Psychedelic drugs

All of the following are psychedelic drugs except:

A. Lysergic acid diethylamide 
B. Phencyclidine
C. Cocaine 
D. Mescaline

The Answer is. (C). Cocaine

Hallucinogens (Psychotomimetics, psychedelics, psychotogens) are drugs which alter mood, behaviour, thought and perception in a manner similar to that seen in psychosis. These are as:

1. Lysergic acid diethylamide (LSD)                2. Psilocybin

3. Harmine                                                            4. Bufotenin

5. Mescaline (Phenyl alkyl amines)                 6. Phencyclidine

7. Lysergic acid amide.

Axonotmesis includes discontinuity in: | PGIMER MCQs for MD MS Preparations

Axonotmesis includes discontinuity in: 

a. Perineurium 
b. Epineurium 
c. Endoneurium 
d. Axon 
e. Myelin sheath

Ans : (D) Axon ; (E) Myelin sheath

• Axonotmesis is characterized by axonal and myelin sheath damage that results in loss of continuity with the cell body and its end organ. There is preservation of the endoneurium, perineurium, and epineuriurn. This type of nerve damage may cause paralysis of the motor, sensory, and autonomic functions. If the force creating the nervedamage is removed in a timely fashion, the axon may regenerate, leading to recovery. 

Functions of limbic system | PGIMER MCQs for MD MS Preparations

Functions of limbic system 

a. Emotion 
b. Memory 
c. Higher function 
d. Planned motor activity 
e. Skilled activity

 Ans : (A) Emotion ; (B) Memory ; (C) Higher function ;

The functional anatomy of limbic system in our body

i) Hypothalamus It is one of the central elements of limbic system. It’s functions

— Vegetative functions e.g. body temperature, osmolality, drive to eat and drink, body weight etc.

— Behavioral control e.g. eating, satiety, sexual drive etc.

— Endocrine functions e.g. releasing and inhibitory hormones.

— Reward and punishment functions of limbic system.

ii) Hippocampus:

— Behavioural patterns like pleasure, rage, passivity or excess sex drive.

— Hyperexciting

— Learning and memory

iii) Amygdala : Stimulation of amygdala can cause almost all the seen effects as those elicited by stimulation of

hypothalamus plus other effects.

— Amygdala is concerned to a great extent with olfactory stimuli and their interrelations with limbic brain.

— The overall function is to help pattern the person’s behavioral response so that it is appropriate for each occasion.

iv) Limbic cortex : Association area for control of behavior.

• Ant. temporal cortex : gustatory and olfactory association.

• Parahippocampal gyri : complex auditory association and complex thought associations derived from Wernike’s area of the posterior or temporal lobe.

• Middle and posterior cingulated cortex : Sensorimotor associations. 

True statements about ions composition in body | PGIMER Frequently Asked Medical PG topics

True statements about ions composition in body: 

a. Intracellular & Extracellular ions compositions are same 
b. Phosphorus and Mg are major ions intracellularly 
c. Na, Cl principal ions in E.C.F. 
d. Kidney tightly regulates Nat K, C1 composition.
e. Ca is major ion intracellularly

Ans: (B) Phosphorus and Mg are major ion intracellularly ; (C) Na, Cl principal ions E.C.F. (D) Kidney tightly regulates Nat K, C1 composition.

• ECF contains large amounts of Na and Cl and reasonably large amounts of HCO3, but only small quantities of K, Ca2, Mg2, P042 and organic acid ions.
• The composition of ECF is carefully regulated by various mechanisms but especially by kidneys. This allows cells to remain continually bathed in a fluid that contains the proper concentration of electrolytes and nutrients for optimal cell function.
• ICF contains large amount of K and P042 plus moderate quantities of Mg2 and sulfation, but only small quantities of Na and CF and almost no Ca2. 

Wernicke’s encephalopathy line of Treatment

A 37-yrs-old alcoholic is brought to the emergency room after he was found unconscious in the street. He is hospitalized for dehydration and pneumonia. While being treated, he becomes acutely confused and agitated. He cannot move his eyes upward or to the right, and he is ataxic. Which of the following diagnosis is most likely?

