Question: Q. Initial Antihypeensive agent of choice in a patient with stable ischemic hea disease is

Answer is A (Beta-Blockers) Beta Blockers are recommended as First Line Agents of choice for treatment of hypeension in hypeensive patients with Stable Ischemic Hea Disease.


Question: Fever increase water losses by mUday per degree Celsius

Ans. is `b' i.e., 200 ml/day per degree Celsius


Question: Duffy antigen on erythrocytes are receptors for


Question: NARP syndrome is a type of

Harrison's principles of internal medicine 17th edition. * Neurogenic muscular weakness with ataxia and retinitis pigmentosa is a mitochondrial disease


Question: Fastest tolerance develops in

(Opiods): (Neeraj Ahujapsychiatry)DRUGUSUAL ROUTE OF ADMINISTRATIONPHYSICAL DEPENDENCEPSYCHIC DEPENDENCETOLERANCE1. AlcoholOral+ ++ ++2. Alcohol (Morphine Heroin)Oral, Parenteral, Smoking+ + ++ + ++ + +3. Cannabis (Marihuana)Smoking, Oral++ ++4. CocaineInhalation,, Oral, Smoking, Parenterl-+ +-5. AmphetaminesOral, Parenteral++ ++ + +6. Lysergic acid Diethylamide (LSD)Oral-++7. BarbituratesOral, Parenteral+ ++ ++ + +8. Benzodiazepine sOral, Parenteral+++9. Volatile SolventsInhalation++ ++10. Phencyclidine (PCP)Smoking, Inhalation, Parenteral, Oral+++


Question: In vitro DNA amplification is done by

(D) Polymerase chain reaction # DNA amplification is done by PCR> Blotting technique Following gel electrophoresis, probes are often used to detect specific molecules from the mixture. However, probes cannot be applied directly to the gel. The problem can be solved by three types of blotting methods: Southern blotting, Northern blotting and Western blotting. Southern blotting is a technique for detecting specific DNA fragments in a complex mixture. Northern blotting is used for detecting RNA fragments, instead of DNA fragments. Western blotting is used to detect a particular protein in a mixture. The probe used is therefore not DNA or RNA, but antibodies. The technique is also called "immunoblotting" PCR: In vitro Techniques such as the polymerase chain reaction allow the amplification of specific DNA sequences so that minute quantities of foreign nucleic acids can be recognized in host specimens. Recombinant DNA refers to a collection of techniques for creating (and analyzing) DNA molecules that contain DNA from two unrelated organisms. One of the DNA molecules is typically a bacterial or viral DNA that is capable of accepting another DNA molecule; this is called a vector DNA. The other DNA molecule is from an organism of interest, which could be anything from a bacterium to a whale, or a human. Combining these two DNA molecules allows for the replication of many copies of a specific DNA. These copies of DNA can be studied in detail, used to produce valuable proteins, or used for gene therapy or other applications. Electrophoresis, also called cataphoresis, is the motion of dispersed particles relative to a fluid under the influence of a spatially uniform electric field. This electrokinetic phenomenon was observed for the first time in 1807 by Reuss , who noticed that the application of a constant electric field caused clay particles dispersed in water to migrate. It is ultimately caused by the presence of a charged interface between the particle surface and the surrounding fluid.


Question: Most important features in cushing syndrome is

(Centripetal obesity) (1050- CMDT-10, 2252-2255-H17th)CUSHING SYNDROME (HYPERCORTISOLISM)ESSENTIALS OF DIAGNOSIS* Central obesity, with a plethoric "moon face" "buffalo hump" supraclavicular fat pad, protuberant abdomen, thin extremities, muscle wasting, thin, skin, purple striae, Hirsutism* Psychological changes - frank psychosis* Olegomenorrhagia or amenorrhea (or impotence in male)* Osteoporosis, hypertension, poor wound healing, polyurea, renal calculi, glaucoma* Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia hypokalemia* Elevated serum cortisol and urinary free cortisol, Lack of normal suppression by dexamethasone*** Hypertension is seen in cushing syndrome because of sodium and water retension so it is sustained hypertension (Not episodic)***Interestingly, hypercortisolism without cushing syndrome can occur in - severe depression, anorexia nervosa, alcoholism and familial cortisol resistance, familial lipodystrophy type I patients receiving anti retroviral therapy for HIV-I infection* Earliest manifestation of cushing's syndrome is - Loss of diurmal variation*** Cushing's disease is associated with increased ACTH and increased cortisol* Conn's syndrome is most commonly associated with cortical adenoma*** NELSON SYNDROME - is a disorder characterized by rapid growth of ACTH secreting pituitary adenoma following bilateral adrenalectomy** (which was performed for cushing disease)* Most common cause of Cushing's syndrome is iatrogenic administration of steroids**Frequency of sign & symptoms of cushing syndrome* Typical habitus (centripetal obesity)97%* Personality changes66%* Increased body weight94%* Ecchymosis65%* Fatigability and weakness87%* Proximal myopathy **62%* Hypertension (BP > 150/90)82%* Edema62%* Hirsutism80%* Polyurea polydipsia23%* Amenorrhea77%* Hypertrophy of clitoris19%* Broad violaceous cutaneous striae67%


Question: Hypogonadism with 47 XXY is a feature of

Ans. d (Klinefelter's syndrome) (Ref: Robbins 7th edition, p.179; Harisson's internal medicine 17th edition, p. 2317)Klinefelter syndrome (XXY)# Common cause of hypogonadism seen in infertility work-up# Dysgenesis of seminiferous tubules | inhibin | FSH.# Abnormal Leydig cell function | testosterone | LH | estrogen.# Testicular atrophy, eunuchoid habitus, tall, long extremities, gynecomastia, female hair distribution. May present with developmental delay. Presence of inactivated X chromosome (Barr body).KLINFELTER'S SYNDROME# Most common genetic cause of hypogonadism6# Incidence:- 1 in 500 (Robbin's)- 1 in 1000 (Harrisions's)# C/F: Eunuchoid body habitat, Atropic testis (< 3.5 mL) (r) Gynaecomastia, Small penis ( < 2.5 cm)# Mean I.Q ... Subnormal (mental retardation uncommon)# Semiferous tubules degenerates, Leydig cells are prominent or increased# Diagnosis: FSH--with low testestorone and high estrogen level# Malignancies:| Risk| RiskCa. Breast, Ca. Lung, NHL (mediastinal), Gonadoblastoma# Educational Points:Ca Prostate (Testesterone dependent)SyndromeAssociated Malignancy Down's SyndromeALL (most common)M7 type AMLJuvenile CML Turner's SyndromeGonadoblastoma, | Ca Colon, Cystic hygroma


Question: Cardiac anomaly seen in Noonan's syndrome is

Pulmonary stenosis and hyperophic cardiomyopathy are generally the most common congenital hea defects found in Noonan syndrome. Pulmonary stenosis is often associated with a thickened and dysplastic valve Ref Robbins 9/e pg .532


Question: Hypoxic pulmonary vasoconstriction due to

Hypoxic pulmonary vasoconstriction (HPV), also known as the Euler-Liljestrand mechanism, is a physiological phenomenon in which small pulmonary aeries constrict in the presence of alveolar hypoxia (low oxygen levels). Ref Harrison20th edition pg 2334

Irreversible pulmonary vasocontriction hypoxia

Reversible pulmonary vasoconstriction due to hypoxia

Occurs hours after pulmonary vasoconstriction


Question: Sumatriptan is

Sumatriptan a 5-HT 1D/1B agonist is used for acute migraine attacks. Buspirone, a 5-HT 1A agonist is an effective nonbenzodiazepine anxiolytic. ref - harrisons internal medicine 20e pg3100


Question: Tentative marks are indicative of


Question: For the following medical conditions, select the associated acid base disturbances.Sepsis

Sepsis can cause cardiovascular insufficiency with lactic acidosis, whereas fever and endotoxemia stimulate the respiratory center, causing respiratory alkalosis.

metabolic acidosis and respiratory acidosis

metabolic acidosis and respiratory alkalosis

metabolic alkalosis and respiratory acidosis

metabolic alkalosis and respiratory alkalosis


Question: Dysphagia is the awareness of something


Question: Most common cause of Neuropathy is

(D) Diabetes mellitus # DIABETIC NEUROPATHY occurs in 50% of individuals with long standing Type I & Type II DM.> It may manifest as poly neuropathy, mono neuropathy, and/or autonomic neuropathy.> As with other complications of DM, the development of neuropathy corrilates with the duration of diabetes and glycemic control.


Question: Embolism of posterior cerebral artery leads to memory' impairment because of damage to

(A) Hippocampal gyrus # Occlusion of the distal PCA causes> Infarction of the medial temporal and occipital lobes.> Contralateral Homonymous hemianopia with macula sparing is the usual manifestation.> Occasionally, only the upper quadrant of visual field is involved.> If the visual association areas are spared and only the calcarine cortex is involved, the patient may be aware of visual defects.> Medial Temporal lobe and hippocampal involvement maycause an acute disturbance> In memory, particularly if it occurs in the dominant hemisphere.


Question: Most common cause of intracranial bleed is

(B) Hypertension # INTRAPARENCHYMAL HEMORRHAGE (IPH) is one extension of intracerebral hemorrhage (the other is intraventricular hemorrhage (IVH)) with bleeding within brain parenchyma.> Intraparenchymal hemorrhage accounts for approx. 8-13% of all strokes and results from a wide spectrum of disorders. It is more likely to result in death or major disability than ischemic stroke or subarachnoid hemorrhage, and therefore constitutes an immediate medical emergency.> Intracerebral hemorrhages and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure (ICP) and potentially fatal herniation syndromes.# Pathophysiology: Nontraumatic intraparenchymal hemorrhage most commonly results from Hypertensive damage to blood vessel walls E.g.: - Hypertension - Eclampsia - Drug abuse, but it also may be due to Autoregulatory dysfunction with excessive cerebral blood flow E.g.: Reperfusion injury - Hemorrhagic transformation - Cold exposure - Rupture of an aneurysm or arteriovenous malformation (AVM) Arteriopathy (E.g. cerebral amyloid angiopathy, moyama) - Altered hemostasis (E.g. thrombolysis, anticoagulation, bleeding diathesis) Hemorrhagic necrosis (E.g. Tumor, Infection) Venous outflow obstruction (E.g. Cerebral venous sinus thrombosis). Non penetrating and penetrating cranial trauma can be also common causes of intracerebral hemorrhage.


Question: Pasteurized milk is most commonly tested by


Question: Best Test for intestinal malabsorption


Question: Inability to abduct left eye with LMN fascial palsy on same side. The lesion is in

(A) Left pons # Foville's syndrome following dorsal pontine injury includes lateral gaze palsy, ipsilateral facial palsy, and contralateral hemiparesis incurred by damage to descending corticospinal fibers.> Millard-Gubler syndrome from ventral pontine injury is similar, except for the eye findings. There is ipsilateral lateral rectus weakness only, instead of gaze palsy, because the abducens fascicle is injured rather than the nucleus. Infarct, tumor, hemorrhage, vascular malformation, and multiple sclerosis are the most common etiologies of brainstem abducens palsy.


