Wave V on BERA | PGI Based MCQ

Wave V on BERA is generated at:

A. Cochlear nerve
B. Superior olivary nucleus
C. ventral nucleus of lateral lemniscus
D. Inferior colliculus
E. nuclei of lateral laminiscus

The Answer is. E. nuclei of lateral laminiscus[Refer Figure # 13]

BERA:

Synonyms: Brain stem evoked response audiometry, auditory brain stem response, ABR audiometry, BAER (Brainstem auditory evoked response audiometry).

Bera is an objective way of eliciting brain stem potentials in response to audiological click stimuli. These waves are recorded by electrodes placed over the scalp.

MCQ: - first described by Jewett and Williston in 1971.

Process: The stimulus either in the form of click or tone ‘pip’ is transmitted to the ear via a transducer placed in the insert ear phone or head phone. The wave froms of impulses generated at the level of brain stem are recorded by the placement of electrodes over the scalp.

In auditory brain stem evoked response audiometry, the impulses are generated by the brain stem. These impulses when recorded contains a series of peaks and troughs. The positive peaks (vortex positive) are referred to by the Roman numerals I - VII.

These peaks are considered to originate from the following anatomical sites:^[vFAQ]

1. Cochlear nerves - waves I and II

2. Cochlear nucleus - wave III

3. Superior olivary complex - wave IV

4. Nulclei of lateral lemniscus - wave V

5. Inferior colliculus - waves VI and VII

These peaks occur in most readable form in response to click stimuli over a period of 1 - 10 milliseconds after the stimulus in normal hearing adults.

BERA is resistant to the effects of sleep, sedation, sleep and anesthesia. Its threshold has been found to be within 10dB as elicited by conventional audiometry.

Stenger test | PGI Based MCQ

Stenger test is used to detect:

A. Conductive hearing loss
B. Sensorineural hearing loss
C. Mixed hearing loss
D. functional hearing loss
E. malingering

The Answer is.D. functional hearing loss, E. malingering

Stenger test, teal test and Lombard test are used to detect functional hearing loss.

Stengertest : a test for detecting simulation of unilateral hearing impairment, in which a tone below the admitted threshold is presented to the test ear and a tone of lesser intensity is presented to the other ear. If the subject is feigning a hearing loss, the lesser tone cannot be appreciated.

Tests for malingering:

ChimaniMooss test:  This is nothing but a variation of Weber's test.  Normally in Weber's test the patient hears the best in the occluded ear.  In malingering the patient will not accept to hear better in the occluded ear.

Stenger's test:  This test is based on "Stenger's phenomenon".  In stenger's phenomenon when a listener is presented with the same type of sound in both ears he /she will heara single sound, that too only in the ear which it is louder.

Procedure:  Two tuning forks with frequency of 512 Hz are kept equidistantly from both ears, one should be able to hear equally well in either side.  In malingering say i.e. left ear, even if the tuning fork is moved too close to the left ear, the patient denies that he is hearing in the right side also.

Teal's test:  In this test a vibrating tuning fork is applied over the mastoid process of the so called deaf ear, the patient accepts to hear it.  Then the patient is blind folded and with a non vibrating fork on the mastoid process, the malingering patient claim's to hear the sound.

Lombard's test:  This test is based on "Lombard's principle".  This principle says that one raises his / her voice when speaking in noisy environment.  While performing this test, the patient is allowed to read  a book.  Noise is introduced into the ear.  The noise is gradually increased till the patient raises his / her voice or stops the process of reading.

Erhardt's test:  This test is also known as loud voice test.  In normal person when the ear is occluded with a finger, it dampens the sound but it can still be heard.  Malingerer often denies hearing the sound even when it is loudest.

Stethoscope test:  In this test, one ear piece of the stethoscope is closed with wax and used on the side of deafness.  The funnel shaped chest piece is used to talk to the patient.

The malingerer gets confused and cannot tell whether he is hearing on the right / left side.

Yellow Fever | PGI MCQ

True about yellow fever 

A. I.P. is 10-14 days 
B. Transmitted by Aedes. 
C. It is found in Asia. 
D. Incidence is increased by humidity. 
E. It is a Flavivirus

The Answer is. (B) Transmitted by Aedes; (D) Incidence is increased by humidity; (E) Itis a Flavivirus

* Yellow fever is caused by Flavivirus and is endemic in Africa and America.

* It is prevalent in Africa and SouthAmerica.

* Yellow fever is transmitted by Aedes aegypti.

* Incubation period is 3-6 days.

* A temperature 24° C or over is required for multiplication of virus in mosquito. 

