Arthroscopy — MCQs
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The joint cavity can be examined in detail with minimal surgical exposure by which procedure?
Triple deformity of the knee is present in which condition?
Boutonniere deformity involves which of the following joint alterations?
Which of the following is a characteristic feature of osteoarthritis?
In which of the following conditions is the proximal interphalangeal joint involved while the distal interphalangeal joint is spared?
Involvement of the joints of the hand is relatively uncommon in which of the following types of arthritis?
Which of the following structures are not normally visualized during arthroscopy of the knee?
Psoriatic arthritis classically involves which joint?
Arthritis mutilans is seen in which condition?
What is the typical position of the lower limb in a post-polio deformity of the hip?
Arthroscopy Indian Medical PG Practice Questions and MCQs
Question 1: The joint cavity can be examined in detail with minimal surgical exposure by which procedure?
- A. Sialography
- B. Arthroscopy (Correct Answer)
- C. Biopsy
- D. Endoscopy
Explanation: **Explanation:** **Arthroscopy** is the correct answer because it is a minimally invasive surgical procedure used to visualize, diagnose, and treat problems inside a joint. It involves inserting a fiber-optic camera (arthroscope) through a small "portal" or stab incision. This allows for a detailed examination of the joint cavity (articular cartilage, ligaments, and synovium) with significantly less morbidity, faster recovery, and minimal surgical exposure compared to traditional open arthrotomy. **Analysis of Incorrect Options:** * **Sialography (A):** This is a radiographic examination of the salivary glands and ducts using a contrast medium. It is unrelated to joint pathology. * **Biopsy (C):** While a biopsy can be performed *during* an arthroscopy, the term refers to the removal of tissue for histological examination. It is a diagnostic technique, not a procedure designed for the comprehensive visualization of a joint cavity. * **Endoscopy (D):** This is a broad umbrella term for looking inside the body using an endoscope. While arthroscopy is technically a type of endoscopy, "Arthroscopy" is the specific and most appropriate clinical term for joint visualization. **High-Yield Clinical Pearls for NEET-PG:** * **Triangulation:** The fundamental skill in arthroscopy where the scope and the surgical instrument meet at a specific point within the joint to perform a task. * **Distension Media:** Normal saline or Ringer’s Lactate is used to expand the joint space for better visualization. * **Common Sites:** The **knee** is the most common joint examined via arthroscopy, followed by the shoulder and ankle. * **Complications:** Although rare, the most common complication of arthroscopy is **hemarthrosis** (bleeding into the joint).
Question 2: Triple deformity of the knee is present in which condition?
- A. Tuberculosis of the knee (Correct Answer)
- B. Pyogenic arthritis of the knee
- C. Osteoarthritis of the knee
- D. None of the above
Explanation: **Explanation:** The **Triple Deformity of the Knee** is a classic clinical feature of advanced **Tuberculosis (TB) of the knee joint**. It occurs due to the progressive destruction of the joint surfaces and the weakening of the cruciate and collateral ligaments, combined with the powerful pull of the hamstring muscles. The "Triple Deformity" consists of: 1. **Flexion:** Due to the spasm and contracture of the hamstrings. 2. **Posterior Subluxation of the Tibia:** The ACL and PCL are destroyed, allowing the tibia to slip backward on the femur. 3. **External Rotation of the Tibia:** The biceps femoris pulls the tibia laterally. **Why other options are incorrect:** * **Pyogenic Arthritis:** While it causes rapid joint destruction and flexion deformity due to pain, it typically presents as an acute emergency. It does not usually progress to the specific "triple" chronic malalignment seen in the indolent, long-standing course of TB. * **Osteoarthritis (OA):** OA typically presents with a **Varus (bow-leg)** deformity due to the collapse of the medial compartment. Posterior subluxation and significant external rotation are not characteristic features of OA. **Clinical Pearls for NEET-PG:** * **Stages of TB Knee:** Stage 1 (Synovitis), Stage 2 (Arthritis/Early destruction), Stage 3 (Erosion/Triple deformity), Stage 4 (Ankylosis - usually fibrous). * **Phemister’s Triad (Radiology):** Juxta-articular osteopenia, peripheral osseous erosions, and gradual narrowing of the joint space. * **Treatment:** TB of the knee is primarily managed with **AKT (Antitubercular Therapy)** and splinting. Surgery (Synovectomy or Arthrodesis) is reserved for specific indications.
