Tumors completely cured with chemotherapy | PGIMER MCQs for MD MS Preparations

Which of the following tumors is completely cured with chemotherapy: 

a. Ovarian tumor 
b. Choriocarcinoma 
c. Carcinoma lung 
d. Carcinoma stomach 
e. All

Ans. is b i.e. Choriocarcinoma

Tumors completely cured with chemotherapy

• ALL                                                      • Gastric trophoblastic neoplasm

• AML                                                    • Wilm’s tumor

• Hodgkin a disease                             • Rhabdomyo carcinoma

• Lymphoma                                         • Ewing’s sarcoma

• Germ cell neoplasm                         • Peripheral neuroepithelioma

— Embryonal carcinoma                    • Neuroblastoma

— Teratocarcinoma                             • Small cell lung carcinoma

— Seminoma / dysgerminoma          • Ovarian carcinoma 

Portal and systemic cirulatory anastomosis | PGIMER MCQs for MD MS Preparations

Portal and systemic cirulatory anastomosis occurs at 

a. Around the umbilicus
b. At the lower end of esophagus
c. At the pyloric end of stomach
d. At the anorectal junction
e. Hepatic hexure

Ans.B

A portacaval anastomosis (also known as portal systemic anastomosis or portal caval system) is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. The lower end of esophagus is one of the important sites for the portosystemic anastomosis . In portal hypertension, as in the case of cirrhosis of liver, the anastomosis opens and forms venous dilatation called esophageal varices. Their rupture causes severe and dangerous haematemesis (hematemesis). Specific types include:

Region	Name of clinical condition	Portal circulation	Systemic circulation
Esophageal	Esophageal varices	Esophageal branch of left gastric vein	Esophageal branches of Azygos vein
Rectal	Rectal Varices	Superior rectal vein	Middle rectal veins and inferior rectal veins
Paraumbilical	Caput medusae	Paraumbilical veins	Superficial epigastric vein
Retroperitoneal	(no clinical name)	Right colic vein, middle colic vein, left colic vein	Renal vein, suprarenal vein, paravertebral vein, and gonadal vein
Intrahepatic	Patent ductus venosus	Left branch of portal vein	Inferior vena cava

Content of Aschotf’s nodules | PGIMER Frequently Asked MCQ Topics

Content of Aschotf’s nodules are All Except 

a. Histiocytes
b. Langhan’s giant cell 
c. Fibrinoid deposition 
d. Aschoft’s cells 
e. Lumbar bodies

Ans. is b and e. i.e. Langhan’s giant cell and Lumbar bodies

• Aschoff bodies are diagnostic of rheumatic fever.

• Aschoff bodies constitute:

— Fibrinoid degeneration (necrosis).

— Fibrinoid necrosis is surrounded by T-cells, plasma cells, plump macrophages called Anitschkow cells (pathognomonic of RE).
• These are distinctive cells have abundant amorphous cytoplasm and central round to ovoid nuclei in central, slender, wavy ribbon (hence designation, caterpillar cells).

• Some of the larger macrophages 

Coarse Crepetations

A 3-year-old girl has fever, cough and respiratory distress since 7-8 days; On examination she has coarse crepetations in right lower zone; On chest x-ray there is consolidation seen in right lower lobe; She improved with antibiotics but on follow up at 6-8 weeks she was again found to have increasing consolidation in right lower lobe; The next investigation for her further evaluation should be which of the following? 

