Question: Most common nephrotic syndrome in children


Question: The most likely cause of bihilar lymphadenopathy

Sarcoidosis is a multi system granulomatous disorder of unknown etiology characterised by the presence of non-caseating granulomas.The definitive feature of Sarcoidosis in a chest X ray is bilateral hilar lymphadenopathy.Lofgren's syndrome is an acute illness characterised by erythema nodosum,peripheral ahropathy,uveitis,bilateral hilar lymphadenopathy,lethargy and occasionally fever. Reference:Davidson' s Medicine-22 nd edition,page no:710 & Harrison


Question: In a patient if administration of exogeneus vasopressin does not increase the osmolality of urine the likely cause is

Answer is C (Renal Hyposensitivity to ADH): Failure of urine osmolality to rise even after administration of exogenous ADH/vasopressin suggests a diagnosis of Nephrogenic Diabetes Insipidus due resistance to action of vasopressin on the Renal tubule (Renal Hyposensitivity to ADH).


Question: For the following side effects, select the most likely medication to cause them.Disinterest in food with protein/calorie malnutrition.

Tricyclic antidepressants and SSRIs are both effective treatments for depression, but their side-effect profiles are different. Tricyclics can promote weight gain while weight loss is more common with SSRIs.

selective serotonin reuptake inhibitors (SSRIs)


Question: Hemiparesis is NOT a feature of

Altered mental status is a common presenting complaint in the emergency depament (ED). Cerebrovascular accidents (CVAs) are one of the most serious etiologies for altered mental status. Ischemic stroke accounts for 87% of CVAs.1 Of these, approximately 20% are the result of veebrobasilar aery occlusion (VBAO). The moality of VBAO can reach 80-95% without successful treatment. Making the diagnosis can be difficult as patients present with a variety of nonspecific signs and symptoms. Fuhermore, the posterior circulation is difficult to visualize, often requiring the use of computed tomography angiography (CTA), magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). We present here a review of the literature and a case of a young patient with VBAO. There are a number of conditions that can cause hemiparesis or hemiplegia. Examples of hemiparesis and hemiplegia causes include strokes, brain injuries, spinal cord injuries, infections, and a handful of other conditions affecting the central nervous system Hemiparesis is not a feature of VAO Ref Harrison20th edition pg 2345


Question: Lung compliance is increased in

Compliance is a measure of distensibility 1 static compliance(compliance when lungs at rest) Causes of decreased static compliance : a) interstitial fibrosis b)atelectasis c)pneumonia d) pulmonary edema e) ARDS 2 dynamic compliance:compliance with airway resistance Decreased in Broncho spasm like asthma.


Question: Frey's syndrome is associated with

Vishram singh textbook of clinical neuroanatomy 2nd edition. * This syndrome occurs following auriculotemporal nerve injury. As a result there is aberrant innervation of sweat glands by parasympathetic secretomotor fibres.

Sympathetic fibres of auriculo temporal nerve

Parasympahetic fibres of trigeminal nerve

Parasympathetic fibres of auriculo temporal nerve


Question: Most common cause of death in Menke disease

Menkes disease, also known as kinky hair disease, is an X-linked neurodegenerative disease of impaired copper transpo The major problems in Menkes disease involve the neurologic, gastrointestinal, and connective tissue (including blood vessels) systems. Pneumonia, leading to respiratory failure, is a common cause of death and also diaphragmatic paralysis Ref Robbins 9/e pg 170


Question: Most common cause of hereditary elliptocytosis is mutation in


Question: A elderly patient presents with hypeension and diabetes , proteinuria without renal failure. Antithypeensive of choice is

Ref Harrison 19 th ed pg 1625 In patients with type 2 diabetes, treatment with an ACEI, an ARB, or aliskiren decreases proteinuria and delays the progres- sion of renal disease. In experimental models of hypeension and diabetes, renal protection with aliskiren is comparable to that with ACEIs and ARBs. However, in patients with type 2 diabetes, addition of aliskiren to an ACEI provides no additional protection against cardiovascular or renal disease and may be associated with more adverse outcomes. Among African Americans with hypeension- related renal disease, ACEIs appear to be more effective than beta blockers or dihydropyridine calcium channel blockers in slowing, although not preventing, the decline of glomerular filtration rate. The renoprotective effect of these renin-angiotensin blockers, com- pared with other antihypeensive drugs, is less obvious at lower blood pressures.


Question: "Erosion of joint" is not a feature of .


Question: Whipple's triad is seen in

(Insulinoma) (2180, 2221-H 16th) (1090-CMDT-2009) (2305-6-H17th)WHIPPLE'S TRIAD - is characteristic of hypoglycemiaI. History of hypoglycemic symptomsII. An associated fasting blood-glucose of 40 mg/dl or lessIII. Immediate recovery upon administration of glucose** The hypoglycemia symptoms in Insulinoma often develop in the early morning or after missing a meal* Most common sites of occurrence the incidence of metastases (PETs) varies greatly: Jejuno-ileum (58%) > lung/bronchus (6%) > rectum (4%)* Three phacomatoses associated with NETs are- Von Recklinghausen's disease (Neurofibromatosis type I)- Von Hippel-Lindau disease- Tuberous sclerosis (Boumeville's disease)* In additions to cerebellar hemangioblastomas, renal cell cancer and phaeochromocytomas, 10-17% of these patients develop a PET.** Hypoglycemia unawareness is very common in patients with Insulinoma. They adapt to chronic hypoglycemia by increasing their efficiency in transporting glucose across the BBB.


Question: The drug of choice for absence seizures

K.D Tripathy essentials of medical pharmacology 7th edition . Valproic acid is the drug of choice for absence seizure.


Question: Most commonly affected valve in SABE


Question: Anominal aphasia is due to defect in

Wernicke's speech area, is one of the two pas of the cerebral coex that are linked to speech (the other is Broca's area). It is involved in the comprehension of written and spoken language (in contrast to Broca's area that is involved in the production of language). It is traditionally thought to be in Brodmann area, which is located in the superior temporal lobe in the dominant cerebral hemisphere (which is the left hemisphere in about 95% of right handed individuals and 60% of left handed individuals). Damage caused to Wernicke's area results in receptive, fluent aphasia. This means that the person with aphasia will be able to fluently connect words, but the phrases will lack meaning. This is unlike non-fluent aphasia, in which the person will use meaningful words, but in a non-fluent, telegraphic manner. Ref Harrison20th edition pg 2756


Question: Streptokinase and urokinase are contraindicated in

Intracranial tumours (ICT) are considered an absolute contraindication for thrombolysis because of their association with spontaneous ICH, although no such cases have been repoed in connection with lytic treatment Absolute contraindications for fibrinolytic use in STEMI include the following: Prior intracranial hemorrhage (ICH) Known structural cerebral vascular lesion. Known malignant intracranial neoplasm. Ischemic stroke within 3 months. Suspected aoic dissection. Active bleeding or bleeding diathesis (excluding menses) Ref Harrison20th edition pg 2234


Question: The commonest intracavitary benign cardiac tumour is

Myxoma, a benign tumor, is the most common type of primary cardiac tumor. Cardiac tumors may occur in any cardiac tissue. They can cause valvular or inflow-outflow tract obstruction, thromboembolism, arrhythmias, or pericardial disorders. Diagnosis is by echocardiography and frequently cardiac MRI. Ref Davidson 23rd edition pg 455


Question: Koplik spots are seen in

Ans. a (Measles). (Ref. Harrison, Medicine, 18th/Table 17-1; Figure e7-2)Koplik's spots, which manifest as white or bluish lesions with an erythematous halo on buccal mucosa, usually occur in the first 2 days of measles and may briefly overlap the measles exanthem. Presence of the erythematous halo differentiates Koplik's spots from Fordyce's spots (ectopic sebaceous glands), which occur in the mouths of healthy individuals.MEASLES (rubeola)# It is caused by a paramyxovirus, which is spread by respiratory droplets produced by sneezing or coughing.# Most infectious of all microbial agents.# Maternal antibodies protect for 6 months.# The measles incubation period is 8-15 days.# Classically, measles is preceded by the three C's:- Hacking cough,- Coryza (nasal rhinorrhea and congestion), and- Conjunctivitis, plus photophobia, malaise, and a high fever persisting for several days.# Part of the enanthem is called Koplik's spots which appear on or after the second day of fever.- Prodromal illness, 1-3 days heralds catarrhal stage.- Catarrhal stage is characterized by respiratory symptoms and Koplik spots.# Koplik spots (pathognomonic of measles) are seen on buccal mucosa opposite to 2nd upper molar tooth.# Koplik's spots develop on the buccal mucosa 2 days before the rash appears. The characteristic rash of measles begins 2 weeks after infection, when the clinical manifestations are most severe, and signal the host's immune response to the replicating virus.# The exanthem classically appears on the fourth day of fever. Rash is "morbilliform" (means measles-like).# RASH appears as natural antibody develops, lasts 5-6 days and then gradually fades with pigmentation.# Generalized lymphadenopathy, diarrhea, convulsions and bacterial/Hoest pneumonia can occur.# SSPE is a rare and late complication, after 6-7 years.# Edmonsten Zagreb strain is used in vaccine preparation. The current monovalent attenuated live virus vaccine (Attenuvax) contains the Moraten ("more attenuated") strain of measles virus, which effectively confers immunity while reducing the incidence of adverse events following vaccination.Diseases Associated with Fever and RashDiseaseEtiologyDescriptionClinical SyndromeRubeola (measles, first disease)Paramyx ovirusDiscrete lesions that become confluent as rash spreads from hairline downward, sparing palms and soles; lasts 3 days; Koplik's spotsCough, conjunctivitis, coryza, severe prostrationRubella (German measles, third disease)TogavirusSpreads from hairline downward, clearing as it spreads; Forscheimer spotsAdenopathy, arthritisErythema infectiosum (fifth disease)Human parvovirus B19Most common among children 3-12 y old;Bright-red "slapped-cheeks" appearance followed by lacy reticular rash that waxes and wanes over 3 weeks; rarely, papular-purpuric "gloves-and-socks" synd on hands and feet.Mild fever; arthritis in adults; rash following resolution of feverDiseaseEtiologyDescriptionClinical SyndromeExanthem subitum (roseola, sixth disease)Human herpesvirus 6Usually affects children <3 years old; Diffuse maculopapular eruption over trunk and neck; resolves within 2 daysRash following resolution of fever; similar to Boston exanthem (echovirus 16); febrile seizures


Question: Bilateral inter nuclear ophthalmoplegia is pathognomonic of

*Patient with bilateral injury to medial longitudinal fasciculus will have bilateral internuclear ophthalmoplegia . *Multiple sclerosis is the most common cause . Reference Harrison20th edition pg 2456


Question: Normal body mass index is between


Question: Ticagrelor is

Ticagrelor is a novel, potent, reversible platelet P2Y12 inhibitor. It is shown to reduce the risk of cardiovascular death, MI, or stroke compared with clopidogrel in ACS patients.This agent reduced moality but increased the risk of bleeding.Other platelets P2Y12 receptor blocker are clopidogrel, prasugrel.Ref: Harrison 19e pg: 1596


Question: Lassa fever virus belongs to family

Answer- A. ArenaviridaeThere are two main phylogenetic branches of Arenaviridae: the Old World viruses, such as lassa fever and lymphocytic choriomeningitis (LCM) viruses.


