- Which of the following vaso-pressors would be preferred in a patient with aortic stenosis?
In hypotensive patients with aortic stenosis, Phenylephrine is vaso-pressor of choice.
- Which of the following features helps in distinguishing seizures from syncope?
a) Loss of consciousness
b) Injury due to fall
c) Urinary incontinence
d) Physical weakness with clear sensorium
Answer: Physical weakness with clear sensorium
Syncope is a transient loss of consciousness associated with loss of postural tone with spontaneous return to baseline neurologic function requiring no resuscitation.
Q-343. Cortico-spinal injury is associated with all EXCEPT
a) Babinski sign present
b) Loss of fine movements in fingers and hand
c) Superficial abdominal reflex absent
d)Clasp knife rigidity
Damage to Descending Motor Pathways (Cortico-spinal): The Upper Motor Neuron Syndrome:
Motor signs and symptoms:
The Babinski sign:
Following damage to descending upper motor neuron pathways, however, this stimulus elicits extension of the big toe and a fanning of the other toes.
A similar response occurs in human infants before the maturation of the cortico-spinal pathway and presumably indicates incomplete upper motor neuron control of local motor neuron circuitry.
Extensive upper motor neuron lesions may also be accompanied by rigidity of the extensor muscles of the leg and the flexor muscles of the arm (called decerebrate rigidity).
Spasticity is probably caused by the removal of inhibitory influences exerted by the cortex on the postural centers of the vestibular nuclei and reticular formation.
Hypo-reflexia of superficial reflexes:
Further signs are the decreased vigor of superficial reflexes such as the corneal reflex, superficial abdominal reflex, and the cremasteric reflex in males.
A loss of the ability to perform fine movements: If the lesion involves the descending pathways that control the lower motor neurons to the upper limbs, the ability to execute fine movements (such as independent movements of the fingers) is lost.
Q-344. Lewy bodies are seen in
a) Alzheimer’s disease
b) Pick’s disease
c) Huntington’s chorea
The 2 major neuro-pathologic findings in Parkinson disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neuritis.
Lewy bodies are intra-cytoplasmic eosinophilic inclusions, often with halos, that are easily seen in pigmented neurons.
They contain polymerized alpha-synuclein; therefore, Parkinson disease is a synucleinopathy.
Q-345. Steroid induced myopathy mainly involves
Steroid induced myopathy:
Steroid myopathy is usually an insidious disease process that causes weakness mainly to the proximal muscles of the upper and lower limbs and to the neck flexors.
Pelvic girdle muscles usually are affected more severely and earlier than are pectoral girdle muscles.
Q-346. Myopathies mainly involve proximal muscles group except
a) Myotonia congenital
b) Myotonia dystrophica
c) Drug induced
d) All of the above
Answer: Myotonia dystrophica
Myopathies mainly involve proximal muscles:
Drug induced myopathy
Limb girdle (Erb)
Myopathies mainly involve distal muscles:
Distal muscular dystrophy
Q-347. Lateral medullary syndrome is due to thrombosis of
a) Posterio inferior cerebellar artery
b) Anterior cerebellar artery
c) Superior cerebellar artery
d) Posterior communicating branch of middle cerebral artery
Answer: Posterio inferior cerebellar artery
Lateral Medullary Syndrome (Wallenberg Syndrome):
Vertebral artery: Superior lateral medullary artery
Posterior inferior cerebellar artery: Less common than vertebral
Medial Medullary Syndrome (Dejerine Syndrome):
Q-348. Which is not a feature of MEN type 2B is?
Multiple Endocrine Neoplasias (MEN): Incidence of tumor types
MEN 1 (Wermer Syndrome):
Facial angio-fibromas and collagenomas
MEN 2A (Sipple Syndrome):
Medullary thyroid carcinoma
Mucosal and GI Ganglio-neuroma
Medullary thyroid carcinoma
Q-349. In von Willebrand disease which is true?
a) Normal prothrombin time
b) Decreased platelets
c) Normal partial thromboplastin time
d) All of the above
Answer: Normal prothrombin time
The most common inherited bleeding disorder
It aggregates platelets and prolongs the half life of Factor VIII.
Except in more severe forms, the a-PTT and PT in v-WD are usually normal.
Q-350. Which of the following pH indicate urinary tract infection?
a) < 4.3 b) < 3.0 c) < 6.5 d) 8.0 Answer: < 6.5 Explanation: A higher-than-normal urine pH could indicate: Gastric suctioning Kidney failure Kidney tubular acidosis Pyloric obstruction Respiratory alkalosis Urinary tract infection Vomiting Important point: If alkaline urine is found in presence of UTI symptoms and positive leukocyte esterase, likely urea splitting such as Proteus, allowing urea to be split into CO2 and ammonia, cause a rise in the urine’s normally acid pH. Q-351. Hamman-Rich Syndrome is treated with a) Vitamin B6 b) Vitamin B12 c) INH d) Steroids Answer: Steroids Explanation: Acute interstitial pneumonia: Clinically known as Hamman-Rich Syndrome Acute onset of dyspnea followed by rapid development of respiratory failure Treatment is supportive care (Mechanical ventilation) and steroid Q-352. Mono-neuritis multiplex is a feature of a) Polyarteritis nodosa b) Hypersensitive vasculitis c) Leprosy d) All of the above Answer: All of the above Explanation: Mono-neuritis multiplex actually is a group of disorders. Mono-neuritis multiplex is associated with systemic disorders such as the following: Polyarteritis nodosa Amyloidosis Vasculitis RA SLE Mono-neuritis multiplex can be associated with the following infections: Lyme disease Leprosy Syphilis Acute viral hepatitis and HIV infection Herpes simplex virus infection Q-353. Treatment of acute cardiac tamponade a) Emergency paracentesis b) Emergency thoracotomy c) Pericardiectomy d) IV Fluids Answer: Emergency paracentesis Explanation: Acute cardiac tamponade: Elevated intra-pericardial pressure > 15 mm Hg
Signs and symptoms:
Pain in inflammatory cases or painless in neoplastic or uremic effusion
Dyspnea and cough
A pericardial friction rub
Tachycardia and tachypnea
Pulsus paradoxus (Also found in obstructive lung disease and asthma)
Echocardiography is primary method for demonstrating pericardial effusion.
ECG: Non-specific T wave changes and low QRS voltage
X-ray chest: Enlarged cardiac silhouette with globular configuration
Urgent paracentesis when tamponade present