Question: In EEG type of wave seen in metabolic encephalophathy

Ans. is 'cl' i.e., Delta E.E.G. changes in metabolic encephalopathy In metabolic encephalopathy changes are typically nonfocal E.E.G. has been widely used to evaluate metabolic encephalopathy. The E.E.G .findings are abnormal in acute encephalopathic stages. It is difficult to establish a diagnosis of metabolic encephalopathy with ceainity through E.E.G. There is generalized slowing of the E.E.G with an excess of the delta and theta waves with suppression of normal alpha and beta wave activity and occasionally bilateral spikes and waves complexes occurring in absence of seizure activity". In metabolic encephalopathies, the E.E.G evolution correlates well with the severity of encephalopathy. o However EEG has little specificity in differentiating etiologies in metabolic encephalopathy. For example, though triphasic waves are most frequently mentioned in hepatic encephalopathy, they can also be seen in uremic encephalopathy or even in aged psychiatric patients treated with lithium. o Spikes and waves may appear in hypo or hyperglycemia uremic encephalopathy or vitamin deficiencies. Common principles of EEG changes in metabolic encephalopathy are : - Varied degrees of slowing Associated mixtures of epileptic discharge High incidence of triphasic waves Reversibility after treatment of underlying causes Metabolic encephalopathy EEG rythm Grade I (almost normal) Dominant activity is alpha rhythm with minimal teta activity Grade II (mildly abnormal) Dominant teta background with some alpha and delta activities. Grade II (moderately abnormal) Continuous delta activity predominates, little activity of faster frequencies Grade IV (severely abnormal) Low-amplitude delta activity or suppression-burst pattern Grade V (extremely abnormal) Nearly"flat" tracing or electrocerebral inactivity.


Question: Predominantly sensory neuropathy is caused by

Pyridoxine is an essential vitamin that serves as a coenzyme for transamination and decarboxylation. However, at high doses (116 mg/d), patients can develop a severe sensory neuropathy with dysesthesias and sensory ataxia. NCS reveal absent or markedly reduced SNAP amplitudes with relatively preserved CMAPs. Nerve biopsy reveals axonal loss of fiber at all diameters. Loss of dorsal root ganglion cells with subsequent degeneration of both the peripheral and central sensory tracts have been repoed in animal models.Ref: Harrison's 18/e p3463


Question: Lactic acidosis is not seen in

Answer is D (Tolbutamide) : Oral hypoglycemics of the biguanide group (Metformin & Phettfelrmin) are known to cause Lactic acidosis. It is not a complication of sulfonylureas such as Tolbutamide, Chlorpropamide etc. Lactic acidosis Lactic acid is produced from pyruvate when oxidative metabolism is reduced and glycolysis is increased. Lactic acidosis occurs when the rate of production of lactic acid from pyruvate in muscle, skin brain and erythrocytes exceeds the rate of removal by liver and kidney. The ingestion of methanol (wood alcohol) causes metabolic acidosis and its metabolites formaldehyde and formic acid cause severe optic nerve and central nervous system damage. Lactic acide, Aceto-acids and other unidentified organic acids contribute to the acidosis.


Question: Most common site of sub ependymal astrocytoma

Ans. is 'b' i.e. Foramen of Munro Most common site of subependymal astrocytoma is Foramen of monro.


Question: The Most common lesion in Wernicke's encephalopathy is found in the

(D) Mamillary bodies > Lesions in the periventricular regions of the diencephalon, midbrain, and brainstem as well as the superior vermis of the cerebellum consist of symmetric discoloration of structures surrounding the third ventricle, aqueduct, and fourth ventricle, with petechial hemorrhages in occasional acute cases and atrophy of the mamillary bodies in most chronic cases.


Question: Hemorrhagic meningitis is caused by

Hemorrhagic Meningitis, also sometimes known as Anthrax Meningitis, occurs when anthrax is inhaled. Bacillus anthracis spreads through the bloodstream from the primary focus of infection causing the Hemorrhagic Meningitis. Ref Harrison20th edition pg 2456


Question: HIV binds to macrophages having


Question: Pseudotumor cerebri is most commonly seen in

Ans. a. Obese females in the age group 20-45 years Pseudotumor cerebri is most commonly seen in obese females in the age group 20-45 years. Pseudotumor Cerebri (Idiopathic Intracranial Hypeension) Benign self-limiting disorder with a orable outcome Majority of patients are young, female and obesee It occurs due to decreased CSF absorptione Mostly idiopathic in nature but seen in hypervitaminosis, expired tetracyclines, OCPs and steroid usee Causes of Pseudotumor Cerebri High doses of vitamin AQ Withdrawal of coicosteroid therapyQ Outdated TetracyclineQ Addison's diseaseQ QuinolonesQ SLEQ HypoparathyroidismQ Clinical Features: Manifested by headache, papilledema, normal CSF and normal ventricle size on imaging. No focal neurological signs Characteristic features of Pseudotumor Cerebri Elevated intracranial pressure (intracranial hypeension) with: Normal or Small sized ventricular systemQ No focal neurological signse PapilledemaQ(enlarged blind spot in visual fluid) Normal CSF findingse Normal CT scan, MRI and isotope brain scane Excessive slow-wave activity on ECGe Treatment: Carbonic anhydrase inhibitor (acetazolamide) lowers ICP by reducing the production of CSF. Weight reduction is vital but often unsuccessful. If acetazolamide and weight loss fail and visual field loss is progressive, a shunt should be performed without delay to prevent blindness. Occasionally, emergency surgery is required for sudden blindness caused by fulminant papilledema

Obese males in the age group 20-45 years

Thin built females in the age group 50-60 years

Thin built males in the age group 50-60 years


Question: A 45 year old man had a Subarachnoid hemorrhage from a intracranial aneurysm 6 years ago . He also had progressive renal impairment associated with hematuria  diagnosis is

ADPCKD is associated with berry aneurysm.


Question: Dicrotic notch is due to closure of

Dicrotic notch is due to backflow of blood in the aoa at the beginning of diastole.It marks the end of ventricular systole. Reference:Textbook of medical physiology Geetha,2nd edition,page no:187.


Question: Zona glomerulosa produces

(B) Aldosterone # Synthesis and Secretion of Adrenocortical Hormones> The Adrenal Cortex Has Three Distinct Layers :> The zona glomerulosa, a thin layer of cells that lies just underneath the capsule, constitutes about 15 per cent of the adrenal cortex.> These cells are the only ones in the adrenal gland capable of secreting significant amounts of aldosterone because they contain the enzyme aldosterone synthase, which is necessary for synthesis of aldosterone.> The secretion of these cells is controlled mainly by the extracellular fluid concentrations of angiotensin II and potassium, both of which stimulate aldosterone secretion.> The zona fasciculata, the middle and widest layer, constitutes about 75 per cent of the adrenal cortex and secretes the glucocorticoids cortisol and corticosterone, as well as small amounts of adrenal androgens and estrogens.> The secretion of these cells is controlled in large part by the hypothalamic-pituitary axis via adrenocorticotropic hormone (ACTH).> The zona reticularis, the deep layer of the cortex, secretes the adrenal androgens dehydroepiandrosterone (DHEA) and androstenedione, as well as small amounts of estrogens and some glucocorticoids.

Sensitive changes in the renal blood flow

Conversion of angiotensinogen to angiotensin


Question: The best method of measuring blood glucose level in the long term would be


Question: A toxin of clostridium tetanus, tetanospasmin causes muscular rigidity by blocking


Question: In Hemolytic anemias the urobilinogen level in the blood would


Question: Gait disorder described as 'Slipping Clutch Syndrome' occurs in

(D) Frontal gait disorder # FRONTAL GAIT DISORDER (gait apraxia) is common in elderly & has a variety of causes.> Term is used to describe a shuffling freezing gait with imbalance and other signs of higher cerebral dysfunction.> Typical features include a wide base of support a short stride shuffling along the floor & difficulty with starts and turns.> Many patients exhibit a difficulty with gait initiation that is descriptively characterized as the "slipping clutch" syndrome or gait ignition failure or lower-body parkinsonism.> Strength is generally preserved & patients are able to make stepping movements when not standing and maintaining their balance at the same time.> Higher-level motor control disorder as opposed to an apraxia.> Most common cause of frontal gait disorder is vascular disease particularly subcortical small-vessel disease.> Lesions are frequently found in the deep frontal white matter and centrum ovale.> Gait disorder may be the salient feature in hypertensive patients with ischemic lesions of the deep-hemisphere white matter (Binswanger's disease).> Clinical syndrome includes mental changes (variable in degree) dysarthria pseudobulbar affect (emotional disinhibition) increased tone and hyperreflexia in the lower limbs.> Communicating hydrocephalus in adults also presents with a gait disorder of this type.> Other features of the diagnostic triad (mental changes incontinence) may be absent in the initial stages.> MRI demonstrates ventricular enlargement an enlarged flow void about the aqueduct and a variable degree of periventricular white-matter change.> Lumbar puncture or Dynamic test is necessary to confirm hydrocephalus.


Question: L'Hermittes' sign is characteristic feature of

(C) Multiple sclerosis # Lhermitte's Sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs, and is produced by bending the neck forward.> Sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla.> Multiple sclerosis: Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including Behget's disease, trauma, radiation myelopathy, vitamin B12 deficiency (subacute combined degeneration), and compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold-Chiari malformation.


Question: 'Square root' sign is characteristic of

square root sign is a charecteristic feature of Constrictive pericarditis Dip & plateau pattern' or 'square root sign': Early diastolic filling of the ventricles is unimpeded and abnormally rapid, but late diastolic filling is abbreted and halts abruptly when total cardiac volume expands to the volume limit set by the stiff pericardium Ref Harrison 20th edition pg 1436

Contractile dysfuncation seen in which type of cardiomyopathy?


Question: SSPE is not diagnosed by

Ans. is 'a' i.e., Tuberculosis Bronchiectasis Sicca or Dry Bronchiectasis is typically associated with Tuberculosis. Tuberculosis is associted with a type of dry bronchiectasis called Bronchiectasis Sicca, which is predominantly seen in upper lobes. Dry Bronchiectasis (Bronchiectasis Sicca) is typically characterized by absence of copious amount of sputum which is usually a hall mark of bronchiectasis. Dry cough associated with hemoptysis is the typical presentation


Question:
Kussmaul's sign is positive in
a. Restrictive cardiomyopathy
b. Constrictive pericarditis
c. Cardiac tamponade
d. Dilated cardiomyopathy
e. Pneumothorax

Kussmaul's sign is rise in JVP with inspiration.  It is seen in constrictive pericarditis  and Restrictive cardiomyopathy.


Question: Drug of choice for hypeension crises in systemic sclerosis is

One of the main causes of death is hypeensive renal crisis, characterised by rapidly developing malignant hypeension and renal failure. Hypeensive renal crisis is much more likely to occur in DCSS than in LCSS, and in patients with topoisomerase 1 antibodies. Hypeension should be treated aggressively with ACE inhibitors, even if renal impairment is present. DAVIDSON&;S 22nd EDITION;PAGE NO 1113


Question: Characteristic ECG finding of pulmonary embolism

Ans. is `b' i.e., SJQ3T3 E.C.G. changes of pulmonary embolism ? Sinus tachycardia is the most frequent and nonspecific finding on electrocardiography in acute pulmonary embolism. Features suggesting acute right hea strain on the ECG occur relatively infrequently, these include. Acute right axis detion P pulmonale Right bundle branch block Inveed T waves ST segment changes in right sided leads. Earlier the following E.C.G. changes were considered highly predictive of acute pulmonary embolism, but these observations were found in less than 12% of patients with pulmonary emboli in recent studies. These E.C.G. features are - S wave in lead I Q wave in lead III Inveed Tin lead III ("S1Q31.3") S waves in lead I, II and III ("Si,S2 S3") Also know Areterial blood gas analysis in pulmonary embolism : Arterial blood gas analysis shows Mid to moderate hypoxemia Increased P (A - a) 0, Mildly reduced PaCO2 Almost all patients with pulmonary embolism have PaO, < 80 mm Hg but no absolute level of Pa02 can be used to exclude the diagnosis.


