Download PGI PG 2020 May Medicine Solved Question Paper

Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) 2020 May Medicine Solved Question Paper

1.WhichofthefollowingisFalseregarding
H.Pyloriinfection:
a)Withchronicinfectionureasebreathtestbecomenegative
b)H.Pyloriinfectionremainlifelongifuntreated
c)Endoscopyisdiagnostic
d)Toxigenicstrainsusuallycausesulcer
e)None
CorrectAnswer-A
AnswerisA.Withchronicinfectionureasebreathtestbecome
negative(Withchronicinfectionureasebreathtestbecomes
negative)
UreasebreathtestdetectsH.pyloninfectionby'bacterialurease
activity'andremainspositivetillthebacteriahasnotbeeneradicated
withtreatment.Thusureasebreathtestbecomesnegativeonlyafter
eradicationoforganismfollowingtreatmentandnotwithchronic
Mfection.
Despiteasubstantialhumoralantibodyresponseinfectionpersists
indefinitely(persistslifelongifuntreated)
InvasivediagnostictestarebasedonEndoscopic,endoscopyisa
diagnosticapplication.
H.pyloriproducesseveralvirulencefactorsthathavebeen
implicatedinthedamageofmucosa.

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2.TRUEstatementregardinginfective
endocarditisis/are?
a)Jahnwaylesionsareblanchablehemorrhagesonplams&soles
b)Jahnwaylesionsaretender
c)Jahnwaylesionsarenon-tender
d)Osler'snodesarepalpablenodulesonthepulpoffingers&
toes
e)Osler'snodesarenon-tender
CorrectAnswer-A:C:D
Answer-A,C,D,Jahnwaylesionsareblanchablehemorrhages
onplams&soles,Jahnwaylesionsarenon-tender,Osler's
nodesarepalpablenodulesonthepulpoffingers&toes
PatientswithIEpresentswithfeaturesoccuringdueto
microembolizationofthecardiacvegetationtothevarioussmall
vessels-
Osler'snodes
Painfultendererythematousnodules.
Seenintheskinofextremitiesusuallyinthepulpofthefinger&
sometimestoes.
Janewaylesions-
Smallflat,redspots,irregularinoutline
Nontender
Seeninpalmsandsoles.
Theyarehemorrhagicandblanchonpressure

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3.Causesofpulsuspardoxususinclude?
a)Constrictivepericarditis
b)Cardiactamponade
c)Pulmonaryembolism
d)Restrictivepericarditis
e)Emphysema
CorrectAnswer-A:B:C
Answer-A,B,C,Constrictivepericarditis,Cardiac
tamponade,Pulmonaryembolism
InnormalindividualthesystolicB.P.decreasesbyl0mmHgduring
inspiration.
CausesofPulsusparadoxus:
1. Cardiactamponade
2. ChronicconstrictivePericarditis
3. Emphysema
4. Pulmonaryembolism

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4.Hypercalcemiawithnormalorincreased
withparatharmoneisassociatedwith?
a)Primaryhyperparathyroidism
b)VitaminDintoxication
c)Thiazidediuretics
d)Milkalkalisyndrome
e)Familialhypercalciurichypercalcemia
CorrectAnswer-A:E
Answer-A,E,Primaryhyperparathyroidism,Familial
hypercalciurichypercalcemia
90%casesofhypercalcemiaarecausedbymalignancyor
hyperparathyroidism.
Medicationsandfamilialhypocalciurichypercalcemia.
FamilialcasesofhighPTHlevels
Neonatalseverehyperparathyroidism
Primaryhyperparathyroidism
Secondary&tertiaryhyperparathyroidism

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5.WhichofthefollowingisTRUEregarding
secondheartsound?
a)WidesplitincompleteRBB
b)Splittingincreasedininspiration&decreasedinexpiration
c)Spilittingdecreasedininspiration&increasedinexpiration
d)WidespiltincompleteLBB
e)BestheardatErb'spoint
CorrectAnswer-A:B:E
Answer-A,B,E,WidesplitincompleteRBB,Splitting
increasedininspiration&decreasedinexpiration,Bestheard
atErb'spoint
Thechangesintheintrathoracicpressuresduringbreathingare
transmittedtotheheartandgreatvessels.
Theincreasedamountofbloodflowthroughthepulmonaryvalve
producesdelayintheclosureofpulmonaryvalve.
ProlongedP2andEarlyA2resultinginsplittingof2ndheartsound.
Duringinspiration(A2andP2areseparatedbymorethan30s)
Duringexpirationthesplittingdisappears.
Erb'sPointreferstothethirdintercostalspaceontheleftsternal
borderwherebothcomponentsofS2(A2andP2)canbewell
appreciated.
a)Delayedelectricalactivationoftherightventricle-
CompleteRBBB(proximaltype)
b)Prolongedleftventricularmechanicalsystole
CompleteLBBB(peripheraltype)

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6.TruestatementregardingEmery-Dreifuss
musculardystrophyis/are?
a)X-linked
b)Suddendeath
c)Conductiondefects
d)Cardiacinvolvementisrare
e)Contractures
CorrectAnswer-A:B:C:E
Answer-A,B,C,E,X-linked,Suddendeath,Conduction
defects,Contractures
Emery-DreifussMuscularDystrophy(EDMD)isararegenetic
degenerativediseaseaffectingskeletalmuscleandtheheart.
EDMDcanbesubdividedinto3categories-
1. X-linkedEDMD
2. Autosomaldominant
3. Autosomalrecessive
Clinicalfeatures-
TriadofsymptomsstronglysuggestsEDMD-
1. Slowlyprogressivemuscleweaknessandwastingina
scapulohumero-peronealdistribution
2. Earlycontracturesoftheelbow,ankle,andposteriorneck
3. Cardiacconductiondefects,cardiomyopathy
Onsetisusuallyintheteenageyears
Cardiacdisease-
Cardiacdiseasemaypresentwithsuddencardiacdeath.

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7.Whichofthefollowingarecorrectabout
cardiacarrestmanagementaccording2015
AmericanHeartAssociationguidelinesfor
Cardiopulmonaryresuscitation(CPR)&
EmergencyCardiovascularCare[ECG]?
a)Ventricularfibrillationrequiressynchronizedcardioversion
b)Monophasicdefibrillatorsarepreferredoverbiphasicdevices
c)Epinephrine(1mg)istheDOCforcardiacarrest
d)Lidocainemaybeconsideredasanalternativetoamiodarone
forunresponsiveVF/pVT
e)Vasopressinprovidesaddedadvantagewhencombinedwith
epinephrine
CorrectAnswer-C:D
Answer-C,D,Epinephrine(1mg)istheDOCforcardiac
arrest,Lidocainemaybeconsideredasanalternativeto
amiodaroneforunresponsiveVF/pVT
Defibrillationisusedtotreatcertaintypesofarrhythmias(ventricular
fibrillationandpulselessventriculartachycardia)whilesynchronized
cardioversionisusedtotreatothersi.e.unstablenarrowandwide
complextachyarrhythmiassuchasatrialfibrillation.atrialflutterand
ventriculartachycardia.)

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8.Endocrinalcausesofweightgaininclude?
a)Thyrotoxicosis
b)Hypothyroidism
c)Addisondisease
d)Cushingsyndrome
e)Pheochromocytoma
CorrectAnswer-B:D
Answer-B,D,Hypothyroidism,Cushingsyndrome
Cushing'ssyndrome
Hypothyroidism
Insulinoma
Craniopharyngioma

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9.Hyperprolactinemiaisassociatedwith?
a)Pituitaryadenoma
b)Hyperinsulinemia
c)Pregnancy
d)Lactation
e)Alloftheabove
CorrectAnswer-E
Answer-E.Alloftheabove
1.Physiologic
Pregnancy
Lactation
2.Hypothalamic-pituitarystalkdamage
Craniopharyngioma
Suprasellarpituitarymass
Emptysella
Granulomas
Rathke'scyst
3.Pituitaryhypersection
Pituitaryadenoma(Prolactinoma)
4.Systemicdisorder
Chronicrenalfailure
Hypothyroidism
Cirrhosis
5.Druginduced
Dopaminereceptorblockers
Opiates
H2antagonists-Cimetidine,ranitidine

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10.Causesofchronicempymainclude?
a)Drainageofpleuraleffusion
b)Inadequateantibiotictreatmentforacuteempyma
c)Inadequateneedleaspirationofacuteempyma
d)Vigorouschestphysiotherapy
e)Rupturedsubphrenicabscess
CorrectAnswer-A:B:C:E
Answer-A,B,C,E,Drainageofpleuraleffusion,Inadequate
antibiotictreatmentforacuteempyma,Inadequateneedle
aspirationofacuteempyma,Rupturedsubphrenicabscess
1. Parapneumonicempyema-Streptococcuspneumoniaisthemajor
pathogen.
2. Antecedentconditionssuchasmalnutrition,measlesorinfection
withantibiotic-resistantorganismsmayincreasetheriskofsevere
pneumoniaaccompaniedbyempyema.
3. Traumaisanotherimportantcauseofempyemathoracis
4. CETisthereforeanimportantsequelaofuntreatedorpoorlytreated
empyemathoracis(treatmentincludesantibiotics).
5. Empyemamayincludespreadfromarupturedsubphrenicabscess,
cardiothoracicsurgerysharpforcetraumatothechest,esophageal
ruptureandfollowingdrainageofapleauraleffusion(thoracentesis).
6. Inthetreatmentofacuteempyema,thechronicconditionisoften
duetoanimpertecilydrainedsinuswithcontinuanceoftheoriginal
empyemacavity.

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11.Apatientpresentedwithrecurrent
hemoptysis.Vesselwhichshouldbe
evaluatedforangiographyinclude?
a)Pulmonaryartery
b)Pulmonaryvein
c)Branchialartery
d)Branchialvein
e)Superiorvenacava
CorrectAnswer-A:C
Answer-A,C,Pulmonaryartery,Branchialartery
Hemoptysisisdefinedasmassive(massivehemoptysis)whenblood
lossismorethan400-600ml/day.
Thelunghastwobloodcirculations-
A.Systemvessels(Bronchialvessels)
B.Pulmonaryvessels
Mostoftenhemoptysisoriginatesfromabronchialarterysource,
withonly70%ofcasesarisingfromthepulmonaryartery.

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12.Communityacquirednativevalveinfective
endocarditisiscausedby?
a)Streptococcusviridians
b)Staphylocoocusaureus
c)Enterococcus
d)Candida
e)Pseudomonasaerogenosa
CorrectAnswer-A:B:C
Answer-A,B,C,Streptococcusviridians,Staphylocoocus
aureus,Enterococcus
StaphylococcusaureusfollowedbyStreptococcioftheviridans
groupandcoagulasenegativeStaphylococciarethethreemost
commonorganismsresponsibleforinfectiveendocarditis.
Staphylococcusaureusisthemostcommonoverallcauseof
infectiveendocarditisandisalsothemostcommoncauseinnative
valveandintravenousdrususers.
Coagulase-negativestaphylococci(staphylococcusaureus)isthe
mostcommoncauseinprostheticvalveendocarditis.
Streptococcusviridiansarethemostfrequentlyisolated
microorganismswhentheinfectionisacquiredinacommunity
setting.
Streptococcusmutansisthemostcommoncauseofendocarditis
afterdentalprocedure.
BacteriascausinginfectiveendocarditisarePseudomonasspecies(
i/vdrugabuser),S.bovis,ClostridiumsepticumandHACEK
organisms.

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CandidaalbicansisassociatedwithendocarditisinIVdrugusers,
patientswithprostheticvalvesandimmunocompromisedpatients.

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13.DiagnosticcriteriaforGullianBarre
syndromeincludes?
a)Areflexia
b)Progressiveweaknessofatleast2limbs
c)Exclusionofvasculitis
d)Albumin-cytologicaldissociation
e)Presenceoffever
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Areflexia,Progressiveweaknessofatleast
2limbs,Exclusionofvasculitis,Albumin-cytological
dissociation
DiagnosticcriteriaforGuillainBarresyndrome-
Required-
.Progressiveweaknessof2ormorelimbsduetoneuropathy.
.Areflexia
.Exclusionofothercauses[e.g.vasculitis]
Supportive-
Mildsensoryinvolvement
Facialnerveorothercranialnerveinvolvement
TypicalC.S.Fprofile(albumino-cytologicaldissocation)
Absenceoffever

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14.Truestatementaboutdiabetic
ketoacidosisis/are?
a)Ph<7.3
b)Ketonemia
c)Absenturinaryketonebodies
d)Glucoselevel>300mg/dl
e)Bicarbonate<15meq/1
CorrectAnswer-A:B:D:E
Answer-A,B,D,E,Ph<7.3,Ketonemia,Glucoselevel>
300mg/dl,Bicarbonate<15meq/1
KetoacidosisisrareintypeIIdiabeteswhereinsulinlevelsalthough
functionallyinadequatearestillsufficienttopreventketonebody
formation.
ArterialpHis7.25-7.35,7.0-7.24&<7.0inmild,moderate&
severeDKA.
Diabeticketoacidosisischaracterizedby-
1. Hyperglycemia,
2. Ketosis(ketonemia)andketonuria
3. Acidosis
Ketonesareanearlyindicatorofdiabeticketoacidosisandshould
bemeasuredinindividlualwithtypeIdiabetesmellitus.
Whentheplasmaglucoseisconsistently>16.7mmol/L(300mg/dl).
Hyperketonemiaandacidosis-
Hormonesensitivelipaseisinhibitedbyinsulinandactivatedby
counterregulatoryhormones.
TheserumbicarbonatelevelinD.K.A.istypicallydecreasedtoless

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than15meq/l.

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15.Inacaseofstrokewhichofthefollowing
heartconditioncanbesuspected?
a)Mitralstenosis
b)Aorticregurgitation
c)Patentforamenovale
d)Recurrentatrialarrhythmias
e)Heartfailure
CorrectAnswer-A:C:D:E
Answer-A,C,D,E,Mitralstenosis,Patentforamen
ovale,Recurrentatrialarrhythmias,Heartfailure
ThemostcommoncauseofembolicstrokesareIntra-cardiac
Thrombi.
Malesex
PreviousStrokeorTransientIschemicAttack
Highbloodpressure
Heartdisease-myocardialinfarction(heartattack),mitralstenosis,
heartfailure
Cardiacarrhythmias-especiallyatrialfibrillation,ventricular
tachycardiaandventricularfibrillation.
Smoking
Diabetes
Highbloodcholesterollevels
Sicklecelldisease
Oralcontraceptives
Excessivealcoholintake

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16.ComponentsofCushing'striadinclude?
a)Bradycardia
b)Tachycardia
c)Widepulsepressue
d)Hypotension
e)Irregularbreathing
CorrectAnswer-A:C:E
Answer-A,C,E,Bradycardia,Widepulsepressue,Irregular
breathing
1. Hypertension
2. Bradycardia
3. Irregularbreathing

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17.Apatientpresentedwithhaematuriawith
acuterenalfailure.Ondoingrenalbiopsy,
itshowedcresentricglomerulonephritis.
ImmunofluoresencefindingsshowedC3&
IgGdeposition.Mostlikelydiagnosis
amongthefollowingis?
a)Membranousglomerulonephritis
b)Minimalchangedisease
c)Monoclonaldepositiondisease
d)Acutepost-infectiousglomerulonephritis
e)Focalsegmentalglomerulosclerosis
CorrectAnswer-D
Answer-D.Acutepost-infectiousglomerulonephritis
PSGNappears1to4weeksafterinfectionofpharynxorskinby
specificnephritogenicstrains(12,4and1)ofgroupAbetahemolytic
streptococci.
ThelesionsarecausedbyTypeIIIhypersensitivityreactionwith
immunecomplexdepositionandcomplementactivation,causing
decreasedcomplementlevel.
Clinicalfeatures-
Hematuria
Oliguria,Non-selectiveproteinuria
PSGNcausesacuterenalfailure.
Byimmunofluorescencemicroscopy,thereareirregulargranular
depositsofIgG.IgMandC3inthemesangiumandalongthe

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basementmembrane(starryskyappearance).

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18.WHOconditionedguidelinesfortreatment
ofMDRTB2016,includes4coredrugs
andaddondrugs.Addondrugsare?
a)Bedaquiline
b)Linzolide
c)Delamnaid
d)Capreomycin
e)Moxifloxacin
CorrectAnswer-A:C
Answer-A,BedaquilineC,Delamnaid
GroupA=levofloxacin,moxilloxacin.gatifloxacin
GroupB=amikacin,capreomycin,kanamycin,(streptomycin);
GroupC=ethionamide(orprothionamide),cycloserine(or
terizidone),lineznlid,clofazimine;
GroupD2=bedaquiline,delamanid

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19.FeaturesofvariantCrutzfeldts-Jakob
diseaseare-
a)Viraldisease
b)Priondisease
c)Occurduetoconsumptionofbeeffromcattlewithbovine
spongiformencephalopathy
d)Sporadicformisthemostcommon
e)Prognosisisgood
CorrectAnswer-B:C:D
Answer-B,C,D,Priondisease,Occurduetoconsumptionof
beeffromcattlewithbovinespongiform
encephalopathy,Sporadicformisthemostcommon
Itisararefataldegenerativediseaseofcentralnervoussystemthat
iscausedbyinfectiousproteincalledprion.
Prionareonlyknowninfectiouspathogens.
TherearefourformsofCJD.Theyaresporadic(80-85%),familial
inherited(15%);iatrogenic/acquired(1%),newvariant(canbe
acquiredbyeatingbeefmeatfromcattleafectedbyadisease
similartoCIDcalledbovinespongiformencephalopathy(BSE)or
commonly"madcow"disease).
Clinicalfeatures-
MostofthePatientofCJDpresentsasdementiaandmyoclonus.

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20.Atuberculosispatientwassputum
positiveeven5monthsafterthetreatment
withrifampicin,isoniazid,moxifloxacin&
amikacin.Diagnosisis?
a)MDRTB
b)XDRTB
c)PolydrugresistanceTB
d)Monoresistance
e)Rifampicinresistance
CorrectAnswer-B:C
Answer-B,XDRTBC,PolydrugresistanceTB
Polydrugresistance:Resistancetomorethanonefirst-lineanti-TB
drug(otherthanINHandrifampicin).
MultidrugresistanceTB(MDRTB)isreferredtoresistanceto
"isoniazidandrifampicin".
Rifampicin-resistanceTB(RR-TB):Itincludesanyresistanceto
rifampicin.whethernonresistance,multidrugresistance,
polydrugresistanceorextensivedrugresistance.

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21.Themarkerusedfordeterminingefficacy
ofhepatitisBvaccinationis?
a)HBsAg
b)IgMantiHBcAg
c)IgGantiHBcAg
d)AntiHBsAg
e)AntiHBeAg
CorrectAnswer-D
Answer-D.AntiHBsAg
"PositiveAntiHBsAgdeterminestheefficacyofhepatitisB
vaccination.

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22.Whichofthefollowingfavoursdiagnosis
ofchronicrenalfailureratherthanacute
renalfailure-
a)Anemia
b)Peripheralneuropathy
c)Smallkidney
d)Renalosteodystrophy
e)Dailyincreaseincreatinine
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Anemia,Peripheralneuropathy,Small
kidney,Renalosteodystrophy
Renalsonogramshowingsmallkidneys-UsuallyCKD
Oliguria,dailyincreasesinserumcreatinineandBUN-Probably
ARForARFsuperimposedonCKD
Severeaneminarenalosteotdystrophy(hyperphosphatemia,
hypocalcemia)-PossiblyCKDbutmaybeARFPeripheral
neuropathy

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23.TRUEstatementregardingscleroderma
is/are?
a)Localizeddiseasemorecommonlyinvolvesfaceand
extremities
b)Thereisprogressivepulmonaryfibrosisinmostcases
c)Pulmonaryarterialdiseasewithoutfibrosiscanalsocause
pulmonaryarterialhypertension
d)ACEinhibitorscanbeusedinrenalhypertension
e)Alloftheabove
CorrectAnswer-E
Answer-E.Alloftheabove
Systemicsclerosischaracterizedbyabnormalaccumulationof
fibroustissueinskinandmultipleorgans.
Theskinismostcommonlyaffected,buttheGIT,kidney,heart,
musclesandlungsalsoareinvolved.
Thediseaseisdividedintotwocategories-
l.Diffusescleroderma-
Thereisrapidprogressionwithearlyvisceralinvolvement.
2.Limited(localized)scleroderma(morphea)-
Skininvolvementisconfnedtofingers,forearmandface.
Pulmonaryfibrosis-Frequent,earlyandsevere
Pulmonaryarterialhypertension-ofteninassociationwithpulmonary
fibrosis.
Treatment-
AmongpatientswithSRC,"ACEinhibitors"arerecommendedrather
thanotherantihypertensiveagents.

