1 Medicine I

AHEAD Test and Discussions MEDICINE I
Next Test Syllabus: Medicine II Neoplastic, Hematopoietic & Hemostatic Disorders, Infectious & Vascular Diseases, Clinical Syndromes, Nosocomial Infections, Shock & Cardiac Arrest, Endocrinology, Nerve & Muscle Disorders
Ref. Book: Harrisons Principles of Internal Medicine

1. Pulsus paradoxus is seen inA. Shock C. Emphysema/Asthma 10. Osmotic fragility is increased inA. Sickle cell anemia B. Hereditary spherocytosis C. Thalassemia D. Chronic lead poisoning 11. Acromegaly is a disorder of excessA. Growth hormone secretion B. Thyroxine secretion C. ACTH secretion D. FSH secretion 12. If a normal individual receives an insulin injection that lowers plasma glucose to 30 mg/dl, which of the following hormones will not be releasedA. ACTH B. Epinephrine C. Growth hormone D. Aldosterone 13. Results of splenectomy are best in: A. Sickle cell anaemia B. Hereditary spherocytosis C. Acquired haemolytic anaemia D. Idiopathic thrombocytopenic purpura 14. A 40-year old female presents with a history of sudden onset of headache and nausea which passed off with rest and analgesics. Later she developed blurring of vision for a few days. On the day of admission she had developed third nerve palsy with neck rigidity. The temperature was 100F. The most likely diagnosis is: A. Acute attack of migraine B. Viral encephalitis C. Sub-arachnoid haemorrhage D. Severe hypertension 15. For a normal healthy person, the daily requirement of vitamin C is: A. 10 to 50 mg B. 50 to 100 mg C. 100 to 200 mg D. 200 to 300 mg 16. A Carey Coombs murmur heard in a child with multiple joint pains is suggestive of: A. Infective endocarditis B. Rheumatoid arthritis C. Rheumatic fever D. Libman-Sacks endocarditis 17. All of the following drugs are used in the prophylaxis of ventricular tachycardia except: A. Verapamil B. Amiodarone C. Digoxin D. Mexiletine 18. Cardiac manifestations of Graves disease would include all of the following except: A. Wide pulse pressure B. Atrial fibrillation C. Pleuropericardial scratch D. Aortic insufficiency 19. Which one of the following cell type of lung cancers is most frequently associated with hypercalcaemia? A. Small cell B. Large cell C. Squamous cell D. Anaplastic
B. Elderly D. High output state
2. Which one of these is uncharacteristic of pure red cell aplasiaA. Anterior mediastinal masses B. Connective tissue disorders C. Low erythropoietin levels D. Parvovirus B19 infection 3. Which one of the following is an emerging viral diseaseA. SARS B. Chickenpox C. Measles D. Rabies 4. Common threat for aspiration pneumonia isA. Blood B. Pus C. Oral flora D. Foreign Body 5. Kleinfelters syndrome is characterized by the karyotypeA. 47 XYY B. 47 XXY C. 45 YO D. 45XO Vagus nerve supplies parasympathetic fibres to: A. The entire gastrointestinal tract up to the rectum B. Stomach, duodenum and small bowel only C. The entire gastrointestinal tract up to the left third of transverse colon D. Liver, pancreas and spleen only All of the following drugs are used for eradication of Helicobacter pylori except: A. Bismuth subcitrate B. Sucralfate C. Metronidazole D. Amoxycillin
A young female patient has been admitted following a road accident with complaints of pain in the right side of the chest. On examination she is found to have rapid and shallow breathing, a fast pulse rate and hyperresonant chest with absent breath sounds on the right side. The most appropriate immediate course of action would be to:
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A. Perform a diagnostic chest aspiration on right side and put in a chest tube B. Order for urgent chest X-ray and start oxygen C. Put the patient on positive pressure ventilation D. Send for the cardiothoracic surgeon for exploration of chest 9. A 30-year old woman presents with a history of amenorrhoea and imparied vision of six months duration. Physical examination shows everything normal except for pale optic discs and diminished visual acuity. The most likely diagnosis is: A. Pituitary adenoma B. Craniopharyngioma C. Hypothalamic glioma D. Benign intracranial hypertension
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20. Which one of the following therapies would be safe in a patient with pulmonary tuberculosis having markedly abnormal liver function? A. Streptomycin + isoniazid B. Ethambutol + isoniazid C. Rifampicin + isoniazid D. Streptomycin + ethambutol 21. All of the following are true of multi-drug resistant tuberculosis except: A. It is caused by mycobacteria other than M. tuberculosis B. It is treated by a combination of 4 to 6 drugs C. Surgical treatment, wherever feasible is preferred D. It is common in patients with acquired immunodeficiency syndrome (AIDS) 22. All of the following about Wilsons disease are true except: A. May present with haemolysis B. Inherited as an autosomal dominant trait C. Is a recognised cause of chronic hepatitis D. Is often treated with d-Penicillamine 23. Male infertility occurs if the sperm count is less than: A. 100 million/ml B. 75 million/ml C. 50 million/ml D. 20 million/ml 24. Ataxic nystagmus is seen in lesions of: A. Medial longitudinal fasciculus B. Cerebellum C. Labyrinth D. Vestibular nuclei 25. Dissociated anaesthesia is a feature of all of the following except: A. Potts paraplegia B. Intramedullary tumour C. Syringomyelia D. Anterior spinal artery thrombosis 26. M spike on serum electrophoresis is seen in: A. Lymphoblastic leukaemia B. Waldenstroms macroglobulinaemia C. Alpha-chain disease D. AIDS 27. Polycythaemia may be a feature of all of the following except: A. Gastric carcinoma B. Hepatoma C. Cushings syndrome D. Hypernephroma 28. Conjugated and unconjugated bilirubins an increased inA. Pre hepatic jaundice B. Hepatocellularjaundice C. Post hepatic jaundice D. Hemolyticjaundice 29. Mononeuritis multiplex is a recognised complication of all of the following except: A. Rheumatoid arthritis B. Polyarteritis nodosa C. Diabetes mellitus D. Psoriatic arthropathy 30. All of the following are autosomal dominant disorders except: A. Tuberous sclerosis B. Polyposis coli C. Cystic fibrosis D. Myotonic dystonia 31. Glucose-6-phosphate dehydrogenase deficiency is: A. Autosomal recessive B. Autosomal dominant C. Sex-linked recessive D. Sex-linked dominant 32. Unilateral supranuclear lesion of facial nervi involvesA. Whole of face B. Only ipsilateral upper part of the face C. Only contra lateral lower part of the face D. Whole of lower face 33. The formation of 25-hydroxycholecalcifierol takes place in the: A. Liver B. Kidneys C. Intestines D. Pancreas 34 One of the characteristic bedside feature of Korsakoffs psychosis is: A. Astereognosis B. Apraxia C. Confabulation D. Hallucination
35. Hypochromic microcytic anaemia is a feature of: A. Thalassemia B. Phenytoin toxicity C. Methotrexate therapy D. Obstructive jaundice 36. The largest cell in the body is the: A. Lymphocyte B. RBC C. Spermatocyte D. Human oocyte 37. Which one of the following is true of features of tuberculoid leprosy? A. Palpable thickening of nerve B. Positive skin smear C. Negative lepromin test D. Predilection for the face 38. Carpel tunnel syndrome is often encountered in all of the following except: A. Rheumatoid arthritis B. Conns syndrome C. Myxoedema D. Pregnancy 39. Prostaglandins are derived from: A. Essential fatty acids B. Non-essential fatty acids C. Essential amino acids D. Non-essential amino acid 40. Epstein-Barr virus is considered responsible for all of the following conditions except: A. Burkitts lymphoma B. Infectious mononucleosis C. Nasopharyngeal carcinoma D. T-cell lymphoma 41. Iron absorption is increased in all except a. Iron deficiency b. Pregnancy c. Hypoxia d. Alkaline pH of stomach 42. Tetany is indicative of: A. Hyponatraemia C. Hypocalcaemia
B. Hyperkalaemia D. Hypochloremia
43. All of the following are symptoms of hyperthyroidism except: A. Voracious appetite B. Cold intolerance C. Emotional disturbance D. Sleeplessness

