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PAST PAPERS
Orthopaedic Surgery

CPSP PART II
(2003 to 2016)

SEQ
Topic Wise

Compiled by:
Dr. Haseeb Hussain
Dr. Kaleem Ullah
Dr. Saad Ilyas
M. Khalid Hussain
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ARTHROPLASTY

Q.3 A patient had total hip replacement done 02 years ago. He has developed pain and
difficulty in walking on the operated leg. (March 2003)
How will you identify the cause?
Investigate and plan management of this patient.

Q.9

What are different types of total knee implants? (Sep 2003)

Describe steps of pre operative planning for TKR.

Discuss complications of TKR.

Q. 9 A 50 year old female presents with bilateral knee pain. She had been taking
NSAIDS. She is unable to squat and cannot walk long distance. (Mar 2004)

a. What is you working diagnosis? Justify.


b. How you will manage this case?

Q.1 A 45 year old male patient has presented with chronic knee pain along medial
compartment. He has full range of motion and mild geno varum. His x-rays show early
degenerative changes along medial compartment and patello femoral joint. He has used
various NSAIDS. (Mar 2005)

Briefly discuss what other non surgical modalities are available for treatment.

Q.1 A 60 years old lady had hemiarthroplasty 4-year ago. She fell in the bathroom yesterday.
Since then she is complaining of pain and deformity of her thigh. X-ray reveals a short
oblique fracture 5cm distal to the tip of the prosthesis.

How would you manage this patient? (Jan 2008)

Q. 10 A 60 years old gentleman had a total hip replacement five years ago. For the last six
month, he is complaining of pain in groin, worst on weight bearing. He is also complaining
of feverish feeling and night cramps. His x-ray shows around femoral component. (Jun
2008)

a. How will you evaluate this patient?


b. Give your treatment plan?
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Q.9 A 55 years old lady presents with five years history of worsening pain and stiffness of
left knee joint. Now she had pain at rest and is mobile with walking aids. About 40 years back
she was treated for tuberculous synovitis of same knee. She had 30-90 flexion arc along
with coarse crepitus. Her blood picture and ESR are within normal range. Radiograph of knee
joint shows advance degenerative changes. (Mar 2009)

a. What is / are treatment option/s for her?


b. What are dangers of arthroplasty in this case and what precautions you will take while
planning surgery?

Q.6 A 68 years old woman was admitted following a fall. She had severe pain in the left thigh
and was unable to stand herself. A radiograph of the left femur showed a peri- prosthetic
fracture just at the tip of total hip implant stem. Prior to her fall she had been independently
mobile with the aid of stick, her hips were asymptomatic and she was no longer under
Orthopaedic review as she had under gone this surgery 4 years ago. Her general medical
condition was reasonable, considering her age, although she was hypertensive and found to
have good control on medicine. (Sep 2009)

a. How will you further investigate this patient?


b. How will you treat this case?

Q. 7 Classify knee arthroplasty implants. (Mar 2010)

Q.1 1 A 70 year old healthy female underwent TKR five months ago and was discharged

home on the 7th day. She developed fever and discharge from the operation site after 15

days. She has been on oral antibiotics since then according to culture and sensitivity.

How will you manage this patient now? (Sep 2010)

Q.6 Regarding the bone-cement-implant interface in cemented total hip arthroplasty. (sep
2010)

a. Draw the zones around cement mass in femur and acetabulum.


b. Enumerate the changes seen on x-rays in the femoral stem and cement around it which
are suggestive or diagnostic of loosening of femoral component.

Q.5 What are the various implants available for total hip replacement? (Oct 2011)
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Q.7 A 62 years old female with severe knee osteoarthritis is planned for total knee
replacement. X-ray shows varus deformity with bony defect in proximal tibia on medial side.
(Oct 2013)

a. At what angle we take the distal femoral and proximal tibial bone cuts?
b. Briefly write the stepwise approach in correction of following deformities:
Varus deformity
Bony defects in proximal tibia

Q.8 A 70 years old patient presents with pain in the thigh and knee 5 years after primary
total hip replacement. Pain is more on weight bearing with increasing difficulty in walking.
(Oct 2013).

a. What can be the cause of his pain?


b. How would you investigate this patient?
c. What is osteolysis? How it is initiated?
d. What are the radiological features of loosening?
e. How can late haematogenous infection be prevented?

Q.7 A 60 years old diabetic lady had total knee replacement one month ago. She has been
complaining of excruciating pain in the knee and has daily rise of temperature On
examination the knee is swollen and tender. How would you evaluate and manage this
patient? (Mar 2013).

Q. 4 65 year old lady presents with increasing right groin and thigh pain for the last two
years. 15 years ago she underwent a THR for avascular necrosis of the femur. She has been
steroids for her SLE. She denies any history of fever and her THR incision is well healed with
no evidence of any erythema or tenderness). (Mar 2013)

a. Enumerate the clinical conditions you will consider in the differential diagnosis for
this patient.
b. What further investigations will you carry out and give their justification?

Q2. Austin moore Hemiarthroplasty has been done for femur neck fracture in55 years old
male in a district hospital 02 months ago. He has presented to you with discharging sinus
at surgery site, fewer and walking with support? (Oct 2014)

a. How would you investigate it? Justify each.


b. Give management plan in light of current literature.
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Q.3 . A 60 years old finer man presented with painful hip since one year. His plain x-ray pelvis
shows AVN Ficats Grade-III of femoral head. (Oct 2014)

a. What is the pathoanatomy of this injury?


b. How will you manage this patient?

Q. A 65 years old man has a swollen painful knee after undergoing a knee replacement 10
years ago. Aspiration of the knee reveals cloudy. Viscous synovial fluid. He has controlled
diabetes with good cardiovascular status. Laboratory studies show an erythrocyte
sedimentation rate of 40 mm/h and a C-reactive protein level of 0.8. (April2015).

What is the most likely diagnosis with justification?


Name other investigations that may help in diagnosis?
Name the surgical procedure you will carry out for treatment?
What are steps of this surgical procedure?

Q.9 A 65-year old man has a swollen painful knee after undergoing a knee replacement 10
years ago. Aspiration of the knee reveals cloudy, viscous synovial fluid. He has controlled
diabetes with good cardiovascular status. Laboratory studies show an erythrocyte
sedimentation rate of 40 mm/hr and a C-reactive protein level of 0.8. (oct 2015)

a. What is the most likely diagnosis with justification?


b. Name other investigations that may help in diagnosis.
c. Name the surgical procedure you will carry out for treatment.
d. Outline steps of this surgical procedure.

Q.2 A 60 year male had THR right hip 7 years back, presented in emergency with history of fall,
he is unable to bear weight on his right leg. On x rays there is periprosthetic fracture.
(April 2016)

a. How will you classify periprosthetic fractures of femur?


b. How will you manage periprosthetic fractures just distal to tip of femoral stem?

Q.4 (April 2016)

a. What are indications and contraindications of hip arthrodesis?


b. What is position of hip arthrodesis?
c. What are different ways of hip arthrodesis?
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Q. 5 A 45 year old active individual has pain on medial side of knee joint on activity. On
examination he has Genu Varum. He has not responded to NSAIDs and muscle strengthening
exercise or activity modification. (Oct 2016)

a. What imaging studies you will do to plan your treatment?


b. What is your treatment if lateral compartment is normal?
c. What are the important steps of your chosen procedure?

Q. No. 4 (March 2011)

A 40 year old gentleman presents with post traumatic arthritis of his shoulder with

significant pain and restriction of glenohumeral movements. X-rays show severe degenerative

changes of glenohumeral joint.

a. What are the treatment options?


b. What are different types of shoulder arthroplasty?
c. What is the position of shoulder arthrodesis?
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INFECTION

Q. 10 One year old child is admitted with history of high grade fever for the last 5 days. The
child is looking ill, dehydrated and toxic. She is keeping her left hip joint in flexion and resists
any attempt to move the joint. (Mar 2004)

What necessary investigations will you carry out to confirm the diagnosis? Give
justification.

How will you treat this child?

Q.1 A 5 years old male child has presented with pain hip joint. The culture of the aspirate
from the hip grew Salmonella micro organism. (Mar 2004)

Name further investigations that should be done.

Give treatment protocol to manage this case.

Q. 3 What are the complications of septic arthritis hip in children? How would you
prevent them? (Aug 2007)

Q.5 A one year old child has been crying excessively, does not move his right leg and keeps it
flexed at the hip joint, There is no history of trauma. He is running swinging temperature.
(Jan 2008)

Discuss the management of this baby.

Q.1 An 8 years old boy presents with pain, fever and swelling of arm for the last one week.
Fever is of high grade and fluctuating. There is also history of high grade fever 6 months back
which lasted for 3 weeks and responded to antibiotics. His x-rays reveals osteopenia of
diaphysis of humerus with periosteal reaction and new bone formation. (Mar 2009)

a. What are the possible diagnoses?


b. How will you investigate to arrive at diagnosis? Please justify.

Q. 5 A one year old child is admitted with history of high grade fever for the last three days.
The child is toxic and dehydrated. Left hip is flexed and slightest movement is agonizing. (Mar
2010)

How would you investigate this patient?

a. How would you treat this patient?

b. How would you manage this patient?


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Q. 10 An 8 year old boy presents with complaints of severe pain and swelling of his left knee
joint for last five days. He is running high grade fever and is unable to bear weight. There is no
history of urinary tract infection. There is also no history of trauma and involvement of any
other joint. Clinically the joint is swollen with increased local temperature and patient does not
allow to move the joint. ESR is 80, WBC count is 11000/dI and CRP is positive. (March 2012)

1. What is the most likely clinical diagnosis?


2. How will you confirm the diagnosis?
3. What should be immediate treatment?

Q.2 A 12 years old child presented with severe pain in right thigh for last 2 months with
gradually increasing swelling. The affected area is red, warm and tender, He also has history of
anorexia and weight loss. (Oct 2013)

a. What is your differential diagnosis?


b. Enumerate 5 key investigations with justification.

