Degenerative Disorders Practice Questions

Q: A 68-year-old man complains of aching pain around his left hip and right knee, which is worse after exertion and relieved with rest. Both joints are tender and swollen, with pain and crepitus on passive motion. Tests for rheumatoid factor and antinuclear antibodies are negative, and ESR is normal. X-rays are likely to reveal all of the following findings, EXCEPT:

Osteoarthritis. The clinical presentation of a 68-year-old patient with weight-bearing joint pain (hip and knee) that worsens with exertion and improves with rest, accompanied by crepitus and negative inflammatory markers (normal ESR, negative RF/ANA), is a classic description of **Osteoarthritis (OA)** [1]. **Why Option B is the Correct Answer:** The question asks for X-ray findings. **Osteoarthritis** is the *diagnosis* itself, not a radiographic finding. While the patient has osteoarthritis, "Osteoarthritis" is not a feature seen on an X-ray; rather, the X-ray reveals specific structural changes that lead to the diagnosis. **Analysis of Incorrect Options (Radiographic Features of OA):** The hallmark X-ray findings of Osteoarthritis (often remembered by the mnemonic **LOSS**) include: * **A. Joint space narrowing:** Caused by the progressive loss and attrition of articular cartilage. * **C. Subchondral bone sclerosis:** Increased bone density (whiteness on X-ray) beneath the joint surface due to increased mechanical stress. * **D. Osteophytes:** Bony spurs at the joint margins representing the body's attempt to increase the joint surface area [1]. * *(Note: Subchondral cysts are the fourth classic feature). **NEET-PG High-Yield Pearls:** * **Pain Pattern:** OA pain is "mechanical" (worse with use), whereas Rheumatoid Arthritis (RA) pain is "inflammatory" (worse with rest/morning stiffness >1 hour) [1]. * **Nodal OA:** Look for **Heberden’s nodes** (DIP joints) and **Bouchard’s nodes** (PIP joints) [1]. * **First-line Management:** Acetaminophen (Paracetamol) is traditionally the initial drug, but topical or oral NSAIDs are often more effective for symptomatic relief. * **Radiology-Clinical Correlation:** X-ray severity in OA often correlates poorly with the degree of clinical pain [1].

Q: True about osteoarthritis?

Increased hydration of articular cartilage. ### Explanation Osteoarthritis (OA) is a degenerative joint disease characterized by the progressive loss of articular cartilage and subchondral bone changes. **Why Option A is Correct:** The earliest biochemical change in osteoarthritis is an **increase in the water content (hydration)** of the articular cartilage. This occurs because the damaged collagen network fails to restrain the swelling pressure of proteoglycans. While the total proteoglycan content eventually decreases, the initial disruption of the collagen "mesh" allows the cartilage to absorb more water, making it softer and less resilient (chondromalacia). **Why the other options are Incorrect:** * **B. Decreased proteolytic enzymes:** In OA, there is actually an **increase** in proteolytic enzymes, specifically **Matrix Metalloproteinases (MMPs)** like collagenase and stromelysin, which degrade the extracellular matrix. * **C. Increased ESR:** OA is primarily a "wear-and-tear" degenerative process, not a systemic inflammatory disease. Therefore, the **ESR and CRP remain normal**. An elevated ESR would point toward Rheumatoid Arthritis or an infectious etiology. * **D. Decreased viscosity of synovial fluid:** While the quality of hyaluronic acid may change, the classic hallmark of OA is **increased or normal viscosity** (non-inflammatory fluid). Decreased viscosity (watery fluid) is characteristic of inflammatory arthritides like Rheumatoid Arthritis. **High-Yield Clinical Pearls for NEET-PG:** * **First change in OA:** Increased water content (Hydration). * **Radiological Hallmarks:** Joint space narrowing (asymmetrical), Osteophytes, Subchondral sclerosis, and Subchondral cysts (Geodes). * **Heberden’s Nodes:** Osteophytes at the DIP joints (more common in females). * **Bouchard’s Nodes:** Osteophytes at the PIP joints. * **Management:** Weight loss and quadriceps strengthening are the most effective non-pharmacological interventions.

Q: What do Ahlback Grade 2 changes of Osteoarthritis of the knee signify?

