NEET-PG 2024 - Orthopaedics Practice Questions

Q: Fracture at which site affects the longitudinal growth of a bone?

Epiphyseal plate. ***Epiphyseal plate*** - The **epiphyseal plate**, also known as the **growth plate**, is a cartilaginous disc responsible for the **longitudinal growth** of long bones. - A fracture in this region can damage the **chondrocytes** and disrupt the normal ossification process, potentially leading to **growth arrest** or limb length discrepancies. *Diaphysis* - The **diaphysis** is the **shaft** or central part of a long bone. - While a fracture here can cause pain and instability, it typically does not directly affect the **longitudinal growth** potential of the bone. *Epiphysis* - The **epiphysis** is the end part of a long bone, initially separated from the main bone by cartilage but later fused with it. - Although it contains the epiphyseal plate in growing individuals, a fracture to the epiphysis itself (excluding the growth plate) primarily affects the **joint surface** and stability, rather than longitudinal growth directly. *Metaphysis* - The **metaphysis** is the transitional zone between the diaphysis and the epiphysis, adjacent to the growth plate. - While fractures in this area can be close to the growth plate, a metaphyseal fracture generally does not directly damage the **growth plate cartilage** to the same extent as a fracture through the plate itself, making its impact on longitudinal growth less direct or severe.

Q: An 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Osteomyelitis. ***Osteomyelitis*** - The presentation of **tenderness**, **warmth over the bone**, **fever**, and elevated **ESR** and **CRP** are classic signs of a bone infection, or osteomyelitis. - While not explicitly shown in the provided text, a radiograph in acute osteomyelitis might show **soft tissue swelling** or subtle **periosteal elevation**, progressing to **bone destruction** and **sclerosis** in later stages. *Ewing's sarcoma* - This is a highly malignant bone tumor that presents with **pain** and **swelling**, but is typically not associated with a pronounced **fever** and signs of systemic infection. - Radiographically, it often shows an "onion-skin" **periosteal reaction** and lytic lesions, without the strong inflammatory markers seen here. *Osteosarcoma* - This is another malignant bone tumor, primarily presenting with bone **pain** and **swelling**, but systemic inflammatory signs like **fever** are rare unless there is a pathologic fracture or infection secondary to tumor necrosis. - Radiographs typically show a "sunburst" appearance, **Codman's triangle**, or mixed lytic and blastic lesions, not indicative of acute infection. *Giant cell tumor* - This is a usually **benign aggressive bone tumor** that causes **pain** and **swelling** around joints. - It does not typically present with systemic signs of infection such as **fever** and significantly elevated **ESR** and **CRP** unless there is a secondary infection, and it usually affects the **epiphyses** of long bones in young adults.

Q: A 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Osteomyelitis. ***Osteomyelitis*** - The clinical presentation of **fever, localized tenderness, and warmth** with elevated **ESR and CRP** levels in an 18-year-old is highly suggestive of **osteomyelitis**, an infection of the bone. - Radiographs in acute osteomyelitis may show soft tissue swelling, periosteal reaction, and areas of **bone destruction**, which can be subtle early in the infection. *Ewing's sarcoma* - This typically presents with local pain and swelling, and can also cause fever and elevated inflammatory markers. - However, characteristic radiographic findings such as an **"onion skin" periosteal reaction** or a **"moth-eaten" appearance** are not clearly visible here. *Osteosarcoma* - This is a primary malignant bone tumor often seen in adolescents, presenting with localized pain and swelling. - Radiographic features typically include a **Codman triangle**, **sunburst appearance**, or a **mixed lytic and blastic lesion**, which are not seen in this image. *Giant cell tumor* - Usually occurs in **young adults (20-40 years old)**, not typically in an 18-year-old, and presents with pain and swelling around the joint. - Radiographically, it is characterized by an **eccentric lytic lesion** in the **epiphysis or metaphysis** of long bones, often described as a **"soap bubble" appearance**, which is not depicted here.

Q: Identify the condition shown in the given X-ray: ![img-63.jpeg](img-63.jpeg)

Osgood-Schlatter disease. ***Osgood-Schlatter disease*** - The X-ray shows fragmentation and irregularity of the **tibial tuberosity**, which is characteristic of Osgood-Schlatter disease. - This condition typically affects adolescents undergoing rapid growth spurts and presents with **pain and swelling** at the tibial tuberosity. *Tibial tuberosity fracture* - This usually involves a **clear fracture line** and displacement of the tibial tuberosity. - It is typically caused by a **sudden, forceful contraction** of the quadriceps muscle. *Lateral epicondyle of femur* - The X-ray shows changes at the **tibial tuberosity**, not the lateral epicondyle of the femur. - The lateral epicondyle is located at the **distal end of the femur**, near the knee joint. *Gerdy's tubercle fracture* - Gerdy's tubercle is the insertion point of the **iliotibial band** on the lateral aspect of the proximal tibia. - Fractures here are **rare** and would present differently on X-ray compared to the observed tibial tuberosity changes.

Question 1

Fracture at which site affects the longitudinal growth of a bone?

Accepted Answer

Epiphyseal plate

Answer

Diaphysis

Answer

Epiphysis

Answer

Metaphysis

Question 2

An 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Accepted Answer

Osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteosarcoma

Answer

Giant cell tumor

Question 3

A 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Accepted Answer

Osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteosarcoma

Answer

Giant cell tumor

Question 4

Identify the condition shown in the given X-ray:
![img-63.jpeg](img-63.jpeg)

Accepted Answer

Osgood-Schlatter disease

Answer

Lateral epicondyle of femur

Answer

Tibial tuberosity fracture

Answer

Gerdy's tubercle fracture

NEET-PG 2024 — Orthopaedics