Degenerative Disorders Practice Questions

Q: Part of knee most commonly involved in osteoarthritis:

Medial compartment. ***Medial compartment*** (Keep the correct option at the top and the incorrect options in the order they are provided in the input) - The **medial compartment** of the knee is subjected to greater weight-bearing forces during normal gait. - This increased stress leads to more frequent **cartilage degeneration** and **osteoarthritis** development in this compartment. *Lateral compartment* - While it can be affected, the **lateral compartment** bears less weight than the medial compartment in most individuals. - Therefore, **osteoarthritis** in the lateral compartment is less common as an initial presentation. *Patellofemoral compartment* - **Patellofemoral osteoarthritis** involves the joint between the kneecap and the thigh bone. - It often presents with pain related to **quadriceps activity** (e.g., stairs, squatting) and is a distinct pattern of involvement, less frequent than medial compartment OA overall. *Medial and lateral compartments* - While **osteoarthritis** can eventually affect multiple compartments, it typically begins in and is more prevalent in the **medial compartment**. - Simultaneous significant involvement of both compartments from the outset is less common than initial medial compartment disease.

Q: Deformity is most commonly seen in primary osteoarthritis of the knee joint -

Genu varus. ***Genu varus*** - **Genu varus** (bow-legged deformity) is the most common angular deformity seen in **primary osteoarthritis of the knee**, particularly due to greater wear in the medial compartment. - This deformity places increased stress on the medial compartment, exacerbating the progression of osteoarthritis in that region. *Genu valgum* - **Genu valgum** (knock-knee deformity) is less common in primary knee osteoarthritis compared to genu varus. - It typically results from greater involvement of the **lateral compartment** of the knee joint. *Genu recurvatum* - **Genu recurvatum** is characterized by hyperextension of the knee joint. - This deformity is often associated with ligamentous laxity or neuromuscular conditions, rather than being the primary or most common deformity in knee osteoarthritis. *Flexion contracture* - A **flexion contracture** refers to the inability to fully extend the knee, causing the knee to be perpetually bent. - While common in advanced knee osteoarthritis due to pain, muscle spasm, and joint space narrowing, it is a contracture, not an angular deformity like genu varus or valgus.

Q: A 68-year-old man presents with pain and swelling of the right knee. Investigations reveal Ahlbäck grade 2 osteoarthritic changes. What is the further management?

Conservative. ***Conservative care*** - **Ahlbäck grade 2** is considered mild to moderate **osteoarthritis**; therefore, initial management should focus on non-surgical interventions. - This includes **pain management** (NSAIDs, analgesics), **physiotherapy**, **weight loss**, and **activity modification**. *High tibial osteotomy* - This procedure is typically reserved for **younger patients** with **varus deformity** and **unicompartmental osteoarthritis** to realign the knee, which is not indicated in this case for a 68-year-old. - It aims to shift the weight-bearing axis away from the damaged compartment to an healthier area, often considered when **total knee replacement** is being delayed. *Total knee replacement* - This is a definitive surgical option for **severe, end-stage osteoarthritis** that has failed conservative management. - Given the patient's **Ahlbäck grade 2**, less invasive treatments should be tried first as this grade does not typically warrant immediate total knee replacement. *Arthroscopic washout* - While it can provide temporary relief of symptoms by removing debris, its **long-term efficacy** in managing **osteoarthritis** has been extensively debated and is generally not recommended as a primary treatment for knee osteoarthritis. - There is little evidence to suggest that it alters the progression of the disease or provides sustained pain relief in **mild to moderate osteoarthritis**.

Q: Osteoarthritis not seen in ?

Ankle joints. ***Ankle joints*** - While other joints are frequently affected by osteoarthritis, the **ankle joint** is *relatively spared* from primary osteoarthritis. - Osteoarthritis in the ankle is more commonly **secondary** to trauma, inflammation, or structural abnormalities rather than a primary degenerative process. *Knee joints* - The **knee joint** is one of the most frequently affected joints in osteoarthritis due to its weight-bearing function and complex biomechanics. - **Cartilage degeneration** in the knee leads to pain, stiffness, and reduced mobility. *Hip joints* - The **hip joint** is another common site for osteoarthritis, particularly in older adults, due to its significant weight-bearing role. - **Acetabular and femoral head cartilage erosion** causes deep groin pain and restricted range of motion. *1st metacarpophalangeal joint* - The **1st metacarpophalangeal (MCP) joint** of the thumb is a common site for osteoarthritis, especially in women. - This is due to the significant **stress and forces** placed on this joint during pinching and gripping activities.

