Question: In Beta thalassemia, the most common gene mutation is

Ans. is 'a' i.e., Intron 1 inversion Thalassemias are autosomal recessive disorder The most common mutation causing 13 thalassemias is intron/inversion Also know: Synthesis of alpha chain is controlled by 2 gene clusters on - Chromosome 16 Synthesis of beta chain is controlled by 2 gene clusters on - Chromosome 11 Thalassemia mutations in India Multations Frequency IVS1-5 (G -->C) 48% 619 bp defection 18% IVS-1 (G T) 9% FR41/42(TCTT) 9% FR8/9 (+G) 5% Codonl5 (G --> A) 6% Others 100%


Question: Treatment of asymptomatic bradycardia is

Ans. is 'a' i.e., No treatment is required


Question: A 30 year old patient presents with odynophagia, there no h/o drug intake. On endoscopy there are multiple ulcers in the esophagus diagnosis is


Question: In a patient with cystic fibrosis, high fever with productive cough. Most common causative organism is

Pseudomonas aeruginosa is the key bacterial agent of cystic fibrosis (CF) lung infections, and the most impoant pathogen in progressive and severe CF lung disease. Once these sticky biofilms are formed, inflammation results and, in some cases, leads to chronic infections that can last for months or years with productive cough and fever Ref Robbins 9/e pg 178


Question: Most common cause of hematochezia in children is

Serious causes of hematochezia in the neonate include necrotizing enterocolitis and midgut volvulus. A wide variety of causes of hemorrhage occur as children grow older. Causes relatively unique to children are intussusception, Meckel's diveiculum, and juvenile polyps Ref Davidson edition23rd pg 809


Question: Round pneumonia is seen with

Ans. is 'a' i.e., Streptococcal pneumonia Grainger & Allison's Diagnostic Radiology Essentials (Elsevier Health Sciences) 2013/38; ('MDT 2014 270] Streptococcus Pneumoniae (pneumococcus) is the most common organism responsible for round pneumonia. Round Pneumonia is a spherical pneumonia that is usually seen in children due to the lack of collateral air drift. Streptococcus Pneumoniae (pneumococcus) is the most common organism responsible for round pneumonia. Round pneumonias are impoant as they may simulate a tumor mass from which they must be differentiated


Question: Patients with atrial fibrillation have


Question: In an old patient, the best indicator of probability of developing cardiovascular disease can be calculated by

Good cholesterol ratio vs. bad cholesterol ratio High-density lipoprotein, or HDL, is considered "good" cholesterol. It makes up 20-30 percent of a person's total cholesterol level. Low-density lipoprotein, or LDL, is considered "bad" cholesterol and makes up 60-70 percent of the total in the body. A high HDL cholesterol number lowers your risk for coronary hea disease. A high LDL cholesterol number raises your risk for coronary hea disease. By comparing your total cholesterol number with your HDL cholesterol number, your healthcare provider can get another number called your total-cholesterol-to-HDL ratio Ref Davidson 23rd edition pg 556


Question: In essential lhypeension the drug prescribed with least cardiovascular effect

Aldosterone Antagonists Spironolactone is a nonselective aldosterone antagonist that may be used alone or in combination with a thiazide diuretic. It may be a paicularly effective agent in patients with low-renin essential hypeension, resistant hypeension, and primary aldosteronism. ref:Harrison&;s principles of internal medicine,ed 18,pg no 3079


Question: A Myocardial infarcted patients presented with nausea, vomiting, epigastric pain, with bradycardia. ECG records first degree heart block infraction. Most common involvment is

(Right coronary artery) (315- CMDT-08) (320- Harsh Mohan 5th) (1533-H17th)* Belching or vomiting and bradycardia is usually associated with Inferior wall infarction**1.Stenosis of the left anteriorMost common (40-50%), region of infarction descending coronary arteryis Anterior part of the left ventricle**including the apex and the anterior 2/3 of interventricular septum2.Stenosis of the right coronary artery30 - 40% - Involves Posterior {Inferior)Bmd the posterior 1/3 of the interventricular septum3.Stenosis of the left circumflex15-20% - Involves lateral wall of the left coronary arteryVentricle


Question: Caplan's syndrome of rheumatoid arthritis with pneumoconiosis is characterized by

Ans. a (Lung nodules and diffuse pulmonary fibrosis). (Ref. Harrison, Medicine, 16th ed., 1524)CAPLAN'S SYNDROME# Caplan's syndrome is characterized by triad of- Pulmonary nodules,- Pneumoconiosis (progressive massive fibrosis), and/in- Rheumatoid disease (seropositive).# The immuno-pathological mechanism involves:- Direct cytotoxicity of inorganic dust- Stimulation of reactive oxygen- Activation of macrophages to produce cytokines and TNF alpha (fibrogenic factor)- Increased protease activity- Increased activation of alpha 1 antitrypsin and leucocyte elastase activity.

Bilateral symmetrical lung cavitations with pulmonary fibrosis.

Air-space consolidation with patchy pulmonary fibrosis.

Interstitial pneumonitis with hilar adenopathy.


Question: Serum ACE levels are reduced in

(B) COPD# Elevated levels of ACE are found in sarcoidosis, and are used in diagnosing and monitoring this disease.> Elevated levels of ACE are also found in leprosy, hyperthyroidism, acute hepatitis, primary biliary cirrhosis, diabetes mellitus, multiple myeloma, osteoarthritis, amyloidosis, Gaucher disease, pneumoconiosis, histoplasmosis, miliary tuberculosis.> Serum levels are decreased in renal disease, obstructive pulmonary disease, and hypothyroidism.


Question: Gorlins formula is used to calculate

Answer-A. Area of stenotic aoic valveThe stenotic valve orifice are is derived fromthe pressure gradient and cardiac output with the formula developed by Gorlin and Gorlin, which involves the fundamental hydraulic relationships, linking the a.ea of an orifice to the flow and pressure drop across the orifice.


Question: The most common type of Glomerulonephritis occurs in HIV infection is

(A) FSGS GLOMERULONEPHRITISCINICAL FEATURESETIOLOGY* ADP-GN* Nephritic syndrome* Post-streptococcal (2/3rd cases)Diffuse proliferative GN* Gross hematuria + edema + hypertension* Leprosy, ABE, SBEAcute GN* Oliguria* RBC cast: most specific* RPGN (Crescentic GN)* Sub acute RF* Nephritic syndrome* Complement level Normal* Respiratory symptoms (hemoptysis in GPS)* RPGN Type* I - Idiopathic, Goodpasture syndrome* II-ldiopathic, SLE, post infectious* III-WG, PAN Churg-Strauss syndrome* Minimal Change Disease (MCD) (Lipoid nephrosis/Nil deposit disease)* Lipiduria and lipid cast in urine* Membranous GN (Hymmens GN)* Most common cause of Nephrotic syndrome in children* Good response to steroids* Most common cause of Nephrotic syndrome in adults* Idiopathic drugs (Rmp, NSAIDS,* IRON-dextran, IFN-a) HIV* Idiopathic (in primary)* SLE and infections (HBV, HCV, Syphilis, P. malariae)* Drugs (penicillamine Gold, Captopril, NSAIDS)* Membranoproliferative GN (MPGN) Mesangiocapiilary GN* Nephrotic (type-I)* Type-II associated with partial lipodystrophy,* Hypocomplementamia* MPGN Type-I (H.o recent URI)* MPGN type-II (dense deposit ds)* MPGN type-III


Question: A patient underwent Bhadrenalectomy in views of B/L pheochromocytoma 1 day later developed lethargy fatigue low BP and pulse normal No signs of volume deficit likely course


Question: The most common cause of embolic stroke

Ans. is 'a' i.e., Non rheumatic atrial fibrillation No rheumatic atrial fibrillation leads to clot formation in left atrial appendage that can embolize to the brain leading to neurological dificits


Question: Intention tremor is seen in

(B) Cerebellar disease > The degree of tremor should be assessed in four positions. The tremor can then be classified by which position most accentuates the tremor.TREMORSTypeEssential TremorResting TremorPhysiologic (Postural) TremorCharacteristicsAppearing or Worsening at onset of movementAppearing in Rest, vanishing in movementAppearing in a Static stateEtiologyWilson Disease: FamiliarParkinson Disease,Parkinson Plus SyndromesAnxietiesTherapyPropranolol, Primidon, Gabapentin, AtenololDopamin Agonists, Levodopa, Amantadin, DBS (Vim, Zona Incerta)Propranolol, Clonazepam


Question: On the basis of BMI obesity is labeled at

Body mass index (BMI) or Quetelet index:Defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2BMIWeight status< 18.5 Underweight18.5-24.9 Healthy25.0-29.9Overweight>= 30.0Obese30.00-34.99 Obese class I35.00-39.99 Obese class II>= 40 Obese class IIIRef: Harrison's 18/e p608, 622, 630


Question: Comment on presentation of this patient.

Chunky pink gelatinous plug in sputum - Pulmonary alveolar proteinosis Blood in the sputum - Angioinvasive A.nigar Hamman crunch sign - associate with pneumothorax/ pneumomediastinum Horner syndrome - associate with Pancoast tumor Fungal ball Aspergilloma - A. Nigar CT- | Angioinvasive | So, Blood in sputum

Horner syndrome with wasting of intrinsic muscles of hand

Hamman Crunch sign with subcutaneous emphysema

Pleural effusion & Pulmonary alveolar proteinosis


Question: Restrictive and constrictive pericarditis occurs together in


Question: Dyslipidemia associated with alcohol consumption


Question: The characteristic "sulfur grains"of actinomycosis are composed chiefly of


Question: Fractional excretion of sodium (FENa) is calculated as

The fractional excretion of sodium (FeNa) is the fraction of the filtered sodium load that is reabsorbed by the tubules FENa relates sodium clearance to creatinine clearance. As such, it depends on sodium intake, effective intravascular volume, GFR, diuretic intake, and intact tubular reabsorptive mechanisms. With prerenal azotemia, the FeNa may be below 1%, suggesting avid tubular sodium reabsorption. FENa may be >1.0% in prerenal ARF if patients are on diuretics or with pre-existing CKD, salt-wasting syndromes or adrenal insufficiency. Ref: Harrison 19e 1807


Question: The drug of choice for the treatment of Pneumocystis jiroveci (Pneumocystis carinii) pneumonia is


Question: The treatment for CNS leukaemia is

Intrathecal methotrexate is a chemotherapy drug which is given to prevent leukaemia cells entering the cerebrospinal fluid (CSF) around the spine and brain. This drug is also used to treat leukaemia found in the CSF for CNS leukemias Ref Davidson 23rd edition pg 788


Question: Serum amylase level is raised in A/E


Question: Fatal complication of sodium polystyrene sulfonate

Intestinal necrosis, typically of colon or ileum is a rare but fatal complication of Sps.


