General Medicine Practice Questions

Q: A 16-year-old female presents with a one-week history of small ulcers on her cheek and tongue. She has a mild fever and multiple ulcers on her buccal and labial mucosa on oral examination. She also reports that she is having her board exams in one week. What is the probable etiology?

Any of the above. **Explanation:** The clinical presentation of multiple, recurrent, painful ulcers on the non-keratinized mucosa (buccal and labial) in a young patient is characteristic of **Aphthous Stomatitis (Canker Sores)**. **1. Why "Any of the above" is correct:** Aphthous ulcers are multifactorial in origin. The question highlights that the patient is preparing for board exams, pointing toward **emotional stress** (Option A) as a major trigger. Stress increases cortisol levels, which can dysregulate the mucosal immune response. However, recurrent ulcers are also frequently associated with **vitamin deficiencies** (Option B), specifically Vitamin B12, Folate, and Iron. Furthermore, **hormonal disturbances** (Option C), such as those occurring during the luteal phase of the menstrual cycle in adolescent females, are well-documented triggers. Since all three factors are common etiologies for this presentation, "Any of the above" is the most accurate choice. **2. Analysis of Options:** * **Emotional disturbances:** Stress is the most common precipitant in students. * **Vitamin deficiency:** Deficiencies in B-complex vitamins lead to impaired mucosal regeneration. * **Hormonal disturbances:** Fluctuations in progesterone and estrogen affect oral mucosal integrity. **Clinical Pearls for NEET-PG:** * **Site:** Aphthous ulcers occur on **non-keratinized** mucosa (buccal mucosa, floor of mouth). Ulcers on keratinized mucosa (gingiva, hard palate) are more likely Herpetic (HSV). * **Types:** Minor ( 10mm, leaves scars), and Herpetiform (multiple pin-head sized). * **Associations:** Always rule out **Behçet’s disease** (triad of oral ulcers, genital ulcers, and uveitis) and **Celiac disease** in recurrent cases. * **Treatment:** Topical corticosteroids (Triamcinolone acetonide) and topical analgesics (Lidocaine).

Q: In the management of sepsis, what is the primary type of fluid administered?

Crystalloids. ### Explanation **1. Why Crystalloids are the Correct Answer:** According to the **Surviving Sepsis Campaign (SSC) guidelines**, crystalloids are the first-line choice for fluid resuscitation in patients with sepsis and septic shock. The primary goal in sepsis is to restore intravascular volume and improve organ perfusion. Crystalloids (such as Normal Saline or Ringer’s Lactate) are preferred because they are effective, inexpensive, and have a better safety profile regarding renal function and coagulation compared to alternatives. The current recommendation is an initial bolus of **30 mL/kg** of intravenous crystalloid within the first 3 hours. **2. Why Other Options are Incorrect:** * **Colloids (Option A):** While colloids (like Albumin) stay in the intravascular space longer, they are significantly more expensive. They are generally reserved as a second-line option when patients require substantial amounts of crystalloids. * **Hydroxyethyl Starch (HES) (Option C):** HES is a synthetic colloid that is specifically **contraindicated** in sepsis. Large clinical trials (like the CHEST and 6S trials) demonstrated that HES increases the risk of **Acute Kidney Injury (AKI)**, the need for renal replacement therapy, and increased mortality in septic patients. **3. High-Yield Clinical Pearls for NEET-PG:** * **Fluid of Choice:** Balanced salt solutions (e.g., **Ringer’s Lactate** or Plasmalyte) are increasingly preferred over Normal Saline (0.9% NaCl) to avoid hyperchloremic metabolic acidosis. * **Vasoactive Support:** If MAP remains <65 mmHg despite fluid resuscitation, **Norepinephrine** is the first-choice vasopressor. * **Dynamic Parameters:** Modern sepsis management emphasizes using dynamic measures (e.g., Passive Leg Raise, Stroke Volume Variation) rather than static measures (CVP) to assess fluid responsiveness. * **Albumin:** Consider adding Albumin only when patients require very large volumes of crystalloids.

