Frailty and Sarcopenia — MCQs

10 questions

Which of the following is least characteristic of anorexia nervosa? a) Lowered vital signs when the weight is low b) Decreased physical activity c) History of obesity d) Denial of illness

A pole vaulter had a fall during pole vaulting and had paralysis of the arm . Which of the following investigations gives the best recovery prognosis -

Which of the following is characterized by denervation atrophy of the muscles?

The muscle which is affected last with Duchenne muscular dystrophy is-

Diabetes is associated with all of the following in the elderly EXCEPT:

A 60-year-old female presenting with proximal muscle weakness, increased serum creatine kinase levels, and no skin manifestations is likely to have:

Recommended interventions to reduce the incidence of coronary artery disease include the following except which of the following?

A diabetic patient's fasting blood glucose level is found to be $160 \mathrm{mg} / \mathrm{dL}$. What will you advise the patient regarding non-pharmacological management?

A 9-year-old girl presents with pigmentation over forehead and redness over upper eyelids. On physical examination following clinical sign was elicited. What is the next best step for diagnosis?

Q10

A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder

Frailty and Sarcopenia Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is least characteristic of anorexia nervosa? a) Lowered vital signs when the weight is low b) Decreased physical activity c) History of obesity d) Denial of illness

A. a and b
B. b and d
C. c and d
D. b and c (Correct Answer)

Explanation: ***bc (Correct Answer)*** **b) Decreased physical activity** is generally *not* characteristic of anorexia nervosa. Rather, many individuals with anorexia engage in **excessive exercise** despite their emaciated state as part of their compulsive behaviors to lose weight. **c) History of obesity** is also *not typical* of anorexia nervosa. The typical onset involves deliberate and progressive weight loss from a normal or slightly above-average weight, not from obesity. *Incorrect Options:* **a) Lowered vital signs** - This IS characteristic of anorexia nervosa. Bradycardia, hypotension, and hypothermia are common and serious consequences of significant weight loss and malnutrition. **d) Denial of illness** - This IS a hallmark feature of anorexia nervosa. Patients often lack insight into the severity of their condition, reflecting the ego-syntonic nature of their disordered eating behaviors and distorted body image, and they typically resist treatment. **Clinical Note:** The question asks for features that are LEAST characteristic. Both decreased physical activity and history of obesity are atypical, making "bc" the correct combination.

Question 2: A pole vaulter had a fall during pole vaulting and had paralysis of the arm . Which of the following investigations gives the best recovery prognosis -

A. Electromyography (Correct Answer)
B. Strength Duration Curve
C. Creatine phosphokinase levels
D. Muscle biopsy

Explanation: Electromyography - **Electromyography (EMG)** can help assess the extent of nerve damage and reinnervation, providing insights into the potential for recovery [1]. - The presence of **spontaneous activity** (fibrillations, positive sharp waves) indicates denervation, while the appearance of **motor unit action potentials (MUAPs)** suggests reinnervation [1]. *Creatine phosphokinase levels* - **Creatine phosphokinase (CPK)** levels primarily indicate **muscle damage**, not the extent of nerve injury or recovery potential. - While muscle damage can occur with nerve injury, CPK does not provide specific prognostic information for nerve regeneration. *Strength Duration Curve* - The **strength duration curve** assesses the excitability of a nerve or muscle to electrical stimulation. - While it can differentiate between **nerve and muscle damage**, it provides less comprehensive prognostic information compared to EMG regarding the status of nerve regeneration. *Muscle biopsy* - A **muscle biopsy** would directly evaluate muscle pathology, such as atrophy or regeneration. - However, it is an **invasive procedure** and provides less direct information about nerve recovery compared to EMG, which directly assesses nerve and muscle electrical activity.

Question 3: Which of the following is characterized by denervation atrophy of the muscles?

