Degenerative Disorders — MCQs

Degenerative Disorders Indian Medical PG Practice Questions and MCQs

Question 61: According to Boyd's classification, when the pain continues but the patient can still walk with effort is:

A. Pain necessitating rest
B. Pain persists but walking is possible with effort (Correct Answer)
C. Pain disappears with walking
D. Severe pain preventing any movement

Explanation: ***Pain persists but walking is possible with effort*** - This description aligns precisely with Boyd's classification for **intermittent claudication** where the patient experiences pain during ambulation but can continue to walk, albeit with notable effort. - It represents a specific grade in the severity continuum of claudication, indicating a functional limitation that is not yet incapacitating. *Pain necessitating rest* - This stage implies a more severe level of claudication where pain becomes **intolerable** during walking and requires the patient to stop and rest for recovery. - It indicates a greater compromise in blood supply to the muscles compared to just pain with effort. *Pain disappears with walking* - This statement is contradictory to the nature of claudication, which is defined by pain brought on or worsened by ambulation. - Pain that disappears with walking would suggest a different underlying pathology, not **vascular claudication**. *Severe pain preventing any movement* - This describes a state of **critical limb ischemia** or rest pain, a much more advanced and serious condition than intermittent claudication. - In this scenario, the pain is so severe that it prevents any movement, often indicating impending tissue loss.

Question 62: A 40-year-old presents with chronic shoulder pain and restricted ROM. X-ray shows decreased joint space. Most likely diagnosis?

A. Osteoarthritis (Correct Answer)
B. Adhesive Capsulitis
C. Impingement Syndrome
D. Rotator Cuff Tear

Explanation: ***Osteoarthritis*** - **Chronic shoulder pain** and **restricted range of motion (ROM)**, coupled with **decreased joint space** on X-ray, are classic signs of osteoarthritis. - This condition involves the **degeneration of articular cartilage**, leading to bone-on-bone friction and joint space narrowing. *Adhesive Capsulitis* - While it causes significant **restricted ROM** and pain, X-rays typically show a **normal joint space** in the early stages, as it primarily affects the joint capsule. - The primary pathology is **fibrosis and thickening of the joint capsule**, not cartilage loss. *Impingement Syndrome* - Characterized by pain, especially with overhead activities, due to the **compression of tendons** (often the rotator cuff) under the acromion. - X-rays usually do not show **decreased joint space** but may reveal spurs or acromial morphology predisposing to impingement. *Rotator Cuff Tear* - Causes pain and weakness, particularly during arm elevation or rotation, and can lead to restricted ROM due to pain or structural damage. - X-rays are typically **normal** or show secondary changes like **humeral head elevation** in chronic, massive tears, but not primary loss of joint space.

Question 63: Keinbock's disease is osteochondritis of ?

A. Scaphoid
B. Lunate (Correct Answer)
C. Calcaneum
D. Tibial tuberosity

Explanation: ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.

Question 64: Which condition can lead to the formation of loose bodies in the joint?

A. Rheumatoid arthritis
B. Ankylosing spondylitis
C. Osteoarthritis (Correct Answer)
D. Systemic lupus erythematosus

Explanation: ***Osteoarthritis*** - In **osteoarthritis**, the **degenerative process** of cartilage can lead to fragments breaking off and floating within the joint space, forming **loose bodies**. - These loose bodies, also known as **joint mice**, can cause mechanical symptoms like locking, clicking, or catching in the joint. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an **inflammatory autoimmune disease** primarily affecting the synovium. - While it can cause joint damage, it typically does not lead to the formation of cartilaginous or bony loose bodies. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints. - Its hallmark is new bone formation and fusion of vertebrae, not the formation of loose bodies within the joint. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease that can affect multiple organs, including joints. - While it can cause **non-erosive arthritis**, it does not typically result in the formation of loose bodies.

Question 65: Triple deformity of the knee includes all except:

A. Lateral rotation of tibia
B. Flexion
C. Posterior subluxation of tibia
D. Medial rotation of tibia (Correct Answer)

Explanation: ***Medial rotation of tibia*** - The "triple deformity of the knee" in **posterior cruciate ligament (PCL) injury** refers to a combination of three specific physical findings: **posterior subluxation of the tibia**, **lateral rotation of the tibia**, and **flexion of the knee**. - **Medial rotation** is not typically part of this specific pathological triad. *Posterior subluxation of tibia* - This is a key component of the triple deformity, indicating the tibia has shifted **posteriorly** relative to the femur. - It arises from the loss of the PCL's primary restraint against posterior tibial translation. *Lateral rotation of tibia* - This is another characteristic component, where the tibia exhibits **excessive external rotation** relative to the femur. - This often contributes to the overall instability and compensatory mechanisms seen in PCL deficiency. *Flexion* - The knee often assumes a position of **flexion** at rest or during gait in patients with a triple deformity. - This can be due to compensatory mechanisms or the inability to fully extend the knee given the other deformities.

Question 66: 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 67: Triple deformity of the knee includes the following components, which one is not typically associated with it?

A. Flexion of knee
B. Internal rotation of tibia
C. Anterior subluxation of tibia
D. Extension of knee (Correct Answer)

Explanation: ***Extension of knee*** - The "triple deformity of the knee" typically refers to the opposite of extension, which is **knee flexion**, along with other specific rotational and translational deformities. - **Knee extension** is not a component of this deformity; rather, a loss of full extension is often observed. *Flexion of knee* - **Knee flexion** is a characteristic component of the triple deformity, often presenting as a fixed flexion contracture. - This persistent flexed position contributes significantly to functional impairment. *Internal rotation of tibia* - **Internal rotation of the tibia** relative to the femur is a key rotational component of the described triple deformity. - This rotational malalignment contributes to the overall structural distortion of the knee joint. *Anterior subluxation of tibia* - **Anterior subluxation of the tibia** on the femur is the translational component of the triple deformity. - This displacement indicates instability and further compromises the biomechanics of the joint.

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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