Question: Drug of choice in CML is

(Imatinib mesylate) (444-CMDT-08) (685-H17th)CHRONIC MYELOID LEUKEMIA* **Allogenic stem cell transplant (SCT) is the only curative therapy for CML and when feasible is the treatment of choice* * * When allogenic SCT is not feasible, Interferon a therapy is the treatment of choice* Recombinant a - Interferon had largely replaced hydroxy urea as the treatment of choice for CML* Leukapheresis - role in the treatment of pregnant women in whom it is important to avoid potentially teratogenc drugs* Splenectomy - used rarely to reduce the size of the spleenTreatment of blast crises* The treatment of all forms of the blast crises is generally ineffective* Myeloid crises and erythroid crises are treated as for AML* Lymphoid blast crises is treated like ALL with vincristine plus prednisone induction therapy with or without an anthracycline* Even SCT is minimally effective during blast crises* The treatment of CML has been transformed by the introduction of imatinib mesylate. Which specifically inhibits the tyrosine kinase activity of the bcr/abl oncogene (444-CMDT- 08)


Question: The Most common site of cerebral hemorrhage in hypertension is

(C) Putamen > Most common sites are:- Basal ganglia (putamen, thalamus). Deep cerebellum. Pons.


Question: IV thrombolysis is of no use in ischaemic stroke beyond

In IV PA trails, efficacy was confirmed in the <3-h time window, and efficacy likely extended to 4.5 h and possibly to 6 h.Depending on the country, IV PA is approved for up to 4.5 hCriteria for administration of Intravenous Recombinant Tissue Plasminogen Activator (PA ) for Acute Ischemic Stroke (AIS)Clinical diagnosis of strokeOnset of symptoms to time of drug administration <=4.5 hCT scan showing no haemorrhage or edema of >1/3 of the MCA territoryAge 18 >= yearsConsent by patient or surrogateRef: Harrison 19e pg: 2562


Question: Features of multiple myeloma are

Multiple myeloma is a malignant proliferation of plasma cells. Normal plasma cells are derived from B cells & prodece immunoglobulins which contain heavy & light chains. Normal immunoglobulins are polyclonal,which means that a variety of heavy chains are produced . In myelona,plasma cells produce immunoglobulin of a single hwavy & light chain , a monoclonal protein commonly referred to as a paraprotein.Reference :Davidson's principles &practice of medicine 22nd edition pg no 1046.


Question: Plasmapheresis (plasma exchange therapy) is used in the treatment of

Ans. is 'c' i.e. Thrombotic thrombocytopenic purpura Plasmapheresis is useful in the treatment ofThrombotic thrombocytopenic purpuraGuillain Barre SyndromeChronic inflammatory demyelinating polyneuropathy.Cryoglobulinemia glomerulopathyGood pasture's diseaseHemolytic uremic syndromeMultiple sclerosisMyasthenia GravisPauci immune glomerulonephritisPoison elimination Treatment of T.T.PPlasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura.The therapy of Thrombotic thrombocytopenic purpura is based on intensive plasmapheresis coupled with infusion of fresh frozen plasma.Therapy removes abnormal forms of VWF, lower the concentration of ADAMTS13 inhibitor and replenish the deficient enzyme. Overall mortality is markedly reduced and majority of patients with T.T.P recover. Most of the patients survive the acute illness, recover completely with no residual renal or neurologic disease.Plasmapheresis has also been used in hemolytic uremic syndrome but it not been as successful as T.T.P.Management of Hemolytic uremic syndrome early dialysisFor acute renal failure and general supportive care including t/t of hypertension.Refractory casesVincristine or cyclosporine Steroids and Antiplatelet agentsQuestionable benefit Fibrinolytic therapyIneffective Platelet transfusionCan worsen the patients status


Question: Tumors most amenable (cured with) to chemotherapy  a) Chorio Ca  b) Embryonal rhabdomyosarcoma  c) Hepatocellular Ca  d) Thyroid Ca


Question: Child with infratentorial tumour with spinal seedling is

(A) Medulloblastoma # MEDULLOBLASTOMA is a highly malignant primary brain tumour which originate in the cerebellum or the surrounding region below the tentorium are therefore called infratentorial tumours.> 2/3 rd of brain tumours in children are infratentorial out of which half of them are medulloblastomas and 1/3 are astrocytomas.> All Primary Neuro Ectodermal Tumours (like medulloblastoma) of the brain are invasive and rapidly growing tumors that, unlike most brain tumors, spread through the cerebrospinal fluid (CSF) and frequently metastasize to different locations in the brain and spine.> Symptoms are mainly due to secondary increased intracranial pressure like diplopia, papilledema, and sixth cranial nerve palsy.> Positional dizziness and nystagmus are also frequent and facial sensory loss or motor weakness may be present.>. Decerebrate attacks appear late in the disease.> This tumour is chemo sensitive & radiosensitive, and surgery is the main modality of treatment.


Question: A man presents with fever, wt loss and cough. Mantoux reads an induration of 17 x 19 mm, Sputum cytology is negative for AFB. Most likely diagnosis is


Question: Most common cardiovascular abnormality in Down syndrome

Endocardial cushion defects - 43%
VSD - 32%


Question:
Granulomatous disease(s) is/ are
(A)Lichen planus
(B)Histoplasmosis
(C)Sarcoidosis
(D)Lupus erythromatosis
(E)Asbestosis

Asbestosis Q, & SLE cause alveolis, intersal inflammaon & fibrosis, not granulomatous lesion (HI 7/1643, H16/1555) SLE pulmonary manifestation (H17/2078)
"The most common pulmonary-' manifestation of SLE is pleuritisR with or without pleural effusion.
Life threatening pulmonary manifestation include interstitial inflammation leading to fibrosis,
shrinking lung syndrome 1 ' & intraalveoiar hemoorrhage."
It is characterized by an accumulation of T lymphocyte, macrophage & epithelioid cells organized into discrete structures (granuloma) in lung parenchyma.
These lesions can progress to fibrosis Many paents with granulomatous lung disease remain free of severe impairment of lung funcon,
or, when symptomac they improve aer treatment. Lung Response : Granulomatous (H19th/1708,17th/i643) Known Cause Hypersensivity
pneumonis Q (organic dust) Inorganic dusts : beryllium Q , silica Unknown cause Sarcoidosis' 3 Langerhan's cell granulomatosis Wegener's granulomatosis'
3 Allergic granulomatosis of Churgstrauss disease Bronchocentric granulomatosis Lymphomatoid granulomatosis "3 Granulomatous vasculides Granuloma of Lung:
Causes (Dahnert 5th/489) 1. Sarcoidosis Q 2. Non Sarcoid granulomatous disease Infecons Bacterial: TB, gumma Opportunisc:
Crytococcosis Parasic : Dirofilaria immis (dog heartworm) Fungal: Histoplasmosis^, Coccidioidomycosis' 3 , nocardiosis Nonifecons Foreign body :
Talc, beryllium 13 , algae, pollen, cellulose, lipids, abuse of nasally inhaled drugs, aspiraon of medicaon Angiocentric lymphoproliferave disease Vasculides
Extrinsic allergic alveolis Langerhans cell hisocytosis Pulmonary' hyalinizing granuloma


Question: The most common late CNS complication of HIV is

CNS involvement in AIDS

Involvement of the CNS is a common and important manifestation of AIDS.
In addition to the lymphoid system, the nervous system is a major target of HIV infection.
Macrophages and microglial cells in the central nervous system that belong to the monocyte and macrophage lineage are predominant to the types in the brain that are infected with HIV.
It is widely believed that HIV is carried into the brain by infected monocytes.
Ninety per cent of patients demonstrate some form of neurological involvement at autopsy.
In addition to opportunistic infection and neoplasm, several virally determined neuropathological changes occur.

These include

A self limited meningioencephalitis.
Aseptic meningitis
Vascular myelopathy
Peripheral neuropathies and
Most commonly a progressive encephalopathy designated clinically as the AIDS dementia complex. AIDS dementia complex
It is the commonest neurological complication in subacute or chronic HIV encephalitis.
Earlier it was called AIDS encephalopathy or encephalitis.
It present as slowly or rapidly progressive dementia accompanied by abnormalities of motor function.


Question: Approximate time interval between HIV infection and development of AIDS is

HIV 1 (India)- 10 years HIV 2 (Africa)- 15 years


Question: Early loss of bladder control is seen in

Ans. is 'a' i.e., Conus medullaris Loss of bladder control is an early and marked feature of conus medullaris.


Question: Persistent low C3 complement level is not found in

Ans. is 'a' i.e. poststreptococcal glomerulonephritis In post streptococcal glomerulonephritis the serum complement level is decreased transiently (not persistently)They classically return to normal within 6-8 weeks.Persistently decreased complement level after this period should suggest another disease.Also knowMembranoproliferative glomerulonephritis is characterized histologically by alterations in the basement membrane, proliferation of glomerular cells and leucocyte infiltration.Because the proliferation is predominantly in the mesangium a frequently used synonym is mesangiocapillary glomerulonephritis.


Question: The defect in achalasia cardia is present in

Achalasia is characterized by impaired esophageal body peristalsis and incomplete lower esophageal sphincter relaxation. It is a rare disease caused by loss of ganglion cells within the esophageal myenteric plexus usually presenting between age 25 and 60. With longstanding disease, aganglionosis is noted. The disease involves both excitatory (cholinergic) and inhibitory (nitric oxide) ganglionic neurons. Functionally, inhibitory neurons mediate deglutitive lower esophageal sphincter (LES) relaxation and the sequential propagation of peristalsisRef: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 347 Diseases of the Esophagus; Page no: 1904


Question: Electrical alternans in ECG is characteristic of

Electrical alternans is an electrocardiographic phenomenon defined as an alternating amplitude or axis of the QRS complexes in any or all leads. It is most commonly associated with a large pericardial effusion and impending threat of cardiac tamponade Ref Davidson 23rd edition pg 467


Question: Lewy bodies are found in the substantia nigra neurons in

Robbins and cotran Pathologic basis of disease-south asia edition,9 edition *In Parkinson's disease the most prominent histologic correlate is the presence of widespread lewy bodies in neurons in coex and brainstem


Question: Water hammer pulse is seen in

(C) Aortic incompetence # Water Hammer Pulse or Corrigan Pulse is seen in : Physiological - Exercise, Emotion, Pregnancy, Alcohol Hyperkinetic circulatory states: Anaemia, Thyrotoxicosis, Paget's disease of bone, Beriberi anoxic Corpulmonale. Leak in Atrial side of Circulation: AR, PDA, AV fistula, Large VSD Complete Heart Block


Question: Typical symptom of gastroesophageal reflux disease is

Answer- A. RegurgitationHeaburn and regurgitation are the typical symptoms of GERD.Dysphagia and chest pain.Extraesophageal syndrome, with an established association to GERD include chronic cough, laryngitis, asthma, and dental erosions.


