General Medicine Practice Questions

Q: Which of the following conditions is least likely to cause pruritus?

Hyperparathyroidism. ***Hyperparathyroidism*** - While hyperparathyroidism can cause some **non-specific symptoms** like bone pain and weakness, **pruritus is not a typical** or common direct symptom associated with it [2]. - The elevated **calcium** and **parathyroid hormone** levels do not directly induce the sensation of itching in most patients [3]. *Polycythemia rubra vera* - This myeloproliferative disorder is well-known for causing **aquagenic pruritus**, which is itching that occurs after contact with water [1]. - The pruritus is thought to be mediated by **histamine release** from an increased mast cell burden. *Uraemia* - **Chronic kidney disease**, especially in its advanced stages leading to uraemia, frequently causes **uraemic pruritus** [1]. - This itching is often severe, generalized, and can significantly impact the patient's **quality of life**, thought to be due to accumulation of toxins. *Hyperthyroidism* - Hyperthyroidism can lead to generalized **pruritus** due to increased **cutaneous blood flow**, elevated skin temperature, and changes in metabolic rates [1]. - The increased metabolic activity and vasodilation can contribute to **skin irritation** and itching.

Q: Obesity is associated with the MOST SIGNIFICANT increased risk of:

Heart disease. ***Heart disease*** - **Obesity** is a major independent risk factor for **cardiovascular diseases**, including coronary artery disease, heart failure, and stroke, due to its impact on metabolic and inflammatory pathways. - It contributes to **atherosclerosis** [1], hypertension, dyslipidemia, and insulin resistance, all of which significantly increase the risk of heart disease. *Hypertension* - While **obesity** is a significant risk factor for **hypertension**, hypertension itself is a component of the broader risk of heart disease, not the most significant singular outcome of obesity. - Elevated blood pressure in obese individuals often results from increased sympathetic activity, insulin resistance, and activation of the **renin-angiotensin-aldosterone system**. *Hyperuricemia* - **Obesity** is associated with **hyperuricemia** due to increased purine production and decreased uric acid excretion, which can lead to **gout**. - However, the overall health burden and mortality risk associated with hyperuricemia are generally less significant compared to heart disease linked to obesity. *Osteoporosis* - **Obesity** is generally considered to be protective against **osteoporosis** because increased body weight places mechanical stress on bones, which can increase bone mineral density. - While obesity can lead to other musculoskeletal issues like osteoarthritis, it does not typically increase the risk of osteoporosis.

Q: All the following conditions can lead to depapillation of the tongue except:

Amyloidosis. ***Amyloidosis*** - Amyloidosis is typically characterized by the deposition of **amyloid protein** in tissues, which does not specifically cause **depapillation of the tongue**. - The **tongue changes** in amyloidosis are often related to macroglossia rather than depapillation. *Luetic glossitis* - Associated with **syphilis**, leading to glossitis and often results in **depapillation** due to inflammation and ulceration of the tongue. - Characterized by **painful, smooth tongue** with loss of papillae, fitting the condition of depapillation. *Pernicious anemia* - Results in **atrophic glossitis**, which is linked to vitamin B12 deficiency and causes **depapillation** of the tongue. - This condition often presents with a smooth, red tongue due to the loss of filiform papillae. *Plummer-Vinson syndrome* - This syndrome is associated with **iron deficiency anemia**, leading to **atrophic glossitis** and **depapillation** of the tongue. - Patients commonly exhibit a smooth and painful tongue, indicative of true depapillation.

Q: Which of the following is a specific cause of metabolic acidosis?

Diabetic ketoacidosis. ***Diabetic ketoacidosis*** - **Diabetic ketoacidosis (DKA)** is a specific condition where an absolute or relative insulin deficiency leads to unchecked **ketone body production** (acetoacetate, beta-hydroxybutyrate), which are organic acids [2]. - The accumulation of these **ketoacids** overwhelms the body's buffer systems, resulting in a **high anion gap metabolic acidosis** [1], [3]. *Diarrhea* - **Diarrhea** causes **metabolic acidosis** due to the loss of **bicarbonate** from the gastrointestinal tract. - This is typically a **normal anion gap metabolic acidosis**, also known as hyperchloremic metabolic acidosis, which is less specific than DKA. *Renal failure* - **Renal failure** can cause **metabolic acidosis** primarily due to the kidneys' inability to excrete acid and reabsorb bicarbonate. - While it often leads to a **high anion gap metabolic acidosis**, it is a broader category and not as specific a cause as DKA, as various types of renal dysfunction can be involved. *None of the options* - This option is incorrect because **diabetic ketoacidosis** is indeed a specific and well-defined cause of metabolic acidosis, characterized by the accumulation of ketoacids due to insulin deficiency [2].

Q: In a clinical scenario, a patient presents with altered mental status due to substance intoxication. Which of the following is the most appropriate management step?

