Compulsion secondary to an obsession

A 28-year-old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. Although he tries to convince himself that his worries are absurd, his anxiety continues to mount until he drives back to the scene of the "accident" and proves to himself that nobody lies hurt in the street. This behavior is an example of? 

A. A compulsion secondary to an obsession 
B. An obsession triggered by a compulsion 
C. A delusional ideation 
D. A typical manifestation of obsessive-compulsive personality disorder

The Answer is. (A). A compulsion secondary to an obsession

A compulsion secondary to an obsession Obsession is a repetitive doubt, thought, images comes to one's mind, identified as one's own & senseless, tries to resist but unable to do so. Compulsion is a act performed is response to obsession. It could be Mental or Physical (Washing hand or cleaning) 

Conversion disorder MCQ

After witnessing a violent argument between her parents, a young woman develops sudden blindness, but does not appear as distraught as would be expected by this development. Her pupils react normally to light, and she manages to somehow avoid obstacles when walking. Her parents, who are in the middle of a bitter divorce, put aside their differences to focus on their daughter's illness. Most likely diagnosis? 

A. Factitious disorder 
B. Malingering 
C. Somatization disorder 
D. Conversion disorder 

The Answer is. (D). Conversion disorder

Conversion disorder Pesudoblindness .Conversion disorder is made only after history of stressor and pt will complain of some bodily problem of motor type like pseudoparalysis, pseudoseizure , pseudoaphonia or sensory type like pseudoblindness not explained by any organic problem. The hall mark of hysteria == conversion disorder or == dissociated disorder is Astia Absia & Labella indifference. In this case she is not appear as distraught as would be expected by this. Which is emotional indifference.Malingering -pt is pretending illness with some bad motive like to gain money from health insurance company Factitious disorder- Pt is pretending illness without any external motive but just want to show him sick to gain sympathy from doctor & others Somatization - Pt presents with multiple physical problems like pains, GIT problems etc even though physical 

examination and investigations r repeatedly normal. 

Cognitive therapy focused topics

Which of the following topics is principally focused on in cognitive therapy?

A. Unconscious and repressed memories
B. Faulty ideas and beliefs
C. Transference manifestations
D. Dream interpretation

The Answer is. (B). Faulty ideas and beliefs

·Cognitive therapy is based on the concept that psychopathology is a consequence of distorted beliefs and faulty assumptions.

·Common thinking errors described in the cognitive model are arbitrary inference (drawing a conclusion in the absence of sup porting evidence), selective abstraction (focusing on only one small part of a situation or event while ignoring other, usually more positive, aspects), over- generalization (drawing a general conclusion on the basis of a single incident), magnification (of problems) and minimization (of positive factors), personalization (tendency to relate external events to oneself without reason for doing so), and dichotomous thinking (extreme, black-or-white thinking).

·Psychoanalysis depends on dream interpretation, transference manifestation, and recovery of repressed memories.

·Relaxation techniques belong to the realm of behavioral therapy 

Hyperventilation | PGIMER Frequently Asked MCQ Topics

In hyperventilation

a. p50 and Hb affinity for 02 increases 
b. p50 and Hb affinity for 02 decreases 
c. p50 increases and 02 affinity decreases 
d. p50 decreases and 02 affinity increases 
e. no change

Ans: (D) p50 decreases and 02 affinity increases

• P50 is the partial pressure of Oxygen (Pa02), at which Hemoglobin is 50% saturated. The normal value is 26.6 mm of Hg. As the oxygen dissociation curve shifts toward left i.e. P50 decreases & 02 affinity increases when there is

hypocarbia due to hyperventilation. 

Upper G.I bleeding Facts | PGIMER MCQs for MD MS Preparations

True about Upper G.I bleeding: 

a. Duodenal ulcer bleed most common 
b. H. Pylori has role 
c. Proton pump blockers used 
d. Surgery always indicated 
e. Coma

Ans. (A) Duodenal ulcer bleed most common; (B) H. Pylori has role; (C) Proton pump blockers used
• The major causes of UGI Bleed are duodenal ulcer hemorrhage (25%), gastric ulcer, hemorrhage (20%), mucosal tears of the esophagus or fundus (Mallory-Weiss tear), esophageal varices, erosive gastritis, erosive esophagitis, Dieulafoy lesion, gastric varices, gastric cancer, and ulcerated gastric leiomyoma.

