Murmur of VSD | AIIMS MCQs for PG Entrance

Which is true about murmur of VSD?

A. A systolic crescendo-decrescendo murmur heard best at the upper right sternal border with radiation to the carotids; the murmur is augmented with transient exercise
B. A systolic murmur at the pulmonic area and a diastolic rumble along the left sternal border
C. A holosystolic murmur at the mid-left sternal border
D. A diastolic decrescendo murmur at the mid-left sternal border

Ans. C. A holosystolic murmur at the mid-left sternal border

A holosystolic murmur at the mid-left sternal border is the murmur most characteristic of a ventricular septal defect. Both the murmur of ventricular septal defect and the murmur of mitral regurgitation are enhanced by exercise and diminished by amyl nitrite. Options a, b, d, and e describe the usual findings in aortic stenosis, atrial septal defect, aortic insufficiency, and patent ductus arteriosus, respectively.

Genetic linkage associated with migraine | Medical PG Preparations

Genetic linkage associated with migraine is attributed to defect in :
A. Sodium channel 
B. Calcium channel
C. Potassium channel 
D. Acetyl choline receptor

Ans. B. Calcium channel

A mutation in P/Q type calcium channel on chromosome 19 is associated with familial migraine.

Primary amebic meningoencephalitis with a rapid fulminant | AIIMS Entrance MCQ

Primary amebic meningoencephalitis with a rapid fulminant course is mostly seen in :
A. Naegleria fowleri 
B. Acanthamoeba
C. Balamuthia mandrillaris 
D. Entamoeba hartmanni

Ans. A. Naegleria fowleri

Primary amebic meningoencephalitis is a fulminant, hemorrhagic, necrotizing meningoencephalitis with a limited purulent exudate. It occurs in healthy children and young adults and is rapidly fatal. It is caused by free-living amebas, most commonly by the amebo-flagellate Naegleri fowleri.

Six well-documented survivors of N .fowleri infections have been reported based on treatment with intravenous and intrathecal amphotericin B, intravenous miconazole, and oral rifampin.

Parameter adds predictive information regarding CVS risk stratification | AIIMS Entrance MCQ

Which parameter adds predictive information regarding CVS risk stratification & measurement of serum cholesterol?
A. Anti-chlamydia pneumoniae antibodies 
B. CRP 
C. Homocysteine
D. Plasminogen activator inhibitor 1

Ans. B. C-reactive protein

Recent studies have demonstrated that markers of inflammation correlate with coronary risk and that inflammation plays a role in atheromatous plaque instability. 

Elevations of C-reactive protein, CRP identify patients at increased risk of myocardial infarction MI and poor outcome of acute coronary syndromes. Measurement of CRP adds information regarding risk stratification to standard risk factor such as hypertension, diabetes, smoking, and lipids.

Elevations in homocysteine, lipoprotein A, and plasminogen activator factor I have all been associated with an increased risk at cardiovascular events; however, at thi~ time none have been shown to be useful in populations to improve risk stratification.

Recent studies have suggested that infection with agents such as pneumoniae and cytomegalovirus may playa role in the development of atherosclerosis.

To date no studies have demonstrated a conclusive association, and early studies looking at the utility of antibiotic treatment in coronary artery disease have shown no benefit.

Obligate coronary vasodilators | AIIMS Entrance MCQ

All of the following are obligate coronary vasodilators except:
A. Nitroglycerine 
B. Nitric oxide
C. Hypoxia and Hypercapnia 
D. Acetylcholine

Ans. D. Acetylcholine

All are known to cause vasodilatation. Only acetylcholine can also be a vasoconstrictor if the endothelium is dysfunctional or absent and nitric oxide can not be produced. In that case it is not an obligate vasodilator.

Chest X-Ray of a rare TB case | Medical PG guidance

Chest X-Ray shows multiple small nodules throughout both lungs in a miliary pattern.In addition there is a opacity in the right lung based and a small right pleural effusion. Miliary TB is a widely disseminated form of TB that account for 1 in 50 cases of TB.

Prognostic factors for operation of biliary duct obstruction in newborn | PGI Frequently Asked Medical PG topics

Better prognostic factors for operation of biliary duct obstruction in newborn are 
A. No passage of bile 
B. size of ductule >200 micron 
C. Weight of baby >3 kg 
D. Preterm baby 
F. Age of 8 weeks

Ans. B. Size of ductule >200 micron ;(C) Weight of baby> 3 kg; (E) Age of 8 weaks : 

• The factors influencing the outcome of billiary tract surgery are (i) Age of patient — better when operation is performed before the age of 8 weeks.
(ii) Microscopic stage of billiary tree: Patients with ductules greater than 200 micron diameter have good prognosis.

