General Medicine Practice Questions

Q: Allergic rhinitis treatment include all except

Antibiotics. ***Antibiotics*** - Allergic rhinitis is an **inflammatory response to allergens**, not a bacterial infection. - Antibiotics are ineffective against allergic reactions and are associated with risks like **antibiotic resistance** and adverse drug reactions. *Corticosteroids* - **Intranasal corticosteroids** are a first-line treatment for allergic rhinitis due to their potent anti-inflammatory effects [1]. - They effectively reduce symptoms like **nasal congestion**, sneezing, itching, and rhinorrhea [1]. *Surgery* - In certain severe cases, surgery may be considered for allergic rhinitis, particularly to address **structural abnormalities** like nasal polyps or turbinate hypertrophy that contribute to symptoms. - Procedures like **turbinate reduction** can improve nasal airflow and symptom control. *Avoiding allergen* - **Allergen avoidance** is a fundamental and often primary strategy in managing allergic rhinitis. - Identifying and minimizing exposure to specific allergens (e.g., pollen, dust mites, pet dander) can significantly **prevent symptom exacerbations** [1].

Q: Hyperbaric Oxygen is not useful in

Vertigo. ***Vertigo*** - **Hyperbaric oxygen therapy (HBOT)** is not a recognized treatment for **isolated vertigo**. Vertigo is primarily a balance disorder often related to inner ear issues or central nervous system dysfunction, not typically amenable to increased oxygen delivery. - While HBOT has been explored for some forms of sudden sensorineural hearing loss, its direct application for general vertigo is not supported by current evidence. *CO poisoning* - HBOT is critical in treating **carbon monoxide (CO) poisoning** as it rapidly displaces CO from hemoglobin and myoglobin, reducing its toxic effects [2]. - It also enhances oxygen delivery to tissues, crucial for preventing neurological damage [1]. *Gas gangrene* - **Gas gangrene**, caused by **Clostridium perfringens**, is an anaerobic infection. HBOT significantly increases tissue oxygen levels, which is directly toxic to the bacteria and inhibits their growth. - It also helps in wound healing and reduces the systemic effects of the bacterial toxins. *Compartment syndrome* - HBOT can be beneficial in **compartment syndrome** by improving oxygenation to ischemic tissues and reducing inflammation and edema. - This can help to preserve muscle viability and reduce the need for fasciotomy, especially when surgical intervention is delayed or incomplete.

Q: Flapping tremors are seen in all EXCEPT:

Thyrotoxicosis. ***Thyrotoxicosis*** - **Thyrotoxicosis** is characterized by an **exaggerated physiological tremor**, which is typically fine and rapid, and differs from the slow, irregular flapping tremor (asterixis). - The tremor in thyrotoxicosis is primarily due to increased metabolic rate and enhanced sympathetic activity, not impaired motor control secondary to metabolic encephalopathy. *CO2 narcosis* - **CO2 narcosis**, a severe complication of hypercapnia, can lead to asterixis due to the depressive effects of high CO2 levels on the central nervous system. - The elevated **pCO2** results in cerebral vasodilation and increased intracranial pressure, contributing to impaired neurological function. *Hepatic encephalopathy* - **Hepatic encephalopathy** is a classic cause of **asterixis (flapping tremor)**, due to the liver's inability to detoxify ammonia and other neurotoxins. - These neurotoxins interfere with neurotransmission and neuronal activity, particularly in the motor cortex and basal ganglia. *Uremia* - **Uremia**, a manifestation of severe kidney failure, can cause **asterixis** due to the accumulation of uremic toxins that impair central nervous system function. - These toxins disrupt normal neuronal excitability and metabolism, leading to a variety of neurological symptoms.

Q: A 60-year-old female with diabetes presents with recurrent carbuncles on her neck and poor glycemic control. What is the best management?

Optimize glucose, start systemic abx. ***Optimize glucose, start systemic abx*** - **Poorly controlled diabetes** compromises the immune system and is a significant risk factor for recurrent **bacterial skin infections** like carbuncles [2], necessitating immediate glycemic optimization [1]. - **Carbuncles** are deeper, more extensive infections than furuncles [3], often requiring **systemic antibiotics** in addition to incision and drainage, especially in immunocompromised individuals [1]. *Immediate drainage w/o abx* - While **drainage** is a crucial step for carbuncles to remove pus and relieve pressure, it is insufficient alone for a patient with diabetes and recurrent infections [1]. - **Systemic antibiotics** are typically required to treat the extensive infection and prevent further spread or recurrence in immunocompromised patients [1]. *Topical abx, daily wound care* - **Topical antibiotics** are generally not effective for **carbuncles**, which are deep-seated infections extending into the subcutaneous tissue and often accompanied by systemic symptoms [3]. - While **daily wound care** is important, it cannot address the underlying systemic infection or the predisposing factor of poorly controlled diabetes. *Observation, follow-up* - **Observation** is an inappropriate management strategy for a diabetic patient with **recurrent carbuncles** and **poor glycemic control**. - Such a presentation indicates a severe, ongoing infection requiring prompt medical intervention to prevent complications like **sepsis** or spread of infection.

