Question: Hypersensitivity vasculitis involve

Hypersensitivity vasculitis, which is usually represented histopathologically as leukocytoclastic vasculitis (LCV), is a term commonly used to denote a small-vessel vasculitis. There are many potential causes of hypersensitivity vasculitis; however, up to 50% of cases are idiopathic. Hypersensitivity vasculitis may present clinically as cutaneous disease only or it may be a cutaneous manifestation of systemic disease. The internal organs most commonly affected in hypersensitivity vasculitis are the joints, gastrointestinal tract, and kidneys. Hypersensitivity vasculitis may be acute and self-limited, recurrent, or chronic. Overall, hypersensitivity vasculitis has a orable prognosis, paicularly when no internal involvement is present . Hypersensitivity vasculitis tends to affect the skin and occasionally the kidney. The loss of integrity of the capillaries and post capillary venules results in extravasation of red blood cells, usually causing purpura and a burning or minimally pruritic sensation. Hypersensitivity vasculitis is thought to be mediated by immune complex deposition.In this form of vasculitis, circulating antigens in the body (produced by factors such as medications, infections, and neoplasms) induce antibody formation. These antibodies bind to the circulating antigen and create immune complexes, which then deposit within vessels, activating complement and inducing inflammatory mediators. Inflammatory mediators, adhesion molecules, and local factors may affect the endothelial cells and play a role in the manifestations of this disease. Additionally, autoantibodies, such as antineutrophil cytoplasmic antibody (ANCA), may be associated with disease manifestations. In ANCA-mediated vasculitis, intracellular proteins from neutrophils become expressed on the cell surface, leading to formation of antibodies (ANCA). These autoantibodies then bind neutrophils, subsequently leading to neutrophil adhesion to vessel walls and cellular activation. Ref - medscape.com


Question: Most common extraintestinal complication of ulcerative colitis is

M/c Arthritis
Peripheral arthritis - responds to treatment
Axial arthritis -does not responds to treatment.


Question: Persistent priapism in childhood is due to

(A) Sickle cell anaemia # Priapism in childhood commonly presents as a common symptom of Sickle Cell Disease especially after puberty, mainly as low flow or as a complication of penile trauma (normally high flow, non-ischemic episodes).> This phenotypic manifestation of SCD can cause persistent impotence, erectile dysfunction and behavioral problems in the sexual realm, as affected individuals fear the induction of an episode of painful erection in the course of normal sexual activity, which is the most common cause of priapism episodes after puberty.> The causative mechanisms are poorly understood but involve complex neurological and vascular factors.>Priapism may be associated with 1. Haematological disorders, especially sickle-cell disease, sickle-cell trait, and 2. Other conditions such as leukemia, thalassemia, and Fabry's disease, and 3. Neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in hanging victims; death erection).> Priapism is also found to occur in extreme cases of rabies,>. Priapism can also be caused by reactions to medications.


Question: The prognosis of rapidly prolifeating glomerulonephritis (Crescentric GN) depends upon

Answer is A (Number of crescents) The prognosis of crescentric glonzerulonephritis relates to the number of crescents Prognosis can he roughly related to the number of crescents' - Robbins


Question: Age related dementia has been associated with increased levels of

Identification of modifiable risk factors provides a crucial approach to the prevention of dementia.. The findings are consistent with moderately raised plasma total homocysteine (>11 mmol/L), which is common in the elderly, being one of the causes of age-related cognitive decline and dementia Ref Harrison20th edition pg 2445


Question: Dengue shock syndrome occurs due to


Question: Most rapid way of lowering potassium is

Insulin. Sta INITIAL INSULIN INFUSION RATE (100 units Regular Insulin/100 mL 0.9% Sodium Chloride): and GlucoseBloodmg/dL) Initial Insulin Infusion Rate. # 75 - 150 = 1 unit IV push then 1 unit per hour.pottasium can be give in a rapid way through insulin drip Ref Davidson 23rd edition pg 234


Question: Kaposi Sarcoma is commonly seen in

Kaposi's sarcoma is a multicentric neoplasm consisting of multiple vascular nodules appearing in the skin, mucous membranes, and viscera. The course ranges from indolent, with only minor skin or lymph node involvement, to fulminant, with extensive cutaneous and visceral involvement. Apa from skin, the lymph nodes, GI tract, and lung are the organ systems most commonly affected by KS. Lesions have been repoed in viuallyevery organ, including the hea and the CNS.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 226 Human Immunodeficiency Virus Disease: AIDS and Related Disorders; Page no: 1269


Question: Drug not used in treatment of Pituitary Adenoma is


Question: Liddle syndrome is characterized by

Liddle syndrome is an autosomal dominant disorder  with genetic defect(gain of function mutation) in collecting tubules sodium channel, resulting in increased tubular sodium reabsorption.

Hypokalemic metabolic alkalosis with hypotension

Hypokalemic metabolic alkalosis with hypertension

Hyperkalemic metabolic acidosis with hypotension

Hyperkalemic metabolic acidosis with hypertension


Question: Cotton dust is associated with


Question: Decreased level off serum Vit B6 is seen ina) CRFb) CHF c) INH therapyd) Alcohol


Question: 1st drug to be used in absence seizures


Question: This clinical sign is seen in <img src=" />

This is a contrast study showing string sign of KantorIn Crohn&;s disease, edema, bowel wall thickening, and fibrosis of the bowel wall within the mass account for the radiographic "string sign" of a narrowed intestinal lumen.Ref: Harrison 19e pg: 1953


Question: Lung carcinomas most frequently metastasize to


Question: Northern blotting is used for analysis of


Question: The lowest recurrence of peptic ulcer is associated with

Answer is C (Vagotomy + Antrectomy) Repeat Vagotomy with Antrectomy is associated with lowest recurrence rates.


Question: The commonest site for impaction of foreign body in the Gastro Intestinal Tract is


Question: In Beta thalassemia, there is

Ans. is 'b' Decrease in Beta chain and increase in alpha chain The abnormality in Beta thalassemia is a total lack of or a reduction in the synthesis of structurally normal Beta Globin chains with unimpaired synthesis of alpha chains.The hematologic consequence of this is not only low intracellular haemoglobin but also relative excess of alpha chains.The free alpha chains tend to aggregate into insoluble inclusions within erythrocytes and their precursors causing premature destruction of maturing erythroblasts within the marrow ( ineffective erythropoises)* as well as lyses of mature red cells in spleen.

Increase in beta chain,decrease in alpha chain

Decrease in beta chain ,increase in alpha chain

Decrease in beta chain decrease in alpha chain

Increase in beta chain, increase alpha chain


Question: Most common ophthalmic complication of diabetes mellitus is

(A) Retinopathy # Most common ophthalmic complication of diabetes mellitus is diabetic retinopathy, with diabetic retinopathy being the most common preventable cause of blindness> Ocular features of diabetes mellitus: Blurring of vision Cataract formation Diabetic pupil Diabetic retinopathy Macular edema Retinal neovascularization Vitreous hemorrhage Retinal detachment Neovascularization of the iris (i.e. Rubeosis iridis) Cranial nerveCN III, IV and VI palsy> Blindness is primarily the result of progressive diabetic retinopathy and clinically significant macular edema.> Diabetic retinopathy is classified into two stages: nonproliferative and proliferative. Nonproliferative diabetic retinopathy usually appears late in the first decade or early in the second decade of the disease and is marked by retinal vascular microaneurysms, blot hemorrhages, and cotton wool spots.> Mild nonproliferative retinopathy progresses to more extensive disease, characterized by changes in venous vessel caliber, intraretinal microvascular abnormalities, and more numerous microaneurysms and hemorrhages. The pathophysiologic mechanisms invoked in nonproliferative retinopathy include loss of retinal pericytes, increased retinal vascular permeability, alterations in retinal blood flow, and abnormal retinal microvasculature, all of which lead to retinal ischemia.


Question: Multiple Sclerosis is

(D) Demylinating disorder > Multiple sclerosis (MS) is characterized by a triad of inflammation, demyelination, and gliosis (scarring); the course can be relapsing-remitting or progressive. Lesions of MS are typically disseminated in time and location.


Question: Opsoclonus as a paraneoplastic manifestation is most commonly seen in

Opsoclonus affects children more frequently than adults. Screening for occult neuroblastoma is necessary in all patients with opsoclonus.


Question: Most reliable investigation in the diagnosis of pulmonary embolism is

The first line diagnostic test for pulmonary embolism is CT pulmonary angiography(CTPA).It has the advantages of visualising the distribution and extent of the emboli,or highlighting an alternative diagnosis,such as consolidation,pneumothorax or aoic dissection. Chest X-ray is most useful in excluding key differential diagnosis such as pneumonia, pneumothorax etc. ECG changes include sinus tachycardia, anterior T-wave inversion and S1Q3T3 pattern. The most common finding in ECG of pulmonary embolism is sinus tachycardia whereas specific finding is S1Q3T3 pattern. Reference:Davidson's Medicine:22nd edition,page no:722.


Question: An adult hypeensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely d/t

Harrison's principles of internal medicine 17 th edition. *SAH characterised by headache ,which is generalised and sudden onset ,neckstiffness,vomiting is common *Althoughsudden headache without focal neurological deficit may occur as hallmark feature of aneurysmal rupure ,but focal neurological deficit may occur .


Question: Fractional excretion of sodium < 1 is seen in

Ans. is 'a' i.e., Pre renal azotemia * Urine Diagnostic Indices in differentiation of prerenal Vs Intrinsic Renal FailureDiagnostic IndexPrerenalARFIntrinsic Renal ARF* Fractional Excretion of Na<1> 1* Urine Sodium Concentration (mmol/L)<10>20* Urine Creatinine to Plasma Creatinine ratio>40<20* Urine osmolality (mosmol/kgH20)>500~ 300* Renal failure Index<1>1* Urine urea Nitrogen to plasma urea Nitrogen>8<3* Plasma BUN/Creatinine Ratio>20< 10-15* Urinary SedimentHyalineCastsMuddy Brown Granular Cast* Urine Specific gravity> 1.020-1.010o Acute tubular necrosis is a cause of intrinsic ARF.


Question: Lucio phenomenon is treated with

Answer- D. Exchange transfusionLucion phenomenon is a very rare comcomplication of leprosy.It presents as sudden necrotizing vasculopathy in Patients with longstanding, untreated lepromatous leprosy.TreatmentOptimal wound care and therapy for bacteremia are indicated. Ulcers tend to be chronic and heal poorly.In severe cases exchange transfusion is indicated.