• A baby with adequate weight withstand the better surgical procedure.
• Prognosis also depends upon
— Extent of hepatic fibrosis.
— Presence of cholangitis.

Raised AFP | PGI Frequently Asked Medical PG topics

Raised AFP is seen in 
A. PCKD 
B. Cystic hygroma 
C. Gastroschisis 
D. Chromosomal trisomies 
E. Hepatitis

Ans. A. PCKD ; (B) Cystic hygroma ; (C) Gastroschisis; E. Hepatitis:

• AFPis higher than normal in
— Liver and germ cell tumour                           — Recent or impending fetal demise
— Gastroschisis                                                   --- Fetal renal damage
— Cirrhosis, hepatitis
* In chromosal trisomies, its value is decreased.

• Extremely high level of AFP is specific for fetal congenital anomalies like meningomyelocele, PCKD, cystic hygroma and Gastroschisis

Histopathological features of Extra hepatic Biliary Atresia | PGI entrance Preparations

Which of the following are histopathological features of Extra hepatic Biliary Atresia 
A. Bile lakes 
B. Hepatocyte ballooning degeneration 
C. Marked bile duct proliferation 
D. Fibrosis of hepatic duct 
E. Parenchymal cholestasis.

Ans. A. Bile lakes ; (C) Marked Bile duct proliferation ; (D) Fibrosis of hepatic duct  (E) Parenchymal cholestasis : 

Histologically florid feature of extrahepatic biliary obstruction are:
— Marked bile ductular proliferation, containing inspissated bile and lakes of extravasated bile.
— Portal tract oedema and fibrosis
Parenchymal cholestasis 

Transitional cell carcinoma of bladder | PGI entrance Preparations

Transitional cell carcinoma of bladder is associated with 
A. Schistosomiasis 
B. Naphthylamine 
C. Smoking 
D. Tuberculosis of bladder
E. None

Ans. A. Schistosomiasis ; (B) Naphthylamine ; (C) Smoking :
• Exposure to schistosoma haematobium causes both squamous (70%) and transitional cell
(30%) carcinoma. Other causes are aniline dyes exposure.

• 2-naphthylamine is also carcinogenic. 

29 Oct World Stroke Day

Medical Pics for Revision | AIPGMEE Preparations

Molecules Used for cell signaling | AIIMS MCQs for PG Entrance

Which one of the following molecules is used for cell signaling? A. CO2 
B. 02 
C. NO 
D. N2

Ans: C. NO
Cyclic GMP is a second messenger; it is formed from the action of guanylyl cyclase on GTP. The soluble form of guanylyl cyclase binds nitric oxide NO, and cyclic GMP mediates the actions of this ubiquitous signaling molecule with potent vasodilator effects

True about ZES (gastrinoma) | PGI MCQs for MD MS Preparations

True about ZES (gastrinoma) 
A. Gastrin levels > 1000 ng/l 
B. BAO (Basal acid output) > 15 meq/hr 
C. Somatostatin is inhibitor of HCL secretion 
D. Omeprazole is helpful 
E. Secretin increases gastrin secretion in Zollinger Ellison Syndrom


Ans. A. Gastrin levels> 1000 ng/l ; (B) BAO (Basal acid output)> 15 meq/hr;  (C) Somatostatin is inhibitor of HCL secretion ; (D) Omeprazole is helpful (E) Secretin increases gastrin secretion in zollinger Ellison Syndrome
• Most patients with Zollinger Ellison syndrome have 

— Fasting hypergastrinemia (> l000ng/L) 

— Increased basal gactric output (> 15 meq/hr) 

—Secretin increases gastrin secretion

• Proton pump inhibitor like orneprazole is helpful. 

• Somatostatin is inhibitor of HCl secretion.

Predisposing factors for stomach carcinoma | PGI Frequently Asked Medical PG topics

Predisposing factors for stomach carcinoma 
A. Gastric ulcer 
B. Pernicious anemia 
C. Hiatus hernia 
D. Atrophic gastritis
E. achlorhydria

Ans. A. Gastric ulcer ; (B) Pernicious anemia; (D) Atrophic gastritis&(E) achlorhydria.
• Predisposing factors for stomach Ca
— Atrophic gastritis Pernicious anaemia
— Decreased gastric acidity (achlorhydria)
— Gastric Surgery
— Gastric ulcer more prone to develop malignancy Adenomatous polyp
—Menetriet’s disease

Left sided Colon Carcinoma | PGI entrance Preparations

True about left sided colon carcinoma 
A. Anemia 
B. Obstruction 
C. Melena 
D. Feculant 
E. Sigmoid spared
.