• Helicobacter Pylon: H. pylon is the main cause of uncomplicated peptic ulcer disease.

Not cause of Hemoptysis | PGIMER MCQs for MD MS Preparations

Not cause of hemoptysis 

a. Pneumonia 
b. Bronchiectasis 
c. Empyema 
d Mitral stenosis
e. Tuberculosis

Ans. (C) Empyema

CAUSES OF HEMOPTYSIS

Tracheobronchial Source

• Neoplasm (bronchogenic, endobronchial tumour, kaposis sarcoma, bronchial carcinoid)

• Bronchitis (acute and chronic)

• Bronchiectasis

• Broncholithiasis

• Airway trauma

• Foreign body.

Pulmonary Parenchymal source

- Lung Abscess

- Pneumonia

- Tuberculosis

- Mycetoma

- Good Pasture’s Syndrome

- Idiopathic Pulmonary haemosiderosis

- Lupus Pneumonitis

- Lung Contusion

Primarily Vascular Source

- Arteriovenous malformation

- Pulmonary embolism

- Mitral stenosis

Miscellaneous causes

- Pulmonary endometriosis

- Systemic coagulopathy or use of anticoagulant thrombolytic agent 

Concentration of Methemoglobin | PGIMER Frequently Asked MCQ Topics

Concentration of methemoglobin to appears cyanosis 

a. 5 gm/dl 
b. 2 gm/dl 
c.1.5 gm/dl 
d. l2gm/dl 
e. 2.5 gm/dl

Ans: (C) 1.5 gldl

• Methemoglobinemia is a condition in which the iron within hemoglobin is oxidized from the ferrous (Fe2) state to the ferric (Fe3) state, resulting in the inability to transport oxygen and carbon dioxide. Clinically, this condition causes cyanosis.

• Methemoglobinemia in children usually results from exposure to

• Oxidizing substances: nitrates or nitrites, aniline dyes, or medications, including lidocaine, prilocaine, and phenazopyridine hydrochloride. 

True regarding Atrial fibrillation

True regarding atrial fibrillation: 

a. ↑Thromboembolism
b. Digoxin treatment 
c.Anticoagulant not required 
d.Aspirin given 
e. Often fatal

Ans: (A) ↑Thromboembolism; (B) Digoxin treatment; (D) Aspirin given

• The morbidity in atrial fibrillation is due to:

·         Systemic embolisation

·         Excessive ventricular rate leads to hypotension, pulmonary congestion or angina pectoris, tachycardia induced cardiomyopathy.

·         Syncope

·         Fatigue

·         Anxiety secondary to palpitation.

Treatment of atrial fibrillation

• Treatment of precipitating factors e.g. Fever, pneumonia, alcoholic intoxications, thyrotoxicosis, pulmonary emboli, CUF or pericarditis.

• Rate control drugs: Beta-blockers, calcium channel blockers and digoxin.

• Rhythm control drugs (only modestly effective to restore sinus rhythm) : Class IA (e.g. Quinidine) or Flecainide like agents (class IC), Amiodarone, Ibutilide / DcSfetilide, Sotalol etc.

• DC cardio version — when clinical states severely compromised. It is highly effective to restore sinus rhythm, either as primary treatment or following failure of anti-arrhythmic therapy.

• Chronic anticoagulation particularly in elderly and if associated with high risk of stroke in patients with atrial fibrillation. Anti-coagulation is done with aspirin or warfarin.

• Ablation therapy for cure of AF generally applied for paroxysmal AF e g Maze procedure 

Diagnosis of Organic Mental Disorders

Best test for diagnosis of Organic Mental Disorders:

A. Sentence completion test
B. Bender Gestalt
C. Rorshach test
D. Thematic Appreciation test

The Answer is. (B). Bender Gestalt

Bender Gestalt Bender Gestalt test detects errors like rotations, omissions, preservation on drawing the standard pictures shown to pt. Preservation is main diagnostic of organic pathology. Rest all other tests are projective tests for psychiatric diagnosis. 

Psychoanalytic Theory

In psychoanalytic theory, which of the following statements is true about the superego? 

