Arthroscopy — MCQs

Arthroscopy Indian Medical PG Practice Questions and MCQs

Question 31: In rheumatoid arthritis, which part of the spinal column is typically involved?

A. Cervical (Correct Answer)
B. Dorsal
C. Lumbar
D. Sacral

Explanation: **Explanation:** Rheumatoid Arthritis (RA) is a chronic inflammatory systemic disease primarily characterized by **synovitis** (inflammation of the synovial membrane). The spinal column is unique in its anatomy; while most of the spine consists of fibrocartilaginous joints (intervertebral discs), the **Cervical Spine** is rich in **synovial joints**. These include the **atlanto-axial (C1-C2) joint**, the facet joints (zygapophyseal joints), and the joints of Luschka. Because RA specifically targets synovial tissue, the cervical spine is the most common (and often only) site of spinal involvement. * **Why Cervical is Correct:** The C1-C2 complex is purely synovial. Inflammation leads to the destruction of the transverse ligament and pannus formation, resulting in **Atlanto-axial subluxation**, a potentially life-threatening complication due to cord compression. * **Why Dorsal, Lumbar, and Sacral are Incorrect:** These regions are rarely involved in RA because they lack the high density of synovial joints found in the neck. Involvement of the lower spine is more characteristic of **Seronegative Spondyloarthropathies** (like Ankylosing Spondylitis), which target the entheses and sacroiliac joints, rather than the synovium. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common cervical deformity:** Anterior atlanto-axial subluxation. 2. **Radiological Hallmark:** Increased **ADI (Atlantodental Interval)**. In adults, an ADI >3mm suggests instability; >9mm indicates a high risk for neurological deficit. 3. **Pre-operative Caution:** Always obtain cervical spine X-rays (flexion/extension views) for RA patients undergoing any surgery to avoid catastrophic cord injury during intubation. 4. **Subaxial Subluxation:** "Stepladder appearance" on lateral X-ray due to multiple levels of vertebral slippage.

Question 32: Bouchard's nodes are seen in which of the following joints?

A. Proximal interphalangeal joints (Correct Answer)
B. Distal interphalangeal joints
C. Sternoclavicular joints
D. Knee joint

Explanation: **Explanation:** **Bouchard’s nodes** are bony outgrowths (osteophytes) specifically located at the **Proximal Interphalangeal (PIP) joints**. They are a classic clinical hallmark of **Osteoarthritis (OA)**, representing the body’s attempt to repair articular cartilage damage through subchondral bone remodeling. * **Option A (Correct):** Bouchard’s nodes occur at the PIP joints. They are less common than Heberden’s nodes but signify the same degenerative process of primary osteoarthritis. * **Option B (Incorrect):** Bony enlargements at the **Distal Interphalangeal (DIP) joints** are known as **Heberden’s nodes**. These are the most common clinical sign of hand OA. * **Option C & D (Incorrect):** While the sternoclavicular and knee joints are frequently affected by osteoarthritis, they do not develop these specific eponymous nodal enlargements. OA of the knee typically presents with joint line tenderness, crepitus, and varus/valgus deformity. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mnemonic:** **B**ouchard’s = **B**elow (closer to the palm/PIP); **H**eberden’s = **H**igh (further away/DIP). 2. **Differential Diagnosis:** In **Rheumatoid Arthritis (RA)**, the PIP joints may show soft tissue swelling (fusiform swelling), but **never** Heberden’s nodes. RA characteristically involves the MCP joints and spares the DIP joints. 3. **Radiological Features of OA:** Joint space narrowing (asymmetrical), subchondral sclerosis, subchondral cysts, and osteophyte formation. 4. **Erosive Osteoarthritis:** A specific subset of OA involving the PIP and DIP joints, often showing a "Gull-wing" appearance on X-ray.

Question 33: Osteoarthritis does not affect which of the following joints?

A. Knee joint
B. Hip joint
C. Interphalangial joint
D. Metacarpophalangial joint (Correct Answer)

Explanation: ### Explanation **Core Concept:** Osteoarthritis (OA) is a degenerative joint disease that primarily affects **weight-bearing joints** and specific small joints of the hand subjected to repetitive mechanical stress. A key clinical differentiator in orthopaedics is that **Primary Osteoarthritis characteristically spares the Metacarpophalangeal (MCP) joints.** If the MCP joints are involved, clinicians must investigate secondary causes (like trauma or metabolic disease) or inflammatory arthritides like Rheumatoid Arthritis. **Analysis of Options:** * **D. Metacarpophalangeal (MCP) joint (Correct):** These joints are typically spared in primary OA. Involvement of the MCP joints is a hallmark of **Rheumatoid Arthritis**. If "OA-like" changes are seen here, it usually indicates **Hemochromatosis** (look for "hook-like" osteophytes) or CPPD. * **A. Knee joint:** This is the most common large joint affected by OA due to its role in weight-bearing and high mechanical load. * **B. Hip joint:** A major weight-bearing joint frequently affected by primary OA, often leading to total hip arthroplasty. * **C. Interphalangeal (IP) joints:** Both Distal (DIP) and Proximal (PIP) joints are classic sites for OA. DIP involvement leads to **Heberden’s nodes**, and PIP involvement leads to **Bouchard’s nodes**. **NEET-PG High-Yield Pearls:** 1. **Nodal Distribution:** OA affects the DIP (Heberden's) and PIP (Bouchard's), whereas Rheumatoid Arthritis (RA) affects the MCP and PIP but **spares the DIP**. 2. **First Carpometacarpal (CMC) Joint:** The base of the thumb is a very common site for OA (squaring of the hand), unlike the MCPs. 3. **Radiological Hallmarks of OA (LOSS):** **L**oss of joint space (asymmetrical), **O**steophytes, **S**ubchondral sclerosis, and **S**ubchondral cysts. 4. **Erosive OA:** A specific variant that shows a "Gull-wing" appearance on X-ray.

