Answer Test Xpress

4.Most common cause of infective endocarditis in iv drug abuser is S.
aureus especially in tricuspid

valve.(Harrison 19/E,page 816)
Left sided I.E. in iv drug abuser is usually of varied aetiology which includes Pseudomonas and
Candida species.
HIV infection in iv drug abuser doesnt influence the causes of endocarditis.
7.
Post kala azar dermal leishmaniasis -2-50% of patient suffer from PKDL.MC lesions include
hypopigmented macules, papulesor nodules of skim or oral mucosa.(Harrison 19/E page 1392)
Lesion here is of nodular type
Parasites are scanty in macular lesion but may be seen and cultured easily in nodular lesion.
MC cells are lymphocytes
Diagnosis-RK39 and other serologic tests are positive
TT-pentavalent antimonial for 60-120 days.
8.Ans c(Harrison 19/e page 2021)
Vaccine of hep. B is recombinant vaccine.Only contraindication of this vaccine is hypersensitivity to

yeast and to previous dose.
9.ans B(Harrison 19/E 2018)
Hepatitis B accounts for > 50% of fulminant cases of viral hepatitis.
10.Ans C(Harrison 19/e 2013)
The likelihood of perinatal transmission of HBV correlates with HBeAg and viral replication.
Quantitative marker of viral replication in hep B is HBV DNA.
90% of HBeAg positive mother transmits but only 10-15% 0f HBeAg negative mother transmits
infection perinataly.
11.
12
13.ans C(Harrison19/e page 1112)
Chronic impairment of lung function in patient of TB includes bronchiectasis, aspergillomas and

chronic pulmonary aspergillosis(CPA).
Diagnosis requires presence of sputum precipitin test or radiological evidence of fungal ball.
TT is antifungal or / surgery
TT of CPA with itraconozole for six months may be superior to conservative treatment .
14.Ans c(Harrison 19/e page 1947)
For unknown reason smoking is protective in ulcerative colitis.
Appendectomy is another protective risk factor in ulcerative colitis.
Oral contraceptive pill use is associated with riskof crohn disease but there is no increased risk of UC
.
15.Ans B(Slesinger textbook of gastroenterology 9/epage 1785-1786)
Treatment with oral zinc suspension has been associated with decrease in duration of acute
diarrhea.
Loperamide is contra indicated in infectious diarrhea.
Ciprofloxacin,Azithromycin and Rifaximin has role in acute traveller diarrhea.
16.Ans A(Harrison 19/e page 269)
Osmotic diaarhea occurs when poorly absorbable osmotically active substances are present in
intestinal lumen.
They draw fluid osmotically causing diarrhea.
Osmotic diarrhea characteristically ceases with fasting and is distinguishing feature from secretory
diarrhea.
Causes of osmotic diarrhea are lactase deficiency diarrhea,use of osmptic laxatives.
Stool osmotic gap formula is =2 *{ stool sodium + stoolpotasssium}< stool osmolarity
Osmotic gap> 50 suggests osmotic diarrhea.
Low stool osmolarity suggests stool diluted with water characteristic of Munchausen syndrome
called fictitious diarrhea.
17.Ans c (Harrisson 19/e page)

Patients suffering from sepsis , head trauma, burns severe trauma have stress ulcer in stomach.
18 .Ans c(Harrisson 19/e page627)
Iron deficiency anemia is characterised by decreased serum ferritin, decreased serum iron.
Raise TIBC, decreased transferrin saturation.
19 Ans a(Harrisson 19/e page 1579)
The major risk factors for atherosclerosisis -
High LDL
Low HDL
Cigarette smoking
Diabetes
Hypertension
20.Ans d (Harrisson 19/e page1569)
Left ventricular outflow tract obstruction represents mc focus of diagnosis although diastolic
dysfunction ,myocardial fibrosis also contribute to myocardial dysfunction.
21.Ans a(Harrisson 19/e page331)
Hirsutism is most commonly idiopathic or the consequence of PCOD(polycystic ovarian syndrome) .
22.Ans a(Harrisson 19/e page 301)
Plasma sodium conc. Falls by 1.2-1.6 mM for every 100mg/dl increase in glucose.
This is due to glucose induced water efflux from the cells .
23.Ansc (Harrisson 19/e page 2315,2325)
Hypoaldosteronism is characterised by hyperkalemia.hyponatremia. metabolic acidosis.
Decrease glucose is characteristic of glucocorticoid deficiency.
24.Ans b (Harrisson 19/e page 2281)
SIADH is a type of euvolemic hyponatremia.
Increase in total body water by 10% reduces plasma osmolarity and sodium by 10%.
Increase in body water causes increase gfr and atrial natriuretic peptides leading to increase in
sodium excretion in urine.
25.Ans b(Harrisson 19/e page 291)
FeNa is < 1% in pre renal azotemia.
Acute gastroenteritis is a cause of pre renal azotemia.
FeNa is > 2% in oliguric renalfailure.
26 .Ans d (Harrisson 19/e page 1824)
Peritoneal dialysis is may be carried out as continuous ambulatory peritoneal dialysis(CAPD)or
Continuous cyclic peritoneal dialysis(CPPD).
CPAD is performed usually three to five times a day.
27.Ans B (Harrisson 19/e page 1823 )
Fistula have highest long term patency rate of all the available vascular acces.
AV graft uses graft of polytetra fluoroethylene as prosthetic material.
28.Ans c(Harrisson 19/e page 1835 )
Wegeners granulomatosis presents as acute nephritic syndrome.
Rest are causes of nephrotic syndrome.
RBC cast is present in nephritic syndrome.
Interstitial nephritis lead to WBC casts.
Muddy brown casts present in AKI because of Acute tubular necrosis.
30.Ans b (Harrisson 19/e page 1859 )
Patchy interstitial scarring and tubular atrophy are the consequences of recurrent vesicoureteral
reflux.
31.Ans b(Harrisson 19/e page 1724-1725 )
32. Ans b (Harrisson 19/e page 1724-1725)
Pickwickian syndromeis a risk factor of obstructive sleep apnea(OSA)
OSA is defined as symptoms of nocturnal breathing difficulty or day time sleepiness in absence of
other medical causes and five or more apneic spells per hour.
33.Ans c (Harrisson 19/e page )
The enhanced secretion of IL-6 and TNF-@ by adipocytes and macrophage lead to insulin resistance
and lipolysis.
34.Ans d (Harrisson 19/e page 2108 )
Heamatopoietic stem cell transplantation (HSCT)provides a very high curative potential for SCID
patients.
For sickle cell and thalassemia HSCT is under research with hope of positive outcome.
35.Ans B (Mitochondria in Pathogenesis edited by John J. Lemasters, Anna-Liisa Nieminen e2002

