Q-51. Pulsus paradoxus is/are present in all except
a) Hypovolemic shock
b) Pulmonary embolism
c) Right ventricular myocardial infarction
d) Cardiac tamponade
e) Severe COPD
Answer: c
Explanation:
Pulsus paradoxus occurs in:
Cardiac tamponade
Constrictive pericarditis
Hypovolemic shock
Acute and chronic obstructive airways disease
Pulmonary embolus
Q-52. Loud S1 present in
a) MS with pliable valve
b) MS with calcified valve
c) MR
d) AS
e) TR
Answer: a
Explanation:
Normal S1: AS
Soft S1: MS with calcified valve, MR, TR
Loud S1: MS with pliable valve
Q-53. Chloride resistant metabolic alkalosis seen in all except
a) Primary aldosteronism
b) Milk alkali syndrome
c) Vomiting
d) Diuretic use
e) Hypokalemia
Answer: c, d and e
Explanation:
Chloride-Resistant Metabolic Alkalosis:
Primary hyper-aldosteronism
Cushing syndrome
Syndrome of apparent mineralo-corticoid excess
Licorice ingestion
Bartter syndrome and Gitelman syndrome
Liddle syndrome
Milk Alkali Syndrome
Q-54. Which of the following statement (s) is not true about myasthenia gravis?
a) More sensitive to non-depolarizing
b) More sensitive to depolarizing
c) Single-fiber electromyography shows blocking and jitters
d) Proximal muscle involvement
e) Repeated electric stimulation enhance muscle power
Answer: b and e
Explanation:
Myasthenia gravis (MG) is a relatively rare autoimmune disorder in which antibodies form against acetylcholine nicotinic postsynaptic receptors at the neuromuscular junction of skeletal muscles.
These patients are resistant to depolarizing agents and hypersensitive to non-depolarizing agents.
Electro-diagnostic studies:
Repetitive stimulation of a muscle at 2-3 Hz, also known as repetitive nerve stimulation (RNS)
Single-fiber electromyography (SFEMG), aimed at evaluating neuromuscular block, jitter, and fiber density
SFEMG is more sensitive than RNS in assessing MG.
During low-frequency (1-5 Hz) RNS, the locally available acetylcholine (ACh) becomes depleted at all neuromuscular junctions (NMJs), and less is therefore available for immediate release. This results in smaller excitatory postsynaptic potentials (EPSPs).
Q-55. Drugs causing pancreatitis
a) Steroids
b) Isoniazid
c) Paracetamol
d) Aspirin
e) Fexofenadine
Answer: a, b and c
Explanation:
Drugs definitely associated with acute pancreatitis include the following:
Azathioprine
Sulfonamides
Sulindac
Tetracycline
Valproic acid
Didanosine
Methyldopa
Estrogens
Frusemide
6-Mercaptopurine
Pentamidine
5-aminosalicylic acid compounds
Corticosteroids
Octreotide
Q-56. Symptom (s) of acute exacerbation of COPD is/are
a) Fever
b) Increased dyspnea
c) Increased sputum production
d) Change in character of sputum
e) Weight loss
Answer: a, b, c and d
Explanation:
Symptoms of acute exacerbation of COPD:
Increased dyspnea
Increased cough; increased sputum purulence and increased sputum volume
Upper airway symptoms
Increased wheeze and chest tightness
Q-57. Clinical feature of hyper-calcemia in carcinoma include (s)
a) Vomiting
b) Diarrhoea
c) Sinus tachycardia
d) Hypo-reflexia
e) Confusion
Answer: a, d and e
Explanation:
Clinical manifestations of humoral hyper-calcemia in malignancy:
Anorexia Nausea Vomiting Constipation
Fatigue
Depression
Mental confusion
Reversible renal tubular defects and increased urination
A short Q interval and cardiac arrhythmias
Q-58. Pancytopenia with hyper-cellular marrow is not a feature of
a) SLE
b) PNH
c) Sarcoidosis
d) Fanconi anemia
Answer: Fanconi anemia
Explanation:
Thrombocytopenia associated with congenital conditions:
Amegakaryocytic thrombocytopenia
Wiskott Aldrich syndrome
Thrombocytopenia absent radius syndrome (TAR Syndrome)
Thrombocytopenia with depression in other blood cell counts associated with congenital conditions:
Fanconi anemia
Dyskeratosis congenital
Q-59. Poor prognostic factor in acute pancreatitis is
a) Increased serum amylase
b) Increased serum calcium
c) Increased blood sugar
d) Increased PaO2
Answer: Increased blood sugar
Explanation:
Ranson criteria for assessing the severity of acute pancreatitis:
Criteria on admission:
Age: >55 years
White blood count: > 16 000/mm
Blood glucose level: > 200 mg/dl (11.0 mmol/ l)
Lactate dehydrogenase (LDH): > 350 IU/ l
Aspartate amino-transferase (AST): > 250 U/ l
Criteria after 48 hours of admission:
Packed cell volume: decrease >10% from admission
Blood urea nitrogen (BUN): increase > 5 mg/dl (1.8 mmol/l) from admission
Calcium: < 8 mg/dl (0.2 mmol/ l) Oxygen partial pressure: <60 mm Hg Base deficit: >4 mmol/ l
Fluid sequestration: >6 l
Q-60. Diarrhoea may be a feature of all of the following disease states, except
a) Carcinoid syndrome
b) Diabetic autonomic neuropathy
c) Thyrotoxicosis
d) Hyperparathyroidism
Answer: Diabetic autonomic neuropathy (Most correct answer)
Explanation:
Causes of chronic diarrhoea:
Osmotic diarrhoea:
Medications: Antacids, lactulose and sorbitol
Disaccharide deficiency: Lactose intolerance
Factitious diarrhoea: Magnesium (Antacids, laxatives)
Motility disorders:
Postsurgical: Vagotomy, partial gastrectomy, blind loop with bacterial overgrowth
Systemic disorders: Scleroderma, DM, hyperthyroidism
Irritable bowel syndrome
Secretory diarrhoea:
Hormonally mediated: VIPoma, carcinoid, medullary carcinoma of thyroid (Calcitonin), ZE syndrome (Gastrin)
Villous adenoma
Bile salt mal-absorption
Factitious diarrhoea: Laxative abuse
Mal-absorption syndromes:
Small bowel mucosal disorders: Celiac sprue, Tropical sprue, Whipple disease, Crohn’s disease, Small bowel resection, Eosinophilic gastro-enteritis
Lymphatic obstruction: Lymphoma, carcinoid, tuberculosis, Kaposi sarcoma, sarcoidosis and retro-peritoneal fibrosis
Pancreatic diseases
Bacterial overgrowth
Inflammatory conditions:
Ulcerative colitis
Crohn’s disease
Microscopic colitis
Malignancy: Lymphoma and Adenocarcinoma
Radiation enteritis
Important points:
Diabetic autonomic neuropathy causes stasis.
Parathyroid crisis is a rare condition that sometimes occurs when people with hyperparathyroidism experience vomiting or diarrhea, which causes excessive fluid loss.