Fill the correct answer with proper reason
Reading File
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I have enough information from the library and my medical knowledge to answer all 19 questions comprehensively. Here are all the answers with full reasoning:
SECTION "A" - BCQ Answers with Reasoning
Q1. Patient in ER - severe pain & profuse bleeding from leg after RTA
Answer: d) Control of obvious hemorrhage
In ATLS protocol, the primary survey follows A-B-C-D-E. However, massive external hemorrhage is treated as a "zero step" - control of life-threatening bleeding is done simultaneously with or even before airway management. Profuse bleeding from a limb is immediately life-threatening (haemorrhagic shock), so direct pressure/tourniquet to stop bleeding is the first priority. Airway management follows right after.
Q2. 29-year-old lady, isolated 4th posterior rib fracture, severe pain, normal chest X-ray
Answer: a) Analgesics and reassurance
A single isolated rib fracture with a normal chest X-ray (no pneumothorax, no haemothorax, no flail chest) is managed conservatively with adequate analgesia (NSAIDs, intercostal nerve block if needed) and reassurance. The main risk is splinting due to pain leading to atelectasis, so pain control is the priority. ORIF is never indicated for a single rib fracture.
Q3. Lady with left heel pain, calcaneal spur on X-ray, GP suggested surgery
Answer: d) Needs shoe modifications and stretching exercises
A calcaneal spur (plantar fasciitis) is primarily managed conservatively. First-line treatment includes:
- Heel cushions and shoe modifications
- Plantar fascia and Achilles tendon stretching exercises
- NSAIDs for pain
Surgery (fasciotomy) is a last resort only after 6-12 months of failed conservative treatment. The spur itself is not always the pain generator - plantar fasciitis is the real diagnosis.
Q4. Maximum recommended dose of Ibuprofen in 24 hours
Answer: c) 1600 mg/day
The standard adult dose of ibuprofen is 400 mg three times daily = 1200 mg/day for OTC use. However, the maximum recommended therapeutic dose is 1600 mg/day (400 mg QID) for prescription use in adults. The absolute maximum in clinical practice can reach 2400 mg/day only under medical supervision. For a non-prescription/standard recommendation, 1600 mg/day (as prescribed here - 600 mg TID = 1800 mg, but the question asks maximum recommended) - the correct answer is c) 1600 mg/day as the standard maximum recommended daily dose for ibuprofen in adults.
Q5. 3-year-old boy - greenstick fractures of radius and ulna mid-shafts
Answer: c) Manipulation under Anesthesia and casting
Greenstick fractures in children are incomplete fractures (the bone bends and partially breaks). Treatment is:
- Manipulation under anesthesia (MUA) to complete and reduce the fracture, followed by casting
- Children's bones have excellent remodeling potential
- Open reduction is NOT needed for simple greenstick fractures
- Simple casting without manipulation may not correct angulation adequately
Q6. 23-year-old, mid-shaft isolated femur fracture - safest transport
Answer: b) Apply Thomas splint with skin traction before shifting
For femoral shaft fractures, the Thomas splint with skin traction is the gold standard for pre-transport immobilization. It:
- Reduces blood loss (up to 1-2L can be lost in femur fracture - traction reduces the volume)
- Reduces pain and risk of fat embolism by immobilizing fracture ends
- Makes transport safe
- Intramedullary nailing is definitive treatment, NOT done before shifting
Q7. 27-year-old, RTA, GCS 14/15, definite indication for intubation
Answer: c) GCS 07 or below
The standard threshold for definitive airway management (intubation) in trauma is GCS ≤ 8. This is because patients with GCS ≤ 8 cannot protect their airway. A GCS of 7 or below is the accepted cut-off. GCS 9 or below is too liberal; GCS 3 or 5 are too late/severe as "indications."
Q8. 40-year-old, fall on outstretched hand, tenderness over anatomical snuff box, normal X-ray
Answer: a) Application of Scaphoid cast and repeat X-rays after two weeks
Tenderness in the anatomical snuff box = scaphoid fracture until proven otherwise, even with normal initial X-rays. Scaphoid fractures are frequently missed on initial radiographs. Management:
- Apply a scaphoid (thumb spica) cast immediately
- Repeat X-rays at 10-14 days (bone resorption at fracture site becomes visible)
- If still negative but clinically suspicious, MRI is the gold standard
- Never leave untreated - risk of avascular necrosis of proximal pole
Q9. 50-year-old lady, displaced intra-articular distal humerus fracture - basic rule
Answer: d) Stable fixation and early mobilization to prevent stiffness
The cardinal principle for intra-articular fractures is:
- Anatomical reduction (restore joint surface)
- Stable fixation (allows early movement)
- Early mobilization - the elbow joint is notorious for stiffness, so early ROM prevents contracture
Rigid fixation with late mobilization leads to stiffness and poor outcomes. This is the AO principle for peri-articular fractures.
