Auer rods and schistocytes Clinical MCQ | PGI based MCQs

A 29-year-old woman complains of tiredness, especially during activity. On examination the patient appears pale. Auer rods and schistocytes can he seen on peripheral blood smear. The patient is referred for a bone marrow biopsy and the extracted cells are sent for cytogenetic analysis. The most likely results are: 

A. t(8:2l) 
B. t (15:17) 
C. t(9:22) 
D. t(14;18) 
E. t (8;14)

The answer is. B. t (15:17)

This patient is suffering from an acute promyelocytic leukaemia, a subtype (M3) of AML. It is due to t(15;17) translocation  which causes the proliferation of promyelocytes.

Complications include: diffuse intravascular coagulation, potentially leading to massive haemorrhage.

The t(8;21) abnonnality part of the acute myelogenous leukaemia disorders (M2 variant) and is associated with variable WCC, anaemia, neutropenia and thrombocytopenia.

The t(9;22) translocation occurs in CML and in 9 per cent of patients is associated with the Philadelphia chromosome. Patients have elevated WCC, basophils, neutrophils and myelocytes with a hypercellular bone marrow.

A t(14;18) karyotype occurs in follicular lymphoma, a tumour of follicles consisting of centrocytes.

A t(8;14) abnormality occurs in Burkitt’s lymphoma secondary to a latent Epstein—Barr (EBV) infection and usually affects the maxilla or mandible. 

True about cystichygroma | PGI based MCQs

True about cystichygroma

A. Congenital sequestration of lymphatics 
B. Resolves spontaneously by 5 year of age 
C. Common in upper 1/3rd of lateral neck 
D. Surgery is the treatment of choice
E. usually diagnosed in adolescent or young adults

The Answer is. (A) Congenital sequestration of lymphatics (D) Surgery is the treatment of choice

• The sequestration of a portion of Jugular lymphatic sac from the lymphatic system accounts for the development of cystic hygroma.

• It usually manifests in the neonate or early infancy ; occasionally present at birth.

• Swelling is in lower third of the neck, as it enlarges it passess upwards towards the ear. Often posterior triangle of neck is mainly involved. 

Tubeless pancreatic function tests | PGI based MCQs

Tubeless pancreatic function tests includes

A. Lundh meal test 
B. Breath tests
C. Fecal elastase 
D. Secretin test
E. Fecal fat test

The answer is. B. Breath tests, C.Fecal elastase, D. Secretin test

Pancreatic Function Tests

Tubeless Tests

Fecal Tests

Fat stain

72-hour fat content

Chymotrypsin, trypsin, elastase content

Indirect Tests

Bentiromide test

Pancreolauryl test

Breath tests

Tube Tests

Lundh test meal

Secretin or cholecystokinin test

Conjugated hyperbilirubinemia | PGI based MCQs

Conjugated hyperbilirubinemia in seen in 

A. Rotors synd. 
B. Dubin Johnson syndrome
C. Gilbert’s syndrome
D. Breast milk jaundice 
E. CrigglerNajjar syndrome

The Answer is. A. Rotors synd.[Refer Figure # 9]

Crigler-Najjar syndrome

There are actually two types of Crigler-Najjar, and both are they different clinically.

Type I CN

-    Rare

-    autosomal recessive disorder

-    Absent UGT1A1 activity. UGT1A1 is a liver enzyme that participates in bilirubin processing

-    The unconjugated bilirubin backs up into the blood, producing severe jaundice and icterus.

-    Usualy fatal in the neonatal period unless liver transplant is done

Type II CN

-    autosomal dominant disorder

-    Some UGT1A1 activity is seen (the enzyme is only capable of forming monoglucuronidated bilirubin).

-    Non fatal, good prognosis.

Gilbert syndrome

-    Common disorder, autosomal recessive

-    Decreased activity of UGT1A1 (but more than Type II Criggler najjar)

-    Unconjugated hyperbilirubinemia, with no clinical consequence

Dubin-Johnson syndrome

-    Autosomal recessive disorder

-    Conjugated bilirubin in the blood.

-    Caused by a defect in secretion of bilirubin glucuronides (which is already conjugated!) across the canalicular membrane (patients are missing a canalicular protein that transports bilirubin glucuronides into bile).

-    Liver biopsy: darkly pigmented because of coarse granules within the hepatocyte cytoplasm.

-    Most patients are asymptomatic (except for yellow skin)

Rotor syndrome

-    Autosomal recessive disorder

-    Conjugated bilirubin in the blood.

