Degenerative Disorders Practice Questions

Q: Which of the following joints is typically NOT involved in osteoarthritis?

Ankle joint. **Explanation:** Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of articular cartilage. It primarily affects **weight-bearing joints** and those subject to repetitive mechanical stress. **Why the Ankle Joint is the Correct Answer:** The **ankle joint** is remarkably resistant to primary osteoarthritis. This is due to the unique properties of its articular cartilage, which is thinner but more resilient to compressive forces compared to the hip or knee. Additionally, the ankle has a high degree of congruency and a specific metabolic profile that protects it from wear. OA in the ankle is almost always **secondary**, occurring after significant trauma (e.g., pilon fractures or chronic ligamentous instability) rather than as a primary degenerative process. **Analysis of Incorrect Options:** * **Hip Joint (A):** This is one of the most common sites for primary OA due to the high axial load it bears during ambulation. * **Distal Interphalangeal (DIP) Joints (B):** OA frequently involves the small joints of the hand. Involvement of the DIP joints leads to the formation of **Heberden’s nodes**, a classic clinical sign. * **Cervical Region (D):** The cervical and lumbar spine are common sites for OA (spondylosis), affecting the intervertebral discs and facet joints due to constant mobility and weight-bearing requirements. **Clinical Pearls for NEET-PG:** * **Nodal Involvement:** DIP joints = Heberden’s nodes; PIP joints = Bouchard’s nodes. * **Sparing Rule:** Primary OA typically **spares** the ankle, wrist, and elbow. If these joints are involved, look for a history of trauma or an underlying metabolic/inflammatory condition. * **Radiological Hallmarks:** Joint space narrowing, subchondral sclerosis, subchondral cysts, and osteophyte formation. * **First-line Management:** Weight loss and quadriceps strengthening exercises; Acetaminophen is the initial drug of choice for mild cases.

Q: What are the earliest imaging changes observed in stress fractures?

MRI. ### Explanation **Correct Answer: D. MRI** **Medical Concept:** Stress fractures occur due to repetitive submaximal loading that outpaces the bone's remodeling capacity. The earliest physiological change is **marrow edema** and hemorrhage. **MRI** is the most sensitive imaging modality (sensitivity ~99%) because it can detect these fluid changes and bone marrow signals within **24 to 72 hours** of symptom onset, long before structural cortical changes occur. **Analysis of Options:** * **A. Bone Scan (Technetium-99m):** Historically, this was the gold standard for early detection as it shows increased "hot spots" due to osteoblastic activity. However, it has been replaced by MRI because it lacks specificity (cannot easily distinguish between infection, tumor, or fracture) and involves ionizing radiation. * **B. Bone Biopsy:** This is an invasive procedure and is contraindicated for diagnosing stress fractures. It may actually lead to a misdiagnosis of osteosarcoma due to the presence of exuberant periosteal reaction and immature callus. * **C. CT Scan:** While CT is excellent for visualizing cortical "dreaded black lines" or subtle fractures in complex anatomy (like the tarsal navicular), it is less sensitive than MRI for detecting early-stage marrow edema. * **X-rays (Not listed but important):** Plain radiographs are usually **negative** in the first 2–3 weeks. The earliest sign on X-ray is often a subtle periosteal reaction or a "grey cortex" sign. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Sensitive:** MRI (STIR sequences are best for visualizing edema). * **Commonest Site:** Tibia (overall), followed by metatarsals (March fracture). * **Female Athlete Triad:** Amenorrhea, eating disorder, and osteoporosis; high risk for stress fractures. * **Dreaded Black Line:** Refers to a stress fracture on the anterior cortex of the tibia; it has a high risk of non-union.

Q: Which condition is associated with Froment's sign?

