Orthopaedics Question Quality Review
Executive Summary
This review covers a candidate sample of 100 validated non-gold questions (60 generic + 40 risky) drawn from a pool of 4,052 Orthopaedics items. The benchmark and recent PYQ sets (16 items total) serve as the quality bar.
The most striking finding in this sample is the severe Blooms-level compression toward recall. Of the 100 candidate items, 44 sit at Blooms-1 and 39 at Blooms-2, leaving only 17 items at Blooms-3 or above. The gold-standard PYQ set, by contrast, consistently delivers clinical vignettes at Blooms-3 (application) with well-constructed distractors that require genuine reasoning. The candidate pool does not match that standard in the majority of items reviewed.
Six distinct problem categories are present in this sample. The most operationally urgent are: (1) factually unsafe or wrong-key items that could actively harm learner performance, (2) broken delivery items that are unanswerable without a missing image, and (3) a large cohort of low-value recall trivia that dilutes the bank's discriminative power. A smaller but important group of items have worthwhile clinical concepts buried under weak execution and are worth fixing rather than discarding.
Headline numbers from the reviewed set:
| Category | Approximate count in sample |
|---|---|
| Wrong Key or Factually Unsafe | 6 |
| Broken Delivery (image-dependent, unanswerable) | 3 |
| Low-Value But Correct (recall trivia, Blooms-1) | ~38 |
| Repetitive or Duplicative Coverage | 5 |
| Worthwhile Concept, Weak Execution | ~18 |
| Wrong Subject or Wrong Topic Placement | 3 |
The overall keep rate for the candidate sample as reviewed is estimated at roughly 30–35%. The remainder require fixing, disabling, or topic reassignment before they can be considered production-ready at the NEET-PG / INI-CET standard.
What Good Looks Like
The benchmark and PYQ items establish a clear quality bar. The following features define a production-ready Orthopaedics question at this level:
Clinical anchoring. The best items open with a patient vignette that forces the candidate to integrate age, mechanism, physical finding, and investigation before selecting a management or diagnosis. Examples: bc66d83a (75-year-old, intracapsular NOF fracture → hemiarthroplasty), b3dd8f1b (26-year-old, proximal femur shaft fracture → interlocking nail), 9fc9e167 (teenager, snuff-box tenderness → scaphoid). The clinical context is not decorative; it is load-bearing for the correct answer.
Distractors that require discrimination. In c532d506 (intertrochanteric fracture in elderly female), all four options — hemiarthroplasty/DHS, IM nail, ORIF with plating, boot and bar — are plausible treatments for hip fractures in general. The candidate must know the specific indication for DHS in this fracture pattern. In e807c756 (external fixator stability ranking), the ordering task demands genuine biomechanical knowledge, not pattern recognition.
Appropriate Blooms distribution. Even the easier PYQ items (e.g., 9dbc5a09 on CTEV components, 432fd780 on Pott's spine pattern) are justified by their direct PYQ provenance and are balanced by harder items in the same set. The benchmark set does not rely on a single recall format.
Clean option construction. No "all of the above," no "none of the above" as the correct answer, no options that are obviously absurd, no options that are subsets of each other in a way that telegraphs the answer.
Stem completeness. Every item is self-contained. No item depends on an image that may not render.
Main Issue Categories
1. Wrong Key or Factually Unsafe
Why this pattern is bad. A wrong key is the most operationally dangerous defect in a question bank. It actively penalises candidates who know the correct answer and rewards those who do not. In a high-stakes exam preparation context, repeated exposure to a wrong key creates durable misconceptions that are difficult to unlearn. These items must be resolved before any other quality work.
How it shows up. In this sample, wrong-key problems cluster around two sub-types: (a) items where the marked correct answer is factually incorrect by standard orthopaedic references, and (b) items where the stem is so ambiguous that the marked key is only one of two defensible answers and the more commonly tested answer is a distractor.
