Question: "Reward pathway" is associated with

(A) Nucleus accumbens# NUCLEUS ACCUMBENS has a significant role in the cognitive processing of motivation, pleasure, and reward and reinforcement learning, and hence has significant role in addiction.


Question: Wernicke's hemianopic pupillary response is seen in the lesion of

Wernick's hemianopic pupil is caused by the division of the optic tract that results in a contralateral homonymous hemianopiaPrimary lesions of the optic tract are very rare and the tract is usually disturbed by compression. The common causes areChordomasPituitary adenomasTentorial meningiomasTemporal lobe gliomasAneurysms of upper basilar distribution or on the superior cerebellar aeries or posterior cerebral aeriesRef: Parson 19/e p528,120


Question: Cavitatory lesions in lung are seen in

Causes of cavitation include infections malignancies tuberculosis but not primary ptb pulmonary abscess septic emboli nontb mycobacterium infection aspergillosis systemic diseases like granulomatosis with polyangitis, sarcoidosis.


Question: Noninfectious cause of Chronic meningitis is associated with Drug hypersensitivity of

(B) Ibuprofen # Noninfectious Causes of Chronic Meningitis: Drug hypersensitivity: Exposure to NSAIDS (ibuprofen), sulfonamides, isoniazid, tolmetin, ciprofloxacin, Penicillin; Carbamazaepine; Lamotrigine; IV Immunoglobulin; OKT3 antibodies; phenazopyridine; improvement after discontir uation of drug; recurrent episodes with recurrent exposure. CSF formula: Shows PMNs; occasionally mononuclear cells or eosinophilsHelpful diagnostic tests: CBC (Esinophilia)INFECTIOUS CAUSES OF CHRONIC MENINGITISCausative AgentRisk Factors and Systemic ManifestationsCommon Bacterial Causes Partially treated suppurative meningitisHistory consistent with acute bacterial meningitis and incomplete treatmentParameningeal infectionOtitis media, pleuropulmonary infection, right-to-left cardiopulmonary shunt for brain abscess; focal neurologic signs; neck, back, ear, or sinus tendernessMycobacterium tuberculosisExposure history; previous tuberculous illness; immunosuppressed or AIDS; young children; fever, meningismus, night sweats, miliary TB on x-ray or liver biopsy; stroke due to arteritisLyme disease (Bannwarth's syndrome) Borrelia burgdorferiHistory of tick bite or appropriate exposure history; erythema chronicum migrans skin rash; arthritis, radiculopathy, Bell's palsy, meningoencephalitis-multiple sclerosis-like syndromeSyphilis (secondary, tertiary) Treponema pallidumAppropriate exposure history; HIV- seropositive individuals at increased risk of aggressive infection; "dementia"; cerebral infarction due to endarteritisUncommon Bacterial Causes ActinomycesParameningeal abscess or sinus tract (oral or dental focus); pneumonitisNocard iaAssociated brain abscess may be presentBrucellaIntake of unpasteurized dairy products; exposure to goats, sheep, cows; fever, arthralgia, myalgia, vertebral osteomyelitisWhipple's disease Tropheryma whippeliiDiarrhea, weight loss, arthralgias, fever; dementia, ataxia, paresis, ophthalmoplegia, oculomasticatory myoclonusRare Bacterial CausesLeptospirosis (occasionally if left untreated may last 3-4 weeks)Fungal CausesCryptococcus neoformansAIDS and immune suppression; pigeon exposure; skin and other organ involvement due to disseminated infectionCoccidioides immitisExposure history--southwestern US; increased virulence in dark-skinned racesCandida sp.IV drug abuse; post surgery; prolonged intravenous therapy; disseminated candidiasisHistoplasma capsulatumExposure history--Ohio and central Mississippi River Valley; AIDS; mucosal lesionsAspergillus sp.Sinusitis; granulocytopenia or immunosuppressionSporothrix schenckiiTraumatic inoculation; IV drug use; ulcerated skin lesionRare Fungal CausesXylohypha (formerly Cladosporium) trichoides and other dark-walled (demateaceous) fungi such as Curvularia, Drechslera; Mucor, and, after water aspiration, Pseudoallescheria boydiiProtozoal CausesToxoplasma gondiiUsually with intracerebral abscesses; common in HIV-seropositive patientsTrypanosomiasis Trypanosoma gambiense, T. rhodesienseEndemic in Africa; chancre, lymphadenopathy; prominent sleep disorderRare Protozoal CausesAcanthamoeba sp. causing granulomatous amebic encephalitis and meningoencephalitis in immunocompromised and debilitated individuals. Balamuthia mandrillaris causing chronic meningoencephalitis in immunocompetent hosts.Helminthic CausesCysticercosis (infection with cysts of Taenia solium)Usually with multiple cysts in basal meninges and hydrocephalus; cerebral cysts, muscle calcificationGnathostoma spinigerumHistory of eating raw fish; common in Thailand and Japan; subarachnoid hemorrhage; painful radiculopathyAngiostrongylus cantonensisHistory of eating raw shellfish; common in tropical Pacific regions; often benignBaylisascaris procyonis (raccoon as-carid)Infection follows accidental ingestion of B. procyonis eggs from raccoon feces; fatal meningoencephalitisRare Helminthic CausesTrichinella spiralis (trichinosis); Fasciola hepatica (liver fluke), Echinococcus cysts; Schistosoma sp. The former may produce a lymphocytic pleocytosis whereas the latter two may produce an eosinophilic response in CSF associated with cerebral cysts (Echinococcus) or granulomatous lesions of brain or spinal cordViral causesMumpsNo prior mumps or immunization; may produce meningoencephalitis; may persist for 3--4 weeksLymphocytic choriomeningitisContact with rodents or their excreta; may persist for 3-4 weeksEchovirusCongenital hypogammaglobulinemia; history of recurrent meningitisHIV (acute retroviral syndrome)HIV risk factors; rash, fever, lymphadenopathy; lymphopenia in peripheral blood; syndrome may persist long enough to be considered as "chronic meningitis"; or chronic meningitis may develop in later stages (AIDS) due to HIVHerpes simplex (HSV)Recurrent meningitis due to HSV-2 (rarely HSV-1) often associated with genital recurrences; EBV associated with myeloradiculopathy, CMV with polyradiculopathy


Question: Pseudotumor cerebri is seen in

* Pseudotumour cerebri(idiopathic intracranial hypeension) usually occur in obese young women . Ref Harrison20th edition pg 2456


Question: Severity of Mitral Regurgitation may be judged by

Answer is C (Left Ventricular S3) The severity of Mitral Regurgitation may be judged clinically by the presence of left ventricular dilatation and the presence of third hea sound (Left Ventricular SJ? . These features indicate a more severe disease 'A third hea sound (S3) in chronic mitral regurgitation is usually indicative of severe regurgitation' Severity of Mitral Regurgitation: . If the murmur is harsher and has a lot of low and medium frequencies. It usually indicates a lot of flow and therefore will imply significant regurgitation. A harsh decrescendo mitral regurgitation murmur is usually indicative of severe regurgitation because the decrscendo effect is caused by early buildup of a very high v wave pressure in the left atrium resulting from a severe degree of regurgitation. Thus decreasing the gradient in late systole (If the murmur, on the other hand, is all pure high frequency and confined only to late systole. Then it must indicate a high pressure difference between the left ventricle and the left atrium and therefore only mild regurgitation). When the mitral regurgitation is severe, the volume overload on the left ventricle will be high, resulting in an enlarged left ventricle. This may be reflected in a displaced hyperdynamic wide -area left ventricular apical impulse. In addition, the hyperdynamic left ventricle will have rapid ejection. This will make the A2 occur early. Resulting in a wide-split S2. Thus, a wide -split S2 in the presence of mitral regurgitation is a sign of severe regurgitation if the wide split is not caused by P2 delay. In addition, severe regurgitation because of the volume load effect will have a torrential inflow through the mitral valve during diastole. This will set up the necessary conditions for the production of an S3 or a mid -diastolic inflow rumble. The presence of an S3 or an inflow rumble at the apex will, therefore, be a sign of significant mitral regurgitation as well. Severity of Mitral Regurgitation : Features indicating increased severity: Presence of Left ventricular S3 or an inflow rumble at the apex Harsh Decrescendo murmur with lot of low and medium frequencies Wide split S, due to early A2 (not caused by P2 delay) in presence of MR Note : Loudness and duration of Mitral regurgitation murmur does not always correlate with the severity of the regurgitation


Question: Hyperkeratosis of palm and sole is seen in


Question: ECG finding in Hypokalemia is

(Prominent 'U' wave): (439-Davidson 21st)HyperkalemiaHypokalemia1. Earliest changes increased T wave amplitude**- Early changes flattening or inversion of T wave **2. Prolong PR interval and QRS duration- Prominent 'U' wave**3. AV conduction delay, loss of P wave- ST segment depression, prolong QU interval4. Sin wave pattern** (progressive widening of the QRS complex merging with T wave)- Prolonged PR interval, decreased voltage and widening of the QRS complex** Prolong QT interval - Hypocalcemia, SAH** Short QT interval - Hypercalcemia, digitalis glycosides


Question: Early reversible shock is characterised by

The presentation of shock is variable with some people having only minimal symptoms such as confusion and weakness. While the general signs for all types of shock are low blood pressure, decreased urine output, and confusion, these may not always be present.While a fast hea rate is common, those on b-blockers, those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding may have a normal or slow hea rate.Specific subtypes of shock may have additional symptoms. Dry mucous membrane, reduced skin turgor, prolonged capillary refill time, weak peripheral pulses and cold extremities can be early signs Ref Davidson 23rd edition pg 355

Cold clammy extremities and increased peripheral resistance


Question: Mucosal candidiasis is caused by

(A) Candida albicans # Mucosal Candidiasis> Candidosis describes a group of yeastlike fungal infections involving the skin and mucous membranes.> Infection is caused by Candida species, typically, Candida albicans.> Acute pseudomembranous candidiasis (thrush)> Thrush may be observed in healthy neonates or in persons in whom antibiotics, corticosteroids, or xerostomia disturb the oral microflora.> Oropharyngeal thrush occasionally complicates the use of corticosteroid inhalers.> Immune defects, especially HIV infection, immunosuppressive treatment, leukemias, lymphomas, cancer, and diabetes, may predispose patients to candidal infection.


Question: Pa of brain involved in narcolepsy

Harrison's principles of internal medicine 17th edition *Recently several convergent lines of evidence suggest that hypothalamic neuropeptide hypocretin(orexin) is involved in the pathogenesis of narcolepsy.


Question: Drug of choice for NSAID resistant Rheumatoid Arthritis

(A) Methotrrexate # Usual approach to Rheumatoid Arthritis: is to attempt to alleviate the patient's symptoms with NSAIDs or Coxibs. Some patients may have mild disease that requires no additional therapy. However, if the patient has any evidence of aggressive disease, initiation of DMARD therapy should be considered as early as feasible. This group of agents includes methotrexate, gold compounds.D-penicillamine, the antimalarials, and sulfasalazine. Despite having no chemical or pharmacologic similarities, in practice these agents share a number of characteristics Methotrexate has emerged as the DMARD of choice because of its relatively rapid onset of action, its capacity to elfect sustained improvement with ongoing therapy, and the higher level of patient retention on therapy.