44. Which one of the following is characteristic of mitral valve prolapse syndrome? A. Rough mid-diastolic murmur B. Collapsing pulse C. Loud first heart sound D. Mid-systolic click 45. Endocarditis in drug addicts is most commonly due to: A. Pneumococci B. Streptococcus faecalis C. Streptococcus viridans D. Staphylococci 46. Which one of the following is the drug of choice in a patient with acute myocardial infarction having premature ventricular contractions? A. Oral digoxin B. IV procainamide C. Oral diphenyl-hydantoin D. IV xylocaine 47. A 40-year old male presents with headache and convulsions. His blood pressure is 210/140 mmHg. Fundus examination reveals papilloedema. Which one of the following drug combinations will be most suitable for this patient? A. Diazoxide + triameterene B. Nitroprusside + triamterene C. Nitroprusside + furosemide D. None of the above 48. A young man came with a history of fever up to 40C with chills and rigors, dyspnoea and cough with expectoration. Bronchial breath sounds and crepitations were present on right chest anteriorly. The drug of choice in this situation is: A. Erythromycin B. Ampicillin C. Ampicillin + gentamicin D. Cotrimoxazole 49. Which one of the following types of bronchogenic carcinoma is most likely to cavitate? A. Adenocarcinoma B. Bronchoalveolar carcinoma C. Oat-cell carcinoma D. Squamous cell carcinoma 50. The therapy of choice in rickettsiosis is: A. Tetracycline and chloramphenicol B. Metronidazole and streptomycin C. Cotrimoxazole and ampicillin D. Clofazimine and rifampicin 51. The chances of acquiring HIV infection following needle prick is: A. 0.3% B. 3.0% C. 0.03% D. 0.003% 52. All of the following infections may be transmitted via blood transfusion, except: A. Parvo B19 B. Dengue virus C. Cytomegalovirus D. Hepatitis G virus 53. A 35-year old male, who complained of dyspnoea for a few years is admitted with severe pain on the left side of his chest, perspiration, tachycardia and tachypnea. His BP is 90/60 mmHg. Breath sounds were absent on the left with mediastinal shift to the right side. The most likely diagnosis is: A. Pulmonary embolism B. Lobar pneumonia left side C. Tension pneumothorax D. Pleural effusion 54. A patient has developed sudden attack of high fever, rigor, cough and foul smelling sputum of three weeks duration. On examination there is dullness with bronchial breath sounds in the above areas. Skiagram of chest shows a rounded opacity in midzone without fluid level. The most likely diagnosis is: A. Bronchiectasis B. Necrotizing pneumonitis C. Amoebic abscess lung D. Infected hydatid cyst 55. HIV can be detected and confirmed by: A. Polymerase chain reaction (PCR) B. Reverse transcriptase - PCR C. Real time PCR D. Mimic PCR. 56. Antibiotic treatment of choice for treating cholera in an adult is a single dose of: A. Tetracycline. B. Co-trimoxazole. C. Doxycycline. D. Furazolidone. 57. Dengue shock syndrome is characterized by the following except: A. Hepatomegaly B. Pleural effusion C. Thrombocytopenia D. Decreased hemoglobin 58. A 12-year old boy had severe vomiting and diarrhoea. He was brought to the hospital because of severe oliguria. He was given IV fluids and furosemide without any diuresis. Blood biochemistry revealed urea 120 mg% and serum creatinine 4 mg%. The most likely diagnosis is: A. Prerenal azotemia B. Haemolytic uraemic syndrome C. Acute glomerulonephritis D. Acute tubular necrosis 59. Which one of the following varieties of nephritis carries the best prognosis: A. Post-streptococcal B. Goodpasture syndrome C. Lupus nephritis D. Drug-induced nephritis 60. Which one of the following is not a complication of acute glomerulonephritis? A. Hypertensive encephalopathy B. Acute left ventricular failure C. Metabolic acidosis D. Metabolic alkalosis 61. The earliest sign of iron deficiency anaemia: a. Increase in iron binding capacity b. Decrease in serum ferritin level c. Decrease in serum iron level d. All of the above 62. All the following are recognised features of acromegaly except: A. Acral enlargement B. Dry ski C. Glucose intolerance D. Hypertension 63. Hyperosmolar coma in diabetes is a feature of: A. Insulin dependent diabetes mellitus B. Non-insulin dependent diabetes mellitus C. Pancreatic diabetes D. J-type diabetes

64. The drug of choice in the treatment of Taenia solium infestation is: A. Mebendazole B. Albendazole C. Niclosamide D. Quinacrine 65. In which one of the following conditions is the stool acidic? A. Acute amoebic dysentery B. Acute bacillary dysentery C. Cholera D. Acute food poisoning 66. Which one of the following drugs may precipitate gout? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampicin 67. Tetanus is characterised by all of the following features except: A. Trismus B. Loss of consciousness C. Spasm of muscles of facial expression D. Spasm of spinal muscles 68. Splenectomy is to be avoided in children because of: A. Loss of blood forming tissue B. Increased risk of infection C. Hypercoagulable state D. Increased risk of lymphoma 69. Seen in chronic inflammatory anemia is: a. Serum iron , S. ferritin and transferring b. Serum iron , S. ferritin and transferring c. Serum iron , S. ferritin and transferring d. Serum iron , S. ferritin and transferring 70. A 40-year old male presents with a painless cystic liver enlargement of four years duration without fever or jaundice. The most likely diagnosis is: A. Amoebic liver abscess B. Hepatoma C. Hydatid cyst of liver D. Choledochal cyst 71. Empyema necessitans is defined as a pleural empyema which: A. Is under pressure B. Has ruptured into the bronchus C. Has ruptured into the pericardium D. Is showing extension to the subcutaneous tissue 72. Deficiency of the intrinsic factor of Castle causes: a. Microcytic anemia b. Pernicious anemia c. Cooleys anemia d. Aplastic anemia 73 A patient is admitted with severe pain in the abdomen, nausea, vomiting and fever. There is tenderness and abdominal rigidity. Serum amylase is found to be 1000 IU/litre. The most likely diagnosis is: A. Perforated peptic ulcer B. Intestinal obstruction C. Acute pancreatitis D. Acute cholecystitis 75. Most sensitive and specific test for diagnosis of iron deficiency is a. Serum iron levels b. Serum ferritin levels c. Serum transferring receptor population d. Transferrin saturation 76. In bronchial asthma, glucocorticoids: A. Act as potent bronchodilators B. Reduce airway inflammation C. Inhibit degranulation of mast cells D. Block the action of humoral mediators 77. A 22-year old man presents with history of bleeding from gums for the last 6 months. On investigation the Hb was found to be 8.2 gm%, TLC 4400/mm3, DLC P 64%, L27%, E3%, M6% and platelet count of 20,000/cu mm. Which one of the following investigations would be most useful in establishing the diagnosis? A. Bleeding time and clotting time B. Prothrombin time C. Partial thromboplastin time D. Bone marrow examination 78. All of the following are features of cerebral malaria except: A. Hyperglycaemia B. Thrombocytopaenia C. Acute respiratory distress syndrome D. Heavy parasitaemia 79. Which one of the following is the most contagious lesion in syphilis? A. Primary sore B. Gumma C. Condylomata D. Papular skin rash 80. In ulcerative colitis, the inflammatory process is usually confined to: A. Mucosa alone B. Mucosa and submucosa C. Mucosa, submucosa and muscularis D. Mucosa, submucosa, muscularis and serosa 81. Reticulocytosis is NOT a feature of a. Paroxysmal nocturnal hemoglobinuria b. Following acute bleeding c. Hereditary spherocytosis d. Anemia in CRF 82. The PHILADELPHIA chromosome is a feature ofA. Leukaemoid reaction B. Chronic myeloid leukemia C. Acute lymphoblastic leukemia D. Chronic lymphocytic leukemia 83. Which one of the following is not associated with Prinzmetals angina? A. S-T segment depression in ECG B. Migraine C. Raynauds phenomenon D. Early morning attacks
74. Which of the following statements about iron deficiency anemia true: a. Decreased TIBC b. Increased Ferritin levels c. Bone marrow iron is decreased after serum iron is decreased d. Bone marrow iron is decreased earlier than serum iron

