Post-Fracture Rehabilitation — MCQs

10 questions

First cell to migrate into a wound due to chemotaxis to start the process of wound healing is -

A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?

Open reduction (OR) is not required in which fracture?

Why is early mobilization important after hip arthroplasty?

During reconstruction of an amputated limb which of the following is done first?

A patient prescribed crutches for residual paralysis in poliomyelitis is a type of -

Best treatment for stage III frostbite is:

The X-ray shows plating done for a fracture. How does this fracture heal?

Which among the following is not used in post laryngectomy rehabilitation?

Q10

An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient

Post-Fracture Rehabilitation Indian Medical PG Practice Questions and MCQs

Question 1: First cell to migrate into a wound due to chemotaxis to start the process of wound healing is -

A. Lymphocyte
B. Macrophage
C. Platelet
D. Neutrophil (Correct Answer)

Explanation: ***Neutrophil*** - Neutrophils are the **first responders** in the wound healing process, rapidly migrating to the site due to **chemotactic signals** [1,2]. - Their primary role includes **phagocytosing pathogens** and debris, facilitating the subsequent healing phases. *Lymphocyte* - Lymphocytes typically arrive later in the healing process and are mainly involved in **immune response** rather than initial wound healing. - They play a significant role in **adaptive immunity** but do not participate in the **early inflammatory phase**. *Platelet* - While platelets aggregate at the wound site and are crucial for **clot formation**, they do not migrate into the wound through chemotaxis like neutrophils [1]. - Their primary function is to initiate the **hemostatic response** rather than directly phagocytosing debris. *Macrophage* - Macrophages are important for **later stages** of wound healing, clearing debris and coordinating tissue repair, but they arrive after neutrophils. - They are involved in the **remodeling phase** and are not the first cells to respond to the wound. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 188-189. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89.

Question 2: A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?

A. Implosion
B. Aversive conditioning (Correct Answer)
C. Biofeedback
D. Flooding

Explanation: ***Aversive conditioning*** - **Aversive conditioning** involves pairing an undesirable behavior or stimulus (e.g., sexual interest in children) with an unpleasant stimulus (e.g., electric shock). - The goal is to create an association between the undesirable behavior and the unpleasant consequence, leading to a reduction in the unwanted behavior or aversion to the stimulus. *Implosion* - **Implosion therapy** is a technique where the patient is asked to imagine vividly and intensely the most terrifying aspects of their phobic stimulus. - This method aims to extinguish the fear response by overwhelming the patient with anxiety-provoking imagery without any actual danger. *Biofeedback* - **Biofeedback** is a technique that teaches individuals to control involuntary physiological responses such as heart rate, muscle tension, or skin temperature. - It uses electronic sensors to monitor these responses and provide real-time feedback to the individual, allowing them to learn self-regulation. *Flooding* - **Flooding** is a behavioral therapy technique where an individual is exposed directly and intensely to a feared object or situation for a prolonged period. - The goal is to extinguish the fear response through habituation, by demonstrating that the feared stimulus is not dangerous despite the initial anxiety.

Question 3: Open reduction (OR) is not required in which fracture?

A. Fracture of the patella
B. Fracture of the outer one-third of the radius (Correct Answer)
C. Displaced fracture of the olecranon
D. Fracture of the condyle of the humerus

Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.

Question 4: Why is early mobilization important after hip arthroplasty?

A. Prevents joint stiffness
B. Prevents DVT
C. Reduces hospital stay
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - Early mobilization is crucial following hip arthroplasty as it offers a multifaceted approach to recovery, addressing **joint stiffness**, the risk of **DVT**, and the duration of **hospital stay**. - This comprehensive benefit highlights the importance of an integrated approach to postoperative care. *Prevents joint stiffness* - While early mobilization helps prevent joint stiffness, it is not the sole benefit, as it also addresses other critical postoperative complications. - Restricted movement in the initial postoperative period can lead to adhesions and **contractures**, limiting the long-term range of motion. *Prevents DVT* - Preventing **deep vein thrombosis (DVT)** is a significant benefit of early mobilization, but it represents only one aspect of its overall importance. - Immobility post-surgery increases the risk of blood clot formation due to venous stasis, making active movement essential. *Reduces hospital stay* - Reducing the length of hospital stay is a key advantage of early mobilization, but it's part of a broader set of benefits that contribute to faster recovery and better outcomes. - Expedited discharge is often a direct result of improved patient mobility, reduced complication rates, and enhanced surgical recovery.

