General Medicine Practice Questions

Q: Immediately after eating, a man develops swelling of face and lips, respiratory distress, intense pruritus, hypotension, and a feeling of impending doom. Which of the following is the most likely diagnosis?

Anaphylaxis. **Explanation:** The clinical presentation described is a classic medical emergency: **Anaphylaxis**. This is a severe, life-threatening, systemic Type I hypersensitivity reaction (IgE-mediated) that occurs rapidly after exposure to an allergen (in this case, food). **Why Anaphylaxis is correct:** The diagnosis is established by the involvement of multiple organ systems: * **Cutaneous:** Swelling of face/lips (angioedema) and intense pruritus. * **Respiratory:** Respiratory distress (likely due to laryngeal edema or bronchospasm). * **Cardiovascular:** Hypotension and the "feeling of impending doom" (a classic symptom of systemic shock). The rapid onset immediately after eating is the hallmark of an anaphylactic trigger. **Why other options are incorrect:** * **Angioneurotic Edema:** While it causes swelling of the face and lips, it typically lacks the systemic features of hypotension, generalized pruritus, and rapid cardiovascular collapse seen here. * **Myocardial Infarction:** While it can cause hypotension and a feeling of doom, it does not explain the acute swelling, pruritus, or the direct temporal link to food ingestion. * **Food stuck in throat (Choking):** This would cause sudden respiratory distress and cyanosis, but not hypotension, pruritus, or facial swelling. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** Intramuscular (IM) **Epinephrine (Adrenaline)** 1:1000 dilution. * **Site of Injection:** Anterolateral aspect of the middle third of the thigh (Vastus lateralis). * **Mechanism:** Epinephrine acts as a physiological antagonist, causing vasoconstriction ($\alpha_1$), decreasing mucosal edema, and bronchodilation ($\beta_2$). * **Biphasic Reaction:** Symptoms can recur 1–72 hours after the initial resolution; hence, observation is mandatory.

Q: A 40-year-old female presents with koilonychias, iron deficiency, and dysphagia. What is the most likely diagnosis?

Plummer-Vinson syndrome. ### Explanation The correct answer is **Plummer-Vinson syndrome** (also known as Paterson-Brown-Kelly syndrome). This diagnosis is defined by a classic clinical triad: 1. **Iron Deficiency Anemia (IDA):** Manifesting here as koilonychia (spoon-shaped nails). 2. **Post-cricoid Esophageal Webs:** Leading to dysphagia. 3. **Glossitis/Cheilosis:** (Often present, though not mentioned in this specific stem). The underlying pathophysiology involves chronic iron deficiency leading to mucosal atrophy and the formation of a thin, eccentric mucosal fold (web) in the upper esophagus. This typically causes **painless, intermittent dysphagia** specifically for solids. **Why other options are incorrect:** * **Achalasia Cardia:** This is a motility disorder characterized by the failure of the Lower Esophageal Sphincter (LES) to relax. It presents with dysphagia for both solids and liquids and is not associated with iron deficiency or koilonychia. * **Esophageal Stricture:** Usually a complication of chronic GERD (peptic stricture) or ingestion of corrosives. While it causes dysphagia, it occurs in the distal esophagus and lacks the systemic signs of iron deficiency. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in middle-aged Caucasian females. * **Malignancy Risk:** It is a **premalignant condition**; patients have an increased risk of developing **Squamous Cell Carcinoma** of the post-cricoid region/upper esophagus. * **Diagnosis:** The best initial test for visualizing the web is a **Barium Swallow** (lateral view). * **Treatment:** Iron supplementation often improves the dysphagia; however, mechanical dilation may be required for significant webs.

Q: A healthy adult runs a marathon in the summer and develops hot dry skin, cessation of sweating, lactic acidosis, hypocalcemia, and muscle necrosis (rhabdomyolysis). Which of the following is the appropriate diagnosis?

