Gait Ataxia | Medical PG MCQs

All are true about gait ataxia except? 

A. Occurs in cerebellar vermis lesions 
B. May be the presenting feature of benign intracranial hypertension 
C. Is a presenting sign of cerebellar ectopia 
D. Occurs as a feature of carbamazepine toxicity

Ans. B. May be the presenting feature of Lesions in one or other cerebellar hemisphere usually cause peripheral limb ataxia e.g. ‘finger to nose ataxia’.  rather than ataxia of gait which is a feature of central cerebellar vermis.  lesions. Gait ataxia is associated with normal pressure hydrocephalus not benign intracranial hypertension. Cerebellar ectopia may present with a combination of gait ataxia and nystagmus often down beating vertically. . Gait ataxia and other cerebellar signs are features of alcohol and anticonvulsant including carbamazepine.  toxicity

Pellagra

Pellagra is a vitamin deficiency disease most frequently caused by a chronic lack of niacin (vitamin B3 or synonym: vitamin PP (from: Pellagra Preventing factor)) in the diet. It can be caused by decreased intake of niacin or tryptophan, and possibly by excessive intake of leucine. It may also result from alterations in protein metabolism in disorders such as carcinoid syndrome or Hartnup disease. A deficiency of the amino acid lysine can lead to a deficiency of niacin, as well.

The connection between maize and pellagra was first described by Casal in Spain in 1735.When it became an endemic disease in northern Italy, Francesco Frapoli of Milan named it 'pelle agra" (pelle, skin; agra, sour). Clinically, the disease is identified by the three Ds-dermatitis, diarrhoea and dementia-and if untreated, pellagra typically leads to death in four or five years.

Mexico despite widespread consumption of maize. The reason appeared to lay in the different way in which the grain was prepared in Mexico.  The people of the Aztec and Mayan civilisations softened the corn to make it edible with an alkaline solution-limewater. This process liberated the bound niacin (also known as niacytin) and the important amino acid tryptophan, from which niacin can be formed, making both "bioavailable" for digestion.

The Brain Stem – The Midbrain..

Examiners love this….
The Brain Stem – The Midbrain..
Ü Lies between the diencephalon and the pons
Ü Central cavity – the cerebral aqueduct
Ü Cerebral peduncles located on the ventral surface of the brain: Has  pyramidal (corticospinal) tracts
Ü Superior cerebellar peduncles: Connect midbrain to the cerebellum
Ü Periaqueductal gray matter surrounds the cerebral aqueduct
Ü Involved in two related functions
o Fright-and-flight reaction
o Mediates response to visceral pain
ü Corpora quadrigemina – the largest nuclei
ü Divided into the superior and inferior colliculi
o Superior colliculi – nuclei that act in visual reflexes
  o Inferior colliculi – nuclei that act in reflexive response to sound
Imbedded in the white matter of the midbrain
Ü Two pigmented nuclei
Ü Substantia nigra – neuronal cell bodies contain melanin
o Functionally linked to the basal nuclei
ü Red nucleus – lies deep to the substantia nigra
o Largest nucleus of the reticular formation

HYP - High yield points: Basal nuclei

HYP - High yield points:
Basal nuclei
ü A group of nuclei deep within the cerebral white matter
ü Caudate nucleus – arches over the thalamus
ü Lentiform nucleus – “lens shaped”
ü Amygdala – sits on top of the caudate nucleus
o Functionally belongs with the limbic system
ü Lentiform nucleus
ü Divided into two parts
o Globus pallidus
o Putamen
Basal nuclei – functions:
ü Cooperate with the cerebral cortex in controlling movements
ü Receive input from many cortical areas
ü Evidence shows that they:
ü Start, stop, and regulate intensity of voluntary movements & estimate the passage of time

BRAIN EMBRYOGENESIS:

BRAIN EMBRYOGENESIS:

Major regions:
1. Prosencephalon (forebrain)
a. Telencephalon: cerebrum
b. Diencephalon: epithalamus, thalamus,hypothalamus
2. Mesencephalon (midbrain)
a. Mesencephalon: cerebral peduncles, colliculi
3. Rhombencephalon (hindbrain)
a. Metencephalon: pons, cerebellum
b. Myelencephalon: medulla oblongata

