Tubercular Osteomyelitis | NEET Based MCQ

Which of the following is NOT TRUE regarding tubercular osteomyelitis? 

A. It is a secondary TB 
B. Periosteal reaction is seen 
C. Sequestration is uncommon 
D. Inflammation is minimum

Answer. B, (Periosteal reaction is seen)

Tubercular osteomyelitis

• The spine is the commonest site of bone and joint tuberculosis, constituting about 50 percent of the total number of cases. The next in order of frequency are the hip, the knee and the elbow.

• Tubercular osteomyelitis more commonly affects the ends of the long bone, unlike pyogenic osteomyelitis which affects the metaphysis.

• Bone and joint tuberculosis is always secondary to some primary focus in the lungs, lymph nodes, etc. The mode of spread from the primary focus may be either hematogenous or by direct extension from a neighboring focus.

• Fibrous ankylosis is a common outcome of healed tuberculosis of the joints except in the spine where bony ankylosis follows more often.

• A tubercular osteomyelitis presents as a well-defined area of bone destruction, typically with minimal reactive new bone formation. This is unlike a pyogenic infection where reactive periosteal new bone formation is an important feature.

Tuberculosis may cause a chronic granulomatous osteomyelitis.

• The most often affected vertebrae are T10 – L1

• Initial X-Ray investigation may only reveal osteoporosis with narrowing of the disc space

• As the condition proceeds radiology shows bone destruction without the periosteal reaction so typical of pyogenic infection.
• In addition to narrowing of the disc space, collapse of the anterior portions of the vertebral bodies and sometimes the delineation of a clear paravertebral abscess.

• There is an increased erythrocyte sedimentation rate and a positive Mantoux test.

• Pure tuberculous osteomyelitis involving flat membranous bone like scapula is extremely rare.

• Characteristic features of acute bacterial infection (osteomyelitis)

— Periosteal reaction is characteristic

— Sequestrum is seen

— Involucrum is seen

— Abscess formation with signs of inflammation 

Bulbar Palsy | PGI based MCQs

Bulbar palsy is seen in 

A. Myesthania gravis 
B. Motor neuron disease
C. Arsenic poisoning 
D. Lead poisoning 
E  Polio

The Answer is. (A) Myasthenia gravis ; (B) Motor neuron Disease ; (E) Polio

* Bulbar palsy is the weakness of LMN type of muscles whose cranial nerve nuclei lie in the medulla (the bulb). Weakness of bulbar muscles is caused by disease of:

— Lower cranial nerve nuclei (e.g. Motor Neuron Disease (MND))

—Ninth to twelve cranial nerves.

— Their neuromuscular junctions (e.g. myasthenia gravis, botulism)

----The muscles themselves

• Causes of IXth to XlIth nerve lesions

(i) With in the brain-stem (ii) At skull base

— Infraction                        — Ca nasopharynx

----Syringobulbia — Glomus tumour

— Motor neuron disease    — Neurofibroma

— Polio myelitis                   — Jugular venous thrombosis

                                                — Trauma

(iii) Within the neck and nasopharynx

— Ca Nasopharynx

— Metastases

----Polyneuropathy

— Trauma.

Causes of pseudobulbar palsy :

•MND

• Multiple sclerosis

• CVA (Typically multi-infarct dementia)

• Following Head injury

In pseudobulbar palsy

* Jaw jerk—brisk.

* Palatal and gag reflex – preserved

* Stiff, slow, spastic tongue

* Dysarrthria with a stiff, slow voice sounding dry and gravelly

* Dysphagia. 

Anterior spinal artery thrombosis | PGI based MCQs

Anterior spinal artery thrombosis is characterized by: 

A. Loss of pain & touch 
B. Loss of vibration sense 
C. Loss of power in lower limb 
D. Sphincter dysfunction

E.  venous plasma leakage

The Answer is. (A) Loss of pain & touch; (C) Loss of power in lower limb (D) Sphincter dysfunction

* Anterior spinal artery (single) supplies anterior 2/3^rd of spinal cord, while posterior columns are supplied by posterior spinal arteries (paired).

