Q-1. A 65 year old female Kamala gives the history of severe unilateral headache on the right side and complains of blindness since 2 days. On examination there is a thick cord like structure on the lateral side of the head. The ESR is 80 mm/Hr in the first hour. The most likely diagnosis is
a) Temporal arteritis
b) Migraine
c) Cluster headache
d) Sinusitis
Ans: Temporal arteritis
Explanation:
Headache is the most common chief complaint and presents in over two thirds of patients with temporal arteritis.
Superficial temporal artery involvement can lead to severe scalp tenderness during such simple acts as resting the head on a pillow, combing hair, or wearing hats and eyeglasses. Patients may also present with visible areas of scalp necrosis.
Similarly, jaw claudication while speaking or chewing is observed in patients with involvement of the maxillary artery, which can occur in half of patients with temporal arteritis.
Visual loss may also be a presenting symptom and can be sudden and painless. Initial visual symptoms are usually transient and intermittent, typically manifesting as unilateral visual loss or occasionally diplopia. However, if left untreated, permanent blindness frequently results.
Most patients with temporal arteritis have an ESR greater than 80 mm/h. However, up to 20% of patients with temporal arteritis may have a normal or low ESR, and thus a normal ESR level cannot exclude a diagnosis of temporal arteritis. CRP has been found to be elevated in patients with temporal arteritis, even in patients with a normal ESR.
Q-2. Renal damage due to Amphotericin B are all except
a) Azotemia
b) Renal tubular acidosis
c) Glomerulo-nephritis
d) Hypo-kalemia
Ans: c
Explanation:
Amphotericin B-induced nephro-toxicity is manifested as azotaemia, renal tubular acidosis, impaired renal concentrating ability and electrolyte abnormalities like hypo-kalemia and sodium and magnesium wasting. All these abnormalities occur to varying degrees in almost all patients receiving the drug. Upon withdrawal of therapy renal function gradually returns to baseline, although in some instances permanent damage is sustained.
Q-3. For comparison grading of pain the scale used is
a) Face’s scale
b) CHEOPES
c) Numerical charts
d) Visual scale
Ans: d
Explanation:
The visual analog and numeric rating scales are simple reporting instruments that can accurately quantify a patient’s subjective pain for the clinician.
The validity of the 10 centimeter visual analog scale has been established and there is evidence that the 10 centimeter scale graded into one centimeter intervals with small markings on the horizontal line is more reliable.
Q-4. Narcolepsy is characterized by all of the following except
a) Sleep paralysis
b) Cataplexy
c) Hallucination
d) Snoring
Ans: Snoring
Explanation:
Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks. Narcolepsy symptoms usually first occur during ages 15 to 30.
Symptoms:
Periods of extreme drowsiness during the day
Sleep paralysis
Cataplexy- A sudden loss of muscle tone while awake that makes you unable to move
Hallucinations: Hypnogogic and hypnopompic hallucination
Multiple Sleep Latency Test (MSLT) to see how long it takes you to fall asleep during a daytime nap.
Q-5. A high amylase level in pleural fluid suggests a diagnosis of
a) Malignancy
b) Tuberculosis
c) Rheumatoid arthritis
d) Pulmonary infarct
Ans: a
Explanation:
Amylase levels elevated in pleural effusions are found in three categories- Pancreatitis with or without pseudo-cyst formation or a direct pancreatic-pleural fistula, rupture of the esophagus, malignancy. Lung cancer and adeno-carcinoma are the most common tumor and histologic type associated with high amylase level in pleural fluid.
Q-6. A normal anion gap metabolic acidosis occurs in patients with
a) Diarrhoea
b) Diabetic keto-acidosis
c) Methyl alcohol poisoning
d) Acute renal failure
Ans: a
Explanation:
Causes of non-anionic gap acidosis
Gastrointestinal bicarbonate loss
Diarrhoea
External pancreatic or small bowel drainage
Drugs induced diarrhoea- Magnesium sulfate and cholestyramine
Acidifying agent- Calcium carbonate
Renal acidosis
Hyper-kalemia
Hypo-kalemia
Drugs induced hyper-kalemia
Potassium sparing diuretics
Trimethoprim
ACE inhibitors and AT-II receptor blockers
NSAID
Other
Rapid saline administration
Q-7. Carcinoid tumor is most common in
a) Esophagus
b) Stomach
c) Jejunum
d) Appendix
Ans: d
Explanation:
Incidence rates for carcinoid tumors have changed; the most common gastrointestinal site is not the appendix, but the small intestine often in terminal ileum, followed in frequency by the rectum, the colon, the appendix, and the stomach.