Question: Left sided facial weakness and right hemisphere site of lesion is

(A) Internal capsule # Most common LACUNAR SYNDROMES are the following: Pure motor hemiparesis from an infarct in the posterior limb of the internal capsule or basis pontis; the face, arm, and leg are almost always involved; Pure sensory stroke from an infarct in the ventrolateral thalamus; Ataxic hemiparesis from an infarct in the base of the pons; Dysarthria and a clumsy hand or arm due to infarction in the base of the pons or in the genu of the internal capsule; and Pure motor hemiparesis with "motor (Broca's) aphasia" due to thrombotic occlusion of a lenticulostriate branch supplying the genu and anterior limb of the internal capsule and adjacent white matter of the corona radiata.> Ischemia within the genu of the internal capsule causes primarily facial weakness followed by arm then leg weakness as the ischemia moves posterior within the capsule. Alternatively, the contralateral hand may become ataxic and dysarthria will be prominent (clumsy hand, dysarthria lacunar syndrome).


Question: Most common symptom of Orthostatic Hypotension is

(B) Lightheadedness # Orthostatic hypotension: Reduction in systolic BP of at least 20 mmHg or diastolic BP of at least 10 mmHg within 3 min of standing or head-up tilt on a tilt table, is a manifestation of sympathetic vasoconstrictor (autonomic) failure.> Characteristic symptoms include light headedness, dizziness, & presyncope (near-faintness) occurring in response to sudden postural change.> Nonspecific Symptoms include generalized weakness, fatigue, cognitive slowing, leg buckling, or headache.> Visual blurring may occur, likely due to retinal or occipital lobe ischemia.> Coat-hanger headache: Neck pain, typically in the suboccipital, posterior cervical, and shoulder region, most likely due to neck muscle ischemia, may be the only symptom.> Orthostatic dyspnea (thought to reflect ventilation-perfusion mismatch due to inadequate perfusion of ventilated lung apices) or angina (attributed to impaired myocardial perfusion even with normal coronary arteries).> Symptoms may be exacerbated by exertion, prolonged standing, increased ambient temperature, or meals.> Syncope is usually preceded by warning symptoms, but may occur suddenly, suggesting the possibility of a seizure or cardiac cause.> Supine hypertension is common in patients with orthostatic hypotension due to autonomic failure, affecting over 50% of patients.


Question: Y descent in jugular venous pulsation is due to

Y descent is due to passive movement of blood from atria to ventricles i.e. early diastolic filling


Question: Tiger skin appearance of colonic mucosa is seen in

Melanosis coli is a condition associated with chronic laxative abuse.
Imparts a brown discoloration to colonic mucosa - Tiger skin.


Question: Penumococcal meningitis is associated with the following CSF findings

Harrison's textbook of internal medicine 17th edition . *Typical finding of CSF in pneumococcal meningitis is increased WBC count (500-10000cells /microL) with _>85%PMNs,an elevated protein level(100-500mg/DL)and decreased glucose level(<30mg/DL).

Pleocytosis with low protein and low sugar

Pleocytosis with high protein and low sugar

Lymphocytosis high protein and low sugar


Question: Tertiary syphilis most frequently involves the


Question: Not useful in clostridium difficile colitis


Question: Lung volume reduction operations have been developed as a method of managing patients with

In a patient with diffuse severe emphysema, resection or pa of the damaged lung may allow the patient's residual lung to function more efficiently. This technique may serve either as an alternative to lung transplantation or as a bridge until an appropriate donor organ is available. ref - Harrisons internal medicine 20e pg 1997


Question: Circinate balanitis is a feature of

Circinate balanitis and Keratoderma Blennorrhagica is a feature of Reactive arthritis.


Question: Shrinking lung syndrome is seen in

Shrinking lung syndrome is a rare manifestation/complication of SLE Characterised by diaphragmatic weakness or dysfunctionAssociated with restrictive physiology and abnormalities of ventilation The restriction is due to the selective weakness of muscles of respiration including the diaphragmThe absence of ove parenchymal or vascular diseaseAnti-Ro antibodies may be present, but not offer an additional diagnostic aidPrognosis of this syndrome is often goodRef: Davidson 20/e p723


Question: Specific role of endoplasmic reticulum


Question: Hyperchloremic acidosis with hypokalemia is a feature of

Ans. a (Renal tubular acidosis). (Ref. Harrison's Medicine 16th/pg. 265, 1702)METABOLIC ACIDOSIS: There are two major categories of clinical metabolic acidosis:# High anion-gap (AG) and# Normal-AG, or hyperchloremic acidosis:Hyperchloremic (nongap) metabolic acidosis# Alkali can be lost from the gastrointestinal tract in diarrhea or from the kidneys (renal tubular acidosis, RTA). In these disorders, reciprocal changes in and result in a normal AG.# In pure hyperchloremic acidosis, therefore, the increase in above the normal value approximates the decrease in . The absence of such a relationship suggests a mixed disturbance.# Metabolic acidosis due to gastrointestinal losses with a high urine pH can be differentiated from RTA because urinary NH4 excretion is typically low in RTA and high with diarrhea.# Urinary NH4 -levels can be estimated by calculating the urine anion gap (UAG):- UAG = -.# When > , and the urine gap is negative, the urine ammonium level is appropriately increased, suggesting an extrarenal cause of the acidosis.# Conversely, when the urine anion gap is positive, urine ammonium level is low, sugg. renal acidosis.The typical findings in classic distal RTA (type 1 RTA) include:# Hypokalemia,# Hyperchloremic acidosis,# Low urinary NH4"# Excretion (positive uag, low urine [NH4U, and# Inappropriately high urine pH (pH -5.5).# Most have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, bone ds common.# Proximal RTA (type 2 RTA) is most often due to generalized proximal tubular dysfunction manifested by glycosuria, generalized aminoaciduria, and phosphaturia (Fanconi syndrome).# In type 4 RTA, hyperkalemia is disproportionate to the reduction in GFR because of coexisting dysfunction of potassium and acid secretion.FindingType 1 RTAType 2 RTAType 4 RTAGI Bicarbonate LossNormal anion-gap acidosisYesYesYesYesMinimum urine pH>5.5<5.5<5.55 to 6% Filtered bicarbonate excreted<10>15<10<10Serum potassiumLowLowHighLowFanconi syndromeNoYesNoNoStones/nephrocalcinosisYesNoNoNoDaily acid excretionLowNormalLowHighUrine anion gapPositiveNegativePositiveNegativeDaily bicarbonate replacement needs<4 mmol/kg>4 mmol/kg<4 mmol/kgVariableTable: COMPARISON OF NORMAL ANION-GAP ACIDOSISAlso remember:FUNCTIONAL CONSEQUENCES OF TUBULOINTERSTITIAL DISEASEDefectCause(s)1Reduced GFRObliteration of microvasculature and obstruction of tubules2Fanconi syndromeDamage to proximal tubular reabsorption of glucose, amino acids, phosphate, and bicarbonate3Hyperchloremic acidosis1. Reduced ammonia production2. Inability to acidify the collecting duct fluid (distal renal tubular acidosis).3. Proximal bicarbonate wasting4Tubular/small-molecular weight proteinuriaFailure of proximal tubule protein reabsorption5Polyuria, isothenuriaDamage to medullary tubules and vasculature6HyperkalemiaPotassium secretory defects including aldosterone resistance7Salt wastingDistal tubular damage with impaired sodium reabsorptionPRIMARY HYPERALDOSTERONISM (Conn's syndrome)# Conn's adenoma is very sensitive to ACTH as is glucocorticoid suppressible hyperaldosteronism, hence morning levels of ACTH and aldosterone are low.# Idiopathic bilateral adrenal hyperplasia is common than adrenal adenoma,# K+ levels are normal in 70% cases.# Increased plasma and urinary aldosterone.# Decreased plasma renin activity.6# Its dexamethasone suppressive hyperaldosteronism.# 18 OH cortisol levels are very high in Conn's adenoma and glucocorticoid suppressible hyperplasia.# Spironolactone is drug of choice.Secondary hyperaldosteronism results from:# Nephritic syndrome,# Cirrhosis,# Heart failure and# Barter's syndrome.'Spirolactone bodies' are seen in ATCH secreting adrenal adenomas treated with Spironolactone.


Question: Most common nerve involved in intracranial Aneurysm is

*in Subarachinoid hemorrhage ,a third nerve palsy may be present due to local pressure from an aneurysm of posterior communicating aery. *85% of SAH are caused by saccular or berry aneurysm. Ref Harrison20th edition pg 2345


Question: Most common Primary Brain tumor is


Question: "Gottron sign" seen in

(Dermatomyositis) (760-CMDT-10, 2696-H 17th)* "Gottron sign" - scaly patches over of the dorsum of PIP and MCP joints are highly suggestive of dermatomyositisDERMATOMYOSITIS - the characteristic rash is dusky red and may appear in a malar distribution mimicking the classic rash of SLE* Facial erythema beyond the malar distribution is also characteristic of dermatomyositis (Shawl's sign)* Periorbital edema and a purplish (heliotrope) suffusion over the eyelids are typical signs, periungual erythema, dilations of nailbed capillaries* Bilateral proximal muscle weakness*** *** Increased risk of malignancy** - in descending order of frequency are ovarian, lung, pancreatic, stomach, colorectal and NHL)* Biopsy of clinically involved muscle is the only specific diagnostic test*** A pathologic hall mark of dermatomyositis is perifascicular atrophy. In polymyositis - endomysical infiltration of the inflammatory infiltrate**** Various auto antibodies against nuclear antigens (antinuclear antibodies) and cytoplasmic antigens are found in upto 20% of patients with inflammatory myopathies* Glucocorticoids: oral prednisone is the initial treatment of choice* Myositis may also be associated with other connective tissue diseases especially - Scleroderma, lupus, mixed connective tissue disease and Sjogren syndrome, overlap syndrome* Antisvnthetase syndrome - polymyositis and dermatomyositis develops- inflammatory arthritis, Raynaud phenomenon, interstitial lung disease, auto antibodies (eg anti Jo I antibodies)* Most common myositis-specific antibody -anti Jo-I antibody** (ILD)* Anti Mi-2 associated with dermatomyositis* Anti SRP (anti- signal recognition particle) associated with polymyositisPolymyositis can occur as a complication of HIV or HTLV-1 infection and with zidovudine therapy as well**** Anti-endomysial antibody - Celiac sprue*** Anti mitochondrial antibody - Primary biliary cirrhosis*** Anti-smooth muscle antibody - Auto immune hepatitis* Anti centromere antibody - CREST syndrome (limited scleroderma)* Histidyl-t-RNA antibody - Inflammatory myopathy * Anti DNA topoisomerase antibody (Scl-70)- Systemic sclerosis * Antibodies of ribonucleoprotein antigen containing ULRNP- Mixed connective tissue disease * SSb(La)* SSb(La)}Antibodies to ribo nucleoprotein antigen- Sjogren syndrome


Question: Diarrhoea with acantholysis in urine

Harrison's principles of internal medicine 17th edition. *Steatorrheal cause of chronic diarrhea is a mucosal malabsorption caused by celiac disease,whipple's disease and abetalipoproteinemia. Abetalipoproteinemia is a rare defect is a defect of chylomicron formation and fat malabsorption in children associated with acantholytic erythrocytes,,ataxia and retinitis pigmentosa.


Question: Female menstrual cycle is diagnosed by


Question: It is considered as the bluntly rounded portion of the heart

B: The blunt, rounded point of the heart is the apex.
A: The aorta is the largest artery that carries blood from the left ventricle to the body.
C: The larger, flat portion at the opposite is the base.
D. The pericardium is also called the pericardial sac. It has a fibrous outer layer and a thin inner layer that surrounds the heart.