Question: Red cell cast are more common with

Ans. (c) Nephritic syndromeRef: Robbins 8th ed. / Ch. 14The presence of red blood cells within the cast is always pathological, and is strongly indicative of glomerular damage, which can occur in# Glomerulonephritis like P.S.G.N, acute glomerulonephritis, R.P.G.N# Vasculitis, including Wegeners granulomatosis, systemic lupus erythematosus or Goodpasture's syndrome.# Renal infarction# Subacute bacterial endocarditis.* They are a yellowish-brown in color and are generally cylindrical with sometimes ragged edges; their fragility makes inspection of a fresh sample necessary.* RBCs may appear normally shaped, swollen by dilute urine (in fact, only cell ghosts and free hemoglobin may remain), or crenated by concentrated urine.* Both swollen, partly hemolyzed RBCs and crenated RBCs are sometimes difficult to distinguish from WBCs in the urine. In addition, red cell ghosts may simulate yeast.* The presence of dysmorphic RBCs in urine suggests a glomerular disease such as a glomerulonephritis. Dysmorphic RBCs have odd shapes as a consequence of being distorted via passage through the abnormal glomerular structure.


Question: Hypercalcemia is diagnosed by

(B) Serum calcium # Approach to medical treatment of hypercalcemia varies with its severity> Mild hypercalcemia,<3.0 mmol/L (12 mg/dL), can be managed by hydration.> More severe hypercalcemia must be managed aggressively;


Question: An elderly man presents with tremors and gives a family history of dementia, The diagnosis is

(B) Parkinsonism dementia-ALS complex # Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's Disease or Maladie de Charcot or motor neurone disease) is a progressive, fatal, neurodegenerative disease caused by the degeneration of motor neurons, the nerve cells in the central nervous system that control voluntary muscle movement> The disorder causes muscle weakness and atrophy throughout the body as both the upper & lower motor neurons degenerate and die, ceasing to send messages to muscles> Unable to function, the muscles gradually weaken, atrophy, and develop fasciculations (twitches) because of denervation. Eventually, the brain completely loses its ability to initiate and control voluntary movement.> Frontotemporal dementia with Parkinsonism-17 (FTDP-17) is a type of progressively worsening dementia that affects the frontal (front) and temporal (side) regions of the brain. It includes some instances of what was once called 'Pick's disease'.> Symptoms may include personality changes with loss of social niceties, diminished cognitive capacity and parkinsonism (lack of facial expression, slow movements, rigidity and balance problems).


Question: In chronic glomerulonephritis the best urinary finding is

In chonic glomerulonephritis the best urinary finding is low Fixed Specific Gravity.

While in acute glomerulonephritis, most characteristic is Erythrocyte casts in urine.


Question: Pulmonary hypeension is caused by

Category 1. Pulmonary aerial hypeension (PAH) Key feature: elevation in pulmonary aerial pressure (PAP) with normal pulmonary capillary wedge pressure (pcwp) Includes: Idiopathic (IPAH) * Sporadic * Familial * Exposure to drugs or toxins * Persistent pulmonary hypeension of the newborn * Pulmonary capillary hemangiomatosis (PCH) Associated with other active conditions * Collagen vascular disease * Congenital systemic-to-pulmonary shunts * Poal hypeension * HIV infection Category 2. Pulmonary venous hypeension Key feature: elevation in PAP with elevation in pcwp Includes: * Left-sided atrial or ventricular hea disease * Left-sided valvular hea disease * Pulmonary venous obstruction * Pulmonary venoocclusive disease (PVOD) Category 3. Pulmonary hypeension associated with hypoxemic lung disease Key feature: chronic hypoxia with mild elevation of PAP Includes: * Chronic obstructive lung disease * Interstitial lung disease * Sleep-disordered breathing * Alveolar hypoventilation disorders * Chronic exposure to high altitude * Developmental abnormalities Category 4. Pulmonary hypeension due to chronic thromboembolic disease Key feature: elevation of PA pressure with documentation of pulmonary aerial obstruction for >3 monthsIncludes: * Chronic pulmonary thromboembolism * Nonthrombotic pulmonary embolism (tumor, foreign material) Category 5. Miscellaneous Key feature: elevation in PAP in association with a systemic diseasewhere a causal relationship is not clearly understood. Includes: * Sarcoidosis * Chronic anemias * Histiocytosis X * Lymphangiomatosis * Schistosomiasis ref:Harrison&;s principles of internal medicine,ed 18,pg no 2078


Question: Pink frothy expectoration is seen in

A. i.e. (Pulmonary oedema) (1466 - H17th) (26 - 27 - CMDT 09)Pink frothy expectoration is seen in - Pulm. Oedema, Mitral stenosisPULMONARY EDEMA - rapid onset of dyspnea at rest**, tachypnea, tachycardia and severe hypoxemia, Rales and wheezing, Hypertension* Hemoptysis results from rupture ofpulmonary bronchial venous connections secondary to pulmonary venous hypertensionAcute Pulmonary edema - presents with severe dyspnea, production of pink frothy sputum** and diaphoresis and cyanosis (357 - CMDT - 09)* Blood may arise from the airways in COPD, Bronchiectasis and bronchogenic carcinoma; from the pulmonary parenchyma in pneumonia, inhalation of crack cocaine or autoimmune diseases (Such as Good pasture disease or Wegner granulomatosis)


Question: Not a feature of triad of hepatopulmonary syndrome


Question: Albuminocytological dissociation is associated with

(A) Guillain-Barre syndrome# GUILLAIN-BARRE SYNDROME> Diagnosis of GBS usually depends on findings such as rapid development of muscle paralysis, areflexia, absence of fever, and a likely inciting event.> Cerebrospinal fluid analysis (through a lumbar spinal puncture) and electrodiagnostic tests of nerves and muscles (such as nerve conduction studies) are common tests ordered in the diagnosis of GBS.> Typical CSF findings include albumino-cytological dissociation. As opposed to infectious causes, there is an elevated protein level (100-1000 mg/dL), without an accompanying increased cell count pleocytosis. A sustained increased white blood cell count may indicate an alternative diagnosis such as infection.


Question: Earliest and often the only presentation of TB kidney is

Ans. is 'a' i.e., Increased frequency Urinary frequency, dysuria, nocturia, hematuria, and flank or abdominal pain is common presentations. However, patients may be asymptomatic and the disease is discovered only after severe destructive lesions of the kidneys have developed. Urinalysis gives abnormal results in 90% of cases, revealing pyuria and hematuria. The documentation of culture-negative pyuria in acidic urine raises the suspicion of TB. IV pyelography, abdominal CT, or MRI may show deformities and obstruction, and calcifications and ureteral strictures are suggestive findings. Culture of three morning urine specimens yields a definitive diagnosis in nearly 90% of cases.


Question: The most characteristic manifestation of megaloblastic anaemia

The presence of red cells that are macrocytic and oval (macro-ovalocytes) is highly characteristic of megaloblastic anaemia.Other features are: Most macrocytes lack the central pallor of normal red cells and even appear "hyperchromic," but the MCHC is not elevated.The reticulocyte count is low. Nucleated red cell progenitors occasionally appear in the circulating blood when anaemia is severe. Neutrophils are also larger than normal (macro polymorphonuclear) and show nuclear hypersegmentation, having five or more nuclear lobules instead of the normal three to fourThe marrow is usually markedly hypercellular as a result of increased hematopoietic precursors, which often completely replace the fatty marrow. Megaloblastic changes are detected at all stages of erythroid development.Robbins 9e pg: 645


Question: High calcium intake leads to

Ans. a. Milk-Alkali syndrome The milk-alkali syndrome is due to excessive ingestion of calcium and absorbable antacids such as milk or calcium carbonate. It is much less frequent since proton-pump inhibitors and other treatments became available for peptic ulcer disease. For a time, the increased use of calcium carbonate in the management of secondary hyperparathyroidism led to reappearance of the syndrome. The chronic form of the disease, termed Burnett's syndrome, is associated with irreversible renal damage. The acute syndromes reverse if the excess calcium and absorbable alkali are stopped.' Milk-Alkali Syndrome The milk-alkali syndrome is due to excessive ingestion of calcium and absorbable antacids such as milk or calcium carbonateQ. It is much less frequent since proton-pump inhibitors and other treatments became available for peptic ulcer disease. For a time, the increased use of calcium carbonate in the management of secondary hyperparathyroidism led to reappearance of the syndrome. Several clinical presentations-acute, subacute, and chronic-have been described, all of which feature hypercalcemia, alkalosis, and renal failureQ. The chronic form of the disease, termed Burnett's syndrome, is associated with irreversible renal damageQ. The acute syndromes reverse if the excess calcium and absorbable alkali are stoppedQ. Individual susceptibility is dependent on the fractional calcium absorption as a function of calcium intake. Some individuals absorb a high fraction of calcium, even with intakes >2 g of elemental calcium per day, instead of reducing calcium absorption with high intake, as occurs in most normal individuals. Development of hypercalcemia causes increased sodium excretion and some depletion of total-body water. These phenomena and perhaps some suppression of endogenous PTH secretion due to mild hypercalcemia lead to increased bicarbonate resorption and to alkalosis in the face of continued calcium carbonate ingestion Alkalosis per se selectively enhances calcium resorption in the distal nephron, thus aggravating the hypercalcemia. The cycle of mild hypercalcemia -4 bicarbonate retention alkalosis renal calcium retention -4 severe hypercalcemia perpetuates and aggravates hypercalcemia and alkalosis as long as calcium and absorbable alkali are ingestedQ.


Question: Raised serum amylase levels are used to diagnose

Answer is 'D' (Acute pancreatitis) 'The diagnosis of acute pancreatitis is usually established by detection of an increased level of serum amylase Harrison 16th 'Serum amylase level is the standard laboratory test carried out to confirm the diagnosis of acute pancreatitis' Kumar & Clarke 5th Measurement during first 24 hours of onset of pain An elevation of three times the upper limit of normal clinches the diagnosis (provided ove salivary gland disease and gut perforation or infarction are excluded) Measeurement late after presentation After 48-72 hrs even with continuing evidence of pancreatitis, total serum levels tend to return to normal With a late presentation thus, serum amylase levels may give a false negative result. Serum amylase level may be increased in acute cholecystitis, but it does not form a criteria for its diagnosis. There is no definitive correlation between the severity of pancreatitis and the degree of serum amylase elevation. An elevated serum lipase Q. or trypsin value is more specific / diagnostic of acute pancreatitis than serum amylase - (Lipase is the single best enzyme to measure for acute pancreatitis Q).