Most common site for Carcinoid tumor in body- Small intestine
Most common site for Carcinoid tumor in GI Tract- Terminal ileum
Q-8 Which one of the following is not a prion associated disease?
a) Kuru
b) Scrapie
c) Alzheimer’s disease
d) C J disease
Ans: c
Explanation:
Prion associated disease:
The prion diseases are a large group of related neurodegenerative conditions, which affect both animals and humans Included are Creutzfeldt-Jakob disease (CJD), Kuru and Gerstmann-Sträussler-Scheinker (GSS) in humans, bovine spongiform encephalopathy (BSE, or “mad cow disease”) in cattle, chronic wasting disease (CWD) in mule deer and elk, and Scrapie in sheep.
Q-9. The most common side effect of chemotherapy administration is-
a) Nausea
b) Alopecia
c) Myelo-suppression
d) Renal distinction
Answer: Nausea
Explanation:
One of the most commonly known side effects of chemotherapy is nausea and vomiting.
Other common side effects:
Fatigue- Fatigue or tiredness is a common side effect of chemotherapy. Almost everyone who has chemotherapy will experience fatigue.
Hair Loss
Infection
Anemia
Secondary neoplasm
Infertility
Terato-genicity
Peripheral neuropathy
Cognitive impairment
Tumor lysis syndrome
Q-10. Henoch Schonlein Purpura is characterized by the deposition of following immunoglobulin around the vessels
a) IgM
b) IgG
c) IgA
d) IgE
Answer: IgA
Explanation:
Henoch-Schonlein purpura (HSP) is an acute immunoglobulin A (IgA)–mediated disorder characterized by a generalized vasculitis involving the small vessels of the skin, the gastrointestinal (GI) tract, the kidneys, the joints, and, rarely, the lungs and the central nervous system (CNS).
Direct immuno-fluorescence (DIF): Immuno-fluorescence studies reveal peri-vascular IgA deposition in almost all patients:
This finding is rare in infantile HSP, in which C3 and IgM are most commonly found in the affected vessel walls.
Renal histology: In most patients, IgA deposits in the mesangium.
Q-11. A 30 year old male resents with numbness of both lower limbs and right upper limb. Examination reveals pulse 88/ minute and B P – 160/110 mm of Hg. He also has digital gangrene involving right 2nd and 3rd finger, urine routine examination is unremarkable. Microscopic examination shows RBC’s Hemogram and serum biochemistry is within normal limits. What is the most probable diagnosis?
a) Systemic lupus erythematosus
b) Polyarteritis nodosa
c) Malignant Hypertension
d) Chrug-Strauss syndrome
Answer: Polyarteritis nodosa
Explanation:
Classic poly-arteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium-sized and small muscular arteries.
Neurologic symptoms:
Sensory and/or motor neuropathies- usually asymmetrical
Mono-neuritis multiplex: This is the successive ischemia or infarction of “named nerves” (e.g., ulnar, radial, peroneal, sural).
Although nerve involvement is initially asymmetrical, the development of additional nerve lesions can cause the clinical picture to resemble symmetrical poly-neuropathy.
CNS involvement – Although rare (≤10% of cases), encephalopathy, focal deficits, strokes, seizures, and, sometimes, brain hemorrhages can occur.
Cutaneous symptoms:
Livedo reticularis
Ulcerations – Especially on the lower extremities, near the malleoli and on the calf
Digital ischemia
Nodules – Usually on the lower extremities
Gastrointestinal symptoms:
Tender abdomen with or without rigidity, guarding, or diminished bowel sounds
GI bleeding
Bowel infarction
Cholecystitis
Renal symptoms:
Hypertension
Costophrenic tenderness
Retroperitoneal or intra-peritoneal hemorrhage
Renal failure
Cardiac symptoms:
Hypertension
Tachycardia out of proportion to fever
Pericardial friction rub
Arrhythmias
Congestive heart failure
Ophthalmologic symptoms:
Retinal vasculitis
Retinal detachment
Cotton-wool spots
Q-12. Ham’s test is useful for the detection of
a) Mannose binding protein
b) Spectrin defect
c) PNH
d) GPI anchor protein
Answer: PNH
Explanation:
The Ham test is a test used in the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH).
