Hospital Medicine Practice Questions

Q: Which of the following causes the majority of UTIs in hospitalized patients?

Invasive procedures. ***Invasive procedures*** - The use of **urinary catheters** or other urological interventions significantly increases the risk of UTIs in hospitalized patients by providing a direct route for bacteria to enter the bladder [1]. - Catheter-associated UTIs (**CAUTIs**) are the most common type of healthcare-associated infection and are predominantly linked to invasive procedures [1]. *Inadequate perineal care* - While poor perineal hygiene can contribute to UTIs, it is typically a less significant factor than invasive procedures in the hospitalized setting, where **catheterization** is a major risk. - Good perineal care is important but cannot fully mitigate the risk introduced by **indwelling catheters**. *Lack of fluid intake* - Insufficient fluid intake can lead to concentrated urine, which may increase the risk of UTI in general, but it is not the primary cause of UTIs in **hospitalized patients**. [2] - **Urine stasis** due to mechanical obstruction or poor bladder emptying (often associated with catheters) is a greater factor than simply reduced fluid intake. *Immunosuppression* - Immunosuppression can increase susceptibility to infections, including UTIs, but it is not the leading cause of UTIs in most hospitalized patients. - The **direct introduction of bacteria** during invasive procedures more commonly bypasses the body's natural defenses, even in immunocompetent individuals.

Q: A 71-year-old man develops dysphagia for both solids and liquids and weight loss of 60 lb over the past 6 months. He undergoes endoscopy, demonstrating a distal esophageal lesion, and biopsies are consistent with squamous cell carcinoma. He is scheduled for neoadjuvant chemoradiation followed by an esophagectomy. Preoperatively he is started on total parenteral nutrition, given his severe malnutrition reflected by an albumin of less than 1. Which of the following is most likely to be a concern initially in starting total parenteral nutrition in this patient?

Hypophosphatemia. ***Hypophosphatemia*** * This patient with severe malnutrition (albumin <1, 60lb weight loss) is at high risk for **refeeding syndrome** when TPN is initiated [1]. * Upon refeeding, **insulin release** causes intracellular shifts of electrolytes, particularly phosphate, leading to severe hypophosphatemia [1]. * *Hypoglycemia* * TPN contains dextrose, which typically causes **hyperglycemia**, not hypoglycemia, especially given its continuous infusion. * Hypoglycemia would be more likely if TPN was abruptly discontinued, causing a rapid drop in glucose levels as basal insulin continues to be secreted. * *Hyperkalemia* * Refeeding syndrome typically causes a rapid **intracellular shift of potassium**, leading to **hypokalemia**, not hyperkalemia [1]. * Hyperkalemia would be a concern in patients with renal insufficiency or those receiving potassium-sparing diuretics. * *Hypermagnesemia* * Similar to potassium and phosphate, refeeding syndrome usually causes an **intracellular shift of magnesium**, leading to **hypomagnesemia** [1]. * Hypermagnesemia is rare and typically seen in patients with severe renal failure or excessive exogenous magnesium intake (e.g., antacids).

Q: Which of the following is the complication of massive blood transfusion?

Metabolic alkalosis. ***Metabolic alkalosis*** - **Citrate**, an anticoagulant in stored blood, is metabolized by the liver into **bicarbonate**, which can accumulate with massive transfusion. [2] - This bicarbonate excess leads to a rise in blood pH, causing **metabolic alkalosis**. [2] *Respiratory alkalosis* - This typically results from **hyperventilation**, leading to excessive CO2 exhalation. [1] - It is not a direct complication of the chemical constituents or physiological effects of massive blood transfusions. *Metabolic acidosis* - While sometimes seen in early phases due to reduced tissue perfusion or hypothermia in massive transfusion, the predominant and later complication (especially with adequately functioning liver) is metabolic alkalosis due to citrate metabolism. - **Lactic acidosis** can occur in shock or hypoperfusion states, but the buffering capacity and citrate metabolism often shift towards alkalosis. *Respiratory acidosis* - This results from **hypoventilation** or impaired CO2 removal, leading to CO2 retention in the blood. [1] - It is not directly caused by the components of a massive blood transfusion itself.

Q: Which of the following cannula is used in patient with severe dehydration and diarrhea?

Grey. A **16-gauge (Grey)** cannula allows for a high flow rate, making it ideal for rapid fluid resuscitation in severely dehydrated patients [1]. This size is crucial for quickly restoring intravascular volume in cases of severe dehydration and diarrhea where large amounts of fluid are lost. [2] A **20-gauge (Pink)** cannula offers a moderate flow rate, suitable for routine intravenous fluid administration or medication delivery, but generally too slow for rapid resuscitation in severe dehydration. An **18-gauge (Green)** cannula provides a good flow rate, making it suitable for blood transfusions or moderate fluid resuscitation. A **22-gauge (Blue)** cannula has a slow flow rate, typically used for pediatric patients, elderly patients with fragile veins, or for maintaining venous access for medication administration.

