Arthrology and Infections — MCQs

Arthrology and Infections Indian Medical PG Practice Questions and MCQs

Question 231: What is the condition commonly referred to as 'draughtsman's elbow'?

A. Lateral epicondylitis
B. Medial epicondylitis
C. Medial epicondyle avulsion fracture
D. Olecranon bursitis (Correct Answer)

Explanation: ***Olecranon bursitis*** - This condition is colloquially known as **"draughtsman's elbow"**, **"student's elbow"**, or **"baker's elbow"** due to its association with prolonged leaning on the elbow. - It involves inflammation and swelling of the **olecranon bursa**, which is located at the posterior aspect of the elbow. *Lateral epicondylitis* - This condition is commonly known as **"tennis elbow"** and involves inflammation of the **extensor tendons** originating from the lateral epicondyle. - It typically presents with pain on the **lateral aspect of the elbow**, worsened by gripping and wrist extension. *Medial epicondylitis* - This condition is commonly known as **"golfer's elbow"** and involves inflammation of the **flexor-pronator tendons** originating from the medial epicondyle. - It causes pain on the **medial aspect of the elbow**, worsened by activities involving wrist flexion and pronation. *Medial epicondyle avulsion fracture* - This is a traumatic injury where a fragment of the **medial epicondyle** is pulled away from the humerus, often seen in overhead throwing athletes. - It usually involves acute pain, swelling, and sometimes **nerve dysfunction**, which differs significantly from the inflammatory process of olecranon bursitis.

Question 232: Garre's osteomyelitis commonly involves

A. Jaw (Correct Answer)
B. Femur
C. Ribs
D. Small bones of hand

Explanation: ***Jaw*** - **Garre's osteomyelitis**, also known as **proliferative periostitis**, most commonly affects the **mandible (jawbone)** in children and young adults. - It arises as a **periosteal reaction** to a low-grade chronic infection, typically originating from an odontogenic source. *Femur* - While osteomyelitis can affect the **femur**, this presentation typically does not lead to the classic **Garre's proliferative periostitis** characterized by significant bone apposition. - Osteomyelitis of the femur is often seen in long bones, but the **fibro-osseous proliferation** distinctive of Garre's is rare here. *Ribs* - **Osteomyelitis of the ribs** is possible but is not a common site for the specific manifestation of **Garre's osteomyelitis**. - Rib infections usually present differently and are often associated with other underlying conditions or trauma. *Small bones of hand* - **Osteomyelitis** can affect the small bones of the hand, but this is usually due to direct inoculation, puncture wounds, or spread from adjacent soft tissue infections. - The **proliferative periosteal reaction** characteristic of Garre's osteomyelitis is not typically observed in these bones.

Question 233: In which condition is chronic recurrent multifocal osteomyelitis primarily observed?

A. SAPHO syndrome (Correct Answer)
B. Werner's syndrome (associated with premature aging)
C. Waenberg's syndrome
D. None of the options

Explanation: **SAPHO syndrome** * **Chronic recurrent multifocal osteomyelitis (CRMO)** is a prominent feature of **SAPHO syndrome** (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis). * SAPHO syndrome is a **rare inflammatory disorder** characterized by bone and joint inflammation often accompanied by skin manifestations. * *Werner's syndrome (associated with premature aging)* * This syndrome is associated with **premature aging**, including features like short stature, bilateral cataracts, skin changes, and susceptibility to certain cancers. * It does **not primarily feature chronic recurrent multifocal osteomyelitis**. * *Waenberg's syndrome* * There is **no recognized medical condition** known as "Waenberg's syndrome." * This appears to be a **distractor option**. * *None of the options* * This option is incorrect because **SAPHO syndrome** is directly associated with chronic recurrent multifocal osteomyelitis.

Question 234: In the context of chronic bone infections, which condition is characterized by a chronic discharging sinus with necrotic bone?

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

Explanation: ***Chronic osteomyelitis*** - This condition is precisely defined by the presence of a **chronic discharging sinus**, often leading to the expulsion of **necrotic bone** (sequestrum) or pus. - It involves persistent infection of the bone, frequently resulting from inadequately treated acute osteomyelitis or open fractures. *Acute osteomyelitis* - Characterized by rapid onset of severe pain, fever, and local signs of inflammation, but typically **lacks a long-standing discharging sinus**. - If left untreated, it can progress to chronic osteomyelitis. *Subacute osteomyelitis* - This is a less aggressive, often indolent form of osteomyelitis that presents with localized pain and swelling, but usually **without a discharging sinus**. - It can be difficult to diagnose due to its milder symptoms and sometimes subtle radiographic findings. *Garre's osteomyelitis* - Also known as **osteitis sclerosing**, this is a rare, non-suppurative form of osteomyelitis characterized by **periosteal new bone formation** and cortical thickening. - It typically does not involve a discharging sinus or evident necrotic bone, but rather a proliferative response to a low-grade infection.

