Tuesday, February 10, 2009

85 - COMEDK PGET 2009 paper mcqs - 2

6.            myelodysplastic syndrome is associated with which chromosome ?


a.            2q

b.            5q

c.             8q

d.            11q


Answer: B . 5q .


7.            progressive supranuclear palsy is associated with all except


a.            tremors

b.            unsteadiness

c.             dysarthria

d.            gaze palsy


answer:  A . tremors .


8q: which of the following is the most common cause of non gonoccal urethritis ?


a.            Chlamydia

b.            Trichomonas

c.             Ureaplasma

d.            Herpes simplex


Answer:  A . Chlamydia .


9q: which of the following is the most common complication of transurethral resection of prostate ( TURP ) ?


a. erectile dysfunction

B. retrograde ejaculation

c. urinary incontinence

d. urethral stricture disease


answer: B . retrograde ejaculation .



10q: all of the following are associated with hydrops fetalis except ?


a.            congenital heart block

b.            cystic hygroma

c.             congenital varicella syndrome

d.            congential nephrosis


answer:  C. congenital varicella syndrome .


11q: in a child with acute liver failure which of the following is the most important abnormal sero biochemical test ?


a.            increasing transminases

b.            increasing bilirubin

c.             increasing prothrombin time

d.            reversal of serum albumin globulin ratio


answer: C . increasing prothrombin time .


12q: thoracic duct crosses the posterior mediastinum at the level of which vertebra ?


a.            T5

b.            T6

c.             T7

d.            T8


Answer: A . T5 Vertebra .

84 - COMEDK PGET 2009 paper mcqs - 1

1.            diaphanous test is used to detect ?


a. pregnancy

b. stoppage of circulation

c. stoppage of  respiration

d. presence of blood


answer: C. stoppage of respiration .



2.            roth’s spots are seen


a.            hypertension

b.            septicemia

c.             diabetes mellitus

d.            central retinal occlusion


answer: b . septicemia .


3.            severe heat strain – heat stress index


a.            10 - 30

b.            40 - 60

c.             70 - 90

d.            100


Answer: B . 40 – 60 .


4. utriacarial lesions are best described as


a.            Non pruritic

b.            bullous

c.             evanescent

d.            macular


answer: C . evanescent .


5. which of the following vasculitis is most commonly associated with coronary artery aneurysm ?


a.            Kawasaki disease

b.            Giant cell arteritis

c.             wegener’s granulomatosis

d.            leukocytic vasculitis


answer: A . Kawasaki disease .


6.            myelodysplastic syndrome is associated with which chromosome ?


a.            2q

b.            5q

c.             8q

d.            11q


Answer: B . 5q .

Sunday, February 8, 2009

83 - NIMS MEDICINE february 2009 paper - 8

8q: a patient who was on total parenteral nutrition developed scaling dermatitis after 4 weeks . which can be the probable cause of his symptoms ?

a. linoleic acid deficiency
b. zinc deficiency
c. vitamin defiiciency
d. glucose intolerance

answer: a . linoleic acid deficiency . one of the important complication of total parenteral nutrition is essential fatty acids deficiency .

Essential fatty acids deficiency. The lack of linoleic acid leads to dermatitis,
hair loss and impaired wound healing. Clinical evidence of fatty acid deficiency
appears after one or two months of parenteral nutrition without lipid
administration but biochemical evidence may be detected much earlier consisting
in an increasing quotient between eicosatrienoic and arachidonic acids above
0.425. This syndrome was reported mostly in North American patients since fat
emulsions were introduced late in the USA. Initially some authorities
recommended the weekly administration of 1000 to 1500 ml of a 10% fat
emulsion to prevent fatty acid deficiency. This practice, however, has largely
been abandoned in favour of the daily administration of 20% fat emulsions to
cover from 30 to 60% of the daily caloric requirements.

82 - NIMS MEDICINE february 2009 paper - 7

7q: what is the enzyme deficiency observed in SCID ( severe combined immunodeficiency syndrome ) ?

a. adenosine deaminase
b. peroxidase
c. glucose 6 phosphatase
d. none

answer: a . adenosine deaminase .

