Dy pmc

1. PBL - 1
• 70 yrs old female was brought to OPD in the afternoon with
history of fall in bathroom. She could not getup on her own.
On examination affected limb was laterally rotated. Patient did
not allow further examination due to pain. She was diagnosed
with fracture neck of femur
1. What is blood supply of head and neck of femur?
- Obturator artery
- Medial and Lateral circumflex femoral artery
- Superior and Inferior gluteal artery
2. How much is normal neck shaft angle?
- 125 degree

2. 3. What are retinacular arteries?
-These are branches from main artery piercing capsule of joint
to supply it.
4. Why intra capsular fracture of neck of femur are difficult to
heal?
-rupture of intra capsular retinacular vessels leads to non-
union of fracture or avascular necrosis
5. Why limb is laterally rotated?
- Due to pull of short extensors
6. Name the ligament which prevent the trunk from falling
backwards in the standing posture? What its another name
- Iliofemoral ligament
Ligament of Bigelow

4. 7. What is shenton’s line?
- Imaginary line drawn along upper border of obturator
foramen & lower margin of neck of femur

5. PBL -2
• 25 yrs old football player was brought to OPD with left
swollen knee. He gave history of blow on lateral side knee and
felt a sharp pain in the knee. He was diagnosed as a case of
medial meniscus tear.
1. Which is most common type of tear in medial meniscus?
- Horizontal tear
2. Why is medial meniscus more commonly injured than lateral
meniscus?
-Medial meniscus is more firmly attached to joint capsule and
medial collateral ligament

6. 3. Mention intra capsular structure of knee joint.
- Synovial Membrane
- Medial and Lateral meniscus
-Anterior and posterior cruciate ligament
- Coronary ligament
- Transverse meniscal ligament
- Tendon of Popliteus
- Meniscofemoral ligament
4. Name the muscle involved in unlocking of knee joint.
- Popliteus

7. 5. Classify knee joint with supportive reasons.
- Compound: More than two bones
-Complex: Compartmentalization of joint cavity due to
meniscus
- Condylar: Condyles articulation
- Modified Hinge: Conjunct rotation is present
- Synovial: Freely moveable due to synovial fluid

9. PBL- 3
• A 52 year old female was brought to OPD with complaint of
difficulty in walking especially with right foot. The lady gave
history of removal of plaster 2 days back after treatment of
fracture of upper end of right fibula. Foot drop of right side
was observed on examination.
1. What is Foot Drop?
- Condition of gait abnormality where forefoot dropping is
seen.
2. Which nerve might be damaged in this case?
- Common peroneal nerve (palpated against neck of fibula)
3. Which muscles are paralysed in this case? (loss of
dorsiflexion)
- TibialisAanterior, Ext. Hallicius Longus, Ext.
DigitorumLongus, PT, Peronius Longus , PBrevis

10. 4. What is the cause of high stepping gait in this patient?
- Foot hangs down with toes pointing downwards
- No dorsiflexion
- Causing toes to scrape the ground while walking
- So the leg is raised more then normal causing high stepping
gait
5. Name the nerve related to neck of fibula and give its root value.
- Common peroneal nerve (Posterior division of L4, L5, S1, S2)
Terminal br of sciatic
6. What is nerve of Lateral compartment of nerve?
- Superficial peroneal nerve

11. PBL-4
• A 50 year old policeman came with a history of chronic dull
aching pain in both legs. Examination showed dilated and
tortuous vein on the medial side of his both legs. The skin on
the medial mallelous was found discolored, dry and scaly.
1. Name the clinical condition
- Varicose vein
2. Name the veins involved
- Great saphenous vein
3. What is the relation of this vein to malleoli?
-The vein runs upwards anterior to medial malleolus along the
medial border of leg.

12. 1. Name the cutaneous nerve related to this vein.
- Saphenous nerve
3. Name the veins that connect it to the deep veins of the lower
limb
- Perforating veins
Cockett’s perforator near ankle joint
Boyd’s perforator below knee joint
Dodd’s perforator above knee joint

13. 6. What is direction of flow of blood in the connecting veins?
- Superficial to deep veins
7. What is anatomical reason for dilated veins?
- Internally veins have valve which maintain unidirectional
blood flow, when these valve become incompetent pooling of
blood start in the distal segment of vein resulting in their
dilation and thus causing tortousity in them.

