Differential diagnosis of microangiopathic anemia

What are the differential diagnosis of microangiopathic anemia: 

a. Sepsis 
b. Hemolytic uremic syndrome 
c. MI 
d. Eclampsia 
e. Scleroderma

Ans. is a, b and d i.e. Sepsis; Hemolytic uremic syndrome; and Eclampsia

• Microangiopathic hemolytic anemia is characterized by mechanical damage and fragmentation of RBC as they traverse through abnormal circulation which is most commonly caused by widespread fibrin deposition in small vessels.
• Causes of microangiopathic hemolytic anemia:

— Disseminated intravascular coagulation (DIC) — Thrombotic thrombocytopenic purpura (HP)

— Hemolytic—uremic syndrome (HUS) — Eclampsia (HELLP syndrome)

— Disseminated cancer — Malignant hypertension

— Renal allograft rejection — Vasculitis of all types

• Note that trauma and hemolysis of RBC by prosthetic valves comes under “microvascular traumatic hemolysis” not microangiopathic hemolysis, although the consequences (i.e., fragmented RBC) are the same. 

Vasculitis

Vasculitis is seen in: 

a. Burger’s disease 
b.HSP 
c. Gout 
d. Reiteres disease - 
e Behcets syndrome

Ans. is a, b and c i.e. Buerger’s disease; Henoch-schonlein purpura; and Behcet’s syndrome

Primary vasculitis syndromes                               Secondary vasculitis syndrome 1

• Polyarteritis nodosa —                                          • Drug-induced vasculitis

• Churg strauss syndrome                                        • Serum sickness

• Microscopic polyangitis                                        • Vasculitis associated with other primary diseases

• Wegeners granulomatosis                                                              — Infections

• Giant - cell arteritis                                                                           — Malignancy

• Takayasus arteritis                                                                            — Rheumatic disease

• Henoch-Schonloin purpura

• Burgers disease

• Behcets syndrome

• Kawasaki disease

• Idiopathic cutaneous vasculitis

• Cryoglobulinemia - essential mixed

• Cogans syndrome

• Isolated vasculitis of CNS 

Socratic method of communication

Which of the following is the Socratic method of communication

A. One way communication 

B. Two way communication 
C. Visual communication 
D. Non-verbal communication

Ans. B. Two way communication

Socratic Method is a two-way communication in which both the communicator and audience take part.

Didactic Method is a one-way communication which is flow of information from communicator to audience, without the active participation of the later.

Types of communications

One-way communication; Two-way communication; Verbal communication 

Common feature of both vitamin K and vitamin C

Which of the following is a common feature of both vitamin K and vitamin C? 

A. The synthesis of clotting factors

B. Posttranslational modifications
C. Antioxidant mechanisms
D. The microsomal hydroxylation reactions

Ans. B.  Posttranslational modification.  

Vitamin C is required in the hydroxylation of proline and lysine in collagen biosynthesis. Vitamin C is helpful in the posttranslational modification in procollagen. Vitamin K is required in clotting factor biosynthesis in the posttranslational modification of glutamate residue. 

- Clotting factor biosynthesis is the function of vitamin K, not of vitamin C. 

- Vitamin C is an antioxidant other includes vitamin A and E. , while this property is not shown by vitamin K.

Changes of Ca2+ Concentration

A small Ca2 binding protein that modifies the activity of many enzymes and other proteins in response to changes of Ca2+ concentration is called as 

A. Cyclin 
B. Calmodulin
C. Collagen 
D. Kinesin

Ans. B. Calmodulin.  

It is a calcium-dependent regulatory protein. it has four Ca2-binding sites. If all the sites are fully occupied, Ca2+ sites allow calmodulin to activate the ion channels and enzymes. Calmodulin is involved in regulation of a number of kinases and enzymes.

Skeletal Muscles Enzymes

Which of the following enzyme is not present in the skeletal muscles? 

A. Creatinine phosphokinase 
B. Hexokinase 
C. Phosphofructokinase 
D. Glucose-6-phosphatase

Ans. D. Glucose-6-phosphatase. 
Glucose-6-phosphatase enzyme is not present in the skeletal muscles; therefore, the end product ofgluconeogenesis in skeleton muscles is glucose-6-phosphate, not glucose.
Key enzymes of gluconeogenesis are:-
•Glucose-6-phosphatase.
• Fructose 1, 6—biphosphatase.
• Phosphoenolpyruvate carboxykinase.
• Pyruvate carboxylase.
All the four enzymes are present in liver and kidney only

CAD Predisposing Factors

CAD prédisposing factors: 

a. Homocysteinemia 
b↑ Lipoprotein B 
c↑ Fibrinogen
d↑ HDL 
e↑ plasminogen activator inhibitor-1

Ans. is a, c and e i.e. Homocysteinemla; ↑ fibrinogen and ↑ Plasminogen activator inhibitor-1 Coronary artery disease which implies atherosclerosis of the epicardial coronary arteries is the most common cause of myocardial ischemia.
Predisposing factors of Coronary artery disease

• Hypertension (BP> 140/90mm Hg; >5 fold 1’ risk with BP> 170/95mm Hg)

• Infections (Chlamydia pneumonia, Cytomegalovirus, Herpes).