Question: Most common benign tumor of liver

BENIGN LIVER TUMORSThree common benign tumors occur and all are found predominantly in women. They are hemangiomas, adenomas, and focal nodular hyperplasia (FNH). FNH is typically benign, and usually, no treatment is needed.Hemangiomas are the most common and are entirely benign. Treatment is unnecessary unless their expansion causes symptoms.Adenomas are associated with contraceptive hormone use. They can cause pain and can bleed or rupture, causing acute problems. Their main interest for the physician is a low potential for malignant change and a 30% risk of bleeding.Reference: Harrison&;s Principles of Internal Medicine; Chapter 111; Tumors of the Liver and Biliary Tree


Question: Rasmussen's aneurysm arises from

Answer is B (Pulmonary Aery): Rasmussen's aneurysm refers. to an aneurysm of the pulmonary aery within/adjacent to a tuberculous cavity Rasmussen's aneurysm This is an aneurysm arising from the pulmonary aery This is typically a `pseudoaneurysm' resulting from inflammatory necrosis of the vessel wall, by direct invasion of the pulmonary aerial wall by adjacent tuberculous infection Typically the vessel injury occurs in the upper lobes of sites of pulmonary tuberculosis Rupture of these aneurysms results in hemoptysis and pulmonary hemorrhage


Question: Major symptoms of hypernatremia are

Hypernatremia increases osmolality of the ECF, generating an osmotic gradient between the ECF and ICF, an efflux of intracellular water, and cellular shrinkage. As in hyponatremia, the symptoms of hypernatremia are predominantly neurologic. Altered mental status is the most frequent manifestation, ranging from mild confusion and lethargy to deep coma. The sudden shrinkage of brain cells in acute hypernatremia may lead to parenchymal or subarachnoid haemorrhages and/or subdural hematomas; however, these vascular complications are primarily encountered in pediatric and neonatal patients. Osmotic damage to muscle membranes can also lead to hypernatremic rhabdomyolysis. Ref: Harrison 19e pg: 303


Question: "Prion" group of diseases include

(A) Creutzfeldt-Jacob disease # Prion Disease:> Prions are infectious proteins that cause degeneration of the Central Nervous System (CNS).> Prion diseases are disorders of protein conformation, the most common of which in humans is called Creutzfeldt-Jackob Disease (CJD).> CJD typically presents with dementia and myoclonus, is restlessly progressive, and generally cause death within a year of onset.> Most CJD patients are between 50 & 75 years of age; however, patients as young as 17 years and as old as 83 years have recorded. SLOW VIRUS DISEASESGroup A* Visna* Maedi (progressive pneumonia)Non-oncogenic retrovirus (Lentivirus), HIVGroup B* Affects in human* Creutzfeldt Jakob disease* Kuru* Fatal familial insomnia* Gerstmann-Straussler-Scheinker syndrome* Sub acute spongioform VE (SSVE)/Bovine* spongioform encephalopathy/(Mad cow disease)* Chronic wasting disease of deer & elk* Scarpie in sheep & goats* Mink transmissible encephalopathyPrion diseasesCorneal transplant may spread C-J diseaseGroup C* SSPE (delayed c/c of measles)* Progressive Multifocal LeukoencephalopathyDue to Papova virus


Question: Topical antifungal used in treatment of Taenia carports

(Tolnaftate) (766-KDT 6th)Topical antifungal agents -Tolnaftate, Undecylenic acid, Benzoic acid, Quiniodochlor, Ciclopirox, Olamine, Sodium thiosulfateTolnaftate - effective drug for T. cruris and T. carporis - most cases respond in 1-3 weeks, because of poor penetrability it is less effective in T. pedis and other hyperkeratinized lesions* for the same reason it is ineffective in T. capitis-involving scalp and tinea unguim-involving nails


Question: Most common neurological disturbance in CKD patients

M/C - Dementia  and sleep disturbances.
Restless leg Syndrome occurs late.


Question: The following should be avoided in asthma patient

Aspirin and other painkillers. Approximately 10% to 20% of adults with asthma have sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs -- or NSAIDS -- such as ibuprofen ( Motrin , Advil) and naproxen ( Aleve , Naprosyn ). Ref Davidson edition23rd pg 576


Question: A 35 year old Lady Malti has unilateral headache, nausea, vomiting and visual blurring. The diagnosis is

Answer is B (Glaucoma): Presence of visual blurring and female sex suggest a diagnosis of glaucoma over cluster headache amongst the options provided. Differential diagnosis are : Female patient (Glaucoma is about four times more common in females while 80% of patients with cluster headache are males) Visual blurring (Visual blurring is a feature of Glaucoma. Cluster headache has ocular features mainly limited to reddening of eye and homolateral lacrimation but vision has not been mentioned as being affected).


Question: Least common site involved in osteoahritis is

Ans. is 'd' i.e., Distal carpophalangeal joint In the hand the joints specifically involved are ? Distal interphalangeal join& (of paicular impoance is the point that this joint is not involved in rheumatoid ahritis). Proximal interphalangeal join& First carpometacarpal jointsQ Remember these two impoant features of joint involvement in osteoahritis It does not involve the metacarpophalangeal jointso It does not involve the wrist joINTEGER(2. It also does not involve the carpometacarpalQ joint (except at the base of thumb). Osteoahritis involves the carpometacarpal joint at the base of thumb, infact it is the second most common area of involvement in osteoahritis. Other joints which are commonly involved in osteoahritis are Hips, Knees, Lower lumbar Cervical. Joints which are usually spared in osteoahritis are WristsQ, carpometacarpale ElbowsQ Shoulder joint


Question: Acute physiology and Chronic Health Evaluation (APACHE) scoring system is used as a scoring system to

Currently, the most commonly utilized scoring systems are the APACHE (acute physiology and chronic health evaluation) system and the SAPS (simplified acute physiology score) system. These systems were designed to predict outcomes in critical illness and use common variables that include age; vital signs; assessments of respiratory, renal, and neurologic function; and an evaluation of chronic medical illnesses. The APACHE II system is the most commonly used SOI scoring system in Noh America. Age, type of ICU admission (after elective surgery vs. nonsurgical or after emergency surgery), a chronic health problem score, and 12 physiologic variables (the most severely abnormal of each in the first 24 h of ICU admission) are used to derive a score. The predicted hospital moality is derived from a formula that takes into account the APACHE II score, the need for emergency surgery, and a weighted, disease-specific diagnostic category. ref:harrison&;s principles of internal medicine,ed 18,pg no 2196

To predict postoperative pulmonary complications

To evaluate prognosis in the critical care settings

To evaluate prognosis after acute myocardial infarction


Question: Sinus bradycardia with MI


Question: Peripheral nerve thickening is not seen in

(A) GBS# Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP), an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of pe-ripheral neuropathies. There are several types of GBS, but unless otherwise stated, GBS refers to the most common form, AIDP.It is frequently severe and usually exhibits as an ascending paralysis noted by weakness in the legs that spreads to the upperlimbs and the face along with complete loss of deep tendon reflexes. With prompt treatment by plasmapheresis or intravenousimmunoglobulins and supportive care, the majority of patients will regain full functional capacity


Question: 'a' wave in JVP Indicates

(a) Right atrial contractionRef: Harrison, 18th ed.,pg. 1823, fig. 227-1Graph of height of JVP with timeThe upward deflections are the"a" atrial contraction"c" ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole)"v" = venous fillingThe downward deflections of the wave are the"x" the atrium relaxes, and the tricuspid valve moves downwardthe "y" descent filling of ventricle after tricuspid opening.


Question: Levine sign is seen in

Answer- A. Stable angina pectorisStable Angina Pectoris:This episodic clinical syndrome is due to transient myocardial ischemiaWhen the patient is asked to localize the sensation, he or she typically places a hand over the sternum, sometimes with a clenched fist, to indicate a squeezing, central, substernal discomfo (Levine's sign).


Question: Causes of severe hypokalemic metabolic alkalosis with severe hypeension include

Liddle syndrome - AD, gain-in-function mutations of ENaC subunits. Activating kidneys to excrete potassium retaining excessive sodium & water, leading to hypeension. C/F- severe hypeension with hypokalemia, unresponsive to spironolactone yet sensitive to amiloride

Bater syndrome, Gitelman syndrome, Liddle and Comparison with SIADH


Question: An alcoholic presented with ascites, bloody tap and elevated alfa fetoprotien. The diagnosis is

(B) Hepatocellular Carcinoma # Hepatocellular carcinoma (HCC) is a primary malignancy of the hepatocyte, generally leading to death within 6-20 months. HCC frequently arises in the setting of cirrhosis, appearing 20-30 years following the initial insult to the liver.> 25% of patients have no history or risk factors for the development of cirrhosis.> Extent of hepatic dysfunction limits treatment options, and as many patients die of liver failure as from tumor progression.# Causes:> Cirrhosis: In general, cirrhosis of any etiology is the major risk factor for HCC.> Major causes of cirrhosis are attributed to alcohol, hepatitis C infection, and hepatitis B infection.# Alcohol> The risk of HCC is greater once the patient stops drinking alcohol, because heavy drinkers do not survive long enough to develop cancer.# Hepatitis B virus> Global incidence of chronic HBV infection is estimated to be 350 million persons; chronic HBV infection is the most common cause of HCC worldwide. In the United States, about 20% of HCC cases are thought to be related to chronic hepatitis B infection.> Chronic infection in the setting of cirrhosis increases the risk of HCC 1000-fold.> The mechanism by which the hepatitis B virus causes HCC is thought to be from a combination of chronic inflammation and integration of the viral genome into the host DNA.# Hepatitis C virus> HCV is a global pandemic affecting 170 million persons. HCV infection results in a higher rate of chronic infection compared to HBV infection (approximately 80% of infected subjects).> Co-infection with HBV further increases the risk; many patients are co-infected with both viruses. Alcohol use in the setting of chronic HCV doubles the risk of HCC compared with HCV infection alone.> Recent studies suggest that antiviral treatment of chronic HCV infections may reduce the risk of HCC significantly.# Hemochromatosis:> Patients with hemochromatosis, especially in the presence of cirrhosis, are at an increased risk of developing HCC. HCC accounts for about 30% of all iron-related deaths in hemochromatosis.# Aflatoxin:> This hepatic carcinogen is a by-product of fungal contamination of foodstuffs in sub-Saharan Africa and East and Southeast Asia. It causes DNA damage and mutations of the p53 gene. Humans are exposed to aflatoxin through the ingestion of moldy foods found in susceptible grains.# Lab Studies:> Expect total bilirubin, aspartate aminotransferase (AST), alkaline phosphatase, albumin, and prothrombin time to show results consistent with cirrhosis.# Alpha-fetoprotein (AFP) is elevated in 75% of cases.> The level of elevation correlates inversely with prognosis> An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy).


