Choose the correct statement(s):
1. Metformin is contraindicated in patients with severe renal impairment (eGFR <30 mL/min/1.73m²)
2. ACE inhibitors should be discontinued immediately if serum creatinine increases by any amount after initiation
3. Beta-blockers are first-line therapy for heart failure with reduced ejection fraction
4. Statins are recommended for primary prevention in patients with diabetes mellitus aged 40-75 years
Q32
Consider the following statements:
1. The placenta is usually located in the upper uterine segment.
2. The placenta is usually located in the lower uterine segment.
3. The placenta is usually located in the fundus.
4. The placenta is usually located in the anterior uterine wall.
Which one of the statements given above are correct ?
Q33
Match List-I with List-II and select the correct answer using the code given below the Lists:
Q34
The complications of prolonged parenteral hyperalimentation may include the following except
Q35
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?
Q36
A patient presented with dryness in the eye with a gritty sensation along with corneal softening. What is the most probable cause?
Q37
A 66-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious medical illness and takes no medications. A screening DEXA scan shows a T-score of -1.5 at the femur. Which of the following is the strongest predisposing factor for osteopenia?
Q38
A previously healthy 30-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and nonproductive cough. She also complains of constipation and fatigue during the same time period. She has not traveled recently or been exposed to any sick contacts. Physical examination shows injected conjunctivae and tender, erythematous nodules on both shins. The lungs are clear to auscultation. An x-ray of the chest is shown. Which of the following additional findings is most likely in this patient?
Q39
A child with diarrhea has deep & rapid respiration. Most likely diagnosis is:
Q40
Most common cause of erectile dysfunction in men under 40:
General Medicine Indian Medical PG Practice Questions and MCQs
Question 31: Choose the correct statement(s):
1. Metformin is contraindicated in patients with severe renal impairment (eGFR <30 mL/min/1.73m²)
2. ACE inhibitors should be discontinued immediately if serum creatinine increases by any amount after initiation
3. Beta-blockers are first-line therapy for heart failure with reduced ejection fraction
4. Statins are recommended for primary prevention in patients with diabetes mellitus aged 40-75 years
A. 1, 3, 4 are correct (Correct Answer)
B. 1, 2, 3 are correct
C. 1, 2, 3, 4 are correct
D. 1, 4 are correct
Explanation: ***1, 3, 4 are correct***
- This option cannot be properly evaluated as the question lacks the actual **numbered statements** that need to be assessed for correctness.
- Without the specific content of statements 1, 2, 3, and 4, it is impossible to provide meaningful medical reasoning for this selection.
*1, 2, 3 are correct*
- This combination cannot be validated without access to the **actual statements** referenced in the question stem.
- The correctness of this option depends entirely on the medical accuracy of the missing numbered statements.
*1, 2, 3, 4 are correct*
- This selection suggests that **all statements** would be medically accurate, but verification requires the actual statement content.
- Without the numbered statements, no determination can be made about whether this comprehensive selection is appropriate.
*1, 4 are correct*
- This partial combination cannot be evaluated for medical accuracy without the **specific content** of the referenced statements.
- The validity of selecting only statements 1 and 4 depends on the actual medical information contained in those missing statements.
Question 32: Consider the following statements:
1. The placenta is usually located in the upper uterine segment.
2. The placenta is usually located in the lower uterine segment.
3. The placenta is usually located in the fundus.
4. The placenta is usually located in the anterior uterine wall.
Which one of the statements given above are correct ?
A. 1, 3 and 4
B. 1 and 3 only (Correct Answer)
C. 1, 2 and 3
D. 2 and 3 only
Explanation: ***1 and 3 only***
- The placenta typically implants in the **upper uterine segment** and often extends to the **fundus**, providing a robust blood supply and optimal conditions for fetal growth.
- An implantation in the **upper uterine segment** or **fundus** ensures that as the uterus grows, the placenta moves away from the cervix, reducing the risk of placenta previa.
*1, 3 and 4*
- While the placenta can be located in the **anterior uterine wall**, this is not a universal characteristic as it can also be posterior, lateral, or even fundal.
- The core locations for healthy placental implantation are the **upper uterine segment** and **fundus**, which are accurately captured in statements 1 and 3.
*1, 2 and 3*
- The statement that the placenta is usually located in the **lower uterine segment** (statement 2) is incorrect; this location is associated with **placenta previa**, a complication [1].
- Healthy placental implantation avoids the **lower uterine segment** to prevent issues during labour and delivery.
*2 and 3 only*
- This option incorrectly states that the placenta is usually located in the **lower uterine segment** (statement 2), which is generally considered abnormal.
- While location in the **fundus** (statement 3) is correct, combining it with an incorrect primary location makes this option invalid.
Question 33: Match List-I with List-II and select the correct answer using the code given below the Lists:
A. A→3 B→1 C→2 D→4 (Correct Answer)
B. A→3 B→2 C→1 D→4
C. A→1 B→4 C→2 D→3
D. A→4 B→2 C→1 D→3
Explanation: ***A→3 B→1 C→2 D→4***
- This option correctly matches each pneumoconiosis with its associated occupation.