A. It is totally unconscious . 
B. It is a defense mechanism 
C. It functions to reduce guilt and shame 
D. It contains the ego ideal

The Answer is. (D). It contains the ego ideal

It contains the ego ideal In his structural theory of the mind, Freud divided the psychic apparatus into three agencies: the id, which contains the instinctual drives; the ego, whose function is to find an equilibrium between gratification of the instinctual drives and the rules of society (and the demands of the superego); and the superego, the agency that contains the internalized parental and societal rules and dictates to the ego what is not to be done. The ego idea!, a component of the superego, is the internal standard of what one should be to be approved all the time by and internalized parental figures. Shame is a consequence of not living up to one's ego ideal, while guilt is the consequence of transgressing the superego's prohibitions. The superego, as well as the ego, have both conscious and unconscious components. 

Sigmund Freud Discription

According to Sigmund Freud, which of the following best describes primary processes? 

A. Typically conscious
B. Nonlogical and primitive
C. Absent during dreaming
D. Characteristic of the neuroses

 The Answer is. (B). Nonlogical and primitive

Nonlogical and primitive. Primary process thinking is primitive, nonlogical, and timeless. Primary processes characterize the operational style of the id and are manifested in dreams. According to Freud's theory; condensation, displacement, and symbolic representation are forms of primary processes. 

Woman with a chronic mental disorder MCQ

A 58-year-old woman with a chronic mental disorder comes to the physician with irregular choreoathetoid movements of her hands and trunk. She states that the movements get worse under stressful conditions. Which of the following medications is most likely to have caused this disorder?

A. Fluoxetine 
B. Clozapine
C. Fluphenazine 
D. Diazepam

The Answer is. (D). Diazepam

Catatonic schizophrenia is characterized by marked psychomotor disturbances including prolonged immobility, posturing, extreme negativism (the patient actively resists any attempts made to change his or her position) or waxy flexibility (the patient maintains the position in which he or she is placed), mutism, echolalia (repetition of words said by another person), and echopraxia (repetition of movements made by another person). Periods of immobility and mutism can alternate with periods of extreme agitation (catatonic excitement) and the treatment of choice is E.C.T.

Vestibular nerve

True about vestibular nerve 

a. Nucleus is supplied by PICA 
b. Anastomotic connection with facial nerve 
c. Vestibular ganglion also called Scarpa’s ganglion. 
d. Nucleus at roof of 4th ventricle. 
e. Connection with trigeminal nerve

Ans. (A) Nucleus is supplied by PICA; (B) Anastoniotic connection with facial nerve (C) Vestibular ganglion also called Scarpa’s ganglion.

• Vestibular nuclei located in the floor of the 4^th ventricle in the rostral medulla and caudal pons.

Scarpa's ganglion: This is the ganglion of the vestibular nerve. It contains the cell bodies of the bipolar primary afferent neurons whose peripheral processes form synaptic contact with hair cells of the vestibular sensory end organs. ^[MCQ]At birth, it is already close to its final size

Sensory supply of from external auditory meatus | PGIMER MCQs for MD MS Preparations

Sensory supply of from external auditory meatus: 

a. Pterygomandibular ganglion 
b. Geniculate ganglion 
c. Facial nerve nucleus 
d. Auriculotemporal nerve
e. Trochlea 

Ans. (D) Auriculotemporal nerve;

Nerve Supply of external auditory meat us

(1) Anterior half Auriculotemporal nerve

(2) Posterior half auricular branch of Vagus.

Tympanic Membrane: nerve supply

Outer surface: anteroinferior — auriculotemporal nerve, poster Superior auricular branch of Vagus.

Inner surface: Glossopharyngeal nerve through tympanic Plexus. r nerve

Physical dependence to Drugs Indications

Physical dependence to drugs is indicated by:

A. Presence of need for increased dosage and withdrawal symptoms occur on absence of drug
B. Absence of need for increased dosage and withdrawal symptoms occur on absence of drug
C. Need for increased dosage but on absence of drug no withdrawal symptoms occur
D. Need for decreased dosage to achieve effects originally produced by higher doses



The Answer is. (D). 

Amphetamine intoxication can result in a psychosis very closely resembling acute paranoid schizophrenia, with symptoms including paranoid delusions and visual hallucinations. Some investigators feel that prominent visual hallucinations and a relative absence of thought disorder are more characteristic of amphetamine psychosis, but other investigators feel the symptoms are indistinguishable. Other drugs that produce psychoses similar to schizophrenia include phencyclidine PCP) and lysergic acid diethylamide (LSD).

