General Medicine — MCQs

General Medicine Indian Medical PG Practice Questions and MCQs

Question 71: Which of the following is the correct technique of giving CPR?

A.
B.
C. (Correct Answer)
D.

Explanation: ***Image A*** - This image illustrates the correct body positioning for effective chest compressions during CPR. The rescuer is kneeling beside the patient with straight arms, positioning their shoulders directly over their hands to leverage their body weight for **deeper compressions**. - The hands are placed correctly on the center of the chest, specifically the lower half of the **sternum**, ensuring the force is applied to the appropriate area for maximum cardiac output. *Image B* - This image shows the correct hand placement for chest compressions: one hand over the other, interlocked fingers, with the heel of the bottom hand on the center of the chest. This technique helps to **stabilize the hands** and deliver effective compressions. - However, it does not depict the full-body posture required for proper compression depth and efficiency. *Image C* - This image shows the rescuer with bent elbows and an incorrect body posture, indicating that they are not using their body weight effectively. This would result in **shallow and ineffective chest compressions**, which are not sufficient to maintain blood circulation. - The rescuer's arms should be straight, and their shoulders should be directly over their hands to maximize the force of compressions. *Image D* - This image depicts the anatomy of the upper airway and carotid arteries, likely demonstrating the **head tilt-chin lift maneuver** for opening the airway or checking for a pulse. - While critical for CPR, it is a component of airway management and pulse assessment, not the technique for chest compressions.

Question 72: The following test is performed for evaluating the integrity of: (Recent NEET Pattern 2016-17)

A. Basal ganglia
B. Cerebellum (Correct Answer)
C. Corticospinal pathway
D. Spinothalamic pathway

Explanation: ***Cerebellum*** - The image depicts a person performing a **tandem gait** (walking heel-to-toe along a straight line), which is a common test for **cerebellar function**. - The cerebellum is critical for **coordination**, balance, and **fine motor control**, including the ability to maintain a straight path during walking. *Basal ganglia* - The basal ganglia are primarily involved in the **initiation and modulation of movement**, and their dysfunction leads to characteristic movement disorders such as **Parkinsonism (bradykinesia, rigidity, tremor)** or **Huntington's disease (chorea)**. - While gait can be affected in basal ganglia disorders (e.g., shuffling gait in Parkinson's), tandem gait specifically emphasizes balance and coordination more directly attributed to cerebellar function. *Corticospinal pathway* - The **corticospinal pathway** (pyramidal tract) is responsible for **voluntary, skilled movements**, particularly of the distal limbs. - Damage to this pathway typically results in **weakness (paresis)**, spasticity, and hyperreflexia, which would manifest as difficulty with initiating or executing movements rather than purely balance and coordination issues highlighted by tandem gait. *Spinothalamic pathway* - The spinothalamic pathway transmits **pain** and **temperature** sensations from the body to the brain. - Evaluating this pathway involves sensory testing (e.g., pinprick, hot/cold sensation), which is unrelated to the motor task of tandem walking.

Question 73: Which pattern of breathing is shown below?

A. Kussmaul breathing (Correct Answer)
B. Apneustic breathing
C. Cheyne-Stokes breathing
D. Biot's breathing

Explanation: ***Kussmaul breathing*** - The image depicts a pattern of breathing that starts shallow, deepens, then becomes very rapid, and finally diminishes before becoming shallow again, without periods of apnea. This fluctuating depth and rate are characteristic of **Kussmaul breathing**. - This pattern is a compensatory mechanism for **metabolic acidosis**, particularly seen in conditions like **diabetic ketoacidosis (DKA)**, where the body attempts to excrete CO2 to raise pH. *Apneustic breathing* - This pattern involves prolonged inspiratory pauses, often followed by a short, gasping expiration, or even periods of prolonged inspiration and no expiration. - It results from damage to the **pons**, such as from a stroke or severe head trauma, indicating a serious neurological injury. *Cheyne-Stokes breathing* - Characterized by a cyclical pattern of progressively **deeper and sometimes faster breathing**, followed by a gradual decrease in breathing that results in a temporary stop (apnea). - This pattern is typically seen in patients with **congestive heart failure**, stroke, or severe brain injury, indicating central nervous system dysfunction. *Biot's breathing* - This pattern consists of groups of quick, shallow inspirations followed by regular or irregular periods of apnea. - It is often indicative of damage to the **medulla oblongata** due to conditions like stroke, trauma, or opioid overdose.

Question 74: A head trauma patient is shown below. Diagnosis is?

