MCI September 2011

1. Oculomotor nerve palsy affects all of the following muscles EXCEPT
a. Medial rectus
b. Superior oblique
c. Inferior oblique
d. Levator palpabrae superioris

2. A 25 year old male has restriction of eye movements in all the directions intermittent ptosis, proximal muscle weakness & fatigability. The most useful test would be
a. Edrophonium test
b. CPK
c. EMG
d. Muscle biopsy

3. All of the following can cause dissociated sensory loss except
a. Anterior spinal artery thromobosis
b. Syringomyelia
c. Ependymoma of spinal cord
d. Tabes dorsalis

4. Which of the following is a useful screening test of diagnosis of Cushing’s disease?
a. Low dose dexamethasone superior test
b. Overnight dexamethasone suppression test
c. High dose dexamethasone suppression test
d. Measurement of fasting serum cortisol at 8AM

5. “Stocking or glove” distribution of sensory loss is a feature of
a. Radiculopathy
b. Peripheral neuropathy
c. Myelopathy
d. Cortical sensory loss

6. Criteria for classification of rheumatoid arthritis include all of the following except
a. Morning stiffness more than one hour
b. Symmetric arthritis
c. Symptoms for at least six months
d. Rheumatoid nodules

7. Substances which have the same atomic number but different mass number are called
a. Isobases
b. Isodoses
c. Isotopes
d. Isomers

8. The typical skin lesions seen in erythema multiforme are
a. Wheals
b. Target lesions
c. Bullae
d. Erosions

9. Hidradenitis suppurative is chronic infection is
a. Apocrine sweat gland
b. Sebaceous gland
c. Lymph node
d. Dermis

10. Drug of choice for deep vein thrombosis prophylaxis in surgical patients is
a. Intravenous unfractionated heparin
b. Subcutaneous unfractionated heparin
c. Subcutaneous low molecular weight heparin
d. Warfarin

11. Initial treatment for pulmonary embolism is
a. Fibrinolysis
b. Anticoagulation
c. Surgical embolectomy
d. Venacaval filter

12. A 43 year old female is diagnosed to have hydatid cyst. The most common site where this is found is:
a. Pancreas
b. Lung
c. Liver
d. Spleen

13. Cervical cancer vaccines are recommended for which age group
a. More than 18 years
b. 18-55 years
c. 9-26 years
d. All post menopausal females

14. High resolution CT is the ideal modality for evaluation of
a. Pleural effusion
b. Lung mass
c. Interstitial lung disease
d. Lymphadenopathy

15. Which of the following antitubercular agent DOES NOT cause hepato-toxicity?
a. Isoniazid
b. Rifampicin
c. Ethambutol
d. Pyrazinamide

16. Which of the following disorders should be suspected in a new born with edema of hand and feet?
a. Turner syndrome
b. Marfan’s syndrome
c. Homocysteinuria

17. Renal vein thrombisis can occur in all of the following except
a. Trauma
b. Renal cell carcinoma
c. Sickle cell anaemia
d. Nephritic syndrome

18. The condition virtually pathognomonic of HIV disease is
a. Oral candidiasis
b. Molluscum contagiosum
c. Oral hairy leukoplakia
d. Tinea versicolor

19. What cut-off score of Mini-Mental State Examination (MMSE) is used to detect dementia ?
a. Less than 20
b. Less than 24
c. Less than 27
d. Less than 29

20. Marrow plasmacytosis is diagnosis of multiple myeloma. What is the threshold level?
a. >5%
b. >10%
c. >30%
d. >50%

21. A patient diagnosed to have deep vein thrombosis is being treated with heparin. Which of the following test will you order to adjust its dosage
a. Platelet count
b. Prothrombin time
c. Bleeding time
d. Activated thromboplastin time

22. A construction worker has sustained a massive crush injury of right lower limb. He soon develops acute renal failure. Which complication has he developed
a. Necrotizing fasciitis
b. Acute osetomyelitis
c. Compartment syndrome
d. Crush syndrome

23. Extradural haematoma occurs because of
a. Rupture of dural sinus
b. Rupture of middle meningeal artery
c. Rupture of internal carotid artery
d. Rupture of middle cerebral artery

24. Recommended rate of chest compression during cardiopulmonary resuscitation in adults is
a. About 72 compression per minute
b. At least 72 compression per minute
c. About 100 compression per minute
d. At least 100 compression per minute

25. Which one of the following ophthalmological findings at characteristic of proliferative diagbetic retinopathy
a. Microaneurysms
b. Dot and blot haemorrhges
c. Macular scar
d. Neovasculariztion

26. Which of the following dose NOT cause hypoglycemia
a. Insulin
b. Glimepiride
c. Metformin
d. Gliclazide

27. All of the following are sings of aortic regurgitation except
a. Quincke’s sign
b. Duroziez’s sign
c. Carvello’s sign
d. De Musset’s sign

28. A 60 year old diabetic is being managed in a hospital for cellulitis. He suddenly develops hypotension. What is the most likely type of shock
a. Hemorrhagic
b. Neurogenic
c. Cardiogenic
d. Septic

29. Which of the following feature is NOT seen in Guilain Barre Syndrome?
a. Symmetric muscle weakness
b. Profound sensory loss
c. Cranial nerve involvement
d. Involvement of autonomic nervous system

30. Wegener’s granuloma is treated mainly by
a. Radiotherapy
b. Surgery
c. Cytotoxic drug and steroids
d. Laser excision

31. “Diffuse axonal Injury” is best detected on
a. Non contract CT
b. Contrast CT
c. MRI
d. Transcranial Doppler

32. Measles rash is characterized by all of the following EXCEPT
a. Appears 4-5 days after onset of fever
b. It is macula-papular in character
c. It first appears on face and back on neck
d. It is associated with cervical and occipital lymphadenopathy

33. All of the following statements regarding Chikungunya arthritis is true,EXCEPT
a. Affects small joints most often
b. Causes early morning pain and swelling
c. Can persist for months
d. Early institution of steroids is essential

34. Following are the causes of the trachea ‘pushed’ to opposite side, EXCEPT in
a. Fibrocavitatory disease
b. Pleural effusion
c. Pneumothorax
d. Tumour

35. Which one of the following is NOT a function of temporal lobes
a. Audition
b. Emotion
c. Motivation
d. Memory

36. The microorgranism most intimately associated with seborrheic dermatitis is
a. Microsporum
b. Stretpcoccus
c. Corynebacterium
d. Pityrosporum

37. The single most effective way to prevent cross infection in hospitals is
a. Hand washing
b. Antibiotic prophylaxis
c. Vaccination
d. Isolation

38. Chagas disease is caused by infection with
a. Trypanosoma gambience
b. Trypanosoma rhodesiense
c. Trypanosoma cruzi
d. Trypanosoma brucei

39. The correct dose of vitamin A for xerophthamia in adult is
a. Two dose of 60 mg two weeks apart
b. Single dose of 60 mg
c. Two doses of 30 mg two week apart
d. Single dose of 30 mg

1 µg retinol = 3.33 IU. Dietary deficiency is traditionally treated with vitamin A palmitate in oil 60,000 IU po once/day for 2 days, followed by 4500 IU po once/day. If vomiting or malabsorption is present or xerophthalmia is probable, a dose of 50,000 IU for infants < 6 mo, 100,000 IU for infants 6 to 12 mo, or 200,000 IU for children > 12 mo and adults should be given for 2 days, with a third dose at least 2 wk later

40. The half life of serum albumin is about
a. 7 days
 b. 14 days
c. 21 days
d. 28 days

41. Which of the following is NOT true regarding prolactinoma?
a. It may manifest as galactorrhea amenorrhea, hypogondism
b. They arise from acidophil cells of pituitary gland
c. Symptoms of raised intracranial tension may occur
d. Transphenoidal surgery is the treatment of choice

42. Which of the following is typically seen in hypothyroidism?
a. Weight loss
b. Tachycardia
c. Brisk tendon reflexes
d. Cold intolerance

43. Acute lymphangitis is caused by
a. Streptococcus pyogenes
b. Pseudomonas
c. Escherichia coli
d. Staphylococcus aureus