The second most common form of SCID after X-SCID is caused by a defective enzyme, adenosine deaminase (ADA), necessary for the breakdown of purines. Lack of ADA causes accumulation of dATP. This metabolite will inhibit the activity of ribonucleotide diphosphate reductase, the enzyme that reduces ribonucleotides to generate deoxyribonucleotides. The effectiveness of the immune system depends upon lymphocyte proliferation and hence dNTP synthesis. Without functional ribonucleotide reductase, lymphocyte proliferation is inhibited and the immune system is compromised.

81 - NIMS MEDICINE february 2009 paper - 6

6q: positive benedict's test is shown by ?

1. glucose
2. homogenitisic acid
3. ascorbic acid
4. ketone bodies

a. 1 , 2 and 3 are correct
b. 1 and 3 are correct
c. 2 and 4 correct
d. only 4 is correct

answer: a . 1 , 2 and 3 are correct .

Urinary sugars when boiled in Benedict's reagent reduce copper sulphate to a reddish cuprous oxide precipitate in hot alkaline medium, the intensity of which is proportional to the amount of sugar present in the urine. The results are reported as I+,2+, etc. depending upon the colour and intensity of the cuprous oxide precipitate.

Benedict's reagent is used as a test for the presence of all monosaccharides, and generally also reducing sugars. These include glucose, galactose, mannose, lactose and maltose. Even more generally, Benedict's test will detect the presence of aldehydes (except aromatic ones), and alpha-hydroxy-ketones, including those that occur in certain ketoses. Thus, although the ketose fructose is not strictly a reducing sugar, it is an alpha-hydroxy-ketone, and gives a positive test because it is converted to the aldoses glucose and mannose by the base in the reagent.

False positive reactions are known to occur due to the presence of non- carbohydrate substances like ascorbic acid, homogentisic acid, creatinine and uric acid. Reducing sugars like lactose, galactose, fructose and pentoses will also give a positive reaction.

80 - NIMS MEDICINE february 2009 paper - 5

5q: most characteristic finding in Von Gierke's disease or glycogen storage disease type 1 is ?

a. fasting hypoglycemia
b. hypouricemia
c. alkalosis
d. none

answer: a . fasting hypoglycemia .

The principal metabolic effects of deficiency of glucose-6-phosphatase or von gierke's disease are:

* hypoglycemia
* lactic acidosis
* hypertriglyceridemia
* hyperuricemia

The hypoglycemia of GSD I is termed "fasting", or "post-absorptive", meaning that it occurs after completion of digestion of a meal-- usually about 4 hours later. This inability to maintain adequate blood glucose levels during fasting results from the combined impairment of both glycogenolysis and gluconeogenesis. Fasting hypoglycemia is often the most significant problem in GSD I, and typically the problem that leads to the diagnosis. Chronic hypoglycemia produces secondary metabolic adaptations, including chronically low insulin levels and high levels of glucagon and cortisol.

Lactic acidosis arises from impairment of gluconeogenesis. Lactic acid is generated both in the liver and muscle and is oxidized by NAD+ to pyruvic acid and then converted via the gluconeogenenic pathway to G6P. Accumulation of G6P inhibits conversion of lactate to pyruvate. The lactic acid level rises during fasting as glucose falls. In people with GSD I, it may not fall entirely to normal even when normal glucose levels are restored.

Hypertriglyceridemia resulting from amplified triglyceride production is another indirect effect of impaired gluconeogenesis, amplified by chronically low insulin levels. During fasting, the normal conversion of triglycerides to free fatty acids, ketones, and ultimately glucose is impaired. Triglyceride levels in GSD I can reach several times normal and serve as a clinical index of "metabolic control".

Hyperuricemia results from a combination of increased generation and decreased excretion of uric acid, which is generated when increased amounts of G6P are metabolized via the pentose phosphate pathway. It is also a byproduct of purine degradation. Uric acid competes with lactic acid and other organic acids for renal excretion in the urine. In GSD I increased availability of G6P for the pentose phosphate pathway, increased rates of catabolism, and diminished urinary excretion due to high levels of lactic acid all combine to produce uric acid levels several times normal. Although hyperuricemia is asymptomatic for years, kidney and joint damage gradually accrue.

79 - NIMS MEDICINE february 2009 paper - 4

4q: contraction stress test is used primarily to know

a. uterine contractions
b. fetus
c. uteroplacental circulation
d. maternal circulation

answer: b . fetus .