Question 5: During reconstruction of an amputated limb which of the following is done first?

A. Arterial repair
B. Venous repair
C. Fixation of the bone (Correct Answer)
D. Nerve anastomoses

Explanation: ***Fixation of the bone*** - **Bone stabilization** is the crucial first step to create a rigid framework, allowing for subsequent precise vascular and nerve repairs. - This prevents movement and tension on delicate repairs, which could lead to failure of the reconnected vessels and nerves. *Arterial repair* - While critical for blood supply, arterial repair is performed *after* bone fixation to ensure the vessels are not disrupted by later bone manipulation. - It's typically done before venous repair to establish arterial flow and identify any potential venous back pressure that needs addressing. *Venous repair* - Venous repair is usually performed after arterial repair, as establishing arterial inflow can help distend the veins, making them easier to identify and repair. - Repairing veins first without establishing arterial flow immediately is less effective and may lead to congestion once arterial flow is restored. *Nerve anastomoses* - Nerve repair is typically the last major step in an amputation reconstruction, following bone stabilization and full vascular repair. - Nerves are fragile and require a stable, well-perfused environment to optimize the chances of successful regeneration.

Question 6: A patient prescribed crutches for residual paralysis in poliomyelitis is a type of -

A. Disability limitation
B. Primordial prevention
C. Primary prevention
D. Rehabilitation (Correct Answer)

Explanation: ***Rehabilitation*** - Rehabilitation is a component of **tertiary prevention** that aims to restore maximum functional ability after permanent damage has occurred from disease. - Providing crutches to a polio patient with **residual (established) paralysis** helps restore mobility and independence, allowing the patient to adapt to their permanent disability. - This intervention occurs **after the disease has run its course** and permanent sequelae have developed, which is the hallmark of rehabilitation. *Disability limitation* - Disability limitation is another component of **tertiary prevention** but focuses on **preventing progression or complications** of an already established disease. - It applies during the **disease active phase** to minimize further damage (e.g., physiotherapy during acute polio to prevent contractures, or strict glycemic control in diabetes to prevent complications). - In this case, the paralysis is **residual (fixed)**, not active, so we are beyond the disability limitation phase. *Primordial prevention* - Primordial prevention targets the underlying environmental and social determinants to prevent the emergence of risk factors at the population level. - This occurs **before any risk factors** for disease have developed (e.g., policies to prevent emergence of sedentary lifestyles). - Not applicable to a patient with established disease. *Primary prevention* - Primary prevention aims to prevent disease occurrence by reducing risk factors or increasing resistance (e.g., polio vaccination, health education). - This intervention is applied **before the disease occurs**, which is not the case for a patient with established paralysis from poliomyelitis.

Question 7: Best treatment for stage III frostbite is:

A. Rapid rewarming (Correct Answer)
B. Gradual thawing
C. Amputation
D. Immediate surgical debridement

Explanation: ***Rapid rewarming*** - This is the cornerstone of frostbite treatment, regardless of the stage, to minimize **cellular damage** and improve outcomes. - **Rapid rewarming** in a circulating water bath maintained at **37-39°C** is preferred, as it quickly restores tissue perfusion and reduces ice crystal formation. *Gradual thawing* - **Gradual thawing** is less effective than rapid rewarming and can lead to prolonged exposure to cold injury, increasing tissue damage due to continued cellular dehydration and **ice crystal growth**. - It does not provide the rapid restoration of blood flow necessary to prevent further ischemic injury. *Amputation* - **Amputation** is a last resort treatment for severe, irreversible tissue necrosis and is typically performed after the extent of tissue damage is clearly demarcated, often weeks after the initial injury. - It is not an immediate initial treatment for frostbite, even for severe stages, as tissue viability needs to be thoroughly assessed first. *Immediate surgical debridement* - **Immediate surgical debridement** is generally contraindicated in freeze injury because it is often difficult to distinguish viable from non-viable tissue early on. - Early debridement can lead to the unnecessary removal of tissue that might otherwise recover, and surgical intervention is usually delayed until demarcation is clear, typically weeks later.

Question 8: The X-ray shows plating done for a fracture. How does this fracture heal?