A. Alcohol intoxication 
B. Korsakoff’s syndrome 
C. Alcohol delirium 
D. Wernicke’s encephalopathy

The Answer is. (D). Wernicke’s encephalopathy

Wernicke’s encephalopathy occurs in nutritionally deficient alcoholics and is due to thiamine deficiency and consequent damage of the thiamine- dependent brain structures, including the mammillary bodies and the dorsomedial nucleus of the thalamus. It presents with mental confusion, ataxia, and sixth nerve paralysis. Wernicke’s encephalopathy is a medical emergency and can rapidly resolve with immediate supplementation of thiamine.

Hypochondriasis MCQ

A middle-aged man is chronically preoccupied with his health. For many years he feared that his irregular bowel functions meant he had cancer. Now he is very preoccupied about having a serious heart disease, despite his physician’s assurance that the occasional “extra beats” he detects when he checks his pulse are completely benign. What is his most likely diagnosis? 

A. Somatization disorder 
B. Hypochondriasis 
C. Delusional disorder 
D. Pain disorder

The Answer is. (B). Hypochondriasis

Hypochodriasis is characterized by fear of developing or having a serious disease, based on the patient’s distorted interpretation of normal physical sensations or signs. The patient continues worrying even though physical exams and diagnostic tests fail to reveal any pathological process. The fears do not have the absolute certainty of delusions. Hypochondriasis can develop in every age group, but onset is most common between 20 and 30 years of age. Both genders are equally represented, and there are no differences in prevalence based on social, educational, or marital status. The disorder tends to have a chronic, relapsing course.

Patient with a h/o Prosopagnosia, loss of memory, 3rd person Hallucinations

A 70 yr old man presents with a h/o prosopagnosia, loss of memory, 3rd person hallucinations since 1 month. On examination deep tendon reflexes are increased, mini mental state examination score is 20/30. What is the most likely diagnosis?

A. Dissociated dementia 
B. Schizophrenia
C. Depression 
D. Cortical dementia

The Answer is. (D). Cortical dementia

Loss of memory is found in dementia in old age .Though there is  3^rd  person hallucination  which can also be present in dementia depression mania but history of  increase in deep tendon reflexes and MMSE score  20 or less, points towards dementia

Agglutination Reactions

For attention-deficit hyperactivity disorder drug of choice is 

A. Haloperidol 
B. Imipramine 
C. Methyiphenidate 
D. Aiprazolam

The Answer is. C (Methyiphenidate)

• Pharmacotherapy: Dextroamphetamine and methylphenidate are the drug of choice. Both are stimulants.

Methylphenidate is used in India.

• Treatment:

o Alternate medications are bupropion, venlafaxine, and clonidine.

o Parental training.

o Counseling and supportive therapy. 

Struma Ovary | PGIMER MCQs for MD MS Preparations

True about Struma Ovary: 

a. Ectopic thyroid 
b. Ectopic ovary 
c. Malignancy 
d. Benign lesion 
e. Included in teratoma

Ans.(D)Benign lesion; (E) Included in teratoma

Struma ovarii in defined by the presence of a benign ovarian tumor containing thyroid tissue as the predominant cell type. They typically occur as part of a teratoma but may occasionally be encountered with serous or mucinous tissue.

• Malignant transformation is rare & usually defined by histologic criteria. 

Greatest stimulator for ADH secretion | PGIMER MCQs for MD MS Preparations

Greatest stimulator for ADH secretion 

a. Hyperosmolarity 
b. Hyponatremia 
c. Hypotension 
d. Hypovolemia 
e. Hypokalemia

Ans : (A) Hyper osmolarity ;

Regulation of ADH secretion

Increase ADH                        Decrease ADH

↑Plasma osmolarity            -Low plasma osmolarity

↓BP

Drugs

Morphine                               Alcohol

Cyclophosphamide              Clonidine

• Osmotic regulations cause ADH secretion as high as 20 times the normal, while hypovolemia (15- 25% decrease) cause as high as 50 times normal

Using rational emotive therapy to treat a patient with depression and anxiety

An psychiatrist is using rational emotive therapy to treat a patient with depression and anxiety. An effective strategy for helping the patient recognize the connections between affect, cognition, and behavior is to: 

A. Focus on mindfulness techniques. 
B. Provide an injunction to address assumptions. 
C. Reinforce behaviors that have a sense of self-efficacy. 
D. Substitute reality-oriented interpretations for the distorted thoughts.