A contraction stress test (CST) is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth. The aim is to induce the contractions and monitor the baby to check for heart rate abnormalities. It involves the release of oxytocin into the blood stream of the pregnant woman by the stimulation of the nipples. The target is to achieve around three contractions every ten minutes.

78 - NIMS MEDICINE february 2009 paper - 3

3q: all of the following are parasomnias except ?

a. somnambulism
b. bruxism
c. sleep terror
d. nocturnal myoclonus

answer: d . nocturnal myoclonus .

Parasomnias are disorders of partial arousal or disorders that interfere with sleep stage transitions. Parasomnias are often attributed to stress, depression, or other psychological and medical conditions. There are four classifications:

Arousal disorders: are disorders of partial arousal which include: confusional arousals, sleepwalking (aka somnambulism: engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject), and sleep terrors (aka Pavor nocturnus or sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror).

Sleep-wake transition disorders: interfere with sleep stage transitions. Common examples include: rhythmic movement disorder, sleep starts, sleeptalking, and nocturnal leg cramps.

Other parasomnias: common sleep disorders such as sleep bruxism (teeth grinding), sleep enuresis (bedwetting), snoring, infant sleep apnea, and sudden infant death syndrome (SIDS), sleep paralysis (conscious paralysis upon waking or falling asleep), partial seizures.

Parasomnias usually associated with REM. These include: nightmares, sleep paralysis, and REM sleep behavior disorder, REM behavior disorder (RBD): acting out violent or dramatic dreams while in REM sleep.

77 - NIMS MEDICINE february 2009 paper - 2

2q: a non small cell cancer of lung with malignant pleural effusion is graded as ?

a. T3
b. T2
c. T4
d. M1

answer: c . T 4 . see the staging of non small cell lung cancer below .

Primary tumour cannot be assessed, or tumour proven by the presence of malignant cells in sputum or
bronchial washings but not visualised by imaging or bronchoscopy

No evidence of primary tumour

Tumour 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without
bronchoscopic evidence of invasion more proximal than lobar bronchus (i.e., not in the main bronchus)

Tumour with any of the following features of size or extent.
• More than 3 cm in greatest dimension
• Involving main bronchus, 2 cm or more distal to the carina.
• Invading the visceral pleura.
• Associated with atliectasis or obstructive pneumonitis that extends to the hilar region but does not
involve the whole lung

• Tumour of any size that directly invades the chest wall (including superior sulcus tumours),
diaphragm, mediastinal pleura, phrenic nerve or parietal pericardium
• Tumours in the main bronchus less than 2 cm distal to the carina but without involvement of carina.
• Associated ateliectasis or obstructive pneumonitis of the entire lung

• Tumour of any size, which invades the mediastinum, heart, great vessels, trachea, oesophagus,
vertebral body or carina
• Secondary nodules in the same lobe of the lung

Regional Lymph Nodes

Regional nodes cannot be assessed

No regional node metastasis

Ipsilateral peribronchial and/or ipsilateral hilar nodes including direct extension

Ipsilateral mediastinal and/or subcarinal nodes

Ipsilateral scalene, contralateral mediastinal, hilar, scalene or supraclavicular nodes
Distant Metastasis

Presence of metastasis cannot be assessed

No distant metastasis

Distant metastasis present; secondary nodules in a different lobe of the lung other than that of primary

76 - NIMS MEDICINE february 2009 paper - 1

1q: antineutrophilic cytoplasmic ( ANCA ) antibodies are seen in all except ?

a. churg strauss syndrome
b. wegener's granulomatosis
c. microscopic polyangitis
d. polyarteritis nodosa

answer: d . polyarteritis nodosa .

antineutrophilic cytoplasmic antibodies are of two types

1. P - ANCA = perinuclear antineutrophilic cytoplasmic antibodies and

2. C - ANCA = antineutrophilic cytoplasmic antibodies directed against cytoplasmic proteinase-3

the causes of P - ANCA are

a. microscopic polyangitis ( microscopic PAN )
b. churg strauss syndrome
c. cresentric glomerulonephritis
d. good pasture syndrome
e. rarely seen in classic PAN

the causes of C - ANCA are

a. wegener's granulomatosis .

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