Q: Which one of the following is the incorrect step in the ideal sequence for effective CPR?

B. Depth of pressure is 2 to 3 cm. ***Depth of pressure is 2 to 3 cm*** - This option describes an **incorrect depth** for chest compressions in adult CPR. - The recommended compression depth for adults is approximately **5-6 cm (2 to 2.4 inches)** to ensure effective blood flow. *100/120 rate per minute* - This rate of **100 to 120 compressions per minute** is the correct and recommended pace for adult CPR, ensuring adequate blood circulation. - A faster or slower rate can compromise the effectiveness of chest compressions. *Compression to ventilation ratio is 30:2* - A **compression-to-ventilation ratio of 30:2** is the standard for adult CPR, particularly for a single rescuer. - This ratio optimizes both blood flow and oxygen delivery to the patient. *Allow complete recoil in between* - Allowing **complete chest recoil** after each compression is crucial for effective CPR. - This permits the heart to fully refill with blood, maximizing cardiac output with each subsequent compression.

Q: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Closed drainage technique to minimize bacterial entry. ***Closed drainage technique to minimize bacterial entry*** - Maintaining a **closed drainage system** prevents the entry of bacteria into the urinary tract, which is a primary cause of CAUTIs. - This technique involves ensuring the connection between the catheter and the drainage bag remains sealed at all times, minimizing **environmental contamination**. *Prophylactic antibiotics are effective* - **Prophylactic antibiotics** are generally not recommended for routine CAUTI prevention due to concerns about **antibiotic resistance** and limited evidence of effectiveness [1]. - Their use is typically reserved for specific high-risk procedures or patient populations. *Use of face mask during catheter insertion* - While maintaining **asepsis** during catheter insertion is crucial, the use of a face mask specifically addresses **respiratory droplet transmission**, which is not the primary route of bacterial entry into the urinary system during catheterization. - **Sterile gloves** and a **sterile field** are more directly relevant for preventing contamination during insertion [1]. *Early catheter removal when clinically appropriate* - While **early catheter removal** is a critical strategy for CAUTI prevention by reducing dwell time, the question asks for the *primary* evidence-based intervention [1]. A **closed drainage system** directly addresses the mechanism of bacterial entry while the catheter is in place. - Reducing catheter duration minimizes risk, but the closed system ensures safety during the necessary period of catheterization.

Q: In total parenteral nutrition, which of the following parameters is not routinely measured daily?

Liver function tests (LFTs). ***Liver function tests (LFTs)*** - **LFTs** are typically monitored periodically (e.g., weekly or bi-weekly) in patients on TPN, not daily, unless there are specific concerns about liver dysfunction [1]. - Daily monitoring is generally not required because changes in liver function due to TPN are usually insidious and not acutely life-threatening in hours. *Electrolyte* - **Electrolytes** (e.g., sodium, potassium, chloride) are crucial for cellular function and fluid balance [2]. They can fluctuate rapidly with TPN administration and patient's clinical status. - Daily measurement ensures prompt correction of imbalances to prevent serious complications like **cardiac arrhythmias** or neurological disturbances [2]. *Fluid intake and output* - **Fluid intake and output** are essential for assessing **hydration status** and preventing fluid overload or dehydration, which can change rapidly [2]. - Daily monitoring helps guide adjustments to fluid administration in TPN and other intravenous fluids. *Magnesium* - **Magnesium** is an important electrolyte involved in numerous enzymatic reactions and neuromuscular function, and its levels can be significantly affected by TPN [2]. - Daily or frequent monitoring is often necessary, especially in the initial phases of TPN or in patients with pre-existing deficiencies, to prevent complications such as **cardiac arrhythmias** or **weakness** [2].

Q: Which of the following is NOT a standard management option for fat embolism?

