Question: Therapeutic hypothermia is of benefit in preventing neurological complications in

Ans. is 'c' i.e., Cardiac arrest Inducing mild therapeutic hypothermia in selected patients surviving out-of-hospital sudden cardiac arrest can significantly improve rates of long-term neurologically intact survival and may prove to be one of the impoant clinical advancements in the science of resuscitation. The types of medical events that hypothermic therapies may effectively treat fall into four primary categories: Cardiac arrest Ischemic stroke Trumatic brain or spinal cord injury without fever. Neurogenic fever following brain trauma


Question: Poal hypeension is defined as, hepatic venous pressure gradient (HVPG) greater than

Poal hypeension is defined as the elevation of the hepatic venous pressure gradient (HVPG) to >5 mmHg. Poal hypeension is caused by a combination of two simultaneously occurring hemodynamic processes: 1) Increased intrahepatic resistance to the passage of blood flow through the liver due to cirrhosis and regenerative nodules, and 2) Increased splanchnic blood flow secondary to vasodilation within the splanchnic vascular bed. Poal hypeension is directly responsible for the two major complications of cirrhosis: variceal haemorrhage and ascites.Ref: Harrison 19e pg: 2063


Question: Eaton Lambe syndrome is associated with

Lambe-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder characterized by muscle weakness of the limbs. In normal neuromuscular function, a nerve impulse is carried down the axon (the long projection of a nerve cell) from the spinal cord. At the nerve ending in the neuromuscular junction, where the impulse is transferred to the muscle cell, the nerve impulse leads to the opening of voltage-gated calcium channels (VGCC), the influx of calcium ions into the nerve terminal, and the calcium-dependent triggering of synaptic vesicle fusion with plasma membrane. These synaptic vesicles contain acetylcholine, which is released into the synaptic cleft and stimulates the acetylcholine receptors on the muscle. The muscle then contracts. In LEMS, antibodies against VGCC, paicularly the P/Q-type VGCC, decrease the amount of calcium that can enter the nerve ending, hence less acetylcholine can be released from the neuromuscular junction. Apa from skeletal muscle, the autonomic nervous system also requires acetylcholine neurotransmission; this explains the occurrence of autonomic symptoms in LEMSP/Q voltage-gated calcium channels are also found in the cerebellum, explaining why some experience problems with coordination. The antibodies bind paicularly to the pa of the receptor known as the "domain III S5-S6 linker peptide".Antibodies may also bind other VGCCs.Some have antibodies that bind synaptotagmin, the protein sensor for calcium-regulated vesicle fusion.Many people with LEMS, both with and without VGCC antibodies, have detectable antibodies against the M1 subtype of the acetylcholine receptor; their presence may paicipate in a lack of compensation for the weak calcium influx anti p/Q antibodies are produced against voltage gated channels mainly P/Q voltage gates Ref Harrison 20th edition pg 567


Question: Foramen spinosum transmits

(B) Middle meningeal artery > The foramen spinosum transmits the middle meningeal artery, the meningeal branch of the mandibular nerve (nervus spinesus) & the posterior trunk of the middle meningeal vein.> The foramen spinosum transmits the middle meningeal artery, the meningeal branch of the mandibular nerve (nervus spinesus) & the posterior trunk of the middle meningeal vein.


Question: Superior colliculus is concerned cells

The superior colliculus (SC) is a midbrain area where visual, auditory and somatosensory information are integrated to initiate motor commands. The SC plays a central role in visual information processing in the mouse; it receives projections from 85% to 90% of the retinal ganglion cells (RGCs). Ref Harrison20th edition pg 2345


Question: Basal exudates, infarcts and hydrocephalus are findings observed in Brain imagine studies. The most likely diagnosis is

Harrison's textbook of internal medicine 17th edition. *Imaging studies (MRI,CT scan) may show hydrocephalus and abnormal enhancement of basal cisterns or ependyma . *CT and MRI reveals contrast enhanced ring lesions ,but biopsy necessary to establish the diagnosis .


Question: Tubular breathing is seen in

Tubular or bronchial breath sounds is seen in lobar pneumonia or consolidation. Normally the breath sounds heard over the chest is vesicular. Reference : Davidson, 23rd Edition, page no :547.


Question: Most common cause of Fulminant hepatitis in pregnancy

Ans. (d) Hep ERef: Harrison 19th ed. /152e-2t, 0215* Most common cause of fulminant hepatitis in pregnancy is HEV* Most common cause of viral hepatitis in India overall = Hepatitis A* Most common cause of blood transfusion associated hepatitis =HCV* Most common viral hepatitis in India in children= HAV* Most common viral hepatitis in India in adults= HEV* Most common cause of FULMINANT hepatic failure= toxins> Hepatitis B>superinfection of Hep B


Question: Most common pulmonary manifestation in AIDS

Ans. is 'b' i.e., Pneumonia Respiratory complications in AIDS Respiratory diseases in AIDS include A) Acute bronchitis and sinusitis They are caused by S. pneumoniae and H influenzae and are very common. B) Pulmonary diseases Pulmonary diseases are :- 1. Pneumonia Most common pulmonary manifestation is pneumonia : Bacterial pneumonia : It is caused most commonly by S pneumoniae and pneumococcal infection is the earliest serious infection in AIDS. H influenzae is also a common cause. P canna pneumonia : It is the most common cause of pneumonia in AIDS. Risk is greater when CD4 count less than 200/ml. 2. Tuberculosis In developing countries like India, most impoant pathogen is M tuberculosis. Other common pathogen causing TB is MAC (atypical mycobacteria). 3. Other pulmonary diseases These are fungal infections (cryptococcus, histoplasma, aspergillus), neopasms (Kaposi sarcoma, lymphoma) and idiopathic interstitial pneumonia.


Question: For a definitive diagnosis of mental retardation reduced level of intellectual functioning should be seen along with

Reduced level of intellectual functioning resulting in diminished ability to adapt to the daily demands of the normal social environment as a diagnostic criteria in ICD, asks for IQ tests to be done with adaptive function assessment .


Question: Good syndrome is

Ans. is 'a' i.e., Thymoma with immunodeficiency Good's syndrome (thymoma with immunodeficiency) is a rare cause of combined B and T cell immunodeficiency in adults. Clinical features of Good's syndrome are :- Increased susceptibility to bacterial infections with encapsulated organisms and oppounistic viral and fungal infection. The most consistent immunological abnormalities are :- Hypogammaglobulinaemia and Reduced or absent B cells Treatment Resection of the thymoma and immunoglobulin replacement to maintain adequate through IgG values


Question: Acid secreting cells in stomach known as

B. i.e. (Parietal cells) (1857- HI7th)* Acid secreting parietal cell is located in the oxyntic gland, also secretes intrinsic factor* Parietal cell express receptors for several stimulants of acid secretion including histamine (H2), gastrin (cholecystokinin) and acetylcholine (Muscarinic M3)* Chief- cells found primarily in the gastric fundus**, synthesizes and secretes pepsinogen* Gut associated lymphoid tissue (GALT) is located in lamina propria**


Question: The commonest side effect of cisplatinum in a patient using it for esophageal carcinoma is


Question: In a person with ventricular tachycardia, extra systoles appear in

Extrasystoles are essentially extra beats, or contractions, which occur when there is electrical discharge from somewhere in the hea other than the SA node. Atrial extrasystoles may also be of little consequence but are exacerbated by alcohol and caffeine The P wave indicates atrial depolarizationp. Multiple abnormalities of the P wave are discussed in detail in ECG Reviews and Criteria. Atrial enlargements can widen the P wave or increase the P wave amplitude. Ectopic atrial rhythms( ventricular tachycardia) dampens of the normal morphology of P waves Ref Harrison 20th edition pg 1456


Question: Single most common finding in Aphasic Patients

*A deficit of naming (anomia) is the single most common finding in aphasic patients. The persistent inability to find the correct word is known as anomia (literally, 'without names'). Anomia is actually a symptom of all forms of aphasia, but patients whose primary language problem is word retrieval are diagnosed as having anomic aphasia. Ref Harrison20th edition pg 2234


Question: The most common causative organism for lobar pneumonia Is


Question: Drug Not used in pulmonary hypertension


Question: Elevated serum ferritin, decreased serum iron and % transferring saturation are most consistent with the diagnosis of

Answer is C (Anemia of chronic disease) Decreased Serum Iron Levels, Decreased Transferrin Saturation and Increased Serum Ferritin Levels are typical features of Anemia of Chronic Disease.