• Low HDL cholesterol (or low Lipoprotein A, HDL <40mg/dl)

• Increasing age (men > 45yrs; women >55 years).

• High LDL cholesterol (or high Lipoprotein B)

• Cigarette smoking                                             • Diabetes mellitus

• Alcohol intake                                                   • Lipoprotein (a)

• Homocysteinemia                                             •  ↑ fibtinogen levels

• .↓ ↓ - plasmin levels                                      • ↑ ↑ pIasmnogen activator inhibitor-1

• Male gender                                                      • Family history

• Obesity (BMI > 30kg/rn2)                               • Physical inactivity

• Stress (type A personality)                              • Inflammation

Micro Nutrients Hand Written Notes

 Hand Written Notes

Child with expansion of erythroid marrow

A 9-month-old boy presented to you with complaints of progressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb —4.5 mg%; MCV —58 ; MCH - 20.

Peripheral blood smear shows target cells and normoblasts, with normal osmotic fragility. Xray skull shows expansion of erythroid marrow. Most probable diagnosis of this patient is 

A. Iron deficiency anemia 
B. Chronic Siderosis
C. Hemoglobin D disease 
D. Hereditary spherocytosis

Ans. A. Iron deficiency anemia. 
In iron deficiency anemia:
• RBC’s becomes smaller microcytosis.  than normal and their Hb content is decreased hypochromia. .
• Bone marrow is hypercellular, with erythroid hyperplasia.
• Normoblasts may have scanty, fragmented cytoplasm with poor hemoglobination. Osmotic fragility will be normal.
• Peripheral blood film will show poikilocytosis, increased RBC distribution, nucleated RBC, normal WBC and sometimes thrombocytosis.
In ALL: There will be leukocytosis with leukoblasts lymphoblasts. .
Hb D disease: It will behave as thalassemia. It is generally asymptomatic or there is only mild anemia and persons lead a normal life.
Hereditary spherocytosis: It will have normal MCV, RBC’s shows spherocytes, reticulocytes osmotic fragility is exaggerated. 

Muscle Relaxant of Depolarizing

One of the following muscle relaxant is depolarizing type: 

A. Inj. Pancuronium 
B. Inj. Tubocurarine 
C. Inj. Vecuronium 
D. Inj. Suxamethonium

Ans. D.  Inj Suxamethonium.

Important about Succinyl choline: 

• Succinylcholine is a depolarizing MR. 

• Succinylcholine causes Hyperkalemia 

• Succinylcholine causes muscle pain 

• Succinyleholine increases Intraocular pressure 

• Succinyicholine increases intragastric pressure 

• Succinylcholine increases Intracranial pressure 

• Succinylcholine triggers Malignant Hyperthermia 

• Succinyicholine causes vagal stimulation 

• Succinylcholine is the shortest acting MR 

• Succinylcholine causes dual-biphasic block 

Succinylcholine has shortest duration of action due to rapid hydrolysis by PSEUDOCHOLINESTERASE. 

PGIMER MCQs for MD MS Preparations | Argyll-Robertson pupil

True about Argyll-Robertson pupil 

a. Near reflex present 
b. Seen in tertiary syphilis 
c. Seen in Diabetes Mellitus 
d. Pupil is small in size 
e. Pupil constrict to near object & not to light

Ans. (A) Near reflex present; (B) Seen in tertiary Syphilis, (C) Seen in Diabetes Mellitus; (D) Pupil is small in size. E. Pupil constrict to near object & not to light

“Argyll- Robertson pupil (ARP) — Accommodation reflex is preserved’

The essential features of A.R. Pupil:

- Bilaterally symmetric

- Meiosis

- Poor dilation in darkness.

- Absence or marked impairment of light reflex.

- Relative preservation of near response (light-near dissociation)

- Pupil may be irregular due to iris damage and shows impaired dilation to mydratic drugs

• Pseudo Argyll -Robertson Pupil is seen in aberrant degeneration of 3rd nerve 

PGIMER entrance Preparations | Hemoprosthetic group

Hemoprosthetic group is found in 

a. Myoglobin 
b. Cytochrome oxidase 
c. Xanthine oxidase 
d. Tyrosine 
e. Glutathione reductase

Ans: (A) Myoglobin; (B) Cytochrome oxidase;

Hemoproteins are

• Hemoglobin

• Myoglobin

Cytochrome oxidase is a Hemoproteins widely distributed in different tissues.

