Loud pulmonary component of second heart sound heard in | PGI Nov 2017 Preparations MCQ

Loud pulmonary component of second heart sound heard in 

A. Pulmonary hypertension 
B.TOF 
C. Eisenmenger’s syndrome 
D. Pulmonary stenosis 
E. AS

Answer. A. Pulmonary hypertension ; (C) Eisenmenger syndrome

• Pulmonary hypertension: P, loud, normal splitting of S2

• TOF: P2 soft & delayed and is generally inaudible as pulmonary artery pressure is reduced and RV outflow obstruction is there. So, s2 is single, the audible sound is A2.

• Eisenmenger syndrome : P2 is loud as there is pulmonary hypertension

• Pulmonary stenosis: P2 is delayed & softer widely split with normal movement.

• Aortic stenosis : P2 is normal; A2 delayed normal splitting, single paradoxical splitting. 

Malignant neuroleptic syndrome | PGI Nov 2017 Preparations MCQ

Malignant neuroleptic syndrome is seen with all of the following except:

A. Atropine 
B. Halothane
C. Ketamine 
D. Anti psychotics
E. Bromocriptine

Answer. A. Atropine ; (B) Halothane ; (C) Ketamine ; (E)Bromocriptine

Malignant neuroleptic syndrome is seen with Anti-psychotics.

There is rigidity , immobility , tremor , fever and semi consciousness .  Due to anti dopaminergic action of antipsychotics . Anticholinergics of no use , Bromocryptine in large doses may be useful .

Statements about hairy cell | PGI Nov 2017 Preparations MCQ

All of the statements about hairy cell are true except: 

A.Massive lympadenopathy
B. Result from an expansion of neoplastic B lymphocytes
C. Cells are positive for tartarate resistant acid phosphate (TRAP) 
D. The cells express CD 5 consistently
E. Lukemia cells look like broken hair ends

Answer. A.Massive lympadenopathy; (D) The cells express CD5 consistently; (E) Lukemia cells look like broken hair ends

Hairy Cell Leukemia

·        Appearance of leukemia cells-fine hairlike projection

·        Hairy cell rearrange and express immunoglobulin genes which firmly assign them to B cell lineage

·        Characteristic-presence of tartrate resistant acid phosphatase (TRAP)

·        Involve mainly older male

·        Splenomegaly (massive)

·        Hepatomegaly not marked

·        Lymphadenopathy rare

·        Pancytopenia in 50% cases

·        Splenectomy is of benefit

·        Alpha interferon has proved to be effective

·        Hairy cells usually express the pan B-cell markers CD19 & CD20 and some times monocyte associated antigen CD11c, CD25, CD103

Barium-study findings in small intestinal malabsorption | NEET Based MCQ

The barium-study findings in small intestinal malabsorption include all the following except: 

A. Increased bowel transit time 
B. Mucosal atrophy 
C. Stricture of bowel 
D. Flocculation of barium


Ans. C. (stricture of bowel)
Small intestinal malabsorption
There are four racliologic groups of findings in small intestinal malabsorption, related to alteration in:
1. Peristalsis - variable peristalsis is hallmark with hypo and hypertonic segments, overall leading to increased transit
time and segmentation of barium.
However, the transit time may be long/short/normal.
Painless transient intussusception may be seen on fluoroscopy.
2. Caliber - dilatation of segments of bowel coils in 80% cases (>3 cm).
3. Secretions - increased secretions cause dilution of barium and later clumping, segmentation and flocculation of barium.
4. Mucosa - edematous mucosa with thickened valvulae conniventes giving cog-wheel’ pattern (colonization of jejunum), instead of their normal feathery’ pattern; later atrophy occurs and mucosal folds disappear with thinning of bowel wall.
Valvulae conniventes may exhibit five types of appearances:
o Normal
o Squared ends
o Thickening of valvulae
o Reversed jejunoileal pattern
o Absence of valvulae conniventes: “moulage sign” characteristic of sprue

CLL Based Clinical MCQ | NEET Based MCQ

An 80-year-old, asymptomatic man presents with a total leucocyte count of 1 lakh, with 80% lymphocytes and 20% PMC’s. Most probably this patient is suffering from 

A. AML 
B. CML 
C. CLL 
D. TB

Ans. C. (CLL)

Explanation
In the question, following things are the reason for the diagnosis—age, 80 years; asymptomatic; gender—male; TLC—l lakh; lymphocytes 80%; with 20% PMCs.