Question: Curschmann spirals are seen in

Curschmann spirals refers to finding in sputum of spiral shaped mucus plugs. They are often seen in association with creola bodies and Charcot leyden crystals. Curschmann's spirals are a microscopic finding in the sputum of asthmatics. They are spiral-shaped mucus plugs from subepithelial mucous gland ducts of bronchi. They may occur in several different lung diseases.and may refer to pas of the desquamated epithelium seen in lavages from asthmatic patients. Ref Davidson edition23rd pg 572


Question: Syndrome x not found in

(D) (Weight loss) (1992-95-H 18th)* Syndrome X is much more common in patients who are obese.Metabolic' syndrome (syndrome X) or Insulin resistance syndrome (805- Davidson 22nd)* DM type II* Hypertension* Dyslipidaemia * Over weight/obesity* Central adiposity is a key feature of the syndrome* Sedentary life style* Aging 50 years* Coronary heart disease* Lipodystrophy* Glucose intoleranceOther ossociated conditions1. Non alcoholic fatty liver disease2. Hyperuricemia3. Polycystic ovary syndrome4. Obstructive sleep apnea


Question: Glanzmann thrombasthenia is due to deficiency of


Question: HLA B27 histocompatibility antigen is correlated With

REF:HARRISONS PRINCIPLE&;S OF INTERNAL MEDICINE 18TH EDITION


Question: Bacteria aquires restriction endonuclease by horizontal transfer. The result would be

C i.e. Bacteria cannot survive because it lacks DNA methylase that protects the host DNA Any bacteria is protected against its own restriction endonuclease (RE) by a companion enzyme site specific DNA methylase which methylates the restriction sites recognized by that paicular REQ. In other wors, every bacteria has its own pair of RE & site specific DNA methylase - So if any bacteria aquires new/ different RE by horizontal transfer (i.e. from other bacteria) this restriction enzyme will cleave (lyse) the bacterial DNA and kill bacteriaQ because the restriction sites for this RE are not methylated & protected.

It helps in DNA proof reading in bacteria


Question: Treatment of choice for tropical splenomegaly is


Question: Causative agent of Trench fever

Q fever - Coxiella burnetii.
Trench fever - Bartonella Quintana.


Question: Incongrous contralateral hemianopia is seen in


Question: Hypokalemia is

Hypokalaemia is a common electrolyte disturbance and is defined as existing when serum K+ falls below 3.5 mmol/L. The main causes of hypokalaemia Ref Davidson 23rd edition pg 363


Question: Lung abscess is least likely a complication of

Lung abscess can be divided on acute (less than 6 weeks) and chronic (more than 6 weeks). It can be called primary as a result of aspiration of oropharyngeal secretions (dental/periodontal infection, para nasal sinusitis, disturbance states of consciousness, swelling disorders, gastro-oesophageal reflux disease, frequent vomiting, necrotizing pneumonia's or in immunocompromised patients. Secondary lung abscesses occurred in bronchial obstructions (by tumor, foreign body or enlarged lymph nodes), with coexisting lung diseases (bronchiectasis, bullous emphysema, cystic fibrosis, infected pulmonary infarcts, lung contusion), then spreading from extrapulmonary sites-hematogenous (abdominal sepsis, infective endocarditis, infected canula or central venous catheter, septic thromboembolisms) or by direct spreading (broncho-oesophageal fistula, subphrenic abscess) (6). Based on way of spreading, lung abscess can be bronchogenic (aspiration, inhalation) and haematogenic-dissemination from other infected sites. Division of lung abscesses: According to the duration: Acute (less than 6 weeks); Chronic (more than 6 weeks); By etiology: Primary (aspiration of oropharyngeal secretions, necrotizing pneumonia, immunodeficiency); Secondary (bronchial obstructions, haematogenic dissemination, direct spreading from mediastinal infection, from subphrenium, coexisting lung diseases); Way of spreading: Brochogenic (aspiration of oropharyngeal secretions, bronchial obstruction by tumor, foreign body, enlarged lymph nodes, congenital malformation); Haematogenic (abdominal sepsis, infective endocarditis, septic thromboembolisms). Ref Davidson edition23rd pg 584


Question: For the following medical conditions, select the associated acid base disturbances.Chronic pulmonary disease on steroids.

Chronic pulmonary disease often causes respiratory acidosis, whereas the steroids frequently used in therapy may cause a metabolic alkalosis.

metabolic acidosis and respiratory acidosis

metabolic acidosis and respiratory alkalosis

metabolic alkalosis and respiratory acidosis

metabolic alkalosis and respiratory alkalosis


Question: Prosopagnosia is associated with the lesion of

(D) Fusiform gyrus and lingual gyrus # Prosopagnosia: Perceptual information about faces and objects initially is encoded in primary (striate) visual cortex and adjacent (upstream) peristriate visual association areas.> This information subsequently is relayed first to the downstream visual association areas of occipitotemporal cortex and then to other heteromodal and paralimbic areas of the cerebral cortex.> Bilateral lesions in fusiform & lingual gyri of the occipitotemporal cortex disrupt this process and interfere with the ability of otherwise intact perceptual information to activate the distributed multimodal associations that lead to the recognition of faces and objects.> Resultant face and object recognition deficits are known as associative prosopagnosia and visual object agnosia.> Patient with prosopagnosia cannot recognize familiar faces, including, sometimes, the reflection of his or her own face in the mirror.> This is not a perceptual deficit since prosopagnosic patients easily can tell whether two faces are identical.> Furthermore, a prosopagnosic patient who cannot recognize a familiar face by visual inspection alone can use auditory cues to reach appropriate recognition if allowed to listen to the person's voice.

Hippocampus, amygdala and entorhinal cortex


Question: A patient with diarrhea has a fecal smear that is negative for leukocytes. The patient&;s diarrhea is most likely caused by

The enterotoxigenic strain of Escherichia coli secretes a heat-labile toxin that stimulates adenylate cyclase, producing a cholera-like syndrome that is responsible for the majority of cases of traveler's diarrhea. Because the bowel mucosa is not invaded and there is no toxin-induced damage, the fecal smear is negative for leukocytes. Campylobacter enteritis, shigellosis, typhoid fever, and amebiasis are all invasive, and infected individuals have stools with inflammatory cells. Typhoid fever is unique because the inflammatory cells are not neutrophils, but mononuclear cells. Ref - Harrison's internal medicine 20e pg 1150t,1152-1153


Question: The growth phase of hair is

(Anagen): (1242- Davidson 21st edition)* Hairs in humans do not grow continuosely but in a cycle with three phases* Anagen, in which the hair grows* Catagen a transitional phase* Telogen a resting stage* The individual duration of the components of the cell cycle varies by site* On the scalp, anagen will last several years, whereas catagen lasts only a few days and telogen around 3 months* Highest density of hair follicles is on the scalp, which has between 500 and 1000/cm2


Question: Most common symptom of primary biliary cirrhosis is

Answer is A (Pruritis): 'The earliest symptom is 'pruiritis' which may be either generalized or limited initially to the plams and soles.' -- Harrison Primary Biliary Cirrhosis Primary biliary cirrhosis is a disease characterized by chronic inflammation and fibrous obliteration of intrahepatic bile ductules due to an unknown (primary) stimulus. Etiology / pathogenesis : PBC is believed to be due to an autoimmune Q etiology as it is often associated with other autoimmune disorders Q such as I . CREST Q :Calcinosis, Raynaud's, Esophageal dysmotility, Sclorodactyly Talenglectasia SICCA SYNDROME Autoimmune thyroiditis Q Renal tubular acidosis Antimitochondrial Antibody (IgG) is positive Clinical feature : Most patients are asymptomatic Q Pruritis is commonest / earliest symptom Q Jaundice Melanosis: gradual darkening of exposed areas of skin Q Deficiency of fat soluble vitamins due to malabsorption Q Vit D deficiency : bone pain - osteomalacia Q Vit K deficiency : bleeding -- bruising (2 Vit A deficiency : Night blindness Q Xanthelisman & xanthomasQ due to protracted elcvaliar of serum lipids. Lab Findings : T1' Serum alkaline phosphatase Q (2-5 fold) Positive antimitochondrial antibody :Q Sensitive and specific Hyperlipidemia Q


Question: J waves are seen in

(Hypothermia) (1319-H) (1389-H17th)ECG-Changes:Hypothermia- Associated with a distinctive convex 'hump' at the J point (Osborn wave)Hypocalcemia- Prolongation of the Q-T interval (ST-segment portion)Hypercalcemia- Abbreviation of the ST segment and shortening of the QT interval.Hypokalemia- Decreased amplitude and broadening of T-wave, prominent U waves, premature ventricular contractions and depressed ST segmentsHyperkalemia- Peaked T waves of increased amplitude, widening of the QRS, and biphasic QRS-T complexes- Severe hyperkalemia causes cardiac arrest with a slow sinusoidal type of mechanism ("sino-wave" pattern) followed by asystole.* "CVA-T-wave" pattern seen in subarachnoid haemorrhage.


Question: Absence of dystrophin


Question: Dural hemorrhage seen in

*dural hemorrhage occur due to rupture of cerebral veins in the dural space . An intracranial hematoma is a collection of blood within the skull, most commonly caused by rupture of a blood vessel within the brain or from trauma such as a car accident or fall. The blood collection can be within the brain ptissue or underneath the skull, pressing on the brain. Ref Harrison20th edition pg 2456


Question: Friedlander Pneumonia refers to Pneumonia caused by

Ans. is 'a' i.e., Klebsiella Klebsiella Pneumonia is also known as "Friedlander Pneumonia". Klebsiella initially described in 1882 by Friedlander was also known as Friendlander's bacillus. Community acquired Pneumonia caused by Friendlander's bacillus (Klebsiella) was termed as Friedlander Pneumonia


Question: Middle aged female with mass in sella turcica hormone increased is

The sella turcica is a saddle shaped depression of the sphenoid bone.
 It forms the caudal border of the pituitary> gland. Sella turcica is an anatomically complex area with a number of different potenal pathologies especially neoplasc process.
Pathologies of sella turcica can lead to important clinical presentaons such as hormonal imbalances from pathologies affecng the pituitary gland and neurological symptoms from the mass effect,
Sella turcica is crically located as several structures pass close to it due to compression of the adjacent structures.