Ans, D. Substitute reality-oriented interpretations for the distorted thoughts.

Rational emotive behavior therapy REBT. , previously called rational therapy and rational emotive therapy, is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problems

and disturbances and enabling people to lead happier and more fulfilling lives. REBT was created and developed by the American 

Over Distended Uterus Clinical Case | PGIMER MCQs for MD MS Preparations

A women in second trimester was found to have over distended uterus. Common causes include: 

a. Wrong date 
b. Hydramnios 
c. Distended bladder 
d.Twins 
e. Fibromyoma

Ans. All

* Woman with a uterus that appears large for gestational age, the following are the possibilities:

- Multiple fetuses

- Elevation of the uterus by a distended bladder

- Inaccurate menstrual history

- Hydramnios

- Rydatidiform mole

- Uterine myomas

- A closely attached adnexal mass

- Fetal macrosomia late in pregnancy. 

All Reduce Lactation | PGIMER MCQs for MD MS Preparations

All reduce lactation except :

a. Maternal anxiety 
b. Retracted nipple 
c. Dehydration 
d. Diabetes 
e. Antibiotics

Ans (C) Dehydration ; (D) Diabetes ; (E) Antibiotics; 

Causes of reduced lactation are

* Infrequent suckling

Depression or anxiety

* Ill development of breast

* Painful breastlesion

* Endogenous supression ofprolactin, e.g. retained placenta.

* Prolactin inhibitors - ergots, diuretics, pyridoxine Uncontrolled diabetes

* Post partum hemorrhage

* Hypothyroidism

In retracted nipple, baby fails to suk and thus lactation is reduced. 

Vaginal smear in old lady | PGIMER Frequently Asked MCQ Topics

Vaginal smear in old lady shows: 

a. Atrophic cells on smear 
b. Basal and parabasal cells 
c. Superficial cells 
d. Few intermediate cells seen
e. all of above

Ans (B) Basal and parabasal cells , (D) Few intermediate cell seen

• Exfoliated vaginal epithelial cells normally include

* PARABASAL Small, round and basophilic, its predominance indicates lack of hormonal activity

* SUPERFICIAL Large thin acidophilic cells with pyknotic nuclei estrogen produces its maturation

* INTERMEDIATE Transparent and basophilic progesterone androgen corticosteroids pill and

pregnancy produces these cell maturation 

Techniques of delivery of after coming head in breech presentation | PGI MCQ

Techniques of delivery of after coming head in breech presentation. 

a. Burns—Marshall method 
b. Forceps delivery 
c. Modified Mauriceau-Srnellie-Veit technique. 
d. Lovset’s maneuver.
e. Gordon’s technique

Ans. (A) Burns—Marshall method; (B) Forceps delivery; (C) Modified Mauriceau-Smellie-Veit technique. 

• For the delivery of after coming head in case of breech presentation following methods are used:

(I) Burns —Marshall method

(ii) Forceps delivery (iii) Modified Mauriceau-Smellie-Veit technique (Molar flexion and shoulder traction)

• Lovset maneuver used in breech with extended arms. 

Pattern of Inheritance MCQ

In a family, the father has widely spaced eyes, increased facial hair and deafness. One of the three children has deafness with similar facial features. The mother is normal. Most likely pattern of inheritance in this case is 

A. Autosomal dominant 
B. Autosomal recessive
C. X-linked dominant 
D. X-linked recessive

Ans. A. Autosomal dominant

Here father is affected and one of three children is affected. Mother is normal. It is not clear whether male or female child is affected. 

• Autosomal dominant disorders: Any child has 50% chances of inheriting the disease. 

• It cannot be Autosomal recessive disorder as here both father and children are affected. And homozygous father and normal mother will have asymptomatic children carrier. 

• X-linked dominant disorder: Affected father will not affect male child. It affects only daughter. 