Question: Feature of severe diarrhea

Diarrhea can cause Non anion gap acidosis. Ref: Harrison&;s 19thE


Question: One of the following condition Is not associated with clubbing

Chronic bronchitis does not cause clubbing Pulmonary causes of clubbing: primary and metastatic lung cancer bronchiectasis asbestosis sarcoidosis lung abscess cystic fibrosis tuberculosis mesothelioma other causes include inflammatory bowel disease,infective endocarditis,cyanotic congenital hea disease ,hepatic cirrhosis etc


Question: A Patient with history of shoness of breath has Decreased FEV1/FVC Ratio, Normal DLCO. A 200 ml increase in baseline FEVI is observed 15 minutes after administration of bronchodilators. The likely diagnosis is


Question: Commonest cause of sustained severe hypeension in children

The chief causes of severe sustained hypeension identified included chronic glomerulonephritis , obstructive uropathy , reflux nephropathy , thrombotic microangiopathy and renovascular disease . ref:Harrison&;s principles of internal medicine,ed 18,pg no


Question: Barrett's esophagus is

Barrett's esophagus is specialized columnar metaplasia that replaces the normal squamous mucosa of the distal esophagus in some persons with GERD. Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus and is readily detected endoscopically, due to proximal displacement of the squamocolumnar junction.Ref: Harrison; 19th edition; Page no: 1895

Lower esophagus lined by columnar epithelium

Upper esophagus lined by columnar epithelium

Lower esophagus lined by ciliated epithelium

Lower esophagus lined by pseudo stratified epithelium


Question: Most common organism associated with reactive ahritis is

Reactive (spondylo)ahritis (ReA) is a 'reaction' to a number of bacterial triggers with clinical features in keeping with all SpA conditions. The known triggers are Chlamydia, Campylobacter, Salmonella, Shigella and Yersinia. Notably, non-SpA-related reactive ahritis can occur following infection with many viruses, Mycoplasma, Borrelia, streptococci and mycobacteria, including M. leprae, which causes leprosy (Hansen's disease); however, the 'reaction' in these instances consists typically of myoahralgias, is not associated with HLA-B27 and is generally not chronic. The ahritis associated with rheumatic fever is also an example of a reactive ahritis that is not associated with HLA-B27.Sexually acquired reactive ahritis (SARA) is predominantly a disease of young men, with a malepreponderance of 15 : 1. This may reflect a difficulty in diagnosing the condition in young women, in whom Chlamydia infection is often asymptomatic and is hard to detect in practical terms. Between 1% and 2% of patients with non-specific urethritis seen at genitourinary medicine clinics have SARA. The syndrome of chlamydial urethritis, conjunctivitis and reactive ahritis was formerly known as Reiter's disease. Ref Davidsons 23e p1031


Question: rtPA is NOT a contraindication in stroke with

(C) Coma # rtPA (Alteplase) is indicated in pulmonary embolism, myocardial infarction, and stroke.> rtPA therapy in patients with stroke is contraindicated in certain situations like suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke), platelet count <100,000/mm3.

Lesion occupying >1/3 of middle cerebral artery territory


Question: Itch sensation from skin is carried by

(C) C-nerve fibre # Itch Pathway: from Skin - C- Nerve Fibers - Dorsal Horn - Spinal Cord - Thlamus - Insula# Itch or Pruritus, is the major symptom in skin diseases with a variety of etiologies and pathophysiologies.> Significant progress has been achieved in understanding the pathophysiology of itch in the last 5 years.> Neurophysiological experiments in humans and animals have revealed that itch is carried by specific C nerve fibers.> Peripheral mediators other than histamine are involved in induction of itch.> Mast cell tryptase seems to be an important mediator in itch by its activation of proteinase activated receptor 2 in the sensory nerves.


Question: The most sensitive test for the diagnosis of ' myasthenia gravis is

*Tensilon (edrophonium) test: a sho-acting anticholinesterase--look for rapid and transient improvement of strength; false-positive (placebo response, motor neuron disease) and false-negative tests occur. Atropine IV should be on hand if symptoms such as bradycardia occur. Ref Harrison20th edition pg 2378

Elevated serum ACH-receptor binding antibodies

Measurement of jitter by Single fibre electromyography


Question: Treatment of choice in Wegner's granulomatosis is

Answer- B. CyclophosphamideCyclophosphamide alongwith glucocoicoids is the treatment of choice, For selected patients whose disease is not immediately life threatening or in those patients who have experienced significant cyclophosphamide toxicity, methotrexate together with glucocoicoids may be considered as an alternative


Question: Most common cause of spontaneous SAH

*85%of SAH are caused by saccular or 'berry' aneurysms arising from the bifurcation of cerebral aeries paicularly in region of the circle of willis . Ref Harrison20th edition pg 2445


Question: Drug for management of hypeension in Phaeochromocytoma

Ans. is 'a' i.e., Phenoxybenzamine Once a pheochromocytoma is diagnosed, all patients should undergo a resection of the pheochromocytoma following appropriate medical preparation. Resetting a pheochromocytoma is a high-risk surgical procedure and an experienced surgeon/anesthesiologist team is required. Some form of preoperative pharmacologic preparation is indicated for all patients with catecholamine-secreting neoplasms. Preoperative medical therapy is aimed at: Controlling hypeension (including preventing a hypeensive crisis during surgery) o Volume expansion In patients with undiagnosed pheochromocytomas who undergo surgery for other reasons (and who therefore have not undergone preoperative medical therapy), surgical moality rates are high due to lethal hypeensive crises, malignant arrhythmias, and multiorgan failure. Combined alpha- and beta-adrenergic blockade Combined alpha- and beta-adrenergic blockade is the most common approach to control blood pressure and prevent intraoperative hypeensive crises. Alpha-adrenergic blockade An alpha-adrenergic blocker is given 10 to 14 days preoperatively to normalize blood pressure and expand the contracted blood volume. Phenoxybenzamine is the preferred drug for preoperative preparation to control blood pressure and arrhythmia in most centers in the United States. It is an irreversible, long-acting, nonspecific alpha-adrenergic blocking agent. The initial dose is 10 mg once or twice daily, and the dose is increased by 10 to 20 mg in divided doses every two to three days as needed to control blood pressure and spells. The final dose of phenoxybenzamine is typically between 20 and 100 mg daily. Beta-adrenergic blockade After adequate alpha-adrenergic blockade has been achieved, beta-adrenergic blockade is initiated, which typically occurs two to three days preoperatively. The beta-adrenergic blocker should never be staed first because blockade of vasodilatory peripheral betaadrenergic receptors with unopposed alpha-adrenergic receptor stimulation can lead to a fuher elevation in blood pressure. The alternatives to a and 13 adrenergic agents are calcium channel blockers and metyrosine. Calcium channel blockers Although perioperative alpha-adrenergic blockade is widely recommended, a second regimen that has been utilized involves the administration of a calcium channel blocker. Nicardipine is the most commonly used calcium channel blocker in this setting; the staing dose is 30 mg twice daily of the sustained release preparation. Metyrosine Another approach involves the administration of metyrosine (alpha-methyl Para-tyrosine), which inhibits catecholamine synthesis.


Question: Patient presents with recurrent duodenal ulcer of 2.5 cm size; procedure of choice

Answer is A (Truncal vagotomy and antrectomy): The question here Strictly specifies recurrence as the major problem 'Recurrent duodenal ulcer'. Hence a procedure with the minimum recurrence rate, would logically be, the best operation. Truncal vagotomy and antrectomy are associated with minimum recurrence rate and is the answer of choice. Note: Operation with maximum Operation with minimum The most widely used procedure in India reduction in acid production operative moality Truncal vagotomy and Highly selective vagotomy Truncal vagotomy plus a drainage procedure Gasirojejunostomy antrectomy is at present the most widely used procedure. Highly selective vagotomy: - In highly selective vagotomy nerves of Latarjet supplying the antrum are preserved.Q- A drainage procedure is not required Q - Operation moality is lower than in any other definitive operation for duodenal ulceration. Q

Laparoscopic vagotomy and gastrojejunostomy


Question: The most common cause of acute cor pulmonale is


Question: Most common neurological finding in whipple's disease

M/C neurological - supranuclear opthalmoplegia and cerebellar ataxia.


Question: Henoch Schonlein Purpura presents with deposition of

Answer is C (IgA) The most common class of antibodies deposited in immune complexes of Henoch Schonlein Purpura is IgA.


Question: Most characteristic lesion in diabetic nephropathy is

Most common - Diffuse Glomerulosclerosis.
Most characteristic - Kimmelsteil Wilson nodules.


Question: A Young boy presents with multiple flaccid bullous lesions over trunk with some oral mucosal lesions. Most likely finding on immunofluorescence study of the biopsy specimen would be

Pemphigus Vulgaris Bullous pemphigoid Autoantibodies against Desmosomal proteins Hemidesmosomal proteins Age 40-60 yrs 60-75 yrs Initial site Oral mucosa Lower extremities Bullae Flaccid Tense Pruritus Mild/- Nonexistent or severe Nikolsky's sign + - Mucosal involvement +(in almost all patients) - (10-40% only) HPE Suprabasal acantholytic blisters (Tombstone appearance) Q Subepidermal blisters (eosinophil-rich dermal infiltrate) DIF IgG & C3 deposits at the intercellular substance of epidermis ("Fishnet appearance")Q IgG, C3, and IgA/IgM at BM zone. IIF Circulating IgG antibodies to the intercellular substance of epidermis. Anti-BM zone antibodies IgG Rx Steroids + immunosuppressants Dapsone Gold Steroids Immunosuppressants Dapsone Postinflammatory Hyperpigmentation + - (Ref. Harrison's 19th ed. Table 55-1)


Question: Universal finding in Asthma is

Answer is A (Hypoxia) Hypoxia is a universal finding during acute exacerbation's Hypoxia is a universal finding during acute exacerbations. Most Asthmatics have hypocapnia and respiratory alkalosis. - Harrison Hvpoxia is the universal finding in Asthma Hypocapnia and respiratory alkalosis is seen in most asthmatic patients Hypercarbia and Respiratory acidosis are very late features of Asthma and sign severe obstruction and respiratory failure. These are not universal findings in Asthma. Metabolic acidosis is not a feature of Asthma.


Question: Reversed splitting of S2 heart sound is heard in

Reversed splitting of heart sound S2 is seen in:

Aortic stenosis
PDA
Complete LBBB
WPW syndrome
Chronic ischemic heart disease
Post stenotic dilation of aorta secondary to aortic stenosis


Question: A  25 yr old female has recurrent headaches for past 3 years. Headache is episodic throbbing in nature and is associated with nausea and vomiting, preceded by visual aura .The patient is suffering from

Headache described is characteristic of migraine. The one with aura is classical, the one without aura is common migraine


Question: Raspberry tongue is a feature of

Strawberry or raspberry tongue is seen in kawasaki disease and scarlet fever.


Question: Severe malnutrition is defined in adults with BMI less than

Body mass index (BMI) BMI = wt (kg)/ ht (m)2 Example: an adult of 70 kg with a height of 1.75 m has a BMI of 70/1.752= 22.9 kg/m2 * BMI is a useful way of identifying under- or over-nutrition but cannot discriminate between lean body or muscle mass and fat mass <img src=" /> Ref Harrison 20th edition pg 76


Question: Fredrickson&;s type II hyperlipoproteinemia is due to excess amounts of

Defective LDL receptors, Elevated LDL cholesterol which is derived from VLDL, Has coronary high risk and atherosclerosis.


Question: A 26 year old man died suddenly during spoing activity. At autopsy the hea revealed chamber and septum Hyperophy. The most likely diagnosis is

Answer is A. (HOCM): Sudden death following competitive spos in young individuals is characteristic of hyperophic obstructive cardiomyopathy (HOCM). The presence of chamber and septal hyperophy on autopsy confirms the suspected diagnosis of HOCM


Question: Rupture of berry aneurysm most commonly results in

Ans. is 'a' i.e., Subarachnoid hemorrhage Most common cause of subarachnoid hemorrhage Trauma Most common cause of spontaneoussubarachnoid hemorrhage Rupture of Berry aneurysm (or Saccular aneurysm) Also know Mycotic aneurysm ? Mycotic aneurysm is caused by a septic embolus that weakens the wall of the vessel in which it lodges.