44. Sunflower cataract is seen in
a. Chalcosis
b. Siderosis
c. Diabetes
d. Trauma

45. Largest source of radiation exposure to general population is
a. Computers
b. Diagnostic radiology
c. Nuclear weapons
d. Freon industry

46. Neuroleptic malignant syndrome and Torsades de pointes are the most feared adverse effects of one of the following drugs for sedation on the ICU
a. Dexmetomidine
b. Haloperidol
c. Propofol
d. Midazolam

47. 2 year old child with high fever and irritability develops seizures within 24 hours of onset. By 4th day, fever subsides and rashes appear. The most likely diagnosis is
a. Erythema infectiosum
b. Exanthema subitum
c. Measles
d. Typhus fever

48. Tractional retinal detachment is seen in
a. High myopia
b. Proliferative diabetic retinopathy
c. Central retinal artery occlusion
d. Malignant hypertension

49. Cocaine overdose presents with all of the following except
a. Diaphoresis
b. Hypertension
c. Constricted pupils
d. Agitation

50. Sympathetic Ophthalmitis occurs following injury to
a. Lens iris and ciliary body
b. Optic nerve
c. Cornea

51. Isolated 3rd nerve palsy is seen in
a. Frontal lobe behavior
b. Weber’s syndrome
c. Diabetes mellitus
d. Lateral medullary syndrome

52. Air travelers have an increased risk of
a. Venous thrombosis
b. Polycythemia
c. Pulmonary edema
d. Cerebral edema

53. All of the following are true regarding management of postural hypotension EXCEPT
a. Head up tilt of the bed
b. Correction of dehydration
c. Fludrocortisones
d. Avoid using Non-Steroidal Anti-Inflammatory Drugs

54. CA 19-9 is usually associated with
a. Cancer ovary
b. Carcinoma beast
c. Carcinoma pancreas
d. Carcinoma lung

55. Acute onset dyspnoea is seen in all of the following conditions except
a. Pulmonary hamartoma
b. Pneumothorax
c. Pulmonary embolism
d. Pulmonary edema

56. A 28 yrs old woman gave birth to a small of age newborn at 38 weeks of pregnancy. On examination, the new born found to have rhinitis, distended abdomen; wrinkled skin, and palmoplanter blister. The woman had an earlier history of abortion and stillbirth. The most likely diagnosis is
a. Neonatal pemphigus
b. Scabies
c. Congenital syphilis
d. Congenital HIV infection

57. Acute subdural haematoma is because of
a. Venous bleeding
b. Arterial bleeding
c. Capillary bleeding
d. Lymphatic oozing

58. Investigation of choice for pericardial effusion is
a. CT scan
b. MRI
c. Echocardiography
d. X-ray chest

59. Investigation of choice in acute subarachnoid haemorrhage is
a. Ultrasound
b. Non-contrast CT
c. Contrast-enhanced CT
d. Contrast –enhanced MRI

60. Beyond what age, absence of social smile is regarded as abnormal
a. 12 weeks
b. 14 weeks
c. 16 weeks
d. 18 weeks

61. Persistent cough may be caused by all of the following except
a. Post nasal drip
b. Angiotensin converting enzyme inhibitor
c. Angiotensin –II receptor antagonists
d. Gastro-esophageal reflux

62. Which one of the following is a feature of normal pressure hydrocephalus?
a. Gait disturbance
b. Aphasia
c. Global confusion
d. Ophthalmoplegia

63. The FAST questionnaire is used for identification of
a. Smoking problems
b. Alcohol problems
c. Sleep problems
d. Memory problems

64. The IV fluid used in Prakland formula for burns is
a. Normal saline
b. Dextrose saline
c. Ringer lactate
d. Haemacel

65. All of the following may be associated with esophageal carcinoma except
a. Barrett’s esophagus
b. Achlasia
c. Hiatus hernia
d. Chronic reflux esophagitis

66. The commonest cause of unilateral foul smelling nasal discharge in children in
a. Antrochoanal polyp
b. Foreign body
c. Acute sinusitis
d. Nasal diphtheria

67. PET imaging of tumour utilizes
a. 18FDG
b. 11C methonine
c. Indium III-DTPA
d. 99 m Tc-DTPA

68. Amenorrhoea is seen in all of the following conditions except
a. Pregnancy
b. Hyperprolactinemia
c. Insulinoma
d. Polycystic ovarian disease

69. First diagnosis to be considered in a patient with deep vein thrombosis with symptoms of chest pain, haemoptysis & breathlessness is
a. Myocardial infarction
b. Pulmonary embolism
c. Pleurisy
d. Pneumonia

70. All of the following are feature of tension pneumothorax except
a. Neck vein distention
b. Tachycardia
c. Chest pain
d. Hypertension

71. Investigation of choice for detecting minimal pleural effusion is
a. Ultrasound
b. CT scan
c. MRI
d. Chest X-ray

72. Polimyelitis involves
a. Anterior horn cells
b. Peripheral nerve
c. Motor cortex
d. Spinothalamic tracts

73. Dupuytren’s contracture of hand commonly start in
a. Thumbs
b. Index finger
c. Middle finger
d. Ring finger

74. In which of the following, orbital metastasis is common
a. Hypernephroma
b. Neuroblastoma
c. Melanoma
d. Hepatoma

75. Horner’s syndrome is characterized by all of the following except
a. Ipsilateral miosis
b. Ipsilateral anhydrosis
c. Ipsilateral proptosis
d. Ipsilateral enophthalmos

76. Scabies can be effectively treated systemically by
a. Psoralens
b. Ivermectin
c. Permethrin
d. Cotrimoxazole

77. A male had crush injury of the thigh. He did not seek any medical attention. 3 days later, he presented with sepsis. Examination of the thigh revealed wound under tension with crepitus. What is the most likely organism responsible for this condition
a. Streptococcus
b. Pseudomonas
c. Clostridium tetani
d. Clostridium welchi

78. The best screening test for diagnosis of Wilson’s disease is
a. Estimation of serum ceruloplasmin
b. Estimation of serum copper
c. Estimation urinary copper
d. Eye test for KF ring

79. Most sensitive test for DIC (Disseminated Intravascular Coagulation) is
a. D-Dimer assay
b. Prothrombin time
c. aPTT
d. TT (Thrombin Test)

80. Best way of pre-operative hair removal to achieve lowest rates of infection is
a. Shaving the night before surgery
b. Shaving just before surgery
c. Cream depilation
d. Hair clipping

81. The perinatal mortality rate is expressed as per 1000
a. Live births
b. Pregnancies
c. Total births
d. Infants

82. Test recommended to assess the relative patency and contribution of radial and ulnar arteries before connulation is
a. Snider’s test
b. Valsava test
c. Palpation of radial and ulnar pulse
d. Modified Allen test

83. The amount of oxygen dissolved in the blood dependent upon:
a. The hemoglobin level
b. The respiratory rate
c. The partial pressure of oxygen
d. Nitrites & suphonamides in blood

84. Myoglobinuria is most commonly seen in
a. Chemical burns
b. Electrical burns
c. Flame burns
d. Radiations burns

AIIMS may 2011

1. Which of the following about atherosclerosis is true?
a. Intake of unsaturated fatty acids is associated with decreased risk
b. Thoracic aorta involvement is more common and severe than abdominal aorta involvement
c. Extent of lesion in veins is same as that in arteries
d. Hypercholesterolemia does not always increase the risk of atherosclerosis per se
Ans. A Intake of unsaturated fatty acid associated with decreased risk
Ref: Harrison 17th edition page no2429

Elementary guys considering the high prevalence of atherosclerosis in india, much has been said regarding the intake of transfats and saturated fats.
Role of PUFA
• “N-3 polyunsaturated fatty acids (n-3 PUFAs) are present in high concertration in fish and in flax seeds
• The most widely used n-3 PUFAs for the treatment of hyperlipdernias are the two active molecules in fish oil: eicosapentanoic acid (EPA) and dcohexanoic acid (DHA)
• N-3 PUFAs have been concentrated-into tablets and decrease fasting triglycerides in doses of 3—4 g/d
• Fish oils can results in an increase in plasma LDL-C levels in some patients
• Fish oils supplements can be used in combination with fibrates, niacin, or stains to treat hypertriglyceridemia. In general, fish oils are well tolerated and appear to be safe, arleast at doses up to 3—4 g
• Although fish oil administration is associated with a prolongation in the bleeding time, no increased in bleeding has been seen in clinical trails
• A lower dose of omega 3 (about 1g) has been associated with reduction in cardiovascular events in CHD patients and is used by some clinicians for this purpose.”

