ACE inhibitor induced cough | PGIMER MCQs for MD MS Preparations

ACE inhibitor induced cough is mediated by. 

A. Bradykinin 
B. Substance - P 
C. Prostaglandin 
D. Serotonin 
E. Renin

Ans. A. Bradykinin ; (B) Substance—P ; (C) Prostaglandin

•About 5-20% of patients taking ACE inhibitors develop a non-productive cough. Onset is usually within 1 week of starting the drug but can be delayed up to 6 months. Mechanism is not known with certainty, but may be due to accumulation of bradykinin, substance-P, and / or prostaglandin which are degraded by ACE. 

• Treatment:Cough disappears within 4 days if stoppage. Sometime require cessation of therapy. 

• Thromboxane antagonism reduces ACE inhibitor induced cough. 

Celiac sprue diagnosis | PGIMER MCQs for MD MS Preparations

Celiac sprue is diagnosed by 

A. Intestinal biopsy 
B. Unequivocal response to gluten restriction 
C. Finding of organism 
D. Improvement on dapsome treatment 
E. H/O fat malabsorption

Ans. B. Unequivocal response to Gluten resriction :

• The diagnosis of celiac spure requires the presence of characteristic hisotpatholocic changes on small intestinal biopsy together with a prompt Clinical and histopathological response following 

the institution of gluten-free diet. 

The changes seen on duodenum/jujunal biopsy are restricted to muscosa and includes-

(i) Absence or reduced height of villi, resulting a “flat” appearance. 

(ii) Increased loss of villus cells in association with ted crypt cell proliferation resulting in crypt hyperplasia and loss of villous structure, with consequent villus but not mucosal atrophy. 

(iii) Cuboidal appearance and nuclei that are oriented basally in surface epithelial cells and increased intraepithelial lymphocytes. 

(iv) increased lymphocytes and plasma cells in the lamina propria. 

• Although histopathological features are characteristic celiac sprue but not diagnostic as similar appearance is seen in — Tropical sprue, eosinophilic enteritis, milk-protein intolerance in children and occasionally in lymphoma, bacterial over growth, Crohn’s disease and gastrinoma with acid hypersecretion. 

Pulmanary flow | PGIMER entrance Preparations

Pulmanary flow is decreased in

A. Fallot’s tetralogy
B. Ebstein’s anomaly 
C. Common atria 
D. TGV with intact septum 
E. Postoperative TGV correction

Ans. A. Fallot’s tetralogy ; (B) Ebstein’s anomaly.

• The route of blood flow in complete Transposition of great vessels (TGA) results in two separate circulation and survival depends on mixing that occur at a trial, ventricular or great vessel level. In TGA with intact septum, mixing occurs through foramen ovale and being small, the mixing is poor. Pulmonary plethora is seen. 

• In corrected TGA, route of blood flow is normal. Haemodynamics depend on associated anomalies.

• Normal or Decreased pulmonary blood flow with cyanosis is seen in

- Tricuspid atresia 

- Ebstein’s anomaly with atrial shunt 

- Pulmonary atresia with intact ventricular septum

- Pulmonic stenosis or atresia with VSD 

- Pulmonic stenosis with right to left atrial shunt

- Complete TGA with pulmonic stenosis 

- Double — out left ventricle with pulmonic stenosis 

- Single ventricle with pulmonic stenosis 

- Pulmonary AV fistula 

- Vena cava to Lt atrial communication. 

• Pulmonary blood flow increased in common artria. 

Hunterian Ligature | MCQs for AIPGMEE

The Hunterian Ligature is performed for: 

A. Varicose veins 
B. Arteriovenous fistulae 
C. Aneurysm 
D. Acute ischemia

Ans. C Aneurysm.                

Hunter's operation involves ligation of an artery in proximal side of an aneurysm above the first collateral.

Arterial ligations are suitable for splenic artery, etc where adequate facilities for sophisticated surgery is not available. 