Question: Most common presentation of Renal cell carcinoma is


Question: Acute renal failure results in

Acute renal failure results in- Hyperkalemia Acidosis-causes are metabolic,diabetic ketoacidosis, respiratory acidosis ,sepsis Elevation in Anion gap. Ref:Harrison 20th edition pg no. 2108


Question: Drug of choice for acute attack of hereditary angioneurotic edema is

Icatibant (Firazyr), a selective bradykinin B2 receptor antagonist, was approved by the US Food and Drug Administration for treatment of acute attacks HAE in adults. Approval was based on 3 double-blind, randomized, controlled clinical trials known as For Angioedema Subcutaneous Treatment (FAST) Ref Davidson 23rd edition pg 481


Question: Christmas tree appearance of urinary bladder is seen in

Ans. is 'a' i.e., Neurogenic bladder Christmas tree appearance of the bladder is seen in neurogenic bladder caused by detrusor hyperreflexia. Detrusor hyperreflexia is caused by lesions of the spinal cord above the sacral segments but below the pons. Such patients have noperception of bladder filling or emptying and voluntary voiding is not possible. Voiding when it does occur is involuntary with simultaneous contractions of the detrusor and external sphincter muscles. Common neurological condition resulting in detrusor hyperreflexia include Multiple sclerosis Myelodysplasia, Spinal cord trauma Spinal cord tumours, A-V malformatio not the spinal cord Radiologically, patients with long terms untreated detrusor hyperreflaxia have characteristic changes of the urinary tact. Bladder is veically oriented, with an irregular contours, consistent with trabeculation. There are frequently multipel diveicula, Such a bladder is referred to as a christmas tree. Automatic bladder Autonomous bladder Lesion site Above T5 or higher Cauda equina damage / lower motero neuron Manifestation Small spastic bladder damage Large flaccid bladder Why this name urge comes again and again due to repeated contractions and hence empties repeatedly after some time Has no urge sensation and continuous DRIBBLING occurs, So it is like the bladder is working all the time but Brain has no control over it and hence called autonomous bladder Radiological data Christmas tree appearance No VUR but still bladder is large and holds lots of residual urine


Question: MODY 1 is caused by mutations in

More than 10 different variants of MODY, caused by mutations in genes encoding islet-enriched transcription factors or glucokinase, are transmitted as autosomal dominant disorders.MODY 1, MODY 3, and MODY 5 are caused by mutations in the hepatocyte nuclear transcription factor (HNF) 4a, HNF-1a, and HNF-1b, respectively. As their names imply, these transcription factors are expressed in the liver but also in other tissues, including the pancreatic islets and kidney. These factors most likely affect islet development or the expression of genes impoant in glucose-stimulated insulin secretion or the maintenance of beta cell mass.Genetic defects of beta cell development or function characterized by mutations in (III A)Hepatocyte nuclear transcription factor (HNF) 4a (MODY 1)Glucokinase (MODY 2)HNF-1a (MODY 3)Insulin promoter factor-1 (IPF-1; MODY 4)HNF-1b (MODY 5)NeuroD1 (MODY 6)Mitochondrial DNASubunits of ATP-sensitive potassium channelProinsulin or insulinOther pancreatic islet regulators/proteins such as KLF11, PAX4, BLK, GATA4, GATA6, SLC2A2 (GLUT2), RFX6, GLIS3Ref: Harrison 19e pg: 2406


Question: In a status epilepticus patient, first line of drugs is

IV benzodiazepines are initiated first in a status epilepticus patient, followed by IV antiepileptics.If refractory seizures, phenobarbital may be given.Ref: Harrison 19e 2558


Question: Lupus vulgaris

A. i.e. (Skin tuberculosis) (46 - Roxburg 17th)LUPUS VULGARIS - Slowly progressive granulomatous plaque on the skin caused by the tubercle bacillus* It often has a thickenedpsoriasi form appearance but blanching with a glass microscope slide (diascopy) will reveal grey - green foci ("apple jelly nodule**") due to the underlying granulomatous inflammation* Lupus pernio - is a particular type of sarcoidosis that involves the tip of nose & earlobes with lesions that are violaceous in colour* Spina ventosa - Tuberculosis of bone in which bone is expanded & the cortex thins eg digits*** Scrofuloderma - Tuberculosis first develops in a lymph node or bone producing a swelling and subsequently ruptures through the overlying skin* The classic renal manifestation of tuberculosis is the presence of microscopic pyuria with a sterile urine culture or "sterile pyuria" (826 - CMDT - 09)


Question: Following cranial nerve is most commonly involved in patients with sarcoidosis

Neurological findings are observed in 5% of patients with sarcoidosisSeventh nerve involvement with unilateral facial palsy is most common. It occurs suddenly and is usually transientOther common features of neurosarcoidosis:Optic nerve dysfunctionPapilledemaPalate dysfunctionHearing abnormalitiesChronic meningitisHypothalamic and pituitary abnormalitiesHeerfordt's syndrome:FeverB/L parotid enlargementAnterior uveitisVIIth nerve palsy(ref:Harrison's 18/e p2809, 17/e p2139)


Question: ECG feature of Hyperkalemia includes

(B) Wide QRS complex # ECG is essential and may be instrumental in diagnosing HYPERKALEMIA in the appropriate clinical setting.> ECG changes have a sequential progression of effects, which roughly correlate with the potassium level. ECG findings may be observed as follows:> Early changes of hyperkalemia include peaked T waves, shortened QT interval, and ST-segment depression.> These changes are followed by bundle-branch blocks causing a widening of the QRS complex, increases in the PR interval, and decreased amplitude of the P wave.> These changes reverse with appropriate treatment.>Without treatment, the P wave eventually disappears and the QRS morphology widens to resemble a sine wave. Ventricula' fibrillation or asystole follows.> ECG findings generally correlate with the potassium level, but potentially life-threatening arrhythmias can occur without warning at almost any level of hyperkalemia.> Atrial fibrillation and J waves are not features of hyperkalemia.


Question: Period of isolation in salmonella infection is till

3 consecutive stool cultures are negative


Question: The most common posterior mediastinal mass is

The posterior mediastinum contains the following structures: sympathetic ganglia, nerve roots, lymph nodes, parasympathetic chain, thoracic duct, descending thoracic aoa, small vessels and the veebrae. Most masses in the posterior mediastinum are neurogenicnature Ref Davidson 23rd edition pg 580


Question: Haemopoietic malignancy is seen in

Human T-cell leukemia virus type 1 (HTLV-1) is a causative agent of a malignant disease of peripheral CD4+ T cells called adult T-cell leukemia-lymphoma (ATL) and several inflammatory diseases such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Ref Davidson 23rd edition pg 1091


Question: Most common cardiac involvement in Rheumatoid arthritis is

(B) Pericarditis # CARDIAC COMPLICATIONS OF RHEUMATOID ARTHRITIS> Pericarditis: Asymptomatic. One-third of patients with seropositive RA.> Myocarditis.> Endocarditis.> Conduction defects.> Coronary vasculitis.> Granulomatous aortitis.


Question: Most common organism causing SBPE after E. coli is

(C) Streptococcus # Spontaneous Bacterial Empyema currently re-termed as pleuritis (SBPe) is the spontaneous infection of the pleural fluid> Its prevalence is seen in 13% of in-hospital cirrhosis patients with hydrothorax and has an estimated morality of over 20% in the same admission.> It is postulated to occur as a direct spread of bacteria from the peritoneal cavity. In 40% patients for SBPe, there is no associated SBP.> SBPe can also occur in the absence of ascites.> Another theory regarding its pathogenesis is that transient bacteremia that infects the pleural space.> Defective local pleural factors such as low fluid complement levels and low opsonic activity (similar to that seen in ascites that develop SBP) is also seen in SBPe pathogens, which enhances bacterial translocation.> Causative micro-organism in most cases of SB EM are E. coli, Streptococcus species, Enterococcus & Klebsiella, which are different from that causing SBP.> A high child-Pugh score, decreased pleural fluid total protein and low levels of C3 component in pleural fluid were proved risk factors for the development of SBEM SBP is also a predictive factor of SBEM.> It is recommended to use the pleural fluid total protein concentration in clinical practice to detect those patients at a risk for developing SBEM.


Question: Etiology of disordered coagulation in antiphospholipid syndrome is


Question: Ibutilide acts by

Ibutilide is a class III antiarrhythmic drug.The classes of antiarrhythmic action are:- Class I, Local anaesthetic effect due to blockade of Na+ currentClass I antiarrhythmics have been fuher subdivided based on the kinetics and potency of Na+ channel bindingClass Ia agents (quinidine, procainamide) are those with moderate potency and intermediate kinetics;Class Ib agents (lidocaine, mexiletine) are those with low potency and rapid kinetics; and Class Ic drugs (flecainide, propafenone) are those with high potency and the slowest kinetics.Class II: Interference with the action of catecholamines at the b-adrenergic receptor (Atenolol, Propranolol, Esmolol, Metoprolol)Class III: Delay of repolarization due to inhibition of K+ current or activation of depolarizing current (Amiodarone, Sotalol, Ibutilide, Dofetilide)Class IV: Interference with calcium conductance (Diltiazem, Verapamil)Harrison 19e pg: 273e-6


Question: These ECG changes are seen in

Classically, the electrocardiographic manifestations in hyperkalemia progress from tall peaked T waves (5.5-6.5 mM) to a loss of P waves (6.5-7.5 mM) to a widened QRS complex (7.0-8.0 mM), and, ultimately, a to a sine wave pattern (>8.0 mM). Ref: Harrison 19e pg: 310


Question: The most common reentrant tachycardia associated with WPW syndrome is

The most common tachycardia caused by an AP is the PSVT designated ohodromic AV reentry. The circulating reentry wavefront propagates from the atrium anterogradely over the AV node and His-Purkinje system to the ventricles and then reenters the atria retrograde conduction over the AP Ref Harrison 20th edition pg 1482


Question: Quick Reduction of blood pressure is done in


Question: Most specific antibody for celiac disease in patients with IgA deficiency

Most specific - Anti - TTG
Most specific in IGA deficiency - Anti - Gliadin.


Question: An obese female patient presented with hypeension chronic headeache and, normal pituitary function.The most likely diagnosis is

Empty sella syndrome (ESS) is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary patients with empty sella syndrome can have headaches as symptoms of elevated spinal fluid pressure; symptoms of hypopituitarism; or visual symptoms, which can sometimes be due to downward, prolapse of the optic chiasm into the empty sella. Ref Harrison20th edition pg 2478


Question: "Upside down" stomach on Barium meal study is seen in

"Upside down" stomach on Ba meal study is seen in Mesenteroaxial gastric volvulus. Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b). ref - <a href=" <p>

Large Gastric adenocarcinoma at antral end


Question: Water shed zone in spinal cord is

(B) T4-T8 > It is generally accepted that the gray matter in the watershed area of the midthoracic level of the spinal cord is the ischemic watershed zone of the spinal cord. Historically, the literature has supported the notion of a spinal cord "watershed zone" of ischemic vulnerability centered at the mid-thoracic level (T4 to T6 level). This assumption was based largely on anatomic studies and case reports describing the relative hypovascularity of the midthoracic region from approximately T4 to T8. Because of the anatomic distribution of the spinal cord arteries with the relative paucity of radicular arteries in the thoracic region, the midthoracic level (T4 to T8) has been recognized as the ischemic watershed zone of the spinal cord.


Question: Migraine is due to

K.D Tripathy essentials of medical pharmacology 7th edition . *Neurogenic theory consider it to be spreading depression of coical electrical activity followed by vascular phenomena.


