Physical Injuries in Workplace — MCQs

10 questions

Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

Which type of ultraviolet radiation causes the most skin disorders?

Match the following weapons with their corresponding injury types: Weapons: A. Axe B. RTA (Road Traffic Accident) C. Blade D. Lathi Injury Types: 5. Incised wound 6. Tram track bruise 7. Grazed abrasion 8. Chop wound

Electrical contact burn usually causes

Late effects of radiation therapy include:

A patient developed memory deficit for recent events. Anterograde amnesia is a feature of:

Cutis marmorata occurs due to exposure to –

Comment on the image shown:

A hospital implements a policy to reduce occupational hand dermatitis in healthcare workers. They propose: (A) Switching from latex to nitrile gloves, (B) Installing alcohol-based hand rub dispensers, (C) Providing emollients, (D) Reducing glove use frequency. Synthesize the best evidence-based strategy.

Q10

Evaluate the following scenario: A 38-year-old worker in an electronics manufacturing unit develops hand dermatitis. Initial patch testing shows multiple positive reactions to metals (nickel, cobalt, chromium). Despite workplace modifications and protective equipment, the dermatitis persists. Re-evaluation reveals positive patch test to colophony. What is the best strategic approach?

Physical Injuries in Workplace Indian Medical PG Practice Questions and MCQs

Question 1: Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

A. ab
B. abc (Correct Answer)
C. acd
D. bcd

Explanation: ***ab*** - All conditions listed under 'a' and 'b' (Dermatitis, Vascularly compromised status of limb, Abrasions) are **absolute contraindications** for skin traction as they directly compromise skin integrity or circulation. - Applying skin traction in these situations can lead to **skin breakdown**, infection, or further **ischemic damage**, worsening the patient's condition. *ab* - While **dermatitis**, **vascular compromise**, and **abrasions** are indeed contraindications, the option for 'abc' implies there might be other correct choices included, which is not the case for this option. - This option is incomplete as it misses 'c' (Abrasions) which is also a significant contraindication. *acd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication, which does not inherently prevent skin traction. - It also omits **vascularly compromised status of limb**, a critical contraindication, while including 'a', 'c', and 'd'. *bcd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication for skin traction. - It also omits **dermatitis**, a key contraindication, while including 'b', 'c', and 'd'.

Question 2: Which type of ultraviolet radiation causes the most skin disorders?

A. UV-A
B. UV-B (Correct Answer)
C. UV-C
D. None of the options

Explanation: ***UV-B*** - **UV-B radiation** is a major cause of **sunburn** and directly damages DNA, leading to most **skin cancers** (basal cell carcinoma, squamous cell carcinoma, and melanoma). - It plays a significant role in photoaging and the development of most **skin disorders** related to sun exposure. *UV-A* - **UV-A radiation** penetrates deeper into the skin than UV-B and is primarily associated with **photoaging**, producing wrinkles and fine lines. - While it contributes to skin cancer development, its direct role in DNA damage and sunburn is less than that of UV-B. *UV-C* - **UV-C radiation** is the most damaging type of UV light, but it is almost entirely **absorbed by the Earth's ozone layer** and does not reach the Earth's surface. - Therefore, it does not typically cause skin disorders in humans under natural conditions. *None of the options* - This option is incorrect because **UV-B radiation** is well-established as a primary cause of numerous skin disorders, including most skin cancers and sunburn.

