Work-Related Musculoskeletal Disorders — MCQs
An elderly male presents with pain in his shoulders and hands. ESR is 105 mm/L. History includes transient blindness and unilateral headache.
Which ministry covers ESI (Employees' State Insurance)?
A 39-year-old woman claims that she injured her hand at work. She states that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a Rs1 Lakh workers' compensation settlement. This clinical presentation is an example of
Which of the following sensations are carried by the lateral spinothalamic tract?
Which are the most commonly fractured ribs during Cardio Pulmonary Resuscitation?
Carpal tunnel syndrome is caused by all, except?
A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?
MIDAS questionnaire is used to assess the extent and disability in which of the following conditions?
Above which level of heat stress index is it not possible to work comfortably?
Ergonomics is a discipline that deals with:-
Work-Related Musculoskeletal Disorders Indian Medical PG Practice Questions and MCQs
Question 1: An elderly male presents with pain in his shoulders and hands. ESR is 105 mm/L. History includes transient blindness and unilateral headache.
- A. Polyarteritis nodosa
- B. Polymyalgia rheumatica (Correct Answer)
- C. Ankylosing spondylitis
- D. Behçet syndrome
Explanation: ***Polymyalgia rheumatica*** - The combination of **shoulder and hand pain** in an elderly male, along with a **very high ESR**, is highly suggestive of polymyalgia rheumatica [1]. - **Sudden transient blindness** and **unilateral headache** are concerning for giant cell arteritis, which is often associated with polymyalgia rheumatica and requires prompt treatment. *Polyarteritis nodosa* - This is a **necrotizing vasculitis** of medium-sized arteries, often presenting with systemic symptoms, **renal involvement**, and **neuropathy**. - It typically does not cause shoulder and hand pain as the primary presenting symptom, and the transient blindness and headache are more characteristic of giant cell arteritis. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton**, causing **inflammatory back pain** and stiffness, particularly in younger individuals [2]. - It does not typically present with shoulder and hand pain, transient blindness, or a temporal headache in an elderly patient. *Behçet syndrome* - Characterized by **recurrent oral and genital ulcers**, **uveitis**, and **skin lesions**. - The presenting symptoms of shoulder and hand pain, high ESR, transient blindness, and unilateral headache are not typical features of Behçet syndrome.
Question 2: Which ministry covers ESI (Employees' State Insurance)?
- A. Ministry of Human Resource Development
- B. Ministry of Health
- C. Ministry of Home
- D. Ministry of Labour (Correct Answer)
Explanation: ***Ministry of Labour*** - The **Employees' State Insurance (ESI) Act, 1948** is administered by the **Ministry of Labour and Employment** in India. - This ministry is responsible for the welfare, social security, and health of the **working class**, which directly aligns with the objectives of ESI. *Ministry of Human Resource Development* - This ministry primarily deals with **education, literacy, and vocational training** for human resource development. - It does not directly oversee social security schemes for employees like ESI. *Ministry of Health* - This ministry focuses on **public health policies, healthcare services, disease control**, and medical research. - While ESI schemes provide healthcare benefits, the overall administration and enforcement of the ESI Act fall under the Ministry of Labour. *Ministry of Home* - The Ministry of Home Affairs is responsible for **internal security, law and order**, and border management. - It has no direct involvement in the administration of employee social security programs like ESI.
Question 3: A 39-year-old woman claims that she injured her hand at work. She states that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a Rs1 Lakh workers' compensation settlement. This clinical presentation is an example of
- A. conversion disorder
- B. factitious disorder by proxy
- C. factitious disorder
- D. malingering (Correct Answer)
Explanation: ***Malingering*** - This scenario describes **intentional feigning** of symptoms for an **external incentive** (the workers' compensation settlement). - The rapid resolution of symptoms post-settlement is characteristic, indicating the pain was not solely due to a genuine physical injury but rather a means to achieve financial gain. *Conversion disorder* - Involves neurological symptoms (e.g., paralysis, blindness) that are **incompatible with neurological pathways** and are not intentionally produced. - There is no evidence of an external incentive; symptoms are often linked to psychological stress, but the patient genuinely believes they are suffering from the symptoms. *Factitious disorder by proxy* - This involves a caregiver (e.g., parent) **falsifying or inducing illness** in another person (e.g., child) to assume the **sick role by proxy**. - The described case involves the patient themselves presenting with symptoms, not a proxy. *Factitious disorder* - Involves **intentional production or feigning of physical or psychological symptoms** with the primary motivation being to assume the **sick role**. - Unlike malingering, there are no obvious external incentives (like financial gain); the primary gain is the psychological satisfaction of being a patient.
Question 4: Which of the following sensations are carried by the lateral spinothalamic tract?
