Degenerative Disorders — MCQs

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?

Degenerative Disorders Indian Medical PG Practice Questions and MCQs

Question 51: 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.

Question 52: A 68-year-old man presents with pain and swelling of the right knee. Investigations reveal Ahlbäck grade 2 osteoarthritic changes. What is the further management?

A. High tibial osteotomy
B. Total knee replacement
C. Conservative (Correct Answer)
D. Arthroscopic washout

Explanation: ***Conservative care*** - **Ahlbäck grade 2** is considered mild to moderate **osteoarthritis**; therefore, initial management should focus on non-surgical interventions. - This includes **pain management** (NSAIDs, analgesics), **physiotherapy**, **weight loss**, and **activity modification**. *High tibial osteotomy* - This procedure is typically reserved for **younger patients** with **varus deformity** and **unicompartmental osteoarthritis** to realign the knee, which is not indicated in this case for a 68-year-old. - It aims to shift the weight-bearing axis away from the damaged compartment to an healthier area, often considered when **total knee replacement** is being delayed. *Total knee replacement* - This is a definitive surgical option for **severe, end-stage osteoarthritis** that has failed conservative management. - Given the patient's **Ahlbäck grade 2**, less invasive treatments should be tried first as this grade does not typically warrant immediate total knee replacement. *Arthroscopic washout* - While it can provide temporary relief of symptoms by removing debris, its **long-term efficacy** in managing **osteoarthritis** has been extensively debated and is generally not recommended as a primary treatment for knee osteoarthritis. - There is little evidence to suggest that it alters the progression of the disease or provides sustained pain relief in **mild to moderate osteoarthritis**.

Question 53: Avascular necrosis is seen in:

A. Corticosteroid use
B. Alcoholism
C. Both corticosteroid use and alcoholism (Correct Answer)
D. Trauma only

Explanation: ***Both corticosteroid use and alcoholism*** - Long-term **corticosteroid use** is a well-established risk factor for avascular necrosis, particularly affecting the femoral head. - **Chronic alcoholism** is also strongly associated with avascular necrosis due to its effects on lipid metabolism and microcirculation. *Corticosteroid use* - While corticosteroid use is a known cause, this option is incomplete as it omits other significant risk factors. - Steroid-induced AVN is thought to be related to **lipid emboli** or direct damage to osteocytes. *Alcoholism* - Alcoholism does contribute to avascular necrosis by affecting **fat metabolism** and disrupting blood flow. - However, this option is also incomplete as it does not include other major causes such as corticosteroid use. *Trauma only* - While **trauma** (e.g., femoral neck fracture) is a significant cause of avascular necrosis due to disruption of blood supply, it is not the *only* cause. - Many cases of avascular necrosis, especially in the hip, are **non-traumatic** and linked to systemic risk factors.

Question 54: Following are the common sites of Avascular necrosis, EXCEPT:

A. Head of the femur
B. The body of talus
C. Patella (Correct Answer)
D. Proximal half of scaphoid

Explanation: ***Patella*** - The patella is rarely affected by **avascular necrosis (AVN)** due to its robust and redundant blood supply, making it an exception to common AVN sites. - While patellar fractures can compromise local blood flow, spontaneous or atraumatic AVN of the patella is exceedingly uncommon compared to other skeletal sites. *Head of the femur* - The **femoral head** is the most common site for **avascular necrosis** due to its precarious blood supply, especially after trauma (e.g., hip dislocation, femoral neck fracture) or in systemic conditions. - Its blood supply relies heavily on the **medial circumflex femoral artery**, which can be easily disrupted. *The body of talus* - The **talus** is highly susceptible to **avascular necrosis**, particularly after fractures or dislocations, as its blood supply enters through a limited number of soft tissue attachments. - The **body of the talus** receives a significant portion of its blood supply from vessels that can be easily compromised by injury. *Proximal half of scaphoid* - The **proximal pole of the scaphoid** is notoriously prone to **avascular necrosis** following scaphoid fractures because its blood supply enters primarily from the distal pole. - A disruption of blood flow (e.g., via the **dorsal carpal branch** of the radial artery) due to a fracture can lead to **non-union** and AVN of the proximal fragment.

Question 55: 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 56: Genu recurvatum is seen in:

A. Rickets
B. Rheumatoid arthritis
C. Poliomyelitis
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Genu recurvatum**, or **hyperextension of the knee**, can result from various conditions that weaken the quadriceps or cause ligamentous laxity. - **Rickets**, **rheumatoid arthritis**, and **poliomyelitis** all compromise the structural integrity or muscular control essential for normal knee alignment. *Rickets* - In **rickets**, defective bone mineralization leads to **softening of bones**, including those of the knee. - This can result in structural deformities and ligamentous laxity, predisposing to genu recurvatum. *Rheumatoid arthritis* - **Rheumatoid arthritis** causes joint destruction, inflammation, and **ligamentous laxity**, particularly in the knee joint. - Chronic inflammation and damage to the knee capsule and ligaments can lead to instability and genu recurvatum over time. *Poliomyelitis* - **Poliomyelitis** by definition is a **paralytic disease**. It selectively attacks **motor neurons**, leading to **muscle weakness** and paralysis, often affecting the quadriceps. - Weakness of the quadriceps muscle, which normally stabilizes the knee, can result in hyperextension (genu recurvatum) for compensatory stability during weight-bearing.