Question: In relation to type 1A DM, honeymoon period is

After the initial clinical presentation of type 1 DM, a "honeymoon" phase may ensue during which time glycemic control is achieved with modest doses of insulin or, rarely, insulin is not needed.However, this fleeting phase of endogenous insulin production from residual beta cells disappears and the individual becomes insulin deficient.Ref: Harrison 19e pg: 2403


Question: Drug of choice associated with pheochromocytoma

Drugs used in management of pheochromocytoma DOC is Phenoxybenzamine Ref- pubmed.com <a href="
Ref


Question: Neoplastic cells in Franklin disease express

Answer- D. CD79aIn classic Franklin disease, neoplastic lymphocytes, plasmacytoid lymphocytes and plasma cells can be found in lymph nodes, Waldeyer ring, gastrointestinal tract and other extranodal sites, spleen, liver, bone marrow.Systemic symptoms- fever, weight loss, weakness, anorexia, recurrent bacterial infections.Neoplastic cells in Franklin disease, are believed to represent post germinal center B cells. The neoplastic cells contain gamma heavy chains in the cytoplasm ofcells (without light chains) and express CD 79a.Neoplastic lpnphocytes in this disorder express CD20, neoplastic plasma cells in this disorder express CD 138.


Question: The most common location of hypeensive intracranial hemorrhage is

The most common locations of hypeensive ICH are: 1) Basal ganglia (putamen or caudate), 2) Thalamus, 3) Pons and 4) Cerebellum. Within the basal ganglia region, it is rare for an ICH to specifically affect one area; Ref Harrison20th edition pg 2345


Question: Most common presentation of Neurocysticercosh is

(A) Seizures # NEUROCYSTICERCOSIS is the most common parasitic disease of the CNS worldwide.> Humans acquire cysticercosis by the ingestion of food contaminated with the eggs of the parasite T. solium,\> Eggs are contained in under cooked pork or in drinking water or other foods contaminated with human feces.> T. gondii is a parasite that is acquired from the ingestion of undercooked meat and from handling cat feces.> In cysticercosis, the clinical manifestations are variable.> Cysticerci can be found anywhere in the body but are most commonly detected in the brain, skeletal muscle, subcutaneous tissue, or eye> Clinical presentation of cysticercosis depends on the number and location of cysticerci as well as the extent of associated inflammatory responses or scarring.> Neurologic manifestations are the most common. Seizures are associated with inflammation surrounding cysticerci in the brain parenchyma. These seizures may be generalized, focal, or Jacksonian.> Hydrocephalus results from obstruction of cerebrospinal fluid (CSF) flow by cysticerci and accompanying inflammation or by CSF outflow obstruction from arachnoiditis.> Signs of increased intracranial pressure, including headache, nausea, vomiting, changes in vision, dizziness, ataxia, or confusion, are often evident.


Question: Hepatitis B virus is NOT present in


Question: Ipsilateral Homogeneous opacification and contralateral mediastinal shift is seen in


Question: Posterolateral lesions of ventral spinal cord leads to


Question: Intake of exogenous steroid causes.

Ans is option 2. Cushing&;s syndrome The most common cause of Cushing&;s syndrome is iatrogenic administration of steroids for a variety of reasons. Ref Harrison 17/e p. 2254-2255


Question: Clinical features of pneumonia are

Chest signs of consolidation in pneumonia include increased vocal fremitus,dull note on percussion,and as conduction of sound is enhanced,auscultation reveals increased breath sounds,bronchial breathing,aegophony & whispering pectoriloquy;crackels are heard through out. Reference:Davidson's medicine-22nd edition,page no:683.


Question: Select the neurologic disorder not associated with antiphospholipid antibodies.

In Antiphospholipid Ab patient can develop antibody induced cerebritis. Antiphospholipid antibodies is a hypercoagulable state -patient will develop ischemic stroke not hemorrhagic. Demyelinating disease: Ab can be attacking myelin sheath & nerve get demylinating. Headache and seizures can also occur in pt. with antiphospholipid antibodies.


Question: Beck's triad of cardic tamponade includesa) Hypotensionb) Neck vein distensionc) Silent heartd) Tachycardia


Question: Delta waves in ECG are characteristic of

(A) Wolf Parkinson White syndrome# DELTA WAVES are quite rare and represent a slurring of the QRS complex associated with Wolff-Parkinson-White syndrome. This may lead to tachycardias, and should be evaluated. Intermittent delta waves are certainly possible and often imply that the accessory pathway does not conduct very rapidly. This situation is relatively rare.> Wolff-Parkinson-White Preexcitation> Although not a true IVCD, this condition causes widening of QRS complex and, therefore, deserves to be considered here QRS complex represents a fusion between two ventricular activation fronts:> Early ventricular activation in region of the accessory AV pathway (Bundle of Kent)> Ventricular activation through the normal AV junction, bundle branch system ECG criteria include all of the following: Short PR interval (<0.12s) Initial slurring of QRS complex (delta wave) representing early ventricular activation through normal ventricular muscle in region of the accessory pathway Prolonged QRS duration (usually >0.10s) Secondary ST-T changes due to the altered ventricular activation sequence


Question: Chronic renal failure with inappropriately high haemoglobin levels may be seen with

Clinical features Haemoglobin and erythropoietin levels in polycystic kidney disease increases Common clinical features are shown in Box 15.21. Affected people are usually asymptomatic until later life but hypeension usually occurs from the age of 20 onwards. One or both kidneys may be palpable and the surface may feel nodular. About 30% of patients with PKD also have hepatic cysts (see Fig. 22.39, p. 893) but disturbance of liver function is rare. Sometimes (almost always in women) this causes massive and symptomatic hepatomegaly, usually concurrent with renal enlargement but occasionally with only minor renal involvement. Berry aneurysms of cerebral vessels are an associated feature in about 5% of patients with PKD. This feature appears to be largely restricted to ceain families (and presumably specific mutations). Mitral and aoic regurgitation is frequent but rarely severe, and colonic diveicula and abdominal wall hernias may occur. Investigations The diagnosis is usually based on family history, clinical findings and ultrasound examination. Ultrasound demonstrates cysts in approximately 95% of affected patients over the age of 20 and is the screening method of choice, but may not detect small developing cysts in younger subjects. Cysts may also be identified by other imaging modalities, such as MRI (Fig. 15.15). Simple renal cysts may occur in normal individuals but are uncommon below the age of 30. The following criteria exist for an ultrasound diagnosis of PKD in patients with a family history but unknown genotype: * 15-39 years of age: at least three unilateral or bilateral kidney cysts * 40-59 years of age: at least two cysts in each kidney * 60 years or older: at least four cysts in each kidney. It is now possible to make a molecular diagnosis by mutation screening of PDK1 or PDK2 but this is seldom used in routine clinical practice because the PKD1 gene is so large and has many possible mutations. Next-generation sequencing allows faster and simpler genetic screening for PKD1 and PKD2. This is likely to be used in cases with an unceain diagnosis (young patients, few cysts, lack of family history), for workup of living kidney donors, or for screening for mutations associated with a worse prognosis (see below). Screening for intracranial aneurysms is not generally indicated but can be done by MR angiography in families with a history of subarachnoid haemorrhage. The yield of screening is low, however, and the risk:benefit ratio of intervention in asymptomatic aneurysms in this disease is not clear. Ref Harrison20th edition pg 288


Question: Primary Tuberculosis most commonly involves

Answer is A (Lungs): The most common primary site for primary tuberculosis is the Lung. 'Primary site is the Lung in upto 95% of cases' - Oski's Pediatrics 'For both primary and reactivation tuberculosis the lungs are the most commonly affected site.' Most common primary site for Primary Tuberculosis is LungsQ Most common site for Post-Primary Reactivation Tuberculosis is Lune Most common primary site for congenital tuberculosis is Liverdeg Most common site /organ involved in congenital tuberculosis in Lune Principles of Pulmonary Medicine (Elsevier) 547107 Primary tuberculosis: It is the first infection with tubercle bacilli in individuals who have not been previously exposed to the organisms Seen in children Q Primary complex is characteristic Primary (Ghon) complex Unilateral enlarged hi lar lymph nodes Q Ghon focus Epitheloid-cell granulomatous inflammation (consolidation) at site of parenchymal infection. Usually small and subpleural most commonly located under pleura in lower pa of upper lobe Usually a symptomatic Q or manifested by a mild tlu like illness at time of tuberculin conversion Lesion heal by fibrosis Q and may calcify Q Radiological evidence of healed primary infection may or may not be present Q Effects of primary tuberculosis Tuberculin positivity Q Paial immunity to tuberculosisQ: individual requires a higher dose to be reinfected by tubercle bacilli Presence of dormant tubercle bacilli


Question: Bristol cha is used fore

Answer- A. Stool consistencyThe Bristol stool scale(Bristol stool cha (BsC)) is a diagnostic medical tool designed to classifr the form of human feces into seven categories.The seven types ofstcol areType 1 Separate hard lumps, like nuts (hard to pass); also known as goat faecesType 2: Sausage-shaped but lumpyType 3: Like a sausage but with cracks on its surfaceType 4: Like a sausage or snake, smooth and softType 5: Soft blobs with clear cut edges (passed easily)Type 6: Fluft pieces with ragged edges, a mushy stoolType 7: Watery, no solid pieces, entirely liquid


Question: Mild MR.features are

Most people with mitral regurgitation (MR) have no symptoms. People with mild tomoderate MR may never develop symptoms or serious complications Mitral regurgitation (MR), mitral insufficiency, or mitral incompetence, is a form of valvular hea disease in which the mitral valve does not close properly when the hea pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. MR is the most common form of valvular hea disease.


Question: A patient comes with sudden respiratory distress, on examination, bilateral basal crepts are present over chest suggestive of pulmonary edema with normal alveoler wedge pressure. The likely cause is


Question: Rytand's murmur is heard in

Rytand's murmur is mid diastolic murmur in complete heart block.


Question: Hypotension while on dialysis is due to

(A) Excessive ultrafiltration # INTRADIALYTIC HYPOTENSION is the presence of a decrease in systolic blood pressure PS20 mmHg or a decrease in mean arterial pressure by 10 mmHg.> Dialysis hypotension is the result of an inadequate cardiovascular response to the reduction in blood volume that occurs when a large volume of water is removed during a short period of time.


Question: Most common presentation of SLE is

Ahritis in SLE Ahralgia is a common symptom, occurring in 90% of patients, and is often associated with early morning stiffness. Tenosynovitis may also occur but clinically apparent synovitis with joint swelling is rare. Joint deformities may arise (Jaccoud's ahropathy) as the result of tendon damage but joint erosions are not a feature. Ref Davidsons 23e p1035


Question: Genetic risk factor for COPD is

Severe a1 Antitrypsin deficiency is a proven genetic risk factor for COPDAlthough only approximately 1% of COPD patients are found to have severe a1AT deficiency as a contributing cause of COPD, these patients demonstrate that genetic factors can have a profound influence on the susceptibility for developing COPDSpecific treatment in the form of a1AT augmentation therapy is available for severe a1AT deficiency as a weekly IV infusion Patients with cystic fibrosis develop bronchiectasisRef: Harrison 19e pg: 1704


Question: Multiple sclerosis is a

(A) Demyelinating disease # MULTIPLE SCLEROSIS (MS) is characterized by a triad of inflammation, demyelination, and gliosis (scarring); the course can be relapsing-remitting or progressive.> Lesions of MS are typically disseminated in time and location.> Demyelinating disorders are characterized by inflammation and selective destruction of central nervous system myelin.> Peripheral nervous system is spared, and most patients have no evidence of associated systemic illness.


Question: A patient has diarrhea, malabsorption,  Abdominal pain and Arthralgia. On intestinal biopsy PAS + organisms present inside macrophage. Most likely diagnosis is

PAS+ Organisms inside macrophage clearly s/o whipple's disease.


