Rehabilitation and Physical Medicine

Rehabilitation and Physical Medicine Indian Medical PG Question 1: Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :

• A. II, III and IV
• B. I, III and IV
• C. I, II and III
• D. I, II and IV (Correct Answer)

Rehabilitation and Physical Medicine Explanation: ***I, II and IV*** - **Primary survey** in trauma management, including head injury, focuses on immediately life-threatening conditions (Airway, Breathing, Circulation, Disability, Exposure). Ensuring adequate **oxygenation and circulation** (Statement I) is paramount to prevent secondary brain injury. - Exclude **hypoglycemia** (Statement II) is critical because altered mental status due to low blood sugar can mimic head injury and delay appropriate treatment, making it an essential part of the 'D' (disability) assessment. Checking **pupil size and response** (Statement IV) is also part of the 'D' assessment, providing vital information about potential brain stem compromise or intracranial pressure changes. *II, III and IV* - While excluding hypoglycemia and checking pupil response are crucial parts of the primary survey, Statement III, "Check for mechanism of injury," is typically part of the **secondary survey** or initial assessment but not immediately life-saving like ABCD. - The primary survey prioritizes immediate threats to life, and while understanding the mechanism of injury informs subsequent care, it does not directly address a patient's immediate physiologic stability. *I, III and IV* - This option includes checking the mechanism of injury (Statement III) as part of the primary survey, which is generally conducted after the **life-threatening conditions** are addressed. - It omits the critical step of excluding **hypoglycemia** (Statement II), which is an immediate reversible cause of altered mental status that must be ruled out during the primary assessment. *I, II and III* - This option correctly includes ensuring adequate **oxygenation and circulation** (Statement I) and excluding **hypoglycemia** (Statement II) as part of the primary survey. - However, it incorrectly includes checking for the **mechanism of injury** (Statement III) as a primary survey component and omits checking **pupil size and response** (Statement IV), which is an essential part of the 'Disability' assessment in the primary survey for head injury.

Rehabilitation and Physical Medicine Indian Medical PG Question 2: Which of the following is not a differential diagnosis of non-accidental injury?

• A. Osteogenesis imperfecta
• B. Scurvy
• C. Caffey's disease
• D. Osteopetrosis (Correct Answer)

Rehabilitation and Physical Medicine Explanation: ***Correct: Osteopetrosis*** - Osteopetrosis is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function - While it causes bones to be brittle and prone to fracture, it has **distinctive radiological features** including diffuse sclerosis and "bone-within-bone" appearance - The **increased bone density on X-ray** is pathognomonic and readily distinguishes it from NAI, making it **less likely to be confused** with non-accidental injury in clinical practice - Fractures occur but the radiological pattern is diagnostic of the underlying metabolic bone disease *Incorrect: Osteogenesis imperfecta* - This is a **classic differential** for NAI causing **multiple brittle bone fractures** that can be mistaken for abuse - Features include **blue sclera**, **dentinogenesis imperfecta**, **wormian bones**, and **family history** - Often presents with multiple fractures at different stages of healing, mimicking the pattern seen in NAI *Incorrect: Scurvy* - Caused by **vitamin C deficiency**, leads to defective collagen synthesis - Results in **subperiosteal hemorrhages**, **metaphyseal fractures**, and **periosteal elevation** that closely mimic NAI - Additional features include **gingival bleeding**, **petechiae**, **follicular hyperkeratosis**, and **poor wound healing** *Incorrect: Caffey's disease* - Also known as **infantile cortical hyperostosis**, presents in infants under 6 months - Causes **periosteal reactions**, **bone thickening**, and **soft tissue swelling** in long bones, ribs, and mandible - The periosteal new bone formation can be mistaken for healing fractures from NAI, making it an important differential

Rehabilitation and Physical Medicine Indian Medical PG Question 3: Which of the following phases are directly involved in the recovery phase of the disaster cycle?

• A. Response and Rehabilitation
• B. Mitigation and Rehabilitation
• C. Response and Preparedness
• D. Rehabilitation and Reconstruction (Correct Answer)