Example question IDs and explanations:
7b6481f8— "Most common complication of intracapsular fracture of neck of femur" — The marked key is Malunion. This is factually wrong. The most common and clinically important complications of intracapsular NOF fracture are avascular necrosis (AVN) and non-union, both of which are direct consequences of disrupted retinacular blood supply. Malunion is not a recognised leading complication of this fracture pattern in any standard orthopaedic text (Apley, Campbell, Rockwood). This is a patient-safety-level error because the concept of AVN after intracapsular NOF fracture is a core exam topic and a core clinical concept. Disable.ac61e924— "Which fracture is known for non-union?" — The marked key is Colles' fracture. Colles' fracture is well known for malunion (dinner-fork deformity), not non-union. The fractures classically associated with non-union are scaphoid (proximal pole), femoral neck, and lateral condyle of humerus in children. Scaphoid is listed as a distractor and is the textbook answer. This is a direct key inversion. Disable.ac61e924is also conceptually related tod9edd9b5("AVN most commonly seen in" → Scaphoid marked correct). The scaphoid is indeed the most common carpal bone for AVN, but the question asks about AVN "most commonly" across all bone locations — femoral head is the most common overall site of AVN in the body. The question is ambiguous between "most common carpal bone" and "most common bone overall." The key is defensible only if the question is read narrowly. This needs a stem fix to specify "carpal bone." Fix.07d51ad3— "A controlled osteotomy performed during surgery to facilitate access or correction is best described as —" — The marked key is Galeazzi fracture. This is completely wrong. A Galeazzi fracture is a specific traumatic injury (distal radius fracture with distal radioulnar joint disruption). A controlled surgical osteotomy is not a fracture eponym at all. The stem appears to be describing a "trochanteric osteotomy" or a generic surgical osteotomy, none of which correspond to any of the four options listed. All four options (Galeazzi, Monteggia, Rolando, Cotton's) are traumatic fracture-dislocation patterns, not surgical procedures. The question is conceptually incoherent and the key is wrong. Disable.c43d4605— "Hill-Sachs lesion is seen in:" — The marked key is Recurrent dislocation of shoulder. The standard teaching is that Hill-Sachs lesion is a posterolateral humeral head compression fracture seen in anterior dislocation of the shoulder (not just recurrent — it occurs after a single anterior dislocation). The distractor "Posterior dislocation of shoulder" is actually associated with a reverse Hill-Sachs (McLaughlin lesion). The key is partially defensible (recurrent anterior dislocations do produce Hill-Sachs), but the more precise and commonly tested answer is "anterior dislocation of shoulder," which is not among the options. The option set is poorly constructed and the key is misleading. Fix (rewrite options to include "anterior dislocation of shoulder" as the correct answer).887181c1— "Clergyman's knee" — The marked key is Infrapatellar bursa. Standard teaching: Clergyman's knee = infrapatellar bursitis (from kneeling upright, as clergy do). Housemaid's knee = prepatellar bursitis (from kneeling forward). This key is actually correct. However, the question is flagged here because it is a pure eponym-recall item with no clinical value beyond memorisation, and it sits in the risky set. The key is correct but the item belongs in the Low-Value bucket. See Category 4.ef2bf82f— "Jumper's fracture is a fracture of which bone?" — The marked key is Pelvis. This is factually wrong. "Jumper's fracture" is not a standard eponym for a pelvic fracture. The term is sometimes loosely applied to calcaneal fractures from jumping/falling from height (also called "Don Juan fracture" or lover's fracture). The pelvis key is unsupported by standard references. Disable.
Recommended disposition: Disable 7b6481f8, ac61e924, 07d51ad3, ef2bf82f. Fix d9edd9b5 (stem clarification), c43d4605 (option reconstruction).
2. Wrong Subject or Wrong Topic Placement
Why this pattern is bad. Misplaced questions corrupt topic-level analytics, cause incorrect syllabus mapping, and confuse candidates who are studying by topic. A question about periodontal bone defects appearing in an Orthopaedics bank is not merely a tagging error — it actively misleads a student who encounters it during an Orthopaedics revision session.
How it shows up. In this sample, wrong-subject contamination is observed in two forms: (a) questions that belong to a different clinical specialty entirely, and (b) questions placed under an incorrect sub-topic within Orthopaedics.
