Q-231. Persistent vomiting most likely causes
a) hyper-kalemia
b) Acidic urine excretion
c) Hypo-chloremia
d) Hyperventilation
Answer: b and c
Explanation:
Persistent vomiting causing:
Hypo-chloremia (Chloride responsive)
Hypo-kalemia
Metabolic acidosis
Paradoxical aciduria or Acidic urine excretion
Q-232. All are true regarding idiopathic edema of women except
a) It is due to estrogen mediated sodium retention
b) It is not related to menstrual cycle
c) There is increased water retention in upright position
d) ACE inhibitors can be useful in some cases
Answer: It is due to estrogen mediated sodium retention
Explanation:
Q-233. In patients with cirrhosis of the liver the site of obstruction in the portal system is in the
a) Hepatic vein
b) Post sinusoidal
c) Extra hepatic portal vein
d) Sinusoids
Answer: Sinusoids
Explanation:
Increased resistant in portal system at
Pre-sinusoidal:
Portal vein thrombosis
Schistosomiasis
Sinusoidal:
Cirrhosis
Post sinusoidal: Outside of liver at level of hepatic vein
Budd Chiari syndrome
Inferior vena cava obstruction
Veno-occlusive diseases
Q-234. In Budd Chiari syndrome, the site of venous thrombosis is
a) Infra-hepatic inferior vena cava
b) Infra-renal inferior vena cava
c) Hepatic veins
d) Portal veins
Answer: Hepatic veins
Explanation:
Increased resistant in portal system at
Pre-sinusoidal:
Portal vein thrombosis
Schistosomiasis
Sinusoidal:
Cirrhosis
Post sinusoidal: Outside of liver at level of hepatic vein
Budd Chiari syndrome
Inferior vena cava obstruction
Veno-occlusive diseases
Q-235. The short bowel syndrome is characterized by all of the following except
a) Diarrhea
b) Hypo-gastrinemia
c) Weight loss
d) Steatorrhoea
Answer: Hypo-gastrinemia
Explanation:
Manifestations of short bowel syndrome:
Diarrhoea and Steatorrhoea
Gastric hyper-secretion of gastrin and increased acid secretion
Increased renal calcium oxalate calculi
Increased cholesterol gall stone
Q-236. Estimation of the following hormones is useful while investigating a case of gynecomastia except
a) Testosterone
b) Prolactin
c) Estradiol
d) Luteinizing hormone
Answer: Prolactin
Explanation:
Investigations in gynecomastia:
Serum Androstenedione
Plasma estradiol and h-CG
Plasma LH and testosterone
TSH and Free thyroxin level
Q-237. All of the following are true about manifestations of vitamin E deficiency, except:
a) Hemolytic anemia
b) Posterior column abnormalities
c) Cerebellar ataxia
d) Autonomic dysfunction
Answer: Autonomic dysfunction
Explanation:
Vitamin E deficiency can cause:
Spinocerebellar ataxia
Myopathy
Peripheral neuropathy
Ataxia
Skeletal myopathy
Retinopathy
Impairment of the immune response
Red blood cell destruction
Cardiac arrhythmia, and
Dementia
Vitamin E deficiency in the premature infant is associated with a hemolytic anemia. This anemia responds to tocopherol and the response is characterized by a rise in the hemoglobin and a fall in the reticulocyte count.
Autonomic dysfunction is not seen with vitamin E deficiency.
Severe deficiency may occur in persons with abetalipoproteinemia or fat mal-absorption.
Autonomic dysfunction and orthostatic hypotension caused by vitamin B12 deficiency.
Q-238. In which of following conditions splenectomy are not useful?
a) Hereditary spherocytosis
b) Porphyria
c) Thalassemia
d) Sickle cell disease with large spleen
Answer: Porphyria
Explanation:
Indications of splenectomy in Red Cell disorders:
Hereditary spherocytosis
Thalassemia
Sickle cell disease
Enzyme deficiency
Parasitic disease
Autoimmune hemolytic anemia
Important point:
Splenectomy has little role to play in management of porphyria.
Q-239. All of the following are the causes of relative polycythemia except
a) Dehydration
b) Dengue hemorrhagic fever
c) Gaisbock’s syndrome
d) High altitude
Answer: High altitude
Explanation:
Spurious/ Relative polycythemia:
Actual red cell mass remains constant
It is due to decrease in plasma volume.
