Geriatric Rehabilitation Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Geriatric Rehabilitation. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Geriatric Rehabilitation Indian Medical PG Question 1: Which of the following drugs is not useful in the rehabilitation of alcoholic patients?
- A. Acamprosate
- B. Rimonabant (Correct Answer)
- C. Naltrexone
- D. Varenicline
Geriatric Rehabilitation Explanation: Rimonabant
- Rimonabant is an inverse agonist of the cannabinoid CB1 receptor that was used as an anti-obesity drug. [1]
- It was withdrawn from the market due to significant psychiatric side effects, including depression and suicidal ideation. [1]
- Rimonabant has absolutely no role in alcohol rehabilitation and is no longer available for clinical use.
Acamprosate
- Acamprosate is commonly used in alcohol rehabilitation to reduce alcohol cravings and promote abstinence in detoxified alcohol-dependent individuals. [2]
- It is thought to act by restoring the balance between excitation and inhibition in the brain, particularly by modulating glutamate and GABA neurotransmission.
- It is FDA-approved for maintenance of alcohol abstinence.
Naltrexone
- Naltrexone is an opioid receptor antagonist used to reduce alcohol craving and relapse by blocking the pleasurable effects of alcohol. [2], [3]
- It is available in both oral and intramuscular long-acting injectable forms and is FDA-approved for alcohol use disorder. [3]
- It can also be used for opioid use disorder. [3]
Varenicline
- Varenicline is a partial agonist of the nicotinic acetylcholine receptor and is primarily FDA-approved for smoking cessation.
- Some research has explored its potential for reducing alcohol consumption due to its effects on reward pathways, though it is not FDA-approved for alcohol dependence.
- Unlike rimonabant (which is withdrawn and has no role), varenicline has some supporting evidence in alcohol treatment, though it remains off-label use.
Geriatric Rehabilitation Indian Medical PG Question 2: Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?
- A. Getting up from a sitting position
- B. Walk downhill (Correct Answer)
- C. Walk uphill
- D. Sitting cross-legged
Geriatric Rehabilitation Explanation: ***Walk downhill***
- An **anterior cruciate ligament (ACL) deficient knee** experiences anterior tibial translation, especially when the muscles can't compensate, leading to instability.
- Walking downhill places higher **anterior shear forces** on the knee joint and often involves knee extension or hyperextension, which dramatically increases the risk of the tibia translating anteriorly relative to the femur.
*Getting up from a sitting position*
- This activity primarily involves **quadriceps muscle contraction** and a concentric movement of the knee, which stabilizes the joint.
- It does not typically place significant **anterior shear stress** on the ACL, even in a deficient knee.
*Walk uphill*
- Walking uphill often involves knee flexion and places the knee in a more protected position against **anterior tibial translation**.
- The quadriceps and hamstrings work synergistically to **stabilize the joint** during this motion, reducing stress on the ACL.
*Sitting cross-legged*
- This position primarily involves **hip and knee flexion and external rotation**, but it is generally a static and non-weight-bearing position.
- It does not impose significant **dynamic loads** or shear forces that would cause instability in an ACL-deficient knee.
Geriatric Rehabilitation Indian Medical PG Question 3: Which of the following is the most appropriate treatment for an overactive bladder in a patient with dementia?
- A. Tolterodine (Correct Answer)
- B. Mirabegron
- C. Behavioral therapy/bladder training
- D. Oxybutynin
- E. Trospium
Geriatric Rehabilitation Explanation: ***Tolterodine***
- **Tolterodine** is a **muscarinic antagonist** that blocks acetylcholine receptors in the bladder, reducing detrusor muscle contractions and overactive bladder symptoms.
- Unlike some other anticholinergics like oxybutynin, it has a **lower propensity to cross the blood-brain barrier** and thus a reduced risk of exacerbating cognitive impairment in patients with dementia.
*Mirabegron*
- **Mirabegron** is a **beta-3 adrenergic agonist** that relaxes the detrusor muscle, increasing bladder capacity.