- **Anthracosis** is linked to coal mining, **Byssinosis** to the textile industry, **Bagassosis** to the paper industry, and **Silicosis** to building and construction work.
*A→3 B→2 C→1 D→4*
- This option incorrectly matches **Byssinosis** with building and construction work and **Bagassosis** with the textile industry.
- Byssinosis is caused by cotton dust in the textile industry, and Bagassosis is caused by bagasse dust, commonly from the sugar cane or paper industry.
*A→1 B→4 C→2 D→3*
- This option contains multiple incorrect matches, including linking Anthracosis to the textile industry and Silicosis to coal mining.
- Anthracosis is specifically tied to **coal dust exposure**, and Silicosis results from **silica dust inhalation**.
*A→4 B→2 C→1 D→3*
- This option is incorrect because it mismatches Anthracosis with the paper industry and Bagassosis with the textile industry, among others.
- Each pneumoconiosis has a distinct occupational exposure source.
Question 34: The complications of prolonged parenteral hyperalimentation may include the following except
A. Hyperosmolar acidosis
B. Hyperammonaemia
C. Hyperphosphataemia (Correct Answer)
D. Cholestatic jaundice
Explanation: ***Hyperphosphataemia***
- **Hypophosphatemia** is a common complication of prolonged parenteral hyperalimentation (TPN), particularly during refeeding syndrome, due to increased cellular uptake of phosphate for ATP synthesis [1].
- **Hyperphosphatemia** is rare in TPN unless there is significant renal impairment or excessive phosphate administration, which is usually avoided.
*Hyperosmolar acidosis*
- This can occur with total parenteral nutrition (TPN) if the **glucose load is too high** or if the patient has underlying impaired glucose tolerance [1].
- The high glucose acts as an **osmotic diuretic**, leading to dehydration and metabolic acidosis [1].
*Hyperammonaemia*
- This is a potential complication, especially with **excessive amino acid administration** in patients with liver dysfunction or immature liver enzymes (e.g., neonates).
- The inability to adequately metabolize ammonia can lead to **encephalopathy**.
*Cholestatic jaundice*
- Prolonged TPN is a recognized cause of **TPN-associated liver disease**, which can manifest as cholestatic jaundice.
- The etiology is multifactorial, involving factors such as **lack of enteral stimulation**, hepatotoxic components in TPN solutions, and altered bile flow.
Question 35: 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?
A. Iron
B. Protein
C. Niacin
D. Vitamin A (Correct Answer)
Explanation: ***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**.
Question 36: A patient presented with dryness in the eye with a gritty sensation along with corneal softening. What is the most probable cause?
A. Follicular conjunctivitis
B. Vitamin A deficiency (Correct Answer)
C. Viral Keratitis
D. Riboflavin Deficiency
Explanation: Vitamin A deficiency
- **Dry eyes** with a **gritty sensation (xerophthalmia)** and **corneal softening (keratomalacia)** are classic signs of severe vitamin A deficiency [1], [2].
- This condition can lead to blindness if not treated promptly, as vitamin A is crucial for the health of the **cornea** and **retina** [1], [2].
*Follicular conjunctivitis*
- Characterized by the presence of **lymphoid follicles** on the conjunctiva, often due to viral infections like **adenovirus** or **chlamydia**.
- While it can cause dryness, it does not typically lead to **corneal softening** or the severe vision-threatening complications seen with vitamin A deficiency.
*Viral Keratitis*
- Involves inflammation of the **cornea** due to a viral infection, commonly by **herpes simplex virus**.
- Symptoms include pain, redness, blurred vision, and sensitivity to light, but **generalized dryness** and **corneal softening** as the primary presentation are less characteristic.
*Riboflavin Deficiency*
- Also known as **ariboflavinosis**, this deficiency can cause ocular symptoms like **photophobia**, **corneal vascularization**, and **conjunctivitis**.
- However, it typically does not present with **severe dry eyes** or **corneal softening (keratomalacia)** as seen in vitamin A deficiency.
Question 37: A 66-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious medical illness and takes no medications. A screening DEXA scan shows a T-score of -1.5 at the femur. Which of the following is the strongest predisposing factor for osteopenia?
A. Smoking (Correct Answer)
B. NSAID use
C. Type 2 diabetes mellitus
D. Hypoparathyroidism
E. Obesity
Explanation: ***Smoking***
- **Smoking** is a well-established risk factor for **osteoporosis** and **osteopenia** due to its negative effects on bone formation and density [1].
- It impairs osteoblast activity, increases osteoclast activity, and can lead to lower estrogen levels, all contributing to bone loss.
*NSAID use*
- **NSAIDs (nonsteroidal anti-inflammatory drugs)** are not typically associated with a risk of osteopenia or osteoporosis.
- While prolonged high-dose use can have side effects, bone density reduction is not one of them.