A. Werdnig-Hoffman disease (Correct Answer)
B. Carnitine palmityl transferase deficiency
C. McArdle disease
D. Pompe disease

Explanation: ***Werdnig-Hoffman disease*** - This is a severe form of **spinal muscular atrophy (SMA)**, characterized by the degeneration of **anterior horn cells** in the spinal cord [1]. - The loss of motor neurons leads to **denervation atrophy** of skeletal muscles, resulting in profound weakness and hypotonia [1], [2]. *Carnitine palmityl transferase deficiency* - This is a **fatty acid oxidation disorder** that primarily affects muscle energy metabolism. - It causes muscle pain, weakness, and **rhabdomyolysis** during sustained exercise, but not denervation atrophy. *McArdle disease* - Also known as **glycogen storage disease type V**, this condition is caused by a deficiency in **myophosphorylase**. - It results in exercise intolerance, muscle cramps, and myoglobinuria, but the muscle damage is metabolic, not from denervation. *Pompe disease* - This is a **lysosomal storage disorder** caused by a deficiency of **acid alpha-glucosidase (GAA)**. - It leads to the accumulation of glycogen in lysosomes, causing muscle weakness, cardiomyopathy, and respiratory failure, but the muscle pathology is due to lysosomal dysfunction, not denervation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1239-1240, 1247-1248. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 730-731.

Question 4: The muscle which is affected last with Duchenne muscular dystrophy is-

A. Facial
B. Abdominal
C. Diaphragm
D. Ocular (Correct Answer)

Explanation: ***Ocular*** - The **extraocular muscles** are typically spared until the very late stages of Duchenne muscular dystrophy (DMD), making them among the last to be affected [1]. - This sparing is a characteristic feature that helps differentiate DMD from some other neuromuscular conditions. *Facial* - While facial muscles can be less severely affected compared to limb muscles, they do show involvement earlier than ocular muscles, contributing to a **mask-like facies** in advanced stages. - Weakness of facial muscles can lead to difficulties with smiling, whistling, and closing the mouth completely *Diaphragm* - The **diaphragm** is a crucial respiratory muscle, and its weakness in DMD is a major cause of **respiratory insufficiency** and mortality, usually occurring in the later stages of the disease progression [1]. - Diaphragmatic involvement typically manifests before ocular muscles are affected, often necessitating ventilatory support. *Abdominal* - **Abdominal muscles** are affected relatively early in the progression of DMD, contributing to difficulties with posture and compromised respiratory function due to poor cough effort. - Weakness in these muscles impacts core strength and stability, preceding the involvement of ocular muscles. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1244-1245.

Question 5: Diabetes is associated with all of the following in the elderly EXCEPT:

A. Cognitive decline
B. Myocardial infarction (Correct Answer)
C. Cerebrovascular accident
D. Osteoarthritis

Explanation: ***Myocardial infarction*** - Diabetes is a major risk factor for **myocardial infarction** (heart attack), significantly increasing its incidence in the elderly [1]. - It accelerates **atherosclerosis**, leading to coronary artery disease, which is the primary cause of myocardial infarction [2]. *Cognitive decline* - Diabetes is strongly associated with an increased risk of **cognitive decline** and **dementia** in older adults. - Mechanisms include microvascular damage, chronic inflammation, and insulin resistance affecting brain function. *Cerebrovascular accident* - Diabetes is a significant risk factor for **cerebrovascular accidents** (strokes), both ischemic and hemorrhagic, in the elderly [2]. - It promotes **atherosclerosis** in cerebral vessels and contributes to hypertension and dyslipidemia, increasing stroke risk [2]. *Osteoarthritis* - While not a direct causal link like cardiovascular complications, diabetes can indirectly contribute to **osteoarthritis** progression, particularly in obese individuals with diabetes. - High glucose levels can lead to changes in cartilage composition and increased inflammation, potentially exacerbating joint damage.