Q10. 5-year-old boy, bowing of both knees (genu varum)
Answer: d) It is a self-limiting issue that needs observation only
Physiological genu varum (bow-legs) is normal in children up to age 2-3 years. In a 5-year-old with no other features:
- It is usually physiological and self-corrects by age 6-7 as the child develops valgus alignment
- No splints, surgery, or imaging needed unless severe, progressive, or asymmetric
- Parents need reassurance and observation
- Pathological causes (rickets, Blount disease) should be excluded if severe
Q11. Elderly woman, mid-shaft humerus oblique fracture, intact skin, no neurovascular damage, history of frozen shoulder (opposite side, recovered)
Answer: c) Plaster of Paris casting
For a closed mid-shaft humerus fracture in an elderly patient:
- Conservative management is the gold standard
- U-slab/coaptation splint (a form of POP) with collar-and-cuff sling allows gravity to aid reduction
- The history of frozen shoulder on the opposite side makes early mobilization important - but the fractured arm needs initial immobilization
- Open reduction is reserved for failed conservative treatment, neurovascular compromise, or specific fracture patterns
- POP/functional bracing is appropriate here
Q12. Open fracture of right tibia - could not close wound, needed plastic surgery for flap coverage
Answer: d) Type 3B
Gustilo-Anderson Classification:
- Type 1: <1 cm wound, clean, low energy
- Type 2: 1-10 cm wound, moderate contamination
- Type 3A: >10 cm wound, adequate soft tissue coverage possible despite extensive laceration/crush
- Type 3B: >10 cm wound with periosteal stripping, bone exposed, requires local/free flap for coverage - wound cannot be closed primarily
- Type 3C: Any size wound with arterial injury requiring repair
Since plastic surgery was needed for flap coverage (cannot close wound primarily), this is Type 3B.
Q13. 12-year-old girl, progressive varus deformity of ankle, prior ankle sprain treated with back slab - Salter-Harris Classification
Answer: d) Type 5
Salter-Harris Classification:
- Type 1: Slip through physis only
- Type 2: Through physis + metaphysis (most common)
- Type 3: Through physis + epiphysis
- Type 4: Through metaphysis + physis + epiphysis
- Type 5: Crush/compression injury of the physis - often missed initially, presents later with growth disturbance and progressive deformity
The key here: the initial injury appeared minor (treated as ankle sprain with back slab), but it caused premature physeal closure leading to progressive varus deformity. This is the hallmark presentation of Salter-Harris Type 5 - it is commonly missed at the time of injury and diagnosed retrospectively when growth arrest occurs.
Q14. 17-year-old, short stature, shorter limbs than trunk, closed physes, saddle nose, larger head, stubby trident hands, frontal bossing, thoracolumbar kyphosis
Answer: a) Achondroplasia
Classic features of Achondroplasia (autosomal dominant, FGFR3 mutation):
- Rhizomelic shortening (proximal limbs shorter)
- Normal trunk length (limbs short relative to trunk)
- Trident hands (stubby, spread fingers)
- Frontal bossing and midfacial hypoplasia (saddle nose)
- Macrocephaly (larger head)
- Thoracolumbar kyphosis/lordosis
- Normal intelligence and lifespan
- Early physeal closure
Q15. Elderly male, severe bony pains for 6 months, hat size increasing, bent tibia, larger head, forward stooping posture, X-ray shows coarse thickened cortex
Answer: d) Paget's disease
Classic presentation of Paget's Disease of Bone (Osteitis Deformans):
- Increasing hat size - classic hallmark (skull enlargement)
- Bent/bowed tibia - "sabre tibia"
- Coarse, thickened cortex on X-ray with mixed lytic/sclerotic pattern
- Progressive bone pain
- Waddling/stooping gait
- Elevated alkaline phosphatase
- Risk of sarcomatous change
Q16. 20-year-old male, back pain 1 year, restricted spinal mobility - confirming test
Answer: c) HLA B27
Young male with chronic back pain and restricted spinal mobility = Ankylosing Spondylitis until proven otherwise.
- HLA-B27 is present in 95% of Caucasian patients with AS
- It is the most specific confirmatory test for the diagnosis in this clinical context
- X-ray lumbar spine may show sacroiliitis and bamboo spine, but early changes can be missed
- XRAY is not as specific; HLA-B27 + clinical picture confirms the diagnosis
Q17. 50-year-old female, distal radius fracture, post-cast removal at 6 weeks, swollen, shiny hand, all joints stiff, severely painful to touch
Answer: b) Regional Sympathetic Dystrophy (RSD)
This is the classic presentation of Complex Regional Pain Syndrome Type 1 (CRPS-1) / Reflex Sympathetic Dystrophy (RSD):
- Follows a fracture or minor trauma
- Diffuse swelling, shiny skin
- Allodynia (severely painful to touch)
- Stiffness of ALL joints (not just fracture site)
- Vasomotor changes
- Can follow prolonged immobilization
Q18. Foot drop after intragluteal injection, cannot extend big toe or dorsiflex ankle, sensation intact on plantar aspect
Answer: a) Common peroneal part of the sciatic nerve
Detailed reasoning:
- Foot drop (inability to dorsiflex) + inability to extend big toe = deep peroneal nerve function (EHL, tibialis anterior)
- Intact plantar sensation = tibial nerve spared
- The sciatic nerve has two components: common peroneal (lateral) and tibial (medial)
- Intragluteal injections classically injure the common peroneal component of the sciatic nerve (it is more superficially placed and runs laterally)
- The common peroneal nerve is more vulnerable to injection injury than the tibial component
- This explains why dorsiflexion is lost but plantar sensation is intact
The answer is a) Common peroneal part of the sciatic nerve (not just "deep peroneal" because the injury is at the gluteal level, affecting the common peroneal component of the sciatic nerve before it divides).
