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Complete Answers with Reasoning

PAGE 1 (MCQ Section - 10 Marks)

Q1. Rickets is diagnosed by:

Answer: a. Low calcium, low phosphate and high alkaline phosphatase levels

Reason: Rickets is a metabolic bone disease caused by vitamin D deficiency. The biochemical hallmarks are:

Low serum calcium (hypocalcaemia)
Low serum phosphate (hypophosphataemia) - because vitamin D is required for phosphate reabsorption
Elevated alkaline phosphatase - a marker of increased osteoblast activity/impaired mineralization

This biochemical combination is the primary diagnostic indicator. While bone scan, clinical assessment, and vitamin D levels all play a role, the classic diagnostic combination is the triad above. A bone scan (b) is non-specific, clinical assessment (c) alone is insufficient, and vitamin D levels (d) indicate cause but not the full diagnostic picture.

Q2. Diagnosis of osteoporosis is confirmed on:

Answer: b. DEXA scan

Reason: The WHO gold standard for diagnosing osteoporosis is Dual-energy X-ray Absorptiometry (DEXA scan) measuring Bone Mineral Density (BMD). A T-score of -2.5 or lower confirms osteoporosis. Calcium and Vit D levels (a) may indicate cause but don't confirm osteoporosis. Osteopenia on X-ray (c) is unreliable - radiological changes only appear after 30-40% bone mass is lost, making it insensitive. Central DEXA has the best correlation with fracture risk.

Swanson's Family Medicine Review confirms: "Central DEXA BMD has better correlation with fracture risk than QCT scan BMD."

Q3. Cafe au lait spots are seen in:

Answer: a. Neurofibromatosis (only)

Reason: Cafe au lait (CAL) spots are a classic hallmark of Neurofibromatosis type 1 (NF1). Six or more CAL spots >5 mm (prepubertal) or >15 mm (postpubertal) is a diagnostic criterion for NF1.

Tuberous sclerosis (b) presents with hypopigmented "ash-leaf" patches, NOT cafe au lait spots. Therefore option (c) "A and b both" is incorrect.

Fanconi anemia (d) does not typically feature CAL spots as a hallmark.

Note: While occasional CAL spots can rarely appear in other conditions, for examination purposes, CAL spots are classically and specifically associated with Neurofibromatosis.

Q4. CT scan of bone tumors are used to see:

Answer: d. All of the above

Reason: CT scan of bone tumors is useful for evaluating:

Calcification - mineralization patterns within tumor matrix
Ossification - bone formation within tumor
Bony destruction - cortical breakthrough, cortical thinning, permeative destruction

CT provides excellent bone detail and is the most useful modality for characterizing all three of these features simultaneously. It is superior to plain X-ray for evaluating cortical integrity and tumor extent.

Q5. A satisfactory triage depends on which of the following:

Answer: d. All of the above

Reason: Effective triage in emergency/disaster settings requires all three components:

Understanding of resources (a) - knowing what personnel, equipment, and beds are available
Organized approach (b) - systematic methodology (START, SALT triage systems)
Critical vs non-critical patient segregation (c) - the very core purpose of triage

All three are interdependent components of successful triage. No single element alone constitutes satisfactory triage.

Q6. Causes of a fracture include:

Answer: d. All of the above

Reason: Fractures occur through multiple mechanisms:

Rotational forces (a) - torsional/spiral fractures (e.g., twisting sports injury)
Repetitive stress (b) - stress/fatigue fractures from repeated loading below yield strength
Direct blow (c) - transverse fractures from direct trauma

All three are well-recognized causes of fractures in orthopedic literature.

Q7. Diagnosis of muscular dystrophy is made upon:

Answer: b. Muscle biopsy

Reason: Muscle biopsy remains the gold standard for definitive diagnosis of muscular dystrophy. It allows:

Histological examination (necrosis, regeneration, fibrosis, fatty infiltration)
Immunohistochemistry for dystrophin and other proteins
Confirmation of the specific type

While genetic testing (d) is increasingly important and EMG (a) can support diagnosis, muscle biopsy provides the definitive histological and protein-level confirmation. MRI (c) is used for identifying affected muscles but is not diagnostic.