Most common posterior Mediastinal tumor | MCQs for AIPGMEE

Most common posterior mediastinal tumor is: 

A. Neurofibroma 

B. Teratoma 
C. Lymphoma 
D. Bronchogenic cyst

Ans. A. Neurofibroma

Mediastinal masses

Ant. mediastinum Anterosuperior.  -Thymoma MC in ant. Mediastinum.  - Lymphoma - Teratoma - Stem cell tumor - Thyroid - Parathyroid -Lipoma - Hernia Hiatal, Morgagni.  - Retrosternal goitre

Middle mediastinum Visceral mediastinum.  - Cyst MC in middle.  - Bronchogenic - Enterogenous cyst - Pleuropericardial cyst - Myxoma - Oesophageal lesion - Lymphoma - Aneurysm - Lipoma

Post mediastinum Paravertebral sulci.  - Neurogenic tumor MC overall.  - Lymphoma - Metastatic germ cell tumor - Enterogenous cyst - Meningocele - Mesenchymal tumor

Feature of Stauffer syndrome | MCQs for AIPGMEE

Which of the following is not a feature of Stauffer syndrome? 

A. Erythrocytosis 

B. Hypercalcemia 
C. Metastatic hepatic dysfunction 
D. Dysfibrinogenemia

Correct Ans. C. Metastatic hepatic dysfunction

A spectrum of paraneoplastic syndromes has been associated with these malignancies, including erythrocytosis, hypercalcemia, nonmetastatic hepatic dysfunction Stauffer syndrome. , and acquired dysfibrinogenemia.

Stauffer syndrome is a constellation of signs and symptoms of liver dysfunction that arise due to presence of renal cell carcinoma but are not due to tumour infiltration into the liver and/or intrinsic liver disease; it is a paraneoplastic syndrome.

It leads to elevated liver function tests, which results from cholestasis, i.e. a cessation of bile flow. The symptoms resolve if the renal cell cancer is successfully treated. 

Viral infection with haemolysis | PGIMER MCQs for MD MS Preparations

Viral infection with haemolysis is seen in 

A. Hepatitis-B 
B. Hepatitis-C 
C. Prolonged fever 
D. Hepatitis-A 
E. CMV

Ans. A. Hepatitis B virus ;(D) Hepatitis A virus ; (E) CMV

• Organisms causing hemolytic anemia 

(i) Viral: CMV, Coxsackie virus, EBV, Hepatitis A virus. Hepatitis B virus, Influenza virus, HSV, HIV, parvovirus B19, Mumps virus, Rubella virus, Rubeola virus and varicella virus.

(ii) Bacterial: Clostridium welchii, Bartonella, Mycoplasma, H-influenzae, E. coli, ampylobacter. salmonella, shigella streptococcus etc. 

(iii) Parastic: Malaria, babesia, toxoplasma, trypanosoma. 

(iv) Fungal : Aspergillus. 

• Hepatitis-C is associated with aplastic anaemia. 

Pseudohypoparathyrodism | PGI entrance Preparations

Which of the following is/are true about pseudohypoparathyrodism?

A. Heterotopic calcification 

B. ↓ed Ca2’ 
C. ↓edPO 
D. ↓ed PTH 
E. ↓ed response of urinary cAMP on PT

Ans. A. Heterotopic calcification ; (D) ↓ed PTH 

Pseudohypoparathyridism is a hereditary disorder characterised by symptoms and signs of hypoparathyroidism, typically in association with distinctive skeletal and developmental defects. The hypoparathyrodism is due to deficiency of endorgan response to PTH. Hyperplasia of parathyroids, in response to hormone resistance, causes elevation of PTH levels. There are hypocalcemia, hyperphosphaemia, heterotropic calcfication and skeletal abnormalities. 

— Defects in metatarsals and metacarpals with sometimes short phalanges. 

— Typically short 4th and 5th metacarpals and metatarsals bilaterally. 

— Exostoses and radius curvtis.

—Impaired olfaction and taste and unusual dermatoglyphic abnormalities

Conn’s syndrome | PGI Frequently Asked MCQ Topics

True about conn’s syndrome 

A. ↑K 
B. ↓K 
C. Proximal myopathy 
D. ↑ed plasma renin activity 
E. Edema

Ans. B. ↓K+ ;(C) Proximal myopathy: 

• Conn’s syndrome is primary hyperaldosteronism characterised by 

— Diastolic hypertension without edema. 

— Hypokalemia and metabolic alkalosis. 

— Hyposecretion of renin (i.e. low plasma renin activity). 

