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APPG 2013 Medicine and paediatrics

MEDICINE AUTHENTIC ANSWERS WITH REFFERENCE PAGE FROM HARRISON 17TH AND 18TH EDITION

101.h.pylori colonisation is a risk factor for all EXCEPT? 1.adenocarcinoma of distal stomach 2.GERD 3.primary gastric lymphoma 4.auto immune gastritis Ans 2 and 4 Harrison 17th Page 947.1870,1871

102.non pancreatic gastrinomas are mostly located in 1.duodenum 2.stomach 3.liver 4.heart Ans 1 Page 2348 table

103.the first choice of demardfor initial treatment of moderate to severe rheumatiod arthritis is 1.hydroxychloroquine 2.methotrexate 3.leflunamide 4.gold salts Ans 2 Page no 2090

104.the most common cause of increased red cell protoporphyrin levels is 1.absolute or relative iron deficiency 2.vit b12 deficiency 3.sideroblastic anaemia 4.erythropoietic protoporphyria Ans 1 Page 631

105.chronic pericardial effusion that is massive but rarely causes cardiac tamponade is a feature of 1.mycotic infections 2.pyogenic infections 3.rhuematiod arthritis 4.myxoedema Ans 4 Page 1493

106.the holiday heart syndrome which typically appears after a drinking binge manifests most freqeuntly as 1.heart failure 2.atrial fibrillation 3.complete heart block 4.sudden death Ans 2 Page 1482

107.one of the following is an esssential component of multi drug regimen in the treatment of staphylococcal prosthetic valve endocarditis 1.gentamycin 2.vancomycin 3.fluroquinolone 4.rifampin(rifampicine) Ans 4 Page 795 h 17th

108.autonomic nueropathy type1 or type2 DM manifests as all,EXCEPT 1.resting tachycardia 2.sudden death 3.gastroparesis 4.anhidrosis of upper extremities Ans 4 Page 2289 h 17 th

109.the most common cause of growth hormone releasing hormone (GHRH)mediated acromegaly is 1.hypothalamic tumors 2.choristomas 3.chest or abdominal carciniod tumors 4.neromas Ans 3 Page

110.acute kidney injury caused by acyclovir is due to 1.tubular necrosis 2.tubular obstruction 3.acute interstitial nephritis 4 all the above Ans 3 reference

GOODMAN & GILMAN'S THE PHARMACOLOGICAL BASIS OF THERAPEUTICS - 11th Ed. (2006 The principal dose-limiting toxicities of intravenous acyclovir are renal insufficiency and CNS side effects. Preexisting renal insufficiency, high doses, and high acyclovir plasma levels (>25 mg/ml) are risk factors for both. Reversible renal dysfunction occurs in approximately 5% of patients, probably related to high urine levels causing crystalline nephropathy. Manifestations include nausea, emesis, flank pain, and increasing azotemia. Rapid infusion, dehydration, and inadequate urine flow increase the risk. Infusions should be given at a constant rate over at least an hour. Nephrotoxicity usually resolves with drug cessation and volume expansion. Neurotoxicity occurs in 1% to 4% of patients and may be manifested by altered sensorium, tremor, myoclonus, delirium, seizures, or extrapyramidal signs. Phlebitis following extravasation, rash, diaphoresis, nausea, hypotension, and interstitial nephritis also have been described. Hemodialysis may be useful in severe cases.

111.lesh-nyhans syndrome is characterised by all except 1.hyperuricemia 2.self mutilation behaviuor 3.choreo athetosis 4partial deficiency of HPRT ANS 4 PAGE 2447 h 17th

112.hyperprolactenemia is caused by all EXCEPT 1.drugs 2.pitutary stalk compression 3.hyperthyriodism 4.renal failure Ans 3 Page 2205

113.the drug of chioce in patients with generalized epilepsy syndromes having mixed seizure type is 1.phenytion 2.oxcarbazepine 3.lamotrigine 4.valproic acid Ans 4 Page 2509 h 17th

114.most cases of hemifacial spasms are related to 1.sequeale of bells palsy 2.secondary to compression of nerve by tumor 3.multiple sclerosis 4vascular compression of facial nerve in pons Ans 1 Page 2585

115.the most common cause of cardioembolic stroke is 1.rhuematic heart disease 2.non rhuematic atrial fibrillations 3.myocardial infraction 4.mitral valve prolapse Ans 2 Page 2517

116.extra renal manifestations of autosomal dominant polycystic kidney disease( ADPKD)includes all EXCEPT 1.saccular anuerysms 2.aortic root and annulus dilatations 3.colonic diverticulae 4.splenic cysts Ans 4 Page 1798 h 17th

117.focal seizures in bacterial meningitis are usually due to 1.cortical venous thrombosis with haemorrage 2.hyponatremia 3.cerebral anoxia 4.toxic effects of high dose pencillin Ans 1 Page

118.patchy specific lesions seen on small bowel biopsy includes all EXCEPT 1lymphoma 2.whipples disease 3.amyloidosis 4 eosinphilic gastroenteritis Ans 2 Page 1880

119 Which one of the following significantly reduces plasma levels of lp(a) upto 40% 1.HMG COA reductase inhibitors 2.fibric acid derivatives 3.nicotinic acid 4.bile acid sesuestrants Ans 3 Page

Wikipedia given only 20 to 30% for nicitinic acid I didnt information in 17 th and 18th harrison

120.in patients with severe structural lung disease ,such as bronchectasis or severe copd,the infective agent most likely to cause pneumonia is 1.h.influenza 2pnuemococcous 3.legionella 4.p.aeruginosa Ans 4 Page 1629

121.the most common life threatening metabolic complication of squamous cell carcinoma of lung is 1.hyponatremia 2.hypercalcemia 3.hypokalemia 4.hypomagnesemia Ans 2 Page 2306

122.the predominant cause of diarrhoea among elederly patients in chronic care institutiins is 1.enteropathogenic e. coli 2.shigella 3.c .difficle 4.klebsiella Ans 3 Harrison 18th editin lines

Enteropathogenic E. coli has been associated with outbreaks of diarrhea in nurseries for newborns. Onethird of elderly patients in chronic-care institutions develop a significant diarrheal illness each year; more than one-half of these cases are caused by cytotoxin-producing C. difficile. Antimicrobial therapy can predispose to pseudomembranous colitis by altering the normal colonic flora and allowing the multiplication of C. difficile (Chap. 129).