Example question IDs and explanations:
cc12b329— "Which bone defect offers the best chance for bone fill? — 3-walled defect" — This question is tagged under Bone Grafts and Substitutes in Orthopaedics, but the concept of 2-walled vs 3-walled osseous defects and bone fill is a core topic in Periodontology / Dentistry, not orthopaedic surgery. The template membership ("Benign vs Malignant Bone Tumor Quiz") is also incorrect for this content. This item does not belong in an Orthopaedics bank. Disable (or transfer to Dentistry/Periodontology bank).d5af10e6— "True statement regarding synovial fluid in gout — presence of urate crystals" — This is placed under Metabolic Bone Diseases in Orthopaedics. While gout has orthopaedic manifestations, the specific question about synovial fluid analysis (urate vs pyrophosphate crystals, WBC count, glucose) is a Rheumatology / Medicine question. The distractor "presence of pyrophosphate crystals" points to pseudogout, which is a Medicine/Rheumatology differential. The question is not testing orthopaedic management or surgical decision-making. Reassign to Medicine/Rheumatology, or disable if already covered there.345a5418— "Subluxation of atlanto-axial joint is seen in all except: Gout" — The topic placement is Spine Disorders (Orthopaedics), which is defensible. However, the question tests knowledge of systemic diseases causing C1-C2 instability (RA, ankylosing spondylitis, odontoid dysgenesis) — this is borderline between Orthopaedics and Medicine/Rheumatology. The key (Gout) is correct. The placement is acceptable but the question is better suited to a Spine Disorders sub-topic. Keep with topic tag review.
Recommended disposition: Disable or transfer cc12b329. Reassign d5af10e6. Review topic tag on 345a5418.
3. Broken Delivery (Missing Image, Malformed Options, Incomplete Stem)
Why this pattern is bad. A question that depends on an image that is not present is completely unanswerable. It wastes candidate time, generates frustration and distrust in the platform, and produces meaningless performance data. These items are operationally broken regardless of whether the underlying concept is valid.
How it shows up. In this sample, image-dependent questions appear with stems that reference a visual finding ("based on the X-ray," "the following physical finding," "spot the diagnosis based on X-ray") but no image is embedded in the question text as provided. Additionally, one item has a stem that is a numbered fragment suggesting it was extracted from a larger document without proper isolation.
Example question IDs and explanations:
b9b9b680— "97. Spot the diagnosis based on X-ray:" — The stem begins with "97." indicating it was copied from a numbered question set without removing the serial number. More critically, the question asks the candidate to diagnose based on an X-ray, but no X-ray image is present in the question text. The correct answer is marked as Osteoid osteoma. Without the image, this is completely unanswerable. The "97." prefix is also a broken delivery artefact. Disable unless the image can be verified and attached.beadb72a— "What is the most probable diagnosis based on the X-ray findings in a 20-year-old female presenting with knee swelling?" — The stem references X-ray findings but provides no X-ray and no description of the X-ray findings in the text. The question is unanswerable without the image. The correct answer (Osteosarcoma) cannot be derived from the stem alone — a 20-year-old with knee swelling could have GCT, osteosarcoma, or osteochondroma, all of which are listed as options. Disable unless image is attached and stem is rewritten to describe the radiological findings.519d5d79— "A 50-year-old orthopaedics doctor went for sky diving while vacationing abroad. On return he had the following physical finding. What is the diagnosis?" — The stem says "the following physical finding" but no image or description of the finding is provided. The correct answer (rupture of long head of biceps) would be identifiable from a "Popeye sign" photograph, but without the image the question is unanswerable. Disable unless image is confirmed present and rendering correctly.35e15d6d— "What is the test being performed in the patient?" — The stem is entirely image-dependent ("the patient" implies a clinical photograph or video). No image is present in the text. The correct answer is Hoover test. Without the image, this is unanswerable. Disable unless image is confirmed.
Recommended disposition: Disable b9b9b680, beadb72a, 519d5d79, 35e15d6d unless images can be verified as attached and rendering correctly in the delivery environment.