In modern practice, genetic testing is becoming co-primary, but for classic exam purposes, muscle biopsy is the answer.

Q8. Osteomalacia is most commonly seen in which of the following conditions?

Answer: a. Vitamin D deficiency

Reason: Osteomalacia (defective bone mineralization in adults) is most commonly caused by Vitamin D deficiency. Vitamin D is essential for calcium and phosphate absorption from the gut. Without adequate vitamin D, the osteoid matrix is laid down but cannot be properly mineralized.

Major causes include: vitamin D deficiency, malabsorption, inadequate sunlight, liver/renal disease, and phosphate depletion - but simple vitamin D deficiency is by far the most common worldwide cause.

While renal failure (b) can cause osteomalacia via impaired 1α-hydroxylation of vitamin D, it is far less common than primary vitamin D deficiency.

Henry's Clinical Diagnosis: "The major categories of diseases that produce osteomalacia or rickets are vitamin D deficiency states, phosphate depletion, systemic acidosis, and inhibitors of mineralization. Vitamin D deficiency is particularly important."

Q9. Which represents the correct sequence of the Primary Survey in ATLS?

Answer: a. Airway, Breathing, Circulation, Disability, Exposure

Reason: The ATLS (Advanced Trauma Life Support) Primary Survey follows the ABCDE mnemonic in strict order:

A - Airway (with cervical spine protection)
B - Breathing and ventilation
C - Circulation with hemorrhage control
D - Disability (neurological status, GCS, pupils)
E - Exposure and environmental control

This sequence is prioritized because airway compromise and hypoxia kill faster than circulatory failure, which kills faster than neurological deterioration.

Miller's Anesthesia and Mulholland & Greenfield's Surgery both confirm: "ATLS emphasizes the ABCDE mnemonic: airway, breathing, circulation, disability, and exposure."

Q10. What is the most common complication associated with bone fractures?

Answer: b. Malunion

Reason: Among the listed options, malunion (fracture heals in an abnormal position - angulation, rotation, shortening) is the most common complication of bone fractures overall. It can occur even with treatment if alignment is not properly maintained.

Compartment syndrome (a) - serious but less common; occurs mainly in closed compartment injuries
Delayed union (c) - slower healing, but eventually heals
Non-union (d) - failure to heal; less common than malunion

Note: Some sources argue compartment syndrome is the most common early complication and malunion the most common late complication. For general purpose, malunion is the standard answer for "most common complication of fractures."

PAGE 2 (Clinical Scenarios - 1/8)

Q1. Patient with road traffic accident, severe pain and bleeding profusely from leg. First line of action?

Answer: d. Control of obvious hemorrhage

Reason: In ATLS, while Airway is the first priority in the primary survey sequence, when a patient has obvious external hemorrhage, this must be controlled immediately as it is directly life-threatening. In a patient actively bleeding profusely, hemorrhagic shock leads to rapid death. The principle of "C-ABCDE" (Circulation first in hemorrhagic scenarios) or the Tactical Combat Casualty Care (TCCC) approach puts hemorrhage control as the first action. Airway control (a) is important but in this specific scenario, exsanguination is the immediate killer.

Q2. 29-year-old lady, isolated 4th posterior rib fracture, severe pain in breathing, normal chest X-ray. Management?

Answer: a. Analgesics and reassurance

Reason: An isolated rib fracture (single rib) with a normal chest X-ray (no pneumothorax, no hemothorax, no pulmonary contusion) is managed conservatively:

Adequate analgesia (NSAIDs, paracetamol, nerve blocks for severe cases)
Reassurance and breathing exercises
Incentive spirometry to prevent atelectasis

Closed reduction and plaster (b) is not applicable to rib fractures. ORIF (d) is only for multiple displaced ribs or flail chest. Local injections (c) may be used for pain but are not the primary management line.