— Hypernatremia. 

— Proximal myopathy due to hypokalemia. 

— Hypomagnesemia.

— Polyuria, polydipsia.

— Renal failure (15%), Proteinuria (50%). 

— Elevated plasma and urine aldosterone levels. 

Sensory motor neuropathy | PGI entrance Preparations

Sensory motor neuropathy is caused by 

A. DM 
B. Lead poisoning 
C. Arsenic 
D. Leprosy 
E. AIDS

Ans. A. DM ;(C) Aresenic  (D) Leprosy ; (E) AIDS

PERIPHERAL NEUROPATHY

• Lead
• Dapsone
• Amyotrophic lateral Sclerosis
• Polyomyelitis
• Herediatary spinal muscular dystrophy
• Adult variant of hexoaminidase A deficiency
• Porphyria (occasional)
• Multifocal motor neuropathy
• Lambert-Eaton myasthetic syndrome
• Tick bite paralysis
• Other toxic neuromuscular blockade

SENSORIMOTOR (SM)

• Diabetes
• Uremia
• Alcohol
• Arsenic
• Diptheria toxin
• Organophosphates
• Thallium
• y-Diketone hexacarbon
• Acrylamide (S > M)
• AIDS (S >> M)
• Leprosy
• Lyme disease (S > M)
• PAN, RA
• Cryoglobulinemia
• Malignancy
• IBS
• Hereditary SM neuropathies
— Chacot-Tooth-Marie disease
— Dejerine sottas disease
— Refsum’s disease
— Friedreich’s ataxia (S > M)

SENSORY (S)
• Cisplatin
• Toxol
• Pyridoxine
• Vit B12 deficiency
• Paraneoplastic
• Sjogren’s syn.
• Dysproteinemia (1 gm)
• Idiopathic acute sensory neuro.and chronic SN.
• Herediatory neuropathies
• Hypothyroidism
• Acromegally
• Polycythemia vera

Herpes simplex encephalitis | PGI entrance Preparations

Herpes simplex encephalitis is diagnosed by 

A. MRI 
B. Biopsy 
C. Cornealscrapping and culture 
D. EEG periodic lateralised 
E. CSF PCR of HSV DNA

Ans. E. CSF PCR for HSV DNA : 

• HSV DNA polymerase chain reaction (PCR) in CSF is a rapid and sensitive and specific tool for early diagnosis and rapidly replacing brain biopsy as the diagnostic standard. 

According to Harrison it is the diagnostic procedure of choice with sensitivity (98%) and specificity (94%), equal or exceed brain biopsy. PCR results are not generally affected  with1 wk of antiviral therapy. 

• Brain biopsy:The isolation of HSV from brain tissue obtained at biopsy was once “gold standard” for diagnosis of HSV encephalitis although with advent of CSF PCR tests for HSV,itis no longer necessary to perform biopsy. Tissue is cultured for virus and examined histopathologically and ultrastructurally. 

•MRI, CT, ECG: Less sensitive than HSV DNA PCR. Approx 10% and 33% of PCR documented cases have normal MRI and CT respectively. CT is less sensitive than MRI. EEG abnormalities occur in >90% of PCR documented cases. HSV encephalitis show focal findings 

(i) Areas of increased signal intensity in frontotemporal, cingulate or insular regions of brain on T2 weighted spino-echo MRI images. 

(ii) Temporoparietal areas of low absorption, mass effect and contrast enhancement on CT. 

(iii) Periodic focal temporal lobe spikes on a back ground of slow or low amplitude activity (flattened) on LEG. BEG finding is non specific. 

• CSF shows lymphocytic pleocytosis, mildly elevated protein, normal glucose, CSF culture for HSV-I encephalitis is invariably negative. 

• Serologic studies and antibodies detection : CSF HSV antibodies and antigen detection are done after 1 week of illness and who are CSF FCR negative for HSV. They are of limited value in 1st week of illness. 

Carbon dioxide retention MCQ | PGI MCQs for MD MS Preparations

Carbon dioxide retention is seen in the following condition 

A. Carbon monoxide poisoning 
B. Lung failure 
C. Drowning 
D. Ventilatory failure 
E. Highaltitude

Ans. B. Lung failure; (C) Drowning; (D) Ventilatory failure:

• Retention of CO2 in the body (hypercapnia) caused by hypoventilation or circulatory deficiency. 

