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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.

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 )

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.

49.Ans b(Harrisson 19/e page 2695)

AIDP-antibody is anti GM1

AMAN-anti GD1a

Miller Fisher variant-anti GQ1b antibodies.

50.Ans a(Harrisson 19/e page 1694)

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.

61. Ans d(Harrison 19/e page )


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

64. Ans a (Harrison 19/e page )


Pulsus paradoxus is a feature of cardiac tamponade

65. Ans a(Harrison 19/e page )


Pulsus alternans is present in severe heart failure.
66. Ans a (Harrison 19/e page )
Pulsus bisferiens is characteristic of AR.

67. Ans a (Harrison 19/e page )


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).
68. Ans a (Harrison 19/e page )
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.
70. Ans d(Harrison 19/e page )
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 )

73. Ans a (Harrison 19/e page )

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

76. Ans d(Harrison 19/e page )

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.

81. Ans b (Harrison 19/e page 2189)

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).

85. Ans b (Harrison 19/e page 1681)

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.

90. Ans b (Harrison 19/e page 1780)

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.

114.Ans d(Harrisson 19/e page 1220)

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.

117.Ans d(Harrisson 19/e page 2631)

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.

122.Ans d (Harrisson 19/e page1901)

Esophageal manometry tests entails positioning a pressure sensor catheter in esophageal lumen
This is most imp inv in esophageal motility disorder.

123.Ans c(Harrisson 19/e page 1689)

Asbestos and smoking act synergistic in causing lung cancer.

Latent period of cancer to develop in asbestosis is 15-19 years.

124.Ans b(Harrisson 19/e page 1457)

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.

130.Ans c (Harrisson 19/e page307)

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.

139.Ans c(Harrisson 19/e page 1374)

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)

144.Ans b (Harrisson 19/e page 1662)

Pulmonary embolism leads to accumulation of intra alveolar blood that increases diffusion capacity
CO.

145.Ans a (Harrisson 19/e page 1443)

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.

148.Ans a (Harrisson 19/e page 1445)

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

152.Ans c(Harrisson 19/e page 564)

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.

153.Ans a(Harrisson 19/e page2401)


HBA1c > 6.5 % is defined as diabetes mellitus.

Fasting is defined as abstinence of calorie diet for more than 8 hrs.

154.Ans b (Harrisson 19/e page 2470)

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

156.Ans a(Harrisson 19/e page2325)

Adrenal crisis is triggered by intercurrent illness, surgical stress etc.

Characterised by hypotension,hypoglycaemia.

TT iv steroid as this is a medical emergfency.

157.Ans b (Harrisson 19/e page 2299)

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.

159.Ans b (Harrisson 19/e page2647)

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.


160.Ans c (Harrisson 19/e page2647)

Tic dulourex is also called trigeminal neuralgia.

161.Ans b(Harrisson 19/e page2678)repeat

162.Ans c (Harrisson 19/e page2690)

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.

165.Ans a(Harrisson 19/e page1179)

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.
168.Ans b(Harrisson 19/e page2562)

rtPA dose 0.9mg/kg maximum of 90 mg/dl.

10% to be given bolus rest over one hour infusion.

169.Ansb (Harrisson 19/e page1785)

170.Ans b (Harrisson 19/e page1785)

Risk of rupture

>7mm in diameter

Location at topof basilar artery or at origin of PCA.

171.Ans (Harrisson 19/e page1784)

SAH is a presentation of berry aneurysm.

Subdural haemorrhage is because of rupture of cortical bridging vein.

172.Ans a(Harrisson 19/e page2564)

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

175.Ans b(Harrisson 19/e page649)

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.

176.Ans d(Harrisson 19/e page1795)

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.

178.Ans b(Harrisson 19/e page 2128)

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.

180.Ans a(Harrisson 19/e page2699)

Steroids have no role in management of GBS.

Both IVIG and plasmapheresis are equally effective.

181.Ans c(Harrisson 19/e page 1847)

Alport syndrome is X linked recessive disese.

Charcerised by sensineural deafness,

Proteinuria (subnephrotic)

Heamturia.

182.Ans d(Harrisson 19/e page 1870)

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.

183.Ans a(Harrisson 19/e page1627)

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.

184.Ans a(Harrisson 19/e page1823)

185.Ans a(Harrisson 19/e page2281)

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.

188.Ans a(Harrisson 19/e page 1769)

AED stands for automated external defibrillator.

189.Ans b(Harrisson 19/e page)

AEDis used in ventricular fibrillation.

190.Ans a(Harrisson 19/e page 2470)

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.

191.Ans a (Harrisson 19/e page2340)

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.

193.Ans a(Harrisson 19/e page2340)

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

195.Ans a (Harrisson 19/e page1957)

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.

198.Ans d (Harrisson 19/e page2066)

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.

199.Ans b(Harrisson 19/e page250)

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.

203.Ans d (Harrisson 19/e page1600)

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.

204.Ans a(Harrisson 19/e page2910)

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.

