Fracture of the medial malleolus and fracture of the fibula | NEET Based MCQs

An obese 32-year-old woman presented with eversion of her right foot. She has a displaced fracture of the medial malleolus and fracture of the fibula above the level of the tibiofibular joint.Treatment of choice would be 

A. Traction. 
B. Bed rest. 
C. External fixation. 
D. Open reduction and internal fixation.

Answer . D. Open reduction and internal fixation

• Fractures of the ankle usually require operative treatment if there is significant disruption of the joint or if there is instability.
• If both malleoli are involved and the fibula is fractured at or above the tibia fibular ligament (also called the syndesmosis ) then surgical plating of the fibula is required.

• If there is a significant medical malleolar fragment then this should also be fixed with a screw or wire.

• Displaced stable fractures can be treated with closed reduction and a plaster.

• Non-displaced, stable fractures may only require a plaster. 

‘Snow ball’ Opacity in vitreous | PGI based MCQs

‘Snow ball’ Opacity in vitreous is seen in 

A. Pars planitis 
B. Sarcoidosis 
C. Juvenile RA. 
D. Toxoplasmosis 
E. Fuch’s lesion

The Answer is.(A) Pars planitis ; (B) Sarcoidosis

VITREOUS OPACITIES – [FAQ]

1. Opaque sheets anterior to the vitreous

Elschnig pearls after extracapsular cataract extraction or needling (posterior  capsule opacification)

Soemmerring ring following extracapsular cataract extraction or needling

Vitreous adhesions to iris, capsule, or intraocular lens (IOL) after cataract  extraction with vitreous loss

2. Pseudoglioma-leukokoria

3. Scattered opacities

A.   Amyloid disease-rare (seen in older persons)

B.   Ankylosing spondylitis

C.   Crystalline deposits

(1)     Asteroid hyalosis

(2)     Synchysis scintillans

D.   Endophthalmitis

E.    Heterochromic uveitis-in persons 20 to 50 years of age; of all uveitis, iris  atrophy, lens changes

F.    Myeloma, multiple-rare: in persons 50 to 70 years old, associated with bone  pain, anemia

G.   Pigment cells-posttraumatic (hemorrhage), senile, or melanotic, associated with  rhegmatogenous retinal

H.   detachment.

I.     Protein coagulated plasmoid vitreous

(1)     Choroidal tumors (very rare-reported in metastatic breast cancer once)

(2)     Contusions

(3)     Intermediate uveitis (pars planitis)

(4)     Retinochoroiditis

J.        Snowball opacities-rare, associated with pars planitis or sarcoidosis,  endophthalmitis (indolent)

K.      Tumor cells-retinoblastoma in older child, reticulum cell sarcoma (older  persons)

L.       Vitreous degeneration-Wagner disease, Ehlers-Danlos syndrome, and Marfan  syndrome, senescent aging changes, myopia

M.     Retinitis pigmentosa

4. Single opacities

A. Anterior hyaloid remnant (Mittendorf dot)-25% normal eyes, dot on posterior  lens surface

B. Hyaloid remnants (uncommon)-persistent hyperplastic primary vitreous

C. Foreign body-history of trauma or surgery

D. Dislocated lens

E. Parasitic cysts

  (1) Hydatid disease (echinococcosis)-rare, children and young adults, tropical area

  (2) Cysticercosis-rare

F. Vitreous detachment-common in older or myopic persons

Keratomalacia | PGI based MCQs

Keratomalacia is associated with 

A. Measles 
B. Mumps 
C. Rubella 
D. Diarrhoea 
E. Chicken pox

The Answer is. (A) Measles; (D) Diarrhoea

• Kerotomalacia is due to deficiency of vitamin-A,

• Measles and diarrhoea - vit A dificiency, there by causes Keratomalacia

Vit A deficiency stages:

1. night blindness (first symptom)

2. conjunctival xerosis (first sign)

3. bitot spots (epidemiological marker)

4. corneal xerosis (non reversible)

5. keratomalacia (last stage, blindness, liquefaction of cornea)

Herpes zoster ophthalmicus | PGI Based MCQ

Polypetide chain termination is enhanced by 

A. Stop codon 
B. promoter 
C. Ribosomal unit 
D. Peptidyl transferase 
E. UAA

The Answer is. (A) Stop codon ; (E) UAA

• Peptide chain termination is enhanced by stop codon or the nonsense codon

• The stop codons are UAG, UGA, UAA

Classes of proteins involved in Replication

— DNA polymerase : Deoxynucleotide polymerization.

