Repeated Medical PG Question- 108

#ORTHOPAEDICS ( NEET-PG)

Q- A 4 yr old child while playing suddenly spun around his elbow from her servant maid's hand and now continuously crying not allowing anyone to touch his elbow. He is keeping his elbow extended .What is most likely the diagnosis ?

A.  Radial head fracture 

B.  Pulled elbow 

C.  Supra condylar fracture

D. Elbow dislocation

ANSWER= B. Pulled elbow

Explain:- Pulled elbow, also called nursemaid’s elbow, is a radial head subluxation caused by axial traction or a sudden pull of the extended pronated arm, and it is a very common phenomenon. In this case of pulled elbow, the child usually avoids moving the affected arm, holding it close to his or her body, without considerable pain, and no obvious swelling or deformity can be seen. While a fracture should be excluded, the pulled elbow can usually be identified based on this presentation.

 

Q- In Monteggia fracture, which is true about ulnar fracture and head of radius?

A. Both ulnar fracture and head of radius is displaced posteriorly 

 B. Both ulnar fracture and head of radius is displaced anteriorly 

 C. Ulnar fractures is posteriorly and head of radius is displaced anteriorly 

 D. Ulnar fracture is anteriorly and head of radius is displaced posteriorly

ANSWER= B. Both ulnar fracture and head of radius is displaced anteriorly
Explain:- In Monteggia fracture there is a fracture of the upper-third of the ulna with dislocation of the head of the radius. It is caused by a fall on an out­stretched hand. It may also result from a direct blow on the back of the upper forearm. These fall into two main categories depending upon the angulation of the ulna fracture - extension and flexion type. The extension type, is the commoner of the two, where the ulna fracture angulates anteriorly (extends) and the radial head dislocates anteriorly. The flexion type is where the ulna fracture angulates posteriorly (flexes) and the radial head dislocates posteriorly.

 

Q- A 56-year-old female presents with nocturnal pain in the right thumb, index and middle finger for the past 3 months. All of the following provocative tests can be performed for the diagnosis of the condition except : 

A. Phalen's test

B. Finkelstein test 

C. Tinel's sign 

D. Tourniquet test

ANSWER= B. Finkelstein test
Explain:- Nocturnal pain in the right thumb, index and middle finger for the past 3 months in a 56-year old female is highly suggestive of Carpal tunnel syndrome. Finkelstein test is used to diagnose DeQuervain's tenosynovitis, not the carpal tunnel syndrome.