Rehabilitation and Physical Medicine Practice Questions

Q: Early recovery of Sudeck's atrophy can be best managed by which of the following interventions?

Intraarterial injection of novacaine.. **Explanation:** **Sudeck’s Atrophy**, also known as Complex Regional Pain Syndrome (CRPS) Type 1, is a condition characterized by post-traumatic pain, swelling, and vasomotor instability, typically occurring after fractures (e.g., Colles' fracture). The underlying pathophysiology involves an **overactive sympathetic nervous system** leading to persistent vasospasm and localized ischemia. **Why Option B is Correct:** The management of early-stage Sudeck’s atrophy focuses on breaking the "pain-vasospasm-pain" cycle. **Intra-arterial injection of Novocaine (Procaine)** acts as a powerful vasodilator and local anesthetic. By injecting it into the main artery of the affected limb (e.g., brachial artery), it provides immediate sympathetic blockade, improves peripheral blood flow, and reduces the intense burning pain, facilitating early mobilization. **Why Other Options are Incorrect:** * **Option A:** Articaine is a local anesthetic primarily used in dentistry. While it has a rapid onset, it is not the traditional or clinically documented agent of choice for intra-arterial sympathetic blockade in CRPS management compared to Novocaine. * **Option C & D:** Since Novocaine is the specific established treatment for this intervention in classical orthopedic teaching, these options are incorrect. **Clinical Pearls for NEET-PG:** * **Radiological Hallmark:** "Spotty" or patchy osteoporosis (sudden demineralization) seen on X-ray. * **Clinical Features:** The "4 Ds" – Discoloration, Dependency edema, Degenerative changes (stiffness), and Desensitization (hyperalgesia). * **Gold Standard Diagnosis:** Triple-phase bone scan (shows increased uptake). * **Other Treatments:** Physiotherapy (most important), Vitamin C (prophylaxis), and Guanethidine blocks.

Q: In a post-polio case, what is the likely result of an iliotibial tract contracture?

Flexion at the hip and the knee. **Explanation:** The **Iliotibial Tract (ITT)** is a thickened lateral portion of the fascia lata. Its anatomical orientation is crucial: it originates from the iliac crest, passes over the greater trochanter, and inserts into **Gerdy’s tubercle** on the lateral condyle of the tibia. Because the ITT lies **anterior to the axis of the hip** and **posterior to the axis of the knee** (when the knee is flexed beyond 30 degrees), a contracture leads to a characteristic deformity pattern. In post-polio residual paralysis (PPRP), the ITT often becomes tight due to muscle imbalances, resulting in: 1. **Flexion, Abduction, and External Rotation at the hip.** 2. **Flexion and Valgus deformity at the knee.** **Analysis of Options:** * **Option C (Correct):** The ITT acts as a tether. When contracted, it pulls the hip into flexion and abduction. At the knee, the insertion point pulls the joint into flexion and lateral rotation (valgus). * **Options A, B, and D (Incorrect):** These suggest extension. The ITT contracture is a classic cause of **flexion deformities**. It cannot cause extension because its shortened state prevents the joints from reaching a neutral or extended position. **Clinical Pearls for NEET-PG:** * **Ober’s Test:** Used to clinically diagnose a tight Iliotibial band/tract. * **Yount’s Fasciotomy:** A surgical procedure involving the excision of a segment of the ITT and lateral intermuscular septum to release these contractures. * **Deformity Triad:** In PPRP, ITT contracture is often associated with pelvic tilt and scoliosis due to the "short leg" effect and hip abduction.

Q: Cock-up splint is used in injuries of:

Radial nerve. The **Cock-up splint** is a classic orthopedic appliance used primarily for **Radial nerve injuries**. ### 1. Why Radial Nerve is Correct The radial nerve innervates the extensors of the wrist and fingers. Injury to this nerve (commonly due to humerus fractures or "Saturday Night Palsy") leads to **Wrist Drop**. In this condition, the patient cannot actively extend the wrist, leading to functional impairment as the grip strength is significantly weakened when the wrist is flexed. * **Mechanism:** The Cock-up splint maintains the wrist in **20°–30° of extension**. * **Purpose:** This prevents contracture of the flexor tendons, protects the paralyzed extensor muscles from being overstretched, and optimizes the "tenodesis effect" to maintain functional grip strength during recovery. ### 2. Why Other Options are Incorrect * **Ulnar Nerve:** Injury leads to "Claw Hand." The appropriate orthosis is a **Knuckle Bender splint** (to prevent hyperextension at the MCP joints). * **Axillary Nerve:** Leads to deltoid paralysis and loss of shoulder abduction. It is managed with an **Aeroplane splint** (maintaining the shoulder in abduction). * **Common Peroneal Nerve:** Leads to **Foot Drop**. This requires an **AFO (Ankle-Foot Orthosis)** or a Foot-drop splint, not a wrist splint. ### 3. High-Yield Clinical Pearls for NEET-PG * **Median Nerve Injury:** Managed with a **Thumb Spica** or **Opponens splint** (to maintain the thumb in opposition). * **De Quervain’s Tenosynovitis:** Also uses a Thumb Spica splint. * **Mallet Finger:** Managed with a **Stack splint** (maintaining the DIP joint in hyperextension). * **Carpal Tunnel Syndrome:** A Cock-up splint is often used at night to relieve pressure on the median nerve.

Question 1

Early recovery of Sudeck's atrophy can be best managed by which of the following interventions?

Accepted Answer

Intraarterial injection of novacaine.

Answer

Intraarterial injection of articaine.

Answer

Both intraarterial injection of articaine and novacaine.

Answer

Neither intraarterial injection of articaine nor novacaine.

Question 2

A patient presents with painful Myositis Ossificans around the elbow. What is the preferred treatment option in this case?

Accepted Answer

Immobilization

Answer

Active mobilization

Answer

Passive mobilization

Answer

Infra-Red Therapy

Question 3

In a post-polio case, what is the likely result of an iliotibial tract contracture?

Accepted Answer

Flexion at the hip and the knee

Answer

Extension at the hip and knee

Answer

Extension at the hip

Answer

Extension at the knee

Question 4

Stump pain is relieved by?

Accepted Answer

None of the above

Answer

Continuous tapping over the stump

Answer

Warming up the stump

Answer

Using steroids

Question 5

Cock-up splint is used in injuries of:

Accepted Answer

Radial nerve

Answer

Ulnar nerve

Answer

Axillary nerve

Answer

Common peroneal nerve

Rehabilitation and Physical Medicine — MCQs

Rehabilitation and Physical Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?