Ans. B. Obstruction :
• Carcinoma left colon are usually of stenosing variety, so main symptoms are those of increasing intestinal obstruction.
—Pain
— Alteration bowel habit

—Distension
• Sigmoid colon can be involved by carcinoma.
• Right sided growths are proliferative and grow towards periphery and are detected late.

True regarding Superficial burns | PGI entrance Preparations

Which of the following is true regarding Superficial burns?
A. Always requires skin grafting 
B. Dry &inelastic 
C. Blister formation 
D. Painless 
E. Can be healed within 7 to 10 days

Ans. B. Dry &inelastic ; (C) Blister formation; (E) Can be healed within 7 to 10 days :
• Superficial burns unless infected heals in 7 to 14 days. It heals by epitheliazation and is usually painless.

• They don’t usually require skin grafting as compared to deep burns. 

List of MCQs.. Never Miss | AIIMS MCQs for PG Entrance

1) doc for hypertention and dyslipidimia
Clonidine
Prazosine✔
Tamsulisine
Nebivilol





2)drug with b1blocking and b2agonist
Carvidalol
 labetalol
 celiprilol✔
Nebivilol


3) beta blocker with calcium channel blocking property
Carvidalol✔
 labetalol
 celiprilol
Nebivilol


4) beta blocker with antioxidant property
Carvidalol✔
 labetalol
 celiprilol
Nebivilol



5)mild hypertension and u want to start 1st antihypertensive ina patient
U start with
B-blocker
Thiazide✔
Ccb
Ace inhibitors



6)beta blockers are used in
All except
Migraine
Glaucoma
Tremors
Heart blocks✔



7)most cardio selective  beta blocker
Atenelol
Betaxolol
Celeprilol
Nebivilol✔


8)beta blocker having local anesthetic property
Atenalol
Timolol
Pindolol✔
Nebivilol


9)antidote of beta blocket toxicity
Calcium gluconate
Indulin
Glucagon✔
Mgso4

Commonest cause of failure of arthrography | AIIMS Entrance MCQ

Commonest cause of failure of arthrography is:
A. Extra-articular injection of contrast
В. Bubbling of air in the joint
С. False positive interpretation
D. Allergic reaction.

Ans. A. Extra-articular injection of contrast medium is the commonest cause of failure of arthrography especially in smaller and deep situated joints. Allergic reaction to contrast medium is rare but when it happens examination will have to be discontinued. Other factors also make this procedure futile

Characters of tricuspid regurgitation | AIIMS MCQs for PG Entrance

Which of the following statements best characterizes tricuspid regurgitation? 
A. Infective endocarditis is a common cause
B. The murmur heard in tricuspid regurgita¬tion decreases with inspiration
C. Large a waves in the jugular venous pulse are characteristic
D. Correction of coexistent left ventricular failure rarely improves the condition

Ans. A. Infective endocarditis is a common cause

Infective endocarditis is a common cause of tricuspid regurgitation. The murmur of tri­cuspid regurgitation typically increases with inspiration. Large v waves are seen in the jug­ular venous pulse. Because a common cause of right ventricular failure and secondary tri­cuspid regurgitation is left ventricular failure, correction of left ventricular failure, when present, often is useful in the treatment of tri­cuspid regurgitation. Diagnosis of tricuspid re­gurgitation usually is made on the basis of clinical or echocardiographic evidence. Car­diac catheterization rarely is used to make the diagnosis

Left ventricular failure Symptoms | Medical PG Preparations

Which of the following physical signs and symptoms is best indicative of left ventricular failure?
A. Neck vein distention 
B. Ascites
C. Anorexia 
D. Orthopnea

Ans. D. Orthopnea

Orthopnea is in­dicative of left ventricular failure. Orthopnea is defined as dyspnea i.e., the feeling of breathlessness that occurs in the recumbent position. Recumbency leads to increased car­diac venous return and, thus, increased left and right ventricular volumes. The increased left ventricular volume results in increased left ventricular filling pressure, which leads to pul­monary congestion and the feeling of breath­lessness. Neck vein distention, ascites, anorexia, and cardiac edema all are signs and symptoms of right ventricular failure.