Question: Commonest type of bronchogenic carcinoma is


Question: Least common symptoms in Friedrich's ataxia is

(A) Moderate mental retardation # Neurologic examination reveals nystagmus, loss of fast saccadiceye movements, truncal titubation, dysarthria, dysmetria, and ataxia of trunk and limb movements. Extensor plantar responses (with normal tone in trunk and extremities), absence of deep tendon reflexes, and weakness (greater distallythan proximally) are usually found. Loss of vibratoryand proprioceptive sensation occurs.> Median age of death is 35 years. Women have a significantly better prognosis than men. Cardiac involvement occurs in 90% of patients. Cardiomegaly, symmetric hypertrophy, murmurs, and conduction defects are reported. Moderate mental retardation or psychiatric syndromes arepresent in a small percentage of patients.> High incidence of diabetes mellitus (20%) is found and is associated with insulin resistance and pancreatic -cell dysfunction. Musculoskeletal deformities are common and include pes cavus, pes equinovarus, and scoliosis. MRI of the spinal cord shows atrophy


Question: Epworth questionaries used in

i.e. (Obstructive sleep apnea syndrome): (J666-H17th )Epworth Sleepness score - for obstructive sleep apnea / hypopnea syndromeEPWORTH SLEEPNESS SCOREHow open are you likely to doze off or fall asleep in the following situations in contrast to feeling just tired? This refer to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choice the most appropriate number foreach situation0 = Would never doze1 = slight change of dozing2 = moderate chance of dozing3 = high chance of dozing* Setting and reading* Watching TV* Sitting, inactive in a public place (eg a theater or meeting)* Asa passenger in a ear for an hour without a break* Lying down to rest in the afternoon when circumstances permit* Sitting and talking to someone* Sitting quietly after lunch without alcohol* In a ear, while stopped for a few minutes in trafficSleep apnoea is defined as an intermittent cessation of airflow at the nose and mouth during sleep. By convention the apnea should be of at least 10 second durationSleep anea causes excessive day time sleepinessObstructive sleep apneaCentral sleep apneaApnea occurs due to occlusion of upper airway usually at the level of oropharynxApnea occurs due to transient stoppage of neural drive tothe ventilatory muscle* Most common age group for obstructive sleep apnea - male aged 30 - 60 yearsC/F of obstructive sleep apnea1. Systemic hypertension2. Pulmonary hypertension3. Heart failure (right & left)4. Personality changes5. Behaviour changes


Question: Low calcium and high phosphate is seen in


Question: AIDS infect


Question: GTT post 1 hour sugar for gestational diabetes is >mg %


Question: Commonest presentation of neurocysticerocosis is

Neurocysticercosis typically is first seen with seizures (70% to 90% of acutely symptomatic patients) and headache.Headache usually indicates the presence of hydrocephalus, meningitis, or increased intracranial pressure. Dementia,radiculopathy,focal neurologic defecits are less common presentations Ref Harrison20th edition pg 2445


Question: Stoke Adam's associated with

(C) High degree AV Block # Those with syncope due to high degree AV block (Stokes-Adams-Morgagni syndrome) may have evidence of conduction system disease (e.g., prolonged PR interval, bundle branch block).> Bradyarrhythmias may occur as a result of an abnormality of impulse generation (e.g., sinoatrial arrest) or impulse conduction (e.g., AV block).> Syncope due to a tachyarrhythmia is usually preceded by palpitation or light-headedness but may occur abruptly with no warning symptoms.> Patients with aortic valvular stenosis and hypertrophic obstructive cardiomyopathy are also at risk for ventricular tachycardia. Individuals with abnormalities of ventricular repolarization (prolongation of the QT interval) are at risk to develop polymorphic ventricular tachycardia (torsades de pointes).


Question: Hibernating myocardium is

Hibernating myocardium refers to a state of chronic reversible myocardial contractile dysfunction,  that is almost completely restored after myocardial repercussion. Recovery  occurs after revascularization,  not spontaneous. Acute coronary occlusion results in stunned myocardium.  Whereas chronic occlusion  results in hibernating myocardium.

Seen in chronic severe coronary stenosis


Question: Not associated with thymoma is

Hypogammaglobulinemia is seen in thymoma not Hypergammaglobulinemia . ref harrisons internal medicine 20e p2496 , 729 ,3232, 3237


Question: Delusion is

(Thought) (60- 61- Neeraj Ahuja 6th)* Delusion is a disorder with disturbed content of thought* Hallucination & Illusion are disorders of perception* Delirium & dementia are disorders of cognition* Insight is disturbed in psychosisDELUSION - False belief based on in correct inference about external reality; not consistent with patient's intelligence and cultural back ground that cannot be corrected by reasoning


Question: Urticarial lesions are best described as


Question: Aseptic meningitis caused by

Ans. is 'b' i.e., Ibuprofen Medications known to cause aseptic meningitis Medications Medication Common Uncommon NSAIDs Ibuprofen Sulindac Naproxen Diclofenac Rofecoxib Antimicrobials Trimethoprim/sulfamethoxazole Sulfonamides Immunomodulating agents Monoclonalantibody OKT3Intravenous IgG Azathioprine Intrahecal agents Metrizamide Cytarabine Methylprednisolone acetate Other Carbamazepine Causes of acute aseptic meningitis Infectious cases Bacterial Lyne disease Leptospirosis Mycobacterium tuberculosis infection Subacute bacterial endocarditis Parameningeal infection (epidural subdural abcess, sinus or ear infection) Paially treated bacterial meningitis Viral Echovirus infection Coxaackie virus infection Mumps St. Louis encephalitis Eastern equine encephalitis Western equine encephalitis Calcifornia encerphalitis Herpes simplex virus type 2 infection HIV infection Lymphocytic choriomeningitis Poliovirus infection


Question: Least common cause of endocarditis is


Question: Best test for lung fibrosis

Ans. is 'c' i.e., HRCT Lung fibrosis is a diffuse parenchymal lung disease. Idiopathic pulmonary fibrosis is the most common form of idiopathic interstitial pneumonia. We have already discussed that best investigation for interstitial lung disease is HRCT Estimated relative frequency of the interstitial lung disease Diagnosis Relative frequency, % Idiopathic interstitial pneumonias 40 Idiopathic pulmonary fibrosis 55 Nonspecific interstitial pneumonia 25 Respiratory bronchiolitis-ILD and 15 Cryptogenic organizing pneumonia 3 Acute interstitial pneumonia <1 Occupational and environmental 26 Sarcoidosis 10 Connective tissue diseases 9 Drug and radiation 1 Pulmonary hemorrhage syndromes <1 Other 13


Question: Cubital tunnel syndrome


Question: Cause of sudden loss of vision in alcoholic pancreatitis is

Putscher's retinopathy is a disease where pa of the eye (retina) is damaged. Usually associated with severe head injuries, it may also occur with other types of trauma, such as long bone fractures, or with several non-traumatic systemic diseases. However, the exact cause of the disease is not well understood. There are no treatments specific for Puscher's retinopathy, and the prognosis varies. The disease can threaten vision, sometimes causing temporary or permanent blindness. Puscher's retinopathy is a rare condition that is associated with complement-activating systemic diseases such as acute pancreatitis Ref Davidson edition23rd pg 840


Question: Most common myeloproliferative disorder is

Examples of Myeloproliferative diseases are Polycythemia rubra vera, Myelofibrosis, and Essential thrombocytopenia. Here CML and CLL are not Myeloproliferative diseases and out the rest two Polycythemia is more common. Reference : Davidaon, 23rd Edition, page no : 969.


Question: Defect seen in Bartter syndrome is

(D) Thick ascending limb of loop of Henle[?]Bartter Syndrome:-An inborn autosomal recessive defect, in the Na+-K+-2C- cotransporter in the thick ascending limb of the loop of Henle, leading to NaCl and water wasting.-Symptoms are polyuria, polydipsia, episodes of dehydration, faltering growth and constipation.-There may be maternal polyhydramnios with an affected fetus.-The resultant ECF volume contraction causes secondary renin secretion and raised aldosterone levels, with avid Na+ and water reabsorption in the distal tubule and reciprocal K+ and H+ secretion into the urine.-The blood pressure is normal; the hyperreninaemia is a compensatory response to maintain normal blood pressure in the presence of chronic ECF volume depletion.-There is also increased renal prostaglandin E2 production.[?]Fanconi Syndrome:oDiffuse proximal tubular dysfunction, leading to excess urinary loss of:-Glucose - glycosuria with normal blood glucose-Phosphate - hypophos- phataemia, rickets-Amino acids - no obvious clinical consequence-HCO3- - leading to proximal RTA-K+ - causing hypokalae- mia-Na+Cl- & water - leading to polyuria & polydipsia, chronic ECF volume depletion, faltering growth.-Tubular proteinuria - loss of low molecular weight proteins including retinol binding protein.


Question: Recurrent aspiration pneumonia caused by

Answer- C. Progressive systemic sclerosisEsophageal hypomotility and incompetence of the lower esophageal sphincter disease causes chronic gastroesophageal reflux and recurrent episodes of aspiration in systemic sclerosis.


Question: Shirmer's test is done for

Answer is C (Facial nerve): Shirmer's test is done to assess the lacrimation function of the Facial Nerve (Greater Superficial Petrosal Nerve).


Question: Standing increases murmur intensity in

The classic ECG finding in hyperophic obstructive cardiomyopathy is large dagger-like "septal Q waves" in the lateral -- and sometimes inferior -- leads due to the abnormally hyperophied interventricular septum.. Wolff-Parkinson-White, or WPW, syndrome can be associated with HOCM The murmur that is pathognomonic for HCM is a crescendo-decrescendo holosystolic murmur best heard at the left sternal boarder. The murmur classically increases with standing and valsalva, while it decreases with squatting, hand-grip, and passive leg lift . Ref Davidson edition23rd pg 463


Question: Nucleotide repeat in Spinocerebellar ataxia type 6.

Fragile X - CGG
Freidrich ataxia - GAA
Myotonic dystrophy - CTG


Question: Characteristic pathological feature of pneumococcal pneumonia

The characteristic pathological feature of pneumococcal pneumonia is radiographic evidence of lobar/segmental consolidation.Consolidation may be associated with a small pleural effusion or empyema in complicated cases.In children,"round pneumonia", a distinctly spherical consolidation is associated with pneumococcal pathology.Non specific findings include elevated polymorphonuclear leukocytes(>15 000/micro Litre in most cases & upward of 40,000/micro Litre in some),elevated liver function tests,etc. Reference:Harrison' s medicine-18th edition,page no:1156.


Question: Warm antibody in autoimmune hemolytic anemia


Question: In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be

The common complications of peptic ulcer are perforation, bleeding and stenosis.The most common site for a peptic ulcer is the first pa of the duodenum.The most common site of bleeding from a peptic ulcer is the posterior aspect of the duodenum. Gastroduodenal aery is the common source ofmajor bleeding.The most common site of perforation is the anterior aspect of the duodenum.Bailey and Love 27e pg: 1127


Question: Blood loss in class III hemorrhagic shock

Class I - < 750 mL
Class II - 750 - 1500mL
Class III - 1500 - 2000mL
Class IV - 2000mL.


