Geriatric Rehabilitation Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Geriatric Rehabilitation. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Geriatric Rehabilitation Indian Medical PG Question 1: Amputation is often not required in:
- A. Buerger's
- B. Chronic osteomyelitis (Correct Answer)
- C. Diabetic gangrene
- D. Gas gangrene
Geriatric Rehabilitation Explanation: ***Chronic osteomyelitis***
- While chronic osteomyelitis can be severe, advancements in **antibiotic therapy**, **surgical debridement**, and **reconstructive procedures** often allow for limb salvage.
- The goal of treatment is to eradicate infection and preserve function, making amputation a last resort when other methods fail to control infection or restore viability.
*Buerger's*
- **Buerger's disease** (thromboangiitis obliterans) is characterized by inflammation and thrombosis of small and medium-sized arteries and veins, primarily in the limbs, leading to severe ischemia and gangrene.
- Due to progressive vascular damage and frequent lack of effective medical treatment for advanced stages, **amputation is often required** to remove necrotic tissue and manage intractable pain.
*diabetic gangrene*
- **Diabetic gangrene** results from a combination of **peripheral neuropathy**, **peripheral arterial disease**, and **infection**, leading to tissue death, particularly in the feet.
- The compromised blood supply and impaired wound healing in diabetic patients make these lesions prone to rapid progression and severe infection, with **amputation frequently necessary** to prevent systemic sepsis and death.
*Gas gangrene*
- **Gas gangrene** is a rapidly progressive and life-threatening infection caused by *Clostridium* species, which produce toxins and gas within tissues.
- Due to its aggressive and destructive nature, requiring immediate and extensive surgical debridement often involving **amputation of the affected limb** to remove all infected tissue and prevent widespread systemic toxicity.
Geriatric Rehabilitation Indian Medical PG Question 2: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
- A. Hemiarthroplasty (Correct Answer)
- B. Closed reduction and fixation with three cancellous screws
- C. Longitudinal skin traction for 6 weeks
- D. Excision arthroplasty
Geriatric Rehabilitation Explanation: ***Hemiarthroplasty***
- For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency.
- This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures.
*Excision arthroplasty*
- **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable.
- It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment.
*Closed reduction and fixation with three cancellous screws*
- This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis.
- In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental.
*Longitudinal skin traction for 6 weeks*
- Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**.
- It does not provide definitive fixation and is not a definitive treatment for a bony fracture.
Geriatric Rehabilitation Indian Medical PG Question 3: The Confusion Assessment Method (CAM) is used for which of the following?
- A. Schizophrenia
- B. Delirium (Correct Answer)
- C. Dementia
- D. Depression
Geriatric Rehabilitation Explanation: ***Delirium***
- The Confusion Assessment Method (CAM) is a widely used and highly sensitive and specific tool for the rapid identification of **delirium**.
- It assesses for acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.
*Schizophrenia*
- Schizophrenia is a chronic mental health disorder primarily characterized by **psychosis**, including hallucinations, delusions, and disorganized thought.
- While patients with schizophrenia can experience cognitive difficulties, specialized scales like the Positive and Negative Syndrome Scale (PANSS) are used, not the CAM.
*Dementia*
- Dementia is a gradual and progressive decline in cognitive function, including memory, thinking, and reasoning, severe enough to interfere with daily life.
- Tools like the mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MoCA) are used for screening and assessing dementia, not the CAM.
*Depression*
- Depression is a mood disorder characterized by persistent sadness, loss of interest, and other emotional and physical symptoms.
- Assessment tools like the Hamilton Depression Rating Scale (HDRS) or Patient Health Questionnaire-9 (PHQ-9) are used for depression.
Geriatric Rehabilitation Indian Medical PG Question 4: A 45-year-old man presents with a history of frequent falls. He has difficulty in looking down also. What is the most probable diagnosis -
- A. Alzheimer's disease
- B. Normal pressure hydro-cephalus
- C. Parkinson's disease
- D. Progressive supranuclear palsy (Correct Answer)
Geriatric Rehabilitation Explanation: ***Progressive supranuclear palsy***
- The combination of **frequent falls** and **difficulty looking down** (supranuclear ophthalmoplegia, especially affecting vertical gaze) is a classic presentation of progressive supranuclear palsy (PSP).
- PSP is a **tauopathy** characterized by **postural instability**, early falls, and distinctive ocular motor dysfunction.
*Alzheimer's disease*
- Primarily presents with **progressive memory loss** and cognitive decline, not typically early or prominent falls or vertical gaze palsy.
- While falls can occur in later stages, they are not usually an initial hallmark symptom associated with restricted eye movements.
*Normal pressure hydrocephalus*
- Characterized by the triad of **gait disturbance** (often described as magnetic gait), **urinary incontinence**, and **dementia** [2].