Joint space obliterated or almost obliterated. The **Ahlback Classification** is a radiographic grading system used to assess the severity of knee osteoarthritis, specifically focusing on the medial or lateral compartments. It is a high-yield topic for NEET-PG as it guides the surgical decision between Unicompartmental Knee Arthroplasty (UKA) and Total Knee Arthroplasty (TKA). ### **Explanation of the Correct Answer** **Grade 2** signifies that the articular cartilage is completely worn down, leading to **joint space obliteration** or near-obliteration. At this stage, there is "bone-on-bone" contact, but significant bone loss (attrition) has not yet occurred. ### **Analysis of Incorrect Options** * **Option B (Minor bone attrition 15 mm):** This corresponds to **Grade 5**. This stage often involves gross subluxation and severe deformity. ### **High-Yield Clinical Pearls for NEET-PG** * **Grade 1:** Joint space narrowing (less than 50% of the normal width). * **Surgical Correlation:** Grades 1 and 2 are often candidates for conservative management or UKA, whereas Grades 3, 4, and 5 typically require TKA due to significant bone loss and ligamentous laxity. * **Kellgren-Lawrence System:** Do not confuse Ahlback with Kellgren-Lawrence. K-L is more commonly used in general practice and focuses on **osteophytes** (Grade 2) and **subchondral sclerosis**, whereas Ahlback focuses on **bone attrition**.

Q: Heberden's nodes denote involvement of which joint?

Distal interphalangeal joint. **Explanation:** **Heberden's nodes** are a classic clinical hallmark of **Osteoarthritis (OA)**. They represent bony overgrowths (osteophytes) that occur at the **Distal Interphalangeal (DIP) joints** of the fingers. These nodes result from the calcification of the articular cartilage and the formation of new bone at the joint margins due to chronic degenerative changes. **Analysis of Options:** * **Option A (Correct):** Heberden's nodes specifically involve the **DIP joints**. They are more common in women and often have a strong genetic predisposition. * **Option B (Incorrect):** Bony enlargements at the **Proximal Interphalangeal (PIP) joints** are known as **Bouchard's nodes**. While also seen in OA, they are distinct from Heberden's nodes. * **Option C (Incorrect):** The Metacarpophalangeal (MCP) joints are typically **spared** in primary Osteoarthritis. Involvement of the MCP joints is more characteristic of inflammatory arthritides like Rheumatoid Arthritis. * **Option D (Incorrect):** While the first Metatarsophalangeal (MTP) joint is a common site for OA (Hallux Rigidus), it is not associated with the term "Heberden's nodes." **High-Yield Clinical Pearls for NEET-PG:** 1. **Nodal OA:** The presence of both Heberden's and Bouchard's nodes is characteristic of "Nodal Osteoarthritis." 2. **Symmetry:** These nodes are often bilateral and symmetrical. 3. **First CMC Joint:** The most common site of OA in the hand is the **1st Carpometacarpal (CMC) joint** (base of the thumb), leading to a "squared hand" appearance. 4. **Radiology:** Classic findings in OA include joint space narrowing, subchondral sclerosis, subchondral cysts, and **osteophytes**.

Q: What is the most common site of primary osteoarthrosis?

Knee joint. **Explanation:** Primary Osteoarthrosis (OA) is a chronic, non-inflammatory degenerative joint disease characterized by the breakdown of articular cartilage. The **Knee joint** is the most common site for primary OA worldwide. This is primarily due to the knee being a major weight-bearing joint that undergoes significant mechanical stress, complex rotational forces, and repetitive loading throughout life. Within the knee, the medial compartment is most frequently affected. **Analysis of Options:** * **Knee joint (Correct):** It is the most common site for primary OA. Risk factors include aging, female gender, and obesity (which increases the mechanical load). * **Hip joint (Incorrect):** While the hip is the second most common large weight-bearing joint affected by OA, its prevalence is lower than that of the knee, especially in Asian populations. * **Ankle joint (Incorrect):** Primary OA of the ankle is rare. Most cases of ankle osteoarthritis are **secondary**, usually resulting from previous trauma (fractures or chronic instability). * **Shoulder joint (Incorrect):** As a non-weight-bearing joint, the shoulder is an uncommon site for primary OA. When it occurs, it is often secondary to rotator cuff tears or previous trauma. **High-Yield Pearls for NEET-PG:** * **Nodal OA:** The most common small joints involved are the **Distal Interphalangeal (DIP) joints**, leading to **Heberden’s nodes**. **Bouchard’s nodes** occur at the PIP joints. * **Radiological Hallmarks:** Joint space narrowing (asymmetrical), subchondral sclerosis, subchondral cysts, and osteophyte formation. * **First-line Management:** Weight loss and quadriceps strengthening exercises. Pharmacologically, Acetaminophen (Paracetamol) is traditionally the first-line simple analgesic, though NSAIDs are more effective for symptomatic relief.

