AIIMS/ NEET-PG 2017: Medicine MCQs 181-200

Q-181. Normal anion gap metabolic acidosis is caused by
a) Cholera
b) Starvation
c) Ethylene glycol therapy
d) Lactic acidosis

Answer: Cholera
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-182. Causes of metabolic alkalosis include all the following except
a) Mineralocorticoid deficiency
b) Bartter’s syndrome
c) Thiazide diuretic therapy
d) Recurrent vomiting

Answer: Mineralocorticoid deficiency
Explanation:
Metabolic alkalosis: Saline responsive
Normal body bicarbonate content:
Contraction alkalosis
Excessive body bicarbonate content:
A. Renal alkalosis:
Diuretics
Carbenicillin
Penicillin, sulfate and phosphate
Post-hypercapnia
B. GI alkalosis:
Antacids, sodium citrate, lactate, acetate, gluconate and NaHCO3 (Baking soda)
Transfusion
Chloride diarrhoea
Loss of HCL from vomiting or nasogastric suction
Metabolic alkalosis: Saline Un-responsive
Excessive body bicarbonate content:
Renal alkalosis: Normotensive
Batter syndrome
Severe potassium depletion
Re-feeding alkalosis
Hyper-calcemia and hypo-parathyroidism
Hypertensive:
A. Exogenous alkali
B. Licorice
C. Exogenous mineralocorticoids
D. Endogenous mineralocorticoids:
Primary aldosteronism
Hyper-reninism
Liddle syndrome
Adrenal enzyme deficiency- 11 and 17 hydroxylase

Q-183. A 50 kg man with severe metabolic acidosis has the following parameters pH 7.05, pCO2 12mm Hg, pO2 108 mm Hg, HCO3 5mEq/L and base excess 30 mEq/ L. The approximate quantity of sodium bicarbonate that he should receive in half hour is?
a) 250 mEq
b) 350 mEq
c) 500 mEq
d) 750 mEq

Answer: 250 mEq
Explanation:
The hallmark of metabolic acidosis is decreased HCO3.
The bicarbonate deficiency can be calculated as follows:
HCO3- deficit = 0.5 x body wt in kg x (24- HCO3-)
Half of the calculated deficit should be administered the first three to four hours to avoid overcorrection and volume overload.

Q-184. Most sensitive and specific test for diagnosis of iron deficiency is
a) Serum iron levels
b) Serum ferritin levels
c) Serum transferrin receptor population
d) Transferrin saturation