4. Low-Value But Correct (Too Simple, Low-Yield, Trivia-Heavy, Weak Exam Relevance)
Why this pattern is bad. This is the largest single quality problem in the reviewed sample. Items that test pure eponym recall, single-word definitions, or isolated anatomical facts at Blooms-1 do not discriminate between prepared and unprepared candidates at the NEET-PG / INI-CET level. They inflate the apparent size of the bank without adding discriminative value. When a candidate encounters ten consecutive recall items, they receive no practice in the clinical reasoning that the actual exam demands. The Blooms distribution data confirms this: 44 of 100 candidate items are Blooms-1, compared to a target distribution that should have the majority at Blooms-2 to 3.
How it shows up. The pattern appears as: (a) pure eponym-to-definition mapping with no clinical context, (b) "most common site of X" questions with no vignette, (c) single-feature recall of a named condition, (d) definition questions where the answer is contained in the question stem.
Example question IDs and explanations:
129499d0— "Green stick fracture is — Incomplete fracture" — This is a definition question. The answer is contained in the name itself (a greenstick bends and partially breaks, like a green twig). No clinical reasoning is required. Blooms-1. The concept is already covered by the PYQ item0e093127(greenstick/nightstick fractures in children) ande4a62d2d(greenstick most common in children). Three items covering the same trivial fact. Disable.e4a62d2d— "Green stick fractures are most common in which age group? — Children" — Same concept as above, marginally more specific but still Blooms-1 recall. Redundant with129499d0and0e093127. Disable (covered by0e093127which has PYQ provenance).cbfc7d3b— "What is the last step in fracture healing? — Remodeling" — Pure sequence recall. No clinical application. Blooms-1. Disable or replace with a vignette asking why a fracture that has consolidated on X-ray still shows cortical irregularity (testing understanding of remodeling).adb58c28— "Pott's spine is commonest at which spinal region? — Thoracolumbar" — This is a direct duplicate of the PYQ item432fd780(most common pattern in Pott's spine = paradiscal) andbb063d0a(most common site = dorsolumbar). Three items covering Pott's spine epidemiology at recall level. This specific item adds nothing beyondbb063d0a. Disable.9cbf2522— "Brown tumor is characteristic of which condition? — Hyperparathyroidism" — Single-association recall. Blooms-1. No clinical context. Disable or upgrade to a vignette with biochemical findings.18f323ed— "Osteochondroma is a disease of which part of the bone? — Metaphysis" — Pure anatomical recall. Blooms-1. Disable or upgrade to a clinical scenario.15365329— "Most common site of adamantinoma of long bones — Tibia" — Adamantinoma is a rare bone tumour. While it is a testable fact, the question is pure recall with no clinical context and the condition is low-yield for NEET-PG/INI-CET. Disable.5f0d77f6— "Wolff's law is: — Osteogenesis is directly proportional to stress and strain" — Definition recall. The option "None of above" is also present, which is a weak distractor construction. Disable.3c0ecd48— "Tennis elbow is defined as: — Inflammation of the lateral epicondyle" — The answer is in the name. No clinical reasoning required. Disable.048629f8— "Most common site of stress fracture — 2nd metatarsal" — Recall. Blooms-1. Acceptable as a fact but adds no discriminative value at this level. Disable or upgrade to a vignette (military recruit, foot pain after marching).8cbea8e5— "March fracture is a fracture of which bone? — Neck of 2nd metatarsal" — This is the same concept as048629f8(stress fracture of 2nd metatarsal) expressed as an eponym. Redundant and recall-only. Disable.1522e0d2— "Bumper fracture is defined as — Lateral tibial condyle fracture" — Eponym recall. Blooms-1. Disable.ee8333d4— "Pat's fracture is a fracture of which of the following?" — Eponym recall. "Pat's fracture" is not a widely standardised eponym in major orthopaedic texts; the term is used variably. Low-yield and potentially ambiguous. Disable.f8be5436— "Most common site of eosinophilic granuloma — Skull" — Recall. Blooms-1. Low clinical yield for surgical orthopaedics exam. Disable.54b6bacc— "Giant cells are seen in which condition? — Osteoclastoma" — Recall. Blooms-1. Disable.848085e2— "Which is a pulsatile tumor? — Osteosarcoma" — This key is also factually questionable: the classically described pulsatile bone tumour is Giant Cell Tumour (osteoclastoma) or ABC (aneurysmal bone cyst), not osteosarcoma. This item may belong in Category 1 (wrong key) as well. Disable.44871478— "Loose body in joint: most common site? — Knee" — Recall. Blooms-1. Minimal clinical reasoning. Disable.cbfc7d3b,1d81261b,f9db1b51,75a8b4b7— All are single-association recall items (Adam's test, sabre tibia, Perthes age group) at Blooms-1 with no clinical vignette. Disable or upgrade.
