General Medicine — MCQs

General Medicine Indian Medical PG Practice Questions and MCQs

Question 71: A 45-year-old male presents with difficulty urinating and a weak stream. A digital rectal examination reveals an enlarged prostate. Which zone of the prostate is most likely involved?

A. Peripheral zone
B. Central zone
C. Transitional zone (Correct Answer)
D. Anterior zone

Explanation: ***Transitional zone*** - **Benign prostatic hyperplasia (BPH)**, which commonly causes symptoms like difficulty urinating and weak stream [1], originates primarily in the **transitional zone**. - Enlargement of this zone compresses the **urethra**, leading to outflow obstruction symptoms. *Peripheral zone* - The **peripheral zone** is the most common site for **prostate cancer**, not typically BPH. - While a DRE can detect abnormalities in this zone, symptoms of urinary obstruction in this age group are less likely to stem primarily from isolated peripheral zone enlargement. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is rarely involved in BPH or carcinoma. - It is more resistant to hyperplasia compared to the transitional zone. *Anterior zone* - The **anterior zone** is largely glandular and is typically non-pathologic and minimally involved in BPH or prostate cancer. - It is composed mainly of fibromuscular tissue.

Question 72: A 70-year-old male presents with difficulty urinating. Examination reveals a mass in the pelvis. Which structure is most likely to be enlarged?

A. Bladder
B. Prostate (Correct Answer)
C. Seminal vesicle
D. Urethra

Explanation: ***Prostate*** - In a 70-year-old male presenting with **difficulty urinating** and a pelvic mass, an enlarged prostate is the most likely cause. This is indicative of **benign prostatic hyperplasia (BPH)**, a common condition in older men. - The enlarged prostate can compress the **urethra**, leading to symptoms like **urinary hesitancy, weak stream, nocturia, and incomplete bladder emptying** [1]. *Bladder* - While bladder distension can occur secondary to **urinary outflow obstruction**, the bladder itself is not typically the structure that *enlarges* as the primary cause of the obstruction in this scenario. - A palpable bladder mass would usually indicate a **distended bladder** due to urinary retention rather than a primary bladder enlargement causing the obstruction. *Seminal vesicle* - Enlargement of the seminal vesicles is generally **not associated with urinary obstruction** and is usually asymptomatic unless there is inflammation or a rare malignancy. - The seminal vesicles are located posterior to the bladder and do not typically exert pressure on the urethra in a way that causes significant urinary symptoms or a palpable pelvic mass in the context of voiding difficulty. *Urethra* - The urethra is a **tube-like structure**; it does not "enlarge" to form a mass in the pelvis. - Instead, the urethra can be **compressed or strictured**, leading to obstruction, but its anatomical structure prevents it from forming a palpable mass.

Question 73: During a routine examination, a patient is found to have a palpable spleen. Which condition is least likely to cause splenomegaly?

A. Portal hypertension
B. Infectious mononucleosis
C. Hemolytic anemia
D. Sickle cell disease (Correct Answer)

Explanation: Sickle cell disease - Sickle cell disease can lead to **splenic autoinfarction**, which results in a shrunken or non-palpable spleen due to repeated vaso-occlusive crises. - Unlike other conditions, it often features **functional asplenia**, making splenomegaly less common. *Infectious mononucleosis* - Typically causes **acute splenomegaly** due to viral infection, specifically from **Epstein-Barr virus**. - Patients often present with **lymphadenopathy** and significant fatigue, along with a palpable spleen. *Hemolytic anemia* - Can lead to splenomegaly due to increased **red blood cell destruction**, causing the spleen to enlarge as it filters out damaged cells [1][2]. - Conditions like **autoimmune hemolytic anemia** are particularly known for causing this enlargement. *Portal hypertension* - Causes **splenomegaly** due to increased pressure in the portal venous system, often resulting from liver disease [1]. - The spleen enlarges as it becomes congested, and is commonly palpable in these cases [1].

Question 74: A 19-year-old female with anorexia nervosa, a BMI of 14, presents with confusion, tachycardia, and hypotension. Laboratory results show decreased potassium, magnesium, and phosphate levels. What is the initial treatment for this patient?

