Category: Image Based Question

Which statement is incorrect about the pathology shown in the image:

A. Tumor arise from epiphyseal to metaphyseal region

B. Tumor has distinct margin

C. Eccentric lesion

D. Chemotherapy is the treatment of choice

What should be the most likely diagnosis of this 65 year old lady presents with backache and following radiograph of the spine shown in image:

A. Osteoporosis

B. Spondylolisthesis

C. Spondylolysis

D. Discitis

Correct Answer » B Explanation

Answer. B. Spondylolisthesis

• Spondylolisthesis is subluxation of lumbar vertebrae, usually occurring during adolescence.
• It usually results from a congenital defect in the pars interarticularis (spondylolysis).
• Spondylolisthesis is usually fixed (ie, permanent and limited in degree). It usually involves the L3-L4, L4-L5, or L5-S1 vertebrae.
• Spondylolisthesis often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a lumbar vertebra weakened by a congenital defect in the pars interarticularis (spondylolysis).
• This defect is easily fractured; separation of the fracture fragments causes the subluxation. Spondylolisthesis can also occur with minimal trauma in patients who are > 60 and have osteoarthritis.
• If mild to moderate (subluxation of = 50%), spondylolisthesis, particularly in the young, may cause little or no pain.
• Spondylolisthesis can predispose to later development of spinal stenosis.
• If due to major trauma, spondylolisthesis can cause spinal cord compression or other neurologic deficits; these deficits rarely occur.

[This x-ray shows stage 1 spondylolisthesis of L5 on S1. The black arrow shows the posterior border of L5, which subluxes anterior to S1. The red arrow points to the spondylolysis (congenital defect in the pars interarticularis).]

Identify the condition as shown:

A. Brodie abscess

B. Osteoid osteoma

C. Intracortical hemangioma

D. Chondromyxoid fibroma

A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis?

A. Colle’s fracture

B. Smith fracture

C. Monteggia fracture

D. Galeazzi’s fracture

Correct Answer » D Explanation

Ans: D. Galeazzi’s fracture

(Ref Apley’s 9/e p771)

• In the given X-ray, a transverse or short oblique fracture is seen in the lower third of the radius, with angulation or overlap.
• The distal radio-ulnar joint is subluxated or dislocated.
• Classically seen in Galeazzi’s fracture.

Galeazzi’s fracture’s X-ray:

• A transverse or short oblique fracture is seen in the lower third of the radius, with angulation or overlap.
• The distal radio-ulnar joint is subluxated or dislocated.

A 9-year-old child presents to your clinic with the following deformity. Which is the most likely fracture leading to such a defect?

A. Colle’s fracture

B. Lateral epicondyle fracture

C. Medial epicondyle fracture

D. Supracondylar fracture

Correct Answer » D Explanation

Ans: D. Supracondylar fracture

(Ref: Apleys 9/e p371, 760)

• The given picture shows cubitus varus or gun-stock deformity.
• The most common cause is ma/union of a supracondylar fracture.

Cubitus Varus (`Gun-Stock’ Deformity):

• The deformity is most obvious when the elbow is extended and the arms are elevated.
• The most common cause is malunion of a supracondylar fracture.
• The deformity can be corrected by a wedge osteotomy of the lower humerus but this is best left until skeletal maturity.

Which of the following test is being demonstrated by the given image?

A. Straight leg raising test

B. Thomas test

C. Narath sign

D. Trendelenburg test

Correct Answer » B Explanation

Ans: B. Thomas test

(Ref Apley’s 9/e p495)

• Given image demonstrates Thomas test.
  • Both hips are flexed simultaneously to their limit, thus completely obliterating the lumbar lordosis.
  • Holding the ‘sound’ hip firmly in position  à hence, keeping pelvis still à Other limb lowered gently à with any flexion deformity the knee will not rest on couch.

Identify the deformity seen in the given picture:

A. Hallux valgus

B. Hallux varus

C. Cubitus valgus

D. Rheumatoid nodule

Correct Answer » A Explanation

Ans: A. Hallux valgus

(Ref: Apley’s  603, 604)

• The given picture shows hallux valgus in which outward or lateral deviation of great toe occurs.

Hallux valgus:

• Commonest of the foot deformities (and probably of all nzusculoskeletal deformities).
• In people never worn shoes the big toe is in line with the first metatarsal, retaining the slightly fan- shaped appearance of the forefoot.
• In people who habitually wear shoes the hallux assumes a valgus position.
• But only if the angulation is excessive is it referred to as `hallux valgus’.

This is the X-ray of a 7-year-old child. Identify the deformity:

A. Coxa vara

B. Coxa valgus

C. Coxa magna

D. Coxa saltans

Correct Answer » A Explanation

Ans: A. Coxa vara

• Coxa vara: Reduced neck shaft angle (<120°)
• Coxa valga: Increased neck shaft angle (>135°)
• Coxa saltans: It is also known as snapping hip, caused by motion of muscles and tendons over bony structures around the hip joint
• Coxa magna: It is the asymmetrical, circumferential enlargement and deformation of the femoral head and neck.

Identify the well circumscribed osteolytic lesion in a 8-year-old child in the calcaneum with pigmented deposit^, with pathologic age:

A. Ochronosis

B. Hemophilic pseudotumor

C. Pigmented villonodular Synovitis

D. Eumycetes/mycetoma

Correct Answer » B Explanation

Ans: b. Hemophilic pseudotumor

• X-ray is useful in diagnosing intraosseous pseudotumors.
• Unilocular or multiloculated, lytic, expansile lesions of variable size appearance in X-ray.
• Pathological fractures can also be present.
• Metaphysis, diaphysis and epiphysis of long bones are involved in this case.

What is the most likely cause of the abnormality seen in the wrist X-ray from a 12 years old boy as shown below?

A. Scaphoid fracture

B. Colles’ fracture

C. Osteoporosis

D. Rickets

Correct Answer » D Explanation

Ans: D. Rickets

• The radiological image above shows cupping and fraying of the metaphyses, typically seen in rickets.
• “In active rickets there is thickening and widening of the growth plate, cupping of the metaphysis and, sometimes, bowing of the diaphysis.
• The metaphysis may remain abnormally wide even after healing has occurred.”