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24.Featureofhypomagnesemia-
a)Seizures
b)Athetoidmovements
c)Tremors
d)Bradycardia
e)ImprovementwithCasupplements
CorrectAnswer-A:B:C
Answer-A,B,C,Seizures,Athetoidmovements,Tremors
Clinicalfeatures-
1. Hypocalcemia&hypokalemialiketiredness,generalizedweakness,
musclecramps.
2. Cardiovascular:-Arrhythmias,hypertension,tachycardia&cardiac
arrestincludingtorsadedepointes.
3. NeuromuscularandCNS:-increasedirritabilityofthenervous
systemwithtremors,parasthesias,system,spasticity.
4. hypomagnesemiaareathetosis,jerking,nystagmus,andan
extensorplantarreflex,confusion,disorientation,hallucination,&
depression.
5. Severehypomagnesemiamaycausegeneralizedtonic-clonic
seizures.
Hypocalcemiacanbeworsenedbyisolatedtreatmentof
hypomagnaemiawithintravenousmagnesiumsulfatebecause
sulfatebindsionizedcalcium.

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25.Featuresofparkinsonismincludeall
except-
a)Intentiontremors
b)Flaccidity
c)Maskface
d)Rigidity
e)Restingtremors
CorrectAnswer-A:B
Answer-A,B,Intentiontremors,Flaccidity
FourcardinalfeaturesofPDthatcanbegroupedundertheacronym
TRAP-
Tremoratrest,Rigidity,Akinesia(orbradykinesia)andPostural
instability.

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26.WhichofthefollowingcanoccurinCOPD
-
a)Hypoxemia
b)Hypercarbia
c)Decreasedgasexchangeinterminalbronchioles
d)Acidosis
e)Hypocarbia
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Hypoxemia,Hypercarbia,Decreasedgas
exchangeinterminalbronchioles,Acidosis
ThemostcommonsymptomsofCOPDaresputumproduction,
shortnessofbreath,andaproductivecough.
Emphysemaischaracteriredbydestructionofgas-exchangingair
spacesi.e.therespiratorybronchioles,alveolarductsandalveoli.
Lowoxygenlevels(hypoxia)thenhighcarbondioxidelevelinthe
blood(hypercapnia/hypercarbia)
Thereisadevelopmentofrespiratoryacidosisalocalled
hpyercapnicacidosis.

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27.Trueregardingporphyriais/are?
a)Hydroxymethylbilanesynthase(HMBS)deficiencycausesacute
intermittentporphyria
b)Photosensitivityiscommoninacuteintermittentpophyria
c)Erythropoeiticporphyriaiscausedbyuroporphyrinogen
decarboxylase(UROD)deficiency
d)Porphyriacutaneatardaischaracterizedbyvesicubullous
lesions
e)Erytheropeiticporphyriashowsstrongphotosensitivity
CorrectAnswer-A:D:E
Answer-A,Hydroxymethylbilanesynthase(HMBS)deficiency
causesacuteintermittentporphyriaD,Porphyriacutaneatarda
ischaracterizedbyvesicubullouslesionsE,Erytheropeitic
porphyriashowsstrongphotosensitivity
Thefollowingtablegivessummaryofthemajorfindingsof
porphyrias
Typeand
Enzymeinvolved Majorsymptoms
class
Hepatic
porphyrias:
Acute
UroporphyrinogenI Abdominalpain
intermittent
synthase
Neuropsychateic.
porphyria
Uroporphyrinogen PhotosensitivityAbdominalpain
porphyria
decarboxylase
Neuropsychateic
cutaneatarda
Coproporphyrin
Photosensitivity
Hereditary
oxidase
Abdominalpain
Protoporphyrinogen

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Protoporphyrinogen
copro-porphyria oxidase
NeuropsychateicPhotosensitivity
Variegate
porphyria
Erythrohepatic
porphyrias:
Uroporphyrinogen
Congenital
Photosensitivity
IIIsynthase
erythrohepatic
porphyrias
Erythrohepatic
porphyrias:
Ferrochelatase
Photosensitivity
Protoporphyria

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28.Safesttransplantationapproachinliver
disease-
a)Directlytransplantingembryonicstemcellintheliver
b)Transplantingdonorhepatocytesintoliver
c)Transplantingmesenchymalstemcellfromadiposetissueto
liver
d)Injectingerythropoietinintobody
e)None
CorrectAnswer-C
Answer-C.Transplantingmesenchymalstemcellfromadipose
tissuetoliver
Today,autologous(fromthepatient)adiposetissuestemcellarethe
onlystemcellsthathavebeenusedclinicallyfortreatingliver
disease.
Manytrialshaveshownthatpatientswithlivercirrhosishave
benefittedfromautologousadiposetissuederivedmesenchymal
stemcells

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29.Trueaboutmultiplesclerosis:
a)Periventricularinvolvementcan'tbeseenbyimagingstudies
b)Mayproducemasslesion
c)Autoimmuneinflammatorycondition
d)OligoclonalbandsmaybepresentinCSF
e)Spinalcordinvolvementmayoccur
CorrectAnswer-B:C:D:E
Answer-B,MayproducemasslesionC,Autoimmune
inflammatoryconditionD,Oligoclonalbandsmaybepresentin
CSFE,Spinalcordinvolvementmayoccur
"ElevatedIgGincerebrospinalfluidanddiscretebandsofIgG
(oligoclonalbands)arepresentinmanypatients.
ItisanautoimmunediseaseoftheCNScharacterizedbychronic
inflammationdemyelination,gliosis(scarring)andneuronalloss;the
coursecanberelapsing-remittingorprogressive.

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30.Whichofthefollowingis/arefeatureof
aorticstenosis-
a)Durationbetweenonsetofsymptomanddeathisgenerally10-
15year
b)Anginaoccursmainlybecauseoffixedcoronarybloodflows
c)Noincreaseincardiacoutputdespiteexercise
d)Ejectionsystolicmurmurradiatingtoneckmaypresent
e)Leftventricularhypertrophy
CorrectAnswer-C:D:E
Answer-C,D,E,Noincreaseincardiacoutputdespiteexercise
(D)Ejectionsystolicmurmurradiatingtoneckmaypresent
(E)Leftventricularhypertrophy
Theaveragetimetodeathaftertheonsetofvarioussymptoms
isasfollows:
anginapectoris,3years
syncope,8years
dyspnea,2years
congestiveheartfailure,1.5-2years.
Mildormoderatestenosis:
usuallyasymptomatic
Exertionaldyspnoea
Angina
Exertionalsyncope
Suddendeath
Episodesofacutepulmonaryoedema
Signs

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Ejectionsystolicmurmur
Slow-risingcarotidpulse
Thrustingapexbeat(LVpressureoverload)
Narrowpulsepressure
Signsofpulmonaryvenouscongestion(e.g.crepitations)
ThemurmnurofASischaracteristicallyanejection(mid)systolic
murmur.
TheLVbecomesincreasinglyhypertrophiedandcoronarybloodflow
maythenbeinadequate.

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31.Inwhichofthefollowingcondition,non-
hepaticsurgeryisassociatedwithmost
adverseoutcome:
a)Child-PughscoreB
b)Child-PughscoreC
c)Acuteviralhepatitis
d)Acutealcoholichepatitis
e)Chronicviralhepatitis
CorrectAnswer-B
Answer-B.Child-PughscoreC
Table3.Child-PughGradingSystem
Class
TotalPoints
A:well-compensateddisease
5-6
B:functionalcompromise-worseningdisease 7-9
C:decompensateddisease
10-15

---

32.Trueaboutorganophosphate-induced
delayedpolyneuropathy:
a)Usuallyoccursafter2-3monthofacuteexposure
b)Involvesbothsensoryandmotornerve
c)Steroidisusedfortreatment
d)Incompleterecovery
e)None
CorrectAnswer-A:B:D
Answer-A,B,D,Usuallyoccursafter2-3monthofacute
exposure(B)Involvesbothsensoryandmotornerve
(D)Incompleterecovery
Organophosphate-induceddelayedpolyneuropathy(OPIDN)isa
rarecomplicationthatusuallyoccurs2-3weeksafteracute
exposure.Itisamixedsensory/motorpolyneuropathy.
Recoveryisoftenincomplete

---

33.Plexiformlesionisprominentinwhich
groupofpulmonaryhypertension-
a)Recurrentthromboemboli
b)Interstitiallungdiseases
c)FamilialpulmonaryHTN
d)Congenitalheartdiseasewithleft-to-rightshunts
e)Pulmonaryhypertensionassociatedwithhuman
immunodeficiency
CorrectAnswer-C:D:E
Answer-C,FamilialpulmonaryHTND,Congenitalheart
disease...E,Pulmonaryhypertensionassociated...
Plexiformlesionsaremostprominentinidiopathicandfamilial
pulmonaryhypertension,unrepairedcongenitalheartdiseasewith
lefttorightshuntsandpulmonaryhypertensionassociatedwith
humanimmunodeficiency.

---

34.Trueaboutcoagulationdisorders-
a)InDICbothPTandaPTTincrease
b)HemophiliaCisaXlinkedrecessivecondition
c)FactorVIIIcanbegiveninhemophiliaB
d)HemophiliaAisinheritedasX-linkedrecessive
e)None
CorrectAnswer-A:D
Answer-A,InDICbothPTandaPTTincreaseD,HemophiliaAis
inheritedasX-linkedrecessive
HemophiliaA:InheritanceisX-linkedrecessive,leadingtoaffected
malesandcarrierfemales.
CommonfindingsincludetheprolongationofPTand/oraPTT;

---

35.UnlikeChildPughscoring,MELDscore
have:
a)Bedsideassessmenteasy
b)Prothrombintimeexpressedasinternationalnormalizedratio
(INR)
c)Serumcreatinineestimation
d)Fourcomponentisusedinscoring
e)Albuminlevelestimation
CorrectAnswer-B:C
Answer-B,Prothrombintimeexpressedasinternational
normalizedratio(INR)and(C)Serumcreatinineestimation
Thisscoreiscalculatedironthreenoninvasiuevariables:the
prothrombintimeexpressedastheinternationalnormalizedratio
(INR),theserumbilirubinlevel,andtheserumcreatinine
concentration
MELDiscurrentlyusedtoestablishprioritylistingforliver
transplantation.

---

36.Trueaboutidiopathicthrombocytopenic
purpura:
a)Inchildren,itisusuallyanchronicdisease
b)Self-limitedcourseinacuteform
c)Inadults,itisamoreacutedisease
d)Immune-mediateddestructionofplatelets
e)None
CorrectAnswer-B:D
Answer-B,Self-limitedcourseinacuteformD,Immune-
mediateddestructionofplatelets
Itisanacquireddisorderinwhichthereisimmune-mediated
destructionofplateletsandpossiblyinhibitionofplateletrelease
fromthemegakaryocyte.
lnchildren,itisusuallyanacutediseasemostcommonlyfollowing
aninfection,andwithaselflimitedcourse.
Inadults,itisamorechronicdisease.

---

37.Finding(s)Inhemolyticanemiais/are:
a)Increaseinconjugatedbilirubin
b)Increaseinunconjugatedbilirubin
c)Increaseinurineurobilinogen
d)Increaseinfaecalstercobilinogen
e)Increasedbilirubininurine
CorrectAnswer-B:C:D
Answer-B,IncreaseinunconjugatedbilirubinC,Increasein
urineurobilinogenD,Increaseinfaecalstercobilinogen
DecreaseHaemoglobin
IncreasedUnconjugatedbilirubin
Increaselactatedehydrogenase
IncreaseReticulocytes
Increaseurobilinogen

---

38.Riskfactorsassociatedwithhealthcare
associatedpneumonia(HCAP)-
a)Acutecarehospitalizationforatleast2daysinthepreceding
90days
b)Homeinfusiontherapy
c)Immunosuppressivediseaseorimmunosuppressivetherapy
d)Antibiotictherapyinthepreceding90days
e)Hospitalizationfor>48h
CorrectAnswer-A:B:C:D:E
Answer-(A)Acutecarehospitalizationforatleast2daysinthe
preceding90days(B)Homeinfusiontherapy
(C)Immunosuppressivediseaseorimmunosuppressive
therapy(D)Antibiotictherapyinthepreceding90days
(E)Hospitalizationfor>48h
Acutecarehospitalizationforatleast2daysinthepreceding90
days
Residenceinanursinghomeorextendedcarefacility
Homeinfusiontherapy,includingchemotherapy,withinthepast30
days
Long-termdialysiswithinthepast30days
Homewoundcare
Familymemberwithaninfectioninvolvingamultipledrugresistant
pathogen
Immunosuppressivediseaseorimmunosuppressivetherapy

---

39.Whichofthefollowingis/areincludedin
managementofacuteischemicstroke-
a)UnfractionedHeparin
b)LMWH
c)Streptokinase
d)Aspirin
e)Recombinanttissueplasminogenactivator(rt-PA)
CorrectAnswer-D:E
Answer-D,AspirinE,Recombinanttissueplasminogenactivator
(rt-PA)
RecombinantTissueplasminogenActivator(RtPA)istheonly
thrombolyticagentthatisapprovedforthetreatmentofacute
ischaemicstroke.
Useofaspirinwithin48hofstrokeonsetreducedbothstroke
recurrenceriskandmortalitymininally.

---

40.PositiveECGsign(s)ofischemiainTread
milltestis/are-
a)UpslopingdepressionoftheSTsegmentmVbelowbaseline
b)DownslopingdepressionoftheSTsegment>0.1mVbelow
baseline
c)JunctionalST-segment
d)Tachycardia
e)Ventricularprematurebeats
CorrectAnswer-B
Answer-B.DownslopingdepressionoftheSTsegment>0.1mV
belowbaseline
ThcischemiaST:-segmentresponegenerallyisdefinedasflator
downslopingdepressionoftheSTsegmant>O.1mV
belowbaseline(i.e.,thaPRsegnent)andlastinglongerthanO.08s.
UpslopingorjunctionalST-segmentchangesarenotconsidered
characteristicofischemiaanddonotconstituteapositivetest.

---

41.Allarefeature(s)ofsarcoidosisexcept:
a)HighCD4:CD8ratio
b)Hypercalciuriaandhypercalcimiamaybepresent
c)fSerumlevelsofangiotensin-convertingenzyme(ACE)
d)Schaumanandasteroidbodiesarepathognomic
e)None
CorrectAnswer-D
Answer-D.Schaumanandasteroidbodiesarepathognomic
Hypercalcemiaand/orHypercalciuriaoccursinabout10%of
sarcoidosispatients.
Bronchoalveolarlavagefluidlnsarcoidosisisusuallycharacterized
byanincreaseinlymphocyteandahighCD4/CD8ratio.
"Schaumanandasteroidbodies-althoughcharacteristic,thesecells
arenotpathognomicofsarcoidosisbecausetheymaybe
encounteredinothergranulomatousdiseases.
Thegranulomaisthepathologichallmarkofsarcoidosis.
"Serumlevelsofanglotensin-convertingenzyme(ACE)canbe
helpfulinthediagnoslsofsarcoidosis.

---

42.Trueaboutatrialflutter:
a)Narrow-complextachycardiaofupto150/min
b)Pwaveabsent
c)Associatedwith2:1,3:1or4:1AVblock
d)Besttherapyiscatheterablation
e)Occurduetomacrore-entrycircuitwithintherightatrium
CorrectAnswer-A:C:D:E
Answer-A,Narrow-complex...C,Associatedwith...D,Best
therapy...E,Occurduetomacrore-entry...
Atrialflutterischaracterisedbyalarge(macro)re-entrycircuit,
usuallywithintherightatriumencirclingthetricuspidannulus.
Theatrialrateisapproximately300/min,andisusuallyassociated
with2:7,3:1or4:1AVblock
Atrialfluttershouldalwaysbesuspectedwhenthereisanarrow-
complextachycardiaof150/min.
Forrecurrentepisodesofcommonatrialflutter,catheterablationof
thecavotricuspidisthmusabolishesthearrhythmiainover90%of
patient.

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43.Transudativepleuraleffusionoccursin:
a)Urinothorax
b)Dresslersyndrome
c)Nephroticsyndrome
d)Myxedema
e)Congestiveheartfailure
CorrectAnswer-A:C:D:E
Answer-(A)Urinothorax(C)Nephroticsyndrome
(D)Myxedema(E)Congestiveheartfailure
Congestiveheartfailure
Cirrhosis
Pulmonaryembolization
Nephroticsyndrome
Peritonealdialysis
Superiorvenacavaobstruction
Myxedema
Urinothorax

---

44.Trueaboutprimarysclerosing
cholangitis:
a)Involvesonlyintrahepaticbileduct,notextrahepaticbileduct
b)AssociatedwithInflammatoryboweldisease
c)Causesmacronodularcirrhosis
d)Periductalfibrosisofsmallerbileducts
e)None
CorrectAnswer-B:D
Answer-(B)AssociatedwithInflammatoryboweldisease
(D)Periductalfibrosisofsmallerbileducts
PSCischaracterizedbylnflammationandobliterativefibrosisof
lntrahepaticandextrahepaticbileductswlthdilationofpreserved
segments.
Inflammatoryboweldisease,particularlyulcerativecolitis,coexists
inapproximately70%ofindividualswithPSC.
Primarysclerosingcholangltiscausesmicronodularcirrhosis.
Followingchangesareseen-fibrosingcholangitis,periductalfibrosis,
dilationofinterveningbileductsandcholestatiswithfullblown
pictureofbiliarycirrhosis"

---

45.Trueabout4thheartsound:
a)Lowpitch
b)Presentduringearlydiastole
c)Absentinatrialfibrillation
d)Producedintheventricleduringventricularfillingphase
e)Presentinsevereleftventricularhypertrophy
CorrectAnswer-A:C:D:E
Answer-A,LowpitchC,AbsentinatrialfibrillationD,Produced
intheventricleduringventricularfillingphaseE,Presentin
severeleftventricularhypertrophy
Fourthheartsounds(S4):
Lowpitched
Pre-systolicsoundproducedintheventricleduringventricularfilling
Producedduringsecondrapidfillingphase(beforeS1)
Bestheardwithbellofstethoscope.
Theright-sidedS4ispresentinpatientswithrightventricular
hypertrophysecondarytoeitherpulmonicstenosisorpulmonary
hypertension.

---

46.Photosensitivityis/arenotseenin-
a)Acuteintermittentporphyria
b)Variegateporphyria
c)Porphyriacutaneatarda
d)Congenitalerythropoieticporphyria
e)Erythropoieticprotoporphyria
CorrectAnswer-B
Answer-B.Variegateporphyria
Ferrochelatase-erythropoieticprotoporphyria
Protoporphyrinogenoxidase-Variegateporphyria
PBGdeaminase-acuteintemittent
Uroporphyrinogensynthetase-Congenitalerythropoieticporphyria
Uroporphyrinogendecarboxylase-porphyriacutaneatarda

---

47.Trueaboutinsulinoma:
a)Encapsulated
b)Mostlymultiple
c)AssociatedwithMEN-I
d)Enucleationisthetreatmentofchoiceforbenigntumour
e)Histologysimilartonormal(3-cells
CorrectAnswer-A:C:D:E
Answer-(A)Encapsulated(C)AssociatedwithMEN-I
(D)Enucleationisthetreatmentofchoiceforbenigntumour
(E)Histologysimilartonormal(3-cells
Insulinomaisusuallysolitaryandwellencapsulatedtumour
10%aremultiple(alwaysassociatedwithMEN1)and10%are
malignant.
Microscopically,thetumouriscomposedofcordsandsheetofwell-
dffirentiatedBeta-cellswhichdonotdifferfromnormalcells.
Enucleationisthetreatmentofchoiceforbenigninsulinomas.