Q19. Classification for neck of femur fracture
Answer: c) Gardens
Garden's Classification (1961) is the standard classification for intracapsular (subcapital) neck of femur fractures:
- Garden I: Incomplete/impacted (valgus impacted)
- Garden II: Complete, undisplaced
- Garden III: Complete, partially displaced
- Garden IV: Complete, fully displaced
Other classifications:
- Gartland - Supracondylar humerus fractures in children
- Schatzker - Tibial plateau fractures
- Salter-Harris - Physeal/growth plate injuries
Summary Table
| Q | Answer | Key Reason |
|---|---|---|
| 1 | d) Control hemorrhage | ATLS - life-threatening external bleed |
| 2 | a) Analgesics & reassurance | Single rib, normal CXR - conservative |
| 3 | d) Shoe modifications & stretching | Plantar fasciitis - conservative first |
| 4 | c) 1600 mg/day | Max recommended ibuprofen dose |
| 5 | c) MUA and casting | Greenstick in child - manipulate + cast |
| 6 | b) Thomas splint + skin traction | Safe femur fracture transport |
| 7 | c) GCS 07 or below | Intubation threshold = GCS ≤ 8 |
| 8 | a) Scaphoid cast + repeat X-ray | Snuffbox tenderness = scaphoid fracture |
| 9 | d) Stable fixation + early mobilization | AO principle for intra-articular fractures |
| 10 | d) Self-limiting, observation only | Physiological genu varum in children |
| 11 | c) Plaster of Paris casting | Closed mid-shaft humerus - conservative |
| 12 | d) Type 3B | Gustilo-Anderson - needs flap coverage |
| 13 | d) Type 5 | Salter-Harris - crush, growth arrest |
| 14 | a) Achondroplasia | Trident hands, frontal bossing, saddle nose |
| 15 | d) Paget's disease | Increasing hat size, bent tibia, thick cortex |
| 16 | c) HLA-B27 | Young male, back pain - confirm AS |
| 17 | b) RSD | Post-cast: swollen, shiny, allodynia |
| 18 | a) Common peroneal part of sciatic | Intragluteal injection, foot drop |
| 19 | c) Gardens | Neck of femur fracture classification |
Fill the correct true or false with proper reason
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I have all the information needed. Here are all answers with complete reasoning:
TRUE / FALSE ANSWERS WITH REASONING
PAGE 4 of 7
Q1. Patient cannot extend her wrist after Humerus shaft fracture
| Option | Answer | Reason |
|---|---|---|
| a. Muscle injury | FALSE | Wrist extension muscles (extensors) are intact - the problem is nerve supply, not the muscle itself |
| b. Median nerve injury | FALSE | Median nerve does NOT supply wrist extensors; it supplies wrist flexors and thenar muscles |
| c. Ulnar nerve injury | FALSE | Ulnar nerve supplies intrinsics and FCU, not wrist extensors |
| d. Radial nerve injury | TRUE | The radial nerve winds around the spiral groove (radial groove) of the humerus shaft. Mid-shaft humerus fractures classically injure the radial nerve, causing wrist drop (inability to extend the wrist). This is the most common nerve injured in humerus shaft fractures (~22%). |
Q2. Patient cannot make an OK sign after supracondylar fracture of right Humerus
| Option | Answer | Reason |
|---|---|---|
| a. Median nerve injury | FALSE | While median nerve is injured in supracondylar fractures, the OK sign specifically tests the anterior interosseous nerve (AIN) - a branch of the median nerve |
| b. Posterior interosseous nerve injury | TRUE | Wait - this needs correction. The inability to make an OK sign (thumb-index pinch forming a circle) = Anterior Interosseous Nerve (AIN) injury (branch of median nerve). AIN supplies FPL + FDP of index = cannot flex distal phalanges = cannot make OK sign. However, the student has marked TRUE for "Posterior interosseous nerve." The correct answer is AIN (anterior interosseous nerve), not posterior. The student's answer here is INCORRECT - it should be FALSE for PIN. |
| c. Radial nerve injury | FALSE | Radial nerve causes wrist drop, not inability to make OK sign |
| d. Ulnar nerve injury | FALSE | Ulnar nerve affects ring/little finger, not the thumb-index OK sign |
Correction note: The TRUE answer for Q2 should be a (Median nerve / AIN branch) - inability to make an OK sign is the hallmark of Anterior Interosseous Nerve (AIN) injury, which is a branch of the median nerve, commonly injured in supracondylar humerus fractures.
