Temporomandibular Joint Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Temporomandibular Joint Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Temporomandibular Joint Disorders Indian Medical PG Question 1: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Temporomandibular Joint Disorders Explanation: ***Arthroplasty***
- **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement.
- It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage.
*Arthrodesis*
- **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint.
- While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients.
*Mc Murray's osteotomy*
- **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint.
- It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis.
*Intra-articular hydrocortisone and physiotherapy*
- **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function.
- These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Temporomandibular Joint Disorders Indian Medical PG Question 2: At the temporomandibular joint (TMJ), two joints work synchronously, and hence, are known as:
- A. Ginglymoid joint.
- B. Biarthrodial joint.
- C. Compound joint. (Correct Answer)
- D. Synovial joint.
Temporomandibular Joint Disorders Explanation: ***Compound joint***
- A compound joint is defined by the presence of **more than two articulating bones** or the involvement of an **intervening disc**, like the temporomandibular joint, which involves the temporal bone, mandible, and an articular disc.
- The TMJ operates as a compound joint because the **articular disc divides the joint cavity** into two separate compartments, allowing for both hinge-like and gliding movements.
*Ginglymoid joint*
- A ginglymoid joint, or **hinge joint**, primarily allows for movement in **one plane**, such as flexion and extension.
- While the TMJ has a hinge-like component in its lower compartment, its overall function is more complex and involves multiple planes of movement.
*Biarthrodial joint*
- This term is not a standard anatomical classification for joints; the TMJ is often described as a **ginglymoarthrodial joint**, combining hinge and gliding actions.
- The term "biarthrodial" does not accurately capture the specific structural and functional characteristics of the TMJ.
*Synovial joint*
- A synovial joint is a broad category of joints characterized by a **synovial cavity**, articular cartilage, and a joint capsule.
- While the TMJ is indeed a synovial joint, this classification is too general and does not specifically describe its unique compound nature with an articular disc.
Temporomandibular Joint Disorders Indian Medical PG Question 3: Which of the following is NOT a feature of Moebius syndrome?
- A. Bilateral facial paralysis
- B. Impaired lateral eye movement
- C. Unilateral or bilateral abducens nerve involvement
- D. Decreased chest movements (Correct Answer)
Temporomandibular Joint Disorders Explanation: ***Decreased chest movements***
- **Decreased chest movements** are not a characteristic feature of **Moebius syndrome**, which primarily affects cranial nerves, particularly the **facial and abducens nerves**.
- While other systemic issues can coexist, respiratory problems like decreased chest movements are not considered a direct or defining symptom of this condition.
*Bilateral facial paralysis*
- **Bilateral facial paralysis** is a hallmark of **Moebius syndrome**, resulting from congenital underdevelopment or absence of the **facial (VII) cranial nerves**.
- This leads to a characteristic **mask-like facial expression**, difficulty with smiling, frowning, and other facial movements.
*Impaired lateral eye movement*
- **Impaired lateral eye movement** is a common feature due to involvement of the **abducens (VI) cranial nerves**, which control the **lateral rectus muscle**.
- Patients often present with **esotropia** (crossed eyes) and are unable to move their eyes past the midline when looking to the side.
*Unilateral or bilateral abducens nerve involvement*
- **Unilateral or bilateral abducens (VI) nerve involvement** is a core diagnostic criterion for **Moebius syndrome**.
- This leads to the characteristic deficit in **lateral gaze**, as the abducens nerve innervates the **lateral rectus muscle**.
Temporomandibular Joint Disorders Indian Medical PG Question 4: Which of the following is the most commonly used extraoral orthodontic appliance:
- A. Face mask.
- B. Head gear. (Correct Answer)
- C. None.
- D. Chin cup.
Temporomandibular Joint Disorders Explanation: **Head gear.**
* **Headgear** is a widely recognized and utilized **extraoral orthodontic appliance** in dental practice due to its versatility in controlling maxillary growth, especially in patients with Class II malocclusion.
* It consists of an **outer bow** (facebow) and an **inner bow**, connected to bands on the molars, which exerts orthopedic force on the maxilla and teeth.
*Face mask.*
* A **face mask** (or protraction headgear) is primarily used for **Class III malocclusions** to encourage maxillary protraction and inhibit mandibular growth.
* While an important extraoral appliance, its usage is less common than headgear, as Class III skeletal patterns are less prevalent than Class II.
*None.*
* This option is incorrect because there are several commonly used extraoral orthodontic appliances, with **headgear** being a prime example.
*Chin cup.*
* A **chin cup** is an extraoral appliance used specifically for the orthopedic management of developing **Class III malocclusions** by restraining mandibular growth.