Q: Which of the following is a characteristic feature of osteoarthritis?

Heberden node. **Explanation:** **Osteoarthritis (OA)** is a degenerative joint disease characterized by the loss of articular cartilage and the formation of new bone at the joint margins (osteophytes). 1. **Heberden Nodes (Correct Answer):** These are palpable bony enlargements (osteophytes) located at the **Distal Interphalangeal (DIP) joints**. They are a hallmark clinical feature of primary OA. Similarly, involvement of the **Proximal Interphalangeal (PIP) joints** is known as **Bouchard nodes**. 2. **Increased ESR (Incorrect):** OA is primarily a non-inflammatory, degenerative condition. Therefore, systemic inflammatory markers like Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) are typically **normal**. An elevated ESR suggests inflammatory arthritides like Rheumatoid Arthritis (RA) or systemic lupus erythematosus. 3. **Onycholysis (Incorrect):** This refers to the painless separation of the nail from the nail bed. It is a characteristic feature of **Psoriatic Arthritis**, not OA. 4. **Z-Deformity (Incorrect):** This is a classic deformity seen in **Rheumatoid Arthritis**, consisting of radial deviation at the wrist and ulnar deviation of the fingers. **High-Yield Clinical Pearls for NEET-PG:** * **Joint Involvement:** OA typically affects weight-bearing joints (hips, knees) and the first carpometacarpal (CMC) joint (squaring of the hand). * **Radiological Hallmarks (4):** Joint space narrowing, subchondral sclerosis, subchondral cysts, and osteophytes. * **Pain Pattern:** Pain worsens with activity and is relieved by rest (unlike RA, where morning stiffness lasts >1 hour and improves with activity). * **DIP vs. PIP:** Remember: **D**istal = **H**eberden (Alphabetical order D-H); **P**roximal = **B**ouchard (P-B).

Q: Which of the following joints are commonly affected in osteoarthritis? I. First metatarsophalangeal joint II. Proximal interphalangeal joint III. Ankle joint IV. 5th and 6th cervical vertebrae joint Select the correct answer using the code given below :

I, II and IV only. ***I, II and IV only*** - **Osteoarthritis** commonly affects joints that bear significant weight or are subject to repetitive stress, such as the **first metatarsophalangeal joint**, **proximal interphalangeal joints**, and the **cervical spine**. - Degenerative changes in these joints, including cartilage loss and **osteophyte formation**, are characteristic findings in osteoarthritis. *I, II, III and IV* - While the first metatarsophalangeal joint, proximal interphalangeal joints, and cervical vertebrae are commonly affected, the **ankle joint** is typically spared in primary osteoarthritis. - Ankle involvement in osteoarthritis is usually secondary to **trauma** or inflammatory arthritis rather than primary degenerative change. *III and IV only* - This option misses the common involvement of the **first metatarsophalangeal joint** and **proximal interphalangeal joints**, which are frequently affected in osteoarthritis. - The ankle joint is less commonly involved in primary osteoarthritis compared to other load-bearing joints like the **knee** and **hip**. *I and II only* - This option incorrectly omits the **cervical vertebrae**, which are a very common site for osteoarthritis, often leading to neck pain and **radiculopathy**. - While the metatarsophalangeal and proximal interphalangeal joints are correct, the exclusion of the cervical spine makes this option incomplete.