Question: Becks triad is seen in

Components of Beck's Triad Hypotension with a Narrowed Pulse Pressure Jugular Venous Distention Muffled hea Sounds it is a pathognomic feature of cardiac tamponade Ref Harrison 20th edition pg 1546


Question: Gerstmann's syndrome is due to involvement of

(B) Left parietal lobe # GERSTMANN SYNDROME: Combination of acalculia (impairment of simple arithmetic), dysgraphia (impaired writing), finger anomia (inability to name individual fingers as the index or thumb) & right-left confusion (inability to tell when a hand, foot or arm of the patient or examiner is on the right or left side of the body).> When this syndrome is in isolation, it is commonly associated with damage to the inferior parietal lobule (especially the angular gyrus) in the left hemisphere.


Question: Treatment of AIDS include

(2 Reverse transcriptase inhibitors + 1 Protease inhibitors) (1124-H) (1197-1201-300-CMDT-09) (1190- H17th)Currently licenced drugs for the treatment of HIV infections fall into three categories: those that inhibit the viral reverse transcriptase enzyme: those that inhibit the viral protease enzymes, and those that interfere with viral entry (1124-H)Reverse transcriptase inhibitors include(i) Nucleoside analogues - Zidovudine, Zalcitabine, Didanosine, Zalcitabine, Stavudine, Lamivudine, abacavir, and emtricibine(ii) Nucleotide analogues - tenofovirNon-nucleoside reverse transcriptase inhibitors - nevirapine, delavirdine and efavirenzProtease inhibitors (PIs) Saquinavir, Ritonavir, Indinavir, Nelfinavir, Amprenavir, Fosamprenavir, Lopinavir, AtazanavirEntry inhibitors (Fusion inhibitors) - Enfuvirtide* The combination of Zidovudine, Lamivudine and indinavir was the first "triple combination" shown to have a profound effect on HIV replication (1134-H)Symptomatic HIV disease or asymptomatic disease and CD4 < 200/pL or asymptomatic disease and special circumstances | Best first line treatment{CombivirEfavirenz Common altemativeregimens once a day regimens |||||* Tenofovir +Lamivudine +Efavirenz Tenofovir +Efavirenz +Afazanavir +Ritonavir + | | Intolerance to regimen Progression of disease or viral load does not decrease by > 0.5 log with initiation of treatment or increase of viral load by > 0.5 log while on treatmentLow pill burden regimens Combivir +Neviripine Trizivir | Change to alternative first line regimens High potency regimens| | Perform resistance testing and change to a regimen with three drugs to which the patient is not resistant. If possible Combivir +Lopinavir withRitonavir Approach to antiretroviral therapy

2 Reverse transcriptase inhibitors + 2 Protease inhibitors

3 Reverse transcriptase inhibitors + 1 Protease inhibitors


Question: Drug of choice for Chronic Myeloid Leukaemia is

(B) Imatinib TRASTUZUMABMechanismMonoclonal antibody against HER-2 (erb-B2). Helps kill breast cancer cells that over express HER-2, possibly through antibody-dependent cytotoxicity.Clinical useMetastatic breast cancerToxicityCardiotoxicityIMATINIBMechanismMonoclonal antibody against the Philadelphia chromosome brc-abl tyrosine kinaseClinical useCML, Gl stromal tumorsToxicityCardiotoxicityVINCRISTINE, VINBLASTINEMechanismM-phase-specific alkaloids that bind to tubulin and block polymerization of microtubules so that mitotic spindle cannot formClinical usePart of the MOPP (Oncovin ) regimen for lymphoma, Wilms tumor, ChoriocarcinomaToxicityVincristine-neurotoxicity (areflexia, peripheral neuritis), paralytic ileus. Vinblastine blasts bone marrow (suppression)PACLITAXEL, OTHER TOXOIDSMechanismM-phase-specific agents that bind to tubulin and hyper stabilize polymerized microtubules so that mitotic spindle cannot break down (anaphase cannot break down (anaphase cannot occur)Clinical useOvarian and breast carcinomaToxicityMyelosuppression and hypersensitivity


Question: Feature of exudates pleural effusion is

According to Light's criteria for distinguishing pleural transudate from exudate,exudate is likely if one or more of the following criteria are met-Pleural fluid protein:serum protein ratio>0.5;Pleural fluid LDH:serum LDH ratio>0.6;Pleural fluid LDH>2/3 rds of the upper limit of normal serum LDH. Reference:Davidson's medicine-22nd edition,page no:662.

Pleural fluid protein: Serum protein ratio> 0.5

Pleural fluid protein: Serum protein ratio> 0.8

Pleural fluid protein: Serum protein ratio<0.5

Pleural fluid protein: Serum protein ratio> 1.0


Question: Adenocarcinoma of oesophagus is associated with

(D) Barret's oesophagus # Geographical variation of oesophageal cancer> Adenocarcinoma now accounts for 60-75% of all oesophageal cancers in several countries.> The reason for the change is not understood, but may be due to a changed incidence of Barret's oesophagus.# Complications of Barret's Oesophagus> Oesophageal ulcers: Barret's ulcer - pain, bleeding, perforation.> Oesophageal stricture: Usually located in middle or upper oesophagus. Peptic stricture occur in the distal oesophagus.> Dysplasia and Adenocarcinoma.


Question: The most common cause of Pulmonary thromboembolism is

A late effect of DVT is a postphlebitic syndrome, which eventually occurs in more than one-half of DVT patients. Postphlebitic syndrome (also known as a post-thrombotic syndrome or chronic venous insufficiency) is a delayed complication of DVT that causes the venous valves of the leg to become incompetent and exude interstitial fluid. Patients complain of a chronic ankle or calf swelling and leg aching, especially after prolonged standing.Ref: Harrison's 18/e p2170, 17/e p1651


Question: Natural elements having anticancer properties   a) Nitrosoamines  b)  Vit. C  c) Vit. D  d) Carotene  e) Selenium


Question: Disease due to deficiency of B Complex vitamins is

Pellagra Niacin deficiency (B complex)Night blindnessVitamin A deficiencyOsteomalacia Vitamin D deficiencySpinocerebellar ataxiaVitamin E deficiency(ref:Harrison's 17/e p442)


Question: Not seen idiopathic pulmonary hemosiderosis

Answer is A (Eosinopenia): Eosinopenia is not a feature of Idiopathic Pulmonary Hemosiderosis Idiopathic Pulmonary Hemosiderosis (IPH) IPH is a disorder of unknown etiology characterized by recurrent episodes of Diffuse Alveolar Hemorrhage (DAH) It has been classically characterized by the triad of iron deficiency anemia, hemoptysis and alveolar infiltrates on chest radiographs.


Question: Double density sign in Mitral stenosis is a sign of enlargement of

Answer- B. Left AtriumDouble density is seen on frontal chest radiograph in the presence of left atrial enlargement and occurs when the right side of the left atrium pushes behind the right cardiac shadows indenting the lung and forming its own district sihhouette.


Question: Coloboma is a defect in


Question: A boy is suffering from acute pyelonephritis


Question: Following is characteristic neurologic finding in primary amyloidosis

Ans. is 'a' i.e., Peripheral motor and sensory neuropathy ATTR usually presents as a syndrome of familial amyloidotic polyneuropathy or familial amyloidotic cardiomyopathy. Peripheral neuropathy usually begins as a lower-extremity sensor and motor neuropathy and progresses to the upper extremities. Autonomic neuropathy is manifest by gastrointestinal symptoms of diarrhea with weight loss and ohostatic hypotension.

Peripheral neuropathy associated with cerebral manifestation

Spinal cord compression in thoracic region


Question: Half life of alteplase

Ref Harrison 19 th ed pg 758 Atleplase has a plasma half-life of 4-6 minutes.


Question: Wenckebach's phenomenon is seen in

Second-degree AV block is subclassified as Mobitz type I (Wenckebach) or Mobitz type II.In type I, the PR interval has a progressive prolongation until finally the atrial impulse is completely blocked and does not produce a QRS electrical impulse.Once the p-wave is blocked and no QRS is generated, the cycle begins again with the prolongation of the PR interval.One of the main identifying characteristics of second-degree AV block (Type 1) is that the atrial rhythm will be regular. Type II second-degree AV block is characterized by intermittent failure of conduction of the P wave without changes in the preceding PR or RR intervals.Harrison 19e pg: 1472


Question: Digoxin is contraindicated in

A. i.e. (Hypertrophic cardiomyopathy) (1485 - H17th)Hypertrophic CMP - Digitalis, diuretics, nitrates, dihydropyridine calcium blockers, vasodilators and b- adrenergic agonists are best avoided, particularly in patients with know LV out flow tract pressure gradients - (1485 - H17th)Dose reduction in Digitalis in following conditions* Hypokalemia** Advanced age** Hypomagnesemia* Hypoxia** **Renal failure* Hypothyroidism* Hypercalcemia* Myocarditis* Electrical - cardioversion* Lidocaine is the drug of choice in digoxin induced arrhythmias* **Diuretics & Hemodialysis are NOT used for treatment of digitalis toxicity* Major electrophysiological effect of digitalis1. Hyperpolarization2. Shortening of atrial action potential3. Increase in AV node refractoriness


Question: Acute metabolic acidosis

It is seen in low anion gap acidosis. Other features seen: low serum albumin (nephrotic syndrome.) High immunoglobulins (multiple myeloma) Increaed Li Increaed : K+, Ca2+, Mg2+ Ref: Harrison&;s 19thE

Does not effect K+ excretion significantly


Question: Hypophosphatemia is a caused by


Question: Intetion tremor, druken gait and scanning speech together point towards involvement of

Answer- A. CerebellumClinical features of Cerebellar lesions:Incordination of rapid alternating movements - dysdiadokokinesiaInaccuracy of purposeful movements - dysmetriaIrregular variations in the volume and rhythm ofspeech - scanning speechBroad based reeling gait - like a drunken sailorQuasirhythmical rocking of the head and trunk - titubationHypotoniaNystagmus


Question: A hypeensive diabetic is having proteinuria , antihypeensive of choice is

Ref Harrison 19 th ed pg 1625 In patients with type 2 diabetes, treatment with an ACEI, an ARB, or aliskiren decreases proteinuria and delays the progres- sion of renal disease. In experimental models of hypeension and diabetes, renal protection with aliskiren is comparable to that with ACEIs and ARBs. However, in patients with type 2 diabetes, addition of aliskiren to an ACEI provides no additional protection against cardiovascular or renal disease and may be associated with more adverse outcomes. Among African Americans with hypeension- related renal disease, ACEIs appear to be more effective than beta blockers or dihydropyridine calcium channel blockers in slowing, although not preventing, the decline of glomerular filtration rate. The renoprotective effect of these renin-angiotensin blockers, com- pared with other antihypeensive drugs, is less obvious at lower blood pressures.