- While it has a different mechanism of action and is less likely to cause anticholinergic cognitive side effects than older anticholinergics, it can still cause **hypertension** and **tachycardia**, which may be problematic in elderly patients with comorbidities.
*Behavioral therapy/bladder training*
- **Behavioral therapy** and **bladder training** are important first-line treatments for overactive bladder.
- However, for patients with **dementia**, cognitive impairment often makes adherence to and understanding of these complex therapies challenging or impossible without significant caregiver support.
*Oxybutynin*
- **Oxybutynin** is an **anticholinergic drug** that is effective for overactive bladder.
- However, it has a **high affinity for muscarinic receptors** in the brain and readily crosses the blood-brain barrier, significantly increasing the risk of **cognitive impairment, confusion, and delirium** in elderly patients, especially those with pre-existing dementia.
*Trospium*
- **Trospium** is a **quaternary amine anticholinergic** that is hydrophilic and has minimal blood-brain barrier penetration.
- While theoretically safer than oxybutynin in terms of CNS effects, it has **lower bladder selectivity** compared to tolterodine and may cause more peripheral anticholinergic side effects (dry mouth, constipation).
Geriatric Rehabilitation Indian Medical PG Question 4: Gradual painful limitation of shoulder movements in an elderly suggest that the most probable diagnosis is:
- A. Periarthritis (Correct Answer)
- B. Myositis ossificans
- C. Osteoarthritis
- D. Arthritis
Geriatric Rehabilitation Explanation: ***Periarthritis***
- This term encompasses conditions like **adhesive capsulitis (frozen shoulder)**, which commonly presents as gradual, painful limitation of shoulder movement, particularly in the elderly.
- It involves **inflammation and thickening of the joint capsule**, leading to stiffness and pain with both active and passive range of motion.
*Myositis ossificans*
- This condition involves the **formation of bone in muscle tissue** after trauma, presenting as a firm, tender mass.
- It does not primarily cause gradual, painful limitation of joint movement in the way described for the shoulder.
*Osteoarthritis*
- While common in the elderly, **osteoarthritis** primarily affects articular cartilage, leading to pain and stiffness that is often worse with activity and relieved by rest.
- It typically affects weight-bearing joints or those with repetitive stress, and while it can affect the shoulder, the description of "gradual painful limitation of movement" is more characteristic of periarthritis/frozen shoulder.
*Arthritis*
- This is a **general term for joint inflammation** and does not specify the particular cause or presentation.
- While periarthritis is a type of arthritis (inflammation of tissues around a joint), "arthritis" alone is too broad to be the most probable specific diagnosis for this clinical picture.
Geriatric Rehabilitation Indian Medical PG Question 5: Which of the following is NOT true about delirium?
- A. Characterized by fluctuating consciousness
- B. Reversible with treatment
- C. Common in elderly patients
- D. It has a slow, insidious onset (Correct Answer)
Geriatric Rehabilitation Explanation: ***It has a slow, insidious onset***
- Delirium is characterized by an **acute** or **subacute** onset, meaning it develops rapidly over hours to days, not slowly and insidiously.
- An insidious onset is more characteristic of **dementia**, which differs significantly from delirium in its course.
*Characterized by fluctuating consciousness*
- **Fluctuating consciousness** is a hallmark feature of delirium, where the level of awareness and cognitive function can change significantly throughout the day.
- Patients with delirium often exhibit periods of **lucidity** interspersed with confusion and disorientation.
*Reversible with treatment*
- Delirium is often **reversible** if the underlying causes, such as infection, metabolic imbalances, or medication side effects, are identified and treated promptly.
- This distinguishes it from **dementia**, which is generally a progressive and irreversible condition.
*Common in elderly patients*
- Delirium is indeed very **common in elderly patients**, particularly those with pre-existing cognitive impairment, multiple comorbidities, or those in critical care settings.
- Their physiological vulnerability makes them more susceptible to the stressors that can precipitate delirium.
