Download Neet PG Internal Medicine MCQs Question Bank
2.Kayser-Fleischerrings(KFrings)areseenin: a)Pterygium b)Hematochromatosis c)Wilson'sdisease d)Menke'skinkedhairsyndrome CorrectAnswer-CWilson'sdisease
3.AllarefeaturesofAbetalipoproteinemia,EXCEPT: a)Plasmalevelsofcholesterolandtriglycerideareextremelylow b)Manifestinearlychildhoodwithdiarrhea c)Progressivepigmentedretinopathyseen d)Neurologicalmanifestationasataxiainfirstdecade CorrectAnswer-DPlasmalevelsofcholesterolandtriglycerideareextremelylowinthisdisorder,andchylomicrons.Abetalipoproteinemiausuallypresentsinearlychildhoodwithdiarrheaandfailuretothrive. Theneurologicalmanifestationslikedecreaseddistallowerextremityvibratoryandproprioceptivesense,dysmetria,ataxia,andthedevelopmentofaspasticgait,oftenbythethirdorfourthdecade. Patientsalsodevelopaprogressivepigmentedretinopathypresentingwithdecreasednightandcolorvision. Ref:HarrisonsPrinciplesofInternalMedicine,18thEdition,Page3153
4.Whichofthefollowingfindingsisdiagnosticofirondeficiencyanemia? a)IncreasedTIBC,decreasedserumferritin b)DecreasedTIBC,decreasedserumferritin c)IncreasedTIBC,increasedserumferritin d)DecreasedTIBC,increasedserumferritin CorrectAnswer-AIrondeficiencyanemiaisassociatedwithincreasedTotalironbindingcapacity(TIBC)anddecreasedserumferritin(storageformofiron)Ref:Harrison'sPrinciplesofInternalMedicine,17thEdition,Page631,663;Davidson'sprinciplesandpracticeofMedicine,20thEdition,Chapter24,Page1025-1027&1030
5.WhichofthefollowingendocrinetumorsismostcommonlyseeninMENI? a)Insulinoma b)Gastrinoma c)Glucagonoma d)Somatostatmoma CorrectAnswer-BAmongsttheoptionsprovided,gastrinomasarethemostcommonenteropancreatictumorsassociatedwithMENIwithinsulinomasbeingthesecondmostcommon.Ref:Harrison'sPrinciplesofInternalMedicine,17thEdition,Page2358&2359;16th/2232;Davidson'sprinciplesandpracticeofMedicine,20thEdition,Chapter20,Page803
6.AllofthefollowingstatementsregardingSickleCellAnemiaistrue,EXCEPT: a)Patientsrequirefrequentbloodtransfusions b)Patientsusuallypresentsbeforetheageof6months c)ThereisapositivecorrelationbetweenHBSandpolymerization ofHBS d)Reccurentinfectionsisthemostcommoncauseofdeath CorrectAnswer-BSicklecellanemiaisanautosomalrecessivedisorder,causedbyanaminoacidsubstitutionofvalineforglutamineinthesixthpositiononthebeta-globinchain.Onsetofthediseasestartsduringthefirstyearoflifeespeciallyafter6monthsofage,whenhemoglobinFlevelsfalls,asasignalissenttoswitchfromproductionofgammaglobintobetaglobin. HemoglobinSisunstableandpolymerizesduringhypoxemiaandacidosis,leadingtosicklingofredbloodcells.Patientsdevelopsjaundice,pigmentedgallstones,spleenomegaly,andpoorlyhealingulcersoverthelowertibia.Acutepainfulepisodescanoccurduetoacutevaso-occlusionbyclustersofsickledredcellsduringinfection,dehydration,orhypoxia.Commonsitesofacutepainfulepisodesincludethebonesandthechest. Ref:CurrentMedicalDiagnosisandTreatment2012,Chapter13;MedicalAssisting:AdministrativeandClinicalCompetenciesByLucilleKeir,6thEdition,Page471
7.Leukoerythroblasticpicturemaybeseeninallofthefollowingconditions, except: a)Myelofibrosis b)Metastaticcarcinoma c)Gaucher'sdisease d)Thalassemia CorrectAnswer-DLeukoerythroblastosisreferstothepresenceofimmaturenucleatedRBCs,immaturewhitebloodcells,andmegakaryocytefragmentsontheperipheralbloodsmear.Itoccurduetobonemarrowinfiltration. Whenmarrowinfiltrationcausesanemiaorpancytopenia,itisreferredtoasmyelophthisicanemia.Themostcommoncauseofmyelophthisisincludesmetastaticcarcinomaofthelung,breast,orprostate.Othercausesincludehematologicmalignancies(leukemia,lymphoma),infections(tuberculosis,fungi),andmetabolicdiseases(Gaucherdisease,Niemann-Pickdisease).Thalassemiaisnotassociatedwithleukoerythroblastosis.Ref:CURRENTDiagnosis&TreatmentinFamilyMedicine,3rdEdition,Chapter31
8.Allofthefollowingaremajorcomplicationsofmassivetransfusion,except: a)Hypokalemia b)Hypothermia c)Hypomagnesemia d)Hypocalcemia CorrectAnswer-AAns:A.)Hypokalemia.Complicationsusuallyseenwithmassivebloodtransfusionare1)hyperkalemia,2)hypocalcemia,3)hypomagnesemia4)hyperammonemia,5)hypothermia,6)Acidosis7)dilutionalcoagulopathiesandDIC(mostworrisomeproblemaftermassivetransfusionandistheusualcauseofdeathaftermassivebloodtransfusion)and8)ARDS.Thelethaltriadofacidosis,hypothermia,andcoagulopathyassociatedwithMTisassociatedwithahighmortalityrate.
9.Richter'ssyndromereferstowhichofthefollowingmalignanttransformation? a)CLLevolvingintoaggressivelymphoma b)HairycellleukemiaevolvingtoAML c)BlastcrisisinCML d)SplenicinfiltrationinNHL CorrectAnswer-AAns.A.CLLevolvingintoaggressivelymphomaRichter'stransformationorRichter'ssyndromeisacomplicationofBcellchroniclymphocyticleukemia(CLL)orhairycellleukemia(HCL)inwhichtheleukemiachangesintoafast-growingdiffuselargeBcelllymphoma.
10.Sicklecellanemialeadstoresistancetowards? a)P.falciparum b)P.ovale c)P.malariae d)P.vivax CorrectAnswer-A Individualswithsicklecelltrait(hemoglobingenotypeAS)areresistanttothelethaleffectsofPlasmodiumfalciparuminfection.Thisisbecausethesicklecelltraitspreventsthedevelopmentofhighparasitemia,probablypartlyasaresultofparasitizedredcellssicklinginthecirculationandbeingremovedbythespleenbeforetheycandevelopintoschizonts.AbsenceofRBCDuffyantigenconfersresistancetoP.Vivax. Ref:Harrison's17thedchapter213;EssentialsofclinicalimmunologybyHelenChapel, Man;e.Haeney,SirajMisbah,5thedition,Page48;LectureNotes:TropicalMedicineeditedbyG.V.Gill,NickBeeching,2011,Page62.
11.Romiplostimactsonwhichofthefollowingreceptors: a)Thrombopoeitin b)IL6 c)IL8 d)PGE1 CorrectAnswer-ARomiplostim:GeneticallyengineeredproteininwhichtheFccomponentofahumanantibodyisfusedtotwocopiesofapeptidethatstimulatesthethrombopoietinreceptors;approvedfortreatmentofidiopathicthrombocytopenicpurpuraRef:Katzung11theditionChapter33.
12.Oncogeneassociatedwithburkitt'slymphomais: a)BCL-1,IgH b)BCL-2,IgH c)C-MYC d)ALK CorrectAnswer-C Disease CytogeneticAbnormality Oncogene Mantlecelllymphoma t(11;14)(q13;q32) BCL-1,IgH Follicularlymphoma t(14;18)(q32;q21) BCL-2,IgH Diffuselargecelllymphoma t(3;-)(q27;-) BCL-6 t(17;-)(p13;-) p53 Burkitt'slymphoma,Burkitt's t(8;-)(q24;-) C-MYC leukemia CD30+Anaplasticlargecell t(2;5)(p23;q35) ALK lymphoma Lymphoplasmacytoidlymphoma t(9;14)(p13;q32) PAX5,IgHRef:Harrison,E-18,P-921
13.FALSEstatementregardingtheECGinacutepericarditisis: a)TwaveinversiondevelopbeforeSTelevationsreturnto baseline b)GlobalSTsegmentelevationisseeninearlypericarditis c)Sinustachycardiaisacommonfinding d)PRsegmentdepressionispresentinmajorityofpatients CorrectAnswer-ATwaveinversiondevelopafterSTelevationsreturntobaseline. TherearefourstagesofECGchangesintheevolutionofacutepericarditis.Instage1,thereiswidespreadelevationoftheSTsegments,oftenwithupwardconcavity,involvingtwoorthreestandardlimbleadsandV2toV6,withreciprocaldepressionsonlyinaVRandsometimesV1,aswellasdepressionofthePRsegmentUsuallytherearenosignificantchangesinQRScomplexes.Instage2,afterseveraldays,theSTsegmentsreturntonormal,andonlythen,orevenlater,dotheTwavesbecomeinverted(stage3).Ultimately,weeksormonthsaftertheonsetofacutepericarditis,theECGreturnstonormalinstage4. Ref:Harrisonsprinciplesofinternalmedicine,18thedition,Page:1971
14.Omalizumabisusedintreatmentof: a)Breastcarcinoma b)Asthma c)Rheumatoidarthritis d)Noneoftheabove CorrectAnswer-BOmalizumabisablockingantibodythatneutralizescirculatingIgEwithoutbindingtocell-boundIgE;itthusinhibitsIgE-mediatedreactions.Thistreatmenthasbeenshowntoreducethenumberofexacerbationsinpatientswithsevereasthmaandmayimproveasthmacontrol.However,thetreatmentisveryexpensiveandonlysuitableforhighlyselectedpatientswhoarenotcontrolledonmaximaldosesofinhalertherapyandhaveacirculatingIgEwithinaspecifiedrange. Ref:Harrison'sprincipleofinternalmedicine17thedition,chapter248.
15.ThepathognomonicfindinginmiliaryTBiswhichofthefollowing? a)Bonemarrowinfiltrations b)Choroidtubercles c)MiliarymottlinginchestX-Ray d)Histologicalfindinginliverbiopsy CorrectAnswer-BEyeexaminationmayrevealchoroidaltubercles,whicharepathognomonicofmiliaryTB,seeninupto30%ofcases. Reference:HarrisonsPrinciplesofInternalMedicine,18thEdition,Page1349
16.AllareimportantpathogenscausingpneumoniainCOPDpatients,EXCEPT: a)Haemophilusinfluenzae b)Pseudomonasaeruginosa c)Legionellaspp d)Klebsiellapneumoniae CorrectAnswer-DAllareimportantpathogenscausingpneumoniainCOPDpatients Haemophilusinfluenzae Pseudomonasaeruginosa Legionellaspp S.pneumoniae Moraxellacatarrhalis Chlamydiapneumoniae Klebsiellaisanimportantpathogencausingpneumoniainchronicalcoholism.Ref:Harrison,E-18,P-2132
17.PNHpatientswillbehavingdeficientsurfaceproteinsthatnormallyprotectthe redcellsfromactivatedcompliments.Whatarethetwodeficientsurfaceproteins? a)CD45andCD59 b)CD51andCD59 c)CD55andCD59 d)CD58andCD59 CorrectAnswer-CThedefinitivediagnosisofPNHisbasedonthedemonstrationthatasubstantialproportionofthepatient'sredcellshaveanincreasedsusceptibilitytocomplement(C),duetothedeficiencyontheirsurfaceofproteins(particularlyCD59andCD55).Reference:HarrisonsPrinciplesofInternalMedicine,18thEdition,Page884
18.WhichofthefollowingbiochemicaltestisusedtodiagnoseDubinJohnson syndrome? a)Serumtransaminases b)Bromsulphaleintest(BSP) c)Hippuratetest d)Gammaglutamyltransferaselevel CorrectAnswer-BBromsulphaleintest(BSP)isthediagnostictestforDubin-JohnsonSyndrome.BiliaryexcretionofnumerousanioniccompoundssuchasBromsulphalein(BSP)iscompromisedinDubin-JohnsonSyndrome(DJS).Inthistest,BSPisadministeredasIVbolusanditsclearancefromplasmaisdetermined.BSPlevelsshowacharacteristicriseinpatientswithDJSafter90minutesofinjection,duetorefluxofconjugatedBSPintothecirculationfromthehepatocyte.Ref:Davidson'sprinciplesandpracticeofMedicine,20thEdition,Chapter23,Page945;Harrison'sPrinciplesofInternalMedicine,16thEdition,Page1821;DigestiveDiseasesandSciencesVol/17numbers6.
19.Cholecystokininisproducedfrom: a)Hepatocyte b)Gastricmucosa c)Duodenalmucosa d)Epithelialcellsofdistalcommonbileduct CorrectAnswer-CThemajorfactorcontrollingthecontractionofthegallbladderisthehormonecholecystokinin(CCK),whichisreleasedfromtheduodenalmucosa(Icells)inresponsetotheingestionoffatsandaminoacids.Reference:HarrisonsPrinciplesofInternalMedicine,18thEdition,Page2616
20.EsophagealmanometryisusefulallthisconditionsEXCEPT: a)Achalasia b)Diffuseesophagealspasm c)ToassesstheperistalticintegritypriortothesurgeryforGERD d)Malignancy CorrectAnswer-DEsophagealmanometry,ormotilitytesting,entailspositioningapressuresensingcatheterwithintheesophagus.Manometryisusedtodiagnose1.Motilitydisorders(achalasia,diffuseesophagealspasm)2.Toassessperistalticintegritypriortothesurgeryforrefluxdisease. Esophagealmalignancyisnotdiagnosedwithesophagealmanometry.UpperGIendoscopyistheeffectivemethodformalignancyandbiopsycanbetaken. Ref:Harrison,Edition-18,Page-2430
21.Whichofthefollowingdrugsisusefulintheprophylaxisofmigraine? a)Propranolol b)Sumatriptan c)Domperidone d)Ergotamine CorrectAnswer-ADrugssuchastopiramate,valproate,propanolol,timolol,candesartan,verapamilandamitryptillineareindicatedinmigraineprophylaxis.Migraineprophylaxisisindicatedwhenmigraineheadachesoccurmorethantwoorthreetimesamonthorwhenitisassociatedwithsignificantdisability.Afterinitiationoftherapy,itshouldbecontinuedforseveralmonths.Oncethepatientremainsheadachefree,thedoseistaperedandthedrugiseventuallywithdrawn.BotulinumtoxintypeAwasapprovedbytheUSFoodandDrugAdministration(FDA)formigrainepreventioninlate2010.Ref:CurrentMedicalDiagnosisandtreatment2012,Chapter24
22.Allofthefollowingaretrueabouttreatmentofmigraine,EXCEPT: a)Naratriptanactslongerthansumatryptan b)Sumatryptanisusedinacuteattackofmigraine c)Sumatryptanactson5HT1B/1Dreceptorsingreatvessels d)Sumatryptanisusedforchronicmigraine CorrectAnswer-DSumatriptanisanagonistat5-HTserotoninreceptors,inparticular5HT receptors.Itisusedin 1B/1D thetreatmentofacutemigraineattacksbutisnotrecommendedformigraineprophylaxis.Thedrugprovidesrapidreliefofmigraineheadacheaswellasreliefoftheassociatedmanifestationsofmigraineincludingnausea,vomiting,photophobiaandphonophobia.Short-acting,rapidlyeffectivetriptansincludealmotriptan,sumatriptan,rizatriptan,zolmitriptan,andeletriptan,whereasnaratriptanandfrovatriptanhavethelongesthalf-lives.5HT receptoragonistsaresumatriptan,naratriptan,rizatriptan,andzolmitriptan. 1B/1D Ref:InstantPharmacologyByKouroshSaeb-Parsy,RaviG.Assomull,FakharZ.Khan,KasraSaeb-Parsy,EamonnKelly,1999,Page300;Harrison's17thedchapter15
23.Lateralmedullarysyndromeisduetotheocclusionofwhichofthefollowingvessels? a)Posteriorsuperiorcerebellarartery b)Anteriorinferiorcerebellarartery c)Basilarartery d)Vertebralartery CorrectAnswer-DLateralmedullarysyndromeisotherwiseknownasWallenberg'ssyndromeorPICAsyndromeorvertebralarterysyndrome.Occlusivediseaseoftheintracranialsegmentofthevertebralarteryisamuchmorefrequentcauseofthelateralmedullarysyndrome.Signsandsymptomsinclude:IpsilateralsideHorner'ssyndromeDecreaseinpainandtemperaturesensationonipsilateralsideoffaceCerebellarsigns(ataxia)Contralateralside:DecreasedpainandtemperatureoncontralateralbodyDysphagia,dysarthria,hoarseness,paralysisofvocalcordVertigo,nausea,vomiting,hiccupsNystagmus,diplopiaNofacialorextremitymuscleweaknessseeninthissyndrome. Ref:PhysicalMedicineandRehabilitationBoardReviewBySaraCuccurullo,2004,Page11;Harrison'sInternalMedicine17thedChapter364.CerebrovascularDiseases,BrainstemdisordersbyPeterPUrban,LouisRCaplanpage205-207.
24.POEMSSyndromeincludesall,EXCEPT: a)Polyneuropathy b)Organomegaly c)Endocrinopathy d)Multiplesclerosis CorrectAnswer-DThefeaturesofthissyndromearepolyneuropathy,organomegaly,endocrinopathy,multiplemyeloma,andskinchanges(POEMS).Patientsusuallyhaveasevere,progressivesensorimotorpolyneuropathyassociatedwithscleroticbonelesionsfrommyeloma.Polyneuropathyoccursin~1.4%ofmyelomas,butthePOEMSsyndromeisonlyararesubsetofthatgroup.Unliketypicalmyeloma,hepatomegalyandlymphadenopathyoccurinabouttwo-thirdsofpatients,andsplenomegalyisseeninone-third. Ref:Harrison'sprincipleofinternalmedicine17thedition,Chapter106.
25.Barrbodyisfoundinthefollowingphase ofthecellcycle: a)Interphase b)Metaphase c)GIphase d)Telophase CorrectAnswer-AAi.e.InterphaseTheinactiveXcanbeseenintheinterphasenucleusasadarklystainingsmallmassincontactwiththenuclearmembraneknownastheBarrbodyorXchromatin.BarrbodyistheinactivatedXchromosome.Innondividinginterphasecellsitremainstightlycoiledandcanbeseenasadarkstainingbodywithinthenucleus.
26.Allofthefollowingstatementsabout PulsusBigeminusaretrue,except: a)MustbedistinguishedfromPulsusAlternans b)Isasignofdigitalistoxicity c)Compensatorypauseisabsent d)RhythmisIrregular CorrectAnswer-CAnswerisC(Compensatorypauseisabsent):PulsusBigeminusisassociatedwithacompensatoryPause.CompensatorypauseisabsentinPulsusAlternansPulsusBigeminusisadisorderofrhythm(Irregularrhythm)causedbyanormalheatalternatingwithaprematurecontractionandacompensatorypauseresultinginalternationofthestrengthofpulse.Thestrokevolumeoftheprematurebeatisdiminishedinrelationtothatofthenormalbeats,andthepulsevariesinamplitudeaccordingly.PulsusBigeminusmostcloselymimicsPulsusAlternansfromwhichitmustbedistinguished.InPulsusAlternanstherhythmisregularandthecompensatorypauseisabsent.
27.PulsusBigeminusisseenintherapywith: a)Digitalis b)BetaBlockers c)ACEInhibitors d)CalciumChannelBlockers CorrectAnswer-AAnswerisA(Digitalis)PulsusBigeminusisrecognizedasacauseofdigitalistoxicity.PulsusBigeminusisadisorderofrhythm(Irregularrhythm;arrhythmia)mostcommonlycausedbyPrematureVentricularContractionsthatresultsinapulsewithirregularrhythmthatalternatesinamplitude(pressure)frombeattobeat.ThemostcommoncauseofPulsusBigeminusisDigitalisandPulsusBigeminusisrecognizedasacauseofdigitalistoxicity.
28.Widepulsepressureisseeninallexcept: a)PDA b)Aorticstenosis c)AorticRegurgitation d)A.V.malformation CorrectAnswer-BAnswerisB(AorticStenosis)AorticStenosisisassociatedwithanarrowpulsepressure.PatentDuctusArteriosus(PDA),AorticRegurgitationandAVMalformations(Arteriovenousshunting)areallassociatedwithawidepulsepressure.
29.Erb'sPointincardiologyrefersto: a)Right2ndintercostalspace b)Left2ndintercostalspace c)Right3rdintercostalspace d)Left2ndintercostalspace CorrectAnswer-CAnswerisC(Right3rdintercostalspace)Incardiology,Erb'spointreferstothethirdintercostalspaceontheleftsternalborderwherebothcomponentsofS2(A2andP2)canbewellappreciated.BothcomponentsofS2(A2andP2)areusuallywelltransmittedtotheErb'spoint.ThephysiologicalsplittingofS2intoA2andP2isbelievedtobeappreciatedbestattheErb'spointorinthepulmonicarea.A2isbestheardovertheaorticareaintherightsecondintercostalspaceP2isbestheardoverthepulmonicareaintheleftsecondintercostalspaceSecondheartsound(S2)isbestheardoverthepulmonicarea(SincebothA2andP2canbeheardatthepulmonicarea)andattheErb'sPoint.NotethatevenatthepulmonicareaA2islouderthanP2 Secondintercostalspacetotherightofthe 1. Aorticarea sternum(alongrightuppersternalborder) Pulmonic Secondintercostalspacetotheleftofthesternum 2. area (alongleftuppersternalborder)Thirdintercostaltotheleftofthesternum(alongleft 3. Erb'spoint sternalborder)
sternalborder) Tricuspid FourthorFifthintercostalspacetotheleftofthe 4. area sternum(alongleftlowersternalborder) Mitralarea 5. Fifthintercostalspaceontheleftmidclavicularline. (Apex)
30.S2isbestappreciatedin: a)3rdleftintercostalspace b)2ndrightintercostalspace c)4thleftintercostalspace d)5leftintercostalspace CorrectAnswer-AAnswerisA(3rdleftintercostalspace)Bestareastoauscultateforbothcomponentsofthesecondheartsound(A2andP2)areeithertheleftsternalborderatthelevelofsecondintercostalspace(Pulmonicarea)ortheleftsternalborderatthelevelofthirdintercostalspace(Erb'spoint).ThesecondheartsoundhastwocomponentsA2(fromAorticclosure)andP2(frompulmonaryclosure).P2isasoftsoundthatispoorlytransmitted.ItisbestheardatthepulmonicareaandistransmittedonlyasfarastheErb'spoint.A2isaloudsoundbestheardovertheaorticareabutsinceitiswidelytransmitteditmaybeheardacrossallareasofthechestevenasfarastheapex.Secondheartsound(S2)isbestheardoverthepulmonicarea(SincebothA2andP2canbeheardatthepulmonicarea).NotethatevenatthepulmonicareaA2islouderthanP2.Theotherareatoauscultateforbothcomponentsofthesecondheartsoundisattheleftsternalborderofthethirdintercostalspace(Erb'spoint)
31.Paradoxicalsplittingofsecondheart soundisseenin? a)RBBB b)ASD c)LBBB d)VSD CorrectAnswer-CAnswerisC(LBBB)LeftBundleBranchBlock(LBBB)istypicallyassociatedwithReversedorParadoxicalSplittingofS2ParadoxicalsplittingofsecondheartsoundiscausedbydelayedA2orearlyP2.LeftBundleBranchBlock(LBBB)isassociatedwithdelayedAorticclosure(delayedA2)duetodelayedelectricalactivationoftheleftventricle.ASDandRBBBareassociatedwithawidephysiological(non-paradoxical)splitofsecondheartsoundduetodelayedpulmonicclosure(DelayedP2)whileVSDisassociatedwithawidephysiological(non-paradoxical)splitsecondheartsoundfromearlyaorticclosure(EarlyA2).
32.Allofthefollowingstatementsaboutthird Heartsound(S3)aretrue,except: a)Occursduetorapidfillingoftheventriclesduringatrialsystole b)SeenininConstrictivePericarditis c)SeeninAtrialSeptalDefect(ASD) d)SeeninVentricularSeptalDefect(VSD) CorrectAnswer-AAnswerisA(Occursduetorapidfillingoftheventriclesduringatrialsystole)Thirdheartsoundoccursattheendofearlyrapidfillingphaseoftheventriclebutnotatthetimeofatrialsystole.Theheartsoundassociatedwithventricularfillingduringatrialsystoleisthefourthheartsound(S4)FourthHeartsoundoccursinassociationwithaneffectiveatrialcontraction()(Itispresumablycausedbyin-rushofbloodintotheventricleswhentheatriacontractsandhenceitisalsocalledthe'AtrialHeartSound)PathologicalThirdHeartSound(S3)maybeassociatedwithASDandVSD`ApathologicalS3isoftenpresentinlargelefttorightshuntsduetohighflowacrossthemitralvalvewithVSDorpatentductusarteriosusandwithhighflowacrossthetricuspidvalvewithASD.Thepresenceofthissoundintheseconditionsdoesnotimplycongestiveheartfailure,andsuchpatientsmaymaintainnormalmyocardialcontractilityforyearsaftertheS3isdetected'-'Hurst:TheHeart'11th/271CongenitalHeartDiseasesassociatedwithLoudS3VentricularseptalDefect(VSD)()
PatentDuctusArteriosus(PDA)QAtrialSeptalDefect(ASD)QPathologicalThirdHeartSound(S3)maybeassociatedwithConstrictivePericarditisConstrictivepericarditisischaracterixsticallyassociatedwithpericardialknockwhichisadistinctformofthirdheartsound(S3)`PericardialknockisS3thatoccursearlier(0.1to0.12afterA2)andishigherpitchedthannormal.Itspresencedependsupontherestrictiveeffectsoftheadherentpericardiumwhichhaltsdiastolicfillingabruptly'
33.LeftAxisDeviationisseenas a)PositiveinLeadIandPositiveinLeadII b)PositiveinLeadIandNegativeinLeadII c)NegativeinLeadIandNegativeinLeadII d)NegativeinLeadIandpositiveinLeadII CorrectAnswer-BAnswerisB(PositiveinLeadIandNegativeinLeadII)LeftaxisdeviationisseenaspositivedeflexioninLeadIandaNegativedeflectioninLeadII.Calculatingthecardiacaxis: Rightaxis Leftaxis NormalAxis deviation deviation LeadI Positive Negative Positive Positiveor LeadII Positive Negative negative Positiveor LeadIII Positive Negative negative Note:LeadI:POSITIVEBETWEEN-90TO+90(CLOCKWISE)LeadII:POSITIVEBETWEEN-30TO+150(CLOCKWISE)LeadIII:POSITIVEBETWEEN+30TO-150(CLOCKWISE)
34.Pwaveisdueto: a)Atrialdepolarization b)Atrialrepolarization c)Ventriculardepolarization d)Ventricularrepolarization CorrectAnswer-AAnswerisA(AtrialDepolarization)Pwaveisproducedduetoatrialdepolarization. Intervals EventsintheHeartDuringInterval Pwave AtrialdepolarizationAtrialdepolarizationandconductionthrough PRinterval AVnodeVentriculardepolarizationandatrial QRSduration repolarizationVentriculardepolarizationplusventricular QTinterval repolarization STinterval(QT Ventricularrepolarization minusQRS)
35.AbsentPWaveisseenin: a)AtrialFibrillation b)Cor-pulmonale c)MitralStenosis d)COPD CorrectAnswer-AAnswerisA(AtrialFibrillation)PwaveistypicallyabsentinAtrialFibrillation.COPDandCor-PulmonaleareassociatedwithtallpwavesfromRightAtrialEnlargement(P-Pulmonale)whileMitralStenosisistypicallyassociatedwithawideandnotchedpwavefromLeftAtrialEnlargement(P-Mitrale)CausesofAbsentWave:Atrialfibrillation(p'waveisabsentorreplacedbyfibrillaryTwave)Atrialflutter(p'waveisreplacedbyflutterwave,whichshowssaw-toothappearance).SAblockorsinusarrestNodalrhythm(usuallyabnormal,smallpwave).Ventricularectopicandventriculartachycardia.Supraventriculartachycardia(p'waveishiddenwithinQRS,duetotachycardia).Hyperkalemia.Idioventricularrhythm RightAtrialEnlargement(RAE)istypically PPulmonale associatedwithtallPwaves(COPDandCor-Pulmonaleareassociatedwith tallpwavesfromRAE)LeftAtrialenlargement(LAE)istypically
associatedwithwidePwaves PMitrale (MitralStenosisistypicallyassociatedwithawide andnotchedpwavefromLAE
36.Apatientinregularrhythmpresentswith absentPwavesonECG.LeadsII,IIIandAVFrevealaSaw-ToothPattern.Whichofthefollowingisthemostlikelydiagnosis: a)AtrialFibrillation b)AtrialFlutterwithVariableBlock c)AtrialFlutterwithFixedBlock d)MultifocalAtrialTachcardia CorrectAnswer-CAnswerisC(AtrialFlutterwithFixedBlock)TheabsenceofanydiscerniblePwavesonECG,togetherwiththepresenceofSawToothFlutterwavesininferiorleads(LeadsII,IIIandAVF)stronglysuggestsadiagnosisofAtrialFlutter.Thepresenceofaregularrhyti,,osuggestsaFixedBlock. Findings/Features Diagnosis IrregularRhythmwithnodiscerniblePwave AtrialFibrillation (Chaoticbaselinewithfibrillaryfwaves)IrregularrhythmwithnodiscerniblePwave AtrialFlutterwith (Sawtooth,Ilutterwavesespeciallyininferior variableblockleadsandVI)RegularrhythmwithnodiscerniblePwaves AtrialFlutterwith (Sawtoothflutterwavesespeciallyininferior fixedblockleadsandV1)IrregularRhythmwithmultiplePwave MultifocalAtrial morphologies(PwavesDiscernible) Tachycardia andVaryingPRintervals
37.AwideandnotchedPwaveistypically seenin: a)MitralStenosis b)Cor-Pulmonale c)COPD d)Pulmonaryembolism CorrectAnswer-AAnswerisA(MitralStenosis)MitralStenosisistypicallyassociatedwithaWideandNotchedPwavefromLeftAtrialEnlargement(LAE)Cor-Pulmonale,COPDandPulmonaryembolismareallassociatedwithRightAtrialEnlargementresultinginaTallPwave(notawidepwave)
38.AQRSdurationbetween100and120 millisecondssuggestsallofthefollowing,Except: a)Normal b)LeftanteriorFascicularBlock c)LeftposteriorFascicularBlock d)LeftBundleBranchBlock CorrectAnswer-DAnswerisD(LeftBundleBranchBlock)LeftBundleBranchblockistypicallyassociatedwithaQRSdurationgreaterthan120milliseconds.PartialBlocks(Fascicularorhemiblocks)intheleftbundlesystem(leftanteriororposteriorfascicularblocks)generallydonotprolongtheQRSdurationsubstantiallyandQRSdurationtypicallyremainslessthan120milliseconds.
39.LowQRSvoltageonECGwithleft ventricularhypertrophyonEchocardiographysuggestsadiagnosisof: a)Pericardialeffusion b)CardiacAmyloidosis c)Corpulmonale d)Infectiveendocarditis CorrectAnswer-BAnswerisB(CardiacAmyloidosis)LowQRSvoltageonECGwithleftventricularhypertrophyonEchocardiographysuggestsadiagnosisofinfiltrativecardiomyopathylikeamyloidosis.ThecombinationoflowQRSvoltageplusathickleftventricleonechocardiogramstronglysuggeststhediagnosisofinfiltrativecardiomyopathylikecardiacamyloidosis.Theincreasedthicknessistheamyloid.Itisnotmuscle(nottruehypertrophy),doesnotdepolarizeandthereforeaddsnothingtoQRSvoltage
40.TallTwavesonECGareseenin: a)Hyperkalemia b)Hypokalemia c)Hypercalcemia d)Hypocalcemia CorrectAnswer-AAnswerisA(Hyperkalemia)HyperkalemiaistypicallyassociatedwithTallpeakednarrowbasedfrntedTwave.
41.STelevationisseeninallofthefollowing conditionsexcept: a)Myocardialinfarction b)Coronaryarteryspasm c)Constrictivepericarditis d)Ventricularaneurysm CorrectAnswer-CAnswerisC(Constrictivepericarditis)STsegmentismeasuredfromtheendofQRScomplextothebeginningoftheTwave,andrepresentsthetimeintervalbetweenventriculardepolarizationandrepolarization.
42.Themostcommonreentranttachycardia associatedwithWPWsyndromeis a)OrthodromicAVreentry b)AntidromicAVreentry c)RapidlyconductingAF d)None CorrectAnswer-AAnswerisA(OrthodromicAVreentry)123.Themostcommonmacro-reentranttachycardiaassociatedWPWsyndromeisorthodromicAVreentry.Themostcommonmacro-reentranttachycardiaassociatedwithWPWsyndromeisreferredtoasOrthodromicAVreentry'
43.Athleticsyndromeischaracterizedby: a)IncreasedamplitudeofQRS b)Tachycardia c)DecreasedQTinterval d)U-waves CorrectAnswer-ATheanswerisA(IncreasedamplitudeofQRScomplex):AthleticHeartSyndromeAthleticHeartSyndromeisabenignconditionconsistingofphysiologicadaptationstotheincreasedcardiacworkloadofexerciseintrainedathletes.Itrepresentsaconstellationofclinicalfindingsthataretheresultofnormalphysiologicadaptationtostrenuousphysicalactivity.Inresponsetotheincreasedphysicaldemand,theleftventriclesdilateandwallthicknessincreases.Themasstovolumeratio,however,doesnotchange.PhysicalexaminationDecreasedbodyfatandincreasedmusclemass(generallyveryphysicallyfit)Pulseslowandoftenirregular(sinusbradycardiaorbradycardiawithfirst-andsecond-degreeblocks)GradeIorIImid-systolicmurmurs(benignfunctionalejectionmurmurresolveswithValsalvamaneuver)Thirdandfourthheartsoundsverycommon(benignfillingsounds)BloodpressuretypicallyremainsnormalElectrocardiogramrhythmRhythm-Sinusbradycardiaof40to55beats/minwhileatrest
-Sinuspausesofmorethan2.0secondsduetoincreasedvagaltone-Wanderingatrialpacemakerfoundonlyindynamicathletes-Firstdegreeatrioventricularblockpresentonlyatrest;P-Rintervalnormalizeswithexercise-Seconddegreeatrioventricularblockpresentonlyatrest:MobitzI(wenckebachblock)commoninmarathonrunners;MobitzIIrareinathlete'sheart.Voltage:TORSvoltage(Amplitude)-Leftventricularhypertrophyfoundin85%ofOlympicmarathonrunners-RightventricularhypertrophycommonindynamicathletesbutrarelyseeninsedentarycontrolsandstaticathletessedentarycontrolandstaticathletesRepolarization-S-TsegmentelevationwithpeakedTwavesnormalizeswithexertion-S-TsegmentdepressionmayberarelyfoundinathletesT-waveinversioninlateralleadsassociatedwithinterventricularseptalhypertrophyinstaticathletes(canbeanormalfindingindynamicathletes)Chestradiography-Theheartisglobularinappearance,particularlyinenduranceathletes.-Cardiomegaly(cardiothoracicratio>0.50)
44.Predisposingfactorsforcoronaryartery diseaseinclude,allExcept: a)Homocysteinemia b)LipoproteinB c)Fibrinogen d)plasminogenactivatorinhibitors1 CorrectAnswer-BAnswerisB(.LipoproteinB)Predisposingfactorsforcoronaryarterydiseaseincludeanincreasedlipoprotein'a'andnotlipoprotein'6'.
45.40yearoldmalepatientpresentstothe Emergencydepartmentwithcentralchestpainfor2hours.TheECGshowsSTsegmentdepressionandcardiactroponinsareelevated.PatienthasapositivehistoryofpreviousPCI3monthsback.HeisadministeredAspirin,Clopidogrel,NitratesandLMWH,intheEmergencyDepartmentandshiftedtothecoronaryareunit.Thebestrecommendedcourseoffurtheractionshouldinclude. a)ImmediateRevascularizationwithThrombolytics b)EarlyRevascularizationwithPCI c)Continueconservativemanagementandmonitoringofcardiac enzymesandECG d)Continueconservationmanagementandplanfordelayed Revascularizationprocedureafterpatientisdischarged CorrectAnswer-BAnswerisB(EarlyRevascularizationwithPCI)ThepatientpresentingasacaseofNSTEMItotheemergencydepartment.ThepresenceofelevatedcardiactroponinsandhistoryofpreviousPCIplacethepatientintoahigh'riskcategory'.ThePatientinquestionisth10a'highrisk'patientwithNSTEMI
SuchpatientsarecandidatesforearlyinvasivemanagementwithPCl/CABG.
46.ThemostcommontoxincausingDilated Cardiomyopathyis: a)Alcohol b)Chemotherapeuticagents c)Heavymetal d)Occupationalexposure CorrectAnswer-AAnswerisA(Alcohol)ChronicAlcoholConsumptionisthemostcommoncauseofToxicDilatedCardiomyopathy.Alcoholisthemostcommontoxinimplicatedinchronicdilatedcardiomyopathy'Note:DilatedcardiomyopathyisthemostcommontypeofcardiomyopathyThemostcommoncauseofdilatedcardiomyopathyisIdiopathic(Two-Thirds)AlcoholConsumptionisthemostcommoncauseofToxicDilatedCardiomyopathy
47.The9montholdchildofadiabeticmother presentswithtachypneaandhepatomegaly.Echocardiographyoftheheartshowednormalcardiacmorphologywithasymmetricseptalhypertrophy.Whichofthefollowingyouwillgivetotreatthischild: a)Digoxin b)Frusemide c)Propranolol d)Isoptin CorrectAnswer-CAnswerisC(Propranolol)ThesymptomsofthepatientandechocardiographicfindingofasymmetricalseptalhypertrophyalmostconfirmsthediagnosisofHypertrophiccardiomyopathy.BetaBlockersshouldbetheinitialdrugQinsymptomaticindividualsManagementofHOCMAvoidanceofstrenuousphysicalactivityBetaBlockersshouldbetheinitialdrugQinsymptomaticindividuals.Theyreduce:-Heartrate-Bloodpressure
-Stiffnessofleftventricle-FatalarrythmiasCalciumchannelBlockersQ(verapamilanddiltiazem)arealternativedrugs.-Theyreduce-stiffnessofventricle-ElevateddiastolicpressuresAmiadaronemaybeusedtoreducearrythmias.Surgicalmyomectomy
48.Kussmaul'ssignisclassicallydescribed in: a)RestrictiveCardiomyopathy b)PericardialTamponade c)Constrictivepericarditis d)RightVentricularInfarct CorrectAnswer-CAnswerisC(Constrictivepericarditis)Kussmaul'ssignisclassicallydescribedinassociationwithConstrictivePericarditis.Kussmaul'ssignreferstoparadoxicalelevationofJVP/CVPduringinspiration(Inhealthypersonsvenouspressurefallsduringinspirationbecausepressuresintherightheartdecreaseasintrathoracicpressuresfall)TheKussmaul'ssignisclassicallydescribedinassociationwithConstrictivepericarditis.Kussmaul'ssignishoweveralsoseeninassociationwithRightVentricularInfarction,RestrictiveCardiomyopathy,PulmonaryEmbolismandAdvancedSystolicSevereHeartFailure
49.HypertensionwithHypokalemiaisseen in: a)BartterSyndrome b)Liddle'sSyndrome c)Gitelman'sSyndrome d)Alloftheabove CorrectAnswer-BAnswerisB(Liddle'sSyndrome)Liddle'sSyndromeistypicallyassociatedwithHypokalemiaandHypertension.Rartter'sSyndromeandGitelman'sSyndromearealsoassociatedwithhypokalemiabutwithouthypertension. Liddle'sSyndrome:ReviewPathophysiology:?Autosomaldominantdisorder.?Geneticdefectinthecollectingtubulesodiumchannel,resultinginincreasedsodiumreabsorptionandlackofinhibitionbyhigherlevelsofintracellularsodiumAgeofPresentation?Oftendiagnosedatyoungage,butcanpresentinadulthoodduetophenotypicvariation.Clinicalpresentation?Classictriadofhypertension,metabolicalkalosis,andhypokalemia.?Consideriffamilyhistoryofhypertensionand/orhypokalemia.atyoungageLabdata?Metabolicalkalosis,hrpokalemia(althoughsomearelownormal),lowurinaryaldosteronesecretionTreatment:?Lifelong.Potassium-sparingdiureticwhichclosesthesodiumchannel(AmilorideorTriamterene).Spironolactonedoesnotworkbecausealdosteroneisnotcausingthesodiumchanneltobeopen.
50.Whichofthefollowingstatementsabout atrialmyxomasistrue a)MostcommoninLeftAtrium b)MorecommoninMales c)Distantmetastasisareseen d)Mostmyxomasarefamilial CorrectAnswer-AAnswerisA(MostcommoninLeftAtrium)CardiacMyxomasareusuallylocatedintheatria,mostcommonintheleft.CardiacmyxomasArethemostcommontypeofprimarycardiactumorsQOccuratallagesandshownosexpreference(mixesequallywithbothsexes)QMostcardiacmyxomasaresporadic,whilesomemaybefamilialSporadicmyxomas:AresolitaryQLocatedinAtria,mostcommonlyintheleftQUnlikelytohavepost-oprecurrenceeOccurinyoungerindividualsQFamilialmyxomas:Aremultiple?MorelikelytohavepostoprecurrenceeMyxomasarebenigntumorsandthereforedistantmetastasisarenotseen.?
51.Whichconditionismostcommonly associatedwithcoarctationofaorta? a)PDA b)Bicuspidaorticvalve c)Aorticstenosis d)VSD CorrectAnswer-BAnswerisB(BicuspidAorticValve)Themostcommonassociatedcardiacanomalywithcoarctationofaortaisbicuspidaorticvalve(Harrison's17th/1462)Coarctationofaortaisassociatedwithabicuspidaorticvalveinmorethan70%ofcases-(Nelson18th/1900) Associatedanomalieswith Shonecomplex coarctationofAortaQ? BicuspidAorticvalve('(commonest) CoarctationofAorta? PDAQ Leftsidedobstructive VSDQ ? lesions ? Tubularhypoplasiaofaorticarch(' (Mitralvalveabnormalities ? AorticstenosisQ(valvular/ andsubaorticstenosis) subvalvular) OtherAssociatedlesionsthathavebeenaskedpreviouslyMitralvalveabnormalities(Subvalvularmitralring/parachutemitralvalve)Turner'ssyndrome('
52.AcuteInfectiveEndocarditiswithabscess formationismostcommonlyassociatedwith a)Listeria b)Staphylococcus c)Streptococcus d)Enterococcus CorrectAnswer-BAnswerisB(Staphylococcus)AcuteInfectiveEndocarditiswithabscessformationismostcommonlyassociatedwithstaphylococcus.`Themostcommonorganismcausingacuteinfectiveendocarditisoverallisstaphylococcusaureus.Staphylococcusaureusendocarditisisparticularlyvirulentandassociatedwithannularandmyocardialabscessformationandahighermortality'
53.InMarfan'ssyndrome,Aorticaneurysm occursmostcommonlyin: a)Ascendingaorta b)Descendingaorta c)Abdominalaorta d)Archofaorta CorrectAnswer-ATheanswerisA(AscendingAorta)AorticaneurysmsinMarfan'ssyndromeoccurmostfrequentlyintheascendingaorta.CardiovascularlesionsinMarfan'ssyndromeCardiovascularlesionsarethemostlife-threateningfeaturesofMarfan'ssyndrome.Mitralvalveprolapse(MVP)Lossofconnectivetissuesupportinmitralvalvesleafletsmakesthemsoftandblowycreatingtheso-called'floppyvalve'.Mitralregurgitationfrequentlyresults.DilatationofAscendingAortaeThemediaundergoescysticnecrosis(cysticmedionecrosis).LossofmedialsupportresultsinprogressivedilatationofaorticvalveringandrootoftheaortaSevereaorticincompetenceAorticdissections
54.Whichofthefollowingisnotexpectedina caseofMicrocyticHypochromicAnemia: a)ReducedserumIron b)ReducedTotalRBCdistributionWidth c)NormalFerritinlevels d)IncreasedTIBC CorrectAnswer-BAnswerisB(ReducedTotalRBCdistributionwidthMicrocyticHypochromicAnemiasaretypicallyassociatedwithaNormalorHighRedCellDistributionWidth Condition Iron Thalassemia Sideroblastic Anemiaofchronic Test deficiency anemia disease (normalvalues) Microcytic Microcytic Microcytic Normocytic hypochromic hypochromic hypochromic normochromic Smear > Microcytic Micro/hypochromic (MCV<80) (butMicro/Hypo maybepresent) Serumiron Low(<30) Normal Normal .1.(<50) (50-150n/d1)TIBC High(>360) Normal Normal ,i,(<300) (300-360 (Chandrasoma ?g/dl) Taylor) % <10(J') NorTed Nor"I' 4, Saturation
Saturation(30-50%) (30-80) (30-80) (10-20) Ferritin <15(fed) T(50-300) T(50-300) (R/1) NormalorT (50-200 (30-200) ?g/L)Hemoglobin Normal Abnormal Normal Normal patternFree Ted Normal Ted Ted ErythrocyteProtporphrinRDW Ted Normal Normal Normal
55.Megaloblasticanemiashouldbetreated withbothfolicacidvitaminB12because: a)Folicacidalonecausesimprovementofhematologicsymptoms butworseningofneurologicalsymptoms b)ItisaCofactor c)Itisenzyme d)Noneoftheabove CorrectAnswer-AAnswerisA(Folicacidalonecausesimprovementinhematologicinsymptomsbutworseningofneurologicalsymptoms)MegaloblasticanemiamaybecausedbyadeficiencyofvitaminB12(cobalamine)ordeficiencyoffolate.Unlessitisclearlyestablished,whichofthetwodeficienceis/folateorcobalamine)isthecauseanemiatreatmentshouldincludeadministrationofboth.folkacidand.vitaminBp.IfonlyfolicacidisadministeredinapatientwithmezaloblasticanemiaduetovitaminBI2deficiency,worseninzofneurologicalsymptoms(cobalamineneuropathy)isseendespiteanimprovementinthehematological.symptoms(anemia)'Althoughprompthematologicresponseheraldedbyreticulocytosisfollowstheadministrationoffolicacid,itshouldhecautionedthatthehematologicsymptomsofavitaminB,2deficiencyanemiaalsorespondtofolatetherapy.HoweverMatedoesnotpreventandmayevenexacerbatetheprogressionofneurologicaldeficitstypicalofvitaminB12deficiencystates'Beforelargedosesoffolicacidaregiven,cobalaminedeficiencymustbeexcludedandifpresentcorrected,otherwisecobalamineneuropathymaydevelopdespitearesponseoftheanemiaof
cobalaminedeficiencytoPalatetherapy.
56.IndirectCoomb'stestdetects: a)AntibodiesattachedtoRBCSurface b)Antibodiesintheserum c)AntigensattachedtoRBCSurface d)Antigensintheserum CorrectAnswer-BAnswerisB(Antibodiesintheserum)IndirectCoomb'stestdetectsIgGantibodiesintheserum(e.g.Anti-DAntibodies).DirectCoomb'stestdetectsIgGAntibodies(orcomplements)attachedtothesurfaceofRBCs.DirectAntihumanGlobulinTestDetectsRBCssensitizedwithIgGorComplements(C3BorC3d)(DAT;Coomb's;DirectCoomb's)DetectsIgGAntibodies(orcomplements)attachedtothesurfaceofRBCs.IndirectAntihumanGlobulinTestDirectCoomb'sTestIntheDirectCoomb'stest,redbloodcells(RBCs)sensitizedwithIgGantibodies(orC3b,C3d)areagglutinatedwhenCoomb'sreagent(RabbitAnti-IgGantibody)isaddedtothetesttubeDetectsAntibodiesintheSerumIndirectCoomb'sTestIntheIndirectCoomb'stestIgGantibodies(e.g.Anti-D)intheserummustfirstbindtobloodgroupType0TestRBCsaddedtothetesttube.AdditionofCoombsReagent,thencausesthesensitizedType0TestRBCstoagglutinate,indicatingthatIgGantibodiesarepresentintheserum.
57.DirectCoomb'stestdetects: a)AntibodiesattachedtoRBCSurface b)Antibodiesintheserum c)AntigensattachedtoRBCSurface d)Antigensintheserum CorrectAnswer-AAnswerisA(AntibodiesattachedtoRBCSurface)DirectCoomb'stestdetectsIgGAntibodies(orcomplements)attachedtothesurfaceofRBCs.IndirectCoomb'stestdetectsIgGantibodiesintheserum(e.g.Anti-DAntibodies).
58.HaemoglobinFisraisedin: a)Juvenilechronicmyeloidleukemia b)Hereditaryspherocytosis c)Congenitalredcellaplasia d)Mysthaniagravis CorrectAnswer-AAnswerisA(JuvenileCML)FetalHaemoglobinlevels(HbF)areincreasedinmostcasesofJuvenileCML?CausesofRaisedHbFlevels(InterpretationofDiagnosticTest8th/411,412)Haemoglobinopathies-thalassemiamajor-thalassemiaminor-SicklecelldiseaseHereditaryPersistanceofHbFAnemia:-NonHereditaryrefractorynormoblasticanemia-Perniciousanemia-AplasticanemiaLeukemiaspeciallyJuvenileMyeloidLeukemiaMultiplemyelomaMolarpregnancyPatientswithTrisomy13orTrisomy21(Down'ssyndrome)Somechronicviralinfections(egCMV,EBV)
59.HAMtestisbasedupon: a)GPIAnchorProteins b)Complement c)Spectrinprotein d)Mannosebindingproteins CorrectAnswer-BAnswerisB(Complements)HAMtestisbaseduponsusceptibilityofRBC'stocomplementmediatedlysisinpatientswithPNH.HAMtestisusedfbrthediagnosisofPNH(ParoxysmalNocturnalHaemoglobinuria).HAMtest(Acidifiedserumlysistest)demonstrateslysisofRBCafteractivationofcomplementbyacid.Inacidifiedserumcomplementisactivatedbythealternatepathway.InpatientswithPNH,RBCareunusuallysusceptibletocomplement,andundergolysiswhenincubatedwithacidifiedfreshserum.
60.Whichisthemostcommoncytogenetic abnormalityinadultmyelodysplasticsyndrome(MDS)- a)Trisomy8 b)20q? c)5q? d)Monosmy7 CorrectAnswer-CAnswerisC(5q-)`Monosomy7isbyfarthemostcommoncytogeneticabnormalityinchildren(pediatricMDS)whereas5q-isobservedmostfrequent!,'inadults'?MyelodysplasticSyndromesbyJohnBennett(2002)/300CytogeneticAbnormalitiesinMDS:FactstoRememberMonosomy7isthemostfrequentcytogeneticabnormalityinchildren.QDeletion5q(5q)isthemostfrequentcytogeneticabnormalityinadultsQ.Trisomy8isthemostfrequenttri.somyQ.DifferencesbetweenMyelodysplasticSyndromesinchildrenandAdults(`MyelodysplasticSyndromes'2002/300;'ChildhoodLeukemias'2'"/549)FeatureChildrenAdults ?Frequency Lesscommon Morecommon ?Presenceof Uncommon Morecommon(,- sideroblasts (<2%) -25%) ?Cytogenetic Abervations Mostcommon Lesscommon -7/7q- (r,30%) (,=-40%)
-7/7q- (r,30%) (,=-40%) Uncommon(--L- Mostcommon -5/5q- 1-2%) (z20%)
61.Gaisbocksyndromeisknownas a)PrimaryFamilialPolycythemia b)HighAltitudeErythrocytosis c)SpuriousPolycythemia d)PolycythemiaVera CorrectAnswer-CAnswerisC(SpuriousPolycythemia)GaisbocksyndromereferstoSpuriousPolycythemiaorRelativeErythrocytosisduetodecreasedplasmavolume.
62.Allofthefollowingstatementsabout Burkitt'slymphomaaretrue,Except: a)Bcelllymphoma b)8,14translocation c)Canpresentasanabdominalmass d)Radiotherapyisthetreatmentofchoice CorrectAnswer-DAnswerisD(Radiotherapyisthetreatmentofchoice)ThetreatmentofchoiceforBurkitt'sLymphomaischemotherapyandnotRadiotherapy.'Burkitt'slymphomarespondswelltoshorttermhighdosechemotherapy.TreatmentofBurkitt'slymphomainbothchildrenandadultsshouldbeginwithin48hoursofdiagnosisandinvolvestheuseofintensivecombinationchemotherapyregimens'?HarrisonsBurkitt'sLymphomaisaBcelllymphomaBurkitt'sLymphomaaretumorsofmatureBcells?Robbins7th/677t(8;14)translocationisthemostcommontranslocationinBurkitt'sLymphomaBurkitt'slymphomasareassociatedwithtranslocationofthec-MYCgeneonchromosome8.Translocationt(8;14)t(8;22)t(2;8)Burkitt'sLymphomamaypresentwithanabdominalmassMostBurkitt'sLymphomapresentsatextranodalsitesbutmaypresentwithlymphadenopathyExtranodalsitesofinvolvementincludethemandibleandabdominalviscera `Burkitt'sLymphomasmaypresentwithperipherallymphadenopathy
oranintraabdominalmass'?Harrison CNSinvolvementisfrequentThediseaseisrapidlyprogressiveandhasapropensitytometastasizetoCNS,prophylactictherapytoCNSisthereforemandatory.Burkitt'sLymphomaisthemostrapidlyprogressivehumantumor
63.'Hairycellleukemia'isaNeoplastic proliferationof: a)T.cells b)B.cells c)Myeloidcells d)Macrophages CorrectAnswer-BAnswerisB(BCells)Wain'CellisararehutdistinctiveB-cellneoplasm.Hairycellleukemiareview:Presentationiswithatriadof: 1. SplenomegalyQ:oftenmassive.Howeverhepatomegalyisless commonwhilelymphadenopathyisrare. 2. PancytopeniaQandthereby,resultinginfections.3. VasculitislikesyndromeQ:Erythemanodosumandcutaneous nodulesduetoperivasculitisandPAN.Course:Hairycellleukemiafollowsanindolentcourse.Q
64.ChemotherapeuticAgentofChoiceforthe treatmentofCMLis: a)Imatinib b)Vincristine c)Cyclophosphamide d)Methotrexate CorrectAnswer-AAnswerisA(Imatinib):TyrosineKinaseInhibitors(Imatinib)arethechemotherapeuticagentsforchoiceinthemanagementofCML.TyrosineKinaseinhibitorstargetthe'constitutivelyactivetyrosinekinase'implicatedinthepathogenesisofCML.Althoughtheydonotcurethedisease,theseagentsareabletoachievelongtermcontrolofCMLinthemajorityofpatients.Mostrecenttexts(IncludingHarrisons)recommendTyrosineKinaseInhibitors(Imatinib)astheinitialtreatmentofchoicefornewlydiagnosedCMLreservingAllogeneicStemCellTransplantation(SCT)forthosewhodevelopImatinibResistance.
65.Theimmunoglobulinmostcommonly involvedinMultipleMyelomais: a)IgG b)IgM c)IgA d)IgD CorrectAnswer-AAnswerisA(IgG)TheMcomponentinMultipleMyelomacanbemadeupoftheimmunoglobulinsIgG,IgM,IgD,IgA,andIgE;lightchainsalone;orheavychainsalone.IgGMyelomaisthemostcommonformofMultipleMyelomawhileIgD(2%)andIgE(Rare)aretheleastcommon.Distributionofimmunoglobulintypesinpatientswithmultiplemyeloma Typeofprotein Percentage(%) IgG 52 IgA 22 IgM 12 IgD 2 IgE Rare
66.Themostcommontranslocationseenin patientswithMultipleMyelomais a)t(11;14) b)t(4;14) c)t(14;16) d)t(14;20) CorrectAnswer-AAnswerisA(t(11;14))ThemostcommontranslocationseeninpatientswithMultipleMyelomais01;14).`ThemostcommontranslocationseeninpatientswithMultipleMyelomaist(11;14)(q13;q32)involvingtheBCL1locusonchromosome11g13andtheimmunoglobulinheavy(IgH)chainlocusonchromosome14q13whichleadstooverexpressionofCyclinD1'-TheWashingtonManualofSurgicalPathology`ThetwomostcommontranslocationseeninpatientswithMultipleMyelomaaret(11;14)andt(4;14).Boththesetranslocationsoccurwithalmostsimilarfrequencies,howevertheincidenceoftranslocation1(11;14)appearstobemarginallyhigher.Patientswitht(4;14)fallwithinapoorprognosissubgroup,whilethosewith1(11;14)haveastandardrisk'-ThePrinciplesofClinicalCytogeneticsThetwomostcommontranslocationseeninpatientswithMultipleMyelomat(11;14)(q13;q32):Associatedwithstandardprognosist(4;14)(p16;q32):AssociatedwithaggressivebehaviourandpoorprognosisThemostcommontranslocationinmultiplemyelomaassociated
withapoorprognosisistranslocationt(4;14)
67.Allthefollowingaretrueaboutmultiple myelomaexcept: a)Osteolyticbonedisease b)t(8-14)translocation c)Lightchainproliferation d)Bence-Jonesproteinsinurine CorrectAnswer-BAnswerisB(t(8-14)translocation)AvarietyofchromosomalalterationshavebeenfoundinpatientswithMultiplemyeloma.Themostcommontranslocationist(11;14)(q13;q32).13q14deletionsand17p13deletionsand11qabnormalitiespredominate.Translocation1(8-14)hasnotbeenmentioned.CompleteImmunoglobulinchaincomprisesofbothheavychainsandlightchains.ButinMultiplemyelomathereisexcessproductionoflightchainseoverheavychains.TheselightchainsareeliminatedinurineasBenceJonesproteinQProteincastinurinearethusmadeupoflightchainsonlyQ(notcompleteimmunoglobulinchains).Bonelesionsinmultiplemyelomaarelyticinnatureandarerarelyassociatedwithosteoblasticnewboneformation.'-Harrison.BonelesionsinMMarecausedbytheproliferationoftumorcellsandactivationofosteoclaststhatdestroythebone.'BonepainisthemostcommonsymptominMMaffecting70%ofpatientsQ'-Harrison
68.Convergingpointofbothpathwayin coagulationisat: a)FactorVIII b)StuartfactorX c)FactorIX d)FactorVII CorrectAnswer-BAnswerisB(StuartfactorX)TheextrinsicandIntrinsicpathwaysincoagulationconvergeattheStuartfactorX.
69.Whichofthefollowingstatementsabout coagulationfactorVIIisnottrue a)DeficiencyisinheritedasanAutosomalRecessivetrait b)DeficiencyisassociatedwithprolongedAPTT c)DeficiencycanbemanagedbyFreshFrozenplasma d)HasashorterhalflifeincomparisontoHagemanfactor(XII) CorrectAnswer-BAnswerisB(DeficiencyisassociatedwithprolongedAPTT)FactorVIIdeficiencyisassociatedwithisolatedprolongationofPT,APTTisnormalinFactorVIIdeficiency Geneticandlaboratorycharacteristicofinheritedcoagulation disorders Inheritance Laboratory Treatment Prevalence Minimum Clotting Abnormality' inGeneral Hemostatic factor aPTI Population leNels deficiency PTTT Iin Fibrinogen AR 100mg/dL Cryoprecipitate 1.000,000 + + + Iin Prothrombin AR 20-30% FFP/Pa's 2.000,000 + + 1in FactorV AR +/- +1- I5-10"/a HP 1.000,0001in FactorIII AR - + - 15-20% FFP/PCCs 500,000 FAINT FactorVIII X-linked Iin5.000 30% + - concentrates FactorIX X-linked Iin30.000 30% FIXconcentrates + - -
FactorIX X-linked Iin30.000 30% FIXconcentrates + - - Iin FactorX AR +1- +/- - 15-20% FFP/PCICs 1.000,000Iin FactorXI AR 15-20% FFP 1,000,000 FactorXII AR 'SO + - h h HK AR ND + Ii h Prckallikrein AR ND _, 6 h Iin FactorXIII AR +/- 2-5% Cryptoprecipitate 2,000,000 Valueswithinnsrmalrange(-)orprolonged(?)Noriskforbleeding,treatmentisnotindicatedHK,high-molecularweightkininogen;AR,autosomalrecessive;aPTT,activatedpartialthromboplastintime;PT,prothrombintime;TT,thrombintime;ND,notdetermined;FFP.freshfrozenplasma;PCCs,prothrombincomplexconcentrates.
70.Thromboticthrombocytopenicpurpurais asyndromecharacterizedby: a)Thrombocytosis,anemia,neurologicabnormalities,progressive renalfailureandfever. b)Thrombocytopenia,anemia,neurologicabnormalities, progressivehepaticfailureandfever c)Thrombocytosis,anemianeurologicabnormalities,progressive renalfailureandfever d)Thrombocytopenia,anemia,neurologicalabnormalities, progressiverenalfailureandfever CorrectAnswer-DAnswerisD(Thrombocytopenia,anemia,neurologicalabnormalities,progressiverenalfailureandfever)ThromboticThrombocytopenicPurpura(TTP)ischaracterizedclinicallybythePentadofMicroangiopathicHemolyticAnemia,Thrombocytopenia.DecreasedRenalFunction.DisturbedNeurologicalfunctionandFever.
71.Hypercoagulabilityduetodefectivefactor Vgeneiscalled: a)Lisbonmutation b)Leidenmutation c)Antiphospholipidsyndrome d)Induciblethrombocytopeniasyndrome CorrectAnswer-BAnswerisB(Leidenmutation)HypercoagulabilityduetodefectiveFactorVgeneiscalled'Leidenmutation'andisnamedafterthecityinwhichitwasdescribed.FactorVLeidenFactorVLeidenisavariant(mutated)ofnormalclottingfactorVanddiffersfromnormalclottingfactorVbyasinglenucleotide.WhileFactorVLeideniscompletelynormalintermsofitsabilitytopreventbleeding,theoneaminoaciddifferencemakesFactorVLeidenresistanttobeingdegradedbyactivatedproteinCandproteinS.ConsequentlyfactorVLeidenpersistsinthecirculationlongerandcontributestoformationofbloodclots.FactorVLeidenmutationisthemostcommonunderlyinggeneticcauseofthrombophilia(venousthrombosis)FactorVLeidenmutationposesalifelongriskofdeepvenousthrombosis.
72.ThepreferredtestforconfirmingH.pylori eradicationis: a)Ureasebreathtest b)Culture c)Serologicaltest d)Biopsyureasetest CorrectAnswer-AAnswerisA(UreaseBreathTest)Thetestofchoicefordocumentingeradicationisureasebreathtest.AssessmentofsuccessofTreatmentwithEradicationofH.Pylorishouldbedoneatleast4weeksaftercompletionofantiH.Pyloritherapy.Non-invasivetestsaretypicallypreferredforassessmentofEradication.Thetestofchoicefordocumentingeradicationisureasebreathtest.UreasebreathtestdetectsH.pyloriinfectionby'bacterialureaseactivity'andremainspositivetillthebacteriahasnotbeeneradicatedwithtreatment.Thusureasebreathtestbecomesnegativeonlyaftereradicationoforganismfollowingtreatmentandnotwithchronicinfection.
73.Allofthefollowingareusedfortreatment ofH.Pylori,except: a)Gentamycin b)Clarithromycin c)Metronidazole d)Amoxicillin CorrectAnswer-AAnswerisA(Gentamycin):Gentamycinisnotusedinanyofthesuccessfulmulti-drugregimensagainstH.PyloriInfection.
74.Commonestsiteofpepticulceris: a)1stpartofDuodenum b)IIndpartofduodenum c)Distal1/3ofstomach d)Pylorusofthestomach CorrectAnswer-AAnswerisA(1stpartofDuodenum)Firstpartofduodenumisthemostcommonsiteforpepticulceration.Sitesinorderofdecreasingfrequency: 1. Duodenum,1stportionQ2. Stomach,usuallyantrumQ3. Atthegastro-esophagealjunction,inthesettingof gastroesophagealrefluxQ 4. WithinthemarginsofagastrojejunostomyQ5. Intheduodenum,stomochorjejunumofpatientswithZollinger- EllisonSyndromeQ 6. WithinoradjacenttoaMeckelsdiverticulumthatcontainsectopic gastricmucosaQPepticulcersareusuallysolitarylesionslessthan4cmindiameter
75.Dumpingsyndromeisdueto: a)Diarrhoea b)Presenceofhypertoniccontentinsmallintestine c)Vagotomy d)Reducedgastriccapacity CorrectAnswer-BAnswerisB(PresenceofHypertonicContentsinsmallintestine)DUMPINGSYNDROMEreferstoasyndromeofabdominalandvasomatorsymptomswhichresultsfromdumpingoffoodstuffswithahighosmoticload,frontthestomach,intothesmallbowel.Lossofstoragecapacityofstomachandablation,bypassordestructionofpylorus,resultsinrapidemptyingofhyperostnolarchymeintoduodenummmandsmallintestine.Extracellularfluidthenshiftsintotheintestinallumentorestoreisotonicityresultingindecreasedintravascularvolume,whichgivesrisetothevasomotorsymptoms.Notethatwhilereducedgastriccapacitycontributes,option(b)isamoreaccurateanswer.DumpingSyndromeisactuallyoftwotypes:Earlydumpingsyndrome(asdescribedabove)Latedumpingsyndrome:ThisisReactivehypoglvcemiae.Thecarbohydrateloadinthesmallintestinelatercausesariseinplasmaglucose,whichinturncausesinsulinlevelstorisecausingasecondaryhypoglycemia.
76.SchillingtestisAbnormalin: a)Intrinsicfactordeficiency b)Amylasedeficiency c)Lipasedeficiency d)Pancreaticendocrineinsufficiency CorrectAnswer-AAnswerisA(Intrinsicfactordeficiency)Shilling'stestistypicallydonetodeterminethecauseofcobalaminemalabsorption(VitaminB12malabsorption)VitaminB12absorption(Schilling)testistypicallyusedtodiagnoseconditionsinwhichintrinsicfactor(IF)maybeabsent,suchasperniciousanemiaorgastricatrophy.AdiagnosisofIntrinsicfactordeficiencycanbeestablishedifradiolabelledcobalamine(VitaminB12)appearsinurineafteradministrationofIntrinsicfactor.Sincecobalamineabsorptionrequiresmultiplestepsincludinggastric,pancreaticandilealprocesses,theSchillingtestcanalsobeusedtoassesstheintegrityoftheseotherorgans.DietaryvitaminB12isboundinthestomachtoanendogenousproteincalledRprotein.PancreaticenzymesdegradetheRproteinintheproximalsmallbowelandloweritsaffinityforvitaminB12resultingintherapidtransferofB12toIF;TheIF-B12Complexcontinuestotheterminalileum,whereitbindstospecificreceptorsonthesurfaceoftheepithelialcells.Thuslackofintrinsicfactor,lackofsufficientpancreaticenzymes(pancreaticexocrinedysfunction)orpresenceofterminalhealmucosaldiseasemayallresultinabnormalvitaminB12excretion.
77.Whichofthefollowingstatements regardingtheschillingtestforvitaminB12malabsorptionismostaccurate? a)Theschillingtestresultsareabnormalinpatientswithdietary vitaminB12deficiency. b)Inpatientswithperniciousanemia,theresultsoftheschilling testnormalizeafteroraladministrationofintrinsicfactor, c)Inpatientswithilealdisease,theresultsoftheschillingtest normalizeafteroraladministrationofintrinsicfactor d)Pancreaticexocrineinsufficiencydoesnotcauseschillingtest resultstobeabnormal. CorrectAnswer-BAnswerisB(Inpatientswithperniciousanemia,theresultsoftheSchillingtestnormalizeafteroraladministrationofintrinsicfactor):AnabnormalSchilling'stestthatcorrectsornormalizesafteradministrationofintrinsicfactorsuggestsadiagnosisofPerniciousAnemia(IntrinsicFactorDeficiency).Shilling'stestisdonetodeterminethecauseofcyanocobalaminedeficiency(VitaminB12).SchillingtestisabnormalinconditionsthataffectcobalamineabsorptionincludingPerniciousanemia,ChronicPancreatitis,BacterialovergrowthsyndromeandIlealdysfunction.AnAbnormalSchilling'stestthatcorrectsafteradministrationofIntrinsicFactorindicatesPerniciousAnemiaAnAbnormalSchilling'stestthatcorrectsafteradministrationofPancreaticEnzymessuggestsExocrinePancreaticInsufficiency(fromChronicPancreatitis)
AnAbnormalSchilling'stestthatcorrectsafteradministrationoffivedaysofantibioticssuggestsBacterialOvergrowthSyndromeAnAbnormalSchilling'stestthatdoesnotcorrectafteradministrationofintrinsicfactor,pancreaticenzymesand/orantibioticssuggestsIlealmucosaldysfunction
78.Allofthefollowingdrugsmaybeusedin thetreatmentofulcerativecolitisExcept: a)Corticosteroids b)Azathioprine c)Sulfasalazine d)Methotrexate CorrectAnswer-DAnswerisD(Methotrexate)Methotrexatehasnotbeenshowntobeeffectivefbrtreatingactiveulcerativecolitisorformaintainingremission.
79.Extraintestinalmanifestationsof Inflammatoryboweldiseaseincludeallofthefollowing,Except: a)Uveitis b)Sclerosingcholangitis c)Osteoarthritis d)Skinnodules CorrectAnswer-CAnswerisC(Osteoarthritis):OsteoarthritisisnotanextraintestinalmanifestationofinflammatoryboweldiseaseUveitis,SclerosingCholangitis,andskinnodules(Erythemanodosum)areallrecognizedextraintestinalmanifestationsofinflammatoryboweldisease.
80.Secretorydiarrheaisnotseenin: a)Phenolphthalein b)Celiacdisease c)Cholera d)Addison'sDisease CorrectAnswer-BAnswerisB(CeliacDisease)CeliacDiseaseisassociatedwithSteatorrhealdiarrhoeafrommucosa!malabsorption. SecretoryDiarrheaCertainBacterialInfectionVibrioCholeraEnterotoxigenicE.ColiNonOsmoticStimulantLaxativesHormoneProducingEndocrineTumorsCarcinoid,VlPomas,Gastrinomas,MedullaryCarcinomaThyroid(Calcitonin)Bileacids(endogenouslaxatives)Bowelresection/diseaseorfistulaAddison'sDiseaseCongenitalElectrolyteAbsorptiondefectsChronicAlcoholIngestionDiabeticDiarrhea
SteatorrhealDiarrheaIntraluminalmaldigestionPancreaticexocrineinsufficiency,Bacterialovergrowth,Bariatricsurgery,LiverdiseaseMucosalmalabsorptionCeliacsprue,Whipple'sdisease,Infections,Abetalipoproteinemia,IschemiaPostmucosalobstruction(1?or2?lymphaticobstruction)
81.Whichofthefollowingisnotaprognostic factorforAcutePancreatitis a)SerumAmylase b)SerumCalcium c)SerumGlucose d)SerumAST CorrectAnswer-AAnswerisA(SerumAmylase):SerumAmylasedoesnotformanycriteriaforprognosisinAcutePancreatitis.Althoughelevatedserumamylaselevelisimportantforestablishingdiagnosisofacutepancreatitis,itplaysnoroleinpredictingprognosisorseverity."Thereappearstobenodefinitecorrelationbetweenseverityofpancreatitisandthedegreeofserumamylaseelevation.After48to72hours,evenwithcontinuingevidenceofpancreatitis,totalserumamylaselevelstendtoreturntonormal."-HarrisonHyperglycemia(Glucose),Hypocalcemia(Calcium)andelevatedserumASTareallpoorprognosticfactorsinaccordancewithRanson'scriteriaaselaboratedinthepreviousquestion.
82.Bestprovocativetestfordiagnosisof Gastrinomais: a)Ca++infusiontest b)Secretininjectiontest c)ACTHstimulationtest d)Steroidassay CorrectAnswer-BAnswerisB(Secretininjectiontest)Gastrinomas(ZollingerEllisonSyndrome)arecharacterizedbypepticulcerationduetohypersecretionofgastrinbyanon-betacelltumor.SecretininjectiontestisthemostvaluableprovocativetestinidentifyingpatientswithZES.
83.ThemostclassicalsymptomofVIPOMA is: a)Gallstones b)Secretorydiarrhea c)Steatorrhea d)Flushing CorrectAnswer-BAnswerisB(SecretoryDiarrhoea)TheprinciplefeatureofVIPOMAislargevolumesecretoryDiarrhoea.Diarrhoeaissecretoryinnature,persistsduringfastingandisalmostalwaysgreaterthan>ILitreperday(>3Litresperdayin70percent).Astoolvolumelessthan700mlperdayisproposedtoexcludethediagnosis.MostpatientsdonothaveaccompanyingSteatorrhea. VIPOMAS(Verner-MorrisonSyndrome/PancreaticCholera/WDHA Syndrome) VIPomasaretumoursthatsecretelargeamountsofVasoactive IntestinalPeptide(VIP) VIPisanimportantneurotransmitterubiquitouslypresentintheCNS andGIT ThemostcommonlocationofVlPomasisthePancreasMostcommonsitewithinthepancreasisthepancreatictailUsuallySolitaryUsuallyMalignant(37-68%havehepaticmetastasisatdiagnosisVIPStimulatesSmallIntestinalchloridesecretionStimulatessmoothmusclecontractility
InhibitsacidsecretionHasvasodilatoryeffects TypicalFeatures (WDHA) WateryDiarrhoea(LargeVolumeSecretoryDiarrhoealeadingtodehydration)Hypokalemia(Diarrhoeasevereenoughtocausehypokalemia)Achlorhydria(Hypochlorhydriafromincreasedsmallintestinalchloridesecretion)TheprincipleSymptomsarelargevolumediarrhoea(100%)severeenoughtocausehypokalemia(80-100%),dehydration(83%),hypochlorhydria(54-76%)andflushing(20%)MostpatientsdonothaveaccompanyingSteatorrhea OtherFeaturesIncreasedstoolVolumeduetoincreasedsecretionofsodiumandpotassiumwhichwiththeanionaccountforosmolalityofthestoolHyperglycemia(25-50%Hypercalcemia(25-50%)ThediagnosisrequiresdemonstrationofanelevatedplasmaVIPlevelandthepresenceoflargevolumesecretorydiarrhea.
84.Allfollowingareat-riskgroupadults meritingHepatitisBvaccinationinlowendemicareasexcept: a)Patientsonchronichemodialysis b)Diabeticsoninsulin c)Medical/nursingpersonnel d)Patientswithchronicliverdisease CorrectAnswer-BAnswerisB(DiabeticsonInsulin):Behavioral:Sexuallyactivepersonswhoarenotinalong-term,mutuallymonogamousrelationship(e.g.,personswithmorethanonesexpartnerduringtheprevious5months):personsseekingevaluationortreatmentforasexuallytransmitteddisease(STD):currentorrecentinjection-drugusers;andmenwhohavesexwithmen.Occupational:Healthcarepersonnelandpublic-safetyworkerswhoareexposedtobloodorotherpotentiallyinfectiousbodyfluids.Medical:Personswithend-stagerenaldisease,includingpatientsreceivinghemodialysis;personwithHIVinfection;andpersonswithchronicliverdisease.Other:HouseholdcontactsandsexpartnersofpersonswithchronicHBVinfection;clientsandstaffmembersofinstitutionsforpersonswithdevelopmentaldisabilities;andinternationaltravellerstocountrieswithhighorintermediateprevalenceofchronicHBVinfection.HepatitisBvaccinationisrecommendedforalladultsinthefollowingsettings:STDtreatmentfacilities;HIVtestingandtreatmentfacilities;
facilitiesprovidingdrug-abusetreatmentandpreventionservices;healthcaresettingstargetingservicestoinjection--drugusersormenwhohavesexwithmen;correctionalfacilities;end-stagerenaldiseaseprogramsandfacilitiesforchronichemodialysispatients;andinstitutionsandnonresidentialday-carefacilitiesforpersonswithdevelopmentaldisabilities.Administermissingdosestocompletea3-doseseriesofhepatitisBvaccinetothosepersonsnotvaccinatedornotcompletelyvaccinated.Theseseconddoseshouldbeadministered1monthafterthefirstdose;thethirddoseshouldbegivenatleast2monthsaftertheseconddose(andatleast4monthsafterthefirstdose).IfthecombinedhepatitisAandhepatitisBvaccine(Twinrix)isused,administer3dosesat0,1,and6months;alternatively,a4-doseTwinrixschedule,administeredondays0,7,and21to30,followedbyaboosterdoseatmonth12maybeused.Adultpatientsreceivinghemodialysisorwithotherimmunocompromisingconditionsshouldreceive1doseof40pg/mL(RecombivaxHB)administeredona3-dosescheduleor2dosesof20Ug/mL(Engerix-B)administeredsimultaneouslyona4-dosescheduleat0,1,2,and6months.
85.ExtrahepaticManifestationsofHepatitisC includeallofthefollowingExcept: a)LichenPlanus b)CeliacDisease c)Glomerulonephritis d)Cryoglobulinemia CorrectAnswer-BAnswerisB(Celiacdisease)ExtrahepaticmanifestationsinviralhepatitisC:Wepatology'byKuntzAgranulocytosisAplasticanaemiaCornealulcerationCiyoglobillinaemiaDiabetesmellitus(typeI)ErythemaexsudativummultiformeGlomerulonephritisGuillain-BarresyndromeHyperlipasaemiaLichenplanusNon-HodgkinlymphomaPolyarteritisnodosaPolyarthritisPolyneuritisPorphyriacutaneatardaSialadenitisSjogren'ssyndrome/SiccasyndromeThrombocytopenia
Thyroiditis
86.Whichisnottrueaboutalcoholichepatitis : a)Gammaglutamyltransferaseisraised b)SGPTisraised>SGOT c)SGOTisraised>SGPT d)Alkalinephosphataseisraised CorrectAnswer-BAnswerisBSGOT/SGPTratiogreaterthan2ishighlysuggestiveofalcoholichepatitisandcirrhosis.ASTissynonymouswithSGOT&ALTissynonymouswithSGPTIngeneralASTandALTlevelsriseparalleltoeachother.InalcoholicliverdiseasetheASTrisesoutofproportiontoALTsuchthattheratioofASTandALTmaybecomegreaterthan2:StigmataofAlcoholichepatitis/cirrhosisthataidindiagnosis: 1. BilateralenlargedparotidsQ.2. GynaecomastiaQ3. TesticularatrophywithlossofbodyhairQ4. WastingofmusclemassQ5. DuputyrenscontractureQ AST(SGOT)outofproportiontoALT(SGPT)seeninQ 1. AlcoholichepatitisQ2. FattyliverinpregnancyQ GammaGlutamyltransferaselevelscorrelatewithlevelsofAlkalinephosphataseandareasensitiveindicaterofbiliarytractdisease--obstructivejaundice.Itisnotanindicatorofalcoholicliverdisease.