edition page 437)
Hypoglycin A is methylenecyclopropyl alanine present in fruit of Ackee .
Within 2-3 hour of eating this fruit patient, symptoms start which includes vomiting, hypoglycaemia
coma, free fatty academia.
36.Ans b(Harrisson 19/e page2678 )
Charcot Marie tooth disease is mc inherited neuropathy.
There is atrophy of anterior compartment of muscles below knee leading to inverted champagne
bottle appearance.
Nerve biopsy revealed onion bulbs (Schwann cell proliferation)
37.Ans d(Harrisson 19/e page 2538-39)
Upper motor neuron lesion is characterised by spasticity,increased tendon jerks, upgoing

planatar(Babinski sign).
Denervation potential is a sign of lower motor neuron lesion.
38.Ans C (Harrisson 19/e page 1216,1219,1220)
AIDS pandemic is primarily caused by HIV 1 M groupviruses.
M group dominates the global pandemic .
Mgroup compromises 9 subtypes of which subtype C predominates in INDIA.
40.Ans d(Harrisson 19/e page 1776 )
Brain death has three essential componenents-
1.deep coma unresponsiveness to all forms of stimulation
2.global brainstem damage with loss of corneal light reflex,oculovestibular light reflex, and pupillary
light reaction.
3.complete and irreversible apne
Apnea is tested by preoxygenation with 100% oxygen and pco2>6.6-8 kpa confirms apnea.
41.Ans b(Harrisson 19/e page 1681 tqble 310-1 )
Farmers lung is typeof hypersensitive pneumonitis
Identified antigen is thermophillic actinomycetes.
Source of antigen grain,mold.hay
42.Ans b(Harrisson 19/e page 1116 table 202-3)
MDR TB is defined as resitance to rifampicin and isoniazide.
XDR-tb includes MDR TB and resistant to fluoroquinolones and also to any three injectables-
amikacin, kanamycin, capreomycin
Bedaquiline is used in MDR TB
43.Ans c (Harrisson 19/e page 2703 )
Lambert Eaton myasthenic symptoms is associated with small cell cancer of lung.
It is caused by autoantibody against p/Q type of calcium channel present in nerve plate.
Tt is 3,4 DAP
44.Ans b (Harrisson 19/e page728 )
Evan syndrome is ITP with haemolytic anemia.
45.Ans b (Harrisson 19/e page 2681 )
Refsum disease is characterised by tetrad of-
1).peripheral neuropathy
2)retinitis pigmentosa
3).cerebellar ataxia
4). Elevated csf protein
This disease is due to mutation in phytanoyl CoA-alfa hydroxylase.
Serum phytanic acids are elevated.
46.Ans c(Harrisson 19/e page 1566)
Cardiac amyloidosis has median survival of 6-12 months.
Diagnosis by abdominal fat or cardiac biopsy

Ecg has low voltage complexes.
Recurs after heart transplant.
47.Ans d (Harrisson 19/e page 1771)
The principal cause of coma include damage to RAS in upper midbrain or its projections.
48.Ans a (Harrisson 19/e page 2635 )
No treatment arrests the underlying pathology of ALS.
Riluzole 100mg/day can be used
Riluzole decreases glutamate release thereby reducing excitotoxicity.
AIDP-antibody is anti GM1
AMAN-anti GD1a
Miller Fisher variant-anti GQ1b antibodies.
Upper lobe bronchiectasis cystic fibrosis, post radiation
Lower lube bronchiectasis-recurrent aspiration,idiopaathicpulmonary fibrosis
Middle lobe- Non tuberculous mycobacteria, immotile cilia syndrome
51.Ansb (Harrisson 19/e page 1158 )
Epidemic tyohus rashappearon trunkon fifth day of fever then become generalised, and it never
involves the face,palm soles
Endemic typhus-rash usually occur on fourth day offever , first detected in axilla or inner surface of
arms.
52.Ans a (Harrison 19/e page1753 )
Multi organ failure is defined as physiologic dysfunction of two or more organs.
Usually associated with severe sepsis and poor outcome.
53.Ans d(Harrisson 19/e page 1751)
SIRS includes-1)fever> 100.4 f or hypothermia< 96.8 f
2).tachypnea
3).tachyacrdia> 90
4).leucocytosis>12,000 or leucopenia< 4000/ul.
54.Ans c (Harrisson 19/e ,echapter 81e1 )
RDW = (standard deviation of MCV divided by mean MCV) x 100 .
In the presence of morphologic anisocytosisRDW (normally 11 - 14%) increases to 15- 18%.
In thalassemia the small red cells are generally of uniform size with a normal RDW.
In iron deficiency the size variability is present and the RDW are large.
55. Ans (Harrison 19/e page )
56. Ans c (Harrison 19/e page )

