General Medicine Practice Questions

Q: A patient complained of gradual diminution of vision. On examination, the patient had dry eyes and a rough corneal surface. What deficiency is most likely causing these manifestations?

Vitamin A. ***Vitamin A*** - **Vitamin A deficiency** is a common cause of **xerophthalmia**, characterized by **dry eyes** (**xerosis conjunctivae**) and roughening of the **cornea** due to impaired mucin production [1]. In vitamin A deficiency, mucus-secreting cells are replaced by keratin-producing cells [2]. - Progression of ocular epithelial keratinization can lead to **Bitot's spots**, corneal ulceration, and ultimately **blindness** [1], [2]. *Iron* - **Iron deficiency** primarily leads to **iron-deficiency anemia**, causing fatigue, pallor, and weakness, but not directly ocular manifestations like dry eyes or rough cornea. - While severe anemia can cause some visual disturbances, it does not typically present with the specific **xerophthalmic** changes seen here. *Protein* - **Protein deficiency** can lead to conditions like **kwashiorkor** (edema, muscle wasting) or **marasmus** (severe wasting), which broadly impair health and immunity. - However, it does not directly cause the specific ocular signs of **dryness** and **corneal roughening** as a primary deficiency, though it can exacerbate other nutritional deficiencies. *Niacin* - **Niacin (Vitamin B3) deficiency** causes **pellagra**, characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**. - Ocular symptoms are not a common or primary feature of niacin deficiency; it does not cause **dry eyes** or **corneal roughening**.

Q: Most common cause of erectile dysfunction in men under 40:

Drug induced. ***Drug induced*** - In men under 40, **medication side effects** are a significant and often overlooked cause of erectile dysfunction [4]. - Common culprits include **antidepressants** (especially SSRIs), **antihypertensives** (like beta-blockers and thiazide diuretics), and some **antihistamines** [2]. *Vascular* - While vascular issues are the **most common cause overall** in older men, they are less prevalent in younger men unless associated with severe underlying conditions like **uncontrolled hypertension** or **dyslipidemia** [2]. - **Atherosclerosis** and reduced blood flow to the penis are the primary mechanisms, which typically manifest later in life [2]. *Diabetes* - **Diabetes** can cause erectile dysfunction through **peripheral neuropathy** and **vascular damage**, leading to impaired nerve function and blood flow [3]. - Although it can occur at any age, its prevalence as a cause of ED generally **increases with the duration and poor control** of the disease, making it less likely to be the *most common* cause in men under 40. *Psychological* - **Psychological factors** such as stress, anxiety, depression, and relationship problems are **very common** contributors to erectile dysfunction in young men [1]. - However, direct **drug-induced ED** is often a primary or exacerbating factor that should be carefully considered, especially given the widespread use of various medications in this age group [2].

Q: Least common association with Morbid Obesity is?

Rheumatoid Arthritis. Rheumatoid Arthritis - While obesity can exacerbate symptoms and complicate management of rheumatoid arthritis (RA), it is not a direct cause or a commonly associated comorbidity. [1] - The pathogenesis of RA is primarily autoimmune, distinct from metabolic factors linked to obesity. *Essential Hypertension* - Obesity is a major risk factor for developing essential hypertension, due to increased blood volume, sympathetic nervous system activity, and insulin resistance. - The prevalence of hypertension rises significantly with increasing body mass index (BMI). [2] *Large bowel cancers* - Obesity is a well-established risk factor for several types of cancer, including colorectal cancer (large bowel cancer), due to chronic inflammation, altered hormone levels, and insulin resistance. - Studies show a clear dose-response relationship between BMI and colorectal cancer risk. *Diabetes Mellitus type II* - Type 2 Diabetes Mellitus is strongly and causally linked to obesity, with insulin resistance being a direct consequence of excess adipose tissue. [3] - Most patients with Type 2 Diabetes are overweight or obese, highlighting this highly common association.

Q: Most appropriate first-line antihypertensive medication for a 45-year-old diabetic patient with no contraindications is:

Lisinopril for hypertension. ***Lisinopril for hypertension*** - **ACE inhibitors** (like lisinopril) are generally recommended as **first-line antihypertensive agents** in diabetic patients due to their **renoprotective effects** and ability to reduce cardiovascular risk [1]. - They *slow the progression of diabetic nephropathy* by reducing intraglomerular pressure and proteinuria [1]. *Metformin for type 2 diabetes mellitus* - While metformin is the **first-line medication for type 2 diabetes**, the question specifically asks for an **antihypertensive medication** [2]. - Metformin's primary role is and *glucose control*, not blood pressure management [2]. *Atorvastatin for hyperlipidemia* - **Statins** like atorvastatin are crucial for **lipid management** in diabetic patients to reduce cardiovascular risk [3]. - However, they do not *lower blood pressure* and therefore are not an *antihypertensive medication*. *Aspirin for cardiovascular protection* - **Aspirin** is used for **cardiovascular protection** in diabetic patients with increased risk, but it is not an *antihypertensive medication*. - Its mechanism involves *antiplatelet effects*, not blood pressure reduction.

