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.
Q-261. All of the following are the known cause of osteoporosis except
a) Fluorosis
b) Hypogonadism
c) Hyperthyroidism
d) Hyperparathyroidism
Answer: Fluorosis
Explanation:
Fluorosis is not associated with osteoporosis but associated with osteo-sclerosis.
Osteoporosis and endocrine disorders:
Hyperthyroidism
Thyrotoxicosis
Hyperparathyroidism
DM type II
Adrenal insufficiency
Acromegaly, Cushing’s syndrome
Hypo-gonadal states
Q-262. Which of the following is not a feature of hyper-calcemia?
a) Diarrhea
b) Polyuria
c) Depression
d) Vomiting
Answer: Diarrhea
Explanation:
Features of hyper-calcemia:
Anorexia
Nausea
Vomiting
Pain abdomen
Polyuria and nocturia
Depression
Mental confusion
ECG findings: Short QT interval
Q-263. The most common location of hypertensive intracranial hemorrhage is:
a) Subarachnoid space
b) Basal ganglia
c) Cerebellum
d) Hypertension
Answer: Basal ganglia
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/ basal ganglia are the most common site for hypertensive hemorrhage.
Q-264. The common cause of subarachnoid hemorrhage is
a) Arterio- venous malformation
b) Cavernous angioma
c) Aneurysm
d) Hypertension
Answer: Aneurysm
Explanation:
The most common cause of subarachnoid hemorrhage is rupture os saccular aneurysm, Berry aneurysm and most commonly occur in the anterior circulation on the circle of the Willis (Excluding head trauma).
Q-265. Which one of the following agents has been associated with hemorrhagic stroke?
a) Phenyl-propanolamine
b) Terfenadine
c) Quinidine
d) Fenfluramine
Answer: Phenyl-propanolamine
Explanation:
Phenyl-propanolamine:
Similar to ephedrine
Used in oral decongestant combination remedies
Used for weight loss as appetitic suppressant.
Its use is associated with hemorrhagic stroke.
Q-266. Which of the following is the most common type of glial tumors?
a) Astrocytoma
b) Medulloblastoma
c) Neurofibroma
d) Ependymoma
Answer: Astrocytoma
Explanation:
Astrocytoma is the most common primary intra-cranial neoplasm.
Q-267. Brain abscess in cyanotic heart disease is commonly located in
a) Cerebellar hemisphere
b) Thalamus
c) Temporal lobe
d) Parietal lobe
Answer: Parietal lobe
Explanation:
Brain abscess associated with congenital heart disease:
The abscesses are located in the parietal, frontal, and temporal lobes.
Parietal and frontal lobe are most common sites because of middle cerebral artery embolization in congenital heart disease.
Q-268. Which one of the following clinical findings excludes the diagnosis of Polymyositis?
a) Neck muscle involvement
b) Extra-ocular muscle involvement
c) Dysphagia
d) Abdominal muscle involvement
Answer: Extra-ocular muscle involvement
Explanation:
Extra-ocular muscle and facial muscle involvement exclude the diagnosis of Polymyositis.
Q-269. A young girl has consumed barium carbonate with suicidal intent. She complains of generalized muscle weakness. The most likely electrolyte is
a) Hypo-natremia
b) Hypo-calcemia
c) Hypo-kalemia
d) Hypo-magnesemia
Answer: Hypo-kalemia
Explanation:
Barium carbonate ingestion results into hypo-kalemia due to large shift of extra-cellular potassium into muscle.
Q-270. All of the following statements regarding primary effusion lymphoma are true except
a) It generally presents in elderly patients
b) There is often an association with HHV-8
c) The proliferating cells are NK cells
d) Patients are commonly HIV positive
Answer: The proliferating cells are NK cells
Explanation:
Primary effusion lymphoma is rare subtype of diffuse large B-cell lymphoma.
Primary effusion lymphoma may also be called body cavity lymphoma.
Primary effusion lymphoma is linked to human herpes virus 8 (HHV8) infections. It is also associated with Epstein-Barr virus (EBV) infection in many cases.
Primary effusion lymphoma most often occurs in people with weakened immune systems, such as those with HIV/AIDS.
Q-271. A patient with leukemia on chemotherapy develops acute right lower abdominal pain associated with anemia, thrombocytopenia and leucopenia. Which of following is the clinical diagnosis?
a) Appendicitis
b) Leukemic colitis
c) Perforation peritonitis
d) Neutropenic colitis
Answer: Neutropenic colitis
Explanation:
Neutropenic entero-colitis, also known as typhlitis is an acute life-threatening condition classically characterized by trans-mural inflammation of the caecum, often with involvement of the ascending colon and ileum, in patients who are severely myelo-suppressed.
Most patients who are affected with neutropenic entero-colitis are receiving anti-neoplastic drugs and are profoundly neutropenic.
