Clinical Case MCQ | AIIMS MCQ for Medical PG Preparations .. NIME

A 60-year-old female presents with epigastric pain, nausea and vomiting, heart rate of 50, and pronounced first-degree AV block on ER cardiac monitor. Blood pressure is 130/80. The coronary artery most likely to be involved in this process is the
 

A. Right coronary
B. Left main
C. Left anterior descending
B. Circumflex


Ans. A.  The right coronary artery supplies most of the inferior myocardium and supplies the AV node in over 70% of patients. Thus occlusion of this artery can cause ischemia of the AV node with AV block or bradycardia, as well as symptoms of an inferior MI as seen in this patient. AV block can occur with anterior MI related to LAD occlusion, but this generally implies a greater area of myocardial involvement and hemodynamic instability.

Clincal Case MCQ | AIPGMEE Preparations

A 35-year-old female complains of slowly progressive dyspnea. Her history is otherwise unremarkable, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. On physical exam, there is jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. ECG shows right axis deviation. A perfusion lung scan is normal with no segmental deficits. The most likely diagnosis in this patient is
A. Primary pulmonary hypertension
B. Recurrent pulmonary emboli
C. Cardiac shunt
D. Interstitial lung disease

Ans. A. Although a difficult diagnosis to make, primary pulmonary hypertension is the most likely diagnosis in this young woman who has used appetite suppressants. There has been a recent increase in primary pulmonary hypertension in the individuals consuming fenfluramines, an  appetite suppressant. The predominant symptom is dyspnea, which is usually not apparent in the previously healthy young woman until the disease has advanced. When signs of pulmonary hypertension are apparent from physical findings, chest x-ray, or echocardiography, the diagnosis of recurrent pulmonary embolus must be ruled out. In this case, a normal perfusion lung scan makes pulmonary angiography unnecessary. Restrictive lung disease should be ruled out with pulmonary function testing. An echocardiogram will show right ventricular enlargement and a reduction in the left ventricle size consistent with right ventricular pressure overload.

 

Protein metabolism | PGI MCQ for Medical PG Preparations .. NIME

True regarding Protein metabolism:
A. Proteins contain about 40 per cent nitrogen
B. Chains containing >100 amino acid residues are called proteins
C. Proteins yield 4 calories per gram absorbed
D. During pregnancy, there is a rise in the plasma concentration of triglycerides
E. During pregnancy, there is a rise in the plasma concentration of albumin

Ans. B, C, D, E

A. CORRECT.

B. WRONG. First-degree prolapse is to the level of the ischialspine.

C. WRONG.

D. WRONG. Cystocoele presents thus. Rectocele involvesprotrusion of the posteriorvaginal wall.

E. WRONG. Vault prolapse involves descent of the cuff ofvaginal tissue left afterhysterectomy.