NEET-PG Orthopedics Previous Year Questions (2017–2026)

Correct answer: C. Radial head subluxation. The history of a sudden longitudinal pull on a young child with a pronated, guarded arm and normal films is classic for a pulled elbow.

This is radial head subluxation (pulled elbow, nursemaid elbow). A quick axial traction on the extended, pronated forearm lets the annular ligament slip up over the radial head and become trapped in the radiocapitellar joint. Because it is a soft-tissue slip and not a fracture, plain radiographs are typically normal. Reduction is achieved by supination with elbow flexion or by hyperpronation, after which the child rapidly uses the arm again.

The annular ligament encircles the radial head; a sudden axial pull lets it slip over the head.

Incorrect Options:

• A. Supracondylar fracture: a distal humeral fracture that typically follows a fall on an outstretched hand and shows a fracture line, an effusion or a displaced fat pad on radiographs, none of which are present here.

  Supracondylar fracture: a distal humeral break usually visible on radiographs.

• B. Elbow dislocation: produces obvious deformity, marked swelling and clear radiographic malalignment, which is not the picture in a well-looking child with normal films.

  Elbow dislocation: gross loss of joint alignment on the radiograph.

• D. Monteggia fracture-dislocation: combines a proximal ulnar fracture with dislocation of the radial head and is clearly abnormal on radiographs, unlike this benign presentation.

  Monteggia injury: proximal ulnar fracture with radial head dislocation.

High-Yield Facts:

• Peak age is roughly 1 to 4 years; the annular ligament is thin and lax at this age.
• The arm is held pronated and slightly flexed, with pain but no swelling or deformity.
• Radiographs are usually normal; imaging is mainly to exclude fracture when the story is atypical.
• Hyperpronation is often more successful and less painful than supination-flexion for reduction.

Correct Answer: A. Carpal tunnel syndrome; evaluated by Durkan's compression test

Nocturnal pins-and-needles in the lateral three and a half digits, relieved by hanging or shaking the hand (the flick sign), is carpal tunnel syndrome from median nerve compression beneath the flexor retinaculum -- the most common entrapment neuropathy. Durkan's compression test, applying steady pressure over the carpal ligament for about 30 seconds to reproduce the symptoms, is the most sensitive and specific provocative test for it.

Why the other options fail

• B. Ulnar tunnel syndrome; evaluated by Froment's sign: wrong nerve for both parts -- ulnar tunnel syndrome causes numbness in the medial one and a half digits, and Froment's tests ulnar motor weakness, not sensory carpal tunnel symptoms.
• C. Carpal tunnel syndrome; evaluated by Froment's sign: the diagnosis is right but Froment's sign tests adductor pollicis (ulnar-innervated) weakness, not the median nerve.
• D. Ulnar tunnel syndrome; evaluated by Durkan's compression test: Durkan's test is specific to the median nerve at the carpal tunnel, not the ulnar nerve at Guyon's canal.

Pearl: nocturnal paresthesia in the radial three and a half fingers relieved by shaking the hand is carpal tunnel syndrome, confirmed at the bedside with Durkan's compression test.

Correct Answer: A. Ankylosing spondylitis

Bamboo spine: bridging marginal syndesmophytes fusing the vertebral column, classic for ankylosing spondylitis.

Inflammatory back pain (morning stiffness improving with activity) plus bilateral heel pain (Achilles/plantar enthesitis) in a young man is ankylosing spondylitis -- a seronegative spondyloarthropathy strongly linked to HLA-B27, starting at the sacroiliac joints and progressing to syndesmophyte-driven spinal fusion.

Why the other options fail

• B. Pott disease: presents with constitutional symptoms and localized progressive pain, not generalized morning stiffness or enthesitis.
• C. Disc herniation: gives acute radicular pain worsened by loading, with focal neurological signs, not chronic systemic stiffness.
• D. Mechanical back pain: worsens with activity and improves with rest, the opposite pattern, and lacks enthesitis.

Pearl: extra-articular features include acute anterior uveitis, aortic regurgitation, and apical pulmonary fibrosis, and the modified Schober test quantifies restricted lumbar flexion in progressive disease.