General Medicine Practice Questions

Q: A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is

Urethral syndrome. ***Urethral syndrome*** - The patient presents with classic symptoms of **urethral syndrome**, including chronic pelvic pain, frequency, urgency, and incomplete evacuation despite negative urine cultures and normal cystoscopy [1]. - This diagnosis is also supported by the absence of significant findings on ultrasound, urine examination, and vaginal cultures, ruling out common infectious or structural causes [1]. *Asymptomatic bacteriuria* - This condition involves the presence of bacteria in the urine without any associated symptoms and would not explain the patient's **chronic pelvic pain**, frequency, and urgency. - While urine cultures would be positive, the absence of symptoms differentiates it from the patient's presentation. *Cystitis* - **Cystitis**, or bladder inflammation, typically presents with similar symptoms to the patient, but would usually show signs of inflammation or infection in urine analysis (e.g., pyuria) or cystoscopy, which are absent here. - Her negative urine cultures also effectively rule out **bacterial cystitis**. *Vulvovaginitis* - **Vulvovaginitis** is an inflammation of the vulva and vagina, usually presenting with vaginal discharge, itching, or irritation, which is conspicuously absent in this patient [2]. - The patient's symptoms are primarily urinary and pain-related, not genitally localized to the vulva or vagina.

Q: Treatment choice in severe dehydration is-

Ringer lactate. ***Ringer lactate*** - **Ringer's lactate** is the preferred solution for severe dehydration, especially in cases with significant fluid and electrolyte loss. - Its composition is similar to that of **extracellular fluid**, containing sodium, potassium, calcium, chloride, and lactate, which is metabolized to bicarbonate, helping to correct metabolic acidosis. *Normal saline* - While **normal saline (0.9% NaCl)** is an isotonic solution, its high chloride content can lead to **hyperchloremic metabolic acidosis** with large volumes [1]. - It does not contain **potassium** or **calcium**, which are essential electrolytes lost during severe dehydration [2]. *DNS 5%* - **Dextrose 5% in normal saline (DNS 5%)** contains free water and sodium, but the dextrose is quickly metabolized, leaving primarily free water. - This can be problematic in severe dehydration as it doesn't effectively restore **plasma volume** and can worsen electrolyte imbalances. *DNS 10%* - **Dextrose 10% in normal saline (DNS 10%)** has a higher dextrose concentration, which further contributes to free water administration once metabolized. - It is generally used when there's a need for significant **caloric intake** and fluid with a high sodium content, which is not the primary goal in severe dehydration management.

Q: A 38-year-old woman presents with a history of backache. X-ray and MRI of the spine reveal collapse of the D12 vertebra with normal intervertebral disc space. The LEAST likely diagnosis is:

Osteoporosis. ***Osteoporosis*** - While osteoporosis can cause **vertebral collapse**, it typically results in a **wedging deformity** or uniform compression, usually without significantly affecting the intervertebral disc space [1]. - The patient's age (38 years old), while not precluding osteoporosis, makes it less likely to be the primary cause of a severe D12 collapse with normal disc space compared to other destructive processes. *Tuberculosis* - **Tuberculous spondylitis (Pott's disease)** commonly affects the vertebral body, often leading to its collapse (gibbus deformity) and subsequent **destruction of the intervertebral disc space** in later stages due to infection spread [2]. - The initial presentation with vertebral collapse and normal disc space followed by disc involvement is characteristic of tuberculous infection, making it a likely consideration. *Metastasis* - **Vertebral metastases** frequently cause osteolytic lesions that weaken the vertebral body, leading to collapse while often **sparing the intervertebral discs** initially due to their avascular nature [3]. - This presentation directly matches the description of D12 collapse with a normal disc space. *Multiple myeloma* - **Multiple myeloma** is a plasma cell malignancy that commonly causes **osteolytic lesions** in the spine, resulting in vertebral body collapse without significant involvement of the intervertebral discs. - This is a highly characteristic presentation for multiple myeloma, making it a strong differential for the given clinical and radiological findings.

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: Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, EXCEPT:

Hypocalcemia. ***Hypocalcemia*** - While hypocalcemia can cause symptoms like **tetany**, muscle cramps, and paresthesias, it typically does not manifest as **episodic generalized weakness** in the same way that other electrolyte disturbances do. - Its neuromuscular effects are primarily due to increased neuromuscular excitability rather than generalized muscle weakness. *Hypophosphatemia* - Severe hypophosphatemia can lead to **generalized muscle weakness** due to impaired ATP production and cellular energy. - This weakness can be profound and include **rhabdomyolysis** in severe cases, making it a cause of acute generalized weakness. *Hypokalemia* - Low potassium levels can cause **muscle weakness** ranging from mild to severe, including paralysis, due to its critical role in muscle cell membrane potential and neuromuscular function. - This can be episodic, especially in conditions like **hypokalemic periodic paralysis**. *Hyponatremia* - Acute hyponatremia can cause rapid fluid shifts into cells, including muscle cells, leading to **generalized weakness**, lethargy, and altered mental status. - This can be episodic depending on the cause of the acute drop in sodium levels.