Q: Obesity predisposes to all, except ?

Peptic ulcer disease. ***Peptic ulcer disease*** - **Obesity** is generally **not considered a direct risk factor** for peptic ulcer disease; instead, factors like *H. pylori* infection and NSAID use are primary causes. - While comorbidities associated with obesity might indirectly influence gastric health, obesity itself doesn't directly predispose to ulcer formation. *Diabetes* - **Obesity**, particularly **abdominal obesity**, greatly increases the risk of **insulin resistance** and **Type 2 Diabetes Mellitus**. - Excess adipose tissue contributes to systemic inflammation and alters glucose metabolism. *Breast cancer* - **Obesity** is a significant risk factor for **postmenopausal breast cancer** due to increased estrogen production in adipose tissue. - It also promotes chronic inflammation, which can contribute to cancer development and progression. *Colon cancer* - **Obesity** is linked to an increased risk of **colorectal cancer** due to associated **insulin resistance**, chronic inflammation, and altered hormone levels. - These factors can stimulate cell proliferation and inhibit apoptosis in the colon.

Q: All of the following are causes of Rhabdomyolysis, Except:

Hyperphosphatemia. ***Hyperphosphatemia*** - While **hyperphosphatemia** is a common **consequence** of rhabdomyolysis due to the release of intracellular phosphate from damaged muscle cells, it is not a **cause** of rhabdomyolysis itself. - It develops **after** muscle breakdown has already occurred, often contributing to acute kidney injury. *Hypokalemia* - **Severe hypokalemia** can lead to muscle weakness, paralysis, and in some cases, **rhabdomyolysis** due to altered membrane excitability and impaired muscle function. - This can occur through direct muscle cell damage or by making muscles more susceptible to injury from activity. *Crush injury* - **Crush injuries** directly damage muscle tissue through mechanical force, leading to widespread cell lysis and the release of intracellular contents. - This is a well-established and significant cause of **traumatic rhabdomyolysis**. *Cocaine Intoxication* - **Cocaine intoxication** can cause rhabdomyolysis through multiple mechanisms, including **hyperthermia**, **vasoconstriction** leading to muscle ischemia, and direct **myotoxicity**. - The elevated body temperature and increased muscle activity associated with cocaine use contribute to muscle breakdown.

Q: Clinical thermometers typically measure a range from

95 to 109degF. ***95 to 109degF*** - Clinical thermometers are designed to measure the range of human body temperatures, which typically spans from **hypothermia** to severe fever. - This specific range of **95°F to 109°F** (approximately 35°C to 42.8°C) covers the critical temperatures for accurate diagnosis and monitoring of most common febrile and hypothermic states. *94 to 108degF* - This range is slightly off, as the lower limit of measurement for human body temperature typically starts closer to **95°F** for clinical accuracy. - While it covers the normal and some febrile states, it might miss some severe **hyperthermic** conditions that can push temperatures up to 109°F. *95 to 104degF* - This range is too narrow and would not be sufficient for a clinical thermometer. It would fail to accurately measure **high fevers** (above 104°F). - Many serious medical conditions involve temperatures exceeding **104°F**, making this range impractical for comprehensive clinical use. *95 to 108degF* - While this range is largely adequate for most routine uses, it still falls short of capturing the most extreme but clinically relevant high temperatures. - In certain severe medical emergencies like **heat stroke** or critical infections, body temperatures can reach **109°F**, which this range would not cover.

Q: Mrs. Katson, a 64-year-old obese woman with bilateral knee osteoarthritis, describes pain on most days and limiting pain at least 2 days per week. She has tried activity modification (walking less) without success. All of the following therapies have been shown to be efficacious EXCEPT:

Glucosamine-chondroitin. ***Glucosamine-chondroitin*** - While widely used and marketed for osteoarthritis, numerous **large, well-designed clinical trials** have consistently shown that **glucosamine-chondroitin supplements** are **not more effective than placebo** in alleviating pain or improving function in osteoarthritis. - The American College of Rheumatology (ACR) and other major medical organizations **do not recommend** its use due to a lack of evidence of efficacy. *Glucocorticoid steroid intra-articular injections* - **Intra-articular corticosteroid injections** provide **short-term pain relief** [1] and reduce inflammation in patients with osteoarthritis, especially during flares. - They are a commonly used and effective treatment for **symptomatic knee osteoarthritis** [1], although repeated injections have potential risks and may not alter long-term disease progression. *Acetaminophen* - **Acetaminophen (paracetamol)** is often recommended as a **first-line oral analgesic** for mild to moderate pain in osteoarthritis due to its relatively favorable side effect profile compared to NSAIDs for long-term use. - It works by **inhibiting prostaglandin synthesis** primarily in the central nervous system, reducing pain perception. *Total joint arthroplasty* - **Total joint arthroplasty (TJA)**, particularly **total knee replacement**, is a highly effective surgical treatment for patients with **severe, end-stage osteoarthritis** [1] who have failed conservative therapies. - It significantly **reduces pain and improves functional outcomes** [1] and quality of life for the vast majority of patients.

