Medicine: AIIMS May 2016

Q-1. In case of suspected TB, pleural fluid be sent for all of the following studies except
a) GeneXpert
b) ADA
c) LDH
d) Albumin

Answer: Albumin
Explanation:
Most important diagnostic tests In case of suspected TB:
GeneXpert or Cartridge Based Nucleic Acid Amplification Test (CB NAAT)
IFN-Gamma (TB-Gold)
ADA
Total protein and LDH levels are required to differentiate between Transudative and exudative diffusion according to Light’s Criteria.
ADA levels> 40-60 U/L in the setting of lymphocytic effusion are specific for TB. Majority of ADA in tuberculosis, pleural fluid is ADA-2.
GeneXpert or Cartridge Based Nucleic Acid Amplification Test (CB NAAT) is automated diagnostic test that can identify Mycobacterium tuberculosis DNA and resistance to rifampicin by nucleic acid amplification test, suitable for use in disease endemic countries.
Interferon-Gamma Release Assays (IGRAs) are whole-blood tests that can aid in diagnosing Mycobacterium tuberculosis infection. They do not help differentiate latent tuberculosis infection from tuberculosis disease.
TB Gold is an interferon-gamma release assay (IGRAs), and is a modern alternative to the tuberculin skin test (TST or Mantoux). It measures the cell-mediated immune response (cytokines-Interferon-gamma) to very specific TB antigens

Q-2. In a patient with Dengue hemorrhagic fever (DHF), which of the following is most important to monitor:
a) Hemoglobin
b) Hematocrit
c) Platelet count
d) TLC

Answer: Hematocrit
Explanation:
Dengue hemorrhagic fever-> increased capillary permeability-> hemo-concentration (Equal or more than 20%)
Hematocrit is best parameter to monitor a DHF.
Important points:
Indicators that suggest the patient has already entered the Critical Phase include sudden change from high (>38.0°C) to normal or subnormal temperatures, thrombocytopenia (Less than or equal to 100,000 cells/mm3) with a rising or elevated hematocrit (Equal or more than 20% increase from baseline), new hypo-albuminemia, new pleural effusion or ascites, and signs and symptoms of impending or frank shock.

Q-3. Tourniquet test is used in daily follow up of patients with
a) Zika
b) Swine flue
c) Chikungunya
d) Dengue

Answer: Dengue
Explanation:
The tourniquet test is part of the new WHO case definition for dengue. The test is a marker of capillary fragility.
Procedure:
Take the patient’s blood pressure and record it. Inflate the cuff to a point midway between SBP and DBP and maintain for 5 minutes. Reduce and wait 2 minutes. Count petechiae below ante-cubital fossa. A positive test is 10 or more petechiae per 1 square inch.
Important point:
Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Aedes albopictus.
This mosquito also transmits Chikungunya, Yellow fever and Zika infection.

Q-4. All are true about isolated AS (Aortic stenosis) except
a) Thrill in carotid artery
b) Cardia apex is displaced laterally to left
c) Pulsus bisferiens
d) Blood pressure maintained in initial phase

Answer: Pulsus bisferiens
Explanation:
Causes of bisferiens:
AR
AR + AS
Hypertrophic cardiomyopathy

Q-5. Best strategy to decrease the intra-cranial pressure in a 45 year old male with head injury is?
a) Oxygen supplementation
b) Administer sedative
c) Administer Nimodipine
d) Limiting pCO2 of patient

Answer: Limiting pCO2 of patient
Explanation:
Control of Intracranial Hypertension in head injury patient:
Hyper-ventilation:
Carbon dioxide dilates the cerebral blood vessels, therefore increasing ICP. Patients should be hyper-ventilated to normocapnia.
Intravenous fluid therapy:
Patients with severe brain injury should be kept normo-volemic. Mannitol is best used by bolus administration where an acute reduction in ICP is necessary. It is an osmotic diuretic.
Sedation and anesthesia:
Continuing sedation will be necessary in most patients to allow adequate ventilation and to prevent coughing or fighting the ventilator. All but the most severely brain injured patients will require anesthesia for intubation.
Important point:
Hyperventilation and decreasing pCO2 is initial and one of the most important treatment strategies to lower the ICP in the patient of head injury.

Q-6. Urobilinogen levels in obstructed jaundice due to gall stones, will be
a) Markedly raised
b) Slightly increased
c) Normal
d) Completely absent

Answer: Completely absent
Explanation:
Urobilinogen is derived from conjugated bilirubin by gut bacteria. In obstructive jaundice, urobilinogen will be absent because of absence of conjugated bilirubin.