Arthrology and Infections — MCQs

A 20 year old male presents with history of gradual onset pain and swelling in left knee since 6 months. Now since last 1 month patient has started limping while walking and also has flexion deformity of knee. Ultrasonography shows presence of synovial thickening. What is the most probable diagnosis?

Q219

Deformity of hip in stage of tubercular synovitis?

Q220

Most common joint involved in septic arthritis:

Arthrology and Infections Indian Medical PG Practice Questions and MCQs

Question 211: Which sign is commonly associated with spinal tuberculosis?

A. Kyphosis (Correct Answer)
B. Lhermitte's sign
C. Abscess formation
D. Reiter's syndrome

Explanation: ***Kyphosis*** - Often referred to as **Pott's deformity** or gibbus deformity, it is a hallmark sign of **spinal tuberculosis** resulting from vertebral collapse. - This **angular kyphosis** is caused by the destruction of the vertebral bodies, particularly in the thoracic spine. *Lhermitte's sign* - This sign is characterized by an **electric shock-like sensation** that radiates down the spine and into the limbs upon neck flexion. - It is most commonly associated with **multiple sclerosis** or other demyelinating diseases affecting the cervical spinal cord. *Abscess formation* - While **abscess formation** (e.g., psoas abscess, cold abscess) can occur in spinal tuberculosis, it is a complication rather than a direct sign of the structural collapse. - It signifies the localized accumulation of pus and necrotic debris, which can lead to other complications like **spinal cord compression**. *Reiter's syndrome* - Reiter's syndrome, now known as **reactive arthritis**, is a triad of arthritis, urethritis, and conjunctivitis. - It is typically triggered by a prior infection (e.g., gastrointestinal or genitourinary) and is **not directly associated with spinal tuberculosis**.

Question 212: A 28-year-old male with a history of trauma presents with a non-healing sinus on the tibia. An X-ray shows a sequestrum. What is the appropriate next step in management?

A. Systemic antibiotics
B. Local wound care
C. Sequestrectomy (Correct Answer)
D. Bone grafting

Explanation: ***Sequestrectomy*** - A **sequestrum** is a piece of dead bone that has become separated from the surrounding healthy bone during necrosis. In the context of **chronic osteomyelitis**, this dead bone acts as a nidus for infection that cannot be eradicated by antibiotics alone. - The presence of a **non-healing sinus** and a sequestrum on X-ray clearly indicates **chronic osteomyelitis**, which requires surgical removal of the infected dead bone (sequestrectomy) for resolution. *Systemic antibiotics* - While systemic antibiotics are crucial in treating acute osteomyelitis and as an adjunct in chronic cases, they are unlikely to cure an infection with a sequestered dead bone. - The **avascular nature of the sequestrum** prevents adequate penetration of antibiotics, making them ineffective as a sole therapy. *Local wound care* - Local wound care might help manage the non-healing sinus superficially but does not address the underlying **bone infection and dead bone**, which is the primary pathology. - This approach would only provide symptomatic relief without resolving the infectious process. *Bone grafting* - Bone grafting is typically performed after the infection has been completely eradicated and involves filling a bone defect. - Performing bone grafting while a **sequestrum and ongoing infection** are present would likely lead to graft failure and continued infection.

Question 213: Which infection often begins at the metaphysis of long bones due to its rich blood supply and vascular stasis?

A. Acute osteomyelitis (Correct Answer)
B. Septic arthritis
C. Subacute osteomyelitis
D. Garre's osteomyelitis

Explanation: ***Acute osteomyelitis*** - This condition frequently affects the **metaphysis of long bones** in children due to its **rich, slow-flowing blood supply** and terminal capillary loops, which predispose to bacterial seeding. - The unique **microvascular anatomy** of the metaphysis, specifically the lack of phagocytic lining cells in the venous sinusoids, facilitates bacterial growth once seeded. *Septic arthritis* - This infection generally involves the **joint space** and synovium, not primarily the bone metaphysis, although it can occur secondary to osteomyelitis in adjacent bones. - It does not typically originate from stasis in the metaphyseal blood supply but rather from direct inoculation, hematogenous spread to the synovium, or contiguous spread. *Subacute osteomyelitis* - While also an infection of the bone, **subacute osteomyelitis (Brodie's abscess)** classically presents with a less aggressive course and often has a walled-off lesion, which is distinct from the initial acute diffuse spread. - It represents a stage of infection that has been partially contained by the host immune response and is not typically the initial presentation of infection in the metaphysis. *Garre's osteomyelitis* - This is a rare form of **chronic osteomyelitis** characterized by **proliferative periostitis**, mainly affecting the jaws due to dental infections. - It is not primarily associated with an acute onset in the metaphysis of long bones or the typical vascular factors described.

Question 214: What is the most common presenting complaint of a patient with subacute osteomyelitis (Brodie's abscess)?

