Osteoarthritis: therapeutic options MCQs With Answer

Osteoarthritis: therapeutic options MCQs With Answer

This curated MCQ set focuses on the therapeutic management of osteoarthritis (OA) tailored for M.Pharm students. It covers pharmacologic strategies, intra‑articular procedures, topical treatments, structure‑modifying candidates, guideline‑based recommendations, mechanisms of action, safety profiles and important clinical considerations such as comorbidities and drug interactions. Questions are designed to test understanding of evidence strength, mechanism-driven choices, and practical prescribing nuances including patient selection and adverse effect management. Use these MCQs to deepen your grasp of OA pharmacotherapeutics, prepare for exams, and reinforce clinical decision-making for optimizing symptomatic control while minimizing harm.

Q1. Which of the following is considered the first‑line oral pharmacologic option for mild to moderate osteoarthritis pain according to many guidelines due to its safety profile?

• Oral non‑selective NSAIDs (e.g., ibuprofen)
• Acetaminophen/paracetamol
• Oral COX‑2 selective inhibitor (e.g., celecoxib)
• Tramadol

Correct Answer: Acetaminophen/paracetamol

Q2. What is the primary mechanism by which nonsteroidal anti‑inflammatory drugs (NSAIDs) provide symptomatic relief in osteoarthritis?

• Blockade of NMDA receptors in the spinal cord
• Inhibition of cyclooxygenase enzymes decreasing prostaglandin synthesis
• Activation of opioid receptors to reduce nociceptive transmission
• Promotion of cartilage matrix synthesis via growth factor release

Correct Answer: Inhibition of cyclooxygenase enzymes decreasing prostaglandin synthesis

Q3. Which statement about COX‑2 selective inhibitors (e.g., celecoxib) in OA is most accurate?

• They have higher gastrointestinal bleeding risk than non‑selective NSAIDs
• They provide analgesia without any increased cardiovascular risk
• They reduce GI toxicity compared with non‑selective NSAIDs but may increase cardiovascular risk
• They are recommended as first‑line in patients with severe heart failure

Correct Answer: They reduce GI toxicity compared with non‑selective NSAIDs but may increase cardiovascular risk

Q4. Topical NSAIDs (e.g., diclofenac gel) are especially recommended for which clinical scenario in OA?

• Generalized polyarticular OA where systemic therapy is preferred
• Localized knee or hand OA in older adults with comorbidities limiting oral NSAID use
• Severe hip OA requiring rapid systemic pain control
• Patients with active peptic ulcer disease and recent GI bleeding

Correct Answer: Localized knee or hand OA in older adults with comorbidities limiting oral NSAID use

Q5. Which intra‑articular therapy is commonly used for short‑term reduction of inflammation and pain in knee OA, with effects typically lasting weeks?

• Intra‑articular hyaluronic acid (viscosupplementation)
• Intra‑articular corticosteroid injection
• Systemic low‑dose methotrexate
• Intra‑articular bisphosphonate infusion

Correct Answer: Intra‑articular corticosteroid injection

Q6. Regarding viscosupplementation with intra‑articular hyaluronic acid for knee OA, which statement best reflects current evidence?

• High‑quality evidence uniformly supports large, durable structure modifying effects
• Evidence is mixed: some patients obtain symptomatic benefit, but guideline recommendations vary
• Hyaluronic acid is contraindicated due to high systemic toxicity
• It is the only therapy proven to reverse cartilage loss in OA

Correct Answer: Evidence is mixed: some patients obtain symptomatic benefit, but guideline recommendations vary

Q7. Which oral agent has been shown in clinical trials to provide benefit for chronic OA pain through modulation of central pain processing and is recommended in some guidelines?

• Duloxetine
• Amitriptyline as monotherapy for all OA patients
• High‑dose vitamin D supplementation
• Colchicine

Correct Answer: Duloxetine

Q8. Which of the following best describes the current status of disease‑modifying osteoarthritis drugs (DMOADs)?

• Multiple DMOADs are approved and routinely used to regenerate cartilage
• No widely accepted, regulatory‑approved DMOAD has yet demonstrated consistent structure‑modifying benefit
• Glucosamine is an FDA‑approved DMOAD that reverses joint space narrowing
• Intra‑articular corticosteroids are classified as DMOADs

Correct Answer: No widely accepted, regulatory‑approved DMOAD has yet demonstrated consistent structure‑modifying benefit

Q9. Which over‑the‑counter supplement has the most consistent supportive evidence for symptomatic benefit in some OA studies, particularly when formulated as prescription‑grade sulfate?