-    Unknown defect

-    Asymptomatic (except for mild jaundice)

Must remember:

1.       CD ROM (Conjugated – Dubin, Rotor)   |   Use CNG: (Unconjugated – Criggler Najjar, Gilbert)

2.       All are AR except type II CN

ACE inhibitors | PGI based MCQs

ACE inhibitors cause 

A. Persistent cough 
B. Taste changes 
C. First dose hypotension 
D. Ankle edema 
E. Angioedema

The Answer is. (A) Persistent cough ;(B) Taste changes; (C) First dose hypotension: (E) Angioedema:

• ACE inhibitors causes

— Persistent cough                              — Hyperkalemia, proteinuria

— Dysguesia due to captopril           — Granulocytopenia

— Anglo-edema                  — Rash, urticaria

— First dose hypotension — Fetotoxicity

• First dose hypotension is uncommon in Lorsartan, less common in Enalapril, Lisinopril.

• ActiveACE inhibitors (not converted to metabolite) are

— Captopril

— Lisinopril

Necrotizing Fasciitis | PGI based MCQs

The following statement(s) is/are true for necrotizing fasciitis. 

A. Mortality rates as high as 40%
B. The infection involves only the superficial fascia, sparing the deep muscular fascia 
C. An impaired immune system is a common factor predisposing to this condition 
D. The infection is usually polymicrobial 
E. Necrotizing fasciitis is most likely to develop in the face of impaired fascial blood supply

The Answer is: A. Mortality rates as high as 40%, C. An impaired immune system is a co tor predisposing to this condition, D. The infection is usually polymicrobial. E. Necrotizing fascitis is most likely to develop in face of impaired fascial blood supply

Necrotizing fascitis is an uncommon complication of the deep and superficial fascia that is as with mortality as high as 40% in many cases. Many underlying disease processes predispose to necrotizing fascitis, three common factors are invariably present:

1) impairment of the immune system; 2) compromise of fascial blood supply

3) presence of microorganisms [MCQ] – staph, strept, enteric bacteria, and few gm –ve (m/c is polymicrobial)

Some microorganisms possess virulence factors that, in conjugation with an underlying host predisposition, allow the necrotic process to occur without dependence on other bacteria. Example: clostridia, Pseudomonas, and Aeromonas. 

Lipid bilayer of cell wall | PGI based MCQs

True about lipid bilayer of cell wall 

A. Asymmetrical arrangement of cell wall component 
B. Lateral diffusion 
C. Symmetrical arrangement of cell wall components 
D. Not made up of amphipathic lipids 
E. it is permeable to ions and other water soluble molecules

The Answer is. (A) Asymmetrical arrangement of cell wall component; (B) Lateral diffusion:

• Membranes have inside-outside asymmetry or transverse asymmetry. The causes:

— Asymmetric distribution of lipids in two monolayers

— Asymmetric locations of protein and oligosaccharides

— Asymmetric orientation of transmembrane proteins across the bilayer

• There is regional asymmetry in membrane.

• Lipids are amphipathic in nature

• Movement of membrane lipids in the lipid bilayer are

— Lateral diffusion

— Rotation

— Flexion

— Flip-flop

* The lipid bilayer is particularly impermeable to most water soluble or hydrophilic moleciules and  ions, to maintain the electrical potential and regulate ion concentrations across membranes

Uses of Salbutamol | PGI based MCQs

Uses of salbutamol are/is :

A. Acute asthma 
B. Premature labour 
C. Bronchitis 
D. Asthma prophylaxis
E. Pulmonary hypertension

The Answer is. (A) Acute asthma ; (B) Premature labour

• Salbutamol is selective β2-agonist. It causes bronchodilatation, vasodilatation and uterine relaxation without producing significant cardiac stimulation, So, it is used in :

— acute asthma

— Premature labour as uterine relaxani .

• For prophylaxis of asthma drug used

---Mast cell stabilizers

----Glucocortiocoids.

Incised wound& heat rupture | PGI based MCQs

Difference between incised wound& heat rupture, favoring heat rupture are

A. Margins well defined 
B. Small &multiple wounds 
C. Nerves &vessels around are visible in floor 
D. Seen only over scalp
E. shows granulation tissue formation

The Answer is. (B) Small &multiple wounds; (C) Nerves &vessels around are visible in floor

• Heat Rupture can occur either before or after death produced by splitting of the soft parts. These splits may be any where, but usually seenover extesor surface and joints. Ruptures occur superficially and resemble laceration or incised-like wound. They can be differentiated by

(i) Absence of bleeding in wound and surrounding tissues

(ii) Intact vessels and nerves in the floor.