Remember:GGTisthemostsensitiveindicatorofbilian,tractdisease
87.HepaticEncephalopathyispredisposed byall,Except: a)Hyperkalemia b)Dehydration c)Constipation d)GIBleeding CorrectAnswer-AAnswerisA(Hyperkalemia):HepaticEncephalopathyispredisposedbyHypokalemiaandnotbyHyperkalemia
88.FeaturesofHepatorenalsyndromeare a)Urinesodium<10meq/1 b)Normalrenalhistology c)Renalfunctionabnormalevenafterliverbecomenormal d)aandb CorrectAnswer-DAnswerisA&B(urineNa<10meq/landNormalRenalHistology)Hepatorenalsyndromeisassociatedwithnormalrenalhistologyandsupportedbyaurinesodiumexcretionl0meq/LHepatorenalsyndromeHepatorenalsyndromeisdefinedasastateoffunctionalrenalfailure(ReducedGFR)inpatientswithsevereliverdiseaseStructurally/Histologicallythekidneysarenormalandrecoverfunctionaftersuccessfullivertransplantation.ThepathogenetichallmarkofhepatorenalsyndromeisintenserenalvasoconstrictionwithcoexistentsystemicvasodilatationThediagnosisofhepatorenalsyndromeisconsideredinaccordancewiththefollowingdiagnosticcriteria.DiagnosticofHepatorenalSyndromeMajorcriteriaLowglomerularfiltrationrate.asindicatedbyserumcreatinine>1.5mg/dLor24-hrcreatinineclearance<40mL/minAbsenceofshock,ongoingbacterialinfection,fluidlosses,andcurrenttreatmentwithnephrotoxicdrugsNosustainedimprovementinrenalfunction(decreaseinserumcreatinineto1.5nig/dLorincreaseincreatinineclearanceto40mL/min)afterdiureticwithdrawalandexpansionofplasmavolume
with1.5LofaplasmaexpanderProteinuriamg/d1,andnouhrasonographicevidenceofobstructiveuropathyorparenchymalrenaldiseaseAdditionalcriteriaUrinevolume<500mL/dUrinesodium<10meq/LUrineosmolalitygreaterthanplasmaosmolalityUrineredbloodcells<50/high-power.fieldSerumsodiumconcentration<130niEqLNote:Allmajorcriteriamustbepresentforthediagnosisofhepatorenalsyndrome.Additionalcriteriaarenotnecessaryforthediagnosisbutprovidesupportiveevidence.
89.Allofthefollowingstatementsabout. Wilson'sdiseasearetrue,EXCEPT- a)Itisanautosomalrecessivedisorder b)Serumceruloplasminlevelis<20mg/dl c)Urinarycopperexcretionis d)Zincacetateiseffectiveasmaintenancetherapy CorrectAnswer-CAnswerisC(Urinarycopperexcretionis<100R/day)Urinecopperisanimportantdiagnostictoo.Symptomaticpatientsinvariablyhaveurinecopperlevels>100p(>1.6umol)per24hours.Wilson'sdiseaseisanautosomalrecessivedisorderItiscausedbyamutationofageneonchromosomeBQwhichpromotesCuexcretion(ATP7Bgene)SymptomaticpatientswithWilson'sdiseaseinvariablyhaveurinarycopperexcretionof>100lig,per24hours(>1.6innol/24hr)ZincisthetreatmentofchoiceformaintainancetherapyinWilson'sdiseaseZincisthetreatmentofchoiceinWilson'sdiseaseforA.Initialtherapyinpatientswithhepatitiswithoutdecompensation(2A.MaintainancetherapyB.PresymptomaticpatientC.PediatricpatientsD.Pregnantpatients
90.A14yearoldboypresentswitrecurrent episodesofhepatitisOpthalmoscopicevalutionrevealsKFringsandserumceruloplasminlevelsare<20mg/dl.Thetreatmentofchoiceforinitialtherapyis a)Zinc b)Penicillamine c)Tetrathromolybdate d)Hepatictransplantation CorrectAnswer-AAnswerisA(Zinc)PresenceofKFringsanddecreasedceruloplasminlevelssuggestthediagnosisofWilson'sdisease.Thepatientinquestionispresentingwithintialhepaticdiseasewithoutanyevidenceofhepaticdecompensation.Zincisthetherapyofchoiceforpatientswithhepatitisorcirrhosiswithoutevidenceofhepaticdecompensationorneuropsychiatricsymptoms.
91.Whatistheuppermostintercostalspace usedforhepaticbiopsy: a)5th b)7th c)9th d)11th CorrectAnswer-BAnswerisB7thTherightsurfaceoftheliverisincontactwiththediaphragmoppositethe7thto11thribs.Inneedlebiopsyoftheliverthroughtheintercostalroute,theneedlemaybeinsertedthroughthe6th7th,8th,9thor10thrightintercostalspaceinthemid-axillaryline.The8thand9thintercostalspacesaremostcommonlyused.Insertioninthe6thor7thintercostalspacemayalsobeusedbutisassociatedwithriskofinjurytotheLung.Needleistypicallyinsertedattheendofexpiration(AttemptedApnoea).
92.Significantweightlossisdefinedas: a)5%weightlossin1-2months b)5%weightlossin2-3months c)10%weightlossin1-2months d)10%weightlossin2-3months CorrectAnswer-AAnswerisA(5%weightlossin1-2months):Significantweightlossisdefinedas5%weightlossinImonth.Percentweightchangeoveraperiodoftimeiscalculatedusingtheperson'scurrentbodyweightandperson'susualbodyweight.Usualweight--CurrentweightPercentweightchange=Usualweight
93.CRFwithanemiabesttreatment: a)OralIronTherapy b)ErythropoietinStimulatingAgents c)Bloodtransfusion d)AndrogenicSteroids CorrectAnswer-BAnswerisB(ErythropoietinStimulatingAgents):Erythropoiesis-stimulatingagents(ESAs)haveemergedasthetreatmentofchoiceforanemiainchronicrenaldisease.Erythropoiesis-stimulatingagents(ESAs)shouldbegiventoallpatientswithchronickidneydisease(CKD)withhaemoglobinlevelsconsistentlybelowIIg/dl.Thisappliesequallyto:PatientswithCKD(stages1-5)developinganaemiaPatientswithCKDstage5treatedwithhaemodialysis(HD)orperitonealdialysis(PD)Transplantpatientswithchronicrenalinsufficiencyandanaemia.StrategiesfortreatmentofAnemiainChronicRenalFailureErythropoiesis-stimulatingagents(ESAs)Erythropoiesis-stimulatingagents(ESAs)haveemergedasthetreatmentofchoiceforanemiainchronicrenaldisease.Theyshouldbegiventoallpatientswithchronickidneydisease(CKD)withhaemoglobin(Hb)levelsconsistentlybelow11g/dl[haematocrit(Hct)<33%]Allchronickidneydisease(CKD)patientswithrenalanaemiaundergoingtreatmentwithanerythropoiesis-stimulatingagent(ESA)shouldbegivensupplementaryirontomaintainadequatebonemarrowironstores
IntravenousadministrationistheoptimumrouteforthedeliveryofirontopatientswithCKD,asoralironispoorlyabsorbedinuremicindividuals. BloodTransfusion Redbloodcelltransfusionsshouldbeavoided,ifatallpossible,inpatientswithchronickidneydisease(CKD),especiallythoseawaitingkidneytransplantation.Transfusionsshouldnotbegivenunlesspatientshaveoneormoreofthefollowing:Symptomaticanaemia(fatigue,angina,dyspnoea)and/orassociatedriskfactors(diabetes,heartfailure,coronaryarterydisease,arteriopathy)Acuteworseningofanaemiaduetobloodloss(haemorrhageorsurgery)orhaemolysisSevereresistanceto,orhyporesponsivenesstoESAtherapy,e.g.duetothepresenceofahaematologicaldiseaseorsevereinflammatorysystemicdisease. Androgens PriortotheintroductionofESAtherapy,androgenswerewidelyusedinthetreatmentofrenalanaemia.ThereisevidencethatandrogensmaypotentiatetheeffectofexogenouserythropoieticproteinandalsostimulateerythropoiesisbyenhancingerythrocytestemcelldifferentiationTheriskofliverdiseaseandmalignancy,virilisationandhirsutisminwomen,priapisminmenanddisfiguringacneinpatientsofbothsexesmayoutweighthebenefitsofandrogentherapyinmostanaemicpatients.AndrogensmaybeaneffectivealternativetherapyincountrieswhereESAsarenotavailable
94.Theinitialtreatmentofchoicefor secondaryhyperparathyroidisminrenalosteodystrophyis: a)Cinacalcet b)Bisphosphonates c)Calciumrestriction d)Phosphatebinders CorrectAnswer-DAnswerisD(PhosphateBinders)TheinitialtreatmentofsecondaryhyperparathyroidisminrenalosteodystrophyismanagementofhighphosphatelevelsbydietaryrestrictionandtheuseofPhosphatebindersTheobjectivesofmanagementaretomaintainbloodlevelsofcalciumandphosphoroustoasclosetonormalaspossible,topreventortreatestablishedhyperparathyroidismearlyandtopreventparathyroidhyperplasia.PhosphateretentionbeginsearlyinthecourseofCKD,perhapsasearlyasinstage2andparticipatesinthedevelopmentofsecondaryhyperparathyroidism.Centraltothemanagementofhigh-turnoverbonediseaseiscontrollingtheserumphosphatelevels.Thismaybeachievedbydietaryphosphaterestrictionorbytheuseofphosphatebinders.Phosphate-bindertherapyisrecommendedwhenserumphosphateconcentrationsareelevateddespitepatientcompliancewithdietaryphosphaterestriction.Calcium-basedphosphatebindersareoftenrecommendedasthe
initialbindertherapy.HighBoneTurnoverDiseaseBoneturnover(theformationandremovalofbone)isincreasedduetoaprocesscalledsecondaryhyperparathyroidism(SHPT).SecondaryhyperparathyroidismrepresentsacommondisorderinpatientswithCKD.Itdevelopsasaresultofhyperphosphatemia,hypocalcemiaandimpairedrenalvitaminDsynthesiswithreductioninserumcalcitriollevels
95.ThemostcommonpresentationforIgA nephropathyis: a)Nephriticsyndrome b)Nephriticsyndrome c)Microscopichematuria d)Repeatedgrosshematuria CorrectAnswer-DAnswerisD(RepeatedGrossHematuria):ThemostcommonpresentationofIgANephropathyiswithrecurrentepisodesofGross(Macroscopic)Hematuriaduringorimmediatelyfollowinganupperrespiratorytractinfection'RecurrentattacksofPainlessGrossHematuriarepresenttheclassicclinicalpresentationofIgANephropathy'--Rudolph'sPaediatrics
96.Disease,doesnotrecurinthekidneyafter renaltransplantis: a)Alportsyndrome b)Amyloidosis c)GoodPasteur'ssyndrome d)Diabeticnephropathy CorrectAnswer-AAnswerisA(Alport'ssyndrome):Alportissyndromehasnotbeenmentionedtorecurinkidneyafterarenaltansplant.
97.Trueaboutlightmicroscopyinminimal changediseaseis: a)Lossoffootprocessseen b)AntiGBMAbsseen c)IgAdepositsseen d)Nochangeseen CorrectAnswer-DAnswerisD(Nochangeseen)Noabnormalityisevidentonlightmicroscopyinacaseofminimalchangedisease.InvestigationLightmicroscopyQElectronmicroscopyQImmunofluorescenceQObservationNoabnormalityhencethetermminimalchangeFusionoffootprocessesAbsenceofimmunoglobulinorcomplement
98.HIVrenalspecificnephropathyis: a)FocalSegmentalGlomerulosclerosis b)MembranoproliferativeGlomerulonephritis c)MesangioproliferativeGlomerulonephritis d)MembranousGlomerulonephritis CorrectAnswer-AAnswerisA(FocalSegmentalGlomerulosclerosis):ThemostcharacteristicglomerulopathyinHIVisFocalSegmentalGlomerulosclerosis(FSGS)whichtypicallyrevealscollapseoftheglomerularcapillarytuftcalledcollapsingglomerulopathy.HIVassociatedNephropathyisasevererapidlyprogressivecollapsingformofFSGS.
99.Distalrenaltubularacidosisisassociated with: a)Oxalatestones b)Citrate c)Calciumstones d)Uricacidstones CorrectAnswer-CAnswerisC(CalciumStones):DistalRenalTubularAcidosisisassociatedwithincreasedincadenceofCalciumPhosphateStonesAlkalineurine,HypercalciuriaandlowlevelsofurinarycitrateprecipitatecalciumphosphatestonesinthekidneyinpatientswithDistalRenalTubularAcidosis(Typel).ProximalRenalTubularAcidosis(Type-2)isnotassociatedwithincreasedincidenceofRenalStonesdespiteHypercalciuriabecauseurinarycitratelevelsarenormalorhigh.
100.Whichofthefollowingstatementabout RenalCellCarcinoma(Hypemephroma)isfalse: a)Originateinthecortex b)HistologicallyareusuallyAdenocarcinomas c)Maypresentwithvaricocele d)Radiosensitive CorrectAnswer-DAnswerisD(Radiosensitive):Renalcellcarcinomaisarelativelyradioresistanttumor.RenalcellcarcinomaoriginatesintheRenalcortex`RenalcellcarcinomaoriginatesintheRenalcortexandtendstogrowoutintoperinephrictissuecausingthetypicalbulgeormasseffectthataidsintheirdetectionbydiagnosticimagingstudies'?Smith'sUrologyRenalCellcarcinomaareadenocarcinomasHistologicallyRenalcellcarcinomaismostoftenamixedadenocarcinoma--Smith'sUrologyRenalcellcarcinomasmaypresentwithvaricocele'RenalcellcarcinomasmaypresentwithRapidlydevelopingvaricocele.Varicoceleisusuallyobservedontheleftside.Thisoccursbecauseleftgonadalveinisobstructedwhereitjoinstheleftrenalvein.RenalcellcarcinomasareRelativelyRadioresistanttumorsRenalcellcarcinomasaregenerallyconsideredradioresistanttumorsRoleofRadiotherapyinrenalCellcarcinoma
PreoperativeRadiationhasshownnoimpactonsurvivalPostoperativeRadiationhasalsoshownnoevidenceofimprovedsurvivalbutmaybeusedasitshowsimprovementinlocalcontrol.PalliativeRadiotherapyhasbeenshowntobeeffectiveinmetastaticdiseasetobrain,boneandlungs.
101.ClassictriadinRenalcellcarcinoma includesallofthefollowing,Except: a)Hematuria b)Hypertension c)Flankmass d)AbdominalPain CorrectAnswer-BAnswerisB(Hypertension):HypertensionmaybeseeninpatientswithRenalcellcarcinomabutitdoesnotfirmpartoftheclassicallydescribedtriad.ClassicTriadofRenalcellcarcinoma(seenin10-20%ofpatients)Hematuria(Gross)Pain(Abdominal/Flank)Mass(Abdominal/Flank)
102.FEVI/FVCisdecreasein: a)Asthma b)Kyphosis c)Scoliosis d)Fibrosis CorrectAnswer-AAnswerisA(Asthma):DecreasedFEV1/FVCsuggestsadiagnosisofObstructiveLungDisease.AmongsttheoptionsprovidedAsthmaistheonlyconditionthatleadstoObstructivePatternofLungDiseaseandhenceistheanswerofchoiceKyphosis,ScoliosisandFibrosisareRestrictiveLungDiseasesthatarecharacterizedbyNormalorElevatedFEVI/FVCratios.
103.Aspirin-sensitiveasthmaisassociated with: a)Obesity b)Urticaria c)Nasalpolyp d)Extrinsicasthma CorrectAnswer-CTheanswerisC(Nasalpolyp):`AspirinassociatedAsthmausuallybeginswithperennialvasomotorrhinitisthatisfollowedbyhyperplasticrhinosinusitiswithnasalpolyps'--HarrisonsAspirinassociatedAsthma:Primarilyaffectsadults,althoughtheconditionmayoccurinchildhood.Usuallybeginswithperennialvasomotorrhinitisthatisfollowedbyhyperplasticrhinosinusitiswithnasalpolyps.Progressiveasthmathenappears.Onexposuretoevenverysmallquantitiesofaspirin,affectedindividualstypicallydevelopocularandnasalcongestionandacute,oftensevereepisodesofairwaysobstruction.Deathmayfollowingestionofaspirin.
104.FeatureofAcutesevereAsthmainclude allofthefollowing,Except: a)Tachycardia>120/min b)Pulsusparadoxus c)Respiratoryacidosis d)Drowsy CorrectAnswer-AAnswerisA.Tachycardia>120/minDiaphoresisBradycardiaParadoxicalthrocobadominalmovementsPEER<33%HypotensionPulsusparadoxusHypercapneaSilentchest
105.AnAdultwithasthmapresentswith asthmasymptomseverydayandwakesupinthenightapproximately2to3daysinaweek.Hecanbeclassifiedashaving: a)IntermittentAsthma b)MildPersistentAsthma c)ModeratePersistentAsthma d)SeverePersistentAsthma CorrectAnswer-CAnswerisC(ModeratePersistentAsthma):'GiudelinesforthediagnosisandmanagementofAsthma'SummaryReport2007(N1HPublicationNumber08-5846);Koda-KimbleandYoung'sAppliedTherapeutics:TheClinicalUseofDrugs10TH/568,569,570ModeratePersistentAsthmainanadult(>12years)isdefinedasDay-TimeSymptomsthatoccurdailyandNight-TimeSymptomsoccurringmorethan1nightperweekbutnoteverynight.
106.InaPatientwithclinicalsignsofAsthma whichofthefollowingtestswillconfirmthediagnosis: a)IncreaseinFEV1/FVC b)>200mlincreaseinFEVIafterMethacholine c)DiurnalvariationinPEF>20Percent d)ReductionofFEVI>20%afterbronchodilators CorrectAnswer-CAnswerisC(DiurnalvariationinPEF>20Percent): DemonstrateOutflowObstruction DecreasedFEV1 DecreasedPEF DecreasedFEV1/FVC Whilerespiratorysymptomssuggestasthma,thesinequanonfor thediagnosisofasthmaisthepresenceofReversibleAirflow Obstructionand/orAirwayHyper-responsivenessorIncreasedPeak ExpiratoryFlow(PEF)Variabilityinsubjectswithoutairways obstruction. ReversibleAirflowObstruction Reversibilityisdemonstratedbyrepeatingspirometryresults15minutesafteradministeringashortactingbronchodilator>12%reversibilityinFEV1>200mlincreaseinBaselineFEV1PositiveReversibilityResultsStrongly(ConsideredDiagnostic) IncreasedPeakExpiratoryFlowRate(PEF)Variability DemonstrationofDiurnalVariationinthePeakExpiratoryFlowRate
AdiurnalvariationinPEFofmorethan20percentStronglysuggestsadiagnosisofAsthma(ConsideredDiagnostic) AirwayHyper-responsiveness MeasuredbyMethacholineorHistaminechallenge.IncreasingConcentrationsofMethacholineareadministeredandiftheFEV1dropsto>20percentofbaselinewithanystandarddosethetestisconsideredpositive.PositiveteststronglysuggestsadiagnosisofAsthma
107.Antibodyusedinthetreatmentof BronchialAsthmais: a)Omalizumab b)Rituximab c)Daclizumab d)Transtusuzumab CorrectAnswer-AAnswerisA(Omalizumab):OmalizumabisarecombinantIgEAntibodyapprovedforuseintreatmentofmoderateandseverepersistentasthmaOmalizumabisarecombinantIgEblockingantibodythatneutralizescirculatingIgE.ItpreventscirculatingIgEfrombindingtoreceptorsonthesurfaceofBasophilsandMastcellsandthusinhibitsIgEmediatedreactions.Omalizumabisindicatedfortreatmentof'moderatetosevere'persistentasthmainpatientswhoreacttoperennialallergens(AllergicAsthma).TreatmentwithOmalizumabhasshowntoreducethenumberofexacerbationsinpatientswithsevereasthmaandmayimproveasthmacontrol.HoweverthistreatmentisveryexpensiveandisonlysuitableforhighlyselectedpatientswhoarenotcontrolledonmaximaldosesofinhalertherapyandhaveahighcirculatingIgE(withinaspecifiedrange).Omalizumabisusuallygivenasasubcutaneousinjectionfor2to4weeksandmaybeusedinadultsandadolescentsmorethan12yearsofage.
108.Whichofthefollowingistheleast commonbacteriaresponsibleforAcuteExacerbationofChronicBronchitis a)Streptococcuspneumoniae b)Moraxellacatarrhalis c)Haemophilusinfluenza d)Staphylocccusaureus CorrectAnswer-DAnswerisD(Staphylocccusaureus):TheGlobalInitiativeforChronicObstructiveLungDisease(GOLD);ReportproducedbytheNationalHeart,Lung,andBloodInstitute(NHLBI)andtheWorldHealthOrganization(WHO)StaphylococcusAureusisnotacommonbacterialpathogenresponsibleforAcuteExacerbationofChronicBronchitis.CommonBacterialPathogens(30%-50%)ResponsibleforAcuteExacerbationsofCOPDHaemophilusinfluenzaStreptococcuspneumoniaMoraxellacatarrhalisPseudomonasaeruginosaandEnterobacteriaceaearealsocommonlyisolated,particularlyfrompatientswithsevereCOPD.AcuteExacerbationofCOPD:BacterialInfectionsTheGOLD,theNHLBIandtheWHO,definesexacerbationofCOPDasacuteincreaseinsymptomsbeyondnormalday-to-dayvariation.Thisgenerallyincludesoneormoreofthefollowingcardinalsymptoms.Coughincreasesinfrequencyandseverity
Sputumproductionincreasesinvolumeand/orchangescharacterDyspneaincreasesConstitutionalsymptoms,decreaseinpulmonaryfunction,andtachypneaarevariablypresentduringanexacerbation,buttheCXRisusuallyunchanged.Inthepresenceofsevereunderlyingairflowobstruction,exacerbationcancauserespiratoryfailureanddeath.Itisestimatedthat70to80%ofexacerbationsofCOPDareduetorespiratoryinfections.Theremaining20to30%areduetoenvironmentalpollutionorhaveanunknownetiology.ViralandbacterialinfectionscausemostexacerbationsBacterialinfectionsappeartotrigger33%to50%ofCOPDexacerbations.Non-typeableH.influenzae,M.catarrhalis,andS.pneumoniaearethebacteriamostfrequentlyisolatedbronchoscopicallyfrompatientshavinganexacerbationofCOPDPseudomonasaeruginosaandothermembersoffamilyEnterobacteriaceaearealsocommonlyisolated,particularlyfrompatientswithsevereCOPD.ExacerbationsofCOPDarestronglyassociatedwithacquisitionofnewstrainofH.influenzae,M.catarrhalis,S.pneumoniae,orP.aeruginosa.Asaresult,ithasbeenproposedthatacquisitionofnewbacterialstrainplayscentralroleinthepathogenesisofanexacerbation.TheideathatexacerbationsofCOPDareduetoacquisitionofnewstrainofbacteriahaslargelyreplacedolderhypothesisthatincreasesinconcentrationofcolonizingbacteriaaretheprimarycauseofexacerbations.
109.OccupationalLungDiseasecommonly seeninTextileIndustryWorkersis: a)Byssinosis b)Bagassosis c)Farmer'sLung d)Asbestosis CorrectAnswer-AAnswerisA(Byssinosis)OccupationalLungDiseaseinTextileIndustryWorkers(Cottonindustry)Byssinosisisanasthma-likeconditioncausedbyinhalationofcottonfiberdustoverprolongedperiodoftime.Workersoccupationallyexposedtocottondust(butalsotoflax,hemporjutedust)intheproductionofyarnsfortextileandropemakingareatriskofByssinosis.Exposureoccursthroughoutthemanufacturingprocessbutismostpronouncedintheportionsofthefactoryinvolvedwiththetreatmentofcottonbeforespinning(blowing,mixing,cardingorstraightening)Byssinosisismorecommonduringmillingandprocessingofcottonthanduringspinning.
110.AllthefollowingarefeaturesofTropical pulmonaryEosinophiliaexcept- a)Eosinophilia>3000/mm3 b)Microfilariainblood c)Paroxysmalcoughandwheeze d)Bilateralchestmottlingandincreasedbronchovascular markings CorrectAnswer-BAnswerisB(Microfilariainblood):InTPE,Microfilariaarerapidlyclearedfromthebloodstreambythelungs.Thus,microfilariaearesequestratedinthelungsandarenotfoundintheblood.TropicalPulmonaryEosinophiliaTropicalPulmonaryEosinophilia(TPE)isadistinctsyndromethatdevelopsinindividualsinfectedwithLymphaticfilarialspecies.Clinicalsymptomsresultfromallergicandinflammatoryreactionelicitedbytheclearedparasites.FeaturesofTropicalPulmonaryeosinophilia(TPE):Malemorecommonlyaffectedthanfemales(4:1)HistoryofresistanceinfilarialendemicregionParoxysmalcoughandwheezingthatareusuallynocturnalWeightloss,lowgradefever,adenopathyEosinophilia>3000eosinophilia/,uLeChestX-Ray:increasedbronchovascularmarkings,diffusemiliarylesions,ormottledopacities.RestrictivechangesonPulmonaryfunctiontest2ElevatedlevelsofIgEe&Antifilarialantibodytiters.
InTPE,Microfilariaarerapidlyclearedfromthebloodstreambythelungs.Thus,microfilariaearesequestratedinthelungsandarenotfoundintheblood.
111.MostcommonpatternofPneumonia seeninKlebsiellainfectionis: a)LobarPneumonia b)Bronchopneumonia c)InterstitialPneumonia d)MiliaryPneumonia CorrectAnswer-AAnswerisA(LobarPneumonia):ThemostcommonpatternofPneumoniaseeninKlebsiellainfectionisLobarPneumoniaStreptococcusPneumoniae(Pneumococcus)andKlebsiellaaretwocommonorganismsthatproducealobarpatternofPneumonia.Theradiographicpatternofpneumonia.LobarLobular(bronchopneumonia)Interstitial
112.Allofthefollowingaremorecommonly seeninKlebsiellaPneumoniathaninPneumococcalPneumonia,Except: a)Lowerlobeinvolvement b)AbscessFormation c)PleuralEffusion d)Cavitation CorrectAnswer-ATheanswerisA(LowerLobeInvolvement):Pneumococcalpneumoniahasapredilectiontoinvolvetherightlowerlobe,whereasKlebsiellausuallyaffectsoneoftheupperlobes. Features Pneumococcal KlebsiellaPneumonia Pneumonia Consolidation ?LobarConsolidation ?LobarConsolidationwith Pattern withpositiveair positiveair bronchogramsign bronchogramsign Lobe ?Thepredilectionto ?Thepredilectionto Predilection involveLowerLobe involveUpperLobe (Anylobemaybe (Anylobemaybe involved) involved) ?UsuallyUnilobar ?OftenMultilobar (Usuallydonot (Tendencytoexpand expandinvolvedlobe) involvedlobe) ?Abscessformation ?AbscessFormation Abscess uncommon common Pleural ?PleuralEffusion ?PleuralEffusion
Effusion uncommon common Cavitation ?Cavitationisrare ?Cavitationiscommon
113.FriedlanderPneumoniarefersto Pneumoniacausedby: a)Klebsiella b)Pneumococcus c)H.lnfluenzae d)Staphylococcus CorrectAnswer-AAnswerisA(Klebsiella):KlebsiellaPneumoniaisalsoknownasFriedlanderPneumonia.Klebsiellainitiallydescribedin1882byFriedlanderwasalsoknownasFriedlander'sbacillus.CommunityacquiredPneumoniacausedbyFriedlander'sbacillus(Klebsiella)wastermedasFriedlanderPneumonia.
114.Atypicalpneumoniacanbecausedby thefollowingmicrobialagentsexcept? a)Mycoplasmapneumoniae. b)Legionellapemmophila c)HumanCoronavirus d)Klebsiellapneumoniae CorrectAnswer-DAnswerisD(Kleibsellapneumonia):CausesofAtypicalpneumonias.1.Mycoplasmapneumonias2.Viralpneumonias-Influenza-RSV-Adenovirus-Rhinovirus-Rubeola-Varicilla-Coronavirus3.Chlamydiapneumonia4.Coxiellabumetti5.Pneumocystiscarinii6.LegionellaCoronavirusisaninfrequentcauseofpneumonia.SARSassociatedcoronavirus(SARS-CoV)causedepidemicofpneumoniafromNov2002toJuly2003-Harrison
115.Themostdefinitivemethodof diagnosingpulmonaryembolismis: a)Pulmonaryarteriography b)Radioisotopeperfusionpulmonaryscintigraphy c)EKG d)Venography CorrectAnswer-AAnswerisA(Pulmonaryarteriography):`SelectivepulmonaryangiographyisthemostspecificexaminationavailableforestablishingthedefinitivediagnosisofPE.'-Harriosn16th/1563Mostdefinitiveinvestigation:Pulmonaryangiographyisaninvasiveprocedure,anditisthemostdefinitiveprocedure.Itishowevercertainlynottheinitialinvestigationofchoice.TheinitialinvestigationofchoiceinacaseofsuspectedpulmonaryembolismiseitheralungventilationperfusionscanoraCTofthechestwithintravenouscontrast.`CTscanningofthechestwithintravenouscontrastistheprincipalimagingtestfordiagnosisofPE.'-Harrison`Lungscanning(V/Qscan)isnowasecondlinediagnostictestforPE'Mostdefinitive/specifictestforPEQBestinitialimagingtestfordiagnosisofPE?PulmonaryangiographyQCTscanwithintravenouscontrastQ(Preferredchoice,againstalungV-Qscan)
116.Allofthefollowingshowlowglucosein pleuralfluid,EXCEPT- a)Empyema b)Malignantpleuraleffusion c)Rheumatoidarthritis d)Dressler'ssyndrome CorrectAnswer-DAnswerisD(Dressler'sSyndrome):Dresslersyndromeisasecondaryformofpericarditisthatoccursinthesettingofinjurytotheheartorthepericardium(theouterliningoftheheart).Itconsistsoffever,pleuriticpain,pericarditisand/orpericardialeffusion.Thediseaseconsistsofpersistentlow-gradefever,chestpain(usuallypleuritic),pericarditisand/orpericardialeffusion.Thesymptomstendtooccur2?3weeksaftermyocardialinfarctionbutcanalsobedelayedafewmonths.Ittendstosubsideinafewdays,andveryrarelyleadstopericardialtamponade.ElevatedESRisanobjectivebutnonspecificlaboratoryfinding.Dressler'sSyndromeisnotassociatedwithlowglucoseinpleuralfluid.RheumatoidArthritis,MalignancyandEmpyema(Bacterialinfections)areallestablishedcausesofpleuraleffusionwithlowglucose.Pleuraleffusionwithlowglucose(<60mg/c11) 1. Malignancy2. Bacterialinfections3. Rheumatoidpleuritis
117.Whichofthefollowingstatementsabout Branchialcystsistrue: a)50-70%areseeninlungs b)Mostcommonsiteismediastinum c)Theyarepremalignantlesions d)InfectionisuncommoninPulmonarybronchogeniccysts CorrectAnswer-BAnswerisB(Mostcommonsiteismediastinum):Mostcommonsiteofbronchial/bronchogeniccystsismediastinum.Onlyabout15%ofbronchogeniccystsoccurinthelungs(pulmonarybronchialcysts).Pulmonarybronchogeniccystsoftenbecomeinfected.Bronchogeniccystsarebenignlesionanddonothavemalignantpotential(notpremalignant).BronchialCyst/Bronchogeniccysts:ReviewBronchialcystsrepresentislandsofbronchialtissueleftbehindduringthebranchingoftheairwaysduringearlyfetaldevelopment.Theyariseduetoabnormalbuddingofthetracheobronchialtreeandforegutandarelinedbybronchialepithelium.Themostcommonsiteofbronchialcystsismediastinum.Theothersiteofbronchialcystiswithinthepulmonaryparenchyma(lung)(Lesscommonsite-15%)MediastinalbronchialcystPulmonaryparenchymalcyst(lungs) Mostcommonsitefor Lesscommonsite(-15%) bronchialcysts Mostcommonsiteisthelower Mostcommonsiteismiddle lobes mediastinum Commonlyarisewhenbronchial Commonlyarisewhen tissueisseparatedfromairways
bronchialtissueis lateingestation separatedfromairwaysearly Communicationwithingestation tracheobronchialtreeismore Communicationwith commonthanwithmediastinal tracheobronchialtreeisrare cysts.Thesecystsoftenbecomeinfected.Mostbronchogeniccystsareasymptomaticanddiscoveredasincidentalradiographicfindingsinayoungadult.Whensymptomsdooccurtheyresultmostcommonlyfrominfection.Pulmonaryparenchymalcystsoftenbecomeinfected?RudolphBronchogeniccystsarenotconsideredpremalignantlesions.HoweveraccordingtoRudolph'stextbookthereisasmallriskofmalignantchangeandthebestapproachisremovalandhistologicalexamination.
118.Whichofthefollowingdrugs,isusedfor SmokingCessation? a)Naltrexone b)Bupropion c)Buprenorphine d)Methadone CorrectAnswer-BAnswerisB(Bupropion):Bupropion(alongwithVareniclineandNicotinereplacementtherapy)isaUSFDAapprovedfirstlineagentforpharmacotherapyinSmokingCessation.USFDAApprovedAgentsforSmokingCessationNicotineReplacementTherapy(TransdermalPatch,gum,lozenges,oralinhaler,nasalspray)Bupropion(AtypicalAntidepressantwithdopaminergicandnoradrenergicactivity)Varenicline(SelectivepartialagonistattheAlpha4-Beta2NicotinicA-Cholinereceptorthatisbelievedtomediatenicotinedependence)ClonidineandNortriptylinearetwoothermedicationsthathaveefficacybutareNOTUSFDAapprovedforthisindication.Theseareclassifiedassecondlineagents.
119.ANCAisNOTassociatedwithwhichof thefollowingdiseases: a)Wegener'sgranulomatosis b)Henochschonleinpurpura c)MicroscopicPAN d)ChurgStrausssyndrome CorrectAnswer-BAnswerisB(H.S.Purpura):H.S.purpuraisnotassociatedwithanyantinuclearcytoplasmicantibody(ANCA).ItisanexampleofANCAnegativevasculitis.ANCA(AntineutrophiliccytoplasmicAntibodies)arcAntibodiesdirectedagainstcertainproteinsincytoplasmicgranulesofNeutrophil&monocytes.ThesearetwomajorcategoriesofANCAbasedondifferenttargetsfortheantibodies.ANCA(Antineutrophiccytoplasmicantibodies):ANCAisof2typesC-ANCA(Cytoplasmicproteinase3qisthetargetantigen)WegenersGranulomatosisq(90-95%) P-ANCA (perinuclearmyeloperoxidaseQisthemajortargetantigen)MicroscopicPAN(microscopicpolyangitis)Churg-StrausssyndromeCrescentericglomerulonephritiseGoodpasteur'ssyndrome
120.Featureofmicroscopicpolyangitisis: a)IgGdepositsinkidney b)Bronchospasm c)Renalinvolvementin80%ofcases d)Alloftheabove CorrectAnswer-CAnswerisC(Renalinvolvementin80%ofcases):Renalinvolvementisseeninatleast80%ofpatientswithMPA.Renalinvolvementisseeninatleast80%ofpatientswithMPARenalinvolvementisseeninatleast80%ofpatientswithMPA-CRDTGlomerulonephritisoccursinatleast79%ofpatients?HarrisonMicroscopicpolyangitisisnotassociatedwithIgGDepositsinkidneyMicroscopicPolyangitisisapauci-immuneglomerulonephritis.ImmunofluorescenceandelectronmicroscopyshownoimmunedepositsMicroscopicPolyangitisisnotassociatedwithbronchospasmAsthma(bronchospasm)andEosinophiliaarefeaturesofChurg-StraussSyndromeandaretypicallyabsentinmicroscopicpolyangitis. Features H.S. Churg- purpura Microscopic Wegner's Strauss Polyangitis Granulomatosis syndrome Depositsin --nt(IgA kidney deposits) - Bronchospasm - - - (Asthma) + Eosinophilia - - - +
Eosinophilia - - - + Predominant - p-ANCA c-ANCA p-ANCA ANCA
121.Jawtightnessistypicallyseenin: a)PAN b)Coarctationofaorta c)Giantcellarteritis d)Wegner'sGranulomatosis CorrectAnswer-CAnswerisC(GiantCellArteritis):JawClaudication(lawTightness)isatypicalmanifestationofTemporalarteritisorGiantcellarteritis.
122.ReversedCoarctationisseenin: a)GiantcellArteritis b)PolyarteritisNodosa c)TakayasuArteritis d)KawasakiDisease CorrectAnswer-CAnswerisC(TakayasuArteritis):Takayasuarteritisisalsoknownas'ReversedCoarctation'. TakayasuArteritis Condition CoarctationofAorta (ReversedCoarctation)Obstructionismost Obstructionismost commonlyseeninproximal commonlyfoundjust Pathology aspectofbranchesofthe distaltotheoriginofthe (Siteof aorticarchincludingthe leftSubclavianartery Obstruction) SubclavianandCommon therebysparingthe Carotidtherebyaffectingthe upperlimbvessels upperlimbvessels Absenceordiminished Absenceordiminishedpulse Pulses pulseinthelowerlimbs intheupperlimbs Blood Increasedbloodpressure Decreasedbloodpressurein Pressure intheupperlimbs theupperlimbs
123.Takayasuarteritismainlyaffects? a)Pulmonaryartery b)Celiacartery c)Subclavianartery d)SMA CorrectAnswer-CAnswerisC(SubclavianArtery):SubclavianarteryisthesinglemostcommonarteryinvolvedinTakayasuarteritis.Takayasuarteritis:MostcommonsitesaffectedTakayasuarteritistypicallyinvolvesmediumandlargesizedarteriesIthasastrongpredilectionfortheaorticarchanditsbranches.TheinvolvementofthemajorbranchesoftheaortaismuchmoremarkedattheiroriginthandistallyThemostcommonlyaffectedarteriesasseenbyarteriographyinorderoffrequencyCoronary(<10%)Vertebral(35%)Coeliacaxis(18%)Pulmonary(10-40%)SuperiorMesenteric(18%)Iliac(17%)Subclavian(93%)CommonCarotid(58%)AbdominalAorta(47%)Renal(38%)
124.MostcommonvariantofTakayasu DiseaseinIndiais: a)Type-1 b)Type-2 c)Type-3 d)Type-4 CorrectAnswer-CAnswerisC(Type-3):ThemostcommontypeofTakayasuarteritisreportedinIndiaisTypeIII.MoststudiesfromIndiahavereportedTypeIIIasthemostcommonformofTakayasuarteritisinIndiaaccountingfor53to76percentofcases. Classification/ PredominantSiteInvolved TypeType-I(Shimizu- Archofaortaanditsbranches Savo) Thoraco-abdominalaortaanditsbrancheswithout Type-II(Kimoto) involvementoftheaorticarchType-III(Inada) CombinedfeaturesofbothType-I&Type-II Pulmonaryinvolvement(inadditiontofeaturesofType-I,IIorIII) Type-IV(Oata) Involvementofcoronaryarteries(inadditiontofeaturesofType-1,IIorIII)
125.Kawasakidiseaseisassociatedwithall ofthefollowingclinicalfeaturesexcept a)Truncalrash b)Posteriorcervicallymphadenopathy c)Thrombocytopenia d)Pericarditis CorrectAnswer-CAnswerisC(Thrombocytopenia):Kawasakidiseaseisassociatedwiththrombocytosisandnotthrombocytopenia.CharacteristiclaboratoryfindingsTreatmentofChoicePrognosisincludeIncreasedESRHighdoseintravenousPrognosisforuneventfulrecoveryisThrombocytosiseimmunoglobulinseexcellente
126.TreatmentofchoiceforKawasaki Diseaseis: a)IVImmunoglobulins b)Steroids c)Dapsone d)Methotrexate CorrectAnswer-AAnswerisA(IVImmunoglobulins):ThetreatmentofchoiceinKawasakidiseaseisintravenousimmunglobulins
127.FeaturesofSLEincludeallofthe followingexcept: a)Recurentabortion b)Sterility c)Coomb'spositivehemolyticanemia d)Psychosis CorrectAnswer-BAnswerisB(Sterility):SystemicLupusErythematosus.RecurrentAbortionsinSLEmaybeseenasamanifestationofAntiphospholipidAntibodysyndrome.SmallproportionofpatientswithSLEmayhaveaCoomb'sPositiveHaemolyticanemia.PsychosisisaknownneurologicalmanifestationofSLE.
128.ShrinkingLungSyndromeisseenin: a)SLE b)RheumatoidArthritis c)Scleroderma d)Sarcoidosis CorrectAnswer-AAnswerisA(SLE):ShrinkinglungsyndromereferstoaconditiontypicalofSLEthatconsistsofapurelyrestrictiverespiratorydiseasewithnormallungparenchymaandmarkedlydecreasedlungvolumes. ShrinkinglungsyndromeShrinkinglungsyndromereferstoaconditiontypicalofSLEthatconsistsofapurelyrestrictiverespiratorydiseasewithnormallungparenchymaandmarkedlydecreasedlungvolumesPathogenticMechanismDiaphragmaticdysfunctionhasbeenadvocatedasthemainpathogeneticmechanismofshrinkinglungsyndromeClinicalPresentationShrinkinglungsyndromeusuallymanifestsasexertionaldyspneaofvariableseverity,whichcanprogressoveraperiodofweeksormonths.(Orthopneaattributedtodiaphragmaticweaknessmayalsooccur).Pleuriticchestpainisreportedfrequently,andaprevioushistoryofpleurisyandpericarditisiscommon.Physicalexaminationisremarkablynormal.InvestigationsChestradiographytypicallyshowselevatedhemi-diaphragms,althoughthisisnotauniversalfindinganditsabsencedoesnotexcludethediagnosis.Pleuraleffusions,Pleuralthickening,andatelectasismaybealsoevidentonplainfilmsorCTscans.Pulmonaryfunctiontestsshowamarkedrestrictivepattern,withdecreasedforcedvitalcapacity
Pulmonaryfunctiontestsshowamarkedrestrictivepattern,withdecreasedforcedvitalcapacity(FVC).Carbonmonoxidediffusioncorrectedbylungvolumesistypicallynormal.Anti-Roantibodiesmaybepresent,althoughtheydonotofferanadditionaldiagnosticaid.PrognosisTheprognosisofthissyndromeisusuallygood(Mostpatientsshowlong-termstabilization)
129.Antibodiesmostcommonlyseenindrug inducedlupusare: a)AntidsDNAAntibodies b)AntiSmAntibodies c)Anti-RoAntibodies d)AntihistoneAntibodies CorrectAnswer-DAnswerisD(AntihistoneAntibodies):ThemostcommonlyusedmarkerfordruginducedlupusisAntihistoneAntibodies.DrugInducedLupusischaracterizedserologicallybythepresenceofAnti-HistoneAntibodiesandtheabsenceofantibodiesagainstdoublestrandedDNA(dsDNAAntibodyNegative;Anti-HistoneAntibodyPositive).Anti-dsDNASerologyinDrugInducedLupusErythematosusAlmostallpatientswithDrugInducedLupuswilltestpositiveforAntinuclearAntibodies(PositiveANATest)ThespectrumofAntinuclearantibodiesinDrugInducedLupusincludesPositiveAntihistoneantibodies(mostcommon;notspecific;alsoseeninSLE)PositiveautoantibodiesagainstsinglestrandedDNA(common;notspecific;alsoseeninSLE)Negative(absenceof)autoantibodiesagainstdoublestrandedDNA(dsDNA)ThepresenceofautoantibodiesagainstdsDNAstronglysuggestsadiagnosisofSLEDrugInducedLupusistypicallyassociatedwithaHomogeneous
ANApatternduetothepresenceofAntihistoneAntibodiesAntibodiesareseeninlessthan5percentofpatientswithDrugInducedLupusThepresenceofAntihistoneantibodiesaloneisnotaspecifictestfordiagnosisofDrugInducedLupusasAntibodiestohistonesmayalsobeseeninupto50to80percentofpatientswithidiopathicSLE.Note:HypocomplementemiaisuncommoninDrugInducedLupusbutnotinSLE.
130.Bilateralparotidenlargementoccursin all,Except: a)Sjogren'ssyndrome b)SLE c)HIV d)Chronicpancreatitis CorrectAnswer-BAnswerisB(SLE):BilateralparotidenlargementisnotafeatureofSLE.CausesofBilateralparotidenlargement Viral Metabolic Endocrinal Miscellaneous infections causes ?Mumps ? Diabetes ? Acromegaly ? Sarcoidosis ?Influenza ? mellitus ? Gonadal ? Amyloidosis ?Epstein ? Hyper hypofunction ? Sjogren barrvirus ? lipoproteinemia syndrome ?Coxackie Chronic virusA pancreatitise ?CMV Cirrhosis ?HIV
131.LupusPernioisseenin: a)Tuberculosis b)SLE c)PAN d)Sarcoidosis CorrectAnswer-DAnswerisD(Sarcoidosis):PernioisatypicalcutaneousmanifestationofSarcoidosis.LupusPernioisthemosttypicalandeasilyrecognizableskinlesionsofSarcoidosis.Itischaracterizedbythepresenceofviolaceous,purpleblueshinyswollenlesionsoverthebridgeofnose,beneaththeeyesandoverthecheeks.Thisspecificcomplexofinvolvementofthebridgeofnose,theareabeneaththeeyesandthecheeksisconsidereddiagnosticforachronicformofSarcoidosis.
132.KeratodermaBlenorrhagicaistypically seenin a)RheumatoidArthritis b)PsoriaticArthritis c)ReactiveArthritis d)Ankylosingspondylitis CorrectAnswer-CAnswerisC(ReactiveArthritis):KeratodermaBlenorrhagicaisthecharachteristicskinlesionseeninpatientswithReactiveArthritis.'ThecharachteristicskinlesionsinReactiveArthritis,KeratodermaBlenorrha2ica,consistofvesiclesthatbecomehyperkeratotic,ultimatelyformingacrustbeforedisappearing.InpatientswithHIVinfection,theselesionsareoftenextremelysevereandextensivesometimesdominatingtheclinicalpicture'-
133.Whichofthefollowingstatementsabout Hematochromatosisisnottrue a)Hypogonadismmaybeseen b)Arthropathymayoccur c)DiabetesMellitusmaydevelop d)Desferrioxamineistreatmentofchoice CorrectAnswer-DAnswerisD(Desferrioromineistreatmentofchoice):Thetherapyofhematochromatosisinvolvesremovalofexcessbodyiron.IronremovalisbestachievedbyperiodicphlebotomieswhichisthetreatmentofchoiceforHematochromosis.Chelatingagentslikedesferoxaminearelesseffectiveandindicatedwhenanemiaorhypoproteinemiaissevereenoughtoprecludephlebotomy.ChelatingagentsarenotthetreatmentofchoiceforHematochromatosis.
134.Renalarterystenosismayoccurinallof thefollowing,except: a)Atherosclerosis b)Fibromusculardysplasia c)Takayasu'sarteritis d)Polyarteritisnodosa CorrectAnswer-DAnswerisD(Polyarteritisnodosa)AmongsttheoptionsprovidedrenalarterystenosisisleastlikelytobeseeninassociationwithPolyarteritisnodosa.AtherosclerosisandFibromusculardisease-Renalarterystenosisisproducedpredominantlybyatheroscleroticocclusivedisease(80%to90%ofpatients)ortibromusculardysplasia(10-15%ofpatients).-CMDT'06p460-hecommoncauseofrenalarterystenosisinthemiddleagedandelderlyisanatheromatousplaqueatoriginofrenalartery.Harrison-Inyoungerwomenstenosisisduetointrinsicstructuralabnormalitiesofthearterialwallcausedbyaheterogenousgroupoflesionscalled'fibromusculardysplasia'.-Harrison16`"/1707PANorTakayasuarteritis?CMDTdonotmentionPANorTakayasuarteritisasacauseforrenalarterystenosis.However,TakayasuarteritisiscertainlyamorecommoncauseofrenalarterystenosisthanPAN.Takayasuarteritis(Aorto-arteritis)isbeleivedstobethemostcommonofrenovascularhypertensioninIndiaandChina.?DiseasesofKidneyandUrinaryTract8th/1279Anumberofresearchpublications,howevershowTakayasuarteritisasacauseforrenalarterystenosis.
asacauseforrenalarterystenosis.PANAlthoughrenalinvolvementisseeninupto60%ofpatientswithPANitspathologydoesnotinvolverenalarterystenosis.Thepathologyinvolvesarteritiswithoutglomerulonephritisandischaracterisedbyaneurysmsofsmallandmediumsizedarteries.Stenosisofmainrenalarteryisanunusualassociation'.CausesofRenalarterystenosis: 1. Atherosclerosis2. Fibromusculardysplasia3. NonspecificAortoarteritis4. Takayasuarteritisandgiantcellarteritis(Takayasu>Giantcell)5. Antiphospholipidsyndrome6. Transplantrenalarterystenosis7. Renalarteryembolism8. Dissectinganeurysmofaorta9. Radiationarteritis
135.ThemostcommoncauseofCushing's syndromeis: a)Pituitaryadenoma b)Adrenaladenoma c)EctopicACTH d)Iatrogenicsteroids CorrectAnswer-DAnswerisD(Iatrogenicsteroids):"ThemostcommoncauseofCushing'ssyndromeisIatrogenicadministrationofsteroidsforavarietyofreasons."
136.Intakeofexogenoussteroidcauses: a)Addison'sdisease b)Cushing'ssyndrome c)Pheochromocytoma d)Conn'ssyndrome CorrectAnswer-BAnswerisB(Cushing'ssyndrome):ThemostcommoncauseofCushing'ssyndromeisiatragenicadministrationofsteroidsforavarietyofreasons.-Harrison
137.MostcommoncauseofAddison's DiseaseinIndiais: a)Autoimmune b)Postpartum c)HIV d)Tuberculosis CorrectAnswer-DAnswerisD(Tuberculosis):'Thecommonestcauseofadrenalinsufficiency(Addison'sdisease)inunderdevelopedcountriesisTuberculosis
138.InitialDrugofchoiceforsuspectedcase ofacuteadrenalinsufficiencyis: a)Norepinephrine b)Hydrocortisone c)Dexamethasone d)Fludrocortisones CorrectAnswer-CAnswerisC(Dexamethasone):ThetreatmentofchoiceforacuteadrenalinsufficiencyisGlucocorticoidReplacementTherapy.Incaseswherethediagnosisofacuteadrenalinsufficiencyissuspected(notconfirmed)DexamethasoneispreferredastheinitialsteroidofchoicebecauseDexamethasonedoesnotcompetewiththecortisolassay.Cosyntropinstimulationtestingmaybeperformedwhilethepatientisontreatment.
139.Nelson'ssyndromeismostlikelyseen after: a)Hypophysectomy b)Adrenalectomy c)Thyroidectomy d)Orchidectomy CorrectAnswer-BTheanswerisB(Adrenalectomy):AdrenalectomypredisposestothedevelopmentofNelson'ssyndrome.NelsonsyndromeNelsonsyndromeisadisordercharacterizedbytherapidenlargementofapreexistingACTHpituitaryadenomaafteradrenalectomy.Thissyndromeoccursbecausethefollowingadrenalectomy,thesuppressiveeffectofcortisolonACTHsecretionandtumorgrowthisremovedresultinginincreasedACTHsecretionandtumorgrowth.PatientswithNelson'ssyndromepresentwithhyperpigmentationandwiththemanifestationofanexpandingintrasellarmasslesion(visualfielddefects,headache,cavernoussinusinvasion,etc.)Thesetumorsrepresentoneofthemostaggressiveandrapidlygrowingofallpituitarytumors.ACTHlevelsaremarkedlyelevated.PreoperativeRadiotherapymaybeindicatedtopreventthedevelopmentofNelson'ssyndromeafteradrenalectomy.
140.PrimaryHyperaldosteronismcanbe diagnosedbyallofthefollowingcriteria,except: a)DiastolicHypertensionwithoutedema b)Hyperaldosteronismwhichisnotsupressedbyvolume expansion c)LowPlasmaReninActivity d)MetabolicAcidosis CorrectAnswer-DAnswerisD(MetabolicAcidosis)Class,TriadofBiochemicalCriteriafordiagnosisofPrimaryHyperaldoteronismHypokalemiawithinappropriatekaliuresis(Metabolicalkalosis)SuppressedplasmareninactivityElevatedAldosteronelevelsthatdonotfallappropriatelyinresponsetovolumeexpansionorsodiumloadTakenfromManualofEndocrinology&Metabolism41h/150
141.Primaryhyperparathyroidismis suggestedbyallofthefollowing,except: a)Increasedserumcalcium b)Lowurinarycalcium c)IncreasedPTH d)IncreasedC-AMP CorrectAnswer-BAnswerisB(LowUrinaryCalcium):PrimaryHyperparathyroidismisassociatedwithnormalorincreasedurinarycalciumlevels.IncreasedPTHandIncreasedSerumcalciuminassociationwithhighlevelsofurinarycalciumsuggestadiagnosisofPrimaryHyperparathyroidismIncreasedPTHandIncreasedSerumcalciuminassociationwithlowlevelsofurinarycalciumsuggestadiagnosisofFamilialHvpocalciuricHvpercalcemia(FHH) Disorder S- S- PTHrP Urine Urinary Ca2? PHOS Calcium Ca2+ Intact Creatinine PTH Clearanceratio PrimaryHPTH 1' sl,(or 1'(or ,I, U-Ca2'> >0.02 N) N) 100mg/24h Familial l' .I(or 1'(or ,I, U-Ca2+ <0.01 benign N) N) <100mg/24h hypercalcemia ThisclearanceratioiscalculatedfromsimultaneousfastingserumandurineCaandcreatininemeasurements.Theurinesamplecan
andurineCaandcreatininemeasurements.Theurinesamplecanbefromaspotora24hcollection.Theclearanceratioiscalculatedasfollows:UrineCa(mg/24h)xplasmacreatinine(mg/dl)/plasmaCa(mg/dL)xurinecreatinine(mg/24h)
142.Hypophosphatemiaisseenin: a)Pseudohypoparathyroidism b)Hyperparathyroidism c)Hyperthyroidism d)Hypoparathyroidism CorrectAnswer-BAnswerisB(Hyperparathyroidism):Hyperparathyroidismistypicallyassociatedwithhypophosphatemia.PrimaryHyperparathyroidismisassociatedwithHypophosphatemiaandHypercalcemiawhileSecondaryHyperparathyroidismisassociatedwithHypophosphatemiaandHypocalcemia.HyperthyroidismistypicalassociatedwithnormalphosphatelevelsHypoparathyroidismandPseudohypoparathyroidismareassociatedwithHyperphosphatemia
143.Granulomatousconditioncausing hypercalcemiaincludeallofthefollowing,except: a)TB b)Sarciodosis c)Berylliosis d)SLE CorrectAnswer-DAnswerisD(SLE):SLEisnotclassifiedasagranulomatousdiseaseandisararecauseofHypercalcemia(DisseminatedSLE).Sarcoidosis,Tuberculosis(TB)andBerylliosisaretypicalGranulomatousdisorderscausinghypercalcemia.GranulomatouscausesofHypercalcemiaInfectiveCausesTuberculosisBerylliosisHistoplasmosisCoccidoimycosisPneumocystisGranulomatousLeprosyCat-ScratchDisease Non-InfectiveCause Sarcoidosis(Mostcommon)Wegner'sGranulomatosisInflammatoryBowelDiseaseHistiocytosis-X
ForeignbodyGranulomasAlmosteverysinglediseaseassociatedwithGranulomaformationhasbeenreportedtocauseHypercalcemia
144.Osteoporosisisseeninallthefollowing except a)Thyrotoxicosis b)Rheumatoidarthritis c)Hypoparathyroidism d)Steroidtherapy CorrectAnswer-CAnswerisC(Hypoparathyroidism):Osteoporosisasassociatedwithlzyperparathyroidism(nothypoparathyroidism).DISEASESASSOCIATEDWITHANINCREASEDRISKOFGENERALIZEDOSTEOPOROSISINADULTS: Nutritionalandgastrointestinal HypogonadalStates disorders TurnerSyndrome Malnutrition Klinefeltersyndrome Parenteralnutrition Anorexianervosa Malabsorptionsyndromes Hypothalmicamenorrhea Gastrectomy Otherprimaryorsecondary Severeliverdisease,especially hypogonadalstates biliarycirrhosis PerniciousanemiaHematologicdisorders/ Endocrinedisorders Malignancy Cushing'ssyndrome Multipledisorders/malignancy Hyperparathyroidism LymphomaandleukemiaMalignancy-associatedparathyroid Thyrotoxicosis hormone-related(PTHrP) Insulin-dependentdiabetes
Insulin-dependentdiabetes production mellitusAcromegaly Mastocytosis Adrenalinsufficiency Hemophilia Thalassemia Selectedinherited& Miscellaneous RheumatologicdisordersOsteogenesisimperfectaQ ImmobilizationQChronicobstructivepulmonary MarfansyndromeQ disease Hemochromatosis Pregnancyandlactation HypophosphatasiaQ Scoliosis Glycogenstoragediseases Multiplesclerosis HomocystinuriaQ Sarcoidosis Ehlers-Danlossyndrome Amyloidosis Porphyria Alcoholism Menkes'syndrome Epidermolysisbullosa Rheumatoidarthritis DRUGSASSOCIATEDWITHANINCREASEDRISKOFGENERALIZEDOSTEOPOROSISINADULTS: Glucocorticoids2 Excessivethyroxin CyclosporineQ Aluminium Cytotoxicdrugs Gonadotropin-releasing Anticonvulsants hormoneagonistsQ Excessivealcohol HeparinLithium
145.Featuresoftumorlysissyndromeare: a)Hypocalcemia b)Hypophosphatemia c)Alkalosis d)Hypokalemia CorrectAnswer-AAnswerisA(Hypocalcemia):TumorLysissyndromeisassociatedwithHypocalcemia.TumorLysisSyndromeisalsoassociatedwithHyperphosphatemia,HyperkalemiaandAcidosis.
146.Apregnancywomanisdiagnosedto sufferingfromGraves'disease.Themostappropriatetherapyforherwouldbe: a)Radioiodinetherapy b)Totalthyroidectomy c)Carbimazoleparenteral d)Propylthiouraciloral CorrectAnswer-DAnswerisD(Propylthiouracil):Propylthiouracil(PTU)isnotassociatedwithanincreasedriskofcongenitalmalformationsandisconsideredthedrugofchoicefortreatinghyperthyroidismisPregnancy.HyperthyroidisminPregnancyMaternalHyperthyroidisminPregnancyisusuallyduetoGrave'sDisease.TRAbcrossestheplacentaandifmotheristhyrotoxicitmustbeassumedthatthefoetusissimilarlyaffectedThetreatmentofchoiceforthyrotoxicosisinPregnancyistherapywithsafeAntithyroidDrugsThionamides(Carbimazole/Propylthiouracil)areequallyeffectiveincontrollingGrave'sHyperthyroidisminPregnancyandareconsideredthedrugsofchoice.AmongstCarbimazole(Methimazole)andPropylthiouracil,Propylthiouracilistypicallythepreferredagent(Traditionaldrugofchoice)RadioactiveIodineTherapyiscontraindicatedinpregnancyasitmaydestroythefetalthyroidThyroidectomy(Surgery)israrelyrequiredduringPregnancy.Whenindicatedpreoperativetreatment
withantithyroiddrugsandiodineisundertakenandsurgeryisperformedduringthesecondtrimester Propylthiouracil EffectiveincontrollingGrave'sHyperthyroidisminPregnancyNotassociatedwithincreasedriskofcongenitalmalformation(AplasiaCutisCongenitahasnotreportedwiththeuseofPropylthiouracil))ConsideredthedrugofchoicefortreatmentofHyperthyroidisminpregnancyConsideredthedrugofchoiceformothersduringBreastfeeding(TransferredtothemilkonetenthasmuchasCarbimazole)EffectiveincontrollingGrave'sHyperthyroidisminPregnancyAplasiaCutisCongenitaisararedisorderreportedinneonatesofmotherswhoreceivedMethimazole(Carbimazole)duringpregnancy.(Consensus:Insufficientdatatoestablishadirectcausalrelationship)ConsideredasaneffectivealternativewherePropylthiouracilisnotavailableorcannotbeusedforanyreasonMaybeusedinmothersduringbreastfeedingatalowdose(TransferredtomilkmorethanPropylthiouracilbutusuallydoesnotadverselyaffecttheinfant'sthyroidfunction)
147.Investigationofchoicein pheochromocytomais: a)CTscan b)Urinarycatecholamines c)MIBGscan d)MRIScan CorrectAnswer-BAnswerisB(UrinaryCatecholamines):Pheochromocytomassynthesizeandstorecatecholamineswhichincludenorepinephrine,epinephrineanddopamine.TheinvestigationofchoicefordiagnosisofPheochromocytomasisdeterminationofelevatedlevelsofcatecholaminesandtheirmethylatedmetabolites(metanephrines)intheplasmaandurine.CTscan,MRIandMBIGScintographyareallusefuldiagnosticmodalitiesforlocalizationofpheochromocytomaoncethediagnosisisestablished.
148.Thepredominantsymptom/signof pheochromocytomais: a)Sweating b)Weightloss c)Orthostatichypotension d)Episodichypertension CorrectAnswer-DAnswerisD(EpisodicHypertension):ThepredominantmanifestationofPheochromocytomaisHypertensionwhichclassicallypresentsasEpisodicHypertension(SustainedHypertensionandOrthostaticHypotensionmayalsobeseen).'ThedominantsignisHypertension.Classicallypatientshaveepisodichypertension,butsustainedhypertensionisalsocommon'-Harrison
149.Thegoldstandardtestfordiagnosisof Insulinomais: a)'72hour'fasttest b)PlasmaGlucoselevels<3mmol/l c)PlasmaInsulinlevels>6?U/ml d)C-peptidelevels<50pmol/e CorrectAnswer-ATheanswerisA('72hour'fasttest):TheGoldstandardtestfordiagnosisofInsulinomaisasupervised'72hourfast'testDiagnosisofinsulinomarequiresdemonstrationofinappropriatelyhighlevelsofplasmaInsulin(andC-peptide)inthepresenceofdocumentedhypoglycemia(Achievedby72-hourfasttest).AbsolutevaluesofInsulinorC-peptidearenotreliableinestablishingadiagnosisunlesshypoglycemiaisdocumentedThe'72hourfasttest'allowsdemonstrationofhypoglycemia,togetherwillelevatedlevelsofInsulinandC-peptideandthusbecomesthemostreliable?goldstandardtestforestablishingadiagnosisofInsulinomaDiagnosisofInsulinoma:'72hourfast'testThediagnosisofInsulinomarequiresthedemonstrationofaninappropriatelyelevatedplasmainsulin(andC-peptide)atthetimeofhypoglycemia.The'72hourfast'testinvolvessupervisedfastingforupto72hoursoruntilhypoglycemiacanbedocumented.Thetestisconsideredpositiveifatanytimewhenbloodglucoselevelsdropto<2.2mmo1/1(40mg/dl),theseruminsulinlevelsarerecordedtobegreaterthan6?U/ml.(andC-peptidelevels>100
pmo1/1)Studiesindicatethat100%ofpatientswithinsulinomawillbedetectedafterasupervised72hourfastandhencethistestisconsideredthegoldstandardtest.First24hours:70-80%ofpatientswithinsulinomacanbedetectedUpto48hours:98%ofpatientswithinsulinomacanbedetectedBy72hours:100%ofpatientswithinsulinomacanhedetected
150.Diagnosisofcarcinoidtumourisdone Urinaryestimationof: a)VMA b)Metanephrines c)Catecholamines d)5HIAA CorrectAnswer-DAnswerisD(5HIAA):CarcinoidTumorsCarcinoidtumorsareassociatedwithelevatedlevelsofmetabolitesofTryptophan/serotoninwhichinclude5HIAA,5HTand5HTP.PheochromocytomasPheochromocytomasareassociatedwithelevatedlevelsofcatecholaminesandtheirmetaboliteswhichincludeVanillylmandelicacid(VMA)andmetanephrinesThediagnosisofTypicalcarcinoidsyndromeissuggestedbyelevatedlevelsof5HIAAThediagnosisofAtypicalCarcinoidSyndromeissuggestedbyelevatedlevelsof5HTP.establishedbyelevatedlevelsof5HIAA.
151.Carcinoidsyndromeproducesvalvular diseaseprimarilyofthe a)Venousvalves b)Tricuspidvalve c)Mitralvalve d)Aorticvalve CorrectAnswer-BAnswerisB(Tricuspidvalve);Themostcommonsiteofinvolvementisthe?VentricularsurfaceofTricuspidvalve.'Cardiacmanifestationsincarcinoidsyndromeareduetofibrosisinvolvingtheendocardium,primarilyontherightsidealthoughleftsidelesionsalsooccur.Densefibrousdepositsaremostcommonlyontheventricularaspectofthetricuspidvalveandlesscommonlyonthepulmonaryvalvecusps.'Theycanresultineitherconstrictionofvalves(stenosis)orfixationofvalvesinopen(regurgitation)-Abnormalityproducedduetotricuspidvalveinvolvement?TricuspidregurgitationQ-Abnormalityproducedduetopulmonaryvalveinvolvement?PulmonarystenosisQ
152.Mostcommoncauseofchronic granulomatousdiseaseinchildrenis: a)Myeloperoxidasedeficiency b)Defectivephagocytosis c)DefectiveH2O2production d)Job'sdisease CorrectAnswer-CAnswerisC(DefectiveH2O2production)Chronicgranulomatousdiseaseisa'disorder'ofmicrobialkilling'characterizedbydecreasedabilityofneutrophilstoproduceH4)-Q Chronicgranulomatousdiseaseisa'disorder'ofmicrobialkilling'characterizedbydecreasedabilityofneutrophilstoproduceH,O2.QPatients,herebecomesusceptibletodiseasecausedbyorganismsthatproduce`catalase',whichdestroysthesmallamountofH2O,presentinthesecellsandleadstofailureofbacterialkilling.Thediseaseiscalledso,becausegranulomas,areformedinvarioustissues,asasecondlinedefenceagainstorganisms,thatnormallywouldberemovedbytheacuteinflammatoryresponse.Manifestations:Recurrentinfectionswithwhichcatalase+vePyogenicbacteriae.g.staph/coliforms.Q -catalasenegativebacteriae.g.streptococcus,Pneumococcusareoftenhandlednormally.QNormalhumoralimmuneresponse?butDefectivekillingprocess:LeucocytesareunabletokillbacteriaafterphagocytosisthemajorreasonbeingdecreasedproductionofH-O2.Q
Screeningmethod:NBTtest:Nitroblueretrazoliumdyeisnotreducedbyneutrophilsinvitro.
153.InTurner'ssyndromewhichofthe followingisNOTseen: a)Shortstature b)Widelyspacednipple c)Webbedneck d)Mentalretardation CorrectAnswer-DAnswerisD(Mentalretardation):MentalretardationisseeninDown&Klinefelter'ssyndromebutnotinTurner'ssyndrome.AllotherfeaturesmentionedasoptionsmaybeseeninTurner'ssyndrome.
154.Broca'saphasiais? a)Fluentaphasia b)Nonfluentaphasia c)Sensoryaphasia d)Conductionaphasia CorrectAnswer-BAnswerisB(Non-fluentAphasia):Broca'sAphasiaisaNon-FluentExpressive(Motor)Aphasiawithpreservedcomprehensionandimpairedrepetition
155.AllofthefollowingareFluentAphasia's Except: a)AnomieAphasia b)Wernicke'sAphasia c)ConductionAphasia d)Broca'sAphasia CorrectAnswer-DAnswerisD(Broca'sAphasia):NeurologicDifferentialDiagnosis:ACase-BasedApproach(CambridgeUniversityPress,2014)/36Broca'sAphasiaisaNon-FluentExpressive(Motor)Aphasiawithpreservedcomprehensionandimpairedrepetition.Non-FluentAphasiasGlobalBroca'sMixedTranscorticalTranscorticalMotorFluentAphasiasAnomieWernicke'sConductionTranscorticalSensory
156.FluentAphasiawithpreserved comprehensionandimpairedrepetitionis: a)Broca's b)Wernicke's c)Anomie d)Conduction CorrectAnswer-DAnswerisD(conduction):ConductionAphasiaisa'Fluent'AphasiawithpreservedcomprehensionandimpairedRepetition. Clinical Non-FluentAphasias FluentAphas'as SyndromeFeatures Wernicke's Transcortical Transcortical Motor Sensory Fluent No No No No Yes Yes Yes Yes Comprehension No No Yes Yes Yes Yes No No Repeat No Yes Yes No Yes No No Yes
157. Involvementofpyramidaltractleadsto allofthefollowingexcept a)Spasticity b)Fasciculation c)Hyper-reflexia d)PositiveBabinskisign CorrectAnswer-BAnswerisB(Fasciculation):FasciculationsareafeatureofLowerMotorNeuronLesions.InvolvementofPyramidaltractindicatesanUpperMotorNeuronLesion.HypertoniawithSpasticity,Hyper-reflexiaandaPositiveBabinskiSignwithanExtensorPlanterresponseareallfeaturesofanuppermotorneuronlesion(PyramidalTractLesion).
158.ThefollowingarecomponentsofBrown Sequardsyndromeexcept: a)Ipsilateralextensorplantarresponse b)Ipsilateralpyramidaltractinvolvement c)Contralateralspinothalamictractinvolvement d)Contralateralposteriorcolumninvolvement CorrectAnswer-DAnswerisD(Contralateralposteriorcolumninvolvement):Brown?Sequardsyndromeorhemisectionofthespinalcordleadstolossofjointpositionandvibratorysense(posteriorcoluntnmovement)ontheipsilateralsideandnotonthecontralateralside.?Harrison16th/2441,144Brownsequardsyndrome:HemisectionofspinalcordIpsilateralinvolvementofcorticospinaltract:ipsilaterallossofmotorpower.Ipsilateralinvolvementofposteriorcolumn:ipsilaterallossofjointpositionandvibratorysense.Contralateralinvolvementofspinothalamictract:contralaterallossofjointpositionandvibratorysense.Segmentalsignssuchasradicularpainmuscleatrophyorlossofdeeptendonreflexesarcunilateral(Lowermotorneuronsignsatleveloflesion).
159.Earlylossofbladdercontrolisseenin a)ConusMedullaris b)CaudaEquina c)GullainBarreSyndrome d)AmyotrophicLateralSclerosis CorrectAnswer-AAnswerisA(ConusMedullaris):Harrison's18thLossofbladdercontrolisanearlyandmarkedfeatureofconusmedullaris. Cauda Conus Feature Equina GBS AMLS Medullaris syndromeEarlyand Lateandless Absent Bladder Uncommon Marked marked /uncommon 'Bladder 'Bladder 'Ifbladder 'Eveninlate Involvement dysfunction involvementis dysfunctiona stagesof is alate prominent aprominent theillness presentation featureand featureand boweland incauda- comesearlyinthe bladder comesearly equina course, functions inthe syndrome diagnostic are courseof possibilities preserved' disease' otherthanGBS shouldbe
considered
160.Mostcommoncauseofembolicstroke is? a)Intra-CardiacThrombi b)ParticulateMatterFromIVDrugInjections c)ProteinCdeficiency d)Antiphospholipidsyndrome CorrectAnswer-AAnswerisA(IntracardiacThrombi):ThemostcommoncauseofembolicstrokesareIntro-cardiacThrombi.ThemostcommonsourcesofsystemicembolismandembolicstrokeareIntra-cardiacthrombiformedasaresultofatrialfibrillation,ST-elevationMI,leftventriculardysfunctionorheartfailure.AtrialFibrillationisthesinglemostimportantpredisposingfactor(AtrialThrombus)followedbyMyocardialInfarction(LeftVentricularThrombus).
161.Thecommoncauseofsubarachnoid hemorrhageis: a)Arterio-venousmalformation b)Cavernousangioma c)Aneurysm d)Hypertension CorrectAnswer-CAnswerisC(Aneurysm):`Themostcommoncauseofsubarachnoidhaemorrhageisruptureofasaccularaneurysm(excludingheadtrauma)'?Harrison.Previouslyaskedfrequentlyasfollows:(Excludinghandtrauma)MostcommoncauseofsubarachnoidhaemorrhageisruptureofasaccularaneurysmQMostcommoncauseofsubarachnoidhaemorrhageisruptureofaBerryaneurysmQMostcommoncauseofsubarachnoidhaemorrhageisruptureof'CircleofWillis'aneurysmQ.(SaccularaneurysmsaresynonymouswithBerryAneurysmsandmostcommonlyoccurintheanteriorcirculationontheCircleofWillis).
162.Lateralmedullarysyndromeiscausedby thrombosisof: a)Anteriorinferiorcerebralartery b)Posteriorinferiorcerebellarartery c)Vertebralartery d)bandc CorrectAnswer-DAnswerisC>B(Vertebralartery>Posteriorinferiorcerebellarartery):`Mostcasesresultfromipsilateralvertebralarteryocclusion;inthereminderocclusionofposteriorinferiorcerebellararteryisresponsible'?HarrisonVesselocclusionthatresultinLateralMedullarysyndrome:-Vertebral(mostcommon) -Posteriorinferiorcerebellar(2ndmostcommon) -Superior,middleorInferiorlateralmedullaryarteries VertebralarteryThevertebralarteryconsistsoffoursegments.Thefourthsegmentcoursesupwardtojointtheothervertebralarterytoformthebasilarartery.Onlythissegmentgivesrisetobranchesthatsupplythebrainstemandcerebellum.EmbolicocclusionorthrombosisofthefourthsegmentisresponsibleforthissyndromeQPosteriorinferiorcerebellararteryPosteriorinferiorcerebellararteryinitsproximalpartsuppliesthelateralmedullaandinitsdistalbranchestheinferiorsurfaceof
cerebellum.
163.Whichofthefollowingstatementsabout thepathologyinAlzheimer'sdiseaseisnottrue: a)NeuriticPlaquesareformedofamyloidprotein b)Neurofibrillarytangles(NFT)aremadeoftauprotein c)NFTsappearextracellularlybeforeintracellularappearance d)NumberofNFTscorrelateswithdementia CorrectAnswer-CAnswerisC(NFTsappearextracellularlybeforeintracellularappearance):NFTsaretypicallyseenintracellularlywithinthesomaandproximaldendritesofneurons.NeurofibrillaryTangles(NFTs)areintracellularaccumulationsofhyperphosphorylated'tau'proteins.NeurofibrillaryTanglesareIntracellularAccumulationsNeurofibrillaryTanglesareintracellularaccumulationsofhyperphosphorylatedmicrotubulebindingprotein'tau'.Pairedhelicalfilamentsoftauprotein(NFTs)formintracellularlywithinthesomaandproximaldendritesofneurons.Thesecytoskeletalproteintangles(NFTs),initiallyimpedecellularmetabolismandaxosplasmictransportleadingtoimpairedsynapticfunctionandeventuallytoneuronaldeath.Theseneurofibrillatytanglesmaybeseenasextracellulartanglesafterdegenerationoftheneuronasevidenceoftheneuronalcell'sdemiseNeurofibrillaryTanglesareintracellularaccumulationsthatmayappearextracellularlyalterdegenerationofneuron(neuronaldeath)
HistopathologicalHallmarksofAlzheimer'sDisease AmyloidPlaques(Extracellular) AmyloidNeuriticPlaquesareformedbyextracellularaccumulationofbetaamyloiddepositswithintheneutropil'Neuritic'or'Senile'I3-amyloidplaquesareanearlyhistopathologicalsignofAlzheimer'sdisease(thatoccurrarelyinhealthysubjects)Theamyloid13-proteinaccumulatedinsingleneuriticplaquesistoxictosurroundingstructuresandadjacentneurons.Clinicopathologicalstudieshaveshownthatamy/aidburdendoesnotdirectlycorrelatewithseverityordurationofdementia. NeurofibrillaryTangles(Intracellular) Neurofibrillarytanglesarcformedbyintracellularaccumulationofhyperphosphorylatedmicrotubulebindingprotein'tau'.NFT'soccurinmanyneurodegenerativediseasesand/oragroupofdiseasescalledlaupathies'.TheseincludeFrontotemporaldementia,Pick'sdiseaseetc.Thecooccuranceoffi-amyloidplaqueswithNFT'ssuggestsadiagnosisofAD.TheNFT'saretoxictotheneuronsandneuronswithNFT'seventuallydieanddegenerateleavingaresidual`ghosttangle',intheextracellularspaceremindingofthepyramidalcellbodyinwhichitwasinitiallyformed.ClinicopathologicalstudieshaveshownthatdementiacorrelatesmorestronglywithNFT'sthanwithsenileplaques(3-amyloid)
164.Whichofthefollowingmetalionsis associatedwithsecondaryParkinsonisms: a)Mangnese(Mn) b)Magnesium(Mg) c)Selenium(Se) d)Molybednum(Me) CorrectAnswer-AAnswerisA(Mangnese(Mn)):ManganeseionexposureisimplicatedinthefreeradicaldamageofthebasalgangliacausingParkinsonism.ToxinsImplicatedinParkinsonism(Harrison)Manganese(Mn)MPTP(1Methyl->Phenyl?1,2,3,6tetrahydropyridine)CarbonmonoxideCarbondisulphideCtanideHexaneMethanolToxinsreportedtoinduceParkinonism:(HandbookofAtypicalParkinsonism)Betelnut(plusantiPsychotics)CarbonmonoxideContrastagentforcardiaccatheterizationCyanideEthanolintoxication,ethanolwithdrawalEthyleneglycol
Herbicides(paraquat,diquat,glyphosate)HeroinHydrogensulfideKava-kavaManganeseManeb(ManganeseEthylene-Bis-Dithiocarbamate)MercuryMethanolMethcathinone(manganeseephedrone)MPTP(I-methyl-4-phenyl-1,2,3,6-tetrahydropyridine)Organicsolvents(carbondisulfide,n-hexane,toluene,trichloroethylene)OrganophosphateinsecticidepoisoningPetroleumproducts
165.Whichofthefollowingsitesis responsiblefortheamnesticdefectinWernicke'sKorsakoffsyndrome: a)Mamillarybody b)Thalamus c)PeriventricularGreymatter d)Hippocampus CorrectAnswer-BAnswerisB(Thalamus):TheAmnesticeffectinWernicke'sKorsakoffSyndromeisrelatedtolesionsinthedorso-medialnucleiofthethalamus.`Lesionsinthedorsomedialnucleusofthethalamusseemtobethebestcorrelateofthememorydisturbanceandconfabulation'-Robbins
166.Inchildrenmostcommonposteriorfossa tumouris: a)Meningiomas b)Astrocytoma c)Medulloblastoma d)Glioblastomamultiforme CorrectAnswer-BAnswerisB(Astrocytoma):CerebellarAstrocytomasarethemostcommonposterior.fossatumorsinchildren.Medulloblastomaarethesecondmostcommonposteriorfossatumorsinchildrenandthemostcommonmalignantposteriorfossatumorsinchildren.AlthoughCPDTandNelson'stextbookmentionanequalincidenceofcerebellarastrocytomaandmedulloblastomaintheposteriorfossainchildren,mostotherstandardtextbooksmentioncerebellarastrocytomasasthemostcommonposteriorfossatumorsinchildren.
