General Medicine Practice Questions

Q: A 42-year-old male is diagnosed with liver and pancreatic disease as a result of alcoholism. Physical examination reveals abnormal enlargement of his mammary glands, a secondary result of his disease process. Which of the following clinical conditions most likely describes this case?

Gynecomastia. **Explanation:** The correct answer is **Gynecomastia**. [1] **1. Why Gynecomastia is correct:** Gynecomastia refers to the benign proliferation of glandular tissue of the male breast. In this clinical scenario, the patient’s history of alcoholism has led to **liver cirrhosis**. The liver is responsible for the metabolism and clearance of estrogen [1]. In chronic liver disease, there is a decreased degradation of estrogen and an increased peripheral conversion of androgens to estrogens. This hormonal imbalance (increased estrogen-to-testosterone ratio) stimulates the mammary glandular tissue, leading to enlargement [1]. **2. Why other options are incorrect:** * **Polythelia (A):** This refers to the presence of an extra nipple (accessory nipple) without associated glandular tissue. It occurs along the embryonic milk line. * **Polymastia / Supernumerary breast (B & C):** These terms are often used interchangeably to describe the presence of more than two breasts (accessory breast tissue), including a nipple, areola, and glandular tissue. These are congenital anomalies, not acquired secondary to systemic disease. **3. Clinical Pearls for NEET-PG:** * **Milk Line:** Ectopic breast tissue or nipples occur along the "milk line," which extends from the axilla to the groin. * **Drugs causing Gynecomastia:** Remember the mnemonic **"STACED"** (Spironolactone, Tiagabine/Tricyclics, Alcohol/Allopurinol, Cimetidine, Estrogen, Digoxin) [1]. * **Histology:** Gynecomastia is characterized by the proliferation of ductal elements and stroma; notably, true **alveoli (lobules) are usually absent** in the male breast. * **Differential:** Always rule out Klinefelter syndrome (47, XXY) in cases of bilateral gynecomastia in younger patients [1].

Q: All of the following are true regarding Chronic Fatigue Syndrome, EXCEPT:

More common in men. Explanation: Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex, multisystem disorder characterized by profound fatigue and cognitive dysfunction. Why Option B is the Correct Answer (The Exception): Chronic Fatigue Syndrome is significantly more common in women than in men (ratio approximately 3:1 or 4:1). It typically affects young to middle-aged adults (20–50 years). Therefore, the statement that it is more common in men is incorrect. Analysis of Other Options: * Option A (Joint Pain): Multijoint pain (arthralgia) is a common clinical feature. Crucially, this occurs without objective signs of inflammation like swelling or redness, which helps distinguish it from inflammatory arthritides like Rheumatoid Arthritis. * Option C (Lymphadenopathy): Patients frequently report tender cervical or axillary lymph nodes. This is part of the "flu-like" prodrome often associated with the onset of the syndrome. * Option D (Rest): A hallmark of CFS is that the fatigue is not relieved by rest and is worsened by physical or mental exertion (Post-Exertional Malaise - PEM). High-Yield Clinical Pearls for NEET-PG: * Diagnostic Criteria (IOM/NAM): Requires 6 months of profound fatigue, Post-Exertional Malaise (PEM), and unrefreshing sleep, plus either cognitive impairment ("brain fog") or orthostatic intolerance. * Etiology: Often follows a viral infection (e.g., EBV, Ross River virus), though no single causative agent is proven. * Treatment: Primarily symptomatic; includes Cognitive Behavioral Therapy (CBT) and pacing (energy management). [1] * Exclusion: CFS is a diagnosis of exclusion; always rule out hypothyroidism, sleep apnea, and major depression first. [2]

Q: Which of the following statements about jaundice is false?

