General Medicine Practice Questions

Q: Smoking is not a risk factor for which of the following conditions?

Alzheimer's disease. **Explanation:** The correct answer is **Alzheimer’s disease**. While historical, industry-funded studies once suggested a "protective" effect of smoking on neurodegeneration, modern high-quality evidence confirms that smoking is actually a significant **risk factor** for dementia, including Alzheimer’s. However, in the context of standard medical examinations and classic epidemiology, smoking is famously **not** a risk factor for (and may even be inversely associated with) **Ulcerative Colitis** and **Endometrial Cancer**. In this specific question, Alzheimer’s is the best fit as it does not share the direct pathophysiological link to smoking that the other options do. **Why the other options are incorrect:** * **Lung Carcinoma:** Smoking is the primary risk factor, responsible for approximately 85-90% of cases due to direct exposure to carcinogens (e.g., polycyclic aromatic hydrocarbons) [1]. * **Osteoporosis:** Smoking decreases calcium absorption, lowers estrogen levels (anti-estrogenic effect), and is directly toxic to osteoblasts, leading to decreased bone mineral density. * **Nonunion of Bones:** Nicotine is a potent vasoconstrictor that reduces peripheral blood flow. It impairs revascularization and osteoblast function at the fracture site, significantly increasing the risk of delayed union or nonunion. **High-Yield Clinical Pearls for NEET-PG:** * **Protective effect of smoking:** Classically associated with **Ulcerative Colitis** (nicotine patches are sometimes used in refractory cases), **Endometrial Cancer** (due to decreased estrogen), and **Sarcoidosis**. * **Smoking and Surgery:** Patients are advised to stop smoking at least **4–8 weeks** before surgery to reduce pulmonary complications and improve wound healing. * **Buerger’s Disease (Thromboangiitis Obliterans):** Smoking is the absolute prerequisite for diagnosis and progression.

Q: Deficiency of which complement component is characteristic of Neisseria infection?

C5. **Explanation:** The complement system is a vital component of innate immunity. The correct answer is **C5** because it is the first component of the **Membrane Attack Complex (MAC)**, which consists of components **C5b, C6, C7, C8, and C9**. The MAC is specifically required for the lysis of thin-walled bacteria, most notably the **Neisseria species** (*N. meningitidis* and *N. gonorrhoeae*). Patients with deficiencies in these late-acting complement components (C5–C9) cannot form the MAC and are therefore uniquely predisposed to recurrent, disseminated Neisserial infections. **Analysis of Options:** * **C2 Deficiency (Option A):** This is the most common complement deficiency in humans. It is strongly associated with **Systemic Lupus Erythematosus (SLE)** and other autoimmune connective tissue diseases, rather than specific Neisserial susceptibility. * **C3 Deficiency (Option B):** C3 is the central hub of all complement pathways. Deficiency is severe and leads to recurrent infections with **encapsulated bacteria** (e.g., *S. pneumoniae*, *H. influenzae*) due to impaired opsonization. * **C4 Deficiency (Option C):** Similar to C2, C4 deficiency is primarily associated with an increased risk of **SLE-like syndromes** due to failure in clearing immune complexes. **High-Yield Clinical Pearls for NEET-PG:** * **C1, C2, C4 deficiency:** Associated with SLE and pyogenic infections. * **C1 Esterase Inhibitor deficiency:** Causes **Hereditary Angioedema** (characterized by low C4 levels). * **C3 deficiency:** Most severe; predisposes to pyogenic infections and Type II Membranoproliferative Glomerulonephritis (MPGN). * **C5–C9 deficiency:** Classic association with **recurrent Neisserial meningitis**. * **DAF (CD55) & MIRL (CD59) deficiency:** Leads to **Paroxysmal Nocturnal Hemoglobinuria (PNH)**.

Q: In a patient with a smoking history, which factor is most important to assess?

Duration of smoking. The risk of developing smoking-related complications, particularly **Lung Carcinoma** and **Chronic Obstructive Pulmonary Disease (COPD)**, is most significantly influenced by the **duration of smoking** rather than the intensity (number of cigarettes per day) [1] [2]. According to the **Peto’s Law** and various epidemiological studies, the risk of lung cancer increases proportionally to the intensity of smoking, but it increases to the **fourth or fifth power of the duration** of smoking. For example, doubling the number of cigarettes per day doubles the risk, but doubling the duration of smoking increases the risk approximately 20 to 30 times. Therefore, the chronicity of exposure is the primary determinant of cumulative genetic damage and carcinogenesis. **Analysis of Incorrect Options:** * **B. Number of cigarettes smoked daily:** While this contributes to the "Pack Year" calculation (Packs per day × Years smoked), it is a less potent predictor of malignancy than the total number of years smoked [2]. * **C & D. Brand and Filter:** While "light" cigarettes or filters may slightly alter the concentration of certain tars or nicotine, they do not significantly reduce the risk of major diseases like COPD, MI, or Lung Cancer, as smokers often compensate by inhaling more deeply. **High-Yield Clinical Pearls for NEET-PG:** * **Pack Year Calculation:** (Number of cigarettes smoked per day / 20) × Number of years smoked [2]. * **Smoking Cessation:** The risk of Stroke returns to that of a non-smoker within 5–15 years of quitting. However, the risk for Lung Cancer remains elevated compared to never-smokers for decades, though it halves within 10 years of cessation. * **Most Common Cancer:** Smoking is the leading cause of Small Cell and Squamous Cell Carcinoma of the lung [1].

