Arthrology and Infections Practice Questions

Q: Gradual painful limitation of shoulder movements in an elderly suggest that the most probable diagnosis is:

Periarthritis. ***Periarthritis*** - This term encompasses conditions like **adhesive capsulitis (frozen shoulder)**, which commonly presents as gradual, painful limitation of shoulder movement, particularly in the elderly. - It involves **inflammation and thickening of the joint capsule**, leading to stiffness and pain with both active and passive range of motion. *Myositis ossificans* - This condition involves the **formation of bone in muscle tissue** after trauma, presenting as a firm, tender mass. - It does not primarily cause gradual, painful limitation of joint movement in the way described for the shoulder. *Osteoarthritis* - While common in the elderly, **osteoarthritis** primarily affects articular cartilage, leading to pain and stiffness that is often worse with activity and relieved by rest. - It typically affects weight-bearing joints or those with repetitive stress, and while it can affect the shoulder, the description of "gradual painful limitation of movement" is more characteristic of periarthritis/frozen shoulder. *Arthritis* - This is a **general term for joint inflammation** and does not specify the particular cause or presentation. - While periarthritis is a type of arthritis (inflammation of tissues around a joint), "arthritis" alone is too broad to be the most probable specific diagnosis for this clinical picture.

Q: Recurrent dislocation is least common in

Knee. ***Knee*** - While knee dislocations are **severe injuries**, they are relatively **rare** in terms of recurrent dislocation compared to other joints listed. - The knee joint's strong ligamentous support and bony configuration make primary dislocation difficult, and recurrent dislocation usually implies significant underlying pathology or trauma. *Patella* - **Patellar dislocation** is quite common, especially in young active individuals, and has a high rate of recurrence due to factors like **patella alta** or **trochlear dysplasia**. - The **medial patellofemoral ligament (MPFL)** plays a crucial role in patellar stability, and its injury often leads to recurrent episodes. *Shoulder* - The **shoulder joint** is the **most commonly dislocated major joint** in the body, largely due to its wide range of motion and relatively shallow glenoid fossa. - Recurrent shoulder dislocations are frequent, particularly in younger patients, often necessitating surgical stabilization to prevent further episodes and progression to **osteoarthritis**. *Hip* - **Hip dislocations** are typically high-energy injuries and are generally **less common** than shoulder or patellar dislocations. - However, once a hip has dislocated, there is an increased risk of **recurrent instability**, especially in cases with associated labral tears or bony defects, though the absolute frequency remains lower than for the shoulder or patella.

Q: Menisci calcification is seen with

Pseudogout. ***Pseudogout*** - **Pseudogout**, also known as calcium pyrophosphate deposition (CPPD) disease, characteristically involves the deposition of **calcium pyrophosphate crystals** in articular cartilage, leading to its calcification, including the menisci. - This calcification, visible on X-ray, is known as **chondrocalcinosis** and is a hallmark of pseudogout. *Hypothyroidism* - While hypothyroidism can cause various musculoskeletal symptoms, it is not typically associated with **meniscal calcification** or chondrocalcinosis. - It more commonly presents with **arthralgia**, myalgia, and effusions due to metabolic imbalances. *Gout* - **Gout** is caused by the deposition of **monosodium urate crystals** in joints, leading to inflammation and pain, often in the big toe. - It does not cause **meniscal calcification** or chondrocalcinosis; instead, it can cause erosions and tophi but not calcified cartilage. *Hyperparathyroidism* - **Hyperparathyroidism** causes increased bone turnover and **hypercalcemia**, which can lead to various bone and joint problems. - While it can be associated with soft tissue calcifications and is a risk factor for **CPPD** (pseudogout), directly causing menisci calcification is not its primary or characteristic feature.

Q: Tardy ulnar neuritis may be due to

Cubitus valgus deformity. ***Cubitus valgus deformity*** - A cubitus valgus deformity increases the carrying angle of the elbow, which places abnormal **tensile stress** on the **ulnar nerve** behind the medial epicondyle. - This chronic stretching and pressure can lead to delayed onset (tardy) neuropathy, presenting as ulnar neuritis. *Advanced osteoarthritis of elbow* - While osteoarthritis can affect the elbow, it primarily involves the **articular cartilage** and bony changes within the joint, not typically directly compressing or stretching the ulnar nerve in a chronic, "tardy" fashion unless severe osteophytes directly impinge it. - The direct link to stretching and chronic irritation of the ulnar nerve as a primary cause of **tardy ulnar neuritis** is more strongly associated with structural deformities like cubitus valgus. *Both of the options* - While severe osteoarthritis could theoretically contribute to ulnar nerve compression through osteophyte formation, **cubitus valgus deformity** is a much more classic and direct cause of **tardy ulnar neuritis** due to the chronic mechanical stretch it places on the nerve. - This option is incorrect because cubitus valgus is the primary and most common long-term cause of tardy ulnar neuritis, making the inclusion of advanced osteoarthritis as equally causative less accurate in this context without further specifying direct nerve involvement. *None of the options* - This option is incorrect because **cubitus valgus deformity** is a recognized and common cause of tardy ulnar neuritis. - The valgus angulation creates a sustained tension and potential irritation of the ulnar nerve, leading to delayed onset symptoms.

