Q-101. Hypergastrinemia with hypochlorhydria is seen in
b) Pernicious anemia
d) Z E Syndrome
Classic pernicious anemia is caused by the failure of gastric parietal cells to produce sufficient IF (a gastric protein secreted by parietal cells) to permit the absorption of adequate quantities of dietary vitamin B-12.
In adults, pernicious anemia is associated with severe gastric atrophy and achlorhydria, which are irreversible.
Hypergastrinemia can occur secondary to uninhibited gastrin production or in response to decreased acid secretion.
Patients who have a gastrinoma as their source of uninhibited gastrin secretion usually present with peptic ulcers secondary to acid hyper-secretion.
In contrast, unopposed gastrin secretion in response to achlorhydria typically occurs in patients with atrophic gastritis or who take proton-pump inhibitors.
Q-102. Which of the following is the most common location of the hypertensive hemorrhage?
c) Sub-cortical white matter
d) Putamen/ external capsule
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)
Q-103. Disseminated intravascular coagulation (DIC) differs from thrombotic thrombocytopenic purpura (TTP). In this reference the DIC is most likely characterized by:
a) Significant numbers of schistocytes
b) A brisk reticulocytosis
c) Decreased coagulation factor levels
d) Significant thrombocytopenia
Disseminated intravascular coagulation (DIC) is characterized by systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to micro-vascular thrombi in various organs and contributing to multiple organs dysfunction syndrome (MODS).
Consumption and subsequent exhaustion of coagulation proteins and platelets (from ongoing activation of coagulation) may induce severe bleeding, though micro-clot formation may occur in the absence of severe clotting factor depletion and bleeding.
In DIC, the levels of coagulation factors are decreased. Whereas in TTP, coagulation factor levels are normal.
Q-104. All of the following are true about manifestations of vitamin E deficiency, except:
a) Hemolytic anemia
b) Posterior column abnormalities
c) Cerebellar ataxia
d) Autonomic dysfunction
Vitamin E deficiency can cause:
Impairment of the immune response
Red blood cell destruction
Cardiac arrhythmia, and
Vitamin E deficiency in the premature infant is associated with a hemolytic anemia. This anemia responds to tocopherol and the response is characterized by a rise in the hemoglobin and a fall in the reticulocyte count.
Autonomic dysfunction is not seen with vitamin E deficiency.
Severe deficiency may occur in persons with abetalipoproteinemia or fat mal-absorption.
Autonomic dysfunction and orthostatic hypotension caused by vitamin B12 deficiency.
Q-105. Anti-centromere antibodies are most commonly associated with:
a) Diffuse cutaneous systemic sclerosis
b) Mixed connective tissue disease
c) CREST syndrome
Anti-centromere antibodies (ACA) occur in auto immune disorders; frequently in limited systemic scleroderma, (formerly called CREST syndrome), and, occasionally are found in the diffuse form of scleroderma.
CREST (Calcinosis, Raynaud phenomenon, Esophageal dys-motility, Sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the cardinal clinical features of the syndrome.
Q-106. C- ANCA positivity indicates antibody formed against
a) Proteinase 3
c) Cytoplasmic antinuclear Antibody
d) Anti centromeric Antibody
Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of auto-antibodies, mainly of the IgG type, against antigens in the cytoplasm of neutrophil granulocytes and monocytes.
C-ANCAs, or Cytoplasmic anti-neutrophil cytoplasmic antibodies, are a type of autoantibody, an antibody produced by the body that acts against one of its own proteins.
These antibodies show a diffusely granular, cytoplasmic staining pattern under microscopy. This pattern results from binding of ANCAs to antigen targets throughout the neutrophil cytoplasm, the most common protein target being Proteinase 3 (PR3).
PR3 is the most common antigen target of ANCA in patients with Wegener’s granulomatosis.
Q-107. Pick’s body in pick’s disease is
a) Tau protein
b) Alpha synuclein
c) Beta synuclein
d) A beta amyloid
Pick’s disease is a rare neurodegenerative disease that causes progressive destruction of nerve cells in the brain.
Symptoms include loss of speech (aphasia) and dementia.
A defining characteristic of the disease is build-up of tau proteins in neurons, accumulating into silver-staining, spherical aggregations known as “Pick bodies”
Q-108. Test of assessment of mucosal function of GIT:
a) D-Xylose test
b) Small bowel study
d) Schilling test
D-Xylose absorption test is a medical test performed to diagnose conditions that present with mal-absorption due to defects in the integrity of the gastrointestinal mucosa.
D-Xylose is a monosaccharide, or simple sugar, that does not require enzymes for digestion prior to absorption.
A decreased urinary excretion of D-Xylose is seen in conditions involving the GI mucosa, such as small intestinal bacterial overgrowth and Whipple’s disease.
Q-109. Beck’s Triad is seen in:
a) Constrictive Pericarditis
b) Cardiac tamponade
c) Right ventricular Myocardial infarction
Beck’s triad is a collection of three medical signs associated with acute cardiac tamponade, an emergency condition wherein fluid accumulates around the heart and impairs its ability to pump blood.
The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.
Q-110. Coarctation of aorta is most commonly seen with?
d) Bicuspid aortic valve
Coarctation of the aorta (CoA) is a relatively common defect that accounts for 5-8% of all congenital heart defects.
More than half of people with coarctation of that aorta also have a congenital heart valve defect (bicuspid aortic valve).