Question: Pure word blindness occurs due to lesion in

Answer- B. Posterior cerebral aeryPure alexia almost always involves an infarct to the left posterior cerebral aery which perfuses the splenium of the corpus callosum and left visual coex, among other things)


Question: Drug used in multiple sclerosis

*beta interferon have a modest effect on exacerbrations and disease progression in relapsing-remitting MS. Ref Harrison20th edition pg 2456


Question: Waddling gait is seen in

*In muscular dystrophies the gait of an individual disclose a lordotic posture caused by combined trunk and hip weakness,frequently exaggerated by toe walking. A waddling gait is caused by the inability of weak hip muscles to prevent hip drop or hip dip . Muscular dystrophy A waddling gait is a symptom of several types of MD, including: Duchenne MD. This disorder occurs almost exclusively in boys and affects the arms, legs, and pelvis. One of the first signs is having difficulty crawling or getting up from the floor Ref Harrison20th edition pg 2456


Question: Low serum alkaline phosphatase is seen with

SAP| - Hypophosphatasia SAP| - Rickets, increase PTH SAP|||- Paget's SAP Normal - Hypoparathyroidism,Pseudo hypoparathyroidism,Multiple myeloma,Osteoporosis


Question: Acute Viral hepatitis A & E are diagnosed by

(A) IgM A & IgM E CLINICAL AND EPIDEMIOLOGIC FEATURES OF VIRAL HEPATITISFeatureHAVHBVHCVHDVHEV* Incubation (days)15-45, mean 3030-180, mean 60-9015-160, mean 5030-180, mean 60-9014-60, mean 40* OnsetAcuteInsidious or acuteInsidiousInsidious or acuteAcute* Age preferenceChildren, young adultsYoung adults (sexual and percutaneous), babies, toddlersAny age, but more common in adultsAny age (similar to HBV)Young adults (20-10 years)Transmission* Fecal-oral+ + +---+ + +* PercutaneousUnusual+ + ++ + ++ + +-* Perinatal-+ + +++-* Sexual++ +++ +-Clinical* SeverityMildOccasionally severeModerateOccasionally severeMild* Fulminant0.1%0.1-1%0.1%5-20%1-2%


Question: The regional aerial resistance of the mesentery and kidney vessels is reduced by

In hyperdynamic sepsis, the peripheral aeriolar tone and BP are low but the cardiac output is often high; therefore the vasoconstrictor noradrenaline (norepinephrine) is appropriate to restore BP, usually at the price of some reduction in cardiac output.In most cases, a vasoconstrictor such as noradrenaline (norepinephrine) is necessary to increase SVR and BP, while an inotrope (dobutamine) may be necessary to maintain cardiac output. In the later stages of severe sepsis, the essential problem is at the microcirculatory level. Oxygen uptake and utilisation are impaired due to failure of the regional distribution of flow and direct cellular toxicity despite adequate global oxygen delivery. Tissue oxygenation may be improved and aerobic metabolism sustained by reducing demand, i.e. metabolic rate. ref:Davidsson&;s principles and practices of medicine,ed 21,pg no 598


Question: Kidney size is normal in

Kidney size :
Normal - Medullary sponge kidney, Simple renal cysts.
Small - Medullary Cystic kidney, Nephronophthisis .


Question: Non contrast ct is investigation of choice for

16 (D) (Interstitial lung disease) (707- Davidson 22nd)High resolution CT is superior to the plain chest x ray for early defection and confirmation of suspected ILD (2163-H 18TH).Clinical assessment including chest x-ray, pulmonary function test, haematology, biochemical andimmunological investigations | High -resolution CT||| |Appearances consistent with usual interstitial pneumonia Inconsistent clinical or CT appearances Appearances consistent with another diffuse parenchymal lung disease e,g, sarcoid| | |Diagnose idiopathic pulmonary fibrosis Further investigations, e,g, bronchoalveolar lavage, transbronchial biopsy, surgical biopsy Diagnose and treat accordinglyAlgorithm for the investigation of patients with interstitial lung disease following initial clinical and chest X-ray examination.


Question: Gibson’s murmur is a feature of

Continuous machinery murmur of PDA is also called Gibson’s murmur.


Question: Most common Posterior fossa Brain tumor in children is

(B) Pilocytic astrocytoma# BRAIN TUMOURS IN CHILDREN# Cystic Cerebellar astrocytoma:> These comprises about 33% of all posterior fossa tumors in children.> Represents 25% of all pediatric tumors. Presentation is 9 years in average. Typically, presents as a laterally located cyst with a well-defined solid component. Tumor may be cystic or solid and located medially in Vermis or laterally in Cerebellar hemisphere. PILOCYTIC ASTROCYTOMA IN POSTERIOR FOSSATumorRelative Incidence (%)PresentationDiagnosisPrognosisMedulloblastoma35-402-3 months of headaches, vomiting, tunical ataxiaHeterogeneous or homogeneously enhancing fourth ventricular mass; may be disseminated65-85% survival; dependent on stage/ type; poorer (20-70%) in infantsCerebellar astrocytoma35-403-6 months of limb ataxia; secondary headaches, vomitingCerebellar hemisphere mass, usually with cystic and solid (mural nodule) components90-100% survival in total resected pilocytic typeBrain stem glioma10-151-4 months of double vision, unsteadiness, weakness & other cranial nerve deficits, facial weakness, swallowing deficits, and other deficitsDiffusely expanded, minimally or partially enhancing mass in 80%; 20% more focal cervicomedullary lesion # Medulloblastoma: Initially arises in inferior medullary velum. It grows to fill 4th ventricle by infiltrating the surrounding structures. Earlier, it is thought to be raised from medulloblastoma cells, which do not exist. Better it to be included in the family of PNETs.# Hemangioblastoma accounts about 7-12% of all posterior fossa tumors. Hemangioblastomas occurs 70% in Cerebellum & are cystic in nature, and presenting at the age of 30-40 years, more common in males, and are associated with von Hippel-Lindau disease.

Occipital fossa tumor * NIMHANS Pattern Post MBBS 2017; NIMHANS DM Neurology 2012


Question: A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and veigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is

basilar migraine is a rare type of migraine that begins in the brain stem. A basilar migraine may be caused by a constriction of blood vessels that limit blood flow to the brain. Other conditions that restrict blood flow, such as touous blood vessels, may also cause basilar migraines Ref Harrison20th edition pg 2345


Question: Total score in Glasgow Coma Scale of a conscious person is

(C) 15 GLASGOW COMA SCALE RESPONSESCORE# EYE OPENING Opens eyes spontaneously4 Opens eyes in response to speech3 Open eyes in response to painful stimulation (Eg, endotracheal suctioning)2 Does not open eyes in response to any stimulation1# MOTOR RESPONSE Follows commands6 Makes localized movement in response to painful stimulation5 Makes nonpurposeful movement in response to noxious stimulation4 Flexes upper extremities/extends lower extremities in response to pain3 Extends all extremities in response to pain2 Makes no response to noxious stimuli1# VERBAL RESPONSE Is oriented to person, place, & time5 Converses, may be confused4 Replies with inappropriate words3 Makes incomprehensible sounds2 Makes no response1


Question: Most common organic cause of erectile dysfunction

M/c organic cause of ED is Atherosclerosis.


Question: Incubation period of syphilis is

Ans. a (9-90 days). (Ref. Harrison, Medicine, 18th/Ch. 169; Table 170-1)SYPHILIS# L Pallidum enters foetal circulation after 20th week of gestation with disappearance of cytotrophoblast in villi (Kerala-2001).# Basic pathology is obliterative endarteritis, in congenital syphilis.# Placenta becomes bulky and spirochaete can hardly be found in placenta.# Spirochaete can however be detected from maculopapular rash in baby.# Irrespective of the serology, treatment should be repeated in subsequent pregnancies.# Incubation period of syphilis is 9-90 days# In blood transfusion and in congenital syphilis, no chancre occurs.# Dark ground microscopic examination is useful but negative results do not exclude diagnosis of syphilis.# Diagnosis by microscopy is applicable in primary and secondary stages and congenital syphilis.# Wet film prepared with exudates is seen under dark ground microscope.# T. pallidum shows slow movement with slender spiral structure# However, serology remains the best diagnostic test for syphilis.# Serological tests for syphilis are:- Tests for antibodies reacting with cardiolipin antigen (Non-specific reagin test, standard tests for syphilis)* VDRL is std test for syphilis- Tests for antibodies reacting with group specific treponemal antigens.- Tests for specific antibodies to pathologic T. pallidum.Comparison of the Treponemes and Associated DiseasesFeatureVenereal SyphilisYawsEndemic SyphilisPintaOrganismT. pallidum subsp. pallidumT. pallidum subsp. pertenueT. pallidum subsp. endemicumT. carateumModes of transmissionSexual, transplacentalSkin-to-skinHousehold contacts: mouth-to-mouth or via shared drinking/ eating utensilsSkin-to-skinUsual age of acquisitionAdulthood or in uteroEarly childhoodEarly childhoodLate childhoodPrimary lesionCutaneous ulcer (chancre)Papilloma, often ulcerativeRarely seenNonulcerating papule with satellites, pruriticLocationGenital, oral, analExtremitiesOralExtremities, faceSecondary lesionsMucocutaneous lesions; condylomata lataCutaneous papul osquamous lesions; osteoperiostitisFlorid mucocutaneous lesions (mucous patch, split papule, condyloma latum); osteoperiostitisPintides, pigmented, pruriticInfectious relapses25%CommonUnknownNoneLate complicationsGummas, cardiovascular and CNS involve- mentaDestructive gummas of skin, bone, cartilageDestructive gummas of skin, bone, cartilageNondestructive, dyschromic, achromic macules


Question: The plateau (phase 2) of the ventricular myocyte action potential

During the plateau phase (phase 2), the membrane&;s conductance to K+ is low. However, the electrochemical gradient for K+ is so strong that some K+ does leak out. The K+ efflux is balanced by the inward movement of Ca2+ and Na + through the slow Ca2+ channels so that the membrane potential plateaus above 0 mV. Sympathetic stimulation and drugs, which increase the concentration of cytosolic Ca2+ (digitalis), shoen the duration of the plateau phase by increasing K+. Ref - Harrison&;s internal medicine 20e pg 1716

Describes when Ca2+ is the only ion moving through the membrane

Describes when Ca2+ influx is balanced by Na+ efflux

Describes when Ca2+ and Na+ influx is balanced by K+ efflux

Can be prolonged by sympathetic nerve stimulation


Question: Botulism characterised by  a) Seizure  b) Fever  c) Ascending paralysis  d) Descending symmetrical paralysis  e) Blurring of vision


Question: Mutation in sickle cell disease is a

It is a point mutation at the 6th code of β globin chain leading to substitution of glutamine by valine.


Question: Sinus tachycardia is seen in


Question: Banana shaped left ventricle is seen in

Ans. is 'a' i.e., HOCM Spherical ventricle Dilated cardiomyopathy Apical ballooning Stress cardiomyopathy/Tako-Tsubo Spade-shaped ventricle Apical hyperophic cardiomyopathy Distoion of ventricle Myocardial infarctions/aneurysms/remodeling Banana-shaped ventricle Hyperophic cardiomyopathy


Question: Multiple brain abscesses are characteristic of

(C) Hematogenous # Metastatic abscesses are commonly located in the parietal, frontal, or temporal lobes, and multiple brain abscesses are usually the result of metastatic spread from remote primary foci, accounting for 6% to 22% of cases.> Most common cause of brain abscesses was haematogenous spread, accounting for 26% of the episodes.


