Itchy papula vesicular lesions on extremities MCQ | Medical PG Preparations

30 year old male had severely itchy papula vesicular lesions on extremities, knees, elbows and buttocks for one year. Direct immunofluorescence staining of the lesions showed IgA deposition at dermoepidermal junction. The most probable diagnosis is

A Pemphigus vulgaris 

B. Bullous pemphigoid

C. Dermatitis herpetiformis 

D. Nummular eczema

Ans. C. Dermatitis herpetiformis. 

Dermatitis herpetiformis - manifested by pruritic papules, vesicles, and papulovesicles mainly on the elbows, knees buttocks, posterior neck, and scalp

Associated with HLA-B8 -DR 3 and DQ-2

Diagnosis

1. Neutrophils at the dermal papillary tips

2. Granular deposition of IgA along the dermal papillae

3. Circulating anti endomysium antibodies and antibodies to tissue transglutaminase are present in 70% cases

Pemphigus vulgaris- Deposition of IgG and C3 on the surface of keratinocytes against desmoglein.  intercellular

Bullous pemphigoid - Linear band of IgG and/or C3 in epidermal basement cone.

Patients have gluten sensitive enteropathy

Patients with dermatitis herpetiformis are at increased risk of development of GI-lymphoma

Treatment - Gluten free diet, Dapsone*

DIRECT IMMUNOFLUORESCENCE FINDINGS IN AUTOIMMUNE BLISTERING DISEASE.
Disease	Pattern and nature of immunoreactants
Pemphigus	Epidermal cell-surface deposits of IgG and C3
Bullous pemphigoid	Linear, homogeneous deposits of IgG epidermal side on salt-split skin.  and C3 at the dermal-epidermal junction.
Linear IgA dermatosis	Linear homozeneousdepositsof IgA at the dermal-epidermal iunction
Herpes gestationis	Linear homogeneous.depositsof C3 at the dermal-epidermal junction
Epidermolysis bullosaacquisita	Linear homogeneous deposits of IgG dermal side on salt-split skin.  and C3 at the dermal- epidermal iunction.
Cicatricial pemphigoid	Linear homogeneous deposits of IgG and C3 at the dermal-epidermal junction
Dermatitis herpetiformis	Focal granular deposits of IgA at the papillary tips
Bullous eruption of lupus erythematosus	Linear homogeneous, or non-homogeneous, deposits of multiple immunoglobulins, C3 and fibrin at the dermal-epidermal junction.

Hidradenitissuppurativa | MCQs for AIPGMEE

Hidradenitissuppurativa is a disease of: 

A. Eccrine sweat glands 
B. Apocrine sweat glands 
C. Kaposi sarcoma 
D. Hair follicle

Ans. B. Apocrine sweat glands

Cutaneous S. aureus infections include impetigo, cellulitis, and hidradenitissuppurativa recurrent follicular infections in regions such as the axilla. . S. aureus is one of the most common causes of surgical wound infection.

Infection of apocrine sweat glands hidradenitissuppurativa.  can also mimic infection of hair follicles, particularly in the axillae .

•This is a rare condition characterized by a painful, discharging, chronic inflammation of the skin at sites rich in apocrine glands axilla, groins. . The cause is unknown but it is commoner in females, and within some families it appears to be inherited in an autosomal dominant fashion . •Clinically it presents after puberty with papules, nodules and abscesses which often progress to cysts and sinus formation. With time, scarring may arise. The condition follows a chronic relapsing/ remitting course and is often worse in obese individuals. 

Cystic fibrosis (homozygous) | PGIMER Frequently Asked Medical PG topics

A pt. of cystic fibrosis (homozygous) married a carrier (heterozygous). The chances of developing cystic fibrosis in the offsprings is

A. 50% carriers, 50% affected 
B. 25% carriers, 75% affected 
C. 75% carriers, 25% affected 
D. All are carriers 
E. All are affected

Ans.  A.  50% carriers, 50% affected

• Cystic fibrosis is an autosomal recessive disorder. Imprtant featrure of AR disease: 

- Either sex affected with equalfrequency or severity. 

- Affected person is homozygous or compound heterozygote for a-single gene deftet. 

- Heterczygous carriers of a deft ctive allele are usually clinically normal. 

