Q-281. Anti-centromere antibodies are most commonly associated with:
a) Diffuse cutaneous systemic sclerosis
b) Mixed connective tissue disease
c) CREST syndrome
d) Polymyositis
Answer: CREST syndrome
Explanation:
Anti-centromere antibodies (ACA) occur in auto immune disorders; frequently in limited systemic scleroderma, (formerly called CREST syndrome), and, occasionally are found in the diffuse form of scleroderma.
CREST (Calcinosis, Raynaud phenomenon, Esophageal dys-motility, Sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the cardinal clinical features of the syndrome.
Q-282. Megaloblastic anemia due to folic acid deficiency is commonly due to
a) Inadequate dietary intake
b) Defective intestinal absorption
c) Absence of folic acid binding protein in serum
d) Absence of glutamic acid in the intestine
Answer: Inadequate dietary intake
Explanation:
Folic acid deficiency most commonly results from either decreased dietary intake or increased metabolic demand.
Q-283. In which of the following age group myelo-dysplastic syndromes (MDS) are most common
a) 2-10
b) 15-20
c) 25-40
d) >50
Answer: >50
Explanation:
Myelo-dysplastic syndromes (MDS):
Cytopenias with hyper cellular bone marrow
Morphologic abnormalities in two or more hematopoietic cell lines
Patients are usually over age 60 years.
Q-284. Smoking is generally not associated as a risk factor with
a) Small cell carcinoma
b) Respiratory bronchiolitis
c) Emphysema
d) Bronchiolitis obliterans organizing pneumonia
Answer: Bronchiolitis obliterans organizing pneumonia
Explanation:
Smoking related respiratory diseases:
Emphysema
Chronic bronchitis
Lung cancer
Respiratory bronchiolitis
Q-285. Which of the following is not a common feature of anorexia nervosa?
a) Binge eating
b) Amenorrhea
c) Self perception of being fat
d) Under weight
Answer: Binge eating
Explanation:
Anorexia nervosa:
Most of patients are female.
Intense fear of being fat
Weight loss
In female, absence of three consecutive menstrual cycles
Q-286. Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?
a) Chronic liver failure
b) Ascites
c) Upper gastrointestinal bleeding
d) Encephalopathy
Answer: Upper gastrointestinal bleeding
Explanation:
Non-cirrhotic portal hypertension:
Splenomegaly or upper-gastrointestinal bleeding from esophageal or gastric varices in patients without liver disease
Q-287. Which of the following colonic polyps is not pre-malignant?
a) Juvenile polyps
b) Hamartomatous polyps associated with Peutz Jeghers syndrome
c) Villous adenomas
d) Tubular adenomas
Answer: Juvenile polyps
Explanation:
Pre-malignant colonic polyps/ mucosal neoplastic adenomatous polyps:
Villous adenomas
Tubular adenomas
Hamartomatous polyps associated with Peutz Jeghers syndrome
Mucosal neoplastic polyps:
Hyperplastic polyps
Juvenile polyps
Hamartomas
Inflammatory polyps
Q-288. Drug induced lupus can be identified by
a) Anti- histone antibodies
b) Double stranded DNA antibodies
c) Antinuclear antibodies
d) Anti-SM antibodies
Answer: Anti- histone antibodies
Explanation:
Fours features of drug induced lupus:
Sex ratio is nearly equal.
Nephritis and CNS features are absent.
Hypo-complimentemia and antibodies to ds-DNA are absent.
The clinical features and most laboratory abnormalities usually revert toward the normal when the offending drug is withdrawn.
Important point:
Anti- histone antibodies are positive in more than 95 % of patients with drug induced lupus and signify a high correlation.
Q-289. The presence of anti-Saccharomyces cerevisiae antibody is a surrogate marker of one of the following
a) Celiac disease
b) Crohn’s disease
c) Ulcerative colitis
d) Tropical sprue
Answer: Crohn’s disease
Explanation:
When the diagnosis of Crohn’s disease remains uncertain, a panel of seven tests that measure auto-antibodies to P-ANCA, Saccharomyces cerevisiae, Porin C of E. coli and Bacterial flagellin Cbir 1 is marked as being 92 % accurate for diagnosing IBD and for distinguishing between Crohn’s disease and ulcerative colitis.
Q-290. Renal artery stenosis may occur in all of the following except
a) Atherosclerosis
b) Fibro-muscular dysplasia
c) Takayasu arteritis
d) Polyarteritis nodosa
Answer: Polyarteritis nodosa
Explanation:
Causes of renal artery stenosis:
Atherosclerosis (80-90 %)
Fibro-muscular dysplasia (5-15 %)
Takayasu arteritis
Polyarteritis nodosa (Rare)
Q-291. C- ANCA positivity indicates antibody formed against
a) Proteinase 3
b) Myelo-peroxidase
c) Cytoplasmic antinuclear Antibody
d) Anti centromeric Antibody
Answer: Proteinase 3
Explanation:
Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of auto-antibodies, mainly of the IgG type, against antigens in the cytoplasm of neutrophil granulocytes and monocytes.
