Category: Quiz

Streptococcus Viridans

Streptococcus Viridans

Q. 1 All of the following statements are TRUE about infectious
endocarditis EXCEPT
 A Cardiac valve leaflets are susceptible to infection
because of their limited blood supply
 B Fatality rates for right-sided disease are greater
than those for left-sided disease
 C Streptococcus viridans is the most common
organism implicated in left-sided disease
 D More than three-fourths of cases of right-sided
endocarditis are caused by Staphyloccus aureus
Q. 1 All of the following statements are TRUE about infectious
endocarditis EXCEPT
 A Cardiac valve leaflets are susceptible to infection
because of their limited blood supply
 B Fatality rates for right-sided disease are greater
than those for left-sided disease
 C Streptococcus viridans is the most common
organism implicated in left-sided disease
 D More than three-fourths of cases of right-sided
endocarditis are caused by Staphyloccus aureus
Ans. B

Explanation:

Fatality rates for left-sided disease are greater than those for right-sided disease because of the increased incidence of cardiac failure and neurologic complications. Streptococcus viridans is the most common organism implicated in left-sided endocarditis, with Staphylococcus aureus increasing in incidence.

Enterococcal and fungal infections are also seen. Right-sided endocarditis is caused by S. aureus in more than 75 percent of cases, followed by S. viridans and gram-negative rods. Blood cultures should be drawn from three different venous sites and sent for aerobic, anaerobic, and fungal cultures. Antifungal agents should be considered in patients with HIV or other immunocompromised states or in patients with indwelling catheters. Murmurs are heard in only 35 to 50 percent of patients with right-sided disease but in up to 80 percent of patients with left-sided disease.


Q. 2

2×102 Streptococcus viridans are inoculated into a flask containing one liter of enriched broth. If the lag time is 30 minutes and the generation time is 20 minutes. How many bacteria will there be in the culture after two and a half hours?

 A

6 x 10^2

 B

1.2 x 10^3

 C

1.6 x 10^3

 D

1.28 x 10^4

Q. 2

2×102 Streptococcus viridans are inoculated into a flask containing one liter of enriched broth. If the lag time is 30 minutes and the generation time is 20 minutes. How many bacteria will there be in the culture after two and a half hours?

 A

6 x 10^2

 B

1.2 x 10^3

 C

1.6 x 10^3

 D

1.28 x 10^4

Ans. D

Explanation:

During the lag time, by definition, bacteria newly introduced into a culture will undergo metabolic changes necessary for use of the medium, but will NOT increase in number.

Therefore, at the end of the first 30 minutes elapsed time, the number of bacteria in the culture will be 2 x 10^2.

Thereafter, the number of bacteria will double every 20 minutes (the definition of generation time).

This means that after 2 1/2 hours of total elapsed time, 6 generations will have occurred, so the original inoculum number is multiplied by 2, 6 times.

 
6 x 10^2 (1st Choice) is not the correct answer.
If this was your answer, you forgot that lag periods occur only once per culture, and also incorrectly multiplied the starting inoculum number by an incorrect number of generations (three).
 
1.2 x 10^3 (2nd Choice) is not the correct answer, and reflects the common student error of counting the number of possible generations and multiplying by that number.
Remember that every generation time means that every bacterium in that culture has divided into two, so you must multiply by two, 6 times or 26.
 
1.6 x 10^3 (3rd Choice) is not the correct answer, and reflects the common error of forgetting that the lag time occurs only one time per culture. If you picked this answer, you divided the 2.5 hours of culture time between three lag periods and three correctly calculated generations (23).

Q. 3

Causes of community acquired native valve endocarditis are-

 A

Streptococcus viridians

 B

Staphylococcus aureus

 C

Diphtheriods

 D

a and b

Q. 3

Causes of community acquired native valve endocarditis are-

 A

Streptococcus viridians

 B

Staphylococcus aureus

 C

Diphtheriods

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e. S. viridans, ‘b’ i.e. S. aureus

Causative organisms of community acquired infective endocarditis

Staphylococcus aureus ( most common)

.   Streptococcus ( Str viridans, Str bovis, other non group A Streptococci)

.  Others- Enterococcus, Coagulase negative Streptococci ( Stop epidermidis), HACEK group, Pneumococcus, candida


Q. 4

A patient of RHD developed infective endocarditis after dental extraction. Most likely organism causing this is –

 A

Streptococcus viridans

 B

Streptococcus pneumoniae

 C

Streptococcus pyogenes

 D

Staphylococcus aureus

Q. 4

A patient of RHD developed infective endocarditis after dental extraction. Most likely organism causing this is –

 A

Streptococcus viridans

 B

Streptococcus pneumoniae

 C

Streptococcus pyogenes

 D

Staphylococcus aureus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Streptococcus viridans

Viridans streptococci are normally resident in the mouth and upper respiratory tract. They cause transient bacteremia following tooth extraction or other dental procedures; and get implanted on damaged or prosthetic valves or in a congenitally diseased heart, and grow to form vegetations.


