General Medicine Practice Questions

Q: A 69-year-old edentulous alcoholic male who lives alone is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 g/dL (normal 14-18 g/dL); no other hematologic abnormalities are noted. Therapy should consist of what?

Administration of vitamin C. The patient's presentation with **poor wound healing**, **ecchymoses**, **perifollicular hemorrhages**, and **splinter hemorrhages**, in an **edentulous alcoholic male** (indicating poor nutrition), are classic signs and symptoms of **scurvy** caused by **vitamin C deficiency** [1]. **Vitamin C (ascorbic acid)** is essential for **collagen synthesis** (wound healing, blood vessel integrity) and iron absorption, explaining the observed symptoms [1]. A dose of 250 mg vitamin C 3 times daily by mouth should saturate the tissues quickly [1].

Q: Which of the following is not a consequence of vitamin A deficiency?

Myopia. ***Myopia*** - **Myopia**, or nearsightedness, is primarily caused by an abnormally long eyeball or excessive curvature of the cornea, leading to distant objects appearing blurry. - It is a **refractive error** and is not directly linked to nutritional deficiencies like vitamin A deficiency. *Night blindness* - **Night blindness** (**nyctalopia**) is one of the earliest and most common symptoms of vitamin A deficiency, occurring because vitamin A is a crucial component of **rhodopsin**, a photopigment in the retina vital for low-light vision [1], [2]. - Impaired rhodopsin regeneration leads to difficulty seeing in dim light [2]. *Corneal dryness* - **Corneal dryness** (**xerophthalmia**) is a severe manifestation of vitamin A deficiency, resulting from the impaired differentiation of goblet cells and squamous metaplasia in the conjunctiva and cornea [1], [3]. - This leads to a lack of mucus production and tears, causing the cornea to dry out and become vulnerable to damage [1], [3]. *Bitot's spots* - **Bitot's spots** are foamy, triangular patches of keratinized epithelium on the conjunctiva, specifically on the temporal side, which are characteristic signs of **vitamin A deficiency** [3]. - These spots are a result of squamous metaplasia and keratinization due to the lack of vitamin A, which is essential for normal epithelial cell differentiation [3].

Q: Which of the following is NOT a cause of hypokalemia?

Tamoxifen therapy. ***Tamoxifen therapy*** - **Tamoxifen**, an estrogen receptor modulator, can cause electrolyte imbalances, but **hypokalemia is not a typical side effect**. - It is more commonly associated with an increased risk of **thromboembolic events** and **endometrial cancer**. *ACTH producing tumors* - **ACTH-producing tumors** lead to increased cortisol production (**Cushing's syndrome**), which can cause **mineralocorticoid effects** [1]. - This results in increased renal potassium excretion, leading to **hypokalemia** [1]. *Diabetic ketoacidosis* - In **diabetic ketoacidosis (DKA)**, potassium shifts from the intracellular to the extracellular space due to **acidosis** and **insulin deficiency**. - Despite elevated serum potassium initially, patients often have significant **total body potassium depletion** and are at risk for **severe hypokalemia** upon insulin and fluid administration. *Non-bilious vomiting* - **Non-bilious vomiting** leads to the loss of **gastric acid (HCl)** [1]. - This causes **metabolic alkalosis**, which promotes potassium shift into cells and increased renal excretion of potassium to conserve hydrogen ions, leading to **hypokalemia** [1].

Q: An elderly hypertensive patient has diabetes mellitus and bilateral renal artery stenosis. The best management is:

Verapamil. ***Verapamil*** - **Verapamil**, a **calcium channel blocker**, is a suitable choice for this patient as it effectively lowers blood pressure without adversely affecting renal function in the presence of **bilateral renal artery stenosis**. - It also does not worsen **diabetes mellitus** or interfere with glucose metabolism, making it a safer option for this specific patient profile. *Enalapril* - **Enalapril**, an **ACE inhibitor**, is contraindicated in patients with **bilateral renal artery stenosis** because it can severely impair renal function and lead to acute kidney injury by reducing glomerular filtration pressure [1]. - While generally good for hypertension and diabetes, the presence of **bilateral renal artery stenosis** overrides these benefits due to the high risk of renal compromise [1], [2]. *Beta blockers* - **Beta blockers** can be used in hypertension, but they can **mask symptoms of hypoglycemia** in diabetic patients and may negatively affect lipid profiles and glucose control. - While not strictly contraindicated by renal artery stenosis, their potential metabolic side effects in a diabetic patient make them less ideal than **calcium channel blockers**. *Thiazides* - **Thiazide diuretics** can cause **glucose intolerance** and worsen glycemic control in patients with diabetes, which is a significant concern for this patient. - Although effective for hypertension, their use in patients with **renal artery stenosis** can sometimes lead to reduced renal blood flow due to volume depletion, potentially compromising kidney function.

Q: An athlete presented with red-coloured urine after 2 days of a history of severe exercise. The most probable cause is?