Symptoms include the following:
Right lower quadrant abdominal pain, which may be cramping and intermittent or a continuous dull ache
Fever
Watery or bloody diarrhea
Nausea
Vomiting
Abdominal distention
Q-272. All of the following are major complications of massive transfusion except
a) Hypokalemia
b) Hypothermia
c) Hypo-magnesemia
d) Hypo-calcemia
Answer: Hypokalemia
Explanation:
Major complications of massive transfusion:
Hyperkalemia
Hypo-calcemia
Hypo-magnesemia
Acidosis
Hypothermia
Fluid overload
Decreased 2, 3 DPG
Q-273. All of the following are risk factors for atherosclerosis except
a) Increased waist-hip ratio
b) Hyper-Homocystinemia
c) Decreased fibrinogen levels
d) Decreased HDL levels
Answer: Decreased fibrinogen levels
Explanation:
Increased level of fibrinogen is associated with increased risk of atherosclerosis.
Q-274. All of the following may occur due to hyper-kalemia, except:
a) Prolonged PR interval
b) Prolonged QRS interval
c) Prolonged QT interval
d) Ventricular asystole
Answer: Prolonged QT interval
Explanation:
ECG findings in hyper-kalemia:
Prolonged PR interval
Prolonged QRS interval
Ventricular asystole
Q-275. All of the following may be seen in patients of cardiac tamponade except
a) Kussmaul’s sign
b) Pulsus paradoxus
c) Electrical Alternans
d) Right ventricular diastolic collapse on echocardiogram
Answer: Kussmaul’s sign
Explanation:
Q-276. All of the following are true for mitral valve prolapse except
a) Transmission may be as an autosomal dominant trait
b) Majority of cases present with features of mitral regurgitation
c) The value leaflets characteristically show Myxomatous degeneration
d) The disease is one of the common cardiovascular manifestations of Marfan’s syndrome
Answer: Majority of cases present with features of mitral regurgitation
Explanation:
Mitral valves prolapse:
Floppy or Myxomatous mitral valve
Associated with skeletal deformities (Pectus excavatum, scoliosis) and systemic collagen abnormality (Marfan or Ehlers Danlos syndrome)
Most patients are female.
Single or multiple mid-systolic clicks and pansystolic or late systolic murmur
Echocardiography is confirmatory.
Q-277. Sudden cardiac death may occur in all of the following except
a) Dilated cardiomyopathy
b) Hypertrophic cardiomyopathy
c) Eisenmenger’s syndrome
d) Ventricular septal defect
Answer: Ventricular septal defect
Explanation:
Causes of sudden cardiac death:
Coronary artery disease
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Valvular disease
Long QT syndrome
Ventricular arrhythmia- Eisenmenger’s syndrome
Heart failure
Shock
Electrolyte imbalance (Hypo-kalemia)
Hypoxia
Q-278. Which of the following is least likely to cause infective endocarditis?
a) Staphylococcus albus
b) Streptococcus fecalis
c) Salmonella typhi
d) Pseudomonas aeruginosa
Answer: Salmonella typhi
Explanation:
Causes of infective endocarditis:
Staphylococcus albus- Prosthetic valve endocarditis
Streptococcus fecalis- Most common cause of entero-coccal infective endocarditis
Pseudomonas aeruginosa- Infective endocarditis in drug users
Q-279. Mycotic aneurysm is an aneurysm infected because of
a) Fungal infection
b) Blood- borne infection (intra-vascular)
c) Infection introduced from outside (extra-vascular)
d) Both intravascular and extra-vascular infection
Answer: Both intravascular and extra-vascular infection
Explanation:
Mycotic aneurysms are an aneurysm arising from infection of the arterial wall, usually bacterial.
Origin of infections:
Intra-vascular
Extra-vascular
Primary or cryptogenic origin
Important points:
Osler first used the term “mycotic aneurysm” in 1885 to describe a mushroom-shaped aneurysm in a patient with sub-acute bacterial endocarditis.
This may create considerable confusion, since “mycotic” is typically used to define fungal infections.
Q-280. Mycotic abscesses are due to
a) Bacterial infection
b) Fungal infection
c) Viral infection
d) Mixed infection
Answer: Fungal infection
Explanation:
Mycotic abscess is characterized by a soft, cystic mass without or with mild inflammation caused by fungal infections.
Q-281. Anti-centromere antibodies are most commonly associated with:
a) Diffuse cutaneous systemic sclerosis
b) Mixed connective tissue disease
c) CREST syndrome
d) Polymyositis
Answer: CREST syndrome
Explanation:
Anti-centromere antibodies (ACA) occur in auto immune disorders; frequently in limited systemic scleroderma, (formerly called CREST syndrome), and, occasionally are found in the diffuse form of scleroderma.
CREST (Calcinosis, Raynaud phenomenon, Esophageal dys-motility, Sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the cardinal clinical features of the syndrome.
Q-282. Megaloblastic anemia due to folic acid deficiency is commonly due to
a) Inadequate dietary intake
b) Defective intestinal absorption
c) Absence of folic acid binding protein in serum
d) Absence of glutamic acid in the intestine
Answer: Inadequate dietary intake
Explanation:
Folic acid deficiency most commonly results from either decreased dietary intake or increased metabolic demand.