Function of the thalamus | Medical PG Preparations

Function of the thalamus is: 
A. Arousal 
B. Relay centre 
C. Pain perception 
D. Pain location

Ans. B. Relay centre
Thalamus acts as a relay centre for the impulses ascending via lateral spinothalamic tract, ventral spinothalamic tract and medial lemniscus. These impulses are transmitted to postcentral gyrus via thalamic radiation. 

Pancreatic Ca | PGI Frequently Asked Medical PG topics

True about pancreatic Ca 
A. M.C. symptom is pain 
B. Ca head of pancreas causes obstruction of both pancreatic and billiary duct 
C. Smoking predisposes
D. Long term DM is a potent risk factor.
E. Family H/O familial adenomatous polyposis syndrome

Ans. A. M.C. Symptom is pain; (B) Ca head of pancreas causes obstruction of both pancreatic and billary duct; (C) Smoking predisposes; D. Long term DM  is a potent risk factor.

• Pancreatic cancer has the following risk factors:-

Male Sex 

— Blacks > whites 

— Age>50 yrs. 

—Cigarette smoking Most consistent risk factor. Whether due to direct carcinogenic effect of tobacco metabolites on the pancreas or an as yet undefined exposure that occurs more frequently in cigarette smokers is uncertain.

— Chronic pancreatitis 

— Long standing DM 

— Obesity 

Mutation in k-ras gene and pio4 

• Alcohol abuse or cholelithiasis are not risk factors nor is it associated with coffee consumption. 

• In Familial adenomatous polyposi,s (FAP), polyps are found in large intestine and is not a/w any other malignancies. 

Marjolins ulcer | PGI MCQs for MD MS Preparations

True about Marjolins ulcer 
A. Develops in long standing sear 
B. Sq cell ca develops 
C. Slow growing lesion 
D. Also know as Baghdad sore 
E. Common in Black races

Ans . A.  Develops in long standing scar; (B) Sq cell Ca develops; (C) Slow growing lesion.
• Marjolin’s ulcer is the name given to a squamous cell carcinoma which arises in a chronic
benign ulcer or scar. The commonest ulcer to become malignant is long standing venous ulcer
The scar which may show malignant change is the scar of an old burn.
• The special features are :Slow growing malignant lesion, probably due to less vascularity.
— Edge of such an ulcer is not raised and everled
— They are less malignant than a typical squamous cell Ca.
• Baghdad sore or oriental sore or Delhi boil is caused by Leishmania Tropica.

Dietery factors associated with colon carcinoma

Dietery factors associated with colon carcinoma 
A. High fiber 
B. Low fiber 
C. Smoked fish 
D. High fat intake 
E. Japanese are common to develop Ca colon

Ans. B. Low fiber ; (C) Smoked fish; (D) High fat intake ; (E) Japanese are common to develop Ca colon :

Dietary risk factors for colorectal Ca, 

— Diet rich in fat and red meat -                           — low fiber diet. 

• Colorectal Ca has increased in Japan since that ration has adopted a more western diet. 

• Animal Fats : Ingestion of animal fats — increased proportion of anaerobes in the gut microflora which leads to conversion of normal bile acids to carcinogens. This provocative hypothesis is supported by several reports of increased amounts of fecal anaerobes in the stools of pts of colonic Ca. 

• Some studies suggest that certain elements of the diet protect against the development of neoplasia. 

Selenium, dithiothiones, thioester’s, terpenes and carotenoids might act as anticarcinogensby reducing free oxygen radicals in the colon at the muscosal surface, 

• Fiber:-An increase in dietary fiber may lower the incidence of Ca in pts who have a high fat diet. 

Dietary fiber —increases the intestinal transit time — Reduction of the exposure of colonic mucosa to potential carcinogen and dilution of these carcinogens because of enhanced fecal bulk. 

• The role of fiber in colorectal Ca is controversial. Because, a diet low in fiber can lead to chronic constipation and diverticulosis. If a low-fiber diet were a significant risk factor in colorectal Ca, individuals with diverticulosis should be at higher risk for developing colorectal Ca ; This is not the case. 

• According to the National Research Council, interim guidelines for diet recommendation for prevention of colorectal Ca are 

—Fat in the diet from 40-30% of total caories, 

— increased consumption of fiber containing foods. 

—* Limit salt-cured, smoked foods. 

—* Limit food additives show to be potential carcinogens, 

 — Establish research protocals for direction of mutagen in foods. 

— Limit alcohol consumption. 

Clinical Case MCQ of Dysphagia of 6 wks Thiration | PGI MCQs for MD MS Preparations

A 60 yrs old pt presenting with dysphagia of 6 wks thiration with solid foods now can swallow only liquids. Investigations done to diagnose her are-A. CxR. 
B. Ba Swallow. 
C. Endoscopy 
D. USG 
E. CT Scan.