---

48.RespiratoryfailuretypeIIis/areseenin-
a)Myastheniagravis
b)AcuteexacerbationinCOPD
c)AcutesevereAsthma
d)Pulmonaryedema
e)Pulmonaryembolism
CorrectAnswer-A:B:C
Answer-A,MyastheniagravisB,Acuteexacerbationin
COPDC,AcutesevereAsthma
Acutesevereasthma
AcuteexacerbationofCOPD
Upperairwayobstruction
Acuteneuropathies/paralysis
Narcoticdrugs
Primaryalveolarhypoventilation
Flailchestinjury

---

49.AllaretrueCeliacdiseaseexcept-
a)Antiendomysialantibodyispresent
b)Oat,ryeandbarleycanbesafelygiven
c)Associatedwithdermatitisherpetiformis
d)Associatedwithgliadin
e)Noriskfordevelopmentofcancer
CorrectAnswer-B:E
Answer-B,Oat,ryeandbarleycanbesafelygivenE,Noriskfor
developmentofcancer
Itisaninflammatorydisorderofthesmallboweloccurringin
geneticallysusceptibleindividuals,whichresultsfrom
intolerancetowheatglutenandsimilarproteinsfoundinrye,barley
and,toalesserextent,oats.
Serumantibodies-IgAantigliadin,antiendomysial,andanti-tTG
antibodies-arepresent.
Celiacdiseaseisassociatedwithdermatitisherpetiformis(DH).
Themostimportantcomplicationofceliacdlseaseisthe
developmentofcancer.

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50.TrueaboutHypersensitivitypneumonitis:
a)Occursduetoinorganicantigen
b)IncreasedCD8+Tcellsinbronchoalveolarlavage
c)Manifestsmainlyasanoccupationalandenvironmentdisease
d)Forsevereacutecases,oralsteroidsisgivenfor3-4weeks
e)Interstitialinflammatoryinfiltrateisseeninlung
CorrectAnswer-B:C:D:E
Answer-(B)IncreasedCD8+Tcellsinbronchoalveolarlavage
(C)Manifestsmainlyasanoccupationalandenvironment
disease(D)Forsevereacutecases,oralsteroidsisgivenfor3-
4weeks(E)Interstitialinflammatoryinfiltrateisseeninlung
Itismanifestedmainlyasanoccupationaldisease,inwhich
exposuretoinhaledorganicagentsleadstoacuteandeventually
chronicpulmonarydisease.
Bronchoalveolarlavagespecimensalsoconsistentlydemonstrate
increasednumbersofbothCD4+andCDB+Tlymphocytes.
HistologyshowsevidenceofaninterstitialinflammatoryinfiItratein
thelung.
Inacutecases,prednisoloneshouldbegivenfor3-4weeks,starting
withanoraldoseof40mgperday.

---

51.Tubularproteinuriais/areseenin:
a)Multiplemyeloma
b)Wilsondisease
c)Leadpoisoning
d)Fanconisyndrome
e)None
CorrectAnswer-B:C:D
Answer-B,WilsondiseaseC,LeadpoisoningD,Fanconi
syndrome
Tubularproteinuriaoccursasaresultoffaultyreabsorptionof
normallyfilteredproteinsintheproximaltubule,suchasBeta2-
microglobulinandimmunoglobulinlightchains.
Causesincludeacutetubularnecrosis,toxiinjury(lead,
aminoglycosides),drug-inducedinterstitialnephritis,andhereditary
metabolicdisorders(WisondiseaseandFanconisyndrome).

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52.AllaretrueaboutSjOgren'ssyndrome
execept-
a)Bilateralparotidglandenlargement
b)Parotidglandenlargementmaybepainful
c)Xerostomiamaypresent
d)Progressiontolymphoma
e)Malesareaffectedmorethanfemales
CorrectAnswer-E
Answer-E.Malesareaffectedmorethanfemales
Sjogren'ssyndromeisanautoimmunedisorderassociatedwith
parotidglands.
Itaffectswomenmore(40-60years)
ClinicalFeatures-
Dryeyes(keratoconjuctivitissicca)
Xerostomia
Vaginaldryness
Raynaud'sphenomenon
Lymphoma
Splenomegaly

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53.Highaniongapacidosisis/areassociate
a)Lacticacidosis
b)Ethyleneglycolpoisoning
c)Aspirinoverdose
d)Diarrhea
e)Renaltubularacidosis
CorrectAnswer-A:B:C
Answer-A,LacticacidosisB,Ethyleneglycol
poisoningC,Aspirinoverdose
Lacticacidosis
Ketoacidosis(diabetic,alcoholic,starvation)
Toxins(ethyleneglycol,methanol,glycol,pyroglutamicacid)
Renalfailure(acuteandchronic)

---

54.Proximalrenaltubularacidosis(RTA)
is/areassociatedwith:
a)Fanconianemia
b)Multiplemyeloma
c)Leadpoisoning
d)Sjogren'ssyndrome
e)SLE
CorrectAnswer-A:B:C
Answer-A,FanconianemiaB,MultiplemyelomaC,Multiple
myeloma
lnheritedFanconi'ssyndromeCystinosis.
HeavymetaltoxicitYLead,cadmiumandmercuryPoisoning
Wilson'sdisease
DrugsCarbonicanhydraseInhibitorslfosfamide
ParaproteinaemiaMyeloma
Amyloidosis
Hyperparathyroidism

---

55.FeatureofFelty'ssyndromeis/are-
a)Seropositiveforrheumatoidfactor
b)Splenomegaly
c)Longstandingrheumatoidarthritis
d)Neutrophilia
e)Keratoconjunctivitissicca
CorrectAnswer-A:B:C:E
Answer-(A)Seropositiveforrheumatoidfactor
(B)Splenomegaly(C)Longstandingrheumatoidarthritis
(E)Keratoconjunctivitissicca
Feltysyndromeisapotentiallyseriousconditionthatisassociated
withrheumatoidarthritis.
Clinicalfeatures-
Lymphadenopathy
Vasculitis,
legulcers
Splenomegaly
Weightloss
Recurrentinfections
Skinpigments
Keratoconjunctivitissicca
SeropositiveforRF

---

56.TrueaboutSevereCombined
Immunodeficiency(SCID):
a)Adenosinedeaminaseenzymemaybegivenfortreatment
b)Haematopoieticstemcelltransplant(HSCT)iscurative
c)MostcommoninheritanceisXlinkedrecessiveandautosomal
recessive
d)Lymphocytosisispresentinmostcases
e)Increasedriskofinfectionbypneumocystisjiroveci
CorrectAnswer-A:B:C:E
Answer-A,Adenosinedeaminaseenzyme...B,Haematopoietic
stem...C,Mostcommoninheritance...E,Increasedriskof
infection...
Themostcommonform,accountingfor5o%to6o%ofcases,X-
linkedandinheritedintheautosomalrecessivemode.
Adenosinedeaminasedeficiency:Thisthefirstimmunodeficiency
diseaseassociatedwithanenzymedeficiency.
PersonswithSCIDhavesevereinfectionsbyCandidaalbicans,
Pneumocystisjiroveci,Pseudomonas,cytomegalovirus,varicella.
HSCtransplantationisthemainstayoftreatment.

---

57.MalignanciesassociatedwithAIDS-
a)PrimaryCNSlymphoma
b)Cervicalcancer
c)Kaposisarcoma
d)Ovariancancer
e)Endometrialcancer
CorrectAnswer-A:B:C:D
Answer-(A)PrimaryCNSlymphoma(B)Cervicalcancer
(C)Kaposisarcoma(D)Ovariancancer
TheneoplasticdiseasesconsideredtobeAIDSdefiningconditions
areKaposi'ssarcomanon-Hodgkin'slymphoma,andinvasive
cervicalcarcinoma,ovariancarcinoma.

---

58.Malignancyassociatedwith
hypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer
d)Prostatecancer
e)Multiplemyeloma
CorrectAnswer-A:C:D:E
Answer-A,BreastcancerC,Non-smalllungcancerD,Prostate
cancerE,Multiplemyeloma
Lungcarcinoma,breastcarcinoma,andmultlplemyelomaaccount
formorethan50%ofallcasesofmalignancy-associated
hypercalcemia.
Gastrointestinaltumarsandprostatecarcinomaarelesscommon
causesofhypercalcemia.

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59.Restrictivelungdiseasediffersfrom
obstructivelungdiseaseby
a)DecreasedFVC
b)DecreasedFEV1
c)DecreasedTLC
d)DecreasedRV
e)DecreasedFEV1/FVC
CorrectAnswer-A:B:C:D
Answer-A,DecreasedFVCB,DecreasedFEV1C,Decreased
TLCD,DecreasedRV
PETResultforRestrictivelungdisease-
FEV1-Decreased
FVC-Decreased
FEV1/FVC-Normalorincreased
TLC-Decreased
DLCO-Decreasedinintrinsicrestrictivelungdisease

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60.Fifthcranialnervepalsycauses
a)Weaknessofopeningofmouth
b)Weaknessofclosureofmouth
c)Lossofcornealreflex
d)Lossoflacrimalreflex
e)Lossoftastesensationfromanterior2/3oftongue
CorrectAnswer-A:B:C:D
Answer-A,WeaknessofopeningofmouthB,Weaknessof
closureofmouthC,LossofcornealreflexD,Lossoflacrimal
reflex
Openingofmouthiscausedbybothlateralpterygoid-->Supplied
bymandibularbranchoftrigeminalnerve.
1. Onesideinjurytotrigeminalnervecausesweaknessofopeningof
mouthanddeviationofjawtoaffectedside.
2. Bothsidepalsycausesweaknessofopeningofmouth.
Cornealreflexandlacrimalreflexpathwayinvolvetrigeminalnerve.
Cornealreflex-Afferentlimbisformedbyophthalmicnerveand
efferentlimbisfacialnerve.

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61.Patientcamewithcomplaintsof
Polydipsia,hypercalciurea,
nephrolithiasis,metabolicalkalosis.
Possiblecauseis
a)Bartterssyndrome
b)Gittlemanssyndrome
c)Addisonsdisease
d)Chronicdiureticuse
e)None
CorrectAnswer-A
Answer-A.Bartterssyndrome
Barttersyndromeisanautosomalrecessivedisordercausedby
mutationingenecodingforbasolateralchloridechannel(ClC-kb).
Thereislossofsodium,chloride,potassiumandcalciuminurine.
Themajorclinicalfindingsarehyponatremia,hypokalemia,polyurea,
polydipsia,metabolicalkalosis,normaltolow
BP,hypomagnesemia(onlyinsomepatients),hypochloremia,
hypercalciuria(causingnephrocalcinosis),andgrowth

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62.Allofthefollowingstatementsabout
Neurofibromatosisaretrue,Except:
a)AutosomalRecessiveInheritance
b)Cutaneousneurofibromas
c)Cataract
d)Scoliosis
e)None
CorrectAnswer-A
Answer-A.AutosomalRecessiveInheritance
Neurofibromatosisisinheritedasanautosomaldominantcondition.
PeripheralNeurofibromatosis(VonRecklinghausen'ssyndrome)
Mostprevalenttype(90%)
DiagnosticCriteriaforNFI
Diagnosedwhenanytwoofthefollowingarepresent
1. Sixmorecafe-au-loitmaculesover5mmingreatestdiameterin
prepubertalindividualsandover15mmingreatestdiameterinpost-
pubertalindividuals.
2. Axillaryoringuinalfreckling
3. TwoormoreirisLischnodules
4. Twoormoreneurofibromasoroneplexiformneurofibroma
5. Adistinctiveosseouslesionsuchassphenoiddysplasiaorcortical
thinningoflongbone,withorwithoutpseudoarthrosis.6.Optic
gliomas.
6. AfirstdegreerelativewithNFIwhosediagnosiswasbasedonthe
aforementionedcriteria.
ScoliosisisthemostcommonorthopaedicmanifestationNFl.

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---

63.TrueaboutECGfindingsofventricular
prematurebeatis/are
a)IncreaseR-Rinterval
b)STsegmentdepression
c)STsegmentelevation
d)Twaveinversion
e)ObsuredPwave
CorrectAnswer-B:C:D:E
Answer-B,STsegmentdepressionC,STsegmentelevationD,T
waveinversionE,ObsuredPwave
ST-Twave
WhenQRScomplexupight
S-Tsegmentisdepressedandconvexupwards
Twaveisinverted
WhenQRScomplexdownward
S-Tsegmentiselevatedandconcaveupwards
Twaveisupright

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64.Vascularchangesofmalignant
hypertensionisare-
a)Hyalinearteriosclerosis
b)Necrotizingarteriolitis
c)Hyperplasticarterioscleroesis
d)Aorticdissection
e)Onionskinning
CorrectAnswer-B:C:D:E
Answer-(B)Necrotizingarteriolitis(C)Hyperplastic
arterioscleroesis(D)Aorticdissection(E)Onionskinning
Hypertensionisassociatedwithtwoforms-
1.Hyalinearteriolosclerosis-
Itischaracteristicofbenignhypertension.
2.Hyperplasticarteriosclerosis
Itischaracteristicofmalignanthypertension
Onionskinning
Thereismucinousintimalthickeningandfibrousintimalthickening.
Theremaybeaccompaniedfibrinoiddepositswithnecrosisofthe
vesselswall-->fibrinoidnecrosis(ornecrotizingarteriolitis).

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65.Patientcomeswithmilddyspnea.OnECG
monomorphicventriculartachycardiawas
found,whichofthefollowingdrugistobe
used
a)Adenosine
b)Lignocaine
c)Amiodarone
d)Propranolol
e)Procainamide
CorrectAnswer-B:C:D:E
Answer-
B,LignocaineC,AmiodaroneD,PropranololE,Procainamide
StablepatientwithmonomorphicVT
1.Ifleftventricularfunctionisnormal-
IVprocainamideor
IVamiodaroneor
IVsotalol/propranol/esmolol
Lidocainemayalsobeused
2.Impairedleftventricularfunction
IVamiodaroneorlidocainearepreferred

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66.Nottrueaboutkaposisarcoma-
a)CausedbyHHV-8
b)ClassicalformisassociatedwithHIV
c)Isanangioproliferativedisorder
d)Monocentrictumor
e)MayinvolveGIT
CorrectAnswer-B:D
Answer-(B)ClassicalformisassociatedwithHIV
(D)Monocentrictumor
KaPosisarcomaismulticentricvasculartumorcausedbyHuman
herpesvirus-8(HHV-8)alsocalledKaposisarcomaassociated
herpesvirus(KSHV).
TherearefourformsofKaposisarcoma-
l)Classicalform(EuropeanorMediterraneanKS)
ThereisnoassociationwithHIV.Thereareskinplaquesand
nodules.
2)Africanform(EndemicformorEquatorialform)
ThereisnoassociationwithHIV.Thereislymphadenopathy
3)Transplantassociated(immunosuppressionassociated)KS
4)AIDScssociated(Epidemic)KS
ItisassociatedwithHIVinfecfion

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67.Capnographyhelpstoknowthe
following
a)Correctintubation
b)Pulmonaryembolism
c)Adequateventilation
d)Lungperfusion
e)Significantmetabolicchange
CorrectAnswer-A:B:C:D:E
Answer-A,CorrectintubationB,Pulmonary
embolismC,AdequateventilationD,Lung
perfusionE,Significantmetabolicchange
ConditionsthataffectETCO2
Increased
Hypoventilation
Rebreathing
Malignanthyperthermia,
Neurolepticmalignantsyndrome
Increasedskeletalmuscleactivity(shivering
Hypermetabolism
Hyperthyroidism&thyroidstorm
Decreased
Hyperventilation
Pulmonaryembolism
Hypoperfusion,hypotension,hypovalemia,shock
Hypothermia

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68.Nottrueregardingmucopolysccharidosis
is/are
a)Theyarelysosomaldiseases
b)AllareautosomaldominantexceptSanfilipposyndrome
c)Theyhavecommonskeletalfeature:Dysostosismultiplex
d)HurlersyndromeisduetodeficiencyofIduronatesulfatase
e)Morquiosyndrome[IV]isduetodeficiencyofBeta-
galactosidase
CorrectAnswer-B:D
Answer-B,AllareautosomaldominantexceptSanfilippo
syndromeD,HurlersyndromeisduetodeficiencyofIduronate
sulfatase
Mucopolysaccharidosis(MPS)representaheterogenousgroupof
inheritablelysosomalstoragediseasesinwhichtheaccumulationof
undegradedglycansleadstoprogressivedamageofaffected
tissues.
Hurler(IH)syndrome-AlphaL-iduronidase
Cornealclouding,dysostosismultiplex,organomegaly;heart
disease,mentalretardation
Sanfilipposyndrome-Autosomalrecessive.
MorquioIVsyndrome-Beta-galactosidase,Galactose-6-sulfate
sulfatase
Maroteaux-Lamysyndrome-N-acetylgalactosamine(Dysostosis
multiplex)

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69.Earlydiastolicmurmurisseeninwhich
condition(s)-
a)Mitralstenosis
b)Tricuspidstenosis
c)Aorticregurgitation
d)Pulmonaryregurgitation
e)Atrialmyxoma
CorrectAnswer-C:D
Answer-(C)Aorticregurgitation(D)Pulmonaryregurgitation
Aorticregurgitation-Themurmurislowintensity,high-pitched,best
heardovertheleftsternalborderorovertherightsecondintercostal
space.
AnAustinFlintmurmurisusuallyassociatedwithsignificantaortic
regurgitation.
Pulmonaryregurgitation-Pulmonaryregurgitationismostcommonly
duetopulmonaryhypertension(Graham-Steellmurmur)
Leftanteriordescendingarterystenosis-Thismurmur,alsoknown
asDock'smurmur.

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70.Continuousmurmurisseenis-
a)Patentductusarteriosus
b)Tetrologyoffallot
c)Pregnancy
d)Coarctationofaorta
e)Ventricularseptaldefect
CorrectAnswer-A:C:D
Answer-(A)Patentductusarteriosus(C)Pregnancy
(D)Coarctationofaorta
CommonCausesofcontinuousmurmurs
Systemicarteriovenousfistula(congenital/acquired)
Coronaryarteriovenousfistula
AnomalousoriginofLeftcoronaryarteryfrompulmonaryartery
Communicationbetweensinusofvalsalvaandrightsideofheart
(i.e.Rupturedsinusofvalsalvaintorightsideofheart)
CoarctationofAorta:Continuousmurmurintheback
PatentDuctusArteriosus(PDA)
Surgicallycreatedshuntse.g.Blalock-Tausigshunt
Mammarysouffle(pregnancy)

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71.Drugsusedinbladder/urinary
incontinence
a)Oxybutynin
b)Tolterodine
c)Trospium
d)Neostigmine
e)Demecarium
CorrectAnswer-A:B:C
Answer-A,OxybutyninB,TolterodineC,Trospium
SelectiveM3antagonists-Oxybutynin,darifenacin,Tolterodine
Nonselectiveantagonist-Trospium,Propiverine
Tricyclicantidepressant-Imipramine

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72.Milk-alkalisyndromeisassociatedwith-
a)HighPTH
b)Hypercalcemia
c)Metabolicacidosis
d)Elevatedcreatinine
e)Hyperphosphatemia
CorrectAnswer-B:D:E
Answer-(B)Hypercalcemia(D)Elevatedcreatinine
(E)Hyperphosphatemia
Thesyndromeischaracterizedby-
1. Hypercalcemia
2. Hyperphosphatemia
3. Metabolicalkalosis
4. Metastaticcalcification
5. Progressiverenalfailure(inreased,BUNandcreatinine)

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73.Whichofthefollowingis/areincludedin
themanagementofstressincontinence
a)Botulinumtoxin
b)Kellyprocedure
c)Antichoinergic
d)Urethropexy
e)Imipramine
CorrectAnswer-B:C:D:E
Answer-B,KellyprocedureC,AntichoinergicD,Urethropexy
E,Imipramine
Thereare4typesoftreatment-
1.Behaviorchanges
2.Medicine
Anticholinergicmedicineshelprelaxthemusclesofthebladder.
Antimuscarinicdrugsblockbladdercontractions.
Imipramine,anantidepressant,helpsrelaxbladdermuscles.
3.Pelvicfloormuscletraining
4.Surgery
Anteriorvaginalrepair(anteriorcolporrhaphyorKellyprocedure)
helpsrestoreweakandsaggingvaginalwalls.
Artificialurinarysphincter
Bulkinginjectionsmaketheareaaroundtheurethrathicker.
BurchurethropexyandMarshall-Marchetti-Krantz(MMK)procedure

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74.Primaquniesensitivityisseeninanemia
withfollowingenzymedeficiencyexcept
a)Pyruvatedehydrogenase
b)Hexokinase
c)Glucose6phosphatedehydrogenase
d)Glucose6phosphate
e)None
CorrectAnswer-A:B:D
Answer-A,PyruvatedehydrogenaseB,HexokinaseD,Glucose6
phosphate
Itisactiveonpreandexo-erythrocyticstage.(Primaquineistheonly
antimalarialwhichisactiveonexoerythrocyticstage).Itactsby
interferingmitochondrialfunction.
ThosewithG-6-PDdeficiencyarehighlysensitiveanilhemolytic
anaemiacanoccur.
ThereforeitshouldbeavoidedinpregnancyasfetuswithG6PD
deficiencymaydevelophemolyticanemia.