ORGANIZATION OF BRAIN:
ü White matter lies deep to the gray matter of the cortex.
ü Within the masses of white matter:
o discrete innermost clusters of gray matter called cerebral nuclei (or basal nuclei).
o oval, spherical, or sometimes irregularly shaped clusters of neuron cell bodies.Q & A on brain meninges: Dura matter:Tough membrane composed of two fibrous layers.
Strongest of the meninges.
Dura mater is composed of two layers.
periosteal layer, the more superficial layer, attaches to the periosteum of the cranial bones
meningeal layer lies deep to the periosteal layer
The meningeal layer is usually fused to the periosteal layer
Exception: in specific areas where the two layers separate to form large, blood-filled spaces called dural venous sinuses.
Arachnoid:
Also called the arachnoid mater or the arachnoid membrane.
Lies immediately internal to the dura mater.
Partially composed of a delicate web of collagen and elastic fibers, termed the arachnoid trabeculae.
Between the arachnoid and the overlying dura mater is the subdural space.
Immediately deep to the arachnoid is the subarachnoid space.
Pia matter:
The innermost of the cranial meninges.
Thin layer of delicate connective tissue that tightly adheres to the brain and follows every contour of the brain surface.

Trachea | Medical PG MCQs

Which of the following statements is correct regarding the trachea 

A. During deep inspiration, the tracheal bifurcation may descend to T6 level
B. The left bronchus is wider and shorter
C. The arch of the aorta lies over the right bronchus and is anterior to it
D. The sensory supply of trachea is by the vagus
E. In the thorax, the esophagus lies anterior to the trachea

Ans is "D" The sensory supply of trachea is by the vagus

• During deep inspiration the tracheal bifurcation may descend below level of T6. 

• Rt. bronchus is wider and shorter: more in the line with lumen of trachea.

• The arch of aorta lies over the left bronchus and posterior to it.

• In thorax, esophagus lies posterior to trachea. Sensory supply of trachea is by vagus

Thorax: FAQ topics warm-up session

Thorax: FAQ topics warm-up session:

• The anterior border of the left pleural cavity deviates laterally between the fourth and sixth ribs to form the cardiac notch—a preferred route for needle insertion into the pericardial cavity.

• When upright, excess fluid tends to collect in the costodiaphragmatic recess.

• Introduction of air into the pleural space results in pneumothorax with loss of lung ventilation. Fluid or blood produces hydrothorax and hemothorax, both of which limit expansion of the lung with reduced ventilation/ perfusion ratio.

• The right mainstem bronchus is wider, shorter, and more vertical than the left mainstem bronchus, and therefore, is where large aspirated objects commonly lodge.

• The right lower lobar bronchus is most vertical, most nearly continues the direction of the trachea, and is larger in diameter than the left, and therefore, is where small aspirated objects commonly lodge, causing segmental atelectasis.

• A bronchopulmonary segment is defined by a segmental bronchus and accompanying segmental artery that lie centrally, as well as by intersegmental veins that form a peripheral venous plexus.

• Because the superior segmental bronchi of the lower lobes are the most posterior, and therefore dependent, when the patient is supine, they are most frequently involved in gastric acid aspiration pneumonia (Mendelson syndrome).

Preferred incision in a patient with suspected abdominal injury | MCQs for AIPGMEE

Which of the following is the preferred incision in a patient with suspected abdominal injury due to blunt trauma? 

A. Transverse 

B. Midline 
C. Incision at the site of injury 
D. Sub costal

Ans: B. Midline

Basics for any case of abdominal trauma blunt and penetrating. .

 The routine approach for abdominal trauma is a full midline loparotomy.

A complete laparotomy is mandatory in each case.

Do not give incision for laparotomy at the site of injury. 

Bleeding from superficial varices of long saphenous system | MCQs for AIPGMEE

The management of bleeding from superficial varices of long saphenous system is :- 

A. Elevation of the affected limb with compression bandaging 

B. An emergency and urgent ligation of the main venous trunk 
C. Urgent Trendelenburg procedure along with stripping of the main axial vein 
D. None of the above

Ans. A.  Elevation of the affected limb with compression bandaging

Spectacular hemorrrhage con occur from large varices in the lower limb, if they are damaged. This is easily controlled by lying, elevating the limb and applying a compression bandage. 