Question: Protein losing enteropathy with mucosal erosion is seen in

Causes of protein losing enteropathy with mucosal erosion are Crohn's disease, ulcerative colitis, radiation damage and lymphoma. Coeliac disease, Menetrier's disease and systemic lupus erythematosus can cause protein losing enteropathy without mucosal erosion. Ref: Davidson's Principles and Practice of Medicine, 22nd edition, p886


Question: A patient with suspected subarachnoid haemorrhage presents with blood isolated in the fouh ventricle on a CT scan. Aneurysmal rupture is likely to have resulted from

*Saccular aneurysm at size of >7mm and at top of basilar aery and at origin of posterior communicating aery are at greater risk of rupture . Ref Harrison20th edition pg 2445

Posterior Inferior Cerebellar Aery Aneurysm


Question: Drug of choice for resistant macrophage activation syndrome

Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases, requiring immediate and appropriate treatment. MAS is a disorder related to hemophagocytic lymphohistiocytosis (HLH), which is divided into primary and secondary HLH. The most common autoimmune diseases associated with MAS are systemic juvenile idiopathic ahritis (SJIA), followed by systemic lupus erythematosus (SLE), Kawasaki disease (KD), and juvenile dermatomyositis (JDM). The symptoms of MAS are quite similar to those of many active autoimmune diseases or severe sepsis; therefore, it is quite difficult to make a diagnosis. MAS is still underrecognized, and its treatment is usually delayed, which then leads to high morbidity and moality. The classical signs and symptoms of patients with MAS are a persistent high-grade fever, hepatosplenomegaly, lymph-adenopathy, and hemorrhagic manifestations. The mainstay of MAS treatment is glucocoicoid therapy. Most of the physicians sta with an intravenous methylprednisolone 30 mg/kg/dose (maximum 1 g) for 1-3 days. If the patients respond well to the high dose of methylprednisolone, this is decreased to 2-3 mg/kg/day in a divided dose. If the clinical status of the patients is stable, the physicians change the dosage to oral prednisolone, thus, preparing for a discharge, as well. For the nonresponders, an additional therapy with cyclosporin A 2-7 mg/kg/day is recommended.


Question: Pinpoint pupils are seen in haemorrhage of

In pontine haemorrhages, deep coma with quadriplegia often occurs over a few minutes. Typically, there is prominent decerebrate rigidity and "pinpoint" (1 mm) pupils that react to light. There is impairment of reflex horizontal eye movements evoked by head turning (doll's-head or oculocephalic maneuver) or by irrigation of the ears with ice waterHyperpnea, severe hypeension and hyperhidrosis are commonRef: Harrison 19e pg: 2583


Question: Treatment of 42 year old obese man with blood glucose 450 mg, urine albumin 2+sugar 4+ketone 1+ is

Answer is A (Insulin): Presence of sugar and ketones in urine and the presence of hyperglycemia (400 mg Glucose) suggests a diagnosis of Diabetic ketoacidosis. The treatment of choice in Diabetic ketoacidosis is Insulin.


Question: Galactorrhoea due to ectopic prolactin is seen in  a) Malignant thymoma  b) Bronchogenic carcinoma  c) Medullary carcinoma thyroid  d) Hypemephroma


Question: Normal asymptomatic case of myocardial infarction previously treated with antiplatelet and thrombolytic therapy. Secondary prophylaxis for this patients with

(Beta- blockers) (324- CMDT-08) (1543-H17th)Secondary prevention of MI* b -blockers improve survival rates, primarily by reducing the incidence of sudden death in high -risk subjects of patients through their value may be less in patients without complications with small infection and normal exercise tests* b -blockade should be avoided in patients with decompensated heart failure, decompensated asthma or high degrees of AV block* Antiplatelet agent - aspirin and clopidogrel are recommended


Question: Drug induced lupus can be identified by

Ref Harrison's internal medicine 20e p2517


Question: Most common test for HIV is

Ans:- a (ELISA) Ref: Harrison 17/edp.I165Most common test for HIV is definitely ELISAAntibodies to HIV usually appear within 6 weeks and almost invariably within 12weeks of primary infection.This antibody detection forms the basis of most diagnostic screening tests for HIV infection such as ELISA and Western blot.Before 6weeks, diagnosis depends on direct detection of HIV by p24 antigen Capture assay.HIVClinical features1. Primary infectionIt is symptomatic in 70-80% of cases and usually occurs 2-4 weeks after exposure. The major clinical manifestations of primary infection are fever. The appearance of specific anti HIV antibodies in serum (Serocinversion) takes place at 3-12 weeks (median 8 weeks)Any HIV infected individual with CD4 T cell count less than 200/cu.mm has AIDS by definition.2. Asymptomatic infectionAsymptomatic infection is a period during which the individual remains well with no evidence of disease except for the possible presence of persistent generalized lymphadenopathy.3. Mildly symptomatic disease.It indicates some impairment of the cellular immune system. These diseases corresponds to AIDS related complex conditions, but by definition are not AIDS defining.Acquired Immunodeficiency SyndromeIt is defined by the development of specified opportunistic infections tumors etc. e.g, esophageal candidiasis, cryptococcal meningitis.Correlation between CD 4 count and HIV associated diseases are given below.>500cells/cu.mm1. Acute primary infection2. Progressive generalized lymphadenopathy3. Recurrent vaginal candidiasis200-500cells/cumm1. Pulmonary tuberculosis2. Herpes zoster3. Oropharyngeal candidiasis4. Oral hairy leucoplakia5. Salmonellosis6. Kaposi's sarcoma7. HIV associated idiopathic thrombocytopenia8. Cervical intra epithelial neoplasia 1 and 29. Lymphoid interstitial pneumonitis<200cells/cu.mm1. Pneumocystis carinii pneumonia2. Mucocutaneous herpes simplex3. Cryptosporidium4. Microsporidium5. Esophageal candidiasis6. Miliary/extra pulmonary tuberculosis7. HIV associated wasting8. Peripheral neuropathy<100 cells/cu.mm1. Cerebral toxoplasmosis2. Cryptococcal meningitis3. Primary CNS lymphoma4. Non-Hodgkin's Lymphoma5. HIV-associated Dementia6. Progressive multi focal leukoencephalopathy.<50cells/cu.mm1. CMV Retinitis/gastro intestinal disease2. Disseminated Mycobacterium avium intacellulare


Question: Clinical features of Erythema nodosum Leprosum  a)  Fever  b) Hepatitis  c) Joint pain  d)  Pancreatitis  e) Skin eruptions


Question: Antibodies against acetylcholine receptors are seen in September 2009

Ans. D: Myasthenia gravis Myasthenia gravis (MG) is a relatively rare autoimmune disorder of peripheral nerves in which antibodies form against acetylcholine (ACh) nicotinic postsynaptic receptors at the myoneural junction. A reduction in the number of ACh receptors results in a characteristic pattern of progressively reduced muscle strength with repeated use of the muscle and recovery of muscle strength following a period of rest. The bulbar muscles are affected most commonly and most severely, but most patients also develop some degree of fluctuating generalized weakness.


Question: The following ECG with ST elevation on VI V2 is associated with the diagnosis of

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


Question: Acute hyponatremia becomes symptomatic at

Severe symptoms (e.g., coma, seizures) typically occur when the sodium level falls below 120 mEq per L, but can occur at less than 125 mEq per L. Severe symptomatic hyponatremia must be corrected promptly because it can lead to cerebral edema, irreversible neurologic damage, respiratory arrest, brainstem herniation, Ref Davidson 23rd edition pg 350


Question: Carey coomb murmur is seen in

Answer is B (Acute Rheumatic carditis) Carey coombs murmur is delayed diastolic murmur seen in acute rheumatic carditis and is attributed to excessive left atrial blood flow due to mitral regurgitation. It is not seen in MR, AR or severe pulmonary Hypeension.


Question: The commonest intrabronchial cause of haemopysis is

Answer is A (Carcinoma lung): The two most common causes for hemoptysis are bronchitis and bronchogenic carcinoma. Bronchitis is not provided amongst the options and hence bronchogenic carcinoma is the single best answer of choice. Although the relative frequency of the different etiologies of hemoptysis varies from series to series, most recent studies indicate that bronchitis and bronchogenic carcinoma are the two most common causes (in the United States)'- Harrisons Facts to Remember The most common cause of Hemoptysis Bronchitis and Bronchogenic CAe (Bronchitis > Bronchogenic CA)Q The most common causes of Hemoptysis in India TuberculosisQ The most common cause of Massive Haemoptysis Bronchectasis (World wide)e Tuberculosis (India)Q


Question: Bronchiectasis sicca is seen with

Bronchiectasis sicca is a dry bronchiectasis seen in tuberculosis Bronchiectasis sicca or dry bronchiectasis is a very rare condition in which there are all the features of bronchiectasis except for the absence of copious amount of sputum which is usually a hall mark of bronchiectasis Dry bronchiectasis is rare condition in which abnormal dilataion of trachea bronchial tree Ref Davidson 23rd edition pg 586


Question: Most common symptom seen in pulmonary tuberculosis is

(D) Chronic Cough # Constitutional symptoms associated with Pulmonary tuberculsosi include Chronic productive cough for atleast 2 or 3 weeks Low grade evening raise of temperature Loss of apetite Significant weight loss Night cries in bone and joint tuberculosis


Question: Low QRS voltage on ECG with left ventricular hyperophy on Echocardiography suggests a diagnosis of

Ans. is 'b' i.e., Cardiac Amyloidosis Low QRS voltage on ECG with left ventricular hyperophy on Echocardiography suggests a diagnosis of infiltrative cardiomyopathy like amyloidosis. Low QRS voltage along with thick left ventricle on echocardiogram suggests infiltrative cardiomyopathy such as amyloidosis or tumour. Causes of low voltage QRS complexes Adrenal insufficiency Anasarca Aifactual or spurious, eg, unrecognized standardization of ECG at one-half the usual gain (i.e., 5 mm/mv) Cardiac infiltration or replacement (e.g., amyloidosis, tumor) Cardiac transplantation, especially with acute or chronic rejection Cardiomyopathy, idiopathic or secondary Chronic obstructive pulmonary disease Constrictive pericarditis Hypothyroidism, usually with sinus bradycardia Left pneumothorax (mid-left chest leads) Myocardial infarction, extensive Myocarditis, acute or chronic Normal varian Obesity Pericardial effusion Pericardial tamponade, usually with sinus tachycardia Pleural effusions


Question: Features of shock

In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls decrease or decline in the GFR implies progression of underlying kidney disease or the occurrence of a superimposed insult to the kidneys. This is most commonly due to problems such as dehydration and volume loss. An improvement in the GFR may indicate that the kidneys are recovering some of their function Ref Davidson 23rd edition pg 460


Question: Best and most successful treatment of bronchial asthma is

(A) Avoidance of antigen # Elimination of the causative agent(s) from the environment of an allergic individual with asthma is the most successful means available for treating this condition (for details on avoidance, Desensitization or immunotherapy with extracts of the suspected allergens has enjoyed widespread favor, but controlled studies are limited and have not proved to be highly effectiv.