In CLL,following important points, we should know

• Median age—65 years

• Male percentage—53%

• Increased number of circulating lymphocytes (i.e., >4 x 10⁹/L and usually> 10 x 10⁹/L) and same finding in bone marrow confirm the diagnosis.

• Peripheral blood smear shows many “smudge” or “basket” cells, nuclear remnants of cells damaged by the physical shear stress.

• Trisomy 12 is found in 25% to 30% of patients.

• Typically, CLL is often found incidently when a complete blood count is done for other reason.

Feature of Schizophrenia | NEET Based MCQ

Which one of the following is not a feature of Schizophrenia? 

A. Literally means ‘splitting of mind’ 
B. Peak incidence occurs in 15 to 30 years age group 
C. People with low intelligence are more predisposed 
D. Both C and D

Ans. C. People with low intelligence are more predisposed
 Eugen Bleuler’s Fundamental Symptoms of Schizophrenia

• Ambivalence: Marked inability to decide for or against.
• Austin: Withdrawal into self.
• Affect disturbances: For example, inappropriate affect.

• Association disturbances: Loosening of associations; thought disorder. 

Diagnostic criteria for pulmonary aspergillosis | PGI Nov 2017 Preparations MCQ

Diagnostic criteria for pulmonary aspergillosis 

A. Asthma 
B. Eosinophillia
C. Bilateral chest ipfiltrates
D. increased lgG 
E. Bronchiectasis

Answer. A. Asthma; (B) Eosinophilia; (E) Central bronchiectasis

Diagnostic criteria for bronchopulmonary Aspergillosis:

Primary

(i) Clinical h/o Asthma

(ii) Eosinophilia

(iii) Immediate skin Reactivity to aspergillus antigen

(iv) Precipitating Ab. To aspergillus Antigen

(v) IgE

(vi) Pulmonary infiltrates

(viii) Central bronchiectasis

In ABPA, the pulmonary infiltrates may be patchy , segmental and even whole lung may be involved.

Hypocalcemia with hyperphosphatemia | PGI Nov 2017 Preparations MCQ

Hypocalcemia with hyperphosphatemia are seen in :

A. CRF 
B. Pseudohypoparathyoidsm
C. Vit-D deficiency 
D. Magnesium deficiency
E. Tumour lysis Syndrome

Answer. A. CRF ; (B) Pseudohypoparathyoidsm; (E) Tumour lysis Syndrome

Hypocalcemia with hyperphosphatemia is associated with :

— Chronicrenal failure.

— Pseudohypoparathyroiclism.

---- Albright’s  heriditary osteodystrophy

---- True hypoparathyrodism.

— Tumour Lysis syndrome.

* Vit. D Deficiency — causes  low or normal level of calcium and phosphate

* Severe Magnesium deficiency is associated with hypocalcemia. Theeffect of Mg on PTH secretion is similar to Ca²⁺ but of little significance because, calcium effectspredominate. Again, it is found that severe Mg deficiency associated with blunted secretion of PTH.

Phosphate level is not elevated in hypomagnesemia, as phosphate deficiency is frequent accompaniment of hypomagnesemia. 

Grievous injuries are | PGI Nov 2017 Preparations MCQ

Grievous injuries are 

A. Severe bodily pain for 10 days 
B. Not able to work for 17 days 
C. Dislocation of tooth 
D. Joint dislocation 
E. Bone fracture

Answer. C. Dislocation of tooth ; (D) Joint dislocation ; (E) Bone fracture

Any hurt which endangers life or unable to follow daily routine.

• In Section 319 IPC

Define ‘hurt’ as bodily pain, disease or infirmity caused to any person. So option A, B is not grievous

injuries as duration is less than 20 days.

Dislocation of tooth, joint dislocation and Bone fractrue — all are grievous injuries.

Grievous injuries (Sec. 320 1PC)

(I) Emasculation

(2) Permanent privation (Loss) of sight of either eye.

(3) Permanent loss of hearing of either ear.

(4) Privation of any member (Part, organ, limb) or joint.

(5) Destruction or permanent impairing of powers of any member or joint.

(6) Permanent disfiguration of head or face

(7) Fracture or dislocation of a bone or tooth.

Somatic death | PGI Nov 2017 Preparations MCQ

Which is true about Somatic death.

A. Cooling of the body. 
B. Cessation of spontaneous respiration
C. Cessation of circulation 
D. Flat isoelectric E.E.G 
E. Deep unconsciousness with no response to external stimuli or internal need

Answer. B. Cessations of spontaneous respiration; (C) Cessation of circulation ; (D) Flat isoelectric EEG; (E) Deep unconsciousness with no response to external stimuli or internal need

Somatic death or clinical death is the complete and irreversible cessation of the vital functions

of brain, heart and lungs.  In somatic death, though life ceases, cells respond to chemical, thermal and electrical stimuli.

