Post-Surgical Rehabilitation — MCQs
Which of the following phases are directly involved in the recovery phase of the disaster cycle?
Which of the following statements about burn management is correct?
A 65-year-old woman, two days after knee implant surgery, complains of calf pain and swelling in her leg. She later develops breathlessness and dies suddenly in the ward. What is the most probable cause?
Which among the following is not used in post laryngectomy rehabilitation?
In combined tendon and nerve injuries, the preferred sequence of repair is:
A person working in a hot environment who consumes more water without salt is likely to develop a condition called
A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?
Lachman's test is performed with the knee in what degree of flexion?
Post parotidectomy, patient feels numb while shaving. Which nerve was involved?
79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
Post-Surgical Rehabilitation Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following phases are directly involved in the recovery phase of the disaster cycle?
- A. Response and Rehabilitation
- B. Mitigation and Rehabilitation
- C. Response and Preparedness
- D. Rehabilitation and Reconstruction (Correct Answer)
Explanation: ***Rehabilitation and Reconstruction*** - **Rehabilitation** is the short-term recovery phase focusing on restoring essential services, providing temporary shelter, medical care, and supporting affected populations to resume normal activities. - **Reconstruction** is the long-term recovery phase involving rebuilding damaged infrastructure, permanent housing, economic restoration, and development improvements. - These two phases together constitute the **recovery phase** of the disaster cycle according to standard disaster management frameworks (WHO, NDMA). *Mitigation and Rehabilitation* - While **rehabilitation** is correctly part of recovery, **mitigation** is traditionally considered a separate continuous phase or part of preparedness, focused on reducing future disaster risks. - **Mitigation** measures are implemented throughout the disaster cycle, not specifically as a direct component of the recovery phase. *Response and Rehabilitation* - **Response** refers to immediate life-saving actions during and immediately after a disaster (search and rescue, emergency medical care, evacuation). - **Response** precedes the recovery phase and is distinct from it, though **rehabilitation** is indeed part of recovery. *Response and Preparedness* - **Preparedness** involves planning, training, and resource allocation before a disaster occurs. - **Response** is the immediate action during/after the disaster. - Neither constitutes the recovery phase, which follows after the immediate response is complete.
Question 2: Which of the following statements about burn management is correct?
- A. Cool (not ice-cold) water should be applied for 10-20 minutes to reduce tissue damage
- B. All partial-thickness burns require sterile dressing to prevent infection
- C. Silver sulfadiazine is contraindicated in patients with sulfa allergies
- D. Escharotomy is indicated for circumferential burns causing compartment syndrome (Correct Answer)
Explanation: ***Escharotomy is indicated for circumferential burns causing compartment syndrome*** - **Escharotomy** is a critical surgical procedure performed for circumferential full-thickness burns that cause **compartment syndrome**, impaired circulation, or respiratory compromise (in chest burns) - The hardened eschar acts as a tourniquet, restricting blood flow and causing vascular compromise - This is a **definitive indication** and represents correct burn management protocol - Escharotomy involves incising through the full-thickness eschar to release the constriction *Cool (not ice-cold) water should be applied for 10-20 minutes to reduce tissue damage* - While this statement is **medically correct** and represents appropriate first aid for burns - Cooling with cool (not ice-cold) water for 10-20 minutes is the standard initial treatment to reduce pain and limit tissue damage - However, in the context of this question focusing on comprehensive burn management principles, the escharotomy statement is more specific and clinically critical *All partial-thickness burns require sterile dressing to prevent infection* - This statement is **incorrect** as worded with the absolute term "all" - Small superficial partial-thickness burns may only require **clean, non-adherent dressing** rather than sterile dressing in routine first aid settings - Not all partial-thickness burns require the same level of sterile technique; depends on size, location, and clinical setting *Silver sulfadiazine is contraindicated in patients with sulfa allergies* - While this statement is **medically accurate** (silver sulfadiazine contains sulfonamide and should be avoided in sulfa-allergic patients) - However, this represents a specific contraindication rather than a general principle of burn management - Other topical agents like bacitracin or mupirocin can be used as alternatives
Question 3: A 65-year-old woman, two days after knee implant surgery, complains of calf pain and swelling in her leg. She later develops breathlessness and dies suddenly in the ward. What is the most probable cause?