Question: Ophthalmoplegic migraine is characterized by

Ophthalmoplegic migraine is a rare neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. The third cranial nerve is most commonly affected, in which case mydriasis and ptosis can also be observed Ophthalmoplegic migraine is a rare neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. The third cranial nerve is most commonly affected, in which case mydriasis and ptosis can also be observed. Most patients recover completely within days to weeks, but a minority are left with persistent neurologic deficits Ref Harrison20th edition pg 1234

Headache with benign recurrent 3 rd N. palsy


Question: Sensitive and specific marker for MI

Cardiac troponin I or T, which are specific, sensitive, and the preferred markers of myocardial necrosis. The MB isoform of creatine kinase (CK-MB) is a less sensitive alternative.Ref: Harrison 19e pg: 1594


Question: Swollen neurons that contain numerous lysosomes filled with lipid are typical of

Swollen neurons that exhibit marked vacuolization of the perikaryon and contain lysosomes filled with lipid are found in TaySachs disease but could occur in other lipid-storage diseases as well. The correct diagnosis can be established by biochemical analysis of the stored material or identification of intermediary metabolites and missing enzymes. The other diseases listed do not produce such neuronal changes. Ref - Harrison's internal medicine 20e pg 3007


Question: Pulsus paradoxus is characteristic feature of

Ref Harrison 19 th ed pg 1574 Paradoxical Pulse This impoant clue to the presence of cardiac tamponade consists of a greater than normal (10 mmHg) inspiratory decline in systolic aerial pressure. When severe, it may be detected by palpating weakness or disappearance of the aerial pulse during inspiration, but usually sphygmomanometric measurement of systolic pressure during slow respiration is required.


Question: A 14 year female on strenuous exercise presented with muscle pains, and voiding red colored urine. The diagnosis is

(A) Glycolytic pathway defect # Disorders of Glycolysis Causing Exercise Intolerance Several glycolytic defects are associated with recurrent myoglobinuria: myophosphorylase deficiency (type V glycogenosis), phosphofructokinase deficiency (type VII glycogenosis), phosphoglycerate kinase deficiency (type IX glycogenosis), phosphoglycerate mutase deficiency (type X glycogenosis), lactate dehydrogenase deficiency (glycogenosis type XI), and beta-enolase deficiency. Clinical muscle manifestations in these conditions usually begin in adolescence. Symptoms are precipitated by brief bursts of high-intensity exercise, such as running or lifting heavy objects. A history of myalgia and muscle stiffness usually precedes the intensely painful muscle contractures, which may be followed by myoglobinuria. Acute renal failure accompanies significant pigmenturia.> Carnitine Palmitoyltransferase Deficiency In contrast to disorders caused by defects in glycolysis, in which muscle cramps follow short, intense bursts of exercise, the muscle pain in CPTII deficiency does not occur until the limits of utilization have been exceeded and muscle breakdown has already begun.> Hypokalemic Periodic Paralysis (HypoKPP) Men are more often affected because of decreased penetrance in women. Attacks are often provoked by meals high in carbohydrates or sodium and may accompany rest following prolonged exercise. Weakness usually affects proximal limb muscles more than distal. Ocular & bulbar muscles are less likely to be affected. Mitochandrial myopathies more often affect ocular muscles.


Question: NOT a feature of ventilator associated pneumonia

(B) Tachycardia> Tachycardia: Clinical criteria for diagnosis of ventilator pneumonia include (fever, Leucotyosis, New changing radiographic infiltrates, development of purulent secretions change in oxygen requirement/ventilator settings, which have high sensitivity but low specificity.


Question: Norepinephrine is produced by

(D) Adrenal medulla # Adrenal Cortex> The adrenal cortex synthesizes three different types of steroids:> Glucocorticoids (principally cortisol), which are synthesized primarily in the zona fasciculata with a small contribution from the zona reticularis.> Mineralocorticoids, the most important being aldosterone, which is generated in the zona glomerulosa.> Sex steroids (estrogens and androgens), which are produced largely in the zona reticularis.> The adrenal medulla is composed of chromaffin cells, which synthesize and secrete catecholamines, mainly epinephrine.\> Catecholamines have many effects that allow rapid adaptations to changes in the environment.> Norepinephrine, epinephrine, and dopamine are secreted by the adrenal medulla.


Question: Thermoregulatory response activated by cold is


Question: Pseudo P Pulmonale seen in

Ans. a. HypokalemiaRef: Oxford Handbook of Clinical Medicine; Page No-90P WAVENormally precedes each QRS complex and upright in II, III and aVF but inverted in aVR.Absent P wave: AF, Sinoatrial block, Junctional (AV nodal) rhythm.Complete heart block indicates; dissociation between P waves and QRS complex.P. mitrale: Bifid P wave, it indicates left arterial hypertrophy.P. Pulmonale: Peaked P wave, it indicates right atrial hypertrophy.Pseudo P. Pulmonale seen if K+ decreases.ELECTROCARDIOGRAPHIC FINDINGS IN ELECTROLYTE DISTURBANCESHypokalemia related with ECGHyperkalemia related with ECG*. U and T wave fuse*. Increased QRS amplitude*. Increased QRS duration*. Increased P wave amplitude,*. Increased P wave duration*. ST segment depression*. PR interval slightly prolonged*. T wave inversion*. Prominent U waves*. Long QU intervalMild Hyperkalemia*. P wave Normal*. QRS Normal*. T wave: Tall and tented, often symmetric with narrow base; usually best seen in leads II. Ill, V2 and V4. The corrected QT interval not prolongedSevere Hyperkalemia*. P wave: Amplitude decreases, duration increases until it eventually disappears*. QRS: Broadens, wide S waves in the left precordial leads*. QRS axis: Superior (left axis deviation).*. ST segment: The terminal S waves become continuous with the tall tented T wave ECG changes in HypocalcaemiaECG Changes in Hypercalcaemia*. Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment*. The T wave is typically left unchanged*. Dysrhythmias are uncommon, although atrial fibrillation has been reported.*. Torsades de pointes may occur, but is much less common than with hypokalaemia or hypomagnesaemia*. The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval*. In severe hypercalcaemia, Osborn waves (J waves) may be seen*. Ventricular irritability and VF arrest has been reported with extreme hypercalcaemia ECG changes in HypomagnesaemiaECG changes in Hypermagnesaemia*. The primary ECG abnormality seen with hypomagnesaemia is a prolonged QTc*. Atrial and ventricular ectopy, atrial tachyarrhythmias and torsades de pointes are seen in the context of hypomagnesaemia*. Tall T wave*. Depressed ST segment*. Prolonged PR interval*. Widened QRS complex


Question: Most common heavy chain disease is

Ans. is 'b' i.e., Seligmann Disease (Alpha heavy chain disease)


Question: Reversal of shunt is not possible in the natural history of

Eisenmenger's syndrome or reversal of shunt is seen in the ventricular septal defect, atrial septal defect, or less commonly, patent ductus aeriosus. ref - Harrisons internal medicine 20e pg 393,1838


Question: HbH is characterized by

Answer- A. Deletion of three alpha genesHbH disease- Deletion of three alpha genes (--/-alpha)- hemolytic anemia

Deletion of three alpha and one beta gene

Deletion of two alpha and two beta genes


Question: Rasmussen's aneurysm is a

In tuberculosis,hemoptysis can occur due to rupture of a dilated vessel in a tuberculous cavity.It is known as Rasmussen's aneurysm. Ref:Harrison's medicine-18th edition,page no:1345.

Dilated vessel in a tubercular lung cavity

Dilated of the root of aoa in valvular stenosis

Dilated renal vessel in hypeensive renal disease


Question: Angiotensin converting enzyme inhibitors are not used in congestive heart failure resulting from


Question: Sensory neural deafness associated with hereditary nephritis is seen in

Clinically patients with Alpos syndrome develop hematuria, thinning and splitting of GBM's,mild proteinuria (<1-2g/24hrs) which appears late in the course followed by chronic glomerulosclerosis leading to renal failure associated with sensorineural deafness. There r four forms of alpos syndrome Type 1 classic As -x linked disorder with Hematuria,sensorineural deafness ,lenticonus Type 2-x linked form associated with diffuse leiomymomatosis T3 -autosomal recessive ,T4autosomal dominant -both forms can cause renal disease without deafness or lenticonus. Ref:Harrison 20 th edition pg no 2146,2977


Question: The first plasma protein to be generated after severe protein deficiency


Question: Patient on risperidone may have

Adverse effects of Risperidone: Weight gainHyperpigmentationRise in prolactin levelsNeuroleptic malignant syndromeRef: Harrison's 18/e Page no: 144, 3333


Question: Not a feature of maintenance phase of acute kidney injury

Hypercalcemia not a feature of maintenance phase.
Hypocalcema Occurs in maintenance phase.


Question: Endoscopy is contraindicated in

Endoscopy is C/I in regurgitant lesions like Achalasia and Zenker's diverticulum as it carries the risk of rupture in mediastinum (Very risky).


Question: Well's grading of puimonary embolism is based ona) Dopplerb) Clinical symptomsc) Hemoptysisd) Heart Rate > 100 beats per min


Question: Pain insensitive structure

The cranium, brain parenchyma, ependymal lining of the ventricles, and choroid plexus are all pain insensitive Ref Harrison20th edition pg 2345


Question: An example of chronic myeloproliferative disorder is

According to WHO classification of myeloid neoplasms,the diseases under myeloproliferative group are chronic myeloid leukemia ,chronic neutrophilic leukemia ,chronic eosinophilic leukemia ,polycythemia vera & essential thrombocytopenia.

Reference :Harsh mohan textbook of pathology sixth edition pg no 357.


Question: Heyde's syndrome is

Heyde's syndrome: GIT bleeding Angiodysplasia Aoic stenosis Caused by the induction of Von Willebrand disease type IIA (vWD-2A) by depletion of vWF in blood flowing through the narrowed valvular stenosis. ref - pubmed.com <a href=" <p>

Mitral stenosis, ahritis, and biliary cirrhosis

Mitral regurgitation, hiatus hernia, and cirrhosis

Aoic stenosis, gastrointestinal bleeding and angiodysplasia of colon

Pulmonary aerial hypeension, tricuspid regurgitation, and cirrhosis


Question: Mcdonald’s criteria is used in diagnosis of

Multiple sclerosis is diagnosed by Mcdonald’s criteria


Question: Shilling's test is used to determine deficiency of

Answer is A (Vitamin B12) Shilling's test is done to determine the cause of cyanocobalamine deficiency (Vitamin B12). Schilling test is abnormal in conditions that affect cobalamine absorption including Pernicious anemia, Chronic Pancreatitis, Bacterial overgrowth syndrome and Heal dysfunction. Conditions with Abnormal Schilling's Test (Abnormal Cobalamine Absorption) Pernicious anemia Chronic Pancreatitis Achlorhydria Bacterial overgrowth syndrome Beal dysfunction Schilling Test: Schilling test is performed to determine the cause of cobalamine malabsorption (Vit B12 malabsorption). Since cobalamine absorption requires multiple steps including gastric, pancreatic and ileal processes, the Schilling test can also be used to assess the integrity of these other organs. The Schilling test is performed by administering Co58-labeled cobalamin orally and collecting urine for 24h 1 mg of cobabmine is administed intramuscularly one hour after ingestion of the Radiolabelled cobalamine. This is done to ensure saturation of cobalamine binding sites in the liver as urinary excretion of cobalamine will reflect cobalamine absorption only provided that intrahepatic binding sites of cobalamine are fully occupied. Once intrahepatic binding sites of cobalamine are saturated all absorbed radiolabelled cobalamine will be excreted in urine. The Schilling test may be abnormal (defined as less than 10 percent excretion in 241i) in conditions that affect cobalamine absorption including Pernicious anemia, Chronic Pancreatitis, Bacterial overgrowth syndrome and Heal dysfunction. The etiology for an abnormal Schilling test may be deduced by administering Co58-labeled cobalamin with intrinsic factor, pancreatic enzymes or after 5 day course of antibiotics. Differential Results of Schilling Test in various diseases associated with cobalamin malabsorption may thus help establish the diagnosis. Diagnosis 58Co-Chl With Intrinsic Factor With Pancreatic Enzymes After 5 Days of Antibiotics Pernicious anemia Reduced Normal Reduced Reduced Chronic pancreatitis Reduced Reduced Normal Reduced Bacterialovergrowth Reduced Reduced Reduced Normal Ileal disease Reduced Reduced Reduced Reduced


Question: Not seen in primary pulmonary hypertension


Question: In a patient with ischaemic stroke, intravenous recombinant tissue has mainly been found to be useful during the initia

Ischemic stroke occurs when a blood clot blocks or plugs an aery leading to the brain. A blood clot often forms in aeries damaged by the buildup of plaques (atherosclerosis). It can occur in the carotid aery of the neck as well as other aeries. Ref Harrison20th edition pg 1123


Question: Mutation in sickle cell anemia is

Missense mutation - Sickle cell anaemia.
Non-sense mutation - Beta thalassemia.