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75.Soluteinduceddiuresisischaracterized
by-
a)Polyuria
b)Decreasedurineosmolality
c)Urine:Plasmaosmolality>0.7
d)Osmoticclearance>3ml/min
e)Urineoutput>3L/day
CorrectAnswer-A:C:D:E
Answer-(A)Polyuria(C)Urine:Plasmaosmolality>0.7
(D)Osmoticclearance>3ml/min(E)Urineoutput>3L/day
Urine-toPlasmaosmolalityratio>0.7
Osmoticclearance>3mL/min
PolyuriaUrineosmolality(>300mosmol)Solute
diuresisGlucose,mannitol,radiocontrast,urea(fromhigh
proteinfeeding)medullarycysticdiseases,resolvingATN,or
obstruction,diuretics.

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76.Redcolorofurineiscausedby
a)Anilinedye
b)Beetrootingestion
c)Rifampicin
d)Penolintake
e)Alkaptonuria
CorrectAnswer-A:B:C
Answer-A,AnilinedyeB,BeetrootingestionC,Rifampicin
Hematuria
Porphyria
Serratiamarcescens
Anilinedyes
Ingestionofblackberries
Ingestionofbeetroot
Phenolphthaliene
Phenytoin
Rifampin(redbrownorange)
Pyridium

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77.Whichofthefollowingis/arefeature(s)of
hypomagnesemia
a)Tremors
b)Improvementseenwithcalciumsupplementation
c)Atheroidmovements
d)Seizure
e)Bradycardia
CorrectAnswer-A:B:C:D
Answer-(A)Tremors(B)Improvementseenwithcalcium
supplementation(C)Atheroidmovements(D)Seizure
Clinicalfeaturesaremostly:
1. Neuromuscular&CNShyperirritability:Tetany,Seizura,tremer,
muscleweakness,ataxia,nystagmus,vertigo,atheroidmovement,
depression,irritability,deliriumandpsychosis.
2. Cardiacarrhythmias:Sinustachycardia,othersupraventricular
tachycardia,andventriculararrhythmias.

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78.ComponentsofAPACHE-11score
include(s)-
a)Age
b)Glassgowcommascale
c)Pa02
d)Alanineaminotransferase(ALT)
e)Serumlactate
CorrectAnswer-A:B:C
Answer-A,AgeB,GlassgowcommascaleC,Pa02
APACHEIIscoreincludesAge,GCS,Physiologicalparameters(BP,
RespiratoryRate,Pa02)andchronicmedicalconditions.
APACHEIISCORE(AcutePhysiologicalAndChronicHealth
EvaluationSystem)
TheAPACHEIIscoringsystemisthemostcommonlyusedseverity
ofillnessscoringsysteminNorthAmerica
TheAPACHEIIscoreisrecordedasthesumoftheAcute
physiologyscore(Vitalsigns,oxygenation,laboratoryvalues),GCS,
AgeandChronichealthpointsasdetailedinthefollowingtable.

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79.Whichofthefollowingstatement(s)is/are
trueaboutmyastheniaGraviswith
muscle-specifictyrosinekinase(MuSK)
antibodiesthananti-AChRAb-
a)Diseaseonsetisearlierwithfemalepredominance
b)Neckandfacialmuscleweaknessaremorecommon
c)Moreproximalmuscleinvolvement
d)Associatedwiththymichyperplasia
e)Poorresponsewithacetylcholineesterase(AChE)inhibitors
CorrectAnswer-A:B:C:E
Answer-(A)Diseaseonsetisearlierwithfemalepredominance
(B)Neckandfacialmuscleweaknessaremorecommon
(C)Moreproximalmuscleinvolvement(E)Poorresponsewith
acetylcholineesterase(AChE)inhibitors
Featuresare-
1. Onsetisearlierwithfemalepredominance
2. Thymushistologyisusuallynormal
3. Selectivefacial,bulbarneckorrespiratorymuscleweakness
4. Involvementofproximalmuscles
5. Relativesparingofocularmuscles
6. Poorresponsetoacetylcholinesteraseinhibitors(anticholinesterase)

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80.Clinicalpresentationofpituitaryapoplexy
include(s)allexcept-
a)Ophthalmoplegia
b)Visualimpairment
c)Fever
d)Severeheadache
e)Hypertension
CorrectAnswer-E
Answer-E.Hypertension
1. Severehypoglycemic
2. Severeheadache(usuallyretroorbital)
3. Impairedconsciousness
4. Fever
5. Visualdisturbances(visualfielddefect,visualacuity)
6. Ophthalmoplegia(ocularparesis)Causingdiplopia
7. Hypotension&shock
8. Nausea/vomiting
9. Meningealsign

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81.Trueaboutventilatorassociated
pneumonia(VAP)-
a)2ndmostcommonnosocomialinfectionintheintensivecare
unit
b)Colonizationofthepharynxwithbacteriaisriskfactor
c)Highestriskoccurinthefirst5days
d)Gastricacidmayplayaroleinprotectionagainstnosocomial
pneumonias
e)Developsonlyafter1weekonmechanicalventilation
CorrectAnswer-A:B:C:D
Answer-(A)2ndmostcommonnosocomialinfectioninthe
intensivecareunit(B)Colonizationofthepharynxwithbacteria
isriskfactor(C)Highestriskoccurinthefirst5days
(D)Gastricacidmayplayaroleinprotectionagainst
nosocomialpneumonias
Ventilatorassociatedpenumoniais2dmostcommonnosocomial
infectionafterurinarytractinfection.
Ventilator-associatedpneumonia(VAP)ispneumoniathatdevelops
48hoursorlongeraftermechanicalventilationisgivenbymeans
ofanendotrachealtubeortracheostomy.
VAPresultsfromtheinvasionofthelowerrespiratorytractandLung
parenchymabymicroorganism.
RiskforVAPisgreatestduringthefirst5daysofmechanical
vantilation.
EarlyonsetVAPisdefinedaspneumoniathatoccurswithin4days.
Gastricacidmayplayaroleinprotectionagainstnosocomial

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pneumonias.

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82.Feature(s)ofvitaminAtoxicityinclude(s)-
a)Hypercalcemia
b)Yellowskin
c)Anorexia
d)Poorwoundhealing
e)Papilledemaandhepatomegaly
CorrectAnswer-A:B:C:E
Answer-(A)Hypercalcemia(B)Yellowskin(C)Anorexia
(E)Papilledemaandhepatomegaly
HypervitaminosisAcanleadtoruptureoflysosomalmembrane.
Acutetoxicity-Pseudotumourcerebri(headache,dizziness,
vomiting,drowsiness,blurredvision)
Chronictoxicity-anorexia,weightloss,nausea,boneandjointpain,
boneabnormalitiesandbonyswelling.

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83.Whichofthefollowingdyadsarecorrect
a)Pulsusparadoxus-aorticregurgitation
b)Pulsusbisferiens-mitralstenosis
c)Water-hammerpulse-aorticregurgitation
d)Pulsusparvusettardus-aorticstenosis
e)Collapsingpulse-aorticregurgitation
CorrectAnswer-C:D:E
Answer-C,Water-hammerpulse-aorticregurgitationD,Pulsus
parvusettardus-aorticstenosisE,Collapsingpulse-aortic
regurgitation

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84.Neurofibromatosistype1is/are
associatedwith-
a)Caf?-au-laitspots
b)Cataracts
c)Axillaryfreckling
d)Facialnervepalsy
e)Opticnervemeningioma
CorrectAnswer-A:C
Answer-(A)Caf?-au-laitspots(C)Axillaryfreckling
FeaturesofNeurofibromatosis1are:cafeaulaitspots,
neurofibromasorplexiformneuroma,freckling,opticgliomaand
Lischnodules.

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85.Exudativepleuraleffusionis/areseenin
allexcept-
a)Cirrhosis
b)Carcinoma
c)Bacterialpneumonia
d)Tuberculosis
e)Congestiveheartfailure
CorrectAnswer-A:E
Answer-(A)Cirrhosis(E)Congestiveheartfailure
Collagenvasculardisease-
Rheumatoidarthritis
SLE
Druginducedlupus
Sjogren'ssyndrome
Wegener'sgranulomatosis
Churgstrausssyndrome
Infectiousdisease-
Bacterialinfection
Tuberculosis
Gastrointestinalinfections-
Esophagealperforation
Pancreaticdisease
Intraabdominalabscesses
Diaphragmatichernia
Neoplastic-
Metastatic

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Mesothelioma

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86.Whichofthefollowingis/aretrueabout
jugularvenouspressure(JVP)waveform
a)awaveoccurjustafterelectrocardiographicPwave
b)Prominentxandydescentsisseeninconstrictivepericarditis
c)Canonawavesoccurinatrioventricular(AV)dissociation
d)vwaveoccurinearlysystoleofcardiaccycle
e)Prominentxdescentbutanabsentydescentisseenincardiac
temponade
CorrectAnswer-A:B:C:E
Answer-A,awaveoccurjustafterelectrocardiographicP
waveB,Prominentxandydescentsisseeninconstrictive
pericarditisC,Canonawavesoccurinatrioventricular(AV)
dissociationE,Prominentxdescentbutanabsentydescentis
seenincardiactemponade
Atrialcontractionproducesthefirstpressurepeakcalledtheawave.
Thecwaveisthetransmittedmanifestationoftheriseinatrial
pressureproducedbythebulgingofthetricuspidvalveintotheatria
duringisovolumetricventricularcontraction.
Thevwavemirrorstheriseinatrialpressurebeforethetricuspid
valveopensduringdiastole.
a-xdescent-Constrictivepericalditis,Cardiactemponade,
Restrictivecardiomyopathy
v-ydescent-Ticuspidregurgitation,Constrictivepericarditis

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87.TreatmentofacuteHyperleukocytosis
includes:
a)Hydroxyurea
b)Isotretinoin
c)Leukapheresis
d)Vincristine
e)All
CorrectAnswer-A:C:D
Answer-(A)Hydroxyurea(C)Leukapheresis(D)Vincristine
Leukapheresisisthetreatmentofchoice.
InpatientswithAML,hydroxyureashouldbestarted.
InALLpatients,higherthan200,000/mm3patientsmaybetreated
withvinctistine,steroids,orboth.

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88.TrueaboutSwan-Ganzcatheter:
a)Measuresrightatrialpressure
b)Measuresleftventricularfillingpressure
c)MeasurePCWP
d)Insertedthroughleftsubclavianvein
e)InserteddirectlyinRightatrium
CorrectAnswer-A:B:C:D
Answer-(A)Measuresrightatrialpressure(B)Measuresleft
ventricularfillingpressure(C)MeasurePCWP(D)Inserted
throughleftsubclavianvein
Continuouscardiacoutputmonitoring.
CentraltemPeraturemonitoring
Measurementofpulmonaryarterypressure(canalsomeasureRA
andRVpressuresduringinsertion)
Measurementofmixedvenoussaturations
Estimationofdiastolicfillingofleftheart(normalPCWP2-12mmHg)

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89.Allaretrueaboutchronicfatigue
syndromeexcept:
a)Fordiagnosis,durationoffatigueshouldbeatleast6month
b)Impairedmemoryandconcentrationmaypresent
c)Fatiguerelievedbyrest
d)Physicalexaminationshowsnoabnormalities
e)Cognitivebehavioraltherapyisusefulfortreatment
CorrectAnswer-C
Answer-C.Fatiguerelievedbyrest
Fatiguelastsforatleast6months
Fatigueisofnewordefiniteonset.
Fatigueisnottheresultofanorganicdiseaseorofcontinuing
exertion
Fatigueisnotalleviatedbyrest.
Fatiguesymptomsaresoarthroat,tendercervicaloraxilarylymph
nodes,musclepain,paininseveraljoints,headaches,malaise

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90.Whichofthefollowingis/areusedfor
assessmentofcarbohydrate
malabsorption:
a)Schillingtest
b)Steatorrhoea
c)D-xylosetest
d)Glucosetest
e)Urinetest
CorrectAnswer-C
Answer-C.D-xylosetest
D-xyloseabsorptiontestisthemostcommonlyemployedtestfor
carbohydrateabsorption-Harrison
Anendoscopicmucosalbiopsyisthemorespecifictestandisnow
consideredessential.
D-xyloseisacarbohydratethatisabsorbedalmostexclusivelyinthe
proximalsmallbowelwithoutthehelpofpancreaticenzymes.A
positiveD-xylosetestindicatesmalabsorptionduetointestinal
mucosaldiseaseandthusbeusedasatestforassessmentof
mucosalfunction.

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91.Allaretrueaboutprimaryaldosteronism
except:
a)Oneofthemostcommoncauseofsecondaryhypertension
b)Hyperkalemia
c)Sodiumretention
d)Ratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)
isausefulscreeningtest
e)Tetanymayoccur
CorrectAnswer-B
Answer-B.Hyperkalemia
Primaryhyperaldosteronismisoneofthemostcommoncauseof
secondaryhypertension.
Excessivelevelsofaldosteronecausesodiumretentionand
potassiumexcretion,withresultanthypertensionandhypokalemia.
Hypokalemiacancauseweakness,parethesias,visualdisturbances
andtetany.
Thediagnosisofprimaryhyperaldosteronismisconfirmedbythe
elvatedlevelofaldostetoneanddepressedlevelsofrenininthe
circulation(lowPRA).
Theratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)is
ausefulscreeningtest.

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92.Allaretrueaboutacutepericarditis
except:
a)Painradiatetoleftshoulder&arm
b)WidespreadelevationoftheSTsegments,oftenwithupward
concavity&thenreturntobaseline
c)Painrelievedbylyingsupine&intensifiedbysittingupand
leaningforward
d)Corticosteroidrelievessymptoms
e)High-pitchedscratchingorcrunchingnoisemayheardin
auscultation
CorrectAnswer-C
Answer-C.Painrelievedbylyingsupine&intensifiedbysitting
upandleaningforward
Thecharacteristicpainofpericarditisisretrosternal,radiatestothe
shouldersandneck(retrosternal,andleftprecoridal).
Characteristically,pericaridialpainmayberelievedbysittingupand
leaningforwardandisintensifiedbylyingsupine.
Apericardialfrictionrubisahigh-pitchedsuperficialscratchingor
crunchingnoise,producedbymovementoftheinflamed
pericardium.
TherearefourstagesofECGchangesintheevolutionofacute
pericarditis.
Instage1,thereiswidespreadelevationoftheSTsegments,often
withupwardconcavity,involvingtwoorthreestandardlimbleads
andV2toV6,withreciprocaldepressionsonlyinaVRand
sometimesV1,aswellasdepressionofthePRsegmentUsually

---

therearenosignificantchangesinQRScomplexes.
Instage2,afterseveraldays,theSTsegmentsreturntonormal,
andonlythen,orevenlater,dotheTwavesbecomeinverted(stage
3).
Ultimately,weeksormonthsaftertheonsetofacutepericarditis,the
ECGreturnstonormalinstage4.
Thepainisusuallyrelievedbyaspirin.

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93.Allaretrueabouthepatorenalsyndrome
except:
a)Creatininelevelraised
b)Albumininfusiongiven
c)Livertransplantationimprovesrenalfunctions
d)Mayoccurincirrhosis
e)Lowdosedopamineinfusionisveryeffective
CorrectAnswer-E
Answer-E.Lowdosedopamineinfusionisveryeffective
Thehepatorenalsyndrome(HRS)isaformoffunctionalrenalfailure
withoutrenalpathologythatoccursinabout10%ofpatientswith
advancedcirrhosisoracuteliverfailure.
Therearemarkeddisturbancesinthcarterialrenalcirculationin
PatientswithHRS.
TyPeIHRS-asignificantreductionincreatinineclearancewithin1-2
weeksofpresentation.
Type2HRS-anelevationofserumcreatininelevel.
HRSisoftenseeninpatientswithrefractoryascites.
Treatment-
dopamineorprostaglandinanalogueswereusedasrenal
vasodilatingmedications.
Patientsaretreatedwithmidodrine,analpha-agonist,alongwith
octreotideandintravenousalbumin.
ThebesttheragyforHRSislivertransplantation.

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94.Whichofthefollowingmarkerssuggest
likelyprimarycancerincarcinomaof
unknownprimary(CUP):
a)CK7isfoundintumorsofthelung,ovary,endometrium&
breast
b)CK20+/CDX-2+/CK7?,suggestiveoflowergastrointestinal
cancer
c)Calretin&WT-1formelanoma
d)Chromogranin,synaptophysin&CD56aremarkerof
neuroendocrineprrimary
e)None
CorrectAnswer-A:B:D
Answer-A,CK7isfoundintumorsofthelung,ovary,
endometrium&breastB,CK20+/CDX-2+/CK7?,suggestiveof
lowergastrointestinalcancerD,Chromogranin,synaptophysin
&CD56aremarkerofneuroendocrineprrimary
CK7,CK20,thrombomodulin-Urothelial
CK7,CK20,CDX-2,carcinoembryonicantigen(CEA)-intestinal
Calretinin,WT-1-Mesothelioma
Chromogranin,synaptophysin,CD56-Neuroendocrine

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95.Feature(s)ofBulbarpalsyis/are:
a)Dysphagia
b)Absentjawjerk
c)Absentgagreflex
d)Tongueatrophy
e)Tonguewasting&fasciculations
CorrectAnswer-A:B:C:D:E
Answer-(A)Dysphagia(B)Absentjawjerk(C)Absentgag
reflex(D)Tongueatrophy(E)Tonguewasting&fasciculations
Paralysisorlossoffunctionsuppliedbycranialnervearisingfrom
bulb(oldnameofmedullaoblongata).
AffectedCNare9,10,11&l2th.
Tongue-flaccid,wasted,fasciculationmaybepresent.
InvolvementofIX&XCN:Nasaltwang,nasalregurgitation,hoarse
voice,dysphagia,lossofsensationoverpl/3tongue,
weakcough,absentgagreflex&weakcoughreflex.
Inu/llesion,thereisneveracompleteparalysisofdeglutitionorof
articulation.

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96.Whichofthefollowingis/arefeature(s)of
acuteinterstitialnephritis:
a)Eosinophiluria
b)Peripheraleosinophilia
c)WBCcast
d)Grosshaematuria
e)Significantproteinuria
CorrectAnswer-A:B:C
Answer-(A)Eosinophiluria(B)Peripheraleosinophilia(C)WBC
cast
Peripheraleosinophiliacanoccur,especiallywithdruginduced.
Microscopichematuriaisinvariablypresent.
Urinalysiscanrevealwhitebloodcell,granularorhyalinecast.
Thepresenceofurineeosinophilsisneithersensitiveorspecific.
Proteinuriacanbeafeature,particularlyinNSAIDS-induced
interstitialnephritis.