• X-lirilced recessive disorder: Affected father will not affect male child. Female child will be affected only if mother is also carrier. 

* Therefore most likely Answer is autosomal dominant disorder

In vasopressin, the greatest fraction of filtered water is reabsorbed by:

In the presence of vasopressin, the greatest fraction of filtered water is reabsorbed by the 

A. Proximal tubule 
B. Distal tubule 
C. Loop of Henle 
D. Collecting duct

Ans. A. Proximal tubule
• Vasopressin acts on the collecting duct to cause water reabsorption. The level of vasopressin and its action of water reabsorption is determined by the body fluid osmolality.
• About 67% of the total water filtered will be absorbed in the PCT. This is obligatory and irrespective of the body fluid osmolality or vasopressin action.
• 15% will be absorbed in the loop of Henle. Approximately 5% will be absorbed in the DCI. In the absence of vasopressin, only about 2% will be absorbed from collecting duct. Thus, about 88—89% of filtered water will be reabsorbed even in the absence of vasopressin.
• In the presence of vasopressin, collecting duct absorption will be about 10—11% fraction of the total filtered water. In addition, 99% of the filtered water will be reabsorbed. Thus, greatest fraction of filtered water will always be absorbed from PCT, irrespective of vasopressin action. 

Most common pattern of onychomycosis

The most common pattern of onychomycosis? 

A. Endonyxonychomycosis
B. Superficial white onychomycosis
C. Proximal subungualonychomycosis
D. Distal and lateral subungualonychomycosis

Ans. D. Distal and lateral subungualonychomycosis    

Distal and lateral subungualonychomycosis DLSO.  is the most common pattern of infection, and usually presents as a streak or a patch of discoloration, white or yellow at the free edge of the nail plate, often near the lateral nail fold. The initial invasion of the hyponychium shows through a relatively normal dorsal nail plate. 

Acute Pyogenic Meningitis | PGIMER entrance Preparations

Acute Pyogenic Meningitis true is/are: 

a. Purulent exudates within leptomeninges 
b. CSF cloudy with PMN 
c. Spreads to ventricle 
d. Causes ventricular enlargements 
e. CSF chloride increased

Ans (A) Purulent exudates within leptomeninges , (B) CSF cloudy with PMN (C) Spreads to ventricle , (D) Causes ventricular enlargements ,

• In acute pygenie meningitis CSF becomes cloudy and sometimes frankly purulent Exudates are evident in the leptomeninges over the surface of the brain. Exudates varies in location e.g. for H influenzae — usually basal for Pneumococcal - cerebral convexities When meningitis is fulminant, the inflammation may extend to ventricles, producing ventriculitis.

• Neutrophil fills entire subarchnoid space in severe cases.

(A) Proteus vulgaris ; (B) Chlamydia

Organisms causing UTI

(i) Community acquired or non-catheter associated

• E. Coli (80% of acute infections)

• Proteus, Klebsiella and occasionally enterobacter — smaller proportion of cases.

• Serratia, Pseudomonas (recurrent UTI, UTI in Urologic manipulation, calculi or obstruction):

• Other organisms:

- Gram-positive cocci e.g. S. Saprophyticus, S. aureus. Chiamydia Trachomatis 

In OPC poisoning, OPC actions are | PGI entrance Preparations

In OPC poisoning, OPC actions are: 

a. Phosphorylated enzyme 
b. Irreversibly inhibit cholinesterase 
c. Oximes effective when given beyond 24 
d. Atropine can’t reverse in early stage
e. Dimercaprol is an antidote for OPC

Ans: (A) Phosphorylated enzyme; (B) Irreversibly inhibit cholinesterase;

- Organophosphorus compounds are powerful inhibitors of carboxylic esterase enzymes, including true acetylcholinesterase and pseudoacetyl cholinesterase.

- It inactivates the esterase enzymes irreversibly by phosphorylation

- Oximes reactivates the inhibited cholinecterase. They should be started as early as possible in organophosphorus poisoning and may be benificial when given even after 24 to 36 hrs of exposure.

- Oximes should be started within 24 hours, before the phosphorylated enzyme has undergone ‘aging’ and become resistant to hydrolysis.