Question: According to Misch bone density classification D2 is


Question: Most common lymph node involved in Hodgkin's lymphoma is

Answer is B (Cervical) The most common lymph nodes involved in Hodgkins Lymphoma are the cervical lymph nodes. The most common lymph nodes involved in Hodgkin's Lymphoma are cervical lymph nodes and supraclavicular lymph nodes (60-70%) 'Detection of an unusual mass or swelling in the superficial, supra-diaphragmatic lymph nodes (60-70% cervical and supraclavicular, 15-20% axillary) is the most common presentation of Hodgkin's Lymphoma. Only 15 to 20 percent of patients have sub-diaphragmatic disease at presentation' -- William's Manual of Hematology


Question: Drugs of choice in diffuse pan bronchioltis is

(Erythromycin): (1489-1490 - H18th edition)Low dose erythromycin is the D.O.C. in the treatment of diffuse panbronchiolitis.Macrolides have to be taken orally for an extended period of time -2-3 yrs.M.O.A - ImmunomodulationThe antibiotic effects of marolides are not involved in their beneficial effects toward reducing inflammation in DPB. They are especially effective at inhibiting the proliferation of neutrophils, by diminishing the ability of interleukin 8 and leukotriene B4 to attract them. They also reduce lymphocyte activity and obstructive mucus and water secretions in airways.Diffuse panbronchiolitis (DPB) is an idiopathic progressive inflammatory obstructive lung diseaseIt tends to present in middle aged (~ 30-60 year old) adults, often non smokers. There is a high prevalence rate in males with a M:F ratio of ~ 2:1.PathologyDiffuse panbronchiolitis is characterized by centrilobularperibronchiolar infiltrates of acute and chronic inflammatory cells, which occur principally at the level of the respiratory bronchioles. There can be bronchiolar dilatation and intra-luminal inflammatory exudates.Radiographic featuresPlain filmNon specific and may show bilateral, diffuse, small nodular shadows with pulmonary hyper inflation.HRCT ChestA periphero-basilar predilection may be present. Features are generally non specific and include:* Centrilobular opacities with branching lines (tree-in-bud pattern)* Bronchiolectasis* Expiratory air trapping


Question: DOC of GTCS in pregnancy


Question: Shifting dullness is the characteristic sign of

Hydropneumothorax is collection of both fluid(lower pa) and air(upper pa) in the pleural cavity.The hallmark diagnosis in hydropneumothorax is 3 'S':Shifting dullness(due to the presence of free fluid & air within the pleural cavity,dullness of fluid shifts from one place to other within chest with the change of posture of the patient),Succussion splash,and Straight fluid level(upper limit of dullness is horizontal).


Question: Burst suppression of EEG is sees in

. * In SSPE ,EEG demonstrates characteristic periodic bursts of triphasic waves. Ref Harrison20th edition pg 2567


Question: An otherwise healthy athlete complaints of chest pain and dyspnea during routine training, on examination has a double impulse at the apex, undergoes sudden death. Likely diagnosis

(A) HOCM # Symptoms of chest pain and dyspnea and findings of double impulse at the apex with sudden death suggest features of HYPERTROPHIC CARDIOMYOPATHY (HCM).> Hypertrophic cardiomyopathy (HCM) clinical features:> The clinical course of HCM is highly variable.> Many patients are asymptomatic or mildly symptomatic and may be relatives of patients with known disease.> Unfortunately, the first clinical manifestation of the disease may be sudden death, frequently occurring in children and young adults, often during or after physical exertion.> In symptomatic patients, the most common complaint is dyspnea, largely due to increased stiffness of the left ventricular walls, which impairs ventricular filling and leads to elevated left ventricular diastolic and left atrial pressures.> Other symptoms include angina pectoris, fatigue, and syncope.> Symptoms are not closely related to the presence or severity of an outflow pressure gradient.> Most patients with gradients demonstrate a double or triple apical precordial impulse, a rapidly rising carotid arterial pulse, and a fourth heart sound.


Question: "Setting Sun" sign is seen in

(A) Hydrocephalus # Setting sun sign:> Retraction of the upper lid without upgaze so that the iris seems to ""set"" below the lower lid; suggestive of neurologic damage in the newborn, but usually clears up without sequelae> The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis. In this condition, the eyes appear driven downward, the sclera may be seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid. Pathogenesis of this sign is not well understood, but it seems to be related to aqueductal distention with compression of periaqueductal structures secondary to increased intracranial pressure.> However, it can also be transiently elicited in healthy infants up to 7 months of age by changes of position or removal of light (benign setting-sun phenomenon). The benign form might represent immaturity of the reflex systems controlling eye movements.> When persistent, this sign is one of the most frequent markers of elevated intracranial pressure, appearing in 40% of children with hydrocephalus (of any cause) and in 13% of patients with ventriculoperitoneal shunt dysfunction. It is an earlier sign of hydrocephalus than enlarged head circumference, full fontanelle, separation of sutures, irritability or vomiting. Consequently, this sign is a valuable early warning of an entity requiring prompt neuroimaging and urgent surgical intervention.


Question: Most common cause of pleural effusion in AIDS patients

Ans. is 'a' i.e., Kaposi sarcoma Ophthalmological diseases The most common abnormal findings on fundoscopic examination are cotton wool spots. CMV retinitis is the most severe ocular complication and occurs when CD4 T-cells count is less than 50/ml. It typical presents as perivascular hemorrhage and exudae with Cottage-Cheese appearance. Acute retinal necrosis syndrome, also called progressive outer retinal necrosis (PORN) is caused by HSV and VZV Other manifestations are chorioretinitis by toxoplasma and P carinii, kaposi sarcoma of eyelid, and lymphoma.


Question: The current drug of choice in paroxysmal Sypraventricular Tachycardia (PAVT ) is

adenosine is the drug of choice for PSVT. Immediate electrical cardioversion is indicated if the arrhythmia is associated with hemodynamic collapse. Adenosine is the preferred drug in those patients in whom verapamil has failed or may cause adverse effects, such as those with hea failure or wide-complex tachycardia In most patients, the drug of choice for acute therapy is either adenosine or verapamil. The use of intravenous adenosine or the calcium channel blocker verapamil are considered safe and effective therapies for controlling SVTs Ref Harrison 20th edition pg 1465


Question: In a patient with myocardial infraction the valvular lesion commonly seen in

Reg Harrison 19 th ed pg 1524 The most common valvular lesion seen in MI is mitral regurgitation.


Question: Complications of lobar pneumonia does not include


Question: Cabergoline is the drug of choice for

(C) Prolactinoma # Cabergoline:> Cabergoline is an ergot derivative.> FDA-approved for the treatment of hyperprolactinemia.> Cabergoline has been linked to valvular heart disease, an effect proposed to reflect agonist activity at the serotonin 5-HT2B receptor.> Dopamine agonist, bromocriptine mesylate, is often the initial drug of choice and may require high doses to achieve clinical improvement and shrinkage of prolactinomas.> It can lower the prolactin level in 70-100% of patients. While the evidence supporting the use of medication therapy first is largely based on uncontrolled observational studies, they do strongly support the use of these medications.> Agents other than bromocriptine have been used (Eg, Cabergoline, Quinagolide).> Cabergoline, in particular, probably is more effective and causes fewer adverse effects than bromocriptine. However, it is much more expensive.> Cabergoline is often used in patients who cannot tolerate the adverse effects of bromocriptine or in those who do not respond to bromocriptine.


Question: Mechanism of hypoxemia in asthma is

Pathophysiology Airway hyper-reactivity (AHR) - the tendency for airways to narrow excessively in response to triggers that have little or no effect in normal individuals is integral to the diagnosis of asthma and appears to be related, although not exclusively, to airwayinflammation . Other factors likely to be impoant in the behaviour of airway smooth muscle include the degree of airway narrowing and neurogenic mechanisms. The relationship between atopy (the propensity to produce IgE) and asthma is well established and in many individuals there is a clear relationship between sensitisation and allergen exposure, as demonstrated by skin-prick reactivity or elevated serum-specific IgE. Common examples of allergens include house dust mites, pets such as cats and dogs, pests such as cockroaches, and fungi. Inhalation of an allergen into the airway is followed by an early and late-phase bronchoconstrictor response . Allergic mechanisms are also implicated in some cases of occupational asthma . In cases of aspirin-sensitive asthma, the ingestion of salicylates results in inhibition of the cyclo-oxygenase enzymes, preferentially shunting the metabolism of arachidonic acid through the lipoxygenase pathway with resultant production of the asthmogenic cysteinyl leukotrienes. In exercise-induced asthma, hyperventilation results in water loss from the pericellular lining fluid of the respiratory mucosa, which, in turn, triggers mediator release. Heat loss from the respiratory mucosa may also be impoant. In persistent asthma, a chronic and complex inflammatory response ensues, characterised by an influx of numerous inflammatory cells, the transformation and paicipation of airway structural cells, and the secretion of an array of cytokines, chemokines and growth factors. Examination of the inflammatory cell profile in induced sputum samples demonstrates that, although asthma is predominantly characterised by airway eosinophilia, neutrophilic inflammation predominates in some patients while in others scant inflammation is observed: so-called 'pauci- granulocytic' asthma. Ref Davidson edition23rd pg 568


Question: The most impoant factor that influences the outcome of penetrating cardiac injuries is

Multiple studies in the literature confirm that injuries to the coronary aeries are the most impoant factor in determining outcome after a penetrating cardiac injury. Tangential injuries are the least serious. Injury to a single chamber--even if comminuted--or to multiple chambers is less likely to be fatal than are injuries that involve a major coronary aery. ref - Harrisons 20th ed


Question: Liver is darkly pigmented in

Dubin Johnson syndrome
Autosomal recessive
Liver darkly pigmented.


Question: Obesity is associated with decreased risk of


Question: Shirmer's test is used to assess

Answer is A (Greater superficial petrosal nerve): Shirmer's test is done to assess the integrity of Greater Superficial Petrosal Nerve (Branch of Facial Nerve) by assessing the Lacrimation function. Topographical Test for Facial Nerve Function Branch / Nerve assessed Shirmer's test Greater Superficial Petrosal Nerve (GSPN) Stapedial Reflex Accoustic Reflex Stapedial branch (Branch to stapedius) Electrogustometry (Taste testing) Chorda Tympani Branch Salivary Flow Rate Chorda Tympani Branch


Question: Alternative parenteral drug for multi drug resistant malaria is

Multidrug-resistant P. falciparum malaria : Either aemether-lumefantrinec (1.5/9 mg/kg bid for 3 days with food) or Aesunatec (4 mg/kg qd for 3 days) plus Mefloquine (25 mg of base/kg--either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3) Aemisinin and derivatives (aemether, aesunate) : Good oral absorption, slow and variable absorption of IM aemether; aesunate and aemether biotransformed to active metabolite dihydroaemisinin; all drugs eliminated very rapidly; t1/2: <1 h (Harrison's Principles of internal medicine, 20th edition, page 1699)


Question: Thyroid carcinoma associated with hypocalcemia is

Answer is B (Medullary Carcinoma) Medullary carcinoma of thyroid secretes calcitonin and this causes reduction in calcium levels.


Question: Massive haemoptysis in mitral stenosis originates from

Ans. a (Pulmonary veins). (Ref. Harrison, Principles of Medicine, 18th ed./Chapter 237.)# Haemoptysis in mitral stenosis results from rupture of pulmonary-bronchial venous connections secondary to pulmonary venous hypertension.# It occurs most frequently in patients who have elevated LA pressure without marked increase in pulmonary venous resistance and is almost never fatal.# But as severity of MS pogresses, PVR increases or when TR/TS develops, episodes of edema and hemoptysis decrease in frequency and severity.# Recurrent pulmonary emboli, sometimes with infarction, are an important cause of morbidity and mortality rates late in the course of MS. Pulmonary infections, i.e., bronchitis, bronchopneumonia, and lobar pneumonia, commonly complicate untreated MS, especially during the winter months.# In general, the bronchial artery is the source of hemoptysis in about 90% of cases, and in remain ing 10% (who don't respond to BAE by polyvinyl alcohol), the source may be Rassmussen's aneurysm (arising from pulmonary arteries)# BAE is a life-saving interventional procedure for massive hemoptysis.


Question: Severity of spreading of plague is detected by

Cheopis index:- It is average number of X. Cheopis / rat.


Question: In type II respiratory failure, there is


Question: A 34 years old male patient presents with symptoms of headache nausea and vomiting and intermittent focal seizures. On investigation patient is diagnosed to be suffering from neurocysticercosis. Antiparasitic drug used in the management of these patients are given for a duration of

Answer- A. 15 - 30 daysFor the treatment of patients with brain parenchl.mal cysticerci. most authorities or antiparasitic drugs, including albendazole (15 mdkgper dayforS-28 days) orpraziquantel (50-100 mdkgdailyinthree divideddoses for 15-30 days).