Q. 5

Culture of streptococcus viridans resemble-

 A

Staphylococcus 

 B

Strept. pyogenes

 C

Pneumococcus 

 D

Strept. fecalis

Q. 5

Culture of streptococcus viridans resemble-

 A

Staphylococcus 

 B

Strept. pyogenes

 C

Pneumococcus 

 D

Strept. fecalis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Pneumococcus 

On blood agar, after incubation for 18 hrs, the colonies of pneumococci are small, dome shaped and glistening with an area of green discoloration (alpha hemolysis) around them, resembling colonies of Str. viridans.


Q. 6

SABE is most commonly due to:

March 2013

 A

Staphylococcus aureus

 B

Streptococcus pneumonia

 C

Streptococcus viridans

 D

HACEK group bacteria

Q. 6

SABE is most commonly due to:

March 2013

 A

Staphylococcus aureus

 B

Streptococcus pneumonia

 C

Streptococcus viridans

 D

HACEK group bacteria

Ans. C

Explanation:

Ans:C i.e. Streptococcus viridans

Subacute bacterial endocarditis/Endocarditis lenta

  • It can be considered a form of Type III hypersensitivity.
  • It is usually caused by a form of streptococci viridians bacteria that normally live in the mouth and throat (Streptococcus mutans, mitis, sanguis or milleri).
  • Osler’s nodes can indicate this condition.
  • Nail clubbing is also often seen in subacute endocarditis.
  • In cases of subacute bacterial endocarditis, the causative organism (streptococcus viridans) needs a previous heart valve disease to colonize and cause such disease.
  • On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease.

Q. 7

Infective endocarditis after tooth extraction is probably due to ‑

 A

Streptococcus viridans

 B

Streptococcus pneumoniae

 C

Streptococcus pyogenes

 D

Staphylococcus aureus

Q. 7

Infective endocarditis after tooth extraction is probably due to ‑

 A

Streptococcus viridans

 B

Streptococcus pneumoniae

 C

Streptococcus pyogenes

 D

Staphylococcus aureus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Streptococcus viridans

  • Viridans streptococci are normally resident in the mouth and upper respiratory tract. They cause transient bacteremia following tooth extraction or other dental procedures; and get implanted on damaged or prosthetic valves or in a congenitally diseased heart, and grow to form vegetations.
  • They are ordinarily nonpathogenic but can on occasion cause disease. In persons with preexisting cardiac lesions, they may cause bacterial endocarditis, Str. sanguis being most often responsible.
  • Str. mutans is important in causation of dental caries.
  • The transient viridans streptococcal bacteremia induced by eating, tooth-brushing, flossing and other source of minor trauma, together with adherence to biological surfaces, is thought to account for the predilection of these organisms to cause endocarditis.
  • Viridans streptococci are also isolated, often as a part of a mixed flora, from sites of sinusitis, brain abscess and liver abscess.
  • Viridans streptococcal bacteremia occurs relatively frequently in neutropenic patients, particularly after bone marrow transplantation or high dose chemotherapy for cancer.

Treatment of varidans streptococcal infections include :-

  1. Bacteremia in neutropenic patients → Vancomycin.
  2. Other infection → Penicillin.

Q. 8

All are important causes of UTI except‑

 A

E coli

 B

Proteus

 C

Klebsiella

 D

Streptococcus viridans

Q. 8

All are important causes of UTI except‑

 A

E coli

 B

Proteus

 C

Klebsiella

 D

Streptococcus viridans

Ans. D

Explanation:

Ans. is ‘d’ i.e., Streptococcus viridans

The dominant etiologic agents, accounting for more than 85% of cases of urinary tract infection, are the gram-negative bacilli that are normal inhabitants of intestinal tract.

By far the most common is Escherichia coli, followed by proteus, klebsiella, and Enterobacter.

In most patients with urinary tract infection, the infecting organisms are derived from the patient’s own fecal flora. This is thus a form of endogenous infection.



