Osteoarthritis of Knee — MCQs
What is the primary action of metalloproteinases in the extracellular matrix?
Which of the following is NOT a radiological feature of osteoarthritis?
Which of the following is the difference between rheumatoid arthritis and osteoarthritis?
Part of knee most commonly involved in osteoarthritis:
Which of the following statements about osteoarthritis is false?
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?
During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
A 50-year-old woman presents with dull, aching pain in both shoulders and hips, associated with morning stiffness lasting more than 30 minutes. ESR is elevated. What is the most likely diagnosis?
Mrs. Katson, a 64-year-old obese woman with bilateral knee osteoarthritis, describes pain on most days and limiting pain at least 2 days per week. She has tried activity modification (walking less) without success. All of the following therapies have been shown to be efficacious EXCEPT:
Deformity is most commonly seen in primary osteoarthritis of the knee joint -
Osteoarthritis of Knee Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary action of metalloproteinases in the extracellular matrix?
- A. Modification of collagen structure
- B. Degradation of extracellular matrix components, including collagen (Correct Answer)
- C. Formation of collagen
- D. Activation of collagen synthesis
Explanation: ***Degradation of extracellular matrix components, including collagen*** - **Metalloproteinases (MMPs)** are a family of zinc-dependent endopeptidases that are crucial for breaking down various components of the **extracellular matrix (ECM)**. - This degradation is essential for processes like **tissue remodeling**, development, wound healing, and also plays a role in disease pathogenesis such as metastasis and inflammation. *Formation of collagen* - The formation of collagen is primarily mediated by **fibroblasts** and involves a complex process of synthesis, hydroxylation, glycosylation, and assembly of procollagen molecules, not MMPs. - MMPs act to break down existing collagen, not to create new collagen fibers. *Modification of collagen structure* - While collagen undergoes post-translational modifications (e.g., hydroxylation, glycosylation) within cells, MMPs are involved in cleaving the peptide bonds, leading to **degradation**, rather than structural modification of intact collagen. - Enzymes like **lysyl hydroxylase** and **prolyl hydroxylase** are responsible for modifying collagen structure. *Activation of collagen synthesis* - Collagen synthesis is primarily regulated by various **growth factors (e.g., TGF-β)** and hormones that stimulate fibroblasts to produce collagen. - MMPs are involved in the breakdown of collagen, which is the opposite of activating its synthesis.
Question 2: Which of the following is NOT a radiological feature of osteoarthritis?
- A. Osteophytes
- B. Cystic lesions close to articular surface.
- C. Narrowing of joint space
- D. Subchondral bone is translucent (Correct Answer)
Explanation: ***Subchondral bone is translucent*** - This is incorrect because **subchondral bone** in osteoarthritis becomes **sclerotic** and appears **more dense or opaque** radiographically, not translucent, due to increased bone formation as a response to cartilage loss. - **Translucency** would suggest reduced bone density, which is not characteristic of osteoarthritic changes in the subchondral bone. *Osteophytes* - **Osteophytes** (bone spurs) are a hallmark radiological feature of osteoarthritis, representing new bone formation at the joint margins. - They develop as the body attempts to increase the joint's surface area and distribute load more effectively. *Narrowing of joint space* - **Narrowing of the joint space** is a key radiological finding in osteoarthritis, indicating the progressive loss of **articular cartilage**. - This loss reduces the cushioning between bones, leading to direct bone-on-bone contact. *Cystic lesions close to articular surface.* - **Subchondral cysts** (geodes) are common in osteoarthritis, forming as a result of synovial fluid forced into the bone through microscopic cracks in the damaged articular cartilage. - These are typically visible as **radiolucent cystic lesions** adjacent to the joint surface.
Question 3: Which of the following is the difference between rheumatoid arthritis and osteoarthritis?
- A. Osteophytes are seen in osteoarthritis
- B. Systemic symptoms are seen in rheumatoid arthritis (Correct Answer)
- C. Rheumatoid arthritis is common in hands and feet
- D. Osteoarthritis is not an autoimmune disease
Explanation: The original Explanation **Systemic symptoms are seen in rheumatoid arthritis** * **Rheumatoid arthritis** is a **systemic autoimmune disease** that can affect various organs beyond the joints, leading to symptoms like **fatigue**, **fever**, weight loss, and **rheumatoid nodules** [1]. * **Osteoarthritis** is a localized joint disease primarily affecting the cartilage and bone, and it typically **does not cause systemic symptoms** [1]. *Osteophytes are seen in osteoarthritis* * While **osteophytes** (bone spurs) are characteristic of **osteoarthritis**, their presence alone does not differentiate it from rheumatoid arthritis, as other conditions can also feature these [1]. * The primary differentiator lies in the underlying **pathophysiology** (degenerative vs. inflammatory) and the presence of systemic manifestations [1]. *Rheumatoid arthritis is common in hands and feet* * It is true that **rheumatoid arthritis** commonly affects the **small joints of the hands and feet**, often in a **symmetrical pattern** [1]. * However, this statement describes a common site of involvement rather than a fundamental difference in the **nature of the disease** or its systemic impact. *Osteoarthritis is not an autoimmune disease* * This statement is correct; **osteoarthritis is not an autoimmune disease**, but rather a **degenerative joint disease**. * While true, it describes what osteoarthritis **is not**, rather than a defining clinical difference in presentation or systemic involvement compared to rheumatoid arthritis.