Q. 6 A 14 months old baby was admitted to the hospital with: history of having stopped walking
02 days before admission. All of her milestones were normal and she began walking at 11
months. She was previously well and there was no history of trauma. She was Afebrile and on
clinical examination was having pain on internal rotation of her right hip at extreme only
Radiological examination of her chest and lower limbs was normal. A complete blood count,
showed raised ESR and TLC, urine culture and throat swab were normal. She was discharged on
anti-inflammatory and oral antibiotics. She was re-admitted 01 week later with a temperature
of 101F and at that time she was again unwilling to bear weight and had painful reduced active
movements of her right hip. Passive movements were painful specially rotations. (March 2014)

a. What is your diagnosis?


b. How will you investigate?
c. What is your management?

Q.3 One year old male child presents with a 04 day history of fever up to 38C and inability to
bear weight on the right lower limb for last 24 hours. There is no history of trauma. On
examination the significant finding is that there is restriction of movement at the right hip joint.
(April 2016)

a. List three differential diagnoses in order of their priority.


b. What lab investigations would you perform to confirm the diagnosis with justification?
c. List the imaging studies that you would order in such a patient, justify them.
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AMPUTATION

Q.7 Write short notes on following aspects of limb amputations: (sep 2003)

Formal versus Guillotine amputation..

Advantages and disadvantages of above knee versus below knee amputations.

Advantages and disadvantages of above elbow versus below elbow amputations.

Care of stump and prosthesis.

Q. 8 A 40 year old male who had dysvascular limb has undergone below knee amputation one
month back. He complains of sensations of pain in amputated foot. (Sep 2005)

What is most likely diagnosis and how would you manage this patient?

Q.7 Discuss a good amputation stump. How does it help in rehabilitation? (Aug 2007)

Q. 9 A 50 years old male comes to you 5 days after above knee amputation for a non-traumatic
condition. He complains of pain and discharge from the wound. (March 2010)

a. What are the immediate and late complications of amputation?


b. How would you manage wound failure?

Q.8 A 17 years old girl sustained crashed injury to her right lower limb in a road traffic accident.
How will you scientifically assess the severity of injury to decide whether the limb is salvageable
and if not to decide the level of amputation? (March 2012)

Q. 5 A young amputee of 25 years presents 9 months after below knee amputation with a
painful stump. (April 2016)

a. Enlist the causes of this painful stump and their appropriate treatment.

Q. No. 9 (March 2011)


a. Give the characteristics of lower limb i. transfemoral, ii transtibial iii. Signs amputation
stumps.
b. What care is taken in stump fashioning for before prosthesis is selected?
c. What are the types of lower limb prosthesis available?
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TUMOR

Q.6 Write short essay comprising of 200 words on:

The management options for a Giant Cell Tumour involving the distal radius of a 35
years old laborer, based on the Ennekng's garding system for GCT. (March 2003)

Q.7 A boy aged 10 years has pain and swelling of left upper arm of 02 months duration.
There is low grade fever: (March 2003)

What are your differential diagnosis?

What investigations you will perform?

How will you treat this patient?

Q.4 A boy 15 years of age presents with painful swelling of right leg just below knee. X-Rays
shows lytic permeative destruction of fibula below its neck. Distal neurovascular status is
normal. (Sep 2003)

What is the your provisional and differential diagnosis?


Precisely give the outline of clinical and lab work up in this case if surgery is
contemplated.
How would you manage this case?

Q.5 An 8 year old girl develops swelling in her left lower thigh. The biopsy revealed an
Ewings sarcoma. (March 2004)

Give relevant imaging studies to be done and give their findings.

How would you treat this patient?

Q. 6 What are the principles of taking incisional biopsy for the malignant bone tumors.

What further steps you will take to get best opinion regarding Pathology? (Mar 2005)

Q. 6 What factors will influence your decision, regarding type of surgery for malignant
musculoskeletal tumors? (Sep 2005)
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Q.3

a. What are the different Cystic lesions of bone? (March 2006)


b. Describe clinical, radiological and pathological feature of a unicameral bone cyst.
c. Discuss the management of pathological fracture through unicameral bone cyst in
proximal femur of a 10 year old child.

Q. 3 40 years old female reported in Accident & Emergency department after sudden fall
while working at home, unable to put weight on right leg. She was having moderate pain in
right thigh since 03 months relieved after taking analgesics. She had surgery for lump breast
1&1/2 years back. X-ray shows fracture right femur proximal 4th. (Aug 2006)

a. What investigation you will require to confirm diagnosis? Give justifications.


b. What is your plan of management for this patient?

Q.2 A 35 year old housewife presents with the progressive pain and swelling in the distal
right radius with intact distal neurovascular status. X-ray shows a radiolucent area without
intralesional densities in the entire epiphysio metaphysieal region of distal radius extending to
and breaking the subchondral bone and cortical break. The zone of transition is permeative.
There is no systemic or biochemical abnormality. Bone scan shows increased uptake in right
distal radius. (Aug 2007)

a. Give the most likely diagnosis.


b. What further investigations would you advice and why?
c. Enumerate surgical options choose and describe the most appropriate method keeping
in mind the age and functional requirement.

Q. 5 A 14 years old presents with painless swelling of proximal right arm for two months.
The swelling had been gradually increasing and associated with anorexia and weight loss. X-ray
shows osteoblastic lesion of proximal metaphyseal area of humerus with periosteal reaction.
(Feb 2007)

How will you further evaluate this girl to arrive at diagnosis and plan the treatment?

Q.7 A 40-year-old gentleman) has beep. complaining of 'pain and swelling around his right
buttock, for the last four months. There is no history of trauma or fever. X-ray reveals lytic
lesion, involving right ilium with spec led calcification. (Jan 2008)

a. What is your most probable diagnosis?


b. How would you evaluate this patient? Give your treatment plan.
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Q. 6 A 20 years old lady has been complaining of pain in her right groin for the last one month,
On examination movements are restricted at the hip joint. X-ray revealed a lytic in the proximal
femur, along with periosteal reaction and sun-ray appearance. (Jun 2008)

a. How would you evaluate this patient?


b. What is your management plan?

Q.7 A 35 years old gentleman presents with pain and swelling of right distal radius, which is
progressively increasing in size_ The patient was operated about six months ago for similar
complaints with probable diagnosis of giant cell tumour, (No documented proof is available).
Intralesional curettage with bone grafting was done. X-rays show expansible, osteolytic lesion
of distal radius. (March 2009)

How will you manage this patient?

Q.5 Give a brief account of pathology, diagnosis and treatment of chordoma. (Sep 2009)

Q. 8 A 10 years old boy presents with a lytic lesion in the proximal Humerus characterized by
cystic symmetrical expansion and thinning of involved cortices. (March 2010)

a. What are the different tumor-like conditions of bone?


b. How would you manage unicameral bone cyst?

Q. 9 A 16 year old female presents with history of swelling around the distal femur for the last 3
months. She has history of weight loss and decreased appetite. (Sep 2010)

a. What is your differential diagnosis?


b. How would you investigate this patient along with reasons for each investigation?

Q.4 A 25 years old female presented with pain and swelling of her left knee joint for last six
months. Radiograph of her left knee shows a lytic lesion of the proximal tibia with suspected
giant cell tumour. (Oct 2011)

a. How will you stage giant cell tumour?


b. What is the treatment for each stage?
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Q.4 A 20 year old medical student presents with insidious swelling of around right shoulder
region for 04 months. Radiologically there is an osteolytic lesion of proximal humerus with
extension to the humeral head. (March 2012)

a. What are possible diagnosis?


b. How will you investigate?
c. How will you treat if histopathology reveals maligant giant cell tumours and justify?

Q.7 A 9 year old girl has pain below the knee joint. Examination reveals a tender ill-defined
firm swelling upper end of tibia on anteromedial side. X-ray of the knee shows permeative
lesion with new bone formation of proximal tibia. (Oct 2012)

a. What is/are possible diagnosis?


b. How will you investigate and confirm your diagnosis?
c. How will you treat this patient?

Q.1 What are the principles of surgery when you are planning open biopsy for a suspected
malignant tumor? (Oct 2013)

Q. 5 Compare the Enneking with American Joint Committee on Cancer (AJCC) staging for
malignant bone tumours and its impact on management. (March 2013)

Q.10 A 12 year old boy complains of pain in the groin radiating to the front of leg for the last 6
.months.: Pain is progressively increasing in intensity. Pain is worst at night and it is relieved
NSAID Radiographically the hip reveals no abnormalities in its articular surfaces. (March 2013)

a. What is your diagnosis?


b. How will you investigate this patient?
c. How would you treat this patient?

Q.4 . An 11 years old girl is brought by the parents with history of pain and swelling distal thigh
for the last three months after she sustained a blunt injury while playing. Her x-rays show
osteolytic areas in the distal third of femur with areas of new bone formation around.
(Oct 2014)

a. What are 3 most common differential diagnoses?


b. Write down management plan.
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Q A 70 years old lady who underwent mastectomy 8 years back, she experienced severe pain
around left hip and thigh as she tried to get up off the sofa. She was unable to bear weight
thereafter. Her x-rays reveal fracture through subtrochanteric lytic areas of left femur.
(April 2015)

a. What other clinical information heads to be gathered in this case?


b. What investigations would you like to have?
c. How would you treat this case?

Q.3 A 14-year old girl is brought by the parents with history of pain and swelling above right
knee for the last three months after she sustained a blunt injury while playing. Her ESR is 30
mm fall at 1 hour. Her X-rays show osteolytic lesion in the distal third of femur with areas of
new bone formation radiating outwards from the cortex. (Oct 2015)

a. What is the most likely diagnosis?


b. Outline your management plan for this case.

Q. 9 A female patient, aged 50 years, is complaining of generalized weakness and generalized


body aches for the last 3 months. She has developed severe backache since last 2 days. X-rays
of the spine show osteoporosis and a compression fracture of the Dorsal 10th vertebra. X-rays
of the skull and pelvis show multiple lytic lesions with 'soft' margins. The ESR is 100.
(April 2016)

a. Name three diseases as differential diagnosis of this scenario, along with reasons.
b. Enumerate four further important investigations, which are required to confirm
diagnosis? Mention justification.
c. What are the treatment options, for the disease which you think is highly suggested by
this scenario?
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Q. 7 A 25 years male had a history of approximately 02 years duration of intermittent vague


discomfort in the region of the left knee. The pain had increased during the six weeks prior to
presentation. A firm, non tender, palpable mass was present in the left popliteal fossa in the
region of the left distal femur. A recent X-ray revealed a lobulated ossified mass on the
posterior aspect of the distal femur. Technetium 99-m bone s can also revealed a solitary lesion
at distal femur. (Oct 2016)

a. What is your provisional diagnosis? What clinical conditions (at least 2) you will consider
in the differential diagnosis for this patient? Give justification.
b. Name factors of prognostic significance at the time of diagnosis of an osteosarcoma.
What is prognosis in this patient? Give justification.
c. How will you treat this patient? Give reconstructive option?