Q: Which intravenous fluid contains the maximum amount of potassium and is preferred for treating hypokalemia?

Isolyte-M. **Explanation:** The correct answer is **Isolyte-M**. The management of electrolyte imbalances requires a precise understanding of the ionic composition of various intravenous fluids. **Why Isolyte-M is correct:** Isolyte-M (Maintenance solution) is specifically designed to provide maintenance electrolytes. It contains the highest concentration of potassium among the common IV fluids listed, typically providing **40 mEq/L** of Potassium ($K^+$). This makes it the preferred choice for treating or preventing hypokalemia when oral supplementation is not feasible. **Analysis of Incorrect Options:** * **Ringer Lactate (RL):** Often called a "balanced" salt solution, it contains only **4 mEq/L** of Potassium. While it is physiological, the concentration is too low to effectively correct significant hypokalemia. * **Isolyte-P (Pediatric):** Designed for pediatric maintenance, it contains approximately **20 mEq/L** of Potassium. While higher than RL, it is still lower than the concentration found in Isolyte-M. * **Isotonic Saline (0.9% NaCl):** This solution contains **zero** potassium. It consists only of Sodium (154 mEq/L) and Chloride (154 mEq/L). **High-Yield Clinical Pearls for NEET-PG:** * **Maximum Infusion Rate:** In a peripheral vein, the maximum concentration of $K^+$ should generally not exceed **40 mEq/L**, and the rate of infusion should not exceed **10–20 mEq/hour** to avoid cardiac arrhythmias and phlebitis. * **Isolyte-G:** Contains high Gastric replacement electrolytes (contains $NH_4Cl$); do not confuse with Isolyte-M. * **ECG in Hypokalemia:** Look for flattened T-waves, prominent **U-waves**, and ST-segment depression. * **Refractory Hypokalemia:** If hypokalemia does not respond to replacement, always check **Magnesium** levels; hypomagnesemia often coexists and hinders $K^+$ correction.

Q: Cyanosis is caused by:

All of the above. Explanation: Cyanosis is the bluish discoloration of the skin and mucous membranes resulting from an excessive concentration of deoxygenated hemoglobin or abnormal hemoglobin derivatives in the capillary blood [2]. 1. Reduced Hemoglobin (Deoxy-Hb): Central cyanosis becomes clinically apparent when the concentration of reduced hemoglobin exceeds 5 g/dl in the capillary bed (or roughly 3.4 g/dl in arterial blood) [2]. Since the option states "above 7.5 g/dl," it comfortably exceeds the threshold required to manifest cyanosis. 2. Abnormal Hemoglobin Derivatives: Cyanosis can also occur due to dyshemoglobins, which have a much higher "cyanotic potential" than reduced Hb: * Methemoglobin (MetHb): Cyanosis appears at levels >1.5 g/dl [1]. This is often described as "chocolate-colored" blood. * Sulfhemoglobin (SulphHb): This is the most potent inducer of cyanosis, visible at levels as low as 0.5 g/dl. It produces a distinctive greenish-blue hue. Why "All of the above" is correct: Each option provides a value that is at or above the established clinical threshold for the appearance of cyanosis. Therefore, all three conditions will result in the clinical manifestation of the sign. High-Yield Clinical Pearls for NEET-PG: * The Anemia Paradox: A severely anemic patient (e.g., Hb < 5 g/dl) cannot develop cyanosis because they cannot produce 5 g/dl of reduced hemoglobin, even if completely deoxygenated. * Polycythemia: These patients develop cyanosis more easily (at higher SaO2 levels) due to high baseline hemoglobin. * Differential Cyanosis: Seen in PDA with reversal of shunt (Eisenmenger syndrome); cyanosis is present in the lower limbs but absent in the upper limbs. * Best site to elicit central cyanosis: Tongue and soft palate (highly vascular, not affected by cold).

Q: Intravenous potassium chloride should be administered how?

