Conservative Management of Degenerative Disorders — MCQs

10 questions

Severe disability in primary osteoarthritis of hip is best managed by -

A 70-year-old man has had a long-term "bowlegged" condition but recently his right knee has become warm, swollen, and tender. He reports no recent trauma and gets no relief with rest or Tylenol (paracetamol). He is otherwise in good health and takes no medication. X-rays show arthritis of the knee. Which would be the best treatment?

Osteoarthritis is associated with all of the following except -

Osteoarthritis not seen in ?

A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?

A drug that is effective for rheumatoid arthritis but is not appropriate for osteoarthritis is :

Not true about osteoarthritis

Halopelvic traction is primarily used for correcting which specific spinal deformity?

Open reduction (OR) is not required in which fracture?

Q10

Drugs used in management of migraine include the following except?

Conservative Management of Degenerative Disorders Indian Medical PG Practice Questions and MCQs

Question 1: Severe disability in primary osteoarthritis of hip is best managed by -

A. Arthroplasty (Correct Answer)
B. Arthrodesis
C. Mc Murray's osteotomy
D. Intra-articular hydrocortisone and physiotherapy

Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.

Question 2: A 70-year-old man has had a long-term "bowlegged" condition but recently his right knee has become warm, swollen, and tender. He reports no recent trauma and gets no relief with rest or Tylenol (paracetamol). He is otherwise in good health and takes no medication. X-rays show arthritis of the knee. Which would be the best treatment?

A. Intra-articular steroid injection, bed rest, and analgesics
B. Bed rest, anti-inflammatory agents, analgesics, and a knee brace
C. Long-leg cast and crutches for 3 weeks, analgesics, and anti-inflammatory agents
D. Use of a cane for ambulating, restriction of knee-bending activities, and implementation of muscle-strengthening exercises (Correct Answer)

Explanation: ***Use of a cane for ambulating, restriction of knee-bending activities, and implementation of muscle-strengthening exercises*** - This approach focuses on **conservative management** to reduce stress on the joint, improve stability, and strengthen supporting muscles, which is appropriate for **osteoarthritis exacerbation** in a "bowlegged" patient. - A cane shifts weight away from the affected knee, rest reduces repetitive stress, and strengthening exercises enhance **joint support** without invasive procedures. *Intra-articular steroid injection, bed rest, and analgesics* - While an intra-articular steroid injection can provide **short-term pain relief** for inflamed joints, it does not address the underlying biomechanical issues of osteoarthritis or provide long-term functional improvement. - Repeated injections carry risks such as **cartilage damage** and infection, and bed rest alone does not promote joint health. *Long-leg cast and crutches for 3 weeks, analgesics, and anti-inflammatory agents* - A long-leg cast is typically used for **fractures** or severe ligamentous injuries to immobilize the joint, which is **not indicated** for an osteoarthritis flare-up. - Prolonged immobilization can lead to **muscle atrophy** and joint stiffness, worsening the condition in the long run. *Bed rest, anti-inflammatory agents, analgesics, and a knee brace* - While anti-inflammatory agents and analgesics can help manage pain and inflammation, **prolonged bed rest** is generally discouraged as it can lead to deconditioning and muscle weakness. - A knee brace might offer some support, but without **active rehabilitation** and lifestyle modifications, it is unlikely to provide a comprehensive treatment for long-term management of osteoarthritis.

Question 3: Osteoarthritis is associated with all of the following except -

A. Subchondral sclerosis
B. Ca++deposition in joint space (Correct Answer)
C. Osteophyte formation
D. Decreased joint space

Explanation: ***Ca++deposition in joint space*** - **Calcium pyrophosphate dihydrate (CPPD) crystal deposition** in the joint space is characteristic of **pseudogout**, not osteoarthritis [1]. - While some **calcification** may occur in osteophytes, direct **calcium crystal deposition** in the synovial fluid is not a primary feature of osteoarthritis [1]. *Subchondral sclerosis* - **Subchondral sclerosis** refers to the increased bone density that occurs beneath the cartilage in areas of stress in osteoarthritis. - This is a common radiological finding in osteoarthritis, reflecting the bone's response to increased mechanical load. *Osteophyte formation* - **Osteophytes** (bone spurs) are bony projections that form along the joint margins in osteoarthritis [2]. - They are a hallmark feature of the disease, resulting from the body's attempt to repair and stabilize the damaged joint [2]. *Decreased joint space* - **Decreased joint space** on radiographs is a classic sign of osteoarthritis, indicating loss of articular cartilage thickness [2]. - As the cartilage erodes, the distance between the bones within the joint decreases. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 683-684. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1210-1212.

Question 4: Osteoarthritis not seen in ?

A. Ankle joints (Correct Answer)
B. Knee joints
C. Hip joints
D. 1st metacarpophalangeal joint

Explanation: ***Ankle joints*** - While other joints are frequently affected by osteoarthritis, the **ankle joint** is *relatively spared* from primary osteoarthritis. - Osteoarthritis in the ankle is more commonly **secondary** to trauma, inflammation, or structural abnormalities rather than a primary degenerative process. *Knee joints* - The **knee joint** is one of the most frequently affected joints in osteoarthritis due to its weight-bearing function and complex biomechanics. - **Cartilage degeneration** in the knee leads to pain, stiffness, and reduced mobility. *Hip joints* - The **hip joint** is another common site for osteoarthritis, particularly in older adults, due to its significant weight-bearing role. - **Acetabular and femoral head cartilage erosion** causes deep groin pain and restricted range of motion. *1st metacarpophalangeal joint* - The **1st metacarpophalangeal (MCP) joint** of the thumb is a common site for osteoarthritis, especially in women. - This is due to the significant **stress and forces** placed on this joint during pinching and gripping activities.

