Physical Modalities in Rehabilitation — MCQs

10 questions

Which of the following statements about malignant hyperthermia is incorrect?

Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

The electromyogram (EMG) is least useful for the diagnosis of:

ECT is contraindicated in -

In the acute management of ecchymosis and hematoma, which thermal modality is most appropriate?

Incorrect statement regarding the management of frostbite:

All may be seen in deep burns except

A 35-year-old woman presents with widespread musculoskeletal pain, fatigue, and poor sleep. She has tenderness in 14 of 18 specific points on physical exam. What is the best treatment strategy?

Which of the following treatment options is not useful in the management of Guillain-Barré syndrome?

Q10

Which of the following is the most effective method to prevent malaria?

Physical Modalities in Rehabilitation Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following statements about malignant hyperthermia is incorrect?

A. End tidal CO₂ is decreased during the episode. (Correct Answer)
B. Dantrolene is the drug of choice for treatment.
C. Most common cause is a mutation in the ryanodine receptor.
D. Tachycardia occurs during the episode.

Explanation: ***End tidal CO₂ is decreased during the episode.*** - Malignant hyperthermia causes **increased metabolism and CO₂ production**, leading to a significant **elevation in end-tidal CO₂**, not a decrease. - The rapid rise in **end-tidal CO₂** is often one of the earliest and most sensitive signs of a malignant hyperthermia crisis. *Dantrolene is the drug of choice for treatment.* - **Dantrolene** is indeed the specific treatment for malignant hyperthermia, as it acts on the **ryanodine receptor** to reduce calcium release from the sarcoplasmic reticulum. - This statement is **correct**, and therefore not the incorrect statement sought by the question. *Most common cause is a mutation in the ryanodine receptor.* - The most common genetic defect underlying malignant hyperthermia is a mutation in the **RYR1 gene**, which codes for the **ryanodine receptor type 1** (RyR1). - This mutation leads to an uncontrolled release of **intracellular calcium** from the sarcoplasmic reticulum in muscle cells. *Tachycardia occurs during the episode.* - **Tachycardia** is a common and early sign of malignant hyperthermia due to the increased metabolic rate and sympathetic nervous system activation. - This rapid heart rate contributes to the overall physiological stress during the crisis.

Question 2: Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

A. ab
B. abc (Correct Answer)
C. acd
D. bcd

Explanation: ***ab*** - All conditions listed under 'a' and 'b' (Dermatitis, Vascularly compromised status of limb, Abrasions) are **absolute contraindications** for skin traction as they directly compromise skin integrity or circulation. - Applying skin traction in these situations can lead to **skin breakdown**, infection, or further **ischemic damage**, worsening the patient's condition. *ab* - While **dermatitis**, **vascular compromise**, and **abrasions** are indeed contraindications, the option for 'abc' implies there might be other correct choices included, which is not the case for this option. - This option is incomplete as it misses 'c' (Abrasions) which is also a significant contraindication. *acd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication, which does not inherently prevent skin traction. - It also omits **vascularly compromised status of limb**, a critical contraindication, while including 'a', 'c', and 'd'. *bcd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication for skin traction. - It also omits **dermatitis**, a key contraindication, while including 'b', 'c', and 'd'.

Question 3: The electromyogram (EMG) is least useful for the diagnosis of:

