General Medicine Practice Questions

Q: Which fluid is ideally given for a patient experiencing dehydration?

Normal Saline. ***Normal Saline*** - **Normal saline (0.9% sodium chloride)** is an **isotonic solution** that effectively increases **extracellular fluid volume**, making it ideal for treating **dehydration** and hypovolemia [1]. - It closely mimics the **osmolality of plasma** and stays predominantly in the intravascular space, helping to restore circulating volume [1]. *Plasma* - **Plasma** is primarily used for **coagulation factor deficiencies** or volume expansion in cases of severe **hypoproteinemia**, not routine dehydration. - It contains **proteins and clotting factors** that are not typically needed for simple dehydration and carries risks of **allergic reactions and transfusion-related acute lung injury (TRALI)**. *Blood* - **Blood transfusions** are indicated for patients with **significant anemia** or **acute blood loss**, not for generalized dehydration. - Using blood for dehydration would be inappropriate due to risks such as **transfusion reactions**, **infections**, and **iron overload**. *5% dextrose* - **5% dextrose in water (D5W)** is an **isotonic solution initially**, but once the dextrose is metabolized, it becomes **hypotonic**, causing free water to shift into the cells [1]. - While it provides some free water, it is not ideal for primary rehydration in cases of significant volume depletion due to its lack of electrolytes and potential for causing **hyponatremia** if given in large quantities [1].

Q: Bilateral parotid enlargement occurs in all, Except:

Chronic pancreatitis. ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.

Q: According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:

10% weight loss in 2-3 months. ***10% weight loss in 2-3 months*** - **Unexplained weight loss** of **10%** or more of usual body weight over a period of **2-3 months** is generally considered a significant amount requiring medical evaluation. - This degree of weight loss can be indicative of underlying serious medical conditions like cancer, gastrointestinal disorders, endocrine disorders, or chronic infections [1]. *5% weight loss in 1-2 months* - While any unexplained weight loss should be noted, a **5% loss** in this timeframe is usually not considered immediately "significant" enough to warrant an aggressive workup unless other concerning symptoms are present. - It might be due to minor lifestyle changes, temporary illness, or benign factors. *5% weight loss in 2-3 months* - A **5% weight loss** over **2-3 months** is a less critical threshold than 10% for initiating an extensive medical evaluation for serious underlying disease. - This level of weight change could be due to a variety of less severe causes or even normal fluctuations. *10% weight loss in 1-2 months* - While a **10% weight loss** is significant, the **1-2 month** timeframe is generally considered slightly too short to immediately classify it as "requiring medical evaluation" in the strictest sense compared to the 2-3 month period which allows for better observation. - Rapid weight loss over a very short period might sometimes be related to acute illness or dehydration rather than chronic underlying conditions, though still warrants attention.

Q: What term is used to describe painful muscle cramps that occur in hot environments?

Heat cramps. ***Heat cramps*** - **Heat cramps** are painful, involuntary muscle spasms that occur during or after strenuous activity in hot environments, often due to **electrolyte imbalances** from excessive sweating. - They are typically the **mildest form** of heat-related illness and do not involve significant changes in core body temperature or mental status. *Heat collapse* - **Heat collapse**, or **heat syncope**, is a sudden, brief loss of consciousness (fainting) due to pooling of blood in the lower extremities, typically occurring after standing for long periods in a hot environment [2]. - It does not primarily involve **muscle cramping** as the main symptom. *Sunstroke* - **Sunstroke** is a layman's term often used interchangeably with heatstroke, which is a **severe, life-threatening condition** characterized by a greatly elevated core body temperature (>40°C or 104°F) and central nervous system dysfunction [1]. - While prolonged sun exposure can lead to sunstroke, it is a much more serious condition than simple **muscle cramps**. *Heat exhaustion* - **Heat exhaustion** is a moderate form of heat-related illness characterized by symptoms like **profuse sweating**, **fatigue**, **nausea**, and **dizziness**, with a body temperature typically between 38°C and 40°C [1]. - While muscle cramps can be a symptom, it is a broader syndrome with more systemic involvement compared to isolated **painful muscle cramps**.

Q: Which of the following is a complication of total parenteral nutrition?