PAGE 5 of 7
Q3. 20-year-old, RTA, loss of normal contour of left shoulder, cannot touch opposite shoulder - radiological diagnosis
| Option | Answer | Reason |
|---|---|---|
| a. Acromioclavicular joint dislocation | FALSE | AC dislocation causes step deformity at the top of shoulder, not loss of normal rounded contour |
| b. Anterior shoulder dislocation | TRUE | Loss of normal rounded deltoid contour ("squared-off shoulder"), inability to touch opposite shoulder (Dugas test positive) = classic anterior shoulder dislocation. The humeral head moves anteriorly, creating a hollow below the acromion. This is the most common (95%) direction of shoulder dislocation. |
| c. Posterior shoulder dislocation | FALSE | Posterior dislocation is rare, typically caused by seizures/electrocution; arm is in internal rotation |
| d. Proximal humerus fracture | FALSE | Fractures cause swelling and tenderness but not the characteristic squared-off shoulder contour change |
Q4. Patient cannot feel tip of little finger after sharp knife injury - structure injured
| Option | Answer | Reason |
|---|---|---|
| a. Anterior interosseous nerve | FALSE | AIN is purely motor (no sensory) |
| b. Median nerve | FALSE | Median nerve supplies the lateral 3½ fingers; the little (5th) finger is NOT in its territory |
| c. Radial nerve | FALSE | Radial nerve supplies dorsal sensation of lateral hand/fingers, not the palmar tip of little finger |
| d. The ulnar nerve | TRUE | The ulnar nerve supplies sensation to the medial 1½ fingers - specifically the little finger (5th) and medial half of ring finger (4th), both dorsal and palmar surfaces. Loss of sensation at the tip of the little finger = ulnar nerve injury. |
Q5. Middle-aged lady, diffuse swelling of left upper limb, left mastectomy 6 months ago, no trauma/fever
| Option | Answer | Reason |
|---|---|---|
| a. Filariasis | FALSE | Filariasis causes lymphedema but in a post-mastectomy patient this is not the primary diagnosis |
| b. Cellulitis | FALSE | Cellulitis causes erythema, warmth, fever - patient denies fever |
| c. Venous thrombosis | FALSE | DVT of upper limb can cause swelling but would present acutely with pain; chronic post-mastectomy swelling has a clear cause |
| d. Lymph oedema | TRUE | Post-mastectomy lymphedema is the classic complication. Axillary lymph node dissection during mastectomy disrupts lymphatic drainage from the ipsilateral upper limb, causing chronic, progressive, non-pitting lymphedema. No fever, no trauma - purely secondary to surgical lymphatic disruption. |
Q6. 20-year-old male vs 46-year-old male - probability of recurrent anterior shoulder dislocation
| Option | Answer | Reason |
|---|---|---|
| a. Increased (in younger patient) | TRUE | Younger age is the single greatest risk factor for recurrent shoulder dislocation. In patients <20 years, recurrence rate is >90%. In patients >40 years, recurrence rate drops to ~10-15%. This is because younger patients have more lax ligaments, higher activity levels, and the initial dislocation is more likely to have torn the Bankart lesion, which heals poorly in young active patients. |
| b. Decreased | FALSE | |
| c. Same | FALSE | |
| d. Age not related | FALSE | Age is the MOST important predictor of recurrence |
Q7. 36-year-old, head-on bus collision, lower limb in flexion, adduction, internally rotated - X-ray finding
| Option | Answer | Reason |
|---|---|---|
| a. Anterior dislocation of right hip | FALSE | Anterior dislocation presents with abduction + external rotation |
| b. Central dislocation of right hip | FALSE | Central dislocation has no classic limb position deformity |
| c. Fracture of right femoral neck | FALSE | Neck fracture presents with external rotation and shortening |
| d. Posterior dislocation of right hip | TRUE | The classic triad of posterior hip dislocation is: Flexion + Adduction + Internal Rotation of the affected limb. Mechanism: knee hits dashboard (dashboard injury) driving the femoral head posteriorly. This is confirmed by textbook references (Campbell's, Rockwood & Green's). |
Q8. 1-month-old child, left foot deformity since birth, restricted dorsiflexion, adducted, in Varus
| Option | Answer | Reason |
|---|---|---|
| a. Talipes Equinovarus | TRUE | The description perfectly matches CTEV (Congenital Talipes Equinovarus / Clubfoot): - Equinus = plantarflexion (restricted dorsiflexion) - Varus = inversion of heel - Adductus = forefoot adduction - Congenital (present since birth). This is the classic clubfoot triad: Equinus + Varus + Adductus. |
| b. Talipes equinus | FALSE | Equinus alone = only plantar flexion, no varus/adductus component |
| c. Talipes equinovalgus | FALSE | Valgus = eversion, but this child has varus |
| d. Vertical Talus | FALSE | Vertical talus causes a "rocker-bottom" foot with convex plantar surface - the opposite deformity |