Recommended disposition: Disable the majority of items in this category. Where the underlying concept is high-yield (e.g., Perthes disease, stress fracture), prefer upgrading to a clinical vignette rather than retaining the recall form.
5. Repetitive or Duplicative Coverage
Why this pattern is bad. Duplicate or near-duplicate items waste bank capacity, create a false sense of topic coverage, and — when both items appear in the same test — frustrate candidates and reduce test reliability. In a bank of 4,052 items, duplication at the recall level is particularly wasteful because the items being duplicated are already low-value.
How it shows up. In this sample, duplication is observed across three concept clusters: greenstick fracture, Pott's spine location, and osteoid osteoma presentation.
Example question IDs and explanations:
Greenstick fracture cluster:
129499d0(definition),e4a62d2d(age group),0e093127(greenstick/nightstick in children, PYQ-tagged),5717022e(term for incomplete fracture = greenstick). Four items covering the same single fact. Only0e093127has PYQ provenance and should be retained. The other three should be disabled.Pott's spine location cluster:
adb58c28(thoracolumbar, generic),bb063d0a(dorsolumbar, risky set),993e9029(paradiscal type, risky set), and the PYQ item432fd780(paradiscal). The PYQ item covers the most important fact (paradiscal pattern).bb063d0aandadb58c28are near-duplicates of each other (thoracolumbar ≈ dorsolumbar).993e9029duplicates the PYQ. Disableadb58c28,bb063d0a,993e9029; retain the PYQ.Osteoid osteoma cluster:
b13905de(25-year-old, femur pain, aspirin relief, lucent nidus with sclerosis → osteoid osteoma — well-constructed vignette),3b22e3f8(20-year-old, distal femur, sclerotic lesion with central nidus → osteoid osteoma — similar vignette),b9b9b680(image-dependent, broken).b13905deis the better item (aspirin relief is the classic discriminating feature).3b22e3f8is a near-duplicate with a slightly different age and location but the same diagnostic logic. Keepb13905de, disable3b22e3f8andb9b9b680.Paget's disease → osteosarcoma:
96301eca(Paget's disease as risk factor for osteosarcoma) andb6f977a6(Paget's disease developing into osteosarcoma after 10 years) and7b0bb575(time period between radiation and osteosarcoma — 10 years). The first two are near-duplicates of the same concept.7b0bb575is a different angle (radiation-induced) but the "10 years" answer is the same. Keep96301eca(better distractor set), disableb6f977a6and7b0bb575.
Recommended disposition: Disable the weaker duplicate in each cluster as identified above. Retain the PYQ-tagged or better-constructed item in each pair.
6. Worthwhile Concept, Weak Execution (Keep the Concept, Fix the Stem/Options/Vignette)
Why this pattern is bad. These items test concepts that are genuinely high-yield and exam-relevant, but the execution — stem construction, distractor quality, clinical framing, or option phrasing — falls below the gold-standard bar. Discarding these items entirely would waste the underlying concept. A targeted rewrite can convert them into production-quality items.
How it shows up. Common execution failures include: (a) stems that ask a direct factual question when a clinical vignette would be more appropriate and more discriminating, (b) distractors that are obviously wrong or that include "all of the above" as the correct answer, (c) "except" / "not true" / "false" formats that are harder to write cleanly and often produce ambiguous items, (d) stems that are ambiguous about the scope of the question.