- Horizontal pattern ofpedigree with a single generation affected. 

• The chance of developing cystic fibrosis in our question is 50%. 

Digoxin Uses | PGIMER MCQs for MD MS Preparations

Digoxin is used in the treatment of 

A. Constrictive pericarditis 
B. Cardiac tamponade 
C. Heart block 
D. Atrial fibrillation 
E. Diastolic failure

Ans. D. Atrial fibrillation
• Digitalis is particularly effective in patients with systolic HF complicated by atrial flutter and fibrillation and a rapid ventricular rate.
• Digitalis is of little or no value in patients with HF, sinus rhythm and the following conditions:
- Hypertrophic cardiomyopathy
- Myocarditis
- Mitral stenosis
Chronic constrictive pericarditis and
- Any form of diastolic HF
• Digoxin is not used in Heart block as it slows A-V conduction.

Whole body radiation MCQ | PGIMER MCQs for MD MS Preparations

Whole body radiation is indicated in 

A. Advanced head & neck tumours 
B. BM transplantation 
C. Medulloblastoma 
D. Mycosis fungoides 
E. Histiocytosis-x ]

 Ans. B.  Bone marrow transplantation ; (D) Mycosis fungoides;
When radiation is given in a way to cover thewhole body it is called total body irradiation or whole body irradiation. This done for one of two reasons
(i) To suppress the pt’s immune system and prevent rejection of donor bone marrow after BM transplantation using donor BM from someone other than the patient.
(ii) To kill abnormal cells that escape other therapies such as surgeries, chemotherapy or local irradiation and remain hidden in the body to regrow later.
• It is used in:
- Aplastic anaemia to prevent rejection of donor marrow.
- Beta thalassernia
- CML
-AML&ALL
-NHL
- Neuroblastoma
- Ewing’s sarcoma I unfavourable pediatric sarcoma
• Mycosis fungoides is treated with whole body radiation.
• Histiocytosis X resolves spontaneously in usual cases and it can be treatedwith Chemotherapy.
•Medulloblastoma can be treated with craniospinal radiation.
• Advanced head & neck turnours are treated with local or regional radio therapy. 

Pnigerophobia | Medical PG Preparations

Pnigerophobia is fear of?'

A. Smothering 
B. Snakes 
C. Cats 
D. Failure

Ans A. . Smothering

Specific Phobias

                Phobia                                                     Definition

                Acrophobia                                              Fear of heights

                Agoraphobia                                            Fear of open spaces

                Alektorophobia                                        Fear of chickens

                Amathophobia                                         Fear of dust

                Amaxophobia                                          Fear of riding in a car

                Apiphobia                                 Fear of bees

Arachibutyrophobia                                Fear of getting peanut butter stuck on the roof of the mouth

                Astrapophobia                                         Fear of lightning

                Aviophobia                                               Fear of flying

                Blennophobia                                          Fear of slime 

Transaction of the spinal cord | Medical PG MCQs

In complete transaction of the spinal cord, the muscle supplied by the lower segment displays: 

A. Increase in tone 

B. Loss of tone
C. Nochangeof tone 
D. Alternate high and low tone

Ans. A. Increase in tone

 Complete transaction of the spinal cord leads to flaccid paralysis. During the recovery stage after about two or three weeks, there occurs paralysis of the upper motor neuron type, characterized by hypertonia, brisk hyperactive reflexes and positive Babinski’s sign

DSM IV classification of psychiatric disorders | MD MS Entrance MCQs

The DSM IV classification of psychiatric disorders as proposed by American Psychiatry Association classifies and helps in diagnosing patient on multiple axes. Of these, axis V represents the degree of: 

A. Present state of symptoms 
B. Comorbid medical condition 
C. Global assessment of function 
D. Comorbid psychosocial problem

Ans. C. Global Assessment of Function.

The DSM IV classification of psychiatric disorders as proposed by American Psychiatry Association:

•Analyze symptoms

•Diagnostic features: Course of illness & Exclusion Criteria

•Diagnostic reliability: Concordance between physicians' diagnoses of same patient

•Lack of validity

Guidelines:

Precedence to conditions due to Substance Abuse &/or Medical problems

DO NOT give separate Dx for minor disorder

Main Axises:

Axis I: Majority of Diagnoses

Axis II: Disorders of Personality & Retardation

Axis III: Any other Medical Conditions related or not.

