Principles of Arthroscopy — MCQs
Rupture of extensor pollicis longus tendon occurs in all of the following except -
Which of the following is the most commonly used extraoral orthodontic appliance:
The operative procedure known as "microfracture" is done for the
Which of the following is a contraindication for open reduction & internal fixation (ORIF)?
What is the most effective management strategy for hemarthrosis?
Axillary Nerve Injury is least likely in:
Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
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?
Principles of Arthroscopy Indian Medical PG Practice Questions and MCQs
Question 1: Rupture of extensor pollicis longus tendon occurs in all of the following except -
- A. De Quervain's disease (Correct Answer)
- B. Rheumatoid arthritis
- C. Drummers
- D. Colles' fracture
Explanation: ***De Quervain's disease*** - This condition involves **tenosynovitis** of the **extensor pollicis brevis** and **abductor pollicis longus** tendons, not a rupture of the extensor pollicis longus. - The pathology is an inflammation and thickening of the tendon sheaths, distinct from a tendon tear. *Rheumatoid arthritis* - **Chronic inflammation** in rheumatoid arthritis can lead to weakening and eventual rupture of tendons, including the **extensor pollicis longus**, often due to synovitis eroding the tendon. - The condition creates an environment where tendons are vulnerable to **attrition** and damage, making rupture a recognized complication. *Drummers* - Repetitive, high-force movements involved in drumming can cause significant **stress** and microscopic damage to tendons, including the **extensor pollicis longus**. - Over time, this cumulative trauma can lead to inflammation, degeneration, and eventual **rupture** due to overuse. *Colles' fracture* - A **Colles' fracture** of the distal radius can cause a delayed rupture of the **extensor pollicis longus (EPL)** tendon. - This occurs due to attrition of the tendon as it rubs over the **roughened fracture site** or due to *avascular necrosis* of the tendon as it passes through a narrow osteofibrous tunnel.
Question 2: Which of the following is the most commonly used extraoral orthodontic appliance:
- A. Face mask.
- B. Head gear. (Correct Answer)
- C. None.
- D. Chin cup.
Explanation: **Head gear.** * **Headgear** is a widely recognized and utilized **extraoral orthodontic appliance** in dental practice due to its versatility in controlling maxillary growth, especially in patients with Class II malocclusion. * It consists of an **outer bow** (facebow) and an **inner bow**, connected to bands on the molars, which exerts orthopedic force on the maxilla and teeth. *Face mask.* * A **face mask** (or protraction headgear) is primarily used for **Class III malocclusions** to encourage maxillary protraction and inhibit mandibular growth. * While an important extraoral appliance, its usage is less common than headgear, as Class III skeletal patterns are less prevalent than Class II. *None.* * This option is incorrect because there are several commonly used extraoral orthodontic appliances, with **headgear** being a prime example. *Chin cup.* * A **chin cup** is an extraoral appliance used specifically for the orthopedic management of developing **Class III malocclusions** by restraining mandibular growth. * Its primary application is to redirect the growth of the mandible downward and backward, but it is less frequently prescribed compared to headgear for Class II correction.
Question 3: 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 4: Which of the following is a contraindication for open reduction & internal fixation (ORIF)?
- A. Active infection
- B. Soft bones
- C. Soft tissue contractures around the fracture site
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Active infection** at the surgical site is a significant contraindication for ORIF due to the high risk of **osteomyelitis** and implant failure. - **Soft bones**, such as those found in patients with **osteoporosis**, may not adequately hold the internal fixation devices (screws, plates), leading to implant loosening or cutout. - **Soft tissue contractures** around the fracture site can make surgical access difficult, compromise soft tissue coverage, and increase the risk of wound complications and poor functional outcomes. *Active infection* - While a direct contraindication, it's not the *only* one for ORIF. - Performing ORIF in the presence of infection significantly increases the risk of **surgical site infection** and implant failure, potentially leading to chronic osteomyelitis. *Soft bones* - This is a significant challenge for ORIF, as the bone quality may not be sufficient to hold the hardware securely. - It increases the risk of **implant failure** and non-union, but again, it's not the sole contraindication listed. *Soft tissue contractures around the fracture site* - Severe contractures can **impede surgical exposure**, make anatomical reduction difficult, and compromise the vascularity of the tissues. - This can lead to increased rates of **wound complications** and poor healing, but it is one of several contraindications.
Question 5: What is the most effective management strategy for hemarthrosis?
- A. Immobilization with a P.O.P. cast
- B. Application of a compression bandage
- C. Needle aspiration to remove excess blood (Correct Answer)
- D. All of the options
Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.
Question 6: Axillary Nerve Injury is least likely in:
- A. Intramuscular injection
- B. Shoulder dislocation
- C. Improper use of crutch (Correct Answer)
- D. Fracture proximal humerus
Explanation: Improper use of crutch - **Improper crutch usage** primarily affects the **radial nerve** in the axilla due to direct compression against the humerus. - While it can cause nerve damage, the **axillary nerve** is less commonly injured by crutch use as it lies more distally and laterally, protected by the deltoid muscle. *Intramuscular injection* - Injections in the **deltoid muscle** can directly injure the **axillary nerve** due to its superficial course around the surgical neck of the humerus. [1] - This risk is higher with improper technique or very deep injections, leading to **deltoid weakness** and **sensory loss** over the lateral shoulder. *Shoulder dislocation* - **Anterior shoulder dislocations** are a common cause of **axillary nerve injury** due to the stretching or tearing of the nerve as the humeral head displaces. - The nerve wraps around the **surgical neck of the humerus**, making it vulnerable during dislocation. *Fracture proximal humerus* - Fractures of the **surgical neck of the humerus** often lead to **axillary nerve damage** because the nerve lies in close proximity to this region. - The blunt force or displacement of bone fragments can directly compress or lacerate the nerve.
Question 7: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
- A. A-3, B-4, C-2, D-1
- B. A-1, B-4, C-3, D-2 (Correct Answer)
- C. A-4, B-2, C-3, D-1
- D. A-2, B-4, C-3, D-1
Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.
Question 8: 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 9: 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 10: 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.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free