General Medicine Practice Questions

Q: Reduced osmolarity ORS does not contain which of the following ions?

Lactate. ***Lactate*** - The **reduced osmolarity ORS** formulation replaced **bicarbonate** with **citrate** and does not contain lactate. - **Citrate** is preferred over lactate / bicarbonate due to its stability, longer shelf life, and ease of dissolution. *Sodium* - **Sodium** is a crucial component of ORS, as it is co-transported with glucose into enterocytes, facilitating water absorption through **solvent drag**. - Reduced osmolarity ORS has a **lower sodium concentration** (75 mEq/L) compared to standard ORS (90 mEq/L) to minimize hypernatremia risk and enhance water absorption. *Potassium* - **Potassium** is included in ORS to replace intestinal losses, as **diarrhea** leads to significant potassium depletion. - Maintaining adequate **potassium levels** is essential for normal cellular function and preventing hypokalemia-related complications. *Citrate* - **Citrate** is a component of ORS that serves as an **alkalinizing agent** to correct metabolic acidosis often associated with dehydration in diarrheal diseases. - It also enhances the absorption of sodium and water in the intestine.

Q: Which of the following conditions does not typically cause subconjunctival hemorrhages?

Pellagra. ***Pellagra*** - Pellagra is a **nutritional deficiency disease** caused by a lack of **niacin (vitamin B3)**, characterized by symptoms affecting the **skin, gastrointestinal tract, and nervous system** (dermatitis, diarrhea, dementia, and death if untreated) [1]. - It does **not typically cause subconjunctival hemorrhages** as it primarily affects other organ systems and isn't associated with vascular fragility in the conjunctiva like the other conditions listed [2]. *Whooping cough* - **Violent coughing paroxysms** in whooping cough (pertussis) can significantly increase **venous pressure in the head and neck**. - This elevated pressure can rupture small conjunctival blood vessels, leading to **subconjunctival hemorrhages**. *Scurvy* - Scurvy is caused by **vitamin C deficiency**, which is essential for collagen synthesis and maintaining **blood vessel integrity**. - Lack of vitamin C leads to **fragile capillaries**, making patients prone to bleeding, including **subconjunctival hemorrhages**. *Purpura* - Purpura refers to **purple-colored spots on the skin caused by bleeding underneath the skin**. It is a general term for various conditions characterized by **small vessel bleeding**. - These conditions often involve **vascular fragility or platelet abnormalities**, making individuals susceptible to bleeding in different sites, including the conjunctiva, resulting in **subconjunctival hemorrhages**.

Q: Choking is a medical emergency that can occur due to various causes. Which of the following is a common cause of choking in adults?

Food obstruction. ***Food obstruction*** - **Food obstruction** is the most frequent cause of choking in adults, often due to large, poorly chewed pieces of food becoming lodged in the airway [1]. - This typically happens during meals, especially when talking or laughing while eating, or consuming alcohol which impairs coordination [1], [2]. *Laryngospasm* - **Laryngospasm** is an involuntary spasm of the vocal cords that temporarily closes the airway, but it typically resolves spontaneously and is not usually the primary cause of sustained choking in adults from foreign body obstruction [1]. - While it can cause transient difficulty breathing, it's often a protective reflex or a complication of intubation/anesthesia, rather than a common choking event. *Anaphylaxis* - **Anaphylaxis** is a severe allergic reaction that can cause airway swelling (angioedema and bronchospasm), leading to difficulty breathing and a sensation of choking. - However, it is a systemic allergic response with other symptoms like rash, hypotension, and gastrointestinal distress, not a direct mechanical obstruction of the airway by a foreign body. *Aspiration of liquids* - **Aspiration of liquids** occurs when fluids enter the trachea and lungs, which can cause coughing, gagging, and lead to aspiration pneumonia. - While it can be a serious event, it rarely causes complete and sudden airway obstruction that is characteristic of choking on a solid object.

Q: In which condition is the Albumin to Globulin (A:G) ratio maintained?