Q9. Newborn, wider perineum, restricted left hip abduction, Ortolani and Barlow tests positive
| Option | Answer | Reason |
|---|---|---|
| a. Slipped capital femoris | FALSE | SCFE occurs in adolescents, not newborns |
| b. Right hip dislocation | FALSE | The restricted abduction and positive tests are on the LEFT side |
| c. Left hip developmental dysplasia | TRUE | Classic presentation of DDH (Developmental Dysplasia of the Hip): - Wider perineum (bilateral DDH spreads perineum; left side dislocation also widens) - Restricted abduction of affected hip - Positive Ortolani (clunk felt as dislocated hip relocates on abduction) - Positive Barlow (hip dislocates on adduction + posterior pressure) - Newborn age = correct screening window |
| d. Acute fracture of femoral neck | FALSE | Newborns don't sustain femoral neck fractures without major trauma |
Q10. 40-year-old, fall on outstretched hand, left wrist pain, swelling, restricted movement, dinner fork deformity
| Option | Answer | Reason |
|---|---|---|
| a. Colles' fracture | TRUE | "Dinner fork deformity" is the pathognomonic description of Colles' fracture. It is a fracture of the distal radial metaphysis with: - Dorsal displacement and angulation - Radial deviation - The lateral profile resembles a dinner fork. Mechanism: fall on outstretched hand. Most common in elderly, but can occur at 40 years. |
| b. Radial head fracture | FALSE | Radial head fractures present with elbow pain, not wrist deformity |
| c. Scaphoid fracture | FALSE | Scaphoid fractures cause snuffbox tenderness without visible deformity |
| d. Ulnar shaft fracture | FALSE | Ulnar shaft fracture causes forearm deformity, not the dinner fork wrist pattern |
PAGE 6 of 7
Q11. Middle-aged patient, left shoulder pain, restricted movement, cannot touch opposite shoulder, loss of normal contour, no neurovascular deficit - clinical diagnosis
| Option | Answer | Reason |
|---|---|---|
| a. Anterior shoulder dislocation | TRUE | Identical clinical picture to Q3 above. Loss of normal rounded shoulder contour + inability to touch opposite shoulder (positive Dugas sign) = anterior shoulder dislocation. The humeral head dislocates anteriorly/inferiorly, creating a squared-off shoulder and a palpable gap under the acromion. |
| b. Central shoulder dislocation | FALSE | Not a standard shoulder dislocation type |
| c. Inferior shoulder dislocation | FALSE | Luxatio erecta - very rare, arm locked overhead |
| d. Posterior shoulder dislocation | FALSE | Posterior dislocation: arm in internal rotation, fixed adduction - different presentation |
Q12. Patient after left shoulder dislocation treatment - lateral shoulder numbness + weakness in abducting shoulder
| Option | Answer | Reason |
|---|---|---|
| a. Axillary nerve injury | TRUE | The axillary nerve is the nerve most commonly injured in anterior shoulder dislocation. It wraps around the surgical neck of the humerus and supplies: - Deltoid muscle (abduction of shoulder) - Teres minor - Sensation over the "regimental badge" area = lateral aspect of the upper arm / shoulder. Loss of lateral shoulder sensation + weak abduction = classic axillary nerve injury. |
| b. Median nerve injury | FALSE | Median nerve: forearm/hand, not shoulder |
| c. Musculocutaneous nerve injury | FALSE | Musculocutaneous: supplies biceps (elbow flexion) and lateral forearm sensation |
| d. Radial nerve injury | FALSE | Radial nerve: wrist/finger extension |
Q13. 5-year-old, Salter-Harris Type 5 injury to distal tibial epiphysis - counseling for parents
| Option | Answer | Reason |
|---|---|---|
| a. Debridement would do the job | FALSE | Debridement is for open/infected wounds - not relevant here |
| b. It will heal if treatment is done on time | FALSE | SH Type 5 injuries have a poor prognosis regardless of timely treatment because the physis itself is crushed |
| c. Salter-Harris is not a reliable prognosis indicator | FALSE | SH classification IS a reliable prognosis indicator - higher types have worse prognosis |
| d. Very high risk for future growth of the distal tibia | TRUE | Salter-Harris Type 5 is a crush/compression injury of the entire physis (growth plate). It is the most serious type because the germinal cells of the physis are destroyed. This leads to premature physeal closure, growth arrest, and angular deformity. It carries the worst prognosis for normal growth. Parents must be counseled about high risk of future growth disturbance and limb length discrepancy. |
Q14. 70-year-old male, pain/swelling left thigh after trivial injury, known prostate cancer under treatment, X-ray: subtrochanteric left hip fracture
| Option | Answer | Reason |
|---|---|---|
| a. Insufficient fracture | FALSE | Insufficiency fractures occur in osteoporotic bone under normal stress - possible but less likely given active cancer |
| b. Trauma | FALSE | The injury was "trivial" - normal bone wouldn't fracture from trivial trauma |