Q3. Lady with heel pain on walking for 3 weeks, calcaneal spur on X-ray. Second opinion after GP suggested surgery. Treatment?

Answer: d. Needs shoe modifications and stretching exercises

Reason: Plantar fasciitis/calcaneal spur management follows a conservative-first approach:

First line: Stretching exercises (plantar fascia, Achilles), shoe modifications (heel cups, orthotic insoles), NSAIDs
Second line: Local corticosteroid injections
Third line: Surgery (only after 6-12 months of failed conservative treatment)

A calcaneal spur seen on X-ray does NOT automatically indicate surgery. Surgery is only warranted after conservative measures fail for >6 months. The GP suggesting immediate surgery is not appropriate - conservative management should be exhausted first.

Q4. 22-year-old with ankle sprain, taking 600 mg Ibuprofen TDS. Maximum recommended dose of Ibuprofen in 24 hours?

Answer: c. 1600 mg/day

Reason: The standard maximum recommended daily dose of Ibuprofen for adults is:

OTC (over the counter): 1200 mg/day
Prescription maximum: 2400-3200 mg/day (under medical supervision)
Standard analgesic dose: 1200-1600 mg/day

600 mg TDS (three times daily) = 1800 mg/day, which exceeds the standard OTC limit. The most commonly cited safe maximum for routine analgesic use is 1600 mg/day (400 mg QDS or 800 mg BD).

Note: For a minor ankle sprain managed by a GP, 1600 mg/day is the appropriate ceiling for safety.

Q5. 3-year-old boy with right mid-forearm radius and ulna shaft greenstick fractures. Best treatment?

Answer: c. Manipulation under Anesthesia and casting

Reason: Greenstick fractures in children are incomplete fractures where one cortex breaks and the other bends. For mid-shaft both-bone forearm greenstick fractures in a 3-year-old:

Simple casting without reduction (b) is insufficient if there is angulation (>10-15 degrees)
Manipulation under anesthesia (MUA) + casting is the standard treatment when reduction is needed
The remodeling potential of a 3-year-old's bones is excellent, but proper alignment must be achieved first
Open reduction/internal fixation (ORIF) or external fixation (d) are NOT indicated in children's greenstick fractures

Q6. 23-year-old with right mid-shaft femur fracture, vitally stable, risk of fat embolism, bystanders want to transfer. Safest transportation?

Answer: b. Apply Thomas Splint with skin traction before shifting

Reason: For a mid-shaft femur fracture before transfer:

Thomas splint with skin traction provides stabilization, reduces pain, controls hemorrhage, and most importantly reduces the risk of fat embolism by immobilizing fracture fragments
Skin traction only (a) is insufficient without the rigid Thomas splint frame
Immediate intramedullary nailing (c) is the definitive treatment but cannot be done on the roadside/before transfer
Not allowing transfer (d) is not appropriate when the patient needs definitive care

Thomas splint is the classic pre-hospital/transport immobilization device for femur fractures.

Q7. 27-year-old male, RTA, conscious, GCS 14/15, "a bit confused." Definite indication for intubation in semiconscious patient?

Answer: c. GCS 07 or below

Reason: The standard threshold for definitive airway management (intubation) is GCS ≤ 8. A GCS of 7 or below indicates:

Inability to protect the airway adequately
High risk of aspiration
Inadequate ventilation

GCS 3 (a) is already in deep coma - intubation is mandatory. GCS ≤ 8 (which makes GCS 07 the correct answer among the options) is the standard clinical trigger. The patient in this scenario with GCS 14/15 does NOT yet need intubation, but the question asks about the definitive indication.

Q8. 40-year-old, fall on outstretched hand, tenderness over anatomical snuff box, unremarkable X-rays. Management?