Q: All of the following are the types of endemic Osteoarthritis except :

Mueller-Weiss disease. ***Mueller-Weiss disease*** - This is a rare **osteonecrosis** of the **navicular bone** in the foot, primarily affecting adults. - It is not classified as an endemic osteoarthritis but rather an **avascular necrosis** with unknown etiology. *Handigodu joint disease* - This is a form of **endemic osteoarthritis** found in specific regions of **South India** (Karnataka). - It is characterized by severe osteoarthritis affecting multiple joints, often associated with environmental factors. *Kashin-Beck's disease* - This is an **endemic osteochondropathy** primarily affecting **children and adolescents** in certain regions of China, Siberia, and North Korea, often linked to selenium deficiency. - It results in widespread **cartilage degeneration** and secondary osteoarthritis. *Mseleni joint disease* - This is an **endemic osteoarthritis** prevalent in the **Mseleni region of South Africa**. - It is characterized by progressive osteoarthritis of large joints and is linked to environmental toxins or nutritional deficiencies.

Q: A 40-year-old presents with chronic shoulder pain and restricted ROM. X-ray shows decreased joint space. Most likely diagnosis?

Osteoarthritis. ***Osteoarthritis*** - **Chronic shoulder pain** and **restricted range of motion (ROM)**, coupled with **decreased joint space** on X-ray, are classic signs of osteoarthritis. - This condition involves the **degeneration of articular cartilage**, leading to bone-on-bone friction and joint space narrowing. *Adhesive Capsulitis* - While it causes significant **restricted ROM** and pain, X-rays typically show a **normal joint space** in the early stages, as it primarily affects the joint capsule. - The primary pathology is **fibrosis and thickening of the joint capsule**, not cartilage loss. *Impingement Syndrome* - Characterized by pain, especially with overhead activities, due to the **compression of tendons** (often the rotator cuff) under the acromion. - X-rays usually do not show **decreased joint space** but may reveal spurs or acromial morphology predisposing to impingement. *Rotator Cuff Tear* - Causes pain and weakness, particularly during arm elevation or rotation, and can lead to restricted ROM due to pain or structural damage. - X-rays are typically **normal** or show secondary changes like **humeral head elevation** in chronic, massive tears, but not primary loss of joint space.

Q: Which of the following is the most common cause of secondary osteoarthritis?

Trauma. ***Trauma*** - **Prior joint injury** (macrotrauma) or repetitive microtrauma is a major risk factor for developing secondary osteoarthritis via post-traumatic arthritis. - Trauma directly damages articular cartilage and alters joint mechanics, accelerating degenerative changes. *Congenital dislocation* - While **developmental dysplasia of the hip** and other congenital joint abnormalities can lead to secondary osteoarthritis, these are less common causes overall compared to trauma. - The abnormal joint morphology and biomechanics lead to uneven stress distribution and accelerated wear. *Inflammatory arthritis* - Conditions like **rheumatoid arthritis** or **gout** can cause secondary osteoarthritis by damaging cartilage and bone through chronic inflammation. - However, the prevalence of these inflammatory conditions as the initiating factor for secondary OA is lower than that of trauma. *Infection* - **Septic arthritis** can destroy joint cartilage rapidly, leading to secondary osteoarthritis. - While a severe cause, its incidence as a predisposing factor for secondary OA is considerably less frequent than trauma-related injuries.

Q: Which condition can lead to the formation of loose bodies in the joint?

Osteoarthritis. ***Osteoarthritis*** - In **osteoarthritis**, the **degenerative process** of cartilage can lead to fragments breaking off and floating within the joint space, forming **loose bodies**. - These loose bodies, also known as **joint mice**, can cause mechanical symptoms like locking, clicking, or catching in the joint. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an **inflammatory autoimmune disease** primarily affecting the synovium. - While it can cause joint damage, it typically does not lead to the formation of cartilaginous or bony loose bodies. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints. - Its hallmark is new bone formation and fusion of vertebrae, not the formation of loose bodies within the joint. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease that can affect multiple organs, including joints. - While it can cause **non-erosive arthritis**, it does not typically result in the formation of loose bodies.