Common site of heterotopic pancreatic tissue | MCQs for AIPGMEE

The most common site of heterotopic pancreatic tissue 

A. Stomach 
B. Jejunum 
C. Appendix 
D. Splenic hilum

Ans: A. Stomach

• Pancreatic tissue has been documented in ectopic sites in the gastrointestinal tract and even elsewhere.

• The most common site for nodules of aberrant pancreatic tissue is on the wall of the stomach, duodenum or jejunum. The nodules may be found in submucosa 75%.  and in the muscular layer or subserous coat in the remainder.

• The overall incidence and relative frequency with which it cause symptoms varies.

• Autopsy studies have found heterotopic pancreatic tissue in the duodenum in as high as 14% of individuals.

• Scattered pancreatic tissue has been found in Meckel diverticulum, gallbladder, colon, Spleen, Liver, Bile ducts, mesentery or even omentum.

• Enterogenous cysts of the thorax have been reported to contain typical pancreatic tissue, including islets.

• With the advent of widespread upper gastrointestinal endoscopy and improvements in contrast studies of the alimentary tract, ectopic pancreas of the stomach and duodenum is being more frequently recognized.

• The pathognomic radiological finding is a smooth, rounded or negative shadow with evidence of a tiny umbilication or even a small duct which may be outlined by a line of barium.

• Probably most individuals with ectopic pancreas have no symptoms whatsoever.

• However, abdominal pain surqestive of peptic ulcer disease sometimes occurs.

• Interference with gastric emptyrg by lesions situated in the pyloric region, direct production of a peptic ulcer, gastrointestinal haemorrhage, intussuscption, and development of a benign or malignant neoplasm arising in the pancreatic rest, have all been documented. 

Clincal Case of Woman with obstipation and distended abdomen

An 83-year-old woman in a nursing home presents with a 24-hour history of obstipation and distended abdomen her vital sign and laboratory tests are normal plain abdominal film reveals a massively dilated loop of bowel in the lower abdomen. Most likely diagnosis for this patient?

A. Small bowel obstruction 
B. Fecal impaction 
C. Cecal volvulus 
D. Sigmoid volvulus

Ans. D.  Sigmoid volvulus

Sigmoid volvulus is most common in elderly and institutionalized individuals and usually presents with acute obstruction, abdominal distention, and obstipation, Plain films reveal a U-shaped, dilated loop of bowel in the lower abdomen. Ogilvie syndrome, or colonic pseudo-obstruction, usually involves the entire large bowel. Small bowel obstruction would appear as “Stair stepping” of loops of small bowel on plain film examination. Cecal volvulus appears as a bean-shaped loop of bowel in the left upper quadrant LUQ.  of the abdomen. 

Liver Biopsy | PGI MCQs for MD MS Preparations

Liver biopsy is normal in 

A. Dubin johnson syndrome 
B. Gilbert syndrome 
C. Hemochromatosis 
D. Wilson’s disease 
E. Rotor’s syndrome

Ans. B. Gilbert syndrome ;(E) Rotor’s syndrome  

• Liver pathology is normal in Gilbert, Crigler Najjar, Rotor Syndrome. 

• Liver biopsy not normal in wilson s disease:-Hemochromatosis.

Features of essential hypertension | PGI MCQs for MD MS Preparations

Features of essential hypertension 

A. Concentric hypertrophy of LV 
B. Increased heart size 
B. Increased size of the heart muscles 
D. Myohypertrophy 
E. Myohyperplasia

Ans. A. Concentric hypeetrophy of LV; (B) increasedheart size ; (C)  increased Size of heart muscle; (D) Myohypertrophy: 

Features of essential hypertension are:- 

• There is concentric hypertrophy of the left ventricles due to pressure overload of the heart. 

• On physical examination the heart is enlarged. 

• The weight of the heart is increased above the normal, often over 500 gm. 