Question 34: Which is the most common joint involved in thalassemia?

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

Explanation: **Explanation:** In patients with **Thalassemia Major**, joint involvement (Thalassemia Arthropathy) is a significant cause of morbidity. The **Knee joint** is the most commonly affected joint. **Why the Knee?** The pathophysiology involves chronic iron overload (hemosiderosis) from repeated blood transfusions and ineffective erythropoiesis. Iron deposits in the synovial membrane, leading to chronic synovitis, cartilage damage, and subchondral bone changes. The knee, being a large, weight-bearing joint with a vast synovial surface area, is most susceptible to these inflammatory and degenerative changes. Additionally, expansion of the bone marrow (erythroid hyperplasia) in the distal femur and proximal tibia can cause juxta-articular osteopenia and microfractures, further predisposing the knee to pain and effusion. **Analysis of Incorrect Options:** * **Hip:** While the hip can be affected by premature epiphyseal closure or osteoporosis-related fractures in thalassemics, it is less frequently involved in the primary arthropathy compared to the knee. * **Shoulder:** This is a non-weight-bearing joint and is rarely the primary site of thalassemic joint involvement. * **Ankle:** Though it can be involved, it is statistically less common than the knee. **High-Yield Clinical Pearls for NEET-PG:** * **Radiological Feature:** Look for "Premature Epiphyseal Fusion" and "Squared Metaphyses" in the long bones of thalassemic children. * **Associated Finding:** Thalassemia is also associated with **secondary gout** due to high cell turnover (hyperuricemia). * **Management:** Iron chelation therapy (e.g., Deferoxamine) is crucial to prevent further synovial iron deposition, though some chelators themselves can rarely cause joint pain.

Question 35: What is a swan neck deformity?

A. Flexion at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints.
B. Extension at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints.
C. Flexion at the proximal interphalangeal (PIP) joint and extension at the distal interphalangeal (DIP) joint.
D. Extension at the proximal interphalangeal (PIP) joint and flexion at the distal interphalangeal (DIP) joint. (Correct Answer)

Explanation: **Explanation:** Swan neck deformity is a characteristic finger deformity characterized by **hyperextension of the Proximal Interphalangeal (PIP) joint** and **flexion of the Distal Interphalangeal (DIP) joint**. The underlying pathophysiology involves a breach of the volar plate (which normally prevents PIP hyperextension) or a dorsal displacement of the lateral bands of the extensor mechanism. This imbalance causes the extrinsic muscles to pull the PIP joint into hyperextension, which subsequently creates a passive pull on the Flexor Digitorum Profundus (FDP) tendon, leading to compensatory flexion at the DIP joint. **Analysis of Options:** * **Option D (Correct):** Accurately describes the extension-flexion pattern (PIP extension, DIP flexion) seen in the deformity. * **Option A & B:** These describe uniform flexion or extension across both joints, which does not match the reciprocal "S-shaped" zig-zag deformity of the finger. * **Option C:** This describes a **Boutonnière deformity** (PIP flexion and DIP hyperextension), which is the clinical opposite of a Swan neck deformity and is caused by a rupture of the central slip of the extensor tendon. **High-Yield Clinical Pearls for NEET-PG:** * **Common Associations:** Rheumatoid Arthritis (most common), Mallet finger (untreated), and Ehlers-Danlos syndrome. * **Differential Diagnosis:** Always distinguish it from **Boutonnière deformity**. Remember: *Swan neck = Extension at PIP; Boutonnière = Flexion at PIP.* * **Management:** Initial treatment is conservative with "Silver ring" splints to prevent PIP hyperextension. Surgical intervention (e.g., volar plate advancement) is reserved for fixed deformities.

Question 36: The operative procedure known as "microfracture" is done for the

A. Delayed union of femur
B. Osteochondral defect of femur (Correct Answer)
C. Non union of tibia
D. Loose bodies of ankle joint

Explanation: ***Osteochondral defect of femur*** - **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**. - It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue. *Delayed union of femur* - **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery. - Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture. *Non union of tibia* - **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**. - This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses. *Loose bodies of ankle joint* - **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage. - This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.

