Medicine
Q-1. Which of these complications of stroke need not be treated and may actually be beneficial to the patient?
a) Fever
b) Dysphagia
c) Spasticity
d) Neglect
Answer: Neglect (Most correct answer)
Explanation:
Neglect occurs most frequently in left hemi-sphere in association with lesions of the right hemisphere (Non dominant hemisphere).
Important point:
Probably the dominant hemisphere responsible for various motor functions is preserved.
Q-2. A 12-year girl presented with on and off abdominal colic for 1 year, aggressive behavior, and para-paresis for 2 days. What is the likely diagnosis?
a) Conversion disorder
b) Mitochondrial disorder
c) Acute inflammatory demyelinating paralysis
d) Acute intermittent porphyria
Answer: Acute intermittent porphyria
Explanation:
Acute intermittent porphyria:
Hereditary hepatic porphyrias (Autosomal dominant)
The deficient enzyme- Porphobilinogen deaminase (PBGD), also known as hydroxy-methyl-bilane synthase (HMB synthase)
Manifests after puberty, especially in women (due to hormonal influences)
Features of Acute intermittent porphyria:
Off and on abdominal pain associated with nausea and vomiting
Constipation
Pain in the back, arms and legs
Muscle weakness (due to effects on nerves supplying the muscles)
Urinary retention
Tachycardia and hypertension
Confusion, hallucinations and seizures
Q-3. A 50-year-old male presented with frontal bossing, enlarged nasal bone, enlarged jaw and spade like fingers. What is the best test to correctly diagnose this patient?
a) IGF1
b) TSH
c) ACTH
d) S. Cortisol
Answer: IGF1
Explanation:
Clinical features of Acromegaly:
Frontal bossing
Enlarged nasal bone
Enlarged jaw and
Spade like fingers
Important point:
Screening investigation of choice: IGF-1
Confirmatory and gold standard: Oral glucose tolerance test
Measurement of single random GH is not useful due to pulsatile GH secretion.
Q-4. A patient presents with ascending muscle weakness for 2 days. On examination, the limb is flaccid. What investigation should be done first?
a) Serum Potassium
b) Serum Mg
c) Serum Creatinine
d) Serum Calcium
Answer: Serum Potassium
Explanation:
Hypokalemia may cause flaccid ascending paralysis.
Important point:
Hypo-calcemia and hypomagnesaemia usually cause tetany.
Q-5. A patient had a femur fracture for which internal fixation was done. 2 days later, the patient developed sudden onset shortness of breath with low grade fever. What is the likely cause?
a) Pneumothorax
b) Pleural effusion
c) Fat embolism
d) Congestive cardiac failure
Answer: Fat embolism
Explanation:
Clinical features of fat embolism:
Hyperpyrexia
Tachycardia
Tachypnea, hypoxemia and hypercapnia
Thrombocytopenia
Occasional mild neurological symptoms
Q-6. Patient presented with fever and altered sensorium. You suspect meningococcal septicemia. Which of the following antibiotic is recommended as the first line for empiric therapy?
a) Ceftriaxone
b) Penicillin G
c) Piperacillin -Tazobactam
d) Cotrimoxazole
Answer: Ceftriaxone
Explanation:
Treatment of meningococcal septicemia:
Third generation cephalosporin ceftriaxone 75-100 mg/kg/day or
Cefotaxime 200 mg/kg/day
Q-7. A 32-year-old epileptic patient was controlled on levetiracetam 1000 mg twice daily for last two years. He recently started to develop anger and aggressive behavior as an intolerable side effect and it was affecting his quality of life. What should be done next?
a) Gradually taper levetiracetam over 6 months
b) Stop levetiracetam immediately
c) Continue at the same dose till 5 years
d) Stop the drug and start another anti-epileptic
Answer: Gradually taper levetiracetam over 6 months
Explanation:
Levetiracetam is used to treat seizures. The most common adverse effects of levetiracetam treatment include CNS effects (Aggression, agitation, anger, anxiety, apathy, neurosis, headache and drowsiness).
Important point:
Anti-epileptic drugs should be tapered slowly over months to prevent breakthrough seizures.
Q-8. ’a’ wave in Jugular venous pulse represents:
a) Passive atrial filling
b) Right atrial contraction
c) Ventricular filling
d) Ventricular relaxation
Answer: Right atrial contraction
Explanation:
Jugular venous pulse waves:
‘a’ wave: Right atrial pre-systolic contraction
‘c’ wave: Carotid pulsation in neck
‘x’ descendent: Atrial relaxation
‘v’ wave: Atrial filling during ventricular systole
‘y’ descendent: Diastolic ventricular filling
Q-9. Window period for thrombolysis in a stroke patient is:
a) 1.5 hours
b) 2.5 hours
c) 4.5 hours
d) 3.5 hours
Answer: 4.5 hours
Explanation:
The window period for effective thrombolysis is four and a half hours from the onset of the stroke.
Q-10. A 70-year-old male patient presents with amblyopia, Exertional chest pain, episodic tachycardia and extra systoles on ECG. What is the probable cause?
a) Cocaine poisoning
b) Chronic nicotine poisoning
c) Arseno-phagia
d) Cannabis ingestion
Answer: Chronic nicotine poisoning
Explanation:
Chronic nicotine poisoning:
Tobacco amblyopia
Exertional chest pain, episodic tachycardia and extra systoles on ECG
Coronary thrombosis
Q-11. A patient presents with syncope. He has a serum potassium level of 5.4 meq /dL and ECG is showing ventricular tachycardia. What will be the drug of choice?
a) Amitriptyline
b) Lignocaine
c) Digoxin
d) Adenosine
Answer: Lignocaine
Explanation:
Management of ventricular tachycardia:
Correction of hypokalemia
DOC for VT is amiodarone but lignocaine can be given in VT.