Heat stroke. **Explanation:** The clinical presentation of a marathon runner in summer with **hot dry skin, cessation of sweating (anhidrosis), and multi-organ dysfunction** is classic for **Heat Stroke**. **1. Why Heat Stroke is correct:** Heat stroke is a medical emergency defined by a core body temperature >40°C (104°F) and central nervous system dysfunction. In **Exertional Heat Stroke**, heavy physical activity in hot/humid conditions overwhelms the body’s thermoregulatory mechanisms. The cessation of sweating occurs due to sweat gland fatigue or hypothalamic failure. The extreme hyperthermia leads to direct thermal injury to tissues, resulting in **rhabdomyolysis** (muscle necrosis), which subsequently causes **lactic acidosis** and **hypocalcemia** (due to calcium deposition in damaged muscle). **2. Why the other options are incorrect:** * **Dysautonomia:** While it can cause anhidrosis, it does not typically present with acute muscle necrosis or lactic acidosis following physical exertion. * **Malignant Hyperthermia:** This is a pharmacogenetic disorder triggered by volatile anesthetics (e.g., halothane) or succinylcholine, not by environmental heat or exercise. * **Myotonic Dystrophy:** This is a genetic muscle-wasting disease characterized by "myotonia" (delayed relaxation of muscles) and would not present acutely with these systemic features. **NEET-PG High-Yield Pearls:** * **Triad of Heat Stroke:** Hyperthermia (>40°C), CNS dysfunction (confusion/coma), and Anhidrosis. * **Management:** Immediate cooling is the priority (Ice-water immersion is the gold standard). * **Complication:** Disseminated Intravascular Coagulation (DIC) and Acute Renal Failure (due to myoglobinuria) are common sequelae. * **Distinction:** Heat exhaustion presents with profuse sweating; Heat stroke presents with dry skin.

Q: Which weight loss regimen decreases the risk of gallstone formation?

Achieving a weight loss of 2-3 kg per month. **Explanation:** The formation of gallstones during weight loss is primarily driven by the **supersaturation of bile with cholesterol** and **gallbladder hypomotility**. **Why Option B is Correct:** Rapid weight loss (typically defined as >1.5 kg per week) triggers a massive flux of cholesterol from adipose tissue into the bile. This increases the lithogenic index of bile, leading to crystal formation. A gradual, controlled weight loss of **2–3 kg per month (approx. 0.5–1 kg per week)** allows the liver to maintain a stable cholesterol-to-bile acid ratio, significantly reducing the risk of cholelithiasis. **Analysis of Incorrect Options:** * **Option A:** While hydration is essential for general health, increasing water intake alone does not alter the biochemical composition of bile or prevent cholesterol crystallization. * **Option C:** Very low-calorie diets (VLCDs), especially those under 800 kcal/day, are a major risk factor. They cause rapid mobilization of cholesterol and lead to decreased gallbladder emptying (stasis) because there is insufficient dietary fat to trigger Cholecystokinin (CCK) release. * **Option D:** While a moderate amount of fat (approx. 7-10g/day) is needed to stimulate gallbladder contraction, a "high-fat" diet is counterproductive for weight loss and may exacerbate biliary symptoms in those with pre-existing sludge. **NEET-PG High-Yield Pearls:** * **The "4 F's" Rule:** Risk factors for gallstones include Female, Fat, Fertile, and Forty. * **Biliary Sludge:** Rapid weight loss can lead to sludge formation in up to 25% of patients within 6 weeks. * **Pharmacological Prophylaxis:** In patients undergoing rapid weight loss or bariatric surgery, **Ursodeoxycholic acid (UDCA)** is often prescribed to prevent stone formation by decreasing cholesterol secretion into bile.

Q: Stress ulcers are caused by all of the following except?

Penicillin therapy. **Explanation:** Stress ulcers (Stress-Related Mucosal Disease) are acute gastric mucosal lesions that occur in patients under severe physiological stress. The pathophysiology primarily involves mucosal ischemia, hypersecretion of gastric acid, and a breakdown of protective mucosal barriers. **Why Penicillin therapy is the correct answer:** Penicillin is a beta-lactam antibiotic used to treat bacterial infections. It does not interfere with gastric mucosal protection, nor does it stimulate acid production or cause systemic physiological stress. Therefore, it is not associated with the formation of stress ulcers. **Analysis of incorrect options:** * **Burns (Curling’s Ulcer):** Severe burns lead to reduced plasma volume and mucosal ischemia. These specific stress ulcers, typically found in the fundus and corpus of the stump, are known as **Curling’s ulcers**. * **Corticosteroid therapy:** Steroids inhibit prostaglandin synthesis, which is essential for maintaining the gastric mucosal barrier and bicarbonate secretion. Chronic or high-dose use significantly increases the risk of peptic and stress ulceration. * **Pulmonary insufficiency:** Patients with respiratory failure requiring mechanical ventilation are at high risk. Hypoxia and hypercapnia lead to splanchnic vasoconstriction and reduced mucosal perfusion, predisposing the stomach to acid injury. **High-Yield Clinical Pearls for NEET-PG:** 1. **Cushing’s Ulcer:** Stress ulcers associated with **increased intracranial pressure** (trauma, tumors, or surgery). They are caused by vagal overstimulation leading to gastric acid hypersecretion. 2. **Prophylaxis:** The two most important risk factors requiring stress ulcer prophylaxis in the ICU are **mechanical ventilation (>48 hours)** and **coagulopathy**. 3. **Location:** Unlike chronic peptic ulcers, stress ulcers are usually multiple, superficial, and located in the acid-secreting portions (fundus/body) of the stomach.