— Helicase : progressive unwinding oi DNA.

— Topoisomerase : Relieves torsional strain that results from helicase-induced unwinding.

— DNA primase : Initiates synthesis of RNA primers.

— DNA ligases seals single strand nick between the nascent chain and okazaki fragments on lagging strand,
— Single stand-Binding protein : prevents premature reannealing of ds DNA.

• RNA polymerase.: It synthesises short strands of RNA 

Investigation of anterior uveitis of a young boy | PGI based MCQs

The investigation of anterior uveitis of a young boy are

A. HLA B27
B. X—ray sacroiliac joint 
C. TORCH agents 
D. ELISA for HIV 
E. USG abdomen

The Answer is.(A) HLAB27 ; (B) X-ray Sacroiliac joint ; (C) TORCH agent ; (D) ELISA for HIV

Anterior uveitis: common causes

Idiopathic

Trauma, which may be mild

Seronegativespondyloarthropathies (HLA-B27+) including ankylosing spondylitis, Reiter syndrome, psoriatic arthritis, inflammatory bowel disease including Crohn disease and ulcerative colitis

Juvenile idiopathic arthritis

HSV and HZV

Sarcoidosis

Fuchs heterochromic iridocyclitis

Lupus erythematosus

Lens-associated uveitis

Intraocular lens implant–associated uveitis

Posner-Schlossman syndrome or glaucomatocyclitic crisis, a type of secondary inflammatory glaucoma.

Infectious posterior uveitis: common causes

Toxoplasmosis

HSV

HZV

Cytomegalovirus

Syphilis

Candidiasis

Toxocariasis

An infant has hepatorenomegaly, hypoglycemia hyperlipidemia, aciodsis | PGI based MCQs

An infant has hepatorenomegaly, hypoglycemia hyperlipidemia, aciodsis& normal structured glycogen deposition in liver. The most probable diagnosis is:

A. Hers disease 
B. Von Gerke’s disease
C. Con’s disease
D. Andersons disease
E. Pompes disease

The Answer is. (B) Von Gerke’s disease

In von Gierke’s disease there is growth retardation, enlarged liver and kidney, hypoglycemia elevated blood lactate, cholesterol, triglyceride and uric acid.

— In von Gierke’s disease the liver biopsy shows hepatocytes distended with glycogen and fat with large prominent lipid vacuoles. There is little associated fibrosis

Related MCQ’s

Symptoms

Constant hunger and need to eat often	Easy bruising and nosebleeds
Fatigue, Irritability	Puffy cheeks, thin chest and limbs, and swollen belly

Signs:

Delayed puberty

Enlarged liver, Gout, Inflammatory bowel disease

hypoglycemia

Stunting

MCQ - usually diagnosed before age 1.

Bilateral uveitis in 10 yr old child | PGI based MCQs

Bilateral uveitis in 10 yr old child, proper investigation(s) for his work up would be 

A. C.T. scan 
B. Tuberculin test 
C. X-ray sacroiliac joint 
D. HIV test 
E. X-ray chest

The Answer is . (B) Tuberculin test; (C) X-ray sacroiliac joint; (D) HIV test (E) X-ray chest

— X-ray chest and Mantoux test done for the evidence of tuberculosis

— X-ray sacrum is done for ankylosing spondylitis

— Antinuclear antibody is done for SLE

True about case control study | PGI based MCQs

True about case control study 

A. Helpful for evaluation of rare diseases 
B. Expensive 
C. Incidence can be measured 
D. Rare causes studied 
E. Selection bias common

The Answer is . (A) Helpful for evaluation of rare diseases: (E) Selection bias common

Advantages of case control study that it is

— Rapid and inexpensive

— particularly suitable to investigate rare diseases or diseases about which little is known.

— require relatively few subjects, with no risk to them

— study of several different aetiological factors

Risk Factors can be identified - attrition problem, ethical problem minimal

Disadvantages

• Problem of bias e.g. selection, Berkesonian, interview etc

• Can not measure incidence, can only extimate relative risk

• Don’t distinguish between cause and associated factors

• Not suited for evaluation of therapy or prophylais of disease

Skin lesions are common in all of the following fungal diseases except

Skin lesions are common in all of the following fungal diseases 

A. Piedra. 
B. Chronic mucocutaneous candidiasis. 
C. Disseminated blastomycosis. 
D. Disseminated candidliasis.

Answer. A. piedra.