A. Myasthenia gravis
B. Charcot-Marie-Tooth disease
C. Spinal muscular atrophy
D. Cerebral palsy (Correct Answer)

Explanation: ***Cerebral palsy*** - Cerebral palsy is a **disorder of movement and posture** caused by non-progressive brain damage, primarily affecting the **upper motor neurons**. - While EMG can assess muscle activity, its primary role is in evaluating **lower motor neuron diseases** and **neuromuscular junction disorders**, making it less directly useful for diagnosing a central nervous system disorder like cerebral palsy. *Myasthenia gravis* - EMG, particularly **repetitive nerve stimulation**, is highly useful for diagnosing myasthenia gravis by revealing a **decremental response** in the compound muscle action potential due to impaired neuromuscular transmission [1]. - It directly assesses the function of the **neuromuscular junction**, which is the site of pathology in myasthenia gravis [1]. *Charcot-Marie-Tooth disease* - EMG and **nerve conduction studies (NCS)** are crucial for diagnosing Charcot-Marie-Tooth disease by demonstrating **abnormal nerve conduction velocities** (demyelinating forms) or **reduced amplitude** of compound muscle action potentials (axonal forms) which indicate peripheral nerve damage. - The findings help characterize the type and severity of **peripheral neuropathy**, a hallmark of this condition. *Spinal muscular atrophy* - EMG is essential for diagnosing spinal muscular atrophy by showing **denervation and reinnervation changes** in muscles, such as **fibrillations**, **positive sharp waves**, and **large-amplitude, long-duration motor unit potentials** [1]. - These findings reflect the loss of **anterior horn cells** and subsequent attempts by surviving motor neurons to reinnervate muscle fibers.

Question 4: ECT is contraindicated in -

A. Very ill patients
B. Raised ICT (Correct Answer)
C. Heart disease
D. Pregnancy

Explanation: ***Raised ICT (Correct Answer)*** - An increase in **intracranial pressure (ICP)** is the **only absolute contraindication** to ECT in modern practice. - ECT causes a **transient rise in ICP** during the seizure due to increased cerebral blood flow and cerebral metabolic rate. - In patients with pre-existing raised ICP (from brain tumors, subdural hematoma, or other space-occupying lesions), this additional increase can precipitate **brain herniation**, which is potentially fatal. - This makes raised ICP an **absolute contraindication** where the risks clearly outweigh any potential benefits. *Very ill patients* - ECT is **not contraindicated** in medically ill patients; in fact, it can be **life-saving** in severe psychiatric emergencies. - With careful medical evaluation, monitoring, and management, ECT can be safely administered to medically fragile individuals. - The rapid therapeutic response of ECT makes it particularly valuable when other treatments have failed or when quick intervention is critical. *Heart disease* - Cardiac conditions are **relative contraindications**, not absolute contraindications. - While conditions like recent MI, unstable angina, or severe arrhythmias require careful evaluation, ECT can be performed safely with appropriate cardiac optimization and monitoring. - Modern anesthetic techniques and cardiovascular management allow most patients with heart disease to receive ECT when clinically indicated. *Pregnancy* - **Pregnancy is NOT a contraindication** to ECT and is considered one of the safest treatment options for severe psychiatric illness during pregnancy. - ECT can be performed safely throughout all trimesters with appropriate obstetric consultation, fetal monitoring, and positioning adjustments. - It avoids the teratogenic risks associated with many psychotropic medications, making it a preferred option for severe depression or psychosis in pregnancy.

Question 5: In the acute management of ecchymosis and hematoma, which thermal modality is most appropriate?

A. Continuous ice pack
B. Pressure and pack
C. Intermittent hot pack
D. Intermittent ice pack (Correct Answer)

Explanation: ***Intermittent ice pack*** - An **intermittent ice pack** is the cornerstone of acute thermal management for ecchymosis and hematoma, reducing **swelling** and **inflammation**. - Cold application causes **vasoconstriction**, minimizing further bleeding into tissues and providing **analgesia** by numbing the affected area. - Intermittent application (15-20 minutes on, 20-30 minutes off) prevents tissue damage while maximizing therapeutic benefit. - Part of the **RICE protocol** (Rest, Ice, Compression, Elevation) for acute soft tissue injuries. *Continuous ice pack* - **Continuous ice pack** application can cause **tissue damage**, including frostbite, nerve injury, and skin necrosis. - Prolonged vasoconstriction impairs tissue perfusion and delays healing by limiting oxygen and nutrient delivery. - Should be avoided in favor of intermittent application. *Pressure and pack* - While **compression/pressure** is indeed an important component of acute hematoma management, this option refers to the mechanical intervention rather than the thermal modality asked in the question. - Pressure dressings are used **in conjunction with** ice application, not as an alternative thermal treatment. - The question specifically asks about thermal modality, making ice the correct answer. *Intermittent hot pack* - **Heat application** in the acute phase causes **vasodilation**, which would increase blood flow and exacerbate bleeding. - This would worsen swelling and hematoma formation in the initial 24-48 hours post-injury. - Heat therapy is reserved for the later stages (after 48-72 hours) to promote healing and reduce chronic inflammation.

