Rehabilitation with Prostheses — MCQs
Amputation is often not required in:
Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint
Objectives of pre-prosthetic surgical procedures include all, except:
Myodesis is employed in amputations for all of the following indications except:
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
Semantic memory includes all except:
The shown apparatus is used for
The Milwaukee brace is used in the treatment of which of the following conditions?
Taylor's Brace is used for which of the following?
Which of the following is NOT true regarding the SACH Foot?
Rehabilitation with Prostheses 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: Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint
- A. $1,2,3,4,5,6$
- B. $3,5,6$ (Correct Answer)
- C. $3,4,5$
- D. $1,2,4$
Explanation: ***3,5,6*** - For **tibia traction** in a femoral shaft fracture, you would need a **Steinmann pin** for skeletal traction, a **Bohler's stirrup** to apply the traction force, and a **Bohler-Braun splint** to support the limb. - The **Steinmann pin** is inserted into the proximal tibia, the **Bohler's stirrup** attaches to the pin, and the **Bohler-Braun splint** provides a fixed structure for the traction system. *1,2,3,4,5,6* - This option incorrectly includes items not specifically used for applying **tibia traction** (e.g., K-wire is for internal fixation, Thomas splint is for early femur fracture management but not specifically for tibia traction application). - While some components might be used in general fracture management, not all are directly involved in setting up tibia traction as requested. *3,4,5* - This option correctly includes the **Steinmann pin** and **Bohler's stirrup** but incorrectly replaces the **Bohler-Braun splint** with a **Denham's pin**. - A **Denham's pin** is an alternative to a Steinmann pin for skeletal traction, but a **Bohler-Braun splint** is crucial for supporting the limb in this setup, which is missing here. *1,2,4* - This option includes a **Thomas splint** (used for femur fracture support, not tibia traction application), a **K-wire** (used for internal fixation, not traction), and a **Denham's pin** (an alternative to Steinmann pin, but lacks the necessary support and traction application equipment). - These items are not suitable for setting up comprehensive **tibia traction** for a femoral shaft fracture.
Question 3: Objectives of pre-prosthetic surgical procedures include all, except:
- A. All of the above (Correct Answer)
- B. Removal of epulis fissuratum
- C. Correction of unfavorably located frenular attachments
- D. Vestibuloplasty
Explanation: ***All of the above*** - The question asks for what is *not* an objective of pre-prosthetic surgical procedures, and since the specific options provided (removal of epulis fissuratum, correction of unfavorably located frenular attachments, and vestibuloplasty) are indeed common objectives, "All of the above" is the correct choice, indicating that none of these procedures are exceptions to the objectives. - The other options represent specific objectives, meaning that they are *included* in the goals of pre-prosthetic surgery. *Removal of epulis fissuratum* - **Epulis fissuratum** is a hyperplastic tissue growth often caused by ill-fitting dentures, and its removal is a common pre-prosthetic surgical procedure. - Its presence can interfere with **denture stability** and cause discomfort, thus its removal is an important objective. *Correction of unfavorably located frenular attachments* - **Frenular attachments** that are too high or thick can dislodge a denture or cause pain, and their surgical correction (frenectomy) is a standard pre-prosthetic procedure. - This procedure aims to improve **denture retention** and comfort by modifying the soft tissue architecture. *Vestibuloplasty* - **Vestibuloplasty** is a surgical procedure designed to increase the depth of the **vestibule**, which is essential for improving denture stability and retention. - This procedure creates a more favorable anatomical foundation for **denture support**, especially in cases of severe alveolar ridge resorption.