Q-283. In which of the following age group myelo-dysplastic syndromes (MDS) are most common
a) 2-10
b) 15-20
c) 25-40
d) >50
Answer: >50
Explanation:
Myelo-dysplastic syndromes (MDS):
Cytopenias with hyper cellular bone marrow
Morphologic abnormalities in two or more hematopoietic cell lines
Patients are usually over age 60 years.
Q-284. Smoking is generally not associated as a risk factor with
a) Small cell carcinoma
b) Respiratory bronchiolitis
c) Emphysema
d) Bronchiolitis obliterans organizing pneumonia
Answer: Bronchiolitis obliterans organizing pneumonia
Explanation:
Smoking related respiratory diseases:
Emphysema
Chronic bronchitis
Lung cancer
Respiratory bronchiolitis
Q-285. Which of the following is not a common feature of anorexia nervosa?
a) Binge eating
b) Amenorrhea
c) Self perception of being fat
d) Under weight
Answer: Binge eating
Explanation:
Anorexia nervosa:
Most of patients are female.
Intense fear of being fat
Weight loss
In female, absence of three consecutive menstrual cycles
Q-286. Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?
a) Chronic liver failure
b) Ascites
c) Upper gastrointestinal bleeding
d) Encephalopathy
Answer: Upper gastrointestinal bleeding
Explanation:
Non-cirrhotic portal hypertension:
Splenomegaly or upper-gastrointestinal bleeding from esophageal or gastric varices in patients without liver disease
Q-287. Which of the following colonic polyps is not pre-malignant?
a) Juvenile polyps
b) Hamartomatous polyps associated with Peutz Jeghers syndrome
c) Villous adenomas
d) Tubular adenomas
Answer: Juvenile polyps
Explanation:
Pre-malignant colonic polyps/ mucosal neoplastic adenomatous polyps:
Villous adenomas
Tubular adenomas
Hamartomatous polyps associated with Peutz Jeghers syndrome
Mucosal neoplastic polyps:
Hyperplastic polyps
Juvenile polyps
Hamartomas
Inflammatory polyps
Q-288. Drug induced lupus can be identified by
a) Anti- histone antibodies
b) Double stranded DNA antibodies
c) Antinuclear antibodies
d) Anti-SM antibodies
Answer: Anti- histone antibodies
Explanation:
Fours features of drug induced lupus:
Sex ratio is nearly equal.
Nephritis and CNS features are absent.
Hypo-complimentemia and antibodies to ds-DNA are absent.
The clinical features and most laboratory abnormalities usually revert toward the normal when the offending drug is withdrawn.
Important point:
Anti- histone antibodies are positive in more than 95 % of patients with drug induced lupus and signify a high correlation.
Q-289. The presence of anti-Saccharomyces cerevisiae antibody is a surrogate marker of one of the following
a) Celiac disease
b) Crohn’s disease
c) Ulcerative colitis
d) Tropical sprue
Answer: Crohn’s disease
Explanation:
When the diagnosis of Crohn’s disease remains uncertain, a panel of seven tests that measure auto-antibodies to P-ANCA, Saccharomyces cerevisiae, Porin C of E. coli and Bacterial flagellin Cbir 1 is marked as being 92 % accurate for diagnosing IBD and for distinguishing between Crohn’s disease and ulcerative colitis.
Q-290. Renal artery stenosis may occur in all of the following except
a) Atherosclerosis
b) Fibro-muscular dysplasia
c) Takayasu arteritis
d) Polyarteritis nodosa
Answer: Polyarteritis nodosa
Explanation:
Causes of renal artery stenosis:
Atherosclerosis (80-90 %)
Fibro-muscular dysplasia (5-15 %)
Takayasu arteritis
Polyarteritis nodosa (Rare)
Q-291. C- ANCA positivity indicates antibody formed against
a) Proteinase 3
b) Myelo-peroxidase
c) Cytoplasmic antinuclear Antibody
d) Anti centromeric Antibody
Answer: Proteinase 3
Explanation:
Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of auto-antibodies, mainly of the IgG type, against antigens in the cytoplasm of neutrophil granulocytes and monocytes.
C-ANCAs, or Cytoplasmic anti-neutrophil cytoplasmic antibodies, are a type of autoantibody, an antibody produced by the body that acts against one of its own proteins.
These antibodies show a diffusely granular, cytoplasmic staining pattern under microscopy. This pattern results from binding of ANCAs to antigen targets throughout the neutrophil cytoplasm, the most common protein target being Proteinase 3 (PR3).
PR3 is the most common antigen target of ANCA in patients with Wegener’s granulomatosis.
Q-292. Which of the following findings is diagnostic of iron deficiency anemia?
a) Increased TIBC, decreased serum ferritin
b) Decreased TIBC, decreased serum ferritin
c) Increased TIBC, increased serum ferritin
d) Decreased TIBC, increased serum ferritin
Answer: Increased TIBC, decreased serum ferritin
Explanation:
Iron deficiency anemia:
Decreased serum iron level
Increased TIBC
Decreased transferrin saturation
Decreased serum ferritin
Q-293. A normo-tensive patient with normal hemoglobin suffered massive blood loss. The following findings would be presents in him except
a) Increased PCV
b) Increased MCV
c) Thrombocytosis
d) Reticulocytosis
Answer: Increased PCV
Explanation:
PCV in acute hemorrhage is either normal or low (Later).