Q: Hyponatremia is seen in all of the following conditions except:

Diabetes insipidus. **Explanation:** The core concept in this question is the balance between water and sodium. **Diabetes Insipidus (DI)** is characterized by either a deficiency of Antidiuretic Hormone (ADH) or a lack of response to it. This leads to the inability of the kidneys to concentrate urine, resulting in massive excretion of dilute urine (polyuria). Because the body is losing pure water in excess of sodium, the serum sodium concentration rises, leading to **hypernatremia**, not hyponatremia. **Analysis of other options:** * **Congestive Heart Failure (CHF):** This is a classic cause of **hypervolemic hyponatremia** [2]. Decreased effective arterial blood volume triggers the release of ADH (non-osmotic release), causing water retention that outweighs sodium retention, thus diluting serum sodium [1]. * **Kidney Problems:** Chronic Kidney Disease (CKD) or acute renal failure often leads to hyponatremia because the kidneys lose the ability to excrete free water effectively, leading to a dilutional state [2]. * **SIADH:** This is the prototype for **euvolemic hyponatremia** [2]. Excessive, unregulated ADH secretion causes continuous water reabsorption in the collecting ducts, diluting the extracellular fluid [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **DI vs. SIADH:** Think of them as opposites. DI = Low ADH/Effect → High Serum Sodium. SIADH = High ADH → Low Serum Sodium [2]. 2. **Urine Osmolality:** In DI, urine is inappropriately dilute ( 100 mOsm/kg) [1]. 3. **Correction Speed:** Rapid correction of hyponatremia can lead to **Osmotic Demyelination Syndrome (Central Pontine Myelinolysis)**. Rule of thumb: Do not exceed 8–10 mEq/L in 24 hours.

Q: What is the most severe and persistent symptom of acute mountain sickness?

Headache. **Explanation:** Acute Mountain Sickness (AMS) is a syndrome caused by rapid ascent to high altitudes (typically above 2500m) where the partial pressure of oxygen is low. **Why Headache is the Correct Answer:** Headache is the **cardinal, most common, and most persistent symptom** of AMS. It is typically described as bitemporal or occipital, throbbing in nature, and worsens with exertion or lying flat. The underlying pathophysiology involves **hypoxia-induced cerebral vasodilation** and a breakdown of the blood-brain barrier, leading to mild cerebral edema. This increases intracranial pressure, which manifests primarily as a persistent headache. **Why other options are incorrect:** * **B. Dizziness:** While common in AMS (alongside nausea and fatigue), it is usually transient and less persistent than the headache. * **C. Drowsiness:** This is a "red flag" sign. If drowsiness or lethargy progresses to obtundation, it indicates a transition from AMS to **High-Altitude Cerebral Edema (HACE)**, a life-threatening emergency. * **D. Cyanosis:** This indicates severe hypoxemia. While it may occur at extreme altitudes, it is a clinical sign of respiratory failure or **High-Altitude Pulmonary Edema (HAPE)** rather than a primary symptom of standard AMS. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** AMS is a clinical diagnosis. The **Lake Louise Score** is the gold standard for assessment (Headache + at least one other symptom like GI upset, fatigue, or dizziness). * **Prophylaxis:** **Acetazolamide** (Carbonic anhydrase inhibitor) is the drug of choice; it induces metabolic acidosis, stimulating ventilation. * **Treatment:** The definitive treatment for severe symptoms is **immediate descent**. Dexamethasone is used for HACE, and Nifedipine (or Sildenafil) is used for HAPE.

Q: Puddle sign is seen in:

Ascites. **Explanation:** The **Puddle Sign** is a specialized physical examination maneuver used to detect small amounts of free intraperitoneal fluid (**Ascites**), typically as little as **120 ml**. **Why Ascites is correct:** The test is based on the principle of gravity. The patient is placed in a "knee-elbow" position for several minutes, allowing fluid to pool (form a "puddle") in the most dependent part of the abdomen (the umbilical region). The clinician then percusses the umbilical area while moving the stethoscope diaphragm across the abdomen. A positive sign is indicated by a sharp change in the intensity and pitch of the percussion note as the stethoscope moves over the pooled fluid. It is more sensitive than the "shifting dullness" test, which requires at least 500–1500 ml of fluid to be positive. **Why other options are incorrect:** * **Hydrothorax & Pneumothorax:** These involve fluid or air in the pleural cavity. They are assessed via chest expansion, vocal fremitus, and percussion of the thoracic wall (e.g., stony dullness for hydrothorax or hyper-resonance for pneumothorax), not the puddle sign. * **Hydrocoele:** This is an accumulation of fluid in the tunica vaginalis of the scrotum. It is diagnosed via **transillumination** and the "get above the swelling" test. **Clinical Pearls for NEET-PG:** * **Order of sensitivity for Ascites:** Puddle Sign (>120 ml) > Shifting Dullness (>500 ml) > Fluid Thrill (Large/Tense ascites). * **Gold Standard for Diagnosis:** Ultrasonography (can detect as little as 5–10 ml of fluid). * **Bulging flanks:** Usually requires at least 2 liters of fluid to be clinically evident.