A. Intravenous rehydration and electrolyte replacement (Correct Answer)
B. Nutritional rehabilitation
C. Cognitive Behavioral Therapy (CBT)
D. Antidepressant medication

Explanation: Intravenous rehydration and electrolyte replacement - This patient exhibits signs of **refeeding syndrome**, characterized by severe **electrolyte imbalances** (low potassium, magnesium, phosphate) and **cardiovascular instability** (tachycardia, hypotension), precipitated by aggressive refeeding in malnourished individuals. - Initial management prioritizes correcting these **life-threatening electrolyte derangements** and addressing **hemodynamic instability** [1] before gradual nutritional support to prevent further complications. *Nutritional rehabilitation* - While critical for long-term recovery in anorexia nervosa, immediate, aggressive nutritional rehabilitation without prior electrolyte correction can worsen **refeeding syndrome**, leading to further cardiac and neurologic decompensation [1]. - Nutritional support should be initiated **slowly and cautiously** after stabilizing the patient's acute medical status and correcting severe electrolyte abnormalities. *Cognitive Behavioral Therapy (CBT)* - **CBT is a cornerstone of long-term psychological treatment** for anorexia nervosa, addressing distorted thoughts and behaviors related to eating, weight, and body image [1]. - However, it is not an acute intervention for immediate medical stabilization in a patient presenting with life-threatening complications like **confusion, tachycardia, and severe electrolyte imbalances**. *Antidepressant medication* - **Antidepressants**, particularly SSRIs, can be part of the long-term management of anorexia nervosa, especially if comorbid depression or anxiety is present. - These medications are **not indicated for acute medical stabilization** in the context of confusion, hemodynamic instability, and severe electrolyte abnormalities, and their effects are not immediate.

Question 75: A 28-year-old male collapses after a marathon, presenting with confusion and seizures. Laboratory results indicate hyponatremia. What is the most likely diagnosis?

A. Exercise-associated hyponatremia (Correct Answer)
B. Excessive fluid intake
C. Inappropriate fluid replacement strategy
D. Heat stroke with electrolyte imbalance

Explanation: ***Exercise-associated hyponatremia*** - This condition occurs during or after prolonged physical exertion, like a marathon, and is characterized by a serum **sodium concentration below 135 mmol/L**. - The combination of **confusion and seizures** in a marathon runner with hyponatremia is a classic presentation of exercise-associated hyponatremia due to **excessive fluid consumption** and impaired renal water excretion [2]. *Excessive fluid intake* - While **excessive fluid intake** is a contributing factor to exercise-associated hyponatremia, it is not the diagnosis itself. - Hyponatremia leads to **cerebral edema**, causing neurological symptoms like confusion and seizures [3]. *Inappropriate fluid replacement strategy* - An **inappropriate fluid replacement strategy**, such as drinking too much hypotonic fluid, can certainly cause hyponatremia during prolonged exercise. - However, this option describes the **cause** of the hyponatremia rather than the clinical diagnosis. *Heat stroke with electrolyte imbalance* - **Heat stroke** is characterized by a core body temperature above 40°C with central nervous system dysfunction, but hyponatremia is not a primary diagnostic criterion [1]. - While **electrolyte imbalances** can occur in heat stroke, hyponatremia as the leading cause of such severe neurological symptoms is more suggestive of EAH.

Question 76: In a patient with severe diarrhea, what is the expected change in the blood acid-base balance?

A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis (Correct Answer)
D. Respiratory acidosis

Explanation: ***Metabolic acidosis*** - Severe diarrhea leads to excessive loss of **bicarbonate (HCO3-)** from the gastrointestinal tract, primarily from the small intestine and colon [1], [2]. - The loss of this principal buffer results in a decrease in blood pH, causing **metabolic acidosis** [1], [2]. *Metabolic alkalosis* - This condition is characterized by an increase in blood pH due to an excess of bicarbonate or a loss of hydrogen ions [3]. - It is typically caused by conditions like **vomiting** (loss of gastric acid) or diuretic use, not diarrhea [2], [3]. *Respiratory alkalosis* - This occurs when there is a decrease in the partial pressure of carbon dioxide (PCO2) due to **hyperventilation**. - While diarrhea can lead to compensatory hyperventilation, the primary disturbance is metabolic, not respiratory [1]. *Respiratory acidosis* - This is characterized by an increase in PCO2 due to **hypoventilation** or impaired gas exchange in the lungs. - Diarrhea does not directly cause respiratory acidosis; in fact, the body might try to compensate for metabolic acidosis by increasing ventilation [2].

Question 77: Which of the following is a sign of severe dehydration?

A. Hypotension (Correct Answer)
B. Increased thirst
C. Oliguria
D. Tachycardia

Explanation: ***Hypotension*** - Severe dehydration leads to a significant reduction in **intravascular volume**, which directly decreases cardiac preload and **blood pressure** [2]. - **Hypotension** is a critical sign indicating that the body's compensatory mechanisms are failing to maintain adequate circulatory function [2]. *Oliguria* - **Oliguria** (reduced urine output) is a common sign of dehydration because the body attempts to conserve fluid [3]. - While concerning, it is generally an early to moderate sign of dehydration and less specific to **severe dehydration** than profound hemodynamic changes. *Increased thirst* - **Increased thirst** is an early and prominent symptom of dehydration, indicating the body's physiological response to fluid deficit [1]. - However, thirst alone does not signify **severe dehydration**, as it can be present even with mild fluid losses [1]. *Tachycardia* - **Tachycardia** (increased heart rate) is a common compensatory mechanism in dehydration, as the heart tries to maintain cardiac output despite reduced blood volume. - While present in moderate to severe dehydration, **hypotension** indicates a more critical stage where compensation is no longer sufficient [2].