Question 235: A 18-year-old male presents with a draining sinus on his left leg, accompanied by pus discharge and the discharge of bony pieces, since 3 months. What is the diagnosis?

A. Chronic osteomyelitis (Correct Answer)
B. Ewing's Sarcoma
C. Osteoid Osteoma
D. Cellulitis

Explanation: ***Chronic osteomyelitis*** - A **draining sinus** with pus discharge and the extrusion of **bony pieces** (sequestra) is a classic presentation of chronic osteomyelitis. - The chronicity (3 months) and the presence of necrotic bone fragments confirm the diagnosis over acute infections or tumors. *Ewing's Sarcoma* - This is a highly malignant bone tumor that typically presents with **localized pain and swelling**, and sometimes a palpable mass. It does not typically present with a draining sinus or bony discharge. - While it can occur in adolescents, its presentation is more commonly characterized by rapid progression and systemic symptoms, rather than chronic drainage with sequestra. *Osteoid Osteoma* - This is a benign bone tumor characterized by **localized pain**, which is typically worse at night and relieved by NSAIDs. It does not lead to bone destruction severe enough to cause sinus tracts or discharge of bony pieces. - It usually presents as a small **nidus** within the bone that causes irritation, not an infective process with drainage. *Cellulitis* - This is a rapidly spreading bacterial infection of the **skin and subcutaneous tissue**, presenting with redness, warmth, swelling, and pain. It can cause pus discharge if an abscess forms, but it does not typically involve the discharge of bony pieces or persist as a chronic draining sinus from bone. - Cellulitis is a soft tissue infection and does not primarily involve bone unless it has progressed significantly, and even then, sequestra discharge is not typical.

Question 236: What is the most common sequela of tuberculous spondylitis in an adolescent?

A. Fibrous Ankylosis
B. Pathological dislocation
C. Chronic osteomyelitis
D. Bony ankylosis (Correct Answer)

Explanation: ***Bony ankylosis*** - **Bony ankylosis** is a frequent outcome in successfully treated tuberculous spondylitis, particularly in adolescents due to their growth potential and robust healing responses. - The inflammatory process and subsequent healing, including bone repair, can lead to the fusion of vertebral bodies as the body attempts to stabilize the affected spinal segment. *Fibrous Ankylosis* - While **fibrous ankylosis** can occur, it's typically an earlier or less complete form of healing compared to bony ankylosis in the context of tuberculosis, which often leads to more extensive bone destruction and repair. - In adolescents, where osteoblastic activity is high, the body often progresses to a more stable bony fusion rather than a fibrous one. *Pathological dislocation* - **Pathological dislocation** is a severe complication that can occur due to extensive bone destruction and vertebral collapse, but it is not the most common sequela after treatment, especially with modern management. - Dislocation implies a loss of alignment and potentially severe neurological deficits, which are rarer than the healing process itself leading to fusion. *Chronic osteomyelitis* - **Chronic osteomyelitis** refers to persistent infection and inflammation within the bone. While tuberculous spondylitis is a form of osteomyelitis, if successfully treated, the infection is resolved, and the sequelae are related to the healing process itself (like ankylosis), not ongoing infection. - The question asks for the most common *sequela* (consequence of the disease or its treatment), assuming the infection has been managed.

Question 237: What condition is characterized by pain and tenderness on the medial epicondyle due to overuse of wrist flexors?

A. Medial epicondylitis (Correct Answer)
B. Lateral epicondylitis
C. Posterior elbow dislocation
D. Lateral collateral ligament injury

Explanation: ***Medial epicondylitis*** - This condition involves inflammation and degeneration of the tendons originating from the **medial epicondyle**, primarily due to repetitive **wrist flexion** and pronation. - Patients typically experience **pain and tenderness** directly over the medial epicondyle, often exacerbated by gripping or wrist movements. *Lateral epicondylitis* - This condition affects the tendons originating from the **lateral epicondyle**, specifically the extensor muscle group, due to overuse of **wrist extensors**. - Pain and tenderness would be located on the **lateral aspect** of the elbow, not the medial side. *Posterior elbow dislocation* - This is a traumatic injury involving the displacement of the **ulna and radius posterior** to the humerus. - It presents with severe pain, obvious deformity, and inability to move the elbow, which is a very different clinical picture from chronic overuse pain. *Lateral collateral ligament injury* - This involves damage to the **ligament on the outside of the elbow**, often due to a varus stress injury. - Symptoms would include pain and instability on the **lateral side** of the elbow, particularly with varus stress testing, not medial epicondyle tenderness from overuse of wrist flexors.

Practice by Chapter

Septic Arthritis

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Osteomyelitis

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Tuberculosis of Bones and Joints

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Fungal and Parasitic Infections

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Diabetic Foot Infections

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Prosthetic Joint Infections

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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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