Conditions:
Dehydration
Dengue hemorrhagic fever
Gaisbock’s syndrome
Absolute polycythemia:
Polycythemia Vera
All causes which increase erythropoietin levels
Q-240. Palpable purpura could occur in the following conditions, except
a) Thrombocytopenia
b) Small-vessel vasculitis
c) Disseminated gonococcal infection
d) Acute meningococcemia
Answer: Thrombocytopenia
Explanation:
Causes of palpable purpura:
Vasculitis:
Polyarteritis nodosa
Henoch Schonlein Purpura
Leukocytoclastic vasculitis
Emboli (Bacterial, fungal or parasitic):
Acute meningococcemia
Disseminated gonococcal infection
Rocky Mountain spotted fever
Ecthyma gangrenosum
Q-241. All of the following may cause ST segment elevation on ECG except
a) Early depolarization variant
b) Constrictive pericarditis
c) Ventricular aneurysm
d) Prinzmetal angina
Answer: Constrictive pericarditis
Explanation:
Cause ST Segment Elevation on ECG:
MI
Prinzmetal angina
Ventricular aneurysm (Post MI)
Early depolarization variant
Q-242. All of the following can cause osteoporosis except
a) Hyperparathyroidism
b) Steroid use
c) Fluorosis
d) Thyrotoxicosis
Answer: Fluorosis
Explanation:
Fluorosis is not associated with osteoporosis.
Osteoporosis and endocrine disorders:
Hyperthyroidism
Thyrotoxicosis
DM type II
Adrenal insufficiency
Acromegaly, Cushing’s syndrome
Q-243. Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with
a) Medullary carcinoma of thyroid
b) Papillary carcinoma of thyroid
c) Anaplastic carcinoma of thyroid
d) Follicular carcinoma of thyroid
Answer: Medullary carcinoma of thyroid
Explanation:
Multiple Endocrine Neoplasia (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-244. All of the following conditions are known to cause diabetes insipidus except
a) Multiple sclerosis
b) Head injury
c) Histiocytosis
d) Viral encephalitis
Answer: Multiple sclerosis
Explanation:
Diabetes insipidus is caused by either deficiency of vasopressin or resistant to action of vasopressin.
Multiple sclerosis is not associated with Diabetes insipidus.
Q-245. Cluster headache is characterized by all except
a) Affects predominantly females
b) Unilateral headache
c) Onset typically in 20-50 years of life
d) Associated with conjunctival congestion
Answer: Affects predominantly females
Explanation:
Cluster headache:
Male predominance
All age above 10 years with peak at 30-50 years
Lateralized
Hereditary factors usually absent
Periodic attacks
Homo-lateral lacrimation, nasal stuffiness, red eye
Q-246. Which of the following drugs is useful in prophylaxis of migraine?
a) Propanolol
b) Sumatriptan
c) Domperidone
d) Ergotamine
Answer: Propanolol
Explanation:
Drugs used in prophylaxis of migraine:
Propanolol, timolol
Sodium valproate
TCA- Amitriptyline
MOA
Serotonergic drugs- Methysergide
Q-247. With which one of the following lower motor neuron lesions are associated?
a) Flaccid paralysis
b) Hyperactive stretch reflex
c) Spasticity
d) Muscular in-coordination
Answer: Flaccid paralysis
Explanation:
The lower motor neuron lesions are associated with weakness of muscle with decreased tone i.e. flaccid paralysis.
Q-248. Which one of the following is the most common location of hypertensive bleed in the brain?
a) Putamen/external capsule
b) Pons
c) Ventricles
d) Lobar white matter
Answer: Putamen/external capsule
Explanation:
Site of hemorrhage or lesion: Abnormal movement
Caudate and putamen: Chorea
Globus pallidus (Lentiform nucleus): Athetosis
Substantia nigra: Parkinsonism
Sub-thalamic nuclei: Hemi-ballismus (Flinging movement of a proximal limb)
Important points:
The putamen is the most common site for hypertensive hemorrhage.
Q-249. Normal CSF glucose level in the normo-glycemic adult is
a) 20-40 mg/dl
b) 40-70 mg/dl
c) 70-90 mg/dl
d) 90-110 mg/dl
Answer: 40-70 mg/dl
Explanation:
CSF constituents:
Volume- 150 ml
CSF pressure- 50-180 mmHg
Glucose- 0-70 mg/dl
Protein- 20-50 mg/dl
Q-250. All of the following CSF findings are present in tuberculous meningitis except
a) Raised protein levels
b) Low chloride levels
c) Cob web formation
d) Raised sugar levels
Answer: Raised sugar levels
Explanation:
Typical CSF finding in tubercular meningitis:
Cells- Mononuclear cells
Protein- Increased above 40 mg/100 ml
Sugar- Usually reduced to less than 2/3rd of blood sugar
Chloride level- Usually reduced
Q-251. Which of the following is a cause of reversible dementia?
