Hospital Medicine Practice Questions

Q: The commonest site of pressure sore is :

Heel. ***Heel*** - The **heel** is a common site for pressure sore development, especially in bedridden or immobile patients, due to sustained pressure on the bony prominence. - While less common as the *most* common site compared to the sacrum, it is still very frequently affected and can be equally severe. *Sacrum* - The **sacrum** is the *most common site* for pressure ulcers, particularly in individuals who are bed-bound or spend prolonged periods in a supine position. - This area experiences high pressure when lying on the back due to the body's weight pressing down on the bony prominence of the sacrum [1]. *Ischium* - The **ischial tuberosities** are common sites for pressure sores in individuals who are wheelchair-bound or spend extended periods in a seated position. - Pressure on this area is particularly high when sitting, making it vulnerable to tissue damage. *Occiput* - The **occiput** (back of the head) is a common site for pressure sores in infants, critically ill patients, or individuals who are supine for extended periods and unable to reposition their heads. - This is due to sustained pressure on the bony prominence of the skull against the mattress or support surface.

Q: Among the following sites, which is the most common location for development of pressure sores in debilitated patients?

heel. Heel - The heels are a common location due to the localized pressure, especially in supine or chair-bound individuals, and are a high-risk area for developing pressure ulcers because they often bear a significant portion of body weight. [1] - The bone prominence and lack of subcutaneous fat make the skin over the heel particularly vulnerable to ischemia and tissue damage from sustained pressure. [1] Greater trochanter - The greater trochanter is a common site for pressure sore development, especially in individuals positioned in a lateral recumbent position. - However, it typically ranks second or third after the sacrum and heels in overall incidence for most debilitated patients. Ischium - The ischium is a high-risk area for pressure sores, particularly in patients who spend prolonged periods sitting. - While significant in seated patients, it is not the most common site generally across all debilitated patients and various positions. Occiput - The occiput is a risk area for pressure sores, especially in patients who are critically ill, intubated, or lying supine for extended periods. - While it is a significant concern for certain patient populations, it is generally less common than the heels or sacrum for pressure ulcer development in the broad category of debilitated patients.

Q: Consider following statements in respect of parenteral nutrition : 1. indicated in patients when enteral nutrition cannot be given 2. parenteral route is a better choice than enteral route 3. abnormalities of liver functions can occur on prolonged use 4. hyperglycemia is common Which of the above statements are correct ?

1, 3 and 4 only. ***1, 3 and 4 only*** - **Parenteral nutrition (PN)** is used when the gastrointestinal tract is non-functional or inaccessible, making **enteral nutrition (EN)** impossible or inadequate. - **Hyperglycemia** is a common complication due to the high glucose content in PN solutions, and **liver function abnormalities** (e.g., cholestasis, steatosis) can develop with prolonged use. *2, 3 and 4 only* - This option incorrectly states that the parenteral route is better than the enteral route. **Enteral nutrition** is generally preferred due to being more physiological, safer, and less expensive [1]. - While hyperglycemia and liver dysfunction are correct complications, the assertion about the superiority of the parenteral route is false. *1, 2 and 3 only* - This option incorrectly claims that **parenteral nutrition** is a better choice than the enteral route (statement 2). **Enteral nutrition** is always the preferred route if the gut works [1]. - It also omits **hyperglycemia**, which is a frequent and significant complication of parenteral nutrition. *1, 2, 3 and 4* - This option incorrectly includes statement 2, which suggests the parenteral route is superior to the enteral route. **Enteral nutrition** is always preferred when feasible [1]. - While statements 1, 3, and 4 are correct, the inclusion of statement 2 makes this option incorrect.

Q: What is the most frequent complication of Total Parenteral Nutrition (TPN)?

