Here are the answers for questions 221-224 (Essential Orthopaedics/Maheshwari):

Q221. A child with upper leg swelling with pulmonary nodule - most probable diagnosis: C. Osteosarcoma Osteosarcoma is the most common primary malignant bone tumor in children/adolescents, classically arising around the knee (distal femur/proximal tibia - "upper leg" swelling), and it metastasizes early and hematogenously to the lungs, producing pulmonary nodules ("cannonball" metastases).

Q222. Calcium content of bone is increased in: D. Estrogen supplementation in postmenopausal women Estrogen inhibits osteoclastic bone resorption. After menopause, estrogen deficiency accelerates bone loss (osteoporosis); replacing estrogen reduces resorption and helps preserve/increase bone calcium content. In contrast, prolonged immobilization, glucocorticoid excess, and hyperparathyroidism all promote bone resorption and decrease bone calcium content.

Q223. Bone dysplasia is due to: B. Faulty development "Dysplasia" literally means abnormal or faulty development of tissue (here, bone/cartilage), as seen in conditions like fibrous dysplasia or skeletal dysplasias - distinct from nutritional, vitamin, or purely hormonal causes.

Q224. Adventitious bursa is: C. Found over bony prominences An adventitious (or acquired) bursa is not present normally at birth - it develops secondary to chronic friction or pressure, typically over a bony prominence exposed to repeated mechanical stress (e.g., over a bunion, olecranon, or ischial tuberosity), unlike true/congenital bursae which occur at fixed anatomical sites over joints.

Q233: A lady with a history of fracture radius, put in a plaster of Paris cast for 4 weeks, who develops swelling of hands with shiny skin after cast removal - the most likely diagnosis is:

B. Reflex sympathetic dystrophy (also known as Complex Regional Pain Syndrome/Sudeck's atrophy)

This is a classic presentation of reflex sympathetic dystrophy (RSD/CRPS), which commonly follows immobilization (e.g., prolonged plaster cast) after a distal radius fracture. It presents with painful swelling, shiny/glossy skin, stiffness, vasomotor changes, and trophic skin changes in the hand - a well-recognized complication of Colles' fracture and prolonged cast immobilization.

Q237. Stress fracture is most common in: D. Neck of femur

Stress fractures result from repetitive submaximal loading rather than a single traumatic event. Among the given options, the neck of femur is a classic and most commonly cited site for stress fractures (seen especially in athletes, military recruits, and the elderly with osteoporotic bone), as referenced in Maheshwari's Essential Orthopaedics. Other well-known stress fracture sites not listed here include the tibia and second metatarsal (march fracture), but of the choices given, femoral neck is correct.

Q261. Positioning a CVA patient in side-lying on the hemiplegic side - which is NOT a benefit: C. Increases the influence of tonic neck and labyrinthine reflexes

Side-lying on the hemiplegic side is used specifically to minimize/inhibit the influence of abnormal tonic reflexes (tonic neck and labyrinthine reflexes) that contribute to spasticity, not increase them. The actual benefits of this position include: elongating the hemiplegic side to reduce spasticity (A), freeing the unaffected extremity for functional tasks (B), and providing weight-bearing input that enhances proprioceptive awareness of the hemiplegic side (D). Increasing reflex influence would be counterproductive to rehabilitation goals, making C the correct "except" answer.