Last 5 Year PYQs in Orthopedics for NEET PG

Q1. A patient presented with pain in the hand. The joints involved were proximal interphalangeal joint, distal interphalangeal joint, and first carpometacarpal joint. The wrist and metacarpophalangeal joints were spared. What is the likely diagnosis?

1. Osteoarthritis
2. Rheumatoid arthritis
3. Psoriatic arthritis
4. Pseudogout

Ans. 1) Osteoarthritis

• Osteoarthritis is a degenerative joint disease that commonly affects the hand joints. It typically presents with pain, stiffness, and swelling in the affected joints. Osteoarthritis often involves the proximal and distal interphalangeal joints (finger joints) and can also affect the first carpometacarpal joint (base of the thumb). The sparing of the wrist and metacarpophalangeal joints aligns with the pattern seen in osteoarthritis. Therefore, osteoarthritis is the likely diagnosis in this case.

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Q2. A maid is playing with a child by spinning him while holding his hands. A few hours later, the child starts crying, does not use his arm, and does not let anybody touch him. What is the possible diagnosis?

1. Pulled elbow
2. Olecranon fracture
3. Fracture head of radius
4. Elbow dislocation

Ans. 1) Pulled elbow

• Pulled elbow: This is the Ans. Pulled elbow, also known as nursemaid's elbow or radial head subluxation, occurs when there is a partial dislocation of the radial head from the annular ligament in the elbow joint. This condition commonly occurs in young children, especially when there is a sudden traction force applied to the extended arm, such as when a child is lifted or swung by their hands. The symptoms described in the question, including pain, avoidance of arm use, and sensitivity to touch, are consistent with pulled elbow.

Q3. What is the probable diagnosis for a patient who was admitted to the intensive care unit 48 hours after fracturing their femur, with a saturation of oxygen in the rebreathing unit at 100% but their SpO2 remained at 60%? The patient is also experiencing confusion, and a chest radiograph shows clear lung fields.

1. Pulmonary embolism
2. Fat embolism
3. ARDS
4. Occult pneumothorax

Ans. 2) Fat Embolism

• Fat embolism happens when fat from bone marrow enters the bloodstream, blocking small blood vessels, notably in the lungs. It often occurs with long bone fractures, particularly of the femur.
• Key symptoms include breathing difficulties, a rash of small red or purple spots (petechiae), confusion, and low oxygen levels. The syndrome may show delayed symptoms, confusion, and low oxygen despite clear lungs on an X-ray.​

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Q4. What is the method of scoliosis measurement portrayed in the provided image?​

1. Cobb’s angle
2. Bohler’s angle
3. Ferguson angle
4. Bauman’s angle

Ans. 1) Cobb’s Angle 

• Cobb's angle: This is the Ans..Cobb's angle is the most commonly used method for measuring the degree of spinal curvature in scoliosis.
• It is measured on an X-ray by drawing lines parallel to the superior endplate of the uppermost tilted vertebra and the inferior endplate of the lowest tilted vertebra, then measuring the angle where they intersect.

Q5. What is the probable diagnosis for a 30-year-old female who presents with a tumor located at the knee joint, as shown in the provided biopsy image?​

1. Osteosarcoma
2. Ewing’s Sarcoma
3. Giant cell tumour
4. Osteoblastoma

Ans. 3) Giant Cell Tumor

• Giant cell tumor (GCT) is a benign bone tumor that commonly exhibits multinucleated osteoclast-like giant cells on histopathological examination, as shown in this image. The presence of these giant cells is a characteristic feature of giant cell tumors. GCT usually affects young adults of age 20 to 40 years with a slight female preponderance. It typically involves epiphysis of long bones. The most common location of a tumor is the distal femur.

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Q6. What is the most probable diagnosis for a 20-year-old male patient who has been experiencing lower backache and morning stiffness for two years, along with bilateral heel pain for the past six months?