Example question IDs and explanations:
73435261— "Which statement regarding genu varum is true? — Occurs due to epiphyseal dysplasia" — The marked key is problematic: physiological genu varum in infants is normal and resolves spontaneously, which makes option A ("In infants, it may be considered normal") also true. The key (epiphyseal dysplasia) is one cause of pathological genu varum but is not the most common cause and is not the most important teaching point. The question is written as a "true statement" format, which is inherently weak. Fix: Rewrite as a vignette — a toddler with bilateral bowing of legs, no history of nutritional deficiency, resolving spontaneously — and ask the most likely diagnosis (physiological genu varum). This tests the same concept at a higher Blooms level.431e88a8— "False statement regarding Salter-Harris classification — Type V represents injury to perichondrial ring" — The concept (Salter-Harris Type V = crush injury to the physis, not perichondrial ring injury) is high-yield and was tested in INICET-2024. The "false statement" format is acceptable but the other three options are all straightforwardly true, making this a process-of-elimination item rather than a knowledge test. Fix: Convert to a positive-stem vignette: "A child sustains a compression injury to the growth plate with no fracture line visible on X-ray. Which Salter-Harris type is this, and what is the prognosis?" This tests the same knowledge at Blooms-3.77aef07a— "18-year-old, football, twisted knee, resumed playing, next day swelling — most probable cause: Medial meniscus injury" — The concept is correct and the vignette format is good. However, the key (medial meniscus) vs the distractor (ACL injury) is clinically ambiguous: ACL tears also present with immediate swelling (haemarthrosis within hours), while meniscal tears classically present with delayed swelling (synovial effusion over 24 hours). The stem says "next day swelling," which does favour meniscal injury, but the vignette does not mention the absence of a "pop" sound or instability, which would help discriminate. Fix: Add "no audible pop at the time of injury, no instability on examination" to the stem to make the meniscal diagnosis unambiguous.84830eff— "RTA patient, right lateral position, bruises on face, elbow, lateral knee — nerve injury: Common peroneal nerve" — Good clinical reasoning question. The concept (common peroneal nerve at fibular neck, vulnerable in lateral position) is correct and high-yield. The distractor "Trigeminal nerve" is too obviously wrong for a PG-level exam. Fix: Replace "Trigeminal nerve" with "Superficial peroneal nerve" to create a more discriminating distractor set.5903741b— "Benefits of immobilization of a fracture — All of the above" — The correct answer is "All of the above." This is a weak format: "all of the above" as the correct answer rewards candidates who recognise that none of the individual options are wrong, rather than testing knowledge of any specific benefit. Fix: Rewrite as a single-best-answer question asking which benefit of immobilization is most directly related to preventing Volkmann's ischemic contracture (answer: reduced chances of further injury to neurovascular structures).00472661— "Which requires emergency treatment? — Vascular compression injury" — The concept (vascular compromise = surgical emergency) is correct and important. However, the option "Car accident" is not a medical condition and is an absurd distractor. "Fracture pelvis" can also be a vascular emergency (pelvic ring disruption with haemorrhage). The stem and options need a complete rewrite. Fix: Rewrite as a vignette — a child with supracondylar fracture, absent radial pulse, pale cold hand — and ask the next step (emergency vascular exploration).8e6b82d1— "32-year-old, recurrent posterior dislocation of shoulder — lesion on anteromedial humeral head" — The concept (reverse Hill-Sachs / McLaughlin lesion on anteromedial humeral head in posterior dislocation) is correct and high-yield. The question is well-constructed but the stem could be strengthened by adding a clinical finding (e.g., "arm held in internal rotation, unable to externally rotate") to make it a true Blooms-3 application item rather than a recall of the lesion location. Fix: Minor stem enhancement.6fe00122— "Palpable step-off in lower lumbar region suggests — Vertebral body disruption" — The concept (step-off = spondylolisthesis or vertebral body displacement) is correct. However, "vertebral body disruption" is an unusual phrasing; the standard term is spondylolisthesis or fracture-dislocation. The distractors (disc disruption, ligamentum flavum injury, facet joint injury) are all reasonable, making this a decent discriminating item. Fix: Replace "Vertebral body disruption" with "Spondylolisthesis" for terminological accuracy.a44acafd— "What material is used in veinplasty? — Polymethyl methacrylate" — The term "veinplasty" is non-standard in orthopaedics; the correct term is vertebroplasty (PMMA injection into vertebral body). This appears to be a typographical error in the stem. The concept (PMMA in vertebroplasty) is high-yield and is also tested by738d4462(vertebroplasty substance). Fixa44acafdby correcting "veinplasty" to "vertebroplasty." Note that738d4462covers the same concept — after fixing, one of the two should be disabled to avoid duplication.7fe30c61— "Which is not a deep heat therapy? — Infrared beam" — The concept (superficial vs deep heat therapy in physiotherapy) is correct and the key is accurate. However, this topic sits awkwardly in "Degenerative Disorders" and is more properly a Physiotherapy/Rehabilitation topic. The question is also low-yield for surgical orthopaedics PG exams. Fix: Reassign to a Rehabilitation sub-topic; consider whether it meets the yield threshold for this bank.