* Lesion (thrombosis, infarction) of anterior spinal artery causes quadriplegia or paraplegia and dissociated sensory loss affecting pain and temperature; but sparing vibration and position sense and loss of sphincter function. It is sudden in onset and sharply demarcated.

* Vibration senses affected with the lesion of posterior spinal artery.

True about PNH | PGI based MCQs

True about PNH is/are :

A. Hypocellularmarrow
B. Budd-chairi syndrome 
C. Thrombosis 
D. LAP Score low
E. venous plasma leakage

The Answer is. (B) Budd-chiari syndrome; (C) Thrombosis; (D) LAP Score low

• Three common manifestations of PNH

— Hemolytic anemia (intravascular)

— Venous thrombosis

— Deficient haematopoiesis (pancytopenia)

•Bone marrow appears normocellular but in vitro marrow progenitor areabnormal in PNH.

• Budd-chiari syndrome is hepatic vein thrombosis can occur in PNH.

• LAP score is low. 

Apple jelly nodules on nasal septum | AIIMS Based MCQ

Apple jelly nodules on nasal septum are seen in: 

A. Leprosy 
B. Syphilis 
C. Tuberculosis 
D. Wegner’s granulomatosis

Answer. C. Tuberculosis

Lupus vulgaris is a chronic progressive form of tuberculosis. Most commonly, it involves skin. It can also involve nasal septum. Clinically the patient presents with nasal discharge, nasal bleeding and crusting in nose. Apple jelly nodules on nasal septum are characteristic finding of lupus vulgaris. The diagnosis is established by nasal biopsy.

Investigation of choice for dysphagia for solids | PGI based MCQs

Investigation of choice for dysphagia for solids: 

A. Barnum swallow 
B. Endoscopy 
C. X-ray chest 
D. C.T. scan
E. MRI

 The Answer is. (A) Barnum swallow ;(B) Endoscopy• Dysphagia for solid food may be due to mechanical causes like
— Carcinonia                       — Peptic and other beingn strictures
— Lower esophageal ring — Thediagnostic procedure of choice
• Ba. Swallow                       • Esophagogastroscopy• Endoscopic biopsy           • For Motor dyphagia investigation — Ba-Swallow, esophageal motility studies

Pancreatic carcinoma | PGI based MCQs

True about pancreatic carcinoma 

A. Head is the most common site 
B. Pain is the most common symptom 
C. Obstruction of bile & pancreatic secretion is common 
D. 80% cases respond well to resection
E. all are true

The Answer is. (A) Head is the most common site ;(B) Pain is the most common symptom

(C) Obstruction of bile &pancreatic secretion is common

• Pancreatic carcinoma occurs twice as frequently in the pancreatic head (70%) as in body (20%) or tail of the gland (10%) of the cases.

• Jaundice due to billiary obstruction is found in > 80% of patients having tumour in pancreatic head.
Complete surgical resection of the tumours offers only effective treatment. But unfortunately such curative operations are possible only in 10-15% of cases. 

True regarding cancer colon | PGI based MCQs

True regarding cancer colon 

A. Obstructive features are more common with right colon 
B. 40% cases at presentation show liver metastasis 
C. Resection possible in25% cases 
D. More common in AIDS patients
E. mortality is as high as 60%

The Answer is. (B) 40% cases at presentation show liver metastasis

• Liver is the most common site of metastasis. Patient may present for the first time with liver metastasis, It is involved in 2/3rd of cases at the time of death; and 1/3rd of cases of recuring colorectal carcinoma.
• Patient with solitary liver metastasis with clinical or radiological evidence of additional tumour involvement should be considered for liver resection.

• Anal Cancer risk is increased both in men and women with AIDS probably immunosuppression permits more severe human parpilloma virus infection.

• Approx 20% of pt’s have metastatic disease at the time of initial diagnosis and another 30% eventually develop metastasis. Long term survival is 55%. Resection of isolated (1 to 3) liver or lung metastasis may result in long-term (5 years) survival in 20-40% of cases.

• Combination therapy provides significant improvement in tumour response rate (40%).

• Almost 90% of the patients have tumours that can be resected completely and mortality rate ranges from 2% to 10%.

