Q-131. A woman complains of headache associated with paresthesias of the right upper and lower limb; likely diagnosis is
a) Trigeminal neuralgia
b) Glosso-pharyngeal neuralgia
c) Migraine
d) Cluster headache
Answer: Migraine
Explanation:
Presentation of Migraine:
The typical migraine headache is throbbing or pulsatile.
The headache is initially unilateral and localized in the fronto-temporal and ocular area, but pain can be felt anywhere around the head or neck.
Nausea and vomiting usually occur later in the attack.
Neurologic symptoms:
Hemiparesis
Aphasia
Confusion
Paresthesias or numbness
Q-132. All of following are feature of MEN II-a except
a) Pituitary tumor
b) Pheochromocytoma
c) Medullary ca thyroid
d) Neuromas
Answer: Neuromas
Explanation:
Multiple Endocrine Neoplasias (MEN): Incidence of tumor types
MEN 1 (Wermer Syndrome):
Parathyroid
Pancreatic
Pituitary
Thyroid adenoma
Facial angio-fibromas and collagenomas
MEN 2A (Sipple Syndrome):
Medullary thyroid carcinoma
Pheochromocytoma
Pituitary
MEN 2B:
Mucosal and GI Ganglio-neuroma
Medullary thyroid carcinoma
Pheochromocytoma
Q-133. A patient with cushinoid features presents with hemoptysis; he shows on response to dexamethasone suppression test; most likely diagnosis here is
a) Adrenal hyperplasia
b) Adrenal adenoma
c) Ca lung with ectopic ACTH production
d) Pituitary micro-adenoma
Answer: Hemolytic jaundice
Explanation:
Q-134. An obese patient presented in casualty in an unconscious state. His blood sugar measured 400 mg %, urine tested positive for sugar and ketones; drug most useful in management is
a) Glibenclamide
b) Troglitazone
c) Insulin
d) Chlorpropamide
Answer: Insulin
Explanation:
Diabetic Keto-acidosis:
Fluid replacement- Rapid 0.9 % saline infusion
Insulin replacement- 0.15 units/kg as intra-venous bolus
Potassium replacement
Q-135. Which of the following is not associated with thymoma?
a) Red cell aplasia
b) Myasthenia gravis
c) Hyper-gamma-globulinemia
d) Compression of the superior mediastinum
Answer: Hyper-gamma-globulinemia
Explanation:
Thymoma originates within the epithelial cells of the thymus, a lymphoid organ located in the anterior mediastinum.
About 30% of people with thymoma also have a condition called myasthenia gravis.
In addition to myasthenia gravis, people with thymoma may have other groups of syndromes, called para-neoplastic syndromes.
These may include severe low red blood cell count or anemia, called pure red cell aplasia, or low levels of antibodies, called hypo-gamma-globulinemia.
Q-136. A young basketball player with ht 188 cm and arm-span 197 cm has a diastolic murmur best heard in second right inter-costal space; likely cause of murmur is
a) AS
b) Coarctation of aorta
c) AR
d) MR
Answer: Hemolytic jaundice
Explanation: AR
Marfan syndrome is caused by defects in a gene called fibrillin-1. Fibrillin-1 plays an important role as the building block for connective tissue in the body.
People with Marfan syndrome are very often tall with long, thin arms and legs and spider-like fingers (called arachnodactyly).
The length of the arms is greater than height when arms are stretched out.
Clinical findings:
Scoliosis and pectus excavatum
Ectopia lentis and myopia
Mitral valve prolapse
Aortic root dilation and AR
Q-137. A patient present with arthritis hyper-pigmentation of skin and hypogonadism; likely diagnosis is
a) Hemochromatosis
b) Ectopic ACTH secreting tumor of lung
c) Wilsons disease
d) Rheumatoid arthritis
Answer: Hemochromatosis
Explanation:
Hemochromatosis is an autosomal recessive disease caused by a mutation in the HFE gene on chromosome 6.
Hemochromatosis: Clinical findings
Arthralgia
Arthropathy
Hepatomegaly/ Liver cirrhosis
Skin pigmentation
Cardiac enlargement
DM
Erectile dysfunction and hypogonadism
Q-138. In myasthenia gravis correct statement regarding thymectomy is
a) Should be done in all cases
b) Should be done in cases with ocular involvement only
c) Not required if controlled by medical management
d) Should be done only in cases that are associated with thymoma
Answer: Should be done in all cases
Explanation:
Treatment options for myasthenia gravis:
Anti-cholinesterase e.g. Neostigmine and Pyridostigmine
Thymectomy
Corticosteroid
Azathioprine, mycophenolate
Plasmapheresis or IVIG therapy
Important points:
Aminoglycosides should be avoided.
Thymectomy should be considered in all patients younger than 60 years, unless weakness is restricted to the extra-ocular muscles.
Q-139. Most common fungal infection in febrile neutropenia is
a) Aspergillus Niger
b) Candida
c) Mucormycosis
d) Aspergillus
Answer: Candida
Explanation:
Amongst fungal infections, Candida spp. and Aspergillus sp. are common in the neutropenic host.
Candida is the most common fungal infection in febrile neutropenia.
Q-140. True statement about neuro-cysticercosis is
a) Seizures due to neuro-cysticercosis are resistant to anti epileptic drugs
b) Albendazole is superior to praziquantel in the treatment of above condition
c) Common presentation is 6th CN palsy and hemiparesis
d) Steroids are used in the management of hydrocephalus
Answer: Albendazole is superior to praziquantel in the treatment of above condition
Explanation:
Neuro-cysticercosis:
Standard therapy consists of Albendazole (10-15 mg/Kg/day) or praziquantel (50 mg/kg/day).
Albendazole is probably preferred, since corticosteroid increase Albendazole levels.