Streptococcus Pyogens: Morphology,Transmission, Antigenicity and Lysogeny

Streptococcus Pyogens: Morphology,Transmission, Antigenicity and Lysogeny

Q. 1

Staphylococcus aureus and Streptococcus pyogenes are SIMILAR in all of the following features EXCEPT one. Pick the INCORRECT statement:

 A

Both produce numerous exotoxins and exoenzymes

 B

Both are Gram-positive cocci

 C

Both cause skin, tissue, and systemic infections

 D

Both are catalase positive

Q. 1

Staphylococcus aureus and Streptococcus pyogenes are SIMILAR in all of the following features EXCEPT one. Pick the INCORRECT statement:

 A

Both produce numerous exotoxins and exoenzymes

 B

Both are Gram-positive cocci

 C

Both cause skin, tissue, and systemic infections

 D

Both are catalase positive

Ans. D

Explanation:

Both are catalase positive. This is the incorrect pair: S. aureus is catalase-positive, but S. pyogenes (like all streps) is catalase-negative. This is an important point in diagnosis in the lab. 

Also Know:
The group B streptococcus (S agalactiae) is the most common cause of sepsis in newborns and the pneumococcus (S pneumoniae) a leading cause of both pneumonia and meningitis in persons of all ages.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 25. Streptococci and Enterococci. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. 

Q. 2

Streptococcus pyogenes is –

 A

Gram positive cocci

 B

Gram negative cocci

 C

Gram positive bacilli

 D

Gram negative bacilli

Q. 2

Streptococcus pyogenes is –

 A

Gram positive cocci

 B

Gram negative cocci

 C

Gram positive bacilli

 D

Gram negative bacilli

Ans. A

Explanation:

Ans is ‘a’ i.e., Gram positive cocci

Streptococcus pvogenes  Gram postive cocci

–       Arranged in chains

–       Non sporing

–       Fresh isolates form capsule which is made up of hyaluronic acid. It protects the organism from phagocytosis

–       Cultural characteristic

.  Virulent strains produce ‘matt’ (finely granular) colony

.  Avirulent strains produce ‘glossy’ colonies.

.    Capsulated strains produce mucoid colonies, corresponding in virulence to the matt type.

–  Senstivity to bacitracin is employed as a convenient method for differentiating str. pyogenes from other hemolytic streptococci (Maxted’s observation).

–  Biochemical reactions

.   Catalase negative

.   Not soluble in 10% bile

.   Hydrolyse PYR

.   Ferment trehalose but not ribose.

–   Longest chain is formed by Str. salivarius which is non pathogenic.

Capsule of grp A & C streptococci is composed of hyaluronic acid, while grp B & D streptococci have polysaccharide capsule.


Q. 3

False regarding streptococcus pyogenes

 A

Causes necrotizing fascitis

 B

Beta hemolytic

 C

M. protein is virulece factor

 D

Resistant to bacitracin

Q. 3

False regarding streptococcus pyogenes

 A

Causes necrotizing fascitis

 B

Beta hemolytic

 C

M. protein is virulece factor

 D

Resistant to bacitracin

Ans. D

Explanation:

Ans. is ‘d’ i.e., Resistant to bacitracin

  • Streptococcus pyogenes is bacitracin sensitive.
  • All other options are correct.

Q. 4

Not true about streptococcus pyogenes ‑

 A

Gram positive

 B

Bacitracin sensitive

 C

Catalase positive

 D

Not soluble in bile

Q. 4

Not true about streptococcus pyogenes ‑

 A

Gram positive

 B

Bacitracin sensitive

 C

Catalase positive

 D

Not soluble in bile

Ans. C

Explanation:

Ans. is ‘c’ i.e., Catalase positive

Streptococcus pyogenes (group A streptococci) are gram-positive cocci arranged in chains. Chain formation is due to cocci dividing in one plane only and daughter cells failing to separate completely. Chain formation is more pronounced in broth media.

  • Fresh isolates form capsule which is made up of hyaluronic acid. It protects the organism from phagocytosis

Cultural characteristics

  • Virulent strains produce ‘matt’ (finely granular) colony
  • Avirulent strains produce ‘glossy’ colonies.
  • Capsulated strains produce mucoid colonies, corresponding in virulence to the matt type.

Biochemical reactions

  • Senstivity to bacitracin is employed as a convenient method for differentiating str. pyogenes from other hemolytic streptococci (Maxted’s observation).
  • Catalase negative
  • Not soluble in 10% bile.
  • Hydrolyse PYR
  • Ferment trehalose but not ribose.

Q. 5

Streptococcus pyogenes shows pathogenicity by all except‑

 A

M protein

 B

Pyrotoxin

 C

Pili

 D

Streptolysin O

Q. 5

Streptococcus pyogenes shows pathogenicity by all except‑

 A

M protein

 B

Pyrotoxin

 C

Pili

 D

Streptolysin O

Ans. C

Explanation:

Ans. is ‘c’ i.e., Pili

Virulence factors of str. pyogenes

Str. pyogenes forms several exotoxins and enzymes which contribute to its virulence, but M protein is the most important of these.