84. All of the following are features of malignant hypertension, except: A. Grade IV hypertensive retinopathy B. Haemolytic blood picture C. Renal failure D. Respiratory failure 85. Shock lung is seen inA. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Neurogenic shock 86. A 20 year female came to the medical OPD with severe pain and redness over dorsum of the foot Past history of severe abdominal pain episodes were present. Peripheral smear showed anemia with presence of poikilocytes. Likely diagnosis isA. Hemoglobin C disease B. Thalassemia minor C. Sickle cell anemia D. G6PD deficiency 87. Intrinsic factor for absorption of vitamin B12 is secreted by the: A. Parietal cells B. Peptic cells C. Chief cells D. Goblet cells 88. Which one of the following statements about H. pylori is not true? A. Its prevalence increases with age B. Its prevalence is inversely related to socio-economic status C. Commonly, fundus is the site of colonization D. It is implicated in duodenal ulcer, gastric ulcer and gastric carcinoma 89. A patient with Bells palsy has _____ palsyA. Upper Motor Neuron V nerve B. Upper Motor Neuron VII nerve C. Lower Motor Neuron V nerve D. Lower motor neuron VII nerve 90. All of the following statements regarding the oculomotor nerve are true except: A. It accommodates the eye B. It raises the upper eyelid C. It innervates lateral rectus D. It constricts the pupil 91. A 16-year old female presents with generalised weakness and palpitations. Her Hb is 7 g/dl and peripheral smear shows microcytic hypochromic anaemia; reticulocyte count = 0.8%, serum bilirubin = 1 mg%. The most likely diagnosis is: A. Iron deficiency anaemia B. Haemolytic anaemia C. Aplastic anaemia D. Folic acid deficiency 92. Consider the following features: 1. Hyperthyroidism 2. Pretibial myxoedema 3. Atrial fibrillatio 4. Ophthalmopathy Those which are characteristic of Graves disease would include: A. 1, 3 and 4 B. 2, 3 and 4 C. 1, 2 and 3 D. 1, 2 and 4 93. In Hemolytic Anemias, the urobilinogen level in the blood wouldA. Increase B. Be absent C. Decrease D. Mildly decrease 94. An Indian adult who has never travelled abroad comes with a history of high fever, headache, jaundice, marked oliguria and shock with TLC of 16,000/cumm. The most likely diagnosis is: A. Viral hepatitis B. Leptospirosis (Weils disease) C. Yellow fever D. Haemolytic uraemic syndrome 95. All of the following can be used to prevent gouty attack except: A. Allopurinol B. Aspirin C. Probenecid D. Sulfinpyrazone 96. A young male presens with joint pains and backache. X-ray of spine shows evidence of sacroilitis. The most likely diagnosis is: A. Rheumatoid arthritis B. Ankylosing spondylosis C. Polyarticular juvenile arthritis D. Psoriatic arthropathy 97. A farmer who worked in the field whole day suddenly took ill and was brought to the hospital with vomiting, diarrhoea, salivation, perspiration, constricted pupils and pulmonary oedema. The most likely diagnosis is: A. Acute left ventricular failure B. Organophosphorus poisoning C. Snake bite D. Aluminium phosphide poisoning 98. Which one of the following is safe in G-6-PD deficiency? A. Primaquine B. Nitrofurantoin C. Nalidixic acid D. Aspirin 99. A patient of bronchial asthma has developed hypertension as well. Which one of the following antihypertensive agents is best avoided in the treatment of this patient? A. ACE inhibitors B. Beta blockers C. Calcium channel blockers D. Prazocin 100. Autosomal dominant inheritance is a feature of all of the following except: A. Huntingtons chorea B. Neurofibromatosis C. Polycystic disease of kidney D. G6PD deficiency

1. Ans. 'C' (Ref: Davidson, Ed. 18th Pg-196) Pulsus paradoxus describes an exaggeration of the normal variation in systolic arterial blood pressui seen with respiration (normally falls by <10 mm on inspiration). It is seen in the presence of- Airway obstruction. - Pericardial tamponade. 2. Ans. 'C' (Ref: Davidson, Ed. 20th Pg-302,1054) The causes of acquired aplastic anemia are as follows: 1. Drugs- Cytotoxic drugs. - Antibiotics (Chloramphenicol, Sulfonamides). - Anti-rheumatic agents (Penicillamine, Gold, Phenylbutazone, Indomethacin). - Antithyroid drugs. - Anticonvulsants. - Immunosuppressives (Azathioprine). - Massive pulmonary embolism. Some conditions associated with pulsus paradoxus are- Constrictive pericarditis. - Restrictive cardiomyopathy. - Cardiac tamponade.
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Chemicals- Benzene toluene solvent misuse (glue sniffing). - Chlorinated hydrocarbons (DDT), Organophosphates and Carbamates. Radiation. Viral hepatitis. Pregnancy. Paroxysmal nocturnal hemoglobinuria.
3. Ans. 'A'(Ref: Davidson, Ed. 20th Pg-695) SARS (Severe Acute Respiratory distress Syndrome) rose to prominence in late 2002 when a series of cases in the Guangdong province in China was followed by an international outbreak. The illness is characterized by- Presence of high fever. - Malaise. - Muscle aches. - Dry cough with shortness of breath or difficulty in breathing. SARS has recently been attributed to Corona virus. 4. Ans. 'C' (Ref: Davidson, Ed. 20th Pg-694): Suppurative abscess and pulmonary pneumonia abscess may be produced by infection of previously healthy lung tissue with Staphylococcus aureus or Klebsiella pneumonia.
5. Ans. 'B' (Ref: Davidson, Ed. 20th Pg-45) 2n (46, XX) - Normal female 2n (46, XY)-Normal male Examples of chromosomal disorders are as followsa) Aneuploidy: - Trisomy 21 (47, XY, +21) - Down's syndrome. - Trisomy 18 (47, XY, +18) - Edward's syndrome. - Trisomy 13 (47, XY, +13)- Patau's syndrome. b) Sex chromosome aneuploidies: - Phenotypically male 6.
1. 47, XXY- Kleinfelter's syndrome. 2. 47, XYY - XYY male (usually asymptomatic, often tall). c) Phenotypically female 1. 47, XXX-Trisomy X (usually asymptomatic, 20% mental handicaps). 2. 45, XO -Turner's syndrome (short stature, webbed neck, primary amennorrhoea).
Ans. C (Essentials of Clinical Anatomy 1st ed., Ramesh Babu p 242) : Parasympathetic supply of midgut: The parasympathetic supply from ileocecal junction to junction of right 2/3rd with left 1/3rd of transverse colon is derived from vagus. Vagus is the nerve for foregut and midgut. Parasympathetic supply of hindgut: Left 1/3rd of transverse colon, left colic flexure, descending colon, sigmoid colon, rectum and anal canal up to pectinate line is supplied by pelvic splanchnic nerves which arise from S2, 3, 4 spinal cord segments. Ans. B (Harrison 16th ed., p 888): Sucralfate is not usually used in management of H. pylori. According to some journals it is sometimes used. Several drugs have been tried but no single agent alone is successful against H. pylori. The recommended regimen is triple therapy with omeprazole, clarithromycin and either metronidazole or amoxycillin. This regimen is used for 2 weeks. The other drugs that have been used are bismuth compounds, tetracycline, ranitidine etc. Ans. A (Harrison 16th ed., p 1568): The patient has developed pneumothorax. The best treatment is to perform a diagnostic chest aspiration and insert a chest tube. Ans. A (Harrison 16th ed., p 2086): The patient is suffering from pituitary adenoma, most likely prolactinoma. It secretes prolactin, which causes amenorrhoea. Pituitary adenoma may press over optic chiasma leading to visual disturbance (bitemporal hemianopia). Remember the following important points commonly asked in examination: 1. Microadenoma is less than 1 cm in size. 2. Macroadenoma is more than 1 cm in size. 3. Amenorrhoea, galactorrhoea and infertility are the main features of prolactinoma.
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9.

