Hospital Medicine

Hospital Medicine Indian Medical PG Question 1: Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?

• A. Green
• B. Yellow (Correct Answer)
• C. Blue
• D. Black

Hospital Medicine Explanation: ***Yellow*** - Patients in the **yellow category** are those who require **significant medical attention** and intervention, such as surgery, but whose condition is stable enough to withstand a delay of a few hours up to 24 hours without immediate threat to life or limb. - This category indicates a **delayed but urgent need** for treatment, distinguishing them from immediate (red) or minor (green) cases. *Blue* - The color **blue** is generally **not a standard triage category** in most commonly used disaster protocols (e.g., START, JumpSTART). - Triage systems typically use red, yellow, green, and black to prioritize patients based on immediate medical need and prognosis. *Green* - The **green category** is for patients with **minor injuries** who are considered "walking wounded" and can often wait for treatment for several hours, sometimes up to a few days. - These individuals are **stable** and do not require immediate intervention to preserve life or limb. *Black* - The **black category** is reserved for individuals who are **deceased** or have injuries so severe that survival is unlikely given the available resources, often implying **palliative care** rather than active life-saving interventions in a mass casualty event. - This category signifies that resources would be better allocated to patients with a higher chance of survival.

Hospital Medicine Indian Medical PG Question 2: Which of the following is not the component of qSOFA?

• A. Respiratory rate >22/min
• B. Altered mental status
• C. Unequally dilated pupils (Correct Answer)
• D. Systolic BP<100 mmHg

Hospital Medicine Explanation: ***Unequally dilated pupils*** - **Unequally dilated pupils** are not a component of the **qSOFA** score. This finding can be indicative of neurological issues such as increased **intracranial pressure** or **uncal herniation**, but not directly part of the sepsis screening tool [1]. - The qSOFA score focuses on easily obtainable clinical signs to rapidly identify patients at risk for poor outcomes from **sepsis**. *Respiratory rate >22/min* - A **respiratory rate greater than 22 breaths per minute** is one of the three criteria for the **qSOFA** score, indicating significant physiological stress. - This elevated respiratory rate suggests an increased work of breathing, often due to **metabolic acidosis** or **systemic inflammation** associated with sepsis. *Altered mental status* - **Altered mental status** (e.g., Glasgow Coma Scale score less than 15) is a core component of the **qSOFA** score [1]. - This sign reflects **cerebral hypoperfusion** or **encephalopathy** due to the systemic effects of sepsis [1]. *Systolic BP<100 mmHg* - A **systolic blood pressure less than 100 mmHg** is another key criterion of the **qSOFA** score. - This indicates **hypotension** and suggests inadequate tissue perfusion, a critical sign of **circulatory dysfunction** in sepsis [1].

Hospital Medicine Indian Medical PG Question 3: Best indicator to determine fluid required in hypovolemic patient is

• A. 2D echo
• B. CVP
• C. PCWP (Correct Answer)
• D. Intra arterial BP

Hospital Medicine Explanation: ***PCWP*** - **Pulmonary capillary wedge pressure (PCWP)** indirectly measures left atrial pressure, which reflects left ventricular end-diastolic pressure, a key indicator of **cardiac preload** and fluid status [1]. - A low PCWP in a hypovolemic patient suggests the need for **fluid resuscitation** to optimize cardiac output. *2D echo* - While 2D echocardiography can assess **cardiac function** and some parameters related to fluid status (like IVC collapsibility), it is not the most direct or specific indicator for fluid requirement in an acutely hypovolemic patient. - Its use often requires a skilled operator and is primarily diagnostic for structural and functional abnormalities rather than real-time fluid responsiveness guidance. *CVP* - **Central venous pressure (CVP)** reflects right atrial pressure, which is a measure of **right ventricular preload** [1]. - CVP can be misleading in patients with **right ventricular dysfunction** or **pulmonary hypertension**, making it less reliable for assessing overall fluid status compared to PCWP [1]. *Intra arterial BP* - **Intra-arterial blood pressure (BP)** is a direct and accurate measure of systemic arterial pressure, indicating **perfusion**. - While hypotension (low BP) is common in hypovolemia, BP alone does not reliably indicate the *amount* of fluid required or the patient's **fluid responsiveness**, as compensatory mechanisms can maintain BP even with significant volume loss.