Aplastic anemia is characterised by pancytopenia as there is decreased in all the progenitors in bone
marrow.
57. Ans a (Harrison 19/e page )
In TR , during inspiration systolic murmur aggravates the phenomenon is called caravallos sign.
58. Ans a(Harrison 19/e page )

In TR , during inspiration systolic murmur aggravates the phenomenon is called caravallos sign.
59 . Ans b (Harrison 19/e page )

The murmur of mitral stenosis is mid diastolic.
Character of murmur is rough roumbling mid diastolic murmur that accentuates during inspiration.
It is also associated with loud S1
60. Ans d(Harrison 19/e page )
Durozeizs sign is murmur heard with pressing the femoral artery with bell steth distally.

TIBC is inversely related with iron stores.
In iron def anemia,iron stores are depleted so TIBC is high.
62.ans b(Sapira's Art and Science of Bedside Diagnosis By Jane M. Orient page 362)
Epicardial bulge in massive pericardial efuusion is Auenbruggers sign.
63.ans c(Essential Revision Notes for Cardiology KBA By Ali Khavandi page 186).
Bronchial breathing at left lower base due to compression of lower lung.
This is present in acute pericarditis

Pulsus paradoxus is a feature of cardiac tamponade
65. Ans a(Harrison 19/e page )

Pulsus alternans is present in severe heart failure.
Pulsus bisferiens is characteristic of AR.

Pulsus parvus et tardus describes a carotid pulse with a small volume (pulsus parvus) that rises
slowly and has a delayed systolic peak (pulsus tardus).
Lung is mc site of involvement in sarcoidosis.
69. Ans b (Harrison 19/e page )

Kveim-Siltzbach test is a skin test used to detect sarcoidosis.
Here a part of a spleen from a patient with known sarcoidosis is injected into the skin of a patient
suspected to have the disease.
If non caseating granulomas are found (46 weeks later), the test is positive.
Glucocorticoids are agents of choice for acute sarcoidosis.
71. Ans d (Harrison 19/e page )
Hemoptysis is a manifestation of mitral stenosis.
72. Ans b (Harrison 19/e ,chapter 477e/2-6 )
Raised ICT is a feature of vit A excess.
The condition is also called as pseudo tumour cerebri.
Hypercalcemia is also a feature of vit A toxicity.
74. Ans b (Harrison 19/e page 413)
Pneumococcal vaccine to be administered 2 weeks prior to splenectomy.
75.ans b
Cushimg syndrome,acromegaly and hypothyroidism are associated with diabetes mellitus.
77.ans b (Harrison 19/e page )
Insulin and pramlintide can be used in both type 1 and type 2 diabetes mellitus.
78. Ans b (Harrison 19/e page )??

79. Ans b (Harrison 19/e page 709 )
80. Ans a (Harrison 19/e page 1361)
Cotrimoxazole is doc for p.carinii infection.
Alternatives are dapsone,atovaquone,pentamidine.
Takayasu arteritis involves subclavian artery in 93 % of cases. Followed by carotid artery in 58%.
82. Ans c(Harrison 19/e page 2189 )
Aortoarteritis involving bilateral sub clavian artery lead to pulseless hand.
83. Ans b (Harrison 19/e page 627-628 )
Iron deficiency anemia is characterised by increased in TIBC and decresed serum ferritin.
84. Ans c (Harrison 19/e page 1355)
Voriconazoleis increasingly used in maduramycosis(eumycosis).
Repeat
86. Ans b (Harrison 19/e page2319 )
Primary heperaldosteronism is associated with hypokalemia,metabolic alkalosis and hypertension.
87. Ans c (Harrison 19/e page1593 )
Ccb are preferred agents in treatment of vasospastic angina as they relieves vasospasm.
88. Ans (Harrison 19/e page )
89. Ans A(Harrison 19/e page 1785)
Excluding head trauma, berry aneurysm is mc cause of SAH.
Herpes encephalitis mostly involves fronto temporal area of brain.