4. Bromocriptine is used for treatment. 5. Trans-sphenoidal surgery is required in some cases. 10. Ans. 'B' (Ref: Davidson, Ed. 20th Pg-1032) Hereditary spherocytosis is usually inherited as an autosomal dominant condition. The severity of spontaneous hemolysis varies. Most cases are associated with an asymptomatic compensated chronic hemolytic state with spherocytes present on blood film and a reticulocytosis. Occasional cases are associated with more severe hemolysis; these may be due to coincidental polymorphism in alphaspectrin or coinheritance of a second defect involving a different protein. 11. Ans. 'A' (Ref: Davidson, Ed. 20th Pg-801) Acromegaly is caused by growth hormone (GH) secretion from a pituitary tumour, usually a macro adenoma. - If GH hypersecretion occurs before epiphyses have fused - Gigantism. - If GH hypersecretion occurs in adult life after epiphyseal closure - Acromegaly. 12. Ans. 'D' (Ref: Chaudhary, Pg-286 & Davidson, Ed. 18th Pg-492) In response to falling blood glucose, there is normally increased secretion of counter regulate hormones which counter the 'blood glucose lowering' effect of insulin. Glucagon and Adrenalin a the most important of these. Growth hormone is anti-insulin. It is also known as 'growth & diabetogenic' hormone. It also prevents peripheral utilization of sugar. 13. Ans. B (Bailey and Love 23rd ed., p 958-961): In hereditary spherocytosis the optimum time for splenectomy is around 7 years of age. All patients should be treated by splenectomy and it cures anaemia because spherocytes are destroyed in spleen. In sickle cell anaemia splenectomy is not done because of autosplenectomy due to multiple splenic infarcts. Splenectomy is especially useful in autoimmune haemolytic anaemia but is not effective in all types of acquired haemolytic anaemias. 60% of ITP patients are cured, 20% improved and 15% or more have no benefit with splenectomy. 14. Ans. C (Harrison 16th ed., p 2388): Sudden headache in the absence of focal neurologic symptoms is the hallmark of aneurysmal rupture. Focal neurological deficit may occur. A third cranial nerve palsy particularly, when associated with pupillary dilatation, loss of light reflex and focal pain above or behind the eye, may occur with an expanding aneurysm at the junction of the posterior communicating artery and internal carotid artery. 15. Ans. B (Harrison 16th ed., p 406): The recommended dietary allowance of vitamin C is 60 mg for adult male and female. In infants the need is 30-35 mg/day. In pregnant women requirement is 70 mg/day and lactating women need 90-95 mg/day. 16. Ans. C (Kumar and Clark 4th ed., p 699; Harrison 16th ed., p 1310): Carey-Coombs murmur is mid diastolic murmur due to mitral valvulitis in rheumatic fever. 17. Ans. C (Kumar and Clark 4th ed., p 670; Harrison 16th ed., p 1352): Digoxin itself may cause VT and has no role in prophylaxis of VT. For prophylaxis initially beta blocker or a class I drug (mexiletine) is used. If they fail then class III drugs (amiodarone and sotalol) are used. Verapamil may be used also for prophylaxis of VT. 18. Ans. D (Harrison 16th ed., p 2114): Aortic insufficiency is not a cardinal manifestation of Graves disease. The commonest cardinal manifestation is sinus tachycardia. Wide pulse pressure, bounding pulse, CHF (high cardiac output), atrial fibrillation are the important features. Pleuropericardial scratch is also called Means Lerman scratch. It is audible in left 2nd intercostal space. 19. Ans. C (Kumar and Clark 4th ed., p 822; Harrison 16th ed., p 567): Hypercalcaemia is most commonly associated with squamous cell CA of lungs and it is a paraneoplastic manifestation. The paraneoplastic endocrine extrapulmonary manifestations are seen in small cell (oat cell) CA of lungs and carcinoid tumour. The paraneoplastic endocrine features are SIADH (due to AVP), Cushings syndrome (due to ACTH), acromegaly (due to GHRH) etc. 20. Ans. D (Harrison 16th ed., p 948): INH, rifampicin and pyrazinamide are hepatotoxic and hence unsafe in patients having markedly abnormal liver function. Streptomycin and ethambutol are safe and can be used. Streptomycin is mainly ototoxic and nephrotoxic and ethambutol causes optic neuritis. 21. Ans. A: MDR TB refers to M. tuberculosis that is resistant to at least two drugs, usually isoniazid and rifampin. MDR TB has been noted mainly among immigrants from countries with high MDR-TB rates, HIV-infected patients, the homeless, and injecting drug users. The most common cause of emergence of drug resistance is previous inadequate or incomplete treatment. 22. Ans. B (Harrison 16th ed., p 2313): Wilsons disease is an autosomal recessive disease.