Question: This ECG is most likely associated with

Ans-2.C, If we focus on any one lead like lead 2 ,tall tented t waves are a seen.T wave is said to be tall when its amplitude is more than 50% of R wave.Cause is hyperacute mi or hyperkalemia.out of these options conn's syndrome will cause hypokalemia(t waves short or absent or inverted)multiple myeloma will lead to hypercalcemia(qt interval short in ECG)renal failure is mostly associated with hyperkalemia,while SIADH causes hyponatremia(normal ECG or decreased qrs amplitude but no t wave abnormality)


Question: Predisposing factor for pneumococal pneumoniaa) CRFb) Lymphoma c) Thalassemiad) Cystic fibrosis


Question: Severe Obstructive sleep apnea is defined as AHI of greater than

Obstructive Sleep Apnea/Hypopnea Syndrome Quantification and Severity scaleApnea-hypopnea index : Number of apnea plus hypopnea per hour of sleepRespiratory disturbance index : Number of apneas plus hypopnea plus RERAs per hour of sleepMild OSAHSAHI of 5-14 events/hourModerate OSAHSAHI of 15-29 events/hourSevere OSAHSAHI of >= 30 events/hourReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 319; Sleep Apnea


Question: Holt Gram syndrome is characterized by


Question: A lady presents with galactorrhea and visual defects. Investigation to be done is

MRI is the imaging of choice for pituitary tumour. It is preferred over CT scan.


Question: In renal failure, metabolic acidosis is due to

Ans. is 'c' i.e., Decreased ammonia synthesis The predominant reason for metabolic acidosis in C.R.E is decreased ammonia production. Metabolic acidosis is a common disturbance in advanced chronic kidney disease The majority of patients can still acidly the urine but they produce less ammonia and, therefore, cannot excrete the normal quantity of protons in combination with this urinary buffer.


Question: Maralgia paresthetica is not caused by

A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve. Meralgia paraesthetica can occur in pregnancy, in obesity and if there is tense ascites. It may be a result of trauma, surgery (such as pelvic osteotomy, spinal surgeries, laparoscopic hernia repair and bariatric surgery) Ref Harrison20th edition pg 2345


Question: Elongated filaments in Pick's disease consist of

Harrison's principles of internal medicine 17th edition. *In Pick's disease dementia is frontotemporal dementia *Molecular basis - tau *Causal genes and chromosome - tau exon and intron mutation(17) *Susceptibility - H1 tau haplophytes * Pathology - tau inclusions,pick bodies,neurofibrillary tangles


Question: Hypokalemia is likely to be seen in


Question: Bone morphogenic protein receptor 2 gene abnormality seen in

primary pulmonary hypeension is idiopathic (BMPR gene abnormality).


Question: Decreased serum ferritin levels are seen in

Ans. a (Iron deficiency anemia). (Ref. Harrison's 17th /Table 98-4; 18th/Ch.103)# Hb contains 70% of iron and 3% myoglobin with remaining being ferritin.# Iron is readily absorbed in ferrous state, but most of the dietary iron is in ferric (Fe+3) state.FACTORS AFFECTING IRON ABSORPTION ARE:# Promoting factors:- Retarding factors:- High pH- Excess mucus- Bile salts- Phosphates- Chlorophyll- Phytates- Vitamin C- Antacids# Mobilferin binds more iron as binding sites increase.# As amount of transferrin in plasma increases, its % of iron saturation decreases.# More iron moves from intercellular iron carrier to transferrin and less binds to apoferritin.# As ferritin stores decreases, less iron is lost in mucosal shedding.# In iron deficiency anaemia ferritin levels decreases.# Normal TIBC is 300.# Low serum iron, decreased MCV with high TIBC is specific for iron deficiency anemia.FERRITIN# Free iron is highly toxic, and the pool of storage iron is tightly bound to either ferritin or hemosiderin.# Ferritin is a protein-iron complex found in all tissues but particularly in liver, spleen, bone marrow, and skeletal muscles.# Intracellular ferritin is located in both the cytosol and lysosomes, in which partially degraded protein shells of ferritin aggregate into hemosiderin granules.# The iron in hemosiderin is chemically reactive and turns blue-black when exposed to potassium ferrocyanide, which is the basis for the Prussian blue stain.# In iron-overloaded cells, most iron is stored in hemosiderin.# Very small amounts of ferritin normally circulate in the plasma.# Since plasma ferritin is derived largely from the storage pool of body iron, its levels correlate well with body iron stores.# In iron deficiency, serum ferritin is always < 12 mg/L, whereas in iron overload, high values approaching 5000 mg/L can be seen.# Iron is transported in plasma by an iron-binding glycoprotein called transferrin, which is synthesized in the liver. In normal individuals, transferrin is about 33% saturated with iron, yielding serum iron levels that average 120 mg/dL in men and 100 mg/dL in women.DIAGNOSIS OF MICROCYTIC ANEMIA TestsIron DeficiencyInflammationThalassemiaSideroblastic Anemia1SmearMicro/ hypoNormal; micro/ hypoMicro/hypo with targetingVariable2SI<30<50Normal to highNormal to high3TIBC>360<300NormalNormal4Percent saturation<1010-2030-8030-805Ferritin (mg/L)<1530-20050-30050-3006Hemoglobin patternNormalNormalAbnormalNormal


Question: Enzyme defect in acute intermittent porphyria


Question: Most common arrhythmia after reperfusion syndrome is

AIVR is currently defined as an enhanced ectopic ventricular rhythm with at least 3 consecutive ventricular beats, which is faster than normal intrinsic ventricular escape rhythm (<=40 bpm), but slower than ventricular tachycardia (at least 100-120 bpm) Ref Harrison 20th edition pg 1432


Question: A young patient presented with blood pressure of 190/120 mm of Hg without any clinical symptom and fundus examination is normal, treatment of choice

Angiotensin-conveing enzyme (ACE) inhibitors block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure. By reducing production of angiotensin II, ACE inhibitors allow blood vessels to widen, which lowers blood pressure and improves hea output. The available ACE inhibitors include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril. Side effects -- In some patients, ACE inhibitors cause a persistent dry hacking cough that is reversible when the medication is stopped. Less common side effects include dry mouth, nausea, rash, muscle pain, or occasionally, kidney dysfunction and elevated blood potassium. A potentially serious complication of ACE inhibitors is angioedema, which occurs in 0.1 to 0.7 percent of people. People with angioedema rapidly (minutes to hours after taking the medication) develop swelling of the lips, tongue, and throat, which can interfere with breathing. These symptoms are a medical emergency, and the ACE inhibitor should be discontinued. oral enalapril may also be used in young hypeensives who presents with ususually high levels of blood pressure to overcome the end stage damages that can happen. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2057


Question: Acute infectious purpura fulminans is caused by

Purpura fulminans is an acute, often fatal, thrombotic disorder which manifests as blood spots, bruising and discolouration of the skin resulting from coagulation in small blood vessels within the skin and rapidly leads to skin necrosis and disseminated intravascular coagulation caused by Neisseria meningitidis and varicella Ref Harrison20th edition pg 1078


Question: Drug of choice for idiopathic intracranial hypeension

Idiopathic intracranial hypeension is treated with acetazolamide. It should not be given in first trimester, in rest of the peroids it is safe. This condition worsens during pregnancy due to weight gain. Reference : Harrison20th edition pg 2334


Question: Thymoma associated with

* Thymus is abnormal in 75% patients with MG. 65% - hyperplastic, 10%- thymic tumours or thymomas Ref Harrison20th edition pg 2345


Question: Chronic renal failure is associated with


Question: Freshwater swimming can lead to

Leptospirosis Leptospires excreted in urine and can survive in water for many months, water is an impoant vehicle in their transmissionBabesiosis Veical transmission, blood transfusion, or tick bitebrucellosisOccupational or domestic exposure to infected animals or their products by ingestion, inhalation, or mucosal or percutaneous exposureLassa feverAerosols from infected rodents, capturing or eating these animals, close person to person contact(ref: Harrison's 18/e p1393)


Question: Marbling is noticed by


Question: The most common clinical manifestation of Multiple Sclerosis is

(C) Optic Neuritis INITIAL SYMPTOMS OF MULTIPLE SCLEROSISSymptomPercent of CasesSymptomPercent of Cases* Sensory loss37* Lhermitte3* Optic neuritis36* Pain3* Weakness35* Dementia2* Paresthesias24* Visual loss2* Diplopia15* Facial palsy1* Ataxia11* Impotence1* Vertigo6* Myokymia1* Paroxysmal attacks4* Epilepsy1* Bladder4* Falling1# Optic neuritis is the commonest presenting feature of multiple sclerosis out of the given choices. It is roughly seen in 36% of cases.> Sensory loss may be the initial symptom in 37% cases.> Optic neuritis generally presents as decreased acuity, dimness or colour desaturation in central field of vision.> Afferent pupillary response may be detected.> Internuclear (not intranuclear) ophthalmoplegia consists of slow adduction of one eye with nystagmus in the abducting eye.> Impaired adduction is due to lesion in medial longitudinal fasciculus.> Bilateral internuclear ophthalmoplegia is highly suggestive of multiple sclerosis. Lhermitte's symptom (sensation of electric shock on flexion of neck) is seen in multiple sclerosis. Seizure and aphasia are uncommon in multiple sclerosis. Afferent pupillary defect is seen in multiple sclerosis. There is abnormality in visual evoked potential. MRI helps in confirming the diagnosis.


Question: Immunoglobulins used in Rx of

IMMUNOLOGICAL TREATMENT OF MYASTHENIA GRAVIS Ref - Davidsons 23e p1142


Question: Canagliflozin acts by

Agents Used for Treat ment of Type 1 or Type 2 Diabetes Mechanism of ActionExamplesHbA Reduction (%)Agent-Specific AdvantagesAgent-Specific DisadvantagesContraindicationsOralBiguanides|Hepatic glucose productionMetformin1-2Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV eventsDiarrhea, nausea, lactic acidosisSerum creatinine> 15 mg/dL (men)>1.4 mg/dL (women)(see text), CHF, radio graphic contrast studies,hospitalized patients,acidosisRenal/liver diseasea-Glucosidase inhibitors|GI glucose absorptionAcarbose, miglitol, voglibose0.5-0.8Reduce postprandial glycemiaGI flatulence, liver function testsRenal/liver diseaseDipeptidyl peptidase IV inhibitorsProlong endogenous GLP-1 actionAlogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin,sitagliptin, teneligliptin, vildagliptin0.5-0.8Well tolerated, donot cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedemaInsulin secretagogues:Sulfonylureas|Insulin secretionGlibornuride, gliclazide, glimepiride,glipizide, gliquidone,glyburide,glyclopyramide1-2Sho onset of action, lower postprandial glucose, inexpensiveHypoglycemia, weight gainRenal/liver diseaseInsulin secretagogues:Nonsulfonylureas|Insulin secretionNateglinide, repaglinide, mitiglinide0.5-1.0Sho onset of action, lower postprandial glucoseHypoglycemiaRenal/liver diseaseSodium-glucose cotranspoer 2 inhibitors|Urinary glucose excretionCanagliflozin,dapagliflozin,empagliflozin0.5-1.0Insulin secretion and action indepentantUrinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemiaLimited clinical experience; moderate renal insufficiencyThiazolidinediones|Insulin resistance,|glucose utilizationRosiglitazone, pioglitazone0.5-1.4Lower insulin requirementsPeripheral edema,CHF, weight gain,fractures, macularedemaCHF, liver disease Ref: Harrison 19e pg: 2414


Question: The drug of choice for the treatment of Thyrotoxicosis during pregnancy is

(C) Propyl Thiouracil # All antithyroid drugs can cross placenta so risk of fetal hypothyroidism and goitre is always there.> Both carbimazole and propylthiourcil can be used during pregnancy, but propyl-thiouracil is the drug of choice because its greater protein binding allows low doses of propylthioracil to be transferred across the placenta and therefore less chance of hypothyroidism.> Lowest effective dose of propyl thiouracil should be given and it is often possible to stop treatment in the last trimester since TSH Receptor antibodies tend to decline in pregnancy.> Radioactive iodine is C/l during pregnancy> It can destroy the fetal thyroid tissue resulting in cretinism> Carbimazole and methimazole have been associated with rare cases of foetal aplasia cutis.