2. A girl presented with severe hyperkalemia and peaked T waves on ECG. Most rapid way to decreased serum potassium level?
a. Calcium gluconate IV
b. Oral resins
c. Insulin + glucose
d. Sodium bicarbonate
Ans. C. Insulin + glucose
Ref: Harrison 17th e/p. 284.
Hyperkalemia is treated by following ways.
• Injection calcium gluconate – it stabilizes cardiac membrane and thus prevent arrhythmia. It does not reduce serum potassium level. It is usually given wen serum potassium level are very high
• Injection dextrose insulin drip – it is the most widely used method to reduce serum potassium level. It is the fastest method to reduce potassium level
• Bêta 2 agonist – like salbutamol & Albuterol can also reduce serum potassium level
• Potassium chelating resin- they are used orally, usually for long term use, the prevent serum potassium level to rise. Resins are slow acting used in chronic hyper kalemia
• Dialysis
• Injection NahCO3- it is used to treat sever acidosis when PH is below 7.1 acidosis is usually associated with hyperkalemia so when we treat by NahCO3, potassium level also falls. But please note NahCO3 is not used to treated hyperkalemia as such

Treatment for urgent control of hyperkalemia.

Modality Onset Duration
Calcium Gluconate 0-5 minutes 1 hour
Sodium Bicarbonate 15-30 minutes 1-2 hour
Insulin 15-30 minutes 4-6 hours
Albuterol 15-30 minutes 2-4 hours

3. A 9 yrs old girl has difficulty in combing hairs and climbing upstairs since 6 /months. She has Gower’s sign positive and maculopapular rash over metacarphalangeal joints. What should be the next appropriate investigation to be done?
a. ESR
b. RA factor
c. Creatine kinase
d. Electromyography
Ans. C. Creatine Kinase
Ref: Harrison ed. 17th pg no: 2700
In the question, as the patient is not able to comb her hair and is unable to climb up stairs it means she is suffering most likely with proximal myopathy. She also has skin lesion. Over the metacarphalangeal joints, she probably has dermatomyositis & the skin lesion seem to be Gottron’s sign
The clinically suspected diagnosis of PM, DM, or IBM is confirmed by examination the serum muscle enzymes, EMG findings and muscle biopsy (Table 383-2)

Table 383-2 (Harrison ed. 17th) Criteria for Diagnosis of inflammatory Myopathies
Criterion Definite Probable Dermatomyositis Inclusion Body Myositis
Myopathic muscle weaknessa Yes Yes Yesb Yes; slow onset, early involvement of distal muscle, frequent falls
Electromyographic findings Myopathic Myopathic Myopathic Myopathic with mixed potentials
Muscle enzymes Elevated (up to 50-fold) Elevated (up to 50-fold) Elevated (up to 50-fold) Elevated (up to 10-fold) or normal
Muscle biopsy findings “Primary” inflammation with the CD8/MHC-1 Ubiquitous MCH-I expression but minimal inflammation and no vacuoles Perifascicular perimysial, or pervascualr infiltrates, perifascicular atrophy Primary inflammation with CD8/MHC-1
Complex; vacuolated fibres with –amyloid deposits; cytochrome oxygenase-negative fibers; sings of chronic myopathy
Rash or cacinosis Absent Absent Present Absent

• ESR & RA factor would not directly help in establishing the diagnosis of inflammatory myopathy Needle
• EMG shows myopathic potentials characterized by short-duration, low-amplitude polyphasic units on voluntary activation and increased spontaneous activity with fibrillations, complex repetitive discharges, and positive sharp waves.
• These EMG findings are not diagnosis of an inflammatory myopathy but are useful to identify be presence of active or chronic myopathy and to exclude neurogenic disorders
• Muscle biopsy is the definitive test for establishing the diagnosis of inflammatory myopathy and for excluding other neuromuscular disease

Hereditary Myopathies
Muscular dystrophy refers to a group of hereditary progressive disease each within unique phenotypic and genetic features. (Table 382-5, 382-7)

Type Inheritance Onset Age Clinical Features Other Organ Systems Involved
Duchenne XR Before 5 years Progressive weakness of girdle muscle
Unable to walk after age 12 Progressive kyphoscoliosis
Respiratory failure in 2d or 3d decade Cardiomyopathy
Metal impairment

Becker XR Early childhood to early adult Progressive weakness of girdle muscles
Able to walk after age 15
Respiratory failure may develop by 4th decade Cardiomyopathy
Limb-girdle AD/AR Early childhood to early adult Slow progressive weakness of shoulder and hip girdle muscle + Cariomyopathy
Emery –Dreifuss XR/AD Childhood to adult Elbow contractures, humeral and peroneal weakness Cardiomyopathy
Congenital AR At birth or within first few months Hypotonia, contracrures delayed milestones
Progression to respiratory failure in some, static course in others CNS abnormalities (hypomyelination, malformation)
Eye abnormalities
Myotonica (DM1, DM2) AD Usually 2d decade
May be infancy if mother affected (DM1only)
Slowly progressive, weakness of face, shoulder girdle, and foot diorsiflexion
Preferential proximal weakness in DM2 Cardiac conduction defects
Mental impairment
Cataracts
Frontal baldness
Gonadal atrophy
Facisoscapulohumeral AD Before age 20 Slowly progressive weakness of face, Shoulder girdle, and foot dorsiflexion Deafness Coats (eye) disease
Oculopharyngeal AD 5th to 6th decade Slowly progressive weakness of extraocular, pharyngeal, and limb muscles s


aTwo forms of myotonic dystrophy, DM1 and DM2, have been identified. Many features overlap (see text)
Abbreviations: XR, X-linked recessive; AD, autosomal dominant; AR, autosomal recessive; CNS, central nervous system

The most sensitive enzyme is CK, which in active disease can be elevated as much as 50-fold. Although the CK level usually parallels disease activity, it is can be normal in some patients with active IBM or DM, especially when associated with a connective tissue disease. The CK is always elevated in patients with active PM. Along with the CK, the serum glutamic-oxaloacetic and glutamate pyruvate transaminases, lactate dehydrogenase, and aldolase may be elevated
EMG findings are not diagnostic of an inflammatory myopathy but are useful to identify the presence of active or chronic myopathy and to exclude neurogenic disorders:

4. 14 yrs old girl on exposure to cold has pallor of extremities followed by pain and cyanosis. In later ages of life she is prone to develop?
a. SLE
b. Scleroderma
c. Rheumatoid arthritis
d. Histiocytosis

Ans. B. Scleroderma
Ref- Harrison ed. 17th pg no. 2101
• “Raynaud’s phenomenon, defined as episodic vasoconstriction in the fingers and toes, develops in virtually every patients with Systemic sclerosis. In some, episodes may also affect the tip of the nose and earlobes
• Attacks are triggered by
o Exposure to cold
o Decrease in temperature
o Emotional stress
o Using vibration tools
• In colder climates, patients commonly experience an increase in the frequency and severity of episodes during the winter months

Table 243-1 Classification of Raynaud’s Phenomenon
Primary or idiopathic Raynaud’s phenomenon” Raynaud’s disease
Secondary Raynaud’s phenomenon
1. Collagen vascular disease : scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis
2. Arterial occlusive disease: atherosclerosis of the extremities, thromboangitis oblietrans, acute arterial occlusion, thoracic outlet syndrome
3. Pulmonary hypertension
4. Neurologic disorders: intervertebral disk disease, syringomyelia, spinal cord tumors, stroke, poliomyelitis, carpal tunnel syndrome
5. Blood dyscrasias: cold agglutinins, cryoglobulinemia, myeloproliferative disorders, Waldenstrom’s macroglobulinemia
6. Trauma: vibration injury, hammer hand syndrome, electric shock, cold injury, typing, piano playing
7. Drugs: ergot derivatives, methysers, Beta-adrenergic receptor blocker, bleomycin, vinblastine, cisplatin

• Typical attacks start with pallor, followed by cyanosis of variable duration. Eventually erythema develops spontaneously or with rewarming of the digit.
• The progression of the three color phases reflects the underlying path mechanisms of vasoconstriction, ischemia, and reperfusion
• Some patients with Raynaud’s phenomenon may experience only pallor or cyanosis
• In a patient of Raynaud's phenomena all arteries (like radial, brachial, popliteal, dorsalis peats, are normally palpaoie.