Q. No. 3 (March 2011)

A 72 year old gentlemen who has had transurethral resection for prostate 5 years ago,

presents with progressively increasing low back and right hip pain for the last 6 months.

a. How would you investigate this case?


b. How would you treat him?
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CONGENITAL & PEDIATRIC INJURIES

Q.2 A 2 months old child with right sided congenital TEV reports to you for treatment.
Give the management plan with complete follow up (CTEV). (March 2003)

Q.8 A 14 year age boy developed pain in his right groin following a brisk walk a week ago. He

is unable to bear weight since then. He also had similar complaints a year ago in the left groin

that settled with medicines. There is no shortness of leg, leg is externally rotated with limited

internal rotation. X-rays pelvis revealed no obvious abnormalities. (Sep 2003)

Discuss differential diagnosis.

How would you proceed to confirm diagnosis. Justify radiological findings leading to

most probable diagnosis.

Discuss the treatment.

Q. 7 A young boy of 10 years is brought to your OPD with pain in his right foot on
walking. On clinical examination, there is flexible pes planus. X-ray shows accessory
navicular. How will you treat his child? (Mar 2004)

Q.3 Screening of a new born child for congenital deformities revealed unstable right hip
joint with positive Barlow's / Orthotani's click. The baby has no other deformities.
(Mar 2004)

What could be the important salient features in history?

Name relevant investigations to confirm the diagnosis.

How would you manage this case up to the age of one year?

Q. 7 How will you manage neglected Monteggia fracture dislocation in children? (Mar 2005)

Q. 7 An eight years old girl fell on her outstretched hand and presented with swelling around
the left elbow. (Sep 2005)

a. Name possible epiphyseal injuries which may have occur.


b. Give their management and prognosis.
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Q. 6 List the causes of Physeal injury other than accidental trauma (Aug 2006)
a. How would you manage a case of acute Traumatic trans-epiphyseal injury )Slater IV) of
distal femur in a child of 8 years.
b. Name the expected complications of growth plate injuries.

Q. 4 A three year boy is brought to you, when the parents noted the child to have
limp on walking and the left leg appeared to be apparently shortened. X-ray of the pelvis shows
the contained hip with neck shaft angle to be 100.(Aug 2007)
a. What is your diagnosis?
b. When is surgery indicated?
c. Briefly outline the steps of the operation and the post operative care.

Q. 3 A 3 years old boy presents with history of fracture off and on mainly in the lower
extremity. He has anterior bowing of left tibia with joint laxity, teeth problems and bluish
sclerae. (Feb 2007)

a. What is your diagnosis, justify?


b. What is the basic pathology and how do you classify this condition?
c. Give a brief outline of its management.

Q.2 A 5 years old boy presents with history of fracture of right tibia 6 months back. He was
treated in plaster cast. He is unable to bear weight on this leg and fracture site is tender and
mobile. (Mar 2009)

a. What is the possible diagnosis?


b. How will you manage this child?

Q.10 A 3 months old baby is brought to you with Bilateral club feet deformities. He had a
swelling in the lower back at birth which was operated by neurosurgeon at the age of 3 weeks.
(Sep 2009)

a. What are the possible problems with this patient?


b. How will you manage those problems?

Q.7 A child of two months of age is brought to you with radial club hand. (Sep 2010)

a. Classify this condition.


b. How would you manage this patient?
c. What is the age at which surgery is most beneficial?
d. Which surgical procedure is most favoured?
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Q.7 Write short notes on bilateral genu varum in children age 1 year to 10 years. As regards:
(Oct 2011)

a. Aetiology
b. Investigations
c. Treatment(

Q. 2 Q.2 A 7 years old boy presented in A&E department with history of fall from tree. He has S
-shaped deformities around both elbow joints. On examination there are no distal pulses but
hands functions are satisfactory. (March 2012)

a. How will you investigate this child?


b. Give treatment plan.
c. Give follow-up protocol.

Q.7 A 4 years old girl presented with inability to feed herself with right hand. Parents give
history of difficult labor and restriction of movements of right shoulder joint since birth.
Clinically elbow and hand functions are normal. How will you manage this child? (March 2012)

Q. 3 A 3 years old boy was brought to the clinic with persistent deformity of both thumbs. Rest
of the musculoskeletal system is normal. You have advised surgical release of this condition
under GA. (Oct 2013)

a. Give diagnosis and pathologic anatomy of this condition.


b. How do you stage this condition?
c. Give the treatment protocol.

Q.6 A mother has brought her four years old boy with flat feet. His 13 years old brother and his
father has a similar problem. The father has pain on walking on uneven ground and mother is
concerned about her two sons. (March 2013)

a. How would you evaluate and manage the children?


b. Enumerate surgical procedures for this condition and their indications.

Q.1 An obese 12 years boy presented with antalgic gait. His mother is unclear about the
duration limping. There is no history of trauma and fever but there is family history of hip
problem. His CBC and ESR are within normal limits. (March 2013)

a. What is the differential diagnosis?


b. How would you investigate this patient and justify?
c. Give your plan for management.
19

Q. 5 A 3 years old boy reported with persistent flexion deformity of both thumbs. Rest of the
musculoskeletal system is normal. You have planned surgical release of this condition.
(March 2013)

a. How this condition is different from adults?


b. Give the staging of this condition?
c. What is the pathognomonic lesion of this condition?
d. What is appropriate age of surgery?
e. Which specific structure is released or excised?

Q.5

a. Enlist the clinical features of congenital torticollis (wryneck) in a 12 years girl. (Oct 2014)
b. How will you treat her?
c. What are the possible complications and problems of treatment?

Q.1 Six years boy presents 4th Time in last six months with fracture of right femoral shaft. He
has previously fractured both tibia and Humerus which united uneventfully. (April 2015)

a. What is most probable diagnosis?


b. What is primary defect in this disease and what other organs can be involved?
c. How will you classify this disease?
d. Name different treatment options for this condition?

Q.7 A 6-year old boy is brought by parents with history of trauma to left leg in infancy. The child
gradually developed bowing of the leg which has increased despite seeking treatment from
various doctors. On examination there is gross anterolateral bowing of the left leg with
shortening. (Oct 2015)

a. What is the diagnosis?


b. How do you classify this condition? c) What are different treatment options?

Q.6 A boy of 7 years having bilateral TEV. On examination there is a scar of previous surgery on
both feet. (April 2016)

How will you manage this case and mention the treatment options.
20

Q.4 A 12 year old boy complains of calf pain for last 03 months on examination where is
bilateral rigid flat foot and limited subtalar joint movements. (Oct 2016)

a. What is the most likely diagnosis?


b. What radiographic studies you will do and justify them?
c. What is you preferred treatment and why?

Q. No. 6 (March 2011)


Parents of newborn baby are concerned about the deformities of their baby's feet. They
want the correction of the deformity. You have examined the baby and found that there is
bilateral congenital club foot deformity.
a. What are the basic component of the deformity?
b. What are the options of treatment?
21

CP POLIO NMD

Q3. A 10 years old child has post polio paralysis of his right shoulder and elbow. He has good
hand function. Deltoid and Biceps are of 0 (zero) grade, triceps is four and trepezius is grade
five. (March 2005)

a. What are options available for surgical Reconstruction?


b. Describe indications and pre requisites for different procedures.

Q.2 A 16 years, old female is brought to you with polio affected left lower limb since early
childhood. On examination a hand on knee gait was noted. Her spine and hips are stable with
no deformity and controlled hips with power grade-IV. Her muscle power charting is as follows:
(Aug 2006)

Knee Quadriceps grade 0, Hamstring grade 5, Foot /ankle Dorsiflexors grade 3, Planter flexors
grade 5, Evertors-grada.5, Invertors grade 0. A Leo Length Deficit of 3 cm is noted with knee
contracture of 15 degree. Describe management plan with justification.

5 A 7 years old boy is brought to you with history of tip toe walking since he started walking. He
was born by c-section due to foetal distress. His milestones are; sitting 07 months, standing 12
months, walking 15 months. His school rating is average. Examination reveals tip toe walking,
10 equines not corrected by knee flexion. No other abnormality or contraction present. (March
2009)

a. What is differential diagnosis?


b. How will you manage this child?

Q.4 A 13 years old girl presented with following post polio residual deformities of right lower
limb since age of 02 years. She has hand-knee gait, flexion contracture of knee 45, shortening 4
cm, ankle and foot have no fixed deformities except clawing of big toe. Muscle power is Tendo-
achilles 3, Tibialis anterior 0. Tibialis posterior 4, Peronei 5, Extensor of toe 5', at knee
quadricep 0 Lateral Hamstring 3, medial Hamstring 2, at hip 20 flexion contracture. All
muscle power is 2 at hip.

Give treatment plan with justification. (Oct 2012)


22

Q.9 . A 13 years girl presents with following post-poliomyelitis deformities since 2 years of age,
having hand knee gait with 150 flexion contracture of knee joint equines at ankle, clawing of
toes, and 4cm shortening. No contracture at hip joint. The muscle charting shows Tendoachilles
5, Peronei 5, Tibialis posterior 4, Tibialis anterior zero, Hamstring 4 and hip is stable. Give an
account of your management plan with justification? (Oct 2014)
23
24

SPINE

Q.4 A 26 years old lady presents with severe pain in the neck with radiation of pain along
both arms. History of fever off and on with recently developed difficulty in deglutition. (
March 2003)

How will you investigate this patient (enumerate)

How would you treat a destructive lesion C6-7 with collapsed vertebrae and soft tissue
shadow anteriorly.

Which approach is preferred in caries spine at this level and why?

Q.5 A bank executive of 46 years presents to you with pain in the neck of a few weeks
duration. He has had difficulty in walking in the last week and staggers with a broad based
gait. His hand function has been severely affected and he is unable to work. Sphincters
are intact. There is no history of trauma. Examination shows UMN lesion in lower limbs and
LMN in the upper limbs. (March 2003)

Enumerate the differential diagnosis

Investigations with justification

Treatment options for each diagnosis.