1. Ankylosing spondylitis
2. Tuberculosis of the spine
3. Disc prolapse
4. Mechanical pain

Ans. 1) Ankylosing spondylitis

• The most likely diagnosis based on the given clinical presentation is A. ankylosing spondylitis.
• Ankylosing spondylitis is a chronic inflammatory condition primarily affecting the axial skeleton, including the sacroiliac joints and the spine.
• It commonly presents in young adults, typically males, and is characterized by inflammatory back pain and morning stiffness that improves with exercise.
• The involvement of the sacroiliac joints, as indicated by the lower backache and morning stiffness in this patient, is a hallmark feature of ankylosing spondylitis.
• The presence of bilateral heel pain (achilles tendonitis) is also frequently observed in patients with ankylosing spondylitis.

Q7. What is the probable diagnosis for a 5-year-old child who visited the pediatrician due to bilateral knee joint pain, normal bone mineral density, and the provided X-ray image of the joints?​

1. Scurvy
2. Rickets
3. Metaphyseal dysplasia
4. Pycnodysostosis

 Ans. 1) Scurvy

• Based on the given X-ray image and the clinical presentation of a 5-year-old child with bilateral knee joint pain, the most likely diagnosis is A. scurvy.
• Scurvy is a vitamin C deficiency disorder that affects collagen synthesis and leads to defective bone formation and maintenance.
• The X-ray findings in the scurvy typically show metaphyseal changes, including widening, irregularity, and fraying of the metaphyses.
• There may also be epiphyseal separation and subperiosteal hemorrhage, known as "corner sign," which appears as a dense line parallel to the growth plate.

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Q8. The following test is done to assess?​

1. Posterior interosseous nerve
2. Median nerve
3. Ulnar nerve
4. Musculocutaneous nerve

Ans. 2) Median Nerve

• The given test is the "Pen Test." It is performed to assess the function and integrity of the median nerve. The test involves holding a pen or similar object and performing specific movements with the hand and fingers.
• It tests Abductor pollicis brevis: abduction of the thumb; a pen is kept at a level higher than the thumb, and the person is asked to touch the tip of the pen.

Q9. A 30-year-old male patient presented with complaints of a gradually progressive swelling around his wrist joint for 3 months. Given below is the image of the swelling on ​​

1. Ewing's sarcoma
2. Osteosarcoma
3. Osteoclastoma
4. Osteochondroma

Ans. 3) Osteoclastoma

The X-ray film shows characteristic features of osteoclastoma, including eccentric lytic lesions with well-defined borders and thinning of the cortex. These findings are typical of osteoclastoma and help differentiate it from other bone tumors. Additionally, the presence of a soap bubble appearance, caused by the multiple small cystic spaces within the tumor, is a characteristic feature of osteoclastoma.

Q10. ​What is the probable diagnosis for a patient who is brought to the hospital after a road traffic accident, complaining of pain around the left hip joint, and is found to have a flexed, adducted, and internally rotated affected limb with noticeable shortening?

1. Anterior hip dislocation
2. Posterior hip dislocation
3. Transcervical fracture
4. Intertrochanteric fracture

Ans. 2) Posterior hip dislocation

• The most likely diagnosis based on the given clinical presentation is B. posterior hip dislocation.
• In a posterior hip dislocation, the femoral head is displaced posteriorly out of the acetabulum. This can occur as a result of high-energy trauma, such as a road traffic accident.
• The characteristic clinical findings in a posterior hip dislocation include:
  • Position of the affected limb: The limb is typically flexed, adducted (moved towards the midline), and medially rotated (inwardly rotated).
  • Obvious shortening: The affected limb may appear shorter compared to the contralateral side due to the displacement of the femoral head.
  • Restricted range of motion: The patient may experience pain and limited range of motion in the affected hip joint.
• To confirm the diagnosis, imaging studies such as X-rays or CT scans of the hip joint can be performed. These imaging modalities will demonstrate the posterior displacement of the femoral head in relation to the acetabulum.