Answer: a. Application of Scaphoid cast and repeat X-rays after two weeks

Reason: Tenderness over the anatomical snuff box is the hallmark clinical sign of a scaphoid fracture, even when initial X-rays are normal. Scaphoid fractures are notoriously difficult to see on initial X-rays (up to 20% are invisible initially). The management protocol is:

Treat as scaphoid fracture until proven otherwise
Apply scaphoid/thumb spica cast
Repeat X-rays in 10-14 days (fracture line becomes visible as bone resorbs)
Or proceed to MRI/CT if clinical suspicion is high

Leaving on analgesics alone (d) risks avascular necrosis of the scaphoid (proximal pole has poor blood supply - retrograde supply only).

Q9. 50-year-old lady with distal humerus displaced intra-articular fracture for ORIF. Basic rule for treating intra-articular fractures?

Answer: d. Stable fixation and early mobilization to prevent stiffness

Reason: The fundamental principle for intra-articular fractures is:

Anatomical reduction - restore the joint surface precisely (to prevent post-traumatic arthritis)
Stable fixation - rigid enough fixation to allow movement
Early mobilization - begin range-of-motion exercises early to prevent joint stiffness and achieve optimal functional outcomes

This is the AO principle. Rigid fixation with late mobilization (b) leads to stiffness and poor functional outcome. External fixation and late mobilization (a) is inappropriate for intra-articular fractures. Stable fixation + early mobilization is the gold standard.

Q10. Parents concerned about bowing of both knees in a 5-year-old boy. Counseling?

Answer: d. It is a self-limiting issue that needs observation only

Reason: Bilateral genu varum (bow legs) in a 5-year-old is a common physiological variant. The natural history:

Birth to 18 months: Physiological genu varum (bow legs) - normal
18 months to 7 years: Progressive correction through genu valgum (knock knees) - normal
By age 7-8: Adult alignment achieved

Bilateral bowing in a 5-year-old is still within physiological range and requires only observation and reassurance. Splinting (a) is outdated and unnecessary. Surgery (b) is absolutely not indicated. CT/MRI (c) is unnecessary unless Blount's disease or rickets is suspected (unilateral, rapidly progressive, or associated with other features).

PAGE 3 - Section A (BCQ's)

Q01. Regarding benign bone tumor - all of true EXCEPT:

Answer: c. Mostly involving extraosseous soft tissue component

Reason: Benign bone tumors are characterized by:

Well-defined mass (a) ✓ TRUE
Sclerotic rim (b) ✓ TRUE - reactive bone border
Narrow zone of transition (d) ✓ TRUE - sharp margin between normal and abnormal bone

Extraosseous soft tissue component (c) is FALSE for benign tumors - this is a feature of aggressive/malignant tumors that break through the cortex. Benign tumors remain contained within bone.

Q02. Regarding malignant tumor of bone - all of true EXCEPT:

Answer: c. No intra-articular invasion

Reason: Malignant bone tumors are characterized by:

Cortical destruction (a) ✓ TRUE
Periosteal reaction (b) ✓ TRUE (Codman triangle, sunburst pattern)
Wide zone of transition (d) ✓ TRUE - poorly defined margins

"No intra-articular invasion" is FALSE - malignant tumors CAN invade joints, particularly through the attachment of the joint capsule or direct spread. This makes (c) the EXCEPTION (the false statement).

Q03. Following statement true regarding complete fracture and types:

Answer: b. Transverse fracture (both a and b are true, but b is the specific type asked)

More precisely: Both a (bone is completely broken into 2 or more fragments) and b (transverse fracture) are correct statements. Option (a) is the definition, and (b) is a type. The question asks which statement is "true regarding complete fracture and its types" - a transverse fracture IS a complete fracture type. Greenstick (d) is an incomplete fracture, making this the key distinction.