Question: Gold criteria for very severe airflow obstruction in COPD is

(D) FEV1/FVC<0.7 and FEV1<30% predicted [?]Hallmark of COPD is airflow obstruction.oPulmonary function test shows airflow obstruction with a reduction in FEV1 and FEV/FVC.oWith worsening disease severity, lung volumes may increase, resulting in an increase in total lung capacity, functional residual capacity, and residual volume.oIn patients with emphysema, the diffusing capacity may be reduced, reflecting the lung parenchymal destruction characteristic of the disease.oDegree of airflow obstruction is an important prognostic factor in COPDoIt is the basis for the Global Initiative for Lung Disease (GOLD) severity classificationGOLD CRITERIA FOR COPD SEVERITYGold StageSeveritySymptomsSpirometry0At riskChronic cough, sputum, productionNormalIMildWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 >80% predictedIIAModerateWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & >=50%FEV1 but <80% predictedIIISevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7SFEV1 >=30% but <50% predictedIVVery SevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 <30% predicted or FEV1 <50% predicted with respiratory failure or signs of right heart failure[?]Stage IV: Very Severe COPD:oSevere airflow limitation (FEV1/FVC<70%;FEV1<.30% predicted) or FEV1<50% predicted plus chronic respiratory failure.-Quality of life is appreciably impaired.-Exacerbations may be life-threatening.oAvoid risk factorsoOffer influenza vaccinationoAdd short-acting bronchodilators as neededoAdd rehabilitationoAdd inhaled glucocorticoids if repeated exacerbationsoAdd long-term oxygen if chronic respiratory failureoConsider surgical treatments-Arterial blood gases & Oximetry may demonstrate resting or exertional hypoxemia.-Radiographic studies may assist in the classification of the type of COPD.-CT scan is the current definitive test for establishing the presence or absence of emphysema in living subjects.-Recent guidelines have suggested testing for a, AT deficiency in all subjects with COPD or asthma with chronic airflow obstruction.-Only three interventions-smoking cessation, oxygen therapy in chronically hypoxemic patients & lung volume reduction surgery in selected patients with emphysema have been demonstrated to i influence the natural history of patients with COPD.

FEV1/FVC<0.7 & >=50% FEV1 but <80% predicted

FEV1/FVC<0.7 & FEV1>=30% but <50% predicted


Question: A patient presented with thunder clap headache. Followed by unconsciousness with progressive 3rd cranial nerve palsy

Harrison's textbook of internal medicine 17th edition . *Sudden transient loss of consciousness may be preceded by brief moment of excruciating head ache ,but most patient first complain of head ache on regain the consciousness . *3rd cranial nerve palsy , associate with pupillary dilatation,loss of ipsilateral light reflex,focal pain above and behind the eye . Ref Harrison20th edition pg 2445


Question: Skin lesions of Tuberous sclerosis includes

(C) Adenoma sebaceum # Cardinal features of Tuberous sclerosis (Bourneville's disease): are skin lesions, convulsion and mental retardation.> Early skin lesions are hypopigmented, ash-leaf shaped macules, red or pink papules (angiofibromas) called adenoma sebaceum on face. These enlarge with age.> Other lesion are shagreen patches, ungal fibromas and oral fibromas.> Adenoma sebaceum is characteristically seen in tuberous sclerosis.


Question: Blood pressure is defined as the product of.

D i.e. Peripheral resistance x cardiac output: Blood pressure is defined as the product of cardiac output and peripheral resistance. Blood pressure = Cardiac output x peripheral resistance or Blood flow (Q) x resistance (R)


Question: Homogenous opacification of right hemithorax with right sided shift of mediastinum may be caused by

Answer is A (Collapse of Right lung): Collapse of Right lung may present with homogeneous opacification of right hemithorax and ipsilateral mediastinal Shift. Condition Findings Consolidation : Ipsilateral Hamogenous opacification & No mediastinal shift Collapse : Ipsilateral Homogenous opacification & Ipsilateral mediastinal shift Hemothorax : Ipsilateral homogenous opacification & Contralateral shift Hydrothorax : Ipsilateral homogenous opacification & Contralateral shift


Question: The treatment of choice for Tension Pneumothorax is

Classical management of tension pneumothorax is emergent chest decompression with needle thoracostomy. A 14-16G intravenous cannula is inseed into the second rib space in the mid-clavicular line. The needle is advanced until air can be aspirated into a syringe connected to the needle Ref Davidson edition23rd pg 627

Wide bore needle inseion in 2nd intercostal space


Question: Gold standard for diagnosing pheochromocytoma is


Question: Most common site of cerebral infarction is in the territory of


Question: Bundle of Kent is associated with

The bundle of Kent is an abnormal extra or accessory conduction pathway between the atria and ventricles that is present in a small percentage (between 0.1 and 0.3%) of the general population. This pathway may communicate between the left atrium and the left ventricle, in which case it is termed a "type A pre-excitation", or between the right atrium and the right ventricle, in which case it is termed a "type B pre-excitation".Problems arise when this pathway creates an electrical circuit that bypasses the AV node. The AV node is capable of slowing the rate of conduction of electrical impulses to the ventricles, whereas the bundle of Kent lacks this capability. When an aberrant electrical connection is made the bundle of Kent, tachydysrhythmias may therefore result. Ref Harrison 20th edition pg 1532


Question: The triad of cirrhosis, hemochromatosis and diabetes are referred to as


Question: The recent terminlogy for status asthmaticus is


Question: Most common complication of Shigellosis

(A) HUS # EXTRAINTESTINAL COMPLICATIONS OF SHIGELLOSIS:> Common complications: Bacteremia HUS: occur with S. dysenteriae type 1 infection. Manifestations of HUS usually develop at end of first week of shigellosis. Oliguria, marked drop in hematocrit are the first signs & progress to anuria with renal failure & to severe anemia with congestive heart failure.> Less common complications: Reactive arthritis> Rare complications: Pneumonia; Meningitis; Vaginitis (in prepubertal girls); Keratoconjunctivitis & "rose spot" rashes.


Question: Absence seizures are characterized on EEG by

EEG shows generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background. Ref - Harrison's internal medicine 20e pg3051-3052, 3060f


Question: A 40 year old presenting with dizziness on standing with systolic reduction of BP of 50mm Hg; appropriate treatment

Graduated compression stockings (GCS) help prevent the formation of blood clots in the legs by applying varying amounts of pressure to different pas of the leg. Thigh or waist-high stockings help reduce pooling of blood in the legs and help prevent lightheadedness or falling when you stand up (ohostatic hypotension). Stockings that rise to just below the knee help limit lower leg swelling due to fluid buildup Ref Davidson 23rd edition pg 450


Question: Carpopedal spasm in hyperventilation occurs because

Answer- C. Increased calcium binding to plasma proteinCarpopedal spasm and tetany is due to hypocalcemia."The alkalosis that result from hyperventilation may worsen the hypocalcemia by increasing the fraction ionized calcium bound to plasma protein.

Increased calcium uptake by sarcoplasmic reticulum of muscles


Question: Cysticercosis present as  a) Seizure  b) Neuropathy  c) Encephalitis  d) Muscular hypertrophy


Question: Risk factor for the development of gastric Carcinoma among the following is

Risk factors are:Long-term ingestion of high concentration of nitrates.H.pyloriIntestinal metaplasia in patients with atrophic gastritis.Gastric ulcers and adenomatous polyps.Menetrier's disease.Patients with blood group A have a higher incidence of Ca stomach than blood group O.Note: duodenal ulcers are not associated with gastric cancer.Ref: Harrison's 18/e 765.


Question: Dose of Reteplase for management of acute MI is

Ref Harrison 19 th ed pg 758 The recommended dose for Reteplase in acute MI is 10 UNIT bolis given over 2 minutes . It is recommended to repeat the second 10 unit dose after 30 minutes . Two bolus doses given 30 minutes apa are recommended.


Question: In a patient with mild ulcerative colitis, mainstay of treatment is

The mainstay of therapy for mild to moderate UC is sulfasalazine and the other 5-ASA agents.The majority of patients with moderate to severe UC benefit from oral or parenteral glucocoicoids.Azathioprine and 6-mercaptopurine (6-MP) are purine analogues commonly employed in the management of glucocoicoid-dependent IBD. Antibiotics have no role in the treatment of active or quiescent UC.Metronidazole is effective in active inflammatory, fistulous, and perianal CD and may prevent recurrence after ileal resection.Ref: Harrison 19e pg: 1960


Question: Iodine requirement in pregnancy and lactation is

Pre school Children - 90 mcg.
School Children ( 6-12 years ) - 120 mcg.
Adults ( > 12 years ) - 150 mcg.
Pregnancy and lactation - 250 mcg.


Question: Gene responsible for resistance to rifampicin

Ans. is 'a' i.e., Rpo B gene ATT Drug Gene responsible for drug resistance INH inhA and Kat G gene Ethambutol emb B gene Rifampicin rpoB gene Pyrazinamide pncA gene


Question: Minamata disease in Japan is caused by toxicity of

(A) Mercury > Minamata disease (Chisso-Minamata disease), is a neurological syndrome caused by severe mercury poisoning. Symptoms include ataxia, numbness in the hands and feet, general muscle weakness, narrowing of the field of vision and damage to hearing and speech. In extreme cases, insanity, paralysis, coma and death follow within weeks of the onset of symptoms. A congenital form of the disease can also affect fetuses in the womb.


Question: Recombinant human insulin is made by


Question: Gestational diabetes develops only during


Question: "Floating tooth sign" seen in

i.e. (Histiocytosis X): (631-Basis pathology 8th) (2201-H 17th) (595-Ghai 7th)"Floating tooth sign " - radiographic examination of the mandible, erosion of the bony alveolus around the teeth, so that they seen to be floating in space. It occurs in some of histiocytosis X** (Internet)HISTIOCYTOSIS - X(Langerhans cell histiocytosis) (LCH)* Malignant proliferations of dendritic cells or macrophages and includes three clinico pathologically related conditions occuring in children - eosinophilic granuloma, Hand-Schiller Christian disease and Letterer - Siwe syndrome* Histiocytosis X comprises a variety of syndrome associated with foci of eosinophilic granuloma, Diabetes insipidus exophthalmos and punched out lytic bone lesions* The hall mark of LCH is the presence of Birbeck granules in the cytoplasm** (rod shaped structure having dilated tennis - racket like terminal end) and positivity for S-100 protein and CD la positivity**** Most common involvement is of the skeleton (80%)Odontogenic Myxoma - locally invasive and recurring tumour characterised by abundant mucoid stroma and loose stellate cellsAmeloblastoma - is the most common benign** but locally invasive epithelial odontogenic tumour* Resemblance to like admantinoma of the tibia**** Follicular pattern is the most common* Commonest site is mandible in the molar ramus areaPindborg tumor - is also known as calcifying epithelial odontogenic tumour. It resembles an ameloblastoma in that it is locally invasive and commonly identified as uni-multilocular swelling in the molar-ramus region* Scattered flecks of calcification throughout the radiolucency give rise to the term Driven SnowAppearance**Eosinophilic granuloma - (108-Dalinert 5th)* Eosinophilic granuloma can cause lytic bevelled lesion or "hole within hole 9 appearance in skull. This is due to assymetric destruction of inner + outer tables* Other characteristic bony lesions(i) 'Floating teeth' - due to lesion in jaw(ii) Vertebra plana or 'coin on edge' appearance due to collapse of vertebra(iii) "punched out lesions "Admantinoma - honey comb appearance, Soap bubble appearance* Radicular cysts (Periapical cysts) - Most common type of jaw cysts**


Question: Atypical antipsychotic with least extrapyramidal side effects

(A) Clozapine # Clozapine:> The risks of extrapyramidal side effects such as Tardive dyskinesia are much less when compared with typical antipsychotics may be due to Clozapine's anticholinergic effects.> Extrapyramidal symptoms subside somewhat after a person switches from another antipsychotic to Clozapine.