Question: Most common oral infection in diabetes mellitus

Ans. is 'a' i.e., Candida Individuals with DM have a greater frequency and severity of infection. The reasons for this include incompletely defined abnormalities in cell-mediated immunity and phagocyte function associated with hyperglycemia, as well as diminished vascularization. Hyperglycemia aids the colonization and growth of a variety of organisms (candida and other fungal species).


Question: A patient presented with thunder clap headache followed by unconsciousness with pregressive III ranial nerve palsy. Likely diagnosis is

davidson's principles and practices of medicine 22nd edition. *85%of SAH caused by saccular aneurysm arise from bifurcation of cerebral aeries. *SAH present with sudden,severe,thunderclap headache (often occipital),which lasts for hours or even days ,often accompanied by vomiting,raised blood pressure and neck stiffness or pain *there may be loss of consciousness at the onset ,so SAH should be consider if patient found comatose *a third nerve palsy may be present due to local pressure from an aneurysm of posterior communicating aery. *focal hemispherical signs like hemiparesis or aphasia ,may be present at onset if there is associated intracerebral haematoma . Ref Harrison20th edition pg 2765


Question: Classical markers for Hodgkin&;s disease is

Reed Sternberg cells in all types of Hodgkin&;s diseases, except in lymphocytic prdominance type,express immunoreactivity for CD 15 & CD 30. RS cells in lymphocytic predominance type are negative for both CD 15 & CD 30, but positive for CD 20.

Reference : Harsh mohan textbook of pathology 6th edition pg no370


Question: Fomepizole is used for

Fomepizole is used as antidote in ethylene glycol poisoning Reference Harrison 20 edition pg 768


Question: Cause of ITP is


Question: Hippocampus lesion

Working memory areas are connected to the hippocampus and the adjacent parahippocampal portions of the medial temporal cortex.
In humans, bilateral destruction of the ventral hippocampus, or Alzheimer’s disease and similar disease processes that destroy its CA1 neurons,
cause striking defects in short-term memory. So do bilateral lesions of the same area in monkeys.
Humans with such destruction have intact working memory and remote memory.
Their implicit memory processes are generally intact.
They perform adequately in terms of conscious memory as long as they concentrate on what they are doing. However,
if they are distracted for even a very short period, all memory of what they were doing and what they proposed to do is lost.
They are thus capable of new learning and retain old prelesion memories, but they cannot form new long-term memories.

Affects memory transformation from short term to long term


Question: Peptide YY is secreted by

Peptide YY - ileum
Motilin - Duodenum and jejunum.


Question: Otomycosis is caused by


Question: Deletion of one alpha globin gene on one chromosome is best defined as

Ans. is 'd' i.e., Alpha thalassemia silent carrier


Question: Cause of polyuria

Causes of polyuria- Diabetic insipidus Primary Polydipsia(psychogenic,hypothalamic disease ,drugs-thioridazine ,chlorpromazine, anti cholinergic drugs ) Solute diuresis Glucose ,mannitol, radiocontrast Urea(from high protein intake) Diuretics Medullary cystic diseases Resolving ATN or obstruction . -poorly controlled diabetes mellitus with glycosuria is the most common cause of solute diuresis. Ref:Harrison 20 th edition pg no 294


Question: Epsilon waves are most specific for

Epsilon waves are most specific for arrythmogenic Rv Cardiomyopathy.


Question: For the following cardiac abnormalities, select the characteristic JVP finding.Right ventricular infarction.

Right ventricular infarction and constrictive pericarditis frequently result in an increase in JVP during inspiration (Kussmaul sign). Severe right-sided failure can also be a cause.


Question: Sustained diarrhoea can lead to


Question: Progressive multifocal leukoencephalopathy is due to

(A) JC virus # Progressive multifocal leukoencephlopathy is due to JC virus.> JC virus, a polyomavirus, was first isolated from the diseased brain of a patient with Hodgkin's lymphoma who was dying of progressive multifocal leukoencephalopathy (PML).> This demyelinating disease occurs usually in immunosuppressed persons and is the result of oligodendrocyte infection by JC virus.> JC virus has also been isolated from the urine of patients suffering from demyelinating disease.> Cryotherapy & laser treatment are the most popular therapies for warts, although surgery may be indicated in some cases.> At the present time, there is no effective antiviral therapy for treatment of infection with polyomavirus or HPV West Nile virus is an arbovirus.> It is transmitted by mosquitoes and birds, especially crows; these animals are a reservoir.> WNV causes a rather mild encephalitis in humans, the exception being older patients or those who may be immunocompromised.


Question: A patient presents with 12 hours following a myocardial infraction . Test of choice

Ref Harrison 19 th ed pg 1594 In addition to the clinical examination, three major noninvasive tools are used in the evaluation of NSTEMI-ACS: the electrocardiogram (ECG), cardiac biomarkers, and stress testing. CCTA is an additional emerging option (Fig. 294-2). The goals are to: (1) recognize or exclude myocardial infarction (MI) using cardiac biomarkers, preferably cTn;


Question: Somatostatin is produced by

Alpha cellsGlucagonBeta cellsInsulin, amylinDelta cellsSomatostatinPP cellsPancreatic polypeptideRef: Harrison 19e pg: 2403


Question: Energy yield of fats is

Carbohydrates and proteins - 4 kcal per gram.
Fats - 9 kcal per gram.


Question: Red bone marrow is involved in erythropoiesis from

Erythropoiesis:
Intra uterine Life:

3 wk to 3 month —> Yolk sac
3 month to 5 month —> Liver + spleen
> 5 Month —> Red bone marrow

Birth to 20 yrs —> Flat + long bones

> 20 yrs — Flat bone


Question: Laron syndrome is due to

Laron syndrome is due to growth hormone receptor insensitivity.
Growth hormone levels are normal.


Question: Treatment of choice in complicated Plasmodium falciparum is

(Artesunate) (1288-90-H17th)* Artesunate is the treatment of choice for severe falciparum malaria (1323-24-CMDT-09)Treatment of MalariaClinical settingDrug TherapyAlternative drugs* Chloroquine sensitiveP- falciparum andP. malaria infectionsChloroquine * Plasmodium vivax and P. ovale infectionsChloroquine then (If G6PD normal) primaquine-* Uncomplicated infections with chloroquine resistantP. falciparumQuinine sulfate plus Doxycycycline or Clinidamycin for 7 days orFansidar - three tablets onceMalarone or Mefloquine orAtcsunate or artermether orCortem* Severe or complicated infections with P. falciparumArtesunateQuinidine gluconate orArtemether* IV Artesunate, a water soluble artemisinin derivative has been shown to reduce mortality rates in severe falciparum malaria by 35% from rates obtained with quinine. Artesunate has therefore become the drug of choice


Question: For the following medical conditions, select the associated acid base disturbances.Hepatic cirrhosis complicated by ARF

Hepatic cirrhosis frequently results in chronic respiratory alkalosis. ARF with metabolic acidosis is common in patients with cirrhosis.

metabolic acidosis and respiratory acidosis

metabolic acidosis and respiratory alkalosis

metabolic alkalosis and respiratory acidosis

metabolic alkalosis and respiratory alkalosis


Question: Cranoitabes (softening of the skull bones) is NOT seen in

(A) Osteogenesis imperfecta # Osteogenesis imperfecta causes a generalized decrease in bone mass (osteopenia) and makes the bones brittle. The disorder is frequently associated with blue sclerae, dental abnormalities (dentinogenesis imperfecta), progressive hearing loss, and a positive family history. The most severe forms cause death in utero, at birth, or shortly thereafter. The course of mild and moderate forms is more variable.# Craniotabesis an abnormal softening or thinning of the skull, although normally present in newborns. Seen mostly in occipital bone and posterior part of parietal bone. Bone is soft and has a ping pong ball like feeling on pressing. The term is derived from the Latin words cranium for skull and tabes for wasting. Any condition that affects bone growth, such as rickets (vitamin D deficiency), marasmus, syphilis, or thalassemia present during a time of rapid skull growth can cause craniotabes. It can be a "normal" feature in premature infants.


Question: Varenicline is used in

Varenicline is a prescription medication used to treat smoking addiction. This medication is the first approved nicotinic receptor paial agonist. Specifically, varenicline is a paial agonist of the alpha4/beta2 subtype of the nicotinic acetylcholine receptor Ref Davidson 23rd edition pg 578


Question: Diuretic used in essential hypertension is


Question: Exudative pleural effusion is seen in


Question: In Myocardial infarction, the most specific marker is

Troponin T is the most specific marker of Myocardial infarction.


Question: National Tuberculosis institute is in

National Tuberculosis institute - Bangalore.
National institute for research in Tuberculosis - Chennai.


Question: Degenerative changes in Huntington's chorea are seen in

Huntington's disease (HD), also known as Huntington's chorea, is an inherited disorder that results in the death of brain cells.The earliest symptoms are often subtle problems with mood or mental abilities.] A general lack of coordination and an unsteady gait often follow.As the disease advances, uncoordinated, jerky body movements become more apparent. People with HD often underestimate the degree of their problems Symptoms of HD most commonly become noticeable between the ages of 35 and 44 years, but they can begin at any age from infancy to old age.In the early stages, there are subtle changes in personality, cognition, and physical skills. are generally not severe enough to be recognized on their own at the earlier stages. Sleep disturbances are also associated symptoms. Especially affected are executive functions, which include planning, cognitive flexibility, abstract thinking, rule acquisition, initiation of appropriate actions, and inhibition of inappropriate actions.[As the disease progresses, memory deficits tend to appear. Repoed impairments range from sho-term memory deficits to long-term memory difficulties, including deficits in episodic (memory of one's life), procedural (memory of the body of how to perform an activity) and working memory.[Cognitive problems tend to worsen over time, ultimately leading to dementia.[This pattern of deficits has been called a subcoical dementia syndrome to distinguish it from the typical effects of coical dementias e.g. Alzheimer's disease.[ Repoed neuropsychiatric manifestations are anxiety, depression, a reduced display of emotions (blunted affect), egocentrism, aggression, and compulsive behavior, the latter of which can cause or worsen addictions, including alcoholism, gambling, and hypersexuality.[Difficulties in recognizing other people's negative expressions have also been observed.[ The prevalence of these symptoms is highly variable between studies, with estimated rates for lifetime prevalence of psychiatric disorders between 33% and 76%.[For many sufferers and their families, these symptoms are among the most distressing aspects of the disease, often affecting daily functioning and constituting reason for institutionalization.[Suicidal thoughts and suicide attempts are more common than in the general population.[Often individuals have reduced awareness of chorea, cognitive and emotional impairments.[ Mutant Huntingtin is expressed throughout the body and associated with abnormalities in peripheral tissues that are directly caused by such expression outside the brain. These abnormalities include muscle atrophy, cardiac failure, impaired glucose tolerance, weight loss, osteoporosis, and testicular atrophy. Ref Harrison20th edition pg 2677


Question: "Lesbianism" is also known as

(B) Tribadism # SEXUAL OFFENCES:# Natural offences: Rape Incest... sexual intercourse by man with a woman who is blood related. Adultery# Unnatural offences: Sodomy... Anal intercourse between two males or between a male and female Tribadism or Lesbianism: Female homosexuality Bestiality Buccal coitus ... Coitus per os or sin of Gomorrah# Sexual perversions: Sadism ... Sexual gratification obtained or increased from acts of physical cruelty or infliction of pain upon one's partner. Masochism ... (opposite of sadism) Sexual gratification obtained or increased by suffering of pain. Necrophilia ... sexual intercourse with dead bodies Fetichism ... using objects for sexual gratification Transvestism ... males obtain sexual pleasure by wearing female dress. Exhibitionism ...Willful and Intentional exposure of genitalia in a public place to obtain sexual pleasure Masturbation (Onanism) ... Deliberate self-stimulation which affects sexual arousal. Voyeurism or Scoptophilia (counter part of exhibitionism)... the voyeur (peeping Tom) must see people undress in order to be sexually satisfied. Frotteurism ... contact with another person to obtain sexual satisfaction (rubbing his private parts against a female's body in crowds.) Undinism ... sexual pleasure is often obtained by witnessing the act of urination by someone of the same or opposite sex.