Answer: Serum ferritin levels
Explanation:
Iron deficiency develops in stages. The first is depletion of iron stores.
At this point, there is anemia and no changes in RBS size.
A ferritin value < 12 mcg/L is a highly reliable indicator of depletion of iron stores. Q-185. Leuko-erythroblastic picture may be seen in all of the following except a) Myelo-fibrosis b) Metastatic carcinoma c) Gaucher’s disease d) Thalassemia Answer: Thalassemia Explanation: Leuko-erythroblastic picture: The leuko-erythroblastic picture is characterized by nucleated red blood cells and teardrop forms, giant platelets, and immature white blood cells in the peripheral blood smear. It is usually accompanied by fibrosis of the bone marrow and may be seen in A. Primary Myelo-fibrosis B. Secondary Myelo-fibrosis Infection- Tuberculosis, fungal and HIV Lipid deposition- Gaucher’s disease Tumors- Metastatic carcinoma, Lymphoma, Multiple myeloma, Leukemia and Polycythemia Vera Q-186. All of the following are poor prognostic factor for acute myeloid leukemias except a) Age more than 60 years b) Leucocytes count more than 100000/μl c) Secondary leukemias d) Presence of t (8:21) Answer: Presence of t (8:21) Explanation: Poor prognostic factor for acute myeloid leukemias: Age more than 60 years Leucocytes count more than 100, 000/μl Secondary leukemias Monosomy 7 Good prognostic factor for acute myeloid leukemias: Age less than 60 years Presence of t (8:21) Leucocytes count less than 100000/μl Q-187. A 63 year old man presented with massive splenomegaly, lymphadenopathy and a total leukocyte count of 17000 per mm³. The following cytometry showed CD19 positive, CD5 positive, CD23 negative, monoclonal B-cells with bright kappa positively comprising 80% of the peripheral blood lymphoid cells. The most likely diagnosis is a) Mantle cell lymphoma b) Splenic lymphoma with villous lymphocytes c) Follicular lymphoma d) Hairy cell leukemia Answer: Mantle cell lymphoma Explanation: Q-188. All of the following statement regarding the ECG in acute pericarditis are true except a) T wave inversions develop before ST elevation return to baseline b) Global ST segment elevation is seen in early pericarditis c) Sinus tachycardia is a common finding PR segment depression is present in majority of patients d) None Answer: T wave inversions develop before ST elevation return to baseline Explanation: ECG in acute pericarditis: A characteristic progression beginning with diffuse ST elevation, followed by a return to baseline and then to T wave inversion Atrial injury is often present and manifested by PR depression especially in the limb leads. Q-189. All of the following are the electrocardiographic features of severe hyper-kalemia except a) Peaked T waves b) Presence of U waves c) Sine waves pattern d) Loss of P waves Answer: Presence of U waves Explanation: Electrocardiographic features of hyper-kalemia: PR interval prolongation Peaked T wave QRS widening Merger of QRS complex and T wave leads to the appearance of a typical sine-wave pattern Biphasic QRS-T complex Electrocardiographic features of Hypokalemia: Decreased amplitude and broadening of T wave Prominent U wave Depressed ST segment Important point: Hyperkalemia impairs neuromuscular transmission causing weakness, flaccid paralysis and ileus. Q-190. Hypo-calcemia is characterized by all of the following features except a) Numbness and tingling of circum-oral region b) Hyperactivity tendon reflexes c) Shortening of Q-T interval in ECG d) Carpo-pedal spasm Answer: Shortening of Q-T interval in ECG Explanation: Hypo-calcemia: Symptoms and signs: Spasm of skeletal muscle causes cramps and tetany Larygospasm with stridor Abdominal pain Convulsion, peri-oral and peripheral paresthesia Chvostek’s Sign- Contraction of facial muscle in response to tapping the facial nerve Trousseau sign- Carpal spasm with occlusion of the brachial artery by blood pressure cuff Laboratory findings: Serum calcium < 8.5 mg/dl Ionized serum calcium < 4.5 mg/dl Low magnesium concentration ECG- Prolonged QT interval Q-191. Which of the following is the most common location of the hypertensive hemorrhage? a) Pons b) Thalamus c) Sub-cortical white matter d) Putamen/ external capsule Answer: Putamen/ external capsule Explanation: 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) Thalamic hemorrhage Pontine hemorrhage Cerebellar hemorrhage Q-192. Absence seizures are characterized on EEG by a) 3 Hz spike & wave b) 1-2 Hz spike & wave c) Generalized poly-spikes d) None of above Answer: 3 Hz spike & wave Explanation: Absence seizures are characterized by impairment of consciousness, sometimes with mild clonic, tonic or atonic components, autonomic components (Enuresis) or accompanying automatisms. EEG: Burst of bilaterally synchronous and symmetrical 3 Hz spike and wave activity. Q-193. Commonest presentation of neuro-cysticercosis is a) Seizures b) Focal neurological deficits c) Dementia d) Radiculopathy Answer: Seizures Explanation: Epilepsy is the most common presentation of neuro-cysticercosis and is also a complication of the disease. Neuro-cysticercosis is the leading cause of adult-onset epilepsy and is probably one of the most frequent causes of childhood epilepsy. Q-194. Commonest cause of sporadic encephalitis is a) Japanese B virus b) Herpes simplex virus c) Human immunodeficiency virus d) Rubeola virus Answer: Herpes simplex virus Explanation: Herpes simplex virus type-1 (HSV-1) encephalitis is the most common cause of sporadic fatal encephalitis worldwide. The clinical syndrome is often characterized by the rapid onset of fever, headache, seizures, focal neurologic signs, and impaired consciousness. Q-195. Serum total lactate dehydrogenase level will NOT be raised in a) Muscle Crush Injury b) Stroke c) Myocardial Infarction d) Hemolysis Answer: Stroke Explanation: LDH enzyme is widely distributed but especially plentiful in cardiac and skeletal muscle, liver, kidney and RBC. Q-196. Thiamine deficiency is known to occur in all of the following except a) Food faddist b) Homocystinemia c) Chronic alcoholic d) Chronic heart failure patient on diuretics Answer: Homocystinemia Explanation: Causes of thiamine deficiency: Malnutrition Dietary habits Alcoholics Food faddist Chronic heart failure Diuretics- induce increased excretion of thiamine in urine Q-197. A 30 year old HIV positive patient presents with fever, dyspnea and non- productive cough. Patient is cyanosed. His chest X-ray reveals bilateral symmetrical interstitial infiltrates. The most likely diagnosis is a) Tuberculosis b) Cryptococcosis c) Pneumocystis carinii pneumonia d) Toxoplasmosis Answer: Pneumocystis carinii pneumonia Explanation: Pneumocystis carinii pneumonia (PCP) is caused by P carinii. It is a frequent cause of morbidity and mortality in persons who are immuno-compromised, especially patients with acquired immunodeficiency syndrome (AIDS). X-Ray Chest Finding: Bilateral diffuse infiltrate beginning peri-hilar region Q-198. A 60 year old man with diabetes mellitus present with painless swollen right ankle joint. Radiographs of the ankle show destroyed joint with large number of loose bodies. The most probable diagnosis is a) Charcot’s joint b) Clutton’s joint c) Osteoarthritis d) Rheumatoid arthritis Answer: Charcot’s joint Explanation: Charcot joint or neuropathic joint (Pain less) is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. This disorder results in progressive destruction of bone and soft tissues at weight-bearing joints. Charcot arthropathy can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle. Charcot arthropathy occurs as a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury and syringomyelia. Diabetes is considered to be the most common cause of Charcot arthropathy. Q-199. Central nervous system manifestation in chronic renal failure are a result of all of the following except a) Hyper-osmolarity b) Hypo-calcemia c) Acidosis d) Hypo-natremia Answer: Hypo-calcemia Explanation: Patient with chronic renal disease tolerate the hypo-calcemia quite well and rarely is a patient symptomatic from the decreased calcium concentration. Q-200. A 25 year old man presented with fever, cough, expectoration and breathlessness of 2 months duration. Contrast enhanced computed tomography of the chest showed bilateral upper lobe fibrotic lesions and mediastinum had enlarged necrotic nodes with peripheral rim enhancement which one of the following is the most probable diagnosis a) Sarcoidosis b) Tuberculosis c) Lymphoma d) Silicosis Answer: Tuberculosis Explanation: Contrast enhanced computed tomography of the chest showed bilateral upper lobe fibrotic lesions and mediastinum had enlarged necrotic nodes with peripheral rim enhancement- A possibility of tuberculosis