Question: 30 year old female comes with visual defects, breast engorgement and Amenorrhea. Investigation of choice is

This is likely to be a case of pituitary adenoma. The most common pituitary adenoma causing the symptoms is prolactinoma.


Question: Acephalgic migraine is

Patients with acephalgic migraine (typical aura without headache) experience recurrent neurologic symptoms, often with nausea or vomiting, but with little or no headache. Veigo can be prominent; it has been estimated that one-third of patients referred for veigo or dizziness have a primary diagnosis of migraine. Migraine aura can have prominent brainstem symptoms, and the terms basilar aery and basilar-type migraine have now been replaced by migraine with brainstem aura. Ref Harrison 20th edition page 3096, 3097 ( table 422-1)

Migraine with typical aura with headache

Migraine with typical aura with out headache


Question: The most common cause of sudden death in sarcoidosis is


Question: Delusions of persecution, grandiosity and infidelity are features of

i.e. (Paranoid schizophrenia): (2721-H 17th)PARANOID SCHIZOPHRENIACharacterized by1. Delusion of persecution2. Delusion of reference3. Delusion of grandeur (or grandiosity)4. Delusion of infidelity (or Jealousy)5. Schneider's first rank symptoms6. The delusions are usually well-systematized7. The personality deterioration is much less than in other types of schizophrenias8. Patients may be apprehensive (due to delusions & hallucination)SCHIZOPHRENIACATATONICClinical presentation is dominated by profound changes in motor activity, negativism and echolalia or echopraxiaPARANOIDProminent preoccupation with a specific delusional systemDISORGANIZEDDisorganized speech and behavior are accompanied by a superficial or silly affectRESIDUALNegative symptomatology exists in the absence of delusions, hallucination or motor disorders


Question: The most common location of spider nevi is

<img src=" /> Ref image - Internet (Researchgate.net)


Question: Wilson's disease is best diagnosed by

Answer is B (Increased urinary copper excretion): Wilson's Disease is charachterized by increased urinary copper excretion. Increased urinary copper excretion over 24 hours is an extremely useful test (+++) for diagnosis of Wilson's disease. Wilson's disease is associated with low levels of serum ceruloplasmin and high urinary copper excretion The basic defect in Wilson's disease is reduced biliary excretion of copper due to a mutation of gene on chromosome 13 which promotes copper excretion. This leads to accumulation of copper initially in the liver and subsequently in plasma and other systems once liver is saturated. Serum ceruloplasmin is the main copper binding protein in the blood and once excess copper spills into the blood, levels of free ceruloplasmin are decreased. Also excess copper is eventually excreted in urine and hence urinary copper levels are increased or high.


Question: Of the following vasculitides, coronary aery aneurysms are most often seen in

Kawasaki disease is a vasculitis that mostly involves the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years. It occurs mainly in Japan and other Asian countries, such as China and Korea, but other ethnic groups may also be affected. Presentation is with fever, generalised rash, including palms and soles, inflamed oral mucosa and conjunctival congestion resembling a viral exanthema. The cause is unknown but it is thought to be an abnormal immune response to an infectious trigger. Cardiovascular complications include coronary aeritis, leading to myocardial infarction , coronary aery aneurysms , transient coronary dilatation, myocarditis, pericarditis, peripheral vascular insufficiency and gangrene. Treatment is with aspirin (5 mg/kg daily for 14 days) and IV Ig (400 mg/kg daily for 4 days) . Ref Davidsons 23e p1041


Question: A middle aged person is rushed to emergency depament with history of loss of motor power on left upper and lower limb since last 30 minutes. Imaging modality of choice to plan appropriate treatment will be

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (hemi- means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke Depending on the type of hemiparesis diagnosed, different bodily functions can be affected. Some effects are expected (e.g., paial paralysis of a limb on the affected side). Other impairments, though, can at first seem completely non-related to the limb weakness but are, in fact, a direct result of the damage to the affected side of the brain. Loss of motor skills Edit People with hemiparesis often have difficulties maintaining their balance due to limb weaknesses leading to an inability to properly shift body weight. This makes performing everyday activities such as dressing, eating, grabbing objects, or using the bathroom more difficult. Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling. Pure Motor Hemiparesis, a form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis Ref Harrison20th edition pg 2234


Question: Reed sternberg cells are found in

* Reed-Sternberg cells * They are usually derived from B lymphocytes, classically considered crippled germinal center B cells. * Seen against a sea of B cells, they give the tissue a moth-eaten appearance. * They are named after Dorothy Reed Mendenhall and Carl Sternberg, who provided the first definitive microscopic descriptions of Hodgkin&;s disease. * Reed-Sternberg cells are large and are either multinucleated or have a bibbed nucleus (thus resembling an "owl&;s eye" appearance) with prominent eosinophilic inclusion-like nucleoli. * Reed-Sternberg cells are CD30 and CD15 positive, usually negative for CD20 and CD45. * The presence of these cells is necessary in the diagnosis of Hodgkin&;s lymphoma - the absence of Reed-Sternberg cells has very high negative predictive value. * They can also be found in reactive lymphadenopathy (such as infectious mononucleosis, carbamazepine associated lymphadenopathy) and very often in other types of non-Hodgkin lymphomas. * A special type of Reed-Sternberg cells is the lacunar histiocyte, whose cytoplasm retracts when fixed in formalin, so the nuclei give the appearance of cells that lie with empty spaces (called lacunae) between them. These are characteristic of the nodular sclerosis subtype of Hodgkin&;s lymphoma REF : HARRISONS 21ST ED


Question: The minimum possible score in “Glasgow coma scale’’ is

Explanation: Glasgow Coma Scale for Head Injury


Question: The investigation of choice for diagnosis of Giant cell Aeritis is

Answer is A (Temporal Aery Biopsy): Temporal aery biopsy is the gold standard test for diagnosing giant cell Aeritis - Current Rheumatology The diagnosis of giant cell Aeritis is confirmed by Temporal Aery Biopsy-Harrisons Diagnosis of Giant cell Aeritis (GCA) 50 years" align="left" height="28" width="300">Diagnosis of GCA is suggested clinically by demonstration of complex offever, anemia and high ESR with or without polymyalgia Rheumatica in a patient > 50 years. Diagnosis is confirmed by biopsy of temporal aery (Gold standard). Colour duplex ultrasonographv of affected temporal aery can show a characteristic halo of edema and stenosis but this investigation is no more sensitive for the diagnosis of GCA than careful physical examination (Current Rheumatology). CT Angiographv and MRI may be useful for assessment of Temporal Aery but are not the investigations of choice.


Question: Most common cause of postural hypotension is

(C) Peripheral neuropathy # Causes of postural syncope: In patients receiving antihypertensive or vasodilator drugs and those who are hypovolemic because of diuretics, excessive sweating, diarrhea, vomiting, hemorrhage, or adrenal insufficiency.


Question: Brill Zinsser disease is caused by

DiseaseEtiologyDescriptionGroup Affected/Epidemiologic FactorsClinical SyndromeEpidemic typhusRickettsia prowazekiiMaculopapular eruption appearing inaxillae, spreading to trunk and later toextremities; usually spares face, palms, soles;evolves from blanchable macules to confluent eruption with petechiae; rash evanescentin recrudescent typhus (Brill-Zinsserdisease)Exposure to body lice;occurrence of recrudescenttyphus as relapseafter 30-50 yearsHeadache, myalgias;moality rates 10-40% ifuntreated; milder clinicalpresentation in recrudescentformRef: Harrison; 19th edition; Page no: 128


Question: Commonest site of the vermiform appendix is


Question: Comment on the diagnosis of the patient based on ECG

HR of patient is variable. Notice the change in RR interval in lead II. The HR changes from 200 bpm to 150 bpm. Notice the changes in amplitude of P waves which leads to diagnosis as Multifocal atrial tachycardia(MAT). Choice 2 is ruled out as A. fibrillation has an absent P waves Choice 3 is ruled out as Mobitz II hea block has bradycardia Choice 4 is ruled out as Wolf Parkinson white syndrome has Delta waves with broad qRS complex is not seen


Question: Erb's point in cardiology refers to

Ans. is 'c' i.e., Right 3rd intercostal space Erb's point refers to the third intercostal space on the left sternal border where both components of S2 (A2 and P2) can be well appreciated. Both components of S2 (A21 and P2) are usually well transmitted to the Erb's point. The physiological splitting of S2 into A2 and P2 is believed to be appreciated best at the Erb point or in the pulmonic area. A2 is best heard over -+ the aoic area in the righ second intercostal space. P2 is best heard over -) the pulmonic area in the left second intercostal space. Second hea sound (52) is best heard over -+ the pulmonc area (Since both A2 and P2 can be heard on the 63.pulmonic area) and at the Erbis Point. Note that even at the pulmonic area A2 is louder than P2 Aoic area - Second intercostal space to the right of the sternum (along right upper sternal border). Pulmonic area - Second intercostal space to the left of the sternum (along left upper sternal border) Erb's point - Third intercostal to the left of the sternum (along left sternal border). Tricuspid area - Fouh or Fifth intercostal space to the left of the sternum (along left lower sternal border). Mitral area (Apex) - Fifth intercostal space on the left midclavicular line


Question: Child criteria include A/E  a) Nutritional status b) S.Bilirubin c) S. Creatinine d) Acid phosphate


Question: NOT a feature of Horner's syndrome

(A) Exophthalmos # HORNER'S SYNDROME:> Enophthalmos, Ptosis, Miosis, & Ipsilateral loss of sweating (Anhydrosis)> Malignant pleural effusion often leads to dyspnea.> Pancoast's (or superior sulcus tumor) syndrome results from local extension of a tumor growing in the apex of the lung with involvement of the eighth cervical and first and second thoracic nerves, with shoulder pain that characteristically radiates in the ulnar distribution of the arm, often with radiologic destruction of the first and second ribs.> Often Horner's syndrome & Pancoast's syndrome coexist.


Question: The first sign of tetanus is


Question: Treatment of orthostatic hypotension is


Question: Herpes simplex encephalitis affects lobe

(A) Temporal > Approximately 10% of patients with PCR-documented HSV encephalitis will have a normal MRI, although nearly 90% will have abnormalities in the temporal lobe


Question: Adenosine is used in

Acute management of narrow QRS PSVT is guided by the clinical presentation. Continuous ECG monitoring should be implemented.For stable individuals, initial therapy takes advantage of the fact that most PSVTs are dependent on AV nodal conduction (AV nodal reentry or ohodromic AV reentry) and therefore likely to respond to sympatholytic and vagotonic maneuvers and drugs (IV adenosine)Harrison 19e pg: 1483


Question: Ryle's tube is best put in

Sitting position with neck slightly flexed

Sitting position with neck slightly extended


Question: In acute pulmonary embolism, the most frequent ECG finding is

The most frequently cited abnormality in pulmonary embolism is sinus tachycardia.Apa from that,it also shows S1Q3T3 sign-an S wave in lead I,a Q wave in lead III,and an inveed T wave in lead III.This finding is relatively specific. S1Q3T3 pattern in ECG of pulmonary embolism is also termed as Mc Ginn White Sign. Reference:Harrison's medicine-18th edition,page no:2172.


