Viva · Specialty
Musculoskeletal Viva Questions
Oral-exam style questions and answers on musculoskeletal for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.
- What does the Meyerding system grade?
- It grades the degree of anterior translation in spondylolisthesis as a percentage of the anteroposterior width of the superior endplate of the vertebra below, on a lateral radiograph.
- Enumerate the Meyerding grades.
- Grade I 0-25%, grade II 26-50%, grade III 51-75%, grade IV 76-100%, and grade V or spondyloptosis when the slip exceeds 100%.
- How exactly do you make the measurement?
- On a true lateral standing film, divide the superior endplate of the caudal vertebra into quarters and see which quarter the posteroinferior corner of the slipped vertebral body overlies; that quarter gives the grade.
- What is meant by low-grade versus high-grade slip?
- Grades I and II are low grade and grades III to V are high grade; the high-grade group generally requires surgical assessment and sagittal balance evaluation.
- How does Meyerding differ from the Wiltse classification?
- Meyerding quantifies severity of the slip, whereas Wiltse classifies aetiology into dysplastic, isthmic, degenerative, traumatic, pathological and iatrogenic types; the two are complementary and both should be reported.
- What are the common pitfalls in applying the grade?
- Using the width of the slipped vertebra rather than the vertebra below as the denominator, and grading only on supine CT or MRI, which can underestimate a slip that reduces when the patient lies down.
- How do erosions differ in erosive OA and RA?
- Erosive OA typically produces central interphalangeal erosions; RA typically begins with marginal bare-area erosions.
- Which hand joints favour RA rather than primary OA?
- MCP joints and the wrist, particularly in a symmetric pattern with marginal erosions and juxta-articular osteopenia.
- What favours PsA over RA?
- DIP/ray involvement, dactylitis, enthesitis and erosions accompanied by juxta-articular new bone formation.
- Does Doppler-positive synovitis prove inflammatory autoimmune arthritis?
- No. Synovitis can also occur in OA and other joint disorders; interpret the whole pattern.
- What does OA-like change in the wrong hand distribution suggest?
- Consider CPPD when MCP or radiocarpal degeneration accompanies chondrocalcinosis and disproportionate cystic change.
- Do normal hand radiographs exclude early RA?
- No. Ultrasound or MRI can demonstrate synovitis, tenosynovitis and early damage before radiographic abnormalities.