Q: A 35-year-old male with a history of chronic alcohol use is at risk for developing liver cirrhosis. What is the primary prevention strategy for liver cirrhosis?

Alcohol cessation programs. ***Alcohol cessation programs*** - **Abstinence from alcohol** is the most effective primary prevention strategy, as it directly addresses the cause of alcohol-related liver damage [1]. - Participating in **alcohol cessation programs** helps individuals stop drinking, thereby preventing the progression to cirrhosis [1]. *Liver function tests* - **Liver function tests (LFTs)** are diagnostic tools used to assess liver damage or dysfunction, not preventive measures [1]. - While LFTs can monitor liver health, they do not prevent the initial development of **cirrhosis** itself. *Treatment of cirrhosis* - This option refers to **tertiary prevention**, which involves managing an existing disease to prevent complications or slow its progression. - The question asks for **primary prevention**, which aims to prevent the disease from occurring in the first place. *Liver transplant* - A **liver transplant** is a treatment for end-stage liver disease, including severe cirrhosis, and is a last resort [2]. - This is a **tertiary prevention** or treatment strategy, not a primary prevention method to stop the onset of cirrhosis [2].

Q: A 45-year-old male presents with difficulty urinating and a weak stream. A digital rectal examination reveals an enlarged prostate. Which zone of the prostate is most likely involved?

Transitional zone. ***Transitional zone*** - **Benign prostatic hyperplasia (BPH)**, which commonly causes symptoms like difficulty urinating and weak stream [1], originates primarily in the **transitional zone**. - Enlargement of this zone compresses the **urethra**, leading to outflow obstruction symptoms. *Peripheral zone* - The **peripheral zone** is the most common site for **prostate cancer**, not typically BPH. - While a DRE can detect abnormalities in this zone, symptoms of urinary obstruction in this age group are less likely to stem primarily from isolated peripheral zone enlargement. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is rarely involved in BPH or carcinoma. - It is more resistant to hyperplasia compared to the transitional zone. *Anterior zone* - The **anterior zone** is largely glandular and is typically non-pathologic and minimally involved in BPH or prostate cancer. - It is composed mainly of fibromuscular tissue.

Q: During a routine examination, a patient is found to have a palpable spleen. Which condition is least likely to cause splenomegaly?

Sickle cell disease. Sickle cell disease - Sickle cell disease can lead to **splenic autoinfarction**, which results in a shrunken or non-palpable spleen due to repeated vaso-occlusive crises. - Unlike other conditions, it often features **functional asplenia**, making splenomegaly less common. *Infectious mononucleosis* - Typically causes **acute splenomegaly** due to viral infection, specifically from **Epstein-Barr virus**. - Patients often present with **lymphadenopathy** and significant fatigue, along with a palpable spleen. *Hemolytic anemia* - Can lead to splenomegaly due to increased **red blood cell destruction**, causing the spleen to enlarge as it filters out damaged cells [1][2]. - Conditions like **autoimmune hemolytic anemia** are particularly known for causing this enlargement. *Portal hypertension* - Causes **splenomegaly** due to increased pressure in the portal venous system, often resulting from liver disease [1]. - The spleen enlarges as it becomes congested, and is commonly palpable in these cases [1].

Q: A 19-year-old female with anorexia nervosa, a BMI of 14, presents with confusion, tachycardia, and hypotension. Laboratory results show decreased potassium, magnesium, and phosphate levels. What is the initial treatment for this patient?

Intravenous rehydration and electrolyte replacement. Intravenous rehydration and electrolyte replacement - This patient exhibits signs of **refeeding syndrome**, characterized by severe **electrolyte imbalances** (low potassium, magnesium, phosphate) and **cardiovascular instability** (tachycardia, hypotension), precipitated by aggressive refeeding in malnourished individuals. - Initial management prioritizes correcting these **life-threatening electrolyte derangements** and addressing **hemodynamic instability** [1] before gradual nutritional support to prevent further complications. *Nutritional rehabilitation* - While critical for long-term recovery in anorexia nervosa, immediate, aggressive nutritional rehabilitation without prior electrolyte correction can worsen **refeeding syndrome**, leading to further cardiac and neurologic decompensation [1]. - Nutritional support should be initiated **slowly and cautiously** after stabilizing the patient's acute medical status and correcting severe electrolyte abnormalities. *Cognitive Behavioral Therapy (CBT)* - **CBT is a cornerstone of long-term psychological treatment** for anorexia nervosa, addressing distorted thoughts and behaviors related to eating, weight, and body image [1]. - However, it is not an acute intervention for immediate medical stabilization in a patient presenting with life-threatening complications like **confusion, tachycardia, and severe electrolyte imbalances**. *Antidepressant medication* - **Antidepressants**, particularly SSRIs, can be part of the long-term management of anorexia nervosa, especially if comorbid depression or anxiety is present. - These medications are **not indicated for acute medical stabilization** in the context of confusion, hemodynamic instability, and severe electrolyte abnormalities, and their effects are not immediate.

Q: A 28-year-old male collapses after a marathon, presenting with confusion and seizures. Laboratory results indicate hyponatremia. What is the most likely diagnosis?