Question: Massive bleeding per rectum in a 70years patient is seen most commonly in

Hemorrhage from a colonic diveiculum is the most common cause of hematochezia in patients >60 years, yet only 20% of patients with diveiculosis will have gastrointestinal bleeding. Patients at increased risk for bleeding tend to be hypeensive, have atherosclerosis, and regularly use aspirin and nonsteroidal anti-inflammatory agents. Most bleeds are self-limited and stop spontaneously with bowel rest. The lifetime risk of rebleeding is 25%.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 353; Diveicular Disease and Common Anorectal Disorder


Question: Antidote of paracetamol is

N-acetylcysteine is the antidote of paracetamolParacetamol is extensively metabolized in the liver to form principally the sulfate and glucuronide conjugates which are excreted in the urine. A small fraction of an ingested dose is metabolized in the liver by isozyme CYP2E1 of the cytochrome P-450 mixed function oxidase enzyme system to form a reactive, potentially toxic, intermediate metabolite. The toxic metabolite preferentially conjugates with hepatic glutathione to form nontoxic cysteine and mercapturic acid derivatives, which are then excreted by the kidney.However, following ingestion of a large overdose, the glucuronide and sulfate conjugation pathways are saturated resulting in a larger fraction of the drug being metabolized the cytochrome P-450 pathway and therefore, the amount of acetaminophen metabolized to the reactive intermediate increases. The increased formation of the reactive metabolite may deplete the hepatic stores of glutathione with subsequent binding of the metabolite to protein molecules within the hepatocyte resulting in cellular necrosis.N-acetylcysteine replenishes the glutathione stores of liver and prevents binding of the toxic metabolite to other cellular constituents(ref: Goodman Gilman 11/e p694)


Question: Most specific test for SLE

Ans.(c) Anti- smith antibodyTest Description* ANA Screening test has sensitivity 95% not diagnostic without clinical features* Anti-dsDNA Antibody: High specificity, sensitivity only 70% and levels are variable based on disease activity* Anti-Sm antibody: Most specific antibody for SLE* AntiSSA (Ro) or Anti-SSB (La) Present in 15% of patients with SLE and other connective tissue disease such as Sjogren syndrome* Lupus anticoagulant* Direct Russell viper venom test to screen for inhibitors in the clotting cascade in antiphospholipid antibody syndrome* Direct Coombs test* Anti-histone : Drug-induced lupus (e.g with procainamide or hydralazine)


Question: The most common inherited from of aplastic anaemia

Answer- A. Fanconi anaemiaMost common inherited congenital anemia is Fanconis anemia.


Question: Most common parotid gland tumour is

(A) Pleomorphic adenoma # Parotid tumours> Most common is pleomorphic adenoma (80-90%)> Low-grade malignant tumours cannot be distinguished from benign neoplasms> High-grade tumours grow rapidly are usually painful and often have lymph node involvement of presentation> CT and MRI are useful> Fine-needle aspiration is better than open biopsy> Tumours should be excised, not enucleated


Question: In severe liver failure, Anaesthetic of choice is

(Isoflurane) (134-Lee's 13th) (373 - KDT 6th)ISOFLURANE - Repeated iso flurane administration have failed to produce measurable changes in liver function Renal and hepatic toxicity has not been encountered.* Anaesthetic choice in - Neurosurgery and safer in myocardial ischaemiaSEVOFLURANE - anaesthetic choice in Liver / Kidney diseases* It may trigger malignant hyperpyrexia in susceptible individuals* Well tolerated in both children and adults* Muscle relaxant of choice in hepatic & renal failure - cisatracurium**


Question: Investigation of choice for diagnosis of bronchiectasis

HRCT is investigation of choice for diagnosis of bronchiectasis. High Resolution Computed tomography (HRCT) HRCT uses very thin 1-2 mm thin slices Q .
HRCT is used primarily to diagnose: Bronchiectasis Q Interstitial lung disease Q (Fibrosing alveolitis, asbestosis) Bronchiectasis Abnormal and permanent dilatation of bronchi Q .
The bronchial dilatation of bronchiectasis of is associated with destructive and inflammatory changes in the walls of medium sized airways,
often at the level of segmental or subsegmental bronchi.

Bronchoscopy with bronchoalveolar lavage


Question: Ibalizumab was approved by FDA in 2018 April for

Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to the CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell. Ref - Harrisons 203 pg 1457 , pubmed.com


Question: Petechiae in scurvy is due to

Vitamin C deficiency causes defective formation of collagen with impaired healing of wounds, capillary haemorrhage and reduced platelet adhesiveness (normal platelets are rich in ascorbate) . Petechiae are formed due to minor bleeds from capillary vessels due to endothelial disintegration . Ref - Davidson 23e p716


Question: Adenocarcinoma of esophagus is commonly found in

Answer is B (Barret's esophagus) Adenocarcinoma is seen in Barret's esophagus Barret's esophagus is a metaplastic change in the lining mucosa of oesophagus in response to chronic gastroesophagus reflex. In Barret's esophagus the junction between oesophageal mucosa (squammous) and gastric mucosa (columnar) moves proximally such that the lower pa of esophagus now becomes lined with different types of gastric mucosa. This pa of oesophagus has an increased risk for adenocarcinoma i.e. Adenocarcinoma is seen in Barrets esophagus.


Question: A patient has prottitetic valve replacement and he develops endocarditis 8 months later. Organism responsible Is

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:161 Infective Endocarditis (IE) It is the colonisation of the hea valves with microbiologic organisms, leading to the formation of friable, infected vegetations and frequently valve injury. Types 1. Acute infective endocarditis: Caused by highly virulent organisms mainly S. aureus (20-30%), seeding a previously normal valve. 2. Subacute infective endocarditis: Caused by organisms of moderate or low virulence mainly Streptococci (60-70%), seeding an abnormal or previously injured valve. 3. Endocarditis occurring in IV drug abusers: Caused predominantly by organisms found on the skin (S. aureus, Candida) and affecting the valves on the right side of the hea. 4. Prosthetic valve endocarditis: This may be early (symptoms appearing within 60 days of valve inseion), due to intraoperative infection of the valve or inseion of an infected valve or late (symptoms appearing after 60 days of valve inseion), due to late bacteraemia or earlier infection with microorganisms having a long incubation period. Prosthetic aoic valve is more prone for infective endocarditis than the mitral valve. Right sided IE has a more ourable prognosis than the left sided IE. However, when right sided IE vegetation size exceeds 2 cm, the moality increases.


Question: Dawson's fingers are seen in

Answer- A. Multiple sclerosisDawson's fingers on MRI scans are diagnostic of Multiple Scerlosis


Question: A year old degbest 'nate presents with fullness of Alt upper quad, a of abdomen. Her medical histoi ant tor type 2 diabetes mellitus f /1


Question: Hydrogen breath test is/ae used for

<p>Davidson&;s principles and practice of medicine 22nd edition. *The lactose hydrogen breath test is an useful non invasive confirmatory investigation. <p>


Question: Antibody found in patients of myaesthenia gravis is directed against

*myasthenia gravis is an autoimmune disease,most commonly caused by antibodies to acetylcholine receptors in the post junctional membrane of the neuromuscular junction ,which are found in around 80%of affected patients. Ref Harrison20th edition pg 2378


Question: Hyponatremia is seen in

Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. .Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L) Ref Davidson 23rd edition pg 370


Question: Daily temperature variation in remmitent fever is


Question: Type 5 Hypersensitivity mimics

Ans. is 'b' i.e., Type 2 Type V hypersensitivity reactions were additionally added to the scheme originally described by Coombs and Gell. Contrary to type IV and in agreement with types I, 11 and III respectively, they are mediated by antibodies too. The type V reactions are sometimes considered as a subtype of the type II hypersensitivity. As its mechanisms do not destroy target cells, they are responsible for induction of organ/tissue dysfunctions only most of authors prefer it to be and independent, the 5' type of hypersensitivity reactions


Question: Epidemiological studies of H. pylori are done by using

Answer is B (Serological markers) An enzyme linked immuno-sorhant assay (ELISA) is the most commonly used serological method. `Compared with endoscopic detection of H.Pyloric infection, ELISA has proved to be sensitive and specific and is paicularly suited for Epidemiological studies'. Diagnostic Tests for Helicobacter pylori Test Sensitivity Comments Serology 95 Does not differentiate between active and remote infection; epidemi()Imjc too i ; titer decreases slowly after eradication Urease assay Breath Biopsy 90-95 90-98 Simple ; may be used to monitor therapy Requires endoscopy Histology Requires endoscopy; may be essential if antibiotic resistance emerges Culture 70-95 Requires endoscopy; may be essential if antibiotic resistance emerges


Question: A patient presented with fever for 8 days and difficulty in breathing for two days, on examination there is red painless rash found on the left side of the chest. Treatment will be

(c) DoxycyclineRef: Harrison 18th ed.,pg. 14081,1413The presence of rash over the chest is typically an eschar, which is black necrotic, painless. Usually it is present in axilla, groin region.INFECTIOUS AGENTSRickettsial infections are caused by various bacterial species from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma. Rickettsia spp. are classically divided into the typhus group and spotted fever group (SFG). Orientia spp, make up the scrub typhus group. The rickettsial pathogens most likely to be encountered during travel outside the United States include R. africae (African tick- bite fever), R. conorii (Mediterranean spotted fever), R. rickettsii (known as both Rocky Mountain spotted fever and Brazilian spotted fever), O. tsutsugamushi (scrub typhus), and R. typhi (murine or fleaborne typhus).TRANSMISSIONMost rickettsial pathogens are transmitted by ectoparasites such as fleas, lice, mites, and ticks. Organisms can be transmitted by bites from these ectoparasites or by inoculating infectious fluids or feces from the ectoparasites into the skin. Inhaling or inoculating conjunctiva with infectious material may also cause infection for some of these organisms. Transmission of some rickettsial diseases after transfusion or organ transplantation is rare but has been reported.EPEDIMIOLOGYEhrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are not seen in Indian subcontinent.Rickettsial infections have been reported in India for several decades. During the World War II era, there were many deaths due to scrub typhus in this region. It was thought that these infections declined over time; however, several reports in the past decade indicate the presence of disease in various parts of India, such as the Himalayan region, the northeast, and the south.TREATMENTThe drug most commonly used is doxycycline or tetracycline, but Azithromycin or chloramphenicol is an alternative. As Rickettsial spp. Lack specific cell wall, so beta lactams and cephalosporins are not indicated in management of Rickettsial diseases.


Question: Use of spironolactone in liver cirrhosis is

Spironolactone(aldosterone antagonist) - potassium sparing diuretic is staed as a Single dose of 100-200mg/day,in cirrhotic patients who have peripheral edema . In moderate ascites, Spironolactone is given along with furosemide . Side effects -gynecomastia is an impoant side effect ,amiloride can be alternatively used in place of Spironolactone. Ref:Harrison 20 th edition pg no 2412


Question: Diagnostic test for group A streptococcal erythroderma is

GAS grow readily on routine media, but they can be isolated more easily using selective media that inhibit the growth of normal pharyngeal flora. Most laboratories inoculate throat swabs on 5% sheep blood agar containing trimethoprim-sulfamethoxazole. A bacitracin disk that contains 0.04U of bacitracin is also placed at the initial inoculation of the swab. After overnight incubation at a temperature of 35-37degC, beta-hemolytic colonies that grow despite inhibition of the antibiotic disk are presumed to be composed of GAS. Cultures that are negative for GAS after 24 hours are held for another overnight incubation and reexamined. Ref - Harrison's principles of internal medicine 20e , medscape.com


Question: Sarcodiosis can be associated with

Causes of Central Diabetes insipidus Ref - pubmed.com


Question: MELD score includes

Model For End-Stage Liver Disease (MELD) for Ages 12 and Older * The Model for End Stage Liver Disease (MELD) predicts survival for patients with advanced liver disease. * The United Network for Organ Sharing (UNOS) made a policy change regarding a revision in the MELD scoring system on January 11, 2016 that is related to transplant listing. * The new MELD scores are calculated first by determining the traditional MELD score as an initial score (MELD(i)); * If the initial MELD(i) scores is 12 or greater, the score is adjusted by incorporating the serum sodium value. * Score: 6 in healthy person to 40 in severe ESLD * Score <15 should not undergo liver transplantation 3- Month Moality based on MELD scores :-


Question: Distinguishing cervical transverse myelitis with spinal shock from Guillian Barre syndrome is that in the

(A) Sharp level of demarcation of sensory and motor symptoms existb> Well defined transverse level on trunk - below which there is sensory and motor loss is a feature of spinal cord lesion.> Transverse myelitis is sometimes manifested as rapid-onset, severe paraparesis or quadriparesis with areflexia, which may lead to diagnostic con-fusion with other causes of ascending weakness,such as the Guillain-Barre syndrome; otherwise, hyperreflexia and Babinski signs are present, con-firming a central rather than a peripheral cause of the muscle weakness. A well-defined truncal sensory level, below which the sensation of pain and temperature is altered or lost, distinguishes myelopathy from cerebral lesions and peripheral neuropathies.> Neuropathic pain may occur in the midline (an aching, deep pain) or in a dermatomal distribution (radicular or lancinating pain or a sensation of burning or itching), with the latter pattern providing a clue to the anatomical level of the lesion.