| c. Pathological fracture | TRUE | Pathological fracture = fracture occurring in diseased/weakened bone with minimal or no trauma. Prostate cancer is one of the most common cancers to metastasize to bone (osteoblastic metastases). The subtrochanteric region is a classic site for metastatic fractures. A "trivial injury" causing a fracture in a known cancer patient = pathological fracture until proven otherwise. |
| d. Osteoporosis | FALSE | While osteoporosis causes fragility fractures, in a known cancer patient, metastasis is the primary concern and diagnosis |
Q15. 1-month-old child diagnosed with congenital hip dysplasia (DDH) - signs
| Option | Answer | Reason |
|---|---|---|
| a. Wider Perineum | TRUE | In bilateral DDH (or even unilateral), the displaced femoral head widens the perineum. This is a classic sign of DDH in newborns. |
| b. Normal Abduction of Hip | FALSE | Abduction is RESTRICTED in DDH (not normal). The dislocated hip cannot be abducted normally - this restriction is a key diagnostic sign. |
| c. Positive Barlow's Test | TRUE | Barlow's test: adduction + posterior pressure dislocates the hip if unstable = POSITIVE in DDH - confirms the diagnosis. |
| d. Negative Ortolani's Test | FALSE | Ortolani's test is POSITIVE in DDH (abduction produces a clunk as the dislocated hip relocates). A negative Ortolani would suggest no dislocation - which contradicts the diagnosis. |
Q16. 30-year-old lady, back pain 6 months, pain rising from lying, CBC/ESR normal, X-ray: squaring + fish vertebrae, doctor suspects osteomalacia - initial investigation for screening
| Option | Answer | Reason |
|---|---|---|
| a. Muscle and bone biopsy | FALSE | Biopsy is invasive; used only when diagnosis remains uncertain after biochemical workup |
| b. Serum Alkaline Phosphatase | TRUE | Serum Alkaline Phosphatase (ALP) is the best initial screening test for osteomalacia. In osteomalacia, ALP is markedly elevated due to increased osteoblastic activity trying to mineralize unmineralized osteoid. It is cheap, widely available, and highly sensitive. Fish vertebrae + squaring on X-ray = classic osteomalacia radiological signs. |
| c. Serum Vitamin D3 level | FALSE | While Vit D level confirms etiology, ALP is the initial screening test before proceeding to vitamin D levels |
| d. Urinalysis | FALSE | Not relevant for osteomalacia screening |
PAGE 7 of 7
Q17. Young girl, bone pains, lives in apartment (limited sun exposure), trouble with digestion (malabsorption)
| Option | Answer | Reason |
|---|---|---|
| a. She is having osteoporosis | FALSE | Osteoporosis = loss of bone mass/density; alkaline phosphatase is normal in osteoporosis; no Looser zones |
| b. She is having osteomalacia | TRUE | Young girl + indoor life (no sun = no Vit D synthesis) + malabsorption (cannot absorb dietary Vit D/calcium) + bone pains = osteomalacia (failure of bone mineralization due to Vit D deficiency). |
| c. Her alkaline phosphatase level will be high | TRUE | ALP is elevated in osteomalacia (active unmineralized osteoid deposition triggers osteoblast activity, releasing ALP). This is a key distinguishing feature from osteoporosis. |
| d. She may have Looser zones in her pelvic X-rays | TRUE | Looser zones (pseudofractures) are pathognomonic of osteomalacia. They are lucent bands perpendicular to the bone cortex, commonly seen in the pubic rami, femoral neck, and scapula. They represent unmineralized osteoid seams. |
Q18. 40-year-old man, RTA, unconscious, deformity of right leg - statements about management
| Option | Answer | Reason |
|---|---|---|
| a. He should be managed according to ATLS protocol | TRUE | Any unconscious trauma patient = ATLS protocol (Airway → Breathing → Circulation → Disability → Exposure). This is non-negotiable. |
| b. His leg should be pulled and cast applied first | FALSE | Never treat an extremity injury before securing ABC. Fracture management is secondary in an unconscious poly-trauma patient. |
| c. His airway should be secured before doing anything | FALSE | This is TRUE in principle, but in ATLS, massive external hemorrhage control is done simultaneously ("C-ABCDE" in hemorrhagic shock). However, in the context of these options where airway IS part of ATLS, the answer depends on interpretation. Per strict ATLS: Airway IS first. But the student marked FALSE - this may be because option (a) already encompasses airway as part of ATLS, and option (c) is redundant/misleading. Given he is unconscious with a limb deformity (closed), airway should be secured - so technically this should be TRUE. |
| d. He can become quadriplegic if not managed properly | TRUE | An unconscious RTA patient must be assumed to have a cervical spine injury until proven otherwise. Improper handling (e.g., not using a collar, rough movement) can convert an incomplete spinal injury to a complete one, resulting in quadriplegia. |