Ulnar nerve palsy. **Explanation:** **Froment’s sign** is a classic clinical test used to identify **Ulnar nerve palsy**, specifically assessing the paralysis of the **Adductor Pollicis** muscle. 1. **Why Ulnar Nerve Palsy is Correct:** The Adductor Pollicis is the only muscle of the thumb supplied by the Ulnar nerve. When a patient with ulnar nerve palsy is asked to hold a piece of paper between the thumb and the index finger (key pinch), they cannot adduct the thumb. To compensate and maintain grip, the patient recruits the **Flexor Pollicis Longus (FPL)**, which is supplied by the **Median nerve**. This results in visible **flexion of the thumb at the Interphalangeal (IP) joint**, constituting a positive Froment’s sign. 2. **Why Other Options are Incorrect:** * **Median nerve palsy:** This would result in "Ape thumb deformity" and loss of opposition (Opponens pollicis). In fact, the Median nerve is the "compensator" in Froment's sign, not the cause of the deficit. * **Musculocutaneous nerve palsy:** This affects the Biceps brachii and Brachialis, leading to loss of elbow flexion and forearm supination, but does not affect intrinsic hand muscles. * **Posterior interosseous nerve (PIN) palsy:** This is a branch of the Radial nerve. Palsy leads to "Finger drop" and "Thumb drop" (loss of extension), but does not affect thumb adduction. **High-Yield Clinical Pearls for NEET-PG:** * **Jeanne’s Sign:** If the IP joint flexes (Froment's) AND the Metacarpophalangeal (MCP) joint hyperextends simultaneously, it is called Jeanne’s sign (also seen in Ulnar nerve palsy). * **Wartenberg’s Sign:** Inability to adduct the little finger due to weakness of the 3rd Palmar Interosseous muscle. * **Mnemonic:** "Ulnar nerve is the Musician’s nerve" (controls fine intrinsic movements). * **Site of Lesion:** Froment's sign is positive in both high and low ulnar nerve palsies.

Q: Which carpal bone is most prone to avascular necrosis?

Scaphoid. **Explanation:** The **Scaphoid** is the most commonly fractured carpal bone and is uniquely susceptible to **Avascular Necrosis (AVN)** due to its peculiar blood supply. **Why Scaphoid is correct:** The blood supply to the scaphoid is **retrograde** (distal to proximal). Approximately 70-80% of the bone is covered by articular cartilage, leaving limited space for vascular entry. The primary blood supply comes from the dorsal carpal branch of the radial artery, which enters the bone at the **distal pole or waist**. Consequently, a fracture through the waist of the scaphoid can easily disrupt the blood flow to the **proximal pole**, leading to ischemia and subsequent AVN (Preiser’s disease). **Why other options are incorrect:** * **Talus:** While the talus is highly prone to AVN (Hawkins' sign), it is a **tarsal bone** of the foot, not a carpal bone. * **Pisiform:** This is a sesamoid bone within the Flexor Carpi Ulnaris tendon; it has a robust blood supply and is rarely associated with AVN. * **Navicular:** This is a **tarsal bone** located in the midfoot. While it can undergo AVN (Kohler’s disease in children or Mueller-Weiss syndrome in adults), it is not a carpal bone. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of scaphoid fracture:** The Waist (60-70%). * **Risk of AVN:** Increases the more proximal the fracture line is located. * **Radiology:** Scaphoid fractures may not appear on initial X-rays; if clinical suspicion exists (tenderness in the **Anatomical Snuffbox**), repeat X-rays in 10-14 days or perform an MRI (most sensitive). * **Kienbock’s Disease:** AVN of the **Lunate** (another high-yield carpal bone disorder).

Q: Which of the following is NOT a deformity of rheumatoid arthritis?