Recommended disposition: Fix all items in this category as described. Priority fixes are 77aef07a, 431e88a8, 84830eff, a44acafd, and 6fe00122. Lower-priority fixes are 73435261, 5903741b, 00472661, 8e6b82d1.
Prioritization
The table below ranks action items by operational urgency. Tier 1 must be resolved before any item in the affected category is served to candidates.
| Tier | Category | Rationale | Approximate item count in sample |
|---|---|---|---|
| 1 — Immediate | Wrong Key or Factually Unsafe | Active harm to learners; patient-safety-level errors | 6 |
| 1 — Immediate | Broken Delivery (image-dependent) | Completely unanswerable; wastes candidate time | 4 |
| 2 — High | Wrong Subject / Topic Placement | Corrupts analytics and misleads candidates studying by topic | 3 |
| 2 — High | Worthwhile Concept, Weak Execution | High-yield concepts at risk of being wasted; fixable with targeted rewrites | ~18 |
| 3 — Routine | Repetitive / Duplicative Coverage | Reduces bank efficiency; disable weaker duplicate | ~10 |
| 3 — Routine | Low-Value But Correct (recall trivia) | Largest volume problem; systematic disable pass recommended | ~38 |
Blooms-level rebalancing is the overarching structural recommendation. The candidate pool is heavily weighted toward Blooms-1 (44%) and Blooms-2 (39%). The content team should target a production distribution closer to Blooms-1: 15%, Blooms-2: 30%, Blooms-3: 40%, Blooms-4: 15% for this subject, consistent with the PYQ and benchmark set profile.
Example Keep / Fix / Disable Calls
The following table provides a concise disposition reference for all specifically cited items in this report.
| Question ID | Short Description | Disposition | Reason |
|---|---|---|---|
75b8d208 |
L4-L5 disc → EHL weakness | Keep | Good clinical vignette, correct key, Blooms-3 |
84830eff |
RTA lateral position → common peroneal nerve | Fix | Replace "Trigeminal nerve" distractor with "Superficial peroneal nerve" |
77aef07a |
Football knee twist → medial meniscus | Fix | Add discriminating clinical details to separate from ACL |
431e88a8 |
False statement Salter-Harris | Fix | Convert to positive-stem vignette for Blooms-3 |
8e6b82d1 |
Posterior shoulder dislocation → anteromedial lesion | Fix | Add clinical finding to stem; concept is correct |
b13905de |
25-year-old, aspirin-relieved femur pain → osteoid osteoma | Keep | Well-constructed vignette, correct key, good distractors |
77a98728 |
90-year-old, skull lucencies, elevated ALP → Paget's | Keep | Good clinical vignette, Blooms-3 |
19620e7b |
88-year-old osteoporosis, multiple fractures → reduced bone mass, normal mineralisation | Keep | Excellent Blooms-2/3 pathophysiology question |
110eb635 |
Dial test positive → posterolateral corner injury | Keep | High-yield clinical examination concept, Blooms-3 |
a28c1aa2 |
FOP (heterotopic ossification, BMP4, short hallux) → near-normal life expectancy is false | Keep | High-yield rare condition, well-constructed |
7b6481f8 |
Most common complication intracapsular NOF → malunion (WRONG KEY) | Disable | Key is factually wrong; AVN/non-union is correct |
ac61e924 |
Fracture known for non-union → Colles' (WRONG KEY) | Disable | Key is factually wrong; scaphoid is correct |
07d51ad3 |
Controlled osteotomy → Galeazzi fracture (WRONG KEY) | Disable | Conceptually incoherent; key is wrong |
ef2bf82f |
