Hospital Medicine Practice Questions

Q: Most clinically significant characteristic of Ringer's Lactate is -

Isotonic. ***Isotonic*** - Ringer's lactate is **isotonic** because its osmolality (approximately $ ext{273 mOsmol/L}$) is similar to that of human plasma ($ ext{275-295 mOsmol/L}$), making it suitable for intravenous fluid replacement [1]. - This characteristic prevents significant shifts of fluid in or out of cells, reducing the risk of **cellular edema** or **dehydration** [1]. *Provides bicarbonate precursors to help in metabolic acidosis.* - While Ringer's lactate contains **lactate**, which is metabolized in the liver to **bicarbonate**, this effect is considered a secondary benefit rather than its most clinically significant characteristic [2]. - The primary clinical utility of Ringer's lactate is its ability to effectively restore **intravascular volume** due to its isotonic nature [2]. *Crystalloid solution.* - Ringer's lactate is indeed a **crystalloid solution**, meaning it contains small molecules that can freely cross semipermeable membranes [1]. - However, being a crystalloid is a classification, while its **isotonicity** is a more direct and clinically significant characteristic regarding its physiological impact and primary use. *Contains potassium in a concentration lower than serum potassium.* - Ringer's lactate contains **potassium** (4 mEq/L), but this concentration is lower than typical serum potassium levels ($ ext{3.5-5.0 mEq/L}$) [2]. - This characteristic is important for fluid balance but not its most defining or clinically significant feature compared to its overall isotonicity.

Q: First line therapy in anaphylactic shock is:

Epinephrine .5 ml of 1:1000 IM. ***Epinephrine .5 ml of 1:1000 IM*** - **Epinephrine** is the **first-line treatment** for anaphylaxis due to its alpha-1 agonist effects (vasoconstriction, which increases blood pressure) and beta-2 agonist effects (bronchodilation, which improves breathing). [1] - The recommended dose and concentration for intramuscular administration in adults is **0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) IM**, repeated every 5-15 minutes as needed. *Atropine 3 mg intravenously* - **Atropine** is an anticholinergic medication used to treat **bradycardia** or organophosphate poisoning, not anaphylaxis. [4] - It does not address the widespread vasaodilation or bronchoconstriction seen in anaphylactic shock. *Adenosine 12 mg intravenously* - **Adenosine** is an antiarrhythmic drug primarily used to convert **supraventricular tachycardia (SVT)** to normal sinus rhythm. [3] - It has no role in the management of anaphylactic shock. *Epinephrine 1 ml of 1:10000 intravenously* - While epinephrine is the correct drug, **intravenous administration** of epinephrine 1:10,000 is typically reserved for **cardiac arrest** [2] or in cases of severe, refractory anaphylaxis under expert care, and carries a higher risk of adverse effects. - The initial and preferred route for anaphylaxis is **intramuscular**, as it provides rapid absorption with lower risks compared to IM administration.

Q: What processing should be done of the blood before transfusion to reduce chances of febrile non-hemolytic transfusion reaction (FNHTR)?

Leucocyte reduction. ***Leucocyte reduction*** - **Febrile non-hemolytic transfusion reactions (FNHTRs)** are primarily caused by cytokines released from donor leukocytes during storage or by recipient antibodies targeting donor leukocytes [1]. - **Leukocyte reduction** removes these donor white blood cells, thereby significantly decreasing the risk of FNHTRs. *Washing* - **Washing** removes plasma proteins and antibodies, which is useful for preventing allergic reactions or anaphylaxis in patients with IgA deficiency, but it is not the primary method for preventing FNHTRs. - While it can remove some cytokines, its main indication is different from preventing leukocyte-mediated reactions. *Irradiation* - **Irradiation** is performed to prevent **transfusion-associated graft-versus-host disease (TA-GVHD)** by inactivating donor lymphocytes, preserving their function but preventing their proliferation. - It does not primarily reduce the number of leukocytes or the associated cytokine release responsible for FNHTRs. *Glycerolization* - **Glycerolization** is a process used to cryopreserve **red blood cells** for long-term storage, often decades. - This process is essential for maintaining the viability of red blood cells in frozen storage but has no direct role in preventing FNHTRs.

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 is not the component of qSOFA?

Unequally dilated pupils. ***Unequally dilated pupils*** - **Unequally dilated pupils** are not a component of the **qSOFA** score. This finding can be indicative of neurological issues such as increased **intracranial pressure** or **uncal herniation**, but not directly part of the sepsis screening tool [1]. - The qSOFA score focuses on easily obtainable clinical signs to rapidly identify patients at risk for poor outcomes from **sepsis**. *Respiratory rate >22/min* - A **respiratory rate greater than 22 breaths per minute** is one of the three criteria for the **qSOFA** score, indicating significant physiological stress. - This elevated respiratory rate suggests an increased work of breathing, often due to **metabolic acidosis** or **systemic inflammation** associated with sepsis. *Altered mental status* - **Altered mental status** (e.g., Glasgow Coma Scale score less than 15) is a core component of the **qSOFA** score [1]. - This sign reflects **cerebral hypoperfusion** or **encephalopathy** due to the systemic effects of sepsis [1]. *Systolic BP<100 mmHg* - A **systolic blood pressure less than 100 mmHg** is another key criterion of the **qSOFA** score. - This indicates **hypotension** and suggests inadequate tissue perfusion, a critical sign of **circulatory dysfunction** in sepsis [1].