Claw hand. **Explanation:** The correct answer is **Claw hand** because it is a neurological deformity, not a primary manifestation of Rheumatoid Arthritis (RA). 1. **Claw Hand:** This deformity results from **peripheral nerve palsies**, most commonly the **Ulnar nerve** (at the wrist or elbow). It is characterized by hyperextension at the Metacarpophalangeal (MCP) joints and flexion at the Interphalangeal (IP) joints. While RA can cause nerve entrapment (like Carpal Tunnel Syndrome), "Claw hand" is classically associated with conditions like Leprosy, Syringomyelia, or Brachial Plexus injuries (Klumpke’s palsy). 2. **Why other options are incorrect (RA Deformities):** * **Swan neck deformity:** Caused by laxity of the volar plate, leading to **hyperextension of the PIP joint** and flexion of the DIP joint. * **Boutonnière deformity:** Results from the rupture or attenuation of the **central slip** of the extensor tendon, leading to **flexion of the PIP joint** and hyperextension of the DIP joint. * **Hallux valgus:** RA frequently involves the forefoot. Synovitis of the first MTP joint leads to lateral deviation of the great toe (Hallux valgus) and bunion formation. **Clinical Pearls for NEET-PG:** * **Earliest sign of RA on X-ray:** Periarticular osteopenia (juxta-articular rarefaction). * **Most common joint involved in RA:** MCP joints (specifically the 2nd and 3rd). * **Z-deformity:** Refers to radial deviation of the wrist with ulnar deviation of the fingers. * **Mnemonic for Boutonnière:** "Central slip is ripped" (Flexed PIP). * **Mnemonic for Swan Neck:** "Volar plate is late" (Extended PIP).

Q: Kienbock's disease is osteochondritis of which bone?

Lunate. **Explanation:** **Kienbock’s disease** is the idiopathic **avascular necrosis (AVN)** or osteochondritis of the **Lunate** bone. It typically affects the dominant hand of young adults (20–40 years) subjected to repetitive trauma. The underlying pathophysiology is often linked to **negative ulnar variance** (a shorter ulna), which leads to increased mechanical stress on the lunate between the radius and the capitate, resulting in microfractures and subsequent ischemia. **Analysis of Options:** * **Lunate (Correct):** As described, Kienbock’s is specific to this carpal bone. Diagnosis is made via X-ray (increased density/collapse) or MRI (early stages). * **Lower pole of patella:** This is known as **Sinding-Larsen-Johansson disease**, an overuse injury seen in active adolescents. * **Capitellum:** Osteochondritis dissecans of the capitellum is known as **Panner’s disease**, typically seen in young baseball pitchers. * **Navicular:** Osteochondritis of the tarsal navicular is **Kohler’s disease** (common in children), while AVN of the carpal scaphoid is known as **Preiser’s disease**. **High-Yield Clinical Pearls for NEET-PG:** * **Radiographic Sign:** Look for "negative ulnar variance" as a predisposing factor. * **Classification:** The **Lichtman Classification** is used to stage the disease (Stage I: Normal X-ray; Stage IV: Pancarpal arthritis). * **Treatment:** Early stages (I-II) may be treated with joint leveling procedures (e.g., radial shortening osteotomy); late stages (IV) require proximal row carpectomy or wrist arthrodesis.

Q: Primary osteoarthritis affects all joints except:

Metacarpophalangeal joint. **Explanation:** Primary Osteoarthritis (OA) is a chronic degenerative disorder of the articular cartilage, typically associated with aging and mechanical "wear and tear." It characteristically involves **weight-bearing joints** and specific small joints of the hand. **Why the Metacarpophalangeal (MCP) joint is the correct answer:** Primary OA characteristically **spares** the MCP joints, the wrists, and the elbows. If a patient presents with involvement of the MCP joints, clinicians must investigate for secondary causes, most notably **Rheumatoid Arthritis** (where MCP involvement is a hallmark) or metabolic conditions like **Hemochromatosis** (the "Iron-handler’s grip"). **Analysis of incorrect options:** * **Hip and Knee Joints (Options A & B):** These are the most common sites for primary OA due to the constant mechanical stress of weight-bearing. The knee is the most frequently affected large joint. * **Distal Interphalangeal (DIP) Joint (Option C):** This is a classic site for primary OA. Involvement here often leads to the formation of **Heberden’s nodes**. The Proximal Interphalangeal (PIP) joints are also commonly affected (Bouchard’s nodes). **NEET-PG High-Yield Pearls:** * **Nodal Distribution:** Primary OA typically involves the DIP, PIP, and the **1st Carpometacarpal (CMC) joint** (base of the thumb), leading to a "squared hand" appearance. * **Radiological Hallmarks (LOSS):** **L**oss of joint space (asymmetrical), **O**steophytes, **S**ubchondral sclerosis, and **S**ubchondral cysts. * **ESR/CRP:** Usually normal in primary OA, helping differentiate it from inflammatory arthritides. * **First-line Management:** Weight reduction and quadriceps strengthening exercises; Paracetamol is the initial drug of choice for pain.