Q: High anion gap metabolic acidosis is/are present in which of the following conditions?

Poorly controlled diabetes. **Explanation:** **1. Why the correct answer is right:** **Poorly controlled diabetes** (specifically Diabetic Ketoacidosis or DKA) leads to **High Anion Gap Metabolic Acidosis (HAGMA)**. In the absence of insulin, the body undergoes excessive fatty acid oxidation, resulting in the production of ketoacids (β-hydroxybutyrate and acetoacetate). These are unmeasured anions that accumulate in the blood, increasing the gap between measured cations ($Na^+$) and measured anions ($Cl^-$ and $HCO_3^-$). **2. Why the incorrect options are wrong:** * **Asthma & COPD (Options A & B):** These are obstructive lung diseases that lead to **Respiratory Acidosis** due to $CO_2$ retention (hypoventilation). Anion gap changes are characteristic of metabolic, not primary respiratory, disturbances. * **Renal Tubular Acidosis (Option D):** RTA is a classic cause of **Normal Anion Gap Metabolic Acidosis (NAGMA)** or hyperchloremic acidosis. In RTA, there is either a failure to excrete $H^+$ or a failure to reabsorb $HCO_3^-$, which is compensated for by an increase in Chloride ($Cl^-$) levels to maintain electroneutrality, keeping the anion gap within the normal range (8–12 mEq/L). **3. High-Yield 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-alimentation, Diarrhea, Carbonic anhydrase inhibitors, Renal Tubular Acidosis, Pancreatic fistula). * **Formula:** Anion Gap = $Na^+ - (Cl^- + HCO_3^-)$. Normal range is 8–12 mEq/L. * **Key Distinction:** If the question mentions "Diarrhea" or "RTA," always think NAGMA. If it mentions "Shock," "Renal Failure," or "Ketoacidosis," think HAGMA.

Question 1

Immediately after eating, a man develops swelling of face and lips, respiratory distress, intense pruritus, hypotension, and a feeling of impending doom. Which of the following is the most likely diagnosis?

Accepted Answer

Anaphylaxis

Answer

Angioneurotic Edema

Answer

Myocardial Infarction

Answer

Food stuck in throat

Question 2

A 40-year-old female presents with koilonychias, iron deficiency, and dysphagia. What is the most likely diagnosis?

Accepted Answer

Plummer-Vinson syndrome

Answer

Achalasia cardia

Answer

Esophageal stricture

Answer

None of the above

Question 3

A healthy adult runs a marathon in the summer and develops hot dry skin, cessation of sweating, lactic acidosis, hypocalcemia, and muscle necrosis (rhabdomyolysis). Which of the following is the appropriate diagnosis?

Accepted Answer

Heat stroke

Answer

Dysautonomia

Answer

Malignant hyperthermia

Answer

Myotonic dystrophy

Question 4

Which weight loss regimen decreases the risk of gallstone formation?

Accepted Answer

Achieving a weight loss of 2-3 kg per month

Answer

Consuming 2-3 liters of water per day

Answer

Following a very low-calorie diet

Answer

Consuming a high-fat diet

Question 5

Immediate antagonism of the cardiac effects of hyperkalemia is achieved by which of the following?

Accepted Answer

IV Calcium

Answer

Dextroversion

Answer

Dialysis

Answer

Glucose + Insulin

Question 6

Stress ulcers are caused by all of the following except?

Accepted Answer

Penicillin therapy

Answer

Burns

Answer

Corticosteroid therapy

Answer

Pulmonary insufficiency

Question 7

Hyponatremia is seen in all of the following conditions except:

Accepted Answer

Diabetes insipidus

Answer

Congestive heart failure

Answer

Kidney problems

Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Question 8

What is the most severe and persistent symptom of acute mountain sickness?

Accepted Answer

Headache

Answer

Dizziness

Answer

Drowsiness

Answer

Cyanosis

Question 9

Puddle sign is seen in:

Accepted Answer

Ascites

Answer

Hydrothorax

Answer

Pneumothorax

Answer

Hydrocoele

Question 10

High anion gap metabolic acidosis is/are present in which of the following conditions?

Accepted Answer

Poorly controlled diabetes

Answer

Asthma

Answer

COPD with CO2 retention

Answer

Renal tubular acidosis

General Medicine — MCQs

General Medicine — MCQs

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