Question: NOT a feature of primary hyperaldosteronism is

Answer is A (Pedal edema): `Patients with primary aldosteronism (Conn's syndrome) characteristically do not have edema since they exhibit an "escape" phenomenon from the sodium retaining aspects of mineralocoicoids'


Question: Reticulocyte count in Hemolytic jaundice is greater than


Question: Best test for subacute cutaneous lupus erythematosus is

Cutaneous lupus erythematosus encompasses a wide range of dermatologic manifestations, which may or may not be associated with the development of systemic disease. Cutaneous lupus is divided into several subtypes, including acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Chronic cutaneous lupus erythematosus includes discoid lupus erythematosus, lupus erythematosus profundus, chilblain cutaneous lupus, and lupus tumidus. Diagnosis of these diseases requires proper classification of the subtype, through a combination of physical exam, laboratory studies, histology, antibody serology, and occasionally direct immunofluorescence, while ensuring to exclude systemic disease. Treatment of cutaneous lupus consists of patient education on proper sun protection along with appropriate topical and systemic agents. Systemic agents are indicated in cases of widespread, scarring, or treatment-refractory disease. Subacute Cutaneous Lupus Erythematosus (SCLE) occurs primarily in young to middle aged women . SCLE is highly photosensitive, with 70-90% of patients meeting the ACR definition of abnormal photosensitivity . There are two morphologic variants of SCLE: annular and papulosquamous An estimated 50% of SCLE patients meet criteria for SLE . Patients with SCLE usually have only mild systemic symptoms, most commonly ahritis and myalgias, while severe systemic symptoms, such as lupus vasculitis, CNS lupus, and nephritis occur in less than 10% . Immunologically, 70% of SCLE patients are anti-Ro (SS-A) positive, and overlap between Sjogren's syndrome and SCLE has been seen . Ref - Davidson 23rd edition pg 941


Question: Lingular lobe bronchiectasis is due to

MAC infection causes middle lobe and Lingulor lobe bronchiectasis :

Tuberculosis - Unilateral upper lobe bronchiectasis.
Cystic Fibrosis - Bilateral upper lobe bronchiectasis.
Aspergillosis - Central bronchiectasis.

Mycobacterium Avium intracellulare infection


Question: In type 2 DM, increased fasting plasma glucose is predominantly due to

Insulin resistance impairs glucose utilization by insulin-sensitive tissues and increases hepatic glucose output; both effects contribute to the hyperglycemia. Increased hepatic glucose output predominantly accounts for increased FPG levels, whereas decreased peripheral glucose usage results in postprandial hyperglycemia. Glucose metabolism in insulin-independent tissues is not altered in type 2 DM.Ref: Harrison 19e pg: 2405

Decreased peripheral utilization of glucose


Question:
Drug used in unstable angina & NSTM
(A)Morphine
(B)Aspirin
(C)Nitrates
(D)Anthrombocthera
(E)CCB


Question: Common cause of obstructive lung disease is

(A) Smoking > Air pollution, airway infection, familial factors, and allergy have also been implicated in chronic bronchitis, and hereditary factors (deficiency of a 1-antiprotease) have been implicated in emphysema.> The pathogenesis of emphysema may involve excessive lysis of elastin and other structural proteins in the lung matrix by elastase and other proteases derived from lung neutrophils, macrophages, and mononuclear cells.> Atopy and the tendency for bronchoconstriction to develop in response to nonspecific airway stimuli may be important risks for COPD.


Question: Main inflammatory mediator in anaemia of chronic disease

IL - 6 Stimularte incresed hepatic production of hepcidin.


Question: "Waxy flexibility" is a feature of

(A) Catatonic schizophrenia # WAXY FLEXIBILITY is a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture.> For instance, if one were to move the arm of someone with waxy flexibility, they would keep their arm where one moved it until it was moved again, as if it were made from wax. Further alteration of an individual's posture is similar to bending a candle.> Although waxy flexibility has historically been linked to schizophrenia, there are also other disorders which it may be associated with, for example, mood disorder with catatonic behaviour


Question: Western blot technique is done for


Question: Antibody in drug induced Lupus

Anti-Histone antibodies - Drug induced Lupus.
Anti-Ribosomal antibodies - CNS Lupus.


Question: NOT causing Peripheral Neuropathy

(D) Candida # INFECTIONS CAUSING NEUROPATHY:> Certain viral or bacterial infections can cause peripheral neuropathy, including Lyme disease, shingles (varicella-zoster), Epstein-Barr virus, hepatitis C, leprosy, diphtheria, syphilis and HIV.


Question: Coarctation of aoa is most commonly associated with

Coarctation occurs in ~7% of patients with congenital hea disease, is more common in males than females, and is paicularly frequent in patients with gonadal dysgenesis (e.g., Turner syndrome). Clinical manifestations depend on the site and extent of obstruction and the presence of associated cardiac anomalies; most commonly a bicuspid aoic valve. Circle of Willis aneurysms may occur in up to 10%, and pose a high risk of sudden rupture and death. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925)


Question: Prolonged QT interval is not seen in

Hypercalcemia: The most common ECG findings of hypercalcemia are a sho QT interval secondary to a shoened ST segment. There may also be a widened or flattened T wave; however, significant hypercalcemia can cause ECG changes that mimic an acute myocardial infarction cuases of prolonged QT Bradycardia Central Nervous System diseases (intracranial trauma, subarachnoid hemorrhage, stroke) Congenital long QT syndrome Dysautonomy (Diabetes mellitus, amyloidosis, others) Elderly Electrolyte disturbances (hypomagnesemia, hypokalemia) Hea Failure Hypoglycaemia Hypothermia Hypothyroidism Ion channel polymorphism Ischemic myocardiopathy Obesity Reduced repolarization reserve Ref : Harrison 20th edition pg 1534


Question: Elective splenectomy is done in

In hereditary spherocytosis, the RBCs have a tendency to be trapped and destroyed in the spleen.
The main features of this disease include anemia, reticulocytosis, jaundice, and splenomegaly. Hence elective splenectomy would be the treatment of choice for this condition.


Question: Visceral leishmaniasis is predisposed by


Question: Pulseless disease

(C) Takayasu's # Pulses are commonly absent in the involved vessels, particularly the subclavian artery in Takayasu's. In Giant cell arteritis patients with involvement of the temporal artery, headache is the predominant symptom and may be associated with a tender, thickened, or nodular artery, which may pulsate early in the disease but may become occluded later


Question: Acute inflammatory demyelinating polyneuropathy (AIDP) is the most common form of

(A) Guillian Barre syndrome # Acute Inflammatory Demyelinating Polyneuropathy (AIDP): is the most common form of GBS, and the term is often used synonymously with GBS. It is caused by an autoimmune response directed against Schwann cell membranes.> Miller Fisher syndrome (MFS): \s a rare variant of GBS and manifests as a descending paralysis, proceeding in the reverse order of the more common form of GBS. It usually affects the eye muscles first and presents with the triad of ophthalmoplegia, ataxia, and areflexia. Anti-GQ1b antibodies are present in 90% of cases.> Acute motor axonal neuropathy (AMAN), or Chinese paralytic syndrome, attacks motor nodes of Ranvier and is prevalent in China and Mexico. It is probably due to an autoimmune response directed against the axoplasm of peripheral nerves. The disease may be seasonal and recovery can be rapid. Anti-GD1a antibodies are present. Anti-GD3 antibodies are found more frequently in AMAN.> Bickerstaff's brainstem encephalitis (BBE):, is a further variant of Guillain-Barre syndrome. It is characterized by acute onset of ophthalmoplegia, ataxia, disturbance of consciousness, hyperreflexia or Babinski's sign. The course of the disease can be monophasic or remitting-relapsing. Large, irregular hyperintense lesions located mainly in the brainstem, especially in the pons, midbrain and medulla are described in the literature. BBE despite severe initial presentation usually has a good prognosis. Magnetic resonance imaging (MRI) plays a critical role in the diagnosis of BBE. A considerable number of BBE patients have associated axonal Guillain-Barre syndrome, indicative that the two disorders are closely related and form a continuous spectrum.


Question: Congenital hea disease associated with decreased pulmonary blood flow

Answer is C (Ebstein's anomaly) Ebstein's anomaly and single ventricle with pulmonic stenosis are associated with normal or decreased pulmonary blood flow Truncus Aeriosus, complete TGA and TAPVC are associated with increased pulmonary blood flow. Cyanotic Congenital Hea Disease Increased pulmonary blood flow Normal or decreased pulmonary blood flow I. Complete transposition of the great aeries I. Tricuspid atresia 2. Double- outlet right ventricle of the Taussing- Bing type 2. Ebstein's anomaly with right- to-let aerial shunt 3. Truncus aeriosus 3. Pulmonary atresia with intact ventricular septum 4. Total anomalous pulmonary venous connection 4. Pulmonic stenosis or atresia with ventricular septal defect (tetralogy of Fallot) 5. Single ventricle without pultnonic. stenosis 5. Pulmonic stenosis with Right -- to -- Left aerial shunt 6. Common atrium 6. Complete transposition of the great aeries with pulmonic stenosis 7. Tetralogy of Fallot with pulmonary atresia and increased collateral aerial flow 7. Double -- Outlet right ventricle with pulmonic stenosis 8. Tricuspid atresia with large ventricular scptal defect and no pulmonic stenosis 8. Single Ventricle with pulmonic Stenosis 9. Hypoplastic 10 hea (aoic atresia, itral atresia) 9. Pulmonary aeriovenous fistula 10. Vena Cava! to left aerial communication


Question: Backwash ileitis is seen in

Ans. is 'a' i.e., Ulcerative colitis Ulcerative colitis always involves the rectum and extends proximally in continuous fashion to involve pa or all pa of the colon. Involvement of terminal ileum in ulcerative colitis is called backwash ileitis


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


Question: Drug of choice in amoebic liver abscess is

(A) Metronidazole # Metronidazole acts directly on the trophozoites of E. histolytica. Because of high concentration in liver extensively small amounts of drug (800 mg, TDS X 5-10 days) effective in Amoebic Liver Abscess.