• Recently a new drug, Bosentan, which is a endothelin receptor blocking drug has been approve for the treatment of Raynaud's phenomenon.
• Bosentan has also approved for the treatment of primary pulmonary arterial hypertension


5. Berry aneurysm –primary Defect lies in
a. Degeneration of internal elastic lamina
b. Deposition of mucoid material in media
c. Defect in muscular layer
d. Disturbance in vessel wall
Ans. a. Degeneration of internal elastic lamina
Ref- Harrison 17h, Page 1727
• Saccular (Berry) aneurysms occur at the bifurcations of the large to medium-sized intracranial arteries; rupture is into the subarachnoid space in the basal cisterns and often into the parenchyma of the adjacent brain.
• Approximately 85% of aneurysms occur in the anterior circulation, mostly on the circle of Willis. About 20% of patients have multiple aneurysms, many at mirror sites bilaterally.
• As an aneurysm develops, it typically forms a neck with a dome. The length of the neck and the size of the dome vary greatly and are factors that are important in planning neurosurgical obliteration or endovascular embolization.
• The arterial internal elastic lamina disappears at the base of the neck.
• The media thins, and connective tissue replaces smooth-muscle cells. At the site of rupture (most often the dome) the wall thins, and the tear that allows bleeding is often <0.5 mm long.
• Aneurysm size and site are important in predicting risk of rupture.
• Those >7 mm in diameter and those at the top of the basilar artery and at the origin of the posterior communicating artery are at greater risk of rupture.

6. In which cotrimoxazole not use in treatment?
a. UTI
b. Prostatitis
c. Chancroid
d. Typhoid
Ans. C. Chancroid

Uses of cotrimoxazole
• Pneumocystis pneumonia
• Toxoplasmosis and nocardiosis .
• Acute exacerbations of chronic bronchitis and infections of the urinary tract where there is good rationale for use
• Acute otitis media in children where there is good rationale Specific indications for its use include:
HIV
Being an antibiotic, co-trimoxazole does not have any activity against HIV itself, but it is often prescribed to immunocompromised patients as Pneumocystis jirovecii'pneumonia prophylaxis.

Bacterial
• Infections caused by Listeria monocytogenes. Nocardia spp., Stenotrophomonas maitophiiia (Zanthomonas maltophilia)
• Staphylococcus saprophytics infections presenting as urinary tract infection or cystitis
• Melioidosis
• Shigellosis
• Whipple's Disease
• Traveler's Diarrhea
• Typhoid

Protozoan
• Isosporiasis
• Prophylaxis of cerebral toxoplasmosis in HIV patients
• Cyclospora cayetanensis

Chronic bacterial prostatitis treatment
• Chronic bacterial prostatitis treatment is with long-term antibiotics, *up to eight weeks, with ciprofloxacin, sulfa drugs [for example, sulfamethoxazole and trimethoprim or erythromycin
• Chancroid - Treatment regimens may include the following azithromycin, ceftriaxone, ciprofloxacin and erythromycin bas
• Typhoid fever-
1. Ciprofloxacin is the most frequently used drug.
2. Ceftriaxone, an intramuscular injection medication, is an alternative s
3. Ampicillin and trimethoprim-sulfamethoxazole are frequently prescribed antibiotics.

7. Thrombotic event is seen in all of following except
a. PNH
b. DIC
c. ITP
d. Heparin induced thrombocytopenia
Ans. C.ITP
Ref- .Harrison 17th edition Page 367
Table 59-3 Risk Factors for Thrombosis
Venous Venous and Arterial
Inherited Inherited
Factor V Leiden Homocystinuria
Prothrombin G20210A Dysfibrinogenemia
Antithrombin deficiency
Protein C deficiency Mixed (Inherited and acquired)
Protein S deficiency Hyperhomocysteinemia
Elevated FVIII
Acquired
Acquired Malignancy
Age Antiphospholipid antibody syndrome
Previous thrombosis Hormonal therapy
Immobilization Polycythemia vera
Major surgery Essential thrombocythemia
Pregnancy & puerperium Paroxysmal nocturnal hemoglobinuria
Hospitalization Thrombotic thrombocytopenic purpura
Obesity Heparin-induced thrombocytopenia
Infection Disseminated intravascular coagulation
APC resistance, nongenetic
Unknown3
Elevated factor II, IX, XI
Elevated TAFI levels
Low levels of TFPi
aUnknown whether risk is inherited or acquired. Note: APC, activated protein C; TAH. ihrombin-aciivatable fibrinolysis inhibitor; TFPI, tissue facior pathway inhibitor

8. A patient develops sudden palpitation with HR 150 / min, regular. What could be the cause?
a. PSVT
b. Sinus tachycardia
c. Ventricular tachycardia
d. Atrial flutter with block

Ans. A. PSVT

• An arrthymia in a structurally normal heart is usually a PSVT.
• Atrial flutter with block will have irregular pulse.
• VT occurs in setting of myocardial ischemia mostly and if it occurs the rates are so fast that most patients are pulseless. Even if you argue for slow VT / AIVR then the textbook states rates of 60-120bpm.
Paroxysmal supraventricular tachycardia (PSVT) is an occasional rapid heart rate.

Causes:
i. PSVT can be initiated in the SA node. In the atria, in the atrial conduction pathways, or other areas.
ii. PSVT can occur with digitalis toxicity and conditions such as Wolff-Parkinson-White syndrome.
iii. The condition occurs most often in young people and infants.

The following increase risk for PSVT:
i. Alcohol use ii. Caffeine use iii. Illicit drug use iv. Smoking

Symptoms
i. Anxiety ii. Chest tightness iii. Palpitations (a sensation of feeling the heart beat)
iv. Rapid pulse v. Shortness of breath vi. Polyuric vii. Dizziness viii. Fainting

Signs and tests
• A physical examination during a PSVT episode will show a rapid heart rate.
• The heart rate may be 150 to 250 beats per minute (bpm). In children, the heart rate tends to be very high. There may be signs of poor blood circulation such as lightheadedness. Between episodes of PSVT, the heart rate is normal (60 to 100 bpm).
• An ECG during symptoms shows PSVT.
• An electrophysiology study (EPS) is often necessary for an accurate diagnosis and to recommend the best treatment.

Treatment

The Valsalva maneuver can be used to interrupt the fast heartbeat.
Emergency treatment of PSVT may include:

1. Medicines through a vein, including adenosine and verapamil.
2. Other medications may be used, such as procainamide, beta-blockers, and propafenone.
3. Electrical cardioversion, the use of electric shock to restore a rapid heartbeat back to normal.

Long-term treatment of PSVT may include:
1. Daily medications such as propafenone, flecainide, moricizine, sotalol, and amiodarone.
2. Pacemakers to override the fast heartbeat; very occasionally used in children with PSVT who have not responded to any other treatment.
3. Radiofrequency catheter ablation; currently the treatment of choice for most PSVTs.

9. Where pulsatile liver and ascites is found
a. TR
b. Critical pulmonary stenosis
c. MR
d. MS

Ans. A. TR
Ref: Harrison, 17th edition page 1479

• For pulsatile liver, the pathology has to be in mainly the right side of the heart. So we can easily eliminate choices c and choice d.
• In pulmonic stenosis of critical levels, the pulmonary blood flow would be so compromised that cyanosis would ensue

• The clinical features of TR result primarily from systemic venous congestion and reduction of CO.
• With the onset of TR in patients with pulmonary hypertension, symptoms of pulmonary congestion diminish, but the clinical manifestations of right-sided heart failure become intensified.
• The neck veins are distended with prominent v waves and rapid y descents, marked hepatomegaly, ascites, pleural effusions, edema, systolic pulsations of the liver, and a positive hepatojugular reflux.
• A prominent RV pulsation along the left parasternal region and a blowing holosystolic murmur along the lower left sternal margin, which may be intensified during inspiration and reduced during expiration or the strain of the Valsalva maneuver (Carvallo's sign), are characteristic findings;
• AF is usually present.