Question: Bibasilar velcro crackles occur in

Idiopathic pulmonary fibrosis is defined as a progressive fibrosing interstitial pneumonia of unknown etiology,occurring in adults.With the advent of widespread CT scanning,it may present as an incidental finding in an otherwise asymptomatic individual, but more typically presents with progressive breathlessness(which may have been insidious) and a non-productive cough.Constitutional symptoms are unusual.Clinical findings include finger clubbing and the presence of bi-basal fine late inspiratory crackles likened to the unfastening of Velcro. Crackles are more commonly a sign of alveolar disease.Processes that fill the alveoli with fluid may result in crackles. Fine localised crackles are a sign of parenchymal infiltration. Fine end inspiratory crackles over both lung bases may be an early sign of LVF. Coarse crackles are seen in gross pulmonary edema. MECHANISM OF CRACKLES: Bubbling or flow of air through secretions in the bronchial level. sudden opening of successive bronchioles and alveoli with rapid equalisation of pressure causing a sequence of explosive sounds. Crackles without sputum production indicates interstitial lung disease. Crackles with sputum production indicate parenchymal lung disease. Early inspiratory crackles - CHRONIC BRONCHITIS Mid inspiratory crackles - BRONCHIECTASIS Late inspiratory crackles - ASBESTOSIS, PULMONARY FIBROSIS, PNEUMONITIS, INTERSTITIAL LUNG DISEASE, PULMONARY EDEMA Expiratory crackles - CHRONIC BRONCHITIS, PULMONARY EDEMA Reference:Davidson's Medicine-22nd edition,page no:708,ALAGAPPAN 4TH EDITION PAGE 216,217


Question: Ohodeoxia is a feature of

Answer- B. Hepatopulmonary syndromeOhodeoxia refeis to aerial desaturation noted when sitting uP as opposed to lying down.Conditions associated:A) Cardiac (intracardiac shunt)Atrial septal defect (ASD)Patent foramen ovale (PFO)PneumonectomyUsually associated with pulmonary hypeension or raised right atrial (RA) pressure (e.g. constrictive pericarditis, cardiac tamponade).B) Pulmonary (intrapulmonary right-to-left shunts)HepatopulmonarysyndromePulmonary diseaseCOPDPulmonary embolismC) Upper airway tumourAcute respiratory distress syndromeD) MiscellaneouscausesAutonomic neuropathyAcute respiratory distress syndrome (ARDS)


Question: The diagnositc test for cerebral cysticercosis


Question: Tt/t of choice in status epilepticus

K.D Tripathy essentials of medical pharmacology 7th edition . *Diazepam 10mgi.v inj.at 2mg/min ,repeat once after 10min if required.


Question: Left atrial filling pressure closely approximates


Question: Multiple cavitatory lesion in lungs, hematuria and renal insufficiency are features in a patient with

Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) is characterised by granuloma formation, mainly affecting the nasal passages, airways and kidney. A minority of patients present with glomerulonephritis. The most common presentation of granulomatosis with polyangiitis is with epistaxis, nasal crusting and sinusitis, but haemoptysis and mucosal ulceration may also occur. Deafness may be a feature due to inner ear involvement, and proptosis may occur because of inflammation of the retro-orbital tissue. This causes diplopia due to entrapment of the extra-ocular muscles, or loss of vision due to optic nerve compression. Disturbance of colour vision is an early feature of optic nerve compression. Untreated nasal disease ultimately leads to destruction of bone and cailage. Migratory pulmonary infiltrates and nodules occur in 50% of patients (as seen on high-resolution CT of lungs). Patients with granulomatosis with polyangiitis are usually proteinase-3 (PR3) antibody-positive (ELISA).Pulmonary involvement may be manifested as asymptomatic infiltrates or may be clinically expressed as cough, hemoptysis, dyspnea,and chest discomfo. It is present in 85-90% of patients. Endobronchialdisease, either in its active form or as a result of fibrous scarring, maylead to obstruction with atelectasis . Renal disease (77% of patients) generally dominates the clinical picture and, if left untreated, accounts directly or indirectly for most of themoality rate in this disease. Although it may smolder in some casesas a mild glomerulitis with proteinuria, hematuria, and red blood cellcasts, it is clear that once clinically detectable renal functional impairment occurs, rapidly progressive renal failure usually ensues unlessappropriate treatment is institutedPatients with active disease usually have a leucocytosis with elevated CRP, ESR and PR3. Complement levels are usually normal or slightly elevated. Imaging of the upper airways or chest . Ref - Davidsons 23e p1041 , harrisons 20e p2578,2579


Question: Ankylosing spondylitis

(A) (HLA B27) (1093 - Davidson 21st)ANKYLOSING SPONDYLITIS JOINTS AND SPINE* Predominating effecting the sacroiliac joints and spine* HLA-B27 positive* Increased facel carriage of Klebsiella aerogens occurs in patients with established as and may relate to exacerbation of both joint and eye disease.* Low back pain and marked stiffness* Symptoms are more marked in the early morning and after inactivity, and are relieved by movement.* Although the lumbosacral area is usually the first and worst affected region.* Planter fasciitis, achilis tendinitis and tenderness over bony prominences. Such as the iliac crest and greater trochanter are common reflecting inflammation at the sites of tendon insertion (Enthesitis or Osteitis)*** The modified Schober test is a useful measure of lumber spine flexion.* Most serious complication of the spinal disease is spinal fracture.* Most common extraarticular manifestation is acute anterior uveitis.EXTRA ARTICULAR FEATURES OF AS* Anterior uveitis and conjunctivitis* Prostatitis usually asymptomatic* Cardiovascular disease> Aortic incompetence> Mitral incompetence> Cardiac conduction defects> Pericarditis* Amyloidosis, psoriasis* Atypical upper lobe pulmonary fibrosis* Retroperitoneal fibrosis* Cauda equina syndromeRadiographic features:* Sacroilitis is often first abnormality.* Earliest changes by standard radiography are blurring of the cortical margins of the subchondral bone.* Anterior "squaring" of vertebrae due to erosion and sclerosis of the anterior comers and periositis of the waist.* "Bamboo Spine" (Bridging the adjacent vertebral bodies).* Osteoporosis and atlanto-axial dislocation can occur as late features.HLA - B 27 is associated with1. Ankylosing spondylitis2. Reiter's syndrome3. Reative arthritis (Yersinia, salmonella, Shigella, Chlamydia)4. Psoriatic spondylitis5. Acute anterior uveitisOther conditions associated with HLA'sHLA B-8 - M. gravisHyperthyroidismDW-4 / DR4- Rheumatoid arthritis P. VulgarisHLA DR 3 - Glutein sensitive enteropathyDiabetes mellitus type IM. gravis chromic active hepatitisHLA - B5 - Bechet's syndromeHLA - DR2 - Narcolepsy, Good pasture's syndrome Multiple selerosis


Question: Pseudochylous pleural effusion is seen in

In chronic effusion like tubercular/rheumatoid ahritis fluid rich in cholesterol mimicking chyle accumulates. Chyliform (pseudochylous) pleural effusion. Author information: A chyliform (pseudochylous) effusion is an uncommon disease entity which develops after an exudative effusion is in situ for a long time. It is commonly initiated by a tuberculous pleurisy and it is impoant to exclude the presence of active tuberculosis Ref Davidson edition23rd pg 626


Question: The commonest histological finding in Hypeensive Nephrosclerosis is

"Hypeensive Nephrosclerosis"Lesser degrees of hypeension induce less severe, but prevalent changes in kidney vessels and loss of kidney function; a large poion of patients reaching ESRD without a specific etiologic diagnosis are assigned the designation "hypeensive nephrosclerosis".Characterised by afferent aeriolar thickening with deposition of homogeneous eosinophilic material (hyaline aeriolosclerosis) associated with narrowing of vascular lumina.Similar vessel changes are associated with aging, dyslipidemia, and glucose intolerance. Antihypeensive therapy slows the progression of proteinuric kidney diseases and reduces the excessive cardiovascular risks associated with CKD, but it does not alter the course of kidney dysfunction identified specifically as hypeensive nephrosclerosis.Ref: Harrison's 18/e p2047


Question: Joint erosions are not a feature of


Question: Down's syndrome is

Ans. c (Trisomy). (Ref Harrison, Medicine, 18th/Ch. 62. Chromosome Disorders)Clinically, the most important of numerical abnormality is trisomy 21, the most frequent cause of Down syndrome.Depending on the maternal age structure of the population and the utilization of prenatal testing, the incidence of trisomy 21 ranges from 1/600 to 1/1000 livebirths, making it the most common chromosome abnormality in live-bom individuals.Like most trisomies, the incidence of trisomy 21 is highly correlated with maternal age, increasing from about 1/1500 livebirths for women 20 years of age to 1/30 for women 45 years.In addition to trisomy 21, only two other autosomal trisomies, 13 and 18, occur with any frequency in livebirths.Incidence rates for trisomies 13 and 18 in livebirths are 1/20,000 and 1/10,000, respectively. Unlike trisomy 21 that is associated with near-normal life expectancy, both trisomies 13 and 18 are associated with death in infancy, typically occurring during the first year of life.Three sex chromosome trisomies the 47,XXX, 47,XXY (Klinefelter's syndrome), and 47,XYY conditions are quite common, with each occurring in about 1/2000 newborns. Of all the trisomic conditions, three have fewest phenotypic complications. In fact, with the exception of infertility in klinefelter's sundrome, it is likely that most individuals with such trisomies may go undetected.TableNumerical chromosomal abnormalities includePolyploidye.g. triploidy = haploid x 3 (69XYY =23x3 common but lethal)AneuploidyAny chromosome number, which is not an exact multiple of haploid number e.g., Down syndrome 47 XY+ 21 or Klinefelter syndrome 47 XXY.TrisomyState of having three representatives of a given chromosome instead of the usual pair, as in trisomy 21 (Down syndrome).