- Atropine is highly effective in counteracting the ,nuscarinic effects, higher dose is required to antagonize central effects. It is not effective against nicotinic actions. 

Diagnosis of CO poisoning post mortem | PGI entrance Preparations

Diagnosis of CO poisoning post mortem 

a. Blood thin and red colored 
b. Congestion of all organs 
c. Cyanosis
d. Burton line
e. zahn line

Ans. (A) Blood is thin and red colored; (B) Congestion of all organs; Postmortem appearances of CO poisoning 

Test for CO poisoning

(a) Water in test tube and the blood is added

(b) Kunkel’s test in tannic acid test

(c) Hoppe-Seylers test

(d) Spectorsopic examination 

Drug not affecting CSF synthesis & absorption

Drug not affecting CSF synthesis & absorption and also does not affect ICP is:-

A. Ketamine 
B. Thiopentone sodium
C. Nitrous oxide 
D. Halothane

Ans. C. Nitrous Oxide.

 Nitrous Oxide.

- It increases cerebral blood flow and volume hence producing
- a mild elevation of intracranial pressure
Thiopentone sodium
- It causes vasoconstriction of CNS blood vessels,
- Thus decreasing cerebral blood volume and intracranial pressure ICP. 
Ketamine
- Increases the cerebral blood flow and intracranial pressure
- Thus, ketamine is relatively contraindicated in patients with an intracranial mass or increased ICP
Halothane
- It causes dilation of cerebral vessels, thus
- Decreases cerebral vascular resistance and increases cerebral blood flow
- Hence, the intracranial pressure rises
Nitrous Oxide does not affect CSF dynamics and ICP as compared to the other anesthetic drugs in the question. Hence it is the best possible answer. 

Oxygenation during one-lung ventilation

Oxygenation during one-lung ventilation may be improved by: 

A. Increasing the tidal volume to 15 ml/kg of body/wt 
B. Applying PEEP 5cm of H20. to the ventilated dependant. lung 
C. Maintaining CPAP 5 cm of H20. in the non- ventilated non-dependant. lung 
D. All of the above

Ans. D.  All of the above

CPAP applied to unventilated lung is usually effective in restoring adequate oxygenation during one lung ventilation when excessive pulmonary shunt develops 

Ventilation with differential PEEP to manipulate regional blood flow is also necessary. 

Maintaining CPAP 5 cm of Ho.  in the nonventilated lung also improves oxygenation during one lung ventilation. 

another potential MCQ asked from the same topic is:

-               m/c cause of hypoxia during one lung ventilation is: malposition, shunt, collapse of lung

Hepatotoxic Inhalational Anesthetic

Which of the following inhalational anesthetic is hepatotoxic: 

A. Halothane 
B. Enfluorane 
C. Ether 
D. Sevofluorane

Ans. A.  Halothane 

• Halothane and other halogenated inhalational anesthetic agents, such as enflurane, isoflurane, sevoflurane, and desfiurane, are known to cause severe liver dysfunction. 

• When the World Health Organization WHO.  drug monitoring database was reviewed for the medications that most commonly cause fatal hepatotoxicity; halothane was one of the 10 most common causes. 

• Two major types of hepatotoxicity are associated with halothane administration. The two forms appear to be unrelated and are termed. 

Carcino-Embryonic Antigen (CEA) | PGIMER Frequently Asked MCQ Topics

True about carcino-embryonic antigen (CEA): 

a. Useful for screening of Ca. colon
b. Gives confirmative evidence of Ca. colon 
c. Helpful for follow-up after resection 
d. Levels decrease immediately after resection of tumor 
e. none of above

Ans. is a and c i.e. Useful for screening of Ca. colon; and Helpful for follow-up after resection

• Tumor marker

Tumor marker is a biochemical indicator of the presence of tumor.

Tumor marker cannot be construed as primary modalities for the diagnosis of cancer.

• Utility of tumor marker

— To support the diagnosis

— To determine the response of therapy

— To indicate relapse during the follow up period.

• CEA (carcino embryonic antigen)

— CEA is a tumor marker

— it normally produced in the embryonic tissue of gut, pancreas and liver.

— It is a complex glycoprotein 

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