Hyperglycemia. ***Hyperglycemia*** - Total parenteral nutrition (TPN) solutions contain a high concentration of **dextrose** (glucose), which can lead to elevated blood glucose levels, especially in patients with pre-existing metabolic issues or high infusion rates. - The sudden and continuous infusion of carbohydrates can overwhelm the body's **insulin response**, resulting in hyperglycemia [3]. *Hyperkalemia* - **Hypokalemia**, rather than hyperkalemia, is a more common electrolyte disturbance associated with TPN due to intracellular shifts of potassium with glucose metabolism [2]. - While TPN solutions do contain potassium, hyperkalemia is generally rare unless there is significant renal impairment or excessive potassium supplementation. *Hyperglycemia and Hyperkalemia* - While **hyperglycemia** is a common complication, **hyperkalemia** is not; in fact, hypokalemia is a more frequent concern linked to the significant glucose load in TPN. - This option incorrectly pairs a common complication with one that is rare and generally only seen in specific circumstances. *Hyperosmolar dehydration* - This condition, also known as **hyperosmolar hyperglycemic state (HHS)**, is a severe complication that can arise from uncontrolled hyperglycemia, where high glucose levels lead to osmotic diuresis and severe dehydration [1]. - While hyperglycemia is a precursor to hyperosmolar dehydration, the direct complication of TPN administration itself is the hyperglycemia.

Q: Which of the following statements about obesity is FALSE?

There is no genetic predisposition to obesity.. There is no genetic predisposition to obesity. - This statement is false because genetic factors play a significant role in an individual's susceptibility to obesity, influencing metabolism, appetite, and fat storage [1]. - While environment and lifestyle are crucial, polygenic influences and certain single-gene disorders can heavily predispose individuals to weight gain [1]. *Smoking is associated with weight loss* - Smoking can lead to appetite suppression and an increased metabolic rate, which may result in weight loss or lower body weight compared to non-smokers. - However, this is not a healthy or recommended method for weight control due to the numerous severe health risks associated with smoking. *Obesity affects only females.* - This statement is false; obesity affects both males and females across all age groups and demographics [2]. - Although there can be differences in fat distribution and associated health risks between sexes, obesity is a global health issue impacting everyone [2]. *The prevalence of obesity decreases with age.* - This statement is generally false; the prevalence of obesity tends to increase with age through middle adulthood before possibly leveling off or slightly declining in older age. - Factors like decreased physical activity, changes in metabolism, and chronic disease accumulation contribute to weight gain later in life [3].

Q: What is the daily temperature variation in remittent fever?

> 1.0 °C. ***> 1.0 °C*** - In **remittent fever**, the temperature fluctuates by **more than 1.0 °C** (or 2°F) over a 24-hour period. [1] - Despite the significant variation, the temperature **never returns to normal** during the day. [1] *< 0.5 °C* - A variation of less than 0.5 °C (or 1°F) is more characteristic of a **sustained or continuous fever**, where the temperature remains elevated with minimal fluctuation. [1] - This pattern is seen in conditions like **typhoid fever** or **pneumonia**. * 2.0 °C* - While a variation greater than 2.0 °C would certainly fall under the definition of remittent fever (as it's > 1.0 °C), the defining lower limit for remittent fever is typically **> 1.0 °C (or 2°F)**. - A larger fluctuation might occur, but > 1.0 °C is the minimum threshold.

Q: What electrolyte imbalance is commonly associated with laxative abuse?

Hypokalemia. ***Hypokalemia*** - Chronic laxative abuse, particularly with stimulant laxatives, can lead to significant **potassium loss** through increased fecal excretion and altered colonic fluid and electrolyte transport. - **Hypokalemia** can manifest with symptoms like muscle weakness, cramps, fatigue, and even cardiac arrhythmias. *Hypomagnesemia* - While laxative abuse can occasionally contribute to **magnesium depletion**, it is not as consistently or significantly associated as potassium loss. - Primarily, **hypomagnesemia** is related to malabsorption syndromes, chronic alcoholism, or certain medications. *Hyponatremia* - **Hyponatremia** is not typically a direct consequence of laxative abuse; rather, it can be associated with excessive fluid intake in an attempt to alleviate constipation or with certain diuretic use. - Laxative abuse primarily causes loss of water and electrolytes from the gut, not a primary dilution of plasma sodium. *Hyperkalemia* - **Hyperkalemia** (high potassium) is the opposite of what occurs with laxative abuse, which causes potassium loss. - It is more commonly associated with kidney failure, certain medications (e.g., ACE inhibitors, potassium-sparing diuretics), or acidosis.

