Arthritis (Rheumatoid, Osteoarthritis, Crystal Arthropathy) MCQs

Orthopedics · 32 free questions with answers & explanations.

1. A 55-year-old woman presents with bilateral knee pain that is worse after prolonged activity and relieved by rest. X-rays show joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts. She has no morning stiffness beyond 20 minutes. The most likely diagnosis is:
2. A 50-year-old man presents with acute monoarthritis of the first metatarsophalangeal joint with severe redness, swelling, and tenderness. Serum uric acid is 9.2 mg/dL. Joint fluid microscopy shows negatively birefringent needle-shaped crystals. The most appropriate acute treatment is:
3. A 55-year-old woman with severe end-stage rheumatoid arthritis of both knees affecting activities of daily living, despite maximal medical therapy, is referred for surgical management. The procedure of choice is:
4. In gout, the key enzyme deficiency in the Lesch-Nyhan syndrome that leads to hyperuricemia and gouty arthritis is:
5. A 62-year-old man with symptomatic varus gonarthrosis (medial compartment OA) and moderate deformity presents requesting joint-preserving surgery. He has an active lifestyle and is BMI 27. High tibial osteotomy (HTO) is planned. The ideal correction target for valgus-producing HTO is to achieve:
6. A patient with severe tricompartmental osteoarthritis of the knee is planned for total knee replacement (TKR). The PRIMARY biomechanical goal of TKR is:
7. In rheumatoid arthritis of the foot, the first metatarsophalangeal (MTP) joint develops a characteristic deformity of:
8. In rheumatoid arthritis of the wrist, the specific deformity of the carpus on X-ray showing volar subluxation and ulnar translation of the carpus on the distal radius is described as:
9. A 72-year-old obese man with bilateral knee osteoarthritis has medial compartment joint space loss, varus deformity of 8°, and intact ACL on MRI. He is a poor surgical candidate for TKR. The most appropriate joint-preserving surgical option is:
10. In calcium pyrophosphate deposition (CPPD) disease, the typical joint involved in 'pseudo-osteoarthritis' pattern is the wrist. Which specific radiological finding distinguishes CPPD from calcium hydroxyapatite deposition disease (HADD)?
11. A 55-year-old woman with advanced knee osteoarthritis, BMI 31, and well-controlled type 2 diabetes is listed for total knee replacement (TKR). During templating, her hip-knee-ankle axis shows 10° varus malalignment. Which neutral mechanical axis correction is the TARGET of TKR alignment?
12. A 60-year-old man with longstanding rheumatoid arthritis has cervical spine involvement. Pre-operative assessment for elective hip replacement reveals atlantoaxial instability on flexion-extension X-rays with anterior atlantodental interval (AADI) of 6 mm. What is the CORRECT anaesthetic implication?
13. A 58-year-old woman with severe bilateral knee OA is planned for total knee arthroplasty. Pre-operative X-ray shows a varus deformity of 18 degrees with medial joint space obliteration and lateral joint preservation. During TKA, the primary soft tissue release performed FIRST on the tight medial side for varus correction is:
14. In rheumatoid arthritis, atlantoaxial instability occurs due to erosion of the transverse ligament. The standard radiological assessment for instability is the atlanto-dens interval (ADI). In adults, the ADI value indicating instability is:
15. A 55-year-old woman with severe knee OA (Kellgren-Lawrence Grade IV) fails conservative management. At TKR, valgus deformity of 18° is noted. Which additional soft tissue release is required over the standard medial approach release for correction of this valgus deformity?
16. The Outerbridge classification is used to grade articular cartilage damage during arthroscopy. Grade IV is defined as:
17. A 55-year-old woman with long-standing RA undergoes total knee replacement. Intraoperatively the surgeon notes valgus deformity of 20° with lateral subluxation of the tibia and fixed flexion contracture. Which soft-tissue release should be performed FIRST to correct the valgus deformity?
18. In acute gout, interleukin-1β plays a central role in the inflammatory cascade triggered by monosodium urate (MSU) crystals. Which mechanism activates IL-1β in gout?
19. A 65-year-old woman with bilateral knee OA has Kellgren–Lawrence Grade III on X-ray and has failed 6 months of physiotherapy, analgesics, and intra-articular corticosteroids. BMI is 32. She has no significant comorbidities. What is the most appropriate next step?
20. A 65-year-old woman presents with acute monoarthritis of the left knee — sudden, severely painful, with large effusion and 39°C fever. Joint aspiration yields turbid fluid; microscopy shows weakly positive birefringent rhomboid crystals under compensated polarised light. Cultures are negative. The most appropriate immediate treatment is:
21. A 50-year-old man presents to the emergency department with acute severe pain, swelling, and redness of the first MTP joint. Serum uric acid is 10.2 mg/dL. Synovial fluid shows negatively birefringent needle-shaped crystals under polarised light. During this acute attack, the drug most rapidly effective in providing pain relief and anti-inflammatory action is:
22. Radiological features of osteoarthritis in the knee include joint space narrowing, subchondral sclerosis, and osteophyte formation. Which radiographic finding distinguishes osteoarthritis from rheumatoid arthritis affecting the same joint?
23. In the orthopaedic management of end-stage knee OA, the patient demonstrates a varus deformity of 15°, moderate bone loss on the medial tibial plateau, and preserved PCL. Which type of TKR implant most appropriately restores kinematics?
24. A 60-year-old woman with long-standing rheumatoid arthritis presents with sudden neck pain and new occipital headache that worsens on neck flexion, with upper motor neurone signs. MRI shows anterior atlantoaxial subluxation with an atlanto-dens interval (ADI) of 12 mm. What is the threshold for ADI in adults above which cord compression risk is significant, and what is the management?
25. A 50-year-old man presents with acute monarthritis of the knee with large effusion. Synovial fluid analysis shows positively birefringent rhomboid-shaped crystals under polarised light. The diagnosis is:
26. Kellgren and Lawrence Grade 4 osteoarthritis on a knee X-ray is characterised by:
27. A 50-year-old woman with rheumatoid arthritis on long-term methotrexate develops cervical spine instability. The atlantoaxial instability in RA is due to:
28. A 55-year-old woman with osteoarthritis of both knees is started on knee bracing. Which type of brace is specifically designed for medial compartment OA to offload the affected compartment?
29. Charcot arthropathy (neuropathic joint) most commonly affects which joint in diabetic patients, and what is the classical early radiological finding?
30. A 50-year-old presents with acute monoarthritis of the first MTP joint with severe pain and swelling. Synovial fluid aspirate shows negatively birefringent needle-shaped crystals under polarised light microscopy. The diagnosis is gout. When should urate-lowering therapy (ULT) be initiated?
31. Calcium pyrophosphate dihydrate (CPPD) deposition disease ('pseudogout') characteristically affects which radiographic finding distinguishing it from osteoarthritis?
32. In calcium pyrophosphate deposition disease (CPPD/pseudogout), the radiological finding on plain film that confirms the diagnosis is chondrocalcinosis. The most common sites where chondrocalcinosis is visible radiographically are: