AIPG DNB HOT MCQs: Medicine

Q-1. Blue sclera disease is
a) Marfan’s syndrome
b) Klinefelter’s syndrome
c) Osteogenesis imperfecta
d) Down’s syndrome

Answer: Osteogenesis imperfecta
Explanation:
Osteogenesis imperfecta:
Clinical features:
Severe osteoporosis
Spontaneous fracture occur in utero or during childhood
Blue sclera
Important points:
It is caused by a major mutation in the gene encoding for type I collagen, major collagen constituent of bone.
Certain polymorphism in this gene predisposes to hypo-gonadal or idiopathic osteoporosis.

Q-2. Lewy bodies are seen in
a) Alzheimer’s disease
b) Pick’s disease
c) Huntington’s chorea
d) Parkinsonism

Answer: Parkinsonism
Explanation:
Parkinson disease:
The 2 major neuro-pathologic findings in Parkinson disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neuritis.
Lewy bodies are intra-cytoplasmic eosinophilic inclusions, often with halos, that are easily seen in pigmented neurons.
They contain polymerized alpha-synuclein; therefore, Parkinson disease is a synucleinopathy.

Q-3. Steroid induced myopathy mainly involves
a) Shoulder
b) Pelvis
c) Neck
d) Arms

Answer: Pelvis
Explanation:
Steroid induced myopathy:
Steroid myopathy is usually an insidious disease process that causes weakness mainly to the proximal muscles of the upper and lower limbs and to the neck flexors.
Pelvic girdle muscles usually are affected more severely and earlier than are pectoral girdle muscles.

Q-4. Myopathies mainly involve proximal muscles group except
a) Myotonia congenital
b) Myotonia dystrophica
c) Drug induced
d) All of the above

Answer: Myotonia dystrophica
Explanation:
Myopathies mainly involve proximal muscles:
Myotonia congenital
Drug induced myopathy
Duchenne type
Becker’s type
Limb girdle (Erb)
Myopathies mainly involve distal muscles:
Myotonia dystrophica
Distal muscular dystrophy

Q-5. Lateral medullary syndrome is due to thrombosis of
a) Posterio inferior cerebellar artery
b) Anterior cerebellar artery
c) Superior cerebellar artery
d) Posterior communicating branch of middle cerebral artery

Answer: Posterio inferior cerebellar artery
Explanation:
Lateral Medullary Syndrome (Wallenberg Syndrome):
Vertebral artery: Superior lateral medullary artery
Posterior inferior cerebellar artery: Less common than vertebral
Medial Medullary Syndrome (Dejerine Syndrome):
Antero-medial artery
Basilar artery

Q-6. Which is not a feature of MEN type 2B is?
a) Hyper-parathyroidism
b) Phaeochromocytoma
c) Neuroma
d) MTC

Answer: Hyper-parathyroidism
Explanation:
Multiple Endocrine Neoplasias (MEN): Incidence of tumor types
MEN 1 (Wermer Syndrome):
Parathyroid
Pancreatic
Pituitary
Thyroid adenoma
Facial angio-fibromas and collagenomas
MEN 2A (Sipple Syndrome):
Medullary thyroid carcinoma
Pheochromocytoma
Pituitary
MEN 2B:
Mucosal and GI Ganglio-neuroma
Medullary thyroid carcinoma
Pheochromocytoma

Q-7. In von Willebrand disease which is true?
a) Normal prothrombin time
b) Decreased platelets
c) Normal partial thromboplastin time
d) All of the above

Answer: Normal prothrombin time
Explanation:
Von-Willebrand disease:
The most common inherited bleeding disorder
It aggregates platelets and prolongs the half life of Factor VIII.
Except in more severe forms, the a-PTT and PT in v-WD are usually normal.

Q-8. Which of the following pH indicate urinary tract infection?
a) < 4.3
b) < 3.0
c) < 6.5
d) 8.0

Answer: < 6.5
Explanation:
A higher-than-normal urine pH could indicate:
Gastric suctioning
Kidney failure
Kidney tubular acidosis
Pyloric obstruction
Respiratory alkalosis
Urinary tract infection
Vomiting
Important point:
If alkaline urine is found in presence of UTI symptoms and positive leukocyte esterase, likely urea splitting such as Proteus, allowing urea to be split into CO2 and ammonia, cause a rise in the urine’s normally acid pH.

Q-9. Hamman-Rich Syndrome is treated with
a) Vitamin B6
b) Vitamin B12
c) INH
d) Steroids

Answer: Steroids
Explanation:
Acute interstitial pneumonia:
Clinically known as Hamman-Rich Syndrome
Acute onset of dyspnea followed by rapid development of respiratory failure
Treatment is supportive care (Mechanical ventilation) and steroid

Q-10. Mono-neuritis multiplex is a feature of
a) Polyarteritis nodosa
b) Hypersensitive vasculitis
c) Leprosy
d) All of the above

Answer: All of the above
Explanation:
Mono-neuritis multiplex actually is a group of disorders.
Mono-neuritis multiplex is associated with systemic disorders such as the following:
Polyarteritis nodosa
Amyloidosis
Vasculitis
RA
SLE
Mono-neuritis multiplex can be associated with the following infections:
Lyme disease
Leprosy
Syphilis
Acute viral hepatitis and HIV infection
Herpes simplex virus infection

Q-11. Treatment of acute cardiac tamponade
a) Emergency paracentesis
b) Emergency thoracotomy
c) Pericardiectomy
d) IV Fluids

Answer: Emergency paracentesis
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)
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

Q-12. HLA associated with myasthenia gravis is
a) B27
b) DR3
c) DR4
d) B8

Answer: DR3
Explanation:
Myasthenia gravis occurs at all ages, sometime associated with a thymic tumor or thyrotoxicosis as well as RA and lupus erythematous.
It is most common in young women, with HLA-DR3.
If thymoma is associated, older men are more commonly affected.

Q-13. Shrinking lung syndrome is seen in
a) SLE
b) Systemic sclerosis
c) Polymyositis
d) Dermato-myositis

Answer: SLE (Most correct)
Explanation:
Shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus (SLE) characterized by unexplained dyspnea, a restrictive pattern on pulmonary function tests, and an elevated hemi-diaphragm.
But it is also associated with Sjögren’s syndrome and Polymyositis.
Steroids are proposed as first-line treatment, alone or associated with β2-adrenergic receptor agonists. In refractory cases, immuno-suppressors are used.

Q-14. Glycosylated hemoglobin percentage which indicates good control of diabetes
a) 8%
b) 10%
c) 15%
d) 20%

Answer: 8%
Explanation:
Acceptable level of glycemic control:
Blood glucose- Fasting: 90-130 mg/dl
Blood glucose- PP: 150 mg/dl
HbA1C Level: < 7 % in non-pregnant adults
HbA1C Level: < 8 % in elderly patients

Q-15. Felty’s syndrome comprises of all except
a) Rheumatoid arthritis
b) Splenomegaly
c) Neutropenia
d) Osteoarthritis

Answer: Osteoarthritis
Explanation:
Felty syndrome:
Immune neutropenia
Sero-positive nodular RA
Splenomegaly

Q-16. Water load test is helpful in diagnosis of
a) Renal edema
b) Addison’s disease
c) Adrenogenital syndrome
d) Congestive heart failure

Answer: Addison’s disease
Explanation:
A water loading ADH suppression test may be used to help diagnose SIADH. With this test, those with SIADH typically have decreased blood sodium and osmolality.
A simplified water-loading test is used for the diagnosis of Addison’s disease.

Q-17. Anion gap is not increased in
a) Renal tubular acidosis
b) Diabetic keto-acidosis
c) Salicytates poisoning
d) Starvation

Answer: Renal tubular acidosis
Explanation:
The anion gap is the difference between primary measured cations (sodium Na+ and potassium K+) and the primary measured anions (chloride Cl- and bicarbonate HCO3-) in serum.
The normal value for the serum anion gap is 6-12 mEq/L.
Decreased anion gap:
Hypo-albuminemia
Plasma cell dyscrasias
Bromide intoxication
Increased anion gap:
a. Metabolic anion
Diabetic keto-acidosis
Alcoholic keto-acidosis
Lactate acidosis
CKD (Advanced stage)
Metabolic alkalosis
Starvation
b. Drug or chemical anion
Salicylates intoxication
Methanol
Oxalic acid (Ethylene glycol)
Sodium Carbenicillin
Normal anion gap:
Loss of HCO3_:
Carbonic anhydrase inhibitors
Ileostomy
Diarrhoea
Recovery from diabetic keto-acidosis
Chloride retention:
Renal tubular acidosis
Ileal loop bladder
Administration of HCl equivalent or NH4Cl:
Arginine and lysine in parenteral nutrition