Rehabilitation and Physical Medicine Explanation: ***Rehabilitation and Reconstruction*** - **Rehabilitation** is the short-term recovery phase focusing on restoring essential services, providing temporary shelter, medical care, and supporting affected populations to resume normal activities. - **Reconstruction** is the long-term recovery phase involving rebuilding damaged infrastructure, permanent housing, economic restoration, and development improvements. - These two phases together constitute the **recovery phase** of the disaster cycle according to standard disaster management frameworks (WHO, NDMA). *Mitigation and Rehabilitation* - While **rehabilitation** is correctly part of recovery, **mitigation** is traditionally considered a separate continuous phase or part of preparedness, focused on reducing future disaster risks. - **Mitigation** measures are implemented throughout the disaster cycle, not specifically as a direct component of the recovery phase. *Response and Rehabilitation* - **Response** refers to immediate life-saving actions during and immediately after a disaster (search and rescue, emergency medical care, evacuation). - **Response** precedes the recovery phase and is distinct from it, though **rehabilitation** is indeed part of recovery. *Response and Preparedness* - **Preparedness** involves planning, training, and resource allocation before a disaster occurs. - **Response** is the immediate action during/after the disaster. - Neither constitutes the recovery phase, which follows after the immediate response is complete.

Rehabilitation and Physical Medicine Indian Medical PG Question 4: Choose the best method of diagnosis for the clinical sign represented in the image.

• A. Serum copper
• B. Serum ceruloplasmin (Correct Answer)
• C. Karyotyping
• D. PCR

Rehabilitation and Physical Medicine Explanation: ***Serum ceruloplasmin*** - The image shows a **Kayser-Fleischer ring**, a greenish-brown discoloration in the periphery of the cornea, which is pathognomonic for **Wilson's disease**. - **Wilson's disease** is a genetic disorder of copper metabolism characterized by **low serum ceruloplasmin** levels (the primary copper-carrying protein in the blood) and increased copper deposition in various tissues. *Serum copper* - While Wilson's disease involves copper accumulation, **total serum copper** can be normal or even elevated due to widespread tissue damage releasing copper into the circulation, making it an unreliable diagnostic marker on its own. - A low serum copper level can be seen, but it is not as specific as low ceruloplasmin, as much of the copper in serum is bound to ceruloplasmin. *Karyotyping* - **Karyotyping** is used to analyze the number and structure of chromosomes and is primarily indicated for diagnosing chromosomal abnormalities, such as Down syndrome or Turner syndrome. - It is not relevant for diagnosing metabolic disorders like Wilson's disease, which is caused by a mutation in a single gene (ATP7B), not a chromosomal aberration. *PCR* - **PCR (Polymerase Chain Reaction)** is a technique used to amplify DNA sequences and can be used for genetic testing to identify specific mutations. - While genetic testing for the **ATP7B gene** mutation is a confirmatory test for Wilson's disease, it is not the primary or best method for initial diagnosis, especially when classic clinical signs and biochemical markers (like low ceruloplasmin) are present.

Rehabilitation and Physical Medicine Indian Medical PG Question 5: What is the correct sequence of the following levels of prevention? 1. Specific protection 2. Early diagnosis and prompt treatment 3. Disability limitation and rehabilitation 4. Health promotion Select the correct sequence from the code given below:

• A. 3, 4, 1, 2
• B. 4, 1, 2, 3 (Correct Answer)
• C. 2, 3, 4, 1
• D. 1, 2, 3, 4

Rehabilitation and Physical Medicine Explanation: ***4, 1, 2, 3*** - The correct sequence of prevention levels starts with **health promotion** (primary prevention), followed by **specific protection** (also primary prevention, but more targeted). - It then moves to **early diagnosis and prompt treatment** (secondary prevention), and finally to **disability limitation and rehabilitation** (tertiary prevention). *3, 4, 1, 2* - This sequence incorrectly places **disability limitation and rehabilitation** (tertiary prevention) at the beginning, which occurs much later in the disease process. - It also scatters the primary prevention components (health promotion and specific protection) rather than grouping them appropriately at the start. *2, 3, 4, 1* - This sequence begins with **early diagnosis and prompt treatment** (secondary prevention), which is not the initial step in the comprehensive prevention model. - It also places **health promotion** and **specific protection** later than they should be, distorting the chronological progression of preventive actions. *1, 2, 3, 4* - This sequence begins with **specific protection**, which is a part of primary prevention but typically follows broader **health promotion** efforts. - It also places **health promotion** (4) as the last step, which is incorrect as it represents the fundamental and initial level of prevention.

Rehabilitation and Physical Medicine Indian Medical PG Question 6: Best therapy suited to teach daily life skills to a child with intellectual disability:

• A. Applied Behavior Analysis (ABA) (Correct Answer)
• B. Cognitive Behavioral Therapy (CBT)
• C. Social skills training
• D. Self-instructional training

Rehabilitation and Physical Medicine Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Rehabilitation and Physical Medicine Indian Medical PG Question 7: What is the investigation of choice in a patient with traumatic paraplegia?