Question: Chances of multiple sclerosis are maximum if

. *In multiple sclerosis genetic factors are also relevant ,the risk of familial recurrence in MS is 15%,with highest risk in first degree relatives (age adjusted risk:4-5% for siblings and 2-3 % for parents or off spring . Ref Harrison20th edition pg 2456


Question: A female child with virilization, hypeension with low plasma renin diagnosis is

Renin is produced from the juxta glomerular cells in the kidney. It acts on the angiotensinogen produced in the liver and conves it to angiotensin I. The latter is conveed to Angiotensin II by the Angiotensin conveing enzyme in the lung. Angiotensin II is a potent vasoconstrictor and acts on the angiotensin receptors. Both high as well as low levels of renin may be associated with hypeension. This aicle deals with hypeensive disorders associated with low renin levels The causes of low renin hypeension are as follows: Low renin essential hypeension (LREH) Primary aldosteronism Conn's syndrome Glucocoicoid-remediable (GRH)/Familial hyperaldosteronism Type I Familial Type II Liddle syndrome Mineralocoicoid receptor mutation Apparent mineralocoicoid excess (AME) Glucocoicoid resistance Gordon syndrome Congenital adrenal hyperplasia (CAH) 11 beta hydroxylase deficiency Ref Robbins 9 /e pg 158


Question: The diagnosis of a patient presenting with familial Polyostosis, Precocious puberty and Pigmentation is

McCune Albright syndrome :

A polyostotic form of fibrous dysplasia
Cutaneous pigmentation
Endocrine dysfunction, especially Precocious puberty in girls.
The triad of symptoms in the question thus characterizes McCune Albright syndrome and hence is the answer.


Question: Austin flint murmur is seen in cases of

The Austin Flint murmur of chronic severe AR is a low-pitched mid to late apical diastolic murmur that sometimes can be confused with MS. The Austin Flint murmur typically decreases in intensity after exposure to vasodilators, whereas the murmur of MS may be accompanied by an opening snap and also may increase in intensity after vasodilators because of the associated increase in cardiac output.

Hypertrophic obstructive cardiac myopathy


Question: The most common cause of Recurrent syncope includes

(D) Neurocardiogenic # CAUSES OF SYNCOPE# Disorders of vascular tone or blood volume> Vasovagal (vasodepressor; neurocardiogenic)> Postural (orthostatic) hypotension1. Drug induced (especially antihypertensive or vasodilator drugs)2. Peripheral neuropathy (diabetic, alcoholic, nutritional, amyloid)3. Idiopathic postural hypotension4. Multisystem atrophies5. Physical deconditioning6. Sympathectomy7. Acute dysautonomia (Guillain-Barre' syndrome variant)8. Decreased blood volume (adrenal insufficiency, acute blood loss, etc.)> Carotid sinus hypersensitivity> Situational1. Cough2. Micturition3. Defecation4. Valsalva5. DeglutitionE. Glossopharyngeal neuralgia# Cardiovascular disorders> Cardiac arrhythmias1, Bradyarrhythmiasa. Sinus bradycardia, sinoatrial block, sinus arrest, sick-sinus syndromeAtrioventricular block> Tachyarrhythmiasa. Supraventricular tachycardia with structural cardiac diseaseb. Atrial fibrillation associated with the Wolff-Parkinson-White syndromec. Atrial flutter with 1:1 atrioventricular conductiond. Ventricular tachycardia> Other cardiopulmonary etiologies1. Pulmonary embolism2. Pulmonary hypertension3. Atrial myxoma4. Myocardial disease (massive myocardial infarction)5. Left ventricular myocardial restriction or constriction6. Pericardial constriction or tamponade7. Aortic outflow tract obstruction8. Aortic valvular stenosis9. Hypertrophic obstructive cardiomyopathy# Cerebrovascular diseaseA. Vertebrobasilar insufficiencyB. Basilar artery migraine# Other disorders that may resemble syncope> Metabolic1. Hypoxia2. Anemia3. Diminished carbon dioxide due to hyperventilation4. Hypoglycemia> Psychogenic1. Anxiety attacks2. Hysterical fainting> Seizures> Neurocardiogenic syncope is frequently recurrent & commonly precipitated by a hot or crowded environment, alcohol, extreme fatigue, severe pain, hunger, prolonged standing, and emotional or stressful situation.


Question: Peripheral pulmonic stenosis is associated with

Answer is C and E (William syndrome and Rubella) Peripheral pulmonic stenosis is often associated with various congenital and acquired conditions including Rubella and williams syndrome.


Question: In Burkitts lymphoma , translocation seen is chromosome

Ans. is 'b' 8-14 translocation Chromosomal translocations Associated Neoplasms8 - 14 -Burkitt's lymphoma*.Acute lymphocytic leukemia (FAB type L3) Immunoblastic B cell lymphoma*15-17 -Promyelocytic leukemia*4-11 -Acute lymphocytic leukemiaH-14 -Chronic lymphocytic leukemia14- 18 -Some B cell lymphomas6 - 14 -Cystadenocarcinoma of ovary3.8 -Renal adenocarcinoma*, mixed parotid tumour.


Question: Most common site of rupture of aortic aneurysm in Marfan's syndrome is


Question: Resistance to chloroquine is common among strains of


Question: Cause of large kidney in CRF are a/e


Question: Recommended Dextrose fluid conc. in adult patient is


Question: The following ECG findings are seen in Hypokalemia

Effects of hypokalaemia on the ECG Changes appear when K+ < 2.7 mmol/l Increased amplitude and width of the P wave Prolongation of the PR interval T wave flattening and inversion ST depression Prominent <a href=" waves (best seen in the precordial leads) Apparent long QT interval due to fusion of the T and U waves Ref Harrison 20th edition pg 1456

Increased PR interval with ST depression

Increased PR interval with peaked T wave

Prolonged QT interval with T wave inversion

Decreased QT interval with ST depression


Question: Bilirubin is absent in urine because it is

Bilirubin metabolism and bile The liver plays a central role in the metabolism of bilirubin and is responsible for the production of bile (Fig. 22.6). Between 425 and 510 mmol (250-300 mg) of unconjugated bilirubin is produced from the catabolism of haem daily. Bilirubin in the blood is normally almost all unconjugated and, because it is not water-soluble, is bound to albumin and does not pass into the urine. Unconjugated bilirubin is taken up by hepatocytes at the sinusoidal membrane, where it is conjugated in the endoplasmic reticulum by UDP-glucuronyl transferase, producing bilirubin mono- and diglucuronide. Impaired conjugation by this enzyme is a cause of inherited hyperbilirubinaemias . These bilirubin conjugates are water-soluble and are expoed into the bile canaliculi by specific carriers on the hepatocyte membranes. The conjugated bilirubin is excreted in the bile and passes into the duodenal lumen. Once in the intestine, conjugated bilirubin is metabolised by colonic bacteria to form stercobilinogen, which may be fuher oxidised to stercobilin. Both stercobilinogen and stercobilin are then excreted in the stool, contributing to its brown colour. Biliary obstruction results in reduced stercobilinogen in the stool, and the stools become pale. A small amount of stercobilinogen (4 mg/day) is absorbed from the bowel, passes through the liver and is excreted in the urine, where it is known as urobilinogen or, following fuher oxidisation, urobilin. The liver secretes 1-2 L of bile daily. Bile contains bile acids (formed from cholesterol), phospholipids, bilirubin and cholesterol. Several biliary transpoer proteins have been identified . Mutations in genes encoding these proteins have been identified in inherited intrahepatic biliary diseases presenting in childhood, and in adult-onset disease such as intrahepatic cholestasis of pregnancy and gallstone formation. Urine tests If the blood level of conjugated bilirubin becomes elevated, e.g. due to liver disease, excess conjugated bilirubin is excreted in the urine, indicating a pathological process. Unconjugated bilirubin is not water-soluble and so is not excreted in the urine. Ref Davidson edition23rd pg 851


Question: Inveed T waves are seen in

Ans. is 'c' i.e., Wellen syndrome Severe anterior wall Ischemia (with or without infarction) may cause prominent T-wave inversions in the precordial leads. This pattern (sometimes referred to as Wellens T-waves) is usually associated with a high-grade stenosis of the left anterior descending coronary aery. Hyperkalemia has tall Tented T-waves. Coronary syndrome Xis characterised by blockage of perforators while the epicardial coronary aery is normal. In these patients stenting of coronaries is not useful. Nitrates are mainstay of therapy.


Question: Lambert Eaton myasthenic syndrome is

Characterized by preserved deep tendon reflexes

Characterized by decremental response in ENMG


Question: Pout and snout reflex is associated with

(B) Frontal lobe# SNOUT REFLEX:> Isa pouting or pursing of the lips that is elicited by light tapping of the closed lips near the midline.> Contraction of the muscles causes the mouth to resemble a snout.> Is tested in a neurological exam and if present, is a sign of brain damage.> Along with the "suck" and palmomental reflexes, snout is considered a frontal release sign.> Are normally inhibited by frontal lobe activity in the brain, but can be "released" from inhibition if the frontal lobes are damaged.> Are normally present in infancy, however, and up until about one year of age, leading to the hypothesis that they are primitive or archaic reflexes.> Frontal release signs are seen in disorders that affect the frontal lobes, such as dementias, metabolic encephalopathies, closed head injuries, and hydrocephalus.> All of these disorders produce diffuse cerebral damage, usually involving many areas and systems in addition to the frontal lobes and pyramidal system, so the frontal release signs are not sufficient for a diagnosis.> It is suggested that the snout refl ex should really be reserved for the refl ex elicited by a constant pressure on the philtrum, which results in a puckering of the lips and is essentially a variation of the tactile rooting response.> Rooting responses can be diagnostically useful in patients in whom apathy is a feature of a frontal lobe syndrome and who have normal neuroimaging.> Occasionally one is unsure whether such patients suffer primarily from an affective disorder or an underlying frontal degeneration.> Detection of a rooting refl ex will direct one towards the latter.


