Punjab PG MCQ Topic | Histologic sections of Lungs

Histologic sections of lung reveal the alveoli to be filled with pale, nongranular pink fluid. Neither leukocytes nor erythrocytes are present within this fluid. Which of the following is the most common cause of this abnormality? 

A. Bacterial pneumonia 
B. Congestive heart failure 
C. lymphatic obstruction by tumor 
D. Pulmonary embolus

Ans. B. Congestive heart failure       

•Pulmonary edema refers to excess accumulation of fluid in the extravascular spaces of the lung. It can be classified based on the etiology into cardio genie pulmonary edema and noncardiogenic pulmonary edema.

•Cardio genic pulmonary edema results from abnormalities of hemodynamic Starling.  forces, while noncardiogenic pulmonary edema results from cellular injury.

•Causes of cardiogenic pulmonary edema include increased hydrostatic forces, as seen with congestive heart failure the most common cause of pulmonary edema. ; decreased oncotic pressure, such as resulting from decreased albumin levels; and lymphatic obstruction.

•Noncardiogenic edema may be the result of either endothelial injury infections, dis seminated intravascular coagulopathy, or trauma.  or alveolar injury from inhaled toxins, aspiration, drowning, or near drowning. .

•Microscopically, pulmonary edema reveals the alveoli to be filled with pale pink fluid. Cardiogenic edema may lead to alveolar hemorrhages and hemosiderin-laden macrophages heart failure cells. .

•Where cardiogenic edema is present, chest x-rays show an increase in the caliber of the blood vessels in the upper lobes, perivascular and peribronchial fluid "cuffing". , and Kerley B lines fluid in the interlobular septa. .

Noncardiogenic edema produces a "whiteout" of the lungs

Medical PG Preparations | Mallory Hyaline

Mallory hyaline is characteristically seen in 

A. Primary biliary cirrhosis 

B. Alcoholic cirrhosis 
C. Wilson's disease 
D. All of the above

Ans. D.  All of the above     

•Globular red hyaline material within hepatocytes.

•This is Mallory's hyaline, also known as "alcoholic" hyaline because it is most often seen in conjunction with chronic alcoholism.

•The globules are aggregates of intermediate filaments in the cytoplasm resulting from hepatocyte injury.

•They are most commonly found in the livers of people suffering from alcoholic hepatitis.

PGIMER MCQs for MD MS Preparations | Structures passing through jugular foramen

Structures passing through jugular foramen are all except

a. IX cranial nerve 

b. X cranial nerve
c. XII cranial nerve 
d. XI cranial nerve
e. VII CN

Ans.C

Through ant. Part-

Inferior petrosal sinus

Meningeal branch of the ascending pharyngeal artery

Through middle part-

9th, 10th & 11th cranial nerves

Through post part

Internal jugular vein

Meningeal branch of the occipital artery

Glossopharyngeal notch near the medial end lodges the

inferior ganglion of the glossopharyngeal nerve

APPG 2016 HAND WRITTEN MICRO NOTES

Link>>>> Mission APPG 2016

APPG Entrance Preparations | About Informed consent

About Informed consent, false is:- 

A. All information should be given about treatment options.
B. All information about expected complications should be told 
C. Any treatment option better than the treatment being provided should be told 
D. All disclosure should be done in a language that the patient can understand

Ans. B.  All information about expected complications should be told

False statement is ‘All information about expected complications should be told’. The physician should not inform the patient about all the adverse effects, instead should inform the patient about one important adverse effect that should be considered in the decision and thus material to the decision making process.

APPG Entrance Preparations | “Integrated disease surveillance programme IDSP.”

According to “Integrated disease surveillance programme IDSP. ”, which disease or condition does not come under regular surveillance?

A. Typhoid 
B. Polio 
C. Road traffic accidents 
D. Hepatitis — B

Ans.  D.  Hepatitis - B

According to IDSP list of core diseases is:

i.  Regular surveillance -

Vector Borne disease                                              1. Malaria

Water borne disease                                               2. Acute diarrhoeal disease Cholera. 

