Diagnostic Arthroscopy — MCQs
The contraindication to internal fixation -
In dental restorations, where is the terminal third of the retentive arm typically placed?
An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
Air embolism in neural surgery maximum in which position:
Which one of the following statements about Compartment Syndrome is NOT correct?
A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
Manoeuvre carried out for diagnosing medial meniscus injury is:
An athlete sustained an injury around the knee joint with suspected cartilage damage. Which of the following is the investigation of choice?
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?
Diagnostic Arthroscopy Indian Medical PG Practice Questions and MCQs
Question 1: The contraindication to internal fixation -
- A. Fracture dislocation
- B. Intraarticular fracture
- C. Physeal injury
- D. Active infection (Correct Answer)
Explanation: ***Active infection*** - **Active infection** is a strong contraindication to internal fixation because introducing foreign material (implants) into an infected area can spread the infection, make it chronic, and lead to implant failure, osteomyelitis, or sepsis. - The presence of bacteria can colonize the implant surface, forming **biofilms** that are highly resistant to antibiotics and host immune responses, severely complicating treatment. *Fracture dislocation* - **Fracture dislocations** are often a strong *indication* for internal fixation to achieve anatomical reduction and stable fixation, allowing for early mobilization and preventing avascular necrosis or persistent instability. - The goal is to restore joint congruity and maintain reduction, which is difficult to achieve and maintain with non-operative methods. *Intraarticular fracture* - **Intraarticular fractures** are frequently *managed with* internal fixation to restore articular surface congruity, minimize post-traumatic arthritis, and allow for early range of motion. - Precise reduction and stable fixation are crucial to prevent long-term complications such as joint stiffness and osteoarthritis. *Physeal injury* - **Physeal injuries** (growth plate fractures) are often *treated with* surgical fixation, particularly unstable or displaced fractures, to ensure anatomical reduction and prevent growth disturbances. - The fixation technique must be chosen carefully to avoid damaging the physis itself, often using smooth pins or screws that do not cross the growth plate.
Question 2: In dental restorations, where is the terminal third of the retentive arm typically placed?
- A. Middle third
- B. Junction of middle and occlusal third
- C. Gingival third
- D. Junction of gingival third and middle third (Correct Answer)
Explanation: ***Junction of gingival third and middle third*** - This position ensures the **retentive arm engages the undercut** of the tooth effectively for retention, while being positioned to minimize bulk and avoid tissue impingement. - Placing the terminal third of the retentive arm at this junction allows for proper **flexibility and passive engagement** with the tooth surface, contributing to the stability of the denture. *Gingival third* - Placing the retentive arm entirely in the **gingival third** could lead to **tissue impingement** and irritation due to its proximity to the gingiva. - This placement might also result in an overly aggressive undercut engagement, making the denture difficult to insert or remove and potentially **damaging the tooth**. *Middle third* - Positioning the terminal third in the **middle third** of the tooth often means it is located above the **height of contour**, which is not ideal for retention. - The retentive arm would then be engaging a non-undercut area, leading to **insufficient retention** and poor stability of the prosthesis. *Junction of middle and occlusal third* - Placing the retentive arm in this area is typically **too occlusal** and would not engage a retentive undercut effectively. - Such placement would lead to **poor retention** of the denture and could interfere with occlusion, causing discomfort or instability during chewing.
Question 3: An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
- A. Posterior Cruciate Ligament
- B. Anterior Cruciate Ligament (Correct Answer)
- C. Lateral Collateral Ligament
- D. Medial Collateral Ligament
Explanation: ***Anterior Cruciate Ligament*** - The **Lachman test** is the most sensitive clinical test for diagnosing an **ACL tear**, indicating anterior tibial translation. - **Pivoting injuries** and **hemarthrosis** (blood in the joint) are classic signs of a severe ACL injury, often involving bone bruising. *Posterior Cruciate Ligament* - PCL injuries are less common and typically result from a direct blow to the **anterior tibia** while the knee is flexed or a hyperextension injury. - The primary test for PCL integrity is the **posterior drawer test**, which assesses posterior tibial translation. *Lateral Collateral Ligament* - LCL injuries usually result from a **varus stress** to the knee, often in contact sports, and can cause pain on the lateral aspect of the knee. - The **varus stress test** is used to assess LCL integrity, but it does not cause hemarthrosis as frequently as an ACL tear. *Medial Collateral Ligament* - MCL injuries are common and result from a **valgus stress** to the knee (a blow to the outside of the knee). - The **valgus stress test** assesses MCL integrity, causing pain on the medial aspect of the knee and typically not resulting in acute hemarthrosis unless other structures are also injured.
Question 4: Air embolism in neural surgery maximum in which position:
- A. Left lateral
- B. Sitting (Correct Answer)
- C. Supine
- D. Trendelenburg
Explanation: ***Sitting*** - In the **sitting position** for neural surgery, the surgical field, particularly the head, is often elevated above the heart. This creates a **negative pressure gradient** in the venous system, increasing the risk of air entrainment if a vein is opened and air is allowed to enter. - The **higher elevation of the operative site** relative to the right atrium significantly increases the likelihood of air being sucked into open veins. *Left lateral* - While air embolism can occur in any position, the **left lateral position** does not inherently create the same significant negative pressure gradient as the sitting position in the surgical field relative to the heart. - The patient's body is positioned on its side, which can help in certain surgical approaches but typically does not elevate the head as dramatically as the sitting position. *Supine* - In the **supine position**, the patient is lying on their back, and the operative field (head or spine) is generally at or below the level of the heart, reducing the pressure gradient that favors air entrainment. - This position typically offers a **lower risk of air embolism** compared to the sitting position due to less negative pressure in exposed veins. *Trendelenburg* - The **Trendelenburg position** involves placing the patient head-down and feet-up, which increases venous pressure in the upper body and head. - This position actively works against the negative pressure gradient, thereby **reducing the risk of air entrainment** into open veins through increased venous pressure.