* Its primary application is to redirect the growth of the mandible downward and backward, but it is less frequently prescribed compared to headgear for Class II correction.
Temporomandibular Joint Disorders Indian Medical PG Question 5: A patient reports to the dentist with symptoms of joint involvement, obscure pain and discomfort, and clicking sounds. The patient is a complete denture wearer. The denture should be checked for:
- A. Very large denture base coverage (over-extended denture)
- B. Improper centric relation
- C. Reduced vertical dimension
- D. Increased vertical dimension (Correct Answer)
Temporomandibular Joint Disorders Explanation: ***Increased vertical dimension***
- An **increased vertical dimension** (VDO) can lead to excessive occlusal force on the temporomandibular joint (TMJ) and surrounding structures, causing **pain, discomfort, and clicking sounds**.
- This occlusal discrepancy forces the condyles into an abnormal position, stressing the joint and muscles, which can manifest as **joint involvement and obscure pain**.
*Very large denture base coverage (over-extended denture)*
- An **over-extended denture base** often causes **sore spots and irritation** on the mucosa, leading to discomfort and problems with retention due to muscle impingement.
- While it causes discomfort, it is less likely to be the primary cause of chronic TMJ pain and **clicking sounds** directly, as these are more related to occlusal or joint biomechanics.
*Improper centric relation*
- An **improper centric relation (CR)**, where the dentures are not occluding in the jaw's most retruded and superior position, can lead to occlusal instability.
- This primarily results in **denture instability, discomfort, and potential damage** to the supporting tissues, but clicking sounds are more typically associated with VDO issues or direct TMJ derangement.
*Reduced vertical dimension*
- A **reduced vertical dimension** can cause a prognathic appearance, "sunken-in" facial features, and **lips that look thin**.
- It also increases the interocclusal space, leading to **chewing inefficiency** and sometimes discomfort, but it is less likely to cause TMJ clicking sounds.
Temporomandibular Joint Disorders Indian Medical PG Question 6: Voluntary retrusion of the mandible in a closed mouth is done by which muscles?
- A. Anterior belly of digastric
- B. Posterior belly of digastric
- C. Deep fibers of masseter
- D. Posterior fibers of temporalis (Correct Answer)
Temporomandibular Joint Disorders Explanation: The original text does not contain any relevant citations from the provided reference set to include.
***Posterior fibers of temporalis***
- The posterior fibers of the **temporalis muscle** are primarily responsible for **retrusion of the mandible**, pulling it backward.
- This action is particularly effective when the mouth is closed, as the muscle's pull retracts the condyle into the glenoid fossa.
*Anterior belly of digastric*
- The anterior belly of the **digastric muscle** is mainly involved in **depressing the mandible** (opening the mouth) and elevating the hyoid bone.
- It does not directly contribute to the retrusion of the mandible.
*Posterior belly of digastric*
- The posterior belly of the **digastric muscle** functions to **elevate the hyoid bone** and assist in depressing the mandible when the hyoid is fixed.
- It does not play a direct role in retracting the mandible.
*Deep fibers of masseter*
- The **masseter muscle**, including its deep fibers, is a powerful muscle of **mastication** primarily responsible for **elevating the mandible** (closing the mouth).
- It also contributes to protraction and only minimally to retrusion, not as a primary mover.
Temporomandibular Joint Disorders Indian Medical PG Question 7: The most frequent direction in which the articular disc gets displaced is:
- A. Anterior and lateral direction
- B. Posterior and lateral direction
- C. Posterior and medial direction
- D. Anterior and medial direction (Correct Answer)
Temporomandibular Joint Disorders Explanation: ***Anterior and medial direction***
- The **articular disc** is most frequently displaced in the **anterior and medial direction** due to sustained clenching/bruxism which leads to hyperactivity of the superior lateral pterygoid muscle.
- This displacement leads to various **internal derangements** of the **temporomandibular joint (TMJ)**, often characterized by clicking, popping, or pain during jaw movement.
*Anterior and lateral direction*
- While anterior displacement is common, the **lateral component** is less frequent combined with anterior displacement because the **medial pole of the condyle** is more vulnerable to displacement.
- The morphology of the glenoid fossa and the attachments of the collateral ligaments usually prevent significant lateral displacement of the disc.
*Posterior and lateral direction*
- **Posterior disc displacement** is very rare because the **retrodiscal tissue** is highly vascularized and innervated, making posterior displacement extremely painful and mechanically difficult.
- The combination with lateral deviation is also atypical given the predominant forces acting on the disc.
*Posterior and medial direction*
- Similar to other posterior displacements, **posterior and medial displacement** is uncommon due to the anatomical constraints and the protective function of the **retrodiscal tissue**.
- No primary force or muscle activity typically drives the disc in this particular direction.