Q.10 What is Scheurmann's kyphosis? (March 2003)

Give criteria for diagnosis and indications for treatment.


Briefly describe the treatment.

Q.5 What is meant by term diastametomyelia? (Sep 2003)

How will you, diagnosis and treat this condition?

Q.6 A 55 year old man presented with low grade fever and dull pain in lower thoracic

spine for 8 -weeks. For the last 15 days he noticed some weakness of both legs. On

examination there is tenderness at T12. Knee and ankle jerks are exaggerated. (Sep

2003)

What differential diagnosis comes to your mind?


25

Q. 9 A 14 year old boy presented with pain in his back. On examination he had angular
Kyphotic deformity of spine measuring 45. Enumerate the causes of angular Kyphosis. How
would you manage this case? (March 2004)

Q.7 58 years age office executive who is tall well built had dull-ache lumbar spine for the last
one tear. He reports with sudden onset of severe pain lower lumbar spine, radiating to left
lower limb since ea* morning. He is also experiencing numbness and feeling weakness of the
lower limb. You advise him complete bed rest, non-steroid anti-inflammation drugs along with
steroid. Instead of getting any relief his symptoms are aggravated and he developed retention
of urine by the evening. (March 2004)

a. What is the most likely diagnosis? Justify.


How will you manage him?

Q.1 A 14 years old girl, is brought to you with deformity of the spine which was noticed by
the parents in ,early childhood but has been progressive. The x- rays reveal a left thoracic
scoliotic curye of 40 degrees with a hemivertebra. (March 2005)

a. How would you label this condition?


b. What important points would you keep in mind while examining this
c. patient?
d. What investigations would you order for this patient?
e. How will you treat her.

Q. 5 A 35 years female presents with low back pain radiating to right lower limb for three
months duration. She complains of tightness of calf. No neurological delicits. X-rays lumbo
sacral spine reveals break in par-interarticularis with displacement at L4-5 Level. (Sep 2005)

How will you manage this lady?

Q.2 28 years old women overweight present with history of low back pain radiating down
to buttock that increase during evening. Examination reveals hypolordotic lumbar spine with
prominent step felt at L4-5 region. (March 2006)

a. What is your diagnosis and justify?


b. Discuss the management.

Q.4 Describe clinical, pathological and radiological features of Scheurman's disease. How
will you treat a patient with Scheurmans Khyphosis? (Aug 2006)
26

Q. 7 A young man (40 years old) has had recurrent bouts of low back pain for the last two
years. He presents to you with an acute episode of low back pain arising when he tried to lift a
weight by bending forward. The pain radiates to his left leg all the way to the big toe. There is
sensory loss in the 1st web space and the extensor Hallucis longus is weak.(Feb 2007)

a. What is the most likely diagnosis and what is the level of the lesion?
b. How will you manage this patient?

Q.4 A 22 years old lady has been complaining of back ache for the last 6 months accompanied
with fever and night cries. For the last 3 weeks she has developed staggering gait. On
examination she has localized kyphus and tenderness at thoracolumbar junction. (Jan 2008)

How would you investigate and treat her?

Q.4 A 60 years old lady has been complaining of occasional backache for last few years. She has
suddenly developed severe pain in the back following a minor fall. Examination revealed, a
hunch back at dorso-lumbar region, without neurological loss.

How would you evaluate and manage this patient? (Jun 2008)

Q.6 A 60 years old lady complains of backache in the lower thoracic area for the last few
weeks after a trivial fall. Her neurology is intact but she is a known case of bronchial asthma for
which she is taking medications for a long time. (Mar 2009)

How will you investigate and manage this patient?

Q.1 1 A 25 years old patient presented with history of gradually increasing pain in
thoracolumbar spine for the last one year and weakness both lower limbs for three months. He
is using ATT for 6 months. His examination reveals that he is tender in thoracolumbar spine and
has exaggerated knee and ankle reflexes. His ESR is 15 mm/first hour. X-rays shows a lytic
lesion in the body of T12 with absent right pedicle, intact spinous process and preserved disc
space. (Sep 2009)

a. What is the differential diagnosis?


b. Give a list of investigation that will help in reaching the diagnosis.
c. What are the different options for treatment?
27

Q. 6 A 30 years old laborer fell from a scaffold and fractured his T12 vertebra. He is paraplegic
with no bowel or bladder control. (Mar 2010)

What would be your initial management?


What are your criteria for operative fixation?
Q. 5 A 65 year old male office worker presents with increasing pain in lower back and both legs
for the last one year. The pain increases on walking and is relieved by bending forward and rest.
His walking distance is about 150 yards. He smokes 25 cigarettes per day for the last 30 years.
On examination he is overweight. His spinal examination reveals reduced flexion so that he can
barely bend to bring his hand to the knees. SLR is 70 degrees on both sides and no motor or
sensory deficit in either legs. His knee and ankle reflexes are equal bilaterally. (Sep 2010)
a. What is your differential diagnosis?
b. How will you confirm your diagnosis?
c. What are the treatment options? (Sep 2010)

Q.6 A 40-years old man presents with severe low back pain radiating to left leg up to the heel
for last 3 months. He is unable to extend his big toe. X-ray shows loss of lumbar lodosis with
early degenerative changes. (Oct 2011)

a. What is the differential diagnosis?


b. How will you investigate this case?
c. Discuss the management plan.

Q.10 35 years old laborer has recently been diagnosed to have caries spine of T12-L1 level with
paraplegia. (Oct 2011)

a. How will you stage paraplegia?


b. How will you manage this patient?
c. What are the indications of surgery in caries spine?

Q. 5 A 35 years laborer presents with severe sudden attack of back pain with radiation to right
lower limb, during work resulting in restriction of his mobility for last 02 days. On examination
SLR right 20 and 60 on left side. How will you manage this patient? (Mar 2012)

Q.3 A 55 years old female housewife complains of low back pain for last 08 months. She is
feeling ill and has low grade fever off and on. Tenderness over lumbar spine, SLR is 60 on both
sides. All movements of spine are restricted. (Oct 2012)

a. What is your diagnosis?


b. What investigations you need for final diagnosis?
c. What are the indications for surgery?
28

Q.4 A 40 years old male was lifting a heavy object about 02 hours ago when he developed
sudden severe low back pain, radiating to both lower limbs. He
anaesthesia, bilateral ankle Areflexia and profound weakness. (Oct 2013)

a. What is the most likely diagnosis?


b. Name one investigation which will confirm the diagnosis.
c. How will you this patient?

Q.10 A 12, years old female brought by the parents in OPD with scoliotic deformity of her
thoracolumbar region which is progressively increasing in severity and. now she has developed
complaint of backache. She has not started her menstruation yet. Neurology is intact. Curve is
flexible. (Mar 2013)

a. How will you workup this case?


b. What treatment will you offer and why?

Q.7 A 45 year old male Achondroplast reports to the orthopaedic OPD with the complaints of
severe low back pain radiating along the right leg for the last 3 months. Although he had
suffered from chronic low back pain for the last many years which made his job of "Door-man"
in front of a prestigious hotel, increasingly difficult. (Mar 2013)

a. What are the three common presentations of Achondroplasia?


b. How would you investigate the patient to ascertain the cause of his problem? Give
justification for the investigation you suggest.
c. How would you manage his backache?

7. A 35 year laborer present with history of sudden onset of low back pain radiating to right
lower limb 02 days ago when he was engaged in lifting heavy bag of cement. (Oct 2014)

How will you manage him?

Q.4 A 40-year old labourer presents with backache radiating to left foot after sudden bending 4
months back. On examination SLR left side is 40 degrees; there is sensory impairment at L5
level. (Oct 2015)

a. What is the most probable diagnosis?


b. What are indications of MRI?
c. What are various treatment options?
29

Q A 55 years old female presented in OPD with low backache. There is no H/O trauma. On
examination there is step off at lower lumbar spine. There is weakness of right hip abductors
and big toe dorsiflexor of foot? (April 2015)

a. What is most probable diagnosis?


b. What level of spine is involved?
c. How will you investigate?
d. What are the indications of surgical intervention and how to treat the patient?

Q. 8 A female patient complaining of pain at the lowest part of the spine specially when sit on
hard object she does not give history of trauma or fall, her routine investigations are normal.
(April 2016)

a. What is your diagnosis?


b. What are the different causes of pain at this side?
c. How would you manage this patient?

Q. 3 A 40 years old male was lifting a heavy object about 02 hours ago when he developed
sudden severe low back pain, radiating to both lower limbs. He also developed bilateral foot
drop. On examination, he has saddle anaesthesia, bilateral ankle Areflexia and profound motor
weakness. (Oct 2016)

a. What is the most likely diagnosis?


b. What is the spinal cord level involved and why?
c. Name one investigation which will confirm the diagnosis with justification.
d. What will be your treatment and give reasons for it?

Q. No. 5 (March 2011)


35 years old house maid presents with right upper limb pain radiating
from the neck to the ulnar border of right hand. Pain is partially relived by rest and increased by
work.
a. What is your differential diagnosis?
b. How would you investigate?
c. How would you manage cervical radio-pathy secondary to prolapsed interrelated disc?
30

SPORTS MEDICINE

Q. 6 A 31 year old man twisted his right knee one week ago while coming downstairs
Subsequent to this he had noticed swelling of his right knee. Now he has difficulty in
walking hand is unable to bend his knee. (Mar 2004)

What is the most likely diagnosis?


How would you investigate?
Q. 5 A 21 years old athlete presents with pain leg after rigorous training. Clinically "there is
tenderness over the proximal tibia. X-ray of the tibia is unremarkable.

a. What is your most likely diagnosis and differential diagnosis?


b. What investigations you would like to do?
c. How would you treat this patient?

Q. 8 Write a short essay on Rotator cuff tear. (Mar 2005)

Q.1 A 17 years old female student present with history of 3rd time dislocation in the last
one year of her right patella without signification trauma. (Mar 2006)

a. List differential diagnosis with justification.


b. Describe the predisposing anatomical factors leading to this problem.
c. Discuss the management plan.