Question 5: Which one of the following statements about Compartment Syndrome is NOT correct?
- A. Pain is on active movement but not on passive movement of muscles (Correct Answer)
- B. Fasciotomy is the treatment of choice
- C. It is commonest in a closed fracture
- D. Volkmann's Ischaemic contracture is a late complication
Explanation: ***Pain is on active movement but not on passive movement of muscles*** - This statement is incorrect because pain in compartment syndrome is characteristically **out of proportion to the injury** and is **exacerbated by passive stretching of the muscles** within the affected compartment. - While active movement can cause pain, the hallmark sign related to pain is its intensification with passive stretching due to increased pressure. *Fasciotomy is the treatment of choice* - **Fasciotomy** is indeed the definitive surgical treatment for compartment syndrome to relieve pressure and prevent irreversible tissue damage. - It involves incising the fascia to decompress the affected muscle compartment. *It is commonest in a closed fracture* - Compartment syndrome most frequently occurs after a **closed fracture**, particularly in the tibia and forearm, because the intact fascial compartments restrict expansion, leading to increased pressure. - The swelling and hemorrhage associated with the fracture are contained, causing pressure to rise rapidly. *Volkmann's Ischaemic contracture is a late complication* - **Volkmann's ischemic contracture** is a severe and debilitating late complication of unresolved or undertreated compartment syndrome, primarily affecting the forearm muscles. - It results from prolonged ischemia, causing muscle necrosis, fibrosis, and subsequent shortening and contracture.
Question 6: A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
- A. Anterior cruciate ligament tear (Correct Answer)
- B. Posterior cruciate ligament tear
- C. Medial meniscus tear
- D. Medial collateral ligament tear
Explanation: ***Anterior cruciate ligament tear*** - The image depicts the **Lachman test**, a highly sensitive and specific clinical test for **ACL integrity**. - A positive Lachman test, characterized by *increased anterior tibial translation* and a *soft or absent endpoint*, confirms an **ACL tear**. *Posterior cruciate ligament tear* - A PCL tear is identified by tests like the **posterior drawer test** or **posterior sag sign**, which show *posterior tibial translation*. - The test shown in the image specifically assesses **anterior stability**, not posterior. *Medial meniscus tear* - Medial meniscus tears are typically diagnosed with tests like **McMurray's test** or **Apley's grind test**, which involve *rotation* and *compression* of the knee. - While a crucial knee structure, the meniscus does not primarily contribute to **anterior-posterior stability** in the way the ACL does. *Medial collateral ligament tear* - An MCL tear is detected by applying a **valgus stress** to the knee at various degrees of flexion. - This tear presents with *medial joint line pain* and *instability to valgus stress*, which is not assessed by the depicted test.
Question 7: Manoeuvre carried out for diagnosing medial meniscus injury is:
- A. McMurray's test (Correct Answer)
- B. Valgus stress test
- C. Lachmann's test
- D. Varus stress test
Explanation: ***McMurray's test*** - This test is specifically designed to assess for meniscal tears, particularly the **medial meniscus**. - A positive test involves eliciting a **click or pain** when extending the knee from a fully flexed position while internally and externally rotating the tibia. *Valgus stress test* - This test evaluates the integrity of the **medial collateral ligament (MCL)**. - It involves applying a valgus (outward) force to the knee while stabilizing the thigh, looking for increased gapping or pain. *Lachmann's test* - This is the most sensitive test for assessing the integrity of the **anterior cruciate ligament (ACL)**. - It involves gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees, looking for excessive anterior translation. *Varus stress test* - This test assesses the integrity of the **lateral collateral ligament (LCL)**. - It involves applying a varus (inward) force to the knee while stabilizing the thigh, looking for increased gapping or pain.
Question 8: An athlete sustained an injury around the knee joint with suspected cartilage damage. Which of the following is the investigation of choice?
- A. X-ray
- B. Clinical examination
- C. Arthroscopy (Correct Answer)
- D. Arthrotomy
Explanation: **Explanation:** The investigation of choice for suspected intra-articular cartilage damage is **Arthroscopy**. It is considered the **"Gold Standard"** because it allows for direct visualization of the articular surfaces, menisci, and ligaments under magnification. Unlike imaging, it provides a dynamic assessment of the tissue's integrity and allows the surgeon to perform immediate therapeutic interventions (e.g., debridement or chondroplasty). **Analysis of Options:** * **X-ray (Option A):** X-rays are excellent for visualizing bony injuries or fractures but are poor at showing soft tissues like cartilage or menisci. They are usually the first-line screening tool but are not definitive for cartilage damage. * **Clinical Examination (Option B):** While essential for initial diagnosis (e.g., McMurray’s or Lachman tests), clinical exams are subjective and can be limited by pain, swelling, or muscle guarding in an acute athlete injury. * **Arthrotomy (Option D):** This involves a large surgical incision to open the joint. It is highly invasive and has been largely replaced by arthroscopy due to higher morbidity and longer recovery times. **Clinical Pearls for NEET-PG:** * **MRI vs. Arthroscopy:** While MRI is the investigation of choice for *non-invasive* screening of soft tissue injuries, **Arthroscopy** remains the overall "Gold Standard" for definitive diagnosis and treatment. * **Triad of O'Donoghue:** Often seen in athletes, involving injury to the ACL, MCL, and Medial Meniscus. * **Arthroscopy Media:** Normal saline or Ringer’s Lactate is used to distend the joint during the procedure. * **Common Portals:** The anterolateral portal is the most common primary portal used in knee arthroscopy.
Question 9: 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 10: 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.
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