Which of the following statements about malignant hyperthermia is incorrect?

End tidal CO₂ is decreased during the episode.

Dantrolene is the drug of choice for treatment.

Most common cause is a mutation in the ryanodine receptor.

Tachycardia occurs during the episode.

Incorrect statement regarding the management of frostbite:

Antibiotics and analgesics not used

A 35-year-old woman presents with widespread musculoskeletal pain, fatigue, and poor sleep. She has tenderness in 14 of 18 specific points on physical exam. What is the best treatment strategy?

Pharmacological pain management with opioids

Surgical intervention for pain relief

Which of the following treatment options is not useful in the management of Guillain-Barré syndrome?

Physical medical rehabilitation

Which of the following is the most effective method to prevent malaria?

Use of insecticide-treated nets

Genetic modification of mosquitoes

Physical Modalities in Rehabilitation for NEET-PG: High-Yield Orthopaedics Lessons

Foundations & Thermotherapy - Warming Up, Cooling Down

Physical Modalities: Therapeutic application of physical agents (thermal, mechanical, electromagnetic) to aid rehabilitation.

Heat and Cold Therapy Modalities

Feature	Superficial Heat	Cryotherapy
Types	Hot packs, paraffin wax, fluidotherapy, infrared (IR)	Ice packs, vapocoolant sprays, cold baths
Physio. Effects	↑Blood flow, ↑metabolism, ↓pain, ↓muscle spasm, ↑collagen extensibility	Initial ↓blood flow, ↓metabolism, ↓pain, ↓muscle spasm, ↓edema
Indications	Chronic pain, joint stiffness, muscle spasm. Temp: 40-45°C; 15-30 min	Acute injury (📌RICE), pain, muscle spasm. Duration: 10-20 min
Contraind.	Acute inflammation, impaired sensation, malignancy, active hemorrhage	Cold hypersensitivity (e.g., Raynaud's), impaired circulation, open wounds

Deep Heat & Ultrasound - Penetrating Power

Deep heat: ↑ blood flow, ↓ pain, ↑ tissue extensibility.

SWD (Shortwave Diathermy): Deepest (3-5cm). ⚠️ Burns with metal implants. CIs: Pacemakers, malignancy.
MWD (Microwave Diathermy): Superficial (1-3cm). ⚠️ Higher risk with superficial metal. CIs: Pacemakers, malignancy.
US (Therapeutic Ultrasound):
- Freq: $1MHz$ (deep, ~5cm), $3MHz$ (superficial, ~1-2cm). Intensity: $0.5-2.0 W/cm^2$.
- Modes: Continuous (thermal), Pulsed (non-thermal/healing).
- CIs: Malignancy, eyes, pregnancy, DVT, epiphyseal plates. Phonophoresis.

Feature	SWD	MWD	US ($1MHz$/$3MHz$)
Penetration	Deep (3-5cm)	Moderate (1-3cm)	Deep (~5cm)/Superficial (~1-2cm)
Heating	Diffuse, large	Focused, smaller	Small, defined
Key CIs	Metal implants, pacemakers	Superficial metal, pacemakers	Malignancy, eyes, growth plates

⭐ Ultrasound is contraindicated over epiphyseal plates in growing children.

Electrotherapy - Shockingly Effective

Modality	Mechanism	Primary Use	Key Params (e.g.)	CIs (Key) 📌
TENS	Gate Control Theory	Pain relief	Conv: $80-120 Hz$, $50-100 µs$; Acu: $2-5 Hz$, $200-300 µs$	Pacemaker, over carotid sinus
IFT	Interferential currents → beat freq	Deeper pain relief	Carrier: $~4000 Hz$; Beat: $1-150 Hz$	Similar to TENS
NMES/FES	Nerve depolarisation → muscle contraction	Muscle re-ed/strength, FES (drop foot)	PD: $200-600 µs$; Freq: $30-50 Hz$; On:Off: 1:3 (strength)	Similar to TENS, unstable fractures

⭐ IFT utilizes two medium-frequency currents (e.g., $4000 Hz$ and $4100 Hz$) that interfere to produce a lower therapeutic beat frequency (e.g., $100 Hz$), allowing deeper tissue penetration with less discomfort than TENS.

Mechanical & Other Forces - Move & Mend

Traction: Spinal/limb pull (Cervical/Lumbar; types).
- Effects: Decompresses spine, separates nerve roots.
- Ind: Nerve root impingement/disc herniation. CIs: Malignancy, instability, acute injury.
- Force: Cervical ~7-10$kg$ (5-7$%BW$); Lumbar 25-50$%BW$.
Massage: Tissue work (Effleurage, Petrissage, Friction, Tapotement).
- Effects: ↑Circulation, ↓muscle spasm/edema.
- Ind: Muscle soreness, lymphedema. CIs: Open wounds, DVT, acute inflammation.
LLLT (Photobiomodulation): Light healing; Mech: ↑ATP.
- Params: 600-1000$nm$, 5-500$mW$, 1-10$J/cm^2$.
- Ind: Wound healing, pain (OA). CIs: Malignancy, eyes, gravid uterus.
ESWT: Acoustic waves for repair (Focused/Radial).
- Mech: Microtrauma → neovascularization.
- Ind: Chronic tendinopathies (plantar fasciitis). CIs: Coagulopathy, infection.

⭐ ESWT: effective for chronic plantar fasciitis if conservative therapy fails.

High‑Yield Points - ⚡ Biggest Takeaways

Ultrasound (US): 1 MHz for deep, 3 MHz for superficial tissues; pulsed US for non-thermal effects.

Shortwave Diathermy (SWD): Contraindicated: metal implants, pacemakers due to deep heat.

TENS: Relieves pain via gate control theory or opioid release; high-frequency for acute pain.

Cryotherapy: Reduces pain, inflammation, spasticity. Contraindicated: Raynaud's, cold urticaria.

NMES/FES: Aids muscle strengthening, re-education, prevents atrophy, manages spasticity.

ESWT: Treats chronic tendinopathies (e.g., plantar fasciitis, tennis elbow).

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