Category: Quiz

Knee joint

KNEE JOINT

Q. 1

When a patient gets up from sitting position which of the following events takes place in his knee joint?

 A

Medial rotation of femur on a fixed tibia

 B

Lateral rotation of femur on a fixed tibia

 C

Medial rotation of tibia on a fixed femur

 D

Lateral rotation of tibia on a fixed femur

Q. 1

When a patient gets up from sitting position which of the following events takes place in his knee joint?

 A

Medial rotation of femur on a fixed tibia

 B

Lateral rotation of femur on a fixed tibia

 C

Medial rotation of tibia on a fixed femur

 D

Lateral rotation of tibia on a fixed femur

Ans. A

Explanation:

When a person gets up from sitting position the femur internally (medially) rotates on the fixed tibia.

When the knee extends, the tibia descends down and then ascends along medial femoral condyle, which is about 1.5 cm longer than the lateral condyle. Along with this movement, the tibia also rotates externally.

Ref: Campbell’s Operative Orthopaedics, 11th Edition, Page 2416; Functional Soft-Tissue Examination and Treatment By Manual Methods, Warren I. Hammer, Part II, Extremities and Lumbar Spine, Page 312


Q. 2

Which of the following is the action of tensor fasciae latae?

 A

Abduction of hip

 B

Flexion of hip

 C

Extension of knee

 D

All the above

Q. 2

Which of the following is the action of tensor fasciae latae?

 A

Abduction of hip

 B

Flexion of hip

 C

Extension of knee

 D

All the above

Ans. D

Explanation:

Tensor fasciae latae extends from iliac crest to iliotibial track. It is also involved in medial rotation of hip. Tensor fascia latae is innervated by the superior gluteal nerve, L4, L5 and S1. The basic functional movement of tensor fascia latae is walking. The tensor fascia lata is heavily utilized in horse riding, hurdling and water skiing. 


Q. 3

Which of the following movements would suffer in case of paralysis of the quadriceps femoris muscle?

 A

Adduction at the hip

 B

Extension at the hip

 C

Extension at the knee

 D

Flexion at the knee

Q. 3

Which of the following movements would suffer in case of paralysis of the quadriceps femoris muscle?

 A

Adduction at the hip

 B

Extension at the hip

 C

Extension at the knee

 D

Flexion at the knee

Ans. C

Explanation:

Quadriceps femoris extends the leg (rectus femoris and the vastus muscles) and helps flex the hip (rectus femoris). It is innervated by the femoral nerve, which is made from the contributions of L2, 3, and 4 in the lumbar plexus. If a patient could not adduct at the hip, the adductor muscles might be damaged. These are supplied by the obturator nerve,which also comes from L2, 3, and 4 in the lumbar plexus.

If a patient could not extend at the hip or flex the leg, the hamstring muscles might be damaged. These muscles are supplied by the tibial nerve, a branch of the sciatic nerve. If a patient could not rotate the knee medially, popliteus might be injured. This muscle, which is innervated by the tibial nerve, allows the knee to twist and unlock from a fully extended position, as in erect stance.


Q. 4

Which of the following muscle acts as unlocker of knee?

 A

Gracilis

 B

Popliteus

 C

Sartorius

 D

Biceps femoris

Q. 4

Which of the following muscle acts as unlocker of knee?

 A

Gracilis

 B

Popliteus

 C

Sartorius

 D

Biceps femoris

Ans. B

Explanation:

Popliteus rotates the tibia medially on the femur or, when the tibia is fixed, rotates the femur laterally on the tibia. At the beginning of flexion of the fully extended knee, lateral femoral rotation by popliteus muscle unlocks the joint.

Must know:
Locking of knee joint is due to the the action of quadriceps femoristhat brings about medial rotation of femur on tibia in later stages of extension.

Q. 5

Chief extensor of knee joint in hip flexion is

 A

Rectus femoris

 B

Vastus medialis

 C

Vastus latralis

 D

Hamstrings

Q. 5

Chief extensor of knee joint in hip flexion is

 A

Rectus femoris

 B

Vastus medialis

 C

Vastus latralis

 D

Hamstrings

Ans. A

Explanation:

A. i.e. Rectus femoris 


Q. 6

Extension of knee joint is caused by

 A

Gracilis

 B

Popliteus

 C

Quadriceps femoris

 D

Semitendinosus

Q. 6

Extension of knee joint is caused by

 A

Gracilis

 B

Popliteus

 C

Quadriceps femoris

 D

Semitendinosus

Ans. C

Explanation:

C. i.e. Quadriceps femoris 


Q. 7

True regarding knee movements are AfE

 A

Flexion is coupled with lateral rotation

 B

Differential motion in lateral & medial Compartments 

 C

Posterior horn of menisci move more than anterior

 D

In full extension collateral ligaments are taut

Q. 7

True regarding knee movements are AfE

 A

Flexion is coupled with lateral rotation

 B

Differential motion in lateral & medial Compartments 

 C

Posterior horn of menisci move more than anterior

 D

In full extension collateral ligaments are taut

Ans. C

Explanation:

C. i.e. Posterior horn of menisci move more than anterior


Q. 8

Locking of knee joint can be caused by:

 A

Osgood shalter

 B

Loose body in knee joint

 C

Tuberculosis of knee

 D

a and b both

Q. 8

Locking of knee joint can be caused by:

 A

Osgood shalter

 B

Loose body in knee joint

 C

Tuberculosis of knee

 D

a and b both

Ans. D

Explanation:

D i.e. Medial meniscus partial tear > B i.e. Loose body in knee joint

Locking of knee joint (i.e. joint held in flexion) is seen in meniscus tearQ, loose bodyQ (d/t osteochondrl fracture) and fractures of tibial spine Mechanism of Locking

Normally the medial meniscus or at least its anterior movable portion glides slightly backwards towards the interior of joint as the knee is flexed.

If the tibia is at the same time abducted (valgus) and the medial compartment of the knee thus opened up, the mobility of the meniscus is still further increased.

Sudden medial rotation of femur on the fixed tibiaQ forces the medial meniscus towards back of joint and causes medial ligament to become taut and it may undergo variety of transverse or oblique tear.

