Metabolic alkalosis PGI MCQ | Crack PGIMER NOV 2016

Metabolic alkalosis is associated with 

A. Fanconi’s anemia 
B. Acetazolamide 
C. Spironoloactone 
D. Triamterene 
E. Hypocalcemia

The Answer is. (E) Hypocalcemia :

• Metabolic alkalosis is associated hypocalcemia when it is due to hyperaldosteronism.

• Hypocalcemia in hypoparathyroidism can cause metabolic alkalosis

• Triamterene, Spironolactone cause incr. K⁺and causes hyperkalemia, arrhythmias.

• Fanconi’s anaemia — pancytopenia + increased chromosomal fragility, Cong. developmental anomalies and increased risk of malignancy

Spalding Sign MCQ | Crack PGIMER NOV 2016

Spalding sign is seen in 

A. Abortion 
B. Still birth 
C.IUD 
D. Infanticide
E. Homicide

The Answer is. (C) IUD

Spalding’s sign : overlapping of the cranial bones. Usually seen in intra uterine death, appears 7 days after death

• Other Radiolocical signs of IUD.

— Robert’s sign as early as 12 hrs. it is gas shadow in chambers and great vesse heart.

— Hyperflexion of spine.

— Crowding of ribs shadow with loss of normal parallelism. 

Liver biopsy is seen in alpha 1 antitrypsin deficiency | Crack PGIMER NOV 2016

Which of the following features in liver biopsy is seen in alpha 1 antitrypsin deficiency

A. PAS positive and diastase resistant globules are seen 
B. Cirrhosis of liver 
C. Mallory hyaline 
D. Bile, duct proliferation 
E. Amyloid deposition

The Answer is. (A) PAS positive and diastase resistant globules are seen; (B) Cirrhosis of liver ;(C) Mallory hyaline

Alpha-1 antitripsin is a glycoprotein synthesized in liver. This protein inhibits leukocytic and bacterial proteinase and other proteolytic enzymes e.g. chymotrypsin, plasmin, thrombin elastase collagenase and Hagmen factor a1 antitrypsin deficiency is characterised by presence of round to oval cytoplasmic granular inclusion in hepatocytes which’ in haematoxylin and eosin stains are acidophilic. and have indistinctly demarcated cytoplasm. They are PAS positive Diastase resistance globules.

• Infrequently fatty changes and Mallory bodies are present.

• α1 antitrypsin deficiency leads to cirrh’osis and hepatocellular carcinoma. 

Palindromic DNA implies | Crack PGIMER NOV 2016

Palindromic DNA implies

A. Short stretches of DNA
B. Recognized by specific restriction endonuclease
C. Codes for bacterial resistance
D. Complementary strands

E. part for microbial genetic drifts

The Answer is(A) Short stretches of DNA; (B) Recognised by specific restriction endonuclease (D)

Complementary strands

• A palindrome is a region of double stranded DNA in which each of twa strands has same sequences when read in the same direction (i.e. in the 5’- 3’ direction)

• They have complementary strands

• Restriction endonuclease also called Restriction enzymes cleave double stranded DNA into smaller, more manageable fragments, opened for DNA analysis. These enzymes recognize short Stretches of DNA (usually 4 to 6 base pairs) that contain specific nucleotide sequences. Thus, sequence which differ for each restriction endonuclease, are palindromes.

• Drug resistance is due to

- Chromosome mediated resistance

- Plasmid mediated resistance

-Transposon mediated resistance 

Pregnant Lady Clinical Case MCQ | Crack AIIMS NOV 2016 MCQs

A 24-year-old woman is in a car accident and is taken to an emergency room, where she receives a chest x-ray and a film of her lower spine. It is later discovered that she is 10 weeks pregnant. She should be counseled that

A. The fetus has received 50 rads
B. Either chorionic villus sampling (CVS) or amniocentesis is advisable to check for fetal chromosomal abnormalities
C. At 10 weeks, the fetus is particularly susceptible to 
derangements of the central nervous system
D. The fetus has received less than the assumed threshold for radiation damage.