23. Ans. D (Kumar and Clark 4th ed., p 914; Harrison 16th ed., p 2188): Normal sperm count is 20 to 200 106/ml. Below 20 106/ml infertility may be seen. More than 60% normal morphology and normal motility is required for fertility. 24. Ans. A: Ataxic nystagmus is seen in lesion of MLF. 25. Ans. A: (Harrison 16th ed., p 2440, 2445): Dissociated sensory loss means incomplete sensory loss for e.g., loss of pain and temperature but not of light touch as seen in syringomyelia. Dissociated sensory loss occurs mainly in partial spinal cord destruction that selectively involves the spinothalamic tract and spares the fasciculus cuneatus and fasciculus gracilis. 26. Ans. B: (Harrison 16th ed., p 661): l M component is seen in serum in excess of 3 g/dl in Waldenstroms macroglobulinaemia. It is a malignancy of lymphoplasmacytoid cells that secrete IgM. Hyperviscosity syndrome with lymphadenopathy and hepatosplenomegaly are the main features. It occurs in old age. Plasmapheresis is done for hyperviscosity. Fludarabine or cladribine are effective in management but median survival is only 3 years. 27. Ans. A: (Kumar and Clark 4th ed., p 388; Harrison 16th ed., p 336): Gastric CA does not cause polycythaemia. It causes anaemia due to blood loss. The various other causes of polycythaemia are polycythaemia vera (idiopathic), Wilms tumour, cerebellar haemangioblastoma, uterine fibroma, high altitude, right to left shunt, heavy smoking, lung disease etc. 28. Ans. 'B' (Ref: Davidson, Ed. 20th Pg-946) Jaundice or icterus refers to the yellow pigmentation of the skin or sclerae by bilirubin. Bilirubin pigment has high affinity for elastic tissue and hence jaundice is particularly rich in elastin content Normal serum bilirubin concentration ranges from 0.2 - 0.8mg/dl. Jaundice becomes clinically evident when the total serum bilirubin exceeds 2mg/dl. A rise of serum bilirubin between the normal and 2mg/dl is generally not accompanied by visible jaundice and is called latent jaundice. 29. Ans. D (Kumar and Clark 4th ed., p 1093; Harrison 16th ed., p 2507): Mononeuritis multiplex means multiple mononeuropathy. The nerve involvement may occur sequentially or together. It is not seen in psoriatic arthropathy. Besides the three causes mentioned in the question the various other causes are vasculitis, polyarteritis nodosa, amyloidosis, sarcoidosis, malignancy, leprosy, neurofibromatosis, HIV etc. Leprosy is still the commonest cause worldwide. According to Harrison PAN is the commonest cause. 30. Ans. C (Kumar and Clark 4th ed., p 783; Harrison 16th ed., p 1543): Cystic fibrosis is an autosomal recessive disease. 31. Ans. C (Kumar and Clark 4th ed., p 381; Harrison 16th ed., p 611): G-6-PD deficiency is X-linked recessive disorder. 32. Ans. 'C' (Ref: Chaurasia, Ed. 3rd, Pg-42) <Indirect reference> In infranuclear lesions of the facial nerve, the whole of the face is paralyzed (Eg: Bell's palsy). In supranuclear lesions of the facial nerve, only the lower part of the face is paralyzed. The upper part (frontalis and part of orbicularis oculi) escapes due to its bilateral representation in the cerebral cortex. 33. Ans. A (Ganong 20th ed., p 376): 1, 25-dihydroxycholecalciferol is synthesized from cholecalciferol. In liver it is converted to 25 OH cholecalciferol by 25 hydroxylase and then to 1, 25 dihydroxycholecalciferol by 1, -hydroxylase enzyme in kidney, which is a rate regulatory enzyme. 34. Ans. C (Harrison 16th ed., p 1636): Confabulation is seen in Korsakoffs psychosis, which occurs due to thiamin deficiency. Confabulation is seen in amnesia where the memory deficit is filled up with imaginary, inaccurate information. In Korsakoffs psychosis memory is impaired especially for new information. Immediate memory, attention span and consciousness are normal. 35. Ans. A (Harrison 16th ed., p 598): Hypochromic microcytic anaemia is a feature of thalassaemia. It occurs due to defect in globin biosynthesis. Patients mainly suffer from ineffective erythropoiesis with severe haemolytic anaemia. Extramedullary haemopoiesis occurs. Hepatosplenomegaly with mild icterus is seen. Chipmunk facies is characteristic in children. Leg ulcers, gall stone, high output heart failure may be observed. Treatment is by bone marrow transplantation. 36. Ans. D (DC Dutta Textbook of Obstetrics 6th ed., p 17): A fully mature ovum is largest cell in the body and is about 130 micron in diameter. Remember the following important points commonly asked in examination: 1. Primitive germ cells are derived from the yolk sac. 4. At puberty number of oogonia is 4,00000 (4 lacs). 2. Numbers of oogonia are maximum at 20th week 5. Out of these some 400 are likely to ovulate. numbering about 7 million. 6. Primary oocyte contains 46 XX chromosomes. 3. At birth number of oogonia is 2 million.

37. Ans. A (Harrison 16th ed., p 968; Short Textbook of Dermatology and Venereology 1st ed., Praveen Jain p 91-93): Tuberculoid leprosy is the less severe spectrum of leprosy. Nerve thickening is a very important feature of tuberculoid leprosy. Most commonly affected nerves are ulnar, posterior auricular, peroneal and posterior tibial nerves. Sometimes it may present as nerve thickening only called neural leprosy. The skin lesion is mainly in the form of anaesthetic, hypopigmented macule, which is often devoid of sweat glands and hair follicles. The lesions are often dry, scaly and anhidrotic. Skin smear for AFB is usually negative. 38. Ans. B (Kumar and Clark 4th ed., p 1092; Harrison 16th ed., p 36, 2035): Carpal tunnel syndrome is a type of entrapment neuropathy. Median nerve is entrapped and it causes nocturnal tingling and pain in hand followed by weakness of the thenar muscles. There is wasting of abductor pollicis brevis with sensory loss of palm and radial three and a half fingers. It is 8 times more common in women. 39. Ans. A (Harper 25th ed., p 250) : Prostaglandins are derived from essential fatty acids. Arachidonic acid is an essential fatty acid. The other essential fatty acids are: 1. Linoleic acid. 2. Linolenic acid. 40. Ans. D (Kumar and Clark 4th ed., p 54; Harrison 16th ed., p 1046): EB virus is mainly responsible for infectious mononucleosis. It is also known as glandular fever. It occurs in young adults and is transmitted by saliva. Fever and sore throat are the main complaints and about 90% of patients suffer from macular rash after taking ampicillin. Paul Bunnel test and monospot tests are used for diagnosis. EB virus is also responsible for oral hairy leukoplakia and immunoblastic lymphoma in AIDS, Burkitts lymphoma, nasopharyngeal carcinoma and post transplant lymphoma. 41. Ans. D [ Ref: Harsh Mohan 4th / 316; Harrison 17th / 629, 630] Iron absorption is increased by acidic pH of stomach and not by an alkaline pH. Factors that enhance / reduce iron absorption. Enhanced absorption. Reduced absorption. Dietary factors. Increased heme iron. Decreased heme iron. Increased animal food. Decreased animal foods. Ferrous iron salt. Ferric iron salts. Luminal factors. Acid pH. Low molecular weight soluble chelates. Iron deficiency. Increased erythropoesis. Pregnancy. Hypoxia. Alkaline pH (e.g. pancreatic secretion) Insoluble iron complexes. Iron overloaded. Decreased erythropoiesis. Inflammatory disorders.
Systemic factors.
42. Ans. C (Harrison 16th ed., p 138): Tetany indicates hypocalcaemia. Decreased free/ionized calcium leads to tetany. 43. Ans. B (Harrison 16th ed., p 2109): Cold intolerance is seen in hypothyroidism. 44. Ans. D (Harrison 16th ed., p 1396): Mid systolic click with late systolic murmur is the hallmark of mitral valve prolapse syndrome. Remember the following important points about MVPS: 1. It is also known as Barlows syndrome or floppy valve syndrome or billowing mitral leaflet syndrome. 2. It is common in Marfan syndrome, osteogenesis imperfecta and Ehlers Danlos syndrome. 3. Posterior leaflet is more commonly affected than anterior leaflet. 4. MVPS is more common in females. 5. 2 D echocardiography detects prolapse of mitral valve leaflets. 45. Ans. D (Kumar and Clark 4th ed., p 771; Harrison 16th ed., p 732): According to Harrison 16th ed., S. aureus commonly affects tricuspid valve in IV drug users. Many of these strains are resistant to methicillin. Staph. epidermidis also commonly causes endocarditis in IV drug abusers. The other organisms responsible for endocarditis in IV drug abusers are Histoplasma, Brucella, Candida and Aspergillus. These organisms cause endocarditis in alcoholics and in patients with prosthetic valves. 46. Ans. D (Harrison 16th ed., p 1456): IV xylocaine is used in management of ventricular ectopic after acute MI. However today the treatment has changed from the time when the question paper was made. Now no drug is prescribed for ventricular ectopic in acute MI. Drug therapy is given mainly for sustained ventricular arrhythmia especially that causing haemodynamic imbalance and the preferred drug is beta-blocker.