Question: Non Anionic gap acidosis is seen in

(A) Diarrheoa # CAUSES OF NON-ANION GAP METABOLIC ACIDOSIS> Gastrointestinal bicarbonate loss: Diarrhea; External pancreatic or small-bowel drainage; Ureterosigmoidostomy, jejunal loop, ileal loop Drugs: Calcium chloride (acidifying agent); Magnesium sulfate (diarrhoea); Cholestyramine (bile acid diarrhea)> Renal acidosis: Hypokalaemia Proximal RTA (type 2) Distal (classic) RTA (type 1)> Hyperkalemia: Generalized distal nephron dysfunction (type 4 RTA) Mineralocorticoid deficiency Mineralocorticoid resistance inc. Na+ delivery to distal nephron Tubulointerstitial disease Ammonium excretion defect> Drug-induced hyperkalemia (with insufficiency):Potassium-sparing diuretics (amiloride, triamterene, spironolactone) Trimethoprim Pentamidine Angiotensin-converting enzyme inhibitors and AT-II receptor blockers Nonsteroidal anti-inflammatory drugs Cyclosporine> Others: Acid loads (ammonium chloride, hyperalimentation) Loss of potential bicarbonate: ketosis with ketone excretion Expansion acidosis (rapid saline administration) Hippurate, Cation exchange resins In lactic acidosis, DKA and salicylate poisoning high anionic gap metabolic acidosis is seen.


Question: In acute renal failure, metabolic acidosis is due to


Question: Most common site for berry aneurysm rupture

Ans. is 'a' i.e., Anterior circulation of brain The most common sites in descending order of frequency are - Li Proximal poion of anterior communicating aery (at the junction of anterior communicating aery with cerebral aery) At the origin of the posterior communicating aery from the stem of the internal carotid aery. At the first major bifurcation of middle cerebral aery. At the bifurcation of internal carotid into middle and anterior cerebral aeries. Veibrobasilar bifurcation (3%)


Question: Sugarcane induced lung disease


Question: Renal involvement in multiple myeloma is characterized by

It is due to the accumulation of light chain immunoglobulins, which here can be referred by nitrogen retention.


Question: Reversed coarctation is seen in

Takayasu aeritis affects the aoa, its major branches and occasionally the pulmonary aeries. The typical age at onset is 25-30 years, with an 8 : 1 female-to-male ratio. It has a worldwide distribution but is most common in Asia. Takayasu aeritis is characterised by granulomatous inflammation of the vessel wall, leading to occlusion or weakening of the vessel wall. It presents with claudication, fever, ahralgia and weight loss. Clinical examination may reveal loss of pulses, bruits, hypeension and aoic incompetence. Investigation will identify an acute phase response and normocytic, normochromic anaemia but the diagnosis is based on angiography, which reveals coarctation, occlusion and aneurysmal dilatation. Treatment is with high-dose glucocoicoids and immunosuppressants, as described for ANCA-associated vasculitis. With successful treatment, the 5-year survival is 83%. Ref - Davidsons 23e p 1041


Question: Diabetes mellitus associated with


Question: Number connection test is used in

Number connection test or constructional apraxia are a clinical features of hepatic encephalopathy.


Question: HAM test is done for


Question: Distal renal tubular acidosis is associated with


Question: Descending order of types of viruses causing paralytic polio

(C) Type 1, type 3, type 2 # POLIOMYELITIS> Definition: Poliomyelitis is an acute infections disease caused by enterovirus.> Poliovirus is an RNA virus with three distinct serotypes v/z.1,2 and 3.> Type 1 is the most frequent and type 2, the least common cause of paralytic poliomyelitis.


Question: The most common cause of hyperparathyroidism is

Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia.Solitary adenomas: A single abnormal gland is a cause in ~80% of patients; the abnormality in the gland is usually a benign neoplasmor adenoma and rarely a parathyroid carcinoma.Ref: Harrison; 19th edition; Page no: 2470


Question: Bronchiectasis with predominantly upper lobe involvement is

More pronounced involvement of the upper lung fields is most common in cystic fibrosis(CF) and is also observed in post radiation fibrosis,corresponding to the lung region encompassed by the radiation po.Bronchiectasis with predominant involvement of the lower lung fields is seen in fibrotic lung diseases or hypogammaglobulinemia.Congenital causes of bronchiectasis with predominant midlung field involvement include the dyskinetic/immotile cilia syndrome or Kaagener's syndrome.Finally,predominant involvement of the central airways is repoed in association with allergic bronchopulmonary aspergillosis. Ref:Harrison's medicine-18th edition,page no:2142.


Question: In primary pulmonary hypeension, basic abnormality in gene lies in

Decreased expression of the voltage-regulated potassium channel, mutations in the bone morphogenetic protein-2 receptor, increased tissue factor expression, overactivation of the serotonin transpoer, transcription factor activation of hypoxia-inducible factor-1 alpha, and activation of nuclear factor of activated T cells. As a result, there appears to be a loss of apoptosis of the smooth muscle cells that allow their proliferation and the emergence of apoptosis-resistant endothelial cells that can obliterate the vascular lumen.Ref: Harrison's 18/e p2077


Question: Woman with myocardial infarction are more likely to present with complications like......than males.

Woman with myocardial infarction are more likely to present with cardiac arrest or cardiogenic shock whereas men are more likely to present with ventricular tachycardia. Ref: Harrison, Edition-18, Page-52


Question: Ellis curve is seen in

o On chest X-rays, pleural effusion presents as homogenous opacity.
o Typically this opacity has a fairly well defined concave upper edge, is higher laterally than medially and obscures the diaphragmatic shadow


Question: Arsenic causes


Question: Tropical pulmonary eosinophilia is caused because of

Ans. is 'a' i.e., Occult filariasis Occult filariasis is a rare condition which is caused by hypersensitivity reaction to filarial antigen. Micro filatia are absent in the blood. Lymphatic filariasis is absent. Indirect evidence of filarial infection is obtained by demonstrating antifilarial antibodies


Question: A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic, with a left venricular ejection fraction of 45% and an end systobc diameter index of 2.9 cm/m2. The most appropriate treatment is

Surgery for chronic, nonischemic, severe MR is indicated once symptoms occur, especially if valve repair is feasible. Other indications for early consideration of mitral valve repair include recent-onset AF and pulmonary hypeension, defined as a PA pressure >=50 mmHg at rest or >=60 mmHg with exercise. Surgical treatment of chronic, nonischemic severe MR is indicated for asymptomatic patients when LV dysfunction is progressive, with LVEF falling below 60% and/or end-systolic dimension increasing beyond 40 mm. ( Harrison&;s principle of internal medicine,18th edition,pg no.1936 )


Question: Necrotising lymphadenitis is seen with


Question: Proliferative glomerular deposits are found in

IgA nephropathy is an immune complex-mediated glomerulonephritis defined by the presence of diffuse mesangial IgA deposits often associated with mesangial hypercellularity. ref - Harrisons internal medicine 20e pg2135-2140


Question: Drug used in acute exacerbation of ulcerative colitis is

Cyclosporine is used for acute exacerbation of ulcerative colitis, and also as rescue therapy to prevent surgery in ulcerative colitis responding poorly to glucocoicoids. Reference : Davidson, 23rd Edition, page no : 821.


Question: In primary immune deficiency, the fraction of plasma protein reduced is


Question: In AIDS patient presenting with fever, cough a diagnosis of pneumocystin pneumonia is best established by

Ans. is 'b' i.e., Bronchoalveolar lavage Diagnosis of PCP requires Demonstration of the organism in samples obtained from induced sputum. Bronchoalveolar lavage, transbronchial biopsy, or open-lung biopsy. If the histological examination fails :? u PCR is required to make the diagnosis

Staining of intra-nuclear inclusion with silver staining


Question: A middle aged man noticed that he can no longer fit in his shoes and that his jaw was protruding and phalanges were enlarged. These effects are likely to be mediated by.

Answer is B (Somatomedins): Many of the physiological affects of Growth Hormone are mediated indirectly through somatomedins like IGF-1 (Insulin like Growth fbactor) which is a potent growth and differentiation factor. Increased shoe size, Prognathism (protruding jaw) and enlarged phalanges in a middle aged man suggest a diagnosis of Growth Hormone oversecretion or Acromegaly. Growth Hormone exes several effects through induction of somatomedins (like IGF), a family of hormones secreted in the blood by the liver and other tissues. What are Somatomedins Somatomedins arc a family of harmones that are potent growth and differentiation factors. The liver is the major source of somatomedins like IGF-1 that mediates many of the physiological effects of Growth Hormone on target tissues. Somatomedins are similar to insulin in molecular structure and are hence also known as 'Insulin like Growth factors' (IGF) and these act on target tissue to increase protein synthesis by increasing the rate of uptake of amino acids. Although GH exes direct effects on target tissues, many of its physiological effects are mediated indirectly through somatomedins like IGF-1


Question: The most common cause of fracture in a patient with Hemophilia is

Answer is A (Osteoporosis and Restricted Joint Movement) The most common cause of fractures in patients with haemophilia is osteoporosis and restricted joint movements (from haemophilic ahropathj). 'Fractures may occur frequently and after tril trauma because of poor musculature, osteoporosis, limited range of motion in affected joint and haemophilic changes in the bone'.


Question: Canon 'a' wave is seen in


Question: Cardiac biomarker for choice of diagnosis of Reinfraction 8 days after initial ischemia is

Ref Harrison 19 th ed pg 1594 CK-MB is the cardiac biomarker of choice for diagnosis of Reinfraction 8 days after initial ischemia event


Question: ECG changes that occur after administration of Digoxin includes

(D) ST depression# Digoxin effects on ECG: Shows down slope ST depression with a characteristic "Salvador Dali sagging" appearance Flattened, inverted, or biphasic T waves. Shortened QT interval. Delay due to development of 1:1 A-V conduction.


Question: Variceal bleeding is best treated with

Bleeding esophageal varices Octreotide is often given as an infusion for management of acute hemorrhage from esophageal varices in liver cirrhosis on the basis that it reduces poal venous pressure, though current evidence suggests that this effect is transient and does not improve survival Ref Davidson edition23rd pg 781


Question: A 35 year old female patient presents with proximal weakness of muscles, ptosis and easily fatiguability. September 2011

Ans. D: Edrophonium test The intravenous injection of the sho acting anticholinesterase, edrophonium bromide, is a valuable diagnostic aid (the tensilon test) for myasthenia gravis Myasthenia gravis/ MG: A disease characterized by episodic muscle weakness, chiefly in muscle innervated by cranial nerves and characteristically improved by anti-cholinesterase inhibiting drug There is decreased myoneural junction transmission due to auto-immune attack on the acetylcholine receptor of the post-synaptic neuromuscular junction, which results in loss of dysfunction of Ach receptors and jeopardizing normal neuromuscular transmission Dysahria, dysphagia and proximal limb weakness is common Sensory modalities and deep tendon reflexes are normal Pyridostigmine/ Neostigmine are the MC used cholinergic drugs Thymectomy is indicated in all patients with generalized MG Plasmapheresis may be useful for preparing refractory cases fro thymectomy and during respiratory crisis


Question: First symptom of digoxin overdose is


Question: The GCS is determined by taking the best response in each category and totaling them; it ranges from


Question: Most common mutated gene in primary hemochromatosis

Primary hemochromatosis - HFE gene Chr6P.