Question: POEMS syndrome is associated with


Question: Lifespan of RBCs in premature neonate

Adults - 120 days.
Term infant - 60 - 90 days.
Premature neonate - 35 - 50 days.


Question: Reversible cause of Dementia includes

(C) Normal pressure hydrocephalus # There are several clearly reversible causes of dementia that are remembered by the mnemonic DEMENTIA. D- Drugs (any drug with anticholinergic activity) E- Emotional- depression M- Metabolic (hypothyroid) E- Eyes and ears declining N- Normal pressure hydrocephalus T- Tumor or other space-occupying lesion I- Infection (syphilis, AIDS) A-Anemia (vitamin B12 or folate deficiency).> Major syndromes with progressive dementia include: Alzheimer disease (AD), vascular dementia (VaD), dementia with lewy bodies (DLB) and frontotemporal dementia (FTD).


Question: Cardiac defect in William's syndrome is

(D) Supravalvular aortic stenosis # WILLIAMS SYNDROME shares some features with autism (such as difficulty understanding the state of mind of conversational partners) and Fetal alcohol syndrome (e.g., certain facial features, possible mental retardation, and negative potential outbursts), although persons with Williams generally possess very good social skills, such that this condition is sometimes called "cocktail- party syndrome. Supravalvular aortic stenosis is common


Question: Post renal transplant lymphoma is mostly associated with

EBV is a very common virus: about 9 in 10 adults have been infected with it. EBV infects B lymphocytes. Some cases of PTLD are not related to EBV (EBV-negative PTLD). They tend to occur months or years after transplant, when the risk of lymphoma is usually lower than it is in the early months after transplant. Ref Harrison20th edition pg 267


Question: The biochemical marker for primary hyperparathyroidism is


Question: Chyluria is due to

Chyluria is described as the passage of milky appearing white urine due to the presence of chyle composed of albumin, emulsified fats and fibrins in varying proportion that are absorbed by intestinal lacieals.

Chvluria is associated with filariasis :-

Chronic filaria can lead to renal involvement:- Chyluria is associated with abnormal retrograde or lateral flow of lymph from intestinal lymphatics of the kidney ureter or bladder allowing chylous material to be discharged into urinary collecting system.
Intestinal lymph may be intermittently discharged into the renal pelvis, causing lymph fluid to pass into the urine.
This is known as chyluria and it results in milky appearance of the urine
Since large amounts of fat and protein can be lost in the urine in individuals with chyluria this condition can lead to nutritional deficiencies including anemia and hvpoproteinemia.


Question: Duroziez sign seen in

Duroziez's sign : Systolic and diastolic bruits while compressing femoral aery. A similar sign is Traube's sign. Reference : Davidson, 23rd page no : 524.


Question: Pulsus alternans occurs in

Ans. Answer is D (MI) Pulsus alternans indicates severe impairment in LV function and may be seen in conditions causing severe LV dysfunction such as Myocardial Infarction Pulsus Alternans Pulsus alterans is charachterized by regular alteration of the pressure pulse amplitude despite a regular rhythm It is defined by beat to beat variation of the pulse amplitude but with a single peak and independent of the respiratory cycle. In pulsus bigeminus there is also a regular beat to beat variation but it is caused by a premature ventricular contraction that follows each regular beat. Pulsus alterans is charachteristically seen in Left ventricular failure and conditions causes LVF ( including MI) Causes of Pulsus Alternans 1. In patients with Hea Disease Left ventricular Failure and conditions causing LVF Presence of pulsus alterans usually indicates severe impairment of LV function. 2. In patients without Hea Diesease During or following paroxysmal tachycardia For several beats following a premature beat


Question: Hypocalcemia with hyperphosphatemia are seen in.

Improved medical management of chronic kidney disease now allows many patients to survive for decades and hence time enough to develop features of renal osteodystrophy, which must be controlled to avoid additional morbidity. Impaired production of 1,25(OH) 2 D is now thought to be the principal factor that causes calcium deficiency, secondary hyperparathyroidism, and bone disease; hyperphosphatemia typically occurs only in the later stages of CKD. Low levels of 1,25(OH) 2 D due to increased FGF23 production in bone are critical in the development of hypocalcemia. The uremic state also causes impairment of intestinal absorption by mechanisms other than defects in vitamin D metabolism. Nonetheless, treatment with supraphysiologic amounts of vitamin D or calcitriol corrects the impaired calcium absorption. Since increased FGF23 levels are seen even in early stages of renal failure in some patients, and have been repoed to correlate with increased moality, there is current interest in methods (lowering phosphate absorption) to lower FGF23 levels and concern as to whether vitamin D supplementation (known physiologically to increase FGF23) increases FGF23 in CKD. Hyperphosphatemia in renal failure lowers blood calcium levels by several mechanisms, including extraosseous deposition of calcium and phosphate, impairment of the bone-resorbing action of PTH, and reduction in 1,25(OH) 2 D production by remaining renal tissue(harrison 18 pg 3116)


Question: A synchronous cardioversion is given in


Question: A seven year old girl presents with repeated episodes of bleeding into joints. APTT is prolonged and PT is normal. The most likely diagnosis is.

Answer is C (Von Willebrand disease) Bleeding into joints along with normal PT and prolonged APTT iii a girl/female suggest a diagnosis of Von Willebrand disease Bleeding into joints along with prolonged APTT and normal PT may be seen in Factor VIII deficiency (Hemophilia A) and Von Willebrand disese. Hemophilia A is an X Linked disorder that alfects only boys and 11107 (Women who carry a single mutated gene are asymptomatic).- The patient in question is a seven year old girl and is hence unlikely to have hemophilia A. Von Willebrand Disease is an Autosomally inherited condition and may affect both boys and girls. This condition may present with bleeding into joints and is associated with prolonged APTT and normal PT. VWF disease is therefore the single best answer of choice Von Willebrand disease and Hemophilia A may both present nN ith bleeding into joints, prolonged APTT and normal PT I RUT Hemophilia A is a sex linked disorder that primarily involves males /boys alone. Features of VWF and differences with Haemophilia A Feature Hemophilia A Von Willebrand Disease Inheritance Sex linked Clinical disease limited to Men /boys (Extremely rare in females) Antosontal (Most eonttnonly A-dominant) Clinical disease may be seen in both boys & girls Factor Ville Decreased . Decreased VWF Normal Decreased Ristocetin cofactor Normal Decreased Common Presentation Features of clotting disorder Skin/Mucosal bleeding Hemahrosis ++ Features of bleeding disorder +- clotting disorder Skin/Mucosal bleeding + Hemahrosis+ Bleeding Time Normal Prolonged APTT Prolonged Prolonged (may be normal) PT Normal Normal Thrombin Time Normal Normal Fibrinogen Normal Normal Platelet aggregation in Response to Ristocetin Normal Decreased Factor VII deficiency is associated N1 ith an isolated prolon2ation of PT (APTT is normal) Causes of isolated prolongation of PT (CMDT): Factor VII deficiency Vitamin K deficiency Warfarin therapy Liver disease Factor XI I deficiency may present with an isolated prolon2ation of APTT (normal PT) associated N% it h clinical Bleedintl tendencies (Nelson/Clinical Hem:twiny) 'Factor XII deficiency is a rare hereditary deject of coagulation factors ill which no clinical apparent' - Clinical Hematology but this condition is not bleeding tendancies are Isolated elongation of APTT with bleeding manifestations Isolated prolongation of APTT without bleeding manifestations Factor VIII detect Factor 11I detect Factor IX defixt Prekallekrein defect Factor XI detect HAIN' Kininogen defect


Question: Mesial temporal lobe epilepsy is associated with

harrison's principle of internal medicine 17th edition *mesial temporal lobe epilepsy is the most common syndrome associated with complex paial seizures Mesial temporal lobe epilepsy (MTLE) involves the medial or internal structures of the temporal lobe. Seizures often begin in a structure of the brain called the hippocampus or surrounding area. MTLE accounts for almost 80% of all temporal lobe seizures


Question: Thyroid Opthalmopathy

The question is on unilateral ptosis whereas thyroid opthalmopathy has PROPTOSIS.

In myasthenia gravis, due to anti-Ach-receptor blocking antibodies there is ptosis which can be unilateral or asymmetrical which will again appear unilateral.
Marfan syndrome has congenital Ptosis.
Pancoast tumor causes horner syndrome in which unilateral sympathetic chain is compressed leading to Ptosis, Miosis, Anhidrosis, Enopthalmos and loss of Cilio-spinal reflex.


Question: Herpes simplex encephalitis affects ………………………….. lobe


Question: Fluent Aphasia with preserved comprehension and impaired repetition is

(D) Conduction COMPREHENSIONREPETITION OF SPOKEN LANGUAGENAMINGFLUENCY* Wernicke'sImpairedImpairedImpairedPreserved or Increased* Broca'sPreserved (except grammar)ImpairedImpairedDecreased* GlobalImpairedImpairedImpairedDecreased* ConductionPreservedImpairedImpairedPreserved* Non fluent (motor) transcorticalPreservedPreservedImpairedImpaired* Fluent (sensory) transcorticalImpairedPreservedImpairedPreserved* IsolationImpairedEcholaliaImpairedNo purposeful speech* AnomicPreservedPreservedImpairedPreserved except for word-finding pauses* Pure word deafnessImpaired only for spoken languageImpairedPreservedPreserved* Pure AlexiaImpaired only for readingPreservedPreservedPreserved# CONDUCTION APHASIA (Associative aphasia), is a relatively rare form of aphasia.> An acquired language disorder, it is characterized by intact auditory comprehension, fluent speech production, but poor speech repetition.> They are fully capable of understanding what they are hearing, but show significant difficulty repeating phrases, particularly as the phrases increase in length and complexity and as they stumble over words they are attempting to pronounce.> Typical lesion location for conduction aphasia is on the supramarginal gyrus of the parietal lobe, posterior to the primary seriscry cortex and just above Wernicke's area.> Classical explanation for conduction aphasia is that of a disconnection between the brain areas responsible for speech comprehension (Wernicke's area) and speech production (Broca's area), due specifically to damage to the arcuate fasciculus, a deep white matter tract.