47. Ans. C (Harrison 16th ed., p 1477, 1480): Nitroprusside is used for immediate reduction of BP. Combination with furosemide will be more beneficial. However other drugs like IV diazepam is also required for control of convulsions. This patient may have either hypertensive encephalopathy or cerebral haemorrhage due to malignant hypertension. Further treatment will depend upon the final diagnosis. 48. Ans. C (Harrison 16th ed., p 1534-1535): The patient is suffering from right-sided pneumonia. However this question is slightly vague because drug of choice can be written only if the causative organism is known. This is probably a communityacquired pneumonia due to Strep. pneumoniae and in susceptible strains penicillin or ampicillin is the drug of choice. But here this information is not clear and the patient is having high fever with chills, rigor and dyspnoea and hence it is safe to add gentamicin 3 mg/kg/day along with ampicillin. This is the most common practice when patient is not able to afford 3rd generation cephalosporins. 49. Ans. D (Kumar and Clark 4th ed., p 820): Squamous cell carcinoma of lung cavitates (10%) at presentation but widespread metastasis occurs relatively late. According to Harrison previously it was the commonest lung cancer but now adenocarcinoma is the commonest type of lung CA. Remember the following important points commonly asked in examination: 1. Lung cancer is the commonest cause of cancer deaths in males. 2. Breast cancer is the commonest cancer in females. 3. Lung cancer is the second most common cancer in females. 4. Pancoasts tumour: CA at apex of lungs erodes ribs and involves brachial plexus (C8, T1 and T2). 5. Bovine cough: CA lung. 6. CA lung may lead to Horners syndrome, superior vena cava obstruction, vocal cord palsy, hypertrophic pulmonary osteoarthropathy. 50. Ans. A (Harrison 16th ed., p 1002): Tetracycline and chloramphenicol are used in management of Rickettsial diseases. 51. Ans. A (Harrison 16th ed., p 1136) 52. Ans. B (Harrison 16th ed p 1164)
53. Ans. C (Harrison 16th ed., p 1568): The patient has developed tension pneumothorax. This patient was probably suffering from COPD and due to rupture of bulla there was pain chest and dyspnoea. He developed pneumothorax & most likely tension pneumothorax because he had perspiration, tachycardia, tachypnoea with hypotension. 54. Ans. B (Harrison 16th ed., p 1536; Kumar and Clark 4th ed., p 801): The patient has developed necrotizing pneumonitis. It is nothing but lung abscess. The main clues to the diagnosis are foul smelling sputum and high fever with rigor. Mostly lung abscess is caused by anaerobic organisms and foul smell is very common. Fluid level in X-ray may or may not be present. Staph. pyogenes and Klebsiella pneumoniae are also complicated by abscess formation. Treatment is with cefuroxime 1 g IV 6 hourly and metronidazole 500 mg IV 8 hourly for 5 days followed by oral medication for a prolonged period. 55. Ans. B (Harrison 16th ed p 1103) 56. Ans. C (Harrison 16th ed p 911 912) 57. Ans. D (Harrison 16th ed p 1170, 1173)
58. Ans. D (Harrison 16th ed., p 1647-1649): Severe vomiting and diarrhoea have resulted in hypotension and ischaemic injury to the kidneys. This has resulted in oliguria. Even after IV fluids and frusemide urine output is nil with raised blood urea and creatinine. Hence it means that patient has developed ischaemic ARF. The severe form of it with extensive tubular damage is called acute tubular necrosis. In such cases recovery usually takes place in 2-4 weeks. Prerenal azotaemia usually recovers with adequate hydration. 59. Ans. A (Kumar and Clark 4th ed., p 537; Harrison 16th ed., p 1681): Post-streptococcal glomerulonephritis has excellent prognosis in children. In adults few may develop hypertension and renal impairment. Prognosis is bad in rest of the three mentioned causes of nephritis. Majority of the patients suffer from end stage renal disease and require dialysis. 60. Ans. D (Harrison 16th ed., p 1650): Acute glomerulonephritis leads to acute renal failure. Metabolic acidosis is the main complication. Metabolic alkalosis is absent. Metabolism of protein generates 50-100 mmol/day of fixed nonvolatile acids that are normally excreted by kidneys. In presence of ARF (with oliguria) these accumulate and result in metabolic acidosis. The other possible complications are: 1. Intravascular volume overload. 2. Hyperkalaemia. 3. Hypocalcaemia. 4. Hypophosphataemia. 5. Hyperuricaemia. 61. Ans. D [ Ref: Harrison 17th /630, Chandrasoma Taylor 3rd/ 687] The first stage of iron deficiency is depletion of iron stores which is associated with a decrease in levels of serum ferritin levels only. As long as some stores are still available, other indices viz, SI, TIBC, Red cell Protoporphyrin levels continue to be within normal limits.

62. Ans. B (Harrison 16th ed., p 2090): Moist skin due to excessive sweating is seen in acromegaly. Dry skin is absent in acromegaly. 63. Ans. B (Harrison 16th ed., p 2161): Hyperosmolar coma is a feature of NIDDM. J type diabetes is a subtype of type III or malnutrition related diabetes, known as protein deficient pancreatic diabetes (PDPD). 64. Ans. C (Harrison 16th ed., p 1274): According to Kumar and Clark 4th ed., p 95 niclosamide 2 g single chewed dose is effective in management of T. solium infestation. According to Harrison intestinal T. solium is treated with a single dose of praziquantal. 65. Ans. A (KD Chaterjee 12th ed., p 24): Stool is acidic in amoebic dysentery and alkaline in bacillary dysentry. 66. Ans. C (Kumar and Clark 4th ed., p 805; Harrison 16th ed., p 949): Pyrazinamide raises serum uric acid level and may precipitate gout. It decreases excretion of uric acid. The main side effect of ethambutol is optic neuritis. In Harrison 16th ed., p 2031 ethambutol is also mentioned as a causative agent of gout. 67. Ans. B (Kumar and Clark 4th ed., p 26; Harrison 16th ed., p 840-841): Tetanus is caused by Clostridium tetani. Clinical features are due to potent neurotoxin, tetanospasmin. It acts on both and motor systems resulting in disinhibition. It also causes neuromuscular blockade and skeletal muscle spasm. Autonomic dysfunction is also common. Remember the following important points about tetanus: 1. Organism is not invasive. 2. Trismus is lockjaw due to spasm of masseter. Spasm of facial muscles produces risus sardonicus. 3. Spasm of spinal muscles leads to opisthotonus. 4. Patients are conscious till end. 5. Tetanus toxoid is given to all patients after recovery from tetanus because disease does not produce sufficient immunity. 68. Ans. B (Harrison 16th ed., p 709): There is increased risk of infection from capsulated organisms (pneumococcus and H. influenzae) after splenectomy. 69. Ans. A (Serum iron , S. ferritin , transferritin): Harrision17th/633] Anemia of chronic inflammations is associated with decreased serum iron, decreased transferring levels (TIBC) and normal or increased ferritin levels. 70. Ans. C (Kumar and Clark 4th ed., p 332; Harrison 16th ed., p 1275): The patient is suffering from hydatid cyst of liver. It is caused by Echinococcus granulosus. It usually occurs in lower part of right lobe. Clinically the patient remains asymptomatic for a long time and only may suffer from dull ache. Ultrasound will show daughter cysts and confirm diagnosis. Cyst can be removed by surgery after sterilizing the cyst with formalin or alcohol. Patient is not asymptomatic in amoebic liver abscess and hepatoma. 71. Ans. D In empyema necessitans the empyema extends below the skin of chest in the form of a fluctuant swelling. 72. Ans. B (Robbins 7th /639). Deficiency of Intrinsic factor leads to a specific form of vitamin B12 deficiency megaloblastic anemia called pernicious Anemia. Pernicious Anemia also known as Addisons Anemia is a megaloblastic anemia due to deficiency of intrinsic factor (secreted by parietal cells of gastic mucosa) that is essential for vitamic B 12 absorption. Note: Intrinsic factor was first described by castle & coworkers and hence intrinsic factor is also called intrinsic factor of Castle. 73. Ans. C (Harrison 16th ed., p 1897): The patient is suffering from acute pancreatitis. 74. Ans. D [Ref: Harrison 17th/630: Serum levels of iron decrease after be marrow iron is decreased. As long as iron stores are present (serum ferritin, bone marrow iron), and can be mobilized, the serum iron, Total Iron binding Capacity (TIBC) and red cell protoprophyrin levels remain within normal limits. Iron deficiency anemia is associated with decreased ferritin levels and an increased TIBC. 75. Ans. B (Serum ferritin levels) [Ref: Harrison 16th / 589, Harrison 17th / 630] Iron deficiency is best detected by measurement of serum ferritin. This is so because: The first stage of iron deficiency is depletion of iron stores which is associated with a decrease in levels of serum ferritin levels only. As long as some stores are still available, other indices viz, SI, TIBC, Red cell protoporphyrin levels continue to be within normal limits.