Question 37: Loose body in joint: most common site?

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

Explanation: ***Knee*** - The **knee joint** is the most common site for loose bodies due to its high mobility, susceptibility to trauma, and prevalence of conditions like **osteochondritis dissecans** and osteoarthritis. - Loose bodies in the knee can cause symptoms such as **locking**, clicking, pain, and effusion. *Hip* - Loose bodies can occur in the hip, but they are far **less common** than in the knee. - Causes can include **osteochondritis dissecans** and **osteoarthritis**, but the hip's deeper anatomy offers more protection. *Elbow* - The elbow joint can develop loose bodies, particularly in conditions like **osteochondritis dissecans** or following trauma. - However, their incidence is **lower** compared to the knee. *Ankle* - Loose bodies in the ankle are **relatively rare** but can be found, often associated with trauma or **osteochondral lesions**. - They are significantly **less frequent** than in the knee joint.

Question 38: What is the purpose of anterolateral arthroscopy of the knee?

A. To see patella femoral articulation (Correct Answer)
B. To see the posterior cruciate ligament
C. To see the anterior portion of lateral meniscus
D. To see the periphery of the posterior horn of medial

Explanation: ***To see patella femoral articulation*** - Anterolateral arthroscopy involves inserting the arthroscope through a portal located **anterolaterally to the patella**, providing an excellent direct view of the **patellofemoral joint**. - This position allows for clear visualization of the **articular cartilage** of the patella and femoral trochlea, crucial for assessing conditions like **chondromalacia patellae** or patellar instability. *To see the posterior cruciate ligament* - Visualizing the **posterior cruciate ligament (PCL)** typically requires a more posterior or posteromedial approach, or specific maneuvers within the joint, as its location is deep within the knee. - The anterolateral portal primarily offers views of the anterior compartment and some lateral structures, making PCL visualization challenging with this sole approach. *To see the anterior portion of lateral meniscus* - While the anterolateral portal can give some oblique views of the lateral compartment, a direct and comprehensive view of the **anterior horn of the lateral meniscus** is often achieved more effectively via an anteromedial portal for triangulation or specific maneuvers. - The primary target for an anterolateral entry is often the patellofemoral joint and general anterior compartment assessment. *To see the periphery of the posterior horn of medial* - Viewing the **periphery of the posterior horn of the medial meniscus** generally requires an anteromedial portal for direct visualization, sometimes supplemented by a posteromedial portal for full assessment. - An anterolateral approach is not ideal for this specific area due to the anatomical location and angle required.

Question 39: Which of the following conditions can cause locking of the knee joint?

A. Osgood Schlatter
B. Tuberculosis of knee
C. a and b both
D. Loose body in knee joint (Correct Answer)

Explanation: ***Loose body in knee joint*** - A **loose body** (e.g., a fragment of cartilage or bone) can get trapped between the articular surfaces of the knee joint, mechanically obstructing its movement and causing sudden, painful **locking**. - This mechanical impingement prevents full extension or flexion of the knee until the loose body shifts, leading to episodic locking symptoms. *Osgood Schlatter* - This condition involves inflammation and potential avulsion of the **tibial tuberosity** where the patellar tendon inserts. - It primarily causes pain and swelling below the kneecap, especially during physical activity, but does not typically result in true mechanical locking of the joint. *Tuberculosis of knee* - **Tuberculosis of the knee joint** is an infectious arthritis that causes chronic pain, swelling, and gradual destruction of articular cartilage and bone. - While it can lead to pain and limited range of motion, it usually does not present with the sudden, intermittent mechanical locking characteristic of a loose body. *a and b both* - Neither **Osgood Schlatter** nor **Tuberculosis of the knee** typically cause the characteristic mechanical locking sensation described for a loose body in the joint. - Each of these conditions has distinct pathophysiological mechanisms and clinical presentations that do not involve a physical obstruction causing locking.

Question 40: An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?

A. Clinical examination
B. Arthroscopy (Correct Answer)
C. Arthrotomy
D. X-ray

Explanation: ***Arthroscopy*** - **Arthroscopy** is the definitive investigation for **cartilage damage** as it allows for direct visualization of the knee joint's internal structures. - It not only confirms the diagnosis but can also facilitate simultaneous **repair or débridement** of damaged cartilage. *X-ray* - **X-rays** are primarily used to assess **bone structures** and detect fractures or significant joint space narrowing, not soft tissue injuries like cartilage. - They are generally **insufficient** for diagnosing subtle or early cartilage damage. *Clinical examination* - A **clinical examination** is crucial for initial assessment and suspicion of cartilage injury, but it cannot definitively diagnose the extent or type of cartilage damage. - It helps guide further investigations but is **not specific enough** to confirm cartilage integrity. *Arthrotomy* - **Arthrotomy** involves a larger incision to open the joint, which is more **invasive** than arthroscopy and typically reserved for open surgical repairs or complex reconstructions, not as a primary diagnostic tool for cartilage. - It carries a **higher risk of complications**, such as infection and prolonged recovery, compared to arthroscopy.

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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