Question: The maximum concentration of potassium delivered central line is

In adults, the preferred concentration central line is 20 mEq/100 ml. The maximum concentration for fluid restricted patients is 20 mEq/50 ml. Ref Davidson 23rd edition pg 345


Question: RHD diagnostic criteria include

Erythema marginatum is a cutaneous finding associated with acute rheumatic fever. The lesions typically develop 7 days to months after the onset of the streptococcal pharyngitis or, rarely, streptococcal skin infections. Erythema marginatum occurs in about 10% cases of acute rheumatic fever. Jones criteria is used for diagnosis of rheumatic fever . Its shown in the following picture Ref Davidson edition23rd pg 532


Question: Commonest site of lytic lesion, in multiple myeloma is

Answer is A (Veebral column) The commonest site of involvement in multiple myeloma is veebral column. Although any bone may be involved, the following order of involvement is most often seen. Veebral column (66%) > Ribs (44%) > Skull(41%)> pelvis (28%)>frinur (24%) > clavicle(10%) > scapula(10%)


Question: Total lung capacity is not increased in

Ans: d (ILD)Ref: Harrison, 17th ed. pg. 1646ILD is a restrictive lung disease characterized by decrease in both total lung capacity as well as residual volume.ParameterObstructive lung diseaseRestrictive lung diseaseTotal lung capacityNormal to IncreaseDecreasesResidual volume VitalIncreasesDecreasescapacity FEV,/FVCDecreasesDecreases(FEV%) FEF 25-75%DecreasesNormal to(Forced expiratory flowDecreases NormalIncreaserate) Diffusion capacity(Decrease in emphysema)Normal DecreasedOut of the four options given, shigellosis is the single best answer of exclusion:Shigellosis clinical manifestations:* Incubation period 1 - 4 days* Diarrhoeal phase - fever, vomiting, tenesmus, watery diarrhoea* Dysenteric phase - small volume bloody mucopurulent stools , acute colitis* Post infectious phaseComplications:* Intestinal - toxic megacolon, intestinal perforation, rectal prolapsed* Metabolic - dehydration, hyponatraemia, hypoglycaemia* HUS - ARF occurs in 55-70 % cases* Ekiri syndrome - toxic encephalopathy associated with abnormal posturing, cerebral oedema, fatty degeneration of viscera, in Japanese children.* Reiter's syndromeBridge:* Shiga toxin by shigella dystentriae type 1 causes HUS* Shigella flexneri causes Reiter's syndromePlease go through Table viral haemorrhagic fevers in Davidson pg. 230 and make your facts clear.Viral fevers with hepatorenal dysfunction:1. Yellow fever2. Dengue fever3. Ebola fever4. Crimean congo haemorrhagic fever5. Hantaan feverPlasmodium falciparum clinical features :Neuro - Coma, seizure, opisthotonus, cranial nerve palsies CVS - Shock , cardiac failure (algid malaria )Renal - ARF, haemoglobinuria Liver - Jaundice, hepatitis Resp - Pulmonary edema


Question: Blood flow in hemodialysis machine

Blood flow - 300-500 ml/min.
Dialysate - 500-800 ml/min in opposite direction.


Question: A female has episodic, recurrent headache in left hemicranium with nausea and parasthesia on right upper and lower limbs is most probably suffering from

Ans. is 'a' i.e Migraine A female giving above mentioned symptoms is most probably suffering from migraine (classical migraine with Aura)migraine headache has the following characteristicsUnilateral locationPulsating qualitiesModerate or severe intensityFrontotemporal in locationAggravation by walking, climbing stairs or similar routine physical activityDuring headache at least one of the followingNausea or VomitingPhotophobia and phonophobiaIf the headache occurs in association with Aura then it is a classical migraine with Aura.Aura usually consists of Homonymous visual disturbance, hemiparesis, Hemisensory symptoms, Dysphasias or any combination of these symptoms.visual aura is most common and usually consists of photopsia & scintillation.sometimes basilar migraine in which headache is accompanied by brainstem symptoms.Glossopharyngeal neuralgiaThe patient gets brief attack of lancinating pain in the side of the throat radiating down the side of the neck, the back of the lower jaw and deep towards the inner ear. The attacks are precipitated by protruding or swallowing the tongue.Post herpetic trigeminal pain - Usually distinguished by h/o of zoster & residual scars, constant quality of pain over the distribution of the trigeminal nerve and sometimes sensory impairment over involved area.Brain tumour - May present with prostrating pounding headache that is associated with nausea & Vomiting. It is usually difficult to distinguish headache of migraine from brain tumour.

Herpes zoster infection of trigeminal Nerve


Question: Complications of lobar pneumonia do not include

Common complications of severe CAP include respiratory failure,shock and multiorgan failure,coagulopathy,and exacerbation of comorbid illnesses.Three paicularly notewohy conditions are metastatic infection,lung abscess,and complicated pleural effusion.Metastatic infection can lead to brain abscess,suppurative ahritis, or infective endocarditis. Reference:Harrison' s Medicine-18th edition,page no:2136 .


Question: A man presented with right sided moderate size pneumothorax without tension, Physical finding present as

Ans A (Ipsilateral chest with bulge)Patients with small pneumothorax findings are:Decreased breath soundsDecreased vocal fremitusResonant percussion noteLarger pneumothrax:Tachypnea and distressBulge of affected hemithoraxImmobile during respirationVery large pneumothorax under tension:Severe respiratory distress DiaphoresisCyanosis HypotensionTraumatic pneumothorax:Subcutaneous emphysema


Question: Intra aerial thrombolysis is indicated in

Answer- A. Suspected occlusion of larger aeryAcute ischemic stroke < 6 hours in durationStroke is significant, (i.e., disabling or life threatening)Suspected occlusion of a large aery (i.e., non-lacunar stroke syndrome)No hemorrhage on screening computed tomography scan


Question: Modified wells criteria is used for initial assessment of patients with suspected


Question: The most common toxin causing dilated cardiomyopathy is

Ref Harrison 19 th ed pg 1558 Toxic 1.Alcohol 2.Catecholamin: amphetamines, cocaine 3.3.Chemotherapeut agents (anthracyclines, trastuzumab) 4.Interferon 5.Other therapeutic agents (hydroxychloroquine, chloroquine)6.Dru of misuse (emetine, anabolic steroids) 7. metals: lead, mercury Occupational exposure: hydrocarbons, arsenicals.


Question: Cause of metabolic alkalosis includes

Causes of Metabolic Alkalosis I. Exogenous HCO3-loads A. Acute alkali administration B. Milk-alkali syndrome II. Effective ECFV contraction, normotension, K+ deficiency, and secondary hyperreninemic hyperaldosteronism A. Gastrointestinal origin 1. Vomiting 2. Gastric aspiration 3. Congenital chloridorrhea 4. Villous adenoma B. Renal origin 1. Diuretics 2. Posthypercapnic state 3. Hypercalcemia/hypoparathyroidism 4. Recovery from lactic acidosis or ketoacidosis 5. Nonreabsorbable anions including penicillin, carbenicillin 6. Mg2+ deficiency 7. K+ depletion 8. Bater's syndrome (loss of function mutations of transpoers and ion channels in TALH) 9. Gitelman's syndrome (loss of function mutation in Na+-Cl-cotranspoer in DCT) III. ECFV expansion, hypeension, K+ deficiency, and mineralocoicoid excess A. High renin 1. Renal aery stenosis 2. Accelerated hypeension 3. Renin-secreting tumor 4. Estrogen therapy B. Low renin 1. Primary aldosteronism a. Adenoma b. Hyperplasia c. Carcinoma 2. Adrenal enzyme defects a. 11b-Hydroxylase deficiency b. 17a-Hydroxylase deficiency 3. Cushing's syndrome or disease 4. Other a. Licorice b. Carbenoxolone c. Chewer's tobacco IV. Gain-of-function mutation of renal sodium channel with ECFV expansion, hypeension, K+ deficiency, and hyporeninemic-hypoaldosteronism A. Liddle's syndrome


Question: Cranial nerve most commonly involved in posterior communicating aery aneurysm is

. *a third nerve palsy may be present due to local pressure from an aneurysm of the posterior communicating aery. Ref Harrison20th edition pg 2456


Question: Spontaneous pneumothorax is seen ina) Smokersb) Male sexc) Exercised) Short stature


Question: Herpes zoster infection can lead to

Ans. is 'd' i.e., Occipital neuralgia Herpes simplex infection has a prediliction for the involvement of Temporal lobe. The lesions in HSV encephalitis are intense hemorrhagic necrosis of the inferior and medial temporal lobe and the mediorbital pa of frontal lobes. The temporal lobe lesions are usually b/L but not symmetrical. The distribution of the lesion is so characteristic that the diagnosis can be made by gross inspection or by their location and appearance on imaging studies. In the acute stages of the disease, intranuclear eosinophilic inclusions are found in neurons and glial cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis C.S.F examination. Increased C.S.F pressure. Pleocytosis, cells are mostly lymphocytes. Red cells sometimes numbering in thousands and xantho chromia are found reflecting the hemorrhagic nature of the brain lesions. Protein content is increased in most cases. Slight reduction


Question: Most common cause of aplastic anemia is

Aplastic anemia is pancytopenia with bone marrow hypocellularity. Acquired aplastic anemia is distinguished from iatrogenic aplasia, marrow hypocellularity after intensive cytotoxic chemotherapy for cancer, and from usually accidental physical and chemical injury, as in radiation poisoning. Most cases of aplastic anemia are idiopathic, little other than history separates these cases from those with a presumed etiology such as a drug exposure. ref - Harrisons internal medicine 20e pg 724


Question: Most common cause of Papillary necrosis is

Major causes of Papillary Necrosis1. Analgesic nephropathy2. Sickle cell nephropathy3. Diabetes with UTI4. Prolonged NSAID use Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 340; Tubulointerstitial Diseases of the Kidney


Question: Cyclosporine inducced HTN is treated by   a)  Clonidine  b) Enalapril   c) Nifedipine   d) Methyl dopa


Question: A CKD patient is having protracted vomiting episodes. pH=7.42, pC02= 40, HCO3= 25, Na= 140mEq, Chloride= 95mEq and HCO3= 25mEq. Comment on the diagnosis.

CKD - M. acidosis Vomiting - M. alkalosis (| Aldosterone) Anion gap = Na+ - (Cl-+ HCO3-) = 140 - (95 + 25) = 140 - 120 High anion gap = 20 meq

Metabolic acidosis and metabolic alkalosis

Metabolic acidosis and compensated respiratory alkalosis

Metabolic acidosis and respiratory acidosis

Normal ABG repo with normal electrolytes


Question: Calculate water deficit for 50 kg male with Na=160 meg

Ans. is 'b' i.e., 2.9L half normal saline


Question: Most common cause of precipitation of renal failure in multiple myeloma is

(C) Hypercalcaemia # Renal failure is seen in 25% patients and hypercalcaemia is the most common cause of renal failure.> Quite often renal failure develops rapidly even at an unchanged ratio of production and serum concentration of light chains. Various factors can favour renal cast formation in myeloma patients. Dehydration, sometimes due to diuretics, reduces the glomerular filtaration rate (GFR) and causes an increase in the plasma concentration of light chains which then exceeds the capacity for reabsorption and catabolism of light chains in the proximal tubuli.> Hypercalcaemia may induce vasoconstriction followed by a decrease in GFR. Several drugs, in particular non- steroidal anti-inflammatory agents (NSAIDs), reduce renal blood flow. Radiographic contrast agents may induce acute renal failure in myeloma patients, particularly if patients are dehydrated and ionic contrast media are used.> The osteoclasts respond to osteoclast activating factors (OAF) made by the myeloma cells . leading to hypercaicaemia. Renal failure occurs in nearly 25% of myeloma patients, and some renal pathology is noted in over half. Hypercalcemia is the most common cause of renal failure. Glomerular deposits of amyloid, hyperuricemia, recurrent infections, and occasional infiltration of the kidney by myeloma cells all may contribute to renal dysfunction. However, tubular damage associated with the excretion of light chains is almost always present. Normally, light chains are filtered, reabsorbed in the tubules, and catabolized. With the increase in the amount of light chains presented to the tubule, the tubular cells become overloaded with these proteins, and tubular damage results either directly from light chain toxic effects or indirectly from the release of intracellular lysosomal enzymes. The earliest manifestation of this tubular damage is the adult Fanconi syndrome (a type 2 proximal renal tubular acidosis), with loss of glucose and amino acids, as well as defects in the ability of the kidney to acidify and concentrate the urine. The proteinuria is not accompanied by hypertension, and the protein is nearly all light chains. Generally, very little albumin is in the urine because glomerular function is usually normal.


Question: Colour coding for Nitrous oxide cylinder is

(C) French blue IDENTIFICATION OF MEDICAL GAS CYLINDERSGasColor of cylinderPressure at 15degC when full British standard (Body/Shoulder)United StatesLbf/in2Bar1. Oxygen (O2)Black / WhiteGreen19871372. Nitrous oxide (N2O)French blueBlue638443. CyclopropaneOrangeOrange7354. Carbondioxide (CO2)GreyGrey725505. Helium (He)BrownBrown19871376. AirGreyYellow19871377. O^HeliumBlackGreen/Brown19871378. OJC02BlackGreen/Grey19871379. EntonoxBlueBlue/Green1987137


Question: Van den Berg test for


Question: Treatment for multiple sclerosis

Beta interferons. These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses Interferon alpha is used to treat various cancers (e.g., leukemia, melanoma, AIDS-related Kaposi's sarcoma). It is also used to treat virus infections Interferon-g 1b is approved by the U.S. Food and Drug Administration to treat chronic granulomatous disease and osteoporosis This medication is used to treat ceain types of ahritis (rheumatoid ahritis, ahritis of the spine, psoriatic ahritis), ceain bowel diseases (Crohn's disease, ulcerative colitis), and a ceain severe skin disease (chronic plaque psoriasis). Ref Harrison20th edition pg 2345


Question: Association of deafness & nephritis is seen in

Answer is B (Alpo's syndrome): Alpo's syndrome is an inherited disorder characterized by hereditary nephritis, sensorineural deafness and ocular abnormalities paicularly lenticonus.