Question: Todd's palsy can occur after episode of

Todd's paralysis, or Todd's palsy. Specialty. Neurology. Todd's paresis (or postictal paresis/paralysis, "after seizure") is focal weakness in a pa or all of the body after a seizure. This weakness typically affects appendages and is localized to either the left or right side of the body. Ref Harrison20th edition pg 2456


Question: Most common sensorineural hearing loss in adults are due to


Question: Kespar Hauser syndrome is due to


Question: Amyotrophic Lateral sclerosis is characterized by

Harrison's principles of internal medicine 17th edition. *Pathologic hallmark is death of lower motor neurons (consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles) and upper, or coicospinal, motor neurons (originating in layer five of the motor coex and descending the pyramidal tract to synapse with lower motor neurons). Although at onset ALS may involve selective loss of only upper or lower motor neurons, it ultimately causes progressive loss of both


Question: Nerve involved in Bell's palsy is

Ans. a (Facial nerve). (Ref. Harrison-medicine, 18th/Chapter 376.)Bell's palsy# The most common form of facial paralysis is Bells palsy. Bell's palsy is idiopathic palsy of facial nerve.Clinical Manifestations# The onset of Bell's palsy is fairly abrupt, maximal weakness being attained by 48 h as a general rule.# Pain behind the ear may precede the paralysis for a day or two.# Taste sensation may be lost unilaterally, and hyperacusis may be present.# In some cases there is mild cerebrospinal fluid lymphocytosis.# MRI may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve, and, in some cases, entrapment of the swollen nerve in the temporal bone.# Approximately 80% of patients recover within a few weeks or months.# The presence of incomplete paralysis in the first week is the most favorable prognostic sign.Pathophysiology# Bell's palsy is associated with the presence of herpes simplex virus type 1 DNA in endoneurial fluid and posterior auricular muscle, suggesting that a reactivation of this virus in the geniculate ganglion may be responsible. However, a causal role for herpes simplex virus in Bell's palsy is unproven.Differential Diagnosis# Tumors that invade the temporal bone (carotid body, cholesteatoma, dermoid).# The Ramsay Hunt syndrome, presumably due to herpes zoster of the geniculate ganglion, consists of a severe facial palsy associated with a vesicular eruption in the pharynx, external auditory canal, and other parts of the cranial integument; often the eighth cranial nerve is affected as well.# Acoustic neuromas frequently involve the facial nerve by local compression.# Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions that interrupt the facial nerve fibers; other signs of brainstem involvement are usually present.# Bilateral facial paralysis (facial diplegia) occurs in Guillain-Barre' syndrome and also in a form of sarcoidosis known as uveoparotid fever (Heerfordt syndrome).# Lyme disease is a frequent cause of facial palsies in endemic areas.# The rare Melkersson-Rosenthal syndrome consists of a triad of recurrent facial paralysis, recurrent--and eventually permanent--facial (particularly labial) edema, and less constantly, plication of the tongue;# Leprosy frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus.# All these forms of nuclear or peripheral facial palsy must be distinguished from the supranuclear type.# In the latter, the frontalis and orbicularis oculi muscles are involved less than those of the lower part of the face, since the upper facial muscles are innervated by corticobulbar pathways from both motor cortices, whereas the lower facial muscles are innervated only by the opposite hemisphere.Treatment# Symptomatic measures include use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and Massage of the weakened muscles.# A course of glucocorticoids, given as prednisone 60 to 80 mg daily during the first 5 days and then tapered over the next 5 days, appears to shorten the recovery period and modestly improve the functional outcome.# In one double-blind study, patients treated within 3 days of onset with both prednisone and acyclovir (400 mg five times daily for 10 days) had a better outcome than patients treated with prednisone alone.


Question: The most common cause of organic amnestic syndrome is

organic amnesia and the amnestic syndrome. .The amnestic syndrome is characterized by disorientation paicularly in time, impairment of immediate recall, loss of recent memory, retroactive loss of remote memory of varying extent and a tendency to confabulation. Ref Harrison20th edition pg 2776


Question: Alternating hemiplegia is best described as

Alternating hemiplegia is a neurological deficit involving limbs on one side and cranial nerves on the opposite side. This is most often related to cranial nerves III, VI, and XII. Although the involvement of the body may be the same, if the lesion is in the midbrain the eye is affected; if it is located in the pons specifically, the lateral rectus muscle is involved; and if the lesion is located in the medulla, the tongue is affected. Ref - Harrison's principles of internal medicine 20e pg 2071

A neurological deficit involving pairs of cranial nerves

A neurological deficit involving limbs on one side and cranial nerves on the other side

A neurological deficit involving four limbs (quadriplegia)

Neurological deficits involving cranial nerves and limbs on the same side


Question: Dissociated sensory loss is seen in

Harrison's principles of internal medicine 17th edition. * The classical presentation in syringomyelia is a central cord syndrome consisting of a dissociated sensory loss and areflexic weakness in upper limbs


Question: Drug used in AV Block  a)  Isoprenaline  b)  Dopamine  c) Astropine  d) Disopyramide  e)  Propranolol


Question: Most common acute complication of dialysis is

Ans. is 'a' i.e., Hypotension Hypotension is the most common acute complication of hemodialysis paicularly among patients with diabetes mellitus. Factors involved are :- Excessive ultrafiltration, with inadequate compensatory vascular filling, impaired vasoactive or autonomic response, osmolar shifts, overzealous use of antihypeensives


Question: AML transformation common in

Aplastic anemia to AML Aplastic anemia (AA) is a clinical syndrome of peripheral blood pancytopenia and a hypocellular bone marrow. Immunosuppressive therapy is a key treatment strategy for AA. Genomic instability in AA does not appear to be a rare event. AA evolves into acute myeloid leukemia (AML) in 5-15% of all cases Ref Davidson 23rd edition pg 969


Question: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes

The syndrome of inappropriate antidiuresis (SIAD) is the most frequent cause of euvolemic hyponatremia. Glucocoicoid deficiency, Hypothyroidism, Stress, Drugs are other causes of euvolemic hyponatremia. Common causes of SIAD include pulmonary disease (e.g., pneumonia, tuberculosis, pleural effusion) and central nervous system (CNS) diseases (e.g., tumour, subarachnoid haemorrhage, meningitis). SIAD also occurs with malignancies, most commonly with small-cell lung carcinoma (75% of malignancy-associated SIAD) SIAD is also a frequent complication of ceain drugs, most commonly the selective serotonin reuptake inhibitors (SSRIs). Ref: Harrison 19e pg: 300


Question: Hyperprolactinoma causes

(Oligomenorhea): (2287-88- H18th edition; 788-Davidson 21st)HYPER PROLACTINEMIA* Hyper prolactinemia is the most common pituitary hormone hyper secretion syndrome in both men and women* PRL- secreting pituitary adenoma (Prolactinomas) are the most common cause of PRL levels > 200 mg/L* Pregnancy and lactation are the important physiologic causes of hyperprolactinemia* Amenorrhea, galactorrhea and infertility are the hall marks of hyperprolactinemia in women* More commonly hyperprolactinemia develops later in life and leads to oligo menorrhea** and ultimately to amenorrhea* Decreased libido, weight gain and mild hirsutism may also complainMen-* Diminished libido , infertility and visual loss, impotence and oligospermia* True galactorrhea is uncommon in men hypogonadism, osteopenia, reduced muscle mass and decreased beard growth


Question: Metabolic encephalopathy presents with

Ans. is 'b' anomic aphasia "Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy and Alzheimer's disease" - HarrisonAnomic aphasia is dysfunction where a person is unable to name objects.His articulation, comprehension and repetition are intact, but naming, word finding and spellings are impaired.

Disorder of Metabolism & Connective Tissue


Question: Vitamin E toxicity causes

(A) Reduce platelet aggregation # Vitamin E Toxicity:> It is likely that patients with vitamin E toxicity have been using vitamin E supplements; obtain the dose and duration of vitamin E usage. Assess concurrent use of anticoagulants or aspirin.> A nutritional assessment for vitamin K deficiency is useful in patients who present with bleeding or an elevated PT.> Effects of acute vitamin E toxicity include the following: Nausea; Gastric distress; Abdominal cramps; Diarrhea; Headache; Fatigue.> Easy bruising and bleeding - Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT).> Inhibition of platelet aggregation: Diplopia - At dosages as low as 300 IU; Muscle weakness; Creatinuria.> Chronic toxicity effects include all of the above, suppression of other antioxidants, and increased risk of hemorrhagic stroke.


Question: Vitamin E deficiency is similar to

(A) Spinocerebellar ataxia # Vitamin E deficiency causes Ataxic neuropathy due to loss of proprioception & myopathy with proximal weakness.


Question: Indications of dialysis after failure of medical management include

Dialysis is indicated when medical management fails to control volume overload, hyperkalemia, or acidosis; in some toxic ingestions; and when there are severe complications of uremia (asterixis, pericardial rub or effusion, encephalopathy, uremic bleeding). One of the major complications of hemodialysis is hypotension, paicularly in the critically ill. Ref: Harrison 19e 1811


Question: Drug of choice for pseudomembranous colitis


Question: Smoking predisposes to carcinoma of  a) Bladder  b) Ovary  c) Buccal mucosa  d) Breast  e) Stomach


Question: Gaisbock syndrome is known as

Answer is C (Spurious Polycythemia) Gaisbock syndrome refers to Spurious Polycythemia or Relative Erythrocytosis due to decreased plasma volume.


Question: The most common cause of pulmonary infection in cystic fibrosis is

Answer is A (Pseudomonas Aeroginosa): The most common cause of Pulmonary infections in cystic fibrosis is Pseudomonas aeroginosa The most common pathogen in CF is Pseudomonas Aeroginosa followed by Staphylococcus' - `Pseudomonsa:Getntnu & Molecular Biology' (Harizon Scientific Press)2008/160 Pulmonary Infection in Cystic Fibrosis The most common cause of Pulmonary infection in cystic fibrosis in children is staphylococcus aureusQ The most common cause of Pulmonary infection in cytic fibrosis in adolescents and adults is Pseudomonas Aeroginosa. The two most common cause of pulmonary infection in cystic fibrosis are staphylococcus aureus and Pseudomonas Aeroginosa. Overall (all age groups) Pseudomonas Aeroginosa is marginally more common than staphylococcus aureus as a cause of pulmonary infection in cystic fibrosis. The most common organism causing chronic lung disease in patients with cystic fibrosis is pseudomonas aeroginosa


Question: Pronator drip is a sign of

In medicine, pronator drift refers to a pathologic sign seen during a neurological examination. Jean Alexandre Barre is credited with having first described it; thus it is sometimes known as the Barre test or sign. A positive result indicates spasticity seen in UMN lesion of upper limb Ref Harrison20th edition pg 2345


Question: Hepatomegaly with liver pulsations indicates

Ref Harrison 19 th ed pg 1548 AyatoSys pulsqtpuls of liver and marked hepatomegaly are characteristic features of tricuspid regurgitation.


