Functional Assessment and Outcome Measures — MCQs
Severe disability in primary osteoarthritis of hip is best managed by -
Thomas test is used for testing?
Which of the following tests is used to test anterior instability of shoulder?
For evaluating the functioning of a health center, which is the most important determinant for assessing clinical management?
In a screening test for DM out of 1000 population, 90 were positive. When the gold standard test was applied to the entire population, 100 were found to have the disease. Assuming all 90 screening positives were confirmed as true positives by the gold standard, calculate the sensitivity.
Which of the following is a new major Jones criterion in a high-risk population, according to the AHA & World Health Federation 2015 criteria?
Any loss or abnormality of psychological, physiological or anatomical structure or function is:
A patient came with complaints of lower limb weakness. Examiner places one hand under the patient's heel and patient is asked to raise his other leg against downward resistance. What is the name of this test?
Which among the following is the best method to assess adequacy of fluid resuscitation in a polytrauma patient?
Berksonian bias is a type of ?
Functional Assessment and Outcome Measures Indian Medical PG Practice Questions and MCQs
Question 1: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Question 2: Thomas test is used for testing?
- A. Knee flexion
- B. Hip abduction
- C. Hip rotation
- D. Hip flexor tightness (Correct Answer)
Explanation: ***Hip flexor tightness*** - The **Thomas test** is a diagnostic maneuver used specifically to assess for the presence of **flexion contractures** within the hip joint. - It helps identify tightness in muscles such as the **iliopsoas**, rectus femoris, and tensor fasciae latae. *Knee flexion* - While hip flexor tightness can indirectly affect knee position, the Thomas test does not primarily measure the range of motion of **knee flexion** itself. - **Other tests**, such as goniometric measurements of the knee joint, are used to assess knee flexion directly. *Hip abduction* - The Thomas test is not designed to evaluate **hip abduction** range of motion. - Hip abduction is tested through maneuvers that move the leg away from the midline of the body, often with the patient in a side-lying or supine position, assessing muscles like the **gluteus medius** and minimus. *Hip rotation* - The Thomas test does not assess **hip rotation** (internal or external). - Hip rotation is typically evaluated with the hip and knee flexed to 90 degrees, assessing the rotational range of the **femoral head within the acetabulum**.
Question 3: Which of the following tests is used to test anterior instability of shoulder?
- A. Push-pull test
- B. Apprehension Test (crank test) (Correct Answer)
- C. Posterior drawer test
- D. Jerk test
Explanation: ***Apprehension Test (crank test)*** - The **apprehension test** assesses for anterior shoulder instability by passively abducting and externally rotating the arm, which is the position of potential anterior dislocation. - A positive test is indicated by the patient's **apprehension** or fear of dislocation, often accompanied by muscle guarding, as the head of the humerus is forced anteriorly. *Push-pull test* - The push-pull test is used to assess for **posterior shoulder stability**, specifically for **posterior labral tears** or instability. - It involves applying axial compression while simultaneously pulling the humerus posteriorly, looking for pain or a clunk. *Posterior drawer test* - The posterior drawer test is primarily used to evaluate **posterior glenohumeral instability**. - It involves stabilizing the scapula and applying a posterior force to the humerus while the arm is flexed, abducted, and internally rotated. *Jerk test* - The jerk test is used to identify **posterior-inferior glenohumeral instability** or a **posterior labral tear**, particularly a reverse Bankart lesion. - It involves axially loading the arm while moving it from an abducted and externally rotated position to an adducted and internally rotated position, looking for a sudden "jerk" or clunk.
Question 4: For evaluating the functioning of a health center, which is the most important determinant for assessing clinical management?
- A. Structure
- B. Input
- C. Process (Correct Answer)
- D. Outcome
- E. Output
Explanation: ***Process*** - Evaluating the **process** involves assessing the actual delivery of care, including adherence to clinical guidelines, patient-provider interactions, and the timeliness and appropriateness of services. This directly reflects the quality of **clinical management**. - It focuses on *how* care is provided, which is crucial for identifying areas of strength and weakness in the day-to-day operations of a health center's clinical functions. *Structure* - **Structure** refers to the resources and settings in which care is provided, such as facilities, equipment, staff qualifications, and organizational policies. - While important, a good structure does not guarantee good clinical management; the structure offers the potential for quality, but the actual delivery of care (process) is what matters most for assessment. *Input* - **Input** is a broad term often overlapping with structure, referring to the resources poured into the system like funding, staff, and materials. - Like structure, input provides the necessary components, but evaluating them alone does not directly assess the *effectiveness* or *quality* of clinical management. *Output* - **Output** refers to the immediate results of service delivery, such as the number of patients seen, procedures performed, or services rendered. - While outputs can be measured, they represent quantity rather than quality and do not directly assess the appropriateness or effectiveness of clinical management itself. *Outcome* - **Outcome** measures the end results of care, such as patient health status, satisfaction, or mortality rates. - While outcomes are critical, they are often influenced by many factors beyond direct clinical management (e.g., patient adherence, social determinants of health) and may not immediately reflect the quality of the *process* of care delivery itself.