167.Allthefollowingaretrueof Craniopharyngiomaexcept a)DerivedfromRathke'spouch b)Containsepithelialcells c)Presentinsellaorinfra-sellarlocation d)Causesvisualdisturbances CorrectAnswer-CAnswerisC(Presentinsellaorinfrasellarlocation):Someoftheselesionsarisefromthesella,butmostaresuprasellarQ(Notinfra-sellar).Theyarisefromnearthepituitarystalkandcommonlyextendintothesuprasellarcistern.CraniopharyngiomasarisefromRathke'spouchandconstitute3-5%ofallintracranialneoplasms.Someoftheselesionsarisefromthesella,butmostaresuprasellarQ(Notinfra-sellar).Theyarisefromnearthepituitarystalkandcommonlyextendintothesuprasellarcistern.Consistsofnestsofcordsofstratifiedsquamousorcolumnarepitheliumembeddedinaspongyreticulum--Robbins61h/1129Visualcomplaintsarethepresentingfeatureinabout80%ofadultsand60%ofchildren.
168.Predominantlysensoryneuropathyis/are causedby: a)Cisplatin b)Pyridoxineexcess c)Suramin d)aandb CorrectAnswer-DAnswerisAandB(CisplatinandPyridoxineexcess):CisplatinandPyridoxineareassociatedwithpredominantlysensoryneuropathies.
169.Whichoneofthefollowingiscorrect regardingEaton-Lambertsyndrome- a)Itcommonlyaffectstheocularmuscle b)Neostigmineisthedrugofchoiceforthissyndrome c)Repeatedelectricalstimulationenhancesmusclepowerinit. d)Itiscommonlyassociatedwithadenocarcinomaoflung CorrectAnswer-CAnswerisC(Repeatedelectricalstimulationenhancesmusclepower):'PatientswithLambert?Eatenmyaethenicsyndromeshowincrementalratherthandecrementalresponseonrepeatednervestimulation'?Harrison17th/2674'Muscleresponsetostimulationofitsmotornerveincreasesremarkablyifnerveisstimulatedrepeatedlyeveninmusclesthatareclinicallyweak'-CMDTLambertEatenMyastheniaSyndromecommonlyinvolvesproximallimbmusclesandmusclesoftrunkExtraocularmusclesarethemostcommonlyinvolvedinMyaestheniaGravisandnotinLambertEatenMyastheniaSyndromeNeostigmineisnotconsideredthedrugofchoicePlasmapharesisandimmunosuppressionformmainstayoftreatment3,4Diaminopyridineisthedrugofchoiceforenhancementofneuromusculartransmission.Pyridostigmine(orNeostigmine)maybesympatomaticallyhelpfulbuttheirresponseisvariable?Harrison&CMDTLambertEatenMyastheniaSyndromeisassociatedwithsmallcellcarcinomaoflung
LambertEatenMyastheniaSyndromeisassociatedwithsmallcellcarcinomaoflungandnotadenocarcinoma
170.Allofthefollowingarefeatureof dermatomyositis,Except: a)SalmonPatch b)Gottron'spatch c)Mechanicfinger d)Periungualtelengiectasias CorrectAnswer-AAnswerisA(SalmonPatch):Salmonpatchisnotafeatureofdermatomyositis.Cutaneousfeaturesofdermatomvositis Cutaneous Description featureHeliotrope Periocularorfacialerythemaandedemawith Rash? pink/purple/blue(heliotrope)hue(bluepurplediscolorationonupperevelidswithedema) Gottren's Violaceouspapulesovertheknuckles PapulesQ Erythemaoftheknuckleswitharaisedviolaceous (Gottren'ssign) scalyeruption Ervthematousrashoverotherbodysurfacessuch `V'sign asanteriorchest(ofteninaVform) Shawlsign Erythematousrashoverotherbodysurfacesincludingtheuppertrunk,neck,back&shoulders(shawlpattern) Periungual Dilatedcapillaryloopsatthebaseoffingernails TelengiectasiaseMechanic's Irregular,thickened,distortedcuticles,withrough
handsQ andcrackedareasoverthelateralandpalmarareasoffingerswithirregulardirtyhorizontallinesresemblingmechanic'shand. Calcinosis Presenceofhardcalciumdepositsintheskin Cutise
171.Bestprognosticfactorforheadinjuryis: a)Glasgowcomascale b)Age c)Modeofinjury d)CT CorrectAnswer-AAnswerisA(Glasgowcomascale):AmongsttheoptionprovidedGCSisthesinglebestanswerofchoice.DeterminingthepatientprognosisafterTBI(TraumaticBrainInjury)isdifficultandcomplex.Severalindependentvariableshavebeenidentifiedthatcorrelatewithseverity.MoststudieshaveindicatedGlasgowComaScaleinthefieldandatarrivalattheemergencydepartmentasahighlypredictiveindicatorofprognosis.Harrison17th/2601Insevereheadinjuryeyeopening,thebestmotorresponseandverbaloutputhavebeenfoundtoberoughlypredictiveofoutcome.TherehavebeensummarizedusingtheGlasgowcomascale.Comascore=E+M+VPatientscoring3or4havean85%chanceofdyingorremainingvegetative.Patientsscoring11orabovehaveonlya5--10%chanceofdyingorremainingvegetative.Intermediatescorescorrelatewithproportionalchancesofrecovery. OtherPoorprognosis indicators:Harrison CTevidenceofcompressionof ? Olderage ? cisterns/midlineshift
? Olderage ? cisterns/midlineshift Delayedevacuationoflarge ? IncreaseICP ? intracerebralhemorrhage CarrierstatusforapolipoproteinE-4 ? Hypoxia&Hypotension ? allele
172.Impotenceisafeatureofwhichofthe following: a)Multiplesclerosis b)Poliomyelitis c)Amyotropiclateralsclerosis d)Meningitis CorrectAnswer-AAnswerisA(Multiplesclerosis):Multiplesclerosisisassociatedwitherectiledy.slitnctionorimpotence.NeurologicaldisordersassociatedwithErectiledysfunctioninclude:SpinalcordinjuryMultiplesclerosisPeripheralneuropathy
173.Whichofthefollowingisthemost commoninitialpresentingfeatureofmultiplesclerosis: a)OpticNeuritis b)CerebellarAtaxia c)Internuclearophthalmoplegia d)Diplopia CorrectAnswer-AAnswerisA(OpticNeuritis):OpticNeuritisisthemostfrequentinitialpresentingfeatureofMSamongsttheoptionsprovided.Themostcommonearliestpresentingfeaturesofmultiplesclerosisaretransientsensorydefectsfollowedbyvisualdisturbancesduetoopticneuritis.InitialSymptomsofMS Percentof Percentof Symptom Symptom Cases Cases Sensoryloss 37 Lhermitte's 3 Opticneuritis 36 Pain 3 Weakness 35 Dementia 2 Paresthesias 24 Visualloss 2 Diplopia 15 Facialpalsy 1 Ataxia 11 Impotence 1 Vertigo 6 Myokymia 1 Paroxysmal 4 Epilepsy 1 attacks 4 1
4 1 Bladder Falling
174."Prosopagnosia"ischaracterizedby: a)Inabilitytoread b)Inabilitytoidentifyfaces c)Inabilitytowrite d)Inabilitytospeak CorrectAnswer-BAns.B.InabilitytoidentifyfacesProsopagnosiaisarecognitiondeficitinwhichthepatientisunabletorecognizefamiliarfaces.Faceandobjectrecognitiondeficitsareknownasprosopagnosiaandvisualobjectagnosiarespectively.Thecharacteristiclesionsinprosopagnosiaandvisualobjectagnosiaconsistsofabilateralinfarctionintheterritoryoftheposteriorcerebralarteriesandinvolvelingualandfusiformgyri.
175.CriteriaforBrainstemdeathincludes: a)PositiveDoll'seyeReflex b)Absentpupillarylightreflexanddelatedpupils c)Pinpointpupils d)Positivevestibulo-ocularreflex CorrectAnswer-BAnswerisB(Absentpupillarylightreflexanddelatedpupils):Brainstemdeathisdefinedbytheabsenceofallbrainstemmediatedcranialnervereflexes.PupillaryLightReflexisabrainstemmediatedcranialnervereflexthatisabsentinbrainstemdeath.Thepupilsareusuallymidsizedbutmaybedilated(shouldnothoweverbesmall).Occulo-cephalic(Doll'seye)reflexandVestibulo-ocular(Caloric)reflexarebothbrainstemmediatedcranialnervereflexsthatshouldbeabsentinBrainstemdeath.CriteriaforBrainDeath/BrainstemdeathThedefinitionofBrainstemdeathrequiressimultaneousdemonstrationthatthepatienthasirreversiblylostthecapacityofconsciousness(Coma)andthecapacitytobreathe(Apnoea)bothofwhicharedependentonintactbrainstem.ClinicalassessmentoftheintegrityofBrainstemhastwocomponentsincludingassessmentoftheintegrityofbrainstemmediatedcranialnervereflexesandtheApneatest. DeepUnresponsiveComa Patientswithbraindeathshowthedeepestcomapossiblewithtotalunresponsivenesstoallstimuli.NospontaneousmovementNoresponsetoexternalstimuli(Verbal/Deeppain)
AbsenceofallBrainstemCranialReflexesAllreflexesmediatedbycranialnervemustbeabsentAbsentPupillaryLightreflex(CNII,III)(Pupilsareusuallymidsizedbutmaybeenlargedbuttheyshouldnotbesmall)AbsentCornealReflex(CNV,VII)AbsentVestibulocochlearReflex(CNIII,IV,VI,VIII)(Noeyemovementinresponsetocaloricirrigationofears)AbsentOculocephalicReflex(AbsentDoll'seyereflex)Eyeswillmovewiththehead(Nooccularmovementsonrapidturningofhead).AbsentGagReflex(CNIX,X)AbsentTrachealCoughReflex(CNX)AbsentCentralMotorResponsetoPain(CNV,VII)(Noresponsetodeepsomaticstimulation). CompleteAponeainpressureofhypercarbia(Absenceof BrainstemRespiratoryReflex) Norespiratoryeffortinresponsetohypercarbianeedstobedemonstratedtoshowthataponeaisduetobrainstem(medullary)damageAbsentrespiratorymovementduringdisconnectionfromtheventilatorwiththePaCO2>60mmHgisrequiredforthetesttobevalidCranialnervereflexesinBrainStemDeathtesting: Cranial Reflex Notes nerves Pupillarylight HAI Usebrightlightsource(not reflex ophthalmoscope)inadimmedenvironment.Lookforbothdirectandconsensualreaction.Importantreflexthatinterrogatesatlevelof midbrainStrokecorneawithgauze,whilstgently Cornealreflex V,VII holdingeyesopen;avoidtraumatocornea.ThevariousnucleiofVarefoundthroughoutthewholelengthofthebrainstem,whilst
brainstem,whilstthatofVII(facialnerve)isintheuppermedulla. Central Applydeeppressurestimulationcentrally V,VII responseto (e.g.supra-orbitalridge)andperipherally(e.g.nailbed).Lookforcentralmotor deepsomatic responseinthedistributionofthefacialnerve.Peripheralstimulationmayillicitperipheral stimulation spinalreflexes. III,IV,VI, Checkpatencyofexternalauditorycanal Coldcaloric VIII withauroscope.Flexheadto30?(orapply30?headuptiltifcervicalspineinjuryis vestibulo- suspected).Slowlyirrigatecanalwith ocular 5OrriL reflex ice-coldwaterover60s.Observefornystagmusforafurther30s.Contra- indicatedintrauma-relatedotorrhea.ThenucleiofIIIandIVliewithjinthemidbrain,whilstthoseofVIandVIIIarein themedulla. Oculocephalic Rapidlateralmovementofthehead VIII,Ill,VI reflex normallyresultsineyedeviationtothe (Doll'seye contralateralside,testingbrainstemgaze reflex) mechanism.Inbrainstemdeatheyesremaininafixed positionwithintheorbit. Gagreflex IX,X Stimulateuvulaunderdirectvisionwiththroatspatula,observingforcontractionofsoftpalate. ThenucleiofIXandXlieinthemedulla. Tracheal X Exposepatienttoumblicus.Stimulate coughreflex tracheatolevelofcarinabyintroductionofsterilesuctioncatheterdownendotrachealtube.Observeforcoughresponse
tube.Observeforcoughresponse
176.Renalpapillarynecrosisisalmostalways associatedwithoneofthefollowingconditions:March2004 a)Diabetesmellitus b)Analgesicnephropathy c)Chronicpyelonephritis d)Poststreptococcalglomerulonephritis CorrectAnswer-AAns.Ai.e.Diabetesmellitus`Renalpapillarynecrosis,anaccompanimentofacutepyelonephritisismostoftenseenindiabeticsandischaracterisedbynecrosisofrenalpapillaeofoneorbothkidneyswithsharpeddemarcationbetweennecroticandlivingtissue'--DorlandsThuswhilepapillarynecrosisisafeatureofmorethanoneconditionsmentionedinthequestion,itismostcommonlyseenwithdiabetesmellitus.
177.Renalveinthrombosisisassociatedwith allofthefollowingexcept:September2011 a)Trauma b)Sicklecellanemia c)Nephroticsyndrome d)Dehydration CorrectAnswer-BAns.B:SicklecellanemiaConditionsassociatedwithRVTare:Trauma,extrinsiccompression(lymohnodes,aneurysm),invasionbyrenalcellcarcinoma,dehydration(infants),nephriticsyndromeandPregnancy/oralcontraceptivesRVT:AcutecasesoccursinchildrenandpresentswithsuddenlossofrenalfunctionGradualthrombosisoccursinelderlyandonlymanifestationmayberecurrentpulmonaryemboliordevelopmentofhypertensionDefinitivediagnosiscanbedonethroughselectiverenalvenographywithvisualizationoftheoccludingthrombusTreatmentoptionsconsistsofanticoagulationandthrombectomy
178.Bestmarkertoassessprognosisafter Surgeryforcoloncarcinoma:March2005 a)CA19-9 b)CA-125 c)Alphafetoprotein d)CEA CorrectAnswer-DAns.D:CEACEAisafamilyofrelatedglycoproteinsinitiallyfoundinembryonictissueandcolonmalignancies.Thehalf-lifeofCEAisapproximately2weeks.PlasmalevelsofCEAcanbedeterminedreadilybyradioimmunoassay.However,itsusefulnessincoloncarcinogenesisscreeningislimitedbecauseofitshighlevelintheplasmaofapatient'smalignanciesoriginatingfromothersitessuchasbreast,pancreas,stomachandlung.Furthermore,CEAplasmalevelsmayalsobeincreasedinsmokersorpatientswithchronicdiseases,suchasinflammatoryboweldisease,bronchitisandalcoholicliverdisease.TheclinicalusefulnessofCEAforscreeningpurposesisfurtherlimitedbythefactthatitsincreaseinleveltypicallyoccursonlywhenthetumorpenetratesthroughtheserosa.Thus,earlylesionsmaynotbedetectedbyserumCEAlevelchanges.CEAistypicallyelevatedwithmetastaticliverdisease,butrarelywithperitonealinvolvement.Thus,whilethespecificityforCEAtoidentifyoccultCRCsishigh,thesensitivityislowinmoststudiesforscreening.Accordingly,CEAisnotausefultestforthescreeningofCRC.Regardlessoftheclinicopathologicstage,apreoperativeelevation
Regardlessoftheclinicopathologicstage,apreoperativeelevationoftheplasmaCEAlevelpredictseventualtumourrecurrence.HighlevelofCA19-9isseenintheplasmaofapatient'smalignanciesoriginatingfromcolon,breastandpancreas
179.Allofthefollowingarefeaturesof Obstructivejaundiceexcept:September2007 a)Normalalkalinephosphatase b)Mildlyelevatedserumaminotransferaseslevel c)Claycolourstools d)Pruritis CorrectAnswer-AAns.A:NormalalkalinephosphataseObstructiontotheflowofbileincommonbileductmayresultfromcholedocholithiasis,malignancyodheadofpancreas,bileductsorampullaofVater.Charcot'striadofintermittentfever,painandjaundiceischaracteristicofascendingcholangitisandindicatesbiliaryobstruction.Hepatomegalyispresentinmostcasesofobstructivejaundiceandisduetocongestionandstretchingoutofintrahepaticbiliaryspaces.ApalpablegallbladderusuallyindicatesobstructionofthedistalCBD,duetoothercauseslikeunderlyingmalignancy,thanstone(Courvoisier'slaw).Hepaticbileflowsuppressionleadstojaundiceaccompaniedbydarkurine(bilirubinuria)andlightcoloured(alcoholic)stools.Bilesaltsandpigmentsinurineandabsenturobilinogenalsofavourthediagnosisofobstructivejaundice.Serumalbuminandprothrombintimearegoodindicatorsofliverfunctionderangement.Serumbilirubinlevelsindicateseverityofjaundiceandhighdirectbilirubinrulesouthemolyticjaundice.MildelevationofSGPTlevelsarealsoseeninobstructivejaundice
MildelevationofSGPTlevelsarealsoseeninobstructivejaundiceconsistentwithliverdysfunction.Anelevatedalkalinephosphataseis,alwayspresentinobstructivejaundice.
180.Chvosteksignisseenin: March2013 a)Hypercalcemia b)Hypoparathyroidism c)Insulinoma d)Diabetesmellitus CorrectAnswer-BAns.Bi.e.HypoparathyroidismHypocalcemiaIdiopathichypoparathyroidismisassociatedwith:Geneticsyndromeofhypoparathyroidism,-Addison'sdiseaseand?MucocutaneouscandidiasisPseudohypoparathyroidism:Nodeficiencyofparathormone,buttargetorgan(boneandkidney)areunresponsivetoitsactionChvostek'ssign:Contractionoffacialmuscles,elicitedbylighttappingofthefacialnerveECGchanges:ProlongationofQTinterval
181.ECGpatternseeninpulmonary embolismis:September2009,March2013 a)S3Q3T1 b)S1Q1T3 c)S1Q3T3 d)S3Q3T3. CorrectAnswer-CAns.C:S1Q3T3
182.Specificantibodyassociatedwith primarybiliarycirrhosisis: a)Anti-myosin b)Anti-nuclear c)Anti-mitochondrial d)Anti-endomysial CorrectAnswer-CAns.C:Anti-mitochondrialPrimarybiliarycirrhosisisstronglyassociatedwiththepresenceofanti-mitochondrialantibodies(AMA),whicharediagnosticPBC:*AssociatedwithCRESTsyndrome,siccasyndrome,auto-immunethyroiditis,typeIDMandIgAdeficiency*IgGAMAisdetectedinmorethan90%ofpatientswithPBC*90%ofwomenarebetween35-60years*Earliestsymptomispruritis*Eventuallyhepatocellularfailureandportalhypertensiondevelops*Labfindings:-Increasedserumalkalinephosphatase-Increasedserum5-nucleotidaseactivity-Increasedgamma-glutamyltranspeptidase-Serumbilirubinisusuallynormal-Aminotransferaselevelsminimallyincreased-Treatment:Ursodiol
183.'v'WaveinJVPisdueto? a)Rightatrialcontraction b)Leftatrialcontraction c)Rightatrialrelaxation d)Closureoftricuspidvalve CorrectAnswer-AAns.isAThefirstelevation(awave)correspondstotheslightriseinatrialpressureresultingfromatrialcontraction.Thefirstdescent(xdescent)reflectsafallinatrialpressurethatstartswithatrialrelaxation.Thesecondelevation(vwave)correspondstoventricularsystolewhenbloodisenteringtherightatriumfromthevenacavaewhilethetricuspidvalveisclosed.Finally,theseconddescent(ydescent)reflectsfallingrightatrialpressureasthetricuspidvalveopensandblooddrainsfromtheatriumintotheventricle.
184.GeneforRhantigenislocatedon chromosome? a)1 b)4 c)9 d)19 CorrectAnswer-AAns.is'a'i.e.,1
185.Mannitolinfusioncausesincreasein a)Bloodviscosity b)Osmolarity c)Intra-oculartension d)Intercranialtension CorrectAnswer-BAns.is'b'i.e.,Omolarity
186.NormalQRSaxis? a)+30to110? b)-30to+110? c)+110?to+150? d)-110?to-150? CorrectAnswer-BAns.is'b'i.e.,-30to+110?Inanormalheart,theaveragedirectionofthevectorduringspreadofthedepolarizationwavethroughtheventricles,calledthemeanQRSvector,isabout+59degrees.Thismeansthatduringmostofthedepolarizationwave,theapexoftheheartremainspositivewithrespecttothebaseoftheheart.Thenormalelectricalaxisoftheheart(meanelectricalaxisormeanQRSvector)liesbetween-30?and+100?.Iftheaxisismorenegativethan-30?itiscalledleftaxisdeviation,whereasiftheaxisismorepositivethan+100?,itiscalledrightaxisdeviation.
187.Acrodermatitishemorrhagicaisdueto deficiencyof a)Zinc b)Manganese c)Copper d)Selenium CorrectAnswer-AAns.is'a'i.e.,ZincSymptomsofZincDeficiencyMilddeficiencySeveredificiencyGrowthretardationDwarfismCardiomyopathyHypogonadismInfertilityLossoftastePoorwoundhealingDeformedbonesDiarrhoeaAlopeciaNightblindnessSkinstriaeNailchangesAcrodermatitisenteropathicaisaninheritedautosomalrecessivedisorderwithimapiredintestinaldisorderandtransportofZinc.Patientsufferswithpustularandbullousdermatitis,alopecia,growthretardationdiarrhoes,secondaryinfection,lethargy,irritabilityanddepression.OralZincsupplementationleadstoremission.Zinc
2ndmostabundanttraceelementinthebody.Mostcommoncatalyticmetalioninthecellcytoplasm.Componentofmorethan100enzymeslikeDNApolymerase,RNApolymerase,transferRNAsynthetase.Itplaysroleinallstagesofinsulinmetabolism.
188.Whichofthefollowingisnotseenin SecondaryAdrenalinsufficiency a)Pigmentation b)Posturalhypotension c)Hypoglycemia d)Lassitude CorrectAnswer-ASecondaryadrenalinsufficiencyisadrenalhypofunctionduetoalackofadrenocorticotropichormone(ACTH).SecondaryadrenalinsufficiencymayoccurinPanhypopituitarismIsolatedfailureofadrenocorticotropichormone(ACTH)productionPatientsreceivingcorticosteroids(byanyroute,includinghighdosesofinhaled,intra-articular,ortopicalcorticosteroids)PatientswhohavestoppedtakingcorticosteroidsSymptomsarethesameasforAddisondiseaseandincludefatigue,weakness,weightloss,nausea,vomiting,anddiarrhea,butthereisusuallylesshypovolemia.
189.Typhoidistreatedbyallexcept a)Erythromycin b)Ceftriaxone c)Amikacin d)Ciprofloxacin CorrectAnswer-AAns.is'a'i.e.,ErythromycinTheolderagentsusedforthetreatmentoftyphoidwere:ChloramphenicolAmpicilinTrimethoprimSulfamethoxazoleBetalactamParenteralCeftriaxoneOrallCefiximeThesedrugsarenotusednowdaysbecauseofwidespreadresistance.oNowdaysthedrugofchoiceforTyphoidallovertheworldisa"Fluroquinolone"(Ciprofloxacin,ofloxacin).AnimportantpointtorememberHighleveloffluoroquinoloneresistance(ciprofloxacin)havebeenreportedfromIndiaandotherpartsofSouthEastAsiainS.paratyphiandS.typhiinfection.NalidixicacidresistantS.typhi(NARST)havedecreasedciprofloxacinsensitivityandarelesseffectivelytreatedwithfluoroquinolones.ThefluroquinolonesshouldnotbeusedasfirstlinetreatmentfortyphoidfeversinpatientsfromIndiaandotherpartsofSouthAsiawithhighratesoffluroquinoloneresistanceunlessantibioticsusceptibilitydatademonstratesfluoroquinoloneornalidixicacid
sensitivity.
190.Drugtreatmentisgivenforhowmany daysinpneumococcalmeningitis a)5days b)7days c)14days d)21days CorrectAnswer-CAns.is'c'i.e.,14daysRecommendationsfordurationoftreatmentPneumococcalmeningitis-->10-14daysMeningococcalmeningitis5-7daysHibmeningitis-->7-14daysListeriameningitis-->21days
191.Markerofacutekidneyinjuryallexcept a)Clusterin b)Osteopontin c)Alanineaminopeptidase d)Acidphosphatase CorrectAnswer-DAns.is'd'i.e.,AcidphosphataseAlanineaminopeptidase(AAP)Kidneyinjurymolecule-1(KIM-1)Alkalinephosphatase(AP)Clusterinutathione-S-transferase(a-GST)Neutrophilgelatinaseassociatedlipocalin(NGAL)yglutamyltranspeptidase(TGT)Interleukin-18(IL-18)N-acetyl-0-glucosaminidase(NAG)Cysteine-richprotein(CYR-61)2-microglobulinOsteopontin(OPN)microglobulinoRetinol-bindingprotein(RBP)Fattyacidbindingprotein(FABPCystatinCSodium/hydrogenexchangerisoform(NHE3)oMicroalbuminExosomalfetuin-A
192.Thetreatmentofchoiceinacute hyperkalemiaoflifethreateningtocardiacmyocytesis a)Infusionofcalciumgluconate b)Oralresins c)Intravenousinfusionofinsulin d)blocker CorrectAnswer-AAns.is`a'i.e.InfusionofcalciumgluconateEmergentt/tofhyperkalemiaisneededinconditionswithseverehyperkalemia(IC>7meq/L).Inthesecasescardiactoxicityormuscularparalysisispresent.Calciumgluconateisthefastestactingagentamongtheagentsusedinthet/tofhyperkalemia?.Itactswithinminutesbutanimportantpointtonoteisthatitdoesnotcausetranscellularmovementofpotassium,instead,itactsoncardiaccellmembrane
193.VitaminEcauses a)Hemorrhagicstroke b)Cardiacfailure c)Ataxia d)Megalablasticanemia CorrectAnswer-CAns.is'c'i.e.,AtaxiaVitaminE(tocopherol)isafat-solublevitaminwithantioxidantproperties;Itprotectscellmembranesfromoxidationanddestruction.VitaminEisfoundinavarietyoffoodincludingoils,meat,eggs,andleafyvegatables.Therearemultipleformsandisomersoftocopherolandtherelatedcompounds,tocotrienols.ThecurrentevidencetheprimarybioactiveformofVitaminEisalfa-tocopherol.SerumvitaminElevelsarestronglyinfluencedbyconcentrationofserumlipids,anddonotaccuratelyreflecttissuevitaminlevels.EffectivevitaminElevelsarecalculatedastheratioofserumalpha-tocopherolpergramtotallipids.AbsorptionofdietaryvitaminErequireseffectivepancreaticexocrinefunctionandfatabsorption,unlessprovidedinasyntheticwater-solubleform.VitaminVitaminEdeficiencyisuncommoninhumansexceptinspecialcircumstances.Thisisduetotheabundanceoftocopherolsinthediet.
194.Whichofthefollowingcirculating antibodieshasthebestsensitivityandsepcificityforthediagnosisofceliacdisease? a)AntiSaccharomycesantibody b)Anti-tissuetransglutaminaseantibody c)Anti-gliadinantibody d)Anti-gliadinantibodyantibody CorrectAnswer-AAns.is'a'i.e.AntisaccharomycesantibodySerologicevaluationinceliacdiseaseImmunoglobulinA(IgA)anti-tissuetransglutaminase(TTG)antibodyisthesinglepreferredtestfordetectionofceliacdiseaseinindividualsovertheageoftwoyears.SerumantibodyassaysAvarietyofserologicstudieshavebeendescribedtoaidinthediagnosisofceliacdisease,including:IgAendomysialantibody(IgAEMA)IgAtissuetransglutaminaseantibody(IgAtTG)IgGtissuetransglutaminaseantibody(IgGtTG)IgAdeamidatedgliadinpeptide(IgADGP)IgGdeamidatedgliadinpeptide(IgGDGP)SerumIgAendomysialandtissuetransglutaminaseantibodytestinghavethehighestdiagnosticaccuracy.TheIgAandIgGantigliadinantibodytestshavelowerdiagnosticaccuracywithfrequentfalsepositiveresultsascomparedwithIgAtTGandIgADGPassaysandarethereforenolongerrecommended
forinitialdiagnosticevaluationorscreeningHowever,theneweranti-deamidatedgliadinpeptide(DGP)assaysdescribedaboveshowhighdiagnosticaccuracy.IgAEMA,IgAtTG,IgADGPandIgGDGPlevelsfallwithtreatment;asaresult,theseassayscanbeusedasanoninvasivemeansofmonitoringtheresponsetoagluten-freediet. AssaysensitivityandspecificityIgAendomysialantibodies-Sensitivity85to98percent;specificity97to100percentIgAtissuetransglutaminaseantibodiesSensitivity90to98percent;specificity95to97percent--IgAdeamidatedgliadinpeptideSensitivity94percent;specificity99percentIgGdeamidatedgliadinpeptideSensitivity92percent;specificity100percent
195.Asepticmeningitiscausedby a)Indomethacin b)Ibuprofen c)Aspirin d)Icatibant CorrectAnswer-BAns.is'b'i.e.,IbuprofenMedicationsknowntocauseasepticmeningitisMedications Medication Common UncommonSulindacNaproxen NSAIDs Ibuprofen DiclofenacRofecoxib Antimicrobials Trimethoprim/sulfamethoxazole Sulfonamides Immunomodulating Monoclonalantibody Azathioprine agents OKT3IntravenousIgG MetrizamideCytarabine Intrahecalagents Methylprednisoloneacetate Other Carbamazepine Causesofacuteasepticmeningitis Infectious cases LynediseaseLeptospirosisMycobacteriumtuberculosisinfection Bacterial Subacutebacterialendocarditis
SubacutebacterialendocarditisParameningealinfection(epiduralsubduralabcess,sinusorearinfection)PartiallytreatedbacterialmeningitisEchovirusinfectionCoxaackievirusinfectionMumpsSt.LouisencephalitisEasternequineencephalitis Viral WesternequineencephalitisCalciforniaencerphalitisHerpessimplexvirustype2infectionHIVinfectionLymphocyticchoriomeningitisPoliovirusinfection
196.HighSteppageGaitisseenin a)Footdrop b)Frontallobestroke c)Tabesdorsalis d)Leprosy CorrectAnswer-CAns.is'c'i.e.,TabesdorsalisHighsteppinggaitorsteppagegaitorfootdropgaitisduetofootdrop-+legisliftedmoreinordertogetclearanceandfirsttotouchthegroundisforefoot(nottheheelasoccurinnormalgait).Itmayoccurinallmotorperipheralneuropathiesinvolvingcommonperonealnerve-->Tabesdorsalis,leprosyetc.[RefHarrison18th/echapter377]
197.Inapatientwithbronchialasthmasilent chestsignifies a)GoodPrognosis b)BadPrognosis c)GravePrognosis d)NotaPrognosticsign CorrectAnswer-CAns.is'c'i.e.,GravePrognosisSilentchest(Little/noairmovementwithoutwheezesinBronchialAsthmasuggestsagraveprognosis/impendingrespiratoryfailure(LifethreateningAsthma).Signsofimpendingrespiratoryfailureinclude:DrowsinessorconfusionDiaphoresisBradycardiaParadoxicalthoracoabdominalSignsofimpendingrespiratoryfailureinAsthmaDrowsinessorconfusionDiaphoresisBradycardiaParadoxicalthracoabdominalmovementsPEFR<33%HypotensionPulsusparadoxusHypercapneaSilentchest
198.Whichiscorrectaboutpneumonia a)Bronchophonia b)Decreasedvocalfremitus c)Shiftingoftrachea d)Amphoricbreathing CorrectAnswer-AAns.is'a'i.e.,BronchophoniaPhysicalexaminationfindingsofCommonpulmonaryconditions Endobronchial Pleuraleffusion Pneumonia tumor Pneumothorax Tracheal Shiftedor Shiftedor Midline Shiftedormidline position midline midline Reducedor Reducedor Reducedor Chestwall Reduced normal normal normalNormalor Fremitus Decreased Increased None decreased Percussion Dull Dull NormalorDull Hyperresonant Breath Normalor Decreased Increased Decreased/absent sounds Decreased Crackles None None None None Wheeze None None Possible None Bandabove Egophony Present None None effusion(skodiac) Trachealposition
DeviatedAwayfromPneumothoraxEffusionDeviatedtowardsCollapseConsolidation TactilevocalfremitusTactilevocalfremitusisvibrationfeltonthepatientschestduringlowfrequencyvocalisation.Commonlythepatientisaskedtorepeataphrasewhiletheexaminerfeelsforvibtationsbyplacingahandoverthepatientchestorback.Tactilefremitusisnormallymoreintenseintherightsecondintercostalspaceaswellasintheinterscapularregionasthese:TactilefremitusIncreasedConsolidationDecreasedorabsentPleuraleffusionorPneumothoraxReasonforincreasedfremitusinaconsolidatedlungisthefactthatthesoundwavesaretransmittedwithlessdecayinsolidorfluidmedium(consolidation)thaninagaseousmedium(consolidation)thaninagaseousmedium(aeratedlung).Converselythereasonfordecreasedfremitusinapleuraleffusionorpneumothorax(oranypathologyseparatingthelungtissueitselffromthebodywall)isthatthisincreasedspacediminishesorpreventsentirelysoundtransmissionEgophonyisachangeintimbre(E0toA)butnotpitchorvolume.Itisduetodecreaseintheamplitudeandanincreaseinthefrequencyofthesecondformantproducedbysolid(includingcompressedlung)interposedbetweentheresonatorandthestethoscopehead.Thesoundofaspoken"E"changeto"A"overanareaofconsolidation.Thespoken"E"ishearedas"A"whenlisteningovertheconsolidationbecausethefrequenciesofthevibrationsare
alteredbytheconsolidation.Egophonyor"E"to"A"changesmayalsooccurinsmallbandlikeareajustaboveapleuraleffusionbecauseofcompressionoflungtissuethatoccursjustabovetheeffusion.
199.SystemicMillaryTBspreadsvia a)Artery b)Vein c)Bronchus d)Lymphatic CorrectAnswer-A.Ans.is'a'i.e.,ArterySystemicmiliaryensueswheninfectivefociinthelungsseedthepulmonaryvenousreturntotheheart;theorganismssubsequentlydisseminatethroughthesystemicarterialsystem.
200.DOCforacuteattackofHereditary angioneuroticedema a)Danazol b)Cl,inhibitorconcentrate c)Icatibant d)Methylprednisolone CorrectAnswer-BAns.is'b'i.e.,ClinhibitorconcentrateMedicationC1inhibitorconcentrate(Plasma-derived)(Berinert,BerinertP,Cinryze.RecombinantC1inhibitorConestatalfa(Ruconest,Rhucin).BradykininBzreceptorantagonistIcatibant(Firazyr).KallikreininhibitorEcallantide(Kalbitor)Plasma
201.Type5Hypersensitivitymimics a)Type1 b)Type2 c)Type3 d)Type4 CorrectAnswer-BAns.is'b'i.e.,Type2TypeVhypersensitivityreactionswereadditionallyaddedtotheschemeoriginallydescribedbyCoombsandGell.ContrarytotypeIVandinagreementwithtypesI,11andIIIrespectively,theyaremediatedbyantibodiestoo.ThetypeVreactionsaresometimesconsideredasasubtypeofthetypeIIhypersensitivity.Asitsmechanismsdonotdestroytargetcells,theyareresponsibleforinductionoforgan/tissuedysfunctionsonlymostofauthorspreferittobeandindependent,the5'typeofhypersensitivityreactions
202.Whichisbestforplaquemorphology a)CCTA b)MRI c)CMR d)IVUS CorrectAnswer-AAns.is'a'i.e.,CCTACoronarylesionspronetorupturehaveadistinctmorphologycomparedwithstableplaques,andprovideauniqueopportunityfornoninvasiveimagingtoidentifyvulnerableplquesbeforetheyleadtoclinicalevents.Thiscanbeachievedusinganon-invasivecardiacimagingusingcoronaryCTangiography.oLargeplaquevolume,lowCTattenuation,napkin-ringsign,positivere-moedlling,andspottycalcificationareallassociatedwithahighriskofacutecardiovasculareventsinpatients.IntravascularUSGcangivecomparableresultsbutisaninvasivetest
203.Mostcommoncauseofheartblockin infantsis a)SLE b)Surgeryforcongentitalheartdisease c)Viralmyocarditis d)Rheumaticfever CorrectAnswer-BAns.is'b'i.e.,SurgeryforcongentitalheartdiseaseInchildren,themostcommoncauseofpermanentacquiredcompleteAVblockissurgeryforcongenitalheartdisease.Postsurgicalcompleteratrioventricularblock(AVB)isthemostcommoncauseforacquiredAVblockinchildren,resultingfromtraumatotheAVnodeattimeofsurgery(i.e.,hemorrhage,ischemia,necrosis,inflammation,traumaticdisruption).ThesecondmostcommoncauseiscongenitalheratdiseaseassociatedwithcompleteAVblock.OtheretiologiesofacquiredAVblockareoftenreversibleandinclude:Digitalisandotherdrugintoxications.Viralmyocarditis.Acuterheumaticfever,Lymedisease,andinfectiousmononucleosis.
204.Aphasiawhichaffectsthearcuatefibres iscalled a)Globalaphasia b)Anomieaphasia c)Conductionaphasia d)Broca'saphasia CorrectAnswer-CAns.is'c'i.e.,ConductionaphasiaArcuatefibersarebundleofnervefibresthatconnectBrocasareatotheWernicke'sarea.Damagetothearcuatefasciculuscausesadisordercalledconductionaphasia
205.Drugformanagementofhypertensionin Phaeochromocytoma a)Phenoxybenzamine b)Phentolamine c)Labetalol d)Esmolol CorrectAnswer-AAns.is'a'i.e.,PhenoxybenzamineOnceapheochromocytomaisdiagnosed,allpatientsshouldundergoaresectionofthepheochromocytomafollowingappropriatemedicalpreparation.Resettingapheochromocytomaisahigh-risksurgicalprocedureandanexperiencedsurgeon/anesthesiologistteamisrequired.Someformofpreoperativepharmacologicpreparationisindicatedforallpatientswithcatecholamine-secretingneoplasms.Preoperativemedicaltherapyisaimedat:Controllinghypertension(includingpreventingahypertensivecrisisduringsurgery)oVolumeexpansionInpatientswithundiagnosedpheochromocytomaswhoundergosurgeryforotherreasons(andwhothereforehavenotundergonepreoperativemedicaltherapy),surgicalmortalityratesarehighduetolethalhypertensivecrises,malignantarrhythmias,andmultiorganfailure.Combinedalpha-andbeta-adrenergicblockadeCombinedalpha-andbeta-adrenergicblockadeisthemostcommonapproachtocontrolbloodpressureandpreventintraoperativehypertensivecrises.Alpha-adrenergicblockade
Analpha-adrenergicblockerisgiven10to14dayspreoperativelytonormalizebloodpressureandexpandthecontractedbloodvolume.PhenoxybenzamineisthepreferreddrugforpreoperativepreparationtocontrolbloodpressureandarrhythmiainmostcentersintheUnitedStates.Itisanirreversible,long-acting,nonspecificalpha-adrenergicblockingagent.Theinitialdoseis10mgonceortwicedaily,andthedoseisincreasedby10to20mgindivideddoseseverytwotothreedaysasneededtocontrolbloodpressureandspells.Thefinaldoseofphenoxybenzamineistypicallybetween20and100mgdaily.Beta-adrenergicblockadeAfteradequatealpha-adrenergicblockadehasbeenachieved,beta-adrenergicblockadeisinitiated,whichtypicallyoccurstwotothreedayspreoperatively.Thebeta-adrenergicblockershouldneverbestartedfirstbecauseblockadeofvasodilatoryperipheralbetaadrenergicreceptorswithunopposedalpha-adrenergicreceptorstimulationcanleadtoafurtherelevationinbloodpressure.Thealternativestoaand13adrenergicagentsarecalciumchannelblockersandmetyrosine.CalciumchannelblockersAlthoughperioperativealpha-adrenergicblockadeiswidelyrecommended,asecondregimenthathasbeenutilizedinvolvestheadministrationofacalciumchannelblocker.Nicardipineisthemostcommonlyusedcalciumchannelblockerinthissetting;thestartingdoseis30mgtwicedailyofthesustainedreleasepreparation.MetyrosineAnotherapproachinvolvestheadministrationofmetyrosine(alpha-methylPara-tyrosine),whichinhibitscatecholaminesynthesis.
206.Causesofhyperparathyroidismareall except a)Solitaryadenoma b)Malignant c)Thyroidmalignancy d)Parathyroidhyperplasia CorrectAnswer-CAns.:C.)ThyroidmalignancyHyperparathyroidismPathologyIncreasedlevelsofthePTHleadtoincreasedosteoclasticactivity.Theresultantboneresorptionproducescorticalthinning(subperiostealresorption)andosteopaenia.Subtypesprimaryhyperparathyroidismparathyroidadenoma(~80%)multipleparathyroidadenomas(4%)parathyroidhyperplasia(10-15%)parathyroidcarcinoma(1-5%)secondaryhyperparathyroidismcausedbychronichypocalcaemiawithrenalosteodystrophybeingthemostcommoncause(othersincludemalnutrition,vitaminDdeficiency)resultsinparathyroidhyperplasiatertiaryhyperparathyroidismautonomousparathyroidadenomacausedbythechronicoverstimulationofhyperplasticglandsinrenalinsufficiency
207.Mentzerindexmorethan13suggestsa diagnosisof a)Irondeficiencyanemia b)Thalassemia c)HereditarySpherocytosis d)AutoimmuneHemolyticAnemia CorrectAnswer-AAns.is'a'i.e.,IrondeficiencyAnemiaMentzerindexmorethan13suggestsadiagnosisofIron-deficiencyanemia.MentzerindexTheMentzerindexisusedtohelpindifferentiatingirondeficiencyanemiafrombetathalassemia.Theindexiscalculatedasthequotientofthemeancorpuscularvolume(MCV,infL)dividedbytheredbloodcellcount(RBC,inmillionspermicroleter).IftheMentzerindexislessthan13,thallassemiaissaidtobemorelikely.IftheMentzerIndexisgreaterthan13,Theniron-deficiencyanemiaissaidtobemorelikely.PrincipleInirondeficiency,themarrowcannotproduceasmanyRBCsandtheyaresmall(imcrocytic),sotheRBCcountandtheMCVwillbothbelow,andasaresult,theindexwillbegreaterthan13.Conversely,inthalassemia,whichisadisorderofglobinsynthesis,thenumberofRBCsproducedisnormal,butthecellsaresmallerandmorefragile.Therefore,theRBCcountisnormal,buttheMCVislow,sotheindexwillbelessthan13.
Inpractice,theMentzerindexisnotareliableindicatorandshouldnot,byitselfbeusedtodifferentiatethetwoconditions. Valuefor Valuefor iron Index Formula iron deficiency thalassemia anemia Mentzer MCV/RBC >13 <13 index count Shineand MCV2x >1530 <1530 Lalindex MCHx0.01MCV?RBC Englandand -(5xHb) >0 <0 Fraserindex 5.19Srivastava MCH/RBC >3.8 <3.8 index MCV2x Greenand RDWx >65 <65 kingindex Hb/100 Redcell MCVx distribution >220 <220 RDW/RBC widthindex
208.Whichofthefollowingstatementsabout irondeficiencyanemiaiscorrect a)DecreasedTIBC b)Increasedferritinlevels c)Bonemarrowironisdecreasedafterserumironisdecreased d)Bonemarrowironisdecreasedearlierthanserumiron CorrectAnswer-DAns.is'D'i.e.,Bonemarrowironisdecreasedearlierthanserumiron"Inirondeficiencyanemiathefirstchangeisdecreaseinironstores"Thedecreaseinironstoresisdemonstratedbydecreasedserumferritinlevel.Remember,Serumferritinreflectstheamountofstorageironinthebody.Asthetotalbodyironlevelbeginstofallacharacteristic,sequenceofeventsensue:FirstStageorPrelatentStageofIronDepletionWhenironlossexceedsabsorption,anegativeironbalanceexists.Storedironbeginstobe,mobilizedfromstores.Theironpresentinthemacrophagesofliver,spleenandbonemarrowaredepletedDecreaseinstoredironisreflectedbydecreaseinserumferritin.Atthisstageallotherparametersofironstatusarenormal.SecondStageorStageofLatentIronDeficiency:Ironstoresareexhaustedbutthebloodhemoglobinlevelremainshigherthanthelowerlimitofnormal.oAftertheexhaustionofironstores:TheplasmaironconcentrationfallsQ.
Plasmaironbindingcapacityincreases2.Percentagesaturationfallsbelow15%Q.ThepercentageofsideroblastdecreasesinthebonemarrowQ.ThirdStageorStageofApparentIronDeficiencyAnemiaSupplyofirontomarrowbecomesinadequatefornormalhemoglobinproduction,SothebloodhemoglobinconcentrationfallsQbelowthelowerlimitofnormalandirondeficiencyanemiaisapparent.
209.Persistentpriapismisdueto a)Sicklecellanaemia b)Hairycellleukaemia c)Paraphimosis d)Urethralstenosis CorrectAnswer-AAns.is'a'i.e.,SicklecellanemiaPriapismisdefinedaserectionlastingfor>4hours.Low-flowpriapismmaybeduetoanyofthefollowing:AnexcessivereleaseofneurotransmittersBlockageofdrainingvenules(eg,mechanicalinterferenceinsicklecellcrisis,leukemia,orexcessiveuseofintravenousparenterallipids)ParalysisoftheintrinsicdetumescencemechanismProlongedrelaxationoftheintracavernoussmoothmuscles(mostoftencausedbytheuseofexogenoussmooth-musclerelaxantssuchasinjectableintra-cavernosalprostaglandinEI)Prolongedlow-flowpriapismleadstoapainfulischemicstate,whichcancausefibrosisofthecorporealsmoothmuscleandcavernosalarterythrombosis.Thedegreeofischemiaisafunctionofthenumberofemissaryveinsinvolvedandthedurationofocclusion
210.Thetypeofarteritiswhichmayleadto myocardialinfarctioninchildrenis a)Kawasakidisease b)Takayasuarteritis c)Polyarteritisnodosa d)Microscopicpolyangitis CorrectAnswer-AAns.is'a'i.e.,KawasakidiseaseoKawasakidiseaseisanacute,selflimitedvasculitisofunknownetiologythatoccurspredominantlyininfantsandyoungchildrenofallraces.Coronaryarteryaneyrysmsorectasiadevelopsin15-25%ofuntreatedchildrenwiththediseaseandmayleadtoischemicheartdisease,myocardialinfarction,orevensuddendeath.IntheUSA,Kawasakidiseasehassurpassedacturerheumaticfeverastehleadingcauseofacquitedheartdiseaseinchildren
211.Onionskinspleenisseenin a)ITP b)Thalassemia c)SLE d)Scleroderma CorrectAnswer-CAns.is'c'i.e.,SLEThecharacterisitchistopathologicpictureofthespleeninSLEisperiaterialfibrosisoranionskinlesion.FirstdescribedbyLibmanandSacks,thislesionisdefinedasthepreseneof3toasmanyas20seperatedlayersofthenormallydenselypackedperiarterialcollagenofthepenicillaryorfolliculararteriesproducingtheappearanceofconcentricrings(onionpeel).
212.Mostcommonpulmonarymanifestation inAIDS a)TB b)Pneumonia c)Bronchiectasis d)Mycobacterialaviumintracellular CorrectAnswer-BAns.is'b'i.e.,PneumoniaRespiratorycomplicationsinAIDSRespiratorydiseasesinAIDSincludeA)AcutebronchitisandsinusitisTheyarecausedbyS.pneumoniaeandHinfluenzaeandareverycommon.B)PulmonarydiseasesPulmonarydiseasesare:-1.PneumoniaMostcommonpulmonarymanifestationispneumonia:Bacterialpneumonia:ItiscausedmostcommonlybySpneumoniaeandpneumococcalinfectionistheearliestseriousinfectioninAIDS.Hinfluenzaeisalsoacommoncause.Pcannapneumonia:ItisthemostcommoncauseofpneumoniainAIDS.RiskisgreaterwhenCD4countlessthan200/ml.2.TuberculosisIndevelopingcountrieslikeIndia,mostimportantpathogenisMtuberculosis.OthercommonpathogencausingTBisMAC(atypicalmycobacteria).3.OtherpulmonarydiseasesThesearefungalinfections(cryptococcus,histoplasma,aspergillus),
neopasms(Kaposisarcoma,lymphoma)andidiopathicinterstitialpneumonia.
213.ChronichemodialysisinESRDpatientis done a)Onceperweek b)Twiceperweek c)Thriceperweek d)Daily CorrectAnswer-CAns.is'c'i.e.,ThriceperweekForthemajorityofpatientswithESRD,between9and12hofdialysisarerequiredeachweek,usuallydividedintothreeequalsessions.CurrenttargetsofhemodialvsisUreareductionratio(thefractionalreductioninbloodureanitrogenperhemodialysissession)of>65-70%.Bodywater-indexedclearancextimeproduct(KT/V)above1.2or1.05.
214.Interstitialnephritisiscommonwith a)NSAID b)Blackwaterfever c)Rhabdomyolysis d)Tumorlysissyndrome CorrectAnswer-AAns.is'a'i.e.,NSAIDDRUGSCAUSINGINTERSTITIALNEPHRITIS Antibiotics Diuretics Anticonvulsants Miscellaneous Lactams Thiazide Phenytoin CaptoprilH Sulfonamides Furosemide Phenobarbitone 2receptor blockers Quinolones Triamterene Carbamazepine OmeprazoleVancomycin NSAIDS Valproicacid Mesalazine Erythromycin Indinavir Minocycline Allopurinol Rifampicin Ethambutol Acyclovir
215.Besttestforlungfibrosis a)Chestx-ray b)MRI c)HRCT d)Biopsy CorrectAnswer-CAns.is'c'i.e.,HRCTLungfibrosisisadiffuseparenchymallungdisease.Idiopathicpulmonaryfibrosisisthemostcommonformofidiopathicinterstitialpneumonia.WehavealreadydiscussedthatbestinvestigationforinterstitiallungdiseaseisHRCTEstimatedrelativefrequencyoftheinterstitiallungdisease Relativefrequency, Diagnosis % Idiopathicinterstitial 40 pneumoniasIdiopathicpulmonaryfibrosis 55 Nonspecificinterstitial 25 pneumoniaRespiratorybronchiolitis-ILD 15 and Cryptogenicorganizing 3 pneumoniaAcuteinterstitialpneumonia <1 Occupationalandenvironmental 26Sarcoidosis 10
Sarcoidosis 10 Connectivetissuediseases 9 Drugandradiation 1 Pulmonaryhemorrhage <1 syndromesOther 13
216.Whichofthefollowingisa Channelopathy a)AtaxiaTelangiectasia b)FrederichAtaxia c)Spinocerebellarataxia d)AndersonTawilSyndrome CorrectAnswer-DAns.is'd'i.e.,AndersonTawilSyndromeAndersonsyndrome(Anderson-Tawisyndrome)isapotassiumchannelchannelopathy.
217.Goodsyndromeis a)Thymomawithimmunodeficiency b)ThymomawithM.Gravis c)Thymomawithserumsickness d)Thymomawithpureredcellaplasia CorrectAnswer-AAns.is'a'i.e.,ThymomawithimmunodeficiencyGood'ssyndrome(thymomawithimmunodeficiency)isararecauseofcombinedBandTcellimmunodeficiencyinadults.ClinicalfeaturesofGood'ssyndromeare:-Increasedsusceptibilitytobacterialinfectionswithencapsulatedorganismsandopportunisticviralandfungalinfection.Themostconsistentimmunologicalabnormalitiesare:-HypogammaglobulinaemiaandReducedorabsentBcellsTreatmentResectionofthethymomaandimmunoglobulinreplacementtomaintainadequatethroughIgGvalues
218.PatientdiagnosedwithHIVand Tuberculosis.HowtostartATTandc-A.R.T a)StartATTfirst b)StartcARTfirst c)Startbothsimultaneously d)StartcARTonly CorrectAnswer-AAns.is'a'i.e.,StartATTfirstInacasewhenHIVandTBarediagnosedtogetherATTshouldbestartedfirst.ATTstartedfirst,becauseofIRIS(ImmuneReconstitutionInflammatorysyndrome).IfARTstartedfirst,itmayimproveCD4cellsatfirst,butlaterapreviouslyacquiredinfection(TB,Herpes),respondswithanovershelminginflammatoryresponsethatparadoxicallymakesthesymptomofinfectionworse.Therefore,startingofATT-2weeksbeforeART,haveshowntodecreasetheincidenceofIRIS.
219.Mostcommoncauseoflungabscess a)Staphaureus b)Oralanaerobes c)Klebsiella d)Tuberculosis CorrectAnswer-BAns.is'b'i.e.,OralAnaerobesMostnonspecificlungabscessesarepresumedtobeduetoanaerobicbacteria.
220.NormalCRPwithelevatedESRseenin a)RA b)SLE c)Scleroderma d)Polymyalgiarheumatica CorrectAnswer-BAns.is'b'i.e.,SLEBothESRandCRParemarkersofinflammationErythrocytesedimentationrateorESRisusedtoseparateinflammationfromnon-inflammation.Anothersignofinflammationistheriseinbloodlevelofnumberofproteinscalledasacutephaseproteins.OneoftheproteinsisC-reactiveprotein(CRP).LikeESRandotheracutephaseproteins,CRPalsogoesupininflammation.Insystemiclupushowevertheleveldoesnotriseunlessthereisinfectionassociated.ThenormalresponsetoactiveinflammatorydiseaseisanincreaseinplasmaCRPconcentration.oForreasonsthatremainunclearthtresponseiseithersignificantlylowerinmagnitudeorentirelyabsentinafewinflammatoryconditions.ThishasprovendiagnosticallyusefulbecausethereareveryfewinflammatoryconditionsinwhichESRissignificantlyraised(reflectinganinflammatoryprocess)butplasmaCRPisonlyslightlyraisedorevennormal.Oneoftheseconditionsissystemiclupuserythematosus(SLEorlupus),arelativelycommonchronicautoimmunediseasethatpredominantlyaffectswomenofchild-bearingage.
WhenthisinflammationoccursinthelupuspatientitisaccompaniedasexpectedbyamarkedincreaseinESR.Howeverincontrsttomostotherinflammatorycondition,theplasmaCRPremainsresolutelynormal.ThecombinationofraisedESRandnormalCRPisausefuldiagnosticfeatureofSLE.OtherdisorderswhereCRPisnotincreasedOsteoarthritis,leukemia,anemiaPolycythemia,viralinfectionUlcerativecolitis,pregnancy,estrogen
221.Restrictiveandconstrictivepericarditis occurstogetherin a)Radiation b)Adriamycin c)Amyloidosis d)Postcardiotomysyndrome CorrectAnswer-AAns.is'a'i.e.,RadiationProgressivefibrosiscancauserestrictivemyocardialdiseasewithoutdilation.Thoracicradiation,commonforbreastandlungcancerormediastinallymphoma,canproduceearlyorlaterestrictivecardiomyopathy.Patientswithradiationcardiomyopathymaypresentwithapossiblediagnosisofcontrictivepericarditis,asthetwoconditionsoftencoexist.
222.Allformboundariesoftriangleof auscultationexcept a)Trapezius b)Latissmusdorsi c)Scapula d)Rhomboidmajor CorrectAnswer-DAns.is'd'i.e.,RhomboidmajorTriangleofauscultationhasthefollowingboundariesSuperiorlyandmedially,bytheinferiorportionoftheTrapezius.Inferiorly,bytheLatissimusDorsi.Laterally,bythemedialborderofthescapula.ThesuperficialfloorofthetriangleisformedbytheSerratusanteriorandthelateralportionoftheerectorspinaemuscles.Deeptothesemusclesaretheosseousportionsofthe6"and7thribsandtheinternalandexternalintercostalmuscles.Typically,theTriangleofAuscultationiscoveredbytheScapula.Tobetterexposethetriangleandlistentorespiratorysoundswithastethoscope,patientsareaskedtofoldtheirarmsacrosstheirchest,mediallyrotatingthescapulae,whilebendingforwardatthetrunk,somewhatresemblingafetalposition.
223.Rytand'smurmurisseenin a)A-VBlock b)Mitralstenosis c)Aorticstenosis d)Aorticregurgitation CorrectAnswer-AAns.is'a'i.e.,A-VBlockRytandMurmurRytan'smurmurismid-diastolic(orlate-diastolic)murmurthatisheardinpatientswithcompleteartioventricularheartblock.Rytand'smurmurisbestheardattheapexandmaybeconfusedwithmitralstenosis.Theslowheartrate,variabledurationofthemurmurchangingintensityoftheSIandlackofopeningsnaparehelpfulAlsoknowCareyCoombsmurmurRheumaticfeverAustinFlintmurmurAorticregurgitationGraham-SteelmurmurPulmonaryregurgitationRytandsmurmurCompleteheartblockDocksmurmurLeftAnteriorDescending(LAD)arterystenosisMillwheelmurmurDuetoairemboli(airinPVcavity)
224.Notassociatedwithdiabetesmellitus a)Cushingsyndrome b)Acromegaly c)Hypothyroidism d)Pheochromocytoma CorrectAnswer-CAns.is'c'i.e.,Hypothyroidism
225.FeverincreasewaterlossesbymUday perdegreeCelsius a)100 b)200 c)400 d)800 CorrectAnswer-BAns.is`b'i.e.,200ml/dayperdegreeCelsius
226.Mostcommoncauseofhypernatremia a)Adipsicdiabetesinsipidus b)Carcinoidsyndrome c)Renallosses d)Sweating CorrectAnswer-CAns.is`c'i.e.,RenallossesMajorcausesofhypernatremiaUnreplacedwaterloss(whichrequiresanimpairmentineitherthirstoraccesstowater)InsensibleandsweatlossesGastrointestinallossesCentralornephrogenicdiabetesinsipidusoOsmoticdiuresisGlucoseinuncontrolleddiabetesmellitusUreainhigh-proteintubefeedingsMannitolHypothalamiclesionsimpairingthirstorosmoreceptorfunctionPrimaryhypodipsiaResetosmostatinmineralocorticoidexcessWaterlossintocellsSevereexerciseorseizuresSodioutnoverloadIntakeoradministrationofhypertonicsodiumsolutions
227.RaresttypeofVonWillebranddisease: a)vWDtype1 b)vWDtype2A c)vWDtype2N d)vWDtype3 CorrectAnswer-DAns.is'd'i.e.,vWDtype3 Condition Defect Mildtomoderatequantitative vWD deficiencyofvWF(ie,about20- type1 25%ofnormallevels).Themostcommonqualitative vWD abnormalityofvWF,isassociated type2A withselectivelossoflargeand medium-sizedmultimersLossofonlylargemultimersas vWD mutantvWFspontaneouslybinds type2B toGplbintheabsenceof subendothelialcontactCharacterizedbyadefectresiding vWD withinthepatient'splasmavWF type2N thatinterfereswithitsabilityto bindFVIIIInvolvesqualitativevariantswithdecreasedplatelet-dependent vWD functionnotresultingfrom type2M absenceofhighmolecularweight multimers
multimersAsevere,quantitativedeficiencyassociatedwithverylittleorno vWD detectableplasmaorplatelet type3 vWF,haveaprofoundbleedingdisorder
228.Apatienthasecchymosisandpetechiae alloverthebodywithnohepato-splenomegaly.Allaretrueexcept a)Increasedmegakaryocytesinbonenarrow b)Bleedingintothejoints c)Decreasedplateletinblood d)Diseaseresolvesitselfin80%ofPatientsin2-6 CorrectAnswer-BAns.is'b'i.e.,BleedingintothejointsFeaturesofAcuteandChronicIdiopathicThrombocytopenicPurpura Feature AcuteITP ChronicITP Peakageof Children2-6 Adults,20-40 incidence year year3:1femaleto Sexpredilection None male Antecedent Common1-2 Unusual infection week Onsetof BeforeAbrupt Insidious bleedingHemorrhagic Presentin Usuallyabsent bullaeinmouth severecasesPlateletcount <20000/4 3000-80000/8L Eosinophiliaand Common Rare yphocytosisSpontaneous Occursin Monthsoryears remission 80%cases Uncommon
remission 80%cases Uncommon
229.Allofthefollowingaretrueabout Rheumatoidarthritis,except a)PIPandDIPjointsinvolvedequally b)Pathologylimitedtoarticularcartilage c)Womenareaffected3timesmorecommonlythanmen d)20%ofpatientshaveextraarticularmanifestations CorrectAnswer-DAns.is'd'i.e.,20%ofpatientshaveextraarticularmanifestationsAssociationofRheumatoidArthritiswithHLADR-4TheclassIImajorhistocompatibilitycomplexalleleHLA-DR4andrelatedallelesareknowntobeamajorgeneticriskfactorforRheumatoidarthritis.RheumatoidArthritisisstronglyassociatedwithHLADR4ThegeneticriskforRheumatoidarthritisisassociatedwithallelicvariationintheHLA-DRBI"genei.e.DRB10401,04,05".SomeoftheHLADRB1allelesbestowahighriskofdiseaseClinicalfeatures:Itoccursbetweentheageof20to50years.Womenareaffectedabout3timesmorecommonlythanmen.Followingpresentationsarecommon:a)Anacute,symmetricalpolyarthritis:Painandstiffnessinmultiplejoints(atleastfour)Symptomsofarticularinflammation.Commonin-MPjointsofhandPIPjointsoffingersWrists,knees,elbows,ankles
230.DevelopmentofLymphomainSjogren's syndromeissuggestedbyallofthefollowingexcept a)Persistentparotidglandenlargement b)Cyoglobilinemia c)Leukopenia d)HighC4compementlevels CorrectAnswer-DAns.is'd'i.e.,HighC4complementlevelsLymphoaisawell-knowncomplicationofSjogren'ssyndromeMostlymphomasareextra-nodal,lowgrademarginalBcelllymphomas.DevelopmentofLymphomainSjogren'ssyndromeissuggestedbylowC4complementlevels.LymphomainSjogren'ssyndromeThedevelopmentofLymphomasinpatientswithSjogrensyndromeissuggestedby:-PersistentparotidglandenlargementPurpuraLeukopeniaCryoglobulinemiaLowC4complementlevels
231.Hemodialysiscanbeperformedforlong periodsfromthesamesitedueto a)Arteriovenousfistulareducesbacterialcontaminationofsite b)Arteriovenousfistularesultsinarterializationofvein c)Arteriovenousfistulareduceschancesofgraftfailure d)Aretiovenousfistulafacilitatessmallboreneedlesforhighflow rates CorrectAnswer-BAns.is'b'i.e.,ArteriovenousfistularesultsinarterializationofveinThetstu/agraft,orcatheterhemodialvsisisoftenreferredtoasadialysisaccess.Anativefistulacreatedbytheanastomosisofanarterytoavein(e.g.theBresica-Ciminofistula,inwhichthecephalicveinisanastomosedend-to-sidetotheradialartery)resultsinarterializationofthevein.Thisfacilitatesitssubsequentuseintheplacementoflargeneedles(typically15Gauge)toaccessthecirculation.Fistulashavethehighestlong-termpatencyrateofalldialysisaccessoptions.Themostimportantcomplicationofarteriovenousgraftsisthrombosisofthegraftandgraftfailure,dueprincipallytointimalhyperplasiaattheanastomosisbetweenthegraftandrecipientvein.Manypatientsundergoplacementofanarteriovenousgraft(i.e.,theinterpositionofprostheticmaterial,usuallypolytetrafluoroethylene,betweenanarteryandavein)oratunneleddialysiscatheter.
232.InAIDSpatientpresentingwithfever, coughadiagnosisofpneumocystinpneumoniaisbestestablishedby a)CTscanchest b)Bronchoalveolarlavage c)Stainingofintra-nuclearinclusionwithsilverstaining d)Aspirationandculture CorrectAnswer-BAns.is'b'i.e.,BronchoalveolarlavageDiagnosisofPCPrequiresDemonstrationoftheorganisminsamplesobtainedfrominducedsputum.Bronchoalveolarlavage,transbronchialbiopsy,oropen-lungbiopsy.Ifthehistologicalexaminationfails:?uPCRisrequiredtomakethediagnosis
233.Themostcommonneurologicaldisorder seeninCRFpatients a)Dementia b)Peripheralneuropathy c)Bakesintestinaldilator. d)Restlesslegsyndrome CorrectAnswer-BAns.is'b'i.e.,PeripheralneuropathyPeripheralneuropathyisthemostcommonneurologicalprobleminCRF,whichmaybe?i)Uremicperipheralneuropathy(duetouremia).ii)MoreoftenapresentingfeatureofthecauseofCRFDiabeticneuropathy(DMisthemostcommoncauseofCRF).
234.ECGimage,Uwaveseen,patientison furosemide&betablocker.Diagnosis a)Hypocalcemia b)Hypokalemia c)Hyperkalemia d)Hypercalcemia CorrectAnswer-BAns.is'b'i.e.,HypokalemiaE.C.G.manifestationsofelectrolytedisordersHvperkalemiaAtallpeakedandsymmetricalT-wavesisthefirstchangeseenonECGinpatientswithhyperkalemia.oRRintervallengthensandQRSdurationincreases.FlatteningordisappearanceofPwave.STelevation.WideningoftheQRScomplexesduetoasevereconductiondelayandmaybecome'sinewave'.TheprogresionandtheseverityoftheE.C.Gchangedonotcorrelatewellwiththeserumpotassiamconcentration.HvpokalemiaSimilartohyperkalemia,hypokalemiaproducechangesontheE.C.Gwhicharenotnecessaryrelatedtoserumpotassiamlevel.DepressionoftheSTsegmentDecreaseinamplitudeofTwavesIncreaseinamplitudeofUwavesUandTwavemergeinsomecasestoformaT-UwavewhichmaybemisdiagnosedasprolongedQTinterval.PwavecanbecomelargerandwiderandPRintervalprolong
slightly.QRSdurationmayincreasewhenhypokalemiabecomesmoresevere.HvpocalcemiaProlongationoftheQTintervalDuetoprolongationofthephase2oftheventricularactionpotentialandlengtheningoftheSTsegmentwhiletheTwave(whichcorrelatewithtimeforrepolarisationremainsunaltered).HvpercalcemiaShorteningoftheQTinterval(Primarilyduetoadecreaseinphase2oftheventricularactionpotentialandresultantdecreaseinSTsegmentduration).IltpothermiaCausesslowimpulseconductionthroughallcardialtissuesresultingin:?ProlongationofalltheECGintervalsRRPRQRS'QTThereisalso"elevationoftheJpoint"(OnlyiftheSTsegmentisunalteredproducingcharacteristicsTorosbornewave.)
235.InZollingerEllisonsyndromewhatis raised? a)Insulin b)VIP c)Gastrin d)Glucagon CorrectAnswer-CAns.is'c'i.e.,GastrinZollingerEllisonsyndrome?Severepepticulcerdiseasesecondarytogastricacidhypersecretionduetounregulatedgastrinreleasefromanon13cellendocrinetumour(gastrinoma),definesthecomponentsofZollingerEllisonsyndrome.PathophysiologyofZollingerEllisonsyndromeThedrivingforceresponsibleforclinicalmanifestationsofZollingerEllisonsyndromeishypergastrinemiaoriginatingfromGastrinoma(autonomusneoplasm,non[3cellneoplasm)GastrinomaHypergastrinemiaHyperacidemiaPepticulcer,erosiveesophagitisanddiarrhoeaOtherimportantcharacteristicofGastrinomaoOver80%ofthesetumoursareseeninGastrinomatriangle?(triangleformedbetweenduodenumandpancreas)mostofthemareseenintheheadofpancreas.oAbout2/3'ofthesetumoursaremalignant?.oAboutonehalfofthesetumoursaremultiple?.
oAboutonefourthofthepatientshavemultipleendocrineneoplasia(MENI)syndromewithtumoursofparathyroid,pituitaryandpancreaticisletsbeingpresent.Remember:Mostcommonsiteofgastrinoma'sisDuodenum(50-70%),(Pancreas20-40%)MostcommonhormonetobesecretedACTHbesidesgastrinisMostcommonsiteofpepticulcersproducedisls'partofDuodenum.MostvaluableprovocativetestinTheSecretininjectiontests.identifyingpatientswithZESisBasalacidoutputisgreaterthan60%ofoutpuBAO>MAOinducedbymaximalstimulationThetermpancreaticendocrinetumourismisnomerbecausethesetumourscanoccureitheralmostexclusivelyinthepancreasoratbothpancreaticandextrapancreaticsites
236.Menke'sdisease"isadiseaseof a)Impairedzinctransport b)Impairedcoppertransport c)Impairedmagnesiumtransport d)Impairedmolybdenumtransport CorrectAnswer-BAns.is'b'i.e.,ImpairedcoppertransportMenke'sdiseaseiscausedduetodefectinthecoppertransport.Thereisdefectinthetransportofcopperpresentintheintestinalmucosatothebloodstream.Themucosalliningofintestinecontainshighlevelofcopperboundtometallothioneinprotein.Ratherthanbeingtransporatedtobloodstream,thecopperremainedinthemucosaandwaslostwhenintestinalcellswerenaturallysoughedoff.Menkesdiseaseiscausedduetodefectinthe"MNK"gene.Theproteinnormallyfunctionbymovingcopperfromtheintestinalmucosalcellsintothebloodstream,whereitishoundbyproteinssuchasalbuminandtransportedtoorgansandtissues.SerumcopperiscriticalforthefunctioningofseveralenzymesLysyloxidaseItisimportantforthecrosslinkingofcollagenandelastinsuchthatdeficienciesleadtoproblemsinconnectivetissuessuchasbonesCytochromeoxidaseInvolvedintemperaturemaintenanceTyrosinaseNecessaryforpigmentationClinicalfeaturesofmenkesdiseaseGrowthretardation
Coarsehair,brittleandivorywhite(resultofdepigmentations).Thehairfibresaretwiistedandbrokenhelically(kinkyhair).SeizuresCerebralandcerebellardegeneration(postmortemanalysis)HypothermiaThrombosisPoorbonedevelopmentIncreasedtendencytowardsaneurysms
237.Anosmiaisearlyclinicalfeatureof a)Alzheimer b)Parkinson'sdisease c)Huntington'schorea d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveMaincausesofanosmiaMaincausesofanosmiaNasal.Smoking.Chronicrhinitis(allergic,atrophic,cocaine,infectious-Herpes,influenza).Overuseofnasalvasoconstrictors.Olfactoryepithelium.Headinjurywithtearingofolfactory,filamentsCranialsurgery.Subarachnoidhemorrhage,meningitis.Toxic(organicsolvents,certainantibiotics-aminoglycosides,tetracyclines,corticosteroids,methotrexate,opiates,1-dopa).Metabolic(thiaminedeficiency,adrenalandthyroiddeficiency,cirrhosis,renalfailure,menses).Wegenergranulomatosis.Compressiveandinfiltrativelesions(craniopharyngioma,meningioma,aneurysm,meningoencephalocele).Degenerativedisease(Parkinson,Alzheimer,HuntingtonTemporallobeepilepsy.
Malingeringandhysteria
238.DOCofGTCSinpregnancy a)Lamotrigine b)CBZ c)Levetiracetam d)Valproate CorrectAnswer-AAns.is'a'i.e.,LamotrigineLamotrigineisoftenbettertoleratedandislessteratogenicthanvalproate.Lamotriginehasbeenincreasinglyprescribedinpregnancyoverolderantiepilepticdrugssuchascarbamazepineandsodiumvalproate.
239.APatientwithhistoryofshortnessof breathhasDecreasedFEV1/FVCRatio,NormalDLCO.A200mlincreaseinbaselineFEVIisobserved15minutesafteradministrationofbronchodilators.Thelikelydiagnosisis a)Asthma b)ChronicBronchitis c)Emphysema d)InterstitialLungDisease CorrectAnswer-AAns.is'a'i.e.,Asthma DiagnosisofAsthmarequireDemonstrationofAirwaysobstructionDecreaseintheratioofFEVI/FVCDemonstrationofacutereversibilityofairflowAdminister2-4puffsofquickactingbronchodilatore.g.,albuterolandrepreatspirometry10-15minAnincreaseinFEV1of12%ormoreaccompaniedbyanabsoluteincreaseinFEVlofatleast20mlAbronchoprovocator(Methacholine)isadministeredhyperresponsivenessoftheairwayisdemonstratedbyreductionofFEV1to20%
240.Pseudo-hemoptysisisseenmostlywith a)Streptococcus b)E.coli c)Serratiamarcescens d)R.S.V CorrectAnswer-CAns.is'C'i.e.,SerratiamarcesensPseudo-hemoptysisisexpectorationofbloodotherthantherespiratorytracti.e.GITorblooddrainingfromthelarynx.Serratiamarcescensisacauseofpseudohemoptysis.
241.Fingerisglovesignisseenin a)PulmonaryalveolarProteinosis b)PneumocystisCarinii c)Tuberculosis d)Bronchocele CorrectAnswer-DAns.is'd'i.e.,BronchoceleRabbitearappearanceMickeymouseappearanceToothpasteshapedopacitiesY-shapedopacitiesV-shapedopacitiesAetiologyObstructiveInbronchialobstruction,theportionofthebronchusdistaltotheobstructionisdilatedwiththepresenceofmucoussecretions(mucusplugging).Causesofbronchialobstructioninclude:BronchialhamartomaBronchiallipomaBronchialcarcinoidBronchogeniccarcinomaCongenitalbronchialatresia(rarely)NonobstructiveCausesinclude.-AsthmaAllergicbronchopulmonaryaspergillosis(ABPA)Cysticfibrosis
242.Whichofthefollowingdisordersisleast likelyassociatedwithprogressiontolymphoma a)Sjogren'ssyndrome b)Araxiatelangiectasia c)Severecombinedimmunodeficiency d)LynchIIsyndrome CorrectAnswer-CAns.is'c'i.e.,Severecombinedimmunodeficiency Choice CancersassociatedNHLmainlyMALT-oma Sjogren involvingsalivary syndrome glands>stomachElevatedincidenceofcancers,approximately100-foldincomparisontothegeneralpopulation.Inchildren,morethan85%of Ataxia neoplasmcasesare telengectasia acutelymphocytic leukemiaorlymphoma.Inadultswithataxia-telangiectaisa,solidtumorsaremorefrequentGastrointestinalcancerassociatedwith
associatedwithendometrial/ovarian Lynch-II carcinoma.Earlyonset syndrome braintumorandlymphomaalsoseeninchildren
243.Womanof30-yearswithRaynaud's phenomenon,polyarthritis,dysphagiaof5-yearsandmildSclerodactyl,bloodshowingAnti-centromereantibodypositive,thelikelycauseis a)CREST b)Mixedconnectivetissuedisorder c)SLE d)Rheumatoidarthritis CorrectAnswer-AAns.is'a'i.e.,CRESTThediseaseisdividedintotwocategories:?1)Diffusescleroderma.Thereiswide-spreadinvolvementofskinatonset.Thereisrapidprogressionwithearlyvisceralinvolvement.ItisassociatedwithAnti-DNAtopoisomerase(anti-Scl70)antibodies.2)Limited(localized)scleroderma(morphea).Skininvolvementisconfinedtofinges,forearmandface.Itisassociatedwithslowprogressionandlatevisceralinvolvement.SomepatientsdevelopCRESTsyndrome(Cacinosis,Raynaud'sphenomenon,esophagealdysmotility,sclerodactyly,andtelangiactasia).Itisassociatedwithanticentromereantibodies.
244.Mostcommonmechanismofarrhythmia a)Re-entry b)Earlyafterdepolarization c)Lateafterdepolarization d)Automaticity CorrectAnswer-AAns.is'a'i.e.,Re-entryThemostcommonarrhythmiamechanismisre-entry.Fundamentally,re-entryisdefinedasthecirculationofanactivationwavearoundaninexcitableobstacle.Re-entryappearstobethebasisformostabnormalsustainedSupraVentricularTachycardias(SVTs)andVentriculartachycardia.Examplesofre-entryare:-PolymorphicVentriculartachycardiainpatientswithageneticallydeterminedionchannelabnormalitysuchastheBrugadasyndrome,catecholaminergicpolymorphicVentriculartachycardia.