- A. Pain & temperature (Correct Answer)
- B. Proprioception
- C. Fine touch
- D. Crude touch
Explanation: ***Pain & temperature*** - The **lateral spinothalamic tract** is primarily responsible for transmitting **pain** and **temperature** sensations from the periphery to the brain. - These pathways cross the midline in the spinal cord at the level of entry and ascend contralaterally. *Proprioception* - **Proprioception**, or the sense of body position and movement, is primarily carried by the **dorsal columns** (fasciculus gracilis and cuneatus) and the **spinocerebellar tracts**. - These pathways are crucial for coordinating movement and maintaining balance, not for pain or temperature. *Fine touch* - **Fine touch**, along with vibration and two-point discrimination, is primarily transmitted by the **dorsal columns** (fasciculus gracilis and cuneatus). - These pathways are part of the **dorsal column-medial lemniscus system**, which decussates at the level of the brainstem, specifically the medial lemniscus. *Crude touch* - **Crude touch**, or light touch, is mainly carried by the **anterior spinothalamic tract**. - While related to the spinothalamic system, it is distinct from the lateral spinothalamic tract's specific role in pain and temperature.
Question 5: Which are the most commonly fractured ribs during Cardio Pulmonary Resuscitation?
- A. 2nd-7th rib (Correct Answer)
- B. 7th-10th rib
- C. 10th-12th rib
- D. 1st & 2nd rib
Explanation: ***2nd-7th rib*** - The **anterior and lateral aspects of the middle ribs (particularly 3rd-7th, extending to the 2nd rib)** are most commonly fractured during CPR due to their position and the direct forces applied to the sternum and rib cage during chest compressions. - These ribs are relatively thin and fixed to the sternum, making them vulnerable to fracture under sustained mechanical stress from repeated compressions. - **This range encompasses the area where CPR compressions are applied** over the lower half of the sternum. *7th-10th rib* - While these ribs can be fractured, they are **less frequently involved** compared to the more central ribs during typical CPR hand placement. - They are somewhat protected by overlying muscle and the costal margin, and lie below the typical compression point. *10th-12th rib* - These are the **floating ribs** and are **rarely fractured during CPR**. - Their free anterior ends provide considerable flexibility, and they are located lower on the torso, well below the area of sternal compressions. *1st & 2nd rib* - The **first rib is extremely well-protected** by the clavicle, scapula, and thick musculature of the shoulder girdle, making it rarely fractured during CPR. - The **second rib**, while more protected than the middle ribs, can occasionally be involved in the fracture pattern, but is **much less commonly fractured** than ribs 3-7. - Isolated fractures of ribs 1-2 typically require very significant force such as severe blunt trauma.
Question 6: Carpal tunnel syndrome is caused by all, except?
- A. Hypothyroidism
- B. Diabetes mellitus
- C. Amyloidosis
- D. Addison's disease (Correct Answer)
Explanation: As specified in the choice-based analysis, carpal tunnel syndrome is caused by all except Addison's disease. ***Addison's disease*** - **Addison's disease** is characterized by primary adrenal insufficiency, leading to symptoms like fatigue, weight loss, and hypovolemia, but it is **not directly associated** with the development of carpal tunnel syndrome. - Carpal tunnel syndrome is caused by **compression of the median nerve** within the carpal tunnel, which is typically due to localized swelling or thickening of tissues, a mechanism not linked to Addison's disease. *Amyloidosis* - **Amyloidosis** can lead to the deposition of **amyloid protein** in various tissues, including the carpal tunnel, which can cause narrowing and compression of the median nerve [1]. - The accumulation of amyloid can result in **thickening of the synovium** and other structures within the wrist, leading to the symptoms of carpal tunnel syndrome [1]. *Hypothyroidism* - **Hypothyroidism** can cause the accumulation of **mucopolysaccharides** (specifically hyaluronic acid and chondroitin sulfate) in the interstitial tissues, including the synovium of the carpal tunnel. - This **fluid retention and tissue swelling** can increase pressure on the median nerve, leading to carpal tunnel syndrome. *Diabetes mellitus* - **Diabetes mellitus** is a common cause of carpal tunnel syndrome, primarily due to **neuropathy** and metabolic changes that affect the median nerve's health and the surrounding tissues. - High blood glucose levels can lead to **glycation of proteins** and increased **inflammation**, contributing to nerve swelling and tissue thickening within the carpal tunnel.
Question 7: A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?