• In Lung failure due to parenchymal causes (e.g. Fibrosis, poor diffusion through the pulmonary membrane or through the tissues); serious hypercapnia usually doesn’t occur because CO2 diffuses 20 times as rapidly as 0₂. If hypercapnia begins to occur, this stimulates pulmonary ventilation which corrects the hypercapnia. 

• Hypercarbia associated with apnea or hypoventilation is less often documented than hypoxia in drowning. 

• In CO-poisoning, there is variable PCO2 

• Hypercapnia is not concomitant when too little 02 in the air, too little Hb, or poisoning of oxidative enzymes 

• In high altitude due to hypoxic stimulation —hyperventilation occurs resulting in fall of PaCO2 

Glutathione reductase | PGI MCQs for MD MS Preparations

True about Glutathione reductase 

A. Sulphur containing enzyme 
B. Important in methemoglobinemia 
C. Free radical scavenger 
D. All 
E. None

Ans. C. Free radical scavenger 

• Glutathione reductase, a flavo protein enzyme containing FAD catalyzes oxidised glutathione to reduced glutathione. This brings reduction of H2O2.

Superior vena cava obstruction | PGI MCQs for MD MS Preparations

In superior vena cava obstruction following are true.

A. Dyspnea 

B. Palpitation 

C. Oedema of the head and neck 

D. Enlarged dilated veins on anterior chest wall 

E. ↑ed JVP

Ans. A. Dyspnea (C) Oedema of head and neck; (D) Enlarged dilated veins on anterior chest; (E) ↑ed JVP: 

• Symptoms of superior vena cava syndrome (SVCS) : Swelling of face and neck, dyspnea, and cough, hoarseness, tongue swelling, headaches, nasal ongestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope and lethargy, visual disturbances, stupor, 

• Signs of SVCS : Non-pulsatile distension of neck veins, oedema and cyanosis of head, neck, hands and arms, dilated anastomatic veins on ant. chest wall. In more severe cases proptosis, glossal and laryngeal edema, and obtundation. 

• CXR : Superior mediastinal widening, most commonly on right side. 

Note : Causes of SVCS:

— Malignancy (90%) like lung cancer (particularly small cell and squamous cell carcinoma accounts 85% of all malignancies), lymphoma and metastatic tumours. 

— Benign lesions: Chronic fibrotic mediastihum (e.g. T.B. histoplasmosis, pyogenic infections, drugs), thrombophlebitis, aneurysm of aortic arch, constrictive pericarditis. 

• Rx of SVCS : Radiation therapy is primary Rx for SVCS caused by Ca Lung.

Levosulpiride acting as antagonist | Medical PG MCQs

Levosulpiride acts as antagonist of which central dopamine receptor?

A. D2 

B. 03 

C. 04 

D. All of the above

Ans. D. All of the above

A substituted benzamide anti-psychotic, reported to be a selective antagonist of central dopamine D-2, D-3 and D-4.  receptors, Levosulpiride is also claimed to have mood elevating properties. Levosulpiride is used in the treatment of psychoses, particularly negative symptoms of schizophrenia, anxiety disorders, dysthymia, vertigo, dyspepsia, irritable bowel syndrome and premature ejaculation.

In a dose range of 50-200 mg/day, Levosulpiride is therapeutic for negative and cognitive symptoms of schizophrenia, and for depressive and somatoform disorders 

LATEST focus - high yield/...important from upcoming point of view.. DNB, AIPG, NEET

Mid Day Meal Scheme

MDM scheme or program:

under MHRD - department of school education and litracy. GOI

With a view to enhancing enrolment, retention and attendance and simultaneously improving nutritional levels among c

hildren, the National Programme of Nutritional Support to Primary Education (NP-NSPE) was launched as a Centrally Sponsored Scheme on 15th August 1995.

In 2001 MDMS became a cooked Mid Day Meal Scheme under which every child in every Government and Government aided primary school was to be served a prepared Mid Day Meal with a minimum content of 300 calories of energy and 8-12 gram protein per day for a minimum of 200 days. The Scheme was further extended in 2002 to cover not only children studying in Government, Government aided and local body schools, but also children studying in Education Guarantee Scheme (EGS) and Alternative & Innovative Education (AIE) centres.