Temporomandibular Joint Disorders Indian Medical PG Question 8: Following are the TM joint ligaments except -
- A. Temporomandibular
- B. Sphenomandibular
- C. Tympanomandibular (Correct Answer)
- D. Stylomandibular
Temporomandibular Joint Disorders Explanation: ***Tympanomandibular***
- The **tympanomandibular ligament** is not a formally recognized ligament associated with the temporomandibular joint (TMJ).
- This term may be a misspelling or a non-existent anatomical structure when discussing TMJ ligaments.
*Temporomandibular*
- The **temporomandibular (or lateral) ligament** is a primary intrinsic ligament of the TMJ, composed of an outer oblique and an inner horizontal portion.
- It plays a crucial role in preventing excessive posterior and inferior movement of the mandible, thereby protecting the retrodiscal tissues.
*Sphenomandibular*
- The **sphenomandibular ligament** is an accessory ligament of the TMJ, originating from the spine of the sphenoid bone and inserting into the lingula of the mandible.
- It acts as a passive support, limiting excessive opening of the mouth.
*Stylomandibular*
- The **stylomandibular ligament** is another accessory ligament of the TMJ, running from the styloid process to the angle and posterior border of the ramus of the mandible.
- It helps to limit excessive protrusion and lateral movements of the mandible.
Temporomandibular Joint Disorders Indian Medical PG Question 9: A swelling behind the ear suggests fracture of:
- A. Zygomatic complex
- B. Temporal bone
- C. Condylar fracture (Correct Answer)
- D. Orbital floor fracture
Temporomandibular Joint Disorders Explanation: ***Condylar fracture***
- A swelling behind the ear (known as the **Battle sign** if associated with ecchymosis) is a classic indicator of a **basilar skull fracture**, which often involves the temporal bone but can also be seen with severe condylar fractures affecting the base of the skull or mastoid area.
- While a direct condylar fracture itself doesn't cause swelling *behind* the ear, **indirect condylar fractures** or those with significant associated trauma could compromise nearby structures leading to such a presentation.
*Zygomatic complex*
- Fractures of the **zygomatic complex** typically cause swelling, ecchymosis, and pain around the **cheekbone** and orbit, not specifically behind the ear.
- These fractures can also lead to limited jaw movement due to impingement on the coronoid process, or orbital symptoms like **diplopia**.
*Temporal bone*
- A **temporal bone fracture** can indeed cause swelling and ecchymosis behind the ear (**Battle sign**).
- However, direct temporal bone fractures are more commonly associated with **otorrhea**, **hemotympanum**, facial nerve palsy, or hearing loss.
*Orbital floor fracture*
- **Orbital floor fractures** are characterized by periorbital swelling, ecchymosis, **diplopia** (especially on upward gaze), and sometimes **enophthalmos** (sunken eye).
- These signs are localized to the **eye region** and do not typically involve swelling behind the ear.
Temporomandibular Joint Disorders Indian Medical PG Question 10: Which of the following is not a ball and socket type of joint?
- A. Incudostapedeal joint
- B. Talocalcaneonavicular joint
- C. Calcaneocuboid joint (Correct Answer)
- D. Shoulder joint
Temporomandibular Joint Disorders Explanation: ***Calcaneocuboid joint***
- The calcaneocuboid joint is a **saddle joint** (or modified plane joint), which allows for movement primarily in gliding motions, but not the multi-axial movement characteristic of a ball-and-socket joint.
- Its structure, specifically the **reciprocally saddle-shaped articular surfaces** of the calcaneus and cuboid bones, limits its range of motion to primarily inversion and eversion during foot movements.
*Talocalcaneonavicular joint*
- This joint functions as a **modified ball-and-socket joint**, allowing for complex movements like pronation and supination of the foot.
- It involves the head of the talus acting as the 'ball' articulating with the navicular anteriorly and the sustentaculum tali of the calcaneus posteriorly, forming a socket.
- This unique configuration allows for multi-axial movement essential for foot adaptation to terrain.
*Incudostapedial joint*
- This is a **synovial saddle-type joint** (not a ball-and-socket joint) found in the middle ear, connecting the lenticular process of the incus and the head of the stapes.
- It allows for limited rocking motion to efficiently transmit sound vibrations through the ossicular chain.
- The joint permits only small amplitude movements necessary for auditory function, not the multi-axial freedom of a ball-and-socket joint.
*Shoulder joint*
- The shoulder joint, also known as the **glenohumeral joint**, is a classic example of a **ball-and-socket joint**, offering the widest range of motion in the human body.
- The **head of the humerus** (ball) articulates with the **glenoid fossa** of the scapula (socket), allowing for flexion, extension, abduction, adduction, rotation, and circumduction.
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