Hospital Medicine Indian Medical PG Question 4: A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

• A. nurses safety checklist
• B. WHO surgical safety checklist (Correct Answer)
• C. universal precautions checklist
• D. MCI patient safety checklist

Hospital Medicine Explanation: **WHO surgical safety checklist** - The questions about patient identity, procedure site, and anticipated critical events are key components of the **"Sign In"** and **"Time Out"** sections of the **WHO Surgical Safety Checklist**. - This checklist is designed to improve **patient safety** by ensuring communication and adherence to essential steps before, during, and after surgery, thereby reducing surgical errors. *nurses safety checklist* - While nurses play a crucial role in patient safety, there isn't a universally recognized "nurses safety checklist" that specifically encompasses these exact comprehensive surgical verification steps. - The comprehensive framework described, with its specific questions, aligns more closely with the broader, interdisciplinary **WHO Surgical Safety Checklist**. *universal precautions checklist* - **Universal precautions** focus on preventing the transmission of bloodborne pathogens and other infectious agents by treating all bodily fluids as potentially infectious. - This checklist primarily addresses **infection control** measures and does not cover patient identification, surgical site verification, or critical event anticipation. *MCI patient safety checklist* - A "MCI patient safety checklist" is not a widely recognized or standardized medical safety protocol. - The scenario describes a standard, internationally adopted set of safety checks specifically for surgical procedures, which is the **WHO Surgical Safety Checklist**.

Hospital Medicine Indian Medical PG Question 5: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)? 1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria. 2. It is same as bacteraemia. 3. It results in Multiple Organ Dysfunction Syndrome (MODS). 4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

• A. 2, 3 and 4
• B. 1, 2 and 3
• C. 1, 3 and 4 (Correct Answer)
• D. 1, 2 and 4

Hospital Medicine Explanation: ***1, 3 and 4*** - **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1]. - One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1]. - A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1]. *2, 3 and 4* - **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious). - While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma). *1, 2 and 3* - **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well. - The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation. *1, 2 and 4* - This option incorrectly states that **SIRS is the same as bacteremia**, which it is not. - Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.

Hospital Medicine Indian Medical PG Question 6: Ambulatory patients after a disaster are categorized into what color of triage?

• A. Red
• B. Yellow
• C. Green (Correct Answer)
• D. Black

Hospital Medicine Explanation: ***Green*** - **Green tag** is for the walking wounded, meaning those with minor injuries who can move independently and do not require immediate medical attention. - These patients can often assist with **their own care** or aid others, and their treatment can be delayed. *Red* - **Red tag** patients have critical, life-threatening injuries that require immediate intervention to save life or limb. - This category includes conditions like **severe bleeding**, shock, or airway compromise. *Yellow* - **Yellow tag** is assigned to patients with serious injuries that are not immediately life-threatening but require definitive treatment within a few hours. - Examples include **stable fractures**, moderate burns, or significant but controlled bleeding. *Black* - **Black tag** indicates patients who are deceased or have injuries so severe that survival is unlikely even with maximal medical care. - Resources are diverted from these patients to those with a higher chance of survival, to **maximize overall saved lives**.

Hospital Medicine Indian Medical PG Question 7: An unconscious child is brought to the casualty. What is the correct sequence of the management?