Question 5: In a screening test for DM out of 1000 population, 90 were positive. When the gold standard test was applied to the entire population, 100 were found to have the disease. Assuming all 90 screening positives were confirmed as true positives by the gold standard, calculate the sensitivity.
- A. All positives identified by the test assumed as true positives (100%)
- B. True positives divided by total actual positives (90%) (Correct Answer)
- C. Underestimated true positives divided by total actual positives (80%)
- D. Total positives identified by the test divided by total actual positives (90%)
Explanation: ***True positives divided by total actual positives (90%)*** - **Sensitivity** is the proportion of true positives correctly identified by a screening test among all individuals who actually have the disease. It is calculated by (Number of True Positives) / (Total Number of Diseased Individuals). - In this case, 90 people screened positive and were confirmed as **true positives**. The total number of people with the disease (actual positives) is 100. So, sensitivity = 90/100 = **90%**. *Total positives identified by the test divided by total actual positives (90%)* - While this option states the correct percentage (90%), the phrasing "total positives identified by the test" is misleading terminology. In screening test evaluation, this could be confused with all test positives (which would include false positives if they existed). - The correct terminology is "true positives" divided by "total actual positives," not "total positives identified by the test." The distinction is important: true positives are confirmed cases, while test positives might include false positives. *All positives identified by the test assumed as true positives (100%)* - This option incorrectly assumes that because all 90 screening positives were confirmed as true positives, the sensitivity must be 100%. However, sensitivity measures how many of ALL diseased individuals were caught, not just those who screened positive. - There were 100 actual diseased individuals, and only 90 were identified by the screening test; therefore, the sensitivity cannot be 100%. The test missed 10 diseased individuals (false negatives). *Underestimated true positives divided by total actual positives (80%)* - This option presents an arbitrary percentage that does not reflect the given data. There is no information to suggest that the true positives were underestimated or that the calculation would result in 80%. - The actual number of true positives (90) and actual positives (100) directly leads to a sensitivity calculation of 90%, not 80%.
Question 6: Which of the following is a new major Jones criterion in a high-risk population, according to the AHA & World Health Federation 2015 criteria?
- A. Monoarthritis (Correct Answer)
- B. Polyarthritis
- C. Monoarthralgia
- D. Chorea
Explanation: ***Monoarthritis*** - In a **high-risk population**, the 2015 AHA guidelines for diagnosing **acute rheumatic fever** (ARF) include monoarthritis as a **major criterion**. [1] - This update acknowledges that in populations with a high burden of ARF, even a single joint involvement can be indicative of the disease. *Polyarthritis* - **Polyarthritis** has traditionally been a major Jones criterion and remains so; however, the question specifically asks for a *new* major criterion in high-risk populations. [1] - While relevant, it is not the specific *new* update for high-risk populations as monoarthritis is. *Monoarthralgia* - **Monoarthralgia** is considered a **minor criterion** in both low-risk and high-risk populations because it represents joint pain without inflammatory signs or objective findings. - Minor criteria alone are insufficient for diagnosing ARF without major criteria or evidence of preceding streptococcal infection. [1] *Chorea* - **Sydenham chorea** is a well-established **major Jones criterion** for ARF, recognized for its characteristic involuntary movements. [1] - It is not a *newly* added major criterion but rather a classical manifestation of ARF.
Question 7: Any loss or abnormality of psychological, physiological or anatomical structure or function is:
- A. Disability
- B. Handicap
- C. Disease
- D. Impairment (Correct Answer)
Explanation: ***Impairment*** - An **impairment** refers to any loss or abnormality of **psychological**, **physiological**, or **anatomical structure** or function. - This definition directly matches the question's description of a deviation from normal function at the **organ or body level**. *Disability* - A **disability** is a restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being, as a result of an **impairment**. - It describes the functional limitation experienced by an individual due to the impairment, not the impairment itself. *Handicap* - A **handicap** is a disadvantage for a given individual, resulting from an **impairment** or **disability**, that limits or prevents the fulfillment of a role that is normal. - It describes the social and environmental consequences of an impairment or disability, reflecting the impact on an individual's social roles. *Disease* - A **disease** is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. - While a disease often *causes* an impairment, the term "disease" describes the underlying pathological process, whereas "impairment" describes the resulting loss or abnormality of function or structure.