3. Typhoid

Respiratory Disease                                                4. Tuberculosis

Vaccine preventable disease                   5. Measles

Disease under eradication                       6. Polio

Other conditions                                      7. Road traffic accidents

Other international commitments             8. Plague

Unusual clinical syndrome                       9. Meningoencephalitis

Respiratory distress

Haemorrhagic fever

Other undiagnosed conditions

ii.  Sentinel surveillance —

Sexually transmitted disease —               10 HIV, HBV, HCV

Other conditions —                                  11. Water quality

12. Outdoor Air quality

iii.  Regular periodic surveys —

Non-communicable disease risk factors anthropometry, physical activites

Blood pressure, tobacco, nutrition blindness and other unusual health conditions 

APPG Entrance Preparations | Critical path method CPM

Predominantly, for management of which one of the following resources, the critical path method CPM. is used as one of the health administration techniques? 

A. Money 
B. Manpower
C. Time 
D. Material

Ans. C.  Time

Critical Path Method CPM.  : The longest path of the network is called “Critical Path”. If any activity along the critical path is delayed, the entire project will be delayed. So it is the time which is used as critical path in health administration techniques. 

APPG Entrance Preparations | Tuberculosis in HIV positive individual

Which statement is false regarding Tuberculosis in HIV positive individual

A. Frequent negative sputum smear. 

B. False negative tuberculin test result
C. Extra pulmonary tuberculosis more common. 
D. Cavitating lesions in lungs as shown by chest X-ray.

Ans. D.  Cavitating lesions in lungs as shown by chest X-ray.

In early part of HIV infection with high CD4 count, the clinical manifestations are more similar to non HIV TB patient. But in latter part of HIV infection when CD4 count is low, TB patient more commonly present with atypical features of pulmonary TB and also features of extra pulmonary TB. In X-ray chest- lower zone infiltration, bilateral interstitial infiltrate, mediastinal hilar lymph gland enlargement and nodular lesions are commonly seen. Cavitary lesion and upper zone infiltration are less common. Extra pulmonary TB are more common in HIV - TB Co infected patient. Sputum smear examination show negative for AFB because of less cavitation in HIV —TB co infected patients. False negative Tuberculin test result is due to decreased immune response in advance I-BY infection

APPG Entrance Preparations | Tracking’ of blood pressure

The term ‘Tracking’ of blood pressure refers to- 

A. Pictoral representation of BP 
B. BP control with nifedipine
C. 24 hrs. BP monitoring 
D. Identifying children at risk of developing hypertension of future date

Ans. D. Identifying children at risk of developing hypertension of future date.

Sol. ‘Tracking’ of blood pressure -If blood pressure levels of individuals were followed up over a period of years from early childhood to adult life, then those individuals whose pressure were initially high in the distribution, would probably continue in same ‘track’ as adult. This phenomenon called ‘tracking’. It is useful in identifying children and adolescent ‘at risk’ of developing hypertension at a future date. 

PGIMER entrance Preparations | Tyrosine

Which one of the following hormones is derived most completely from tyrosine?

A. Glucagon 

B. Thyroxine 
C. Insulin 
D. Prostaglandins

Ans. B. Thyroxine

Two of the major hormones are derived from the amino acid tyrosine:

The adrenal hormone epinephrineand the thyroid hormonethyroxine tetraiodothyronine. . Epinephrine is the catabolic antagonist of insulin, a polypeptide hormone, and is similar in action to glucagon, a liver-specific polypeptide hormone. Thyroxine is important in governing the basal metabolic rate. 

PGIMER entrance Preparations | clinical diagnosis of inflammatory carcinoma

A 35-year-old woman who underwent a modified radical mastectomy of her right breast for infiltrating ductal carcinoma 2 years ago presents with enlargement of her right breast. The breast has a swollen, red-discolored appearance. It is diffusely indurated and tender on palpation. Multiple axillary lymph nodes are palpable in the lower axilla. The working clinical diagnosis is inflammatory carcinoma. Which histologic features is most characteristic of this clinical diagnosis? 