Question 6: Incorrect statement regarding the management of frostbite:

A. Antibiotics and analgesics not used (Correct Answer)
B. Amputation in severe cases
C. Rewarming is done
D. The area is dried and cleaned

Explanation: ***Antibiotics and analgesics not used*** - This statement is incorrect as **antibiotics are used** in the management of frostbite for prophylaxis against infection, especially in severe cases or open wounds. - **Analgesics are also crucial** to manage the significant pain associated with frostbite and the rewarming process [1]. *Amputation in severe cases* - **Amputation** is a necessary intervention for severe, irreversible tissue damage and necrosis caused by frostbite, typically reserved as a last resort [1]. - This decision is usually made after sufficient time has passed to demarcate viable from non-viable tissue, often several weeks post-injury [1]. *Rewarming is done* - **Rapid rewarming** of the affected area in a warm water bath (37-39°C) is the most critical initial treatment for frostbite to minimize tissue damage. - This process is painful and should be done only when there is no risk of refreezing. *The area is dried and cleaned* - After rewarming, the affected area should be **gently dried** to prevent further skin breakdown and the development of maceration. - **Cleaning the wound** helps prevent infection and maintains a sterile environment for healing.

Question 7: All may be seen in deep burns except

A. Hyperthermia (Correct Answer)
B. Vasodilatation
C. Fluid loss by evaporation
D. Increase vascular permeability

Explanation: ***Hyperthermia*** - While burns can initially cause a slight elevation in body temperature due to the inflammatory response, **deep burns** typically lead to **hypothermia** due to massive heat loss from the damaged skin barrier. - The body's ability to regulate temperature is severely impaired, making **hyperthermia** an unlikely persistent finding. *Vasodilatation* - **Vasodilation** occurs in response to the inflammatory mediators released after a burn injury. - This increased blood flow contributes to **edema** and fluid shifts in the affected areas. *Fluid loss by evaporation* - **Deep burns** destroy the protective skin barrier, leading to significant and continuous **evaporative fluid loss**. - This can quickly result in **hypovolemia** and is a major concern in burn management. *Increase vascular permeability* - Burn injury causes the release of inflammatory mediators like histamine and bradykinin, leading to a marked **increase in vascular permeability**. - This allows plasma proteins and fluid to leak from the capillaries into the interstitial space, contributing to **edema** and potential **shock**.

Question 8: A 35-year-old woman presents with widespread musculoskeletal pain, fatigue, and poor sleep. She has tenderness in 14 of 18 specific points on physical exam. What is the best treatment strategy?

A. Pharmacological pain management with opioids
B. CBT and exercise (Correct Answer)
C. Anti-inflammatory medications
D. Surgical intervention for pain relief

Explanation: ***CBT and exercise*** - **Cognitive Behavioral Therapy (CBT)** addresses the psychological factors contributing to pain perception and coping, which is crucial in managing **fibromyalgia**. - **Exercise**, particularly low-impact aerobic activities, has been shown to improve widespread pain, fatigue, sleep disturbances, and overall function in patients with **fibromyalgia** [1]. *Pharmacological pain management with opioids* - **Opioids** are generally not recommended for fibromyalgia due to their limited efficacy for chronic widespread pain and significant risk of **dependence** and side effects [2]. - Their use can lead to **hyperalgesia** and worsened pain perception over time, contrary to the desired outcome. *Anti-inflammatory medications* - **NSAIDs** are typically ineffective for fibromyalgia because it is not primarily an inflammatory condition [1]. - While they might provide mild symptomatic relief, they do not address the central sensitization and neurochemical imbalances characteristic of **fibromyalgia** [1]. *Surgical intervention for pain relief* - **Surgical intervention** is not indicated for fibromyalgia, as it is a systemic chronic pain condition without a focal structural anomaly requiring surgery. - There is no evidence supporting the efficacy of surgery for the relief of widespread musculoskeletal pain in **fibromyalgia**.