A. Bronchoscopy
B. Bacterial culture of the nasopharynx
C. CTscanofthorax
D. Allergen sensitivity test

Ans. C. CTscanofthorax

This child is not likely to have foreign body aspiration as there should be initial air-traping, followed by lung / segmental collapse; This child has recurrent consolidation which needs to rule out underlying predisposing lung pathology like pulmonary sequestration, etc and hence CT scan of chest would be best option for further evaluation; However it should be kept in mind that best investigation before surgery for suspected cases of lung sequestration is angiography;

After 5 months of ATT treatment, if sputum is positive for AFB

After 5 months of ATT treatment, if sputum is positive for AFB 

A. Treatment failure 
B. Relapse
C. Return after default 
D. Recurrence

Ans. A. Treatment failure

Failure case - A patient who was initially smear positive, who began treatment and who remained or became smear positive again at five months or later during the course of treatment.
Relapse -A patient who returns smear positive having previously been treated for tuberculosis and declared cured after the completion of his treatment.
Return after default - A patient who returns sputum smear positive, after having left treatment for at least two months.

Causes of eosinophilia | Frequently Asked MCQ Topics

All of the following are causes of eosinophilia except:

A. Hodgkin’s disease 
B. Filariasis
C. MI 
D. HIV infection

Ans. C.

• Conditions producing allergic reactions & resulting eosinophilia are: 

* Drugs: Iodides, Aspirin, Sulfonamides, Nitrofurantoin, Penicillin, Cephalosporins. 

* Disease conditions : Hay fever, Asthma, Eczema, Serum sickness, Allergic vasculitis, Pemphigus. 

* All types of parasitic infection. 

* Collagen vascular disease : RA, Eosinophillic fasciitis, Allergic angiitis, Polyarteritis nodosa. 

* Malignancy : Hodgkins disease, Mycosis fungoides, CML, Ca stomach, ovary, lung, pancreas 

and uterus. 

* Other diseases Job’s syndrome, Sarcoidosis, Skin disease. 

* Viral infection like HIV and human T-cell lymphotropic virus HTLV-1.  

* In MI polymorphonuclear leukocytosis seen.

* Most dramatic hypereosinophilia syndromes are eosinophil count 50,000 to 1,00,000/pA.  

- Loeffler’s syndrome 

- Tropical pulmonary eosinophlllia 

- Loeffler’s endocarditis 

- Eosinophilic leukaemia 

- Idiopathic hypereosinophillic syndrome. 

* In eosinophilia, eosinophil count>500

* Eosinopenia seen in 

- Stress 

- Acute bacterial infection 

- After Rx of glucocorticoids. 

Community acquired Pneumonia out patient treatment | PGIMER Frequently Asked MCQ Topics

In community acquired pneumonia out patient treatment is 

a. Azithromycin 
b. Cepfotaxime 
c. Ampicillin . 
d. Gentarnicin 
e.Vancomycin

Ans. (A) Azithromycin; (C) Ampicillin

• Drugs uses as follows in out patient basis in pneumonia.

No cardlo pulmonary disease, no risk factor for DRSP infection

• Macrolide i.e. olarithromycin

— azithromyein

• Doxycycline

• Cardiopulmonary disease

Risk factor in drugs resistance S. Pneumoniae (DRSP)

High DRSP prevalence in the community

• Quinolone e.g. Levofloxacin, moxifloxacin, Gatifloxacin

• B—lactam e.g. cafodoxime -‘

- cefuroxime

- amoxicillin

- amoxicillinfclavulanie acid plus macrolide or doxycycline

- Telithromycin 

Myasthenià gravis | PGIMER Frequently Asked Medical PG topics

In Myasthenià gravis, muscle least likely to be involved: 

a. Proximal limb muscles 
b .Dilator pupillae 
c. Extraocular muscle 
d.Facial muscle 
e. Palate

Ans. (B) Dilator pupillae

• In myasthenia gravis weakness typically begins with extra-oculars muscles, patient presented  initially with ptosis

and diplopia.

• Papillary response is normal.

• Proximal muscle mainly involves.

• Facial weakness produces a “snarling” expression when patient attempt to smile.

• Palatal weakness produced nasal regurgitation and nasal intonation.

• Involvement of papillary muscle not mentioned. 

