musings on MRB questions

every answer on electrotherapy is probably false

Setting MCQs are difficult. That too having questions which are about clinical practice is hard. Because of following reasons:

Lack of adherence to evidence-based practice – we all rely on our personal opinions, outdated tet books, some PDF your “senior” gave you or our gurus rather than established evidence. As we know these are the reason why everyone will have a answer which they will claim is the right one.

For example, consider the following MCQ:

Which of the following is the best treatment for reducing pain and disability in patients with mild to moderate knee osteoarthritis?

A) Interferential Therapy (IFT)
B) Shortwave Diathermy (SWD)
C) Open kinematic chain progressive resisted exercise
D) Closed kinematic chain progressive resisted exercise

It is likely that different PTs we will choose different answers, each justifying their choice based on a textbook, an online resource, mechanisitic thinking or personal experience. This variability makes it difficult to create standardized, evidence-based questions without disagreement.
PS tthe above may have a best answer

the second problem is the evidence is uncertain in many conditions to have best answer. case in point:

• what is the best treatment for adhesive capsulistis
  1. Manual therapy
  2. active range of motion exerccise
  3. electro therapy
  4. MET

  The answer for this wil again be based on our biases rather than any concrete evidence. the best answer for this question may be i dont know

So lets some of the questions with ambigous or unknow answers which were asked in MRB

Question no 1. :

SWD is best (effective) in:

1. Degenerative joint conditions

2. Capsular lesions in large joints

3. Tenosynovitis

4. Moderate edema"

We've been teaching the same outdated concepts for years just because someone once read them in a book. SWD—someone assumed deeper penetration meant better results, and that idea stuck. Instead of questioning it with real evidence, we keep passing down the same nonsence. I have written a detail blob on it which can be accessed here

Question number 2:

Sympathetic dystrophy (or) shoulder hand syndrome can be treated effectively by

(A) Interferential therapy

(B) GALVANIC

(C) Di dynamic Current

(D) TENS

what the fuck are the option? who writes these- a teacher who teaches the same clayton book for 20 years ? all the options seem ridiculous.

First off, the terminology matters. It should be called Complex Regional Pain Syndrome (CRPS)—that’s the term you need to use when searching the literature. If you check the Cochrane Database, you’ll find a more evidence-based answer.

This is exactly why reading some outdated textbook doesn’t make you well-read. Follow the evidence. Learn to say, “We don’t know.” That mindset leads to better research and, ultimately, better treatment for patients—not just endless debates among ourselves.

So if you are fighting TENS is right answer or IFT well all are wrong.

Basic science is usually a safer bet, which is why most PG entrance exams focus on it—there’s less ambiguity in the answers. However, in physiotherapy, even what we call "basic science" is often debatable and far from conclusive.

For example everything, i mean everything about ultrasound we read as physiological and theurapuetic effects are poor science. done in vitro studies. The physiological effects of therapeutic ultrasound like cavitation, microstreaming etc have been studied in both in vitro (lab-based) and in vivo (human/animal) studies. The impedence of the tissue which we think is true or read in the books are may not true when done human (in vivo).
Question No. 49 / Question ID 50
Which one of the following shows the characteristics of coupling media in ultrasound therapy?

(A) Low transmissivity for Ultrasound
(B) Acoustic impedance similar to the tissue (Correct Alternative)
(C) Low viscosity
(D) High susceptibility for bubble formation

In this answer, the gel has a impedance similar to tissue, not only is wrong, highly stupid as the impedence of which tissues is not specified and also more importantly some one thought the human living tissue will be similar to a non living water based gel? huf.

The sad thing is people are collecting evidence to prove both the points. How useless our education is.

Range rather than absolute values: I think this is a silly mistake which could have been easily avoided
example Question :A baby will be able to jump and walk up and downstairs (two feet per step) by

(A) 36 months

(B) 48 months

(C) 18 months

(D) 24 months

This is what happens when we dont understand biology or maths. Why the original options were flawed: Fixed values (e.g., "24 months") inappropriately imply uniformity, whereas developmental milestones exist on a spectrum. A well-constructed question should reflect this reality.
the right answer should be something like 24 to 36 months

The K tape debacle

The whole fucking section on K tape is a disgrace. I know some group of idiots have included these in the syllabus and other leaches are teaching and making money out of it. we all stood there and clapped our hands. now we get these moronic questions

joke number one: Question No. 83 / Question ID 98
What is the primary purpose of kinesiology taping?

A. To protect skin
B. To restrict blood flow
C. To lift the skin
D. To restrict motion
This question and the persumed right answer is wrong in so many way. again this what happens if we follow anything which is written wthout critically thinking about it
joke number 2 Question No. 98 / Question ID 99
Marks: 1.00

Once the kinesiology tape has been applied to the area, it then needs to be heat-activated by:

A. Infrared radiation
B. An electric dryer
C. Rubbing the tape
D. Leaving it without touching for 5 minutes

These are basically a how to do for the product K tape. not science. How low can we fall. Whenever i think we are at rock bottom, i am proven wrong.

The idiot who took these questions are probably thinking they learnt something and are thinking these are advanced questions. Thats what happens if you dont know whats science or advancement.

This is getting long. So i will stop with this. I assume some of you are going to irate and insulted by this post. Please contact me @ hariohm@hotmail.com or come home to vent you anger.

I hope we all use our thinking faculties and make PT great again.

love
Hariohm