91. Ans a(Harrison 19/e page 1675)
FEV1/FVC is decreased in obstruvtive airway disease
Asthma is an obstructive airway disease.
92. Ans d (Harrison 19/e page 1940)
Abetalipoproteinemia is characterised by normal villi and epithelial celss are loaded with fat
postprandially.
93. Ans b (Harrison 19/e page 1718,1573)
Hemothorax is characterised by hypotension with tachycardia.
Use of accessory muscles indicate respiratory compromise.
94. Ans c(Harrison 19/e page 1460)
Vascular access site bleeding is most common complication of cardiac catherisation.
95. Ans d Textbook of Clinical Pediatrics By A. Y. Elzouki, 2/e,page 159)
Patients with sle can develop into macrophage activation syndrome characterised by pancytopenia,
hepatosplenomegaly , fever,increased ferritin.
96. Ans b(Harrison 19/e page 2340)
Sipple syndrome is MEN type 2 characterisedby MEN 2 which includes MTC, PTH tm and
phaeochromocytoma
97 Ansb (Harrison 19/e page2126)
Anti ds dna is most specific aantibody of sle.
98.
99 Ans a(Harrison 19/e page1446.)
Pulsus bigeminy is side effect of digitalis.
100. Ans a(Harrison 19/e page 2426)
Pregabalin is effective in diabetic neuropathy to control pain.
101
102.ans b.(Anesthesia for Cardiac Surgery By James A. DiNardo, David A. Zvara,3/e.page 21)
Judkins method is used for coronary arteriography via femoralroute.
103 .Ans b(Harrison 19/e page 564)
Carcinoid syndrome presnts with right sided lesion mostly tricuspid regurgitation as predominant
lesion.
Carcinoid syndrome occurs after liver metastasis.
104.Ans A(Harrison 19/e page 2418-19 )
DKA is more common in type 1 DM
Ph in DKA is 6.8-7.3
Sodium bicarbonate is given if Ph is less than 7
If potassium is less than 3.3 meq, insulin should not be infused.
105.
106.Ans b(Harrison 19/e page 2537,58)
Babinski sign is feature of UMN.
It is normally present is children upto 2 years.
107.Ans C(Harrison 19/e page )
CFTR is epidermal anion channel
Conduit for Chloride ,HCO3 transport that leads to passive flow of water.
CFTR mutation leads to decrease influid leading to viscous secretion.
109.Ans b(Harrisson 19/e page 1116 table 202-3)
MDR TB is defined as resitance to rifampicin and isoniazide.
XDR-tb includes MDR TB and resistant to fluoroquinolones and also to any three injectables-
amikacin, kanamycin, capreomycin
Bedaquiline is used in MDR TB.
110 .Ans b(Harrisson 19/444e chapter)
Gene SCN4 sodium alpha 4 subunit.

111.Ans d(Harrisson 19/e,page 1502-1505)
PCWP> 25 mmhg suggests pulmonary edema.
112. .Ans d(Harrisson 19/e 476e chapter.)
High altitude pulmonary edema is associated with normal PCWP.
113. .Ans d (Harrisson 19/e page 1220)
HIV E is prevalent in Thailand.
In Africa highest prevalence is of HIV 1 subtype C
115.Ans c (Harrisson 19/e page 673)
Gaseback syndromeis spurious polycythemia incase of plasma leakage.
Striatum is major input of basal ganglia.
Neurotransmitter is dopamine
118.Ans a (Harrisson 19/e page2621)
Loss of striated fibre in caudate nucleus is associated with Huntington chorea
HC is also associated with atrophy of head of caudate nucleus
This is a tri nucleotide repeat disorder of CAG in huntingtin gene,chr.4p
119.Ans a(Harrisson 19/e page)
Best prognosis in liver transplant is in acute liver failure
120.Ans a (Harrisson 19/e page 2330)
Measurement of plasma metanephrine in pheochromocytoma can be done by oral administration of

clonidine 300microgm.
121.Ansb (Harrisson 19/e page 1557)
Infective causes are mc common cause of dilated cardiomyopathy.
Viral infections and chagas are predominant.
Esophageal manometry tests entails positioning a pressure sensor catheter in esophageal lumen
This is most imp inv in esophageal motility disorder.
Asbestos and smoking act synergistic in causing lung cancer.
Latent period of cancer to develop in asbestosis is 15-19 years.
Obsorn waves are j point elevation in ecg in patients of hypothermia.
125.Ansb (Harrisson 19/e page2647)
Bells palsy is most common cause of LMN facial palsy
Its an idiopathic disorder
Risk factors include pregnancy and diabetes mellitus.
126.Ans c (Harrisson 19/e page177)
Conduction aphasia is due to lesion of arcuate fasciculus which connects broca and Wernicke area.
Fluency and comprehension is preserved as wernickes and brocas are intact
Loss of repition and naming is characteristic feature.
128.Ans B.
Koennens tumpur are periungal fibroma in tuberous sclerosis.
It is characterised by adenoma cebacioum and seizure
129.Ans c (Harrisson 19/e page2514-15)
This is a case of bronze diabetes.
Hyperpigmentation,hypogonadism and diabetes mellitus with raised aminotransferase are

characteristic featureof hemochromatosis.
Hypokalemia is feature of type 1 RTA.
Type 4 is associated with hyperkalemia.
131.Ans (Harrisson 19/e page301)
CPM is due to rapid correction of hyponatremia.
Sodium to be corrected maximum to 8-10 meq /l in 24 hr.
CPM is characterised by dysarthria,sezure, quadriplegia.

