Fractures and dislocations: cast syndrome: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: cast syndrome

Sample item

A 16-year-old girl is placed in a body cast after scoliosis correction. On the third day she has repeated bilious vomiting and epigastric fullness that gets worse after meals and eases when she lies prone. Which is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Superior mesenteric artery syndrome

Cast syndrome is superior mesenteric artery syndrome after a body cast or spinal lengthening. The third part of the duodenum is compressed between the superior mesenteric artery and the aorta, aggravated by loss of the mesenteric fat pad and lordosis. Treatment is to remove or window the cast, give fluids and nasogastric decompression, and position prone or left lateral.

Option by option

  • A. Paralytic ileus due to hypokalaemia

    Ileus produces diffuse distension with absent bowel sounds and is not relieved by posture.

  • B. Acute pancreatitis

    Pancreatitis causes severe epigastric pain radiating to the back with raised amylase, not postural relief.

  • C. Acute cholecystitis

    Cholecystitis causes right upper quadrant pain with fever and Murphy sign.

  • D. Superior mesenteric artery syndrome (correct)

    Correct. Bilious vomiting with postprandial fullness relieved by lying prone points to duodenal compression by the superior mesenteric artery.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Superior mesenteric artery syndrome. Cast syndrome is superior mesenteric artery syndrome after a body cast or spinal lengthening.

Why is "Paralytic ileus due to hypokalaemia" not the answer?

Ileus produces diffuse distension with absent bowel sounds and is not relieved by posture.

Why is "Acute pancreatitis" not the answer?

Pancreatitis causes severe epigastric pain radiating to the back with raised amylase, not postural relief.

Why is "Acute cholecystitis" not the answer?

Cholecystitis causes right upper quadrant pain with fever and Murphy sign.

What concept does this question test?

It tests Fractures and dislocations: cast syndrome in Orthopaedics. The third part of the duodenum is compressed between the superior mesenteric artery and the aorta, aggravated by loss of the mesenteric fat pad and lordosis. Treatment is to remove or window the cast, give fluids and nasogastric decompression, and position prone or left lateral.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: cast syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.