Question: Atrial Natriuretic Peptide (ANP) causes

(A) | Blood volume# Atrial distention and/or a sodium load cause release into the circulation of atrial natriuretic peptide (ANP), a polypeptide; a high-molecular-weight precursor of ANP is stored in secretory granules within atrial myocytes.> Release of ANP causes:> Excretion of sodium and water by augmenting glomerular filtration rate, inhibiting sodium reabsorption in the proximal tubule, and inhibiting release of renin and aldosterone; and> Arteriolar and venous dilatation by antagonizing the vasoconstrictor actions of All, AVP, and sympathetic stimulation. Thus, ANP has the capacity to oppose sodium retention and arterial pressure elevation in hypervolemic states.# ANP is secreted in response to: Stretching of the atrial wall Reduced Sympathetic stimulation of b-adrenoceptors Raised sodium concentration (hypernatremia), though sodium concentration is not direct stimulus for increased ANP secretion Angiotensin-II Endothelin, a potent vasoconstrictor Exercise


Question: In Asthma patient positive bronchodilator reversibility test is indicated by

Answer- B. Increase in FEV1 > 12% after SABA inhalation Bronchial reversibility is defined as SABA induced increase in FEVI > 12% and > 0.20 litres (200 ml)

Increase in FEV1 > 5% after SABA inhalation

Increase in FEV1 > 25% after SABA inhalation

Increase in FEV1 > 50% after SABA inhalation


Question: ECG with ST elevation on VI V2, the diagnosis is

(A) Hyperkalemia # ST Elevation:> Most important cause of ST segment elevation is acute Ischemia. Other causes are: Early repolarization Acute pericarditis: ST elevation in all leads except aVR Pulmonary embolism: ST elevation in V1 and aVR Hypothermia: ST elevation in V3-V6, II, III and aVF Hypertrophic cardiomyopathy: V3-V5 (sometimes V6) High potassium (hyperkalemia): V1-V2 (V3) During acute neurologic events: all leads, primarily V1-V6 Acute sympathic stress: all leads, especially V1-V6 Brugada syndrome. Cardiac aneurysm. Cardiac contusion Left ventricular hypertrophy Idioventricular rhythm including paced rhythm.


Question: A patient develops hepatosplenomegaly, lymphadenopathy following sexual contact, 3 weeks back. The best test to rule out HIV infection is

the p24 antigen is the earliest marker for HIV infections.
Acute HIV syndrome develops 3-6 weeks after the infection.
The acute HIV syndrome represents the initial or primary response of an immunocompetent adult to the HIV infection.
It is characterized by a high level of virus production, viremia and widespread seeding of the lymphoid tissue.
During this phase, the virus can be rapidly isolated from the blood and there are high levels of HIV p.24 Ag in the serum.
Thus, this phase of HIV infection is detected by demonstrating p24 Ag of the HIV virus.
The HIV antibody-based test such as ELISA and western blot cannot be used for diagnosing this phase of infection because the immune response has not yet developed.
Soon, however, a virus-specific immune response develops evidenced by seroconversion (development of antibody).
The seroconversion usually occurs within 3-7 weeks of presumed exposure.
 Once the antibody develops, the antibody-based tests ELISA and western blot are used in the diagnosis.


Question: Parinaud syndrome is caused by damage to

Answer- B. Posterior commisureAlso known as dorsal midbrain syndrome, this is a distinct supranuclear veical gaze disorder caused by damage to the posterior commissure.Pineal region tumors, cysticercosis, and stroke also cause Parinaud's syndrome.


Question: The Recommended treatment of early diabetic nephropathy manifested by microalbuminuria is

Answer is C (Strict glycemic control, Low protein Diet, ACE Inhibitors): Recommended intervention for early diabetic nephropathy manifested by microalbuminuria include glycemic control, strict blood pressure control, ACE Inhibitors/ARB and low protein diet. The Recommendation for treatment of early diabetic nephropathy manifested by microalbuminuria is to delay the progression from microalbuminuria to macroalbuminuria Effective Recommended Interventions i. diabetic patiMilar oalbuminuria Immproved Glycemic control (Normalization of glycemia) Strict Blood Pressure Control (Blood pressure aim < 125/75) ACE Inhibitors and/or Angiotensin Receptor Blockers (Provide drug specific benefit independent of blood pressure control) Modest Reduction in Protein Intake (0.8g/kg /day)

Strict glycemic control and Low Protein Diet

Strict glycemic control, Low protein Diet and ACE Inhibitors


Question: Most appropriate drug used in the management of chelating iron in beta thalassemia major is

Deferiprone and Deferasirox are oral chelators used for beta-thalassaemia. Reference : Medicine, Prep Manual for UG, George Mathew, 5th Edition, page no : 33.


Question: Site specific recombination is

Inversion in same orientation / Non precise


Question: Drug of choice in sarcoidosis is

Management of sarcoidosis Patients who present with acute illness and erythema nodosum should receive NSAIDs and, on occasion, a sho course of glucocoicoids. The majority of patients enjoy spontaneous remission and so, if there is no evidence of organ damage, systemic glucocoicoid therapy can be withheld for 6 months. However, prednisolone (at a staing dose of 20-40 mg/day) should be commenced immediately in the presence of hypercalcaemia, pulmonary impairment, renal impairment and uveitis. Topical glucocoicoids may be useful in cases of mild uveitis, and inhaled glucocoicoids have been used to shoen the duration of systemic glucocoicoid use in asymptomatic parenchymal sarcoid. Patients should be warned that strong sunlight may precipitate hypercalcaemia and endanger renal function. Features suggesting a less ourable outlook include age over 40, Afro-Caribbean ethnicity, persistent symptoms for more than 6 months, the involvement of more than three organs, lupus pernio and a stage III/IV chest X-ray. In patients with severe disease, methotrexate (10-20 mg/week), azathioprine (50-150 mg/day) and specific tumour necrosis factor alpha (TNF-a) inhibitors have been effective. Chloroquine, hydroxychloroquine and low-dose thalidomide may be useful in cutaneous sarcoid with limited pulmonary involvement. Selected patients may be referred for consideration of single lung transplantation. The overall moality is low (1-5%) and usually reflects cardiac involvement or pulmonary fibrosis. ref - Davidsons 23e p608-610


Question: Immediate antagonism of the cardiac effects of hyperkalemia is done by

Intravenous calcium serves to protect the hea. Calcium raises the action potential threshold and reduces excitability, without changing the resting membrane potential. By restoring the difference between resting and threshold potentials, calcium reverses the depolarization blockade due to hyperkalemia. The recommended dose is 10 mL of 10% calcium gluconate (3-4 mL of calcium chloride), infused intravenously over 2-3 min with cardiac monitoring. Ref: Harrison 19e pg: 312


Question: A middle aged female repoed with dull diffuse progressive headache of 2 months duration associated with episodes of vomiting and blurred vision at times. Cough increases the headache.Likely patient has

A space-occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypeension include: A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related headache, or headache waking the patient from sleep Ref Harrison20th edition pg 2456


Question: Diagnostic feature of CRF is

Ans. is 'a' i.e., Broad casts in urine Casts ? Urinary casts are formed only in the distal convoluted tubulee (DCT) or the collecting dude (distal nephron). The proximal convoluted tubule and loop of henle are not the locations for cast formation. Casts are formed through the solidification of materials in the tubules of nephrons Later the material is flushed out of the kidney upon the production of more urine leaving a small solidified microscopic cylinder that can also contain what ever other materials that might be within the tubules of the kidneys at the time of cast formation. The microscopic detection of various types of casts can often be helpful diagnostic tool in the study of various types of renal diseases


Question: Most common cause of death in dialysis patient

Cardiovascular disease constitutes the major cause of death in ESRD (rates are higher in patients receiving dialysis than in post transplantation pts) . causes are :associated risk factors (DM, HTN...), changes in extracellular volume, alterations in cardiovascular dynamics during dialysis treatment . Hypotension is the most common acute complication of HEMODIALYSIS paicularly among diabetic pts. Major complications of peritoneal dialysis -peritonitis, weight gain, residual uremia. Ref:Harrison 20th edition pg no.2125,2124


Question: Interstitisl lung disease is seen in

Pulmonary involvement in Systemic sclerosis Pulmonary hypeension complicates long-standing disease and is six times more prevalent in lcSScl than in dcSScl. It usually presents with insidiously evolving exeional dyspnoea and signs of right hea failure. Interstitial lung disease is common in patients with dcSScl who have topoisomerase 1 antibodies (Scl70). Dyspnoea can evolve slowly over time or rapidly in occasional cases. Ref - Davidsons 23e p1038


Question: Perl's stain is used to demonstrate

(B) Haemosiderin > Hemosiderosis: With progressive accumulation of hemosiderin, parenchymal cells throughout the body (principally in the liver, pancreas, heart, & endocrine organs) become pigmented, iron can be visualized in tissues by the Prussian blue histochemical reaction, in which colorless potassium ferrocyanide is converted by iron to blue-black ferric ferrocyanide.> Perl's Prussian Blue Stain for Iron-Positive Cells (e.g., activated macrophages) (a.k.a. Perl's acid ferrocyanide reaction)


Question: Refractory gastric ulcer is defined as.

Refractory gastric ulcer - Fails to heal by 3 month of regular proper dose PPI (Reason could be - Zollinger Ellison syndrome) Refractory Duodenal Ulcer : > 8 weeks with regular PPI Treatment Refractory Gastric Ulcer : > 12 weeks

Ulcer that fails to heal despite 4 weeks of regular proper dose PPI

Ulcer that fails to heal despite 8 weeks of regular proper dose PPI

Ulcer that fails to heal despite 12 weeks of regular proper dose PPI

Ulcer that fails to heal despite 16 weeks of regular proper dose PPI


Question: The drug of choice in Status epilepticus is

(A) # Status epilepticus is a medical emergency.> Initial management includes maintenance of the airway and 50% dextrose (25-50 mL) intravenously in case hypoglycemia is responsible. If seizures continue, 10mg of Diazepam is given intravenously over the course of 2 minutes, and the dose is repeated after 10 minutes if necessary.> Alternatively, a 4 mg intravenous bolus of lorazepam, repeated once after 10 minutes if necessary, is given in place of diazepam.> This is usually effective in halting seizures for a brief period but occasionally causes respiratory depression.


Question: A young lady complains of sudden onset of palpitations, extreme weakness and sweating. On examination, she was found to have B.P. 90/70 with a regular pulse rate of 180/minute. Her symptoms disappeared after vomitting but she complained of polyuria. The most likely diagnosis is


Question: Biomarker not involved in acute kidney injury is


Question: Risk factors for coronary aery disease

Ref Harrison 19 th ed pg 1579 The major risk factors for atherosclerosis (high levels of plasma low-density lipoprotein , low plasma high-density lipoprotein , cigarette smoking, hypeension, and diabetes mellitus disturb the normal functions of the vascular endothelium.


