General Medicine Practice Questions

Q: Choking is a medical emergency that can occur due to various causes. Which of the following is a common cause of choking in adults?

Food obstruction. ***Food obstruction*** - **Food obstruction** is the most frequent cause of choking in adults, often due to large, poorly chewed pieces of food becoming lodged in the airway [1]. - This typically happens during meals, especially when talking or laughing while eating, or consuming alcohol which impairs coordination [1], [2]. *Laryngospasm* - **Laryngospasm** is an involuntary spasm of the vocal cords that temporarily closes the airway, but it typically resolves spontaneously and is not usually the primary cause of sustained choking in adults from foreign body obstruction [1]. - While it can cause transient difficulty breathing, it's often a protective reflex or a complication of intubation/anesthesia, rather than a common choking event. *Anaphylaxis* - **Anaphylaxis** is a severe allergic reaction that can cause airway swelling (angioedema and bronchospasm), leading to difficulty breathing and a sensation of choking. - However, it is a systemic allergic response with other symptoms like rash, hypotension, and gastrointestinal distress, not a direct mechanical obstruction of the airway by a foreign body. *Aspiration of liquids* - **Aspiration of liquids** occurs when fluids enter the trachea and lungs, which can cause coughing, gagging, and lead to aspiration pneumonia. - While it can be a serious event, it rarely causes complete and sudden airway obstruction that is characteristic of choking on a solid object.

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

20. ***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.

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

Multiple myeloma. 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.

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

Elevation of testis reduces pain in epididymitis.. ***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.

Q: 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.

Hypercalcemia. ***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.

Q: Treatment of choice in hypertension with diabetes mellitus is

ACE inhibitors. ***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].

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 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 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: 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

Choking is a medical emergency that can occur due to various causes. Which of the following is a common cause of choking in adults?

Accepted Answer

Food obstruction

Answer

Laryngospasm

Answer

Anaphylaxis

Answer

Aspiration of liquids

Question 2

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

Accepted Answer

20

Answer

19

Answer

21

Answer

22

Question 3

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

Accepted Answer

Multiple myeloma

Answer

Primary biliary cirrhosis

Answer

Hyperparathyroidism

Answer

Hepatitis

Question 4

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

Accepted Answer

Elevation of testis reduces pain in epididymitis.

Answer

Pain is referred to the groin in epididymitis

Answer

No change in pain with elevation of testis in epididymitis

Answer

Elevation of testis increases pain in epididymitis.

Question 5

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.

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Hypocalcemia

Answer

Hypokalemia

Question 6

Treatment of choice in hypertension with diabetes mellitus is

Accepted Answer

ACE inhibitors

Answer

Some beta blockers

Answer

Thiazide diuretics

Answer

Calcium channel blockers

Question 7

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 8

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 9

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 10

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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