10. In renal cell carcinoma which is not associated :
a. Polycythemia
b. Amyloidosis
c. Cushing syndrome
d. Malignant hypertension

Ans. C. Cushing syndrome Ref-Harrison 17th/e p.2254, 592.

• RCC para-neoplastic manifestations secondary to production of renin and erythropoietin explains polycyathemia and hypertension.
• The presenting signs and symptoms include hematuria, abdominal pain, and a flank or abdominal mass.
• This classic triad occurs in 10-20% of patients. Other symptoms are fever, weight loss, anemia, and a varicocele (Tabie 90-4).
• The tumor can also be found incidentally on a radiograph. Widespread use of radiologic cross-sectional imaging procedures (CT, ultrasound, MRI) contributes to earlier detection, including incidental renal masses detected during evaluation for other medical conditions.
• The increasing number of incidentally discovered low-stage tumors has contributed to an improved 5-year survival for patients with renal cell carcinoma and increased use of nephron-sparing surgery (partial nephrectomy).
• A spectrum of paraneoplastic syndromes has been associated with these malignancies, including erythrocytosis, hypercalcemia, non-metastatic hepatic dysfunction (Stauffer syndrome), and acquired dysfibrinogenemia.
• Erythrocytosis is noted at presentation in only about 3% of patients. Anemia, a sign of advanced disease, is more common.

Table 90-4 Signs and Symptoms in Patients with Renal Cell Cancer

Presenting Sign or Symptom Incidence %
Classic triad: hematuria, flank pain, flank mass 10-20
Hematuria 40
Flank pain 40
Palpable mass 25
Weight loss 33
Anemia 33
Fever 20
Hypertension 20
Abnormal liver function 15
Hypercalcemia 5
Erythrocytosis 3
Neuromyopathy 3
Amyloidosis 2
Increased erythrocyte sedimentation rate 55

11. Cause of alpha thalassemia
a. Deletion of alpha genes
B. Deletion of beta genes
C. Excess of alpha gene
D. Single amino acid substitution in alpha chain
Ans A. Deletion of alpha genes
Ref: Harrison 17th e/p.641.
The four classic alpha thalassemias, most common in Asians, are thalassemia alpha -2 trait, in which one of the four -globin loci is deleted; alpha -thalassemia-1 trait, with two deleted loci; HbH disease, with three loci deleted; and hydrops fetalis with Hb Bart's, with all four loci deleted.

Table 99-4 The alpha Thalassemias
Condition Hemoglobin A,
% Hemoglobin H (p4), % Hemoglobin Level, g/L (g/dL) MCV, fL
Normal 97 0 150(15) 90
Silent thalassemia: -a/aa 98-100 0 150(15) 90
Thalassemia trait: -a/-ochomozygous a-thal-2* or - -/aaheterozygous a-thal-1a 85-95 Rare red blood cell inclusions 120-130(12-13) 70-80
Hemoglobin H disease: --/-aheterozygous a-thal-1/a-thai-2 70-95
* 5-30 60-100 (6-10) 60-70
Hydrops fetalis: - -/- - homozygous a-thal-1 0 S-10D Fatal in utero or at birth

12. Reperfusion is useful for
a. Stunt myocardium
c. Non ischemic viable myocardium
b. Hibernating myocardium
d. Mixed ischemic myocardium

Ans. B. Hibernating myocardium
• "LV dysfunction can be due to non contractile or hypo contractile segments that are viable but are chronically ischemic (hibernating myocardium).
• As a consequence of chronic reduction in myocardial blood flow these segments down regulate their contractile function.
• These can be detected by using consequence of chronic reduction in myocardial blood flow these segments down regulate their contractile function.
• These can be detected by using radionuclide scans of myocardial perfusion and metabolism, PET, CMR imaging, or delayed scanning with thallium-20 I; or by improvement of regional functional impairment, provoked by low-dose dobutamine.
• " In such patients, revascularization improves myocardial blood flow, can return function., and can improve survival.,:
• Stunned myocardium can be differentiated from hibernating myocardium by three clinical parameters, namely, LV wall motion, myocardial perfusion, and myocardial metabolism. b
• Stunned myocardium has abnormal wall motion that tends to normalize in response to inotrope and postextrasystolic potentiation.
• Perfusion is adequate and metabolism is alsQ adequate. Hibernating myocardium also has abnormal wall motion, which normalizes after nitrates, inotrope, post extrasystolic potentiation (PESP), PTCA, or CABG.
• Myocardial perfusion is reduced but can be reversed with PTCA or CABG and metabolism is adequate.
e: Recent Advances:
Following are the methods to reperfuse the myocardium
a. Thrombolytic therapy
b. Mechanical method:
i. PTCA
ii. Stent:
iii. Rotablator
iv. LASER
c. Coronary artery bypass graft (CABG)

13. Positive hepatojugular reflux is found in all of the following conditions except?
a. Tricuspid regurgitation
b. Right heart failure
c. Decreased after load
d. Increased pulmonary capillary bed pressure
Ans. C. Decreased after load
Ret: Harrison, 17th edition, page 1384
• In patients suspected of having right ventricular failure who have a normal CVP at rest, the abdominojugular reflux test may be helpful.
• The palm of the examiner's hand is placed over the abdomen, and firm pressure is applied for 10 s or more. In normal persons, this maneuver does not alter the jugular venous pressure significantly but when right heart function is impaired, the upper level of venous pulsation usually increases.
• A positive abdominojugular test is best defined as an increase in JVP during 10 s of firm midabdominal compression followed by a rapid drop in pressure of 4 cm blood on release of the compression.

a. The most common cause of a positive test is right-sided heart failure secondary to elevated left heart filling pressures.
b. Increase after load is associated with LVF. That is why ACEI are used in the treatment of LVF (To reduce after load)


14. Gold standard test for diagnosis of insulinoma is
A. 72 hour fast test
B. Plasma glucose levels < 3 mmol/l
C. Plasma insulin levels > 6µU/ml ]
D. C-peptide levels < 50 p/mol/lit
Answer is A (72 hour' fast test)-
Ref: Harrison's 17h/2354. 2355

Diagnosis
• The diagnosis of insulinoma requires the demonstration of an elevated. Plasma insulin level at the time of hypoglycemia.
• A number of other conditions may cause fasting hypoglycemia, such as the inadvertent or surreptitious use of insulin or oral hypoglycemic agents, severe liver disease, alcoholism, poor nutrition, or other extrapancreatic tumors.
• The most reliable test to diagnose insulinoma is a fast up to 72 h with serum glucose, C-peptide, and insulin measurements every 4-8 h. If at any point the patient becomes symptomatic or glucose levels are persistently <2.2 mrnol/L (40 mg/dL), the test should be terminated and repeat samples for the above studies obtained before glucose is given.
• Some 70-80% of patients will develop hypoglycemia during the first 24 h and 98% by 48 h. In nonobese normal subjects, serum insulin levels should decrease to <43 pmol/L (<6 uU/mL) when blood glucose decreases to <2.2 mmol/L (<40 mg/dL) and the ratio of insulin to glucose is <0.3 (in mg/dL).
• In addition to having an insulin level >6 uU/mL when blood glucose is -:-40 mgydL, some investigators also require an elevated C-peptide and serum proinsulin level an insulin/glucose ratio >0.3: and a decreased plasma 8-hydroxybtityrate level for the diagnosis of insulinomas.
• Surreptitious use of insulin or hypoglycemic agents may be difficult to distinguish from insulinomas.
• The combination of proinsulin levels (normal in exogenous insulin/hypogiycemic agent users), C-peptide levels (low in exogenous insulin users), antibodies to insulin (positive in exogenous insulin users), and measurement of sulfonylurea levels in serum or plasma will allow the correct diagnosis to be made.
• The diagnosis of insulinoma has been complicated by the introduction of specific insulin assays that do not also interact with proinsulin. as do many of the older radioimmunoassays (RIAs), and therefore give lower plasma insulin levels.
• The increased use of these specific insulin assays has resulted in increased numbers of patients with insulinomas having lower plasma insulin values than the 43 pmol/L (6 uU/mL) levels proposed to be characteristic of insulinomas by RIA.
• In these patients the assessment of proinsulin and C-peptide levels at the time of hypoglycemia are particularly helpful for establishing the correct diagnosis.