Myoglobinuria. ***Myoglobinuria*** - Myoglobinuria is the most probable cause of red-colored urine following strenuous exercise, as **myoglobin** is released into the bloodstream from damaged muscle fibers and then excreted in the urine. - This condition is often associated with **rhabdomyolysis**, which can occur after intense physical exertion. *Hemoglobinuria* - Hemoglobinuria occurs due to hemolysis, often from **intravascular destruction of red blood cells**, not directly from muscle damage due to exercise [2]. - While strenuous exercise can sometimes cause minor hemolysis, it is less likely to be the primary cause of significant red urine compared to myoglobinuria. *Hemosiderinuria* - Hemosiderinuria is the presence of **hemosiderin** in the urine, which is a breakdown product of hemoglobin, observed in chronic hemolytic states. - It does not typically present as acute red-colored urine after exercise but rather reflects ongoing iron excretion and is identified microscopically. *Hematuria* - Hematuria involves the presence of **intact red blood cells** in the urine, usually indicating damage to the urinary tract (kidneys, bladder, etc.) [1]. - While exercise can occasionally lead to transient hematuria, the history of severe exercise and the typical presentation of rhabdomyolysis make myoglobinuria a more likely cause for the specific red-colored urine described [1].

Q: What is the BMI value that classifies obesity?

≥30. **≥30** - A **Body Mass Index (BMI)** of **30 kg/m² or greater** is the widely accepted classification for obesity in adults [1]. - This threshold is used globally by health organizations like the **World Health Organization (WHO)** to define and categorize obesity [1]. *≥20* - A BMI of 20 kg/m² typically falls within the **normal weight range** (18.5 to 24.9 kg/m²) [1]. - This value is significantly below the threshold for classifying obesity [2]. *≥40* - A BMI of **40 kg/m² or greater** is classified as **Class III obesity** (also known as severe or morbid obesity) [1]. - While it indicates obesity, it's a specific sub-classification and not the general threshold for obesity. *≥50* - A BMI of 50 kg/m² categorizes an individual into an even more severe subclass of **Class III obesity**. - It represents an extreme level of obesity, far exceeding the general threshold.

Q: What is the most common cause of restless leg syndrome?

Iron deficiency anemia. ***Iron deficiency anemia*** - **Iron deficiency** is a well-established and the most common reversible secondary cause of **restless leg syndrome (RLS)**, affecting dopamine synthesis and function in the brain [1]. - Correcting iron levels, often with oral iron supplements, can significantly improve RLS symptoms. *Chronic kidney disease* - While **chronic kidney disease (CKD)** is a known cause of secondary RLS, it is less common than iron deficiency anemia. [1] - RLS in CKD is often associated with **uremia** and electrolyte imbalances [1]. *Hyperthyroidism* - **Hyperthyroidism** is not typically associated with restless leg syndrome. - Symptoms of hyperthyroidism usually include **tremor**, anxiety, weight loss, and heat intolerance. *Peripheral neuropathy* - **Peripheral neuropathy** can cause leg discomfort and sensory symptoms, but these are generally described as burning, tingling, or numbness rather than the irresistible urge to move associated with RLS [1]. - While some neuropathies may coexist with RLS, it is not the most common direct cause of RLS itself [1].

Q: Hyperkalemia is due to all of the following except:

Alkalosis. ***Alkalosis*** - **Alkalosis** causes an **intracellular shift of potassium** in exchange for hydrogen ions [1], typically leading to **hypokalemia**, not hyperkalemia [1]. - This shift helps to buffer the alkaline state by moving hydrogen ions out of cells. *Acute renal failure* - In **acute renal failure**, the kidneys lose their ability to excrete potassium, leading to its accumulation in the blood. - This impaired **potassium excretion** is a common cause of **hyperkalemia** in these patients. *Addison's disease* - **Addison's disease** (primary adrenal insufficiency) results in decreased production of **aldosterone**, a hormone that promotes potassium excretion [1]. - Reduced **aldosterone** activity leads to reduced potassium secretion in the renal tubules, causing **hyperkalemia** [1]. *Excess hemolysis* - **Hemolysis** refers to the breakdown of red blood cells, which contain a high concentration of **intracellular potassium** [1]. - When red blood cells lyse, they release their intracellular potassium into the bloodstream, directly causing **hyperkalemia**.

Question 1

A 69-year-old edentulous alcoholic male who lives alone is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 g/dL (normal 14-18 g/dL); no other hematologic abnormalities are noted. Therapy should consist of what?

Accepted Answer

Administration of vitamin C

Answer

Administration of factor IX

Answer

Administration of folic acid

Answer

Administration of vitamin D

Question 2

Which of the following is not a consequence of vitamin A deficiency?

Accepted Answer

Myopia

Answer

Corneal dryness

Answer

Bitot's spots

Answer

Night blindness

Question 3

Which of the following is NOT a cause of hypokalemia?

Accepted Answer

Tamoxifen therapy

Answer

ACTH producing tumors

Answer

Diabetic ketoacidosis

Answer

Non-bilious vomiting

Question 4

An elderly hypertensive patient has diabetes mellitus and bilateral renal artery stenosis. The best management is:

Accepted Answer

Verapamil

Answer

Enalapril

Answer

Beta blockers

Answer

Thiazides

Question 5

An athlete presented with red-coloured urine after 2 days of a history of severe exercise. The most probable cause is?

Accepted Answer

Myoglobinuria

Answer

Hemoglobinuria

Answer

Hemosiderinuria

Answer

Hematuria

Question 6

What is the BMI value that classifies obesity?

Accepted Answer

≥30

Answer

≥20

Answer

≥40

Answer

≥50

Question 7

What is the most common cause of restless leg syndrome?

Accepted Answer

Iron deficiency anemia

Answer

Chronic kidney disease

Answer

Hyperthyroidism

Answer

Peripheral neuropathy

Question 8

Hyperkalemia is due to all of the following except:

Accepted Answer

Alkalosis

Answer

Addison's disease

Answer

Excess hemolysis

Answer

Acute renal failure

General Medicine — MCQs

General Medicine — MCQs

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