INI-CET 2026 - Orthopaedics PYQs Practice Questions

Q: A 60-year-old man with treated TB 1 year ago presents with low back pain. MRI spine shows a lesion. What is the most appropriate next investigation?

Mantoux test. ***Mantoux test*** - In a patient with a history of treated tuberculosis presenting with a new spinal lesion, reactivation or reinfection must be considered, and the **Mantoux test** (or Tuberculin Skin Test) helps assess the patient's immune response to Mycobacterium tuberculosis. - While the Mantoux test helps guide the clinical suspicion, a **positive test** in a previously treated patient requires careful clinical correlation to distinguish between old immunity and active disease. *CECT spine* - A **CECT spine** generally provides less soft-tissue resolution compared to an MRI, which has already been performed in this case. - Further imaging with contrast is usually focused on the extent of the disease or planning for intervention rather than the primary next diagnostic step in this context. *CT chest* - While **CT chest** may show old healed TB foci or reactivation, it is not the next most appropriate step to characterize the specific spinal lesion presenting as back pain. - It is a secondary investigation to rule out pulmonary involvement but does not directly diagnose the spinal pathology. *Biopsy* - Although **histopathology** via biopsy is the gold standard for a definitive diagnosis of Pott's spine or suspected malignancy, it is an invasive procedure generally reserved for cases where prior non-invasive testing or clinical suspicion remains unresolved. - In the initial diagnostic workup for a suspected tuberculous spinal lesion, less invasive investigations are prioritized before proceeding to surgical intervention. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 30-year-old female post-RTA has persistent pain uncontrolled by analgesics. Compartment pressure is 90 mmHg with absent pulse. What is the treatment?

Emergency fasciotomy. ***Emergency fasciotomy*** - This patient presents with hallmark signs of **acute compartment syndrome**, specifically a pressure of 90 mmHg (normal is <10-15 mmHg) and absent pulses indicating **vascular compromise**. - **Emergency fasciotomy** is the definitive and limb-saving treatment to release the internal pressure and restore **tissue perfusion**. *Observation* - Observation is dangerous and inappropriate given the clinical evidence of **ischemia** and elevated compartment pressures. - Delaying surgical intervention significantly increases the risk of permanent **neuromuscular damage** and **rhabdomyolysis**. *Increase IV analgesics* - Increasing analgesia masks the symptoms without addressing the underlying **pathophysiology** of the increased **intra-compartmental pressure**. - Pain out of proportion to the injury is a classic sign of compartment syndrome that mandates surgical decompression, not sedation. *External fixation* - While external fixation is used to stabilize fractures, it does not relieve the **intramuscular pressure** causing the compartment syndrome. - Relying on stabilization rather than decompression leads to irreversible ischemic contractures such as **Volkmann's contracture**. [Practice more Orthopaedics PYQs on OnCourse]

Q: In femoral neck fracture management using Garden classification, which treatment is indicated for an elderly patient?

Hemiarthroplasty. ***Hemiarthroplasty*** - In elderly patients with displaced femoral neck fractures, Hemiarthroplasty is the preferred treatment as it lowers the risk of non-union and avascular necrosis compared to internal fixation. - This procedure provides immediate stability and early mobilization, reducing the complications associated with prolonged bed rest in geriatric populations. *Cannulated screws* - These are typically reserved for **nondisplaced** femoral neck fractures (Garden I and II) or in younger patient populations where preserving the femoral head is a priority. - Using screws in elderly patients with displaced fractures carries a high risk of **fixation failure** and the need for reoperation. *Total hip replacement (THR)* - While THR can be used for displaced femoral neck fractures, it is generally reserved for active, physiologically younger, or high-functioning elderly individuals with intact acetabular cartilage. - It is a more extensive surgery than hemiarthroplasty and carries a slightly higher risk of **dislocation**, though it offers better long-term functional outcomes. *Conservative management* - This approach is almost exclusively reserved for patients who are medically unfit for surgery due to severe comorbidities or extremely limited baseline mobility. - It generally leads to poor outcomes, including significant pain, loss of independence, and high rates of **complications related to immobility** like pneumonia and deep vein thrombosis. [Practice more Orthopaedics PYQs on OnCourse]

Q: A proximal humerus fracture is classified using Neer's classification. Which surgical option is most appropriate for a 4-part fracture in a young patient?