Q.5

a. Discuss the role of arthroscopy in knee joint affections. (Mar 2006)


b. Enumerate the portals of entry and describe the complication of knee arthroscopy.

Q.6 Describe clinical, radiological and pathological features of Osteochondritis


dissecans. How do you treat Osteochondritis dissecans of talus. (Mar 2006)

Q.1 A 20 years old man sustains an injury to his right knee while playing football. His knee
swells up within minutes and is acutely painful. He is unable to straighten it fully, nor bear
weight on it. (Aug 2006)

Discuss the possible diagnosis and management plan?

Q.8 Discuss different therapeutic uses of Arthroscopy of knee. (Jan 2008)


31

Q.9 A 60 years old retired officer suddenly developed severe pain on the posterior aspect of his
right heel while playing tennis, He finds it difficult to walk and is complaining of swelling around
the heel. (Jun 2008)

a. What is you diagnosis and justify?


b. How would you evaluate this patient?
c. How would you treat this patient?

Q.2 A young football player is brought from the play ground to the emergency room with his
right knee injury (direct blow). His examination reveals swollen, tense, painful right knee with
intact distal nerves and palpable pulses. His vitals are within safe limits and he is conscious.
(Sep 2009)

a. What initial management would you like to provide in emergency room?


b. What is the differential diagnosis?
c. Give management plan for this patient.

Q.9 An 18 years old male police recruit complains of pain left shin which is increased on running
and relieved on rest. There is tenderness on mid shaft tibia. (Oct 2011)

a. What is your differential diagnosis?


b. How would you investigate this case? Give reasons for each investigation.
c. How would you treat this case?

Q.6 A 25 years aged footballer presents immediately to you following fall resulting in pain and
swelling of left knee during play. The regional examination reveals massively swollen knee joint
with abrasion over anterior aspect of knee. X-ray show avulsion of anterior tibial spine. There
are no injuries to other systems. (Oct 2014)

a. What other possible associated injuries he can have?


b. What step you will take to arrive at diagnosis?

Q A 25 years old footballer received a kick on the lateral side of his right knee two years ago.
He has not been able to play since then. He complains of recurrent swelling and inability to
straighten his knee easily on certain occasions. He experiences giving way of knee specifically
while climbing down the stairs. On examination, there is quadriceps wasting and tenderness in
posterior part of medial joint line. (April 2015)

a. What are possible components of this injury?


b. What investigations are required to confirm the diagnosis?
c. Outline procedures likely to be performed in this case.
32

Q.6 A 65-year old man complains of sudden pain in the right shoulder and inability to abduct
the shoulder for one week. This happened while trying to put some luggage on an overhead
shelf. Now the pain is less but unassisted shoulder abduction is not possible. On examination
there is tenderness in the right subacromial region anterolaterally. Passive movements of the
right shoulder are full. On attempting active abduction the shoulder shrugs but the arm does
not move. Abducting the arm passively to about 30 makes further active abduction possible.
(Oct 2015)

a. What is the diagnosis in this patient? List the investigations needed to


b. confirm the diagnosis.
c. List the etiological factors for this condition.
d. What are the treatment options for this condition?

Q.8 A 53-year old man is referred to you with pain in the right knee that has been worsening
over the past two years. He usually plays tennis several times per week, but recently the pain
has made it difficult for him to continue this routine. Conservative treatment measures have
failed to relieve the patient's pain. Current physical examination of the right knee shows
moderate effusion and tenderness along the medial joint line. McMurray's test is positive. MRI
of the knee shows a 3-cm defect of the articular cartilage the medial femoral condyle. Weight-
bearing X-rays of the right knee show no narrowing of the joint space. (Oct 2015)

a. Enlist four possible procedures for articular cartilage repair.


b. Outline procedure of choice in the light of literature for this case.
Q A 25 years old footballer received a kick on the lateral side of his right knee two years ago. He
has not been able to play since then. He complains of recurrent swelling and inability to
straighten his knee easily on certain occasions. He experiences giving way of knee specifically
while climbing down the stairs. On examination, there is quadriceps wasting and tenderness in
posterior part of medial joint line. (April 2015)
a. What are possible components of this injury?
b. What investigations are required to confirm the diagnosis?
c. Outline procedures likely to be performed in this case.

Q. No. 8 (March 2011)


A 25 years old gentlemen has presented to you in NE department with history of 3rd
time ant dislocation of his right shoulder joint during last six months
a. How will you initially manage this patient?
b. How will you evaluate recurrent instability when the patient comes for followup?
c. What is the definite management for anterior instability with?
I. Bankart lesion
II. Hill Sacahs lesion
33

TRAUMA MALUNION NON-UNION

Q.1 An elderly female has presented with unstable comminuted intertrochanteric fracture
of right hip. Fixation with DHS has been decided. (March 2003)

Describe merits and demerits of


Anatomical fixation
Fixation by medial displacement osteotomy (Dimon Hughston)
Fixation with valgus osteotomy (Sarmiento)
What is a reverse oblique intertrochanteric fracture
What are the problems of fixation with DHS and how to avoid them?

Q.1 A 20 year old gentleman has fallen from roof and has been complaining of pain in
the right groin and inability to bear weight. Scout films show a fracture in the region of
acetabulum. Ssep 2003)

Discuss role of different imaging techniques which will help you to plan definite
treatment.

Q. 2 Describe stages of healing of fractures of long and cancellous hone. (Sep 2003)

Discuss role of various factors that influence healing.

What is the difference between primary and secondary bone healing?

Q. 3 A 60 years old farmer had grade-II open fracture-dislocation of left ankle which is
reduced & splinted with POP slab. Twenty days later wound was pouring pus. Repeat X-rays
ankle reveals increased density with patchy rarefaction of talus How would you evaluate
and what are the treatment options? . (Sep 2003)

Q.10 A 20 years old labourer comes to emergency 'department with a hyperextension

injury of left knee. The foot is pale and cold. (sep 2003)

a. What clinical entities you would consider?

b. How would you investigate this patient?

c. What is the definite management of this patient?

Q.1 A 55 years old female presents with sub-trochanteric fracture of right femur
following tripping over a carpet. Give a detailed account of pre-operative workout for this
lady. Justify your investigations. (Mar 2004)

Q. 2 Discuss the management of bleeding in pelvic fractures. (Mar 2004)


34

Q. 3 17 year old footballer suffers a direct blow and sustains a fracture of his left clavicle,
which s clinically obvious. He is taken off the field and given analgesia and a broad arm sling. He
is then brought to you. You notice that his fingers on the fracture side are pale and he
complains of paresthesia in his hand. How would you investigate and treat his injury?
(Mar 2004)

Q. 4 A 60 year old woman trips and falls, landing on her left elbow. She sustains a
fracture of her olecranon. Discuss and justify the treatment of choice with reference to
various types of olecranon fractures in this age group. (Mar 2004)

Q.2 A 40 years old man report immediately after a gunshot injury to left thigh. There is
bleeding from wound, swelling and deformity of thigh. No other injuries.

How will you manage this patient? (Mar 2004)

Q.4 A 65 year old female falls on her outstretched hand. Clinicoradiologically she has Colles
fracture. (Mar 2004)

Classify distal radial fractures

How would you manage this patient?

Describe criteria for acceptability of reduction.

Q.6 Classify tibial plateau fracture (Mar 2004)


What are the important considerations in the treatment of tibial pleatau fractures?

Enumerate the complications of these fractures.

Q. 9 A 20 years young boy admitted with history of gunshot in his right lower extremity 2 hours
ago. Clinical examination reveals wound of entrance in his right inguinal region and exit is below
the greater trochanter on the lateral aspect of the thigh. There is huge swelling in the inguinal
region. Limb is cold, pale and lying externally rotated:

How will you manage this patient? (Mar 2005)

Q. 10 A 30 years old farmer sustained injury to his right leg with a fallen tree 12 hours back.
He is brought to you with deformed, bleeding leg with tight bandage, swollen foot with
agonizing pain. (Mar 2005)

What emergency measures will you take? and Discuss management plan.
35

Q.1 'What are commonly used classifications for intracapsular fracture neck of the
femur? What are the basis of these classifications and their significance? (Sep 2005)

Q. 4 A30 years aged gentleman presents with gross swelling of thigh and discharge of pus from
a sinus in distal part of incision, three weeks after open nail Fixation for femur fracture.
(Sep 2005) Discuss the management.

Q. 3 A 26 years aged factory worker sustained severely comminuted fracture of right distal
humerus two years back. He was managed non-operatively. He complains of persistent pain
which is interfering in his daily activities. Range of elbow motionis-30 to 100 degree. No
neurological defects. (Sep 2005)

a. What treatment options are available? Give their merits and demerits.
b. How will you treat this patient and justify?

Q.4 An 18 years old adolescent got involved in a road traffic accident and was brought to the
accident and emergency room after an hour with a wooden splint tiod on his right forearm. On
examination after removal of the splint, forearm was found swollen and there was obvious
deformity and no open wound. X-rays showed fracture of both radius and ulna proximal 1/3rd of
the shall, with minimal communition of union. (Mar 2006)

a. What further examination would you conduct on this patient Ina view of treatment he
had?
b. What would be your management plan for his forearm injury?
c. What complication do you expect?

Q. 10 Describe the types and predisposing factors leading to non-union of mid shaft
humeral fracture. How will you treat a case of atrophic non-union Humerus fractures in a
middle aged labourer? (Mar 2006)

Q. 8 A young man of 30 years age is having infected gap (6 cm) non-union of right tibia mid
shaft with quite good skin coverage. Discuss the management and complications expected
during treatment. (Aug 2006)

Q. 10 25 years aged man is brought to you with history of road traffic accident 2 hours back.
He has sustained injury to pelvic region. He has got passed urine after injury. His pulse rate is
100/min. BP-90/60 mm of Hg. There is blood at external urethral meatus. (Aug 2006)

a. What possible injuries he has sustained?


b. Discuss the golden hour management.
c. What are definite treatment options? Give the priorities to 'treatment options, with
reasons.
36

Q.6 A young man of 30 year has been brought after a train accident. His right leg was
crushed between the train and the Patform. (Aug 2007)
a. Briefly describe assessment methodology.
b. Discuss the management.
Q. 9 A 25 year old foot bailer sustained pelvis fracture following an accident. He is
haemodynamically unstable. Radiographic survey revealed displaced, transverse, acetabular
fracture with a large displaced posterior wall fracture. (Aug 2007)
He has no other injuries.
a. How will you treat this patient in accident and emergency room? Enumerate orderly
steps.
b. Why the surgical stabilization in displaced acetabular fracture and is necessary?
c. Give a schedule for surgical stabilization for this patient and justify.