Early hematological changes in acute bleeding:
Thrombocytosis and neutrophilia (Immediate)
Reticulocytosis
Transient Increase in MCV
Q-294. Autoimmune hemolytic anemia is associated with malignancy of which lineage
a) T cell
b) B cell
c) Pre B cell
d) Pre T cell
Answer: B cell
Explanation:
Autoimmune hemolytic anemia is associated with B-cell malignancies such as CLL and Lymphoproliferative disorders, such as non-Hodgkin’s lymphoma,
Q-295. Pancytopenia with cellular marrow is seen in
a) PNH
b) G6PD deficiency
c) Acquired Aplastic anemia
d) Thalassemia
Answer: PNH
Explanation:
Pancytopenia with cellular marrow:
PNH
Myelo-dysplasia syndromes
Myelo-fibrosis
Bone marrow lymphoma
Megaloblastic anemia (Bone marrow always hyper-cellular)
Q-296. Pancytopenia with hyper-cellular marrow is seen in
a) PNH
b) Megaloblastic anemia
c) Acquired Aplastic anemia
d) Thalassemia
Answer: Megaloblastic anemia
Explanation:
Pancytopenia with cellular marrow:
PNH
Myelo-dysplasia syndromes
Myelo-fibrosis
Bone marrow lymphoma
Megaloblastic anemia (Bone marrow always hyper-cellular)
Hypersplenism
Q-297. Bone marrow biopsy is absolutely indicated in
a) Acute leukemia
b) Megaloblastic anemia
c) Hairy cell leukemia
d) Thalassemia
Answer: Hairy cell leukemia
Explanation:
In hairy cell leukemia, borrow tap is dry tap and hence bone marrow biopsy become an absolute indication for establishing the diagnosis.
Q-298. In PML, all of the following are seen except
a) Retinoic acid is used in treatment
b) 15/17 trans-locations may be seen
c) CD 15/34 both seen in same cell
d) Associated with disseminated intravascular coagulation (DIVC)
Answer: CD 15/34 both seen in same cell
Explanation:
Acute pro-myelocytic leukemia (APL) is a unique subtype of the acute leukemias.
Characterized by a balanced translocation between chromosomes 15 and 17
APL differs from AML in that most patients present with coagulopathy (DIVC).
Acute pro-myelocytic leukemia (APL) treatment has three phases: induction, consolidation, and maintenance.
An important agent in all three phases of treatment is all-trans-retinoic acid (ATRA).
Q-299. 80 year old asymptomatic man present with a total leukocyte count of 1 lakh with 80 % lymphocytes and 20% PMC’s. What is the most probable diagnosis?
a) HIV
b) CML
c) CLL
d) TB
Answer: CLL
Explanation:
Chronic lymphocytic leukemia:
CLL is disease of older patients and a median age at presentation of 70 years.
Lymphadenopathy
Enlargement of liver or spleen
Isolated lymphocytosis (Hallmark)
White blood count > 20000/mcL
75-98 % of circulating cells are lymphocytes
Q-300. Which of the following statements about mycosis fungoides is not true?
a) It is the most common form of cutaneous lymphoma
b) Pautrier’s micro-abscess
c) Indolent course and easily amenable to treatment
d) Erythroderma seen and spreads to peripheral circulation
Answer: Indolent course and easily amenable to treatment
Explanation:
Mycosis fungoides is a cutaneous T cell lymphoma.
Selective serotonin reuptake inhibitors may produce eruption clinically and histologically identical to those of mycosis fungoides.
Localized or generalized erythematous patches or plaques usually on trunks
Pruritis
Lymphadenopathy
The skin biopsy remains the basis of diagnosis.
The treatment is complex and early and aggressive treatment has not proved to cure or prevent progression of the disease.
Q-301. Erythropoietin is increased in all of the following conditions except
a) Hepato-cellular carcinoma
b) Renal cell carcinoma
c) Cerebellar hemangio-blastoma
d) Pancreatic carcinoma
Answer: Pancreatic carcinoma
Explanation:
Raised erythropoietin levels:
Renal cell carcinoma
Hepato-cellular carcinoma
Cerebellar hemangio-blastoma
Adrenal adenoma
Pheochromocytoma
Meningioma
Uterine fibromyoma
Q-302. A patient on aspirin will show the following finding
a) Prolonged BT
b) Prolonged PT
c) Prolonged a-PTT
d) Prolonged CT
Answer: Prolonged BT
Explanation:
Bleeding time is indicative of function of platelets.