15. Insuiin + acarbose given to patient and hypoglycemia seen. What is the treatment?
A. Sucrose
B. Maltase
C. Glucose
D. Galactose

Ans. C. Glucose
Ref: Harrison 17th e/p.2310.
When acarbose used in combination with insulin or other insulin secretagogues (Sulfonylureas or repaglinide), hypoglycemia may occur.
When used as monotherapy, acarbose and miglitol do not enhance insulin secretion and hence in overdose do not cause hypoglycemia .

Treatment
• Hypoglycemia associated with the use of acarbose or miglitol plus insulin or a insulin secretagogue should be treated with oral glucose (dextrose) and not sucrose or other complex carbohydrates, which may be ineffective.
• The hydrolysis of sucrose (can sugar) to fructose and glucose is inhibited by acarbose and thus products containing sucrose are unsuitable for the rapid correction of hypoglycemia.
• Patient should be aware of the need to have a readily available source of glucose (dextrose^ d-glucose) to treat hypoglycemic episodes.
• In server hypoglycemia, intravenous dextrose or glucagon injections may be required.

16. In a child with respiratory distress, failure to thrive. His sweat chloride levels were estimated 35 & 41. What is next best test to do cystic fibrosis for diagnosis?
a. Nasal transmembrane potential
b. DNA analysis A 508 mutation
c. CT chest
d. 72 hour fecal fat estimation
Ans. A. Nasal transmembrane potential
Ref: Nelson 1&h edition, chapter 400
Diagnosis And Assessment.

The diagnosis of CF has been based on a positive quantitative sweat test (CI- > 60 mEq/L) in conjunction with 1 or more of the following: typical chronic obstructive pulmonary disease, documented exocrine pancreatic insufficiency, or a positive family history. Diagnostic criteria have been recommended to include additional testing procedures (Table 400-3).

TABLE 400 - 3. Diagnostic Criteria for Cystic Fibrosis (CF)
Presence of typical clinical features (respiratory, gastrointestinal, or genitourinary)
OR
A history of CF in a sibling
OR
A positive newborn screening test
PLUS
Laboratory evidence for CFTR dysfunction:
Two elevated sweat chloride concentrations obtained on separate days
OR
Identification of two CF mutations
OR
An abnormal nasal potential difference measurement.

CFTR, CF transmembrane regulator

Abnormal nasal potential difference measurement
The finding of increased potential differences across nasal epithelium, the loss of this difference with topical amiloride application, and the absence of a voltage response to a ^-adrenergic agonist have been used to confirm the diagnosis in patients with equivocal or frankly normal sweat chloride values. Failure to sweat when a combination of isoproterenol and atropine is injected into the skin has also been used to characterize CF variants.

Radiology:
Pulmonary radiologic findings suggest the diagnosis but are not specific.

DNA analysis A 508 mutation
Several commercial laboratories test for 30-80 of the most common CFTR mutations. This testing identifies >90% individuals who carry 2 CF mutations.

Pancreatic Function.
Exocrine pancreatic dysfunction is clinically apparent in many patients. Documentation is desirable if there are questions about the functional status of the pancreas. Measurement of fat balances with a 3 day stool collection or direct documentation of enzyme secretion after duodenal intubation and pancreo-zymin-secretin stimulation provides a reliable measure, but these methods are cumbersome or invasive for children and are not routinely used.

17. Death in acute Ml with thrombolytic therapy is due to?
A. Intracranial hemorrage
B. Vasospasm
C. Hydrocephalus
D. Hyponateremia
Ans. A. Intracranial hemorrage
Ref: Harrison, 17th edition, chapter no 1538

Complications of Thrombolytic therapy
• Allergic reactions to streptokinase occur in -2% of patients who receive it.
• Hypotension While a minor degree of hypotension occurs in 4-10% of patients given this agent, marked hypotension occurs, although rarely, in association with severe allergic reactions.
• Hemorrhage is the most frequent and potentially the most serious complication. Because bleeding episodes that - require transfusion are more common when patients require invasive procedures, unnecessary venous or arterial interventions should be avoided in patients receiving fibrinolytic agents.
• Hemorrhagic stroke is the most serious complication and occurs in -0.5-0.9% of patients being treated with these agents.
• This rate increases with advancing age, with patients >70 years experiencing roughly twice the rate of intracranial hemorrhage as those <65 years.

18. Octreotide is not useful for?
A. Insulinoma
B. Glucagonoma
C. Carcinoid tumor
D. Glioma
Ans. D. Glioma
Octreotide is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor fo growth hormone, glucagon, and insulin than the natural hormone.

Uses of Octreotide:
1. Acromegaly /. Carcinoid/Carcinoid syndrome/
3. Diarrhea secretory
4. Dumping syndrome,
5. Glucagonoma
6. Hepatorenal syndrome
7. insulinoma
8. Intestinal obstructive
9. Metastatic neuroendocrine tumor
10. Nausea and vomiting
11. Nonfunctioning pituitary tumor
12. Oncogenic osteomalacia
13. Orthostatic hypotension
14. Pancreatitis
15. Thymoma,
16. TSH-secreting adenomas
17. Variceal bleeding
18. VIPoma
19. Zollinger-Ellison syndrome

heart burn MCQ of sept 2011

1.85. Excess pressure of stethoscope in blood pressure (BP) measurement
a. Artificial lowers diastolic BP by 10mm Hg !
b. Artificially lowers systolic BP by 5mm Hg
c. Artificially lowers systolic BP by 10mm Hg
d. Causes no change

the answer is a .WHO manual of BP measurement mentions that sometimes when we are in hurry we may not put the BP cuff properly. Ideally it should be atleast 2 finger width above the crease of the cubital fossa. this means now you have less space to squeeze in the bell of the steth. This implies that you would now press on the steth too hard on the arm of the patient. IT CAN NOT CHANGE THE FORCE WITH WHICH OUR HEART WILL PUMP BLOOd. SO SYSTOLIC BP WILL BE NOT CHANGED which is appearance of the first KOROTOKOFF sound. however it will afflict the disappearance of the fifth korotokoff sound which is the diastolic BP .

2. The correct dose of vitamin A for xerophthamia in adult is
a. Two dose of 60 mg two weeks apart !!
b. Single dose of 60 mg
c. Two doses of 30 mg two week apart
d. Single dose of 30 mg
answer is A
1 µg retinol = 3.33 IU.
Dietary deficiency is traditionally treated with vitamin A palmitate in oil 60,000 IU po once/day for 2 days, followed by 4500 IU po once/day. If vomiting or malabsorption is present or xerophthalmia is probable, a dose of 50,000 IU for infants < 6 mo, 100,000 IU for infants 6 to 12 mo, or 200,000 IU for children > 12 mo and adults should be given for 2 days, with a third dose at least 2 wk later