Question: Drug of choice for MRSA skin infection is

(B) Vancomycin # Drugs used in the treatment of MRSA: Vancomycin, Linezolid, Teicoplanin, Cotrimoxazole, Oxacillin, RifampicinTREATMENT OF COMMON INFECTIONS OF THE SKINDiagnosis/ConditionPrimary TreatmentAlternative TreatmentAnimal bite (prophylaxis or early infection)Amoxicillin/clavulanate, 875/125 mg PO bidDoxycycline, 100 mg PO bidAnimal bitea (established infection)Ampicillin/sulbactam, 1.5-3.0 g IV q6hClindamycin, 600-900 mg IV q8h plusCiprofloxacin, 400 mg IV q12horCefoxitin, 2 g IV q6hBacillary angiomatosisErythromycin, 500 mg PO qidDoxycycline, 100 mg PO bidHerpes simplex (primary genital)Acyclovir, 400 mg PO tid for 10 daysFamciclovir, 250 mg PO tid for 5-10 daysorValacyclovir, 1000 mg PO bid for 10 daysHerpes zoster (immunocompetentAcyclovir, 800 mg PO 5 times daily forFamciclovir, 500 mg PO tid for 7-10 dayshost >50 years of age)7-10 daysorValacyclovir, 1000 mg PO tid for 7 daysCellulitis (staphylococcal or streptococcalb.c)Nafcillin or oxacillin, 2 g IV q4-6hCefazolin, 1-2 g q8horAmpicillin/sulbactam, 1.5-3.0 g IV q6horErythromycin, 0.5-1.0 g IV q6horClindamycin, 600-900 mg IV q8hMRSA skin infectionVancomycin, 1 g IV q12hLinezolid, 600 mg IV q12hNecrotizing fasciitis (group A streptococcalb)Clindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4hClindamycin, 600-900 mg IV q6-8hplusCephalosporin (first- or second-generation)Necrotizing fasciitis (mixed aerobes and anaerobes)Ampicillin, 2 g IV q4hplusClindamycin, 600-900 mg IV q6-8hplusCiprofloxacin, 400 mg IV q6-8hVancomycin, 1 g IV q6hplusMetronidazole, 500 mg IV q6hplusCiprofloxacin, 400 mg IV q6-8hGas gangreneClindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4-6hClindamycin, 600-900 mg IV q6-8hplusCefoxitin, 2 g IV q6h


Question: Monday chest tightness is characteristic of


Question: A permanent staining of teeth may be produced in infants due to the administration of following in pregnancy

(A) Tetracyclines # Tetracyclines are contraindicated in children > 8 years of age because of mottling of the permanent teeth; doxycycline may be less likely than the other tetracyclines to cause this problem.> Worsening of renal function in patients with preexisting renal dysfunction has been reported with use of tetracycline.> Doxycycline & perhaps Minocycline appear to be free from these renal side effects. Alternative effective agents are nearly always available for use in patients with renal dysfunction. Minocycline can cause vertigo in up to 70% of women receiving therapeutic doses and in a lower percentage of men.


Question: pH is 7.2, pO2 is 46, pCO2 of 80 are indicative of

Type 2 respiratory failure paco2 increases ,pao2 decrease. An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of asthma, including shoness of breath, wheezing, cough, and chest tightness. Exacerbations are marked by decreases from baseline in objective measures of pulmonary function, such as peak expiratory flow rate and FEV1 . Ref Davidson edition23rd pg 573


Question: Not seen in pre capillary pulm. hypertension


Question: Pathognomonic of miliary TB

Ans. is 'b' i.e., Choroid tubercles on fundus examination


Question: The most impoant regulator of serum 1,25 (OH)2 vitamin D concentration is

A major function of parathyroid hormone is to act as a trophic hormone to regulate the rate of formation of 1,25(OH)2 vitamin D. The mechanism by which parathyroid hormone exes this effect may be secondary to its effects on phosphorus metabolism. Other hormones, including prolactin and estrogen, also may playa role in stimulating the production of 1,25(OH)2 vitamin D. Ref - Harrison's internal medicine 20e pg bone effects of PTH 2956-2957 PTH in calcium homeostasis, 2095, 2912, 2931f


Question: Volcano ulcers in esophagus are seen in

Answer- A. Herpetic esophagitisThe ulcers of herpes esophagitis can haye a punctate, linear, stellate, or volcano-like appearance, often with a thin halo fo edemaat the margins.The ulcers may be clustered together or widely separated with normal intemening mucosa.


Question: Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is

Answer is B (Botulism): Sudden onset of blurred vision, absent pupillary reflexes (fixed /dilated pupil with lack of accomodation), symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy (4 'D's of Bulbar Palsy) (Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed / Dilated pupils) Descending motor paralysis (Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin) Symmetry of symptoms/signs A clear sensorium Absence of fever Lack of sensory findings


Question: Korsakoff's psychosis is caused by deficiency of vitamin


Question: Rasmussen's aneurysm occurs due to

Rasmussen's aneurysm is a pulmonary aery aneurysm adjacent or within a tuberculous cavity. It occurs in up to 5% of patients with such lesions. It may lead to rupture and haemorrhage.


Question: For the following dyslipidemias, select the most characteristic finding.Hyperchylomicronemia.

Very elevated triglycerides are a prominent feature of this disorder. In the familial type 1 form, the defect is believed to be a deficiency of lipoprotein lipase activity. It is a rare autosomal recessive syndrome, and usually presents in childhood with typical eruptive xanthoma and abdominal pain secondary to acute pancreatitis. Secondary hyperchylomicronemia (diabetes, hypothyroidism, uremia) is a much more common syndrome.


Question: A 35 years old man Ramu has fasting and post prandial blood sugar within normal limit but urine sugar is 3 plus (+++). The diagnosis is.

Answer is A (Renal Glycosuria): 'Renal glycosuria' is characterized by urinary excretion of glucose at normal concentration of glucose in blood: Patient in question is testing positive for urinary glucose despite normal levels of both fasting and postprandial glucose in blood. This thus leads us to the diagnosis of renal glycosuria.

High carbohydrate diet taken in the morning


Question: Best method to monitor intracranial pressure is

The intraventricular catheter is the most accurate monitoring method.of intracranial pressure The catheter is inseed through the brain into the lateral ventricle. This area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal cord. Ref Harrison20th edition pg 2234


Question: NOT a characteristic feature of Alzheimer's disease

(D) Only recent memory loss[?]ALZHEIMER'S DISEASE (Senile Dementia) is a progressive disease that destroys memory and other important mental functions.oMemory loss & confusion are the main symptoms. Aphasia, Amnesia, Agnosia, Acaiculia & Aiexia.Alzheimer's Symptoms10 Warning Signs*. Short term memory loss - forgetting recent events, names and places.1. Memory loss*. Difficulty performing familiar tasks.2. Difficult to performing familiar tasks*. Disorientation especially away from normal surroundings.3. Problems with language*. Increasing problems with planning and managing.4. Disorientation to time & place*. Trouble with language.5. Poor or decreased judgment*. Rapid, unpredictable mood swings.6. Problems with abstract thinking*. Lack of motivation.7. Misplacing things*. Changes in sleep and confusion about the time of day.8. Changes in mood or behavior*. Reduced judgment E.g., being unaware of danger.9. Changes in personality10. Loss of initiative MAKING SENSE OF MEMORY LOSSSymptoms of Alzheimer'sMemory loss from Normal AgingForgetting whole experiencesForgetting part of an experienceRarely able to remember laterOften able to remember laterGradually unable to follow written I spoken directionsUsually able to follow written I spoken directionsGradually unable to use notes as remindersUsually able to use notes as remindersGradually unable to care for oneselfUsually able to care for oneself.oCurrently, there is no cure for Alzheimer's.oDrug & non-drug treatments may help with both cognitive & behavioral symptoms.oTreatments available for Alzheimer's do not slow or stop the progression of the disease, but they may help with the symptoms for a time.oThere are three cholinesterase inhibitors to treat Alzheimer's:-Donepezil; Rivastigmine; Galantamine

Intranuclear neurofibrillary tangles (NFTs)


Question: Muehrcke lines in nails are seen in


Question: In the central nervous system (CNS), oligodendrocytes share a similar function with

Oligodendrocytes in the central nervous system (CNS) share a similar function with Schwann cells in the peripheral nervous system-synthesis of myelin. Oligodendrocytes are small, round, lymphocyte-size cells that produce and maintain CNS myelin, which is primarily located in the white matter. Ceain diseases, such as progressive multifocal leukoencephalopathy, caused by a papovavirus, specifically attack oligodendrocytes and produce demyelination. Oligodendrogliomas are malignant tumors that are derived from oligodendrocytes. However, unlike Schwann cells, oligodendrocytes contribute segments of myelin sheaths to more than one axon. Gemistocytes are reactive astrocytes that have an eosinophilic cytoplasm. They are commonly seen along the periphery of cerebral infarctions. Some astrocytomas have a gemistocytic appearance. Astrocytes provide the structural framework for the neurons and are analogous to the fibroblasts in connective tissue. However, scarring in the brain is not associated with collagen synthesis but with filling in the defect with the cellular processes of astrocytes. A cerebral abscess is the only example of CNS repair with collagen, which is derived from the blood vessels. Microglial cells are derived from monocytes. They are the phagocytic cell of the CNS. Ependymal cells line the ventricles of the brain and the spinal canal. They do not produce CSF nor are they responsible for reabsorption of CSF, a function relegated to arachnoid cells. Ref - Harrison's principles of internal medicine 20e pg 349 , britannica.com


Question: Most common organ involved in sarcoidosis

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology that is characterised by the presence of non-caseating granulomas . The condition is more frequentlydescribed in colder pas of nohern Europe .The tendency for sarcoid to present in the spring and summer has led to speculation about the role of infective agents, including mycobacteria, propionibacteria and viruses, but the cause remains elusive. Genetic susceptibility is suppoed by familial clustering; a range of class II HLA alleles confer protection from, or susceptibility to, the condition. Sarcoidosis occurs less frequently in smokers. It may be associated with common variable immunodeficiency .Bilateral hilar lymphadenopathy (BHL) is often seen in young women .Alternatively, BHL may be detected in an otherwise asymptomatic individual undergoing a chest X-ray for other purposes. Sarcoidosis is considered with other DPLDs, as over 90% of cases affect the lungs, but the condition can involve almost any organ . Lofgren's syndrome - an acute illness characterised by erythema nodosum, peripheral ahropathy, uveitis, bilateral hilar lymphadenopathy (BHL), lethargy and occasionally fever - is often seen in young women. Alternatively, BHL may be detected in an otherwise asymptomatic individual undergoing a chest X-ray for other purposes. Pulmonary disease may also present in a more insidious manner with cough, exeional breathlessness and radiographic infiltrates; chest auscultation is often surprisingly unremarkable . Ref - Davidsons 23e p630


Question: A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is.