Question: Patient with elfin facies and friendly behaviour; increased curiosity, Supravalvular aortic stenosis, mental depression etc. The diagnosis is

(A) Williams syndrome # WILLIAMS SYNDROME (also named Williams-Beuren Syndrome) is a genetic condition that is present at birth and can affect anyone. It is caused by the omission of about 26 genes from the long arm of chromosome 7, and can lead to problems with development. Williams Syndrome occurs in about 1 in 8,000 births and there is no cure. Williams Syndrome mainly affects the gene that produces elastin, a protein that allows blood vessels and other tissues in the body to stretch.> Some symptoms of Williams Syndrome are: Delayed speech; Developmental delay; Easily distracted; attention deficit disorder (ADD) Learning disorders, Mild to moderate mental retardation> Personality traits including being very friendly, trusting strangers, fearing loud sounds or physical contact, and being interested in music Short compared to the rest of the person's family; Sunken chest (pectus excavatum); Unusual appearance of the face; Flattened nasal bridge with small upturned nose; Partially missing teeth> Some signs that show the appearance of Williams Syndrome are: Blood vessel narrowing; Farsightedness High blood calcium level (hypercalcemia) that may cause seizures and rigid muscles; High blood pressure> Some complications that may occur with Williams Syndrome are: Calcium deposits in the kidney and other kidney problems; Death (in rare cases from anesthesia); Heart failure due to narrowed blood vessels; Pain in the abdomen.> Many of the symptoms and signs of Williams Syndrome may not be obvious at birth. People who have a family history of Williams Syndrome should seek genetic counseling and prenatal testing before conceiving.


Question: Pitying testing for lower motor neuron lesion involving nucleus ambiguous; uvula

Answer- B. Is deted to the normal sideIt is the column of cells running almost the entire length of medulla.Motor neurons in the nucleus ambiguous innervate the constrictor muscles of the pharynx, muscles of the velopharynx (such as constrictor veli palatine), intrinsic muscle of the larynx, and single muscle of the tongue.In case of unilateral lower motor neuron lesion, when the patient phonates the soft palate will raise asymmetrically, with higher elevation on the healthy side and the uvula pulled of the midline in the same direction i.e. it is deted to the normal unaffected side.


Question: Commonest Organism Producing acute pyelonephritis


Question: Most common cardiac defect in Turner syndrome


Question: The cardinal features of Parkinson’s syndrome include


Question: Postural hypotension is not seen in

Postural hypotension may occur in patients with tabes dorsalis because of interruption of circulatory reflexes. In patients with polyneuropathies, autonomic involvement is not uncommon. Postural hypotension is uncommon in diabetes but can occur secondary to autonomic neuropathy. Symptoms are rare and include dizziness, weakness, blurred vision, tiredness, and loss of consciousness. They have a poorer prognosis than patients with symptomatic autonomic neuropathy without postural hypotension. Drug classes at greater risk for development or exacerbation of ohostatic hypotension may be identified in nitrates, a-antagonists and non-dihydropyridine calcium channel blockers, while ACE-inhibitors, angiotensin II receptor antagonists, dihydropyridine calcium channel blockers and b-blockers carry a lower risk Ref Davidson 23rd edition pg 461


Question: Hemolytic Uremic Syndrome is characterizeda) Microangiopathic haemolytic anaemiab) ↓ed LDHc) Thrombocytopaeniad) Renal failuree) Positive Coomb's test


Question: Cerebral infarcts at its earliest is detected by

Diffusion-weighted magnetic resonance imaging (DWI or DW-MRI) is the use of specific MRI sequences as well as software that generates images from the resulting data that uses the diffusion of water molecules to generate contrast in MR images The most common application of conventional DWI (without DTI) is in acute brain ischemia. DWI directly visualizes the ischemic necrosis in cerebral infarction in the form of a cytotoxic edema,appearing as a high DWI signal within minutes of aerial occlusion.With perfusion MRI detecting both the infarcted core and the salvageable penumbra, the latter can be quantified by DWI and perfusion MRI Ref Harrison20th edition pg 2234


Question: Following an attack of myocardial infarction the mortality and morbidity of the patient is indicated by

Ans. is 'b' left ventricular ejection fraction Several techniques can be used to assess the impaired cardial functions in patients. Such asend diastolic pressurecardial output andstroke volume.The disadvantage with these methods is that they can be found normal with impaired cardiac functionso a more sensitive test i.e. Ejection fraction is used for the assessment of impaired cardiac function.Ejection fraction = stroke volume/enddiastolic volume.It is more sensitive in the sense that when other parameters such as stroke volume and enddiastolic pressure are normal during any cardiac impairment, abnormality can be detected in the ejection fraction

Percentage of narrowness of coronary artery


Question: Methyl alcohol poisoning is treated with

Ans. b (Ethyl alcohol). (Ref. Harrison, Medicine, 18th/Ch. 47)TREATMENT OF METHYL ALCOHOL POISONING# Patient in quiet, dark room# Gastric lavage with sodabicarb and Combat acidosis by IV sodabicarb infusion (the most vital measure, prevents retinal damage).# Ethanol 100mg/dl (retards methanol metabolism), Fomepizole (specific alcohol dehydrogenase inhibitor) and Haemodialysis are useful.PoisioningFeaturesRxEthylene Glycol (anti-freeze)High anion gap Metabolic acidosis and severe damage to the CNS, heart, lungs, and kidneys.Prompt institution of a saline or osmotic diuresis, thiamine and pyridoxine supplements, fomepizole or ethanol, and hemodialysis.Methanol (wood alcohol)Causes high anion gap metabolic acidosis, and its metabolites formaldehyde and formic acid cause severe optic nerve and CNS damage.Similar to that for ethylene glycol intoxication, including general supportive measures, fomepizole, and hemodialysis .Isopropyl Alcohol (as little as 150 ml of rubbing alcohol, solvent, or de-icer can be fatal)A plasma level >400 mg/dL is life-threatening. Isopropyl alcohol differs from ethylene glycol and methanol in that the parent compound, not the metabolites, causes toxicity, and an AG acidosis is not present because acetone is rapidly excreted. Ethylene glycol, Methanol and Isoporpyl alcohol, all 3 cause an elevated osmolal gap, but only the first two cause a high-AG acidosis.Treated by watchful waiting and supportive therapy; IV fluids, pressors, ventilatory support if needed, and occasionally hemodialysis for prolonged coma or levels >400 mg/dL.Treat Benzodiazepines overdose with flumazenil (competitive antagonist at GABA receptor).


Question: The typical feature of interstitial lung disease is

Rales are abnormal lung sounds characterized by discontinuous clicking or rattling sounds. They can sound like salt dropped onto a hot pan or like cellophane being crumpled. Crackles are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are usually heard only with a stethoscope ("on auscultation"). Bilateral crackles refers to the presence of crackles in both lungs. Basal crackles are crackles apparently originating in or near the base of the lung. Bibasal crackles refer to crackles at the bases of both the left and right lungs. Bilateral basal crackles also refers to the presence of basal crackles in both lungs. Crackles are caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. Crackles can be heard in patients with pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis, acute respiratory distress syndrome (ARDS), interstitial lung disease or post thoracotomy or metastasis ablation. Pulmonary edema secondary to left-sided congestive hea failure can also cause crackles. Ref Davidson 23rd edition pg 579


Question: Platypilea is seen in

platypnea ohodeoxia is typically an ove symptom when the patient's posture changes from the supine to the upright position. .Especially when a significant pleural ef- fusion (hydrothorax) is present, the intrathoracic effusion spreads diffusely over the posterior space of the thorax in the supine position. Ref Davidson 23rd edition pg 619


Question: Bad prognosis in AML Is indicated by

Acute myeloid leukemia (AML) with monosomy 7 is associated with poor disease-free survival when treated by aggressive conventional chemotherapy alone. Similarly, outcomes are poor in children with myelodysplastic syndrome (MDS) with monosomy 7 treated by chemotherapy, immunosuppressive drugs or suppoive measures Myelodysplastic syndrome AML arising from a pre-existing myelodysplastic syndrome (MDS) or myeloproliferative disease (so-called secondary AML) has a worse prognosis, as does treatment-related AML arising after chemotherapy for another previous malignancy. Both of these entities are associated with a high rate of unorable cytogenetic abnormalities Cytogenetics The single most impoant prognostic factor in AML is cytogenetics, or the chromosomal structure of the leukemic cell. Ceain cytogenetic abnormalities are associated with very good outcomes (for example, the (15;17) translocation in acute promyelocytic leukemia). About half of people with AML have "normal" cytogenetics; they fall into an intermediate risk group. A number of other cytogenetic abnormalities are known to associate with a poor prognosis and a high risk of relapse after treatment. Genotype A large number of molecular alterations are under study for their prognostic impact in AML. However, only FLT3-ITD, NPM1, CEBPA and c-KIT are currently included in validated international risk stratification schema. These are expected to increase rapidly in the near future. FLT3 internal tandem duplications (ITDs) have been shown to confer a poorer prognosis in AML with normal cytogenetics. Several FLT3 inhibitors have undergone clinical trials, with mixed results. Two other mutations - NPM1 and biallelic CEBPA are associated with improved outcomes, especially in people with normal cytogenetics and are used in current risk stratification algorithms. Researchers are investigating the clinical significance of c-KIT mutations in AML. These are prevalent, and potentially clinically relevant because of the availability of tyrosine kinase inhibitors, such as imatinib and sunitinib that can block the activity of c-KIT pharmacologically. It is expected that additional markers (e.g., RUNX1, ASXL1, and TP53) that have consistently been associated with an inferior outcome will soon be included in these recommendations. The prognostic impoance of other mutated genes (e.g., DNMT3A, IDH1, IDH2) is less clear. Ref Davidson 23rd edition pg 789


Question: Treatment of choice for aplastic anaemia is

The prognosis of severe aplastic anemia managed with suppoive therapy is only poor and more than 50% of people die, usually in the first year. The curative treatment for patients under 35 years of age is allogenic hematopoietic stem cell transplantation if there is an available sibling donor. Older patients and those with suitable donors should proced to bone marrow transplantion as soon as possible. Reference : Davidson, 23rd Edition, page no : 969.


Question: Hemorrhagic fever of dengue is transmitted by

Ans. c (A. aegypti) (Ref. Ananthanarayan Microbiology 7th/pg. 86)DENGUE FEVER# Dengue virus (4 serotypes; flaviviruses).# Occurs in tropics and subtropics; transmitted by mosquito (A. aegypti).# Rash in 50% of cases; initially diffuse flushing; midway through illness, onset of maculopapular rash, which begins on trunk and spreads centrifugally to extremities and face; pruritus, hyperesthesia in some cases.# After defervescence, petechiae on extremities in some cases.# Headache, musculoskeletal pain ("breakbone fever"); leukopenia; occasionally biphasic ("saddleback") fever.# A. aegypti, also an efficient vector of the yellow fever and chikungunya viruses, typically breeds near human habitation, using relatively fresh water from sources such as water jars, vases, discarded containers, coconut husks, and old tires. A. aegypti usually inhabits dwellings and bites during the day.OrganismVectorW. bancroftiCulexB. malayiMansoniaB. timoriAnophelesO. volvulusSimulian fliesLoa loaChrysops


Question: Poocaval encephalopathy is treated with

Lactulose(15-30mL 3times daily) is increased until the bowels are moving twice daily. It produces an osmotic laxative effect, reduces the pH of the colonic content, thereby limiting the colonic ammonia absorption, and promotes the incorporation of nitrogen into bacteria. Reference :Davidson, 23rd Edition, page no : 865.'