Question 8: A patient came with complaints of lower limb weakness. Examiner places one hand under the patient's heel and patient is asked to raise his other leg against downward resistance. What is the name of this test?
- A. O'Donoghue test
- B. McBride test
- C. Waddell's test
- D. Hoover test (Correct Answer)
Explanation: ***Hoover test*** - This specific maneuver is used to detect **malingering or non-organic weakness** in the lower limbs [1]. The examiner expects an involuntary downward thrust from the heel of the seemingly weak leg when the patient attempts to lift the contralateral leg. - Absence of this expected downward pressure on the examiner's hand when the patient is asked to lift the "strong" leg suggests the patient is not genuinely attempting to lift the affected leg. *O'Donoghue test* - The O'Donoghue test assesses for **meniscal or ligamentous injury** in the knee joint by combining passive and resisted motions of the knee. - It involves motions like resisted flexion, extension, and rotation to elicit pain, which is different from the described procedure. *McBride test* - The McBride test is used to evaluate the integrity of the **collateral ligaments of the knee**, particularly after injury. - It involves specific manipulations of the knee and ankle to assess stability and pain, which is not what the question describes. *Waddell's test* - Waddell's signs are a set of five physical signs that indicate **non-organic or psychological components to low back pain**. - These signs include superficial tenderness, simulated axial loading pain, distraction signs, regional weakness/sensory disturbance, and overreaction during examination, none of which involve the specific maneuver for detecting lower limb motor weakness described in the question.
Question 9: Which among the following is the best method to assess adequacy of fluid resuscitation in a polytrauma patient?
- A. BP
- B. CVP
- C. Urine output (Correct Answer)
- D. Pulse
Explanation: ***Urine output*** - **Urine output** is a direct and reliable indicator of **renal perfusion** and overall **volume status**, reflecting effective **systemic circulation** in a polytrauma patient. - Consistent hourly urine output (e.g., >0.5 mL/kg/hr in adults) suggests adequate fluid resuscitation and organ perfusion, particularly the kidneys. *BP* - **Blood pressure (BP)** can be maintained within normal limits by compensatory mechanisms even during significant **hypovolemia**, making it an unreliable early indicator of fluid status. - BP can also be affected by pain, stress, or medications, making its interpretation in isolation challenging in polytrauma. *CVP* - **Central venous pressure (CVP)** is a measure of preload but can be influenced by multiple factors such as **intrathoracic pressure**, **ventilator settings**, and **cardiac function**, making its accuracy in assessing fluid status debatable in trauma. - CVP measurements might also be elevated in patients with **cardiac contusions** or pre-existing **cardiac conditions**, leading to misinterpretation of fluid needs. *Pulse* - **Pulse rate** is an early indicator of hypovolemia (tachycardia) but is highly sensitive to other factors such as pain, anxiety, and medications, limiting its specificity as a sole measure of fluid status. - In a polytrauma patient, an elevated pulse could be due to pain, stress, or other injuries, not solely reflecting inadequate fluid intake.
Question 10: Berksonian bias is a type of ?
- A. Selection bias (Correct Answer)
- B. Information bias
- C. Interviewer bias
- D. Recall bias
Explanation: ***Selection bias*** - **Berkson's bias** is a form of **selection bias** that arises in studies conducted using hospital data. - It occurs when the probability of admission to a hospital or inclusion in a study is conditional on both exposure and disease status, leading to a **flawed association** between them. *Interviewer bias* - **Interviewer bias** is a type of **information bias** where the interviewer's expectations or knowledge about the study or participants influence the way information is sought or recorded. - This typically affects the **data collection process** and not the selection of participants. *Information bias* - **Information bias** is a broad category of biases that arise from **systematic errors in measurement** or classification of exposure or disease. - While Berkson's bias can lead to misinformation, its root cause is in how subjects are selected, not how data on those subjects is collected after selection. *Recall bias* - **Recall bias** is a type of **information bias** where there are systematic differences in the way participants **recall past events or exposures**. - It is particularly common in **case-control studies** where individuals with a disease may remember exposures differently than healthy controls.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free