Question: In coarctation of aoa, the side of rib notching is

Rib notching is unusual in infancy but becomes more frequent with increased age; it is present in 75% of adults with coarctation. Rib notching occurs along the inferior margin of the third to the eighth ribs; it is caused by pulsation of dilated intercostal aeries. Ref Davidson 23rd edition pg 443


Question: Lewy bodies contain

(A) a-synuclein # Examination of brain in Parkinson's Disease (PD):> Grossly reveals mild frontal atrophy with loss of the normal dark melanin pigment of the midbrain.> Microscopically there is degeneration of the dopaminergic cells with the presence of Lewy bodies (LBs) in the remaining neurons and processes of the substantia nigra pars compacta (SNpc), other brainstem nuclei, and regions such as the medial temporal, limbic, and frontal cortices.> LBs have a high concentration of a-synuclein and are the pathologic hallmark of the disorder.> Mutations in the a-synuclein gene can cause familial PD by promoting the formation of a-synuclein-positive filaments that aggregate into LBs and Lewy neuritis.


Question: Chronic hemodialysis in ESRD patient is done

Ans. (c) Thrice per weekRef : Harrison 19th ed. /1823For the majority of patients with ESRD, between 9 and 12 h of dialysis are required each week, usually divided into three equal sessions.Current Targets of Hemodialysis* Urea reduction ratio (the fractional reduction in blood urea nitrogen per hemodialysis session) of >65-70%.* Body water-indexed clearance x time product (KT/V) above 1.2 or 1.05.REMEMBERHypotension is the most common acute complication of hemodialysis. Since the introduction of bicarbonate- containing dialysate, dialysis-associated hypotension has become less common. The management of hypotension during dialysis consists of discontinuing ultrafiltration, the administration of 100-250 mL of isotonic saline or 10 mL of 23% saturated hypertonic saline, or administration of salt-poor albumin.


Question: Diarrhea with acanthocytosis is seen in

Diarrhea with acanthocytes Seen in both wolman disease & abetalipoproteinemia * Wolman&;s disease : also called * Acid Cholesterol Ester Hydrolase Deficiency, Type 2 * LIPA Deficiency * LAL Deficiency * Rare autosomal recessive deficiency of lysosomal acid lipase activity causing accumulation of cholesterol and triglycerides throughout body tissues and death within first 6 mos) ref - harrisons internal medicine 20th pg2896,


Question: Carbmezpine is the drug of choice in

K D Tripathy essentials of medical pharmacology 7th edition. *Carbamazepine is the most effective drug for CPS


Question: In Alzheimer's disease, the characteristic lesion is seen in

(B) Nucleus of Meynert # Pathology in Alzeihmer's disease:> The most severe pathology is usually found in the hippocampus, temporal cortex, and nucleus basalis of Meynert (lateral septum).> The most important microscopic findings are neuritic "senile" plaques and NFTs.> These lesions accumulate in small numbers during normal aging of the brain but occur in excess in AD.> Neuritic plaques contain a central core that includes A p amyloid, proteoglycans, Apo E4, a1 antichymotrypsin, and other proteins.> A amyloid is a protein of 39 to 42 amino acids that is derived proteolytically from a larger transmembrane protein, amyloid precursor protein (APP), which has neurotrophic and neuroprotective activity.> The normal function of A p amyloid is unknown.> Soluble amyloid fibrils may represent the initial pathologic event in AD leading to formation of neuritic plaques.> The plaque core is surrounded by the debris of degenerating neurons, microglia, and macrophages.> The accumulation of amyloid in cerebral arterioles, termed amyloid angiopathy, may lead to cerebral lobar hemorrhages.


Question: The treatment most likely to benefit a patient of massive pulmonary embolism in shock

For a patient with massive pulmonary embolism in shock,primary therapy consists of clot dissolution with thrombolytics like tPA/streptokinase or removal of PE by embolectomy.The preferred fibrinolytic regimen is 100 mg of recombinant tPA(tissue plasminogen activator) administered as a continuous peripheral iv infusion over 2 hours.Anticoagulation with heparin and warfarin or placement of an inferior vena cava filter constitutes secondary prevention of recurrent PE. Reference:Harrison's Medicine-18th edition, page no:2174-2176.


Question: WPW syndrome is caused by

Ans. is 'b' i.e., Right sided accessory pathway Anatomy (Location ofAccessory pathway) in W.R W syndrome Electrophysiological studies and mapping have shown that accessory. Atrioventricular pathways may be located anywhere along the A-V rign or groove in the septum. The most frequent locations are : - Left lateral (50%), posteroseptal (30%) right anteroseptal (10%). Right lateral (10%). Preexcitation resulting from left sided accessory is called type A preexcitation. Preexcitation resulting from right sided accessory pathway is called type B preexcitation.


Question: In plasmodium vivax malaria, relapse is caused by


Question: Hippocampal sclerosis is seen in

Mesial temporal lobe epilepsy (MTLE) is the most common syndrome associated with focal seizures with dyscognitive features and is an example of an epilepsy syndrome with distinctive clinical, electroencephalographic, and pathologic features. Highresolution magnetic resonance imaging (MRI) can detect the characteristic hippocampal sclerosis that appears to be essential in the pathophysiology of MTLE for many patients Ref: Harrison 19e 2544


Question: Dose of streptokinase for fibrinolysis in MI

Streptokinase is administered as 1.5 million units (MU) intravenously over 1 h. The current recommended regimen of tPA consists of a 15-mg bolus followed by 50 mg intravenously over the first 30 min, followed by 35 mg over the next 60 min. rPA is administered in a double-bolus regimen consisting of a 10-MU bolus given over 2-3 min, followed by a second 10-MU bolus 30 min later.TNK is given as a single weight-based intravenous bolus of 0.53 mg/kg over 10 s.Ref: Harrison 19e pg: 1605


Question: High cardiac output & low peripheral resistance shock

(C) Septic shock# SEPTIC SHOCK: An inflammatory stimulus (eg, a bacterial toxin) triggers production of proinflammatory mediators, including I NF and IL-1. These cytokines cause neutrophil-endothelial cell adhesion, activate the clotting mechanism, and generate microthrombi> Initially, arteries and arterioles dilate, decreasing peripheral arterial resistance; cardiac output typically increases. This stage has been referred to as warm shock.> Later, cardiac output may decrease, BP falls (with or without an increase in peripheral resistance), and typical features of shock appear.> With sepsis, patients typically have fever, tachycardia, diaphoresis, and tachypnea; BP remains normal. Other signs of the causative infection may be present.


Question: A 17 Year old male complains of recurrent episodes of cough, wheeing and shoness of breath paicularly at night for the last 3 days. His sibling has a history of similar symptoms. A skin test with pollen produces immediate wheal and flare. He should be treated with

The patient is having atopic asthma,with sensitization to allergens like pollen,dust mites,etc.The primary modality of treatment for asthma is bronchodilators,which give rapid relief of symptoms mainly through relaxation of airway smooth muscle and relieving bronchoconstriction.Beta agonists(sho acting and long acting),anticholinergics and theophylline are three classes of bronchodilators in current use,of which beta agonists like salbutamol,terbutaline,salmeterol are the most effective. Ref:Harrison's medicine-18th edition,page no: 2109,2110.


Question: Recommended drug for patients with intrahepatic Wilson's disease i.e. patients with hepatitis, is

Answer- A. ZincHepatitis or cirrhosis without decompensation Zinc (first choice) & Trientine (2nd choice).


Question: . In cardiac shock

Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to severe depression of the cardiac index and sustained systolic aerial hypotension (<90 mmHg) despite an elevated filling pressure . It is associated with in-hospital moality rates >50%. . Circulatory failure based on cardiac dysfunction may be caused by primary myocardial failure, most commonly secondary to acute myocardial infarction(MI) , and less frequently by cardiomyopathy or myocarditis , cardiac tamponade, or critical valvular hea disease Systolic and diastolic myocardial dysfunction results in a reduction in cardiac output and often pulmonary congestion. Systemic and coronary hypoperfusion occur, resulting in progressive ischemia. Although a number of compensatory mechanisms are activated in an attempt to suppo the circulation, these compensatory mechanisms may become maladaptive and produce a worsening of hemodynamics. *Release of inflammatory cytokines after myocardial infarction may lead to inducible nitric oxide expression, excess nitric oxide, and inappropriate vasodilation. This causes fuher reduction in systemic and coronary perfusion. A vicious spiral of progressive myocardial dysfunction occurs that ultimately results in death if it is not interrupted. LVEDP, left ventricular end-diastolic pressure ref:harrison&;s principles of internal medicine,ed 18,pg no 2232


Question: Loud pulmonary component of second hea sound heard in

The loudness of each component of the second hea sound is propoional to the respective pressures in the aoa and pulmonary aery at the onset of diastole.P2 is relatively loud in young patients in whom the pulmonary aeries are quite close to the chest wall.The pulmonic component is considered to be abnormally loud in a subject over age 20 if it is greater than the aoic component in the second left inter-costal space (ICS) or if it is audible at the cardiac apex.This may be seen in pulmonary aery hypeension and ASDThe term Eisenmenger's syndrome is applied to patients with a large communication between the two circulations at the aoopulmonary, ventricular, or atrial levels and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary hypeension. Hence, the P2 is loud.However, in Eisenmenger&;s syndrome with a large ventricular septal defect (VSD), the pulmonary closure may get completely fused with aoic closure throughout the respiratory cycle. Here, the duration of right and left ventricular systole become viually equal. Hence, a single loud S2 is heard in both phases of respiration.Ref: Harrison's 18/e p1923


Question: Most common cause of abdominal aortic aneurysm is

(A) Atherosclerosis # ABDOMINAL AORTIC ANEURYSMS:> Abdominal aortic aneurysms occur more frequently in males than in females, and the incidence increases with age.> Abdominal aortic aneurysms may affect 1 to 2% of men older than 50 years.> At least 90% of all abdominal aortic aneurysms > 4.0 cm are affected by atherosclerosis, and most of these aneurysms are below the level of the renal arteries.> Prognosis is related to both the size of the aneurysm and the severity of coexisting coronary artery and cerebrovascular disease.> The risk of rupture increases with the size of the aneurysm.


Question: Pellagra like clinical syndrome is found in

Hartnup disease is an autosomal recessive disorder caused by impaired neutral aminoacid transport.
Presents with pellagra Like skin eruptions , Cerebellar ataxia , and gross aminoaciduria.


Question: A female developed brown macule on the cheek, forehead and nose after exposure to light following delivery of a baby, the diagnosis is

Answer is B (Chloasma): Patient has a characteristic 'brown' macule on cheek, with no history suggestive of any systemic involvement, with positive history of delivery of a baby suggesting pregnancy.


Question: In the lower motor neuron lesion diseases, there is

(B) There may be wasting of muscles in long standing cases # UMN LESION - Spasticity, Weakness, loss of superficial reflexes, brisk DTR, Clonus present, Babinski sign positive, Hypertonia Clasp Knife spasticity)# LMN lesion - Flaccidity, Decreased tone, loss of superficial & deep reflexes, plantar B/L Flexor, Wasting, Fibrillations.Signs That Distinguish Patterns of WeaknessSIGNS THAT DISTINGUISH PATTERNS OF WEAKNESSSignUpper Motor NeuronLower Motor NeuronMyopathicAtrophyNoneSevereMildFasciculationsNoneCommonNoneToneSpasticDecreasedNormal/decreasedDistribution of weaknessPyramidal/ regionalDistal/segmenta 1ProximalTendon reflexesHyperactive Normal/hypoactiveBabinskils signPresentHypoactive/absent AbsentAbsent


Question: For hiatus hernia, investigation of choice is

Barium swallow and meal examination give the best appreciation of gastro-oesophageal anatomy. The patient is in the Trendelenburg position to demonstrate barium in the fundus.Bailey and Love 26th edition Pg: 1015

Barium meal upper GI in Trendelenberg position


Question: In ARDS  mechanical TV is

Low volume ventillation(6 ml/kg predicted body weight)has got lower mortality(31%) as compared to the conventional ventilation (12 mL/kg predicted body weight)-40%.