Piedra is an infection of the hair that results in hair breakage. It does not have skin lesions associated with it. Chronic mucocutaneous candidiasis occurs in individuals who have an endocrine defect that result (without treatment) in overwhelming cutaneous lesions and allergy to Candida antigens. When Blastomyces disseminates, it frequently disseminates to the skin or brain. Fungemias (Candida infections) may also lead to maculonodular or maculopapular skin lesions. 

Conditions are associated with Molar Pregnancy | NEET Based MCQs

The following conditions are associated with molar pregnancy except 

A. Pregnancy-induced hypertension
B. Thyrotoxicosis
C. Gestational diabetes
D. Hyperemesis gravidarum

Drug of choice for the treatment of chlamydial infection | NEET Based MCQs

The drug of choice for the treatment of chlamydial infection is 

A. Ampicillin
B. Third generation cephalosporins 
C. Metronidazole 
D. Doxycycline

Answer: D (Doxycycline)
Treatment of chlamydial infection
• Doxycycline or tetracycline:
o 7-day course for genital infections.
o 2-week course for complicated (PID, epididymis) chlamydial infections.
o 3-week course for LGV.
• Azithromycin—highly active against C. trachomatis, exhibits prolonged bioavailability, is concentrated intracellularly and single dose (1 g) therapy.
• Ofloxacin (300 mg BD for 7 days).
• Erythromycin base 500 mg QD for 10—14 days is regimen of choice for pregnant women.
• Amoxicillin (500 mg TDS for 10 days) has also been used successfully in pregnant women. 

Most common site of ureteric injury | NEET Based MCQs

The most common site of ureteric injury during Wertheim’s hysterectomy is

A. At the level of infundibulopelvic ligament 
B. Where the uterine artery crosses the ureter from above 
C. Where ureter traverses through the musculature of the bladder 
D. In the ovarian fossa

Poor prognostic factors in the management of Cancer Cervix | NEET Based MCQs

Poor prognostic factors in the management of cancer cervix are the following except 

A. Young age 
B. Well-differentiated squamous cell carcinoma 
C. Hydroureter 
D. Adenocarcinoma

Answer: B (Well-differentiated squamous cell carcinoma)
Prognosis of carcinoma of the cervix:
1. Stage of lesion at the initial therapy (most important factor)

Stages	Survival rate (%)
I	85
II	55
Ill	3
IV	15

2. Endocervical tumor—diagnosed late and grows faster. (Adenocarcinoma develops from endocervical canal.)
3. Depth of tumor when <1 cm, less lymph nodes are involved and improved survival.
4. Tumor size >4 cm, associated with more lymph node metastasis and poor survival.
5. Well-differentiated squamous cell carcinoma grows slowly and metastasis late than the anaplastic type.
6. Young age is usually associated with poorly differentiated squamous cell carcinoma or adenocarcinoma and is prognostically poor

7. Lymph node involvement—pelvic and para-aortic reduces the survival rate by 50%.
8. HPV-positive younger patients have better prognosis 

Wave V on BERA | PGI Based MCQ

Wave V on BERA is generated at:

A. Cochlear nerve
B. Superior olivary nucleus
C. ventral nucleus of lateral lemniscus
D. Inferior colliculus
E. nuclei of lateral laminiscus

The Answer is. E. nuclei of lateral laminiscus[Refer Figure # 13]

BERA:

Synonyms: Brain stem evoked response audiometry, auditory brain stem response, ABR audiometry, BAER (Brainstem auditory evoked response audiometry).

Bera is an objective way of eliciting brain stem potentials in response to audiological click stimuli. These waves are recorded by electrodes placed over the scalp.

MCQ: - first described by Jewett and Williston in 1971.

Process: The stimulus either in the form of click or tone ‘pip’ is transmitted to the ear via a transducer placed in the insert ear phone or head phone. The wave froms of impulses generated at the level of brain stem are recorded by the placement of electrodes over the scalp.

In auditory brain stem evoked response audiometry, the impulses are generated by the brain stem. These impulses when recorded contains a series of peaks and troughs. The positive peaks (vortex positive) are referred to by the Roman numerals I - VII.