A. Decorticate rigidity
B. Decerebrate rigidity (Correct Answer)
C. Acute dystonia
D. Catatonia

Explanation: ***Decerebrate rigidity*** - The image shows **extension and internal rotation of the arms** with pronation, and **extension of the legs** with plantar flexion. This posture is characteristic of decerebrate rigidity. - This posturing indicates severe damage to the **brainstem**, specifically below the red nucleus, which is a more ominous sign than decorticate posturing. *Decorticate rigidity* - Decorticate rigidity would present with **flexion of the arms** at the elbows and wrists (to the core), adduction of the shoulders, and extension of the lower limbs. - This posturing is typically due to damage to the **corticospinal tracts above the red nucleus** (e.g., cerebral hemispheres, internal capsule, thalamus). *Acute dystonia* - Acute dystonia involves sustained or repetitive muscle contractions leading to **twisting and repetitive movements** or abnormal fixed postures. - It often affects specific muscle groups, such as the neck (torticollis), eyes (oculogyric crisis), or trunk, and is not typically a generalized rigidity pattern seen in head trauma as extensively as shown. *Catatonia* - Catatonia is a neuropsychiatric syndrome characterized by a variety of motor or behavioral abnormalities, including **immobility, mutism, stupor, waxy flexibility, and negativism**. - While it can involve abnormal posturing, it is a conscious state often associated with psychiatric conditions or general medical conditions, and doesn't manifest as the specific brainstem-related rigidity evident in the image.

Question 75: A patient presents with the following lesions on the elbows and his blood work shows lactescent plasma. Which is correct about the lesions?

A. Molluscum contagiosum
B. Leads to decreased risk for coronary atherosclerosis
C. Leads to increased risk for pancreatitis (Correct Answer)
D. Due to increased LDL cholesterol

Explanation: ***Leads to increased risk for pancreatitis*** - The lesions shown are **eruptive xanthomas**, which are associated with severe hypertriglyceridemia, often indicated by **lactescent plasma**. - Markedly elevated triglyceride levels (typically >1000 mg/dL) significantly increase the risk of developing **acute pancreatitis**. *Molluscum contagiosum* - **Molluscum contagiosum** lesions are typically flesh-colored, dome-shaped papules with a characteristic **umbilicated center**. - These lesions are distinct from the yellowish-red papules seen in eruptive xanthomas, and **molluscum contagiosum** is not associated with hyperlipidemia or lactescent plasma. *Leads to decreased risk for coronary atherosclerosis* - The condition described (eruptive xanthomas and lactescent plasma) indicates **severe hypertriglyceridemia**, which is a significant risk factor for **coronary artery disease (atherosclerosis)**, not a decreased risk. - High triglyceride levels contribute to the formation of **atherosclerotic plaques**. *Due to increased LDL cholesterol* - While high LDL cholesterol can cause **xanthomas** (e.g., tendinous, tuberous), **eruptive xanthomas** and **lactescent plasma** are specifically linked to extremely high **triglyceride levels**, often part of chylomicronemia, rather than primarily increased LDL cholesterol. - The "lactescent" or milky appearance of plasma is due to the high concentration of **chylomicrons** and **VLDL**, which are rich in triglycerides.

Question 76: Which of the following sites in the most common site of intraparenchymal bleeding?

A. A
B. B (Correct Answer)
C. C
D. D

Explanation: ***B*** - Label B points to the **lenticulostriate arteries** territory, specifically within the **basal ganglia**, including the putamen. The **putamen** is the **most common site** for spontaneous intraparenchymal hemorrhages, often due to **hypertensive vasculopathy** affecting these small penetrating arteries. - Hypertensive hemorrhages typically occur in areas supplied by small-caliber perforating arteries, which are particularly susceptible to the effects of chronic hypertension, leading to **lipohyalinosis** and microaneurysms (Charcot-Bouchard aneurysms) that rupture. *A* - Label A points to the **corona radiata** or surrounding white matter. While intraparenchymal bleeds can occur here, it is less common than in the basal ganglia. - Hemorrhages in the corona radiata would be more consistent with **lobar hemorrhages** which are often associated with **cerebral amyloid angiopathy** in older patients. *C* - Label C points towards the **thalamus**. The thalamus is one of the common sites for intraparenchymal hemorrhage, particularly due to hypertension, but it is less frequent than the putamen. - Thalamic hemorrhages often present with distinct clinical syndromes, such as **sensory deficits** and eye movement abnormalities, due to the critical structures located here. *D* - Label D points to the **temporal lobe cortex** and subcortical white matter. Lobar hemorrhages can occur in the temporal lobe, but they are not the most common site overall for intraparenchymal bleeding from all causes. - Temporal lobe hemorrhages can be caused by various factors, including **cerebral amyloid angiopathy**, vascular malformations, or trauma, but hypertensive bleeds rarely occur in the cortex.

Question 77: The deformity shown below can be due to involvement of: (AIIMS May 2016)

A. Ulnar nerve (Correct Answer)
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve

Explanation: ***Ulnar nerve*** - The image displays a characteristic **claw hand deformity**, especially prominent in the ring and little fingers, where the metacarpophalangeal (MCP) joints are hyperextended, and the interphalangeal (IP) joints are flexed. - This deformity results from **paralysis of the ulnar innervated intrinsic hand muscles** (interossei and medial two lumbricals), leading to an imbalance between extrinsic and intrinsic muscles. *Median nerve* - **Median nerve injury** typically causes features like "ape hand" (loss of thenar eminence and inability to abduct/oppose thumb) or "hand of benediction" (inability to flex the index and middle fingers). - These deformities primarily affect the radial side of the hand and the thumb, which is not primarily seen in the image. *Radial nerve* - **Radial nerve injury** proximally results in "wrist drop" and inability to extend the wrist and fingers. - This involves paralysis of the extensors of the wrist and digits, which is different from the flexion deformity seen in the image. *Musculocutaneous nerve* - The **musculocutaneous nerve** primarily innervates muscles in the anterior compartment of the arm (biceps brachii, brachialis, coracobrachialis) and provides sensation to the lateral forearm. - Its injury affects elbow flexion and forearm sensation, and does not cause a "claw hand" deformity.