Features of Carcinoid | PGI based MCQs

Features of carcinoid are 

A. Wheezing 
B. Cyanosis 
C. Flushing 
D. Mitral valve involvement 
E. Clubbing

The Answer is. (A) Wheezing ; (C) Flushing

• The important clinical Features of carcinoid :

---- Flushing and diarrhea : M.C. symptoms.

— Cardiac manifestations e.g. fibrosis in endo-cardium primarily on right side. Tricuspid valve (ventricular aspect) being commonly affected. Heart failure, tricuspid regurgitation,  pul. stenosis occur.

• Lt sided lesion can also occur.

— Asthma like symptoms or wheezing and pellgra like skin lesions also appear. 

Predisposing factors for Carcinoma Oesophagus | PGI based MCQs

Predisposing factors for carcinoma oesophagus: 

A. Tylosis
B. Plummer vinson syndrome 
C. Reflux esophagitis 
D. Lye stricture
E. lead intoxication

The Answer is. (A) Tylosis; (B) Plummer vinson syndrome (C) Reflux esophagitis ; (D) Lye stricture
Aetiological Factors associated with Oesophageal carcinoma:

Age – most patients over 60 yrs	Tobacco smoking and heavy alcohol use – synergestic effect [MCQ] Tobacco: esophageal adenocarcinoma
Heredity	Corrosive injury to the esophagus by swallowing strong alkalines (lye) or acids
Human papillomavirus	Dietary substances, such as nitrosamines
A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer. Plummer–Vinson syndrome (anemia and esophageal webbing)	Tylosis and Howel–Evans syndrome (hereditary thickening of the skin of the palms and soles)
Radiation therapy for other conditions in the mediastinum	Coeliac disease predisposes towards squamous cell carcinoma
Thermal injury as a result of drinking hot beverages or eating hot food	Achalasia
H. pylori induces chronic gastritis, which is a risk factor for reflux, which in turn is a risk factor for esophageal adenocarcinoma.

Cognitive disorders | PGI based MCQs

Cognitive disorders are 

A. Intellectualization 
B. Depersonilization
C. Dementia 
D. Delirium
E. multiple personality disorder

The Answer is. (C) Dementia ; (D) Delirium

• Cognitive disorders are characterized by syndromes of Delirium, Dementia and Amnesia

• Intellectualization is an ego defense mechanism, defined as excessive use of intellectual processes (‘logic’) to avoid affective expression (‘emotion’).

• Depersonalization is characterized by alteration in perception or experience of self so that the feeling of one’s own reality is temporarily lost or changed. It is an ‘as if ‘ phenomena. 

Dissociative disorder Features | PGI based MCQs

Following are included in Dissociative disorder 

A. Multiple personality disorder 
B. Fugue 
C Hypochondriasis 
D. Somatization disorder 
E. OCD

Ans (A) Multiple personality disorder (B) Fugue

Dissociative disorders are characterized by

- Disturbance in the normally integrated functions of consciousness, identity and/or memory

- Onset is sudden disturbance is temporary, and recovery is often abrupt

- Often, there is a precipitating stress before the onset There is a clear temporal relation between stressor and the onset of illness

- A secondary gain.

- Physical examination and investigation s don’t reveal any abnormality.

Following are the common clinical types

- Dissociative Amnesia

- Dissociative fugue

- Multiple personality disorder

- Trance and possession disorder

- Others e.g. Ganser’s syndrome (hysterical dementia commonly found in prison inmates. The characteristic feature is vorbeireden which is also called approximate The Answer is.s)

• Somatization disorder hypochondriasis are Somatoform disorder 

Vascular dementia characteristic | PGI based MCQs

Vascular dementia is characterized by:

A. Disorientation
B. Memory deficit
C. Emotional liability
D. Visual hallucination
E. Personality Deterioration

The Answer is. A. Disorientation, B. Memory deficit, C. Emotional liability, E. Personality Deterioration

-       Vascular dementia is diagnosed by following features in addition to general features of dementia

-       Development of multiple cognitive deficits manifested by both.

-       Memory impairment

-       One or more of following cognitive disturbances- aphasia, apraxia, Agnosia disturbances in executive functioning.

-       Significant impairment in social or occupational functioning.