Q.10 A young man 35 year old is involved in a RTA and sustains an injury to his right thigh
with no wounds. Thigh is swollen and is deformed. He is brought to the accident and
emergency within the golden period. Discuss his management. (Aug 2007)

Q.1 35 year aged labourer was operated for Gustilo type I open fracture of diaphysis of tibia.
Internal fixation with 4.5 mm narrow D.C plate was done On 7th post operative day he
presented with pain, fever (100 F) and serious discharge from wound.
Discuss the management of this patient? (Feb 2007)

Q. 2 Classify the dislocation of Acromioclavicular joint. Briefly describe its treatment plan.
(Feb 2007)

Q. 4 A 24 years old man underwent radial head excision for type III radial head fracture 2
years ago. He has regained excellent ROM of his right elbow ix having increasing wrist pain for
the last 6 months. (Feb 2007)

a. What is the cause of this pain?


b. Discuss the pathophysiology leading to this problem.
c. Enumerate possible solution for his problem.

Q.2 A 35 years old farmer sustained a Gustillo Anderson type III-B segmental fracture tibia
fibula, one hour ago while working in the field. He has no other injury.

Discuss the management of this patient. (Jan 2008)


37

Q.10 A 40 years old gentleman sustained intacapsular fracture neck of femur 6 months ago. He
was treated by 6.5 mn lag screws on the second day. He complains of pain and inability to bear
full weight since surgery. X-ray reveals non union of fracture with increased density of head of
femur.

How would you manage this patient? (Jan 2008)

Q.1 A thirty years old gentleman sustained injury to his right hip in a road traffic accident 4
weeks ago. He also had head injury for which he remained admitted in neurosurgical ward. The
patient has been discharged and referred to you for further management. On Examination the
limb is short and internally rotated. His x-rays reveals posterior dislocation of hip with multiple
fragments of posterior lip of accetabulum. (Jun 2008)

a. How would you evaluate this patient?


b. What is your treatment plan for this patient?

Q. 2 A 30-years-old gentlemen sustained multiple injuries in RTA two hours ago. He is


suspected to have following. (Jun 2008)

a. Cervical spine injury


b. Close fracture left femur and contra lateral closed fracture tibia-fibula
c. Blunt injury abdomen.

Q. 3 A Thirty years old gentleman, sustained fracture- shaft of humerus, consequent to gunshot
wound five months ago. The fracture was managed by an external fixator. At present the
patient is unable to straighten his fingers and extend the wrist. (Jun 2008)

a. How would you evaluate the patient?


b. What is you management plan for this patient?

Q.3 A 35 years old gentleman walks into emergency room one hour after fall from fifteen feet
height. He complains of pain / swelling of left ankle and foot, There are no other injuries.
(Mar 2009)

How will you manage him?

Q.4 A 25 years old laborer had a fall on right shoulder 3 months ago. There is painful swelling
of tip of right shoulder joint. Distal functions are normal. (Mar 2009)

a. What are possible injuries?


b. How will you manage this patient?
38

Q.3 A 30 years old man presents with multiple discharging sinuses of right tibia & fluctuating
fever. He had RTA few months ago & got fracture of tibia for which internal fixation was done. X
-ray shows a sclerotic bone of 6cm involving middle part of tibia & separated from rest of bone.
He is unable to bear weight & experiences pain. (Sep 2009)

a. What are the options available to mange this patient?


b. How will you counsel the patient for a long duration treatment?

Q.7 A 30 year old right handed labour& fell off a scaffolding of 10 meter height. He landed on
his right shoulder. He complains of swelling and inability to move his right shoulder. His hand
functions are normal. X-rays of the shoulder shows fracture dislocation of the shoulder.
(Sep 2009)

a. How will you classify fractures of the proximal humerus?


b. How would you manage this patient?

Q.2 A 30 years old man presents with multiple discharging sinuses of tibia and fluctuating fever.
He had road traffic accident few months ago and sustained fracture of tibia for which internal
fixation compression plating was done. Radiograph shows multiple lytic areas with peri-osteal
reaction along with loose implant. He is unable to bear weight due to pain. (Mar 2010)

a. What are the management options available for this patient?


b. How will you counsel this patient?

Q.2 A 30 years old man presents with multiple discharging sinuses of tibia and fluctuating fever.
He had road traffic accident few months ago and sustained fracture of tibia for which internal
fixation compression plating was done. Radiograph shows multiple lytic areas with peri-osteal
reaction along with loose implant. He is unable to bear weight due to pain. (Mar 2010)

a. What are the management options available for this patient?


b. How will you counsel this patient?

Q.3 A 25 years old male sustained fracture femur and tibia two days ago. He
has fluctuating conscious level. He is tachypneic and pulse is 110/min. (Mar 2010)

a. What are the diagnostic possibilities?

b. What investigations would you order?

c. How would you treat this patient?


39

Q.2 A 20 year old professional cricketer fell on out-stretched hand. In emergency, his x-ray

shows posterior dislocation of elbow. (Sep 2010)

a. How would you clinically assess this patient?


b. What are the stabilizers of the elbow?
c. How would you manage this patient?

Q.8 A 30 years young man is brought to A&E with history of RTA 2 hours ago. He has a systolic
BP of 60 mmhg, bruising over the pelvic region and bleeding per urethra. (Oct 2011)

a. What are the possible injuries?


b. What are investigations with justification?
c. What are the priorities in management?

Q.1 A 35 years old man presents in A&E department with history of motor vehicle accident. He
complains of pain, swelling and bruising over right shoulder. On examination there is tenting of
lateral end of clavicle. X-ray shows Rockwood type IV dislocation of acromioclavicular joint.
(Mar 2012)

a. What are possible diagnoses?


b. How will you investigate?
c. How will you treat if histopathology reveals malignant giant cell tumours and justify?

Q. 5 An old lady of 65 years presents in outpatient clinic with complaint of pain left hip and
anterior thigh for the last 02 weeks. She has a history of operation upon her left hip for the neck
of femur fracture 14 months ago. She is otherwise in good health having controlled
hypertension on anti- hypertensive drugs. (Oct 2012)

a. How will you investigate her problem?


b. How will you treat this patient?

Q. 8 A 25 year old football player presents immediately after trauma during play with right knee
pain and massive swelling. X-ray shows displaced fracture of the anterior tibial spine. (Oct 2012)

a. What assessment will you carry out?


b. How will you manage this case?
40

Q. 9 A 35 years old gentleman reports two hours after fall on outstretched hand resulting in
closed fracture distal 1 /3rd of humerus (OTA/A0 type 1r2 Al). He is unable to extend wrist and
fingers. He has no other-injuries. How will you manage this patient? (Oct 2012)

Q.5 (Oct 2013)

a. Name the methods and their indications for the treatment of Distal Radial Fractures.
b. What are the complications that can occur following the treatment?

Q.6 Pelvic External Fixation is indicated for the immediate management of patients with
haemodynamic instability after pelvic fractures. (Oct 2013)

a. What are the sites of pin placement and why these sites are chosen?
b. Name the complications that can occur after application of the pelvic fixator.

Q.1 A 30 years old gentleman jumped out of third storey after a fire thirty minutes ago. On
arrival in A&E Deptt he was found to be in shock, with dyspnoea and tenderness of lower
abdomen. He has been resuscitated by 1 litre Haemaccel and is normotensive now. An
attempted Foley's catheterization was unsuccessful. An urgent x-ray pelvis showed diastasis of
pubic symphysis with 6cm separation and right iliac bone is shifted 5cm proximally. (Mar 2013)

a. How would you handle the patient before definitive orthopaedic management?
b. How would you manage the orthopaedic injury in emergency?
c. What are the principles of definitive management of this skeletal injury?

Q.2 A 45 years old patient sustained fracture upper 1 /3rd of humerus which was treated by
interlocking intramedullary nail one year ago. At- the moment fracture is painful and fracture
line is visible. How would you manage this patient? (Mar 2013)

Q.8 A young policeman sustained firearm injury to left thigh one year ago. On examination he
cannot dorsiflex / planterflex the foot with loss of sensation over plantar aspect of foot. How
would you manage the patient? (Mar 2013)

Q. 2 A Patient aged 25 years develops-unbearable pain in the leg following road traffic accident
and fracture tibia fibula. (Mar 2013)

a. How would you investigate to reach the diagnosis?


b. How will you treat this patient?
41

Q. 3 A 35 years old man has sustained gunshot wound to right arm, On examination there is
2cm, entry wound on anterolateral and 5cm wound on posteromedial aspect of midarm. There
is radial nerve injury X-rays show comminuted fracture midshaft humerus. (Mar 2013)

a. How would you manage this patient?


b. Name the tendon transfer you will use to restore deficit tendon functions in radial nerve
palsy and give its detail.

Q.8 . A 45 years obese gentleman present two hours after run over by a vehicle resulting in
avulsion of skin flap from right going to knee joint and comminuted supracondylar fracture of
femur with intact vascularity and neurology. (Oct 2014)

List three immediate life threatening conditions which this patient can suffer and how will you
prevent them?

Q.1 A 36-year old office clerk presents to you with 2 years history of hip trauma. He
underwent ORIF then, but this failed and implants were removed after 3 months. Ever since
then he had lost hope and never sought any further treatment. Now his X-rays reveal non-
united fracture neck of femur. (Oct 2015)

a. What investigations are required to plan treatment?


b. Outline various possible surgical options.

Q.2 A 20-year old male was operated at some other centre for fracture shaft of femur by K-nail.
Immediate postoperative X-ray shows fracture neck of the femur on the same side. Patient has
now come to you after 20 days of trauma and 10 days after surgery. (Oct 2015)

a. How will you counsel the patient's attendants?


b. How will you manage this case?
c. How can you prevent this complication?