• A. Circulation, Airway, Breathing
• B. Breathing, Circulation, Airway
• C. Circulation, Breathing, Airway
• D. Airway, Breathing, Circulation (Correct Answer)

Hospital Medicine Explanation: ***Airway, Breathing, Circulation*** - The **ABC sequence** is the cornerstone of pediatric resuscitation as per **PALS (Pediatric Advanced Life Support) guidelines** - In an unconscious child, a patent **airway** is the absolute first priority - without this, no oxygen can reach the lungs regardless of breathing effort - Once airway patency is ensured, **breathing** must be assessed and supported to provide adequate ventilation and oxygenation - Only after securing airway and breathing should **circulation** be addressed, as effective circulation without oxygenation is futile - This sequence prevents **hypoxic brain injury**, which can occur within 4-6 minutes of oxygen deprivation *Circulation, Airway, Breathing* - This violates the fundamental **ABC principle** of emergency management - Prioritizing **circulation** before establishing a patent **airway** means attempting to circulate deoxygenated blood - Without airway patency, any circulatory support will fail to deliver oxygen to vital organs, leading to **irreversible hypoxic damage** - In pediatric emergencies, respiratory failure is more common than primary cardiac arrest, making airway management even more critical *Breathing, Circulation, Airway* - Attempting to support **breathing** before securing the **airway** is physiologically ineffective - An obstructed airway prevents air entry despite breathing efforts or bag-mask ventilation attempts - This sequence can lead to **gastric distension, aspiration**, and worsening hypoxia - Delays in airway management increase the risk of **cardiac arrest** from prolonged hypoxemia *Circulation, Breathing, Airway* - This sequence dangerously delays **airway management**, the most time-critical intervention - In an unconscious child, airway obstruction from tongue falling back or secretions is common and immediately life-threatening - Without a patent airway, neither breathing support nor circulatory measures can prevent **brain death** from anoxia - Following this sequence contradicts all **international resuscitation guidelines** (PALS, AHA, ERC)

Hospital Medicine Indian Medical PG Question 8: Which one of the following is NOT an electronic information site in surgery?

• A. Embase
• B. Cochrane library
• C. Pubmed
• D. Surgical textbook (Correct Answer)

Hospital Medicine Explanation: ***Surgical textbook*** - A surgical textbook is a **physical or digital book** containing detailed information on surgical procedures, principles, and concepts. It is a traditional source of information, not an electronic information site. - While it provides valuable knowledge, it does not function as an **online database** or search engine for current medical literature. *Embase* - **Embase** is a comprehensive biomedical and pharmacological database, used for searching medical literature and evidence. - It contains a vast amount of information, including **articles, conference abstracts**, and drug-related data, making it an electronic information site. *Cochrane library* - The **Cochrane Library** is a collection of databases that contain different types of high-quality, independent evidence to inform healthcare decision-making. - It is particularly known for its **systematic reviews and meta-analyses**, making it a key electronic information site for evidence-based medicine. *Pubmed* - **PubMed** is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. - It is one of the most widely used **electronic information sites** for medical literature searches by healthcare professionals and researchers.

Hospital Medicine Indian Medical PG Question 9: In the evaluation of a newly diagnosed case of acute lymphoid leukemia (ALL), which of the following tests is not routinely included?

• A. Plasma viscosity (Correct Answer)
• B. Bone marrow biopsy
• C. Complete metabolic panel
• D. Cell surface phenotyping

Hospital Medicine Explanation: ### Plasma viscosity - **Plasma viscosity** measurement is not a standard diagnostic or staging test for **acute lymphoid leukemia (ALL)**. [1] - While it can be elevated in conditions with high protein levels or hypergammaglobulinemia, it does not provide specific information relevant to ALL diagnosis or treatment planning. [1] *Bone marrow biopsy* - A **bone marrow biopsy** is crucial for diagnosing ALL, confirming the presence of **lymphoblasts**, and assessing disease burden. [2] - It also helps in identifying cytogenetic and molecular abnormalities. [2] *Cell surface phenotyping* - **Cell surface phenotyping** (immunophenotyping) via **flow cytometry** is essential for classifying the subtype of ALL (e.g., B-ALL, T-ALL) and identifying specific markers. [2] - This information guides treatment protocols and predicts prognosis. [2] *Complete metabolic panel* - A **complete metabolic panel (CMP)** assesses organ function (e.g., kidney, liver), **electrolyte balance**, and levels of substances like **uric acid** and **lactate dehydrogenase (LDH)**. - These measurements are vital for identifying complications, assessing baseline health, and monitoring for **tumor lysis syndrome** which can be seen in ALL.

