General Medicine — MCQs

General Medicine Indian Medical PG Practice Questions and MCQs

Question 91: In a man with a weight of 45 kg and a height of 1.5 m, what is the BMI?

A. 19
B. 20 (Correct Answer)
C. 21
D. 22

Explanation: ***20*** - The Body Mass Index (BMI) is calculated using the formula: **weight (kg) / [height (m)]²**. - In this case, 45 kg / (1.5 m * 1.5 m) = 45 / 2.25 = **20**. *19* - This answer would result from an incorrect calculation, possibly dividing 45 by 2.36 or using a slightly different height value. - A BMI of 19 would fall within the **normal weight range (18.5-24.9)** but is not the precise calculation for the given metrics. *21* - This answer would result if the denominator was smaller, for example, if the height squared was approximately 2.14, which is not 1.5 times 1.5. - A BMI of 21 still falls within the **normal weight range** but deviates from the accurate calculation. *22* - This answer indicates an error in the calculation, where a smaller denominator was used or a larger numerator was applied. - A BMI of 22 is within the **normal weight range** but does not match the provided weight and height.

Question 92: In which of the following conditions is serum alkaline phosphatase typically not elevated?

A. Primary biliary cirrhosis
B. Hyperparathyroidism
C. Hepatitis
D. Multiple myeloma (Correct Answer)

Explanation: In which of the following conditions is serum alkaline phosphatase typically not elevated? ***Hyperparathyroidism*** - In hyperparathyroidism, serum alkaline phosphatase levels can be normal or only mildly elevated, depending on bone metabolism changes. - This condition primarily elevates **serum calcium** and affects the bones rather than significantly affecting alkaline phosphatase levels [1]. *Primary biliary cirrhosis* - This condition is associated with **cholestasis**, leading to significantly elevated alkaline phosphatase levels due to liver involvement [1]. - Typically, patients also have other markers such as **AMA (anti-mitochondrial antibodies)** indicating liver-specific pathology. *Hepatitis* - Hepatitis can cause a rise in serum alkaline phosphatase levels, especially if there is associated cholestasis or liver injury. - It often accompanies elevated transaminases, indicating liver inflammation. *Multiple myeloma* - Multiple myeloma may show elevated alkaline phosphatase levels due to bone lesions and increased osteoclastic activity [2]. - The condition is primarily characterized by **monoclonal protein** detection and associated with various bone complications. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 392-393.

Question 93: What does a positive Prehn's sign indicate in the context of epididymitis?

A. Pain is referred to the groin in epididymitis
B. No change in pain with elevation of testis in epididymitis
C. Elevation of testis reduces pain in epididymitis. (Correct Answer)
D. Elevation of testis increases pain in epididymitis.

Explanation: ***Elevation of testis reduces pain in epididymitis.*** - A **positive Prehn's sign** is characterized by the **alleviation of testicular pain** when the scrotum and testis are elevated, which is typical for epididymitis. - This maneuver is thought to relieve pressure on the inflamed epididymis by reducing traction on the **spermatic cord**. *No change in pain with elevation of testis in epididymitis* - A situation where elevation causes no change in pain, particularly a complete absence of relief, would suggest a **negative Prehn's sign**. - This finding would point away from epididymitis and more towards conditions like **testicular torsion**, where pain is often constant regardless of position. *Pain is referred to the groin in epididymitis* - **Referred pain to the groin** can indeed occur in epididymitis due to shared nerve pathways, but it is not what is solely indicated by a positive Prehn's sign itself. - Prehn's sign specifically assesses the effect of **scrotal elevation** on testicular pain, not the location to which the pain radiates primarily. *Elevation of testis increases pain in epididymitis.* - An increase in pain upon testicular elevation is **not consistent** with epididymitis and a positive Prehn's sign. - This response would be more indicative of conditions where movement or position exacerbates the pathology, such as **testicular appendage torsion** or other acute scrotal issues.

Question 94: All the following conditions can lead to depapillation of the tongue except:

A. Pernicious anemia
B. Luetic glossitis
C. Amyloidosis (Correct Answer)
D. Plummer-Vinson syndrome

Explanation: ***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.

Question 95: The electrolyte abnormality seen in Ramesh, a 40-year-old patient presenting with polyuria, pain abdomen, nausea, vomiting, and altered sensorium, who was found to have bronchiogenic carcinoma, would be.