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: Which of the following is the most common cause of hyponatremia in hospitalized patients?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH). ***Syndrome of inappropriate antidiuretic hormone secretion (SIADH)*** - **SIADH** is the most common cause of euvolemic hyponatremia in hospitalized patients [1]. - It results from excessive ADH release, leading to water retention, expanded extracellular fluid volume, and subsequent **dilutional hyponatremia** [2]. *Congestive heart failure* - Patients with **congestive heart failure** often develop hyponatremia due to increased ADH and activation of the renin-angiotensin-aldosterone system, leading to water retention [1]. - However, this is typically a **hypervolemic hyponatremia** and is less common overall than SIADH in the general hospitalized population [1]. *Cirrhosis* - **Cirrhosis** can cause hyponatremia, usually hypervolemic, due to impaired free water excretion secondary to high ADH levels and reduced effective arterial blood volume [1]. - While significant, it is a less frequent cause of hyponatremia compared to SIADH in the diverse hospitalized patient population. *Nephrotic syndrome* - **Nephrotic syndrome** can lead to hyponatremia, typically hypervolemic, as a result of profound hypoalbuminemia causing reduced plasma oncotic pressure and subsequent ADH release [1]. - It is a less common cause of hyponatremia compared to SIADH, which affects a broader range of hospitalized patients due to various underlying conditions [3].

Q: What is the primary function of a central venous catheter?

Administer fluids and medications. ***Administer fluids and medications*** - Central venous catheters (CVCs) are designed for the **long-term or rapid administration** of fluids, medications (especially **vasoactive drugs** or **chemotherapy**), and large volumes of nutrition (e.g., **total parenteral nutrition**) [1]. - Their placement in a large central vein allows for **rapid dilution** of infused substances, reducing the risk of peripheral vein irritation and damage [1]. *Monitor heart rate* - While a CVC itself doesn't directly monitor heart rate, an **ECG machine** connected to electrodes on the skin is used for this purpose. - Heart rate monitoring is a basic vital sign assessment, not a specialized function of a central venous catheter. *Deliver oxygen* - Oxygen is delivered via the respiratory system, typically through **nasal cannulas**, **face masks**, or **endotracheal tubes**. - A central venous catheter is part of the circulatory access system and plays no direct role in delivering oxygen for respiration. *Perform dialysis* - Specific types of central venous catheters, known as **dialysis catheters** or **permcaths**, are indeed used for hemodialysis, but this is a specialized application rather than the primary function of *any* central venous catheter [2]. - The primary, broad function of CVCs encompasses various therapeutic infusions, of which dialysis access is a distinct subset requiring a specific catheter design.

Question 1

Most clinically significant characteristic of Ringer's Lactate is -

Accepted Answer

Isotonic

Answer

Provides bicarbonate precursors to help in metabolic acidosis.

Answer

Crystalloid solution.

Answer

Contains potassium in a concentration lower than serum potassium.

Question 2

First line therapy in anaphylactic shock is:

Accepted Answer

Epinephrine .5 ml of 1:1000 IM

Answer

Atropine 3 mg intravenously

Answer

Adenosine 12 mg intravenously

Answer

Epinephrine 1 ml of 1:10000 intravenously

Question 3

What processing should be done of the blood before transfusion to reduce chances of febrile non-hemolytic transfusion reaction (FNHTR)?

Accepted Answer

Leucocyte reduction

Answer

Washing

Answer

Irradiation

Answer

Glycerolization

Question 4

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 5

Which of the following is not the component of qSOFA?

Accepted Answer

Unequally dilated pupils

Answer

Respiratory rate >22/min

Answer

Altered mental status

Answer

Systolic BP<100 mmHg

Question 6

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

Accepted Answer

Grey

Answer

Pink

Answer

Green

Answer

Blue

Question 7

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 8

Which statement best describes the use of central venous catheters versus peripheral intravenous lines for chemotherapy administration?

Accepted Answer

Central venous catheters are advantageous for long-term chemotherapy despite their infection risks.

Answer

Peripheral lines are associated with lower infection risk and greater patient comfort, making them suitable for short-term use.

Answer

Peripheral lines should be used when minimizing infection risk is a priority.

Answer

Central venous catheters should be avoided due to their higher infection risk compared to peripheral lines.

Question 9

Which of the following is the most common cause of hyponatremia in hospitalized patients?

Accepted Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer

Congestive heart failure

Answer

Cirrhosis

Answer

Nephrotic syndrome

Question 10

What is the primary function of a central venous catheter?

Accepted Answer

Administer fluids and medications

Answer

Monitor heart rate

Answer

Deliver oxygen

Answer

Perform dialysis

Hospital Medicine — MCQs

Hospital Medicine — MCQs

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