C-ANCAs, or Cytoplasmic anti-neutrophil cytoplasmic antibodies, are a type of autoantibody, an antibody produced by the body that acts against one of its own proteins.
These antibodies show a diffusely granular, cytoplasmic staining pattern under microscopy. This pattern results from binding of ANCAs to antigen targets throughout the neutrophil cytoplasm, the most common protein target being Proteinase 3 (PR3).
PR3 is the most common antigen target of ANCA in patients with Wegener’s granulomatosis.
Q-292. Which of the following findings is diagnostic of iron deficiency anemia?
a) Increased TIBC, decreased serum ferritin
b) Decreased TIBC, decreased serum ferritin
c) Increased TIBC, increased serum ferritin
d) Decreased TIBC, increased serum ferritin
Answer: Increased TIBC, decreased serum ferritin
Explanation:
Iron deficiency anemia:
Decreased serum iron level
Increased TIBC
Decreased transferrin saturation
Decreased serum ferritin
Q-293. A normo-tensive patient with normal hemoglobin suffered massive blood loss. The following findings would be presents in him except
a) Increased PCV
b) Increased MCV
c) Thrombocytosis
d) Reticulocytosis
Answer: Increased PCV
Explanation:
PCV in acute hemorrhage is either normal or low (Later).
Early hematological changes in acute bleeding:
Thrombocytosis and neutrophilia (Immediate)
Reticulocytosis
Transient Increase in MCV
Q-294. Autoimmune hemolytic anemia is associated with malignancy of which lineage
a) T cell
b) B cell
c) Pre B cell
d) Pre T cell
Answer: B cell
Explanation:
Autoimmune hemolytic anemia is associated with B-cell malignancies such as CLL and Lymphoproliferative disorders, such as non-Hodgkin’s lymphoma,
Q-295. Pancytopenia with cellular marrow is seen in
a) PNH
b) G6PD deficiency
c) Acquired Aplastic anemia
d) Thalassemia
Answer: PNH
Explanation:
Pancytopenia with cellular marrow:
PNH
Myelo-dysplasia syndromes
Myelo-fibrosis
Bone marrow lymphoma
Megaloblastic anemia (Bone marrow always hyper-cellular)
Q-296. Pancytopenia with hyper-cellular marrow is seen in
a) PNH
b) Megaloblastic anemia
c) Acquired Aplastic anemia
d) Thalassemia
Answer: Megaloblastic anemia
Explanation:
Pancytopenia with cellular marrow:
PNH
Myelo-dysplasia syndromes
Myelo-fibrosis
Bone marrow lymphoma
Megaloblastic anemia (Bone marrow always hyper-cellular)
Hypersplenism
Q-297. Bone marrow biopsy is absolutely indicated in
a) Acute leukemia
b) Megaloblastic anemia
c) Hairy cell leukemia
d) Thalassemia
Answer: Hairy cell leukemia
Explanation:
In hairy cell leukemia, borrow tap is dry tap and hence bone marrow biopsy become an absolute indication for establishing the diagnosis.
Q-298. In PML, all of the following are seen except
a) Retinoic acid is used in treatment
b) 15/17 trans-locations may be seen
c) CD 15/34 both seen in same cell
d) Associated with disseminated intravascular coagulation (DIVC)
Answer: CD 15/34 both seen in same cell
Explanation:
Acute pro-myelocytic leukemia (APL) is a unique subtype of the acute leukemias.
Characterized by a balanced translocation between chromosomes 15 and 17
APL differs from AML in that most patients present with coagulopathy (DIVC).
Acute pro-myelocytic leukemia (APL) treatment has three phases: induction, consolidation, and maintenance.
An important agent in all three phases of treatment is all-trans-retinoic acid (ATRA).
Q-299. 80 year old asymptomatic man present with a total leukocyte count of 1 lakh with 80 % lymphocytes and 20% PMC’s. What is the most probable diagnosis?
a) HIV
b) CML
c) CLL
d) TB
Answer: CLL
Explanation:
Chronic lymphocytic leukemia:
CLL is disease of older patients and a median age at presentation of 70 years.
Lymphadenopathy
Enlargement of liver or spleen
Isolated lymphocytosis (Hallmark)
White blood count > 20000/mcL
75-98 % of circulating cells are lymphocytes
Q-300. Which of the following statements about mycosis fungoides is not true?
a) It is the most common form of cutaneous lymphoma
b) Pautrier’s micro-abscess
c) Indolent course and easily amenable to treatment
d) Erythroderma seen and spreads to peripheral circulation
Answer: Indolent course and easily amenable to treatment
Explanation:
Mycosis fungoides is a cutaneous T cell lymphoma.
Selective serotonin reuptake inhibitors may produce eruption clinically and histologically identical to those of mycosis fungoides.
Localized or generalized erythematous patches or plaques usually on trunks
Pruritis
Lymphadenopathy
The skin biopsy remains the basis of diagnosis.
The treatment is complex and early and aggressive treatment has not proved to cure or prevent progression of the disease.