Nephritic syndrome. ***Nephritic syndrome*** - In nephritic syndrome, the **glomerular filtration is often preserved**, allowing for the maintenance of A:G ratio despite the presence of hematuria and proteinuria [1]. - The condition typically leads to a **moderate degree of proteinuria**, retaining a relatively normal serum albumin level [1]. *Multiple myeloma* - In multiple myeloma, there is often a **high level of paraproteins** leading to a significant drop in albumin, affecting the A:G ratio. - Patients frequently exhibit **renal impairment**, resulting in a disrupted A:G ratio due to increased urinary protein loss. *Protein losing enteropathy* - This condition causes **loss of proteins** like albumin through the gastrointestinal tract, leading to **hypoalbuminemia** and altered A:G ratio. - It is characterized by **diarrhea** and fluid accumulation, further impacting the protein status in circulation. *Cirrhosis* - Cirrhosis leads to **decreased albumin synthesis**, resulting in a low serum albumin and an altered A:G ratio. - The condition is associated with **portal hypertension** and ascites, complicating the biochemical status.

Q: What is the BMI range that defines preobesity?

25-29.9. ***25-29.9*** - A **Body Mass Index (BMI)** between 25 and 29.9 kg/m² is classified as **overweight** [1] or **preobesity**. - This range indicates an increased risk of developing various health problems associated with higher body weight [1]. *18.5-24.9* - This BMI range is considered **normal weight**, which is generally ideal for health [1]. - Individuals within this range typically have the lowest risk of weight-related health complications [1]. *30-34.9* - A BMI in this range is classified as **obesity class I** [1]. - This category indicates a significantly increased risk of developing co-morbidities such as type 2 diabetes and cardiovascular disease [1]. *35-39.9* - This BMI range represents **obesity class II** (severe obesity) [1]. - Individuals in this category face a high risk of serious health issues and often require more aggressive intervention strategies [1].

Q: Which of the following statements about obesity is FALSE?

There is no genetic predisposition to obesity.. There is no genetic predisposition to obesity. - This statement is false because genetic factors play a significant role in an individual's susceptibility to obesity, influencing metabolism, appetite, and fat storage [1]. - While environment and lifestyle are crucial, polygenic influences and certain single-gene disorders can heavily predispose individuals to weight gain [1]. *Smoking is associated with weight loss* - Smoking can lead to appetite suppression and an increased metabolic rate, which may result in weight loss or lower body weight compared to non-smokers. - However, this is not a healthy or recommended method for weight control due to the numerous severe health risks associated with smoking. *Obesity affects only females.* - This statement is false; obesity affects both males and females across all age groups and demographics [2]. - Although there can be differences in fat distribution and associated health risks between sexes, obesity is a global health issue impacting everyone [2]. *The prevalence of obesity decreases with age.* - This statement is generally false; the prevalence of obesity tends to increase with age through middle adulthood before possibly leveling off or slightly declining in older age. - Factors like decreased physical activity, changes in metabolism, and chronic disease accumulation contribute to weight gain later in life [3].

Q: A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

HALE. ***HALE*** - This acronym stands for **Heart-failure Associated Lung Edema**. The symptoms of **progressive dyspnea**, **orthopnea**, **bilateral pedal edema**, **elevated JVP**, **S3 gallop**, and **hepatomegaly** are classic signs of **congestive heart failure** leading to fluid overload and pulmonary congestion [1]. - The pathophysiology involves the heart's inability to pump blood effectively, causing a buildup of pressure in the pulmonary and systemic circulations, leading to the observed symptoms [1]. *DALEY* - This is not a recognized acronym in medical pathophysiology. The symptoms presented are strongly indicative of a specific cardiovascular condition. - There is no clinical scenario where "DALEY" would accurately describe the underlying pathophysiology of dyspnea, edema, and heart failure signs. *OALY* - This is not a recognized acronym in medical pathophysiology. The presented clinical picture requires a well-established and specific pathophysiological explanation. - Using an unrecognized term would not provide an accurate or helpful description of the patient's condition. *None of the options* - The acronym HALE (Heart-failure Associated Lung Edema) accurately captures the core pathophysiology evident from the patient's symptoms and signs. - Given the strong clinical presentation of congestive heart failure with pulmonary and systemic congestion, one of the provided options *does* accurately describe the situation.

Q: What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?

