Q-111. Which of the following is preferred marker for detecting acute STEMI in athletes?
a) CK MB
b) LDH
c) Troponin T/I
d) CRP
Ans: c
Explanation:
Cardiac biomarkers should be measured in all patients who present with chest discomfort consistent with acute coronary syndrome (ACS).
Cardiac Troponin T and I:
Cardiac Troponin T and I are the preferred markers for myocardial injury as they have the highest sensitivities and specificities for the diagnosis of acute myocardial infarction.
Patients with negative cardiac biomarkers within 6 hours of the onset of symptoms that are consistent with ACS should have biomarkers re-measured in the timeframe of 8 to 12 hours after the onset of symptoms.
Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart.
CK-MB:
CK-MB levels increase within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours.
Sensitivity and specificity are not as high as for Troponin levels.
Athletes have been observed to have very high resting concentration of CK-MB in skeletal muscle.
Patients without biochemical evidence of myocardial necrosis but with elevated C-reactive protein (CRP) level are at increased risk of a subsequent ischemic event.
Q-112. A 45 year man is diagnosed with diabetes at his present visit for the first time. When should he visit an ophthalmologist:-
a) On his 50th birthday
b) When dimness of vision starts
c) Before his 50th birthday
d) Immediately at time of diagnosis
Answer: Immediately at time of diagnosis.
Explanation:
The ADA Clinical Practice Guidelines recommend ophthalmologic evaluation for all Type 1 diabetes that have had diabetes for at least 3 years and in all patients with Type 2 diabetes.
A major difference between type 1 and type 2 diabetes mellitus is that many persons with type 2 diabetes have had the disease for many years prior to diagnosis
Patients with type 2 diabetes, who generally have had years of undiagnosed diabetes and who have a significant risk of prevalent diabetic retinopathy at time of diabetes diagnosis, should have an initial dilated and comprehensive eye examination soon after diagnosis.
Q-113. Lung biopsy of a HIV patient showed intra nuclear basophilic inclusion bodies with peri-nuclear halo. The patient’s CD4 was 100 at the time of death. What is the probable cause of death?
a) CMV
b) MAC
c) Pneumocystis
d) TB
Answer: CMV
Explanation:
CMV infection characteristically is associated with “owl’s-eye” cells, which are large cells with basophilic intra-nuclear inclusions and a surrounding clear Halo.
The presence of viral inclusions is diagnostic, although this method has low sensitivity. Therefore, absence of inclusions does not always exclude infection or active disease.
Q-114. Young male having pain with daily morning stiffness of spine for 30 minutes and reduced chest movements
a) Ankylosing Spondylitis
b) Rheumatoid Arthritis
c) Gouty Arthritis
d) Osteoarthritis
Answer: Ankylosing Spondylitis
Explanation:
Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic disease of unknown cause. It mainly affects the spine and the sacroiliac joints. Sometimes other joints and other parts of the body are affected.
Tendons and ligaments in various parts of the body (in addition to those attached to the vertebrae of the lower spine) may become inflamed and painful where they attach to bones. Common examples are the Achilles tendon where it attaches to the heel, and where chest muscles attach to the ribs.
New criteria to define inflammatory back pain have been proposed; when 2 of the 4 criteria are present, they yield a sensitivity of 70.3% and specificity of 81.2%.These criteria includes the following:
Morning stiffness that lasts more than 30 minutes
Improvement of back pain with exercise but not rest
Nocturnal back pain during second half of the night only
Alternating buttock pain
Q-115. Evidence of decreased risk of cardiovascular disease is associated with all of the following except –
a) Vitamin E supplementation
b) Low to moderate daily alcohol consumption
c) Regular physical activity
d) Potassium
Answer: Vitamin E supplementation
Explanation:
Research has shown that vitamin E does not have any overall benefit in lowering mortality or decreasing the risk of heart death or stroke, and therefore should not be recommended for heart disease prevention.
Drinking moderate amounts of alcohol may have some benefits in terms of reducing the risk for cardiac disease and death related to cardiac disease. While many previous studies have suggested there may be heart benefits from drinking a moderate amount of red wine, the new study shows the findings hold with a moderate intake of any type of alcohol.