These peaks are considered to originate from the following anatomical sites:^[vFAQ]

1. Cochlear nerves - waves I and II

2. Cochlear nucleus - wave III

3. Superior olivary complex - wave IV

4. Nulclei of lateral lemniscus - wave V

5. Inferior colliculus - waves VI and VII

These peaks occur in most readable form in response to click stimuli over a period of 1 - 10 milliseconds after the stimulus in normal hearing adults.

BERA is resistant to the effects of sleep, sedation, sleep and anesthesia. Its threshold has been found to be within 10dB as elicited by conventional audiometry.

Stenger test | PGI Based MCQ

Stenger test is used to detect:

A. Conductive hearing loss
B. Sensorineural hearing loss
C. Mixed hearing loss
D. functional hearing loss
E. malingering

The Answer is.D. functional hearing loss, E. malingering

Stenger test, teal test and Lombard test are used to detect functional hearing loss.

Stengertest : a test for detecting simulation of unilateral hearing impairment, in which a tone below the admitted threshold is presented to the test ear and a tone of lesser intensity is presented to the other ear. If the subject is feigning a hearing loss, the lesser tone cannot be appreciated.

Tests for malingering:

ChimaniMooss test:  This is nothing but a variation of Weber's test.  Normally in Weber's test the patient hears the best in the occluded ear.  In malingering the patient will not accept to hear better in the occluded ear.

Stenger's test:  This test is based on "Stenger's phenomenon".  In stenger's phenomenon when a listener is presented with the same type of sound in both ears he /she will heara single sound, that too only in the ear which it is louder.

Procedure:  Two tuning forks with frequency of 512 Hz are kept equidistantly from both ears, one should be able to hear equally well in either side.  In malingering say i.e. left ear, even if the tuning fork is moved too close to the left ear, the patient denies that he is hearing in the right side also.

Teal's test:  In this test a vibrating tuning fork is applied over the mastoid process of the so called deaf ear, the patient accepts to hear it.  Then the patient is blind folded and with a non vibrating fork on the mastoid process, the malingering patient claim's to hear the sound.

Lombard's test:  This test is based on "Lombard's principle".  This principle says that one raises his / her voice when speaking in noisy environment.  While performing this test, the patient is allowed to read  a book.  Noise is introduced into the ear.  The noise is gradually increased till the patient raises his / her voice or stops the process of reading.

Erhardt's test:  This test is also known as loud voice test.  In normal person when the ear is occluded with a finger, it dampens the sound but it can still be heard.  Malingerer often denies hearing the sound even when it is loudest.

Stethoscope test:  In this test, one ear piece of the stethoscope is closed with wax and used on the side of deafness.  The funnel shaped chest piece is used to talk to the patient.

The malingerer gets confused and cannot tell whether he is hearing on the right / left side.

Yellow Fever | PGI MCQ

True about yellow fever 

A. I.P. is 10-14 days 
B. Transmitted by Aedes. 
C. It is found in Asia. 
D. Incidence is increased by humidity. 
E. It is a Flavivirus

The Answer is. (B) Transmitted by Aedes; (D) Incidence is increased by humidity; (E) Itis a Flavivirus

* Yellow fever is caused by Flavivirus and is endemic in Africa and America.

* It is prevalent in Africa and SouthAmerica.

* Yellow fever is transmitted by Aedes aegypti.

* Incubation period is 3-6 days.

* A temperature 24° C or over is required for multiplication of virus in mosquito. 

Irregular non-healing ulcer | PGI MCQ

A 47-year-old man with chronic post-thrombotic edema of the left leg has an irregular non-healing ulcer above the medial malleolus. The following is/are true: 

A. The cause of the ulceration is extension of venous thrombosis to the superficial capillary bed 
B. The ulcer is certain to be infected and merits antibiotic treatment 
C. The underlying perforating veins are likely incompetent
D. Isolated saphenous vein incompetence can produce such a situation
E. Immidiate excision of ulcerated area is best  management

The answer is. C. The underlying perforating veins are likely incompetent, D. Isolated saphenous vein incompetence can produce such a situation

The presentation indicates chronic venous insufficiency with stasis ulceration secondary to sustained venous hypertension. The pathophysiology involves leukocyte capillary trapping, an inflammatory reaction, and scarring of the subcutaneous tissues with ischemia of the skin. The stasis ulcer can be managed by occlusive dressing, special boots and elastic support without antibiotics. The location is typical for stasis ulcer due to adjacent underlying incompetent perforator veins. Such a situation can also be seen with isolated saphenous vein incompetence. 