Q: Shock is clinically best assessed by:

Mental status. **Mental status** - The **brain** is highly sensitive to tissue perfusion, and changes in mental status (e.g., confusion, disorientation) are often among the **earliest and most reliable clinical indicators of inadequate organ perfusion** in shock [1]. - Assessing mental status is a quick, non-invasive method to gauge the adequacy of **cerebral blood flow**, directly reflecting the body's response to hypoperfusion [1]. *CVP* - **Central Venous Pressure (CVP)** primarily reflects the right ventricular preload and overall fluid status but does not directly measure tissue perfusion throughout the body [1]. - While CVP can guide fluid resuscitation, it is not a direct measure of systemic tissue oxygenation and can be affected by numerous factors unrelated to shock severity [1]. *BP* - **Blood pressure (BP)** is a relatively late and insensitive indicator of shock, as compensatory mechanisms can maintain BP within normal limits even when significant hypoperfusion is already occurring [1]. - By the time **hypotension** (low BP) is observed, shock is often advanced, and other signs of organ dysfunction may already be present [1]. *Hydration* - **Hydration status** refers to the body's overall fluid balance and, while important in managing shock, is not the best clinical assessment tool for defining the presence or severity of shock itself. - While dehydration can contribute to hypovolemic shock, assessing hydration is an indirect measure and doesn't directly reflect systemic tissue perfusion or oxygen delivery.

Question 1

Which fluid is ideally given for a patient experiencing dehydration?

Accepted Answer

Normal Saline

Answer

Plasma

Answer

Blood

Answer

5% dextrose

Question 2

Bilateral parotid enlargement occurs in all, Except:

Accepted Answer

Chronic pancreatitis

Answer

HIV

Answer

SLE

Answer

Mumps

Question 3

According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:

Accepted Answer

10% weight loss in 2-3 months

Answer

5% weight loss in 1-2 months

Answer

5% weight loss in 2-3 months

Answer

10% weight loss in 1-2 months

Question 4

What term is used to describe painful muscle cramps that occur in hot environments?

Accepted Answer

Heat cramps

Answer

Heat collapse

Answer

Sunstroke

Answer

Heat exhaustion

Question 5

Which of the following is a complication of total parenteral nutrition?

Accepted Answer

Hyperglycemia

Answer

Hyperkalemia

Answer

Hyperglycemia and Hyperkalemia

Answer

Hyperosmolar dehydration

Question 6

Which of the following statements about obesity is FALSE?

Accepted Answer

There is no genetic predisposition to obesity.

Answer

Smoking is associated with weight loss

Answer

Obesity affects only females.

Answer

The prevalence of obesity decreases with age.

Question 7

What is the daily temperature variation in remittent fever?

Accepted Answer

> 1.0 °C

Answer

< 0.5 °C

Answer

< 1.0 °C

Answer

> 2.0 °C

Question 8

An 86-year-old lady presented with severe constipation. She was a known hypertensive on medications for 10 years. In clinic, her BP was 157/98 mm Hg with a heart rate of 58/min. On taking her BP in the supine position, it was found to be 90/60 mm Hg. She had a recent history of depression. She is taking atenolol, thiazide, imipramine, haloperidol, and docusate. What is the next best step in the management?

Accepted Answer

Change imipramine and haloperidol to fluoxetine and risperidone and add bisacodyl for constipation

Answer

Change atenolol and thiazide to calcium channel blocker and ACE inhibitor and add bisacodyl for constipation

Answer

Only add bisacodyl for constipation and continue rest of the medications

Answer

Discontinue all her medications and start her on steroids

Question 9

What electrolyte imbalance is commonly associated with laxative abuse?

Accepted Answer

Hypokalemia

Answer

Hypomagnesemia

Answer

Hyponatremia

Answer

Hyperkalemia

Question 10

Shock is clinically best assessed by:

Accepted Answer

Mental status

Answer

CVP

Answer

BP

Answer

Hydration

General Medicine — MCQs

General Medicine — MCQs

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