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97.Whichofthefollowingistrueabout
medicationoveruseheadache:
a)Notassociatedwithtriptanuse
b)Restrictionofanalgesicsshouldbedone
c)Opioidismainlyresponsible
d)Preventivetherapyshouldbeencouragedafterstopping/
reducinganalgesic
e)None
CorrectAnswer-B:C:D
Answer-(B)Restrictionofanalgesicsshouldbedone
(C)Opioidismainlyresponsible(D)Preventivetherapyshould
beencouragedafterstopping/reducinganalgesic
medicationsthatarethemostcommonculpritsarecompound
analgesia(particularlycodeineandotheropiatecontaining
preparations)andtriptans,andMOHisusuallyassociatedwithuse
onmorethan10-15dayspermonth.
Managementisbywithdrawaloftheresponsibleanalgesics
Migraineprophylacticsmaybehelpfulinreducingtherebound
headaches.

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98.Whichistrueaboutthrombolysisinacute
ischemicstroke:
a)Mosteffectiveifusedwithin3hour
b)Contraindicatedinh/opriorintracranialhaemorrahage
c)Useofheparinwithin48hrisnotacontraindication
d)Contraindicatedifplatelets<100,000permicroliter
e)All
CorrectAnswer-A:B:D
Answer-A,Mosteffectiveifusedwithin3
hourB,Contraindicatedinh/opriorintracranial
haemorrahageD,Contraindicatedifplatelets<100,000per
microliter
Intravenousthrombolysiswithrecombinanttissueplasminogen
activator(rt-PA)increasestheriskofhaemorrhagictransformationof
thecerebralinfarctwithpotentiallyfatalresults.However,ifitis
givenwithin4.5hoursofsymptomonsettocatefullyselected
patients,thehaemorrhagicriskisoffsetbyanimprovementin
overalloutcome.

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99.Highaniongapmetabolicacidosisis/are
presentin:
a)Asthma
b)COPDwithCO2retention
c)Poorlycontrolleddiabetes
d)Renaltubularacidosis
e)All
CorrectAnswer-C
Answer-C.Poorlycontrolleddiabetes
Ketoacidosis
Diabetic
Alcoholic
Starvation

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100.Extrathyroidfeatureofhypothyroidism
includes:
a)Pretibialmyxedema
b)Carpaltunnelsyndrome
c)Bradycardia
d)Thyroidacropathy
e)Peripheraledema
CorrectAnswer-B:C:E
Answer-(B)Carpaltunnelsyndrome(C)Bradycardia
(E)Peripheraledema
Commonsymptomsare-Weightgain,Fatigue,Dryskinandhair,
Menorrhagia,Hoarseness,coldness
CVS-Bradycardia,Myxoedema,hypertension
Nervoussystem-Carpaltunnelsyndrome,
Facialfeatures-purplishlips,malarflush,periorbitaloedema
Yellowingofskinoccursduetoaccumulationofincreasecarotene.

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101.TrueaboutMcCune-Albrightsyndrome:
a)Occurinchildren&duringpuberty
b)Precociouspubertyinfemale
c)Involvelongboneoflimb
d)Associatedwithhypothyroidism
e)All
CorrectAnswer-A:B:C
Answer-A,Occurinchildren&duringpubertyB,Precocious
pubertyinfemaleC,Involvelongboneoflimb
McCune-Albrightsyndrome(MAS)ischaracterizedbythetriadof
polyostoticfibrousdysplasia,cafeaulaitskinpigmentation,and
peripheralprecociouspuberty.
Albrightsyndromeisprecocioussexualdevelopment,whichoccurs
mostofteningirls.
Theaverageageatonsetinaffectedgirlsisabout3yrandpuberty.

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102.Increasedportalveinpressure&normal
hepaticveinpressurecanbeseeninall
except:
a)Alcoholiccirhhosis
b)Alcholoichepatitis
c)BuddChairisyndrome
d)Portalveinthrombosis
e)Inferiorvenacavaobstruction
CorrectAnswer-C:E
Answer-C,BuddChairisyndromeE,Inferiorvenacava
obstruction
"Budd-Chiarisyndrome(Obstructionofhepaticveinsatanysitefrom
efferentveinofthelobuletotheentryoftheIVCintorightatrium.
Posthepatic-Budd-Chiarisyndrome,Inferiorvenacavalwebs

---

103.Trueaboutmultiplesclerosis:
a)Corticosteroidsareusedinacuteattack
b)IntravenousImmunoglobuliniseffectivemodeoftreat?ment
c)IFNa-usedinrecurrence
d)IFN-P-usedinrecurrence
e)Plasmapheresismaybeusedinsevererelapses
CorrectAnswer-A:D:E
Answer-(A)Corticosteroidsareusedinacuteattack(D)IFN-P-
usedinrecurrence(E)Plasmapheresismaybeusedinsevere
relapses
MaindrugsusedfortreatingmultiplesclerosisincludeInterferon-
1a
Frequencyofrelapsesinmultiplesclerosispatientisdecreasedby
beta-interferon/glatiramer.
Newerdrugapprovedforrelapseinmultiplesclerosispatientsis
Fingolimod.
Glucocorticoidsareusedtomanageeitherfirstattacksoracute
exacerbations.
Natalizumabisamonoclonalantibodyagainst4subunitof41
integrinonlymphocytes,usefulintreatingmultiplesclerosis.
Itreducestherelapseratewhengivenintravenouslyoncemonthly.

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104.Whichofthefollowingstatement(s)
is/areregardingAmericanHeart
Association(AHA)Guideline-2015for
cardiopulmonaryresuscitation(CPR)&
Emergencycardiovascularcare(ECC):
a)Chestcompression:ventilationCompressionventilationratio
withoutadvancedairway?rate30:2irrespectiveofrescuer&
ageofpatient
b)Compressionrate-atleast100/min
c)FailuretoachieveanETCO2of10mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeen
associatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)
d)Limitinterruptionsinchestcompressionstolessthan10
seconds
e)None
CorrectAnswer-C:D
Answer-C,FailuretoachieveanETCO2of10mmHgby
waveformcapnographyafter20minutesofresuscitationhas
beenassociatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)D,Limitinterruptionsinchest
compressionstolessthan10seconds
Compressionrateismodifiedtoarangeofl00to120/min.
Compressionventilationratiowithoutadvancedairway-1or2
rescuers30:2

---

FailuretoachieveanETCO2ofI0mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeenassociated
withanextremelypoorchanceofROSCandsurvival.
Theclarifiedrecommendatio-nforcfrestcompressiondepthfor
adultsisatleast2inches(Scm)butnotgreaterthan2.4inches(6
cm).

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105.Haintestis/areusedfor:
a)DetectionofINHresistanceonly
b)Detectionofrifampicinresistanceonly
c)Detectionofbothrifampicin&INHresistance
d)DetectionofresistanceofalldrugsoffirstlineATT
e)All
CorrectAnswer-C
Answer-C.Detectionofbothrifampicin&INHresistance
"GenotypeMTBDRplus("HAINtest")qNAAandhybridization-based
testuseimmobilizedDNAprobesonnitrocellulosemembranes(line
probeassayLPA)&Colorimetricchangeindicateshybridization.
ldentifiesM.tuberculosisanddetectsRif&INHresistanceinaday.

---

106.TrueaboutPulmonaryartery
catheterization(Swan-Ganzcatheter
placement):
a)Measuresrightatrialpressure
b)Measuresleftventricularfillingpressure
c)MeasurePCWP
d)Insertedthroughleftsubclavianvein
e)Measurescentralvenouspressure
CorrectAnswer-A:B:C:D
Answer-(A)Measuresrightatrialpressure(B)Measuresleft
ventricularfillingpressure(C)MeasurePCWP(D)Inserted
throughleftsubclavianvein
Continuouscardiacoutputmonitoring
Centraltemperaturemonitoring
Measurementofpulmonaryarterypressure(canalsomeasureRA
andRVpressuresduringinsertion)
Measurementofmixedvenoussaturations.
Estimationofdiastolicfillingofleftheart
Itmeasuresthepressureatthreedifferentplaces:rightatrium,
pulmonaryarteryandpulmonarycapillaries.

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107.Presentationoftabesdorsalisincludes:
a)Lancinatingpaininleg
b)Lossofproprioception
c)Sensorydefect
d)Noinvolvementofbladder&bowel
e)Sensoryataxia
CorrectAnswer-A:B:C:E
Answer-(A)Lancinatingpaininleg(B)Lossofproprioception
(C)Sensorydefect(E)Sensoryataxia
Symptomsare
Ataxicwide-basedgait
Footdrop
Paresthesia;
Bladderdisturbances;
Impotence;
Areflexia;and
Lossofpositional,Deep-pain,andTemperaturesensations.
Trophicjointdegeneration(Charcot'sjoints)canresultfromlossof
painsensation.
Opticatrophyoccursintabes.

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108.TrueaboutPrinzmetal'sangina:
a)Maypresentatrest
b)Occursdueatheroscleroticobstructionofcoronaryarteries
c)Smokingisariskfactor
d)Nitratesareusedfortreatment
e)CCBsareusedfortreatment
CorrectAnswer-A:C:D:E
Answer-(A)Maypresentatrest(C)Smokingisariskfactor
(D)Nitratesareusedfortreatment(E)CCBsareusedfor
treatment
ThissyndromeisduetofocalspasmofanepicardialcoronAry
artery,leadingtoseveremyocardialischemialeadingtosevere
myocardialischemia.
Therightcoronaryarteryisthemostfrequentsite,followedbythe
leftanteriordescendingcoronaryartery.
Acetylcholinereleasedbytheparasympatheticsystematrestwill
simplycausecontractionofthevascularsmoothmuscle.
ItusuallyoccursatrestandisassociatedwithtransientST-segment
elevation.
Etiology
cigarettesmokers
Treatment-
Nitratesandcalciumchannelblockersarethemaintreatmentsfor
patientswithvariantangina.

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109.Whichofthefollowingis/aretrueabout
RevisedJonesCriteria2015ofAHAfor
diagnosisofacuterheumaticfever-
a)Polyarthritisinlow-riskpopulationsisamajorcriteria
b)Polyarthralgiainmoderate-andhigh-riskpopulationsisaminor
criteria
c)Monoarthritisinmoderate-andhigh-riskpopulationsisamajor
criteria
d)EchocardiographywithDopplerstudyshouldbeperformedin
allcasesofconfirmedandsuspectedARF
e)Echocardiography/Dopplerstudyshouldbeperformedto
assesswhethercarditisispresentintheabsenceof
auscultatoryfindings
CorrectAnswer-A:C:D:E
Answer-(A)Polyarthritisinlow-riskpopulationsisamajor
criteria(C)Monoarthritisinmoderate-andhigh-risk
populationsisamajorcriteria(D)Echocardiographywith
Dopplerstudyshouldbeperformedinallcasesofconfirmed
andsuspectedARF(E)Echocardiography/Dopplerstudy
shouldbeperformedtoassesswhethercarditisispresentin
theabsenceofauscultatoryfindings
Clinicalmanifestationsanddiagnosis
2015RevisedJonesCriteriafordiagnosisofRheumaticFever
B.MajorCriteria
Moderate-andhigh-
Low-riskpopulations
riskpopulation

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Carditis
Carditis
Clinicaland/orsubclinical
Clinicaland/orsubclinicalcarditis
carditis
Arthritis
Arthritis
Monoarthritisor
Polyarthritis
polyarthritis
Polyarthralgia
Chorea
Chorea
Erythemamarginatum
Erythemamarginatum
Subcutaneousnodules
Subcutaneousnodules
C.Minorcriteria
Moderate-andhigh-risk
Low-riskpopulations
populations
Polyarthralgia
Monoarthralgia
Fever(>38.5?)
Fever(>38?C)
ESR.60mmin1'thour
ESR30mm/hand/orCRP>3.0
and/CRP>3.0mg/dl
ormg/dL
4.ProlongedPRinterval,afteraccountingforagevariability
(unlesscarditisisamajorcriterion)inallpopulation.

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110.Feature(s)ofincreasedICPis/are:
a)Hypotension
b)DecreaseHR
c)IncreaseHR
d)Hypertension
e)Decreasedlevelofconsciousness
CorrectAnswer-B:D:E
Answer-(B)DecreaseHR(D)Hypertension(E)Decreasedlevel
ofconsciousness
Cushing'striadisthetriadofwideningpulsepressure(rising
systolic,decliningdiastolic),changeinrespiratory
Pattern(irregularrespirations),andbradycardia.Itissignof
increasedintracranialpressure,and,itoccursasaresultofthe
Cushingreflex.

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111.AllaretrueaboutHepatitisEexcept:
a)Maybefatalinpregnantwomen
b)Causedbynon-enveloped,positive-sense,singlestranded
RNAgenomic,HAVlikevirus
c)Carrierstateiscommon
d)Majorityprogresstochronicity
e)Feco-oraltransmission
CorrectAnswer-C:D
Answer-(C)Carrierstateiscommon(D)Majorityprogressto
chronicity
HEVistransmittedviathefaecal-oralroute.
Itiscausedbynon-enveloped,positive-sense,single-strandedRNA
genomic,HAVlikevirus.
HepatitisEisawaterbornedisease,andcontaminatedwaterorfood
supplieshavebeenimplicatedinmajoroutbreaks.Ingeneral,
hepatitisEisaself-limitingviralinfectionfollowedbyrecovery.
Prolongedviraemiaorfaecalsheddingareunusualandchronic
infectiondoesnotoccur.
Occasionally,afulminantformofhepatitisdevelops,withoverall
patientpopulationmortalityratesrangingbetween0.5-4.0%.
Fulminanthepatitisoccursmorefrequentlyinpregnancyand
regularlyinducesamortalityrateof20%amongpregnantwomenin
the3rdtrimester.
SincecasesofhepatitisEarenotclinicallydistinguishablefrom
othertypesofacuteviralhepatitis,diagnosisismadebybloodtests
whichdetectelevatedantibodylevelsofspecificantibodiesto
hepatitisEinthebodyorbyreversetranscriptasepolymerasechain

---

reaction(RT-PCR).Unfortunately,suchtestsarenotwidely
available.

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112.Whichofthefollowingcranialnerve
is/areinvolvedinGagreflex:
a)9
b)10
c)11
d)12
e)7
CorrectAnswer-A:B
Answer-(A)9(B)10
Gagreflex
Afferent
Glossopharyngealnerve
Efferent
Vagusnerve

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113.Whichofthefollowingis/aretrueabout
Duchenemusculardystrophy:
a)Mentalimpairmentmaypresent
b)TSerumCKlevels
c)Cardiomyopathymaybepresent
d)Autosomalrecessivedisorder
e)Onsetduringpuberty
CorrectAnswer-A:B:C
Answer-(A)Mentalimpairmentmaypresent(B)TSerumCK
levels(C)Cardiomyopathymaybepresent
DuchenneMuscularDystrophy:ThisX-linkedrecessivedisorder
sometimesalsocalledpseudohypertrophicmusculardystrophy.
Age-Before5years
C/F
Progressiveweaknessofgirdlemuscles
Unabletowalkafterage12
Progressivekyphoscoliosis
Respiratoryfailurein2dor3ddecade
Cardiomyopathy
Mentalimpairment

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114.Trueaboutacuteintermittentporphyria:
a)OccurduetodeficiencyofenzymeHMB-synthase
b)Uroporphyrinispresentinurine
c)Abdominalpainiscommonsymptom
d)TPorphobilinogenintheurine
e)Leukocytosisisoftenpresent
CorrectAnswer-A:B:C:D
Answer-(A)OccurduetodeficiencyofenzymeHMB-synthase
(B)Uroporphyrinispresentinurine(C)Abdominalpainis
commonsymptom(D)TPorphobilinogenintheurine
Deficientenzyme-HMB-synthase
Inheritance-Autosomaldominant
Abdominalpain,themostcommonsymptom.
Cramping,lleus,abdominaldistention,anddecreasedbowelsound.
Peripheralneuropathy
Abdominaltenderness,fever,andleukocytosisareusuallyabsentor
mild
Nausea,vomiting,constipation,tachycardia,hypertension,mental
symptoms,paininthelimbs,head,neck,orchest;
Muscleweakness,sensoryloss,dysuria,andurinaryretentionare
characteris
Tachycardia,hypertension,restlessness,tremors,andexcess
sweatingareduetosympatheticoveractivity.
Investigation-
Thediagnosiscanbeconfirmedbydemonstratinganincreased
amountofporphobilinogenintheurine,ALA,Uroporphyrin.

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115.ChildPughAcriteriaforclinicalseverity
ofcirrhosisincludes:
a)Bilirubin<2.0mg/dL
b)Prothrombintime>70(%ofcontrol)
c)Serumalbumin2.0-3.0g/dl
d)Presenceofencephalopathy
e)Absenceofascites
CorrectAnswer-A:B:E
Answer-(A)Bilirubin<2.0mg/dL(B)Prothrombintime>70(%
ofcontrol)(E)Absenceofascites
Assign Assign
Assign
Parameter
1point 2points
3points
Ascitis
Absent Slight
Mpderate
Bilirubin(mg/dL)
<2
2-3
>3
Albumin(g/dL)
>3.5
2.8-3.5
<2.8
Prothrombintime
<4
4-6
>6
(secondovercontrol) <1.7
1.7-2.3
>2.3
orINR
Grade1-2(Mildto
Grade3-4
Encephalopathy
None
moderate
(Severe)

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116.AllaretrueaboutAbdominalaneurysm
except:
a)Atherosclerosisisthecommonestcause
b)Mostcommonlyarisesfromabovethelevelofrenalartery
c)Forasymptomaticaneurysms,repairisindicatedifthediameter
is>5.5cm
d)Endovascularplacementofanaorticstentisuseforrepair
e)Mostlyasymptomatic
CorrectAnswer-B
Answer-B.Mostcommonlyarisesfromabovethelevelofrenal
artery
90%ofabdominalaorticaneurysm(AAA)ofsize>4cmindiameter
isduetoatherosclerosis.
Malearemorefrequentlyaffectedthanfemale.
Theaneurysmmostcommonlyarisesbelowthelevelofrenalartery.

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117.Apatientdiagnosedwithcushing's
syndrome.Dexamatha?sone
suppressiontestshoweddecreasein
cortisollevelsandcorticotrophin-
releasinghormone(CRH)administration
causesincreasedcortisol
levels.Treatmentoption(s)forthispatient
is/are:
a)Adrenalectomy
b)Pituitaryirradiation
c)Adrenalglandremoval
d)Stereotacticpituitaryradiosurgery
e)SurgicalremovalofectopictissueproducingACTHindifferent
organs
CorrectAnswer-A:B:C:D
Answer-(A)Adrenalectomy(B)Pituitaryirradiation(C)Adrenal
glandremoval(D)Stereotacticpituitaryradiosurgery
Treatmentofchoice-removalofpituritarycorticotropetumour
(transphenoidalapproach)
Pituitaryirradiation
Metyraponeandketoconazole
Adrenocorticalcarcinoma-mitotane

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118.Inwhichofthefollowingvasculitislung
involvementdoesnotoccur:
a)Eosoniphilicgranulomatosiswithvasculitis
b)Polyarteritisnodosa(PAN)
c)Microscopicpolyangitis
d)Granulomatosiswithpolyangitis
e)Bechetsyndrome
CorrectAnswer-B
Answer-B.Polyarteritisnodosa(PAN)
Microscopicpolyangiitis(microscopicpolyarteritis,hypersensitivity,
orleukocytoclasticvasculitis):Thistypeofnecrotizingvasculitis
generallyaffectsarterioles,capillaries,andvenule.
Wegenergranulomatosis(Granulomatosiswithpolyangitis)-isa
necrotizingvasculitischaracterizedbythetriadof
1. acutenecrotizinggranulomas
2. necrotizingorgranulomatousvasculitis
3. renaldiseaseintheformoffocalnecrotizingoftencrescentic,
glomerulitis
"Churg-Strausssyndrome(allergicgranulumatosisandangiitis)isa
multisystemdiseaseswithcutaneousinvolvementgastrointestinal
tractbleeding,andrenaldisease.