Question: Most common presentation of hepatitis A is

Hepatitis A Clinical symptoms then develop, often with a presentation similar to that of gastroenteritis or a viral respiratory infection. The most common signs and symptoms include fatigue, nausea, vomiting, fever, hepatomegaly, jaundice, dark urine, anorexia, and rash Ref Harrison20th edition pg 990


Question: Oxalate crystals in urine is seen in poisoning with

Ans: b (Ethylene glycol)Ref: Harrison, 17 ed. pg. 291, Davidson 21 ed. pg.Ethylene glycol poisoning (Antifreeze)Ethylene glycol is metabolized into glycoaldehyde, glycolic acid, glycoxylic acid, oxalic acid causing metabolic acidosis; oxalate causes renal damage due to calcium oxalate crystals in urine.C/F: Ophthalmpoplegia, cranial nerve palsies, myoclonus, hyporeflexia renal failureManagement* Assay not widely available* Diagnosed by the presence of high anion gap, osmolal gap> 10 mOsm and presence of oxalate crystals in urine* Antidote - Oral ethanol, Fomipazole -Inhibit alcohol dehydrogenase* Hemodialysis in severe cases* Hypocalcaemia treated only if severe ECG changes/ seizures present


Question: Commonest lesion in middle mediastinum is


Question: Suicide tendency are common in

B. (Depression) (236- 37 - Neeraj Ahuja 6th)SUICIDE is a type of deliberate self harm (DSH) and is defined as a human act of self - intentioned and self inflicted cessation (death) It ends with a fatal out comeRISK FACTORS FOR SUICIDE1. Age > 40 years2. Male sex3. Staying single4. Preveious suicidal attempts5. Depression (risk about 25 times more than usual)i. Presence of guilt, self - accusation agitation, nihilistic ideation, worthlessness, hypochondriacal delusions and severe insomniaii. More at the beginning or towards the end of a depressive episodes6. Suicidal preoccupation (eg a "suicide note" is written or detailed plans are made for committing suicide)7. Alcohol or drug dependence8. Severe disabling, painful or untreatable physical illness9. Recent serious-loss or major stressful life event10. Social isolation


Question: Cause of vasodilatation in spider nevi

Spider angiomas form due to failure of the sphincteric muscle surrounding a cutaneous aeriole. The central red dot is the dilated aeriole and the red "spider legs" are small capillaries carrying away the freely flowing blood. If momentary pressure is applied, it is possible to see the emptied capillaries refilling from the center. No other angiomas show this phenomenon. The dilation, in turn, is caused by increased estrogen levels in the blood. Many pregnant women and women using hormonal contraception have spider angiomas, which is due to high estrogen levels in their blood. Individuals with significant liver disease also show many spider angiomas, as their liver cannot metabolize circulating estrogens, specifically estrone, which derives from the androgen androstenedione Ref - Wikipedia https://en.m.wikipedia.org/wiki/Spider_angioma


Question: Most common cause of death in diphtheria is due to

Answer- B. Toxic cardiomyopathyMost common cause of death in diphtheria cardiomyopathy


Question: In SLE, characteristic kidney lesion is

Answer is C (Wire loop lesions): Wire loop lesions are characteristic of SLE Wire loop lesions: Wire loop lesions represent local PAS - Positive thickening of glomerular capillary walls and are characteristically sen in Lupus Nephritis (SLE) These lesions result from subendothelial deposits between endothelium and basement membrane. When extensive and confluent, these subendothelial deposits create a homogenous thickening of the capillary wall which can be seen in light microscopy as 'Wire loop lesion' Wire loop lesions are most characteristic of Lupus Nephritis Class IV or Diffuse Lupus Nephritis These may however also be seen in Class III (Focal Lupus Nephritis) and Class V (membranous) Lupus Nephritis.


Question: Hemoglobin Poland is best defined as

Answer- C. Zeta 2 : Gamma 2Hb Gower I - Zeta 2 / epsilon 2Hb Poland - Zeta 2 / gamma 2Hb Gower II - Alpha 2 / epsilon 2


Question: Cause of salt Losing Nephropathy

Causes :
Reflux Nephropathy.
Interstitial nephropathy.
Post - obstructive uropathy.
Medullary Cystic disease.
Recovery phase of ATN.

Maintenance phase of acute tubular necrosis

Post  - Streptococcal Glomerulonephritis


Question: Most common tumour of the posterior cranial fossa is


Question: Kviem siltzbach test is used in the diagnosis of

Ans. is'b'i.e., Sarcoidosis Kveim-Siltzbath skin test It is a useful intradermal diagnostic test The antigen is prepared from involved lymph node or spleen is injected intradermally In a positive test, nodular lesions appears in 3-6 weeks at the inoculation site, which on microscopic examination shows presence of noncaseating granulomas (sarcoidosis like lesions) The kviem siltzbath material is no longer available and with the use of transbronchial biopsy to obtain lung parenchvm for diagnostic purposes, the kviem siltzbath test is only of historic interest. Laboratory anomalies Common abnormalities in the blood include Lymphocytopenia, mild eosinophilia Increased E.S.R., hyperglobulinemia Elevated level of ACE False positive tests for rheumatoid factor or ANA's Hypercalccmia or an elevated 24 hr urine calcium level The lung function abriormalties of sarcoidosis are typical for interstitial Lung diseaseQ and include decreased lung volumes with and diffusing capacity with a normal or supernormal ratio of the forced expiratory volume in is to the forced vital capacity. Also know Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi and small blood vessesls. Pleura is involved in 1-5% of cases almost always manifesting as unilateral pleural effitsionso. The effusions usually clear within a few week. Pneumothorax of hydropneumothorax is observed in sarcoidosis but is very rare.


Question: Mechanism of action of metformin is

Agents Used for Treatment of Type 1 or Type 2 Diabetes Mechanism of Action Examples HbA Reduction (%) Agent-Specific Advantages Agent-Specific Disadvantages Contraindications Oral Biguanides |Hepatic glucose production Metformin 1-2 Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV events Diarrhea, nausea, lactic acidosis Serum creatinine > 15 mg/dL (men) >1.4 mg/dL (women) (see text), CHF, radio graphic contrast studies, hospitalized patients, acidosis Renal/liver disease a-Glucosidase inhibitors |GI glucose absorption Acarbose, miglitol, voglibose 0.5-0.8 Reduce postprandial glycemia GI flatulence, liver function tests Renal/liver disease Dipeptidyl peptidase IV inhibitors Prolong endogenous GLP-1 action Alogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, vildagliptin 0.5-0.8 Well tolerated, do not cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedema Insulin secretagogues: Sulfonylureas |Insulin secretion Glibornuride, gliclazide, glimepiride, glipizide, gliquidone, glyburide, glyclopyramide 1-2 Sho onset of action, lower postprandial glucose, inexpensive Hypoglycemia, weight gain Renal/liver disease Insulin secretagogues: Nonsulfonylureas |Insulin secretion Nateglinide, repaglinide, mitiglinide 0.5-1.0 Sho onset of action, lower postprandial glucose Hypoglycemia Renal/liver disease Sodium-glucose cotranspoer 2 inhibitors |Urinary glucose excretion Canagliflozin, dapagliflozin, empagliflozin 0.5-1.0 Insulin secretion and action indepentant Urinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemia Limited clinical experience; moderate renal insufficiency Thiazolidinediones |Insulin resistance, |glucose utilization Rosiglitazone, pioglitazone 0.5-1.4 Lower insulin requirements Peripheral edema, CHF, weight gain, fractures, macular edema CHF, liver disease Ref: Harrison 19e pg: 2414


Question: An upper motor neuron (UMN) lesion involving cranial nerve VII would most likely produce

The physical finding of facial asymmetry is suggestive of an abnormality involving the facial nerve (CN VII). The facial nucleus, which is located within the pons, is divided in half, the upper neurons innervate the upper muscles of the face, while the lower neurons innervate the lower poion of the face. It is impoant to realize that each half receives input from the contralateral motor coex, while only the upper half receives input from the ipsilateral motor coex. Therefore an upper motor neuron (UMN) lesion will produce a defect involving only the contralateral lower half of the face. Causes of UMN lesions involving the facial nerve includes strokes that involve the coex or the internal capsule. In contrast, lesions that affect the facial nerve from the facial nucleus to the remaining length of the nerve result in LMN lesions. Patients present with facial asymmetry involving the ipsilateral upper and lower quadrants. Lesions to the facial nerve within the facial canal (frequently due to cold weather) cause Bell's palsy. Patients present with paralysis of all muscles of facial expression. Bell's phenomenon refers to the finding of the affected eye looking up and out when patients try to close their eyes. Because the lacrimal punctum in the lower eyelid moves away from the surface of the eye, lacrimal fluid does not drain into the nasolacrimal duct. This produces "crocodile tears." ref - pubmed.com

Contralateral weakness of the lower half of the face with sparing of the upper half of the face

Decreased gag (pharyngeal) reflex with decreased taste sensation from the posterior one-third of the tongue

Hemianesthesia of the face with flaccid paralysis of the muscles of mastication

Ipsilateral anosmia with primary amenorrhea in females


Question: Hemiplegia is most commonly caused by thrombosis of


Question: Select the best initial treatment for a patient with Behcet syndrome and ocular involvement

Diagnostic Criteria of Behcet's Syndrome Recurrent oral ulceration Plus 2 of the following: Recurrent genital ulceration Ocular lesions Skin lesions Positive Pathergy test Rx: Condition Treatment Lesion in uveal/ oral cavity Topical Steroids CNS/ocular Systemic steroids Serious cases Thalidomide Recent study Apremilast(Phosphodiesterase-4 inhibitor) Mucocutaneous manifestations ,Ahritis Colchicine

Topical glucocoicoids to the oral ulcers and conjunctiva


Question: The most common physical sign of cerebral metastasis

*in brain metastases,presentation is with headaches(40-50%),focal neurological deficit(20-40%),coognitive dysfunction(35%),seizures(10-20%) and papilledema(<10%). A focal neurologic deficit is a problem with nerve, spinal cord, or brain function. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits Ref Harrison20th edition pg 2764


Question: Electrical alterans in ECG is characteristic of


Question: Normal PCWP with pulmonary oedema is seen in

Ref Harrison 19 th ed pg 1763 The use of a Swan-Ganz catheter permits measurement of PCWP and helps differentiate high-pressure (cardiogenic) from normal- pressure (noncardiogenic) causes of pulmonary edema. High altitude has been grouped together as one of the miscellaneous causes for ARDS reflecting pulmonary oedema with a normal PCWP


Question: Investigation of choice for detection and characterization of interstitial lung disease is

High Resoluon CT (HRCT) is investigation of choice for interstitial lung disease as it can delineate the lung parenchyma upto the level of secondary pulmonary lobule.


Question: Treatment of choice for hairy cell leukaemia is

The first-line therapy for hairy cell leukemia is cladribine, 0.1 mg/kg/d by continuous intravenous infusion for 7 days. The drug can be administered on an outpatient basis with a pump, after placement of a percutaneous intravenous central catheter (PICC). Ref Harrison 20th edition pg 544


Question: The treatment of choice in acute hyperkalemia of life threatening to cardiac myocytes is

Ans. is `a' i.e. Infusion of calcium gluconate


Question: Mass Chemoprophylaxis is given for


Question: Most radiosensitive brain tumour is

pediatric ependymomas, GTR with adjuvant local radiotherapy has been established as the standard treatment, especially for tumors located in the posterior fossa . Radiotherapy is an impoant treatment modality due to the radiosensitivity of ependymomas. Ref Harrison20th edition pg 1316


Question: Brown tumour is found in

(Hyper parathyroidism) (990- CMDT-08) (1765-H17th)Hyper parathyroidism causes a loss of cortical bone and again of trabecular bone. Osteitis fibrosa cystica may present as pathologic fracture or as "brown tumours " or cysts of Jaw.More commonly, patients have bone pain and arthralgia


Question: Most common cause of embolic stroke is

Ans. is 'a' i.e., Intra-Cardiac Thrombi The most common cause of embolic strokes are Intra-cardiac Thrombi. The most common sources of systemic embolism and embolic stroke are Intra-cardiac thrombi formed as a result of atrial fibrillation, ST-elevation MI, left ventricular dysfunction or hea failure.

Paiculate matter from IV drug injections


Question: The most definitive method of diagnosing pulmonary embolism is

Pulmonary aeriography is the most definitive method of diagnosing pulmonary embolism.Chest CT with contrast has viually replaced invasive pulmonary angiography as a diagnostic test.A definitive diagnosis of PE depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion("cut-off") of vessels,segmental oligemia or avascularity,a prolonged aerial phase with slow filling,and touous,tapering peripheral vessels. Reference:Harrison's medicine-18th edition,page no:2174.