The inner fragment slips into the interior of the joint and when , extension is attempted and the knee begins to screw home’ the fragment is nipped between the condyles and the joint is ‘locked’ i.e. held in flexion.


Q. 9

Unlocking of knee is done by which muscle:

September 2009, March 2013 (d, e, h)

 A

Adductor magnus

 B

Biceps femoris

 C

Popliteus

 D

Sartorius

Q. 9

Unlocking of knee is done by which muscle:

September 2009, March 2013 (d, e, h)

 A

Adductor magnus

 B

Biceps femoris

 C

Popliteus

 D

Sartorius

Ans. C

Explanation:

Ans. C: Popliteus

Popliteus muscle

Origin: Lateral surface of lateral condyle of femur

Insertion: Posterior surface of shaft of tibia above soleal line

Nerve supply: Tibial nerve L4, 5; S1

Action: Flexes leg at knee joint; unlocks knee joint by lateral rotation of femur on tibia and slackens ligaments of joint


Q. 10

What Movement at Knee Joint is attributed to the muscle marked red in the Diagram 

 A

Medial Rotation of Flexed Leg

 B

Lateral Rotaion of Flexed Leg

 C

Flexion at Knee Join

 D

Both A and B

Q. 10

What Movement at Knee Joint is attributed to the muscle marked red in the Diagram 

 A

Medial Rotation of Flexed Leg

 B

Lateral Rotaion of Flexed Leg

 C

Flexion at Knee Join

 D

Both A and B

Ans. B

Explanation:

The Muscle Shown is Biceps femoris responsible for Lateral Rotaion of Flexed Knee Joint

 

Biceps femoris:

·         Origin: Long head-upper part of ischial tuberosity

·         Short head-from the lateral lip of linea aspera, upper 2/ 3rd of lateral supra – condylar line Insertion: To head of the fibula

·         Nerve supply: Long Head -Tibial part of sciatic nerve; Short Head- Common Peroneal part of sciatic nerve

Movements at Knee Joint


Extension Quadriceps femoris

Tensor fascia lata

 

Flexion Biceps femoris, Semitendinosus, Semimembraneous  Gracilis, Sartorius,popliteus

 

Medial Rotation of flexed Leg Semi membranosus, Semitendinosus, Popliteus Gracilis, Sartonus

 

Lateral Rotation of flexed leg Biceps femoris



Q. 11

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Q. 11

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Ans. D

Explanation:

Popliteus

Popliteus is a deep muscle of posterior compartment of leg.

Features of popletius are –

Origin

  • Lateral surface of lateral condyle of femur, origin is intracapsular.
  • Outer margin of lateral meniscus of knee.

Insertion

  • Posterior surface of shaft of tibia above soleal line.

Nerve supply

  • Tibial nerve

Action

  • Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
  • Accessory flexor of knee.


Ligaments of knee joint

LIGAMENTS OF KNEE JOINT

Q. 1 Which of the following is the arterial supply to anterior cruciate ligament
 A Fibular head artery
 B Descending genicular artery
 C Superior genicular artery
 D Middle genicular artery
Q. 1 Which of the following is the arterial supply to anterior cruciate ligament
 A Fibular head artery
 B Descending genicular artery
 C Superior genicular artery
 D Middle genicular artery
Ans. D

Explanation:

Middle genicular artery

-Middle genicular artery is a branch of popliteal artery and supplies the cruciate ligaments & the synovial

membrane of knee joint.

-lt reaches the interior of knee by piercing the oblique popliteal ligament of the knee.

-Fibular head artery (A) is the circumflex fibular branch given by the posterior tibial artery, which contributes towards the anastomosis around the knee joint.

-Descending genicular artery (B) is a branch of femoral artery and also contributes to the knee joint anastomosis.

-Superior genicular artery (C) is a branch of popliteal artery and is an important branch in the anastomosis around the knee joint.


Q. 2

All of the following maintain the stability of ankle joint except:

 A

Cruciate ligament

 B

Shape of the bones

 C

Tendons of muscle which cross the joint

 D

Collateral ligament

Q. 2

All of the following maintain the stability of ankle joint except:

 A

Cruciate ligament

 B

Shape of the bones

 C

Tendons of muscle which cross the joint

 D

Collateral ligament

Ans. A

Explanation:

Cruciate ligament 

Cruciate ligaments are found in the knee and not ankle. Cruciate ligaments are pairs of ligaments arranged like a letter X. They are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They maintain anteroposterior stability of the knee joint.


Q. 3

Which of the following is true about posterior cruciate ligament?

 A

Attached to lateral femoral condyle

 B

Intrasynovial

 C

Prevents posterior dislocation of tibia

 D

Relaxed in full flexion

Q. 3

Which of the following is true about posterior cruciate ligament?

 A

Attached to lateral femoral condyle

 B

Intrasynovial

 C

Prevents posterior dislocation of tibia

 D

Relaxed in full flexion

Ans. C

Explanation:

Posterior cruciate ligament is stronger than the ACL and attaches to the posterior intercondylar area of the tibia. The posterior cruciate ligament ascends in an anteromedial direction to attach on the lateral surface of the medial femoral condyle.The posterior cruciate ligament resists posterior translation of the tibia on the femur or anterior translation of the femur on the tibia.


Q. 4

Posterior cruciate ligament prevents the following action of the tibia on femur?

 A

Anterior dislocation

 B

Posterior dislocation

 C

Rotation

 D

Limit hyperflexion

Q. 4

Posterior cruciate ligament prevents the following action of the tibia on femur?

 A

Anterior dislocation

 B

Posterior dislocation

 C

Rotation

 D

Limit hyperflexion

Ans. B

Explanation:

Functions of posterior cruciate ligament:

  • Stabilises knee
  • Prevents posterior dislocation of the tibia on femur
  • Limits hyper extension of knee only if the anterior cruciate is ruptured
Function of ACL: Prevents anterior dislocation of the tibia on femur.