Inv of choice is MRI brain
132.Ansb (Harrisson 19/e page)
Same as above
133.Ans b (Harrisson 19/e page2461)
Phosphate precipitates as calcium phosphate resulting in hypocalcemia.(tetany, nephrocalcinosis

and cardiac calcification)
136. c.Ans (Harrisson 19/e page 1996)
MELD score includes bilirubin s.creatinine and INR.
MELD score is used in allocation of argan before transplantation.
137.Ans c(Harrisson 19/e page2053)
If discriminate function is > 32, steroid is indicated as treatment of alcoholic hepatitis.
138. .Ans c(Harrisson 19/e page1962-63)
Steroid isTOC of for acute exacerbation of ulcerative colitis.
Tropical splenomegaly syndrome is associated with raised Ig M and malarial antibody.
It can evolve into malignant lyphoproliferative disorder.
140 .Ans c(Harrisson 19/e page 2041)
It is also associated with sjogren syndrome,lichen planus, porphyria cutanea tarda,T2 DM, metabolic
syndrome.
141. .Ans a(Harrisson 19/e page1390-91)
AMB is DOC for kala azar.
AMB causes hypokalemia and hypomagnesemia.
143. .Ans c(Harrisson 19/e page)
Pulmonary embolism leads to accumulation of intra alveolar blood that increases diffusion capacity
CO.
Holt oram syndrome is associated with unopposable thumb with ASD.
146. .Ans a(Harrisson 19/e page 1565)

Except for alkaptonura ,all are associated with increased incidence of cardiomyopathy.
147.Ans a (Harrisson 19/e page 15566-67)
Amyloidosis is associated with restrictive cardiomyopathy.
Ventricular conduction defects occur in restrictive type of cardiomyopathy.
Cardiac involvement in amyloidosis is mc cause of death in amyloidosis.
dicrotic notch in pulse is due to aortic valve closure.
The pressure change of aortic valve closure manifests as dicrotic notch.
149.Ans a(Harrisson 19/e ,echapter 290)
Beri beri ,thyrotoxicosis , anemia and pregnancy are associated with hyperdyanamic circulation.
These conditions are associated with high output cardiac failure.
150.Ans d (Harrisson 19/e page)
ASO titre is useful for diagnosis of acute rheumatic fever.
Titre > 200 is significant.
Its included in minor criteria for diagnosis.
It doesnt correlate with disease severity.
151.Ans a (Harrisson 19/e page 364,365)
Sickle cell anemia is associated with-
chest syndrome, hand foot syndrome, priapism.
This is due to stagnation of sickled celss.
Very painful condition.
Tt involves oxygen therapy, hydration and opiod analgesic
Type 1 gastric NET is associated with chronic gastritis.
Type 2 is associated with MEN 1 symdrome.
NET are positive for chromogranin ,neuron specific enolase.

HBA1c > 6.5 % is defined as diabetes mellitus.
Fasting is defined as abstinence of calorie diet for more than 8 hrs.
Parathyroid adenoma solitary accounts for 80% of cases of primary hyperPTH
Its a benign neoplasm.
Surgical excision is treatment.
155.Ans b (Harrisson 19/e page)
Sameas Q. no 45
Adrenal crisis is triggered by intercurrent illness, surgical stress etc.
Characterised by hypotension,hypoglycaemia.
TT iv steroid as this is a medical emergfency.
Most common lab manifestation of sick euthyroid syndrome is decrease in T3 ,normal T4 and normal
TSH.
Increase reverse T3
All these hormonal chamges are due to il6.
158.Ans b(Harrisson 19/e page2682,table 459-6)
Diabetic neuropathy is a very painfull condition.
First line treatment includes-
linoderm, TCA, gabapentin, pregabalin, Duloxetine.
Trigeminal neuralgia is characterised by pain in cheek and gum while chewing in the distribution of
trigeminal nerve distribution.
Pain is very excruciating so that patient winces
There is subjective sensory loss.

Tic dulourex is also called trigeminal neuralgia.
161.Ans b(Harrisson 19/e page2678)repeat
Vit E deficiency is characterised by ataxia,opthalmoplegia and areflexia.
Areflexia is due to neuropathy.
Though neurological conditions arey very less responsve but vit E supplementation has some role.
163.Ans c
Repeat
164.Ans b(Harrisson 19/e page177)
Brocas aphasia is a non fluent type of aphasia as it is motor aphasia.
Fluency is decreased.
However comprehension is normal in contrast to wernickes aphasia.
HSV is mc cause of mollarette meningitis.
Its a recurrent lymphocytic meningitis.
166.Ans d(Harrisson 19/e page898)
Protozoal and fungal meningitis cause increase in csf eosinophil.
Since both causes eosinophilic response.
167.Ans a(Harrisson 19/e page2562).
Thrombolysis is contraindicated if
BP>185/110 mmhg
Blood glucose , 40 mg/dl or > 400mg/dl
Past history of intracranial bleed
Thrombocytopenia.
rtPA dose 0.9mg/kg maximum of 90 mg/dl.
10% to be given bolus rest over one hour infusion.
Risk of rupture
>7mm in diameter
Location at topof basilar artery or at origin of PCA.
SAH is a presentation of berry aneurysm.
Subdural haemorrhage is because of rupture of cortical bridging vein.
Also most of cardio embolic stroke are non rheumatic in origin.
Atrial fibrillation is associated with majority of cases.
Valvular atrial fibrillation is also a cause of embolic stroke.
174.Ans b(kdigo guideline)
Failure is defined as urine output < 0.3ml/kg/hr for 24 hr or anuria for 12 hr
Imjury is defined as urine output <0.5ml/kg/hr for 12 hr
This is a caseof haemolytic anemia as reflected by reticulocytosis.
So coombs test to be used to find aetiology of hemolysis.
Autoimmune hemolysis may occur in systemic lupus erythematousis and other auto immune
condition.
Tumour lysis syndrome is characterised by hyperuricemia ,hyperkalemia, hyper phosphotemia and