Q19. 6-year-old girl, bilateral flat foot, healthy and active, no trauma - best treatment
| Option | Answer | Reason |
|---|---|---|
| a. Observation and reassurance to parents | TRUE | Physiological flat foot (pes planus) is extremely common in children up to age 6-8 years and is almost always flexible (arch appears when standing on tiptoe). It is self-correcting as the plantar fat pad resolves and the arch develops. A healthy, asymptomatic, active 6-year-old with bilateral flat feet requires only reassurance - no treatment is needed. |
| b. Plaster treatment | FALSE | Plaster is not indicated for physiological flexible flat foot |
| c. Special shoes | FALSE | No evidence that arch supports/special shoes improve outcomes in physiological flat foot |
| d. Surgical correction | FALSE | Surgery is absolutely contraindicated in a flexible, asymptomatic child |
Q20. Classification of peads (peds = pediatric) bone fractures
| Option | Answer | Reason |
|---|---|---|
| a. Salter and Harris | TRUE | The Salter-Harris classification is THE standard classification specifically for pediatric physeal (growth plate) injuries. It is universally used and is the most important fracture classification in pediatric orthopedics. |
| b. Gustilo Anderson | FALSE | Gustilo-Anderson classifies open fractures (by wound size and contamination) - applicable to all ages, not specific to pediatric bone fractures |
| c. AO | FALSE | AO classification is a comprehensive adult long bone fracture classification system |
| d. Neer's | FALSE | Neer's classification is for proximal humerus fractures in adults |
Quick Summary Table
| Q | Key Point |
|---|---|
| 1 | Radial nerve in radial groove → wrist drop in humerus shaft fracture |
| 2 | AIN (branch of median) → OK sign loss in supracondylar fracture |
| 3 | Anterior shoulder dislocation → loss of contour, cannot touch opposite shoulder |
| 4 | Ulnar nerve → sensation of little finger tip |
| 5 | Post-mastectomy → lymphedema |
| 6 | Young age → highest recurrence risk for shoulder dislocation |
| 7 | Flexion + adduction + IR = posterior hip dislocation |
| 8 | Equinus + varus + adductus since birth = CTEV (clubfoot) |
| 9 | Ortolani/Barlow +ve + restricted abduction = DDH |
| 10 | Dinner fork deformity = Colles' fracture |
| 11 | Loss of contour + Dugas sign = anterior shoulder dislocation |
| 12 | Lateral shoulder numbness + weak abduction = axillary nerve |
| 13 | SH Type 5 = crush physis = worst growth prognosis |
| 14 | Known cancer + trivial fracture = pathological fracture |
| 15 | DDH: wide perineum ✓, restricted abduction (not normal), +Barlow ✓, +Ortolani (not negative) |
| 16 | Osteomalacia screening = Serum ALP |
| 17 | Osteomalacia: ALP high ✓, Looser zones ✓ |
| 18 | ATLS protocol + spinal precautions (quadriplegia risk) |
| 19 | Flexible flat foot age 6 = observation only |
| 20 | Salter-Harris = pediatric bone/physeal fracture classification |
Fill the correct true or false with proper reason
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I have all the information needed. Here are all answers with complete True/False markings and reasoning:
TRUE / FALSE ANSWERS WITH FULL REASONING
Q3. GCS for a patient making incomprehensible sounds, withdrawing from pain, and eyes opening to pain
Calculating GCS:
| Component | Response | Score |
|---|---|---|
| Eye Opening (E) | Opens to pain | 2 |
| Verbal (V) | Incomprehensible sounds | 2 |
| Motor (M) | Withdraws from pain | 4 |
| TOTAL | = 8 |
| Option | Answer | Reason |
|---|---|---|
| a. 9 | FALSE | E2 + V2 + M4 = 8, not 9 |
| b. 7 | FALSE | 8, not 7 |
| c. 6 | FALSE | 8, not 6 |
| d. 8 | TRUE | Correct calculation: Eye opening to pain = 2, Incomprehensible sounds = 2, Withdrawing from pain = 4. Total = 8. Confirmed by Rosen's Emergency Medicine: "2 points for eye opening to pain, 2 points for incomprehensible sounds, and 4 points for withdrawing = 8." |
Q4. Characteristic feature of psoriatic arthritis is:
| Option | Answer | Reason |
|---|---|---|
| a. Symmetrical swelling of small joints | FALSE | Symmetrical small joint involvement = Rheumatoid Arthritis, NOT psoriatic arthritis. Psoriatic arthritis is typically asymmetric. |
| b. Swelling of large joints | FALSE | Psoriatic arthritis does involve large joints but this alone is not its characteristic/distinguishing feature |
| c. Swelling of the entire digit | TRUE | Dactylitis ("sausage digit") - swelling of the entire finger or toe - is the hallmark and most characteristic feature of psoriatic arthritis. It involves the tendon sheaths and joints throughout the entire ray of the digit, giving it a "sausage" appearance. This is a distinguishing feature from RA. Confirmed by textbook: "Dactylitis, a swelling of the entire finger causing a sausage digit." |
| d. All of the above | FALSE | Since a and b are not characteristic, "all of the above" is incorrect |
Q5. Which joint does gout commonly involve?