245.-30to-90degreeaxisdeviationindicates a)LeftAxisDeviation b)RightAxisDeviation c)ExtreneRightAxisDeviation d)NormalCardiacAxis CorrectAnswer-AAns.is'a'i.e.,LeftAxisDeviationCardiacaxisTheelectricalsignalrecordedontheelectrocardiogram(ECG)containsinformationrelativetodirectionandmagnitudeofthevariouscomplexes.Theaveragedirectionofanyofthecomplexescanbedetermined.NormalCardiacAxisThenormalQRSelectricalaxis,asestablishedinthefrontalplane,isbetween-30and90?(directeddownwardorinferiorandtotheleft)inadults.LeftAxisDeviationAnaxisbetween-30?and-90?(directedsuperiorandtotheleft)istermedleftaxisdeviation.RightAxisDeviationIftheaxisisbetween90?and180?(directedinferiorandtotheright),thenrightaxisdeviationispresent.ExtremeRightAxisDeviationAnaxisbetween-90'and-180?(directedsuperiorandtotheright)isreferredtoasextremerightorleftaxis.IndeterminateIftheQRSisequiphasicinallleadswithnodominantQRSdeflection,itisindeterminateaxis.Causesofaxisdeviationinclude Rightaxis Leftaxisdeviation
deviation Normalvariation Normalvariation(physiologic, (verticalheartwith oftenwithage) anaxisof90?) Mechanicalshifts, Mechanicalshifts,suchassuchas expiration,highdiaphragm inspirationand (pregnancy,ascites,abdominal emphysema tumor) Rightventricular Leftventricularhypertrophy hypertrophyLeftposterior Leftbundlebranchblock fascicularblockDextrocardia LeftanteriorfascicularblockCongenitalheartdisease(prim Ventricularectopic umatrialseptalHefect, rhythms endocardialcushiondefect) Ventricularectopic Emphysema rhythmsPre-excitationsyndrome(Wolff- HyperkalemiaParkinson-WhiteLateralwallmyocardial Ventricularectopicrhythms infarctionSecundumatrial Pre-excitationsyndromes septaldefect (Wolff-Parkinson-WhiteInferiorwallmyocardial infarction
246.Whichofthefollowingisnotasignof uppermotorneuronparalysis a)Babinskisign b)Spasticparalysis c)DenervationpotentialinEMG d)Exaggerationoftendonreflexes CorrectAnswer-CAns.is'c'i.e.,DenervationpotentialinEMGDifferencebetweenupperandlowermotorneuronparalysis Uppermotor Lowermotorneuron neuron paralysis paralysisMusclesaffectedin Individualmusclesmay groupsnever beaffected individualmusclesoAtrophy Atrophypronouncedup slightanddue to70%ofthetotalbulk todisuseSpasticitywith FlaccidityandhypotoniaQ hyperactivityof ofaffectedmuscleswith thetendon lossoftendonreflexes reflexesandExtensor Plantarreflexifpresentis plantarreflex ofnormalflexortype (Babinskisign)
(Babinskisign)Fascicular Fasciculationmaybe twitches present absentNormalnerve Abnormalnerve conduction conductionstudies; studies;no denervationpotential denervation (fibrillations, potentialsin fasciculationspositive E.M.G. sharpwaves)inEMG
247.Mostcommonoralinfectionindiabetes mellitus a)Candida b)Aspergillus c)Streptococcus d)Stphylococcus CorrectAnswer-AAns.is'a'i.e.,CandidaIndividualswithDMhaveagreaterfrequencyandseverityoftheinfection.Thereasonsforthisincludeincompletelydefinedabnormalitiesincell-mediatedimmunityandphagocytefunctionassociatedwithhyperglycemia,aswellasdiminishedvascularization.Hyperglycemiaaidsthecolonizationandgrowthofavarietyoforganisms(candidaandotherfungalspecies).
248.Allarefeaturesofhypernatremiaexcept a)Convulsions b)Elevatedintracranialtension c)Periodicparalysis d)Doughyskin CorrectAnswer-CAns.is'c'i.e.,PeriodicparalysisPeriodicparalysis,isseeninhyponatermiaClinicalfeaturesofHypernatremia:?Mostpatientswithhypernatremiaaredehydratedandhavethetypicalsignsandsymptomsofdehydration.Hypernatremiaevenwithoutdehydrationcausescentralnervoussystemsymptomsthattendtoparallelthedegreeofsodiumelevationandtheacuityoftheincrease.Patientsareirritable,restlessweakandlethargicSomehavehighpitchedcryandhyperpnea.Alertpatientareverythirsty.HypernatremiacausesfeveralthoughmanypatientshaveunderlyingprocessthatcontributestothefeverExceptfordehydration,thereisnocleardirecteffectofhypernatremiaonotherorgansortissuesexceptthebrain.Complicationofhypernatremia:?Brainhemorrhageisthemostdevastatingconsequenceofhypernatremia.Astheextracellularosmolarityincreaseswatermovesoutofbraincells,resultingindecreaseinbrainvolume.Thiscanresultintearingofintracerebralveinsandbridgingvesselsasthebrainmovesawayfromtheskullandthemeninges.Patientmayhavesubarachnoid,subduralandparenchymalhemorrhage.
Seizureandcomaarepossiblesequaleofthehemorrhageeventhoughseizuresaremorecommonduringt/t.Thromboticcomplicationsarecommoninseverehypernatremicdehydrationandincludestroke,duralsinusthrombosis,peripheralthrombosisandrenalveinthrombosis.Theintracranialtensioncanbeincreasedduetohemorrhage
249.Doughyskinandwoodyindurationof tongueisseenin a)Hypernatremia b)Hyponatremia c)Hypokalemia d)Hyperkalemia CorrectAnswer-AAns.is'a'i.e.,HypernatremiaBecauseofintracellularwaterloss(hypernatremicdehydration),thepinchedabdominalskinofahypernatremicdehydratedpatienthasa"doughy"feelandthereisdrywoodytongue.
250.WhichofthefollowingisMOST commonlyaffectedbyCrohn'sDisease a)Cecum b)Rectum c)Sigmoidcolon d)TerminalIleum CorrectAnswer-DAns.is'd'i.e.,TerminalileumInflammatoryBoweldiseasesiteofinvolvement Ulcerative Crohn's cocitis Anypartofthe Limitedtothe Goutfrommouth colon toanus Involvesthe Mostcommonly entirecolon affectedissmall startingfromthe intestine rectum particularlyileum (retrograde manner)Rectumismost Terminalileitisor commonly affectedIleumnotinvolvedmayget Granulomatous involvedmayget colitis involvedinsomecases
cases(backwashileitis). Rectumspared Fullthicknessoftheintestineinvolvedbutin patchymannerskiplesions
251.Alloffollowingcauseintravascular hemolysis,except a)Mismatchedbloodtransfusion b)Paroxysmalcoldhemoglobinuria c)Thermalburns d)Hereditaryspherocytosis CorrectAnswer-DAns.is'd'i.e.,HereditaryspherocytosisBloodtransfusionABOmismatchedtransfusionInfectedbloodThermalburnsSnakebitesSepsisBacterial/parasiticinfectionsClostridialsepsisMalariaBartonellosisMycoplasmapneumoniaeMechanicalheartvalvesParoxysmalhemoglobinuriaPNHPCH
252.Bloodtransfusionshouldbecompleted withinhoursofinitiation a)1-4hours b)3-6hours c)4-8hours d)8-12hours CorrectAnswer-AAns.is'a'i.e.,1-4hoursFromstartingtheinfusion(puncturingthebloodwiththeinfusionset)tocompletion,infusionpackshouldtakeamaximumof4hours.
253.VitaminBlevelinchronicmyeloid leukemiais a)Elevated' b)Decreased c)Normal d)Markedly CorrectAnswer-AAns.is'a'i.e.,ElevatedCMLtherewillberiseinB1,levelLDHlevelAnddecreasedlevelsofALP.
254.Whichisthemostcommonorgan involvedinsarcoidosis a)Lung b)Liver c)CNS d)Eye CorrectAnswer-AAns.is'a'i.e.,Lung Followingorgansarecommonlyaffected:?1)Lungandlymphnodes(95%)2)Skin(24%-43%)3)Eye(12-29%
255.Followingstatementsaboutsarcoidosis isfalse a)Elevatedlevelofangiotensinconvertingenzyme(ACE) b)Bilateralparotidenlargementistherule c)Pleuraleffusioniscommon d)Facialnervepalsymaybeseen CorrectAnswer-CAns.is'c'i.e.,PleuraleffusioniscommonDiffuseEffusionisanuncommonatypicalmanifestationinSarcoidosisreportedinupto5%ofpatients.ParotidenlargementisaclassicfeatureofsarcoidosisandbilateralinvolvementistheruleNeurologicaldiseaseisreportedin5-10%ofpatientswithsarcoidosisFacialnervepalsyisthesinglemostcommonneurologicalmanifestationofsarcoidosisseeninupto50%ofpatientswithNeurosarcoidosis.Angiotensinconvertingenzyme(ACE)levelsareraisedinsarcoidosisLunginvolvementinsarcoidosisMostcommoninvolvedorgan(90%).CharacterizedbyB/Lhilaradenopathy.CavitationsarerarePleuraleffusionarerare(1-2%)
256.Themostcommoncauseofseizuresina patientofAIDSis a)Toxoplasmosis b)Cryptococcalmeningitis c)Progressivemultifocalleucoencephalopathy d)CNSlymphoma CorrectAnswer-AAns.is'a'i.e.,ToxoplasmosisNeurologicalmanifestationsofH.I.V.AIDSdementiacomplex(HIVencephalopathy)isaresultofdirecteffectsofHIVonCNS(notanopportunisticdisease).Itissubcorticaldementia.Mostcommoncauseofseizures-->ToxoplasmaMostcommoncauseofmeningitis-->CryptococcusM.C.causeoffocalneurologicaldeficit-->ToxoplasmaToxoplasmosisisthemostcommonCNSinfectioninAIDS.CNSlymphomaandprograssivemultifocalleukoencephalopathymayoccur.
257.Generesponsibleforresistanceto rifampicin a)RpoBgene b)KatGgene c)RpmBgene d)EmbBgene CorrectAnswer-AAns.is'a'i.e.,RpoBgene Gene ATTDrug responsiblefordrugresistanceinhAandKatG INH gene Ethambutol embBgene Rifampicin rpoBgene Pyrazinamide pncAgene
258.Lepsroycauses? a)MembranousGN b)Focalglomerulosclerosis c)MembranoproliferativeGN d)MesangioproliferativeGN CorrectAnswer-AAns.is'a'i.e.,MembranousGNInfectiousdiseasescausingmembranousGN ?HepatitisB ?Hydatiddisease ? Leprosy andC?Filariasis ?Syphilis ? Enterococcal ?Malaria ?Endocarditis ? Schistosomiasis
259.Nephroticsyndromeisthehallmarkof thefollowingprimarykidneydiseasesexcept a)MembranousGlomerulopathy b)IgAnephropathy c)Minimalchangedisease d)FocalsegmentalGlomerulosclerosis CorrectAnswer-BAns.is'b'i.e.,IgAnephropathyMostcommonpresentationofIgAnephropathyisgrasshematuria.ItisthemostcommonformofglomerulonephritisworldwideCausesofNephroticsyndromeMinimalchangediseaseFocalsegmentalglomerulosclerosisoMembranousglomerulonephritisoDiabetesnephropathyALandAAamyloidosisLightchaindepositiondiseaseFibrillaryimmunotactoiddisease
260.Bechterewsdiseasealsoknownas a)Rheumatoidarthritis b)Ankylosingspondylitis c)Osteoarthritis d)Syphiliticarthritis CorrectAnswer-BAns.is'b'i.e.,AnkylosingspondylitisANKYLOSINGSPONDYLITIS(MARIE-STRUMPELLDISEASE)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.Prototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.oMaletofemaleratiois2-3:1StrongcorrelationwithHLA-B2790-95%ofcasesarepositiveforHLAB27.JointsinvolvedinankvlosingspondylitisAnkylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.oRarelyknee(Ebenzar4thie593)andankle(Apley's9th/e67)arealsoinvolved.ClinicalfeaturesLowbackpainofinsidiousonsetDurationusuallylessthan3months
SignificantmorningstiffnessandimprovementwithexerciseoLimitedchestexpansionDiffusetendernessoverthespineandsacroiliacjointsLossoflumbarlordosis,increasedthoracickyphosisDecreasedspinalmovements(especiallyextension)inalldirections.RadiologicalfeaturesofankvlosingspondvlitisRadiographicevidenceofsacroiliacjointisthemostconsistentfindinginankylosingspondylitisandiscrucialfordiagnosis.Thefindingsare:?SclerosisofthearticulatingsurfacesofSIjointsWideningofthesacroiliacjointspaceBonyankylosisofthesacroiliacjointsCalcificationofthesacroiliacligamentandsacro-tuberousligamentsEvidenceofenthesopathy-calcificationattheattachmentofthemuscles,tendonsandligaments,particularlyaroundthepelvisandaroundtheheel.oX-rayoflumbarspinemayshow:-Squaringofvertebrae:Thenormalanteriorconcavityofthevertebralbodyislostbecauseofcalcificationoftheanteriorlongitudinalligament.LossofthelumbarlordosisBridging`osteophytes'(syndesmophytes)Bamboospineappearance
261.Comprehensioninintactwithaphasiain a)Wernicke's b)Broca's c)Globalaphasia d)Transcorticalsensory CorrectAnswer-BAns.is'b'i.e.,Broca's
262.Followingstatementsaboutsarcoidosis isfalse a)Thefirstmanifestationofthediseaseisanaccumulationof mononuclearinflammatorycells,mostlyCD8+THIlymphocytesinaffectedorgans b)TheHeerfordt-Waldenstromsyndromedescribesindividuals withfever,parotidenlargement,anterioruveitis,andfacialnervepalsy c)Elevatedlevelofangiotensinconvertingenzyme(ACE)area feature d)Bilateralparotidinvolmentistherule CorrectAnswer-AAns.is'a'i.e.,Thefirstmanifestationofthediseaseisanaccumulationofmononuclearinflammatorycells,mostlyCD8+THIlymphocytesinaffectedorgans
263.Thetreatmentoptionsforpatientswith RRMS(relapsing-remittingmultiplesclerosis)areallexcept a)IFN-1b b)IFN-1a c)Glatirameracetate d)TNF-a CorrectAnswer-DAns.is'd'i.e.,TNF-aTreatmentofRRMSisdividedinto:-i)Inacuteattack:Corticosteroidsaregivenii)Prophylaxisofacuteattack(relapse)duringremission:DiseasemodifyingagentsforMSareusedtoreducethebiologicalactivity.TreatmentisstartedbyIFN-PlaorIFN-[31borGlatiramerorfingalimod.Ifthereispoorresponseorintolerancetothesedrugs,Natalizumabisstarted.
264.DOCforTourettesyndrome a)Haloperidol b)Valproate c)Bcomplex d)Clonidine CorrectAnswer-DAns.is'd'i.e.,ClonidineEarlierHaloperidolwasconsideredasDOCforTourettesyndrome.ClonidineisconsideredasDOCforTourettesyndrome
TreatmentThere'snocureforTourettesyndrome.Treatmentisaimedatcontrollingticsthatinterferewitheverydayactivitiesandfunctioning.Whenticsaren'tsevere,treatmentmightnotbenecessary.MedicationMedicationsthatblockorlessendopamine.Fluphenazine,haloperidol(Haldol),risperidone(Risperdal)andpimozide(Orap)canhelpcontroltics.Botulinum(Botox)injectionsCentraladrenergicinhibitors.Medicationssuchasclonidine(Catapres,Kapvay)andguanfacine(Intuniv)--typicallyprescribedforhighbloodpressure--mighthelpcontrolbehavioralsymptomssuchasimpulsecontrolproblemsandrageattacks.Antidepressants.Fluoxetine(Prozac,Sarafem,others)Antiseizuremedications.TherapyBehaviortherapy.CognitiveBehavioralInterventionsforTics,includinghabit-reversaltraining,canhelpyoumonitortics,identifypremonitoryurgesandlearntovoluntarilymoveinawaythat'sincompatiblewiththetic.Psychotherapy.InadditiontohelpingyoucopewithTourettesyndrome,psychotherapycanhelpwithaccompanyingproblems,suchasADHD,obsessions,depressionoranxiety.Deepbrainstimulation(DBS).Forsevereticsthatdon'trespondtoothertreatment,DBSmighthelp.DBSinvolvesimplantingabattery-operatedmedicaldeviceinthebraintodeliverelectricalstimulationtotargetedareasthatcontrolmovement.
265.SSPEisnotdiagnosedby a)EEG b)AntibodiestomeaslesinCSF c)Antibodiestomeaslesinblood d)Antigeninbrainbiopsy CorrectAnswer-CAns.is'c'i.e.,Antibodiestomeaslesinblood[Ref.Nelsonl8n/echapter2431]ThediagnosisofSSPEcanbeestablisheilthrougltdocumentationofacompatibleclinicalcourseandatleastIofthefollowingsupportingfindings.MeaslesantibodydetectedinCSF.Characteristicelectroencephalographicfindings.Typicalhistologicfndingsand/orisolationofviursorviralantigeninbraintissueobtainedbybiopsyorpost-mortemexamination.CSFanalysisrevealsnormalcellsbutelevatedIgGandIgMantibodytitersindilutionsof>1.8.Electroencephaloraphicpatternsarenormalinstagel,butinthemyclonicphasesuppression-burstepisodesareseenthatarecharacteristicofbutnotpathognomicfor,SSPE.Brainbiopsyisnolongerroutinelyindicatedfordiagnosiso/SSPE.
266.BronchiectasisSiccaisseenwith a)Tuberculosis b)Pertussis c)Cysticfibrosis d)Kartagenersyndrome CorrectAnswer-AAns.is'a'i.e.,TuberculosisBronchiectasisSiccaorDryBronchiectasisistypicallyassociatedwithTuberculosis.TuberculosisisassocitedwithatypeofdrybronchiectasiscalledBronchiectasisSicca,whichispredominantlyseeninupperlobes.DryBronchiectasis(BronchiectasisSicca)istypicallycharacterizedbyabsenceofcopiousamountofsputumwhichisusuallyahallmarkofbronchiectasis.DrycoughassociatedwithhemoptysisisthetypicalpresentationEndobronchialtuberculosiscommonlyleadstobronchiectasis,eitherfrombronchialstenosisorsecondarytractionfromfibrosis.Tractionbronchiectasischaracteristicallyaffectsperipheralbronchi(whichlackcartilagesupport)inareasofend-stagefibrosis
267.Brock'sSyndromeis a)BronchiectasisSicca b)MiddleLabeBronchiectasis c)Kartagener'sSyndrome d)Sarcoidosis CorrectAnswer-BAns.is'b'i.e.,MiddleLobeBronchiectasisBrock'sSyndromeRightmiddlelobebronchiectasisoccurringasalatesequelofprimaiytuberculosisisknownasBrock'ssyndromeormiddlelobesyndrome.Brock'ssyndromeisbelievedtobecausedbypressureoflymphnodesinprimarytuberculosisonthemiddlelobebronchus.Ithasbeendescribedasatypicaloutcomeofhilarnodeinvolvementbytuberculosisinchildhood.Thistermisalsoappliedtorecurrentatelectasisoftherightmiddlelobeintheabsenceofendobronchialobstruction.Bronchiectasisdevelopsafterrecurrentepisodesofatelectasisandfibrosis
268.Centralbronchiectasisisseenwith a)CysticAdenomatoidMalformation b)Cysticfibrosis c)Bronchocarcinoma d)Tuberculosis CorrectAnswer-BAns.is'b'i.e.,CysticfibrosisThedistribution()I.bronchiectasismarbeimportantdiagnosticallyAcentralPerihilarallergicbronchopulmonaryaspergillosis.PredominantupperlobeoMiddleandlowerlobeCysticfibrosisoroneofitsvariants.DistributionisconsistentwithPCDLowerlobeinvolvementisMiddlelobeandlingularsegmentoftheLULinvolvementischaracteristicofnontuberculousmycobacteria(NTM).Idiopathicbronchiectasis
269.Type3respiratoryfailureoccursdueto? a)Post-operativeatelectasis b)Kyphoscoliosis c)Flailchest d)Pulmonaryfibrosis CorrectAnswer-AAns.is'a'i.e.,Post-operativeatelectasis
270.BilateralPainlessparotidenlargementis seeninallexcept a)Mumps b)Alcoholics c)Sarcoidosis d)Diabetesmellitus CorrectAnswer-AAns.is'a'i.e.,MumpsBilateralparotidenlargementisseenin Viral Metaboliccauses Endocrinal Sarcoidosis infectionQMumps Diabetesmcuitus Gonadal AmyloidosisSjogren's Influenza Hyperlipoproteinemia hypofunction syndromeEpstein Chronicpancreatitis Acromegaly barrvirusCoxackie Hepaticcirrhosis virusACMV HIV
271.Allofthefollowingarefeaturesof Sclerodermaarefollowingexcept a)Diffuseperiostealreaction b)Esophagealdysmotility c)Erosionoftipofphalanges d)LungNodularinfiltrates CorrectAnswer-AAns.is'a'i.e.,DiffuseperiostealreactionSkininvolvementinsystemicsclerosisSkininvolvementisanearlyuniversalfeatureofsystemicsclerosis(SSc).Itischaracterizedbyvariableextentandseverityofskin.Thickeningandhardening.Thefingers,hands,andfacearegenerallytheearliestareasofthebodyinvolved.Edematousswellinganderythemamaypreceedeskininduration.Otherprominentskinmanifestationsinclude:PruritusintheearlystagesEdemaintheearlystagesSclerodactylyDigitalulcersPittingatthefingertipsTelangiectasiaCalcinosiscutisRadiographsofthehandsmayrevealSofttissuecalcifications(calcinosiscutis).Resorptionofthedistalphalangealtufts(acro-osteolysis).Lesscommonradiographicfindingsare:
ArticularerosionsJointspacenarrowingDemineralizationThesymptomsofthefemaleandpresenceofantinuclearantibodypointstowardsthediagnosisofsystemicsclerosis.Itisacaseofsystemicsclerosisorscleroderma.Thecluestothediagnosisofsclerodermaare:SclerodactylyRaynaud'sphenomenonDysphagiaPresenceofantinuclearantibodyThoughsystemicsclerosisisamultisystemdisease,thetwomostdistinguishingfeaturesofsystemicsclerosisare:oStrikingcutaneouschangesNotableskinthickening.Thisisthemosteasilyrecognizedmanifestationofscleroderma.Raynaud'sphenomenonThisisthefirstmanifestationofdiseaseinalmosteverypatients.DysphagiaAttributabletoesophagealfibrosisanditsresultanthypomotlityispresentinmorethan50%ofpatients.Remember,WheneverskinthickeningispresentalongwithRaynaud'sphenomenon,itisalmostalwaysacaseofscleroderma".Thesetwofeaturesarenotpresentinanyothermultisystemdiseasewhoseclinicalfeaturesoverlapwiththatofsystemicsclerosise.g.SLE,rheumatoidarthritis,inflammatorymyopathy,Sjogrensyndrome".AlthoughskinchangesandRaynaud'sphenomenonarethemajordiagnosticclues,sclerodermaisamultisystemdiseasethatmostcommonlytargetsperipheralcirculation,muscles,joints,gastrointestinaltract,lung,heartandkidney.So,thesymptomsencounteredinearlypresentationofsclerodermaincludemusculoskeletaldiscomfort,fatigue,weightloss,andheartburnanddysphagiaassociatedwithgastroesophagealreflexdisease(GERD).Whenthesesymptomsareaccompaniedbytheskinthicknessand
Raynaudcphenomenon,diagnosisofsclerodermashouldbeconsidered.RoleofautoantibodiesinthediagnosisofsclerodermaAutoantibodiesarefoundinnearlyeverypatientwithscleroderma(sensitivity>95%),buttheyarenotspecificforscleroderma0.Sclerodermaisassociatedwithwidearrayofautoantibodies.TwoANA'Swhicharemoreorlessuniquetosclerodermaare: Seeninpatientswith Antitopoisomerase diffusesystemic antibody(20-40%) sclerosis Patientswiththisautoantibodyaremorelikelytohavepulmonary .fibrosisandperipheralvasculardisease Patientswiththese autoantibodieshavepoorprognosisTheseautoantibodies Anticentromere areseeninpatientswith antibody(20-40%) limitedsystemicsclerosis
272.LBBBisseenwithallexcept a)AcuteMI b)Ashmannsyndrome c)Hypokalemia d)Hyperkalemia CorrectAnswer-CAns.is'c'i.e.,HypokalemiaCausesofLBBBare:-AorticstenosisIschaemicheartdiseaseHypertensionDilatedcardiomyopathyAnteriorMIPrimarydegenerativedisease(fibrosis)oftheconductingsystem(Lenergredisease)HyperkalaemiaDigoxintoxicityAshmannphenomenon(hasbothLBBBandRBBB)AtrialfibrillationhasanarrowcomplexqRSbutAshmannphenomenonseeninatrialfibrillationischaracterizedbybroadcomplexqRSwithusuallyaRBBBmorphology.ThusifanimpulselandsonthebundleofHISandfindstherightbundlerefractorythenRBBBwilloccur.AlsorememberthattherefractoryperiodofrightfascicleixmorethanthatoftheleftfascicleresultinginRBBBmostlyinthesepatients.ECGfindingsofLBBBNormallytheseptumisactivatedfromlefttoright,producingsmallQwavesinthelateralleads.InLBBB,thenormaldirectionofseptal
depolarisationisreversed(becomesrighttoleft),astheimpulsespreadsfirsttotheRVviatherightbundlebranchandthemtotheLVviatheseptum.ThissequenceofactivationextendstheqRSdurationto>120msandeliminatesthenormalseptalQwavesinthelateralleads.Theoveralldirectionofdepolarisation(fromrighttoleft)producestallRwavesinthelateralleads(IaVLV5V6)deepSwavesintherightprecordialleads(V4R)andusuallyleadstoleftaxisdeviation.Astheventriclesareactivatedsequentially(right,thenleft)ratherthansimultaneously,thisproducesabroadornotched(`W-shaped)Rwaveinthelateralleads.Non-concordanceinSTsegmentandTwavechanges.Thepointisthatthetwofascilesofbundleofhishavedifferentrefractoryperiodswiththerightfasciclehavinghigherrefractoryperiodthantheleft.ThismeansthatifanimpulselandsonthebundleofHISandfindstherightbundlerefractorythenRBBBwilloccur.Inatrialfibrillationbecauseoffasterconduction,normallyweseenarrowcomplexqRSbutsometimeswemayseebroadcomplexqRSalsowhichistechnicallycalledAshmannphenomenon.MostlyinAshmannphenomenonRBBBisseenbasedonthephysiologicalprincipleofrefractoryperiodofrightfasciclemorethantheleftone.However,rarelyLBBBcanalsobeseeniftheimpulselandstofindtheleftfasciclerefractory.IrrespectiveofRBBBorLBBB,broadcomplexqRSwilloccurincaseofatrialfibrillationandAshmannphenomenonisoccurrenceofbroadcomplexqRSinatrialfibrillationandnottheoccurrenceofRBBBasisthepopularperception.HyperkalemiacancausedefectiverepolarizationandhencecauseBundlebranchblockthatculminatesinsinewavepattern.InacuteMI,ischemiacandamagetheleftbundleleadingtoLBBB.
273.Therapeutichypothermiaisofbenefitin preventingneurologicalcomplicationsin a)Sepsis b)Poly-trauma c)Cardiacarrest d)lschemicstroke CorrectAnswer-CAns.is'c'i.e.,CardiacarrestInducingmildtherapeutichypothermiainselectedpatientssurvivingout-of-hospitalsuddencardiacarrestcansignificantlyimproveratesoflong-termneurologicallyintactsurvivalandmayprovetobeoneoftheimportantclinicaladvancementsinthescienceofresuscitation.Thetypesofmedicaleventsthathypothermictherapiesmayeffectivelytreatfallintofourprimarycategories:CardiacarrestIschemicstrokeTrumaticbrainorspinalcordinjurywithoutfever.Neurogenicfeverfollowingbraintrauma
274.DistributionofweaknessinPyrimidal tractlesions? a)Extensorsmorethanflexorsinlowerlimb b)Flexorsmorethanextensorsinupperlimb c)Antigravitymusclesareaffected d)Antigravitymusclesarespared CorrectAnswer-DAns.is'd'i.e.,AntigravitymusclesaresparedThefollowingclinicalfeaturescharacterizeaUMNlesion:Increasedtone(spasticitv)Initially,UMNweaknessmaybeflaccid,withabsentordiminisheddeeptendonreflexes.Thereislittleunderstandingofthereasonsbehindthisinitialflaccidityanditisoftenreferredtoas'shock'.IncreasedtoneofaUMNtypeiscalledspasticity.Itmaydevelopseveralhours,daysorevenweeksaftertheinitiallesionhasoccurred.Spasticityismanifestedby:Spasticcatch':Mildspasticitymaybedetectedasaresistancetopassivemovementor'catch'inthepronatorsonpassivesupinationoftheforearmandintheflexorsofthehand/forearmonextensionofthewrist/elbow.The'clasp-knife'phenomenon:Inmoreseverelesions,followingstrongresistancetopassiveflexionofthekneeorextensionoftheelbow,thereisasuddenrelaxationoftheextensormusclesofthelegandflexormusclesinthearm.Clonus:Rhythmicinvoluntarymuscularcontractionsfollowanabruptlyappliedandsustainedstretchstimulus,e.g.attheanklefollowing
suddenpassivedorsiflexionofthefoot.`Pyramidal-pattern'weaknessTheantigravitymusclesarepreferentiallysparedandstrongerTheflexorsoftheupperlimbsandtheextensorsofthelowerlimbs.Thepatientcandevelopacharacteristicpostureofflexedandpronatedarmswithclenchedfingers,andextendedandadductedlegswithplantarflexionofthefeet.InupperextremiteisRelativesparingoftheflexorsMoreinvolvementoftheextensorInlowerextremitiesPredominantinvovlementoftheflexorswithRelativesparingoftheextensororAbsenceofmusclewastingandfasciculationsFocalmusclewastingandjasciculationsarefeaturesofanLMNlesion.Withchronicdisuse,somelossofmusclebulkcanoccurafteraUMNlesion,butthisisrarelysevereorfocal.BrisktendonreflexesandextensorplantarresponsesThetendonreflexesarebrisk.Thecremastericandabdominalor'cutaneous'reflexesaredepressedorabsent.Theplantarresponsesareextensor(upgoingtoes'or'positive'babinskisign).Anti-gravitymusclesaretypicallysparedinpyramidaltractlesions.Weakness,inpyramidaltractlesionsisoftentermedas'pyramidal'indistributionaffectingextensorsmorethanflexorsintheupperlimb,andflexorsmorethanextensorsinthelowerlimb(Anti-gravitymusclesarespared).PyramidalweaknessLossofpowermostmarkedintheextensorsmusclesinthearmsandflexorsinthelegsProximalweaknessShoulders,hips,trunks,neckandsometimesface.Associatedwithmyopathy.DistalweaknessAffectshandsandfeets.Associatedwithperipheralmotorneuropathy.GlobalweaknessGeneralizedweaknessinlimbswhichmayresultfromseverepathologies.
275.Aldosereductaseinhibitordrugsare usefulin a)Cataract b)Diabetesmellitus c)Hereditaryfructoseintolerance d)Essentialfructosuria CorrectAnswer-BAns.is'b'i.e.,DiabetesmellitusAldosereductasecatalyzestheNADPH-dependentconversionofglucosetosorbitol,thefirststepinpolyolpathwayofglucosemetabolism.Aldosereductaseinhibitorsareaclassofdrugsbeingstudiedasawaytopreventeyeandnervedamageinpeoplewithdiabetesmellitus.Examplesofaldosereductaseinhibitorsinclude:Tolrestat(withdrawnfrommarket)ApalrestatRanirestatFidarestat
276.Notacauseofhypernatremia a)Adipsicdiabetesinsipidus b)Decreasedinsensiblelosses c)Nephrogenicdiabetesinsipidus d)Carcinoidsyndrome CorrectAnswer-BAns.is'b'i.e.,DecreasedinsensiblelossesMajorcausesofhypernatremiaUnreplacedwaterloss(whichrequiresanimpairmentineitherthirstoraccesstowater)InsensibleandsweatlossesGastrointestinallossesCentralornephrogenicdiabetesinsipidusOsmoticdiuresisGlucoseinuncontrolleddiabetesmellitusUreainhigh-proteintubefeedingsMannitolHypothalamiclesionsimpairingthirstorosmoreceptorfunctionPrimaryhypodipsiaResetosmostatinmineralocorticoidexcessWaterlossintocellsSevereexerciseorseizuresSodioumoverloadIntakeoradministrationofhypertonicsodiumsolutions
277.Backwashileitisisseenin a)Ulcerativecolitis b)Crohn'sdisease c)Coloniccarcinoma d)healpolyp CorrectAnswer-AAns.is'a'i.e.,UlcerativecolitisUlcerativecolitisalwaysinvolvestherectumandextendsproximallyincontinuousfashiontoinvolvepartorallpartofthecolon.Involvementofterminalileuminulcerativecolitisiscalledbackwashileitis
278.Whichofthefollowingisnotseenin HereditarySpherocytosis a)DirectCoomb'sPositive b)IncreasedOsmoticFragility c)Splenomegaly d)Gallstones CorrectAnswer-AAns.is'a'i.e.,DirectCoomb'spositiveHereditarySpherocytosisMembranecytoskeletonthatliescloselyopposedtotheinternalsurfaceoftheplasmamembrane,isresponsibleforelasticityandmaintenanceofRBCshape.Membraneskeletonconsists:?SpectrinThechiefproteincomponentresponsibleforbiconcaveshape.Ankyrinandband4-2Bindsspectrintoband3Band3Atransmembraneiontransportprotein.Band4.1BindsspectrintoglycophorinA,atransmembraneprotein.Hereditaryspherocytosisisanautosomaldominantdisordercharacterizedbyintrinsicdefectsinredcellmembrane.Thisresultsinproductionofredcellsthataresphere(spherocytes)ratherthanbiconcave.Themutationmostcommonlyinvolvesthegenecodingforankyrin,followedbyBand-3(anionictransportchannel),spectrin,andBand4.2(alsocalledpalladin).
AlsoknowMostcommon,defectinhereditaryelliptocytosisisinspectrinPathogensisofHereditaryspherocytosisLossofmembranecytoskeletonproteins(ankyrin,spectrin,Band3,4.2)resultsinreducedmembranestability.Reducedmembranestabilityleadstospontaneouslossofmembranefragmentsduringexposuretoshearstressesinthecirculation.Thelossofmembranerelativetocytoplasmforcesthecellstoassumethesmallestpossiblediameterforagivenvolumecellsbecomemicrospherocytes.Becauseoftheirspheroidalshapeandreducedmembraneplasticity,redcellsbecomelessdeformableandaretrappedintospleenastheyareunabletopassthroughtheinterendothelialfenestrationsofthevenoussinusoids.Inthesplenicsinusoides,redcellsarephagocytosedbyREcellsExtravascularhemolysis.ClinicalfeaturesofHereditoryspherocytosisTheclinicalfeaturesarethoseofextravascularhemolysis:AnemiaMildtomoderateJaundice(Mainlyindirectbilirubin)SplenomegalyGallstonesElevatedexcretionofbilirubinpromotesformationofpigmentstone.LegulcerRareclinicalmanifestation.AplasticcrisisTriggeredbyparvo-virusinfection.LaboratoryfindingsSpherocytosis-->PeripheralsmearshowsmicrospherocyteswhicharesmallRBCswithoutcentralpallor(Normallycentral1/3pallorispresentinredcells).MCV4MCHCrIncreasedunconjugatebilirubinUrineurobilinogen1'StoolstercobilinogenReticulocytosis-4Asseenwithanytypeofhemolyticanemia.Hemoglobin1SerumHeptoglobin-->Nonnaltodecreased.
Increasedosmoticfragilityonpinktest.Coomb'stestisusedtodistinguishhereditaryspherocytosisfromautoimmunehemolyticanemias.Autoimmunehemolyticanemiasarecoomb'spositive_whereashereditaryspherocytosisiscoomb'snegative.
279.UsuallyassociatedwithparvovirusB19 infectioninthosewithhereditaryspherocytosis a)Mildtomoderatesplenomegaly b)Aplasticcrisis c)Gallstones d)Hemolyticcrisis CorrectAnswer-BAns.is'b'i.e.,AplasticcrisisParvovirusB19selectivelyinfectserythroidprecursorsandisthemostcommonaetiologicalagentthatinducesaplasticcrisisinpatientswithhereditaryspherocytosis(andotherHemolyticdisorders).TransientaplasticcrisisPersonswithdecreasederythrocytescausedbyconditionssuchasirondeficiencyanemia,humanimmunodeficiencyvirussicklecelldisease,spherocytosisorthalassemiaareatriskoftransientaplasticcrisisifinfectedwithparvovirusB19.Theviruscausesacessationoferythrocyteproduction.ParvovirusinfectionmaybethefirstmanifestationinHS.Itbeginswithreticulocytosisandthrombocytosis
280.Whichofthefollowingisgiventotreat thrombocytopeniasecondarytoanti-cancertherapyandisknowntostimulateprogenitormegakaryocytes a)Filgrastim b)Oprelvekin c)Erythropoietin d)Anagrelide CorrectAnswer-BAns.is'b'i.e.,OprelvekinOprelvekin(IL-11)isusedtopreventandtreatthrombocytopenia.[RefHarrison's18thchapter85andKatzung11th580-581]
281.Lambda-Pandasignistypicallyseenin a)Sarcoidosis b)Tuberculosis c)Histoplasmosis d)Leishmaniasis CorrectAnswer-AAns.is'a'i.e.,SarcoidosisLambdasignandPandasignonGalliumscanaretypicallydescribedforsarcoidosis.Activepulmonaryand/ormediastinalsarcoidosisisgalliumavidandapositivegalliumscancansupportthediagnosisofsarcoidosis.Typicalpatternsofuptakehavebeendescribedas'panda'and'lambda'signs.LambdasignFormedfromincreaseduptakeinbilateralhilarandrightparatrachealnodesPandasignFormedfromincreaseduptakeintheparotidsandlacrimalglandsALambdasignincombinationwithaso-calledPandasign(Lambda-PandaSign)isahighlyspecificpatternforsarcoidosis.Thedegreeofuptaketypicallydependsontheactivityofdiseaseandgalliumscanispositiveonlyinthesettingofactiveparenchymaldiseaseandnegativeinremission
282.Allareindicationsforstoppingeffending ATTdrugpermanentlyexcept a)Gout b)Autoimmunethrombocytopenia c)Opticneuritis d)Hepatitis CorrectAnswer-DAns.is'd'i.e.,HepatitisForpatientswithsymptomatichepatitisandthosewithmarked(fivetosixfold)elevationsinserumlevelsofaspartateaminotransferase,treatmentshouldbeimmediatelystoppedanddrugsreintroducedoneatatimeafterliverfunctionhasreturnedtonormal.IndicationsforstoppingtheA.T.T.permanentlyHyperuricemiaandarthralgiaOpticneuritisAutoimmunethrombocytopenia
283.Interferongammareleaseassay measuresIFNreleaseagainstwhichM.TBantigen a)ESAT-6 b)ESAT-7 c)CF-11 d)CF-12 CorrectAnswer-AAns.is'a'i.e.,ESAT-63Interferon-gammareleaseassays(IGRAs)arediagnostictoolsforlatenttuberculosisinfection(LTBI).TheyaresurrogatemarkersofMycobacteriumtuberculosisinfectionandindicateacellularimmuneresponsetoM.tuberculosis.aIGRAscannotdistinguishbetweenlatentinfectionandactivetuberculosis(TB)diseaseandshouldnotbeusedfordiagnosisofactiveTB,whichisamicrobiologicaldiagnosis.ApositiveIGRAresultmaynotnecessarilyindicateactiveTB,andanegativeIGRAresultmaynotruleoutactiveTB.3BecauseIGRAsarenotaffectedbyBacilleCalmette-Guerin(BCG)vaccinationstatus,IGRAsareusefulforevaluationofLTBIinBCG-vaccinatedindividuals,particularlyinsettingswhereBCGvaccinationisadministeredafterinfancyormultiple(booster)BCGvaccinationsaregiven.AssayantigensM.tuberculosis-specificantigensinclude:-Earlysecretedantigenictarget6(ESAT-6)andCulturefiltrateprotein10(CFP-10).
Theseareencodedbygeneslocatedwithintheregionofdifference1(RD1)segmentoftheM.tuberculosisgenome.TheyaremorespecificforM.tuberculosisthanpurifiedproteinderivative(PPD)becausetheyarenotsharedwithanyBCGvaccinestrainsormostspeciesofNTMotherthanMmarinum,M.kansasii,Mszulgai,andM.flavescens.TypesofassaysTwoIGRAsareavailableinmanycountries:-TheQuantiFERON-TBGoldIn-Tube(QFT-GIT)assay,whichhasreplacedthesecond-generationQuantiferonTBGold(QFT-G)assay,andtheT-SPOTTBassay.TheQFT-GITassayisanenzyme-linkedimmunosorbentassay(ELISA)-based,whole-bloodtestthatusespeptidesfromthreeTBantigensi.e.,CFP-10,andTB7.7)inanin-tubeformatTheresultisreportedasquantificationofinterferon(IFN)-gammaininternationalunits(IU)permL.Anewerassay,theQuantiFERON-TBGoldPlus(QFT-Plus),becameavailablein2015.ThistestisavailableinEuropebutnotinNorthAmerica.TheQFT-PlusassayhastwoTBantigentubes,unliketheQFTassay(whichhasasingleTBantigentube).SensitivityandspecificityIGRAshavespecificity>95percentfordiagnosisoflatentTBinfection.ThesensitivityforT-SPOTTBappearstobehigherthanforQFT-GITorTST(approximately90,80,and80percent,respectively)[2].ThehighersensitivityofT-SPOTTBmaybeusefulforevaluatingindividualswithimmunosuppressiveconditions.TSTspecificityishighinpopulationsnotvaccinatedwithBCG(97percent).AmongpopulationswhereBCGisadministered,itismuchloweralthoughvariable(approximately60percent).
284.Thetermend-stagerenaldisease(ESRD) isconsideredappropriatewhenGFRfallsto a)50%ofnormal b)25%ofnormal c)10-25%ofnormal d)5-10%ofnormal CorrectAnswer-DAns.is'd'i.e.,5-10%ofnormal
285.Muehrckelinesinnailsareseenin a)Nephroticsyndrome b)Barrtersyndrome c)Nailpatellasyndrome d)Acutetubularnecrosis CorrectAnswer-AAns.is'a'i.e.,NephroticsyndromeMuehrcke'slinesarecharacteristicofhypoalbuminemia.Nephroticsyndromecauseshypoalbunemia.
286.Nottrueobstructivesleepappoea a)Nocturnalasphyxia b)Alcoholismisacofactor c)Pronetohypertension d)Overnightoximetryisdiagnostictoreplacepolysomnography CorrectAnswer-DAns.is'd'i.e.,OvernightoximetryisdiagnostictoreplacepolysomnographyCardinalfeaturesinadultsinclude:Obstructiveapneas,hypopneas,orrespiratoryeffortrelatedarousalsDaytimesymptomsattributabletodisruptedsleep,suchassleepiness,fatigue,orpoorconcentrationSignsofdisturbedsleep,suchassnoring,restlessness,orresuscitativesnortsClinicalpresentationMostpatientswithOSAfirstcometotheattentionofaclinicianbecausethepatientcomplainsofdaytimesleepiness,orthebedpartnerreportsloudsnoring,gasping,snorting,orinterruptionsinbreathingwhilesleeping.Daytimesleepiness,distinctfromfatigue,isacommonfeatureofOSASleepinessistheinabilitytoremainfullyawakeoralertduringthewakefulnessportionofthesleep-wakecycle.SnoringistheothercommonfeatureofOSA.Whilesnoringisassociatedwithasensitivityof80to90percentforthediagnosisofOSA,itsspecificityisbelow50percent.Clinicalfeaturesofobstructivesleepapnea(OSA) Daytimesleepiness Obesity
Daytimesleepiness ObesityLargeneck Nonrestorativesleep circumference Systemic Loudsnoring hypertension Witnessedapneasby Hypercapnia bedpartnerAwakeningwith Cardiovascular choking disease Nocturnal Cerebrovascular restlessness disease Insomniawith Cardiac frequentawakenings dysrhythmias Narrowor Lackofconcentration "crowded" airwayPulmonary Cognitivedeficits hypertension Changesinmood Corpulmonale Morningheadaches Polycythemia Vivid,strange,or Floppyeyelid threateningdreams syndrome Gastroesophageal Nocturia reflux PolysomnographyFull-night,attended,in-laboratorypolysomnographyisconsideredthe"gold-standarddiagnostic"testforOSA.Itinvolvesmonitoringthepatientduringafullnight'ssleep.Unattended,outofcentresleep"(OCST)maybeusedasanalternativetopolysomnographyforthediagnosisofOSAinpatientswithahighpre-testprobabilityofmoderatetosevereOSA,providedtherearenomedicalcomorbiditiessuchasheartfailurethatpredisposetoalternativeoradditionalsleeprelatedbreathingdisorders.ThediagnosisofOSAisbaseduponthepresenceorabsenceofrelatedsymptoms,aswellasthefrequencyofrespiratoryevents
duringsleep(ie,apneas,hypopneas,andrespiratoryeffortrelatedarousalsIRERAsJasmeasuredbypolysomnographyorout-of-centersleeptesting(OCST).Inadults,thediagnosisofOSAisconfirmedifeitherofthetwoconditionsexists:Thereare"fil_y"ormorepredominantlyobstructiverespiratoryevents(obstructiveandmixedapneas,hypopneas,orRERAs)perhourofsleep(forpolysomnography)orrecordingtime(forOCST)inapatientwithoneormoreofthefollowing:Sleepiness,nonrestorativesleep,fatigue,orinsomniasymptoms.Wakingupwithbreathholding,gasping,orchoking.Habitualsnoring,breathinginterruptions,orbothnotedbyabedpartnerorotherobserverHypertension,mooddisorder,cognitivedysfunction,coronaryarterydisease,stroke,congestiveheartfailure,atrialfibrillation,ortype2diabetesmellitusThereare15ormorepredominantlyobstructiverespiratoryevents(apneas,hypopneas,orRERAs)perhourofsleep(forpolysomnography)orrecordingtime(forOCST),regardlessofthepresenceofassociatedsymptomsorcomorbidities
287.Obstructivesleepapnoeamayresultin allofthefollowingexcept a)Systemichypertension b)Pulmonaryhypertension c)Cardiacarrhythmia d)Impotence CorrectAnswer-CAns.is'c'i.e.,CardiacarrhythmiaDaytimefunctionandcognitionOSAisassociatedwithexcessivedaytimesleepiness,inattention,andfatigue,whichmayimpairdailyfunction,induceorexacerbatecognitivedeficits,andincreasethelikelihoodoferrorsandaccidents.CardiovascularmorbidityPatientswithOSA,areatincreasedriskforabroadrangeofcardiovascularmorbidities,includingsystemichypertension,pulmonaryarterialhypertension,coronaryarterydisease,cardiacarrhythmias,heartfailure,andstroke.Metabolicsyndromeandtype2diabetesPatientswithOSAhaveanincreasedprevalenceofinsulinresistanceandtype2diabetes.NonalcoholicfattyliverdiseaseIntermittentnocturnalhypoxiaduetoOSAmaycontributetothedevelopmentandseverityofnonalcoholicfattyliverdisease(NAFLD),independentofsharedriskfactorssuchasobesity.PerioperativecomplicationsPatientswithOSAmaybeatgreaterriskforperioperativecomplicationssuchaspostoperativeoxygendesaturation,acute
respiratoryfailure,postoperativecardiacevents,andintensivecareunittransfers.MortalityPatientswithuntreatedsevereOSA(ie,AHI30eventsperhour)haveatwo-tothreefoldincreasedriskofall-causemortalitycomparedwithindividualswithoutOSA,independentofotherriskfactorssuchasobesityandcardiovasculardisease.
288.Tophiingoutfoundinallregionsexcept a)Prepatellarbursae b)Muscle c)Helixofear d)Synovialmembrane CorrectAnswer-BAns.is'b'i.e.,MuscleLocationofTophiTheyareclassicallylocatedalongthehelixoftheear.Canalsobeseenin:-FingersToesPrepattelarbursaOlecranonAlthoughgouttypicallycuasesjointinflammation,itcanalsocauseinflammationinothersynovial-basedstructures,suchasbursaeandtendons.Tophiarecollectionsofuratecrystalsinthesofttissues.Theytendtodevelopafteraboutadecadeinuntreatedpatientswhodevelopchronicgoutyarthritis.Tophimaydevelopearlierinolderwomen,particularlythosereceivingdiuretics.
289.Alldrugsusedintreatmentofacutegout except a)Allopurinol b)Aspirin c)Colchicine d)Naproxen CorrectAnswer-AAns.is'a'i.e.,AllopurinolManagementofgoutTreatmentofacutegoutToproviderapidandsafepainreliefDrugsusedare:i)NSAIDs:Thesearethemostfrequentlyuseddrugstotreatgoutbecausetheyaresowelltolerated.IndomethacinistheagentofchoicebutotherNSAIDsmaybejustaseffective.Aspirinisusuallyavoidedbecauselowdosesofaspirinaggravatehyperuricemia.ii)Colchicinee:ColchicineiseffectivebutlesswelltoleratedthanNSAIDsiii)GlucocorticoidsQ:UsuallyreservedforpatientsinwhomcolchicinesorNSAIDsarecontraindicatedorineffective.Treatmentofchronicgout(maintainserumuratelevelsat5.0mg/dlorless)AllopurinolQ:XanthineoxidaseinhibitorAgentofchoiceformostpatientswithgouty'Uricosuricagents
Probenecid2SulfinpyrazoneQTreatmentofgoutaccordingtothestage Notreatmentindicated,thecausesshouldbe Asymptomatic determinedandany hyperuricemia associatedproblemshould beaddressedrigorously) Acutegouty NSAIDsorcolchicinesor arthritis glucocorticoid Intercritical Prophylacticcolchicines(to period reducefurtherattacks) Acute Uratelowering tophoaecous druggout (allopurinolorprobenecid,sulfinpyrinazole)
290.Wrongabourcontinuousmurmur a)Seenwithcoarctationofaorta b)PeaksatS2 c)Heardbothinsystoleanddiastole d)Increaseonsquatting CorrectAnswer-DAns.is'd'i.e.,IncreaseonsquattingAcontinuousmurmurisdefinedasonethatbeginsinsystoleandextendsthroughS2intopartorallofdiastole.Itneednotoccupytheentirecardiaccycle.Continuousmurmursarenotaffectedbydynamicauscultationmaneuverslikesquattingetc.Theycanofternbedifficulttodistinguishfromindividualsystolicanddiastolicmurmursinpatientswithmixedvalvularheartdisease.Theclassicexampleofacontinuousmurmuristhatassociatedwithapatentductusarteriosus,whichusuallyisheardinthesecondorthirdinterspaceataslightdistancefromthesternalborder.
291.Bananashapedleftventricleisseenin a)HOCM b)DCM c)RCM d)Takotsubocardiomyopathy CorrectAnswer-AAns.is'a'i.e.,HOCM Spherical Dilatedventricle cardiomyopathyStress Apical cardiomyopathy/ ballooning Tako-TsuboSpade- Apicalhypertrophic shaped cardiomyopathy ventricle Myocardial Distortion infarctions/ofventricle aneurysms/ remodeling Banana- Hypertrophic shaped cardiomyopathy ventricle
292.WideQRScomplex0.12secondsmaybe seeninallofthefollowing,except a)Hyperkalemia b)WolfParkinsonWhiteSyndrome c)VentricularTachycaridia d)LeftAnteriorFascicularBlock CorrectAnswer-DAns.is'd'i.e.,LeftAnteriorFascicularBlockLeftAnteriorFascicularBlockisapartialblockintheleftbundlesystemanddoesnotprolongtheQRSdurationsignificantly.TypicallytheQRSdurationisslightlyprolongedandremainsbetween0.10to0.12seconds.MajorcausesofawideORScomplexIntrinsicintraventricularconductiondelayoLeftbundlebranchblockandvariantsRightbundlebranchblockandvariantsoOthernonspecificIVCDpatternsExtrinsicintraventricularconductiondelayHyperkalemiaDrug-induced-type1antiarrhythmicdrugsandrelatedsodiumchannelblockingagents(eg,tricyclicantidepressantsandphenothiazines)VentricularbeatoPrematureoEscapePacedVentricularpreexcitationWolff:Parkinson-White(WPW)patternandvariantsFactitiousECGunintentionallyrecordedatfastpaperspeeds(50or100mm/s)
WideQRScomplextachyarrhythmiasVentriculartachycardiaSupraventriculartachycardiaoratrialfibrillationorflutterwithaberrantintraventricularconductiondueto:BundlebranchblockAtrioventricularbypasstract(preexcitationsyndromeswithorthodromicconduction
293.Subacturecombineddegenerationof cordiscausedduetodeficiencyof a)VitaminB1 b)VitaminB5 c)VitaminB6 d)VitaminB12 CorrectAnswer-DAns.is'd'i.e.,VitaminB12SubacatecombineddegenerationofthespinalcordisthetermusedforthedegenerationofthespinalcordduetovitaminB12deficiency.Thespinalcord,brain,opticnerves,peripheralnervesmayallbeaffectedinvitaminB12deficiencybutthespinalcordisusuallyaffectedfirstandexclusively.Thetractsmainlyinvolvedinthespinalcordare:oPosteriorcolumnCorticospinaltractLateronperipheralnervesareinvolvedClinicalfeaturesofvitaminBdeficiencyorsubacutecombineddegenerationofthecord:Patientfirstnoticesmildgeneralweakenssandparesthesiaconsistingoftingling'pinsandneedle'.Astheillnessprogressesthegaitbecomesunsteadyandstiffnessandweakenssofthelimbsandlegsdevelop.Ifthediseaseremainsuntreatedataxicparaplegiaevolve.Sometimestheremaybelossofsuperficialsensations,suchastactile,painandthermalsensations,butthesesignsarerare.Lossof"vibrationsense"isthemostconsistentsignandisusually
accompaniedbylossofpositionsensee.Motorsignsseenare:-LossofstrengthinproximallimbmusclesSpasticity,changesintendonreflexesClonusandextensorplantarresponsesSometimestendonreflexesmaybeabsente(duetoinvolvementofperipheralnerve)oGaitisataxicNow,TheClinicopathologicalCorrelation Clinical Tracts features involved Paresthesia,inpairmentof Duetolesiondeep inposterior sensationand columnataxiaWeakness, Dueto spasticityand corticospinal increased tract tendon involvement reflexes Dueto Occasional spinothalamic findingsof tract lossofpain involvement and (rarely temperature involved) Distaland Involvementof symmetrical peripheral impairmeatof nervesuperficial (occassionally)
294.Footulcersindiabetesareduetoall except a)Decreasedimmunity b)Neuropathy c)Microangiopathy d)Macroangiopathy CorrectAnswer-AAns.is'a'i.e.,DecreasedimmunityThereasonsfortheincreasedincidenceoffootulcersinDMinvolvetheinteractionofseveralpathogenicfactorsNeuropathy(Microvascularcomplication)Motorandsensoryneuropathyleadtoabnormalfootmusclemechanicsandstructuralchangesinthefoot(hammertoe,clawtoedeformity,prominentmetatarsalheads,Charcotjoint).AutonomicneuropathyResultsinanhidrosisandalteredsuperficialbloodflowinthefoot,whichpromotedryingoftheskinandfissureformation.PADandpoorwoundhealingimpedetheresolutionofminorbreaksintheskin,allowingthemtoenlargeandtobecomeinfected.Abnormalfootbiomechanics.P.A.D.(Macrovascularcomplication)Thisleadstoocclusivearterialdiseasethatresultsinischemiainthelowerextremityandanincreasedriskofulcerationindiabeticpatients.Poorwoundhealing.GradesofdiabeticfootulcersGrade0skinintactbutbonydeformitiesproducea"footatrisk".Grade1localized,superficialulcer.
Grade2deepulcertotendon,bone,ligament,orjoint.Grade3deepabscess,osteomyelitisGrade4gangreneoftoesorforefootGrade5gangreneoftheentirefoot
295.NotacauseofGynaecomastia a)Hypothyroidism b)Kallman c)obesity d)Klinefeltersyndrome CorrectAnswer-A.Ans.is'a'i.e.,HypothyroidismCausesofGynaecomastiaPubertyDuringpuberty,theserumoestradiolrisestoadultlevelsbeforetestosterone,causingtransientgynaecomastia.Thisnormallyresolveswithinsixmonthstotwoyears.CirrhosisGynaecomastiaoccursduetoalteredsexhormonemetabolism,andanincreaseintheoestradiol;freetestosteroneratio.HypogonadismPrimaryhypogonadismcausesacompensatoryriseinLH,inturncausingincreasedperipheralaromatizationoftestosteronetooestradiol.Secondaryhypogonadism,duetopituitaryorhypothalamicdisease(e.g.prolactinexcess,Kallman'ssyndromehaemachromatosis),mayalsocausegynaecomastiadespiteLHdeficiency,sincetheadrenalcortexcontinuestoproduceoestrogenprecursors,whichareconvertedtooestrogensinperipheraltissues.TumoursTesticulartumours:Germcelltumoursaccountforover95%testiculartumours.Gynaecomatiaoccursin5%ofpatients,duetohCGsecretion
stimulatingoestradolproductionbythetestes.Leydigcelltumourscausegynaecomastiain20?30%ofcases.Thesetumourspresentwithprecociouspubertyinboys,orpootlibidoandgynaecomastiainyoungmales.Approximately10%ofthesetumoursaremalignant.Sertolicellturnourscausegynaecomastiathroughexcessaromatizationofandrogentstooestrogens.TheseturnoursmayoccurinPeutz-Jeger'ssyndrome.Adrenocorticalturnoursmaycausegynaecomastiathroughoverproductionofandrogenssuchasandrostenedione,whichareconvertedtooestrogensinperipheraltissues.EctopichCG-secretingtumoursincludelung,gastric,renal,andhepatocellularcarcinomas.Hypogonadismfromchemotherapyorradiotherapymayalsocausegynaecomastiainpatientswithtesticulartumours.GravesdiseaseGynaecomastiamayoccurduetoincreasedsexhormone-bindingglobulin(SHBG),anddecreasedfreetestosteronelevels.Chronicrenalfailure:Halfofpatientsreceivinghaemodialysisdevelopgynaecomastiaduetodecreasedleydigcellfunction.Gynaecomastiamayalsooccurfollowingkidneytransplantationduetociclosporinuse.Androgeninsensitivitysyndrome:Completeandrogeninsensitivity,.formerlytermed'testicularfeminizationsyndrome',causesafemalephynotypeinpatientswhoaregenotypemales.Thesepatientsareregardedasfemale,andthereforepresentwithinfertilityandamenorrhoearathergynaecomastia.Partialandrogenreceptordefectsmaycausegynaecomastiainphenotypicmales.DrugscausegvnaecomastiaAnti-androgensCyproteroneacetateFinasteride/dutasterideGastrointestinaldrugsCimetidine/ranitidineCancerchemotherapyAlkylatingagents/vincaalkaloids(duetotesticulardamageand
hypogonadism)Imatinib(tyrosinekinaseinhibitorusedforchronicmyeloidleukemia(CML)andgastrointestinalstromaltumour(GIST).CardiovasculardrugsSpironolactone(displacesoestrogenfromSHBG,increasingfreeoestrogen:testosteroneratio)DigoxinAmiodaroneMethyl-dopaAntimicrobialdrugsIsoniazidKetoconazoleMetronodazoleAnti-viraldrugsHighlyactiveanti-retroviral(HAART)therapy(especiallyproteaseinhibitors)NeurologicaldrugsPhenothiazinesMetoclopramideTricyclicanti-depressantsOpiates
296.Braintumorcausinghypernatremiain children a)Medulloblastoma b)Cerebellarastrocytoma c)Craniophyrangioma d)Brainstemglioma CorrectAnswer-CAns.is'c'i.e.,CraniophyrangiomaCraniophyrangiomaleadstocentraldiabetesmellitusandresultantlossofwaterleadstohypernatremia.
297.Poorlycontrolleddiabeteswithblood sugarof450mg%isassociatedwith: a)Hyponatremia b)Hypernatremia c)Hypokalemia d)Hypomagnesemia CorrectAnswer-AAns.is'a'i.e.,HyponatremiaPoorlycontrolleddiabetesdrawswateroutofcellsresultinginhyponatremia.nPlasmaconcentrationfallsby1.4mmol/Lforevery100mg/d1riseinplasmaglucoseconcentrationofsodium.
298.Allofthefollowingdrugsmaybeusedin thetreatmentofulcerativecolitisExcept a)Corticosteroids b)Azathioprine c)Sulfasalazine d)Methotrexate CorrectAnswer-DAns.is'd'i.e.,MethotrexateMethotrexateincrohn'sdiseaseMethotrexatehasbeenshowntobeeffectiveforinducingremissioninpatientswithsteroiddependentandsteroidrefractorycrohn'sdisease.Agentsthatmaybeusedfortreatmentofulcerativecolitis5-ASAGlucocorticoidsAzathioprineand6mercaptopurineCyclosporineorTNFalphatherapy(Infliximab).Tacrolimusisamacrolideantibodythathasshowntobeeffectiveinadultswithsteroiddependentorrefractoryulcerativecolitis.Drugsusedincrohn'sdiseaseCyclosporineorinfliximab6-MercaptopurineorazathioprineGlucocorticoidIVGlucocorticoidoralGlucocorticoidrectal5-ASArectalororal
299.Withregardstohereditary spherocytosis,whichofthefollowingisfalse a)Usuallyhasautosomaldominantinheritance b)Causedbymutationsingenesforproteinssuchasspectrin, ankrinorband3 c)Redbloodcellsaredestroyedinthespleen d)Aplasticcrisesarecommon CorrectAnswer-DAns.is'd'i.e.,AplasticCrisisarecommonAplasticcrisisarearare/uncommoncomplicationofHereditarySpherocytosistypicallycausedbyvirallyinducedbonemarrowsuppression.ThemostcommonaetiologicalagentthatinducesAplasticCrisisinpatientswithHereditarySpherocytosisisParvovirusB19Hereditaryspherocvtosisusuallyhasautosomaldominantinheritancecausedbymutationingenesforproteinssuchasspectrin.ankrinorband3.ThegenesresponsibleforHSincludeakyrin,bspectrin,band-3-protein,a-spectrin,andprotein4.2.Inapproximatelytwo-thirdstothree-quarterofHSpatients,inheritanceisautosomaldominant.Intheremainingpatients,inheritanceisnon-dominantduetoautosomalrecessiveinheritanceofadenovomutation.InpatientswithhereditaryspherocvtosisRedbloodcellsaredestroyedinthespleenThespleenplaysacriticalroleinthepathobiologyofHS,asdestructionofspherocytesinthespleenistheprimarycauseof
hemolysisinHSpatients.AplasticCrisisisanUncommonComplicationAplasticcrisisfollowingvirallyinducedbonemarrowsuppressionareuncommon,butmayresultinsevereanaemiawithseriouscomplicationsincludingcongestiveheartfailureorevendeath.ThemostcommonaetiologicalagentinthesecasesisparvovirusB19.Parvovirusselectivelyinfectserythropoieticprogenitorcellsandinhibitstheirgrowth
300.Allofthefollowingaretrueregarding splenectomyinpatientswithhereditaryspherocytosis,except? a)Avoidinmildcases b)Delaysplenectomyuntilatleast4yearsoldage c)Anti-pneumococcalvaccinationmustbegivenbefore splenectomy d)Prolongedanti-pneumococcalantibioticprophylaxismustbe givenaftersplenectomy CorrectAnswer-DAns.is'd'i.e.,ProlongedAnti-pneumococcalAntibioticProphylaxismustbegivenaftersplenectomySplencectomvinpatientswithHereditaryspherocytosisAvoidsplenectomyinmildcases.Delaysplenectomyuntilatleast4yearsofageaftertheriskofseveresepsishaspeaked.Anti-pneumococcalvaccinationbefoesplenectomyisimperativewhileanti-pneumococcalprophylaxispost-splenectomyiscontroversial.
301.Mostcommonheavychaindiseaseis a)Franklindisease b)Seligmanndisease c)Muheavychaindisease d)Waldenstromcryoglobulinemia CorrectAnswer-BAns.is'b'i.e.,SeligmannDisease(Alphaheavychaindisease)Therearefourforms:*Alphachaindisease(Seligmann'sdisease)-mostcommontype*Gammachaindisease(Franklin'sdisease)*Muchaindisease*Deltachaindisease
302.Treatmentofchoiceinacutesarcoidosis is a)Prednisolone b)Cyclosporin c)Infliximab d)IVimmunoglobulins CorrectAnswer-AAns.is'a'i.e.,PrednisolonePrednisolone(corticosteroid)isthetreatmentofchoiceforbothacuteandchronicphaseofsarcoidosisthatrequirestreatment.
303.MDRTBmustbetreatedforatleast? a)12months b)18months c)20months d)36months CorrectAnswer-CAns.is'c'i.e.,20months Resistance(or Throughout RZE intolerance) (6)toHResistance(or Throughout HZEQ intolerance) (12-18)toR ZEQ+S(for Throughout Resistance another (atleast20 toH+R injectable months) agents) 1injectableagent+3of Resistance Throughout ofthese toallfirst- (atleast20 4linedrugs months ethionamidecycloserine,Q,PAS Intolerance HRE toZ
304.Thefollowingarethecomplicationof haemodialysisexcept- a)Hypotension b)Peritonitis c)Hypertension d)bleedingtendency CorrectAnswer-BAns.is'b'i.e.,PeritonitisPatientswithendstagerenaldisease(ESRD)onlongtermdialysistherapyhaveveryhighmortalityduetopredominantlycardiovascularcauses.'Suddencardiacdeathisthesinglemostcommonformofdeathinhemodialysis,accountingfor20%to30alldeathsinthiscohort.'Dialysispatientshaveextraordinarityhighmortailtyrateswithcardicdiseaseaccountingfor43percentdeathsinthispopulation.Dataindicatesthatapproximately27%ofthemortailtiesareduetosuddencardicdeath.MoreoncardiovascularcomplicationsindialysisCardiovasuculardiseaseisthemajorcauseofdeathinESRDpatientsandatherosclerosesispresentinalllongtermdialysispatients.Prematurecardiacdeathhasreachedepidemiclevelsinworlddialysispopulationoccurringfivetotentimesascommonlyasinagematchedgeneralpopulationandaccountingforatleasthalfofallpatientsdeath.oHypertensionisamajorriskfactorOtherriskfactorare:-Hyperphosphetemiaandelevatedcalciumphosphoruswithcalciumdepositionincoronaryarteries.
AnemiaHypertriglyceridemiaLowHDLcholesterolIncreasedlipoprotein(a)InsulindeficiencyorresistanceHyperhomocysteinemAlsoknowComplicationsofdialysis Acute Longterm complicationsof complications hemodialysisoHypotension oCardiovascular oCramps oAnemiaSecondary Nauseaand hyperparathyrodism vomiting and Headacheo MalnutritionoHepatitis(A,B,C, Chestpaino D,E Backpain DepressionoDialysis Itching encephalopathy Feverandchills MalignanttumoursCarpaltunnel syndrome Uremicneurophty
305.Themostlikelydiagnosisinthecaseofa patientwithmultiplepulmonarycavities,hematuriaandredcellcastsis a)Anti-GBMdisease b)Churg-Strauss c)Systemiclupuserythematousus d)Wegner'sgranulomatosis CorrectAnswer-DAns.is'd'i.e.,Wegner'sgranulomatosisMultilungcavitiesandhematuriaarecharacteristicofWegner'sgranulomatosis.Anti-GBMdisease(Goodpasture'ssyndrome)usuallydoesnotcauselungcavities.Churg-strausssyndromeusuallydoesnotcausehematuria.SLEisnotausualcauseoflungcavities.
306.Hung-upreflexesareseenin a)Chorea b)Atheotosis c)Cerebralpalsy d)Cerebellarpalsy CorrectAnswer-AAns.is'a'i.e.,ChoreaHungupkneejerkWhenpatellortendonistappedwhilethefootishangingfree,thelegmaybeheldinextensionforfewsecondsbeforerelaxingowingtoprolongedcontractionofquadriceps.Thisisseenin"chorea".OtherneurologicalsignsassociatedwithchoreaMilkmaidsgripPianosignHandwritingMilkmaid'sgripInabilitytomaintainsustainedvoluntarycontractionofmusclegroupataconstantlevel.Inabilitytoapplysteadypressureduringhandshakeleadingtoacharacteristicsqueezeandreleaseofgrip.Patient'shavedifficultymaintainingsustainedeyelidclosureandsustainedtongueprotrusion
307.Arsenicpoisoningcauses a)Polyneuritis b)Mononeuritismultiplex c)Radiculopathy d)Myelopathy CorrectAnswer-AAns.is'a'i.e.,PolyneuritisThereissensoryandmotor(i.e.mixed)polyneuropathy,withpainfulparesthesiaofhandsandfeetandmuscletenderness.
308.Tropicalpulmonaryeosinophiliais causedbecauseof a)Occultfilariasis b)Cerebralmelaria c)Penumonicplague d)Asthmaticbronchitis CorrectAnswer-AAns.is'a'i.e.,OccultfilariasisOccultfilariasisisarareconditionwhichiscausedbyhypersensitivityreactiontofilarialantigen.Microfilatiaareabsentintheblood.Lymphaticfilariasisisabsent.Indirectevidenceoffilarialinfectionisobtainedbydemonstratingantifilarialantibodies
309.CharacteristicECGfindingofpulmonary embolism a)Sinustachycardia b)SQ3T3 c)Twaveinversion d)Epsilonwaves CorrectAnswer-BAns.is`b'i.e.,SJQ3T3E.C.G.changesofpulmonaryembolism?Sinustachycardiaisthemostfrequentandnonspecificfindingonelectrocardiographyinacutepulmonaryembolism.FeaturessuggestingacuterightheartstrainontheECGoccurrelativelyinfrequently,theseinclude.AcuterightaxisdeviationPpulmonaleRightbundlebranchblockInvertedTwavesSTsegmentchangesinrightsidedleads.EarlierthefollowingE.C.G.changeswereconsideredhighlypredictiveofacutepulmonaryembolism,buttheseobservationswerefoundinlessthan12%ofpatientswithpulmonaryemboliinrecentstudies.TheseE.C.G.featuresare-SwaveinleadIQwaveinleadIIIInvertedTinleadIII("S1Q31.3")SwavesinleadI,IIandIII("Si,S2S3")Alsoknow
Areterialbloodgasanalysisinpulmonaryembolism:ArterialbloodgasanalysisshowsMidtomoderatehypoxemiaIncreasedP(A-a)0,MildlyreducedPaCO2AlmostallpatientswithpulmonaryembolismhavePaO,<80mmHgbutnoabsolutelevelofPa02canbeusedtoexcludethediagnosis.
310.Pleuraleffusioninrheumatoidarthritisis typicallyassociatedwiththefollowingfeaturesexcept a)Glucose>60mg/dl b)Protein>3gm/di c)Pleuralfluidprotientoserumproteinratioof>0.5 d)PleuralfluidLDHtoserumLDHratioof>0.6 CorrectAnswer-AAns.is'a'i.e.,Glucose>60mg/dlCausesoflowglucosepleuralfluidMalignancyRheumatoidarthritisEmpyemaHemothoraxParagonimiasisChurgstrausssyndromeLupuspleuritis(occasionally)
311.Inanklyosingspondylitisjoint involvementisleastin? a)Wristandhand b)Sacroiliacjoint c)Acromio-clavicularjoint d)Costochondraljunction CorrectAnswer-AAns.is'a'i.e.,WristandhandAnkylosingspondylitis(marie-strumpelldisease)Ankylosingspondylitisisachronicprogressiveinflammatorydiseaseofthesacroiliacjointsandtheaxialskeleton.Prototypeofseronegative(absenceofrheumatoidfactor)spondyloarthropathies.Inflammatorydisorderofunknowncause.Usuallybeginsinthesecondorthirddecadewithamedianageof23,in5%symptomsbeginafter40.Maletofemaleratiois2-3:1StrongcorrelationwithHLA-B2790-95%ofcasesarepositiveforHLA-B27.JointsinvolvedinankylosingspondylitisPrimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspineIntheworstcasesthehipsorshouldersarealsoaffected.oHipjointisthemostcommonlyaffectedperipheraljoint.oRarelykneeandanklearealsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,ligamentsorjointcapsuleonboneisoneofthehallmarksofthisentityofdisease.Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftentheearliestmanifestationofA.S..Involvementofcostovertebraljointsfrequentlyoccur,leadingtodiminishedchestexpansion(normal5cm)Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rdpatients.Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarelyaorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.Pathologicalchangesproceedinthreestages?Inflammationwithgranulationtissueformationanderosionofadjacentbone.FibrosisofgranulationtissueOssificationofthefibroustissue,leadingtoankylosisofthejoint.Inflammatoryboweldisease(CD,UC)mayalsobeseen.Clinicalfeatures(symptoms)LowbackpainofinsidiousonsetDurationusuallylessthan3monthsSignificantmorningstiffnessandimprovementwithexerciseLimitedchestexpansionDiffusetendernessoverthespineandsacroiliacjointsLossoflumbarlordosis,increasedthoracickyphosisDecreasedspinalmovements(especiallyextension)inalldirections.RadiologicalfeaturesofankvlasingspondylitisRadiographicevidenceofsacroiliacjointisthemostconsistentfindinginankylosingspondylitisandiscrucialfordiagnosis.Thefindingsare:-DSclerosisofthearticulatingsurfacesofSIjointsWideningofthesacroiliacjointspaceBonyankylosisofthesacroiliacjointsCalcificationofthesacroiliacligamentandsacro-tuberousligamentsEvidenceofenthesopathy-calcificationattheattachmentofthemuscles,tendonsandligaments,particularlyaroundthepelvisandaroundtheheel.X-rayoflumbarspinemayshow:-
LiSquaringofvertebrae:Thenormalanteriorconcavityofthevertebralbodyislostbecauseofcalcificationoftheanteriorlongitudinalligament.Lossofthelumbarlordosis.Bridging'osteophytes'(syndesmophytes)BamboospineappearanceIntheearlydiseaseprocess,plainx-raysmaybereadasnormal.MoreaccurateandearlydiagnosiscanbedonebyusingMR1and/orCTscan.DynamicMRIwithfatsaturation,eithershorttauinversionrecovery(STIR)sequneceorTIweightedimageswithcontrastenhancementishighlysensitiveandspecificforidentifyingearlyintra-articularinflammation,cartilagechanges,andunderlyingbonemarrowedemainsacroilitis.Magneticresonanceimagingallowsforvisualizationofacutesacroilitis,spondylitis,andspondylodiscitis,andcanalsodetectacuteinflammationoftheentheses,boneandsynovium.Theabilitytodetectearlyinflammatiionandacuratelyvisualizecartilaginousandenthesallesionsmakesmagneticresonanceimagingausefulassessmenttoolinthespondyloarthropathies.
312.Leastcommonsiteinvolvedin osteoarthritisis a)Hipjoint b)Kneejoint c)Carpometacarpaljointofthumb d)Distalcarpophalangealjoint CorrectAnswer-CAns.is'C'Inthehandthejointsspecificallyinvolvedare?Distalinterphalangealjoin&(ofparticularimportanceisthepointthatthisjointisnotinvolvedinrheumatoidarthritis).Proximalinterphalangealjoin&FirstcarpometacarpaljointsQRememberthesetwoimportantfeaturesofjointinvolvementinosteoarthritisItdoesnotinvolvethemetacarpophalangealjointsoItdoesnotinvolvethewristjoINTEGER(2.ItalsodoesnotinvolvethecarpometacarpalQjoint(exceptatthebaseofthumb).Osteoarthritisinvolvesthecarpometacarpaljointatthebaseofthumb,infactitisthesecondmostcommonareaofinvolvementinosteoarthritis.OtherjointswhicharecommonlyinvolvedinosteoarthritisareHips,Knees,LowerlumbarCervical.Jointswhichareusuallysparedinosteoarthritisare
WristsQ,carpometacarpaleElbowsQShoulderjoint
313.InvertedTwavesareseenin a)Hyperkalemia b)Hyperthermia c)Wellensyndrome d)Coronarysyndrome CorrectAnswer-CAns.is'c'i.e.,WellensyndromeSevereanteriorwallIschemia(withorwithoutinfarction)maycauseprominentT-waveinversionsintheprecordialleads.Thispattern(sometimesreferredtoasWellensT-waves)isusuallyassociatedwithahigh-gradestenosisoftheleftanteriordescendingcoronaryartery.HyperkalemiahastallTentedT-waves.CoronarysyndromeXischaracterisedbyblockageofperforatorswhiletheepicardialcoronaryarteryisnormal.Inthesepatientsstentingofcoronariesisnotuseful.Nitratesaremainstayoftherapy.
314.WideQRScomplexistypicallyseenin a)BundleBranchblock b)Sicksinussyndrome c)MobitztypeIblock d)MobithztypeIIblock CorrectAnswer-AAns.is'a'i.e.,BundleBranchblockRepeatfromprevioussession.IntrinsicintraventricularconductiondelayssuchasleftbundleblockandrightbundlebranchblockareassociatedwithwideQRScomplex.
315.LowQRSvoltageonECGindicates? a)Pulmonaryembolism b)Pericardialeffusion c)Corpulmonale d)Infectiveendocarditis CorrectAnswer-BAns.is'b'i.e.,PericardialeffusionCausesoflowvoltageQRScomplexesAdrenalinsufficiencyAnasarcaArtifactualorspurious,eg,unrecognizedstandardizationofECGatone-halftheusualgain(i.e.,5mm/mv)Cardiacinfiltrationorreplacement(e.g.,amyloidosis,tumor)Cardiactransplantation,especiallywithacuteorchronicrejectionCardiomyopathy,idiopathicorsecondaryChronicobstructivepulmonarydiseaseConstrictivepericarditisHypothyroidism,usuallywithsinusbradycardiaLeftpneumothorax(mid-leftchestleads)Myocardialinfarction,extensiveMyocarditis,acuteorchronicNormalvarianObesityPericardialeffusionPericardialtamponade,usuallywithsinustachycardiaPleuraleffusions
316.65-year-oldmanpresentswithanemia, posteriorcolumandysfunction,andplanterextensor.Whichofthefollowingisthelikelycause a)Tabesdorsalis b)Frederich'sataxia c)VitaminB1deficiency d)VitaminB12deficiency CorrectAnswer-DAns.is'd'i.e.,VitaminB12deficiencyAnemiaalongwithinvolvementofposteriorcolumnischaracteristicofsubacutecombineddegenerationofspinalcordcausedbyvitaminB12deficiency.
317.Proptosisisnotseenin a)Grave'sdisease b)Sarcoidosis c)Pituitaryadenoma d)Myxoedema CorrectAnswer-DAns.is'd'i.e.,MyxoedemaProptosisoccursinthyrotoxicosisnotinhypothyroidism Choices LogicCytokinesappeartoplayamajorroleinthyroid-associatedophthalmopathyThereisinfiltrationoftheextraocularmusclesbyactivatedTcells;thereleaseofcytokinessuchas Grave's IFN-alphaandTNFresultsinfibroblastactivationandincreasedsynthesisofglycosaminoglycansthattrapwater,therebyleadingtocharacteristicmuscleswellingApproximately20%,of
Approximately20%,ofpatientswithophthalmicfindingsofsarcoidhavesofttissueinvolvementof Sarcoidosis theorbitorlacrimal glandandpresentasamasslesionwithproptosis,ptosis,orophthalmoplegia.Macro-adenoma Pituitary associatedwith adenoma pituitaryapoplexycanleadtoproptosis.