Question 4: Myodesis is employed in amputations for all of the following indications except:
- A. Ischemia (Correct Answer)
- B. Tumor
- C. Children
- D. Trauma
Explanation: ***Ischemia*** - **Ischemia** is the primary exception where myodesis is often contraindicated or avoided - In ischemic limbs, compromised blood supply limits muscle viability and healing capacity - Poor vascularity prevents adequate muscle-to-bone integration and increases risk of wound complications - Simple myoplasty (muscle-to-muscle suturing) or guillotine-type procedures are often preferred in severe ischemia to ensure primary healing - The priority is achieving a viable stump rather than optimal functional reconstruction *Trauma* - Trauma is one of the **best indications** for myodesis when adequate healthy tissue is available - Creates a stable, functional residual limb with better proprioception for prosthetic fitting - Muscle-to-bone attachment provides superior control and reduces phantom limb pain - Standard technique in traumatic amputations with good soft tissue coverage *Tumor* - Myodesis can be performed in oncological amputations if surgical margins allow - While oncological clearance is the priority, functional reconstruction with myodesis is still pursued when feasible - Modern limb-sparing principles encourage maintaining function alongside adequate resection *Children* - Children are **excellent candidates** for myodesis - Promotes better skeletal growth and long-term functional adaptation - Maintains soft tissue bulk and provides stable base for prosthetic use as the child grows - Helps prevent muscle atrophy and improves quality of life
Question 5: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 6: Semantic memory includes all except:
- A. Rules
- B. Language
- C. Events (Correct Answer)
- D. Words
Explanation: ***Events*** - **Episodic memory** is the type of long-term memory that stores information about specific **personal events** and experiences, complete with their contextual details like time and place. - Semantic memory, in contrast, involves general facts and knowledge, decoupled from specific personal experiences. *Rules* - **Semantic memory** encompasses our understanding of operating principles and **general truths**, such as the laws of physics or social conventions. - This abstract knowledge about how things work or are structured is a core component of semantic memory. *Language* - The understanding of **vocabulary**, **grammar**, and syntax necessary for communication is a key aspect of semantic memory. - This includes knowledge of word meanings, relationships between words, and how to construct grammatically correct sentences. *Words* - The meaning and definition of individual **words** are stored within **semantic memory**. - This allows us to comprehend spoken and written language and to use words appropriately in context.
Question 7: The shown apparatus is used for
- A. Ankle knee stabilizer
- B. Thomas splint
- C. Knee brace
- D. Patella tendon bearing brace (Correct Answer)
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.
Question 8: The Milwaukee brace is used in the treatment of which of the following conditions?
- A. Scoliosis (Correct Answer)
- B. Kyphosis
- C. Cubitus varus
- D. Genu varum
Explanation: **Explanation:** The **Milwaukee brace** (also known as a Cervico-Thoraco-Lumbo-Sacral Orthosis or CTLSO) is a classic active corrective orthosis designed specifically for the non-operative management of **Scoliosis**. **1. Why Scoliosis is Correct:** The brace is used for curves with an apex above T7. It works on the principle of **longitudinal traction** and **lateral pressure**. It consists of a pelvic mold, three upright metal stays (one anterior, two posterior), and a neck ring with a throat mold and occipital pads. This design encourages the patient to pull away from the pads, thereby actively correcting the spinal curvature. It is typically indicated for progressive curves between 25° and 40° (Cobb’s angle) in a skeletally immature child (Risser sign 0-II). **2. Why Other Options are Incorrect:** * **Kyphosis:** While a modified Milwaukee brace can be used for Scheuermann’s kyphosis, it is primarily and classically associated with Scoliosis in medical examinations. For lower thoracic kyphosis, a Boston brace or Taylor’s brace is more common. * **Cubitus varus:** This is a coronal plane deformity of the elbow (Gunstock deformity), usually a late complication of supracondylar fractures. It is treated surgically (e.g., French osteotomy), not with a spinal brace. * **Genu varum:** This refers to "bow legs." Treatment involves observation, Vitamin D (if rachitic), or corrective braces like the **HKAFO** or medial upright orthotics, but never a spinal brace. **High-Yield Clinical Pearls for NEET-PG:** * **Boston Brace:** A TLSO (Thoraco-Lumbo-Sacral Orthosis) used for curves with an apex below T7; it is "low-profile" and lacks the neck ring. * **Charleston Bending Brace:** A nocturnal (night-time) brace used for scoliosis. * **Somerset/SOMI Brace:** Used for cervical spine stabilization. * **Indication Rule:** Bracing is generally indicated when the Cobb’s angle is **25°–40°**. If the angle exceeds **40°–45°**, surgical intervention (e.g., spinal fusion with pedicle screws) is usually required.
