Q-41. Most common viral cause of kidney transplant rejection
a) Polymyoma virus
b) HCV
c) HBV high risk
d) Herpes simplex type
Answer: Polymyoma virus
Explanation:
The polyomaviruses cause clinical disease among immuno-compromised patients.
BK virus and JC virus are the two most common polyomaviruses associated with human disease and the only two associated with nephropathy.
The major diseases caused by BK virus are tubule-interstitial nephritis and ureteral stenosis in renal transplant recipients, and hemorrhagic cystitis in bone marrow transplant recipients.
BK virus causes clinical disease of the genitourinary tract, due in part to its tropism for genitourinary epithelium.
The JC virus causes a similar disease among kidney transplant recipients, but is far less common.
BK-induced nephropathy reportedly occurs in up to 10 percent of kidney allograft recipients. Overall, the reported incidence of allograft failure ranges from 15 to 50 percent of affected individuals.
Q-42. Not a cause of pancreatitis
a) Hyperlipidemia
b) Islet cell hyperplasia
c) Abdominal trauma
d) Trypsinogen
Answer: Islet cell hyperplasia
Explanation:
Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start “digesting” the pancreas itself.
A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including:
Alcoholism, Gallstones, Abdominal surgery and during, ERCP procedure, certain medications, Cigarette smoking, Cystic fibrosis, Family history of pancreatitis, Hyper-calcemia, Hyper-triglyceridemia, Infection, Injury to the abdomen and Pancreatic cancer
Q-43. The following are absorbable sutures
a) Catgut
b) Silk
c) Polyamide (Nylon)
d) Polyglyconate
e) Polyglactin (Vicryl)
Answer: Catgut, Polyglyconate and Polyglactin (Vicryl)
Explanation:
Absorbable suture materials include the original catgut as well as the newer synthetics Polyglyconate, Polyglactin (Vicryl), and caprolactone.
They are broken down by various processes including hydrolysis and proteolytic enzymatic degradation.
Non-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon.
Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery.
Q-44. The following cause hyper-calcemia
a) Sarcoidosis
b) Primary hyperparathyroidism
c) Acute pancreatitis
d) Metastatic bronchial carcinoma
e) Milk-Alkali syndrome
Answer: Sarcoidosis, Primary hyperparathyroidism, Metastatic bronchial carcinoma and Milk-Alkali syndrome
Explanation:
Hyper-calcemia is a disorder that most commonly results from malignancy or primary hyperparathyroidism.
Other causes that are non-malignancy-related include milk-alkali syndrome (which involves large intake of calcium in association with volume contraction, systemic alkalosis and renal insufficiency) and medication-induced hyper-calcemia (especially chronic lithium therapy).
Granulomatous disorders with high levels of calcitriol may be found in patients with sarcoidosis, berylliosis, tuberculosis, leprosy, coccidioidomycosis, and histoplasmosis.
Acute pancreatitis induces hypo-calcemia.
Q-45. Early metabolic complications of parental nutrition
a) Hyperglycemia
b) Re-feeding syndrome
c) Hypo-kalemia
d) Hyper-phosphatemia
e) Hyper-chloremic acidosis
Answer: Hyperglycemia, Re-feeding syndrome, Hypo-kalemia, Hyper-chloremic acidosis
Explanation:
Early metabolic complications of parental nutrition:
Volume overload
Hyperglycemia
Re-feeding syndrome
Hypo-kalemia
Hypophosphatemia
Hypo-magnesemia
Hyper-chloremic acidosis
Late metabolic complications of parental nutrition:
Essential fatty acid deficiency
Vitamin deficiency
Trace mineral deficiency
Metabolic bone disease
Hepatic steatosis and Hepatic cholestasis
Q-46. Regarding gas gangrene
a) It is due to Clostridium botulinum infection
b) Clostridial species are gram-negative spore forming anaerobes
c) The clinical features are due to the release of protein endotoxin
d) Gas is invariably present in the muscle compartments
e) Surgical debridement and antibiotics are an essential part of treatment
Answer: Gas is invariably present in the muscle compartments and Surgical debridement and antibiotics are an essential part of treatment
Explanation:
Gas gangrene is caused by an anaerobic, gram-positive, spore-forming bacillus of the genus Clostridium. C perfringens is the most common etiologic agent that causes gas gangrene.
These organisms are true saprophytes and are ubiquitous in soil and dust.
C perfringens produces exotoxins.
The combination of aggressive surgical debridement and effective antibiotic therapy is the determining factor for successful treatment of gas gangrene.
Q-47. Ideal treatment of alkaline reflux gastritis after Billroth I and Billroth II gastrectomy is
a) Conversion of Billroth I gastrectomy to Billroth II gastrectomy
b) Roux en Y gastro-jejunostomy
c) Total gastrectomy
d) Conservative management
Answer: Roux en Y gastro-jejunostomy
Explanation:
Once a diagnosis of alkaline reflux gastritis is made, treatment is directed at the relief of symptoms.
Medical or conservative treatment is not very helpful and do not show consistent benefit.
Surgery is recommended for those who have intractable symptoms.
The surgical procedure of choice is conversion of Billroth II to Roux-en Y Gastro-jejunostomy in which the Roux limb is lengthened to 45 cm
Q-48. Babu is brought to the emergency as case of RTA. He is hypotensive. Most likely ruptures organ is
a) Spleen
b) Mesentry
c) Kidney
d) Rectum
Answer: Spleen
Explanation:
The liver and spleen are the most common organs involved in patients with blunt abdominal trauma with hemo-peritoneum.
Spleen is the most common damaged organ in blunt abdominal trauma in adult. In children, the liver is the most commonly injured abdominal organ.
The spleen is the second most commonly injured intra-abdominal organ in children.
Q-49. Which of the following soft tissue sarcomas frequently metastasizes to lymph nodes?
a) Fibro-sarcoma
b) Osteosarcoma
c) Embryonal Rhabdomyosarcoma
d) Angio-sarcoma
Answer: Embryonal Rhabdomyosarcoma and Angio-sarcoma
Explanation:
Lymph node metastasis is unusual in soft tissue sarcomas.
Variant of soft tissue sarcomas with high nodal metastasis
Rhabdomyosarcoma
Angio-sarcoma
Epithelioid sarcoma
Clear cell sarcoma
Melanoma of soft part
Q-50. The following is/are maker (s) of Paget’s disease of the mammary gland
a) S-100
b) HMB 45
c) CEA
d) Her-2 oncoprotein
Answer: CEA and Her-2 oncoprotein
Explanation:
Paget’s disease of the breast is a rare type of cancer of the nipple-areola complex and that is often associated with an underlying in situ or invasive carcinoma.
The use of immunohistochemical staining, such as carcino-embryonic antigen (CEA), mucin or Her-2 oncoprotein, has been suggested to enhance the diagnosis.