Question: Nerve involved in Bell’s palsy is

Bell's palsy
■ The most common form of facial paralysis is Bells palsy. Bell’s palsy is idiopathic palsy of facial nerve. Clinical Manifestations
■ The onset of Bell’s palsy is fairly abrupt, maximal weakness being attained by 48 h as a general rule.
■ Pain behind the ear may precede the paralysis for a day or two.
■ Taste sensation may be lost unilaterally, and hyperacusis may be present.
■ In some cases there is mild cerebrospinal fluid lymphocytosis.
■ MRI may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve, and, in some cases, entrapment of the swollen nerve in the temporal bone.
■ Approximately 80% of patients recover within a few weeks or months.
■ The presence of incomplete paralysis in the first week is the most favorable prognostic sign. Pathophysiology
■ Bell’s palsy is associated with the presence of herpes simplex virus type 1 DNA in endoneurial fluid and posterior auricular muscle,
suggesting that a reactivation of this virus in the geniculate ganglion may be responsible. However, a causal role for herpes simplex virus in Bell’s palsy is unproven.
Differential Diagnosis
■ Tumors that invade the temporal bone (carotid body, cholesteatoma, dermoid).
■ The Ramsay Hunt syndrome, presumably due to herpes zoster of the geniculate ganglion, consists of a severe facial palsy associated with a vesicular eruption in the pharynx,
external auditory canal, and other parts of the cranial integument; often the eighth cranial nerve is affected as well.
■ Acoustic neuromas frequently involve the facial nerve by local compression.
■ Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions that interrupt the facial nerve fibers; other signs of brainstem involvement are usually present.
■ Bilateral facial paralysis (facial diplegia) occurs in Guillain-Barre' syndrome and also in a form of sarcoidosis known as uveoparotid fever (Heerfordt syndrome).
■ Lyme disease is a frequent cause of facial palsies in endemic areas.
■ The rare Melkersson-Rosenthal syndrome consists of a triad of recurrent facial paralysis, recurrent—and eventually permanent—facial (particularly labial) edema, and less constantly,
plication of the tongue;
■ Leprosy frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus.
■ All these forms of nuclear or peripheral facial palsy must be distinguished from the supranuclear type.
■ In the latter, the frontalis and orbicularis oculi muscles are involved less than those of the lower part of the face, since the upper facial muscles are innervated by corticobulbar pathways from both motor cortices, whereas the lower facial muscles are innervated only by the opposite hemisphere. Treatment
■ Symptomatic measures include use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and Massage of the weakened muscles.
■ A course of glucocorticoids, given as prednisone 60 to 80 mg daily during the first 5 days and then tapered over the next 5 days,
appears to shorten the recovery period and modestly improve the functional outcome.
■ In one double-blind study, patients treated within 3 days of onset with both prednisone and acyclovir (400 mg five times daily for 10 days) had a better outcome than patients treated with
prednisone alone.


Question: "Creola Bodies" in sputum are pathognomonic of

Creola bodies are clumps of benign ciliated respiratory epithelium. They can be seen in spontaneously expectorated sputum of asthmatic patients, as well as in cytology preparations of bronchoalveolar lavage specimens.Other common findings in the sputum of asthma patients include Charcot-Leyden crystals,Curschmann&;s spirals, and eosinophils.


Question: Barth syndrome refers to

Barth syndrome is severe congenital neutropenia along with muscle  weakness and dilated cardiomyopathy.

Cardiac tamponade + skeletal myopathy + lymphopenia

Dilated cardiomyopathy + skeletal myopathy + neutropenia

Restrictive cardiomyopathy + skeletal myopathy + neutrophils

Restrictive cardiomyopathy + skeletal myopathy + lymphopenia


Question: CLL is differentiated from Mantle Cell Lymphoma by

Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) share many morphologic and immunophenotypic features. In addition to histomorphologic examination, it is customary to use the absence of CD23 to differentiate MCL from CLL/SLL. ref - Harrisons internal medicine 20thediton pg764-767


Question: fix of choice hi chronic alcoholic with normal RBS,normal UN, but altered sensorium


Question: Most common early finding in Tuberous sclerosis complex is

(D) Ash leaf spot # Shagreen patch: is a connective tissue hamartoma located in the lower back region. A shagreen patch has an orange peel or leathery texture and often presents in children aged 2-6 years but may not appear until puberty in Tuberous sclerosis.> Axillary freckling: is the presence of flat, tan colored spots in the armpit area. Axillary freckles are sometimes referred to as Crowe's sign or cafe-au-lait macules and can be associated with a disease called neurofibromatosis type 1 (NF1).> Adenoma sebaceum: is a misnamed cutaneous disorder consisting of angiofibromas that begin in childhood and appear clinically as red papules on the face. Adenoma sebaceum may at times be associated with tuberous sclerosis. Gradually the papules become more prominent with time and persist throughout life> Hypomelanotic macules: are overwhelmingly the most common early finding in tuberous sclerosis complex. These hypopigmented lesions are described as ash-leaf spots. These are best observed using a Wood lamp. A Fitzpatrick patch or ash-leaf spot may be observed in the general population, but the presence of at least 3 spots constitutes one of the major diagnostic criteria of Tuberous sclerosis. (Ash leaf spot - often missed as a birth mark).


Question: Banana sign seen in the fetal brain suggests

(C) Spina bifida # Spina Bifida:> Spinal dysraphism, spinabifida, is the incomplete closure of the neural tube.> It may be Spina bifida aperta, Spina bifida Cystica, or Spina bifida occulta.> Spina bifida Cystica is associated with > 90% neurological defects --- 1. Simple Meningocele, 2. Myelocele, 3. Myelomeningocele, 4. Myeloschisis.> Myelomeningocele is associated with 1. Hydrocephalus (70-90%), 2. Chiari II malformation (100%), 3. Congenital/acquired kyphoscoliosis (90%) 4. Vertebral anomalies, 5. Diastematomyelia, 6. Duplication of central canal, 7. Hemimyelocele, 8. Hydromyelia & 9. Chromosomal anomalies (trisomy 18, 13, &triploidy).> Ultrasonography of cranium in Spina bifida (myelomeningocele) shows: Banana Sign: Obliteration ofcisterna magna with cerebellum wrapped around posterior brainstem secondary to downward traction of spinal cord in Arnold Chiari malformation type II (in 96% of fetuses > 24 weeks). Lemon Sign: concave/linear frontal contour abnormality located at coronal suture associated with nonskin covered myelomeningocele (in 98% of fetuses < 24 weeks + 13% of fetuses > 24 weeks) Other features include -- nonvisualisation of cerebellum, effaced cysterna magna (100% sensitivity), ventriculomegaly etc.


Question: Pleural calcification is seen commonly in


Question: Most common presentation of organ damage in Diabetes mellitus is

(A) Retinal changes # CHRONIC SYMPTOMS OF DIABETES are due to vascular damage from persistent hyperglycemia.> Vascular damage leads to end-organ damage.> Other conditions associated with diabetes, such as hypertension, dyslipidemia (as well as smoking) accelerate the development of vascular damage and the chronic complications of diabetes, which are the following:# Microvascular complications are a significant cause of morbidity. Persistent hyperglycemia is the major cause for the microvascular complications which are highly specific for diabetes. Retinopathy with potential loss of vision Nephropathy leading to kidney failure Peripheral neuropathy leading to pain, foot ulcers, and limb amputation Autonomic neuropathy causing gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction# Macrovascular complications are the main cause of mortality.> Although persistent hyperglycemia may contribute to macrovascular complications, it is the associated conditions (hypertension, dyslipidemia, smoking) that account for most of the burden of the macrovascular complications. Coronary heart disease which is the major cause of death for patients with diabetes Peripheral vascular disease Cerebrovascular disease> Diabetic retinopathy may be the most common microvascular complication of diabetes. The risk of developing diabetic retinopathy or other microvascular complications of diabetes depends on both the duration and the severity of hyperglycemia. Development of diabetic retinopathy in patients with type 2 diabetes was found to be related to both severity of hyperglycemia and presence of hypertension.> Diabetic nephropathy is the leading cause of renal failure. It is defined by proteinuria > 500 mg in 24 hours in the setting of diabetes, but this is preceded by lower degrees of proteinuria, or "microalbuminuria." Microalbuminuria is albumin excretion of 30-299 mg/24 hours. Without intervention, diabetic patients with microalbuminuria typically progress to proteinuria and overt diabetic nephropathy. This progression occurs in both type 1 and type 2 diabetes.


Question: Corpulence index means

Corpulence index = actual weight divided by the desirable weight(Ref: Park 20/e p348)

Measurement of copper level in the serum

Pressure difference between various chambers of the hea


Question: III Nerve palsy associated with contralateral hemiplegia is together known as

(A) Weber's syndrome > Injury to structures surrounding fascicles of the oculomotor nerve descending through the midbrain has given rise to a number of classic eponymic designations.> In Nothnagel's syndrome, injury to the superior cerebellar peduncle causes ipsilateral oculomotor palsy and contralateral cerebellar ataxia.> In Benedikt's syndrome, injury to the red nucleus results in ipsilateral oculomotor palsy and contralateral tremor, chorea, and athetosis.> Claude's syndrome incorporates features of both the aforementioned syndromes, by injury to both the red nucleus and the superior cerebellar peduncle.> Finally, in Weber's syndrome, injury to the cerebral peduncle causes ipsilateral oculomotor palsy with contralateral hemiparesi:


Question: A high amylase level in pleural fluid suggests a diagnosis of

Answer is B (Malignancy): Malignancy is associated with high levels of amylase in pleural fluid High amylase level in pleural fluid suggests Esophageal rupturedeg Pancreatic pleural effusiondeg (Pancreatitis/Pancreaticpseudo cyst) Malignancydeg (Adenocarcinoma of lung/pancreas)


Question: A 55yers old male has sudden onset of thunder clap headache following by loss of consiusness for 4 hour investigation is

