General Medicine Practice Questions

Q: First line therapy in anaphylactic shock is:

Epinephrine .5 ml of 1:1000 IM. ***Epinephrine .5 ml of 1:1000 IM*** - **Epinephrine** is the **first-line treatment** for anaphylaxis due to its alpha-1 agonist effects (vasoconstriction, which increases blood pressure) and beta-2 agonist effects (bronchodilation, which improves breathing). [1] - The recommended dose and concentration for intramuscular administration in adults is **0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) IM**, repeated every 5-15 minutes as needed. *Atropine 3 mg intravenously* - **Atropine** is an anticholinergic medication used to treat **bradycardia** or organophosphate poisoning, not anaphylaxis. [4] - It does not address the widespread vasaodilation or bronchoconstriction seen in anaphylactic shock. *Adenosine 12 mg intravenously* - **Adenosine** is an antiarrhythmic drug primarily used to convert **supraventricular tachycardia (SVT)** to normal sinus rhythm. [3] - It has no role in the management of anaphylactic shock. *Epinephrine 1 ml of 1:10000 intravenously* - While epinephrine is the correct drug, **intravenous administration** of epinephrine 1:10,000 is typically reserved for **cardiac arrest** [2] or in cases of severe, refractory anaphylaxis under expert care, and carries a higher risk of adverse effects. - The initial and preferred route for anaphylaxis is **intramuscular**, as it provides rapid absorption with lower risks compared to IM administration.

Q: Treatment of choice for anaphylactic shock is:

Adrenaline 0.5 mL of 1:1000 solution by intramuscular route. ***Adrenaline 0.5 mL of 1:1000 solution by intramuscular route*** - **Intramuscular adrenaline** (epinephrine) is the **first-line treatment** for anaphylaxis due to its rapid absorption and systemic effects [1]. - The recommended dose for adults is **0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution)**, administered into the **anterolateral thigh**. *Adrenaline 1 mL of 1:10000 by intravenous route* - **Intravenous adrenaline** is generally reserved for patients in **cardiac arrest** or those who do not respond to IM injections, and should be administered cautiously due to the risk of arrhythmias and hypertension. - The concentration of **1:10,000 (0.1 mg/mL)** is typically given intravenously in much smaller, titrated doses (e.g., 0.1 mg, repeated as needed) compared to the initial IM dose. *Atropine 3 mg intravenously* - **Atropine** is an **anticholinergic agent** used primarily to treat **bradycardia** and certain poisonings, but it has no role in the management of anaphylactic shock. - It does not counteract the vasodilation, bronchoconstriction, or increased vascular permeability characteristic of anaphylaxis. *Adenosine 12 mg intravenously* - **Adenosine** is an **antiarrhythmic drug** used to treat **supraventricular tachycardia** by transiently blocking the AV node. - It would be ineffective in anaphylactic shock and could potentially worsen the patient's condition by causing further vasodilation or hypotension.

Q: Least common cause for bilateral pedal edema

Chronic vascular insufficiency. ***Chronic vascular insufficiency*** - While chronic venous insufficiency is a common cause of bilateral pedal edema, **arterial insufficiency** (a type of chronic vascular insufficiency) is a much less common cause of pure edema and is more often associated with **ischemic pain**, **ulcers**, and **skin atrophy** [1]. - **Arterial insufficiency** primarily causes limb ischemia rather than significant edema, differentiating it from situations where fluid retention is the primary issue [2]. *CKD* - **Chronic kidney disease (CKD)** leads to impaired fluid and sodium excretion, causing generalized fluid overload. - This fluid overload commonly manifests as **bilateral pedal edema** due to gravity-dependent fluid accumulation. *CLD* - **Chronic liver disease (CLD)**, particularly cirrhosis, results in **portal hypertension** and decreased hepatic synthesis of **albumin**. - This leads to reduced oncotic pressure and increased hydrostatic pressure, driving fluid into the extravascular space, often causing **ascites** and **bilateral pedal edema**. *HF with reduced ejection fraction* - **Heart failure with reduced ejection fraction (HFrEF)** impairs the heart's ability to pump blood effectively, leading to fluid backup in the venous system [2]. - This increased hydrostatic pressure in the peripheral capillaries directly causes **bilateral pedal edema** as fluid extravasates into the interstitial space [2].

Q: Which of the following conditions is the most common cause of unintentional weight loss in elderly patients?