hypocalcemia.
Usually occurs during chemotherapy.
Rapid death of cells lead to all these manifestatrions.
TT is allopurinol,
Rasburicase and hemodialysis.
177.Ans a(Harrisson 19/e,echapter 464e1)
Chronic fatigue syndrome is characterised by severe fatigue not relieved by rest
Painfull cervical lymphadenopathy.
Sub acute lupus erythematous are exquisitevely photosensitive
Most patients are antibody to Ro positive.
Antinuclear antibody has very high negative predictive value.
179.Ans a(Harrisson 19/e page2157.,382 -3 table)
Diffuse scleroderma ia associated with topoisomerase 1 ab
MCTD associated with U1RNP
Lcssc associated with ab to centromere.
Steroids have no role in management of GBS.
Both IVIG and plasmapheresis are equally effective.
Alport syndrome is X linked recessive disese.
Charcerised by sensineural deafness,
Proteinuria (subnephrotic)
Heamturia.
Thiazides diuretics in dosese higher than used in hypertension decreses calcium excretion in urine
This property of thiazide is used for tt of hyperclciuria.

Hypercalciuria is a cause of nephrolithiasis.
Fibromuscular dyplasia is mc cause in young patient whereas
Atherosclerosis is mc cause renal artery stenosis in elederly >55 years.
Renal artery stenosis is a correctable cause of hypertension.
Increase in ADH leads to concentrated urine which ischaracteristic of siadh.
So urine osmolarity is significantly raised.
There is hyponatremia.
187.Ans a (kundu bedside clinics)
Cavernous type of breathing is a type of bronchial breathing present in cavitory lesion.
Tubular bronchial breathing occurs in consolidation.
AED stands for automated external defibrillator.
189.Ans b(Harrisson 19/e page)
AEDis used in ventricular fibrillation.
Adenoma mostly occur in inferior PTH gland
Adenoma are mc cause of priamary hyperpth.
Chief cells predominate both in adenoma and hyperplasia.
It is charterised by hypercalcemia , peptic ulcer and nephrolithiasis.
MEN 2B is characterised by pheochromocytoma, MTC and neuroma.
hyperPTH doesnt occur in MEN2B.
192.Ans d (Harrisson 19/e page2340).

Weber syndrome is midbrain syndrome.
Characterised by ipsialteral 3rd C.N. palsy and contralateral hemiplegia.
Explained in 192 question
194.Ans
Mobious syndrome is characterised by 3rd,6 th ,7thC.N. palsy
Involvement of chest muscle in formof Poland syndrome occurs
Erythema nodosum occurs in 15 % crohns disease and 10% in ulcerative colitis
Crohns disease is panmuralcolitis.
Erythema nododsum correlates with the disease of activity.
Pyoderma gangrenosusm is other dermatological manifestation of IBD.
196.Ans (Harrisson 19/e page)
197.Ans a (Harrisson 19/e page1957-59)
Ulcerative colitis usually presents as proctocolitis.
Only treatment option in hepatorenalsyndrome is liver transplant that can reverse the pathology.
HRS is characterised by raise in serum creatinine in absence of other intrinsic renal cause with
nornalusg findings of kidney.
Myxedema n lyphatic filariasis are causes of non pitting edema.
200.Ans c
Peptic ulcer is mc cause of upper gi bleed in india.
2nd mc cause is ariceal bleed.
201.congenital tb-refer to paediatric book
202.Ans b.FSGS(Harrisson 19/e page1849)
FSGS collapsing variant variant is mc renal manifestation of HIV associated nephropathy.
Cyctic dilation and inclusion are other histological features present in renalbiopsy.
Treatment is ART irrespective of CD4 count.
Tall t waves are earliest finding in MI in ECG.this is followed by ST elevation then T wave inversion
then finally q wave appears.
205.Ans b(Harrisson 19/e page817,818)
Staphylococcus causes acute infective endocarditis which is associated with absess formation.
Streptoccus and otherorganism causes sub acute bacterial endocarditis.
Most lethal form of inf.endocarditis.
Mostly middle and lower zone of lung is involved in primary which is associated with hilar
lymphadenopathy.
207.Ans b(Harrisson 19/e page 2650-51)
Sacral sparing is a feature of intramedullary lesion.
Rest are feature of extra medullary compression.
Conus meduularis is characterised by early bladder bowel involvement and loss of sacral reflexes.
In cauda equina,blaader involvement occurs in late course of disease
209.Ans c (Harrisson 19/e page2611-12)
Manganese exposure and smoking are associated with risk of Parkinson disease.
They predominantly affects basal ganglia.
Cns lymphoma is mc intra cranial tm in HIV
It is associated with EBV
Occurs when CD$ count is< 50/microl
211.Ansd (Harrisson 19/e page2543,900)
SSPE eeg is characterised by burst of high voltage sharp slow waves every 3-8 sec followed by flat
back ground.
This is a complication of measle infection.

