MCI SEPT 2009 MEDICINE

Respiratory system

1. Muscles involved in quiet breathing:
a. Diaphragm alone
b. Diaphragm with external intercostals!
c. Diaphragm with internal intercostals
d. Diaphragm with scalaneus anterior
2. Rapid shallow breathing is seen with:
a. Asthma!
b. ILD
c. Pneumonia
d. Brochiectasis

3. Not seen in legionarre disease
a. Dry cough
b. Fever
c. Diarrhea
d. Mental confusion!
4. Apical lung cancer can cause:
a. horner syndrome!
b. SVC syndrome
c. Caplan syndrome
d. Felty syndrome

5. Type 2 respiratory failure is seen with:
a. COPD!
b. Fracture Rib
c. Pulmonary edema
d. Bronchiectasis

6. Anti tobacco day:
a. 31st may!
b. 31st august
c. 31st September
d. 31st December

7. bupripion acts by:
a. Inhibiting nor –epinephrine /dopamine uptake and reduces craving!
b. Inhibits serotonin and reduced withdrawl symptoms of smoking
c. Inhibits Ach levels
d. Inhibits choline acyl transferase.

8. Type 3 respiratory failure which is difficult:
a. Walking 100 metres!
b. Use bathroom
c. Get up from the bed
d. All of above
9. felty syndrome is associated with
a. Rheumatoid arthritis!
b. SLE
c. Sarcoiudosis
d. Hamman rich syndrome
10. 100%oxygen will not improve cyanosis in
a. TOF!
b. Pneumonia
c. Shock
d. Pulmonary edema
11. ECG change in pulmonary embolism
a. S1Q3T3!
b. Sinus bradycardia
c. T wave inversion
d. Tall T waves in V5-V6
12. Preferred Ventilation modality for pulmonary edema:
a. CPAP!
b. IPPV
c. ACMV
d. PSV

13. Best diagnosis for Brochiectasis
a. HRCT!
b. Bronchoscopy flexible
c. Bronchoscopy rigid
d. MRI
14. When both vagi are cut, what happens to respiration:
a. Fast and shallow
b. Fast and deep
c. Slow and deep
d. Slow and shallow
15. PO2/ FiO2 ratio in ARDS is less than
a. 500
b. 400
c. 300
d. 200!

16. Dyspnea at rest is which grade by classification:
a. 1
b. 2
c. 3
d. 4!
17. For minmal pleural efffussion diagnosis by CXR, pleural fluid amount is:
a. 50ml!
b. 150ml
c. 200ml
d. 250ml

18. SVC syndrome is caused by:
a. Ca lung!
b. Lymphoma
c. Sarcoidosis
d. Silicosis
19. Acute asthma can be best treated by:
a. Steroids
b. leukotriene modifiers
c. ketotifen
d. salbutamol.!
Hematology

20. auer rods are seen in which variety of AML
a. M3!
b. M4
c. M5
d. M6
21. Decreased osmotic fragility is seen in:
a. Hereditary spherocytosis
b. Sickle cell anemia!
c. thalassemia
d. Autoimmune hemolytic anemia

22. False about tumor lysis syndrome is
a. hypercalcemia!
b. hyperphosphtemia
c. Hyperkalemia
d. hyperuricemia
23. All are true about heparin except:
a. Anti-dote is protamine sulfate
b. Increased activity of anti-thrombin
c. Can only be given in –vivo!
d. Inhibits conversion of activated factor X

24. Characteristic of chediak hegashi syndrome is all except:
a. Defective phagocytosis!
b. Life threatening bacterial infections with staph aureus
c. Oculo cutaneous albinism
d. Lysosomal storage disorder
25. Not a complicatin of blood transfusion except:
a. Citrate poisoning
b. hypocalcemia
c. hypomagnesemia
d. Hypokalemia!