Q: Which of the following statements about osteoarthritis is false?

It is an inflammatory arthritis. ***It is an inflammatory arthritis*** - This statement is **false** because **osteoarthritis (OA)** is fundamentally a **degenerative joint disease**, not a primary inflammatory arthritis. - While it can have an inflammatory component, this is secondary to cartilage breakdown, and it does not share the systemic inflammatory features of conditions like rheumatoid arthritis. *Does not involve synovial joints* - This statement is false because **osteoarthritis** primarily affects **synovial joints**, such as the knees, hips, and hands. - It involves the progressive degeneration of articular cartilage within these synovial joints, leading to pain and dysfunction. *Progressive softening of the articular cartilage* - This statement is true, as **progressive softening of the articular cartilage** is a key pathological feature of **osteoarthritis**. - This softening precedes fibrillation and eventual loss of cartilage, leading to bone-on-bone contact and further joint damage. *Does not produce marginal osteophytes* - This statement is false because the formation of **marginal osteophytes** (bone spurs) is a hallmark feature of advanced **osteoarthritis**. - These bony outgrowths develop at the joint margins as the body attempts to repair or stabilize the damaged joint.

Question 1

Part of knee most commonly involved in osteoarthritis:

Accepted Answer

Medial compartment

Answer

Lateral compartment

Answer

Patellofemoral compartment

Answer

Medial and lateral compartments

Question 2

Deformity is most commonly seen in primary osteoarthritis of the knee joint -

Accepted Answer

Genu varus

Answer

Genu valgum

Answer

Genu recurvatum

Answer

Flexion contracture

Question 3

A 68-year-old man presents with pain and swelling of the right knee. Investigations reveal Ahlbäck grade 2 osteoarthritic changes. What is the further management?

Accepted Answer

Conservative

Answer

High tibial osteotomy

Answer

Total knee replacement

Answer

Arthroscopic washout

Question 4

Osteoarthritis not seen in ?

Accepted Answer

Ankle joints

Answer

Knee joints

Answer

Hip joints

Answer

1st metacarpophalangeal joint

Question 5

All of the following are the types of endemic Osteoarthritis except :

Accepted Answer

Mueller-Weiss disease

Answer

Handigodu joint disease

Answer

Kashin-Beck's disease

Answer

Mseleni joint disease

Question 6

A 70-year-old man has had a long-term "bowlegged" condition but recently his right knee has become warm, swollen, and tender. He reports no recent trauma and gets no relief with rest or Tylenol (paracetamol). He is otherwise in good health and takes no medication. X-rays show arthritis of the knee. Which would be the best treatment?

Accepted Answer

Use of a cane for ambulating, restriction of knee-bending activities, and implementation of muscle-strengthening exercises

Answer

Intra-articular steroid injection, bed rest, and analgesics

Answer

Bed rest, anti-inflammatory agents, analgesics, and a knee brace

Answer

Long-leg cast and crutches for 3 weeks, analgesics, and anti-inflammatory agents

Question 7

A 40-year-old presents with chronic shoulder pain and restricted ROM. X-ray shows decreased joint space. Most likely diagnosis?

Accepted Answer

Osteoarthritis

Answer

Adhesive Capsulitis

Answer

Impingement Syndrome

Answer

Rotator Cuff Tear

Question 8

Which of the following is the most common cause of secondary osteoarthritis?

Accepted Answer

Trauma

Answer

Congenital dislocation

Answer

Inflammatory arthritis

Answer

Infection

Question 9

Which condition can lead to the formation of loose bodies in the joint?

Accepted Answer

Osteoarthritis

Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Answer

Systemic lupus erythematosus

Question 10

Which of the following statements about osteoarthritis is false?

Accepted Answer

It is an inflammatory arthritis

Answer

Progressive softening of the articular cartilage

Answer

Does not involve synovial joints

Answer

Does not produce marginal osteophytes

Degenerative Disorders — MCQs

Degenerative Disorders — MCQs

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