Question: For the following explanations for hirsutism, select the most likely cause.Can be associated with anovulation, obesity, and amenorrhea.

The most severe form of PCOD, Stein-Leventhal syndrome, is associated with chronic anovulation, hirsutism, enlarged cystic ovaries, obesity, and amenorrhea. The spectrum of disease, however, is quite wide, and some patients have only mild hirsutism.


Question: Remitting and relapsing features are associated with

(A) Multiple Sclerosis # Classification of Multiple Sclerosis> Progression of MS subtypes> Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. They are important not only for prognosis but also for therapeutic decisions. In 1996 the United States National Multiple Sclerosis Society standardized four subtype definitions Relapsing remitting Secondary progressive Primary progressive Progressive relapsing> Relapsing-remitting subtype is characterized by unpredictable relapses followed by periods of months to years of relative quiet (remission) with no new signs of disease activity. Deficits suffered during attacks may either resolve or leave sequelae, the latter being more common as a function of time.> This describes the initial course of 85-90% of individuals with MS.> When deficits always resolve between attacks, this is sometimes referred to as benign MS.> The relapsing-remitting subtype usually begins with a clinically isolated syndrome (CIS). In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis.> However only 30 to 70% of persons experiencing CIS later develop MS.> Guillain-Barre syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP), an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of peripheral neuropathies.


Question: The most common cause of sudden arrhythmic


Question: A Cluld brought with bleeding nostrils. H/o viral infection 3 months back & treated with aspirin. The diagnosis is

(B) Reye's syndrome # Reye's syndrome is a rare and severe illness affecting children.> Reye's syndrome is associated with viral infection and aspirin use.> Patients with Reye's syndrome present with vomiting and mental-status changes.> Diagnosing Reye's syndrome primarily depends on the clinical history of symptoms.> Most common abnormal laboratory tests with Reye's syndrome include elevated liver enzymes, elevated ammonia levels, and low serum glucose levels.> Treatment is supportive, and even with treatment, severe cases result in permanent brain damage and death.


Question: The most strongly implicated premalignant condition of the oral cavity is

ConditionUsual locationClinical featuresCourseFordyce spotsBuccal and labial mucosaNumerous small yellowish spots just beneath the mucosa; no symptoms; due to hyperplasia of sebaceous glandsbenignErythroplakiaFloor of mouth in men; tongue and buccal mucosa in womenVelvety, reddish plaqueHigh risk for squamous cell cancerMedian rhomboid glossitisMedian posterior poion of tongueCongenital abnormality of tongue with ovoid, denuded areabenignErythema multiformeOral mucosa Intraoral ruptured bullae surrounded by inflammatory areas; lips may show hemorrhagic crustsNot a premalignant condition(Ref: Harrison's 18/e p217, table 32.1-32.4)


Question: Xanthogranulomatous pyelonephritis is most often due to

Xanthogranulomatous pyelonephritis occurs when a chronic urinary obstruction (often by staghorn calculi), together with chronic infection, leads to the suppurative destruction of renal tissue.Proteus infection is associated with staghorn formation.Ref: Harrison; 19th edition; Page no: 1033


Question: Apart from dental caries, streptococcus mutans can cause


Question: These ECG changes are seen in <img src=" />

Electrocardiographic changes in hypokalemia include broad flat T waves, ST depression, prominent U waves (best seen in the precordial leads) and QT prolongation; these are most marked when serum K+ is <2.7 mmol/L. Ref: Harrison 19e pg: 307


Question: Routine use of recombinant erythropoietin in patients of chronic kidney disease obtes the chances of

Answer- A. Regular blood transfusionsRecombinant human EPO and modified EPO products, such as darbepoetin- alpha, has been one of the most significant advances in the care of renal patients since the introduction of dialysis and renal transplantation.The routine use of these products has obted the need for regular blood transfusions in severely anemic CKD patients.Frequent blood transfusions in dialysis patients also leads to the development of allo-antibodies that could sensitize the patient to donor kidney antigens and make renal transplantation difficult.Adequate bone marrow iron stores should be available before treatment with EPO is initiated.For patients on hemodialysis, IV iron can be administered during dialysis.


Question: Increased serum amylase in pleural effusion is seen in

(Malignancy) (269- CMDT-08) (1658-H17th)Serum amylase level in PE - suggest pancreatits, pancreatic pseudocyst, adenocarcinoma of the lung or pancreas or esophageal rupture, - MalignancyGlucose < 60 mg/ dL - occurs in Malignancy, Bacterial infections, Rheumatoid pleuriticIncreased amvlase acids are found in perforated duodenal ulcers acute cholecystitis. High intestinal obstruction, acute mesenteric vascular occlusion, DKA leaking aortic aneurysm, mumps, ectopic pregnancy after administration of narcotics, after abdominal surgery* Bacterial pneumonia and cancer are the most common cause of exudative effusion* High concentration of cholesterol in most rheumatoid effusions


Question: Antibody seen in neonatal Lupus with conduction abnormalities in heart

Anti-Ro (SSa) -
Subacute Cutaneous Lupus.
Neonatal Lupus.
Congenital heart block.


Question: Strong correlation with colorectal cancer is seen in

NON NEOPLASTIC POLYPSPOLYPSLOCATIONHISTOLOGICAL TYPERISK OF MALIGNANCYASSOCIATED LESIONSHyperplastic polypscolonHyperplastic colonic epithelial celssRareJuvenile polypsLarge and small intestine, stomachHamaomasrarePeutz jeghers syndromeJejunum(mainly)hamaomasrarePigmentation in the mouth.tumours of the ovary, breast, endometrium, and pancreas.NEOPLASTIC POLYPSTubular adenomatous polypsLarge and small intestine, stomachadenoma1-3%Villous adenomasLarge intestineadenoma40%Familial polyposis coliLarge intestineadenoma100%Gardner's syndromeLarge and small intestineadenoma100%Bone and soft tissue lesions, ampullary cancer, congenital hyperophy of pigment epitheliumTurcot's syndromeLarge intestineadenoma100%Brain tumors(Ref: Harrison's 18/e768,769,7770)


Question: Trinucleotide repeat sequence defect is not seen in

(B) Alzhiemer's disease # Alzheimer's disease (AD), also known simply as Alzheimer's, is a neurodegenerative disease that, in its most common form, is found in people over age 65. Approximately 24 million people worldwide have dementia of which the majority (-60%) is due to Alzheimer's.> The ultimate cause of Alzheimer's is unknown.> Genetic factors are clearly indicated as evidenced by dominant mutations in three different genes have been identified that account for the small number of cases of familial, early-onset AD.> For the more common form of late onset AD (LOAD), ApoE is the only clearly established susceptibility gene. All four genes can contain mutations or variants that confer increased risk for AD, but account for only 30% of the genetic picture of AD.> These four genes have in common the fact that mutations in each lead to the excessive accumulation in the brain of Ab, the main component of the senile plaques that litter the brains of AD patients> Huntington disease is caused by a defect in the gene (an inherited unit which contains a code for a protein) of unknown function called Huntington. The nucleotide codes (building blocks of genes arranged in a specific code which chemically forms into proteins), contain CAG repeats (40 or more of these repeat sequences).> The extra building blocks in the Huntington gene cause the protein that is made from it to contain an extra section as well. It is currently thought that this extra protein section, or portion, interacts with other proteins in brain cells where it occurs, and that this interaction ultimately leads to cell death.> The HD gene is a dominant gene, meaning that only one copy of it is needed to develop the disease. HD affects both males and females. The gene may be inherited from either parent, who will also be affected by the disease. A parent with the HD gene has a 50% chance of passing it on to each offspring. The chances of passing on the HD gene are not affected by the results of previous pregnancies.# Trinucleo Repeat Syndrome: Category I: Huntington disease and spinocerebellar ataxia Category II: Phenotypically diseases with expansions which all heterogenous small in magnitude but also found in exons of genes Category III: Fragile X syndrome, myotonic dystrophy, two of spirocerebellar ataxias, Juvenile myoclonic epilepsy, friedrich's ataxia. Have typically larger repeat expansions, located outside protein coding regions of genes.> Spinocerebellar ataxia type 2 is a minor cause of familial parkinsonism.


Question: Sinus Bradycardia is defined as hea rate of


Question: JVP wave with absent y descent and prominent X wave is seen in

JVP: the y descent is abolished due to an increase in intrapericardial pressure, preventing diastolic filling of the ventricles (cardiac tamponade causes an increase in both central venous pressure and pulmonary aery occlusion pressure). Cyanosis and pulmonary oedema may occur. Ref Davidson 23rd edition pg 334


Question: Hypotonia with brisk tendon reflexes are seen in

Ghai essential paediatrics 8th edition. *In hypotonic cerebral palsy despite pyramidal involvement patients are atonic or hypotonic. Tendon reflexes are normal or brisk and Babinski response is positive.


Question: Persistent priapism is due to

Ans. is 'a' i.e., Sickle cell anemia Priapism is defined as erection lasting for > 4 hours. Low-flow priapism may be due to any of the following: An excessive release of neurotransmitters Blockage of draining venules (eg, mechanical interference in sickle cell crisis, leukemia, or excessive use of intravenous parenteral lipids) Paralysis of the intrinsic detumescence mechanism Prolonged relaxation of the intracavernous smooth muscles (most often caused by the use of exogenous smooth-muscle relaxants such as injectable intra-cavernosal prostaglandin E I) Prolonged low-flow priapism leads to a painful ischemic state, which can cause fibrosis of the corporeal smooth muscle and cavernosal aery thrombosis. The degree of ischemia is a function of the number of emissary veins involved and the duration of occlusion


Question: A 12 years old girl with tremors and emotional liability has golden brown discolouration in escement's membrane. The most likely diagnosis


Question: The diagnosis of gout is best established by the presence of

Gout / Hyperuricemia Gout refers to the disease that occurs in response to the presence of monosodium urate (MSU) crystals in joints, bones, and soft tissues.Causes of GoutIncreased productionDecreased renal excretionHypoxanthine-guanine phosphoribosyltransferase (HGP) deficiencyPhosphoribosylpyrophosphate (PRPP) synthetase overactivityGlucose -6-phosphatase deficiencyMyeloproliferative disorderLymphoproliferative disorderMalignanciesHemolytic disorderPsoriasisObesityEthanol abuseExcessive dietary purine ingestionCytotoxic drugsInherited isolated renal tubular defectRenal failureLead poisoningDiabetic ketoacidosisLactic acidosisHypothyroidismDrugs- thiazides, pyrazinamide, cyclosporineClinical featuresDiagnosisAcute gout -ahritis ( MP joint of big toe), bursitis (olecranon bursa )Chronic gout - increase in frequency of acute gouty attacksTophi - collection of solid urate in connective tissues, irregular firm painless nontender nodules on extensor surfaces of finger, hand, and elbow.Polarizing microscopy - identification of monosodium urate crystals Histology - birefringent urate crystals on biopsy Elevated uric acid levels24-hour urinary uric acid excretion Radiology - narrowing of joint space, sclerosis, cysts, osteophytes & calcified tophi.Treatment:Acute attack - NSAIDsChronic stage - Allopurinol, Probenecid, benzbromarone Definitive diagnosis of gout requires aspiration of the involved joint and demonstration of intracellular monosodium urate crystals in synol fluid. Under polarized light, these are demonstrated as "strongly negative birefringent needle-shaped crystals."(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2836-2839)

Involvement of the first metatarsal phalangeal joint


Question: Drug of Choice for absence seizure in children < 3 years of age is

Answer- A. EthosuximideEthosuximide is the DOC for absence seizures in children below 3 years of age as Na valproate may cause fulminant hepatitis in children below 3 years of age. Broadly. Na valproate is the DOC for absence seizures.