Q: Patient with severe acidosis is treated with

i.v. NaHCO3. ***i.v. NaHCO3*** - **Intravenous sodium bicarbonate (NaHCO3)** is the primary treatment for severe metabolic acidosis to directly correct the acid-base imbalance by providing bicarbonate ions [3]. - It works to **neutralize excess acid** in the bloodstream, raising the pH [4]. *Dextrose* - **Dextrose** (glucose) is used to provide calories and prevent hypoglycemia, but it does not directly treat acidosis [1]. - While sometimes given in critically ill patients, it does not have an immediate or direct effect on **acid-base balance** [2]. *Ringers lactate* - **Ringer's lactate solution** contains lactate, which is metabolized to bicarbonate in the liver; however, in severe acidosis, particularly **lactic acidosis**, the liver's ability to metabolize lactate might be impaired. - Although it contains some electrolytes and can help with volume expansion, its bicarbonate-generating effect is slower and less reliable than direct bicarbonate administration in **severe acidosis**. *None of the options* - This option is incorrect because **i.v. NaHCO3** is a well-established and effective treatment for severe acidosis.

Q: Morbid obesity is defined if BMI is greater than:

40. ***40*** - **Morbid obesity** is defined as a Body Mass Index (BMI) of **40 or higher**, or a BMI of 35 or higher with significant obesity-related health conditions. - This level of obesity is associated with a significantly increased risk of severe health complications and reduced life expectancy. *25* - A BMI of **25 or greater** is considered **overweight**, not morbidly obese [1]. - Normal weight is classified as a BMI between 18.5 and 24.9 [1]. *30* - A BMI of **30 or greater** is classified as **obese (Class I)**, but not yet morbidly obese. - Morbid obesity (Class III) starts at a BMI of 40. *18.5* - A BMI **below 18.5** is generally classified as **underweight** [1]. - This range indicates insufficient body fat and can also be associated with health risks.

Question 1

A patient complained of gradual diminution of vision. On examination, the patient had dry eyes and a rough corneal surface. What deficiency is most likely causing these manifestations?

Accepted Answer

Vitamin A

Answer

Iron

Answer

Protein

Answer

Niacin

Question 2

Most common cause of erectile dysfunction in men under 40:

Accepted Answer

Drug induced

Answer

Vascular

Answer

Diabetes

Answer

Psychological

Question 3

Least common association with Morbid Obesity is?

Accepted Answer

Rheumatoid Arthritis

Answer

Essential Hypertension

Answer

Large bowel cancers

Answer

Diabetes Mellitus type II

Question 4

Most appropriate first-line antihypertensive medication for a 45-year-old diabetic patient with no contraindications is:

Accepted Answer

Lisinopril for hypertension

Answer

Metformin for type 2 diabetes mellitus

Answer

Atorvastatin for hyperlipidemia

Answer

Aspirin for cardiovascular protection

Question 5

Obesity predisposes to all, except ?

Accepted Answer

Peptic ulcer disease

Answer

Diabetes

Answer

Breast cancer

Answer

Colon cancer

Question 6

All of the following are causes of Rhabdomyolysis, Except:

Accepted Answer

Hyperphosphatemia

Answer

Hypokalemia

Answer

Crush injury

Answer

Cocaine Intoxication

Question 7

Clinical thermometers typically measure a range from

Accepted Answer

95 to 109degF

Answer

94 to 108degF

Answer

95 to 104degF

Answer

95 to 108degF

Question 8

Mrs. Katson, a 64-year-old obese woman with bilateral knee osteoarthritis, describes pain on most days and limiting pain at least 2 days per week. She has tried activity modification (walking less) without success. All of the following therapies have been shown to be efficacious EXCEPT:

Accepted Answer

Glucosamine-chondroitin

Answer

Glucocorticoid steroid intra-articular injections

Answer

Acetaminophen

Answer

Total joint arthroplasty

Question 9

Patient with severe acidosis is treated with

Accepted Answer

i.v. NaHCO3

Answer

Dextrose

Answer

Ringers lactate

Answer

None of the options

Question 10

Morbid obesity is defined if BMI is greater than:

Accepted Answer

40

Answer

25

Answer

30

Answer

18.5

General Medicine — MCQs

General Medicine — MCQs

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