Question: Hyaline casts are seen in

Hyaline casts
Normal urine , Febrile disease, diuretics thereapy, prerenal azotemia.


Question: Hemangioblastoma associated with VHL are most commonly seen in

Answer is A (Cerebellum) Hemangioblastomas associated with Von-Hippel-Lindau Disease are most commonly seen in the cerebellum. The hallmark lesion of Von-Hippel-Lindau (VHL) disease is the hemangioblastoma. These are most commonly seen in the cerebellum but occasionally seen in the medulla oblongata (most common brainstem site), spinal cord and supratentorially in the optic nerves and cerebral hemispheres' - MR1 of the Brain and spine (Lippincott). 'The most common CNS manifestation of VHL is the charachteristic cerebellar hemangioblastoma. Approximately 6080% of VHL patients ultimately develop a CNS Hemangioblastoma. Three quaers of these are cerebellar in location with the majority of the remaining hemangioblastomas located in the spinal cord. Hemangioblastomas of the cerebral hemisphere account for only a small minority of lesions '


Question: Most common cause of acute polyneuropathy is

(B) Guillian Barre syndrome # Myocarditis & Polyneuropathy are the prominent toxic manifestations of diphtheria. The risk of each is proportional to the severity of local disease.> Polyneuropathy typically begins 3 to 5 weeks after onset of diphtheria and has a slow course. It appears earliest in patients who experience the most severe and prolonged neurologic abnormalities. Guillain-Barre syndrome (GBS) sometimes called Landry's paralysis, is an acute inflammatory demyelinating polyneuropathy (AIDP), a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom. It can cause life-threatening complications, particularly if the breathing muscles are affected or if there is dysfunction of the autonomic nervous system. The disease is usually triggered by an acute infection. Guillain-Barre syndrome is a form of peripheral neuropathy. Rarely in Sarcoidosis, multiple lesions occur that mimic multiple sclerosis, spinal cord abnormalities, and peripheral neuropathy. Charcot-Marie-Tooth disease type 1, also known as hereditary motor sensory neuropathy type 1, is an uncommon autosomal dominant disease that causes destruction of peripheral nerves with a varied clinical course, but often leads to muscle weakness. If the peroneal muscle is involved, the patient may develop a characteristic slapping gait.


Question: 'a' wave is absent in

(A) # 'a' wave of JVP: Due to right atrial contraction Synchronous with carotid artery pulse> Absent 'a' wave: Atrial fibrillation> Diminished 'a' wave: Tachycardia; Prolonged PR interval> 'a' Wave Fused with 'c' Wave: Supra ventricular tachycardia> Large 'a' Waves: Pulmonary hypertension Pulmonary stenosis; Tricuspid stenosis Tricuspid atresia; AV dissociation> Cannon Waves (Giant 'a' Waves): Complete heart block when right atrium occasionally contracts against closed tricuspid valve Ventricular tachycardia; Ectopic beats


Question: Appendicectomy is protective in

There is a protective effect of the previous appendectomy with confirmed appendicitis (reduction of 13-26%), paicularly at a young age, on the development of UCRef: Harrison 19e pg: 1947


Question: Treatment of tetanus is

If possible, the entry wound should be identified, cleaned, and debrided of necrotic material in order to remove anaerobic foci of infection and prevent fuher toxin production. Metronidazole (400 mg rectally or 500 mg IV every 6 h for 7 days) is the preferred antibiotic. An alternative is penicillin (100,000-200,000 IU/kg per day), although this drug theoretically may exacerbate spasms. (Harrison's Principles of internal medicine,20th edition, page 1199)


Question: Skip granulomatous lesions are seen in

Ans. is 'b' i.e., Crohn's disease Skip lesions are characteristic of Crohn's disease. This pt. is suffering with Crohn's ds. The characterstics of Crohn's ds and their comparison with Ulcerative colitis are given --> Once you know them the answer becomes obvious


Question: A patient presents with B/L proptosis, heat intolerance and palpitations; most unlikely diagnosis here would be

Answer is D (Reidel's thyroiditis) : Reidel's thyroiditis is usually a consistently hypothyroid condition. The patient in the given question is presenting with symptoms of Hypehyroidism. The condition, most unlikely to produce the picture is the one where hypehyroidism is not a feature, not even transient. Reidel's thyroiditis is one such consistently hypothyroid condition. Thyrotoxicosis is usual with thyroid adenoma and diffuse thyroid goitre and Hashimoto's thyroiditis can present with transient hypehyroidism. Hashimoto's Thyroiditis (Auto immune): In this variant, mild hypehyroidism may be present initially, although hypothyroidism is inevitable. Hypothyroidism may develop rapidly or extremely slowly. The initial phase of hypehyroidism may account for the symptoms in the given patient. Thyroid adenoma, diffuse toxic goitre or Grave's disease, toxic nodular goitre, toxic nodule: All are causes of thyrotoxicosis & explain the symptoms of thyrotoxicosis in the above patient. 733/L&B Riedle's thyroiditis is a very rare disease wherein , the thyroid tissue is replaced by cellular fibrous tissue. The goitre may be unilateral or bilateral & is very hard and fixed. This condition presents with features of hypothyroidism. Hypehyroidism is not manifested, not even transiently. The differential diagnosis is from an anaplastic carcinoma & can be made with ceainity only by biopsy. Diffuse thyroid goitre :Most commonly presents with a euthyroid status however patients may present with hypehyroidism.


Question: Conn's syndrome is characterized by diastolic hypeension without edema.

Answer is A Excess Aldosterone is associated with Hypokalemia and not Hyperkalemia.


Question: The single most common feature in Aphasic patients is

(C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network.


Question: Nail and half nail sign, seen in uremia is

Ans. is 'b' i.e. Increased capillary density at the distal half of nails Half and Half nail are characterized by a band in the midportion of the nail separating the darker distal portion from the proximal white portion. They are a common occurrence in renal failure and are seen in l/3rd patients of renal failure.Pathophysiology of Half and half nailThey are also called Lindsay's nailTheir pathogenesis is not clearly understood.Two mechanisms have been proposed.increased melanin depositionthe proximal half of the nail appears white because of the edema associated with dilated capillary network According to Oxford text book of clinical nephrology 2nd/e chapter 11.3.11. "The so called "half-and half nail" in typical of uremia the distal portion of each nail bed is red, pink or brown, occupies 20-60 percent of the total nail length, and always sharply demarcated, the proximal portion has dull whitish ground glass appearance.When pressure is applied, the discoloration does not fade completely. This change can affect single nails, or all the nails, or all the nails of the hand or feet or both. Half and half nail often begins before dialysis. It occurs in 15-50% of patients on regular dialysis.The histology of the nail plate itself shows no change and it contains no melanin, the number of capillaries under the nail plate is increased, with remarkable thickening of the capillary walls.The increase in capillary density of the nail bed might account for the band.The disorder in probably partially reversible. In some patients a lightening of the colour and a decrease in the width of the brown are have been seen after months of observation


Question: Amongst various current criteria for FUO (Fever of Unknown origin), one relates to body temperature =

Ans. d (101deg F). (Ref: Harrison's 17th edition, P. 130).PUO/FUO# Petersdorf and Beeson (1961)# Temperature > 101deg F (38.3degF) on several occasions# Duration of fever > 3 weeks# Failure to reach diagnosis despite inpatient investigations for 1 week.Also Remember:Neutropenic FUO# Neutrophil count < 500/cmmHIV Associated FUO# Duration of fever >4 weeks# And inpatient investigation with failure to reach diagnosis is > 3 daysMost common cause of PUO# Infection (26%) -m/c extrapulmonary TBMost common cause of PUO in elderly# Multisystem disease (Giant cell artheritis)Undiagnosed Cause for FUO# 25-30Malignancies associated with FUO# Ca colon (most common cause)# Hepatoma# Gall bladder Ca# Lymphoma, leukemia# Pancreatic cancer# Renal cell cancer# Sarcoma# Atrial myxoma# Renal angiomyoliposa


Question: Adenoma sebaceum is seen in

i.e. (Tuberous sclerosis): (96Q-CMDT-11) (1798 -1000-H17th)* Adenoma sebaceum subungual fibromas, shagreen patches (leathery plaques of subepidermal fibrosis) and leaf shaped hypopigmented spots - cutaneous abnormalities seen in TUBEROUS - SCLEROSIS* Renal abnormalities includes - Renal cysts, Angiolipomas, Renal cell carcinoma***TUBEROUS - SCLEROSIS* TS - is an Autosomal dominant inheritance* *** Mutations that inactivating in either the TSCJ gene encoding tuberin or the TSC2 gene encoding hamartin* CNS hamartomas can cause seizures, mental retardation and autism* Associated abnormalities includes - retinal lesions, benign rhabdomyomas of the heart, lung cysts, benign tumours in the viscera and bone cysts* Classical Triad -(i) Seizures(ii) Mental retardation(iii) Adenoma sebacium* The characteristic brain lesion is a "Cortical Tuber" The most common neurological manifestations include seizures, cognitive impairment and behavioral abnormalities including autism


Question: The commonest cause of chronic renal failure is

Commonest cause of chronic renal failure is pyelonephritis.


Question: Pariaeriole space is formed in spleen by

Lymphocytes that aggregate around the central aery (mostly T-lymphocytes) create the periaerial lymphatic sheath(ref:Gray's Anatomy 40/e p1194)


Question: Water brash is a classic symptom of

Water brash is excessive salivation resulting from a vagal reflex triggered by acidification of the esophageal mucosa. This is not a common symptom. Afflicted individuals will describe the unpleasant sensation of the mouth rapidly filling with salty thin fluid, often in the setting of concomitant heaburn.When classic symptoms of gastroesophageal reflux are present, such as water brash and substernal heaburn, presumptive diagnosis andempirical treatment is often sufficient.Ref: Harrison; 19th edition; Page no: 1901


Question: Most accurate, inexpensive, noninvasive, simpler test of Helicobacter pylori

(C) Urea breath test TESTS COMMONLY USED TO DETECT H. PYLORI:NoninvasiveSerologyInexpensive & convenientCannot be used for early follow-up; some commercial kits inaccurate13C or14C urea breath testInexpensive and simpler than endoscopy; useful for follow-up after treatmentLow-dose irradiation in 14C testStool antigen testInexpensive and convenient; useful for follow-up after treatment; may be useful in childrenNew test; role not fully established; appears less accurate than urea breath test


Question: impaired function of aquorporin results in


Question: Elevated JVP is seen in


Question: Gelastic seizure is a

(A) Laughing epilepsy # Gelastic seizure or "Gelastic epilepsy" is a rare type of seizure that involves a sudden burst of energy, usually in the form of laughing or crying. This syndrome usually occurs for no obvious reason and is uncontrollable. It is slightly more common in males than females.> Term Gelastic originates from the Greek word "Gelos" which means laughter. The main sign of a gelastic seizure is a sudden outhurst of laughter or crying with no apparent cause. The laughter may sound unpleasant and sardonic rather than joyful. The outburst usually lasts for less than a minute.> During or shortly after a seizure, an individual might display some twitching, strange eye movements, lip smacking, fidgeting or mumbling. If a person of who suffers from the seizures is hooked up to an electroencephalogram it will reveal interictal epileptic discharges.> A gelastic seizure is typically caused by a hypothalamic hamartomas, or a brain tumor.> Gelastic seizures are not responsive to therapy. They can produce secondary seizure characteristics which may respond to medications or surgery.


Question: Gestational hypehyroidism occurs due to

A common cause of overactive thyroid in pregnant women is Graves' disease. This disease occurs when your immune system becomes overactive and forms antibodies (immune proteins) that attack the thyroid. This causes the gland to enlarge and make too much thyroid hormone. Most women with Graves' disease find out they have it and get treatment before they become pregnant. Women with severe nausea and vomiting or those expecting twins may develop temporary hypehyroidism. Called transient gestational thyrotoxicosis, this hypehyroidism is due to high levels of a pregnancy hormone called human chorionic gonadotropin or hCG. Because it resolves by week 14 to 18 of pregnancy, women do not need antithyroid drugs to treat this condition. Ref - pubmed.com


Question: Stroke prevention

(C) Warfarin# MEDICATIONS for TIA/STROKE PREVENTION> Anti-platelet medications:> Anti-platelet medications used to prevent and reduce the risk of stroke include: Aspirin; Aspirin/extended-release dipyridamole; Clopidogrel; Ticlopidine> Aspirin is the most commonly used preventive therapy for patients at risk for stroke. However, at least 10 percent of patients are unable to take aspirin long-term, usually due to stomach problems.> Anticoagulant medication: that is usually prescribed to reduce the risk of stroke is warfarin. Warfarin usually is prescribed in patients with atrial fibrillation and other cardiovascular disorders to reduce the risk of stroke. If you are in the hospital, heparin is an anticoagulant that may be given intravenously. Anticoagulants can also be injected into the skin to prevent clots in the legs. Such clots can form when patients are on bed rest.> Anticoagulants decrease the blood's ability to clot and prevent the formation of additional clots. If you are prescribed an anticoagulant, your follow-up will include frequent blood tests so your response to the medication can be monitored.> Treatment for acute (sudden onset) stroke is the administration of a thrombolytic agent, or "clot buster," including streptokinase or streptase and tissue plasminogen activator (TPA).> These medications can dissolve the blockage within the artery to restore blood flow to the brain. They must be given within the first three hours of the onset of stroke symptoms and are usually given in a hospital where the patient can be closely monitored. The risk, however, is bleeding into the brain, which can worsen the disability. Patients need to be carefully screened and evaluated before and after thrombolytic treatment.


Question: Pleural effusion, in standing position gravitates n the region of

i.e. (Costodiaphragmatic recess: (1658-66 - H17th) (306-8-CMDT-l1)* Most dependent recess of the pleura is the posterior costophrenic angle**. So in pleural effusion this recess would be filled earliest. But at least 100-200 ml of fluid. Would be required to fill this recess before it can be defected on a PA view* The lung is less dense than water and floates on pleural fluid that accumulates in dependent regions* Sub pulmonary fluid may appear as lateral displacement of the apex of the diaphragm with an abrupt slop to the costophrenic sulcus or a greater than 2 cm seperation between the gastric air bubble and the lung.* On a standard upright chest radiograph approximately 75-100 ml of pleural fluid must accumulate in the posterior costophrenic sulcus to the visible on the lateral view and 175-200 ml must be present in the lateral costophrenic sulcus to be visible on he frontal view (307-CMDT-l 1)* Best method to defect minimal pleural effusion decubitus view with a horizontal beam*** Most common cause of pleural effusion is LVF* Most common cause of an exudative pleural effusion developing countries TuberculosisCriteria of Exudative pleural effusion1. Pleural fluid protein / serum protein > 0.52. Pleural fluid LDH / serum LDH >0.63. Pleural fluid more than two thirds normal upper limit for serumCauses of Transudative Pleural Effusion 1. CHF (>90% of cases)2. Cirrhosis with ascitis3. Pulmonary embolization4. Nephrotic syndrome5. Peritoneal dialysis6. SVC obstruction7. Myxedema8. Urinothorax9. Constrictive pericarditis10. Atelectasis (Acute)Chest CT scan may identify as little as 10 ml of fluid


Question: According to CDC, past smoker is

Person who had smoked >100 cigarettes previously and is not smoking currently

Person who has smoked >10 cigarettes previously and is not smoking currently

Person who has smoked >100 cigarettes previously and  reduces to 10 cigarettes per day

Person who has smoked > 100 cigarettes in his or her lifetime, who smokes now, but does not smoke every day


Question: Low serum iron and low serum ferritin is seen in

Low serum iron is seen in iron deficiency anemia. Serum iron will be also low in case of anemia of chronic diseases and also in case of malabsorption, pregnancy and in pubey where the demand increases. Serum ferritin is a measure of iron stores and is the best single test to confirm iron deficiency. Reference : Davidson, 23rd Edition, page no : 941.


Question: Hyperventilation can provoke the following

The electrophysiologic hallmark of typical absence seizures is a generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background.In tonic-clonic seizures, The EEG during the tonic phase of the seizure shows a progressive increase in generalized low-voltage fast activity, followed by generalized high-amplitude, polyspike discharges. In the clonic phase, the high-amplitude activity is typically interrupted by slow waves to create a spike-and-wave pattern. The postictal EEG shows diffuse slowing that gradually recovers as the patient awakens.Hyperventilation tends to provoke these electrographic discharges and even the seizures themselves and is routinely used when recording the EEG.Ref: Harrison 19e 2543


Question: A patient on amphotericin emia of

Ans. d. 120-160 mEq over 24 hours Except in unusual circumstances, the total amount of potassium administered daily should not exceed 200 mEq. Potassium Supplementation A prudent protocol to follow is to add potassium chloride to IV solutions at a final concentration of 40-60 mEq/L and to administer no more than 10-20 mEq/L of potassium per hour Except in unusual circumstances, the total amount of potassium administered daily should not exceed 200 mEq. IV potassium replacement is indicated for patients with severe hypokalemia and for those who can not take oral supplementation. For severe deficiency, potassium may be given through a peripheral IV line in a concentration that should exceed 40 mEq/L, at the rates upto 40 mEq/L/Hour. Continuous ECG monitoring is indicated and the serum potassium levels should be checked every 3-6 hours. For the initial administration, avoid glucose containing fluid to prevent fuher shift of potassium intothe cells. . Magnesium deficiency also needs to be corrected at the same time, paicularly in refractory hypokalemia


Question: Calcium homeostasis disturbance is seen in


Question: Lisch Nodules are seen

Harrison's principles of internal medicine 17 th edition. *Multiple neurofibromas usually in combination with 6 or more CALM measuring>1.5 cm, axillary freckling and multiple Lisch nodules are seen in NF type 1.


Question: In Budd chiary syndrome , the site of venous thrombosis is

i.e. (Hepatic veins): (673-CMDT-ll) (661, 733, 1945, 1950 H17th)Budd chiary syndrome is characterized by post sinusoidal obstruction outside the liver at the level of hepatic veinsFactors that predispose to hepatic vein thrombosis (Budd chiary syndrome)* Polycythemia vera** or other myeloproliferative disease* Activated protein C resistance (factor V Leiden mutation)* Protein C or S or antithrombin deficiency*** Hyper prothrombinemia (factor 11 G 20210 A mutation)* Methylenetetra hydrofolate reductase TT 677 mutation,* Antiphospholipid antibodies* Caval webs, right sided heart failure or constrictive pericarditis, neoplasm.* Paroxysmal nocturnal hemoglobinuria, Behcet's syndrome, blunt abdominal trauma, use of oral contraceptives** and pregnancy* Some cytotoxic agents (cyclophosphamide, azathioprine, carmustine, busulfan or etoposide) and pyrrolizidine alkaloids ("bush & eas")The screening test of choice is contrast - enhanced, color or pulsed doppler ultrasonography* Classical Triad of Budd Chiary Syndrome - Abdominal pain, ascites and hepatomegaly


Question: Disecting hematoma is a clinical complication occurring in

Marfan Syndrome Marfan syndrome is a disorder of connective tissues, manifested principally by changes in the skeleton, eyes, and cardiovascular system. Its prevalence is estimated to be 1 in 5000. Approximately 70% to 85% of cases are familial and transmitted by autosomal dominant inheritance. The remainder are sporadic and arise from new mutations. Pathogenesis. Marfan syndrome results from an inherited defect in an extracellular glycoprotein called fibrillin- 1. There are two fundamental mechanisms by which loss of fibrillin leads to the clinical manifestations of Marfan syndrome: loss of structural suppo in microfibril rich connective tissue and excessive activation of TGF-b signaling. Each of these is discussed below. * Fibrillin is the major component of microfibrils found in the extracellular matrix. These fibrils provide a scaffolding on which tropoelastin is deposited to form elastic fibers. Although microfibrils are widely distributed in the body, they are paicularly abundant in the aoa, ligaments, and the ciliary zonules that suppo the lens; these tissues are prominently affected in Marfan syndrome. Fibrillin occurs in two homologous forms, fibrillin-1 and fibrillin-2, encoded by two separate genes, FBN1 and FBN2, mapped on chromosomes 15q21.1 and 5q23.31, respectively. Mutations of FBN1 underlie Marfan syndrome; mutations of the related FBN2 gene are less common, and they give rise to congenital contractural arachnodactyly, an autosomal dominant disorder characterized by skeletal abnormalities. Mutational analysis has revealed more than 600 distinct mutations of the FBN1 gene in individuals with Marfan syndrome. Most of these are missense mutations that give rise to abnormal fibrillin-1. These can inhibit polymerization of fibrillin fibers (dominant negative effect). Alternatively, the reduction of fibrillin content below a ceain threshold weakens the connective tissue (haploinsufficiency). * While many clinical manifestations of Marfan syndrome can be explained by changes in the mechanical propeies of the extracellular matrix resulting from abnormalities of fibrillin, several others such as bone overgrowth and myxoid changes in mitral valves cannot be attributed to changes in tissue elasticity. Recent studies indicate that loss of microfibrils gives rise to abnormal and excessive activation of transforming growth factor-b (TGF-b), since normal microfibrils sequester TGF-b and thus control the bioavailability of this cytokine. Excessive TGF-b signaling has deleterious effects on vascular smooth muscle development and it also increases the activity of metalloproteases, causing loss of extracellular matrix. This schema is suppoed by two sets of observations. First, in a small number of individuals with clinical features of Marfan syndrome (MFS2), there are no mutations in FBN1 but instead gain-of-function mutations in genes that encode TGF-b receptors. Second, in mouse models of Marfan syndrome generated by mutations in Fbn1, administration of antibodies to TGF-b prevents alterations in the aoa and mitral valves. Ref Robbins 9/e pg 144