(iii) Irregular margins

(iv) Absence of bruising or other signs of vital reactions in the margin. 

Good prognosis in schizophrenia | AIIMS Based MCQ

Good prognosis in schizophrenia is indicated by:

A. Soft neurological signs 
B. Affective symptoms
C. Emotional Blunting 
D. Insidious onset

The Answer is. (B). Affective symptoms

Good Prognostic Factors	Poor Prognostic Factors
(1) Late Onset                                      (2) Catatonic features        (3)Pyknic Built                       (4) No Family history (5)Acute onset                      (6) Emotions are preserved (7)Type I	(1) Younger age of onset    (2) Disorganized type (3) Asthenic built (4) Family history present (5) Chronic type (6) Blunting of affect or atypical Feature Present (7) Type II

Clearance of a substance | NEET Based MCQ

What is the clearance of a substance when its concentration in plasma is 10mg./dl, its concentration in urine is 100 mg./dl. and urine flow is 2 ml./min.:

A. 2 ml. / min 
B. 5 ml. / min.
C. 10 ml./min. 
D. 20 ml./mm.

The Answer is  D. 20 ml. / min.  

• NOTE: Clearance = concentration in urine X Urine flow

concentration in plasma

= 100mg./dl.X2ml./min.

l0mg./dl.

=20 ml. /min.

Glucose uptake by facilitated diffusion | AIIMS Based MCQ

Glucose uptake by facilitated diffusion occurs in the cells of;

A. Intestinal epithelium 
B. Kidney
C. Brain 
D. Skeletal muscle

The Answer is C. Brain  

• NOTE: In brain, the glucose uptake mostly occurs by the process of facilitated diffusion which involves carrier proteins transporting the glucose into the cells, along its concentration gradient without requiring energy for

the process. (MCQ)

• In muscle and adipose tissue, the glucose uptake is dependant on insulin. (MCQ)

• In kidney and epithelial cells of small intestine glucose uptake mainly occurs by secondary active transport (sodium-glucose cotransport). (MCQ)

• REMEMBER: In contrast to facilitated diffusion, active transport occurs against the electrical and chemical gradient and requires energy. (MCQ)

Dales vasomotor reversal | PGI based MCQs

Dales vasomotor reversal 

A. Stimulation of alpha-I receptors 
B Stimulation of alpha-2 receptors 
C. Stimulation of beta-I receptors 
D. Stimulation of beta-2 receptors
E. stimulation of beta 3 receptors

The Answer is. (D) Stimulation of beta-2 receptors

— Adrenaline acts on a1, a2, β1 and β2 and receptors and weak β3 action while at low concentration continue to act on β receptor When a-blocker is given to patient on adrenaline the a-blockers block the pressor action of adren1ine and then it prn4nres only fall in BP due to β2-mediated vasodilation called casomotor reversal of dale.

Drugs inhibiting formation of purines | PGI based MCQs

Drugs inhibiting formation of purines :

A. 5-FU 
B. 6- mercaptopurine
C. Hydroxyurea
D. Methotrexate 
E. Cytosine arabinoside

The Answer is. (B) 6- mercaptopurine , (D) Methotrexate

• The purine antagonists are : 6 Mercaptopurine (6-MP)

                                Thioguanine (6-TG)

                                Azathiprine

• 5-FU cytnine arabinncid arepyrimidine antagonist

•Methotrexate is a folate antagonist that inhibit dihydrofolate reductase enzyme required for tetrahydrofolate

formation Tetrahydrofolate is used in Purine synthesis. Methotrexate limits the tetrahydrofolate available for purine synthesis. 

Anti Tubercular drug metabolism under genetic control | PGI based MCQs

Which antitubercular drug metabolism is under genetic control

A. Rifampicin 
B. INH 
C. Cyclosporine 
D. PZM 
E. Kanamycin

The Answer is. (B) INH

• INH is extremely metabolized by liver by acetylations and metabolites are excreted in urine. The rate of

acetylation of INH is under genetic control. The variations.

Fast acetylation

Slow acetylation note:

Rifampicin is metabolized in in liver to an active metaholite which is excreted mainly in bile and some in urine.
• Pyrizinamideis extensively metabolized in liver excreted in urine

• Kanamycin excreted unchanged by the kidney

Painless lower GI bleed | PGI based MCQs

Painless lower GI bleed 

A. Meckle’s diverticulum 
B. Rectal polyp 
C. Anal fissure 
D. Ac. Appendicitis
E. Deficiency of intrinsic factor

The Answer is. (A) Meckle’s diverticulum; (B) Rectal polyp

• Painless lower GI bleeding in a child is seen with :

— Rectal polyp

— Meckel’s diverticulum

---- Piles secondary to vascular malformation

* In Meckel’s diverticulum, haemorrhage occurs almost below 10 yrs and invariably results from peptic ulceration of ileal mucosa adjacent to the meckel’s diverticulum, lined with gastric mucosa. Diagnosis established by isotope scanning with technetium-99.