(A) (MRI angiogram) (128- H 18th) (Brad- Lee Neurology 5th)Primary thunderclap headache* Sudden onset of severe headache may occur in the absence of any known provocation* D/D-(i) Sentinel bleed of an intracranial aneurysm(ii) Cervicocephalic arterial dissection(iii) Cerebral venous thrombosis(iv) Sympathomimetic drugs or tyramine containing foods in patients who is taking MAO is or they may be a symptom of pheochromocytoma.* First presentation of any sudden onset severe headache should be vigoruously investigated with neuroimaging (CT or when possible MRI with MR angiography) and CSF examination* Nimodipine may be helpful. Although by definition the vasoconstriction of primary thunder clap headache resolves spontaneously.Red flag svmptons in headache (1157- Dividson 22nd)SymptomsPossible explanationSudden onset (Maximal immediately or with in minutes)- Subarachnoid haemorrhage- CCA- Pituitary apoplexy- MeningitisFocal neurological symptoms (other than for typically migrainous)Intracranial mass lesionsVascularNeoplasticInfectionsConstitutional symptoms* Weight loss* General malaise* Pyrexia* Meningism* Rash* Meningoencephalitis* Neoplastic (lymphoma or metastasis) Inflammatory (vasculitic)Raised intracranial pressure (worse on wakening/lying down, associated Vomiting)Intracranial mass lesionsNew onset aged > 60 yearsTemporal arteritis* Thunderclap headache is an acute and servre headache that is maximum in intensity at onset and has been likened to a clap thunder.* The term TCH was initially used by Day and Raskin in reference to the pain associated with an unruptured intracranial aneurysm.* However, multiple cause of thunderclap headache have since been described"subarachnoid hemorrhage is the most common cause of thunderclapQ".Primary Thunder Clap headache* Primary TCH is diagnosed when all other potential underlying cause have been eliminated by diagnostic testing* Primary TCH's can recur intermittently and are generally associated with benign outcomeThe international Headache society's diagnostic criteria for primary TCHA. Severe headpain fulfilling criteria B and CB. Both of the following characteristics- Sudden onset,- Reaching maximum intensity in < 1 min lasting form 1 hour to 10 daysC. Does not recur regularly over subsequent weeks or months.D. Not attributed to another disorder (normal cerebrospinal fluid and normal brain imaging are needed)Secondary causes of Thunderclap headache- Subarachnoid hemorrhage0- Sentinel headache- Cerebral venous sinus thrombosis0- Cervical artery dissection- Spontaneous intracranial hypotension- Pituitary apoplexy0- Retroclival hematoma- Ischaemic stroke- Acute hypertensive crisis- Reversible cerebral vasoconstriction syndrome- Third ventricle colloid cyst- Intracranial infection- Priamary thunderclap headache- Primary cough, sexual and exertional headache


Question: Kerley B lines seen in

In pulmonary edema,the vascularity of the lung fields becomes more prominent,and the right and left pulmonary aeries dilate.Subsequently,interstitial edema causes thickened interlobular septa and dilated lymphatics.These are evident as horizontal lines in the costophrenic angles(septal or Kerley B lines). <reference:Davidson' s medicine-22nd edition page no:550.


Question: Analgesic used for pain associated with STEMI

Morphine is a very effective analgesic for the pain associated with STEMI.However, it may reduce sympathetically mediated aeriolar and venous constriction, and the resulting venous pooling may reduce cardiac output and aerial pressure. These hemodynamic disturbances usually respond promptly to elevation of the legs, but in some patients, volume expansion with intravenous saline is required. These side effects usually respond to atropine (0.5 mg intravenously). Morphine is routinely administered by repetitive (every 5 min) intravenous injection of small doses (2-4 mg), rather than by the subcutaneous administration of a larger quantity, because absorption may be unpredictable by the latter route.Ref: Harrison 19e pg: 1603


Question: Moeller's glossitis is due to a

Atrophic glossitis. Atrophic glossitis, also known as bald tongue, smooth tongue, Hunter glossitis, Moeller glossitis, or Moller-Hunter glossitis, is a condition characterized by a smooth glossy tongue that is often tender/painful, caused by complete atrophy of the lingual papillae Ref Davidson 23rd edition pg 1036


Question: A patient with previous spells of diplopia, ataxia, dysahria, and dizziness becomes acutely comatose. The most likely cause is

Patients with basilar aery stenosis frequently have spells of ischemic brainstem dysfunction before a catastrophic stroke caused by aerial thrombosis. Timely anticoagulation and allowing a higher blood pressure can arrest the progression of this potentially fatal stroke. Acute coma can occur in association with each of the cerebrovascular accidents mentioned in the question Except carotid occlusion. Subarachnoid hemorrhage causes an acute increase in intracranial pressure that reduces blood flow to the brain. Unilateral coical infarction does not cause coma, but damage to brainstem structures infarction or compression will cause coma. Ref - Harrison's principles of internal medicine 20e pg 2073


Question: The most likely diagnosis in the case of a patient with multiple pulmonary cavities, hematuria and red cell casts is

Ans. is 'd' i.e., Wegner's granulomatosis


Question: Cause of RF in rhabdomyolysis is

Myoglobin is released from injured muscle cells leading to acute kidney injury. Other endogenous compounds causing AKI - Hemoglobin Uric acid Myeloma light chains Ref:Harrison 20th edition pg no .2103


Question: Finger is glove sign is seen in

Ans. is 'd' i.e., Bronchocele Rabbit ear appearance Mickey mouse appearance Toothpaste shaped opacities Y-shaped opacities V-shaped opacities Aetiology Obstructive In bronchial obstruction, the poion of the bronchus distal to the obstruction is dilated with the presence of mucous secretions (mucus plugging). Causes of bronchial obstruction include : Bronchial hamaoma Bronchial lipoma Bronchial carcinoid Bronchogenic carcinoma Congenital bronchial atresia (rarely) Non obstructive Causes include .- Asthma Allergic bronchopulmonary aspergillosis (ABPA) Cystic fibrosis


Question: Hypokalemia is associated frequently with

Insulin, b2-adrenergic activity, thyroid hormone, and alkalosis promote Na+/K+-ATPase-mediated cellular uptake of K+, leading to hypokalemia. Causes of Hypokalemia I. Decreased intake A. Starvation B. Clay ingestion II. Redistribution into cells A. Acid-base 1. Metabolic alkalosis B. Hormonal 1. Insulin 2. Increased b2-adrenergic sympathetic activity: post-myocardial infarction, head injury 3. b2-Adrenergic agonists - bronchodilators, tocolytics 4. a-Adrenergic antagonists 5. Thyrotoxic periodic paralysis 6. Downstream stimulation of Na+/K+-ATPase: theophylline, caffeine C. Anabolic state 1. Vitamin B12 or folic acid administration (red blood cell production) 2. Granulocyte-macrophage colony-stimulating factor (white blood cell production) 3. Total parenteral nutrition D. Other 1. Pseudohyperkalemia 2. Hypothermia 3. Familial hypokalemic periodic paralysis 4. Barium toxicity: systemic inhibition of "leak" K+ channels III. Increased loss A. Nonrenal 1. Gastrointestinal loss (diarrhea) 2. Integumentary loss (sweat) B. Renal 1. Increased distal flow and distal Na+ delivery: diuretics, osmotic diuresis, salt-wasting nephropathies 2. Increased secretion of potassium a. Mineralocoicoid excess b. Apparent mineralocoicoid excess c. Distal delivery of nonreabsorbed anions 3. Magnesium deficiency Ref: Harrison 19e pg: 305


Question: Main cause of oedema in nephrotic syndrome is

Nephrotic syndrome Nephrotic syndrome is characterised by very heavy proteinuria (>3.5 g/24 hrs), hypoalbuminaemia and oedema (see below). Blood volume may be normal, reduced or increased. Renal sodium retention is an early and universal feature; the mechanisms of this are shown in Figure 14.5 (p. 354). The diseases that cause nephrotic syndrome all affect the glomerulus (see Fig. 15.9), either directly, by damaging podocytes, or indirectly, by causing scarring or deposition of exogenous material such as amyloid into the glomerulus. Investigation of nephrotic syndrome usually involves renal biopsy, although non-invasive tests may also be helpful in suggesting the underlying cause (Box 15.10). In children, minimal change disease is by far the most common cause of nephrotic syndrome and therefore renal biopsy is not usually required unless the patient fails to respond to high-dose glucocoicoid therapy. Similarly, most patients with diabetes presenting with nephrotic syndrome will have diabetic nephropathy, and so renal biopsy is usually not performed unless the course of the disease is atypical (rapidly increasing proteinuria or rapid decline in renal function; p. 757). Management of nephrotic syndrome should be directed at the underlying cause. In addition, nephrotic syndrome is associated with a number of complications (Box 15.11), which may require suppoive management unless the nephrosis is expected to resolve rapidly, such as in glucocoicoid-responsive minimal change disease. Ref Harrison20th edition pg 278


Question: Most common Complication of dialysis is


Question: In pneumococcal meningitis empirical treatment given is

Currently, dual therapy using high dose vancomycin (60 mg/kg/day) and either a third-generation cephalosporin (cefotaxime or ceftriaxone) or rifampin has been proposed as the optimal empirical treatment for suspected pneumococcal meningitis until antibiotic susceptibilities are known Ref Harrison20th edition pg 2345


Question: The normal P wave is biphasic in lead

The normal P wave in lead V1 may be biphasic with a positive component reflecting right atrial depolarization, followed by a small (<1 mm2 ) negative component reflecting left atrial depolarization. Ref Harrison 20th edition pg 1455


Question: In a course of epidemic of hepatitis, fulminant hepatitis is seen in

Fulminant hepatic failure (FHF) is usually defined as the severe impairment of hepatic functions or severe necrosis of hepatocytes in the absence of preexisting liver disease. However, unlike in adults, encephalopathy may be absent, late, or apparent in children only at the terminal stages. Thus, the emphasis in children is placed on the presence of significant coagulopathy in the absence of sepsis or disseminated intravascular coagulation that is not correctable by the administration of parenteral vitamin K within 8 hours. Ref Davidson edition23rd pg883


Question: Pulmonary embolism is caused due to


Question: Shrinking lung is a feature of

Shrinking lung syndrome (SLS) is an uncommon feature of systemic lupus erythematosus (SLE) characterized by dyspnea, pleuritic chest pain, diaphragmatic elevation, restrictive ventilatory defect and reduced respiratory muscle strength as measured by volitional tests. Ref - pubmed.com


Question: A patient of rheumatoid ahritis develops sudden onset quadriparesis, Babinsky sign was positive, increased muscle tone of limbs with exaggerated tendon jerks and worsening of gait with no sensory. sphincter involvement. Best initial investigation is

Ans. a. X-ray of cervical area of neck in flexion and extension In patients of rheumatoid ahritis with compressive Myelopathy or neurological dysfunction investigation to be done next is X-ray of cervical area of neck in flexion and extension Neurological Involvement in Rheumatoid Ahritis Atlanto-axia linvolvement of cervical spine is clinically notewohy because of its potential to cause compressive Myelopathy and neurological dysfunctionQ Neurological manifestations are rarely a presenting sign or symptom of atlanto-axial disease, but they may evolve over time with progressive instability of Cl or C2Q It does not affect thoracic or lumbar spineQ Investigation: In patients of compressive Myelopathy or neurological dysfunction investigation to bedone next is X-ray of cervical area of neck in flexion and extensionQ


Question: In case of hepatic porphyria the safe anticonvulsant is

(A) Clonazepam > Seizures can be due to neurologic effects or to hyponatremia.> Treatment of seizures is difficult because virtually all antiseizure drugs (except bromides) may exacerbate> AIP (clonazepam may be safer than phenytoin or barbiturates).