Important point:
Amitriptyline can itself causes VT and contraindicated in VT.
Q-12. A patient after motor vehicle accident develops breathing difficulty. His blood pressure in 120/80 mm Hg and Glasgow coma score of 15. On examination, there are decreased breath sounds on the right side, trachea is shifted to the left and heart sounds are present. What will be the first step in management?
a) Needle thoracostomy
b) Pericardiocentesis
c) Chest tube insertion and drainage
d) Immediate exploratory thoracotomy
Answer: Needle thoracostomy
Explanation:
Tension pneumothorax:
X-Ray chest: Findings
The diagnosis of pneumothorax is established by demonstrating the outer margin of the visceral pleura (and lung), known as the pleural line, separated from the parietal pleura (and chest wall) by a lucent gas space devoid of pulmonary vessels (Absence of vascular marking).
Deviation of the trachea away from the side of the tension
Ipsilateral increased intercostal spaces
Shift of the mediastinum
Depression of the hemi-diaphragm
Important point:
Classical management of tension pneumothorax is emergent chest decompression with needle thoracostomy.
A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line.
Q-13. A 50-year-old smoker and hypertensive was diagnosed to have non-small cell lung carcinoma with brain metastases. He is on Enalapril and hydrochlorothiazide for hypertension. On investigation, he had a serum sodium 120 mg/dL, urinary sodium 110 mg/dL, serum creatinine 0.8 mg/dL, serum osmolarity 285 mosm/ L, urinary osmolarity 350 mosm/L, urinary K+ 9 mg/dL, blood sugar 112 mg/dL and BP of 150/90 mm Hg. Which of the following is the most probable cause for his hypo-natremia?
a) Cerebral salt wasting
b) SIADH
c) Diuretic induced
d) Pseudo-hypo-natremia
Answer: SIADH
Explanation:
Clinical diagnosis of SIADH:
Hypo-natremia and Decreased Plasma osmolality
Urine Na+ > 40 mEq/L and urine osmolality > 100 mOsm/Kg of water
Normal thyroid and adrenal function
Absence of heart, kidney or liver disease
Q-14. A young girl with APML on Day 3 of treatment develops tachypnea, weight gain and fever. Chest X-ray shows bilateral pulmonary infiltrates. What will be the management?
a) Dexamethasone
b) Dacarbazine
c) Cytarabine
d) Doxorubicin
Answer: Dexamethasone
Explanation:
All-trans-retinoic-acid (ATRA) is able to induce complete remission in almost all patients with acute pro-myelocytic leukemia (APML) through in vivo differentiation of APML blasts.
ATRA differentiation syndrome:
It is characterized by fever, peripheral edema (Weight gain), pulmonary opacities, hypoxemia, respiratory distress, hypotension, renal and hepatic dysfunction, rash, and serositis resulting in pleural and pericardial effusions.
Treatment of ATRA differentiation syndrome:
Intravenous dexamethasone
Diuretics to treat acute renal failure and weight gain
Q-15. A man falls in front of the liquor shop and becomes unconscious, He has a fast pulse, feeble respiratory rate and slurring of speech. When he woke up, he was normal but had amnesia and did not remember what happened the previous night. What is the likely explanation?
a) Delirium
b) Drunkenness
c) Concussion
d) Brain tumor
Answer: Drunkenness
Explanation:
Features of drunkenness:
Blackout
Episode of temporary antero-grade amnesia
Impaired judgment and coordination
Headache, nausea, vomiting and fatigue
Peripheral neuropathy and cerebellar degeneration
Wernicke’s syndrome (Ophthalmo-paresis, ataxia and encephalopathy), Korsakoff’s syndrome (Retrograde and ante-grade amnesia)
Auditory hallucination and paranoid delusion
Q-16. The definition of pyrexia of unknown origin in includes all except:
a) Diagnosis requires fever persisting for 3 weeks
b) Fever undiagnosed after 1 week of in-patient work up
c) Absence of immunological compromise
d) Temperature of 38.3 degree C or more
Answer: Fever undiagnosed after 1 week of in-patient work up
Explanation:
Pyrexia of unknown origin:
A temperature greater than 38.3 degree C (101 degree F) on several occasions,
More than 3 weeks’ duration of illness
Failure to reach a diagnosis despite one week of inpatient investigation
Absence of immunological compromise
Q-17. A patient has TSH elevated above normal and sub normal free T4. What is the likely diagnosis?
a) Primary hypothyroidism
b) Secondary hypothyroidism
c) Hyperthyroidism
d) Subclinical hypothyroidism
Answer: Primary hypothyroidism
Explanation:
Subclinical hypothyroidism:
Elevated TSH with normal free T3/T4
Primary Hypothyroidism:
Elevated TSH with decreased or subnormal free T3/T4
Secondary Hypothyroidism:
Decreased TSH with decreased free T3/T4
Q-18. A 45-year-old man presents with NYHA Class III breathlessness with a serum creatinine of 2.5 mg/dL and potassium level of 4.5 mEq/ L. Which of the following drug is contraindicated?
a) Carvedilol
b) Spironolactone
c) Enalapril
d) Digoxin
Answer: Spironolactone
Explanation:
Spironolactone is contraindicated in deranged renal function or renal failure due risk of hyper-kalemia.
Important point:
Spironolactone is potassium sparing diuretics.