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119.Drugcausingsclerodermais/are:
a)Bleomycin
b)Pentazocin
c)Polyinylchloride
d)Steroid
e)Tetracycline
CorrectAnswer-A:B:C
Answer-(A)Bleomycin(B)Pentazocin(C)Polyinylchloride
Vinylchloride,bleomycin,pentazocin,organicsolvents,carbidopa,
tryptophan,rapeseedoil.

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120.Apatientofasthmawasoninhaledshort
acting13-agonist.Buttherewasno
significantrelief.Afterthatheaddedlow
doseofinhaledsteroidfromlast5day
byMDI,butstillnotresponding.What
youwilladvisehimfornextlineof
treatment:
a)ContinueinhaledshortactingP-agonist
b)Addinhaledlongacting13-agonist
c)Increasedoseofinhaledcorticosteroid
d)Startoralcorticosteroid
e)Startparenteralcorticosteroid
CorrectAnswer-A:B:C
Answer-(A)ContinueinhaledshortactingP-agonist(B)Add
inhaledlongacting13-agonist(C)Increasedoseofinhaled
corticosteroid

---

---

121.Whichofthefollowingclinicalcriteria
belongstoHIVstageI:
a)Asymptomaticpatient
b)Persistentgeneralisedlymphadenopathy
c)Unexplainedchronicdiarrhoeafor>1mth
d)Unexplainedpersistentfever(>37.5?Cfor>1mth)
e)Neutropenia
CorrectAnswer-A:B
Answer-(A)Asymptomaticpatient(B)Persistentgeneralised
lymphadenopathy
WorldHealthOrganization(WHO)clinicalstage-
Asymptomatic
Persistentgeneralisedlymphadenopathy

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122.Pulmonarybloodflowincreasedinall
except:
a)ASD
b)VSD
c)TOF
d)Transpositionofgreatarteries(TGA)
e)PDA
CorrectAnswer-C
Answer-(C)TOF
TruncusArteriosus,completeTGAandTAPVCareassociatedwith
increasedpulmonarybloodflow.
TOF-WhentheRVoutllowobstructionissevere,pulmonaryblood
llowisreducedmarked.

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123.Caudaequinaisdifferentiatedfrom
conusmedullarisbypresenceof:
a)Anklejerkmaylost
b)Kneejerkmaylost
c)Motorchanges
d)Bladder&bowelinvolvementasinitialpresentation
e)Rootpain
CorrectAnswer-B:C:E
Answer-(B)Kneejerkmaylost(C)Motorchanges(E)Rootpain
ConusMedullarisvs.CaudaEquinaSyndromes
Conusmedullaris
Caudaequinasyndrome
syndrome
Vertebral
L1-L2
L2-sacrum
level
Sacralcordsegmentand
Spinallevel
Lumbosacralnerveroots
roots
Presentation Suddenandbilateral
Gradualandunilateral
Radicular
Lesssevere
Moresevere
pain
Lowback
More
Less
pain
Symmetrical,lessmarked
Moremarkedasymmetric
Motor
hyperreflexicdistalparesis areflexicparaplegia,
strength
ofLL,fasciculation
atrophymorecommon
Bothkneeandanklejerks
Reflexes
Anklejerksaffected
affected

---

Localizednumbnessto
Localizednumbnessat
Sensory
perianalarea,
saddlearea,asymmetrical,
symmetricalandbilateral
unilateral
Sphincter
Earlyurinaryandfecal
Tendtopresentlate
dysfunction incontinence
Impotence
Frequent
Lessfrequent

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124.Whichofthefollowingis/arethefeature
(s)ofheadacheduetoincreasein
intracranialpressure:
a)Increaseonsupineposition
b)Mostcommonlypresentsassevereacuteheadache
c)Pulsatileinnature
d)Throbbingcharacter
e)Analgesicsarenotveryhelpful
CorrectAnswer-A:E
Answer-(A)Increaseonsupineposition(E)Analgesicsarenot
veryhelpful
"Headacheduetointracranialpathologrorraisedintracranialtension
worsensduringcoughingstrainingoradoptingtheheadinlow
posture.
Generalizedheadachethatispresentonwakingandimprovesas
thedaygoeson.
Headacheonrisinginthemorningornocturnalheadacheisako
characteristicofobstructivesleepapneaorpoorlycontrolled
hypertension.
Corticosteroidarerecommendedinacuteheadacheduetoraised
ICP.

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125.Allaretrueaboutuseoftriptansin
migraineexcept:
a)Usedinprophylaxisofmigraine
b)Efficacyincreasedwithconcomitantuseofergot
c)CanbegivenforlongtermwhereNSAIDSisnoteffective
d)GivenwhenNSAIDSisnoteffective
e)None
CorrectAnswer-A:B:C
Answer-(A)Usedinprophylaxisofmigraine(B)Efficacy
increasedwithconcomitantuseofergot(C)Canbegivenfor
longtermwhereNSAIDSisnoteffective
TriPtansarerapidlyeffectiveagentforabortingattacks.
OralStimulationofS-HT1B/1Dreceptorscanstopanacutemigraine
attack.
Triptansareselective5-HT1B/lDreceptoragonists.

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126.Allaretrueaboutrenalarterystenosis
except:
a)ACEinhibitorscanbeusedinbilateralrenalarterystenosis
b)ACEinhibitorscanbeusedinunilateralrenalarterystenosis
c)ACEinhibitorsarebestdrugtocontrolDMassociated
hypertension
d)Excision&Graftingistreatmentofchoice
e)Angioplastywithorwithoutstenting,andsurgicalbypassused
onlyinrefractorycases
CorrectAnswer-A:D
Answer-(A)ACEinhibitorscanbeusedinbilateralrenalartery
stenosis(D)Excision&Graftingistreatmentofchoice
ACEinhibitorsarecontraindicatedinbilateralrenalarterystenosis.
ACEinhibitorsareusefulinrenovascularhypertension.
ARFisprecipitatedbyACEinhibitorsinpatientswithb/lrenal
stenosis
Atheroscleroticischemicrenaldiseaseaccountsfornearlyallcases
ofrenalarterystenosis.
Renalangiographyisthegoldstandardfordiagnosis.

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127.Whichofthefollowingcauses
glomerularproteinuria:
a)DM
b)Amyloidosis
c)Multiplemyeloma
d)ACEinhibitorsdecreasesproteinuria
e)All
CorrectAnswer-A:B:D
Answer-(A)DM(B)Amyloidosis(D)ACEinhibitorsdecreases
proteinuria
Nephroticsyndrome
Membranoproliferativeglomerulonephritis,membranous
nephropathy
HepatitisBandCnephropathy,HIVnephropathy
Refluxnephropathy
Amyloidosis
Postinfectiousglomerulonephritis,lgA,nephropathy,Henoch-
Schonleinnephritis,lupusnephritis,Alport,syndrome

---

128.AllaretrueaboutChylouspleural
effusionexcept:
a)StainpositivewithsudanIII
b)Cutoffleveloftriglycerideforchylouseffusionis>150mg/dl
c)Cutoffleveloftriglycerideforchylouseffusionis>50mg/dl
d)Milkycolourdisappearswithalkali
e)Milkycolourdisappearswithether
CorrectAnswer-B:C
Answer-(B)Cutoffleveloftriglycerideforchylouseffusionis>
150mg/dl(C)Cutoffleveloftriglycerideforchylouseffusionis
>50mg/dl
Pleuralfluid-milkywhite,triglyceridelevels>ll0mgldL
Chylomicronsisalsodiagnosticofachylothorax&canbeusedasa
confirmatorytestifthetriglyceridelevelsareequivocal.
Onmicroscopy,fatglobulewiIIclearwithalkaliorether&willstain
withSudanIII.
Themostcommoncauseofchylothoraxistrauma.

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129.Chylouspleuraleffusionoccurin:
a)T.B
b)Malignancy
c)SLE
d)Thoracicductinjury
e)Congestiveheartfailure
CorrectAnswer-A:B:D
Answer-(A)T.B(B)Malignancy(D)Thoracicductinjury
TB
Malignancy
Lymphoma
Filariaisis
Myxoedema
Trauma

---

130.Whichofthefollowingcausesmassive
splenomegaly:
a)CLL
b)Multiplemyeloma
c)Follicularlymphangitis
d)Gaucher'sdisease
e)Sjogren'ssyndrome
CorrectAnswer-A:D
Answer-(A)CLL(D)Gaucher'sdisease
Thecausesofmassivesplenomegalyinclude:
Thalassemia
Visceralleishmaniasis(KalaAzar)
Schistosomiasis
Chronicmyelogenousleukemia
Chroniclymphocyticleukemia
Lymphomas
Hairycellleukemia
Myelofibrosis
Polycythemiavera
Gauchersdisease
NiemannPickdisease
Sarcoidosis
Autoimmunehemolyticanemia
Malaria
Syphilis

---

131.ACTHdependentcushingsyndrome
is/arecausedby:
a)Pituitaryadenoma
b)Adrenaladenoma
c)Adrenocorticalcarcinoma
d)Pheochromocytoma
e)All
CorrectAnswer-A:D
Answer-(A)Pituitaryadenoma(D)Pheochromocytoma
CushingsyndromeiscausedtoACTH-producingadenoma.
ETIOLOGY
Pituitarycorticotropeadenomas
Iatrogenichypercortisolism(mostcommon)
EctopictumourACTHproduction
Cortisol-producingadrenaladenomas
Adrenalcarcinoma
Adrenalhyperplasia
Pheochromocytoma

---

132.HyperglycemicHyperosmolarstate
(HHS)ischaracterizedby:
a)Hyperglycemia
b)Acidosis
c)Dehydration
d)Coma
e)None
CorrectAnswer-A:C:D
Answer-(A)Hyperglycemia(C)Dehydration(D)Coma
Thisisalifethreateningcomplicationofdiabetesmellitus
characterizedbymarkedhyperglycemia,dehydration,comaand
hyperosmolaritywithorwithoutmentalobtundationintheabsenceof
significantketoacidosis

---

133.Whichofthefollowingistrueabout
Pheochromocytoma:
a)Sestabimiscanisdonebeforesurgery
b)Mostlyaremalignant
c)Surgeryismainstayoftreatment
d)Priorablockerisgiven
e)Priorpblockerisgiven
CorrectAnswer-C:D:E
Answer-(C)Surgeryismainstayoftreatment(D)Priorablocker
isgiven(E)Priorpblockerisgiven
Sestambiscanningisthepreferredwayinwhichtolocalizediseased
parathyroidglandspriortooperation.
Pheochromocytoma&paragangliomaarecatecholaminesproducing
tumoursderivedfromsympatheticandparasympatheticnervous
system.
TheyarederivedfromChromaffincells.
Treatment-
Laproscopicresection
Alphaadrenoreceptorblocker(phenoxybenzamine)-block
catecholamineexcess
Betablockade-tachycardiaorarrhythmias
Centralvenouscatheter&invasivearterialmonitoringused.
AdultDoseofClonidineforClonidineSuppressiontestis0.3mg
(0.3mg/70kg)administeredorally.ClonidineSuppressionTest
Completetumorremovalistheuhimatetherapeuticgoal,,canbe
achievedbypartialortotaladrenalectomy.

---

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134.Treatmentofcrohn'sdiseaseincludes:
a)Steroid
b)5-Aminosalicylicacidagents
c)Azathioprine
d)Daclizumab
e)Adalimumab
CorrectAnswer-A:B:C:E
Answer-(A)Steroid(B)5-Aminosalicylicacidagents
(C)Azathioprine(E)Adalimumab
Treatment-
5-ASAagents(mesalamine)notusednow
Mildtomoderatediseaseinvolvingterminialileumorascending
colon?Budesonide
Severediseaseinvolvingproximalsmallintestineordistalcolon?
Prednisone
Immunomodulators(Azathioprine,mercaptopurine,methotrexate)
andformaintenanceofremissionor
inductionofremissionalongwithsteroidsinseveredisease
Anti-TNFtherapy(Infliximab,adalimumab,certolizumab)-first-line
agentstoinduceremissioninmoderatetoseverediseaseandto
maintainremission
Anti-integrins:Natalizumab(anti-a4integrin)?ifnoresponsetoanti-
TNFagents

---

135.EnergyselectioninCPRaccordingto
AHA2010guidelineis/are:
a)Monophasic120-200J,Biphasic360J
b)Monophasic200J,Biphasic360J
c)Monophasic120J,Biphasic200J
d)Monophasic360J,Biphasic120-200J
e)Monophasic360J,Biphasic220J
CorrectAnswer-D
Answer-(D)Monophasic360J,Biphasic120-200J
2010AIIAguidelineforCPRContrarytopreviousrecommendation
of3succesiveshocks(200,300,360J)nowadayslst&all
subsequentshocksareof360Jouleswithmonophasic&120-200
louleswithbiphasic.

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136.Whichofthefollowinglesionrepresent
tertiarysyphilis:
a)Condylomatalata
b)Mattedlymphnode
c)Condylomataacuminata
d)Tabesdorsalis
e)Gummaformation
CorrectAnswer-D:E
Answer-(D)Tabesdorsalis(E)Gummaformation
Gumma,neurosyphilis/tabesdorsalis
Ostitis,periostitis
Aortitis,aorticinsufficiency,coronarystenosisandnocturnalangina

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137.Whichofthefollowingstatement(s)
is/arecorrectregardingsyphilisin
pregnancy&congenitalsyphilis:
a)Foetushasmorechanceofinfectionin3rdT.M
b)Syphiliscanbepreventedbygivingpenicillininneonate
c)Ifinfantshowingsignsofsyphilis,he/sheshouldbegivensingle
doseofcrystallinepenicillin
d)Ifinfantdoesnothaveanysignsofsyphilis,he/sheshouldbe
givenbenzathinepenicillin
e)Foetusismostlikelyaffectedifmotherissufferingfromprimary
orsecondarysyphilisthanlatesyphilis
CorrectAnswer-A:B:D:E
Answer-(A)Foetushasmorechanceofinfectionin3rdT.M
(B)Syphiliscanbepreventedbygivingpenicillininneonate
(D)Ifinfantdoesnothaveanysignsofsyphilis,he/sheshould
begivenbenzathinepenicillin(E)Foetusismostlikelyaffected
ifmotherissufferingfromprimaryorsecondarysyphilisthan
latesyphilis
CongenitalSyphilis
(a)EarlyCongenitalSyphilis:
Snuffles(rhinitis)istheearliestfeature.
Lesionsarevesiculobullousandsnailtrackulcersonthemucosa
(b)LateCongenitalSyphilis:
CharacterizedbyHutchinson'striadinterstitialkeratitis
8thnervedeafness
Hutchinson'steethi.e.peggedcentralupperincisors

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Saddlenose,sabretibia,mulberrymolars
Bulldog'sjaw(protrusionofjaw)
Rhagades(linearfissureatmouth,nares)
Frontalbossing,hotcrossbundeformityofskull
Clutton'sjoint(painlessswellingofjoints,mostcommonlybothknee)
Syphilisinpregnancy-
Allpregnantwomenshouldhaveanontreponemalserologictestfor
syphilisatthetimeofthefirstprenatalvisit.
Theonlyacceptabletreatmentforsyphilisinpregnancyispenicillin
indosageschedulesappropriateforthestageofdisease.
Penicillinpreventscongenitalsyphilisin90%ofcases,evenwhen
treatmentisgivenlateinpregnancy.
Syphiliticwomentoherfoetusmayoccuratanystageofpregnancy.

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138.AsciticfluidwithTSAAG&Talbumin
is/arefoundin:
a)T.B
b)CHF
c)Cirrhosis
d)Pancreatitis
e)Nephroticsyndrome
CorrectAnswer-B
Answer-B.CHF
Serum-ascitesalbumingradient(SAAG)isusefulfordistinguishing
ascitescausedbyportalhlpertensionfromnonportalhypertensive
ascites.
ASAAG>1.1g/dl-reflectsthepresenceofportalhypertension
ASAAG<1.1g/dl-tuberculousperitonitis,peritoneal
carcinomatosis,orpancreaticascites.
Forhigh-SAAG(>1.1)ascites-
Anasciticproteinlevelof>2.5g/dlindicatesthatthehepatic
sinusoidsoccursincardiacascites,sinusoidalobstruction
syndrome,orearlyBudd-Chiarisyndrome.
Anasciticproteinlevel<2.5g/dl,indicatescirrhosis,lateBudd-
Chiarisyndrome,ormassivelivermetastases.

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139.Forcancerpain,ladder2stepinWHO's
painstepladderincludes:
a)Oralmorphine
b)Injectablemorphine
c)Codeine
d)Fentanyl
e)Tramadol
CorrectAnswer-C:E
Answer-(C)Codeine(E)Tramadol
Secondstep:Intermediatestrengthopioids:codeine,tramadolor
dextropropoxyphene.

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140.Trueaboutpepticulcer:
a)H.pyloricausespepticulcer
b)EradcationtherapybetterthanPPItherapy
c)EradicationtherapyalsocontainPPI
d)DuodenumulcerismorecommonlyassociatedwithH.pylori
thangastriculcer
e)GastriculcerismorecommonlyassociatedwithH.pylorithan
duodenalulcer
CorrectAnswer-A:B:C:D
Answer-(A)H.pyloricausespepticulcer(B)Eradcation
therapybetterthanPPItherapy(C)Eradicationtherapyalso
containPPI(D)Duodenumulcerismorecommonlyassociated
withH.pylorithangastriculcer
Hpyloriinfection.
Medicaltreatment:ProtonpumpinhibitorsorH2blockers;H.pylori
eradication
EradicationofH.pyloriandtherapy/preventionofNSAID-induced
diseaseisthemainstayoftreatment.
Combinationregimensthatusetwoorthreeantibioticswithaproton
pumpinhibitor.

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141.FeaturesofConstrictivepericarditis
whichdifferentiatewithrestrictive
cardiomyopathy:
a)Prominentydescentmorecommon
b)Pericardialknock
c)Thirdheartsound
d)Thickenedpericardium
e)Rightventricularhypertrophy
CorrectAnswer-A:B:D
Answer-(A)Prominentydescentmorecommon(B)Pericardial
knock(D)Thickenedpericardium
Diastolicpressureareequalizedinconstrictivepericarditisbutnotin
RestrictivecardiomyopathyThickennedpericardiumisseenin
constrictivepericarditisbutnotinRestrictivecardiomyopathy
Rightventricularsizeisusuallynormalinbothandpericardial
effusionisusuallyabsentinboth,RVsizeandpericardialeffusion,
thereforecannotdistinguishbetweenconstrictivepericarditisand
Restrictivecardiomyopathy.

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142.CURB-65criteriaforseverepneumonia
includes:
a)Confusion
b)Uremia
c)Respiratoryrate30/min
d)SystolicBloodpressure80mmHg
e)Diastolicbloodpressure,systolic50mmHg
CorrectAnswer-A:B:C
Answer-(A)Confusion(B)Uremia(C)Respiratoryrate30/min
TheCURB-65assessesfive-
Confusion
Uremia
Respiratoryrate
Bloodpressure
Age>65

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143.Whichofthefollowingfeaturefavours
emphysemaratherthaninterstitial
fibrosis:
a)TFEV1
b)LFEV1/FEV6
c)TRV
d)TTLC
e)4,Peakexpiratoryflow
CorrectAnswer-B:C:D:E
Answer-(B)LFEV1/FEV6(C)TRV(D)TTLC(E)4,Peakexpiratory
flow
Interstitiallungdiseaselikeinterstiulfibrosisarecharacterizedbya
normalorelevatedFEVIFVCratiowhichischaracteristically>0.7.
PFTresultscomparingobstructiveandrestrictivedisease(maynot
beapplicableforallformsoflung(disease)
FEVI=forcedexpiratoryvolumeinonesecond;FVC=ForcedVital
Capacity;FEF25_75=ForcedExpiratoryFlowat25%=75%vital
capacity;TLC=TotalLungCapacity;DLCO=DiffusionCapacityof
theLungforCarbonmonoxide.