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Q11.  A woman, during her routine examination, presents with the following X-ray finding. What is her most likely diagnosis?

1. A multiple brown tumor
2. Fibrous dysplasia
3. Multiple enchondromas
4. Multiple exostoses

Ans. 3) Multiple Enchondromas

• Enchondromas are benign hyaline cartilage tumors of unknown etiology occurring in bones of endochondral origin.
• Although they can develop in other bones as well, these tumors are most frequently found in the tiny bones of the hands and feet.
• When multiple enchondromas manifest in a unilateral pattern, the ailment is known as Ollier's disease.
• In the given X-ray growth of some benign tumors made of cartilage tissue near the tiny bones of the hand is observed.

Q12. Which of the following is true about the type of fixation shown in the image?​

1. Fracture tibia, ilizarov fixator
2. Fracture tibia, spanning fixator
3. Fracture femur, spanning fixator
4. Periarticular fracture of knee, spanning fixator

 Ans. 4) Periarticular fracture of knee, spanning fixator

• The type of fixation shown in the image is periarticular fracture of the knee and the device used to treat it is a spanning fixator.
• A fracture that develops close to the knee's joint surface is referred to as a periarticular fracture.
• A knee periarticular fracture is treated with a spanning fixator. Two metal bars that are attached to the bone on either side of the fracture make up the external fixation device. The surgeon can manage the location of the bone fragments and aid in healing by connecting the bars with a series of rods and screws.

​​Q13. A male patient presented with the fracture of Tibia following a road traffic accident. He was managed appropriately, but after 2 days he developed dyspnea, petechiae involving the whole body, and a fall in oxygen saturation. What is the likely diagnosis?

1. Fat embolism
2. Air embolism
3. Venous thromboembolism
4. Pulmonary hypertension​

​Ans. 1) Fat Embolism

• Dyspnea and the presence of petechiae all over the body in a male patient who has broken a long bone in a car accident could be signs of the hazardous medical disorder known as fat embolism syndrome (FES)
• Fat embolism syndrome (FES) is a serious medical condition that can occur after a bone fracture or other traumatic injury.
• Symptoms of FES include dyspnea, decreased oxygen saturation, and petechiae all over the body.​

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Q14. An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding ?

1. Achondroplasia
2. Osteogenesis imperfecta
3. Cretinism
4. Marfan syndrome

 Ans. 2) Osteogenesis Imperfecta

Multiple long bone fractures seen on an ultrasound during the 13th week of pregnancy are typically indicative of osteogenesis imperfecta, a genetic disorder. The bones are affected by this uncommon genetic condition, which makes them brittle and prone to fractures. 

• Hearing issues, dental deformities, and discolored sclera (the whites of the eyes) are further signs of osteogenesis imperfecta.
• Therefore, the correct option is osteogenesis imperfecta.

Osteogenesis Imperfecta:

• Osteogenesis imperfecta is a genetic condition that affects bone strength and causes brittle bones.
• Ultrasound imaging can detect multiple long bone fractures in a fetus with osteogenesis imperfecta.
• Decrease in Type 1 collagen.

Genetic disorders and prenatal screening:

• Prenatal screening tests can detect genetic disorders such as osteogenesis imperfecta during pregnancy.
• Most commonly, COL1A1 and COL1A2.
• Parents may choose to undergo genetic counseling to understand their risk of passing on genetic disorders to their children​

Q15. What is the most common late complication of this condition if left untreated ?​

1. Pulled elbow
2. Dinner fork deformity
3. Cubitus varus
4. Osteoarthritis​

 Ans. 3) Cubitus Varus

• Cubitus varus, or bow elbow, or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. It occurs in only the extension type of supracondylar fracture of the humerus, causing a reduction or loss of the carrying angle​

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Q16. A 40-year-old patient presents to the emergency department following a road traffic accident. The radiograph of his pelvis is shown below. What is the most likely diagnosis?