Radioisotope perfusion pulmonary scintigraphy


Question: The most common cause of death in patients in Marfan syndrome patients is

Between 75% and 85% of patients with the Marfan syndrome have dilatation of the ascending aoa and annuloaoic ectasia (dilatation of the aoic sinuses and annulus). Such aoic abnormalities are the most common cause of death among patients with Marfan syndrome ref - Harrisons 20edition pg1918,2975,829


Question: Most common cause of Acute pancreatitis is

B. i.e. (Biliary calculus) (2006-HI7th)* Gall stone is the most common cause (30 - 60%)* Alcohol is the second most common cause (15 - 30%)* Pancreatic pseudocysts occurs most commonly after - Pancreatitis*** Gall stone pancreatitis has the best prognosis**Common causes of Acute Pancreatitis* Gall stones (Including microlithiasis) commonest cause* Alcohol (Acute and chronic alcoholism)* Hypertriglyceridemia* ERCP after biliary manometry* Trauma (especially blunt abdominal trauma)* Post operative (Abdominal and non abdominal operations* **Drugs (Azathioprine, 6 mercaptopurine, sulphonamide estrogens, Tetracyclines, valproic acid anti- HIV medications)* Sphincter of oddi- dysfunction


Question: Pigmented "muddy brown" granular cast is characteristic of

AKI from ATN due to ischemic injury, sepsis, or ceain nephrotoxins has characteristic urine sediment findings: pigmented "muddy brown" granular casts and tubular epithelial cell casts. These findings may be absent in more than 20% of cases Ref: Harrison 19e pg: 1805


Question: Aoic dissection is associated with

The factors that predispose to aoic dissection include systemic hypeension, a coexisting condition in 70% of patients, and cystic medial necrosis. Aoic dissection is the major cause of morbidity and moality in patients with Marfan syndrome ( Chap. 363 ) and similarly may affect patients with Ehlers-Danlos syndrome. The incidence also is increased in patients with inflammatory aoitis (i.e., Takayasu's aeritis, giant cell aeritis), congenital aoic valve anomalies (e.g., bicuspid valve), coarctation of the aoa, and a history of aoic trauma. In addition, the risk of dissection is increased in otherwise normal women during the third trimester of pregnancy. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2063


Question: Kartagener’s syndrome is characterized by A/E

Kartagener's syndrome is characterized bv triad of:-
 Situs inversus
 Chronic sinusitis
Bronchiestasis It is a subset of primary ciliary dyskinesia Primary ciliary dyskinesia
Primary ciliary dyskinesia (PCD, also called the immotile-cilia syndrome) is characterized by congenital impairment of mucociliary clearance (MCC).
 Clinical manifestations include:-
 Chronic cough
 Chronic rhinitis and
Chronic sinusitis
Otitis and otosalpingitis (common in childhood)
 Nasal polyposis and agenesis of the frontal sinuses


Question: A Patient presented with Hypokalemia, Severe Hypertension, and Metabolic Alkalosis. The diagnosis is

(A) Liddle syndrome[?]Liddle's Syndrome: Autosomal dominant & is characterized by activating mutation of collecting duct Na+ channel with enhanced sodium reabsorption.oLow renin, low aldosterone levels.oClinical picture mimics Primary Hyperaldosteronism: Hypertension, Hypokalemia & Alkalosis.oIncreased activity of the Epithelial Sodium Channel (E-Na Ch):-Activating kidneys to excrete potassium retaining excessive sodium & water, leading to hypertension.-Classically manifest severe hypertension with hypokalemia, unresponsive to spironolactone yet sensitive to amiloride.oHypertension & hypokalemia are, however, variable aspects of the Liddle's phenotype; more consistent features include a blunted aldosteirone response to ACTH & reduced urinary aldosterone excretion.oIt is a 'gain of function' mutation in the gene encoding ENaC of the collecting tubule resulting in autonomous function of these channel without the influence of aldosterone.oCan be differentiated from Primary Hyperaldosteronism by normal Na+ level and low aldosterone and reninOther OptionsCONGENITAL HYPOKALEMIA ASSOCIATED SYNDROMES[?]Bartter's Syndrome (BS):-Loss of the transport functions of the TALH nephron segments causes hereditary hypokalemic alkalosis.-Typically suffer from polyuria & polydipsia, due to the reduction in renal concentrating ability. May have an increase in urinary calcium excretion & 20% are hypomagnesemia-Marked activation of the renin-angiotensin-aldosterone axis.-Antenatal patients suffer from marked electrolyte wasting, polyhydramnios, and hypercalciuria with nephrocalcinosis; renal prostaglandin synthesis and excretion are significantly increased, accounting for much of the systemic symptoms.-Presence of five disease genes for BS, all of them functioning in some aspect of regulated Na+,K+ & Cl- transport by the TALH.[?]Gitelman's Syndrome (GS):-Loss of the transport functions of the DCT nephron segments causes hereditary hypokalemic alkalosis.-Genetically homogeneous, caused almost exclusively by loss-of-function mutations in thiazide-sensitive Na+-Cl- co transporter of DCT.-Uniformly hypomagnesemic & exhibit marked hypocalciuria, rather than the hypercalciuria typically seen in BS; urinary calcium excretion is thus a critical diagnostic test in GS.-May suffer from chondrocalcinosis, an abnormal deposition of Calcium Pyrophosphate Dihydrate (CPPD) in joint cartilage.[?]Distal Renal Tubular Acidosis:-Defects in multiple renal tubular transport pathways are associated with hypokalemia.-Loss-of-function mutations in subunits of the acidifying-H+-ATPase in alpha-intercalated cells cause hypokalemic distal renal tubular acidosis, as do many acquired disorders of the distal nephron.[?]Cushing's Syndrome:-Hypokalemia may also occur with systemic increasing in glucocorticoids.-Increase in pituitary ACTH incidence of hypokalemia is only 10%, whereas, 60-100% in patients with ectopic secretion of ACTH.


Question: A child has cyanotic disease with left ventricular enlargement wiht left axis deviation. Probable diagnosis is


Question: Cytotoxic T cells induced by infection with virus A will kill target cells

The CD8+ cytotoxic T cells have antigen specific T-cell receptors (TCR) on their membranes that will recognize and bind to self class I antigens. Since the viral peptides are presented as a complex with the self class I antigens, the CD8+ cells can now recognize and react to the virus A peptides. Remember that class I antigens are expressed on all nucleated cells and platelets. Ref: Levinson W. (2012). Chapter 58. Cellular Basis of the Immune Response. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

From the same host infected with any virus

Infected by virus A and identical at class I MHC loci to the cytotoxic T cells

Infected by virus A and identical at class II MHC loci to the cytotoxic T cells

Infected with any virus and identical at class I MHC loci to the cytotoxic cells


Question: This sound is produced during the closure of the semilunar valves.

B: The second heart sound can be represented by dupp. It occurs at the beginning of ventricular diastole and results from the closure of the semilunar valves.
A: The first heart sound can be represented by the syllable lubb. It occurs at the beginning of ventricular systole and results from closure of the AV valves.


Question: Moth eaten alopecia is seen

The hair loss can be moth-eaten, diffuse or both. The "moth-eaten" pattern is the most common type and is considered to be a pathognomonic manifestation of secondary syphilis. The alopecia, which is nonscarring, can occasionally affect hair-bearing areas other than the scalp Ref Davidson 23rd edition pg 238


Question: Angina pectoris is best diagnosed by

Ans. A. HistoryAngina Pectoris is best diagnosed by history.a. This is due to myocardial ischemia and presents as a central chest tightness or heaviness (Levine sign) which is brought on by exertion and relieved by rest.b. It may radiate to one or both arms, the neck, jaw or teeth. Atherosclerosis is the most common cause of CAD.c. ECG and Echo may be normal and cardiac enzyme are usually not raised in angina.


Question: Most common cause of Auto splenectomy

A,b,C are causes of Auto splenectomy m/c cause is sickle cell anemia.


Question: Cyanosis cannot occur in severe anaemia because

Cyanosis seen when deoxygenated hb >4 gm. so in severe anemia where HB less than 4 gm we cannot see cyanosis.

Anaemic blood has a higher O2 carrying capacity per gram of Hb

It requires a critical concentration of reduced Hb in blood

Patient improves his alveolar oxygen as a compensation for anaemia

There is an increased blood flow through the skin


Question: Turner syndrome is associated with

Turner's syndrome is associated with coarctation of aoa. Reference: Ghai essential pediatrics, 9 th edition, page 638


Question: Percentage of bilirubin production from old RBCs

(B) 80% > Bilirubin is the end product of heme degradation.> From 70 to 90% of bilirubin is derived from degradation of the hemoglobin of senescent red blood cells.> Bilirubin produced in the periphery is transported to the liver within the plasma, where, due to its insolubility in aqueous solutions, it is tightly bound to albumin.


Question: The operation of choice in ulcerative colitis

The operation of choice in ulcerative colitis is proctocolectomy (with preservation of the anal sphincter complex) with ileoanal J pouch anastomosis (IPAA).Total proctocolectomy has the advantage of removing all diseased mucosa, thereby preventing fuher inflammation and the potential for progression to dysplasia or carcinoma. ie; Total colon and rectum are removed, ileal pouch is constructed (to function like rectum) and anastomosed to the anal canalRef: Sabiston 20e pg: 1372, Harrison 19e pg: 1962

Proctocolectomy with ileoanal anastomosis

Proctocolectomy and permanent end ileostomy

Subtotal colectomy and ileorectal anastomosis


Question: Blood transfusion should be completed within hours of initiation


Question: Resistant schizophrenia is treated with

(D) Clozapine # Clozapine can cause agranulocytosis and seizures as side-effects, it should be used with caution.ANTI PSYCHOTIC DRUGSA. Typical Or Traditional Antipsychotics1. Chlorpromazine (CPZ)300-15002. Thioridazine300-8003. Trifluoperazine15-604. Haloperidol5-1005. Pimozide4-126. Triflupromazine100-4007. Prochlorperazine45-1508. Flupenthixol3-109. Loxapine25-15010. Zuclopenthixol50-150B. Atypical Or Newer Antipsychotics11. Clozapine25-45012. Risperidone2-813. Olanzapine5-2014. Ziprasidone40-160


Question: In epidural anaesthesia, local drug deposited in

(Extradural) (494- Lee's 13th) (361- KDT6th) (128-A. yadav. Anaesthesia 3rd)Epidural Anaesthesia - mainly used for controlling post operative pains** Main site of action is Anterior and posterior nerve root*** Drugs diffuses through dura and arachnoid and inhibits descending pathways in spinal cord* Epidural (extradural) anaesthesia* Spinal (Intradural) anaesthesia* Extradural - The extent to which drugs reach their site of action is termed bioavailability* Intradural - although the dura is a relatively rough, avascular fibrous membrane, the arachnoid with its tight overlapping cells represents 90% of resistance in drug permeability and keeps CSF confined to the subarachnoid space*** Epidural anaesthesia - LA injected in the this space acts primarily on nerve roots (in the epidural as well as subarachnoid spaces to which it diffuses) and small amount permeates through intervertebral foramena to produce multiple paravertebral blocks


Question: Adenosine deaminase In CSF Is significantly higher In

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and moality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis Ref Harrison20th edition pg 2456


Question: C wave in JVP is DUE TO

Bulging of tricuspid valve during the isovolumetric contraction phase


Question: The feature of shock lung is


Question: Grossly incongruous, incomplete (contralateral) Homonymous Hemianopia causing lesion is

(B) Lateral optic chiasma # Visual fields that accompany damage to the visual pathways.1. Optic nerve: unilateral amaurosis.2. Lateral optic chiasm: grossly incongruous, incomplete (contralateral) homonymous hemianopia.3. Central optic chiasm: bitemporal hemianopia.4. Optic tract: incongruous, incomplete homonymous hemianopia.5. Temporal (Meyer's) loop of the optic radiation: congruous partial or complete (contralateral) homonymous superior quadrantanopia.6 Parietal (superior) projection of the optic radiation: congruous partial or complete homonymous inferior quadrantanopia.7. Complete parieto-occipital interruption of the optic radiation: complete congruous homonymous hemianopia with psycho- physical shift of the foveal point, often sparing central vision and resulting in "macular sparing."8. Incomplete damage to the visual cortex: congruous homonymous scotomas, usually encroaching at least acutely on central vision.