Axis IV: Environmental &/or Psychosocial problems

Axis V: Global Assessment of Functioning GAF. 

•Psychological, Social & Occupational functions

•NOT Physical functions 

For Persons with Disabilities - Accessible India Campaign (Sugamya Bharat Abhiyan)

A step further: India proud to announce - Accessible India Campaign (Sugamya Bharat Abhiyan)

Brief of the scheme: 

1. For Persons with Disabilities (PwDs) universal accessibility is critical for enabling them to gain access for equal opportunity and live independently and participate fully in all aspects of life in an inclusive society. Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 under sections 44, 45 land 46 categorically provides for non-discrimination in transport, non-discrimination on the road and non-discrimination in built environment respectively. United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), to which India is a signatory, under Article 9 casts obligations on the Governments for ensuring to PwDs accessibility to (a) Information, (b) Transportation, (c) Physical Environment, (d) Communication Technology and (e) Accessibility to Services as well as emergency services.

2. In furtherance of the vision of the Department, it is imperative to launch a Nation-wide Awareness Campaign towards achieving universal accessibility for all citizens including PwDs in creating an enabling and barrier-free environment.In this direction, Department of Empowerment of Persons with Disabilities (DEPwD), Ministry of Social Justice & Empowerment has conceptualised the“Accessible India Campaign (Sugamya Bharat Abhiyan)”as a nation-wide flagship campaign for achieving universal accessibility that will enable persons with disabilities to gain access for equal opportunity and live independently and participate fully in all aspects of life in an inclusive society. The campaign targets at enhancing the accessibility of built environment, transport system and Information & communication eco-System.

For more info: http://disabilityaffairs.gov.in/content/page/parliament-questions.php

Cerebral infarction | PGIMER entrance Preparations

Cerebral infarction is caused by 

A. Toxoplasma 
B. Cryptococcus 
C. Aspergillus 
D. Mucor 
E. Histoplasma

Ans. A. Toxoplasma ; (C) Aspergillus ; (D) Mucor : 

• Arteritis of small and large vessls, in association with syphilis and tuberculosis formerly accounted for cerebral infarcts ; infectious vasculitis in now more commonly seen in setting of immunosuppression and opportunistic infections (such as toxoplasmosis, apergillosis and CMV encephalitis). 

• Mucor and aspergillus frequently cause vasculitis.

WHO grading system for Leprosy Patients

WHO grading system

Hands and feet
Grade 0 No anaesthesia, no visible deformity or damage
Grade 1 Anaesthesia present, but no visible deformity or damage
Grade 2 Visible deformity or damage present
Eyes
Grade 0 No eye problem due to leprosy; no evidence of visual loss
Grade 1 Eye problems due to leprosy present, but vision not severely affected as a result (vision: 6/60 or better; can count fingers at 6 metres).
Grade 2 Severe visual impairment (vision worse than 6/60; inability to count fingers at 6 metres); also includes lagophthalmos, iridocyclitis and corneal opacities.

Non-reducing disaccharides | PGIMER MCQs for MD MS Preparations

Non-reducing disaccharides are: 

A. Lactose 
B. Sucrose 
C. Maltose 
D. Fructose 
E. Glucose

Ans. B. Sucrose 

* Disaccharides (Two monosaccharide units).

* Reducings with free aldehyde or ketogroup eg. maltose, lactose and isomaltose. 

* Non-reducing : sucrose, trehalose. 

Drugs which act by intercalating with DNA | PGIMER entrance Preparations

Drugs which act by intercalating with DNA :

A. Actinomycin D 
B. Tetracycline. 
C. Bleomycin 
D. Doxorubicin. 
E. Doxycycline

Ans. A. Actinomycin D ; (C) Bleomycin; (D) Doxorubicin:

• Actinomycin D, Doxorubicin, Bleomycin-all causes intercalation between DNA strands thereby inhibits RNA, and DNA synthesis. 

• They can alter DNA structure replication and topoisomerase function.

Naturally occurring amino acids | MD MS Entrance MCQs

True about naturally occurring amino acids: 

A. All are racemic mixtures 
B. Have specific genetic code 
C. 20 in number 
D. All are D-isomers 
E. All are L-isomers

Ans. B. Have specific genetic code ; 

• Of the over 300 naturally occurring amino acids., 20 constitute the monomer units of proteins.