Exercise-associated hyponatremia. ***Exercise-associated hyponatremia*** - This condition occurs during or after prolonged physical exertion, like a marathon, and is characterized by a serum **sodium concentration below 135 mmol/L**. - The combination of **confusion and seizures** in a marathon runner with hyponatremia is a classic presentation of exercise-associated hyponatremia due to **excessive fluid consumption** and impaired renal water excretion [2]. *Excessive fluid intake* - While **excessive fluid intake** is a contributing factor to exercise-associated hyponatremia, it is not the diagnosis itself. - Hyponatremia leads to **cerebral edema**, causing neurological symptoms like confusion and seizures [3]. *Inappropriate fluid replacement strategy* - An **inappropriate fluid replacement strategy**, such as drinking too much hypotonic fluid, can certainly cause hyponatremia during prolonged exercise. - However, this option describes the **cause** of the hyponatremia rather than the clinical diagnosis. *Heat stroke with electrolyte imbalance* - **Heat stroke** is characterized by a core body temperature above 40°C with central nervous system dysfunction, but hyponatremia is not a primary diagnostic criterion [1]. - While **electrolyte imbalances** can occur in heat stroke, hyponatremia as the leading cause of such severe neurological symptoms is more suggestive of EAH.

Q: Which of the following conditions is least likely to cause impotence?

Congenital urethral malformation. ***Congenital urethral malformation*** - While often requiring surgical correction, **congenital urethral malformations** (e.g., hypospadias) primarily affect the **urinary stream** and **ejaculatory function**, rather than directly impacting erectile physiology [2]. - Many individuals with corrected or even uncorrected urethral malformations retain the capacity for **erection**. *Double penis (diphallia)* - This rare congenital condition involves the presence of two penises, which often have **structural abnormalities**, including **vascular** and **neural deficits**. - These associated defects commonly lead to **erectile dysfunction** due to impaired blood flow or nerve supply to one or both penile shafts. *Bilateral castration* - This procedure removes both testicles, leading to a profound and immediate drop in **testosterone levels** [1]. - **Testosterone** is crucial for libido, erectile function, and maintaining penile structure, making **impotence** a near-certain outcome [1]. *Penile amputation* - The surgical removal of the penis directly eliminates the organ necessary for **erection** and intercourse. - This results in a complete and irreversible **loss of erectile function** and sexual penetrative capacity.

Question 1

Allergic rhinitis treatment include all except

Accepted Answer

Antibiotics

Answer

Corticosteroids

Answer

Surgery

Answer

Avoiding allergen

Question 2

Hyperbaric Oxygen is not useful in

Accepted Answer

Vertigo

Answer

CO poisoning

Answer

Gas gangrene

Answer

Compartment syndrome

Question 3

Flapping tremors are seen in all EXCEPT:

Accepted Answer

Thyrotoxicosis

Answer

CO2 narcosis

Answer

Hepatic encephalopathy

Answer

Uremia

Question 4

A 60-year-old female with diabetes presents with recurrent carbuncles on her neck and poor glycemic control. What is the best management?

Accepted Answer

Optimize glucose, start systemic abx

Answer

Immediate drainage w/o abx

Answer

Topical abx, daily wound care

Answer

Observation, follow-up

Question 5

A 35-year-old male with a history of chronic alcohol use is at risk for developing liver cirrhosis. What is the primary prevention strategy for liver cirrhosis?

Accepted Answer

Alcohol cessation programs

Answer

Liver function tests

Answer

Treatment of cirrhosis

Answer

Liver transplant

Question 6

A 45-year-old male presents with difficulty urinating and a weak stream. A digital rectal examination reveals an enlarged prostate. Which zone of the prostate is most likely involved?

Accepted Answer

Transitional zone

Answer

Peripheral zone

Answer

Central zone

Answer

Anterior zone

Question 7

During a routine examination, a patient is found to have a palpable spleen. Which condition is least likely to cause splenomegaly?

Accepted Answer

Sickle cell disease

Answer

Portal hypertension

Answer

Infectious mononucleosis

Answer

Hemolytic anemia

Question 8

A 19-year-old female with anorexia nervosa, a BMI of 14, presents with confusion, tachycardia, and hypotension. Laboratory results show decreased potassium, magnesium, and phosphate levels. What is the initial treatment for this patient?

Accepted Answer

Intravenous rehydration and electrolyte replacement

Answer

Nutritional rehabilitation

Answer

Cognitive Behavioral Therapy (CBT)

Answer

Antidepressant medication

Question 9

A 28-year-old male collapses after a marathon, presenting with confusion and seizures. Laboratory results indicate hyponatremia. What is the most likely diagnosis?

Accepted Answer

Exercise-associated hyponatremia

Answer

Excessive fluid intake

Answer

Inappropriate fluid replacement strategy

Answer

Heat stroke with electrolyte imbalance

Question 10

Which of the following conditions is least likely to cause impotence?

Accepted Answer

Congenital urethral malformation

Answer

Double penis

Answer

Bilateral castration

Answer

Penile amputation

General Medicine — MCQs

General Medicine — MCQs

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