Question: Severity in acute hepatitis is best estimated by

Acute Alcoholic Hepatitis The pattern of liver test abnormality is hepatocellular. The AST is typically in the 100 to 200 IU/L range, even in severe disease, and the ALT level may be normal, even in severe cases. The AST level is higher than the ALT level, and the ratio is greater than 2:1 in 70% of patients. Ref Harrison20th edition pg 677


Question: In the Glasgow Coma Scale, coma score is given by the sum of scores for Eye Opening (E), Best Motor Response (M) and Verbal Response (V). The values assigned to E, M and V in the Glasgow Coma Scale are respectively

(C) 4, 6, 5 GLASGOW COMA SCALE (CCS)Eye openingVerbal responseSpontaneous4Orientated5To speech3Confused conversation4To pain2Inappropriate words3Nil1Incomprehensible sounds2Nil1 Best motor responseObeys6Localises5Withdraws4Abnormal flexion3Extension response2Nil1# EMV:# Glasgow Coma Scale (CCS):> The maximum score Is 15, the minimum 3> E + M + V-3 to 15> Less than or equal to 8 are in coma> Greater than or equal to 9 not in coma> 8 is the critical score> Less than or equal to 8 at 6 hours - 50& die> 9-11 = moderate severity> Greater than or equal to 12 = minor injury> Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.


Question: Commonest cause of rupture of spleen is

spontaneous splenic rupture, which remain widely accepted to date: Mechanical effect of distention secondary to leukemic infiltration of the spleen, paicularly the capsule; splenic infarct with capsular hemorrhage and subsequent rupture; Ref Davidson edition23rd pg812


Question: HRT is protective for

(A) Hip fracture # BONE DENSITY By reducing bone turnover and resorption rates, estrogen slows the aging-related bone loss experienced by most postmenopausal women. More than 50 randomized trials have demonstrated that postmenopausal estrogen therapy, with or without a progestin, rapidly increases bone mineral density at the spine by 4 to 6% and at the hip by 2 to 3%, and maintains those increases during treatment.> Fractures Data from observational studies indicate a 50 to 80% lower risk of vertebral fracture and a 25 to 30% lower risk of hip, wrist, and other peripheral fractures among current estrogen users; addition of a progestin does not appear to modify this benefit. Discontinuation of estrogen therapy leads to a diminution of protection.> In the WHI, 5 to 6 years of either combined estrogen-progestin or estrogen-only was associated with a 30 to 40% reduction in hip fracture and 20 to 30% fewer total fractures among a population unselected for osteoporosis.BENEFITS & RISKS OF POSTMENOPAUSAL HORMONE THERAPY (HT) IN PRIMARY PREVENTION SETTINGSOutcomeEffectDefinite Benefits Symptoms of menopauseDefinite improvementOsteoporosisDefinite increase in bone mineral density and decrease in fracture riskDefinite Risks Endometrial cancerDefinite increase in risk with estrogen alone; no increase in risk with estrogen- progestinVenous thromboembolismDefinite increase in riskBreast cancerIncrease in risk with long-term use (5 years) of estrogen-progestinGallbladder diseaseDefinite increase in riskProbable or Uncertain Risks and Benefits Coronary heart diseaseProbable increase in risk among older women and women many years past menopause; possible decrease in risk or no effect in younger or recent menopausal womenStrokeProbable increase in riskOvarian cancerProbable increase in risk with long-term use (5 years)Colorectal cancerProbable decrease in risk with estrogen-progestinDiabetes mellitusProbable decrease in riskCognitive dysfunctionUnproven decrease in risk (inconsistent data from observational studies and randomized trials)


Question: ECT is most useful in

(Major depression) (98- 213- NA 6th)* Panic disorders (discrete episodes of acute anxiety)* The drug of choice ofgenerilized anxiety disorders are benzodiazepines and for panic disorder (both benzodiazepines and anti depressants* Absolute indication of ECT is (1) major severe depression with suicidal risk (This is the first and most important indication for ECT) with stupur, poor intake of food and fluids, melancholia, psychotic features (2) severe catatonia (functional) (3) severe psychosis (SZP or mania)* The only absolute contraindication is the presence of raised intracranial tension* Bilateral ECT is more effective, but unilateral ECT causes less short term memory impairments


Question: Rapid X descent unlikely in

Answer is C (RVMI) Rapid 'x' descent is rare in RVMI Feature Tamponade Constrictive Pericaditis Restrictive Cardiomyopathy RVMI Prominent x descent Present Usually present Present Rare Prominent y descent Absent Usually present Rare Rare


Question: Specific marker for intestinal inflammation

Fecal lactoferrin is a highly sensitive and specific marker for detecting intestinal inflammation. Fecal calprotectin levels correlate well with histologic inflammation, predict relapses, and detect pouchitis. Both fecal lactoferrin and calprotectin are becoming an integral pa of IBD management and are used frequently to rule out active inflammationRef: Harrison 19e pg: 1952


Question: Artemesinin is best used for

Treatment of cerebral malaria:

IV Quinine: Needs continuous cardiac monitoring; can cause QTc prolongation, hypoglycemia
IV Artesunate has better efficacy and safer than quinine, 2.4 mg/kg IV BD. then OD
Exchange transfusion if parasite index is > 10%
Artemisinin (qinghaosu) acts rapidly against erythrocytic stages of malarial parasites. It is effective against complicated and multidrug resistant malaria. Due to their short half life, recrudescence is high if used alone, hence not useful for prophylaxis also.
Chloroquine sensitive falci and vivax: Chloroquine l g, 500mg at 6, 24,48 hrs, followed by Primaquine 15mg for 14 days
Chloroquine resistant, uncomplicated falciparum: Oral quinine. Mefloquine, Doxy, Clindamycin, Oral Artesunate


Question: Pneumococcal vaccination is indicated in   a) Postsplenectomy  b) Sickle cell anemia  c) HIV  d) After radiotherapy


Question: Menkes syndrome is a disorder of

Menkes kinky hair syndromeEtiologyFeaturesPrognosisX-linked metabolic disturbance of copper metabolismMutation in copper-transpoing ATP7A geneMental retardationHypocupremiaDecreased circulating ceruloplasminChildren with this disease often die within 5 years because of dissecting aneurysms or cardiac rupture(Ref: Harrison's 18/e p604)


Question: Infectious cause of Erythematous rashes are seen in

(A) Measles # Characteristic erythematous, nonpruritic, maculopapular rash of measles begins at the hairline and behind the ears, spreads down the trunk and limbs to include the palms and soles, and often becomes confluent. At this time, the patient is at the most severepoint of the illness. By the fourth day, the rash begins to fade in the order in which it appeared. Early physical findings of enteric fever include rash ("Rose Spots"), hepatosplenomegaly, epistaxis, and relative bradycardia. Rose spots make up a faint, salmon-colored, blanching, Maculopapular rash located primarily on the trunk and chest. The rash is evident in 30% of patients at the end of the first week and resolves after 2 to 5 days without leaving a trace. Patients can have two or three crops of lesions, and Salmonella can be cultured from punch biopsies of these lesions. The faintness of the rash makes it difficult to detect in dark-skinned patients. Rashes are not generally a symptom of malaria, but they may appear in some cases, such as in acute falciparum malaria. A classical urticaria (dark red, itchy bumps) or itchy papular rash (round bumps usually 0.5 inches in diameter) may appear.


Question: Fasting hyperglycemia is almost always seen in

fasting glucose levels greater than or equal to 7.0 mmol/l, is frequently present in patients with phaeochromocytoma (24% in the present study) and the diabetes is reversed by removal of the tumour(pheochromocytoma). Ref - Harrison20th edition pg 99


Question: Female patient with bilateral hilar lymphadenopathy and joint pain. ACE levels are elevated. The diagnosis in this patient is

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology characterised by presence of non caseating granulomas. LOFGREN SYNDROME - an acute illness characterised by erythema nodosam, peripheral ahropathy, uveitis, bilateral hilar lymphadenopathy,lethargy and fever often seen in young women. Bilateral hilar lymphadenopathy may be sometimes discovered incidentally on chest x-ray . Ref Davidson edition23rd pg 608


Question: Most common cause of Seizures in an elderly with Cerebrovascular Stroke is

(B) Cerebrovascular stroke # SEIZURE DISORDERS become increasingly common after the age of 60 years.> Seizures are associated with subdural hematoma, stroke, and CNS infection.> They also can occur with systemic metabolic conditions such as uremia, hyperglycemia, hypoglycemia, hyponatremia, and alcohol withdrawal.> Cerebrovascular stroke is the second common disease after heart disease and the most important cause of seizure in elderly.> Of the degenerative disorders, Alzheimer's dementia and amyloid angiopathy are known major causes of seizures> Certain drugs commonly prescribed to elderly people, such as tramadol, also reduce seizure threshold, and are best avoidec> Older people seem to be more susceptible to the epileptogenic effects of some other drugs, such as antipsychotics, antidepressants (particularly tricyclics), antibiotics, theophylline, levodopa, thiazide diuretics and even the herbal remedy, ginkgo biloba> Drugs for first-line monotherapy of seizures in elderly patients include carbamazepine, valproic acid, oxcarbazepine, gabapentin, and lamotrigine.