• Both D-amino acids and non a anion acids occur in nature, but only L α — amino acids arepresent in proteins. D-amino acids that occur naturally inclued D-serine and D-aspartate in brain tissue, D-alanine and D-glutamate in cell walls of Gram +ve bacteria and D-amino acids in some non-mammalian peptides and certain antibiotics.

• The genetic code is universal, specific, non-overlapping and degenerate. This universal nature of genetic code has lead to incorporation of 20 amino acids during protein synthesis in cells. 

• Racemic mixture has both D and L isomers in equal concentration, thereby optically neutral. 

M/C site of cholongio CA | MD MS Entrance MCQs

M/C site of cholongio CA: 

A. lntrahepaitic 
B. Distal biliary tract 
C. Hilum 
D. Multifocal

Ans: C. Hilum

Risk factor for cholangio carcinoma

• Primary sclerosing cholongitis

• Choledochal cyst

• Ulcerative colitis

• Clonorchissinensis injection

• Chronic typhoid carries

2/3 of cholangio carcinoma are located at hepatic duct bifurcation here they are called as KLATSKIN’ S tumours.

M/C type is adeno carcinoma

Painless jaundice is the most common presentation. 

Spigelian hernia | MD MS Entrance MCQs

Spigelian hernia is: 

A. Intraparietal internal hernia 
B. Hernia occurring at the level of arcuate line 
C. Hernia through the lineaalba above or below the umbilicus.
D. Posterior abdominal wall hernia

Ans. B. Hernia occurring at the level of arcuate line.      

Spigelian hernia:

•This is a variety of interparietal hernia occurring at the level of the arcuate line.

•It is very rare with only 1000 cases reponed in the literature.

•The fundus of the sac, clothed by exrtaperitoneal fat, may lie beneath the internal oblique muscle where it is virtually impalpable.

•More often it advances through that muscle and spreads out like a mushroom between the internal and external oblique muscles, and gives rise to a more evident swelling.

•The patient is often corpulent and usually over 50 years of age, men and women being equally affected. Typically, a soft, reducible mass will be encountered lateral to the rectus muscle and below the umbilicus.

•Diagnosis is confirmed by CT or USG. the latter having the advantage of being able to stand the patient upright ifno defect is visible in the reclining position.

•Owing to the rigid fascia surrounding the neck, strangulation may occur.

•Treatment.

o Operation. If a defect is palpable.a muscle-splitting approach is used.

o, Ext oblique, Int oblique, Transverse abd retracted laterally during surgery.

Members of southeast Asia of WHO | Medical PG Preparations

Members of southeast Asia of WHO are 

A. Japan 
B. Afganistan 
C. India 
D. Pakistan 
E. Srilanka

Ans. C. India ;(E) Srilanka 

SEARO— The South East Asia Regional Office Headquarter is located in New Delhi (India). It has new eleven members — Bangladesh, Bhutan, lndia, indonesia, Korea, Maldives Islands, Mongolia, Myanmar, Nepal, Srilanka, Thailand. 

The WHO activities in South East Asia Region cover a wide range of subjects such as malaria eradication, tuberculosis control, control of other communicable disease, health laboratory services and production of vaccine, health statistics, public health administration and rural health service, maternal and child health nursing, environmental health, dental health, medical rehabilitation, quality control of drugs and medical education. 

Parkinsonism | Medical PG Preparations

Drugs causing parkinsonism include A. Bromocriptine 
B. Phenothiazine 
C. Haloperidol 
D. Amantadine 
E. Carbidopa

Ans. B. Phenothiazine; (C) Haloperidol: 

• Phenothiazine and Haloperidol causes parkinsonism due to dopamine blockade. All antipsychotics except clozapine have potent— dopamine D2 receptor blocking action.

