General Medicine — MCQs

General Medicine Indian Medical PG Practice Questions and MCQs

Question 51: "Humanity has hit three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever." It is a saying of?

A. Sir William Osler (Correct Answer)
B. Joseph Lister
C. William Harvey
D. Ronald Ross

Explanation: ***Sir William Osler*** - This quote is widely attributed to **Sir William Osler**, a renowned physician and one of the four founding professors of Johns Hopkins Hospital. - He is known for his influential contributions to medical education and clinical practice. *Joseph Lister* - **Joseph Lister** was a British surgeon and a pioneer of **antiseptic surgery**, known for promoting the idea of sterile surgical fields. - While significant, this particular quote is not associated with his work. *William Harvey* - **William Harvey** was an English physician who made seminal contributions to **cardiology**, being the first to describe completely the systemic circulation and properties of blood being pumped by the heart. - His work was focused on the circulatory system, not general observations on diseases like fever. *Ronald Ross* - **Ronald Ross** was a British medical doctor who received the **Nobel Prize for his work on malaria**, specifically demonstrating that mosquitoes transmit the disease. - His contributions were centered on parasitic diseases, and this quote is not part of his known writings.

Question 52: Patient with severe acidosis is treated with

A. Dextrose
B. Ringers lactate
C. i.v. NaHCO3 (Correct Answer)
D. None of the options

Explanation: ***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.

Question 53: A 60-year-old man with a history of nodular prostatic hyperplasia and recurrent cystitis presents with pain in the scrotum. His temperature is 38degC (101degF). Physical examination reveals a small, tender nodule attached to the testis. Which of the following is the most likely diagnosis?

A. Urethritis
B. Epididymitis (Correct Answer)
C. Orchitis
D. Spermatocele

Explanation: ***Epididymitis*** - The patient's history of **benign prostatic hyperplasia (BPH)** and **recurrent cystitis** increases the risk for ascending infections [2, 5], which are the most common cause of epididymitis in older men. - The presentation of **scrotal pain**, **fever**, and a **tender nodule attached to the testis** (most likely the epididymis) is classic for epididymitis [1, 2]. *Urethritis* - While urethritis can cause dysuria and urethral discharge, it typically does not present with a **tender scrotal nodule or fever** in this manner. - It could be a precursor to epididymitis [2], but the primary scrotal findings point elsewhere. *Orchitis* - **Orchitis** primarily involves inflammation of the **testis itself** and is often associated with mumps or viral infections. - While it can cause testicular pain and swelling, the description of a **small, tender nodule attached to the testis** is more indicative of epididymal involvement. *Spermatocele* - A **spermatocele** is a benign cyst that typically presents as a **painless, smooth mass** above the testis. - It does not cause acute pain, fever, or signs of inflammation.

Question 54: Thiamine deficiency causes -

A. Peripheral neuropathy
B. Ophthalmoplegia
C. Cardiomyopathy
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Thiamine (vitamin B1)** is critical for nervous system, heart, and muscle function, as it is a coenzyme in carbohydrate metabolism [1], [2]. - Deficiency can manifest as **Wernicke-Korsakoff syndrome** (affecting the central nervous system), **beriberi** (affecting cardiovascular and peripheral nervous systems), or both [1]. *Peripheral neuropathy* - This is a hallmark of **dry beriberi**, leading to **symmetrical peripheral neuropathy** with muscle weakness and sensory loss [1]. - It results from the impaired function of peripheral nerves due to thiamine's role in myelin maintenance and nerve signal transmission [1]. *Ophthalmoplegia* - This symptom is characteristic of **Wernicke encephalopathy**, a severe neurological manifestation of thiamine deficiency. - It involves paralysis or weakness of the eye muscles, often accompanied by **nystagmus** and ataxia. *Cardiomyopathy* - This is a characteristic feature of **wet beriberi**, where thiamine deficiency impacts cardiac function due to decreased cellular energy production [1]. - It can lead to **high-output cardiac failure**, manifesting as edema and shortness of breath [1].