Ans A.  CXR ; (B) Ba- swallow (C) Endoscopy (D) USG ; (E) CT-Scan. 

Progressive dysphagia and weight loss of short duration are initial symptoms in vast majority

of the cases of esophageal carcinoma. Dysphagia initialy for solid foods and gradually progressive to semisolids and liquids suggestive of Ca esophagus. Esophagoscopy is the preferred investigation as it can visualise the tumour and biopsy can be  done for definite diagnosis. 

• Ba-swallow is helpful for diagnosis ;irregular filling defects are seen in oesophagus. 

• Chest CT scan — to detect extent of the tumour to mediastinum and para aortic lymph nodes. 

• A 60 yrs old patient with H/o dysphagia initially to solids & gradually to liquids is a case of Ca esophagus. 

INVESTIGATON OF CHOICES Part 3

INVESTIGATON OF CHOICES for various conditions
fibroid - USG
tubal patency- HSG
Mullerian anomalies - MRI
Endometriosis - Laproscopy
post coital bleeding - PAPS
post menopausal bleeding -
endometrial biopsy
pid - USG
adenexal mass - USG
amenorrhoea - hormonal asessment
molar - USG
Ectopic - TVS
ovulation - follicular monitoring
hirsutism with menstrual irregularity- -serum testosterone
AUB USG
Adenomyosis - MRI
ovarian reserve - FSH
VVF - Cystoscopy

Antibodies

Antibodies

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IgG about 80 % of antibodies in serum
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IgG provides long term protection because it persists for months and years after the prescence of the antigen that has triggered their production
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IgG They can leave the blood cells and move to ares of inflammation
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IgG Monomer
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IgG Crosses the placenta providing the foetus with passive immunity
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IgG Protect against bacteris, viruses, neutralise bacterial toxins, trigger compliment protien systems and bind antigens to enhance the effectiveness of phagocytosis
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IgA 10-15% of antibodies
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IgA consists of two monomners joined togther
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IgA The most common form of antibodies in mucous membranes and body secretion. E.g. mucus, saliva, tears, breast milk
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IgA Main function is to bind antigens on microbes before they invade tissues. It aggregates the antigens and keeps them in the secretions so when the secretion is expelled, so is the antigen
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IgM Make up 10-15% of Antibodies
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IgM Large size so do not leave the blood vessels - Pentamer
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IgM Involved in the ABO blood group antigens on the surface of RBCs
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IgM Effective in aggregating antigens because it has ten binding sites
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IgM Involved in compliment
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IgM Enhance ingestions of cells by phagocytosis
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IgD 0.2% of serum antibodies
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IgD Found in te blood, lymph and especially on the surface of B cells. We have limited knowledge of their function
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IgD Monomer
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IgE 0.0002% of antibodies
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IgE Bind to mast cells and basophils wich participate in the immune response
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IgE When and antigen such as pollen binds to ths antibody, the mast cell or basophil releases histamine..


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IgE Involved in allergicc reactions
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IgE It attract complement and phagocytic cells..

AFP is raised in | PGI MCQs for MD MS Preparations

AFP is raised in 
A. Prostate en 
B. Hepatic ca. 
C. Lung Ca.
D. Breast en. 
E. Colon Ca.


Ans.  (B) Hepatic Ca ; (c) Lung Ca
• Alfa — fetoprotein (AFF) is a tumor marker & high serum concentrations seen in
- Primary hepatomas
- Testicular tumors
-Lung Ca
- Stomach Ca
- Pancreatic Ca
- Biliary tree tumors.

Predisposing factor of Testicular germ cell tumor | PGI MCQs for MD MS Preparations

Predisposing factor of Testicular germ cell tumor 
A. Cryptorchidism.
B. Testicular feminization syndrome. 
C. Klinefelter’s syndrome. 
D. Radiation. 
E. Trauma

Ans.  (A) Cryptorchidism. (B) Testicular Feminization syndrome; (C) Klinefelter’s syndrome

• Predisposing factors of testicular germ cell tumors are
- Cryptorchidism
- Testicular Feminization Syndrome
- Testicular dysgenesis - Klinefelter syndrome
- Exposure to environmental oestrogens.
- Development of Cancer in one testis is a/w markedly increased risk of neoplasia in the contralateral one.
-Testicular trauma is a coincidence only. This may not precipitate a testicular tumor, but brings to the attention of the patient