Q-18. Respiratory acidosis is seen with
a) Diabetes keto-acidosis
b) Pneumonia
c) Emphysema
d) Liver failure

Answer: Emphysema
Explanation:
Respiratory acidosis results from hypo-ventilation and subsequent hypercapnia.
Respiratory alkalosis occurs from hyperventilation and subsequent Hypocapnia.
Respiratory acidosis:
Central nervous system disease or drug-induced respiratory depression
Neuromuscular disease or paralysis (Myasthenia gravis, GB syndrome)
Airway obstruction (Asthma and COPD)
Respiratory Alkalosis:
a. Mechanical ventilation
b. Hypoxia
c. Pulmonary diseases:
Interstitial lung disease
Pneumonia
Pulmonary edema and embolism
d. CNS mediated disorders:
Hyperventilation
Neurologic diseases and tumors
CVA
Gram negative septicemia
Heat exposure
Hepatic failure
Drugs and hormonal stimulation: Salicylates, nicotine, xanthine and progesterone (Pregnancy)

Q-19. Pneumatocele is commonest in
a) Pneumococcal pneumonia
b) Staphylococcal pneumonia
c) H. influenzae pneumonia
d) Viral pneumonia

Answer: Staphylococcal pneumonia
Explanation:
Pulmonary Pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma.
They can be single emphysematous lesions but are more often multiple, thin-walled, air-filled, cyst like cavities.
Most often, they occur as sequelae to acute pneumonia, commonly caused by Staphylococcus aureus.

Q-20. Osmotic diarrhea is seen in
a) Lactase deficiency
b) Ulcerative sprue
c) Cholera
d) Bile salt enteropathy

Answer: Lactase deficiency
Explanation:
Osmotic diarrhea:
Normal stool osmolality < 50 mosm/kg
Caused by ingestion (laxative) or mal-absorption of an osmotically active substances

Q-21. 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-22. 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-23. 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.

Q-24. Gastric ulcer is caused by with bacteria
a) E. coli
b) Helicobacter
c) Proteus
d) Entamoeba histolytica
Answer: Helicobacter pylori
Explanation:
Helicobacter pylori:
Helicobacter is a Gram-negative, micro-aerophilic spiral-shaped bacterium found in stomach, causing peptic ulcer disease, gastric cancer or mucosa-associated-lymph-tissue (MALT) lymphoma.

Q-25. Creatinine phospho-kinase is increased in
a) Alcoholic myopathy
b) Clofibrates therapy
c) After electro-cardioversion
d) All

Answer: All
Explanation:
Creatine phospho-kinase (CPK) is an enzyme found mainly in the heart, brain, and skeletal muscle.
High CPK levels may be seen in patients who have:
Brain injury or Stroke, Convulsion
Polymyositis, Muscular dystrophies, Myopathy, Electric shock
Myocarditis, MI, after electro-cardioversion
Important points:
Clofibrates therapy causes myopathy, including rhabdomyolysis with acute renal failure secondary to myoglobinuria.
The myopathy may be dose-related in conjunction with increases in creatine phospho-kinase (CPK). Therapy with fibric acid derivatives should be administered cautiously in patients with preexisting myopathy or a myo-neural disorder.

Q-27. Sensation lost first in Syringomyelia is
a) Pain & temperature
b) Position
c) Touch
d) Vibration

Answer: Pain & temperature
Explanation:
Syringomyelia interrupts the decussating spino-thalamic fibers that mediate pain and temperature sensibility, resulting in loss of these sensations, while light touch, vibration, and position senses are preserved (dissociated sensory loss).