Q: All are true about osteoarthritis, except

Quadriceps atrophy. ***Quadriceps atrophy*** - While muscle weakness can occur in osteoarthritis due to pain and disuse, **quadriceps atrophy** is not a universal or defining characteristic of the disease itself, nor is it consistently observed as a primary feature. - The statement implies that quadriceps atrophy is *always* true about osteoarthritis, which is incorrect as it's a potential consequence but not inherently present in all cases or a direct pathological feature. *MCP is spared* - The **metacarpophalangeal (MCP) joints** are typically spared in osteoarthritis, unlike in rheumatoid arthritis. - Osteoarthritis predominantly affects the **distal interphalangeal (DIP)** and **proximal interphalangeal (PIP)** joints of the hands, as well as the **carpometacarpal (CMC) joint of the thumb**. *Glucosamines are beneficial* - **Glucosamine sulfate** is a commonly used supplement in osteoarthritis, with some studies suggesting it may provide modest pain relief and slow cartilage degradation in certain patients. - While its efficacy is debated and not universally accepted as curative, many patients report subjective benefit, and it is considered a complementary therapy. *Loose bodies in the ankle joint* - **Loose bodies**, also known as joint mice, are fragments of cartilage or bone that can break off and float within the joint space. - These are a recognized complication of osteoarthritis, particularly in weight-bearing joints like the **ankle**, and can cause locking or catching sensations.

Question 1

A 68-year-old man complains of aching pain around his left hip and right knee, which is worse after exertion and relieved with rest. Both joints are tender and swollen, with pain and crepitus on passive motion. Tests for rheumatoid factor and antinuclear antibodies are negative, and ESR is normal. X-rays are likely to reveal all of the following findings, EXCEPT:

Accepted Answer

Osteoarthritis

Answer

Joint space narrowing

Answer

Subchondral bone sclerosis

Answer

Osteophytes

Question 2

True about osteoarthritis?

Accepted Answer

Increased hydration of articular cartilage

Answer

Decreased proteolytic enzymes of articular cartilage

Answer

Increased ESR

Answer

Decreased viscosity of synovial fluid

Question 3

A 60-year-old male complains of pain in both knees that has been gradually worsening over the past 2 years. The pain is relieved by rest and exacerbated by movement. Physical examination reveals bony enlargement of the knees with mild inflammation and crepitus on motion. There are no other significant findings except for bony enlargement at the distal interphalangeal joints. The patient's height is 5 feet 9 inches and his weight is 88 kg. What is the best way to prevent disease progression?

Accepted Answer

Weight reduction

Answer

NSAIDs and calcium supplementation

Answer

Total knee replacement

Answer

Oral prednisone

Question 4

What do Ahlback Grade 2 changes of Osteoarthritis of the knee signify?

Accepted Answer

Joint space obliterated or almost obliterated

Answer

Minor bone attrition (<5 mm)

Answer

Moderate bone attrition (5-15 mm)

Answer

Severe bone attrition (>15 mm)

Question 5

Heberden's nodes denote involvement of which joint?

Accepted Answer

Distal interphalangeal joint

Answer

Proximal interphalangeal joint

Answer

Metacarpophalangeal joint

Answer

Metatarsophalangeal joint

Question 6

What is the most common site of primary osteoarthrosis?

Accepted Answer

Knee joint

Answer

Hip joint

Answer

Ankle joint

Answer

Shoulder joint

Question 7

Which of the following is a characteristic feature of osteoarthritis?

Accepted Answer

Heberden node

Answer

Increased ESR

Answer

Onycholysis

Answer

Z deformity

Question 8

Which of the following joints are commonly affected in osteoarthritis?
I. First metatarsophalangeal joint
II. Proximal interphalangeal joint
III. Ankle joint
IV. 5th and 6th cervical vertebrae joint

Select the correct answer using the code given below :

Accepted Answer

I, II and IV only

Answer

I, II, III and IV

Answer

I and II only

Answer

III and IV only

Question 9

All are true about osteoarthritis, except

Accepted Answer

Quadriceps atrophy

Answer

MCP is spared

Answer

Glucosamines are beneficial

Answer

Loose bodies in the ankle joint

Question 10

Joint not involved in osteoarthritis

Accepted Answer

MCP

Answer

PIP

Answer

DIP

Answer

Knee

Degenerative Disorders — MCQs

Degenerative Disorders — MCQs

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