Question: Pseudohyperkalemia can result from

Hyperkalemia should be distinguished from factitious hyperkalemia or "pseudohyperkalemia," an aifactual increase in serum K+ due to the release of K+ during or after venipuncture. Pseudohyperkalemia can occur in the setting of excessive muscle activity during venipuncture (e.g., fist clenching), a marked increase in cellular elements (thrombocytosis, leukocytosis, and/or erythrocytosis) within vitro efflux of K+, and acute anxiety during venipuncture with respiratory alkalosis and redistributive hyperkalemia. Cooling of blood following venipuncture is another cause, due to reduced cellular uptake; the converse is the increased uptake of K+ by cells at high ambient temperatures, leading to normal values for hyperkalemic patients and/or to spurious hypokalemia in normokalemic patients. Finally, there are multiple genetic subtypes of hereditary pseudohyperkalemia, caused by increases in the passive K+ permeability of erythrocytes. For example, mutations in the red cell anion exchanger (AE1, encoded by the SLC4A1 gene) Ref: Harrison 19e pg: 309


Question: The most common translocation associated with poor prognosis in patients with Multiple Myeloma is

Answer is B (t(4;14)) The most common translocation associated with poor prognosis in patients with Multiple Myeloma is t(4;14). 'The two most common translocation seen in patients with Multiple Myeloma are t(11;14)and t(4; 14). Both these translocations occur with almost similar frequencies, however the incidence of translocation to 1;14) appears to be marginally higher. Patients with t(4; 14) fall within a poor prognosis subgroup, while those with t(11;14) have a standard risk' - The Principles of Clinical Cytogenetics Ribs (44%) > Skull(41%)> pelvis (28%)>frinur (24%) > clavicle(10%) > scapula(10%)" align="left" height="24" hspace="65" width="653">The two most common translocation seen in patients with Multiple Myeloma: The most common translocation associated with poor prognosis in patients with Multiple Myeloma is t(4;14) The most common translocation associated with standard prognosis in patients with Multiple Myeloma is t(1 1;14)


Question: Bernard soluier syndrome is due to defective


Question: Most common presenting feature of adult hypopituitarism is

In adults decreased pituitary function is first shown by hypogonadism.


Question: Endaeritis obliterans is seen in


Question: 1% w/v of methylene blue is injected intravenously into the tissue to reverse the toxic effects of


Question: The syndrome of inappropriate antidiuretic hormone is characterized by the following

(A) Hyponatremia and urine sodium excretion > 20 meq/l # Syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH) is defined by the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.# Diagnosis:> In the absence of a single laboratory test to confirm the diagnosis, SIADH is best defined by the classic Bartter-Schwartz criteria, which can be summarized as follows: Hyponatremia with corresponding hypo-osmolality Continued renal excretion of sodium Urine less than maximally dilute Absence of clinical evidence of volume depletion Absence of other causes of hyponatremia Correction of hyponatremia by fluid restriction> Cardinal features of SIADH include: Hyponatremia (dilutional hyponatremia with Na+ <135 mmol/l) Decreased plasma osmolality (<280 m osm/kg) with inappropriately increased urine osmolality > 150 m osm). Urine sodium over 20 meq/l Low Blood urea Nitrogen < Wmg/L Hypouricemia (<4mg/dL) Absence of cardiac, liver or renal disease Normal thyroid and adrenal function> A high BUN suggests a volume contracted state and excludes a diagnosis of SIADH.

Hyponatremia and urine sodium excretion > 20 meq/1.

Hyponatremia and urine sodium excretion < 20 meq/1.


Question: The earliest phenotypic manifestation of idiopathic hereditary hemochromatosis is

Hemochromatosis is a common inherited disorder of iron metabolism in which dysregulation of intestinal iron absorption results in deposition of excessive amounts of iron in parenchymal cells with eventual tissue damage and impaired function in a wide range of organs. When the diagnosis of hemochromatosis is established, it is impoant to counsel and screen other family members.Asymptomatic and symptomatic family members with the disease usually have an increased saturation of transferrin and an increased serum ferritin concentration. These changes occur even before the iron stores are greatly increasedA fasting serum transferrin saturation greater than 50% is abnormal and suggests homozygosity for hemochromatosis.Ref: Harrison's 19/e p2516

Postprandial increase in serum iron concentration


Question: Investigation of choice for bronchiectasis

Chest CT is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis.CT findings include airway dilation(tram track or signet ring sign),lack of bronchial tapering,bronchial wall thickening in dilated airways,inspissated secretions or cysts emanating from the bronchial wall Ref:Harrison's med:18th edition,page no:2143.


Question: Chang staging is used for

Ans. is 'b' i.e. Medulloblastoma Ref: Nelson 18/ep2134; style="color: rgba(0, 102, 204, 1); font-family: Times New Roman, Times, serif">.aspThe Chang staging system is used for Medulloblastoma.Chang staging system is based on:Size and invasiveness of the primary tumor at surgery, denoted as the "T stage" or tumor stage.Evidence of spread outside the posterior fossa, marked as the "M stage" or metastatic stage.Chang staging system for medulloblastomaT stageM stageT1Tumor <3cm in diameterM0No evidence of subarachnoid or hematogenous metastasisT2Tumor >3cm in diameter, further invading one adjacent structureMlTumor cells found in cerebrospinal fluidT3aTumor >3cm in diameter with invasion into 2 adjacent structures , or completely filling the 4th ventricle, causing marked hydrocephalusM2Intracranial tumor beyond primary siteT3btumor >3 cm and with unequivocal extension into brainstemM3Gross nodular seeding in spinal subarachnoid spaceT4Tumor >3cm in diameter with extension up past the aqueduct of Sylvius and/or down past the foramen magnum (ie. Beyond the posterior fossa)M4Metastasis outside the cerebrospinal axis (especially to bone marrow, bone)(Source: Pediatric Radiation Oncology; Halperin, Constine, Tarbell, Kun)The M stage appears to be more significant prognostic factor in determining the intensity of therapy that is appropriate, as well as predicting the outcome for the patient.Names of some other staging systems:Ann Arbor staging- LymphomasDuke's staging- Colon cancerClark and Breslow staging- MelanomaButchart staging system- MesotheliomaChild-Pugh classification system- Liver CirrhosisDurie-Salmon staging system- Multiple myelomaEvans staging system- NeuroblastomaFAB (French/American/British) classification system- Hematological malignanciesGleason tumor score- Prostatic tumorsRobson staging system- Renal cell carcinomaRye classification system- Hodgkin disease


Question: Simple partial motor seizure is diagnosed by the following

(C) EEG > All patients who have a possible seizure disorder should be evaluated with an EEG as soon as possible. The EEG measures electrical activity of the brain by recording from electrodes placed on the scalp. The potential difference between pairs of electroces is amplified and displayed on a computer monitor, oscilloscope, or paper.> The characteristics of the normal EEG depend on the patient's age and level of arousal. The recorded activity represents the post- synaptic potentials of vertically oriented pyramidal cells in the cerebral cortex and is characterized by its frequency.


Question: Lupus vulgaris is


Question: Most common pattern of Penumonia seen in Klebsiella infection is


Question: Highly selective proteinuria is seen in

Loss of glomerular basement membrane (GBM) polyanion has been proposed as a cause of the selective proteinuria in minimal change nephrotic syndrome (MCNS).The exact role of charge selectivity in the pathogenesis of nephrotic proteinuria remains controversial Proteinuria that is more than 85% albumin is selective proteinuria. Nonselective proteinuria, being a glomerular leakage of all plasma proteins, would not involve changes in glomerular net charge but rather a generalized defect in permeability Ref Harrison20th edition pg 287


Question: In treatment of Parkinsonism with Levodopa dose limiting toxicity is

(B) Vomitings # ADVERSE EFFECTS 2# HAEMATOLOGICAL Dose limiting toxicity> Leucopenia, nadir 21 - 28 days, recovery 28 - 35 days.> Thrombocytopenia, nadir 16 days, recovery 21 days.# GASTROINTESTINAL Dose limiting toxicity> Severe nausea and vomiting, duration 1-12 hours. Aggressive antiemetic prophylaxis is recommended.> Nausea is most severe on the first day of multiple day treatment.# LOCAL REACTIONS> Severe pain at injection site and along vein during administration. Slow infusion rate, and place an ice pack above the injection site. Further dilution of solution may be required.# MISCELLANEOUS> Hypotension, with single doses of 850 mg/m2 or greater.> Elevated liver function tests, venous occlusive disease, acute liver dystrophy with fatal thrombosis.> Increased blood urea and serum creatinine.> Reversible alopecia, facial paraesthesia, facial flushing.> Flu-like symptoms e.g. fever, myalgia, and malaise may occur, especially after large, single doses. Onset 7 days, duration 7-21 days.


Question: Drug of choice for maintenance in PSVT is

Adesosine (3-12mg rapidly IV in incremental doses until tachycardia stops) or verapamil(5mg IV over 1min) will restore sinus rhythm in most cases. Reference : Harrison 20th edition pg 1432


Question: Most common causative organism of community acquired pneumonia is

(B) Streptococcus pneumoniae # Community acquired pneumonia: Occurs outside of the hospital or less than 48 hours after admission, in a patient who is not hospitalized or residing in a long-term care facility for more than 14 days before onset of symptoms.> Risk factors for increased mortality and morbidity rates from community acquired pneumonia.* Advanced age; Alcholism; Comorbid medical conditions; Altered mental status; Resp. rate > 30/min; Hypotension (< 90/60 mm Hg); BUN > 30 mg/dl. A predictor of patients risk and mortality from community acquired pneumonia has been developed and validated by pneumonia patient outcome research team (PORT).> Community acquired pneumonia is characterized by:* Sign and symptoms of acquired lung infection--fever, hypothermia, cough with or without sputum, dyspnea, sweat/rigors.* Bronchial breath sounds, rales.* Parenchymal infiltrate on chest radiograph.* Most common bacterial pathogen-- streptococcus pneumoniae in about two-thirds of cases.> Other pathogens--H. influenza Mycoplasma, Pneumoniae, Chlamydia, Pneumoniae, Staph, aureus, N. meningitidis Klebsiella pneumoniae.


Question: Normal ESR with elevated CRP is seen in some cases of

Investigations in PMR and GCA The typical laboratory abnormality is an elevated ESR, often with a normochromic, normocytic anaemia. CRP may also be elevated and abnormal liver function can occur. Rarely, PMR and GCA can present with a normal ESR. More objective evidence for GCA should be obtained whenever possible. There are three investigations to consider: temporal aery biopsy, ultrasound of the temporal aeries and 19fluorodeoxyglucose positron emission tomography (19FDG PET scan). Characteristic biopsy findings are fragmentation of the internal elastic lamina with necrosis of the media in combination with a mixed inflammatory cell infiltrate. Diagnostic yield is highest with multiple biopsies and multiple section analysis (to detect 'skip' lesions). A negative biopsy does not exclude the diagnosis. On ultrasound examination, affected temporal aeries show a 'halo' sign. A strongly positive 19FDG PET scan is highly specific but sensitivity is low. Caution is needed in interpreting weakly positive images. Low-grade vascular uptake may occur in atheromatous aerial disease. Ref Davidsons 23e p1042


Question: Best for diagnosing carcinoid tumour is

Conventional tumour pathology criteria and dna cytometry have limited value in assessing the malignancy of a neuroendocrine tumour. Hence, the detection of substances that are more specific for carcinoid tumours can facilitate a more exact diagnosis. Two markers are primarily used to diagnose and follow carcinoid tumours: 5-hydroxy-indole-acetic acid (5-hiaa) and chromogranin A (CgA). Serotonin released by carcinoid tumours is metabolized by monoamine oxidases in the liver, lungs, and brain to 5-hiaa. When measured in a 24-hour urine sample, 5-hiaa level has a sensitivity of 73% and a specificity of 100% for diagnosing carcinoid . The normal range for urinary 5-hiaa is 3-15 mg/24 h, but the figure may vary depending on the laboratory . Chromogranin A is found in the wall of synaptic vesicles that store serotonin and glucagons. Levels of CgA tend to correlate with tumour bulk but not with symptoms. In general, CgA levels are elevated in 85%-100% of patients with carcinoid tumour, regardless of whether the tumour is functional or nonfunctional. Ref - pubmed.com


Question: Sulphasalazine is NOT used for the treatment of


Question: Acute Infective Endocarditis with abscess formation is most commonly associated with

Answer is B (Staphylococcus) Acute Infective Endocarditis with abscess formation is most commonly associated with staphylococcus. `The most common organism causing acute infective endocarditis overall is staphylococcus aureus. Staphylococcus aureus endocarditis is paicularly virulent and associated with annular and myocardial abscess formation and a higher moality'


Question: The submerged pa of cerebral coex is

Answer- A. InsulaFunctions of insulaInsula provides an emotional context that is suitable for a given sensory experience.It has also been shown to be associated with pain processes as well as with several basic emotions such as anger, fear, disgust, joy.