Diluted in normal saline. **Explanation:** The administration of intravenous (IV) potassium chloride (KCl) requires strict adherence to safety protocols because rapid or concentrated infusion can lead to fatal cardiac arrhythmias or severe local tissue injury. **Why Option B is Correct:** Potassium chloride must always be **diluted** before administration. **Normal Saline (0.9% NaCl)** is the preferred vehicle. Dilution ensures that the concentration remains within safe limits (usually 40 mmol/L for peripheral lines and up to 100 mmol/L for central lines) to prevent phlebitis and cardiac toxicity. **Why Other Options are Incorrect:** * **Options A & D:** Administering KCl as a **bolus** (whether peripheral or central) is strictly contraindicated. A sudden surge in serum potassium levels can cause immediate cardiac arrest in diastole. * **Option C:** Diluting KCl in **5% Dextrose** is generally avoided during the initial correction of hypokalemia. Dextrose stimulates insulin release, which shifts potassium from the extracellular fluid into the cells. This can further drop the serum potassium levels initially, potentially worsening the patient's condition. **High-Yield Clinical Pearls for NEET-PG:** 1. **Maximum Rate:** In a stable patient, the infusion rate should not exceed **10–20 mmol/hour**. 2. **Monitoring:** Continuous ECG monitoring is mandatory if the infusion rate exceeds 10 mmol/hour. 3. **Concentration:** For peripheral veins, the concentration should not exceed **40 mmol/L** to avoid thrombophlebitis and pain. 4. **Refractory Hypokalemia:** If hypokalemia does not respond to KCl, always check **Magnesium levels**; hypomagnesemia often coexists and prevents effective potassium replacement.

Q: Total Parental Nutrition includes all of the following, except:

Fibers. **Explanation:** Total Parenteral Nutrition (TPN) is the intravenous administration of all necessary nutrients to patients who cannot or should not use their gastrointestinal tract for absorption. **Why Fibers is the correct answer:** Fibers are non-digestible carbohydrates (like cellulose and pectin) that function primarily within the lumen of the gut to add bulk to stool and regulate bowel movements. Since TPN bypasses the gastrointestinal tract entirely and is infused directly into the bloodstream, **fibers have no physiological role in parenteral nutrition.** Furthermore, fibers are insoluble solids that cannot be formulated into a sterile intravenous solution. **Why the other options are incorrect:** * **Carbohydrates:** These are provided typically as **Dextrose** (glucose). They serve as the primary energy source, providing approximately 3.4 kcal/g in TPN formulations. * **Proteins:** These are provided in the form of **Crystalline Amino Acids**. They are essential for maintaining nitrogen balance, tissue repair, and enzyme synthesis. * **Lipids:** These are provided as **Intravenous Fat Emulsions** (e.g., soybean or safflower oil). They provide a concentrated energy source (9 kcal/g) and prevent Essential Fatty Acid Deficiency (EFAD). **High-Yield Clinical Pearls for NEET-PG:** * **Route:** TPN is usually hypertonic and must be administered through a **Central Venous Catheter** (e.g., Subclavian vein) to prevent thrombophlebitis. * **Complications:** The most common metabolic complication is **Hyperglycemia**. The most serious acute complication during refeeding is **Refeeding Syndrome** (characterized by severe Hypophosphatemia). * **Monitoring:** Long-term TPN can lead to **Acalculous Cholecystitis** or cholestasis due to lack of gallbladder stimulation.

Q: What is the maximum percentage of dextrose that can be safely administered through a peripheral intravenous line?