PT, a-PTT and CT → Coagulation defect
Q-303. The following set of finding is seen in DIVC
a) Increased fibrinogen, increased anti-thrombin III, increased thrombin- anti-thrombin III complexes
b) Increased FDP, decreased PT, increased anti-thrombin III
c) Increase FDP, prolonged PT, increased thrombin-anti-thrombin complexes
d) Increased FDP, prolonged PT, reduced platelets
Answer: Increased FDP, prolonged PT, reduced platelets
Explanation:
Disseminated intra-vascular coagulation:
Progressive thrombocytopenia
Progressive prolongation of coagulation studies
Prolongation of a-PTT and PT
Low level of fibrinogen
Raised Fibrin Degradation Products (FDP)
Raised D-dimer
Schistocytes on blood smear
Q-304. Which is not regarding Bernard Soulier Syndrome?
a) Ristocetin aggregation is normal
b) Aggregation with collagen and ADP is normal
c) Large platelets
d) Thrombocytopenia
Answer: Ristocetin aggregation is normal
Explanation:
Bernard Soulier Syndrome:
Autosomal recessive bleeding disorder
Reduced or abnormal platelet membrane expression of glycoprotein Ib/IX (v-WF receptor)
Abnormal large platelets
Thrombocytopenia
Prolonged bleeding time
Platelet aggregation studies show as marked defect in response to Ristocetin
The diagnosis can be confirmed by platelet flow cytometry
Q-305. The following is the least useful investigation in multiple myeloma
a) ESR
b) X-ray
c) Bone scan
d) Bone marrow biopsy
Answer: Bone scan
Explanation:
Bone radiographs are important in establishing the diagnosis of the multiple myeloma.
Lytic lesions are most commonly seen in axial skeleton.
Radio-nucleotide bone scan is not useful in detecting bone lesion since there is usually no osteoblastic component.
Q-306. The following ECG findings are seen in hypokalemia
a) Increased PR interval with ST depression
b) Increased PR interval with peaked T wave
c) Prolonged QT interval with T wave inversion
d) Decreased QT with ST depression
Answer: Increased PR interval with ST depression
Explanation:
ECG findings are seen in hypokalemia:
ST depression
Flattened or inverted T wave
Prominent U wave
Prolonged P-R interval
Rarely S-A block
Q-307. CCF is associated with increase in all of the following except
a) Right atrial mean pressure
b) Serum sodium
c) Serum urea
d) Serum nor-epinephrine
Answer: Serum sodium
Explanation:
Congestive cardiac failure:
Hypo-natremia
Elevated serum urea
Elevated serum nor-epinephrine
Increased right atrial mean pressure
Q-308. A person with mitral regurgitation and atrial fibrillation presents with syncope. On examination the person has a heart rate of 55. What is the most probable cause?
a) Digitalis toxicity
b) Incomplete heart block
c) Stroke
d) Subarachnoid hemorrhage
Answer: Digitalis toxicity
Explanation:
Patient has a complete heart block most likely from digitalis intoxication.
Q-309. A patient presents with acute anterior wall infarction and hypotension. Which will be the immediate treatment modality for this patient?
a) Intra aortic balloon counter pulsation
b) Anticoagulation
c) Thrombolytic therapy
d) Angiography and primary angioplasty
Answer: Angiography and primary angioplasty
Explanation:
Immediate coronary angiography and primary percutaneous intervention is the treatment of choice for patient of ST elevation MI presenting within the first 12 hours of MI.
Q-310. A 70 year old man develops pneumonia and septicemia. Patient goes into renal failure and has a BP of 70/50 mm of Hg. Drug that should be used to maintain BP is
a) Adrenaline
b) Ephedrine
c) Phenylephrine
d) Nor epinephrine
Answer: Nor epinephrine
Explanation:
Treatment of septic shock:
Aggressive fluid resuscitation and oxygen supplementation -> persistent hypotension-> dopamine-> persistent hypotension-> more potent Nor-epinephrine
Q-311. All of the following are true about Raynaud’s disease except
a) More common in females
b) Positive antinuclear antibodies
c) Most common cause of Reynaud’s phenomenon
d) Has good prognosis
Answer: Positive antinuclear antibodies
Explanation:
Raynaud Phenomenon (RP) is classified as primary (Idiopathic or Raynaud disease) or secondary.
Primary RP is more common and common in young females.
Secondary PR is less common and chiefly associated with rheumatic disease (ANA).
Raynaud’s disease is benign and good prognosis.
Q-312. The following are components of Kawasaki disease except
a) Purulent conjunctivitis
b) Pedal edema
c) Truncal rash
d) Pharyngeal congestion
Answer: Purulent conjunctivitis
Explanation:
Kawasaki disease:
Fever
Bilateral non-exudative conjunctivitis
Mucous membrane changes
Peripheral extremities changes
Polymorphous rash and cervical lymphadenopathy
Q-313. Increased ICT is associated with all except
a) Paraparesis
b) Abducent paralysis
c) Headache
d) Visual blurring
Answer: Paraparesis
Explanation:
Increased ICT:
Headache
Nausea and vomiting
Visual blurring
Abducent paralysis
Stupor/ coma
Papillo-edema
Cushing reflex
Important point:
Abducent paralysis- Caused by stretching of one or both Abducent nerves over the petrous tip as a result of downward displacement of the brain stem from raised intra-cranial pressure.
Q-314. Pontine stroke is associated with all except
a) Bilateral pin point pupil
b) Pyrexia
c) Vagal palsy
d) Quadriparesis
Answer: Vagal palsy
Explanation:
Pontine infarcts are one form of brainstem infarction involving the posterior circulation. Infarcts in the pons are typically focal in nature.