26. Defect in Di-george syndrome is:
a. Defective cell mediated immunity!
b. hypocalcemia
c. Thymus hypoplasia
d. Agammaglobulinemia
27. Not seen with hogkins lymphoma
a. B cell lineage
b. Contigous spread to lymph nodes
c. Chemotherapy for stage 2A!
d. Associated with EBV

Cardiovascular
28. CVP cathrether is ideally placed at
a. SVC
b. RA !
c. SVC and RA
d. Subclavian vein
29. Coronary predominance is determined by
a. Vessel feeding post descending artery!
b. Vessel feeding left circumflex artery
c. sinu atrail artery
d. Vessel feeding LAD
30. Austin flint murmur is seen in:
a. AR!
b. AS
c. MR
d. MS

31. Postural hypotension is defined as
a. Fall in BP exceeding 20/10 mm Hg on change of posture/table tilt test!
b. Fall in BP exceeding 40/20 mmHg on change of posture
c. Any fluctuation of BP on change of posture that causes dizziness/syncope
d. Fall in only SBP more than 20 mg Hg on change of posture

32. Sustained VT is best managed by
a. CCB
b. digoxin
c. Adenosine
d. lignocaine!

Central nervous system

33. acetycholine receptors at neuro-muscular end plate is reduced in
a. Myasthenia Gravis!
b. Lambert Eaton syndrome
c. Hyokalemic periodic paralysis
d. Spino-cerebellar ataxia
34. Correct about prions is:
a. misfolded cellular proteins!
b. Smallest living particle with nucleic acid
c. EEG shows 3/sec spike and slow wave on EEG
d. Not demons ratable on brain biopsy

35. sumatriptan is
a. 5HT antagonist used for acute migraine!
b. 5HT agonist used for opthalmoplegic migraine
c. NE uptake inhibitor used for recurrent attacks of migraine prophylaxis
d. Dopamine uptake inhibitor used for migraine attacks
36. Most common cause of meningitis in adults is
a. Strept pneumoniae!
b. Neisseria meningitis
c. Hemophilus influenzae
d. Listeria monocytogenes

37. kernig sign is seen in
a. Acute bacterial meningitis!
b. Encephalitis
c. Viral meningitis
d. All of above
38. Chronic meningitis is seen with
a. crytococcosis
b. C. jejuni
c. TB!
d. arboviruses
39. In duchenne muscular dystrophy the muscles mainly affected are
a. truncal muscles
b. Shoulder girdle muscles
c. Lower limb proximal muscles!
d. Lower limb distal muscles
Fluids and electrolytes
40. Delirium and worsening of neurological status in patient of TURP is due to
a. Water intoxication!
b. hypernatremia
c. Pontine myelinosis
d. hypomagnesemia
41. Normal anion gap is seen in
a. CRF
b. Methyl alcohol poisoning
c. Starvation
d. ureterosigmoidostomy!
42. ECG finding of Hypokalemia is
a. Elevated T wave
b. Inverted T wave!
c. Normal T wave
d. Bified T wave
Endocrinology

43. Most common cause of hypothyroidism is India
a. Iodine deficieny!
b. riedel thyroidits
c. hashimoto thyroiditis
d. Drug induced

