show low phosphate, elevated alkaline phosphatase, and a low-normal calcium level. A bone biopsy reveals an increased osteoid matrix that is poorly mineralized.Which of the following statements about osteomalacia are NOT true?
A) It is caused by vitamin D deficiency
B) It presents with proximal myopathy
C) Serum calcium is always normal
D) It shows raised serum calcium
E) Bone biopsy shows increased demineralized matrix
The most common site for open fractures is the tibia and phalanges.
T
F
Gustilo Anderson Type IIIc involves vascular injury requiring repair, irrespective of wound size.
T
F
Denosumab is a monoclonal antibody against sclerostin, which stimulates osteoblasts.
T
F
Teriparatide is a synthetic PTH that increases osteoblast activity and is used as first-line therapy in severe osteoporosis.
T
F
Bisphosphonates are first-line drugs in osteoporosis and act by inhibiting osteoblasts
T
F
DEXA scan T-score of –1 to –2.5 indicates osteoporosis.
T
F
Cod-fish vertebrae may be seen in osteoporosis, osteomalacia, and osteogenesis imperfecta.
T
F
Champagne bottle deformity of the pelvis is a radiological feature seen in osteomalacia and achondroplasia
T
F
In primary hyperparathyroidism, serum phosphate is decreased due to increased renal phosphate excretion
T
F
PTH receptors are present on osteoclasts, which directly stimulate bone resorption.
T
F