318.Trueaboutobesity a)Seenmostlyinfemales b)Prevalencedecreaseupto40yearsofage c)Nogeneticpredisposition d)Smokingisariskfactor CorrectAnswer-DAns.is'd'i.e.,SmokingisariskfactorCessationofsmokingWeightgainisverycommonwhenpeoplestopsmoking.Thisisthoughttobemediatedatleastinpartbynicotinewithdrawal,whichisassociatedwithincreasedfoodintakeandreducedenergyexpenditure.Weightgainof1to2kginthefirsttwoweeksisoftenfollowedbyanadditional2to3kgweightgainoverthenextfourtofivemonths.Theaverageweightgainis4to5kgbutcanbemuchgreater.Obesityiscommoninbothmenandwomen(morecommoninwomen).EtiologicClassificationofObesitylatrogeniccausesDrugsthatcauseweightgainHypothalamicsurgeryDietaryobesityInfantfeedingpracticesProgressivehyperplasticobesityFrequencyofeatingHighfatdietsOvereatingNeuroendocrineobesities
HypothalamicobesitySeasonalaffectivedisorderCushing'ssyndromePolycysticovarysyndromeHypogonadismGrowthhormonedeficiencyPseudohypoparathyroidismSocialandbehavioralfactorsSocioeconomicstatusEthnicityPsychologicalfactorsRestrainedeatersNighteatingsyndromeBinge-eatingSedentarylifestyleEnforcedinactivity(post-operative)AgingGenetic(dysmorphic)obesitiesAutosomalrecessivetraitsAutosomaldominanttraitsX-linkedtraitsChromosomalabnormalitiesOtherLowbirthweight
319.Whatistheofcorrectionofsodium deficit a)0.5mmol/hour b)1mmol/hour c)1.5mmol/hour d)2.0mmol/hour CorrectAnswer-AAns.is'a'i.e.,0.5mmol/HrForserioussymptomatichyponatremia,thefirstlineoftreatmentispromptintravenousinfusionofhypertonicsaline,withatargetincreaseof6mmol/Lover24hours(notexceeding12mmol/L)andanadditional8mmol/Lduringevery24hoursthereafteruntilthepatient'sserumsodiumconcentrationreaches130mmol/L.
320.Maximumlossofsodiuminachild occursin a)Gastricjuice b)Ilealfluid c)NoncholeraDiarrhoea d)Cholera CorrectAnswer-BAns.is'b'i.e.,healfluidCationsandanionsinbiologicalfluidsinmeq/dl Fluid Sodium Potassium Chloride Gastric 60 10 85 juiceheal 130 10 115 fluidDiarrhea 10-90 10-80 10-110 stool
321.WithregardstoG6PDdeficiency,which ofthefollowinginfalse a)Affectsthepentosephosphatepathway b)Associatedwithneonataljaundice c)Acutehaemolysiscanbeprecipitatedbybroadbeans d)X-linkedrecessivedisorderthatdoesnotaffectheterozygous famales CorrectAnswer-DAns.is'd'i.e.,X-linkedrecessivedisorderthatdoesnotaffectheterozygousfamalesGlucose6-phosphatedehydrogenase(G6PD)deficiency,anX-linkeddisorder,isthemostcommonenzymaticdisorderofredbloodcellsinhumans,affecting400millionpeopleworldwide.ClinicalspectrumTheclinicalexpressionofG6PDvariantsencompassesaspectrumofhemolyticsyndromesThefourformsofsymptomaticG6PDdeficiency:AcutehemolyticanemiaFavismCongenitalnonspherocytichemolyticanemiaNeonatalhyperbilirubinemiaG6PDdeficiencyisexpressedinmalescarryingavariantgenethatresultsinsufficientenzymedeficiencytoleadtosymptoms.AcutehemolyticanemiaAlmostallindividualswiththemostprevalentG6PDvariants,G6PDA-andG6PDMediterranean,areasymptomaticinthesteadystate.Theyhaveneitheranemia,evidenceofincreasedredcelldestruction,noranalterationinbloodmorphology,.oHowever
suddendestructionofenzymedeficienterythrocytescanbetriggeredbycertaindrugsorchemicals,byselectedinfections,andrarelybymetabolicabnormalities(eg,diabeticketoacidosis).ClinicalcourseAttwotofourdaysafterdrugingestion,thereisthesuddenonsetofjaundice,pallor,anddarkurine,withorwithoutabdominalandbackpain.Thisisassociatedwithanabruptfallinthehemoglobinconcentrationof3to4g/dL,duringwhichtimetheperipheralbloodsmearrevealsredcellfragments,microspherocytes,andeccentrocytesor"bite"cells.Theanemiainducesanappropriatestimulationoferythropoiesis,characterizedbyanincreaseinreticulocytesthatisapparentwithinfivedaysandismaximalat7to10daysaftertheonsetofhemolysis.Evenwithcontinueddrugexposure,theacutehemolyticprocessendsafteraboutoneweek,withultimatereversaloftheanemia.IncitingeventsPatientswithclassIIorIIIvariantsdevelopintermittenthemolysisonlyafteroneormoreofthefollowingincitingevents.InfectionOxidantdrugsChemicalagents(eg,mothballs,anilinedyes,hennacompounds)DiabeticketoacidosisIngestionoffavabeansDrugsandchemicalsPrimaquine,dapsone,andanumberofotherdrugscanprecipitatehemolysisinG6PDdeficientsubjects.Foods:favabeansandbittermelonG6PDdeficiencycanalsobeprecipitatedbythetheingestionoffreshfavabeans(favism).Manifestationoffavismbegins5-24hrsafterfavabeaningestionandincludeheadache,nausea,backpain.CongenitalnonspherocytichemolyticanemiaPatientswithclassIG6PDvariantshavesuchsevereG6PDdeficiencythatlifelonghemolysisoccursintheabsenceofinfectionordrugexposure.
Suchpatientsfallunderthecategoryofhavingcongenitalnonspherocytichemolyticanemia.TheseG6PDvariantshavelowinvitroactivityand/ormarkedinstabilityofthemolecule,andmosthaveDNAmutationsattheglucose-6-phosphateorNADPbindingsites.ThesesitesarecentraltothefunctionofG6PD,whichoxidizesglucose-6-phosphateandreducesNADPtoNADPH.Itispresumedthatthefunctionaldefectissoseverethattheredcellscannotwithstandeventhenormaloxidativestressesencounteredinthecirculation.Anemiaandjaundiceareoftenfirstnotedinthenewbornperiod,andthedegreeofhyperbilirubinemiaisfrequentlyofsufficientseveritytorequireexchangetransfusion.Afterinfancy,hemolyticmanifestationsaresubtleandinconstant.Mostindividualshavemildtomoderateanemia(hemoglobin8to10g/dL)withareticulocytecountof10to15percent.Pallorisuncommon,scleralicterusisintermittent,splenomegalyisrare,andsplenectomygenerallyisoflittlebenefit.Hemolysiscanbeexaggeratedbyexposuretodrugsorchemicalswithoxidantpotentialorexposuretofavabeans.SomedrugswithrelativelymildoxidantpotentialthataresafeinpatientswithclassIIorclassIIIG6PDvariantsmayincreasehemolysisinpatientswithclassIvariants.NeonatalhyperbilirubineiniaTheclinicalpictureofneonataljaundiceduetoG6PDdeficiencydiffersfromneonataljaundiceseeninhemolyticdiseaseofthefetusandnewborn(HDFN)associatedwithRh(D)incompatibilityintwomainrespects.G6PDdeficiency-relatedneonataljaundiceisrarelypresentatbirth;thepeakincidenceofclinicalonsetisbetweendaystwoandthree.aThereismorejaundicethananemia,andtheanemiaisrarelysevere.Theseverityofjaundicevarieswidely,frombeingsubclinicaltoimposingthethreatofkernicterusifnottreated
322.Allofthefollowingstatementsabout geneticsofG6PDdeficiencyaretrue,except a)X-linkedinheritance b)MoresevereinMen c)ContradictsLyonHypothesis d)MayaffectHeterozygousfemales CorrectAnswer-CAns.is'c'i.e.,ContradictsLyonHypothesisGeneticsofG6PDThegeneforG6PDislocatedontheXchromosome(bandXq28)[8]andhasbeenclonedandsequenced.oEventhoughfemaleshavetwoXchromosomespercell,normalmalesandfemaleshavethesameenzymeactivityintheirredcellsbecauseoneoftheXchromosomesineachcellofthefemaleembryoisinactivatedandremainsinactivethroughoutsubsequentcelldivisions(Lyonhypothesis).G6PDdeficiencyisexpressedinmalescarryingavariantgene,whileheterozygousfemalesareusuallyclinicallynormal.However,themeanredbloodcellenzymeactivityinheterozygousfemalesmaybenormal,moderatelyreduced,orgrosslydeficientdependinguponthedegreeoflyonizationandthedegreetowhichtheabnormalG6PDvariantisexpressed.G6PDsupportsLyon'shypothesis:-Accordingtolyon'shypothesisoneofthetwochromosomeineachcellofthefemaleembryoisinactivatedandremainsinactivethroughoutsubsequentcelldivision.
G6PDisinheritedasanX-linked(recessive)disorder,itismorecommoninmales.HeterozygousFemalemayalsobeaffecteddependontheextentoflyonisation(inactivationofoneX-chromosome)buttheoverallaveragedegreesofhemolysisinheterozygousfemaleisless.Aheterozygousfemalewith50percentnormalG6PDactivityhas50percentnormalredcellsand50percentG6PD-deficientredcells.Thedeficientcellsareasvulnerabletohemolysisastheenzyme-deficientredbloodcellsinmales.MaleMales,whohaveonlyonecopyoftheXchromosome,areeithernormalorhemizygousforthevariantglucose6-phosphatedehydrogenase(G6PD)gene.Thus,G6PDdeficiencyisexpressedinmalescarryingavariantgeneontheirXchromosomethatproducessufficientenzymedeficiencytoleadtosymptoms.Alloftheredcellsinaffectedmalesarevulnerabletohemolysis.FemaleFemales,whohavetwocopiesoftheXchromosome,areeithernormal,heterozygous,orhomozygousforthevariantgene.Heterozygousfemalesareusuallyclinicallynormal.However,theirmeanredbloodcellenzymeactivitymaybenormal,moderatelyreduced,orgrosslydeficientdependinguponthedegreeofXchromosomeinactivation(lyonization)andthedegreetowhichtheabnormalG6PDvariantisexpressed.Afemalewith50percentnormalG6PDactivity,duetoinactivationofoneXchromosomeineachcellvialyonization,has50percentnormalredcellsand50percentG6PD-deficientredcells.Thedeficientcellsareasvulnerabletohemolysisastheenzyme-deficientredbloodcellsinmales.Homozygousfemalesareasseverelyaffectedclinicallyashemizygousmales.Alloftheirredcellsarevulnerabletohemolysis
323.Plateletsinstoredblooddonotliveafter a)24hours b)48hours c)72hours d)96hours CorrectAnswer-CAns.is'c'i.e.,72hoursPlateletsareprovidedasapooledpreparationfromoneorseveraldonors,usuallyasa6-unitbag,whichistheusualamountgiventoanaverage-sizedadult.Eachunitcontainsapproximately8x101?plateletsandshouldincreasetheplateletcountbyabout7000-10,000/pLina75kgadult.Plateletsstoredatroomtemperaturecanbeusedforupto5daysandhavealifespanof8days.Thosestoredat4?Careusefulforonly24hours(only50-70%oftotalplateletactivityispresentat6hours)andhavealifespanofonly2-3days.ABOcompatibilityshouldbeobservedforplatelets,butisnotessential.Foreachdonorused,thereisasimilarriskoftransmittinghepatitisandHIVasforoneunitofblood.Plateletshouldbeadministeredthrougha170pmfilter.
324.Earliestandoftentheonlypresentation ofTBkidneyis a)Increasedfrequency b)Colickypain c)Hematuria d)Renalcalculi CorrectAnswer-AAns.is'a'i.e.,IncreasedfrequencyUrinaryfrequency,dysuria,nocturia,hematuria,andflankorabdominalpainiscommonpresentations.However,patientsmaybeasymptomaticandthediseaseisdiscoveredonlyafterseveredestructivelesionsofthekidneyshavedeveloped.Urinalysisgivesabnormalresultsin90%ofcases,revealingpyuriaandhematuria.Thedocumentationofculture-negativepyuriainacidicurineraisesthesuspicionofTB.IVpyelography,abdominalCT,orMRImayshowdeformitiesandobstruction,andcalcificationsandureteralstricturesaresuggestivefindings.Cultureofthreemorningurinespecimensyieldsadefinitivediagnosisinnearly90%ofcases.
325.MostcommoncauseofdiarrheainAIDS patients? a)Salmonellatyphimurium b)Cryptosporidium c)Candida d)isophora CorrectAnswer-BAns.is'b'i.e.,CryptosporidiumMostcommoncauseofdiarrheainHIVCryptosporidium.DiseasesofOropharvnxandGIsysteminH.I.V.Theseare:?Orallesions:Thrush(oralcandidiasis),oralHairyleukoplakia(causedbyEBV),andaphthousulcer.Esophageal:EsophagitisbyCMV,HSVorcandida.Diarrhea:Diarrheaiscausedby:-Bacteria:Salmonella,Shigella,Campylobacter,andmycobacteriaaviumintracellulare.Fungal:Histoplasma,Coccidioides,penicillium.Other:CMV,microsporidia,isosporahelli,andcryptosporidia.AIDSenteropathy(HIVenteropathy)
326.Notseenwithuremiclung a)alveolarinjury b)Pulmonaryedema c)Interstitialfibrosis d)Fibrinousexudateinalveoli CorrectAnswer-CAns.is'c'i.e.,InterstitialfibrosisUremiclungisreferredtoabnormalitiesexpressedchestx-rayabnormalitiesseeninpatientswithCKD.Thepathogenesiswasbelievedtoberelatedtobloodureanitrogenandcreatinineretention.Thereis:Itspathophysiologyisbasedonuremia-inducedincreasedpermeabilityofpulmonaryalveolo-capillaryinterfaces,leadingtoInterstitialandintra-alveolaredemaAtelectasisAlveolarhemorrhagePulmonaryhyalinemembraneformation.Thesechangesarecompoundedbybleedingdiathesissecondarytoplateletdysfunctioninadvancedrenaldisease.Thepulmonarysymptomsandradiographicfindingsarereversiblewithhemodialysis.
327.OliguricphaseofARFischaracterized byA/E a)Chestpain b)Acidosis c)Hypertension d)Hypokalemia CorrectAnswer-DAns.is'd'i.e.,Hypokalemia Maintenancephase(Oliguricphase)(Lastsfor1-2weeks)Uremiccomplicationsandelectrolyteabnormalitiesariseduringthisphase-?GFRreachesitslowestpoint,urineoutputislowest(typically5-10ml/min)?Duetofluidoverloadanddecreasedelectrolyteexcretion,followingelectrolyteabnormalitiesareseen?Hyperkalemia-(d/treducedexcretion).Hyponatremia-s(d/tvolumeoverload).Hyperphosphatemia4(d/treducedexcretion).Hypermagnesemia-(d/treducedexcretion).Hyperuricemia->(d/treducedexcretion).Hypocalcemia->(d/tdepositionofcalciumphosphate).ElevationofB.U.N.4(d/treducedexcretion).Hyposmolality->(d/tvolumeoverload).Anemia4(d/tImpairederythropoiesisHemolysis,bleedingDilution)
328.InEEGtypeofwaveseeninmetabolic encephalophathy a)Alpha b)Beta c)Gamma d)Delta CorrectAnswer-DAns.is'cl'i.e.,DeltaE.E.G.changesinmetabolicencephalopathyInmetabolicencephalopathychangesaretypicallynonfocalE.E.G.hasbeenwidelyusedtoevaluatemetabolicencephalopathy.TheE.E.G.findingsareabnormalinacuteencephalopathicstages.ItisdifficulttoestablishadiagnosisofmetabolicencephalopathywithcertainitythroughE.E.G.ThereisgeneralizedslowingoftheE.E.Gwithanexcessofthedeltaandthetawaveswithsuppressionofnormalalphaandbetawaveactivityandoccasionallybilateralspikesandwavescomplexesoccurringinabsenceofseizureactivity".Inmetabolicencephalopathies,theE.E.Gevolutioncorrelateswellwiththeseverityofencephalopathy.oHoweverEEGhaslittlespecificityindifferentiatingetiologiesinmetabolicencephalopathy.Forexample,thoughtriphasicwavesaremostfrequentlymentionedinhepaticencephalopathy,theycanalsobeseeninuremicencephalopathyoreveninagedpsychiatricpatientstreatedwithlithium.oSpikesandwavesmayappearinhypoorhyperglycemiauremicencephalopathyorvitamindeficiencies.CommonprinciplesofEEGchangesinmetabolic
encephalopathyare:-VarieddegreesofslowingAssociatedmixturesofepilepticdischargeHighincidenceoftriphasicwavesReversibilityaftertreatmentofunderlyingcauses Metabolic EEGrythm encephalopathy Dominantactivityis GradeI(almost alpharhythmwith normal) minimaltetaactivityDominantteta GradeII(mildly backgroundwithabnormal) somealphaanddeltaactivities.Continuousdelta GradeII activity (moderately predominates,little abnormal) activityoffasterfrequenciesLow-amplitudedelta GradeIV activityor (severely suppression-burst abnormal) pattern GradeV Nearly"flat"tracing (extremely orelectrocerebral abnormal) inactivity.
329.Asbestosiscausesallexcept a)Shaggyheartborders b)Honeycombing c)Hilarlymphadenopathy d)Basalperibronchialfibrosis CorrectAnswer-CAns.is'c'i.e.,HilarlymphadenopathyAsbestosiscausesfibrosisinthelowerlobesofthelung.Pleuralplaqueformedbyasbestosismostcommonlyaffectsanterolateralandposterolateralaspectsofparietalpleuraandoverthedomeofdiaphragm
330.Themostcommoncauseofsudden deathinsarcoidosisis a)Pneumonia b)Corpulmonale c)Arrythmias d)Liverfailure CorrectAnswer-CAns.is'c'i.e.,ArrhythmiasCardiacinvolvementoccursinitiallywithinflammationandgranulomaformationfollowedbyscarring.Theinitialinflammationcanleadtotriggeredventriculararrhythmiaswithsubsequentscarringresultinginthesubstrateforreentrantmonomorphicventriculartachycardia.
331.MostcommoncauseofunilateralHilar lymphadenopathy a)Histoplasmosis b)Sarcoidosis c)Aspergillosis d)Tuberculosis CorrectAnswer-DAns.is'd'i.e.,TuberculosisPrimaryTBmostcommonlypresentswithfocalalveolarpneumoniaandassociatedunilateralhilarormediastinaladenopathy.
332.WhichofthefollowingiscauseofRBBB a)Itcanoccurinanormalperson b)Pulmonaryembolism c)Corpulmonale d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveCausesofRBBBNormalphysiologicalPulmonaryembolism/corpulmonalePulmonaryarteryhypertensionASDRheumaticheartdisease
333.AlternatingRBBBwithLeftanterior hemiblockisseenin a)1'degreeheartblock b)Completeheartblock c)MobitztypeIIblock d)Bi-fascicularblock CorrectAnswer-DAns.is'd'i.e.,Bi-fascicularblockBifascicularblockcombinationofRBBBwitheitherleftanteriorhemiblockorleftposteriorhemiblock.TrifascicularblockRBBBpluseitherLAHB/LPHB+firstdegreeAVblock.CompleteheartblockdestructionofAVnodeleadingtoAVdissociation
334.InLVH,SV1+RV6ismorethanmm a)25 b)30 c)35 d)45 CorrectAnswer-CAns.is'c'i.e.,35ArrhythmiasbyKathrynLewisp.219]oInLVH,SV-1plusRV-6ismorethan15mm.TodiagnosetheleftventricularhypertrophyonECGoneofthefollowingcriteriashouldbemet:?Thesokolow-lyoncriteriaismostoftenused-RinV,orV6+5inV>35mminmenThecornell-criteriahasdifferentvaluesRinaVLandSinV3>28mminmenRinaVLandSinV3>20mminwomenAstheleftventricularwallbecomesthickerQRScomplexesarelargerinleadsV1-V6SwaveisdeepinV,RwaveishighinV4STdepressioninV,,-V,(strainpattern)
335.Mostcommonsiteforberryaneurysm rupture a)Anteriorcirculationofbrai b)Posteriorcirculationofbrain c)Ascendingaorta d)Descendingaorta CorrectAnswer-AAns.is'a'i.e.,AnteriorcirculationofbrainThemostcommonsitesindescendingorderoffrequencyare-LiProximalportionofanteriorcommunicatingartery(atthejunctionofanteriorcommunicatingarterywithcerebralartery)Attheoriginoftheposteriorcommunicatingarteryfromthestemoftheinternalcarotidartery.Atthefirstmajorbifurcationofmiddlecerebralartery.Atthebifurcationofinternalcarotidintomiddleandanteriorcerebralarteries.Vertibrobasilarbifurcation(3%)
336.Obesityisseeninallexcept a)Cushingsyndrome b)Pickwiniansyndrome c)Praderwillisyndrome d)Sipplesyndrome CorrectAnswer-DAns.is`d'i.e.,SipplesyndromeImportantsyndromesassociatedwithobesityAlbrighthereditaryosteodystrophy(pseudohypoparathyroidismtypela)AlstromsyndromeBardet-BiedlsyndromeBeckwith-WiedemannsyndromeCarpentersyndromeCohensyndrome?Prader-willisyndrome
337.Causeofdeathindiabeticketoacidosis inchildren a)Cerebraledema b)Hypokalemia c)Infection d)Acidosis CorrectAnswer-AAns.is'a'i.e.,CerebraledemaHighbloodsugarwillcrosstheblood-brainbarrierandsimultaneouslywilldrawwaterinsideleadingtocerebraledema.Cerebraledemaaccountsfor60-90%ofallDKArelateddeathsinchildren.InfectionisaprecipitatorforthedevelopmentofDKA.Otherprecipitatingfactorscanbetissueischemia,inadequateinsulinadministration,drugs(cocaine)andpregnancy.
338.Acutehyponatremiabecomes symptomaticat a)<135mEq b)<125mEq c)<120mEq d)<110mEq CorrectAnswer-BAns.is'b'i.e.,<125mEqSerumlevelofsodiumatwhichsymptomsdevelopAcute<125meq/LChronic<120meq/LHyponatremiaiscommonlydefinedasaserumsodium<135mmol/L(<135mEq/L).Neurologicalsymptomsoccuratdifferentlevelsoflowsodium,dependingnotonlyontheabsolutevaluebutalsoontherateoffall.Inpatientswithhyponatremiathatdevelopsoverhours,life-threateningseizuresandcerebraledemamayoccuratvaluesashighas125mmol/L.Incontrast,somepatientswithmorechronichyponatremiathathasslowlydevelopedovermonthstoyearsmaybeasymptomaticevenwithserumlevels<110mmol.AcuteorhvperacutehvponatremiaThehyponatremiadevelopedwithintheprevious24hours,itiscalled"acute."Ifthehyponatremiadevelopedoverjustafewhoursduetoamarkedincreaseinwaterintake(self-inducedwaterintoxication,asmaybeseeninmarathonrunners,psychoticpatients,andusersofecstasy),itiscalled"hyperacute."
ChronichyponatremiaIfitisknownthatthehyponatremiahasbeenpresentfbrmorethan48hours,orifthedurationisunknown(suchasinpatientswhodevelophyponatremiaathome),itiscalled"chronic."MildtomoderatehyponatremiaMildhyponatremiaisusuallydefinedasaserumsodiumconcentrationbetween130and135meq/L.Moderatehyponatremiaisoftendefinedasaserumsodiumconcentrationbetween121and129meq/L.SeverehvponatremiaSeverehyponatremiacanbedefinedasaserumsodiumof120meq/Lorless.SymptomsofhvponatremiaAbsentsymptomsPatientswithhyponatremiaarefrequentlyasymptomatic,particularlyifthehyponatremiaischronicandofmildormoderateseverity(ie,serumsodium>120meq/L).However,suchpatientsmayhavesubclinicalimpairmentsinmentationandgait.MildtomoderatesymptomsMildtomoderatesymptomsofhyponatremiaarerelativelynonspecificandincludeheadache,nausea,vomiting,fatigue,gaitdisturbances,andconfusion.Inpatientswithchronichyponatremia(ie,>48hoursduration),thesefindingsarenotassociatedwithimpendingherniation;however,inpatientswithmoreacutehyponatremia,suchsymptomsshouldbeconsideredominousandmayevolvewithoutwarningtoseizures,respiratoryarrest,andherniation.SeveresymptomsSeveresymptomsofhyponatremiaincludeuSeizuresObtundationComaRespiratoryarrest.
339.Hyponatremiaisseenin a)Hyperthyroidism b)Hypothyroidism c)Diabetesinsipidus d)Increasedinsensiblelosses CorrectAnswer-BAns.is'b'i.e.,Hypothyroidism[RefHarrison's18thHypothyroidismischaracterisedbylowcardiacoutputleadingtoincreasedAVPproductionandresultanthyponatremia.AddisondiseasemustberuledoutinchroniccasesofhyponatremiaMajorcausesofhyponatremiaDisordersinwhichADHlevelsareelevatedEffectivecirculatingvolumedepletionTruevolumedepletionHeartfailureCirrhosisThiazidediureticsSyndromeofinappropriateADHsecretion,includingresetosmostatpatternHormonalchangesAdrenalinsufficiencyHypothyroidismPregnancyDisordersinwhichADHlevelsmaybeappropriatelysuppressedAdvancedrenalfailurePrimarypolydipsiaBeerdrinker'spotomama
HyponatremiawithnormalorelevatedplasmaosmolalityHighplasmaosmolality(effectiveosmols)HyperglycemiaMannitolHighplasmaosmolality(ineffectiveosmols)RenalfailureAlcoholintoxicationwithanelevatedserumalcohloconcentrationNormalplasmaosmolalityPsedohyponatremia(laboratoryartifact)HightriglyceridesChloestaticandobstructivejaundice(lipoproteinx)MultiplemyelomaAbsorptionofirrigantsolutionsGlycineSorbitolMannitol
340.ChronicNon-Spherocytichemolytic anemiaisseeninwhichclassofG6PDdeficiency a)ClassI b)ClassII c)ClassIII d)ClassIV CorrectAnswer-AAns.is'a'i.e.,ClassIThefourformsofsymptomaticG6PDdeficiency:AcutehemolyticanemiaFavismCongenitalnonspherocytichemolyticanemiaNeonatalhyperbilirubinemiaCongenitalnonspherocvtichemolyticanemiaPatientswithclassIG6PDvariantshavesuchsevereG6PDdeficiencythatlifelonghemolysisoccursintheabsenceofinfectionordrugexposure.Suchpatientsfallunderthecategoryofhavingcongenitalnonspherocvtichemolyticanemia.TheseG6PDvariantshavelowinvitroactivityand/ormarkedinstabilityofthemolecule,andmosthaveDNAmutationsattheglucose-6-phosphateorNADPbindingsites.ThesesitesarecentraltothefunctionofG6PD,whichoxidizesglucose-6-phosphateandreducesNADPtoNADPH.Itispresumedthatthefunctionaldefectissoseverethattheredcellscannotwithstandeventhenormaloxidativestressesencounteredinthe
circulation.Anemiaandjaundiceareoftenfirstnotedinthenewbornperiod,andthedegreeofhyperbilirubinemiaisfrequentlyofsufficientseveritytorequireexchangetransfusion.Afterinfancy,hemolyticmanifestationsaresubtleandinconstant.Mostindividualshavemildtomoderateanemia(hemoglobin8to10g/dL)withareticulocytecountof10to15percent.Pallorisuncommon,scleralicterusisintermittent,splenomegalyisrare,andsplenectomygenerallyisoflittlebenefit.Hemolysiscanbeexaggeratedbyexposuretodrugsorchemicalswithoxidantpotentialorexposuretofavabeans.SomedrugswithrelativelymildoxidantpotentialthataresafeinpatientswithclassIIorclassIIIG6PDvariantsmayincreasehemolysisinpatientswithclassIvariants.DiseasevariantsofGlucose6phosphatedehvdrogenasedeficiencyTheWorldHealthOrganizationhasclassifiedthedifferentG6PDvariantsaccordingtothemagnitudeoftheenzymedeficiencyandtheseverityofhemolysis.ClassesIVandVareofnoclinicalsignificance. Types Features Variantshavesevereenzymedeficiency(lessthan10percent Class ofnormal)andhavechronic I (nonspherocytic)hemolyticanemia.Variants,suchasG6PDMediterranean,alsohavesevereenzymedeficiency,but Class thereare,usuallyonly II intermittentepisodesofacutehemolysisassociatedwithinfection,drugs,orchemicals.Variants,suchasG6PDA-,havemoderateenzyme Class deficiency(10to60percentof normal)withintermittent
III episodesofacutehemolysisusuallyassociatedwithinfection,drugs,orchemicals Class VariantshavenoIV enzyme.deficiencyorhemolysis. Class VariantshaveincreasedV enzymeactivity
341.WhatistheNeutrophilcountfor moderateneutropenia a)<500/mm' b)500-1000/mm' c)>1000/mm3 d)100/mm3 CorrectAnswer-BAns.is'b'i.e.,500-1000mm'MildneutropeniaIspresentwhentheANCis1000-15000cells/?LModerateneutropeniaIspresentwithanANCof500-1000/4SevereneutropeniaANClowerthan500cells/pL.Theriskofbacterialinfectionisrelatedtoboththeseverityanddurationoftheneutropenia.
342.Goutcanbeprecipitatedbyallofthe following a)Thiazides b)Furosemide c)Cyclosporine d)Highdosesalicylates CorrectAnswer-DAns.is'd'i.e.,HighdosesalicylatesHighdoseSalicylatesareuricosuricanddonotcauseHyperuricemia.DiureticsincludingThiazidesandFurosemideareknowntocauseHyperuricemia.CyclosporineandTacrolimusarealsoassociatedwithHyperuricemia.HighDosesofSalicylates>3.0g/dayareuricosuric,whileLowdoses(0.3to3.0g/day)areassociatedwithuricacidretentionandHyperuricemia.AlsoknowCausesofdrugordietinducedhvperuricemia.Diuretics(thiazidesandloopdiuretics)Cyclosporineandtacrolimus.Lowdosesalicylates.Ethambutol.Pyrazinamide.Ethanol.Levodopa.Methoxyflurane.Laxativeabuse(alkalosis).Saltrestriction.
343.RelativeriskofdevelopingTBinpatients alreadyinfectedwithTBbacilusishighestin a)Diabetes b)Recentinfection c)Posttransplantation d)Malnutrition CorrectAnswer-CAns.is'c'i.e.,PosttransplantationRelativeriskofdevelopingT.B. Post 20- transplantation 70 HIV 30 Silicosis 30 Recentinfection 12 Diabetes 3-4 Malnutrition 2-3
344.I.R.I.S.is a)Immunereconstitutionidiopathicsyndrome b)Immunereconstitutionimmunologicalsyndrome c)Immunereconstitutioninflammatorysyndrome d)Inflammatoryreconstitutionimmunesyndrome CorrectAnswer-CAns.is'c'i.e.,ImmunereconstitutioninflammatorysyndromeCausesofbonemarrowsuppressioninpatientswithHIVinfection HIVinfection MedicationsMycobacterial Zidovudine infectionsFungal Dapsone infectionsB19parvovirus Trimethoprim/Sulfamethoxazole infection Pyrimethamine5-Flucytosine Lymphoma GanciclovirInterferonaTrimetrexateFoscarnet
345.Inrenalfailure,metabolicacidosisisdue to a)Increasedfrproduction b)LossofHCO, c)Decreasedammoniasynthesis d)Useofdiuretics CorrectAnswer-CAns.is'c'i.e.,DecreasedammoniasynthesisThepredominantreasonformetabolicacidosisinC.R.Eisdecreasedammoniaproduction.MetabolicacidosisisacommondisturbanceinadvancedchronickidneydiseaseThemajorityofpatientscanstillacidlytheurinebuttheyproducelessammoniaand,therefore,cannotexcretethenormalquantityofprotonsincombinationwiththisurinarybuffer.
346.DiagnosticfeatureofCRFis a)Broadcastsinurine b)Elevatedbloodurea c)Proteinuria d)Bleedingdiathesis CorrectAnswer-AAns.is'a'i.e.,BroadcastsinurineCasts?Urinarycastsareformedonlyinthedistalconvolutedtubulee(DCT)orthecollectingdude(distalnephron).Theproximalconvolutedtubuleandloopofhenlearenotthelocationsforcastformation.CastsareformedthroughthesolidificationofmaterialsinthetubulesofnephronsLaterthematerialisflushedoutofthekidneyupontheproductionofmoreurineleavingasmallsolidifiedmicroscopiccylinderthatcanalsocontainwhateverothermaterialsthatmightbewithinthetubulesofthekidneysatthetimeofcastformation.Themicroscopicdetectionofvarioustypesofcastscanoftenbehelpfuldiagnostictoolinthestudyofvarioustypesofrenaldiseases
347.Eosinophilicmeningitisisseenwithall except? a)Coccidiomycosis b)Cryptococcalmeningitis c)Leptomeningealmetastasis d)Helminthicinfections CorrectAnswer-BAns.is'b'i.e.,CryptococcalmeningitisCausesofeosinophilicmeningitisInfectious,parasiticcausesRoundworm(nematode)infections-commonlypresentaseosinophilicmeningitisAngiotronglyluscantonensis-migratinglarvaeinherentlyneurotropicGnathostomaspinigerum-migratinglarvaeinvisceraland/orneuraltissuesBaylisascarisprocyonis-migratinglarvaeinherentlyneurotropicTapeworm(cestode)infections-maypresentaseosinophilicmeningitisCysticercosis-CystsdevelopinCNSand/orvisceraltissuesFluke(trematode)infections-occasionallycauseeosinophilicmeningitisParagonimuswestermani-ectopicspinalorcerebrallocalization.Schistosomiasis-ectopicspinalorcerebrallocalization.Fascioliasis-ectopicCNSlocalization.OtherroundworminfectionswhichoccasionallycauseeosinophilicmeningitisToxocariasis-migratinglarvaeNonparasitic,infectiouscauses
CoccidioidomycosisCryptococcosis-CSFeosinophiliarareMyiasis-withCNSpenetrationVirusandbacteria-areofuncertaincausalityNoninfectiouscausesIdiopathichypereosinophilicsyndromesVentriculoperitonealshuntsLeukemiaorlymphomawithCNSinvolvement(Hodgkin's)NonsteroidalantiinflammatorydrugsAntibiotics-ciprofloxacin,trimethoprim-sulfamethoxazole,intraventriculargentamicinorvancomycinMyelographycontrastagents
348.Christmastreeappearanceofurinary bladderisseenin a)Neurogenicbladder b)Stressincontinence c)Autonomousbladder d)Enuresis CorrectAnswer-AAns.is'a'i.e.,NeurogenicbladderChristmastreeappearanceofthebladderisseeninneurogenicbladdercausedbydetrusorhyperreflexia.Detrusorhyperreflexiaiscausedbylesionsofthespinalcordabovethesacralsegmentsbutbelowthepons.Suchpatientshavenoperceptionofbladderfillingoremptyingandvoluntaryvoidingisnotpossible.Voidingwhenitdoesoccurisinvoluntarywithsimultaneouscontractionsofthedetrusorandexternalsphinctermuscles.CommonneurologicalconditionresultingindetrusorhyperreflexiaincludeMultiplesclerosisMyelodysplasia,SpinalcordtraumaSpinalcordtumours,A-VmalformationotthespinalcordRadiologically,patientswithlongtermsuntreateddetrusorhyperreflaxiahavecharacteristicchangesoftheurinarytact.Bladderisverticallyoriented,withanirregularcontours,consistentwithtrabeculation.Therearefrequentlymultipeldiverticula,Suchabladderisreferredtoasachristmastree.
Automatic Autonomous bladder bladderCaudaequina AboveT5or damage/ Lesionsite higher lowermoteroneuron Smallspastic damageLarge Manifestation bladder flaccidbladderHasnourgesensationand urgecomes continuous againand DRIBBLING againdueto occurs,Soitisrepeated likethe Whythis contractions bladderis name andhence workingallthe empties timebutBrain repeatedly hasnocontrol aftersome overitand time hencecalledautonomousbladderNoVURbut Christmas stillbladderis Radiological tree largeand data appearance holdslotsofresidualurine
349.thediffusioncapacityoflung(DL)is decreasedinallofthefollowingconditionsexcept a)Inerstitiallungdiseas b)Goodpasture'ssyndrome c)PneumocystisJiroveci d)Primarypulmonaryhypertension CorrectAnswer-BAns.is'b'i.e.,Goodpasture'ssyndromeGasdiffusiontests:Gasdiffusiontestsmeasuretheamountofoxygenandothergasesthatcrossthealveoliintotheblood.Thesetestsevaluatehowwellgasesarebeingabsorbedintothebloodfromlungs.Gasdiffusiontestsinclude.Carbonmonoxidediffusingcapacity(transferfactorDLcy)ArterialbloodgasesCarbonmonoxidediffusingcapacity(DL):Thismeasureshowwellthelungtransfersasmallamountofcarbonmonoxideintotheblood0.Normally,inthelung,agashastocrossthealveolarmembrane,capillarymembranetoreachthebloodwhereitcombineswithhemoglobin.SoquietobviouslythediffusioncapacityofgasdependsuponDrivingpressureofthegasSurfaceareaofalveolarcapillarymembraneThicknessofalveolarcapillarymembraneDiffusioncoefficientofthegas
Redbloodcellvolume.Reactionratewithhemoglobinandhemoglobinlevelofpatient.DegreeofV/Qmismatching.
350.Keratoderma-Blenorrhagicumis pathogno-monicof a)Behcet'sdisease b)Reiter'sdisease c)Lyme'sdisease d)Glucagonoma CorrectAnswer-BAns.is'b'i.e.,Reiter'sdiseaseKeratodermaBlenorrhagicaisthecharacteristicskinlesionseeninpatientswithReactiveArthritis."TheCharacteristicskinlesionsinReactiveArthritis,KeratodermaBlenorrhagica,consistofvesiclesthatbecomehyperkeratotic,ultimatelyformingacrustbeforedisappearing.Theseareseeninpalmsandsoles.
351.InTakayasu'sarteritisthereis a)Intimalfibrosis b)Renalhypertension c)Coronaryaneurysm d)Alloftheabove CorrectAnswer-BAns.is`b'i.e.,Renalhypertension Potential Artery clinicalmanifestationArmclaudication, Subclavian Raynaud'sphenomenonVisualchanges,syncope Commoncarotid transient, ischaemicattacksstrokeAbdominal AbdominalAorta pain,nausea vomitingHypertension,renalfailure,aortic Renal insufficiency,congestiveheartfailure
heartfailureVisual Vertebral changes,dizzinessAbdominal Coeliacaxis pain,nauseavomiting IliacLeg claudication Atypicalchest Pulmonary paindyspneaChestpain Coronary myocardialinfarction
352.Whichisnotahighpitchedheartsound a)Midsystolicclick b)Pericardialshudder c)Openingsnap d)Tumorplopsound CorrectAnswer-DAns.is'd'i.e.,TumorplopsoundLowpitchheartsoundsare:S3S4TumorplopsoundMidsystolicclicksareHeardinmitralvalveprolapseduringsystoleandarehighpitchsounds.Thepericardialknock(PK)isAlsohigh-pitchedandoccursslightlylaterthantheopeningsnap,correspondingintimingtotheabruptcessationofventricularexpansionaftertricuspidvalveopeningandtoanexaggeratedydescentseeninthejugularvenouswaveforminpatientswithconstrictivepericarditis.AtumorplopisAlower-pitchedsoundthatcanbeheardinpatientswithatrialmyxoma.Itmaybeappreciatedonlyincertainpositionsandarisesfromthediastolicprolapseofthetumoracrossthemitralvalve
353.Broadcomplextachycardia,dueto ventriculartachycardiaissuggestedbyallexcept a)Fusionbeats b)AVdissociation c)Capturebeats d)Terminationoftachycardiabycarotidsinusmassage CorrectAnswer-DAns.is`d'i.e.,Terminationoftachycardiabycarotidsinusmassage
354.Ruptureofberryaneurysmmost commonlyresultsin a)Subarachnoidhemorrhage b)Subduralhemorrhage c)Extraduralhemorrhage d)Intra-parenchymalhemorrhage CorrectAnswer-AAns.is'a'i.e.,Subarachnoidhemorrhage Mostcommoncauseof Trauma subarachnoidhemorrhage RuptureofBerry Mostcommoncauseof aneurysm spontaneoussubarachnoid (or hemorrhage Saccularaneurysm) AlsoknowMycoticaneurysm?Mycoticaneurysmiscausedbyasepticembolusthatweakensthewallofthevesselinwhichitlodges.
355.TargetBPbeforethrombolysisin ischemicstrokeisbelow a)185/110mmHg b)165/100mmHg c)145/100Hg d)120/80mmHg CorrectAnswer-AAns.is'a'i.e.,185/110mmHgRecommendedtargetbloodpressurebeforethrombolysisinpatientswithischemicstrokeislessthan185/110mmHg.
356.Themostcommoncauseofmalignant adrenalmassis a)Adrenocorticalcarcinoma b)Malignantphaeochromocytoma c)Lymphoma d)Metastasisfromanothersolidtissuetumor CorrectAnswer-DAns.is'd'i.e.,MetastasisfromanothersolidtissuetumorThemostcommoncauseofadrenaltumorsismetastasisfromanothersolidtumorlikebreastcancerandlungcancer. Malignant Percentage Adrenocorticalcarcinoma 2-5% Malignant <I% pheochromocytomaAdrenalneuroblastoma <0-1% Lymphomas(incl.primary <1% adrenalymphoma)Metastases(mostfrequent: 15% Breast,lung)
357.Thedrugusedinthemanagementof medullarycarcinomathyroidis a)Cabozantinib b)Rituximab c)Tenofovir d)Anakinra CorrectAnswer-AAns.is'a'i.e.,CabozantinibMedullarythyroidcancers(MTCs)areneuroendocrinetumorsofthyroidparaf011icularcellsthatdonotconcentrateiodine.TheprimarytreatmentforMTCisextensiveandmeticuloussurgicalresection.Thereisalimitedroleforexternal-beamradiotherapy.Forpatientswithasymptomaticmetastatictumorsgenerallylessthan1to2cmindiameter,growingindiameterlessthan20percentperyearSystemictherapyisnotrequiredSuchpatientsshouldbemonitoredfordiseaseprogression.KnownsitesofmetastaticdiseaseshouldbeimagedbyCTorMRIevery6to12months,andpotentialnewsitesofdiseaseshouldbeimagedevery12to24months.Forpatientswithmetastatictumorsatleast1to2cmindiameter,growingbyatleast20percentperyear,orOrpatientswithsymptomsrelatedtomultiplemetastaticfocithatcannotbealleviatedwithsurgeryorexternalbeamradiotherapyAdministersystemictreatmentaspartofaclinicaltrial.ForpatientswithmetastatictumorsatleastIto2cmindiameter,
growingbyatleast20percentperyear,orforpatientswith.symptomsrelatedtomultiplemetastaticfociwhocannotparticipateinaclinicaltrialAnoraltyrosinekinaseinhibitor(TKI)issuggested,ratherthantraditionalcytotoxicchemotherapy.ForinitialTKItherapyCabozantiniborvandetanibratherthansorafeniborsunitinib.Cytotoxicchemotherapy,ofwhichdacarbazine-basedregimenssuchascyclophosphamide-vincristinedacarbazinearepreferable,isanalternativeoptionforpatientswhocannottolerateorwhofailmultipleTKIsDrugsusedinmedullarycarcinomathyroid Tyrosine Cvtotoxic kinase chemotherapy inhibitorsCabozanitib CyclophosphamideVandetanib VincristineSorafenib Dacarbazine Sunitinib
358.Incorrectaboutcerebralsaltwasting syndrome a)Urinesodium>20mEq/d1 b)Hyponatremia c)Fludrocortisoneisused d)Expansionofplasmavolume CorrectAnswer-DAns.is'd'i.e.,ExpansionofplasmavolumeCerebralsaltwastingsyndrome(renalsaltwasting)Cerebralsaltwasting(CSW)ischaracterizedbyhyponatremiaandextracellularfluiddepletionduetoinappropriatesodiumwastingintheurineinthesettingofacutediseaseincentralnervoussystem(CNS),usuallysubarachnoidhemorrhage.CSWisamuchlesscommoncauseofhyponatremiainpatientswithcerebralinjurythanthesyndromeofinappropriateADHsecretion(SIADH).ThepathophysiologyofCSWisrelatedtoimpairedsodiumreabsorption,possiblyduetothereleaseofbrainnatriureticpeptideand/ordiminishedcentralsympatheticactivity.Regardlessofthemechanism,sodiumwastingcanleadsequentiallytovolumedepletion,increasedADHrelease,hyponatremiaduetotheassociatedwaterretention,andpossiblyincreasedneurologicinjury.LaboratoryfindingsHyponatremiawithalowplasmaosmolalityAninappropriatelyelevatedurineosmolality(above100mosmol/kgandusuallyabove300mosmol/kg)Aurinesodiumconcentrationabove40meq/L,and
Alowserumuricacidconcentrationduetouratewastingintheurine.CSWmimicsallofthelaboratoryfindingsintheSIADHTheonlycluetothepresenceofCSWratherthanSIADHisclinicalevidentofextracellularvolumedepletion,suchashypotensionanddecreasedskinturgor,and/orincreasedhematocrit,inapatientwithaurinesodiumconcentrationabove40meq/LUnlikeSIADH,volumerepletioninCSWleadstoadiluteurine,duetoremovalofthehypovolemicstimulustoADHrelease,andsubsequentcorrectionofthehyponatremia.TreatmentIVhypertonicsalinesolutionsareemployedtocorrectintravascularvloumedepletionandhyponatremiaandtoreplaceongoingurinarysodiumlossFlurocortisonepromotessodiumre-absorption
359.A70kgadultmalepresentswithserum sodiumof110meq/dl.Calculatecorrectionrequiredin24hours a)100mEq b)200mEq c)300mEq d)400mEq CorrectAnswer-DAns.is`d'i.e.,400mEqGoalsoftherapyinhyponatremiaInpatientswhoaretreatedtoincreasetheserumsodium,thegoalofinitialtherapyistoraisetheserumsodiumconcentrationby4to6meq/Lina24-hourperiod.Inpatientswhorequireemergencytherapy,thisgoalshouldbeachievedquickly,oversixhoursorless;thereafter,theserumsodiumcanbemaintainedataconstantlevelfortheremainderofthe24-hourperiodtoavoidoverlyrapidcorrection.Everyeffortshouldbemadetokeeptheriseinserumsodiumlessthan9meq/Linanv24-hourperiod.Ingeneral,thesamerateofrisecanbecontinuedonsubsequentdaysuntilthesodiumisnormalornearnormal.Therationalefortheserecommendationsisasfollows:Sodiumdeficit=TotalbodywaterxdesiredSNa-ActualSNa=.6x70x120-110=420mEqTreatmentofhvponatrentiaAprviatitleaet_uIsuponriskstratificationThefollowinggeneralapproachfortreatingpatientswith
hyponatremiaisbaseduponthedurationandseverityofthehyponatremiaanduponthepresenceandseverityofsymptoms:DispositionPatientswithacuteorhyperacutehyponatremia,mostpatientswithseverehyponatremia,andmanysymptomaticpatientswithmoderatehyponatremiashouldbetreatedinthehospital.Incontrast,patientswithmildhyponatremiaandasymptomaticpatientswithmoderatehyponatremiausuallydonotrequirehospitalization.EmergencytherapyAggressivetherapytoraisetheserumsodiumassoonaspossible(typicallywithhypertonicsaline)isindicatedinthefollowingsettings.Patientswithseveresymptomsduetohyponatremia,suchasseizuresorobtundation.Patientswithacutehyponatremiawhohavesymptomsduetohyponatremia,evenifsuchsymptomsaremild.Becauseofosmoticallydrivenwaterflowacrosstheblood-brainbarrier,anacuteonsetofhyponatremiacanresultinlife-threateningcerebraledema.Thus,evenmildsymptomsinacutehyponatremiapresentamedicalemergencythatrequirespromptandaggressivetreatmentwithhypertonicsalinetopreventbrainherniation.Patientswithhyperacutehyponatremiaduetoself-inducedwaterintoxication,eveniftherearenosymptomsatthetimeofinitialevaluation.Brainherniationhasbeenreportedinsuchpatients,andtheserumsodiummayworsenspontaneouslyduetodelayedabsorptionofingestedwaterSymptomaticpatientswhohaveeitheracutepostoperativehyponatremiaorhyponatremiaassociatedwithintracranialpathology.Aswithhyperacutehyponatremia,herniationmayoccur;andtheserumsodiummaydecreasefurtherbecauseofabsorptionofingestedwaterortheexcretionofhighconcentrationsofsodiumintheurine(desalination).
360.Whichofthefollowingisaquantitative defectinglobinsynthesis a)Thalassemia b)Sicklecellhemoglobinopathy c)G6PDdeficiency d)Diamond-Blackfansyndrome CorrectAnswer-AAns.is'a'i.e.,ThalassemiaThethalassemiasyndromesareaheterogeneousgroupofdisorderscausedbyinheritedmutationsthatdecreasethesynthesisofeitherthec-globinorp-globinchainsthatcomposeadulthemoglobin,HbA(c2p2),leadingtoanemia,tissuehypoxia,andredcellhemolysisrelatedtotheimbalanceinglobinchainsynthesis.
361.Themostimportantdiagnositicfeature forbetathalassemiatrait a)RaisedHbF b)ReducedMCH c)ReducedMCV d)RaisedHbA2 CorrectAnswer-DAns.is'd'i.e.,RaisedHbA2AnabnormalincreaseinthelevelofHbA2isthemostsignificantparameterinthediagnosisofbeta-thalassemiacarriers.HbA-2isconstanlyelevatedinheterozygouscarriersof[3-thalassemiainalltheethnicgroupsstudied.Thevaluesrangefrom3.5to7%.InvestigationsinthalassemiaHemoglobinelectrophoresisshouldalwaysbethefirstinvestigationtoinclude/excludethediagnosisofthalasemia.ThelevelofnormaladulthemoglobinHbAismarkedlydecreasedwithproportionateincreaseinHbA2andHbF.X-rayskullshows:?i)Crew-cutappearanceii)Haironendappearance
362.Uricaseusedinthetreatmentofchronic goutis a)Allopurinol b)Benzbromarone c)Pegloticase d)Methotrexate CorrectAnswer-CAns.is'c'i.e.,PegloticasePegloticaseisarecombinantmammalianUricaselinkedtopolyethyleneglycol(PEG)approvedforthetreatmentofHyperuricemiainpatientswithtreatmentrefractorygout.PegloticasefacilitatestheconversionofUricacidintoallantoin,whichisfarmoresoluble.Pegloticaseisapprovedforintravenousadministrationanditsuseisassociatedwithrapidandmarkeddeclineinserumuricacidlevels.AgentsinhibitingIL-1actionareusedforthetreatmentofrefractoryGoutAnakinraCanakinumab
363.AllareseeninacuteHiVsyndrome except a)Diarrhoea b)Pneumonia c)Wightloss d)Myelopathy CorrectAnswer-BAns.is'b'i.e.,PneumoniaClinicalfindingsintheacuteHIVsyndrome General Neurologic Dermatology rash Fever Meningitis Erythematous ulceration Pharyngitis Encephalitis maculo-papular Lymphadenopathy Peripheral Mucocutaneous Headache/retroorbital neuropathy pain Myelopathy Arthralgias/myalgiasLethargy/malaiseAnorexia/weightlossNausea/vomiting/diarrhea [RefHarrison19th/ep.1249]
364.Nephrocalcinosisisseeninallexcept a)Polycystickidney b)Hyperparathyroidism c)Medullaryspongekidney d)Renaltubularacidosis CorrectAnswer-AAns.is'a'i.e.,PolycystickidneyCausesofNephrocalcinosisMedullaryspongekidneyHyperparathyroidismHypoparathyroidismRenaltubularacidosis(specificallydistalRTA)RenaltuberculosisRenalpapillarynecrosisHyperoxaluriaImmobilizationMilk-alkalisyndromeHypervitaminosisDSarcoidosis
365.Mostcommonacutecomplicationof dialysisis a)Hypotension b)Bleeding c)Dementia d)Musclecramps CorrectAnswer-AAns.is'a'i.e.,HypotensionHypotensionisthemostcommonacutecomplicationofhemodialysisparticularlyamongpatientswithdiabetesmellitus.Factorsinvolvedare:-Excessiveultrafiltration,withinadequatecompensatoryvascularfilling,impairedvasoactiveorautonomicresponse,osmolarshifts,overzealoususeofantihypertensives
366.
Characteristicfeaturesofalesioninthelateralpartofthemedullaincludeallexcept a)IpsilateralHomer'ssyndrome b)Contralaterallossofproprioceptiontothebodyandlimbs c)Nystagmus d)Dysphagia CorrectAnswer-BAns.is'b'i.e.,ContralaterallossofproprioceptiontothebodyandlimbsDamagetolateralpartofmedulla(lateralmedullarysyndromeorwallenbergsyndrome)causes:?1)Ipsilateral:Facialsensoryloss,facialpain,ataxia,nystagmus,homersyndrome.2)ContralateralOtherfeaturesarenausea&vomitng,vertigodysphagiaandhorseness.
367.Roundpneumoniaisseenwith a)Streptococcalpneumonia b)Keroseneoilaspiration c)Lungcancer d)Mendelsonsyndrome CorrectAnswer-AAns.is'a'i.e.,StreptococcalpneumoniaStreptococcusPneumoniae(pneumococcus)isthemostcommonorganismresponsibleforroundpneumonia.RoundPneumoniaissphericalpneumoniathatisusuallyseeninchildrenduetothelackofcollateralairdrift.StreptococcusPneumoniae(pneumococcus)isthemostcommonorganismresponsibleforroundpneumonia.Roundpneumoniaisimportantastheymaysimulateatumormassfromwhichtheymustbedifferentiated
368.AnelderlymaleadmittedforPneumonia presentswithdiarrheaandgrippingabdominalpainfivedaysafterdischargefromthehospital.Drugwhichislikelytobenefitis a)Imodium b)Metranidozole c)Diphenoxylate d)Levofloxacin CorrectAnswer-DAns.is'd'i.e.,LevofloxacinDevelopmentofpneumoniaandgastrointestinalsymptoms(diarrhea&grippingabdominalpain)within10daysafterdischargefromhospitalhintstoapossiblediagnosisofLegionnaire'sdisease.Thedrugsofchoiceforlegionnairs'sdiseaseincludeAzithromycinandRespiratoryFluoroquinolonessuchaslevofloxacin,gatifloxacin,GemifloxacinandMoxifloxacinItisacaseoflegionnaire'sdisease.Legionnairesdiseaseusuallypresentsasatypicalpneumoniae.TheuniquefeatureoflegionnairesdiseaseisthattheclinicalmanifestationofthisdiseaseareusuallymoreseverethanthoseofmostatypicalpneumoniasandthecourseandprognosisoflegionellapneumoniamorecloselyresemblethoseofbacteremicpneumococcalpneumoniathanthoseofpneumoniaduetootherorganismsThinkaboutthediagnosisaslegionaire'sdiseasewheneverthe
questiontalksaboutapneumonialikepicturealongwithanyofthefollowing-Gastrointestinaldisturbancessuchasdiarrhoea.Neurologicalabnormalitiessuchasconfusionandheadachealteredsensorium.Highfever(>40?Cor>104?F)Numerousneutrophils,butnoorganismsrevealedbygram'sstainingofrespiratorysecretions.Failuretorespondto$lactamdrugs(penicillinsandcephalosporins)andaminoglycosideantibiotics.Hyponatremia(S.Na-<131meq/1)Elevationinliverfunctiontests.Occurrenceofillnessinanenvironmentinwhichthepotablewatersupplyisknowntobecontaminatedwithlegionella.Onsetofsymptomswithin10daysofdischargefromhospital.Occurenceofillnessinimmunocompromisedindividual
369.Durationofapneainobstructivesleep apneais a)<10sec b)<20sec c)<30sec d)<60sec CorrectAnswer-AAns.is'a'i.e.,<10secSleepapnea?oSleepapneaisdefinedasintermittentcessationofairflowatthenoseandmouthduringsleep.oByconventionapneasofatleast10secondsdurationhavebeenconsideredimportantbutinmostpatientstheapneasare20sto30secondsindurationandmaybeaslongas2-3minutes.oSleepapneaisoftwotypes-Sleepapnea Obstructivesleepapnea Centralsleepapnea Occursdueto Occursduetoocclusionof transientabolitionupperairwayatthelevelof ofthecentralneuraloropharynx drivetotherespiratorymusclesPrimaryandsecondarycentralalveolarhypoventilation Conditionsassociatedare syndrome,hypoxiaadenotonsillarhypertrophy, (highaltitude)
retrognathia, cardiovascular macroglossiaalcohol, disease,pulmonary obesity congestion,centralnervoussystemdisease,prolongedcirculationtime. Clinicalfeaturesofsleepapnea-ExcessivedaytimesleepinessCardiorespiratorydisturbanceswhichincludeRecurrentrespiratoryfailurePulmonaryhypertensionHeartfailureSystemichypertension7ChronichypoventilationPolycythemiaoArterialbloodgasanalysisrevealshypoxemiaandhypercapnia.
370.Causesofhaemorrhagicpleuraleffusion areallexcept a)Pulmonaryinfarction b)Mesothelioma c)Bronchialadenoma d)Tuberculosis CorrectAnswer-CAns.is'c'i.e.,BronchialadenomaCausesofhemorrhagicpleuraleffusionTraumaMalignancyPostpericardiotomysyndromeAsbestosrelatedeffusionTuberculosis
371.Followingischaracteristicneurologic findinginprimaryamyloidosis a)Peripheralmotorandsensoryneuropathy b)Peripheralneuropathyassociatedwithcerebralmanifestation c)Guillain-Barretypeofsyndrome d)Spinalcordcompressioninthoracicregion CorrectAnswer-AAns.is'a'i.e.,PeripheralmotorandsensoryneuropathyATTRusuallypresentsasasyndromeoffamilialamyloidoticpolyneuropathyorfamilialamyloidoticcardiomyopathy.Peripheralneuropathyusuallybeginsasalower-extremitysensorandmotorneuropathyandprogressestotheupperextremities.Autonomicneuropathyismanifestbygastrointestinalsymptomsofdiarrheawithweightlossandorthostatichypotension.
372.Reactivearthritisisusuallycausedby a)Shigellaflexneri b)Shigellaboydii c)Shigelashiga d)Shigeladysentriae CorrectAnswer-AAns.is'a'i.e.,ShigellaFlexneriOrganismsthathavebeenassociatedwithReiterArthritisincludethefollowing:Ctrachomatis(L2bserotype)UreaplasmaurealyticumNeisseriagonorrhoeaeShigellaflexneriSalmonellaentericaserovarsTyphimuriumMycoplasmapneumoniaeMycobacteriumtuberculosisYersiniaenterocoliticaandpseudotuberculosisCampylobacterjejuniClostridiumdifficileBeta-hemolytic(example,groupA)andviridansstreptococci
373.Whichofthefollowingarrhythmiais mostcommonlyassociatedwithalcoholbingeinthealcoholics a)Ventricularfibrillations b)Ventricularprematurecontractions c)Atrialflutter d)Atrialfibrilation CorrectAnswer-DAns.is'd'i.e.,AtrialfibrilationWheneverthepulseisirregularlyirregularatrialfibrillationisalmostalwaysthediagnosis.Arrythmiaoccuringafteradrinkingbingeisk/aHolidayheartsyndrome.ArrythmiasknowntofollowdrinkingBingeinorderoffrequencyAtrialfibrillation(MC)AtrialflutterVentricularprematureContractionsAlsoknowThemostcommoncardiaceffectofchronicdrinkingisDilatedCardiomyopathy
374.Treatmentofasymptomaticbradycardia is a)Notreatmentisrequired b)Giveatropine c)Isoprenaline d)Cardiacpacing CorrectAnswer-AAns.is'a'i.e.,NotreatmentisrequiredThenormalheartratehasbeenconsideredhistoricallytorangefrom60to100beatsperminute,withsinusbradycardiabeingdefinedasasinusrhythmwitharatebelow60beatsperminute.Treatmentisnotindicatedinasymptomaticpatientswithsinusbradycardia.nPharmacologictherapymaybeimportantinanacutemyocardialinfarctionwhentheSAnodeisdepressedbyexcessiveparasympathomimeticactivityorpossiblyischemia.TreatmentisindicatedwhenSinusbradycardiaresultsinhemodynamiccompromise.
375.WPWsyndromeiscausedby a)BundleBranchBlock b)Rightsidedaccessorypathway c)Ectopicpacemakerinatrium d)LeftbudleBranchblock CorrectAnswer-BAns.is'b'i.e.,RightsidedaccessorypathwayAnatomy(LocationofAccessorypathway)inW.RWsyndromeElectrophysiologicalstudiesandmappinghaveshownthataccessory.AtrioventricularpathwaysmaybelocatedanywherealongtheA-Vrignorgrooveintheseptum.Themostfrequentlocationsare:-Leftlateral(50%),posteroseptal(30%)rightanteroseptal(10%).Rightlateral(10%).PreexcitationresultingfromleftsidedaccessoryiscalledtypeApreexcitation.PreexcitationresultingfromrightsidedaccessorypathwayiscalledtypeBpreexcitation.
376.DoseofrTPAinischaemicstrokeis a)60mg b)90mg c)100mg d)120mg CorrectAnswer-BAns.is'b'i.e.,90mgRecommendeddoseforthrombolysiswithIVTPAis0.9mg/kgwiththemaximumdosebeing90mg.10%shouldbegivenasabolusoveroneminute,followedbyremaining90%asacontinuousinfusionover60minutes.
377.Cerebralangiographywasperformedby a)SirWalterDandy b)GeorgeMoore c)Seldinger d)EgasMoniz CorrectAnswer-DAns.is'd'i.e.,EgasMonizEgasMonizfirstperformedcerebralAngiographyin1927.nHereceivedtheNobelPrizefordevelopingfordevelopingfrontalleucotomyasatreatmentforpsychiatricdiseases.
378.Mauriac'ssyndromeischaracterizedby allexcept a)Diabetes b)Obesity c)Dwarfism d)Cardiomegaly CorrectAnswer-DAns.isDi.e.,CardiomegalyMauriacSyndromeChildrenwithpoorlycontrolledtypeIdiabetesmaydevelopMauriacsyndrome.Itischaracterizedby:-GrowthattenuationDelayedpubertyHepatomegalyAbnormalglycogenstorageandsteatosisCushingoidfeaturesRareinthemoderneraofinsulintherapybutisoccasionallyreported.
379.Whichofthefollowingisassociatedwith hyponatremiaandlowosmolality a)Hyperlipidemia b)SIADH c)CHF d)CKD CorrectAnswer-CAns.is'c'i.e.,CHFCHFischaracterisedbylowperfusionofkidneysstimulatingR.A.A.Sandresultantabsorptionofsaltanddisproportionateamoutofwaterwouldleadtohyponatremiawithdecreasedosmolality.Isotonichyponatremiaisseenwithhyperlipidemiaandhvperproteinemialikeinparaproteinemia.Intravenousimmunoglobulintherapyalsointerfereswithmeasurementofserumsodium.MajorcausesofhyponatremiaDisordersinwhichADHlevelsareelevatedEffectivecirculatingvolumedepletionTruevolumedepletionHeartfailureCirrhosisThiazidediureticsSyndromeofinappropriateADHsecretion,includingresetosmostatpatternHormonalchangesAdrenalinsufficiencyHypothyroidismPregnancy
DisordersinwhichADHlevelsmaybeappropriatelysuppressedAdvancedrenalfailurePrimarypolydipsiaBeerdrinker'spotomaniaHyponatremiawithnormalorelevatedplasmaosmolalityHighplasmaosmolality(effectiveosmols)HyperglycemiaMannitolHighplasmaosmolality(ineffectiveosmols)RenalfailureAlcoholintoxicationwithanelevatedserumalcohloconcentrationNormalplasmaosmolalityPsedohyponatremia(laboratoryartifact)HightriglyceridesChloestaticandobstructivejaundice(lipoproteinx)MultiplemyelomaAbsorptionofirrigantsolutionsGlycineSorbitolMannitol
380.Deletionofonealphaglobingeneonone chromosomeisbestdefinedas a)HbBartshydropsfetails b)Alphathalassemiamajor c)Alphathalassemiatrait d)Alphathalassemiasilentcarrier CorrectAnswer-DAns.is'd'i.e.,Alphathalassemiasilentcarrier Clinical Condition Defect Genotype syndrome Deletionof1 SilentThalassemia -a/aa Normal alphagenes Deletionof2 -a/-a Microscopic Thalessemiatrait alphagenes (homogygous) hypochromic Bloodpicture (heterogenous) but No/Minimal Anemia Deletionof3 Hemolytic HbHdisease --/-a alphagenes anemia Hydropsfetalis(Hb Deletionof4 --/-- Fatalinuteroor Barts) alphagenes atbirth
381.Whichofthefollowingiscausedby deletionofallfouralphaglobingenes a)Betathalassemiamajor b)HbBarts c)HbH d)a?thalassemiatrait CorrectAnswer-BAns.is'b'i.e.,HbBarts Clinical Condition Defect Genotype syndrome Deletionof1 SilentThalassemia -a/aa Normal alphagenes Deletionof2 -a/-a Microscopic Thalessemiatrait alphagenes (homogygous) hypochromic Bloodpicture (heterogenous) but No/Minimal Anemia Deletionof3 Hemolytic HbHdisease --/-a alphagenes anemia Hydropsfetalis(Hb Deletionof4 --/-- Fatalinuteroor Barts) alphagenes atbirth
382.InBetathalassemia,themostcommon genemutationis a)Intron1inversion b)Intron22 c)619bpdeletion d)3.7bpdeletion CorrectAnswer-AAns.is'a'i.e.,Intron1inversionThalassemiasareautosomalrecessivedisorderThemostcommonmutationcausing13thalassemiasisintron/inversionAlsoknow:Synthesisofalphachainiscontrolledby2geneclustersonChromosome16Synthesisofbetachainiscontrolledby2geneclustersonChromosome11ThalassemiamutationsinIndia Multations Frequency IVS1-5(G-->C) 48% 619bpdefection 18% IVS-1(GT) 9% FR41/42(TCTT) 9% FR8/9(+G) 5% Codonl5(G-->A) 6% Others 100%
383.Bencejonesproteinuriaisbestdetected by a)Dipstickmethod b)Sulfosalicylicacid c)Heattest d)Electrophoresis CorrectAnswer-DAns.is`d'i.e.,ElectrophoresisBenceJonesproteinsareseeninmultiplemyeloma.Urinaryproteinelectrophoresiswillexhibitadiscreteproteinpeak.Inmyelomaplasmacellsproduceimmuno-globulinofasingleheavyandlightchain,amonoclonalproteincommonlyreferredtoasaparaprotein.Heattestisfalsenegativein50%ofpatientswithlightchainmyeloma.Dipstickdetectsalbuminandnotparaproteins.
384.HIVRNAbyPCRcandetectaslowas a)30copiesviralRNA/mlofblood b)40copiesviralRNA/mlofblood c)50copiesofviralRNA/mlofblood d)60copiesofviralRNA/mlofblood CorrectAnswer-BAns.is'b'i.e.,40copiesviralRNA/mlofbloodThisassaygeneratesdataintheformofnumberofcopiesofHIVRNApermillilitreofserumorplasmaandcanreliablydetectasfewas40copiesofHIVRNApermililitreofplasma.Researchbasedassaycandetectdowntoonecopy/ml.
385.Mostcommoncauseofpleuraleffusion inAIDSpatients a)Kaposisarcoma b)TB c)PneumocystisJiroveci d)Mycoplasma CorrectAnswer-AAns.is'a'i.e.,KaposisarcomaOphthalmologicaldiseasesThemostcommonabnormalfindingsonfundoscopicexaminationarecottonwoolspots.CMVretinitisisthemostsevereocularcomplicationandoccurswhenCD4T-cellscountislessthan50/ml.IttypicalpresentsasperivascularhemorrhageandexudaewithCottage-Cheeseappearance.Acuteretinalnecrosissyndrome,alsocalledprogressiveouterretinalnecrosis(PORN)iscausedbyHSVandVZVOthermanifestationsarechorioretinitisbytoxoplasmaandPcarinii,kaposisarcomaofeyelid,andlymphoma.
386.Biomarkernotinvolvedinacutekidney injuryis a)NGAL b)KIM1 c)MicroRNA122 d)CystatinC CorrectAnswer-CAns.is'c'i.e.,MicroRNA122BiomarkersofacutekidneyinjuryAlanineaminopeptidase(AAP)Alkalinephosphatase(AP)a-glutathione-S-transferase(a-GST)y-glutamyltranspeptidase(yGT)N-acetyl-13-glucosaminidase(NAG)pfmicroglobulinaimicroglobulinRetinol-bindingprotein(RBP)CystatinCMicroalbuminKidneyinjurymolecule-1(KIM-1)ClusterinNeutrophilgelatinaseassociatedlipocalin(NGAL)Interleukin-18(IL-18)Cysteine-richprotein(CYR-61)Osteopontin(OPN)Fattyacidbindingprotein(FABP)Sodium/hydrogenexchangerisoform(NHE3)Exosomalfetuin-A
387.Mostcommonsiteofcerebralinfarction isintheterritoryof a)Anteriorcerebralartery b)Middlecerebralartery c)Posteriorcerebralartery d)Posteriorinferiorcerebellarartery CorrectAnswer-BAns.is'b'i.e.,MiddlecerebralarteryHemiplegiamostcommonlyoccursduetolesionofmiddlecerebralartery
388.Hemiplegiaismostoftencausedby thrombosisof? a)Anteirorcerebralartery b)Middlecerebralartery c)Posteriorcerebralartery d)Basiliarartery CorrectAnswer-BAns.is'b'i.e.,MiddlecerebralarteryMiddleCerebralArteryDeepbranchesofthemiddlecerebralarteryonthelenticulostriatebranchessupplytheinternalcapsule(posteriorlimb).MotortractsaredenselypackedinthisregionandhenceocclusionofdeepbranchesorlenticulostrialsbranchesleadstoDensseHemiplegia/PuremotorHemiplegia.Anteriorchoroidalarterysuppliestheposteriorlimbofinternalcapsule(andnotanteriorlimbofinternalcapsule).Anteriorchorodialarteryarisesfromtheinternalcarotidarteryandsuppliestheposteriorlimbofinternalcapsule.Thecompletesyndromeofanteriorchoroidalarteryocclusionconsistsofcontralateralhemiplegiahemianesthesia(hypoesthesia)andhomonymoushemianopiaPosteriorCerebralArteryTheposteriorcerebralarterysuppliesthemidbrain,thalamuslateralgeniculatebodies,posteriorofchroidplexus,occipitallobes,inferiorandmedialaspectofthetemporallobeandposteriorinferiorareasoftheparietallobeOcclusionofthePosteriorCerebralArteryusuallyresultsintwocommonclinicalsyndromedependingontheareas
involved P1Syndrome P2SyndromeOcclusionofthe Occlusionofthe distalsegment proximalsegment ofPCA ofPCAfromitsoriginto distaltotheitsunionwiththe junctionof posterior PCAwith communicatingartery theposteriorcommunicatingarteryP2syndrome P1syndromepresent presents primarilywiththe primarily followingsigns withthefollowingsignsTemporallobe Midbrainsigns signs Thalamicsigns Occipitallobe Subthalamicsigns signs
389.Indicationforprophylaxisin pneumocystiscarinipneumoniainclude a)CD4count<200 b)Tuberculosis c)Viralload>25,000copies/ml d)Oralcandidiasis CorrectAnswer-AAns.is'A'i.e.,CD4count<200PROPHYLAXISOFPNEUMOCYSTICCARINIPNEUMONIAPrimaryprophylaxisisindicatedforPatientswithCD4-cellcountsof<200/4HistoryoforopharyngealcandidiasisSecondaryprophylaxisisindicatedforBothHIVinfectedandnon-HIVinfectedpatients.WhohasrecoveredfrompneumocystosisPrimaryandsecondaryprophylaxismaybediscontinuedinHIVinfectedpersonsonce.CD4+countshaverisento>200/p1andremainedatthatlevelfor3months.AlsoknowFirstchoiceagentforprophylaxisTrimethoprim,sulphamethoxazole.Otheragentsusedinprophylaxis.Dapsone,pentamidine.
390.Canon'a'waveisseenin a)Junctionalrhythm b)Atrialfibrillation c)Atrialflutter d)Ventricularfibrillation CorrectAnswer-AAns.is'a'i.e.,JunctionalrhythmRegularly?>Duringjunctionalrhythm?IrregularlyA-Vdissociationwithventriculartachycardiacompleteheartblock.
391.Mostcommoncauseofunilateralpedal edema a)Pregnancy b)Lymphedema c)Venousinsufficiency d)Milroydisease CorrectAnswer-CAns.is'c'i.e.,VenousinsufficiencyThemostlikelycauseoflegedemainpatientsoverage50isvenousinsufficiency.Venousinsufficiencyaffectsupto30%ofthepopulation,whereasheartfailureaffectsonlyapproximately1%.Themostimportantcauseofunilateralpedaledemaisvenousinsufficiency.Milroysdisease:ThedefectinMilroy'sdiseaseispresentfrombirthandsymptomsareusuallyfirstexperiencedinchildhood.Themostcommonproblemisone-sidedlegswelling,unilateraledema,whichisprogressiveandcanaffectbothlegs.Impairedintestinallymphaticscancausesteatorrheaduetoimpairedtransportofchylomicrons
392.Griselsyndromeallaretrueexcept a)Post-adenoidectomy b)Conservationtreatment c)Inflammationofcervicalspineligaments d)Noneedforneurosurgeon CorrectAnswer-DAns.d.NoneedforneurosurgeonGriselSyndrome:Non-traumaticatlanto-axialsubluxationmayoccursecondarytoanyinflammatoryprocessintheupperneckItisdescribedfollowingtonsillectomyandadenoidectomyConservationtreatment:Cervicalimmobilization,AnalgesiaandAntibioticstoreducetheriskofneurologicaldeficitGriselSyndromeNon-traumaticatlanto-axialsubluxationmayoccursecondarytoanyinflammatoryprocessintheupperneckQDueinfectionintheperi-odontoidvascularplexusQthatdrainstheregion,bringingaboutparaspinalligamentlaxityDescribedfollowingtonsillectomyandadenoidectomyQItmaybeassociatedwithoveruseofdiathermyeitherforremovalofadenoidorfollowingcurettageQ,whenusedforhemostasis.ChildrenwithDownsyndrome?haveatlanto-axialinstabilityTreatment:CervicalimmobilizationQAnalgesiaQAntibioticsQtoreducetheriskofneurologicaldeficit
393.Afemalepatientof26years,presents withoralulcers,photosensitivityandskinmalarrashinfacesparingthenasolabialfoldsofbothside. a)Sturgewebersyndrome b)SLE c)Dermatitis d)Psoriasis CorrectAnswer-BAnswer-B(SLE)Commonsymptomsincludepainfulandswollenjoints,fever,chestpain,hairloss,mouthulcers,swollenlymphnodes,feelingtired,andaredrashwhichismostcommonlyontheface.
394.Mostcharacteristiccardiovasculardefect seeninRubella- a)Pulmonaryarterystenosis b)Coarctationofaorta c)Ankylosisspondylitis d)Rheumaticfever CorrectAnswer-AAnswer.A.PulmonaryarterystenosisTheclassictriadforcongenitalrubellasyndromeis:Sensorineuraldeafness(58%ofpatients)Eyeabnormalities?especiallyretinopathy,cataract,andmicrophthalmiaCongenitalheartdisease?especiallypulmonaryarterystenosisandpatentductusarteriosus.
395.OsbornJwavesisseenin- a)Hypothermia b)Hyperkalemia c)Hypocalemia d)Hypokalemia CorrectAnswer-AAnswer.A.HypothermiaCausepeoplesufferingfromhypothermiawithatemperatureoflessthan32?C(90?F).
396.WhichisnotrelatedtoHIV a)PrimaryCNSlymphoma b)Tertiarysyphilis c)Oesophagealcandidasis d)None CorrectAnswer-BAnswer.B.TertiarysyphilisTertiarySyphilishasnorelationtoHIVstatusandprimarilybasedonthedurationoftheinfectionandcomplicationsofSyphilis.
397.Essentialmajorbloodculturecriteriafor infectiveendocarditis. a)Singlepositivecultureofhacek b)Singlepositivecultureofcoxiella c)Singlepositivecultureofcornybacterium d)Botha&b CorrectAnswer-AAnswer.A.SinglepositivecultureofHACEK
398.Respiratorycentresarestimulatedby a)Oxygen b)Lacticacid c)Carbondioxide d)Calcium CorrectAnswer-CAnswer.C.CarbondioxideThebody'srespiratorycenterinthemedullaisnormallystimulatedbyanincreasedconcentrationofcarbondioxide,andtoalesserextent,bydecreasedlevelsofoxygeninarterialblood.Stimulationoftherespiratorycentercausesanincreaseintherateanddepthofbreathing,thusblowingoffexcesscarbondioxideandreducingbloodacidity.
399.Alcoholicshowswhichtypeof cardiomyopathy- a)Hypercardiomyopathy b)Dilatedcardiomyopathy c)Pericarditis d)Myocarditis CorrectAnswer-BAnswer.B.DilatedcardiomyopathyAlcoholiccardiomyopathyisadiseaseinwhichthechroniclong-termabuseofalcohol(i.e.,ethanol)leadstoheartfailure.Alcoholiccardiomyopathyisatypeofdilatedcardiomyopathy.
400.Whichmurmurincreasesonstanding? a)HOCM b)MR c)MS d)VSD CorrectAnswer-AAnswer.A.HOCMMurmurwillgetsofterwithValsalvaorstandingfromsquattingbecauselessbloodisbeingejectedthroughtheaorticvalve.RapidsquattingfromastandingpositionforcesincreasedvenousreturnandwouldhavetheoppositeeffectofValsalvaorrapidstanding.
401.Whichwallofheartenlargementcanbe seenonbariumswallowinpatientwithmitralstenosis- a)Leftatrium b)Rightatrium c)Leftventricle d)Rightventricle CorrectAnswer-DAnswer.D.RightventricleMitralstenosisisassociatedwithrightventricularhypertrophy.LeftventriculardiastolicpressureisnormalinisolatedMS.Mitralstenosis:FeaturesleftatrialpressureisincreasedpulmonaryarterialpressureisincreasedIncreasedrightventricularafterloadimpedestheemptyingofthischamberandRightventricularenddiastolicpressureandvolumeincrease.Rightventricularhypertrophyoccurs.