44. Medical adrenalectomy is done with
a. aminogluthemide!
b. mitotane
c. Meta-pyrone
d. mirapex
a.Aminoglutethimide is an anti-steroid drug, It blocks the production of steroids derived from cholesterol and is clinically used in the treatment of Cushing's syndrome and metastatic breast cancer. It is also a drug of abuse by body builders.
Aminoglutethimide has a two mechanisms of action:
It blocks aromatase[2] in the generation of estrogens from androstenedione and testosterone.
It blocks the conversion of cholesterol to pregnenolone by inhibiting the enzyme P450scc and consequently decreases synthesis of all hormonally active steroids.
Side effects
Its side effects are skin rash, hepatotoxicity, inhibition of cortisol in the human body, and it may also cause hypothyroidism.Since cortisol helps break down muscle, aminoglutethimide is used by bodybuilders in a steroid cycle.
Clinical uses
Aminoglutethimide is indicated in conjunction with other drugs for the suppression of adrenal function in patients with Cushing's syndrome.
It is also a 2nd or 3rd line choice for the treatment of hormone sensitive (estrogen and progesterone) metastatic breast cancer.
Abuse
Aminoglutethimide is abused by body builders and other steroid users to lower circulating levels of cortisol in the body and prevent muscle loss. Cortisol is catabolic to protein in muscle and effective blockade of P450scc by aminogluthethimide at high doses prevents muscle loss
b. Metyrapone (Metopirone) is a drug used in the diagnosis of adrenal insufficiency and occasionally in the treatment of Cushing's syndrome (hypercortisolism).
Metyrapone blocks cortisol synthesis by inhibiting steroid 11β-hydroxylase. This stimulates ACTH secretion, which in turn increases plasma 11-deoxycortisol levels. When excess ACTH secretion is the cause of hypercortisolism, the metyrapone test helps clarify if the source of the ACTH is pituitary or ectopic (non-pituitary
Uses
Metyrapone can be used in the diagnosis of adrenal insufficiency. Metyrapone 30mg/kg, maximum dose 3000 mg, is administered at midnight usually with a snack. The plasma cortisol and 11-deoxycortisol are measured the next morning between 8:00 and 9:00 am. A plasma cortisol less than 220nmol/l indicates adequate inhibition of 11β-hydroxylase. In patients with intact Hypothamalmo-pituitary-adrenal axis, CRH and ACTH levels rise as a response to the falling cortisol levels. This results in an increase of the steroid precursors in the pathway. Therefore if 11-deoxycortisol levels do not rise and remains less than 7 mcg/dl then it is highly suggestive of impaired HPA axis.Metyrapone test may aid in verifying the cause of Cushing's syndrome. Most patients with pituitary dysfunction and/or pituitary microadenoma will increase ACTH secretion in response to metyrapone, while most ectopic ACTH-producing tumors will not. Pituitary macroadenomas do not always respond to metyrapone.
c.Mitotane, is a medication used in the treatment of the adrenocortical carcinoma.Mitotane alters steroid peripheral metabolism, directly suppresses the adrenal cortex and alters cortisone metabolism leading to hypocortisolism. Side effects include anorexia and nausea (88%), diarrhea (38%), vomiting (23%), decreased memory and ability to concentrate (50%), rash (23%), gynecomastia (50%), arthralgia (19%), and leukopenia (7%).
d.mirapex [ that’s the trade name for Pramipexole! And man are u expected to know that?] Pramipexole is used for treatment of Parkinsonism and paralysis agitans.
45. Best for diagnosis of primary hypothyroidism is:
a. Elevated TSH !
b. Reduced TSH
c. Reduced T4 and T3
d. Elevated TRH
46. sibutramine is used in
a. Obesity With BMI 30-35!
b. Obesity with BMI 35-40
c. Pre- obesity
d. Weight gain on patient of hypothyroidism
47. catecholamine maximum secreted in phaeochromocytoma is :
a. nor epinephrine!
b. epi nephrine
c. serotonin
d. 5 HT derivatives
48. Nodular glomerulosclerosis is seen with
a. Lipoid nephrosis
b. finnish variety of nephrotic syndrome
c. Diabetes mellitus!
d. IgA nepgropathy
49. After splenectomy infection not seen is
a. Streptococcus pneumoniae
b. Gonococcus
c. H. influenzae
d. klebsiella!

50. Nosocomial infection can be best reduced by
a. Hand washing
b. Antibiotics determined by culture sensitivity
c. GM –CSF administration
d. Face masks and good air flow!

51. Serum alkaline phosphatase SAP is increased in all except:
a. Multiple myeloma!
b. Rickets
c. hypoparathyrodism
d. osteomalacia
52. Sequence of changes in tips of fingers in Raynauds phenomenon is:
a. white –blue –red!
b. white –red- blue
c. red –blue white
d. blue- white red

53. All occur in heat stroke except:
a. Loss of conciousness
b. Hyperthermia
c. Muscle cramps
d. Sweating!
54. Best for diagnosis of diabetic nephropathy is
a. Urine micro-albuminemia
b. Renal biopsy!
c. DMSA scan
d. Glycosylated hemoglobin

55. Atrophy of adrenal gland will cause levels of which hormone to decrease
a. ACTH
b. Prolactin
c. CRH!
d. TRH
GIT
:
56. Heller’s myotomy is best suited for
a. achalsia cardia!
b. GERD
c. Nutcracker esophagus
d. Barret esophagus
57. Bleeding esophageal varices are best treated by:
a. octreotide!
b. vsopressin
c. somatostatinAVP