Q. 5

Anterior cruciate ligament prevents :

 A

Anterior dislocation of tibia

 B

Posterior dislocation of tibia

 C

Anterior dislocation of femur

 D

Posterior dislocation of femur

Q. 5

Anterior cruciate ligament prevents :

 A

Anterior dislocation of tibia

 B

Posterior dislocation of tibia

 C

Anterior dislocation of femur

 D

Posterior dislocation of femur

Ans. A

Explanation:

A i.e. Anterior dislocation of tibia


Q. 6

Posterior dislocation of tibia on femur is prevented by:

 A

Posterior cruciate ligament

 B

Anterior cruciate ligament

 C

Medial meniscus

 D

Lateral meniscus

Q. 6

Posterior dislocation of tibia on femur is prevented by:

 A

Posterior cruciate ligament

 B

Anterior cruciate ligament

 C

Medial meniscus

 D

Lateral meniscus

Ans. A

Explanation:

A i.e. Posterior cruicate ligament


Q. 7

Artery piercing the oblique popliteal ligament of knee –

 A

Superior genicular

 B

Inferior genicular

 C

Middle genicular

 D

Popliteal

Q. 7

Artery piercing the oblique popliteal ligament of knee –

 A

Superior genicular

 B

Inferior genicular

 C

Middle genicular

 D

Popliteal

Ans. C

Explanation:

 Middle genicular

  • Oblique popliteal ligament is an expansion from the tendon of semimembranosus attachment to intercondylar line of femur.
  • It is closely related to popliteal artery and is pierced by middle genicular vessels and nerve and the terminal part of the posterior division of the obturator nerve.

Q. 8

Posterior gliding of tibia on femur is prevented by ‑

 A

Anterior cruciate ligament

 B

Posterior cruciate ligament

 C

Medial collateral ligament

 D

Lateral collateral ligament

Q. 8

Posterior gliding of tibia on femur is prevented by ‑

 A

Anterior cruciate ligament

 B

Posterior cruciate ligament

 C

Medial collateral ligament

 D

Lateral collateral ligament

Ans. B

Explanation:

Ans. is ‘b’ i.e., Posterior cruciate ligament

Posterior cruciate ligament

  • PCL begins from posterior part of intercondylar area of tibia and runs upwards, forwards and medially to attach the anterior part of the lateral surface of medial condyle of femur.
  • PCL is extrasynovial but intracapsular, i.e., lies between synovium and capsule of the knee joint.
  • It provides antero-posterior stability and prevents posterior gliding of tibia on femur.
  • It is taut in flexion.
  • Blood supply of cruciate (anterior & posterior) ligaments is from : –
  1. Middle genicular artery (major supply)
  2. Inferior genicular (medial & lateral) artery (less important).
  • Nerve supply of cruciate ligaments (ACL & PCL) is from posterior articular branch of tibial nerve.

Q. 9

Origin of PCL- Posterior cruciate ligament

 A

Posterior part of intercondylar area of tibia

 B

Anterior part of intercondylar area of tibia

 C

Medial part of medial femoral condyle

 D

Lateral part of medial femoral condyle

Q. 9

Origin of PCL- Posterior cruciate ligament

 A

Posterior part of intercondylar area of tibia

 B

Anterior part of intercondylar area of tibia

 C

Medial part of medial femoral condyle

 D

Lateral part of medial femoral condyle

Ans. A

Explanation:

Posterior cruciate ligament (PCL)

  • PC L begins from posterior part of intercondylar area of tibia and runs upwards, forwards and medially to attach the anterior part of the lateral surface of medial condyle of femur.
  • PCL is extrasynovial but intracapsular, i.e. lies between synovium and capsule of the knee joint.
  • It provides antero-posterior stability and prevents posterior gliding of tibia on femur.
  • It is taut in flexion.
  • Blood supply of cruciate (anterior & posterior) ligaments is from :-
  1. Middle genicular artery (major supply).
  2. Inferior genicular (medial & lateral) artery (less important).
  3. Nerve supply of cruciate ligaments (ACL & PCL) is from posterior articular branch of tibial nerve.


Muscles of foot

MUSCLES OF FOOT

Q. 1 True about lumbricals is
 A Flex IP joints and extends MCP joint
 B 1st and 2nd supplied by radial nerve
 C 3 and 4 supplied by superficial branch of ulnar
 D Origin  from  tendons  of  flexor  digitorum profundus
Q. 1 True about lumbricals is
 A Flex IP joints and extends MCP joint
 B 1st and 2nd supplied by radial nerve
 C 3 and 4 supplied by superficial branch of ulnar
 D Origin  from  tendons  of  flexor  digitorum profundus
Ans. D

Explanation:

Origin from tendons of flexor digitorum profundus*

The four  lumbrical muscles arise from the tendons of flexor digitorum profundus. They have different origins:

  •  Each passes distally to the radial side of its nearest metacarpophalangeal joint of the fingers to be inserted into the dorsal extensor expansionof digits two to five.
  • Their actions on these digits are to:
  • o Extend the interphalangeal joints
  • Flex the metacarpophalangeal joints
  • The innervation of the lumbricals is dual:
  • o The radial first and second lumbricals are supplied by the median nerve (C8, T1)
  • o The ulnar third and fourth lumbricals are supplied by the deep branch of the ulnar nerve (C8, T1)
  • Occasionally, the third lumbrical can receive its innervation from the median nerve.

Q. 2

Among the following, the structure that passes deep to the flexor retinaculum is:

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Q. 2

Among the following, the structure that passes deep to the flexor retinaculum is:

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Ans. B

Explanation:

Tibialis posterior


Q. 3

The muscle that acts primarily as an evertor of ankle inserted into the medial cuneiform is which of the following?

 A

Peroneus longus

 B

Peroneus brevis

 C

Tibialis anterior

 D

Tibialis posterior

Q. 3

The muscle that acts primarily as an evertor of ankle inserted into the medial cuneiform is which of the following?

 A

Peroneus longus

 B

Peroneus brevis

 C

Tibialis anterior

 D

Tibialis posterior

Ans. A

Explanation:

The peroneus longus and brevis act primarily as evertors, with the peroneus brevis being the stronger of the two. In the question, the evertor inserted to the medial cuneiform, which is peroneus longus.

