INI-CET High Yield Questions for Orthopedics

Mastering the INI-CET demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in Orthopedics that are highly likely to appear on the INI-CET. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of Orthopedics concepts, enhancing your confidence and readiness for exam day.

1. Below is a cross-sectional diagram of a bone. Identify the parts and select the correct option.

a) Cancellous bone

b) Volkmann’s canal

c) Compact bone

d) Haversian canals

A)1-a,2-d,3-b,4-c

B)1-a,2-b,3-c,4-d

C)1-c,2-a,3-b,4-d

D) 1-c,2-d,3-b,4-a

Correct Option D - 1-c,2-d,3-b,4-a:

Incorrect Options

Options A, B and C

2. A hypochondriac 20-year-old male comes to the hospital with fatigue, a swollen left knee, loss of appetite, and headache for three weeks. His temperature and vital signs are normal. He admits he does not take regular home-cooked meals and often eats outside. He also frequently suffers from foodborne infections. His blood investigations show raised ESR, Hb 12 g/dL, and WBC 10,000 cells/mm3. A knee X-ray is ordered and returned, as shown in the image below. Subsequent aspiration of the knee yields no signs of infection. What is the most likely diagnosis?

A. Osteoid osteoma

B. Brodie’s abscess

C. TB osteomyelitis

D. Eosinophilic granuloma

Correct Option B - Brodie’s Abscess:

• A three-week history of systemic symptoms such as fatigue, loss of appetite, and headache in a patient with a swollen knee indicates a systemic condition.
• Sterile pus is aspirated from the knee. This finding, coupled with a cavity surrounded by a sclerotic rim in the upper end of the tibia on the X-ray, points towards a diagnosis of subacute osteomyelitis.

Incorrect Options:

Option A - Osteoid Osteoma:

• Brodie's abscess can be confused with osteoid osteoma, due to overlapping features of pain with or without swelling. However, the pain in osteoid osteoma is specifically nocturnal in nature, and patients will often report pain relief following consumption of NSAIDs. The X-ray findings are also very different.

Option C - TB Osteomyelitis:

• This patient has no features or history suggestive of TB infection.

Option D - Eosinophilic Granuloma:

• There are no hematological abnormalities in this patient's blood work. This condition often affects the skull.

3. A 19 year old male presented to the OPD with mild knee pain unrelieved by his pain medication. A knee X-ray revealed a clear osteolytic lesion in the epiphysis of proximal tibia. A biopsy was subsequently performed and the HPE showed sheets of chondroblasts with cobblestone appearance. What is the most likely diagnosis based on the above findings?

A. Chondroma

B. Chondromyxoid fibroma

C. Chondroblastoma

D. Maffusi syndrome

Correct Option C - Chondroblastoma:

• It involves clear lytic lesion in the epiphysis of long bones with sheets of chondroblasts and cobblestone appearance on histopathological examination.

Incorrect Options:

Option A - Chondroma: It commonly occurs in the hands and feet. It involves expansile, lytic, and popcorn calcifications.

Option B - Chondromyxoid fibroma: The least common benign bone tumor arises from the metaphysis of long bones. Males and females are equally affected and have no potential for malignant transformation.

Option D - Maffusi syndrome: It is a condition that involves multiple enchondromatosis with hemangiomas of the face.

4. A 20-year-old professional car racer met with an accident due to a wall collision and was brought to the emergency department. He sustained multiple injuries, one of which is displayed in the X-ray image given below. Identify the fracture?

A. Colles fracture

B. Dorsal Barton fracture

C. Radial Styloid fracture

D. Volar Barton fracture

Correct Option D - Volar Barton fracture

• Intra-articular fracture of lower end of radius along with carpal dislocation/subluxation
• The fracture shown in the X-ray can be easily confused with a lot of differential diagnoses.

Incorrect Options:

Option A - Colles fracture:

• Barton fracture is intra-articular whereas Colles fracture is exclusively extra-articular

Option B - Dorsal Barton fracture:

• Barton fracture, dorsal type-the fractured fragment is facing the volar side, not dorsal

Option C - Radial Styloid fracture:

• This is also called a Chauffer fracture. This is an isolated Radial Styloid fracture.

5. A 46-year-old patient came to the clinic with complaints of scaly lesions on the skin and joint pain for 1 week. On examination, Scaly erythematous plaques and guttate lesions were present, and arthritis of the knee and distal interphalangeal joints were seen. The patient was managed with NSAIDs. Which of the following is the diagnosis of this condition?

A. Psoriatic arthritis

B. Osteoarthritis

C. Gout

D. Osteoporosis

Correct Option A - Psoriatic arthritis:

• Psoriatic arthritis is characterized by scaly lesions on the skin, joint pain, scaly erythematous plaques, and guttate lesions
• Arthritis of the knee joint, ankle joint, and distal interphalangeal joints is seen
• No lab or radiological features specific for Psoriatic arthritis
• Diagnosis is purely clinical
• NSAIDs, Physiotherapy, and Methotrexate, Intra-articular steroid injections are used for the treatment of this condition

Incorrect Options:

Option B - Osteoarthritis: In Osteoarthritis, most common joint affected is DIP. But there will be no skin lesions. So this cannot be the answer.

Option C -Gout: Metatarsophalangeal Joint will be commonly affected in Gout. But there will be no skin lesions. So it cannot be answer.

Option D - Osteoporosis: Osteoporosis is not associated with any skin lesions

• So this cannot be the answer

Also Read: INI-CET Previous Year Question Papers

6. A 45 year old male who is a chronic smoker came to the clinic with complaints of painful ankle and knee joints for 2 weeks. On examination, the joints were swollen, red. Serum uric acid levels were examined and the report showed 10 mg/dl. Which of the following is the drug of choice in this condition?

