Q-81. All is true about Huntington’s disease except
a) Chorea
b) Behavioral disturbance
c) Early loss of memory loss
d) Cog wheel rigidity
Ans: c
Explanation:
Huntington’s disease:
The most characteristic initial physical symptoms are jerky, random, and uncontrollable movements called chorea.
The clear appearance of symptoms such as rigidity, writhing motions or abnormal posturing appear as the disorder progresses.
Cog-wheel rigidity refers to a body motion (typically the arm) that resembles cogs in a wheel- it’s very jerky and similar to a spring-like action.
Psychomotor functions become increasingly impaired, such that any action that requires muscle control is affected. Common consequences are physical instability, abnormal facial expression, and difficulties chewing, swallowing, and speaking.
Cognitive abilities are impaired progressively. Especially affected are executive functions which include planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions. As the disease progresses, memory deficits tend to appear.
Memory loss is frequently not impaired until late in the disease.
Q-82. A patient has an accident with resultant transection of the pituitary stalk: what will not occur
a) Diabetes mellitus
b) Diabetes insipidus
c) Hyper-prolactinemia
d) Hypothyroidism
Answer: Diabetes mellitus
Explanation:
Pituitary stalk interruption syndrome, also known as pituitary stalk transection syndrome, is characterized by an (1) absent or hypo-plastic adeno-hypophysis, (2) ectopic neuro-hypophysis, and (3) absent or hypo-plastic pituitary stalk.
Q-83. In a patient of acute inferior wall MI; best modality of management is
a) IV fluids
b) Digoxin
c) Diuretics
d) Vasodilators
Answer: IV fluids
Explanation:
RV infarction is present in one third of patients with inferior wall infarction.
It presents with low BP with raised venous pressure with relatively preserved LV function.
Diagnosis is suggested by ST segment elevation in right sided anterior chest leads, particularly RV4.
Treatment consists of fluid loading to improve LV filing and ionotropic agents if necessary.
Q-84. A 26 yr old asymptomatic woman is found to have Arrhythmias and a systolic murmur associated with mid-systolic clicks; which investigation would you use?
a) Electro-physiological testing
b) Tc Scan
c) Echocardiography
d) Angiography
Answer: Echocardiography
Explanation:
Mitral Valve Prolapse or Floppy or Myxomatous mitral valve:
Often associated with skeletal changes (Scoliosis, pectus, straight back) or hyper-reflexivity of joints
Chest pain and palpitations
Murmur pansystolic or only late in systole
Single or multiple mid-systolic clicks
Echocardiography is confirmatory.
Q-85. A patient complains of intermittent claudication, dizziness and headache; likely cardiac lesion is
a) TOF
b) ASD
c) PDA
d) Coarctation of aorta
Answer: Coarctation of aorta
Explanation:
Clinical presentation of coarctation of aorta:
Most patients are asymptomatic.
Headache
Dizziness
Cold extremities and weakness of legs
Claudication with exercise
Epistaxis
Q-86. All of the following are true about ASD except
a) Right atrial hypertrophy
b) Left atrial hypertrophy
c) Right ventricular hypertrophy
d) Pulmonary hypertension
Answer: Left atrial hypertrophy
Explanation:
Atrial septal defect:
The most common form of atrial septal defect is persistence of the ostium secundum in the mid septum.
Echocardiography and Doppler is diagnostic.
The pulmonary pressures are moderately elevated in most patients with ASD.
X-Ray Chest Findings:
Large pulmonary artery
Increased pulmonary vascularity
Enlarged RA and RV
A small aortic knob
Q-87. Mitral valve vegetations do not usually embolise to
a) Lung
b) Liver
c) Spleen
d) Brain
Answer: Lung
Explanation:
Emboli in right side of heart→ tricuspid valve→ pulmonary circulation→ lungs abscess
Emboli in left side of heart→ mitral valve→ systemic circulation→ brain, kidney, spleen etc
Q-88. A woman has septic abortion done; vegetation on tricuspid valve is likely to go to
a) Septic infarcts to lung
b) Liver
c) Spleen infarcts
d) Emboli to brain
Answer: Septic infarcts to lung
Explanation:
Emboli in right side of heart→ tricuspid valve→ pulmonary circulation→ lungs abscess
Emboli in left side of heart→ mitral valve→ systemic circulation→ brain, kidney, spleen etc
Q-89. Kussmaul’s sign is NOT seen in
a) Restrictive cardiomyopathy
b) Constrictive pericarditis
c) Cardiac tamponade
d) RV infarct
Answer: Cardiac tamponade
Explanation:
Kussmaul’s sign is the paradoxical rise in jugular venous pressure with inspiration.
Decreased intra-thoracic pressure during inspiration normally leads to an increase in venous return to the right side of the heart, with an associated decrease in jugular venous pressure.
When there is impaired filling of the right ventricle, the jugular veins instead become engorged.
Causes of Kussmaul’s sign include right ventricular infarction, severe right ventricular failure, restrictive cardiomyopathy, constrictive pericarditis, and tricuspid stenosis.
Q-90. A pt presents with engorged neck veins, BP 80/50 and pulse rate of 100 following blunt trauma to the chest. Diagnosis is
a) Pneumothorax
b) Right ventricular failure
c) Cardiac tamponade
d) Hemothorax
Answer: Cardiac tamponade
Explanation:
Acute cardiac tamponade:
Elevated intra-pericardial pressure > 15 mm Hg
Signs and symptoms:
Pain in inflammatory cases or painless in neoplastic or uremic effusion
Dyspnea and cough
A pericardial friction rub
Tachycardia and tachypnea
Pulsus paradoxus (Also found in obstructive lung disease and asthma) and a relatively preserved systolic pressure
Elevated central venous pressure
Investigation:
Echocardiography is primary method for demonstrating pericardial effusion.
ECG: Non-specific T wave changes and low QRS voltage X-ray chest: Enlarged cardiac silhouette with globular configuration
Treatment:
Urgent paracentesis when tamponade present