Ham’s test relies on the principle that complements attach to RBCs at a moderately acidic pH.
Positive test result shows lysis of Red cells in acidified serum samples with patient’s cell (not with normal cells).
Q-13. Most common site of intracranial hemorrhage in hypertensive hemorrhage is:
a) Basal ganglia
b) Brainstem
c) Cerebellum
d) Hippocampus
Answer: Basal ganglia
Explanation:
Hypertensive intra-cerebral hemorrhages are common. In fact hypertension is the most common cause of intra-cerebral hemorrhages. They can be conveniently divided according to their typical locations which include, in order of frequency:
Basal ganglia hemorrhage (especially the putamen)
Thalamic hemorrhage
Pontine hemorrhage
Cerebellar hemorrhage
Q-14. VHL (Von Hippel Lindau) syndrome includes all except:
a) Endolymphatic sac tumors
b) Pheochromocytoma
c) Hemangioendotheliomas
d) Islet cell tumors
Answer: Hemangioendotheliomas
Explanation:
Von Hippel–Lindau (VHL) disease is a rare, autosomal dominant genetic condition that predisposes individuals to benign and malignant tumors.
The most common tumors found in VHL are central nervous system and retinal hemangioblastomas, clear cell renal carcinomas, pheochromocytomas, pancreatic neuro-endocrine tumors, pancreatic cysts, endo-lymphatic sac tumors and epididymal papillary cystadenomas.
VHL results from a mutation in the von Hippel–Lindau tumor suppressor gene on chromosome 3p25.3.
Q-15. Post transplant lymphoma is
a) T cell
b) B cell
c) Null cell
d) NK cell
Answer: B cell
Explanation:
Post-transplant lymphoproliferative disease (PTLD) is a well-recognized complication of both solid organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT).
It is one of the most common post-transplant malignancies.
In most cases, PTLD is associated with Epstein-Barr virus (EBV) infection of B cells, either as a consequence of reactivation of the virus post-transplantation or from primary EBV infection.
While T-cell lymphoproliferative disorders that are not typically associated with EBV infection also occur after SOT and HSCT, the vast majority are B-cell proliferations.
Q-16. Antibody found in myositis is
a) Anti jo-1
b) Anti scl 70
c) Anti Sm
d) Anti Ku
Answer: Anti jo-1
Explanation:
Myositis-specific auto-antibodies (MSAs):
Aminoacyl-tRNA synthetases (ARSs) are the enzymes that catalyze the binding of amino acids to their corresponding t-RNAs.
Six different auto-antibodies reacting with different ARSs have been identified so far: anti-Jo-1, anti-PL-7, anti-PL-12, anti-EJ, anti-OJ and anti-KS in myositis.
With a few exceptions, each patient has only one of these auto-antibodies.
Patients with anti-SRP (Anti-signal Recognition Particle Antibody) antibody show severe myositis: severe muscle weakness resulting in marked disability, dysphagia and highly elevated levels of serum creatine kinase, with relatively acute onset.
Other auto-antibodies- Anti-Mi-2, Anti-CADM-140, Anti-p155
Q-17. Beevor sign is seen in
a) Abdominal muscle
b) Respiratory muscle
c) Facial muscle
d) Hand muscle
Answer: Abdominal muscle
Explanation:
Beevor’s sign is medical sign seen in the selective weakness of the lower abdominal muscles, involving the movement of the umbilicus towards the head on flexing the neck.
Beevor’s sign is characteristic of spinal cord injury between T10 and T12 levels.
This occurs when the upper part of the Rectus abdominis muscle is intact but the lower part is weak because of the spinal injury.
The sign has also been observed in amyotrophic lateral sclerosis and in facioscapulohumeral muscular dystrophy.
Q-18. Hyperkalemia without ECG changes treated with all except:-
a) Calcium gluconate
b) Resins
c) Na bicarbonate
d) Insulin with dextrose
Answer: Calcium gluconate
Explanation:
In the presence of hypotension or marked QRS widening, intravenous bicarbonate, calcium, and insulin given together with dextrose may be given.
Calcium usually is not indicated in hyper-kalemia without ECG changes or only peaked T waves.
Avoid calcium if digoxin toxicity is suspected. Magnesium sulfate (2 g over 5 min) may be used alternatively in the face of digoxin-toxic cardiac arrhythmias.