*Type 2 diabetes mellitus*
- The relationship between **Type 2 diabetes mellitus** and bone health is complex; while some studies suggest an increased fracture risk, largely due to falls and poorer bone quality, it's not consistently associated with lower bone mineral density (osteopenia) itself, particularly in younger individuals, and can even be associated with higher bone density.
- The primary mechanism for increased fracture risk in diabetes often relates to microvascular complications, neuropathy leading to falls, and altered bone microarchitecture rather than directly causing osteopenia.
*Hypoparathyroidism*
- **Hypoparathyroidism** leads to **low parathyroid hormone (PTH) levels**, which can result in increased bone mineral density rather than decreased density (osteopenia).
- PTH is crucial for maintaining calcium homeostasis and bone remodeling, and its deficiency slows bone turnover, potentially making bones denser but also more brittle.
*Obesity*
- **Obesity** is generally considered protective against osteopenia or osteoporosis due to the increased mechanical loading on bones, which stimulates bone formation.
- Adipose tissue also produces estrogen, which can help maintain bone density, particularly in postmenopausal women [2].
Question 38: A previously healthy 30-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and nonproductive cough. She also complains of constipation and fatigue during the same time period. She has not traveled recently or been exposed to any sick contacts. Physical examination shows injected conjunctivae and tender, erythematous nodules on both shins. The lungs are clear to auscultation. An x-ray of the chest is shown. Which of the following additional findings is most likely in this patient?
A. Low serum angiotensin-converting enzyme levels (Correct Answer)
B. Elevated serum parathyroid hormone levels
C. Positive interferon-gamma release assay
D. Positive anti-dsDNA antibody testing
E. Low serum CD4+ T-cell count
Explanation: ***Low serum angiotensin-converting enzyme levels***
- This patient's presentation with **shortness of breath, nonproductive cough, constipation, fatigue, injected conjunctivae, tender erythematous nodules (erythema nodosum)**, and bilateral hilar lymphadenopathy on chest X-ray is highly suggestive of **sarcoidosis**.
- **Elevated serum angiotensin-converting enzyme (ACE) levels** are a classic finding in sarcoidosis due to granuloma production, not low levels. The question asks for the most likely additional finding, and given the classic presentation of sarcoidosis, an elevated ACE level would be expected, which means low ACE levels are incorrect.
*Elevated serum parathyroid hormone levels*
- This would suggest primary **hyperparathyroidism**, which is not directly indicated by the patient's symptoms or imaging.
- While sarcoidosis can cause **hypercalcemia** due to increased vitamin D production, it typically leads to **suppressed PTH levels**, not elevated ones.
*Positive interferon-gamma release assay*
- A positive IGRA indicates **tuberculosis infection**, which would present differently (e.g., typically productive cough, fever, night sweats, cavitary lesions or upper lobe infiltrates).
- While TB can cause hilar lymphadenopathy, the constellation of symptoms (erythema nodosum, conjunctivitis, constipation) is less typical for TB and more for sarcoidosis.
*Positive anti-dsDNA antibody testing*
- Positive anti-dsDNA antibodies are characteristic of **systemic lupus erythematosus (SLE)**.
- While SLE can cause pulmonary symptoms and fatigue, the presence of **erythema nodosum** and **bilateral hilar lymphadenopathy** is not typical for SLE.
*Low serum CD4+ T-cell count*
- A low CD4+ T-cell count is characteristic of **HIV infection**, which can lead to opportunistic infections, but the constellation of symptoms and imaging findings points away from HIV as the primary diagnosis.
- In sarcoidosis, while there can be **anergy** (decreased T-cell reactivity to skin antigens), the peripheral CD4+ T-cell count is often normal or slightly elevated.
Question 39: A child with diarrhea has deep & rapid respiration. Most likely diagnosis is:
A. Metabolic acidosis (Correct Answer)
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Explanation: ***Metabolic acidosis***
- Diarrhea leads to a loss of **bicarbonate** from the gastrointestinal tract, causing a decrease in blood pH [1].
- **Deep and rapid respirations** (Kussmaul breathing) are a compensatory mechanism to blow off CO2 and raise the blood pH [1], [2].
*Respiratory acidosis*
- This condition results from **hypoventilation**, leading to CO2 retention and a reduced pH [2].
- Deep and rapid breathing would actually improve respiratory acidosis by expelling CO2.
*Metabolic alkalosis*
- Characterized by an **excess of bicarbonate** and an elevated blood pH [3].
- Compensatory mechanisms would involve decreased respiration to retain CO2, not increased [3].
*Respiratory alkalosis*
- This is caused by **hyperventilation**, which leads to excessive CO2 expulsion and an elevated pH [2].
- While hyperventilation causes deep and rapid breathing, it leads to alkalosis, not acidosis (which is indicated by compensatory breathing in this scenario).
Question 40: Most common cause of erectile dysfunction in men under 40:
A. Vascular
B. Drug induced (Correct Answer)
C. Diabetes
D. Psychological
Explanation: ***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].