402.Whichofthefollowingstatementsistrue aboutthebundleofkent? a)Abnormalpathwaybetweentwoatria b)Itismuscularornodalpathwaybetweentheatriaandventricle inWPWsyndrome c)ItisslowerthantheAVnodalpathway d)None CorrectAnswer-BAnswer.B.ItismuscularornodalpathwaybetweentheatriaandventricleinWPWsyndromeTheWolff-Parkinson-Whitesyndromeisdefinedbythecombinationofanatrioventricularpre-excitation(bundleofKent)andparoxysmalsupraventriculartachycardias.Thediagnosisofatrioventricularpre-excitationinsinusrhythmisestablishedontheassociationbetweenashortPRinterval,awideQRS,adeltawave,anormalterminalQRSportionandfrequentrepolarizationdisorders.
403.Deepvenousthrombosiswhichis incorrect? a)Clinicalassessmenthighlyreliable b)Mostlybilateral c)Mostcommonclinicallypresentsaspainandtendernessincalf d)Somecasesmaydirectlypresentaspulmonary thromboembolism CorrectAnswer-BAnswer.B.MostlybilateralWellsscoreorcriteria:(possiblescore-2to9)Activecancer(treatmentwithinlast6monthsorpalliative):+1pointCalfswelling=3cmcomparedtoasymptomaticcalf(measured10cmbelowtibialtuberosity):+1pointSwollenunilateralsuperficialveins(non-varicose,insymptomaticleg):+1pointUnilateralpittingedema(insymptomaticleg):+1pointPreviousdocumentedDVT:+1pointSwellingofentireleg:+1pointLocalizedtendernessalongthedeepvenoussystem:+1pointParalysis,paresis,orrecentcastimmobilizationoflowerextremities:+1pointRecentlybedridden=3days,ormajorsurgeryrequiringregionalorgeneralanestheticinthepast12weeks:+1pointAlternativediagnosisatleastaslikely:-2points
404.Punchedoutulcerinesophagusisseen in a)herpes b)cmv c)Oesophagitis d)candida CorrectAnswer-CAnswer.C.OesophagitisItislikelytopresentwithasingle,largeshallowlinearulcerasopposedtothemultiplevesicular/"punched-out"ulcersseeninherpesesophagitis.
405.Typeofsensationlostonsamesideof BrownSequardsyndrome- a)Pain b)Touch c)Proprioception d)Temperature CorrectAnswer-CAnswer.C.ProprioceptionDamagetoonehalfofthespinalcord,resultinginparalysisandlossofproprioceptiononthesame(oripsilateral)sideastheinjuryorlesion,andlossofpainandtemperaturesensationontheopposite(orcontralateral)sideasthelesion.
406.Achondroplasiashowswhichtype inheritance- a)XLR b)XLD c)Autosomalrecessive d)Autosomaldominant CorrectAnswer-DAnswer.D.AutosomaldominantAchondroplasiaisinheritedinanautosomaldominantpattern,whichmeansonecopyofthealteredgeneineachcellissufficienttocausethedisorder.
407.MELDscoreincludes a)Serumcreatinine b)Transaminase c)Albumin d)Alkalinephosphatase CorrectAnswer-AAnswer.A.SerumcreatinineTheModelforEnd-stageLiverDisease(MELD)isaprospectivelydevelopedandvalidatedchronicliverdiseaseseverityscoringsystemthatusesapatient'slaboratoryvaluesfor?LiSerumbilirubinSerumcreatinineTheinternationalnormalizedratio(INR)forprothrombintimetopredictthreemonthsurvival.Patientswithcirrhosis,andincreasingMELDscoreisassociatedwithincreasingseverityofhepaticdysfunctionandincreasedthree-monthmortalityrisk.Givenitsaccuracyinpredictingshort-termsurvivalamongpatientswithcirrhosis,MELDwasadoptedbytheUnitednetworkfororgansharing(UNOS)in2002forprioritizationorpatientsawaitinglivertransplantationintheUnitedstates.
408.Infarctsinvolvingwhichportionofthe myocardiumcauseaneurysmasapost-MIcomplication- a)Subendocardial b)Anteriortransmural c)Posteriortransmural d)Inferiorwall CorrectAnswer-DAnswer.D.InferiorwallLeftventricularaneurysmformation:Leftventricularapicalaneurysmformationusuallyoccursfollowingantero-apicalmyocardialinfarction,afterLADocclusion.Thisweakeningoftheapicalwallresultsinanoutpouchingor"dyskinesis"oftheapexoftheheartduringsystole.
409.Riskfactorsforalzheimer'sdisease include- a)Klinefeltersyndrome b)LowBP c)Down'ssyndrome d)None CorrectAnswer-CAnswer.C.Down'ssyndromePeoplewithDownsyndromearebornwithanextracopyofchromosome21,whichcarriestheAPPgene.Thisgeneproducesaspecificproteincalledamyloidprecursorprotein(APP)withagethesegetaccumulatedinthebraincellandaffectsthefunctioningofthebrainleadingtoalzheimer'sdementia.
410.Apatientwithnativeaorticvalvedisease camewithrighthemiparesis.Whatwillyoudotopreventfurtherstroke? a)Antiplateletonly b)Anticoagulantonly c)Bothantiplateletandanticoagulant d)Onedoseoflowmolecularweightheparinsub-cutaneously followedbydualantiplatelettherapy CorrectAnswer-AAnswer-A.Antiplateletonly*Aspirinistheonlyantiplateletagentthathasbeenprovenelfectivefortheacutetreatmentofischemicstroke;useofaspirinwithin48hoarsofstrokeonsetreducedbothstrokerecurrenceriskandmortalityminimally.*Asprinistheonlyantiplateletagentthathasbeenproveneffecfivefortheacutetreatmentofischemicstroke;thereareseveralantiplateletagentsprovenforthesecondarypreventionofstroke.*Twolayertrials,theInternationalStrokeTrial(IST)andtheChineseAcuteStrokeTrial(CAST),foundthattheuseofaspirinwithin48hoursofstrokeonsetreducedbothstrokerecurrenceriskandmortalityminimally.
411.ThemostcommonsubtypeofNon- Hodgkin'slymphomainIndiais: a)Diffusesmallcelllymphocyticlymphoma b)DiffuselargeBcelllymphoma c)Follicularlymphoma d)Burkitt'slymphoma CorrectAnswer-BAnswer-B.DiffuselargeBcelllymphomaThemostcommonsubtypeofNon-Hodgkin'slymphomtinIndiaisdilfuselargeBcelllymphoma.DiffuselargeB-celllymphoma:MCsubtype(34%)Follicularcentre-celllymphomas:12.6%.B-celfsmalllymphocyticlymphoma:.5.7%Mantle-celllymphoma:3.4%MarginalzoneB-celllymphomas(includingMALTlymphomas):8.2%
412.Whichofthefollowingdrugcanbegiven inpatientsofprimarypulmonaryhypertension? a)Icatibant b)Bosentan c)Labetolol d)Sodiumnitroprusside CorrectAnswer-BAnswer-B.BosentanTreatmentforPrimarypulmonaryhypertension:CALCIUMCHANNELBLOCKERS:Patientswhorespondtoshort-actingvasodilatorsatthetimeofcardiaccatheterizationshouldbetreatedwithcalciumchannelblockers.TheendothelinreceptorantagonistsbosentanandambrisentanareapprovedtreatmentsofPAHBosentaniscontraindicatedinpatientswhoareoncyclosporineorglyburideconcurrently.
413.An86yearsoldladypresentedwith severeconstipation.Shewasaknownhypertensiveonmedicationsfor10years.Inclinic,herBPwas157/98mmHgwithaheartrateof58/min.OntakinghereBPinthesupinepositionitwasfoundtobe90/60mmHg.Shehadtherecenthistoryofdepression.Sheistakingatenolol,thiazide,imipramine,haloperidolanddocusate.Whatwillbethenextbeststepinthemanagement? a)Changeatenololandthiazidetocalciumchannelblockerand ACEinhibitorandaddbisacodylforconstipation b)Changeimipramineandhaloperidoltofluoxetineand risperidoneandaddbisacodylforconstipation c)Onlyaddbisacodylforconstipationandcontinuerestofthe medications d)Discontinueallhermedicationsandstartheronsteroids CorrectAnswer-BAns:B.Changeimipramineandhaloperidoltofluoxetineandrisperidoneandaddbisacodylforconstipation(RefHarrison19/ep1623-1624,18/ep3531:GoodmanGilman12/ep410.1333)EffectsofImipramine:
Posturalhypotension-DuetoalphablockadebyImipramine&thiazidesinteraction.Anti-cholinergicside-effect.Hence,Imipramine(TCA)mustbediscontinued.ShouldbestartedonSSRI,fluoxetin&laxative(existingconstipation).Effectofhaloperidol:Anti-cholinergicsideeffects.ShouldstartonatypicalantipsychoticRisperidone.
414.pANCApositivevasculitisis a)Wegener'sgranulomatosis b)Churg-Strausssyndrome c)Polyarteritisnodosa d)Alloftheabove CorrectAnswer-BAnswer-b.Churg-StrausssyndromePANCATypicallyfoundin:MicroscopicpolyangiitisChurg-StrausssyndromeIdiopathiccrescenticglomerulonephritisGoodpasteur'ssyndrome.pANCA'sarealsoassociatedwithcertainnon-vasculiticentitiessuchascertainrheumaticandnonrheumaticautoimmunediseases,Inflammatoryboweldiseases,certaindrugs.Infectionssuchasendocarditisandbacterialairwayinfectioninpatientswithcysticfibrosis
415.Levinesignisseenin a)Stableanginapectoris b)Acutebronchialasthma c)Hemolyticanemia d)Gastroesophagealrefluxdisease CorrectAnswer-AAnswer-A.StableanginapectorisStableAnginaPectoris:ThisepisodicclinicalsyndromeisduetotransientmyocardialischemiaWhenthepatientisaskedtolocalizethesensation,heorshetypicallyplacesahandoverthesternum,sometimeswithaclenchedfist,toindicateasqueezing,central,substernaldiscomfort(Levine'ssign).
416.Whichofthefollowingcomplicationsis notseeninmitralvalveprolapse? a)Stroke b)Infectiveendocarditis c)Mitralstenosis d)Ventriculararrhythmia CorrectAnswer-CAnswer-C.MitralstenosisSurfacemarkingofthemitralvalveisBehindsternalendofleft4thcostalcartilage.InfectiveendocarditisMitralinsuficiency(mitralregurgitation)StrokeorothersystemicinfarctresultingfromembolismofleafletthrombiArrhythmias
417.HbA1ccontrolforhowmuchtime a)2-3weeks b)3-6weeks c)6-8weeks d)14-18weeks CorrectAnswer-CAnswer-C.6-8weeksThehalf-lifeofanerythrocyteistypically60days,thelevelofglycatedhemoglobin(HbA1c)reflectsthemeanbloodglucoseconcentrationoverthepreceding6-8weeks.
418.AllareseeninMENIIAsyndrome except a)Medullarycarcinomaofthyroidisseenin100%ofthepatients b)40-30%patientshavephaeochromocytoms c)CausedbylossoffunctionmutationinIIRTprotooncogene d)Primaryhyperparathyroidismisthemostvariablefeatureof MENIIAsyndrome CorrectAnswer-CAnswer-C.CausedbylossoffunctionmutationinIIRTprotooncogeneMEN-2AorSipplesyndrome,ischaracterizedbypheochromocytoma,medullarycarcinomaofthethyroid,andparathyroidhyperplasia.Parathyroidhyperplasiaandevidenceofhypercalcemiaorrenalstones.MEN-2AisclinicallyandgeneticallydistinctfromMEN-Iandiscausedbygermlinegain-of-functionmutationsintheRETproto-oncogeneonchromosomel0qll.2.40%to50%havepheochromocytomas.PrimaryhyperparathyroidismisthemostvariablefeatureofMEN2Asyndrome.
419.Hypoxicpulmonaryvasoconstrictiondue to- a)Irreversiblepulmonaryvasocontrictionhypoxia b)Reversiblepulmonaryvasoconstrictionduetohypoxia c)Directbloodtopoorlyventilatedareas d)Occurshoursafterpulmonaryvasoconstriction CorrectAnswer-BAnswer-b.ReversiblepulmonaryvasoconstrictionduetohypoxiaHypoxicpulmonaryvasoconstriction(HPV)isanadaptivevasomotorresponsetoalveolarhypoxiawhichredistributesbloodtooptimallyventilatidlungsegmentsbyanactiveprocessof'vasoconstriction,particularlyinvolvingthesmallmuscularresistancepulmonaryarteries(PA).
420.Polyuriawithlowfixedspecificgravity urineisseenin? a)Diabetesmellitus b)Diabetesinsipidus c)Chronicglomerulonephritis d)Potomania CorrectAnswer-CAnswer-C.Chronicglomerulonephritis Polyuriawithfixedlowspecificgravityisafeatureofchronicglomerulonephritis. Specificgravitymeasuresthekidney'sabilitytoconcentrateordiluteurineaboutplasma. Becauseurineisasolutionofminerals,salts,andcompoundsdissolvedinwater,the specificgravityisgreaterthan1.000.Themoreconcentratedtheurine,thehighertheurine specificgravity. Anadult'skidneyshavearemarkableabilitytoconcentrateordiluteurine. Ininfants,therangeforspecificgravityislessbecauseimmaturekidneysarenotableto concentrateurineaseffectivelyasmaturekidneys. Alowspecificgravityoccursinthreesituations. Indiabetesinsipidus,thereisanabsenceordecreaseofanti-diuretichormone.Without anti-diuretichormone,thekidneysproduceanexcessiveamountofurine,oftenupto15to 20litersperdaywithlowspecificgravity. Glomerulonephritisandpyelonephritiscausedecreasedurinevolumeandlowspecific gravity.Inthesediseases,damagetothekidney'stubulesaffectstheabilityofthekidneyto re-absorbwater.Asaresult,theurineremainstodilute. Thethirdreasonforlowspecificgravityisrenalfailure,whichresultsinafixedspecific gravitybetween1.007and1.010.Inrenalfailure,theremainingfunctionalnephrons undergocompensatorystructuralandhypertrophicchanges.Thesecompensatorychanges resultinurinethatisalmostisotonicwithplasma.Therefore,apatientexperiencingrenal failurewillpresentwithspecimensmeasuringthesame,orfixed,specificgravityregardless
ofwaterintake.
421.DOCfortreatmentofSSPE- a)Abacavir b)Inosinepranobex c)Glatiramer d)Interferon CorrectAnswer-BAnswer-B.InosinepranobexInosinepranobexisusedasanimmune-modulatorforthemanagementofpatientswith-Immune-depressionsufereingfromviralinfectionsasSSPErecurrentherpessimplexgenitalwarts.
422.RademeckercomplexinEEGisseenin- a)SSPE b)vCJD c)cCJD d)Kuru CorrectAnswer-AAnswer-A.SSPECharacteristicperiodicactivity(Rademeckercomplex)isseenonEEGshowingwidespreadcorticaldysfunctioninSSPE.Itischaracterisedbyhighvoltagespikeoccuningathiglrlrequencyof0.5-1.5seconds.
423.Charcot'sjointindiabetesaffects commonly- a)Shoulderjoint b)Kneejoint c)Hipjoint d)Tarsaljoint CorrectAnswer-DAnswer-D.TarsaljointTabesdorsalisKnees,hip&anklesLoosebodyinjointAloosebodyisafree-floatingpieceofbone,cartilageorforeignobjectinajoint.Thekneeisthemostcommonjointwhereonewouldfindaloosebody.Causesofloosebodiesinclude:-i)Osteoarthritisiii)Osteochondralfracture(injury)v)Synovialchondromatosisii)Osteochondritisdessicansiv)Charcot'sdisease
424.Shelflifeofplateletstobloodbankis a)5days b)7days c)10days d)21days CorrectAnswer-AAnswer-A.5daysPlateletsareapprovedbyFDAforstoredupto5daysat20-24(RoomTemperature)becauseofriskofbacterialcontamination.
425.DOCforlisteriameningitis- a)Ampicillin b)Cefotaxime c)Cefotriaxone d)Ciprofloxacin CorrectAnswer-AAnswer-A.AmpicillinTheantibioticofchoiceforlisteriainfectionisampicillinorpenicillinG.
426.Dent'sdiseaseischaracterizedbyall except a)Chloridechanneldefect b)Malesareaffected c)Nephrolithiasis d)DefectinlimbofLoopofHenle CorrectAnswer-DAnswer-D.DefectinlimbofLoopofHenleDent'sdiseasereferstoheterogenousgroupofX-linkeddisorders.Itbcharacterizedbymanifestationsofproximaltubuledysfunction(PT)dysfunctionassociatedwithhypercalciurianephrolithiasis,nephrocalcinosisandprogressiverenalfailureThesefeaturesarefoundinmalesonly.mutationingeneencodingCLS-S,aVoltagegatedChloidechannel.
427.Allaretruefortransplantedkidney except a)Humoralantibodyresponsibleforrejection b)CMIisresponsibleforrejection c)Previousbloodtransfusion d)HLAidentitysimilarityseenin1:100people CorrectAnswer-DAnswer-D.HLAidentitysimilarityseenin1:100peopleWithinanyparticularfamily,sibling'shavea7:4chanceofbeingHLAidentical.Incontrastamongunrelatedpeople,theprobabilitiesofHLAidentityinseveralthousanddependinguponphenotypeinvolved'ItisduetothefactthatHLAcomplexisinheritedintactastwohaplotypes.
428.Bestmanagementafterhumanbite- a)Ampicillinplussulbactam b)ClindamycinplusTMP-SMX c)Fibroquinolone d)Doxycycline CorrectAnswer-AAnswer-A.Ampicillinplussulbactam 1. Ampicillin/sulbactam2. Imipenem3. Cefoxitininpenicillinallergics
429.Duroziez'ssignisseenin a)AorticRegurgitation b)TricuspidRegurgitationMitralstenosis c)Pericardialeffusion d)None CorrectAnswer-AAnswer-A.AorticRegurgitationInsevereaorticregurgitation,gradualpressureoverthefemoralarteryleadstoasystolicanddiastolicbruit.Referstosystolicanddistolicmurmursheardoverthefemoralarterywhilepartiallycompresslngthevesselwiththediaphragmofthestethoscope.
430.TTKGinhypokalemiais- a)<3-4 b)>6-7 c)>9-10 d)>10-15 CorrectAnswer-AAnswer-A.<3-4AnormalTTKinnormalsubjectsonnormaldietis8-9Withoutotherdisease,hypokalemiashouldproduceaTTKG<3
431.Mostcommoncauseofdeathin diphtheriaisdueto a)Airwaycompromise b)Toxiccardiomyopathy c)Sepsis d)Descendingpolyneuropathy CorrectAnswer-BAnswer-B.ToxiccardiomyopathyMostcommoncauseofdeathindiphtheriacardiomyopathy
432.Upperlobebronchiectasisisseenin whichdisease? a)Cysticfibrosis b)Aspergilloma c)HIV d)Bronchogeniccarcinoma CorrectAnswer-AAnswer-A.CysticfibrosisUpperlobebronchiectasis-CysticfibrosisTuberculosisNontuberculousmycobacterialinfections
433.OnmedicalcheckupofaPunjabi studentfollowingfindingswereseenHbof9.9gm/d1,RBCcountof5.1million,MCVof62.5flandRDWof13.51%.Whatisthemostprobablediagnosis? a)HbD b)Thalassemiatrait c)Irondeficiencyanemia d)Anemiaofchronicdisease CorrectAnswer-BAnswer-B.ThalassemiatraitNormalRDWwithlowMCVisseenin-- 1. Anemiaofchronicdisease2. Heterozygousthalassemia(Thalassemiatrait)3. HemoglobinEtrait.
434.Riskfactorsassociatedwithhealthcare associatedpneumonia(HCAP)- a)Acutecarehospitalizationforatleast2daysinthepreceding 90days b)Homeinfusiontherapy c)Immunosuppressivediseaseorimmunosuppressivetherapy d)Antibiotictherapyinthepreceding90days e)Hospitalizationfor>48h CorrectAnswer-A:B:C:D:EAnswer-(A)Acutecarehospitalizationforatleast2daysinthepreceding90days(B)Homeinfusiontherapy(C)Immunosuppressivediseaseorimmunosuppressivetherapy(D)Antibiotictherapyinthepreceding90days(E)Hospitalizationfor>48hAcutecarehospitalizationforatleast2daysinthepreceding90daysResidenceinanursinghomeorextendedcarefacilityHomeinfusiontherapy,includingchemotherapy,withinthepast30daysLong-termdialysiswithinthepast30daysHomewoundcareFamilymemberwithaninfectioninvolvingamultipledrugresistantpathogenImmunosuppressivediseaseorimmunosuppressivetherapy
435.Malignancyassociatedwith hypercalcemia: a)Breastcancer b)Smallcelllungcancer c)Non-smalllungcancer d)Prostatecancer e)Multiplemyeloma CorrectAnswer-A:C:D:EAnswer-A,BreastcancerC,Non-smalllungcancerD,ProstatecancerE,MultiplemyelomaLungcarcinoma,breastcarcinoma,andmultlplemyelomaaccountformorethan50%ofallcasesofmalignancy-associatedhypercalcemia.Gastrointestinaltumarsandprostatecarcinomaarelesscommoncausesofhypercalcemia.
436.Capnographyhelpstoknowthe following a)Correctintubation b)Pulmonaryembolism c)Adequateventilation d)Lungperfusion e)Significantmetabolicchange CorrectAnswer-A:B:C:D:EAnswer-A,CorrectintubationB,PulmonaryembolismC,AdequateventilationD,LungperfusionE,SignificantmetabolicchangeConditionsthataffectETCO2IncreasedHypoventilationRebreathingMalignanthyperthermia,NeurolepticmalignantsyndromeIncreasedskeletalmuscleactivity(shiveringHypermetabolismHyperthyroidism&thyroidstormDecreasedHyperventilationPulmonaryembolismHypoperfusion,hypotension,hypovalemia,shockHypothermia
437.Theseverityofmitralstenosiscanbe judgedby- a)Intensityofmurmur b)Durationofmurmur c)LeftventricularS3 d)LoudS1 CorrectAnswer-BAnswer-B.DurationofmurmurDurationdependsonseverityofMS.InsevereMS,themiddiastolicmurmurislongandmergeswiththepresystolicmurmurtoproduceholodiastolicmurmur..
438.Puremotorpalsyseeninpoisoningof a)Leadpoisoning b)Arsenicpoisoning c)Cocainepoisoning d)Cannabispoisoning CorrectAnswer-AAns.is'A'i.e.,LeadpoisoningTheperipheralneuropathyofleadtoxicityisapuremotorneuropathyaffectingtheupperlimbsmorethanthelowerlimbs,presentingassymmetricorasymmetricwristdrop.Theweaknessmayalsoinvolveothermusclegroupsofthedistalupperextremities,theinvolvementoflowerextremities,includingisolatedfootdrop,alsomayoccur.
439.Smokersarepronetowhichlung infection a)Mycobacteriumtuberculosis b)Pneumonia c)Influenza d)Alltheabove CorrectAnswer-DAnswer-D.Alltheabove
440.Somepatientswithsevereformof Idiopathicinfantilehypercalcemia,presntwithphenotypicfeaturessimilartowhichofthefollowing? a)Williamssyndrome b)Potterssyndrome c)Angelmansyndrome d)VHLsyndrome CorrectAnswer-AAnswer-A.WilliamssyndromeInthesevereform,PrenatalandpostnatalgrowthfailurearecommonandnumberofphenotypicfeaturesofWilliamssyndromeareobservedinsomeofthepatientsincludecardiovascularabnormalities(usuallysupravalvularaorticstenoisandperipheralpulmonicstenosis),latepsychomotordevelopment,selectivementaldeficiency,acharacteristicunusualfaciesandshortstature.Theserumcalciumlevelsrangebetween12-19mg/dL.
441.Whichliverdisease/sis/areassociated withductopenia? a)Chronicgraftrejection b)Hepaticsarcoidosis c)Paraneoplasticsyndromerelatedtohodgkinslymphoma d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveLossofbileductsfromtheportaltractsisreferredtoasductopenia.Ductopeniaismostcommonlyseenrelatedtochronicallograftrejectionandincludesdrugrelatedinjury,primarybinarycirrhosis,primarysclerosingcholangitis,chronicgraft-vs-hostdisease,hepaticsarcoidosis,paraneoplasticsyndromerelatedtoHodgkindisease,andsyndromicpaucityofbileducts(Alagillesyndrome).
442.Whichofthefollowingisnottrueabout metabolicsyndrome? a)ItisalsocalledSyndromeX b)Acanthosisandsignsofhyperandrogenismmaybeseen c)TypeAhasautoantibodiesagainsttheinsulinreceptor d)Insulinresistanceincreasestheriskoftype2DMinpatients withPCOS CorrectAnswer-CAnswer-C.TypeAhasautoantibodiesagainsttheinsulinreceptorItisaninsulinresistanceconditionwhichcomprisesaspectrumofdisorders,withhyperglycemiarepresentingoneofthemostreadilydiagnosedfeatures.Themetabolicsyndrome,theinsulinresistancesyndrome,orsyndromeXaretermsusedtodescribeaconstellationofmetabolicderangementsthatincludesinsulinresistance,hypertension,dyslipidemia(decreasedHDLandelevatedtriglycerides),centralorvisceralobesity,type2diabetesorIGT/IFG,andacceleratedcardio-vasculardisease.Acanthosisnigricansandsignsofhyperandrogenism(hirsutism,acne,andoligomenorrheainwomen)arealsocommonphysicalfeatures.Twodistinctsyndromes- 1. typeA,whichaffectsyoungwomenandischaracterizedbysevere hyperinsulinemia,obesity,andfeaturesofhyperandrogenism;andtypeAinsulinresistancesyndromehaveanundefineddefectintheinsulin-signalingpathway. 2. typeB,whichaffectsmiddle-agedwomenandischaracterizedby
severehyperinsulinemia,featuresofhyperandrogenism,andautoimmunedisorders.
443.Metabolicsyndromediagnosisinmen basedonNCEPATPIIIcriteriaincludesthefollowingexcept a)Abdominalobesity>40inches b)HDL<50mg/dL c)BP>/=130/85mmHg d)Fastingglucoe>110mg/dL CorrectAnswer-BAnswer-B.HDL<50mg/dL
444.Ejectionclickofpulmonarystenosisis betterheardin a)Inspiration b)Expiration c)Patientbendingforward d)Patientlyinginleftlateralposition CorrectAnswer-BAnswer-B.ExpirationItemanatesfromastenoticpulmonaryvalveoradilatedpulmonaryartery.Itsmostcharacteristicfeatureistodisappearorbecomemarkedlysofterwithinspirationi.e.itisbetterheardinexpiration.Itislocalizedto2ndand3rdintercostalspaces.Theymayalsobepresentinpatientswithpulmonaryhypertentionortheoneswithdilatedpulmonaryartery.
445.ReciprocalchangesinECGinpatients withinferiorwallmyocardialinfarctionareseeninwhichleads a)I b)II c)III d)aVF CorrectAnswer-AAnswer-A.I
446.Allarefeaturesofaorticstenosis except a)Congestiveheartfailureduetosystolicordiastolicdysfunction b)Presenceofejectionsystolicmurmur c)Presenceofpulsustardus d)Pressureintheaortaisthesameasinleftventricle CorrectAnswer-DAnswer-D.PressureintheaortaisthesameasinleftventricleClinicalFindings-SystolicejectionmurmurCarotidpulsusparvusettardusDiminishedaorticcomponentof2ndheartsoundSuddendeathinseverestenosisafterexerciseClassicaltriad-AnginaSyncopeShortnessofbreath(heartfailure)
447.Whichofthefollowingisnottrueabout bicuspidaorticvalve? a)Usuallyundetectedinearlylife b)Itismorecommoninfemalesthaninmales c)Post-stenoticdilatationofascendingaortacanbeseen d)Diagnosisismadebyechocardiography CorrectAnswer-BAnswer-B.ItismorecommoninfemalesthaninmalesThecongenitalbicuspidaorticvalve,whichmayinitiallybefunctionallynormal,isoneofthemostcommoncongenitalmalformationsoftheheartandmaygoundetectedinearlylife.Morefrequentinmales(3:1)Diagnosisismadebyechocardiography,whichrevealsthemorphologyoftheaorticvalveandaorticrootandquantitatesseverityofstenosisorregurgitation.Theascendingaortaisoftendilated,misnamed"poststenotic"dilatation;thisisduetohistologicabnormalitiesoftheaorticmediasimilartothoseinMarfan'ssyndromeandmayresultinaorticdissection.
448.Whichofthefollowinghemodynamic changesisnotevidentincardiactamponadeduringdiastole? a)Rightatrialandventricularcollapse b)AbsentywaveonJVP c)Biphasicvenousreturn d)Elevatedpericardialpressure CorrectAnswer-CAnswer-C.BiphasicvenousreturnDuringthediastolethepericardialpressureremainselevated.ItisgreaterthantheintracavitarypressurethusthereisnofillingduringthediastoleTheabsenceofvenousreturnduringthediastoleleadstoabsenceof"y"wavesontheJ.V.P.andthe"diastoliccollapse"oftherightatriaandventricle.
449.Majorcriteriaforinfectiveendocarditis includewhichofthefollowing a)Injectiondruguser b)Fever c)Oslersnodes d)Typicalorganismofinfectiveendocarditisisolatedfromtwo separatebloodcultures CorrectAnswer-DAnswer-D.Typicalorganismofinfectiveendocarditisisolatedfromtwoseparatebloodcultures
450.WhichofthefollowingECGfeaturesare notseeninpatientswithventriculartachycardias? a)BizzareQRScomplexes b)PresenceofAVdissociation[fusionbeats] c)ProlongeddurationofQRScomplexes d)Ppulmonale CorrectAnswer-DAnswer-D.PpulmonaleAVdissociation(atrialcapture,fusionbeats)QRSduration>140msforRBBBtypeV1morphology,VI>160msforLBBBtypeVImorphologyFrontalplaneaxis-900to1800DelayedactivationduringinitialphaseoftheQRScomplexLBBBpattern-RwaveinV1,V,>40msRBBBpattern-onsetofRwavetonadirofS>100msBizarreQRSpatternthatdoesnotmimictypicalRBBBorLBBBQRScomplex.ConcordanceofQRScomplexinallprecordialleadsRSordominantSinV6forRBBBVTQwaveinV6withLBBBQRSpatternMonophasicRorbiphasicqRofR/SinV,withRBBBpattern
451.Cerebro-occulo-genitalsyndromehas thefollowingfeaturesexcept a)Microcephaly b)Shortstature c)Agenesisofcorpuscallosum d)Flaccidquadriplegia CorrectAnswer-DAnswer-D.FlaccidquadriplegiaCerebro-occulo-genitalsyndromeisassociatedwithmicrocephaly,shortstature,microophthalmia,agenesisofcorpuscallosum,hypospadiasandspasticquadriplegia.
452.Pulsusbiseferians,whichofthe followingisnottrue a)Itisseeninaorticregurgitation b)Itisbetterfeltinperipheralarteries c)Ithasonepeakinsystoleandoneindiastole d)Ithastwopeaks CorrectAnswer-CAnswer-C.IthasonepeakinsystoleandoneindiastoleItischaracterizedbytwosystolicpeaks.Itisseeninpatientsofaorticregurgitation.Thepulsewaveupstrokerisesrapidlyandforcefullyproducingthefirstsystolicpeak(percussionwave).Abriefdeclineinpressureisfollowedbyasmallerandsomewhatslowerrisingpositivepulsewave.Inbisiferianspulsethesecondriseinsystoleisenhancedbyreflectionfromperipheralarteriesthereforeitismoreprominentinperipheralpulse.
453.SquarewaveseeninECGrecording denote a)Atrialdepolarization b)Ventriculardepolarization c)Ventricularrepolarization d)StandardizationofECG CorrectAnswer-DAnswer-D.StandardizationofECGEachECGmachinehasaprovisionforStandardization(STD)ofCalibration(CAL).Thestandardizationleverreleasesacurrentof1mVtothestylusofECGmachinethatrecordsashiftof10mmontheECGpaper.Thestandardizationcurrentgivesrisetoawavepatterncalledsquarewavepatternasdepictedintheimagebelow.
454.Whichofthefollowingisnottrueabout Torsadesdepointes? a)PresenceofprolongedQTintervalonECG b)PresenceofpolymorphicQRScomplexes c)Itisatypeofsupraventriculartachycardia d)QRScomplexesappeartorotatearoundtheisoelectric baselineofECG CorrectAnswer-CAnswer-C.ItisatypeofsupraventriculartachycardiaThesignificanceofthelongQTsyndromeisitsassociationwiththedevelopmentofaspecifictypeofventriculartachycardiacalledTorsadesdepointsorpolymorphicventriculartachycardiaAwidecomplextachyarrythmiawithQRScomplexesofvaryingaxisandmorphologythatappeartorotatearoundtheisoelectricbaseline.
455.ProlongedQTintervalisseeninallofthe followingexcept a)Hypokalemia b)Hypocalcemia c)Useofmacrolideantibiotitcs d)Hypernatremia CorrectAnswer-DAnswer-D.HypernatremiaMetabolicHypokalemiaHypocalcemiaHypomagnesemia
456.Followingaretheclinicalsignsof widenedpulsepressureseeninpatientsofaorticregurgitationexcept a)Corriganssign b)DeMussetssign c)WaterHammerpulse d)Diastolicmurmur CorrectAnswer-DAnswer-D.DiastolicmurmurCorrigan'spulse:ArapidandforcefuldistensionofthearterialpulsewithaquickcollapseDeMusset'ssign:Bobbingoftheheadwitheachheartbeat(likeabirdwalking)Muller'ssign:VisiblepulsationsoftheuvulaQuincke'ssign:CapillarypulsationsseenonlightcompressionofthenailbedTraube'ssign:Systolicanddiastolicsoundsheardoverthefemoralartery("pistolshots")Duroziez'ssign:GradualpressureoverthefemoralarteryleadstoasystolicanddiastolicbruitHill'ssign:Poplitealsystolicbloodpressureexceedingbrachialsystolicbloodpressureby60mmHg(mostsensitivesignforaorticregurgitation)Waterhammerpulse
457.Episodeofstableanginapectoris typicallylastsfor a)Lessthan1min b)2-5mins c)5-10mins d)>10mins CorrectAnswer-BAnswer-B.2-5minsAnginaisusuallycrescendo-decrescendoinnature,typicallylasts2to5min,andcanradiatetoeithershoulderandtobotharms(especiallytheulnarsurfacesoftheforearmandhand).Italsocanariseinorradiatetotheback,interscapularregion,rootoftheneck,jaw,teeth,andepigastrium.Anginaisrarelylocalizedbelowtheumbilicusorabovethemandible.
458.NotTrueaboutPrinzmetal'sangina: a)Maypresentatrest b)Occursdueatheroscleroticobstructionofcoronaryarteries c)Smokingisariskfactor d)Nitratesareusedfortreatment CorrectAnswer-BAnswer-B.OccursdueatheroscleroticobstructionofcoronaryarteriesThissyndromeisduetofocalspasmofanepicardialcoronAryartery,leadingtoseveremyocardialischemialeadingtoseveremyocardialischemia.Therightcoronaryarteryisthemostfrequentsite,followedbytheleftanteriordescendingcoronaryartery.Acetylcholinereleasedbytheparasympatheticsystematrestwillsimplycausecontractionofthevascularsmoothmuscle.ItusuallyoccursatrestandisassociatedwithtransientST-segmentelevation.Etiologycigarettesmokers
459.Obstructiveshockcanbeseenin a)Pulmonaryembolism b)Tensionpneumothorax c)Pericardialtamponade d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveCausesintraumapatientsincludepulmonaryembolism,pericardialtamponade,acutecoronarysyndromes,increasedintrathoracicpressureasintensionpneumothorax,positivepressureventilationandexcessivePEEP.
460.Pharmacologicalstressduringstress myocardialradionucleotideperfusionimagingcanbeinducedusing a)Dipyridamole b)Adenosine c)Dobutamine d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveDipyridamoleoradenosinecanbegiventocreateacoronary"steal"bytemporarilyincreasingflowinnondiseasedsegmentsofthecoronaryvasculatureattheexpenseofdiseasedsegments.Alternatively,agradedincrementalinfusionofdobutaminemaybeadministeredtoincreaseMVO2.Thedevelopmentofatransientperfusiondefectwithatracersuchasthallium-201or99m-technetiumsestamibiisusedtodetectmyocardialischemia.
461.Whiletreatingpatientswithmalignant hypertentionthemaximumalloweddecreaseinbloodpressureinthefirst2-6hoursshouldnotexceed% a)15 b)20 c)25 d)30 CorrectAnswer-CAnswer-C.25HypertensionwithsystolicBP180mmHganddiastolicBP120mmHgisclassifiedas"severehypertension".Severehypertension(180/120)doesnotnecessarilymeanhypertensiveemergencyormalignanthypertension.?PatientswithB.P.180/120mayremainasymptomaticwithoutcausinganycomplications.Theinitialaimoftreatmentinmalignanthypertensionandhypertensiveencephalopathyistolowerdiastolicbloodpressuretoabout100to105mmHgwithinminutesto,two-sixhourswiththemaximumfallinB.P.overthisperiodoftimenotexceeding25%oftheoriginalvalue.
462.Contraindicationforpercutaneousballon mitralvalvotomyincludethefollowingexcept a)Presenceofpulmonaryhypertension b)Leftatrialthrombus c)Severemitralregurgitation d)Commissuralcalcification CorrectAnswer-AAnswer-A.PresenceofpulmonaryhypertensionPatientswithvalvularcalcification,thickenedfibroticleafletswithdecreasedmobilityandsubvalvularfusion,haveincidenceofacutecomplicationsandhigherrateofrestenosisonfollowup.Suchpatientsareconsideredacontraindicationfortheprocedure.Othercontraindicationsincludemorethanmoderatemitralregurgitation,presenceofleftatrialthrombi,andcommissuralcalcification.
463.Mitralvalvereplacementis recommendedinpatientswith a)ModerateMSinNYHAclassII b)ModerateMSinNYHAclassIII c)SevereMSinNYHAclassII d)SevereMSinNYHAclassIII CorrectAnswer-DAnswer-D.SevereMSinNYHAclassIIISincetherearealsolong-termcomplicationsofvalvereplacement,patientsinwhompreoperativeevaluationsuggeststhepossibilitythatMVRmayberequiredshouldbeoperatedononlyiftheyhavesevereMS--i.e.,anorificearea"1cm2--andareinNYHAClassIII,i.e.,symptomaticwithordinaryactivitydespiteoptimalmedicaltherapy".
464.HOCMiscommoninwhichagegroup? a)10-30years b)20-40years c)30-50years d)40-60years CorrectAnswer-BAnswer-B.20-40yearsHypertrophiccardiomyopathyischaracterizedbymarkedleftventricularhypertrophyintheabsenceofothercauses,suchashyper-tensionorvalvedisease.Earliertermedhypertrophicobstructivecardiomyopathy(HOCM)Hypertrophiccardiomyopathyischaracterizedhemodynamicallybydiastolicdysfunction,originallyattributedtothehyper?trophy,fibrosis,andintraventriculargradientwhenpresent.Hypertrophiccardiomyopathyusuallypresentsbetweentheagesof20and40years.Dyspneaonexertionisthemostcommonpresentingsymptom,reflectingelevatedintracardiacfillingpressures
465.Preferredveinforcentralvenous catheterinsertionis a)Rightinternaljugularvein b)Leftinternaljugularvein c)Rightsubclavianvein d)Rightantecubitalvein CorrectAnswer-AAnswer-A.RightinternaljugularveinPlacementofthecentralvenouscatheterisindicatedforthemonitoringofthecentralvenouspressureandforprolongeddrugadministrationforparenteralnutrition.Thepreferredsiteforinsertionofcatheterintothesuperiorvenacavaisfrominternaljugularveinoftheneck.Otherusedsitesarefromthesubclavianveinorfromtheperipheralveinintheantecubitalfossa.Commonlyusedveincannulationsitesforcentralvenousaccessinclude:JugularveinExternaljugularveinInternaljugularvein(central,posterior,anteriorapproaches)Subclavianvein(supraclavicular,infraclavicular,axillaryapproaches)FemoralveinBasilicvein
466.KerleyBlinesseeninmitralstenosis whentherestingleftatrialpressureexceeds a)10mmHg b)20mmHg c)30mmHg d)40mmHg CorrectAnswer-BAnswer-B.20mmHgKerleyBlinesarefine,dense,opaque,horizontallinesthataremostprominentinthelowerandmid-lungfieldsandthatresultfromdistentionofinterlobularseptaeandlymphaticswithedemawhentherestingmeanLApressureexceedsapproximately20mmHg.
467.Whichofthefollowingisthemost commonanamolyinpatientswithfanconi'sanemia? a)Hyperpigmentationofthetrunk,neckandintertriginousareas b)Absentradiiandthumb c)Weakradialpulse d)Presenceofhorseshoekidneys CorrectAnswer-AAnswer-A.Hyperpigmentationofthetrunk,neckandintertriginousareasFanconianemia(FA)isprimarilyinheritedinanautosomalrecessivemanner(oneuncommonformisX-linkedrecessive).ThemostcommonanomalyinFAishyperpigmentationofthetrunk,neck,andintertriginousareas,aswellascaf?-au-laitspotsandvitiligo,aloneorincombination.Anomaliesofthefeet,congenitalhipdislocation,andlegabnormalitiesareseen.
468.Patientswithwhichofthefollowing conditionsareatgreatestriskofpernio a)Raynaud'sphenomenon b)Kawasakidisease c)HenochSchonlenpurpura d)HepatitisCinfection CorrectAnswer-AAnswer-A.Raynaud'sphenomenonThetwomostcommonnonfreezingperipheralcoldinjuriesarechilblain(pernio)andimmersion(trench)foot.Chilblainresultsfromneuronalandendothelialdamageinducedbyrepetitiveexposuretodrycold.Youngfemales,particularlythosewithahistoryofRaynaud'sphenomenon,areatgreatestriskofpernio(chilblain).Persistentvasospasticityandvasculitiscancauseerythema,mildedema,andpruritus.Eventuallyplaques,bluenodules,andulcerationsdevelop
469.WhatisTiffeneau-Pinelliindex? a)FEV1/FVCratio b)Bodymassindex c)Quetletindex d)Ventilation/Perfusionratio CorrectAnswer-AAnswer-A.FEV1/FVCratio
470.Lightscriteriaisusedfor a)Pleuraleffusions b)Pericardialeffusions c)Ascites d)Increasedintracranialtension CorrectAnswer-AAnswer-A.PleuraleffusionsLight'scritenaforclassificationofunilateralpleuraleffusionThepleuralfluidisanexudateifoneormoreofthefollowingciteriaaremet.Pleuralfluidproteindividedbyserumprotein>0.5PleuralfluidlacatodehyoctogenaseLDHdividedbyserumLDH>0.6
471.Commoncauseofdeathinapatientwith chronicbronchieactasisis a)Rightsidedheartfail b)Infection c)Hemoptysis d)Carcinoma CorrectAnswer-AAnswer-A.RightsidedheartfailIntodaysworld,rightsidedheartfailureinpatientswithdiffuselongstandingbronchieactasisisacommoncauseofdeathinpatientswithchronicbronchieactasis.Pneumoniaandhemorrhagearelesscommoncausesofdeath.
472.Leutrieneinhibitorsareusedinasthma for a)Monotherapyforacuteattack b)Add-ontherapyinpatientsnotcontrolledbylowdoseinhaled glucocorticoids c)Statusasthmaticus d)Noneoftheabove CorrectAnswer-BAnswer-B.Add-ontherapyinpatientsnotcontrolledbylowdoseinhaledglucocorticoidsCysteinyl-leukotrienesarepotentbronchoconstrictors,causemicrovascularleakage,andincreaseeosinophilicinflammationthroughtheactivationofcys-LT1-receptors.Lukotrieneinhibitorssuchasmontelukastandzafirlukast,blockcys-LT1-receptorsandprovidemodestclinicalbenefitinasthma.Theyarelesseffectivethaninhaledcorticosteroidsincontrollingasthmaandhavelesseffectonairwayinflammation,butareusefulasanadd-ontherapyinsomepatientsnotcontrolledwithlowdosesofinhaledcorticosteroids.
473.Apneahypoapneaindexindicating obstructivesleepapneais- a)<1 b)2-5 c)5-8 d)>8 CorrectAnswer-AAnswer-A.<1Normalpreschoolandschool-agechildrengenerallyhaveatotalAHIoflessthan1.5(obstructiveAHI<1),andthisisthemostwidelyusedcutoffvalueforObstructiveSleepApneainchildren12yrandbelow;inolderadolescents,theadultcutoffofanAHI5isgenerallyused.
474.Multipleepisodesofacutechest syndromeareassociatedwith a)Asthma b)Bronchieactasis c)SLE d)Sjogrenssyndrome CorrectAnswer-AAnswer-A.AsthmaPatientpresentswithrecurrentepisodesofacutechestsyndrome.Thecharacteristicsymptomsduringanepisodeofasthmaarewheezing,dyspnea,andcoughing,whicharevariable,bothspontaneouslyandwiththerapy.Prodromalsymptomsmayprecedeanattack,withitchingunderthechin,discomfortbetweenthescapulae,orinexplicablefear(impendingdoom).
475.Triadofskinlesions,mononeuritis multiplex,eosinophilsseenin a)Alportssyndrome b)Churg-Strausssyndrome c)Cryoglobulinemia d)Wegenersgranulomatosus CorrectAnswer-CAnswer-C.CryoglobulinemiaChurg&Straussischaracterizedbyasthma,eosinophilla,extravasculargranulomaformation,vasculitis.ClinicalFeatures-Fever,malaise,anorexia,weightloss.Mononeuritismultiplexisthesecondmostcommonfeatures.Allergicrhinitisandsinusitis.AsthmaPeripheralandtissueeosinophillia,extravascularnecrotizinggranuloma.
476.Chronicbronchitisissaidtobepresent whenpatienthaschroniccough a)3consecutivemonthsinatleasttwoconsecutiveyears b)2consecutivemonthsfor3consecutiveyears c)3consecutivemonthsinoneyear d)1monthinayearfor2consecutiveyears CorrectAnswer-AAnswer-A.3consecutivemonthsinatleast2consecutiveyears.Cigarettesmokingisthemostimportantriskfactor;airpollutantsalsocontribute.Thedominantpathologicfeaturesaremucushypersecre-tionandpersistentinflammation.Histologicexaminationdemonstratesenlargementofmucous-secretingglands,gobletcellhyperplasia,chronicinflammation,andbronchiolarwallfibrosis.
477.Brockssyndromeisduetowhichlobeof lung? a)Rightmiddlelobe b)Rightlowerlobe c)Leftupperlobe d)Leftlowerlobe CorrectAnswer-AAnswer-A.RightmiddlelobeBrockssyndromeisduetocollapseofrightmiddlelobeoflung.Itisseenasanacutecomplicationofpulmonarytuberculosis.Itoccurssecondarytohilarnodeinvolvement.
478.PresenceofVelcrocracklesatthelung baseonauscultationisasignof a)Scleroderma b)SystemicLupus c)WegenersGranulomatosus d)Polyarteritisnodosa CorrectAnswer-AAnswer-A.SclerodermaCLINICALFEATURES-Skin-sclerodactyly,Ranaud'sphenomenon,calcinosis,telangiectasia,skinthickening.(inadvancestagefingersbecomeclawlike&facemasklike)Musculoskeletalfeatures-Arthralgia,flexortenosynovitisGIT-oesophagitis,dysphagia,malabsorptionCardiorespiratoryfeatures-pulmonaryfibrosis,pulmonaryhypertensionRenalfeatures-hypertensiverenalcrisisMalignanthypertensionPhysicalexaminationmayreveal"Velcro"cracklesatthelungbases.
479.TypeIVrespiratoryfailureoccursdueto a)Alveolarflooding b)InabilitytoeliminateCO2 c)Lungatelactasis d)Hypoperfusionofrespiratorymuscles CorrectAnswer-DAnswer-d.HypoperfusionofrespiratorymusclesTypeIVRespiratoryFailure:resultsfromhypoperfusionofrespiratorymusclesinpatientsinshock.Commonlycausedbycardiogenicshock,septicshockandhypovolemicshock.
480.Tool/swhichobjectivelyassestheriskof adverseoutcomesinapatientwithpneumoniais/are a)Pneumoniaseverityindex[PSI] b)CURB-65criteria c)ApacheeScore d)Glasgowscale CorrectAnswer-A:BAnswer-(A)Pneumoniaseverityindex[PSI](B)CURB-65criteriaToolsthatobjectivelyassesstheriskofadverseoutcomesarethePneumoniaSeverityIndex(PSI),aprognosticmodelusedtoidentifypatientsatlowriskofdying;andtheCURB-65criteria,aseverity-of-illnessscore.TheCURB-65criteriaincludefivevariables:confusion(C);urea>7mmol/L(U);respiratoryrate30/min(R);bloodpressure,systolic"90mmHgordiastolic"60mmHg(B);andage65years(65).
481.InICUsettingpatientssufferingfrom whichrespiratorypathologyareatriskofCO2narcosis? a)Pneumonia b)Asthma c)Emphysema d)Bronchieactasis CorrectAnswer-CAnswer-C.EmphysemaHypoventilationsyndromeoccursmostfrequentlyinpatientswithahistoryofchronicCO,retentionwhoarereceivingoxygentherapyforemphysemaorchronicpulmonarydisease.TheelevatedPaco,leadingtoCO,narcosismayhaveadirectanestheticeffect,andcerebralvasodilationfromincreasedPaco,canleadtoincreasedICP
482.Inspiratorysqueaksarethephysical examinationfindingof a)Bronchiolitis b)Pulmonaryhypertension c)Pneumonia d)Pulmonaryedema CorrectAnswer-AAnswer-A.BronchiolitisILDassociatedwithinflammationbutarelesslikelytobeheardinthegranulomatouslungdiseases.Cracklesmaybepresentintheabsenceofradiographicabnormalitiesonthechestradiograph.Scatteredlateinspiratoryhigh-pitchedrhonchi--so-calledinspiratorysqueaks--areheardinpatientswithbronchiolitis.Cyanosisandclubbingofthedigitsoccurinsomepatientswithadvanceddisease.
483.Whichofthefollowingaretheclinical abnormalitiesofuremia? a)Hyperphosphatemia b)Uremicfrost c)Pepticulcer d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveVolumeexpasion(I)Hyperkalemia(I)Hyponatremia(1)Hyperphosphatemia(I)
484.WhichtypeofBartter'ssyndromeis associatedwithmutationsinbarttin? a)Type1 b)Type2 c)Type3 d)Type4 CorrectAnswer-DAnswer-D.Type4Bartter'ssyndromemayresultfrommutationsaffectinganyoffiveiontransportproteinsintheTAL.Theproteinsaffectedincludetheapicalloopdiuretic-sensitivesodium-potassium-chlorideco-transporterNKCC2(type1),theapicalpotassiumchannelROMK(type2),andthebasolateralchloridechannelC1C-Kb(type3).Bartter'stype4resultsfrommutationsinbarttin,anessentialsubunitofCIC-KaandC1C-Kbthatenablestransportofthechloridechannelstothecellsurface.Barttinisalsoexpressedintheinnerear;thisaccountsforthedeafnessinvariablyassociatedwithBartter'stype4.
485.Testusedforscreeningforurinarytract infectionis a)Nitritetest b)Nanitroprussidetest c)PaulBunneltest d)Fentonstest CorrectAnswer-AAnswer-A.NitriteTestEffectiveandrapidmethodusedforscreeningurineforthepresenceofbacterialinfection.Testisbasedonthefactthatmostbacteriapresentintheurine,havethecapacitytoreduceurinenitratetonitrite.
486.Patientwithnephroticsyndromehas decreasedamountofwhichantibody a)IgG b)IgE c)IgM d)IgA CorrectAnswer-AAnswer-A.IgGTheimmunologicalabnormalitiesnotedareverypeculiarIgGantibodyisdecreaseIgEandIgMantibodyincreaseReducedresponsestoPHAandConA(ConcanavalinA)IncreaseofbetamicroglobulinlevelsReducedproductionofIL2IncreasedproductionofvascularpermeabilityandimmunosuppressorfactorsbyCD4TcellsandCD8Tcellsrespectively.
487.RIFLEcriteriaisusedfordiagnosisof a)Acutekidneyinjury b)Acutesplenicinjury c)Acuteliverinjury d)Acutebowelinjury CorrectAnswer-AAnswer-A.AcutekidneyinjuryTheRIFLEcriteria,definesthreesincreasinglevelsofseverityofacutekidneyinjuryonthebasisoftheincreaseinserumcreatinineconcentrationordecreaseinurineoutput.
488.Hemodynamicallyimportantlesionsof renalarterystenosisarepredictedbyrenalarteryvelocitiesmorethanonDopplerultrasound. a)100cm/s b)125cm/s c)150cm/s d)200cm/s CorrectAnswer-DAnswer-D.200cm/sRenalarteryvelocitiesbyDopplerultrasoundabove200cm/sgenerallypredicthemodynamicallyimportantlesions(above60%vessellumenocclusion),althoughtreatmenttrialsrequirevelocityabove300cm/stoavoidfalsepositives.Renalresistiveindexhaspredictivevalueregardingtheviabilityofthekidney.Itremainsoperator-andinstitution-dependent.
489.Gitelman'ssyndromeresemblesthe effectsofwhichofthefollowingdrugs? a)Thiazide b)Furosemide c)Spironolactone d)Amiloride CorrectAnswer-AAnswer-A.ThiazideGitelman'ssyndromeisduetomutationsinthethiazide-sensitiveNa-Clco-transporter,NCCT,inthedistalconvolutedtubule(DCT).DefectsinNCCTinGitelman'ssyndromeimpairsodiumandchloridereabsorptionintheDCTandthusresembletheeffectsofthiazidediuretics.Itremainsunclearhowthisdefectleadstoseveremagnesiumwasting.
490.Definitionofcomplicatedurinarytract infectionis,theinfectionwhichfailtoresolveorrecurwithinweek/sofstandardtherapy. a)1week b)2weeks c)3weeks d)4weeks CorrectAnswer-BAnswer-B.2weeksComplicatedurinarytractinfectionsreferstotheinfectionsthatfailtoresolveorrecurwithin2weeksofstandardtherapy.Theseareassociatedwithbacteremiaorsepsisandareassocatedwithperiurethralabscess,obstructionsandpyelonephritis
491.Apatientpresentswithblunttraumato abdomen.Oninvestigationspatientisfoundtohavehepaticinjurywhichhasarupturedsubcapsularhematomawithactivebleeding.Whatisthegradeofliverinjury? a)GradeI b)GradeII c)GradeIII d)GradeIV CorrectAnswer-CAnswer-C.GradeIII
492.Excellentpredictorofmortalityand morbidityinpatientsafterhepatectomyis a)Serumlactatelevels b)Serummagnesiumlevel c)Serumironlevel d)Serumcopperlevel CorrectAnswer-AAnswer-A.SerumlactatelevelsHyperlactemiaandhypophosphatemiaarecommonderangementsinpatientsundergoingliverresection.Gluconeogenesiscarriedoutbythelivernormallyconsumes40-60%oflactate.Whentheliverisdamaged,stressedorresected,itproduceslactateratherthanmetabolizingit.Duetotheadditiveeffectsoflactate-containingintravenoussolution,non-lactatecontainingsolutionsarerecommendedforpostoperativeuseafterhepatectomy.
493.AsciticfluidSAAG<1.1whatisthe diseaseassociatedwith a)Hepaticfailure b)Idiopathicportalfibrosis c)Constrictivepericarditis d)Peritonealcarcinomatosis CorrectAnswer-DAnswer-D.PeritonealcarcinomatosisLowalbumingradient(SAAG<1.1g/dL)PeritonealcarcinomatosisPeritonealtuberculosisPancreatitisSerositisNephroticsyndrome
494.Geneassociatedwiththedevelopmentof Peutz-Jegherssyndromeis a)STK11 b)PTEN c)KRAS d)BRCA1 CorrectAnswer-AAnswer-A.STK11Germlineheterozygousloss-of-functionmutationsinthegeneSTKilarepresentinapproximatelyhalfofindividualswithfamilialPeutz-JegherssyndromeaswellasasubsetofpatientswithsporadicPeutz-Jegherssyndrome.
495.Righthanddominantpatientpresents withnormalcomprehensionbutspeakswithshortutterancesofafewwordsatatime,comprisedmostlyofnouns.Whatisthemostprobablelocationofthelesion a)Leftinferiorfrontalgyrus b)Rightinferiorfrontalgyrus c)Leftsuperiortemporalgyrus d)Rightsuperiortemporalgyrus CorrectAnswer-AAnswer-A.LeftinferiorfrontalgyrusPatienthasnormalcomprehensionbutspeakswithshortutterancesofafewwordsatatime,comprisedmostlyofnouns.Thesefindingsaresuggestiveofbrocasaphsia.Itisseeninpatientshavingaffectionoftheinferiorfrontalgyrusofthedominanthemisphere.Thepatientisrighthandedsothelefthemisphere,willthedominantone.Thusmostprobablelocationofthelesionisleftinferiorfrontalgyrus.
496.Pureworddeafnessisassociatedwith a)Middlecerebralarterystroke b)Posteriorcerebralarterystroke c)Vertebralarteryaneurysm d)Basilararteryaneurysm CorrectAnswer-AAnswer-A.MiddlecerebralarterystrokeThemostcommoncausesareeitherbilateralorleft-sidedmiddlecerebralartery(MCA)strokesaffectingthesuperiortemporalgyrus.TheneteffectoftheunderlyinglesionistointerrupttheflowofinformationfromtheauditoryassociationcortextoWernicke'sarea.
497.Globalaphasiaisseendueto a)Strokesinvolvingentiremiddlecerebralarterydistributioninleft hemisphere b)Strokesinvolvingentiremiddlecerebralarterydistributionin righthemisphere c)Strokesinvolvingentireposteriorcerebralarterydistributionin lefthemisphere d)Strokesinvolvingentireposteriorcerebralarterydistributionin righthemisphere CorrectAnswer-AAnswer-A.StrokesinvolvingentiremiddlecerebralarterydistributioninlefthemisphereThissyndromerepresentsthecombineddysfunctionofBroca'sandWernicke'sareasandusuallyresultsfromstrokesthatinvolvetheentiremiddlecerebralarterydistributioninthelefthemisphere.Relatedsignsincluderighthemiplegia,hemisensoryloss,andhomonymoushemianopia.
498.LambertEatonsyndrometrueis a)Itisaparaneoplasticsyndromeassociatedwithsquamouscell carcinomaoflung b)IgMantibodiesagainstligandgatedcalciumchannels c)Thereisincreaseinreleaseofpresynapticacetylcholine d)Withcontinuousstimulationthereismarkedincreasein amplitudeofactionpotentials. CorrectAnswer-DAnswer-D.Withcontinuousstimulationthereismarkedincreaseinamplitudeofactionpotentials.ItisaparaneoplasticsyndromeassociatedwithcancerparticularlysmallcellCaoflung.Itisadisorderofneuromuscularjunctiontransmission(Presynaptic)TheseIgGautoantibodiesagainstthevoltagesensitivecalciumchannelsreducethenumberoffunctioningchannels.Thiscausesdecreaseinreleaseofpresynapticacetylcholine.SymptomsMusclesofthetrunkshouldergirdle,pelvicgirdleandmusclesoflowerextremities(musclesoftheproximallegarethemostcommonlyinvolvedmuscles)Oftenthefirstsymptomsaredifficultyinarisingfromachair,climbingstairsandwalking,theshouldermusclesareaffectedlateron.
499.WhichisnotseeninAlzheimersdisease a)Gradualdevelopmentofforgetfulness b)Defectivevisuospatialorientation c)Depression d)Sequenceofneurologicalabnormalitiesfollowsadescribed order CorrectAnswer-DAnswer-D.SequenceofneurologicalabnormalitiesfollowsadescribedorderThesequenceofneurologicaldisabilitiesmaynotfollowanydescribedorderandoneoranotherdeficitmaytakepreceedencebutusuallythediseasepreceedesinthefollowingfourobservedpatterns.1)Korsakoffamnesticstate2)Dysnomia3)Visuospatialorientationbecomesdefective4)Paranoiaandotherpersonalitychanges
500.Whichlobeisaffectedintheearlycourse ofalzheimersdisease a)Frontallobe b)Parietallobe c)Medialtemporallobe d)Lateraltemporallobe CorrectAnswer-CAnswer-C.MedialtemporallobeStructuresofthemedialtemporallobe,includinghippocampus,entorhinalcortexandamygdala,areinvolvedearlyinthecourseandareusuallyseverelyatrophiedinthelaterstages.
501.Whichis/aretheusualfirstdeformity/ies tobeseeninCMTdisease? a)Pescavus b)Clubhand c)Mannusvalgus d)Flexiondeformityofknee CorrectAnswer-AAnswer-A.PescavusCharcot-Marie-Tooth(CMT)diseaseisthemostcommontypeofhereditaryneuropathy.Thereisprogressivemuscleweaknessandatrophythatusuallybeginsinthefirsttwodecadesoflife.Thefirstsignsofthediseaseareusuallypescavus,footdeformitiesandscoliosis.Thereisslowlyprogressiveweaknessandwasting,firstofthefeetandlegsandthenofthehands.ThemostcommonformofCMTistype1,ademyelinatingneuropathywithautosomaldominantinheritance,mappedmostcommonlytotheshortarmofchromosome17.
502.Huntingtonsdiseaseiscommonlyseen inagegroupbetween a)15-35years b)25-45years c)35-55years d)45-65years CorrectAnswer-BAnswer-B.25-45yearsHDisaprogressive,fatal,highlypenetrantautosomaldominantdisordercharacterizedbymotor,behavioral,andcognitivedysfunction.Onsetistypicallybetweentheagesof25and45years(range,3-70years)withaprevalenceof2-8casesper100,000andanaverageageatdeathof60years.Huntigton'sdiseaseischaracterizedbytriadofAutosomaldominantinheritenceChoreoathetosisDementia
503.WhichcranialnerveisinvolvedinWeber syndrome? a)II b)III c)IV d)V CorrectAnswer-BAnswer-B.IIIWeber'ssyndrome-Midbrain-Oculomotornerve-Ipsilateralthird-nervepalsy
504.Violentabnormalflingingmovements whichareirregularandaffectingonesidearecalledas- a)Chorea b)Athetosis c)Dystonia d)Hemiballismus CorrectAnswer-DAnswer-D.HemiballismusItisdefinedasthedysfunctionintheimplementationofappropriatetargetingandvelocityofintendedmovements,dysfunctionofpostureandabnormalinvoluntarymovement,ortheperformanceofnormalappearingmovementsatinappropriateorunintendedtimes.
505.Wernickesencephalopathydevelops secondarytoaccumulationofwhichsubstrate? a)Glutamate b)Aspartate c)Lactate d)Acetate CorrectAnswer-AAnswer-A.GlutamateGlutamateaccumulatesowingtoimpairmentofaketoglutamatedehydrogenaseactivityandincombinationwithenergydeficiencymayresultinexcitotoxiccelldamage.
506.Whichofthefollowingclinicaltestwhen positivesuggestspresenceofsensoryataxia? a)Rombergtest b)Adsontest c)Stinchfieldtest d)CrossedSLRtest CorrectAnswer-AAnswer-A.RombergtestTheRombergtestisatestofthebody'ssenseofpositioning(proprioception),whichrequireshealthyfunctioningofthedorsalcolumnsofthespinalcord.TheRombergtestisusedtoinvestigatethecauseoflossofmotorcoordination(ataxia).ApositiveRombergtestsuggeststhattheataxiaissensoryinnature,thatis,dependingonlossofproprioception.
507.Toddsparalysisisexperiencefollowing episodeof a)Focalseizure b)Generalisedseizure c)Aftercorrectionofhyponatremia d)Aftercorrectionofhypokalemia CorrectAnswer-AAnswer-A.FocalseizureFocalseizuresarisefromaneuronalnetworkeitherdiscretelylocalizedwithinonecerebralhemisphere.Theroutineinterictal(i.e.,betweenseizures)electroencephalogram(EEG)inpatientswithfocalseizuresisoftennormalormayshowbriefdischargestermedepileptiformspikes,orsharpwaves.Second,patientsmayexperiencealocalizedparesis(Todd'sparalysis)forminutestomanyhoursintheinvolvedregionfollowingtheseizure.
508.Cerebro-occulo-genitalsyndromehas thefollowingfeaturesexcept a)Microcephaly b)Shortstature c)Agenesisofcorpuscallosum d)Flaccidquadriplegia CorrectAnswer-DAnswer-D.FlaccidquadriplegiaCerebro-occulo-genitalsyndromeisassociatedwithmicrocephaly,shortstature,microophthalmia,agenesisofcorpuscallosum,hypospadiasandspasticquadriplegia.
509.Frontallobesyndromeconsists a)Euphoria b)Indifference c)Irritability d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveEuphoria,indifference,disinhibition,andirritabilityareconsequencesoffrontallobelesions.Theseemotionalandbehaviouraldisturbancesareusuallyreferredtoasfrontallobesyndrome.Otherfeaturesaredecreasedsocialconcern,jocularity,facetiousness,coarseness,hyperkinesia,disinhibition,lossofsocialgraces,inappropriatesexualadvances,sexualexhibitionism,impulsiveness,restlessness,andgrandiosedelusions.
510.Flappingtremorsarenotseenin a)CO2toxicity b)Hypomagnesemia c)Subarachnoidhemorrhage d)Carbolicacidpoisoning CorrectAnswer-DAnswer-D.CarbolicacidpoisoningItisanimportantclinicalsignItisnotpathognomonicofanyconditionbutitgivescluetoseriousunderlyingdiseaseprocess.Flappingtremorisamotordisturbancemarkedbyintermettentlapsesofanassumedpostureasaresultofintermittencyofsustainedcontractionofgroupofmuscles.
511.Featureswhichdifferentiateseizures fromsyncopeincludethefollowingexcept a)Noimmediateprecipitatingfactorslikestress,valsalva, orthostatichypotension b)Immediatetransitiontounconciousness c)Presenceofcyanosisandfrothingofmouth d)Presenceofpremonitorysymptomslikediaphoresisand tunnelingofvision CorrectAnswer-DAns.D.Presenceofpremonitorysymptomslikediaphoresisandtunnelingofvision
512.Finetremorsarefoundinwhich disorder a)Mercurypoisoning b)Excesssmoking c)Hypoglycemia d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveFinetremorsarenotedwhenalimbisheldinanantigravitypostureTheyarenotedinsituationsofcatecholamineexcesssuchasanxietystates,thyrotoxicosis,hypoglycemiaandinalcoholismandexcesssmoking.Theyarealsonotedafteringestionofdrugslikecaffeine,salbutamol,theophylline,amphetamine,tricyclicantidepressants,Lithium,valproate,steroids,andinmercurypoisoning.
513.Trueaboutelectrophoresisinpatientsof multiplemyeloma a)Mcomponentspikeisforthealphaglobulins b)Monoclonalantibodymustbepresentataconcentrationofat least10g/L[1.0g/dL]tobeaccuratelyquantitatedbyelectrophoresis c)McomponentisIgMin53%ofthepatients d)McomponentisIgAin25%ofthepatients CorrectAnswer-DAnswer-D.McomponentisIgAin25%ofthepatientsTheimmunoglobulinsmoveheterogeneouslyinanelectricfieldandformabroadpeakinthegammaregion.Theyglobulinregionoftheelectrophoreticpatternisusuallyincreasedintheseraofpatientswithplasmacelltumors.ThereisasharpspikeinthisregioncalledanMcomponent(Mformonoclonal).TheserumMcomponentinmultiplemyelomawillbeIgGin53%ofpatients,IgAin25%,andIgDin1%;20%ofMietitswillhaveonlylightchainsinserumandurine.
514.Allbutoneistrueforbetathalassemia major a)Growthanddevelopmentisimpaired b)Redcellcount<4x10'2/L c)LevelsofHbA2<3.5% d)Bonemarrowironisdepleted CorrectAnswer-DAnswer-D.BonemarrowironisdepletedAnaemiaHbgm/dl-<7(severe)IncreasedHbF,HbA2andabsenceofHbA.Severityofdisease++++GrowthanddevelopmentimpairedSplenomegaly++++Skeletalchanges+++ThalassemiafaciesB.M.Iron-decreased
515.Immunethrombocytopenicpuprpura associatedwith a)HepatitisAinfection b)HepatitisBinfection c)HepatitisCinfection d)HepatitisDinfection CorrectAnswer-CAnswer-C.HepatitisCinfectionImmunethrombocytopenicpurpura(ITP;alsotermedidiopathicthrombocytopenicpurpura)isanacquireddisorderinwhichthereisimmune-mediateddestructionofplateletsandpossiblyinhibitionofplateletreleasefromthemegakaryocyte.ITPistermedsecondaryifitisassociatedwithanunderlyingdisorder;autoimmunedisorders,particularlysystemiclupuserythematosus(SLE),andinfections,suchasHIVandhepatitisC,arecommoncauses.
516.Whichofthefollowingisnotacauseof secondaryIdiopathicthrombocytopenicpurpura? a)Systemiclupuserythmatosus b)HepatitisCinfection c)Rheumatoidarthritis d)HIVinfection CorrectAnswer-CAnswer-C.RheumatoidarthritisITPistermedsecondaryifitisassociatedwithanunderlyingdisorder;autoimmunedisorders,particularlysystemiclupuserythematosus(SLE),andinfections,suchasHIVandhepatitisC,arecommoncauses.
517.Drug/susedinmanagementrelapsed multiplemyelomais a)Bortezomib b)Lenalidomide c)Doxorubicin d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveThecombinationofbortezomibandliposomaldoxorubicinisactiveinrelapsedmyeloma.Thalidomide,ifnotusedasinitialtherapy,canachieveresponsesinrefractorycases.High-dosemelphalanandstemcelltransplant,ifnotusedearlier,alsohaveactivityinpatientswithrefractorydisease.
518.TreatmentofchronicphaseofCMLin pregnantwomenis- a)Imatinib b)Leukapheresis c)Spleenectomy d)Interferontherapy CorrectAnswer-BAnswer-B.LeukapheresisIntensiveleukapheresismaycontrolthebloodcountsinchronic-phaseCML;however,itisexpensiveandcumbersome.Itisusefulinemergencieswhereleukostasis-relatedcomplicationssuchaspulmonaryfailureorcerebrovascularaccidentsarelikely.SplenectomywasusedinCMLinthepastbecauseofthesuggestionthatevolutiontotheacutephasemightoccurinthespleen.Splenicradiationisusedrarelytoreducethesizeofthespleen.
519.Whichofthefollowingdrug/scanbe usedforimmediateparenteralanticoagulationinpatientswithvenousthromboembolism? a)Unfractionedheparin b)Lowmolecularweightheparin c)Fondaparinux d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveImmediatelyeffectiveanticoagulationisinitiatedwithaparenteraldrug:unfractionatedheparin(UFH),low-molecular-weightheparin(LMWH),orfondaparinux.Oneshoulduseadirectthrombininhibitorargatroban,lepirudin,orbivalirudininpatientswithprovenorsuspectedheparin-inducedthrombocytopenia.Warfarinrequires5-7daystoachieveatherapeuticeffect.
520.Apatientpresentswithicterus,butthere isnoevidenceofbilirubininurine.Whatisthemostlikelycauseofjaundiceinthispatient? a)Hemolysis b)Gallstones c)Carcinomaheadofpancreas d)Biliaryatresia CorrectAnswer-AAnswer-A.HemolysisHemolysisandhyperbilirubinemiaIncreaseddestructionoferythrocytesleadstoincreasedbilirubinturnoverandunconjugatedhyperbilirubinemia;thehyperbilirubinemiaisusuallymodestinthepresenceofnormalliverfunction.Therefore,hemolysisalonecannotresultinasustainedhyperbilirubinemiaofmorethan-68umol/L(4mg/dL).Whenhemolysisistheonlyabnormalityinanotherwisehealthyindividual,theresultisapurelyunconjugatedhyperbilirubinemia.
521.Trueaboutsideroblasticanemia a)SeverityofthediseasedependsontheresidualerythroidALA synthaseactivity b)Prussianbluestainingsideroblastsareobserved c)Pyridoxinesupplementationcanbeusedfortreatment d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveXLSAresultsfromthedeficientactivityoftheerythroidformofALA-synthaseandisassociatedwithineffectiveerythropoiesis,weakness,andpallor.Typically,maleswithXLSAdeveloprefractoryhemolyticanemia,pallor,andweaknessduringinfancy.Peripheralbloodsmearsrevealahypochromic,microcyticanemiawithstrikinganisocytosis,poikilocytosis,andpolychromasia;theleukocytesandplateletsappearnormal.AvarietyofPrussianblue-stainingsideroblastsareobserved.Levelsofurinaryporphyrinprecursorsandofbothurinaryandfecalporphyrinsarenormal.
522.Massivetransfusionisdefinedas transfusionof a)10/24ormoreredcellproductsinhours. b)5/12ormoreredcellproductsinhours. c)10/48ormoreredcellproductsinhours. d)5/24ormoreredcellproductsinhours. CorrectAnswer-AAnswer:A10/24ormoreredcellproductsinhours.Variousdefinitionsofmassivebloodtransfusion(MBT)havebeenpublishedinthemedicalliteraturesuchas:Replacementofoneentirebloodvolumewithin24hTransfusionof>10unitsofpackedredbloodcells(PRBCs)in24hTransfusionof>4unitsofPRBCsin1hwhenon-goingneedisforeseeable
523.Whichisthemostcommoncauseof thrombocytopeniainanICUpatient? a)Sepsis b)Bonemarrowfailure c)ITP d)Druginduced CorrectAnswer-AAnswer-A.SepsisThrombocytopeniaisacommonlaboratoryabnormalitythathasbeenassociatedwithadverseoutcomesinICUpatients.Thrombocytopeniaisdefinedasplateletcount<150X103cells/mcL.CommoncausesofthrombocytopeniainICUpatients:SepsisDisseminatedintravascularcoagulationConsumption(eg,majortrauma,cardiopulmonarybypass)Dilution(withmassivetransfusion)MyelosuppressivechemotherapyMechanicalcirculatorysupportdevices(eg,intra-aorticballoonpump)Lesscommonbutimportantcausesofthrombocytopeniathatshouldnotbemissed:Heparin-inducedthrombocytopeniaHemophagocyticsyndromeUncommoncausesofthrombocytopeniathatdevelopduringICUadmissionDrug-inducedthrombocytopenia(otherthanheparinorcytotoxicchemotherapy)
Leukemia,myelodysplasia,aplasticanemia,etc,unlessabnormalitieswerealreadypresentbeforeICUadmission
524.WhatpercentageofMultiplemyeloma patientshavevertebralinvolvement? a)22% b)44% c)66% d)88% CorrectAnswer-CAnswer-C.66%Bonelesionsaremostcommoninthevertebralcolumn.Thefollowingdistributionwasseeninalargeseriesofcases:Vertebralcolumn66%Ribs-44%Skull4%Pelvis28%Femur28%Clavicle10%
525.Multiagentchemotherapyinduces remissioninofthepatientsofacutemyelogenousleukemia a)65-70 b)75-80 c)85-90 d)95-100 CorrectAnswer-CAnswer-C.85-90Aggressivemultiagentchemotherapyissuccessfulininducingremissioninapproximately85-90%ofpatients.Prognosticfeatures[t(8;21);t(15;17);inv(16);APL]andimprovedoutcomewithchemotherapy,matchedsiblingstemcelltransplantationisrecommendedonlyafterarelapseMatched-siblingbonemarroworstemcelltransplantationafterremissionachieveslong-termdisease-freesurvivalinabouttwothirdsofpatients.
526.HbA1Ccriteriaforapatienttobe diagnosedwithdiabetesmellitusis a)>4.5% b)>5.5% c)>6.5% d)>7.5% CorrectAnswer-CAnswer-C.>6.5%Fastingplasmaglucose>(126mg/dl)Twohourplasmaglucose>(200mg/d1)duringanoralGTTA/C>6.5%
527.Whichofthefollowingisnottrueabout thedevelopmentofthyroidtumorsinnodulargoiter? a)Prevalenceofthyroidcarcinomarangesbetween5-15%inthe patientswithmultinodulargoiter b)Papillarycarcinomaisthemostcommoncarcinomadeveloped inpatientswithnodulargoiter c)Bothbenignandmalignantneoplasmscanbeseeninpatients withnodulargoiter d)Theriskofdevelopmentofcarcinomaisnotcorrelatedwiththe levelofTSH CorrectAnswer-DAnswer-D.TheriskofdevelopmentofcarcinomaisnotcorrelatedwiththelevelofTSHThyroidtumorsbothbenignandmalignantcanbeseenincolloidgoiterwithbothsolitaryandmultiplenodules.Theprevalenceofthyroidcarcinomarangesfrom5?15%inmultinodulargoiterand8?17%insolitarycolloidnodules.Theprevalenceinhigherinmencomparedtowomenandusuallyoccursinolderagegroup.Themostcommonmalignanttumorarisinginmutinodulargoiterispapillarycarcinoma.Otherlikefollicularcarcinoma,hurthlecellcarcinomaandmedullarycarcinomaarealsoencountered
528.Indicationforgivingliothyronineas therapeuticmanagementis a)Resistantdepression b)Socialphobia c)Alzheimersdisease d)Cataplexy CorrectAnswer-AAnswer-A.ResistantdepressionItisthesyntheticlevorotatoryisomeroftriiodothyronine(T3).Liothyronineisthemostbroadlyusedthyroidhormonefortreatmentofdepression.Liothyronineisusedtoacceleratetheresponsetotricyclicantidepressantsparticularlyinwomen.Itisknowntoaugmentresponsetoantidepressantsinpatientswithmooddisorders,inthosewhofailedtorespondtoatricyclicantidepressanttrialie.Inpatientswithresistantdepression.
529.Medicalmanagementof hyperparathyroidismincludeswhichofthefollowing? a)Bisphosphonates b)Calcitonin c)Plicamycin d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveExpansionofintravascularvolume,administrationofloopdiuretics,pharmacotherapywhichreducesosteoclasticboneresorption(likeBisphosphonates,Calcitonin,andPlicamycin)areusefulinthemedicalmanagementofhyperparathyroidism.