A. Duct ectasia with numerous plasma cells 
B. Extensive invasion of dermal lymphatics 
C. Infiltrating malignant ducts surrounded by numerous neutrophils 
D. Malignant vascular tumor forming slit-like spaces

Ans. B. Extensive invasion of dermal lymphatics

Inflammatory breast carcinoma is often misunderstood because of the qualifying adjective inflammatory. The term does not refer to the presence of inflammatory cells, abscess, or any special histologic-type of breast carcinoma; rather, it refers to more of a clinical phenomenon, in that the breast is swollen, erythematous, and indurated and demonstrates a marked increase in warmth. These changes are caused by widespread lymphatic and vascular permeation within the breast itself and in the deep dermis of the overlying skin by breast carcinoma cells. The clinical induration and erythema are presumably related to lymphatic-vascular blockage by tumor cells; if present, these findings mean a worse prognosis.

APPG Entrance Preparations | Guttate psoriasis

Guttate psoriasis: 

A. Most common in elderly adults. 
B. It is the most common variety of psoriasis and is insidious onset with chronic clinical course. 
C. Association with a-hemolytic streptococci known. 
D. Eruptive psoriasis.

Ans. d. Guttate psoriasis eruptive psoriasis.  is the most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients presents with many small erythematous, scaling papules, frequently after upper respiratory tract infection with β-hemolytic streptococci. The differential diagnosis should include pityriasisrosea and secondary syphilis. The most common variety of psoriasis is called plaque-type.

State Medical PG Entrance | Anxiety Symptoms MCQ

A 20 years old young female presented with acute onset dyspnea in emergency department. She is feeling restless and has feeling' of impending doom. On asking further about history, she mentioned that she has examinations coming up and is feared about it. What is the most likely diagnosis? 

A. Panic disorder 
B. Anxiety 
C. Schizophrenia 
D. OCD

Ans. B. Anxiety    

Panic disorder runs a chronic course and intermittent multiple panic attacks are experienced.

Anxiety is more likely diagnosis in this case.

PANIC DISORDER: Recurrent unexpected attacks of Intense Anxiety that include marked physical symptoms, such as Tachycardia,Hyperventilation, Dizziness& Sweating. Associated with separations during childhood & interpersonal loss in adulthood.Occur in response to "Panicogens" i.e. Lactate, C02, Caffeine&Yohimbine. 

Associated problems

Agoraphobia, Depression, Generalized Anxiety & Substance Abuse

Treatment

Short term Treatment: Benzodiazepines Alprazolam. 

Long term Treatment: SSRI Fluoxetine.  &/or TCAs Imipramine. 

 Others: Clonazepam & MOI Phenelzine. 

Psychotherapy 

APPG Entrance Preparations | TOC erythrodermic psoriasis

For erythrodermic psoriasis the treatment of choice is: 

A. Topical corticosteroids 

B. Coal tar topically

C. Methotrexate 

D. Corticosteroids

Ans. A Topical corticosteroids

An important point in treatment of erythrodermic psoriasis is not to irritate the skin further and therefore anthralin and' other irritating compounds are relatively contraindicated in erythrodermic psoriasis. Bland topical steroids such as 1 % hydrocortisone in an ointment base applied liberally can be useful. If there is not a reasonably rapid improvement, consideration should be given to the use of cyclosporine 2 to 5 mg/kg/per dose or methotrexate 5 mg, 12 hourly for 3 doses, once a week. When the acute episode has subsided, UVB or PUVA car be restarted.