Answer is A (Irritable bowel syndrome) Stress related increase in abdominal pain with change in bowel habit and passage of mucus in stool, together with absence of 'red flag' signs such as blood in stool in a 'young female' suggest a diagnosis of Irritable bowel syndrome. Young age and Female sex are epidemiological risk factors for lBS "Younger people have a higher prevalence of lBS in the community" Although IBS may affect all ages most patients have their onset of symptoms before age of 45. Older people have a lower rate repoing frequency and onset in patients > 50 years of age is a 'Red Flag' sign that may suggest the possibility of another disease `Women are diagnosed two or three times as often as men and make up 80% of the population with severe IBS' - Harrison 17th/1899 Onset of symptoms in periods of stress suppo a diagnosis of IBS. Onset of symptoms in periods of stress or emotional upset are suggestive of IBS' - IBS is charachteristically associated with absence of blood in stool Presence of blood in stool is a 'Red Flag 'sign that suggests possibility of another disease.- "Red flag" conditions in irritable bowel syndrome that suggest possibility of another disease Presence of any of the following calls lbr fuher investigation to rule out other disease processes: Fever Blood in stools Nocturnal pain Abnormal physical findings Onset in patients> 50 years of age Weight loss or anorexia Anemia Abnormal blood studiesFamily history of inflammatory bowel disease or malignancy Abdominal pain with change in bow el habit together with passage of mucus in stool (in the absence of 'Red Flag' signs) suppos a diagnosis of IBS Symptoms that cumulatively suppo the diagnosis of Irritable Bowel Syndrome: Abnormal stool frequencyQ (for research purposes, "abnormal- defined as > 3 bowel movements/week) Abnormal stool fOrmationQ (lumpy/hard or loose/watery stool) Abnormal stool habitsQ (straining, urgency, or feeling of incomplete evacuation) Passage of mucusQ Bloating or feeling of abdominal distention


Question: In maturity onset diabetes on the young ( mody) not found is.

(D) (Glucokinase deficiency) (2968- H 18Th)Maturity- onset diabetes of the young (MODY)* Single gene defect with autosomal dominant inheritance* Early onset of hypoglycemia (usually <25 years)** Mutations in the insulin receptors cause a group of rare disorders characterized by severe insulin resistance *** MODY - ie noninsulin requiring diabetes presenting before theage of 25 years, very rarely, diabetes can develop at or soon after birth. This neonatal diabetes is usually genetic in origin with 50% due to mutations in the KATP channel of the pancreatic B cell causing insulin deficiency and diabetic ketoacidosis. However sulphonyl urea drugs overcome the defect in potassium channel signaling, so that insulin therapy is not necessary in these patients (807- Dividson 22nd)* The genetic mutation seen in the most common type of MODY is Hepatocyte Nuclear factor 1 (one)


Question: Least common finding in lymphoedema


Question: Not a cause of conjugated hyperbilirubinemia

Gilbert syndrome - Unconjugated hyperbilirubinemia.


Question: Subdural haematoma most commonly results from rupture of

Answer is C (Injury to coical bridging veins): Subdural Haemorrhage results from rupture of bridging veins that run from the coex to dural sinuses. The superior cerebral veins that bridge the coex to superior saggital sinus are most commonly involved.

Lenticulostriate branch of middle cerebral aery


Question: Most common type of emphysema

Ans. (c) Centriacinar emphysemaRef: Harrison 19th ed. /1701Emphysema: The abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of the walls and without obvious fibrosis. It begins in the respiratory bronchioles and spreads peripherally.SMOKING CAUSES intake of TAR which causes | marcrophages in alveolar region. These macrophages secrete enzyme Elastase which causes autodigestion of elastin a leading to | elasticity a EmphysemaCentriacinar emphysema is MOST COMMON FORM.* Associated with smoking* Usually seen in apices* Causes type-I respiratoryfailure: |pO2 |pCO2* MOST RELIABLE radiographic sign: Flattening of the diaphragm* Symptoms:Persistent cough, Dyspnea, Wheezing, Chest pain, Fever.* Upon examination:# Increased RR# BARREL SHAPED CHEST (AP diameter > transverse)# No cyanosis# Pink puffersAlso Know*Panlobular emphysema: involves entire ecinus UNIFORMLY.* Paraseptal emphysema: involves only distal acinus (alveolar ducts and sac). Found near pleura and can result in pneumothorax.* Irregular or cicatricial: can be either of them.


Question: The most common source of pulmonary embolism


Question: Giant cell (Hecht's) pneumonia is due to


Question: Left vertricular hypertrophy is not a feature of


Question: Neurofibromatosis I is most commonly associated with

Robbins and cotran Pathologic basis of disease-south asia edition, 9 edition * NF1 is characterised by neurofibromas of peripheral nerve, gliomas of optic nerve,Lisch nodules and cafe au lait spots.


Question: Normal value of arterial HC03' in gas exchange is

(B) 20-24 meql/L GAS EXCHANGE (SEA LEVEL)Arterial 02 tensionPao212.7 +-0.7 kPa (95+-5mmHg)Arterial C02 tensionPaco25.3 +-0.3 kPa (40 +- 2 mmHg)Arterial 02 saturationSao20.97 +-0.02 (97 +-2%)Arterial blood pHpH7.40 +- 0.02Arterial bicarbonateHCO3-24 + 2meqfLBase excessBE0 +- 2meqfLDiffusing capacity for carbon monoxide (single breath)DLco0.42 mLCO/s per mmHg (25 mL CO/ min per mmHg)Dead space volumeVD2 mUkg body wtPhysiologic dead space: dead space-tidal volume ratioVD/VT Rest <35% VTExercise <20% VTAlveolar-arterial difference for O2P(A-a)o2<2.7 kPa S20 kPa (<20 mmHg)


Question: Ambulance brings a 35 years old woman to the emergency medical services room and the diagnostic tests confirm supraventricular tachycardia as the reason for palpitations. Vagal maneuvers fails to provide adequate response. The best therapy that can be advocated is

Answer: d) Adenosine (HARRISON 19TH ED, P-1623)PAROXYSMAL SUPRA VENTRICULAR TACHYCARDIAAV NODAL RE-ENTRANT TACHYCARDIAMost common form of PSVTRegular tachycardia with a rate of 120-240/minIt tends to occur in the absence of structural heart diseaseEpisodes may last from a few seconds to many hoursThe patient is usually aware of a rapid, very forceful, regular heart beat and may experience chest discomfort, lightheadedness or breathlessness.Polyuria, mainly due to the release of atrial natriuretic peptide, is sometimes a feature.ECGTachycardia with normal QRS complexeP wave usually differs in contour from sinus beats and is often buried in the QRS complex ManagementTreatment is not always necessary.An episode may be terminated by carotid sinus massage (increase AV block) or by the Valsalva manoeuvre.Adenosine (3-12 mg rapidly IV in incremental doses until tachycardia stops) or verapamil (5 mg IV over 1 min) will restore sinus rhythm in most cases.In patients with recurrent SVT, catheter ablation is the most effective therapyWOLFF PARKINSON WHITE SYNDROMENormally AV node is the only pathway between atria and ventricles with some conduction delayAccessory bundle between atria and ventricles without conduction delay constitutes WPWA depolarization enters the ventricles early and causes pre-excitationWPW syndrome and AV nodal reentry tachycardia are examples of SVTSymptoms: palpitations, light-headedness, or syncopeECG findingsShort PR interval ( < 120 ms or < 0.12 s)Slurred upstroke of QRS complexes (delta wave)Wide QRS complexesTOC (recurrent symptomatic episodes, incessant SVT, HR > 200)- catheter ablationTreatment in pre-excited atrial fibrillation (life threatening) - DC cardioversionCarotid sinus massage or i.v. adenosine can terminate tachycardiaProphylaxis (amiodarone or propranolol) indicated in symptomatic patients onlyAV nodal reentrant tachycardia: frog sign can be elicited during arrhythmiasResponse to I.V AdenosineSupraventricular tachycardiaTerminationAtrial fibrillation, atrial flutterTransient AV blockVentricular fibrillationNo response


Question: Autism is

(B) Social & language communication problem# Autism (i.e. marked impairment in reciprocal social and interpersonal interaction): Absent social smile, Lack of eye-to-eyecontact, Lack of awareness of others' existence or feelings; treats people as furniture, Lack of attachment to parents and absence of separation anxiety, No or abnormal social play; prefers solitary games, Marked impairment in making friends, Lack of imitative behavior, Absence of fear in presence of danger.

Social and language communication problem


Question: In myasthenia gravis the neuromuscular junctions contain deposits of

Antibodies to the acetylcholine receptor can be demonstrated in the serum of most patients with myasthenia gravis. This immunoglobulinsare deposited at the neuromuscular junction and can be demonstrated immunohistochemically in muscle biopsies. Ref - Harrison's internal medicine 20e pg 3232


Question: A 23 yr. old female came with arthritis, Malar rash, oral ulcers, serositis (pleuritis or pericarditis). The likely investigation to be positive is

(A) Anti nuclear antibody # Antinuclear antibody (ANA) tests are positive in 5 to 10 percent of the general population, a rate that increases with age.> Thus, given a one in 20 frequency for ANAs and a one in 2,000 frequency for systemic lupus erythematosus, only one in 100 persons with a positive ANA test will have the disease.> Consequently, positive ANA test results must be interpreted with caution.> Given the high sensitivity of the currently used substrate for testing, a negative ANA test essentially rules out systemic lupus erythematosus.


Question: Proximal muscle weakness is not a feature of

In Myotonic dystrophy the Muscles affected are Face(including ptosis), sternocleidomastoids, distal limb, generalised later. In all other above mentioned options the proximal muscles are affected. Reference : Harrison20th edition pg 2278


Question: The best treatment for Hepatorenal syndrome


Question: Veical transmission rate in hepatitis C is

Veical transmission refers to viral transmission from the mother to the infant during pregnancy, at the time of delivery, or during the first 28 days after bih. In most infants, HCV RNA levels only become detectable several weeks after bih, suggesting perinatal infection Approximately 5% of pregnant women with chronic HCV infection will transmit the virus to their infants Ref Harrison20th edition pg 980


Question: A young man back from leisure trip has swollen knee joints & foreign body sensation in eyes. Likely cause 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. Clinical features The onset is typically acute, with an inflammatory enthesitis, oligoahritis and/or spinal inflammation. Lower limb joints and entheses are predominantly affected. In all types of ReA, there may be considerable systemic disturbance, with fever and weight loss. Achilles inseional enthesitis/tendonitis or plantar fasciitis may also be present. The first attack of ahritis is usually self-limiting, but recurrent or chronic ahritis can develop and about 10% still have active disease 20 years after the initial presentation. Low back pain and stiffness due to enthesitis and osteitis are common and 15-20% of patients develop sacroiliitis. Many extra-aicular features in ReA involve the skin, especially in SARA: * circinate balanitis, which stas as vesicles on the coronal margin of the prepuce and glans penis, later rupturing to form superficial erosions with minimal surrounding erythema, some coalescing to give a circular pattern * keratoderma blennorrhagica, which begins as discrete waxy, yellow-brown vesico-papules with desquamating margins, occasionally coalescing to form large crusty plaques on the palms and soles of the feet * pustular psoriasis * nail dystrophy with subungual hyperkeratosis * mouth ulcers * conjunctivitis * uveitis, which is rare with the first attack but arises in 30% of patients with recurring or chronic ahritis. Other complications in ReA are very rare but include aoic incompetence, conduction defects, pleuro-pericarditis, peripheral neuropathy, seizures and meningoencephalitis . Ref - Davidsons 23e p1031


Question: SIADH feature

(A) Hyponatremia with sodium excretion > 20mEq/l # Syndrome of Inappropriate Antidiuretic Hormone (ADH) secretion (SIADH) is defined by the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.> Diagnosis:> In the absence of a single laboratory test to confirm the diagnosis, SIADH is best defined by the classic Bartter-Schwartz criteria, which can be summarized as follows: Hyponatremia with corresponding hypo-osmolality Continued renal excretion of sodium Urine less than maximally dilute Absence of clinical evidence of volume depletion Absence of other causes of hyponatremia Correction of hyponatremia by fluid restriction> Cardinal features of SIADH include: Hyponatermia (dilutional hyponetremia with Na+ < 135 mmol/l) Decreased plasma osmolality (<280 m osm/kg) with inappropriately increased urine osmolality > 150 m osm). Urine sodium over 20 meq/l Low Blood urea Nitrogen < Wmg/L Hypouricemia (<4mg/dL), Absence of cardiac, liver or renal disease, Normal thyroid and adrenal function> A high BUN suggests a volume contracted state and excludes a diagnosis of SIADH.