Q: Circumduction test is used for:

Posterior shoulder instability. ***Posterior shoulder instability*** - The **circumduction test** involves circumducting the arm while applying a **posteriorly directed force** to the humeral head. - A positive test, indicated by a **clunk** or patient apprehension, suggests **posterior glenohumeral instability**. *Inferior shoulder instability* - Inferior instability is often tested using the **sulcus sign**, which assesses for a gap between the acromion and the humeral head when traction is applied. - The circumduction test primarily focuses on posterior translation, not inferior laxity. *Anterior shoulder instability* - **Anterior instability** is typically evaluated by tests like the **apprehension test** or **relocation test**, where the arm is abducted and externally rotated. - These tests provoke a sense of apprehension or pain in patients with anterior instability, which differs from the mechanism of the circumduction test. *Either of above* - Each type of shoulder instability (anterior, posterior, inferior) has specific physical examination maneuvers designed to identify it. - The circumduction test has a particular diagnostic utility for **posterior instability** and is not broadly applicable to all forms of instability.

Q: 12 years male came with swelling of lower end tibia which is surrounded by rim of reactive bone. What is most likely diagnosis?

Brodie's Abscess. ***Brodie's Abscess*** - A **Brodie's abscess** is a subacute or chronic osteomyelitis characterized by a localized bone abscess, typically with a surrounding **sclerotic rim of reactive bone**. - It often occurs in the **metaphysis of long bones** (like the lower end of the tibia) in children and adolescents, presenting with localized pain and swelling. *GCT* - **Giant cell tumor (GCT)** typically occurs in **skeletally mature adults** (20-40 years old) and is a lytic lesion often found in the **epiphysis** of long bones, rarely with a distinct sclerotic rim. - GCTs are generally more aggressive and demonstrate a **soap-bubble appearance** with cortical expansion rather than a thick reactive bone rim. *Hyper PTH* - **Hyperparathyroidism** causes bone changes such as **osteopenia**, **subperiosteal bone resorption**, especially in the phalanges, and **brown tumors** (lytic lesions). - It does not typically present as a localized lesion with a **sclerotic rim of reactive bone** in a child. *Osteomyelitis* - While chronic osteomyelitis can involve local bone destruction and reactive bone formation, a **Brodie's abscess** is a specific, well-circumscribed form of **subacute osteomyelitis**. - Acute osteomyelitis presents with more diffuse systemic symptoms (fever, malaise) and less defined reactive bone in its early stages compared to the distinct **sclerotic rim** seen in a Brodie's abscess.

Q: A 25-year-old male presents with chronic leg pain and a draining sinus. What is the most likely diagnosis?

Chronic osteomyelitis. ***Chronic osteomyelitis*** - **Chronic leg pain** combined with a **draining sinus** is highly suggestive of chronic osteomyelitis, indicating persistent bone infection with a tract to the skin. - The draining sinus allows for the discharge of pus and necrotic debris from the infected bone, a classic sign of this condition. *Ewing's sarcoma* - While it can present with bone pain and swelling, a **draining sinus** is not a typical feature of Ewing's sarcoma. - This tumor is often characterized by a rapidly growing mass and systemic symptoms like fever, which are not mentioned. *Osteosarcoma* - This malignant bone tumor typically presents with localized **bone pain and swelling**, often around the knee. - A **draining sinus** is not a hallmark characteristic of osteosarcoma; it is more associated with infection than primary bone malignancy. *Cellulitis* - **Cellulitis** is a superficial soft tissue infection that causes redness, warmth, and tenderness of the skin. - It does not involve the bone and therefore would not present with **chronic bone pain** or a **draining sinus from bone**.

Q: What clinical finding is critical for identifying chronic osteomyelitis after sequestrectomy?