Question 4: Part of knee most commonly involved in osteoarthritis:
- A. Lateral compartment
- B. Medial compartment (Correct Answer)
- C. Patellofemoral compartment
- D. Medial and lateral compartments
Explanation: ***Medial compartment*** (Keep the correct option at the top and the incorrect options in the order they are provided in the input) - The **medial compartment** of the knee is subjected to greater weight-bearing forces during normal gait. - This increased stress leads to more frequent **cartilage degeneration** and **osteoarthritis** development in this compartment. *Lateral compartment* - While it can be affected, the **lateral compartment** bears less weight than the medial compartment in most individuals. - Therefore, **osteoarthritis** in the lateral compartment is less common as an initial presentation. *Patellofemoral compartment* - **Patellofemoral osteoarthritis** involves the joint between the kneecap and the thigh bone. - It often presents with pain related to **quadriceps activity** (e.g., stairs, squatting) and is a distinct pattern of involvement, less frequent than medial compartment OA overall. *Medial and lateral compartments* - While **osteoarthritis** can eventually affect multiple compartments, it typically begins in and is more prevalent in the **medial compartment**. - Simultaneous significant involvement of both compartments from the outset is less common than initial medial compartment disease.
Question 5: Which of the following statements about osteoarthritis is false?
- A. Progressive softening of the articular cartilage
- B. It is an inflammatory arthritis (Correct Answer)
- C. Does not involve synovial joints
- D. Does not produce marginal osteophytes
Explanation: ***It is an inflammatory arthritis*** - This statement is **false** because **osteoarthritis (OA)** is fundamentally a **degenerative joint disease**, not a primary inflammatory arthritis. - While it can have an inflammatory component, this is secondary to cartilage breakdown, and it does not share the systemic inflammatory features of conditions like rheumatoid arthritis. *Does not involve synovial joints* - This statement is false because **osteoarthritis** primarily affects **synovial joints**, such as the knees, hips, and hands. - It involves the progressive degeneration of articular cartilage within these synovial joints, leading to pain and dysfunction. *Progressive softening of the articular cartilage* - This statement is true, as **progressive softening of the articular cartilage** is a key pathological feature of **osteoarthritis**. - This softening precedes fibrillation and eventual loss of cartilage, leading to bone-on-bone contact and further joint damage. *Does not produce marginal osteophytes* - This statement is false because the formation of **marginal osteophytes** (bone spurs) is a hallmark feature of advanced **osteoarthritis**. - These bony outgrowths develop at the joint margins as the body attempts to repair or stabilize the damaged joint.
Question 6: 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 7: During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
- A. Osteolysis
- B. Osteomyelitis
- C. Osteonecrosis (Correct Answer)
- D. Osteogenesis
Explanation: ***Osteonecrosis*** - **Osteonecrosis**, also known as **avascular necrosis**, is characterized by the death of bone tissue due to a lack of blood supply, which leads to the collapse of the subchondral bone and articular cartilage destruction. - The description of **wedge-shaped subchondral depressions** and **articular cartilage destruction** is highly indicative of osteonecrosis, especially in the context of advanced hip joint pathology requiring total hip replacement. *Osteolysis* - **Osteolysis** refers to the active resorption of bone, often seen around implants in prosthetic joints due to wear particles, leading to bone loss. - While it involves bone destruction, it typically presents as diffuse bone loss rather than specific wedge-shaped subchondral depressions. *Osteomyelitis* - **Osteomyelitis** is an infection of the bone or bone marrow, often leading to bone destruction, but it is primarily characterized by inflammation and pus formation. - The presented scenario does not mention signs of infection (e.g., fever, pus, inflammation) but focuses purely on structural destruction consistent with vascular compromise. *Osteogenesis* - **Osteogenesis** is the process of bone formation or development. - This term describes the creation of bone tissue and is the opposite of bone destruction, making it an incorrect answer for a condition involving cartilage and bone deterioration.