Q-19. All of the following are used in the treatment of Hyperkalemia except-
a) Calcium gluconate
b) NAHCO3
c) 50 ml of 50% dextrose
d) Salbutamol
Answer: 50 ml of 50% dextrose
Explanation:
Calcium increases threshold potential, thus restoring normal gradient between threshold potential and resting membrane potential, which is elevated abnormally in hyper-kalemia.
Glucose and insulin temporarily shift K+ into cells. Administration of hypertonic dextrose alone is not recommended.
Bicarbonate ion neutralizes hydrogen ions and raises urinary and blood pH.
Adrenergic agonist increases plasma insulin concentration, which may in turn help shift K+ into intracellular space.
Q-20. A girl presented with severe hyper-kalemia and peaked T waves on ECG. Fastest way of shifting potassium intra-cellularly is
a) Calcium gluconate IV
b) Oral resins
c) Insulin + glucose
d) Sodium bicarbonate
Answer: Insulin + glucose
Explanation:
Calcium gluconate:
Calcium increases threshold potential, thus restoring normal gradient between threshold potential and resting membrane potential, which is elevated abnormally in hyper-kalemia.
Calcium usually is not indicated in hyper-kalemia without ECG changes or only peaked T waves.
Avoid calcium if digoxin toxicity is suspected. Magnesium sulfate (2 g over 5 min) may be used alternatively in the face of digoxin-toxic cardiac arrhythmias.
Glucose and insulin:
Glucose and insulin temporarily shift K+ into cells.
Glucose and insulin is the fasted way to lower serum potassium.
Administration of hypertonic dextrose alone is not recommended.
Sodium bicarbonate:
Bicarbonate ion neutralizes hydrogen ions and raises urinary and blood pH.
Adrenergic agonist:
Adrenergic agonist increases plasma insulin concentration, which may in turn help shift K+ into intracellular space.
In the presence of hypotension or marked QRS widening, intravenous bicarbonate, calcium, and insulin given together with dextrose may be given.
Q-21. Horner’s syndrome is seen in all except
a) Carotid artery aneurysm
b) Medial medullary syndrome
c) Multiple sclerosis
d) Surgical treatment of Reynaud’s Syndrome
Answer: Medial medullary syndrome
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Causes of Horner syndrome:
First-order neuron lesions: Arnold-Chiari malformation, Basal meningitis (e.g., syphilis), Basal skull tumors, Wallenberg syndrome/lateral medullary syndrome, Demyelinating disease (e.g., multiple sclerosis), Lesions in the hypothalamus or medulla, Intra-pontine hemorrhage, Pituitary tumor, Syringomyelia
Neck trauma e.g., Surgical treatment of Reynaud’s Syndrome- Cervical symphathectomy
Horner syndrome occurring in association with spinal cord trauma suggests a high cervical cord lesion because it does not occur with lesions below T2 or T3
Second-order neuron lesions: Pan-coast tumor, Birth trauma with injury to lower brachial plexus, Cervical rib, Aneurysm or dissection of the aorta, Lesions of the subclavian or common carotid artery, Central venous catheterization, Trauma or surgical injury, Chest tubes, Lymph-adenopathy, Mandibular tooth abscess, Lesions of the middle ear and Neuroblastoma
Third-order neuron lesions: Internal carotid artery dissection, Raeder syndrome (para-trigeminal syndrome), Carotid cavernous fistula, Cluster or migraine headache and Herpes zoster
Q-22. Which one of the following about Horner’s syndrome is not correct?
a) Miosis
b) Anhidrosis
c) Hyper-chromatic iris
d) Apparent exophthalmos
Answer: Apparent exophthalmos
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Iris hetero-chromia (hetero-chromia iridis) – The affected iris may remain blue when the other iris changes to brown; this may be present if the lesion is in a child younger than 2 years but is uncommon in older patients.
Iris pigmentation is under sympathetic control during development, which is completed by the age of 2 years
Signs: Miosis, partial ptosis, anhidrosis, enophthalmos, loss of ciliospinal reflex and bloodshot conjunctiva
Q-23. Treatment of choice of Kawasaki disease
a) IV Immunoglobulin
b) Steroid
c) Dapsone
d) Methotrexate
Answer: IV Immunoglobulin
Explanation:
Kawasaki disease (KD) is an acute febrile vasculitic syndrome of early childhood that, although it has a good prognosis with treatment, can lead to death from coronary artery aneurysm (CAA) in a very small percentage of patients.