Question 78: Treatment of choice in acute sarcoidosis is

A. Prednisolone (Correct Answer)
B. Cyclosporin
C. Infliximab
D. IV immunoglobulins

Explanation: ***Prednisolone*** - **Corticosteroids** like prednisolone are the first-line treatment for acute sarcoidosis due to their potent **anti-inflammatory** and **immunosuppressive** effects. - They effectively reduce granuloma formation and inflammation, alleviating symptoms and preventing organ damage [1]. *Cyclosporin* - Cyclosporine is an **immunosuppressant** used in some autoimmune diseases and organ transplantation but is not the primary treatment for acute sarcoidosis. - It carries significant side effects, including **nephrotoxicity** and increased infection risk. *Infliximab* - Infliximab is a **TNF-alpha inhibitor** used for chronic, refractory sarcoidosis or in cases where steroids are contraindicated or ineffective. - It is considered a second-line or third-line agent, not the treatment of choice for acute presentation. *IV immunoglobulins* - IV immunoglobulins (IVIG) are used for various **immune deficiencies** and certain autoimmune disorders. - They are not indicated for the initial management of acute sarcoidosis.

Question 79: Which of the following conditions is least likely to cause impotence?

A. Double penis
B. Bilateral castration
C. Penile amputation
D. Congenital urethral malformation (Correct Answer)

Explanation: ***Congenital urethral malformation*** - While often requiring surgical correction, **congenital urethral malformations** (e.g., hypospadias) primarily affect the **urinary stream** and **ejaculatory function**, rather than directly impacting erectile physiology [2]. - Many individuals with corrected or even uncorrected urethral malformations retain the capacity for **erection**. *Double penis (diphallia)* - This rare congenital condition involves the presence of two penises, which often have **structural abnormalities**, including **vascular** and **neural deficits**. - These associated defects commonly lead to **erectile dysfunction** due to impaired blood flow or nerve supply to one or both penile shafts. *Bilateral castration* - This procedure removes both testicles, leading to a profound and immediate drop in **testosterone levels** [1]. - **Testosterone** is crucial for libido, erectile function, and maintaining penile structure, making **impotence** a near-certain outcome [1]. *Penile amputation* - The surgical removal of the penis directly eliminates the organ necessary for **erection** and intercourse. - This results in a complete and irreversible **loss of erectile function** and sexual penetrative capacity.

Question 80: A 25-year-old alcoholic presented with edema, hypertension, ocular disturbance, and changes in mental state. A diagnosis of high output cardiac failure was made with Wet Beri Beri. This condition is due to a deficiency of which vitamin?

A. Vitamin B3
B. Vitamin B6
C. Vitamin B9
D. Vitamin B1 (Correct Answer)

Explanation: Vitamin B1 - The constellation of **edema**, **hypertension**, **ocular disturbances**, and **mental status changes** in an **alcoholic** patient with **high-output cardiac failure** (Wet Beri Beri) is a classic presentation of **thiamine (Vitamin B1) deficiency** [2], [3]. - **Thiamine** is crucial for **carbohydrate metabolism** and **neurological function**, and a deficiency can lead to severe cardiovascular and neurological dysfunction, especially in chronic alcoholics due to poor absorption and increased metabolic demand [1], [3]. Vitamin B3 - Deficiency of Vitamin B3 (niacin) causes **pellagra**, characterized by the "4 D's": **dermatitis**, **diarrhea**, **dementia**, and death. - While it can cause psychiatric symptoms (dementia), it does not directly lead to the specific cardiovascular manifestations of high-output cardiac failure as seen in Wet Beri Beri. Vitamin B6 - Deficiency of Vitamin B6 (pyridoxine) can result in **peripheral neuropathy**, **anemia**, and **seizures**. - It is not directly linked to the cardiac and edematous symptoms characteristic of Wet Beri Beri. Vitamin B9 - Deficiency of Vitamin B9 (folate) primarily causes **megaloblastic anemia** and can lead to **neural tube defects** in developing fetuses. - While it can manifest with fatigue and weakness due to anemia, it does not typically present with the acute cardiovascular and neurological syndrome described.

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