530.Whichofthefollowingcausesof hypercalcemiaisnotassociatedwithhighboneturnover? a)Hyperthyroidism b)VitaminAintoxication c)VitaminDintoxication d)Thiazides CorrectAnswer-CAnswer-C.VitaminDintoxicationVitaminDrelatedVitaminDintoxicationIncreased1,25(OH)2Deg.SarcoidosisIdiopathichypercalcemiaofinfancyAssociatedhighboneturnoverHyperthyroidismImmobilizationThiazidesVitaminAintoxication
531.Fastinghypoglycemiaiscausedbythe followingexcept a)Alcoholintake b)Pentamidinetherapy c)Renalinsufficiency d)Chronicpancreatitis CorrectAnswer-DAnswer-D.ChronicpancreatitisInappropriate(High)InsulinLevelInsulinreactioninpatientswithdiabetes-Thisisthemostcommoncauseofhypoglycemia,duetoanimbalancebetweeninsulinsupplyandinsulinrequirements.Insulinsecretagogueoverdoseintype2diabetespatients-Insulinsecretagoguesareoralhypoglycemicagentsthatworkbystimulatinginsulinreleasefrombetaisletcellsand,herefore,havethepotentialtocausehypoglycemia.Sulfonylureas(themostcommonlyprescribedtypeofthesemedications)areclearedbythekidney,soelderlypatientswithcompromisedrenalfunctionareatriskfordevelopinghypoglycemiawhileontheseagents.Factitioushypoglycemia(selfinducedorinadvertent)AutoimmunehypoglycemiaPentamidine-Pentamidineusedfortreatment/prophylaxisofPCPinpatientswithAIDScancausehypoglycemiabydirectinjurytothebetaisletcellscausinghyperinsulinemia.ExcessInsulinSecretion(Insulinoma)
532.Diabetesinsipidusissaidtobepresent when a)>30ml/hrurineoutputin24hrsand<260mosml/Losmolarity b)>40ml/hrurineoutputin24hrsand<280mosml/Losmolarity c)>50ml/hrurineoutputin24hrsand<300mosml/Losmolarity d)>60ml/hrurineoutputin24hrsand<320mosml/Losmolarity CorrectAnswer-CAnswer-C.>50ml/hrurineoutputin24hrsand<300mosml/LosmolarityDecreasedsecretionoractionofargininevasopressinusuallymanifestsasdiabetesinsipidus,asyndromecharacterizedbytheproductionofabnormallylargevolumesofdiluteurine.DImustbedifferentiatedfromotheretiologyofpolyuria.Thetestshouldbestartedinthemorningwithcarefulsupervisiontoavoiddehydration.Bodyweight,plasmaosmolality,serumsodium,andurinevolumeandosmolalityshouldbemeasuredhourly.Thetestshouldbestoppedwhenbodyweightdecreasesby5%orplasmaosmolality/sodiumexceedtheupperlimitofnormal.The24-hoururinevolumeis>50ml/kgbodyweightorurineosmolalityMeasurementofAVPlevelsbeforeandafterfluiddeprivationmaybehelpfultodistinguishcentralandnephrogenicDI.Occasionally,hypertonicsalineinfusionmayberequirediffluiddeprivationdoesnotachievetherequisitelevelofhypertonicdehydration,butthisshouldbeadministeredwithcaution.
533.Chronicadrenalinsufficiencyiscaused bythefollowingorganismsexcept a)Mycobacteriumtubercle b)Histoplasmacapsulatum c)Coccidioidesimmitis d)Mycobacteriumbovis CorrectAnswer-DAnswer-D.MycobacteriumbovisInfections,particularlytuberculosisandthoseproducedbyfungi,causeprimarychronicadrenocorticalinsufficiency.Whenpresent,tuberculousadrenalitisisusuallyassociatedwithactiveinfectioninothersites,particularlyinthelungsandgenitourinaryAIDSsufferersareatriskfordevelopingadrenalinsufficiencyfromseveralinfectious(cytomegalovirus,Mycobacteriumaviumintracellulare)andnoninfectious(Kaposisarcoma)complications.
534.Whichofthefollowingisnotafeatureof myxedemacoma? a)Reducedlevelofconsciousnessandseizureswithother featuresofhypothyroidismisseen b)Hypoventilationleadingtohypoxiaandhypercapnia c)Levothyroxinecanbegivenviaintravenousandnasogastric route d)Levothyroxineshouldnotbeusedinthemanagement CorrectAnswer-DAnswer-D.LevothyroxineshouldnotbeusedinthemanagementMyxedemacomaisdefinedasseverehypothyroidismleadingtodecreasedmentalstatus,hypothermia,andothersymptomsofhypothyroidism.Reducedlevelofconsciousness,sometimesassociatedwithseizuresmayalsobeseen.Factorsthatpredisposetomyxedemacomaincludecoldexposure,trauma,infection,andadministrationofnarcotics.Therapyformyxedemacomashouldincludelevothyroxine(500g)asasingleIVbolusfollowedbydailytreatmentwithlevothyroxine(50?100g/d),alongwithhydrocortisone(50mgevery6h)forimpairedadrenalreserve,ventilatorysupport,spaceblankets,andtreatmentofprecipitatingfactors.
535.Acuteadrenalinsufficiencycanpresent as a)Acuteabdomenwithabdominaltenderness,nausea,vomiting andfever b)Neurologicdiseasewithdecreasedresponsivenessprogressing tostuporandcoma c)Hypovolemicshock d)Alloftheabove CorrectAnswer-DAnswer-D.AlloftheabovePosturalhypotensionmayprogresstohypovolemicshock.Adrenalinsufficiencymaymimicfeaturesofacuteabdomenwithabdominaltenderness,nausea,vomiting,andfever.Insomecases,theprimarypresentationmayresembleneurologicdisease,withdecreasedresponsiveness,progressingtostuporandcoma.Anadrenalcrisiscanbetriggeredbyanintercurrentillness,surgicalorotherstress,orincreasedglucocorticoidinactivation(e.g.,hyperthyroidism).
536.Hypotonicsolutiongiventocorrect a)Dehydrationsecondarytodiuretictherapy b)Diabeticketoacidosis c)Hyperosmolar,hyperglycemicnonketoticsyndrome d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveHypotonicsolutionhasosmolaritylowerthanseumosmolarity.Whenapatientreceiveshypotonicsolution,fluidshiftsoutofthebloodvesselsandintothecellsandinterstitialspaces,whereosmolarityishigher.Hypotonicsolutionhydratescellswhilereducingfluidinthecirculatorysystem.IndicationsDehydrationsecondarytodiuretictherapy.DiabeticketoacidosisHyperosmolar,hyperglycemicnonketoticsyndromeExamplesofhypotonicsolutions:halfnormalsaline,0.33%sodiumchloride,dextrose2.5%inwater,dextrose2.5%.
537.Allofthefollowingarecausesofacute hyponatremiaexcept a)GlycineirrigationinTURP b)Recentinstitutionofthiazidetherapy c)MDMAingestion d)Liquoriceingestion CorrectAnswer-DAnswer-D.LiquoriceingestioncausesofhyponatremiaIatrogenicPostoperative:premenopausalwomenHypotonicfluidswithcausesof1'vasopressinGlycineirrigation:TURP,uterinesurgeryColonoscopypreparationRecentinstitutionofthiazidesPolydipsiaMDMAingestionExercise-inducedMultifactorial,e.g.,thiazideandpolydipsia
538.Respiratoryacidosisisrecognized primarilybyincreasein a)Pa02 b)PaCO2 c)HCO3 d)Noneoftheabove CorrectAnswer-BAnswer-B.PaCO2RespiratoryacidosisoccurswhenthereisaccumulationofCO2duetotypeIIrespiratoryfailure.itcanalsooccurduetoseverepulmonarydisease,respiratorymusclefatigue,orabnormalitiesinventilatorycontrolandisrecognizedbyanincreaseinPaco2anddecreaseinpHThisresultsinariseinthePCO2,withacompensatoryincreaseinplasmabicarbonateconcentration,particularlywhenthedisorderisoflongdurationandthekidneyhasfullydevelopeditscapacityforincreasedacidexcretion
539.Whichofthefollowingdrug administrationisnotassociatedwithhypomagnesemia? a)Cisplatin b)Valproate c)Foscarnet d)Cetuximab CorrectAnswer-BAnswer-B.ValproateDrugscausinghypomagnesemiaEthanolDiuretics(loop,thiazide,osmotic)CisplatinPentamidine,foscarnetCyclosporineAminoglycosides,amphotericinBCetuximab
540.DoseofbenzathainepenicillinGtobe giveninpatientsoflatentsyphilisinpatientswithoutpenicillinallergyandnormalCSFfindingsis a)0.6mUIM/weekfor3weeks b)1.2mUIM/weekfor3weeks c)2.4mUIM/weekfor3weeks d)4.8mUIM/weekfor3weeks CorrectAnswer-CAnswer-C.2.4mUIM/weekfor3weeksPrimary,secondary,orearlylatent-CSFnormalornotexamined:PenicillinGbenzathine(singledoseof2.4mUIM)CSFabnormal-TreatasneurosyphilisLatelatent(orlatentofuncertainduration),cardiovascular,orbenigntertairy-CSFnormalornotexamined:PenicillinGbenzathine(2.4mUIMweeklyfor3weeks).CSFabnormal:Treatasneurosyphilis
541.SARSinfectioncasefatalityrateof>50% isobservedinpatientsofwhichagegroup? a)<20yrs b)20-40years c)40-60years d)>65years CorrectAnswer-DAnswer-D.>65yearsThecasefatalityratefromSARS-CoVinfectionduringthe2003outbreakwas10-17%.Nopediatricdeathswerereported.Theestimatedcasefatalityrateaccordingtoagevariedfrom<1%forthoseyoungerthan20yearofageto>50%forthoseolderthan65yrofage.
542.Whichofthefollowingcorroboratesto thepresenceofclostridiumdifficleinfectioninpatientstakingantibioticsforanothercause? a)Diarrhoeaunformedstoolsper12hfor2dayswithnoother recognizedcause b)Diarrhoeaunformedstoolsper24hfor2dayswithnoother recognizedcause c)Diarrhoeaunformedstoolsper24hfor3dayswithnoother recognizedcause d)Diarrhoeaunformedstoolsper24hfor4dayswithnoother recognizedcause CorrectAnswer-BAnswer-B.Diarrhoeaunformedstoolsper24hfor2dayswithnootherrecognizedcauseDiarrhoeaunformedstoolsper24hfor2dayswithnootherrecognizedcause.ToxinAorBdetectedinthestoolbyPCRorculture.Pseudomembranesseenincolonbyendoscopy.
543.Followingarethefeaturesofneuropathy associatedwithvaricella-zosterinfectionexcept a)Persistentinfectioninneuronsofsensoryganglia b)Withreactivationvirustransportedalongnervestoskin c)Shinglesaredistributedalongmotordermatomes d)Intranuclearinclusionsarenotfoundinperipheralnervous system CorrectAnswer-CAnswer-C.ShinglesaredistributedalongmotordermatomesVaricella-zosterisoneofthemostcommonviralinfectionsoftheperipheralnervoussystem.Followingchickenpox,alatentinfectionpersistswithinneuronsofsensoryganglia.Ifthevirusisreactivated,sometimesmanyyearslater,itmaybetransportedalongthesensorynervestotheskin.Hereitinfectskeratinocytes,leadingtoapainful,vesicularskineruption(shingles)inadistributionthatfollowssensorydermatomesMostcommonistheinvolvementofthoracicortrigeminalnervedermatomes.
544.Whichofthefollowingisnottrueabout theepididymo?orchitisofmumps? a)Itisthemostcommonmanifestationofmumpsinfection b)Testicularenlargementusuallyresolvesin1week c)Bilateraltesticularinvolvementseenin10-30%ofcases d)Sterilityrarelydevelopsinthesepatients CorrectAnswer-AAnswer-A.ItisthemostcommonmanifestationofmumpsinfectionEpididymo-orchitisisthesecondmostcommonmanifestationofmumps,developingin15?30%ofcasesinpostpubertalmales.?Orchitis,characterizedbyapainful,tender,feverandenlargedtestis,isbilateralin10?30%ofcasesandresolveswithin1week.?Oophoritis(manifestedbylowerabdominalpainandvomiting)occursin~5%ofwomenwithmumps.?Sterilityinmumpsisrare.
545.Mostcommonnerveaffectedinleprosy a)Posteriortibial b)Ulnar c)Median d)Facial CorrectAnswer-AAnswer-A.PosteriortibialLeprosyaffectsperipheralmixednervesandcutaneousnerves.Themostcommonperipheralnervesaffectedintheorderoffrequencyaretheposteriortibial>ulnar>median>lateralpopliteal>facial>radial
546.Austriansyndromeiscausedbywhich infection a)Staphylococcusaureus b)Streptococcuspneumoniae c)Staphylococcusepidermidis d)Streptococcusviridans CorrectAnswer-BAnswer-B.StreptococcuspneumoniaeAustriansyndromeisamedicalconditionfirstdescribedbyRobertAustrianin1957.Theclassicaltriadconsistsofpneumonia,endocarditis,andmeningitis,allcausedbyStreptococcuspneumoniae.Itisassociatedwithalcoholism,duetothepresenceofhyposplenia(reducedsplenicfunctioning),andcanbeseeninmalesbetween40and60yearsold.
547.Factorscontributingtothedevelopment ofcomplicationsinmeaslesarethefollowingexcept- a)Agegroup5-20years b)Highercasefatalitywithovercrowding c)Severemalnutrition d)Lowerserumretinollevels CorrectAnswer-AAnswer-A.Agegroup5-20yearsComplicationsofmeaslesarelargelyattributabletothepathogeniceffectsofthevirusontherespiratorytractandimmunesystem.Morbidityandmortalityfrommeaslesaregreatestinpatientsyoungerthan5yrofage(especially<1yrofage)andolderthan20yrofage.
548.TrueaboutVHLsyndromeis a)Itisanautosomalrecessivecondition b)Centralnervoussystemisnotinvolved c)Regularscreeningforclearcellcarcinomaofkidneysis essential d)VHLisagrowthpromotergene CorrectAnswer-CAnswer-C.RegularscreeningforclearcellcarcinomaofkidneysisessentialVonHippel-Lindaudisease(VHL)isarareautosomaldominantdiseasecharacterizedbyabnormalangiogenesiswithbenignandmalignanttumorsthataffectmultipletissues.ThediseaseisinheritedasamutationinonealleleoftheVHLtumor-suppressorgene.Somaticmutationofthenormalalleleleadstoretinalangiomas,centralnervoussystem(CNS)hemangioblastomas,pheochromocytomasandmulticentricclearcellcysts,hemangiomas,andadenomasofthekidney.ThehihriskofrenalcellcarcinomamandatesieriodicsurveillanceusuallearlinadultsbCTorMRI.Routinescreeningandawarenessofthenaturalhistoryoflesionshasenabledrenal-sparingapproachestodiseasemanagement.
549.Tuberoussclerosisiscausedby mutationsinthefollowingproteins a)Hamartin b)Tuberin c)Merlin d)Ankyrin CorrectAnswer-A:BAnswer-A.Hamartin&B.TuberinItiscausedbymutationsineithertheTSC1gene,whichmapstochromosome9q34,andencodesaproteintermedhamartin,ormutationsintheTSC2gene,whichmapstochromosome16p13.3andencodesthetuberinprotein.Hamartinformsacomplexwithtuberin,whichinhibitscellularsignalingthroughthemammaliantargetofrapamycin(mTOR),andactsasanegativeregulatorofthecellcycle.Patientswithtuberoussclerosishaveseizures,mentalretardation,adenomasebaceum(facialangiofibromas),shagreenpatch,hypomelanoticmacules,periungualfibromas,renalangiomyolipomas,andcardiacrhabdomyomas.
550.Whatcharacteristicfindingoftuberous sclerosisispresentatbirthbutnotlaterinlife? a)Cardiacrhabdomyosarcoma b)Facialangiofibroma c)Periungalfibroma d)Renalangiomyolipoma CorrectAnswer-AAnswer-A.CardiacrhabdomyosarcomaPatientswithtuberoussclerosishaveseizures,mentalretardation,adenomasebaceum(facialangiofibromas),shagreenpatch,hypomelanoticmacules,periungualfibromas,renalangiomyolipomas,andcardiacrhabdomyomas.Cardiacrhabdomyosarcomascanbepresentatbirthinupto80%oftheinfantswithtuberoussclerosis.Theseinvoluteinthefirstthreeyearsoflifeandcompletelydisappearbyadulthood
551.Followingisnottrueaboutepinephrine a)Haspotentalphaandbetastimulatingproperties b)Itimprovescoronaryperfusionpressureandmyocardialblood flow c)IncreasescerebralbloodflowduringCPR d)Routineuseofhighdoseepinephrineduringresuscitationis indicated CorrectAnswer-DAnswer-D.RoutineuseofhighdoseepinephrineduringresuscitationisindicatedEpinephrine(adrenaline)isanendogenouscatecholaminewithpotenta-and11-adrenergicstimulatingproperties.Theadrenergicaction(vasoconstriction)increasessystemicandpulmonaryvascularresistance.TheresultanthigheraorticdiastolicbloodpressureimprovescoronaryperfusionpressureandmyocardialbloodfloweventhoughitreducesglobalcardiacoutputduringCPR.epinephrinealsoincreasescerebralbloodflowdurinooduualiCPRbecauseperipheralvasoconstrictiondirectsagreaterproportionofflowtothecerebralcirculation.However,epinephrinecandecreaselocalcerebralmicrocirculatorybloodflowatatimewhenglobalcerebralflowisincreased.
552.Ztracktechniquemustbeusedfor administrationof a)InjectionIronDextrandeepIM b)InjectionHydroxyzinehydrochloridedeepIM c)InjectionDepomedroxyprogesteroneiv d)Injectionerythromycin CorrectAnswer-A:BAnswer-A.InjectionIronDextrandeepIM&B.InjectionHydroxyzinehydrochloridedeepIMWithintramuscularinjectionsmedicationscanleakupwardintothesubcutaneoustissuescausingstaining,bruisingandsignificantpainforseveralweeksorlongerwithsomemedications.NursesareencouragedtousetheZtracktechnique(causinganeedletrackorpathwayintheshapeofZ)anytimeanintramuscularinjectionisgiven,topreventleakageandassociatedpain.TheZtracktechniquemustbeusedwheneveradeepintramuscularinjectionofirondextran,andotherirritatingsolutionssuchashydroxyzinehydrochlorideandseveralantipsychoticagentsaregiven.
553.Inmanwhatquantityofethylalcohol consumeddailyfor>10yearsincreasestherelativeriskofdevelopmentofalcoholicliverdisease a)20g/d b)40g/d c)60g/d d)80g/d CorrectAnswer-DAnswer-D.80g/d80g/dayx10+yr.
554.Whichofthefollowingantineoplastic agentsisusedinthemanagementofHodgkinslymphoma,nonHodgkinslymphomaandsmallcellcarcinomaoflung? a)Cisplatin b)Bleomycin c)Paclitaxel d)Doxorubicin CorrectAnswer-AAnswer-A.CisplatinCisplatinisusedinthemanagementofHodgkinslymphoma,nonHodgkinslymphomaandsmallcellcarcinomaoflung.
555.Pierrerobinsyndromefollowingistrue except a)Consistsofmicrognathiaandcleftpalate b)Tongueisofnormalsize c)Airwayobstructionparticularlyduringexpiration d)30-50%patientshaveSticklersyndrome CorrectAnswer-CAnswerC.AirwayobstructionparticularlyduringexpirationPierreRobinsyndromeconsistsofmicrognathiausuallyaccompaniedbyahigharchedorcleftpalate.Thetongueisusuallyofnormalsize,butthefloorofthemouthisforeshortened.Theairpassagescanbecomeobstructed,particularlyoninspiration,usuallyrequiringtreatmenttopreventsuffocation.Theinfantshouldbemaintainedinaproneorpartiallypronepositionsothatthetonguefallsforwardtorelieverespiratoryobstruction.Somepatientsrequiretra-cheostomy.Mandibulardistractionproceduresintheneonatecanimprovemandibularsize,enhancerespiration,andfacilitateoralfeedings.Sufficientspontaneousmandibulargrowthcantakeplacewithinafewmonthstorelievethepotentialairwayobstruction.Oftenthegrowthofthemandibleachievesanormalprofilein4-6year.
556.Mantlefieldradiationwasusedfor managementof- a)Hodgkinslymphoma b)Mantlecelllymphoma c)Multiplemyeloma d)Cervicalcarcinoma CorrectAnswer-AAnswer-A.HodgkinslymphomaMantlefieldradiationisatypeofradiationtreatmentusedforHodgkin'slymphomaTheterm'mantle'isderivedfromthenameofagarment,muchlikeacloak,usedmanyyearsback.Theshapeoftheexposedareatheradiationfieldhascontoursthatresembletheshieldingcloak.Thistypeoflargeradiationfieldisnotcommonlyusedtoday.
557.Alienlimbsyndromeseenin a)Postneurosurgicalcases b)Alzheimersdisease c)Creutzfeldt-Jakobdisease d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveAlienhandsyndrome(AHS)isaconditioninwhichapersonexperiencestheirlimbsactingseeminglyontheirown,withoutcontrolovertheactions.Thetermisusedforavarietyofclinicalconditionsandmostcommonlyaffectsthelefthand.Alienhandsyndromeisbestdocumentedincaseswhereapersonhashadthetwohemispheresoftheirbrainsurgicallyseparated,aproceduresometimesusedtorelievethesymptomsofextremecasesofepilepsy.Italsooccursinsomecasesafterbrainsurgery,stroke,infection,tumor,aneurysmandspecificdegenerativebrainconditionssuchasAlzheimer'sdiseaseandCreutzfeldt-Jakobdisease.
558.OsmolarityofMilkF-100is a)399mOsm/L b)409mOsm/L c)419mOsm/L d)429mOsm/L CorrectAnswer-CAnswer-C.419mOsm/LUNICEFandWHOpreparedtwoformuladietsbymodificationofthecowsmilk-MilkF-75(starter75kcal/100ml)andF-100(followup100kcal/100ml).
559.Whichofthefollowingdrugscancause seizuresexcept? a)Lithium b)Phencyclindine c)INH d)Ketorolac CorrectAnswer-DAnswer-D.KetorolacPsychotropicsAntidepressantsAntipsychoticsLithiumDrugsofabuseAmphetamineCocainePhencyclidineMethylphenidateFlumazenil
560.Riboflavindeficiencycauses a)Cornealvascularization b)Anemia c)Personalitychanges d)Alltheabove CorrectAnswer-DAnswer-D.AlltheaboveRiboflavindeficiencyismanifestedprincipallybylesionsofthemucocutaneoussurfacesofthemouthandskin.Inadditiontothemucocutaneouslesions,cornealvascularization,anemia,andpersonalitychangeshavebeendescribedwithriboflavindeficiency.
561.Soretbandinwhichporphyrinsabsorb lightlieatwhatwavelengthofthespectrumoflight? a)200nm b)300nm c)400nm d)500nm CorrectAnswer-CAnswer-C.400nmDuetothisstructureporphyrinsavidlyabsorblightinaregionnear400nmofthelightspectrum.ThispartofthelightspectrumiscalledtheSoretband.
562.Whichofthefollowingisnotseenafter nervetransection? a)Morphologicpatternofwalleriandegeneration b)Myelinovoids c)Painfulneuroma d)Neuromaincontinuity CorrectAnswer-DAnswer-D.NeuromaincontinuityThemorphologichallmarksofaxonalneuropathiesproducedbycuttingaperipheralnerve,resultsinaprototypicalpatternofinjurydescribedasWalleriandegenerationWithinadayofinjury,thedistalaxonsbegintofragmentandtheassociatedmyelinsheathsunravelanddisintegrateintosphericalstructures(myelinovoids).Afailureoftheoutgrowingaxonstofindtheirdistaltargetcanproducea"pseudotumor"termedtraumaticneuroma--anonneoplastichaphazardwhorledproliferationofaxonalprocessesandassociatedSchwanncellsthatresultsinapainfulnodule.
563.Reactivenitrogenspeciesforkillingof microbesaremainlyderivedfrom a)Elementalnitrogen[N3] b)NitricOxide[NO] c)NitrogenDioxide[NO2] d)NitrousOxide[N20] CorrectAnswer-BAnswer-B.NitricOxide[NO]Killingofmicrobesisaccomplishedbyreactiveoxygenspecies(ROS,alsocalledreactiveoxygenintermediates)andreactivenitrogenspecies,mainlyderivedfromnitricoxide(NO),andtheseaswellaslysosomalenzymesdestroyphagocytoseddebris.Thisisthefinalstepintheeliminationofinfectiousagentsandnecroticcells.
564.Duringstateofarousalinmenrelaxation ofsmoothmuscleincorpuscavernosumismainlycausedby a)Acethycholine b)Nitricoxide c)Bicarbonateions d)Calcium CorrectAnswer-BAnswer-B.NitricoxideErectiledysfunction(ED)referstotheinabilityofmentoattainandmaintainanerectpeniswithsufficientrigiditytoallowsexualintercourse.Nitricoxide(NO)releasedparasympatheticnonadrenergicnoncholinergic(NANC)nervesandvascularendotheliumisthemajortransmittercausingrelaxationofsmoothmuscleincorpuscavernosumandbloodvesselssupplyingit;AChandPGsalsoplayarole.
565.Whichofthefollowinggenesifaffected willsporadicallycauseJuvenilemyeloidleukemia? a)NF1 b)PTEN c)APC d)SMAD2 CorrectAnswer-AAnswer-A.NF1NF1-Neurobiastoma,juvenilemyeloidleukemia
566.ChronicmanifestationsofAspergillosis arenotevidentinwhichofthefollowingorgans? a)Skin b)Brain c)Lung d)Eye CorrectAnswer-DAnswer-D.EyeLung,sinus,brain,skin,heart,
567.Oculogyriccrisisisknowntobe producedbyallofthefollowingdrugsexcept a)Trifluoperazine b)Atropine c)Perchlorperazine d)Perphenazine CorrectAnswer-BAnswer-B.AtropineOculogyriccrisisisoneofthemanifestationsseeninacutedystonicreaction(acutemusculardystonia).Othermanifestationsarefacialgrimacing,torticollis,lockedjaw,abnormalcontractionofspinalmuscles(opisthotonus).Itoccurswithin1to5daysofantipsychotictherapy.Trifluperazine,perchlorperazineandperphenazineareantipsychotic
568.Whichmetabolicderangementisseenin pregnancy? a)Metabolicacidosis b)Metabolicalkalosis c)Respiratoryacidosis d)Respiratoryalkalosis CorrectAnswer-DAnswer-D.RespiratoryalkalosisHyperventilationinpregnancywillleadtorespiratoryalkalosis.Thehyperventilationthatoccurduringpregnancyisprobablydueinparttoprogesteronestimulatingthecentre.Lungvolumechangesandalteredcompliancemayalsocontribute.Theeffectisachronicrespiratoryalkalosiswhichiscompensatedbyrenalexcretionofbicarbonate.
569.Whichofthefollowingisnotusedfor investigationoffatmalabsorption a)13CTrioctanoin b)13CTriolein c)13CTripalmitin d)13CTriclosan CorrectAnswer-DAnswer-D.13CTriclosanTestsusedforfatmalabsorption 1. "CTriolenebreathtest2. '3CTripalmitinbreathtest3. '3CMixed-Triglyceridebreathtest4. "C-Trioctanoinbreathtest
570.VitaminEdeficiencycauses a)Hemorrhagicstroke b)Cardiacfailure c)Ataxia d)Megalablasticanemia CorrectAnswer-CAnswer-C.AtaxiaClinicalManifestationsAxonaldegenerationHemolyticanaemiaPeripheralneuropathySpinocerebellarataxiaDryskinThrombocytosisAtaxia
571.1yearoldmalechildishavingaHeart Rate40/min,BP90/60.HisserumPotassium=6.5whatisthenextbestmanagement? a)Ipratropium b)Adrenaline c)Sodiumbicarbonate d)Calciumchloride CorrectAnswer-CAnswer-C.SodiumbicarbonateForsevereelevation7meq/LYouneedtoshiftpotassiumintothecellstogetherwitheliminationofpotassiumfromthebody 1. Stabilizetheheart2. Shiftpotassiumintocells3. Promotespotassiumexcretion ShiftpotassiumintothecellsCalciumChloride:reducetheeffectofpotassiumatthemyocardialcellmembraneSodiumbicarbonateGlucoseplusinsulinNebulizedalbuterolPromotespotassiumexcretionDiuretics(Furosemide)KayexalateDialysis[RefHarrison's18`51echapter45]
572.Mostcommonpresentationofextra- pulmonaryTB a)Tubercularlymphadenitis b)PeritonealTB c)PericardialTB d)Tubercularmeningitis CorrectAnswer-AAnswer-A.TubercularlymphadenitisThemostcommonpresentationofextra-pulmonaryTBinbothHIVsero-negativeandHIV-infectedpatientstoabout35%ingeneral,lymphnodediseaseisparticularlyfrequentamongHIVinfectedpatientsandinchildren.
573.Incorrectabouttakayasuarteritis a)Sparespulmonaryartery b)Renovascularhypertension c)Bloodpressuredifferencebetweenleftandrightlimbs d)Stronglypositivemantoux CorrectAnswer-AAnswer-A.SparespulmonaryarteryTakayasuarteritisisgranulomatousvasculitisoflargeandmediumarteries.Itischaracterizedprincipallybyoculardisturbanceandmarkedweakeningofpulsesintheupperextremities->Pulselessdisease.Itisalsocharacterizedbyastrongpredilectionforaorticarchanditsbranches-Aorticarchsyndrome.SubclavianarteryisinvolvedmostcommonlyOthervesselsinvolvedarecommoncarotid,abdominalaorta,coeliac,superiormesenteric,renal,vertebral,iliac,pulmonaryandcoronaryarteries.
574.Whichofthefollowingisassociatedwith highestriskofAnaphylaxis a)Irondextran b)Ironsucrose c)Ferumoxytol d)IronGluconate CorrectAnswer-AAnswer-A.IrondextranTheriskofanaphylaxisismaximallyassociatedwithhighmolecularweightdextran(notsowithlowmolecularweightdextran).
575.Herpessimplexinfectioncanleadto? a)Frontallobeinfarction b)Parietallobeinfarction c)Temporallobeinfarction d)Occipitalneuralgia CorrectAnswer-CAnswer-C.TemporallobeinfarctionHerpessimplexinfectionhasapredilectionfortheinvolvementofTemporallobe.ThelesionsinHSVencephalitisareintensehemorrhagicnecrosisoftheinferiorandmedialtemporallobeandthemediorbitalpartoffrontallobes.
576.CVjunctionabnormalitiesareseeninall ofthefollowingexcept a)Rheumatoidarthritis b)Ankylosingspondylitis c)Odontoiddysgenesis d)Basilarinvagination CorrectAnswer-BAnswer-B.AnkylosingspondylitisDevelopmentalandacquiredabnormalitiesAtlantoaxialinstability 1. Errorsofmetabolism(e.g.Morquio'ssyndrome)2. Infections(e.g.Grisel'ssyndrome)3. Inflammatory(e.g.rheumatioidarthritis,Psoriasis,Ankylosing Spondylitis) 4. Traumaticatlanto-axialdislocation,Atlantal-dislocation,Down syndrome 5. Malignancy(e.g.Chordoma,Plasmacytoma,Osteoblastoma, Neurofibromatosis) 6. Degenerative(e.g.fetalwarfarinsyndrome,Conradi'sSyndrome, Goldenharsyndrome
577.Mostcommonmechanismofarrhythmia ? a)Re-entry b)Earlyafterdepolarization c)Lateafterdepolarization d)Automaticity CorrectAnswer-AAnswer-A.Re-entryRe-entryappearstobebasisformostabnormalsustainedSupraVentricularTachycardias(SVTs)andVTs.Examplesofre-entryare:-VFduetoacutemyocardialischemiaand
578.Whichofthefollowingisthecommon causeofrespiratoryfailuretype2? a)Chronicbronchitisexacerbation b)Acuteattackasthma c)ARDS d)Pneumonia CorrectAnswer-AAnswer-A.ChronicbronchitisexacerbationTypeIIrespiratoryfailureoccursduetoalveolarhypoventilation
579.Whichofthefollowingisseenin sarcoidosis a)Hypercalcemia b)Hypocalcemia c)Hyperphosphatemia d)Hypophosphatemia CorrectAnswer-AAnswer-A.HypercalcemiaGranulomaofsarcoidosiscansecret1-25(OH)2vitaminD.Therefore,patientsofsarcoidosismaydevelophypercalcemia.
580.InapatientwithCOPD,best managementoptionis a)Quitsmoking b)Bronchodilators c)Lowflowoxygen d)Mucolytics CorrectAnswer-CAnswer-C.LowflowoxygenTherapyisstartedwithshort-actingbronchodilator(beta-agonistoranticholinergic).Long-termoxygentherapyisusedinallpatientswithCOPDwhohavechronichypoxemia
581.Inapatientthereisdyspneainupright positionwhichisrelievedinsupineposition,Diagnosis? a)Tachypnea b)Orthopnea c)Paroxysmalnocturnaldyspnea d)Platypnea CorrectAnswer-DAnswer-D.PlatypneaPlatyapnea(Orthodeoxia)Dyspnoeawhenapatientmovestosittingorstandingpositionfromarecumbentposition.
582.AfterRoadtrafficaccidentapatient presentedtocasualtywithvitalsshowingBPof90/60mmHgwithheartof56bpm.Whichkindofshockoccurs? a)Cardiogenic b)Neurogenic c)Distributive d)Hypovolemiashock CorrectAnswer-BAnswer-B.NeurogenicNeurogenicshockisadistributivetypeofshockresultinginlowbloodpressure,occasionallywithaslowedheartrate,thatisattributedtothedisruptionoftheautonomicpathwayswithinthespinalcord.Itcanoccurafterdamagetothecentralnervoussystemsuchasspinalcordinjury.
583.Mostcommoncauseofidiopathic interstitialpneumoniais a)Sarcoidosis b)Organizingpneumonia c)Idiopathicpulmonaryfibrosis d)Lipoidpneumonia CorrectAnswer-CAnswer-C.IdiopathicpulmonaryfibrosisIdiopaticpulmonaryfibrosisIdiopathicnonspecificinterstitialpneumonia
584.Manworkinginhotenvironment& drinkinglotsofwaterwithoutintakeofsaltsisliabletodevelop- a)Heathyperpyrexia b)Heatcramps c)Heatstroke d)Heatencephalopathy CorrectAnswer-BAnswer-B.HeatcrampsHeatcramps/Miner'scramps/Stoker'scramp/Firemen'scrampThesearepainfulspasmofvoluntarymuscleswhichfollowsternousworkinahotatmosphere.Thesearecausedbylossofwaterandsaltinprofuseprespiration(sweating).
585.ClickingnoiseinPneumomediastinumis knownas a)Hammansign b)Trailsign c)Kussmaulsign d)None CorrectAnswer-AAnswer-A.HammansignCrunchingorclickingnoiseheardsynchronouslywiththeheartbeatonauscultationandbestheardintheleftlateraldecubitusposition.Itisassociatedwith"Pneumomediastinum".
586.TrueabourdruginducedSLEisexcept? a)Female:Maleratio=9:1 b)Anti-histoneAntibodies c)CNSinvolvementnotcommon d)Renalinvolvementnotcommon CorrectAnswer-AAnswer-A.Female:Maleratio=9:1ItispredominantincaucasiansIthaslessfemalepreddictionthanSLEItrarelyinvolveskidneysorbrainItisrarelyassociatedwithantiDsDNAItiscommonlyassociatedwithantibodiestohistonesItusuallyresolvesoverseveralweeksafterdiscontinuationoftheoffendingmedication.
587.Emphysemapresentswithallexcept a)Cyanosis b)Barrelshapedchest c)Associatedwithsmoking d)TypeIrespiratoryfailure CorrectAnswer-AAnswer-A.CyanosisDyspnoeaCoughorwheezing(somepatient)WeightlossBarrel-ChestFEVCandFEV1arereduced.TLC,RC,andFRCareincreasedduetohyperinflation.Cyanosisisrare(incontrasttochronicbronchitis)Emphysema(COPD)causestype-1respiratoryfailure
588.Allareseeninemphysemaexcept a)Decreasedvitalcapacity b)Hyperinflation c)Rhonchi d)ReducedDlco CorrectAnswer-CAnswer-C.RhonchiCoughorwheezing(somepatient)WeightlossBarrel-ChestFEVCandFEV1arereduced.TLC,RCandFRCareincreasedduetohyperinfcation.Cyanosisisrare(incontrasttochronicbronchitis)Emphysema(COPD)causestype-1respiratoryfailure
589.Flushingwithniacininreducedby- a)Laropiprant b)Premedicationwithaspirin c)Tachyphylaxis d)Alloftheabove CorrectAnswer-DAnswer-D.AlloftheaboveLaropiprant(selectiveprostaglandinD2receptorantagonid)PremedicationwithaspirinFlushingassubjecttotachyphylaxisandoftenimproveswithtime.
590.Mostcommoncauseoflungabscessis comatosepatient a)Staphaureus b)Oralanaerobes c)Klebsiella d)Tuberculosis CorrectAnswer-BAnswer-B.OralanaerobesMostlungabscessesinmoribundintubatedpatientsareduetoanaerobicbacteria,likepeptostreptococcus,Bacteroidesetc.LungabscessThetermpulmonaryabscessdescribesalocalsuppurativeprocesswithinthelung,characterizedbynecrosisoflungtissuesEtiologyAsaspirationoforopharyngealsecretionsisthemostcommoncause,organismsmostcommonlycausinglungabscessarethosenormallyfoundinoralcavity,i.e.,Anaerobicbacteria(Bacteroides,Fusobacterium,peptococcusspecies).OtherorganismsareS.aureus,Klebsiella,Nocardiaandgramnegativebacteria.
591.Whichcanbegiveinhemorrhagicstroke ? a)Normalsaline b)Colloids c)Bloodtransfusion d)Hypertonicfluids CorrectAnswer-AAnswer-A.NormalsalineNormalsalineinitiallyshouldbeusedformaintenanceandreplacementfluids:Hypotonicfluidsarecontraindicatedastheymayexacerbatecerebraledemaandintracranialpressure.Hypervolemiashouldbeavoidedasitmayworsencerebraledema.
592.Ifapersonishavingventriular tachycardia,extrasystolesappearsto a)Pwave b)QRScomplex c)Twave d)Rwave CorrectAnswer-BAnswer-B.QRScomplexExtrasystoleinventriculartachycardiaappearsinQRScomplexwhenanirritablefocusinanypartoftheventricularmyocardiumactivatestheventriclesbeforethearrivalofthenextnormalwaveofdepolarisationfromtheatriaaventricularextrasystoleisproduced.
593.MostcommonarrhythmiainICUpatients - a)Atrialflutter b)Atrialfibrillation c)PSVT d)NPAT CorrectAnswer-BAnswer-B.AtrialfibrillationMostcommonarrhythmiainI.C.U.patientAtrialfibrillationMostcommonarrhythmiainapatientwithCardiacarrestVentricularfibrillation
594.Inapatientwhowasbroughttocasualty afterRTAwithpulserate108,SBP80.Whichfluidistobegivenideally? a)Plasma b)NormalSaline c)Blood d)5%dextrose CorrectAnswer-BAnswer-B.NormalSalineInitialresuscitationrequiresrapidreexpansionofthecirculatingintravascularbloodvolumealongwithinterventionstocontrolongoinglosses.VolumeresuscitationisinitiatedwiththerapidinfusionofeitherisotonicsalineorabalancedsaltsolutionsuchasRinger'slactate
595.Patientof1stdegreeheartblock complainsofdizziness.Besttreatmentforthispatientis a)Atropine b)Isoprenaline c)Adrenaline d)Pacemaker CorrectAnswer-DAnswer-D.PacemakerThemostdefinitiveorreliabletreatmentforpatientwithsymptomaticA.V.conductionsystemistemporaryorpermanentpacing.
596.Whichofthefollowingconditiondoes notcausemultiplepainfululcersontongue? a)TB b)Sacroidosis c)Herpes d)Behcetdisease CorrectAnswer-BAnswer-B.SacroidosisPainfululcersinmouthApthousulcersBehcetdiseaseDenturestomatitisThermalburnsTuberculosisHerpesCarcinomatongueArsenicpoisoning
597.Allareusedforsecondarypreventionof MIexcept a)Aspirin b)Statins c)Betablockers d)Warfarin CorrectAnswer-DAnswer-D.WarfarinMedicinesusedinthesecondarypreventionofM.I.LongtermdualantiplatelettherapywithaspirinandP2Y12receptorblocker.Statins(highintensity).Angiotensinconvertingenzymeinhibitorsinpatientwithdiabetesheartfailure,leftventricularejectionfraction.f3blockers.
598.Whichofthefollowingsubstancesis primarilyfoundintendons? a)Collagen b)Fibrin c)Fibrillin d)Protedglycans CorrectAnswer-AAnswer-A.CollagenTendonisprimarilymadeupofcollagen.
599.Notrecommendedincoronaryartery diseasepatients a)Dailyexercise b)Potassium c)Vitamin-E d)Statins CorrectAnswer-CAnswer-C.Vitamin-EInterventionstudiesusingvitaminEtopreventcardiovasculardiseaseorcancerhavenotshownefficacy
600.Numberofbarrbodiesinklinfellter's syndromeis- a)0 b)1 c)2 d)3 CorrectAnswer-BAnswer-B.1FoundinfemaleBut-KleinefeltersyndromeismalewithoneBarrbody.TurnersyndromeisfemalewithoutBarrbody.
601.Digitalisisusedinmitralstenosiswhen patientdevelops a)Atrialfibrillation b)Rightventricularfailure c)Acutepulmonaryedema d)Myocarditis CorrectAnswer-AAnswer-A.AtrialfibrillationDrugsusefulinslowingtheventricularrateofpatientswithAFBetablockers,Nondihydropyridinecalciumchannelblockers(e.g.,verapamilordiltiazem),andDigitalisglycosides
602.IncorrectaboutLAMBsyndrome- a)Lentigines b)AtrialMyxoma c)Myaesthenicsyndrome d)BlueNevi CorrectAnswer-CAnswer-C.MyaesthenicsyndromeLAMBsyndromeischaracterizedbypresenceof:-LentiginesAtrialMyxomaBluenevi.
603.Whichoneofthefollowingisnotan earlycomplicationofacutemyocardialinfarction? a)Papillarymuscledysfunction b)Ventricularseptaldefect c)Paricarditis d)Dressler'ssyndrome CorrectAnswer-DAnswer-D.Dressler'ssyndromeDressler'ssyndromeisalatecomplicationofmyocardialinfarction.Itusuallyoccurs1-8weeksaftermyocardialinfarctions
604.Mostcommonmalignanttumorofheart inadults a)Sarcoma b)Rhabdomyoma c)Lipoma d)Paraganglioma CorrectAnswer-AAnswer-A.SarcomaAlmostallprimarycardiacmalignanciesaresarcomas.
605.Inwhichofcausesoforalulcer,Auto- antibodiesarenotseen? a)Behcetdisease b)SLE c)Pemphigus d)Celiacdisease CorrectAnswer-AAnswer-A.BehcetdiseaseBehcet'sdiseaseisclassifiedamongthevasculitideslaboratorydiagnosticdoesnotincluderegularlyautoantibodiesassociatedwithvascularmanifestationsofsystemicautoimmunedisease.
606.Whichisthebestwaytodifferentiate betweenstableanginaandNSTEMI? a)ECG b)Cardiac-biomarker c)TransthoracicEchocardiography d)MultiuptakegatedAcquisitionscan CorrectAnswer-BAnswer-B.Cardiac-biomarkerThedifferentiatingfeaturebetweenAnginaandMIistheelevationofcardiacmarkers?.(noelevationisseeninAngina)
607.AetiologyofDresslerSyndromeis a)Viral b)Autoimmune c)Idiopathic d)Toxinmediated CorrectAnswer-BAnswer-B.AutoimmuneImmunologicalfactorsarethoughtstobeofprimaryimportance.Theimmunecomplexeshataregeneratedaredepositedintothepericardium,pleuraandlungs.
608.Murmurheardinaorticstenosis a)Right2ndintercistal,lowpitchmurmur b)Apex,lowpitchmurmur c)LeftSternalarea,lowpitchmurmur d)Pen-systolicmurmur,highpitchmurmur CorrectAnswer-AAnswer-A.Right2ndintercistal,lowpitchmurmurTypicallyheardatthebaseoftheheartinAorticarea(secondintercostalspace).Harshquality.GenerallybeginsafterSiandendSbeforeS2.
609.Allaretrueaboutcross-matchingof bloodexcept- a)Mandatoryinallcasesexceptemergency b)Recipientserumistestedagainstdonorpackedcells c)Donorserumistestedagainstrecipientpackedcells d)Involvesvisibleagglutination CorrectAnswer-CAnswer-C.DonorserumistestedagainstrecipientpackedcellsCrossmatchinginvolvestestingthepatientsserumwithdonorcellstodeterminewhetherthepatienthasanantibodywhichmaycauseahemolytictransfusionreaction
610.Beckstriadisseenin a)Constrictivepericarditis b)Restrictivecardiomyopathy c)Cardiactamponade d)Noneoftheabove CorrectAnswer-CAnswer-C.CardiactamponadeBeck'striadischaracteristicofcardiacTamponade,itincludes:IncreasedvenouspressureDecreasedarterialpressureMuffledheartsounds,silentheart(duetopresenceoffluidinpericardium).
611.AllareseeninNephroticsyndrome except a)Atherosclerosis b)Thrombo-embolism c)IncreasedproteinClevels d)Lipiduria CorrectAnswer-CAnswer-C.IncreasedproteinClevelsNephroticsyndromeisaclinicalcomplexcharacterizedbyanumberofrenalandextrarenalfeatures,mostprominentofwhichareProteinuria(inpractice>3.0to3.5gm/24hrs),Hypoalbuminemia,EdemaHypertensionHyperlipidemia,LipiduriaHypercoagulabilty(resultofLossofAntithrombinIII)
612.Allareseenincarney'striadexcept- a)Atrialmyxoma b)GIST c)Chondroma d)Paraganglioma CorrectAnswer-AAnswer-A.AtrialmyxomaExtra-adrenalparaganglioma(e.g.extraadrenalphaeo-chromocytoma)GastrontestinalstromaltumorspreviouslyknownasgastricepithelioidleiomyosarcomaPulmonarychondromahamartomaonly2ofthe3tumorsarepresentatthetimeofdiagnosistypicallyaffectsyoungpeople.
613.Basketweaveappearanceofglomerular basementmembraneonelectronmicroscopyisseenin a)Alportsyndrome b)AcutepoststretptococcalGN c)Polyarteritisnodosa d)Giantcellarteritis CorrectAnswer-AAnswer-A.AlportsyndromeBasketweaveappearanceofglomerularbasementmembraneonElectronMicroscopyisseeninAlport'ssyndrome.InAlport'sSyndrome,theglomerularbasementmembraneshowsirregularthinningandthickeningwithalamellatedbasket-weaveappearanceinthethickenedareaduetoextensiveremodelingandinjuryofthebasementmembrane.
614.Allofthefollowingcausesacuterenal failureexcept a)Pyelonephritis b)Snakebite c)Rhabdomyolysis d)Analgesicnephropathy CorrectAnswer-DAnswer-D.AnalgesicnephropathyAnalgesicnephropathycauseschronicinterstitialnephritisandpresentswithchronickidneydisease.AKIisaseriouscomplicationofsnakebitesbytheviperidaefamily
615.Martelsignisseenin- a)Gout b)Ankylosingspondylitis c)Osteoarthritis d)Rheumatoidarthritis CorrectAnswer-AAnswer-A.GoutMartel'ssignisnotpresentinallcasesofgoutyarthritis.Martel'ssign,whichisaradiologicalsign(straightarrow)todescribetheoverhangingmarginofthenewbonealonetheedgeoferosion.
616.AllaretrueaboutGFRexcept a)30-40%decreaseafter70yearsofage b)Bestestimatedbycreatinineclearance c)C.K.DisdefiedasGFR<30ml/min/1.732for4weeks d)GFRisdependentonheightinchildren CorrectAnswer-CAnswer-C.C.K.DisdefiedasGFR<30ml/min/1.732for4weeks
617.ManifestationsofvitaminE.deficiency areallexcept- a)Hemolyticanemia b)Posteriorcolumnabnormalities c)Cerebellarataxia d)Autonomicdysfunction CorrectAnswer-DAnswer-D.AutonomicdysfunctionTheclinicalmanifestationsareedema,hemolyticanemia(duetofragileredcell'smembraneasaresultoflipidperoxidation)andthrombocytosis.Nerveandmusclemembranedamagemayoccur.VitaminEdeficiencycausesaxonaldegenerationofthelargemyelinatedaxonsandresultsinposteriorcolumnandspinocerebellarsymptoms.
618.Dialysisindications a)Hypertension b)Hypokalemia c)Pericarditis d)Metabolicalkalosis CorrectAnswer-CAnswer-C.PericarditisIndicationsofdialysisinchronicrenalfailurePericarditisorpleuritis(urgentindication).Progressiveuremicencephalopathyorneuropathy,withsignssuchasconfusion,asterixis,myoclonus,wristorfootdrop,or,inseverecases,seizures(urgentindication).Aclinicallysignificantbleedingdiathesisattributabletouremia(urgentindication).Persistentmetabolicdisturbancesthatarerefractorytomedicaltherapy;theseincludehyperkalemia,metabolicacidosis,hypercalcemia,hypocalcemia,andhyperphosphatemia.Fluidoverloadrefractorytodiuretics.Hypertensionpoorlyresponsivetoantihypertensivemedications.Persistentnauseaandvomiting.Evidenceofmalnutrition.
619.Whichofthefollowingmicroorganismis incriminatedininfectionafterhemodialysis a)Chlamydia b)Grampositiveorganisms c)Gramnegative d)Anaerobes CorrectAnswer-BAnswer-B.GrampositiveorganismsHemo-dialysiscatheter-relatedbloodstreaminfections(CRBSIs)areamajorcomplicationoflong-termcatheterusinHD.Grampositiveorganismareseenfollowedbygramnegativeorganisms.
620.Dietarydeficiencyofwhichvitamin usuallydoesnotexist- a)Vitamin-B6 b)Thiamine c)Vitamin-E d)Vitamin-D CorrectAnswer-CAnswer-C.Vitamin-EDietarydeficiencyofvitaminEdoesnotexist.
621.LowserumcopperduetoATP7Agene isdueto? a)Dubin-johnson'ssyndrome b)Wilsondisease c)Menkedisease d)Gilbert'sdisease CorrectAnswer-CAnswer-C.MenkediseaseMenke'sdisease,alsoknownaskinkyhairdisease,isanX-linkedneurodegenerativediseaseofimpairedcoppertransport,duetoATP7AgenelocatedonXp12-13.
622.I.R.I.S.is- a)Immunereconstitutionidiopathicsyndrome b)Immunereconstitutionimmunologicalsyndrome c)Immunereconstitutioninflammatorysyndroma d)Inflammatoryreconstitutionimmunesyndrome CorrectAnswer-CAnswer-C.ImmunereconstitutioninflammatorysyndromaTheterm"immunereconstitutioninflammatorysyndrome"(IRIS)describesacollectionofinflammatorydisordersassociatedwithparadoxicalworseningofpreexistinginfectiousprocessesfollowingtheinitiationofhighlyactiveantiretroviraltherapy.
623.Bloodtransfusionassociatedacutelung injuryoccursdueto- a)Nosocomialinfections b)HLAmediated c)Auto-immunedisorder d)Geneticsusceptibility CorrectAnswer-BAnswer-B.HLAmediatedTRALIusuallyresultsfromthetransfusionofdonorplasmathatcontainshightitreantiHLAclassIIantibodiesthatbindrecipientleucocytes.Theleucocytesaggregateinthepulmonaryvasculatureandreleasemediatorsthatincreasecapillarypermeability.Testingthedonor'splasmaforAntiHLAantibodiescansupportthisdiagnosis.
624.Rockallscoreisusedforprognosisof patientsof a)UpperGIbleeding b)LowerGIbleeding c)Hepaticencephalopathy d)IBD CorrectAnswer-AAnswer-A.UpperGIbleeding
625.Whichofthefollowingisgivento decreaseSerumTriglycerides? a)Fibrates b)Statine c)Ezetimibe d)Niacin CorrectAnswer-AAnswer-A.FibratesFibratesaredrugsofchoiceforhypertriglyceridemia(typeIV)andchylomicronemia(typeI).
626.Streptococcusbovisinfectionis associatedwith- a)CLL b)Hairycellleukemia c)Colorectalcancer d)Multiplemyeloma CorrectAnswer-CAnswer-C.ColorectalcancerColonandrectaltumorsStreptococcusbovis(bacteremia)
627.Whichisahormonedependentliver tumor? a)Adenoma b)Hemangioma c)Hepatocellularcarcinoma d)Hemangiopericytoma CorrectAnswer-AAnswer-A.AdenomaAdenomasareassociatedwithcontraceptivehormoneuse.
628.PolyarticularonsetJRAinvolvesmore thanhowmanyjoints- a)3 b)4 c)5 d)6 CorrectAnswer-CAnswer-C.5PolyarticularJRAItischaracterizedbyinvolvementof5ormorejoints.Therearetwosubtypes:-i)PolyarticularRApositiveItischaracterizedbysymmetricaljointinvolvementalongwithUveitis,andrheumatoidnodules.RAfactorandANAarepositive.ii)PolyarticularRAnegativeRAfactorandrheumatoidnodulesarenotseen.
629.Poikilocytosisandanisocytosisisseen in a)Megaloblasticanaemia b)Irondeficiencyanaemia c)Nutritionaldeficiencyanaemia d)Thalassemia CorrectAnswer-BAnswer-B.IrondeficiencyanaemiaAnisocytosismeansthatRBC'sareunequalinsizeindicatingthatsomeoftheRBC'sareeithertoobigortoosmall.PoikilocytosismeansthatsomeoftheRBC'sareabnormallyshaped.
630.AlzehiemertypeIIastrocyteareseenin- a)Hepaticencephalopathy b)Alzehiemer's c)Parkinsonism d)Biswangerdisease CorrectAnswer-AAnswer-A.HepaticencephalopathySwollenastrocytesinhepaticencephalopathyarecalledAlzheimertypeIIastrocytes.TheirnucleiarelargeandappearclearinH&Estains.TheyarealsoseeninWilsondisease.
631.Whichofthefollowingantibodiesis highlyspecificforsystemiclupuserythematosus- a)Anti-Sm b)Anti-RO-1 c)Anti-UIRNP d)Anti-Centromere CorrectAnswer-AAnswer-A.Anti-SmSensitivetestforSLEAntinuclearantibodies(ANA)SpecifictestforSLEAntidsDNA,AntiSm
632.Allofthefollowingarecharacteristic featuresoftreatmentofirondeficiencyanemiawithoralironsupplements,except a)BioavailabilityisenhancedwithvitaminC b)Theproportionofironabsorbedreducesashemoglobin improves c)Thereticulocytecountshouldbegintoincreaseintwoweeks andpeakin4weeksthissuggestsgoodresponsetotreatment d)Thetreatmentshouldbediscontinuedimmediatelyonce hemoglobinnormalizestopreventsideeffectsofiron CorrectAnswer-DAnswer-D.ThetreatmentshouldbediscontinuedimmediatelyoncehemoglobinnormalizestopreventsideeffectsofironThereticulocytecountbegintoincreasewithin4-7daysafterinitiationoftherapyandpeakat1.5weeks.Typicallyforironreplacementtherapy,upto200mgofelementalironperdayisgiven,usuallyasthreeorfourirontablets(eachcontaining50-65mgelementaliron)givenoverthecourseoftheday.Adoseof200mgofelementalironperdayshouldresultinabsorptionofironupto50mg/day.Thissupportsaredcellproductionlevelof2-3timesnormalinanindividualwithanormallyfunctioningmarrowandappropriateerythropoietinstimulus.Asthehemoglobinlevelrise,erythropoietinstimulationdecreases,andtheamountofironabsorbedisreduced.Thegoaloftherapyinindividualswithiron-deficiencyanemiaisnotonlytorepairtheanemia,butalsotoprovidestoresofatleast0-5-1
onlytorepairtheanemia,butalsotoprovidestoresofatleast0-5-1gofiron.Thissustainedtreatmentforaperiodof6-12monthsaftercorrectionoftheanemiawillbenecessary.
633.Whichofthefollowingisnotexpectedin acaseofMicrocyticHypochromicanemia a)ReducedserumIron b)ReducedtotalRBCdistributionwidth c)NormalFerritinlevels d)IncreasedTIBC CorrectAnswer-BAnswer-B.ReducedtotalRBCdistributionwidthThefirstchangeinirondeficiencyanemiaisdecreasedinironstore,whichismanifestedasdecreasedserumferritinlevel.Bonemarrowirondecreasesearlierthanserumiron.Thereismicrocytichypochromicanemia(microcytosisprecedeshypochromia).
634.A23-yearoldwomanhasexperienced episodesofmyalgias,pleuraleffusion,pericarditisandarthralgiaswithoutjointdeformityovercourseofseveralyears.Thebestlaboratoryscreeningtesttodiagnoseherdiseasewouldbe- a)CD,lymphocytecount b)Erythrocytesedimentationrate c)Antinuclearantibody d)Assayforthyroidhormones CorrectAnswer-CAnswer-C.AntinuclearantibodySensitivetestforSLEAntinuclearantibodies(ANA)SpecifictestforSLEAntidsDNA,AntiSm
635.Zievesyndromeischaracterizedbyall except a)Alcoholabuse b)Hemolysis c)Hypertriglyceridemia d)Pancreaticlipasedeficiency CorrectAnswer-DAnswer-D.PancreaticlipasedeficiencyZieve'ssyndromeisanacutemetabolicconditionthatcanoccurduringwithdrawalfromprolongedalcoholabuseZievesyndromeisarareconditioncharacterizedbyhemolyticanemiainconjunctionwithsecondaryhyperlipidemiainpatientssufferingfromalcohol-relatedtoxicliverdamage.
636.Whichisthemostcommontumor leadingtodeathinadults? a)Lungcancer b)Prostatecancer c)Colorectalcancer d)Leukemia CorrectAnswer-AAnswer-A.LungcancerLungcancerconstitutesupto29%ofallcancerrelateddeathsinmalesand26%ofallcancerrelateddeathinwoman.
637.Hemoglobinwithzeta2andgamma2 chainsareseeninwhichofthefollowing a)GowerI b)GowerII c)Portland d)FetalGb CorrectAnswer-CAnswer-C.PortlandHbGowerIZeta2/epsilon2HbPortlandZeta2/gamma2HbGowerHAlpha2/epsilon2
638.Inlongstandingrheumatoidarthritis whichwillbeseen- a)Milkalkalisyndrome b)Nephrolithiasis c)Paradoxicalaciduria d)Secondaryamylodosis CorrectAnswer-DAnswer-D.SecondaryamylodosisReactiveamyloidA(AA)amyloidosis,oneofthemostseverecomplicationsofRA,isserious,potentiallylifethreateningdisordercausedbydepositionofAAamyloidfibrilsinmultipleorgans
639.AllaretrueaboutCNSleukemiaexcept a)CNSirradiationisgiven b)Intrathecalmethotrexateisgiven c)Seenwithacutemyeloidleukemia d)SingleblastinCSFissufficientfordiagnosis CorrectAnswer-CAnswer-C.SeenwithacutemyeloidleukemiaMostchildrenwithleukemiahavesubclinicalCNSinvolvementatthetimeofdiagnosis.Fewchildrenshowcentralnervoussysteminvolvementatthetimeofdiagnosis,mostareasymptomaticbutsomehavefeaturesofraisedintracranialtension.CNSinvolvementismostlyduetoALL.CNSinvolvementismorecommoninALLthanAML.
640.Thrombocythemiaischaracterizedby a)Plateletselevation b)Lowplatelets c)Neutrophilia d)Monocytosis CorrectAnswer-AAnswer-A.PlateletselevationThrombocythemiaorthrombocytosisistheelevationofplatelets.
641.Hyperuricemiacanbecausedbyall except- a)Ethanol b)Thiazide c)Furosemide d)None CorrectAnswer-DAns.is.D.NoneCausesofdrugordietinducedhyperuricemiaDiuretics(thiazidesandloopdiuretics)CyclosporineandtacrolimusLowdosesalicylates.EthambutolPyrazinamideEthanolLevodopaMethoxyfluraneLaxativeabuse(alkalosis)Saltrestriction
642.Glucosefeverisrelatedwith- a)Glucagon b)Parathyroid c)GH d)Aldosterone CorrectAnswer-DAnswer-D.AldosteroneHypoglycemiainAddisondiseaseismanagedwithhydrocortisone/dexamethasone.AdministrationofI.V.glucoseinAddisonleadstodevelopmentoffeverandiscalledas"glucosefever".Inpatientswithadrenalinsufficiency,whohavenotreceivedglucocorticoidsglucoseinfusionmaycausehighfever(glucosefever)followedbycollapseanddeath.
643.PatientoninsulininCKDstage4.What isthedoseadjustmentofinsulinrequired? a)Increasedinsulin b)Decreasedinsulin c)Normalinsulin d)AddDPP-4inhibitors CorrectAnswer-BAnswer-B.DecreasedinsulinInsulinrequirementsshowabiphasiccourseindiabeticpatientswithrenaldisease.Itisnotuncommonforglucosecontroltodeteriorateasrenalfunctiondeteriorates,asincreasinginsulinresistancecanaffectbothtypeIandtype2diabetics.
644.Mostcommoncauseofdeathincancer is- a)Bleeding b)Infection c)Respiratoryfailure d)Renalfailure CorrectAnswer-BAnswer-B.InfectionThemostcommoncausesofdeathinpatientswithcancerareinfection(leadingtocirculatoryfailure),respiratoryfailure,hepatic,andrenalfailure.Intestinalblockagemayleadtoinanitionandstarvation.
645.Whichisthebestindicatorforshortterm control(2-3weeks]ofbloodglucose? a)Serumfructosamine b)HbAlc c)Bloodsugar d)Urinesugar CorrectAnswer-AAnswer-A.SerumfructosamineSerumfructosamineTellssugarfluctuationsin2-3weeksGlycosylatedhemoglobinTellssugarfluctuationsinprevious6-8weeks.
646.PostPrandialcapillaryglucoseshould bemg/dlforadequatediabetescontrol a)<100mg/dl b)<140mg/dl c)<180mg/dl d)<200mg/dl CorrectAnswer-CAnswer-C.<180mg/dlHbAIC-twoPreprandialcapillaryplasmaglucose-70-130mg/d1<Peakpostprandialcapillaryplasmaglucose-180mg/d1<Bloodpressure-130/80
647.Mosaicpatternofcomentlineis characteristicallyseenin- a)Hyperthyroidism b)Paget'sdiseaseofbone c)Renalosteodystrophy d)Osteomalacia CorrectAnswer-BAnswer-B.Paget'sdiseaseofboneMosaicpatternofcementlineischaracteristicallyassociatedwithpaget'sdiseaseofthebone
648.Hyperpigmentationisseenwithwhich hormone? a)FSH b)LH c)TSH d)ACTH CorrectAnswer-DAnswer-D.ACTHHyperpigmentationoftheskinandmucousmembranesoftenprecedesallothersymptomsbymonthstoyears.Itiscausedbythestimulanteffectofexcessadrenocorticotrophichormone(ACTH)onthemelanocytestoproducemelanin.ThehyperpigmentationiscausedbyhighlevelsofcirculatingACTHthatbindtothemelanocortin1receptoronthesurfaceofdermalmelanocytes.Othermelanocyte-stimulatinghormonesproducedbythepituitaryandothertissuesincludealpha-MSH(containedwithintheACTHmolecule),beta-MSH,andgamma-MSH.Whenstimulated,themelanocytechangesthecolorofthepigmenttoadarkbrownorblack.TheincreasedMSHinAddison'scausesmelanocytestodispersemelaninintheepidermisthusincreasingpigmentation.
649.Femalewithbloodsugarof600mg%and sodiumof110mEq.Insulinwasgiven,whatwillhappentoserumsodiumlevels? a)Sodiumincrease b)Sodiumdecrease c)Sodiumunaffected d)Relativesodiumdeficiency CorrectAnswer-AAnswer-A.SodiumincreaseAstheglucoseleveldecreases,thereisdecreaseintheosmolarityofextracellularfluid.Thiscausesmovementofintracellularfluidbackintothecellularcompartmentproducingincreaseinserumsodium.
650.Whichofthefollowingpresentswith hypokalemiaandmetabolicacidosis? a)Diarrhea b)Vomiting c)Nasogasticsuction d)Nasogasticsuction CorrectAnswer-AAns-A.DiarrheaDiarrheacauseshypokalemiawithmetabolicacidosis.Vomitingnosogastricsuctionandconn'ssyndromecausemetabolicalkalosis.
651.Lafora'sdiseasepresentswith- a)G.T.C.S b)Myoclonicepilepsy c)Petitmalepilepsy d)Partialseizures CorrectAnswer-BAnswer-B.MyoclonicepilepsyLoforadiseaseisanautosomalrecessivepoliencephalopathyoflatechildhoodorearlyadultlife.Itischaracterizedbyprogressivedementia,dysarthria,visualloss,pyramidal&cerebellarsigns,andmyoclonic&otherseizures.Thediagnosticpathologicalfindingisloforabodies.
652.Incobalamindeficiencywhichisnot seen a)Microcyticanemia b)Longtractsigns c)Lossofproprioception d)Rhombergsign CorrectAnswer-AAnswer-A.MicrocyticanemiaCobalminedeficiencycausesmegaloblastic(macrocytic)anemia(notmicrocytic).Cobalaminedeficiencyalsocausessubacutecombineddegenerationofspinalcordduetoinvolvementofposteriorcolumn,affectingvibration,finetouch,andimbolance(Rombergsign).
653.HypernatremiacausesallEXCEPT a)Seizure b)Thrombus c)Brainhemorrhage d)Centralpontinemyelinosis CorrectAnswer-DAnswer-D.CentralpontinemyelinosisComplicationofhypernatremiaarebrainhemorrhage,seizures,coma,thromboticcomplicationsandraisedICT.Centralpontinemyelinosisisclassicallyassociatedwithoverlayrapidcorrectionofhyponatremia.Clinicalfeatures-Patientsareirritable,restlessweakandlethargicSomehavehighpitchedcryandhyperpnea.Alertpatientareverythirsty.Hypernatremiacausesfeveralthoughmanypatientshaveunderlyingprocessthatcontributestothefever.
654.Allofthefollowingareassociatedwith hyponatremiaexcept a)anorexia b)Convulsions c)Drowsiness d)Myalgia CorrectAnswer-DAnswer-D.MyalgiaAnorexia,nausea&vomitingComaConvulsionsDrowsinessHeadacheCirculatoryfailureandhypotensionHyponatremiacanalsocausemusclecrampsandweakness.
655.Mostcommontypeofmultiplesclerosis? a)Relapsingremittingtype b)Secondryprogressivemultiplesclerosis c)Progresiverelapsingmultiplescelrosis d)Primaryprogresivemultiplesclerosis CorrectAnswer-AAnswer-A.RelapsingremittingtypeRepapsing-remittingmultiplesclerosis(RRMS)Thisisthemostcommonformofmultiplesclerosis.About85%ofpeoplewithM.S.areinitiallydiagnosedwithrelapsing-remittingmultiplesclerosis.
656.Aspirindecreasestheriskof developmentofwhichofthefollowing- a)Colorectalcancer b)Stomachcancer c)Carcinoid d)MALToma CorrectAnswer-AAns.A.ColorectalcancerRegularaspirinusereducestheriskofcolonadenomasandcarcinomasaswellasdeathfromlarge-bowelcancer
657.Dermatitismaybeaclinical manifestationofdeficiencystatesofalloffollowingnutrientsexcept- a)Biotin b)Niacin c)Pyridoxine d)Thiamine CorrectAnswer-DAnswer-D.ThiamineVitaminB3(Niacin)deficiencycausesdermatitis.BiotinandVitaminB6(pyridoxin)deficiencycausesseborrheicdermatitis.
658.InEEGwhichtypeofwavesareseenin metabolicencephalopathy a)Alpha b)Beta c)Gamma d)Delta CorrectAnswer-DAnswer-D.DeltaE.E.G.hasbeenwidelyusedtoevaluatemetabolicencephalopathy.TheE.E.G.findingsareabnormalinacuteencephalopathystages Metabolic 'vthm encephalopathyGradeI(almost Dominantactivityisrhythmwithminima,theta normal) activity GradeII(mildly Dominantthetabackgroundwithsomealpha abnormal) anddeltaactivities GradeII Continuousdeltaactivetypredominates,little (morderately activityoffasterfrequencies abnormal)GradeIV(severely Low-amplitudedeltaactivityorsuppression- abnormal) burstpattern GradeV(extremely Nearly"flat"tracingorelectrocerebralinactivity abnormal)
659.Whichvitamintoxicityisassociatedwith excessivesweating- a)Choline b)Biotin c)Foliccid d)VitaminB CorrectAnswer-AAnswer-A.CholineToxicityfromcholineresultsin-HypotensionCholinergicsweatingDiarrheaSalivationFishybodyodor
660.Isaacsyndromaischaracterisedby- a)Peripheralnerveexcitability b)Opsoclonus c)Encephalomyelitis d)Limbicencephalitis CorrectAnswer-AAnswer-A.PeripheralnerveexcitabilityIsaccsyndrome(neuromyotonia)PeripheralnervehyperexcitabilitySpontaneousandcontinuousmusclefiberactivityofperipheralnerveorigin.Clinicalfeaturesincludecramps,muscletwitching(fasciculationsormyokymia)StiffnessDelayedMusclerelaxation(pseudomyotonia)Spontaneousorevokedcarpalorpedalspasms.
661.Glasgowcomascalemotor4 represents? a)Withdrawalorflexion b)Decorticateposturing c)Decorticateposturing d)Localisepain CorrectAnswer-AAnswer-A.Withdrawalorflexion
662.Apatientafteranaccidentwas unconscious.OnphysicalexaminationtherewasunilateralpupillarydilatationPossiblereasonforthesameis a)Uncalherniation b)Tonsillarherniation c)Cingulateherniation d)Transcalvarialherniation CorrectAnswer-AAnswer-A.UncalherniationTranstentorialherniationisthedisplacementofmedialtemporallobeintothetentorialopeningitisusuallyseenafterextraduralhemorrhage.
663.FirstSymptomsofparkinsonsdiseaseis - a)Posturalinstability b)Rigidity c)Tremors d)Bradykinesia CorrectAnswer-CAnswer-C.TremorsParkinsonismisaprogressivedegenerative,extrapyramidaldisorderofmusclemovement,duetodysfunctioninbasalganglia,comprisingfourcardinalfeaturesBradykinesiaorhypokinesiaMusclerigidityRestingtremor
664.IncreasedICTisshownby a)Miosis b)Systemichypotension c)Tachycardia d)ReductioninGCS CorrectAnswer-DAnswer-D.ReductioninGCSIncreasedICTleadstobradycardiawithHypertension.Uncalherniationofbrainleadstoipsilateralpupillarydilatation.ReductioninGCSduetodamagetoreticularactivatingsystemleadstodevelopmentofcoma.
665.Plaquesjaunesareseenin a)Syphilis b)Headinjury c)Endocarditis d)Atherosclerosis CorrectAnswer-BAnswer-B.HeadinjuryPlaqueJaunesisatermusedtodescribethecharacteristicgrossappearanceofoldtraumaticcontusionsonthesurfaceofbrainfrompreviousheadinjuries.
666.Commonestcauseofcerebrovascular accident a)Infarction b)Infarction c)Embolism d)Aorticdissection CorrectAnswer-AAnswer-A.Infarction 1. Ischemic(85%)(infarction):Causesareembolism(75%ofischemic stroke)andthrombosis(25%ofischemicstroke). 2. Hemorrhagic(15%):Intraparenchymal,subdural,epidural, subarachnoid.
667.Thispatientcametothecasualtywith palpitations.HisECGhasbeenshownbelow.Whatisyourdiagnosis? a)Ventriculartachycardia b)A-Vdissociation c)Supraventriculartachycardia d)Sinustachycardia CorrectAnswer-CAnswer-C.SupraventriculartachycardiaTheoverallrhythmisrapidandrgular.TheR-Rintervalisalmostexactly1.5largeboxesinduration-establishingtherateat180-190beatsperminthisisanECGshowingnarrowcomplextachycardiamostprobablyduetoAVNRT(AvNodalReentrantTachycardia)akasupraventriculartachycardia.[RefHarrison's18th/ep.1888]
668.WhatisReifensteinsyndrome? a)Associatedwithgonadaldysgenesis b)Partialandrogeninsensitivitysyndromeduetoreceptor mutation c)Associatedwithmentalretardation d)5-alphareductasedeficiendyassociatedwithperineo?scrotal hypospadias CorrectAnswer-BAnswer-B.PartialandrogeninsensitivitysyndromeduetoreceptormutationItispartialandrogeninsensitivitysyndromebecauseoflesssevereandrogenreceptormutation.Patientsoftenpresentininfancywith: 1. Perineoscrotalhypospadiasandsmallundescendedtestes.2. Gynecomastiaatthetimeofpuberty.3. Thoseindividualsraisedasmalesrequirehypospadiasrepairin childhoodandbreastreductioninadolescence. 4. Supplementaltestosteronerarelyenhancesandrogenization significantly,asendogenoustestosteroneisalreadyincreased.
669.Followingareabsoluteindicationfor hemo-dialysisexcept a)GIbleeding b)Convulsions c)Pericarditis d)Hyperkalemiaof6.5mEq/L CorrectAnswer-DAnswer-D.Hyperkalemiaof6.5mEq/LImportantindicationsforhemodialysisare: 1. Severemetabolicacidosiswhersodiumbicarbonatecannotbeused (duetoriskoffluidoverload). 2. Severehyperkalemia3. Drugpoisoninglikelithium&aspirin4. Uremia(Uremicpericarditis,encephalopathyorGIbleeding).
670.Insclerodermafeaturesareallexcept: a)DecreaseintoneofLES b)Restrictivecardiomyopathy c)Syndactyly d)Halitosis CorrectAnswer-CAnswer-C.SyndactylySyndactylyisnotassociatedwithscleroderma.Loweresophagealsphinctertoneisdecreasedinscleroderma.Sclerodermacancauserestrictivecardiomyopathy.Halitosis(badsmellinbreath)canoccurinscleroderma.
671.Bestformanagementofrespiratory alkalosis? a)Rebreathinginpaperbag b)IPPV c)Normalsaline d)Acetazolamide CorrectAnswer-AAnswer-A.RebreathinginpaperbagChangingventilatorsettingmaybeusedtopreventortreatrespiratoryalkalosisinpersonswhoarebeingmechanicallyventilated.Personswithhyperventilationsyndromemaybenefitfromreassurance,rebreathingfromapaperbagduringsymptomaticattacks,andattentiontothepsychologicalstress.
672.Adrenalreserveisbesttestedbymeans ofinfusionwith a)Glucocorticoids b)ACTH c)GnRH d)Metyrapone CorrectAnswer-BAnswer-B.ACTHGlucocorticosteroidreservecanbeevaluatedbytheACTHstimulationtestAmoresensitivetestofadrenalreserveisthestandardised24-hourACTHinfusiontest.UndermaximalACTHstimulationthecortisolsecretionincreasestenfold.IfgtucocorucoidcoverageisrequiredduringtheACTHstimulationtest,dexamethasonecanbeusedbecauseitdoesnotinterferewiththelaboratoryvaluesofendogenousglucocorucoids.
673.Grahamsteelmurmurisseenin a)PS b)PR c)TR d)TS CorrectAnswer-BAnswer-B.PRGrahamsteel'smurmurAdiastolicmurmuraudiblealongtheleftsternalborderduetopulmonaryregurgitationinpatientswithpulmonaryhypertension.GrahamsteelmurmurisahighpitcheddecressendomurmurloudestduringinspirationGrahmsteel's-EarlyDM-PR
674.CVPismonitoredinA/E a)Anteriorjugularvein b)Internaljugularvein c)Externaljugularvein d)Inferiorvenacava CorrectAnswer-DAnswer-D.InferiorvenacavaCommonlyusedveincannulationsitesforcentralvenousaccessinclude:JugularveinExternaljugularveinInternaljugularvein(central,posterior,anteriorapproaches)Subclavianvein(supraclavicular,infraclavicular,axillaryapproaches)FemoralveinBasilicvein
675.Centralvenousmonitoringisdoneforall except a)Regulatingthespeedandamountoffluidinfusion b)Administeringthrombolytics c)Decidingtheneedforplasmainfusion d)Decidingtherequirementforbloodtransfusion CorrectAnswer-BAnswer-B.Administeringthrombolytics1)Administrationofnoxiousmedications2)Hemodynamicmonitoring-Bloodtransfusionorplasmatransfusion3)Plasmapheresis,apheresis,hemodialysis,orcontinuousrenalreplacementtherapy4)Poorperipheralvenousaccess
676.Thrombosisismostcommonly associatedwithwhatsiteinCVP a)Internaljugularvein b)Subclavianvein c)Femoralvein d)Externaljugularvein CorrectAnswer-CAnswer-C.FemoralveinAdvantages-RapidaccesswithhighsuccessrateDoesnotinterferewithCPRDoesnotinterferewithintubationNoriskofpneumothoraxTrendelenburgpositionnotnecessaryduringinsertionDisadvantages-DelayedcirculationofdrugsduringCPRPreventspatientmobilizationDifficulttokeepsitesterileDifficultforPAcatheterinsertionIncreasedriskofiliofemoralthrombosis
677.Serumasciticfluidgradientof1.5 (SAAG)withasciticfluidproteinof2.8gm/d1.themostlikelycauseis a)Nephriticsyndrome b)Cardiacfailure c)TB d)Portalhypertension CorrectAnswer-BAnswer-B.CardiacfailureSerumtoascitesalbumingradient>1.5suggestseithercirrhosisorcardiacfailure.Thetotalproteinconcentration>2.5suggestsascitesduetocardiaccauseThetotalproteinconcentrationhelpstodifferentiateuncomplicatedascitesfromcirrhosisfromcardiacascitesbothofwhichhaveaSAAG1.1g/dL.
678.Coronarystealphenomenoncauseddue to a)Arterialdilation b)Coronarymicrovesseldilation c)Epicardialvesseldilation d)Capacitancevesseldilation CorrectAnswer-BAnswer-B.CoronarymicrovesseldilationCoronarystealisthetermgiventobloodbeingstolenfromoneregionofthecoronarytreebyanother.Itisalsocalledcoronarystealsyndrome.Itiscommonlyseenwithpowerfulcoronarydilatordrugslikedipyridamoleorhydralazine.Thesedrugsarepotentarteriolardilatorsanddilatesresistancevesselstoo.Theobstructedbranchhassignificantarteriolardilationevenwhenoxygendemandislowbecauseoftheaccumulationofmetabolitesintheischemictissue.
679.DecreasedCVPisseenin a)Pneumothorax b)PEEP c)Bacterialsepsis d)Heartfailure CorrectAnswer-CAnswer-C.BacterialsepsisDecreasedHypovolemiaSepticshockDeepinhalation(transient)Increasedvenouscompliance
680.Lemierre'ssyndromeis a)Carotidsinusaneurysm b)ThromobophlebitisofIJV c)TraumaticocclusionofIJV d)Anyoftheabove CorrectAnswer-BAnswer-B.ThromobophlebitisofIJVRarethrombophlebitisofthejugularveinswithdistantmetastaticsepsisinthesettingofinitialoropharyngealinfections(pharyngitis,t/-peritonsillarabscess).