Ans: The answer is d.While a 50-rad exposure in thefirst trimester of pregnancy would be expected to entail a high likelihood of serious fetal damage and wastage, the anticipated fetal exposure for chest x-ray and one film of the lower spine would be less than 1 rad. This is well below the threshold for increased fetal risk, which is generally thought to be 10 rads. High doses of radiation in the first trimester primarily affect developing organ systems such as the heart and limbs; in later pregnancy, the brain is more sensitive. The chromosomes are determined at the moment of conception. Radiation does not alter the karyotype, and determination of the karyotype is not normally indicated for a 24-year-old patient. The incidence of leukemia is raised in children receiving radiation therapy or those exposed to the atomic bomb, but not from such a minimal exposure as here

Disease vaccine is contraindicated in pregnancy MCQ | Crack AIIMS NOV 2016 MCQs

For which of the following disease, vaccine is contraindicated in pregnancy, even following maternal exposure?

A. Rabie
B. Measles 
C. Typhoid
D. Hepatitis B

The answer is b.Teratogenic concerns regarding the vaccine must be weighed against the potential for harm from the infectious agent. In the case of hepatitis A and B, rabies, tetanus, and varicella, patients may be treated with hyperimmunoglobulin or pooled immune serum globulin. Inactivated bacterial vaccines can be used for cholera, plague, and typhoid as appropriate. Vaccines for measles and mumps are generally considered to be contraindicated as these are live viruses, although the rubella vaccine, which is known to have been administered inadvertently to over 1000 pregnant women, has never caused a problem and in fact can be used in selected circumstances of exposure.

Substances has been associated with behavioral and developmental abnormalities in children

A patient of yours has a history of multiple substance abuses. She is now pregnant again and tells you that she has a little boy that is 2 years old who is slow in school and has difficulty concentrating. Which of the following substances has been associated with behavioral and developmental abnormalities in children?

A. Tobacco 
B. Cocaine 
C. Caffeine 
D. Marijuana

The answer is a. Moderate consumption of coffee has not been associated with any fetal risks. Consumption of more than five cups of coffee a day has been shown to be associated with a slightly increased risk of spontaneous abortion in some studies. Cocaine use has been associated with an increased incidence of placental abruption and a constellation of congenital anomalies (skull defects, disruptions in urinary tract development, limb defects, and cardiac anomalies). Marijuana has not been associated with any adverse fetal effects. Tobacco use has been associated with a number of adverse pregnancy outcomes including spontaneous abortion, preterm labor, growth restriction, placental abruption, placenta previa, and attention deficit disorder and behavior and learning problems.

Fetal blood Returned to the umbilical arteries MCQ | Crack AIIMS NOV 2016 MCQs

Fetal blood is returned to the umbilical arteries and the placenta through the

A. Hypogastric arteries
B. Ductusvenosus
C. Portal vein 
D. Inferior vena cava

The answer is A.

Fetal blood is returned directly to the placenta through the two hypogastric arteries. The distal portions of the hypogastric arteries atrophy and obliterate within 3 to 4 days after birth; remnants are called umbilical ligaments. Fetal oxygenation is aided by the presence of three vascular shunts: the ductusvenosus, foramen ovale, and ductusarteriosus. The ductusvenosus shunts oxygenated blood from the umbilical vein into the inferior vena cava. The foramen ovale deflects the more oxygenated blood from the right atrium into the left atrium, thereby bypassing pulmonary circulation. Approximately two- thirds of the blood ejected from the right ventricle is shunted pulmonary circulation through the ductusarteriosus.