Structures piercing during pericardiocentesis | PGIMER MCQs for MD MS Preparations

Structures piercing during pericardiocentesis: 

a. Skin 
b. Diaphragm . 
c. Intercostals muscles. 
d.Pleura
e. Rectus Muscle

Ans. (A) Skin; (B) Diaphragm (E) Rectus muscle

• Pericardiocentesis involves removal of pericardial fluid by percutaneous catheterisation of the pericardial sac. The subxiphoid ‘blind’ approach to pericardio-centesis has been the traditional approach, which involves placing the patient in a supine 300 - 45° head-up position to facilitate the movement of the effusion towards the anterior chest wall.

• Indications

Therapeutic

- Cardiac tamponade

- Haemodynamic compromise due to large/rapidly developing pericardial effusion

- Management of large pericardial effusion (>20 mm separation of pericardial membranes on echocardiography)

Diagnostic :

- Obtaining pericardial fluid for analysis

- Pericardioscopy

- Epicardial or pericardial biopsy

Contraindications
- Aortic dissection as cause for pericardial effusion

- Uncorrected bleeding diathesis

- Anticoagulation

- Marked thrombocytopenia (<50,000/mm3)

- Loculated pericardial effusion

- Small pericardial effusion

- Posteriorly located pericardial effusion

The structures pierced during pericardiocentesis are:

- Skin & subcutaneous tissues

- Rectus muscle

- Transverses abdominis

- Diaphragm

- Parietal pericardium. 

The two nitrogen atoms in urea

The two nitrogen atoms in urea arise from: 

A. Ammonia and glutamine 
B. Ammonia and aspartic acid
C. Glutamine and glutamic add
D. Glutamine and alanine

 Ans. B. Ammonia and Aspartic acid

Urea cycle
• Takes place in liver and brain.
• 1st two reactions occur in mitochondria.
• 1st two reactions are rate controlling reactions.
• Nitrogen atoms arise from Ammonia and Aspartic acid
• Combination of “Hyperammonemia+ increased Blood Glutamine +Blood urea” suggests defect in Urea Cycle. Lethargy, vomiting, coma are associated

Type II hypersensitivity

Type II hypersensitivity: 

a. Blood transfusion reaction 
b. Arthus reaction 
c. Pemphigus Vulgaris 
d. Glomerulonephritis
e. Pernicious anemia

Ans. (A) Blood transfusion reaction  ; C. Pemphigus Vulgaris ; E. Pernicious anemia

Examples of antiboby medicated type 2 hypersesitivity reactions are

- Autoimmune haemolytic anaemia

- Autoimmune thromocytopenia

- Pemphigus vulgaris

- Vasculitis caused by ANA

- Good pasture syndrome

- Acute rheumatic fever

- Myasthenia gravis

- Insulin Resistance diabetes.

- Pernicious anaemia 

Features suggesting secondary polycythemia | PGIMER Frequently Asked Medical PG topics

Features suggesting secondary polycythemia 

a. Smoking 
b. Stress 
c. Burn 
d. High altitude Characterized by 
e. CO poisoning

Ans. (A) Smoking; (D) High altitude; (E) CO poisoning

•Secondary polycythemia is defined as an absolute increase in red blood cell mass caused by enhanced stimulation of red blood cell production.

- Carbon monoxide poisoning

- Smoking

- Chronic heart or lung disease

- Cyanotic congenital heart disease

- Hormonal (endocrine) disorders: pheochromocytoma and adrenal adenoma with Cushing syndrome

- Exposure to high altitudes

- Hypoventilation syndromes:

- High affinity hemoglobinopathy

- Kidney cysts, hemangioma

- Renal artery stenosis

- Tumors of the brain, liver, or uterus and kidney.

- Anabolic steroids or erythropoietin therapy

• Spurious polycythemia, stress polycythemia, or Gaisbock’s syndrome, relative polycythemia is characterized by

normal numbers of red blood cells but decreased levels of plasma (the fluid part of the blood). Causes of spurious polycythemia include:

- Bunis

- Diarrhea

- hemoconcentration

- Stress

• Polycythemia (rubra) vera is a myeloproliferative disorder associated with trilineage marrow hyperplasia and characterized by an increased red cell mass, usually in association with leukocytosis and thrombocytosis. 