Jaundice is detected when bilirubin levels are greater than 2 mg%. **Explanation:** **1. Why Option A is the correct (False) statement:** Clinically, jaundice (icterus) becomes detectable to the naked eye only when serum total bilirubin levels exceed **2.5 to 3 mg/dL**. While the normal range is 0.3–1.2 mg/dL, the range between 1.2 and 2.5 mg/dL is termed "latent jaundice," where levels are elevated but not yet visible on physical examination [1]. Therefore, stating it is detected at >2 mg% is technically inaccurate for clinical diagnosis. **2. Analysis of other options:** * **Option B:** Bilirubin has a very high affinity for **elastin fibers**. Since the sclera is rich in elastin, it is often the first site where jaundice becomes visible. * **Option C:** This statement is actually the **most controversial** in the question. In long-standing **conjugated** hyperbilirubinemia, bilirubin oxidizes to biliverdin, giving a greenish tint [2]. However, in the context of standard medical exams, Option A is the "more false" numerical fact. *Note: Some texts consider a green hue specific to obstructive (conjugated) jaundice.* * **Option D:** Carotenemia (due to excessive Vitamin A/carrots) causes yellowing of the skin (palms/soles) but **spares the sclera** because carotene does not bind to elastin. This is a classic bedside differentiator. **High-Yield Clinical Pearls for NEET-PG:** * **First site to detect jaundice:** Upper sclera (examine while the patient looks down). * **Van den Bergh Reaction:** Direct-acting (conjugated) vs. Indirect-acting (unconjugated). * **Cholestasis:** Characterized by pruritus (due to bile salt deposition) and clay-colored stools [3]. * **Achuric Jaundice:** Seen in hemolytic jaundice (unconjugated bilirubin is not water-soluble and doesn't appear in urine) [1].

Q: A patient has the following blood gases: PaCO2- 25, pH- 7.50, HCO3-- 19. Which of the following could not be the cause of this condition?

PaO2/FiO2 ratio <100. ### **Explanation** **1. Analysis of Blood Gas Parameters:** * **pH 7.50:** Indicates **Alkalosis** (Normal: 7.35–7.45). * **PaCO2 25 mmHg:** Indicates **Respiratory Alkalosis** (Normal: 35–45 mmHg). * **HCO3⁻ 19 mEq/L:** Indicates a compensatory decrease (Normal: 22–26 mEq/L). The primary disturbance is **Respiratory Alkalosis**. **2. Why Option B is the Correct Answer:** A **PaO2/FiO2 ratio <100** is a hallmark of severe **Acute Respiratory Distress Syndrome (ARDS)**. In severe ARDS, there is a significant "shunt" and loss of lung compliance, leading to refractory hypoxemia and eventually **Respiratory Acidosis** (due to respiratory failure and CO2 retention) or **Metabolic Acidosis** (due to lactic acid from tissue hypoxia). It does not typically present as a simple, compensated respiratory alkalosis in its severe stage. **3. Analysis of Incorrect Options:** * **Anxiety Attack & Hysteria (Options A & C):** These are classic causes of hyperventilation. Excessive "blowing off" of CO2 leads to an increase in pH, resulting in acute respiratory alkalosis. * **Aspirin Toxicity (Option D):** Salicylates directly stimulate the medullary respiratory center, causing hyperventilation and **Respiratory Alkalosis** as the *earliest* acid-base disturbance (often followed by a mixed metabolic acidosis in later stages). ### **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In Respiratory Alkalosis, for every 10 mmHg drop in PaCO2, the pH rises by 0.08 (Acute) or 0.03 (Chronic). * **Salicylate Poisoning:** The most common mixed acid-base disorder in adults is **Respiratory Alkalosis + Metabolic Acidosis**. * **P/F Ratio Categories (Berlin Criteria):** * Mild ARDS: 200–300 * Moderate ARDS: 100–200 * Severe ARDS: <100

Q: All of the following cause high anion gap metabolic acidosis EXCEPT?