• Xanthine oxidase is a flavoprotein contains molybdenum and plays an important role in conversion of Purine bases to uric acid.

PGIMER Frequently Asked MCQ Topics | polymorphism

True about polymorphism is 

a. Single locus - multiple normal alleles 
b. Single locus - multiple abnormal alleles 
c. Single phenotype - Single locus - multiple abnormal alleles 
d. Single phenotype: Single locus-multiple normal alleles. 
e. Multiple loci--- multiple alleles

Ans. (D) Single phenotype, single locus, multiple normal allele

Polymorphisms are normal variation in DNA sequence that have frequency of at least 1%. Usually, they don’t result in a perceptible phenotype i.e. phenotype same.

• They constitute:

- Single base-pair substitution (often) Deletions ‘and insertions 

PGIMER Frequently Asked Medical PG topics | Formation of d-TMP from d-UMP

What is involved in Formation of d-TMP from d-UMP? 

a. N5, N10- methylene tetra hydrofolate 

b. Form imino folate 
c. N5 formyl folate 
d. Dihydro folate 
e. Cyanocobalamin and tetrahydrofolate

Ans. (A) N5, N10, Methylenetetrahydrofolate

Thymidylate synthetase is the enzyme used to generate thymidine monophosphate (dTMP), which is subsequently phosphorylated to thymidine triphosphate for use in DNA synthesis and repair.

5,10-methylenetetrahydrofolate + dUMP  dihydrofolate + dTMP

PGIMER Frequently Asked MCQ Topics | Marker for Cell Membrane

What is marker for cell membrane? 

a. 5’ nucleotidase 
b. LDH 
c. galactosyl transferase 
d. Glutamate dehydrogenase
e. G-6-phosphatase

Ans. (A) 5’—Nucleotidase

Enzymatic markers of different membranes:

Membrane	Enzymes
Plasma	5 ‘—Nucleotidase, Adenylcyclase, Na- K ATPase
Endoplasmic reticulum	Glucose — 6 Phosphatase
Gologi apparatus Cis Medial Trans	Glc NAc transferase I Golgi Mannosidase II Galatosyl transferase Sialyl transferase
Inner mitochondrial membrane	ATP synthase

Punjab PG MCQ Topic | Infections caused by coagulase positive staphylococcus

Infections caused by coagulase positive staphylococcus are A/E

a. Wound sepsis 

b. TSS
c. Food poisoning 
d. AGN

Correct Ans D

Toxxins elabcrated by staphylococcus aureus are TSS toxin, exfoliative toxin causing staphylococcus scalded skin  syndrome lipases allow colony to colorise in fat rich areas. Panton valentine leucocidin is cytolytic to polymorphonyclear cells coagulase negative staphylococcus causes would infection, UTI and infective endocardites. 

Punjab PG MCQ Topic | Factors for LASIK surgery

A lady wants LASIK surgery for her 15 year old daughter. She asks for your opinion. Which of the following is not suitable for performing LASIK surgery

A. Myopia of 4 D 
B. Age of 15 years
C. Stable refraction for 1 year 
D. Corneal thickness of 600 microns

Ans. B. Age of 15 years. 

• Choice a.  myopia of 1—20 D can be operated,

• Choice b. —most suitable age is >18 years,

• Choice c. --re fraction must be stable for 18 months, and

• Choice d. —corneal thickness of >500 micron is suitable

Medical PG Coaching MCQs | feature of Diabetic Retinopathy on Fundus examination

Not a feature of diabetic retinopathy on fundus examination? 

A. Microaneurysms 

B. Retinal hemorrhages
C. Arteriolar dilatation 
D. Neovascularization

Ans. C. Arteriolar dilatation.  

Ophthalmoscopically in: 

• Background diabetic retinopathy,isseendotand blot hemorrhage, microaneurysm white or yellow exudates. 

• Diabetic maculopathy—macular edema, central hard exudates, both are seen when the leakage of dilated capillaries ischemia is present.

State Medical PG Entrance | Retinitis Pigmentosa

Which of the following is not true about retinitis pigmentosa? 

A. Genetic inheritance X-linked. 

B. Early diagnosis and treatment prevents progression
C. Visual acuity not diminished till late in course
D. Associated with systemic abnormalities

Ans. B. Early diagnosis and treatment prevents progression.  

Explanation: Retinitis pigmentosa AD/AR.XR. It is associated with Laurence—Moon--Biedel syndrome and Refsum’s syndrome, etc. Till late there is tubular vision present. It is a genetically inheritable disease vitamin A and E are given to further progression

Punjab PG MCQ Topic | Millard-Gubler syndrome

In Millard-Gubler syndrome, which of the following is Not involved

A. 6th CN 
B. 7th CN
C. 5th N 
D. Contralateral hemiplegia

Ans. C. 5th CN.  Millard-Gubler syndrome

Lesion is in the lower part of the pons ventral pontine injury. .