Malignancy. ***Malignancy*** - **Malignancy** is the most common cause of unintentional weight loss in elderly patients, accounting for 20-30% of cases [1]. - Cancers often increase **metabolic demand** and produce cytokines that can cause **cachexia**, leading to significant weight loss [1]. *Hyperthyroidism* - While hyperthyroidism can cause **unintentional weight loss** due to an increased metabolic rate, it is less common than malignancy as a cause in the elderly population. - Other typical symptoms of hyperthyroidism, such as **tachycardia**, **tremors**, and **heat intolerance**, would usually be present. *Diabetes mellitus* - **Uncontrolled diabetes** (especially type 1 or severe type 2) can lead to weight loss due to **glucosuria** and fat/muscle breakdown. - However, it is not as frequent a cause of unintentional weight loss in the elderly as malignancy, and would often be accompanied by symptoms like **polyuria**, **polydipsia**, and **blurred vision**. *Chronic obstructive pulmonary disease* - Severe **COPD** can lead to weight loss due to increased **work of breathing**, **systemic inflammation**, and reduced oral intake. - While a significant cause of weight loss in some elderly patients, overall prevalence as the primary cause of unintentional weight loss is lower than malignancy.

Q: Which of the following is NOT a recognized complication of persistent vomiting?

Hyperglycemia. ***Hyperglycemia*** - Persistent vomiting generally leads to **fluid and electrolyte imbalances** and can even cause **hypoglycemia** due to poor oral intake, rather than hyperglycemia. - While stress can cause a transient increase in blood glucose, **persistent hyperglycemia** is not a direct or recognized primary complication of vomiting. *Hypokalemia* - Vomiting leads to the loss of gastric contents, including potassium, directly contributing to **hypokalemia** [1]. - Renal compensation for volume depletion can also lead to increased **potassium excretion** in the urine [1]. *Metabolic alkalosis* - The loss of **hydrochloric acid** from the stomach during vomiting causes a net gain of bicarbonate in the blood, leading to metabolic alkalosis [1]. - This is a hallmark electrolyte disturbance seen in patients with prolonged vomiting [1]. *Aspiration pneumonia* - Repeated vomiting increases the risk of inhaling gastric contents into the lungs, especially if the patient has a **depressed gag reflex** or is obtunded. - This can lead to **aspiration pneumonitis** or **pneumonia**, a serious pulmonary complication.

Q: Which of the following is NOT a common cause of generalized edema?

Pulmonary embolism. ***Pulmonary embolism*** - A **pulmonary embolism** primarily causes **localized edema** due to venous obstruction in a specific limb, or can cause **pulmonary edema** if severe, but it is not a common cause of **generalized edema**. - Generalized edema typically results from systemic fluid retention or widespread capillary leakage, which is not the primary mechanism of PE unless it leads to severe right heart failure and venous congestion. *Hypothyroidism* - **Hypothyroidism** can cause **generalized edema** due to the accumulation of **hyaluronic acid** and **chondroitin sulfate** in the interstitial space, leading to **myxedema**. - This increased interstitial colloid osmotic pressure pulls fluid into the extravascular space, resulting in widespread swelling. *Congestive heart failure* - **Congestive heart failure** leads to **generalized edema** due to increased **hydrostatic pressure** in capillaries and reduced renal perfusion, activating the **renin-angiotensin-aldosterone system**. - These mechanisms cause fluid retention and shifting of fluid from the intravascular to the interstitial space, particularly in dependent areas. *Nephrotic syndrome* - **Nephrotic syndrome** is characterized by severe **proteinuria**, leading to **hypoalbuminemia**, which reduces the plasma **oncotic pressure**. - This decreased oncotic pressure causes fluid to shift from the intravascular space into the interstitial space, resulting in significant **generalized edema**.

Q: Which of the following is a common cause of localized, non-pitting edema?

Lymphatic obstruction. ***Lymphatic obstruction*** - Lymphatic obstruction leads to the accumulation of protein-rich fluid in the interstitial space, commonly causing **non-pitting edema** [1]. - This type of edema is often **localized** to the area where lymphatic drainage is impaired, such as an arm after mastectomy [1]. *Congestive heart failure* - CHF typically causes **pitting edema**, often **bilateral and dependent** due to increased hydrostatic pressure [2], [4]. - It's usually associated with systemic symptoms like **dyspnea** and **orthopnea** [4]. *Nephrotic syndrome* - Nephrotic syndrome results in **generalized, pitting edema** due to significant proteinuria causing decreased oncotic pressure [2], [3]. - This edema often starts in **periorbital** regions and becomes more diffuse. *Liver cirrhosis* - Liver cirrhosis leads to **generalized edema**, particularly **ascites** (fluid in the peritoneal cavity) and lower extremity edema, primarily due to low albumin and portal hypertension. - This edema is usually **pitting** and widespread rather than localized and non-pitting.

Q: Which of the following conditions is least likely to be associated with dyspnea?