206.Ans c(Harrisson 19/e page1108)

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.

208.Ans c(Harrisson 19/e page2651)

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.

210.Ans a (Harrisson 19/e page1270)

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.

213.Ans a(Harrisson 19/e page 2034)

Lamivudine is given in HBeAG reactive patients,lesser efficacy in HBeag negative patients.

Other two are not indication of intiation of anti viral therapy.

214.Ansb (Harrisson 19/e page1481)

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

217.Ans a(Harrisson 19/e page2432)

Increase insulin causes hypoglycaemia.

218.Ans a(Harrisson 19/e page1808)

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.

219.Ans a(Harrisson 19/e page2330)

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.

222.Ans b(Harrisson 19/e page 2682)

Distal symmetric sensory motor neuropathy is mc typeof neuropathy in diabetes mellitus.


Symptoms include sensory and motor .

Treatment is pregabalin.

223.Ans d(Harrisson 19/e page1839)

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.

225.Ans a(Harrisson 19/e page1539-40)

MS is characterised by pulmonary hypertension

Pulmonary HTN leads toRVH which manifests as parasternal heave.

226.Ans a(Harrisson 19/e page 1521)

ASD is having fixed wide split S2

228.Ans c(Harrisson 19/e page1532)

Average time of death after symptom onset in AS

Angina-3 yrs

Syncope-3 years

Dyspnea- 2 yrs

CHF-1.5 years

229.Ans c(Harrisson 19/e page2291)

Hypothyroidism is risk factor for atrial fibrilaation.

230.Ans d(Harrisson 19/e page627)

Transferrin saturation below 15-20% leads to suppression of haemoglobin synthesis.

231.Ans a(Harrisson 19/e page1938)

Schilling test is used for diagnosis of B12 deficincy anemia.

232.Ans a(Harrisson 19/e page187-88)


EBV is associated with burkitts lymphoma

HIV is also associated with burkitt lymphoma.

233.Ans a (Harrisson 19/e page2342)

Vhl is also associated with renal cell cancer,pheochromocytoma

Brain is mc site of hemangioblastoma.

Gene responsiblefor vhl codes for hypoxia inducible protein.

234.Ans d(Harrisson 19/e page2695)

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

236.Ans d(Harrisson 19/e page710)

Most easily and frequently done site for biopsy in secondary amyloidosis is abdominal fat asprate.

237.Ansb (Harrisson 19/e page721)

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

239.Ans b(Harrisson 19/e page2390)

Fasting glucose >126 mg/dlis diagnostic of diabete mellitus

Repeat.

240.Ans a(Harrisson 19/e page2399)

Type 1 DM is considered to be autoimmune in aetiology with ab against insulin.

241.Ans (Harrisson 19/e page1737)

243.ans A

244.Ansb (Harrisson 19/e page1697-98)

CF involves exocrine gland.

245.Ans a (Harrisson 19/e page2575)


Dejerrine thalamic syndrome is due to stroke in thalamus.

246.Ans a(Harrisson 19/e page1785)

Third cranial nerve is most commonly involved.

247.Ans a(Harrisson 19/e page2572-73)

Middle cerebral artery is most common site of stroke and frequently lead to hemiplegia.

249.Ans (Harrisson 19/e page2582)

Putamen is mc site of bleed.

250.Ansb (Harrisson 19/e page177)

Brocas area is loactedin inferior frontal gyrus

Lesion leads to motor aphasia.

251.Ans c(Harrisson 19/e page 176)

Wernickes area is located in superior temporal gyrus.

Lesion causes sensory aphasia.

252.Ans b (Harrisson 19/e page177)

In wernickes apahsia fluency is intact.but speech is meaningless.

253.Ans b(Harrisson 19/e page2150)

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.

255.Ans b(Harrisson 19/e page1839)

256.Ans b(Harrisson 19/e page1119)

HIV withTB regimen is

2(NRTI) +1(NNRTI)

Protease inh are usually avoided because if drug interaction.

Rifampicin to be replaced by rifabutin.

257.Ans a(Harrisson 19/e page273)


Because of erythrocytosis ESR is less.

258.Ans a(Harrisson 19/e page2208)

Facial nerve is mc nerve involved in neuro sarcoidosis.

259.Ans c(Harrisson 19/e page510)

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

262.Ans c(Harrisson 19/e page2688)

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.

265.Ans d(Harrisson 19/e page1457)


Hypokalemia is associated with

U wave,

increase QT interval.

T wave flattening or

T wave inversion lastly asystole.

266.Ans c(Harrisson 19/e page1379)

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.

267.Ans b(Harrisson 19/e page1419)

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.

269.Ans b(Harrisson 19/e page 1293)

Coxsackie infection is associated with

hand food mouth syndrome,

pleurodynia and

herpangina.

270.Ans b(Harrisson 19/e page2325)

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.

271.Ans d(Harrisson 19/e page1395)


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

273.Ans c (Harrisson 19/e page1051)

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 .