The principal goal of treatment is to prevent coronary artery disease and to relieve symptoms.
High dose of IV immunoglobulin along with aspirin reduces likelihood of coronary artery disease in Kawasaki disease.
Steroid-Typically in patients unresponsive to standard treatment
Q-24. Pseudo-tumor Cerebri is seen in
a) Obese Female of 20-40 years
b) Obese Male of 20-40 years
c) Thin Female of 50-60 years
d) Thin Male of 50-60 years
Answer: Obese Female of 20-40 years
Explanation:
Idiopathic intracranial hypertension or pseudo tumor cerebri, or benign intracranial hypertension is a disorder of unknown etiology that predominantly affects obese women of childbearing age.
The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papillo-edema, which may lead to progressive optic atrophy and blindness.
The main symptoms are headache, nausea, and vomiting, as well as pulsatile tinnitus, double vision and other visual symptoms. If untreated, it may lead to swelling of the optic disc in the eye, which can progress to vision loss.
Q-25. Type of wave in Metabolic Encephalopathy
a) Alpha
b) Beta
c) Gamma
d) Delta
Answer: Delta
Explanation:
An EEG showing diffuse slowing of the background and presence of triphasic waves is highly suggestive of a metabolic encephalopathy.
The most prominent component is a positive sharp wave that is preceded by a short-duration negative sharp wave and followed by a long-duration negative slow wave.
Though triphasic waves are most frequently mentioned in hepatic encephalopathy, they can also be seen in uremic encephalopathy, or even in aged psychiatric patients treated with lithium.
Delta waves are normally observed in adults in slow wave sleep. They are also seen normally in infants. Focal Delta waves occur with sub-cortical lesions, and in more general distribution with diffuse lesions of the brain, with metabolic encephalopathy.
Abnormal patterns of theta waves can be seen as a focal disturbance in sub-cortical lesions from trauma, and can be seen in generalized distribution in diffuse brain disorders, metabolic encephalopathy, deep midline disorders, and in some instances of hydrocephalus.
Q-26. Most common type spino-cerebral Ataxia in India is
a) SCA 1
b) SCA 2
c) SCA 3
d) SCA 4
Answer: SCA 2
Explanation:
Spinocerebellar ataxia (SCA) is one of a group of genetic disorders characterized by slowly progressive in-coordination of gait and is often associated with poor coordination of hands, speech, and eye movements.
Most common type spino-cerebral Ataxia in India is SCA 2.
Most common type spino-cerebral Ataxia in World is SCA 3.
Most common type spino-cerebral Ataxia in south is SCA 1.
Q-27. Fever Blister can occur due to:
a) Primary HSV-1 Infection
b) Varicella
c) Reactivation of HSV-1 Infection
d) CMV
Answer: Reactivation of HSV-1 Infection
Explanation:
Cold sores, sometimes called fever blisters, are groups of small blisters on the lip and around the mouth. The skin around the blisters is often red, swollen, and sore.
Cold sores and fever blisters are caused by the herpes simplex virus type 1 (HSV-1)
The first time HSV-1 invades the skin, it causes a primary infection, which usually occurs in childhood or adolescence. It may cause a fever, sore mouth and sore throat.
After this primary infection subsides, the virus remains dormant (inactive) indefinitely in nerve roots near the affected skin area.
In some people, the virus becomes active again from time to time and causes new active sores on the skin, usually on the lip.
These sores have become known as cold sores or fever blisters because the virus can be reactivated by a cold or fever.
Q-28. Blink reflex is used for
a) Mid pontine lesions
b) Neuro-muscular transmission
c) Axonal neuropathy
d) Motor neuron disease
Answer: Mid pontine lesions
Explanation:
The corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea.
The evolutionary purpose of this reflex is to protect the eyes from foreign bodies and bright lights (the latter known as the optical reflex).
The reflex is mediated by:
- The naso-ciliary branch of the ophthalmic branch (V1) of the 5th cranial nerve (trigeminal nerve) sensing the stimulus on the cornea, lid, or conjunctiva (i.e. it is the afferent).
- The temporal and zygomatic branches of the 7th cranial nerve (Facial nerve) initiating the motor response (i.e. it is the efferent).