Sharp level of demarcation of sensory and motor symptoms exist.

Decreased stretch and superficial reflexes


Question: For the following cardiac abnormalities, select the characteristic JVP finding.Complete heart block

Large a waves occur with increased resistance to filling (tricuspid stenosis, pulmonary hypertension) or when the right atrium contracts against a tricuspid valve closed by right ventricular systole (Cannon a waves) in complete heart block or other arrhythmias.


Question: Pan acinar emphysema is seen in

Centriancinar - Smokers, chronic bronchitis.
Pan acinar - α1 - antitrypsin deficiency.


Question: Net protein utilization of egg is


Question: Dominant cell type in grey hepatization stage of community acquired pneumonia is

In the third phase grey hepatisation, no new erythrocytes are extravasating, and those already present have been lysed and degraded.
The neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared. This phase corresponds with successful containment of the infection and improvement in gas exchange.


Question: Causes of pulsus bisferiens

Pulsus bisferiens(2 systolic peaks) is seen in

Aortic regurgitation +/aortic stenosis
Hypertrophic cardiomyopathy


Question: Invariably involved site in ulcerative colitis;

Most common site involved in ulcerative colitis is the rectum. Rectum is usually spared in Crohn's disease.


Question: Paradoxical breathing is seen in

Two of the symptoms of flail chest are chest pain and shoness of breath. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a pa of the chest wall moves independently. This so-called "paradoxical breathing" is painful and increases the work involved in breathing Ref Davidson 23rd edition pg 579


Question: Carcinoid syndrome produces valvular disease primarily involving


Question: The pulmonary function test done on this patient of asthma would be

The patient is having atopic asthma.Pulmonary function tests in asthma show an obstructive pattern with reduced FEV1,FEV1/FVC ratio.Reversibility is demonstrated by a >12% and 200 ml increase in FEV1 15 minutes after an inhaled sho acting beta2 agonist or in some patients by a 2 to 4 week trial of oral coicosteroids. Ref:Harrison's medicine-18th edition,page no:2109.


Question: The following set of finding is seen in DIVC

In disseminated intravascular coagulation (DIC), coagulation is usually activated when blood is exposed to tissue factor. Severe, rapid-onset DIC causes severe thrombocytopenia, prolonged PT and PTT, a rapidly declining plasma fibrinogen level, and a high plasma d-dimer level Fibrinogen degradation product (FDP) testing is commonly used to aid in the diagnosis of disseminated intravascular coagulation (DIC). Increases in serum FDP levels can be caused by the following : DIC. Post fibrinolytic therapy. Ref Davidson 23rd edition pg 876

Increased fibrinogen, increased antithrombin III increased thrombin-antithrombin III comolexes

Increased FDP, decreased PT, increased antithrombin III

hicreased FDP, prolonged PT, increased thrombin- antithrombin complexes

Increased FDP, prolonged PT, reduced platlets


Question: A failure of synthesis of ceruloplasmin is seen in

Wilson's disease (hepatolenticular degeneration) is a rare but impoant autosomal recessive disorder of copper metabolism caused by a variety of mutations in the ATP7B gene on chromosome 13. Total body copper is increased, with excess copper deposited in, and causing damage to, several organs. Normally, dietary copper is absorbed from the stomach and proximal small intestine and is rapidly taken into the liver, where it is stored and incorporated into caeruloplasmin, which is secreted into the blood. The accumulation of excessive copper in the body is ultimately prevented by its excretion, the most impoant route being bile. In Wilson's disease, there is almost always a failure of synthesis of caeruloplasmin; however, some 5% of patients have a normal circulating caeruloplasmin concentration and this is not the primary pathogenic defect. The amount of copper in the body at bih is normal but thereafter it increases steadily; the organs most affected are the liver, basal ganglia of the brain, eyes, kidneys and skeleton . Ref - Davidsns internal medicine 23e p896


Question: Treatment of Torsades de pointes is intravenous


Question: Keshan disease is due to deficiency of

(A) Selenium # Keshan disease is an endemic cardiomyopathy found in children and young women residing in regions of China where dietary intake of selenium is low (<20 pg/dl).Concomitant deficiencies of iodine and selenium may worsen the clinicalnr attestations of cretinism.> Keshan disease: is a congestive cardiomyopathy caused by a combination of dietary deficiency of selenium and the presence of a mutated strain of Coxsackievirus, named after Keshan County of Heilongjiang province, Northeast China, where symptoms were first noted.> Often fatal, the disease afflicts children and women of child bearing age, characterized by Heart failure and Pulmonary edema.> Over decades, Supplementation with selenium reduced this affliction.> It has previously been linked to the coxsackie B virus.> Current research suggests that the lack of selenium results in a more virulent strain of the coxsackievirus becoming the dominant viral species present in the population of virus, but the mechanism of this selection event is presently unclear


Question: Commonest etiological factor in acute exacerbations of COPD is

Exacerbations are a prominent feature of the natural history of COPD. Exacerbations are episodes of increased dyspnea and cough and change in the amount and character of sputum.Studies suggest that acquiring a new strain of bacteria is associated with increased near-term risk of exacerbation and that bacterial infection/superinfection is involved in over 50% of exacerbations. Viral respiratory infections are present in approximately one-third of COPD exacerbations.In a significant minority of instances (20-35%), no specific precipitant can be identifiedRef: Harrison 19e pg: 1707


Question: Kyasanur Forest Disease (KFD) is transmitted by

KFD is a tick-borne viral hemorrhagic fever endemic to South AsiaThe disease is caused by a virus belonging to family Flaviviridae, which also includes yellow fever and dengue feverThe vector for KFD is Haemophysalis spinigera, a forest tickHumans contract infection from the bite of nymphs of the tickReservoir hosts are porcupines, rats, squirrels, mice and shrewsRef: Harrison's 18/e p1236, table 189-4


Question: A 36 year old male with Cavitatory Lung lesions, Sinusitis, Ulcers in the mouth. RBC casts in the urine can be seen. Diagnosis is

Wegener's also called Granulomatosis with polyangitis.


Question: Following is a clinical feature of cerebellar disease

. *Dysmetria and ataxia are the two impoant symptoms of cerebellar disease. Cerebellar ataxia can occur as a result of many diseases and may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements.Lesions to the cerebellum can cause dyssynergia, dysmetria, dysdiadochokinesia, dysahria and ataxia of stance and gait. Deficits are observed with movements on the same side of the body as the lesion (ipsilateral). Clinicians often use visual observation of people performing motor tasks in order to look for signs of ataxia Ref Harrison20th edition pg 2756


Question: A sho statured boy with rhizomelic limbs and brachydactyly is a feature of

Features of Achondroplasia Ref image - Researchgate.net


Question: Treatment of choice for Kawasaki Disease

Answer is A (Immunoglobulins) : The treatment of choice for Kawasaki disease is intravenous immunoglobulins


Question: The most common presentation of endemic goiter is

Answer is B (Diffuse Goiter) : 'Euthyroid state is generally the rule' - Robbins Endemic goiter :occurs in geographical areas where the soil, water and food supply contains only low levels of iodine. The lack of the iodine leads to decreased synthesis of thyroid hormones and a compensatory increase in TSH, which in turn leads to follicular cell hyperophy and hyperplasia and goitrous enlargement - Diffuse hyperplastic goitre. 'Euthyroid state is generally the rule' 'Rare patients are hypehyroid'


Question: A dissociated sensory loss is seen in

Impairment of pinprick and temperature appreciation but relative preservation of light touch, position sense and vibration senseA dissociated sensory loss can reflect spinothalamic tract involvement in the spinal cord, especially if the deficit is unilateral and has an upper level on the torsoBilateral spinothalamic tract involvement occurs with lesions affecting the center of the spinal cord, such as in syringomyeliaRef: Davidson's 21/e p1157


Question: Senile plaques in brain is a feature of


Question: Pontine harmorrhage is characterized by

(A) Pin point pupil reacting to light # Pontine hemorrhage (sudden onset, pinpoint pupils, loss of reflex eye movements and corneal responses, ocular bobbing, posturing, hyperventilation, and excessive sweating);


Question: Most common cause of idiopathic interstitial pneumonia is

Idiopathic pulmonary fibrosis is the most common form of idiopathic interstitial pneumonia.It is characterised by exeional dyspnea,non productive cough,inspiratory crackles with or without digital clubbing.HRCT show patchy,predominantly basilar,subpleural reticular opacities,traction bronchiectasis and honeycombing.Pulmonary function tests often reveal a restrictive pattern. Reference:Harrison' s medicine-18th edition,page no:2165.


Question: A patient with congestive heart failure was started on digoxin and diuretics. He later presents with bradycardia and GIT upset and visual disturbances. His K+ was found to be 2.5 The reason for these feature is

(B) Digoxin toxicity > Digitalis is effective in patients with systolic HF complicated by atrial flutter and fibrillation and a rapid ventricular rate, who benefit both from slowing of the ventricular rate and from the positive inotropic effect.> Although digitalis does not improve survival in patients with systolic HF and sinus rhythm, it reduces symptoms of HF and the need for hospitalization.> Digitalis is of little or no value in patients with HF, sinus rhythm, and the following conditions: hypertrophic cardiomyopathy, myocarditis, mitral stenosis, chronic constrictive pericarditis, and any form of diastolic HF.> Digoxin, which has a half-life of 1.6 days, is filtered n the glomeruli and secreted by the renal tubules. Significant reductions of the glomerular filtration rate reduce the elimination of digoxin and, therefore, may prolong digoxin's effect, allowing it to accumulate to toxic levels, unless the dose is reduced.> DIGITALIS INTOXICATION: This is a serious and potentially fatal complication. Advanced age, hypokalemia, hypomagnesemia, hypoxemia, renal insufficiency, hypercalcemia, and acute myocardial infarction all may reduce tolerance to digitalis. Chronic digitalis intoxication may be insidious in onset and is characterized by anorexia, nausea, and vomiting, exacerbations of HF, weight loss, cachexia, neuralgias, gynecomastia, yellow vision, and delirium. The most frequent disturbances of cardiac rhythm are ventricular premature beats, bigeminy, ventricular tachycardia, and, rarely, ventricular fibrillation. Atrioventricular block and nonparoxysmal atrial tachycardia with variable atrioventricular block are characteristic of digitalis intoxication; withdrawal of the drug and treatment with li-adrenocepior blocker or lidocaine are indicated. If hypokalemia is present, potassium should be administered cautiously by the oral route. Fab fragments of purified, intact digitalis antibodies are a potentially lifesaving approach to the treatment of severe intoxication.> The administration of quinidine, verapamil, amiodarone, and propafenone to patients receiving digoxin raises the serum concentration of the latter, increasing the propensity to digitalis intoxication.> The dose of digitalis should be reduced by half in patients receiving these drugs.