Ureterosigmoidostomy. **Explanation:** Metabolic acidosis is classified into two categories based on the **Anion Gap (AG)**: High Anion Gap Metabolic Acidosis (HAGMA) and Normal Anion Gap Metabolic Acidosis (NAGMA). **1. Why Ureterosigmoidostomy is the correct answer:** Ureterosigmoidostomy causes **NAGMA** (Hyperchloremic metabolic acidosis). When ureters are diverted into the sigmoid colon, the intestinal mucosa is exposed to urine. The colon reabsorbs chloride ($Cl^-$) in exchange for bicarbonate ($HCO_3^-$) secretion into the bowel lumen. This loss of bicarbonate leads to acidosis, but because the chloride levels rise to compensate for the lost bicarbonate, the anion gap remains normal. **2. Why the other options are incorrect (HAGMA causes):** In HAGMA, an unmeasured organic acid accumulates, consuming bicarbonate without increasing chloride. * **Lactic Acidosis:** Accumulation of lactate (e.g., in shock or sepsis) increases the AG. * **Salicylate Poisoning:** Aspirin overdose leads to the accumulation of salicylic acid and interferes with the Krebs cycle, producing organic acids. * **Ethylene Glycol Poisoning:** Metabolism of this antifreeze agent produces glycolic and oxalic acids, leading to a high AG and often "envelope-shaped" calcium oxalate crystals in urine. **Clinical Pearls for NEET-PG:** * **Mnemonic for HAGMA:** **MUDPILES** (Methanol, Uremia, DKA, Propylene glycol, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates). * **Mnemonic for NAGMA:** **USED CARP** (Ureterosigmoidostomy, Small bowel fistula, Extra chloride, Diarrhea, Carbonic anhydrase inhibitors, Renal tubular acidosis, Pancreatic fistula). * **Key Distinction:** Diarrhea is the most common cause of NAGMA, while Lactic acidosis is the most common cause of HAGMA in clinical practice.

Q: What is the formula for parenteral iron therapy?

4.4 x body weight (kg) x Hb deficit (g/dL). The correct formula for calculating the total dose of parenteral iron required to restore hemoglobin levels and replenish iron stores is the **Ganzoni Formula**. ### 1. Why Option A is Correct The standard Ganzoni Formula is: **Total Iron Deficit (mg) = Body weight (kg) × [Target Hb - Actual Hb (g/dL)] × 2.4 + Iron stores (mg)** In many simplified clinical calculations and competitive exams like NEET-PG, the factor **4.4** is used as a shorthand. This constant accounts for: * The iron content of hemoglobin (0.34%). * The blood volume (approx. 7% of body weight). * The additional iron required to replenish depleted stores (usually 500 mg for adults). When these variables are integrated into a single coefficient for rapid calculation, **4.4** is the mathematically accepted constant to determine the total milligram dose. ### 2. Why Other Options are Incorrect * **Options B, C, and D (3.3, 2.2, 1.1):** These values are mathematically incorrect. They do not account for the physiological constants of blood volume and hemoglobin iron concentration. Using these would result in significant under-dosing, failing to correct the anemia or replenish the necessary 500 mg of storage iron (ferritin). ### 3. NEET-PG High-Yield Pearls * **Target Hb:** Usually taken as 15 g/dL for calculations. * **Iron Stores:** For a body weight >35 kg, the storage iron is assumed to be **500 mg**. * **Indications for Parenteral Iron:** Oral iron intolerance, malabsorption (e.g., Celiac disease, IBD), chronic kidney disease (CKD) on EPO, or the need for rapid correction before surgery. * **Adverse Effect:** While rare with newer formulations like Iron Sucrose or Ferric Carboxymaltose, always monitor for **anaphylaxis**.

Q: A 47-year-old man with known liver cirrhosis presents with unresponsiveness. He flexes his elbows and wrists when stimulated, opens his eyes only when his sternum is rubbed, and groans without forming words. What is this patient's Glasgow Coma Scale (GCS) score?