Jumper's fracture → pelvis (WRONG KEY) | Disable | Key is unsupported by standard references |
848085e2 |
Pulsatile tumour → osteosarcoma (likely wrong key) | Disable | GCT/ABC is the standard answer; key suspect |
b9b9b680 |
"97. Spot diagnosis based on X-ray" | Disable | Broken delivery: no image, serial number artefact |
beadb72a |
X-ray findings, 20-year-old knee swelling | Disable | Broken delivery: no image, unanswerable |
519d5d79 |
"Following physical finding" after skydiving | Disable | Broken delivery: no image |
35e15d6d |
"Test being performed in the patient" | Disable | Broken delivery: no image |
cc12b329 |
3-walled bone defect → best bone fill | Disable | Wrong subject: Periodontology, not Orthopaedics |
d5af10e6 |
Synovial fluid in gout → urate crystals | Reassign | Belongs in Medicine/Rheumatology |
129499d0 |
Greenstick fracture = incomplete fracture | Disable | Blooms-1 recall, duplicate of 0e093127 |
e4a62d2d |
Greenstick most common in children | Disable | Duplicate of 0e093127 |
5717022e |
Term for incomplete fracture = greenstick | Disable | Duplicate of 0e093127 |
adb58c28 |
Pott's spine commonest at thoracolumbar | Disable | Duplicate of PYQ 432fd780 and bb063d0a |
bb063d0a |
Most common site TB spine = dorsolumbar | Disable | Duplicate of PYQ 432fd780 |
993e9029 |
Most common type spinal TB = paradiscal | Disable | Duplicate of PYQ 432fd780 |
3b22e3f8 |
20-year-old, distal femur nidus → osteoid osteoma | Disable | Near-duplicate of b13905de |
b6f977a6 |
Paget's → osteosarcoma after 10 years | Disable | Near-duplicate of 96301eca |
cbfc7d3b |
Last step fracture healing = remodeling | Disable | Blooms-1 recall, low value |
9cbf2522 |
Brown tumour → hyperparathyroidism | Disable | Blooms-1 recall, low value |
18f323ed |
Osteochondroma = metaphysis | Disable | Blooms-1 recall, low value |
15365329 |
Adamantinoma most common site = tibia | Disable | Blooms-1 recall, low yield |
5f0d77f6 |
Wolff's law definition | Disable | Blooms-1 recall, weak distractors |
3c0ecd48 |
Tennis elbow = lateral epicondyle inflammation | Disable | Blooms-1 recall, answer in question |
048629f8 |
Most common stress fracture = 2nd metatarsal | Disable | Blooms-1 recall, duplicate of 8cbea8e5 |
8cbea8e5 |
March fracture = neck 2nd metatarsal | Disable | Blooms-1 recall, duplicate of 048629f8 |
1522e0d2 |
Bumper fracture = lateral tibial condyle | Disable | Blooms-1 eponym recall |
ee8333d4 |
Pat's fracture definition | Disable | Blooms-1, non-standard eponym |
a44acafd |
"Veinplasty" material = PMMA | Fix | Correct "veinplasty" to "vertebroplasty"; then check for duplication with 738d4462 |
6fe00122 |
Step-off lumbar → vertebral body disruption | Fix | Replace with "spondylolisthesis" for terminological accuracy |
c43d4605 |
Hill-Sachs lesion → recurrent shoulder dislocation | Fix | Rewrite options to include "anterior dislocation of shoulder" as correct answer |
d9edd9b5 |
AVN most commonly in scaphoid | Fix | Clarify stem: "most common carpal bone" vs "most common bone overall" |
00472661 |
Which requires emergency treatment | Fix | Remove absurd distractor "Car accident"; rewrite as vignette |
5903741b |
Benefits of immobilization = all of the above | Fix | Remove "all of the above" format; rewrite as single-best-answer |
73435261 |
True statement genu varum | Fix | Rewrite as clinical vignette; current key is ambiguous |