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