No effective treatment.
Lamivudine is given in HBeAG reactive patients,lesser efficacy in HBeag negative patients.
Other two are not indication of intiation of anti viral therapy.
Bundle of kent is accesoory pathway responsible for WPW syndrome
This accessory pathway provides rapid conduction of impulses as it has high conductivity.
215.Ans b(Harrisson 19/e page2276-77)
Nephrogenic DI are unresponsive to ADH and vasopressin
Associated with high urine volume.
216.Ansb
repeat
Increase insulin causes hypoglycaemia.
Cystatin C is a new marker of acute kidney injury.
Other is kidney injury molecule(kim).
Markers are of some help to distinguish acute and chronic kidney disease.
Increased VMA (vinyl mandellic acid ) are metabolites of actecholamines which are increased in
phaeochromocytoma.
24 hour urinary metanephrines are used in diagnosis of pheochromocytoma.
220.Ansb (Harrisson 19/e page 2006)
HBeAG is qualitative amrkerof Hep B replication.
HBV DNA is quantitative marker of viral replication.
HBsAg is used for diagnosis of infection.
Distal symmetric sensory motor neuropathy is mc typeof neuropathy in diabetes mellitus.

Symptoms include sensory and motor .
Treatment is pregabalin.
These are characteristic of henoch scolen purpura
Rash is predominant in trunl and buttocks.
Other feature include pain abdomen and anthritis.
224.Ans a(Harrisson 19/e page1556-57)
Systolic dysfunction is most prominent in dilated cardiomyopathy.
This is because dilated myofibres are inefficient in contraction.
MS is characterised by pulmonary hypertension
Pulmonary HTN leads toRVH which manifests as parasternal heave.
ASD is having fixed wide split S2
Average time of death after symptom onset in AS
Angina-3 yrs
Syncope-3 years
Dyspnea- 2 yrs
CHF-1.5 years
Hypothyroidism is risk factor for atrial fibrilaation.
Transferrin saturation below 15-20% leads to suppression of haemoglobin synthesis.
Schilling test is used for diagnosis of B12 deficincy anemia.

EBV is associated with burkitts lymphoma
HIV is also associated with burkitt lymphoma.
Vhl is also associated with renal cell cancer,pheochromocytoma
Brain is mc site of hemangioblastoma.
Gene responsiblefor vhl codes for hypoxia inducible protein.
Though gbs is considered to be idiopathic but infection with campylobacter has been found in 30%
of cases that may initiate formation of autoantibodies.]
235.Ansc (Harrisson 19/e page630)
Repeat
Most easily and frequently done site for biopsy in secondary amyloidosis is abdominal fat asprate.
Heart is second mc organ involved after renal system.
Heart involvement is mc cause of death.
Cardiac biopsy is required to establish the diagnosis.
238.Ans d.repeat
Fasting glucose >126 mg/dlis diagnostic of diabete mellitus
Repeat.
Type 1 DM is considered to be autoimmune in aetiology with ab against insulin.
243.ans A
244.Ansb (Harrisson 19/e page1697-98)
CF involves exocrine gland.

Dejerrine thalamic syndrome is due to stroke in thalamus.
Third cranial nerve is most commonly involved.
Middle cerebral artery is most common site of stroke and frequently lead to hemiplegia.
Putamen is mc site of bleed.
Brocas area is loactedin inferior frontal gyrus
Lesion leads to motor aphasia.
Wernickes area is located in superior temporal gyrus.
Lesion causes sensory aphasia.
In wernickes apahsia fluency is intact.but speech is meaningless.
Carrey coomb murmur is diastolic murmur due to carditiis.
Carditis leads to MR .
254.Ans a (Harrisson 19/e page2651) conus medularis lead to early bladder involvement.
Rest are feature of conus medullaris.
HIV withTB regimen is
2(NRTI) +1(NNRTI)
Protease inh are usually avoided because if drug interaction.
Rifampicin to be replaced by rifabutin.

Because of erythrocytosis ESR is less.
Facial nerve is mc nerve involved in neuro sarcoidosis.
Hemoptysis is not a triad of pancost tumour
260.Ans a
261.Ans c(Harrisson 19/e page1737-37)
Pulmonary edma is not a feature of ARDS.
PCWP is normalin ARDS
Lead toxicity causes axonal degeneration of motor neurons.
Other feature of lead poisoning includes-
lead encephalopathy,
anemia
constipation
wrist drop , foot drop
menstrual irregularity nd infertility.
Mild sensory involvement is common in GBS
263.Ans c(Harrisson 19/e page1698-99)
Sweat chloride test is most sensitive test for cystic fibrosis.
CF is due to CFTR gene mutation
Its an autosomal recessive disorder.
Recurrent pulmonary infection occurs because of thick viscous secretion.
264.Ans b(Harrisson 19/e page)1457
Hypocalcemia leads to increase in QT interval.
Hypercalcemia causes shortening of QT interval.