K+ is critical to the maintenance of cardiovascular disease health and the normokalemic state is vital to the prevention of potentially serious sequelae, especially in the at-risk cardiovascular disease patient. So a diet that includes potassium-rich fruits and vegetables is good for the heart.
Q-116. True regarding multiple myeloma a/e
a) Plasmacytosis
b) Increased IgG
c) ANA Antibody
d) Increased M spikes
Answer: ANA Antibody
Explanation:
ANAs are found in patients with a number of different autoimmune diseases, such as systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis, Polymyositis, scleroderma, Hashimoto’s thyroiditis, juvenile diabetes mellitus, Addison disease, Vitiligo, pernicious anemia, Glomerulo-nephritis, and pulmonary fibrosis.
Diagnostic Tests for multiple myeloma:
The beta-2 micro-globulin (ß2-M) level is considered to be a standard measure of tumor burden (the extent of disease).
Quantitive immunoglobulin testing provides measurements of the levels of the different types of immuno-globulins—that is, IgG, IgA, and IgM—that are elevated and produced by myeloma cells.
Serum protein electrophoresis (SPEP) detects the presence and level of various proteins in the blood, including M protein. Higher levels of M protein indicate more extensive disease.
A bone marrow aspirate or biopsy shows that at least 10 percent of the cells are plasma cells (plasmacytosis).
Q-117. False about blackout
a) Confused state
b) Antero-grade amnesia
c) Alcohol intake is reason
d) Remote memory intact
Answer: Confused state
Explanation:
Blackouts are caused by breakdown in the transfer of short-term memory into long-term storage and subsequent retrieval primarily through dose-dependent disruption of hippocampal CA1 pyramidal cell activity. The exact mechanism is believed to involve potentiation of gamma-aminobutyric acid-alpha mediated inhibition and interference with excitatory hippocampal N-methyl-d-aspartate [NMDA] receptor activation, resulting in decreased long-term potentiation.
Alcohol primarily interferes with the ability to form new long–term memories, leaving intact previously established long–term memories and the ability to keep new information active in memory for brief periods.
Blackouts represent episodes of amnesia, during which subjects are capable of participating even in salient, emotionally charged events—as well as more mundane events—that they later cannot remember. Periods of amnesia are primarily “antero-grade,” meaning that alcohol impairs the ability to form new memories while the person is intoxicated, but does not typically erase memories formed before intoxication.
Q-118. Right atria chronic overload or acute overload is indicated by P wave of more than
a) 2.5
b) 3.5
c) 4.5
d) 5.5
Answer: 2.5
Explanation:
Right atrial enlargement is diagnosed by the presence of a P wave 2.5 millimeters or greater in height. This increased voltage is caused by hypertrophy or acute strain of right atrial tissue.
Dilation or hypertrophy of the left atrium may increase the duration of the P wave. The P wave is normally less than 0.11 msec.
The long or abnormally shaped P wave occurs because of delay in electrical activation of the enlarged left atrium.
A P wave longer than 0.11 milliseconds is diagnostic of left atrial enlargement
Q-119. Creatinine phospho-kinase is increased in injury of
a) Heart
b) Brain
c) Skeletal muscle
d) All
Answer: All
Explanation:
Creatine phospho-kinase (CPK) is an enzyme found mainly in the heart, brain, and skeletal muscle.
High CPK levels may be seen in patients who have:
Brain injury or Stroke, Convulsion
Polymyositis, Muscular dystrophies, Myopathy, Electric shock
Myocarditis, MI, after electro-cardioversion
Important points:
Clofibrates therapy causes myopathy, including rhabdomyolysis with acute renal failure secondary to myoglobinuria.
The myopathy may be dose-related in conjunction with increases in creatine phospho-kinase (CPK). Therapy with fibric acid derivatives should be administered cautiously in patients with preexisting myopathy or a myo-neural disorder.
Q-120. A normal anion gap metabolic acidosis occurs in patients with
a) Small bowel drainage
b) Diabetic keto-acidosis
c) Methyl alcohol poisoning
d) Acute renal failure
Ans: Small bowel drainage
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