681.WideQRSdurationis- a)>0.8sec b)>0.9sec c)>.12sec d)None CorrectAnswer-CAnswer-C.>.12secQRSduration0.08-0.12sec.QTinterval0.40sec.PRinterval0.12-20sec.QRSAxisrange+90to-30?
682.Torsadesdepointesisseeninall except a)Hyponatremia b)Hypocalcemia c)Hypomagnesemia d)Hypokalemia CorrectAnswer-AAnswer-A.HyponatremiaHypokalemiaQHypocalcemiaQHypomagnesemia
683.SinusbradycardiawithMItreatment a)Atropine b)Digoxin c)Calciumchannelblocker d)Propranolol CorrectAnswer-AAnswer-A.AtropineTheSAnoderategenerallyincreasesaftertheadministrationofavagolyticdrug,suchas"atropine".
684.InCOPDwhichistrue a)FEV1/FVC<0.7 b)FEV1/FVC c)RV4 d)TLV1 CorrectAnswer-AAnswer-A.FEV1/FVC<0.7SpirometryfindingsinCOPDincludesreducedFEV1andareducedFEV1/FVCratio.Diffusioncapacityforcarbonmonoxidereflectstheabilityoflungtotransfergasacrossalveolar/capillaryinterface.Diffusioncapacityislowinpatientswithemphysemaandinfiltrativelungdiseases.Itisincreasedinpatientswithpulmonaryhemorrhage,congestiveheartfailureandasthma.
685.Whichofthefollowingismarkedly decreasedinrestrictivelungdisease a)FVC b)FEVI c)FEVI/FVC d)RV CorrectAnswer-AAnswer-A.FVCForcedvitalcapacity(FVC)-Decreased(morethanobstruction)Forcedexpiratoryvolumein1second(FEV,)-DecreasedinproportiontoFVCFEVi/FVC-NearnormalorincreasedForcedmidexpiratoryflowrate-ReducedTotallungcapacity-DecreasedResidualvolume-GenerallydecreasedFunctionalresidualcapacity-Decreased
686.Cepaciasyndromefulminantillnessseen in a)Sarcoidosis b)Cysticfibrosis c)Tuberculosis d)Immotileciliasydrome CorrectAnswer-BAnswer-B.CysticfibrosisCapaceasyndromeisarapidclinicaldeteriorationinpatientswithcysticfibrosisduetonewacquisitionoforchroniccolonizationwithBurkholderiacepaciacomplexandcarriesaveryhighmortality.Inchronicallycolonizedpatientsthedeteriorationisoftentriggeredbyanintercurrentillness.
687.Empyemathoracisismostcommonly causedbywhichorganism a)Streptococcuspneumoniae b)Pseudomonas c)Mycoplasma d)Stapylococcusaureus CorrectAnswer-AAnswer-A.StreptococcuspneumoniaeEmpyemathoraciciscommonlycausedbythosebacteriasthatcausepneumoniassuchasstreptococcuspneumoniaeandstaphlococcusaureus.E.coli,FLinfluenzas,Klebsiellapneumoniae.
688.Mostcommoncauseoflobar consolidation a)Mycoplasma b)Chlamydia c)Streptococcus d)Legionela CorrectAnswer-CAnswer-C.StreptococcusLobarpneumoniastypicallyoccurswithprimarypneumoniascausedbyvirulentagents,mostcommonlypneumococci.
689.ClinicalfeatureofBronchiestasisareall except a)Hemoptysis b)Nightsweats c)Chestpain d)Productivecough CorrectAnswer-BAnswer-B.NightsweatsTheclassicclinicalmanifestationsofbronchiectasisarecoughandthedailyproductionofmucopurulentandtenacioussputumlastingmonthstoyears.complaintsincludedyspnea,wheezinghemoptysis,andpleuriticchestpain.
690.Allofthefollowingarefeaturesof interstitiallungdiseaseexcept a)Exertionaldyspnea b)Earlyproductivecough c)Digitalclubbing d)Coarsecrepitationduringclubbing CorrectAnswer-BAnswer-B.EarlyproductivecoughCoughisusuallynonproductive,aproductivecoughisunusualHemoptysisWheezingChestpainClubbingcanoccurwithinterstitiallungdisease.
691.ChestX-rayshowsB/Llunginfiltrates nextinvestigationis a)Sputumexamination b)CT c)Bronchoscopy d)Antibiotics CorrectAnswer-BAnswer-B.CTPresenceofB/Llunginfiltratessuggestsinterstitiallungdisease.Highresolutioncomputedtomography(HRCT)isobtainedinalmostallpatientswithdiffusepulmonaryparenchymaldisease.
692.Drugofchoiceininterstitiallungdisease is a)Antibiotics b)Steroid c)Bronchodilators d)Aspirin CorrectAnswer-BAnswer-B.SteroidTheusualinitialtreatmentis"oralprednisolone".Forseveredisease,-"Pulsemethylprednisolone"isused.
693.Laststageofacuteasthmais a)Hypocapnia b)Hypercapnia c)Hyperoxia d)Alkalosis CorrectAnswer-BAnswer-B.HypercapniaLatestagesofAsthmaarecharacterizedby"hypercapnia".InasthmapatientswithimpendingrespiratoryfailuretheCO,levelexceeds45mmHg.
694.AGN(acuteglomerulonephritis)is diagnosedby a)Hyalinecast b)WBCcast c)RBCcast d)Granularcast CorrectAnswer-CAnswer-C.RBCcastPresenceofRBCcastsinurineischaracteristicofnephriticsyndromeduetoglomerulonephritis.
695.CystatinClevelsareusedinurologyfor a)DetectingUTI b)EstimatingGFR c)EstimatingdifferencebetwenCRFandARF d)ScreeningofRenaCa CorrectAnswer-BAnswer-B.EstimatingGFRGFRestimationsdeterminedbycreatininebasedequationsarenotprecise,soothersubstancessuchas"cystatinC"arebeingexploredtoestimateGFR.
696.WhichisnotseenindistalRTA a)UrinepH<5.5 b)Hypokalemia c)Hypercalciuria d)Nephrolithiasis CorrectAnswer-AAnswer-A.UrinepH<5.5Normalaniongapmetabolicacidosis/acidemiaHypokalemiaUrinarystoneformation(relatedtoalkalineurine,hypercalciuria,andlowurinarycitrate).Nephrocalcinosis(depositionofcalciuminthesubstanceofthekidney)Bonedemineralisation(causingricketsinchildrenandosteomalaciainadults)
697.Whichofthefollowingisnotafeatureof distalrenaltubularacidosis a)Normalaniongap b)Renalhypercalciuria c)Alkalineurine d)Hyperkalemia CorrectAnswer-AAnswer-A.NormalaniongapNormalaniongapmetabolicacidosis/acidemiaHypokalemiaUrinarystoneformation(relatedtoalkalineurine,hypercalciuria,andlowurinarycitrate).Nephrocalcinosis(depositionofcalciuminthesubstanceofthekidney)Bonedemineralisation(causingricketsinchildrenandosteomalaciainadults)
698.Hyperkalemiaaciduriaisseenin a)TypeIRTA b)TypeIIRTA c)TypeIVRTA d)Sigmoidocolostomy CorrectAnswer-CAnswer-C.TypeIVRTAType4RTAisdueeithertoadeficiencyofAldosteroneortoaresistancetoitseffects.Itwasincludedintheclassificationofrenaltubularacidosesasitisassociatedwithamild(normalaniongap)metabolicacidosis(hyperchloremicacidosis)duetoaphysiologicalreductioninproximaltubularammoniumexcretion(impairedammoniagenesis),whichissecondarytohypoaldosteronism,andresultsinadecreaseinurinebufferingcapacity.
699.Apatientwithdiabetes,hyperkalemia, urinarypH<5.5Causeis a)Uremia b)Pseudohyperaldosteronism c)TypeIRenaltubularacidosis d)TypeIVRTA CorrectAnswer-DAnswer-D.TypeIVRTAHyperkalemiawithurinarypH<5.5alongwithdiabetessuggeststypeIVrenaltubularacidosis.
700.Calciphylaxisisaseverelifethreatening conditionwhichoccursis a)Parathyroidectomy b)Medullarycarcinomathyroid c)Hyperthyroidism d)EndstageRenaldisease CorrectAnswer-DAnswer-D.EndstageRenaldiseaseCalciphylaxisisarareandseriousdisordercharacterizedbysystemicmedialcalcificationofthearteriolesthatleadstoischemiaandsubcutaneousnecrosis.Calciphylaxisisoneofseveraltypesofextra-osseouscalcification(whichalsoincludesintimal,medial,andvalvularcalcification)thatmayoccurinpatientswithend-stagerenaldisease(ESRD).CalciphylaxismostcommonoccursinpatientswithESRDwhoareonhemodialysis.
701.Thehallmarkofhenochschonlein purpurais a)Palpablepurpura b)Abdominalpain c)Arthritis d)Renaldysfunction CorrectAnswer-AAnswer-A.PalpablepurpuraPalpablepurpuraisessentialfordiagnosis.Diagnosisisconfirmedbypresenceofpalpablepurpurawithnormalplateletcountalongwithoneormoreofthefollowing:abdominalpain,arthralgia/arthritisandmesangialdepositionofIgA.
702.A:Gmaintainedin a)Nephriticsyndrome b)Cirrhosis c)Proteinlosingenteropathy d)Multiplemyeloma CorrectAnswer-AAnswer-A.NephriticsyndromeDecreasedalbumin/Globulinratioisseen:MultiplemyelomaormetastaticsdiseaseAIDSRenaldiseaseLiverdisease(cirrhosis)Intestinaldisease(Proteinlosingenteropathy)CachexicpatientCHFA/Gratioisdecreasedinnephroticsyndrome.
703.Whichisnotastroke a)TIA b)Hemiplegia c)SAH d)Intracerebralhemorrhage CorrectAnswer-AAnswer-A.TIAStrokeoccurswhenpoorbloodflowtobrainresultsindeathofbraincells.Strokeisoftwotypes:- 1. Ischemicstroke:Itisthemostcommontypeandoccursdueto thrombosisofcerebralbloodvessels. 2. Hemorrhagicstroke:Itoccursduetohemorrhageeitherinbrain tissue(Intracerebralhemorrhage)orinsubarachnoidspace(subarachnoidhemorrhage).Symptomsofstrokeare:- 1. Suddenonsetofhemiparesis/hemiplagia
704.ThefeaturesofCushingtriadareall except a)Bradycardia b)Hypotension c)Irregularbreathing d)Hypertension CorrectAnswer-DAnswer-D.HypertensionCushing'striadisasignofincreasedintracranialpressure.Itisthetriadof:-Hypertension,BradycardiaandIrregularbreathing
705.Aliceinwonderlandsyndromeoccurs in a)SSPE b)Epilepsy c)Cerebralhemorrhage d)Multiplesclerosis CorrectAnswer-B:CAnswer-(B)Epilepsy&(C)CerebralhemorrhageInfectious:CMV,EBV(IMN),InfluenzaAencephalitis,coxsackieB1encephalitis,scarletfever,typhoidencephalopathy,VZVencephalitis.CNSlesions:-Acutedisseminatedencephalomyelitis,cavernousangioma,cerebralarteriosclerosis,braintumor,cerebralhemorrhage.Paroxysmalneurologicaldisorders:Epilepsy(temporallobeepilepsy),migraine1
706.Watershedinfarctinbrain a)Occursintheproximalportionofmainarteries b)Occursinthecentralportionofmainarteries c)Occursintheterminalportionofmainarteries d)Anyoftheabove CorrectAnswer-CAnswer-C.OccursintheterminalportionofmainarteriesBorderzoneorwatershedinfarctsareischemiclesionthatoccursincharacteristiclocationatthejunctionbetweentwomainarterialterritories.Watershedstrokesarenamedthatwaybecausetheyaffectthewatershedareasofthebrain.Theseareasarethinstripsofbrainwhicharesandwichedinbetweenthefarthestendbranchesoftwoadjacentvascularterritories.
707.InWilsonsdiseasecopperdeposition occursin a)Pons b)Medulla c)Cerebellum d)Basalganglia CorrectAnswer-DAnswer-D.BasalgangliaInbrain,thetoxicinjuryprimarilyaffectsthebasalgangliaparticularlytheputamenwhichdemonstratesatrophyandcavitation.
708.Abdominojugularreflexappearsafter compressingabdomenfor a)5sec b)10sec c)15sec d)30sec CorrectAnswer-CAnswer-C.15secThisisdonebyapplyingfirmpressurewiththepalmofthehandtotherightupperquadrantoftheabdomenfor10-15secondswiththepatientsbreathingquietlywhilethejugularveinisobserved.Apositiveabdominojugularrefluxsignisdefinedbyanincreaseinthejugularvenouspressureofgreaterthan3cm,sustainedforgreaterthan15seconds.
709.Genitourinarycomplicationofulcerative colitis a)Cystitis b)Pyelonephritis c)Urinarycalculi d)Urethritis CorrectAnswer-CAnswer-C.UrinarycalculiUrinarycalculi(oxalatestonesinilealdisease),localextensionofCrohndiseaseinvolvingureterorbladder,amyloidosis,drug-relatednephrotoxicity.
710.Liverbiopsyindicationisallexcept a)Amoebichepatitis b)Wilson'sdisease c)ChronichepatitisBandC d)Autoimmunehepatitis CorrectAnswer-AAnswer-A.AmoebichepatitisGradingandstagingofchronichepatitisBandCDiagnosisof:Hemochromatosis(quantitativeestimationofhepaticiron)Wilson'sdisease(quantitativehepaticcopper)FocalliverlesionsEvaluationof:Cholestaticliverdisease:Primarybiliarycirrhosis,primarysclerosingcholangitisAbnormalliverbiochemicaltestsinapatientwithanegativeorinconclusiveserologicwork-upTreatmentefficacySideeffectsoftreatmentregimens(suchasmethotrexateforrheumatoidarthritis)PostlivertransplantbyprotocolorforevaluationofabnormalliverbiochemicaltestsDonorliverFeverofunknownorigin
711.Useofspironolactoneinlivercirrhosis is a)Decreaseedema b)Improvesliverfunction c)Decreaseafterload d)Decreaseintravascularvolume CorrectAnswer-AAnswer-A.DecreaseedemaTreatmentofascitesinpatientwithcirrhosisisaimedattheunderlyingcauseofthehepaticdiseaseandatthesodiumwaterretentionDiuretictherapytypicallyconsistsoftreatmentwithspironolactoneandfurosemideinaratioof100:40mg/daywithdosestitratedupwardasneeded(upto400mgspironolactoneandfurosemideinaratioof100:40mg/day).
712.Peasoupdiarrheaisseenin- a)Cholera b)Typhoid c)Yersinosis d)Hepatitis CorrectAnswer-BAnswer-B.TyphoidPeaSoupdiarrhoeaischaracteristicofsalmonellainfection.About2weeksafterinfectionwithsalmonellatyphimostpeoplesufferingfromtyphoiddevelopayellowgreenfoulliquidstoolthatresemblespeasoupinappearancei.e.,peasoupstool.
713.Mostsignificantriskfactorfor developmentforgastriccarcinomais a)Panethcellmetplasia b)Pyloricmetaplasia c)Intestinalmetaplasia d)Ciliatedmetaplasia CorrectAnswer-CAnswer-C.IntestinalmetaplasiaA)EnvironmentalfactorsB)Hostfactors:Chronicgastritis(causinghypochlorhydriaorintestinalmetaplasia),partialgastrectomy,gastricadenoma,Barrett'sesophagus,andMenetrierdisease.IntestinalmetaplasiaisthemostsignificantprecursorlesionforGastriccancerC)Geneticfactors
714.Adultmalewithchronicatrophic gastritis,growthonskirrowsmedium&rapidureasetestpositive.Diagnosisis a)Hpylori b)H.influnzae c)Kpneumonia d)V.Cholarae CorrectAnswer-AAnswer-A.HpyloriAllfavorthediagnosisofHpyloriinfection.
715.SeeninSIADH a)Generalizededema b)Ascites c)NormalBP d)Drymucousmembrane CorrectAnswer-CAnswer-C.NormalBPHyponatremia(dilutionalhyponatremiawithNet'<135mmol/L)Decreasedplasmaosmolality(<280mosm/kg)withinappropriatelyincreasedurineosmolality>150mosm).Highurinesodium(over20meq/1)Lowbloodureanitrogen<10mg/LHypouricemia(<4mg/dL)Clinicaleuvolemia
716.Adiabeticpatienthavingsensory involvement,tingling,numbness,ankleswelling,nopain.Diagnosisis a)Charcotsjoint b)Gout c)Rheumatoidarthritis d)Ankylosingspondylitis CorrectAnswer-AAnswer-A.CharcotsjointItisaprogressivedestructivearthritisassociatedwithlossofpainsensation?,proprioception?orboth,inadditionnormalmuscularreflexesthatmodulatejointmovementsaredecreased.Itismostcommonlycausedbydiabetesmellitus.[RefHarrison18`5/ep.2855,2856;17th/ep.2180-2181]
717.PatienthavingCushingsyndromedueto adrenaltumor.Drugtobegiven a)Cortisol b)Betamethasone c)Ketoconazole d)Fludrocortisones CorrectAnswer-CAnswer-C.KetoconazoleTREATMENT-Treatmentofchoice-removalofpituritarycorticotropetumour(transphenoidalapproach)PituitaryirradiationMetyraponeandketoconazoleAdrenocorticalcarcinoma-mitotane
718.Metabolicchangeinseverevomitingis a)Metabolicalkalosis b)Respiratoryalkalosis c)Metabolicacidosis d)Hyperkalemia CorrectAnswer-AAnswer-A.MetabolicalkalosisPersistentgastricvomitingleadstoHyponatremiaHypokalemiaHypochloremiaAlkalosis
719.Treatmentofhypercalcemiaincludesall except a)Steroids b)Bisphosphonates c)Phosphate d)Strontium CorrectAnswer-DAnswer-D.StrontiumTreatmentofacutehypercalcemiaHydrationwithsalineForceddiuresis:Salineplusloopdiuretics(furosemide)Bisphosphonates(pamidronate,zoledronate)CalcitoninSpecialtherapies:Phosphate(oral),glucocorticoids,dialysis
720.Myelodysplasticsyndromeiscommonin whichagegroup a)2-10yrs b)15-20yrs c)25-40yrs d)>50yrs CorrectAnswer-DAnswer-D.>50yrsMyelodysplasticsyndromeoccursmostcommonlyinolderadultswithmedianageatdiagnosisinmostcasesof65yearsandamalepreponderance.Onsetofthediseaseearlierthanage50isunusual.
721.Thebestdrugtolowerprolactinlevelin afemalewithinfertilityis a)Bromocriptine b)GnRH c)Testosterone d)Corticosteroid CorrectAnswer-AAnswer-A.BromocriptineThetreatmentofchoiceforprolactinomais"bromocriptine".Bromocriptineisadopamineagonistwhichinhibitsthesecretionandsynthesisofprolactin.
722.Whichofthefollowingisnotcommonly seeninPolycythemiaVera a)Thrombosis b)Hyperuricemia c)Proneforacuteleukemia d)Spontaneoussevereinfection CorrectAnswer-DAnswer-D.SpontaneoussevereinfectionClinicalfeatures-Hyperviscosity,hypovolaemia,hypermetabolism,erythocytosis,thrombosis.Headache,vertigo,tinnitus,syncopeorevencoma,transientvisuallossSplenomegaly,haemtemesisandmelena,bleeding.Pruritis&pepticulceration(basophiliawithhistaminerelease)Hyperuricaemia-uratestonesandgout
723.Evanssyndromeis a)Anemiaandthrombocytopenia b)Pancytopenia c)Lymphopeniaandanemia d)Thrombocytosisandlymphocytosis CorrectAnswer-AAnswer-A.AnemiaandthrombocytopeniaEvanssyndrome(ES)referstothecombinationofCoombs-positivewarmautoimmunehemolyticanemia(AIHA)andimmunethrombocytopenia(ITP),although,lesscommonly,somepatientswillalsohaveautoimmuneneutropenia(15percentinoneseries).
724.Allaremajorcomplicationsofmassive transfusionexcept a)Hypokalemia b)Hypothermia c)Hypomagnesemia d)Hypocalcemia CorrectAnswer-AAnswer-A.HypokalemiaComplicationsofMassivetransfusion:-CoagulopathyCitratetoxicityHypothermiaMetabolicalkaptosisHyperkalemiaAcuterespiratorydistresssyndromeCoagulationfactordepletion
725.RegardingMSUDwhichisnottrue a)Deficiencyofbranchedchainaminoacidenzymes b)Hyperaminoaciduria c)Asymptomatic d)FeC13turnsnavyblue CorrectAnswer-CAnswer-C.AsymptomaticItisaninherited(autosomalrecessive)disorderofbranchedchainaminoacidi.e.-Valine,LeucineandIsoleucine.Maplesyrupurinedisease(MSUD)isd/tdefectinenzyme-a-ketoaciddehydrogenase.DiagnosisTheketoacidsmaybedetectedbyaddingafewdrops2-4dinitrophenylhydrazine(DNPH)reagentwhichproducesayellowprecipitateinpositivetest.Ferricchloridegivesnavybluecolourwiththepatientsurine.
726.Resultofliquoriceingestion a)Hyperkalemicalkalosis b)Hypokalemicalkalosis c)Hypokalemicacidosis d)Hypermalemicacidosis CorrectAnswer-BAnswer-B.HypokalemicalkalosisLiquorice(Licorice)ingestioncausesapparentmineralocorticoidexcess(pseudohyperaldosteronism)duetoinhibitionofenzyme11-13-HSD.Thiscausesmetabolicalkalosis,hypokalemiaandvolumeoverload.
727.Mostcommoncarcinomaassociated withRA a)DiffuselargeBcelllymphoma b)Largegranularlymphocyticleukemia c)Chroniclymphocyticleukemia d)Noneoftheabove CorrectAnswer-BAnswer-B.LargegranularlymphocyticleukemiaLymphogranularproliferationmaybepresentinpatientswithRheumatoidarthritisandinminorityitwillproceedto"largegranularlymphocyticleukemia"inRheumatoidarthritis
728.Systemicsclerosisshowsallexcept a)Acroosteolysis b)Tufting c)Calcinosiscutis d)Digitalulcers CorrectAnswer-BAnswer-B.TuftingSkininvolvementinsystemicsclerosisPruritusintheearlystagesEdemaintheearlystagesSclerodactylyDigitalulcersPittingatthefingertipsTelangiectasiaCalcinosiscutis
729.Tetanyisseenin a)Hypocalcemia b)Hypercalcemia c)Hypoparathyroidism d)Hyperparathyroidism CorrectAnswer-AAnswe-A.HypocalcemiaAcutehypocalcemiadirectlyincreasesperipheralneuromuscularirritability.Tetanyconsistsofrepetitivehighfrequencydischargesafterasinglestimulus.Hyperexcitabilityofperipheralneuronsisprobablythemostimportantpathophysiologiceffectofhypocalcemia.
730.Ininflammatorymyopathy,whichgroup ofmusclesisnotaffected a)Ocular b)Facial c)Proximalmusclesoflimb d)Distalmusclesoflimb CorrectAnswer-CAnswer-C.ProximalmusclesoflimbInflammatorymyopathiesrepresentthelargestgroupofacquiredandpotentiallytreatablecauseofskeletalmuscleweakness.Theyareclassifiedintothreemajorgroups: 1. Polymyositis2. Dermatomyositis3. Inclusionbodymyositis Thesedisorderspresentasprogressiveoftensymmetricmuscleweakness.Theproximalmusclesareinvolvedpredominantly,firstofthelowerlimborgirdlefollowedbyproximalmusclesofupperlimb.Occularmusclesarespared.Distalmusclesofthelimbareinvolvedrarely.
731.SignsofBartter'ssyndrome- a)Hypokalemia b)Hypernatremia c)Hyperkalemia d)Acidosis CorrectAnswer-AAnswer-A.HypokalemiaInheritedformsofhypochloremicmetabolicalkalosisandhypokalemiawithouthypertensionareduetogeneticmutationsofvariousiontransportersandchannelsofthethickascendinglimbofHenle'sloop(TAL)anddistalconvolutedtubule(DCT).[Ref:HarrisonsPrinciplesofInternalMedicine,18thEdition,Pages2360,61]
732.DescriptionofWaterhouseFriedrich syndrome a)Adrenalhemorrhagepostmalignancy b)Congenitaladrenalsdeficiency c)Adrenalhemorrhageaftermeningococcalinfection d)Adrenalhemorrhageaftercorticosteroidwithdrawal CorrectAnswer-CAnswer-C.AdrenalhemorrhageaftermeningococcalinfectionWaterhouseFriderichsensyndromeormassiveadrenalhemorrhageisanuncommonusuallyfatalconsequenceofoverwhellingsepsis.Itismostfrequentlyseenasaresultof"meningococcalinfection".
733.Intotalparenteralnutrition,noneedto measuredaily a)Electrolyte b)Fluidintakeandoutput c)LFTalbumin d)Magnesium CorrectAnswer-CAnswer-C.LFTalbuminMonitoringofparenteralnutritiondaily:-MeasurementoffluidintakeandoutputSerumelectrolyteGlucoseCalciumMagnesiumPhosphateMonitorthefollowingparametersweekly:-AminotransferaseBilirubinTriglycerides
734.Drugofchoiceforkala-azaris a)Antimonials b)AmphotericinB c)Quinine d)Parmomycin CorrectAnswer-AAnswer-A.AntimonialsFirstline:Pentavalentantimony(Sodiumstibogluconateisthedrugofchoice),andamphotericin-B.Alternatives:Paromomycin,pentamidine,miltefosine,sitamoquine
735.DMDnotseenis a)Musclepseudohypertrophy b)Weakness c)Tenderness d)Cardiomyopathy CorrectAnswer-CAnswer-C.TendernessDMD,alsocalledpeudohypertrophicmuculardystrophy,isthemostcommonhereditaryneuromusculardystrophy.ItisanX-linkedrecessivedisorder.Itiscausedbyamutationingeneresponsibleforproducingdystrophin(asarcolemmalprotein).Thereisprogressivemuscleweaknessaffectingproximalmusclesoflimbs.Childwalksclumsily,hasdifficultyinclimbingstairsandthegaitiswaddling(Trendelenburg).Scoliosis,epilepsyandmildmentalretardation
736.Mostsensitivetestformyaesthenia gravis a)Edrophoniumtest b)SinglefibreEMG c)MultiplefibreEMG d)Repetitivenervestimulation CorrectAnswer-BAnswer-B.SinglefibreEMGDiagnosis-Anti-AchRradioimmunoassayElectrophysiologicaltestingSingle-fibreelectromyography(mostsensitive)
737.Dyslipidemiaassociatedwithalcohol consumption a)DecreasedHDL b)IncreasedHDL c)Decreasedtriglycerase d)Decreasedlipoprotein CorrectAnswer-BAnswer-B.IncreasedHDLSeremHDLcholesterolincreasesby4.0mg/dl(.1mmol/L)SerumapolipoproteinA.1increaseby8.8mg/dlSerumTriglycerideincreasesby5-4mgmg/dl
738.Migraineisdueto a)Dilatationofcranialarteries b)Constrictionofcranialarteries c)Corticalspreadingdepression d)Meningialinflammation CorrectAnswer-CAnswer-C.CorticalspreadingdepressionCorticalspreadingdepressionisaselfpropagatingwaveofneuronalandglialdepolarizationthatspreadsacrossthecerebralcortex.Theactivationoftrigeminalafferentsbycorticalspreadingdepressioninturncausesinflammatorychangesinthepain-sensitivemeningesthatgeneratetheheadacheofmigrainethroughcentralandperipheralreflexmechanisms.
739.-30?to-60?leftaxisdeviationisseenin a)Leftventricularhypertrophy b)Rightventricularhypertrophy c)Aorticstenosis d)Leftatrialenlargement CorrectAnswer-AAnswer-A.LeftventricularhypertrophyNormally,QRSaxisrangesfrom-30?to90?CAnaxismorenegativethan-30?isreferredtoasleftaxisdeviationandanaxismorepositivethan+100?iscalledrightaxisdeviationLeftaxisdeviationAxismorenegativethan-30?AssociatedwithLeftventricularhypertrophyLeftanteriorfascicularblockInferiorM.I.
740.Whichisincreasedinplasmaofchronic heartdiseasepts a)BNP b)Endothelin1 c)Cortisol d)None CorrectAnswer-AAnswer-A.BNPTheplasmaconcentrationsofbothhormonesareincreasedinpatientswithasymptomaticandsymptomaticleftventriculardysfunction,permittingtheiruseindiagnosis.BNPlevelsaresimpleandobjectivemeasuresofcardiacfunction.Thesemeasurescanbeusedtodiagnooseheartfailureincludingdiastolicfunction.
741.Inasthmadiagnosisisby a)FEVi b)Measurementoftidalvolume c)Endexpiratoryflowrate d)Totallungcapacity CorrectAnswer-AAnswer-A.FEViAsthmaisclassifiedaccordingtothefrequencyofsymptoms,forcedexpiratoryvolumeinonesecond(FEV1),andpeakexpiratoryflowrate.Spirometryisrecommendedtoaidindiagnosisandmanagement.Itisthesinglebesttestforasthma.IftheFEV1measuredbythistechniqueimprovesmorethan12%andincreasesbyatleast200millilitersfollowingadministrationofabronchodilatorsuchassalbutamol,thisissupportiveofthediagnosis.
742.Apersonhasasthmaattacksmorethan onceduringdayandonceduringnight a)Mildintermittentasthma b)Mildpersistentasthma c)Moderateasthma d)Severeasthma CorrectAnswer-DAnswer-D.SevereasthmaSevereasthmaSymptoms-ThroughoutdayNightawakenings-DailyShort-actingB2-agonistuseforsymptomcontrol-SeveraltimesperdayInterferencewithnormalactivity-ExtremelimitationFEV1-<60%FEV1/FVC=>5%reduced
743.Achildpresentswithrecurrent pulmonaryinfectionsforhemoptysisduetoassociatedbronchiectasiaandonimagingcharacterizedbyunilaterallossoflungvolumewithhyperlucencyonchestradiograph,reductioninvascularityonCTscanofthechest.Theabdominalorgansarenormallyplace(d)mostlilkelycauseis a)Kartagener'ssyndrome b)Swyer-James-MacLeodsyndrome c)Mendelson'ssyndrome d)Immotileciliasyndrome CorrectAnswer-BAnswer-B.Swyer-James-MacLeodsyndromeSwyer-James-MacLeodsyndromeorunilateralherlucentlunndromeisarareentityassociatedwithpostinfectiousbronchiolitisobliteransoccurringinchildhood.Itischaracterizedbyhypoplasiaand/oragenesisofthepulmonaryarteriesresultinginpulmonaryparenchymahypoperfusion,showingacharacteristicradiologicalpattern,suchastranslucentorhyperlucentunilaterallung.
744.Fibrosisofupperlobeisdueto a)Pneumonia b)ABPA c)BronchiectasisinCOPD d)Rheumatoidarthritis CorrectAnswer-BAnswer-B.ABPASilicosis(ProgressivemassivefibrosisSarcoidosisCoalworkerpneumoconiosisAnkylosingspondylitisRadiationAllergicbronchopulmonaryaspergillosisTuberculosisExtrinsicallergicalveolitis
745.WhatisnotseeninCRF a)Hypercalcemia b)Hyperkalemia c)Hyperphosphatemia d)Hypocalcemia CorrectAnswer-AAnswer-A.HypercalcemiaAbnormalitiesseeninCRFAcidosisHyperkalemiaAnemiaHypernatremiaHyperphosphatemiaHyperlipidemiaHyponatremiaHypocalcemiaUremia
746.Maximumurinarycatheterinduced infection a)E.coli b)Pseudomonas c)Staphylococcusepidermidis d)Proteus CorrectAnswer-AAnswer-A.E.coliCatheterassociatedurinarytractinfectionsrepresentthemostcommontypeofnosocomialinfection.MostcommonorganismcausingcatheterassociatedurinarytractinfectionsareE.coli.
747.Mostcommonsymptomofgenitourinary TB a)Renalcolic b)Increasedfrequency c)Hematuria d)Painfulmicturition CorrectAnswer-BAnswer-B.IncreasedfrequencyTheclinicalmanifestationsarevariable.Theonsetofclinicallyevidentgenitourinarytuberculosisisusuallyinsidious.Themostcommonsymptomsare:-Dysuria,increasedfrequencyofurinationandgrosshematuria
748.Anominalaphasiaisduetodefectin a)Leftinferiorfrontal b)Parietal c)Temporaloccipital d)Cerebellum CorrectAnswer-CAnswer-C.TemporaloccipitalAnomiacanbegeneticorcausedbydamagetovariouspartsoftheparietallobeorthetemporallobeofthebrainbyanaccidentorstroke,orabraintumor.
749.Unabletoconsolidatelongtermmemory. Whichlobeofthebrainisinvolved a)Frontal b)Parietal c)Temporal d)Occipital CorrectAnswer-CAnswer-C.ParietalMedialtemporallobeistheareaofbrainresponsibleforconsolidation,i.e.processingofshorttermmemoryintolongtermmemory.
750.Gerstmannssyndromeallexcept a)Acalculia b)Agraphia c)Aphasia d)Agnosia CorrectAnswer-CAnswer-C.AphasiaGerstmannsyndromeconsistsof: 1. Agraphia2. Acalculia3. Fingeragnosia4. Leftrightdisorientation
751.Pontinehemorrhagemostcommon causeis a)Hypertension b)Diabetes c)Trauma d)Aneurysmalrupture CorrectAnswer-AAnswer-A.HypertensionMostcommoncauseofpontinehemorrhageishypertension.
752.Dailytemperaturevariationinremmitent feveris a)<0.5C b)>1?C c)<1.0C d)>2C CorrectAnswer-BAnswer-B.>1?CContinuousfeverTemperatureremainsabovenormalthroughoutthedayanddoesnotfluctuatemorethan1?Cin24hours.IntermittentfeverThetemperatureelevationispresentonlyforacertainperiod,laterbacktonormale.g.malaria,kalaazarsepticaemia.
753.Hyperthermia a)Temperature>41.5 b)>40withautonomicdysfunctuion c)Nochangeinhypothalamicthermostat d)Failureofthermoregulation CorrectAnswer-DANswer-D.FailureofthermoregulationHyperthermiaisdefinedaselevationofcorebodytemperatureabovethenormaldiurnalrangeof36to37.5?Cduetofailureofthermoregulationatthelevelofhypothalamus.Hyperthermiaisnotsynonymouswiththemorecommonsignoffever,whichisinducedbycytokineactivationduringinflammation,andregulatedatthelevelofthehypothalamus.
754.Myastheniagravisisassociatedwith a)AntibodiesagainstAchreceptors b)Decreasedmyosin c)AbsenttroponinC d)Increasedmyoneuraljunctiontransmission CorrectAnswer-AAnswer-A.AntibodiesagainstAchreceptorsThecharacteristicpathologicalfeatureofmyastheniagravisispresenceofantibodiesagainstacetylcholinereceptors.Theseautoantibodiesagainsttheacetylcholinereceptorsleadtolossoffunctionalacetylcholinereceptorsattheneuromuscularjunction.
755.EatonLambertsyndromeisseenwith- a)Cabreast b)Caliver c)Calung d)CNStumors CorrectAnswer-CAnswer-C.CalungParaneoplasticsyndromeAssociatedwithSmallcellcarcinomalungCertainautoimmunediseases
756.Lesionofglobuspalliduscauses a)Chorea b)Athetosis c)Hemibalismus d)Flexiondystonia CorrectAnswer-BAnswer-B.AthetosisAthetosis-Globuspallidus(mainly)andSubthalamicnucleus.Lesionattheglobuspallidusandstriatumcauseathetosis,whichischaracterizedbycontinuous,slowwrithingmovements.Chorea:rapid,involuntarydancingmovementsMostcommonly,thelesionisinthestriatum.Ballism:involuntaryflailing,intenseandviolentmovements.Themovementsareoflargeamplitudeandpredominantlyinvolvesproximalmuscles.Thelesioninthesubthalamicnucleus.Athetosis:continuous,slowwrithingmovementsLesionatglobuspallidusandstriatum.
757.MostcommontumorassociatedwithNF 1 a)Opticglioma b)2ndnerveschwannoma c)Astrocytoma d)Bilateralacousticneuroma CorrectAnswer-AAnswer-A.Opticglioma"Opticpathwaygliomas"arethepredominanttypeofneoplasmassociatedwithneurofibromatosistypeIbutothercentralnervoussystemandnonCNStumourscanoccur.
758.CSFpictureinviralmeningitis a)Lymphocyticpleocytosis b)WBCcount>1500/mL c)Sugarisreduced d)Proteinisdecreased CorrectAnswer-AAnswer-A.Lymphocyticpleocytosis Normal Bacterial Viral Opening 7-18 >30 NormalorMildlyIncreased Pressure Clear, Appearance Turbid Clear Colorless Protein 23-38 Increased NormaltoDecreased (mg/dl) 2/3rds Glucose Serum Decreased Normal (mmol/L) Glucose Positive160-90%of GramStain Negative Negative Cases) GlucoseCSF:Serum 0.6 <0.4 >0.6 Ratio WhiteCell cells PredominatelyNeutrophils PredominatelyLymphocytes Count
759.InherpesencephalitisA/E a)Focalsymptomscommon b)Temporallobeinvolved c)MRIisdiagnostic d)EEGnotdiagnostic CorrectAnswer-DAnswer-D.EEGnotdiagnosticDiagnosisMostsensitiveandspecificinvestigationforHSV-1encephaliticisMRIIncontrast,cranialCTscanshaveonly50%sensitivityandthattooearlyinthedisease.EEGfindingsinHSV-1encephalitis
760.Whichofthefollowingprovide protectionagainstmalariaallexcept a)Duffybloodgroup b)Sicklecellanemia c)Thalassemia d)PNH CorrectAnswer-DAnswer-D.PNHRedcellsurfaceantigenthatofferprotectionagainstmalariaDuffybloodgroupsystemABO(H)bloodgroupsystemGlycophorinsGerbichantigenComplementreceptortypeIKnopsbloodgroupAbnormalitiesoftheredcellcytoskeletonwhichmayofferprotectionincludeSouth-eastasiaovalocytosisHereditaryelliptocytosisHereditaryspherocytosisSicklecellHbA/S
761.Richner-Hanhartsyndromeis a)Autosomaldominant b)Occularandcutaneousfeatures c)Associatedwithabnormalityinlipidmetabolism d)Normalmentalfunction CorrectAnswer-BAnswer-B.OccularandcutaneousfeaturesRareautosomalrecessivedisorderoftyrosinemetabolismduetodeficiencyofthecytosolicfractionofhepatictyrosineaminotransferase.Occursduetodeficiencyof"Tyrosineaminotransferase".Mentalretardation.Thepatienthashighurinarytyrosinelevelsalongwithhighplasmatyrosinelevels.Thesepatientsrespondsdramaticallytodietaryrestrictionoftheaminoacidsphenylalanineandtyrosine
762.Fabry'sdiseaseaffects a)ER b)Lysosome c)Mitochondria d)Cellmembrane CorrectAnswer-BAnswer-B.LysosomeFabrydisease,alsocalledAnderson-Fabrydisease,isthesecondmostprevalentlysosomalstoragedisorderafterGaucherdisease.ItisanX-linkedinbornerroroftheglycosphingolipidmetabolicpathway.Thisresultsinaccumulationofglobotriaosylceramide(Gb3)withinlysosomesinawidevarietyofcells,therebyleadingtotheproteanmanifestationsofthedisease.
763.Calciumhomeostasisdisturbanceis seenin a)Malignanthyperthermia b)DMD c)Tibialmusculardystrophy d)Limbgirdlemuscledystrophy CorrectAnswer-AAnswer-A.MalignanthyperthermiaMalignanthyperthermiaisapharmacogeneticconditioncausedduetomutationofthe"Ryanodinereceptorgene".Ryanodinereceptorgenecontrolsthelevelof"cytosoliccalcium"andthereforeskeletalmusclecontraction.
764.Tetanyisseenin a)Respiratoryalkalosis b)Respiratoryacidosis c)Metabolicacidosis d)Hyperkalemia CorrectAnswer-AAnswer-A.RespiratoryalkalosisInalkalosistetanyoccursbecauseofthedecreasedconcentrationoffreeionizedcalcium.Itisthefreeionizedcalciumthatisphysiologicallymoreimportant.[RefHarrison18th/ep.362,360;Guyton10thiep.342]
765.Hypomagnesemiaisnotseenin a)Barterssyndrome b)Diabetesmellitus c)Diarrhea d)Gitelmansyndrome CorrectAnswer-AAnswer-A.BarterssyndromeHypomagnesemiamayoccurinBarter'ssyndromebutusuallytheserummagnesiumlevelisnormalinBarterssyndrome.
766.PrimarySjogrenssyndrometrueis a)Canbeseeninchildren b)IncreasedcomplementC4leadstothymoma c)Associatedwithrheumatoidarthritis d)Salivaryglandenlargement CorrectAnswer-DAnswer-D.SalivaryglandenlargementSjogrensyndromeisachronicdiseasecharacterizedbydryeyes(keratoconjuctivitissicca)anddrymouth(xerostomia)resultingfromimmunologicalmediateddestructionofthelacrimalandsalivaryglands.Itoccursintwoforms 1. Primaryform(SICCASYNDROME)Occursasanisolated disorder. 2. SecondryformWhenitoccursinassociationwithother autoimmunedisorder.Itismorecommon.AutoimmunediseasesassociatedwithsjogrensyndromeSymptomsresultfrominflammatorydestructionoftheexocrineglands. 1. Keratoconjunctivitis2. Xerostomia3. Parotidglandenlargement
767.ProphylaxisforHIVisoptimallyeffective ifstartedupto.....hrsofexposure a)1 b)2 c)4 d)12 CorrectAnswer-AAnswer-A.1goalistostartwithinonetotwohoursorearlierafterexposureoftenusingastarterpackwithappropriatedrugsasimmediatelyavailable.Themediantimetoinitiationofpostexposureprophylaxisis1.8hrs.Thecentrefordiseasecontrolandprevention(CDC)recommendationsaretoofferprophylaxisupto24-36hrsafterexposure,forlongertimelapses,therecommendationsistoseekadvicefromanexpert
768.Oddpair a)Erythemamarginatum-rheumaticfever b)Erythemagyrensripens-malignancy c)Necroticacralerythema-HCV d)Erythemachronicummigransmalignancy CorrectAnswer-DAnswer-D.Erythemachronicummigransmalignancy"Erythemagyratumrepens"isarareandcharacteristicrashstronglyassociatedwithmalignancy.ErythemachromicumnigransErgthemamarginatumItisacharacteristiccutaneousmanifestationofrheumaticfever.
769.Yellow-nailsyndromeconsistsof a)Kneejointeffusionandlymphedema,associatedwith discolorednails b)Pericardialandlymphedema,associatedwithdiscolorednails c)Peritonealeffusionandlymphedema,associatedwith discolorednails d)Pleuraleffusionandlymphedema,associatedwithdiscolored nails CorrectAnswer-DAnswer-D.Pleuraleffusionandlymphedema,associatedwithdiscolorednailsYellownailsyndromeisararedisorderofthenail,whichisusuallyaccompaniedbyLymphoedemaItmayalsobeassociatedwith:RecurrentpleuraleffusionsBronchiectasis
770.Nottobegiveninmalignantmalariais- a)Quinolone b)Quinine c)Doxycycline d)Artesunate CorrectAnswer-AAnswer-A.QuinoloneArtemisininderivative:ArtesunateQuinineorQuinidinePlusoneofthefollowing:Doxycycline,TetracyclineandClindamycin
771.Muir?Torresyndromeshows a)Sebaceouskeratomas b)Lischnodules c)Intestinalpolyp d)Hyperelasticjoints CorrectAnswer-AAnswer-A.SebaceouskeratomasMuir-TorresyndromeisanautosomalskinconditionofgeneticorigincharacterizedbytumorsofthesebaceousglandorkeratoacanthomathatareassociatedwithvisceralmalignantdiseaseCutaneouscharacteristicAdenomaEpitheliomaCarcinomaMultiplekeratoacanthomas
772.Firstsymptomofleprosy a)Decreasedvibration&positionsense b)Decreasedpain c)Decreasedtemperature d)Decreasedlighttouch CorrectAnswer-BAnswer-B.DecreasedpainIn90%ofpatientsthefirstsignofthediseaseisafeelingofnumberswhichmaypreceedesskinlesionsbyanumberofyears.Temperatureisthefirstsensationlostfollowedbylighttourchpainandthendeeppressure.[RefHarrison18thiep.1363-1364]
773.Migraineisdueto a)Dilatationofcranialarteries b)Constrictionofcranialarteries c)Corticalspreadingdepression d)Meningialinflammation CorrectAnswer-CAnswer-C.CorticalspreadingdepressionCorticalspreadingdepressionisaselfpropagatingwaveofneuronalandglialdepolarizationthatspreadsacrossthecerebralcortex.Theactivationoftrigeminalafferentsbycorticalspreadingdepressioninturncausesinflammatorychangesinthepain-sensitivemeningesthatgeneratetheheadacheofmigrainethroughcentralandperipheralreflexmechanisms.
774.Whichofthefollowingisendogenous pyrogen a)PGE2 b)PGD2 c)PGF2alpha d)PGI2 CorrectAnswer-AAnswer:-A.PGE2PyrogenPyrogensaresubstancesthatcausefever.PyrogensmaybeexogenousorendogenousExogenousBacterialtoxinsEndogenousIL-1,TNF-a,IL-6,Interferons,CiliaryneurotrophicfactorThesepyrogensincreasethelevelofPGE,inthehypothalamusthatelevatesthethermoregulatorysetpointandcausesfever.
775.InBarttersyndromedefectisseenin: a)DefectinPCT b)DefectinDCT c)Defectinthickascendinglimbofloopofhenle d)None CorrectAnswer-CAnswer:C-DefectinthickascendinglimbofloopofhenleAutosomalrecessivedisorder.GeneticdefectinthethickascendinglimboftheloopofhenleDefectsinNa-K-2C/coLtransporter,KorClchannelsresultinlackofconcentratingability
776.Notseeninallergicpulmonary aspergillosisis a)HighIgElevel b)Recurrentpneumonia c)Occurrenceinpatientswitholdcavitarylesions d)Pleuraleffusion CorrectAnswer-BAnswer:B-RecurrentpneumoniaAllergicbronchopulmonaryaspergillosisisapulmonaryhypersensitivitydisordercausedbyallergytofungalantigensthatcolonizethetracheobronchialtree.Itmostcommonlyoccursinatopicasthmaticindividualsinresponsetoantigenofaspergillusspecies.MaindiagnosticcriteriaClinicalhistoryofAsthmaQPulmonaryinfiltrates(transient/fleetingorfixed)QPeripheraleosinophilia(>1000/,uL)QImmediateskinreactivitytoAspergillusantigen(whealandflareresponse)SerumprecipitinstoA.fumigatusElevatedserumIgElevels(>100Ong/ml)Central/proximalbronchiectasisSecondarydiagnosticcriteriaHistoryofbrownishplugsinsputumIdentification/cultureofA.,fumigatusfromsputumLateskinreactivitytoaspergillusantigen-CMDTElevatedIgE(andIgG)classantibodiesspecificforA.fumigatus-Harrisons
NoteElevatedIgE(andIgG)classantibodiesspecificforA.fumigatushasbeenmentionedasasecondarydiagnosticcriteriainHarrison'stextbookwhileFishman'stextbookincludesthisasamain/majordiagnosticcriteria.
777.PseudoPPulmonale a)Hypokalemia b)Hyponatremia c)Hypocalcemia d)Hypercalcemia CorrectAnswer-AAnswer:A.HypokalemiaInsomecasestherecanbeanotched(orbifid)p-waveknownas"pmitrale",indicativeofleftatrialhypertrophywhichmaybecausedbymitralstenosis.Theremaybetallpeakedp-waves.Thisiscalled"p-pulmonale"andisindicativeofrightatrialhypertrophyoftensecondarytotricuspidstenosisorpulmonaryhypertension.Asimilarpicturecanbeseeninhypokalemia(knownas"pseudop-pulmonale").
778.AutomaticImplantableCardioverter Defibrillator,(AICD)implantationisdoneforwhichoffollowingconditions: a)Brugadasyndrome b)Ventricularfibrillation c)AcutecoronarysyndromewithlowEF d)Alloftheabove CorrectAnswer-DAnswer:D.AlloftheaboveAnAutomaticImplantableCardioverterDefibrillator,(AICD),isasmallelectronicdevicethatisimplantedintoyourchesttomonitorandcorrectanabnormalheartrhythm,orarrhythmia.Thesedevicesareusedtotreatseriousandlife-threateningarrhythmiasandarethemosteffectivewayofdoingso.Brugadasyndromeisaconditionthatcausesadisruptionoftheheart'snormalrhythm.Ventricularfibrillationisaheartrhythmproblemthatoccurswhentheheartbeatswithrapid,erraticelectricalimpulse.Acutecoronarysyndromeisatermusedtodescribearangeofconditionsassociatedwithsudden,reducedbloodflowtotheheart.
779.Whatisthelineoftreatmentfor intractableSydenhamchorea? a)Haloperidol b)Valproate c)Warfarin d)Risperidone CorrectAnswer-BAnswer:B.ValproateSydenham'schorea(SC)/Choreaminor/Rheumaticchorea(RC)/St.Vitus'sDanceMajordiagnosticcriteriaforrheumaticdiseaseMostcommonacquiredchoreaduringchildhoodCharacterizedbyrapid,uncoordinatedjerkingmovementsprimarilyaffectingtheface,handsandfeetBenzodiazepinesfacilitatetheactionofGABAandvalproateenhancestheactiononGABA,hencetheseagentsareusedtotreatchorea
780.Neurofibromatosis1criteriaexcept a)Braintumor b)Acousticneuromas c)Pseudoarthrosis d)Cafe-au-laitspots CorrectAnswer-BAnswer:B-AcousticneuromasClinicaldiagnosisrequirespresenceofatleast2of7criteriatoconfirmpresenceofneurofibromatosis,type1.Despitesuspicion,mostsignsdonotappearuntillatechildhood/adolescentThe7clinicalcriteriausedtodiagnoseNF1areasfollows:Sixormorecaf?-au-laitspots/hyperpigmentedmaculesgreaterthanorequalto5mmindiameterinprepubertalchildren&15mmpostpubertalAxillaryoringuinalfreckles(>2)TwoormoretypicalneurofibromasoroneplexiformneurofibromaOpticnervegliomaTwoormoreirishamartomas(Lischnodules)(oftenidentifiedonlythroughslit-lampexamination)Sphenoiddysplasiaortypicallong-boneabnormalitiessuchaspseudarthrosisStrongfamilyhistory(1stdegreerelativewithNF1)
781.Mostcommonsiteofchronicgastric ulcer a)Pyloricantrum b)Upperpartoflessercurvature c)Lowerpartoflessercurvature d)Segmentoflargeintestine CorrectAnswer-AAnswer:A-PyloricantrumAmajorcausativefactor(60%ofgastric&upto50?75%ofduodenalulcers)ischronicinflammationduetoHelicobacterpylorithatcolonizestheantralmucosa.
782.ApproximatetimeintervalbetweenHIV infection&manifestationofAIDSis? a)7.5yr b)10yr c)12yr d)11yr CorrectAnswer-BAnswer:B-10yearsTheapproximatetimeframerequiredforincubationisusually10years.mediantimefrominfectiontothedevelopmentofAIDSinadultsisabout9years.AsmallproportionofuntreatedHIV-infectedpeoplearelong-termnon-progressors,withCD4countsinthereferencerangefor10yearsormore.Somelong-termnon-progressorshaveundetectableviralloadsandareknownas`elitecontrollers'.
783.Heller'smyotomyisdonefor a)Zenker'sdiverticulum b)Achalasiacardia c)Bunions d)Kneearthroscopy CorrectAnswer-BAnswer:B-AchalasiacardiaAchalasia,adisorderofesophaguscharacterizedbyprogressiveinabilitytoswallowsolids&liquids.Causesincludeweakenedesophagealmuscles&issueswithloweresophagealsphincterrelaxationHellerMyotomy,surgicalprocedureofferslongtermsymptomaticrelieftothesepatients.Itinvolvesweakeningofmusclesatgastroesophagealjunction,allowingthevalvebetweenoesophagus&stomachtoremainopen.
784.Myocardialstunningpatternnot matchingtheECG.Whatisthediagnosis. a)Takotsubocardiomyopathy b)Restrictivecardiomyopathy c)Brigade'scardiomyopathy d)Pericardialsomething CorrectAnswer-AAnswer:A-Takotsubocardiomyopathy"MyocardialStunning"isastatewherecertainsegmentsofmyocardium(correspondingtoareaofmajorcoronaryocclusion)showsformsofcontractileabnormality.Asegmentaldysfunctionpersistingforavariableperiodoftime,abouttwoweeks,evenafterischemiahasbeenrelieved(byforinstanceangioplastyorcoronaryarterybypasssurgery).Takotsubocardiomyopathy/Takotsubosyndrome,atemporaryconditionwhereyourheartmusclebecomessuddenlyweakenedor'stunned'.
785.Alternativedrugforcardiacarrestin placeofepinephrineis? a)Amiodaroneinfusion b)Atropine c)Highdosevasopressin d)Adenosine CorrectAnswer-CAnswer:C-HighdosevasopressinVasopressinisanalternativevasopressorathighdoses,causesvasoconstrictionbydirectlystimulatingsmoothmuscleV1receptors.AmericanHeartAssociation(AHA)guidelinesstates"Vasopressinisareasonablefirst-linevasopressorinpatientswithventricularfibrillationorpulselessventriculartachycardia.Additionally,theguidelinescommentthatonedoseofvasopressin40Umayreplacethefirstorseconddoseofepinephrineinallpulselesssuddencardiacarrestscenarios,includingasystoleandpulselesselectricalactivity.
786.Patientpresentingwithcutaneous vasculitis,glomerulonephritis,peripheralneuropathy,Whichinvestigationistobeperformednextthatwillhelpyoudiagnosethecondition? a)ANCA b)RAfactor c)Hbsag d)MIF CorrectAnswer-AAnswer:A-ANCAAnti-neutrophilcytoplasmicantibodies(ANCAs):GroupofautoantibodiesIgGtypemainly,Producedagainstantigensincytoplasmofneutrophilgranulocytes&monocytes.Particularlyassociatedwithsystemicvasculitis,socalled"ANCA-associatedvasculitis".
787.Cryoglobulinemia a)Hepatitisc b)Ovariancancer c)Diabetes d)Leukemia CorrectAnswer-AAnswer:A.HepatitisCCryoglobulinemia/CryoglobulinemicdiseasewithlargeamountsofcryoglobulinsinbloodCryoglobulinsareproteins(mostlyimmunoglobulinsthemselves)Becomeinsolubleatreducedtemperatures.MixturesofmonoclonalorpolyclonalIgM,IgG,and/orIgA&bloodcomplementproteinslikeC4areassociatedwithcasesofinfectiousdiseases,particularlyHepatitisCinfection,
788.Causesofhypokalemicmetabolic alkalosiswithhypertension a)Liddlesyndrome b)Barttersyndrome c)Gitelmansyndrome d)Renaltubularacidosis CorrectAnswer-AAnswer:A.LiddlesyndromeLiddlesyndrome-RarehereditarydisorderIncreasedactivityoftheepithelialsodiumchannel(E-NaCh)Activatingkidneystoexcretepotassiumretainingexcessivesodium&water,leadingtohypertension.
789.GoldcriteriaforverysevereCOPD a)Fev1/Fvc<70andFev1<30 b)Fev1/Fvc<70andFev1<70 c)Fev1/Fvc<70andFev1<50 d)BothAandC CorrectAnswer-AAnswer:A.Fev1/Fvc<70andFev1<30COPDshouldbeconsideredinanypatientwhohasdyspnea,chroniccoughorsputumproduction,and/orahistoryofexposuretoriskfactorsforthedisease.Spirometryisrequiredtomakethediagnosis.Presenceofpost-bronchodilatorFEV1/FVC<0.70confirmsthepresenceofpersistentairflowlimitation.StageIV/VerySevereCOPDSevereairflowlimitation(FEV1/FVC<70%;FEV1<.30%predicted)orFEV1<50%predictedpluschronicrespiratoryfailure.PatientsmayhaveVerySevere(StageIV)COPDevenifFEV1is>30%predicted.
790.ABPIincreasesartificiallyin a)Arteriosclerosiscalcifiedarteries b)Ischemiculcers c)Intermittentclaudication d)DVT CorrectAnswer-AAnswer:A.ArteriosclerosiscalcifiedarteriesTheankle-brachialpressureindex(ABPI)/Ankle-Brachialindex(ABI):Ratioofbloodpressureatankletobloodpressureinupperarm(brachium).Comparedtoarm,lowerbloodpressureinlegsuggestsblockedarteriesduetoperipheralarterydisease(PAD).Anklebrachialpressureindex(ABPI)isamethodforthequantificationofperipheralvasculardiseasethatresultsfromadvancedatherosclerosis.
791.Minimaldysfunctionsyndromeseenin a)Dyslexia b)ADHD c)Mentalsubnormality d)Down'ssyndrome CorrectAnswer-AAnswer:A.DyslexiaClinicalfeatureofMinimaldysfunctionsyndromeincludesdyslexia.Minimalbraindysfunction:Neurodevelopmentaldisorder.Characterizedbyevidencesofimmaturityinvolvingcontrolofactivity,emotions,&behaviorSpecificlearningdisabilitiesinvolvingthecommunicatingskillsneededinreading,writing,andmathematics.Inabilitytomaintainattention&concentrationInabilitytoskillfullyblendtheauditory&visualfunctionsessentialinlanguageperformance
792.Theearliestfeatureof3rdcranialnerve involvementindiabetesmellituspatientis- a)Normallightreflex b)Abnormallightreflex c)Normallightandaccommodationreflex d)Abnormallightandaccommodationreflex CorrectAnswer-AAnswer:A.NormallightreflexTheoculomotornerveisthethirdcranialnerve.Itenterstheorbitviathesuperiororbitalfissureandinnervatesmusclesthatenablemostmovementsoftheeyeandthatraisetheeyelid.Thenervealsocontainsfibersthatinnervatethemusclesthatenablepupillaryconstrictionandaccommodation(abilitytofocusonnearobjectsasinreading).Theoculomotornerveisderivedfromthebasalplateoftheembryonicmidbrain.Inpeoplewithdiabetesandolderthan50yearsofage,anoculomotornervepalsyoccurs.
793.Mobitztype2seconddegreeAVblockis seeninallexcept: a)Hypothyroidism b)CoronaryArteryDisease c)Sarcoidosis d)Cushingsyndrome CorrectAnswer-DAns:D.CushingsyndromeDelayorlackofconductionthroughtheatrioventricular(AV)nodeandbelowhasmultiplecauses.Degenerativechanges(eg,fibrosis,calcification,orinfiltration)arethemostcommoncauseofnon-ischeamicAVblock.IdiopathicfibrosisorcalcificationoftheAVconductionsystem,commonlyseenintheelderly,cancausecompleteAVblock.CausesofMobitztype2seconddegreeAVblockare-Damageoftheconductionsystemfromcoronaryarterydisease,valvesurgery,myocardialinfarction,myocarditis,infiltrativecardiomyopathies(sarcoidosis,hemochromatosis),myxedema,Lymedisease,neuromusculardisease,andAVjunctionablation[6]
794.Whichdrugregimenisgivenina pregnantwomanwithHIVinfection? a)Tenofovirdisoproxilfumaratewithemtricitabine b)Tenofovirdisoproxilfumaratewithlamivudine c)Abacavirwithlamivudine d)All CorrectAnswer-DAns.D.AllPreferredRegimensforHIVAntiretroviralTherapy(ART)inPregnancyTwo-NRTIbackboneRegimensincludethefollowing:Tenofovirdisoproxilfumaratewithemtricitabine(TDF/FTCco-formulated)ortenofovirdisoproxilfumaratewithlamivudine(3TC)oncedaily(usewithcautioninrenalinsufficiency)orAbacavirwithlamivudine(ABC/3TC)oncedaily(onlyifHLA-B5701?negative);avoidcombinationwithritonavir-boostedatazanavirifthepretreatmentHIVviralloadexceeds100,000copies/mL.ForwomenwhohavenevertakenHIVmedicines,thepreferredHIVregimenshouldincludetwonucleosidereversetranscriptaseinhibitors(NRTIs)plusanintegrasestrandtransferinhibitor(INSTI),anon-nucleosidereversetranscriptaseinhibitor(NNRTI),oraproteaseinhibitor(PI)withlow-doseritonavir(brandname:Norvir).TheregimengenerallyshouldincludeatleastoneofthefollowingNRTIsthatpasseasilyacrosstheplacenta:abacavir(brandname:Ziagen)emtricitabine(brandname:Emtriva)
lamivudine(brandname:Epivir)tenofovirdisoproxilfumarate(brandname:Viread)zidovudine(brandname:Retrovir)
795.Nutcrackeresophagus,thecorrect statementis a)Thereisextremelyforcefulperistalticactivityleadingto episodesofchestpainanddysphagia b)Thereisnomedicalt/tavailable c)TypeofoesophagealMalignancy d)None CorrectAnswer-AAns:A.ThereisextremelyforcefulperistalticactivityleadingtoepisodesofchestpainanddysphagiaNutCrackerOesophagusisahypermotilitydisorderwithhighamplitudeperistalsis.Itisaconditioninwhichextremelyforcefulperistalticactivityleadstoepisodicchestpainanddysphagia.Treatmentiswithnitratesornifedipine.Ref.davidsonsprinciplesandpractice23rdeditionpageno.795
796.Whichofthefollowingcriteriaisusedto assesstheprognosisoftheliverconditionasrepresentedinthepicturebelow? a)Childpughscore b)Milanscore c)Meldscore d)Alvaradoscore CorrectAnswer-AAns:A.Childpughscoretheliverconditionasrepresentedinthepictureabovedemonstrateslivercirrhosis.Child-Pughscore(ortheChild?Turcotte?PughscoreorChildCriteria)isusedtoassesstheprognosisofchronicliverdisease,mainlycirrhosis.Itisnowusedtodeterminetheprognosis,aswellastherequiredstrengthoftreatmentandthenecessityoflivertransplantation. Factor 1 2points 3points point Totalbilirubin <34 34-50 >50 (mol/L)Serumalbumin >35 28-35 <28 (g/L)PTINR <1.7 1.71-2.30 >2.30 Ascites None Mild ModeratetoSevere Hepatic None GradeI-II(orsuppressed GradeIII-IV(or
Hepatic None GradeI-II(orsuppressed GradeIII-IV(or encephalopathy withmedication) refractory) Interpretation: Points Class Oneyearsurvival Two-yearsurvival5?6 A 100% 85% 7?9 B 81% 57% 10?15 C 45% 35%
797.Suddenonsetheadachewithneck rigidity? a)Intraparenchymalhemorrhage b)Sah c)Meningitis d)Noneoftheabove CorrectAnswer-BAns:b.Sahsuddenonsetofasevereheadache(oftendescribedas"theworstheadacheofmylife")nauseaandvomitingstiffnecksensitivitytolight(photophobia)blurredordoublevisionlossofconsciousnessseizures
798.Vegetationinmitralvalveseeninwhich condition a)Libmansacks b)Infectiveendocarditis c)NBTE d)Rheumaticfever CorrectAnswer-BAns:B.InfectiveendocarditisInfectiveendocarditisischaracterizedbylesions,knownasvegetations,whichisamassofplatelets,fibrin,microcoloniesofmicroorganisms,andscantinflammatorycells.Inthesubacuteformofinfectiveendocarditis,thevegetationmayalsoincludeacenterofgranulomatoustissue,whichmaybefibrosedorcalcified.
799.Waterhammerpulseisseenin a)Aorticregurgitation b)Mitralstenosis c)Aorticstenosis d)Leftventricularfailure CorrectAnswer-AAns:A.AorticregurgitationWaterhammerpulseItisalargeboundingpulse,associatedwithanincreasedstrokevolumeoftheleftventricleandadecreaseintheperipheralresistance,leadingtowidepulsepressure.Thepulsestrikesthepalpatingfingerwitharapid,forcedjerkandquicklydisappears.Itisbestfeltintheradialarterywiththepatient'sarmelevated.Itisseeninaorticregurgitation.
800.Whatwillyoudowhen3yrsoldchild parentscometophcwithfever,coughsince5dayswithchestindrawingpresentundermnciclassification a)Giveantipyreticsonly b)Giveantibioticsandfollowup c)Referurgentlytotertiarycare d)Giveantibioticsandrefertotertiarycare CorrectAnswer-DAns:D.Giveantibioticsandrefertotertiarycare
801.Whatpoisonwillyoudetectinskeleton evenafteremaciation a)Lead b)Arsenic c)Mercury d)Cadmium CorrectAnswer-BAns:B.ArsenicArseniccanbedetectedeveninconflagratedhumanbones.Hence,itispossibletodetectpoisoningbyarsenicevenwhenthebodyhasbeenburntforalongtime.FMT2ndeditionPageno.184
802.Ph7.2,HCO3-(10or12),pco2-35, metabolicacidosisdueto a)K+excretionbythekidney b)Co2expirationbylungs c)H+excretionbythekidney d)Hco3lossbykidney CorrectAnswer-DAns:D.Hco3lossbykidneyInthequestion,pHisdecreased(acidosis)&pCO2isdecreased(Normal=40-45mmHg).AdecreasedpCO2willtrytoincreasepH,henceitmustbeasecondarycompensatingmechanism.So,theprimarymechanismcausingtheacid-baseimbalancemustbeadecreaseinserumbicarbonateconcentrationi.e.metabolicacidosis.
803.ImpairedfunctionofAquaporinresultsin a)Liddelsyndrome b)NephrogenicDI c)Cysticfibrosis d)Bartersyndrome CorrectAnswer-BAns:B.NephrogenicDIAquaporins,alsocalledwaterchannels,areintegralmembraneproteinsfromalargerfamilyofmajorintrinsicproteinsthatformporesinthemembraneofbiologicalcells,mainlyfacilitatingthetransportofwaterbetweencells.Geneticdefectsinvolvingaquaporingeneshavebeenassociatedwithseveralhumandiseasesincludingnephrogenicdiabetesinsipidusandneuromyelitisoptica.
804.ThemostcommoncauseofdeathinSLE inchildren a)Lupusnephritis b)Lupuscerebritis c)Libmansacksendocarditis d)Anemiaandinfections CorrectAnswer-AAns:A.LupusnephritisMajorcausesofdeathinpediatricSLEinclude: 1. Renaldisease(lupusnephritis)2. Severediseaseflare3. Infections
805.ApatienthavingmultipleGallstonesand shows8mmdilationand4stonesinCBD,besttreatmentmodalitiesare? a)Cholecystectomywithcholedocholithotomyatthesamesetting b)ESWL c)CholecystectomyandwaitforERCP d)All CorrectAnswer-AAns:A.CholecystectomywithcholedocholithotomydoneatthesamesittingManagementofsuspectedorprovenCBDstonesassociatedwithgallbladderstonesForgallstones-laparoscopiccholecystectomyistheprocedureofchoice.ForCBDstonestwothingscanbedone:1)IfthesurgeonisexperiencedinlaparoscopictechniquesofCBDstoneremovalthenbothcholecystectomyandcholedocholithotomyaredoneinthesamesitting.CBDstonesarefirstconfirmedbyanintraoperativecholangiogramthenthestonesareremovedlaparoscopicallyviathecysticductorbycholedochotomy.2)IfthesurgeonisnotexperiencedwithlaparoscopicmethodsofCBDstoneremoval,preoperativeendoscopicsphincterotomywithstoneremovalandlaterlaparoscopiccholecystectomyisdone.Laparoscopiccholecystectomywithcholedocholithotomyinthesamesittingisthepreferredtechnique(providedthesurgeonisexperienced)
Butonemustkeepinmindherethat"forelderly,poor-riskpatientswithgallstonesandCBDstones,somehaverecommendedERCPandsphincterotomyasthesoletreatment,leavinggallbladderandstonesinsitu".-Maingot's10/eUsuallythegallstonesinthesepatientsremainasymptomaticandiftheneedarisescanbemanagedbycholecystectomy
806.Pulmonaryplethoraisseenwithall except: a)TGS b)Ebsteinanomalies c)Hypoplasticleftheartsyndrome d)Doubleoutletrightventricle CorrectAnswer-BAns:B.EbsteinanomaliesPulmonaryplethoraisseeninTOFTAEbstein'sanomalyPulmonaryatresia
807.Hemodynamicallyunstablepatientwith SVT a)IVIBUTILIDE b)IVDILTIAZEM c)CARDIOVERSION d)Ivbeta-blockers CorrectAnswer-CAns:C.CARDIOVERSION
808.AFemalepatientwasonlithiumfor bipolardisorderfor6months.shefastedforsomedaysduetoreligiousconditionandlaterpresentedwithseizures,tremors,confusionandweakness.Whatinvestigationshavetobedonetodiagnosehercondition a)serumelectrolytes b)serumlithium c)ECG d)MRI CorrectAnswer-BAns:B.serumlithiumBecauseofitseffectsonmultiplebodysystems,includingbutnotlimitedtorenal,hematologic,andthyroidsystems,appropriatebaselinestudiesmustprecedethestartoflithiumtherapy.Theminimalteststobedoneincludeserumcreatinine,electrolytes,thyroidfunctiontests,andacompletebloodcountwithdifferential.Additionally,becauseofitscardiaceffect,anECGisindicated.Anywomanthoughttobepregnantshouldhaveapregnancytest.Ref:NurcombeB.(2008).Chapter12.DiagnosticFormulation,TreatmentPlanning,andModesofTreatmentinChildrenandAdolescents.InM.H.Ebert,P.T.Loosen,B.Nurcombe,J.F.Leckman(Eds),CURRENTDiagnosis&Treatment:Psychiatry,2e.
809.Lithiumcauses: a)Hypokalemia b)Hyperkalemia c)Hypocalcemia d)Hypercalcemia CorrectAnswer-AAns:A.HypokalemiaSideeffectsoflithium 1. Neurological:-Tremoristhecommonestsideeffectoflithium.Other CNSsideeffectsaregiddiness,ataxia,motorincoordination,hyperreflexia,mentalconfusion,nystagmus. 2. Renal:-Nephrogenicdiabetesinsipiduswithpolyuria&polydipsia. AmilorideistheDOCforLithiuminducednephrogenicDI. 3. Cardiovascular:-Effectsaresimilartohypokalemia.Themost commonECGchangeisTwavedepression. 4. Endocrine:-Goitre,hypothyroidism5. GIT:-Nausea,vomiting,diarrhea,metallictest,abdominalpain.6. Dermatological:-Acneiformeruptions,papulareruption, exacerbationofpsoriasis. 7. Teratogenicity:-Ebstein'sanomalyinthefetus.
810.A50-year-oldmanpresentswith paresthesia.HB-6.8g/dl.Peripheralsmearshowsmacrocytosisandneutrophilswithhypersegmentednuclei.endoscopyrevealsatrophicgastritis.amostprobablediagnosisis a)Folatedeficiency b)VitaminB12deficiency c)Riboflavindeficiency d)Irondeficiency CorrectAnswer-BAns:B.VitaminB12deficiencyMacrocytosisandhypersegmentedneutrophilsonperipheralsmear,poorabsorption(Atrophicgastritis)suggestthediagnosisofB12deficiency.Thepresenceofanemia(Hb=6gm%)Macrocytosis(MCV=104)anddecreasedvitaminB12levels(B12=60pg/ml)suggestsadiagnosisofmegaloblasticanemiaduetovitaminB12deficiency.ThepatientinquestionthushasmacrocyticanemiaduetovitaminB12deficiency.
811.Alltransretinoicacidisusedinthe treatmentoftumourassociatedwith a)BCR-ABL b)PML-RARA c)CMYC d)CEBPA CorrectAnswer-BAns:B.PML-RARAAll-transretinoicacid(ATRA)isanactivemetaboliteofvitaminAunderthefamilyretinoid.Retinoids,throughtheircognatenuclearreceptors,exertpotenteffectsoncellgrowth,differentiationandapoptosis,andhavesignificantpromiseforcancertherapyandchemoprevention.DifferentiationtherapywithATRAhasmarkedamajoradvanceandbecomethefirstchoicedruginthetreatmentofacutepromyelocyticleukemia(APL).All-transretinoicAcidisusedinthetreatmentforAcutePromyelocyticLeukemia(PML)
812.RenaltubularacidosiswithABGvalue pH=7.24P02=80;PaCO2=36Na=131;HCO3=14Cl=90;BE=-13Glucose=135aboveABGpicturesuggest? a)Respiratoryacidosis b)Respiratoryalkalosis c)Metabolicacidosis d)Metabolicalkalosis CorrectAnswer-CAns:C.MetabolicacidosisThegivenvalueshavelowpH,andlowHCo3IndicatemetabolicacidosisPCO2inlowernormalrange(normalvalue35-45mm/hg)
813.Patientwithpulmonaryfibrosis.Which antiarrhythmicdrugshouldnotbegiven a)Amiodarone b)Flecainide c)Ivibutilide d)lidocaine CorrectAnswer-AAns:A.AmiodaroneAmiodaroneanditsmetabolitescanproducelungdamagedirectlybyacytotoxiceffectandindirectlybyanimmunologicalreaction.ThelatterissupportedbythefindingofcytotoxicTcellsinbronchoalveolarlavage(BAL)fluidfrompatientswithdiagnosedAPT.AmiodaronemayinducetheproductionoftoxicO2radicals,whichcandirectlydamagecells
814.A42-year-oldpatientwithobstructive jaundice.Alp,Ggt,haptoglobinallincreased.Themostlikelycauseis: a)Alcohol b)Lead c)Chronicrf d)Noneoftheabove CorrectAnswer-AAns:A.AlcoholAnindicatorthatshouldmaketheclinicianhighlysuspiciousofalcohol-relatedliverinjuryisAST:ALTratioof2:1ormore.Gamma-glutamyltransferase(GGT)isanothersensitivebutnon-specificmarkerforthehepaticinjurywhichcannotbeusedsolelytodiagnosealcohol-relatedhepaticinsult.LevelsofGGTgreaterthantwicethenormalvaluesinadditiontoAST:ALTratio>2stronglyindicatealcohol-inducedliverinjuryaswell.
815.ThedifferentiatingfeaturebetweenIBS andorganicGIdiseaseis: a)Diarrhea b)Stoolcalprotectin c)Painabdomen d)Mucusinstools CorrectAnswer-BAns:B.StoolcalprotectinBothorganicIBDandnon-organicfunctionaldisorderslikeIBSexhibitverysimilarsymptomsresearchershaveidentifiedseveralstool-basedbiomarkerstodifferentiatebetweenIBDandIBS.Thesebecomeespeciallycrucialwhentakingthenextsteptowardsdecidinghowtomanagethedisease(e.g.therapeuticintervention,etc.).Thosebiomarkersincludethefollowing:CalprotectinAlpha-1AntitrypsinLysozymeSecretoryIgAAlbumin
816.Atienthasfatigue.Butnotgaining weight.Bodywaswarm.Investigationwillshow: a)LowTSHwithmoret3ort4 b)HighTSHwithnormalt3ort4 c)HighTSHwitheuthyroid d)Increaseduptakeoft3,butdecreaset4 CorrectAnswer-AAns:A.LowTSHwithmoret3ort4
817.WarminginFrostfrostbiteshouldbe doneatwhattemperature: a)37degree b)42degree c)44degree d)46degree CorrectAnswer-AAns:A.37degreeAttemperaturebelowfreezing(dry-coldcondition)frostbiteoccursthetissuefreeze&icecrystalsforminbetweenthecellsAffectedpartshouldbewarmedusingwaterat44?isunderCriticism,Warmingshouldlastabout20minutesatatime,Intakeofhotfluidspromotesgeneralrewarming
818.Whichofthefollowingisnotseenin Pituitaryapoplexy a)Headache b)Hypertension c)Hypotension d)Vomiting CorrectAnswer-CAns:C.HypotensionFollowingareseeninPituitaryapoplexySeverehypoglycemiaSevereheadache(usuallyretro-orbital)ImpairedconsciousnessFeverVisualdisturbances(visualfielddefect,visualacuity)Ophthalmoplegia(ocularparesis)CausingdiplopiaHypotension&shockNausea/vomitingMeningealsign
819.Lossofpain/temperaturesensationon ipsilateralface&C/Lbodyduetothrombosisin a)PICA b)Posteriorcerebellarartery c)Superiorcerebellarartery d)Noneoftheabove CorrectAnswer-AAns:A.PICA.Mostcasesresultfromipsilateralvertebralarteryocclusion;occlusionoftheposteriorinferiorcerebellararteryisresponsibleforit.VesselocclusionthatresultsinLateralMedullarysyndrome:Vertebral(mostcommon)Posteriorinferiorcerebellar(2ndmostcommon)Superior,middleorInferiorlateralmedullaryarteriesLateralmedullarysyndrome(Wallenbergsyndrome):VertigoNumbnessofipsilateralfaceandcontralaterallimbsDiplopiaDysphagiaDysarthriaAtaxiaHoarseness
820.AllfoundinLVFexcept a)Lungoligemia b)Kerleyblines c)Rales d)Pedaledema CorrectAnswer-AAns:A.LungoligemiaChestX-rayFeaturesofLeftventricularfailure:CardiomegalyKerleylinesProminentupperlobeveinsBat'swingsshadowPleuraleffusionKerleyBlineisduetointerstitialedema.Prominentrightdescendingpulmonaryarteryisseeninacutepulmonaryembolism.
821.A25yearsoldladywithahistoryoffever for1monthpresentswithheadacheandataxia.Brainimagingshowsdilatedventriclesandsignificantbasalexudates.WhichofthefollowingwillbethemostlikelyCSFfinding: a)Lymphocytosis,LowGlucose,Highprotein b)Lymphocytosis,NormalGlucose,Highprotein c)Lymphocytosis,LowGlucose,Normalprotein d)Neutrophilia,Lowglucose,LowProtein CorrectAnswer-AAns:A.(Lymphocytosis,LowGlucose,Highprotein)Presenceofsignificantbasalexudates,togetherwithdilatedventricles(hydrocephalus)inayoungfemalewithaprolongedhistoryoffeverandheadachesuggestsadiagnosisofTubercularMeningitis.TubercularMeningitisischaracterizedbyLymphocyticPleocytosis,LowGlucoseandHighProteinwithintheCSF.ThepathologicalhallmarkofTubercularMeningitisisthepredominantinvolvementofbasalcisternsthatareobservedbythepresenceofbasalinflammatorytissueexudate.
This post was last modified on 23 November 2021