Question 6: A 60-year-old female presenting with proximal muscle weakness, increased serum creatine kinase levels, and no skin manifestations is likely to have:

A. Polymyositis (Correct Answer)
B. Dermatomyositis
C. Limb-girdle muscular dystrophy
D. Inclusion body myositis

Explanation: ***Polymyositis*** - **Polymyositis** primarily affects adults, causing **proximal muscle weakness** (shoulders, hips, thighs) and elevated **creatine kinase (CK)** levels due to muscle damage [1]. - The absence of **skin manifestations** in this case strongly supports polymyositis over dermatomyositis, as dermatomyositis typically presents with characteristic cutaneous features [1]. *Dermatomyositis* - While dermatomyositis can present with identical **proximal muscle weakness** and elevated CK levels, it is characteristically associated with **skin manifestations** [1]. - The absence of **heliotrope rash**, **Gottron papules**, or **shawl sign** in this clinical scenario makes dermatomyositis less likely despite similar muscle involvement [1]. *Limb-girdle muscular dystrophy* - **Limb-girdle muscular dystrophy** is a genetically heterogeneous group of disorders, typically presenting in **childhood or adolescence**, though some forms can manifest later in life. - It causes **progressive symmetric muscle weakness** predominantly affecting the **shoulders and hips**, with highly variable CK levels depending on the specific genetic mutation. *Inclusion body myositis* - **Inclusion body myositis** typically affects older individuals (over 50), presenting with **progressive, asymmetrical muscle weakness**, more prominently in the **distal muscles** (e.g., forearm flexors, quadriceps). - While CK levels can be elevated, they are usually **less markedly increased** than in polymyositis or dermatomyositis, and the disease often progresses more slowly.

Question 7: Recommended interventions to reduce the incidence of coronary artery disease include the following except which of the following?

A. Reduce salt intake to < 5g per day.
B. No alcohol consumption.
C. Dietary cholesterol < 100 mg/1000kcal/d
D. Fat intake < 20% of total energy. (Correct Answer)

Explanation: ***Fat intake < 20% of total energy.*** - While reducing unhealthy fat intake is crucial for cardiovascular health, recommending total fat intake to be less than 20% of total energy is generally **too restrictive** and not a standard recommendation for the general population. - Current guidelines focus on the *type* of fat (limiting saturated and trans fats) rather than a strict overall percentage, as healthy fats are essential for various bodily functions [3]. *Dietary cholesterol < 100 mg/1000kcal/d* - Reducing dietary cholesterol intake is a widely accepted recommendation to lower the risk of **coronary artery disease (CAD)**, as high cholesterol contributes to atherosclerosis [3]. - Limiting cholesterol intake to less than 100 mg per 1000 kcal per day aligns with strategies for managing blood lipid levels [1]. *Reduce salt intake to < 5g per day.* - Reducing salt intake to less than 5 grams per day is strongly recommended to lower **blood pressure**, a major risk factor for CAD [2]. - High sodium intake contributes to hypertension, which places increased strain on the cardiovascular system [2]. *No alcohol consumption.* - While excessive alcohol consumption is detrimental to cardiovascular health, a recommendation of **no alcohol consumption** is not universally made to reduce CAD risk. - Moderate alcohol intake (e.g., one drink per day for women, two for men) has been associated with a potential reduction in CAD risk in some studies, though this is debated.

Question 8: A diabetic patient's fasting blood glucose level is found to be $160 \mathrm{mg} / \mathrm{dL}$. What will you advise the patient regarding non-pharmacological management?

A. At least 25-35 g of dietary fibre
B. <30 % of the calories should come from fat (Correct Answer)
C. Dietary cholesterol <300 mg per day
D. <2.3 g sodium intake every day