Question: Sickle cell Anemia leads to resistance towards

Ans. is 'a' i.e., P. Falciparum Red cell surface antigen that offer protection against P. fakiparum Duffy blood group system ABO (H) blood group system Glycophorins Gerbich antigen Complement receptor type I Knops blood group Abnormalities of the red cell cvtoskeleton which may offer protection against Rfalciparum South-east asia ovalocytosis Hereditary elliptocytosis Hereditary spherocytosis Sickle cell HbA/S


Question: A 70 year old man develops pneumonia and septicemia. Patient goes into renal failure and has a BP of 70/50 mm of Hg. Drug that should be used to maintain BP is


Question: Pancreatic pseudocyst most commonly occurs after

Answer is B (Pancreatitis) Most common cause of pancreatic pseudocyst is Pancreatitis (90%). The second most common cause is trauma (10%).


Question: RBBB with left Axis Detion Is characteristic of

Left axis detion may occur as a normal variant but is more commonly associated with left ventricular hyperophy, a block in the anterior fascicle of the left bundle system (left anterior fascicular block or hemiblock), or inferior myocardial infarction. In ostium primum ASD, the RV conduction defect is accompanied by left superior axis detion and counterclockwise rotation of the frontal plane QRS loop. ( Harrison&;s principle of internal medicine,18th edition,pg no.1834 )


Question: Management of uncomplicated essential hypeension is

Ref Harrison 19 th ed pg 1617 Management of uncomplicated essential hypeension includes health promoting lifestyle modifications (includes dietary modification and exercise) and pharmacological therapy (drugs).


Question: QT interval is shoens in

Hypocalcemia typically prolongs the QT interval (ST poion), whereas hypercalcemia shoens it . Digitalis glycosides also shoen the QT interval, often with a characteristic "scooping" of the ST-T-wave complex (digitalis effect). Ref Harrison 20th edition pg 1567


Question: Cause of transudate pleural effusionn is

Causes of transudative effusion includes Nephrotic syndrome,congestive hea failure,cirrhosis,pulmonary embolization, myxedema,etc.Causes of exudative effusion includes neoplasms;infections like pneumonia,TB,collagen vascular diseases,Meigs syndrome,etc. Most common cause of exudative pleural effusion is bacterial pneumonia. Reference:Davidson's Medicine-22nd edition,page no:661.


Question: Most common site of sub ependymal astrocytoma (giant cell)

Subependymal giant cell astrocytoma (SEGA, SGCA, or SGCT) is a low-grade astrocytic brain tumor (astrocytoma) that arises within the ventricles of the brain. It is most commonly associated with tuberous sclerosis complex (TSC). Although it is a low-grade tumor, its location can potentially obstruct the ventricles and lead to hydrocephalus Subependymal giant cell astrocytoma (SEGA) is a slowly growing tumor of unknown histogenesis mainly arising in the periventricular regions adjacent to the foramen of Monro which causes increased intracranial pressure, seizures, and focal neurologic signs Ref Harrison20th edition pg 2456


Question: Menke's disease" is a disease of

Ans. is 'b' i.e., Impaired copper transpo Menke's disease is caused due to defect in the copper transpo. There is defect in the transpo of copper present in the intestinal mucosa to the blood stream. The mucosal lining of intestine contains high level of copper bound to metallothionein protein. Rather than being transporated to bloodstream, the copper remained in the mucosa and was lost when intestinal cells were naturally soughed off. Menkes disease is caused due to defect in the "MNK" gene. The protein normally function by moving copper from the intestinal mucosal cells into the blood stream, where it is hound by proteins such as albumin and transpoed to organs and tissues. Serum copper is critical for the functioning of several enzymes Lysyl oxidase - It is impoant for the cross linking of collagen and elastin such that deficiencies lead to problems in connective tissues such as bones Cytochrome oxidase - Involved in temperature maintenance Tyrosinase - Necessary for pigmentation Clinical features of menkes disease Growth retardation Coarse hair, brittle and ivory white (result of depigmentations). The hair fibres are twiisted and broken helically (kinky hair). Seizures Cerebral and cerebellar degeneration (postmoem analysis) Hypothermia Thrombosis Poor bone development Increased tendency towards aneurysms


Question: Human leukocyte antigen (HLA) DR4 occurs in about 70% of patients with rheumatoid ahritis HLA DR4 encoded in the major histocompatibility complex (MHC) region on

Rheumatoid ahritis (RA) is a common form of inflammatory ahritis, occurring throughout the world and in all ethnic groups. The prevalence of RA is approximately 0.8-1.0% in Europe and the Indian subcontinent, with a female-to-male ratio of 3 : 1. The prevalence is lower in South-east Asia (0.4%). The highest prevalence in the world is in Pima Indians (5%). It is a chronic disease characterised by a clinical course of exacerbations and remissions . RA is a complex disease with both genetic and environmental components. The impoance of genetic factors is demonstrated by higher concordance of RA in monozygotic (12-15%) compared with dizygotic twins (3%), and an increased frequency of disease in first-degree relatives of patients. Genome-wide association studies have detected nearly 100 loci that are associated with the risk of developing RA. The strongest association is with variants in the HLA region. Recent studies have shown that the association with HLA is determined by variations in three amino acids in the HLA-DRb1 molecule (positions 11, 71 and 74) and single variants HLA-B (at position 9) and HLA-DPb1 (at position . The HLA locus is located on the sho arm of chromosome 6 and covers a 7.6 Mb region that contains over 250 highly polymorphic genes. The region is organized in three sub-regions: class I, class II and class III, which all have different functions. Both class I and II regions encode for glycoproteins that are expressed as cell surface receptors, whereas the class III region contains genes that encode for a variety of secreted immune system proteins, including complement factors and cytokines. The class I region encodes for three main subsets of HLA molecules; HLA-A, HLA-B and HLA-C. Class I HLA molecules are composed of an HLA-coded heavy a-chain and an invariant light chain, beta-2 microglobulin (b2m), which is essential for functional expression of the HLA molecule at the cell surface. The a-chain is folded to form a peptide-binding cleft that is "closed" and can accommodate sho antigenic peptides, typically 8-10 amino acids long. These class I molecules are expressed on all nucleated cells and specialize in presentation of intracellular antigens, including viral antigens, to cytotoxic (CD8+) T cells. Genes in the class II region encode for HLA-DR, HLA-DP and HLA-DQ molecules as well as a few other related proteins. Class II HLA molecules are composed of an a-chain and a b-chain, both coded by the HLA class II region. Unlike the class I molecules, the peptide-binding cleft of class II molecules are "open" which allows the accommodation of larger peptides of 15-20 amino acids long. Class II molecules are initially expressed on the cell surface of immune cells, in paicular antigen presenting cells such as macrophages or dendritic cells, as well as B cells and activated T cells. These molecules present antigens from outside the cell to (CD4+) T cells which in turn stimulate B cells to produce antibodies towards that specific antigen. This results in an antigen specific immune response. After activation of the immune system, the HLA class II molecules can be expressed on other cells. Ref - pubmed.com , Davidsons 23e p1044


Question: An elderly female presents to the emergency depament with history of fever, headache and double vision. Biopsy of temporal aery revealed panaeritis. The most likely diagnosis is

Answer is D i.e. (Temporal Aeritis): The clinical complex of fever, headache and diplopia together with panaeritis on biopsy of temporal aery suggests the diagnosis of temporal aeritis.


Question: Pulmonary fibrosis is associated with the use of


Question: Pulsus paradoxus is a characteristic feature of


Question: Toxic shock syndrome caused by staphylococcus is due to

Staphylococcal infections Staphylococci are usually found colonising the anterior nares and skin. Some staphylococci produce coagulase, an enzyme that conves fibrinogen to fibrin in rabbit plasma, causing it to clot. Staph. aureus is coagulase-positive, and most other species are coagulase-negative. In modern laboratory practice, however, the identification of Staph. aureus rarely involves the coagulase test. Staph. aureus is the main cause of staphylococcal infections. Staph. intermedius is another coagulase-positive staphylococcus, which causes infection following dog bites. Among coagulase- negative organisms, Staph. epidermidis is the predominant commensal organism of the skin, and can cause severe infections in those with central venous catheters or implanted prosthetic materials. Staph. saprophyticus is pa of the normal vaginal flora and causes urinary tract infections in sexually active young women. Others implicated in human infections include Staph. lugdunensis, Staph. schleiferi, Staph. haemolyticus and Staph. caprae. Coagulase-negative staphylococci are not usually identified to species level. Staphylococci are paicularly dangerous if they gain access to the blood stream, having the potential to disseminate widely . In any patient with staphylococcal bacteraemia, especially injection drug-users, the possibility of endocarditis must be considered . Growth of Staph. aureus in blood cultures should not be dismissed as a 'contaminant' unless all possible underlying sources have been excluded and repeated blood culture is negative. Any evidence of spreading cellulitis indicates the urgent need for an antistaphylococcal antibiotic, such as flucloxacillin (unless there is a likely risk of MRSA). This is paicularly true for mid-facial cellulitis, which can result in cavernous sinus thrombophlebitis. In addition, Staph. aureus can cause severe systemic disease due to the effects of toxin produced at superficial sites in the absence of tissue invasion by bacteria. Skin infections Staphylococcal infections cause ecthyma, folliculitis, furuncles, carbuncles, bullous impetigo and the scalded skin syndrome . They may also be involved in necrotising infections of the skin and subcutaneous tissues . Wound infections Many wound infections are caused by staphylococci, which may significantly prolong post-operative hospital stays Prevention involves careful attention to hand hygiene, skin preparation and aseptic technique, and the use of topical and systemic antibiotic prophylaxis. Treatment is by drainage of any abscesses plus adequate dosage of antistaphylococcal antibiotics, done early, paicularly if prosthetic implants have been inseed. Cannula-related infection Staphylococcal infection associated with cannula sepsis and thrombophlebitis is an impoant and common reason for morbidity following hospital admission. The Visual Infusion Phlebitis (VIP) score aids cannula evaluation . Ref Harrison20th edition pg 1077


Question: Spur cell anaemia is seen in

Spur cell anemia (SCA) is an acquired hemolytic anemia, characterized by an increase in the percentage of spur cells (acanthocytes) associated with liver cirrhosis . The presence of >=5% spur cells on peripheral blood smears has been observed in 31% of patients with liver cirrhosis Ref Davidson 23rd edition pg 891


Question: A patient Shweta with raised serum alkaline phosphatase and raised parathormone level along with low calcium and low phosphate level is likely to have

Answer is D (Vitamin D deficiency) Serum Ca Serum phosphorus Alkaline phosphatase PTH * Osteomalacia (Rickets) (|iNit. D) | | | | * Primary hyperparathyroidism bone disease | | , | | * Bone disease in renal failure with secondary hyperparathyroidism N/| | | | * Lytic bone neoplasms N/| N/| N/| N * Osteoporosis N N N N * Paget's disease N N | N


Question: The term post traumatic epilepsy refers to seizures occurring

Posttraumatic epilepsy (PTE) is a recurrent seizure disorder that apparently results from injury to the brain. This injury may be due to multiple types of head insults often labled traumatic brain injury (TBI). There is an increase in PTE due to increasing TBI. PTE must be differentiated from posttraumatic seizures (PTS), which is a broader-spectrum term and signifies seizures that occur as a sequel to brain injury. Seizures that occur within 24 hours after brain injury are called immediate PTS. PTS that occur within 1 week after injury are termed early PTS, and seizures that occur more than 1 week after injury are termed late PTS. About 20% of people who have a single late posttraumatic seizure never have any fuher seizures, and these people should not be labeled as having PTE. The former definition of epilepsy required 2 unprovoked seizures, but the updated definition of epilepsy can be met with 1 unprovoked seizure and high likelihood of another. This blurrs the definition of PTS and PTE, but it is impoant to differentiate between the two. As PTS is a provoked seizure it is different than unprovoked seizure, but late PTS may be hard to differentiate from PTE Ref - Harrison's internal medicine 20e , medscape.com

Within several weeks to months after head injury.


