Hospital Medicine Practice Questions

Q: What is the single most useful clinical sign of severity in a person without underlying lung disease?

Systolic BP less than 90 mm/Hg. ***Systolic BP less than 90 mm/Hg*** - A **systolic blood pressure below 90 mm/Hg** indicates **hypotension**, reflecting inadequate tissue perfusion and potential **shock**, which is a critical sign of severity in any acute illness [1]. - This suggests **cardiovascular compromise** and requires immediate medical attention to prevent organ damage [1]. *Temp more than 38.5°C* - A **fever above 38.5°C** (101.3°F) indicates an infection or inflammatory process but is not as immediate a sign of life-threatening severity as profound hypotension. - While concerning, fever alone rarely signals imminent circulatory collapse in individuals without underlying conditions. *No significant clinical sign* - This option is incorrect because **systolic blood pressure less than 90 mm/Hg** is a highly significant clinical sign of severity, indicating potential decompensation. - Relying on the absence of signs can lead to delays in critical care for patients exhibiting clear signs of distress [1]. *Heart rate more than 100 bpm* - A **heart rate greater than 100 bpm** (**tachycardia**) can be a response to various stressors, including fever, pain, or anxiety, and is less specific for severe circulatory compromise than hypotension [1]. - While it may indicate an underlying problem, it is often a compensatory mechanism that does not, on its own, signify immediate danger without other signs of organ dysfunction.

Q: Cavitating lesions in the lung are seen in:

Granulomatosis with polyangiitis (GPA). ***Granulomatosis with polyangiitis (GPA)*** - **Granulomatosis with polyangiitis (GPA)**, previously known as Wegener's granulomatosis, classically presents with a **triad of upper airway disease**, **lower airway disease**, and **glomerulonephritis** [1]. - **Cavitating lung lesions** are a hallmark feature of GPA due to the necrotizing vasculitis and granuloma formation in the pulmonary parenchyma [1]. *Polyarteritis nodosa (PAN)* - **Polyarteritis nodosa** is a necrotizing vasculitis of **medium-sized arteries**, but it typically **spares the pulmonary circulation** [1]. - Its clinical manifestations usually involve the skin, peripheral nerves, kidneys, and gastrointestinal tract, with **pulmonary involvement being rare**. *Systemic lupus erythematosus (SLE)* - **Systemic lupus erythematosus** can affect the lungs, causing pleurisy, pneumonitis, or interstitial lung disease, but **cavitating lesions are highly unusual** [1]. - **Pulmonary hemorrhage** or **thromboembolism** can occur, but these do not typically lead to cavitation [1]. *Goodpasture's syndrome* - **Goodpasture's syndrome** is characterized by rapidly progressive **glomerulonephritis** and **pulmonary hemorrhage** due to anti-GBM antibodies [1]. - While it causes lung disease, it typically manifests as **diffuse alveolar hemorrhage** rather than cavitating lesions [1].

Q: MC late complication of central venous line is:

Sepsis. **Sepsis** - **Catheter-related bloodstream infections (CRBSIs)** are the most common late complication of central venous lines, leading to sepsis [1]. - The risk of sepsis increases with the **duration** of catheter placement, frequency of line access, and inadequate aseptic technique [1]. *Air embolism* - An **air embolism** is typically an immediate or early complication during insertion or removal of the central line, or connection/disconnection of administration sets. - It is not considered a late complication as it occurs due to a sudden entry of air into the venous system. *Thromboembolism* - While **thrombosis** can complicate central venous lines, leading to potential thromboembolism, it is less common than sepsis as a late complication [2]. - The formation of a thrombus is often localized to the catheter tip or vessel wall and may or may not lead to a symptomatic embolism [2]. *Cardiac arrhythmias* - **Cardiac arrhythmias** can occur during central venous line insertion if the guidewire or catheter tip irritates the myocardium, making it an immediate or early complication. - This is usually a transient event and not a long-term or late complication associated with the mere presence of the catheter.

