General Medicine Practice Questions

Q: "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?

Sir William Osler. ***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.

Q: Patient with severe acidosis is treated with

i.v. NaHCO3. ***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.

Q: 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?

Epididymitis. ***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.

Q: Thiamine deficiency causes -

All of the options. ***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].

Q: Morbid obesity is defined if BMI is greater than:

40. ***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.

Q: All are features of accidental hypothermia, EXCEPT

Increased number of FFA. ***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.

Q: Which of the following is a manifestation of magnesium deficiency?

Tetany. ***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.

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

Enalapril. ***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].

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.

Question 1

"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?

Accepted Answer

Sir William Osler

Answer

Joseph Lister

Answer

William Harvey

Answer

Ronald Ross

Question 2

Patient with severe acidosis is treated with

Accepted Answer

i.v. NaHCO3

Answer

Dextrose

Answer

Ringers lactate

Answer

None of the options

Question 3

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?

Accepted Answer

Epididymitis

Answer

Urethritis

Answer

Orchitis

Answer

Spermatocele

Question 4

Thiamine deficiency causes -

Accepted Answer

All of the options

Answer

Peripheral neuropathy

Answer

Ophthalmoplegia

Answer

Cardiomyopathy

Question 5

Morbid obesity is defined if BMI is greater than:

Accepted Answer

40

Answer

25

Answer

30

Answer

18.5

Question 6

All are features of accidental hypothermia, EXCEPT

Accepted Answer

Increased number of FFA

Answer

Lactic acidosis

Answer

Bradycardia

Answer

Hypoglycemia

Question 7

Which of the following is a manifestation of magnesium deficiency?

Accepted Answer

Tetany

Answer

Hyperreflexia

Answer

Hyporeflexia

Answer

All of the options

Question 8

Allergic rhinitis treatment include all except

Accepted Answer

Antibiotics

Answer

Corticosteroids

Answer

Surgery

Answer

Avoiding allergen

Question 9

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

Accepted Answer

Enalapril

Answer

Propranolol

Answer

Methyldopa

Answer

Furosemide

Question 10

Hyperbaric Oxygen is not useful in

Accepted Answer

Vertigo

Answer

CO poisoning

Answer

Gas gangrene

Answer

Compartment syndrome

General Medicine — MCQs

General Medicine — MCQs

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