Hospital Medicine Indian Medical PG Question 10: A 38-year-old man presents with pain and shortness of breath. His pulse rate is 85 per minute, blood pressure is 180/80 mmHg, and the cardiac examination reveals an ejection systolic murmur. The ECG shows a LVH pattern and ST depression in the anterior leads. His Troponin T test is positive. Based on these findings, the echocardiogram is likely to reveal which of the following conditions?

• A. Aortic regurgitation
• B. Aortic stenosis (Correct Answer)
• C. Mitral regurgitation
• D. Mitral valve prolapse

Hospital Medicine Explanation: Aortic stenosis - The presence of an **ejection systolic murmur** [2], **left ventricular hypertrophy** on ECG [1], and a history of **pain and shortness of breath** are classic signs of aortic stenosis. The **wide pulse pressure** (180/80 mmHg) despite a normal pulse rate suggests increased peripheral resistance, common in advanced aortic stenosis. - **Elevated troponin T** suggests myocardial injury, which can occur due to increased myocardial oxygen demand in the context of severe aortic stenosis and LVH. *Aortic regurgitation* - This condition typically presents with a **diastolic murmur**, not an ejection systolic one [3]. - While it can cause LVH, the hallmark symptom of an **ejection systolic murmur** points away from regurgitation. *Mitral regurgitation* - This condition is characterized by a **holosystolic murmur** best heard at the apex and radiating to the axilla, different from the ejection systolic murmur described [1]. - While it can lead to LVH over time, the clinical presentation and specific murmur type are not consistent with mitral regurgitation. *Mitral valve prolapse* - This condition is often associated with a **mid-systolic click** followed by a late systolic murmur, rather than a clear ejection systolic murmur [4]. - Although it can sometimes cause chest pain, it rarely leads to the degrees of LVH and **troponin elevation** described in this scenario without other contributing factors.

Hospital Medicine Flashcard 1 of 8

Question: Color sequence for multiple collections of venous and/or arterial blood samples in a single patient:Yellow, pink, and blue� light Blue� _____� green� lavender� _____.

Answer: red; grey

Hospital Medicine Flashcard 2 of 8

Question: Which crystalloid solution is iso-osmolar (osmolarity 294mosm/L) with plasma and is a suitable diluent for RBC Transfusion?_____

Answer: Plasmalyte

Hospital Medicine Flashcard 3 of 8

Question: Major risk factors for parotitis include dehydration, _____ (elderly postoperative patients), and anti-cholinergics

Answer: intubation

Hospital Medicine Flashcard 4 of 8

Question: Metabolic complications related to decreased or increased feeding (hypo/hyperglycemia) is commonly seen in _____enteral nutrition.

Answer: total par

Hospital Medicine Flashcard 5 of 8

Question: The massive insulin surge in refeeding syndrome results in _____phosphatemia, hypocalcemia, hypokalemia, and hypomagnesemia

Answer: hypo

Hospital Medicine Flashcard 6 of 8

Question: The best position for a conscious patient to be in during the insertion of Ryle's tube is _____ with neck flexion.

Answer: sitting

Hospital Medicine Flashcard 7 of 8

Question: Non-ICU inpatients of community acquired pneumonia are treated with:_____ Or -lactam + Macrolide / Doxycycline

Answer: Fluoroquinolone

Hospital Medicine Flashcard 8 of 8

Question: Along with transfusions, pt. with ACS should also be given prophylactic _____ therapy and incentive spirometry

Answer: abx