Sodium. ***Sodium*** - The primary electrolyte in **Oral Rehydration Salts (ORS)** is **sodium**, which is crucial for replacing losses due to diarrhea and facilitating water absorption in the intestines [1]. - The standard ORS formulation, recommended by the WHO, contains **75 mEq/L of sodium** to effectively rehydrate individuals with acute watery diarrhea [1]. *Potassium* - While **potassium** is an essential electrolyte found in ORS, its concentration is typically lower than sodium, usually around **20 mEq/L**. - Potassium helps replenish intracellular losses and supports normal cellular function, but it is not the primary electrolyte at the 75 mEq/L concentration. *Glucose* - **Glucose** is a crucial component of ORS, but it is a sugar, not an electrolyte. - Its role is to facilitate the co-transport of **sodium and water** across the intestinal wall, enhancing fluid absorption, but it does not contribute to the electrolyte concentration in mEq/L [1]. *Chloride* - **Chloride** is an electrolyte present in ORS, primarily to balance the charge of **sodium** and prevent hyynatremia. - Its concentration is typically around **65 mEq/L**, making it slightly less concentrated than sodium but still vital for maintaining electrolyte balance.

Q: Which of the following is an acquired condition?

Mastitis. ***Mastitis*** - **Mastitis** is an **inflammatory condition** of the breast, often caused by bacterial infection, particularly common during **lactation** [1]. - It is an **acquired condition** as it develops after birth due to external or internal factors, not present at birth. *Polymastia (supernumerary breasts)* - **Polymastia** is a **congenital condition** where additional breast tissue develops along the **milk line**. - This condition is present at birth and results from *embryological development anomalies*, not acquired later in life. *Polythelia (extra nipples)* - **Polythelia** refers to the presence of **accessory nipples** along the embryonic milk line and is a **congenital anomaly**. - Like polymastia, it is present from birth due to *developmental errors* and is not an acquired condition. *Amastia (absence of breast tissue)* - **Amastia** is a rare **congenital anomaly** characterized by the complete absence of breast tissue, nipple, and areola. - It is a **birth defect**, meaning it is present from birth and not an acquired condition.

Question 1

Reduced osmolarity ORS does not contain which of the following ions?

Accepted Answer

Lactate

Answer

Sodium

Answer

Potassium

Answer

Citrate

Question 2

Which of the following conditions does not typically cause subconjunctival hemorrhages?

Accepted Answer

Pellagra

Answer

Whooping cough

Answer

Scurvy

Answer

Purpura

Question 3

Choking is a medical emergency that can occur due to various causes. Which of the following is a common cause of choking in adults?

Accepted Answer

Food obstruction

Answer

Laryngospasm

Answer

Anaphylaxis

Answer

Aspiration of liquids

Question 4

In which condition is the Albumin to Globulin (A:G) ratio maintained?

Accepted Answer

Nephritic syndrome

Answer

Cirrhosis

Answer

Protein losing enteropathy

Answer

Multiple myeloma

Question 5

What is the BMI range that defines preobesity?

Accepted Answer

25-29.9

Answer

18.5-24.9

Answer

30-34.9

Answer

35-39.9

Question 6

Which of the following statements about obesity is FALSE?

Accepted Answer

There is no genetic predisposition to obesity.

Answer

Smoking is associated with weight loss

Answer

Obesity affects only females.

Answer

The prevalence of obesity decreases with age.

Question 7

An 86-year-old lady presented with severe constipation. She was a known hypertensive on medications for 10 years. In clinic, her BP was 157/98 mm Hg with a heart rate of 58/min. On taking her BP in the supine position, it was found to be 90/60 mm Hg. She had a recent history of depression. She is taking atenolol, thiazide, imipramine, haloperidol, and docusate. What is the next best step in the management?

Accepted Answer

Change imipramine and haloperidol to fluoxetine and risperidone and add bisacodyl for constipation

Answer

Change atenolol and thiazide to calcium channel blocker and ACE inhibitor and add bisacodyl for constipation

Answer

Only add bisacodyl for constipation and continue rest of the medications

Answer

Discontinue all her medications and start her on steroids

Question 8

A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

Accepted Answer

HALE

Answer

DALEY

Answer

OALY

Answer

None of the options

Question 9

What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?

Accepted Answer

Sodium

Answer

Potassium

Answer

Glucose

Answer

Chloride

Question 10

Which of the following is an acquired condition?

Accepted Answer

Mastitis

Answer

Polymastia (supernumerary breasts)

Answer

Polythelia (extra nipples)

Answer

Amastia (absence of breast tissue)

General Medicine — MCQs

General Medicine — MCQs

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