Q. 6

Antibiotic used to for sensitivity in identification of streptococcus pyogenes‑

 A

Bacitracin

 B

Novobiocin

 C

Penicillin

 D

Optochin

Q. 6

Antibiotic used to for sensitivity in identification of streptococcus pyogenes‑

 A

Bacitracin

 B

Novobiocin

 C

Penicillin

 D

Optochin

Ans. A

Explanation:

Ans. is ‘a’ i.e., Bacitracin

Senstivity to bacitracin is employed as a convenient method for differentiating str. pyogenes from other hemolytic streptococci (Maxted’s observation).



Streptococcus Pneumonia

Streptococcus Pneumonia

Q. 1

Which of the following is a characteristic feature on culture of Streptococcus pneumoniae organism?

 A

Alpha-hemolytic colonies inhibited by optochin on blood agar and lysed by bile

 B

Beta-hemolytic colonies that are bacitracin-resistant on blood agar

 C

Beta-hemolytic colonies that are inhibited by bacitracin on blood agar

 D

Catalase-negative organisms that hydrolyze esculin in 40% bile and 6.5% NaCI

Q. 1

Which of the following is a characteristic feature on culture of Streptococcus pneumoniae organism?

 A

Alpha-hemolytic colonies inhibited by optochin on blood agar and lysed by bile

 B

Beta-hemolytic colonies that are bacitracin-resistant on blood agar

 C

Beta-hemolytic colonies that are inhibited by bacitracin on blood agar

 D

Catalase-negative organisms that hydrolyze esculin in 40% bile and 6.5% NaCI

Ans. A

Explanation:

These findings are used to identify Streptococcus pneumoniae. Optochin sensitivity is used to differentiate the viridans streptococci (resistant) from S. pneumoniae (sensitive). Another test used to identify S. pneumoniae is the Quellung reaction. The only medically important optochin-sensitive organism that gives a positive Quellung reaction is S. pneumoniae.

  • Beta-hemolytic colonies that are bacitracin-resistant on blood agar is seen with Streptococcus agalactiae.
  • Beta-hemolytic colonies that are inhibited by bacitracin on blood agar is seen with Streptococcus pyogenes.
  • Catalase-negative organisms that hydrolyze esculin in 40% bile and 6.5% NaCI is seen with Enterococcus faecalis.
Also Know:
Pneumococci possess polysaccharide capsules of more than 85 antigenically distinct types. With type-specific antiserum, capsules swell (quellung reaction), and this can be used to identify the type. 
 
Another important surface component of Str. pneumoniae is a teichoic acid in the cell wall called C-substance (also known as C-polysaccharide).
It is medically important not for itself, but because it reacts with a normal serum protein made by the liver called C-reactive protein (CRP).
CRP is an “acute-phase” protein that is elevated as much as 1000-fold in acute inflammation
Ref: Levinson W. (2012). Chapter 15. Gram-Positive Cocci. In W. Levinson (Ed),Review of Medical Microbiology & Immunology, 12e.

Q. 2

A child has a history of recurrent infections with organisms having polysaccharide antigens (i.e., Streptococcus pneumoniae and Haemophilus influenzae). This susceptibility can be explained by a deficiency of ?

 A

C3 nephritic factor

 B

C5

 C

IgG subclass 2

 D

Myeloperoxidase in phagocytic cells

Q. 2

A child has a history of recurrent infections with organisms having polysaccharide antigens (i.e., Streptococcus pneumoniae and Haemophilus influenzae). This susceptibility can be explained by a deficiency of ?

 A

C3 nephritic factor

 B

C5

 C

IgG subclass 2

 D

Myeloperoxidase in phagocytic cells

Ans. C

Explanation:

IgG is the predominant antibody in the secondary immune response. IgG subclass 2 is directed against polysaccharide antigens and is involved in the host defense against encapsulated bacteria.

C3 nephritic factor  is an IgG autoantibody that binds to C3 convertase, making it resistant to inactivation. This leads to persistently low serum complement levels and is associated with Type II membranoproliferative glomerulonephritis.
C5 is a component of the complement system. C5a is an anaphylatoxin that affects vasodilatation in acute inflammation. It is also chemotactic for neutrophils and monocytes and increases the expression of adhesion molecules. A deficiency of C5a would affect the acute inflammatory response against any microorganism or foreign substance.
Myeloperoxidase in phagocytic cells is an element of the oxygen-dependent pathway present in phagocytic cells that effectively kills bacterial cells. The hydrogen peroxide-halide complex is considered the most efficient bactericidal system in neutrophils. Chronic granulomatous disease is associated with a deficiency of NADPH oxidase, which converts molecular oxygen to superoxide (the first step in the myeloperoxidase system). Patients are susceptible to granulomatous infections and staphylococcal infections.
 
Ref:  Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg’s Medical Microbiology, 26e.