Hyperglycemia. ***Hyperglycemia*** - **Hyperglycemia** is the most common metabolic complication of TPN due to the high dextrose content, especially in patients with pre-existing glucose intolerance or stress. - Close monitoring of blood glucose and insulin administration are often necessary to manage this complication. *Rebound hyperglycemia* - **Rebound hyperglycemia** typically refers to a surge in blood glucose levels following a period of hypoglycemia, or in response to a sudden cessation of insulin, neither of which is the most frequent primary complication of TPN initiation. - While TPN can cause hyperglycemia, the term "rebound hyperglycemia" is not the most accurate description for the initial and most frequent TPN-associated glucose abnormality. *Hypoglycemia* - **Hypoglycemia** is less common during continuous TPN infusion but can occur if TPN is abruptly discontinued, or if excessive insulin is administered. - It is not the most frequent complication observed during steady-state TPN administration. *Hypertriglyceridemia* - **Hypertriglyceridemia** can occur with TPN, particularly with excessive lipid emulsion administration or in patients with impaired lipid metabolism. - Although a potential complication, it is not as frequent as hyperglycemia.

Q: During the discharge of a COVID patient treated with steroids and remdesivir, which of the following will you inform him about? 1. Repeat RT-PCR after 7 days of discharge 2. Watch for the persistence of Anosmia 3. Watch for headache and nasal discharge 4. Monitor glucose levels 5. Watch for Sinusitis symptoms

3,4 and 5. **3, 4, and 5** - For patients treated with **steroids**, it is crucial to monitor **glucose levels** due to the potential for steroid-induced hyperglycemia [1]. - Symptoms like **headache** and **nasal discharge** (and by extension **sinusitis symptoms**) could indicate conditions like **mucormycosis**, a serious fungal infection seen in immunocompromised COVID-19 patients, especially those having received steroids. *1, 3, and 4* - A **repeat RT-PCR after 7 days** of discharge is generally not recommended as per current guidelines, as viral shedding can persist without infectivity. - While monitoring for headache, nasal discharge, and glucose levels is appropriate, omitting the direct vigilance for **sinusitis symptoms** is less comprehensive. *2, 3, and 4* - While **anosmia** (loss of smell) can persist post-COVID, it is primarily a lingering symptom of the infection itself and typically resolves spontaneously, not usually requiring specific discharge instructions for monitoring its persistence to prevent complications. - The focus should be on new or worsening symptoms that might indicate post-COVID complications or secondary infections. *1, 2, 3, 4, and 5* - Including **repeat RT-PCR** and solely "watch for the persistence of Anosmia" without emphasizing resolution or specific actions makes this option less pertinent for discharge advice. - The priority for discharge instructions should be preventable complications and warning signs of serious conditions.

Question 1

The commonest site of pressure sore is :

Accepted Answer

Heel

Answer

Sacrum

Answer

Ischium

Answer

Occiput

Question 2

Among the following sites, which is the most common location for development of pressure sores in debilitated patients?

Accepted Answer

heel

Answer

greater trochanter

Answer

ischium

Answer

occiput

Question 3

Consider following statements in respect of parenteral nutrition :

1. indicated in patients when enteral nutrition cannot be given
2. parenteral route is a better choice than enteral route
3. abnormalities of liver functions can occur on prolonged use
4. hyperglycemia is common Which of the above statements are correct ?

Accepted Answer

1, 3 and 4 only

Answer

2, 3 and 4 only

Answer

1, 2 and 3 only

Answer

1, 2, 3 and 4

Question 4

What is the most frequent complication of Total Parenteral Nutrition (TPN)?

Accepted Answer

Hyperglycemia

Answer

Rebound hyperglycemia

Answer

Hypoglycemia

Answer

Hypertriglyceridemia

Question 5

During the discharge of a COVID patient treated with steroids and remdesivir, which of the following will you inform him about?

1. Repeat RT-PCR after 7 days of discharge
2. Watch for the persistence of Anosmia
3. Watch for headache and nasal discharge
4. Monitor glucose levels
5. Watch for Sinusitis symptoms

Accepted Answer

3,4 and 5

Answer

1,3 and 4

Answer

2,3 and 4

Answer

1,2,3,4 and 5

Hospital Medicine — MCQs

Hospital Medicine — MCQs

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