A. Hyperkalemia
B. Hypercalcemia (Correct Answer)
C. Hypocalcemia
D. Hypokalemia

Explanation: ***Hypercalcaemia*** - Bronchiogenic carcinoma can lead to **paraneoplastic hypercalcaemia**, often due to osteolytic metastasis or secretion of parathyroid hormone-related peptide (PTHrP) [2]. - Symptoms such as **polyuria, nausea, vomiting**, and **altered sensorium** are common manifestations of elevated calcium levels in the blood [1], [2]. *Hypocalcaemia* - Usually presents with **muscle cramps**, **tetany**, or **neuromuscular irritability**, unlike the symptoms described here. - Contrary to the patient's case, it does not typically result from bronchiogenic carcinoma. *Hyperkalemia* - Often causes **muscle weakness**, **arrhythmias**, and **ECG changes**, which are not aligned with the patient's presentation. - More commonly associated with conditions like **renal failure** or **adrenal insufficiency**, rather than bronchiogenic carcinoma. *Hypokalemia* - Typically results from conditions causing **excessive fluid loss**, such as **vomiting**, but leads to **muscle weakness** rather than altered sensorium [3]. - Rather unlikely in the context of a cancer patient showing signs that suggest an **elevated calcium level** instead.

Question 96: Which of the following conditions is associated with hypokalemia and metabolic acidosis?

A. Vomiting
B. Chronic kidney disease
C. Nasogastric suction
D. Diarrhea (Correct Answer)

Explanation: ***Diarrhea*** - Profuse **diarrhea** leads to a significant loss of **bicarbonate** from the gastrointestinal (GI) tract, resulting in **metabolic acidosis**. - The loss of potassium-rich fluid from the GI tract also directly causes **hypokalemia** [1]. *Vomiting* - **Vomiting** leads to the loss of gastric acid (HCl), causing **metabolic alkalosis**, not acidosis [1]. - While it can cause **hypokalemia** due to renal compensation and direct loss, the acid-base disturbance is opposite to what is asked [1]. *Chronic kidney disease* - **Chronic kidney disease** often leads to impaired acid excretion, causing **metabolic acidosis**, but typically causes **hyperkalemia** due to reduced potassium excretion, especially in advanced stages [2]. - In earlier stages, potassium levels might be normal, but hypokalemia is not a characteristic feature. *Nasogastric suction* - **Nasogastric suction** removes gastric acid and fluids, similar to vomiting, leading to a loss of hydrogen ions and chloride. - This typically results in **metabolic alkalosis** and can cause **hypokalemia**, which is inconsistent with metabolic acidosis [1].

Question 97: Treatment of choice in hypertension with diabetes mellitus is

A. Some beta blockers
B. Thiazide diuretics
C. ACE inhibitors (Correct Answer)
D. Calcium channel blockers

Explanation: ***ACE inhibitors*** - **ACE inhibitors** are considered first-line therapy for hypertension in patients with diabetes mellitus due to their **renoprotective effects**, which help prevent or slow the progression of diabetic nephropathy [1]. - They reduce **glomerular pressure** and proteinuria [1], which are crucial benefits in diabetic patients [2]. *Some beta blockers* - While beta blockers can lower blood pressure, some **non-selective beta blockers** can mask the symptoms of **hypoglycemia** and may worsen glycemic control in diabetic patients. - They are generally reserved for specific indications such as coexisting angina or heart failure, and preferred agents are those with **cardioselective** properties. *Thiazide diuretics* - **Thiazide diuretics** can increase blood glucose levels and may exacerbate **insulin resistance**, making them less ideal as a first-line treatment for hypertension in diabetic patients. - They can also worsen **dyslipidemia**, which is often a comorbidity for diabetic patients. *Calcium channel blockers* - **Calcium channel blockers** are effective in lowering blood pressure but do not offer the same **renoprotective benefits** as ACE inhibitors in diabetic patients. - They are often used as an alternative or add-on therapy if ACE inhibitors are not tolerated or insufficient [2].

Question 98: Which of the following is an early symptom of hypermagnesemia?