The smallest anteroposterior diameter of the pelvic inlet | Crack AIIMS NOV 2016 MCQ

The smallest anteroposterior diameter of the pelvic inlet is called the 

A. Interspinous diameter
B. True conjugate
C. Diagonal conjugate
D. Obstetric conjugate

The answer is d. The obstetric conjugate is the shortest distance between the promontory of the sacrum and the symphysis pubis. It generally measures 10.5 cm. Because the obstetric conjugate cannot be clinically measured, it is estimated by subtracting 1.5 to 2 cm from the diagonal conjugate, which is the distance from the lower margin of the symphysis to the sacral promontory. The true conjugate is measured from the top of the symphysis to the sacral promontory. The interspinous diameter is the transverse measurement of the midplane and generally is the smallest diameter of the pelvis.

Processes inhibited by the presence of extracellular nucleases | Crack PGIMER 22 MAY 2016

Which of the following processes is most likely to be inhibited by the presence of extracellular nucleases? 

A. Conjugation 
B. Generalized transduction 
C. Specialized transduction 
D. Transformation 
E. Transposition

The answer is. D. Transformation

In transformation, the DNA is extracellular before it is picked up by the competent cells; during this period, the DNA is subject to the extracellular endonucleases. Because the DNA in generalized and specialized transductions is protected extracellularly by the virus capsid, it is not subject to extracellular endonucleases. In conjugation, the DNA is never outside of a cell. Transposition is a mechanism of inserting a transposon into another molecule of DNA and has no extracellular transport mechanism associated with it. 

Iron is present in which protein | Crack PGIMER 22 MAY 2016

Iron is present in which protein 

A. Na-K-ATPase 
B. Superoxide dismutase 
C. Cytochrome C 
D. Peroxidase 
E. Metallothionene

The Answer is. (C) Cytochrome C ; (D) Peroxidase:

• Iron is present as cofactor in eizymes

— Cytochrome C

— Peroxidase

— Catalase

• Superoxide dismutase — copper present

• Metallothionene—cystine + metal (Cu, Zn, Cd, Hg)

• Na-K-ATPase contains — Mg²⁺ as cofactor. 

Rheumatic Heart Disease | Crack PGIMER 22 MAY 2016

Rheumatic heart disease can be diagnosed on the basis of 

A. Aschoff bodies 
B. Vegetations along the lines of closure of valves 
C. Endocardial involvement only 
D. Follows skin and throat infection
E. Electrocardiogram

The Answer is. (A) Aschoff bodiesThe pathognomonic features of pancarditis in Rheumatic Fever is presence of distinctive Aschoff nodules Or Aschoff bodies
• Rheumatic heart disease is preceded by streptococcal (GroupA, Serotype 1, 3, 5,6, 18 etc.) pharyngitis and tonsillitis (Not of skin infection), is seen in 3% of cases
• Vegetations along lines of closure of valves is seen in
— Rheumatic valvular disease
— Non-bacterial thrombotic endocarditis
• Annular mitral calcification - Degenerated calcific deposits in the ring of mitral valve, appear as irregular stony hard and occasionally ulcerated nodules that lie behind the leaflets. Itdoes not generally affect valvular function. It is most common in woman> 60 years and individuals withrnyxomatous mitral valve or elevated left atrial pressrue
Complication — Stroke, inf. endocarditis, regurgitation (unusual)
Note:
* Button hole or Fish Mouth Mitral valve
* Bread and butter pericarditis
* Carey-coomb’s murmur (delayed diastolic murmur)                               Feature of RHD “Mac Callum’s patch”

Keratoacanthoma | Crack PGIMER 22 MAY 2016

True about keratoacanthoma :

A.Benign tumor 
B. Malignant skin tumor like squamous cell carcinoma
C. Treatment same as for squamous cell carcinoma 
D.Easy to differentiate from squamous cell Ca. histologically 
E. Treatment is Mohs surgery

The Answer is. (A) Benign tumor (E) Treatment is masterly inactivity

Keratoacanthoma is a rapidly developing neoplasm clinically and histologicaly mimics squamous cell carcinoma. It is a low grade squamous cell carcinoma originating from the neck of hair follicle

— It is not easily differentiated from sq cell. Ca. Keratoacanthoma may progress to invasive SCC and hence promt treatment if advocated

• Histology — Centre with a keratin filled crater surrounded by proliferating epithelial cells.