Pontine stroke:
Hyperpyrexia
Pin point pupil
Deep coma with quadriplegia
Hyperhidrosis
Decerebrate rigidity/ posturing
Loss of reflex, eye movement and corneal response
Q-315. Millard Gubler syndrome includes the following except
a) 5th nerve palsy
b) 6th nerve palsy
c) 7th nerve palsy
d) Contra-lateral hemiparesis
Answer: 5th nerve palsy
Explanation:
Ventral Pontine Syndrome (Millard-Gubler Syndrome):
Contra-lateral hemiplegia (sparing the face) due to pyramidal tract involvement
Ipsilateral lateral rectus palsy with diplopia that is accentuated when the patient looks toward the lesion, due to cranial nerve VI involvement
Ipsilateral peripheral facial paresis, due to cranial nerve VII involvement
Q-316. All of the following statements are true about Benedikt syndrome except
a) Contra-lateral tremor
b) 3rd nerve palsy
c) Involvement of the penetrating branch of the basilar artery
d) Lesion at the level of the pons
Answer: Lesion at the level of the pons
Explanation:
Benedikt syndrome:
The syndrome may result from occlusion of the penetrating branches of the basilar artery in the midbrain.
It is a consequence of damage to the red nucleus – the outflow from the opposite cerebellar hemisphere.
Benedikt’s Syndrome describes an ipsilateral III nerve palsy accompanied by contra-lateral ‘cerebellar’ tremor.
There may also be contra-lateral hyper-aesthesia.
Q-317. The following are components of Brown Sequard syndrome except
a) Ipsilateral extensor plantar response
b) Ipsilateral pyramidal tract Involvement
c) Contra-lateral spino-thalamic tract involvement
d) Contra-lateral posterior column involvement
Answer: Contra-lateral posterior column involvement
Explanation:
Brown-Séquard’s syndrome results from a lesion in one (lateral) half of the spinal cord (Ipsi-lateral involvement of cortico-spinal tract and posterior column; and contra-lateral involvement of spino-thalamic tract).
Total ipsilateral loss of position, light touch and vibration sensation at the level of the lesion
Contra-lateral loss of pain and temperature
Ipsilateral spastic para-paresis with loss of vibration and joint-position sense below the lesion
Reflexes are brisk with up-going plantar reflex
Q-318. Which of the following is the classical CSF finding seen in TBM
a) Increased protein, decreased sugar, increased lymphocytes
b) Increased protein, sugar and lymphocytes
c) Decreased protein, increased sugar and lymphocytes
d) Increased sugar, protein and neutrophils
Answer: Increased protein, decreased sugar, increased lymphocytes
Explanation:
Q-319. All of the following organs may be involved in leprosy except
a) Uterus
b) Ovary
c) Testes
d) Eye
Answer: Uterus
Explanation:
The female genital tract is rarely involved in leprosy, when involved ovary is the most common.
Q-320. Treatment of severe ulnar neuritis in borderline tuberculoid leprosy is
a) MDT only
b) MDT+ steroid
c) Wait and watch
d) MDT+ thalidomide
Answer: MDT+ steroid
Explanation:
Treatment for severe neuritis in Leprosy:
MDT- Eliminate infection
Steroid- Prevent further nerve damage
Q-321. All are major criteria for rheumatic fever except
a) Carditis
b) Subcutaneous nodule
c) Arthralgia
d) Chorea
Answer: Arthralgia
Explanation:
Jones Criteria for Diagnosis of Rheumatic Fever:
Major Diagnostic Criteria
Carditis
Poly-arthritis
Chorea
Erythema marginatum
Subcutaneous Nodules
Minor Diagnostic Criteria
Fever
Arthralgia
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
Diagnostic
Required Criteria- 2 major criteria and 0 minor criteria or 1 major criteria and 2 minor criteria
Q-322. Division of chromosome perpendicular to the usual axis of division forms
a) Acrocentric chromosome
b) Telocentric chromosome
c) Ring chromosome
d) Isochromosome
Answer: Isochromosome
Explanation:
Arms of Isochromosome are equal in length and genetically identical, and produced during mitosis or meiosis when centromere splits transversely instead of longitudinally.
Q-323. Cyanosis does not develop in severe anemia because of
a) It requires a critical concentration of reduced hemoglobin in blood
b) In anemia the blood flow through the skin is decreased
c) In anemia the hemoglobin has greater oxygen carrying capacity per unit gram of hemoglobin
d) Due to decreased oxygen carrying capacity of blood
Answer: It requires a critical concentration of reduced hemoglobin in blood
Explanation:
Cyanosis is caused by excessive de-oxygenated hemoglobin in the skin blood vessels, especially in the capillaries.
In general, definite cyanosis appears whenever the arterial blood contains more than 5 grams of deoxygenated hemoglobin in each 100 ml of blood.
Q-324. Which of the following statements is true about ESR in tuberculosis?
a) ESR confirms recovery from TB
b) ESR remains normal
c) ESR values are increased due to decrease in the size of the RBCs
d) ESR values are increase due to formation of larger aggregates of RBCs
Answer: ESR values are increase due to formation of larger aggregates of RBCs
Explanation:
Erythrocyte sedimentation rate (ESR) is a useful but non-specific marker of underlying inflammation.