Hypothyroidism. ***Hypothyroidism*** - While severe **hypothyroidism** can lead to respiratory muscle weakness or pleural effusions, **dyspnea** is not a primary or common symptom. - The metabolic rate is **decreased**, so the demand for oxygen is lower, making dyspnea less likely. *Asthma* - **Asthma** is characterized by **bronchoconstriction**, airway inflammation, and increased mucus production, leading to significant dyspnea, wheezing, and chest tightness [1]. - Patients often present with **recurrent episodes** of breathlessness, especially during triggers or exertion [1]. *Pneumonia* - **Pneumonia** involves inflammation and consolidation of the lung parenchyma, which impairs gas exchange and reduces lung compliance, resulting in **dyspnea**, cough, and hypoxemia. - The infection can lead to an increased **respiratory rate** and effort to maintain adequate oxygenation. *Myocardial infarction* - An **MI** causes damage to the heart muscle, impairing its pumping ability, and can lead to **acute heart failure** and **pulmonary edema**, which manifest as severe dyspnea [1], [2]. - The sudden decrease in cardiac output and subsequent fluid accumulation in the lungs directly contribute to the sensation of **shortness of breath** [2].

Q: Which of the following is the BEST definition of hyperpyrexia?

It is defined as a body temperature >41.5°C. **It is defined as a body temperature >41.5°C** - **Hyperpyrexia** refers to an extremely high fever, specifically a core body temperature exceeding **41.5°C (106.7°F)**. - This extreme elevation can be life-threatening and is often associated with conditions like **sepsis**, **central nervous system hemorrhage**, or **drug-induced hyperthermia** [1]. *Antipyretics may be ineffective in some cases.* - While true that antipyretics may be ineffective, this describes a characteristic of treatment rather than a definition of the condition itself. - For instance, in **heatstroke**, antipyretics are largely ineffective because the pathology is non-pyrogenic [1]. *It does not always indicate an infection.* - This statement is correct, as hyperpyrexia can be caused by non-infectious conditions like **heatstroke**, **malignant hyperthermia**, or **drug reactions** [1], [2]. - However, it is an observation about its etiology, not a precise definition of the temperature range for hyperpyrexia. *It can occur in children.* - Hyperpyrexia can indeed occur in children, often due to infections or conditions like **febrile seizures** [2]. - This is a demographic characteristic, not the definition of the abnormal temperature itself.

Question 1

True about Postural Hypotension:

Accepted Answer

Decreases in systolic blood pressure 20 mmHg within 3 minutes.

Answer

Decreases in systolic blood pressure 20 mmHg within 6 minutes.

Answer

Decreases in diastolic blood pressure 20 mmHg within 6 minutes.

Answer

Decreases in diastolic blood pressure 20 mmHg within 3 minutes.

Question 2

First line therapy in anaphylactic shock is:

Accepted Answer

Epinephrine .5 ml of 1:1000 IM

Answer

Atropine 3 mg intravenously

Answer

Adenosine 12 mg intravenously

Answer

Epinephrine 1 ml of 1:10000 intravenously

Question 3

Treatment of choice for anaphylactic shock is:

Accepted Answer

Adrenaline 0.5 mL of 1:1000 solution by intramuscular route

Answer

Adrenaline 1 mL of 1:10000 by intravenous route

Answer

Atropine 3 mg intravenously

Answer

Adenosine 12 mg intravenously

Question 4

Least common cause for bilateral pedal edema

Accepted Answer

Chronic vascular insufficiency

Answer

CKD

Answer

CLD

Answer

HF with reduced ejection fraction

Question 5

Which of the following conditions is the most common cause of unintentional weight loss in elderly patients?

Accepted Answer

Malignancy

Answer

Hyperthyroidism

Answer

Diabetes mellitus

Answer

Chronic obstructive pulmonary disease

Question 6

Which of the following is NOT a recognized complication of persistent vomiting?

Accepted Answer

Hyperglycemia

Answer

Hypokalemia

Answer

Metabolic alkalosis

Answer

Aspiration pneumonia

Question 7

Which of the following is NOT a common cause of generalized edema?

Accepted Answer

Pulmonary embolism

Answer

Hypothyroidism

Answer

Congestive heart failure

Answer

Nephrotic syndrome

Question 8

Which of the following is a common cause of localized, non-pitting edema?

Accepted Answer

Lymphatic obstruction

Answer

Congestive heart failure

Answer

Nephrotic syndrome

Answer

Liver cirrhosis

Question 9

Which of the following conditions is least likely to be associated with dyspnea?

Accepted Answer

Hypothyroidism

Answer

Pneumonia

Answer

Myocardial infarction

Answer

Asthma

Question 10

Which of the following is the BEST definition of hyperpyrexia?

Accepted Answer

It is defined as a body temperature >41.5°C

Answer

Antipyretics may be ineffective in some cases.

Answer

It does not always indicate an infection.

Answer

It can occur in children.

General Medicine — MCQs

General Medicine — MCQs

On this page

Want unlimited practice?