- Mediated by centre in the pons of brainstem
Blink reflex study is a useful electro-physiological technique for evaluation of patient with involvement of trigeminal or facial nerve, variety demyelinating poly-neuropathies and central lesion in brain stem.
Q-29. All are major criteria for rheumatic fever except
a) Carditis
b) Subcutaneous nodule
c) Arthralgia
d) Chorea
Answer: Arthralgia
Explanation:
Jones Criteria for Diagnosis of Rheumatic Fever:
Major Diagnostic Criteria
Carditis
Poly-arthritis
Chorea
Erythema marginatum
Subcutaneous Nodules
Minor Diagnostic Criteria
Fever
Arthralgia
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
Diagnostic
Required Criteria- 2 major criteria and 0 minor criteria or 1 major criteria and 2 minor criteria
Q- 30. Blue sclera disease is
a) Marfan’s syndrome
b) Klinefelter’s syndrome
c) Osteogenesis imperfecta
d) Down’s syndrome
Answer: Osteogenesis imperfecta
Explanation:
Osteogenesis imperfecta:
Clinical features:
Severe osteoporosis
Spontaneous fracture occur in utero or during childhood
Blue sclera
Important points:
It is caused by a major mutation in the gene encoding for type I collagen, major collagen constituent of bone.
Certain polymorphism in this gene predisposes to hypo-gonadal or idiopathic osteoporosis.
Q- 31. HLA associated with myasthenia gravis is
a) B27
b) 1DR3
c) DR4
d) B8
Answer: DR3
Explanation:
Myasthenia gravis occurs at all ages, sometime associated with a thymic tumor or thyrotoxicosis as well as RA and lupus erythematous.
It is most common in young women, with HLA-DR3.
If thymoma is associated, older men are more commonly affected.
Q- 32. Shrinking lung syndrome is seen in
a) SLE
b) Systemic sclerosis
c) Polymyositis
d) Dermato-myositis
Answer: SLE (Most correct)
Explanation:
Shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus (SLE) characterized by unexplained dyspnea, a restrictive pattern on pulmonary function tests, and an elevated hemi-diaphragm.
But it is also associated with Sjögren’s syndrome and Polymyositis.
Steroids are proposed as first-line treatment, alone or associated with β2-adrenergic receptor agonists. In refractory cases, immuno-suppressors are used.
Q- 33. Glycosylated hemoglobin percentage which indicates good control of diabetes
a) 8%
b) 10%
c) 15%
d) 20%
Answer: 8%
Explanation:
Acceptable level of glycemic control:
Blood glucose- Fasting: 90-130 mg/dl
Blood glucose- PP: 150 mg/dl
HbA1C Level: < 7 % in non-pregnant adults HbA1C Level: < 8 % in elderly patients Q- 34. Felty’s syndrome comprises of all except a) Rheumatoid arthritis b) Splenomegaly c) Neutropenia d) Osteoarthritis Answer: Osteoarthritis Explanation: Felty syndrome: Immune neutropenia Sero-positive nodular RA Splenomegaly Q- 35. Water load test is helpful in diagnosis of a) Renal edema b) Addison’s disease c) Adrenogenital syndrome d) Congestive heart failure Answer: Addison’s disease Explanation: A water loading ADH suppression test may be used to help diagnose SIADH. With this test, those with SIADH typically have decreased blood sodium and osmolality. A simplified water-loading test is used for the diagnosis of Addison’s disease. Q- 36. Anion gap is not increased in a) Renal tubular acidosis b) Diabetic keto-acidosis c) Salicytates poisoning d) Starvation Answer: Renal tubular acidosis Explanation: The anion gap is the difference between primary measured cations (sodium Na+ and potassium K+) and the primary measured anions (chloride Cl- and bicarbonate HCO3-) in serum. The normal value for the serum anion gap is 6-12 mEq/L. Decreased anion gap: Hypo-albuminemia Plasma cell dyscrasias Bromide intoxication Increased anion gap: a. Metabolic anion Diabetic keto-acidosis Alcoholic keto-acidosis Lactate acidosis CKD (Advanced stage) Metabolic alkalosis Starvation b. Drug or chemical anion Salicylates intoxication Methanol Oxalic acid (Ethylene glycol) Sodium Carbenicillin Normal anion gap: Loss of HCO3_: Carbonic