Question 78: Which disease occurs due to involvement of the structure marked in red? (AIIMS May 2018)

A. Depression
B. Alzheimer's disease
C. Paralysis agitans (Correct Answer)
D. Huntington's chorea

Explanation: ***Paralysis agitans*** - The red circle points to the **substantia nigra**, a key brain structure involved in producing **dopamine**. - **Paralysis agitans**, also known as **Parkinson's disease**, is characterized by the degeneration of dopaminergic neurons in the substantia nigra, leading to motor symptoms like tremor, rigidity, and bradykinesia. *Depression* - Depression is a mood disorder associated with imbalances in various **neurotransmitters** (e.g., serotonin, norepinephrine, dopamine) and often involves brain regions such as the prefrontal cortex and limbic system, not primarily the substantia nigra. - While dopamine pathways can be implicated in motivation and reward, the primary pathology of major depression is not direct degeneration of the substantia nigra. *Alzheimer's disease* - Alzheimer's disease is a neurodegenerative disorder primarily characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles**, leading to neuronal loss and brain atrophy, particularly in the hippocampus and cerebral cortex, not the substantia nigra. - It results in progressive **memory loss** and cognitive decline, distinct from the motor symptoms seen in Parkinson's. *Huntington's chorea* - Huntington's chorea is a hereditary neurodegenerative disease caused by the degeneration of GABAergic neurons in the **striatum** (caudate and putamen). - It is characterized by **involuntary movements** (chorea), cognitive decline, and psychiatric symptoms, which result from basal ganglia dysfunction but not specifically originating from the substantia nigra.

Question 79: What is the function of the tube shown below?

A. Barium enema
B. Soap water enema
C. Nasogastric feeding
D. Gastric lavage (Correct Answer)

Explanation: ***Gastric lavage*** - The pictured device is a historical form of a **stomach pump**, featuring a funnel, tubing, and a rubber bulb, consistent with instruments used for **gastric lavage**. - **Gastric lavage** involves flushing the stomach with fluid and then suctioning it out to remove ingested toxins or substances, often performed in cases of poisoning or overdose. *Barium enema* - A barium enema involves introducing a **contrast agent (barium sulfate)** into the colon via the rectum, not the stomach, for radiographic imaging of the lower gastrointestinal tract. - The device used for a barium enema is typically a bag or container for the barium mixture connected to a rectal tube, which is different from the pictured instrument. *Soap water enema* - A soap water enema is administered rectally to stimulate bowel movements, primarily to relieve **constipation** or to cleanse the colon before medical procedures. - While it involves fluid administration, the device used is usually a more simple enema bag and rectal tube, not this specialized stomach pump. *Nasogastric feeding* - **Nasogastric feeding** involves delivering nutritional formulas directly into the stomach (or small intestine) through a tube inserted via the nose. - The device pictured is not a modern nasogastric feeding tube or its delivery system; these typically involve smaller bore tubes and often use gravity or pumps for continuous administration.

Question 80: A 40-year-old farmer tried committing suicide by consuming two Sulphas (aluminium phosphide) tablets. On admission pulse is 110 bpm with BP of 80 / 60 mm Hg and GCS of 7 / 15 . SpO2 in room air is 80 %. ECG was performed. All are true about this poisoning except:

A. Emergent gastric lavage (Correct Answer)
B. Sodium bicarbonate
C. Toxic agent is phosphine
D. ECG in lead II shows sinus tachycardia and ST segment depression

Explanation: ***Emergent gastric lavage*** - **Gastric lavage is contraindicated** in aluminum phosphide poisoning due to the risk of **phosphine gas release** upon contact with stomach acid, which can exacerbate lung injury or expose healthcare workers. - The use of **emetics** or **charcoal** is also generally not recommended for the same reasons. *Sodium bicarbonate* - **Sodium bicarbonate is indicated** in aluminum phosphide poisoning to help neutralize gastric acid, which reduces the release of toxic phosphine gas. - It also aids in managing metabolic acidosis, a common complication of severe poisoning. *Toxic agent is phosphine* - When **aluminum phosphide** reacts with **gastric acid**, it releases the highly toxic gas **phosphine (PH3)**, which is responsible for the systemic effects of the poisoning. - Phosphine gas causes **cellular dysfunction** by inhibiting cytochrome c oxidase, leading to **multiorgan failure**. *ECG in lead II shows sinus tachycardia and ST segment depression* - The provided ECG image indeed shows evidence of **sinus tachycardia** (increased heart rate) and **ST segment depression**, which are common findings in aluminum phosphide poisoning. - These ECG changes reflect **cardiac toxicity**, including myocardial injury and ischemia, due to the metabolic disturbances and direct cellular damage caused by phosphine.

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