a) Sub-acute combined degeneration
b) Picks disease
c) Creutzfeldt-Jakob disease
d) Alzheimer’s disease
Answer: Sub-acute combined degeneration
Explanation:
Potentially reversible dementia:
Vitamin deficiency:
Thiamine (B1) – Wernicke’s encephalopathy
B12- Pernicious anemia, Sub-acute combined degeneration
Nicotinic acids
Chronic infections:
Neuro-syphlis
Tuberculosis, fungal, protozoal
Whipple’s disease
Neoplastic:
Primary brain tumor
Metastatic brain tumor
Endocrine and other organ failure:
Hypothyroidism
Adrenal insufficiency
Hypo-parathyroidism and hyper-parathyroidism
Renal failure
Liver failure
Lung failure
Q-252. Serum angiotensin converting enzyme may be raised in all of the following except
a) Sarcoidosis
b) Silicosis
c) Berylliosis
d) Bronchogenic carcinoma
Answer: Bronchogenic carcinoma
Explanation:
Raised ACE level:
Sarcoidosis
Silicosis
Berylliosis
Hepatitis
Lymphoma
Tuberculosis
Leprosy
Fungal infection
Hypersensitivity pneumonitis
Q-253. 5- Nucleotidase activity is increased in
a) Bone diseases
b) Prostate cancer
c) Chronic renal failure
d) Cholestatic disorders
Answer: Cholestatic disorders
Explanation:
Raised enzymes in cholestasis:
5- Nucleotidase
Alkaline phosphatase
Gamma-glutamyl trans-peptidase
Q-254. A 40 year old male with history of daily alcohol consumption for the last 7 years is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgment and insight.
a) Alcoholic hallucinosis
b) Delirium tremens
c) Wernicke’s encephalopathy
d) Korsakoff’s psychosis
Answer: Delirium tremens
Explanation:
Delirium tremens is most severe form of alcoholic withdrawal syndrome and usually manifest within 2-3 days after the last drink.
Characteristic features of delirium tremens:
Mental confusion, tremors, sensory hyperactivity
Autonomic hyperactivity
Visual hallucination
Diaphoresis
Dehydration Electrolyte disturbance (Hypo-kalemia and hypo-magnesemia)
Cardiovascular abnormalities
Q-255. A 45 year male with a history of alcohol dependence presents with confusion, Nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from
a) Korsakoff’s psychosis
b) Wernicke’s encephalopathy
c) De Clerambault Syndrome
d) Delirium tremens
Answer: Wernicke’s encephalopathy
Explanation:
Wernicke-Korsakoff syndrome is associated with thiamine deficiency in alcoholics.
Wernicke’s encephalopathy consists of the triad of confusion, ataxia and ophthalmoplegia (Typical 6th nerve)
Korsakoff’s psychosis is characterized by both ante-grade and retro-grade amnesia with confabulation early in course.
Q-256. EEG is usually abnormal in all of the following except
a) Sub-acute sclerosing pan-encephalitis
b) Locked – In state
c) Creutzfeldt- Jakob disease
d) Hepatic encephalopathy
Answer: Locked – In state
Explanation:
Normal alpha activity on the EEG in patient of coma:
Locked – In state
Hysteria
Catatonia
Q-257. All of the following are neurologic channelopathies except
a) Hypokalemic periodic paralysis
b) Episodic ataxia type 1
c) Familial hemiplegic migraine
d) Spinocerebellar ataxia 1
Answer: Spinocerebellar ataxia 1
Explanation:
Neurological channelopathies:
Ataxias:
Episodic ataxia 1
Episodic ataxia 1
Spinocerebellar ataxia 6
Periodic paralysis:
Hyper-kalemic periodic paralysis
Hypo-kalemic periodic paralysis
Migraine:
Familial hemiplegic migraine
Epilepsy:
Benign neonatal familial convulsion
Myotonia:
Myotonia congenital
Para-Myotonia congenital
Deafness:
Autosomal dominant progressive deafness
Jervell and Lange-Nielsen syndrome
Q-258. Vitamin B12 deficiency can give rise to all of the following except
a) Myelopathy
b) Optic atrophy
c) Peripheral neuropathy
d) Myopathy
Answer: Myopathy
Explanation:
Vitamin B12 deficiency:
Optic atrophy
Peripheral neuropathy
Myelopathy
Dementia
Q-259. The most sensitive lest for the diagnosis of myasthenia gravis is
a) Elevated serum ACh- receptor binding antibodies
b) Repetitive nerve stimulation test
c) Positive Edrophonium test
d) Measurement of jitter by single fiber electromyography
Answer: Positive Edrophonium test (?)
Explanation:
The traditional anti-cholinesterase test, done at bedside and using the short-acting (< 5 min) drug Edrophonium, is positive in most patients who have myasthenia with overt weakness. AChR antibodies are present in 80 to 90% of patients with generalized myasthenia but in only 50% with the ocular form. Electromyography (EMG) Anti-MuSK antibodies Single-fiber EMG can detect abnormal neuromuscular transmission in > 95%.
Q-260. Joint erosions are not a feature of
a) Rheumatoid arthritis
b) Psoriasis
c) Multi-centric reticulo-histiocytosis
d) Systemic lupus erythematosus
Answer: Systemic lupus erythematosus
Explanation:
SLE is characterized typically by no-erosive arthritis involving two or more peripheral joints characterized by tenderness, swelling or effusion.