Question 8: A 50-year-old woman presents with dull, aching pain in both shoulders and hips, associated with morning stiffness lasting more than 30 minutes. ESR is elevated. What is the most likely diagnosis?
- A. Rheumatoid arthritis
- B. Fibromyalgia
- C. Osteoarthritis
- D. Polymyalgia rheumatica (Correct Answer)
Explanation: ***Polymyalgia rheumatica*** - This condition is characterized by **bilateral aching and morning stiffness** in the **shoulders and hips** in individuals over 50, accompanied by an **elevated ESR**. [1] - Symptoms typically arise rapidly and respond well to **low-dose corticosteroids**. *Rheumatoid arthritis* - This typically affects **smaller joints symmetrically** (e.g., wrists, MCPs, PIPs) rather than primarily the shoulders and hips. [1] - While it can cause morning stiffness and elevated ESR, the **pattern of joint involvement** is different, and it's often associated with positive rheumatoid factor or anti-CCP antibodies. *Fibromyalgia* - Characterized by **widespread musculoskeletal pain** and tenderness at specific points, along with fatigue, sleep disturbances, and cognitive issues. [1] - Unlike polymyalgia rheumatica, fibromyalgia is not typically associated with inflammation, so **ESR is usually normal**. *Osteoarthritis* - This is a **degenerative joint disease** that causes pain, stiffness, and reduced range of motion, often in weight-bearing joints or those with previous injury. [1] - Morning stiffness is usually **less than 30 minutes**, and while ESR can be slightly elevated, it's not a primary feature of acute inflammation in the way it is with polymyalgia rheumatica.
Question 9: Mrs. Katson, a 64-year-old obese woman with bilateral knee osteoarthritis, describes pain on most days and limiting pain at least 2 days per week. She has tried activity modification (walking less) without success. All of the following therapies have been shown to be efficacious EXCEPT:
- A. Glucosamine-chondroitin (Correct Answer)
- B. Glucocorticoid steroid intra-articular injections
- C. Acetaminophen
- D. Total joint arthroplasty
Explanation: ***Glucosamine-chondroitin*** - While widely used and marketed for osteoarthritis, numerous **large, well-designed clinical trials** have consistently shown that **glucosamine-chondroitin supplements** are **not more effective than placebo** in alleviating pain or improving function in osteoarthritis. - The American College of Rheumatology (ACR) and other major medical organizations **do not recommend** its use due to a lack of evidence of efficacy. *Glucocorticoid steroid intra-articular injections* - **Intra-articular corticosteroid injections** provide **short-term pain relief** [1] and reduce inflammation in patients with osteoarthritis, especially during flares. - They are a commonly used and effective treatment for **symptomatic knee osteoarthritis** [1], although repeated injections have potential risks and may not alter long-term disease progression. *Acetaminophen* - **Acetaminophen (paracetamol)** is often recommended as a **first-line oral analgesic** for mild to moderate pain in osteoarthritis due to its relatively favorable side effect profile compared to NSAIDs for long-term use. - It works by **inhibiting prostaglandin synthesis** primarily in the central nervous system, reducing pain perception. *Total joint arthroplasty* - **Total joint arthroplasty (TJA)**, particularly **total knee replacement**, is a highly effective surgical treatment for patients with **severe, end-stage osteoarthritis** [1] who have failed conservative therapies. - It significantly **reduces pain and improves functional outcomes** [1] and quality of life for the vast majority of patients.
Question 10: Deformity is most commonly seen in primary osteoarthritis of the knee joint -
- A. Genu varus (Correct Answer)
- B. Genu valgum
- C. Genu recurvatum
- D. Flexion contracture
Explanation: ***Genu varus*** - **Genu varus** (bow-legged deformity) is the most common angular deformity seen in **primary osteoarthritis of the knee**, particularly due to greater wear in the medial compartment. - This deformity places increased stress on the medial compartment, exacerbating the progression of osteoarthritis in that region. *Genu valgum* - **Genu valgum** (knock-knee deformity) is less common in primary knee osteoarthritis compared to genu varus. - It typically results from greater involvement of the **lateral compartment** of the knee joint. *Genu recurvatum* - **Genu recurvatum** is characterized by hyperextension of the knee joint. - This deformity is often associated with ligamentous laxity or neuromuscular conditions, rather than being the primary or most common deformity in knee osteoarthritis. *Flexion contracture* - A **flexion contracture** refers to the inability to fully extend the knee, causing the knee to be perpetually bent. - While common in advanced knee osteoarthritis due to pain, muscle spasm, and joint space narrowing, it is a contracture, not an angular deformity like genu varus or valgus.
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