Q.5 (Oct 2015)

a. Name the methods and their indications for the treatment of Distal Radial Fractures.
b. What are the complications that can occur following the treatment?
42

Q A young man aged 25 years is brought to A&E department with history of road traffic
accident. He has sustained injury to pelvic region 2 hours back. He has not passed urine since
injury. His pulse is 100/min, BP is 90/60 mm of Hg, there is ecchymosis in pelvic region. There is
blood at external urethral meatus. (April 2015)

a. What possible injuries has he sustained?


b. What investigations you will do to reach the diagnosis and decide management?
c. Give treatment outline according to priorities and justification.

Q A 30 years old motorcyclist is brought with pain and gross swelling of Right calf after
suffering accidental fail. On examination his leg skin has normal color and temperature. His
distal pulses are palpable. Passive stretching of his toes is excruciatingly painful. X-rays show an
oblique fracture of tibia which is minimally displaced. (April 2015)

1. What complication is suspected in this case?


2. How would you manage this case?

Q. 1 A 30 years male admitted with a closed fracture shaft of Humerus and femur 01 day back.
He is brought in state of unconsciousness, labored breathing at A&E department. His pulse is
96/min, BP 100/60 mmHg and temperature is 380 C. (Oct 2016)

a. Give 03 possible diagnoses with justification.


b. Give 03 important investigations to establish diagnosis with reasoning.
c. What is plan of treatment, if it turns to be fat embolism syndrome?

Q. 2 18 Years old male referred from DHQ hospital after one day of RTA with x-ray pelvis which
shows fracture acetabulum with posterior dislocation of femoral head. (Oct 2016)

Q. No. 10 (March 2011)


A 22 year old female presents with discharging sinus on the postromedial aspect of left
lower thigh for the last 4 years. She has had multiple surgeries during this period without
success.
a. What is the staging system of chronic osteomyelitis?
b. What are the different treatment modalities available?
43

HAND & NERVE INJURIES

Q.8 A 25 year old housewife complains of painful left dominant wrist for the last six
months. There is no history of injury. X-rays reveal increased density of lunate but its
configuration is maintained. (March 2003)

Discuss the etiology of the problem

Discus the different treatment options and their rationale.

Q.9 Write short essay not more than 200 words on:

Flexor tendon sheath in a finger: Its anatomy and function. (March 2003)

Q. 5 A 23 year old man fell on his extended right hand and complains of pain in his wrist. The
AP and lateral X-rays of his wrist have been reported as normal. There is acute tenderness in
the snuff box. (Mar 2004)

How will you follow and treat this patient?


Enumerate the complications of fracture scaphoid.
Q. 8

a. Give a brief review of anatomy of palmar spaces? (Mar 2004)


b. What will be the clinical presentation of deep palmer abscess?
c. Discuss the management.

Q. 4 A 30 years old man reports two hours after injury to his left hand resulting in loss of full
thickness skin and extensor tendons. (Mar 2005)

Discuss the management.

Q. 10 A 30 years office assistant sustained high radial nerve injury associated with close spiral
fracture of distal humerus, one week back. (Sep 2005)

How will you treat his radial nerve injury if you decide to treat fracture non-operatively?
What surgical options are available to you if nerve function fail to
recover in the six months and clinical examination reveals absent palmaris longus tendon?
44

Q.8 A 30 year old office worker presents soon after the injury to his right dominant hand. He
has a sharp laceration on the volar aspect of proximal phalanx of middle and ring fingers.
Patient is unable to flex his injured fingers and complains of reduced sensation. Describe your
physical examination to define the diagnosis in this patient. Outline the management of this
patient including post-operative management. (Aug 2007)

Q. 8 A right handed office worker presents with inability to flex his right index and middle
fingers. Three months back he sustained a knife injury at bases of h fingers. Give an account of
essential clinical examination you will perform along with management plan. (Feb 2007)

Q.9 A 30 years old sportsman fell on his outstretched hand six months ago. He was treated by
POP cast for the fracture waist of scaphoid. At present he still complains of pain and weakness
of grip.

How would you evaluate and treat this patient? (Jan 2008)

Q. 8 A 40 years old lady has been complaining of progressive flexion deformity m,of ring and
little finger, for the last one year. She finds it difficult to hold objects in her hand.

How would you evaluate and manage this patient? (Jun 2008)

Q.8 A 45 years old male who is cn carbamazepine for epilepsy developed thickness in the palm
& flexion deformity of little finger. (Mar 2009)

a. What is your diagnosis?


b. How will you manage?
Q. 10 (Mar 2009)

a. Give an account of surgical anatomy of irreducible dislocation of meta-carpophalangeal


joint of thumb?
b. How will you treat acute meta-carpophalangeal joint dislocation of thumb?

Q.4 A 30 years married lady presented with pain both hands and numbness in her radial
three fingers. Her symptoms increase at night. (Sep 2009)

Give an account of your plan to arrive at the diagnosis.


45

Q. 9 (Sep 2009)

a. What is Bennett fracture?


b. What anatomical factors are responsible for its displacement?
c. How will you treat Bennett fracture in a 25 years old office executive?

Q. 10 A 30 years old right handed dominant labourer presents in emergency room with glass
cut injury on the dorsum of the wrist, just distal to extensor retinaculum. He is unable to extend
his middle and ring finger. (Mar 2010)

a. Enumerate the dorsal compartments of wrist with their contents?


b. What will be your rehabilitation programme after repair of the extensor tendons?

Q.3 A 45 year chef presents to you with pain at the base of his thumb at the level of radial
styloid. Pain is increased on using his thumb mainly in extension. There is slight swelling but no
history of trauma. (Oct 2011)

a. What is your differential diagnosis?


b. How would you manage this case?

Q.9 What are anatomical factors responsible for irreducibility of metacarpophalangeal joint
dislocation of thumb? How will you treat 08 weeks old dislocation of metacarpophalangeal joint
of right thumb? (Mar 2012)

Q.10 (Oct 2012)

a. What is Bennett's fracture dislocation?


b. What is its patho-anatomy?
c. How will you manage fresh case of Bennett's fracture dislocation?
d. What are the immediate and late complications?

Q.10 A young fine-arts student had a glass cut injury on the volar aspect of the wrist resulting in
loss of sensation of thumb and index finger. (Oct 2013)

a. How would you assess the injury?


b. What is your diagnosis?
c. How would you treat?
d. What is the post operative management?
46

Q.4 A 25 year old guitarist sustained glass injury 5cm proximal to volar wrist crease of his
dominant hand one hour ago. (Mar 2013)

a. How would you clinically evaluate this patient?


b. Give your postoperative rehabilitation plan for flexor tendon injury.

1. A 23 years old boy came in the OPD with history of trauma to his right index finger 15 days
back. X-ray shows dislocation of metacarpophalangeal joint of this finger.
d. What is the pathoanatomy of this injury?
e. How will you manage this patient? (Oct 2014)

Q A 23 years old banker had a glass cut injury at the level of distal palmar crease. He is unable
to flex his middle and index finger. (April 2015)

a. How will you assess his injury?


b. How will you treat him?
c. What will be post operative care?

Q. 6 A 20 years old man is having pain in the wrist for the last 4 months. He is a labourer. The
pain increases with manual exertion. There is no history of fever. On examination, there is no
swelling or discoloration. Tenderness is present at the middle of the wrist and there is some
loss of wrist motion. X-rays of the wrist show increases density (sclerosis) of the lunate bone.
(Oct 2016)

a. What is the most likely diagnosis in this case and why?


b. What further investigations are required for establishing the diagnosis? Mention
justification.
c. What is the treatment in this case?

Q. No. 2 (March 2011)

A 30 year old female suffering from advanced rheumatoid arthritis presents

with hand deformity causing hindrance in her routine daily activities.

a. Enumerate different hand deformities in RA.

b. What are the different surgical options for wrist deformities?


47

FOOT & ANKLE

Q. 10 A female of 48 year presents with pain and paresthesia in the sole of her right foot. She
has tenderness behind the medial malleolus. X-rays of the foot show no abnormality. The pain
is aggravated on dorsiflexion, eversion of the foot. (Mar 2004)

a. What is the differential diagnosis?


b. How will you investigate this case?
c. What is the surgical treatment?

Q. 2 A 13 years aged girl presents with pain and deformity of right ankle for the last

two weeks. She is not able to put weight on right foot. She had such episodes

3-4 time in last two years. Clinical examination reveals Pes Plano-Valgus deformity. Passive
correction is very painful and cause 3-4 beats cionus in ankle (Sep 2005)

a. What is your diagnosis and justify?


b. How would you treat her?

Q.3 A 30 year old driver without a seat belt had a head on collision and suffered from injury to

his foot. X-ray shows displaced fracture neck of talus. (Sep 2010)

a. Classify this fracture


b. What are the management options?
c. What are the complications of this injury?

Q.3 A 30 years old labourer presents in A&E Deptt after fall from height. He complains of pain
and swelling of both heels and vital signs are stable. His x-ray reveals fracture of both calcanei.
(Mar 2013)

a. What clinical examination you would perform?


b. How would you evaluate the calcaneal injury?
c. What are the indications for surgical management?
48

GENERAL ORTHOPEDICS

Q. 7 Doscribe the role of various skeletal traction with justification, used in clinical
practice. Describe the mechanism of Hamilton Russell traction. (Mar 2006)

Q. 9 Being a casualty medical officer at a peripheral hospital, you have to refer a poly trauma
patient to a tertiary care centre. Discuss the pre-requisites and protocol of transportation
of this patient? (Mar 2006)

Q. 5 What do you understand by the terms Minimal Access Surgery' Discuss role of
"Minimal Access Surgery" in orthopaedic practice? (Aug 2006)

Q. 9 (Aug 2006)

a. Describe with justification the different methods and sites of traction used in clinical
practice.,
b. List the complications of various traction.
c. c) Describe the major steps in application of Dunlop traction.

Q. 5 (Aug 2007)

a. What is reflex sympathetic dystrophy (RSD)?


b. Describe the pathophysiology?
c. Describe the clinical presentations and outline of management.

Q.3 A 20 years old young man has a non healing ulcer of the sole of right foot following a
gunshot injury of distal thigh 3 months ago. His thigh wounds have healed and there was no
bony injury. (Jan 2008)

How will you manage this case?