A. High fever
B. Localized pain (Correct Answer)
C. General malaise
D. Joint effusion

Explanation: ***Localized pain*** - **Localized pain** is the most common presenting complaint in patients with **Brodie's abscess**, as the infection is typically contained within the bone and progresses slowly. - This pain is often **milder and less acute** than in acute osteomyelitis, and may be present for weeks to months. *High fever* - **High fever** is more characteristic of **acute osteomyelitis**, which involves a more rapid and widespread inflammatory response. - In subacute osteomyelitis (Brodie's abscess), systemic symptoms like fever are often **absent or mild** because the infection is usually walled off. *General malaise* - **General malaise** is a non-specific symptom that can be associated with various illnesses, including acute infections. - While it might be present, it is **not the most common or specific** initial complaint for a localized, subacute infection like Brodie's abscess. *Joint effusion* - **Joint effusion** suggests an inflammatory process within a joint space, such as septic arthritis, rather than primarily an intramedullary bone lesion. - While osteomyelitis can sometimes extend to involve adjacent joints, it is **not the initial or most common presentation** for subacute osteomyelitis itself.

Question 215: Which classification is most appropriate for assessing chronic osteomyelitis?

A. Enneking classification
B. Gustilo-Anderson classification
C. Cierny-Mader classification (Correct Answer)
D. Weber classification

Explanation: ***Cierny-Mader classification*** - This system is specifically designed for staging **chronic osteomyelitis**, considering both the anatomical extent of the disease and the physiological status of the host. - It guides treatment decisions by categorizing disease types (medullary, superficial, localized, diffuse) and host types (A, B, C for comorbidities). *Enneking classification* - Primarily used for staging **musculoskeletal tumors**, particularly sarcomas. - It classifies tumors based on their grade, local extent (intracompartmental or extracompartmental), and presence of metastases. *Gustilo-Anderson classification* - This classification system is used to assess the severity of **open fractures**, categorizing them based on the soft tissue injury, wound size, and contamination. - It helps in guiding immediate management, including debridement and antibiotic prophylaxis, rather than long-term chronic infection. *Weber classification* - Primarily used for classifying **ankle fractures** based on the relationship of the fracture to the syndesmosis. - It helps determine the stability of the ankle joint and guides surgical management for acute traumatic injuries.

Question 216: A 25-year-old male presents with localized pain in the tibia and swelling. Imaging reveals a bone abscess. Identify the condition.

A. Brodie abscess (Correct Answer)
B. Osteoid osteoma
C. Intracortical hemangioma
D. Chondromyxoid fibroma

Explanation: ***Brodie abscess*** - A Brodie abscess is a **subacute or chronic osteomyelitis** characterized by a well-circumscribed, **radiolucent lesion** (an abscess cavity) often surrounded by a zone of **sclerosis**, representing the body's attempt to wall off the infection. - The presentation of localized pain and swelling in the tibia, with imaging revealing a bone abscess, is consistent with this condition, which is a common form of localized osteomyelitis. *Osteoid osteoma* - This is a **benign bone tumor** characterized by a small, radiolucent nidus surrounded by a large area of **sclerotic bone**. The pain from an osteoid osteoma is typically **worse at night** and dramatically relieved by NSAIDs. - While it can cause localized pain and swelling, the imaging features of a distinct abscess cavity are not characteristic of an osteoid osteoma. *Intracortical hemangioma* - An intracortical hemangioma is a **rare benign vascular lesion** within the cortex of a bone. - Imaging typically shows a **lytic lesion** with a characteristic **"honeycomb" or "sunburst" appearance**, not a well-defined abscess. *Chondromyxoid fibroma* - This is a rare, **benign cartilaginous tumor** that usually presents as an **eccentric lytic lesion** in the metaphysis of long bones, often with a scalloped border and sclerotic rim. - While it can cause localized pain and swelling, the imaging appearance of an abscess with sclerotic margins is not typical of a chondromyxoid fibroma.

Question 217: Which of the following conditions is most commonly associated with genu recurvatum?

A. Poliomyelitis
B. Rickets
C. Rheumatoid arthritis
D. Congenital recurvatum
E. Lax ligaments
F. Cerebral palsy (Correct Answer)

Explanation: ***Cerebral palsy*** - **Cerebral palsy** is frequently associated with **genu recurvatum** due to muscle imbalances, particularly spasticity of the quadriceps and weakness of the hamstrings or calf muscles. - The abnormal muscle tone and motor control can lead to hyperextension of the knee joint during gait. *Rheumatoid arthritis* - While rheumatoid arthritis can cause joint deformities, **genu recurvatum** is not a typical or most common presentation; it's more associated with flexion deformities or valgus/varus deformities. - Joint damage and inflammation in RA usually lead to **decreased range of motion** and stability rather than hyperextension. *Poliomyelitis* - Poliomyelitis can cause muscle weakness and paralysis, which might lead to altered gait and joint instability. - However, **genu recurvatum** is less commonly seen as the primary knee deformity compared to conditions involving spasticity or congenital factors. *Rickets* - Rickets primarily affects **bone mineralization**, leading to soft and weakened bones. - It commonly causes bowing of the legs (**genu varum**) or knock-knees (**genu valgum**), but not typically **genu recurvatum**. *Congenital recurvatum* - While **congenital recurvatum** can cause genu recurvatum, making it a direct cause, it refers to the condition itself, rather than an underlying disease or neurological disorder associated often with it. - Cases of isolated congenital recurvatum are less common than recurvatum seen secondary to broader neuromuscular conditions. *Lax ligaments* - **Lax ligaments** alone can contribute to joint instability and potentially **genu recurvatum**. - However, it's often a contributing factor or a consequence of underlying conditions, rather than being the single most common associated condition in a broad context.