Question 3: Boutonniere deformity involves which of the following joint alterations?
- A. Flexion at the proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint
- B. Extension at the proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint
- C. Flexion at the proximal interphalangeal (PIP) joint and extension at the distal interphalangeal (DIP) joint (Correct Answer)
- D. Extension at the proximal interphalangeal (PIP) joint and flexion at the distal interphalangeal (DIP) joint
Explanation: **Explanation:** **Boutonniere deformity** is a classic hand deformity characterized by **flexion of the PIP joint** and **hyperextension of the DIP joint**. **Pathophysiology:** The primary pathology is the **rupture or avulsion of the central slip** of the extensor tendon from its insertion at the base of the middle phalanx. This allows the lateral bands to slip volarly (towards the palm) past the axis of the PIP joint. Once displaced, these lateral bands act as flexors of the PIP joint. Simultaneously, the increased tension on the lateral bands is transmitted distally, leading to compensatory hyperextension at the DIP joint. **Analysis of Options:** * **Option C (Correct):** Accurately describes the PIP flexion and DIP extension (hyperextension) resulting from central slip injury. * **Option A & B:** These do not match the reciprocal nature of the deformity caused by the displacement of lateral bands. * **Option D:** This describes a **Swan-neck deformity** (PIP hyperextension and DIP flexion), which is essentially the "opposite" of a Boutonniere deformity. **High-Yield NEET-PG Pearls:** * **Etiology:** Most commonly seen in **Rheumatoid Arthritis** (due to synovitis) and trauma (jammed finger). * **Elson’s Test:** The gold standard clinical test to diagnose early central slip injury before the deformity becomes fixed. * **Treatment:** Initial management involves splinting the PIP joint in full extension for 6–8 weeks while allowing active DIP motion. * **Pseudo-Boutonniere:** Involves PIP flexion but lacks DIP hyperextension; it is usually caused by a volar plate injury.
Question 4: Which of the following is a characteristic feature of osteoarthritis?
- A. Heberden node (Correct Answer)
- B. Increased ESR
- C. Onycholysis
- D. Z deformity
Explanation: **Explanation:** **Osteoarthritis (OA)** is a degenerative joint disease characterized by the loss of articular cartilage and the formation of new bone at the joint margins (osteophytes). **1. Why Heberden Nodes are correct:** Heberden nodes are palpable osteophytes (bony overgrowths) occurring at the **Distal Interphalangeal (DIP) joints**. They are a hallmark clinical feature of nodal osteoarthritis, more common in women, and often have a strong genetic predisposition. Similar swellings at the **Proximal Interphalangeal (PIP) joints** are known as **Bouchard nodes**. **2. Analysis of Incorrect Options:** * **Increased ESR:** OA is a non-inflammatory "wear and tear" condition; therefore, systemic inflammatory markers like ESR and CRP remain **normal**. An elevated ESR typically suggests inflammatory arthritides like Rheumatoid Arthritis (RA) or infection. * **Onycholysis:** This refers to the painless separation of the nail from the nail bed. It is a classic feature of **Psoriatic Arthritis**, not OA. * **Z-deformity:** This refers to a specific deformity of the thumb (hyperextension of the IP joint and flexion of the MCP joint) or ulnar deviation of the hand, which is characteristic of **Rheumatoid Arthritis**. **High-Yield Clinical Pearls for NEET-PG:** * **Joint Involvement:** OA characteristically **involves the DIP joints** but **spares the MCP joints** (unlike RA, which involves MCP and PIP but spares the DIP). * **Radiological Hallmarks (LOSS):** **L**oss of joint space (asymmetrical), **O**steophytes, **S**ubchondral sclerosis, and **S**ubchondral cysts. * **First-line Treatment:** Acetaminophen (Paracetamol) is traditionally the initial drug, though topical/oral NSAIDs are most effective for symptomatic relief. * **Kellgren-Lawrence Grading:** The standard radiological classification system used to assess the severity of OA.
Question 5: In which of the following conditions is the proximal interphalangeal joint involved while the distal interphalangeal joint is spared?
