Geriatric Rehabilitation — MCQs
Amputation is often not required in:
Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
Gold standard investigation for diagnosing GERD:
The Confusion Assessment Method (CAM) is used for which of the following?
A 45-year-old man presents with a history of frequent falls. He has difficulty in looking down also. What is the most probable diagnosis -
A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
Loss of part or function is referred to as:
AIDS, secondary infection will be all except
The commonest site of pressure sore is :
Which is the most common complication of deep vein thrombosis (DVT)?
Geriatric Rehabilitation Indian Medical PG Practice Questions and MCQs
Question 1: Amputation is often not required in:
- A. Buerger's
- B. Chronic osteomyelitis (Correct Answer)
- C. Diabetic gangrene
- D. Gas gangrene
Explanation: ***Chronic osteomyelitis*** - While chronic osteomyelitis can be severe, advancements in **antibiotic therapy**, **surgical debridement**, and **reconstructive procedures** often allow for limb salvage. - The goal of treatment is to eradicate infection and preserve function, making amputation a last resort when other methods fail to control infection or restore viability. *Buerger's* - **Buerger's disease** (thromboangiitis obliterans) is characterized by inflammation and thrombosis of small and medium-sized arteries and veins, primarily in the limbs, leading to severe ischemia and gangrene. - Due to progressive vascular damage and frequent lack of effective medical treatment for advanced stages, **amputation is often required** to remove necrotic tissue and manage intractable pain. *diabetic gangrene* - **Diabetic gangrene** results from a combination of **peripheral neuropathy**, **peripheral arterial disease**, and **infection**, leading to tissue death, particularly in the feet. - The compromised blood supply and impaired wound healing in diabetic patients make these lesions prone to rapid progression and severe infection, with **amputation frequently necessary** to prevent systemic sepsis and death. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by *Clostridium* species, which produce toxins and gas within tissues. - Due to its aggressive and destructive nature, requiring immediate and extensive surgical debridement often involving **amputation of the affected limb** to remove all infected tissue and prevent widespread systemic toxicity.
Question 2: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
- A. Hemiarthroplasty (Correct Answer)
- B. Closed reduction and fixation with three cancellous screws
- C. Longitudinal skin traction for 6 weeks
- D. Excision arthroplasty
Explanation: ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.
Question 3: Gold standard investigation for diagnosing GERD:
- A. 24 hour pH monitoring (Correct Answer)
- B. USG
- C. HIDA
- D. Manometry
Explanation: ***24 hour pH monitoring*** - This is considered the **gold standard** for diagnosing GERD because it directly measures the frequency and duration of **acid reflux events** into the esophagus. - It helps correlate symptoms with reflux episodes, providing objective evidence for the diagnosis and guiding treatment. *USG* - **Ultrasound (USG)** is primarily used for imaging abdominal organs like the **gallbladder**, liver, and kidneys, not for directly assessing esophageal acid reflux. - While it can sometimes detect complications, it cannot diagnose the presence or severity of GERD itself. *HIDA* - **HIDA scan** (hepatobiliary iminodiacetic acid scan) is used to diagnose problems of the **gallbladder** and bile ducts, such as cholecystitis or biliary obstruction. - It is not relevant for the diagnosis of gastroesophageal reflux disease. *Manometry* - **Esophageal manometry** measures the **pressure and coordination of esophageal muscle contractions**, assessing motility disorders [1]. - While it can identify related conditions like achalasia or ineffective peristalsis, it does not directly measure acid reflux and therefore is not the gold standard for GERD diagnosis.
Question 4: The Confusion Assessment Method (CAM) is used for which of the following?
- A. Schizophrenia
- B. Delirium (Correct Answer)
- C. Dementia
- D. Depression
Explanation: ***Delirium*** - The Confusion Assessment Method (CAM) is a widely used and highly sensitive and specific tool for the rapid identification of **delirium**. - It assesses for acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. *Schizophrenia* - Schizophrenia is a chronic mental health disorder primarily characterized by **psychosis**, including hallucinations, delusions, and disorganized thought. - While patients with schizophrenia can experience cognitive difficulties, specialized scales like the Positive and Negative Syndrome Scale (PANSS) are used, not the CAM. *Dementia* - Dementia is a gradual and progressive decline in cognitive function, including memory, thinking, and reasoning, severe enough to interfere with daily life. - Tools like the mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MoCA) are used for screening and assessing dementia, not the CAM. *Depression* - Depression is a mood disorder characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. - Assessment tools like the Hamilton Depression Rating Scale (HDRS) or Patient Health Questionnaire-9 (PHQ-9) are used for depression.
