Q-171. The following condition is not associated with an Anti-phospholipid syndrome:
a) Venous thrombosis
b) Recurrent fetal loss
c) Thrombocytosis
d) Neurological manifestations
Answer: Thrombocytosis
Explanation:
Anti-phospholipid antibody syndrome:
Hyper-coagulability with venous or arterial thrombosis
Recurrent fetal loss
Thrombocytopenia
Neurological manifestations
Livedo reticularis
Important point:
Lifelong anticoagulation with Warfarin is recommended.
Q-172. All of the following phases of the jugular venous pulse and their causes are correctly matched except
a) c wave- Onset of atrial systole
b) a-x descent – Atrial relaxation
c) v-y – Emptying of blood from right atrium into right ventricle
d) y-a ascent- Filling of the right atrium from the vena cava
Answer: c wave- Onset of atrial systole
Explanation:
Jugular venous pressure (JVP) provides an indirect measure of central venous pressure.
The JVP consists of certain waveforms and abnormalities of these can help to diagnose certain conditions.
Waves:
a – Pre-systolic; produced by right atrial contraction
c – Bulging of the tricuspid valve into the right atrium during ventricular systole (iso-volumic phase)
v – Occurs in late systole; increased blood in the right atrium from venous return
Descents:
a-x – A combination of atrial relaxation, downward movement of the tricuspid valve and ventricular systole
v-y – The tricuspid valve opens and blood flows into the right ventricle.
y-a ascent- Filling of the right atrium from the vena cava
Q-173. Which of the following is the correct statement regarding findings in JVP
a) Cannon wave: Complete hearth block
b) Slow v-y descent: Tricuspid regurgitation
c) Giant c wave: Tricuspid stenosis
d) Increased JVP with prominent pulsations: SVC obstruction
Answer: Cannon wave: Complete hearth block
Explanation:
Cannon waves are very large ‘a’ waves that occur when the right atrium contracts against a closed tricuspid valve.
They occur irregularly in complete heart block and ventricular tachycardia.
Q-174. While inserting a central venous catheter a patient develops respiratory distress. The most likely cause is
a) Hemothorax
b) Pneumothorax
c) Pleural effusion
d) Hypovolemia
Answer: Pneumothorax
Explanation:
Sites of central venous catheterization
Subclavian vein
Internal jugular vein
Femoral vein
Complications of central venous catheterization:
Pneumothorax (Most common and manifested as sudden respiratory distress)
Hemothorax
Air embolism
Q-175. All of the following are clinical features of myxoma; except
a) Fever
b) Clubbing
c) Hypertension
d) Embolic phenomenon
Answer: Hypertension
Explanation:
Cardiac myxoma:
The most common cardiac tumor
Carney complex: It consists of myxoma, pigmented skin lesions and endocrine neoplasia.
The characteristics include fever, malaise, wt loss, Leukocytosis, emboli, clubbing and increased ESR.
Diastolic sound or tumor plop
The diagnosis is established by Echocardiography or pathological study of embolic material.
Q-176. Renal vein thrombosis is most commonly associated with
a) Diabetic nephropathy
b) Membranous Glomerulopathy
c) Minimal change disease
d) Membrano-proliferative glomerulonephritis
Answer: Membranous Glomerulopathy
Explanation:
Membranous Nephropathy:
Most common cause of primary nephrotic syndrome
Associated with coagulopathy, eg, renal vein thrombosis
An immune mediated disease characterized by spike and dome pattern on kidney biopsy from sub-epithelium deposits.
Secondary Causes of Membranous Nephropathy:
HBV
Endocarditis
Syphlis
Autoimmune diseases
Carcinomas
Drugs- Gold, penicillamine and captopril
Q-177. One of the following is a characteristic of Henoch Schonlein purpura
a) Blood in stool
b) Thrombocytopenia
c) Intracranial hemorrhage
d) Susceptibility to infection
Answer: Blood in stool
Explanation:
Henoch Schonlein purpura:
It is most common systemic vasculitis in children and also occurs in adults.
Clinical features:
Palpable purpura
Abdominal pain
Arthritis
Hematuria
Important points:
Pathological features include leukocytoclastic vasculitis with IgA deposition.
Abdominal pain secondary to vasculitis of intestinal tract is often associated with GI bleeding.
Q-178. Renal osteodystrophy differs from nutritional and genetic forms of Osteomalacia in having
a) Hypocalcaemia
b) Hyper-calcemia
c) Hypo-phosphatemia
d) Hyper-phosphatemia
Answer: Hyper-phosphatemia
Explanation:
Renal osteodystrophy:
In end-stage renal disease, renal 1-hydroxylase is diminished or lost, and excretion of phosphate is defective.
This leads to low levels of 1, 25 (OH) 2 vitamin D, hypo-calcemia, hyper-phosphatemia and failure of osteoid calcification.
Important points:
In Osteomalacia, there is hypo-phosphatemia.
Q-179. Medullary cystic disease of the kidney is best diagnosed by
a) Ultrasound
b) Nuclear scan
c) Urography
d) Biopsy
Answer: Biopsy
Explanation:
Medullary cystic disease of the kidney or medullary spongy kidney:
Benign disorder present at birth and not usually diagnosed until the fourth or fifth decade
It is caused by autosomal dominant mutation in the MCKD1 or MCKD2 genes on chromosome 1 and 16 respectively.
It is associated with medullary cysts that are diffuse giving a “Swiss cheese” appearance in this region.
The diagnosis can be made by CT which shows cystic dilatation of the distal collecting tubules, a striated appearance in this area and calcification in renal collecting system.
Open renal biopsy is definitive.
Q-180. A patient with nephrotic syndrome on longstanding cortico-steroid therapy may develop all the following except
a) Hyperglycemia
b) Hypertrophy of muscle
c) Neuropsychiatric symptoms
d) Suppression of the pituitary adrenal axis
Answer: Hypertrophy of muscle
Explanation:
Side effects of corticosteroid:
Hyperglycemia
Atrophy muscle and muscular weakness
Neuropsychiatric symptoms
Suppression of the Hypothalamo-pituitary-adrenal axis
Cushing’s disease
Peptic ulceration
Post sub-scapular cataract/ Glaucoma
Osteoporosis
Delayed wound healing
Growth retardation
Susceptibility to infection