Q. 3

Which is the commonest Post splenectomy infection‑

 A

Streptococcus pyogenes

 B

Staphylococcus aureus

 C

Streptococcus Pneumoniae

 D

Pseudomonas aeruginosa

Q. 3

Which is the commonest Post splenectomy infection‑

 A

Streptococcus pyogenes

 B

Staphylococcus aureus

 C

Streptococcus Pneumoniae

 D

Pseudomonas aeruginosa

Ans. C

Explanation:

Ans is c ie. Streptococcus

Streptococcus pneumoniae is the most common inf. in post splenectomy patient.

• Schwartz 9/e writes -“The most common causal organism, accounting for as many as 50 to 90% of all OPSI

• cases, remains pneumococcus. Meningococcus, H. influenzae type B, and group A streptococci follow in order of frequency.”


Q. 4

Quellung reaction is seen in ‑

 A

Group B streptococcus

 B

Staphylococcus

 C

Pneumococcus

 D

Enterococcus

Q. 4

Quellung reaction is seen in ‑

 A

Group B streptococcus

 B

Staphylococcus

 C

Pneumococcus

 D

Enterococcus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Pneumococcus

A suspension of pneumococci is mixed on a slide with a drop of the type specific antiserum and methylene blue. On the presence of homologous antiserum capsule becomes apparently swollen, sharply delineated and refractile. o This is called Quellung reaction.


Q. 5

Streptococcus pneumonia produces which type of hemolysis ‑

 A

Alpha

 B

Beta

 C

Gamma

 D

Any of the above

Q. 5

Streptococcus pneumonia produces which type of hemolysis ‑

 A

Alpha

 B

Beta

 C

Gamma

 D

Any of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Alpha



Streptococcus

Streptococcus

Q. 1

Streptococcus all are true except :

 A

Streptodornase cleaves DNA

 B

Streptolysin 0 is active in reduced state

 C

Streptokinase is produced from serotype A,C,K

 D

Pyrogenic toxin A is plasmid mediated

Q. 1

Streptococcus all are true except :

 A

Streptodornase cleaves DNA

 B

Streptolysin 0 is active in reduced state

 C

Streptokinase is produced from serotype A,C,K

 D

Pyrogenic toxin A is plasmid mediated

Ans. D

Explanation:

Pyrogenic exotoxin

  • Most strains of streptococcus pyogenes produce one or more toxins
  • that are called pyrogenic exotoxins because of their ability to induce fever.
  • Three types of streptococcal pyrogenic exotoxins have been identified, i.e. A, B, and C.

–  “The genes of SPE “A” and SPE ‘C’ are transmitted between the strains of streptococcus by bacteriophage° and stable production depends on lysogenic conversion”.

–  “The genes for SPE B are coded by chromosomesQ“.(not plasmids)

  • SPE A and SPE C’ are also called erythrogenic toxins as they are responsible .for rash observed in patients with scarlatina.

–   They have superantigen activity which causes massive release of inflammatory gtokines from T lymphocytes causing fever, shock and tissue damage.

  • Pyrogenic exotoxin A          Gene transmitted by /3 phase
  • Pyrogenic extoxin B            Gene transmitted by chromosome
  • Pyrogenic exotoxin C             Gene transmitted by fi phase

Q. 2

FALSE statement about the Streptococcus is:

 A

M protein is responsible for production of mucoid colonies

 B

M protein is the major surface protein of group A streptococci

 C

Mucoid colonies are virulent

 D

Endotoxin causes rash of scarlet fever

Q. 2

FALSE statement about the Streptococcus is:

 A

M protein is responsible for production of mucoid colonies

 B

M protein is the major surface protein of group A streptococci

 C

Mucoid colonies are virulent

 D

Endotoxin causes rash of scarlet fever

Ans. A

Explanation:

Strains with well marked capsules produce mucoid colonies. Streptococcus pyogenes can be typed based on surface proteins to M,T,R. M protein is most important of these. It act as a virulence factor by inhibiting phagocytosis. It is antigenic and antibody to this promotes phagocytosis of coccus.

M protein is heat labile and acid stable but susceptible to tryptic digestion.  
 
Also know:                          
Pyrogenic exotoxins (erythrogenic, dick, scarlatinal toxin) -dick test is used to identify children susceptible to scarlet fever, a type of acute pharyngitis with erythematous rash.
 
The M protein itself is a fibrillar coiled-coil molecule with structural homology to myosin.
Its carboxy terminus is rooted in the peptidoglycan of the cell wall, and the amino-terminal regions extend out from the surface.
The specificity of the multiple serotypes of M protein is determined by variations in the amino sequence of the amino-terminal portion of the molecule.
Antigenicity and functions differ in domains of the molecule.
There are more than 80 M protein serotypes present.
Ref: Ray C.G., Ryan K.J. (2010). Chapter 25. Streptococci and Enterococci. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. 