The peroneus brevis inserts on the base of the fifth metatarsal and the peroneus longus courses under the cuboid to insert on the base of the first metatarsal and medial cuneiform. 

The tibialis anterior is the dorsiflexor of foot at the ankle joint. It is the invertor of the foot at the midtarsal and subtalar joints.

Tibialis posterior is the principal invertor of the foot.


Q. 4

Among the following, the structure that passes deep to the flexor retinaculum is?

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Q. 4

Among the following, the structure that passes deep to the flexor retinaculum is?

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Ans. B

Explanation:

Tibialis posterior is the deepest and most centrally located muscle in the deep posterior compartment of the leg. It arises from the upper posterior aspect of tibia, fibula and interosseous membrane and passes medially deep to the flexor retinaculum. Its tendons flares and inserts into the navicular, tarsal bones, and bases of the second, to fourth metatarsals.

Flexor retinaculum is a thick band of deep fascia on the medial aspect of the ankle 
Medial calcaneal nerve and medial calcaneal artery pierce the retinaculum.
Structures passing below it from above down are:
  • Tibialis posterior tendon
  • Flexor digitorum longus tendon
  • Flexor hallucis longus tendon
  • Posterior tibial artery
  • Tibial nerve.

Q. 5

Muscles used in normal walk during stance and swing?

 A

Popliteus

 B

Gastrocnemius

 C

Tibialis anterior

 D

Iliopsoas

Q. 5

Muscles used in normal walk during stance and swing?

 A

Popliteus

 B

Gastrocnemius

 C

Tibialis anterior

 D

Iliopsoas

Ans. B

Explanation:

Gastrocnemius muscle attaches proximally to the femoral condyles; distally, it attaches to the calcaneus bone via the calcaneal tendon. The gastrocnemius muscle plantar flexes the foot and flexes the knee. It runs from its two heads just above the knee to the heel, and is involved in standing, walking, running and jumping. The tibial nerve (S1 and S2) innervates this muscle.


Q. 6

A sesamoid bone is present in the tendon of which of the following muscles?

 A

Flexor hallucis longus.

 B

Extensor hallucis brevis.

 C

Adductor hallucis

 D

Flexor hallucis brevis

Q. 6

A sesamoid bone is present in the tendon of which of the following muscles?

 A

Flexor hallucis longus.

 B

Extensor hallucis brevis.

 C

Adductor hallucis

 D

Flexor hallucis brevis

Ans. D

Explanation:

Sesamoids are found in locations where a tendon passes over a joint, such as the hand, knee, and foot. In the foot, the first metatarsal bone usually has two sesamoid bones at its connection to the big toe (both within the tendon of flexor hallucis brevis).

In the knee – The patella (within the quadriceps tendon).
 
In the hand – Two sesamoid bones are commonly found in the distal portions of the first metacarpal bone (within the tendons of adductor pollicis and flexor pollicis brevis). 
 
In the wrist – The pisiform of the wrist is a sesamoid bone (within the tendon of flexor carpi ulnaris).

 


Q. 7

Violent inversion of the foot will lead to avulsion of tendon of which the following muscle attached to the tuberosity of the 5th metatarsal?

 A

Peroneus brevis

 B

Peroneus longus

 C

Peroneus tertius

 D

Extensor digitorum brev

Q. 7

Violent inversion of the foot will lead to avulsion of tendon of which the following muscle attached to the tuberosity of the 5th metatarsal?

 A

Peroneus brevis

 B

Peroneus longus

 C

Peroneus tertius

 D

Extensor digitorum brev

Ans. A

Explanation:

A i.e. Peroneus brevis 

Violent inversion of foot may cause avulsion of tuberosity of 5n1, metatarsal base, the insertion of peroneus (fibularis) brevis muscleQ.


Q. 8

Muscle acting both at knee and ankle joint is/are:

 A

Gastrocnemius

 B

Soleus

 C

Plantaris

 D

A and c both

Q. 8

Muscle acting both at knee and ankle joint is/are:

 A

Gastrocnemius

 B

Soleus

 C

Plantaris

 D

A and c both

Ans. D

Explanation:

A i.e. Gastrocnemius C i.e. Plantaris 


Q. 9

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Q. 9

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Ans. D

Explanation:

A i.e. Extensor digitorum longus; B i.e. Extensor hallucis longus; C i.e. Tibialis anterior


Q. 10

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Q. 10

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Ans. D

Explanation:

A. i.e. Plantans; B. i.e. FHL; C. i.e. Soleus


Q. 11

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Q. 11

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Inversion of foot


Q. 12

Which flexor muscle is attached to hook of hamate‑

 A

Flexor pollicis brevis

 B

Flexor pollicis longus

 C

Flexor digiti minimi

 D

Flexor carpi ulnaris

Q. 12

Which flexor muscle is attached to hook of hamate‑

 A

Flexor pollicis brevis

 B

Flexor pollicis longus

 C

Flexor digiti minimi

 D

Flexor carpi ulnaris

Ans. C

Explanation:

Ans. is ‘c’ i.e., Flexor digiti minimi


Q. 13

Which is called as peripheral heart ‑

 A

Popliteus

 B

Soleus

 C

Plantaris

 D

None

Q. 13

Which is called as peripheral heart ‑

 A

Popliteus

 B

Soleus

 C

Plantaris

 D

None

Ans. B

Explanation:

Ans. is ‘b’ i.e., Soleus

Soleus is known as ‘peripheral heart’ as it helps in venous return from lower limb.



Movements of foot & ankle

MOVEMENTS OF FOOT & ANKLE

Q. 1

 

You are examining an infant and the findings are as follows:
Adductor angle  –  100
Popliteal angle  –  90
Dorsiflexion Angle of foot  –  70
Scarf sign  –  Elbow crosses the middle but doesn’t reach the anterior axillary line

What is the appropriate age of the infant?

 A

0 – 3 months

 B

4 – 6 months

 C

10 – 12 months

 D

7 – 9 months

Q. 1

 

You are examining an infant and the findings are as follows:
Adductor angle  –  100
Popliteal angle  –  90
Dorsiflexion Angle of foot  –  70
Scarf sign  –  Elbow crosses the middle but doesn’t reach the anterior axillary line

What is the appropriate age of the infant?