Humerus plating. ***Humerus plating*** - In **young patients** with a **4-part proximal humerus fracture**, the goal is **joint preservation** and anatomical restoration of the humeral head. - **Open Reduction Internal Fixation (ORIF)** using a **locking plate** provides stable fixation, allowing for early rehabilitation while avoiding the long-term complications of arthroplasty. *Humerus nailing* - **Intramedullary nailing** is generally reserved for **2-part surgical neck fractures** or certain proximal shaft fractures. - It is often unsuitable for **4-part fractures** because it provides poor purchase in the fragmented humeral head and complicates reduction of the tuberosities. *Hanging cast/K-wires* - A **hanging cast** is a conservative management technique typically used for **diaphyseal humeral shaft fractures**, not intra-articular proximal fractures. - **K-wire fixation** generally lacks the **mechanical stability** required to maintain a complex 4-part fracture pattern during the healing process. *Shoulder hemiarthroplasty* - This is typically reserved for **elderly patients** with low functional demand or where the **vascularity of the humeral head** is severely compromised resulting in a high risk of avascular necrosis. - In a **young patient**, hemiarthroplasty is considered a salvage procedure due to limited longevity and the potential for **glenoid erosion** over time. [Practice more Orthopaedics PYQs on OnCourse]

Q: A child presents with a Gower sign. What does this finding indicate?

Proximal muscle weakness. ***Proximal muscle weakness*** - The **Gowers sign** is a classic clinical finding where a child must use their hands and arms to 'walk' up their own body to transition from a seated or squatting position to a standing one. - It indicates significant weakness of the **proximal hip and thigh muscles**, typically associated with conditions like **Duchenne muscular dystrophy**. *Sensory neuropathy* - While sensory neuropathies can cause gait disturbances or balance issues, they do not cause the structural weakness of proximal muscles required for the **Gowers maneuver**. - Symptoms typically include **numbness**, **tingling**, or **sensory loss** in a stocking-glove distribution rather than motor weakness. *Joint laxity* - Joint laxity often relates to connective tissue disorders like **Ehlers-Danlos syndrome** and typically results in joint instability or hypermobility. - Patients with laxity do not exhibit the specific compensatory motor pattern seen in **Gowers sign** unless there is a concurrent myopathy. *Distal muscle weakness* - Distal muscle weakness often manifests as **foot drop** or difficulty with fine motor tasks, rather than core and thigh strength deficits. - Conditions affecting distal muscles, such as **Charcot-Marie-Tooth disease**, typically present with atrophy of the lower legs rather than the proximal compensatory movements seen here. [Practice more Orthopaedics PYQs on OnCourse]

Question 1

A 60-year-old man with treated TB 1 year ago presents with low back
pain. MRI spine shows a lesion. What is the most appropriate next
investigation?

Accepted Answer

Mantoux test

Answer

CECT spine

Answer

CT chest

Answer

Biopsy

Question 2

A 30-year-old female post-RTA has persistent pain uncontrolled by analgesics. Compartment
pressure is 90 mmHg with absent pulse. What is the treatment?

Accepted Answer

Emergency fasciotomy

Answer

Observation

Answer

Increase IV analgesics

Answer

External fixation

Question 3

In femoral neck fracture management using Garden classification, which treatment is indicated
for an elderly patient?

Accepted Answer

Hemiarthroplasty

Answer

Cannulated screws

Answer

Total hip replacement (THR)

Answer

Conservative management

Question 4

A proximal humerus fracture is classified using Neer's classification. Which surgical option is
most appropriate for a 4-part fracture in a young patient?

Accepted Answer

Humerus plating

Answer

Humerus nailing

Answer

Hanging cast/K-wires

Answer

Shoulder hemiarthroplasty

Question 5

A child presents with a Gower sign. What does this finding indicate?

Accepted Answer

Proximal muscle weakness

Answer

Sensory neuropathy

Answer

Joint laxity

Answer

Distal muscle weakness

Question 6

A 2-year-old child with a history of old knee injury now has varus deformity of the left knee.
Deformity persists on flexion; blood report is normal. X-ray shows unilateral genu varum and
angulated tibia. What is the diagnosis?

Accepted Answer

Malunion of tibial fracture

Answer

Osteofibrous dysplasia

Answer

Rickets

Answer

Focal fibrocartilaginous dysplasia

Question 7

In neuropraxia, what is the pathological finding?

Accepted Answer

Physiological conduction block with intact axon

Answer

Nerve trunk damage

Answer

Perineurium damage

Answer

Axon disruption

Question 8

A 28-year-old male with bilateral femoral and tibial fractures and a chest wound presents with
unstable blood pressure and tachycardia. After initial stabilization, what is the most appropriate
initial management of his long bone fractures?

Accepted Answer

External fixation of both femur and tibia

Answer

Internal fixation of femur with screws and external fixation of tibia

Answer

External fixation of femur and internal fixation of tibia with nailing

Answer

External fixation, or screw/plating/nailing depending on surgical skill of the surgeon which saves time

Question 9

An MRI of the ankle shows a whitish, irregular
abnormality in the Achilles tendon. What is the most
likely finding and its corresponding management?

Accepted Answer

Thompson test positive

Answer

Steroid injection

Answer

Plaster cast

Answer

Surgical repair

INI-CET 2026 — Orthopaedics