15. PBL- 5
• A patient was given intramuscular injection in the gluteal
region. After few weeks, he complaints of difficulty while
stepping on right foot while walking. The patient experienced
difficulty in dorsiflexion and eversion of right foot.
difficulty in dorsiflexion-foot drop
1. Name the nerve that is injured by injection needle in the
gluteal region.
- Sciatic Nerve
2. Which component of nerve is injured based on symptoms and
sings of patient?
- Common peroneal nerve

16. 3. Name the site of intra muscular injection.
- Upper and outer quadrant of gluteal region.
4. In which gluteal muscle injection is given and why?
- Gluteus maximus, as finer branches of inferior gluteal nerve
reaches the superficial surface.
5. Give the root value of nerve and level at which it divides.
- Posterior divison of L4, L5, S1,S2,S3.
- Superior angle of Popliteal Fossa

18. PBL- 6
• A 50 year old female came to hospital, when she noticed a
lemon size swelling in the upper right thigh. On examination,
the swelling was found to be inferior and lateral to pubic
tubercle. She was diagnosed as a case of Femoral hernia.
1. What could be the possible anatomical cause for the swelling?
- A loop of small intestine was pushed into the hernial sac
causing swelling.
2. Name the weak area through which hernia enters the thigh
- Femoral ring and femoral canal

19. 3. Name the boundaries of that weak passage.
- Anteriorly: Inguinal ligament
Posteriorly: Pecten Pubis
Medially: Lacunar ligament
Laterally: Femoral vein
4. Why it is more common in females?
- Greater width of the pelvis, so larger diameter of the ring and
canal.
5. Describe direction of hernia and its importance to the surgeon.
- Downward, Forward and Upward. During manual reduction of
hernia surgeon reverse the order by pushing the hernia
downward, backward and upwards.

21. PBL- 7
• 38 year old patient was admitted in surgery ward with
gangrene of the great toe of right foot. He gave history of pain
in lower extremity since last 3 years. Pain increased with
walking and was relived by rest. Patient was chronic smoker
and belonged to lower socioeconomic strata. On examination
the right extremity has lost its normal color, loss of hair was
noted and its was cooler than left side. Dorsalis pedis artery
pulsations were also diminished.
1. Which arteries can be palpated in lower extremity
-Femoral, Popliteal , Anterior tibial, Posterior tibial and
Dorsalis pedis artery.
2. What is peripheral vascular disease?
-A circulatory condition where lumen of blood vessels narrows
resulting in diminished blood flow to target tissue.

22. 3. What is cause of pain in above case?
- Reduced amount of blood supply to muscles in use.
4. What is Gangrene?
-Death of tissue due to either lack of blood supply or sever
bacterial infection.
5. What is the cause of loss of normal colour, hair, coolness of
the affected limb?
-Lack of blood supply causes discoloration and eventually the
area become dry and dark, hair follicle nutrition is affected so
hair fall is seen and as arterial blood supply is lost so high
pressure blood flow is absent resulting in coolness.

23. PBL-8
• A young student on her way to morning lecture misses out a
step on staircase and slips off with her foot in inverted
condition. During lecture she experiences pain in ankle joint.
On examination in orthopedic opd she was asked whether she
wear high heel foot wear?, there was tenderness and swelling
over ankle joint and pain increased on inversion.
1. How is this injury related to the use of high heels?
- Because of heel raised there are more chances of loosing
balance while walking and thus causing injury to ankle or
foot.
2. What type of injury do you suspect in this case?
- Ligament tear injury

24. 3. Which ligament of ankle joint is likely to be injured in this
case?
- Anterior talofibular ligament
- Posterior talofibular ligament
4. Which joints are involved in eversion, inversion ,
plantarflexion & dorsilflexion?
- Inversion & Eversion: Talocalcaneonavicular Joint
- Plantar and Dorsiflexion : Ankle joint
5. What is close pack position of joint?
-Position where there is maximum congruency of articulating
bones and joint stability is derived from alignment of bones.