Surgical intervention. ***Surgical intervention*** - **Fat embolism syndrome (FES)** is a medical emergency primarily managed with **supportive care**, not surgery. - Surgical intervention is only indicated for the **initial injury**, such as stabilizing long bone fractures, which helps prevent fat emboli, but not for treating an already established FES [1]. *Oxygen therapy* - **Oxygen therapy** is a crucial component of FES management, as the syndrome often leads to **hypoxemia** due to lung involvement. - It helps maintain adequate **tissue oxygenation** and can be administered via nasal cannula, face mask, or mechanical ventilation in severe cases. *Heparin administration* - **Heparin administration** was historically used with the rationale of preventing thrombus formation and potentially breaking down fat globules. - However, its effectiveness is **unproven**, and it carries risks such as bleeding, so it is generally **not recommended** for FES. *Low Molecular Weight Dextran* - **Low Molecular Weight Dextran** has been investigated for its potential to improve blood flow, reduce fat globule aggregation, and expand plasma volume in FES. - While some studies showed promising results, it is **not a universally accepted standard treatment** due to conflicting evidence and potential side effects.

Q: All of the following are selective indications for the use of hypotonic solutions, except:

Burns. ***Burns*** - **Hypotonic solutions** are generally *not* indicated for burn patients because these patients typically lose large amounts of **isotonic fluid** through damaged skin. [1] - The primary goal in burn resuscitation is to replace lost plasma volume with **isotonic crystalloids** (e.g., Lactated Ringer's) to prevent **hypovolemic shock**. [1] *Hypernatremia* - **Hypernatremia** is a condition of excess sodium relative to water, meaning the body has a **water deficit**. [1] - **Hypotonic solutions** are used to gradually lower serum sodium by providing **free water** to dilute the excess sodium. *Free water deficit* - A **free water deficit** indicates a lack of pure water relative to solutes, leading to increased plasma osmolality. [2] - **Hypotonic solutions** are specifically designed to provide **free water** to correct this deficit and restore proper fluid balance. *Maintenance fluid therapy in stable patients* - For stable patients requiring maintenance fluids, **hypotonic solutions** (e.g., D5W with 0.45% NS) are often used to cover obligatory fluid losses and provide adequate water without causing **sodium overload**. [1] - In such cases, the goal is to prevent dehydration and electrolyte imbalances over time, which often requires a balance of electrolytes and **free water**. [1]

Question 1

Which of the following causes the majority of UTIs in hospitalized patients?

Accepted Answer

Invasive procedures

Answer

Inadequate perineal care

Answer

Lack of fluid intake

Answer

Immunosuppression

Question 2

A 71-year-old man develops dysphagia for both solids and liquids and weight loss of 60 lb over the past 6 months. He undergoes endoscopy, demonstrating a distal esophageal lesion, and biopsies are consistent with squamous cell carcinoma. He is scheduled for neoadjuvant chemoradiation followed by an esophagectomy. Preoperatively he is started on total parenteral nutrition, given his severe malnutrition reflected by an albumin of less than 1. Which of the following is most likely to be a concern initially in starting total parenteral nutrition in this patient?

Accepted Answer

Hypophosphatemia

Answer

Hypoglycemia

Answer

Hyperkalemia

Answer

Hypermagnesemia

Question 3

Which of the following is the complication of massive blood transfusion?

Accepted Answer

Metabolic alkalosis

Answer

Respiratory alkalosis

Answer

Metabolic acidosis

Answer

Respiratory acidosis

Question 4

Which of the following cannula is used in patient with severe dehydration and diarrhea?

Accepted Answer

Grey

Answer

Pink

Answer

Green

Answer

Blue

Question 5

Which one of the following is the incorrect step in the ideal sequence for effective CPR?

Accepted Answer

B. Depth of pressure is 2 to 3 cm

Answer

A. 100/120 rate per minute

Answer

C. Compression to ventilation ratio is 30:2

Answer

D. Allow complete recoil in between

Question 6

What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Accepted Answer

Closed drainage technique to minimize bacterial entry

Answer

Use of face mask during catheter insertion

Answer

Prophylactic antibiotics are effective

Answer

Early catheter removal when clinically appropriate

Question 7

In total parenteral nutrition, which of the following parameters is not routinely measured daily?

Accepted Answer

Liver function tests (LFTs)

Answer

Electrolyte

Answer

Fluid intake and output

Answer

Magnesium

Question 8

Which of the following is NOT a standard management option for fat embolism?

Accepted Answer

Surgical intervention

Answer

Heparin administration

Answer

Low Molecular Weight Dextran

Answer

Oxygen therapy

Question 9

All of the following are selective indications for the use of hypotonic solutions, except:

Accepted Answer

Burns

Answer

Free water deficit

Answer

Hypernatremia

Answer

Maintenance fluid therapy in stable patients

Question 10

About Transfusion-Related Acute Lung Injury (TRALI), all of the following are true except:

Accepted Answer

Signs and symptoms usually subside within 2-3 weeks of onset

Answer

Steroids have a doubtful role in management

Answer

Mortality is less than 10%

Answer

Supportive care is the mainstay of treatment

Hospital Medicine — MCQs

Hospital Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?