Rim sign. ***Rim sign*** - The **rim sign** refers to the presence of a persistent radiolucent 'halo' or rim around the bone post-sequestrectomy, indicating **residual infection** or a cavity that has not obliterated, which is characteristic of ongoing chronic osteomyelitis. - This finding suggests that despite the removal of the necrotic bone (sequestrum), the infection has not been fully eradicated, necessitating further intervention. *Paprika sign* - The **paprika sign** is a diffuse, speckled pattern of increased uptake seen on bone scintigraphy, often associated with **reflex sympathetic dystrophy** or **complex regional pain syndrome**, not chronic osteomyelitis. - It reflects increased peripheral blood flow and bone turnover in the affected limb, a different pathological process from bacterial infection. *Codman's triangle* - **Codman's triangle** is an elevated periosteal reaction seen on radiographs, typically associated with **aggressive bone lesions** such as osteosarcoma or Ewing's sarcoma, or sometimes with rapidly progressing infections. - While it indicates periosteal new bone formation, it is not a direct sign of chronic osteomyelitis itself, nor is it specific to post-sequestrectomy findings. *Sunburst appearance* - The **sunburst appearance** is a classic radiographic finding characterized by radiating spicules of new bone formation perpendicular to the bone cortex, almost exclusively seen in **osteosarcoma**. - This pattern is indicative of a highly aggressive bone tumor and has no relevance to the diagnosis or persistence of chronic osteomyelitis.

Q: In chronic osteomyelitis, which complication may result in a non-healing sinus?

Sequestrum (dead bone fragment). ***Sequestrum (dead bone fragment)*** - A **sequestrum** is a piece of dead, necrotic bone that has separated from the healthy bone within an infected area. - This **foreign body-like presence** acts as a persistent nidus for infection, preventing complete healing and often leading to a chronic draining sinus. *Cloaca (drainage opening in bone)* - A **cloaca** is an opening in the involucrum, formed by the body to allow the discharge of pus and necrotic debris from the infected bone. - While a cloaca is a *pathway* for drainage, it is the underlying **sequestrum** that necessitates the persistent drainage and prevents healing. *Brodie's abscess (localized bone infection)* - A **Brodie's abscess** is a subacute or chronic localized osteomyelitis, typically presenting as a sterile abscess with granulation tissue. - While it is a chronic bone infection, it is usually contained and less likely to form a persistently draining sinus, especially compared to the generalized necrosis associated with a sequestrum. *Involucrum (bone surrounding necrosis)* - The **involucrum** is a collar of new bone growth that forms around the infected or necrotic bone (sequestrum) in chronic osteomyelitis. - Its formation is a reparative response, but it often encases the sequestrum, **walling off the infection** and preventing effective antibiotic penetration or surgical debridement, thereby contributing to chronicity, but it is not the direct cause of the non-healing sinus.

Question 1

A 40-year-old female patient presented to the OPD with joint pain in the wrist, MCP, PIP and DIP joints B/L. The involved joints were tender and swollen. Patient also gave a history of certain skin lesions which occurred before the joints were involved along with certain nail changes were also seen. Lab findings revealed HLA-B27 positivity. Which of the following x-ray findings most commonly correlates with the above condition?

Accepted Answer

Option A shows pencil in cup deformity- seen in psoriatic arthritis

Answer

Option B shows Z-deformity - seen in RA

Answer

Option C shows spade phalanx - seen in acromegaly

Answer

All of the options are seen.

Question 2

Gradual painful limitation of shoulder movements in an elderly suggest that the most probable diagnosis is:

Accepted Answer

Periarthritis

Answer

Myositis ossificans

Answer

Osteoarthritis

Answer

Arthritis

Question 3

Recurrent dislocation is least common in

Accepted Answer

Knee

Answer

Patella

Answer

Shoulder

Answer

Hip

Question 4

Menisci calcification is seen with

Accepted Answer

Pseudogout

Answer

Hypothyroidism

Answer

Gout

Answer

Hyperparathyroidism

Question 5

Tardy ulnar neuritis may be due to

Accepted Answer

Cubitus valgus deformity

Answer

Advanced osteoarthritis of elbow

Answer

Both of the options

Answer

None of the options

Question 6

Circumduction test is used for:

Accepted Answer

Posterior shoulder instability

Answer

Inferior shoulder instability

Answer

Anterior shoulder instability

Answer

Either of above

Question 7

12 years male came with swelling of lower end tibia which is surrounded by rim of reactive bone. What is most likely diagnosis?

Accepted Answer

Brodie's Abscess

Answer

GCT

Answer

Hyper PTH

Answer

Osteomyelitis

Question 8

A 25-year-old male presents with chronic leg pain and a draining sinus. What is the most likely diagnosis?

Accepted Answer

Chronic osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteosarcoma

Answer

Cellulitis

Question 9

What clinical finding is critical for identifying chronic osteomyelitis after sequestrectomy?

Accepted Answer

Rim sign

Answer

Codman's triangle

Answer

Sunburst appearance

Answer

Paprika sign

Question 10

In chronic osteomyelitis, which complication may result in a non-healing sinus?

Accepted Answer

Sequestrum (dead bone fragment)

Answer

Brodie's abscess (localized bone infection)

Answer

Cloaca (drainage opening in bone)

Answer

Involucrum (bone surrounding necrosis)

Arthrology and Infections — MCQs

Arthrology and Infections — MCQs

On this page

Practice by Chapter

Want unlimited practice?