Q. 7 What do you understand by LCP. Discus the biomechanical principles, indications,


advantages and disadvantages of this implant. (Jun 2008)

8 Give a brief account of role of ultrasound in orthopaedic and trauma. (Sep 2009)

Q. 4 What is the pathophysiology of blast injuries? (Mar 2010)


49

Q.4 A 14 year old boy sustained a minor injury to his knee. He immediately developed swelling

of the knee. He has past history of similar episodes. (Sep 2010)

a. What is your differential diagnosis?


b. How will you confirm your diagnosis?
c. How would you manage this patient?

Q. 8 You are an orthopaedic surgeon, incharge of a rehabilitation center for paraplegics.


(Sep 2010)

Enumerate the role of:

i. Nurses
ii. Physiotherapist
iii. Occupational therapist
iv. Orthopaedic surgeon

Q.1O (Sep 2010)

a. What is minimal invasive surgery?


b. What are the requirements of minimal invasive surgery?
c. Enumerate the role of minimal invasive surgery in orthopaedics?

Q.1 Define orthosis. Classify and describe its role in orthopaedics? (Oct 2011)

Q.2 Write short notes on: (Oct 2011)

a. Interlocking finnail principle and its uses


b. What are the principles of locking plate? Give its uses.
c. What are the different types of bearing surface available for total hip arthroplasty? Give
pros and cons of metal on metal surfaces.

Q. 3

a. What is Platelet Rich Plasma (PRP)? What is its role in orthopaedics?


b. What are the indications, advantages and disadvantages of Retrograde femoral
interlocking nail? (Mar 2012)

Q.1 You have a patient with hepatitis C on your list for internal fixation of femur. What are the
recommended operating room protocol which are to be followed during this patient's surgery?
(Oct 2012)
50

Q.2 What are the sources of autogenous bone graft? Give different techniques in which
autogenous bone graft can he harvested and their uses. (Oct 2012)

Q.6 (Oct 2012)

a. What is meant by Damage Control Orthopaedic?


b. What is the role of stern cells in modem orthopaedic surgery?

Q.9 What are the modern operation, theater protocols used to reduce the incidence of
surgical site infection. (Oct 2013)

Q.9 You are an orthopaedic surgeon in DHQ hospital and have observed an alarming increase in
number of patients having low Vitamin D level. The District Administration has asked you to
evaluate this epidemic and give concrete suggestions. How would you proceed? (Mar 2013)

Q.8 Enumerate bone graft substitutes used in orthopaedic surgery. Give examples and
mechanism of action of each group. (Mar 2013)

Q.9 What are the occupational hazards to an Orthopaedic surgeon and measures to prevent
them? (Mar 2013)

Q.10 .

a. What do you understand by stem cell therapy?


b. What are the sources of stem cells?
c. What is its role in musculo-skeletal disease? (Oct 2014)

Q (April 2015)

a. What are mechanisms of injuries in Bomb blast incidents?


b. English possible musculoskeletal injuries due to Bomb blast.
c. Outline management strategies for these musculoskeletal injuries.

Q (April 2015)

a. What do you understand by bone banking system?


b. What are pre-requisites for safe harvesting and storage of Allografts?
51

Q.10 (Oct 2015)

a. What is triage and what is its principle?


b. How is triage done?
c. Enlist steps to have effective "triage system" in your hospital A&E.

Q.1 A 28 year old girl slipped and fell down 10 stairs onto her right hand. She sustained
fractures of the right radius and ulnar shafts. She underwent surgery, the next day. General
anaesthesia was administered, prophylactic antibiotic and a rubber band tourniquet were used.
Open reduction and internal fixation of the fractures was performed with two DCPs and the
surgery seemed uneventful.

After recovery she was found to have wrist drop and inability to flex or extend the fingers.
Sensations were intact. (April 2016)

a. What is the diagnosis and cause?

What is the prognosis? How will you council this patient? c) What precautions Q. 9 Discuss the
mechanism of actions and clinical uses of Bisphosphonates and Calcitonin. (Sep 2005)

1 A 60 year old lady presents to you with severe low back pain, more at night for last
three months. She has lost weight significantly during this period.
There is no history of fever. Her pain is not relieved by usual NSAIDs.
Examination reveals diffuse tenderness over lumbar spinal region. Her ESR is 120 in the first
hour. Radiography of the vertebral column shows diffuse- demineralization of the spine and
pelvis, and collapse of L2 and L3 vertebrae. (Aug 2007)
a. Enumerate the causes.
b. How will you investigate this patient and justify?
c. Discuss the management for non-malignant collapsed vertebrae.

Q.6 A 30-years-old lactating, multiparous has been complaining of backache, muscle cramps
and generalized body is).7-shes. She has difficulty in getting up from bed. On examination
movements of hip are painful and limited. (Jan 2008)

a. What is the possible diagnosis?


b. How will you evaluate and manage her?
52

Q.1 A 60 years old postmenopausal lady presents with backache and generalized body aches.
Her ESR, serum calcium, phosphate and thyroid function tests are normal. Spine x-ray shows
osteopenia with decreased vertebral height.(Mar 2010)

a. How would you investigate this patient?


b. What are the management option?
Non-pharmacological
Pharmacological so-

What steps should be taken to avoid such complications?

Q. 10 (April 2016)

a. Enlist the components of "Trauma System"?


b. Enlist the measures you will suggest for Government to reduce trauma burden and
effective trauma management?

Q. No. 1 (March 2011)

a. What are bone morphogenic proteins?


b. How many types BMPs are there and what are their clinical uses?
c. Which types of BMPs have clinical role in orthopaedic surgery?

Q. No. 7 (March 2011)


Describe what do you understand by MIPO technique.
a. What are the options of treatment?
b. What are the advantages of this technique?
c. What would be your patient selection criteria and what would be the contraindication?
53

METABOLIC DISEASE

Q. 9 Discuss the mechanism of actions and clinical uses of Bisphosphonates and Calcitonin.
(Sep 2005)

1 A 60 year old lady presents to you with severe low back pain, more at night for last
three months. She has lost weight significantly during this period.
There is no history of fever. Her pain is not relieved by usual NSAIDs.
Examination reveals diffuse tenderness over lumbar spinal region. Her ESR is 120 in the first
hour. Radiography of the vertebral column shows diffuse- demineralization of the spine and
pelvis, and collapse of L2 and L3 vertebrae. (Aug 2007)
d. Enumerate the causes.
e. How will you investigate this patient and justify?
f. Discuss the management for non-malignant collapsed vertebrae.
Q.6 A 30-years-old lactating, multiparous has been complaining of backache, muscle cramps
and generalized body is).7-shes. She has difficulty in getting up from bed. On examination
movements of hip are painful and limited. (Jan 2008)

c. What is the possible diagnosis?


d. How will you evaluate and manage her?

Q.1 A 60 years old postmenopausal lady presents with backache and generalized body aches.
Her ESR, serum calcium, phosphate and thyroid function tests are normal. Spine x-ray shows
osteopenia with decreased vertebral height.(Mar 2010)

c. How would you investigate this patient?


d. What are the management option?
Non-pharmacological
Pharmacological so-
54

MISCELLANEOUS

Q. 8 A 45 years old man, non diabetic and chronic smoker comes to you with foul smelling
black patch at the tip of big toe (right), developed after trauma. He also has history of right calf
cramps and increasing tiredness in legs on distant walk. On examination, no sensory or motor
deficit found. CBC, urine examination, sugar and urea are within normal range. How would you
assess this patient to solve his problem? (Mar 2004)

Q. 8 A middle aged man of 45 years present with diabetic big toe having foul smelling trophic
ulcer. Describe the underlying pathology. How will manage this case? (Mar 2006)

Q. 7 A 45 years old chronic smoker present with intermittent sever pain in his right

foot. Examination revealed gangrenous changes in his right distal 3rd and 4th

toes. His dorsalis pedis and post tibial pulsation are not palpable. Arterial Doppler

flow test reveal weak pulses at knee. (Aug 2006)

a. What is your diagnosis? Justify.

b. Briefly describe underlying pathology of this disease

c. How will you manage this case?

Q. 6 A 33 year old man present to you with a history of progressively painful left hip over the
past 18 months, he is now unable to weight bear. He is a knows case of ulcerative colitis and is
dependent on high dose of corticosteroids to control his colitis for the past 5 year. (Feb 2007)

a. What is your diagnosis?


b. How would you evaluate (investigate) this case?
c. Enumerate the treatment options for his management, justify.

Q. 5 A 12 years girl presents with history of difficulty to feed herself with right hand. She was
delivered by forceps, Immediately after delivery there were no movement of right upper limb.
With physiotherapy she has improved function of hand and elbow. (Jun 2008)

a. How will you evaluate her?


b. How will you treat her?

Q. 6 What are the indications for arthrodesis of shoulder joint? What is the position of
arthrodesis? What are different techniques which can be used to achieve arthrodesis?
(Mar 2012)
55

Q. 7 A Lady of 30 years of age, complaining of pain and parasthesia extending from shoulder
down to ulnar aspect of arm and medial two fingers.

On examination there is mild claw of 4th and 5th fingers with weakness and wasting of intrinsic
muscles. (April 2016)

a. What is yours diagnosis and give different diagnosis


b. How will you manage this patient?

Q. 8 A 40 year old insulin dependent poorly controlled diabetic presents with non-healing ulcer
on planter aspect of 1st metatarsal head. (Oct 2016)

a. How will you clinically assess the lesion to establish the pathogenesis of the ulcer?
b. What investigations you will do to rule out ischemic cause?
c. What investigation you will do to rule out infection?
d. What will be your treatment options if it turns out to be neuropathic ulcer?

Q. 9 A 38 years old right hand dominant male, who sustained a right brachial plexus injury,
presented for treatment 9 months post-injury. He lacked the ability to flex the elbow and to
move the shoulder joint. There was marked atrophy about the supra and infra spinatous fossae,
mild to moderate subacromial subluxation, substantial atrophy of the forearm or hand. Motor
testing (preoperative) showed absent (0/5) function of deltoid, supraspinatus, infraspinatus,
and biceps and normal spinal accessory function. (Oct 2016)

a. Name priorities of reconstruction.


b. Enumerate procedures of choice for reconstruction of peripheral nervous pathway
(neurotization) for each priority.

Q. 10 (Oct 2016)

a. What is the stem cell therapy?


b. What are the sources of stem cells?
c. Name the orthopaedic conditions treated by stem cells therapy?
d. What is the role of stem cell therapy in AVN femoral head?