medicine and pediatrics march 2011

MEDICINE
1. Which of the following changes of megaloblastic anemia CANNOT be corrected by administration of folic acid?
a. Megaloblastic hyperplasia of bone marrow
b. Macrocytic changes in RBCs
c. Neurological changes*
d. Diarrhea and achlorhydia
2. The following worm infestation may result in malabsorption
a. Ascar’s lumbricoides
b. Ancylostoma duodenlae
c. Giardia lamblia
d. Necator americanus
3. A 45 yrs old male presented with increasing abdominal discomfort with abdominal enlargement for past 2 yrs. On examination, massive splenomegaly was noted. Most likely diagnosis is
a. Sickle cell anemia
b. Infectious mononucleosis
c. Myelofibrosis*
d. Hemochromatosis
4. Common radiographic finding on chest X-ray of a pateitn with sarcoidosis is
a. Bronchiectasis
b. Coin lesion
c. Cavitation
d. Hilar nodes*
5. Most common cause of hypercapneic respiratory failure is
a. Interstitial lung disease
b. Bronchial asthma
c. Chronic obstructive pulmonary disease*
d. Pneuothorax
6. Which of the following statements regarding pyrexia of unknown origin (PUO) is FLASE?
a. Duration of fever>3 weeks
b. Fever more than 1010F on several occasions
c. Failure to reach a diagnosis despite 2 OPD visits*
d. Failure to reach a diagnosis despite 3 days of inpatient investigations
7. Which of the following pressure is best suitable to monitor the fluid status of a patients in shock?
a. Systolic arterial blood pressure
b. Diastolic arterial blood pressure
c. Pulse pressure
d. Central venous pressure*
8. Which of the following is not seen in thrombotic thrombocytopenic Purpura(TTP)
a. Fever
b. Hemolytic anemia
c. Thrombocytosis*
d. Renal failure
9. Which of the following parameters is the most important factor for prognosis of a patient with malignant melanoma?
a. Size of tumor
b. Location of tumor
c. Age of patient
d. Level of invasion and tumor thickness*
10. Non specific aortic aneurysm is most commonly seen in
a. Ascending aorta
b. Arch of aorta
c. Descending thoracic aorta*
d. Infra renal abdominal aorta
11. All of the following are risk factors for obstructive sleep apnea syndrome except
a. Obesity
b. Male gender
c. Acromegaly
d. Protuberant mandible*
12. Which of the following parameter is used to assess the renal perfusiojn adequacy during shock?
a. Serum creatinine
b. Hourly urine output*
c. Blood pressure
d. Blood uea
13. Hemotysis is a feature of
a. Miliary tuberculosis
b. Tropical pulmonary eosinophlia
c. Pneumoconiosis
d. Pulmonary embolism*
14. Rapid correction of which of the following metabolic abnormality can result in pontine myelinolysis?
a. Hyponatremia*
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia
15. The most specific antibody associated with primary biliary cirrhosis is
a. Anti mitochondrial antibody
b. Anti nuclear antibody
c. Anti netrophil cytoplasmic antibody
d. Anti actin antibody
16. D-Xylose test may be abnormal in all of the following except
a. Chronic pancreatitis *
b. Bacterial overgrowth syndrome
c. Celiac sprue
d. Intestinal lymphangiectasia
17. Which of the following serum marker suggest the pressure of acute hepatitis B
a. ALT level =30 IU
b. HBeAg
c. Anti HBc*
d. Anti HBs
18. True statement regarding pleural effusion is
a. Hemorrhagic pleural effusion clearly indicates malignancy
b. In congestive heart failure, bilateral pleural effusion is the rule
c. In tubercular pleural effusion, mycobacteria are commonly isolated
d. In pancreatic pleural effusion, amylase content is usually high *
19. Which of the following tumor is most commonly associated with Tumor lysis syndrome?
a. Plasmacytoma
b. Hairy Cell leukemia
c. Seminoma
d. Burkitt’s lymphoma *
20. Dermatitis herpetiformis is associated with
a. Glucagonoma
b. Celiac disease *
c. Crohn’s disease
d. Zollinger Ellison syndrome
21. Commonest cause of acute nephritis in children is
a. Urinary tract infection
b. Drugs
c. Immunologic*
d. Trauma
22. Fresh frozen plasma is used to correct
a. Protein deficiency
b. Immune deficiency
c. Coagulation factor deficiency *
d. Platelet deficiency
23. Which of the following sign indicates severity of bronchial asthma
a. Bilateral extensive wheeze*
b. Bradycardia
c. Tachypnoea
d. Pulsus paradoxus
24. Which of the following drug should be avoided un hypertrophic obstructive cardiomyopathy?
a. Beta blockers
b. Digoxin*
c. Amiodarone
d. Verapamil
25. All the following require zinc except
a. Spermatogenesis
b. Fetal growth
c. DNA and RNA synthesis
d. Coagulation pathway*
26. All of the following are prognostic factors for lymphoma except
a. Constitutional symptoms*
b. Size of lymph node
c. Stage of disease
d. Histological type of lymphoma
27. Congenial malformation in the fetus can occur due to excessive intake of
a. Vitamin A*
b. Vitamin B12
c. Vitamin C
d. Folic acid
28. Obesity is diagnosed when the waist circumference is above this in men
a. 80
b. 85
c. 90*
d. 95
29. Massive blood transfusion in a previously healthy adult male can result in bleeding, because of
a. Dilutional thrombocytopenia*
b. Increased tPA
c. Hypofibronogenemia
d. Vitamin K deficiency
30. Which of the following organ is commonly involved in Mushroom poisoning?
a. Heart
b. Liver
c. Kidney
d. Nerves*
31. Investigation of choice in acute subarachnoid hemorrhage is
a. Ultrasound
b. Non contract CT
c. Contrast enhanced CT*
d. Contrast enhanced MRI
32. All of the following are seen in disseminated intravascular coagulopathy except
a. Thrombocytopenia
b. Decreased fibrinogen
c. Decreased aPTT*
d. Increased aPTT
33. Triad of massive blood loss and transfusion in characterized by
a. Alkalosis, hypothermia and coagulopathy
b. Acidosis, hypothermia and coagulopathy*
c. Alkalosis, hypotension and coagulopathy
d. Acidosis, hypotension and oligouria
34. Neoadjuvant chemotherapy is recommended in carcinoma breast patients for
a. Curing distant metastasis
b. Improveing survival
c. Down staging and considering breast conservation*
d. Preventing distant metastasis
35. Which type of IV fluid should not be used in hemorrhagic shock
a. Normal saline
b. Ringer lactate
c. 5% dextrose
d. Albumin*
36. Antobody having the best sensitivity and specificity for the diagnosis of celiac disease is
a. Anti-endomysial antibody*
b. Anti-tissue transglutaminase antibody
c. Anti-gliadin antibody
d. Anti-reticulin antibody
37. WPW syndrome is associated with which one of the following congenital anomaly?
a. Fallot’s tetralogy
b. Ebstein’s anomaly*
c. Lutembacher syndrome
d. Patent ductus arteriosus
38. Long term prognosis in COPD can be improved by treatment with
a. Long term O2 therapy*
b. Inhaled B2 agonists
c. Ihaled steroids
d. Oral steroids
39. Treatment of choice for small bowel lymphoma is
a. Surgery*
b. Radiotherapy
c. Chemotherapy
d. None of the above
40. All of the following cancers are associated with HV infection except
a. Kaposi’s sarcoma
b. Non-Hodkin lymphoma
c. Carcinoma of cervix
d. Carcinoma of stomach*
41. Which of the following is not a metabolic cause of abdominal pain?
a. Diabetic ketoacidosis
b. Sickle cell anemia*
c. Porphyria
d. Hyperparathyroidism
42. Kussmaul’s sign is absent in
a. Constrictive pericarditis
b. Cardiac tamponade*
c. Right Ventricular Myocardial Infarction (RVMI)
d. Severe right heart failure
PEADIATRICS
43. The most common virus responsible for acute bronchilotis in infancy is
a. Respiratory syncytial virus*
b. Influenza virus
c. Parainfluenza virus
d. Rhinovirus
44. Boot shaped heart is seen in
a. Atrial septal defect
b. Ventricular septal defect
c. Tetralogy of Fallot*
d. Patent ductus arteriosus
45. As compared to cow’s milk, breast milk has more content of
a. Vitamin K
b. Proteins
c. Minerals
d. Vitamin C and D*
46. During breastfeeding the infant should have “Good attachment” to mother’s breast. It includes all of the following except
a. Mouth of infant is wide open
b. Chin of the infant touches mother’s breast
c. Lower lip of infant is inverted*
d. Upper part of areola is visible more than the lower part
47. At what age a child normally attains a height of 100cm?
a. 2 years
b. 3 years
c. 4 years*
d. 5 years
48. The most common type of seizure in a neonate is
a. Tonic
b. Clonic
c. Myoclonic
d. Subtle*
49. All of the following are useful in the treatment of meconium aspiration syndrome except
a. Positive pressure ventilation
b. Antibiotic
c. Corticosteroids*
d. Correction of acidosis
50. Which of the following is not seen in Marasmus?
a. Severe muscle wasting
b. Minimal Subcutaneous fat
c. Edema*
d. ear normal serum albumin values

errata - INR Question No. 23 in pharmacology

Thanks Guys for the feedback..In the question no. 23 of INR in pharmacology, the answer would be Vitamin K