- While gait disturbance can lead to falls, the specific difficulty in looking down is not a feature of NPH.
*Parkinson's disease*
- Characterized by **bradykinesia**, **rigidity**, **tremor**, and **postural instability** leading to falls later in the disease [1].
- However, difficulty looking down (vertical gaze palsy) is not a typical feature of Parkinson's disease, and falls tend to occur later in the disease course compared to PSP.
Geriatric Rehabilitation Indian Medical PG Question 5: A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
- A. Hemiarthroplasty (Correct Answer)
- B. Total Hip Replacement
- C. Dynamic Hip Screw
- D. Conservative Management
Geriatric Rehabilitation Explanation: ### **Explanation: Management of Fracture Neck of Femur in the Elderly**
The management of **intracapsular neck of femur (NOF) fractures** is primarily determined by the patient's age, activity level, and the risk of **Avascular Necrosis (AVN)** or non-union due to the precarious retrograde blood supply (medial circumflex femoral artery).
#### **Why Hemiarthroplasty is Correct**
For an **elderly patient (typically >65–70 years)** with a displaced intracapsular fracture, **Hemiarthroplasty** is the most common management.
* **Rationale:** It allows for **early mobilization** (weight-bearing as tolerated), which is crucial to prevent complications like pneumonia, DVT, and pressure sores.
* It is preferred over internal fixation because the elderly have poor bone quality and a high risk of fixation failure or AVN.
#### **Why Other Options are Incorrect**
* **Total Hip Replacement (THR):** While THR provides better long-term functional outcomes and less pain compared to hemiarthroplasty, it is reserved for **active elderly** patients without cognitive impairment or those with pre-existing osteoarthritis. Hemiarthroplasty remains the "most common" choice for the general elderly population due to shorter operative time and lower dislocation risk.
* **Dynamic Hip Screw (DHS):** This is the gold standard for **extracapsular (intertrochanteric)** fractures, not intracapsular fractures.
* **Conservative Management:** Rarely indicated; only used for patients who are medically unfit for any anesthesia, as it carries a very high mortality rate due to prolonged recumbency.
#### **High-Yield Clinical Pearls for NEET-PG/INI-CET**
* **Garden’s Classification:** Used for intracapsular fractures. Stage III and IV (displaced) in the elderly require arthroplasty.
* **Young Patients (<55-60 years):** Always attempt **Internal Fixation** (e.g., Multiple Cannulated Cancellous Screws) to "Save the Head," regardless of displacement.
* **Unipolar vs. Bipolar:** Bipolar hemiarthroplasty is often preferred to reduce acetabular wear.
* **Most common complication of Hemiarthroplasty:** Acetabular erosion (protrusio acetabuli) over long-term follow-up.
Geriatric Rehabilitation Indian Medical PG Question 6: Loss of part or function is referred to as:
- A. Impairment (Correct Answer)
- B. Disability
- C. Disease
- D. Handicap
Geriatric Rehabilitation Explanation: ***Impairment***
- An **impairment** refers to the **loss of part or function** of the body, whether physical, sensory, or mental.
- It describes the direct functional limitation in a body structure or mental function, such as hearing loss or a missing limb.
*Disability*
- A **disability** is the **restriction or lack of ability** to perform an activity in the manner or within the range considered normal for a human being.
- It describes the impact an impairment has on a person's ability to perform tasks, such as difficulty walking due to a foot impairment.
*Disease*
- A **disease** is a **pathological condition** that affects the body or mind, characterized by a set of signs and symptoms.
- It refers to the underlying medical condition causing the impairment, rather than the loss of function itself.
*Handicap*
- A **handicap** is a **social disadvantage** that results from an impairment or disability, limiting or preventing the fulfillment of a role.
- It reflects the societal barriers and environmental factors that disable an individual, rather than the direct body function loss.
Geriatric Rehabilitation Indian Medical PG Question 7: AIDS, secondary infection will be all except
- A. Candida
- B. Kaposi's sarcoma (Correct Answer)
- C. HSV
- D. Rubella
Geriatric Rehabilitation Explanation: ***Kaposi's sarcoma***
- Kaposi's sarcoma is a **cancer** caused by human herpesvirus 8 (HHV-8) [2] that is common in patients with AIDS, but it is a **malignancy**, not a secondary infection [2],[3].
- While it arises due to immune suppression, it represents abnormal cell proliferation rather than direct microbial invasion.
*Candida*
- **Candidiasis** (e.g., oral thrush, esophageal candidiasis) is a common opportunistic fungal infection in AIDS patients due to their **impaired cellular immunity** [1].
- It often presents as **white plaques** on mucous membranes and is a clear example of a secondary infection.
*HSV*
- **Herpes Simplex Virus (HSV)** infections, including oral and genital herpes, are common and often severe in AIDS patients.