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: About fibromyalgia all are true except

More common in males than females. ***More common in males than females*** - Fibromyalgia is significantly **more prevalent in females** than in males, with a female-to-male ratio ranging from 2:1 to 7:1 in various studies. - The exact reasons for this gender disparity are still under investigation, but hormonal, genetic, and psychosocial factors are thought to play a role. *Associated with EEG abnormalities* - Patients with fibromyalgia often exhibit **abnormal EEG patterns**, particularly during sleep, characterized by an alpha rhythm intrusion into non-REM sleep [1]. - These EEG abnormalities are thought to contribute to the characteristic **non-restorative sleep** experienced by many fibromyalgia patients [1]. *Associated with decreased blood flow to the brain* - Studies using imaging techniques like **SPECT** and **fMRI** have shown areas of **reduced cerebral blood flow** in patients with fibromyalgia, particularly in regions involved in pain processing [1]. - This decreased blood flow may contribute to the cognitive symptoms, such as **"fibro fog"**, and altered pain perception [1]. *Associated with low free cortisol levels* - Fibromyalgia is often associated with dysregulation of the **hypothalamic-pituitary-adrenal (HPA) axis**, leading to abnormalities in cortisol secretion [1]. - While total cortisol levels can be variable, many studies report **lower free cortisol levels**, particularly during daytime hours, reflecting a blunted stress response [1].

Q: A patient on total parenteral nutrition for 20 days presents with weakness, vertigo and convulsions. Diagnosis is

Hypomagnesemia. Hypomagnesemia - **Weakness, vertigo, and convulsions** in a patient on **total parenteral nutrition (TPN)** for 20 days are classic signs of magnesium deficiency. - TPN without adequate magnesium supplementation can lead to this condition, as magnesium is crucial for **neuromuscular function**. *Hypercalcemia* - Symptoms of hypercalcemia typically include **bone pain, kidney stones (nephrolithiasis) [1], abdominal groans (constipation, nausea, vomiting)**, and **psychiatric overtones (depression, lethargy)**. - It does not typically cause vertigo or convulsions as primary symptoms, especially not after TPN. *Hypermagnesemia* - Hypermagnesemia is usually associated with **renal failure** or excessive magnesium intake (e.g., antacids, laxatives). - Symptoms often include **hypotension, bradycardia, respiratory depression**, and **loss of deep tendon reflexes**, which are not described here. *Hypocalcemia* - Hypocalcemia can cause neuromuscular irritability, leading to **tetany, muscle cramps**, and **paresthesias**. - While it can manifest with seizures, the combination of **vertigo** and the context of TPN makes hypomagnesemia a more direct and often co-occurring cause.

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.

Question 1

A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is

Accepted Answer

Urethral syndrome

Answer

Asymptomatic bacteriuria

Answer

Cystitis

Answer

Vulvovaginitis

Question 2

Treatment choice in severe dehydration is-

Accepted Answer

Ringer lactate

Answer

Normal saline

Answer

DNS 5%

Answer

DNS 10%

Question 3

A 38-year-old woman presents with a history of backache. X-ray and MRI of the spine reveal collapse of the D12 vertebra with normal intervertebral disc space. The LEAST likely diagnosis is:

Accepted Answer

Osteoporosis

Answer

Tuberculosis

Answer

Metastasis

Answer

Multiple myeloma

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

Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, EXCEPT:

Accepted Answer

Hypocalcemia

Answer

Hypophosphatemia

Answer

Hypokalemia

Answer

Hyponatremia

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

About fibromyalgia all are true except

Accepted Answer

More common in males than females

Answer

Associated with EEG abnormalities

Answer

Associated with decreased blood flow to the brain

Answer

Associated with low free cortisol levels

Question 9

A patient on total parenteral nutrition for 20 days presents with weakness, vertigo and convulsions. Diagnosis is

Accepted Answer

Hypomagnesemia

Answer

Hypercalcemia

Answer

Hypermagnesemia

Answer

Hypocalcemia

Question 10

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

General Medicine — MCQs

General Medicine — MCQs

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