Degenerative Disorders Practice Questions

Q: Frieberg's disease involves which of the following?

2nd metatarsal. **Explanation:** **Freiberg’s disease** is an **osteochondrosis** (avascular necrosis) affecting the head of the metatarsal. It most commonly involves the **2nd metatarsal head (Option C)** because it is the longest and most rigid metatarsal, making it susceptible to repetitive microtrauma and excessive loading during the toe-off phase of gait. It is typically seen in adolescent girls and presents with pain, swelling, and limited range of motion at the metatarsophalangeal joint. **Analysis of Incorrect Options:** * **Option A (Tibial tuberosity):** This is the site for **Osgood-Schlatter disease**, a traction apophysitis caused by repetitive strain from the patellar tendon. * **Option B (Calcaneal tuberosity):** This is the site for **Sever’s disease**, an apophysitis of the calcaneus common in active children. * **Option D (5th metatarsal):** The base of the 5th metatarsal is the site for **Iselin’s disease** (apophysitis). While the 5th metatarsal is also prone to Jones fractures, it is not the classic site for Freiberg’s. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in adolescent females (ratio ~3:1). * **Radiology:** Early stages show flattening and sclerosis of the metatarsal head; late stages show joint space narrowing and secondary osteoarthritis. * **Hierarchy of Involvement:** 2nd Metatarsal (most common) > 3rd Metatarsal > 4th Metatarsal. * **Management:** Conservative (activity modification, orthotics) is first-line; surgery (debridement or osteotomy) is reserved for refractory cases.

Q: What is the deformity most commonly seen in primary osteoarthritis of the knee joint?

Genu varus. ### Explanation **Correct Answer: C. Genu varus** In primary osteoarthritis (OA) of the knee, the **medial compartment** is the most common site of cartilage degeneration. This occurs because the mechanical axis of the lower limb normally passes slightly medial to the center of the knee joint, causing the medial compartment to bear approximately 60-70% of the load during walking. As the medial articular cartilage thins and the joint space narrows, the tibia tilts medially relative to the femur, resulting in a **bow-legged** appearance known as **Genu varus**. **Analysis of Incorrect Options:** * **A. Genu valgum (Knock-knees):** This is less common in primary OA. It occurs when the lateral compartment undergoes preferential degeneration. It is more frequently associated with Rheumatoid Arthritis or secondary OA. * **B. Genu recurvatum:** This refers to hyperextension of the knee. It is typically caused by ligamentous laxity (e.g., polio, Ehlers-Danlos syndrome) or quadriceps weakness, rather than primary degenerative changes. * **D. Procurvatum:** This is a forward bowing of the bone (fixed flexion deformity). While OA can lead to a fixed flexion deformity due to posterior capsular contracture, "Genu varus" is the classic coronal plane deformity described. **Clinical Pearls for NEET-PG:** * **Kellgren-Lawrence Grading:** The standard radiological classification for OA (Grade 0-4), based on joint space narrowing, osteophytes, and sclerosis. * **First Sign on X-ray:** Often subchondral sclerosis or small osteophytes; however, joint space narrowing is the hallmark. * **Management:** High Tibial Osteotomy (HTO) is a high-yield surgical option for young, active patients with isolated medial compartment OA and varus deformity to realign the weight-bearing axis. * **Heberden’s Nodes:** Found at the DIP joints (characteristic of primary OA).

Q: Stress fracture occurs most commonly in which of the following bones?

Metatarsals. **Explanation:** A **stress fracture** (also known as a fatigue fracture) occurs due to repetitive mechanical stress or rhythmic muscle action on a bone that has not had time to adapt to the load. Unlike traumatic fractures, these result from cumulative micro-trauma. **Why Metatarsals are correct:** The **metatarsals** are the most common site for stress fractures in the human body, specifically the **second and third metatarsals**. This is because they are relatively thin and rigid compared to the first metatarsal, bearing significant weight during the "toe-off" phase of the gait cycle. When occurring in the metatarsal shaft, it is classically referred to as a **"March Fracture,"** historically associated with military recruits or long-distance runners. **Analysis of Incorrect Options:** * **Metacarpals:** These are rare sites for stress fractures as they are not weight-bearing bones. * **Calcaneum:** This is the **second most common** site for stress fractures. It typically presents with heel pain aggravated by the "squeeze test" (mediolateral compression of the calcaneus). * **Talus:** While stress fractures can occur in the talar neck or body (often in athletes), they are significantly less common than those in the metatarsals or calcaneum. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site overall:** 2nd Metatarsal (March Fracture). * **Most common site in athletes:** Tibia (specifically the junction of the middle and lower thirds). * **Investigation of Choice:** **MRI** is the most sensitive and specific early investigation (shows marrow edema). * **X-ray findings:** Often negative in the first 2–3 weeks; later shows a faint hairline crack or exuberant callus formation. * **Female Athlete Triad:** Amenorrhea, disordered eating, and osteoporosis significantly increase the risk of stress fractures.

Question 1

Osteoarthritis is typically not seen in which of the following joints?

Accepted Answer

Ankle joints

Answer

Knee joints

Answer

Hip joints

Answer

First metacarpophalangeal joint

Question 2

Frieberg's disease involves which of the following?

Accepted Answer

2nd metatarsal

Answer

Tibial tuberosity

Answer

Calcaneal tuberosity

Answer

5th metatarsal

Question 3

A 56-year-old Type II diabetic presents with complaints of swelling in the left ankle with effusion but only minimal pain. X-rays show severe osteopenia with bone destruction, extensive osteophytosis, and loose bodies. Which of the following is NOT a component of the management of this patient?

Accepted Answer

Total ankle replacement

Answer

Resting and splinting

Answer

Aspiration and compression bandage

Answer

Ankle arthrodesis

Question 4

What is the deformity most commonly seen in primary osteoarthritis of the knee joint?

Accepted Answer

Genu varus

Answer

Genu valgum

Answer

Genu recurvatum

Answer

Procurvatum

Question 5

Stress fracture occurs most commonly in which of the following bones?

Accepted Answer

Metatarsals

Answer

Metacarpals

Answer

Calcaneum

Answer

Talus

Degenerative Disorders — MCQs

Degenerative Disorders — MCQs

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