• Thickening of the Lt. ventricular wall, increased the ratio of its wall thickness to radius. 

• Microscopically the earliest changes of systemic hypertensive heart disease is an increased in transverse myocytes diameter. 

• In advanced stage the cellular and nuclear enlargement are prominent. 

• There may be multiple minute foci of degenerative changes and necrosis in hypertrophied myocardium, 

• Electron microscopy reveals increase in number of myofilaments comprising myofibrils, mitochondrial changes and multiple intercalated discs. 

Necrosis in Anoxia of liver | PGI MCQs for MD MS Preparations

In anoxia of liver, necrosis is seen in: 

A. Centrilobular 
B. Around the periphery 
C. Around the central vein 
D. Around the bile duct
E. around the central artery

Ans. C. Around the central vein: 

• The histological hallmark of ischemic hepatitis or shock1iver is zone three necrosis. 

• Depending upon the degree of ischemia, a variable degree of architectual collapse around the central vein may occur with severe and prolonged ischemia. Necrosis may extended to the midzonal hepatocytes.

Note: Functions of different zone of liver.

Zone 1 — Glycogen synthesis and glycogenolysis inhibitor-I: 

— Main area for protein metabolism 

— Formation of plasma protein 

— Conjugation of certain drugs. 

Zone 3 —* Glycogen storage 

Lipid and pigment formation metabolism of certain drugs and chemicals.

Zone 2 -4- Share functions of both zones.

Autoimmune type-II Liver disease | PGI MCQs for MD MS Preparations

True about Autoimmune type-II Liver disease 

A. Antinuclear antibody 
B. LKM-1 antibody 
C. Anti smooth muscle antibody 
D. Ds DNA 
E. LC-1, & LC-2

Ans. B. LKM-1 antibody ;(E) LC-1, LC-2.

Depending upon the present of antibody in serum, autoimmune hepatitis is of 3 types:-
(1) AIH type I — It is characterised by ANA with or without SMA.
• It is the most common autoimmune hepatitis.
(2) AIH type II — Characterised by anti p 450 and anti UGT autoimmunity.
• LKM-l antibody against — P4502D6 is found.
• This type most commonly leads to fulminant hepatitis.
• Low IgA level also common.
• Common in paediatrics age group.
• Anti LC-1 (Liver cytosol-1) and LC-2 along with LKM-1 found.
(3) AIHtype-III is characterised by absence of ANA, SMA, and LKM-1 and anti SLA/L.P, and ASGPR (asialoglycoprotein receptor) is present.
• Long time result is most important for liver transplantation in type-2.

Vasculitis Presence | PGI MCQs for MD MS Preparations

Vasculitis is seen in 

A. Burger’s disease 
B. HSP 
C. Gout 
D. Reiter’s disease 
E. Behcets syndrome

Ans. A. Burger’s disease ; (B) HSP; (D) Reiter’s disease ; (E) Behcet’s syndrome
Classification of vasculitis
I. Systemic necrotizing vasculitis
A. Poly arteritis nodosa (PAN)
1. Classic PAN
2.Microscopic polyangitis
B. Allergic angitis and granulomatosis of churg strauss
C. Polyangitis overlap syndrome.
II. Wegener’s granulomatosis.
III. Temporal arteritis
IV. Takayasu’s arteritis
V. Henoch-Schonlein purpura.
VI. Predominantly cutaneous vasctilitis. (hypersensitivity vasculitis)
A. Exogenous stimuli suspected
1. Drugs-induced vasculitis.
2. Serum sickness and serum sickness like reaction.
3. Vasculitis associated with infection disease
B. Endogenous antigen likely involved
1. Vasculitis associated with neoplasm.