- A. Pulmonary embolism (Correct Answer)
- B. Stroke
- C. Myocardial infarction
- D. ARDS
Explanation: ***Pulmonary embolism*** - The combination of **calf pain** and **swelling** post-surgery indicates a probable **deep vein thrombosis (DVT)**, which can dislodge and travel to the lungs. - The sudden onset of **breathlessness** and death is characteristic of a **massive pulmonary embolism**, where a large clot obstructs blood flow to the lungs and heart. *Stroke* - A stroke typically presents with **focal neurological deficits**, such as sudden weakness, numbness, or speech difficulties, which are not described here. - While post-operative stroke is possible, sudden death with preceding calf pain and swelling is not typical for its presentation. *Myocardial infarction* - A **myocardial infarction** (heart attack) would likely involve chest pain, radiating pain, and EKG changes, though silent MIs can occur. - While a life-threatening event, the preceding DVT symptoms and breathlessness point more towards a pulmonary cause of sudden death, especially in a post-surgical patient. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is characterized by widespread inflammation in the lungs leading to severe hypoxemia, often developing over hours to days. - While it causes severe breathlessness, the rapid onset of death and the clear indicators of a preceding DVT make ARDS less likely as the immediate cause of sudden demise.
Question 4: 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 5: In combined tendon and nerve injuries, the preferred sequence of repair is:
- A. Tendons should be repaired before nerves
- B. Nerves should be repaired before tendons (Correct Answer)
- C. None of the above
- D. Tendons should not be repaired simultaneously with nerves
Explanation: ***Nerves should be repaired before tendons*** - Nerve repairs are **more delicate** and require precise microsurgical technique with minimal tension - Repairing nerves first allows optimal **anatomical positioning** and coaptation without interference from tendon manipulation - Tendon repair involves **greater tissue handling and tension**, which could disrupt a freshly repaired nerve if done first - This sequence is the **standard teaching** in hand surgery (Green's Operative Hand Surgery, Campbell's Operative Orthopaedics) - Once nerves are secured, tendons can be repaired with the necessary tensioning without risk to neural structures *Tendons should be repaired before nerves* - This would subject the **fragile nerve repair to mechanical stress** during subsequent tendon manipulation - Tendon repair requires **forceful suturing and tensioning** that could displace or damage a previously repaired nerve - This sequence makes nerve repair technically more difficult as tendons may obstruct access *Tendons should not be repaired simultaneously with nerves* - While the exact sequence matters, both structures are typically repaired **in the same surgical setting** - The statement is confusing as "simultaneously" could mean same surgery (which is done) versus same moment (which is avoided) - Modern practice favors complete repair in one operation when possible *None of the above* - There is a well-established preferred sequence in combined tendon and nerve injuries - The principle of nerve-before-tendon repair is supported by surgical literature and clinical practice
Question 6: A person working in a hot environment who consumes more water without salt is likely to develop a condition called
- A. Heat cramps (Correct Answer)
- B. Heat stroke
- C. Heat hyperpyrexia
- D. Heat exhaustion
Explanation: ***Heat cramps*** - This condition occurs due to **excessive sweating** in a hot environment, leading to significant **electrolyte (salt) loss**, particularly sodium. - Consuming large amounts of **plain water without electrolyte replacement** further dilutes the remaining electrolytes in the body, exacerbating hyponatremia and increasing the likelihood of painful muscle cramps. *Heat stroke* - **Heat stroke** is a life-threatening condition characterized by a **core body temperature >104°F (40°C)** and central nervous system dysfunction (e.g., altered mental status). - While fluid and electrolyte imbalances can contribute, its defining feature is the severe **thermoregulatory failure** leading to organ damage, which is distinct from simple muscle cramps. *Heat hyperpyrexia* - This term refers to an **extremely high body temperature** (often above 106°F or 41.1°C) but is not a specific diagnosis in the context of heat-related illness. - It is more of a symptom that could be present in severe heatstroke, not a primary condition resulting from excessive plain water intake. *Heat exhaustion* - **Heat exhaustion** presents with symptoms like fatigue, dizziness, nausea, and profuse sweating, but without significant central nervous system dysfunction or extremely high core body temperature. - While it involves fluid and electrolyte loss, the specific scenario of drinking plain water without salt primarily leads to muscle cramps due to electrolyte dilution, rather than the broader symptoms of heat exhaustion.