Question 5: A 45-year-old man presents with a history of frequent falls. He has difficulty in looking down also. What is the most probable diagnosis -
- A. Alzheimer's disease
- B. Normal pressure hydro-cephalus
- C. Parkinson's disease
- D. Progressive supranuclear palsy (Correct Answer)
Explanation: ***Progressive supranuclear palsy*** - The combination of **frequent falls** and **difficulty looking down** (supranuclear ophthalmoplegia, especially affecting vertical gaze) is a classic presentation of progressive supranuclear palsy (PSP). - PSP is a **tauopathy** characterized by **postural instability**, early falls, and distinctive ocular motor dysfunction. *Alzheimer's disease* - Primarily presents with **progressive memory loss** and cognitive decline, not typically early or prominent falls or vertical gaze palsy. - While falls can occur in later stages, they are not usually an initial hallmark symptom associated with restricted eye movements. *Normal pressure hydrocephalus* - Characterized by the triad of **gait disturbance** (often described as magnetic gait), **urinary incontinence**, and **dementia** [2]. - While gait disturbance can lead to falls, the specific difficulty in looking down is not a feature of NPH. *Parkinson's disease* - Characterized by **bradykinesia**, **rigidity**, **tremor**, and **postural instability** leading to falls later in the disease [1]. - However, difficulty looking down (vertical gaze palsy) is not a typical feature of Parkinson's disease, and falls tend to occur later in the disease course compared to PSP.
Question 6: A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
- A. Hemiarthroplasty (Correct Answer)
- B. Total Hip Replacement
- C. Dynamic Hip Screw
- D. Conservative Management
Explanation: **Hemiarthroplasty** - **Hemiarthroplasty** is the most common management for **intracapsular neck of femur fractures** in elderly patients, especially those who are frail or have substantial comorbidities. - This procedure replaces the **femoral head** with a prosthesis, preserving the native acetabulum, which is sufficient given the higher risk of complications with a full replacement in this age group. *Total Hip Replacement* - **Total hip replacement (THR)** is typically reserved for more active elderly patients with **pre-existing osteoarthritis** or for those requiring revision surgery, due to better functional outcomes but higher surgical risks. - It involves replacing both the **femoral head** and the **acetabulum**, *Dynamic Hip Screw* - A **dynamic hip screw (DHS)** is primarily used for **extracapsular femur fractures** (e.g., trochanteric fractures), where the blood supply to the femoral head is largely preserved. - It involves fixation, which is not suitable for most **intracapsular fractures** due to the disruption of blood supply, increasing the risk of **avascular necrosis** and non-union. *Conservative Management* - **Conservative management** (e.g., bed rest, pain control) is generally not recommended for **intracapsular neck of femur fractures** in mobile elderly patients due to high rates of complications such as **deep vein thrombosis**, **pressure ulcers**, and **avascular necrosis**. - It may be considered only in patients who are **non-ambulatory** or have severe contraindications to surgery.
Question 7: Loss of part or function is referred to as:
- A. Impairment (Correct Answer)
- B. Disability
- C. Disease
- D. Handicap
Explanation: ***Impairment*** - An **impairment** refers to the **loss of part or function** of the body, whether physical, sensory, or mental. - It describes the direct functional limitation in a body structure or mental function, such as hearing loss or a missing limb. *Disability* - A **disability** is the **restriction or lack of ability** to perform an activity in the manner or within the range considered normal for a human being. - It describes the impact an impairment has on a person's ability to perform tasks, such as difficulty walking due to a foot impairment. *Disease* - A **disease** is a **pathological condition** that affects the body or mind, characterized by a set of signs and symptoms. - It refers to the underlying medical condition causing the impairment, rather than the loss of function itself. *Handicap* - A **handicap** is a **social disadvantage** that results from an impairment or disability, limiting or preventing the fulfillment of a role. - It reflects the societal barriers and environmental factors that disable an individual, rather than the direct body function loss.