Q: What is the most common complication of blood transfusion that can lead to death?

T.R.A.L.I. ***T.R.A.L.I*** - **Transfusion-Related Acute Lung Injury (TRALI)** is the leading cause of transfusion-related mortality, characterized by sudden onset of **non-cardiogenic pulmonary edema** within 6 hours of transfusion [1]. - It is thought to be mediated by **donor antibodies** that activate recipient neutrophils in the pulmonary vasculature, leading to capillary leakage [1]. *Hyperkalemia* - Can occur, especially in massive transfusions or rapid infusion of stored blood, but it is less common and typically less lethal than TRALI [1]. - Often manageable with interventions to shift potassium intracellularly or remove it from the body. *Citrate toxicity* - Associated with **massive transfusions** or in patients with **liver dysfunction**, as the liver metabolizes citrate. - Leads to **hypocalcemia** due to citrate chelating calcium, but is rarely fatal and reversible with calcium administration. *Hypothermia* - Can occur with rapid infusion of large volumes of cold blood products, particularly in trauma or surgical settings. - While it can exacerbate coagulopathy and arrhythmias, it is generally preventable with blood warmers and rarely a direct cause of death compared to TRALI.

Q: Which of the following is a step that should not be performed before an arterial blood gas (ABG) analysis?

Flexion of wrist. Flexion of wrist - **Flexion of the wrist** compresses the radial artery and surrounding structures, making it difficult to locate and successfully access the artery for ABG sampling. - To facilitate arterial puncture, the wrist should be **slightly extended** to make the radial artery more prominent and easier to palpate and access. *Allen's test* - The **Allen's test** is a crucial step performed prior to radial artery puncture to assess the patency of the ulnar artery and ensure adequate collateral circulation to the hand. - If the ulnar artery is not patent, radial artery puncture could lead to **ischemia** of the hand. *Heparin to rinse the syringe* - **Heparin** is used to rinse the syringe to prevent the blood sample from clotting, which would render the ABG analysis inaccurate. - A small amount of **anticoagulant** ensures the blood remains liquid until it reaches the analyzer. *Poking at 45deg angle* - An insertion angle of **45 degrees** (or 30-45 degrees) is the standard technique for obtaining an ABG sample from the radial artery. - This angle allows for optimal access to the artery while minimizing the risk of puncturing through both vessel walls or causing hematoma formation.

Question 1

What is the single most useful clinical sign of severity in a person without underlying lung disease?

Accepted Answer

Systolic BP less than 90 mm/Hg

Answer

Temp more than 38.5°C

Answer

No significant clinical sign

Answer

Heart rate more than 100 bpm

Question 2

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

Question 3

Which of the following statements about normal saline is false?

Accepted Answer

normal saline 0.9% is most suitable to treat acute severe hyponatremia

Answer

fluid of choice for hypovolemic shock

Answer

lead to hyperchloremic metabolic acidosis

Answer

fluid of choice for head injury patient

Question 4

Cavitating lesions in the lung are seen in:

Accepted Answer

Granulomatosis with polyangiitis (GPA)

Answer

Polyarteritis nodosa (PAN)

Answer

Systemic lupus erythematosus (SLE)

Answer

Goodpasture's syndrome

Question 5

MC late complication of central venous line is:

Accepted Answer

Sepsis

Answer

Thromboembolism

Answer

Cardiac arrhythmias

Answer

Air embolism

Question 6

What is the most common complication of blood transfusion that can lead to death?

Accepted Answer

T.R.A.L.I

Answer

Hyperkalemia

Answer

Citrate toxicity

Answer

Hypothermia

Question 7

Which of the following is a step that should not be performed before an arterial blood gas (ABG) analysis?

Accepted Answer

Flexion of wrist

Answer

Allen's test

Answer

Heparin to rinse the syringe

Answer

Poking at 45deg angle

Hospital Medicine — MCQs

Hospital Medicine — MCQs

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