• A. Myelography
• B. CT scan
• C. MRI scan (Correct Answer)
• D. Plain X-ray

Rehabilitation and Physical Medicine Explanation: ***MRI scan*** - An **MRI scan** provides superior imaging of **soft tissues**, including the spinal cord, nerves, and ligaments, which are crucial for assessing damage in **traumatic paraplegia**. - It is essential for detecting **spinal cord compression**, hemorrhage, edema, and ligamentous injuries that may not be visible on other imaging modalities. *Plain X-ray* - A **plain X-ray** primarily visualizes bony structures and can detect major **fractures or dislocations** but offers limited information about the spinal cord or soft tissue damage. - It may miss subtle bony injuries and provides no information on **spinal cord integrity**, which is critical in paraplegia. *Myelography* - **Myelography** involves injecting contrast dye into the spinal canal and then performing X-rays or CT scans, which is an **invasive procedure** with potential risks. - While it can demonstrate **spinal cord compression** indirectly, it has largely been replaced by MRI due to its invasiveness and MRI's direct visualization capabilities. *CT scan* - A **CT scan** is excellent for evaluating **bony injuries**, such as vertebral fractures and alignment, with good detail. - However, it is less effective than MRI for directly visualizing the **spinal cord itself** and assessing soft tissue damage, which is paramount in paraplegia.

Rehabilitation and Physical Medicine Indian Medical PG Question 8: According to American College of Rheumatology, all of the following are clinical criteria for the diagnosis of osteoarthritis, EXCEPT:

• A. Lack of warmth
• B. Crepitus
• C. Atrophy of quadriceps muscles (Correct Answer)
• D. Age > 50 years

Rehabilitation and Physical Medicine Explanation: ### Atrophy of quadriceps muscles - While muscle weakness can be a consequence of **osteoarthritis (OA)** due to pain and disuse, **quadriceps atrophy** is not a primary diagnostic criterion according to the American College of Rheumatology (ACR) criteria for OA. Local examination of the knee in OA may frequently reveal weakness and wasting of the quadriceps muscle [1]. - The ACR criteria primarily focus on patient symptoms, physical exam findings, and radiographic evidence to define OA. ### Lack of warmth - This is a typical physical finding in osteoarthritis, as **inflammation** is generally mild or absent compared to inflammatory arthropathies, thus joints are usually **not warm** to the touch. - It helps differentiate OA from conditions like septic arthritis or gout, where warmth is a prominent feature. ### Crepitus - **Crepitus**, or crackling/grating sounds during joint movement, is a classic clinical finding in osteoarthritis, indicating a roughened articular surface. Examination often reveals restricted flexion/extension accompanied by coarse crepitus [1]. - It is one of the key clinical signs used in the ACR criteria for OA, especially when combined with other symptoms like pain and stiffness. ### Age > 50 years - **Age over 50 years** is a significant risk factor and a clinical criterion for diagnosing osteoarthritis, as the prevalence of OA increases with age. While typical symptoms usually present after age 45-50, early-onset OA is rare and often linked to trauma [1]. - The ACR criteria often incorporate age as a factor when considering symptomatic OA.

Rehabilitation and Physical Medicine Indian Medical PG Question 9: Best therapy suited to teach daily life skill to a mentally challenged child:

• A. Contingency management (Correct Answer)
• B. Cognitive reconstruction
• C. Self instruction
• D. CBT (Cognitive behavior therapy)

Rehabilitation and Physical Medicine Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Rehabilitation and Physical Medicine Indian Medical PG Question 10: Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

• A. Southampton grading system (Correct Answer)
• B. Apgar score
• C. Glasgow scoring system
• D. ASA classification

Rehabilitation and Physical Medicine Explanation: ***Southampton grading system*** - The **Southampton grading system** is specifically designed for the **severity of wound infection**, offering a clear framework for classification based on clinical signs. - Its utility in **surveillance and research** stems from its structured and reproducible assessment, allowing for consistent data collection on wound healing and infection rates. *Apgar score* - The **Apgar score** is a rapid assessment of a **newborn's health** immediately after birth, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color. - It is not used for assessing wound infection severity. *Glasgow scoring system* - The **Glasgow Coma Scale (GCS)** is used to assess the **level of consciousness** in a person following a brain injury, comprising eye opening, verbal, and motor responses. - It is not relevant to wound infection assessment. *ASA classification* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health before surgery**, providing an indication of anesthetic risk. - It is not used for evaluating wound infection.

Rehabilitation and Physical Medicine Flashcard 1 of 1

Question: Hand-knee gait seen in polio is due to the involvement of _____ muscle

Answer: quadriceps