7. To determine the correct Glasgow Coma Scale (GCS) score, we must evaluate the three components: Eye Opening (E), Verbal Response (V), and Motor Response (M). Conscious level should be measured using the Glasgow Coma Scale (GCS) to monitor improvement or deterioration [1]. **1. Component Analysis:** * **Eye Opening (E):** The patient opens his eyes only when his sternum is rubbed (painful stimulus). This corresponds to **E2**. * **Verbal Response (V):** The patient groans without forming recognizable words (incomprehensible sounds). This corresponds to **V2**. * **Motor Response (M):** The patient flexes his elbows and wrists (decorticate posturing/abnormal flexion) when stimulated. This corresponds to **M3**. **Total GCS = E2 + V2 + M3 = 7.** **2. Analysis of Incorrect Options:** * **Option A (6):** This would be the score if the patient showed decerebrate posturing (M2) instead of decorticate (M3), or if there were no verbal response (V1). * **Option C (8):** This would be the score if the patient localized pain (M4) or uttered inappropriate words (V3). * **Option D (9):** This would be the score if the patient withdrew from pain (M4) and used inappropriate words (V3). **3. NEET-PG High-Yield Pearls:** * **Mnemonic for Motor (Old):** **6** (Obeys), **5** (Localizes), **4** (Withdraws), **3** (Abnormal Flexion/Decorticate), **2** (Extension/Decerebrate), **1** (Nil). * **Decorticate vs. Decerebrate:** Remember **"COR"** in De**cor**ticate—the arms move toward the **"CORe"** (flexion). Decerebrate (extension) usually indicates a more caudal brainstem injury and a worse prognosis. * **Clinical Significance:** A GCS score of **≤ 8** is the traditional threshold for "Coma" and often indicates the need for endotracheal intubation to protect the airway ("GCS of 8, intubate") [2]. * **Context:** In a cirrhotic patient, this presentation strongly suggests Grade IV Hepatic Encephalopathy.

Question 1

A 42-year-old male is diagnosed with liver and pancreatic disease as a result of alcoholism. Physical examination reveals abnormal enlargement of his mammary glands, a secondary result of his disease process. Which of the following clinical conditions most likely describes this case?

Accepted Answer

Gynecomastia

Answer

Polythelia

Answer

Supernumerary breast

Answer

Polymastia

Question 2

All of the following are true regarding Chronic Fatigue Syndrome, EXCEPT:

Accepted Answer

More common in men

Answer

Multiple painful joints associated with knee pains without swelling

Answer

Painful cervical lymph nodes

Answer

Pain not relieved even after rest

Question 3

Central cyanosis is seen if?

Accepted Answer

O2 saturation is < 85%

Answer

Methemoglobin is 0.5 gm/dl

Answer

O2 saturation is < 94%

Answer

Hemoglobin is 4 gm%

Question 4

Which of the following statements about jaundice is false?

Accepted Answer

Jaundice is detected when bilirubin levels are greater than 2 mg%

Answer

Jaundice has a high affinity for scleral elastin

Answer

A green hue of the conjunctiva is seen in unconjugated hyperbilirubinemia

Answer

Carotenemia does not cause scleral icterus

Question 5

Apart from diarrhea, in which other conditions is oral rehydration solution employed?

Accepted Answer

Heat stroke and burn cases

Answer

Severe vomiting

Answer

Burn cases

Answer

Heat stroke

Question 6

A patient has the following blood gases: PaCO2- 25, pH- 7.50, HCO3-- 19. Which of the following could not be the cause of this condition?

Accepted Answer

PaO2/FiO2 ratio <100

Answer

Anxiety attack

Answer

Hysteria

Answer

Aspirin toxicity

Question 7

All of the following cause high anion gap metabolic acidosis EXCEPT?

Accepted Answer

Ureterosigmoidostomy

Answer

Lactic acidosis

Answer

Salicylate poisoning

Answer

Ethylene glycol poisoning

Question 8

What is the formula for parenteral iron therapy?

Accepted Answer

4.4 x body weight (kg) x Hb deficit (g/dL)

Answer

3.3 x body weight (kg) x Hb deficit (g/dL)

Answer

2.2 x body weight (kg) x Hb deficit (g/dL)

Answer

1.1 x body weight (kg) x Hb deficit (g/dL)

Question 9

Which of the following is not typically seen in heat stroke?

Accepted Answer

Pancreatitis

Answer

Rhabdomyolysis

Answer

Hypovolaemia

Answer

Seizures

Question 10

A 47-year-old man with known liver cirrhosis presents with unresponsiveness. He flexes his elbows and wrists when stimulated, opens his eyes only when his sternum is rubbed, and groans without forming words. What is this patient's Glasgow Coma Scale (GCS) score?

Accepted Answer

7

Answer

6

Answer

8

Answer

9

General Medicine — MCQs

General Medicine — MCQs

On this page

Want unlimited practice?