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144.Featureofunstableangina:
a)TTroponin
b)TransientelevationofSTsegment
c)DepressionofSTsegment
d)Qwave
e)Twaveinversion
CorrectAnswer-B:C:E
Answer-(B)TransientelevationofSTsegment(C)Depression
ofSTsegment(E)Twaveinversion
InUA,ST-segmentdepression,transientST-segmentelevation,
and/orT-waveinversionoccurin30to50%ofpatients.
ThePresenceofnewST-segmentdeviation.
T-wavechangesaresensitiveforischemiadeepT-waveinversions.

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145.Allaretrueaboutrheumatoidfactor
except:
a)AlsofoundinSjogrensyndrome
b)Mayalsopresentnormally
c)ItisbasicallyIgM
d)Itspresenceisdiagnosticofrheumatoidarthritis
e)None
CorrectAnswer-A:B:C
Answer-(A)AlsofoundinSjogrensyndrome(B)Mayalso
presentnormally(C)ItisbasicallyIgM
-IgM,IgG,andIgAisotypesofRFoccurinserafrompatientswith
RA.
SerumIgMRFhasbeenfoundin75-80%ofpatientswithRA.
Foundinotherconnectivetissuediseases,suchasprimary
Sjogren'ssyndrome,systemiclupuserythematosus,andtypeII
mixedessentialcryoglobulinemia.
Anti-CCPantibodiesarethemostspecificbloodtestforrheumatoid
arthritis

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146.Feature(s)ofTICTinclude:
a)Constrictedpupil
b)Tachycardia
c)Bradycardia
d)Hypertension
e)Respiratorydepression
CorrectAnswer-C:D:E
Answer-(C)Bradycardia(D)Hypertension(E)Respiratory
depression
Bloodpressureelevationaccompaniedbybradycardiaand
respiratoryslowingclassicallyresultsfromraisedintracranial
pressure.
Lossofthenormalautoregulationofbloodpressureandpulse,called
theCushingsreflexisahallmarkofseverebraininjuryorimminent
crisis.
Anisocoria,unequalpupilsize,isanothersignofserioustraumatic
braininjury.

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147.TrueaboutKallmansyndrome:
a)Amenorrhoea
b)Hypergonadotrophicstate
c)Anosmia
d)Failureofsecondarysexualdevelopment
e)None
CorrectAnswer-A:C:D
Answer-(A)Amenorrhoea(C)Anosmia(D)Failureofsecondary
sexualdevelopment
Kallmannsyndromeiscausedfromdefectivegonadotropinreleasing
hormone(GnRH)synthesis.
Clinicalfeatures-
Anaemia&hyposmiaduetoolfactorybulbagenesis&hypophasia.
Colorblindness,opticatrophy,nervedeafness.
Cleftpalate,cryptoorchidism&mirrormovements(neurological
defects)
Inmales-delayedpuberty,micropenis.
Infemales-primaryamenorrhea,failureofsecondarysexual
development.
LowLH&FSHlevels&sexsteroids.

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148.Whichofthefollowingis/aretrue
regardingAsthma&COPD:
a)COPDshowslessreversibilitytobronchodilatorswhileasthma
showssignificantimprovement
b)Asthmahasagradualprogressionofdyspneaonexertion,
punctuatedbyacuteexacerbationsofshortnessofbreath.while
mostCOPDpatientshavenormalbreathingthemajorityofthe
time
c)COPDpatientsmayhaveacuteexaberationswhileasthmatic
patientshaverecurrentepisode
d)Steroidtherapyismorebeneficialtoasthmapatientsthan
COPDpatients
e)Neutrophilshaveprimaryaroleinpathogenesisofasthma&
eosinophilshaveprimaryroleinCOPD
CorrectAnswer-A:C:D
Answer-(A)COPDshowslessreversibilitytobronchodilators
whileasthmashowssignificantimprovement(C)COPD
patientsmayhaveacuteexaberationswhileasthmaticpatients
haverecurrentepisode(D)Steroidtherapyismorebeneficialto
asthmapatientsthanCOPDpatients
PatientswithCOPDhasagradualprogressionofdyspneaon
exertion,punctuatedbyacuteexacerbationsofshortnessofbreath.
Mostasthmaticshavenormalbreathingwithrecurrentepisodesof
dyspneaduetotriggeringfactor.
COPDisseenspecificallyinsmokers.
Asthmaticsoftenshowanacuteresponsetoinhaled
bronchodilators.

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bronchodilators.
COPDisgenerallynotresponsivetooralcorticosteroidtherapy.
Inhaledcorticosteroidsareoneofthemosteffectivewaysof
controllingasthma.
Eosinophilicinfiltrationisacharacteristicfeatureofasthmaticairway.
InCOPDthereismacrophageactivation&neutrophilrecruitmentin
airway.

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149.Allaretrueaboutacuteradiation
pneumonitisexcept:
a)Fevernotpresent
b)Steroidisbeneficial
c)X-raychestfindingcorrelatespoorlywithsymptom
d)Developimmediatelyafterradiotherapy
e)All
CorrectAnswer-A:D
Answer-(A)Fevernotpresent(D)Developimmediatelyafter
radiotherapy
Twophasesofthepulmonaryresponsetoradiationare
apparent:
acutephase(radiationpneumonitis)
chronicphase(radiationfibrosis)
Clinicalfeatures-
manifestedbyfever,dyspneaoutofproportiontothevolumeoflung
irradiated,pleuraleffusion.
Withsteroidthetapy,thesesymptomsmayresolvecompletelyin
somepatientswithoutlong-termefects.
Epithelialcellatypiaandfoamcellwithinvesselwallsarealso
characteristicofradiationdamage.

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150.Whichofthefollowingis/aretrueabout
SubarachnoidHemorrhage(SAH):
a)SaccularaneurysmismostcommoncauseofSAHafterhead
trauma
b)Severeheadachemaypresent
c)CTangiographyhelpinlocalizinganeurysm
d)CTscanisinvestigationofchoiceforacuteSAH
e)DigitalsubtractionangiographyisbetterthanCTangiography
forSAH
CorrectAnswer-B:C:D
Answer-(B)Severeheadachemaypresent(C)CTangiography
helpinlocalizinganeurysm(D)CTscanisinvestigationof
choiceforacuteSAH
Suddenlossofconsciousnessmaybeprecededbyabriefmoment
ofexcraciatingheadache.
ThehallmarkofaneurysmalruptureisbloodintheCSF.
Caseshaveenoughbloodtobevisualizedonahighqualitynon
contrastCTscan&bindwithin72hrs.
Alumbarpunctureshouldbperformedtoestablishthepresenceof
subarachnoidblood.

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151.Whichoftheconditioncausepericarditis
duetohypersensitivity:
a)SLE
b)Rheumaticfever
c)Dresslersyndrome
d)Uraemia
e)Myxedema
CorrectAnswer-A:B:C
Answer-(A)SLE(B)Rheumaticfever(C)Dresslersyndrome
A.Rheumaticfever
B.Collagenvasculardisease(systemiclupuserythematosus,
rheumatoidarthritis,ankylosingspondylitis,scleroderma,acute
rheumaticfever,granulomatosiswithpolyangiitis(Wegener's)
C.Drug-induced(e.9.,procainamide,hydralazine,phenytoin,
isoniazide,minoxidil,anticoagulants,methysergide)
D.Post-cardiacinjury
1. Postmyocardialinfarction(Dressler'ssyndrome)
2. Postpericardiotomy
3. Posttraumatic

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152.ECGchange(s)inpulmonaryembolism
mayincludes:
a)STelevationinVI&aVR
b)TwaveinversioninVItoV4
c)S1Q3T3pattern
d)Leftaxisdeviation
e)Rightbundlebranchblock
CorrectAnswer-A:B:C:E
Answer-(A)STelevationinVI&aVR(B)TwaveinversioninVI
toV4(C)S1Q3T3pattern(E)Rightbundlebranchblock
Sinustachycardiaisthemostfrequentandnonspecificfindingon
electrocardiographyinacutepulmonaryembolism.
FeaturessuggestingacuterightheartstrainontheECGoccur
relativelyinfrequently,theseinclude.
Acuterightaxisdeviation
Ppulmonale
Rightbundlebranchblock
InvertedTwaves
STsegmentchangesinrightsidedleads.
EarlierthefollowingE.C.G.changeswereconsideredhighly
predictiveofacutepulmonaryembolism,buttheseobservations
werefoundinlessthan12%ofpatientswithpulmonaryemboliin
recentstudies.
TheseE.C.G.featuresare-
SwaveinleadI
QwaveinleadIII

---

InvertedTinleadIII(S1Q31.3)
SwavesinleadI,IIandIII("S1,S2S3)

---

153.Allaretrueabout"a"waveexcept:
a)Itisoftenthelargestpositivewavevisible
b)Giantwaveinatrialfibrillation
c)Tricuspidstenosisproducesgaintwave
d)Heartblockdiminishmagnitudeofawave
e)Producedbyrightatrialcontraction
CorrectAnswer-B:D
Answer-(B)Giantwaveinatrialfibrillation(D)Heartblock
diminishmagnitudeofawave
Awavereffectsrightatrialpresystoliccontractionandoccursjust
aftertheelectrocardiographicPwave,precedingthefirstheart
sound(S1).Aprominentalphawaveisseeninpatientswithreduced
rightventricularcompliance;acannonawaveoccurswith
atrioventricufar(AV)dissociationandrightatrialcontractiondgainst
aclosedtricuspidvalve.
Inapatientwithawidecomplextachycardia,theappreciationof
cannonawavesinthejugularvenouswaveformidentifiesthe
rhythmasventricularinorigin.
TheAwaveisnotpresentwithatrialfibrillation.

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154.Apatienthasshorth/oincreasedjugular
venouspressure,weakperipheralpulse
&lowB.P.Likelycondition(s)maybe:
a)Tensionpneumothorax
b)Venousgasembolism
c)Pulmonaryembolism
d)Cardiactemponade
e)Septicshock
CorrectAnswer-A:B:C:D
Answer-(A)Tensionpneumothorax(B)Venousgasembolism
(C)Pulmonaryembolism(D)Cardiactemponade
"SepticshockhaslowCVPwithhighcardiacoutput.
Venousgasembolism:Itcancauseacutecorpulmonale&
cardiovascularcollapse.
Tensionpneumothorax:Thereisdecreasedvenousreturntothe
heartdtcardiacoutputfallsleadingtohypotension.
Cardiactemponade(Pericardialeffusion)shouldbeconsideredin
anypatientwithhypotension,lowvolumepulse&raisedlVP.

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155.A40yearoldladyfromHimanchal
Pradeshhasfever&escharonbody.
Bloodinvestigationrevealed:Hb=12
gm%,TLC=9800/1.11,Platelet80000.
Whichofthefollowingdrug(s)maybe
usedinhertreatment:
a)OralDoxycycline
b)Meropenem
c)Azithromycin
d)Tetracycline
e)Chloramphenicol
CorrectAnswer-A:C:D:E
Answer-(A)OralDoxycycline(C)Azithromycin(D)Tetracycline
(E)Chloramphenicol
Theclinicalmanifestationsofalltheacutepresentationsaresimilar
duringthefirst5days:feverheadache,andmyalgiaswithorwithout
nausea,vomiting,andcough.
Clinicalmanifestations-includingoccurrenceofamacular,
maculopapular,orvesicularrash;eschar;pneumonitis;and
meningoencephalitis.
Doxycyclineisthedrugofchoiceformostoftheseinfections.
Tetacyclineisdrugofchoiceforspecifictreatmentofallrickettsial
diseases.
Longacting(doxycycline,minocycline)nowmakesingledose
treatmentpossible.

---

---

156.Whichofthefollowingistrueregarding
pseudobulbarpalsy:
a)Dysphagia
b)Jawjerkbrisk
c)Absentgagreflex
d)Tonguefasciculationpresent
e)Plantarreflexisextensor
CorrectAnswer-A:B:E
Answer-(A)Dysphagia(B)Jawjerkbrisk(E)Plantarreflexis
extensor
Dysarthria
Dysphagia
Gagreflex
Jawjerkhyperactive
Emotionallability
Intellectualimpairment

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157.Whichofthefollowingistrueregarding
adrenocorticalcarcinomas:
a)IncreasedurinaryexcretionofVMA
b)Doesnotcausemetastasis
c)Surgeryismainstaytreatment
d)AssociatedwithLi-Fraumenisyndrome
e)None
CorrectAnswer-C:D
Answer-(C)Surgeryismainstaytreatment(D)Associatedwith
Li-Fraumenisyndrome
IncreasedVMAexcretionintotheurinecanoccurin
Neuroblastomas,pheochromocytomas,andotherneuroendocrine
tumors.
TworareinheritedcausesofadrenalcorticalcarcinomasareLi-
FraumenisyndtomeandBeckwith-Wiedenannsyndrome.
Metastasestoregionalandperiaorticnodesarccommon.
ACCcarriesapoorprognosisandcurecanbeachievedonlyby
completesurgicalremoval.

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158.ApatientpresentedwithhighpH,low
arterialCO2&lowplasmaHCO3-level.
Whichofthefollowingstatementistrue
regardingthepresentation&various
causes:
a)Compensatedrespiratoryalkalosis
b)Chronicrenalfailure
c)Persistentvomiting
d)Cerebro-vascularaccident
e)Hepaticfailure
CorrectAnswer-A:D:E
Answer-(A)Compensatedrespiratoryalkalosis(D)Cerebro-
vascularaccident(E)Hepaticfailure
HighpHmeans-alkalosis
DecreaseCO,meansrespiratoryalkalosis
LowHCO3-levelmeansmetabolicacidosis
Thereforeitisacaseofrespiratoryalkalosiswithmetabolicacidosis
(Compensatedrespiratoryalkalosis)

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159.MIBG(metaiodobenzylguanithidine)is
analogueto:
a)Epinephrine
b)Adenine
c)Norepinephrine
d)Guanine
e)Phenylephrine
CorrectAnswer-C
Answer-(C)Norepinephrine
Pheochromocytomacanbelocalizedusingradioactivetracers
including131I-or123l-metaiodobenzylguanithidine(MIBG),111ln-
somatostatinanalogues,or18F-dopa(ordopamine)Positron-
emissiontomography(PET).

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160.Presentation(s)ofBechetsyndrome
mayinclude:
a)Erosivearthritis
b)Recurrentaphthousulcersofthemouth
c)Uveitis
d)Genitalulcer
e)Pathergytest
CorrectAnswer-B:C:D:E
Answer-(B)Recurrentaphthousulcersofthemouth(C)Uveitis
(D)Genitalulcer(E)Pathergytest
Behcet'ssyndromeisamultisystemdisorderpresentingwith
recurrentoralandgenitalulcerationsaswellasocularinvolvement.
Non-deformingarthritisorarthralgiasareseenin50%ofpatients
andaffectsthekneesandankles.
Recurrentoralulcerationplustwoofthefollowing:
Recurrentgenitalulceration
Eyelesions
Skinlesions
Pathergytest
ThehallmarkofBehcetdiseaseispainfulaphthousulcerationinthe
mouth.
Eitheranteriororposterioruveitisposterioruveitismaybe
asymptomatic

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161.Braindeathcanbeassessedby:
a)Apnoeatest
b)CTscan
c)MRIscan
d)Cerebralangiography
e)TranscranialDoppler
CorrectAnswer-A:D:E
Answer-(A)Apnoeatest(D)Cerebralangiography
(E)TranscranialDoppler
Spinalcordreflexesmaybepreservedincoma&re-examination
(not<2hourapart)isoptional.
Apneatestshouldbedoneatlastbecauseofitsharmfuleffectson
intracranialpressure.
IsoelectricEEG,absentbrainstemauditoryevokedpotentials&
absenceofcerebralperfusion(onangiography,radioisotopescanor
transcranialDoppler)areconfirmatorybutnotrequiredtests.

---

162.AccordingtoSurvivingSepsis
Guidelines2013,whichofthefollowing
is/arecorrectregardingsepsis&septic
shocktreatmentguideline:
a)Urineoutputshouldbe>2m1/kg
b)Meanarterialpressuregoalshouldbe65mmHg
c)Dopamineasthefirstchoicevasopressor
d)Colloidisinitialfluidofchoiceintheresuscitation
e)Administrationofeffectiveintravenousantimicrobialswithinthe
firsthourofrecognition
CorrectAnswer-B:E
Answer-(B)Meanarterialpressuregoalshouldbe65mmHg
(E)Administrationofeffectiveintravenousantimicrobialswithin
thefirsthourofrecognition
Crystalloidsastheinitialfluidofchoiceintheresuscitaiionofsevere
sepsisandsepticshock.
Norepinephrineasthefirstchoicevasopressor.
Dopamineasanalternativevasopressoragenttonorepinephrine
onlyinhighlyselectedpatients.
Thegoalsduringthefirst6hoursofresuscitationshouldbe
(GradelC):
Meanarterialpressure(MAP)65mmHg;
Centralvenouspressure(CVP)8-12mmHg(12-15mmHgin
Patientsreceivingmechanicalventilationorwithknownpreexisting
decreasedventricularcompliance)
Urineoutput0.5mL/kg/hr(35mL/hrforsomeoneweighing70kg

---

or154lbs)
Centralvenousoxygensaturation(fromthesuperiorvenacava)
70%,ormixedvenousoxygensaturation(fromapulmonaryartery
catheter)65%

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163.AllaretrueaboutMenetrier'sdisease
except:
a)Increasedgastricacidsecretion
b)Protein-losinggastropathy
c)Mainlyaffectsbody&fundus
d)Nomalignantpotential
e)Transforminggrowthfactor-aisoverexpressed
CorrectAnswer-D
Answer-(D)Nomalignantpotential
Menetrier'sdiseaseisanunusualconditioncharacterisedby
hypertrophyofthegastricmucosalfolds,mucusproduction&
hypochohydria.
Itisapremalignantcondition.
ThemucosalfoldsinMenetrier'sdiseaseareoftenmostprominentin
thebodyandfundus.
CausedbyexcessivesecretionofTGF.
Clinicalfeatures-
Hypoproteinaemia
Anaemia
Increasedriskofgastricadenocarcinomaassociatedwithprotein
losingenteropathy.
MaygetconfusedwithZollinger-Ellisonsyndrome.

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164.Whichofthefollowingistrueabout
treatmentofasthma:
a)LongactingP2agonistforacuteattack
b)Longacting32agonistforlongtermtreatment
c)Shortacting(32agonistforacuteattack
d)I.VSteroidforsevereasthmaexacerbation
e)Inhaledsteroidforpersistentasthma
CorrectAnswer-B:C:D:E
Answer-(B)Longacting32agonistforlongtermtreatment
(C)Shortacting(32agonistforacuteattack(D)I.VSteroidfor
severeasthmaexacerbation(E)Inhaledsteroidforpersistent
asthma
Oralcorticosteroidsshouldgenerallybeprescribedforearly
administrationathomeinpatientswithmoderatetosevereasthma

---

NAEPP3recommendationsemphasizedailyanti-inflammatory
therapywithinhaledcorticosteroidsasthecornerstoneoftreatment
ofpersistentasthma.