123.in bronchiectasis pedominant involvement of central airways is seen in 1.allergic bronchopulmonary aspergillosis 2.infection with m avium complex 3.cystic fibrosis 4tuberculosis Ans 1 Page 1259

124.all the sideeffects of interferon theray are reversible upon dose lowering or cessation of therapy EXCEPT. 1alopecia 2.diarrhoea 3.autoimmune thyrioditis 4.tingling of extremities Ans 3 Page see below

Complications of IFN therapy include systemic "flu-like" symptoms; marrow suppression; emotional lability (irritability, depression, anxiety); autoimmune reactions (especially autoimmune thyroiditis); and miscellaneous side effects such as alopecia, rashes, diarrhea, and numbness and tingling of the extremities. With the possible exception of autoimmune thyroiditis, all these side effects are reversible upon dose lowering or cessation of therapy.

125.in juvenile pernicious anemia all are present EXCEPT 1.gatric atrophy 2.achlorhydria 3.serum IF antibodies 4parietal cell anti bodeis Ans 4 Page 648

126.a unique form of hemolytic anemia (with spur cells and acanthocytes) can occur in patiens with sever alcoholic hepatitis is called as 1.kostmanns syndrome 2.zieves syndrome 3.seckel syndrome 4dubowitz syndrome Ans 2 Page 1972

127.in vertebral osteomylitis,anterior erosions of the superior end plate of vertebrae are typically the first feature to become evident in 1.typhiod 2 tuberculosis 3.brucellosis 4.staphylococcal osteomylitis Ans 3 Page 804

128 aplstic anemia with pancreatic insufficiency and malabsorption is seen in 1.fanconis syndrome 2.dyskeartosis congenita 3.shwachmann diamond syndrome 4 diamond blackfan syndrome Ans 3 Page 665

129.the areas most often involved in lesions of toxoplasmosis in CNS includes all EXCEPT 1brain stem 2.meninges 3.basal ganglia 4.pitutary gland Ans 2 Page 1308

130.autosommal reccessive hyper ig E syndrome is charecterised by all EXCEPT 1.recurrent bacterial infections of skin and respiratory tract 2severe allergic manifestations 3.T & B lymphocyte count are low 4.deficiency in tyk2,a JAK family kinase Ans 4 page

131. All are primary causes of nephrotic syndrome in infants younger than one year, EXCEPT

A. Congenital nephrotic syndrome B. Minimal change disease C. Membranous nephropathy. D. Systemic lupus erythematosus Ans d Page robbins 7th edition 979

132. Regarding Reye syndrome, all of the following statements are TRUE, EXCEPT A. The white liver disease and encephalopathy with fatty degeneration of the viscera are its other nomenclatures B.Sporadic Reye syndrome can occur in the context of varicella or influenza B virus infection C. The condition is usually observed in children below 3 years of age D. Mitochondrial dysfunction of fatty acid oxidation is significant Ans c Page 524 op ghai

133. Hemorrhagic cystitis is a dreaded complication associated with use of

A. Clobazam B. Cyclosporin C. Cycloserine D. Cyclophosphamide Ans d Page katzung 885

134. An 18 month old boy presents with prominent eyeballs and periorbital ecchymosis and an enlarging swelling on the left upper abdomen. He is markedly pale. A large left sided mass distinct from the spleen was palpable. The most likely diagnosis is

A. Wilm's tumor B. Osteopetrosis C. Neuroblastoma D. Gauchers Disease Ans C Page op ghai 573

135. One of the following intrauterine infections has characteristically the following triad of chorioretinitis, microcephaly and intraceiebral calcifications.

A. Cytomegalovirus B. Toxoplasmosis , C. Rubella D. Herpes simplex Ans A pg 1110 harrison 17th

136. A 5 year old girl has 3 months history of joint pains and morning stiffness. Knees and ankles are involved with mild swelling and tenderness. Slit lamp examination reveals IRIDOCYCLITIS. The diagnosis is A. Juvenile Rheumatoid Arthritis (JRA) B. Systemic Lupus Erythematosus (SLE) C. Henoch Schonlein Purpura (HSP) D. Rheumatic Arthritis

Ans A 581 Op ghai

137. A 7 year old/ boy has short stature, large skull, prominent forehead, saddle shaped nose, exaggerated lordosis and normal intelligence and development, the diagnosis is A. Noonan syndrome B. Hypopituitarism C. Isolated Growth Hormone V Deficiency D. Achondroplasia Ans D

138. Immediately after birth, the preventable causes of mental retardation include all of the following, EXCEPT

A. Hypothyroidism B. Phenylketonuria. C. Kernicterus D. Hurlers disease Ans d 545 op ghai

139. Which of the following is associated with large anterior fontanel ? A. Achondroplasia B. Apert syndrome C. Cleidocranial Dysostosis D. All of the above Ans D

140. An aggressive looking, thin and tall adolescent boy aged 15 years is noted to have prominent long limbs and small testes. What is the most relevant investigation ? A. Hormonal assays B. Chromosomal analysis C. Skeletal survey D. Ultrasound evaluation Ans b