PGIMER entrance Preparations | O2 dissociation cause shifts to right

O2 dissociation cause shifts to right in all except

a. Hypercarbia 
b. low 2-3 DPG
c. during exercise 
d. Increased temperature
e. alkalosis

ANS. B, E

	left shift (high affinity for O2)	right shift (low affinity for O2)
Temperature	decrease	increase
2.3-DPG	decrease	increase
p(CO2)	decrease	increase
pH (Bohr effect)	increase (alkalosis)	decrease (acidosis)
type of haemoglobin	fetal haemoglobin	adult haemoglobin

PGIMER entrance Preparations | Pyogenic Granuloma

Pyogenic Granuloma, true statements is/are: 

a. Vascular pathology 
b. Bleeds rarely 
c. Increased in pregnancy 
d. Local excision 
e. Recurrent & malignant

Ans. (A) Vascular pathology; (C) Increased in pregnancy; (B) Local excision

• Pyogenic Granuloma (Lobular capillary hemangioma) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. This is neither infectious nor

granulomatous.

• The lesion usually occurs in children and young adults as a solitary glistening red papule or nodule that is prone to bleeding and ulceration. The surface has a raspberry-like or raw minced meat appearance.

Females are affected more commonly due to the pregnancy tumor phenomenon.

• it typically evolves rapidly over a period of a few weeks, most often on the head, neck, extremities, and upper trunk.

• Treatment:

Curettage and cauterization

Laser surgery

Cryotherapy

• Silver nitrate is used for chemical cauterization. 

State Medical PG Entrance | Regarding Lamotrigine,

Regarding Lamotrigine, which of the following is a TRUE statement? 

A. It is a dopaminergic agonist used in Parkinsonism 

B. It acts by blocking NMDA type of glutamate receptors 
C. It is a broad spectrum antiepileptic drug 
D. It suppresses tonic-clonic seizures but worsens absence seizures

Ans. C. It is a broad spectrum antiepileptic drug

•Lamotrigine is useful for the treatment of various types of seizures including GTCS, absence seizures and myoclonic epilepsy.

•Lamotrigine acts by blocking Na+ channels, T-type Ca2+ channels and by increasing GABAergic activity.

•Major adverse effect of lamotrigine is Steven Johnson syndrome and toxic epidermal necrolysis. 

State Medical PG Entrance | Beta-endorphin

Which statement about beta-endorphin is most accurate? 

A. It is exclusively located in the spinal cord 

B. Enzymes for its synthesis are located in nerve endings 
C. It selectively activates delta opioid receptors 
D. Its actions are mainly inhibitory

Ans. D.  Its actions are mainly inhibitory

The opioid peptides are widely distributed in the CNS at all levels of the neuraxis and are synthesized in the cell bodies.

They activate several receptor subtypes and cause inhibition. No mechanism has been described for termination of the synaptic actions of endogenous peptides

Medical PG Coaching MCQs | Acute drug dystonia

A 45 year old female was brought to casualty with stiff and deviation neck to one side. She has a history of haloperidol 5 mg tds prescribed one day back. She also has same altercation with her husband. Most common cause for this is 

A. Conversion reaction 
B. Acute psychosis
C. Acute drug dystonia 
D. CVA

Ans. C. Acute drug dystonia.  

Explanation: Drug-induced dystonia is an acute extrapyramidal side effect caused most commonly by typical antipsychotics. This involves large muscle groups. Common manifestation is in the form of torticollis, lingual dystonia, linguofacial dystonia. This side effect can occur in a single dose or within the first week of initiating treatment. Treatment is benztropine, promethazine, and hydroxyzine.

upto 12 wks Warfarin 3 mg tab upto 36 wks Heparin upto 7 days postpartum

MD MS Entrance MCQs | Flying range of aedes aegypti

Flying range of aedes aegypti 

A. 200 meters 
B. 300 meters
C. 400 meters 
D. 100 meters.

ANS. D. 100 METERS.

Aedes is responsible for dengue outbreak.

m/c vector is aedes aegypti

The aedes aegypti index is kept to minimum of 1%as prevention for outbreak.

The airports and sea ports are kept as aedes free zone for a radius of 400mt for prevention of spread of dengue or vector borne disease. Flying range of the mosquito is taken as 100meters.