Question: Vitamin K is given to a patient with jaundice, but PT remains unchanged. Probable cause is

An elevated prothrombin time indicates either vitamin K deficiency due to prolonged jaundice and malabsorption of vitamin K or significant hepatocellular dysfunction. The failure of the prothrombin time to correct with parenteral administration of vitamin K indicates severe hepatocellular injuryReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 58; Jaundice


Question: Plasma ACTH levels are high between these following hours

(B) 4 AM and 10 AM # ACTH the primary stimulator of adrenal cortisol production is synthesized by pituitary in response to CRH, which is released by hypothalamus.> Plasma ACTH and cortisol levels exhibit peaks at 6-8 AM and nadirs at 11 PM.> Referene values: 10-60 pg for AM values. No established reference values for PM.


Question: Incidence of Down's syndrome is directly proportional to

Ans. c (Maternal age). (Ref. Harrison, Internal Medicine, 16th ed., 383)The incidence of Down ys syndrome is highly correlated to maternal age.QUADRUPLE TEST FOR DOWN'S SYNDROME# AFP |# beta-HCG |# Unconjugated estriol |# Human placental lactogen/placental protein A |


Question: Gold standard for diagnosis of pulmonary embolism

CT-pulmonary angiography (CTPA) is the gold standard test for pulmonary embolism.It has the advantages of visualising the distribution & extent of the emboli,or highlighting an alternative diagnosis,such as,consolidation,pneumothorax, or aoic dissection.A definitive diagnosis of PE depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion ("cut-off") of vessels,segmental oligemia or avascularity,a prolonged aerial phase with slow filling, and touous,tapering peripheral vessels. Reference:Harrison's medicine-18th edition,page no:2174.


Question: The Investigation of choice for diagnosing Zollinger Ellison syndrome includes

(D) Endoscopic ultrasound # Endoscopic ultrasound (EUS) permits imaging of the pancreas with a high degree of resolution (<5 mm).> EUS modality is particularly helpful in excluding small neoplasms within the pancreas & in assessing the presence of surrounding lymphnodes & vascular involvement.SENSITIVITY OF IMAGING STUDIES IN ZOLLINGER ELLISON SYNDROMEStudySensitivity, %Primary GastrinomaMetastatic GastrinomaUltrasound21-2814CT scan35-5935-72Selective angiography35-6833-86Portal venous sampling70-90N/ASASI55-7841MR!30-6071Octreoscan67-8680-100EUS80-100N/A


Question: Prosopognosia is

(A) Inability to recognise face> Prosopognosia is a face-blindness (inability to recognise face) can be a developmental disorder, rather than one induced by strokes or lesions. Indeed, it turns out to be relatively common, affecting around 2 percent of the population.


Question: Not a feature of Riboflavin deficiency


Question: Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is

Answer is A (Medullary Carcinoma thyroid) Presence of thyroid nodule along with palpable cervical lymph nodes and amyloid histologically is clearly indicative of Medullary variety of Carcinoma Thyroid. Medullary Carcinoma thyroid : It is a neuroendocrine carcinoma rising from parafollicular 'C' cells of thyroid Parafollicular 'C' cells are derived from neural crest and secrete calcitonin. Medullary carcinoma should be suspected whenever : a. High level of serum calcitoninQ are discovered b. Cervical lymph node are discovered at time of presentation. Q - Involvement of lymph nodes occurs early.Q - Thyroid and blood born metastasis occurs early.Q c. DiarrheaQ is a presentation d. AmyloidQ is present in stroma histologically. e. MEN setting : Evidence of Pheochromocytoma / Hyperparathyroidism / Thyroid cancer in family. (Discovery of medullary carcinoma thyroid makes family surveillance advisable).ef Hypocalcemia is associated: These cancers are associated with HypocalcemiaQ because calcitonin is secreted. Medullary carcinoma thyroid is seen as ? Sporadic : 80% Familial : 20% - Non MEN setting / MEN II a / MEN II b


Question: A male patient presents with headache , profuse sweating and palpitations with a blood pressure of 180/120 mmHg . The drug of choice would be

Ref Harrison 19 th ed pg 1627 Symptomatic hypeension with diastolic pressure of 120 suggests a diagnosis of hypeensive emergency . Labetalol (IV) is the drug of choice for management of hypeensive emergency.


Question: Most common manifestation of severe hemophilia A is

Recurrent heamarthrosis is a common manifestation of moderate / severe disease.


Question: HIV RNA by PCR can detect as low as

Ans. is 'b' i.e., 40 copies viral RNA/ml of blood


Question: Beck's triad of cardiac tamponade doesn't includes

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: Uhthoff's phenomenon is seen in

(B) Multiple sclerosis # UHTHOFF'S PHENOMENON (Uhthoff's syndrome or Uhthoff's's sign or Uhthoff's Symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs. It is possibly due to the effect of increased temperature on nerve conduction.> With an increased body temperature, nerve impulses are either blocked or slowed down in a damaged nerve but once the body temperature is normalized, signs and symptoms may disappear or improve.> In multiple sclerosis -- Heat sensitivity refers to neurologic symptoms produced by an elevation of the body's core temperature. For example, unilateral visual blurring may occur during a hot shower or with physical exercise (Uhthoff's symptom).


Question: Most common cause of Euvolemic hyponatremia is

(C) SIADH # Euvolemic Hyponatremia can occur in moderate to severe hypothyroidism, with correction after achieving a euthyroid state.> Severe hyponatremia can also be a consequence of secondary adrenal insufficiency due to pituitary disease; whereas the deficit in circulating aldosterone in primary adrenal insufficiency causes hypovolemic hyponatremia, the predominant glucocorticoid deficiency in secondary adrenal failure is associated with euvolemic hyponatremia.> Glucocorticoids exert a negative feedback on A VP release by the posterior pituitary such that hydrocortisone replacement in these patients will rapidly normalize the A VP response to osmolality, reducing circulating A VP.> Syndrome of Inappropriate Anti Diuresis (SIAD) is the most frequent cause of Euvolemic Hyponatremia.> Generation of hyponatremia in SIAD requires an intake of free water, with persistent intake at serum osmolalities that are lower than the usual threshold for thirst; as one would expect, the osmotic threshold and osmotic response curves for the sensation of thirst are shifted downward in patients with SIAD.


Question: Cryoprecipitate contains

Answer: a) Factor VIII and fibrinogen CryoprecipitateMade from fresh plasma by cooling the plasma to 4degC and collecting the supernatant layerContents: Fibrinogen, factor VIII, vWF, factor XIII


Question: Ice pack test is due for

Answer- A. Myesthenia gravisThe ice pack test is a bedside test to help in the diagnosis of myethenia gravis


Question: Chronic fibrosing mediastinitis is seen ina) Tuberculosisb) Histoplasmosisc) Plagued) Sarcoidosis


Question: Metabolic acidosis is compensated by

i.e. (Hyperventilation): (289-90-H17th) (860-CMDT-l1)Metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body.Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled,Arterial blood gas sampling is essential for the diagnosis. If the pH is low (under 7.35) and the bicarbonate levels are decreased (<24mmol/l), metabolic acidemia is present, and metabolic acidosis is presumed. Due to respiratory compensation (hyperventilation), carbon dioxide is decreased and conversely oxygen is increased, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation.Compensatory mechanismsMetabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate.The body regulates the acidity of the blood by four buffering mechanisms.* bicarbonate buffering system* intracellular buffering by absorption of hydrogen atoms by various molecules, including proteins, phosphates and carbonate in bone.* Respiratory compensation* Renal compensationBufferThe decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes the buffer (from water and carbon dioxide) and additional renal generation. The buffer reactions are:H+ + HCO3' - H2CO3 - CO2 + H2OThe Henderson - Hasselbalch equation mathematically describes the relationship between blood pH and the components of the bicarbonate buffering system.


Question: "Kussmaul's sign" is

(Increase in the JVP during inspiration) (1306-H) (1384-H17lh)Kussmaul's sign - an increase rather than the normal decrease in the JVP during inspiration-is most often caused by severe right-sided heart failure, it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction**

Change in the blood pressure during exercise


Question: Treatment of Acute Hyperkalemia

Insulin & Glucose reduces hyperkalemia within 4 hrs


Question: Acrodermatitis hemorrhagica is due to deficiency of

Ans. is 'a' i.e., Zinc Symptoms of Zinc Deficiency Mild deficiency Severe dificiency Growth retardation Dwarfism Cardiomyopathy Hypogonadism Infeility Loss of taste Poor wound healing Deformed bones Diarrhoea Alopecia Night blindness Skin striae Nail changes Acrodermatitis enteropathica is an inherited autosomal recessive disorder with imapired intestinal disorder and transpo of Zinc. Patient suffers with pustular and bullous dermatitis, alopecia, growth retardation diarrhoes, secondary infection, lethargy, irritability and depression. Oral Zinc supplementation leads to remission. Zinc 2nd most abundant trace element in the body. Most common catalytic metal ion in the cell cytoplasm. Component of more than 100 enzymes like DNA polymerase, RNA polymerase, transfer RNA synthetase. It plays role in all stages of insulin metabolism.


Question: Klebsiella pneumonia is

Klebsiella pneumonia :

Air bronchogram sign positive.
Involves upper lobe.
Cavitations and pleural effusion is common.

Lobar pneumonia with absent air bronchogram sign


Question: Unilateral diaphragmatic paralysis cause

Hemi diaphrogm palsy results in :

↓ TLC
↓ FVC
↓ IRV
↓ Normal FEV1 and FRC


Question: A child presents with sho episodes of vacant stare several times a day. The vacant episode begins abruptly and the child remains unresponsive during the episode. There is no associated history of aura or postictal confusion and the child is otherwise normal, The likely diagnosis is

*Sudden, brief lapses of consciousness without loss of postural control.*Consciousness lasts for only seconds, and returns, and there is no postictal confusion.*Bilateral motor signs such as rapid blinking of the eyelids, chewing movements, or small-amplitude, clonic movements of the hands.*Usually in childhood (ages 4-8 years) or early adolescence and the first clue to absence epilepsy is often unexplained "daydreaming" and a decline in school performance recognized by a teacher.*EEG shows generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background.