Provide supportive care and monitoring. ***Provide supportive care and monitoring*** - For most substance intoxications causing altered mental status, **supportive care** (e.g., airway management, fluid resuscitation, temperature control) is the cornerstone of treatment while the body metabolizes the substance [1][2]. - **Continuous monitoring** of vital signs and neurological status ensures early detection and management of complications [2][4]. *Administer activated charcoal* - **Activated charcoal** is useful for certain ingested toxins to prevent absorption, but its efficacy is time-dependent (best within 1-2 hours of ingestion) and it's contraindicated in patients with unprotected airways or those who ingested corrosives or hydrocarbons [1]. - In a patient with **altered mental status**, there is a significant risk of aspiration if the airway is not secured, making routine administration of activated charcoal inappropriate [1]. *Administer flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepine overdose, but it is rarely indicated for general altered mental status due to substance intoxication. - Its use can precipitate **seizures** in patients with benzodiazepine dependence or co-ingestion of proconvulsant substances, making it a high-risk intervention for an undifferentiated altered mental status. *Perform gastric lavage* - **Gastric lavage** involves flushing the stomach with fluid and aspirating it to remove ingested toxins, but it's rarely indicated due to low efficacy and significant risks. - Risks include **aspiration**, **esophageal perforation**, and disruption of the gag reflex, especially in patients with altered mental status and an unprotected airway [1][3].

Q: Acute renal failure in a patient who received an incompatible blood transfusion with a hemolytic reaction is best managed by:

Stopping blood transfusion. ***Stopping blood transfusion*** - The immediate priority in managing an incompatible blood transfusion reaction is to **halt the transfusion** to prevent further hemolysis and renal damage. - Continuing the transfusion would exacerbate the hemolytic process, leading to increased release of **hemoglobin**, which is nephrotoxic. *20% Mannitol* - While mannitol can be used to induce diuresis and potentially flush cast formation in the renal tubules, it is **not the primary or initial step** in managing an acute hemolytic transfusion reaction causing renal failure. [1] - Administering mannitol without first stopping the source of the hemolytic reaction would be ineffective and potentially harmful. *IV fluids with K+ supplementation* - **IV fluids** are crucial to maintain renal perfusion and prevent acute tubular necrosis, especially after stopping the transfusion. [1] - However, **K+ supplementation** is generally contraindicated in cases of acute renal failure (ARF) due to hemolysis, as ARF often leads to hyperkalemia, not hypokalemia. [2] *Alkalinizing the urine* - **Alkalinization of urine** (e.g., with sodium bicarbonate) can help prevent the precipitation of myoglobin or hemoglobin in the renal tubules, which can exacerbate renal damage. - This is a secondary measure that follows discontinuing the transfusion and initiating fluid resuscitation, and not the immediate first step.

Q: What is the single most useful clinical sign of severity in a person without underlying lung disease?

Systolic BP less than 90 mm/Hg. ***Systolic BP less than 90 mm/Hg*** - A **systolic blood pressure below 90 mm/Hg** indicates **hypotension**, reflecting inadequate tissue perfusion and potential **shock**, which is a critical sign of severity in any acute illness [1]. - This suggests **cardiovascular compromise** and requires immediate medical attention to prevent organ damage [1]. *Temp more than 38.5°C* - A **fever above 38.5°C** (101.3°F) indicates an infection or inflammatory process but is not as immediate a sign of life-threatening severity as profound hypotension. - While concerning, fever alone rarely signals imminent circulatory collapse in individuals without underlying conditions. *No significant clinical sign* - This option is incorrect because **systolic blood pressure less than 90 mm/Hg** is a highly significant clinical sign of severity, indicating potential decompensation. - Relying on the absence of signs can lead to delays in critical care for patients exhibiting clear signs of distress [1]. *Heart rate more than 100 bpm* - A **heart rate greater than 100 bpm** (**tachycardia**) can be a response to various stressors, including fever, pain, or anxiety, and is less specific for severe circulatory compromise than hypotension [1]. - While it may indicate an underlying problem, it is often a compensatory mechanism that does not, on its own, signify immediate danger without other signs of organ dysfunction.

Q: What is the first-line treatment for chronic orthostatic hypotension?

Fludrocortisone. ***Fludrocortisone*** - **Fludrocortisone** is a **mineralocorticoid** that increases **sodium and water retention**, thereby expanding blood volume and improving orthostatic hypotension. - It is often considered a **first-line pharmacological agent** for chronic orthostatic hypotension, alongside non-pharmacological measures. *Dopamine* - **Dopamine** is a **vasopressor** typically used in **acute hypotensive states** and shock due to its potent vasoconstrictive and inotropic effects. - It is not a first-line agent for **chronic orthostatic hypotension** and has a short half-life, making it impractical for long-term management. *Diuretics* - **Diuretics** work by **decreasing blood volume** through increased urine output, which would worsen rather than improve orthostatic hypotension. - They are contraindicated in conditions like **orthostatic hypotension** where increased blood volume is desired. *Calcium channel blockers* - **Calcium channel blockers** are primarily used to treat **hypertension** and certain **arrhythmias** by causing **vasodilation** and reducing cardiac contractility. - Their vasodilatory effects would **aggravate hypotension**, making them unsuitable for treating orthostatic hypotension.