Question: The Most common cause of embolism causing cerebro vascular disease is

(B) Non rheumatic atrial fibrillation # Sources of cardioembolic embolism include the following:> Valvular diseases Rheumatic mitral stenosis Prosthetic valves Calcific aortic stenosis Bicuspid aortic valves Mitral annulus calcification Nonbacterial thrombotic (marantic) endocarditis associated with malignancies and prothrombic states Myxomatous mitral valvulopathy with prolapse> Infective endocarditis Inflammatory valvulitis (ie, Libman-Sacks endocarditis, Behget disease, syphilis) Lambl excrescences and/or strands> Left ventricular thrombi Ischemic heart disease Acute myocardial infarction Left ventricular akinesis or aneurysm Idiopathic hypertrophic subaortic stenosis Trauma (myocardial contusion) Ventricular noncompaction Nonischemic cardiomyopathies (E.g., idiopathic dilating, viral myocarditis-associated, echinococcal, peripartum, amyloid- associated, hypereosinophilia syndrome-associated, rheumatic myocarditis-associated, sarcoidosis-related, neuromuscular disorder-associated, alcoholism-related, catecholamine-induced, Chagas disease-associated, doxorubicin-induced, mitoxantrone-related, crack cocaine-related, cardiac oxalosis-associated) Left ventricular thrombi associated with prothrombotic states Antiphospholipid antibodies Diffuse intravascular coagulation Essential thrombocythemia & myeloproliferative diseases> Left atrial thrombi Arrhythmias A trial fibril la tion (Mos t common) Sick sinus syndrome/atrial asystole Atrial flutter Atrial septal aneurysms Chiari network > Cardiac tumors Atrial myxoma> Cardiac sarcoma Endocardial fibroelastoma Metastatic disease> Paradoxical emboli (major risk) Atrial septal defects> PFO Ventricular septal defects Pulmonary arteriovenous fistulas> Miscellaneous Postcardiac catheterization> Postvalvuloplasty> Esophageal-atrial fistula


Question: The severity of mitral stenosis is assessed by

Mitral stenosis. A normal mitral valve will have an area of >4 cm2, but symptoms are usually only present once the stenosis is moderate-severe. Grading into mild, moderate, or severe disease is based on both the pressure needed to drive blood across the valve (mean pressure gradient) and the valve area. Ref Davidson 23rd edition pg 435


Question: Sustained Response to antiviral therapy (IFN + Ribavarin) in hepatitis C is indicated by

Answer is D (Female sex): Female sex is a ourable feature, associated with sustained responsiveness to antiviral therapy Male sex is associated with reduced responsiveness. Reduced Responsiveness Genotype 1 High levels of HCV RNA Adranced fibrosis (ciorrhosis, bridging fibrosis) Long duration disease Age > 40 years I mmunosupression African American Obesity Hepatic steatosis Reduced adherence Male sex (Handbook of Gastroenterology) Sustained Responsiveness Genotype 2 and 3 Low levels of HCV RNA Minimal fibrosis Sho duration disease Age < 40 years Immunocompetance Others Absence of obesity Absence of Hepatic steatosis Increased Adherence Female sex (Handbook of Gastroenterology)


Question: Rytand's murmur is seen in

Ans. is 'a' i. e.,A-V Block Rytand Murmur Rytan 's murmur is mid-diastolic (or late-diastolic) murmur that is heard in patients with complete aioventricular hea block. Rytand's murmur is best heard at the apex and may be confused with mitral stenosis. The slow hea rate, variable duration of the murmur changing intensity of the S I and lack of opening snap are helpful Also know Carey Coombs murmur - Rheumatic fever Austin Flint murmur - Aoic regurgitation Graham-Steel murmur - Pulmonary regurgitation Rytands murmur - Complete hea block Docks murmur - Left Anterior Descending (LAD) aery stenosis Mill wheel murmur - Due to air emboli (air in PV cavity)


Question: Most common presentation of Neurocysticercosis is

(A) Seizures # Neurocysticercosis:> Symptoms of cysticercosis may include seizures, elevated intracranial pressure (ICR), meningoencephalitis, psychiatric disorder, stroke, and/or radiculopathy or myelopathy, if the spinal cord is involved.> Symptoms are mainly due to mass effect, an inflammatory response, or obstruction of the foramina and ventricular system of the brain.> Most common symptoms include seizures, focal neurologic signs, and intracranial hypertension.> Generally, the patient's history includes exposure to an area where the parasite is endemic and an adolescent- or adult-onset seizure disorder.> Symptoms of hydrocephalus should raise concerns about extraparenchymal disease.> Parenchymal CNS disease Seizures may be focal, focal with secondary generalization, or generalized. Headaches are common and may be migrainelike or tension-type. Neurocognitive deficits, while rare, may include learning disabilities, depression, or even psychosis.> Extraparenchymal disease Most patients present with headaches or symptoms of hydrocephalus. Symptoms of increased ICP may include headache, nausea or vomiting, altered mental status, dizziness, and decreased visual acuity due to papilledema. Patients with numerous cysticerci in the basilar cisterns may present with communicating hydrocephalus, meningismus (without fever), symptoms of lacunar infarcts due to small-vessel vasculitis, or symptoms of large-vessel infarcts due to cysticercal erosion into major arteries or severe inflammation of those arteries. Patients with spinal cysticerci typically present with radicular symptoms, but rarely with motor or sensory deficits traceable to a spinal level. Patients with ocular cysticerci report visual changes.> Spinal cord involvement Radiculopathy Myelopathy> Other Meningoencephalitis Stroke (in young adults) Subcutaneous nodules Ocular cysts> "These is wide variety of presentation of Neurocysticercosis depending on the intensity of the infestation, the localization o: cystecerci and the degree of inflammatory reaction.> Epilepsy (seizure activity) is the most common manifestation occuring in up to 50% cases.> Cysticercosis is infection with the larval stage (cysticercus) of T. solium.> These cysts are located in order of frequency in : CNS (Neurological manifestations are the most common) Subcutaneous tissue Striated muscle Globe of the eye> Most common cause of sporadic viral encephalitis HSV-I> Most common cause of epidemic viral encephalitis Arbovirus> Most common cause of viral meningitis is Enterovirus.


Question: Auenbrugger's sign is seen in

Bulging of the epigastrium (Auenbrugger's sign) seen in cases of large pericardial effusion.


Question: Treatment of choice of severe ITP is

Ans. b (IV gamma globulin). (Ref. Harrison, Principles of Medicine, 18th/Chapter 115.)IDIOPATHIC THROMBOCYTOPENIC PURPURA# Explosive onset of severe thrombocytopenia following recovery of viral exanthema or URI is common in children and accounts for 90% of paediatric immunologic thrombocytopenia.# 90% recover in 3-6 months.# Chronic ITP is common in females, 20-40 years of age.# Treatment include- glucocorticoids- danazol,- IV Ig or anti-RhD.- Emergency splenectomy depending on response to medical line of treatment is recommended.- Anti CD 20 abs (Rituximab) is also being tried in treatment of ITP.Initial treatment in patients without significant bleeding symptoms, severe thrombocytopenia (<5000/L), or signs of impending bleeding (such as retinal hemorrhage or large oral mucosal hemorrhages) can be instituted as an outpatient using single agents. Traditionally, this has been prednisone at 1 mg/kg, although Rh (D) immune globulin therapy (WinRho SDF), at 50-75 g/kg, is also being used in this setting.IVIgG has more efficacy than anti-Rh0(D) in postsplenectomized patients. IVIgG is dosed at 2 g/kg total, given in divided doses over 2-5 days.For patients with severe ITP and/or symptoms of bleeding, hospital admission and combined-modality therapy is given using high-dose glucocorticoids with IVIgG or anti-Rh D therapy, and, as needed, additional immunosuppressive agents. Rituximab, an anti-CD20 (B cell) antibody, has shown efficacy in the treatment of refractory ITP.Splenectomy has been used for treatment of patients who relapse after glucocorticoids are tapered.Thrombopoietin receptor agonists are now available for the treatment of ITP. Two agents, one administered subcutaneously (romiplostim) and another orally (eltrombopag), have shown response in many patients with refractory ITP.