Pairs in Amyloids

Correctly matched pairs in Amyloids: 

a. Multiple myeloma — light chain 
b. Chronic inflammation — AA 
c. Cardiac - ATTR 
d. Neural — beta 2 microglobulin
e. medullary carcinoma - ATTR

Ans. (A) Multiple myeloma-Light chain ; (B) Chronic inflammation - AA ; (C) Cardiac-ATTR; (D) Neural-beta 2 microglobulin

* Multiple myeloma—AL Type

* Chronic inflammation—AA Type

* Hereditary polyneuropathies—ATTR

* Senile cardiac-ATTR

* Medullary carcinoma- Procalcitonin. systemic amyloidosis 

Similar feature between cerebral abscess & infarct | PGIMER entrance Preparations

Similar feature between cerebral abscess & infarct 

a. diffuse lesions with no distinct demarcation
b. Liquefactive necrosis 
c. Healing by fibrosis 
d. embolic tendency
e. Coagulation necrosis

(B).Liquefactive necrosis; (C) Healing by fibrosis;

Similar feature between cerebral abscess & infarct is Liquefactive necrosis and healed by fibrosis.

• Cerebral abscess on macroscopic examination is a discrete lesions with central liquefactive necrosis surrounded by fibrous capsule. Abscess is healed by marked gliosis

• Coagulative necrosis is the characteristic of hypoxic injury of the all the organ except brain where liquefactive necrosis seen. 

Exotoxin Facts

Which of the following is true regarding exotoxin?

A. They are very stable and resist most physical and chemical agents 
B. Highly antigenic 
C. Produced abundantly by gram negative bacilli 
D. Lipopolysaccharide-protein complex in nature

Ans. B. Highly antigenic

Endotoxin	Exotoxin
Liberated after cell disintegration	Excreted by living cells
Lipolysaccharide LPS. -protein complex	Proteins with molecular weight 70,000 — 1,00,000.
Heat stable	Heat labile and lose their toxicity on exposure to 60 degree centigrade. Only exception is enterotoxin of Staphylococcus aureus
Can not be converted to toxoid	Can be converted to toxoid
Nonspecific in action	Highly specific in action
Weakly toxic	Highly toxic substances
Poorely antigenic	Highly antigenic
Produced by gram negative bacteria	Produced by gram positive and negative bacteria

Pneumococcal Pneumonia Clinical Case MCQ

8-month boy baby is evaluated because of repeated episodes of pneumococcal pneumonia. Serum studies demonstrate very low levels of 1gM, IgG, and IgA. This is related to a deficiency of which of the following? 

A. Adenosine deaminase 
B. Class III MHC gene 
C. Gamma chain of the IL-2 receptor 
D. Tyrosine kinase

Ans.D.  Tyrosine kinase

As the history is of recurrent infections with bacteria pneumococcal pneumonia. , it indicates primary humoral immunodeficiency. As this is occurring in an 8-month old male child, it indicates X-linked agammaglobulinemia also called as Burton’s agammaglobulinemia. In this disorder there is deficiency of the enzyme tyrosine kinase, which is required for B cell maturation

True about Protooncogene

True about protooncogene: 

a. Important for normal cell growth 
b. Oncogenesis 
c. C-myc overexpression causes lymphoma 
d. Mutation causes RB 
e. Deletion cause Sickle cell disease

Ans. (A) Important for normal cell growth; (B) Oncogenesis; (D) Mutation causes RB

* Protooncogenes are important for cellular function related to growth and proliferation.

* C-Myc tranlocation causes Burkitt’s lymphoma.

* Transcription of RB causes Retioblastoma. Rb gene is a tumour supression gene, mutation of it cause Retinoblastoma (RB).