Q-151. Pulmonary edema associated with normal PCWP is observed. Which of these is not a cause?
a) High altitude
b) Cocaine overdose
c) Post cardio-pulmonary bypass
d) Bilateral renal artery stenosis
Answer: Bilateral renal artery stenosis
Explanation:
Pulmonary edema associated with normal PCWP is considered the gold standard for determining the cause of acute pulmonary edema.
Pulmonary edema with normal PWP suggested a diagnosis of acute respiratory distress syndrome (ARDS).
Pulmonary capillary wedge pressure (PCWP) is routinely used as an indirect measure of the left atrial pressure (LAP).
It is also helpful to measure PCWP to diagnose the severity of left ventricular failure and to quantify the degree of mitral valve stenosis.
Important points:
Normal pulmonary capillary wedge pressure is ≤ 18 mm Hg.
Bilateral renal artery stenosis is not associated with ARDS.
Q-152. An ABG analysis shows pH 7.2, raised pCO2, de creased HCO3-; diagnosis is
a) Respiratory acidosis
b) Compensated metabolic acidosis
c) Respiratory and metabolic acidosis
d) Respiratory alkalosis
Answer: Respiratory and metabolic acidosis
Explanation:
A pH 7.2→ Acidosis
Raised pCO2→ Respiratory Acidosis
Decreased HCO3-→ Metabolic Acidosis
Q-153. ABG analysis of a patient on ventilator; shows decreased pCO2, normal pO2, pH 7.5; diagnosis is
a) Respiratory acidosis
b) Metabolic alkalosis
c) Respiratory alkalosis
d) Metabolic acidosis
Answer: Respiratory alkalosis
Explanation:
Ventilator induced hyperventilation-> Decreased pCO2 and increased Ph-> Respiratory alkalosis
Q-154. False statement about type I respiratory failure is
a) Decreased PaO2
b) Decreased PaCO2
c) Normal PaCO2
d) Normal A-a gradient
Answer: Normal A-a gradient
Explanation:
Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination.
Hypoxemic respiratory failure (type I):
PaO2: Lower than 60 mm Hg
Normal or low PaCO2
Increased A-a gradient
Hypercapnic respiratory failure (type II):
PaO2: Lower than 60 mm Hg
Increased PaCO2
Normal A-a gradient
Important points:
Alveolar-arterial gradient (A-a gradient) is a measurement of the difference between the alveolar concentration of oxygen and the arterial concentration of oxygen.
A normal A-a gradient is less than 10 mmHg, but can range from 5-20 mmHg.
Q-155. A 60 year old man presents with non productive cough for 4 weeks. He has grade III clubbing and a lesion in the apical lobe on X-ray. Most likely diagnosis here is
a) Small cell ca
b) Non small cell ca
c) Fungal infection
d) Tuberculosis
Answer: Non small cell ca
Explanation:
Old age + Non productive cough + Grade III clubbing + Apical lesion→ Non small cell ca
Common presenting symptoms of small cell carcinoma:
Shortness of breath
Cough
Bone pain
Weight loss
Fatigue
Neurologic dysfunction
Q-156. The following condition is not associated with an increased anion-gap type of metabolic acidosis:
a) Shock
b) Ingestion of ante- freeze
c) Diabetic keto-acidosis
d) COPD
Answer: COPD
Explanation:
Metabolic acidosis:
Normal anion gap:
Diarrhoea/ Fistula
Renal tubular acidosis
Ingestion of ammonium chloride
Increased anion gap:
Lactic acidosis- Shock, cardiopulmonary arrest, severe anemia, CO and CN- poisoning
Keto-acidosis- Diabetic, alcoholic and starvation
Exogenous substances- Methanol, salicylates, ethylene glycol (Used as anti-freeze)
Q-157. Acute metabolic acidosis
a) Has biphasic effect on K+ excretion
b) Dose not effect K+ excretion significantly
c) Decreases urinary K+ excretion
d) Increases urinary k+ excretion
Answer: Decreases urinary K+ excretion
Explanation:
Acute metabolic acidosis:
Urinary H+ secretion is increased.
Urinary K+ excretion is inhibited by increased secretion of H+ in exchange of Na+ in acute metabolic acidosis.
Q-158. Urinary anion gap an indication of excretion of
a) Keto-acids
b) NH4+ ion
c) H+ ion
d) k+ ion
Answer: NH4+ ion
Explanation:
Increased renal NH4+Cl- excretion to enhance H+ removal is the normal physiological response to metabolic acidosis.
The urinary anion gap reflects the ability of the kidney to excrete NH4+Cl-.
The urinary anion gap differentiates between GI and renal cause of hyperchloremic acidosis.
Q-159. The commonest mode of inheritance of congenital heart disease is
a) Autosomal dominant
b) Autosomal recessive
c) Sex linked dominant
d) Multi factorial
Answer: Multi factorial
Explanation:
Multi-factorial genetic and environmental factors account for the majority of cases of congenital heart disease.
Q-160. Which one of the following is an autosomal dominant disorder?
a) Cystic fibrosis
b) Hereditary spherocytosis
c) Sickle cell anemia
d) G-6PD deficiency
Answer: Hereditary spherocytosis
Explanation:
X-linked diseases:
Color blindness/ ocular albinism
Fabry’s disease
Hypo-phosphatemic rickets (Dominant)
Hemophilia A (Recessive)
G6P deficiency (Recessive)
Duchene/ Becker muscular dystrophy (Recessive)
Fragile X syndrome (Recessive)
Autosomal recessive disorders:
Sickle cell anemia
Beta thalassemia
Cystic fibrosis
Alpha-1 Antitrypsin deficiency
Deafness/ Albinism
Wilson disease
Hemochromatosis
Fanconi syndrome
Freidrich’s ataxia
Homocystinuria, Phenyl-ketonuria and Gaucher’s disease
Autosomal dominant disorders:
Hereditary spherocytosis
Marfan syndrome
Adult polycystic kidney disease
Polyposis of colon
Tuberous sclerosis
Achondroplasia
Neurofibromatosis
Familial hypertrophic cardiomyopathy
Huntington chorea
Acute intermittent porphyria
Von-Willebrand disease
Myotonic dystrophy
Osteogenesis imperfecta tarda