The placenta of twins | NEET Based MCQ

The placenta of twins may be

A. Dichorionic and monoamniotic in dizygotic (DZ) twins
B. Dichorionic and monoamniotic in monozygotic (MZ) twins
C. Monochorionic and monoamniotic in DZ twins
D. Dichorionic and diamniotic in MZ twins

The answer is D

Dizygotic twins of different sexes always have a dichorionic and diamniotic placenta, and monochorionic monozygotic twins are always of the same sex. The dichorionic placentas of dizygotic twins may be totally separated or intimately fused. Of monozygotic twins, 20 to 30% have dichorionic placentation, the result of separation of the blastocyst in the first 2 days after fertilization. The majority of monozygotic twins have a diamniotic and monochorionic placenta. The least common type of placentation in monozygotic twins is the monochorionic and monoamniotic placenta; its incidence is only about 1%.

Toxicity of local anesthetics | NEET Based MCQ

Which of the following statements regarding toxicity of local anesthetics is false?

A. The first signs of toxicity are dizziness, tinnitus, and nystagmus
B. Systematic convulsions are rare and usually self-limited
C. Most allergic reactions are to aminoamide compounds
D. For patients allergic to local anesthetics, diphenhydramine hydrochloride 1% can be injected into the wound.

The answer is C. Most allergic reactions are to aminoamide compounds

• Slow injections limit the chance for local anesthetic toxicity. When history of allergy is uncertain, an antihistamine such as diphenhydrarnine injected directly into the wound can be used as an alternative and achieves anesthesia in approximately 30 mm.
• True allergic reactions to local anesthetics are rare, especially to aminoamide compounds such as lidocaine and bupivicaine. The ester derivatives of paraaminobenzoic acid, such as procaine, are responsible for most local anesthetic allergic reactions.
• Toxicity should be suspected in patients who complain of dizziness, tinnitus, and periorbital tingling. Rarely, systemic convulsions follow.

• These are usually self-limited because of rapid redistribution of the drug, with resultant lower serum levels. 

Laparoscopic salpingostomy vs. laparotomy with salpingectomy | NEET Based MCQ

In comparing laparoscopic salpingostomy vs. laparotomy with salpingectomy for the treatment of ectopic pregnancy, laparoscopic therapy results in

A. Decreased hospital stays 
B. Lower fertility rate
C. Lower repeat ectopic pregnancy rate
D. Comparable persistent ectopic tissue rate

The answer is a. Conservative laparoscopic treatment of ectopic pregnancy is now commonplace, although not yet universal. With increasing sophistication of techniques and fiberoptics, many microsurgical procedures can be done through the laparoscope. Recent studies suggest that the fertility rates for laparoscopy and laparotomy are comparable, as are the implications of repeat ectopic pregnancies. Certainly laparoscopy, because of its small incision, results in fewer break- downs and shorter hospital stays, but the incidence of complications due to retained ectopic tissue is higher.

Intrauterine fetal demise | NEET Based MCQ

A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your clinic 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient isat increased risk for

A. Septic abortion 
B. recurrent abortion
C. Consumptive coagulopathy with hypofibrinogenemia
D. Ectopic pregnancies

The answer is c. In modern clinical medicine, once the diagnosis of fetal demise has been made, the products of conception are removed. If, however, the gestational age is over 14 weeks and the fetal death occurred 5 weeks ago, coagulation abnormalities may be seen. Septic abortions were more frequently seen during the era of illegal abortions, although occasionally sepsis can occur if there is incomplete evacuation of the products of conception in either a therapeutic or spontaneous abortion.

Ectopic pregnancy | NEET Based MCQ

A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?

A. Previous tubal surgery
B. Pelvic inflammatory disease (PID)
C. Use of a contraceptive uterine device (IUD)
D. Induction of ovulation

The answer is b. Any factor delaying transit of the ovum through the fallopian tube may predispose a patient to ectopic pregnancy. The major predisposing factor in the development of ectopic pregnancy is pelvic inflammatory disease. However, any operative procedure on the fallopian tubes may increase a patient’s risk. It appears that tubal sterilizations with laparoscopic fulguration have a higher rate of ectopic pregnancy than tubal ligations performed with clips or rings. Women who have had one ectopic pregnancy are at increased risk of having a second. DES exposure, induction of ovulation, and IUD use increase the possibility of ectopic pregnancy.The best choice is B PID.

Instituting single-agent chemotherapy | NEET Based MCQ

Indications for instituting single-agent chemotherapy following evacuation of a hydatidiform mole usually include

A. A rise in HCG titers
B. A plateau of HCG titers for 1 week
C. Return of HCG titer to normal at 6 weeks after evacuation
D. Appearance of liver metastasis

The answer is a. Single-agent chemotherapy is usually instituted if levels of hCG remain elevated 8 weeks after evacuation of a hydatidiform mole. Approximately 50% of the patients who have persistently high hCG titers will develop malignant sequelae. If hCG titers rise or reach a plateau for 2 to 3 successive weeks following molar evacuation, a single-agent chemotherapy should be instituted, provided that thetrophoblastic disease has not metastasized to the liver or brain. The presence of such metastases usually requires initiation of combination chemotherapy. 

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.