Q04. All of true regarding osteosarcoma - EXCEPT:

Answer: c. Mostly occur in children < 10 years

Reason: True facts about osteosarcoma:

Most common in tibia and femur (distal femur, proximal tibia) (a) ✓ TRUE
Aggressive periosteal reaction: sunburst pattern, Codman triangle (b) ✓ TRUE
May lead to pathological fracture (d) ✓ TRUE

FALSE: "Mostly occur in children < 10 years" - Osteosarcoma has a bimodal distribution. The primary peak is in adolescents/teenagers (10-20 years) during the rapid growth spurt, not in children under 10. The second peak is in adults >60 years (secondary to Paget's disease or radiation). Therefore (c) is the FALSE statement.

Q05. Regarding liver cirrhosis - all of true EXCEPT:

Answer: b. Portal vein measuring < 1.2 cm

Reason: True features of liver cirrhosis:

Liver small in size (shrunken liver) (a) ✓ TRUE - late cirrhosis
Ascites (c) ✓ TRUE - portal hypertension consequence
Splenomegaly (d) ✓ TRUE - portal hypertension

FALSE: "Portal vein measuring < 1.2 cm" - In liver cirrhosis with portal hypertension, the portal vein is DILATED (> 1.3 cm). A portal vein diameter > 13 mm (1.3 cm) is a sonographic sign of portal hypertension. A measurement < 1.2 cm would actually suggest a normal or reduced portal vein, which is opposite to what occurs in cirrhosis.

Q06. Following statement true regarding incomplete fracture and its type:

Answer: b. Torus fracture (along with a)

Both (a) and (b) are correct:

(a) "Bone is incompletely divided and periosteum remains the continuity" - this is the definition of an incomplete fracture ✓
(b) Torus fracture (buckle fracture) - IS an incomplete fracture where the cortex buckles/compresses without breaking through ✓

Compression fracture (c) and Segmental fracture (d) are complete fractures - they go through the full width of the bone. The question asks which is TRUE about incomplete fractures, so the answer highlighting the correct type is Torus fracture (b).

PAGE 4 (Continued Questions)

Q06. Patient cannot fully extend knee, position supine with dorsi-flexed foot, hip flexed 60° then 90°. Tightness most likely caused by:

Answer: a. Hamstrings

Reason: This describes the straight leg raise / hamstring tightness test. When the hip is flexed with the knee extended (or during progressive hip flexion with the knee extended), tightness limiting knee extension is caused by the hamstrings (biceps femoris, semitendinosus, semimembranosus). The hamstrings cross both the hip and knee - they flex the knee and extend the hip. When hip is flexed and knee is being extended, tight hamstrings resist this position. Gastrocnemius tightness (c) would be revealed by ankle dorsiflexion tests, not this maneuver.

Q07. All are correct about Q angle EXCEPT:

Answer: d. Medial tibial torsion cannot produce effect on Q angle

Reason: True facts about Q angle:

Normal Q angle: Male 13°, Female 18° (a) ✓ TRUE
Excessive Q angle forms in genu valgum (b) ✓ TRUE
Measured from mid-patella to ASIS and tibial tubercle (c) ✓ TRUE

FALSE: "Medial tibial torsion cannot produce effect on Q angle" - Medial tibial torsion DOES affect the Q angle by altering the position of the tibial tubercle, which is one of the landmarks used in Q angle measurement. Tibial torsion changes the orientation of the tibial tubercle and therefore directly affects the Q angle.

Q08. All of the following are indication for ACL reconstruction EXCEPT:

Answer: d. A positive pivot shift test

Reason: Indications for ACL reconstruction include:

Instability due to complete/partial ACL tear (a) ✓ INDICATION
Posterolateral, posteromedial rotatory instability (b) ✓ INDICATION
Frequent episodes of knee buckling during ADLs (c) ✓ INDICATION

A positive pivot shift test (d) is a clinical SIGN/FINDING of ACL insufficiency - it is a diagnostic test, not itself an indication for surgery. The pivot shift sign (Galway test) confirms ACL injury but the indication for reconstruction is based on functional instability, patient activity level, and goals - not just a positive test. Hence it is the EXCEPTION.