Question: Mycobacterium causing lung infection are   a) Mycobacterium Tuberculosis   b) Mycobacterium Kansasii  c) Mycobacterium Fortuitum  d) Mycobacterium avium intracellularae  e) Mycobacterium Scrofuloceuml


Question: Cause of nephrocalcinosis in granulomatous disorders

Hypercalcemia occurs in most granulomatous disorders. High serum calcium levels are seen in about 10% of patients with sarcoidosis; hypercalciuria is about three times more frequent. Tuberculosis, fungal granulomas, berylliosis, and lymphomas are other conditions that are associated with disorders of calcium metabolism. These abnormalities of calcium metabolism are due to dysregulated production of 1,25-(OH2)D3 (calcitriol) by activated macrophages trapped in pulmonary alveoli and granulomatous inflammation. Undetected hypercalcemia and hypercalciuria can cause nephrocalcinosis, renal stones, and renal failure. Coicosteroids cause prompt reversal of the metabolic defect. Chloroquine, hydroxychloroquine, and ketoconazole are the drugs that should be used if the patient fails to respond or develops dangerous side effects to coicosteroid therapy. Ref - pubmed.com


Question: Egg is a poor source of

Egg is a poor source of Vitamin C and carbohydrates.


Question: The typical CSF profile in cases of viral meningitis after 48 hours of onset is

harrison's principles and practices of medicine 17th edition. * typical profile in viral meningitis is lymphocytic pleocytosis (25-500cells/microL),normal or slightly elevated protein concentration, normal glucose concentration,normal or mildly elevated opening pressure .

Lymphocytic pleocytosis, normal glucose level, normal or slightly elevated protein level

Neutrophilic pleocytosis, raised glucose level normal protein level

Lymphocytic pleocytosis, low glucose level, low protein level

Neutrophilic pleocytosis, normal glucose level, elevated protein level -


Question: A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is

Answer is B (Urinary protein > 550 mg/day for 3 consecutive sample): The most reliable indicator for diabetic nephropathy is presence of ove proteinuria. Urinary protein > 550 mg/day in 3 consecutive samples confirms the diagnosis of ove proteinuria, reflects irreversible pathological changes in kidneys and confirms progression to end stage renal disease (diabetic nephropathy) This is evident from the following lines from Harrisons text: Once ove proteinuria is present there is steady state decline in G.F.R. and -50% of individuals reach end stage renal disease in 7-10 days. Once nephropathy becomes ove the pathological changes are irreversible. Stages of diabetic nephropathv: (IDDM) Year Stage Findings 0 I Raised GFR, increase in Renal size and plasma flow 2 II Thickening in glomerular capillary basement membrane 6-10 III Microalbuminuria 10-15 IV Ove proteinuria, Clinical nephropathy, changes become irreversible. 16-25 V End stage renal disease.

Urinary protein >550 mg per day for 3 consecutive samples


Question: Most common vessels involved in cutaneous vasculitis

Cutaneous Vasculitis also called hypersensitivity vasculitis involves Post-Capillary Venules.


Question: Saddle back fever can be seen in

(B) Dengue fever # Saddle back or Biphasic fevers are those that are constant for several days, spontaneously reduce for 1 to 2 days, & then increase again. Saddle back fevers can be seen in such infections as Dengue, Yellow fever & Influenza. Dengue virus infection typically presents with two febrile periods separated by an afebrile interval of one to three days (saddle back fever).> Malaria fever: Fevers that occur at regular intervals of 42-78 hours are virtually pathognomonic otP.vivax, P.ovale, P.malariae infections.> Although untreated Typhoid fever classically presents with a continued fever associated with relative bradycardia, almost any fever pattern can develop.> Pel-Ebstein fever is one that occurs daily for a period of about one week, resolves for about an equal time, and then recurs, Pel-Ebstein fevers are often seen in Lymphomas. Intermittent fever is one with wide fluctuations, usually normal in the morning and peaking in the afternoon or evening. This fever pattern can be seen in many viral diseases as well as Endocarditis or Localized Pyogenic infections such as an Abscess. Diurnal pattern also known as Typhus inversus, is the reverse of normal circadian pattern in which the highest temperature is in the morning. It can be found in Milliary TB, Hepatic Abscesses & Endocarditis. Jarisch-Herxheimer reaction is a fever (and sometimes more systemic symptoms such as hypotension) that occurs several hours after treatment with antibiotics. It is a classic reaction for Syphilis, but can also be seen in Leptospirosis, Relapsing fever & Brucellosis.>Dengue fever: Break-bone fever; a virus (togavirus, flavivirus) disease conveyed by mosquito Aedes aegypti, & characterized by a 5 to 7 day pyrexia with a saddle-back course, a measly rash & severe pains in back & limbs. Exposure 7-10 days before onset. Sudden onset of high fever, chills, severe aching, headache, sore throat, prostration, & depression.> Biphasic fever curve: Initial phase 3-7 days; remission, few hours to 2 days; second phase, 1-2 days.> The rash is biphasic: First evanescent, followed by maculopapular, scarlatiniform, morbilliform, or petechial changes from extremities to torso. Leukopenia and thrombocytopenia in hemorrhagic form.


Question: Anticipation phenomenon is seen in

Anticipation -  Phenomenon wherein clinical features worsen with each successive generation.


Question: Shock lung synonym is used for

Ans. C. ARDSShock Lung/ARDS is a clinical syndrome caused by diffuse alveolar capillary and epithelial damage. There is usually rapid onset of life-threatening respiratory insufficiency, cyanosis, and severe arterial hypoxemia that is refractory to oxygen therapy and that may progress to multisystem organ failure. The histologic manifestation of ARDS in the lungs is known as diffuse alveolar damage.


Question: Shy Dragor Syndrome is

Shy Drager syndrome (SDS) is a rare condition that causes progressive damage to the autonomic nervous system.
A neurological syndrome associated with orthostatic hypotension.
The autonomic nervous system controls vital involuntary body function such as heart rate, breathing, and intestinal, urinary, and sexual functions. The autonomic nervous system also controls skin body temperature, and how the body responds to stress. Shy-Drager syndrome leads to dizziness or fainting when standing up, urinary incontinence, impotence, and muscle twitches.


Question: Upturned Moustache sign or Antler sign is seen in

Mitral stenosis leads to increased left atrial and hence pulmonary venous pressures. The prominence of pulmonary veins on chest X-rays leads to Upturned Moustache sign or Antler sign.


Question: Milk maid grip is seen in


Question: Chronic diarrhea results in the following acid base imbalance

(A) Normal anion gap metabolic acidosis # Causes of Non-Anion-Gap Acidosis# Gastrointestinal bicarbonate loss> Diarrhea> External pancreatic or small-bowel drainage> Ureterosigmoidostomy, jejunal loop, ileal loop> Drugs1 Calcium chloride (acidifying agent)2. Magnesium sulfate (diarrhea)3. Cholestyramine (bile acid diarrhea)> Hypokalemia1. Proximal RTA (type 2)2. Distal (classic) RTA (type 1)> Hyperkalemia# Generalized distal nephron dysfunction (type 4 RTA)> Mineralocorticoid deficiency> Mineralocorticoid resistance> Na+ delivery to distal nephron> Tubulointerstitial disease> Ammonium excretion defect# Drug-induced hyperkalemia (with renal insufficiency)> Potassium-sparing diuretics (amiloride, triamterene, spironolactone)> Trimethoprim> Pentamidine> Angiotensin-converting enzyme inhibitors and AT-II receptor blockers> Nonsteroidal anti- inflammatory drugs> Cyclosporine# Other> Acid loads (ammonium chloride, hyperalimentation)> Loss of potential bicarbonate: ketosis with ketone excretion> Expansion acidosis (rapid saline administration)> Cation exchange resins


Question: The microvascular complication of diabetes is


Question: Bronchial asthma is associated with raised levels of

Acute asthma attacks are often triggered by allergens or exercise. Inflammatory molecules called leukotrienes are one of several substances which are released by mast cells during an asthma attack, and it is leukotrienes which are primarily responsible for the bronchoconstriction Ref Davidson edition23rd pg 575


Question: Caplan Syndrome is Pneumoconiosis with

Answer is C (Rheumatoid Ahritis): Caplan's syndrome refers to the association of Pneumoconiosis and Rheumatoid Ahritis. Caplan's Syndrome is a rare subset of pulmonary nodulosis characterized by the development of nodules and pneumoconiosis following silica exposure in patients with Rheumatoid Ahritis. Caplan's Syndrome first described in coal miners but subsequently found in patients with silicosis includes seropositive Rheumatoid ahritis with charachteristic pneumoconiotic nodules. Silica has immunoadjuvant propeies and is often present in anthractic coal dust.


Question: Rheumatoid Ahritis is best diagnosed by

Answer is A (Anti-CCP Antibodies): 'Anti CCP antibodies are the most specific blood test for rheumatoid ahritis (specificity -95%)' - CMDT 09/727 Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is paicularly useful in the diagnosis of rheumatoid ahritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid ahritis.


Question: Platelets in stored blood do not live after

Ans. is 'c' i.e., 72 hours Platelets are provided as a pooled preparation from one or several donors, usually as a 6-unit bag, which is the usual amount given to an average-sized adult. Each unit contains approximately 8 x 101deg platelets and should increase the platelet count by about 7000-10,000/ pL in a 75kg adult. Platelets stored at room temperature can be used for up to 5 days and have a life span of 8 days. Those stored at 4degC are useful for only 24 hours (only 50-70% of total platelet activity is present at 6 hours) and have a life span of only 2-3 days. ABO compatibility should be observed for platelets, but is not essential. For each donor used, there is a similar risk of transmitting hepatitis and HIV as for one unit of blood. Platelet should be administered through a 170pm filter.


Question: The most likely cause of fluctuating jaundice in a middle aged or elderly man is


Question: For Contralateral weakness and sensory loss, worse in face and arm; homonymous hemianopsia; aphasia or neglect syndrome select the site of the lesion of cerebrovascular disease,

Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).

Penetrating branch, middle cerebral aery