- A. Osteoarthritis
- B. Psoriatic arthritis
- C. Rheumatoid arthritis (Correct Answer)
- D. Ankylosing spondylitis
Explanation: **Explanation:** **Rheumatoid Arthritis (RA)** is a chronic inflammatory systemic disease that primarily targets the **synovium**. The hallmark of RA in the hands is the involvement of the **Proximal Interphalangeal (PIP)** and **Metacarpophalangeal (MCP)** joints, while characteristically **sparing the Distal Interphalangeal (DIP) joints**. This sparing occurs because the DIP joints have minimal synovial tissue compared to the more proximal joints. **Analysis of Options:** * **Osteoarthritis (OA):** Typically involves the **DIP joints** (forming Heberden’s nodes) and the PIP joints (forming Bouchard’s nodes). The involvement of the DIP joint is a classic differentiating feature from RA. * **Psoriatic Arthritis:** This seronegative spondyloarthropathy is notorious for involving the **DIP joints**. It often presents with "dactylitis" (sausage digits) and nail pitting. * **Ankylosing Spondylitis:** Primarily affects the axial skeleton (sacroiliac joints and spine). While it can involve peripheral joints, it usually affects large girdle joints (hips/shoulders) rather than the small joints of the hand in the pattern described. **High-Yield Clinical Pearls for NEET-PG:** * **RA Hand Deformities:** Swan-neck deformity (PIP hyperextension, DIP flexion), Boutonniere deformity (PIP flexion, DIP hyperextension), and Z-deformity of the thumb. * **Joint Sparing:** If the DIP is involved, think OA or Psoriatic Arthritis. If the DIP is spared, think RA. * **Radiological Signs of RA:** Periarticular osteopenia, symmetrical joint space narrowing, and marginal erosions. * **Mnemonic:** **R**heumatoid **A**rthritis **R**ejects the **D**IP.
Question 6: Involvement of the joints of the hand is relatively uncommon in which of the following types of arthritis?
- A. Ankylosing spondylitis (Correct Answer)
- B. Reactive arthritis
- C. Psoriatic arthritis
- D. Rheumatoid arthritis
Explanation: ### Explanation The correct answer is **Ankylosing Spondylitis (AS)**. **1. Why Ankylosing Spondylitis is the correct answer:** Ankylosing spondylitis is the prototype of **Seronegative Spondyloarthropathies (SpA)**. Its hallmark is the involvement of the **axial skeleton**, specifically the sacroiliac joints (sacroiliitis) and the spine. While peripheral joint involvement occurs in approximately 30% of cases, it typically affects **large, proximal joints** (hips and shoulders). Involvement of the small joints of the hand is exceptionally rare in AS compared to other inflammatory arthritides. **2. Why the other options are incorrect:** * **Rheumatoid Arthritis (RA):** This is a chronic inflammatory disease that characteristically targets the small joints of the hands (MCP, PIP, and wrist) in a symmetrical fashion. It is the most common cause of hand deformities. * **Psoriatic Arthritis (PsA):** Hand involvement is a classic feature. It is unique for involving the **Distal Interphalangeal (DIP) joints** and can cause "Dactylitis" (sausage digits) and "Telescoping fingers" (Arthritis mutilans). * **Reactive Arthritis:** While it often presents as an asymmetric oligoarthritis of the lower limbs, it frequently involves the fingers (dactylitis) and can manifest with small joint involvement in the hands during the acute phase. **3. NEET-PG High-Yield Pearls:** * **HLA-B27:** Strongly associated with AS (>90% of cases). * **Bamboo Spine:** Radiographic appearance in AS due to marginal syndesmophytes and squaring of vertebrae. * **DIP Joint Involvement:** If a question mentions DIP joint involvement, think **Psoriatic Arthritis** or **Osteoarthritis** (Heberden’s nodes), but **never** Rheumatoid Arthritis. * **Sausage Digit:** Classic for Psoriatic and Reactive arthritis, not AS.
Question 7: Which of the following structures are not normally visualized during arthroscopy of the knee?