A. NSAIDs

B. Intraarticular and systemic steroids

C. Oral and IV Colchicines

D. Losartan

Correct Option A - NSAIDs:

• The condition mentioned in the scenario is Acute gout
• The drug of choice for the treatment of Acute Gout is NSAIDs
• Gout is characterized by painful,red,swollen ankle and knee joints
• Serum uric acid level is elevated in Gout
• The other drugs used for the management of Acute Gout are Oral and IV colchicines, Intra-articular and systemic steroids

Incorrect Options

Option B, C & D:

• These are the drugs used for the management of Gout
• But the drug of choice is NSAIDs

7. A 28-year-old female comes to the OPD with her 5-month-old baby girl, saying that the baby has an inconsolable cry during oil massages, especially in the hip region. She also complains that she found some difference in the length of both legs. They were then sent to an orthopedician, who found a positive Galeazzi sign on examination of the baby. What is the best treatment for this baby?

A. Schanz osteotomy

B. Von Rosen splint

C. Manipulation with immobilization

D. ORIF with long plates and screws

Correct Option C- Manipulation with immobilization:

• Positive Galeazzi sign/Allis test and limb length discrepancy in a 5-month-old baby girl suggests the diagnosis of DDH.
• The choice of treatment in DDH in a 5-month-old baby is gentle manipulation with and immobilization in a plaster cast with the hip in 90-degree flexion and 45-degree abduction position.

Incorrect Options: 

Option A- Schanz osteotomy: This is done in a neglected case of DDH (> 6 months)

Option B- Von Rosen splint: This is done in infants below 3 months with DDH

Option D- ORIF with long plates and screws:

• Galeazzi sign should not be confused with Galeazzi fracture and ORIF with long plates is a choice of treatment in Galeazzi fracture.

8. A 40-week pregnant woman is admitted to the hospital for a scheduled cesarean section. The fundal height is less than expected and USG reveals oligohydramnios. The baby was delivered safely by LSCS. Examination of the baby shows the following abnormality. X-ray was done and reveals that the talar axis has shifted to the 3rd metatarsal. What is the most likely diagnosis?

A. Tom Smith arthritis

B. CDH

C. CTEV

D. Osteonecrosis

Correct Option C- Congenital talipes equinovarus (CTEV):

• Oligohydramnios can often lead to constricted/abnormal posture of the baby in the uterus.
• The talar axis normally passes anteriorly through the navicular and 1st metatarsal
• An X-ray showing the talar axis deviating to the 3rd metatarsal - is not normal.
• This provides enough information for establishing a diagnosis of CTEV.

Incorrect Options: 

Option A- Tom Smith arthritis:

• This shows total destruction of the femur but the question does not indicate any infection or relevant X-ray signs.

Option B - CDH:

• This can be closely confused with CTEV, but no limb shortening, hip deformities, or other features that support CDH in this baby.

Option D- Osteonecrosis:

• Osteonecrosis cannot be seen early on X-ray, and the question does not suggest signs like the crescent sign supporting osteonecrosis.

9. A 20-year-old migrant worker in the dental alloy industry comes to the OPD due to an intractable cough, fatigue, weight loss, and night sweats for several weeks. He also complains of pain and swelling near the knee for four months. An X-ray image below shows elevated periosteum and microcalcifications along Sharpey's fibers. Suggest the possible diagnosis.

A. TB knee

B. Acute pyogenic osteomyelitis

C. Osteogenic Sarcoma

D. Syphilitic osteomyelitis

Correct Option C - Osteogenic sarcoma:

• This clinical vignette is about a patient who works in the dental alloy industry exposing him to significant amounts of beryllium. This exposure poses a risk of developing osteogenic sarcoma.
• The cough, weight loss, and fatigue can be a result of either metastatic lung lesions or berylliosis.
• The elevated periosteum in the distal femur in the X-ray is highly suggestive of osteosarcoma

Incorrect Options:

Option A - TB knee: Though intractable chronic cough, weight loss, fatigue and night sweats are features of TB, TB infection of the knee does not involve elevation of the periosteum.

Option B - Acute pyogenic osteomyelitis: Though raised periosteum is a common finding in acute pyogenic osteomyelitis, no symptoms suggest acute bacterial infection. This patient’s presentation is chronic.

Option D - Syphilitic osteomyelitis: There is no evidence of syphilitic infection in this patient.

10. A 32-year-old male patient came to the OPD due to pain and swelling in the right knee for a month. Posterior subluxation and lateral shift of the right tibia were noted on physical examination. Hematological studies revealed leukocytosis and the foci of infection were sent for microbiological studies and are shown in the image. What is the most appropriate management for this patient's current condition?

A. ATT and rest

B. ATT with traction

C. ATT with synovectomy and joint debridement

D. ATT with fusion of joint/TKR

Correct Option D - ATT Therapy with joint fusion/THR:

• The given image shows the growth of Mycobacterium tuberculosis in Lowenstein-Jensen medium.
• Poster subluxation and lateral shift of the tibia on examination points towards the stage of late arthritis/pathological dislocation (features of triple deformity in TB of the knee).
• ATT with arthrodesis and total knee replacement is the appropriate management for this late stage.

Incorrect Options:

Option A - Anti-tubercular therapy and rest: This is the preferred treatment for initial stages only.

Option B - ATT with traction: Triple deformity requires surgical management and not traction alone.

Option C - ATT with synovectomy and joint debridement: This management is done in the stage of early arthritis.

Also Read: Rib Fracture: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

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