The signs of somatic death or immediate signs of death are:-

-  Insensibility to touch, pain, temperature and loss of voluntary power.

-Cessation of circulation

- Loss of E.C.G. rhythm.

- Loss of E.E.G rhythm.

- Cessation of respiration

* Cooling of body is the sign of cellular death. 

Widmark formula Used In | PGI Nov 2017 Preparations MCQ

Widmark formula is used in which poisoning: 

A. Blood alcohol concentration
B. Predicting time elapsed since last drink
C. Carbolic acid poisoning
D. Clephos poisoning 
E. Barbiturate

Answer. A. Blood alcohol concentration ; (B) Predicting time elapsed since last drink.

The Widmark Equation is a useful tool for:

• Predicting Blood Alcohol Concentration (BAC).
• Predicting time elapsed since the last drink.
• Estimating how many drinks were consumed if the time of the last drink and BAC are known.

BAC is given by formula: 

BAC =     

r = 0.68 for males and 0,55 for females

Risk factors for cholangio carcinoma | PGI Nov 2017 Preparations MCQ

All of the following are risk factors for cholangio carcinoma except:

A. Primary sclerosing cholangitis 
B. Caroli's disease
C. Clonorchissinensis 
D. Cirrhosis of the liver
E. Ascaris lumbricoides

Answer. D. Cirrhosis of the liver

Primary sclerosing cholangitis is characterized by diffuse inflammation and fibrosis of the biliary system with irregular patchy strictures. It can present with jaundice, pruritis, fatigue, and recurrent cholangitis. End-stage liver disease may result in liver transplantation. There is a strong association with inflammatory bowel disease, particularly pan-ulcerative colitis. Primary sclerosing cholangitis is a strong risk factor for cholangiocarcinoma.

Caroli's disease consists of congenital segmental, saccular dilatations of the intrahepatic bile ducts.

It is associated with stone formation, recurrent bacterial cholangitis, and cholangiocarcinoma.

The parasite clonorchis sinensis can reside in bile ducts for as long as 30 years and can be a risk factor for cholangiocarcinoma. Ascaris lumbricoides may also be a risk factor.

Erythropoietin secreting tumor(s) | PGI Nov 2017 Preparations MCQ

Erythropoietin secreting tumor(s) 

A. Cerebellar hemangioblastoma 
B. Hepatoma 
C. Renal cell Ca. 
D. Adrenal adenoma 
E. Fibromyoma of uterus

Answer. A.Cerebeller hemangioblastoma ; (B) Hepatoma ; (C) Renal cell Ca; (E) Fibromyoma

of uterus :

Erythropoietin secreting tumours are

— Renal cell carcinoma

— Hepatoma

— Cerebellar haemangioblastom

— Massive uterine leiomyoma

— Other e.g. pheochromocytoma

Uses of tumor marker | PGI Nov 2017 Preparations MCQ

Uses of tumor marker are 

A. Screening of a cancer 
B. Follow up of a cancer patient, esp. for knowing about recurrence 
C. Confirmation of a diagnosed cancer 
D. For monitoring the treatment of a cancer
E. In Differentiating malignant from benign condition.

Answer. A. Screening of a cancer ; (B) Follow up of a cancer patient, esp. for knowing about recurrence; (D) For monitoring the treatment of a cancer ; (E).  In Differentiating malignant from benign condition. 

Applications of tumour markers

Detection : Screening in asymptomatic person.

Diagnosis : Differentiating malignant from benign condition.

Monitoring : Predicting effect of therapy and detecting recurrent of tumour.

Classification: Choosing therapy and prediction tumour behaviour (Prognosis).

Staging : Defining extent of disease.

Loca1isation: Nuclear scanning of injection radioactive antibodies.

Therapy: Cytotoxic agent directed to marker containg cell.

Which condition causes the maximum hearing loss | NEET Based MCQ

Which condition causes the maximum hearing loss? 

A. Ossicular disruption with intact tymnpanic membrane 
B. Disruption of melleus and incus as well tympanic membrane
C. Partial fixation of the stapes footplate 
D. Otitis media with effusion

The answer is A.

 Average Hearing loss seen in different lesions of conductive apparatus:

Complete obstruction of ear canal = 30dB

Perforation of tympanic membrane (it varies and is directly proportional to the size of perforation) = 10-40 dB

Ossicular interruption with intact drum = 54 Db

Closure of oval window = 60 Db