- A. Meniscus
- B. Cruciate ligaments
- C. Collateral ligaments (Correct Answer)
- D. Patellar articular surface
Explanation: ### Explanation **Core Concept:** Knee arthroscopy is an **intra-articular** procedure, meaning the camera (arthroscope) is inserted into the joint capsule to visualize structures within the synovial cavity. The **Collateral Ligaments** (Medial Collateral Ligament and Lateral Collateral Ligament) are **extracapsular** or capsular structures. They lie outside the joint cavity and are covered by the joint capsule and synovium; therefore, they cannot be directly visualized from within the joint during a standard diagnostic arthroscopy. **Analysis of Options:** * **A. Meniscus:** Both the medial and lateral menisci are intra-articular fibrocartilaginous structures. Visualizing and probing them is a primary goal of arthroscopy to check for tears. * **B. Cruciate Ligaments:** The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) are intra-articular (though technically extrasynovial). They are clearly visible in the intercondylar notch during arthroscopy. * **D. Patellar Articular Surface:** The posterior surface of the patella is lined with hyaline cartilage and faces the joint cavity. It is easily inspected by looking into the suprapatellar pouch. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Portals:** The most common portals used are the **Anterolateral** (viewing portal) and **Anteromedial** (working portal). * **Structures seen in the Suprapatellar Pouch:** Patellar articular surface, trochlea, and the plica (synovial folds). * **The "Blind Spot":** The posterior horns of the menisci and the posterior capsule are the most difficult areas to visualize and often require specialized maneuvers or accessory portals. * **Triad of O'Donoghue:** Often diagnosed via arthroscopy, involving injury to the ACL, MCL, and Medial Meniscus. Note that while the ACL and meniscus tears are seen directly, the MCL injury is usually inferred by "medial compartment opening" or valgus laxity.
Question 8: Psoriatic arthritis classically involves which joint?
- A. Proximal interphalangeal (PIP) joint
- B. Distal interphalangeal (DIP) joint (Correct Answer)
- C. Metacarpophalangeal (MCP) joint
- D. Carpometacarpal (CM) joint
Explanation: **Explanation:** Psoriatic Arthritis (PsA) is a chronic inflammatory spondyloarthropathy associated with psoriasis. The hallmark of PsA is its predilection for the **Distal Interphalangeal (DIP) joints**, which helps distinguish it from other inflammatory arthritides like Rheumatoid Arthritis (RA). **Why Option B is Correct:** The involvement of the DIP joint is considered a "classic" or pathognomonic feature of Psoriatic Arthritis, especially when accompanied by characteristic **nail changes** (pitting, onycholysis). While PsA can present in various patterns (symmetric, asymmetric, or spondylitic), the DIP-predominant subtype is highly specific to this condition. **Why Other Options are Incorrect:** * **Option A (PIP Joint):** While PIP joints can be involved in PsA, they are more classically associated with **Rheumatoid Arthritis** and **Osteoarthritis** (Bouchard’s nodes). * **Option C (MCP Joint):** MCP involvement is a hallmark of **Rheumatoid Arthritis**. In PsA, MCP involvement is less common than DIP involvement. * **Option D (CM Joint):** The first carpometacarpal joint is the most common site for **primary Osteoarthritis** of the hand, typically presenting with "squaring" of the wrist. **High-Yield Clinical Pearls for NEET-PG:** * **Radiological Signs:** Look for the **"Pencil-in-cup" deformity** (tapering of the proximal phalanx into the widened base of the distal phalanx). * **Dactylitis:** Also known as "Sausage digit," it is a common finding due to global inflammation of the digit. * **Mnemonic:** PsA involves the **D**IP, while RA **D**oesn't (RA characteristically spares the DIP). * **Association:** Strong association with **HLA-B27** (especially in the sacroiliitis/spondylitic variant).
Question 9: Arthritis mutilans is seen in which condition?