• Features

o Ipsilateral lateral rectus 6th nerve.  palsy

o Ipsilateral Horner’s syndrome

o Ipsilateral deafness 8th nerve. 

o Ipsilateral facial palsy 7th nerve. 

o Contra lateral hemiplegia 

PGIMER Frequently Asked MCQ Topics | skeletal muscle relaxants undergo Hoffman’s elimination

Which of the following skeletal muscle relaxants undergo Hoffman’s elimination? 

a. Atracurium 
b. Cis-atracurium 
c. Mivacurium 
d. Vecuronium 
e. rocuronium

Ans. (A) Atracurium; (B) Cis-atracurium;

• Atracurium is a non-depolarizing muscle relaxant. Its unique feature is that it undergoes spontaneous non-enzymatic degradation (Hoffman elimination) in addition to degradation by plasma cholinesterase. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation.

Cisatracurium: It is a R-cis, enantiomer of atracurium. It also undergoes spontaneous Hofman elimination, but  unlike atracurium it is not metabolized by plasma cholinesterase. It is 4 times more potent than atracurium, slow onset and similar duration of action.

•Mivacariam— Metabolized by plasma cholinesterase. 

PGIMER Frequently Asked Medical PG topic | Halothane

True about Halothane 

a. Non-irritant 
b. Antiarrhythmic 
c. It antagonises bronchospasm 
c. Vasodilator 

e. Non explosive

Ans. (A) Non irritant ; (C) It antagonizes bronchospasm ; ((D) Vasodilator E. Non explosive

• Halothane is a colousless, relatively non-irritant vapour. It is non-flammable non-explosive when mixed with 02 in any concentrations used clinically. Effects on organs CVS : - Myocardial depression, fall of arterial pressure. Vasodilatation, dilates coronary arteries

- Bradycardia.

- tmyocardial excitability, ventricular extrasystoles.

- Arrythmia after LV. infusion of Adrenaline > 10 micro g/min. 

PGIMER entrance Preparations | Properties of Helium

Properties of Helium 

a. Atomic no 2 

b. Viscosity is zero. 

c. Used in COPD 

d. used in gas chromatography

e. is heavier than air

Ans. (A) Atomic no 2; (B) Viscosity is zero; (C) Used in COPD (D). used in gas chromatography

• Helium is one of the noble gas with the atomic number of 2. It has monatomic molecules, and is the lightest of all gases except hydrogen.

• it has no freezing point, and its viscosity is apparently zero; it passes readily through minute cracks and pores and will even creep up the sides and over the lip of a container.

• Helium is the second most abundant element in the universe, after hydrogen; however, it is rare on Earth, primarily found mixed with natural gas trapped in underground pockets.

Uses:

• Because it is noncombustible, helium is preferred to hydrogen as the lifting gas in lighter-than- air balloons.
• Used in inert gas arc welding for light metals such as aluminum and magnesium alloys that might otherwise oxidize; the helium protects heated parts from attack by air.

•Used in place of nitrogen as part of the synthetic atmosphere breathed by deep-sea divers (SCUBA), caisson workers, and others, because it reduces susceptibility to the bends.

• Helium with Oxygen (HELIOX) used in medicine to relieve sufferers of respiratory difficulties because helium moves more easily than nitrogen through constricted respiratory passages as in COPD & bronchial asthma.

• In Surgery, beams of ionized helium from synchrocyclotron sources are proving useful in treating eye tumors, by stabilizing or even shrinking the tumors. Such beams are also used to shrink blood-vessel malformations in the brains of patients.

• Helium can be inhaled and visually detected via MRI, which produces high-contrast images of the body’s soft tissues. The use of helium is a departure from traditional MRI, which typically distinguishes body tissues from one another by tracking differences in water content. 

PGIMER entrance Preparations | Nerves supply Scalp

Which nerves supply scalp? 

a. Infratrochlear 
b. Zygomaticotemporal
c. Greater occipital 
d. Auriculotemporal 
e. abducens nerve

Ans. (B) Zygomaticotemporal; (C) Greater occipital; (D) Auriculotemporal

Nerves of the scalp and superficial temporal regions.

In front of auricle	Behind the auricle
Sensory nerve	Sensory nerve
1. Supra trochlear (br. of Trigeminal) 2. Supra orbital  (br of Trigeminal) 3.Zygomaticoremporal (br. of Zygornatic nerve) 4. Auriculotemporal (br of mandibular)	1. Post division of  great auricular 2. Lesser occipital 3. Greater occipital 4. Third occipital
Motor nerve	Motor nerve
1. Temporal br of facial nerve	1. Posterior br of facial nerve