Question 9: Taylor's Brace is used for which of the following?
- A. Cervical immobilization
- B. Dorsolumbar immobilization (Correct Answer)
- C. Scoliosis
- D. Fracture femur
Explanation: **Explanation:** **Taylor’s Brace** is a high-yield spinal orthosis in orthopaedics. It is a **thoraco-lumbo-sacral orthosis (TLSO)** designed specifically for **dorsolumbar immobilization**. The brace consists of two vertical posterior bars (paraspinal bars) and a pelvic band. It works on the principle of **three-point pressure**, providing hyperextension to the spine. By limiting flexion and rotation of the thoracolumbar junction, it stabilizes the spine, making it the gold standard for conditions like **Pott’s disease (Spinal TB)** and stable compression fractures of the lower thoracic or upper lumbar vertebrae. **Analysis of Options:** * **A. Cervical immobilization:** This requires a cervical collar (e.g., Philadelphia collar) or a Halo-vest. Taylor’s brace does not extend high enough to stabilize the neck. * **C. Scoliosis:** While some TLSOs are used for scoliosis, the specific brace of choice is usually the **Milwaukee brace** (for high curves) or the **Boston brace** (for lower curves). Taylor’s brace is for immobilization, not for corrective lateral forces. * **D. Fracture femur:** Femur fractures are managed with traction, intramedullary nails, or plates; orthotic management involves a Thomas splint or a Knee-Ankle-Foot Orthosis (KAFO), not a spinal brace. **Clinical Pearls for NEET-PG:** * **Ashman’s/Knight’s Brace:** Used for Lumbo-sacral immobilization (LSO). * **Milwaukee Brace:** A CTLSO used for Scoliosis with an apex above T8. * **Somersault/SOMI Brace:** Used for cervical spine injuries (C4-C5 level). * **Key Component:** Taylor’s brace specifically restricts **flexion and extension** of the dorsolumbar spine.
Question 10: Which of the following is NOT true regarding the SACH Foot?
- A. It has a solid ankle cushion heel.
- B. It is a type of prosthesis.
- C. It facilitates easy squatting. (Correct Answer)
- D. It does not look like a normal foot.
Explanation: **Explanation:** The **SACH (Solid Ankle Cushion Heel) Foot** is the most commonly used non-articulated prosthetic foot. The correct answer is **Option C** because the SACH foot is rigid and lacks a functional ankle joint, which makes **squatting very difficult** for the user. In the Indian context, where squatting is culturally significant, specialized modifications or different prostheses (like the Jaipur Foot) are preferred. **Analysis of Options:** * **A. It has a solid ankle cushion heel:** This is **true**. The SACH foot consists of a rigid internal wooden or plastic keel surrounded by a molded foam rubber shell. The "cushion heel" compresses at heel strike to simulate plantarflexion. * **B. It is a type of prosthesis:** This is **true**. It is a distal component of a lower limb prosthesis used for transtibial (below-knee) and transfemoral (above-knee) amputees. * **D. It does not look like a normal foot:** This is **true**. While it is shaped like a foot, it is a static, cosmetic block. It lacks the realistic texture, toe movements, and flexibility of a natural foot or more advanced lifelike prosthetics. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It simulates "pseudo-plantarflexion" through heel compression during the early stance phase. * **Indication:** Best for elderly patients or those with low activity levels due to its high stability and low maintenance. * **Contraindication:** Not ideal for uneven terrain or activities requiring squatting/pivoting. * **Comparison:** Unlike the SACH foot, the **Jaipur Foot** allows for squatting and cross-legged sitting, making it more suitable for the Indian lifestyle.
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