True about Cholesteatoma | PGIMER MCQs for MD MS Preparations

True about cholesteatoma: 

a. Benign tumour 
b. Bone erosion present 
c. MC cause of conductive deafness 
d. Found in apex of petrous bone commonly 
e. Contains cholesterol

Ans: (B) Bony erosion present

* Congenital cholesteatoma occurs in 3 important sites :

- middle ear

- petrous apex

- C.P. angle

Primary & secondary acquired cholesteatoma mainly seen in middle ear & later on invades the inner ear. 

Compound(s) is/are broken down in Soda-Lime

Which compound(s) is/are broken down in soda-lime?

A. Halothane
B. Sevoflurane
C. Desflurane
D. All of the above

Ans: D all of above.

Halothane: volatile, diflourovinyl compound which is nephrotoxic in rats, but not humans. It is temp & humidity dependent.

Sevoflurane: unstable in soda lime but products apparently non-toxic in humans. It is temp dependent (increased degradation with increased temperature)

Desflurane: produces CO

Digoxin Toxicity Caused by?

Digoxin toxicity may result from the concurrent administration of digoxin with all drug EXCEPT 

a. Quinidine b. Hydrochlorothiazide 
c. Triamterene 
d. Furosemide

Ans. (C). Triamterene

Triamterene is a potassium-sparing diuretic that may protect against diuretic-induced digoxin toxicity. Di-goxin toxicity may be caused by drugs that increase serum digoxin levels or increase the binding of digoxin to its receptor, the sodium-potassium adenosine tnphosphatase (ATPase). Quinidine decreases digoxin volume of distribution and clearance. Verapamil also decreases the clearance of digoxin. Both drugs may thereby increase serum digoxin levels and precipitate digoxin toxicity. Diuretics (e.g., hydrochlorothiazide, furosemide) may cause hypokalemia and hypomagnesemia, both of which may predispose to cardiac arrhythmias. Furthermore, hypokalemia increases di-goxin binding to sodium-potassium ATPase. 

Potassium iodide

Potassium iodide: 

A. Increases bronchial secretions. 
B. On prolonged use may result in hyperthyroidism. 
C. Is useful in inflammation of the bronchi. 
D. Is contraindicated in thyroid storm.

The Answer is. A. 

Potassium iodide irritates the bronchial glands thus increasing the volume of secretions from the bronchi. This is not desirable in bronchial inflammation. Long-term use can cause hypothyroidism due to inhibition of thyroid hormone release. To stop any further release of the hormones from the gland it is given either orally/parenterally in thyroid storm. 

Use of Vaiproic acid and Lamotrigine

Concomitant use of vaiproic acid and lamotrigine increases the risk of: 

a. Chondrodysplasia punctata 
b. Paroxysmal Nocturnal hemoglobinuria 
c. Stevens-Johnson syndrome 
d. Floppy infant syndrome

Ans. (C) Stevens-Johnson syndrome
Concomitant use of valproic acid and lamotrigine increases the plasma level of lamotrigine and increases the risk of Stevens Johnson syndrome; hence, lamotrigine should be started as a low dose with gradual escalation. 

Hemodialysis MCQ | PGIMER Frequently Asked Medical PG topics

Hemodialysis is not useful in 

a. Benzodiazepines
b. Methanol 
c. Digitalis. 
d. Theophylline 
e. Salicylates

Ans. (C) Digitalis

• Digoxin having large volume of distribution and hence hemodialysis is not very effective in removing drug from body.

• Hemodialysis is effective in poisoning with methanol, Phenobarbital, Phenytoin, theophylline and salicylate.
Extra corporeal treatment of poisoning: Hemoperfusion, Hemofiltration

Drugs related factors	Dialysis related factors
Low mol wt	Large surface area of membrane
Low protein binding	High flux dialyzer
Low vol. of distribution	High blood and dialysate flow rate
Water soluble	Increased ultrafiltration rate

Extended spectrum beta lactamase inhibitors | PGIMER Frequently Asked Medical PG topics

Extended spectrum beta lactamase inhibitors: 

a. Imipenem 
b. Ceftazidime 
c. Cefoperazone 
d. Ceftriaxone 
e. Aztreonam

Ans. (A) Imipenem

• ESBL (extended spectrum beta lactamase) are beta-lactamases enzymes that mediate resistance (by hydrolyzing) to

extended-spectrum (third generation) cephalosporins (e g, cefiazidime, cefotaxime, and cefiriaxone), penicillins, narrow spectrum cephalosporins and monobactams (e.g., aztreonam) but do not affect cephamycins (e.g., cefoxitin and cefotetan) or carbapenems (e.g., meropenem or imipenem).