Question 7: A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?
- A. NSAIDs
- B. Physical therapy
- C. Intra-articular corticosteroid injections
- D. Total hip replacement (Correct Answer)
Explanation: ***Total hip replacement*** - For **severe osteoarthritis (OA)** causing significant pain and **functional impairment** despite failed conservative management, **total hip replacement** is the most definitive and effective treatment. - This procedure alleviates pain and restores **mobility**, dramatically improving the patient's quality of life. *NSAIDs* - **NSAIDs** are typically part of **initial conservative management** for symptomatic relief in mild to moderate OA, but they have already failed in this patient. - Continued use in elderly patients carries risks of **gastrointestinal, renal, and cardiovascular side effects**, making it a less desirable long-term solution. *Physical therapy* - **Physical therapy** is a crucial component of conservative management to improve **strength, flexibility, and function**, but it often becomes insufficient in advanced OA. - Since this patient has worsening symptoms despite conservative measures, physical therapy alone is unlikely to provide adequate relief. *Intra-articular corticosteroid injections* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation but do not address the underlying **structural damage** of severe OA. - Their effectiveness diminishes over time, and repeated injections are discouraged due to potential cartilage damage.
Question 8: Lachman's test is performed with the knee in what degree of flexion?
- A. 5
- B. 20 (Correct Answer)
- C. 70
- D. 90
Explanation: ***20*** - The **Lachman's test** is most accurately performed with the knee in **20-30 degrees of flexion** to better isolate the **anterior cruciate ligament (ACL)**. - This neutral position allows the posterior capsule and other secondary restraints to be relaxed, making an **ACL tear** more evident during anterior translation of the tibia. *5* - Positioning the knee at only **5 degrees of flexion** is not ideal, as it may keep the **posterior capsule** under too much tension, potentially masking an **ACL injury**. - This position does not adequately relax the secondary stabilizers, which can lead to a false negative result for **ACL laxity**. *70* - At **70 degrees of flexion**, the knee is too bent to effectively assess the **ACL**. - In this position, the **menisci** and other structures can block clear anterior translation, and it is more common for other knee stability tests like the **anterior drawer test** to be performed. *90* - With the knee flexed to **90 degrees**, the **anterior drawer test** is typically performed, not the Lachman's test. - In this position, the **posterior horn of the menisci** can interfere with anterior translation, making the Lachman's test less sensitive for detecting an **ACL tear**.
Question 9: Post parotidectomy, patient feels numb while shaving. Which nerve was involved?
- A. Mandibular
- B. Facial
- C. Greater auricular (Correct Answer)
- D. Auriculotemporal
Explanation: ***Greater auricular*** - The **greater auricular nerve** provides sensory innervation to the skin over the angle of the mandible, parotid gland, and mastoid process, as well as the lower half of the auricle. - Due to its superficial course over the **sternocleidomastoid muscle** and proximity to the parotid gland, it is frequently damaged during parotidectomy, leading to **numbness** in its distribution. *Mandibular* - The **mandibular nerve** (V3) is a branch of the trigeminal nerve that provides motor innervation to the muscles of mastication and sensory innervation to the lower face and chin. - While it has sensory branches to the lower lip and chin, it is not directly involved in the sensory innervation of the skin over the parotid gland. *Facial* - The **facial nerve (CN VII)** is primarily a motor nerve, responsible for facial expression, and also carries taste sensations from the anterior two-thirds of the tongue. - Damage to the facial nerve during parotidectomy would result in **facial paralysis** (e.g., drooping of the mouth, inability to close the eye), not numbness. *Auriculotemporal* - The **auriculotemporal nerve**, a branch of the mandibular nerve (V3), supplies sensory innervation to the skin anterior to the ear, the temporomandibular joint, and the parotid gland capsule. - While it does innervate the parotid region, damage to this nerve is more typically associated with **Frey's syndrome** (gustatory sweating) rather than simple numbness after parotidectomy.
Question 10: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
- A. Hip spica
- B. Nailing
- C. Hemiahroplasty (Correct Answer)
- D. Total Hip Replacement
Explanation: ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.
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