Question: As per etiological classification of diabetes mellitus, Gestational diabetes mellitus is

Etiologic Classification of Diabetes MellitusI. Type 1 diabetes (beta cell destruction, usually leading to absolute insulin deficiency)Immune-mediatedIdiopathicII. Type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance)III. Other specific types of diabetesGenetic defects of beta cell development or function characterized by mutations in:Genetic defects in insulin actionDiseases of the exocrine pancreas--pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy, mutations in carboxyl ester lipaseEndocrinopathies--acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hypehyroidism, somatostatinoma, aldosteronomaDrug- or chemical-induced- Glucocoicoids, vacor (a rodenticide), pentamidine, nicotinic acid, diazoxide, b-adrenergic agonists, thiazides, calcineurin and mTOR inhibitors, hydantoins, asparaginase, a-interferon, protease inhibitors, antipsychotics (atypicals and others), epinephrineInfections--ongenital rubella, cytomegalovirus, coxsackievirusUncommon forms of immune-mediated diabetes--"stiff-person" syndrome, anti-insulin receptor antibodiesOther genetic syndromes sometimes associated with diabetes--IV. Gestational diabetes mellitus (GDM)Ref: Harrison 19e pg: 2399


Question: Parenteral agent used in diabetes

Agents Used for Treatment of Type 1 or Type 2 Diabetes Parenteral Amylin agonists Slow gastric emptying, glucagon Pramlintide 0.25-0.5 Reduce postprandial glycemia, weight loss Injection, nausea, risk of hypoglycemia with insulin Agents that also slow GI motility GLP-1 receptor agonists Insulin, glucagon, slow gastric emptying, satiety Exenatide, liraglutide, dulaglutide 0.5-1.0 Weigh loss, do not cause hypoglycemia Injection, nausea, risk of hypoglycemia with insulin secretagogues Renal disease, agents that also slow Gi motility; medullary carcinoma of thyroid Insulin Glucose utilization, hepatic glucose production and other anabolic actions See text and Table 418-4 Not limited Known safety profile Injection, weight gain , hypoglycemia Ref: Harrison 19e pg: 2414


Question: Pleural effusion with very low glucose is

Rheumatoid ahritis produces an exudative pleural effusion with predominant lymphocytes,positive rheumatoid factor and anti-CCP antibodies,and very low glucose in pleural . Pleural involvement is the most frequent manifestation of rheumatoid ahritis (RA) in the chest. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count low glucose also seen in malignancy,and tubercular effusion. Ref Davidson edition23rd pg 580


Question: Marker test for vertical transmission of HIV

Ans. (a) p24 antigenRef : Harrison 19th ed. /1246-47* Following HIV infection, the sequences of markers to identify infection in their chronologic order of appearance in serum are: viral RNA followed by p24 antigen and lastly anti-HIV antibody.* ELISA is positive in all babies born to HIV positive mother, due to transplacental transferrin of anti - HIV antibody.* About 2 weeks after infection, viremia is thought to increase exponentially and then decline to a steady- state level as the humoral and cell-mediated immune responses control HIV replication. This time interval, the serologic "window period," is characterized by seronegativity, occasionally detectable antigenemia, viremia (as measured by RNA), and variable CD4 lymphocyte levels. Detection of specific antibody to HIV signals the end of the window period and labels the individual as seropositive.* The exact time when HIV RNA, antigen, and antibody can be detected depends on several factors, including the test used, individual host responses, and viral characteristics. Viral RNA can be detected within the first 2 weeks using the highly sensitive RT-PCR method. Antigen, although transient, can appear as early as 2 weeks after infection and lasts 3 to 5 months Newer generation antibody assays, including the HIV third generation antigen-sandwich antibody assays, can detect antibody in most individuals at about 3 to 4 weeks post- infection and Hep D.


Question: The common cause of subarachnoid hemorrhage Is

*Subarachnoid hemorrhage commonly,but exclusively results from rupture of congenital berry aneurysms in the interpeduncular cistern . Subarachnoid haemorrhage, a medical emergency, is usually from a bulging blood vessel that bursts in the brain (aneurysm). It may lead to permanent brain damage or death if not treated promptly Ref Harrison20th edition pg 2567


Question: Vanishing tumor is seen in

Answer- B. LungAccumulation of fluid in the interlobar spaces of the lung (as a result of CHF) appears as a neoplasm on a radiograph.It is called as Phantom tumor or pseudotumor or vanishing tumor.


Question: Restrictive and constrictive cardiomyopathy occurs together in

The etiologies of RCM may be grouped into broad categories as follows: Primary/idiopathic: Endomyocardial fibrosis (EMF), loeffler eosinophilic endomyocardial disease Secondary: Infiltrative, amyloidosis (the most common cause of RCM in the United States), sarcoidosis , progressive systemic sclerosis (scleroderma) , hemochromatosis, , carcinoid hea disease, glycogen storage disease of the hea, radiation/treatment induced, metastatic malignancy, anthracycline toxicity Ref Davidson 23rd edition pg 467


Question: DOC for Tourette syndrome

Ans. is 'd' i.e., Clonidine Earlier Haloperidol was considered as DOC for Tourette syndrome. Clonidine is considered as DOC for Tourette syndrome


Question: Duration of apnea in obstructive sleep apnea is

Ans. is 'a' i.e., <10 sec Sleep apnea ? o Sleep apnea is defined as intermittent cessation of airflow at the nose and mouth during sleep. o By convention apneas of at least 10 seconds duration have been considered impoant but in most patients the apneas are 20s to 30 seconds in duration and may be as long as 2-3 minutes. o Sleep apnea is of two types - Sleep apnea Obstructive sleep apnea Central sleep apnea Occurs due to occlusion of upperairway at the level of oropharynx Occurs due to transient abolition ofthe central neural drive to the respiratory muscles Conditions associated are adenotonsillarhyperophy, retrognathia, macroglossiaalcohol, obesity Primary and secondary central alveolarhypoventilation syndrome, hypoxia (high altitude) cardiovascular disease, pulmonary congestion, central nervous system disease, prolonged circulation time. Clinical features of sleep apnea - Excessive daytime sleepiness Cardiorespiratory disturbances which include Recurrent respiratory failure Pulmonary hypeension Hea failure Systemic hypeension 7 Chronic hypoventilation Polycythemia o Aerial blood gas analysis reveals hypoxemia and hypercapnia.


Question: Direct Coomb's test detects

Ans. is 'a' i.e., Antibodies attached to RBC surface


Question: The jejunal biopsy is diagnostic in

Abetalipoproteinemia is characterized by a normal mucosal appearance except for the presence of mucosal absorptive cellsthat contain lipid postprandially and disappear after a prolonged period of either fat-free intake or fasting.Ref: Harrison; 19th edition; Page no: 1939


Question: The key factor in the transpo of carbon dioxide as bicarbonate is

Since the Pco2 in the tissue is high,CO2 diffuses from tissues into the plasma. From there it enters the RBC which contains plenty of carbonic anhydrase. In blood,70% of CO2 is transpoed as HCO3 by the action of carbonic anhydrase. Reference:Textbook of medical physiology-Geetha N,2nd edition,page no:245.

The presence of carbonic anhydrase in the erythrocytes

The acid nature of carbon dioxide and the alkaline nature of bicarbonate


Question: Characteristic feature of early congenital syphilis is

Vesicular rash with bulla over palms and soles


Question: Definition of TIA is, patient signs and symptoms resolve by

When blood flow is quickly restored, brain tissue can recover fully and the patient's symptoms are only transient, this is called a transient ischemic attack (TIA). The definition of TIA requires that all neurologic signs and symptoms resolve within 24 h without evidence of brain infarction on brain imaging. Most TIAs last <1 h.Stroke has occurred if the neurologic signs and symptoms last for >24 h or brain infarction is demonstratedRef: Harrison 19e pg: 2559


Question: 26 year old man died while playing. His autopsy of the hea revealed myocyte hyperophy. Diagnosis is

Ref:Harrison&;s 19th E pg 1568. Most probably it is HOCM. Patients with hyperophic cardiomyopathy have an increased risk of sudden cardiac death from ventricular tachyarrhythmias. Vigorous physical activity and competitive spo are prohibited.


Question: Features of diabetic nonproliferative retinopathy are a) Hard exudatesb) Soft exudatesc) Microaneurysms d) RD


Question: In myasthenia gravis antibody are formed against\

(A) ACh receptor > The major problem in myasthenia gravis is a marked reduction of acetylcholine receptors on the motor endplate where cranial nerves form a neuromuscular junction with muscles.> In these patients, autoantibodies against the acetylcholine receptors effectively reduce receptor numbers.> Normally, acetylcholine molecules released by the nerve terminal bind to receptors on the muscle endplate, resulting in a stimulation of contraction by depolarizing the muscle membrane.> The condition is improved with drugs that inhibit acetylcholinesterase. CALCIUM CHANNEL DISORDERS OF MUSCLE: Hypokalemic Periodic Paralysis (HypoKPP). SODIUM CHANNEL DISORDERS OF MUSCLE: Hyperkalemic Periodic Paralysis (HyperKPP). POTASSIUM CHANNEL DISORDERS: Andersen's Syndrome


Question: Most common cause of death in primary amyloidosis is

Primary amyloidosis: (light chain amyloidosis or AL-amyloid disease)Primarily a consequence of plasma cell disordersThe kidney is the most frequently involved organ(80%)Hea is second most frequently involved(40%)Cardiac failure is the most common cause of deathCardiac amyloidosis mostly manifests as restrictive cardiomyopathy(ref: Harrison's 18/e p948)


Question: HLA DQA1 is associated with

Molecular analysis of human leukocyte antigen (HLA) class II genes has revealed that Sjogren's syndrome, regardless of the patient's ethnic origin, is highly associated with the HLA DQA1*0501 allele. Reference: Harrison 19th edition PG: 2166


Question: The most common cause of bronchopulmonary aspergillosis is

Aspergillus fumigatus is responsible for most cases of invasive aspergillosis including bronchopulmonary aspergillosis,almost all cases of chronic aspergillosis,and most allergic syndromes.A.flavus is more prevalent in some hospitals and causes a higher propoion of cases of sinus and cutaneous infections and keratitis than A.fumigatus.A.Niger can cause invasive infection, but more commonly colonizes the respiratory tract and causes external otitis.A.terreus causes only invasive disease,usually with a poor prognosis.A.nidulans occasionally causes invasive infection,primarily in patients with chronic granulomatous disease. Reference:Harrison's medicine-18th edition,page no:1655.


Question: Acute rheumatic fever occurs most commonly in


Question: Broad Granular casts are seen in

Broad granular casts - Chronic renal failure.
RBC casts - Glomerular injury.


Question: Theoretical "Optimal PEEP" in ARDS is

In most clinical settings, positive end-expiratory pressure (PEEP) is empirically set to minimize Fio2 (inspired O2 percentage) and maximize Pao2 (aerial paial pressure of O2). On most modern mechanical ventilators, it is possible to construct a static pressure-volume curve for the respiratory system. The lower inflection point on the curve represents alveolar opening (or "recruitment"). The pressure at this point, usually 12-15 mmHg in ARDS, is a theoretical "optimal PEEP" for alveolar recruitment.Ref: Harrison 19e pg: 1738


Question: Features not seen in Cushing&;s Syndrome

In Cushing&;s syndrome, hyperglycemia usually occur; hyperglycemia may progress to frank diabetes. Page 1940,Nelson textbook of pediatrics 19th edition


Question: Paradoxical splitting of S2 is seen in

Paradoxical splitting: Reverse of normal physiology, splitting of second hea sounds during expiration, singular during inspiration Seen in conditions that cause delayed conduction down the left bundle (LBBB, pre-excitation of the right ventricle, right ventricular pacing, premature RV beats), aoic stenosis ref - Harrisons internal medicine 20e pg1802-1805


Question: A negative nitrogen balance is observed


Question: Beck's triad is seen in

Ref Harrison 19 th ed pg 1573 The three principal features of tamponade (Beck's triad) are hypo- tension, soft or absent hea sounds, and jugular venous distention with a prominent x descent but an absent y descent. The limitations of ventricular filling are responsible for a reduction of cardiac output. The quantity of fluid necessary to produce cardiac tamponade may be as small as 200 mL when the fluid develops rapidly to as much as >2000 mL in slowly developing effusions when the pericardium has had the oppounity to stretch and adapt to an increasing volume.