Q: Which joint is LEAST involved in primary osteoarthritis?

Coraco-clavicular. **Explanation:** The correct answer is **D. Coraco-clavicular**. **1. Why Coraco-clavicular is the correct answer:** Primary Osteoarthritis (OA) typically affects **weight-bearing joints** and **high-mobility synovial joints**. The coraco-clavicular connection is primarily a syndesmosis (fibrous joint) maintained by the conoid and trapezoid ligaments. It is not a synovial joint and does not undergo the typical hyaline cartilage degeneration seen in primary OA. While the adjacent Acromioclavicular (AC) joint is a common site for OA, the coraco-clavicular space is rarely involved unless there is secondary ossification following trauma. **2. Analysis of Incorrect Options:** * **A. Hip:** This is a major weight-bearing ball-and-socket joint and is one of the most common sites for primary OA, often leading to total hip arthroplasty. * **B. Trapezio-metacarpal (1st CMC joint):** This is the most common site of primary OA in the hand (especially in post-menopausal women). It is a classic "high-yield" joint for OA questions. * **C. Knee:** The knee is the most common weight-bearing joint affected by primary OA globally, characterized by medial compartment narrowing. **3. Clinical Pearls for NEET-PG:** * **Most common joint in OA:** Knee. * **Most common hand joint in OA:** 1st Carpometacarpal (Trapezio-metacarpal) joint, followed by DIP joints (Heberden’s nodes) and PIP joints (Bouchard’s nodes). * **Joints typically SPARED in primary OA:** Wrist (except 1st CMC), Elbow, and Ankle. If OA is seen here, suspect **Secondary OA** (e.g., post-traumatic or hemophilic). * **Radiological Hallmarks:** Joint space narrowing, Osteophytes, Subchondral sclerosis, and Subchondral cysts (mnemonic: **LOSS**).

Question 1

Osteoarthritis commonly involves which of the following joints?

Accepted Answer

Proximal interphalangeal (IP) joint

Answer

Distal interphalangeal (IP) joint

Answer

First carpometacarpal (CMC) joint

Answer

Wrist joint

Question 2

Which of the following joints is typically NOT involved in osteoarthritis?

Accepted Answer

Ankle joint

Answer

Hip joint

Answer

Distal interphalangeal (DIP) joints

Answer

Cervical region

Question 3

What are the earliest imaging changes observed in stress fractures?

Accepted Answer

MRI

Answer

Bone scan

Answer

Bone biopsy

Answer

CT scan

Question 4

Which condition is associated with Froment's sign?

Accepted Answer

Ulnar nerve palsy

Answer

Median nerve palsy

Answer

Musculocutaneous nerve palsy

Answer

Posterior interosseous nerve palsy

Question 5

Which carpal bone is most prone to avascular necrosis?

Accepted Answer

Scaphoid

Answer

Talus

Answer

Pisiform

Answer

Navicular

Question 6

Which of the following is NOT a deformity of rheumatoid arthritis?

Accepted Answer

Claw hand

Answer

Swan neck deformity

Answer

Boutonnière deformity

Answer

Hallux valgus

Question 7

Kienbock's disease is osteochondritis of which bone?

Accepted Answer

Lunate

Answer

Lower pole of patella

Answer

Capitellum

Answer

Navicular

Question 8

Primary osteoarthritis affects all joints except:

Accepted Answer

Metacarpophalangeal joint

Answer

Hip Joint

Answer

Knee joint

Answer

Distal interphalangeal joint

Question 9

Which of the following statements regarding Mseleni joint disease is true?

Accepted Answer

It is endemic to the northern KwaZulu-Natal area in South Africa.

Answer

Shoulder, elbow, and wrist involvement is characteristic.

Answer

Elderly males are commonly involved.

Answer

Height is unaffected.

Question 10

Which joint is LEAST involved in primary osteoarthritis?

Accepted Answer

Coraco-clavicular

Answer

Hip

Answer

Trapezio-metacarpal

Answer

Knee

Degenerative Disorders — MCQs

Degenerative Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?