| Option | Answer | Reason |
|---|---|---|
| a. 1st Metacarpophalangeal joint | FALSE | 1st MCP (hand) is not the classic site - it can be involved but is not the primary/classic joint |
| b. 1st Metatarsophalangeal joint | TRUE | The 1st MTP joint (big toe) = podagra = the classic, most common joint involved in gout. Seen in ~75% of gout patients at some point. Urate crystals preferentially deposit here due to lower temperature and reduced circulation. Confirmed by multiple textbooks: "The classic location for gout is the first MTP joint (podagra)." |
| c. Knee joint | FALSE | Knee can be involved in gout but is NOT the most common site |
| d. Elbow joint | FALSE | Elbow (olecranon bursa) can show tophi but is not the primary joint in gout |
Q6. HLA B27 is positive in which of the following
| Option | Answer | Reason |
|---|---|---|
| a. Osteoarthritis | FALSE | Osteoarthritis is a degenerative, non-inflammatory joint disease - no HLA-B27 association |
| b. Rheumatoid arthritis | FALSE | RA is associated with HLA-DR4 and RF, not HLA-B27 |
| c. Spondylosis | FALSE | Spondylosis = degenerative spinal disease - no HLA-B27 link |
| d. Ankylosing spondylitis | TRUE | HLA-B27 is strongly associated with Ankylosing Spondylitis (AS). Present in 88-96% of AS patients (confirmed by Campbell's Operative Orthopaedics). AS is a seronegative spondyloarthropathy affecting the sacroiliac joints and spine. HLA-B27 is also positive in other seronegative spondyloarthropathies (reactive arthritis, psoriatic arthritis, IBD-related arthritis) but AS has the strongest association. |
Q7. Dislocation of elbow joint is most commonly:
| Option | Answer | Reason |
|---|---|---|
| a. Anterior | FALSE | Anterior elbow dislocation is very rare |
| b. Anterolateral | FALSE | Not the most common direction |
| c. Posterolateral | TRUE | Posterolateral is the most common direction of elbow dislocation. The mechanism is a fall on an outstretched hand with the elbow slightly flexed and the forearm supinated - the olecranon pivots and the radius and ulna displace posteriorly and laterally. This is the standard teaching in orthopedics. The typical presentation is elbow held in slight flexion with visible posterior displacement of the olecranon. |
| d. Lateral | FALSE | Pure lateral dislocation is rare |
Note: Some textbooks simply call it "posterior" dislocation as the broad category, with "posterolateral" being the specific subtype. In this question context, c (Posterolateral) is the most precise and correct answer.
Q8. Carpal tunnel is due to entrapment of median nerve:
| Option | Answer | Reason |
|---|---|---|
| a. Under flexor retinaculum at wrist joint | TRUE | Carpal tunnel syndrome is caused by compression of the median nerve as it passes under (deep to) the flexor retinaculum (transverse carpal ligament) at the wrist. The carpal tunnel is bounded by the carpal bones (floor and sides) and the flexor retinaculum (roof). The median nerve is compressed within this tunnel. Confirmed by multiple authoritative textbooks (Tintinalli, Bradley and Daroff's Neurology, Adams and Victor's). |
| b. Over flexor retinaculum at wrist joint | FALSE | The nerve runs UNDER (not over) the retinaculum - the retinaculum forms the roof of the tunnel and compresses the nerve beneath it |
| c. At elbow joint | FALSE | Median nerve entrapment at the elbow = Pronator teres syndrome or anterior interosseous nerve syndrome - not carpal tunnel |
| d. At axilla | FALSE | Axillary entrapment would cause combined median + other nerve deficits |
Q9. Gower's sign is seen in:
| Option | Answer | Reason |
|---|---|---|
| a. Duchenne muscular dystrophy | TRUE | Gower's sign is pathognomonic of Duchenne Muscular Dystrophy (DMD). It describes the characteristic way children with proximal lower limb weakness rise from the floor - they roll to prone, push up on hands and knees, then "walk" their hands up their thighs to climb up their own body, due to severe weakness of hip extensors and quadriceps. It reflects proximal muscle weakness, most classically seen in DMD. |
| b. Myasthenia gravis | FALSE | Myasthenia causes fatigable weakness of ocular, bulbar, and respiratory muscles - Gower's sign is not a feature |
| c. Rickets | FALSE | Rickets causes bone deformity and pain, not proximal muscle weakness requiring Gower's maneuver |
| d. Poliomyelitis | FALSE | Polio causes asymmetric lower motor neurone weakness; Gower's sign is specific to the proximal symmetric muscle weakness of muscular dystrophies |
Q10. Which tumor is most common in elderly patients:
| Option | Answer | Reason |
|---|---|---|
| a. Ewing sarcoma | FALSE | Ewing sarcoma occurs in children and young adults (5-25 years) - it is the primary bone tumor of youth, NOT the elderly |
| b. Chondrosarcoma | TRUE | Chondrosarcoma is the most common primary malignant bone tumor in elderly patients (peak age 40-70 years). Unlike osteosarcoma (young adults) and Ewing's (children), chondrosarcoma increases in incidence with age. It arises from cartilage cells and is the second most common primary malignant bone tumor overall, and the most common in older age groups. |
| c. Both a and b | FALSE | Ewing sarcoma is NOT common in elderly - so "both" is incorrect |
| d. None of the above | FALSE | Chondrosarcoma IS common in elderly |
Summary Table
| Q | Correct Answer | Key Teaching Point |
|---|---|---|
| 3 | d) 8 | E2 (pain) + V2 (incomprehensible) + M4 (withdraws) = GCS 8 |
| 4 | c) Swelling of entire digit | Dactylitis = sausage digit = hallmark of psoriatic arthritis |
| 5 | b) 1st MTP joint | Podagra = classic gout = big toe joint in 75% of cases |
| 6 | d) Ankylosing spondylitis | HLA-B27 positive in 88-96% of AS patients |
| 7 | c) Posterolateral | Most common direction of elbow dislocation |
| 8 | a) Under flexor retinaculum at wrist | Median nerve compressed under transverse carpal ligament |
| 9 | a) Duchenne muscular dystrophy | Gower's sign = proximal weakness, pathognomonic of DMD |
| 10 | b) Chondrosarcoma | Most common primary malignant bone tumor in elderly (40-70 yrs) |
This is a shared conversation. Sign in to Orris to start your own chat.