Question: RBBB with left Axis eviation is characteristic of


Question: Normal CRP with elevated ESR seen in

Ans. is 'b' i.e., SLE Both ESR and CRP are markers of inflammation Erythrocyte sedimentation rate or ESR is used to separate inflammation from non-inflammation. Another sign of inflammation is the rise in blood level of number of proteins called as acute phase proteins. One of the proteins is C-reactive protein (CRP). Like ESR and other acute phase proteins, CRP also goes up in inflammation. In systemic lupus however the level does not rise unless there is infection associated. The normal response to active inflammatory disease is an increase in plasma CRP concentration. o For reasons that remain unclear tht response is either significantly lower in magnitude or entirely absent in a few inflammatory conditions. This has proven diagnostically useful because there are very few inflammatory conditions in which ESR is significantly raised (reflecting an inflammatory process) but plasma CRP is only slightly raised or even normal. One ofthese conditions is systemic lupus erythematosus (SLE or lupus), a relatively common chronic autoimmune disease that predominantly affects women of child-bearing age. When this inflammation occurs in the lupus patient it is accompanied as expected by a marked increase in ESR. However in contrst to most other inflammatory condition, the plasma CRP remains resolutely normal. The combination of raised ESR and normal CRP is a useful diagnostic feature of SLE. Other disorders where CRP is not increased Osteoahritis, leukemia, anemia Polycythemia, viral infection Ulcerative colitis, pregnancy, estrogen


Question: A patient following head injury was admitted in intensive care ward with signs of raised intracranial pressure. He was put on ventilator and ataed on intravenous fluids and diuretics. Twenty four hours later his urine output was 3.5 litres, serum sodium 156 mEq/l and urine osmolality of 316 mOsm/kg. The most likely diagnosis based on these parameters is

Answer is A (High output due to diuretics): Presence of high urine osmolality >300 (316 mosmol/Kg) along with increased serum Na suggest a diagnosis of solute diuresis. The patient inquestion has sustained head injury and mannitol is often used insuch cases to reduce the intracranial pressure. Solute diuresis secondary to use of mannitol (diuretic) explains the parameters of the patient in question.


Question: Most common cause of sudden death


Question: ATM mutation is seen in

(A) Ataxia telangiectasia # Ataxia telangiectasia mutated (ATM) is a serine/threonine protein kinase that is recruited and activated by DNA double-strand breaks.> ATM phosphorylates several key proteins that initiate activation of the DNA damage checkpoint, leading to cell cycle arrest, DNA repair or apoptosis.> Several of these targets, including p53, CHK2 and H2AX are tumor suppressors.> Ataxia telangiectasia (autosomal recessive): 11 q22-23; ATM gene for regulation of cell cycle; mitogenic signal transduction and meiotic recombination Ataxia-telangiectasia - caused by mutations in the ATM gene Breast cancer - associated with the ATM gene Other cancers - increased risk from variations of the ATM gene Cancers of the stomach, bladder, pancreas, lung, and ovaries occur more frequently in ATM mutation carriers than in people who do not carry these mutations.


Question: Renal vein thrombosis is most commonly associated with

Renal Vein Thrombosis(RVT):The left renal vein is more commonly involved and two-thirds of cases are bilateralEtiology: 1. endothelial damage-Homocystinuria, endovascular intervention, and surgery 2. Venous stasis-Dehydration, retroperitoneal fibrosis and abdominal neoplasms(compression and kinking of the renal veins) 3. hypercoagulable states-proteins C and S, antithrombin deficiency, factor V Leiden, disseminated malignancy, oral contraceptives, APLA, nephrotic syndrome(membranous nephropathy) It can either present with flank pain, tenderness, hematuria, rapid decline in renal function, and proteinuria or it can be silentDiagnostic screening can be performed with Doppler ultrasound; the most sensitive test is CT angiographyTreatment for RVT is anticoagulation and therapy for the underlying cause; Endovascular thrombolysis may be used; Nephrectomy in life-threatening complicationsRef: Harrison's 18/e p2382


Question: The Modern Stethoscope was invented by

(D) George Phillip Cammann# Stethoscope was invented in France in 1816 by Rene Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural.> In 1840, Golding Bird described a stethoscope he had been using with a flexible tube.> Irish physician Arthur Leared invented a binaural stethoscope.> The modern binaural Stethoscope was invented by the American physician George Philip Cammann in 1852.> George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since.> Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible.


Question: Frequency of tuning fork used to test vibration sense is

(C) 512 hZ # TUNING FORK TESTS: These tests are performed with tuning forks of different frequencies such as 128, 256, 512,1024, 2048 and 4096 Hz, but for routine clinical practice, tuning fork of 512 Hz is ideal.> Forks of lower frequencies produce sense of bone vibration while those of higher frequency have a shorter decay time and are thus not routinely preferred.> Tuning Fork Tests: Rinne test Weber Test Absolute bone conduction test Schwabach's test, Benign test, Gelle's test


Question: The most impoant area involved in planning and organizing complex sequential skilled movements is

Answer is C (Supplementary motor Area): The most impoant area involved in planning and organizing complex sequential skilled movements is the Supplementary Motor Area (SMA). The SMA is impoant for planning and organizing complex sequential movements. For example the sequence of finger movement required to play a muscal instrument such as Clarinet or Piano is planned and organized in the SMA'.


Question: In gram negative septicemia, early findings setting

Answer is B (Cardiac output, Total peripheral resistance) septic shock is characterized by normal or. increased cardiac output and decreased systemic vascular resistance. Septic Shock :Usually results from a severe decrease in systemic vascular resistance, besides various other features. Cardiac output is initially normal or even elevated. lnfact, normal or increased cardiac output and decreased systemic vascular resistance characterize septic shock (as in Gram negative septicemia here) and distinguish it from cardiogenic, extra-cardiac, obstructive and hypovolumic shock.


Question: Features of bronchiolitis are  a) Caused by R.S.V.  b) Wheeze present  c) Pulmonary edema common  d) Seen in immunocompromised hosts  e) Common age groups is from 5 to 15 years age


Question: The most common neurological disorder seen in CRF patients


Question: The typical movement of mitral valve calcification is


Question: Not a feature of chronic liver disease

Koilonychia is not a feature of chronic liver disease.


Question: Banding technique used for studying translocations involving centromere is

M/c used for cytogenetic analysis - G banding.
For studying translocations involving centromere - C banding.


Question: Aldose reductase drugs are useful in

Aldose reductase (AR) is an enzyme of aldoketo reductase super-family that catalyzes the conversion of glucose to sorbitol in the polyol pathway of glucose metabolism. In this context, aldose reductase inhibitors (ARIs) have received much attention worldwide. Decreased sorbitol flux through polyol pathway by ARIs could be an emerging target for the management of major complications of diabetes. The ARIs developed vary structurally, and representative structural classes of ARIs include i) carboxylic acid derivatives (such as Epalrestat, Alrestatin, Zopalrestat, Zenarestat, Ponalrestat, Lidorestat, and Tolrestat), ii) spirohydantoins and related cyclic amides (such as Sorbinil, Minalrestat, and Fidarestat), and iii) phenolic derivatives (related to Benzopyran-4-one and Chalcone). Among these inhibitors, Epalrestat is the only commercially available inhibitor till date. In addition, some other ARIs such as Sorbinil and Ranirestat had been advanced into late stage of clinical trials and found to be safe for human use. Adapting ARIs could prevent sepsis complications, prevent angiogenesis, ameliorate mild or asymptomatic diabetic cardiovascular autonomic neuropathy and appear to be a promising strategy for the treatment of endotoxemia and other ROS-induced inflammatory diseases . Ref - pubmed.com


Question: A smoker presented with altered sensorium. His blood osmolality was found to be 240 and urine osmolality 340. His Na+ is 122 meq/L. The diagnosis is

(B) SIADH # Psychogenic polydipsia and beer potomania--Marked excess free water intake (generally >10 L/d) may produce hyponatremia.> Euvolemia is maintained through the renal excretion of sodium.> Urine sodium is therefore generally elevated (> 20 mEq/L), but unlike SIADH, levels of ADH are suppressed.> Urine osmolality is appropriately low (< 300 mosm/kg) as the increased free water is excreted.> Hyponatremia from bursts of ADH occurs in manic-depressive patients with excess free water intake.> Psychogenic polydipsia is observed in patients with psychological problems, and these patients frequently take drugs interfering with water excretion.> Similarly, excessive intake of beer, which contains very small amounts of sodium (< 5 mEq/L), can cause severe hyponatremia in cirrhotic patients, who have elevated ADH and often a decreased GFR.


Question: Prolonged intake of PPI causes

Proton Pump (H+, K+-ATPase) Inhibitors Omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole are substituted benzimidazolederivatives that covalently bind and irreversibly inhibit H+, K+- ATPase.Long-term acid suppression, especially with PPIs, has been associated with a higher incidence of community-acquired pneumonia as well as community and hospital-acquired Clostridium difficile-associated disease.Long-term use of PPIs was associated with the development of hip fractures in older women.Long-term use of PPIs has also been implicated in the development of iron and magnesium deficiency, but here again, the studies are limited and inconclusive. PPIs may exe a negative effect on the antiplatelet effect of clopidogrel.Reference: Harrison; 19th edition; Page no: 1921


Question: Dose of rTPA in ischaemic stroke is

Ans. is 'b' i.e., 90 mg Recommended dose for thrombolysis with IV TPA is 0.9 mg/kg with the maximum dose being 90 mg. 10% should be given as a bolus over one minute, followed by remaining 90% as a continuous infusion over 60 minutes.


Question: A common finding in osteomalacia is


Question: Not associated with diabetes mellitus


Question: Highest calcium Concentration is present in


Question: Anticentromere antibodies are most commonly associated with

The constellation of calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia, was historically termed the CREST syndrome . Anti-centromere antibodies (ACAs; often styled solid, anticentromere) are autoantibodies specific to centromere and kinetochore function. They occur in some autoimmune diseases, frequently in limited systemic scleroderma (formerly called CREST syndrome), and occasionally in the diffuse form of scleroderma. Ref - HArrisons 20e p2546


Question: B cell prolymphocytic leukemia patients differ from those with B cell chronic lymphocytic leukemia in


Question: Anti histone antibodies are characteristics of

Ref - Harrison's internal medicine 20e p2517


Question: Pulsus alternans is seen in

Pulses alterans is defined by beat-to-beat variability of pulse amplitude.It is seen in patients with severe left ventricular dysfunction and systolic hea failure,and is thought to be due to cyclic changes in intracellular calcium and action potential duration. Hyperophic obstructive cardiomyopathy is characterised by jerky pulse (pulses bisferens). Aoic stenosis is characterised by slow rising carotid pulse.(pulses parvus et tarsus) AS may also have anacrotic pulse Harrison's Medicine-20 the edition.


Question: Right Frontal lobe lesion leads to

(A) Impaired left conjugate gaze# Conjugate gaze refers to the eyes working in unison. A disorder of conjugate gaze means that patients are unable to look in certain directions with both eyes, such as upward, downward or laterally.> Centre for lateral conjugate gaze is seen in frontal lobe cortices & in occipital lobe cortices.> Frontal lobe centres for lateral conjugate gaze lie in the posterior aspect of frontal lobes.> They are quite close to the motor cortex and hence conjugate deviation of the eyes is seen in a number of paralytic strokes.> Frontal lobe centre for lateral conjugate gaze control voluntary conjugate eye movements to the opposite side. Teleologically, this makes sense: the left half of the brain "sees" space on the right side, therefore the left side of the brain controls movements of the right arm and leg, as well as eye movements to the right side.> In one side of frontal lobe centre destruction, as in a cerebral infarct, the tonic impulses from the opposite frontal lobe cause a deviation of the eyes towards the side of the lesion and patient looks to- wards the lesion and away from the paralyzed side.> Conjugate deviation occurs only in acute phase of an infarct and eventually the patient will recover, but there may be an intermediate stage where they are unable to move the eyes away from the lesion on command, yet able to follow an object to the opposite side.> Occipital lobe centre for lateral gaze control the ability of the eyes to follow an object to the opposite side.> In a patient with destruction of the right frontal centre but with an intact right occipital lobe centre cannot look to the left on command, but may be able to follow an object to the left.> If the patient is unable to follow a moving object, such as a finger, you can assess the occipital lobe centre by having them fixate on an immobile object while you move their head.> Remember! Lesions of occipital centre for lateral conjugate gaze are less common than lesions of frontal centre for lateral conjugate gaze.> Brainstem centre for lateral conjugate gaze are in the pons, very close to the sixth nerve nuclei.> The right frontal centre connects with the left pontine centre, and the left frontal centre with the right pontine centre. The left pontine centre controls lateral conjugate eye movement to the left, and the right pontine centre controls lateral conjugate eye movement to the right.> Thus, a patient who has a destruction of one pontine centre will look away from the lesion and towards the paralyzed side because of the unopposed action of the opposite pontine centre. Recovery of conjugate gaze after a brainstem lesion is unusual.


