Hospital Medicine — MCQs

Hospital Medicine Indian Medical PG Practice Questions and MCQs

Question 11: Most clinically significant characteristic of Ringer's Lactate is -

A. Isotonic (Correct Answer)
B. Provides bicarbonate precursors to help in metabolic acidosis.
C. Crystalloid solution.
D. Contains potassium in a concentration lower than serum potassium.

Explanation: ***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.

Question 12: First line therapy in anaphylactic shock is:

A. Epinephrine .5 ml of 1:1000 IM (Correct Answer)
B. Atropine 3 mg intravenously
C. Adenosine 12 mg intravenously
D. Epinephrine 1 ml of 1:10000 intravenously

Explanation: ***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.

Question 13: What processing should be done of the blood before transfusion to reduce chances of febrile non-hemolytic transfusion reaction (FNHTR)?

A. Leucocyte reduction (Correct Answer)
B. Washing
C. Irradiation
D. Glycerolization

Explanation: ***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.

Question 14: Which of the following is the complication of massive blood transfusion?

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

Explanation: ***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.

Question 15: Which of the following is not the component of qSOFA?

A. Respiratory rate >22/min
B. Altered mental status
C. Unequally dilated pupils (Correct Answer)
D. Systolic BP<100 mmHg

Explanation: ***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].

Question 16: Which of the following cannula is used in patient with severe dehydration and diarrhea?

A. Pink
B. Grey (Correct Answer)
C. Green
D. Blue

Explanation: 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.

Question 17: Which one of the following is the incorrect step in the ideal sequence for effective CPR?

A. B. Depth of pressure is 2 to 3 cm (Correct Answer)
B. A. 100/120 rate per minute
C. C. Compression to ventilation ratio is 30:2
D. D. Allow complete recoil in between

Explanation: ***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.

Question 18: Which statement best describes the use of central venous catheters versus peripheral intravenous lines for chemotherapy administration?

A. Peripheral lines are associated with lower infection risk and greater patient comfort, making them suitable for short-term use.
B. Central venous catheters are advantageous for long-term chemotherapy despite their infection risks. (Correct Answer)
C. Peripheral lines should be used when minimizing infection risk is a priority.
D. Central venous catheters should be avoided due to their higher infection risk compared to peripheral lines.

Explanation: ***Central venous catheters are advantageous for long-term chemotherapy despite their infection risks.*** - **Central venous catheters (CVCs)** provide reliable long-term access for chemotherapy that may be infused continuously or given over many cycles, minimizing repeated **venipunctures**. [1] - Although CVCs carry a higher risk of **catheter-related bloodstream infections (CRBSIs)** and complications like **thrombosis**, the benefits for prolonged and vesicant chemotherapy often outweigh these risks [1]. *Peripheral lines are associated with lower infection risk and greater patient comfort, making them suitable for short-term use.* - While **peripheral intravenous (PIV) lines** do have a lower initial infection risk and can be more comfortable for *single, short-term infusions*, they are generally unsuitable for **long-term chemotherapy** or **vesicant drugs** [1]. - Their shorter lifespan and risk of **infiltration** and **phlebitis** with prolonged or irritating infusions make them impractical for extended treatment regimens. *Peripheral lines should be used when minimizing infection risk is a priority.* - Although PIVs have a lower infection risk than CVCs for *short-term, non-irritating infusions*, they are not practical for **long-term chemotherapy** and the risk of **repeated venipunctures** can itself introduce infection risk over time. - For vesicant chemotherapy, peripheral lines carry a significant risk of **extravasation**, leading to tissue damage, which outweighs the perceived advantage of lower infection risk in this context [1]. *Central venous catheters should be avoided due to their higher infection risk compared to peripheral lines.* - While CVCs do have an inherently greater risk of **CRBSIs** due to their invasive nature and direct access to central circulation, avoiding them entirely is not appropriate for patients requiring **long-term** or **irritating chemotherapy** [1]. - The benefits of consistent, reliable access, the ability to infuse **vesicants** safely, and avoidance of **repeated peripheral venipunctures** often make CVCs the preferred and medically necessary option despite their risks.

Question 19: Which of the following is the most common cause of hyponatremia in hospitalized patients?

A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Correct Answer)
B. Congestive heart failure
C. Cirrhosis
D. Nephrotic syndrome

Explanation: ***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].

Question 20: What is the primary function of a central venous catheter?

A. Administer fluids and medications (Correct Answer)
B. Monitor heart rate
C. Deliver oxygen
D. Perform dialysis

Explanation: ***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.

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