Question: Drug not used in multiple sclerosis

*beta interferons act as immune modulators ,given as subcutaneous or I.M route ,help to reduce relapse rate *glatiramer acetate is parentrally administered ,act as competitor antigen ,help to reduce relapse rate of MS. Ref Harrison20th edition pg 2234


Question: After a transient ischemic attack, chances of stroke are maximum in

Answer-A. First 48 hoursThe largest study of risk of recurrent stroke after TIA showed that 50% of all ischemic strokes after TIA occur within 48 hours of the TIA.TIAs are episodes of stroke symptoms that last only briefly < 24h, but most TIAs last < 1 h.The risk of stroke after a TlA is- 1O - 15% in the first 3 months,with most events occurring in the first 2days.


Question: Brain abscess in cyanotic hea disease is commonly, located in

The most common microbe in children with cyanotic congenital hea disease was of the Streptococcus milleri group (52%). Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere Ref Harrison20th edition pg 2567


Question: Lambe Eaton syndrome is associated with

Lambe-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder that is characterized by muscle weakness of the limbs. Lambe-Eaton myasthenic syndrome is caused by autoantibodies to the presynaptic membrane. Myasthenia gravis is caused by autoantibodies to the postsynaptic acetylcholine receptors.Around 60% of those with LEMS have an underlying malignancy, most commonly small cell lung cancer Ref Harrison20th edition pg 2345


Question: Ankylosing spondylitis may be associated with


Question: Neutropenia is not a feature of

Ans: c) Congenital asplenia1) X linked Immmunodeficiency with Hyper IgM syndrome* Defective isotype switching leads to increased Ig M and decreased Ig G and A* Due to abnormal CD- 40 ligand leading to defective B-T cell interactions: so T cell response is also abnormal (pneumocytosis, aspergillosis, CMV infections also)* Neutropenia is frequent in affected males (Harrison 17th edition)* Defective NFK^ essential modulator (NEMO) causes Hyper IgM with ectodermal dysplasia* Achranon induced cytidine deaminase (AID), URAGIDNA glycosylase (UNG). So Hyper IgM may be due to abnormal CD 40 C/ NEMO/AID/UNG.2) Wiskott Aldrich syndrome:* Eczema (increased IgE); thrombocytopenia (small and short lived) and infections (decreased IgM; T cell deficiency)* WASP gene mutation* IgM is low; IgG and A normal; IgE increased* Lymphoreticular malignancy* Failure to make Antibody to polysaccharide antigen (protein antigen also if advanced)* Neutropenia; defective chemotaxis of neutrophils also may be seen.3) Kostmann syndrome:Is a hereditary neutropenic syndrome due to mutation in anti-apoptosin gene HAX -1.Other Congenital Neutropenias:Mutation Neutrophil elastase: Severe chronic neutropeniaHereditary cyclic neutropeniaCartilage hair hypoplasia syndromeSchwachmann - Diamond syndromeWHIM syndrome;G-CSF receptor mutation associated with Wiskott Aldrich CD-40 L defect (Harrison 17th edition)Congenital asplenia: is a cause of NeutrophiliaJob's syndrome:Hyper IgE recurrent infection syndrome (eczema, skin abscess, Staphylococcus aureus pneumonia)


Question: A 23 year old male has presented with repeated episodes of hematemesis. There is no history of jaudice or liver decompensation. On examination ther significant findings include splenomegaly (8 ems below costal margin), and presence of esophageal varices. There is no ascites or peptic ulceration. The liver function tests are normal. The most likely diagnosis is

Answer is B (Non cirrhotic poal fibrosis) : Features of poal hypeension in an adult with a large splenomegaly (8cm below coastal margin) with no history of jaundice or liver decompensation suggests a diagnosis of Non-cirrhotic poal hypeension. Non cirrhotic poal hypeension encompasses two distinct pathological condition that present with similar clinical features. Distinction between the two conditions should ideally he made byliwther investigations as the similarly in presentation makes clinical criteria unreliable. Nevehless if we do have to choose one single best option the following clues may be helpfitl. NCPF NCPF presents in young adults most commonly during the third and fouh decade Mode of presentation The onset of symptoms is gradual Mass in left upper quadrant (splenomegaly) is about 4 times more common in NCPF than EHPH Extrahepatic poal hypeension llPH may present in two age groups children (Ist & 2nd decade) (congenital malformations) Adults (4th & 5th decade) (thrombotic event) The onset is gradual in children where the cause is congenital malformation The onset is acute in adults where the cause is usually a thrombotic even Mass in left upper quadrant (splenomegaly) is four times less common in patients with EHPH Thus a young adult presenting with a gradually progressive cause and a moderate to massive splenomegaly suggests the diagnosis of Non cirrhotic poal fibrosis.

Hepatic venous outflow tract obstruction


Question: The most common cause of Pulmonary thromboembolism

The most common cause of pulmonary thromboembolism is deep venous thrombosis.


Question: iloprost used in pulmonary hypeension

Pulmonary hypeension is incurable but new treatments have delivered significant improvements in exercise performance, symptoms and prognosis. Allpatients should be anticoagulated with warfarin, and oxygen, diuretics and digoxin prescribed as appropriate. Specific treatment options include high-dose calcium channel blockers, prostaglandins such as epoprostenol (prostacyclin) or iloprost therapy inhalation , the PDE5 inhibitor sildenafil, and the oral endothelin antagonist bosentan. ref:davidsson&;s principles and practices medicine,21 st ed,pg no 702


Question: Water Deprivation Test is used to assess

Answer is C (Distal Tubular Function) Water Deprivation Test is used to assess Distal Tubular Function. Water Deprivation Test Water deprivation test is used to assess the tubule's ability to concentrate urine. When a normal person is deprived of water, ADH secretion occurs, which acts on the distal tubule and collecting ducts, making them freely permeable to water, allowing reabsorption of water from these segments, thereby producing concentrated urine. Inability to concentrate urine during the water deprivation test thereby suggests dysfinction of distal tubules and helps to identifi, nephrogenic diabetes insipidus.


Question: Tendon Xanthomas are seen in


Question: Most common pathogen causing, pulmonary infection in cystic fibrosis in infants & young children is

Answer is A (Staphylococcus Aureus): Staphylococcus Aureus (Methicillin sensitive) are the most common pathogen isolated in sputum of children with cystic fibrosis during the first decade. The most prevalent pathogen to cause pulmonary infection in cystic fibrous during childhood is staphylococcus aureus. Pseudomonas aeroginosa becomes the most common organism in adolescents and adults. Hemophilus influenza is also seen in early life (2-5 years) and its frequency decreases with age. Bukholderia capacia is also infrequent but its incidence increase with age. Stenotrophomonos is an infrequent organism seen at any age. - USMLE Step III: Review/Q1 Case 7 The most common cause of pneumonia in a patient with cystic, fibroses is Pseudomonas aeroginosa, but initial infection is most often due to staphylococcus aureus'- Microbiology: Pearls of Wisdom' by Booth (Jones & Barlett) 2000/203 Bronchial Ademoma and Bronchial Cysts


Question: Most common cause of malabsorption in our country is

Coeliac disease or coeliac sprue inflammatory disorder of the small bowel occurring in genetically susceptible individuals, which results from intolerance to wheat gluten and similar proteins found in rye, barley and, to a lesser extent, oats. It can result in malabsorption and responds to a gluten-free diet. The condition occurs worldwide but is more common in nohern Europe. The prevalence in the UK is approximately 1%, although 50% of these people are asymptomatic. These include both undiagnosed 'silent' cases of the disease and cases of 'latent' coeliac disease - genetically susceptible people who may later develop clinical Ref Davidson edition23rd pg 805


Question: First heart sound is loud in

(C) Mitral stenosis with friable valves # Loud S1 (Cannon sound)> Intensity of the First heart sound (S1) is influenced by: Position of the mitral leaflets at the onset of ventricular systole Rate of rise of the left ventricular pressure pulse Presence or absence of structural disease of the mitral valve Amount of tissue, air, or fluid between the heart and the stethoscope.> S1 is louder if diastole is shortened because of tachycardia, if AV flow is increased because of high cardiac output or prolonged because of mitral stenosis, or if atrial contraction precedes ventricular contraction by an unusually short interval, reflected in a short PR interval> Loud S1 in mitral stenosis usually signifies that the valve is pliable and that it remains open at the onset of isovolumetric contraction because of the elevated left atrial pressure.> A soft S1 may be due to poor conduction of sound through the chest wall, a slow rise of the left ventricular pressure pulse, a long PR interval, or imperfect closure due to reduced valve substance, as in mitral regurgitation.> Reversed splitting of the S1, in which the mitral component follows Tricuspid component, may be present in patients with severe mitral stenosis, left atrial myxoma, and left bundle branch block.


Question: 'Huhle cells' are seen in

Answer is B (Hashimoto's Thyroiditis) "The thyroid follicles are small and are lined by epithelial cells with abundant eosinophilic granular cytoplasm termed as Huhk cells" Huhle cells may be seen in : Hashimoto's Thyroiditis Q -Robbins 6th / 1135 Huhle cell Thyroid adenoma Q -Robbins 6th/1141 Follicular cell carcinomas Q -Bailey 23rd / 728 "Huhle cell tumors are a variant of Follicular neoplasms in which oxyphill or Huhle /Ashkenazi cells predominate" - Bailey


Question: Commonest histological Variety of  nephrotic syndrome in children is

M/C in adults  - membranous.
M/C in children - Minimal change disease.


Question: Most common site of intracranial hemorrhage in hepeensive hemorrhage is

*The most common site for hypeensive hemorrhage is basal ganglia,cerebellum,thalamus,pons. Ref Harrison20th edition pg 2345


Question: Left Axis Detion is seen are

Ans. is 'b' i.e., B Positive in Lead I and Negative in Lead II The normal QRS axis lies between -30deg and + 90". Left axis detion is conventionally diagnosed when QRS axis lies more leftward negative than -30". A quick way to assess QRS axis is to look at leads I and II. If the QRS axis is positive in leads 1 and II then the axis is normal. If the QRS complex positive in lead I and negative in lead II left axis detion. If the QRS complex is negative in lead I and positive in lead II right axis detion. Negative QRS complexes in both leads I and II most commonly indicates -4 incorrect positioning of the limb electrodes.

A Positive in Lead I and Positive in Lead 11

C Negative in Lead I and Negative in Lead II

D Negative in Lead I and Positive in Lead II