A. Primary healing (Correct Answer)
B. Secondary healing
C. Tertiary healing
D. Distraction histiogenesis

Explanation: **Primary healing** - **Plating of a fracture** aims to achieve **absolute stability** at the fracture site, which facilitates primary bone healing. - In primary healing, there is **direct bone formation** across the fracture gap without the formation of a significant callus. *Secondary healing* - Secondary healing involves the formation of a **callus** (fibrous tissue, cartilage, and immature bone) to bridge the fracture gap. - This type of healing occurs in situations with **relative stability** and some micromotion at the fracture site, such as with casting or intramedullary nailing. *Tertiary healing* - **Tertiary healing** is not a recognized term in the context of fracture healing. - Bone healing typically involves either primary or secondary mechanisms depending on the stability achieved. *Distraction histiogenesis* - **Distraction histiogenesis** is the process by which new bone is formed between bone surfaces that are gradually pulled apart using an external fixator (**distraction osteogenesis**). - This is used in procedures like **limb lengthening** and is distinct from the direct healing of a fracture fixed with a plate.

Question 9: Which among the following is not used in post laryngectomy rehabilitation?

A. Tracheostomy tube (Correct Answer)
B. Esophageal speech
C. Tracheoesophageal puncture
D. Electrolarynx

Explanation: ***Tracheostomy tube*** - Following total laryngectomy, the **trachea is permanently diverted** to form a permanent stoma in the neck for breathing. - In the context of **post-laryngectomy rehabilitation**, the focus is on **voice restoration** methods rather than airway management devices. - While laryngectomy tubes or stoma buttons may be used temporarily for **stoma care** (preventing stenosis, maintaining patency), traditional **tracheostomy tubes are not part of voice rehabilitation** protocols. - The patient breathes directly through the permanent stoma, and rehabilitation centers on restoring communication ability. *Esophageal speech* - **Esophageal speech** is a voice rehabilitation method where air is injected into the esophagus and then expelled, vibrating the pharyngoesophageal segment to produce sound. - It requires no external devices, only extensive training, and can provide functional voice for communication. - This is one of the **three main voice restoration options** after laryngectomy. *Tracheoesophageal puncture* - **Tracheoesophageal puncture (TEP)** with voice prosthesis is the **gold standard** for voice rehabilitation post-laryngectomy. - A small fistula is created between trachea and esophagus, and a one-way valve (voice prosthesis) is inserted. - Air from the lungs is diverted through the prosthesis into the esophagus, vibrating the pharyngoesophageal segment to produce speech. - Provides the **most natural-sounding voice** among rehabilitation options. *Electrolarynx* - An **electrolarynx** is an external, battery-operated device held against the neck or placed intraorally that generates vibrations. - The vibrations are articulated by the mouth and tongue to produce speech. - Provides **immediate communication** post-laryngectomy, though the voice quality is mechanical or robotic.

Question 10: An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient

A. Indicated to reduce incidence of early onset post traumatic seizures (Correct Answer)
B. Is contraindicated due to risk of rash
C. Is likely to cause increased cerebral edema
D. Indicated to reduce incidence of late onset post traumatic seizures

Explanation: ***Indicated to reduce incidence of early onset post traumatic seizures*** - This patient has risk factors for **early post-traumatic seizures (PTS)**, including a **cortical contusion** and a **skull fracture**. Prophylactic antiepileptic drug (AED) therapy, particularly with phenytoin or levetiracetam, is recommended for the first 7 days to reduce the incidence of early PTS in high-risk patients. - Risk factors for early PTS include: cortical contusion, depressed skull fracture, GCS <10, penetrating head injury, and intracranial hematoma. This patient has cortical contusion and moderate head injury (GCS 10). - While AEDs don't prevent late PTS, their benefit in preventing early seizures in high-risk patients makes their use indicated in this scenario. *Is contraindicated due to risk of rash* - While some AEDs (e.g., phenytoin, carbamazepine) can cause rashes, this is not a contraindication to their use, especially when the benefit of preventing early seizures outweighs the risk in a critical trauma setting. - The risk of rash can be managed by careful drug selection, monitoring, and dose titration. Levetiracetam is an alternative with lower risk of rash. *Is likely to cause increased cerebral edema* - There is currently no evidence that commonly used AEDs for PTS prophylaxis (e.g., phenytoin, levetiracetam) significantly increase cerebral edema. - Some AEDs can have mild sedative effects, but this is distinct from causing increased cerebral edema. *Indicated to reduce incidence of late onset post traumatic seizures* - Prophylactic AEDs are **not effective** in preventing **late post-traumatic seizures** (occurring more than 7 days after the injury), as shown in multiple randomized controlled trials. - The primary goal of AED prophylaxis in head trauma is to reduce the incidence of early seizures, which can worsen secondary brain injury and neurological outcome.

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