• Glucosamine sulfate
• Vitamin C
• Omega‑3 fish oil
• Calcium carbonate

Correct Answer: Glucosamine sulfate

Q10. Which adverse effect is most commonly associated with topical capsaicin used for OA pain?

• Systemic hypotension
• Local burning or stinging at the application site
• Renal toxicity
• Severe immunosuppression

Correct Answer: Local burning or stinging at the application site

Q11. In patients with OA and a history of ischemic heart disease, which class of analgesic should be used with caution due to potential cardiovascular risk?

• Topical NSAIDs
• Oral non‑selective NSAIDs and COX‑2 inhibitors
• Acetaminophen/paracetamol
• Duloxetine

Correct Answer: Oral non‑selective NSAIDs and COX‑2 inhibitors

Q12. Which opioid characteristic makes them generally a last‑resort option for OA pain management?

• Low risk of dependency and abuse
• Effective disease modification in OA
• Risk of tolerance, dependence, sedation and reduced physical functioning with modest benefit
• No interaction with other central nervous system depressants

Correct Answer: Risk of tolerance, dependence, sedation and reduced physical functioning with modest benefit

Q13. What is the primary rationale for recommending weight loss and exercise as core interventions in OA management?

• They cure OA by regenerating cartilage
• They have been shown to reduce pain, improve function and decrease joint load with minimal risk
• They replace the need for any pharmacologic therapy permanently
• They increase systemic inflammation and thus precondition joints

Correct Answer: They have been shown to reduce pain, improve function and decrease joint load with minimal risk

Q14. Which laboratory monitoring is most important when a patient with OA is prescribed long‑term oral NSAIDs?

• Periodic serum creatinine and assessment for hypertension and GI symptoms
• Routine pulmonary function tests every 3 months
• Serial bone mineral density measurement monthly
• Frequent serum potassium monitoring only

Correct Answer: Periodic serum creatinine and assessment for hypertension and GI symptoms

Q15. Concerning intra‑articular corticosteroid injections for knee OA, which statement is correct?

• They are ineffective and never recommended
• Their analgesic benefit is typically rapid but often temporary, commonly lasting about 4–6 weeks
• They permanently restore joint cartilage within weeks
• They are best administered weekly for long‑term control

Correct Answer: Their analgesic benefit is typically rapid but often temporary, commonly lasting about 4–6 weeks

Q16. Which patient factor would most strongly discourage use of oral NSAIDs for chronic OA pain?

• Young age with isolated knee OA and no comorbidities
• History of recent peptic ulcer bleeding or serious GI hemorrhage
• Mild seasonal allergies
• Well‑controlled hypothyroidism

Correct Answer: History of recent peptic ulcer bleeding or serious GI hemorrhage

Q17. What is the proposed mechanism by which glucosamine and chondroitin might exert symptomatic effects in OA?

• Direct blockade of sodium channels in peripheral nerves
• Serving as substrates or modulators for cartilage matrix synthesis and anti‑inflammatory effects in the joint milieu
• Increasing systemic cortisol levels to reduce inflammation
• Irreversible inhibition of cyclooxygenase enzymes

Correct Answer: Serving as substrates or modulators for cartilage matrix synthesis and anti‑inflammatory effects in the joint milieu

Q18. Which guideline‑recommended topical agent provides an opioid‑free option for moderate localized OA pain especially in elderly patients?

• Topical diclofenac
• Oral tramadol
• Intravenous morphine
• Oral high‑dose aspirin

Correct Answer: Topical diclofenac

Q19. Capsaicin cream reduces pain through depletion of which neurotransmitter from sensory nerve terminals?

• Substance P
• Dopamine
• GABA
• Acetylcholine

Correct Answer: Substance P

Q20. Which of the following best describes the role of intra‑articular hyaluronic acid (viscosupplementation) in current clinical practice for knee OA?

• Universally recommended as first‑line therapy for all knee OA patients
• Considered an option for selected patients with persistent symptoms despite conservative measures; benefits are variable and patient‑specific
• Contraindicated in patients with any prior knee surgery
• Provides immediate systemic analgesia within minutes of injection

Correct Answer: Considered an option for selected patients with persistent symptoms despite conservative measures; benefits are variable and patient‑specific

Download