Q- 31. HLA associated with myasthenia gravis is
a) B27
b) 1DR3
c) DR4
d) B8
Answer: DR3
Explanation:
Myasthenia gravis occurs at all ages, sometime associated with a thymic tumor or thyrotoxicosis as well as RA and lupus erythematous.
It is most common in young women, with HLA-DR3.
If thymoma is associated, older men are more commonly affected.
Q- 32. Shrinking lung syndrome is seen in
a) SLE
b) Systemic sclerosis
c) Polymyositis
d) Dermato-myositis
Answer: SLE (Most correct)
Explanation:
Shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus (SLE) characterized by unexplained dyspnea, a restrictive pattern on pulmonary function tests, and an elevated hemi-diaphragm.
But it is also associated with Sjögren’s syndrome and Polymyositis.
Steroids are proposed as first-line treatment, alone or associated with β2-adrenergic receptor agonists. In refractory cases, immuno-suppressors are used.
Q- 33. Glycosylated hemoglobin percentage which indicates good control of diabetes
a) 8%
b) 10%
c) 15%
d) 20%
Answer: 8%
Explanation:
Acceptable level of glycemic control:
Blood glucose- Fasting: 90-130 mg/dl
Blood glucose- PP: 150 mg/dl
HbA1C Level: < 7 % in non-pregnant adults HbA1C Level: < 8 % in elderly patients Q- 34. Felty’s syndrome comprises of all except a) Rheumatoid arthritis b) Splenomegaly c) Neutropenia d) Osteoarthritis Answer: Osteoarthritis Explanation: Felty syndrome: Immune neutropenia Sero-positive nodular RA Splenomegaly Q- 35. Water load test is helpful in diagnosis of a) Renal edema b) Addison’s disease c) Adrenogenital syndrome d) Congestive heart failure Answer: Addison’s disease Explanation: A water loading ADH suppression test may be used to help diagnose SIADH. With this test, those with SIADH typically have decreased blood sodium and osmolality. A simplified water-loading test is used for the diagnosis of Addison’s disease. Q- 36. Anion gap is not increased in a) Renal tubular acidosis b) Diabetic keto-acidosis c) Salicytates poisoning d) Starvation Answer: Renal tubular acidosis Explanation: The anion gap is the difference between primary measured cations (sodium Na+ and potassium K+) and the primary measured anions (chloride Cl- and bicarbonate HCO3-) in serum. The normal value for the serum anion gap is 6-12 mEq/L. Decreased anion gap: Hypo-albuminemia Plasma cell dyscrasias Bromide intoxication Increased anion gap: a. Metabolic anion Diabetic keto-acidosis Alcoholic keto-acidosis Lactate acidosis CKD (Advanced stage) Metabolic alkalosis Starvation b. Drug or chemical anion Salicylates intoxication Methanol Oxalic acid (Ethylene glycol) Sodium Carbenicillin Normal anion gap: Loss of HCO3_: Carbonic anhydrase inhibitors Ileostomy Diarrhoea Recovery from diabetic keto-acidosis Chloride retention: Renal tubular acidosis Ileal loop bladder Administration of HCl equivalent or NH4Cl: Arginine and lysine in parenteral nutrition Q- 37. Respiratory acidosis is seen with a) Diabetes keto-acidosis b) Pneumonia c) Emphysema d) Liver failure Answer: Emphysema Explanation: Respiratory acidosis results from hypo-ventilation and subsequent hypercapnia. Respiratory alkalosis occurs from hyperventilation and subsequent Hypocapnia. Respiratory acidosis: Central nervous system disease or drug-induced respiratory depression Neuromuscular disease or paralysis (Myasthenia gravis, GB syndrome) Airway obstruction (Asthma and COPD) Respiratory Alkalosis: a. Mechanical ventilation b. Hypoxia c. Pulmonary diseases: Interstitial lung disease Pneumonia Pulmonary edema and embolism d. CNS mediated disorders: Hyperventilation Neurologic diseases and tumors CVA Gram negative septicemia Heat exposure Hepatic failure Drugs and hormonal stimulation: Salicylates, nicotine, xanthine and progesterone (Pregnancy) Q- 38. Pneumatocele is commonest in a) Pneumococcal pneumonia b) Staphylococcal pneumonia c) H. influenzae pneumonia d) Viral pneumonia Answer: Staphylococcal pneumonia Explanation: Pulmonary Pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma. They can be single emphysematous lesions but are more often multiple, thin-walled, air-filled, cyst like cavities. Most often, they occur as sequelae to acute pneumonia, commonly caused by Staphylococcus aureus. Q- 39. Osmotic diarrhea is seen in a) Lactase deficiency b) Ulcerative sprue c) Cholera d) Bile salt enteropathy Answer: Lactase deficiency Explanation: Osmotic diarrhea: Normal stool osmolality < 50 mosm/kg Caused by ingestion (laxative) or mal-absorption of an osmotically active substances Q- 40. Superficial vein thrombosis involves cerebral white matter while deep thrombosis involving gray matter in a) Thalamus b) Internal capsule c) Basal ganglia d) Cerebellum e) Optic chiasma Answer: a and c Explanation: Deep venous thrombosis typically results in bilateral symmetrical involvement of thalami and occasionally basal ganglia. Causes of deep venous thrombosis: Oral contraceptives Pregnancy Infection Trauma Dehydration Unknown etiology (20-15 %)