• ESBLs have been reported for E.coli, Kiebsiella Enterobacter, Proteus, Pseudornonas, Salmonella, Serratia and Gram positive organism e g Staphylococcus 

Natural elements having anticancer properties | PGIMER entrance Preparations

Natural elements having anticancer properties: 

a. Nitrosoamines 
b. Vit. C 
c. Vit.D 
d. Carotene 
e. Selenium

Ans  (B) Vit. C ; (D) Carotene ; (E) Selenium ;

• Natural elements having anti cancer properties are: - Carotene, Retinol, tocopherol, Selenium, Ascorbic acid.
• Nitrosoamines are carcinogenic especially for stomach carcinoma. Dietary nitrates (in preserved, smoked, cured foods) converted to nitrites.

Hereditary spherocytosis Related Deficiency | PGIMER Frequently Asked MCQ Topics

Hereditary spherocytosis is due to deficiency: 

a. Spectrin 
b. Invertin
c. Cytokeratin 
d. peptidoglycan membrane protein
e. All of the above

Ans. is a i.e Spectrin

Hereditary spherocytosis It is characterized by spherical RBC due to a molecular defect in one of the proteins in the cytoskeleton spectrin of the ABC membrane; this leads to a loss of membrane and hence decrease ratio of surface area to volume and consequently spherocytosis. Ankyrin that makes bridge between spectrin and transmembrane ion transporter.

Thrombocytopenic purpura

True about thrombocytopenic purpura is: 

a. Hemolysis is extra vascular 
b. Normal renal function test 
c. Thrombosis in cerebral blood vessels 
d. immediate cure following plasmapheresis 
e. none of above

Ans. is d i.e. Immediate cure following plasmapheresis

Diseases associated with Thrombotic Thrombocytopenic Purpura.

Infections : — Human immunodeficiency virus — Escherichia coli, Shigella

Positive direct Coomb’ test for detection of C3 on the red cell surface but 1gM responsible or coating on red cells is not found 

Bismuth subsalicylate

Bismuth subsalicylate is used in the treatment of peptic ulcer primarily because of its ability to: 

a. Neutralize gastric acid 
b. Eradicate Helicobacter pylori 
c. Stimulate mucus secretion 
d. Inhibit acid secretion

Ans. (B). Eradicate Helicobacter pylori

The gram-negative bacillus Helicobacter pylori is believed to be a significant factor in the pathogenesis of duodenal ulcers. Ulcer treatment includes bismuth salts because they eradicate this organism and are effective in preventing ulcer recurrences. Bismuth preparations may also coat the ulcer base, adsorb pepsin, and enhance prostaglandin synthesis. 

Bismuth does not directly inhibit acid secretion or pepsin production and it is not an antacid. 

The Ames test is a method for detecting -

The Ames test is a method for detecting 

a. Carcinogenesis in rodents 
b. Carcinogenesis in primates 
c. Teratogenesis in any mammalian species 
d. Mutagenesis in bacteria

Ans. (D) Mutagenesis in bacteria

The Ames test is carried out in Salmonella and detects mutations in the bacterial DNA. Because mutagenic potential is associated with carcinogenic risk for many chemicals, the Ames test is often used to claim that a particular agent may be a carcinogen. However, the test itself only detects mutations. 

Sporicidal agent | PGI MCQs

Sporicidal agent:

a. Formaldehyde 
b. Ethylene glycol 
c. Ethylene oxide 
d. Chlorine
e. Phenol

Ans (A) Formaldehyde ; (C) Ethylene oxide

* Glutaraldehyde, Formaldehyde, Ethylene oxide are sporonticidal.

* Phenol and cresol have little effect on spores and pseudomonas.

* Phenol is bactericidal at 1% solution.

* Chlorine has no effect on spore.

* Ridal walker test is done for disinfection efficiency.