Q. 3

Staphylococcus differes from streptococcus by ‑

 A

Coagulase test

 B

Catalase test

 C

Phasphatase

 D

Gram negative

Q. 3

Staphylococcus differes from streptococcus by ‑

 A

Coagulase test

 B

Catalase test

 C

Phasphatase

 D

Gram negative

Ans. B

Explanation:

.   Coagulase test is used to differentiate the different species of staphylococci (staph aureus, staph. epidermidis).

.  Catalase test is used to differentiate staphylococci from streptococci.

.     Coagulase test cannot be used to differentiate streptococci from staphylococci because certain species of staphylococci are coagulase negative (coagulase negative staphylococci) as streptococci.

.  But you should keep in mind that staphylococcus aureus (not all specises of staphylococci) can be differentiated from streptococci by coagulae test also as staph. aureus is coagulase positive while streptococci are coagulase negative.


Q. 4

C-carbohydrate in Streptococcus hemolyticus is important for –

 A

Lancefield classification

 B

Phagocytic inhibition

 C

Toxin production

 D

Haemolysis

Q. 4

C-carbohydrate in Streptococcus hemolyticus is important for –

 A

Lancefield classification

 B

Phagocytic inhibition

 C

Toxin production

 D

Haemolysis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lancefield classification


Q. 5

Which of the following factor is mainly responsible for virulence in Streptococcus –

 A

Carbohydrate

 B

Streptokinase

 C

Streptodornase

 D

M protein

Q. 5

Which of the following factor is mainly responsible for virulence in Streptococcus –

 A

Carbohydrate

 B

Streptokinase

 C

Streptodornase

 D

M protein

Ans. D

Explanation:

Ans. is ‘d’ i.e., M protein

Virulence factors of str. pyogenes

Str. pyogenes forms several exotoxins and enzymes which contribute to its virulence, but M protein is the most important of these.


Q. 6

Which toxin of streptococcus causes hemolysis

 A

Streptolysin O

 B

Streptolysin S

 C

Streptodornanse

 D

a and b

Q. 6

Which toxin of streptococcus causes hemolysis

 A

Streptolysin O

 B

Streptolysin S

 C

Streptodornanse

 D

a and b

Ans. D

Explanation:

Ans. is D.) ‘a’ i.e., Streptolysin 0; ‘b’ i.e., Streptolysin S.

List of Streptococcal hemolysins:

  • Streptolysin S
  • Streptolysin O
  • Pneumolysin
  • β-Haemolysin/cytolysin
  • Intermedilysin.

List of Streptococcal Toxins:

• Streptolysin O

  • 1. Oxygen and heat labile
  • 2. Antigenic
  • 3. ASO titres used in retrospective diagnosis Rheumatic fever (ASO titres > 200 significant)
  • 4. ASO titres – low after skin infection

• Streptolysin S

  • 1. Oxygen stable, soluble in serum
  • 2. Not antigenic

• Pyrogenic exotoxin/Erythrogenic/Dick/Scarlational toxin – Superantigen

  • 1. Associated with streptococcal toxic shock syndrome Et scarlet fever
  • 2. Dick test – intradermal test to identify children susceptible to scarlet fever
  • 3. Schultz-Charlton reaction – diagnostic test for scarlet fever

• Streptokinase(Fibrinolysin)

  • 1. Facilitates spread of infection
  • 2. Used in retrospective diagnosis

• DNAase or Streptodornase

  • 1. Liquefies thick pus and responsible for thin serous character of streptococcal exudates Anti-DNAse,
  • Anti-hyaluronidase: retrospective diagnosis of pyoderma & glomerulonephritis

• Hyaluranidase – Spreading factor


Q. 7

True about streptococcus –

 A

Lancefield classification is based on M protein

 B

Group `G’ not found in human

 C

Group ‘B’ causes neonatal meningitis

 D

Group ‘C’ can be isolated from vaginal flora

Q. 7

True about streptococcus –

 A

Lancefield classification is based on M protein

 B

Group `G’ not found in human

 C

Group ‘B’ causes neonatal meningitis

 D

Group ‘C’ can be isolated from vaginal flora

Ans. C

Explanation:

Ans. is `c i.e.  Group ‘B’ causes neonatal meningitis

  • Lancefield classification is based on carbohydrate ‘C’ antigen not on M protein.
  • Besides Str. pyogenes, streptococci belonging to group B, C, D, F, G and rarely H, K, 0 and R may also cause human infections.
  • Group B streptococcus is the single most common cause of neonatal meningitis.
  • Group C streptococci are part of normal flora of throat (not of vaginal flora)
  • Group D streptococci ie enterococci can cause urinary tract infection.