Question: Commonest presentation of MEN I

Ans. a (Primary hyperparathyroidism) (Ref. H-17th/2359; 2361)# MEN1 is the most common multiple endocrine neoplasia syndrome.# Primary hyperparathyroidism is the most common manifestation of MEN1.# Parathyroid hyperplasia is the most common cause of hyperparathyroidism in MEN1.# Enteropancreatic tumors are the second most common manifestation of MEN1.# Gastrinomas are the most common enteropancreatic tumors observed in MEN 1.# Insulinomas are the second most common enteropancreatic tumors in patients who suffer from MEN 1.# MTC is the most common manifestation of MEN2A.MEN SYNDROMEMEN1 (Wermer's syndrome)MEN2Mixed SyndromesParathyroid hyperplasia or adenomaIslet cell hyperplasia, adenoma, or carcinomaPituitary hyperplasia or adenomaOther less common manifestations: foregut carcinoid, pheochromo- cytoma, subcutaneous or visceral lipomasMEN2AMTCPheochromocytomaParathyroid hyperplasia or adenomaMEN2A with cutaneous lichen amyloidosisMEN2A with Hirschsprung diseaseFamilial MTCMEN2BMTCPheochromocytomaMucosal and gastrointestinal neuromasMarfanoid featuresVon Hippel-Lindau syndromePheochromocytomaIslet cell tumorRenal cell carcinomaHemangioblastoma of central nervous systemRetinal angiomasNeurofibromatosis with features of MEN1 or 2Carney complexMyxomas of heart, skin, and breastSpotty cutaneous pigmentationTesticular, adrenal, and GH-producing pituitary tumorsPeripheral nerve schwannomas


Question: The following is an example of atypical antipsychotic

K.D Tripathy essentials of medical pharmacology 7th edition . *atypical antipsychotics are olanzapine,clozapine,risperidone,quetiapine,aripiprazole *haloperidol belongs to butyrophenones antipsychotic *amitriptyline is TCAs *zuclopenthixol belongs to thioxanthene antipsychotics.


Question: According to American Psychiatric Association, criteria for prolonged seizure after ECT, if the seizure lasts more than

Answer- D. 180 secProlonged seizure is defined as one that lasts for more than 3 minutes""Duration of more than 3 minutes is the criterion for prolonged seizures according to the American psychiatric association (1990)"


Question: Rheumatic activity involves mosfly......valves

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:147 Valve Involvement in Rheumatic Hea Disease Mitral valve alone 50% Aoic valve alone 15-20% Mitral and Aoic valves together 35-40% Mitral, Aoic and Tricuspid valves 2-3% Pulmonary valve is viually never involved. In RHD, mitral valve is most commonly involved followed by involvement of the aoic valve as the pressure gradient across the mitral valve is the greatest, followed by that across the aoic valve. So, the mitral valve is more susceptible to develop pathological changes than the aoic valve


Question: Risk factor for development of gastric Ca

Risk factors are:Long-term ingestion of high concentration of nitrates.H.pyloriIntestinal metaplasia in patients with atrophic gastritis.Gastric ulcers and adenomatous polyps.Menetrier's disease.Patients with blood group A have a higher incidence of Ca stomach than blood group O.Note: duodenal ulcers are not associated with gastric cancer.


Question: The vaccine currently used against hepatitis B infection is


Question: In MVP, you would expect the ejection click to be more accentuated and the murmur to move closer the first hea sound in a patient

Anxiety, with an increase in hea rate or decreasing venous return to the hea (standing), causes the click and murmur to occur earlier in systole (closer to S1). Lying down, squatting, sustained hand grip exercise, or passive leg lifting in the supine position increase venous return and cause the click and murmur to occur later in systole (less gravity and more venous return). The diagnosis is best made by echocardiography. -adrenergic blocking agents are frequently used for treatment of supraventricular tachycardias. Calcium channel blockers are also used in symptomatic cases. Ref - Harrison's internal medicine 20e pg 1821,1697

Who is passive leg lifting in the supine position


Question: A patient presents with a cavitatory lesion in right upper lobe of Lung. The best investigation is


Question: Reactivation of TB affects

Reactivation of TB tends to involve apical and  posterior segments of  upper Lobe and Superior segments of lower lobe.

Apical and posterior segments of  upper Lobe

Posterior and inferior segments of lower lobe


Question: Mill Wheel Murmur heard in case of

Mill WHEEL murmur: constant machine like sound, late sign, heard over precordium heard in cases of air embolism.


Question: Hypokalemia is defined as a plasma potassium concentration of

Hypokalemia, defined as a plasma K+ concentration of <3.5 mM, Hyperkalemia is defined as a plasma potassium level of 5.5 mM Ref: Harrison 19e pg: 305


Question: Extradural haemorrhage is due to

A. i.e. (Middle meningeal artery) (2597 - HI 7th)* Extradural (epidural) haemorrhageMiddle meningeal artery* Subdural haemorrhageSuperior cerebral artery vein* Sub arachnoid haemorrhageBerry aneurysm* Intracerebral haemorrhageHypertension* Contusions are easily visible on CT and MRI scans, appearing as in homogeneous hyperdensities On CT and as hyperintensities on MRI (2597 - HI7th).


Question: Most sensitive method for detecting low density microfilaraemia


Question: . Angloid streaks occur in

Angioid streaks are bilateral, narrow, irregular lines deep to the retina configured in a radiating fashion emanating from the optic disc, which result from breaks in a weakened Bruch's membrane. common associations is PEPSI: Pseudoxanthoma elasticum, Ehler-Danlos syndrome, Paget's disease of bone, Sickle cell disease and other hemoglobinopathies, Idiopathic. Ref Harrison20th edition pg 2456


Question: Most common cause of lung abscess

Ans. is 'b' i.e., Oral Anaerobes According to Harrison Most nonspecific lung abscesses are presumed to be due to anaerobic bacteria.


Question: Patient came with complaints of Polydipsia, hypercalciurea, nephrolithiasis, metabolic alkalosis. Possible cause is

Answer- A. Baters syndromeBater syndrome is an autosomal recessive disorder caused by mutation in gene coding for basolateral chloride channel (ClC-kb). There is loss of sodium, chloride, potassium and calcium in urine.The major clinical findings are hyponatremia, hypokalemia, polyurea, polydipsia, metabolic alkalosis, normal to lowBP, hypomagnesemia (only in some patients), hypochloremia, hypercalciuria (causing nephrocalcinosis), and growth


Question: 'C' wave in JVP is due to

Ans. is 'b' i.e., Tricuspid valve bulging into right atrium The Jugular venous pulse (JVP) reflects phasic pressure changes in the right atrium and it consists of three positive waves and two negative troughs.It will be useful to keep in mind the events of the cardiac cycle while evaluating Jugular venous pulse.JUGULAR VENOUS PULSE. a waveIt is the positive presystolic wave produced by right atrial contraction.x descenta wave is followed by the negative systolic wave the 'x' descent.The x descent is produced due to atrial relaxation Q.The atrial relaxation is produced as a result of ventricular contraction.c waveThe x descent is interrupted by second positive wave the 'c' wave.It is produced by bulging of the tricuspid valve into the right atrium Q during RV isovolumetric contraction.v waveIt is the positive systolic wave.It result from increase in the blood volume in the vena cava during systole, when the tricuspid valve is closed Q.y descentFollowing the "v wave" this is a negative descending limb referred to as the y descent or diastolic collapse Q.It is due to tricuspid valve opening and rapid inflow of blood into the right ventricle.So there areThree visible major positive waves (a, c and v) andTwo negative waves (x and y).


Question: Most common site of intracranial hemorrhage is

The most common locations of hypeensive ICH are: 1) Basal ganglia (putamen or caudate), 2) Thalamus, 3) Pons and 4) Cerebellum. Within the basal ganglia region, it is rare for an ICH to specifically affect one area; Ref Harrison20th edition pg 2334


Question: A crisis in a patient with sickle cell disease is most likely to be caused by

A crisis in sickle cell disease occurs when deoxygenated HbS precipitates, deforming (sickling) red blood cells and .blocking capillaries. Variables that increase the propoion of ofHbS in the "deoxy" state tend to increase the probability of a crisis by increasing the extent of sickling. The "deoxy" form of hemoglobin is ored by a decrease in pH (acidosis). An increase in pH (alkalosis), increased oxygen concentration, decreased CO2 concentration and decreased 2,3-bisphosphoglycerate concentration would all or the" oxy" form of hemoglobin. Ref - Harrison's internal medicine 20e pg 692-93


Question: The number of cafe au lait macules as one of the diagnostic criteria for adult neurofibromatosis is

Answer- D. 6l.5 cm orlarger in individuals past pubey0.5 cm or larger in individuals before pubey.


Question: Dose of streptokinase to be used in MI is

Ref Harrison 19 th ed pg 758 The adult dose of streptokinase for acute myocardial infraction is 1.5 million units IV over 60 minutes .


Question: Anticoagulant  used for osmotic fragility test

Heparin - osmotic fragility test.
EDTA - Blood cell counts.
3.2% trisodium citrate  - ESR, platelet studies.


Question: Carcinoid syndrome produces valvular disease primarily of the

Answer is B (Tricuspid valve); The most common site of involvement is the - Ventricular surface of Tricuspid valve. 'Cardiac manifestations in carcinoid syndrome are due to fibrosis involving the endocardium, primarily on the right side although left side lesions also occur. Dense fibrous deposits are most commonly on the ventricular aspect of the tricuspid valve and less commonly on the pulmonary valve cusps.' They can result in either constriction of valves (stenosis) or fixation of valves in open (regurgitation) - Abnormality produced due to tricuspid valve involvement - Tricuspid regurgitation Q - Abnormality produced due to pulmonary valve involvement - Pulmonary stenosis Q


Question: Perioperative respiratory failure is

TYPE III RESPIRATORY FAILUREThis form of respiratory failure results from lung atelectasis. Because atelectasis occurs so commonly in the perioperative period, this form is also called perioperative respiratory failure. After general anaesthesia, decreases in functional residual capacity lead to the collapse of dependent lung units. Such atelectasis can be treated by frequent changes in position, chest physiotherapy, upright positioning, and control of incisional and/or abdominal pain.Noninvasive positive-pressure ventilation may also be used to reverse regional atelectasis.Harrison 19e pg:1732


Question: Plasmapheresis is treatment of choice for


Question: Antibodies to calcium channel are seen in

Lambe-Eaton syndrome presents with proximal muscle weakness that improves with exercise & is caused by the development of antibodies to presynaptic calcium channels. Myasthenia gravis is autoimmune disease caused by the development of antibodies to postsynaptic acetylcholine receptors.Polymyositis & Dermatomyositis are related disorders that are characterised by an inflammatory process affecting skeletal muscle. In dermatomyositis,characteristic skin changes also occur. Davidson's Medicine-22nd edition,page no:272,1114,1226,1227


Question: Find the disease by analysing pedigree chart.

Rule of dominance - If the child is diseased, one of the parent must be diseased.
Rule of X-linked - Father never transmits to son.
In the image - Father transmits to son.
Crouzon syndrome is autosomal dominant.


Question: Lymphnode metastasis is seen with

Stages II and III soft tissue sarcoma They tend to grow and spread quickly. Some stage III tumors have already spread to nearby lymph nodes. Even when these sarcomas have not yet spread to lymph nodes, the risk of spread (to lymph nodes or distant sites) is very high Ref Harrison 20th edition pg 543