Question 5: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?

A. Conservative management
B. Total knee replacement (Correct Answer)
C. Arthroscopic washing
D. Partial knee replacement

Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.

Question 6: A drug that is effective for rheumatoid arthritis but is not appropriate for osteoarthritis is :

A. Infliximab (Correct Answer)
B. Rofecoxib
C. Acetaminophen
D. Ketorolac

Explanation: ***Infliximab*** - **Infliximab** is a **biologic disease-modifying antirheumatic drug (DMARD)**, specifically a TNF-alpha inhibitor, used to treat **autoimmune inflammatory conditions** like rheumatoid arthritis. - Its mechanism involves modulating the immune system to reduce inflammation, which is not applicable to the **degenerative process** seen in osteoarthritis. *Rofecoxib* - **Rofecoxib** was a **COX-2 selective NSAID** used for pain and inflammation in both rheumatoid arthritis and osteoarthritis. - It was withdrawn from the market due to increased cardiovascular risk, but its initial indication covered both conditions for symptomatic relief. *Acetaminophen* - **Acetaminophen** (paracetamol) is an **analgesic** and **antipyretic** primarily used for pain relief in both osteoarthritis and rheumatoid arthritis. - It does not have significant anti-inflammatory properties and therefore is not a disease-modifying agent for rheumatoid arthritis. *Ketorolac* - **Ketorolac** is a potent **non-selective NSAID** commonly used for **acute pain** of moderate to severe intensity. - It provides symptomatic relief for pain and inflammation in both osteoarthritis and rheumatoid arthritis but does not alter the disease course in either condition.

Question 7: Not true about osteoarthritis

A. Narrowing of joint space
B. Non-Inflammatory condition
C. Most common joint disease
D. DIP joint is spared (Correct Answer)

Explanation: ***DIP joint is spared*** - This statement is **incorrect** because **distal interphalangeal (DIP) joints** are commonly affected in osteoarthritis. - In fact, the presence of **Heberden's nodes** (at the DIP joints) and **Bouchard's nodes** (at the PIP joints) are characteristic features of osteoarthritis. *Narrowing of joint space* - **Joint space narrowing** is a hallmark radiological feature of osteoarthritis, resulting from **cartilage loss**. - This loss of articular cartilage leads to bones rubbing against each other, causing pain and further damage [2]. *Non-Inflammatory condition* - Osteoarthritis is primarily considered a **degenerative disease** rather than a pure inflammatory one, though inflammation can play a secondary role [1]. - The dominant pathology involves the breakdown of **articular cartilage** and changes in the bone below [1], [2]. *Most common joint disease* - Osteoarthritis is indeed the **most prevalent form of arthritis** and a leading cause of disability worldwide. - It affects millions of people, particularly with increasing age, due to wear and tear on the joints [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 675-676. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1210-1212.

Question 8: Halopelvic traction is primarily used for correcting which specific spinal deformity?

A. Kyphosis (Correct Answer)
B. Spondylolisthesis
C. Scoliosis
D. Spinal stenosis

Explanation: **Kyphosis** * **Halopelvic traction** is a technique specifically designed to apply sustained corrective forces to the spine, making it particularly effective in treating severe **kyphosis**, especially in young patients prior to surgical correction. * It aids in gradually stretching soft tissues and straightening the spinal curvature over time, often used in cases of congenital or severe developmental kyphosis. *Scoliosis* * While traction can be used in some spinal deformities, **scoliosis** (lateral curvature) is more commonly treated with **bracing** or **surgical fusion**, as halopelvic traction is less effective in correcting the rotational component. * Correction of scoliotic curves typically involves forces applied in multiple planes, which halopelvic traction is not ideally suited for. *Spondylolisthesis* * **Spondylolisthesis** involves the **slippage of one vertebra over another**, which is primarily managed through **stabilization** to prevent further slippage. * Halopelvic traction is not indicated as it could potentially exacerbate instability in the presence of vertebral slippage. *Spinal stenosis* * **Spinal stenosis** refers to the **narrowing of the spinal canal**, which compresses nerves and is usually treated with **decompressive surgery** or **conservative management** for pain relief. * Traction methods are generally not used for spinal stenosis as they do not address the underlying anatomical narrowing and may worsen symptoms.

Question 9: Open reduction (OR) is not required in which fracture?

A. Fracture of the patella
B. Fracture of the outer one-third of the radius (Correct Answer)
C. Displaced fracture of the olecranon
D. Fracture of the condyle of the humerus

Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.

Question 10: Drugs used in management of migraine include the following except?

A. Topiramate
B. Valproate
C. Ethosuximide (Correct Answer)
D. Verapamil

Explanation: ***Ethosuximide*** - **Ethosuximide** is an anti-epileptic drug primarily used to treat **absence seizures** by blocking T-type calcium channels [1]. - It has no established role in the **acute** or **prophylactic** management of migraine headaches. *Topiramate* - **Topiramate** is an anti-epileptic drug that is also approved for **migraine prophylaxis**. - Its mechanism of action in migraine includes modulating **GABA receptors**, blocking **voltage-sensitive sodium channels**, and inhibiting **carbonic anhydrase** [2]. *Valproate* - **Valproate** (valproic acid) is an anti-epileptic drug and mood stabilizer commonly used for **migraine prevention**. - Its migraine prophylactic effect is believed to involve increasing **GABA levels** and modulating **neurotransmitter release** [1]. *Verapamil* - **Verapamil** is a **calcium channel blocker** sometimes used off-label for **migraine prophylaxis**, particularly in cases of difficult-to-treat migraines or specific subtypes like **hemiplegic migraine**. - It works by reducing cerebral vasospasm and stabilizing neuronal membranes.

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