Hospital Medicine Practice Questions

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: 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.

Question 1

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 2

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 3

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

Hospital Medicine — MCQs

Hospital Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?