Question 3: Match the following weapons with their corresponding injury types: Weapons: A. Axe B. RTA (Road Traffic Accident) C. Blade D. Lathi Injury Types: 5. Incised wound 6. Tram track bruise 7. Grazed abrasion 8. Chop wound

A. A-5, B-6, C-8, D-7
B. A-6, B-8, C-7, D-5
C. A-8, B-7, C-5, D-6 (Correct Answer)
D. A-7, B-5, C-6, D-8

Explanation: ***A-8 (Axe - Chop wound), B-7 (RTA - Grazed abrasion), C-5 (Blade - Incised wound), D-6 (Lathi - Tram track bruise)*** - An **axe** is a heavy cutting tool that typically causes a **chop wound**, characterized by a combination of cutting and crushing. - A **Road Traffic Accident (RTA)** frequently results in **grazed abrasions** due to friction and shearing forces as the body slides against rough surfaces. - A **blade** (like a knife or razor) is designed to cut, producing an **incised wound** with clean, sharp edges. - A **lathi** (a heavy stick or baton) delivers blunt force trauma, often causing a **tram track bruise** due to the skin being crushed between the impactor and underlying bone, leading to parallel lines of bruising. *A-5, B-6, C-8, D-7* - This option incorrectly associates an **axe** with an **incised wound** (which is caused by a blade) and a **blade** with a **chop wound** (caused by an axe). - It also misattributes **RTA** to a **tram track bruise** and a **lathi** to a **grazed abrasion**, which are not the most typical injury patterns for these respective weapons/mechanisms. *A-6, B-8, C-7, D-5* - This pairing mistakenly links an **axe** with a **tram track bruise** and a **blade** with a **grazed abrasion**. - It also incorrectly associates an **RTA** with a **chop wound** and a **lathi** with an **incised wound**. *A-7, B-5, C-6, D-8* - This option incorrectly matches an **axe** with a **grazed abrasion** and a **lathi** with a **chop wound**. - It also inaccurately connects an **RTA** with an **incised wound** and a **blade** with a **tram track bruise**.

Question 4: Electrical contact burn usually causes

A. Superficial second degree burns
B. First degree burns
C. Third degree burns (Correct Answer)
D. Deep second degree burns

Explanation: ***Third degree burns*** - Electrical burns often cause **deep tissue damage** because electrical current generates significant heat as it passes through the body, leading to destruction of all skin layers and underlying tissues. - The entry and exit points of an electrical current can appear relatively small, but the damage internally can be extensive and severe, justifying a **third-degree classification**. *Superficial second degree burns* - These burns involve the epidermis and superficial dermis, characterized by **blisters** and significant pain. - Electrical burns typically cause much deeper tissue destruction than what is seen in superficial partial-thickness burns. *First degree burns* - First-degree burns only affect the epidermis, causing **redness** and **mild pain** without blistering. - Electrical contact, even brief, almost invariably causes more severe damage than a superficial first-degree burn. *Deep second degree burns* - Deep second-degree burns extend into the deep dermis, often presenting with **blisters** and potentially some loss of sensation due to nerve damage. - While electrical burns can cause deep partial-thickness injuries, the current's path often leads to complete destruction of skin layers and underlying structures, making a full-thickness (third-degree) burn more common.

Question 5: Late effects of radiation therapy include:

A. Mucositis, Enteritis, Nausea and vomiting, Pneumonitis
B. Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations
C. Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations
D. Mucositis, Enteritis, Pneumonitis, Somatic mutations (Correct Answer)

Explanation: ***Mucositis, Enteritis, Pneumonitis, Somatic mutations*** - **Somatic mutations** leading to **secondary malignancies** are a classic late effect of radiation (occurs years after exposure due to DNA damage) [1] - **Radiation pneumonitis** progressing to **pulmonary fibrosis** is a well-recognized late complication (typically 1-3 months to years post-treatment) [1] - **Chronic radiation enteritis** with fibrosis and vascular damage can occur months to years after abdominal/pelvic radiation [1] - **Chronic mucositis** with fibrosis can persist as a late effect, though mucositis is more commonly acute - This option represents the **most comprehensive list of late effects** among the choices *Mucositis, Enteritis, Nausea and vomiting, Pneumonitis* - **Nausea and vomiting** are predominantly **acute side effects** occurring during or immediately after radiation therapy, not late effects - While mucositis and enteritis can have chronic forms, including nausea/vomiting makes this option incorrect *Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Though it includes somatic mutations (correct late effect), the presence of an acute symptom invalidates this choice *Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Omits enteritis, which can manifest as chronic radiation enteritis with fibrosis and strictures **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Central Nervous System Synapse, pp. 437-439.

Question 6: A patient developed memory deficit for recent events. Anterograde amnesia is a feature of:

A. Traumatic paraplegia
B. Stroke
C. Spinal cord injury
D. Post-head injury (Correct Answer)

Explanation: ***Post-head injury*** - **Anterograde amnesia**, the inability to form new memories after an event, is a common consequence of **traumatic brain injury** or **head injury** affecting memory-related brain structures [1], [3]. - Damage to areas like the **hippocampus** and medial temporal lobes, often seen in head trauma, directly impairs memory consolidation [2]. *Traumatic paraplegia* - **Paraplegia** refers to paralysis affecting the lower half of the body, usually due to a **spinal cord injury**. - This condition primarily impacts motor and sensory functions below the level of injury and does not directly cause memory deficits. *Stroke* - A **stroke** can cause various neurological deficits depending on the affected brain region, including memory impairment if crucial memory centers are involved. - However, the question specifically mentions **anterograde amnesia** following an unspecified "event," and while possible, post-head injury is a more classic and common association for this specific symptom profile [1]. *Spinal cord injury* - A **spinal cord injury** primarily affects the transmission of motor, sensory, and autonomic signals between the brain and the body. - It does not directly impact cognitive functions like memory formation, as the **spinal cord** is distinct from the brain structures responsible for memory.

Question 7: Cutis marmorata occurs due to exposure to –

A. Cold temperature (Correct Answer)
B. Dust
C. Hot temperature
D. Humidity

Explanation: ***Cold temperature*** - **Cutis marmorata** is a physiological response to **cold temperatures**, characterized by a mottled, reticulated vascular pattern on the skin. - This occurs due to **vasoconstriction** of the small arteries and arterioles, alongside **vasodilation** of the venules, creating the characteristic marbled appearance. *Dust* - Exposure to **dust** typically causes **irritation**, allergic reactions, or respiratory issues, such as **dermatitis**, **contact urticaria**, or **asthma**. - It does not directly lead to the characteristic vascular changes seen in cutis marmorata. *Hot temperature* - **Hot temperatures** generally cause **vasodilation** in the skin to facilitate **heat dissipation**, leading to redness and warmth. - This is the opposite physiological response to cutis marmorata, which involves vasoconstriction. *Humidity* - **Humidity** primarily affects **skin hydration** and the rate of perspiration, potentially exacerbating certain skin conditions like **eczema** or **fungal infections**. - High or low humidity does not directly induce the vascular changes that result in cutis marmorata.

Question 8: Comment on the image shown:

A. Corn
B. Callosity (Correct Answer)
C. Warts
D. Cutaneous horn

Explanation: ***Callosity*** - The image displays several **thickened, hyperkeratotic patches** on the palm, characteristic of callosities. - Callosities are caused by repeated friction and pressure, leading to **diffuse epidermal thickening** without a central core. *Corn* - A **corn** is a small, well-demarcated lesion with a **central core** that causes localized pain, unlike the diffuse thickening seen here. - They typically occur over bony prominences and are less spread out than the lesions in the image. *Warts* - **Warts** are caused by the **human papillomavirus (HPV)** and present as rough, elevated lesions with characteristic **black puncta** (thrombosed capillaries) upon paring, which are not visible in the image. - They often have a **papillomatous** or verrucous surface, different from the relatively smooth, thickened appearance here. *Cutaneous horn* - A **cutaneous horn** is a conical projection of **hyperkeratotic material** resembling an animal horn, typically developing on sun-exposed areas. - It is usually a solitary lesion and has a different morphology than the multiple, flat, thickened lesions shown.