Question 55: Morbid obesity is defined if BMI is greater than:

A. 25
B. 30
C. 40 (Correct Answer)
D. 18.5

Explanation: ***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 56: All are features of accidental hypothermia, EXCEPT

A. Lactic acidosis
B. Increased number of FFA (Correct Answer)
C. Bradycardia
D. Hypoglycemia

Explanation: ***Increased number of FFA*** - In **hypothermia**, the body's **metabolic rate** slows down significantly, leading to reduced lipolysis and thus a **decreased** number of **free fatty acids (FFA)**, not an increased number. - This reduction in FFA contributes to the overall energy conservation mechanisms observed during cold exposure. *Lactic acidosis* - **Lactic acidosis** is a common feature of severe hypothermia due to **tissue hypoperfusion** and **anaerobic metabolism** [2]. - Reduced blood flow in cold conditions impairs oxygen delivery, leading to increased lactate production. *Bradycardia* - **Bradycardia** is a classic cardiovascular response to hypothermia, as the heart rate slows down in proportion to the decrease in core body temperature [1]. - The reduced metabolic demand in colder temperatures necessitates a slower heart rate to maintain cardiac output efficiency. *Hypoglycemia* - **Hypoglycemia** is frequently observed in accidental hypothermia, as the body's **glucose metabolism** is profoundly affected by cold temperatures. - Reduced endogenous glucose production and impaired hormonal responses contribute to low blood sugar levels.

Question 57: Which of the following is a manifestation of magnesium deficiency?

A. Tetany (Correct Answer)
B. Hyperreflexia
C. Hyporeflexia
D. All of the options

Explanation: ***Tetany*** - Magnesium deficiency can lead to increased neuronal excitability and **neuromuscular irritability**, manifesting as **tetany**. - This is often seen in conjunction with **hypocalcemia** because magnesium is essential for normal parathyroid hormone function and calcium homeostasis. *Hyperreflexia* - While magnesium deficiency can cause increased neuromuscular excitability, **hyperreflexia** is not the primary or most characteristic manifestation. - Instead, tetany, which involves more generalized muscle spasms and cramps, is a more specific sign of severe deficiency. *Hyporeflexia* - **Hyporeflexia** is more commonly associated with **hypermagnesemia**, where high magnesium levels depress neuromuscular transmission. - Magnesium deficiency, in contrast, tends to enhance muscle and nerve activity, leading to symptoms like tetany. *All of the options* - While some forms of increased neuromuscular excitability like hyperreflexia might be present, **tetany** is the most direct and classic manifestation of significant magnesium deficiency due to its critical role in regulating muscle and nerve function. - Hyporeflexia is characteristic of excess magnesium, not deficiency.

Question 58: Allergic rhinitis treatment include all except

A. Corticosteroids
B. Surgery
C. Antibiotics (Correct Answer)
D. Avoiding allergen

Explanation: ***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].

Question 59: An elderly patient presents with hypertension and diabetes, proteinuria without renal failure. Antihypertensive of choice is

A. Enalapril (Correct Answer)
B. Propranolol
C. Methyldopa
D. Furosemide

Explanation: ***Enalapril*** - As an **ACE inhibitor**, enalapril is the **antihypertensive of choice** for patients with diabetes and proteinuria due to its **renoprotective effects** [2], [3]. - It reduces **glomerular hydrostatic pressure** and decreases proteinuria by dilating the efferent arteriole of the glomerulus [2], [3]. *Propranolol* - **Beta-blockers** like propranolol are generally not first-line for hypertension in diabetic patients because they can mask symptoms of **hypoglycemia** and may worsen **insulin resistance**. - While effective for hypertension, they don't offer the specific **renoprotective benefits** of ACE inhibitors in the presence of proteinuria. *Methyldopa* - **Methyldopa** is primarily used for hypertension in **pregnancy** due to its favorable safety profile in this population. - It is not a preferred agent for general hypertension management, particularly in patients with diabetes and proteinuria, as it lacks the **renoprotective effects** of ACE inhibitors. *Furosemide* - **Furosemide** is a loop diuretic primarily used to manage **fluid overload** and severe hypertension, especially in patients with **renal impairment** or heart failure [4]. - While it lowers blood pressure, it does not offer the same **renoprotective advantages** in reducing proteinuria as ACE inhibitors and may not be suitable as a monotherapy for chronic hypertension with diabetes [1].

Question 60: Hyperbaric Oxygen is not useful in

A. CO poisoning
B. Vertigo (Correct Answer)
C. Gas gangrene
D. Compartment syndrome

Explanation: ***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.

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Approach to the Medical Patient

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Differential Diagnosis Development

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Rational Diagnostic Testing

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Medical Decision Making

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Cost-effective Care

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Patient-centered Communication

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Interprofessional Collaboration

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Systems-based Practice

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High-value Care

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Transitions of Care

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Chronic Disease Management

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Medical Uncertainty Management

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