Question 218: A 20 year old male presents with history of gradual onset pain and swelling in left knee since 6 months. Now since last 1 month patient has started limping while walking and also has flexion deformity of knee. Ultrasonography shows presence of synovial thickening. What is the most probable diagnosis?

A. Synovial sarcoma
B. Hemarthrosis
C. Tuberculosis of the knee (Correct Answer)
D. Pigmented villonodular synovitis

Explanation: ***Tuberculosis of the knee*** - **Gradual onset** of pain, swelling, and **flexion deformity** in the knee, especially in a young male, is highly suggestive of **tuberculosis arthritis**, which is an **insidious chronic monoarthritis**. - **Synovial thickening** on ultrasonography supports inflammation and chronic joint involvement consistent with granulomatous inflammation seen in TB. *Pigmented villonodular synovitis* - This condition is characterized by **hemosiderin deposition** within the synovium, causing painless or minimally painful swelling and recurrent effusions. - While it causes synovial thickening, **flexion deformity** and limping are not typical early features and pain is often less prominent than in TB. *Synovial sarcoma* - Synovial sarcoma is a rare, aggressive **malignant tumor** that can affect soft tissues around joints, leading to pain and swelling. - However, it typically presents as a **palpable soft tissue mass** rather than isolated synovial thickening, and limping with flexion deformity would be a late sign due to mass effect. *Hemarthrosis* - Hemarthrosis is the presence of **blood in the joint space**, usually due to trauma, coagulopathy, or a bleeding disorder. - While it can cause pain and swelling, it is typically of **acute onset** and not associated with gradual progression and chronic flexion deformity unless related to repeated traumatic events.

Question 219: Deformity of hip in stage of tubercular synovitis?

A. Flexion, abduction external rotation (Correct Answer)
B. Flexion, adduction internal rotation
C. Flexion, abduction, internal rotation
D. Flexion, adduction, external rotation

Explanation: ***Flexion, abduction external rotation*** - In the early **synovial stage** of hip tuberculosis, the joint capsule distends due to effusions and inflammation. - This distension pushes the femoral head into a position of maximal comfort, which is typically **flexion, abduction, and external rotation**. *Flexion, adduction internal rotation* - This position, often called the **'telescopic' or 'wandering acetabulum'** deformity, is characteristic of later stages of tubercular hip disease, particularly when bone destruction and subluxation occur. - It results from muscle spasm and destruction of the articular surfaces as the disease progresses, not the initial synovial stage. *Flexion, adduction, external rotation* - While flexion and external rotation might be present in some hip pathologies, **adduction** combined with external rotation is not the typical initial position for tubercular synovitis. - Adduction usually occurs in later, destructive stages due to muscle contractures or subluxation. *Flexion, abduction, internal rotation* - Although flexion and abduction are components of the correct answer, **internal rotation** is not typically observed in the early synovial stage of tubercular hip disease. - Internal rotation is more commonly associated with other hip conditions or specific muscle spasms not characteristic of early TB synovitis.

Question 220: Most common joint involved in septic arthritis:

A. Knee (Correct Answer)
B. Hip
C. Shoulder
D. Elbow

Explanation: ***Knee*** - The **knee joint** is the most commonly affected joint in **septic arthritis**, accounting for about 50% of cases in adults. - Its large size and frequent exposure to trauma contribute to its susceptibility to infection. *Hip* - The hip joint is the **second most common site** for septic arthritis in adults, especially in children and the elderly. - While significant, its incidence is lower than that of the knee. *Shoulder* - The shoulder can be affected by septic arthritis, particularly in individuals with **intravenous drug use** or those who are **immunocompromised**. - However, it is less frequently involved compared to the knee and hip. *Elbow* - Septic arthritis of the elbow is relatively **uncommon** compared to the larger weight-bearing joints. - It may be seen in cases of trauma or systemic infection, but it is not the most common site.

Practice by Chapter

Septic Arthritis

Practice Questions

Osteomyelitis

Practice Questions

Tuberculosis of Bones and Joints

Practice Questions

Fungal and Parasitic Infections

Practice Questions

Diabetic Foot Infections

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Prosthetic Joint Infections

Practice Questions

Reactive Arthritis

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Management of Joint Infections

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Prevention of Orthopaedic Infections

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Biofilms in Orthopaedic Infections

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Antibiotic Prophylaxis

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Implant-Related Infections

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