• Though piles occur in all ages but uncommon below 20 yrs.

• Bleeding due to anal fissure associated with severe pain. 

Peripheral edema in CCF | PGI based MCQs

Peripheral edema in CCF is due to: 

A. Increased sympathetic tone 
B. ANP (atrial natriuretic peptide) 
C. Increased hydrostatic pressure 
D. Pulmonary hypertension
E. all of above

The Answer is. (A) Increased sympathetic tone, (C) Increased hydrostatic pressure:

* Oedema in CCF is due to :

- Activation of Renin angiotensin system

- Increased sympathetic tone via intrinsic renal mechanism

- Increased capillary hydrostatic pressure.

- Chronic hypoxia tnay cause injury to capillary wall causing increased capillary permeability.

* Atrial Natri-uretic peptides released from atria in response to volume expansion This peptides cause increased

GFR and inhibit sodium reabsorption..

— Circulating units of ANP and BNP are elevated in CCF but obviously not sufficient to prevent edema formation and they evoke compensatory response tending to reduce cardiac load (preload and after load) by vasodilatation and by enhancing sodium and water excretion

---- In oedematous state there is abnormal resistance to actions of Natriuretic peptides. 

Enterocutaneous Fistula | PGI based MCQs

True about enterocutaneous fistula 
A. High output fistula drains 500 mI/day 
B. Malignancy is most common cause 
C. Fluid &electrolyte loss can occur 
D. No skin damage
E. may occur following tubercular infection

The Answer is. (C) Fluid & electrolyte loss can occur 

• Causes of enterocutaneous fistula

— Following operation of gangrenous appendicitis and draining of appendicular abscess

— Malignancy (carcinoma colon)

— Tubercular enteritis.

• Type of enterocutaneous fistula

—Those with high output > 1 liter /day.

--- Those with low output < 1 liter /day.

Features

• Discharge            • Excoriation of skin           • Fluid and electrolyte imbalance e.g. hypokalemia 

Carcinoma in the medial portion of the lower lip Clinical MCQ | AIIMS Based MCQ

A carcinoma in the medial portion of the lower lip is most likely to first metastasize via which of the following lymph nodes? 

A. Submandibular lymph nodes 
B. Parotid lymph nodes 
C. Superficial cervical lymph nodes 
D. Submental lymph nodes

Answer. D. Submental lymph nodes 

• Lymph from the medial portion of the lower lip preferentially drains through the submental nodes in the chin and metastases may first appear here.

• Lymph from the upper lip and lateral portions of the lower lip drains preferentially through the submandibular nodes on the inferolateral aspect of the mandible.

• The parotid nodes receive lymph from upper and lateral regions of the face including the forehead, eyelids, and middle ear,

• Superficial and deep cervical nodes receive lymph from other nodes including the parotid and retroauricular. Buccal lymph nodes drain the cheeks and sides of the nose. 

An abnormal ventilationperfusion ratio (Qs/Qr) | NEET Based MCQ

An abnormal ventilationperfusion ratio (Qs/Qr) in the postoperative patient has been associated with 

A. Pulmonary thromboembolism 
B. Lower abdominal surgery 
C. Starvation 
D. The upright position

Answer A. Pulmonary thromboembolism

Abnormalities of ventilation-perfusion ratio result from the shunting of blood to a hypoventilated lung or from the ventilation of hypoperfused regions of lung tissue. When this imbalance is extreme, as following massive pulmonary thromboembolism, the effect is life-threatening hypoxemia. Other common predisposing factors in the postoperative patient that contribute to this maldistribution include the assumption of a supine position, thoracic and upper abdominal incisions, obesity, atelectasis, and reduced cardiac output.
 

Renal trauma | AIIMS Based MCQ

Renal trauma is best treated by: 

A. Observation and supportive measures 
B. Early drainage and perirenal haematoma 
C. Heminephrectomy 
D. Nephrostomy

Answer. A. Observation and supportive measures

Conservative treatment of closed renal trauma is usually successful but appropriate measures must be instituted without delay.Surgical exploration is necessary in less than 10% of closed injuries and is indicated if either there are signs of progressive blood loss or there is an expanding mass in the loin. Approach should be trans-peritoneal.