12.5%. **Explanation:** The primary limiting factor for administering intravenous fluids through a peripheral vein is **osmolarity**. Peripheral veins are small and have relatively low blood flow; high-osmolarity solutions exert significant osmotic pressure on the vascular endothelium, leading to chemical irritation, phlebitis, and venous thrombosis. **Why 12.5% is the correct answer:** In clinical practice and standard nutritional guidelines (such as ASPEN), the maximum recommended osmolarity for peripheral parenteral nutrition is approximately **900 mOsm/L**. Dextrose 12.5% provides an osmolarity that sits right at this threshold. While 10% is frequently used, **12.5% is the absolute maximum concentration** tolerated by peripheral veins before the risk of thrombophlebitis becomes unacceptably high. Any concentration above this requires a Central Venous Catheter (CVC) where high blood flow in the superior vena cava rapidly dilutes the hypertonic solution. **Analysis of Incorrect Options:** * **A. 10%:** This is commonly used and safe for peripheral lines, but it is not the *maximum* allowable concentration. * **C. 15% & D. 25%:** These concentrations are highly hypertonic (25% dextrose is ~1260 mOsm/L). Administering these peripherally would cause rapid endothelial damage, severe pain, and tissue necrosis if extravasation occurs. These must be administered via a central line. **High-Yield NEET-PG Pearls:** * **Energy Content:** 1 gram of anhydrous dextrose provides **3.4 kcal** (not 4 kcal, which is for dietary carbohydrates). * **Central Line Requirement:** Total Parenteral Nutrition (TPN) solutions with dextrose concentrations of 15–25% must be delivered via a central line. * **Neonatal Fact:** In neonates, the threshold is sometimes more strictly observed at 12.5% to prevent loss of peripheral access sites.

Question 1

A 16-year-old female presents with a one-week history of small ulcers on her cheek and tongue. She has a mild fever and multiple ulcers on her buccal and labial mucosa on oral examination. She also reports that she is having her board exams in one week. What is the probable etiology?

Accepted Answer

Any of the above

Answer

Emotional disturbances

Answer

Vitamin deficiency

Answer

Hormonal disturbances

Question 2

In the management of sepsis, what is the primary type of fluid administered?

Accepted Answer

Crystalloids

Answer

Colloids

Answer

Hydroxyethyl starch

Answer

None of the above

Question 3

A 48-year-old woman has developed persistent swelling and puffiness in the left arm after a mastectomy with axillary node dissection for breast cancer 1 year ago. She developed cellulitis in the left arm 3 months ago. Physical examination shows firm skin over the left arm and "doughy" underlying soft tissue. The arm is not painful or discolored. Which of the following terms best describes these findings?

Accepted Answer

Lymphedema

Answer

Subclavian arterial thrombosis

Answer

Thrombophlebitis

Answer

Tumor embolization

Question 4

A 35-year-old patient presents with features of septicemia, including hypotension and low urine output. The patient is undergoing treatment for colonic necrosis. What is the primary management strategy?

Accepted Answer

Intravenous fluid only

Answer

Intravenous fluid and dopamine

Answer

Dopamine only

Answer

High-dose antibiotics

Question 5

A 50-year-old male patient weighs 65 kg and has a pH of 7.05, PCO2 of 15 mmHg, HCO3 of 5 mEq/L, and a base deficit of 40 mEq/L. How much sodium bicarbonate should be administered in the first 4 hours?

Accepted Answer

150 mEq

Answer

300 mEq

Answer

450 mEq

Answer

600 mEq

Question 6

Which intravenous fluid contains the maximum amount of potassium and is preferred for treating hypokalemia?

Accepted Answer

Isolyte-M

Answer

Ringer lactate

Answer

Isolyte-P

Answer

Isotonic saline

Question 7

Cyanosis is caused by:

Accepted Answer

All of the above

Answer

Reduced Hb above 7.5 g/dl

Answer

MetHb above 1.5 g/dl

Answer

SulphHb above 0.5 g/dl

Question 8

Intravenous potassium chloride should be administered how?

Accepted Answer

Diluted in normal saline

Answer

As a bolus in a peripheral intravenous line

Answer

Diluted in 5% Dextrose

Answer

As a bolus in a central intravenous line

Question 9

Total Parental Nutrition includes all of the following, except:

Accepted Answer

Fibers

Answer

Lipids

Answer

Carbohydrates

Answer

Proteins

Question 10

What is the maximum percentage of dextrose that can be safely administered through a peripheral intravenous line?

Accepted Answer

12.5%

Answer

10%

Answer

15%

Answer

25%

General Medicine — MCQs

General Medicine — MCQs

On this page

Want unlimited practice?