Irregular non-healing ulcer | PGI MCQ

A 47-year-old man with chronic post-thrombotic edema of the left leg has an irregular non-healing ulcer above the medial malleolus. The following is/are true: 

A. The cause of the ulceration is extension of venous thrombosis to the superficial capillary bed 
B. The ulcer is certain to be infected and merits antibiotic treatment 
C. The underlying perforating veins are likely incompetent
D. Isolated saphenous vein incompetence can produce such a situation
E. Immidiate excision of ulcerated area is best  management

The answer is. C. The underlying perforating veins are likely incompetent, D. Isolated saphenous vein incompetence can produce such a situation

The presentation indicates chronic venous insufficiency with stasis ulceration secondary to sustained venous hypertension. The pathophysiology involves leukocyte capillary trapping, an inflammatory reaction, and scarring of the subcutaneous tissues with ischemia of the skin. The stasis ulcer can be managed by occlusive dressing, special boots and elastic support without antibiotics. The location is typical for stasis ulcer due to adjacent underlying incompetent perforator veins. Such a situation can also be seen with isolated saphenous vein incompetence. 

Biosaftey precaution grade 3 | NEET Based MCQs

Biosaftey precaution grade 3 is practiced in labs handling all except? 

A. Human influenza virus 
B. St louis encephalitis virus 
C. Coxiella burnetti 
D. Mycobacterium tuberculosis

Answer. A. Influenza Virus where Biosafety 2 comes into picture.

BIOSAFETY LEVEL 1

This level is suitable for work involving well-characterized agents not known to consistently cause disease in healthy adult humans and of minimal potential hazard to laboratory personnel and the environment

It includes several kinds of bacteria and viruses including E. coli, Chicken pox, a well as some cell cultures and non- infectious bacteria

The precaution includes basic and simple techniques as gloves, eye, facial protections. The laboratory may not be isolated from general traffic areas and ergonomics do not require stringent working SOP’s

BIOSAFETY LEVEL 2

This level is similar to Biosafety Level 1 and is suitable for work involving agents of moderate potential hazard to personnel and the environment.

Includes various bacteria and viruses that cause only mild disease to humans or are difficult to contract via aerosol in a lab setting, such as Hepatitis , influenza A, Lyme disease , Dengue, salmonella mumps, bacillus subtilis, HIV, scrapie, MRSA etc.

^[FAQ] There is trained laboratory personel for working and handling BS 2 SOP’s (SOP = standard operating protocols)

BIOSAFETY LEVEL 3

This level is applicable to clinical diagnostic teaching research or production facilities in which work is done with rare or exotic agents which may cause serious or potentially lethal disease as a result of exposure by the inhalation route.

It includes various bacteria and viruses that can cause severe to fatal disease in humans but for which vaccines or other treatment exist, such as Anthrax, West Nile Virus, SARS, Typhus, JE, TB, Encephalitis, RMSF

Laboratory personnel have specific training in handling pathogehic and potentially lethal agents, and are supervised by competent scientists who are experienced in working with these agents. The laboratory has specialized working and safety mechanisms as ventilations, exhausts, access, recommended safe practices, SOP’s

'Most Common’ cause of intravenous catheter related infection | NEET Based MCQs

Which species pseudomonas is the most common’ cause of intravenous catheter related infection?

A. Pseudomonas cepacia 
B. P aeruginosa 
C. P maltophilia 
D. Burkholderia pseudomallel

Answer. D Burkholderia pseudomallei

• Burkholderia pseudomallei is a type of pseudomonas infection. It causative agent of melioidosis.

• B.pseudomallei also causes chronic pulmonary infection with systemic manifestations that mimic those of tuberculosis, including chronic cough, fever, hemoptysis, night sweats, and cavitary lung disease

• Besides pneumonia, the other principal form of B. pseuclomallei disease is skin ulceration with associated lymphangitis and regional lymphadenopathy

• Spread from the lungs or skin, which is most often documented in debilitated individuals, gives rise to septicemic forms of melioidosis that carry a high mortality rate. 

Cataract Evaluation | PGI MCQs for MD MS Preparations

Cataract is evaluated by

A. Gonioscopy 
B. Tonometry
C. stereoaquity 
D. Contrast
E. Colour vision

The Answer is. (A) Gonioscopy; (B) Tonometry; (E) Colour vision

Pre-operative thorough evaluation should be carried out before surgery. This include

I. (a) General medical condition of the patient to include the presence of serious systemic diseases like DM, HTN,

Cardiac problem, COPD, any potential source of infection in the body such as septic gum, UTI etc.

II. Ocular examination

A thorough examination of eyes including slit-lamp biomicroscopy is desirable in all cases.

a) Retinal function test –

* Perception of light (PL).

* Test for Marcus Gum Pupillary response.

* Projection of rays.

* Two light discrimination test.

* Maddox rod test.

- Electrophysiological study e.g., ERG, EOG and VER and indirect ophthalmoscopy if possible.

b) Search for local source of infection as conjunctival or related organ infections

c) Pre-operative evaluation of intra-ocular pressure – tonometry, gonioscopy – ant. Chamber visualization

Ophthalmaa neonatorum | PGI entrance Preparations

Ophthalmaa neonatorum is caused by 

A. Gonorrhoea
B. H. Influenzae
C. Chlamydia
D. Pseudomonus
E. Staph.aureus

The Answer is.(A) Gonorrhoea; (C) Chlamydia ; (E) Staph aureus

OphthalmicNeonatorumor Neonatal conjunctivitis: is conjunctivitis contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with Neisseria, gonorrhea or Chlamydia trachomatis. Other infections include:

ü The virus - oral and genital herpes

ü Skin - Staphylococcus aureus

ü Bacteria from the mother’s gastrointestinal tract, such as Pseudomonas or Klebsiella

Autism Case MCQ | AIIMS Based MCQ

4-year-old child presents with delayed speech and poor concentration. He is not interested in friends and has difficulty in communication most probable diagnosis in this patient is 

A. Autism 
B. ADHD 
C. Specific learning disability 
D. Mental retardation

The Answer is. A. (Autism)

Autism typically the onset occurs before the age of two and half years. In some cases, the onset may occur later in the childhood. The characteristic features of autism are as follows:

• Marked impairment in reciprocal social and interpersonal interaction, e.g., impairment in making friends and prefers solitary games.