1. Central dislocation of the hip
2. Fracture shaft of femur
3. Posterior dislocation of the hip
4. Anterior dislocation of the hip

Ans. 3) Posterior dislocation of the hip

• In posterior hip dislocation, the femoral head is displaced posteriorly from the acetabulum.
• It is the most common type of hip dislocation resulting from high-energy trauma, such as a road traffic accident.
• Mode of injury: axial force applied to a flexed, adducted, and internally rotated hip.
• Example: Dashboard injury.
• 50% of PDH are associated with posterior chip fracture of the acetabulum.
  • A plain x-ray won't give any results.
  • A CT scan is the investigation of choice in dislocation with fractures.
• Differentiation of PDH and ADH on x-ray
  • In ADH - Head is larger
  • In PDH - Smaller head

Q17. A 12-year-old boy presents with gradually progressing swelling and dull aching pain since 6 months in his lower leg .He is otherwise healthy. The radiographic image of his leg is shown below. The most likely diagnosis is:​

1. Osteosarcoma
2. Osteoblastoma
3. Brodie's abscess
4. Ewing's sarcoma

Ans. 3: Brodie's Abscess

Brodie's abscess is a subacute or chronic bone abscess typically caused by a Staphylococcus aureus infection. It often presents with localized pain and swelling. Radiographic findings may reveal a well-defined lytic lesion with a sclerotic border.

• In children, Brodie's abscess is most common in the metaphyseal area.
  • Occurs before epiphyseal closure in a child.
• In adults, more common in epiphysio-metaphyseal junction
  • Occurs after epiphyseal closure in adults.
• Most common sites: upper tibia, lower femur.
• The most common organism is Staphylococcus aureus.
• Most common age: 2nd decade.
• Pathophysiology: Low virulence of the organism and good host resistance lead to confirming the infection.
  • A cavity is formed.
  • On aspiration, sterile pus is seen—due to good host resistance.

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Q18. Which of the following fractures is most prone to non-union?

1. Proximal scaphoid
2. Inter-trochanteric
3. Distal radius
4. Talar neck

Ans. 1) Proximal Scaphoid

• The scaphoid bone is located in the wrist, and fractures in the proximal portion (near the base) of the scaphoid are notorious for their high risk of non-union. Non-union refers to the failure of a fracture to heal properly, resulting in persistent pain, limited function, and potential complications. The blood supply to the proximal scaphoid is relatively poor, making it susceptible to delayed or inadequate healing.

Q19. Which of the following best describes the condition known as "painful arc syndrome"?

1. A condition in which joint stiffness lasts for more than 30 minutes in the morning, affecting multiple joints.
2. A condition characterized by localized, sharp pain at the site of an injury or inflammation.
3. A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction.
4. A condition marked by generalized musculoskeletal pain, fatigue, and tender points in various areas of the body.

Ans. 3) A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction

•  Painful arc syndrome, also known as "subacromial impingement," is characterized by pain during a specific range of motion, usually between 60 and 120 degrees of shoulder abduction. This condition often occurs due to compression or impingement of structures in the subacromial space, such as the rotator cuff tendons, as the arm is raised.

Q20. De-gloving injury refers to_____?

1. Skin and subcutaneous fat are stripped from the underlying fascia
2. Skin, subcutaneous fat and fascia are stripped from tendons
3. Skin, subcutaneous fat, fascia and tendons are stripped from bone
4. Only skin is stripped off

Ans. 1) Skin and subcutaneous fat are stripped from the underlying fascia

•  Injuries where the skin and subcutaneous fat are stripped from the underlying fascia are called degloving injuries.
• In a de-gloving injury, the trauma or force applied to an area causes the skin and the layer of fat beneath it to separate from the underlying tissues, similar to removing a glove from a hand.
• This type of injury can result in extensive damage to the blood vessels, nerves, and other structures beneath the skin.

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