MCI 2011

MCI MARCH 2011

PHARMACOLOGY
1. All of the above are used for the management of thyrotoxic crisis except
a. Propylthiourcil
b. Propanolol
c. Oral potassium iodine
d. Levothyroxine *

2. Which of the following drugs is avoided in a patient with serum creatinine of more than 3mg/dl?
a. Gentamicin*
b. Azithromycine
c. Ampicilin
d. Amlodipine

3. Which of the following is NOT an inotropic drug?
a. Amrinone*
b. Isoprenaline
c. Amiodarone
d. Dopamine

4. Baclofen is used in the treatment of
a. Schizophrenia
b. Depression
c. Anxiety
d. Spasticity*

5. Which of the following is used for prophylaxis of rheumatic heart disease?
a. Ampicillin
b. Penicillin-G
c. Bezathine Penicillin*
d. Phenoxy-methyl penicillin

6. Dopamine is preferred over vasopressor agents in shock with oligouria because of its effects related to
a. Better cardiac stimulation
b. Less peripheral vasoconstriction*
c. Lower risk of cardiac arrhythmias
d. More CNS stimulation

7. The treatment of choice of bacterial vaginosis is
a. Clindamycin
b. Erythromycin
c. Ampicillin
d. Metronidazole*

8. The antidote for paracetamol poisoning is
a. Activated charcoal
b. N-acetyl cysteine*
c. Adrenaline
d. Magnesium hydroxide gel

9. all of the following therapeutic uses of corticosteroids are appropriate except
a. beclomethasone in bronchial asthma
b. cortisone for Cushing’s syndrome*
c. prednisolone for rheumatoid arthritis
d. dexamethasone for reducing intracranial pressure

10. Major organ involved in Bleomycin toxicity is
a. Liver
b. Bone marrow
c. Skin
d. Lungs*

11. sulfasalazine is used in
a. ulcerative colitis*
b. osteoarthritis
c. gouty arthritis
d. irritable bowel syndrome

12. Methotrexate toxicity can be treated by
a. Folic acid*
b. Folinic acid
c. Riboflavin
d. Cyanocabalamine

13. In a patient of chronic open glaucoma, which one of the following drugs is NOT useful
a. Pilocarpine
b. Physostigmine
c. Homatropine*
d. Timolol

14. Which one of the following is an adverse effect associated with combined oral contraceptives
a. Cerebral stroke*
b. Aggravation of asthma
c. Peripheral neuropathy
d. Nephritic syndrome

15. All of the following are the feature of atropine poisoning except
a. Mydriasis
b. Hallucinations
c. Hypothermia*
d. Coma

16. All of the following drugs should be avoided in pregnancy except
a. Propylthiouracil*
b. Valproic acid
c. Warfarin
d. Tetracyclines

17. All of the following statements about heparine are true EXCEPT
a. It act by inhibiting factor IIa via its action on anti thrombin III
b. Protamine sulphate is antidote
c. aPTT is used to monitor its effect
d. It has only in vivo anticoagulant action*

18. Allopurinol is a competitive inhibitor of
a. Uricase
b. Xanthine oxidase*
c. Guanase
d. Adenosine deaminase

19. Drug of choice for treatment of absence seizures is
a. Phenytoin
b. Valproate*
c. Ethosuximide
d. Carbamazepine

20. Scabies can be effectively treated systematically by
a. Psoralens
b. Ivermectin*
c. Permethrin
d. Septran

21. The antifungal which has a fungicidal mode of action against dermatophyte infections in therapeutic doses is
a. Fluconazole
b. Terbinafine*
c. Itraconazole
d. Ketoxonazole

22. pulmonary fibrosis is a side effect associated with the use of
a. actinomycin
b. busulfan*
c. doxorubicin
d. mithramycin

23. On a routine check up, a patient on warfarin therapy is found to have an international normalized ratio (INR) of 8. the most appropriate action is to stop the drug said
a. Give vitamin K injection
b. Give fresh frozen plasma infusion*
c. Start low molecular weight heparin
d. Restart warfarin after decrease of INR

24. The drug that is contraindicated in angle closure glaucoma is
a. Pilocarpine
b. Atropine*
c. Dorzolamide
d. Timolol

25. All of the following drugs can cause gynaecomastia except
a. Digoxin
b. Amiloride*
c. Cimetriden
d. Spironolactone

26. all of the following are useful in the management of acute asthma except
a. hydrocortisone intravenously
b. salbutamol inhalation
c. salmeterol inhalation*
d. terbutaline inhalation

27. Which of the following drugs have long post antibiotic effect?
a. Quinolones*
b. Macrolides
c. Tetracyclines
d. Oxazolidinones

28. All of the following are vitamin K dependent coagulation factors except
a. Factor VII
b. Factor VIII*
c. Factor X
d. Protein C


PATHOLOGY

29. The coagulation studies of a patient showed normal prothrombin time and prologation of activated partial thromboplastin tine and bleeding time. The most probable diagnosis is
a. Hemophilia
b. DIC
c. von Willebrand disease*
d. ITP

30. EAV rosetters formation is a characteristic of
a. T cells*
b. B cells
c. Monocytes
d. None of the above

31. Which of the following is NOT a prion associated disease
a. Scrapine
b. Kuru
c. Creutzfeldt Jakob Disease
d. Sub acute sclerozing panencephalitis (SSPE)*

32. Bilateral breast carcinoma occurs commonly in
a. Schirrous carcinoma
b. Medullary carcinoma
c. Colloid carcinoma
d. Lobular carcinoma*

33. The most important prognostic factor for invasive carcinoma of breast is
a. Histological subtype
b. Tumor grade
c. Estrogen and progesterone receptor status
d. Axillary lymph node status*

34. Which is the commonest type of cancer seen in patients wit AIDS?
a. Diffuse large B cell lymphoma
b. Anaplastic large cell lymphoma
c. Hairy cell leukemia
d. Kaposi sarcoma*

35. all of the following are features of secondary immune response except
a. abundant IgG
b. May be induced any time after primary response
c. Repeatable in physiological limits
d. Latent period of five days before it appears*

36. father to son inheritances is never seen in cases of
a. autosomal dominant inheritance
b. autosomal recessive inheritance
c. multifactorial inheritance
d. X-linked dominant inheritance *

37. The tumor Which is least likely to metastasize to the brain is
a. Prostatic carcinoma*
b. Breast carcinoma
c. Renal cell carcinoma
d. Choriocarcinoma

38. tumor marker for endodermal sinus tumor is
a. CEA
b. hCG
c. Alpha fetoprotein*
d. Cytokeratin

39. Carcinoma of the urinary bladder is associated with all of the following except
a. Cigarette smoking
b. Alcohol intake*
c. Cyclophosphamide
d. Schistosomiasis

40. Which mediator of inflammation does NOT cause fever
a. IL-1
b. TNF-a
c. Nitric Oxide*
d. Prostaglandin

41. The characteristic abnormality in B-Thalassemia minor is
a. Raised HbA2 level*
b. Marked rise of HbF
c. Very high red cell distribution width (RDW)
d. Severe anemia

42. The tumor which has a predilection for ephiphyses is
a. Chondroblastoma*
b. Osteosarcoma
c. Osteochodnroma
d. Ewing’s sarcoma

43. Regarding panacinar emphysema, which of the following is true?
a. Involves the entire lung
b. Is most severe in apical region
c. Is associated with a1-antitrypine deficiency*
d. Is almost invariably related to scarring

44. Which of the following is NOT true of fibroadenoma?
a. Painless
b. Well circumscribed
c. It is almost always unilateral*
d. Hormone responsive

45. all of the following results in microcytic hypochromic anemia except
a. fanconi’s anemia*
b. iron deficiency
c. thalassemia
d. lead poisoning

46. all of the following are features of hemolytic anemia except
a. unconjugated hyperbilirubinemia
b. reticulocytosis
c. increased plasma hapten*
d. hemoglobinuria


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