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165.Side-effect(s)ofinhalationalsteroid
is/areallexcept:
a)Adrenalsuppression
b)Cataract
c)Osteoporosis
d)Hypoglycemia
e)Skinthinning
CorrectAnswer-D
Answer-D.Hypoglycemia
Localsideeffectsincludehoarseness(dysphonia)andoral
candidiasis
growthretardationinchildrenortoosteoporosisinadults.
bruising,petechiae
Hyperglycemia&pituitary-adrenalsuppression

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166.Whichofthefollowingdyadsofdisease-
neurotansmitteriscorrect:
a)Myastheniagravis-Acetycholinereceptor
b)Spasticity-GABA
c)Lambert-Eatonmyasthenicsyndrome-Acetycholine
d)Stiff-personsyndrome-Glycine
e)Parkinson'sdisease-Dopamine
CorrectAnswer-A:C:E
Answer-(A)Myastheniagravis-Acetycholinereceptor
(C)Lambert-Eatonmyasthenicsyndrome-Acetycholine
(E)Parkinson'sdisease-Dopamine
Acetylcholine(ACh)-Myastheniagravis,Lambert-Eatonsyndrome,
Botulism,Alzheimer'sdisease
Dopamine-Parkinson'sdisease
Norepinephrine(NE)-Mooddisorder,anxiety,Orthostatic
tachycardiasyndrome
Serotonin-Mooddisorder,Migrainepainpathway
GABA-Stiff-personsyndrome,epilepsy
Glycine-Spasticity

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167.Allaretrueaboutsyncopeexcept:
a)Consciousnessislost
b)Morecommoninstandingthanlyingpostion
c)Vasovagaltypeiscommon
d)Returnofconsciousnessisslow&takehours
e)Shortduration
CorrectAnswer-D
Answer-D.Returnofconsciousnessisslow&takehours
Syncopeisatransient,self-limitedlossofconsciousnessdueto
acuteglobalimpairmentofcerebralbloodflow.
Asyncopalattackbeginswhenthepatientisusuallyinanupright
position(sittingorstanding)Returnofconsciousnessisprompt.
Vasovagalsyncopeisduetoexcessivevagaltoneorimpairedreflex
controloftheperipheralcirculation.
ThemostfrequenttypeofvasodepressorsyncoPeisvasovagal
hypotensionorthecommonfaint.

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168.Drug(s)giveninthyroidcrisis:
a)Esmolol
b)Iodine
c)Hydrocortisone
d)Aspirin
e)Propylthiouracil
CorrectAnswer-A:B:C:E
Answer-(A)Esmolol(B)Iodine(C)Hydrocortisone
(E)Propylthiouracil
TREATMENT-
Propylthiouracil(drugofchoice)
StableiodideblocksthyroidhormonesynthesisviaWolff-Chaikoff
effect.
Potassiumiodide
Porpranolol,esmolol
Glucocorticoids,Hydrocortisone
Calciumchannelblocker

---

169.Unequalpulseinupper&lower
extremeties(i.e.,radio-femoraldelay)
is/areseenin:
a)Aorticdissection
b)Post-ductalcoarctationofaorta
c)Supra-valvularAorticstenosis
d)Sub-valvularAorticstenosis
e)Takayasu'ssyndrome
CorrectAnswer-B
Answer-(B)Post-ductalcoarctationofaorta
InqualitybetweenTwoRadialPulse(Radio-RadialDelay)
Thoracicinletsyndrome(cervicalrib'scalenesyndrome)
Aneurysmofaorta
Takayasu'sdisease
Pre-subclaviancoarctation
SuPravalvularaorticstenosis
Atherosclerosisofaorta

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170.Non-exertionalclassicheatstrokeis/are
predisposedin:
a)Personwithpreviouschronicillness
b)Elderly
c)Young&healthyperson
d)Adolescent
e)All
CorrectAnswer-A:B
Answer-(A)Personwithpreviouschronicillness(B)Elderly
Heatstrokepresentswithahyperthermiaofgreaterthan40.6?C
(105.1?F)incombinationwithconfusionandalackofsweating.
Therearetwoformsofheatstroke-Classic(epidemic)&exertational
PatientswithCHScommonlyhavechronicdiseasesthatpredispose
toheat-relatedillness.
Ifcoolingisdelayed,severehepaticdysfunction,renalfailure,
disseminatedintravascularcoagulation,andfulminantmultisystem
organfailuremayoccur.
Classicheatstrokeisolderpatient.

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171.Whichofthefollowingcause(s)motor
neuropathy:
a)GBS
b)Diphtheria
c)Diabetes
d)Fridericataxia
e)All
CorrectAnswer-A:B:D
Answer-(A)GBS(B)Diphtheria(D)Fridericataxia
Parkinson'sdiseaseischaracterizedbyresttremor,rigidity,
bradykinesia,andgaitimpairment,knownasthe"cardinalfeatures"
ofthedisease.
Canincludefreezingofgait,posturalinstability,speechdfficulty,
autonomicdisturbances,sensoryalterations,mooddisorders,sleep
dysfunction,cognitiveimpairment,anddementia.

---

172.Whichofthefollowingis/arefeatureof
Pre-renalARFincomparisontointrinsic
renalfailure:
a)FractionalexcretionofSodium<1
b)Renalfailureindex>1
c)Urineosmolality>500mosmol/kgH20
d)Urinecreatinine/plasmacreatinine>40
e)PlasmaBUN/creatinineratio<20
CorrectAnswer-A:C:D
Answer-(A)FractionalexcretionofSodium<1(C)Urine
osmolality>500mosmol/kgH20(D)Urinecreatinine/plasma
creatinine>40
ComparisonoflabfindingsinAKI(1)
Test
PrerenalAKI
IntrinsicAKI
Urinespecificgravity
>1.020
1.010
Urinesodium,mEq/L
<20
>40
Fractionalexcretionof
<1%(neonates
>2%(neonates
sodium
<2%)
>2.5%)
Fractionalexcretionofurea <35%
>50%
Urineosmolality,mOsm/kg >500
<350
Ureanitrogen-creatinine
>20
10-50
ratio

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173.Drugcausingpulmonaryfibrosisis/are:
a)Amiodarone
b)Cisplatin
c)Gold
d)Bleomycin
e)All
CorrectAnswer-A:C:D
Answer-(A)Amiodarone(C)Gold(D)Bleomycin
Nitrofurantoin
Bleomycin
Busulfan
CyclophosphamideMethysergide
Phenytoin

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174.Whichofthefollowingcauses
hyperkalemia:
a)Barttersyndrome
b)RTAI
c)RTAII
d)Tumorlysissyndrome
e)Addison'sdisease
CorrectAnswer-D:E
Answer-(D)Tumorlysissyndrome(E)Addison'sdisease
Inadequateexcretion
A.Advancedrenalinsufficiencv
1. Chronickidneydisease
2. End-stagerenaldisease
3. Acuteoligurickidneyinjury
B.Primaryadrenalinsufficiency
1. Autoimmune:Addison'sdisease,polyglandularendocrinopathy
2. Infectious:HlV,cytomegalovirus,tuberculosis,disseminatedfungal
infection
3. Infiltrative:amyloidosis,malignancy,metastaticcancer
4. Drug-associated:heparin,low-molecular-weightheparin
5. Hereditary:adrenalhypoplasiacongenita,congenitallipoidadrenal
hyperplasia,aldosteronesynthasedeficiency
6. Adrenalhemorrhageorinfarction,includinginantiphospholipid
syndrome

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175.TreatmentofHyperkalemiaincludes:
a)Insulin
b)CaHCO3
c)Hemodialysis
d)p2agonist
e)50mlof50%dextrosewithinsulin
CorrectAnswer-A:C:D:E
Answer-(A)Insulin(C)Hemodialysis(D)p2agonist(E)50mlof
50%dextrosewithinsulin
Calciumsupplementation(calciumgluconate)
Insulinintravenousinjectionalongwithdextrosetoprevent
hypoglycemia,willleadtoashiftofpotassiumionsintocells,
secondarytoincreasedactivityofthesodium-potassiumATPase.
Bicarbonatetherapy
Salbutamol
SodiumPolystyrenesulfonate
Non-emergencyhyperkalemiatreatment:
Loopdiuretics-ByrenalK+excretion.
Resins[Sodiumpolystyrenesulfate]-BybindingK+
Hemodialysis-ByextracorporealK+removal

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176.NeoplasticlesioninAIDSincludes:
a)Analcarcinoma
b)Non-Hodgkin'slymphoma
c)Esophagealcarcinoma
d)Burkit'slymphoma
e)Cervicalcarcinoma
CorrectAnswer-A:B
Answer-A,AnalcarcinomaB,Non-Hodgkin'slymphoma
Kaposisarcoma(Multifocaltumorofvascularorigin)(HHV-8)
NonHodgkinlymphoma
Primarylymphomaofbrain
Invasivecancerofuterinecervix
Immunoblasticlymphoma(mostcommonlymphoma)
PrimaryEffusionLymphoma(PEL)
Plasmacyticlymphomaoftheoralcavity
Burkitt'slymphoma(EBvirus)

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177.Treatmentoffacio-cervical
actinomycosisincludes:
a)Surgeryistreatmentofchoice
b)DrugofchoiceispenicillinG
c)Metronidazole
d)Amoxicillin
e)All
CorrectAnswer-B:D
Answer-B,DrugofchoiceispenicillinGD,Amoxicillin
1stchoice-Penicillinoramoxicillinforsixtotwelvemonths
2ndchoice-Doxicycline
Surgeryifthediseaseisextensive

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178.Whichofthefollowingis/arenotfeature
ofanorexianervosa:
a)Strictdieting
b)Hallucination
c)Amenorrhoea
d)Distortionofbodyimage
e)Endocrineabnormalities
CorrectAnswer-B
Answer-B.Hallucination
PSYCHOLOGICALSYMPTOMS:
DistortedBodyImage.
EMOTIONAL:
Moodswings
Increasedcommitmenttowork
BEHAVIORAL-Excessiveexercise,starvation.
PHYSICAL:Extremeweightlossandstuntedgrowth,amenorrhea,
nippledischarge,dehydration,hypothermia,osteoporosis.

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179.Communityacquiredpneumoniais/are
causedby:
a)Staph.aureus
b)Mycoplasmapneumoniae
c)Streptococcuspneumoniae
d)Influenzavirus
e)Neisseriagonorrhoeae
CorrectAnswer-A:B:C:D
Answer-A,Staph.aureusB,Mycoplasma
pneumoniaeC,StreptococcuspneumoniaeD,Influenzavirus
Streptococcuspneumoniae
Haemophilusinfluenzae
Moraxellacatarrhalis
Staphylococcusaureus
Legionellapneumophila
Enterobacteriaceae(Klebsiellapneumoniae)andPseudomonas
sPP.
Mycoplasmapneumoniae
ChlamydiasPP.
InfluenzaA

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180.Whichofthefollowinginvestigationis
usefulforZollinger-EllisonSyndrome
(gastrinoma):
a)USG
b)MRI
c)CTscan
d)OctreoScan
e)Endoscopicultrasound
CorrectAnswer-A:B:C:D:E
Answer-A,USGB,MRIC,CTscanD,OctreoScanE,Endoscopic
ultrasound
Investigations-
Serumgastrinelevated
PatientshouldfirstundergoanabdominalCTscan,MRI,or
OctreoScantoexcludemetastaticdisease.
Endoscopicultrasound(EUS)permitsimagingofthepancreaswith
ahighdegreeofresolution
Radiolabelledsomatostatinreceptorscintigraphy.
Gastrinomapatientshavefastinggastrinlevel>150-200pg/ml
BAO>15meq/hinthepresenceofhypergastrinemiais
pathognomonicofZES.
BAO/MAOratio>0.6beinghighlysuggestiveofZES.
Themostsensitiveandspecificgastrinprovocativetestforthe
diagnosisofgastrinomaisthesecretinstudy.(Anincreaseingastrin
of120pgwithin15minofsecretininjectionhasasensitivityand
specificityof>90%forZES.)

---

---

181.Paraneoplasticsyndromesoflung
carcinomainclude:
a)Hypercalcemia
b)SIADH
c)Hypocalcemia
d)Hypoglycemia
e)Hypernatremia
CorrectAnswer-A:B:C
Answer-A,HypercalcemiaB,SIADHC,Hypocalcemia
Hypercalcemiaofmalignancy
SIADH
Cushing'ssyndrome
Hypoglycemia
Malefeminization
Diarrhoeaorintestinalhypermotility
Osteomalacia
Acromegaly
Hyperthyroidism
Hypertension

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182.Aperson'sX-raychestshowing
homogenousopacityonrightsidewith
shiftingofmediastinumonopposite
side.Mostprobablediagnosisis/are:
a)Collapse
b)Pleuraleffusion
c)Pneumothorax
d)Consolidation
e)Post-pnemectomy
CorrectAnswer-B
Answer-(B)Pleuraleffusion
Pneumonectomychest(Earlysip:within24hr):Partialfillingof
thorax,ipsilateralmediastinalshift&diaphragmaticelevation.
Homogenousopacity
Shiftofmediastinumtotheoppositeside
Concaveupperborder(Ellis'scurve)

---

183.Whichofthefollowingis/aretrueabout
pneumothorax:
a)Decreasedchestmovement
b)Dullonpercussion
c)Decreasebreathingsound
d)Hyper-resonantnoteonpercussion
e)End-expiratorycrepitation
CorrectAnswer-A:C:D
Answer-A,DecreasedchestmovementC,Decreasebreathing
soundD,Hyper-resonantnoteonpercussion
Inpneumothorax,intra-pleuralpressureequilibrateswiththe
ambientbarometricpressureandthelung'snaturalrecoiltendency
causesittocollapse.
Pneumothoraxtendstocausecollapseofthelungsandadecreased
compliance.
ClosedPneumothorax-
Reducedchestmovement
Hyper-resonantnoteonpercussion
Absentairentry
Mediastinalshifttooppositeside
Cointest
OpenPneumothorax-
Crackpotsoundonpercussion
Amphoricbreathsounds
Displacementofmediastinumwithrespiration
Increasingbreathlessness,cyanosis&tachycardia

---

---

184.WhichofthefollowingincludedinATPIII
criteriaforMetabolicsyndrome:
a)B.P130/85
b)Triglyceride150mg/dl
c)Fastingglucose100
d)Waistcircumferenceinfemale>80cm
e)None
CorrectAnswer-A:B:C
Answer-A,B.P130/85B,Triglyceride150mg/dlC,Fasting
glucose100
Criteria
Harmonized
NCEP(2001) IDF(2005)
WHO(1998)
(2009)
WC:Z90
DM.IFG.IGT,
Prerequisite
None
cm(men) None
IR
&
280cm
(women)t
No.ofother
and22of:
23of.
and22of: 23of:
criteria
Already
BMI:230&for WC:3102
WC:Z90cm
Obesity
considered
WHR:>0.9
cm(men)&
(men)e.
as
(men)&
388cm
perquisite 3$0cm
>0.85
(women)
criterion
(women)t
(women)
3130/135or Z:130/85
3130/85or
BP(mmHg)
Z140/90
Rx
orRx
Rx

---

BP(mmHg)
Z140/90
Rx
orRx
Rx
<35(men)&
<40(men)
HDL-C(mg/di)
<39(women) <40(men)&
<40(men)&
&
or
<50
<50
<50(women)
(women)
(women)or
orRx
orRx
Rx
TG(mg/d1)
Z150
150orRx
2l50orRx kis()orRx
Fastingglucose
2100or
2110,la
2100orRx
2100orfix
(mg/d1)
No
Urinary
albumin220
ug/minor
Microalbuminuria albumin-
creatinine
ratio>30
mg/g
tRecommendedwaistcircumferencethresholdsfortheabdominal
obesityinpeopleofAsianorigin.

---

185.Whichofthefollowingis/aretrueabout
inflammatoryboweldisease:
a)SmokingdecreasesriskofCrohn'sdisease&increasesriskof
ulcerativecolitis
b)PANCA-ulcerativecolitis
c)Linearulcer-Crohn'sdisease
d)Pseudopolyp-Crohn'sdisease
e)Cobblestoning-ulcerativecolitis
CorrectAnswer-B:C
Answer-(B)PANCA-ulcerativecolitis(C)Linearulcer-Crohn's
disease
ULCERATIVE
CROHN'SDISEASE
COLITIS
Wateryorbloody
Chronicdiarrhea
diarrhea
Rectaldischargeof
Abdominalpain
mucus,perforation
Weightloss,pyrexia,
Proctitis
abdominalmass
Acuteintestinal
Colitis
obstruction
Multipleperianal
Proctosigmoditis
fissures,fistula
&abscess
Toxicrnegacolon,
Fatwrappings
severehemorrhage
{creepingrnesentry)

---

ULCERATIVE CROHN'SDISEASE
COLITIS
Gross-
Gross?
Onlythe
Inflammatoryinvolvesfullthicknessofbowelwall
mucosa
thicknessofbowelwallinvolvingserosa
involved
Cobblestoneappearance
Superficial
Deepfissuredulcers
ulceration
Lymphadenopathy
Exudation
Fistulapresent
Pseudopolyps Skipareas
Micro-
Cryptabscess
common
Micro?
Inflammatory Noncaseatinggiantcellgranulomapresent
polyps
Pipestem
colon
ULCERATIVE
CROWN'SDISEASE
COLITIS
Age-2ndto4th&7thto
Age-2ndto4thdecade
9Thdecade
Gender-bothare
Femalesaremore
equallyaffected
affected
Etiology-
Etiology?
Morecommoninnon/
Morecommonin
exsmokers
smokers
Anatomical
Anatomical
distribution?
distribution-
Commonestinileum
Alwaysinvolvesrectum 160%)
&descending
Anallesionsare
colon/sigmoid
common

---

186.Herpesencephalitisfindingsare:
a)Mostcommonlyinvolvesfrontal&temporallobe
b)Commonlyinvolvesbasalganglia
c)HyperintenselesionintemporallobeonT1-weightedimages
d)HyperintenselesionintemporallobeonT2-weightedimages
e)None
CorrectAnswer-A:D
Answer-(A)Mostcommonlyinvolvesfrontal&temporal
lobe(D)HyperintenselesionintemporallobeonT2-weighted
images
HSVencephalitis-
Examplesoffocalfindingsinclude:
1. areasofincreasedsignalintensityinthefrontotemporal
2. focalareasoflowabsorption,masseffect,andcontrast
enhancementonCT
3. periodicfocaltemporallobespikesonabackgroundofsloworlow-
amplitude("flattened")activityonEEG
80%willhaveabnormalitlesinthetempotallobe.
HyperintenseonT2-images.

---

187.Paradoxical/reversesplittingofsecond
heartsoundis/areseenin:
a)AS
b)PS
c)Completeleftbundlebranchblock
d)Pulmonaryarterialhypertension
e)All
CorrectAnswer-A:C
Answer-(A)AS(C)Completeleftbundlebranchblock
LeftBundleBranchBlock(LBBB)istypicallyassociatedwith
ReversedorParadoxicalSplittingofS2
ParadoxicalsplittingofsecondheartsoundiscausedbydelayedA2
orearlyP2.LeftBundleBranchBlock(LBBB)isassociatedwith
delayedAorticclosure(delayedA2)duetodelayedelectrical
activationoftheleftventricle.
ASDandRBBBareassociatedwithawidephysiological(non-
paradoxical)splitofsecondheartsoundduetodelayedpulmonic
closure(DelayedP2)whileVSDisassociatedwithawide
physiological(non-paradoxical)splitsecondheartsoundfromearly
aorticclosure(EarlyA2).

---

188.Whichofthefollowingcausesacute
pancreatitis:
a)Hypertriglyceridemia
b)Hypercalcemia
c)Steroid
d)Stavudine
e)Gallstone
CorrectAnswer-A:B:C:E
Answer-(A)Hypertriglyceridemia(B)Hypercalcemia(C)Steroid
(E)Gallstone
Gallstones(mostcommon)
Alcoholabuseisthesecondcauseofacutepancreatitis.
Occultdiseaseofthebiliarytreeorpancreaticducts,especially
microlithiasis,sludge.
Hypertriglyceridemia
Pancreasdivisum
Pancreaticcancer
SphincterofOddidysfunction
Cysticfibrosis
Drugs-Steroids,Azathioprine,Valproate,Estrogens,L-
Asparaginase,6-mercaptopurine,Sulfonamides,Tetracycline,Anti-
retroviralagents,Thiazidediuretics
Familialorgenetic
Hyperparathyroidism
Hypercalemia
PostERCP
Mostcommoncausesinchildren:bluntabdominalinjuries,

---

Mostcommoncausesinchildren:bluntabdominalinjuries,
multisystemdisease(hemolyticuremicsyndromeandinflammatory
boweldisease)biliarystonesormicrolithiasis(sludging),anddrug
toxicity

---