Ejection click in pulmonary stenosis is:
a) Better heard in expiration
b) Better heard in inspiration
c) No change with respiration
d) None of the above
Correct answer: a) Better heard in expiration
The ejection click in pulmonary stenosis occurs when the stiff valve opens.
It varies with respiration and is better heard in expiration.
It is usually seen in association with post stenotic dilatation of the pulmonary artery.
Mechanism of respiratory variation of ejection click in pulmonary stenosis
During inspiration, the increased venous return results in an increase in right ventricular end diastolic volume
This in turn results in pushing up of the pulmonary valve leaflets
Hence, when the valve opens during ventricular systole, the excursion of the valve leaflets is reduced
But during expiration, the venous return is decreased and the end diastolic volume is lower
The valve leaflets do not get pushed up
Hence, during systole, the valve leaflets have to move a greater distance resulting in the production of a prominent click
Read more about phasic ejection click : https://cardiophile.org/phasic-ejection-click/
Symmetric, high voltage, triphasic, slow wave EEG pattern is seen in?
A. Uremic encephalopathy
B. Hypoxic ischemic encephalopathy
C. Hypercapnic encephalopathy
D. Hepatic encephalopathy
Correct answer : D. Hepatic encephalopathy
Symmetric, high voltage, triphasic, slow wave EEG pattern is characteristic of hepatic encephalopathy.
But it is also seen in other conditions like
Encephalopathy secondary to pulmonary or renal failure
All are drugs used in the management of status epilepticus except?
C. Thiopentone sodium
Correct answer : B. Carbamazepine
Drugs used for management of status epilepticus in adults are :
The last three are used for refractory cases of status epilepticu
NARP Syndrome is a?
A. Lysosomal storage disorder
B. Mitochondrial function disorder
C. Glycogen storage disorder
D. Golgi body transport disorder
Correct answer : B. Mitochondrial function disorder
NARP syndrome is a mitochondrial function disorder.
The main components of NARP syndrome are:
Neuropathy (peripheral neuropathy which mostly affects sensory nerves)
Other features include seizures, hearing loss and cardiac conduction defects.
It occurs due to a mutation in the MT-ATP6 gene, which results in altered structure or function of mitochondrial ATP synthase leading to decreased ATP production.
As it involves a mutation of mitochondrial DNA, it is inherited from mother to child (maternal inheritance).
Other maternally inherited mitochondrial DNA disorders include: Leigh syndrome, Leber’s hereditary optic neuropathy & Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes ( MELAS ).
Sterile pyuria is characteristic of ?
A. Chronic hydronephrosis
B. Renal cell carcinoma
C. Renal tuberculosis
Correct answer : C. Renal tuberculosis
Sterile pyuria refers to the presence of more than 5 white blood cells (WBC’s) per high power field in the absence of bacteria in a routine urine specimen
It can be either due to various causes
Structural defects of kidney
Intrinsic renal pathology
Although hydronephrosis can also cause sterile pyuria, it is a characteristic feature of renal tuberculosis
Which of the following is responsible for drug induced pulmonary fibrosis?
C. Actinomycin D
Correct answer : B. Bleomycin
Drug induced pulmonary fibrosis – Bleomycin
Bleomycin is a glycopeptide antibiotic obtained from Streptomyces verticillus. It is used for the treatment of Hodgkin’s lymphoma, squamous cell carcinomas, and testicular cancer. Bleomycin therapy can result in life-threatening interstitial pulmonary fibrosis. This side effect is seen about 10 percent of patients treated with Bleomycin. There is destruction of Type 1 pneumocytes with hyperplasia of type II pneumocytes.
Other drugs causing pulmonary fibrosis include : Methotrexate, Amiodarone, Busulfan, Sulfasalazine, Carmustine
Recent Research : Sorafenib found to ameliorate bleomycin-induced pulmonary fibrosis – Cell Death Dis. 2013 Jun 13;4:e665
Use of streptokinase is contraindicated in?
A. Pulmonary embolism
B. AV fistula
D. Intracranial tumour
Correct answer : D. Intracranial tumour
Absolute contraindications for thrombolysis:
Previous history of intracranial haemorrhage
Cerebral vascular lesions (like AV malformations)
Suspected aortic dissection