Question: Interstitial nephritis is common with

Ans. (a) NSA1DRef: Harrison 19th ed. /1856Choices B,C,D lead to acute tubular necrosis and hence by exclusion the answer is A.Causes of Acute Interstitial Nephritis* Drugs like beta lactams, quinolones, NSAID,COX-2 inhibitors, phenytoin, valproate and P.P.I* Infections like streptococcus, staphylococcus* Connective tissue disorder like SLE, Sjogren* Light chain nephropathy* Urate nephropathyCauses of Chronic Interstitial Nephritis* V.U.R* Sickle cell disease* Hypokalemic nephropathy


Question: Function of infliximab used in Crohn&;s is

Infliximab, a chimeric IgG1 antibody against TNF-a, is approved for treatment of moderately to severely active UC.Infliximab is also effective in CD patients with refractory perianal and enterocutaneous fistulasAdalimumab and ceolizumab, golimumab are other Anti-TNF therapies approved for IBDInfliximab is also approved for psoriasis, psoriatic ahritis, ankylosing spondylitis, and rheumatoid ahritisRef: Harrison 19e pg: 1961


Question: A patient with engorged neck veins, BP 80/50 and pulse rate of 100 following blunt trauma to the chest . Diagnosis of

Ref Harrison 19 th ed pg 1573-1574 Cardiac tamponade should be suspected in any patient who has a rapid down hill course and exhibits the features of rising venous pressure and falling aerial pressure following blunt trauma to the chest.


Question: Investigation of choice for ureteric stones for ureteric stone

Ans. is `a' i.e., CT scan CT scan has become the diagnosis of choice for ureteric stones The "gold standars" diagnostic test is holical CT without contrast. All of routine methods have become less usefull with the advent of more sensitive and specific nonenhanced computed tomography (CT) scanning. When CT is available, it is now considered the examination of choice for the detection and localization of urinary stones


Question: Rate of IV infusion of potassium in severe hypokalemia should not exceed

Rate of K+ infusion should not exceed 20 mmol/hour unless paralysis or malignant ventricular arrhythmias are present. The use of intravenous administration should be limited to patients unable to use the enteral route or in the setting of severe complications (e.g., paralysis, arrhythmia). Intravenous K+-Cl- should always be administered in saline solutions, rather than dextrose, because the dextrose-induced increase in insulin can acutely exacerbate hypokalemia. The peripheral intravenous dose is usually 20-40 mmol of K+-Cl- per liter; higher concentrations can cause localized pain from chemical phlebitis, irritation, and sclerosis. If hypokalemia is severe (<2.5 mmol/L) and/or critically symptomatic, intravenous K+-Cl- can be administered through a central vein with cardiac monitoring in an intensive care setting, at rates of 10-20 mmol/h; higher rates should be reserved for acutely life-threatening complications. Ref: Harrison 19e pg: 308


Question: The most sensitive test for the diagnosis of myasthenia Gravis is

Answer is D (Single Fiber Electromyography (SFEMG)) : Single Fiber Electromyography (SFEMG) is the single most sensitive assay of neuromuscular function dysfunction in myasthenia gravis `SFEMG is the single most sensitive assay of neuromuscular function dysfunction in myasthenia gravis having a sensitivity of greater than 95% when applied to clinically affected muscle' - Merrit's Neurology 12th(2009) /389 `Single fiber electromyography is the most sensitive diagnostic test for MG, but abnormalities are not specific'. - 'Neuromuscular Junction Disorders: Diagnosis & Treatment (2003)/109 `Single fiber EMG is the most sensitive electrophysiological test for myasthenia gravis' - Adult Neurology' 2nd (Blackwell publishing) /299 Taken from 'Neuromuscular Junction Disorder's: Diagnosis & Treatment (2003) /109 Edrophonium test / Tensilon test Highly sensitive test with 85% sensitivity in ocular and 95% sensitivity in systemic myasthenia -Kanski Diagnosis is highly probable if test in unequivocally positive An initial dose of 2mg of edrophonium is given intravenously. If improvement occurs the test is considered positive and terminated. If there is no change an additional 8mg are given intravenously . Acetylcoline Receptor antibodies Sensitivity of 80-90% in systemic myasthenia - CMDT Highly specific and presence of Anti ACH Receptor Antibodies is viually diagnostic of M. gravis 85% positive in generalized M.G. 50% positive in ocular M.G. Definitive if positive Negative test does not exclude M.G. 40% of Anti antibody negative patients have Anti-Musk antibodies. Repetitive nerve stimulation / Electrodiagnostic test Helpful diagnostic evidence Best when weak muscles/ proximal ms. groups are tested Amplitude of evoked muscle end potential is measured - No change in normal patients - Reduction by > 10-15 % in myasthenic patients. Single fiber electromyography Demonstrates blocking and jitter with normal fiber density Most sensitive diagnostic test for MG with sensitivity of greater than 95% Confirmatory but not specific Often performed in conjunction with repetitive nerve stimulation test (Oxford handbook)

Elevated ACH Receptor Antibodies (ACHR Antibodies)

Positive Edrophonium test (Tensilon test)


Question: HIV infects most commonly

Ans. is 'a' i.e CD4+ helper cells CD4+ T lymphocytes and CD4+ cells of monocyte lineage are the principal targets of HIV.Virtually any cell that expresses the CD4+molecule together with Coreceptor molecules can potentially be infected with H.I.V. e.g.Dendritic cellsLangerhans cellsEven Megakaryocytes, eosinophilis, Astrocytes, oligodendrocytes, microglial cells, CD4+ T cells can also be infected with HIV.


Question: Coronary sinus opens into


Question: Commonest type of seizure in newborn/neonates

*Subtle seizures are the commonest type of seizures in newborns especially they can occur within 72 hours of bih .. *They may result from hypoxic-ischemic encephalopathy in preterm infants Ref Harrison20th edition pg 2034


Question: EEG pattern in REM sleep is

(A) High amplitude, slow waves # SLEEP PATTERNS:> There are two different kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow wave, sleep.> NREM sleep is divided into four stages. A person falling asleep first enters stage 1, which is characterized by low-amplitude, high-frequency EEG activity> Stage 2 is marked by appearance of sleep spindles.> These are bursts of alpha-like, 10-14-Hz, 50-pV waves.> In stage 3, the pattern is one of lower frequency and increased amplitude of the EEG waves.> Maximum slowing with large waves is seen in stage 4.> Thus, the characteristic of deep sleep is a pattern of rhythmic slow waves, indicating marked synchronization.# REM Sleep:> The high-amplitude slow waves seen in the EEG during sleep are sometimes replaced by rapid, low- voltage EEG activity, which in primates, including humans, resembles that seen in stage 1 sleep.> However, sleep is not interrupted; indeed, the threshold for arousal by sensory stimuli and by stimulation of the reticular formation is elevated.> This condition is sometimes called paradoxical sleep, since the EEG activity is rapid.> Rapid, roving movements of the eyes occur during paradoxical sleep, and it is for this reason that it is also called REM sleep.> No such movements are present in slow-wave sleep, which consequently is often called NREM sleep.> Another characteristic of REM sleep is the occurrence of large phasic potentials, in groups of three to five, that originate in the pons and pass rapidly to the lateral geniculate body and from there to the occipital cortex.> For this reason, they are called pontogeniculo-occipital (PGO) spikes.


Question: Commonest site of involvement of herpes zoster

People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster Ref Harrison20th edition pg 980 Ref Davidson edition23rd pg 240


Question: Chronic asbestos exposure causes


Question: The net diffusion of water from one solution of water from one solution through a semipermeable membrane to another solution containing a lower concentration of water is termed

Osmosis is defined as the diffusion of water through a semipermeable membrane to a solution with a lower concentration of water.
Filtration is the process in which fluids are pushed through biologic membranes by unequal processes.
Diffusion (Brownian motion) is the random kinetic motion causing atoms and molecules to spread out evenly.


Question: The finding of urine sodium concentration <20 mmol/L in hypovolemic hyponatremia implies

Hypovolemic hyponatremia Urine sodium concentration >20 mmol/L Renal losses Diuretic excess Mineral coicoid deficiency Salt-losing deficiency Bicarbonaturia with Renal tubal acidosis and Metabolic alkalosis Ketonuria Osmotic diuresis Cerebral salt wasting syndrome Urine sodium concentration <20 mmol/L Extrarenal losses Vomiting Diarrhea Third spacing of fluids Burns Pancreatitis Trauma Ref: Harrison 19e pg: 299


Question: &;V&; wave in jugular venous pulse is due to

&;V&; wave in jugular venous pressure corresponds to right atrial filling during ventricular systole when the tricuspid valve is closed. The JVP has a biphasic waveform. * The "a" wave: First positive presystolic wave. * Right Atrial contraction. * Precedes the upstroke of carotid pulse, syn follows P wave of ECG. J. * * Peak of the &;a&; wave demarcates (\c the end of atrial systole. * Dominant wave in JVP during inspiration. * Larger than "v" wave. s, * The "x" descent: (Systolic collapse) * Follows the &;a&; wave * Corresponds to atrial relaXation and rapid atrial filling pressure. * Most prominent motion of normal JVP. * Begins during systole and ends just before S2. * Larger than "y" descent. * The " x&; " (x prime) descent * Follows the &;c&; wave * Occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole. * As stroke volume is ejected, the ventricle takes up less space in pericardium, allowing relaXed atrium to enlarge. * Can be used as a measure of right ventricle contractility. * The "c" wave * and positive venous wave. * Right ventricular (isovolumic) Contraction 4 tricuspid valve to bulge towards the right atrium. The "v" wave * 3rd positive wave. * Begins in late systole and ends in early diastole. * Corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return. * Occurs during and following the carotid pulse and peaks after S2. * The "y" descent: * Downslope of v wave. * Decline in RA pressure -rapid emptYing of the RA into the RV following the opening of the tricuspid valve in early diastole. Reference : Harrison 20th edition, pg 1421


Question: Brain tumor causing hypernatremia in children


Question: Hyperkalemia is seen in

Type - 1,2,3, - Hypokalemia.
Only type - 4 Hyperkalemia.


Question: The minimum dosage of Candesartan to begin with

(A) 2 mg # Candesartan: It has the highest affinity for the AT 1 receptor & produces largely unsurmountable antagonism, probably due to slow dissociation from the receptors or receptor desensitization.> It is indicated i both Hypertension & CHF.> Hypertension: 2-32 mg; CHF: 4-32 mg


Question: Hyperkalemia is a feature of

Answer- C. Pseudohypoaldosteronism type 2Pseudohypoaldosteronism tnre 2 is associated with hyperkalemia.Conns syndrome, Gitelman's syndrome and Liddle syndrome are associated with hypokalemia.