anhydrase inhibitors Ileostomy Diarrhoea Recovery from diabetic keto-acidosis Chloride retention: Renal tubular acidosis Ileal loop bladder Administration of HCl equivalent or NH4Cl: Arginine and lysine in parenteral nutrition Q- 37. Respiratory acidosis is seen with a) Diabetes keto-acidosis b) Pneumonia c) Emphysema d) Liver failure Answer: Emphysema Explanation: Respiratory acidosis results from hypo-ventilation and subsequent hypercapnia. Respiratory alkalosis occurs from hyperventilation and subsequent Hypocapnia. Respiratory acidosis: Central nervous system disease or drug-induced respiratory depression Neuromuscular disease or paralysis (Myasthenia gravis, GB syndrome) Airway obstruction (Asthma and COPD) Respiratory Alkalosis: a. Mechanical ventilation b. Hypoxia c. Pulmonary diseases: Interstitial lung disease Pneumonia Pulmonary edema and embolism d. CNS mediated disorders: Hyperventilation Neurologic diseases and tumors CVA Gram negative septicemia Heat exposure Hepatic failure Drugs and hormonal stimulation: Salicylates, nicotine, xanthine and progesterone (Pregnancy) Q- 38. Pneumatocele is commonest in a) Pneumococcal pneumonia b) Staphylococcal pneumonia c) H. influenzae pneumonia d) Viral pneumonia Answer: Staphylococcal pneumonia Explanation: Pulmonary Pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma. They can be single emphysematous lesions but are more often multiple, thin-walled, air-filled, cyst like cavities. Most often, they occur as sequelae to acute pneumonia, commonly caused by Staphylococcus aureus. Q- 39. Osmotic diarrhea is seen in a) Lactase deficiency b) Ulcerative sprue c) Cholera d) Bile salt enteropathy Answer: Lactase deficiency Explanation: Osmotic diarrhea: Normal stool osmolality < 50 mosm/kg Caused by ingestion (laxative) or mal-absorption of an osmotically active substances Q- 40. Superficial vein thrombosis involves cerebral white matter while deep thrombosis involving gray matter in a) Thalamus b) Internal capsule c) Basal ganglia d) Cerebellum e) Optic chiasma Answer: a and c Explanation: Deep venous thrombosis typically results in bilateral symmetrical involvement of thalami and occasionally basal ganglia. Causes of deep venous thrombosis: Oral contraceptives Pregnancy Infection Trauma Dehydration Unknown etiology (20-15 %)
Q-41. Incorrect statement (s) about small cell carcinoma of lung
a) Not associated smoking
b) Surgery is treatment of choice
c) Associated with para-neoplastic syndrome
d) Most patients have distant metastases on diagnosis
e) Contain neuro-secretory granules
Answer: a and b
Explanation:
Small cell lung cancer is a neuro-endocrine carcinoma that exhibits aggressive behavior, rapid growth, early spread to distant sites, exquisite sensitivity to chemotherapy and radiation, and frequent association with distinct para-neoplastic syndromes, including hyper-calcemia, Eaton-lambert syndrome, syndrome of inappropriate diuretic hormone, and many others.
The predominant cause of small cell lung cancer (SCLC) (and non-SCLC) is tobacco smoking.
Q-42. Features seen in Menkes disease is/are
a) Increased copper level
b) Decreased circulating cerulo-plasmin
c) Hypo-pigmented & brittle hair
d) Mental retardation
e) Failure to thrive
Answer: b, c, d and e
Explanation:
Menkes disease, also known as kinky hair disease, is an X-linked neurodegenerative disease of impaired copper transport.
Children with the classic form of Menkes disease usually present at 2-3 months of age with the following:
Loss of developmental milestones
Profound truncal hypotonia
Epilepsy
Failure to thrive
Kinky, colorless or steel colored hair
Q-43. Clubbing is/are seen in
a) Mesothelioma
b) Bronchial asthma
c) Idiopathic pulmonary fibrosis
d) TB
e) Sarcoidosis
Answer: a, c, d and e
Explanation:
Finger clubbing may be a clue to an underlying systemic disorder. Digital clubbing is classified into primary (i.e., idiopathic, hereditary) and secondary forms.