Diagnosis: by skin biopsy

Treatment by curettage, or electro cautry.However excision is diagnositic and therapeutic.Mohs surgery is margin controlled surgery, allows for good margin control with minimal tissue removal

Renal cell showing ‘perinuclear halo’ & “Plant like” structure | Crack PGIMER 22 MAY 2016

Renal cell carcinoma histopathologicaly showing ‘perinuclear halo’ & “Plant like” structure in malignant cells 

A. Clear cell tumor 
B.Adenocarcinoma
C. Collecting duct. Ca.
D. Oncocytoma
E. None

The Answer is. e.(None)

• The histopathological changes — “perinuclear halo” ‘Plant like’ is found in chromophobe renal carcinoma.

Histopathological change of other renal cell carcinoma:

• Clear cell Carcinoma:Growthpattern varies from cord like to tubular

—Cells are polygonal or rounded with clear or granular cytoplasm with glycogen and lipid.

— Solid as wall as cystic areas, have delicate branching vasculature.

— Some have marked nuclear atypia with bizarre nuclei and giant cells.

• Papillary :— Papillary arrangement of cells

— Interstitial foam cells,Psamomma bodies

• Collecting duct Ca :aka bellini duct cancer / tubulocystic carcinoma. Has strong association with the transitional cell carcinoma. Histology:bubble wrap appearance.

• Oncocytoma :Eosinophillic cells with abuudant mitochondria. 

Hernia PGI MCQ | Crack PGIMER 22 MAY 2016

True about hernia

A. Direct hernias are usually acquired
B. Femoral is most common hernia to strangulate
C. Extrabdominal hernia is more common
D. 50% old people suffer from direct type of hernia with strangulation
E. Treatment of choice for indirect inguinal hernia is surgery

The Answer is. (A) Direct hernias are usually acquired ; (B) Femoral is most common hernia to strangulate; (C) Extra abdominal hernia are more common (E) Treatment of choice for indirect inguinal hernia is surgery

Direct hernia is always acquired.

• Although inguinal hernia is 10 times more common than femoral hernia, a femoral hernia is more likely to strangulate because of narrowness of neck and rigid surroundings.

• Treatment of choice for indirect hernia is surgery. 

Patient with raised JVP and CVP of 16 mm of H2O and persistent hypotension | Crack PGIMER 22 MAY 2016

Following a major trauma a patient presented 3 days later with raised JVP and CVP of 16 mm of H2O and persistent hypotension. The possible causes could be

A. Tension pneumothorax 
B. Cardiac tamponade 
C. Head injury
D. Splenic trauma 
E. Air embolism

The Answer is. (A) Tension pneumothorax ;(B) Cardiac tamponade

• As, the patient having persistent hypotension with raised JVP following history of trauma the possibilities are

(a) Tension pneumothorax                                (b) Cardiac tamponade

• Important features

In cardiac tamponade  incr. JVP ; Narrow pulse pressure, hypotension, .paradoxical low voltage in ECG, etc.
Tension pneumothorax Respiratory distress, mediastinal shifting, reduced air entry: present with weak or absent breath sounds, incr JVP, hypotension

• In head injury, splenic trauma, air-embolism, JVP is not raised. 