The ESR is an indirect measurement of serum acute phase protein concentrations particularly fibrinogen.
An accelerated ESR is caused by elevated level of fibrinogen that favored rouleaux formation.
Anemia increases ESR because change in the erythrocyte plasma ratio favors rouleaux formation.
Red cells with abnormal shape such as sickle cells or spherocytes hinder rouleaux formation and lowers ESR.
TB is a chronic bacterial infection and ESR value is increased in such patients.
ESR is not used to confirm recovery from the disease.
Q-325. A 16-year-old girl presented with abdominal pain after administration of a sulfa drug. She was incoherent and suffered a seizure. Which of the following is the most likely possibility?
a) Acute intermittent porphyria
b) Congenital erythropoietic porphyria
c) Adenosine deaminase deficiency
d) HGPRT deficiency
Answer: Acute intermittent porphyria
Explanation:
The sequence of events in attacks of acute intermittent porphyria (AIP) usually is as follows:
Abdominal pain
Psychiatric symptoms (eg, hysteria)
Peripheral neuropathies, mainly motor neuropathies
Central nervous system signs may include the following: Seizures, Delirium, Cortical blindness, Coma
Drugs causing acute Intermittent Porphyria (AIP):
Barbiturates
Chloramphenicol
Sulfonamides
Rifampicin
Oral contraceptives
Phenylbutazone
Q-326. Trans-esophageal echocardiogram (TTE) is superior to trans-thoracic echocardiogram (TTE) because of
a) Convenient
b) Is more sensitive in picking up left ventricular apical thrombus
c) Is more sensitive in picking up atheromatous plaques in ascending thoracic aorta
d) TTE is more sensitive in picking up atrial appendage thrombus
Answer: Is more sensitive in picking up atheromatous plaques in ascending thoracic aorta
Explanation:
In most patients, TEE provides superior image quality, particularly for posterior cardiac structures which is near to the esophagus and less well visualized on TTE.
Q-327. Left bundle branch block (LBBB) on ECG can suddenly develop in all of the following except
a) Acute MI
b) Ashman syndrome
c) Hypokalemia
d) Hyperkalemia
Answer: Hypokalemia
Explanation:
Left bundle branch block (LBBB) associated with:
Acute MI
Hypertension
Coronary artery disease
Cardiomyopathy
Ashman syndrome (RBBB is more common)
Hyperkalemia
Q-328. A 55 year old male presents with renal failure. He gives a history of mild bone pains for the last 7 years. X-ray pelvis shows osteolytic lesions. Serum electrophoresis reveals is M spike. Peripheral blood evaluation showed rouleaux formation of RBCs with 35% plasma cells. Bone marrow examination showed an increase in plasma cells with aberrant antigen expression. The most likely diagnosis is
a) Monoclonal gammopathy of undetermined significance
b) Multiple myeloma
c) Smoldering multiple myeloma
d) Plasma cell leukemia
Answer: Plasma cell leukemia
Explanation:
Primary plasma cell leukemia is a rare and aggressive plasma cell proliferative disorder with a very poor prognosis.
Compared with multiple myeloma, it presents more often with extra-medullary involvement, anemia, thrombocytopenia, hyper-calcemia, elevated serum β2-microglobulin and lactate dehydrogenase levels, as well as impaired renal function.
Peripheral blood smears of patients:
Leukocytosis with circulating plasma cells
Plasma cells contain clock face or spoke wheel chromatin without nucleoli.
Q-329. An elderly female presents with acute onset of confusion and bumping into things. On examination she is alert, oriented with fluent speech and normal comprehension. On further examination there is impaired writing, right-left orientation, arithmetic abilities and finger identification. MRI imaging revealed several foci of cortical and sub-cortical increased T2 signals and various areas of lepto-meningeal enhancement. The most probable diagnosis is
a) Gerstmann Syndrome
b) Millard-Gubler syndrome
c) Anton syndrome
d) Korsakoff’s psychosis
Answer: Gerstmann Syndrome
Explanation:
The syndrome is characterized by the loss or absence of four cognitive abilities-
The loss of the ability to express thoughts in writing (agraphia, dysgraphia)
To perform simple arithmetic problems (acalculia)
To recognize or indicate own or another’s fingers (finger agnosia)
Distinguish between the right and left sides of one’s body.
Important point:
Damage to the left parietal lobe causes Gerstmann Syndrome.
Q-330. In medically intractable seizures, which of the following modalities of treatment has shown the best seizures-free interval?
a) Vagus nerve stimulation
b) Epilepsy surgery
c) Ketogenic diet
d) Deep brain stimulation
Answer: Epilepsy surgery
Explanation:
Treatment of drug resistant epilepsy:
Resective epilepsy surgery (Treatment of choice)
Vagus nerve stimulation
Deep brain stimulation
Cortical stimulation
Trans-cranial magnetic stimulation
Ketogenic diet
Q-331. Which of the following drugs is effective as mono-therapy as a replacement for sodium valproate in a female of childbearing age group for treatment of juvenile myoclonic epilepsy?
a) Levetiracetam
b) Lacosamide
c) Phenytoin
d) Carbamazepine
Answer: Levetiracetam
Explanation:
Treatment of juvenile myoclonic epilepsy:
Valproate (First line treatment of choice)
Levetiracetam
Lamotrigine
Topiramate
Important point:
It should be avoided in child bearing age because of its teratogenic risks.