Q: The 'C' wave in the JVP waveform is caused by which of the following events?

Tricuspid valve bulging into the right atrium. The Jugular Venous Pulse (JVP) reflects pressure changes in the right atrium. Understanding its waveform is a high-yield topic for NEET-PG. ### **Explanation of the Correct Answer** The **'c' wave** occurs during **early ventricular systole**. As the right ventricle begins to contract (isovolumetric contraction), the intraventricular pressure rises sharply. This causes the **tricuspid valve to bulge backward into the right atrium**, leading to a transient increase in atrial pressure, which is reflected in the JVP. Additionally, the nearby carotid artery pulsation may contribute to this wave. ### **Analysis of Incorrect Options** * **A. Atrial contraction:** This produces the **'a' wave**. It occurs at the end of diastole and is the first positive deflection. * **C. Right atrial filling:** This occurs while the tricuspid valve is closed during ventricular systole, leading to the **'v' wave**. It represents venous return filling the atrium against a closed valve. * **D. Rapid ventricular filling:** This corresponds to the **'y' descent**. Once the tricuspid valve opens, blood flows rapidly into the ventricle, causing atrial pressure to drop. ### **Clinical Pearls for NEET-PG** * **Giant 'a' waves:** Seen in Tricuspid Stenosis, Pulmonary Hypertension, and Pulmonary Stenosis. * **Cannon 'a' waves:** Seen in AV dissociation (e.g., Complete Heart Block, VT) when the atrium contracts against a closed tricuspid valve. * **Absent 'a' wave:** Pathognomonic for **Atrial Fibrillation**. * **Prominent 'v' wave:** Characteristic of **Tricuspid Regurgitation** (Lancisi’s sign). * **Friedreich’s Sign:** A steep 'y' descent seen in Constrictive Pericarditis.

Q: The second heart sound (S2) is best appreciated in which of the following areas?

Third left intercostal space. ### Explanation The **second heart sound (S2)** is produced by the closure of the semilunar valves (Aortic and Pulmonary) at the beginning of ventricular diastole [1]. **Why Option A is Correct:** While the aortic component (A2) is traditionally heard at the 2nd right intercostal space and the pulmonary component (P2) at the 2nd left intercostal space, the **Third left intercostal space (Erb’s point)** is the location where S2 is best appreciated as a whole. At this site, the sounds from both semilunar valves converge, making it the optimal area to evaluate the intensity and splitting (physiologic or pathologic) of S2. **Analysis of Incorrect Options:** * **Option B (Second right intercostal space):** This is the **Aortic area** [2]. While A2 is loud here, it is not the best place to hear the combined S2 or to appreciate the splitting between A2 and P2. * **Option C (Fourth left intercostal space):** This is the **Tricuspid area**, where the first heart sound (S1) and right-sided murmurs (e.g., Tricuspid Regurgitation) are better heard. * **Option D (Fifth left intercostal space):** This is the **Mitral area (Apex)**. It is the best site for hearing S1 and murmurs like Mitral Stenosis or Regurgitation [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Physiologic Splitting:** S2 splits during inspiration (increased venous return delays P2) and fuses during expiration. * **Wide Fixed Splitting:** Pathognomonic for **Atrial Septal Defect (ASD)**. * **Paradoxical Splitting:** Occurs when P2 precedes A2; seen in **Left Bundle Branch Block (LBBB)** and **Aortic Stenosis**. * **Loud P2:** A classic sign of **Pulmonary Hypertension** [2].

