Q-321. All are major criteria for rheumatic fever except
b) Subcutaneous nodule
Jones Criteria for Diagnosis of Rheumatic Fever:
Major Diagnostic Criteria
Minor Diagnostic Criteria
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
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
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
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
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
The sequence of events in attacks of acute intermittent porphyria (AIP) usually is as follows:
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):
Q-326. Trans-esophageal echocardiogram (TTE) is superior to trans-thoracic echocardiogram (TTE) because of
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
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
Left bundle branch block (LBBB) associated with:
Coronary artery disease
Ashman syndrome (RBBB is more common)
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
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
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.
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
Treatment of drug resistant epilepsy:
Resective epilepsy surgery (Treatment of choice)
Vagus nerve stimulation
Deep brain stimulation
Trans-cranial magnetic stimulation
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?
Treatment of juvenile myoclonic epilepsy:
Valproate (First line treatment of choice)
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
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
d) Insulin promoter factor-1
Answer: Hepatocyte nuclear factor -1
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