Question: "Telescope fingers" occur in

Ahritis mutilans (A feature of psoriatic ahritis) This is a deforming erosive ahritis targeting the fingers and toes; it occurs in 5% of cases of PsA. Prominent cailage and bone destruction results in marked instability. The encasing skin appears invaginated and 'telescoped' ('main en lorgnette') and the finger can be pulled back to its original length. Ref Davidsons 23e p1033


Question: The commonest hepatotropic virus causing increased chronic carrier state is

Ans. is 'd' i.e.,. HCV Most common hepatitis to progress to chronicity is Hepatitis (G). . HCV =It's major feature, however, is its propensity to cause chronic hepatitis in more than 80% of those infected Clinical and epidemiologic features of viral hepatitis Features HAV HBV HCV HDV HEV * Incubation (days)* 15-45 30-180 15-160 30-180 14-60 * Age* Children, young Adults Young adults Any age but more in adult Any age Young adults * Transmission * Fecal-oral* +++ -- -- -- +++ * Percutaneous* unusual +++ +++ +++ -- * Perinatal* -- +++ + + -- * Sexual * + ++ + ++ -- * Clinical * Severity* Mild Occasionally Severe Moderate Occasionally Severe Mild * Fulminant* l% .1%- 1% .1% 5-20% 1-2% * Progression* to chronicity None Occasional (1-10%) Common (50-70%) Common None * Carrier* None. 1-30% 1.5-3.2% Variable None * Prognosis Excellent Worse with age Moderate Acute, good chronic poor Good


Question: Flourine levels intake required for development of Skeletal Fluorosis


Question: Duroziez's sign is seen in

Ref Harrison 19 th ed pg 1536 booming "pistol-shot" sound can be heard over the femoral aeries (Traube's sign), and a to-and-fro murmur (Duroziez's sign) is audible if the femoral aery is lightly compressed with a stethoscope.


Question: Not seen with uremic lung

Ans. is 'c' i.e., Interstitial fibrosis Uremic lung is referred to abnormalities expressed chest x-ray abnormalities seen in patients with CKD. The pathogenesis was believed to be related to blood urea nitrogen and creatinine retention. There is : Its pathophysiology is based on uremia-induced increased permeability of pulmonary alveolo-capillary interfaces, leading to Interstitial and intra-alveolar edema Atelectasis Alveolar hemorrhage Pulmonary hyaline membrane formation. These changes are compounded by bleeding diathesis secondary to platelet dysfunction in advanced renal disease. The pulmonary symptoms and radiographic findings are reversible with hemodialysis.


Question: Ingestion of arsenic causes

Ans. is 'c' Non cirrhotic Portal fibrosis. "Chronic ingestion of Arsenic has been incriminated in causation of NCPF. High Hepatic arsenic levels in patients with NCPF have been reported" - API


Question: Arsenic is assocaited with increased risk of   a) Mesothelioma   b) Melanoma     c) Basal cell carcinoma  d) Squamous cell carcinoma


Question: S2 is best appreciated in

Ans. is 'a' i.e., 3rd left intercostal space


Question: The recommended target HbA1C to minimise the risk of vascular complications in diabetic individual is


Question: Method of choice to confirm H. Pylori eradication is


Question: Isosthenuria is seen in

Causes :
Chronic renal failure.
Administration of furosomide.
Hypercalcemia.


Question: A Parietal lobe lesion presented with Sensory seizures, motor deficits' visual disorders, no touch perception on opposite side and on simultaneous bilateral touch. This is associated with

(A) Unilateral parietal lobe dysfunction Unilateral parietal lobe dysfunction (Right or left)Dominant (left) parietal lobe dysfunction (in most right- handed and some left handed patients)Non-dominant (right) parietal lobe dysfunctionBilateral parietal lobe dysfunction* Sensory deficits (asterognosis, agraphesthesia, sensory seizures)* Motor deficits (mild hemiparesis)* Visual disorders (homonymous hemianopia, inferior quadrantanopia, visual inattention)* Contralateral neglect (more obvious for right sided lesions)* Constructional and dressing apraxia* Language disorders (aphasia, alexia)* Gertsmann syndrome (dyscalculia, dysgraphia, finger agnosia, right-left confusion)* Apraxia* Hemispatial neglect* Sensory and visual inattention* Constructional and dressing apraxia (greater severity for right sided lesions)* Visuospatial disorientation* Balint syndrome (optic ataxia, oculomotor apraxia, simultanagnosia)# Symptoms & Signs of Parietal lobe dysfunction: Paroxysmal localized paraesthesia (tingling sensations/'pins and needles'), affecting the contralateral side of the body. Also known as sensory seizures. Sensory deficits to the contralateral side can occur, leading to astereognosis, agraphesthesia, loss of proprioception, vibration and fine touch. Primary sensory modalities may return after a short time, however discrimination between sensations may not. Mild hemiparesis could also occur.


Question: "Seal finger" and "whale finger" are associated with infection of

(B) Erysipelothrix # Erysipelothrix rhusiopathiae> E. rhusiopathiae is a natural parasite of many animals.> It causes swine erysipelas & human erysipeloid.> Human infection usually occurs on the hand or fingers of persons handling animals fish or animal products> Lesions are painful, edematous and erythematous, usually involving the local lymphnodes and joints.> Occasional cases of endocarditis have been reported.> The bacillus is sensitive to penicillin, erythromycin and broad spectrum antibiotics.


Question: The Investigation of choice for Acute stroke is

(A) CT scan # Investigation of Acute Stroke: CT is the most practical and widely available method of imaging the brain. It will usually exclude non-stroke lesions, including subdural haematomas and brain tumours.> It will demonstrate intracerebral haemorrhage within minutes of stroke onset.> However, especially within the first few hours after symptom onset, CT changes in cerebral infarction may be completely absent or very subtle, though changes usually evolve over time.> For most purposes, a CT scan performed within the first day or so is adequate for clinical care but there are certain circumstances in which an immediate CT scan is essential.> Even in the absence of changes suggesting infarction, abnormal perfusion of brain tissue can be imaged with CT after injection of contrast media (i.e. perfusion scanning). This can be useful in guiding hyper-acute treatment of ischaemic stroke.> MRI is not as widely available as CT, scanning times are longer & it cannot be used in some individuals with contraindications


Question: Mechanism of action colchicine in acute gout

* Gout is a hereditary disorder with increase in serum uric acid due to increased production, or decreased excretion of uric acid and uric salt. * Thought to be caused by lack of an enzyme needed to completely metabolise purines for renal excretion. REF : HARRISONS 21ST ED

Renal disease involving interstitial tissues


Question: Dawson disease is

Answer- A. SSPESSPE is ako known as Dawson encephalitis and measles encephalitis.


Question: Gene mutations in Cystic fibrosis occurs at


Question: Diabetes control is best monitored by


Question: ANCA negative vasculitis among the following is

c- ANCA predominant vasculitis p- ANCA predominant vasculitis 1. Wegener`s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Crescentic glomerulonephritis


Question: Prophylactic gonadectomy is done in

Gonadectomy is often advised in CAIS due to the risk of gonadal malignancy.
The malignancy risk is poorly defined (possibly 5-10% in childhood rising to 30% by the age of 50 years) and is thought to be due to intra abdominal position of the testes.

Timing of gonadectomy is controversial.

Some clinicians advocate early i.e. childhood gonadectomy due to the malignant potential with subsequent HRT to induce puberty.
Others prefer to delay gonadectomy until after puberty to allow endogenous gonadal hormones to work throughout puberty.
Hormone replacement therapy is essential after gonadectomy for many aspects of health and well being. One of these is the maintenance of bone mineral density.

More on management of CAIS

Majority of women with CAIS will have a shortened vagina.
The hypoplastic vagina requires treatment.
The two main options for vaginal enlargement are vaginoplasty surgery or manual vaginal dilatation.
Vaginal dilatation is usually the first line treatment.


Question: Comment on the diagnosis of the patient.

Given X ray shows prominent descending right pulmonary aery- giving "Jug handle" appearance Aoic Dissection - seen on CT COA - 3 sign TOF - Boot shaped hea

Thromboembolism and Fat Embolism Syndrome


Question: ROSE questionnaire is used for

The Rose Angina Questionnaire (RAQ) was developed in 1962 to detect ischemic hea pain (angina pectoris and myocardial infarction) for epidemiological field-surveys.1 Since then, the RAQ has been used in many countries to detect coronary hea disease (CHD) in epidemiological research . Ref Davidson edition23rd pg 460


Question: Of the following vasculitides, coronary artery aneurysms are most often in


Question: The most important drug in the treatment of Ischemic Heart Disease

Aspirin is the most important drug in the management of Ischemic heart disease


Question: A 45year old patient is having FBS 111mg/dl, PPBS 181mg/dl, HbA1C 6.1%. The diagnosis is


Question: A 60 year old man presents with choreoathetosis. O/e KF rings is seen in cornea. Initial treatment of choice is

Zinc is the initial treatment of choice.


Question: Maximum loss of sodium in a child occurs in

Ans. is 'b' i.e., heal fluid Cations and anions in biological fluids in meq/dl Fluid Sodium Potassium Chloride Gastric juice 60 10 85 heal fluid 130 10 115 Diarrhea stool 10-90 10-80 10-110


Question: Most common GI manifestation in HIV infection is


Question: A known case of bronchial asthma with eosinophilea. Most common cause of the fungal infection is

(Aspergillosis) (1335- CMDT- 08) (234-CMDT-09) (1259-H17th)Allergic bronchopulmonary aspergillosis - occurs in patients with preexisting asthma who develop worsening bronchospasm and fleeting pulmonary infiltrates accompanied by eosinophilia high levels of IgE, IgG, Aspergillus precipitins in the bloodCRYPTOCOCCOSIS - Most common cause of fungal meningitis, Predisposing factors - Hodgkin's disease corticosteroids therapy, HIV infectionsMUCORMYCOSIS (Zygomycosis, phycomycosis) - Predisposing conditions include Diabetic ketoacidosis, CRF, desferoxamine therapy, treatment with corticosteroid or cytotoxic drugsCANDIDIASIS - risk factors - prolonged neutropenia, recent abdominal surgery, broad- spectrum antibiotic therapy, renal failure, presence of intravascular catheters (especially when providing TPN) and Injection drug use* Gastrointestinal mucosal disease, particularly esophagitis most common


Question: Thickening of pulmonary memb. is seen in


Question: Murmur increasing with valsalva maneouvre