Hyponatremia with sodium excretion > 20 mEq/L

Hypernatremia with Na+ excretion < 20 mEq/L


Question: Mannitol infusion causes increase in


Question: Subacture combined degeneration of cord is caused due to deficiency of

Ans. is 'd' i.e., Vitamin B12 Subacate combined degeneration of the spinal cord is the term used for the degeneration of the spinal cord due to vitamin B12 deficiency. The spinal cord, brain, optic nerves, peripheral nerves may all be affected in vitamin B12 deficiency but the spinal cord is usually affected first and exclusively. The tracts mainly involved in the spinal cord are: o Posterior column Coicospinal tract Later on peripheral nerves are involved Clinical features of vitamin B deficiency or subacute combined degeneration of the cord : Patient first notices mild general weakenss and paresthesia consisting of tingling 'pins and needle'. As the illness progresses the gait becomes unsteady and stiffness and weakenss of the limbs and legs develop. If the disease remains untreated ataxic paraplegia evolve. Sometimes there may be loss of superficial sensations, such as tactile, pain and thermal sensations, but these signs are rare. Loss of "vibration sense" is the most consistent sign and is usually accompanied by loss of position sensee. Motor signs seen are:- Loss of strength in proximal limb muscles Spasticity, changes in tendon reflexes Clonus and extensor plantar responses Sometimes tendon reflexes may be absente (due to involvement of peripheral nerve) o Gait is ataxic Now, The Clinicopathological Correlation Clinical features Tracts involved Paresthesia, inpairment of deep sensation and ataxia Due to lesion in posterior column Weakness, spasticity and increased tendon reflexes Due to coicospinal tract involvement Occasional findings of loss of pain and temperature Due to spinothalamic tract involvement (rarely involved) Distal and symmetrical impairmeat of superficial Involvement of peripheral nerve (occassionally)


Question: For Pure motor hemiparesis involving face, arm, and leg select the site of the lesion of cerebrovascular disease,

Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).

Penetrating branch, middle cerebral aery


Question: Critical narrowing of coronary blood vessels is


Question: Most common cause of cardioembolic stroke is

Nonrheumatic atrial fibrillation is the most common cause of cerebral embolism overall. The presumed stroke mechanism is thrombus formation in the fibrillating atrium or atrial appendage, with subsequent embolization. Patients with atrial fibrillation have an average annual risk of stroke of ~5%.MI, prosthetic valves, rheumatic hea disease, and ischemic cardiomyopathy are other causes.Ref: Harrison 19e pg: 2564


Question: Screening test for sclerodema

Answer- A. Anti-nuclear antibodyANA is the screening method of choice for systemic rheumatic disease such as systemic lupus erythyematous (SLE), mixed connective tissue disease, Sjogren syndrome, scleroderma, CREST syndrome, rheumatoid ahritis, polymyositis, dermatomyositis.


Question: Bilateral loss of sensation below a definite level of spinal cord is


Question: Pseudobulbar palsy is seen with

Answer- B. Bilateral coicobulbar lesionsThis pattern of weakness results from disorders that affect the upper motor neurons or their axons in the cerebral coex, subcoical white matter, internal capsule, brainstem, or spinal cord.With coicobulbar involvement, weakness usually is observed only in the lower face and tongue; extraocular, upper facial, pharyngeal, and jaw muscles almost always are spared.With bilateral coicobulbar lesions, pseudobulbar palsy often develops: dysahria, dysphagia, dysphonia, andemotional lability accompany bilateral facial weakness and a brisk jaw jerk.


Question: Most common abnormality associated with ARDS

The most common feature associated with ARDS is hypoxaemia,i.e.,the aerial Po2(mm Hg)/FIo2 (inspiratory O2 fraction) Reference:Harrison's Medicine- 20edition,page no:2031


Question: Marcus gunn pupil lesion

(A) Cortex# Marcus Gunn pupil is a medical sign observed during the swinging-flashlight test whereupon the patient's pupils constrict less (therefore appearing to dilate) when the light swings from the unaffected eye to the affected eye.> The affected eye still senses light and produces pupillary constriction to some degree, albeit reduced.> The most common cause of Marcus Gunn pupil is a lesion of the optic nerve (before the optic chiasm) or severe retinal disease.> The Marcus Gunn phenomenon is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye.> In the swinging flashlight test, a light source is alternately shone into the left and right eyes.> A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. This indicates an intact direct and consensual pupillary light reflex.> When the test is performed in an eye with an afferent pupillary defect, light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact afferent path, and an intact consensual pupillary reflex).


Question: Autoimmune destruction of platelets is seen in

Immune Thrombocytopenic PurpuraImmune thrombocytopenic purpura (ITP; also termed idiopathic thrombocytopenic purpura) is an acquired disorder in which there is an immune-mediated destruction of platelets and possibly inhibition of platelet release from the megakaryocyte. In children, it is usually an acute disease, most commonly following an infection, and with a self-limited course. In adults, it is a more chronic disease, although, in some adults, spontaneous remission occurs, usually within months of diagnosis.ITP is termed secondary if it is associated with an underlying disorder; autoimmune disorders, paicularly systemic lupus erythematosus (SLE), and infections, such as HIV and hepatitis C, are common causesReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 140; Disorders of Hemostasis


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

Vascular disease, by itself or in conjunction with peripheral neuropathy in DM, is a common cause of erectile dysfunction. The lesions can be in large vessels (aortic occlusion, Leriche syndrome), small arteries, or even in the sinusoidal spaces.

failure of erection with absent nocturnal penile tumescence (NPT)

absence of orgasm with normal libido and erectile function


Question: For Sudden, Unilateral or bilateral weakness, sensory loss, disorder of ocular motility, loss of facial sensation, ataxia select the site of the lesion of cerebrovascular disease,

Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).

Penetrating branch, middle cerebral aery


Question: Features of secondary syphilis are/is  a) Condyloma accuminata  b) Condyloma lata  c) Mulberry/moon molar  d) Lesions over palms/sales


Question: Palpable purpura is seen in

Answer is C (H. S. Purpura): Henoch Sconlein Purpura is associated with palpable purpura without thrombocytopeniae

Idiopathic thrombocytopenic purpura (ITP)


Question: The most common cause of dementia is

Causes of Dementia:

Alzheimer’s  (most common in >65 years old)
Vascular dementia/Multi-infarct dementia
Lewy body dementia
Fronto-Temporal dementia (50-70 years)
Huntington’s
Traumatic/Dementia pugilistica
Creutzfeldt-Jakob disease

Reversible causes of Dementia

Structural brain lesions:- Normal Pressure Hydrocephalus, SubDural Hematoma, Brain Tumors
Alcohol dementia/ Wernicke’s encephalopathy
Vitamin B12 deficiency
Endocrine:- Hypo/Hyper-thyroidism, Hypo-Parathyroidism
Metabolic disorders:- Dyselectrolytemia (Na, Ca, K), hepatic or renal failure
Autoimmune:- Hashimoto’s paraneoplastic encephalopathy (anti- Yo, Hu, Ri)
Infections:- Whipple’s, Lyme disease, Syphilis, HIV dementia.


Question: The commonest type of seizure in a newborn is

The most common seizures in late infancy and early childhood are febrile seizures.The overall prevalence is 3-5% and Patients often have a family history of febrile seizures or epilepsy.Febrile seizures usually occur between 3 months and 5 years of age and have a peak incidence between 18 and 24 months.The typical scenario is a child who has a generalized, tonic-clonic seizure during a febrile illness during the rising phase of the temperature curve (i.e., during the first day).A simple febrile seizure is a single, isolated event, brief, and symmetric in appearance.Complex febrile seizures are characterized by repeated seizure activity, duration >15 minutes, or by focal features.Complex febrile seizures have a risk of 2-5% of recurrence.Ref: Harrison; 19th edition


Question: Midday meal Contains

Midday meal should supply 1/3rd of total energy requirement and 1/2 of total protein requirement.


Question: Bilateral loss of tendon jerk and extensor plantar response is seen in


Question: The Most common presentation of multiple sclerosis

(A) Sensory loss # Initial symptoms of MSSYMPTOM%SYMPTOM OF CASES%* Sensory loss37* Lhermitte3* Optic neuritis36* Pain3* Weakness35* Dementia2* Paresthesias24* Visual loss2* Diplopia15* Facial palsy1* Ataxia11* Impotence1* Vertigo6* Myokymia1* Paroxysmal attacks4* Epilepsy1* Bladder4* Falling1


Question: Shock lung is seen in


Question: The aery most frequently responsible for bleeding in massive hemoptysis is

Answer is A (Bronchial Aery): The most common source of bleeding in massive hemoptysis are the Bronchial aeries which are pa of the high pressure systemic circulation The most common source of bleeding in hemoptysis is the tracheobronchial tree which can be affected by inflammation (bronchitis, bronchiectasis) or neoplasm (bronchiogenic carcinoma, endobronchial metastatic carcinoma or bronchial carcinoid tumor). The bronchial aeries which originate from either the aoa or from intercostal aeries, and are therefore pa of the high pressure systemic circulation are the source of bleeding in bronchitis, bronchiectasis or with endobronchial tumors ' `While alveolar haemorrhages arise from capillaries that are pa of the low pressure pulmonary circulation, bronchial bleeding is generally from bronchial aeries which are under systemic pressure and therefore predisposed to large volume bleeding'


Question: A patient comes to hospital with a history of sore throat, diarrhoea and sexual contact 2 weeks before. The best investigation to rule out HIV is