Q. 8

Which group of streptococcus grow at > 60°C

 A

A

 B

B

 C

C

 D

D

Q. 8

Which group of streptococcus grow at > 60°C

 A

A

 B

B

 C

C

 D

D

Ans. D

Explanation:

Ans. is ‘d’ i.e., D

Among streptococci, enterococcus (group D streptococcus) is heat resistant.


Q. 9

Pneumococcus can be differentiated from streptococcus by –

 A

Type of hemolysis

 B

Gram staining

 C

Growth characteristics

 D

Bile solubility

Q. 9

Pneumococcus can be differentiated from streptococcus by –

 A

Type of hemolysis

 B

Gram staining

 C

Growth characteristics

 D

Bile solubility

Ans. D

Explanation:

Ans. is ‘d’ i.e., Bile solubility

After 18 hrs of incubation both Str. viridans and pneumococcus produce similar colonies with alpha hemolysis but on further incubation the colonies of pneumococcus become flat with raised edges and central umbonation, so that concentric rings are seen on the surface when viewed from above (draughtsman or carrom coin appearance).

Differentiation between Stn pneumoniae and Sir. viridans


Q. 10

Streptococcus and pneumococcus are differentiated by-

 A

Bile salt solubility

 B

Growth characteristic

 C

Gram staining

 D

all

Q. 10

Streptococcus and pneumococcus are differentiated by-

 A

Bile salt solubility

 B

Growth characteristic

 C

Gram staining

 D

all

Ans. A

Explanation:

Ans. is ‘a’ i.e., Bile salt solubility

.  Pneumococcus is bile soluble, while streptococcus is insoluble.

  • Pneumococcus ferments inulin, streptococcus does not.

Q. 11

Streptococcus is classified based on – 

 A

M protein

 B

Cultural characteristics

 C

Bile solubility

 D

Cell wall carbohydrate

Q. 11

Streptococcus is classified based on – 

 A

M protein

 B

Cultural characteristics

 C

Bile solubility

 D

Cell wall carbohydrate

Ans. D

Explanation:

Ans. is ‘d’ i.e., Cell wall carbohydrate 


Q. 12

Group A streptococcus causes all except

 A

Scarlet fever

 B

Erysipelas

 C

Impetigo

 D

Epidermolysis bullae

Q. 12

Group A streptococcus causes all except

 A

Scarlet fever

 B

Erysipelas

 C

Impetigo

 D

Epidermolysis bullae

Ans. D

Explanation:

Ans. is ‘d’ i.e., Epidermolysis bullae 


Q. 13

True about streptococcus are all except –

 A

Group C causes no human infection

 B

Classification by lancefield based on carbohydrate antigen

 C

Group B causes neonatal meningitis

 D

Group B lives in female genital tract

Q. 13

True about streptococcus are all except –

 A

Group C causes no human infection

 B

Classification by lancefield based on carbohydrate antigen

 C

Group B causes neonatal meningitis

 D

Group B lives in female genital tract

Ans. A

Explanation:

Ans. is ‘a’ i.e., Group C causes no human infection 


Q. 14

Which of the following does not cause meningitis ‑

 A

Listeria

 B

Pneumococcus

 C

β Streptococci

 D

Streptococcus type A

Q. 14

Which of the following does not cause meningitis ‑

 A

Listeria

 B

Pneumococcus

 C

β Streptococci

 D

Streptococcus type A

Ans. D

Explanation:

Ans. is ‘d’ i.e., Streptococcus type A


Q. 15

Which is not true of carbuncle –

 A

Infective gangrene of subcutaneous tissue

 B

Caused by staphylococcus

 C

Diabetics are more prone

 D

Caused by streptococcus

Q. 15

Which is not true of carbuncle –

 A

Infective gangrene of subcutaneous tissue

 B

Caused by staphylococcus

 C

Diabetics are more prone

 D

Caused by streptococcus

Ans. D

Explanation:

Ans. is ‘d’ i.e., Caused by streptococcus 


Q. 16

Commonest cause of cellulitis is ‑

 A

Staphylococcus

 B

Streptococcus

 C

E. coli

 D

Hemophilus

Q. 16

Commonest cause of cellulitis is ‑

 A

Staphylococcus

 B

Streptococcus

 C

E. coli

 D

Hemophilus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Streptococcus 

“The most common organisms associated with cellulitis are group A streptococci and S. aureus.”- Schwartz


Q. 17

The organism causing destruction of skin grafts is ‑

 A

Streptococcus

 B

Staphylococcus

 C

Pseudomonas

 D

Clostridium

Q. 17

The organism causing destruction of skin grafts is ‑

 A

Streptococcus

 B

Staphylococcus

 C

Pseudomonas

 D

Clostridium

Ans. A

Explanation:

Ans. is ‘a’ i.e., Streptococcus 


Q. 18

Pseudomembranous conjunctivitis is caused by:

 A

Gonococcus

 B

Staphylococcus

 C

Streptococcus

 D

Keratoconjunctivitis sicca

Q. 18

Pseudomembranous conjunctivitis is caused by:

 A

Gonococcus

 B

Staphylococcus

 C

Streptococcus

 D

Keratoconjunctivitis sicca

Ans. C

Explanation:

Ans. Streptococcus


Q. 19

The most frequent bacterial agent causing non­granulomatous uveitis is:

 A

Staphylococcus

 B

Streptococcus

 C

Pneumococcus

 D

Influenza bacillus

Q. 19

The most frequent bacterial agent causing non­granulomatous uveitis is:

 A

Staphylococcus

 B

Streptococcus

 C

Pneumococcus

 D

Influenza bacillus

Ans. B

Explanation:

Ans. Streptococcus


Q. 20

Uveitis is caused by all except:

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

Klebsiella

Q. 20

Uveitis is caused by all except:

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

Klebsiella

Ans. D

Explanation:

Ans. Klebsiella


Q. 21

Most common cause of cellulitis ‑

 A

Streptococcus

 B

Staphylococcus

 C

Pseudomonas

 D

E. coli

Q. 21

Most common cause of cellulitis ‑

 A

Streptococcus

 B

Staphylococcus

 C

Pseudomonas

 D

E. coli

Ans. A

Explanation:

Ans. is ‘a’ i.e., Streptococcus


Q. 22

CAMP test is positive for‑

 A

Group A streptococcus

 B

Group B streptococcus

 C

Group C streptococcus

 D

Group D streptococcus

Q. 22

CAMP test is positive for‑

 A

Group A streptococcus

 B

Group B streptococcus

 C

Group C streptococcus

 D

Group D streptococcus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Group B streptococcus



Sciatic foramen

SCIATIC FORAMEN

Q. 1

All of the following passthrough lesser sciatic foramen except:

 A

Pudendal nerve

 B

Internal pudendal vessels

 C

Nerve to obturator internus

 D

Inferior gluteal vessels

Q. 1

All of the following passthrough lesser sciatic foramen except:

 A

Pudendal nerve

 B

Internal pudendal vessels

 C

Nerve to obturator internus

 D

Inferior gluteal vessels

Ans. D

Explanation:

Ans:D.)Inferior Gluteal Vessels.

The following pass through the Lesser Sciatic foramen:

  • the tendon of the Obturator internus
  • internal pudendal vessels
  • pudendal nerve
  • nerve to the obturator internus

Q. 2

Structures passing through lesser sciatic foramen are all, except:

 A

Pudendal nerve

 B

Internal pudendal artery

 C

Nerve to obturator externus

 D

Tendon of obturator internus

Q. 2

Structures passing through lesser sciatic foramen are all, except:

 A

Pudendal nerve

 B

Internal pudendal artery

 C

Nerve to obturator externus

 D

Tendon of obturator internus

Ans. C

Explanation:

Structures passing through lesser sciatic foramen are tendon of obturator internus muscle, nerve to obturator internus, pudendal nerve, internal pudendal artery and vein.

Structures passing through greater sciatic foramen are:

  • Piriformis
  • Sciatic nerve
  • Posterior cutaneous nerve of thigh
  • Superior and inferior gluteal nerve
  • Nerve to obturator internus and quadratus femoris
  • Pudendal nerve
  • Superior and inferior gluteal nerves and arteries
  • Internal pudendal artery and vein

Q. 3

All of the following structures passes through lesser sciatic foramen, EXCEPT ?

 A

Inferior gluteal vessels

 B

Internal pudendal vessels

 C

Pudendal nerve

 D

Nerve to obturator internus

Q. 3

All of the following structures passes through lesser sciatic foramen, EXCEPT ?

 A

Inferior gluteal vessels

 B

Internal pudendal vessels

 C

Pudendal nerve

 D

Nerve to obturator internus

Ans. A

Explanation:

Structures passing through the lesser sciatic foramen are tendon of obturator internus, internal pudendal vessels and pudendal nerve.
 
Structures passing through greater sciatic foramen are:
  • Piriformis muscle
  • Superior and inferior gluteal vessel
  • Internal pudendal vessel
  • Pudendal nerve
  • Sciatic nerve
  • Posterior femoral cutaneous nerve
  • Nerve to obturator internus
  • Quadratus femoris
Structures passing through both greater and lesser sciatic foramen:
  • Pudendal nerve
  • Internal pudendal vessels
  • Nerve to obturator internus


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.


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