Question 9: Which of the following treatment options is not useful in the management of Guillain-Barré syndrome?

A. Plasmapheresis
B. Intra-venous immunoglobulin
C. Physical medical rehabilitation
D. Intra-venous methotrexate (Correct Answer)

Explanation: ***Intra-venous methotrexate*** - **Methotrexate** is an **immunosuppressant** used in conditions like **rheumatoid arthritis** or certain cancers, but it has no established role in treating the acute phase of **Guillain-Barré Syndrome (GBS)**. - Its mechanism of action and side effect profile are not suitable for the rapid-onset, immune-mediated demyelination characteristic of GBS, and it could potentially worsen the condition or delay recovery. *Intra-venous immunoglobulin* - **Intravenous immunoglobulin (IVIg)** is a standard treatment for GBS that works by providing a concentrated dose of pooled human antibodies to neutralize pathogenic autoantibodies and modulate the immune response. - It is effective in reducing the severity and duration of GBS symptoms, improving recovery rates and decreasing the need for mechanical ventilation. *Plasmapheresis* - **Plasmapheresis (plasma exchange)** is another effective first-line treatment for GBS, involving the removal of plasma from the blood to filter out harmful antibodies and inflammatory mediators that contribute to nerve damage. - It helps to reduce the autoimmune attack on the peripheral nerves, leading to faster recovery and reduced neurological deficits. *Physical medical rehabilitation* - **Physical medical rehabilitation** is crucial for long-term recovery in GBS, focusing on regaining muscle strength, movement, and functional independence once the acute phase has passed. - It includes **physical therapy**, **occupational therapy**, and **speech therapy** to address residual weakness, fatigue, and other neurological deficits, helping patients adapt and improve their quality of life.

Question 10: Which of the following is the most effective method to prevent malaria?

A. Vaccination
B. Antimalarial drugs
C. Genetic modification of mosquitoes
D. Use of insecticide-treated nets (Correct Answer)

Explanation: ***Use of insecticide-treated nets*** - **Insecticide-treated nets (ITNs)** provide a physical and chemical barrier against **Anopheles mosquitoes**, the primary vectors of malaria, reducing human-vector contact effectively during sleep. - The insecticide on the nets kills or repels mosquitoes, preventing bites and reducing the **mosquito population** within homes and surrounding areas. *Vaccination* - While significant progress has been made with **malaria vaccines** like RTS,S/AS01 (Mosquirix), their **efficacy is partial** (around 30-40% effective against severe malaria over several years) and requires multiple doses. - It is an important complementary tool but **not yet the most effective standalone method** for preventing widespread malaria transmission compared to vector control. *Antimalarial drugs* - **Antimalarial drugs** are primarily used for **treatment** of active malaria infections or for **chemoprophylaxis** (preventive treatment) in travelers or specific high-risk populations. - While effective for individual prevention during travel or in specific scenarios, widespread prophylactic use is **not a sustainable or most effective primary public health strategy** for preventing malaria transmission across entire communities due to cost, drug resistance, and adherence issues. *Genetic modification of mosquitoes* - **Genetic modification of mosquitoes** (e.g., using **gene drives** to reduce mosquito populations or render them incapable of transmitting malaria) is a promising but **experimental strategy** under development. - It involves significant ethical, ecological, and regulatory challenges, and is **not currently an implemented or widely available method** for malaria prevention.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free