Biosaftey precaution grade 3 | NEET Based MCQs

Biosaftey precaution grade 3 is practiced in labs handling all except? 

A. Human influenza virus 
B. St louis encephalitis virus 
C. Coxiella burnetti 
D. Mycobacterium tuberculosis

Answer. A. Influenza Virus where Biosafety 2 comes into picture.

BIOSAFETY LEVEL 1

This level is suitable for work involving well-characterized agents not known to consistently cause disease in healthy adult humans and of minimal potential hazard to laboratory personnel and the environment

It includes several kinds of bacteria and viruses including E. coli, Chicken pox, a well as some cell cultures and non- infectious bacteria

The precaution includes basic and simple techniques as gloves, eye, facial protections. The laboratory may not be isolated from general traffic areas and ergonomics do not require stringent working SOP’s

BIOSAFETY LEVEL 2

This level is similar to Biosafety Level 1 and is suitable for work involving agents of moderate potential hazard to personnel and the environment.

Includes various bacteria and viruses that cause only mild disease to humans or are difficult to contract via aerosol in a lab setting, such as Hepatitis , influenza A, Lyme disease , Dengue, salmonella mumps, bacillus subtilis, HIV, scrapie, MRSA etc.

^[FAQ] There is trained laboratory personel for working and handling BS 2 SOP’s (SOP = standard operating protocols)

BIOSAFETY LEVEL 3

This level is applicable to clinical diagnostic teaching research or production facilities in which work is done with rare or exotic agents which may cause serious or potentially lethal disease as a result of exposure by the inhalation route.

It includes various bacteria and viruses that can cause severe to fatal disease in humans but for which vaccines or other treatment exist, such as Anthrax, West Nile Virus, SARS, Typhus, JE, TB, Encephalitis, RMSF

Laboratory personnel have specific training in handling pathogehic and potentially lethal agents, and are supervised by competent scientists who are experienced in working with these agents. The laboratory has specialized working and safety mechanisms as ventilations, exhausts, access, recommended safe practices, SOP’s

'Most Common’ cause of intravenous catheter related infection | NEET Based MCQs

Which species pseudomonas is the most common’ cause of intravenous catheter related infection?

A. Pseudomonas cepacia 
B. P aeruginosa 
C. P maltophilia 
D. Burkholderia pseudomallel

Answer. D Burkholderia pseudomallei

• Burkholderia pseudomallei is a type of pseudomonas infection. It causative agent of melioidosis.

• B.pseudomallei also causes chronic pulmonary infection with systemic manifestations that mimic those of tuberculosis, including chronic cough, fever, hemoptysis, night sweats, and cavitary lung disease

• Besides pneumonia, the other principal form of B. pseuclomallei disease is skin ulceration with associated lymphangitis and regional lymphadenopathy

• Spread from the lungs or skin, which is most often documented in debilitated individuals, gives rise to septicemic forms of melioidosis that carry a high mortality rate. 

Cataract Evaluation | PGI MCQs for MD MS Preparations

Cataract is evaluated by

A. Gonioscopy 
B. Tonometry
C. stereoaquity 
D. Contrast
E. Colour vision

The Answer is. (A) Gonioscopy; (B) Tonometry; (E) Colour vision

Pre-operative thorough evaluation should be carried out before surgery. This include

I. (a) General medical condition of the patient to include the presence of serious systemic diseases like DM, HTN,

Cardiac problem, COPD, any potential source of infection in the body such as septic gum, UTI etc.

II. Ocular examination

A thorough examination of eyes including slit-lamp biomicroscopy is desirable in all cases.

a) Retinal function test –

* Perception of light (PL).

* Test for Marcus Gum Pupillary response.

* Projection of rays.

* Two light discrimination test.

* Maddox rod test.

- Electrophysiological study e.g., ERG, EOG and VER and indirect ophthalmoscopy if possible.

b) Search for local source of infection as conjunctival or related organ infections

c) Pre-operative evaluation of intra-ocular pressure – tonometry, gonioscopy – ant. Chamber visualization