Q-28. All of the following are endocrine manifestations of renal cell carcinoma except
a) Polycythemia
b) Fever
c) Peptic ulcer
d) Renin induced hypertension

Answer: Peptic ulcer
Explanation:
Endocrine manifestations of renal cell carcinoma:
Fever
Erythrocytosis
Hyper-calcemia
Cushing syndrome
Hypertension

Q-29. In which type of renal tubular acidosis hyper-kalemia is a prominent feature
a) Type-I
b) Type II
c) Type III
d) Type IV

Answer: Type IV
Explanation:
Renal tubular acidosis:
Type I: Classical distal
Renal defect- Distal H+ secretion
Serum potassium level- Decreased
Type II: Proximal secretion
Renal defect- Proximal H+
Serum potassium level- Decreased
Type IV: Hyporeninemic hypo-aldosteronism
Renal defect- Distal Na+ reabsorption, K+ secretion and H+ secretion
Serum potassium level-Increased

Q-30. In Fanconi syndrome, failure of tubular re-absorption leads to excessive excretion of except
a) Glucose
b) Phosphate
c) Amino acid
d) Uric acid

Answer: All
Explanation:
Various defects of proximal tubular transport function occur, including impaired resorption of glucose, phosphate, amino acids, HCO3- and uric acid.
Fanconi syndrome causes glucosuria, phosphaturia, generalized aminoaciduria, and HCO3-wasting.

Q-31. Diabetes insipidus is characterized by
a) A decreased urine osmolality, increased serum osmolality
b) A normal urine osmolality, increased serum osmolality
c) A decreased urine osmolality, normal serum osmolality
d) An increased urine osmolality, decreased serum osmolality

Answer: A decreased urine osmolality, increased serum osmolality
Explanation:
Urinary specific gravity of 1.006 or less, and urinary osmolality of less than 200 mOsm/kg are the hallmark of Diabetes insipidus.
Random plasma osmolality generally is greater than 287 mOsm/ kg.

Q-32. Acute attack of gout may be precipitated all except
a) Dietary excess
b) Alcoholic binge
c) Local trauma
d) Use of nitrates for angina

Answer: Dietary excess (?) or Use of nitrates for angina (?)

Explanation:
Acute attacks can be precipitated by several factors, such as increased alcohol consumption, trauma, use of diuretics, dehydration, cyclosporine, diet (organ meat, shellfish), and any drug that can lead to sudden changes (increase or decrease) in urate levels, such as hypo-uricemic agents.
Nitrates contribute to gout by altering blood chemistry and inducing dehydration.

Q-33. Pseudo-membranous colitis is caused by
a) Cl. Perfringens
b) Cl. Welchii
c) Pseudomonas
d) Cl. Difficile

Answer: Cl. Difficile
Explanation:
Antibiotic associated colitis is almost always caused by Cl. Difficile infection.
In patients with severe illness, true pseudo-membranous colitis is seen.
This is characteristic appearance with yellow adherent plaques 2-10 mm in diameter scattered over colonic mucosa interspersed with hyperemic mucosa.
Biopsy reveals epithelial ulceration with classic volcano exudates of fibrin and neutrophils.

Q-34. Respiratory acidosis is seen in all except
a) Fibrosing alveolitis
b) Salicylates poisoning
c) Myasthenia gravis
d) Ext. inter-costal muscle paralysis

Answer: Salicylates poisoning
Explanation:
Respiratory acidosis results from hypo-ventilation and subsequent hypercapnia.
Respiratory alkalosis occurs from hyperventilation and subsequent Hypocapnia.
Respiratory acidosis:
Central nervous system disease or drug-induced respiratory depression
Neuromuscular disease or paralysis (Myasthenia gravis, GB syndrome)
Airway obstruction (Asthma and COPD)

Q-35. All are sexually transmitted except
a) Candida albicans
b) Echinococcus
c) Molluscum contagiosum
d) Group B streptococcus

Answer: Echinococcus
Explanation:
Echinococcosis occurs when humans are intermediate hosts for canine tapeworm.
Infection is acquired by ingesting food contaminated with canine feces containing parasite eggs.
After human ingest parasite eggs, the eggs hatch in the intestine to form oncospheres, which penetrate the mucosa, enter the circulation and encyst in specific organs as hydatid cysts.
E. granulosus forms the cysts most commonly in the liver (65 %) and lungs (25 %), but cyst may develop in any organs.

Q-36. Hypokalemia is seen with
a) Metabolic acidosis
b) Respiratory acidosis
c) Metabolic alkalosis
d) Respiratory alkalosis

Answer: Metabolic alkalosis
Explanation:
Metabolic alkalosis:
Arterial-pH and bicarbonate: Elevated
Serum potassium- Decreased
Serum chloride- Decreased
Anion gap- Increased