Explanation: ***<30 % of the calories should come from fat*** - Reducing dietary fat intake to less than 30% of total calories is a crucial non-pharmacological strategy for diabetic patients to manage blood glucose levels and prevent cardiovascular complications [1]. - Excess dietary fat, especially saturated and trans fats, can contribute to insulin resistance and weight gain, both of which negatively impact glycemic control [1]. *At least 25-35 g of dietary fibre* - While adequate dietary fiber (typically 25-30g for adults, sometimes up to 35g for men) is beneficial for managing blood glucose, it is generally recommended as a baseline for healthy eating and not the primary or most impactful intervention to address a fasting glucose of 160 mg/dL [1]. - Fiber helps slow glucose absorption and can improve insulin sensitivity, but a specific "at least 25-35g" statement without further context on total caloric intake or other macronutrient distribution might not be the most targeted advice for this specific glucose level [1]. *Dietary cholesterol <300 mg per day* - Limiting dietary cholesterol to less than 300 mg per day is a general recommendation for cardiovascular health, which is particularly important for diabetic patients due to their increased risk of atherosclerosis [2]. - However, for directly addressing a fasting blood glucose of 160 mg/dL, focusing on overall fat intake and carbohydrate quality would have a more immediate impact on glucose control than dietary cholesterol alone. *<2.3 g sodium intake every day* - Restricting sodium intake to less than 2.3 g per day is recommended for managing hypertension and reducing cardiovascular risk, which is often comorbid with diabetes [2]. - While important for overall health in diabetic patients, this recommendation does not directly target blood glucose control and would not be the primary non-pharmacological advice for a fasting glucose of 160 mg/dL.

Question 9: A 9-year-old girl presents with pigmentation over forehead and redness over upper eyelids. On physical examination following clinical sign was elicited. What is the next best step for diagnosis?

A. CK level (Correct Answer)
B. Rheumatoid factor
C. Electromyography
D. Nerve conduction studies

Explanation: ***CK level*** - The combination of **Gottron's papules** (pigmentation over joints), **Heliotrope rash** (redness over upper eyelids), and difficulty standing up as depicted (suggesting **proximal muscle weakness**) are classic signs of **dermatomyositis**, especially in a child. - **Creatine Kinase (CK)** is a key enzyme released by damaged muscle fibers, making its measurement the most appropriate initial diagnostic step to assess for muscle inflammation and damage in dermatomyositis. *Rheumatoid factor* - **Rheumatoid factor (RF)** is primarily associated with **rheumatoid arthritis**, which typically affects joints and not primarily the skin or proximal muscles in the manner described. - While some autoimmune conditions can overlap, RF is not a primary diagnostic marker for dermatomyositis. *Electromyography* - **Electromyography (EMG)** measures muscle electrical activity and can indeed show abnormalities in dermatomyositis (e.g., fibrillation potentials, positive sharp waves, and polyphasic motor unit potentials). - However, it is typically a **secondary diagnostic step** performed after initial biochemical tests like CK levels indicate muscle involvement. *Nerve conduction studies* - **Nerve conduction studies (NCS)** assess the function of peripheral nerves and are primarily used to diagnose **neuropathies**. - Dermatomyositis is a **myopathy** (muscle disease) not a neuropathy, so NCS would likely be normal or show non-specific findings, making it less relevant for initial diagnosis.

Question 10: A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder

A. muscle
B. neuromuscular junction (Correct Answer)
C. peripheral nerve
D. anterior horn cell

Explanation: ***neuromuscular junction*** - The **fatigability** and **end-of-day worsening** of weakness, along with the **decreased handgrip strength with repetitive testing**, are classic signs of **myasthenia gravis**, a disorder of the neuromuscular junction [1], [2]. - In myasthenia gravis, **acetylcholine receptor antibodies** block or destroy receptors at the neuromuscular junction, impairing nerve-to-muscle signal transmission [3]. *muscle* - Primary muscle disorders (myopathies) typically present with **proximal muscle weakness** but do not usually show the characteristic **fatigability with repetitive use** or end-of-day worsening. - Muscle bulk, tone, and reflexes would often be affected in significant primary muscle disease. *peripheral nerve* - Peripheral nerve disorders (neuropathies) usually cause **sensory changes** (tingling, numbness) along with motor weakness, and often present with **diminished reflexes**. - The distinguishing feature of **fatigability with repetitive testing** is not typical of peripheral neuropathies. *anterior horn cell* - Anterior horn cell disorders, such as **amyotrophic lateral sclerosis (ALS)**, cause progressive weakness, muscle atrophy, and fasciculations. - While they cause weakness, they typically do not exhibit the significant **day-to-day fluctuation** or **fatigability with repetitive use** described.

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