Q: A patient on amphotericin B develops hypokalemia with a potassium level of 2.3 mEq/L. What is the appropriate K+ supplementation required for this patient?

80 mEq over 24 hours. ***80 mEq over 24 hours***- For a potassium level of 2.3 mEq/L (moderate to severe hypokalemia), **80 mEq over 24 hours** represents appropriate aggressive replacement while maintaining safety.- This dose accounts for both the **existing deficit** and **ongoing renal potassium wasting** caused by amphotericin B, which impairs renal tubular function.- Standard guidelines recommend **60-80 mEq daily** for moderate to severe hypokalemia, divided into multiple doses with continuous cardiac monitoring.- Higher doses risk **rebound hyperkalemia** and cardiac complications [1]; replacement should be titrated based on serial potassium measurements.*40 mEq over 24 hours*- This dosage is insufficient for correcting a potassium level of 2.3 mEq/L, particularly with **ongoing drug-induced renal losses**.- It may be appropriate for mild hypokalemia (3.0-3.5 mEq/L) or maintenance therapy, but not for this clinical scenario.*60 mEq over 24 hours*- While this represents a reasonable starting dose for moderate hypokalemia, it may be **insufficient** given the severity (K+ 2.3 mEq/L) and ongoing losses from amphotericin B.- This dose might require escalation after reassessment of potassium levels.*100-120 mEq over 24 hours*- This dose **exceeds standard safe replacement protocols** and risks causing rebound hyperkalemia and cardiac arrhythmias [1].- Maximum safe infusion rates are typically **10-20 mEq/hour** (up to 40 mEq/hour only in critical situations with intensive monitoring).- Such aggressive replacement is not recommended in standard clinical practice for this scenario.

Question 1

Which of the following conditions is least likely to cause pruritus?

Accepted Answer

Hyperparathyroidism

Answer

Uraemia

Answer

Polycythemia rubra vera

Answer

Hyperthyroidism

Question 2

Obesity is associated with the MOST SIGNIFICANT increased risk of:

Accepted Answer

Heart disease

Answer

Hyperuricemia

Answer

Osteoporosis

Answer

Hypertension

Question 3

All the following conditions can lead to depapillation of the tongue except:

Accepted Answer

Amyloidosis

Answer

Pernicious anemia

Answer

Luetic glossitis

Answer

Plummer-Vinson syndrome

Question 4

Which of the following is a specific cause of metabolic acidosis?

Accepted Answer

Diabetic ketoacidosis

Answer

Diarrhea

Answer

Renal failure

Answer

None of the options

Question 5

In a clinical scenario, a patient presents with altered mental status due to substance intoxication. Which of the following is the most appropriate management step?

Accepted Answer

Provide supportive care and monitoring

Answer

Administer activated charcoal

Answer

Administer flumazenil

Answer

Perform gastric lavage

Question 6

Acute renal failure in a patient who received an incompatible blood transfusion with a hemolytic reaction is best managed by:

Accepted Answer

Stopping blood transfusion

Answer

20% Mannitol

Answer

IV fluids with K+ supplementation

Answer

Alkalinizing the urine

Question 7

A patient after vomiting several times develops carpopedal spasms. The most appropriate treatment would be.

Accepted Answer

Intravenous injection of 20 ml 10% calcium gluconate solution

Answer

Intravenous infusion of isotonic saline

Answer

5% CO2 inhalation

Answer

Oral ammonium chloride 1g four times a day

Question 8

What is the single most useful clinical sign of severity in a person without underlying lung disease?

Accepted Answer

Systolic BP less than 90 mm/Hg

Answer

Temp more than 38.5°C

Answer

No significant clinical sign

Answer

Heart rate more than 100 bpm

Question 9

What is the first-line treatment for chronic orthostatic hypotension?

Accepted Answer

Fludrocortisone

Answer

Dopamine

Answer

Diuretics

Answer

Calcium channel blockers

Question 10

A patient on amphotericin B develops hypokalemia with a potassium level of 2.3 mEq/L. What is the appropriate K+ supplementation required for this patient?

Accepted Answer

80 mEq over 24 hours

Answer

40 mEq over 24 hours

Answer

60 mEq over 24 hours

Answer

100-120 mEq over 24 hours

General Medicine — MCQs

General Medicine — MCQs

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