Geriatric Rehabilitation Indian Medical PG Question 6: Which of the following is a mature defence mechanism?
- A. Displacement
- B. Denial
- C. Humor (Correct Answer)
- D. Rationalization
Geriatric Rehabilitation Explanation: ***Humor***
- **Humor** is considered a mature defense mechanism as it allows individuals to cope with difficult or stressful situations by finding the amusing or ironic aspects.
- It enables a person to express unacceptable feelings or thoughts in an appropriate and socially acceptable way, fostering emotional release and perspective.
*Displacement*
- **Displacement** is an immature defense mechanism where unacceptable feelings or impulses are redirected from their original source to a safer, more acceptable target.
- This mechanism does not resolve the underlying issue and can lead to difficulties in relationships or unexplained anger.
*Denial*
- **Denial** is an immature defense mechanism involving the refusal to accept reality or a fact, even when presented with clear evidence.
- It often leads to maladaptive behaviors as the individual avoids addressing the problem, hindering personal growth and problem-solving.
*Rationalization*
- **Rationalization** is an immature defense mechanism where one attempts to justify unacceptable behavior, feelings, or thoughts with apparently logical reasons to avoid the true explanation.
- This often involves self-deception and prevents an individual from acknowledging their true motives or taking responsibility for their actions.
Geriatric Rehabilitation Indian Medical PG Question 7: Intense nihilism, somatization and agitation in old age are the hallmark symptoms of -
- A. Depressive stupor
- B. Atypical depression
- C. Involutional melancholia (Correct Answer)
- D. Somatized depression
Geriatric Rehabilitation Explanation: ***Involutional melancholia***
- This **historical term** (now obsolete in DSM-5 and ICD-11) described a severe depressive episode occurring in late life, characterized by **intense nihilism**, **somatization**, and **agitation**.
- In modern psychiatry, this presentation would be diagnosed as **Major Depressive Disorder with melancholic features** or **with psychotic features** (if nihilistic delusions are present).
- Though no longer used as a formal diagnosis, this term may still appear in older psychiatric literature and some textbook references, particularly describing the classical triad in elderly patients.
- Key features included: severe guilt, nihilistic themes, marked psychomotor agitation (not retardation), and somatic preoccupations in older adults.
*Depressive stupor*
- This is a rare and severe form of depression characterized by extreme **psychomotor retardation**, where the individual is almost entirely unresponsive, withdrawn, and has minimal or no movement or speech.
- The key differentiating feature is **marked retardation** rather than **agitation** - these are opposite psychomotor presentations.
- While it involves severe depression, the primary features of **agitation** and active **somatization** as described in the question are not characteristic of depressive stupor.
*Atypical depression*
- This type of depression is characterized by **mood reactivity** (mood improves in response to positive events), increased appetite or weight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity.
- Features **reversed neurovegetative symptoms** (hypersomnia and hyperphagia rather than insomnia and anorexia).
- The symptoms of **nihilism**, **somatization**, and **agitation** are not typical features; atypical depression often involves anergic features and is more common in younger patients.
*Somatized depression*
- This refers to depression where psychological distress is primarily expressed through **physical symptoms** such as pain, fatigue, or gastrointestinal issues, often leading to medical consultations.
- While **somatization** is the predominant feature, it lacks the specific constellation of **intense nihilism** and severe **agitation in elderly patients** that characterizes the classical involutional presentation.
- More commonly seen in cultures where psychological expression of distress is stigmatized.
Geriatric Rehabilitation Indian Medical PG Question 8: In below-elbow amputation the length of stump should be
- A. 15 - 20 cm (Correct Answer)
- B. 5 - 10 cm
- C. 20 - 25 cm
- D. 10-15 cm
Geriatric Rehabilitation Explanation: ***15 - 20 cm***
- For a **below-elbow amputation** to be functional, the **stump length** should be approximately **15 to 20 cm** from the olecranon to allow for optimal prosthetic fitting and control.