Question: For the following causes of sexual dysfunction, select the most likely clinical feature.Can be caused by high prolactin level.

High prolactin level suppresses luteinizing hormone-releasing hormone (LH-RH), and can result in low plasma gonadotropin and testosterone levels. It may not be obvious on physical examination. Therapy with a dopamine agonist may lower prolactin levels and reverse impotence.

failure of erection with absent nocturnal penile tumescence (NPT)

absence of orgasm with normal libido and erectile function


Question: A post operative cardiac surgery patient developed sudden hypotension, raised Central venous pressure, pulsus paradoxus at the 4th post operative hour .The most probable diagnosis is

Ref Harrison 19 th ed pg 1573-1574 Features of rising pressure , falling aerial pressure and pulsus paradoxus following surgery on the hea leads us to the diagnosis of cardiac tamponade.


Question: Complication of streptokinase  a) Myocardial rupture  b)  Joint pain  c) Intracranial bleed   d) Anaphylaxis  e)  Parkinsonism


Question: Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the

The trachea will shift according to the pressure gradients within the thoracic cavity.
In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side.
If there is no significant air or fluid accumulation, the trachea will not shift.
Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the
release of normal thoracic pressure gradients on the injured side.

Contralateral side in a simple pneumothorax


Question: A 25 year old female with 16 weeks of gestation presents with excess vomiting, apathy, ataxia, nystagmus and ophthalmoplegia. The diagnosis is

(A) Wernicke's encephalopathy# Features of WERNICKE'S DISEASE:> Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine> Characteristic clinical Triad is that of Ophthalmoplegia, Ataxia, & Global confusion. Only 1/3rd of patients with acute Wernicke's disease present with the classic clinical triad.> Most patients are profoundly disoriented, indifferent, and inattentive, although rarely they have an agitated delirium related to ethanol withdrawal.> If the disease is not treated, stupor, coma, and death may ensue.> Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis.> Gait ataxia probably results from a combination of polyneuropathy, cerebellar involvement, and vestibular paresis.> Pupils are usually spared, but they may become miotic with advanced disease.> Tachycardia & postural hypotension may be related to impaired function of the autonomic nervous system or to the coexisterce of cardiovascular beriberi.> Most common cause of Wernike's disease is noise-induced hearing loss.> Other causes include: Neurological damage - Multiple sclerosis, Ear infections, Oxidative stress, Emotional stress.


Question: The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes

In severe kyphoscoliosis RV is normal TLC decreased FRC decreased/normal FVC decreases


Question: Helmet cells are a feature of

Bite cells / Blister cells / Helmet cells - G6PD deficency.


Question: Angina & sycope in same patient is seen in


Question: Insulin preperation with longest action

Propeies of Insulin PreparationsPreparationTime of Action (Hr)Onset PeakEffective durationSho actingAspa<0.250.5-1.52-4Glusiline<0.250.5-1.52-4Lispro<0.250.5-1.52-4Regular0.5-1.02-33-6Long actingDetemir1-4---12-24Glargine2-4---12-24NPH2-44-1010-16Ref: Harrison 19e pg: 2411


Question: Person having cerebellar signs on the same side with hearing loss. Site of damage is

(A) Left cerebellopontine angle # CEREBELLOPONTINE ANGLE TUMORS:> Tumors within the nerve canaliculi initially present with unilateral sensorineural hearing loss, unilateral tinnitus, or disequilibrium (vertigo is rare, on account of the slow growth of neuromas).> Speech discrimination out of proportion to hearing loss, difficulty talking on the telephone are frequent accompaniments.> Tumors extending into the CPA will likely present with disequilibrium or ataxia depending on the amount of extension on the brainstem.> With brainstem extension, midfacial and corneal hypesthesia, hydrocephalus, and other cranial neuropathies become more prevalent.> Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors.> Most CPA tumors are benign, with over 85% being vestibular Schwannomas (acoustic neuromas), lipomas, vascular malformations, & hemangiomas.> Most frequent non acoustic CPA tumors are meningiomas, epidermoids (primary cholesteatomas), and facial or lower cranial nerve Schwannomas.> Primary malignancies or metastatic lesions account for less than 2% of neoplasms in the CPA.> Presenting symptoms of CPA tumors (including acoustic neuromas) include the following: Hearing loss - 95% Tinnitus - 80% Vertigo/unsteadiness - 50-75% Headache - 25% Facial hypesthesia - 35-50% Diplopia-10%> Presenting symptoms can vary according to the size and location of the lesion.


Question: A patient on amphotericin B has weakness and cramps. Serum potassium = 2.3 mEq/dl. Calculate the total parenteral potassium supplementation to be given to the patient over the next 24 hours

For causing a rise of potassium in blood by 1 mEq/dl, 200 mEq of potassium supplementation is required. Since symptoms develops with serum potassium less than 3 mEq/dl, the clinician should give sufficient potassium to rise upto 3 mEq/dl intravenous route. Following this oral potassium supplement will suffice Hence mathematically speaking this patient requires approximately 0.7 mEq/dl of potassium to rise in the blood leading to a requirement of 0.7x 200 = 140 mEq over 24 hours


Question: Microalbuminuria is defined as albumin

30-300 microgms/24 hrs. urine collection

300-550 microgms/24 hrs. urine collection


Question: NESTROFT test is used for screening of

NESTROFT (Naked eye single tube red cell osmotic fragility test) is used for screening  of thalassema.


Question: A 28 years old man has anterior lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is

Ans. d. Alpo's syndrome The given clinical picture is typical of Alpo's syndrome, which is characterized by triad of hereditary nephritis (ESRD), sensorineural deafness and ocular abnormalities (anterior lenticonus). Alpo's Syndrome (Characterized by triad of) Hereditary Nephritis Hematuria (earliest feature)Q Mild ProteinuriaQ Chronic glomerulosclerosis Progressive renal insufficiency Nephrotic syndrome (rare) Sensorineural Deafness MC extra-renal abnormalityQ AsymmetricQ Ocular Abnormalities Anterior lenticonusQ Dot and Fleck retinopathy Recurrent corneal erosionsQ and opacitiesQ CataractQ Retinal detachment Nystagmus Leiomyomatosis Treatment of Alpo's Syndrome Primary treatment is control of systemic hypeension and use of ACE inhibitors to slow renal disease progression


Question: Retinopathy is most likely to be seen with

Complication of Retinopathy/nephropathy takes 5 years to develop in type 1 diabetes. Complication of Retinopathy/nephropathy takes 15-20 years to develop in type 2 diabetes.


Question: Patient had loss of temporal field of vision in right eye and nasal field of vision in the left eye. The possible site of lesion is