Cellulitis of lower limb | Crack PGIMER 22 MAY 2016

True about cellulitis of lower limb

A.Infection of skin & subcutaneous tissue 
B. Fever & malaise are common 
C. Margins are distinct 
D. External wound always present 
E. Involved site is red & hot

The Answer is. (A) Infection of skin & subcutaneous tissue ; (B) Fever & malaise are common

(C) Margins are distinct; (E) involved site is red & hot

• Cellulitis is an acute inflammatory condition of skin and subcutaneous tissue characterized by localized pain, erythema, swelling and heat

• Systemic signs are common SIRS, chills, fever and rigors along with signs of inflammation 

Investigation of choice for blunt trauma abdomen | Crack PGIMER 22 MAY 2016

Investigation of choice for blunt trauma abdomen in unstable patient 

A. X-ray abdomen 
B. USG 
C. Diagnostic Peritoneal lavage 
D. MRI 
E. CT scan

The Answer is. (C) Diagnostic Peritoneal lavage, (B) USG, (E) CT scan

• Blunt abdominal trauma is evaluated by ultrasound imaging in most major trauma centres

• CT and DPL are mainstay of investigation in blunt trauma of abdomen. DPL is however, the gold standard before the use of CT / USG

DPL is superior over CT in diagnosis for hemoperitoneum, presence of intrabd. Organ injuries

* in single best The The Answer is. is. DPL

X-Ray features of leukemia MCQ | Crack PGIMER 22 MAY 2016

X-Ray features of leukemia in a 2 year old child is/are

A. Osteolytic lesions in flat bones 
B. Subperiosteal erosions 
C. Osteoporosis 
D. Thick line just below growth plate
E. Metaphyseal infarcts

The Answer is. (B) Subperiosteal erosions ; (C) Osteoporosis (D) Thick line just below growth plate

• Characteristicaly, there are zones of rarefaction with delicate subperiosteal new-bone formation in the metaphyseal regions of femur, humerus or spine or pelvis.

* X-ray reveals sub periosteal and subepithelial reabsorption of bones and presence of dark-bands above the metaphysis called growth arrest lines.

• Osteolytic lesions is seen in half of the cases and is commonest in shafts of long bones.

• Other X-ray features of ALL :

— Metaphyseal cortical erosion

---- Periosteal reactions.

— Altered medullary trabeculation, sub-epiphyseal bone resorption. 

Sixth gravida has postpartum hemorrhage | Crack AIIMS 8 May 2016 MCQs

A sixth gravida has postpartum hemorrhage immediately after a spontaneous vertex delivery. The placenta and membranes are expelled completely. The uterus is not very firm. The first-line of treatment would be

A. Blood transfusion 
B. Massaging the uterus and administering an oxytocic 
C. Inspecting the vagina and cervix for laceration 
D. Exploring the uterine cavity

Answer.B (Massaging the uterus and administering an oxytocic)

Postpartum bleeding: Hemorrhage in excess of 500 ml from genital tract after delivery,

(a) Primary: within 24 hours following birth,

(b) Secondary: after 24 hours.

Causes
1. Atonic uterus (80%)—commonest cause. Conditions often interfere with retraction of the uterus—grand multipara, overdistension of uterus as in multiple pregnancy, hydramnios, and large baby malnutrition and anemia, prolonged labor, uterine seda tives, uterine fibroid, induced labor placenta previa malformed uterus.

2. Traumatic (20%).

3. Combined. 

Chediak-Higashi Syndrome | Crack PGIMER 22 MAY 2016

Which is seen in Chediak-Higashi syndrome:

A. Leukocytosis 
B. Neutropenia 
C. Defective microbial killing 
D. Presence of large granules in neutrophil 
E. Immunodeficiency

The Answer is. (B) Neutropenia; (C) Defective microbial killing; (D) Presence of large granules in neutrophil; (E) Immunodeficiency:

• Chediak-Higashi syndrome is a rare disease with autosomal recessive inheritance due to defect in lysosomal transport protein LYST, encoded by genes CHS 1 at 1q 42. The protein is required for normal packaging and disbursement of granules.

• There is hypopigmentation of skin, eyes and hair, photophobia, nystagmus and giant peroxidase positive inclusions in the cytoplasm of leukocytes,

• Neutropenia occurs

• Defective microbial killing, impaired chemotaxis are seen

• Immune deficiency (Primary) can occur