-       Focal neurological signs and symptoms.

-       Neurological deficit doesnot occur exclusively in the course of delirium.

Clinical Case Involving Acetyicholinesterase | AIIMS Based MCQ

After an individual is admitted to the hospital, it determined that he displays a variable weakness of cranial nerve and limb muscles but shows no clinical signs of denervation from tests, which include dectromyogram (EMG) recordings. This disorder was partially reversed by the administration of drugs that inhibit acetyicholinesterase. Which of the following is the most likely diagnosis? 

A. Multiple sclerosis (MS) 
B. Amyotrophic lateral sclerosis (ALS) 
C. Myasthenia gravis 
D. Combined system disease

Answer. C. Myasthenia gravis

Myasthenia gravis is an autoimmune disease that causes cranial nerve and limb muscle weakness by producing antibodies that act against the nicotinic receptor at the neuromuscular junction. The result is that the action of nerve fibers that innervate skeletal muscle are affected producing loss of the effects of ACI at the. neuromuscular junction. The net result is a reduction of the size of the action potential in the muscle, producing a weakness in the affected muscle. This disorder is reversed by administration of drugs that inhibit the efizyme, acetyicholinesterase, that degrades ACh. Multiple sclerosis, ALS, and combined systerndisease (see the chapter entitled “The Spinal Cord11) involve damage to axons and/or nerve cells within the CNS, producing much more profound damage to motor functions and, in the case of combined system disease, damage to both motor and sensory systems. Muscular dystrophy is typically characterized, in part, by progressive weakness of muscles and degeneration of the muscle fibers. The other disorders listed all involve disorders affecting the CNS, and thus, the symptoms associated with these disorders differ significantly from those described in this case. Excessive release of ACh is not a realistic event that is likely to occur (except from the bite of a black widow spider). In theory, if it were to occur, therc is no reason to believe that muscular weakness would be a symptom. Instead, there would be some rigidity and muscle spasms. 

The ‘E’ in ETDRS stands for | AIIMS Based MCQ

The ‘E’ in ETDRS stands for:

A. Elective treatment 
B. Extended Rx 
C. Early treatment 
D. Eye test drum review study

Answer. C. Early treatment

The Early Treatment Diabetic Retinopathy Study (ETDRS) evaluated the effectiveness of laser treatment for the leaking phase of diabetic retinopathy. Patients with macular edema (leaking near or within the center part of the retina, that part which is used for reading, driving etc, see photo), were randomly assigned to receive either laser treatment to the leaking microaneurysms or were simply observed without treatment The results showed that timely laser treatment ieduced th risk of moderately severe visual loss by about three-fold at three years after treatment and significantly increased the likelihood of moderate visual gain. More importantly, this study provides the treating retinal specialist with  a detailed guide as to when laser therapy is necessary based upon the location of leaking areas. With this knowledge, we can treat patients at the appropriate time so as to prevent vision loss and conversely, avoid unnecessary treatment for those for whom it is not beneficial. 

Commonest form of oesophageal atresia | AIIMS Based MCQ

In the commonest form of oesophageal atresia: 

A. The lower pouch opens into the trachea 
B. The upper pouch opens into the trachea 
C. Both lower and the upper pouch open into the treachea 
D. Both lower and the upper pouch have a blind ending

Answer.  A. The lower pouch opens into the trachea

In the most common type of tracheo-oesophageal fistula the upper part of oesophagus ends blindly and the lower part of oesophagus is connected to trachea with a fistula. In this type of esophageal atresia the infant has drooling of saliva and with the first feed there is overflow of milk and saliva. 

Clinical Case Of Sepsis | AIIMS Based MCQs

A 45-year-old woman presents to the emergency room with altered mental status. On physical examination, her temperature is 102°F, pulse is 120/mm, and respirations are 24/mm. She has increased fremitus and bronchial breath sounds at the left base. Neurologic exam reveals no focal deficits, but the patient is disoriented to place and time. Chest radiograph confirms the diagnosis of pneumonia. The patient’s PACO2 is 30 mmHg. Which of the following best categorizes this patient’s illness? 