Finger clubbing associated with Underlying Systemic Diseases:
Cyanotic congenital heart disease
Infective endo-carditis
Variety of lung diseases
Metastatic lung carcinoma
Bronchiectasis
Asbestosis
Sarcoidosis
Lung abscess
Cystic fibrosis
Tuberculosis
Mesothelioma
Hepatic cirrhosis
In Jackhammer operators
Primary Hypertrophic Osteo-arthropathy
Q-44. Correct combinations are
a) Apnea: Airway blockage or on air entry through nasal aperture for ⪖ 10 sec
b) Hypopnea: ⪖ 10 sec events in which there is continued breathing but the ventilation is reduced by at least 50% from the previous baseline during sleep
c) Snoring: Occur from obstruction of lower airway
d) Apnea index: No of apnoeic episode/hr
e) Apnea-Hypocapnia index: 5-15 indicates mild obstruction
Answer: a, b, d and e
Explanation:
Apnea: Airway blockage or on air entry through nasal aperture for ⪖ 10 sec
Hypopnea: ⪖ 10 sec events in which there is continued breathing but the ventilation is reduced by at least 50% from the previous baseline during sleep
Apnea index: No of apnoeic episode/hr
Apnea-Hypocapnia index < 5/ hour: Normal Apnea-Hypocapnia index 10-15/ hour: Mild Apnea-Hypocapnia index 15-30/ hour: Moderate Apnea-Hypocapnia index > 30/ hour: Sever
Q-45. Hypernatremia is/are seen in
a) Severe brain trauma
b) Supra-sellar mass surgery
c) Judicious use of diuretics
d) Extensive burn
e) Intra-cerebral hemorrhage
Answer: a, b, d and e
Explanation:
Hypernatremia: Causes
Non-renal causes:
Fever, exercise, heat exposure, severe burn, mechanically ventilated patients and diarrhoea
Renal causes:
Osmotic diuresis (Over use)
Diabetes insipidus
Most common causes of central diabetes insipidus is destruction of neuro-hypophysis. This may occur as result of trauma, neurosurgery, granulomatous diseases, neoplasms, vascular accidents or infection.
Q-46. Causes of secretary diarrhea is/are
a) V. cholera
b) Laxatives use
c) Excess phenolphthalein intake
d) Ulcerative colitis
e) Pancreatic exocrine insufficiency
Answer: a, b and c
Explanation:
Ulcerative colitis- Inflammatory diarrhoea
Pancreatic exocrine insufficiency- Steatorrheal diarrhoea
Causes of secretary diarrhea:
Viral damage to mucosal epithelium
Bacterial Entero-toxin mediated
Excessive laxative use (Non-osmotic laxative use
Phenolphthalein)
Neoplastic conditions: Villous adenoma in distal colon and tumors elaborating peptides, serotonin and prostaglandins
Q-47. CRF can differentiated from ARF by presence of following feature in CRF
a) Normocytic normochromic Anemia in CRF
b) Small size kidney
c) Hyper-phosphatemia
d) Hyperkalemia
e) Peripheral neuropathy
Answer: a, b and e
Explanation:
CRF:
Pericardial Effusion/ pericarditis
Progressive Azotemia
Bilateral small kidney
Normocytic normochromic anemia
Peripheral neuropathy
Q-48. Feature of acute rheumatic fever includes
a) Carey Coombs murmur
b) Pan-carditis
c) Always cause residual joint disease
d) Chorea
e) Previous h/o of streptococcal infection
Answer: a, b, d and e
Explanation:
Jones criteria
The presence of two major manifestations or one major and two minor manifestations indicates a high probability of ARF.
Major criteria:
Carditis
Polyarteritis
Chorea
Erythema marginatum
Subcutaneous nodules
Minor criteria:
Arthralgia
Fever
Elevated ESR or CRP level
Prolonged PR interval
Evidence of preceding group A streptococcal infection Elevated or rising streptococcal antibody titer
-> Carey Coombs murmur is a delayed diastolic mitral murmur heard during the course of acute rheumatic fever.
Q-49. A patient is suffering from HIV & TB which of the following statement is correct regarding management of the patient:
a) ATT drugs should be given before ART drug
b) ART drugs should be given before ATT drugs
c) Efavirenz dose should be reduced
d) Adverse drug effects of ATT may be more pronounced
Answer: a and d
Explanation:
Q-50. Acute flaccid paralysis is/are seen in all except
a) Porphyria
b) Hypokalemia
c) Hypo-magnesemia
d) Hyper-calcemia
e) Hypophosphatemia
Answer: c and d
Explanation:
Acute flaccid paralysis seen in:
Metabolic causes:
Hypokalemia and Hyperkalemia
Hypophosphatemia
Hyper-magnesemia