The concept is evolved from the idea of a group of children sitting together in a circle and having their meal served hot. Equal importance is given to boys and girls with communal harmony. Orange colour is used for the food plate to represent it as hot and fresh food. It also symbolizes energy, heat and sun. At the bottom of the image a picture of a book is used to bring in the relation of education and mid-day meal program. Overall form also represents the shape of a flower as a symbol of childhood, happiness, healthiness, progress and well being of the future generation. The logo is visually balanced using the form of children, book and logo text in Hindi and in English.

Anatomy high yields NIME

Anatomy high yield: FACE development

• FRONTONASAL PROCESS: Forms Nasal Processes and Globular Processes.
• PAIRED MAXILLARY PROCESSES: Grows toward the midline to meet each other.
• PAIRED MANDIBULAR PROCESSES: Grows toward the midline to meet each other.
• Process:
• First, Olfactory Pits form in the Frontal Process.
• The Frontal Processes then grow around these pits, forming the following:
2 Lateral Nasal Processes -- Forms the lateral ala of nose.
1 Medial Nasal Process -- Forms philtrum.
2 Globular Processes, on the end of the Lateral Nasal Processes. They fuse together to form the premaxilla.
• CLEFT LIP: Failure to join of the Maxillary Process and Globular Process. Could be on the same side or bilateral.
• CLEFT PALATE: An opening between the nasal and oral cavities, caused by a failure of the maxillary shelves to come together and fuse.
• BRANCHIAL FISTULA: Failure of the Branchial clefts to disappear. The cleft stays completely open. They are located on the side of the neck.
• BRANCHIAL SINUS: Incomplete breakdown of the branchial clefts. The cleft is partially open, either to the inside or outside. They are located on the side of the neck.
• FIRST ARCH SYNDROMES: Rare syndromes involving the first arch. Due to middle ear ossicles, these syndromes lead to deafness

True about Isoenzymes | PGI MCQs for MD MS Preparations

True about isoenzymes is/are 

A. Different km value 
B. Act on different substrate 
C. Consist of multimeric complex 
D. Same electrophoretic mobility 
E. Have different physical properties

Ans. A. different km value; (C) Consist of multimeric complexes; (E)Have different physical properties

Isoenzymes are distinct enzyme forms that catalyze same reaction It exists in the same organism in several molecular forms 

— Most of the isoenzymes are enzymes that catalyse the same reaction but differ in their physical properties because of genetically determined differences in amino acid sequence. 

— They have different Km value. 

— Isoenzyme of an oligomeric enzyme process different combination of its peptide protomer.

True about nitric oxide | PGI MCQs for MD MS Preparations

True about nitric oxide 

A. Free radical 
B. Vasodilator 
C. Oxidizing agent 
D. Catalyst 
E. Platelet aggregator

Ans. A. Free radical ; (B) Vasodilator ; (C) Oxidizing agent ; (D) Catalyst 

• Nitric oxide is a gas synthesized by endothelial cells previously known as endothelium derived relaxing Factor (EDRF), causes vasodilatation. It stimulates guanyl cyclase.

- NO has very short half life (3-4 sec.) as in tissues it reacts with oxygen and superoxide producing peroxynitrite which decomposes to form highly reactive OH radical. 

Carbohydrate moiety Components | PGI MCQs for MD MS Preparations

Which important component of cell wall has carbohydrate moiety 

A. Phosphoglyceride 

B. Triacylglycerol 
C. Sphingomyelin 
D. Cholesterol 
E. GM2 Gangliosides

Ans. E. GM2 Gangliosides :
• The major lipids in mammalian membranes are
— Phospholipids
— Glycosphingolipids
— Cholesterol
• Among these, lipid with carbohydrate component is glycosphingolipids. They are
—Cerebrosides
—Gangliosides
• Phosphoglycerides = Glycerol + Fatty acids + Phosphate + Nitrogenous or Non- Nitrogenous group (choline, ethanolamine, serine and inositol)
• Sphingomyelin fatty acid sphingosine + phosphate - Nitrogenous group

Hunter’s syndrome | Medical PG MCQs

Products accumulated in Hunter’s syndrome are: 