2. Vasculities associated with connective tissue disease e.g. RA, SLE, sjogren syndrome.
3. Vasculitis associated with underlying disease e.g. SBE, EB virus infection HIV infection, ulcerative coilits ; congenital deficiencies of various complement components, retroperitonial fibrosis and primary biliary cirrhosis. Predominantly cutanous vasculitis with α-antitrypsin deficiency ;intestinal bypass surgery, and relapsing polychondritis.
4. Vasculitis associated with congenital deficiency of complement system.
VII. Other vaculitis syndrome
A. Kawasaki disease
B, Isolated central nervous system vasculitis
C. Thromboangiitis obliterans (Burger’s disease)
D. Behcet’s syndrome
E. Miscellaneous vascutilis
Direct infection related to vasculitis,
Bacterial (e.g. — Neisseria)
Rickettsial (e.g. Rocky Mountain spotted fever)
Spirochetal (e.g. syphilis)
Fungal (e.g. aspergillosis, murmor mycosis)
Viral (e.g. Herpes Zoster, variable hepatitis virus infection)
 → The seronegative arthropathies, amkylbsing spondylitis, Reiter’s Syndrome, Psoriatic arthrits and arthrities associated ulcerative colitis and regional enteritis may be accompained by paricarditis and Proximal aoritis.

Accessory Spleen Location | Medical PG Preparations

Accessory spleen is mostly found in: 

A. Hilum of spleen 
B. Lienorenal ligament 
C. Gastrosplenic ligament 
D. Around tail of pancreas

Ans. A.  Hilum of spleen

Fifty percent of accessory spleen are located near the hilum of the spleen.

Splenunculi Accessory spleen. 

Most common congenital anomaly of spleen.Can be single or multiple, found in 30% of population.

Failure to identify and remove these at the time of splenectomy give raise to persistent disease

Other sites of accessory spleen

oGastrocolic ligament

o Greater omentum

oSplenocolic ligament

o Left broad ligament

o Tail of pancreas

o Greater curvature of stomach

o Mesentery of small and large bowel

Remember: Splenosis is ectopic spleen that may cause pain or GI obstruction. It is not connected to portal circulation. Occur due to peritoneal seeding in some patient with splenic rupture. 

Complications of arterial catheterization | MD MS MCQs

Complications of arterial catheterization for a 96-h period of monitoring include all the following EXCEPT 

A. Arterial thrombosis 

B. Infection at the catheter site 
C. Hemorrhage 
D. Septicemia

Ans. D.  Septicemia

Arterial catheterization in the critically ill patient is an important method of monitoring changes in blood pressure and permitting frequent sampling of arterial blood. Arterial thrombosis is especially common with smaller arteries such as the radial or dorsalispedis. This problem can be reduced by the use of continuous heparin flow rather than intermittent flushing. Infection at the catheter site can be minimized by careful management of the wound and by percutaneous placement of the catheter without arterial cutdown. Hemorrhage can occur if the system becomes disconnected. Septicemia is extremely unusual if the catheter is not left in situ for more than 4 days, but it becomes an increasing problem with longer use. Wound hematoma can occur especially if there is difficulty with he arterial puncture. This complication may be dangerous when catheterization of the femoral artery is used because the blood losJ> in pelvis or thigh may not be appreciated

Chronic arsenic poisoning Causes | MCQs for AIPGMEE

Chronic arsenic poisoning can cause 

A. Malignant melanoma
B. Basal cell carcinoma 
C. Mesothelioma 
D. Squamous cell carcinoma

Ans. D.  Squamous cell carcinoma

Arsenic and arsenic compounds cause:

1. Lung cancer

2. Skin cancer squamous cell carcinoma. 

3. Haemongiosarcoma

Predisposing factors for squamous cell carcinoma

1. Industrial carcinogens Tons and oils. 

2. Chronic ulcer und draining osteomyelltis

3. Old bum scar

4. Ingestion of arsenicals

S. ionizing radiation

6.. Tobacco and betel nut chewing

7. Most common exogenous cause in exposure to UV light 

Complication in peripheral venous access | MCQs for AIPGMEE

Frequent complication seen in peripheral venous access 

A. Venous thrombophlebitis 

B. Migratory thrombophlebitis 
C. Pulmonary embolism
D. Thrombosis

Ans. A.  Venous thrombophlebitis

Venous thrombosis thrombophlebitis.  is a frequent complication of varicose vein and following cannulation of vein for IV infusion.

• Spontaneous superficial thrombophlébitis occur in

1. Polycythemia 2. Polyarthritis

3. Buerger disease 4. Visceral malignancy