As the patients are not anemic yet, RBC morphology is essentially normal. Remember. Iron is stored as Ferritin. Ferritin found in circulation is in equilibrium with tissue ferritin. Serum Ferritin levels fall as iron stores are depleted.
76. Ans. B (Harrison 16th ed., p 1513): Glucocorticoids help in reduction of airway inflammation. 77. Ans. D The young patient is suffering from pancytopenia. Haemoglobin is low; TLC and platelet counts are also low. Out of the given choices bone marrow examination will help to arrive at a diagnosis. It will help to find out the various causes like aplastic anaemia, aleukaemic leukaemia, megaloblastic anaemia etc. 78. Ans. A (Harrison 16th ed., p 1222): Hypoglycaemia occurs in falciparum malaria. Hyperglycaemia is not seen. Hypoglycaemia results from failure of hepatic gluconeogenesis and increased consumption by both the parasite and the host. It is specially a problem in children and pregnant women. Remember the following important points commonly asked in examination: Quinine and quinidine used to treat cerebral malaria cause hypoglycaemia by stimulating release of insulin. The other complications of severe malaria are renal failure, DIC, hypotension, acidosis, ARDS, convulsions, haemoglobinuria, jaundice etc. 79. Ans. C (Short Textbook of Dermatology and Venereology 1st ed., Praveen Jain p 95): Condylomata lata is a warty plaque like lesion found in perianal area and other moist body sites. It is seen in secondary syphilis and is the most contagious lesion. It heals without treatment. In secondary syphilis most common organ involved is skin and most common lesion is papulosquamous rash. 80. Ans. B (Harrison 16th ed., p 1778): In ulcerative colitis the inflammation is confined to mucosa and superficial submucosa usually. In fulminant disease the deeper layers are also involved. 81. Ans. D (Anemia in C.R.F.): API 6th / 856, API 7th / 923: Harrison 17th / 633, 634, 662 Anemia of chronic disease is associated with a normal / low Reticulocyte count. Reticulocytes are young red cells with presence of nuclear remnants in the cytoplasm. Their number gives an estimate of the adequacy of marrow response to anaemia. Reticulocyte count (Normal is 0.5 to 1.5% of all red cells): High Reticulocyte count Low Reticulocyte Count 1. Haemolysis from any cause eg. Haemolytic anemias 1. Aplastic anemia including hereditary Spherocytosis & PNH. 2. Bleeding (Blood loss) 2. Nutritional deficiency anemia. Note: Reticulocytosis occurs in nutritional anemias as soon as treatment is started. 82. Ans. 'B' (Ref: Davidson, Ed. 20th, Pg-1044) Leukemias are classified into1. Acute lymphoblastic leukemia (ALL). 2. Acute myeloid leukemia (AML). 3. Chronic lymphoblastic leukemia (CLL). 4. Chronic myeloid leukemia (CML). Acute leukemias are characterized by predominance of undifferentiated leukocyte precursors or leukemic blasts. Acute lymphoblastic leukemia (ALL)Derived from myeloid stem cells. According to FAB classification, leukemia is acute if the bone marrow consists of more than 30% blasts. - Mainly affects children 15 years; comprise 80% of childhood leukemias.
- Remission rate is high. Acute myeloid leukemia (AML)- Mainly affects adults between 15-40 years. - Remission rate is low. Chronic myeloid leukemia (CML)The disease occurs between 30 years and 80 years of age, with a peak incidence at 55years. Approximately 95% of patients with CML have a chromosome abnormality known as the 'Philadelphia chromosome'. This is a shortened chromosome 22 and is the result of a reciprocal translocation of material with chromosome 9. - This disease has three phases-
83. Ans. A (Harrison 16th ed., p 1448; Beside Interpretation of ECG A Practical Approach 1st ed., TK Koley p 71): Prinzmetals angina is variant angina. It mainly occurs at rest. It is due to coronary vasospasm. Most often the spasm occurs around an atherosclerotic plaque. ECG shows ST segment elevation in Prinzmetals angina. Q waves are usually absent. Remember: Treatment is with nifedipine. Beta-blockers are contraindicated.