Question 57: All of the following are the types of endemic Osteoarthritis except :

A. Mueller-Weiss disease (Correct Answer)
B. Handigodu joint disease
C. Kashin-Beck's disease
D. Mseleni joint disease

Explanation: ***Mueller-Weiss disease*** - This is a rare **osteonecrosis** of the **navicular bone** in the foot, primarily affecting adults. - It is not classified as an endemic osteoarthritis but rather an **avascular necrosis** with unknown etiology. *Handigodu joint disease* - This is a form of **endemic osteoarthritis** found in specific regions of **South India** (Karnataka). - It is characterized by severe osteoarthritis affecting multiple joints, often associated with environmental factors. *Kashin-Beck's disease* - This is an **endemic osteochondropathy** primarily affecting **children and adolescents** in certain regions of China, Siberia, and North Korea, often linked to selenium deficiency. - It results in widespread **cartilage degeneration** and secondary osteoarthritis. *Mseleni joint disease* - This is an **endemic osteoarthritis** prevalent in the **Mseleni region of South Africa**. - It is characterized by progressive osteoarthritis of large joints and is linked to environmental toxins or nutritional deficiencies.

Question 58: Most common cause of AVN of the hip is -

A. Corticosteroid use
B. Alcoholism
C. Fracture neck of femur
D. Idiopathic (Correct Answer)

Explanation: ***Idiopathic*** - The most common cause of **avascular necrosis (AVN)** of the hip is **idiopathic**, meaning no specific underlying cause can be identified. - While many risk factors are associated with AVN, a significant proportion of cases occur without a clear etiology, making **idiopathic AVN** the most frequent presentation. *Corticosteroid use* - **Corticosteroid use** is a major **risk factor** for AVN, but it is not the most common cause overall, as not all cases are associated with steroid exposure. - Long-term use of **high-dose corticosteroids** can disrupt blood supply to the bone by various mechanisms, including **fat emboli** and **vasoconstriction**. *Alcoholism* - **Alcoholism** is another significant **risk factor** for AVN, contributing to a substantial number of cases. - Excessive alcohol consumption can lead to **fatty liver disease** and fat emboli, which can obstruct the blood vessels supplying the femoral head. *Fracture neck of femur* - A **fracture of the neck of the femur** is a well-known cause of **traumatic AVN** due to damage to the blood supply, particularly the **medial circumflex femoral artery**. - However, when considering all causes, including non-traumatic forms, fractures represent a specific subgroup rather than the overall most common cause.

Question 59: Choose the wrong statement regarding chondromalacia patella _____:

A. There is increasing osteoporosis of the patella (Correct Answer)
B. It primarily affects the articular cartilage of the patella
C. It is commonly associated with vastus medialis weakness
D. It commonly affects the lateral facet and central ridge of the patella

Explanation: ***There is increasing osteoporosis of the patella*** - This statement is incorrect because **chondromalacia patella** is characterized by the softening and breakdown of the **articular cartilage** of the patella, not by **osteoporosis** of the patellar bone itself. - While prolonged disuse or altered biomechanics might lead to some bone changes, **osteoporosis** is not a primary or defining feature of chondromalacia patella. *It primarily affects the articular cartilage of the patella* - This statement is correct. **Chondromalacia patella** refers specifically to the damage and softening of the **hyaline cartilage** on the posterior aspect of the kneecap. - This condition involves the **degeneration** of the smooth, protective cartilage that allows the patella to glide smoothly over the trochlear groove of the femur. *It is commonly associated with vastus medialis weakness* - This statement is correct. Weakness of the **vastus medialis obliquus (VMO)** can lead to an imbalance in the forces acting on the patella, causing it to track laterally. - This **improper tracking** increases stress and friction on the patellar cartilage, contributing to the development or exacerbation of chondromalacia patella. *It commonly affects the lateral facet and central ridge of the patella* - This statement is correct. Due to the biomechanics of the patellofemoral joint, especially in cases of **maltracking**, the **lateral facet** and the **central ridge** of the patella are frequently subjected to increased pressure and friction. - This concentrated stress on these specific areas makes them particularly vulnerable to **cartilage softening and erosion** in chondromalacia patella.

Question 60: 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.

Practice by Chapter

Osteoarthritis: Pathophysiology

Practice Questions

Osteoarthritis of Hip

Practice Questions

Osteoarthritis of Knee

Practice Questions

Osteoarthritis of Shoulder

Practice Questions

Osteoarthritis of Ankle and Foot

Practice Questions

Degenerative Spinal Conditions

Practice Questions

Conservative Management of Degenerative Disorders

Practice Questions

Pharmacotherapy of Osteoarthritis

Practice Questions

Surgical Options for Osteoarthritis

Practice Questions

Rehabilitation in Degenerative Disorders

Practice Questions

Novel Therapies in Osteoarthritis

Practice Questions

Quality of Life Assessment

Practice Questions

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