Question: Acute and recurrent pancreatitis is repoed to occur in

Recurrent acute pancreatic attacks is a rare clinical condition (2-5% of all acute pancreatis) in children and is mainly idiopathic in most cases. Sometimes it may be associated with congenital anomalies, metabolic diseases or hereditary conditions. Isovaleric acidemia (IVA) is a rare autosomal recessive amino acid metabolism disorder associated with isovaleryl coenzyme A dehydrogenase deficiency presenting the clinical findings such metabolic acidosis with increased anion gap, hyperammonemia, ketonemia, hypoglycemia, "the odor of sweaty feet," abdominal pain, vomiting, feeding intolerance, shock and coma. Recurrent acute pancreatitis associated with IVA have been rarely repoed . Ref Davidson 23rd edition pg 1151


Question: Ritcher transformation, CLL transforms to

Richter's Syndrome (RS), also known as Richter's Transformation, is a rare complication of Chronic Lymphocytic Leukaemia (CLL) and/or Small Lymphocytic Lymphoma (SLL). It is characterised by the sudden transformation of the CLL/SLL into a significantly more aggressive form of large cell lymphoma. Richter's Syndrome occurs in approximately 2-10% of all CLL/SLL patients during the course of their disease. In the most cases the normally slow growing, or indolent, CLL transforms into a common type of non-Hodgkin lymphoma (NHL) known as Diffuse Large B-Cell Lymphoma (DLBCL). Rarer cases transform into Hodgkin lymphoma(HL)/Hodgkin Disease (HD), and some types of T-cell lymphomas also have been repoed The most common symptoms of Richter's Syndrome arise from a sudden and dramatic increase in the size of lymph nodes (also known as 'lymphadenopathy') characterised by usually painless areas of swelling in the neck, axilla, abdomen (most commonly in the spleen, also known as 'splenomegaly') or groin. Patients also often experience a dramatic increase in unexplained weight loss, fevers and night sweats (often collectively referred to as 'B-symptoms'). Other signs and symptoms may include low haemoglobin (anaemia) characterised by: increasing fatigue shoness of breath dizziness and possible palpitations low platelets (thrombocytopaenia) characterised by excessive bruising or bleeding an increase in serum lactate dehydrogenase (LDH) or elevated serum calcium (hypercalcaemia) on routine blood tests. It is impoant to note that whilst some of these signs and symptoms may already be present to a lesser degree in people with previously diagnosed CLL/SLL, the possibility of Richter's Syndrome needs to be considered if there is a sudden and dramatic increase in these symptoms, which is not generally considered to be a typical feature of normally relatively indolent CLL/SLL disease. Richter's syndrome is a serious complication of CLL/SLL and unfounately is often fatal. If Richter's syndrome is diagnosed, it is advised that the person should seek recommended treatments, but also to get their lives in order to prepare for any outcome. You may wish to discuss an advanced health directive with your treatment team, to let them and your family know how you would like your health to be managed if your treatments are not successful Richter's Syndrome affects approximately 2-10% of patients with a prior diagnosis of CLL/SLL and can occur at any time throughout the course of the disease. Ref Davidson 23rd edition pg 789


Question: Zellwenger syndrome, defect is in

Zellweger syndrome is a rare congenital disorder characterized by the reduction or absence of functional peroxisomes in the cells of an individual. It is one of a family of disorders called Zellweger spectrum disorders which are leukodystrophies . Zellweger spectrum disorder is a group of conditions that have overlapping signs and symptoms and affect many pas of the body. This group of conditions includes Zellweger syndrome, neonatal adrenoleukodystrophy (NALD), and infantile Refsum disease. Ref - <a href="


Question: APGAR scale in infant measures

Respiratory, Neurological, and Circulatory system

Respiratory, Neurological and digestive system


Question: Vitamin E causes

Ans. is 'c' i.e., Ataxia Vitamin E (tocopherol) is a fat-soluble vitamin with antioxidant propeies; It protects cell membranes from oxidation and destruction. Vitamin E is found in a variety of food including oils, meat, eggs, and leafy vegatables. There are multiple forms and isomers of tocopherol and the related compounds, tocotrienols. The current evidence the primary bioactive form of Vitamin E is alfa-tocopherol. Serum vitamin E levels are strongly influenced by concentration of serum lipids, and do not accurately reflect tissue vitamin levels. Effective vitamin E levels are calculated as the ratio of serum alpha-tocopherol per gram total lipids. Absorption of dietary vitamin E requires effective pancreatic exocrine function and fat absorption, unless provided in a synthetic water-soluble form. Vitamin Vitamin E deficiency is uncommon in humans except in special circumstances. This is due to the abundance of tocopherols in the diet.


Question: Most common pattern of Joint involvement in psoriatic arthropathy

Asymmetrical inflammatory Oligoarthritis - Most common pattern.


Question: Comprehension in intact with aphasia in


Question: 'Syndrome of apparent mineralocoicoid excess' is due to deficiency of

Syndrome of apparent mineralocoicoid excess is due to genetic deficiency of 11b-dehydrogenase-2, cause hypokalemia. Liddle's syndrome is caused by autosomal dominant gain-in-function mutations of ENaC subunits, cause hypokalemia. Loss of the transpo functions of the thick ascending loop of Henle and distal convoluted tubule nephron segments causes hereditary hypokalemic alkalosis, Bater's syndrome (BS) and Gitelman's syndrome (GS), respectively. Ref: Harrison 19e pg: 305


Question: Risk of stroke after TIA is

The risk of stroke after a TIA is 10-15% in the first 3 months, with most events occurring in the first 2 days. This risk can be directly estimated using the well-validated ABCD2 scoreA: Age >=60 years 1B: SBP >140 mmHg or DBP >90 mmHg 1C: Clinical symptomsUnilateral weakness Speech disturbance without weakness 21D: Duration>60 min 10-59 min 21D: Diabetes (oral medications or insulin) 1Score of 0 has 0% increased rate, whereas score of 7 has 22% rate of stroke in 3 months.Ref: Harrison 19e pg: 2569


Question: Long term glycaemic control in DM with

(Glycated haemoglobin) (2296-H17th)Measurement of glycated haemoglobin is the standard method for assessing long term glycaemic controlWhen plasma glucose is consistently elevated there is an increase in non enzymatic glycation of haemoglobin small amount of HbA are non enzymaticaly glycated to form HbAjcThis alteration reflects the glycemic history over previous 2-3 months (since erythrocytes have an average life span of 120 days)* HbAlc assay performed by the high performance liquid chromatography (HPLC)HbAir measurement becomes unreliable in condition like- Haemoglobinopathies- Hemolytic anemia- Uremia* An alternative indicator of glycemic control when HbAjc is inaccurate is glycated albumin*** Nomal values 4-6% of the total hemoglobin* When HPLC the HbAlc approximate the following mean plasma glucose value* HbAlc 6% is 7.5 mmol/L (135mg ldl)7% is 9.5 mmol.L (170 mg/dl)8% is 11.5 mmol/L (205 mg/dL)(al% rise in HbA1c translates into 2.0 mmol/dL (35mg/dL) increase the mean glucose)GLUCOSE TOLERANCE TEST* Most valuable in investigating a case of "symptomless" glycosuria such as renal glycosuria and lag type glycosuria* Helpful in recognizing milder case of DM and "early DM"Decrease Glucose toleranceIncreased glucose tolerance* DM* In hyper activity of anterior pituitary and adrenal cortex* Hyperthyroidism* Hypopitutarism* Hyperinsulinism* Hypothyroidism* Adrenal cortical hypofunction (such as Addison's disease)* If there is decreased absorption like sprue, celiac disease* Fructosamine assay (albumin) generally reflects the status of glycemic control for only the preceding 2 weeks* Important for - hemoglobinopathies or hemolytic states or when a narrower time frame is required such as for ascertaining glycemic control at the time of conception in a diabetic women who has recently become pregnant (CMDT)


Question: Reverse transcriptase of hepatitis B virus is coded on the following gene


Question: Vasculitis not commonly seen in adults

Kawasaki's disease is an acute, febrile, multisystem disease of children. Some 80% of cases occur prior to the age of 5, with the peak incidence occurring at <=2 years. It is characterized by nonsuppurative cervical adenitis and changes in the skin and mucous membranes such as edema; congested conjunctivae; erythema of the oral cavity, lips, and palms; and desquamation of the skin of the fingeips. Although the disease is generally benign and self-limited, it is associated with coronary aery aneurysms in ~25% of cases, with an overall case fatality rate of 0.5-2.8%. These complications usually occur between the third and fouh weeks of illness during the convalescent stage. Vasculitis of the coronary aeries is seen in almost all the fatal cases that have been autopsied. There is typical intimal proliferation and infiltration of the vessel wall with mononuclear cells. Beadlike aneurysms and thromboses may be seenalong the aery. Other manifestations include pericarditis, myocarditis,myocardial ischemia and infarction, and cardiomegaly . Ref - Harrisons 20e p2588


Question: Wide pulse pressure is seen in

Wide pulse pressure is when SBP increases by more than 50%. It is seen in:

Aortic regurgitation
PDA
Anemia
Beri beri
Hyperthyroidism
Fever
Complete  heart block
AV shunts


Question: Torsade de pointes is caused by

Electrolyte disturbances including hypomagnesmia predispose patients for marked QT prolongation and Torsade de pointes as a result of reduced repolarization reserve Ref Harrison 20th edition pg 1423


Question: For the following dyslipidemias, select the most characteristic finding.Type III hyperlipoproteinemia.

In the rare familial form, raised yellow plaques appear on palms and fingers, and reddish-yellow xanthomas occur on the elbows. This disorder is felt to be secondary to accumulation of abnormal chylomicron and very low-density lipoprotein (VLDL) remnants. It is probably due to inherited homozygous defects in Apo E-II structure.


Question: Lateral medullary syndrome is associated with

Lateral medullary syndrome is a neurological disorder causing a range of symptoms due to ischemia in the lateral pa of the medulla oblongata in the brainstem. The ischemia is a result of a blockage most commonly in the veebral aery or the posterior inferior cerebellar aery Ref Harrison20th edition pg 2334


Question: Devic's disease is associated with

(D) Aquaporin 4 # NEUROMYELITIS OPTICA (NMO) or Devic's disease or Devic's syndrome, is a heterogeneous condition consisting of recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis).> Currently at least two different causes are proposed based on the presence of autoantibodies against AQP4.> Autoimmune reactions against aquaporin 4 produce Devic's disease Mutations in the aquaporin-2 gene cause hereditary nephrogenic diabetes insipidus in humans. Mice homozygous for inactivating mutations in the aquaporin-0 gene develop congenital cataracts.> A small number of people have been identified with severe or total deficiency in aquaporin-1. Interestingly, they are generally healthy, but exhibit a defect in the ability to concentrate solutes in the urine and to conserve water when deprived of drinking water.


Question: A student from Punjab presents for evaluation of anemia. His RDW was observed to be 13.5 while the MCV was 62.5. fl. The likely diagnosis is

Ans. is 'd' i.e., Anemia of chronic disease The normal red cell distrubution width (RDW) is less than 14.5 (Ranges from 11.5 to 14.5 but there is no known cause of decreased RDW). Normal MCV varies from 79.93.3 ft. The patient in question therefore has a Reduced MCV and a Normal RDW. Low MCV along with normal RDW suggests a diagnosis of Anemia of chronic disease. Conditions with Reduced MCV and a Normal RDW o Anemia of Chronic disease Beta thalasemia Minor/Trait Alpha Thalassemia Minor/Trait Hemoglobin E Trait Note : Thalassemia Trait - Low MCV: Normal RDW Anemia of chronic disease - Low MCV : Normal RDW or Normal MCV and Normal RDW Iron deficiency Anemia - Low MCV : Increased RDW


Question: De Musset's sign is seen in

De Musset's sign - nodding of head with each systole seen in Aortic regurgitation.


Question: Floppy iris syndrome is associated with usage of

Selective alpha- adrenergic antagonist side effects may include hypotension, dizziness, nasal congestion, headache, and floppy iris syndrome. Ref Harrison 20th edi page no 2833