- A. 9
- B. 11 (Correct Answer)
- C. 7
- D. 13
Explanation: ***11*** - The Glasgow Coma Scale (GCS) comprises three components: **Eye opening**, Verbal response, and Motor response. - In this case, **eyes opening to pain** scores 2, **confused verbal response** scores 4, and **localizing to pain** scores 5, totaling 2 + 4 + 5 = 11. *9* - A score of 9 would correspond to a lower response in one or more categories, such as **abnormal flexion (decorticate)** as a motor response (3 points) or incomprehensible sounds as verbal response (2 points). - This option does not match the patient's described responses for eye opening (2), verbal (4), and motor (5) components. *7* - A score of 7 indicates a more severe neurological impairment, for instance, no eye opening (1), incomprehensible sounds (2), and **abnormal extension (decerebrate)** as a motor response (2 points). - This GCS score is much lower than what would be calculated from the patient's described responses. *13* - A score of 13 would indicate better neurological function, potentially with spontaneous eye opening (4) or responding with an oriented verbal response (5). - This score suggests less severe injury than the patient's responses of eyes opening to pain (2) and confused verbal response (4).
Question 8: MIDAS questionnaire is used to assess the extent and disability in which of the following conditions?
- A. Cluster headache
- B. Temporal arteritis
- C. Migraine (Correct Answer)
- D. Myasthenia Gravis
Explanation: ***Migraine*** - The **MIDAS (Migraine Disability Assessment)** questionnaire is a specific tool designed to assess the impact and disability caused by migraine headaches over a 3-month period. [1] - It quantifies days missed from work/school, household duties, and social activities due to headache, along with how many days the headache reduced productivity. *Cluster headache* - While a severe headache disorder, cluster headache disability is not typically assessed using the **MIDAS questionnaire**, which is tailored for the more chronic and widespread impact of migraine. [1] - Due to their episodic and typically shorter, but excruciating, nature, other tools or direct clinical assessment might be more suitable. *Temporal arteritis* - This is a **vasculitis** affecting large arteries of the head, causing headache, jaw claudication, and vision changes, and requires urgent treatment. [2] - **MIDAS** is irrelevant as it's not a primary headache disorder and disability is linked to inflammatory systemic effects rather than headache frequency or severity alone. *Myasthenia Gravis* - This is a **neuromuscular autoimmune disease** causing muscle weakness, not a primary headache disorder. - Its assessment tools focus on muscle strength, fatigue, and functional limitations, not headache-related disability.
Question 9: Above which level of heat stress index is it not possible to work comfortably?
- A. 20 – 40
- B. 40 – 60 (Correct Answer)
- C. 60 – 80
- D. 80 – 100
Explanation: ***40 – 60*** - A heat stress index **above 40** represents the threshold where it becomes **not possible to work comfortably** due to increasing thermal load on the body. - At this level, the thermal environment causes significant discomfort and increases the risk of heat-related illnesses such as **heat exhaustion**. - While work can still be performed with precautions (frequent breaks, hydration, reduced workload), **comfortable working conditions** are no longer sustainable. - This is the recognized threshold in occupational health where workers begin experiencing notable heat stress symptoms. *20 – 40* - A heat stress index between **20 and 40** represents comfortable to moderately warm conditions where normal work activities can be performed comfortably. - This range is generally safe for sustained physical activity without significant risk of heat-related illness. - No special precautions are typically required, though basic hydration remains important. *60 – 80* - A heat stress index of **60 to 80** indicates **dangerous heat stress** where even modified work becomes hazardous. - At this level, the risk of **heat stroke** and **heat exhaustion** is high, requiring immediate protective measures or cessation of work. - This range is well beyond uncomfortable—it represents a serious occupational health hazard. *80 – 100* - An index of **80 to 100** signifies **extreme danger** with imminent risk of **heat stroke** even with minimal exertion. - Work is essentially impossible and potentially life-threatening at this level. - Emergency protocols and complete avoidance of heat exposure are necessary.
Question 10: Ergonomics is a discipline that deals with:-
- A. Fitting the job to the workers (Correct Answer)
- B. Study of working environment
- C. Human relationship in the specific context of production
- D. Study of the system of laws and institutions
Explanation: ***Fitting the job to the workers*** - **Ergonomics** is fundamentally about designing and arranging workplaces, products, and systems so that they fit the people who use them, optimizing **human well-being** and **overall system performance**. - This involves considering various human capabilities and limitations, such as **physical dimensions**, **cognitive abilities**, and **psychological factors**, to prevent injuries and improve efficiency. *Study of working environment* - While the working environment is a component of ergonomic considerations, ergonomics is a broader discipline focused on the **interaction between people and their environment**, rather than just the environment itself. - It involves **modifying the job or environment** to suit the worker, not merely observing the existing environment. *Human relationship in the specific context of production* - This describes aspects of **organizational psychology** or **human resources management**, which focus on social interactions and productivity within a work setting. - Ergonomics, in contrast, is centered on the **physical and cognitive suitability** of tasks and tools for individuals. *Study of the system of laws and institutions* - This refers to **jurisprudence** or **political science**, which deal with legal frameworks and governmental structures. - Ergonomics is a **scientific discipline** focused on human factors in design, not legal or institutional analysis.
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