- Due to immunocompromise, these infections can be **more widespread**, chronic, or recur frequently, qualifying as secondary infections.
*Rubella*
- **Rubella (German measles)** is a viral infection that is generally mild and self-limiting in immunocompetent individuals.
- It is **not considered an opportunistic infection** or a common secondary infection specifically associated with AIDS; rather, it is listed as a differential diagnosis for the primary HIV infection rash [1].
Geriatric Rehabilitation Indian Medical PG Question 8: The commonest site of pressure sore is :
- A. Sacrum
- B. Heel (Correct Answer)
- C. Ischium
- D. Occiput
Geriatric Rehabilitation Explanation: ***Heel***
- The **heel** is a common site for pressure sore development, especially in bedridden or immobile patients, due to sustained pressure on the bony prominence.
- While less common as the *most* common site compared to the sacrum, it is still very frequently affected and can be equally severe.
*Sacrum*
- The **sacrum** is the *most common site* for pressure ulcers, particularly in individuals who are bed-bound or spend prolonged periods in a supine position.
- This area experiences high pressure when lying on the back due to the body's weight pressing down on the bony prominence of the sacrum [1].
*Ischium*
- The **ischial tuberosities** are common sites for pressure sores in individuals who are wheelchair-bound or spend extended periods in a seated position.
- Pressure on this area is particularly high when sitting, making it vulnerable to tissue damage.
*Occiput*
- The **occiput** (back of the head) is a common site for pressure sores in infants, critically ill patients, or individuals who are supine for extended periods and unable to reposition their heads.
- This is due to sustained pressure on the bony prominence of the skull against the mattress or support surface.
Geriatric Rehabilitation Indian Medical PG Question 9: Which is the most common complication of deep vein thrombosis (DVT)?
- A. Cerebrovascular accident (CVA) - associated with arterial embolism, not DVT
- B. Pulmonary embolism (Correct Answer)
- C. Renal failure - not a common complication of DVT
- D. Myocardial infarction (MI) - a complication of arterial thrombosis, not DVT
Geriatric Rehabilitation Explanation: ***Pulmonary embolism***
- A **pulmonary embolism (PE)** occurs when a blood clot, most commonly from a **deep vein thrombosis (DVT)** in the legs, travels to the lungs and blocks an artery [1].
- This is the **most serious and common acute complication** of DVT, potentially leading to respiratory distress, hemodynamic instability, and even death [1].
*Cerebrovascular accident (CVA) - associated with arterial embolism, not DVT*
- A **cerebrovascular accident (CVA)**, or stroke, is most often caused by **arterial embolism** or thrombosis, not typically by venous clots from DVT [1].
- While paradoxical embolism via a patent foramen ovale can occur, it is a **rare mechanism** for CVA from DVT.
*Renal failure - not a common complication of DVT*
- **Renal failure** is not a direct or common complication of DVT; DVT primarily affects the venous system in the limbs and can lead to PE.
- Complications like **post-thrombotic syndrome** are more characteristic of long-term DVT effects on the affected limb.
*Myocardial infarction (MI) - a complication of arterial thrombosis, not DVT*
- A **myocardial infarction (MI)**, or heart attack, is almost exclusively caused by **thrombosis in a coronary artery**, which is part of the arterial system [1].
- DVT involves the venous system, and clots from DVT do not typically travel to the coronary arteries to cause an MI.
Geriatric Rehabilitation Indian Medical PG Question 10: Which of the following is the most common cause of reversible dementia in the geriatric population?
- A. Depression (Correct Answer)
- B. Normal Pressure Hydrocephalus
- C. Hypothyroidism
- D. Vitamin B12 deficiency
Geriatric Rehabilitation Explanation: The correct answer is **Depression**. In the geriatric population, depression often presents with cognitive impairment, memory loss, and poor concentration, a clinical entity known as **Pseudodementia**. It is the most common cause of reversible cognitive decline [1]. Unlike true dementia (e.g., Alzheimer’s), patients with pseudodementia typically provide "I don't know" answers during testing, appear distressed by their deficits, and show significant improvement with antidepressant therapy or ECT. Analysis of Incorrect Options: **Normal Pressure Hydrocephalus (NPH):** Characterized by the triad of gait ataxia, urinary incontinence, and dementia ("Wet, Wobbly, and Wacky"). While reversible via a ventriculoperitoneal shunt, it is statistically less common than depression [1]. **Hypothyroidism:** Can cause cognitive slowing and "myxedema madness." While a standard part of the dementia workup (checking TSH), it is a less frequent cause of isolated reversible dementia compared to psychiatric illness. **Vitamin B12 Deficiency:** Leads to Subacute Combined Degeneration of the spinal cord and cognitive changes. While common in the elderly due to atrophic gastritis, it ranks below depression in prevalence as a primary cause of reversible cognitive impairment [1].
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