 A

0 – 3 months

 B

4 – 6 months

 C

10 – 12 months

 D

7 – 9 months

Ans. B

Explanation:

The normal ranges of angles during infancy are given below:

Age Adductor angle Popliteal angle Dorsiflexion angle of foot Scarf sign
0 – 3 400 – 800 800 – 1000 600 – 700 Elbow doesn’t cross the midline
4 – 6 700 – 1100 900 – 1200 600 – 700 Elbow crosses midline
7 – 9 1100 – 1400 1100– 1600 600 – 700 Elbow goes beyond anterior axillary line
10 – 12 1400 – 1600 1500 – 1700 600 – 700  

 

Ref: Meharban Singh, Edition 3, Page 74

 


Q. 2

At which joint does inversion of foot occur?

 A

Talocrural

 B

Talocalcaneal

 C

Calcaneocuboid

 D

Cuneonavicular

Q. 2

At which joint does inversion of foot occur?

 A

Talocrural

 B

Talocalcaneal

 C

Calcaneocuboid

 D

Cuneonavicular

Ans. B

Explanation:

The subtalar joint, also known as the talocalcaneal joint is the articulation between the talus and the calcaneus. The primary joint surface is the posterior facet, with much smaller middle and anterior facets. The motion of this joint is inversion of approximately 30 degrees and eversion of approximately 10 degrees. The tibialis posterior causes inversion and the peroneus brevis eversion at the subtalar joint.

Inversion occurs both actively and passively at the time of toe-off. Active control is achieved by the gastrocsoleus and posterior tibial muscles, and passive inversion occurs by the action of the plantar aponeurosis, the external rotation of the lower extremity, and the oblique metatarsal break.

Q. 3

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Q. 3

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Ans. D

Explanation:

A i.e. Extensor digitorum longus; B i.e. Extensor hallucis longus; C i.e. Tibialis anterior


Q. 4

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Q. 4

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Ans. D

Explanation:

A. i.e. Plantans; B. i.e. FHL; C. i.e. Soleus


Q. 5

Inversion and eversion occurs at:           

 A

Subtalor joints

 B

Ankle joint

 C

Inferior Tibiofibular joint

 D

All of the above

Q. 5

Inversion and eversion occurs at:           

 A

Subtalor joints

 B

Ankle joint

 C

Inferior Tibiofibular joint

 D

All of the above

Ans. A

Explanation:

The talocalcaneonavicular and the calcaneocuboid joints are together referred to as the midtarsal or transverse tarsal joints. The important movements of inversion and eversion of the foot take place at the subtalar and transverse tarsal joints. Inversion is the movement of the foot so that the sole faces medially.

Eversion is the opposite movement of the foot so that the sole faces in the lateral direction.

Inversion is performed by the tibialis anterior, the extensor hallucis longus, and the medial tendons of extensor digitorum longus; the tibialis posterior also assists.

Eversion is performed by the peroneus longus, peroneus brevis, and peroneus tertius; the lateral tendons of the extensor digitorum longus also assist.

Ankle joint’s active movements are dorsiflexion and plantar flexion

Inferior Tibiofibular joint permits slight movements so that the lateral malleolus can rotate laterally during dorsiflexion of the ankle


Q. 6

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Q. 6

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Inversion of foot



Ankle joint- ligaments

ANKLE JOINT- LIGAMENTS

Q. 1

The deltoid ligament is a strong ligament. It is attached to all of the following structures, EXCEPT?

 A

Medial malleolus

 B

Medial cuneiform

 C

Spring ligament

 D

Sustentaculum tali

Q. 1

The deltoid ligament is a strong ligament. It is attached to all of the following structures, EXCEPT?

 A

Medial malleolus

 B

Medial cuneiform

 C

Spring ligament

 D

Sustentaculum tali

Ans. B

Explanation:

Medial collateral ligament (deltoid ligament) attaches to the medial malleolus of the tibia and the navicular, talus, and calcaneus bones. This ligament prevents medial distraction (eversion) and excessive range of motion. It is subdivided into four parts:

  • Tibionavicular part attaches the margin of the plantar calcaneonavicular ligament (spring ligament).
  • Tibiocalcaneal part attaches to the sustentaculum tali of the calcaneus bone.
  • Posterior tibiotalar part attaches to the medial side and medial tubercle of the talus.
  • Anterior tibiotalar part attaches to the medial surface of the talus.

Q. 2

True about ankle joint is/ are :

 A

The joint is strengthened by deltoid ligament

 B

It is more stable at dorsi-flexed position

 C

It is a hinge joint

 D

All

Q. 2

True about ankle joint is/ are :

 A

The joint is strengthened by deltoid ligament

 B

It is more stable at dorsi-flexed position

 C

It is a hinge joint

 D

All

Ans. D

Explanation:

A i.e. The joint is strengthened by deltoid ligament B i.e. It is more stable at dorsiflexed position C i.e. It is a hinge joint


Q. 3

The stability of the ankle joint is maintained by the following, except

 A

Plantar calcaneonavicular (spring) ligament

 B

Deltoid ligament

 C

Lateral ligament

 D

Shape of the superior talar articular surface

Q. 3

The stability of the ankle joint is maintained by the following, except

 A

Plantar calcaneonavicular (spring) ligament

 B

Deltoid ligament

 C

Lateral ligament

 D

Shape of the superior talar articular surface

Ans. A

Explanation:

A. i.e. Planter calcaneonavicular ligament 

Calcaneonavicular/ Spring ligament is most important ligament for maintaining the median longitudinal arch of foot but has nothing to do with stability of ankle joint because it is not around ankle joint


Q. 4

The most common ligament injured around ankle joint is

 A

Anterior talofibular

 B

Deltoid ligament

 C

Posterior talofibular

 D

Spring ligament

Q. 4

The most common ligament injured around ankle joint is

 A

Anterior talofibular

 B

Deltoid ligament

 C

Posterior talofibular

 D

Spring ligament

Ans. A

Explanation:

A i.e. Anterior Talofibular 

  • The most common site of ligament injury is ankle jointQ.
  • The most common mode of ankle injury is inversion of planter flexed foot(2.
  • Over 90°% of the ankle ligament injury involves lateral collateral ligament usually the anterior tibiofibular ligamentQ.