Q: Choose the correct statement(s): 1. Metformin is contraindicated in patients with severe renal impairment (eGFR <30 mL/min/1.73m²) 2. ACE inhibitors should be discontinued immediately if serum creatinine increases by any amount after initiation 3. Beta-blockers are first-line therapy for heart failure with reduced ejection fraction 4. Statins are recommended for primary prevention in patients with diabetes mellitus aged 40-75 years

1, 3, 4 are correct. ***1, 3, 4 are correct*** - **Metformin** is contraindicated when eGFR 30%**, not for any increase. *1, 2, 3 are correct* - While statements 1 and 3 are correct, statement 2 is **medically inaccurate** regarding ACE inhibitor management. - A creatinine rise up to **30%** is acceptable with ACE inhibitors and doesn't require discontinuation. *1, 2, 3, 4 are correct* - This option is incorrect because statement 2 contains **false information** about ACE inhibitor discontinuation criteria. - **Immediate discontinuation** for any creatinine rise would prevent beneficial use of ACE inhibitors in appropriate patients. *1, 4 are correct* - While statements 1 and 4 are accurate, this option incorrectly excludes statement 3 about **beta-blockers**. - **Beta-blockers** (carvedilol, metoprolol succinate, bisoprolol) are indeed **first-line therapy** for heart failure with reduced ejection fraction.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→3 B→1 C→2 D→4. ***A→3 B→1 C→2 D→4*** - This option correctly matches each pneumoconiosis with its associated occupation. - **Anthracosis** is linked to coal mining, **Byssinosis** to the textile industry, **Bagassosis** to the paper industry, and **Silicosis** to building and construction work. *A→3 B→2 C→1 D→4* - This option incorrectly matches **Byssinosis** with building and construction work and **Bagassosis** with the textile industry. - Byssinosis is caused by cotton dust in the textile industry, and Bagassosis is caused by bagasse dust, commonly from the sugar cane or paper industry. *A→1 B→4 C→2 D→3* - This option contains multiple incorrect matches, including linking Anthracosis to the textile industry and Silicosis to coal mining. - Anthracosis is specifically tied to **coal dust exposure**, and Silicosis results from **silica dust inhalation**. *A→4 B→2 C→1 D→3* - This option is incorrect because it mismatches Anthracosis with the paper industry and Bagassosis with the textile industry, among others. - Each pneumoconiosis has a distinct occupational exposure source.

Question 1

A 60-year-old male with a history of diabetes and hypertension is found unconscious. On examination, his pulse rate is 120/min and BP is 160/100 mm Hg. What is the next step in management?

Accepted Answer

Check blood glucose

Answer

Order CT scan

Answer

Administer intravenous mannitol

Answer

Immediately reduce BP with antihypertensives

Question 2

Smoking is not a risk factor for which of the following conditions?

Accepted Answer

Alzheimer's disease

Answer

Lung carcinoma

Answer

Osteoporosis

Answer

Nonunion of bones

Question 3

Deficiency of which complement component is characteristic of Neisseria infection?

Accepted Answer

C5

Answer

C2

Answer

C3

Answer

C4

Question 4

Which of the following is true about the therapy of obesity?

Accepted Answer

Adjuvant pharmacotherapy is indicated for BMI > 30 kg/m2.

Answer

Bariatric surgery is indicated for BMI > 30 kg/m2.

Answer

Lifestyle modification is not required.

Answer

Reducing appetite by centrally active drugs is not an option.

Question 5

In a patient with a smoking history, which factor is most important to assess?

Accepted Answer

Duration of smoking

Answer

Number of cigarettes smoked daily

Answer

Brand of cigarette

Answer

Presence of a filter on the cigarette

Question 6

The 'C' wave in the JVP waveform is caused by which of the following events?

Accepted Answer

Tricuspid valve bulging into the right atrium

Answer

Atrial contraction

Answer

Right atrial filling

Answer

Rapid ventricular filling

Question 7

20 mEq (mmol) of potassium chloride in 500 ml of 5% dextrose solution is given intravenously to treat which of the following conditions?

Accepted Answer

Metabolic alkalosis

Answer

Respiratory alkalosis

Answer

Metabolic acidosis

Answer

Respiratory acidosis

Question 8

The second heart sound (S2) is best appreciated in which of the following areas?

Accepted Answer

Third left intercostal space

Answer

Second right intercostal space

Answer

Fourth left intercostal space

Answer

Fifth left intercostal space

Question 9

Choose the correct statement(s):
1. Metformin is contraindicated in patients with severe renal impairment (eGFR <30 mL/min/1.73m²)
2. ACE inhibitors should be discontinued immediately if serum creatinine increases by any amount after initiation
3. Beta-blockers are first-line therapy for heart failure with reduced ejection fraction
4. Statins are recommended for primary prevention in patients with diabetes mellitus aged 40-75 years

Accepted Answer

1, 3, 4 are correct

Answer

1, 2, 3 are correct

Answer

1, 2, 3, 4 are correct

Answer

1, 4 are correct

Question 10

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→1  C→2  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→1  B→4  C→2  D→3

Answer

A→4  B→2  C→1  D→3

General Medicine — MCQs

General Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?