Q-332. Which of the following is true about CLL treatment?
a) Should be offered to all patients
b) Can be withheld in asymptomatic patients
c) Is curative
d) Combination chemo-radiotherapy should be given in patients above 50 years age
Answer: Can be withheld in asymptomatic patients
Explanation:
Treatment options for chronic lymphocytic leukemia (CLL) vary greatly, depending on the person’s age, the disease risk group, and the reason for treating (for example, which symptoms it is causing).
Many people live a long time with CLL, but in general it is very difficult to cure, and early treatment hasn’t been shown to help people live longer.
Q-333. The genetic mutation seen in the most common type of maturity onset diabetes of young (MODY) is
a) Hepatocyte nuclear factor-4
b) Hepatocyte nuclear factor -1
c) Glucokinase
d) Insulin promoter factor-1
Answer: Hepatocyte nuclear factor -1
Explanation:
Maturity onset diabetes of young (MODY):
Non-insulin dependent diabetes diagnosed at a young age (< 25 years) Autosomal dominant transmission and lack of auto-antibodies Mutations in Hepatocyte nuclear factor -1 alpha and the glucokinase gene are most commonly identified occurring in 52 to 65 and 15 to 32 percent of MODY cases respectively. Q-334. An asymptomatic boy on ECG is detected to have a short PR interval and delta waves. The least effective measure for the boy would be a) Holter monitoring b) Treadmill stress test c) Beta blockers d) Reassurance Answer: Treadmill stress test Explanation: Wolff Parkinson White syndrome pattern on EEG: Short PR interval Delta wave Q-335. A 8-year-old boy complains of muscle weakness. On examination, his calves are bulky and show muscle tightening. His serum creatine kinase levels are decreasing with age. Which of the following is the most likely diagnosis? a) Hereditary sensori-motor neuropathy b) Myelin deficiency c) Dystrophin deficiency d) Congenital myopathy Answer: Dystrophin deficiency Explanation: Duchenne and Becker muscular dystrophy: X-linked recessive traits and mutation of the dystrophin gene Duchenne muscular dystrophy is associated with the most severe clinical symptoms. Pseudo-hypertrophy of the calf muscle Elevated levels of serum creatine kinase (Serum creatine kinase levels decreasing with age) Q-336. A person presents with the following parameters: pCO2: 30 mm Hg, PO2: 105 mm Hg, pH: 7.45. He is having partially compensated a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis Answer: Respiratory alkalosis Explanation: Respiratory alkalosis = ↑ pH and ↓ pCO2 Q-337. An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination there is marked neck rigidity and on focal neurological deficit was found. The symptoms are most likely due to a) Intra-cerebral parenchymal hemorrhage b) Subarachnoid hemorrhage c) Meningitis d) Ischemic stroke Answer: Subarachnoid hemorrhage Explanation: Clinical feature of subarachnoid hemorrhage: Sudden and severe headache Brief period of unconsciousness Signs of meningeal irritation Important point: Abrupt onset of focal neurological deficit → Hypertensive intra-cerebral hemorrhage Q-338. A boy presented with a history of fever, headache and vomiting since 3 days and disorientation since 1 day. On examination, neck rigidity was positive. He also had 1 episode of generalized tonic clonic seizures (GTC) and then he became unconscious. CECT was found to be normal. CSF examination reveals a cell count of 300 cell/mm (polymorphs-50-70%), proteins 70 mg/dl and sugar 50 mg/dl (blood: 95 mg/dl). Which of the following is the most likely diagnosis? a) Pyogenic meningitis b) Tubercular meningitis c) Herpes encephalitis d) Cerebral malaria Answer: Pyogenic meningitis Explanation: Q-339. All of the following are characteristic features of Klüver-Bucy Syndrome in children except a) Visual agnosia b) Hyper-metamorphosis c) Hyper-sexuality d) Intractable seizure Answer: Intractable seizure Explanation: Klüver-Bucy syndrome is a neuro-behavioral syndrome associated with bilateral lesions in the anterior temporal horn or amygdala. Clinical features of Klüver-Bucy Syndrome: Visual agnosia Oral tendencies - they would examine their surroundings with their mouths instead of their eyes Hyper-metamorphosis - a desire to explore everything. They lost fear where it would normally occur. Even after being attacked by a snake, they would casually approach it again. This was called “placidity”. Hyper-sexuality Q-340. A person is found to be sero-positive for both HBsAg and HBeAg. He is suffering from a) Concurrent Hepatitis B and hepatitis E b) Past hepatitis B infection c) Chronic hepatitis B infection d) Acute infectious hepatitis Answer: Chronic hepatitis B infection Explanation: HBsAg and HBeAg: Chronic hepatitis B with high infectivity