Q. 5

Ligament supporting the head of talus ‑

 A

Talonavicular ligament

 B

Cervical ligament

 C

Plantar calcaneonavicular ligament

 D

Deltoid ligament

Q. 5

Ligament supporting the head of talus ‑

 A

Talonavicular ligament

 B

Cervical ligament

 C

Plantar calcaneonavicular ligament

 D

Deltoid ligament

Ans. C

Explanation:

 Plantar calcaneonavicular ligament

  • Spring ligament (Plantar calcaneonavicular ligament) connects the calcaneum with the navicular bone. o However, its principal job is to provide a sling for the talus, to support the head of talus (though it has no attachment to talus).
  • This aids in supporting the weight of the body.
  • Weaknes or lengthening along this ligament can cause flat foot.


Bones of foot

BONES OF FOOT

Q. 1

Which of the following bones is not part of the medial arch of the foot?

 A

Cuneiform bones

 B

Navicular

 C

Calcaneus

 D

Cuboid

Q. 1

Which of the following bones is not part of the medial arch of the foot?

 A

Cuneiform bones

 B

Navicular

 C

Calcaneus

 D

Cuboid

Ans. D

Explanation:

The medial arch of the foot consists of the talus, calcaneus, cuneiforme, and the three medial metatarsal bones. The cuboid bone belongs to the lateral arch of the foot together with the calcaneus, and the two remaining metatarsal bones.


Q. 2

Tibialis posterior is inserted in all of the following bones distally, EXCEPT?

 A

Navicular bone

 B

Intermediate cuneiform

 C

Metatarsal 2

 D

Talus

Q. 2

Tibialis posterior is inserted in all of the following bones distally, EXCEPT?

 A

Navicular bone

 B

Intermediate cuneiform

 C

Metatarsal 2

 D

Talus

Ans. D

Explanation:

Tibialis posterior muscle attaches proximally to the interosseous membrane and the tibia and fibula; distally, it attaches to the navicular bone, all cuneiform bones, and metatarsals 2 to 4. The tibialis posterior muscle inverts and plantarflexes the foot, providing support to the medial arch of the foot during walking. The tibial nerve (L4 and L5) innervates this muscle.

Q. 3

The example of syndesmosis type of joint is ‑

 A

Sacroiliac

 B

Inferior tibiofibular

 C

Superior tibiofibular

 D

Mid tarsal

Q. 3

The example of syndesmosis type of joint is ‑

 A

Sacroiliac

 B

Inferior tibiofibular

 C

Superior tibiofibular

 D

Mid tarsal

Ans. B

Explanation:

B i.e. Inferior tibiofibular


Q. 4

True about cuboid bone :

 A

It develops by membranous ossification

 B

Proximally articulate with lunate bone

 C

Flexor retinaculum is attached

 D

Articulates with Calcaneum

Q. 4

True about cuboid bone :

 A

It develops by membranous ossification

 B

Proximally articulate with lunate bone

 C

Flexor retinaculum is attached

 D

Articulates with Calcaneum

Ans. D

Explanation:

D i.e. Articulates with Calcaneum


Q. 5

Length of tibia is:           

 A

10% of height

 B

20% of height

 C

30% of height

 D

40% of height

Q. 5

Length of tibia is:           

 A

10% of height

 B

20% of height

 C

30% of height

 D

40% of height

Ans. B

Explanation:

Ans. 20% of height



Adductor canal

ADDUCTOR CANAL

Q. 1

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Q. 1

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Ans. B

Explanation:

Femoral artery and vein, saphenous nerve and, in the upper part, the nerve to vastus medialis.

Adductor canal or subsartorial or Hunter‘s canal is a gutter-shaped tunnel in the middle third of the thigh. It extends from the apex of the femoral triangle to the adductor hiatus in the tendon of adductor magnus. 

Boundaries are given below:

  • Anterior and lateral wall: vastus medialis
  • Posterior wall – superior: adductor longus; inferior: adductor magnus
  • Medial wall: Sartorius, which overlies the groove between the above muscles, forming the roof of the canal.

Q. 2

Hunter’s canal is seen in‑

 A

Cubital fossa

 B

Popliteal fossa

 C

Thigh

 D

Calf

Q. 2

Hunter’s canal is seen in‑

 A

Cubital fossa

 B

Popliteal fossa

 C

Thigh

 D

Calf

Ans. C

Explanation:

Ans. is ‘c’ i.e., Thigh


Q. 3

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Q. 3

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Ans. C

Explanation:

Ans. is ‘c’ i.e., Femoral nerve

Contents of adductor canal are femoral artery, femoral vein, Saphenous nerve, nerve to vastus medialis, descending genicular artery, deep lymph vessels, and two terminal divisions of obturator nerve.



Hip joint

HIP JOINT

Q. 1

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Q. 1

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Ans. A

Explanation:

Flexors of hip: Psoas major and illiacus are the chief flexors of hip joint. Pectineus, rectus femoris, adductors and sartorius are the accessory muscles. Adductors mainly the adductor longus participate in the early stages of flexion.


Q. 2

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Q. 2

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Ans. A

Explanation:

The iliofemoral ligament is a Y-shaped ligament extending from the anterior inferior iliac spine to the anterior surface of the intertrochanteric line of the femur. It prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum. (The ischiofemoral ligament also helps to prevent hyperextension of the hip joint by screwing the femoral head into the acetabulum).

Ligamentum capitis femoris attaches the head of the femur to the acetabular fossa. The pubofemoral ligament connects the pubic portion of the rim of the bony acetabulum to the medial surface of the femoral neck. It prevents over abduction of the hip joint.

Zona orbicularis is a band of circularly oriented ligamentous fibers that reinforce the capsule of the hip joint. it helps keep the head of the femur in its socket.


