ECG of a patient shows progressively increasing PR intervals followed by dropped beat.

What is the condition?

1. Third degree heart block
2. Mobitz Type 1
3. Sinus arrhythmia
4. Mobitz Type 2
Heart blocks are of three types: 1.First degree heart block: PR interval prolonged (>200 ms)
2.Second degree heart block: Mobitz Type 1: Progressive lengthening of the PR interval until a
beat is dropped (a P wave not followed by a QRS complex). Mobitz Type 2: Dropped beats that
are not preceded by a change in the length of the PR interval 1.Third degree heart block: The
atria & ventricles beat independently of each other.
A patient has been taking anti-tuberculous therapy for MDR-TB. His drugs regimen
contains 6 drugs. The patient eventually develops difficulty in distinguishing red & green
colours. Which of the following drugs is responsible for this effect?
1. Amiodrone
2. Pyrazinamide
3. Rifampicin
4. Ethambutol
5. Ciprofloxacin
Ethambutol is one of the drugs used in anti-tuberculous therapy. Optic neuritis is an important,
though rare side effect of ethambutol. If optic neuritis develops, red-green colour vision may be
lost first. This agent should probably not be used in young children in whom it may be difficult
to assess vision.
Which of the followings cross placenta?
1. IgM
2. IgA
3. IgG
4. IgD
Of all the immunoglobins only IgG is the only antibody that crosses placenta. It is main antibody
in secondary response and the most abundant one. It fixes complement, opsonized bacteria,
neutralizes bacterial toxins and viruses.
Corneal opacities are caused by:
1. Ethambutol
2. Phenothiazines
3. Cholorquine
4. Penicillamine
Chloroquine is commonly used anti-malarial used for the treatment & prevention of Malaria.
One of its important side effects occurs in the eyes. It can cause corneal deposits, lenticular
deposits & damage to the retina.
Gastroesophageal junction competence is increased by:
1. Lying supine
2. Paralysis of the diaphragm
3. Use of Morphine
4. Use of Metoclopromide
5. Increased intra-abdominal pressure
Metoclopromide is D2 receptor antagonist that increased the resting tone of GIT, increases
contractility & increases Lower esophageal junction tone. It is clinically used for Diabetic &
post-surgery gastroparesis. Toxicity includes parkinsonian effects, restlessness, drowsiness,
fatigue, depression, nausea, diarrhea. Contraindicated in patients with small bowel obstruction.
Other option under this question actually decrease the GE junction tone.
Which of the followings is increased in first response?
1. IgM
2. IgD
3. IgE
4. IgG
IgM is the antibody produced in primary response to an antigen. IgG is the main antibody in
secondary response. IgM also fixes complement but does not cross placenta.
Serum Gastrin levels are increased by prolonged use of:
1. H2 Receptor blockers
2. Proton Pump Inhibitors
3. Antacids
4. Anticholinergics
The most appropriate answer is Proton Pump Inhibitors (PPI) because they irreversibly inhibit
H+ /K+ -ATPase in stomach parietal cells. H2 blockers on the other hand cause a reversible
block of histamine H2 receptors resulting in decreased production of H+. Since the PPI are
irreversible blockers of the Proton pump they cause a more sustained decrease in H+ production.
This, through positive feedback increases the secretion of Gastrin. Generally increased acid (H+
ions) causes decreased production of Gastrin & decreased acid (such as through PPI use) cause
increase in Gastrin secretion.
Which muscle divides the Submandibular gland into deep & superficial parts?
1. Omohyoid
2. Sternothyroid
3. Mylohyoid
4. Anterior belly of diagastric
Submandibular gland lies in the floor of the mouth. It has two parts, a deep part and a superficial
part. The gland is hook shaped. It hooks around the origin of mylohyoid muscle from the
mylohyoid line on the inner suface of body of mandible. As it hooks around this muscle, the
gland is itself gets divided into a deep & superficial part.
In kidney select the correct order of arteries:
1. Renal artery > Arcuate artery >Interlobar artery > Efferent arteriole
2. Renal artery > Interlobular artery > Interlobar artery> Arcuate artery > Efferent arteriole
3. Renal artery > Interlobar artery > Interlobular artery > Arcuate artery > Afferent arteriole
4. Renal artery > Interlobar artery> Arcuate artery > Interlobular artery> Afferent arteriole
Renal artery gives off Interlobar arteries which run between the pyramids of medulla. Interlobar
arteries give off arcuate arteries which run parallel to the junction of cortex and medulla. Arcuate
arteries give Interlobular branches into the cortex which in turn give rise to the afferent
arterioles.
Captopril causes:
1. Hyperkalemia
2. Hypernatremia
3. Hypokalemia
4. Hypercalcemia
Captopril is one of the ACEI (Angiotensin Converting Enzyme Inhibitor). Major side effects of
ACEIs are cough (due to increased levels of bradykinin), angioedema, hyperkalemia ,proteinuria.
Hyperkalemia with ACEI therapy occurs because: Renin-Angiotensin system is a potent
stimulator of aldosterone release. Aldosterone inturn conserves sodium & increases the excretion
of potassium. With ACEIs, the rennin-angiotensin system is inhibited, so is aldosterone
secretion, resulting in low plasma levels of aldosterone. Low aldosterone prevents the excretion
of potassium, which builds up in body resulting in hyperkalemia.