Question 9: A hospital implements a policy to reduce occupational hand dermatitis in healthcare workers. They propose: (A) Switching from latex to nitrile gloves, (B) Installing alcohol-based hand rub dispensers, (C) Providing emollients, (D) Reducing glove use frequency. Synthesize the best evidence-based strategy.

A. Implement all four measures as glove occlusion worsens dermatitis
B. Implement only A and C to reduce costs
C. Implement A, B, and C; avoiding D as it compromises infection control (Correct Answer)
D. Focus only on B and C as glove material is not the primary issue

Explanation: ***Implement A, B, and C; avoiding D as it compromises infection control*** - Combining **non-latex (nitrile) gloves**, **alcohol-based rubs**, and **emollients** is the evidence-based triad for reducing **irritant contact dermatitis** and **Type I hypersensitivity** while maintaining skin barrier integrity. - Reducing the frequency of glove use (D) is an inappropriate strategy because it directly **compromises infection control** and increases the risk of **bloodborne pathogen exposure**. *Implement all four measures as glove occlusion worsens dermatitis* - While **glove occlusion** can contribute to dermatitis, intentionally reducing glove use (D) violates standard precautions for **patient and provider safety**. - The goal is to optimize the **type of glove** and **skin care regimen** rather than sacrificing necessary barrier protection. *Implement only A and C to reduce costs* - Excluding **alcohol-based hand rubs (B)** is counterproductive, as frequent washing with water and detergent is actually more **irritating to the skin** than alcohol rubs. - A strategy based solely on cost ignores the clinical evidence that **barrier creams and emollients** work best when integrated with less damaging hand hygiene methods. *Focus only on B and C as glove material is not the primary issue* - This ignores the significant prevalence of **latex allergy** and sensitivity to **accelerants** found in standard gloves, which contributes to **allergic contact dermatitis**. - Switching to **nitrile gloves (A)** is a critical step in a comprehensive occupational policy to eliminate **Type I latex hypersensitivity** risks.

Question 10: Evaluate the following scenario: A 38-year-old worker in an electronics manufacturing unit develops hand dermatitis. Initial patch testing shows multiple positive reactions to metals (nickel, cobalt, chromium). Despite workplace modifications and protective equipment, the dermatitis persists. Re-evaluation reveals positive patch test to colophony. What is the best strategic approach?

A. The persistent dermatitis indicates evolution to chronic actinic dermatitis
B. Colophony in soldering flux is the relevant occupational allergen; the metal sensitivities may be cross-reactions or co-sensitization (Correct Answer)
C. All positive reactions are equally relevant and complete job change is mandatory
D. The multiple sensitivities indicate systemic contact dermatitis requiring systemic therapy

Explanation: ***Colophony in soldering flux is the relevant occupational allergen; the metal sensitivities may be cross-reactions or co-sensitization*** - **Colophony** (rosin) is a frequent sensitizer in the **electronics industry**, where it is used as a flux in **soldering** to prevent oxidation. - Persistence of symptoms despite metal avoidance highlights the importance of identifying the **relevant allergen** versus incidental background sensitivity or **cross-reactivity**. *The persistent dermatitis indicates evolution to chronic actinic dermatitis* - **Chronic actinic dermatitis** is a photosensitive condition and is not a typical progression of **allergic contact dermatitis** caused by chemical exposure. - There is no clinical evidence of **photosensitivity** or UV-induced lesions mentioned in this occupational scenario. *All positive reactions are equally relevant and complete job change is mandatory* - Not all positive **patch tests** translate to clinical relevance; some may represent **excited skin syndrome** or past, non-relevant exposures. - A **job change** is a last resort; the management focus should be on specific **allergen substitution** or improved engineering controls for the **colophony** exposure. *The multiple sensitivities indicate systemic contact dermatitis requiring systemic therapy* - **Systemic contact dermatitis** occurs when an allergen is medicinally or dietarily ingested, not through **occupational cutaneous contact**. - Primary management involves **allergen avoidance** and topical therapists rather than initiating long-term **systemic immunosuppression** for manageable contactants.

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