Q. 3

Bigelow’s ligament is at

 A

Knee joint

 B

Shoulder joint

 C

Hip joint

 D

Ankle joint

Q. 3

Bigelow’s ligament is at

 A

Knee joint

 B

Shoulder joint

 C

Hip joint

 D

Ankle joint

Ans. C

Explanation:

C. i.e. Hip joint


Q. 4

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Q. 4

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Ans. A

Explanation:

A i.e. Medial rotation & abduction is caused by gluteus medius & minimus

Gluteus medius & minimus are powerful abductors of hip & also cause medial rotation (not lateral rotation). Gluteus maximus is extensor & lateral rotator of hip.

Sartorius is flexor, abductor & lateral rotator of hip & flexes knee joint. (i.e. palthi posture/ sitting crossed leg / position in which tailors sit).

Tensor fascia lata is flexor, abductor & medial rotator of hip; helps in knee extension.

Hyper extension is prevented by iliofemoral ligament (Ligament of Bigelow)  not by capsular thickening

Femoral nerve (L2L3L4) supplies flexor muscles of hip (anterior compartment of thigh) i.e. – Sartorius, Quadriceps femoris (rectus femoris + vastus laterlis, medialis & intermedius), articularis genu  not lateral rotators of thigh (eg. Gluteus maximus)


Q. 5

Ligament resisting hyperextension of hip are all except:        

 A

Ischiofemoral ligament

 B

Pubofemoral ligament

 C

Iliofemoral ligament

 D

Sacroiliac ligament

Q. 5

Ligament resisting hyperextension of hip are all except:        

 A

Ischiofemoral ligament

 B

Pubofemoral ligament

 C

Iliofemoral ligament

 D

Sacroiliac ligament

Ans. D

Explanation:

Ans. D: Sacroiliac ligament

When the knee is flexed, flexion is limited by the anterior surface of the thigh coming into contact with the anterior abdominal wall.

When the knee is extended, flexion is limited by the tension of the hamstring group of muscles.

Extension, which is the movement of the flexed thigh backward to the anatomic position, is limited by the tension of the iliofemoral, pubofemoral, and ischiofemoral ligaments.

Abduction is limited by the tension of the pubofemoral ligament, and adduction is limited by contact with the opposite limb and by the tension in the ligament of the head of the femur.

Lateral rotation is limited by the tension in the iliofemoral and pubofemoral ligaments, and medial rotation is limited by the ischiofemoral ligament.

The following movements take place:

  • Flexion is performed by the iliopsoas, rectus femoris, and sartorius and also by the adductor muscles.
  • Extension (a backward movement of the flexed thigh) is performed by the gluteus maximus and the hamstring muscles.
  • Abduction is performed by the gluteus medius and minimus, assisted by the sartorius, tensor fasciae latae and piriformis.

Adduction is performed by the adductor longus and brevis and the adductor fibers of the adductor magnus. These muscles are assisted by the pectineus and the gracilis.

Lateral rotation is performed by the piriformis, obturator internus and externus, superior and inferior gemelli, and quadratus femoris, assisted by the gluteus maximus.



Fess

FESS

Q. 1

In FESS surgery structure preserved is?

 A

Ethmoid sinus

 B

Sphenoid sinus

 C

Maxillary sinus

 D

None

Q. 1

In FESS surgery structure preserved is?

 A

Ethmoid sinus

 B

Sphenoid sinus

 C

Maxillary sinus

 D

None

Ans. C

Explanation:

 

TYPES OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY:

Type 1

Nasal endoscopy and uncinectomy with or without agger nasi cell exenteration.

Type 2

Nasal endoscopy, uncinectomy, bulla ethmoidectomy, removal of sinus lateralis mucous

membrane and exposure of frontal recess/ frontal sinus

Type 3

Type 2 plus maxillary sinus antrostomy through the natural sinus ostium

Type 4

Type 3 plus complete posterior ethmoidectomy

Type 5

Type 4 plus sphenoidectomy & stripping of mucous membrane


Q. 2

Which of the following surgery is not contraindicated below 12 years of age?

 A

Rhinoplasty

 B

FESS

 C

SMR

 D

Septoplasty

Q. 2

Which of the following surgery is not contraindicated below 12 years of age?

 A

Rhinoplasty

 B

FESS

 C

SMR

 D

Septoplasty

Ans. B

Explanation:

 

FESS is the only surgery which can be perform before 17 years.

In rarest circumstances, septal surgery is performed in children,  septoplasty is also done and never SMR.


Q. 3

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Q. 3

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Ans. B

Explanation:

Q. 4

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Q. 4

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

Q. 5

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Q. 5

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

 

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery which has superceded other modes of polyp removal in all age groups.
  • In this procedure all polyps are removed under endoscopic control especially from the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred
  • Caldwell-Luc operation is avoided these days.

Q. 6

Orbital cellulitis is a complication of:

 A

Parasinusitis

 B

Faciomaxillary trauma

 C

Endoscopic sinus surgery

 D

All of these

Q. 6

Orbital cellulitis is a complication of:

 A

Parasinusitis

 B

Faciomaxillary trauma

 C

Endoscopic sinus surgery

 D

All of these

Ans. D

Explanation:

Q. 7

The best surgical treatment for chronic maxillary sinusitis is:

 A

Repeated antral washout

 B

Fibreoptic endoscopic sinus surgery

 C

Caldwell-Luc’s operation

 D

Horgan’s operation

Q. 7

The best surgical treatment for chronic maxillary sinusitis is:

 A

Repeated antral washout

 B

Fibreoptic endoscopic sinus surgery

 C

Caldwell-Luc’s operation

 D

Horgan’s operation

Ans. B

Explanation:

Q. 8

FESS means:

 A

Factual endoscopic sinus surgey

 B

Functionl endonasal sinus surgery

 C

Factual endonasal sinus surgery

 D

Functionl endoscopic sinus surgery

Q. 8

FESS means:

 A

Factual endoscopic sinus surgey

 B

Functionl endonasal sinus surgery

 C

Factual endonasal sinus surgery

 D

Functionl endoscopic sinus surgery

Ans. D

Explanation:

Q. 9

Endoscopic nasal surgery is indicated in:

 A

Chronic sinusitis

 B

Epistaxis

 C

Both

 D

None

Q. 9

Endoscopic nasal surgery is indicated in:

 A

Chronic sinusitis

 B

Epistaxis

 C

Both

 D

None

Ans. C

Explanation:

Ans. is c i.e. Both


Q. 10

indications of FESS:

 A

Inverted papilloma

 B

Orbital abscess

 C

Nasal polyposis

 D

All

Q. 10

indications of FESS:

 A

Inverted papilloma

 B

Orbital abscess

 C

Nasal polyposis

 D

All

Ans. D

Explanation:

Ans. is all

[indications of Function) endoscopic Endoscopic Surgery (FESS)

Nasal conditions:

Indian = Inflammation of sinus (sinusitis – chronic and fungal)

Prime = Polyp removal

Minister = Mucocelea of frontal and ethmoid sinus

Can = Choanal atresia repair Speak = Septoplasty

Fluent = Foreign body removal English = Epistaxis

Other conditions: Nose is separated from orbit by lamina papyracea, anterior cranal fossa by cribriform plate and pituitary by sphenoid.

Hence FESS can be used in:

  • Orbital conditions

–       Orbital decompression

–       Optic nerve decompression

–       Blow out of orbit

–       Drainage of periorbital abscess

–       Dacryocystorhinostomy

  • CSF leak
  • Pituitary surgery like trans sphenoid hypophysectomy

Q. 11

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Q. 11

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Ans. A

Explanation:

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. FESS with polypectomy would be the best management for the patient.

FESS (Functional Endoscopic Sinus Surgery):

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery, which has superseded other modes of polyp removal.
  • In this procedure, all polyps are removed under endoscopic control especially from the the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred.




Rhinosporidiosis

Rhinosporidiosis

Q. 1 Which of the following is true about rhinosporidiosis?
 A The most common organism is Klebsiella rhinoscleromatis
 B Seen only in immunocompromised patients
 C Presents as a nasal polyp
 D Can be diagnosed by isolation of the organism
 
Q. 1 Which of the following is true about rhinosporidiosis?
 A The most common organism is Klebsiella rhinoscleromatis
 B Seen only in immunocompromised patients
 C Presents as a nasal polyp
 D Can be diagnosed by isolation of the organism
 
Ans. C

Explanation:

Rhinosporidiosis – It is fungal granuloma caused by Rhinosporidium seeberi.

  • The disease mostly affects nose and nasopharynx
  • The disease is acquired through contaminated water of ponds and cow-pets
  • Presents as a leafy, polypoidal mass, pink to purple in colour and attached to nasal septum or lateral wall, sometimes it extends into the nasopharynx and may hang behind the soft palate

The mass is very vascular and bleeds easily on touch its surface is studded with white dots representing the sporangia of fungus Early stages complains of nasal discharge which is often blood-tinged or nasal stuffiness Sometimes frank epistaxis is the only presenting complaint

Diagnosis is made by biopsy, not possible to culture

Treatment – complete excision of the mass with diathermy knife and cauterization of its base, Dapsone has been tried with some success.


Q. 2

True statement about Rhinosporidiosis is:

 A

Most common organism is klebsiella rhinoscleromatis

 B

Seen only in immunocompromised patients

 C

Presents as a nasal polyp

 D

Can be diagnosed by isolation of organism

Q. 2

True statement about Rhinosporidiosis is:

 A

Most common organism is klebsiella rhinoscleromatis

 B

Seen only in immunocompromised patients

 C

Presents as a nasal polyp

 D

Can be diagnosed by isolation of organism

Ans. C

Explanation:

Q. 3

In rhinosporidiosis, the following is true:

 A

Caused by R.seeberi

 B

Grayish mass

 C

Surgery is the treatment 

 D

a and c

Q. 3

In rhinosporidiosis, the following is true:

 A

Caused by R.seeberi

 B

Grayish mass

 C

Surgery is the treatment 

 D

a and c

Ans. D

Explanation:

  • Rhinosporidiosis is a chronic granulomatous infection of the mucous membranes that usually manifests as vascular friable polyps that arise from the nasal mucosa.
  • The etiologic agent of rhinosporidiosis, R seeberi.
  • Rhinosporidium seeberi is an aquatic bacterium (not a fungus).
  • Rhinosporidiosis is treated with surgical excision.

Q. 4

Ideal treatment of Rhinosporidiosis is:

 A

Rifampicin

 B

Excision with cautery at base

 C

Dapsone

 D

Laser

Q. 4

Ideal treatment of Rhinosporidiosis is:

 A

Rifampicin

 B

Excision with cautery at base

 C

Dapsone

 D

Laser

Ans. B

Explanation:

Q. 5

Nasal polypoidal mass with subcutaneous nodules on skin are seen in:

 A

Zygomycosis

 B

Rhinosporidiosis

 C

Sporotrichosis

 D

Aspergillosis

Q. 5

Nasal polypoidal mass with subcutaneous nodules on skin are seen in:

 A

Zygomycosis

 B

Rhinosporidiosis

 C

Sporotrichosis

 D

Aspergillosis

Ans. B

Explanation:

 

In Rhinosporiodiosis, leafy, polypoidal mass of pink-purple color is seen attached to nasal septum or lateral wall. Subcutaneous nodules may be seen on skin.


Q. 6

Causative agent of rhinosporidiosis is ‑

 A

Bacteria

 B

Fungus

 C

Protozoa

 D

Virus

Q. 6

Causative agent of rhinosporidiosis is ‑

 A

Bacteria

 B

Fungus

 C

Protozoa

 D

Virus

Ans. A

Explanation:

Ans: is. ‘a’ i.e., Bacteria

“Molecular studies have shown that the organism is not a fungus, but a primitive aquatic bacterium”.

“By using molecular tools, recently it has been found that R. seeberi is not a fungus but an unusual protist that shares phylogenetic features with microbes that cause infection in fish” 

“The etiological agent, Rhinosporidium seeberi, has never been successfully propagated in vitro. Initially thought to be a parasite for more than 50 years, R seeberi had been considered a water mould. Molecular biological techniques have recently demonstrated that this organism is an aquatic protistan parasite. It is currently included in a new class, the mesomycetozoea, along with organisms that cause similar infections in amphibians and fish”.



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