Question: Marker for the renal vasculitis in children is

Answer is A (Increased IgA levels): The most common systemic vasculitis in children is Henoch Schonlein Purpura, and the most common primary of glomerular disease is IgA Nephropathy. H.S purpura and IgA nephropathy may actually represent spectra of same disease and both are associated with elevated levels of IgA which is the single best answer of choice.

| Antineutrophilic cytoplasmic antibody titre


Question: Basilar migraine differs from classic migraine in the

In both classic migraine and basilar migraine ,women are more susceptible. aura and visual disturbances are seen in both. But it is more severe in basilar migraine that it may lead to complete blindness, frank psychosis, quadriplegia and coma.


Question: Most common site of intracranial bleed on Hypertension is


Question: Persistent priapism is rarely seen as a consequence IS

Harrison's principles of internal medicine 17th edition. * Priapism refers to a persistent and painful erection and may be associated with hypercoagulable states,spinal cord injury or injection of vasodilator agents in to the penis


Question: Ocular dipping is seen in

"Ocular bobbing" describes brisk downward and slow upward movements of the eyes associated with loss of horizontal eye movements and is diagnostic of bilateral pontine damage, usually from thrombosis of the basilar aery."Ocular dipping" is a slower, arrhythmic downward movement followed by a faster upward movement in patients with normal reflex horizontal gaze; it usually indicates diffuse coical anoxic damage.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 328; Coma


Question: Ventricular aneurysm has one of the following characteristic features

A left ventricular aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI). Without knowing the past medical history, the ECG changes of an aneurysm may mimic an acute anterior MI. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2 with associated Q waves indicating the old anterior MI. In an inferior aneurysm it would be in lead II, III and aVF, although this is less common. The only way to be sure that the ECG changes present are from an LV aneurysm (not ST elevation from an acute MI) is to have the patient's history of a prior MI and cardiac imaging to document the presence of an aneurysm. The shape of the ST elevation is also relatively unique and has been described as "coving" as seen below Ref Harrison 20th edition pg 1435


Question: Most common cause of Acquired Complete Hea Block in children is

Ans. is 'a' i.e., Cardiac Surgery Post surgical third degree A-V block resulting from trauma to the A-V node at operation is the most common cause of acquired A-V block in children


Question: Chromosome X is

Submetacentric - X-chromosome
Acrocentric - Y-chromosome


Question: The marker for B lymphocyte is

CD19 is a marker of B lymphocytesPrimarily B cell-associated antigensCD10 and CD19 to CD23 i.e. CD10, CD19, CD20, CD21, CD22, CD23Primarily T cell-associated antigensCD1 to CD8 with the exception of CD6Primarily monocyte macrophage-associated antigensCD13, CD14, CD15, CD33Primarily NK cells associated antigensCD16 and CD56 (also CD2 which is found expressed in a subset(Ref: Harrison's 18/e p2652)


Question: Proved association of Celiac disease is with

Celiac disease is associated with dermatitis herpetiformis(DH), but this association has not been explained.Patients with DH have characteristic papulovesicular lesions that respond to dapsone. Almost all patients with DH have histologic changes in the small intestine consistent with celiac disease, although usually much milder and less diffuse in distribution. Celiac disease is also associated with diabetes mellitus type 1, IgA deficiency, Down syndrome, and Turner's syndrome.Ref: Harrison; 19th edition; Page no: 1942


Question: Rheumatoid factor is

(A) IgM Ab against Fc fragment of IgG # Rheumatoid factor is a IgM Ab against Fc fregment of IgG.> Serum IgM RF has been found in 75-80% of patients with RA; therefore, a negative result does not exclude the presence of this disease. It is also found in other connective tissue diseases, such as primary Sjogren's syndrome, systemic lupus erythematosus, and type II mixed essential cryoglobulinemia, as well as chronic infections such as subacute bacterial endocarditis and hepatitis B and C. Serum RF may also be detected in 1-5% of the healthy population.Mnemonic: Man Towards Girl: IgM Ab against Fc fragment of IgG.


Question: Most common inherited cause of Aplastic anemia

M/C acquired cause - Idiopataic.
M/C inherited - Fanconi anemia.


Question: The main component of hyperlipidemia constituting a major risk factor for atherosclerosis is

high density lipoprotein (HDL) cholesterol

intermediate density lipoprotein (IDL) Cholesterol

low density lipoprotein (LDL) cholesterol

very low density lipoprotein (VLDL) cholesterol


Question: Not a cause of hemoptysis

Empyema is collection of pus in pleural space which is characterised by severe pleuritic pain or persisting or recurrent pyrexia.Other features include rigor,sweating,malaise and weight loss.Usually there is no hemoptysis. Pneumococcal pneumonia often causes rusty coloured sputum.Bronchiectasis and intracavitary mycetoma can cause catastrophic bronchial hemorrhage.Mitral stenosis can also leads to hemoptysis. Ref:Davidson's med:22nd edition, page no:658.


Question: Episodic hypertension is classical feature of

Ans. b (Pheochromocytoma) (Ref H-17th12270; Table 337-1)The dominant sign of Pheochromocytoma is hypertension. Classically, patients have episodic hypertension, but sustained hypertension is also frequent. These paroxysms generally last less than an hour and may be precipitated by surgery positional changes,exercise, pregnancy, urination (particularly bladder pheochromocytomas), and various medications (e.g., tricyclic antidepressants, opiates, metoclopramide).PHEOCHROMOCYTOMAClinical FeaturesThe clinical presentation is so variable that pheochromocytoma has been termed "the great masquerader". Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad.To enlist:HeadachesWeight lossSweating attacksParadoxical response to antihypertensive drugsPalpitation and tachycardiaPolyuria and polydipsiaHypertension, sustained or paroxysmalConstipationAnxiety and panic attacksOrthostatic hypotensionPallorDilated cardiomyopathyNauseaErythrocytosisAbdominal painElevated blood sugarWeaknessHypercalcemiaPheochromocytoma, DiagnosisDiagnostic MethodSensitivitySpecificity24-h urinary tests Vanillylmandelic acid++++++Catecholamines++++++Fractionated metanephrines++++++Total metanephrines+++++++Plasma Catecholamines+++++Free metanephrines+++++++Plasma Chromogranin A+++++CT+++++++MRI+++++++MIBG scintigraphy+++++++Somatostatin receptor scintigraphy++++Dopa (dopamine) PET (preliminary data)++++++++


Question: A double apical impulse is seen in

(D) HOCM# Physical findings of HCM are associated with the dynamic outflow obstruction that is often present with this disease.> Upon auscultation, the heart murmur will sound similar to the murmur of aortic stenosis.> However, a murmur due to HCM will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle (such as standing abruptly or the strain phase of a Valsalva maneuver). Administration of amyl nitrite will also accentuate the murmur by decreasing venous return to the heart.> Classically, the murmur is also loudest at the left parasternal edge, 4th intercostal space, rather than in the aortic area.> If dynamic outflow obstruction exists, physical examination findings that can be elicited include the pulsus bisferiens and the double apical impulse with each ventricular contraction.> A double apical impulse may be recognized, particularly with the patient in the left lateral recumbent position.


Question: MCardle's syndrome is due to

McArdle disease (also known as glycogen storage disease type V) is a disorder affecting muscle metabolism. The condition is caused by the lack of an enzyme called muscle phosphorylase. This results in an inability to break down glycogen 'fuel' stores. McArdle disease leads to pain and fatigue with strenuous exercise. Ref Robbins 9/e pg 153

Deficiency of liver phosphorylase kinase


Question: Hypomagnesemia is associated with

(B) Hypokalemia > Other electrolyte abnormalities often seen with Hypomagnesemia, including hypocalcemia (with hypocalciuria) and hypokalemia, may not be easily corrected unless magnesium is administered as well.


Question: The largest volume of water is reabsorbed in the nephron at the


Question: Most common cause of lobar hemorrhage in the elderly

Answer- C. Amyloid angiopathyLobar intracerebral hemorrhage is bleeding in the largest pa of the brain called the cerebrum.Intracerebral hemorrhage are attributed to hypeensive vasculopathy in small penetrating brain aeries and subcoical vessels in patients with amyloid angiopathy.Amyloid angiopathn a chronic deposition of congophilic rnaterial in brain vessels, is the most common cause of lobar hemorrhage in older patients.


Question: A Thiy five year old female has proximal weakness of muscles, ptosis and easy fatigability. The most sensitive test to suggest the diagnosis is

Single fiber electromyography (SFEMG) was established by Stalberg and Eskedt in the 1960s, and is of proven value in the diagnosis of neuromuscular disorders, especially myasthenia gravis. It has proved to be the most sensitive technique in detecting a neuromuscular transmission defect in comparison with the tensilon test, repetitive stimulation, and acetyl choline receptor antibody estimation. Single fiber electromyography typically requires the use of a specially contracted single fiber EMG needle electrode or facial concentric needle electrode with a small recording surface (25 micrometers), which is exposed at a po on the side of the electrode, 3 mm from the tip. Ref Harrison20th edition pg 2456


Question: Alzeihmer's disease is associated with

Patients with trisomy 21 have 3 copies of the gene for amyloid precursor protein and develop neurological characteristics of Alzheimer's disease by midlife. Alzheimer's Disease in People with Down Syndrome. Many, but not all, people with Down syndrome develop Alzheimer's disease when they get older. People with Down syndrome are born with an extra copy of chromosome 21, which carries the APP gene. This gene produces a specific protein called amyloid precursor protein (APP) .which leads to development of Alzheimer's Ref Harrison20th edition pg 2756


Question: Type I diabetes mellitus is associated with


Question: Find the type of inheritence

Only females can transmit the disease to offsprings. Males cannot transmit.


Question: A patient presented with pulmonary embolism the treatment to be given is

(B) i.v. Heparin with continuous infusion followed by coumarin for 4-5 months # Thrombolysis:> Successful thrombolytic therapy rapidly reverses right heart failure and leads to a lower rate of death and recurrent PE.# Thrombolysis usually:> Dissolves much of the anatomically obstructing pulmonary arterial thrombus;> Prevents the continued release of serotonin and other neurohumoral factors that exacerbate pulmonary hypertension; and Dissolves much of the source of the thrombus in the pelvic or deep leg veins, thereby decreasing the likelihood of recurrent PE.> The preferred thrombolytic regimen is 100 mg of recombinant tissue plasminogen activator (tPA) administered as a continuous peripheral intravenous infusion over 2 h.> Patients appear to respond to thrombolysis for up to 14 days after the PE has occurred.> Contraindications to thrombolysis include intracranial disease, recent surgery, or trauma. There is a 1 to 2% risk of intracranial hemorrhage.> Careful screening of patients for contraindications to thrombolysis is the best way to minimize bleeding risk.


Question: The drug of choice for absence seizure

Valproate is the drug of choice for absence seizure.


Question: Gradient in pulmonary artery wedge pressure and left venticular end diastolic pressure is seen in


Question: Anuria is defined as urine output less than

Anuria is nonpassage of urine, in practice is defined as passage of less than 100milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stones or tumours. It may occur with end stage renal disease. It is a more extreme reduction than oliguria (hypouresis), with 100 mL/day being the conventional (albeit slightly arbitrary) cutoff point between the two Ref Harrison20th edition pg 277