Q09. Open-chain exercise recommended to develop control and strength of knee extension:

Answer: b. Straight leg lowering

Reason: Open kinetic chain (OKC) exercises for knee extension - the distal segment (foot) is free:

Straight leg lowering ✓ - classic OKC exercise for quadriceps, particularly in early rehab post knee surgery (maintains quad control without joint compression)
Hamstring curls (a) - OKC but for knee FLEXION, not extension
Standing wall slides (c) - closed kinetic chain
Partial lunges (d) - closed kinetic chain

Straight leg lowering is the classic OKC quadriceps/knee extension exercise.

Q10. Preferred Practice Pattern for total knee arthroplasty:

Answer: c. 4H

Reason: According to the APTA Guide to Physical Therapist Practice, the Preferred Practice Pattern for musculoskeletal conditions involving impaired joint mobility, motor function, muscle performance, and range of motion associated with joint arthroplasty is Pattern 4H. This pattern covers patients following total knee arthroplasty rehabilitation.

Q11. Intracapsular fractures:

Answer: a. Can compromise vascular supply to head of femur

Reason: Intracapsular femoral neck fractures (subcapital, transcervical) threaten the blood supply to the femoral head. The retinacular vessels (from medial and lateral femoral circumflex arteries) run along the femoral neck within the capsule. Fracture disrupts these vessels, causing avascular necrosis (AVN) of the femoral head - the most feared complication.

(b) "Most often sustained by elderly men" - FALSE; elderly women (due to osteoporosis) are more commonly affected
(c) "Complications occur more frequently with nondisplaced versus displaced fractures" - FALSE; displaced fractures have far higher rates of AVN and non-union

Q12. Girdlestone procedure is also called:

Answer: b. Excision arthroplasty

Reason: The Girdlestone procedure (Girdlestone resection arthroplasty) involves excision of the femoral head and neck. It is specifically called an excision arthroplasty (resection arthroplasty). It is used as a salvage procedure for infected hip replacements or severe hip pathology. It is NOT an interposition, implant-based, or joint replacement arthroplasty.

Q13. Pointing index finger deformity is due to injury of:

Answer: b. Median nerve

Reason: "Pointing index finger" (or "index finger pointing sign") refers to the inability to flex the index finger at the interphalangeal joints, causing it to remain extended/pointing while other fingers can flex. This occurs due to:

Median nerve injury at the wrist/forearm affecting the flexor digitorum superficialis and profundus to the index finger
The index (and middle) finger flexors are supplied by the median nerve
With median nerve palsy, the index finger cannot flex properly and appears to "point"

Note: The classic "pointing index finger" in a context of trying to make a fist is indeed median nerve (anterior interosseous nerve branch).

Q14. Major tendon transfer for restoration of extension substituting for loss of ECRL and ECRB:

Answer: a. Brachioradialis

Reason: ECRL (Extensor Carpi Radialis Longus) and ECRB (Extensor Carpi Radialis Brevis) provide wrist extension. When lost (radial nerve palsy), tendon transfer is needed. The Brachioradialis is commonly transferred to restore wrist extension as it:

Is a strong flexor that can be repurposed
Has adequate excursion
Is supplied by the radial nerve (but proximal to where the nerve is often injured)

The brachioradialis-to-ECRB transfer is a classic tendon transfer for restoring wrist extension in radial nerve palsy.