- A. Psoriatic arthropathy (Correct Answer)
- B. Rheumatoid arthritis
- C. Spondyloarthropathy
- D. Reactive arthritis
Explanation: **Explanation:** **Arthritis Mutilans** is the most severe and destructive form of inflammatory arthritis, characterized by extensive bone resorption (osteolysis) leading to the collapse of joint surfaces. **Why Psoriatic Arthropathy is Correct:** While several conditions can rarely cause joint destruction, **Psoriatic Arthritis (PsA)** is the classic and most common association cited in medical literature and exams. It occurs in about 5% of PsA patients. The hallmark is "telescoping fingers" (main-en-lorgnette), where the digits shorten because the bones have dissolved, and the overlying skin becomes redundant and wrinkled. Radiologically, this presents as the **"Pencil-in-cup" deformity**, where the proximal bone is whittled down (pencil) and the distal bone surface is excavated (cup). **Analysis of Incorrect Options:** * **Rheumatoid Arthritis (B):** While RA causes significant joint erosion and deformities (like ulnar deviation), it typically does not lead to the gross osteolysis and "telescoping" seen in true arthritis mutilans. * **Spondyloarthropathy (C):** This is a broad category (including Ankylosing Spondylitis). While PsA is a type of Seronegative Spondyloarthropathy, the term "Arthritis Mutilans" specifically refers to the peripheral joint destruction most unique to the Psoriatic subtype. * **Reactive Arthritis (D):** Usually presents as an asymmetric oligoarthritis of the lower limbs; it rarely progresses to the level of bone resorption seen in mutilans. **High-Yield Clinical Pearls for NEET-PG:** * **Radiological Sign:** "Pencil-in-cup" appearance is pathognomonic for Psoriatic Arthritis. * **Clinical Sign:** "Main-en-lorgnette" (Opera-glass hand). * **Other Associations:** Arthritis Mutilans can also be seen in severe cases of Leprosy (due to neurotrophic changes) and multicentric reticulohistiocytosis. * **Dermatology Link:** Look for nail changes (pitting, onycholysis) in patients with Psoriatic Arthritis.
Question 10: What is the typical position of the lower limb in a post-polio deformity of the hip?
- A. Extension, Adduction, Internal rotation
- B. Extension, Abduction, Internal rotation
- C. Flexion, Abduction, External rotation (Correct Answer)
- D. Flexion, Adduction, External rotation
Explanation: ### Explanation The characteristic deformity of the hip in **Post-Polio Residual Paralysis (PPRP)** is **Flexion, Abduction, and External Rotation (FABER)**. **1. Why Flexion, Abduction, and External Rotation is Correct:** In Polio, muscle involvement is often asymmetrical and patchy. The deformity is primarily driven by the **contracture of the Iliotibial Band (ITB)** and the **Tensor Fasciae Latae (TFL)**. * **Flexion:** The TFL and Sartorius (often spared) act as flexors. * **Abduction:** The ITB is a strong abductor; its contracture pulls the hip outward. * **External Rotation:** The short external rotators are frequently stronger than the paralyzed internal rotators. Furthermore, the patient often adopts this "frog-leg" position to stabilize the pelvis during gait or sitting, leading to fixed contractures over time. **2. Why the Other Options are Incorrect:** * **Extension & Adduction (Options A & D):** These are the opposite of the typical polio pattern. Adduction deformities are more common in Cerebral Palsy (due to spasticity) or late-stage Hip Osteoarthritis. * **Internal Rotation (Options A & B):** Internal rotation is rare in PPRP because the muscles responsible (Gluteus Medius/Minimus anterior fibers) are often weaker than the external rotators. **3. Clinical Pearls for NEET-PG:** * **Ober’s Test:** Used to clinical assess the contracture of the Iliotibial Band. * **Soutter’s Release:** A surgical procedure (muscle slide) used to correct hip flexion contractures in polio. * **The "Pelvic Obliquity":** ITB contracture at the hip can lead to a secondary scoliosis and pelvic tilt. * **Triad of PPRP Hip:** Flexion, Abduction, and External Rotation is the classic "triple deformity" frequently tested in orthopedic exams.
Practice by Chapter
Principles of Arthroscopy
Practice Questions
Knee Arthroscopy
Practice Questions
Shoulder Arthroscopy
Practice Questions
Hip Arthroscopy
Practice Questions
Ankle Arthroscopy
Practice Questions
Elbow Arthroscopy
Practice Questions
Wrist Arthroscopy
Practice Questions
Arthroscopic Equipment and Setup
Practice Questions
Diagnostic Arthroscopy
Practice Questions
Therapeutic Arthroscopic Procedures
Practice Questions
Complications in Arthroscopy
Practice Questions
Post-Arthroscopy Rehabilitation
Practice Questions
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