A. The patient has bacterernia 
B. The patient has systemic inflammatory response syndrome 
C. The patient has sepsis 
D. The patient has severe sepsis

Answer. D. The patient has severe sepsis

Classsical deifinition based MCQ’s related to topic:

Bacteremia is the presence of bacteria in blood culture bottles. SIRS (systemic inflammatory response syndrome) is not a diagnosis but a response to a variety of clinical situations (i.e., infection, burns, trauma, pancreatitis) and is characterized by two or more of the following:

(1) temperature of >100.5°F or <97°F,

(2) heart rate of > 90/min,

(3) respiratory rate of >20/min

(4) Paco2 of <32 mmHg,

(5) white blood cell count of>l2,000/-Q or <4,000/PL or >10% immature (band) forms.

Sepsis is a systemic response to infection manifested by two of the five described conditions of SIRS.

Severe sepsis is sepsis associated with organ dysfunction, hypoperfusion, or hypotension (i.e., lactic acidosis, oliguria, altered mental status). Septic shock is sepsis-induced hypotension despite adequate fluid resuscitation.

Sepsis- induced hypotension is a systolic blood pressure of<90 mmHg or a reduction of>40 mmHg from baseline in the absence of other causes to explain the hypotension.

MODS is the presence of organ dysfunction in an acutely ill patient such that homeostasis cannot be maintained without intervention. 

Blow out # orbit is characterized by | PGI based MCQs

Blow out # orbit is characterized by 

A. Diplopia
B. Tear drop sign 
C. Forced duction test 
D. Exophthalmos 
E. All of above

The Answer is. (A) Diplopia; (B) “Tear drop” sign ; (C) Forced duction test

Orbital blow-out fractures are usually the result of a direct blow to the orbit. This results in a sudden increase in the intra-orbital pressure which in turn causes decompression by fracture of one or more of the bounding walls of the orbit.

Associated clinical findings may include:

Enophthalmos - due to increased orbital volume

Diplopia - due to extra-ocular muscle entrapment

Orbital emphysema - especially when fracture is into an adjacent paranasal sinus

Malar region numbness - due to injury to the inferior orbital nerve

Blow-out fractures can occur through one or more of the walls of the orbit:

1.       Inferior (floor): most common, usually associated with medial wall #.

In children: trapdoor fracture (fracture bone springs back to place)

2.       Medial wall (lamina papyracea): prolapse of orbital fat into ethmoid air space is typical

3.       Superior (roof): uncommon, associated with CSF leaks and meningitis

4.       Lateral wall (rare)

Signs:

Orbital emphysema: black eyebrow sign

Herniation of orbital fat inferiorly: tear drop sign

It is recommended to perform the forced duction test under sedation, local, or general anesthesia:  to check for entrapment of the soft tissues, in case extra ocular muscles are not functioning

Extracapsular cataract extraction (ECCE) | PGI based MCQs

Advantages of extracapsular cataract extraction (ECCE): 

A. Less chance of vitreoushemorrhage and RD
B. Decreased chances of CME (cystoid macular edema) 
C. Can be used in traumatic lens dislocation 
D. Minimal endothelial damage 
E. Suture-less surgery

The Answer is. (A) Less chance of vitreous hemorrhage and RD

(B) Decreased chances of CME (cystoid macular edema)

(D) Minimal endothelial damage

Comparison between extracapsular cataract extraction(ECCE) against intracapsular cataract extraction
(ICCE):

Features	ECCE	ICCE
1. Age	Can be performed at all ages	can’t be performed in younger age as zonuls are strong
2. Posteror chamber IOL implantation	Yes	No
3.Marked subluxated and dislocated lens	Absolute contraindication	Absolute indicatin
4 Eye camp, lack of facilities and trained surgeon for microsurgery	Not suitable	Advantageous
5 Simple cheap easy less time consuming	Not observed in ECCE	Seen in ICCE
6.Post operative Complications
Cystoids macular edema	âed incidence	More incidence
Retinal detachment	Less common	More common
Vitreous touch synd: papillary black, herniation of AC
Endophthalmitis	Less common	More common
After cataract	Common	Not seen
Vitreous loss	Less common	More common
Endothelium damage	Less common as due to (PC IOL)	Common when antechamber IOL