A. Arrhythmias
B. Diarrhea
C. Hypotension
D. Loss of deep tendon reflexes (DTR) (Correct Answer)

Explanation: Loss of deep tendon reflexes (DTR) - Loss of deep tendon reflexes (DTRs) is one of the earliest and most reliable signs of increasing magnesium toxicity, often occurring when serum magnesium levels are between 4-6 mEq/L. - This symptom reflects the neuromuscular blocking effects of magnesium, which reduces acetylcholine release at the neuromuscular junction [1]. *Hypotension* - Hypotension is a later and more severe symptom of hypermagnesemia, typically occurring at higher magnesium levels (e.g., above 6 mEq/L). - It results from the vasodilating effects of magnesium on smooth muscle, leading to decreased peripheral vascular resistance. *Diarrhea* - Diarrhea is actually a common side effect of oral magnesium supplementation, as magnesium acts as an osmotic laxative. - It is generally *not* an early symptom of systemic hypermagnesemia resulting from impaired excretion or excessive parenteral administration. *Arrhythmias* - Arrhythmias, particularly bradycardia and heart block, are significant and *late-stage* cardiac complications of severe hypermagnesemia (often above 8-10 mEq/L). - These are caused by magnesium's interference with myocardial conduction and are more dangerous than early DTR changes.

Question 99: A 70-year-old woman complains of leaking urine in small amounts, which occurs when laughing, coughing, bending, or exercising. Her five children are concerned about her urinary problems. Which is the most likely type of urinary incontinence?

A. Stress incontinence (Correct Answer)
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence

Explanation: ***Stress incontinence*** - This is characterized by the involuntary leakage of urine with activities that increase **intra-abdominal pressure**, such as **coughing, sneezing, laughing, bending, or exercising**. - It commonly results from **weakness of the pelvic floor muscles** or dysfunction of the urethral sphincter, often due to childbirth or aging. *Urge incontinence* - This involves a sudden, **intense urge to urinate** followed by involuntary loss of urine, often without any precipitating activity. - It is typically caused by **detrusor overactivity**, where the bladder muscles contract involuntarily. *Overflow incontinence* - This occurs when the bladder is **overfilled** and urine leaks out, often in small amounts, because the bladder cannot empty properly. [1] - It can be caused by **bladder outlet obstruction** (e.g., enlarged prostate in men) or impaired detrusor contractility (e.g., neurological conditions). [1] *Functional incontinence* - This refers to urine leakage that occurs because of **physical or cognitive impairments** that prevent a person from reaching the toilet in time. [1] - The urinary tract itself may be normal, but external factors limit effective toileting. [1]

Question 100: A patient after vomiting several times develops carpopedal spasms. The most appropriate treatment would be.

A. Intravenous injection of 20 ml 10% calcium gluconate solution (Correct Answer)
B. Intravenous infusion of isotonic saline
C. 5% CO2 inhalation
D. Oral ammonium chloride 1g four times a day

Explanation: **Intravenous injection of 20 ml 10% calcium gluconate solution** - Repeated vomiting leads to loss of **hydrochloric acid**, causing **metabolic alkalosis** [1] and subsequent **hypocalcemia**, which manifests as carpopedal spasms. - Administering **intravenous calcium gluconate** directly addresses the low ionized calcium responsible for the spasms. *Intravenous infusion of isotonic saline* - While fluid replacement might be necessary to correct dehydration, isotonic saline alone does not directly address the underlying **hypocalcemia** or metabolic alkalosis causing the spasms [1]. - It would not immediately relieve the **carpopedal spasms**. *5% CO2 inhalation* - Inhaling CO2 would increase blood pCO2, causing **respiratory acidosis**, which could theoretically counteract metabolic alkalosis to some extent [1]. - However, this is not the primary or most effective treatment for acute **hypocalcemic tetany** and does not directly provide calcium. *Oral ammonium chloride 1g four times a day* - Oral ammonium chloride works as an **acidifying agent**, which could help correct **metabolic alkalosis**. - However, it works too slowly to provide immediate relief for acute, symptomatic **carpopedal spasms** and does not directly treat the hypocalcemia.

Practice by Chapter

Approach to the Medical Patient

Practice Questions

Differential Diagnosis Development

Practice Questions

Rational Diagnostic Testing

Practice Questions

Medical Decision Making

Practice Questions

Cost-effective Care

Practice Questions

Patient-centered Communication

Practice Questions

Interprofessional Collaboration

Practice Questions

Systems-based Practice

Practice Questions

High-value Care

Practice Questions

Transitions of Care

Practice Questions

Chronic Disease Management

Practice Questions

Medical Uncertainty Management

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free