Q15. Partial claw hand occurs due to paralysis of first and second lumbricals due to:

Answer: Ulnar nerve (as written on the paper "Ulnar")

Reason: Wait - this requires careful analysis:

All 4 lumbricals: 1st and 2nd lumbricals are supplied by median nerve; 3rd and 4th are supplied by ulnar nerve
Claw hand deformity: When lumbricals are paralyzed, the MCP joint hyperextends and IP joints flex = claw
Ulnar nerve palsy causes paralysis of 3rd and 4th lumbricals (ring and little fingers) → "Ring and little finger claw" = classic ulnar claw
Median nerve palsy causes paralysis of 1st and 2nd lumbricals (index and middle fingers)

The question says "partial claw hand due to paralysis of first and second lumbricals" - these are supplied by the median nerve. However, median nerve injury produces a less obvious claw (because the long flexors to index/middle are also weakened by median nerve injury, reducing the claw).

The classic teaching is:

Ulnar nerve = claw hand (ring + little fingers) - "ulnar claw"
Median nerve = ape hand (thenar wasting) + index/middle finger claw

The answer written on the paper says "Ulnar" which appears to be an error. The correct answer for paralysis of the 1st and 2nd lumbricals is MEDIAN NERVE - but the visible/obvious claw in clinical practice is more associated with ulnar nerve. The written answer "Ulnar" likely refers to the classic association of claw hand overall.

For exam purposes: Partial claw (index + middle) = Median nerve; Full/typical claw (ring + little) = Ulnar nerve. If the question says "first and second lumbricals" specifically, the answer is Median nerve.

Summary Table:

Q	Answer	Key Point
P1-Q1	a	Low Ca, low PO4, high ALP = rickets
P1-Q2	b	DEXA scan = gold standard for osteoporosis
P1-Q3	a	CAL spots = Neurofibromatosis (not tuberous sclerosis)
P1-Q4	d	CT shows calcification, ossification AND bony destruction
P1-Q5	d	All three components needed for triage
P1-Q6	d	All three mechanisms cause fractures
P1-Q7	b	Muscle biopsy = gold standard for muscular dystrophy
P1-Q8	a	Vitamin D deficiency = most common cause of osteomalacia
P1-Q9	a	ATLS: A-B-C-D-E
P1-Q10	b	Malunion = most common fracture complication
P2-Q1	d	Hemorrhage control first in exsanguinating patient
P2-Q2	a	Isolated rib fracture + normal CXR = analgesia + reassurance
P2-Q3	d	Calcaneal spur = shoe modifications + stretching first
P2-Q4	c	Ibuprofen max = 1600 mg/day (standard)
P2-Q5	c	Greenstick forearm fracture = MUA + casting
P2-Q6	b	Femur fracture transport = Thomas splint with skin traction
P2-Q7	c	Intubation indicated at GCS ≤ 7
P2-Q8	a	Snuff box tenderness = scaphoid cast + repeat X-ray
P2-Q9	d	Intra-articular fracture = stable fixation + early mobilization
P2-Q10	d	Bilateral bow legs in 5-year-old = self-limiting, observe
P3-Q1	c	Benign tumors do NOT have extraosseous soft tissue component
P3-Q2	c	Malignant tumors CAN invade joints
P3-Q3	b	Transverse = complete fracture; greenstick = incomplete
P3-Q4	c	Osteosarcoma peaks at age 10-20, NOT <10 years
P3-Q5	b	Portal vein is DILATED (>1.3 cm) in cirrhosis
P3-Q6	b	Torus fracture = incomplete fracture type
P4-Q6	a	Hamstring tightness causes limited knee extension
P4-Q7	d	Medial tibial torsion DOES affect Q angle
P4-Q8	d	Positive pivot shift = diagnostic sign, not indication
P4-Q9	b	Straight leg lowering = OKC knee extension exercise
P4-Q10	c	4H = preferred practice pattern for TKA
P4-Q11	a	Intracapsular fractures compromise femoral head blood supply
P4-Q12	b	Girdlestone = excision arthroplasty
P4-Q13	b	Pointing index finger = median nerve injury
P4-Q14	a	Brachioradialis transfer for ECRL/ECRB loss
P4-Q15	Median	1st & 2nd lumbricals = median nerve (not ulnar)

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