84. Ans. D (Harrison 16th ed., p 1480): Respiratory failure is not a feature of malignant hypertension. Fundus examination reveals papilloedema with haemorrhage and exudates. It may present as hypertensive encephalopathy in the form of headache, vomiting, altered sensorium. It may present as CCF. Oliguria with azotaemia is the renal manifestation of malignant hypertension. Fibrinoid necrosis of walls of small renal arteries and arterioles may be seen. Microangiopathic haemolytic anaemia is probably secondary to kidney involvement. Nifedipine (5 mg) is given sublingually to reduce blood pressure urgently. The main problem with nifedipine is that the fall in BP can not be controlled. Sodium nitroprusside is the drug of choice for hypertensive emergency. 85. 'B' (Ref: Kumar, Cotran, Robbins, Ed. 6th, Pg-79) The lungs are seldom affected in pure hypovolemic shock because they are somewhat resistant to hypoxic injury. However when shock is caused by bacterial sepsis or trauma, diffuse alveolar damage may be seen, which is known commonly as 'shock-lung'. H ypovolemic Shock Results from loss of blood or plasma volume, which may be caused by hemorrhage, fluid loss from severe burns or trauma. Septic Shock It is caused by systemic microbial infection Most commonly it occurs in the setting of gram -ve infections (endotoxic shock) It can also occur with gram +ve and fungal infections. Anaphylactic Shock Initiated by a generalized IgE-mediated hypersensitivity response and is associated with systemic vasodilatation and increased vascular permeability In these instances, widespread vasodilation causes a sudden increase in the capacity of the vascular bed, which cannot be filled adequately by the normal circulating blood volume Thus, tissue hypoperfusion and cellular anoxia result. Neurogenic Shock This may occur in the setting of an anesthetic accident or a spinal cord injury due to loss of vascular tone and peripheral pooling of blood. 86. Ans. C (Ref: Davidson, Ed. 18th, Pg-765) Features presented by this subject coincide well with the likely diagnosis of sickle cell anemia. Poikilocytosis is the term used to describe variations in shape of red blood corpuscles. Examples are - Eilliptocytosis, Spherocytes, Dacryocytes, Sickle cells, Schizocytes, Echinocytes and Acanthocytes. Sickle Cell Anemia- Here, the red cells contain hemoglobin S and are prone to sickle even in vivo under normal conditions. - Sickle cells increase blood viscosity, traverse capillaries poorly and tend to obstruct flow, thereby increasing the sickling of other cells and eventually stopping the flow. - Thrombosis and areas of tissue infarction are seen, which may cause severe pain, swelling and tenderness. - Sickle cells are phagocytosed in large numbers by the mononuclear-phagocyte system, which reduces their life span and gives rise to hemolysis. 87. Ans. A (Harrison 16th ed., p 602): Intrinsic factor is secreted by parietal cell, lack of which leads to vitamin B12 deficiency. It is seen in type A chronic gastritis, which leads to pernicious anaemia. 88. Ans. C (Harrison 16th ed., p 1749): The initial site of colonization of H. pylori is antrum of stomach and then it spreads gradually proximally. Rest of the three statements are correct. It is also associated with gastric MALT lymphoma. The various risk factors for development of H. pylori infection are: a. Low socioeconomic status. b. Domestic overcrowding. c. Unhygienic living conditions. d. Drinking unclean water. e. Exposure to gastric content of infected person. 89. 'D' (Ref: Davidson, Ed. 18th, Pg-996) In idiopathic facial nerve palsy or Bell's palsy, the site of damage is probably the portion of the facial nerve lying within the facial canal. Pain around the ear may precede loss of movement on one side of the face. Hyperacusis occurs if the nerve to stapedius is involved and there may also be loss of salivation and tear secretion. Crocodile tears may be seen. 90. Ans. C (Parsons Diseases of the Eye 19th ed., p 427, 466): Lateral rectus is innervated by the 6th nerve. In complete paralysis of the third nerve there is ptosis (which prevents diplopia), semidilated and immobile pupil and paralysis of accommodation. Slight degree of proptosis may occur due to loss of tone of the paralysed muscles. There is limitation of movement upwards and inwards, on raising the lid eye is seen to be deflected outwards and rotated internally owing to tone of two unparalysed muscles (lateral rectus and superior oblique). Remember: (LR6SO4)3: Lateral rectus is supplied by 6th nerve. Superior oblique is supplied by 4th nerve. Rest of the extraocular muscles are supplied by 3rd nerve.

91. Ans. A (Harrison 16th ed., p 588-589): The patient is suffering from iron deficiency anaemia. Microcytic hypochromic anaemia is found in: 1. Iron deficiency. 2. Thalassaemia. 3. Sideroblastic anaemia. In this patient reticulocyte count is normal which excludes thalassaemia and haemolytic anaemia in which reticulocyte count is raised. There are no features suggestive of sideroblastic anaemia. In aplastic anaemia there is normochromic and normocytic anaemia. In folic acid deficiency there is megaloblastic anaemia. 92. Ans. D (Harrison 16th ed., p 2113): The three main features of Graves disease are goitre with hyperthyroidism, ophthalmopathy and dermopathy (pretibial myxoedema). Hyperthyroidism is due to thyroid stimulating antibodies. Ophthalmopathy and dermopathy are due to immunologically mediated activation of fibroblasts in extraocular muscles and skin that lead to accumulation of glycosaminoglycans, which in turn lead to oedema. Atrial fibrillation is a feature of thyrotoxicosis, which is also seen in Graves disease. 93. 'A' (Ref: Davidson, Ed. 18th, Pg-761) In hemolytic anemia, the catabolic pathways for hemoglobin degradation are overloaded and there is a modest increase in unconjugated bilirubin in the blood and increased re-absorption if urobilinogen from the gut, which is excreted in the urine in increased amounts. Bilirubin does not appear in urine. Jaundice is mild. There is increased bilirubin concentration in the body fluids in jaundice.
94. Ans. B (Harrison 16th ed., p 990): The patient has developed leptospirosis. The combination of hepatic and renal involvement is the main clue to the diagnosis. 95. Ans. B (Harrison 16th ed., p 2047): Aspirin is a NSAID and it is used to treat acute attack of gout. 96. Ans. B (Harrison 16th ed., p 1994): Sacroilitis is a classical feature of ankylosing spondylitis that affects young adults. Ankylosing spondylitis is commonly seen in young male and it is associated with HLA B27. Sacroilitis is the main feature in the early part of the disease. Gradually the spine is involved. There are features of both enthesitis and synovitis. There is subchondral granulation tissue with infiltration of inflammatory cells. Synovitis follows with pannus formation. Iliac cartilage is eroded before thicker sacral cartilage and gradually the joint space may be obliterated. TNF alpha antagonists are now the drug of choice for ankylosing spondylitis. 97. Ans. B (Harrison 15th ed., p 2614; 16th ed., p 2589): The farmer has developed organophosphorous poisoning. Vomiting, diarrhoea, sweating, salivation with constricted pupil are the main clue for organophosphorous poisoning. 98. Ans. D (KDT 4th ed., p 801; Harrison 16th ed., p 611): G-6-PD deficiency makes the RBC susceptible to hemolysis due to oxidant stress. G-6-PD helps to generate NADPH in HMP shunt which is used to reduce glutathione. This helps to protect RBC against oxidant stress. Primaquine, pamaquine, dapsone, sulphonamide, nitrofurantion, acetanilid, vitamin K, doxorubicin, methylene blue, nalidixic acid, furazolidone, niridazole, phenazopyridine etc cause hemolysis in G-6-PD deficiency. 99. Ans. B (Harrison 16th ed., p 1475): The sympathetic system causes bronchodilatation via beta receptors in lungs. Hence beta blockers if used in asthma will have a bronchoconstriction effect. Even in normal persons with increased airway reactivity beta blocker may cause bronchoconstriction. Even the selective 1 blockers at high dose may exacerbate bronchial asthma. 100. Ans. D (Harrison 16th ed., p 611): G-6-PD has X linked inheritance. Mode of inheritence of various disease. Mode of inheritence Diseases Autosomal dominant Retinoblastoma, Familial adenomatous polyposis, von-Hippel-Lindau syndrome, MEN I and II syndrome, Hereditary spherocytosis, von-Willebrand's disease, HOCM, Long QT syndrome, Polycystic kidney disease, Hereditary haemorrhagic telangiectasia, Peutz-Jegher syndrome, Achondroplasia, Marfan syndrome, Osteogenesis imperfecta, Amyloidosis, Ehlers-Danlos syndrome, Familial hypercholesterolaemia, Huntington's disease, Neurofibromatosis type I and II, ALS, Malignant hyperthermia, Spinocerebeller ataxia type 1 and 2 Autosomal recessive Ataxia telangiectasia, Sickle cell disease, thalassemia, Cystic fibrosis, 1 antitrypsin deficiency, Wilson's disease, Haemochromatosis, Congenital adrenal hyperplasia, Glycogen storage disease type I-VIII, Gaucher disease, Tay-Sachs disease, Phenylketonuria, Niemann Pick disease, Friedreich's ataxia X linked recessive Hemophilia A and B, G6PD deficiency, Menkes syndrome, Androgen insensitivity, Becker and Duchenne muscular dystrophy, Fragile X syndrome, Adrenoleukodystrophy, Spinobulbar muscular atrophy Y linked Male-to-female sex reversal. _________________________________________________________________________________

1 Medicine I

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1 Medicine I

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AHEAD Test and Discussions MEDICINE I

Ref. Book: Harrisons Principles of Internal Medicine

B. Elderly D. High output state

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

AHEAD Test and Discussions MEDICINE I

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