Hypokalemia is associated with
U wave,
increase QT interval.
T wave flattening or
T wave inversion lastly asystole.
Artemisin analogue are used for chloroquine resistant malaria.
Practically till now hardly a case resistant to artemisin has been found in india.
Not safe in first trimester of pregnancy.
DEC is doc for filariasis.
DEC given 1000mg 8 hourly for 21 days.
Albendazole is also effective in filariasis.
268.Ans c(Harrisson 19/e page)
Maddrey discrimination score > 32 carries poor prognosis.
Its a severity indicator in alcoholic hepatitis
Severe alcoholic hepatitis requires steroid treatment.
Coxsackie infection is associated with
hand food mouth syndrome,
pleurodynia and
herpangina.
Salt and water depletion occurs because of mineralocorticoid deficiency
Hyperpigmentation because of increased ACTH which stimulates melanocytes.
Secondary adisson disease leads to hypopigmentation of skin.

Other drug used in chagas disease is benznidazole.
Chagas disease also called American trypanosomiasis.
It causes cardiac conduction defect in heart and achalasia cardia
272.Ans a(Harrisson 19/e page)
In first week there is bacteremia so highest chance of bacterial isolation.
BASU is mnemonic
Blood culture first week
Antibody-second week
Stool culture-third week
Urine culture-fourth week
Perforation is deadliest complication of enteric fever.
It usually occurs in third week.
TT-ceftriaxone is doc.
Refer to above question for more explanation
274. .Ansb (Harrisson 19/e page2623)
275. .Ans a(Harrisson 19/e page)
Eeg is inestigation of choice in seizure.
Different form of brain waves are studied.
EEG is most usefull in ictal state .

Answer Test Xpress

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Answer Test Xpress

Uploaded by

Copyright:

Available Formats

4.Most common cause of infective endocarditis in iv drug abuser is S.

aureus especially in tricuspid

HIV infection in iv drug abuser doesnt influence the causes of endocarditis.

Lesion here is of nodular type

MC cells are lymphocytes

Diagnosis-RK39 and other serologic tests are positive

TT-pentavalent antimonial for 60-120 days.

8.Ans c(Harrison 19/e page 2021)

Vaccine of hep. B is recombinant vaccine.Only contraindication of this vaccine is hypersensitivity to

9.ans B(Harrison 19/E 2018)

Hepatitis B accounts for > 50% of fulminant cases of viral hepatitis.

10.Ans C(Harrison 19/e 2013)

Quantitative marker of viral replication in hep B is HBV DNA.

13.ans C(Harrison19/e page 1112)

Chronic impairment of lung function in patient of TB includes bronchiectasis, aspergillomas and

14.Ans c(Harrison 19/e page 1947)

For unknown reason smoking is protective in ulcerative colitis.

Appendectomy is another protective risk factor in ulcerative colitis.

15.Ans B(Slesinger textbook of gastroenterology 9/epage 1785-1786)

Loperamide is contra indicated in infectious diarrhea.

Ciprofloxacin,Azithromycin and Rifaximin has role in acute traveller diarrhea.

16.Ans A(Harrison 19/e page 269)

They draw fluid osmotically causing diarrhea.

Causes of osmotic diarrhea are lactase deficiency diarrhea,use of osmptic laxatives.

Stool osmotic gap formula is =2 *{ stool sodium + stoolpotasssium}< stool osmolarity

Osmotic gap> 50 suggests osmotic diarrhea.

17.Ans c (Harrisson 19/e page)

18 .Ans c(Harrisson 19/e page627)

Raise TIBC, decreased transferrin saturation.

19 Ans a(Harrisson 19/e page 1579)

The major risk factors for atherosclerosisis -

20.Ans d (Harrisson 19/e page1569)

21.Ans a(Harrisson 19/e page331)

Hirsutism is most commonly idiopathic or the consequence of PCOD(polycystic ovarian syndrome) .

22.Ans a(Harrisson 19/e page 301)

This is due to glucose induced water efflux from the cells .

23.Ansc (Harrisson 19/e page 2315,2325)

Hypoaldosteronism is characterised by hyperkalemia.hyponatremia. metabolic acidosis.

Decrease glucose is characteristic of glucocorticoid deficiency.

24.Ans b (Harrisson 19/e page 2281)

SIADH is a type of euvolemic hyponatremia.

FeNa is < 1% in pre renal azotemia.

Acute gastroenteritis is a cause of pre renal azotemia.

FeNa is > 2% in oliguric renalfailure.

26 .Ans d (Harrisson 19/e page 1824)

Peritoneal dialysis is may be carried out as continuous ambulatory peritoneal dialysis(CAPD)or

Continuous cyclic peritoneal dialysis(CPPD).

CPAD is performed usually three to five times a day.

27.Ans B (Harrisson 19/e page 1823 )

AV graft uses graft of polytetra fluoroethylene as prosthetic material.

28.Ans c(Harrisson 19/e page 1835 )

Wegeners granulomatosis presents as acute nephritic syndrome.

Rest are causes of nephrotic syndrome.

29.Ans b(Harrisson 19/e page 1837)

RBC cast is present in nephritic syndrome.

Interstitial nephritis lead to WBC casts.

Muddy brown casts present in AKI because of Acute tubular necrosis.

30.Ans b (Harrisson 19/e page 1859 )

31.Ans b(Harrisson 19/e page 1724-1725 )

32. Ans b (Harrisson 19/e page 1724-1725)

Pickwickian syndromeis a risk factor of obstructive sleep apnea(OSA)

33.Ans c (Harrisson 19/e page )

35.Ans B (Mitochondria in Pathogenesis edited by John J. Lemasters, Anna-Liisa Nieminen e2002

Hypoglycin A is methylenecyclopropyl alanine present in fruit of Ackee .