- This length provides sufficient leverage and preserves enough forearm musculature for effective **prosthetic operation**.
*5 - 10 cm*
- A stump length of **5-10 cm** from the olecranon would be considered too short for a below-elbow amputation, making it difficult to achieve **adequate prosthetic suspension** and control of the artificial limb.
- Such a short stump might be classified as a **very short below-elbow amputation**, which often requires specialized prosthetic designs and can limit functionality.
*20 - 25 cm*
- A stump length of **20-25 cm** from the olecranon would be considered too long for a below-elbow amputation, encroaching on the wrist and hand area.
- An excessively long stump can make it challenging to fit a standard **transradial prosthesis** comfortably and effectively, and might even be classified as a **wrist disarticulation** if extending too far distally.
*10 -15 cm*
- While **10-15 cm** from the olecranon can sometimes be functional, it is often considered on the shorter end of the ideal range for a below-elbow amputation, potentially limiting the effectiveness of certain **prosthetic designs** and control mechanisms.
- A stump in this range might work, but the **15-20 cm range** generally offers superior functional outcomes and easier prosthetic fitting.
Geriatric Rehabilitation Indian Medical PG Question 9: The shown apparatus is used for
- A. Ankle knee stabilizer
- B. Thomas splint
- C. Knee brace
- D. Patella tendon bearing brace (Correct Answer)
Geriatric Rehabilitation Explanation: ***Patella tendon bearing brace***
- This orthotic device is designed to **transfer weight-bearing load through the patella tendon**, reducing stress on the lower extremity during ambulation.
- It features a **molded cuff** that fits snugly below the patella and distributes weight through the **patellar tendon bearing area**, commonly used in **prosthetic applications** and **below-knee amputees**.
*Ankle knee stabilizer*
- This device provides **combined support to both ankle and knee joints** simultaneously, typically used for **multi-joint injuries** or instability.
- It features **dual bracing systems** with straps and supports extending from ankle to knee, unlike the focused patellar tendon bearing design.
*Thomas splint*
- A **rigid metal-framed splint** used primarily for **femur fracture stabilization** and maintaining **skeletal traction** in emergency situations.
- It consists of a **ring that fits around the upper thigh** with extending metal bars, designed for **fracture immobilization** rather than weight distribution.
*Knee brace*
- A general **knee joint support device** used for **ligament injuries**, **post-surgical recovery**, or **osteoarthritis management**.
- Available in various forms (**sleeve, hinged, or wraparound designs**) but lacks the specific **weight-bearing transfer mechanism** of a patella tendon bearing brace.
Geriatric Rehabilitation Indian Medical PG Question 10: The following gait is seen due to weakness of:
- A. Gluteus maximus
- B. Gluteus medius (Correct Answer)
- C. Psoas major
- D. Tibialis anterior
Geriatric Rehabilitation Explanation: ***Gluteus medius***
- Weakness of the **gluteus medius** leads to a **Trendelenburg gait**, where the pelvis drops on the unsupported side during the swing phase of gait.
- The image suggests pelvic tilting, which is characteristic of the body attempting to compensate for the inability of the gluteus medius to stabilize the pelvis.
*Gluteus maximus*
- Weakness of the gluteus maximus causes difficulty in **hip extension**, resulting in a **lurching gait** where the trunk is thrown backward at heel strike.
- This is commonly known as a **gluteus maximus lurch**, which is not depicted in an obvious manner here.
*Psoas major*
- Weakness of the psoas major would primarily affect **hip flexion**, making it difficult to lift the leg off the ground (e.g., during the swing phase).
- This would result in compensatory movements such as circumduction or hiking the hip, rather than the characteristic pelvic drop.
*Tibialis anterior*
- Weakness of the tibialis anterior causes **foot drop**, leading to a **steppage gait** where the knee is lifted high to avoid dragging the foot.
- The image does not show a foot drop or high stepping, thus ruling out tibialis anterior weakness.
More Geriatric Rehabilitation Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