Question 8: AIDS, secondary infection will be all except
- A. Candida
- B. Kaposi's sarcoma (Correct Answer)
- C. HSV
- D. Rubella
Explanation: ***Kaposi's sarcoma*** - Kaposi's sarcoma is a **cancer** caused by human herpesvirus 8 (HHV-8) [2] that is common in patients with AIDS, but it is a **malignancy**, not a secondary infection [2],[3]. - While it arises due to immune suppression, it represents abnormal cell proliferation rather than direct microbial invasion. *Candida* - **Candidiasis** (e.g., oral thrush, esophageal candidiasis) is a common opportunistic fungal infection in AIDS patients due to their **impaired cellular immunity** [1]. - It often presents as **white plaques** on mucous membranes and is a clear example of a secondary infection. *HSV* - **Herpes Simplex Virus (HSV)** infections, including oral and genital herpes, are common and often severe in AIDS patients. - Due to immunocompromise, these infections can be **more widespread**, chronic, or recur frequently, qualifying as secondary infections. *Rubella* - **Rubella (German measles)** is a viral infection that is generally mild and self-limiting in immunocompetent individuals. - It is **not considered an opportunistic infection** or a common secondary infection specifically associated with AIDS; rather, it is listed as a differential diagnosis for the primary HIV infection rash [1].
Question 9: The commonest site of pressure sore is :
- A. Sacrum
- B. Heel (Correct Answer)
- C. Ischium
- D. Occiput
Explanation: ***Heel*** - The **heel** is a common site for pressure sore development, especially in bedridden or immobile patients, due to sustained pressure on the bony prominence. - While less common as the *most* common site compared to the sacrum, it is still very frequently affected and can be equally severe. *Sacrum* - The **sacrum** is the *most common site* for pressure ulcers, particularly in individuals who are bed-bound or spend prolonged periods in a supine position. - This area experiences high pressure when lying on the back due to the body's weight pressing down on the bony prominence of the sacrum [1]. *Ischium* - The **ischial tuberosities** are common sites for pressure sores in individuals who are wheelchair-bound or spend extended periods in a seated position. - Pressure on this area is particularly high when sitting, making it vulnerable to tissue damage. *Occiput* - The **occiput** (back of the head) is a common site for pressure sores in infants, critically ill patients, or individuals who are supine for extended periods and unable to reposition their heads. - This is due to sustained pressure on the bony prominence of the skull against the mattress or support surface.
Question 10: Which is the most common complication of deep vein thrombosis (DVT)?
- A. Cerebrovascular accident (CVA) - associated with arterial embolism, not DVT
- B. Pulmonary embolism (Correct Answer)
- C. Renal failure - not a common complication of DVT
- D. Myocardial infarction (MI) - a complication of arterial thrombosis, not DVT
Explanation: ***Pulmonary embolism*** - A **pulmonary embolism (PE)** occurs when a blood clot, most commonly from a **deep vein thrombosis (DVT)** in the legs, travels to the lungs and blocks an artery [1]. - This is the **most serious and common acute complication** of DVT, potentially leading to respiratory distress, hemodynamic instability, and even death [1]. *Cerebrovascular accident (CVA) - associated with arterial embolism, not DVT* - A **cerebrovascular accident (CVA)**, or stroke, is most often caused by **arterial embolism** or thrombosis, not typically by venous clots from DVT [1]. - While paradoxical embolism via a patent foramen ovale can occur, it is a **rare mechanism** for CVA from DVT. *Renal failure - not a common complication of DVT* - **Renal failure** is not a direct or common complication of DVT; DVT primarily affects the venous system in the limbs and can lead to PE. - Complications like **post-thrombotic syndrome** are more characteristic of long-term DVT effects on the affected limb. *Myocardial infarction (MI) - a complication of arterial thrombosis, not DVT* - A **myocardial infarction (MI)**, or heart attack, is almost exclusively caused by **thrombosis in a coronary artery**, which is part of the arterial system [1]. - DVT involves the venous system, and clots from DVT do not typically travel to the coronary arteries to cause an MI.
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