• Marked impairment in language and nonverbal communication.

• Abnormal behavioral characteristics, especially repetitive behaviors. 

Uses the number of females in reproductive years | Crack PGIMER NOV 2016

Which of the following uses the number of females in reproductive years

A. Birth Rate
B. G.F.R
C. T.F.R
D. Maternal mortality rate
E. Gross reproduction rate

The Answer is . (B) GFR; (C) TFR, (E) Gross Reproduction rate

• Reproductive age group woman are involved in G.F.R, TFR, General marital fertility rate (GMFR), Gross

reproduction rate (GRR)

• G.F.R (General fertility Rate)

Number of live birth in an area during the yr

--------------------------------------------------------X 1000

Mid yr female population age 1 5-44 in the same area in same yr

• Maternal mortality ratio =

Total no of female death due to complication of Pregancy, child birth or within

42 days of delivery from puerperal causes in an area during a given yr

-------------------------------------------------------------------------------------------------x 1000

Total no of live birth in the same area and yr

                                No of live birth during the year

• Birth rate= -----------------------------------------------------------------------------x 1000

                                                Mid year population

• TFR (Total fertility rate) represents the average number of children a women would have if she were

to pass through her reproductive years bearing children at the same rates as the women now in each
age group{15 - 45 years is the reproductive age group for women} 

Megaloblastic anemia | Crack PGIMER NOV 2016

Which is the true statement regarding megaloblastic anemia

A. Megaloblastic precursors are present in bone marrow
B. Mean corpuscular volume is increased
C. Serum LDH is increased
D. Thrombocytosis occurs
E. Target cells are found

The Answer is . (A) Megaloblastic precursors are present in bone marrow; (B) Mean corpuscular volume

is increased ; (C) Serum LDH is increased

• Megaloblastic anaemia is due to maturation disorder of Red cells

• Laboratory Features :MCV- increased (> 110 / L)

MCHC - Not elevated : Normal or reduced

MCH   - elevated

• Bone Marrow shows hypercellularity, erythrocyte precursors at different stages of development is found. Increased megaloblast causes ineffective erythropoiesis. In severe anaemia as many as 90% of RBC precursors may be destroyed before theIr release into the circulation (Normal 10-15%). Thereby increased unconjugated bilirubin and lactic acid dehydrogenase

• Reticulocytes, plateletcount and leukocyte count decreased

• Cells are macrocytic, hyperchromic, anisocytosis, hypersegmented neutorphils. BM have decreased myeloid,

erythroid ratio (Normal 3:1)

• Target cells result due to increased ratio of RBC surface area to volume, seen in hemoglobin disorders,

thalassemias, liver disease

Note: In megaloblastic anemia nuclear maturation lags behind cytoplasmic maturation

Tone decay test and SISI test | Crack PGIMER NOV 2016

Tone decay test and SISI test are used to detect:

A. Cochlear and retrocochlear pathology respectively
B. retrocochlear and cochlear pathology respectively
C. Cochlear pathology
D. Retrocochlear pathology
E. functional HL

The Answer is. B. retrocochlear and cochlear pathology respectively

These are special test of hearing. They are used in patients with sensorineural hearing loss to further differentiable a cochlear or a retrocochlear cause.

Special test of hearing include

Cochlear tests	SISI Test ABLB test
Retrocochlear tests	Tone decay test Speech discrimination score

SISI (Short Increment Sensitivity Index) is designed to test the ability to recognise 1 dB increase in intensity during a series of bursts of pure tones presented 20 dB above threshold. The SISI test differentiates between cochlear and retrocochlear disorders. A patient with a cochlear disorder will be able to perceive the increments of 1 dB, a patient with a retrocochleardisorder will not.

Tone Decay Test: the sounding of a continuous tone at threshold for 1 min; if the intensity must be increased by more than 5 dB for continued perception, it is indicative of a neural hearing loss

PGI Quest in Delhi 16 Sept Onwards

Dear Doctor 

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Join it to strengthen the preparation for the ultimate goal.
The only PGI oriented crash course. Classroom program of Covering 6 Major subjects in 6 days.
Dates: 16-17-18 Sept. (Fri-Sat-Sun)
23-24-24 Sept. (Fri-Sat-Sun)
Subjects: Micro-Patho-PSM-Biochem-Pharma-Surgery.

Regards
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NIME 9914619911
8699014009

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