A. Keratan sulfate 
B. Dermatan sulfate 
C. Chondroitin sulfate 
D. Heparan sulfate 
E. Hyaluronic acid

Ans. B. Dermatan sulfate ; (D) Heparan sulfate

• In Hunter syndrome the accumulated metabolites are
—Dermatan sulfate
— Heparan sulfate
• Hunter’s syndrome is X-linked recessive disorder.
• Other mucopolysaccharidoses:-

Type	Syndrome	Enzyme to defect	Accumulated Metabolite
I	Hurler or scheie	Iduronidase	Dermation sulfate Heparan sulfate
II	Hunter	Iduronate sulfatase	—
IIIA	Sandfilippo A	Heparan-N-sulfatase	Heparan sulfatase
IIIB	SandfilippoB	N-Acetylglucosaminidase	Heparan sulfatase
IV	Morquio	N-Acetyl galactosamine 6-sulfatase	Keratan sulfatase
VI	Maroteaux-Lamy	N-Acetyl galacto samine 4-sulfatase	Dermatan sulfatase
VII	Sly	3-Glucuronidase	Dermatan sulfatase; Heparan sulfatase

Pneumocystis carinii pneumonia | Medical PG MCQs

All are true about pneumocystis carinii pneumonia except? 

A. First line treatment should be with intravenous pentamidine

B. CXR may be normal 
C. Severe hypoxemia is common 
D. Pleural effusion is uncommon

Ans. A. First line treatment should be with

Pneumocystis carinii pneumonia often presents with severe dyspnoea, dry cough, pyrexia and hypoxia. Chest X-ray may be normal in 10% but typically shows diffuse bilateral perihilar shadowing. Pleural effusion and lymphadenopathy is uncommon. Silver staining of the Pneumocystis organism now a fungus.  is positive in over 90% of patients on lavage or induced sputum specimens. Arterial p02 and transfer factor are decreased. Treatment of choice is cotrimoxazole but Periamidine may be given instead intravenous or nebulised. . Mortality following first episode of Pneumocystis carinii pneumonia is less than 10% and secondary prophylaxis should be given nebulisedpentamidine, cotrimoxazole, dapsone or pyrimethamine. . Tuberculosis and severe bacterial infection are commoner causes of opportunistic infection in HIV-positive Africans with AIDS. 

Most common factor in postoperative renal failure | Medical PG MCQs

Most common factor in postoperative renal failure is

A. Postoperative hypovolemia
B. Use of nephritic anesthetic drugs
C. Hemolysis following massive blood transfusion 
D. Associated post-renal obstruction preoperatively

ANS. A.  Postoperative hypovolemia. 

There are three categories of ARF

Pre-renal ARF 5 5%.  due to renal hypoperfusion without compromising the integrity of renal parenchyma.

Intrinsic renal ARF 40%.  disease that directly involves renal parenchyma.

Post-renal 5%.  disease associated with urinary tract obstruction.

Prerenal ARF most common form of ARF and represents a physiologic response to mild to moderate renal hyperperfusion. 

Intrinsic renal ARF due to ischemia is likely to occur following severe renal hypoperfusion complicating hypovolemic or septic shock or following major surgery.

ARF due to hemolysis is relatively rare and is observed following massive blood transfusion reactions.

Best measure of Airflow Obstruction | Medical PG MCQs

Which one of the following is the best measure of airflow obstruction? 

A. Diffusing capacity DLCO. 

B. Residual volume RV. 
C. 1-Second forced expiratory volume FEV1. 
D. 1- FEV1/FVC ratio

Ans. D. 1- FEV1/FVC ratio

A decrease in the 1-second forced expiratory volume—forced vital capacity FEV1/ FVC.  ratio is the hallmark of airflow obstruction The FEV1 is the volume of air forcefully expired during the first second after a maximal inhalation; the FVC is the total volume of air that can be forcibly expelled from the lungs after a maximal inhalation. The FEy1 is decrease obstructive as well as restrictive lung disease capacity DLCO.  and the residual volume RV.  do not identify airway obstruction. The DLCO indicates the adequacy of the alveolar—capillary membrane; the RV is the volume of air remaining in the lungs after a maximal expiratory effort.