• Bromocriptine, amantidine and carbidopa are used in treatment of parkinsonism

Candidate(s) for global eradication by WHO | Medical PG Preparations

Candidate(s) for global eradication by WHO 

A. Malaria 
B. Dracunculosis 
C. Polio 
D. Measles 
E. Chicken pox

Ans. B. Dracunculosis ; (C) Polio ; (D) Measles 

During recent years, three diseases have been seriously advanced as candidates for global eradication within the forsecable future are 

— Polio 

— Measles 

— Dracunculosis 

If thrombosis is present in the coronary sinus | MD MS Entrance MCQs

Even if thrombosis is present in the coronary sinus, which of the following cardiac veins might remain normal in diameter 

A. Middle cardiac vein 
B. Anterior cardiac vein 
C.Small cardiac vein 
D. Oblique cardiac vein

Ans. B. Anterior cardiac vein

- Anterior cardiac veins drain directly into the right atrium and not the coronary sinus, hence are spared in this particular patient.

- The coronary sinus is the main drainage channel of venous blood from the myocardium. It is the main derivative of the left horn of the sinus venosus of fetal life. It is situated within the atrioventricular groove coronary sulcus.  on the posterior surface of the heart between the left atrium and ventricle.

- It commences towards the left of the groove at the point at which it receives the oblique vein of the left atrium. It passes to the right and inferiorly to terminate by draining into the right atrium at the coronary sinus orifice.

- The coronary sinus is drained into by a number of smaller veins; typically, from left to right along its course, the:

Great cardiac vein* from left side. 

Oblique vein of the left atrium from superior side. 

Posterior vein of the left ventricle

Middle cardiac vein** from inferior side. 

Small cardiac vein from right side. 

The great cardiac vein is the largest lumen wise.  of the veins draining into the coronary sinus from the myocardium. It commences near to the apex of the heart in the anterior part of the interventricular groove. It passes superiorly in the company of the anterior interventricular artery LAD. .

-At the junction of the interventricular groove with the atrioventricular groove, it enters the latter and passes to the left in the company of the circumflex artery. It passes over the left border of the heart within the atrioventricular groove to merge with the left end of the coronary sinus.

- The great cardiac vein drains the territory supplied by the left coronary artery e.g. the left atrium and ventricle.

Onodi cells and Haller cells of ethmoid labyrinth | MD MS Entrance MCQs

Onodi cells and Haller cells of ethmoid labyrinth are seen in relation to following respectively:-

A. Optic nerve & floor of orbit 

B. Optic nerve &Internal carotid artery 
C. Optic nerve and naso lacrimal duct 
D. Orbital floor and nasolacrimal duct

Ans. A. Optic nerve & floor of orbit

Ethmoid bone is a pneumatic bone and has numerous air cells around the nose.

•  Onodicellis the most posterior ethmoidal cell that is present superior & lateral to the sphenoid sinus and is intimately related to the optic nerveand internal carotid artery.

•Optic nerve may be seriously damaged in ESS Endoscopic sinus surgery. 

•Haller cell represent an extension of anterior ethmoidal air cells extending into the infra-orbital margin roof of maxillary sinus. . 

Filumterminale | MD MS Entrance MCQs

Filumterminale is chiefly composed of 

A. Piamater 
B. Duramater
C. Fibrous tissue 
D. Neural tissue

Ans. C. Fibrous tissue

The filumterminale is a delicate filament, about 20 cm. in length, prolonged downward from the apex of the conusmedullaris.

It consists of two parts, an upper and a lower.

The upper part, or filumterminale internum, measures about 15 cm. in length and reaches as far as the lower border of the second sacral vertebra. It is contained within the tubular sheath of dura mater, and is surrounded by the nerves forming the caudaequina, from which it can be readily recognized by its bluish-white color.

The lower part, or filumterminaleexternum, is closely invested by, and is adherent to, the dura mater; it extends downward from the apex of the tubular sheath and is attached to the back of the first segment of the coccyx.

The filumterminale consists mainly of fibrous tissue, continuous above with that of the pia mater. 

Lymph from heel and lateral aspect of foot | MD MS MCQs

Lymph from heel and lateral aspect of foot first drains into 

A. Popliteal lymph nodes 

B. Deep inguinal
C. Superficial inguinal 
D. Obturator node

Ans. A. Popliteal lymph nodes.

Deep inguinal lymph node Glands of Cloquet&Rosenmuller.  drains :

·      Superficial inguinal node

·      Popliteal node

·      Glans penis, labia minora

·      Deep lymphatic of the lower limb accompanying the femoral vessels